Search

Introduction: impulsivity in older people with cognitive impairment has yet to be examined rigorously as a risk factor for falls. The objective of this study was to evaluate the psychometric properties of a new fall-related impulsive behaviour scale (FIBS) for a cognitively impaired population living in residential care.Methods: one hundred and nine care home residents (84.5 ± 8.3 years) were assessed on the FIBS and a range of behavioural, physical and neuropsychological measures. Participants were then prospectively followed up for falls for 6 months.Results: the internal reliability (Cronbach's α = 0.77) and test–retest reliability (intra-class correlation coefficient = 0.93) of the FIBS were both good. Construct validity was supported by significant correlations between the FIBS and the neuropsychiatric inventory (r = 0.43, P < 0.001), wandering (r = 0.33, P = 0.001) and global cognition (r = −0.2, P = 0.04). Compared with residents with FIBS scores <1, those with FIBS scores of ≥1 were nearly three times more likely to fall in the following 6 months, AOR = 2.92 (95% CI: 1.03–8.29).Conclusion: the FIBS is a simple, valid and reliable scale for assessing fall-related impulsivity in care home residents and can be recommended for use in this group for both research and clinical purposes. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To develop a simple screen based on easily collectable measures to identify older people living in residential care facilities at high risk of falls. Methods: This prospective study was conducted in seven residential care facilities in the U.K. Residents aged>60 years who were not bedbound or terminally ill participated. Demographics, medical history, medication use, cognition (mini mental state examination (MMSE)), function (Barthel, balance and sit-to-stand ability) and behavior (neuro-psychiatric inventory (NPI) and impulsivity) were recorded at baseline. Falls and injuries were prospectively recorded over 6 months. Data were analyzed for differences between fallers and non-fallers and significant variables entered into logistic regression analysis. Results: Two hundred and forty residents completed the study. In the follow-up period, 50% fell ≥1 times. Fallers had worse function, cognition, behavior and balance and took more medications. Falling in the past year, walking frame and hypnotic/anxiolytic and anti-depressant medication use were also associated with increased likelihood of falling. Logistic regression identified MMSE<17, impulsivity score≥2, standing balance score<6, requiring a walking frame, falling in the previous year and use of antidepressants and hypnotics/anxiolytics as independent and significant predictors of falls. The area under the receiver operating curve (ROC) for this model was 0.79 (95% CI 0.73–0.84). Conclusions: This tool comprising multi-factorial measures provides a simple way of quantifying the probability with which a care home resident will fall over a 6-month period. The tool may also assist in guiding the development and targeting of interventions to prevent falls in this group. [Copyright &y& Elsevier]

Abstract: Objectives: To better understand fall risk factors in older adults with cognitive impairment living in residential care. Design: A prospective observational cohort study. Setting: Residential care homes in South London, UK. Participants: Residents older than 60, with cognitive impairment who had a life expectancy of at least 6 months and were not bedbound or recently discharged from hospital. Measurements: Baseline assessments were undertaken in domains of demographics, medical history, medication use, behavior, affect, gait, balance, sensorimotor performance and neuropsychological function. Participants were followed for 6 months for falls using care home reporting systems. Results: A total of 109 participants completed baseline assessment and had adequate falls follow-up. Fallers took more medications, were more likely to be taking antidepressants, had more functional impairment, poorer balance and gait, were more impulsive and anxious, exhibited more dementia-related behaviors, and performed worse on cognitive tests involving attention and orientation, memory, and fluency. Logistic regression analysis identified 4 significant and independent predictors of falls: poor attention and orientation, increased postural sway with eyes closed, anxiety, and antidepressant use. The AUC for this model was 0.84 (95% CI 0.76–0.91). Conclusions: This study identified important risk factors for falls potentially amenable to intervention in older people with cognitive impairment living in residential care. This information may be useful in designing effective approaches to fall prevention in this high-risk population. [Copyright &y& Elsevier]

Background: the Timed Up and Go Test (TUGT) has been recommended as a simple screening tool to identify those at risk of fairing. However, subsequent detailed assessment is required to identify underlying falls risk factors to provide direction for optimal targeted intervention strategies. Methods: 110 consecutive falls clinic patients underwent the TUGT, the Abbreviated Mental Test and the Physiological Profile Assessment (PPA), a validated tool for quantifying risk of falling based on a combination of physiological measures--contrast sensitivity, knee extension strength, proprioception, reaction time and postural sway. Regression analysis was used to determine how well the TUGT and presence of cognitive impairment could identify patients at high risk of falls as defined by the PPA. Results: TUGT and cognitive status were found to be independent and significant predictors of PPA scores. These variables accounted for 21% of the variance in PPA scores (multiple R = 0.47, P<0.001). The standardised beta weights were 0.403 for TUGT and 0.236 for cognitive status. A receiver-operator curve (ROC) indicated that 15 seconds in the TUGT was the optimal cut-point for identifying those with a high risk of falling: 70% of the total sample. Conclusions: the TUGT and a simple test of cognition can be used to streamline referrals in a high-risk population, allowing for more efficient use of available resources in clinical practice. A subsequent PPA provides quantification of risk and direction for tailored intervention. [ABSTRACT FROM AUTHOR]