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Objectives: Falls are one of the major health issues faced by older adults, and they can result in physical harm, eventual loss of independence, and even death. Herein, we investigated the prevalence, alongside the main risk factors and resulting injuries, of falls among older adults. Methods: We employed a descriptive cross-sectional approach. Data were collected between February and July 2021 from 403 older adults aged 60 years or above via an online self-reported questionnaire. Basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs) were also recorded. Results: The prevalence of falls among community-dwelling older adults was 47.4%. Among those who had experienced a fall, 36.2% incurred injuries, 25.3% had fractures, and 23.1% required walking aids. Age between 95-104 years, female sex, participants on anti-hypertensive medications, history of hip or knee replacement surgery, and presence of a caregiver, were significantly more likely to have had a previous history of falls (p < 0.05). Furthermore, having a previous history of stroke, osteoporosis, lower limb weakness, dizziness, using wheelchairs as walking aids, and living with the fear of stumbling or slipping were significantly associated with history of previous falls (p < 0.05). Conclusions: The prevalence of falls is high among community-dwelling older adults in Jeddah. Physicians should identify older adults with higher falling risk and provide them with appropriate interventions. Public health strategies could significantly reduce falls and fall-related injuries in older adults. List of Abbreviations: KSA: Kingdom of Saudi Arabia, BADLs: Basic activities of daily living, IADLs: Instrumental activities of daily living, SPSS: Statistical Package for the Social Sciences, χ2: Chi-squared test. doi: https://doi.org/10.12669/pjms.39.1.6993 How to cite this: Alamri SH, Ghamri RA, Alshehri WH, Alhuthayli RS, Alamoudi NM, Alnufaei RD, et al. Falls and correlations among community-dwelling older adults: A Cross-sectional study in Jeddah, Saudi Arabia. Pak J Med Sci. 2023;39(1):---------. doi: https://doi.org/10.12669/pjms.39.1.6993 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

OBJECTIVE: To determine if a positive test for COVID-19 is associated with self-reported audio-vestibular symptoms. DESIGN: Self-reported changes in hearing, tinnitus, hyperacusis, and dizziness/rotatory vertigo were assessed in hospitalised and non-hospitalised COVID-19 patients during and after the acute phase of the disease and compared to non-COVID controls. STUDY SAMPLE: There were 150 severe cases of COVID-19 requiring hospital admission and 150 mild cases that were managed at home. Controls were 267 adults, 32 of whom had been hospitalised for a non-COVID-19 condition, and a further 85 who worked in hospital settings. RESULTS: Deterioration in hearing and/or tinnitus was reported in 8% of the COVID-19 cases (tinnitus had resolved in 2% after the acute phase), with no significant difference between severe and mild cases. Deterioration in hearing or tinnitus was not significantly different from controls. However, rotatory vertigo was reported by 5% in the COVID-19 groups and 1.1% in the controls, and this difference was statistically significant. CONCLUSIONS: There is no evidence that COVID-19 results in deterioration in hearing or tinnitus during the acute phase or after recovery in mild or severe cases. However, rotatory vertigo, which could be vestibular in origin, may be a clinical manifestation of COVID-19.

Purpose: The multiple mini-interview (MMI) is a validated technique used in the admissions process in some undergraduate and postgraduate schools and is reported to reduce subjectivity in selecting postgraduate applicants. No studies have been conducted in Saudi Arabia concerning the MMI. The authors report their experience of transitioning from traditional interviews to the MMI and the results of a post-MMI survey undertaken by participating applicants and interviewers. Materials and Methods: The authors did retrospective analysis after MMI had been conducted at the College of Medicine, King Saud University, Riyadh, Saudi Arabia, in 2019, in coordination with an internal medicine residency program. They implemented MMIs totaling four stations of 10 min each that focused on the domains of communication, attitude, knowledge, and a mini-interview personalized for each candidate. Ten questioners interviewed 99 applicants, of whom 68 undertook a post-MMI survey. Results: In terms of their perceptions and experience, the applicants and interviewers responded positively to the transition from traditional interviews to the MMI. MMI was seen to be more objective, 75% of applicants felt it was associated with less anxiety, and 79% believed it provided a better portrayal of their abilities. Conclusion: The use of the MMI in selecting postgraduate applicants in Saudi Arabia is feasible and acceptable. Furthermore, it may give an improved objective portrayal of applicants' abilities and reduce their interview-associated anxiety.

Background Myelin loss is a feature of cerebral small vessel disease (cSVD). Although physical activity levels may exert protective effects over cSVD pathology, its specific relationship with myelin content in people living with the cSVD is unknown. Thus, we investigated whether physical activity levels are associated with myelin in community-dwelling older adults with cSVD and mild cognitive impairment. Methods Cross-sectional data from 102 individuals with cSVD and mild cognitive impairment were analyzed (mean age [SD] = 74.7 years [5.5], 63.7% female). Myelin was measured using a magnetic resonance gradient and spin echo sequence. Physical activity was estimated using the Physical Activity Scale for the Elderly. Hierarchical regression models adjusting for total intracranial volume, age, sex, body mass index, and education were conducted to determine the associations between myelin content and physical activity. Significant models were further adjusted for white matter hyperintensity volume. Results In adjusted models, greater physical activity was linked to higher myelin content in the whole-brain white matter (R2change = .04, p = .048). Greater physical activity was also associated with myelin content in the sagittal stratum (R2change = .08, p = .004), anterior corona radiata (R2change = .04, p = .049), and genu of the corpus callosum (R2change = .05, p = .018). Adjusting for white matter hyperintensity volume did not change any of these associations. Conclusions Physical activity may be a strategy to maintain myelin in older adults with cSVD and mild cognitive impairment. Future randomized controlled trials of exercise are needed to determine whether exercise increases myelin content.

Objectives: World aging poses a big challenge with the rise of people with cognitive impairment. We aim in this study to understand the perspective of the caregivers towards the early signs of memory decline and cognitive impairment in their elderly relatives; we also aim to understand the impact of culture on their perspective. Methods: This is a cross-sectional, descriptive study with a quantitative approach. It was approved by the Institutional Review Board prior to data collection, using a survey containing 41 items of collected data from 101 caregivers. We obtained signed written informed consent from each subject. Results: A sample of 101 participants enrolled in this study, of whom about 60.4% (n=61) were males and 39.6% (n=40) were females. The mean age of the elderly relatives of the caregivers was (73.5±10.0) years and mean years of education was (6.5±7.5) years. Significant differences between males and females were found in terms of driving and using public transportation as this might alert the caregiver about early signs of memory decline (2=6.785, p=0.009). Conclusion: Some cultural perspective could be identified that could help earlier detection of cognitive impairment in elderly people who rely largely on their caregivers. Caregivers are the first people to encounter the early changes in the behavior of the demented elderly; understanding their perspective can help providing more efficient health care. Key words: dementia, caregivers, perspective, memory decline, culture

Background: Neurological manifestations have increasingly become recognized in COVID-19. People from different ethnic backgrounds are experiencing different outcomes related to SARS-CoV-2 infection. Several cohort studies reported the common neurological manifestations and complications associated with COVID-19 disease around the world however, the prevalence of neurological complications associated with SARS-CoV-2 infection in the Arab countries and Saudi Arabia is still unknown.Objective: To study the prevalence, risk factors, and characteristics of the neurological complications associated with COVID-19 and their relationship with clinical outcomes.Methods: We conducted a prospective, single-center, observational, cohort study of consecutive hospitalized adults COVID-19 patients with and without neurological manifestation admitted between March 2020 until the end of December 2020. Data was collected prospectively using electronic medical records; Cases and controls were observed until they either get discharged from the hospital or died. The primary outcomes were death, survival, and survival with sequalae.Results: Among 497 patients with COVID-19, 118 patients (23.7%) had neurological complications, 94 patients (18.9%) had encephalopathy, and 16 patients (3.2%) had cerebrovascular accidents (CVA). Patients with COVID-19-related neurological complications were older and more likely to have a pre-existing neurological disease. The most common neurological syndrome associated with COVID-19 were encephalopathy (18.9%) and headache (13.7%). Pre-existing neurological disease and an elevated neutrophil count were the strongest predictors of developing any neurological complications. Death form COVID-19 was associated with age (OR 1.06, 95% CI 1.02–1.10, P = 0.001), invasive ventilation (OR 37.12, 95% CI 13.36–103.14), COVID-19-related-neurological complications (OR 3.24, 95% CI 1.28–8.21, P = 0.01), and elevated CRP level (OR 1.01, 95% CI 1.00–1.01, P = 0.01).Conclusions: COVID-19 is associated with a wide range of neurological manifestations in people living in Saudi Arabia, with older individuals and those with underlying neurological disorders being most at risk. The presence of neurological complications was associated with increased mortality and poor outcomes.

White matter hyperintensities (WMH) are associated with greater falls risk and slow gait speed. Whether these deficits are caused by the disruption of large-scale functional networks remains inconclusive. Further, physical activity moderates the association between WMHs and falls, but whether this extends to the disruption of functional networks remains unknown. One hundred and sixty-four adults (>55 years old) were included in this study. Using lesion network mapping, we identified significant correlations between the percentage of WMH-related disruption of the dorsal attention network and Physiological Profile Assessment (PPA) score (r = 0.24, p < 0.01); and between disruption of both the sensorimotor (r = 0.23, p < 0.01) and ventral attention networks (r = 0.21, p = 0.01) with foam sway. There were no significant associations with floor sway or gait speed. Physical activity moderated the association between the dorsal attention network and PPA score (p = 0.045). Thus, future research should investigate whether physical activity should be recommended in the clinical management of older adults with cerebral small vessel disease.

Introduction. Currently, there are standard and basic versions of the MoCA, the latter designed for those with lower educational achievements. Community-based normative data on these versions of the MoCA from Arabic populations are deficient, and there is little data demonstrating how both scales perform in comparison. We aim to obtain normative performances from both versions and equate the measures of both scales. Methods. Community-based recruitment of healthy volunteers ≥ 18 years of age. Participants underwent testing with both versions. Demographic data was collected with regard to age, gender, years of education, diabetes, and hypertension. Regression analysis was performed to determine significance of variables, and the circle-arc equating method was used to equate the two scores from each scale. Results. 311 participants were included in the study. The mean (sd) age was 45.8 (15.96), females were 184 (59.16%), and the duration of education was 12.7 (5.67) years. The mean scores on the MoCA-A and MoCA-B were 21.47 (4.53) and 24.37 (4.71) ( P < 0.0001 ), respectively. Multivariate regression showed significance of age and years of education in both versions (both variables with P < 0.0001 ). Correlation coefficient between the two scales was 0.77 ( P < 0.0001 ). The largest equated difference between both MoCA versions was four points in those scoring from 10-20 on the MoCA-A. Conclusion. We present normative data from a large Saudi Arabian community-based sample with two different MoCA tests, and an equating graph is presented to determine the corresponding expected performance between the two scales.

Background: Neurological COVID-19 disease has been reported widely, but often without using standard case definitions or detailed diagnostic work up. Several meta-analyses, based on such reports, describe the neurological diagnoses but give little information on outcomes and risk factors. Methods: We conducted an individual patient data meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute, and extracted aggregate data from published reports. We analysed features associated with poor outcome (moderate to severe sequelae or death, 3-6, on the modified Rankin scale) using multivariable models. Findings: We identified 381 studies (31 unpublished) describing 4443 patients with COVID-19 and neurological disease: 83 of these provided IPD for 1979 (45%) patients. Encephalopathy (978 [49%]) and cerebrovascular events (506 [26%]), were the most common diagnoses in the IPD database and aggregate data. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41] overall), and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-Dimer. Overall, 30-day mortality was 30% (27-32). The hazard of death was reduced for patients in the WHO European region, but increased in low- and lower-middle-income countries. Interpretation: Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission. Funding This study was funded by the UK Medical Research Council’s Global Effort on COVID-19 Programme (MR/V033441/1); UK National Institute for Health Research (NIHR)-funded Global Health Research Group on Acute Brain Infections (17/63/110); and the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections (NIHR200907), at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine and the University of Oxford (Grant Nos. IS-HPU-1112-10117 and NIHR200907). Declaration of Interests: BS reports a grant from UKRI/DHSC Global Effort on COVID-19 Research (Medical Research Council) and non-financial support from UK National Institute for Health Research Global Health Research Group on Brain Infections. SL and TS are supported by a grant from the EU Zika Preparedness Latin American Network consortium (ZikaPLAN). ZikaPLAN has received funding from the EU's Horizon 2020 research and innovation programme under grant agreement number 734584. LCG reports non-financial support from Pfizer, non-financial support from Gilead. LB reports grants from GlaxoSmithKline, Research England and Wellcome Trust. AMBM reports grants from Conselho Nacional de Desenvolvimento Cientifico e Tecnologico CNPq/Brazil, and Sao Paulo Research Foundation FAPESP/Brazil. AP reports personal fees from ZAMBON, UCB , BIOMARIN, and ABBvie pharma. TS was an adviser to the GlaxoSmithKline Ebola Vaccine programme, chaired a Siemens Diagnostics clinical advisory board, and advises the WHO Brain Health Unit Forum on Neurology and COVID-19; TS has also previously filed a patent for a test for bacterial meningitis based on a blood test (GB 1606537.7, April 14, 2016), and has grants from the UK Medical Research Council and National Institute for Health Research. All other authors declare no conflict of interest

OBJECTIVE: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), manifests with a wide spectrum of presentations. Most reports of COVID-19 highlight fever and upper respiratory symptoms as the dominant initial presentations, consistent with the World Health Organization guidelines regarding suspected SARS-CoV-2 infection. However, atypical presentations of this disease have been evolving since the initial outbreak of the pandemic in December 2019. We report a case of an older male patient who presented at our hospital with an unusual manifestation of COVID-19. DESIGN: Brief report. SETTING: A university hospital in Saudi Arabia. PARTICIPANT: A 73-year-old man who presented with confusion in the absence of any respiratory symptoms or fever. INTERVENTION: The patient was initially admitted with delirium and underwent a further work-up. MEASUREMENTS: Given his recent history of domestic travel and the declaration of a global COVID-19 pandemic status, the patient was administered a swab test for SARS-CoV-2. RESULTS: The patient's positive test led to a diagnosis of COVID-19. Although he began to experience a spiking fever and mild upper respiratory symptoms, he recovered rapidly with no residual sequela. CONCLUSION: The recognition of atypical presentations of COVID-19 infection, such as delirium, is critical to the timely diagnosis, provision of appropriate care, and avoidance of outbreaks within healthcare facilities during this pandemic. J Am Geriatr Soc 68:1382-1384, 2020.