Risk factors for recurrent falls among Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS)

Pinheiro, Marcelo de Medeiros; Ciconelli, Rozana Mesquita; Martini, Lígia Araújo; Ferraz, Marcos Bosi

doi:10.1590/s0102-311x2010000100010

Cited by 52 publications

(42 citation statements)

References 36 publications

(49 reference statements)

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“…This might be due to a slightly higher frequency of falls in our control group than that described in other community-dwelling studies (approximately 30%) 26,27 . This may also reflect the fact that balance dysfunction occurring in AD patients that do not present parkinsonism, vestibular signs or other motor abnormalities may not be severe enough as to determine a higher incidence of falls, in the absence of other risks factors.…”

Section: Discussioncontrasting

confidence: 56%

Assessment of balance in mild and moderate stages of Alzheimer's disease: implications on falls and functional capacity

Kato-Narita

Nitrini

Radanovic

2011

Arq. Neuro-Psiquiatr.

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Objective: To analyze the correlation between balance, falls and loss of functional capacity in mild and moderate Alzheimer's disease(AD). Method: 40 subjects without cognitive impairment (control group) and 48 AD patients (25 mild, 23 moderate) were evaluated with the Berg Balance Scale (BBS) and the Disability Assessment for Dementia (DAD). Subjects answered a questionnaire about falls occurrence in the last twelve months. Results: Moderate AD patients showed poorer balance (p=0.001) and functional capacity (p <0.0001) and it was observed a correlation between falls and balance (r= -0.613; p=0.045). Conclusion: There is a decline of balance related to AD which is a factor associated to the occurrence of falls, albeit not the most relevant one. The loss of functional capacity is associated with the disease's progress but not to a higher occurrence of falls. The balance impairment did not correlate with functional decline in AD patients. Key words: Alzheimer's disease, balance, falls, functional capacity, elderly.Avaliação do equilíbrio na doença de Alzheimer leve e moderada: implicações na capacidade funcional e na ocorrência de quedas RESUMO Objetivo: Analisar a correlação entre déficit de equilíbrio, ocorrência de quedas e prejuízo funcional na doença de Alzheimer (DA). Método: 40 idosos sem comprometimento cognitivo (grupo controle) e 48 idosos com DA (25 leves e 23 moderados), avaliados através da Escala de Equilíbrio de Berg (EEB) e Escala de Avaliação de Incapacidade (EAI), e questionados quanto à ocorrência de quedas nos últimos doze meses. Resultados: O equilíbrio no grupo DA moderada foi pior do que no grupo leve (p=0,001), bem como a capacidade funcional (p<0,0001), sem diferença na ocorrência de quedas entre os grupos. Na DA moderada, houve correlação entre ocorrência de quedas e EEB (r= -0,613; p=0,045). Conclusão: Há um declínio do equilíbrio associado à progressão da DA. O declínio da capacidade funcional não foi associado à maior ocorrência de quedas. O déficit de equilíbrio não se correlacionou ao declínio funcional na DA. Palavras-chave: doença de Alzheimer, equilíbrio, quedas, capacidade funcional, idosos.

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Section: Discussioncontrasting

confidence: 56%

Assessment of balance in mild and moderate stages of Alzheimer's disease: implications on falls and functional capacity

Kato-Narita

Nitrini

Radanovic

2011

Arq. Neuro-Psiquiatr.

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“…Prior studies in Brazil, the Netherlands, and Australia have linked benzodiazepine prescriptions-without a dose relationship-to patient selfreporting of poorer health status. [21][22][23] Benzodiazepine prescriptions were similarly linked to higher frequencies of medical diagnoses in two population-based Canadian studies, 40,41 and with a higher score on the Charlson comorbidity index in an Israeli study. 18 Studies linking benzodiazepines to a higher number of medical visits 21 and increased length of hospital stay 26 have been conducted in Israel and Japan, respectively.…”

Section: Discussionmentioning

confidence: 92%

“…40 Osteoporosis has been linked to fractures alongside benzodiazepine prescriptions in The referent for odds ratios for diagnoses and other prescriptions is patients who did not have that diagnosis or prescription patients at risk of falls, although no direct relationship between osteoporosis and benzodiazepine prescriptions has been described. 41,42 Prescribing benzodiazepines disproportionately to patients with COPD, substance use disorders, and osteoporosis, and who are older may contribute to their mortality risk through these mechanisms. Associations between benzodiazepines and tobacco use have been cited as a possible explanation for the association between benzodiazepines and cancer risk; 8 our finding of a similar association supports the hypothesis that tobacco use confounds the relationship between benzodiazepines and the risk of cancer, although we did not measure cancer diagnoses directly, and this relationship remains poorly understood.…”

Section: Discussionmentioning

confidence: 99%

Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care

et al. 2016

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BACKGROUND: Benzodiazepine use is associated with adverse drug events and higher mortality. Known risk factors for benzodiazepine-related adverse events include lung disease, substance use, and vulnerability to fracture. OBJECTIVE: To determine whether benzodiazepine prescribing is associated with risk factors for adverse outcomes. DESIGN: Longitudinal cohort study between July 1, 2011, and June 30, 2012. PARTICIPANTS: Patients who visited hospital-and community-based practices in a primary care practicebased research network. MAIN MEASURES:Odds ratio of having a target medical diagnosis for patients who received standard and highdose benzodiazepine prescriptions; rates per 100 patients for outpatient and emergency department visits and hospitalizations. KEY RESULTS: Among 65,912 patients, clinicians prescribed at least one benzodiazepine to 15 % (9821). Of benzodiazepine recipients, 5 % received high doses. Compared to non-recipients, benzodiazepine recipients were more likely to have diagnoses of depression (OR, 2.7; 95 % CI, 2.6-2.9), substance abuse (OR, 2.2; 95 % CI, 1.9-2.5), tobacco use (OR, 1.7; 95 % CI, 1.5-1.8), osteoporosis (OR, 1.6; 95 % CI, 1.5-1.7), chronic obstructive pulmonary disease (OR, 1.6; 95 % CI, 1.5-1.7), alcohol abuse (OR, 1.5; 95 % CI, 1.3-1.7), sleep apnea (OR, 1.5; 95 % CI, 1.3-1.6), and asthma (OR, 1.5; 95 % CI, 1.4-1.5). Compared to low-dose benzodiazepine recipients, high-dose benzodiazepine recipients were even more likely to have certain medical diagnoses: substance abuse (OR, 7.5; 95 % CI, 5.5-10.1), alcohol abuse (OR, 3.2; 95 % CI, 2.2-4.5), tobacco use (OR, 2.7; 95 % CI, 2.1-3.5), and chronic obstructive pulmonary disease (OR, 1.5; 95 % CI, 1.2-1.9).Benzodiazepine recipients had more primary care visits per 100 patients (408 vs. 323), specialist outpatient visits (815 vs. 578), emergency department visits (47 vs. 29), and hospitalizations (26 vs. 15; p < .001 for all comparisons). CONCLUSIONS: Clinicians prescribed benzodiazepines and high-dose benzodiazepines more frequently to patients at higher risk for benzodiazepine-related adverse events. Benzodiazepine prescribing was associated with increased healthcare utilization.

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“…Since elderly females are known to be one of the groups at highest fall risk [89][90][91], it is critical that studies match or control for gender. In this review, however, less than one-half of the articles reviewed accounted for gender differences [5,6,53,[63][64][65][66][67]72,74,80,84].…”

Section: Study Characteristicsmentioning

confidence: 99%

Kinematic measures for assessing gait stability in elderly individuals: a systematic review

Hamacher

Singh

Dieën

et al. 2011

J. R. Soc. Interface.

324

261

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Falls not only present a considerable health threat, but the resulting treatment and loss of working days also place a heavy economic burden on society. Gait instability is a major fall risk factor, particularly in geriatric patients, and walking is one of the most frequent dynamic activities of daily living. To allow preventive strategies to become effective, it is therefore imperative to identify individuals with an unstable gait. Assessment of dynamic stability and gait variability via biomechanical measures of foot kinematics provides a viable option for quantitative evaluation of gait stability, but the ability of these methods to predict falls has generally not been assessed. Although various methods for assessing gait stability exist, their sensitivity and applicability in a clinical setting, as well as their cost-effectiveness, need verification. The objective of this systematic review was therefore to evaluate the sensitivity of biomechanical measures that quantify gait stability among elderly individuals and to evaluate the cost of measurement instrumentation required for application in a clinical setting. To assess gait stability, a comparative effect size (Cohen's d ) analysis of variability and dynamic stability of foot trajectories during level walking was performed on 29 of an initial yield of 9889 articles from four electronic databases. The results of this survey demonstrate that linear variability of temporal measures of swing and stance was most capable of distinguishing between fallers and non-fallers, whereas step width and stride velocity prove more capable of discriminating between old versus young (OY) adults. In addition, while orbital stability measures (Floquet multipliers) applied to gait have been shown to distinguish between both elderly fallers and non-fallers as well as between young and old adults, local stability measures (ls) have been able to distinguish between young and old adults. Both linear and nonlinear measures of foot time series during gait seem to hold predictive ability in distinguishing healthy from fall-prone elderly adults. In conclusion, biomechanical measurements offer promise for identifying individuals at risk of falling and can be obtained with relatively low-cost tools. Incorporation of the most promising measures in combined retrospective and prospective studies for understanding fall risk and designing preventive strategies is warranted.

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Risk factors for recurrent falls among Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS)

Abstract: Abstract

Cited by 52 publications

References 36 publications

Assessment of balance in mild and moderate stages of Alzheimer's disease: implications on falls and functional capacity

Assessment of balance in mild and moderate stages of Alzheimer's disease: implications on falls and functional capacity

Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care

Kinematic measures for assessing gait stability in elderly individuals: a systematic review

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