Preventing and Managing Indoor Falls with Home-Based Technologies in Mild and Moderate Alzheimer's Disease Patients: Pilot Study in a Community Dwelling

Tchalla, Achille; Lachal, Florent; Cardinaud, Noëlle; Saulnier, Isabelle; Rialle, Vincent; Preux, Pierre‐Marie; Dantoine, Thierry

doi:10.1159/000351863

Cited by 56 publications

(75 citation statements)

References 66 publications

(42 reference statements)

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“…For effective management, it is necessary to know how to predict rapid decline early in the course of dementia, by evaluating relevant risk factors. Then, preventative strategies involving home-based technologies may slow RCD [44]. Such variables constitute important parameters when clinical studies including dementia subjects are planned [45].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Rapid Cognitive Decline in Patients with Mild-to-Moderate Alzheimer Disease: A Prospective Cohort Study with 12-Month Follow-Up Performed in Memory Clinics

Tchalla

Clément

Saulnier

et al. 2018

Dement Geriatr Cogn Disord

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Background/Aims: Alzheimer disease (AD) is particularly devastating, with no cure, no means of prevention, and no proven way to slow progression. AD is associated with the worsening of cognitive function attributable to a variety of factors of which little is known. Our main objective was to determine factors associated with rapid cognitive decline (RCD) in older AD patients. Methods: We conducted a 12-month, prospective, multi-centre cohort study. Community-living individuals aged ≥65 years with mild-to-moderate AD were included. RCD was defined as the loss of ≥3 points/year in the Mini-Mental State Examination (MMSE) score. Potential individual-level predictors were collected at baseline. Results: A total of 521 individuals were included. The mean age was 80.8 ± 9.0 years and 66.0% were females. The average baseline MMSE score was 20.5 ± 4.5. The incidence of RCD was 40.9% (95% confidence interval [CI], 36.7–45.1). RCD was more common in patients with moderate (53.5%) than mild (22.3%) AD. The factors associated with RCD were: a parental history of dementia (odds ratio [OR], 2.32 [95% CI, 1.24–4.21], p = 0.011), psychotic symptoms (OR, 2.06 [95% CI, 1.22–3.48], p = 0.007), malnutrition (OR, 1.61 [95% CI, 1.06–2.63], p = 0.028), and the female gender (OR, 1.48 [95% CI, 1.03–2.15], p = 0.036). An MMSE score < 20 at treatment onset was also associated with RCD (p < 0.001). Conclusion: The factors associated with RCD were an MMSE score < 20 at treatment onset, female gender, psychotic symptoms, malnutrition, and a family history of dementia. These results may be directly relevant to patients, their families, and their physicians, enabling early anticipation of difficult clinical trajectories and poor functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Predictors of Rapid Cognitive Decline in Patients with Mild-to-Moderate Alzheimer Disease: A Prospective Cohort Study with 12-Month Follow-Up Performed in Memory Clinics

Tchalla

Clément

Saulnier

et al. 2018

Dement Geriatr Cogn Disord

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“…Finally, the biggest strength of this study is the simplicity of the intervention, consisting only of a LED strip combined with a motion sensor. This study shows the potential of simple automated lighting interventions in fall prevention, which has been only studied to a limited extent [21,24,26,27].…”

Section: Limitations and Strengthsmentioning

confidence: 97%

“…We hypothesized that the lighting provided by Gight during ambulation would have this effect by improving postural stability and spatial awareness [24]. Tchalla et al [26,27] conducted randomized controlled trials concerning the aforementioned combined intervention of light paths and tele-assistance services. They demonstrated decreased fall rates in the intervention groups in both a population of frail older people and a population of people with Alzheimer's disease.…”

Section: Fall Ratementioning

confidence: 99%

A Guiding Nightlight Decreases Fear of Falling and Increases Sleep Quality of Community-Dwelling Older People: A Quantitative and Qualitative Evaluation

Thölking

Lamers²,

Rikkert

2020

Gerontology

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Background: Even though poor lighting at nighttime is an important risk factor for falls (and most falls occur during the night), lighting interventions to improve nightly lighting from bed to bathroom are rarely evaluated for fall prevention. Objective: We tested the hypothesis that an automated guiding light would reduce nightly fear of falling (FOF) and increase sleep quality of community-dwelling older people. Methods: This study had a pragmatic uncontrolled beforeafter design, including participants during a period of 8 months if they (i) were aged at least 65 years, (ii) ambulated independently at night, and (iii) had no cognitive or audiovisual impairments obstructing outcome measurement. Automated LED strips (Gight TM ) were installed in the participants' homes. The primary outcome measure was overnight FOF on a scale of 0-10. Secondary outcome measures included sleep quality on a scale of 0-10 and fall rate. Additionally, a sample of participants was interviewed about their experiences with Gight. Results: Sixty-four participants were included (mean age: 80.8 ± 8.1 years; 89% living independently). Mean study length was 118 days (range: 30-231). In the intention-to-treat analysis, overnight FOF declined from 5.5 ± 3.0 to 3.8 ± 3.2 (p = 0.001), and sleep quality increased from 6.7 ± 2.4 to 7.4 ± 1.7 (p = 0.012). The fall rate during the study was too low to detect changes. Participants appreciated Gight (8.4 ± 0.8 on a scale of 10), and the majority (57%) reported a subjective decrease in FOF. Conclusion: Gight shows promising results for overnight FOF and sleep quality, but the effect of lighting interventions on fall rate should be evaluated further before widespread implementation.

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“…7,38 Use of monitoring AT for decreasing fall risk is another focused area for researchers in France and the Netherlands. 36,[39][40][41] Human-like assistive communication robots for the emotional well-being of people with dementia are used in Australia. 42,43 AT supported leisure activities are also a hot research area for research in Australia for well-being of people with dementia.…”

Section: P-indexmentioning

confidence: 99%

Assistive technology for people with dementia: an overview and bibliometric study

Asghar

Cang

2017

Health Info Libraries J

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Preventing and Managing Indoor Falls with Home-Based Technologies in Mild and Moderate Alzheimer's Disease Patients: Pilot Study in a Community Dwelling

Cited by 56 publications

References 66 publications

Predictors of Rapid Cognitive Decline in Patients with Mild-to-Moderate Alzheimer Disease: A Prospective Cohort Study with 12-Month Follow-Up Performed in Memory Clinics

Predictors of Rapid Cognitive Decline in Patients with Mild-to-Moderate Alzheimer Disease: A Prospective Cohort Study with 12-Month Follow-Up Performed in Memory Clinics

A Guiding Nightlight Decreases Fear of Falling and Increases Sleep Quality of Community-Dwelling Older People: A Quantitative and Qualitative Evaluation

Assistive technology for people with dementia: an overview and bibliometric study

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