Why Do Individuals with Cirrhosis Fall? A Mechanistic Model for Fall Assessment, Treatment, and Research

Murphy, Susan L.; Tapper, Elliot B.; Blackwood, Jennifer; Richardson, James K.

doi:10.1007/s10620-018-5333-8

Cited by 15 publications

(14 citation statements)

References 77 publications

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“…Ambulation requires an interplay of postural control, positional/sensory awareness, and ability to adjust and react to unexpected shifts; all altered in HE. 84,85 In one retrospective study of 130 patients with predominantly Child A and B cirrhosis, 40% of patients with CHE reported a fall in the preceding year compared with only 12.9% of patients without CHE. 10 Additionally, falls in those with CHE were associated with a higher need for primary care physician visits or hospitalization.…”

Section: Fallsmentioning

confidence: 99%

Changing Epidemiology of Cirrhosis and Hepatic Encephalopathy

Louissaint

Deutsch‐Link

Tapper

2022

Clinical Gastroenterology and Hepatology

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Section: Fallsmentioning

confidence: 99%

Changing Epidemiology of Cirrhosis and Hepatic Encephalopathy

Louissaint

Deutsch‐Link

Tapper

2022

Clinical Gastroenterology and Hepatology

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“…Most falls in cirrhosis are attributable to a coalescence of discrete subclinical impairments (19). There are complex potential mechanisms driving fall risk in cirrhosis as follows: cognitive dysfunction, hepatic encephalopathy, alcoholic intoxication and poor environmental awareness stemming from neuropathy alter proprioception (20).…”

Section: Discussionmentioning

confidence: 99%

A self-reported Frailty Index predicts long-term mortality in hospitalized patients with cirrhosis

Deng¹,

Lin²,

Hou³

et al. 2020

Ann Transl Med

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Background: Frailty is a syndrome that diminishes the potential for functional recovery in liver cirrhosis (LC). However, its utility is limited due to sole reliance on physical performance, especially in hospitalized patients. We investigate the predictive value of a modified self-reported Frailty Index in cirrhotics, and identify which health deficits play more important roles. Methods: Consecutive LC patients were assessed by our frailty scale. Outcomes of interest were mortality for 90-day, 1-year and 2-year. Independent predictors were identified by multivariate Cox regression. Receiver operating characteristic curve (ROC) was performed to evaluate discriminative ability. We used a combination of stepwise selection, best subset selection, and Akaike information criteria (AIC) to identify pivotal frailty components. Results: The study cohort consisted of 158 patients, in which 37 expired during follow-up. Compared with non-frail groups, the frail group had higher 1-and 2-year mortality. The area under ROC of the Child-Turcotte-Pugh classification (CTP) and Frailty Index were 0.66 and 0.68, while 0.72 for CTP + Frailty Index (P=0.034), respectively. The optimal predictors comprised instrumental activities of daily living (IADL) limitation, falls and loss of weight (AIC =170, C-statistic =0.67). Conclusions: It is plausible for incorporating Frailty Index to improve prognostication in cirrhotics. IADL limitation, falls and loss of weight play more crucial roles on mortality determination.

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“…Common risk factors for falls include the use of sedating medications, older age, lower‐extremity weakness, alcohol intake, frailty, and cognitive deficits, all of which are more common among patients with cirrhosis 10,11 . Several physiological changes associated with aging and present in cirrhosis include worsening postural control, body‐orienting reflexes, muscle tone, and step height 12 .…”

Section: Why Do Patients Fall?mentioning

confidence: 99%

“…Several physiological changes associated with aging and present in cirrhosis include worsening postural control, body‐orienting reflexes, muscle tone, and step height 12 . Fall avoidance requires accurate perception of perturbation before a successful response by generating enough torque in the hip and core muscles to adjust weight or shift foot placement 11 . Three separate domains—sensory, neurocognitive, and muscular—play a physiological role in fall avoidance (Figure 1).…”

Section: Why Do Patients Fall?mentioning

confidence: 99%

“…Common risk factors for falls include the use of sedating medications, older age, lower-extremity weakness, alcohol intake, frailty, and cognitive deficits, all of which are more common among patients with cirrhosis. 10,11 Several physiological changes associated with aging and present in cirrhosis include worsening postural control, body-orienting reflexes, muscle tone, and step height. 12 Fall avoidance requires accurate perception of perturbation before a successful response by generating enough torque in the hip and core muscles to adjust weight or shift foot placement.…”

Section: Why Do Patients Fall?mentioning

confidence: 99%

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