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JFSF 2019

Original Article JFSF, Vol 4, No 1, March 2019, p.1-10
Developing the React to Falls resources to support care home staff in managing falls
Katie Ruth Robinson, Katherine Jones, Jane Balmbra, Kate Robertson, Jane Horne, Philippa Anne Logan
Keywords: Falls, Falls Prevention, Care Homes, Training, Online Training
Objectives: Care home residents are falling three times more often than elderly frail people living in their own homes and as such, the management of falls is an important area for care home staff to consider. This paper outlines the development of the ‘React to Falls’ training resources to support care home staff in the management of falls. Methods: The ‘React to Falls’ resources were developed in collaboration with falls prevention researchers, expert clinicians working in the field of falls management in care homes and care home staff and residents. Results: A freely accessible online and paper based resource was developed to meet the needs of different care home settings. Expert clinicians and care homes emphasised the importance of promoting activity and quality life and ensuring the resources were a learning tool that supported positive risk taking. Expert clinicians highlighted the need to convey the importance of continually reacting to reducing risk in the management of falls. Conclusions: This study has developed a set of training resources on falls management to support care home staff to continually react and consider the risks and management of falls. An evaluation of the impact of the resource on care staff behaviour and organisational changes is recommended.
Original Article JFSF, Vol 4, No 1, March 2019, p.11-19
Effects of a falls exercise intervention on strength, power, functional ability and bone in older frequent fallers: FaME (Falls Management Exercise) RCT secondary analysis
Dawn A. Skelton, Olga M. Rutherford, Susie Dinan-Young, Marlene Sandlund
Keywords: Exercise, Falls, Strength, Power, Bone Health, Physical Function
Objectives: Falls Management Exercise (FaME) has been shown to reduce falls in frequent fallers and in lower risk sedentary older people. The effects of FaME on the strength, power, physical function and bone health of frequently falling older women are yet to be established. Methods: This paper reports secondary analysis of data from the original randomised controlled trial of FaME in 100 community dwelling women aged ≥65 years with a history of ≥3 falls in the previous year. Intervention was group delivered, weekly one hour tailored dynamic balance and strength exercise classes and home exercise for nine months. Outcome measures included: strength (handgrip, quadriceps, hamstrings, hip abductors, ankles), lower limb explosive power and functional tests (timed up and go, functional reach, timed floor rise and balance), analysed using Linear Mixed Model analysis. Bone Mineral Density (BMD) at hip and spine was measured in a smaller sub-group and analysed using t-tests. Results: Significant time*group interactions in all measures of strength, except isometric ankle dorsiflexion, concentric hamstring and eccentric quadriceps strength. These improvements in strength equated to average improvements of 7-45%. There were also significant improvements in explosive power (W/kg) (18%, p=0.000), timed up and go (16%, p=0.000), functional reach (17%, p=0.000), floor rise (10%, p=0.002) and eyes closed static balance (56%, p=0.000). There was a significant loss of hip BMD in the control group (neck of femur p<0.05; ward’s triangle p<0.02). Conclusion: The FaME intervention improves lower limb strength, power and clinically relevant functional outcomes in frequently falling older women.
Original Article JFSF, Vol 4, No 1, March 2019, p.20-25
The benefits to functional ambulation and physical activity of group-based rehabilitation in frail elderly Bulgarians undergoing total knee arthroplasty. Preliminary results
Julian Krumov, Vasil Obretenov, Alexandrina Vodenicharova, Kostantin Kanalev, Vladimir Stavrev, Troycho Troev, Jannis Papathanasiou
Keywords: Knee Osteoarthritis, Group-based Rehabilitation, Frailty, PASE, Total Knee Arthroplasty
Objectives: Frailty is a geriatric syndrome associated with increased vulnerability of older adults. Knee osteoarthritis (OA) is the most prevalent joint disease and one of the leading causes of disability and poor physical activity (PA) of elderly individuals worldwide. Total knee arthroplasty TKA has been recognized as an effective surgical treatment in end-stage of knee OA. There is a lack of consensus regarding the universally accepted rehabilitation protocol for frail elderly subjects after TKA. Aim: to evaluate the potential benefits in functional ambulation (FA) and PA among frail elderly Bulgarian subjects underwent TKA, a novel group-based rehabilitation protocol was performed from the subjects. Materials and methods: A total of 130 frail elderly Bulgarian TKA recipients (67 women and 63 men aged 72, 69 ± 0.44,) were included. FA was assessed by the six-minute walking distance (6MWD). PA was evaluated by the PASE questionnaire. Participants were evaluated one week before TKA, as well as 3 and 6 months after the group-based rehabilitation. Results: Significant increase in FA was observed at the third and sixth month after the group-based intervention (p< 0.001). PASE score, was increased at the third and sixth month after the group-based intervention (p<0.001, r2=0.74). Conclusions: Our results suggest that the applied group-based intervention led to a significant improvement in FA as well as in PA of frail elderly subjects over the first six months after the group-based intervention.
Expert Opinion Article JFSF, Vol 4, No 1, March 2019, p.26-28
Gap in stroke patients’ and carers’ education
Margialena Manola, Konstantina Petropoulou, Foti Calogero
Keywords: Stroke, Carers, Patient satisfaction, Education, Carers’ burden
Stroke is a multidimensional illness as it affects various aspects in a person’s quality of life. The rehabilitation team focuses mainly on complications but there seems to be a gap in the education of the patients and their carers in skills relevant to the competencies required for community, aged care, health, housing and disability support services. Stroke patients’ and carers’ education-training, as well as their satisfaction has not been studied adequately. The current article presents important studies in the field about the association of patients’ and carers’ satisfaction and based on authors’ opinion suggests appropriate interventions in order to improve the health of the patients.
Mini Review JFSF, Vol 4, No 2, June 2019, p.30-35
Integrating functional ageing into daily clinical practice
Jean-Pierre Michel, Fiona Ecarnot
Keywords: Ageing, Daily functioning, Chronic diseases, Disability, Prevention
The analysis of the ageing trajectory clearly demonstrates the constant involvement of functional ability in daily life, from its development in youth, to its preservation through midlife into very old age. While maintaining function appears to be largely related to persistent regular exercise, the risk factors for functional decline are extremely diverse, ranging from a decrease or discontinuation of physical activity, to nutritional/metabolic disturbances, chronic diseases and unfavourable socio-demographic and socio-economic contexts. Prevention of functional decline is a major public health challenge, both for individuals and for society as a whole, and needs to be urgently addressed. Engaging citizens to be conscious of their responsibility for, and role in their own ageing process is equally as important as reinforcing the involvement of society in promoting healthy ageing through enhanced basic and health education, promotion of a healthy diet, long term practice of moderate physical activity, and the continual battle against deleterious life habits and behaviours. The success of these combined actions would be quite simply demonstrated by a change from the current pandemics of morbidity, to the compression of disability, which is expected by all.
Original Article JFSF, Vol 4, No 2, June 2019, p.36-44
Evaluating a hydration intervention (DRInK Up) to prevent urinary tract infection in care home residents: A mixed methods exploratory study
Jo Booth, Rona Agnew
Keywords: Care homes, Fluids, Hydration, Urinary tract infection, Falls
Objectives: To investigate potential effects and acceptability of a theoretically driven hydration intervention (DRInK-Up), on the prevalence of urinary tract infections (UTIs), falls and emergency admissions in care home residents. Methods: A single group pre-post evaluation design to test the DRInK-Up intervention, to increase fluid intake by 200-400ml daily. The number of UTIs, falls and emergency hospital admissions for each resident recorded over the DRInK-Up intervention period were compared to rates in the 24 weeks prior. A qualitative investigation of experiences of DRInK-Up was undertaken using focus group interviews with care home staff to determine acceptability. Results: 24 care home residents took part in the intervention. There was a clinically meaningful, but non-statistically significant reduction in number of treated UTIs during the intervention period from 51 UTIs pre-DRInK-Up to 37 post-DRInK-Up (t=.498, 18df, p=0.625). The volume of fluid intake recorded was not correlated with number of UTIs (r= 0.103, p=.676). Falls reported dropped from 52 pre- to 28 post-intervention (t=3.148, df 19, p=0.005). Emergency admissions did not change. Focus group interviews suggested goal setting was uncommon and took the form of externally generated targets for fluid intake rather than negotiated goals. Barriers to increasing fluid intake included resident-related factors or arose from the care home context. A range of facilitators included verbal persuasion, praise and reward. Conclusion: The DRInK-Up study provides preliminary evidence suggesting that increasing daily fluid intake by small amounts may have a potentially positive effect on number of UTIs experienced and number of falls in frail older care home residents. Further research is needed.
Research Protocol JFSF, Vol 4, No 2, June 2019, p.45-50
Education Program for Carers in Facilities with Neuro Disabled Subjects EPoCFiNDS
Yannis Dionyssiotis, Eleftheria Vellidou, Stathis Th. Konstantinidis, Pavlos Sarafis, Sofia Artemi, Katerina Stergiopoulou, Anne Mette Vind, Niculina Birsanu, Sophie Duport, Dimitrios Koutsouris, and EPoCFiNDS Consensus attendants group*
*Ioanna Iliadi, Marilena Tarousi, Michalis Sarafidis, Mariana Gabriela Radu, Marie Hvidt, Jetti Vendelbo

Keywords: Carers, Aging, Neurodisability, Rehabilitation, Care
The prevalence of chronic illness and the disabilities they cause are strongly associated with age. According to the United Nations, in most countries around the world, 8-10% of the population has some form of disability. Carers are helping subjects who have severe or profound core activity limitations in the community and hospice facilities. The skills acquired by carers in their caring role are relevant to the competencies required for occupations and qualifications in community, aged care, health, youth, housing and disability support services. With the aging population the number of subjects with neurological lesions living in hospices and long-term care facilities is increased. It makes a strong case to educate carers to help these subjects. There is a lack of evidence on how to design and implement mechanisms such as foundation skills courses and programs to best meet the needs of carers. The goal of Education Program for Carers in Facilities with Neuro Disabled Subjects (EPoCFiNDS), is to create training programs for carers in neurodisabled subjects living in various facilities. In Europe we need to develop educational programs, aimed at volunteers, relatives or any other group of people so that they better organize benefits care for neurodisabled subjects.
Original Article JFSF, Vol 4, No 2, June 2019, p.51-60
Frailty among institutionalized older people: a cross-sectional study in Natal (Brazil)
Fabienne Louise Juvêncio Paes de Andrade, Javier Jerez-Roig, Louise Natália Mesquita Belém, Kenio Costa de Lima
Keywords: Aging, Health of institutionalized elderly, Frail elderly, Long-term institution for elderly, Cross-sectional studies
Objective: Verify the prevalence of frailty and its associated factors in institutionalized older people. Methods: Crosssectional study carried out in 10 nursing homes in Natal (Brazil), between October/2013 and January/2014. All institutionalized older people 60+ that were not hospitalized, in terminal state, coma or under palliative care were included in the study. The dependent variable of the study was the presence/absence of frailty, classified according to the following criteria: severe cognitive decline and/or impossibility of independent walking or being bedridden. The 5 criteria (muscular weakness, unintentional weight loss, low physical activity level, slowness and exhaustion) of Fried et al. were considered for those with preserved cognitive and walking capacity. The chi-square test or Fisher’s test and logistic regression were used for bivariate and multiple analysis, respectively. Sociodemographic, institution-related and health-related variables were also included. Results: Of the 321 participating older people, 80.1% were considered frail, 16.8% pre-frail and 3.1% non-frail. The final model demonstrated association of frailty with age (OR=2.67; 95%CI 1.39-5.14; p=0.003), presence of chronic diseases (OR=10.27; 95%CI 3.42-30.90; p<0.001), systemic arterial hypertension (OR=0.11; 95%CI 0.05-0.27; p<0.001) and institutionalization due to lack of caregiver (OR=2.55; 95%CI 1.36-4.76; p=0.003) adjusted by sex and type of institution. Discussion: Frailty was highly prevalent in institutionalized older people and its association with multi-factor aspects suggested that action of health services and government representations could aid in the prevention or delay of frailty onset, improving the life quality of older people.
Original Article JFSF, Vol 4, No 3, September 2019, p.65-70
Beyond balance and mobility, contributions of cognitive function to falls in older adults with cardiovascular disease
Jennifer Blackwood, Shweta Gore
Keywords: Cardiovascular disease, Cognition, Recall, Falls, Mobility
Objectives: Older adults with cardiovascular disease (CVD) are at risk for cognitive impairment. Cognitive function is associated with falls in older adults however it is unknown if a relationship exists between cognitive function and falls in CVD. The aim of this study was to examine the contributions of cognitive function on falls in older adults with CVD. Methods: A secondary analysis was performed on data from the Health and Retirement Study cohort 2010 (N=3413) of older adults with CVD. Group assignment was based on falls history (yes/no) within the two years prior to the survey. Demographic (age, education, gender, marital status), physical (strength, balance, physical activity, and mobility) and cognitive (immediate and delayed recall, orientation, semantic verbal fluency, numeracy) information was extracted to characterize the sample. Comparisons between groups were completed for all of these variables. Logistic regression was performed to examine associations between each of the cognitive variables and falls while controlling for age, gender, marital status, education, and BMI. Results: Demographic (age, gender, marital status, and education), physical (grip strength, tandem stance time, and gait speed), and cognitive (orientation, immediate and delayed recall) variables differed by falls history (p<0.05). After controlling for confounding, immediate recall was the only significant predictor of falls (OR=1.09, 95% CI=1.01-1.17) (Nagelkerke R2=0.037, χ2=35.14, p<0.05) with correctly classifying 65.9% of cases. Conclusions: In older adults with CVD, cognitive and physical functions are more impaired in those with a falls history. Screening for cognitive function, specifically immediate recall, should be a part of the management of falls in this population.
Original Article JFSF, Vol 4, No 3, September 2019, p.71-77
Current practice in the diagnosis and management of sarcopenia and frailty – results from a UK-wide survey
Natalie J. Offord, Andrew Clegg, Gill Turner, Richard M. Dodds, Avan A. Sayer, Miles D. Witham
Keywords: Sarcopenia, Frailty, Survey, Questionnaire, Older people
Objectives: Despite a rising clinical and research profile, there is limited information about how frailty and sarcopenia are diagnosed and managed in clinical practice. Our objective was to build a picture of current practice by conducting a survey of UK healthcare professionals. Methods: We surveyed healthcare professionals in NHS organisations, using a series of four questionnaires. These focussed on the diagnosis and management of sarcopenia, and the diagnosis and management of frailty in acute medical units, community settings and surgical units. Results: Response rates ranged from 49/177 (28%) organisations for the sarcopenia questionnaire to 104/177 (59%) for the surgical unit questionnaire. Less than half of responding organisations identified sarcopenia; few made the diagnosis using a recognised algorithm or offered resistance training. The commonest tools used to identify frailty were the Rockwood Clinical Frailty Scale or presence of a frailty syndrome. Comprehensive Geriatric Assessment was offered by the majority of organisations, but this included exercise therapy in less than half of cases, and medication review in only one-third to two-thirds of cases. Conclusions: Opportunities exist to improve consistency of diagnosis and delivery of evidence-based interventions for both sarcopenia and frailty.
Original Article JFSF, Vol 4, No 3, September 2019, p.78-90
The Footfall Programme: participant experiences of a lower limb, foot and ankle exercise intervention for falls prevention - an exploratory study
Monserrat Conde, Gordon Hendry, Dawn A. Skelton
Keywords: Exercise, Falls, Feet, Feasibility, Older adults
Objectives: Despite growing evidence that foot and ankle exercise programmes are effective for falls prevention, little is known about older adults’ views and preferences of programme components for long-term maintenance. The aims of this study were to explore the experiences and acceptability of Scottish and Portuguese older adults of undertaking a home-based foot, ankle and lower limb exercise intervention. Methods: Ten Scottish (mean age 76 years, 7 female) and fourteen Portuguese (mean age 66 years, 12 female) community-dwelling older adults undertook the programme for one week, followed by focus group discussions (2-6 people per group), guided by a semi-structured interview guide. Data was analysed using thematic analysis. Results: Seven themes were identified: Assessment, Group exercise taster, Home based exercise; Footfall programme kit, Midweek phone call, Reasons for participation and the Research Process. Programme components, support telephone calls and research procedures were generally well accepted by participants and they valued having a contribution to the design. They preferred a blended home and intermittent groupbased programme format for motivation and progression and recommended changes to some of the exercises and equipment to reduce barriers to participation. Some cultural differences emerged, including importance of the functional assessments for Portuguese participants, time issues and difficulty in completion of the exercise diary, reflecting lower literacy levels. Conclusions: Participants found the programme acceptable but preferred a blended home and occasional group-based programme for adherence and motivation. A strong educational component to improve health literacy and simple paperwork completion to avoid data loss in future studies with Portuguese older adults is important.
Original Article JFSF, Vol 4, No 4, December 2019, p.91-101
Osteosarcopenic obesity, the coexistence of osteoporosis, sarcopenia and obesity and consequences in the quality of life in older adults ≥65 years-old in Greece
Konstantia Keramidaki, Amalia Tsagari, Mina Hiona, Grigoris Risvas
Keywords: Sarcopenic obesity, Osteopenic obesity, Obesity, Frailty, Quality of life
Objective: We investigated the coexistence of sarcopenia and obesity in older adults≥65 years diagnosed with osteoporosis and the association with Quality of Life (QoL). Methods: A Cross-sectional survey has been performed on a randomized sample of 50 diagnosed osteoporotic elderly people from both sexes (Men=16; Women=34). Measurements: Quantitative ultrasound was conducted to identify osteoporosis and defined with a T score ≤2.5. Validated anthropometric equations were used in order to estimate body fat percentage and skeletal muscle mass so as to detect the reallocation of body fat and lean muscle. 10m gait speed and hand grip strength was measured in order to diagnose sarcopenia according to European Society for Clinical Nutrition and Metabolism (ESPEN) algorithm. The evaluation of QoL was conducted using a QoL questionnaire specific to osteoporosis. The data were analyzed with descriptive statistics and a chi-square test was performed to examine if Osteosarcopenic Obesity (OSO) is sex related and the correlation between OSO and QoL. Results: From the 50 participants, 40%(n=19) were classified as people with OSO and 60%(n=31) without OSO. From n=19 people that experienced OSO women represent 20% (n=9) and men 18% (n=9); with the latter had a greater decline in muscle mass than women, while women had lower BMD than men according to the z score. OSO is not related with sex (p>.05) and there is no significant association between OSO and QoL (p>.05 for all the domains of QoL questionnaire). Conclusion: Osteoporosis in the elderly often coexists with reduced muscle mass and muscle strength as well as an increase in adiposity and was independently associated with QoL. People that experience OSO presenting lower functionality that increases the risk for falls and bone fractures originated from the decline in bone and muscle mass, and increased adiposity. Increased awareness of OSO may help develop efficient interventions and public health policies for healthier and more active elderly people.
Original Article JFSF, Vol 4, No 4, December 2019, p.102-110
Changes in physical activity predict changes in a comprehensive model of balance in older communitydwelling adults. A longitudinal analysis of the TILDA study
Ilona I. McMullan, Brendan P. Bunting, Suzanne M. McDonough, Mark A. Tully, Karen Casson
Keywords: Falls, Low-intensity physical activity, TILDA
Objective: Falls due to poor balance can cause injury, disability, and death in older adults. The relationship between free-living physical activity (PA) and balance over time is poorly understood. The aim of this study is to explore the association between PA and balance in older adults over time. Methods: Using two waves of data from the TILDA study (n=8,504 participants) a structural equation model was used to identify a composite measure of balance that incorporated measures of Timed Up and Go; handgrip strength; Mini Mental State Exam; vision; hearing; and steadiness. The patterns of change in PA and balance were then compared over time (controlling for covariates). Results: The results showed that one extra metabolic equivalent of task (MET) minute of PA improves balance by 4% over one week (Est=-0.10, SE=0.12), and by 5% cumulatively over two years (Est=-0.13, SE=0.02). Medication, alcohol consumption, sex, age, fear of falling, education, pain, and problems performing activities of daily living (ADL) were risk factors for balance. Conclusion: This study provides a novel and robust model that should guide comprehensive balance assessment. PA promotion should engage older adults in more free-living PA that may be more relevant to them.
Opinion Article JFSF, Vol 4, No 4, December 2019, p.111-115
Implementing frailty assessment into a healthcare system: a clinical opinion paper
Eftychia Kyriakou, Dimitrios Tzefronis, Georgia Dagianta, Ioannis K. Triantafyllopoulos
Keywords: Screening, Frailty assessment, Frailty diagnosis, Frailty syndrome, Geriatric assessment instruments
Frailty is a multifactorial medical syndrome characterized by reduced endurance and decreased physiological ability. The aim of this narrative literature review is to present the frailty diagnostic instruments that are already used in most Western countries and provide recommendations for use in clinical practice. Among the numerous available frailty instruments identified in current literature, the Frailty Index and the Physical Frailty Phenotype are most commonly used. There are large differences in each instrument design, ease of use by healthcare teams and also significant heterogeneity in the design of the studies based on these instruments. Therefore, future studies should be designed to properly address the discrepancy in the comparison of the existent instruments and consider their validity and feasibility of implementation in different healthcare settings with different healthcare providers.
Original Article JFSF, Vol 4, No 4, December 2019, p.116-121
Evaluation of physical performance in musculoskeletal and rheumatic diseases with jumping mechanography
Yannis Dionyssiotis, Grigorios Skarantavos, Inga Kantaidou, Maria-Christina Papadatou, Panayiotis Papagelopoulos, Antonios Angoules, Jannis Papathanasiou, George P. Lyritis
Keywords: Sarcopenia, Jumping mechanography, Rheumatic diseases, Osteoporosis, Menopause
Objective: Low muscle function is a component of sarcopenia. Rheumatic and musculoskeletal diseases are related to increased muscle loss and decreased muscle performance. Our purpose was to study muscle function among pre and postmenopausal women and women with rheumatic diseases. Methods: Two hundred fifty seven women were included in the study: Group POST OST included 61 osteoporotic postmenopausal women under treatment with osteoporotic drugs and calcium/vitamin D supplements (mean age 65±9.6 years), group POST HEALTH consisted of 117 healthy postmenopausal women (mean age 62.9±9.8 yrs), Group RHEUM included 20 women with rheumatic diseases (mean age 58.85±13yrs), and group PRE included 59 healthy premenopausal women (mean age 35±7.6 yrs). For the measurement of objective parameters of movement (Force, velocity, Power), we used the mechanography system in Leonardo platform (Novotec, Germany). Personal Power (Power/Weight) was also calculated. Results: Height was decreased with age, while body mass index (BMI) and weight were significantly increased. In groups POST OST, POST HEALTH, RHEUM, all measured parameters were statistically decreased in comparison with group PRE. No statistical significance was found among POST HEALTH and POST OST women. Conclusions: Jumping mechanography can be proposed as a novel tool to assess physical performance in musculoskeletal and rheumatic diseases. It offers to the clinician additional information, while quantitatively assesses muscle function, for assessing sarcopenia.