Cynthia L. Arfken

The prevalence and correlates of fear of falling in elderly persons living in the community

OBJECTIVES Fear of falling has been recognized as a potentially debilitating consequence of falling in elderly persons. However, the prevalence and the correlates of this fear are unknown. METHODS Prevalence of fear of falling was calculated from the 1-year follow-up of an age- and gender-stratified random sample of community-dwelling elderly persons. Cross-sectional associations of fear of falling with quality of life, frailty, and falling were assessed. RESULTS The prevalence of fear increased with age and was greater in women. After adjustment for age and gender, being moderately fearful of falling was associated with decreased satisfaction with life, increased frailty and depressed mood, and recent experience with falls. Being very fearful of falling was associated with all of the above plus decreased mobility and social activities. CONCLUSIONS Fear of falling is common in elderly persons and is associated with decreased quality of life, increased frailty, and recent experience with falls.

Factors Responsible for Impaired Fibrinolysis in Obese Subjects and NIDDM Patients

Accelerated atherosclerosis is the leading cause of death in patients with non-insulin-dependent diabetes mellitus (NIDDM). Impaired endogenous fibrinolytic activity may accelerate atherosclerosis by exposing vascular luminal wall surfaces to persistent and recurrent thrombi and clot-associated mitogens. This study was conducted to further characterize endogenous fibrinolysis in lean and obese nondiabetic subjects and in NIDDM patients and to identify mechanisms responsible for the alterations identified. Obese and diabetic subjects had threefold elevations of plasma concentrations of plasminogen activator inhibitor type 1 (PAI-1) compared with values in lean control subjects. Despite the lack of significant differences in plasma concentrations of tissue-type plasminogen activator in the obese and diabetic subjects, both basal and stimulated endogenous fibrinolytic activities were decreased. The decreases were associated with increased activity of PAI-1 in plasma, in turn correlated with increased concentrations of immunoreactive insulin and C-peptide. These results are consistent with our previous observations demonstrating direct stimulatory effects of insulin and its precursors on cellular expression of PAI-1 in vitro and observations by others demonstrating decreased basal fibrinolytic activity in NIDDM patients. Impaired endogenous fibrinolytic activity could lead to prolonged or recurrent exposure of luminal surfaces of vessel walls to microthrombi and clot-associated mitogens that may accelerate atherosclerosis in hyperinsulinemic subjects.

Clock completion : an objective screening test for dementia

Objective To develop a simple, readily administered and scored screening test for dementia utilizing the clock‐drawing task.

Frailty and injuries in later life: the FICSIT trials.

Physical frailty and fall‐related injuries present two of the biggest threats to older peoples functioning and quality of life. The Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT) trials represent a set of eight different clinical trials concerning physical frailty and injuries in later life. This report documents the history and organization of the trials and provides an overview of the measures being collected at multiple sites and the analytic strategies to be used for multi‐site investigations.

Falls in the Elderly: Reliability of a Classification System

To determine risk factors for falls, previous studies have classified falls according to the contribution of factors both intrinsic and extrinsic to the host. Due partly to the lack of operational definitions and the absence of information on reliability, no consensus on classification has been reached. Consequently, in a 3‐year prospective study of falls occurring in a probability sample of community‐dwelling elderly (n = 1,358), a fall classification system was developed and tested for interrater reliability. The 366 falls in the first year of the study were independently classified by two reviewers on the basis of a narrative description and structured interview. The falls in the four major categories of the classification system included: falls related to extrinsic factors (55%), falls related to intrinsic factors (39%), falls from a non‐bipedal stance (8%) and unclassified falls (7%). The interrater reliability for the four major categories was 89.9% with a kappa of 0.828. The system provides operational definitions for types of falls and a reliable and flexible method for classifying falls in the elderly.

Softness and potential to cause rebreathing: Differences in bedding used by infants at high and low risk for sudden infant death syndrome

OBJECTIVE This study was carried out to determine whether bedding used by infants, who are at either high or low risk for sudden infant death syndrome (SIDS), differs in physical properties favoring rebreathing of exhaled gases. STUDY DESIGN We compared softness and limitation of carbon dioxide dispersal by bedding, using a mechanical model. A questionnaire was used to describe sociodemographic risk factors and sleep practices; bedding was studied in homes with a model positioned where each infant was found sleeping that morning. RESULTS The groups differed with respect to five sociodemographic risk factors (p values all < or = 0.0001). In addition, infants at higher risk were more likely to have been placed to sleep prone (46%, p = 0.02) by parents who were less likely to be aware of the risk associated with the prone position (62% aware, p = 0.005). Infants at higher risk had softer bedding (p < 0.0001, 54.1+/-17.2 cm2 vs 33.7+/-7.7 cm2 in contact with model), which caused more limitation of carbon dioxide dispersal (p = 0.008; CO2 retained, 0.60%+/-0.15% vs 0.34%+/-0.05%). CONCLUSIONS A series of infants who are at high risk for SIDS because of sociodemographic factors more often sleep on bedding that has physical properties favoring rebreathing, and their parents are less often aware of the risk associated with prone sleeping.

Acceptability and Feasibility of a Community Approach to Asthma Management: The Neighborhood Asthma Coalition (NAC)

Understanding of asthma and co-management between patient and physician improves outcome. Feasibility of programs to achieve these goals in underserved settings is not documented. We used the Precede-Proceed model to document (a) community acceptance of a program to engage peer support of asthma management and care; (b) program revision to emphasize greater attention to availability of care and promotional events as channels for education; (c) engagement of intended audiences in planning and implementation; (d) participation of parents in program activities; and (e) peer-based education/support to reach parents, including socially isolated parents whose children experience heightened morbidity.

Obesity in Inner‐city African Americans

OBJECTIVE Obesity, a risk factor for chronic diseases, has a high prevalence in African Americans and low-income individuals. However, little is known about perceptions of overweight, attempts to lose weight, and strategies used to lose weight among African Americans in inner cities. DESIGN A 1990 cross-sectional telephone survey (n = 1445) of north St Louis and central Kansas City, USA. RESULTS Obesity was common (44%) in this sample of inner-city African Americans. The obese perceived themselves as overweight (70%) and were trying to lose weight (66%). The majority of the obese (68%) were both dieting and exercising to lose weight. Smoking prevalence was not higher among the obese or those trying to lose weight. Many of the obese had received medical advice recently on low-fat diets (51%) and had been advised to lose weight (40%). Factors independently associated with perception, attempts to lose weight and medical advice differed, but included degree of obesity. CONCLUSIONS These results corroborate US national data that obesity is a public health problem in this population and that obese inner-city African Americans perceive themselves as overweight and are trying to lose weight, especially as degree of obesity increases. It also appears that smoking is not being used as a weight loss strategy and that the obese, as a group, are receiving some medical advice on low-fat diets. This information is critical for designing culturally sensitive weight-control programmes.

Visual Acuity, Visual Disabilities and Falling in the Elderly

Poor vision has been suggested as a risk factor for falling in the elderly. We analyzed the findings from a cohort of community-dwelling elderly (N = 875) to determine the relative risks for impaired visual acuity and various visual disabilities with falling, recurrent falling, and serious injurious falls. The prevalences of impaired visual acuity and four visual disabilities were low. None of the vision variables examined predicted time to first serious injurious fall after controlling for balance, cognition, age, and gender. However, bumping into objects predicted falling and recurrent falling. The lack of associations between visual disabilities and falling suggests that poor vision, as measured here, plays a limited role in predicting falling in relatively well community-dwelling elderly.

Major decrements in glycated hemoglobin levels between 1978 and 1989 in patients with insulin-dependent diabetes mellitus.

The Diabetes Control and Complications Trial has shown that intensive treatment can deter the development and progression of diabetic complications. Integral to intensive treatment is improved glycemic control. To describe the trend in glycemic control for subjects with insulin-dependent diabetes mellitus, we examined the medical records of 662 subjects seen between 1978 and 1989 at the Model Demonstration Unit of the Diabetes Research and Training Center (Washington University School of Medicine). Mean value of glycated hemoglobin showed steady decline from a peak of 11.5% in 1979 to 9.0% in 1989. This decline was observed both in subjects evaluated only once (annual rate of decline estimated from linear regression, -0.17 +/1 0.03; p = 0.0001) and in subjects evaluated more than once (annual rate of decline estimated from growth curves, -0.18 +/- 0.06; p = 0.0001). These results suggest that substantial lowering of glycated hemoglobin has occurred during the last decade. This reduction should result in a lowered risk of diabetic complications.