Hei Fen Hwang

Psychometric Comparisons of the Timed Up and Go, One‐Leg Stand, Functional Reach, and Tinetti Balance Measures in Community‐Dwelling Older People

Objectives: To compare the practicality, reliability, validity, and responsiveness of the timed up and go (TUG), one‐leg stand (OLS), functional reach (FR), and Tinetti balance (TB) performance measures in people aged 65 and older.

A Randomized, Controlled Trial of Fall Prevention Programs and Quality of Life in Older Fallers

OBJECTIVES: To compare the effects of three fall‐prevention programs (education (ED), home safety assessment and modification (HSAM), and exercise training (ET)) on quality of life (QOL), functional balance and gait, activities of daily living (ADLs), fear of falling, and depression in adults aged 65 and older.

Community-Based Tai Chi and Its Effect on Injurious Falls, Balance, Gait, and Fear of Falling in Older People

Background and Purpose. It is important to determine the effect of adherence to a tai chi program on falls and related functional outcomes in older people. This study examined the effect of a community-based tai chi program on injurious falls, balance, gait, and fear of falling among people aged 65 years and older in Taiwan. Subjects and Methods. In 6 rural villages in Taichung County, 1,200 subjects participated in the initial assessment. During a 1-year intervention period, all study villages were provided with education on fall prevention. Two villages had been provided tai chi exercise (n=472 participants or “tai chi villagers”), and 4 villages served as control villages (n=728 participants or “control villagers”). Injurious falls were ascertained by telephone interviews every 3 months over a 2-year study period; additionally, balance, gait, and fear of falling were assessed in 2 follow-up assessments. Results. Eighty-eight subjects, 83 from the tai chi villages and 5 from the control villages, participated and practiced in the tai chi program (the group labeled “tai chi practitioners”). After the tai chi program, injurious falls among the control villagers significantly declined by 44% (adjusted rate ratio [RR]=0.56; 95% confidence interval [CI]=0.36–0.92). Compared with the results for the control villagers, the decline was 31% greater (RR=0.69; 95% CI=0.30–1.56) among the tai chi villagers and 50% greater (RR=0.5; 95% CI=0.11–2.17) among the tai chi practitioners; the results did not reach statistical significance. Furthermore, compared with the scores for the control villagers, the scores for the tai chi practitioners increased by 1.8 points (95% CI=0.2–3.4) on the Tinetti Balance Scale and increased by 0.9 point (95% CI=0.1–1.8) on the Tinetti Gait Scale. No significant changes in the fear of falling were detected among the tai chi practitioners, tai chi villagers, and control villagers. Discussion and Conclusion. Tai chi can prevent a decline in functional balance and gait among older people. However, the reduction in injurious falls attained with tai chi did not reach statistical significance; the statistical inefficiency may have resulted partly from the large decline in injurious falls in control villagers. Finally, the unexpected effect of educational intervention on reducing injurious falls in different settings needs to be further examined.

The impact of the Chi-Chi earthquake on quality of life among elderly survivors in Taiwan--a before and after study.

This paper examines the impact of the Chi-Chi earthquake, which hit central Taiwan on September 21, 1999, on the quality of life among the elderly survivors. The 28-item Taiwanese-adapted brief version of the World Health Organizations quality of life questionnaire (WHOQOL-BREF) was used to measure quality of life in four domains: physical capacity, psychological well-being, social relationships, and environment. These measures were coincidently collected in a separate study from 368 subjects aged 65 and older in the affected area shortly before the earthquake. Of these subjects, 268 were interviewed in a follow-up assessment 12 months after the earthquake. Linear mixed models were applied to investigate how quality of life in each of the four domains changed from the pre-earthquake assessment to 12 months after the earthquake, and how these changes depended on the level of damage to residences. In conclusion, elderly survivors tended to report lower quality of life in physical capacity, psychological well-being, and environment 12 months after the earthquake than at the assessment prior to the earthquake, regardless of the level of damage to their residences during the earthquake. However, those whose residences completely collapsed during the earthquake reported a higher quality of life in social relationships while others reported the opposite.

Crash severity, injury patterns, and helmet use in adolescent motorcycle riders.

BACKGROUND This study examined crash severity and injury patterns between helmeted and unhelmeted adolescent motorcycle riders. METHODS Among an initial population of 4,721 junior college students, 1,284 students were involved in 1,889 motorcycle crashes during a 20-month follow-up period. Crash severity was measured by both the type of collision object and the repair cost of motorcycle damage. RESULTS The incidence rates of crash, injury, hospitalization, and deaths per 1,000 person-years in the cohort were 358, 104, 14, and 1.3, respectively. Compared with helmeted riders, unhelmeted riders had more noncollisions and fewer collisions with a moving car but there was no significant difference in repair cost of motorcycle damage between these groups. More injuries to the external skin, face, and head and more severe injuries occurred in unhelmeted than in helmeted riders. Among crashes resulting in hospitalization/death, more injuries to the face and head occurred in unhelmeted riders than in helmeted riders. CONCLUSION Crashes involving unhelmeted riders were not more severe but more frequently involved face and head injuries than crashes involving helmeted riders.

Use of Quantitative Ultrasound for Identifying Low Bone Density in Older People

Objective. This study examined criterion, convergent, and discriminant validities of quantitative ultrasound (QUS) for identifying low bone density among people aged 55 years and older in Taiwan. Methods. We recruited 453 community‐dwelling volunteers and 30 patients with lower extremity fractures. Bone density was assessed using both calcaneal QUS and femoral neck dual‐energy x‐ray absorptiometry (DXA). Two QUS parameters, speed of sound (SOS) and broadband ultrasound attenuation (BUA), were also used to estimate heel bone mineral density (HBMD). Results. Using DXA as the criterion for identifying low bone density (DXA T score of 1.0 or lower), likelihood ratios for BUA and SOS at the 50th percentile and HBMD for men were 1.50, 1.75, and 1.28, respectively; the counterparts for women were 1.54, 2.13, and 1.29. As for identifying osteoporosis (DXA T score of −2.5 or lower), higher likelihood ratios of the 3 QUS parameters were gained. For convergent validity, Pearson correlation coefficients for DXA with BUA, SOS, and HBMD ranged from 0.40 to 0.43 for men and from 0.48 to 0.53 for women. For the ability to discriminate men and women with lower extremity fractures from those without, no significant differences in the area under the receiver operating characteristic curve were detected between BUA, SOS, and HBMD and DXA after adjusting for age, body mass index, fall history, and current smoking. Conclusions. Although having very good convergent and discriminant validities and fair criterion validity, calcaneal QUS may be a screening tool for identifying low bone density.

Effect of Fracture Type on Health-Related Quality of Life Among Older Women in Taiwan

OBJECTIVE To investigate changes in health-related quality of life (HRQOL) during the first year after injury in elderly Taiwanese women who had fractured a hip, vertebra, distal forearm, or multiple sites. DESIGN Longitudinal cohort study. SETTING Personal or telephone interviews of patients from 3 teaching hospitals. PARTICIPANTS Women (N=347; mean age ± SD, 78.0±6.6y) who had sustained a fracture of the hip, vertebra, or distal forearm due to a fall participated in the baseline assessment, in which both current and prefracture HRQOL data were collected. At 6 and 12 months after the fracture, 285 and 254 women, respectively, completed the follow-up assessments. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The 4 domains of physical capacity, psychological well-being, social relationships, and environment of the brief version of the World Health Organization Quality of Life questionnaire were assessed. RESULTS After adjusting for prefracture HRQOL scores and baseline characteristics, women with a hip fracture showed a significant improvement in physical capacity (3.5 points) and a significant decline in social relationships (-3.7 points). Relative to women with a hip fracture at 12 months after injury, those with a vertebral fracture exhibited significantly greater improvement (5.2 points) in physical capacity; those with a distal forearm fracture had significantly greater improvements in physical capacity (11.5 points), psychological well-being (8.4 points), social relationships (7.2 points), and environment (10.9 points), while those with multiple fractures displayed significantly greater improvement in physical capacity (16.5 points), psychological well-being (13.3 points), and environment (10.3 points). CONCLUSIONS Among the 4 fracture types in elderly women, hip fractures may result in the smallest improvement in the physical domain and the greatest declines in the psychological, social, and environmental domains during the first year. The magnitude of the impact of each fracture type varied across different domains.

A prospective study of factors influencing return to work after traumatic spinal cord injury in Taiwan.

UNLABELLED Lin M-R, Hwang H-F, Yu W-Y, Chen C-Y. A prospective study of factors influencing return to work after traumatic spinal cord injury in Taiwan. OBJECTIVE To examine comprehensively the effects of physical, psychologic, and sociologic characteristics on employment among persons after a traumatic spinal cord injury (SCI) in Taiwan. DESIGN A prospective study with follow-up telephone interviews over a 3-year period. SETTING To register people who had sustained an SCI, medical records of 4 hospitals were reviewed using codes of the International Classification of Diseases-9th Revision-Clinical Modifications from 806.0 to 806.9 and from 952.0 to 952.9. PARTICIPANTS Subjects (N=219) employed at the time of injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Employment status after an SCI. RESULTS The employment rate was 32.9%. After controlling for other variables, education level (relative rate [RR]=4.01 approximately 8.17), autonomy in transportation (RR=5.13), professional licensure (RR=1.86), and thrill and adventure-seeking trait (RR=1.12) were positively and significantly associated with employment, while subjects with more severe overall injury severity (RR=0.95), preinjury chronic conditions (RR=0.20), necessity for aids for daily living (RR=0.31), and depression (RR=0.38) were less likely to have been employed than their counterparts. CONCLUSIONS In addition to education level and traditional physical factors, overall injury severity and psychologic factors such as thrill and adventure seeking and depression can also influence the return to work after an SCI.

Effects of fall injury type and discharge placement on mortality, hospitalization, falls, and ADL changes among older people in Taiwan

A longitudinal study was conducted to investigate the effects of injury type and discharge placement on mortality, falls, hospital admissions, and changes in activities of daily living (ADLs) over a 12-month period among older fallers. Of 762 community-dwelling people aged 65 years or older who visited an emergency department (ED) of a general hospital in Taiwan due to a fall, 273 sustained a hip fracture, 157 had a vertebral fracture, 47 had a distal forearm fracture, 102 had a traumatic brain injury, and 183 had soft-tissue injuries. Results showed that, compared to patients with a soft-tissue injury, those with TBI had significantly higher risks of dying (rate ratio (RR)=3.59) and hospital admissions (RR=3.23) and better improvement in ADLs (1.93 points) at 6 months post-injury, and those who sustained a hip fracture (4.26 and 4.41 points), a vertebral fracture (3.81 and 3.83 points), or a distal-forearm fracture (2.80 and 2.80 points) had significantly better improvement in ADLs at 6 and 12 months post-injury. Patients discharged to a nursing home had a significantly increased risk of death (RR=2.08) and hospital admission (RR=2.05) than those returning to their usual residence during the first year post-injury. No significant differences in the occurrence of falls during the first post-injury year were found among patients with different injury types or between those with different discharge placements. In conclusion, among the five major fall injury types in older people, TBIs result in the highest risk of death and hospital admissions, while hip and vertebral fractures exhibited the largest improvement during the first year after injury. Additionally, nursing home care may be associated with increased risks of death and hospital admissions than home care. In addition to primary prevention of falls, further research to investigate mechanisms leading to TBIs during a fall is needed to facilitate effective secondary fall-prevention programs for older people.