Karl-Günter Gaßmann

Predictors for occasional and recurrent falls in community-dwelling older people

BACKGROUND Little is known about the prevalence of falls and the related risk factors in the general population of community-living older people in Germany. OBJECTIVES To assess the prevalence and related predictors of different types of falls in a sample of community-dwelling 65 years and older people in Germany living in a metropolitan area. Study design and setting prospective cohort study in 622 community dwelling people aged > or =65 years. RESULTS A total of 107 persons (17.2%) reported falling at least once (occasional fallers), while 36 (5.7%) experienced two or more falls (recurrent fallers) in the last 6 months. Main predictors for all fallers were age (OR 1.8; 95% CI 1.1-3.0), being female (OR 1.7; 95% CI 1.1-2.2), living alone (OR 1.9; 95% CI 1.2-2.9), poor health status (OR 3.3; 95% CI 2.1-5.3), varifocals (OR 1.7; 95% CI 1.0-3.1), disturbance of memory (OR 1.7; 95% CI 1.0-3.0), depression (OR 4.8; 95% CI 2.5-9.2), sleep disturbances (OR 2.7; 95% CI 1.7-4.3), incontinence (OR 2.1; 95% CI 1.3-4.9), dizziness (OR 3.0; 95% CI 1.9-5.0), 3 medical conditions or more (OR 3.3; 95% CI 2.1-5.1), lower physical functioning and mobility. Two of the strongest predictors were reported falls (OR 4.9; 95% CI 3.1-7.7) and recurrent falls (OR 10.0; 95% CI 5.0-20.0) in the last 6 months. CONCLUSION Older adults living at home should be screened for falls in history and problems in gait and mobility in any anamnesis to identify those who are at risk for falls.

Instrumented gait analysis: a measure of gait improvement by a wheeled walker in hospitalized geriatric patients

BackgroundIn an increasing aging society, reduced mobility is one of the most important factors limiting activities of daily living and overall quality of life. The ability to walk independently contributes to the mobility, but is increasingly restricted by numerous diseases that impair gait and balance. The aim of this cross-sectional observation study was to examine whether spatio-temporal gait parameters derived from mobile instrumented gait analysis can be used to measure the gait stabilizing effects of a wheeled walker (WW) and whether these gait parameters may serve as surrogate marker in hospitalized patients with multifactorial gait and balance impairment.MethodsOne hundred six patients (ages 68–95) wearing inertial sensor equipped shoes passed an instrumented walkway with and without gait support from a WW. The walkway assessed the risk of falling associated gait parameters velocity, swing time, stride length, stride time- and double support time variability. Inertial sensor-equipped shoes measured heel strike and toe off angles, and foot clearance.ResultsThe use of a WW improved the risk of spatio-temporal parameters velocity, swing time, stride length and the sagittal plane associated parameters heel strike and toe off angles in all patients. First-time users (FTUs) showed similar gait parameter improvement patterns as frequent WW users (FUs). However, FUs with higher levels of gait impairment improved more in velocity, stride length and toe off angle compared to the FTUs.ConclusionThe impact of a WW can be quantified objectively by instrumented gait assessment. Thus, objective gait parameters may serve as surrogate markers for the use of walking aids in patients with gait and balance impairments.

Comparing the predictive accuracy of frailty, comorbidity, and disability for mortality: a 1-year follow-up in patients hospitalized in geriatric wards

Background Studies evaluating and comparing the power of frailty, comorbidity, and disability instruments, together and in parallel, for predicting mortality are limited. Objective This study aimed to evaluate and compare the measures of frailty, comorbidity, and disability in predicting 1-year mortality in geriatric inpatients. Design Prospective cohort study. Patients and setting A total of 307 inpatients aged ≥65 years in geriatric wards of a general hospital participated in the study. Measurements The patients were evaluated in relation to different frailty, comorbidity, and disability instruments during their hospital stays. These included three frailty (the seven-category Clinical Frailty Scale [CFS-7], a 41-item frailty index [FI], and the FRAIL scale), two comorbidity (the Cumulative Illness Rating Scale for Geriatrics [CIRS-G] and the comorbidity domain of the FI [Comorbidity-D-FI]), and two disability instruments (disability in basic activities of daily living [ADL-Katz] and the instrumental and basic activities of daily living domains of the FI [IADL/ADL-D-FI]). The patients were followed-up over 1 year. Results Using FI, CIRS-G, Comorbidity-D-FI, and ADL-Katz, this study identified a patient group with a high (≥50%) 1-year mortality rate in all of the patients and the two patient subgroups (ie, patients aged 65–82 years and ≥83 years). The CFS-7, FI, FRAIL scale, CIRS-G, Comorbidity-D-FI, and IADL/ADL-D-FI (analyzed as full scales) revealed useful discriminative accuracy for 1-year mortality (ie, an area under the curve >0.7) in all the patients and the two patient subgroups (all P<0.001). Thereby, CFS-7 (in all patients and the two patient subgroups) and FI (in the subgroup of patients aged ≥83 years) showed greater discriminative accuracy for 1-year mortality compared to other instruments (all P<0.05). Conclusion All the different instruments emerged as suitable tools for risk stratification in geriatric inpatients. Among them, CFS-7, and in those patients aged ≥83 years, also the FI, might most accurately predict 1-year mortality in the aforementioned group of individuals.

Prediction of future falls in a community dwelling older adult population using instrumented balance and gait analysis

BackgroundThe role of instrumented balance and gait assessment when screening for prospective fallers is currently a topic of controversial discussion.ObjectivesThis study analyzed the association between variables derived from static posturography, instrumented gait analysis and clinical assessments with the occurrence of prospective falls in a sample of community dwelling older people.MethodsIn this study 84 older people were analyzed. Based on a prospective occurrence of falls, participants were categorized into fallers and non-fallers. Variables derived from clinical assessments, static posturography and instrumented gait analysis were evaluated with respect to the association with the occurrence of prospective falls using a forward stepwise, binary, logistic regression procedure.ResultsFallers displayed a significantly shorter single support time during walking while counting backwards, increased mediolateral to anteroposterior sway amplitude ratio, increased fast mediolateral oscillations and a larger coefficient (Coeff) of sway direction during various static posturography tests. Previous falls were insignificantly associated with the occurrence of prospective falls.ConclusionVariables derived from posturography and instrumented gait analysis showed significant associations with the occurrence of prospective falls in a sample of community dwelling older adults.ZusammenfassungHintergrundDer Nutzen instrumenteller Gang- und Gleichgewichtsanalyse, zur Früherkennung von Stürzereignissen, wird aktuell kontrovers diskutiert.FragestellungUntersucht wurde der Zusammenhang zwischen Variablen der statischen Posturographie, der instrumentellen Ganganalyse und klinischer Assessments mit dem Auftreten von Stürzereignissen, bei selbstständig lebenden älteren Personen.MethodenBasierend auf einem prospektiv aufgetretenen Sturz wurden 84 ältere Personen in „Stürzer“ und „Nichtstürzer“ klassifiziert. Variablen aus klinischen Assessments, der statischen Posturographie und der instrumentellen Ganganalyse wurden in Hinblick auf eine Assoziation mit prospektiven Stürzen evaluiert, dazu diente ein vorwärts schrittweises, binärer, logistisches Regressionsverfahren.ErgebnisseStürzer zeigten eine signifikant kürzere monopedale Standphase bein Gehen und Rückwärtszählen, im Vergleich mit anterior-posterioren Schwankungen höheremedio-laterale Schwankungen, verstärkte schnelle mediolaterale Oszillationen und einen vergrößerten Koeffizient der Schwankungsrichtung während verschiedener statische posturographischer Tests. Frühere Stürzereignisse waren nicht signifikant assoziiert mit prospektiv erfassten Stürzen.DiskussionVariablen der statischen Posturographie und instrumenteller Ganganalyse zeigten bei selbstständig lebenden älteren Personen signifikante Assoziationen mit prospektiv erfassten Stürzen.

Operationalizing a frailty index using routine blood and urine tests

Background Uncomplicated frailty instruments are desirable for use in a busy clinical setting. The aim of this study was to operationalize a frailty index (FI) from routine blood and urine tests, and to evaluate the properties of this FI compared to other frailty instruments. Materials and methods We conducted a secondary analysis of a prospective cohort study on 306 patients aged ≥65 years hospitalized on geriatric wards. An FI comprising 22 routine blood parameters and one standard urine parameter (FI-Lab), a 50-item FI based on a comprehensive geriatric assessment (FI-CGA), a combined FI (FI-combined [items from the FI-Lab + others from the FI-CGA]), the Clinical Frailty Scale, rule-based frailty definition, and frailty phenotype were operationalized from data obtained during patients’ hospital stays (ie, before discharge [baseline examination]). Follow-up data were obtained up to 1 year after the baseline examination. Results The mean FI-Lab score was 0.34±15, with an upper limit of 0.74. The FI-Lab was correlated with all the other frailty instruments (all P<0.001). The FI-Lab revealed an area under the receiver-operating characteristic curve (AUC) for 6-month and 1-year mortality of 0.765 (0.694–0.836) and 0.769 (0.706–0.833), respectively (all P<0.001). Each 0.01 increment in FI-Lab increased the risk (adjusted for age and sex) for 6-month and 1-year mortality by 7.2% and 7.1%, respectively (all adjusted P<0.001). When any of the other FIs (except the FI-combined) were also included in the models, each 0.01 increment in FI-Lab score was associated with an increase in the risk of 6-month and 1-year mortality by 4.1%–5.4% (all adjusted P<0.001). Conclusion The FI-Lab showed key characteristics of an FI. The FI-Lab can be applied as a single frailty measure or in combination with/in addition to other frailty instruments.