Marika Salminen

Effect of a Risk-Based Multifactorial Fall Prevention Program on the Incidence of Falls

OBJECTIVES: To evaluate the effects of a multifactorial fall prevention program on falls and to identify the subgroups that benefit the most.

Effects of risk-based multifactorial fall prevention on health-related quality of life among the community-dwelling aged: a randomized controlled trial.

BackgroundThis study aimed to assess the effects of a risk-based, multifactorial fall prevention programme on health-related quality of life among the community-dwelling aged who had fallen at least once during the previous 12 months.MethodsThe study is a part of a single-centre, risk-based, multifactorial randomised controlled trial. The intervention lasted for 12 months and consisted of a geriatric assessment, guidance and treatment, individual instruction in fall prevention, group exercise, lectures on themes related to falling, psychosocial group activities and home exercise. Of the total study population (n = 591, 97% of eligible subjects), 513(251 in the intervention group and 262 in the control group) participated in this study. The effect of the intervention on quality of life was measured using the 15D health-related quality of life instrument consisting of 15 dimensions. The data were analysed using the chi-square test or Fishers exact test, the Mann-Whitney U-test and logistic regression.ResultsIn men, the results showed significant differences in the changes between the intervention and control groups in depression (p = 0.017) and distress (p = 0.029) and marginally significant differences in usual activities (p = 0.058) and sexual activity (p = 0.051). In women, significant differences in the changes between the groups were found in usual activities (p = 0.005) and discomfort/symptoms (p = 0.047). For the subjects aged 65 to 74 years, significant differences in the changes between the groups were seen in distress (p = 0.037) among men and in usual activities (p = 0.011) among women. All improvements were in favour of the intervention group.ConclusionFall prevention produced positive effects on some dimensions of health-related quality of life in the community-dwelling aged. Men benefited more than women.

One-time counselling decreases the use of benzodiazepines and related drugs among community-dwelling older persons

BACKGROUND evidence about possibilities to help older persons to withdraw the long-term use of benzodiazepines (BZD) is scarce. Effective and practicable methods are needed. OBJECTIVE the study aimed to assess the persistence of one-time counselling by a geriatrician to reduce psychotropic drugs, especially BZD and related drugs (RD). DESIGN a prospective randomised controlled trial with a 12-month follow-up was conducted. SUBJECTS five hundred ninety-one community-dwelling people aged 65 or older participated in the study. METHODS instructions to withdraw, reduce or change psychotropic drugs were given to the intervention group. A 1-h lecture about these drugs and their adverse effects was given later on. No changes in the drug therapy were suggested for the controls. RESULTS the number of regular users of BZD and RD decreased by 35% (12/34) (odds ratios (OR) = 0.61, 95% confidence interval (95% CI) 0.44-0.86) in the intervention group while it increased by 4% (2/46) (OR = 1.05, 95% CI 0.81-1.36) in the controls (P = 0.012). No significant changes in the users of other types of psychotropics were found. CONCLUSION one-time counselling of psychotropics and other fall-risk-increasing drugs by a geriatrician followed with a 1-h lecture about adverse effects of these drugs had positive effects in decreasing the number of regular users of BZD and RD, and these effects persisted for the total 12-month intervention period.

Withdrawal of psychotropic drugs decreases the risk of falls requiring treatment

This non-randomized, controlled trial assessed the effects of ceasing fall-risk-increasing drugs (FRIDs) (psychotropics or opiates or potent anticholinergics) on the risk of falls requiring medical treatment as a sub-analysis of a randomized, controlled multifactorial fall prevention. The population in this 12-month study consisted of 528 community-dwelling subjects aged 65 years or older with a history of at least one fall. The subjects were divided retrospectively into three groups according to the use of any FRID, any psychotropic drug, and benzodiazepine or related drug (BZD/BZDRD). The subjects in the intervention group (IG) ceasing the drug use were compared with the subjects in IG and the control group (CG) not ceasing the use of the corresponding type of drugs during the intervention period. Falls were recorded from medical records. For the year after the 12-month intervention the relative risk ratio (with 95% confidence intervals=CI) for controls in CG compared with the withdrawal group in IG was 8.26 (1.07-63.73) among the users of psychotropics and 8.11 (1.03-63.60) among the users of BZDs/BZDRDs. Withdrawal of psychotropics, especially BZDs/BZDRDs may have played an important role by lowering the risk of falls requiring medical treatment during the year after the 12-month multifactorial intervention.

The long-term effect of a multifactorial fall prevention programme on the incidence of falls requiring medical treatment.

OBJECTIVES To evaluate the long-term effects of a multifactorial fall prevention programme on the incidence of falls requiring medical treatment. STUDY DESIGN A randomized controlled trial. METHODS Five hundred and ninety-one community-dwelling elderly people (> or = 65 years) living in the town of Pori, Finland with at least one fall during the previous 12 months were randomized into an intervention group (n=293) and a control group (n=298). Subjects in the intervention group participated in a multifactorial 12-month fall prevention programme. This study evaluated the incidence of falls requiring medical treatment during the 3-year follow-up period. RESULTS The intervention did not significantly reduce the incidence of falls requiring medical treatment during the 3-year follow-up period [incidence rate ratio (IRR) for the intervention group compared with the control group 0.87, 95% confidence interval (CI) 0.63-1.21]. The number of falls requiring medical treatment was lower in the intervention group (n=32) compared with the control group (n=50) (IRR 0.65, 95%CI 0.40-1.07) during the second year of follow-up, but this was not found during the first year (48 and 48 falls, respectively; IRR 1.04, 95%CI 0.64-1.69) or the third year (44 and 48 falls, respectively; IRR 0.94, 95%CI 0.58-1.53) of follow-up. CONCLUSIONS The multifactorial fall prevention programme did not decrease the incidence of falls requiring medical treatment of fall-prone elderly people during the 3-year follow-up period. However, some positive effect was found during the second year of follow-up (immediately after the 12-month intervention).

Self-detection of atrial fibrillation in an aged population: the LietoAF Study

Background Early detection of atrial fibrillation (AF) in older people is important because AF is often asymptomatic and its first manifestation may be a disabling stroke. The objective of the LietoAF Study is to assess the motivation and capability of older people to learn pulse palpation and continue regular pulse measurements, and whether this self-assessment is helpful in the detection of new AF. Design and method The LietoAF Study is an intervention study. A total of 205 people aged ≥75 years were randomly selected to participate in the programme where a trained nurse gave individual education on pulse palpation. At 1 month, the eligible participants came to the first follow-up visit to assess the success of pulse self-monitoring. Results A total of 139 participants (68%) learned pulse palpation and performed regular measurements during the early follow-up period. The significant independent predictors for learning and motivation were high Mini-Mental State Examination score (>24) (OR 7.5, 95% CI 1.5–37.3, p = 0.014), computer use at home (OR 4.7, 95% CI 1.9–11.5, p = 0.001), independence at daily activities (OR 4.2, 95% CI 1.4–13.6, p = 0.013) and low heart rate (OR 1.04, 95% CI 1.0–1.08, p = 0.037). Education did not cause extra visits to local healthcare centres and did not affect quality of life. Four participants observed a new asymptomatic AF during the 1-month follow-up. Conclusion Active older people are motivated and seem to learn pulse palpation. Our early experience suggests that simple nurse-based education is effective and useful in the early detection of asymptomatic AF.

Effects of risk-based multifactorial fall prevention program on maximal isometric muscle strength in community-dwelling aged: a randomized controlled trial

Background and aims: The aim of this study was to assess the effects of risk-based multifactorial fall prevention program on maximal isometric strength in the community-dwelling aged. Methods: 591 subjects were randomized in two age groups (65–74 and ≥75 yrs), intervention group (IG) (n=293) and control group (CG) (n=298). A 12-month program consisted of individual geriatric assessment, individual guidance on fall prevention, home hazards assessment, physical exercises in groups, lectures, psychosocial activity groups, and home exercises. Strength was measured on an adjustable dynamometer chair. Results: Among women, the extension strength of the left knee increased by 7% in IG and 2% in CG (p=0.006), and that of the right knee by 7% and 4% (p=0.057), respectively. Subgroup analyses in the two age groups revealed a significant difference between groups among men aged 65–74 yrs, in favour of CG subjects, whose flexion strength of the left knee increased by 14% whereas the corresponding increase in IG was only 1% (p=0.042). Among women aged 65–74 yrs, the extension strength of right (increase of 8% in IG, 4% in CG) (p=0.046) and left knees (9% and 3%) (p=0.008) and flexion strength of right (10% and 4%) (p=0.042) and left knees (10% and 4%) (p=0.041) increased more in IG than in CG. Conclusions: The 12-month fall prevention program increased maximal isometric muscle strength among women only, especially those aged 65–74 years. We suggest that more intensive exercise, including the use of extra weights or resistance, is needed to increase muscle strength in men.

The metabolic syndrome defined by modified International Diabetes Federation criteria and mortality: A 9-year follow-up of the aged in Finland

AIM The aim of this study was to investigate the relationship between the metabolic syndrome (MetS) and mortality in the aged population. METHODS In this prospective population-based study with a 9-year follow-up, the participants were all residents of the municipality of Lieto, Finland, aged 64 and over in 1998-99 (n=1529). Altogether, 1260 (82%) were included in the study. Cox proportional-hazard models were used to estimate hazard ratios (HRs) for all-cause, cardiovascular (CVD), coronary heart disease (CHD) and cerebrovascular (CV) mortality as predicted by MetS (defined by modified International Diabetes Federation criteria). RESULTS At baseline, 17% of the men and 21% of the women had MetS. During the 9-year follow-up, 422 deaths occurred. After multivariable adjustment, no significant differences were found between subjects with and without MetS for all-cause, CVD, CHD or CV mortality in all study participants or by gender. On evaluating MetS components separately, elevated blood pressure was found to predict lower all-cause mortality in all participants [HR: 0.65; 95% confidence interval (CI): 0.47-0.89], and lower CHD mortality in men (HR: 0.42; 95% CI: 0.18-0.97). In women, high triglyceride levels predicted lower all-cause mortality (HR: 0.67; 95% CI: 0.47-0.95), whereas low HDL cholesterol predicted higher all-cause (HR: 1.61; 95% CI: 1.15-2.24) and CV (HR: 2.44; 95% CI: 1.05-5.67) mortality. CONCLUSION These findings suggest that MetS does not predict mortality later in life and, of the separate components of MetS, only low HDL cholesterol is predictive of mortality in women. Also, even markedly higher blood pressure values than those included in the criteria for MetS fail to predict mortality in this age group.

Effects of family-oriented risk-based prevention on serum cholesterol and blood pressure values of children and adolescents

Objective To describe the effects of family-oriented prevention on total and LDL cholesterol and blood pressure of children. Design. A controlled intervention study. Setting Family-oriented prevention of risk factors of coronary heart disease (CHD) in Eastern Finland. The programme consisted of two counselling meetings at childrens schools, and three at childrens homes. Subjects. In total 388 in the intervention group (IG) with a family history of cardiovascular diseases (CVDs), and 470 in control groups: 151 in control group I (CI) with a family history of CVDs, and 319 in control group II (CII) with no family history. Main outcome measures. Serum mean total and LDL cholesterol, and blood pressure. Results. Among the youngest (6-9 years) girls, changes in total (−0.3 vs. +0.2 mmol/l) and LDL cholesterol (−0.3 vs.±0.0 mmol/l) were more favourable in IG than in CI. Diastolic blood pressure increased less among the youngest boys in IG (+3 mm Hg) than among those in CI (+11 mm Hg) or CII (+10 mm Hg). Conclusion. Family-oriented health counselling had favourable effects on total and LDL cholesterol among girls aged 6-9 years, and on the development of diastolic blood pressure among boys aged 6-9 years.

Leucine 7 to proline 7 polymorphism in the neuropeptide Y gene and changes in serum lipids during a family-based counselling intervention among school-aged children with a family history of CVD.

OBJECTIVE To compare whether serum lipids and their changes during a health education intervention are associated with the Leu7Pro polymorphism in the signal peptide part of neuropeptide Y (NPY) in children with normal weight and in those with overweight. DESIGN An intervention study. SETTING A family-based intervention of risk factors for prevention of CHD in Finland. SUBJECTS Subjects were 443 children with a family history of CVD participating in family-based health education. The children were divided into two groups according to NPY genotype: children with Leu7/Pro7 or Pro7/Pro7 genotype (n 50) and children with Leu7/Leu7 genotype (n 393). The final sample of the follow-up study included 353 (80 %) children (Pro7 allele carriers, n 43; Leu7/Leu7, n 310). RESULTS At baseline, the Leu7Pro polymorphism was not associated with serum lipid values after adjustment for body weight in boys or girls. There was a significant interaction of NPY genotype group by time and body weight (P = 0.043 for three-way interaction: time x NPY genotype x body weight) in LDL-cholesterol (LDL-C) concentration among boys. LDL-C decreased among boys with normal weight in both NPY groups and in overweight boys with the Leu7/Leu7 genotype, whereas it increased in overweight boys with the Pro7 allele. Two-way interaction (time x NPY genotype) showed no significant differences in changes of serum lipids between the NPY genotype groups among boys or girls. CONCLUSIONS The Leu7Pro polymorphism may be associated with dietary response to LDL-C concentration in overweight boys with a family history of early-onset CVD.