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Identifying Fallers among Home Care Clients with Dementia and Parkinson’s Disease

Published online by Cambridge University Press:  18 July 2016

Symron Bansal ,
John P. Hirdes ,
Colleen J. Maxwell ,
Alexandra Papaioannou  and
Lora M. Giangregorio
Symron Bansal
Affiliation:
Department of Kinesiology, University of Waterloo
John P. Hirdes
Affiliation:
School of Public Health and Health Systems, University of Waterloo
Colleen J. Maxwell
Affiliation:
School of Pharmacy, University of Waterloo
Alexandra Papaioannou
Affiliation:
Department of Medicine, McMaster University
Lora M. Giangregorio*
Affiliation:
Department of Kinesiology, University of Waterloo
*
†La correspondance et les demandes de tire-à-part doivent être adressées à: / Correspondence and requests for offprints should be sent to: Dr. Lora Giangregorio University of Waterloo 200 University Ave W Waterloo, ON N2L 3G1 ([email protected])
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Abstract

Few studies have focused on falls among home care (HC) clients with neurological conditions. This study identified factors that increase risk of falling among HC clients with no recent history of falls, and explored whether risk profiles varied among those with dementia or parkinsonism compared to those without selected neurological conditions. A retrospective cohort design was used and analysis of data from community-based HC clients across Ontario was conducted on a sample of ambulatory clients with dementia, parkinsonism, or none of the selected neurological conditions. Data were obtained from the Resident Assessment Instrument for HC (RAI-HC) assessment. The outcome used in multivariable analyses was whether clients fell during follow-up. Unsteady gait was a strong predictor of falls across all three groups. Co-morbid parkinsonism most strongly predicted falls in the dementia group. Clients with borderline intact to mild cognitive impairment had higher odds of falling within the parkinsonism and comparison groups.

Résumé

Il y a eu peu d’études qui se concentrent sur les chutes chez les clients qui reçoivent des soins à domicile (SD) avec des conditions neurologiques. Cette étude a identifié les facteurs qui accroissent le risque de chutes chez les clients SD sans histoire récente de telles chutes, et a exploré si les profils de risque variaient parmi les personnes atteintes de démence ou le parkinsonisme, par rapport à celles sans conditions neurologiques sélectionnés. Une étude de cohorte rétrospective a été utilisée, et l’analyse des données provenant de clients SD communautaires de l’Ontario a été menée sur un échantillon de clients ambulatoires atteints de démence, de parkinsonisme, ou d’aucune des conditions neurologiques sélectionnées. Les données ont été obtenues à partir de l’instrument d’évaluation des résidents en soins à domicile (IERSD-SD). Dans l’analyse multivariée, le résultat utilisé était de savoir si les clients ont tombé au cours du suivi. Une démarche instable était un fort prédicteur des chutes dans les trois groupes. Le parkinsonisme co-morbide a prédit plus fortement les chutes dans le groupe de démence. Les clients qui ont montré la limite intacte à la déficience cognitive légère étaient plus susceptibles de se sont trouvés dans les groupes de parkinsonisme et de comparaison. Les chances de tomber étaient plus élevées pour les clients avec la limite intacte à la déficience cognitive légère qui également faisaient partie des groupes de la maladie de Parkinson et de comparaison.

Keywords

agingdementiafallshome careinterRAIParkinson’s diseasevieillissementchutessoins à domicileinstrument d’évaluation des residents en soins à domicile (IERSD)maladie de Parkinson (parkinsonisme)
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 35 , Issue 3 , September 2016 , pp. 319 - 331
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Copyright
Copyright © Canadian Association on Gerontology 2016 

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References

Aarsland, D., & Kurz, M. W. (2010). The epidemiology of dementia associated with Parkinson’s disease. Brain Pathology, 20(3), 633–639.CrossRefGoogle ScholarPubMed
Allen, N. E., Canning, C. G., Sherrington, C., Lord, S. R., Latt, M. D., Close, J. C. T., ... Fung, V. S. (2010). The effects of an exercise program on fall risk factors in people with Parkinson’s disease: A randomized controlled trial. Movement Disorders, 25(9), 1217–1225.Google Scholar
Arfken, C. L., Lach, H. W., Birge, S. J., & Miller, J. P. (1994). The prevalence and correlates of fear of falling in elderly persons living in the community. American Journal of Public Health, 84(4), 565–570.Google Scholar
Armstrong, J. J., Stolee, P., Hirdes, J. P., & Poss, J. W. (2010). Examining three frailty conceptualizations in their ability to predict negative outcomes for home-care clients. Age and Ageing, 39(6), 755–758.Google Scholar
Ashburn, A., Fazakarley, L., Ballinger, C., Pickering, R., McLellan, L. D., & Fitton, C. (2007). A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson’s disease. Journal of Neurology, Neurosurgery and Psychiatry, 78(7), 678–684.Google Scholar
Baltadjieva, R., Giladi, N., Gruendlinger, L., Peretz, C., & Hausdorff, J. M. (2006). Marked alterations in the gait timing and rhythmicity of patients with de novo Parkinson’s disease. European Journal of Neuroscience, 24(6), 1815–1820.Google Scholar
Brown, J. S., Vittinghoff, E., Wyman, J. F., Stone, K. L., Nevitt, M. C., Ensrud, K. E., & Grady, D. (2000). Urinary incontinence: Does it increase risk for falls and fractures? Journal of the American Geriatrics Society, 48(7), 721–725.Google Scholar
Buchner, D. M., & Larson, E. B. (1987). Falls and fractures in patients with Alzheimer-type dementia. Journal of the American Medical Association, 257(11), 1492–1495.CrossRefGoogle ScholarPubMed
Burrows, A. B., Morris, J. N., Simon, S. E., Hirdes, J. P., & Phillips, C. (2000). Development of a minimum data set-based depression rating scale for use in nursing homes. Age and Ageing, 29(2), 165–172.Google Scholar
Caesar-Chavannes, C. R., & MacDonald, S. (2013). Cross-Canada forum–national population health study of neurological conditions in Canada. Chronic Diseases and Injuries in Canada, 33(3), 188–191.Google Scholar
Canadian Institute for Health Information. (2014). Preventing falls: From evidence to improvement in Canadian health care. Retrieved from https://www.accreditation.ca/sites/default/files/falls-joint-report-2014-en.pdf Google Scholar
Carpenter, I., & Hirdes, J. P. (2013). Using interRAI assessment systems to measure and maintain quality of long-term care. A good life in old age? Monitoring and Improving Quality in Long-Term Care (p. 93). Paris, France: OECD.Google Scholar
Deandrea, S., Lucenteforte, E., Bravi, F., Foschi, R., La Vecchia, C., & Negri, E. (2010). Risk factors for falls in community-dwelling older people: A systematic review and meta-analysis. Epidemiology, 21(5), 658–668.Google Scholar
Dibble, L. E., Addison, O., & Papa, E. (2009). The effects of exercise on balance in persons with Parkinson’s disease: A systematic review across the disability spectrum. Journal of Neurologic Physical Therapy, 33(1), 14–26.Google Scholar
Fletcher, P. C., & Hirdes, J. P. (2002). Risk factors for falling among community-based seniors using home care services. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 57(8), M504–M510.CrossRefGoogle ScholarPubMed
Foebel, A. D., Hirdes, J. P., Heckman, G. A., Kergoat, M. J., Patten, S., & Marrie, R. A. (2013). Diagnostic data for neurological conditions in interRAI assessments in home care, nursing home and mental health care settings: A validity study. BMC Health Services Research, 13(1), 457.Google Scholar
Foley, A. L., Loharuka, S., Barrett, J. A., Mathews, R., Williams, K., Mcgrother, C. W., & Roe, B. H. (2012). Association between the geriatric giants of urinary incontinence and falls in older people using data from the Leicestershire MRC incontinence study. Age and Ageing, 41(1), 35–40.CrossRefGoogle ScholarPubMed
Friedman, S. M., Munoz, B., West, S. K., Rubin, G. S., & Fried, L. P. (2002). Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. Journal of the American Geriatrics Society, 50(8), 1329–1335.CrossRefGoogle Scholar
Fries, B. E., Simon, S. E., Morris, J. N., Flodstrom, C., & Bookstein, F. L. (2001). Pain in U.S. nursing homes: Validating a pain scale for the Minimum Data Set. Gerontologist, 41(2), 173–179.Google Scholar
Goodwin, V. A., Richards, S. H., Henley, W., Ewings, P., Taylor, A. H., & Campbell, J. L. (2011). An exercise intervention to prevent falls in people with Parkinson’s disease: A pragmatic randomised controlled trial. Journal of Neurology, Neurosurgery and Psychiatry, 82(11), 1232–1238.CrossRefGoogle ScholarPubMed
Gruber-Baldini, A. L., Zimmerman, S. I., Mortimore, E., & Magaziner, J. (2000). The validity of the Minimum Data Set in measuring the cognitive impairment of persons admitted to nursing homes. Journal of the American Geriatrics Society, 48(12), 1601–1606.CrossRefGoogle ScholarPubMed
Hirdes, J. P., Frijters, D. H., & Teare, G.F. (2003). The MDS-CHESS scale: A new measure to predict mortality in institutionalized older people. Journal of the American Geriatrics Society, 51(1), 96–100.Google Scholar
Hirdes, J. P., Ljunggren, G., Morris, J. N., Frijters, D. H., Finne Soveri, H., Gray, L., & Gilgen, R. (2008). Reliability of the interRAI suite of assessment instruments: A 12-country study of an integrated health information system. BMC Health Services Research, 8, 277.CrossRefGoogle ScholarPubMed
Hirdes, J. P., Mitchell, L., Maxwell, C. J., & White, N. (2011). Beyond the “iron lungs of gerontology”: Using evidence to shape the future of nursing homes in Canada. Canadian Journal on Aging, 30(3), 371–390.Google Scholar
Hirdes, J. P., Poss, J. W., Mitchell, L., Korngut, L., & Heckman, G. (2014). Use of the interRAI CHESS scale to predict mortality among persons with neurological conditions in three care settings. PLoS One, 9(6), e99066.CrossRefGoogle ScholarPubMed
Husson, N., Watfa, G., Laurain, M., Perret-Guillaume, C., Niemier, J., Miget, P., & Benetos, A. (2013). Characteristics of polymedicated (≥ 4) elderly: A survey in a community-dwelling population aged 60 years and over. Journal of Nutrition, Health and Aging, 18(1), 87–91.Google Scholar
Landi, F., Tua, E., Onder, G., Carrara, B., Sgadari, A., Rinaldi, C., ... Bernabei, R. (2000). Minimum data set for home care: A valid instrument to assess frail older people living in the community. Medical Care, 38(12), 1184–1190.Google Scholar
Lee, C. Y., Chen, L. K., Lo, Y. K., Liang, C. K., Chou, M. Y., Lo, C. C., ... Lin, Y. T. (2011). Urinary incontinence: An under-recognized risk factor for falls among elderly dementia patients. Neurological Urodynamics, 30(7), 1286–1290.Google Scholar
Lewis, C. L., Moutoux, M., Slaughter, M., & Bailey, S. P. (2004). Characteristics of individuals who fell while receiving home health services. Physical Therapy, 84(1), 23–32.Google Scholar
Lundebjerg, N. (2001). Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society, 49(5), 664–672.Google Scholar
Luukinen, H., Koski, K., Honkanen, R., & Kivela, S. (1995). Incidence of injury-causing falls among older adults by place of residence: A population-based study. Journal of the American Geriatrics Society, 43(8), 871–876.Google Scholar
Mahoney, J., Sager, M., Dunham, N. C., & Johnson, J. (1994). Risk of falls after hospital discharge. Journal of the American Geriatrics Society, 42(3), 269–274.Google Scholar
Mirelman, A., Herman, T., Brozgol, M., Dorfman, M., Sprecher, E., Schweiger, A., ... Hausdorff, J. M. (2012). Executive function and falls in older adults: New findings from a five-year prospective study link fall risk to cognition. PLoS ONE, 7(6), 1–8.Google Scholar
Mirolsky-Scala, G., & Kraemer, T. (2009). Fall management in Alzheimer-related dementia: A case study. Journal of Geriatric Physical Therapy, 32(4), 181–189.Google Scholar
Morris, J. N., Fries, B. E., & Morris, S. A. (1999). Scaling ADLs within the MDS. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 54(11), M546–M553.Google Scholar
Morris, J. N., Fries, B. E., Steel, K., Ikegami, N., Bernabei, R., Carpenter, G. I., ... Topinková, E. (1997). Comprehensive clinical assessment in community setting: Applicability of the MDS-HC. Journal of the American Geriatrics Society, 45(8), 1017–1024.Google Scholar
Muir, S. W., Speechley, M., Wells, J., Borrie, M., Gopaul, K., & Montero-Odasso, M. (2012). Gait assessment in mild cognitive impairment and Alzheimer’s disease: The effect of dual-task challenges across the cognitive spectrum. Gait and Posture, 35(1), 96–100.CrossRefGoogle ScholarPubMed
Nazir, A., Mueller, C., Perkins, A., & Arling, G. (2012). Falls and nursing home residents with cognitive impairment: New insights into quality measures and interventions. Journal of the American Medical Directors Association, 13(9), 819.e1–819.e6.Google Scholar
Oliver, D., Connelly, J. B., Victor, C. R., Shaw, F. E., Whitehead, A., Genc, Y.,... Gosney, M. A. (2007). Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: Systematic review and meta-analyses. British Medical Journal, 334(7584), 82–85.CrossRefGoogle ScholarPubMed
Poss, J. W., Jutan, N. M., Hirdes, J. P., Fries, B. E., Morris, J. N., Teare, G. F., & Reidel, K. (2008). A review of evidence on the reliability and validity of Minimum Data Set data. Healthcare Management Forum, 21(1), 33–39.CrossRefGoogle ScholarPubMed
Protas, E. J., Mitchell, K., Williams, A., Qureshy, H., Caroline, K., & Lai, E. C. (2005). Gait and step training to reduce falls in Parkinson’s disease. NeuroRehabilitation, 20(3), 183–190.Google Scholar
Robbins, A. S., Rubenstein, L. Z., Josephson, K. R., Schulman, B. L., Osterweil, D., & Fine, G. (1989). Predictors of falls among elderly people. Results of two population-based studies. Archives of Internal Medicine, 149(7), 1628–1633.CrossRefGoogle ScholarPubMed
Robinovitch, S. N., Feldman, F., Yang, Y., Schonnop, R., Leung, P. M., Sarraf, T., & Loughin, M. (2013). Video capture of the circumstances of falls in elderly people residing in long-term care: An observational study. The Lancet, 381(9860), 47–54.Google Scholar
Roychowdhury, S., & Forsyth, D. R. (2012). Sleep disturbance in Parkinson disease. Journal of Clinical Gerontology and Geriatrics, 3(2), 53–61.Google Scholar
Suttanon, P., Hill, K. D., Said, C. M., Byrne, K. N., & Dodd, K. J. (2012). Factors influencing commencement and adherence to a home-based balance exercise program for reducing risk of falls: Perceptions of people with Alzheimer’s disease and their caregivers. International Psychogeriatrics, 24(7), 1172–1182.Google Scholar
Szczerbinska, K., Hirdes, J. P., & Zyczkowska, J. (2012). Good news and bad news: Depressive symptoms decline and undertreatment increases with age in home care and institutional settings. American Journal of Geriatric Psychiatry, 20(12), 1045–1056.Google Scholar
Taylor, M. E., Delbaere, K., Lord, S. R., Mikolaizak, A. S., & Close, J. C. T. (2013). Physical impairments in cognitively impaired older people: Implications for risk of falls. International Psychogeriatrics, 25(1), 148–156.Google Scholar
Thorpy, M. J. (2004). Sleep disorders in Parkinson’s disease. Clinical Cornerstone, 6(Suppl. 1A), S7–S15.Google Scholar
Tinetti, M. E., Speechley, M., & Ginter, S. F. (1988). Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 319(26), 1701–1707.Google Scholar
Tinetti, M. E., & Williams, C. S. (1997). Falls, injuries due to falls, and the risk of admission to a nursing home. New England Journal of Medicine, 337(18), 1279–1284.Google Scholar
van Dijk, P. T. M., Meulenberg, O. G. R. M., van de Sande, H. J., & Habbema, J. D. F. (1993). Falls in dementia patients. The Gerontologist, 33(2), 200–204.Google Scholar
Voss, T. S., Elm, J. J., Wielinski, C. L., Aminoff, M. J., Bandyopadhyay, D., Chou, K. L., ... Tilley, B. C. (2012). Fall frequency and risk assessment in early Parkinson’s disease. Parkinsonism and Related Disorders, 18(7), 837–841.Google Scholar
Winter, H., Watt, K., & Peel, N. M. (2013). Falls prevention interventions for community-dwelling older persons with cognitive impairment: A systematic review. International Psychogeriatrics, 25(2), 215–227.Google Scholar
Wood, B. H., Bilclough, J. A., Bowron, A., & Walker, R.W. (2002). Incidence and prediction of falls in Parkinson’s disease: A prospective multidisciplinary study. Journal of Neurology, Neurosurgery and Psychiatry, 72(6), 721–725.Google Scholar
Ziere, G., Dieleman, J. P., Hofman, A., Pols, H. A. P., Van Der Cammen, T. J. M., & Stricker, B. H. C. (2006). Polypharmacy and falls in the middle age and elderly population. British Journal of Clinical Pharmacology, 61(2), 218–223.Google Scholar