[Preventing falls in older adults]. / Prévention des chutes chez les personnes âgées.

Preventing falls in older adults requires a comprehensive approach that distinguishes between accidental falls and falls related to underlying medical problems, such as syncope. For unintentional falls, prevention follows a three-stage model. The primary level focuses on encouraging regular physical activity, assessing, and reducing footwear and environmental risks, managing comorbidities, and promoting healthy lifestyles. The secondary level aims to identify and manage all risk factors, including in-depth medical assessment and education of older people and their careers. Finally, the tertiary level aims to minimise the consequences of falls through post-fall care, regular medical monitoring and the introduction of mobility aids or monitoring technologies. Educating older people about the risks, adopting safe behaviours, promoting physical activity, and creating safe environments go beyond these levels. This holistic approach anticipates, identifies, and mitigates risks, promotes safe and active ageing, and aims to achieve overall well-being, reduce adverse outcomes, and promote optimal quality of life throughout the ageing process.

La prévention des chutes chez les personnes âgées exige une approche complète, distinguant les chutes accidentelles des chutes liées à des problèmes médicaux sous-jacents, comme la syncope. Pour les chutes accidentelles, la prévention adopte un modèle en trois niveaux. Le niveau primaire favorise l'encouragement à l'exercice physique régulier, l'évaluation et la réduction des risques liés au chaussage ou à l'environnement, l'équilibration de comorbidités et la promotion d'un mode de vie sain. Le niveau secondaire cible l'identification et la prise en charge de l'ensemble des facteurs de risque, impliquant une évaluation médicale approfondie et une éducation du sujet âgé et de ses aidants proches. Enfin, le niveau tertiaire vise à minimiser les conséquences des chutes par des soins post-chute, un suivi médical régulier, et l'introduction d'aides à la mobilité ou de technologies de surveillance. L'éducation des personnes âgées sur les risques, l'adoption de comportements sécuritaires, la promotion de l'activité physique, et la création d'environnements sûrs transcendent ces niveaux. Cette approche holistique anticipe, identifie, et atténue les risques, favorisant un vieillissement actif et sécurisé, et visant le bien-être global, la réduction des conséquences néfastes des chutes et la promotion d'une qualité de vie optimale au cours du vieillissement.

Frailty but not sarcopenia nor malnutrition increases the risk of developing COVID-19 in older community-dwelling adults.

BACKGROUND: The identification of coronavirus disease 2019 (COVID-19) risk factors is requested to implement prevention strategies. AIM: To explore the associations between the COVID-19 incidence and malnutrition, sarcopenia, and frailty, identified as potential risk factors in previous cross-sectional studies. METHODS: Malnutrition, sarcopenia, and frailty were assessed at the last available follow-up from the Sarcopenia and Physical Impairments with Advancing Age (SarcoPhAge) cohort (i.e., the fifth year that ended in 2019) according to the Mini-Nutritional Assessment short-form, the European Working Group on Sarcopenia in Older People (EWGSOP2), and the Fried criteria, respectively. Information regarding the COVID-19 was gathered by phone calls interviews in April 2021 to measure its self-declared incidence. Adjusted Cox regressions and Kaplan-Meier curves were performed. RESULTS: The present study included 241 participants [median age 75.6 (73.0-80.6) years, 63.1% women]. Among them, 27 participants (11.2%) developed the non-fatal Covid-19. No significant increased risks of COVID-19 were observed in patients with malnutrition [adjusted HR 1.14 (0.26-5.07)] and sarcopenia [adjusted HR 1.25 (0.35-4.42)]. Nevertheless, the incidence of COVID-19 was significantly higher in frail (44.4%) than in robust participants (8.5%) [Adjusted HR 7.01 (2.69-18.25)], which was confirmed by the Kaplan-Meier curves (p < 0.001). Among the frailty syndrome components, a low physical activity level was the only one significantly associated with an increased risk of COVID-19 [adjusted HR 5.18 (1.37-19.54)]. CONCLUSION: Despite some limitations in the methodology of this study (i.e., limited sample size, COVID-19 incidence self-reported and not assessed systematically using objective measurements) requiring careful  consideration, an increased risk to develop COVID-19 was observed in the presence of the frailty syndrome. Further investigations are needed to elaborate on our findings.

Unmet needs, health policies, and actions during the COVID-19 pandemic: a report from six European countries.

PURPOSE: The United Nations (UN) has published a Policy Brief on the impact of the Coronavirus Disease 2019 (COVID-19) that identifies policies and responses to protect older adults. Our objective was to summarize actions, health policies and clinical guidelines adopted by six European countries (Belgium, France, Italy, Poland, Spain and United Kingdom) during the pandemic, and to assess the impact of national policies on reducing adverse effects of the COVID-19 pandemic in older populations. METHODS: Reports by geriatricians on the measures and actions undertaken by governmental institutions in each country between March and July 2020, as well as the role of primary care during the pandemic, covered three areas: (a) general health strategies related to the pandemic; (b) impact of COVID-19 on health inequity; and (c) initiatives and challenges for the COVID-19 pandemic and beyond. RESULTS: In the six countries, COVID-19 mortality in nursing homes ranged from 26 to 66%. Although all countries endorsed the World Health Organization general recommendations, the reports identified the lack of harmonized European guidelines and policies for nursing homes, with competencies transferred to national (or regional) governments. All countries restricted visits in nursing homes, but no specific action plans were provided. The role of primary care was limited by the centralization of the crisis in hospital settings. CONCLUSIONS: The older population has been greatly affected by COVID-19 and by the policies initiated to control its spread. The right to health and dignity are transgenerational; chronological age should not be the sole criterion in policy decisions.

Using supervised learning machine algorithm to identify future fallers based on gait patterns: A two-year longitudinal study.

INTRODUCTION: Given their major health consequences in the elderly, identifying people at risk of fall is a major challenge faced by clinicians. A lot of studies have confirmed the relationships between gait parameters and falls incidence. However, accurate tools to predict individual risk among independent older adults without a history of falls are lacking. OBJECTIVE: This study aimed to apply a supervised learning algorithm to a data set recorded in a two-year longitudinal study, in order to build a classification tree that could discern subsequent fallers based on their gait patterns. METHODS: A total of 105 adults aged >65 years, living independently at home and without a recent fall history were included in a two-year longitudinal study. All underwent physical and functional assessment. Gait speed, stride length, frequency, symmetry and regularity, and minimum toe clearance were recorded in comfortable, fast and dual task walking conditions in a standardized laboratory environment. Fall events were recorded using personal falls diaries. A supervised machine learning algorithm (J48) has been applied to the data recorded at inclusion in order to obtain a classification tree able to identify future fallers. RESULTS: Based on fall information from 96 volunteers, a classification tree correctly identifying 80% of future fallers based on gait patterns, gender, and stiffness, was obtained, with accuracy of 84%, sensitivity of 80%, specificity of 87%, a positive predictive value of 78%, and a negative predictive value of 88%. DISCUSSION: While the performances of the classification tree warrant further confirmation, it is the first predictive tool based on gait parameters that are identified (not clustered) allowing its use by other research teams. CONCLUSION: This original longitudinal pilot study using a supervised machine learning algorithm, shows that gait parameters and clinical data can be used to identify future fallers among independent older adults.

Gait symmetry in the dual task condition as a predictor of future falls among independent older adults: a 2-year longitudinal study.

BACKGROUND: Given the potential consequences of falls among older adults, a major challenge is to identify people at risk before the first event. In this context, gait parameters have been suggested as markers of fall risk. AIM: To examine, among older people, the prospective relationship between gait patterns assessed in comfortable and challenging walking conditions, and future fall(s). METHOD: A total of 105 adults older than 65 years, living independently at home and without a recent fall history were included in a 2-year, longitudinal, observational study. All underwent physical and functional assessment. Gait speed, stride length, frequency, symmetry and regularity and Minimum Toe Clearance (MTC) were recorded in comfortable (CW), fast (FW) and dual task walking (DTW) conditions. Gait parameter changes occurring between CW and FW and between CW and DTW were calculated and expressed in percent. DTW cost was calculated as the change of DTW relative to CW. Fall events were recorded using fall diaries. Comparisons according to fall occurrence were performed by means of univariate analysis and multivariate binary logistic regression analysis. RESULTS: Two-year follow-up was available for 96 participants, of whom 35 (36.5%) fell at least once. Comparative analysis showed that future fallers had shorter FW stride length and higher symmetry DTW cost than non-fallers (p < 0.05). Binary logistic regression analysis showed that each additional percent of stride symmetry cost was associated with an increase in future fall risk (odds ratio 1.018, 95% Confidence Interval (CI) 1.002-1.033; p = 0.027). DISCUSSION: Our results confirm the association between a symmetry decrease in DTW and future fall(s). Indeed in this study, the mean symmetry DTW cost in fallers is almost 20% higher than in non-fallers, meaning a fall risk that is around 36% higher than among non-fallers. CONCLUSION: This exploratory study shows the usefulness of considering gait parameters, particularly symmetry in challenging walking conditions, for early identification of future fallers.

Validation of the SarQoL®, a specific health-related quality of life questionnaire for Sarcopenia.

BACKGROUND: A specific self-administrated health-related quality of life questionnaire for sarcopenia, the Sarcopenia and Quality Of Life (SarQoL®), has been recently developed. This questionnaire is composed of 55 items translated into 22 questions and organized into seven domains of quality of life. The objective of the present work is to evaluate the psychometric properties (discriminative power, validity, reliability, floor and ceiling effects) of the SarQoL® questionnaire. METHODS: Sarcopenic subjects were recruited in an outpatient clinic in Liège, Belgium and were diagnosed according to the algorithm developed by the European Working Group on Sarcopenia in Older People. We compared the score of the SarQoL® between sarcopenic and non-sarcopenic subjects using a logistic regression after adjustment for potential confounding variables. Internal consistency reliability was determined using Cronbach's alpha coefficient; construct validity was assessed using convergent and divergent validities. Test-retest reliability was verified after a two-week interval using the intra-class correlation coefficient (ICC). At last, floor and ceiling effects were also tested. RESULTS: A total of 296 subjects with a median age of 73.3 (68.9-78.6) years were recruited for this study. Among them, 43 were diagnosed sarcopenic. After adjustment for potential confounding factors, the total score and the scores of the different dimensions of the SarQoL® questionnaire were significantly lower for sarcopenic than for non-sarcopenic subjects (54.7 (45.9-66.3) for sarcopenic vs. 67.8 (57.3 - 79.0) for non sarcopenic, OR 0.93 (95%CI 0.90-0.96)). Regarding internal consistency, the Cronbach's alpha coefficient was 0.87. The SarQoL® questionnaire data showed good correlation with some domains of the Short-Form 36 (SF-36) and the EuroQoL 5-dimension (EQ-5D) questionnaires and with the mobility test. An excellent agreement between the test and the retest was found with an ICC of 0.91 (95% CI 0.82-0.95). At last, neither floor nor ceiling effects were detected. CONCLUSIONS: The SarQoL® questionnaire is valid, consistent, and reliable and can therefore be recommended for clinical and research purposes. However, its sensitivity to change needs to be assessed in future longitudinal studies.

Development of a self-administrated quality of life questionnaire for sarcopenia in elderly subjects: the SarQoL.

BACKGROUND: The impact of sarcopenia on quality of life is currently assessed by generic tools. However, these tools may not detect subtle effects of this specific condition on quality of life. OBJECTIVE: The aim of this study was to develop a sarcopenia-specific quality of life questionnaire (SarQoL, Sarcopenia Quality of Life) designed for community-dwelling elderly subjects aged 65 years and older. SETTINGS: Participants were recruited in an outpatient clinic in Liège, Belgium. SUBJECTS: Sarcopenic subjects aged 65 years or older. METHODS: The study was articulated in the following four stages: (i) Item generation-based on literature review, sarcopenic subjects' opinion, experts' opinion, focus groups; (ii) Item reduction-based on sarcopenic subjects' and experts' preferences; (iii) Questionnaire generation-developed during an expert meeting; (iv) Pretest of the questionnaire-based on sarcopenic subjects' opinion. RESULTS: The final version of the questionnaire consists of 55 items translated into 22 questions rated on a 4-point Likert scale. These items are organised into seven domains of dysfunction: Physical and mental health, Locomotion, Body composition, Functionality, Activities of daily living, Leisure activities and Fears. In view of the pretest, the SarQoL is easy to complete, independently, in ∼10 min. CONCLUSIONS: The first version of the SarQoL, a specific quality of life questionnaire for sarcopenic subjects, has been developed and has been shown to be comprehensible by the target population. Investigations are now required to test the psychometric properties (internal consistency, test-retest reliability, divergent and convergent validity, discriminant validity, floor and ceiling effects) of this questionnaire.

The effects of vitamin D on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials.

CONTEXT: There is growing evidence that vitamin D plays a role on several tissues including skeletal muscle. OBJECTIVE: The aim was to summarize with a meta-analysis, the effects of vitamin D supplementation on muscle function. DATA SOURCES: A systematic research of randomized controlled trials, performed between 1966 and January 2014 has been conducted on Medline, Cochrane Database of Systematics Reviews, Cochrane Central Register of Controlled and completed by a manual review of the literature and congressional abstracts. STUDY SELECTION: All forms and doses of vitamin D supplementation, with or without calcium supplementation, compared with placebo or control were included. Out of the 225 potentially relevant articles, 30 randomized controlled trials involving 5615 individuals (mean age: 61.1 years) met the inclusion criteria. DATA EXTRACTION: Data were extracted by two independent reviewers. DATA SYNTHESIS: Results revealed a small but significant positive effect of vitamin D supplementation on global muscle strength with a standardized mean difference (SMD) of 0.17 (P = .02). No significant effect was found on muscle mass (SMD 0.058; P = .52) or muscle power (SMD 0.057; P = .657). Results on muscle strength were significantly more important with people who presented a 25-hydroxyvitamin D level <30 nmol/L. Supplementation seems also more effective on people aged 65 years or older compared to younger subjects (SMD 0.25; 95% CI 0.01 to 0.48 vs SMD 0.03; 95% CI -0.08 to 0.14). CONCLUSIONS: Vitamin D supplementation has a small positive impact on muscle strength, but additional studies are needed to define optimal treatment modalities, including dose, mode of administration, and duration.

Prevalence of vitamin D inadequacy in European women aged over 80 years.

Inadequate vitamin D status is associated with secondary hyperparathyroidism and increased bone turnover and bone loss, which in turn increases fracture risk. The objective of this study is to assess the prevalence of inadequate vitamin D status in European women aged over 80 years. Assessments of serum 25-hydroxyvitamin D levels (25(OH)D) were performed on 8532 European women with osteoporosis or osteopenia of which 1984 were aged over 80 years. European countries included in the study were: France, Belgium, Denmark, Italy, Poland, Hungary, United Kingdom, Spain and Germany. Two cut-offs of 25(OH)D inadequacy were fixed: <75 nmol/L (30 ng/ml) and <50 nmol/L (20 ng/ml). Mean (SD) age of the patients was 83.4 (2.9) years, body mass index was 25.0 (4.0) kg/m(2) and level of 25(OH)D was 53.3 (26.7) nmol/L (21.4 [10.7] ng/ml). There was a highly significant difference of 25(OH)D level across European countries (p<0.0001). In these women aged over 80 years, the prevalence of 25(OH)D inadequacy was 80.9% and 44.5% when considering cut-offs of 75 and 50 nmol/L, respectively. In the 397 (20.0%) patients taking supplemental vitamin D with or without supplemental calcium, the mean serum 25(OH)D level was significantly higher than in the other patients (65.2 (29.2) nmol/L vs. 50.3 (25.2) nmol/L; P<0.001). This study indicates a high prevalence of vitamin D (25(OH)D) inadequacy in old European women. The prevalence could be even higher in some particular countries.

[Contribution of the new technologies to the rehabilitation of the old fallers: a pilot study]. / Apport de la revalidation fonctionnelle chez les sujets âgés chuteurs. Contribution de nouvelles technologies : une étude pilote.

PURPOSE OF THE STUDY: To verify the interest of Vibrosphère™ in the rehabilitation of geriatric fallers. MATERIAL AND METHOD: 24 persons aged 85.5 hospitalized in geriatric wards for a fall during the last 6 months are divided in 2 groups. The group 1 has performed a classical revalidation and the group 2 a rehabilitation with the technics of Vibrosphère™, both during 9 days. The assessment is realized on day 0 and day 10. It consists in a walking test with Locometrix, a postural assessment a time get up and go and the fall efficacity scale. A control group of 20 non faller subjects aged 79.9 is constituted. RESULTS: In the second population a gain (p<0.05) is obtained for speed of gait, and also a tendancy in a better frequency, length, symmetry and regularity of step. Postural status is better at the end of the 9 days in the grouped using Vibrosphère™. The 2 ways of rehabilitation have similar effects on the gait and balance parameters. CONCLUSION: This study confirms efficiency of rehabilitation program for 9 days which is rather short. The improvements show that Vibrosphère™ is a well adapted tool to revalidate geriatric fallers. Its effect on balance should explain the benefit observed in the gait parameters. This technique seems to be complementary with classical rehabilitation in old geriatric hospitalized patients.