Reliability and Validity of Caregivers' Fear of Falling Index When Caring for Home-Based Rehabilitation Patients With Fall-Related Fractures.

OBJECTIVE: To evaluate the reliability and validity of this new measure, called the caregivers' fear of falling index (CFFI). METHODS: The study surveyed home-based rehabilitation patients with fall-related fracture, and their primary caregivers. The characteristics of these patients were evaluated, and the caregivers were surveyed using the CFFI and Falls Efficacy Scale-International (FES-I). The reliability of the CFFI was assessed using item-total correlation, while the validity of the CFFI was evaluated through correlation coefficients calculated between the CFFI and the FES-I. RESULTS: The participants were 51 patient-caregiver pairs. The internal consistency of the CFFI showed an alpha coefficient of 0.904. No items were excluded in the corrected item-total correlations. The CFFI showed a moderate correlation with FES-I (r=0.432, p=0.002). CONCLUSION: This study found the CFFI to be a reliable and valid tool for measuring the primary caregivers' fear. The CFFI may be a useful tool for healthcare professionals to identify and supporting these primary caregivers.

Association between Caregivers' Fear of Post-fracture Patients Falling and a Decline in Patients' Activities.

Objectives: To evaluate caregivers' fear of post-fracture patients falling, we previously developed the Caregivers' Fear of Falling Index (CFFI). In this study, we investigated the relationship between patient performance in activities of daily living (ADLs) and CFFI. Methods: We surveyed 55 patients receiving home-visit rehabilitation after fall-related fracture and their primary caregivers. Participants (patient and caregiver pair) were divided into two groups based on patient performance in basic ADLs (BADLs) and instrumental ADLs (IADLs). ROC analysis was conducted to assess the usefulness of CFFI and Falls Efficacy Scale-International (FES-I) in determining declines in performance in BADLs and IADLs. Multivariate logistic regression analysis was performed to examine the association between CFFI and declining performance in BADLs and IADLs. Results: ROC analysis showed that CFFI exhibited a higher accuracy than FES-I (AUC: 0.73 in BADLs, 0.77 in IADLs) as an indicator of reduced ADL performance. Multivariate logistic analysis adjusted for age, sex, and physical function showed that CFFI was associated with a decline in patients' performance in IADLs (odds ratio, 0.92; 95% confidence interval, 0.85-0.99). Conclusions: Caregivers' fear of post-fracture patients falling was associated with a decline in patients' performance in IADLs. These findings may serve as a guide for supporting caregivers of post-fracture patients.

Proposal of index to evaluate caregivers' fear of care recipient falls.

This study aimed to identify evaluation items that can be used to create an index to evaluate caregivers' fear of care recipient falls. A three-round Delphi method was conducted with medical professionals engaged in discharge support for patients with fall-related fractures. In the first round, a working group brainstormed evaluation items. In the second and third rounds, opinions of medical professionals were quantified and evaluation items were refined. The Delphi method showed convergence of opinion with Kendall's W of 0.561 in the third round. Of the 109 evaluation items pooled in the first round, the consensus was reached on the importance of 19 items and one more item was additionally included. The 20 items may be useful for creating an index that sensitively measures caregivers' fear of care recipient falls.

Differential Characteristics of Skeletal Muscle in Community-Dwelling Older Adults.

BACKGROUND: Sarcopenia is diagnosed on the basis of skeletal muscle mass and muscle strength/function. However, more simple and accurate measures for muscle mass and muscle strength/function should be explored. OBJECTIVE: The aim of this study was to compare the skeletal muscle characteristics at each stage of sarcopenia (normal, presarcopenia, dynapenia, and sarcopenia) via ultrasonography, multifrequency bioelectrical impedance analysis (BIA), and physical assessment batteries in community-dwelling older adults. By evaluating the relationship between muscle quality/quantity indicators and muscle mass/muscle function, we attempted to identify better muscle quantity and quality indicators for the diagnosis of sarcopenia. SETTING AND SUBJECTS: Community-dwelling older men (n = 100, 81.6 ± 7.4 years) and women (n = 247, 79.7 ± 6.9 years) participated in this study. MEASUREMENTS: Skeletal muscle quantity and quality were measured by ultrasonography and multifrequency BIA. Ultrasonographic (thickness and echo intensity) and multifrequency BIA (volume and density) indicators, as well as physical assessment measures, were compared among each stage of sarcopenia. In addition, receiver-operating characteristic analysis was used to assess the sensitivity and specificity of each indicator. RESULTS: Most of the muscle quantity indicators were lower in the sarcopenia and presarcopenia groups than in the other groups, whereas most of the muscle quality indicators were lower in the sarcopenia and dynapenia groups than in the other groups. According to the receiver-operating characteristic analysis, quadriceps muscle thickness and thigh muscle volume were better indicators of muscle mass, whereas the quadriceps muscle echo intensity and thigh muscle density were more robust indicators of muscle function. CONCLUSIONS: In this study, we found potential muscle quality and quantity indicators for sarcopenia diagnosis by ultrasonography and multifrequency BIA. Future longitudinal studies are warranted to define the role of these indicators for the diagnosis of sarcopenia.

Combination of Low Body Mass Index and Low Serum Albumin Level Leads to Poor Functional Recovery in Stroke Patients.

BACKGROUND: Nutritional status is associated with the functional recovery of stroke patients. This study aimed to examine the influence of the combination of body mass index (BMI) and serum albumin level on functional recovery in subacute stroke patients. METHODS: This retrospective cohort study included 259 subacute stroke patients (mean age 68.9 ± 12.3 years). Patients were categorized into 4 groups according to their BMI and serum albumin level: group 1, low BMI (<18.5 kg/m2) and low serum albumin level (<3.5 g/dL); group 2, low BMI and high serum albumin level (≥3.5 g/dL); group 3, normal weight (≥18.5 kg/m2) and low serum albumin level; and group 4, normal weight and high serum albumin level. The outcome variable was the motor subscale of the Functional Independence Measure (M-FIM) effectiveness. We defined the first quartile of M-FIM effectiveness as poor functional recovery. Multivariate logistic regression analysis was performed to examine the influence of the combination of BMI and serum albumin level on poor functional recovery. RESULTS: Multivariate logistic regression analysis adjusted for baseline characteristics (reference, group 4) showed that group 1 was mostly associated with a significant risk of poor functional recovery (odds ratio, 4.13; 95% confidence interval, 1.53-11.15). CONCLUSIONS: Our results suggested that the combination of low BMI and low serum albumin level was more significantly associated with poor functional recovery in subacute stroke patients than either factor alone. The combination of BMI and serum albumin level should be taken into account when predicting functional recovery in subacute stroke patients.