Abstract: BACKGROUND: Fear of falling (FOF) is often reported post-hospitalization and has been associated with functional decline. Identifying the determinants of FOF during hospitalization and patients’ perception of FOF can help guide their managements. To inform a planned future intervention study, this study aimed to evaluate (1) the effects of acute hospitalization on FOF among older adults, (2) older adults’ perception of risk factors, interventions and coping strategies for FOF. METHODS: Thirty-two older inpatients were recruited in an acute teaching hospital. This was a mixed methods study. FOF was measured quantitatively using the Single-item question “Are you afraid of falling?” and…Fall-Efficacy Scale-International (FES-I), self-reported for premorbid status (retrospectively), on admission and again at discharge. Patients with FOF completed a questionnaire exploring their perception of FOF, possible coping strategies and interventions they believed may help. RESULTS: No significant changes in FES-I scores were detected over time, suggesting acute hospitalization did not change FOF in this cohort. A change in FOF (FES-I) score was associated with the history of falls in previous year. Perceived risk factors included balance problems (n = 10), breathlessness (n = 5), reduced lower limb muscle strength (n = 5) and history of falls (n = 4). To cope with FOF, most would avoid activity, seek help and slow their pace. Exercises and education were perceived as effective interventions to reduce FOF. CONCLUSIONS: Fear of falling did not appear to develop or change during hospitalization. Patients had faith in education and exercise prescription as effective treatments for FOF post-hospitalization.
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Keywords: Fear of falling, hospitalization, older adults, perception, FES-I
Abstract: Background: Centrally acting angiotensin converting enzyme inhibitors (CACE-Is) are associated with reduced rates of cognitive decline in patients with dementia. CACE-Is may also improve exercise tolerance in functionally impaired older adults with normal cognition, suggesting that CACE-Is may positively influence activities of daily living (ADL) in dementia. Objective: To compare rates of decline in patients with mild to moderate Alzheimer’s disease (AD) receiving CACE-Is to those not currently treated with CACE-Is (NoCACE-I), included in the Doxycycline and Rifampicin for Alzheimer’s Disease study (n = 406). Methods: Patients were included if baseline and end-point (twelve months apart) scores were available for…measures including the Standardized Alzheimer’s Disease Assessment Scale – Cognitive Subscale; Quick Mild Cognitive Impairment screen; Clinical Dementia Rating Scale (CDR-SB), and Lawton-Brody ADL Scale. Results: There was a significant, 25% difference (median one-point) in the 12-month rate of decline in ADL scores in patients taking CACE-Is (n = 91), compared to the NoCACE-I group (n = 274), p = 0.024. This remained significant after adjusting for age, gender, education, and blood pressure, p = 0.034. When individual CACE-Is were compared to the NoCACE-I group, a significant reduction in the rate of decline in ADLs (median one versus four points), were only observed for perindopril, p = 0.01. The CDR-SB was also reduced (median one-point) for the perindopril compared to the NoCACE-I group, p = 0.04. Conclusion: This observational study suggests that CACE-Is, and potentially perindopril in particular, are associated with a reduced rate of functional decline in patients with AD, without an association with mood or behavior. This suggests that CACE-Is may slow disease progression in AD.
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