Approach to prevent fall injuries no better than usual care
Falls can be serious, even deadly, for older adults. Each year, about 3 million adults 65 and older are treated in emergency departments nationwide for serious injuries from a fall. These injuries can result in disability and reduced quality of life. Fear of falling can lead older adults to be less physically and socially active.
Several factors can increase fall risk. Aging often brings changes to eyesight and reflexes. Muscle weakness, problems with balance, and foot problems can also increase the likelihood of a fall. Certain medications can contribute by causing dizziness and confusion. But falls are often preventable. Researchers have been studying strategies to prevent serious fall injuries among older adults.
A new study tested a fall injury intervention tailored to individuals and administered by specially trained nurses. The trial, called Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE), was funded by NIH’s National Institute on Aging (NIA) and the nonprofit Patient-Centered Outcomes Research Institute. Findings were published in the New England Journal of Medicine on July 9, 2020.
More than 5,400 participants, aged 70 and older, were enrolled at 86 primary care practices across 10 U.S. health care systems. The older adults who took part had been injured from a fall, had fallen at least two times in the previous year, or were afraid of falling because of difficulty walking or balancing.
The volunteers were first screened for fall injury risk factors. These included issues with walking and balance, falling hazards in the home, vision problems, problems with feet or shoes, weakened bones, certain medications, and low blood pressure when standing up.
Half the practices were randomly selected to use the tailored fall prevention plan. Specially trained nurses helped them to identify their risk factors and work to reduce one to three of them.
The other practices served as the control group. Participants received an informational pamphlet on falls and were encouraged to discuss fall prevention with their primary care doctors, who also received the risk factor screening results.
The researchers measured the length of time to the first serious fall injury. After a participant reported a serious injury, it was verified at the practice or through health records. The team looked at the intervention’s effectiveness over 20 months or more.
The overall rate of serious fall injuries in the trial was much lower (about 5%) than the team expected. While they hoped the fall prevention plan would reduce serious injuries, there was little difference in the rate of serious fall injuries between the two groups.
“The study reflects just how challenging it is to implement interventions to prevent fall injury in the real world,” says Dr. Shalender Bhasin of Brigham and Women’s Hospital, who co-led the study. “Measures that may reduce risk in the setting of a clinical trial can be less effective in the real world, where daily challenges such as being unable to afford transportation, or the cost of follow-up care, may delay or prevent access for patients.”
Past studies have shown that many falls in older adults can be prevented. Researchers will continue to explore the most effective ways to minimize serious fall injuries.
Sleep disturbances linked to abnormal deposits of certain proteins in the brain
Two recent NIA-supported studies have found abnormal deposits of certain proteins — alpha-synuclein filaments, tau tangles, and beta-amyloid plaques — in the brains of individuals with a history of sleep disturbances. The findings, which were reported in Acta Neuropathologica and Current Biology, highlight the importance of sleep in healthy aging.
A team led by researchers at Boston University focused on people with chronic traumatic encephalopathy (CTE), which is a condition associated with repeated head injuries from boxing, football, or other activities. Previous research has shown that some people with repeated head injuries have a sleep disorder that causes them to move limbs and shout during dream activity. The disturbance occurs during the rapid eye movement (REM) phase of sleep. The research team set out to learn whether REM sleep disorder would be frequently found in people with CTE after repeated head injuries. A second aim was to find out whether the sleep disorder would be associated with the presence of Lewy bodies, which are accumulations of alpha-synuclein protein filaments, or with tau tangles in the brainstem region.
The study was conducted with brain tissue from 247 men with CTE resulting from contact sports. The tissue was obtained from the brain bank that is part of the NIH-supported Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Study. The researchers found that 80 (one-third) of the men with CTE had probable REM sleep disorder, based on family members reporting that they acted out their dreams while sleeping. These men with sleep disorder were significantly more likely to have a longer history of repeated head injury through sports. The men with sleep disorder were also significantly more likely than men without sleep disorder to have the presence of Lewy bodies in their brain.
After examining the brainstem tissue, the research team discovered that men with sleep disorder without Lewy bodies were significantly more likely to have tau tangles in this area than men without sleep disorder. The finding suggests that repeated head injuries damage the part of the brainstem region that is important for sleep. The team concluded that sleep disorder can be predicted by the presence of tau tangles in the brainstem, Lewy bodies, and years of playing contact sports. The researchers claim to be the first to establish a connection for tau tangles in the brainstem, contact sports, and sleep disorder.
Whereas the Boston University team was interested in REM sleep disorder, a team led by researchers at the University of California, Berkeley, studied brain activity in non-REM sleep. During the non-REM sleep stage, the brain can clear toxins and other compounds, including beta-amyloid, which is implicated in Alzheimer’s and other brain disorders. In rodent studies, long-term restriction of sleep is linked to a rise in the level of beta-amyloid in the brain.
The UC Berkeley team set out to determine whether disordered sleep in healthy adults could be linked with a faster accumulation of beta-amyloid plaques over time. Last year, they reported that poor sleep in middle age was linked to beta-amyloid plaques and tau tangles. For this study, they measured the rate of accumulation over several years.
Following a group of nine men and 23 women between the ages of 70 and 80 that are part of the NIA-funded Berkeley Aging Cohort Study, the team measured non-REM sleep slow-wave activity and sleep quality, plus used PET brain imaging scans to track the development of beta-amyloid plaques. At the beginning of the study, the participants went to a sleep lab to assess sleep efficiency, which is the total amount of sleep as a percentage of total time in bed. After that, the participants received two to five PET scans over one to six years to track change in beta-amyloid plaques over time. Most participants had beta-amyloid plaques detected on the first PET scan.
Analysis revealed that those with lower slow-wave brain activity developed plaques faster than those with higher slow-wave activity. The researchers concluded that non-REM sleep in the lower frequency domain might predict future plaque accumulation. In addition, participants who had the least efficient sleep at the beginning of the study later had the greatest increase of beta-amyloid accumulation.
The researchers noted that they did not find statistically different changes in cognition over time related to the beta-amyloid accumulation. Measurable cognitive decline may not occur until years after plaques are detected on PET scans.
Further research in more people is needed to explore the relationships between sleep activity and the accumulation of alpha-synuclein, tau tangles, and beta-amyloid in the brain over time. But these measures of sleep activity may have the potential to be developed into markers that can predict the abnormal accumulation of proteins in the brain before cognitive decline and other symptoms of brain disease develop. For example, measuring sleep quality and disturbances with wearable devices may offer a noninvasive, repeatable, and safe way to screen for cognitive risk factors, even before cognitive symptoms of brain disorders develop.
Here’s a quick review on how to properly wear a mask. Make sure it:
To help prevent the spread of COVID-19, a mask should be worn in all public places and when social distancing isn’t possible. Routine and frequent washing of your masks is recommended. While most of us are trying to stay home more and avoiding public places, sometimes that isn’t possible. If you find yourself wearing your mask more than a few hours total each day, it should be washed before reuse.
How to wash your cloth mask
If your mask is machine-washable, you can include it with your laundry using regular detergent and the warmest appropriate water temperature for the load. In the dryer, use the highest heat setting possible and don’t take it out until it’s completely dry.
If your mask can’t go in the washer or a machine washer isn’t available, you can sanitize it by hand with a bleach solution. First though, make sure the bleach you have is intended for disinfection. Some bleaches are made for colored clothing and might not disinfect properly. After confirming you have the correct bleach, follow these steps:
Other reminders to keep you and your mask hygienic:
Remember to do your part by wearing a mask to help reduce the spread of COVID-19 and continue to practice social distancing and frequent handwashing. These three simple steps are still the best defense we have to reduce transmission. And that’s always in fashion!
CINTAA Elder care shares useful information regarding healthcare on weekly basis. The post is only for information purpose only. Please check with your health care professional before using this information. To keep yourself updated with many other health tips, stay with us. We provide certified caregivers for seniors at home. If you need any help regarding eldercare, please feel free to call us today at 561-963-1915.