The 'Bermuda Triangle' of orthostatic hypotension, cognitive impairment and reduced mobility: prospective associations with falls and fractures in The Irish Longitudinal Study on Ageing.
cognitive impairment
falls
fracture
mobility
older people
orthostatic hypotension
Journal
Age and ageing
ISSN: 1468-2834
Titre abrégé: Age Ageing
Pays: England
ID NLM: 0375655
Informations de publication
Date de publication:
01 02 2023
01 02 2023
Historique:
received:
03
08
2022
entrez:
3
2
2023
pubmed:
4
2
2023
medline:
8
2
2023
Statut:
ppublish
Résumé
Orthostatic hypotension (OH), cognitive impairment (Cog) and mobility impairment (MI) frequently co-occur in older adults who fall. This study examines clustering of these three geriatric syndromes and ascertains their relationship with future falls/fractures in a large cohort of community-dwelling people ≥ 65 years during 8-year follow-up. OH was defined as an orthostatic drop ≥ 20 mmHg in systolic blood pressure (from seated to standing) and/or reporting orthostatic unsteadiness. CI was defined as Mini Mental State Examination ≤ 24 and/or self-reporting memory as fair/poor. MI was defined as Timed Up and Go ≥12 s. Logistic regression models, including three-way interactions, assessed the longitudinal association with future falls (explained and unexplained) and fractures. Almost 10% (88/2,108) of participants had all three Bermuda syndromes. One-fifth of participants had an unexplained fall during follow-up, whereas 1/10 had a fracture. There was a graded relationship with incident unexplained falls and fracture as the number of Bermuda syndromes accumulated. In fully adjusted models, the cluster of OH, CI and MI was most strongly associated with unexplained falls (odds ratios (OR) 4.33 (2.59-7.24); P < 0.001) and incident fracture (OR 2.51 (1.26-4.98); P = 0.045). Other clusters significantly associated with unexplained falls included OH; CI and MI; MI and OH; CI and OH. No other clusters were associated with fracture. The 'Bermuda Triangle' of OH, CI and MI was independently associated with future unexplained falls and fractures amongst community-dwelling older people. This simple risk identification scheme may represent an ideal target for multifaceted falls prevention strategies in community-dwelling older adults.
Sections du résumé
BACKGROUND
Orthostatic hypotension (OH), cognitive impairment (Cog) and mobility impairment (MI) frequently co-occur in older adults who fall. This study examines clustering of these three geriatric syndromes and ascertains their relationship with future falls/fractures in a large cohort of community-dwelling people ≥ 65 years during 8-year follow-up.
METHODS
OH was defined as an orthostatic drop ≥ 20 mmHg in systolic blood pressure (from seated to standing) and/or reporting orthostatic unsteadiness. CI was defined as Mini Mental State Examination ≤ 24 and/or self-reporting memory as fair/poor. MI was defined as Timed Up and Go ≥12 s. Logistic regression models, including three-way interactions, assessed the longitudinal association with future falls (explained and unexplained) and fractures.
RESULTS
Almost 10% (88/2,108) of participants had all three Bermuda syndromes. One-fifth of participants had an unexplained fall during follow-up, whereas 1/10 had a fracture. There was a graded relationship with incident unexplained falls and fracture as the number of Bermuda syndromes accumulated. In fully adjusted models, the cluster of OH, CI and MI was most strongly associated with unexplained falls (odds ratios (OR) 4.33 (2.59-7.24); P < 0.001) and incident fracture (OR 2.51 (1.26-4.98); P = 0.045). Other clusters significantly associated with unexplained falls included OH; CI and MI; MI and OH; CI and OH. No other clusters were associated with fracture.
DISCUSSION
The 'Bermuda Triangle' of OH, CI and MI was independently associated with future unexplained falls and fractures amongst community-dwelling older people. This simple risk identification scheme may represent an ideal target for multifaceted falls prevention strategies in community-dwelling older adults.
Identifiants
pubmed: 36735845
pii: 7024511
doi: 10.1093/ageing/afad005
pmc: PMC9897301
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Références
J Gerontol A Biol Sci Med Sci. 2009 Aug;64(8):896-901
pubmed: 19349593
J Am Geriatr Soc. 2017 Mar;65(3):474-482
pubmed: 28295143
Clin Rehabil. 2003 Feb;17(1):108-13
pubmed: 12617386
Ageing Res Rev. 2021 Nov;71:101452
pubmed: 34450352
J Gerontol A Biol Sci Med Sci. 2021 Aug 13;76(9):1699-1706
pubmed: 33649763
J Am Geriatr Soc. 2006 Feb;54(2):255-61
pubmed: 16460376
J Am Med Dir Assoc. 2021 Jun;22(6):1235-1241.e1
pubmed: 33516675
Eur Heart J. 2018 Jun 1;39(21):1883-1948
pubmed: 29562304
PLoS One. 2018 Mar 29;13(3):e0194967
pubmed: 29596521
Clin Med (Lond). 2021 May;21(3):e275-e282
pubmed: 34001585
Age Ageing. 2021 Nov 10;50(6):1914-1924
pubmed: 34120163
Age Ageing. 2003 May;32(3):315-20
pubmed: 12720619
J Psychiatr Res. 1975 Nov;12(3):189-98
pubmed: 1202204
Neurol Sci. 2014 Apr;35(4):601-4
pubmed: 24366243
Clin Med (Lond). 2014 Apr;14(2):200-2
pubmed: 24715135
Clin Geriatr Med. 2002 May;18(2):159-73
pubmed: 12180241
Circulation. 2020 Mar 3;141(9):712-724
pubmed: 31747780
J Am Coll Cardiol. 2001 Nov 1;38(5):1491-6
pubmed: 11691528
J Am Med Dir Assoc. 2016 Mar 1;17(3):193-9
pubmed: 26455926
J Gerontol A Biol Sci Med Sci. 2022 Jun 1;77(6):1230-1238
pubmed: 34791239
JAMA. 2019 Aug 13;322(6):535-545
pubmed: 31408138
Phys Ther. 2015 Aug;95(8):1095-110
pubmed: 25655877
BMC Geriatr. 2021 Dec 10;21(1):689
pubmed: 34893027
Age Ageing. 2015 Mar;44(2):282-6
pubmed: 25520310
J Am Geriatr Soc. 2020 Jun;68(6):1286-1292
pubmed: 32170869
Alzheimers Dement. 2019 Oct;15(10):1264-1273
pubmed: 31515066
J Nutr Health Aging. 2016;20(5):561-8
pubmed: 27102796
J Am Soc Hypertens. 2018 Aug;12(8):597-604.e1
pubmed: 29937420
Age Ageing. 2012 May;41(3):299-308
pubmed: 22374645
Clin Auton Res. 2017 Jun;27(3):167-173
pubmed: 28243824
QJM. 2009 May;102(5):335-9
pubmed: 19273552
JAMA. 2012 Aug 15;308(7):679-80
pubmed: 22893164
J Neurol. 2010 Mar;257(3):392-8
pubmed: 19784714
PLoS One. 2017 Jul 21;12(7):e0180997
pubmed: 28732008
JAMA. 2013 Sep 18;310(11):1168-77
pubmed: 24045741
Int J Epidemiol. 2018 Oct 1;47(5):1398-1398l
pubmed: 30124849
J Eval Clin Pract. 2014 Aug;20(4):396-400
pubmed: 24814338
QJM. 2021 Feb 18;114(1):32-38
pubmed: 32866245
JAMA. 2019 Jun 4;321(21):2131-2133
pubmed: 31162561
Curr Trauma Rep. 2017 Jun;3(2):118-123
pubmed: 28845383
Am J Med. 1987 Feb;82(2):231-5
pubmed: 2880504
J Alzheimers Dis. 2014;42(1):183-91
pubmed: 24825565
J Am Coll Cardiol. 2018 Sep 11;72(11):1294-1309
pubmed: 30190008
J Am Geriatr Soc. 2008 Oct;56(10):1816-20
pubmed: 18795982
J Am Med Dir Assoc. 2018 Jul;19(7):607-612
pubmed: 29752159
JRSM Cardiovasc Dis. 2020 Sep 03;9:2048004020954628
pubmed: 32953093
J Am Geriatr Soc. 2014 Jan;62(1):117-22
pubmed: 25180380
Sr Care Pharm. 2021 Apr 1;36(4):217-222
pubmed: 33766194
PLoS Med. 2021 Nov 9;18(11):e1003821
pubmed: 34752479
Brain. 2011 Jan;134(Pt 1):73-83
pubmed: 21156660
Age Ageing. 1999 Mar;28(2):121-5
pubmed: 10350407
J Hypertens. 2014 Aug;32(8):1562-71; discussion 1571
pubmed: 24879490
J Am Heart Assoc. 2018 Oct 2;7(19):e008976
pubmed: 30371298
J Gerontol A Biol Sci Med Sci. 2020 Jan 1;75(1):117-122
pubmed: 30169579
Pilot Feasibility Stud. 2018 Feb 17;4:49
pubmed: 29468084