29 results on '"Willems, A."'
Search Results
2. How a broken vertebra can lead to a fatal hemorrhage: a case report.
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Ploumen, Roxanne A. W., van Wezenbeek, Martin R., Willems, Paul C. P. H., Gerretsen, Suzanne C., and Ten Bosch, Jan A.
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DIAGNOSIS of bone fractures ,HEMORRHAGE diagnosis ,BLOOD vessels ,ACCIDENTAL falls ,LUMBAR vertebrae ,COMPUTED tomography ,TERMINATION of treatment ,DEATH - Abstract
Background: Unintentional falls are common among the elderly and given the expected increase of the aging population, these falls contribute to a high number of admissions to the emergency department. Relatively low-energy trauma mechanisms can lead to serious injuries in the elderly, with contributing factors being comorbidities, medication use and degenerative abnormalities. Case presentation: A 94-year-old female suffered an unintentional fall at home. Upon arrival of the ambulance at her house she was hemodynamically stable and mobilized to the gurney with assistance. During primary survey at the emergency department, her blood pressure and oxygen saturation decreased, she was not able to move her legs anymore and lost consciousness. A full-body CTA was performed, which showed a fracture through the vertebral body of L2 with significant dislocation and a large active bleeding of the corpus, extending to the retroperitoneum and the epidural space. Despite resuscitation, her vital signs deteriorated and given the severe abnormalities on CTA, it was decided to discontinue further treatment, after which she deceased. The performed CTA and an x-ray from 2016 suggested diffuse idiopathic skeletal hyperostosis, which might have contributed to the severity and instability of the vertebral fracture. Mobilization after the fall might have increased the dislocation of the fracture. The use of oral anticoagulants worsened the subsequent bleeding and the extension to the epidural space caused the paralysis of the legs. Conclusions: It is important to be aware of the possible serious consequences of unintentional falls in the elderly population and to provide strict immobilization of the spinal column until proper imaging. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Accidental falling in community-dwelling elderly with chronic kidney disease
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Goto, Namiko A., Hamaker, Marije E., Willems, Hanna C., Verhaar, Marianne C., and Emmelot-Vonk, Mariëlle H.
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- 2019
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4. Imminent fall risk after fracture.
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Schene, Merle R, Wyers, Caroline E, Driessen, Annemariek M H, Souverein, Patrick C, Gemmeke, Marle, Bergh, Joop P van den, and Willems, Hanna C
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RELATIVE medical risk ,RETROSPECTIVE studies ,ACCIDENTAL falls ,BONE fractures ,LONGITUDINAL method - Abstract
Rationale Adults with a recent fracture have a high imminent risk of a subsequent fracture. We hypothesise that, like subsequent fracture risk, fall risk is also highest immediately after a fracture. This study aims to assess if fall risk is time-dependent in subjects with a recent fracture compared to subjects without a fracture. Methods This retrospective matched cohort study used data from the UK Clinical Practice Research Datalink GOLD. All subjects ≥50 years with a fracture between 1993 and 2015 were identified and matched one-to-one to fracture-free controls based on year of birth, sex and practice. The cumulative incidence and relative risk (RR) of a first fall was calculated at various time intervals, with mortality as competing risk. Subsequently, analyses were stratified according to age, sex and type of index fracture. Results A total of 624,460 subjects were included; 312,230 subjects with an index fracture, matched to 312,230 fracture-free controls (71% females, mean age 70 ± 12, mean follow-up 6.5 ± 5 years). The RR of falls was highest in the first year after fracture compared to fracture-free controls; males had a 3-fold and females a 2-fold higher risk. This imminent fall risk was present in all age and fracture types and declined over time. A concurrent imminent fracture and mortality risk were confirmed. Conclusion/Discussion This study demonstrates an imminent fall risk in the first years after a fracture in all age and fracture types. This underlines the need for early fall risk assessment and prevention strategies in 50+ adults with a recent fracture. [ABSTRACT FROM AUTHOR]
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- 2023
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5. The association between chronic kidney disease, falls, and fractures: a systematic review and meta-analysis
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Hanna C. Willems, Marielle H. Emmelot-Vonk, M. E. Hamaker, N. A. Goto, F. M. Oosterlaan, Marianne C. Verhaar, and A. C. G. Weststrate
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Population ,Poison control ,Review ,Cochrane Library ,Medicare ,Cohort Studies ,Fractures, Bone ,Endocrinology ,Chronic kidney disease ,Journal Article ,medicine ,Humans ,Renal osteodystrophy ,Prospective Studies ,Renal Insufficiency, Chronic ,education ,Accidental falls ,Dialysis ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,Nutrition Surveys ,medicine.disease ,United States ,Diabetes and Metabolism ,Cross-Sectional Studies ,Fracture ,Case-Control Studies ,Meta-analysis ,Female ,business ,Kidney disease ,Fall prevention - Abstract
Patients with chronic kidney disease (CKD) are more likely to experience falls and fractures due to renal osteodystrophy and the high prevalence of risk factors for falls. However, it is not well established how great the risk is for falls and fractures for the different stages of CKD compared to the general population. The objective of this systematic review and meta-analysis was to assess whether, and in which degree, CKD was associated with falls and fractures in adults. A systematic search in PubMed, Embase, CINAHL, and The Cochrane Library was performed on 7 September 2018. All retrospective, cross-sectional, and longitudinal studies of adults (18 years of older) that studied the association between CKD, fractures, and falls were included. Additional studies were identified by cross-referencing. A total of 39 publications were included, of which two publications assessed three types of outcome and four publications assessed two types of outcome. Ten studies focused on accidental falling; seventeen studies focused on hip, femur, and pelvis fractures; seven studies focused on vertebral fractures; and thirteen studies focused on any type of fracture without further specification. Generally, the risk of fractures increased when kidney function worsened, with the highest risks in the patients with stage 5 CKD or dialysis. This effect was most pronounced for hip fractures and any type of fractures. Furthermore, results on the association between CKD and accidental falling were contradictory. Compared to the general population, fractures are highly prevalent in patients with CKD. Besides more awareness of timely fracture risk assessment, there also should be more focus on fall prevention. Electronic supplementary material The online version of this article (10.1007/s00198-019-05190-5) contains supplementary material, which is available to authorized users.
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- 2019
6. A pilot study on the feasibility and effectiveness of treadmill-based perturbations for assessing and improving walking stability in chronic obstructive pulmonary disease
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Jeannet M. Delbressine, Martijn A. Spruit, Christopher McCrum, Anouk W. Vaes, Paul C. Willems, Wai-Yan Liu, Maud Koopman, Kenneth Meijer, Nutrition and Movement Sciences, RS: NUTRIM - R3 - Respiratory & Age-related Health, Pulmonologie, MUMC+: MA Anesthesiologie (9), and RS: NUTRIM - R1 - Obesity, diabetes and cardiovascular health
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Perturbation-based balance training ,medicine.medical_specialty ,MUSCLE FATIGUE ,medicine.medical_treatment ,Population ,Biophysics ,Stability (learning theory) ,Balance training ,Pulmonary disease ,Pilot Projects ,Perturbation -based balance training ,Walking ,Pulmonary Disease, Chronic Obstructive ,LOCOMOTOR ADAPTABILITY ,Physical medicine and rehabilitation ,medicine ,Humans ,COPD ,Orthopedics and Sports Medicine ,Pulmonary rehabilitation ,Treadmill ,OLDER-ADULTS ,education ,Postural Balance ,LOWER-EXTREMITY STRENGTH ,education.field_of_study ,business.industry ,FALLS ,Gait stability ,Gait adaptability ,POSTURAL CONTROL ,medicine.disease ,REFERENCE VALUES ,BALANCE ,Exercise Test ,Feasibility Studies ,Falls ,Accidental Falls ,business ,GAIT ,Locomotion ,Fall prevention - Abstract
BACKGROUND: Falls risk is elevated in chronic obstructive pulmonary disease (COPD). However, there is a lack of evidence regarding the contributing factors. Here, we examined the feasibility of, and initial responses to, large walking perturbations in COPD, as well as the adaptation potential of people with COPD to repeated walking perturbations that might indicate potential for perturbation-based balance training in COPD. METHODS: 12 participants with COPD undergoing inpatient pulmonary rehabilitation and 12 age-gender-matched healthy control participants walked on an instrumented treadmill and experienced repeated treadmill-belt acceleration perturbations (leading to a forward balance loss). Three-dimensional motion capture was used to quantify the stability of participants body position during perturbed walking. Feasibility, stability following the initial perturbations and adaptation to repeated perturbations were assessed. FINDINGS: Using perturbations in this manner was feasible in this population (no harness assists and participants completed the minimum number of perturbations). No clear, specific deficit in reactive walking stability in COPD was found (no significant effects of participant group on stability or recovery step outcomes). There were mixed results for the adaptability outcomes which overall indicated some adaptability to repeated perturbations, but not to the same extent as the healthy control participants. INTERPRETATION: Treadmill-based perturbations during walking are feasible in COPD. COPD does not appear to result in significant deficits in stability following sudden perturbations and patients do demonstrate some adaptability to repeated perturbations. Perturbation-based balance training may be considered for fall prevention in research and practice in people with COPD. ispartof: CLINICAL BIOMECHANICS vol:91 ispartof: location:England status: published
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- 2022
7. The Clinical Relevance of Hyperkyphosis: A Narrative Review
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Willem F. Lems, M. C. Koelé, and Hanna C. Willems
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0301 basic medicine ,medicine.medical_specialty ,Aging ,Thoracic spine ,Mini Review ,Endocrinology, Diabetes and Metabolism ,fall ,Kyphosis ,review ,030209 endocrinology & metabolism ,lcsh:Diseases of the endocrine glands. Clinical endocrinology ,kyphosis ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Endocrinology ,Risk Factors ,Medicine ,Humans ,Clinical significance ,hyperkyphosis ,Risk factor ,older adults ,lcsh:RC648-665 ,Cobb angle ,business.industry ,Fall risk ,medicine.disease ,Prognosis ,Spine ,Review article ,030104 developmental biology ,fracture ,Spinal Fractures ,Narrative review ,Accidental Falls ,measurement ,business - Abstract
The kyphosis angle of the thoracic spine tends to increase with aging. Hyperkyphosis is a kyphosis angle, exceeding the normal range. This narrative literature review aims to provide an overview of the current literature concerning kyphosis measurement methods, the etiology and adverse health effects of hyperkyphosis. As of yet, a well-defined threshold for hyperkyphosis is lacking. To attain more generalizability and to be able to compare study results in older adults, we propose to define age-related hyperkyphosis as a Cobb angle of 50° or more in standing position. Hyperkyphosis may be a potentially modifiable risk factor for adverse health outcomes, like fall risk and fractures. Additionally, hyperkyphosis may indicate the presence of osteoporosis, which is treatable. Prospective and intervention studies, using a Cobb angle of 50° as a clear and uniform definition of hyperkyphosis, are warranted to investigate the clinical relevance of hyperkyphosis.
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- 2020
8. [Inpatient treatment costs, cost-driving factors and potential reimbursement problems due to fall-related fractures in patients with Parkinson's disease]
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René D, Verboket, Nils, Mühlenfeld, Mathias, Woschek, Ingo, Marzi, Martin, Pieper, Johann Philipp, Zöllner, Adam, Strzelczyk, and Laurent M, Willems
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Hospitalization ,Inpatients ,Humans ,Accidental Falls ,Neurodegenerative Diseases ,Parkinson Disease ,Health Care Costs ,Hospital Costs ,Length of Stay ,Retrospective Studies - Abstract
In an increasingly economically oriented healthcare system the analysis of disease-specific costs is becoming more and more relevant, especially in chronic diseases with long duration of hospitalization. As a frequent neurodegenerative disease idiopathic Parkinson's disease (IPD) causes high healthcare costs. The pathognomonic affection of mobility and equilibrium often leads to fall-related fractures in the course of the disease, which cause further costs through hospitalization and possibly surgical treatment.The aim of the study was the calculation of inpatient treatment costs of fall-related fractures in IPD as well as the analysis of relevant cost-causing factors. In addition, an alternative calculation of the treatment costs was carried out with the question of potential remuneration problems in the current diagnosis-related groups (DRG) system.The basis of this retrospective, single center analysis was the actual revenue of 95 patients treated between January 2011 and January 2018 at the University Hospital Frankfurt am Main. The proceeds were systematically reviewed for relevant demographic, healthcare and disease-related aspects and statistically analyzed for cost-related factors using univariate analysis. The alternative calculation of the treatment costs was carried out according to commonly used health economics methods.The median revenue per patient and injury was 9295 € (±8038 €, median 7148 €) with a mean length of stay of 13.5 days (±7.2 days, median 13 days). The alternative calculation of treatment costs per patient was an average of 9789 € (±6423 €, median 8906 €). High treatment costs were associated with age75 years (p = 0.028), surgical treatment (p = 0.004), intensive care unit (ICU) stay (p = 0.004), limb fractures (p = 0.028) and an advanced stage of IPD (p = 0.028). Significant differences between actual revenue and calculated costs were found for hospital stays ≥14 days (p = 0.009) and advanced stages of disease (p = 0.036).The costs of care in patients with IPD and fall-related fractures are high and relevant to health economics. In general, remuneration based on the DRG system seems to largely cover the costs; however, compensation problems arise especially for patients with a long duration of hospitalization or advanced IPD.
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- 2019
9. The association between hyperkyphosis and fall incidence among community-dwelling older adults.
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Koelé, Marije C., Willems, Hanna C., Swart, Karin M. A., van Dijk, Suzanne C., Lips, Paul, de Groot, Lisette C. P. G. M., van der Cammen, Tischa J. M., Zillikens, M. Carola, van Schoor, Natasja M., and van der Velde, Nathalie
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PATIENT aftercare , *CONFIDENCE intervals , *AGE distribution , *DISEASE incidence , *REGRESSION analysis , *KYPHOSIS , *RISK assessment , *INDEPENDENT living , *ACCIDENTAL falls , *DESCRIPTIVE statistics , *LONGITUDINAL method , *THORACIC vertebrae , *DISEASE complications - Abstract
Summary: Hyperkyphosis, an increased kyphosis angle of the thoracic spine, was associated with a higher fall incidence in the oldest quartile of a large prospective cohort of community-dwelling older adults. Hyperkyphosis could serve as an indicator of an increased fall risk as well as a treatable condition. Introduction: Hyperkyphosis is frequently found in adults aged 65 years and older and may be associated with falls. We aimed to investigate prospectively in community-dwelling older adults whether hyperkyphosis or change in the kyphosis angle is associated with fall incidence. Methods.: Community-dwelling older adults (n = 1220, mean age 72.9 ± 5.7 years) reported falls weekly over 2 years. We measured thoracic kyphosis through the Cobb angle between the fourth and 12th thoracic vertebra on DXA-based vertebral fracture assessments and defined hyperkyphosis as a Cobb angle ≥ 50°. The change in the Cobb angle during follow-up was dichotomized (< 5 or ≥ 5°). Through multifactorial regression analysis, we investigated the association between the kyphosis angle and falls. Results: Hyperkyphosis was present in 15% of the participants. During follow-up, 48% of the participants fell at least once. In the total study population, hyperkyphosis was not associated with the number of falls (adjusted IRR 1.12, 95% CI 0.91–1.39). We observed effect modification by age (p = 0.002). In the oldest quartile, aged 77 years and older, hyperkyphosis was prospectively associated with a higher number of falls (adjusted IRR 1.67, 95% CI 1.14–2.45). Change in the kyphosis angle was not associated with fall incidence. Conclusions: Hyperkyphosis was associated with a higher fall incidence in the oldest quartile of a large prospective cohort of community-dwelling older adults. Because hyperkyphosis is a partially reversible condition, we recommend investigating whether hyperkyphosis is one of the causes of falls and whether a decrease in the kyphosis angle may contribute to fall prevention. [ABSTRACT FROM AUTHOR]
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- 2022
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10. Accidental falling in community-dwelling elderly with chronic kidney disease
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N. A. Goto, Hanna C. Willems, Marielle H. Emmelot-Vonk, Marije E. Hamaker, Marianne C. Verhaar, Geriatrics, APH - Aging & Later Life, and AMS - Ageing & Morbidty
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Male ,Nephrology ,medicine.medical_specialty ,Chronic kidney failure ,Urology ,Population ,030232 urology & nephrology ,Renal function ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Prevalence ,Nephrology - Original Paper ,Humans ,Medicine ,Renal Insufficiency, Chronic ,Correlation of Data ,education ,Geriatric Assessment ,Accidental falls ,Netherlands ,Aged ,Aged, 80 and over ,Geriatrics ,education.field_of_study ,Univariate analysis ,business.industry ,Odds ratio ,medicine.disease ,Chronic renal insufficiency ,Cross-Sectional Studies ,Aged 80 and over ,Cohort ,Female ,Independent Living ,business ,Glomerular Filtration Rate ,Kidney disease - Abstract
Purpose: The aim of the current study was to evaluate the association between a decreased estimated glomerular filtration rate (eGFR) and accidental falling in elderly patients who visited the day clinic of the department of geriatric medicine of the University of Medical Center Utrecht (UMCU). Study design: A cross-sectional analysis with people aged ≥ 65 years of the Utrecht Cardiovascular Cohort was performed. Patients were stratified into different stages of kidney disease (< 45, 45–59, and ≥ 60 ml/min per 1.73 m2). Logistic regression models were used to evaluate the association between chronic kidney disease and falling. Results: Our analysis included 1000 participants with a mean age 79.4 (± 6.6) years, of whom 38% had an eGFR of < 60 ml/min per 1.73 m2 and 17% < 45 ml/min per 1.73 m2. Univariate analysis showed a significant higher prevalence [odds ratio 1.75 (95% confidence interval 1.21–2.53; p ≤ 0.01)] of falling in the population with an eGFR < 45 ml/min per 1.73 m2 compared to patients with an eGFR ≥ 60 ml/min per 1.73 m2. After correcting for multiple potential confounders in the multivariate analysis, this association was no longer present. Conclusions: In geriatric patients ≥ 65 years, patients with a decreased eGFR fall more often than patients with a preserved kidney function. This seems to be related with the risk profile of patients with CKD and not with a decreased eGFR itself, as after correcting for potential confounders no association remained. Nevertheless, accidental falling is a highly prevalent problem in the elderly CKD population. Therefore, nephrologists should actively ask about accidental falling, and thereby screen for high-risk patients.
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- 2019
11. Fractures in Parkinson's Disease: injury patterns, hospitalization, and therapeutic aspects.
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Mühlenfeld, Nils, Söhling, Nicolas, Marzi, Ingo, Pieper, Martin, Paule, Esther, Reif, Philipp S., Strzelczyk, Adam, Verboket, René D., and Willems, Laurent M.
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INTENSIVE care units ,LENGTH of stay in hospitals ,CONFIDENCE intervals ,EPIDEMIOLOGY ,RETROSPECTIVE studies ,PARKINSON'S disease ,ACCIDENTAL falls ,HOSPITAL care ,HIP joint injuries ,QUALITY of life ,WOUNDS & injuries ,BONE fractures - Abstract
Aim: The primary aim of this study was to analyze the frequency and characteristic patterns of fall-related fractures as well as consecutive hospitalization and management relating to such fractures. In addition, important pathognomonic and therapeutic aspects are discussed. Methods: This retrospective mono-center study was conducted at the University Hospital Frankfurt am Main, Germany. Between 2007 and 2017, a total of 145 PD patients with fall-related fractures were identified via a retrospective systematic query in the hospital information system using the ICD-10 German modification codes G20.0–G20.9. Patients with unclear or falsely coded PD were strictly excluded. Results: The mean age of the cohort was 77.7 years (± 7.5, median 77.) and 57.9% of the cohort were females (n = 84). A total number of 151 fractures were reported, with 140 patients (96.6%) suffering from one, four patients from two (2.8%), and one patient from three fractures (0.6%) at a time. For 43.9% (n = 65) of the cohort, fractures concerned lower extremities (LE) followed by trunk (38.1%, n = 58) and upper extremities (UE, 17.9%, n = 27). Most common fracture types in LE were femoral neck fractures (52.3%, n = 34). Mean length of hospital stay (LOS) was 13.6 days (95% CI 12.4–14.7). In 43.4% (n = 63) of cases, an interim admission to an intensive-care unit (ICU) was necessary. Mean ICU LOS was 2.3 days (95% CI 1.5–3.0), and mean LOS for normal care unit was 10.5 days (95% CI 10.3–12.4). Surgical treatment was necessary in 75.9% of the cases (n = 110). Patients undergoing surgical treatment showed significantly longer LOS compared to conservatively treated patients (p < 0.001). Moreover, fractures of the LE (p = 0.018) and UE (p = 0.010) were associated with a significant longer LOS. Conclusion: Fall-related fractures are a common and relevant complication in PD patients leading to increased immobility, frequent hospitalization, and immediate surgical care. Fractures of the lower extremities and trunk were the most common in the cohort for this study. A PD patient presenting to the emergency room or at the general practitioner with a fracture should always be checked for osteoporosis and a fall-related injury should be seen as a red flag for reviewing a patient's individual therapeutic regime. [ABSTRACT FROM AUTHOR]
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- 2021
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12. Risk incidence of fractures and injuries: a multicenter video-EEG study of 626 generalized convulsive seizures.
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Frey, Katharina, Zöllner, Johann Philipp, Knake, Susanne, Oganian, Yulia, Kay, Lara, Mahr, Katharina, Keil, Fee, Willems, Laurent M., Menzler, Katja, Bauer, Sebastian, Schubert-Bast, Susanne, Rosenow, Felix, and Strzelczyk, Adam
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SEIZURES (Medicine) ,ACCIDENTAL falls ,TOOTH mobility ,VERTEBRAL fractures ,WOUNDS & injuries ,BACKACHE ,SHOULDER dislocations - Abstract
Objective: To evaluate the incidence and risk factors of generalized convulsive seizure (GCS)-related fractures and injuries during video-EEG monitoring. Methods: We analyzed all GCSs in patients undergoing video-EEG-monitoring between 2007 and 2019 at epilepsy centers in Frankfurt and Marburg in relation to injuries, falls and accidents associated with GCSs. Data were gathered using video material, EEG material, and a standardized reporting form. Results: A total of 626 GCSs from 411 patients (mean age: 33.6 years; range 3–74 years; 45.0% female) were analyzed. Severe adverse events (SAEs) such as fractures, joint luxation, corneal erosion, and teeth loosening were observed in 13 patients resulting in a risk of 2.1% per GCS (95% CI 1.2–3.4%) and 3.2% per patient (95% CI 1.8–5.2%). Except for a nasal fracture due to a fall onto the face, no SAEs were caused by falls, and all occurred in patients lying in bed without evidence of external trauma. In seven patients, vertebral body compression fractures were confirmed by imaging. This resulted in a risk of 1.1% per GCS (95% CI 0.5–2.2%) and 1.7% per patient (95% CI 0.8–3.3%). These fractures occurred within the tonic phase of a GCS and were accompanied by a characteristic cracking noise. All affected patients reported back pain spontaneously, and an increase in pain on percussion of the affected spine section. Conclusions: GCSs are associated with a substantial risk of fractures and shoulder dislocations that are not associated with falls. GCSs accompanied by audible cracking, and resulting in back pain, should prompt clinical and imaging evaluations. [ABSTRACT FROM AUTHOR]
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- 2020
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13. A flexed posture in elderly patients is associated with impairments in postural control during walking
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Jos P. C. M. van Campen, Maartje H. de Groot, Hanna C. van der Jagt-Willems, Claudine J. C. Lamoth, Jos H. Beijnen, Willem F. Lems, Rheumatology, MOVE Research Institute, and SMART Movements (SMART)
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Male ,COMPRESSION FRACTURES ,medicine.medical_specialty ,Posture ,Osteoporosis ,Biophysics ,Kyphosis ,STRIDE ,Poison control ,VERTEBRAL FRACTURE ,Walking ,Risk Assessment ,Thoracic Vertebrae ,Postural control ,Physical medicine and rehabilitation ,Elderly ,Injury prevention ,STRENGTH ,Humans ,Medicine ,Orthopedics and Sports Medicine ,OLDER-ADULTS ,Gait ,Postural Balance ,Aged ,Aged, 80 and over ,COORDINATION ,Lumbar Vertebrae ,business.industry ,Rehabilitation ,Torso ,WOMEN ,ENTROPY ,medicine.disease ,Trunk ,KYPHOSIS ,Preferred walking speed ,VARIABILITY ,Linear Models ,Physical therapy ,Spinal Fractures ,Flexed posture ,Accidental Falls ,Female ,business ,human activities ,GAIT STABILITY - Abstract
A flexed posture (FP) is characterized by protrusion of the head and an increased thoracic kyphosis (TK), which may be caused by osteoporotic vertebral fractures (VFs). These impairments may affect motor function, and consequently increase the risk of falling and fractures. The aim of the current study was therefore to examine postural control during walking in elderly patients with FP, and to investigate the relationship with geriatric phenomena that may cause FP, such as increased TK, VFs, frailty, polypharmacy and cognitive impairments. Fifty-six elderly patients (aged 80 ± 5.2 years; 70% female) walked 160 m at self-selected speed while trunk accelerations were recorded. Walking speed, mean stride time and coefficient of variation (CV) of stride time were recorded. In addition, postural control during walking was quantified by time-dependent variability measures derived from the theory of stochastic dynamics, indicating smoothness, degree of predictability, and local stability of trunk acceleration patterns. Twenty-five patients (45%) had FP and demonstrated a more variable and less structured gait pattern, and a more irregular trunk acceleration pattern than patients with normal posture. FP was significantly associated with an increased TK, but not with other geriatric phenomena. An increased TK may bring the body's centre of mass forward, which requires correcting responses, and reduces the ability to respond on perturbation, which was reflected by higher variation in the gait pattern in FP-patients. Impairments in postural control during walking are a major risk factor for falling: the results indicate that patients with FP have impaired postural control during walking and might therefore be at increased risk of falling.
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- 2014
14. Gait in patients with symptomatic osteoporotic vertebral compression fractures over 6 months of recovery.
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Jacobs, Eva, McCrum, Christopher, Senden, Rachel, van Rhijn, Lodewijk W., Meijer, K., and Willems, Paul C.
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ALGORITHMS ,COMPARATIVE studies ,CONVALESCENCE ,DIAGNOSIS ,ACCIDENTAL falls ,BONE fractures ,GAIT in humans ,OSTEOPOROSIS ,VERTEBRAL fractures ,VIRTUAL reality ,TREADMILLS ,COMPRESSION fractures - Abstract
Background: One factor related to disability in people with spinal deformity is decreased postural control and increased risk of falling. However, little is known about the effect of osteoporotic vertebral compression fractures (OVCFs) and their recovery on gait and stability. Walking characteristics of older adults with and without vertebral fractures have not yet been compared. Aims: The purpose of the current study was to examine the spatiotemporal gait parameters and their variability in patients with an OVCF and healthy participants during treadmill walking at baseline and after 6 months of recovery. Methods: Twelve female patients suffering a symptomatic OVCF were compared to 11 matched controls. Gait analysis was performed with a dual-belt instrumented treadmill with a 180° projection screen providing a virtual environment (computer-assisted rehabilitation environment). Results of patients with an OVCF and healthy participants were compared. Furthermore, spatiotemporal gait parameters were assessed over 6 months following the fracture. Results: Patients suffering from an OVCF appeared to walk with significantly shorter, faster and wider strides compared to their healthy counterparts. Although stride time and length improved over time, the majority of the parameters analysed remained unchanged after 6 months of conservative treatment. Discussion: Since patients do not fully recover to their previous level of mobility after 6 months of conservative treatment for OVCF, it appears of high clinical importance to add balance and gait training to the treatment algorithm of OVCFs. Conclusions: Patients suffering from an OVCF walk with shorter, faster and wider strides compared to their healthy counterparts adopt a less stable body configuration in the anterior direction, potentially increasing their risk of forward falls if perturbed. Although stride time and stride length improve over time even reaching healthy levels again, patients significantly deviate from normal gait patterns (e.g. in stability and step width) after 6 months of conservative treatment. [ABSTRACT FROM AUTHOR]
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- 2020
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15. Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study
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Maartje H. de Groot, Claudine J. C. Lamoth, Willem F. Lems, Jos P. C. M. van Campen, Hanna C. van der Jagt-Willems, SMART Movements (SMART), Movement Disorder (MD), Personalized Healthcare Technology (PHT), Rheumatology, MOVE Research Institute, AMS - Amsterdam Movement Sciences, and Geriatrics
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Posture ,Kyphosis ,Poison control ,Falls in older adults ,Thoracic Vertebrae ,Cohort Studies ,Physical medicine and rehabilitation ,Risk Factors ,OSTEOPOROTIC FRACTURES ,Epidemiology ,STRENGTH ,medicine ,Humans ,EPIDEMIOLOGY ,Prospective Studies ,Prospective cohort study ,RANCHO-BERNARDO ,Aged ,Aged, 80 and over ,Rehabilitation ,business.industry ,MORTALITY ,WOMEN ,medicine.disease ,PREVENTION ,body regions ,medicine.anatomical_structure ,Thoracic kyphosis ,Vertebral fractures ,Older adults ,Thoracic vertebrae ,Physical therapy ,RISK-FACTORS ,Spinal Fractures ,Flexed posture ,Accidental Falls ,Female ,Falls ,Geriatrics and Gerontology ,HYPERKYPHOTIC POSTURE ,business ,FOLLOW-UP ,Research Article ,Cohort study - Abstract
Background: Vertebral fractures, an increased thoracic kyphosis and a flexed posture are associated with falls. However, this was not confirmed in prospective studies. We performed a prospective cohort study to investigate the association between vertebral fractures, increased thoracic kyphosis and/or flexed posture with future fall incidents in older adults within the next year.Methods: Patients were recruited at a geriatric outpatient clinic. Vertebral fractures were evaluated on lateral radiographs of the spine with the semi-quantitative method of Genant; the degree of thoracic kyphosis was assessed with the Cobb angle. The occiput-to-wall distance was used to determine a flexed posture. Self-reported falls were prospectively registered by monthly phone contact for the duration of 12 months.Results: Fifty-one older adults were included; mean age was 79 years (SD = 4.8). An increased thoracic kyphosis was independently associated with future falls (OR 2.13; 95% CI 1.10-4.51). Prevalent vertebral fractures had a trend towards significancy (OR 3.67; 95% CI 0.85-15.9). A flexed posture was not significantly associated with future falls.Conclusion: Older adults with an increased thoracic kyphosis are more likely to fall within the next year. We suggest clinical attention for underlying causes. Because patients with increased thoracic curvature of the spine might have underlying osteoporotic vertebral fractures, clinicians should be aware of the risk of a new fracture.
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- 2015
16. Response to letter to the editor, regarding "The association between hyperkyphosis and fall incidence among community-dwelling adults".
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Koelé, Marije C., Willems, Hanna C., and van der Velde, Nathalie
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AGE distribution , *COGNITION , *KYPHOSIS , *ACCIDENTAL falls , *VISION disorders , *BONE fractures , *DISEASE risk factors , *DISEASE complications , *OLD age - Published
- 2022
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17. The role of the combination of bone and fall related risk factors on short-term subsequent fracture risk and mortality
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Piet Geusens, Paul C. Willems, Tineke A. C. M. van Geel, Kirsten M.B. Huntjens, Joop P. W. van den Bergh, Bjorn Winkens, Peter R. Brink, Svenhjalmar van Helden, Surgery, Family Medicine, Interne Geneeskunde, Orthopedie, FHML Methodologie & Statistiek, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, and RS: CAPHRI School for Public Health and Primary Care
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,VERTEBRAL FRACTURES ,genetic structures ,Sports medicine ,Poison control ,GUIDELINES ,Fractures, Bone ,Rheumatology ,Risk Factors ,Internal medicine ,OSTEOPOROTIC FRACTURE ,Epidemiology ,IMPLEMENTATION ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,skin and connective tissue diseases ,Prospective cohort study ,Aged ,Aged, 80 and over ,business.industry ,Proportional hazards model ,Hazard ratio ,Orthopedics ,MEN ,Middle Aged ,Confidence interval ,Surgery ,POSTMENOPAUSAL WOMEN ,Orthopedic surgery ,Accidental Falls ,Female ,business ,Follow-Up Studies ,Research Article - Abstract
Background: We analysed whether a combination of bone-and fall-related risk factors (RFs) in addition to a recent non-vertebral fracture (NVF) contributed to subsequent NVF risk and mortality during 2-years in patients who were offered fall and fracture prevention according to Dutch fracture-and fall-prevention guidelines.Methods: 834 consecutive patients aged >= 50 years with a recent NVF who were included. We compared subgroups of patients according to the presence of bone RFs and/or fall RFs (group 1: only bone RFs; group 2: combination of bone and fall RFs; group 3: only fall RFs; group 4: no additional RFs). Univariable and multivariable Cox regression analyses were performed adjusted for age, sex and baseline fracture location (major or minor).Results: 57 (6.8%) had a subsequent NVF and 29 (3.5%) died within 2-years. Univariable Cox regression analysis showed that patients with the combination of bone and fall RFs had a 99% higher risk in subsequent fracture risk compared to all others (Hazard Ratio (HR) 1.99; 95% Confidence Interval (CI) 1.18-3.36) Multivariable analyses this was borderline not significant (HR 1.70; 95% CI: 0.99-2.93). No significant differences in mortality were found between the groups.Conclusion: Evaluation of fall RFs contributes to identifying patients with bone RFs at highest immediate risk of subsequent NVF in spite of guideline-based treatment. It should be further studied whether earlier and immediate prevention following a NVF can decrease fracture risk in patients with a combination of bone and fall RFs.
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- 2013
18. Identifying fallers with Parkinson's disease using home-based tests: who is at risk?
- Author
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Alice Nieuwboer, Katherine Baker, Gert Kwakkel, Anne Marie Willems, Diana Jones, I. Lim, Vicki Hetherington, Lynn Rochester, Erwin E. H. van Wegen, Medical oncology, MOVE Research Institute, VU University medical center, and Research Institute MOVE
- Subjects
Adult ,Male ,Risk ,medicine.medical_specialty ,Multivariate statistics ,Multivariate analysis ,Activities of daily living ,Parkinson's disease ,Adolescent ,In Vitro Techniques ,Logistic regression ,Young Adult ,SDG 3 - Good Health and Well-being ,Rating scale ,Activities of Daily Living ,medicine ,Humans ,Gait Disorders, Neurologic ,Balance (ability) ,Aged ,Aged, 80 and over ,Neurologic Examination ,business.industry ,Parkinson Disease ,Middle Aged ,medicine.disease ,Gait ,Neurology ,Multivariate Analysis ,Physical therapy ,Accidental Falls ,Female ,Neurology (clinical) ,business - Abstract
The objective of this work is to determine risk factors for falling in patients with Parkinson's disease (PD) using home-based assessments and develop a prediction model. Data on falls, balance, gait-related activities, and nonmotor symptoms were obtained from 153 PD patients (Hoehn-Yahr 2-4) in their home. Fifty-one candidate determinants for falling were independently tested using bivariate logistic regression analysis. A multivariate logistic regression model was developed to identify patients susceptible to falls. Sixty-six subjects (43%) were classified as fallers. Eighteen determinants for falling were selected. The final multivariate model showed an accuracy of 74% and included: (1) Freezing of Gait Questionnaire, (2) Timed Get Up and Go (TGUG) score, (3) disease duration, (4) item 15 of the Unified Parkinson's Disease Rating Scale. Based on disease duration, freezing symptoms, walking problems, and a prolonged TGUG duration, assessed in the home situation, it was possible to accurately identify 74% of PD patients as fallers. © 2008 Movement Disorder Society.
- Published
- 2008
19. Risk of falling in patients with a recent fracture
- Author
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Peter R. Brink, Pieter C. Dagnelie, Caroline E. Wyers, Svenhjalmar van Helden, Piet Geusens, Martien C. J. M. van Dongen, Gittie Willems, Algemene Heelkunde, Epidemiologie, Interne Geneeskunde, RS: NUTRIM School of Nutrition and Translational Research in Metabolism, RS: CAPHRI School for Public Health and Primary Care, and RS: NUTRIM - R2 - Gut-liver homeostasis
- Subjects
Male ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Osteoporosis ,Poison control ,Fractures, Bone ,Hypotension, Orthostatic ,Rheumatology ,Risk Factors ,Internal medicine ,Epidemiology ,Activities of Daily Living ,medicine ,Humans ,Orthopedics and Sports Medicine ,Risk factor ,Sex Distribution ,Aged ,Polypharmacy ,Aged, 80 and over ,business.industry ,Incidence (epidemiology) ,Incidence ,Odds ratio ,Middle Aged ,medicine.disease ,Multivariate Analysis ,Physical therapy ,Accidental Falls ,Female ,lcsh:RC925-935 ,business ,Fall prevention ,Follow-Up Studies ,Research Article - Abstract
Background Patients with a history of a fracture have an increased risk for future fractures, even in short term. The aim of this study was to assess the number of patients with falls and to identify fall risk factors that predict the risk of falling in the first three months after a clinical fracture. Methods Prospective observational study with 3 months of follow-up in a large European academic and regional hospital. In 277 consenting women and men aged ≥ 50 years and with no dementia and not receiving treatment for osteoporosis who presented to hospital with a clinical fracture, fall risk factors were assessed according to the guidelines on fall prevention in the Netherlands. Follow-up information on falls and fractures was collected by monthly telephone interview. Incidence of falls and odds ratio's (OR, with 95% confidence intervals) were calculated. Results 512 consecutive patients with a fracture were regarded for analysis, 87 were not eligible for inclusion and 137 patients were excluded. No follow-up data were available for 11 patients. Therefore full analysis was possible in 277 patients. A new fall incident was reported by 42 patients (15%), of whom five had a fracture. Of the 42 fallers, 32 had one new fall and 10 had two or more. Multivariate analysis in the total group with sex, age, ADL difficulties, urine incontinence and polypharmacy showed that sex and ADL were significant fall risk factors. Women had an OR of 3.02 (95% CI 1.13–8.06) and patients with ADL-difficulties had an OR of 2.50 (95% CI 1.27–4.93). Multivariate analysis in the female group with age, ADL difficulties, polypharmacy and presence of orthostatic hypotension indicated that polypharmacy was the predominant risk factor (OR 2.51; 95% CI: 1.19 – 5.28). The incidence of falls was 35% in women with low ADL score and polypharmacy compared to 15% in women without these risk factors (OR 3.56: CI 1.47 – 8.67). Conclusion 15% of patients reported a new fall and 5 patients suffered a new fracture within 3 months. Female sex and low ADL score were the major risk factors and, in addition, polypharmacy in women.
- Published
- 2007
20. The risk of being fearful or fearless of falls in older people: an empirical validation
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Kim Delbaere, Tine Willems, Geert Crombez, Nele Van Den Noortgate, and Dirk Cambier
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Risk ,medicine.medical_specialty ,Aging ,Activities of daily living ,Frail Elderly ,Poison control ,Suicide prevention ,Fear of falling ,Occupational safety and health ,Physical medicine and rehabilitation ,Surveys and Questionnaires ,Injury prevention ,Activities of Daily Living ,medicine ,Postural Balance ,Humans ,Muscle Strength ,Balance (ability) ,Aged ,Rehabilitation ,Fear ,Middle Aged ,Research Design ,Regression Analysis ,Accidental Falls ,medicine.symptom ,Psychology ,Psychomotor Performance - Abstract
To investigate the risk of being fearful or fearless of falls in older people.Using a force plate, postural control in different sensory and rhythmic conditions was measured in 263 community-dwelling older people. Other assessments included fear of falling, and handgrip strength. Fall incidence was assessed at baseline and during a one-year follow-up period.Logistic regression analysis revealed that increased lateral sway in near-tandem stance with eyes open (OR = 5.33; p0.01) and a worse performance on anteroposterior rhythmic weight shifts (OR = 0.65; p0.05) were related to falls. Univariate analyses revealed that older people with inappropriate high fear of falling according to their fall incidence had worse balance capacities on the rhythmic weight shifts (p0.05) but had similar static balance and physical capacities. Older people with inappropriate low fear of falling had a better hand grip (p0.05) but equally worse balance capacities than the comparison group.The results indicate the importance of lateral stability in relation to falls. They also suggest a substantial impact of inappropriate fear of falling on physical performance. Inappropriate high fear of falling may result in worse performance during dynamic balance tests, whereas older people with inappropriate low fear seem to overrate their capacities because of higher strength.
- Published
- 2006
21. The Physical Performance Test as a predictor of frequent fallers: a prospective community-based cohort study
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Nele Van Den Noortgate, Jan Bourgois, Kim Delbaere, Dirk Cambier, Willems Tine, and Guy Vanderstraeten
- Subjects
Male ,medicine.medical_specialty ,Poison control ,Physical Therapy, Sports Therapy and Rehabilitation ,Logistic regression ,Fear of falling ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Medicine ,Humans ,Mass Screening ,Prospective Studies ,Prospective cohort study ,Geriatric Assessment ,Mass screening ,Balance (ability) ,Aged ,business.industry ,Rehabilitation ,Odds ratio ,Models, Theoretical ,Logistic Models ,030221 ophthalmology & optometry ,Physical therapy ,Accidental Falls ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Psychomotor Performance ,Cohort study - Abstract
Objective: To construct a risk model in order to identify elderly individuals at risk of frequent falling. Design: Prospective community-based cohort study over 12 months. Setting: Baseline measures were performed at a local community centre. Subjects: Two hundred and sixty-three community-dwelling elderly people (mean age 72 years). Measurements: A variety of variables were evaluated, including medical, psychological, sensory, physical and postural control measurements. Fall incidence was monitored retrospectively and during one-year follow-up. Results: Logistic regression analysis showed that polypharmacia was the most prominent medical fall predictor with an odds ratio (OR) of 1.29 (P =0.005), poor visual acuity the best sensory predictor (OR=0.84; P =0.009) and general fear of falling the most crucial psychological predictor (OR=3.25; P B=0.001). Increased postural sway in near-tandem stance with eyes open was selected as the best balance predictor for falls (OR=5.60; P =0.010), followed by delayed anteroposterior movement velocity during rhythmic weight shifts (OR=0.42; P =0.004). The best physical predictor was a low score on the Physical Performance Test (OR=4.16; P Conclusion: This study confirms the multicausality of falls, since medical, psychological, sensory, postural control as well as physical variables provides a predictive value. The composed fall risk model was mainly physically oriented.
- Published
- 2006
22. Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study
- Author
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Kim Delbaere, Guy Vanderstraeten, Dirk Cambier, Geert Crombez, and Tine Willems
- Subjects
Gerontology ,Male ,Aging ,medicine.medical_specialty ,Activities of daily living ,Frail Elderly ,Poison control ,Motor Activity ,Logistic regression ,Fear of falling ,Occupational safety and health ,Cohort Studies ,Physical medicine and rehabilitation ,Sex Factors ,Injury prevention ,Activities of Daily Living ,medicine ,Humans ,Prospective Studies ,Balance (ability) ,Aged ,business.industry ,Muscles ,General Medicine ,Fear ,Logistic Models ,Accidental Falls ,Female ,Geriatrics and Gerontology ,medicine.symptom ,business ,Cohort study - Abstract
Objective: to investigate the relationship between fear-related avoidance of activities and physical frailty. Subjects and methods: fear-related avoidance of activities, physical performance, maximal isometric muscle strength and postural control were assessed in 225 community-living elderly (94 men and 131 women), aged between 61 and 92 years of age. Results: bivariate analyses revealed significant correlations between avoidance of activities on the one hand, and physical performance, muscle strength, forward endpoint excursion of the centre of gravity, and previous falls on the other hand. Logistic regression analysis revealed that fear of falling and avoidance of activities in daily life were predictive of falls within a 1-year follow-up, together with general fear of falling, old age and being female. Conclusions: fear-related avoidance of activities may have negative effects on physical abilities and may also be predictive for future falls. Avoidance of activities is therefore an important additional psychological variable in the development of physical frailty and falling in community-living elderly.
- Published
- 2004
23. Why do geriatric outpatients have so many moderate and severe vertebral fractures? Exploring prevalence and risk factors.
- Author
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van der Jagt-Willems, Hanna C., van Hengel, Marike, Vis, Marijn, van Munster, Barbara C., van Campen, Jos P. C. M., Tulner, Linda R., and Lems, Willem F.
- Subjects
- *
RISK factors of fractures , *CHEST X rays , *CHI-squared test , *COGNITION , *COGNITION disorders , *CONFIDENCE intervals , *DEMENTIA , *EPIDEMIOLOGY , *ACCIDENTAL falls , *BONE fractures , *LONGITUDINAL method , *LUMBAR vertebrae , *MULTIVARIATE analysis , *PROBABILITY theory , *SERUM albumin , *SPINAL injuries , *T-test (Statistics) , *U-statistics , *VITAMIN D , *COMORBIDITY , *DATA analysis , *BODY movement , *DISEASE prevalence , *SEVERITY of illness index , *DATA analysis software , *DESCRIPTIVE statistics , *INJURY risk factors - Abstract
Objectives: to determine the prevalence of vertebral fractures and their risk factors in geriatric patients.Design: prospective cohort study.Setting: teaching hospital in Amsterdam, The Netherlands.Subjects: three hundred and three geriatric patients, who had their first visit at a diagnostic day hospital between April and August 2007.Measurements: lateral X-rays of the lumbar spine and chest were performed; vertebral fractures were scored according to the semi-quantitative method of Genant by trained observers and compared with the official report of radiologists. Co-morbidity, reported falls, mobility and cognitive function were scored.Results: vertebral fractures were observed in 51% (156/303) of geriatric patients. Sixty-nine per cent (107/156) of these fractures were moderate to severe. In 21% (33/156) of the patients with a fracture, vertebral fractures were diagnosed on the lumbar spine X-ray alone. Patients with vertebral fractures had more previous non-vertebral fractures (odds ratio: 2.40 95% CI: 1.40–4.10), had lower serum albumin levels (OR: 0.92 95% CI: 0.87–0.97) and more current prednisone use (OR: 8.94 95% CI: 1.12–71.45). Co-morbidity and cognitive decline were not identified as risk factors. Radiologists reported vertebral fractures in 53% (82/156) of the cases.Conclusion: this study showed a very high prevalence of vertebral fractures in geriatric patients; particularly the high prevalence of moderate and severe fractures is remarkable. Because of this high prevalence, the routinely performed lateral X-ray of the chest should be used to look for vertebral fractures. An additional X-ray of the lumbar spine might be useful in patients without vertebral fractures on the chest X-ray. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
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24. The Physical Performance Test as a predictor of frequent fallers: a prospective community-based cohort study.
- Author
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Delbaere, Kim, Van den Noortgate, Nele, Bourgois, Jan, Vanderstraeten, Guy, Tine, Willems, and Cambier, Dirk
- Subjects
ACCIDENTAL falls ,OLDER people ,COMMUNITY centers ,DIAGNOSIS ,PSYCHOLOGICAL tests ,POSTURE disorders - Abstract
Objective: To construct a risk model in order to identify elderly individuals at risk of frequent falling. Design: Prospective community-based cohort study over 12 months. Setting: Baseline measures were performed at a local community centre. Subjects: Two hundred and sixty-three community-dwelling elderly people (mean age 72 years). Measurements: A variety of variables were evaluated, including medical, psychological, sensory, physical and postural control measurements. Fall incidence was monitored retrospectively and during one-year follow-up. Results: Logistic regression analysis showed that polypharmacia was the most prominent medical fall predictor with an odds ratio (OR) of 1.29 (P = 0.005), poor visual acuity the best sensory predictor (OR = 0.84; P = 0.009) and general fear of falling the most crucial psychological predictor (OR = 3.25; P < 0.001). Increased postural sway in near-tandem stance with eyes open was selected as the best balance predictor for falls (OR = 5.60; P = 0.010), followed by delayed anteroposterior movement velocity during rhythmic weight shifts (OR = 0.42; P = 0.004). The best physical predictor was a low score on the Physical Performance Test (OR = 4.16; P < 0.001), followed by decreased maximal handgrip strength (OR = 0.87; P < 0.001) and increased timed chair-stands (OR = 1.13; P = 0.003). Step-by-step regression analysis revealed a risk model for the prediction of future falls, as a combination of the Physical Performance Test and maximal handgrip strength. Conclusion: This study confirms the multicausality of falls, since medical, psychological, sensory, postural control as well as physical variables provides a predictive value. The composed fall risk model was mainly physically oriented. [ABSTRACT FROM AUTHOR]
- Published
- 2006
- Full Text
- View/download PDF
25. Effect of Exercise on Postural Sway in the Elderly
- Author
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Liliane Delaquerriere-Richardson, Keith C. Hayes, Karen J. Trenholm, Deborah A. Willems, and Richard G. Crilly
- Subjects
Aging ,medicine.medical_specialty ,genetic structures ,Posture ,Poison control ,Physical exercise ,Random Allocation ,Exercise program ,Activities of Daily Living ,Injury prevention ,Humans ,Medicine ,Force platform ,Exercise ,Gait ,Eyes open ,Aged ,Aged, 80 and over ,business.industry ,Postural stability ,Physical therapy ,Accidental Falls ,Female ,Geriatrics and Gerontology ,Nursing homes ,business - Abstract
Fifty female subjects, aged 72-92 (mean 82) years, were enrolled in a 12-week (36 classes) exercise program aimed at increasing postural stability. Subjects were residents of sheltered apartments, rest homes or nursing homes, well enough and mobile enough to participate in the classes. The subjects were randomized into an exercise or a control group. Their postural sway, standing at rest on a force platform, was measured with eyes open and eyes closed. The groups were well matched in all respects. The results showed no improvement in the postural sway as a result of the exercise program. We hypothesize that increasing postural sway in the elderly represents a deterioration in, for the most part, the nervous system and may at this extreme of life indicate an irreversible loss of function. For this reason no improvement in postural sway may be possible.
- Published
- 1989
26. Investigating the Effectiveness of Care Delivery at an Acute Geriatric Community Hospital for Older Adults in the Netherlands: A Prospective Controlled Observational Study.
- Author
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Ribbink, Marthe E., MacNeil Vroomen, Janet L., Franssen, Remco, Kolk, Daisy, Ben, Ângela Jornada, Willems, Hanna C., and Buurman, Bianca M.
- Subjects
- *
DEATH , *MEDICAL care , *GERIATRICS , *PATIENT readmissions , *HOSPITALS , *LONGITUDINAL method , *ODDS ratio , *CONFIDENCE intervals , *REGRESSION analysis , *ACCIDENTAL falls - Abstract
Hospital admission in older adults is associated with unwanted outcomes such as readmission, institutionalization, and functional decline. To reduce these outcomes, the Netherlands introduced an alternative to hospital-based care: the Acute Geriatric Community Hospital (AGCH). The AGCH is an acute care unit situated outside of a hospital focusing on early rehabilitation and comprehensive geriatric assessment. The objective of this study was to evaluate if AGCH care is associated with decreasing unplanned readmissions or death compared with hospital-based care. Prospective cohort study controlled with a historic cohort. A (sub)acute care unit (AGCH) and 6 hospitals in the Netherlands; participants were acutely ill older adults. We used inverse propensity score weighting to account for baseline differences. The primary outcome was 90-day readmission or death. Secondary outcomes included 30-day readmission or death, time to death, admission to long-term residential care, occurrence of falls and functioning over time. Generalized logistic regression models and multilevel regression analyses were used to estimate effects. AGCH patients (n = 206) had lower 90-day readmission or death rates [odds ratio (OR) 0.39, 95% CI 0.23-0.67] compared to patients treated in hospital (n = 401). AGCH patients had a lower risk of 90-day readmission (OR 0.38, 95% CI 0.21-0.67) but did not differ on all-cause mortality (OR 0.89, 95% CI 0.44-1.79) compared with the hospital control group. AGCH patients had lower 30-day readmission or death rates. Secondary outcomes did not differ. AGCH patients had lower rates of readmission and/or death than patients treated in a hospital. Our results support further research on the implementation and cost-effectiveness of AGCH in the Netherlands and other countries seeking alternatives to hospital-based care. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
27. A home-based multidimensional exercise program reduced physical impairment and fear of falling
- Author
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Tine Willems, Jan Bourgois, Dirk Cambier, N. Van Den Noortgate, Kim Delbaere, and Guy Vanderstraeten
- Subjects
Male ,Muscle Strength Dynamometer ,medicine.medical_specialty ,Activities of daily living ,Physical fitness ,Physical exercise ,Fear of falling ,law.invention ,Physical medicine and rehabilitation ,Randomized controlled trial ,law ,medicine ,Humans ,Dynamic balance ,Postural Balance ,Balance (ability) ,Aged ,Aged, 80 and over ,business.industry ,General Medicine ,Fear ,Exercise Therapy ,Physical Fitness ,Physical therapy ,Accidental Falls ,Female ,medicine.symptom ,business - Abstract
To investigate the efficacy of a guided and graded home-based exercise program for improving a range of physical outcomes in older people.Controlled clinical trial of 16 weeks.Two geographical areas in Gent, Belgium.66 independent-living older people (age: 71-98) with a history of falls and moderate physical impairment.Twenty-four 30-minute training sessions were given by a trained physiotherapist over a period of 16 weeks in the participant's home. Different types of exercises on balance, aerobic performance, flexibility, and muscle strength were provided.Muscle strength, static and dynamic balance, aerobic performance, activities in daily living, fear of falling and avoidance of daily activities were assessed at baseline and after 16 weeks intervention.At baseline, there were no significant differences in the measured variables between exercise and control groups. After 16 weeks, the exercise group showed significantly improved ankle muscle strength, balance performance and aerobic capacity, and decreased fear of falling, dependency in daily activities and avoidance of daily activities compared to the control group. The improvements in knee muscle strength, timed chair stands, and functional reach were not significant.The home-based, individualized exercise program was effective in reducing several physical factors associated with falls in community-dwelling older people with moderate physical impairment. The decrease in fear of falling and other behavioural variables needs to be considered with care and needs further investigation.
28. Thoracic vertebral fractures and hyperkyphosis in elderly patients with end-stage kidney disease; do these patients have different clinical outcomes?
- Author
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Goto, N.A., Koelé, M.C., van Loon, I.N., Boereboom, F.T.J., Verhaar, M.C., Emmelot-Vonk, M.H., Hamaker, M.E., and Willems, H.C.
- Subjects
- *
CHRONIC kidney failure , *OLDER patients , *CHEST X rays , *HEMODIALYSIS patients , *ACCIDENTAL falls - Abstract
Elderly patients with end-stage kidney disease (ESKD) are at high risk for fractures. However, the prevalence of vertebral fractures and hyperkyphosis is not studied well. This is relevant, because in the general population, both vertebral fractures and hyperkyphosis are associated with poor outcome. Therefore, the primary aim of our study was to assess the prevalence of vertebral fractures and hyperkyphosis in the ESKD population. The secondary aim was to assess if patients with vertebral fractures and/or hyperkyphosis more often have poor outcome after starting dialysis, such as accidental falling, functional decline and mortality compared to the patients without vertebral fractures and/or hyperkyphosis. This study included patients ≥65 years with ESKD who were enrolled in the Geriatric assessment in Older patients starting Dialysis (GOLD) study of whom a lateral chest radiograph was available. Chest radiographs were scored independently by two observers for vertebral fractures (Genant ≥1) and hyperkyphosis (≥50 degrees). The relation between vertebral fractures and hyperkyphosis with clinical outcomes (falls, decline in ADL and IADL, mortality) was studied using the Chi-square test. Of the 196 enrolled patients, chest radiographs were available for 160 patients. Mean age was 75.3 (SD ±6.9), and 35% were female. The prevalence of vertebral fractures was 43% and of hyperkyphosis 22%. Patients with hyperkyphosis had a higher one-year mortality compared to patients without hyperkyphosis (20% vs. 8%, p = 0.04). No differences were observed between patients with and without hyperkyphosis, vertebral fractures and the remaining outcomes after six months of follow-up. In patients ≥65 years old with ESKD starting dialysis, vertebral fractures are highly prevalent. In contrast to the general population, patients with vertebral fractures did experience poor outcome as often as patients without vertebral fractures. Remarkably, patients with hyperkyphosis did have a higher one-year mortality. However, these patients did not experience more functional decline or accidental falls. • 43% of incident dialysis patients had prevalent vertebral fractures • 22% of incident dialysis patients had hyperkyphosis • 16% of incident dialysis patients had both vertebral fractures and hyperkyphosis • Hyperkyphosis is associated with a higher one year mortality • No association was seen between vertebral fractures and falls, functional decline and mortality [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
29. A pilot study on the feasibility and effectiveness of treadmill-based perturbations for assessing and improving walking stability in chronic obstructive pulmonary disease.
- Author
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McCrum, Christopher, Vaes, Anouk W., Delbressine, Jeannet M., Koopman, Maud, Liu, Wai-Yan, Willems, Paul, Meijer, Kenneth, and Spruit, Martijn A.
- Subjects
- *
THERAPEUTICS , *PILOT projects , *MEDICAL rehabilitation , *GAIT in humans , *POSTURAL balance , *LUNG diseases , *TREADMILLS , *OBSTRUCTIVE lung diseases , *WALKING , *BODY movement , *ACCIDENTAL falls , *MOTION capture (Human mechanics) - Abstract
Falls risk is elevated in chronic obstructive pulmonary disease (COPD). However, there is a lack of evidence regarding the contributing factors. Here, we examined the feasibility of, and initial responses to, large walking perturbations in COPD, as well as the adaptation potential of people with COPD to repeated walking perturbations that might indicate potential for perturbation-based balance training in COPD. 12 participants with COPD undergoing inpatient pulmonary rehabilitation and 12 age-gender-matched healthy control participants walked on an instrumented treadmill and experienced repeated treadmill-belt acceleration perturbations (leading to a forward balance loss). Three-dimensional motion capture was used to quantify the stability of participants body position during perturbed walking. Feasibility, stability following the initial perturbations and adaptation to repeated perturbations were assessed. Using perturbations in this manner was feasible in this population (no harness assists and participants completed the minimum number of perturbations). No clear, specific deficit in reactive walking stability in COPD was found (no significant effects of participant group on stability or recovery step outcomes). There were mixed results for the adaptability outcomes which overall indicated some adaptability to repeated perturbations, but not to the same extent as the healthy control participants. Treadmill-based perturbations during walking are feasible in COPD. COPD does not appear to result in significant deficits in stability following sudden perturbations and patients do demonstrate some adaptability to repeated perturbations. Perturbation-based balance training may be considered for fall prevention in research and practice in people with COPD. • Treadmill-based gait perturbations are feasible in people with COPD. • People with COPD do not show large deficits in reactive gait stability. • People with COPD demonstrate some but reduced adaptability to perturbations. • Perturbation-based balance training may be considered for people with COPD. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
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