Fear of Falling Linked to Future Falls in Elderly

August 20, 2010 — Seniors who have an irrationally high fear of falling are at increased risk for future falls, irrespective of their actual physiological risk, according to a new study published online today by the British Medical Journal.

"Both falls and fear of falls can substantially reduce quality of life and independence and so contribute to the placement of an elderly person into institutionalized care," write Kim Delbaere, PhD, from the University of New South Wales, Sydney, Australia, and colleagues. "However, the complex nature of psychological risk factors for falling and the limited background information on this phenomenon hamper its inclusion in falls prevention programmes."

Excessive fear of falling can cause seniors to limit their participation in physical and social activities, so that they become physically deconditioned, socially isolated, and depressed. In contrast, an inappropriately low fear of falling can cause seniors to take risks that are beyond their true ability to cope, the authors write.

The aim of this study was to expand understanding about irrational fear — either too much or too little — and to study its effect on the risk for future falls.

The study included 500 seniors aged 70 to 90 years living in Sydney. Their mean age was 77.9 years, and 54% were women. All underwent extensive medical, physiological, and neuropsychological assessment.

The investigators used the Physiological Profile Assessment (PPA) to determine participants' physiological (actual) fall risk and the Falls Efficacy Scale International to determine their perceived risk of falling. Participants were followed up monthly for falls for 1 year.

The researchers found that actual and perceived fall risk were both independent predictors of future falls. The risk for falls significantly increased with a higher PPA score (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.06 - 1.61; P = .011) and a higher Falls Efficacy Scale International score (OR, 1.05; 95% CI, 1.02 - 1.08; P = .001).

The researchers then split the study participants into 4 groups — vigorous, anxious, stoic, and aware — according to the disparity between their actual and perceived risk.

Most of the participants had an accurate perception of their risk of falling. Those in the vigorous group, who had low actual and perceived fall risk, were considered at low risk for future significant falls, and those in the aware group, who had high actual and perceived fall risk, were deemed to be at high risk for future significant falls.

However, about a third of the study cohort either underestimated or overestimated their risk for falls.

The anxious group had a low actual risk but high perceived risk; this was related to depressive symptoms (P = .029), neurotic personality traits (P =.026), and decreased executive functioning (P = .010).

In contrast, the stoic group had a high actual but low perceived fall risk, which was protective against falling and was related through a positive outlook on life (P = .001) and continuation of physical activity and community participation (P = .048).

"Overall, it seems that high levels of perceived fall risk may lead to future falls, independent of physiological risk, and that the disparity between physiological and perceived fall risk contributes to fall risk mainly through psychological pathways," the study authors write. "This indicates that measures of both physiological and perceived fall risk should be included in fall risk assessments."

Limitations of the study include the use of the PPA, which is an estimate and may result in measurement error, and the fact that the data used to develop the psychological profiles of the participants were self-reported, the authors note. Also, the population studied were healthy community-dwelling elders; results, therefore, cannot be generalized to those with cognitive impairment or others at particularly high risk of falling such as patients with Parkinson’s disease.

They conclude that fall risk assessments should include measures of both actual and perceived risk, and that this may assist in designing specific interventions to prevent falls in the elderly.

The study was supported by the Australian National Health and Medical Research Council.

Green leafy veg 'may cut diabetes risk'

A diet rich in green leafy vegetables may reduce the risk of developing diabetes, UK research says.

In an analysis of six studies into fruit and vegetable intake, only food including spinach and cabbage was found to have a significant positive effect.

A portion and a half a day was found to cut type 2 diabetes risk by 14%, the British Medical Journal (BMJ) reports.

But experts urged people to continue to aim for five portions of fruit and vegetables a day.
The researchers from Leicester University reviewed data from the studies of 220,000 adults in total.

They found that eating more fruit and vegetables in general was not strongly linked with a smaller chance of developing type 2 diabetes but "there was a general trend in that direction".

Yet when it came to green leafy vegetables, which the researchers said also includes broccoli and cauliflower, the risk reduction was significant.

The team calculated that a daily dose of 106g reduced the risk of diabetes by 14% - a UK "portion" is classed as 80g.

It is not clear why green leafy vegetables may have a protective effect but one reason may be they are high in antioxidants, such as vitamin C and another theory is that they contain high levels of magnesium.

Study leader Professor Melanie Davies, professor of diabetic medicine at the University of Leicester, said the message to eat five portions of fruit and vegetables a day remains an important one.

But she added: "People like very specific health messages.

"We know that intake of fruit and vegetables is important, but this study suggests that green leafy vegetables seem to be particularly important in terms of preventing diabetes."

The team are now planning a study in people at high risk of developing the condition to see if increasing their intake of vegetables like spinach and kale can help to reduce their chances of being diagnosed with diabetes.

Fruit and veg

In 2008/09, the National Diet Nutrition Survey showed that, although fruit and vegetable intake has risen over the past decade, only a third of men and women eat the recommended five-a-day.

In an accompanying editorial in the BMJ, Professor Jim Mann from the University of Otago in New Zealand, stressed that the message of increasing overall fruit and vegetable intake must not be lost "in a plethora of magic bullets," even though green leafy vegetables clearly can be included as one of the daily portions.

Dr Iain Frame, director of research at Diabetes UK said: "We already know that the health benefits of eating vegetables are far-reaching but this is the first time that there has been a suggested link specifically between green leafy vegetables and a reduced risk of developing type 2 diabetes."

But he warned the evidence was limited and it was too early to isolate green leafy vegetables and present them alone as a method to cut the chances of developing the condition.

"We would be concerned if focusing on certain foods detracted from the advice to eat five portions of fruits and vegetables a day, which has benefits in terms of reducing heart disease, stroke, some cancers and obesity as well as type 2 diabetes."

Diabetes UK is currently funding research into whether fermentable carbohydrates found in foods such as asparagus, garlic, chicory and Jerusalem artichokes could help weight loss and prevent Type 2 diabetes.

Blood Test for Right Blood Pressure Meds

CHICAGO, Aug 18 (Reuters) - Tests for a blood-pressure regulating hormone called renin may help doctors decide which blood pressure drugs their patients should take, researchers said on Wednesday. They said a mismatch between drugs and patient characteristics may help explain why many people do not benefit from blood pressure drugs, and testing for renin levels may help. "The one-size-fits-all approach must be abandoned," said Dr. Curt Furberg of Wake Forest University School of Medicine in North Carolina, who wrote a commentary on the studies in the American Journal of Hypertension. Currently, fewer than half of patients are helped when they take just one blood pressure drug, and many must take more than one to keep blood pressure down. A study in May in the Journal of the American Medical Association found that about half of the 65 million people in the United States with high blood pressure have it under control. Furberg said researchers have known for years that patients respond differently to different drugs for high blood pressure, yet this has not translated into tests and strategies that help find the best treatments for individual patients. In a series of studies in the same journal, three research teams looked at different aspects of this problem. Stephen Turner and colleagues of the Mayo Clinic in Rochester, Minnesota, found that blood tests measuring for renin, a hormone produced in the kidney, can help guide doctors in selecting blood pressure drugs. Patients who had high levels of renin were more likely to respond to the common beta blocker atenolol and less likely to respond to hydrochlorothiazide, a diuretic used to rid the body of unneeded water and salt. A team led Michael Alderman of Albert Einstein College of Medicine in New York and colleagues found that some peopletaking blood pressure drugs actually have an increase in their systolic blood pressure -- the top blood pressure reading. This was more common in people with low renin levels who were given a calcium channel blocker or an ACE inhibitor. And a third study by Ajay Gupta of Imperial College London found that blacks were less likely than whites to respond to anti-renin drugs. Furberg says the findings suggest the need for new guidelines for treating high blood pressure that incorporate tests to measure a patient's renin levels. Morris Brown of Britain's University of Cambridge said in a commentary that it may be useful to identify patients with extremely high or low renin levels who may not benefit from standard combination of drugs. Brown said it may be time to consider measuring renin as a part of routine care for high blood pressure. High blood pressure, or too much force exerted by blood as it moves against vessel walls, is the second-leading cause of death in the United States. About $73 billion is spent per year in the United States treating it.

Predictive blood test for TB 'a step closer'

International researchers say they have made a "significant step" towards a predictive blood test for tuberculosis.

A DNA fingerprint in the blood shows promise in identifying which carriers of TB will go on to get symptoms and spread the infection.

Such a test would allow earlier diagnosis and treatment of the lung disease, potentially saving many lives.

Experts say the research, published in Nature, is "remarkable" but needs to be proven by further work.

Tuberculosis, or TB, is an infectious bacterial disease of the lungs, causing symptoms such as coughing, chest pains and weight loss.

Someone in the world is newly infected with TB every second, with nearly two million deaths each year.

Only around one in 10 people infected with TB go on to develop the active form of disease.

Currently, although a skin or blood test can show if someone is harbouring TB, but not showing symptoms, it is impossible to predict who will get the full-blown disease.

Researchers from the UK, US and South Africa examined the genetic signature in the blood of patients with active TB.

The same genetic markers were found in about 10% of patients with latent infections, suggesting they are candidates for the full-blown form of the disease.

These patients will now be followed up in the future, to see if they do go on to get symptoms.

Promise

Lead researcher Dr Anne O'Garra of the MRC's National Institute for Medical Research in London, said the blood test showed promise but needed further work.

She told the BBC: "If you could predict which so-called carriers of TB will progress to the full-blown disease, this would have major ramifications for stopping the global epidemic.

"We just have to prove it now, but it's very promising."

Mike Mandelbaum, chief executive of the charity TB Alert, said good progress had been made in the diagnosis of latent TB infection in recent years, but there was a need for a specific test for the active disease.

The diagnosis of TB is often difficult to make until the disease has become infectious to others, he said, particularly in the developing world which has fewer resources.

"A new diagnostic technique based on a blood test would be extremely valuable to save lives and prevent the spread of this disease," he said, "and may be particularly important in HIV positive patients with TB where the usual technique of diagnosis from sputum is often unhelpful."

Dr Marc Lipman, chairman of the TB special advisory group at the British Thoracic Society, said it was "a remarkable piece of research".

He explained: "This for the first time perhaps enables us to start to design tests which can predict who is at highest risk of progressing to active disease and also how we might stop that occurring in the first place.

"Any such advance is 20-30 years away," he added.

Heart Attack, Stroke-Prone Arteries More Common in Nasty People

People with antagonistic or disagreeable personalities have thicker arterial walls that may make them more prone to heart attacks and strokes, researchers said. The carotid artery lining was significantly thicker in people who rated low on a scale of agreeableness, reported Angelina Sutin of the National Institute on Aging in Bethesda, Md., and colleagues. In a study of 5,614 residents of the Italian island of Sardinia, those ranking in the lowest 10 percent of agreeableness were 1.4 times as likely to have thickening in their lining of their carotid artery, the researchers found. This held true even after the researchers adjusted for cholesterol levels, smoking status and other risk factors. The researchers also found that an antagonistic personality predicted increased thickening over approximately three years of follow-up.Previous studies have linked cardiovascular disease with certain personality types, notably the hard-charging "Type A" personality. Subsequent research showed that hostility was a major contributor to these findings, Sutin and colleagues reported.

They also cited some earlier studies linking various antisocial behavior patterns to arterial thickening. But these focused on specific populations, including poor young adults, women transitioning to menopause and men with untreated high blood pressure.

"Large, population-based samples are needed to test whether these associations hold across different demographic groups," Sutin and colleagues wrote.
Their sample came from an ongoing, prospective study in Sardinia designed to uncover genetic and environmental factors associated with complex and age-related health problems. Approximately 62 percent of the population in four towns has participated in the study.

One of the questionnaires included in the study was the Revised NEO Personality Inventory (Italian translation), a self-assessment that includes 48 items covering six traits associated with agreeableness: trust, straightforwardness, altruism, compliance, modesty, and tendermindedness. Each is rated on a five-point scale from "strongly agree" to "strongly disagree."

Carotid artery thickening was assessed by ultrasound at the time of enrollment and approximately three years later. The follow-up measurement was performed in 83 percent of participants.

Other risk factors included in the statistical analysis were age, sex, education, waist circumference, systolic and diastolic blood pressure, LDL and HDL cholesterol, triglycerides, fasting plasma glucose and insulin, smoling status, and use of antihypertensive, statin, or diabetic medications.

Sutin and colleagues found that agreeableness scores were significantly associated with initial arterial thickness and with changes during the three-year follow-up. The specific traits of straightforwardness and compliance were most strongly associated with the arterial thickness.
On the other hand, when the researchers looked at the risk of being in the top quartile of arterial thickness, high agreeableness scores did not appear to have a protective effect in participants from either gender.

Dr. Redford Williams of Duke University in Durham, N.C., who was not involved with the study, commented that the findings highlight the largely unappreciated role of psychological factors in cardiovascular disease risk.

"Psychological and social factors are just as strong, as this study clearly documented, in putting people at higher risk of heart disease and other health problems," he said in an interview.

Williams noted the degree of cardiovascular event risk suggested by the study findings as associated with antagonistic personality traits was comparable to that of high LDL cholesterol, hypertension, or smoking.

"We really need, in this country and around the world, to begin to focus on ameliorating the effect of psychosocial risk factors just as we are on the physical risk factors," he said.

He suggested that patients with these traits should consider anger-management training, though he cautioned that cardiovascular benefits remain uncertain.

"I think we need the clinical trials -- carefully done, randomized clinical trials -- to make sure the kinds of anger-management training we might employ really are not only reducing anger, but reducing the rate of disease development. That's the gold standard we have to hit," Williams said.

But he adds, "It's certainly not going to hurt you to learn how to manage anger better."

Women beer drinkers 'increase psoriasis risk'

Women who drink beer regularly are more likely to develop the skin disease psoriasis, a US study suggests.

The study found that women who drank five beers a week doubled their risk of developing the condition compared with women who did not drink.

The Boston study, in Archives of Dermatology, looked at more than 82,000 female nurses aged 27 to 44 and their drinking habits from 1991 until 2005.

Non-alcoholic beer, wine and spirits were not found to increase the risk.

In the study, researchers said that woman who drank more than two alcoholic drinks a week increased their risk of psoriasis by two-thirds compared with non-drinkers.

For women who drank five glasses of beer per week their risk of developing psoriasis was 1.8 times higher again
When stricter criteria were used to confirm psoriasis cases, their risk was increased 2.3 times.

Yet women who drank any amount of low- or non-alcoholic beer, white wine, red wine or spirits per week were not found to be at increased risk.

Barley content

Author Dr Abrar Qureshi, from Harvard Medical School, Boston, wrote in the journal: "Non-light beer was the only alcoholic beverage that increased the risk of psoriasis, suggesting that certain non-alcoholic components of beer, which are not found in wine or liquor, may play an important role in new-onset psoriasis."

The study suggests that it could be the gluten-containing barley, used in the fermentation of beer, which is the cause of the increased psoriasis risk.

Previous studies have shown that a gluten-free diet may improve psoriasis in patients who are sensitive to gluten.

People with psoriasis may have a so-called latent-gluten sensitivity, compared with people without psoriasis, says the study.

"Women with a high risk of psoriasis may consider avoiding higher intake of non-light beer," the authors conclude.

Psoriasis is a chronic skin disease characterised by itchy red scaly patches that most commonly appear on the knees, elbows and scalp but can show up anywhere, including the face.

The effects can range from mild to disfiguring enough to be socially disabling.

Immune genes 'key in Parkinson's disease'

The immune system may have a key role in the development of Parkinson's disease, say US researchers.

In a 20-year study of 4,000 people, half with Parkinson's disease, the team found an association between genes controlling immunity and the condition.

The results raise the possibility of new targets for drug development, Nature Genetics reports.

Parkinson's UK said the study strengthened the idea that immunity is an important driver of the disease.

The team were not just looking for a genetic cause of the disease, but also considered clinical and environmental factors.

During their search, they discovered that groups of genes collectively known as HLA genes are associated with the condition.

These genes are key for the immune system to differentiate between foreign invaders and the body's own tissues.

In theory, that enables the immune system to attack infectious organisms without turning on itself - but it is not always an infallible system.

The genes vary considerably between individuals.

Some versions of the genes are associated with increased risk or protection against infectious disease, while others can induce autoimmune disorders in which the immune system attacks the body's own tissues.

Inflammation

Multiple sclerosis has already been shown to be associated with the same HLA genetic variant seen in the latest study in Parkinson's disease, the researchers said.

It was already known that people who take anti-inflammatory drugs, such as ibuprofen, have a decreased risk of developing Parkinson's disease, which also supports the idea that the immune system has a role in the disease.

But this protective effect is not the same for everyone, probably because of genetic differences.

With better understanding of the link between Parkinson's disease, immunity and inflammation, it may be possible to design more effective drugs for treating the condition, the researchers said.

"Over the years, there have been subtle hints that immune function might be linked to Parkinson's disease," said study leader Dr Cyrus Zabetian, associate professor of neurology at the University of Washington.

"But now we have much more convincing evidence of this and a better idea of which parts of the immune system might be involved."

He added: "Our results also pointed to several other genes that might play a role in developing Parkinson's disease, and these findings need to be confirmed, so we have a lot of work ahead of us."

Dr Kieran Breen, director of research at Parkinson's UK, said the work provides additional evidence of the role of inflammation in the development of Parkinson's disease.

"We know already that some people are more susceptible to getting Parkinson's due to their genetic makeup. This study also points to some genes that may be involved."

He added: "This research, combined with Parkinson's UK funded research at Oxford University into the role of inflammation, may lead to the development of new drug treatments for the condition."