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Falls Among Community-dwelling Mid- and Older-Adults in New Zealand
No full textBackground: Falls and subsequent injuries among older adults (65 years and over) are a major
public health issue contributing to increased morbidity and mortality. Risk factors for falls
among older adults have been examined extensively over the years. However, there is a dearth
of literature regarding risk factors for falls among middle-aged adults (50 – 84 years) − the age
where the trajectory for fall rates starts to increase.
Aim and Objectives: The main aim of this thesis is to identify the risk factors for any type
(injurious and non-injurious), injurious, and recurrent falls among community-dwelling midand older-adults aged 50- 84 years in New Zealand (NZ).
Methods: A systematic review examined the published literature on risk factors for falls among
community-dwelling mid- and older-adults aged 50 years and over which informed the design
of the main analytical component of the thesis.
A secondary analysis was carried out on data collected as part of the Vitamin D Assessment
(ViDA) study; a randomised, double-blind, placebo-controlled trial that recruited 5,108 adults
aged 50-84 years in Auckland with over three years of follow-up. Data analysed included
sociodemographic, lifestyle characteristics, and medical conditions collected at the ViDA
baseline assessment. Prescription data came from the NZ Ministry of Health
Pharmaceutical Information Database. Follow-up data on self-reported falls was collected
from questionnaires mailed initially monthly, and then 4-monthly, to the home of ViDA
participants. Descriptive analyses summarised the distribution of baseline characteristics and
prescription medications. A univariate analysis utilising t-tests and chi-square tests was
conducted to investigate the cumulative fall risk (for any type of fall, injurious falls and
recurrent falls) during follow-up for participants according to different exposure levels. For
cohort analysis, cox proportional hazards and negative binomial regression (plus mean
cumulative function analysis) were used to examine the risk factors for the fall types of interest.
A test for interaction analysis was utilised to compare the relationship between factors across
the three outcome measures of interest. Directed Acyclic Graphs (DAG) were constructed to
assist with interpreting results and identifying interactions between variables and fall outcomes.
Results: 152 studies met the literature review inclusion criteria. Risk factors were classified
into five domains: socio-demographic, lifestyle, physical, medical conditions, and
pharmaceutical risk factors. The key findings revealed the following as risk factors for falls: age, sex, ethnicity (White), living alone, marital status, poor self-rated health, depression,
diabetes, stroke, angina, arthritis, pain, history of fracture, history of falls, respiratory diseases
(asthma, emphysema and shortness of breath), benzodiazepines, antiepileptic/anticonvulsant
medications, antidepressants, psychotropic medications, analgesics, diuretics, and respiratory
medications. While Black/African American was shown to have a protective effect against
falls.
Cohort analyses of the outcome ‘any type of fall’ were carried out on 5,049 participants after
excluding those who did not return a fall questionnaire during follow-up (n=52) or who were
missing time to first fall (n=7). Analyses of the outcomes ‘injurious fall’ and ‘recurrent falls’
were caried out on 5,053 participants after excluding those who did not return a fall
questionnaire during follow-up (n=52) or were missing time-dependent variables (time to
injurious fall/total no. of recurrent falls data, n=3).
Factors associated with increased hazard ratios [HR] of having any fall (all types including
injurious) were female sex [HR 1.44, p<0.0001], living alone [HR 1.16, p=0.01], stroke and/or
transient ischemic attack (TIA) [TIA only; HR 1.28, p=0.03], fall history [HR 1.77, p<0.0001],
decreased confidence to do daily activities without falling [Quite Confident: HR 1.33,
p<0.0001], arthritis [HR 1.10, p=0.03], previous fracture (or broken bone) [HR 1.10, p=0.03],
asthma [HR 1.16, p=0.01], depression [HR 1.34, p<0.0001], antiepileptic medication [HR 1.26,
p=0.02], antidepressants [HR 1.16, p=0.03], and anti-Parkinson medication [HR 1.94, p=0.02].
Medication affecting the renin angiotensin system (ARAS) and education level were the only
protective factors associated with reduced hazard of any fall [HR 0.85, p=0.001].
For injurious falls, significant risk factors included female sex [HR 1.48, p<0.0001], living
alone [HR 1.21, p=0.0004], employment [retired; HR 1.15, p=0.01], stroke and/or angina [TIA
only; HR 1.43, p=0.01], fall history [HR 1.76, p<0.0001], decreased confidence to do daily
activities without falling [Quite Confident; HR 1.33, p<0.0001], arthritis [HR 1.11, p=0.03],
previous fracture (or broken bone) [HR 1.13, p=0.01], asthma [HR 1.15, p=0.02], depression
[HR 1.31, p=0.0002], and anti-Parkinson medications [HR 2.09, p=0.003]. Ethnicity (South
Asian) [HR 0.63, p=0.004] and current smoking [HR 0.79, p=0.02] were the only factors
associated with reduced hazard of injurious falls.
Factors associated with increased incidence rate ratios [IRR] of recurrent falls included female
sex [IRR 1.17, p=0.0003], living alone [IRR 1.22, p= 0.0001], employment (retired) [IRR 1.24,
p<0.0001], heart attack and/or angina [Angina only; IRR 1.25, p=0.02], stroke and/or TIA [TIA only; IRR 1.47, p=0.0003], fall history (last four weeks) [IRR 1.92, p<0.0001], decreased
confidence to do daily activities without falling [Quite, IRR 1.49, p<0.0001; Not at all, IRR
2.14, p<0.0001], chronic pain [IRR 1.23, p<0.0001], depression [IRR 1.24, p=0.002],
antidepressants [IRR 1.18, p=0.01] and anti-Parkinson’s medications [IRR 4.07, p<0.0001].
Factors associated with reduced incidence rate of recurrent falls were ethnicity (South Asian)
[IRR 0.64, p<0.0001] and BMI (underweight and overweight) [IRR 0.40, p=0.01; HR 0.86,
p=0.002 respectively].
A test for interaction indicated that the hazard/rate of falls was consistent across all three fall
outcomes, and the following are the most significant risk factors for falls among mid and older
adults in NZ: sex (female), living alone, employment (retired), angina, TIA, fall history (last
four weeks), arthritis, previous fracture, chronic pain, asthma, depression, antiepileptic
medication, antidepressants, and anti-Parkinson medication; while ethnicity (South Asian),
education (secondary), current smokers, and BMI (under-weight and overweight) were
significantly protective against falls across all three fall outcomes. DAG diagrams were created
for all variables that were included in the final multivariable models, which provided a clear
picture of mediators and confounding factors that may impede the association of certain factors
with falls. These variables (i.e., marital status) were then not included in the final multivariable
models.
Conclusion: This study indicates that risk factors for falls (any, injurious and recurrent) among
mid and older community-dwelling older adults are complex and multifaceted. In addition to
traditional risk factors identified, other factors not commonly researched − such as asthma, TIA
only, anti-Parkinson’s medications, and antiepileptic drugs − were shown to be associated with
significantly increased risk of falls; while ethnicity (South Asian) and current smokers were
shown to have a reduced fall risk in this population sub-group. This is the first cohort study to
use pharmaceutical dispensing data to examine the association between certain medications
such as psychotropic, antipsychotics, laxatives and fall risk. The findings indicate that older
adult fall prevention strategies need to commence in middle age, and consideration needs to be
given to addressing novel factors in future risk prevention strategies. Additional research is
required to reaffirm the association between medical conditions and specific medication classes
on fall risk and to understand why there is a lower risk of falls among South Asian population
groups
“His Side of the story”: Tongan Men’s Perception on Mo’ui lelei and their Priority Health Needs in South Auckland, New Zealand
No full textFull text is available to authenticated members of The University of Auckland only.Aim: The aim of this study is to achieve a better understanding of Tongan men’s (16-65 years) perceptions on mo’ui lelei (health) and their priority health needs in South Auckland. It is envisioned that findings from this research will contribute significantly to understanding why inequalities in health is currently present amongst NZ-born and migrant Tongan men living in Auckland. Moreover, identifying their priority health needs can provide sufficient grounds for a more Tongan male-specific approach to addressing Tongan men’s health issues. Method: Study design: This study was predominantly exploratory in nature. It utilised a concurrent embedded mixed methods approach whereby the secondary quantitative method is embedded within the dominant qualitative method. Setting: The setting of the study was in South Auckland which contains the largest Tongan population (51%) in the Auckland region. Participants: A purposive snowball sampling technique was utilized to recruit the participants. The inclusion of participants was based on men who; have Tongan ethnic backgrounds (including men with mixed ancestry); speak Tongan or English; are within the ages 16-65 years and; live in South Auckland. Recruitment produced 4 New Zealand born (NZ-born) and 8 migrant Tongan men. Data Collection: Data collections of both the quantitative and qualitative approaches were carried out concurrently. The quantitative data was collected through a demographic questionnaire. The qualitative data was collected using one-on-one semi structured interviews which incorporated the ethnic specific talanoa methodology. The duration of data collection was 90 minutes in which were recorded using an electronic recorder. Data Analysis: The data from the quantitative questionnaire was analysed using the SPSS computer software programme. The qualitative data was analysed using David Thomas’s General Inductive Approach utilising the Nvivo10 computer software programme. Results: This study has recognized that there is a difference between migrant and NZ-born Tongan men’s perception in terms of traditional and contemporary interpretations of mo’ui lelei. Findings also suggest that Tongan men’s perception on the term ‘mo’ui lelei’ today has evolved to adopt certain aspects of the WHO definition of health. Participants define the term mo’ui lelei as holistic health, balanced life, free from physical diseases, maintaining good physical health and the ability to function normally. Priority health needs identified were multi-dimensional encapsulating the physical, social, mental and spiritual dimensions of Tongan men’s health/mo’ui lelei status. This highlights the need for a multi-sectorial approach to address Tongan men’s poor health outcomes. Other health significant issues highlighted were sexual health, violence (including domestic and family violence) and suicide. Key approaches to addressing poor health outcomes among Tongan men included capacity building, male ethnic specific policies, development of a Tongan social environment and a male ethnic specific healthcare service. Conclusion: This study provides a male ethnic specific perspective on men’s health or mo’ui lelei. It acknowledges the complex and heterogeneous issues around Tongan men’s health compared to women and the rest of the NZ male population. Further research is needed to explore the perceptions of Tongan men on culturally taboo health issues such as sexual health and areas in access to health services, lack of knowledge and its relationship with culture
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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