older adults

Background
Improper footwear has been identified as a modifiable risk factor for falls in older adults. Studies suggest that certain footwear characteristics can impair gait and balance, thereby increasing the risk of falls. However, the impact of footwear on gait and balance control may vary across research protocols. A systematic review focusing on these relationships is currently unavailable to date. This study aims to investigate the impact of footwear on gait and balance control in older adults, as well as the research protocols employed and the study outcomes.

Method
A systematic review was conducted using PubMed, IEEE Xplore, Scopus, Web of Science, and Clinical Trials to identify relevant studies published between 2017 and 2024. Keywords were systematically searched, and data were manually extracted. Thirteen studies were included. The review synthesized findings on the influence of various footwear designs on gait and balance control in older adults.

Result
Footwear featuring a minimal outsole, a textured insole design, and a high collar design was generally associated with improved balance outcomes. The evidence for toe-beveled footwear designs was mixed. Studies incorporated both walking and balance assessments, with some including perception-based questionnaires. A combination of walking, balance, and perceptual assessments provides a more comprehensive understanding of how footwear affects balance in older adults.

Conclusion
Among the included studies, featuring a minimal outsole, a textured insole design, and a high collar design showed consistency to benefit older adults that provides textured feedback while offering foot protection, which may enhance balance control. However, some studies also implied that certain designs may have potential negative effects, including toe-beveled, minimal outsole, less-fixation, and barefoot condition. The lack of comprehensive descriptions of experimental footwear affects scientific transparency and reproducibility.

Background: Older adults often struggle to find footwear suitable for their clinical needs, thus affecting mobility, safety, and quality of life. Proper footwear is important due to fall risk, balance impairments, knee osteoarthritis (OA), hallux rigidus, plantar fasciitis, diabetic neuropathy, and limb length discrepancies (LLDs). Barriers such as inadequate clinical guidance and limited patient understanding persist. This paper provides updated, evidence-based recommendations for these challenges.

Methods: A topic review was conducted to evaluate shoe wear characteristics that address geriatric needs. Recommendations were synthesized from more than 45 years of clinical experience in physical therapy and categorized by clinical conditions. Evidence identified effective shoe features, including sole stiffness, tread patterns, heel elevation, and orthotic modifications to improve function, reduce pain, and reduce fall risk.

Results: Balance and fall risk: Shoes with wide soles, medium-firm materials, low heels, and high collars improved stability and reduced postural sway. Cupped, rigid insoles enhanced dynamic control, while treaded rubber outsoles minimized slipping. Knee OA: Flexible shoes with laterally wedged insoles and minimal heel lift reduced medial knee loads and pain. Supportive shoes and medially wedged insoles decreased lateral knee loads and pain. Hallux rigidus/bunions: Rocker-bottom shoes and stiffer soles accommodate deformities, improving function and comfort. Plantar fasciitis: Orthoses, supportive therapies, and stretching regimens were efficacious. Diabetic neuropathy: Rigid rocker soles and custom insoles reduced plantar pressure and ulcer recurrence. LLDs: Gradual shoe lift introduction alleviated low back pain. General recommendations: Properly fitted, comfortable shoes with moderately firm insoles, slip-resistant outsoles, and secure fastening mechanisms improve safety and function.

Conclusions: Footwear significantly impacts the mobility, safety, and well-being of older adults. Tailored recommendations enhance pain management, independence, and fall prevention. Providers should involve patients in decisions and counsel against the use of slippers or excessively elevated heels.

Keywords: fall prevention; older adults; orthoses; pain; shoes.

Importance
Postpolypectomy surveillance is a common colonoscopy indication in older adults; however, guidelines provide little direction on when to stop surveillance in this population.

Objective
To estimate surveillance colonoscopy yields in older adults.

Design, Setting, and Participants
This population-based cross-sectional study included individuals 70 to 85 years of age who received surveillance colonoscopy at a large, community-based US health care system between January 1, 2017, and December 31, 2019; had an adenoma detected 12 or more months previously; and had at least 1 year of health plan enrollment before surveillance. Individuals were excluded due to prior colorectal cancer (CRC), hereditary CRC syndrome, inflammatory bowel disease, or prior colectomy or if the surveillance colonoscopy had an inadequate bowel preparation or was incomplete. Data were analyzed from September 1, 2022, to February 22, 2024.

Exposures
Age (70-74, 75-79, or 80-85 years) at surveillance colonoscopy and prior adenoma finding (ie, advanced adenoma vs nonadvanced adenoma).

Main Outcomes and Measures
The main outcomes were yields of CRC, advanced adenoma, and advanced neoplasia overall (all ages) by age group and by both age group and prior adenoma finding. Multivariable logistic regression was used to identify factors associated with advanced neoplasia detection at surveillance.

Results
Of 9740 surveillance colonoscopies among 9601 patients, 5895 (60.5%) were in men, and 5738 (58.9%), 3225 (33.1%), and 777 (8.0%) were performed in those aged 70-74, 75-79, and 80-85 years, respectively. Overall, CRC yields were found in 28 procedures (0.3%), advanced adenoma in 1141 (11.7%), and advanced neoplasia in 1169 (12.0%); yields did not differ significantly across age groups. Overall, CRC yields were higher for colonoscopies among patients with a prior advanced adenoma vs nonadvanced adenoma (12 of 2305 [0.5%] vs 16 of 7435 [0.2%]; P = .02), and the same was observed for advanced neoplasia (380 of 2305 [16.5%] vs 789 of 7435 [10.6%]; P < .001). Factors associated with advanced neoplasia at surveillance were prior advanced adenoma (adjusted odds ratio [AOR], 1.65; 95% CI, 1.44-1.88), body mass index of 30 or greater vs less than 25 (AOR, 1.21; 95% CI, 1.03-1.44), and having ever smoked tobacco (AOR, 1.14; 95% CI, 1.01-1.30). Asian or Pacific Islander race was inversely associated with advanced neoplasia (AOR, 0.81; 95% CI, 0.67-0.99).

Conclusions and Relevance
In this cross-sectional study of surveillance colonoscopy yield in older adults, CRC detection was rare regardless of prior adenoma finding, whereas the advanced neoplasia yield was 12.0% overall. Yields were higher among those with a prior advanced adenoma than among those with prior nonadvanced adenoma and did not increase significantly with age. These findings can help inform whether to continue surveillance colonoscopy in older adults.

Background: Atrial fibrillation (AF) has consistently been associated with a higher risk of incident dementia. Observational evidence has suggested catheter ablation may be associated with a lower risk of dementia in patients with AF, but further research is needed. The objectives of this study were to use a global health research network to examine associations between catheter ablation, incident dementia and mortality in older adults with AF, and amongst subgroups by age, sex, co-morbidity status, and oral anticoagulant use.

Methods: The research network primarily included healthcare organizations in the United States. This network was searched on 28th September 2022 for patients aged ≥65 years with a diagnosis of AF received at least 5 years prior to the search date. Cox proportional hazard models were run on propensity-score matched cohorts.

Results: After propensity score matching, 20,746 participants (mean age 68 years; 59% male) were included in each cohort with and without catheter ablation. The cohorts were well balanced for age, sex, ethnicity, co-morbidities, and cardiovascular medications received. The risk of dementia was significantly lower in the catheter ablation cohort (Hazard Ratio 0.52, 95% confidence interval: 0.45-0.61). The catheter ablation cohort also had a lower risk of all-cause mortality (Hazard Ratio 0.58, 95% confidence interval: 0.55-0.61). These associations remained in subgroup analyses in individuals aged 65-79 years, ≥80 years, males, females, participants who received OACs during follow-up, participants with paroxysmal and non-paroxysmal AF, and participants with and without hypertension, diabetes mellitus, ischemic stroke, chronic kidney disease and heart failure, including heart failure with preserved ejection fraction and heart failure with reduced ejection fraction.

Conclusion: The observed lower risk of dementia and mortality with catheter ablation could be an important consideration when determining appropriate patient-centered rhythm control strategies for patients with AF. Further studies including data on the success of ablation are required.