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OBJECTIVE -Older adults with type 2 diabetes are more likely to fall, but little is known about risk factors for falls in this population. We determined whether diabetes-related complications or treatments are associated with risk of falls in older diabetic adults.RESEARCH DESIGN AND METHODS -In the Health, Aging, and Body Composition cohort of well-functioning older adults, participants reported falls in the previous year at annual visits. Odds ratios (ORs) for more frequent falls among 446 diabetic participants whose mean age was 73.6 years, with an average follow-up of 4.9 years, were estimated with continuation ratio models.RESULTS -In the first year, 23% reported falling; 22, 26, 30, and 31% fell in subsequent years. In adjusted models, reduced peroneal nerve response amplitude (OR 1.50 Ϫ95% CI 1.07-2.12], worst quartile versus others); higher cystatin-C, a marker of reduced renal function (1.38 [1.11-1.71], for 1 SD increase); poorer contrast sensitivity (1.41 [0.97-2.04], worst quartile versus others); and low A1C in insulin users (4.36 [1.32-14.46], A1C Յ6 vs. Ͼ8%) were associated with risk of falls. In those using oral hypoglycemic medications but not insulin, low A1C was not associated with risk of falls (1.29 [0.65-2.54], A1C Յ6 vs. Ͼ8%). Adjustment for physical performance explained some, but not all, of these associations.CONCLUSIONS -In older diabetic adults, reducing diabetes-related complications may prevent falls. Achieving lower A1C levels with oral hypoglycemic medications was not associated with more frequent falls, but, among those using insulin, A1C Յ6% increased risk of falls. Diabetes Care 31:391-396, 2008O lder adults with type 2 diabetes have an increased risk of falls, but little is known about risk factors for falls in this population (1-4). Factors of particular concern include diabetesrelated complications of peripheral neuropathy, reduced vision, and renal function. Insulin therapy is associated with increased falls (3,5), possibly because of more severe disease and/or hypoglycemic episodes. Reduced balance, strength, and gait are likely intermediaries in any association between diabetesrelated complications and risk of falls. Previous studies of falls among older diabetic adults were cross-sectional or had limited data characterizing glycemic control and diabetes-related complications. We used longitudinal data for diabetic participants in the Health, Aging, and Body Composition (Health ABC) Study to determine whether factors associated with diabetes progression or treatment increase risk of falls and whether associations are mediated by poor performance on tests of balance, gait, and strength.RESEARCH DESIGN AND METHODS -Health ABC is a prospective study of 3,075 men and women aged 70 -79 years recruited at

The objective of this study was to determine if ultraviolet germicidal irradiation (UVGI), moist heat incubation (MHI), or microwave-generated steam (MGS) decontamination affects the fitting characteristics, odor, comfort, or donning ease of six N95 filtering facepiece respirator (FFR) models. For each model, 10 experienced test subjects qualified for the study by passing a standard OSHA quantitative fit test. Once qualified, each subject performed a series of fit tests to assess respirator fit and completed surveys to evaluate odor, comfort, and donning ease with FFRs that were not decontaminated (controls) and with FFRs of the same model that had been decontaminated. Respirator fit was quantitatively measured using a multidonning protocol with the TSI PORTACOUNT Plus and the N95 Companion accessory (designed to count only particles resulting from face to face-seal leakage). Participants' subjective appraisals of the respirator's odor, comfort, and donning ease were captured using a visual analog scale survey. Wilcoxon signed rank tests compared median values for fit, odor, comfort, and donning ease for each FFR and decontamination method against their respective controls for a given model. Two of the six FFRs demonstrated a statistically significant reduction (p< 0.05) in fit after MHI decontamination. However, for these two FFR models, post-decontamination mean fit factors were still ≥ 100. One of the other FFRs demonstrated a relatively small though statistically significant increase (p < 0.05) in median odor response after MHI decontamination. These data suggest that FFR users with characteristics similar to those in this study population would be unlikely to experience a clinically meaningful reduction in fit, increase in odor, increase in discomfort, or increased difficulty in donning with the six FFRs included in this study after UVGI, MHI, or MGS decontamination. Further research is needed before decontamination of N95 FFRs for purposes of reuse can be recommended.

Physical activity and physical performance have been linked to fall risk in the elderly. The authors examined the relation between physical activity and physical performance with incident falls in the Osteoporotic Fractures in Men Study, a large prospective cohort study of 5,995 community-dwelling men in the United States at least 65 years of age. The authors also examined what types of activities are associated with falling. Incident falls between 2000 and 2005 were captured from up to 17 triannual follow-up questionnaires per participant and analyzed with generalized estimating equations. Follow-up averaged 4.5 years. The average risk of falling in the first 4 months of follow-up was 6.6%. The most active quartile had a significantly greater fall risk than did the least active quartile (relative risk = 1.18, 95% confidence interval (CI): 1.07, 1.29). Men with greater leg power and grip strength had significantly reduced fall risk (for highest leg power quartile vs. lowest: relative risk = 0.82, 95% CI: 0.73, 0.92; for highest grip strength quartile vs. lowest: relative risk = 0.76, 95% CI: 0.69, 0.85). Partitioning components of activity showed no association between fall risk and leisure activities but a positive association with household activities (for highest quartile vs.lowest: relative risk = 1.17, 95% CI: 1.07, 1.28).

FOR THE HEALTH ABC STUDYOBJECTIVE -Poor peripheral nerve function is prevalent in diabetes and older populations, and it has great potential to contribute to poor physical performance.RESEARCH DESIGN AND METHODS -Cross-sectional analyses were done for the Health, Aging, and Body Composition (Health ABC) Study participants (n ϭ 2,364; 48% men; 38% black; aged 73-82 years). Sensory and motor peripheral nerve function in legs/feet was assessed by 10-and 1.4-g monofilament perception, vibration detection, and peroneal motor nerve conduction amplitude and velocity. The Health ABC lower-extremity performance battery was a supplemented version of the Established Populations for the Epidemiologic Studies of the Elderly battery (chair stands, standing balance, and 6-m walk), adding increased stand duration, single foot stand, and narrow walk.RESULTS -Diabetic participants had fewer chair stands (0.34 vs. 0.36 stands/s), shorter standing balance time (0.69 vs. 0.75 ratio), slower usual walking speed (1.11 vs. 1.14 m/s), slower narrow walking speed (0.80 vs. 0.90 m/s), and lower performance battery score (6.43 vs. 6.93) (all P Ͻ 0.05). Peripheral nerve function was associated with each physical performance measure independently. After addition of peripheral nerve function in fully adjusted models, diabetes remained significantly related to a lower performance battery score and slower narrow walking speed but not to chair stands, standing balance, or usual walking speed.CONCLUSIONS -Poor peripheral nerve function accounts for a portion of worse physical performance in diabetes and may be directly associated with physical performance in older diabetic and nondiabetic adults. The impact of peripheral nerve function on incident disability should be evaluated in older adults.