Frailty Syndrome-Fall Risk and Rehabilitation Management Aided by Virtual Reality (VR) Technology Solutions: A Narrative Review of the Current Literature

Frailty, a physiological syndrome (FS) affecting primarily the older adults, manifests itself through significantly depleted bodily reserves, and appreciably higher (up to over threefold) individual exposure to fall risk. Concomitant medical conditions such as balance impairment, reduced visual acuity, limited mobility, and significantly diminished daily functional performance further exacerbate the patients' condition. Their resultant susceptibility to frequent hospitalisations makes their prognosis even worse. This narrative review aimed to provide an overview of published studies focused on rehabilitation management approaches aided by virtual reality (VR) technology in frail older adults. The authors had it also augmented with their own, evidence-based body of experience in rehabilitation. Making use of technologically advanced exercise machinery, specially adapted for rehabilitating frail older adults, combined with a structured exercise regimen, further aided by the application of select virtual reality (VR) technology solutions, clearly proved effective. Consequently, the patients were helped to move back from the frail to the pre-frail stage, as well as had their motor and cognitive functions appreciably enhanced. The application of modern technology in rehabilitating older adults over 65, affected by FS, when specifically aided by the select VR technology solutions, was also proven to complement successfully the conventional rehabilitation management. The overall versatility of the VR technology solutions, e.g., adaptation for home use allowing remote supervision, also makes this novel approach to rehabilitation far more appealing to the patients. They find it both very attractive and far more mentally engaging. Its considerable potential lies mostly in being appreciably more effective in bringing in desirable therapeutic outcomes.

Implementation of a rehabilitation model in a Program of All-Inclusive Care for the Elderly (PACE): Preliminary data

BACKGROUND

Nursing home eligible participants in the Program of All-inclusive Care for the Elderly (PACE) are at high risk for falls. Physical function is a modifiable predictor of falls and an important target for prevention. We engaged a PACE site to explore feasibility of implementing progressive intensive rehabilitation to improve physical function and preliminary patient-level improvements.

METHODS

The research involved a mixed-methods, pre-post implementation study with longitudinal patient follow-up at one Denver PACE site. Older adults at risk for institutionalization (N = 28) took part in Screening and high-intensity interventions to Improve Falls risk and Transform expectations in age and aging (SHIFT) rehabilitation program over six weeks. Outcomes included the short physical performance battery (SPPB); 4-meter gait speed at baseline, discharge, and 6 and 12 months postdischarge from SHIFT. A focus group with staff explored facilitators and barriers to program implementation in the PACE setting and with complex patients and perceived effectiveness.

RESULTS

The rehabilitation team demonstrated high treatment fidelity to SHIFT (>80%). No treatment-specific adverse events were reported. SPPB scores and gait speeds improved significantly over time (p < 0.005). The average SPPB score at evaluation was 4.6 ± 0.24 compared to 7.7 ± 0.38 points at discharge. The average gait speed at evaluation was 0.58 ± 0.03 meters/second (m/s) compared to 0.79 ± 0.04 m/s at discharge. Common barriers to program completion included changes in health status and environmental factors (e.g., transportation).

CONCLUSIONS

Rehabilitation therapists incorporated a high-intensity resistance training program into routine care of complex older adults in PACE and improved pre-post physical function to levels above independence thresholds (SPPB ≥6; gait speed ≥0.65 m/s). Our pilot implementation study informed refinement of eligibility criteria, number of visits, and strategies to address long-term adherence to enhance scalability and optimize impact.

Measuring Kinematic Response to Perturbed Locomotion in Young Adults

Daily life activities often require humans to perform locomotion in challenging scenarios. In this context, this study aimed at investigating the effects induced by anterior-posterior (AP) and medio-lateral (ML) perturbations on walking. Through this aim, the experimental protocol involved 12 participants who performed three tasks on a treadmill consisting of one unperturbed and two perturbed walking tests. Inertial measurement units were used to gather lower limb kinematics. Parameters related to joint angles, as the range of motion (ROM) and its variability (CoV), as well as the inter-joint coordination in terms of continuous relative phase (CRP) were computed. The AP perturbation seemed to be more challenging causing differences with respect to normal walking in both the variability of the ROM and the CRP amplitude and variability. As ML, only the ankle showed different behavior in terms of joint angle and CRP variability. In both tasks, a shortening of the stance was found. The findings should be considered when implementing perturbed rehabilitative protocols for falling reduction.

Effects of Hallux Valgus Surgery on Balance and Gait in Middle Aged and Older Adults

Hallux valgus is associated with balance deficits, and has been implicated as an independent risk factor for falls in older adults. However, it is unknown what effect hallux valgus surgery has on static and dynamic (i.e., while walking) balance in older adults. We enrolled 13 middle-aged and older aged adults (mean age 54.3 ± 12.7 years, range 47 to 70) who underwent isolated hallux valgus surgery and followed them for 12 months. Preoperative and postoperative gait and balance performance was assessed using non-invasive body worn sensors with standardized and validated testing protocols. Visual analog scale (VAS) for pain and radiographic angles were also assessed. All subjects reported improvements in pain (VAS mean change -38.3 ± 10.3 mm), and all subjects demonstrated improvements in their hallux valgus angles and first/second intermetatarsal angles (mean change 16.3 ± 8.8°, and 5.5 ± 3.0°, respectively). While standing in full tandem, center of mass (COM) sway was improved upon by 59% at 1 year postoperative (p < .05, paired t-test). While most gait parameters demonstrated little change postoperatively, patients tended to spend less time in double support (p = .08, paired t-test), while gait variability increased by 55% (p = .03, paired t-test) and medial-lateral sway while walking increased by 43% (p = .08, paired t-test) 12 months postoperatively. Balance improved after hallux valgus surgery in our population, particularly when subjects were forced to rely on their operative foot for support (e.g., full tandem). Patients also seemed to walk with greater variability in stride velocity and with greater medial-lateral sway postoperatively, suggesting perhaps increased ambulatory confidence after successful hallux valgus surgery.

Mindful and Compassionate Self, Grounded Together: A Qualitative Description of Postmenopausal Women's Perceptions of Balance Flow Yoga

Yoga has promising benefits for women to reduce fall-injury risk by improving balance, strength, confidence, and other risk factors, although the effect of yoga on reducing injury risk and fall rates is still not clearly established. The objective of the present study was to determine postmenopausal women's perceived changes in overall health and well-being and some of the facilitators and challenges to participating in a 12-week Balance Flow Yoga class, a group-based hatha yoga intervention designed specifically to address fall risk factors. Thirty-six women 50-70 years of age participated in an intervention study consisting of 12 weeks of a control period followed by 12 weeks of twice-weekly hatha Balance Flow Yoga in a community yoga studio. Twenty-three women and four yoga instructors/trainers participated in focus group discussions after the intervention was completed. Discussion was audiotaped, transcribed, and analyzed through inductive thematic analysis by three researchers, a student trainee, and a research assistant. Two overarching themes and four subthemes were revealed. The two overarching themes Mindful and Compassionate Self and Grounded Together represented participants' perceptions of personal growth and their approach to living and the sense of community support and connection. Four interrelated subthemes were Creating a Safe Space; Sense of Community and Commitment; Benefits: Physical and Beyond ; and Balancing Individual Needs. This study demonstrated perceptions of physical, emotional, and social benefits after 12 weeks of Balance Flow Yoga; these benefits could influence women's health, wellness, and future fall risk.

Disparity between Perceptual Fall Risk and Physiological Fall Risk in Older Cannabis Users: A Pilot Study

Aging is associated with cognitive decline and increased fall risk. Cognitive impairment is associated with cannabis use, which is increasing among older adults. Perceptual and physiological fall risk are discordant in some older adults, but whether cannabis use influences this association is unknown. The purpose of this study was to investigate possible disparities between perceptual and physiological fall risk in older cannabis users. Eight older medical cannabis users and eight sex- and age-matched non-users provided data on perceptual and physiological fall risk. Group differences were assessed, and perceptual fall risk was correlated with physiological fall risk. Perceptual risk and most of the physiological fall risk variables were equivalent between the groups. However, cannabis users performed significantly worse on unipedal stance than non-users. In addition, perceptual fall risk had weak correlations with physiological fall risk in the users (Spearman’s rho = 0.17–0.41) and moderate-strong correlations in non-users (rho = −0.18–0.67). Cannabis users might have a discrepancy between perceptual and physiological fall risk. Because both concepts play a role in quality of life, identifying strategies to improve them may have significant benefits. Future studies investigating additional perceptual (e.g., cognition, fear of falling, depression, anxiety), physiological (e.g., more challenging static and dynamic balance conditions), and general fall risk are warranted.

Automatic Recognition and Analysis of Balance Activity in Community-Dwelling Older Adults: Algorithm Validation

BACKGROUND

Clinical mobility and balance assessments identify older adults who have a high risk of falls in clinics. In the past two decades, sensors have been a popular supplement to mobility and balance assessment to provide quantitative information and a cost-effective solution in the community environment. Nonetheless, the current sensor-based balance assessment relies on manual observation or motion-specific features to identify motions of research interest.

OBJECTIVE

The objective of this study was to develop an automatic motion data analytics framework using signal data collected from an inertial sensor for balance activity analysis in community-dwelling older adults.

METHODS

In total, 59 community-dwelling older adults (19 males and 40 females; mean age = 81.86 years, SD 6.95 years) were recruited in this study. Data were collected using a body-worn inertial measurement unit (including an accelerometer and a gyroscope) at the L4 vertebra of each individual. After data preprocessing and motion detection via a convolutional long short-term memory (LSTM) neural network, a one-class support vector machine (SVM), linear discriminant analysis (LDA), and k-nearest neighborhood (k-NN) were adopted to classify high-risk individuals.

RESULTS

The framework developed in this study yielded mean accuracies of 87%, 86%, and 89% in detecting sit-to-stand, turning 360°, and stand-to-sit motions, respectively. The balance assessment classification showed accuracies of 90%, 92%, and 86% in classifying abnormal sit-to-stand, turning 360°, and stand-to-sit motions, respectively, using Tinetti Performance Oriented Mobility Assessment-Balance (POMA-B) criteria by the one-class SVM and k-NN.

CONCLUSIONS

The sensor-based approach presented in this study provided a time-effective manner with less human efforts to identify and preprocess the inertial signal and thus enabled an efficient balance assessment tool for medical professionals. In the long run, the approach may offer a flexible solution to relieve the community's burden of continuous health monitoring.

The effect of vitamin D and exercise on balance and fall risk in postmenopausal women: A randomised controlled study

OBJECTIVE

To evaluate the effects of vitamin D and exercise on balance, fall risk and quality of life (QoL) in postmenopausal women.

METHODS

In this prospective, randomised, controlled, single-blind study postmenopausal women aged 50-70 years were included. Participants with <25nmol/L 25(OH) vitamin D were randomised to three groups: group-I (vitamin D replacement) (n = 21), group-II (core and balance exercises) (n = 18), and group-III (vitamin D replacement plus core and balance exercises) (n = 20). The participants with >75nmol/L 25(OH) vitamin D (group-IV) (n = 40) were designated as control group and received the core and balance exercises. The participants were evaluated before and after 8 weeks with Berg balance test and Biodex balance system (postural stability and fall risk tests) for balance and Nottingham Health Profile (NHP) for QoL.

RESULTS

Group IV had better baseline BBT, NHP pain, NHP emotional reactions, NHP social isolation subdomain and total score. After treatment, all groups showed significant improvement in balance (except group I, mediolateral stability index) and QoL (except group II). There was no significant difference between groups (I, II and III) after intervention.

CONCLUSION

Vitamin D replacement therapy has positive effects on balance and QoL. Core strengthening and balance exercises are essential for better balance and fall prevention in postmenopausal women. Any superior effect of vitamin D or exercise on each other was not determined.

The Effect of Exercise Intervention on Reducing the Fall Risk in Older Adults: A Meta-Analysis of Randomized Controlled Trials

Exercise intervention has a positive effect on reducing the fall risk in older adults. To investigate the effect of different factors of exercise intervention (type, duration, and frequency) on reducing the fall risk in older adults, a meta-analysis was performed in this study. According to the PRISMA^®, two researchers independently searched PubMed, Web of Science, and the China National Knowledge Infrastructure databases to assess the quality of the studies using the PEDro scale. A total of 648 subjects in 10 randomized controlled trials were included in this study, and the exercise interventions included integrated training (resistance training, core training, and balance training), balance training, core training, Pilates, Ba Duan Jin, and Tai Chi. These studies show that exercise intervention has a huge and significant impact on reducing the risk of falls of the elderly. In conclusion, an integrated intervention with a frequency of more than five times a week and a duration of more than 32 weeks are more effective in reducing the fall risk.

Effects of intensive multiplanar trunk training coupled with dual-task exercises on balance, mobility, and fall risk in patients with stroke: a randomized controlled trial

OBJECTIVE

We determined whether an exercise regime comprising high-intensity training, multiplanar trunk movements, and dual-task practice could improve trunk control, balance, functional mobility, and reduce fall risk in patients with hemiplegic stroke.

METHODS

In this randomized controlled trial, 74 patients (mean age 61.71 years) were randomly assigned to the experimental and comparison groups. Primary outcome was trunk impairment scale (TIS) scores. Secondary outcomes were scores on the Berg balance scale, 10-meter walk test, Timed-up-and-go test, timed-Up-Go-cognitive, and Stroke Impact Scale-16 to measure between-group changes from baseline. We used linear mixed modeling to identify changes over time within and between groups on each scale and whether changes persisted at 6- and 12-month follow-ups.

RESULTS

We observed significantly increased mean TIS scores from baseline to 3 months post-treatment (7.74); the increased scores were maintained at 6- and 12-month follow-ups (8.60 and 8.43, respectively). In the experimental group, all secondary outcomes showed significant and clinically meaningful results. Fall risk between groups was significantly reduced at 6 and 12 months.

CONCLUSIONS

Intensive multiplanar trunk movements coupled with dual-task practice promoted trunk control, balance, and functional recovery in patients with stroke, reduced fall risk, and improved independent mobility.Trial registration: #IRCT20200127046275N1.

Fall prevention education to reduce fall risk among community-dwelling older persons: A systematic review

OBJECTIVES

This review aims to identify types of the existing fall prevention education (FPE) and their effectiveness in promoting fall risk awareness, knowledge and preventive fall behaviour change among community-dwelling older people.

BACKGROUND

FPE is a cost-effective and helpful tool for reducing fall occurrences.

EVALUATION

This is a systematic review study using electronic searches via EBSCOHost® platform, ScienceDirect, Scopus and Google Scholar in March 2021. The review protocol was registered with PROSPERO (CRD42021232102). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement flow chart guided the search strategy. Articles published from January 2010 to March 2021 were included for quality appraisal using the 'Transparent Reporting of Evaluations with Non-randomised Designs' (TREND) and the 'Consolidated Standards of Reporting Trials' (CONSORT) statement for randomised controlled trial studies.

KEY ISSUES

Six FPE studies selected emphasised on personal health status, exercise and environmental risk factors. These studies reported an increase in fall risk awareness or knowledge and a positive change in fall preventive behaviours. Two studies included nurses as educators in FPE.

CONCLUSION

FPE evidently improved awareness or knowledge and preventive fall behaviour change among older adults. Nurses are in great potential in planning and providing FPE for older adults in community settings.

IMPLICATIONS FOR NURSING MANAGEMENT

Expand nurses' roles in fall prevention programmes in community settings by using high-quality and evidence-based educational tools. Highlight the nurse's role and collaborative management in FPE.

Anticholinergic Burden of Geriatric Ward Inpatients

Background and Objectives: Anticholinergic drug use in the pharmacotherapy of elderly persons is common despite the increased risk of side effects. We examined the prevalence of anticholinergic drug use and total anticholinergic drug burden among patients admitted to an acute care geriatric ward in Poland. Materials and Methods: Cross-sectional study of 329 subjects hospitalized at the geriatric ward. Patient condition was assessed with a comprehensive geriatric assessment. The Anticholinergic Cognitive Burden (ACB) scale was used to estimate the total anticholinergic load. Results: Mean patient age was 79.61 ± 6.82 years. 40.73% of them were burdened with at least one anticholinergic drug. The clinically significant anticholinergic burden was observed in 13.98% of subjects. Patients with dementia, risk of falls, and severe disability had significantly higher total ACB scores compared to other groups. The receiver operating characteristics (ROC) curve revealed that the total ACB score ≥ 1 was significantly associated with dementia and the risk of falls. Total ACB score ≥ 2 was significantly associated with severe disability. Conclusions: Patients admitted to an acute care geriatric ward had an anticholinergic cognitive burden score comparable to other patient populations. We found associations at both low and elevated levels of anticholinergic burden with dementia and risk of falls. At elevated anticholinergic burden levels, we found associations with severe disability. Despite recommendations against the use of anticholinergics in older adults these medications are still commonly prescribed. Further study is necessary to define the characteristics of anticholinergic medication most closely associated with negative outcomes in elderly populations.

A Mobile App (FallSA) to Identify Fall Risk Among Malaysian Community-Dwelling Older Persons: Development and Validation Study

BACKGROUND

Recent falls prevention guidelines recommend early routine fall risk assessment among older persons.

OBJECTIVE

The purpose of this study was to develop a Falls Screening Mobile App (FallSA), determine its acceptance, concurrent validity, test-retest reliability, discriminative ability, and predictive validity as a self-screening tool to identify fall risk among Malaysian older persons.

METHODS

FallSA acceptance was tested among 15 participants (mean age 65.93 [SD 7.42] years); its validity and reliability among 91 participants (mean age 67.34 [SD 5.97] years); discriminative ability and predictive validity among 610 participants (mean age 71.78 [SD 4.70] years). Acceptance of FallSA was assessed using a questionnaire, and it was validated against a comprehensive fall risk assessment tool, the Physiological Profile Assessment (PPA). Participants used FallSA to test their fall risk repeatedly twice within an hour. Its discriminative ability and predictive validity were determined by comparing participant fall risk scores between fallers and nonfallers and prospectively through a 6-month follow-up, respectively.

RESULTS

The findings of our study showed that FallSA had a high acceptance level with 80% (12/15) of older persons agreeing on its suitability as a falls self-screening tool. Concurrent validity test demonstrated a significant moderate correlation (r=.518, P<.001) and agreement (k=.516, P<.001) with acceptable sensitivity (80.4%) and specificity (71.1%). FallSA also had good reliability (intraclass correlation .948; 95% CI .921-.966) and an internal consistency (α=.948, P<.001). FallSA score demonstrated a moderate to strong discriminative ability in classifying fallers and nonfallers. FallSA had a predictive validity of falls with positive likelihood ratio of 2.27, pooled sensitivity of 82% and specificity of 64%, and area under the curve of 0.802.

CONCLUSIONS

These results suggest that FallSA is a valid and reliable fall risk self-screening tool. Further studies are required to empower and engage older persons or care givers in the use of FallSA to self-screen for falls and thereafter to seek early prevention intervention.

Audiologists should not fail with falls: A call to commit to prevention of falls in older adults

Globally, falls are a serious economic and public health concern. While all age groups are impacted by falls, the threats to morbidity and mortality are most severe in older adults. Recent literature has linked hearing loss, and related issues such as an increase in sedentary behaviour, to a greater risk of falls. Therefore, this opinion article aims to raise audiologists’ awareness of falls in ageing patients or clients, and calls for change in terms of having these rehabilitation professionals embrace identification and management of fall risk.

Random Forest for Automatic Feature Importance Estimation and Selection for Explainable Postural Stability of a Multi-Factor Clinical Test

Falling is a common incident that affects the health of elder adults worldwide. Postural instability is one of the major contributors to this problem. In this study, we propose a supplementary method for measuring postural stability that reduces doctor intervention. We used simple clinical tests, including the timed-up and go test (TUG), short form berg balance scale (SFBBS), and short portable mental status questionnaire (SPMSQ) to measure different factors related to postural stability that have been found to increase the risk of falling. We attached an inertial sensor to the lower back of a group of elderly subjects while they performed the TUG test, providing us with a tri-axial acceleration signal, which we used to extract a set of features, including multi-scale entropy (MSE), permutation entropy (PE), and statistical features. Using the score for each clinical test, we classified our participants into fallers or non-fallers in order to (1) compare the features calculated from the inertial sensor data, and (2) compare the screening capabilities of the multifactor clinical test against each individual test. We use random forest to select features and classify subjects across all scenarios. The results show that the combination of MSE and statistic features overall provide the best classification results. Meanwhile, PE is not an important feature in any scenario in our study. In addition, a t-test shows that the multifactor test of TUG and BBS is a better classifier of subjects in this study.

Performance and Characteristics of Wearable Sensor Systems Discriminating and Classifying Older Adults According to Fall Risk: A Systematic Review

Sensor-based fall risk assessment (SFRA) utilizes wearable sensors for monitoring individuals’ motions in fall risk assessment tasks. Previous SFRA reviews recommend methodological improvements to better support the use of SFRA in clinical practice. This systematic review aimed to investigate the existing evidence of SFRA (discriminative capability, classification performance) and methodological factors (study design, samples, sensor features, and model validation) contributing to the risk of bias. The review was conducted according to recommended guidelines and 33 of 389 screened records were eligible for inclusion. Evidence of SFRA was identified: several sensor features and three classification models differed significantly between groups with different fall risk (mostly fallers/non-fallers). Moreover, classification performance corresponding the AUCs of at least 0.74 and/or accuracies of at least 84% were obtained from sensor features in six studies and from classification models in seven studies. Specificity was at least as high as sensitivity among studies reporting both values. Insufficient use of prospective design, small sample size, low in-sample inclusion of participants with elevated fall risk, high amounts and low degree of consensus in used features, and limited use of recommended model validation methods were identified in the included studies. Hence, future SFRA research should further reduce risk of bias by continuously improving methodology.

Muscle Mass and Gait Characteristics in Older Women Fallers vs. Non-Fallers

Background: Falling is a major public health concern of elderly people. We aimed to determine if lean mass and spatiotemporal gait parameters could predict the risk of falling in elderly women and also study the relationships between lean mass and gait characteristics. Methods: Twenty-four community women were prospectively recruited (mean age, 72.30 ± 5.31 years). Lean mass was measured using dual-energy fan-beam X-ray absorptiometry. Gait characteristics were assessed using spatiotemporal analysis. Fall risks were assessed using the Berg Balance Scale (BBS) and the Falls Efficacy Scale-International. Fall histories were recorded. Appropriate statistical analyses were applied to determine lean mass and gait characteristics in predicting the risk of fall and the associations between lean mass and gait characteristics. Results: There were 14 participants (58.33%) with fall histories. Patients with fall histories had a significantly narrower base of support and lower BBS score. However, only the base of support was significantly associated with fall risk (odds ratio, 0.415; p = 0.022). Lean mass was significantly negatively associated with proportion of swing phase and positively associated with proportions of stance and double-support phases. Conclusion: Fall risk among elderly women can be predicted using base of support, where a narrower base predicts a greater fall risk. Although the lean mass was not related to risk of fall, lean mass is still related to some gait characteristics.

Adapting Footfall Rhythmicity to Auditory Perturbations Affects Resilience of Locomotor Behavior: A Proof-of-Concept Study

For humans, the ability to effectively adapt footfall rhythm to perturbations is critical for stable locomotion. However, only limited information exists regarding how dynamic stability changes when individuals modify their footfall rhythm. In this study, we recorded 3D kinematic activity from 20 participants (13 males, 18–30 years old) during walking on a treadmill while synchronizing with an auditory metronome sequence individualized to their baseline walking characteristics. The sequence then included unexpected temporal perturbations in the beat intervals with the subjects required to adapt their footfall rhythm accordingly. Building on a novel approach to quantify resilience of locomotor behavior, this study found that, in response to auditory perturbation, the mean center of mass (COM) recovery time across all participants who showed deviation from steady state (N = 15) was 7.4 (8.9) s. Importantly, recovery of footfall synchronization with the metronome beats after perturbation was achieved prior (+3.4 [95.0% CI +0.1, +9.5] s) to the recovery of COM kinematics. These results highlight the scale of temporal adaptation to perturbations and provide implications for understanding regulation of rhythm and balance. Thus, our study extends the sensorimotor synchronization paradigm to include analysis of COM recovery time toward improving our understanding of an individual’s resilience to perturbations and potentially also their fall risk.

Effect of Home-Based Exercise Program on Physical Function and Balance in Older Adults With Sarcopenia: A Multicenter Randomized Controlled Study

In the prospective, randomized, controlled multicenter study, 100 patients who were clinically diagnosed with sarcopenia were assigned to either a home-based exercise group or a control group. The home-based training program included exercises with gradually increasing intensity comprising posture, stretching and upper- and lower-extremity muscle-strengthening exercises, balance and coordination exercises, and gait training. Before and 3 months after the exercise program, all the patients were evaluated. The 6-min walking test and Berg Balance Scale scores increased significantly after 3 months in the home-based exercise group compared with the controls. There was also a significant decrease in timed up and go test scores and a significant improvement in quality of life in the exercise group compared with the control group. Our findings indicated that a home-based exercise program can have a positive effect on physical function, balance, and quality of life in patients with sarcopenia.

Physical Fitness among Community-Dwelling Older Women with and without Risk of Falling-The Taipei Study, Taiwan

The purposes of this study were to compare the differences in physical fitness between community-dwelling older women fallers and non-fallers, with and without a risk of falling, and to investigate the relation between physical fitness and falling risk factors. This study was a secondary data analysis from a community- and exercise-based fall-prevention program. Baseline assessments pertaining to body weight and height, self-reported chronic diseases, the 12-item fall risk questionnaire (FRQ), senior fitness test, single-leg stand test, and handgrip strength test were extracted. Participants (n = 264) were classified into fallers and non-fallers, and sub-classified according to the risk of falling (FRQ ≥4 and <4). While controlling for the effect of age, body mass index (BMI), and multimorbidity, one-way analysis of covariance indicated that older women with a risk of falling showed poorer performances of the 8-foot up-and-go, 2-min step and 30-s chair stand compared with those without a risk of falling, regardless of the history of falls. Additionally, weaker grip strength was found in non-fallers with falling risk. Some significant, but low-to-moderate, correlations were found between physical fitness tests and fall risk factors in the FRQ, particularly in gait/balance problem and leg muscle weakness. Proactive efforts are encouraged to screen and manage deterioration in the identified physical fitness.

A mixed methods systematic review of informal caregivers' experiences of fall risk among community-dwelling elders with dementia

Evidence on effective fall prevention strategies for community-dwelling elders with dementia is limited, although these elders are at high risk of falling. Informal caregivers may play an essential role in managing fall risk for elders with dementia. Thus, understanding caregiver's experiences is critically important. This systematic review aims to (a) identify caregivers' perceptual, emotional and behavioural responses to fall risk in elders with dementia and (b) examine the outcomes and effects of caregiver behavioural responses. A mixed methods systematic review of 10 databases (PubMed, PsycINFO, CINAHL, Social Service Abstracts, Social Work Abstracts, EMBASE, Web of Science, Scopus, Cochrane Library and TRIP Medical Database) was conducted. We searched English language, peer-review articles (January 1, 1985-March 20, 2020) that met the predefined inclusion/exclusion criteria. Study quality was assessed using the Mixed Methods Appraisal Tool. Data were analysed using thematic synthesis techniques. Twenty-nine studies were included. Six analytic themes were generated concerning caregivers' perceptual, emotional and behavioural responses: (a) fear of the negative health consequences of falls; (b) limited insights into factors contributing to falls; (c) varying expectations of managing fall risk; (d) multi-level efforts; (e) struggling with responsibilities; and (f) inaction and withdrawal. The findings about the outcomes and effects of caregivers' behaviours were synthesised into three analytic themes: (a) multi-faceted outcomes; (b) uncertain and inconsistent evidence; and (c) unclear associations. The study generated new insights in understanding caregivers' responses of fall risk among community-dwelling elders with dementia and identified significant gaps in examining the impact of caregivers' responses and what shapes these responses. Investment in understanding caregivers' perspectives will inform future interventions and policies to reduce negative outcomes for elders, caregivers and care systems.

Preoperative screening in patients having elective shoulder surgery reveals a high rate of fall risk

INTRODUCTION

Fall risk is an acknowledged but relatively understudied concern for older patients undergoing shoulder surgery. The cause is multifactorial, and it includes advanced age, impaired upper extremity function, use of shoulder abduction braces, and postoperative use of opioid medications. No previous study has examined preoperative fall risk in patients undergoing elective shoulder surgery. Previous literature looking at fall risk in elective orthopedic procedures has predominantly focused on falls occurring in the hospital setting, although falls have also been shown to occur in the outpatient setting. Gait speed and Timed Up and Go (TUG) are well-researched functional measures in the aging population with established cutoff scores indicating increased fall risk. The purpose of this study was to quantify gait speed and TUG scores in a series of patients who were scheduled to undergo either rotator cuff repair (RCR) or total shoulder arthroplasty (TSA) in order to assess overall risk of fall in these populations.

METHODS

A total of 198 patients scheduled for TSA or RCR surgery were evaluated preoperatively from multiple outpatient physical therapy clinics within Greenville, South Carolina. The TUG score (>14 seconds considered high fall risk) and 10 Meter Walk test (<0.7 m/s considered high risk for falls) were recorded for each patient. Patient-reported outcomes were also collected, including Veteran's Rand 12 Physical Component and Mental Component Scores, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, and the Single Assessment Numeric Evaluation.

RESULTS

Patients undergoing TSA (n = 80; 65.4 ± 11.4 years) were older than those undergoing RCR (n = 118; 59.0 ± 14.2 years). Fifty-nine percent of all patients were classified as being a high risk for falls based on gait speed <0.7 m/s. Patients in the TSA group were more likely to display preoperative fall risk compared to patients in the RCR group (62% vs. 38%; χ² = 8.9, P = .03). There were no significant differences in ambulatory status, Veteran's Rand 12 Physical Component and Mental Component Scores, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, or Single Assessment Numeric Evaluation scores between groups (P = .11).

DISCUSSION

Both patient groups demonstrated a high rate of fall risk in preoperative evaluation. Patients undergoing TSA more often displayed fall risk compared with patients undergoing RCR. Although patients in the TSA group were older, there was no association between age or ambulatory status and fall risk.

CONCLUSION

Our results suggest that fall risk screening may be important for patients undergoing TSA and RCR surgeries. The higher fall risk in the TSA group may be an important consideration as this procedure shifts toward outpatient status.

Long-Term Use of a Sensory Prosthesis Improves Function in a Patient With Peripheral Neuropathy: A Case Report

Background: Peripheral neuropathy (PN) can result in either partial or complete loss of distal sensation resulting in an increased fall risk. Walkasins® uses a shoe insert to detect the magnitude and direction of sway and sends signals to a leg unit that provides sensory balance cues. The objective of this case report is to describe the long-term influence of the Walkasins® lower limb sensory neuroprosthesis on balance and gait for an individual with diabetic PN. Case Description: A 51-year-old male with a 3-year history of PN and a 10-year history of type II diabetes mellitus was fitted bilaterally with Walkasins® and utilized them 8-10 hours/day for more than 2 years. Although, vibration and tactile sensation thresholds were severely impaired at his 1st metatarsophalangeal joint and the lateral malleolus bilaterally he could perceive tactile stimuli from the Walkasins® above the ankles. Outcomes: Following Walkasins® use, his Activities-specific Balance Confidence Scale (ABC) scores improved from 33 to 80%. His mean Vestibular Activities of Daily Living (VADL) scores decreased from 3.54 to 1. His Functional Gait Assessment (FGA) scores increased from 13/30 to 28/30 and his miniBESTest scores improved from 15/28 to 26/28. Gait speed increased from 0.23 to 1.5 m/s. The patient described a decrease in pain and cramping throughout his lower extremities and an increase in function. Discussion: Gait and balance improved with the use of the Walkasins® and participation in a wellness program. This improvement suggests that the use of sensory substitution devices, such as the Walkasins®, may replace sensory deficits related to gait and balance dysfunction experienced by patients with PN. Further research is needed to determine if other patients will have a similar response and what the necessary threshold of sensory function is to benefit from use of the Walkasins®.

Is Fall Risk Systematically Evaluated in Memory Clinics? A National Survey of Practice in France

BACKGROUND

Falls are a major health problem in older persons but are still under-diagnosed and challenging to prevent. Current guidelines do not target high-risk populations, especially people living with dementia. In France, people with neurocognitive disorders are mainly referred to memory clinics (MCs).

OBJECTIVE

We aimed to survey the routine practice of physicians working in MCs regarding fall risk assessment.

METHODS

We conducted a cross-sectional survey in France from January to May 2019 among physicians working in MCs, through an anonymous online questionnaire: twenty-seven questions about the physician's background and their practice of fall risk assessment, especially use of clinical and paraclinical tools. We compared the results according to the age and the specialty of the physician.

RESULTS

We obtained 171 responses with a majority of women (60%) and geriatricians (78%). All age classes and all French regions were represented. Most of respondents (98.8%) stated that they address gait and/or falls in outpatient clinic and 95.9%in day hospitals. When asked about how they assess fall risk, fall history (83%) and gait examination (68.4%) were the most widely used, while orthostatic hypotension (24%) and clinical standardized tests (25.7%) were less common. Among standardized tests, One-leg Balance, Timed Up and Go Test, and gait speed measurements were the most used. Geriatricians had more complete fall risk assessment than neurologists (e.g., 56%versus 13%for use of standardized tests, p < 0.0001).

CONCLUSION

Almost all physicians addressed the question of fall in MC, but practices are widely heterogeneous. Further investigations are needed to standardize fall risk assessment in MCs.