Factors affecting the coefficient of variation of stride time of the elderly without falling history: a prospective study

[Purpose] The purpose of this study was to investigate the factors affecting the coefficient of variation (CV) of stride time in an exercise intervention for the elderly without falling history. [Subjects and Methods] The subjects were 42 elderly women who had participated in a care prevention program for 12 weeks. Stride time CV, motor function, movement ability, balance, Modified Falls Efficacy Scale (MFES) score, and Life-space Assessment (LSA) score before and after the intervention were examined for significant differences using the paired t-test. Multiple regression analysis was used to determine the factors that changed in the stride time CV. [Results] There were significant differences in muscle strength, sit-and-reach flexibility, the one-leg standing time (eyes open), the maximum walking speed, local stability of trunk acceleration, The Timed Up and Go Test (TUG-T), the MFES score, and the LSA score between the pre-intervention and post-intervention. Stepwise multiple regression analysis revealed that improvement of quadriceps muscle strength, sit-and-reach flexibility, the one-leg standing time, TUG-T, local stability of trunk acceleration (vertical direction) and MFES score were independent variables explaining the reduction in stride time CV. [Conclusion] The results was suggested that it might be possible to reduce the stride time CV by improving strength, flexibility and dynamic balance, and reducing fear of falls through interventions.

Regional Gray Matter Volumes Are Related to Concern About Falling in Older People: A Voxel-Based Morphometric Study

BACKGROUND

Concern about falling is common in older people. Various related psychological constructs as well as poor balance and slow gait have been associated with decreased gray matter (GM) volume in old age. The current study investigates the association between concern about falling and voxel-wise GM volumes.

METHODS

A total of 281 community-dwelling older people aged 70-90 years underwent structural magnetic resonance imaging. Concern about falling was assessed using Falls Efficacy Scale-International (FES-I). For each participant, voxel-wise GM volumes were generated with voxel-based morphometry and regressed on raw FES-I scores (p < .05 family-wise error corrected on cluster level).

RESULTS

FES-I scores were negatively correlated with total brain volume (r = -.212; p ≤ .001), GM volume (r = -.210; p ≤ .001), and white matter volume (r = -.155; p ≤ .001). Voxel-based morphometry analysis revealed significant negative associations between FES-I and GM volumes of (i) left cerebellum and bilateral inferior occipital gyrus (voxels-in-cluster = 2,981; p < .001) and (ii) bilateral superior frontal gyrus and left supplementary motor area (voxels-in-cluster = 1,900; p = .004). Additional adjustment for vision and physical fall risk did not alter these associations. After adjustment for anxiety, only left cerebellum and bilateral inferior occipital gyrus remained negatively associated with FES-I scores (voxels-in-cluster = 2,426; p < .001). Adjustment for neuroticism removed all associations between FES-I and GM volumes.

CONCLUSIONS

Our study findings show that concern about falling is negatively associated with brain volumes in areas important for emotional control and for motor control, executive functions and visual processing in a large sample of older men and women. Regression analyses suggest that these relationships were primarily accounted for by psychological factors (generalized anxiety and neuroticism) and not by physical fall risk or vision.

How fear of falling can increase fall-risk in older adults: applying psychological theory to practical observations

It is widely reported that fear of falling (FOF) has a profound and largely detrimental effect on balance performance in older adults. However, the mechanisms by which FOF influence postural stability are poorly understood. In the current article, we use psychological theory to explain FOF-related changes to postural control. First, we review literature describing associations between FOF and the 'stiffening' strategies observed during control of posture, including observations of eye and head movements. Second, we present a framework illustrating the interactions between increased age, FOF, and altered attentional processes, which in turn influence balance performance and fall-risk. Psychological theory predicts that anxiety can cause attentional bias for threatening and task-irrelevant stimuli and compromise the efficiency of working memory resources. We argue that while the adoption of stiffening strategies is likely to be beneficial in avoiding a loss of balance during simple postural tasks, it will ultimately compromise performance in dynamic and highly demanding functional tasks. The adoption of stiffening strategies leads to inadequate acquisition of the sensory information necessary to plan and execute dynamic and interactive movements. We conclude with some suggestions for future research.

Factors associated with fear of falling and associated activity restriction in community-dwelling older adults: a systematic review

OBJECTIVE

Fear of falling (FOF) is an important threat to autonomy. Current interventions to reduce FOF have yielded conflicting results. A possible reason for this discrepancy could be its multicausality. Some risk factors may not have been identified and addressed in recent studies. The last systematic review included studies until 2006.

METHODS

To identify additional risk factors for FOF and to test those mentioned previously, we conducted a systematic literature review. Studies examining FOF in community-dwelling older adults between 2006 and October 2013 were screened.

RESULTS

Outcomes are summarized with respect to different constructs such as FOF, fall-related self-efficacy/balance confidence, and FOF-related activity restriction. Odds ratios and p values are reported. There is no clear pattern with regard to the different FOF-related constructs studied. The only parameters robustly associated across all constructs were female gender, performance-based and questionnaire-based physical function, the use of a walking aid, and, less robust, a history of falls and poor self-rated health. Conflicting results were identified for depression and anxiety, multiple drugs, and psychotropic drugs. Other potentially modifiable risk factors were only mentioned in one or two studies and warrant further investigation. Parameters with mainly negative results are also presented.

CONCLUSION

Only few risk factors identified were robustly associated across all FOF-related constructs and should be included in future studies on FOF. Some newer factors have to be tested again in different cohorts. The comprehensive overview might assist in the conceptualization of future studies.

Comparison of the effects of water- and land-based exercises on the physical function and quality of life in community-dwelling elderly people with history of falling: a single-blind, randomized controlled trial

PURPOSE

The purpose of this study was to identify the effects of water-based exercises on the physical functions and quality of life (QOL) in community-dwelling elderly people with history of falling.

MATERIALS AND METHODS

Participants were randomly assigned to the water-based exercise group (n=34) or land-based exercise groups (n=32). To identify the effects on physical functions, muscle strength, flexibility, and mobility were measured. QOL and fear of falling were evaluated using the Short Form 36-item questionnaire and the modified falls efficacy scale (M-FES). The measurements were performed before and after the 10-week training period.

RESULTS

Within-group analysis indicated that hip abduction and adduction strength improved significantly in both groups (p=0.005; p=0.007). However, no statistically significant within-group differences were found in the back scratch test (p=0.766) and chair sit-and-reach test (p=0.870). QOL was significantly different in both groups (health transition: p=0.014, physical functioning: p<0.001, role physical: p<0.001, role emotional: p=0.002, bodily pain: p<0.001, vitality: p<0.001, and mental health: p<0.001). There was a significant difference in the M-FES in both groups (p=0.040).

CONCLUSIONS

These results indicate that water-based exercises are beneficial to improve the QOL, as well as physical activities, of community-dwelling elderly compared with land-based exercise. Water-based exercises would be useful to improve physical and psychological health in the elderly people with history of falling.

Effects of communal exercise with visual and auditory feedback provided by a smart application on gait ability and fear of falling in Parkinson's disease patients

Parkinson's disease is a chronically developing neurodegenerative disease showing typical motor symptoms of the following triad: resting tremor, freezing of gait, and bradykinesia-hypokinesia. In the present study, we investigated the effects of a communal exercise program, using the visual and auditory feedback provided by a smart application, to assess gait ability, fear of falling, and fall efficacy in Parkinson's disease patients. Subjects consisted of 29 Parkinson's disease patients who were non-demented individuals. The subjects were randomly divided into three groups: the control group (n= 9, CG), the communal exercise group using the smart application (n= 10, CCEG), and the individual exercise group using the smart application (n= 10, ICEG). The communal exercise program consisted of a warm up (10 min) followed by communal exercise using the smart application (40 min), and a cool down (10 min) for 3 days per week over 10 weeks. The results presented here show that velocity and cadence were significantly increased among groups. Step and stride length were significantly increased among times. Fear of falling and fall efficacy were significantly different among groups and times. In particular, fear of falling was lower and fall efficacy was higher in the CCEG than in the ICEG and CG. These findings indicate that 10 weeks of the communal exercise program using the smart application can be effective in improving gait ability, fear of falling, and fall efficacy in Parkinson's disease patients.

A randomized trial comparing Tai Chi with and without cognitive-behavioral intervention (CBI) to reduce fear of falling in community-dwelling elderly people

The aim of this randomized trial was to compare the effects of Tai Chi with and without CBI on a primary outcome of reducing the fear of falling, and on secondary outcomes including encouraging better social engagement, improving self-perceived personal wellbeing, and achieving better mobility among elderly people with fear of falling. One hundred and twenty-two community-dwelling elderly people aged ≥ 65 were randomly assigned to either a Tai Chi or a Tai Chi plus CBI group. Participants' level of fear of falling, physical mobility, self-perceived personal wellbeing and social participation were compared before and after completing the 8-week intervention and then at a 2-month follow-up. The findings showed that Tai Chi both with and without CBI had a similar effect on reducing elderly people's fear of falling, but only Tai Chi plus CBI had a positive effect on participants' self-perceived personal wellbeing. Tai Chi both with and without CBI had no effect on participants' self-perceived social participation and mobility. Apart from a slight improvement in participants' self-perceived personal wellbeing, other outcome effects were similar for Tai Chi with and without CBI. This finding raises a question about the additive effects of combined intervention over Tai Chi alone in reducing elderly people's fear of falling. In view of the higher demand for resources and manpower to implement a combined intervention, further study is still required to confirm the potential additional benefits of this combined intervention prior to recommending it to community services.

The association between fear of falling and gait variability in both leg and trunk movements

The aim of this study was to explore whether FoF was associated with variability in both leg and trunk movements during gait in community-dwelling elderly. Ninety-three elderly people participated in this study. Each participant was categorized into either Fear or No-Fear group on the basis of having FoF. The participants walked 15m at their preferred speed. The wireless motion recording sensor units were attached to L3 spinous process and right posterior surface of heel during gait. Gait velocity, stride time and stride length were calculated. Variability in lower limb movements was represented by coefficient of variation (CV) of stride time. Trunk variability was represented by autocorrelation coefficients (AC) in three directions (vertical: VT, mediolateral: ML and anteroposterior: AP), respectively. Gait parameters were compared between groups, and further analyses were performed using generalized linear regression models after adjustment of age, sex, fall experience, height, weight, and gait velocity. Although gait velocity, mean stride time and stride length did not differ significantly between groups, stride time CV and all ACs were significantly worse in the Fear group after adjustment for variables, even including gait velocity (stride time CV: p=0.003, β=-0.793; AC-VT: p=0.011, β=0.053; AC-ML: p=0.044, β=0.075; AC-AP: p=0.002, β=0.078). Our results suggest that fear of falling is associated with variability in both leg and trunk movements during gait in community-dwelling elderly. Further studies are needed to prove a causal relationship.

Functional capacity and fear of falling in cancer patients undergoing chemotherapy

Cancer patients, particularly during chemotherapy, often encounter functional status limitations. This study examines fear of falling, balance, gait and lower limb strength in cancer patients during ongoing or recently completed (≤12 months) chemotherapeutic treatment in comparison to age-matched and senior controls (≥65 years). Data were obtained from 69 subjects; 21 cancer patients (51±7 years) with histological confirmed diagnosis and two control groups (2×n=24): one age-matched (53±7 years) and one senior group (70±3 years). Fear of falling (FoF) was evaluated using the Falls Efficacy Scale-International Version. Motor function measurement included postural sway (centre of pressure) in upright stance with eyes covered, gait speed (comfortable fluid walking) and maximum voluntary isometric quadriceps strength (MIVF). One-way ANOVA followed by corrected post hoc paired-sample t-test revealed inferior values in cancer patients than in age-matched healthy regarding all parameters. Gait speed and MIVF of cancer patients were higher than in the senior control group (p<.05), whereas their FoF and postural sway were comparable (p>.05). Physical performance parameters of cancer patients were found to be lower in comparison to healthy age-matched subjects. Cancer patients show physical impairments which may limit independence and may increase fall risk. The present findings call for routine screening of physical function in cancer patients, and further stress the relevance of exercise interventions during and after chemotherapy.

The relationship between fear of falling to spatiotemporal gait parameters measured by an instrumented treadmill in people with multiple sclerosis

People with multiple sclerosis (MS) identify mobility limitations as one of the greatest challenges of this disease. Continued loss of mobility and falls are among their greatest concerns for the future. Our objective was to determine if fear of falling is associated with spatial and temporal gait parameters in persons with MS, when measured by an instrumented treadmill. This observational case control study was performed at the MS Center, Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel. Sixty-eight relapsing-remitting patients diagnosed with MS, 38 women, aged 40.9 (S.D. = 11.9), participated in this investigation. Twenty-five healthy subjects, 14 women, aged 39.5 (S.D. = 9.4) served as controls gait controls. Gait spatiotemporal parameters were obtained using the Zebris FDM-T Treadmill (Zebris(®) Medical GmbH, Germany). The Falls Efficacy Scale International was used to assess the level of concern relating to falls. Forty-one people with MS were classified as highly fearful of falling. Twenty-seven patients were slightly concerned. Highly fearful of falling patients walked slower had a shorter step length, a wider base of support and prolonged double support phase compared to slightly concerned patients. Fearful patients also demonstrated elevated variability of the center of pressure (CoP) trajectory compared to slightly concerned MS patients. Fear of falling and spatiotemporal gait alterations in people with MS are linked. Additionally, variability of the CoP during walking appears to be connected with the level of concern.

Fear of falling during activities of daily living after total hip arthroplasty in Japanese women: a cross-sectional study

OBJECTIVES

To investigate the prevalence of fear of falling, and identify factors associated with fear of falling during activities of daily living after total hip arthroplasty (THA).

DESIGN

Cross-sectional study.

SETTING

Community.

PARTICIPANTS

Two hundred and fourteen women who had undergone THA.

MAIN OUTCOME MEASURES

Fear of falling after THA was assessed for 12 activities of daily living using a fear of falling score. The number of falls in the past year, total Oxford Hip Score (OHS), total Penn State Worry Questionnaire (PSWQ) score and walking capacity were recorded as descriptive statistics. Multiple linear regression analysis was performed, with total fear of falling score as the dependent variable and age, body mass index, time since THA, bilateral THA, total OHS, history of falling, walking capacity and total PSWQ score as the independent variables.

RESULTS

A number of participants (mean age = 64.2) experienced fear of falling while ascending and descending stairs: 45% (97/214), taking a bath: 26% (56/214), bending to pick something up off the floor: 26% (55/214), and getting up from lying on the floor: 25% (54/214). Fear of falling during activities of daily living after THA was significantly correlated with total OHS, history of falling, walking capacity, total PSWQ score and age (P<0.05).

CONCLUSIONS

Fear of falling develops in certain activities of daily living after THA. It is associated with poorer functional outcome, history of falling, lower walking capacity, higher anxiety level and older age.

Effects of dual-tasking on control of trunk movement during gait: respective effect of manual- and cognitive-task

Trunk control during gait provides a stable platform for vision and head control. However, in dual-task gait, cognitive tasks result in increased trunk movements, reduced gait speed, and increased gait variability. Manual tasks have been associated with reduced gait speed, but their effects on trunk movement have not been fully investigated. Furthermore, the fear of falling (FoF) during dual-task gait remains relatively unstudied. We aimed to assess trunk movements during cognitive-task gait (CG) and manual-task gait (MG), and examine the effects of CG and MG on individuals with and without FoF. The participants were 117 healthy older adults. We used two triaxial accelerometers: one to record trunk movements at the L3 spinous process and one at the heel to measure initial contact. Participants counted backward by one (CG) or carried a ball on a tray (MG), and we calculated stride time variability and standardized root-mean-square trunk accelerations in the mediolateral (ML) and anteroposterior (AP) directions. CG significantly increased lower trunk oscillations in the ML (t=4.9, p<0.001) and AP directions (t=6.1, p<0.001). Conversely, MG significantly decreased trunk oscillations in the ML (t=-5.9, p<0.001) and AP directions (t=-8.3, p<0.001). The difference in trunk oscillations during CG in the ML direction was significantly larger in subjects with FoF than without FoF (t=2.6, p<0.01). We conclude that for the tasks we studied, CG and MG have different effects on trunk movement. Finally, FoF was associated with changes in trunk movement in the ML direction during CG but not MG.

Effects of the implementation of an evidence-based program to manage concerns about falls in older adults

PURPOSE OF THE STUDY

Concerns about falls and related activity avoidance are common in older people. A multicomponent program reduced these concerns and increased daily activity among older people in a randomized controlled trial. This study explored whether the effects and acceptability of the program maintain after its implementation into home care organizations.

DESIGN AND METHODS

In a pretest-post-test study, the effects and acceptability of the 8-week cognitive behavioral program was evaluated in 125 community-living older adults. Data on concerns about falls, related avoidance behavior, falls, fall-related medical attention, feelings of loneliness and anxiety, and symptoms of depression were collected prior to the start of the program and at 2 and 4 months.

RESULTS

Pretest-post-test analyses showed significant improvements at 4 months for concerns about falls, activity avoidance, number of falls in the past 2 months, feelings of anxiety, and symptoms of depression. No significant differences were shown for daily activity, feelings of loneliness, and fall-related medical attention.

IMPLICATIONS

After implementation in home care organizations, the program reduced concerns about falls, avoidance behavior, and falls in community-living older adults. These findings are highly consistent with the outcomes of a previously performed randomized controlled trial, indicating that the program can be successfully implemented in practice. Further dissemination of the program is recommended to reduce concerns about falls and related activity avoidance in community-living older people.