Mobility device use in older adults and incidence of falls and worry about falling: findings from the 2011-2012 national health and aging trends study

Mobility Device Use and Mobility Disability in U.S. Medicare Beneficiaries With and Without Cancer History

BACKGROUND/OBJECTIVES

To examine the prevalence of mobility device use in U.S. community-dwelling older adults including older adults with cancer history ("survivors") and to estimate mobility disability noting variation by cancer history, cancer site, and other factors to improve early detection of mobility limitations.

DESIGN

Cross-sectional analysis from the 2011 National Health and Aging Trends Study.

SETTING

In-person interviews in the homes of study participants.

PARTICIPANTS

Nationally representative sample of community-dwelling Medicare beneficiaries, aged 65 and older (n = 6,080 including 1,203 survivors).

MEASUREMENTS

Participants were asked about cancer history, pain that limited activity, mobility device use (eg, canes, walkers, wheelchairs, and scooters), history of falls, and medical conditions plus they were assessed for approximate mobility disability using a 3-m gait speed test. The results were scored on a scale of 0 to 4 (0 = lowest, 4 = highest) using criteria from the National Institute on Aging.

RESULTS

A total of 19% of older adults and 23% of survivors reported using one or more mobility device, most commonly a single-point cane. Approximately 10% of breast, 6% of prostate, and 3% of colorectal cancer survivors reported using two or more devices in the past month. Survivors had lower mean gait speed scores (2.27) than adults without cancer history (2.39). In regression models, survivors were 18% less likely than adults without cancer history to score high on the gait speed test (odds ratio = .82; P < .05). Prior mobility device use, history of multiple falls, unhealthy weight, Black race, multimorbidity, and pain that limited activity were associated with lower gait speed scores in all participants (all P < .05).

CONCLUSION

A greater proportion of older survivors used mobility devices than adults without cancer history. Mobility device use varied by cancer site and was highest in survivors of breast, colorectal, and gynecological cancer. Survivors were also more likely to show signs of mobility disability, based on gait speed, compared with adults without cancer history. These indications, although modest, suggest that older survivors may require special attention to functional changes in survivorship.

Innovations in Geroscience to enhance mobility in older adults

Aging is the primary risk factor for functional decline; thus, understanding and preventing disability among older adults has emerged as an important public health challenge of the 21st century. The science of gerontology - or geroscience - has the practical purpose of "adding life to the years." The overall goal of geroscience is to increase healthspan, which refers to extending the portion of the lifespan in which the individual experiences enjoyment, satisfaction, and wellness. An important facet of this goal is preserving mobility, defined as the ability to move independently. Despite this clear purpose, this has proven to be a challenging endeavor as mobility and function in later life are influenced by a complex interaction of factors across multiple domains. Moreover, findings over the past decade have highlighted the complexity of walking and how targeting multiple systems, including the brain and sensory organs, as well as the environment in which a person lives, can have a dramatic effect on an older person's mobility and function. For these reasons, behavioral interventions that incorporate complex walking tasks and other activities of daily living appear to be especially helpful for improving mobility function. Other pharmaceutical interventions, such as oxytocin, and complementary and alternative interventions, such as massage therapy, may enhance physical function both through direct effects on biological mechanisms related to mobility, as well as indirectly through modulation of cognitive and socioemotional processes. Thus, the purpose of the present review is to describe evolving interventional approaches to enhance mobility and maintain healthspan in the growing population of older adults in the United States and countries throughout the world. Such interventions are likely to be greatly assisted by technological advances and the widespread adoption of virtual communications during and after the COVID-19 era.

Development, reliability and validity of the Safe Use of Mobility Aids Checklist (SUMAC) for 4-wheeled walker use in people living with dementia

BACKGROUND

Balance and gait problems are common and progressive in dementia. Use of a mobility aid provides physical support and confidence. Yet, mobility aid use in people with dementia increases falls three-fold. An assessment tool of mobility aid safety in people with dementia does not currently exist. The objectives of this study were: 1) to develop a tool for the evaluation of physical function and safe use of a 4-wheeled walker in people with dementia, and 2) to evaluate its construct and criterion validity, inter-rater and test-retest reliability and minimal detectable change.

METHODS

Healthcare professionals (HCP) experienced in rehabilitation of people with dementia participated in focus groups for item generation of the new tool, The Safe Use of Mobility Aid Checklist (SUMAC). The SUMAC evaluates physical function (PF) and safe use of the equipment (EQ) on nine tasks of daily life. Reliability was evaluated by HCP (n = 5) scored participant videos of people with dementia (n = 10) using a 4-wheeled walker performing the SUMAC. Inter-rater and test-retest reliability was assessed using intra-class correlation coefficients (ICC). Construct validity evaluated scores of the HCPs to a consensus HCP panel using Spearman's rank-order correlations. Criterion validity evaluated SUMAC-PF to the Performance-Oriented Mobility Assessment (POMA) gait subscale using Spearman's rank-order correlations.

RESULTS

Three focus groups (n = 17) generated a tool comprised of nine tasks and the components within each task for physical function and safe use. Inter-rater reliability was statistically significant for SUMAC-PF (ICC = 0.92, 95%CI (0.81, 0.98), p < 0.001) and SUMAC-EQ. (ICC = 0.82, 95%CI (0.54, 0.95), p < 0.001). Test-retest reliability was statistically significant for SUMAC-PF (ICC = 0.89, 95%CI (0.81, 0.94), p < 0.001) and SUMAC-EQ. (ICC = 0.88, 95%CI (0.79, 0.93), p < 0.001). As hypothesized, the POMA gait subscale correlated strongly with the SUMAC-PF (r_s = 0.84), but not EQ (r_s = 0.39).

CONCLUSIONS

The focus groups and research team developed a tool of nine tasks with evaluation on physical function and safe use of a 4-wheeled walker for people with dementia. The SUMAC tool has demonstrated content validity for the whole scale and good construct and criterion validity for the SUMAC-PF and SUMAC-EQ. The subscores of the SUMAC demonstrated excellent to good inter-rater and test-retest reliability.

Factors associated with falls in older women with breast cancer: the use of a brief geriatric screening tool in clinic

PURPOSE

Unintentional falls and breast cancer are common among older women, but the associations between them are understudied. We aimed to identify factors associated with falls in older women with breast cancer.

METHODS

We retrospectively reviewed clinical records of older women with breast cancer at Duke Medical Center who had completed the Senior Adult Oncology Program geriatric assessment. Characteristics were compared between women had had at least one fall in the past year and those who did not. Pearson's Chi-square tests and t tests were used for comparison of groups' characteristics. Logistic regression determined factors associated with falling.

RESULTS

We identified 425 women, age 76.2 years (range 65-89 years), at the time of the assessment. 118 (27.8%) women reported a fall in the prior year. Age, race, ethnicity, and time since diagnosis (all p > 0.05) were similar between groups. In univariate analyses, metastatic disease (p = 0.023) and history of endocrine therapy (p = 0.042) were more common among women who fell. Women who fell had lower systolic (p = 0.001), diastolic (p < 0.001) blood pressures, and SpO₂ (p = 0.018). Women who had fallen had a higher Charlson Comorbidity Index (CCI: p = 0.033), and were more likely to report using a walking aide (p < 0.001), nutritional issues (p = 0.006), and depression symptoms (p = 0.038). In multivariate analysis, falling was associated with low DBP (OR 0.93; p = 0.0017), low SpO₂ (OR 0.79; p = 0.0169), a higher CCI (OR 1.23; p = 0.0076), and depression symptoms (OR 1.61; p = 0.039).

CONCLUSIONS

Among older women with breast cancer, depressive symptoms, higher comorbidity level, and vital sign measurements were associated with having fallen.

Depression and activity-limiting fall worry among older adults: longitudinal reciprocal relationships

OBJECTIVES

Late-life depression, falls, and fall worry are public health problems. While previous research confirms the cross-sectional relationship between depression and fall worry, few longitudinal studies have examined whether changes in fall worry are associated with changes in depressive illness and vice versa. This study examined longitudinal relationships between probable major depression (PMD) and activity-limiting fall worry (ALW).

DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS

This longitudinal panel observational study used data from the National Health and Aging Trends Study (NHATS) waves 5 (referred to as T1 in this study) and 6 (T2), conducted in 2015 and 2016, respectively (N = 6,299, aged 65 and older). We examined associations of new and continued ALW between T1 and T2 with T2 PMD, controlling for T1 PMD; and associations of new and continued PMD between T1 and T2 with T2 ALW, controlling for T1 ALW. We used χ2 and t tests for descriptive statistics and logistic regression for multivariable analysis.

RESULTS

Those with new ALW at T2 had significantly greater odds of T2 PMD compared to those without ALW at both time points (AOR = 2.64, 95% CI = 1.98-3.51), and those with new PMD at T2 had significantly greater odds of T2 ALW (AOR = 2.42, 95% CI = 1.66-3.52). Those with continued PMD also had greater odds of T2 ALW compared to those without PMD at either time point (AOR = 2.31, 95% CI = 1.62-3.29).

CONCLUSIONS

The findings add to knowledge about bidirectional (mutually reinforcing) relationships between depression and activity-limiting fall worry. Innovative interventions are needed to reduce both late-life depression and activity-limiting fall worry.

Psychophysical Health Factors and Its Correlations in Elderly Wheelchair Users Who Live in Nursing Homes

Background: The aging is a multi-faceted process comprising both-the physical and mental alterations. Thus, the aim of the study was to evaluate the variables affecting the psychophysical state of the elderly people using wheelchairs and living in nursing homes (NH). Methods: 165 older wheelchair users were included in the study after meeting the inclusion criteria and expressing written consent. The assessment involved cognitive functioning, depression, body balance and flexibility, lung capacity and upper limbs dexterity, strenght and endurance. The results showed negative correlation between depression and balance, upper limb dexterity and endurance and shoulder flexion. A positive correlation between cognitive functioning and balance, upper limb dexterity, strenght and endurance, lung capacity and joint mobility was determined. Also, the study proved positive correlation between daily functioning and functional fitness, muscle strength and endurance, body flexibility, joint mobility. The regression analysis showed that better scores in balance test and joint mobility implied with higher scores in cognitive functioning. The most important determinants of functional fitness were balance, hand grip strenght and joint mobility. Conclusion: The future study should be focused on developing interventions aimed at senior wheelchair users living in NHs to prevent the deterioration of their mental and physical fitness.

Depression in Community-Dwelling Older Adults Living Alone in China: Association of Social Support Network and Functional Ability

Older adults who live alone are more likely to experience depressive symptoms compared to those who live with others. The current study aimed to investigate the prevalence of depression and identify its associated factors among community-dwelling older adults living alone in China. A cross-sectional questionnaire survey was conducted with a total of 172 older adults living alone in Nanjing city, Jiangsu province of mainland China. The prevalence of depression among this group of Chinese older adults was 18.6%. The possibility of depression among older adults who had social isolation risk was 2.59 times higher than those who had no such risk. Compared with older adults who had normal functional abilities, the possibility of depression was 3.31 times higher in older adults with mild functional impairments and 4.72 times higher in those with severe functional impairments. The results suggest that health care providers should develop effective interventions to help older adults living alone maintain their mental health by enhancing their functional abilities and increasing their social support networks and social engagement. [Research in Gerontological Nursing, 13(2), 82-90.].

Identifying the Effects of Assistive and Resistive Guidance on the Gait of Elderly People Using a Smart Walker

Progression of technology has expanded applications of smart walkers in clinical fields. However, it is essential to investigate the effects of different types of gait guidance in order to introduce smart walkers more widely throughout these fields. The purpose of this study was to identify the effects of assistive and resistive guidance on the gait of elderly people using a smart walker. Gait parameters, surface electromyography of lower limb muscles, and trunk acceleration were measured. The assistive guidance force significantly increased gait speed, step length, and cadence while increasing trunk acceleration variability. The same amount of resistive guidance force did not change gait parameters; instead, however, it restrained the speed-dependent increase of trunk acceleration variability in the mediolateral direction. An analysis of muscle activity suggested that the lower limb muscle activity could be increased by varying gait parameters including speed, step length, and cadence.

Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association

Fragala, MS, Cadore, EL, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, MD, and Ryan, ED. Resistance training for older adults: position statement from the national strength and conditioning association. J Strength Cond Res 33(8): 2019-2052, 2019-Aging, even in the absence of chronic disease, is associated with a variety of biological changes that can contribute to decreases in skeletal muscle mass, strength, and function. Such losses decrease physiologic resilience and increase vulnerability to catastrophic events. As such, strategies for both prevention and treatment are necessary for the health and well-being of older adults. The purpose of this Position Statement is to provide an overview of the current and relevant literature and provide evidence-based recommendations for resistance training for older adults. As presented in this Position Statement, current research has demonstrated that countering muscle disuse through resistance training is a powerful intervention to combat the loss of muscle strength and muscle mass, physiological vulnerability, and their debilitating consequences on physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy. This Position Statement provides evidence to support recommendations for successful resistance training in older adults related to 4 parts: (a) program design variables, (b) physiological adaptations, (c) functional benefits, and (d) considerations for frailty, sarcopenia, and other chronic conditions. The goal of this Position Statement is to a) help foster a more unified and holistic approach to resistance training for older adults, b) promote the health and functional benefits of resistance training for older adults, and c) prevent or minimize fears and other barriers to implementation of resistance training programs for older adults.

The Use of Mobility Devices and Personal Assistance: A Joint Modeling Approach

Objective: To examine whether mobility device use substitutes for personal assistance among U.S. older adults. Method: Using the National Health and Aging Trends Study, we identified 3,211 community-living older adults (aged 65 and older) who reported mobility difficulties at baseline. We used recursive bivariate probit models to simultaneously estimate the effect of covariates on the likelihood of using (a) mobility devices and (b) personal assistance to accommodate mobility difficulty. Independent variables included age, gender, race, physical/mental health status, cognition, and comorbidities. Results: Predictors of the use of personal assistance and mobility devices exhibit important similarities and differences. Device use reduced the odds of receiving personal assistance by 50% (odds ratio [OR] = 0.50, 95% confidence interval [CI] = [0.29, 0.86]). Discussion: Findings suggest device use substitutes for personal assistance. Practitioners and policymakers should promote the appropriate use of mobility devices while recognizing the importance of assistance with some groups and the potential of increasing mobility device use.

Does Prolonged Use of Walkers in Shoulder Arthroplasty Patients Lead to Accelerated Failure Rates?

Introduction: The effect of weight-bearing on a shoulder arthroplasty (SA) remains unclear, and recommendations regarding the use of a walker in SA patients have not been established. The purpose of this study was to determine outcomes and survivorship of SA in patients who routinely use a walker.

Methods: Fifty-three primary SA (10 hemiarthroplasties (HAs), 33 anatomic total shoulder arthroplasties (TSAs), 10 reverse shoulder arthroplasties (RSAs)) in 41 walker-dependent patients were followed for a minimum of three years (mean 64 months, range, 36-156). The average age at SA was 76 years. Shoulders were assessed for pain, range of motion (ROM), satisfaction, Neer ratings, American Shoulder and Elbow Surgeons (ASES) score, complications, survivorship, and radiographic outcomes.

Results: At most recent follow-up, 40 shoulders (75%) were pain free, elevation and external rotation improved significantly (P < .0001), and 87% of the patients were satisfied. Postoperative ASES scores averaged 74 (range, 38-92) points. There were 25 excellent, 16 satisfactory, and 12 unsatisfactory results based on modified Neer ratings. Four shoulders (7.5%) required reoperation at a mean of 40 months after the index arthroplasty. Radiographically, there were six cases of glenoid loosening in the anatomic SA group (25%), and two cases of severe glenoid erosion in the HA group (25%).

Conclusion: Routine use of a walker does not appear to lead to a markedly increased rate of SA failure at mid-term follow-up. Concerning radiographic findings were more common after HA and anatomic TSA than after RSA. Longer follow-up is required to determine the long-term impact of walker use on SA.

Association between Recent Falls and Changes in Outdoor Environments near Community-Dwelling Older Adults' Homes over Time: Findings from the NHATS Study

Neighborhood environments have been increasingly associated with incidents of falling and the fear of falling. However, little is known about the causal impact of neighborhood environments on falling. This study identifies whether changes in outdoor environmental attributes over a one-year period are associated with the occurrence of recent falls among community-dwelling older adults aged 65 and older in the United States. Data were obtained from 4802 adults aged 65 years or older from the National Health and Aging Trends Study (NHATS). Logistic regression analyses were performed to identify neighborhood risk factors linked to the odds of experiencing recent falls at the one-year follow-up. Almost one in ten subjects (9.7% of 4802 subjects) who had not fallen before reported experiencing recent falls after one year. After adjusting for sociodemographic, health, and walking-related behavioral covariates, these subjects were more likely to reside in areas with higher environmental barriers on sidewalks/streets and uneven walking surfaces or broken steps, compared to non-fallers. Our findings suggest that safe and well-maintained outdoor environments may help prevent falls among community-dwelling older adults who engage in outdoor activities. Clinical and environmental interventions for promoting both safe walking and safe environments are warranted.

Lateral Transfer Assist Robot (LTAR): Development of a proof-of-concept prototype

BACKGROUND

Falls during transfer to and from a wheelchair are associated with numerous problems. Factors responsible for difficulty in transferring include horizontal/vertical gaps between surfaces; obstacles, such as armrests; and complicated brake/footrests configurations before transferring. Moreover, controlling a wheelchair sufficiently close to the transfer surface within the confined home space is difficult.

OBJECTIVE

We described the design of the novel Lateral Transfer Assist Robot (LTAR) for solving problems during transfer. Furthermore, the effectiveness and usability of the robot were preliminary examined in healthy adults.

METHOD

The transfer problems and basic designs were organized. The effectiveness of the prototype was measured by three-dimensional motion analysis and questionnaire.

RESULTS

The prototype LTAR was developed. With just a push on a button, the footplate lowers to the floor and the seat and armrest lowers to the height of the seating surface to fill the gap between the surfaces. Using these features, users can transfer by simply shifting their buttocks sideways. Additionally, LTAR has omnidirectional wheels that help move it within a narrow space. The LTAR was confirmed to reduce the physical and subjective burden, except for maneuverability.

CONCLUSION

The LTAR was found to be effective for home use and reducing burden of transfer.

Association Between Sleep Medications and Falls and Fall-related Worries in Community-Dwelling Older Adults in the United States

Background Falls are the leading cause of unintentional fatal and nonfatal injuries in seniors. Sleep medications are associated with adverse events risk in older adults. The objective of this study is to quantify the relationship between different levels of sleep medication use with falls and fall-related worries in United States adults aged 65 years and older using a nationally representative sample. Methods Using the 2011 National Health and Aging Trends Study, survey-weighted multiple logistic regression was used to determine the association between participants who reported sleep medication use and the outcomes: falls in the last month, falls in the last year, multiple falls in the last year, fall-related worries, and limitation of activities due to fall-related worries. Results In adjusted analyses, older adults who used sleep medications every night compared to non-users of sleep medications were at increased odds of falls in the last year with an odds ratio (OR) of 1.51 (95% confidence limit [CL] 1.27, 1.78) and of multiple falls with an OR = 1.67 (95% CL 1.35, 2.06). For those who used sleep medications less than every night compared to non-users, there were no statistically significant increased odds of fall outcomes. Older adults who used sleep medication most nights (5–6 nights per week) and every night compared to non-users had increased odds of having fall-related worries with an OR = 1.61 (95% CL 1.06, 2.45) and an OR = 1.32 (95% CL 1.11, 1.58), respectively. Conclusion Older adults who use sleep medication every night are at greater odds of experiencing falls and having fall-related worries. Increased involvement by pharmacists in the community setting and pharmacist-led comprehensive medication reviews are efforts that may reduce sleep medication use and result in fewer falls in older adults.

The effects of a positional feedback device on rollator walker use: a validation study

BACKGROUND

According to clinical guidelines, rolling walker users should walk with their feet between the posterior wheels of the walker; however approximately 50% of users do not.

OBJECTIVE

To describe the development and effects of a custom device designed to attach to a walker and provide visual feedback to encourage improved user position.

METHODS

Fourteen older adults participated in this study to validate the effects of this device when a 10% decrease in the users' habitual distance away from the walker was encouraged via feedback. Users' relative distances were recorded using a non-contact distance sensor within the device, while kinematics were measured using commercial wearable wireless inertial sensors.

RESULTS

Individuals were able to ambulate on average 20% closer or more to their walker when prescribed the visual feedback. This was primarily achieved through a reduction in shoulder flexion. Trunk and cervical postures were less generalizable as only small and variable changes were observed.

CONCLUSIONS

These findings suggest that the device has promise, as individuals attended to the device and walked in a position closer to that recommended by clinical guidelines. The device did not appear to improve posture. Future work is needed to determine long-term effects.

Historical and projected fractures associated with mobility scooters presenting to U.S. emergency departments: 2004-2025

Introduction

The proportion of mobility scooter users in the United States continues to rise. However, these devices impart a substantial yet underappreciated risk of serious injury - namely, fractures - on users.

Methods

The purpose of this cross-sectional, retrospective study was to use the National Electronic Injury Surveillance System (NEISS) to quantify the national burden of these device-associated fractures between 2004 and 2017, analyzing in two-year intervals. We also projected estimates to 2025, and described the demographic characteristics of those injured.

Results

We found that national estimates of device-associated fractures increased significantly between the 2004-2005 (N = 2583; C.I. 1851 - 3316) and 2016-2017 (N = 6553; C.I. 5026 - 8081) periods (p < 0.001). A linear regression model (R² = 0.89; P = 0.002) was applied to project 9824 such fractures (C.I. 8273-11,328) in the 2024-2025 period. Injured patients were commonly over age 65 (63.5%; C.I. 57.7%-69.4%) and white (61.4%; C.I. 50.7% - 72.1). Fractures often occurred at home (28.6%; C.I. 22.0%-35.3%) or in public (26.0%; C.I. 21.1%-30.9%).

Conclusion

Our study suggests that osteoarthritic patients relying on mobility scooters to manage pain during ambulation should be considered candidates for total joint replacement procedures. This may help minimize the growing economic and health burden of mobility scooter fractures.

Geriatric Polypharmacy: Pharmacist as Key Facilitator in Assessing for Falls Risk: 2019 Update

This article highlights the significant health impact of falls among older adults. An emphasis is placed on the vital role of the pharmacist, regardless of practice setting, in assessing and reducing falls risk for this growing population. In addition, the importance of a stepwise comprehensive approach to falls assessment by pharmacists in collaboration with other clinicians is elucidated.

Sensor-Based Passive Remote Monitoring and Discordant Values: Qualitative Study of the Experiences of Low-Income Immigrant Elders in the United States

BACKGROUND

Remote monitoring technologies are positioned to mitigate the problem of a dwindling care workforce and disparities in access to care for the growing older immigrant population in the United States. To achieve these ends, designers and providers need to understand how these supports can be best provided in the context of various sociocultural environments that shape older adults' expectations and care relationships, yet few studies have examined how the same remote monitoring technologies may produce different effects and uses depending on what population is using them in a particular context.

OBJECTIVE

This study aimed to examine the experiences and insights of low-income, immigrant senior residents, family contacts, and staff of housing that offered a sensor-based passive monitoring system designed to track changes in movement around the home and trigger alerts for caregivers. The senior housing organization had been offering the QuietCare sensor system to its residents for 6 years at the time of the study. We are interested in adoption and discontinuation decisions and use over time, rather than projected acceptance. Our research question is how do cultural differences influence use and experiences with this remote monitoring technology? The study does not draw generalizable conclusions about how cultural groups interact with a given technology, but rather, it examines how values are made visible in elder care technology interactions.

METHODS

A total of 41 participants (residents, family, and staff) from 6 large senior housing independent living apartment buildings were interviewed. Interviews were conducted in English and Korean with these participants who collectively had immigrated to the United States from 10 countries.

RESULTS

The reactions of immigrant older adults to the passive monitoring system reveal that this tool offered to them was often mismatched with their values, needs, and expectations. Asian elders accepted the intervention social workers offered largely to appease them, but unlike their US-born counterparts, they adopted reluctantly without hope that it would ameliorate their situation. Asian immigrants discontinued use at the highest rate of all residents, and intergenerational family cultural conflict contributed to this termination. Social workers reported that none of the large population of Russian-speaking residents agreed to use QuietCare. Bilingual and bicultural social workers played significant roles as cultural navigators in the promotion of QuietCare to residents.

CONCLUSIONS

This research into the interactions of culturally diverse people with the same monitoring technology reveals the significant role that social values and context play in shaping how people and families interact with and experience elder care interventions. If technology-based care services are to reach their full potential, it will be important to identify the ways in which cultural values produce different uses and responses to technologies intended to help older adults live independently.

Toward Unobtrusive In-Home Gait Analysis Based on Radar Micro-Doppler Signatures

OBJECTIVE

In this paper, we demonstrate the applicability of radar for gait classification with application to home security, medical diagnosis, rehabilitation, and assisted living. Aiming at identifying changes in gait patterns based on radar micro-Doppler signatures, this paper is concerned with solving the intra motion category classification problem of gait recognition.

METHODS

New gait classification approaches utilizing physical features, subspace features, and sum-of-harmonics modeling are presented and their performances are evaluated using experimental K-band radar data of four test subjects. Five different gait classes are considered for each person, including normal, pathological, and assisted walks.

RESULTS

The proposed approaches are shown to outperform existing methods for radar-based gait recognition, which utilize physical features from the cadence-velocity data representation domain as in this paper. The analyzed gait classes are correctly identified with an average accuracy of 93.8%, where a classification rate of 98.5% is achieved for a single gait class. When applied to new data of another individual, a classification accuracy on the order of 80% can be expected.

CONCLUSION

Radar micro-Doppler signatures and their Fourier transforms are well suited to capture changes in gait. Five different walking styles are recognized with high accuracy.

SIGNIFICANCE

Radar-based sensing of gait is an emerging technology with multi-faceted applications in security and health care industries. We show that radar, as a contact-less sensing technology, can supplement existing gait diagnostic tools with respect to long-term monitoring and reproducibility of the examinations.

Virtual reality-based wheelchair simulators: A scoping review

Sense of presence (SoP) has recently emerged as one of the key elements promoting the effectiveness of virtual reality-based training programs. In the context of wheelchair simulators (WSs), the effectiveness of the simulation has been sought using different perception and interaction devices, providing the end-users with different levels of SoP. We performed a scoping review searching scientific and grey literature databases with the aim of assessing the extent of published research dealing with SoP and effectiveness of WSs. Sixty-two articles, describing 29 WSs, were included in the review. In spite of promising results, the high heterogeneity of the employed technological solutions, of the training programs and of their outcomes precluded drawing definitive conclusions about the optimal solution for the enhancement of SoP and thus of WSs' effectiveness. Future research should focus on controlled trials in order to help researchers in assessing the most suitable technologies and methodologies for the application of WSs in clinical practice.

Smartwatches Can Detect Walker and Cane Use in Older Adults

BACKGROUND AND OBJECTIVES

Clinicians commonly prescribe assistive devices such as walkers or canes to reduce older adults' fall risk. However, older adults may not consistently use their assistive device, and measuring adherence can be challenging due to self-report bias or cognitive deficits. Because walking patterns can change while using an assistive device, we hypothesized that smartphones and smartwatches, combined with machine-learning algorithms, could detect whether an older adult was walking with an assistive device.

RESEARCH DESIGN AND METHODS

Older adults at an Adult Day Center (n = 14) wore an Android smartphone and Actigraph smartwatch while completing the six-minute walk, 10-meter walk, and Timed Up and Go tests with and without their assistive device on five separate days. We used accelerometer data from the devices to build machine-learning algorithms to detect whether the participant was walking with or without their assistive device. We tested our algorithms using cross-validation.

RESULTS

Smartwatch classifiers could accurately detect assistive device use, but smartphone classifiers performed poorly. Customized smartwatch classifiers, which were created specifically for one participant, had greater than 95% classification accuracy for all participants. Noncustomized smartwatch classifiers (ie, an "off-the-shelf" system) had greater than 90% accuracy for 10 of the 14 participants. A noncustomized system performed better for walker users than cane users.

DISCUSSION AND IMPLICATIONS

Our approach can leverage data from existing commercial devices to provide a deeper understanding of walker or cane use. This work can inform scalable public health monitoring tools to quantify assistive device adherence and enable proactive fall interventions.

Feasibility of Automated Mobility Assessment of Older Adults via an Instrumented Cane

This study explored the feasibility of automated characterization of functional mobility via an Instrumented Cane System (ICS) within an older adult sample of cane users. An off-the-shelf offset cane was instrumented with inertial, force, and ultrasound sensors for noninvasive data collection. Eighteen patients from a neurological out-patient rehabilitation clinic and nine independently mobile controls participated in standard clinical evaluations of mobility using the ICS while under the care of an attending physical therapist. Feasibility of the ICS was gauged through two studies. The first demonstrated the capability of the ICS to reliably collect meaningful usage metrics, and the second provided preliminary support for the discriminability of high and low falls risk from system-reported metrics. Specifically, the cane significantly differentiated patients and controls (p < 0.05), and a measure of the variation in rotational velocity was associated with total scores on the Functional Gait Assessment (partial r = 0.61, p < 0.01). These findings may ultimately serve to complement and even extend current clinical assessment practices.

Walking Aid Use in Canada: Prevalence and Demographic Characteristics Among Community-Dwelling Users

BACKGROUND

Mobility limitations represent the third most prevalent cause of disability, affecting more than 1.9 million community-dwelling Canadians. Walking aids are often prescribed to reduce the impacts of mobility impairments. There are limited data on walking aids since 2004.

OBJECTIVE

The objectives of this study were to investigate the prevalence of walking aid use in Canada and to explore demographic characteristics among users of walking aids.

DESIGN

The design used was a secondary analysis of a cross-sectional national survey.

METHODS

Data were obtained from the 2012 Canadian Survey on Disability from community-dwelling individuals who were 15 years old or older, had a self-identified activity limitation, and indicated that they used at least 1 walking aid (cane/walking stick/crutches or walker). Prevalence estimates were calculated as weighted frequencies. Analytic variables included walking aid type, sex, age, province/territory of residence, and main cause of activity limitation.

RESULTS

Approximately 1,125,000 community-dwelling individuals who were 15 years old or older used walking aids, representing 4.1% of the Canadian population. Of these individuals, 962,290 used canes/walking sticks/crutches, and 465,340 used a walker. Users of walking aids were predominantly female, with a mean age of 68 years.

LIMITATIONS

Self-reported results reflect only the perceptions of individuals living in Canadian communities. Analyses excluded individuals in residential or long-term care settings and individuals living on First Nations reserves.

CONCLUSIONS

Since 2004, there has been a 2% increase in the prevalence of walking aid use by the Canadian population, which is likely related to the aging of the population. The high prevalence of walking aid use highlights the need for better use of existing resources to ensure that individuals are receiving the correct devices. Results of this study suggest a need to evaluate the impact of device use to better understand how resources should be allocated for prescription and maintenance of walking aids and training of users.

Mobility device use in people with Parkinson's disease: A 3-year follow-up study

OBJECTIVES

This study aimed to investigate how the use and perceived unmet need of mobility devices (MD) in people with Parkinson's disease (PD) evolve over a 3-year period.

METHODS

The study reports baseline assessments (n = 255) and comparisons for participants with complete data at baseline and the 3-year follow-up (n = 165). Structured questions addressed the use and perceived unmet need of various MDs indoor and outdoor (eg, canes, wheeled walkers, and manual and powered wheelchairs). McNemar tests were used to investigate differences over time.

RESULTS

In the total sample at baseline, 30% and 52% of the participants reported using MDs indoors and outdoors, respectively. Among those with complete data also at the 3-year follow-up, the proportion of participants using MDs increased significantly (P < .001) from 22% to 40% for indoors and from 48% to 66% for outdoors, with transition of MD toward more assistive potential (ie, wheeled walker and manual wheelchair). Wheeled walkers were the most commonly used MD indoors as well as outdoors on both occasions. Among the users of multiple MDs, the most common combination was cane and wheeled walker on both occasions. The proportion of participants who reported a perceived unmet need of MDs was 5% at baseline, whereas it was 21%, 3 years later.

CONCLUSIONS

The use and perceived unmet need of MDs in people with PD increase over time. There is a need for addressing MDs at clinical follow-ups of people with PD, with continuous attention in primary health care and municipality contexts.

Risk factors for incident falls in older men and women: the English longitudinal study of ageing

Background

Falls are a major cause of disability and death in older people, particularly women. Cross-sectional surveys suggest that some risk factors associated with a history of falls may be sex-specific, but whether risk factors for incident falls differ between the sexes is unclear. We investigated whether risk factors for incident falls differ between men and women.

Methods

Participants were 3298 people aged ≥60 who took part in the Waves 4–6 surveys of the English Longitudinal Study of Ageing. At Wave 4, they provided information about sociodemographic, lifestyle, behavioural and medical factors and had their physical and cognitive function assessed. Data on incident falls during the four-year follow-up period was collected from them at Waves 5 and 6. Poisson regression with robust variance estimation was used to derive relative risks (RR) for the association between baseline characteristics and incident falls.

Results

In multivariable-adjusted models that also controlled for history of falls, older age was the only factor associated with increased risk of incident falls in both sexes. Some factors were only predictive of falls in one sex, namely more depressive symptoms (RR (95% CI) 1.03 (1.01,1.06)), incontinence (1.12 (1.00,1.24)) and never having married in women (1.26 (1.03,1.53)), and greater comorbidity (1.04 (1.00,1.08)), higher levels of pain (1.10 (1.04,1.17) and poorer balance, as indicated by inability to attempt a full-tandem stand, (1.23 (1.04,1.47)) in men. Of these, only the relationships between pain, balance and comorbidity and falls risk differed significantly by sex.

Conclusions

There were some differences between the sexes in risk factors for incident falls. Our observation that associations between pain, balance and comorbidity and incident falls risk varied by sex needs further investigation in other cohorts.

Falls and Social Isolation of Older Adults in the National Health and Aging Trends Study

A longitudinal secondary analysis of 2 years of data from the National Health and Aging Trends Study was undertaken to determine the extent to which social isolation predicts falls in older adults. Social isolation during Year 1 (baseline) was operationalized as a multiple-indicator measure based on Social Network Index participation domains. Falling during the previous year was self-reported using Year 2 data. Logistic regression models revealed social isolation significantly predicted falls (odds ratio [OR] = 1.11; 95% confidence interval [CI] [1.05, 1.17]). The relationship remained significant after adjusting for age, gender, and education (OR = 1.08; 95% CI [1.02, 1.14]). The relationship weakened after adjusting for self-reported general health, depression risk, and worry about falling (OR = 1.02; 95% CI [0.96, 1.08]). Adjusting for Short Physical Performance Battery (SPPB), assistive mobility device, and activities of daily living further weakened the relationship (OR = 0.99; 95% CI [0.94, 1.04]). SPPB demonstrated the strongest correlation with social isolation (r = -0.42; p < 0.01). Fall prevention intervention studies specifically targeting social isolation may incorporate physical performance as a shorter-term and cost-effective proxy outcome for falls. [Res Gerontol Nurs. 2018; 11(2):61-70.].

[Factors associated with the use of wheelchairs by institutionalized elderly people]

Due to the high prevalence of wheel-chair use by institutionalized elderly people, the scope of this research was to verify whether factors involving gender, age, education, length of institutionalization, comorbidities, cognition and functionality are associated with the use of such equipment, as well as ascertain the reasons for use according to the perceptions of the elderly. It is a cross-sectional descriptive study that included 55 elderly people subdivided into G1 (locomotion without assistance) and G2 (wheelchair users). Analysis of the profile in medical records, cognition and functionality by the Mini-Mental State Examination and Barthel index was conducted. Wheelchair users asked about the factors that lead to wheelchair use were recorded: 33 (60%) of the elderly were in G1 and 22 (40%) in G2. There were differences between the groups with respect to functionality (p = 0.005). The elderly who have not suffered a stroke are less likely to use a wheelchair (OR: 0.09; 95% CI: 0.02 to 0.36). Elderly wheelchair users reported: fear of falling, pain, tiredness, weakness in the legs, difficulty walking and lack of assistance in walking. Strokes and functionality are associated with wheelchair use. Knowledge of these factors and the reasons reported by the elderly may enable alternatives of prevention to be defined.

Gender Differences in Mobility Device Use Among U.S. Older Adults

Objectives

Research has shown greater mobility limitations among women than men. We aimed to examine (a) gender differences in the use of canes for mobility and (b) what factors contribute to these differences under the frameworks of the disablement model and the Theory of Planned Behavior.

Method

Using National Health and Aging Trends Study data, we estimated hierarchical logistic regression models to predict the likelihood of cane use among older adults who completed performance-based measures (n = 5,503). We tested the interactions between gender and selected variables to further understand gender difference.

Results

In unadjusted analysis, 22% of women and 16% of men used canes. In models adjusted in steps for sociodemographics, health, physical impairments, capacity, psychosocial, and social environment factors, women were progressively less likely to use canes, significantly so at the last step. Suppression effect analyses showed the influence of living alone and receiving mobility help variables. Interaction analyses showed that women reporting poor health or balance were less likely to use canes; obese women were more likely.

Discussion

Significant gender differences exist in cane use among older community-living adults. Findings suggest that health and function partly account for these differences. Future research is needed to understand social/cultural factors involved.

Physical Activity, Functional Ability, and Obesity in Older Adults: A Gender Difference

Disability, institutionalization, and loss of independence may be directly caused or exacerbated by physical inactivity and obesity. The purpose of the current cross-sectional survey was to explore the impact of gender and obesity on functional ability tasks, physical activity, and psychosocial factors in older adults. Participants comprised 964 University retirees (55% female, mean age = 75.3 years, SD = 6.7 years) with a mean body mass index (BMI) of 26.1 kg/m² (SD = 4.7 kg/m²). Results revealed significant gender and BMI interaction effects. Women were less active than men and obese women were most functionally impaired, particularly in activities that target lower extremity function, regardless of weight status. These findings suggest that physical activity interventions for older adults should focus on exercises that improve functional ability and are tailored to meet individual needs while considering weight and gender. Type, intensity, frequency, and duration of exercises should be individualized to limit injuries and improve functional ability and physical activity adherence. [Journal of Gerontological Nursing, 43(9), 38-46.].

Geriatric Polypharmacy: Pharmacist as Key Facilitator in Assessing for Falls Risk

This article highlights the significant health impact of falls among older adults. An emphasis is placed on the vital role of the pharmacist, regardless of practice setting, in assessing and reducing falls risk for this growing population. In addition, the importance of a stepwise comprehensive approach to falls assessment by pharmacists in collaboration with other clinicians is elucidated.

The Impact of a Participatory Care Model on Work Satisfaction of Care Workers and the Functionality, Connectedness, and Mental Health of Community-Dwelling Older People

This study describes and evaluates an innovative program designed to reduce functional decline among seniors, using a participatory care approach and integrated health teams. The evaluation provides older people and community support workers (CSWs) with the opportunity to share their experiences of being involved with an innovative program to reduce functional decline (mobility, skin integrity, nutrition, mental health, continence) of older, community dwelling adults implemented by a Nursing Service in a major capital city in Australia. As part of the program, CSWs were trained to provide care that aimed to reduce functional decline, and improve the quality of life for the care recipients. Data were collected through in-depth interviews with older people receiving care and a focus group (FG) was conducted with CSWs. Seven themes emerged during data analysis: 1) functionality/independence; 2) prevention; 3) confidence; 4) connection; 5) the approach; 6) care plans; and 7) the role of the CSWs. The relationship built between care giver and receiver and the mutual respect facilitated through adopting a participatory care approach was crucial. This relationship-focused care contributed to improved functionality and consequently quality of life for the older person, and for the CSW professional it contributed to their development, improved satisfaction with their role, and increased pride in the difference they make in the lives of their clients. Opportunities for improvement of the program included ensuring that participants understood the rationale for all aspects of the program, including regular reminders, as well as the use of regular reviews of individual outcomes.

Using Administrative Data to Examine Health Disparities and Outcomes in Neurological Diseases of the Elderly

The fields of neurodegenerative disease and dementia research have grown considerably in the last several decades. Due to tremendous efforts of basic and clinical research scientists, we know a great deal about dementia risk factors and have multiple treatment options. Clinician recognition of cognitive impairment has increased considerably, national policies which support screening for and documenting cognitive dysfunction now exist, and public awareness of neurodegenerative disease has never been greater. These conditions promote (and demand) the growth of translational epidemiology and health services research, which focuses on examining outcomes in groups of individuals as a function of health care experiences. This review discusses the use of administrative data to answer health care outcomes and disparities questions in dementia. Of particular interest are publically available datasets that contain varying amounts of diagnostic, clinical, pharmacy, and patient information. Methodological challenges that are frequently encountered and must be understood to minimize biased inference are also discussed.

MAPx (Mobility Aid Personalization): examining why older adults "pimp their ride" and the impact of doing so

We all do this. We personalize things. We buy leopard-printed seat covers and fuzzy dice for our cars, and display action figures and photographs in our offices. Studying older adults who have extended this process of personalization to their mobility devices, the purpose of the mobility aid personalization (MAPx) project is to examine MAPx and its impact on the health and mobility of older adults. Using a qualitative research design, field observations and interviews were conducted with 72 older adults to gain an in-depth understanding of device customization from an emic (insider's) perspective. Findings illustrate that older adults personalize their devices for reasons of fun, function and fashion. MAPx - the process of purposefully selecting or modifying a mobility device to suit individual needs and preferences - was also found to promote health and mobility by encouraging device acceptance, increasing social participation, enhancing joy and preserving identity. MAPx makes an important contribution to our understanding of the complex relationship between older adults and assistive devices and provides a new approach to some old problems including falls, inactivity and social isolation. Encouraging MAPx is a promising rehabilitation strategy for promoting health and community mobility among the older adult population. Implications for Rehabilitation Personalizing an assistive device facilitates device acceptance, promotes health and well-beingand should be supported and encouraged in rehabilitative care. Choice, variety and access are critical aspects of assistive devices; vendors, manufacturers andpractitioners should work together to provide clients with a greater range of affordable optionsfor new devices. Function is more than mechanical or physical; social factors including social identity, stigma andsocial roles must be adequately considered and explicit in rehabilitative practice.

Treatment of Older Women With Endometrial Cancer: Improving Outcomes With Personalized Care

Endometrial cancer is the most common gynecologic cancer, and with a median age of 62 at diagnosis, it affects a significant number of older women. With increasing age and obesity rates in the world's population, there is an anticipated concomitant increase in older women with endometrial cancer. Older women are more likely to die of endometrial cancer compared with younger patients. Reasons for this include more aggressive tumor biology, less favorable clinicopathologic features, and more advanced disease. Other factors, however, such as reluctance to offer surgical treatment to the older patient and increased complications of treatment are likely to be important. Management of endometrial cancer requires multidisciplinary care (surgery, radiation therapy, and systemic therapy). For each treatment, the feasibility (related to technical aspect of the procedure/treatment), side effects and safety (related to older-patient factors), and the overall benefit as it pertains to older women with endometrial cancer should be assessed carefully with a multidisciplinary approach. Despite the importance of these issues, the data are limited to answer these issues with clarity. In this article, we will review each treatment modality for older women with endometrial cancer. We will introduce the components of comprehensive geriatric assessment and their practical implication for older women with cancer in general and older women with endometrial cancer specifically.