Role of physical activity in the prevention of falls and their consequences in the elderly

The immediate and lasting balance outcomes of clinical falls-prevention programs: A non-randomised study

PURPOSE

Exercise-based falls-prevention programs are cost-effective population-based approaches to reduce the risk of falling for older adults. The aim was to evaluate the short-term and long-term efficacy of three existing falls-prevention programs.

METHODS

A non-randomized study design was used to compare the immediate-post and long-term physical outcome measures for three falls prevention programs; one high-level land-based program, one low-level land-based program and a water-based Ai Chi program. Timed-up-and-go (TUG), five-times sit-to-stand (5xSTS), six-minute walk test (6MWT) and six-meter walk test were assessed at baseline, post-program, and at six-months follow-up. Linear mixed models were used to analyze between- and within- group differences, with the high-level land-based program used as the comparator.

RESULTS

Thirty-two participants completed post-program assessment and 26 returned for follow-up. There was a difference in the age (years) of participants between programs (p = 0.049). The intercept for TUG and six-meter walk test time was 47.70% (23.37, 76.83) and 32.31s (10.52, 58.41), slower for the low-level group and 40.49% (17.35, 69.89) and 36.34s (12.75, 64.87), slower for the Ai Chi group (p < 0.01), compared with the high-level group. Mean time taken to complete the TUG was less both immediately post-program and at 6-month follow-up (p = 0.05). Walking speed for the six-meter walk test was only faster at six-months (p < 0.05). The 5xSTS duration was significantly reduced only at post-intervention (p < 0.05).

CONCLUSION

These results indicate land-based and water-based falls-prevention programs improve physical outcome measures associated with falls-risk and many improvements are maintained for six months after the completion of the program. (Retrospective trial registration: ACTRN1262300119069).

Divergent Experiences Reported by Rural and Frontier Older Adults Aging in Place

Aging research tends to define rural as any area that is not urban without considering the diversity that exists within rural environments. Using government guidelines defining frontier and rural counties, the purpose was to identify similarities and differences in the aging experience reported by community-dwelling rural and frontier older adults. Individual interviews were completed in Wyoming with 142 older adults from frontier (n = 72) and rural counties (n=70). Summative content analysis was used to evaluate responses within the framework of social influences and nested environmental interactions of a socio-ecological model. Rural older adults reported needing more medical services and care, while frontier adults indicated an absence for many of these services. Similar response patterns were indicated with regard to grocery stores and general shopping. Current interview statements provide foundational information for future policies that recognize frontier aging in place that does not equate to aging in rural specific areas.

The association between health costs and physical inactivity; analysis from the Physical Activity at Work study in Thailand

Introduction

Physical inactivity increases the risks of several common yet serious non-communicable diseases, costing a tremendous amount of health expenditure globally. This study aimed to estimate the association between health costs and physical inactivity in Thailand.

Methods

Data from the Physical Activity at Work cluster randomized controlled trial participants with valid objective physical activity data were extracted. Health costs were collected using the Health and Welfare Survey and the Work Productivity and Activity Impairment Questionnaire and were categorized into past-month outpatient illness, past-year inpatient illness, and past-week presenteeism and absenteeism. Time spent in moderate-to-vigorous physical activity was used to determine the activity level according to the current guideline (i.e., ≥150 minutes moderate-intensity or ≥75 minutes vigorous-intensity equivalent physical activity per week). The primary analysis evaluated the association between direct cost (treatment and travel costs) and societal cost (direct cost plus absenteeism due to the illness) of past-month outpatient illness and physical inactivity using a two-part model.

Results

In total, 277 participants with a mean age of 38.7 were included. Average direct and societal cost due to past-month outpatient illness were 146 THB (3.99 USD) (SD = 647 THB) and 457 THB (12.5 USD) (SD = 1390 THB), respectively. Compared to active participants, direct and societal cost of past-month outpatient illness were 153 THB (4.18 USD) (95%CI: -54.7 to 360 THB) and 426 THB (11.7 USD) (95%CI: 23.3 to 829 THB) higher in physically inactive individuals, respectively, adjusted for covariates. The additional societal cost of past-month outpatient illness was 145% higher in physically inactive participants compared to active participants. On the other hand, there was no significant association in direct and societal cost of past-year inpatient illness nor past-week indirect costs between physically active and non-active participants.

Discussion

Results were similar to recent findings in different countries. However, the findings should be generalized with caution due to the small sample size and potential bias from reverse causation. Future research is crucial for clarifying the health costs of physical inactivity in Thailand and other countries.

Effects of Dementia on Outcomes after Cervical Spine Injuries in Elderly Patients: Evaluation of 1512 Cases in a Nationwide Multicenter Study in Japan

We aimed to retrospectively investigate the demographic characteristics and short-term outcomes of traumatic cervical spine injuries in patients with dementia. We enrolled 1512 patients aged ≥ 65 years with traumatic cervical injuries registered in a multicenter study database. Patients were divided into two groups according to the presence of dementia, and 95 patients (6.3%) had dementia. Univariate analysis revealed that the dementia group comprised patients who were older and predominantly female and had lower body mass index, higher modified 5-item frailty index (mFI-5), lower pre-injury activities of daily living (ADLs), and a larger number of comorbidities than patients without dementia. Furthermore, 61 patient pairs were selected through propensity score matching with adjustments for age, sex, pre-injury ADLs, American Spinal Injury Association Impairment Scale score at the time of injury, and the administration of surgical treatment. In the univariate analysis of the matched groups, patients with dementia had significantly lower ADLs at 6 months and a higher incidence of dysphagia up to 6 months than patients without dementia. Kaplan-Meier analysis revealed that patients with dementia had a higher mortality than those without dementia until the last follow-up. Dementia was associated with poor ADLs and higher mortality rates after traumatic cervical spine injuries in elderly patients.

Reduction in fall risk markers following CPAP treatment of obstructive sleep apnoea in people over 65 years

OBJECTIVES

Falls in older people can lead to serious injury and significant societal health and financial burden. Obstructive sleep apnoea (OSA) is associated with impaired gait/balance and may increase fall risk, yet few studies examined whether treating OSA reduces fall risk. This study examined the effect of continuous positive airway pressure (CPAP) on fall risk markers in people over 65yrs diagnosed with OSA.

DESIGN

Single arm intervention study.

SETTING

University and tertiary care CPAP clinic.

PARTICIPANTS

Individuals over 65 years diagnosed with OSA and recommended CPAP.

INTERVENTION

3-6 months CPAP therapy.

MEASUREMENTS

28 participants had a physiological profile assessment (PPA) at baseline and following 3-6 months of CPAP. The PPA examines visual contrast sensitivity, lower limb proprioception, knee extension strength, reaction time and postural sway to generate a fall risk score (FRS). t-tests were used to determine difference between pre- and post-treatment FRS. Regression was used to examine the associations between CPAP use and daytime sleepiness with FRS.

RESULTS

CPAP significantly reduced the FRS ([Mean ± SD] 0.59 ± 1.0 vs 0.04 ± 1.1, p = 0.016), contrast sensitivity and lower limb proprioception (P < 0.05). Increased CPAP use was associated with improvement in FRS in unadjusted analysis (β = -0.213, 95%CI -0.371 to -0.056, p = 0.01). Reduction in Epworth sleepiness score was associated with a reduction in FRS in unadjusted (p = 0.023) and adjusted analysis (adjusted for AHI p = 0.027 or O2Nadir p = 0.015).

CONCLUSIONS

CPAP may reduce fall risk in people over 65yrs, possibly related to better CPAP adherence and reduced daytime sleepiness. Future controlled trials and mechanistic studies are needed to elucidate how CPAP may reduce fall risk.

Seasonally Dependent Change of the Number of Fractures after 50 Years of Age in Poland-Analysis of Combined Health Care and Climate Datasets

Aim: The incidence of fractures correlates with many independent and interrelated factors. The aim of the study was to examine trends in fracture incidence and to find possible reasons for changes. Materials and methods: A complete dataset of Polish population aged above 50 from the National Heath Fund—which is a single, state-owned payer for the health service procedures in Poland—covering the years between 2010 and 2015 was analyzed along with climate dataset. Results: The analysis indicated that there was a substantial and statistically significant decrease in the incidence of forearm and hip fractures (p = 0.007 and 0.007, respectively). On the other side, there was a statistically significant increase in incidence of humerus and lumbar fractures (p = 0.002, p < 0.001, respectively). The observed changes (especially decrease in forearm and hip fracture incidence) happened mostly in the cold season and were correlated to mean-temperature changes during the assessed time period. Conclusion: In the analysis based on the dataset obtained from fracture-related database collected in Poland in the years 2010−2015 in the population of patients over 50 years of age, we observed that the changes of fracture incidence during the observation period are associated with and may be dependent on the season (warmer versus colder) and on mean temperature increase during the observation period.

Beliefs and motivation regarding physical activity among older adults in Germany: results of a qualitative study

Purpose: As the proportion of older adults in Germany continues to grow, so does the need for physical activity as a strategy for health promotion. The purpose of this study is to gain insights into the belief system underlying older adults' physical activity and its interplay with motivation by integrating Theory of Planned Behaviour and Self-Determination Theory.Methods: We conducted 20 semi-structured interviews with residents of Germany who were 65 years of age or older. Transcripts of interviews were analysed with a coding frame of deductive main categories and inductive subcategories.Results: Part of our results is a typology that divides our sample into four groups based on the intensity and perceived sufficiency of their physical activity. These groups mainly differ in their intrinsic vs. extrinsic motivation and how they deal with barriers to physical activity, i.e., control beliefs.Conclusion: Messages to promote physical activity should be tailored regarding older adults' varying beliefs and motivation. To overcome barriers, intrinsic motivation plays a crucial role. Intrinsic motivation is closely linked to activities that are joyful and satisfy basic psychological needs. Moreover, it is important for older adults to be able to adjust their activities to age-related physical limitations and chronic diseases.

Prediction of fear of falling at 6 months after stroke based on 279 individuals from the Fall Study of Gothenburg

The early identification of individuals at risk of fear of falling after stroke is crucial in order to individualise preventive actions and interventions. The aim of this study was to identify the incidence of, and baseline factors in acute stroke that are associated with fear of falling at 6 months after stroke. Fear of falling was assessed by one question, which was answered by 279 of 452 eligible individuals. Univariable and multivariable logistic regression analyses were performed to determine the factors that were associated with fear of falling. The dependent variable was fear of falling at 6 months after stroke. The independent variables were related to function, activity and participation, including personal and environmental factors. Fear of falling was reported by 117 (41.9%) individuals. Poor postural control in acute stroke, measured using the modified version of the Postural Assessment Scale for Stroke Patients (odds ratio [OR]: 2.60, 95% confidence interval [CI]: 1.26–5.36), and being physically inactive prior to the stroke, measured using the Saltin-Grimby Physical Activity Scale (OR: 2.04, 95% CI: 1.01–4.12), were found to be associated with fear of falling at 6 months after stroke. The findings in this study are useful in clinical practice to optimise rehabilitation after stroke.

Risk Factors for Hospital Admission After a Fall: A Prospective Cohort Study of Community-Dwelling Older People

BACKGROUND

Falls in later life that require admission to hospital have well-established consequences for future disability and health. The likelihood and severity of a fall will result from the presence of one or more risk factors. The aim of this study is to examine risk factors identified for their ability to prevent falls and to assess whether they are associated with hospital admission after a fall.

METHODS

Analyses of data from the English Longitudinal Study of Aging (ELSA), a prospective cohort study. In a sample of 3783 men and women older than 60 years old, a range of potential risk factors measured at Wave 4 (demographic, social environment, physical, and mental functioning) were examined as predictors of fall-related hospitalizations, identified using International Classification of Diseases, 10th Revision (ICD-10) code from linked hospital records in the United Kingdom. Subdistribution hazard models were used to account for competing risk of death.

RESULTS

Several risk factors identified by previous work were confirmed. Suffering from urinary incontinence (subdistribution hazard ratio = 1.49; 95% CI: 1.14, 1.95) and osteoporosis (subdistribution hazard ratio = 1.48; 95% CI: 1.05, 2.07), which are not commonly considered at an early stage of screening, were found to be associated with hospital admission after a fall. Both low and moderate levels of physical activity were also found to somewhat increase the risk of hospital admission after a fall.

CONCLUSIONS

Several predictors of having a fall, severe enough to require hospital admission, have been confirmed. In particular, urinary incontinence should be considered at an earlier point in the assessment of risk.

A Study of Leisure Walking Intensity Levels on Mental Health and Health Perception of Older Adults

Research suggests that different levels of intensity of leisure walking can affect the mental health of older adults. Unfortunately, insufficient evidence exists as to the recommended intensity levels of leisure walking for their health benefits. The purpose of this study was to investigate how leisure walking intensity levels are associated with the mental health and health perceptions of older adults. Using a purposive sampling method, the data of 4,737 adults over the age of 65 were drawn from the 2017 California Health and Interview Survey. The results of analysis of these data showed that older adults who engaged in moderate and vigorous leisure walking reported higher health perceptions than those involved in light leisure walking. In addition, older adults who participated in moderate leisure walking reported higher mental health than those who engaged in light leisure walking. This study suggests that moderate and/or vigorous leisure walking can increase the mental health and health perceptions of older adults.

Postadychute-AG, Detection, and Prevention of the Risk of Falling Among Elderly People in Nursing Homes: Protocol of a Multicentre and Prospective Intervention Study

Introduction: While falls among the elderly is a public health issue, because of the social, medical, and economic burden they represent, the tools to predict falls are limited. Posturography has been developed to distinguish fallers from non-fallers, however, there is too little data to show how predictions change as older adults' physical abilities improve. The Postadychute-AG clinical trial aims to evaluate the evolution of posturographic parameters in relation to the improvement of balance through adapted physical activity (APA) programs. Methods: In this prospective, multicentre clinical trial, institutionalized seniors over 65 years of age will be followed for a period of 6 months through computer-assisted posturography and automatic gait analysis. During the entire duration of the follow-up, they will benefit from a monthly measurement of their postural and locomotion capacities through a recording of their static balance and gait thanks to a software developed for this purpose. The data gathered will be correlated with the daily record of falls in the institution. Static and dynamic balance measurements aim to extract biomechanical markers and compare them with functional assessments of motor skills (Berg Balance Scale and Mini Motor Test), expecting their superiority in predicting the number of falls. Participants will be followed for 3 months without APA and 3 months with APA in homogeneous group exercises. An analysis of variance will evaluate the variability of monthly measures of balance in order to record the minimum clinically detectable change (MDC) as participants improve their physical condition through APA. Discussion: Previous studies have stated the MDC through repeated measurements of balance but, to our knowledge, none appear to have implemented monthly measurements of balance and gait. Combined with a reliable measure of the number of falls per person, motor capacities and other precipitating factors, this study aims to provide biomechanical markers predictive of fall risk with their sensitivity to improvement in clinical status over the medium term. This trial could provide the basis for posturographic and gait variable values for these elderly people and provide a solution to distinguish those most at risk to be implemented in current practice in nursing homes. Trial Registration: ID-RCB 2017-A02545-48. Protocol Version: Version 4.2 dated January 8, 2020.

Differential Risk of Incident Fractures Depending on Intensity and Frequency of Physical Activity According to Cognitive Status: A Nationwide Longitudinal Study

Background: Previous studies have demonstrated an increased risk of fractures in subjects with various degrees of cognitive impairments. Recently, there has been growing recognition of the vital effect of physical activity (PA) on delay and prevention of fractures in older adults.

Objectives: This study aimed to evaluate the optimal intensity and frequency of PA needed to prevent fractures in cognitively preserved older adults (CP), participants with subjective cognitive decline (SCD), and dementia patients using a large-scale nationwide cohort study.

Methods: Data from a nationwide health screening program for individuals at the transitional age of 66 years were used in this study. A total of 968,240 subjects was enrolled, followed from 2007 to 2014, and classified as CP (n = 759,874), SCD (n = 195,365), or dementia group (n = 13,001). Adjusted hazard ratios (aHRs) by demographic and known risk factors for fractures were evaluated to identify the impact of various frequency and intensity PA on the occurrence of hip, vertebral, and limb fractures.

Results: In CP participants, the most noticeable reduction of hip and vertebral fracture risk was shown in those performing vigorous-intensity PA at least three times per week. In the SCD group, the risk decrement in hip and vertebral fractures was most prominent in subjects who performed multiple-intensity PAs at least three times a week regardless of intensity. In the dementia group, only high-frequency walking and high-frequency & multiple-intensity PA decreased the risk of hip fractures compared with absence of PA.

Conclusion: These findings suggest a role for various PA intensity and frequency levels to prevent hip and vertebral fractures according to cognitive status. Further study is needed to validate the effects of PA intensity and frequency proposed in this study on fractures according to cognitive status.

Can Smartphone-Derived Step Data Predict Laboratory-Induced Real-Life Like Fall-Risk in Community- Dwelling Older Adults?

Background: As age progresses, decline in physical function predisposes older adults to high fall-risk, especially on exposure to environmental perturbations such as slips and trips. However, there is limited evidence of association between daily community ambulation, an easily modifiable factor of physical activity (PA), and fall-risk. Smartphones, equipped with accelerometers, can quantify, and display daily ambulation-related PA simplistically in terms of number of steps. If any association between daily steps and fall-risks is established, smartphones due to its convenience and prevalence could provide health professionals with a meaningful outcome measure, in addition to existing clinical measurements, to identify older adults at high fall-risk. Objective: This study aimed to explore whether smartphone-derived step data during older adults' community ambulation alone or together with commonly used clinical fall-risk measurements could predict falls following laboratory-induced real-life like slips and trips. Relationship between step data and PA questionnaire and clinical fall-risk assessments were examined as well. Methods: Forty-nine community-dwelling older adults (age 60-90 years) completed Berg Balance Scale (BBS), Activities-specific Balance Confidence scale (ABC), Timed Up-and-Go (TUG), and Physical Activity Scale for the Elderly (PASE). One-week and 1-month smartphone steps data were retrieved. Participants' 1-year fall history was noted. All participants' fall outcomes to laboratory-induced slip-and-trip perturbations were recorded. Logistic regression was performed to identify a model that best predicts laboratory falls. Pearson correlations examined relationships between study variables. Results: A model including age, TUG, and fall history significantly predicted laboratory falls with a sensitivity of 94.3%, specificity of 58.3%, and an overall accuracy of 85.1%. Neither 1-week nor 1-month steps data could predict laboratory falls. One-month steps data significantly positively correlated with BBS (r = 0.386, p = 0.006) and ABC (r = 0.369, p = 0.012), and negatively correlated with fall history (r _p = -0.293, p = 0.041). Conclusion: Older participants with fall history and higher TUG scores were more likely to fall in the laboratory. No association between smartphone steps data and laboratory fall-risk was established in our study population of healthy community-dwelling older adults which calls for further studies on varied populations. Although modest, results do reveal a relationship between steps data and functional balance deficits and fear of falls.

Winter of our contentment: Examining risk, pleasure, and emplacement in later-life physical activity

In the West, many in the media and the health sector emphasize physical activity as important for the old, so that they can circumvent the impacts of aging and the associated costs. At the same time, neoliberal health discourse advises older people to avoid activities that may cause injuries, such as slips and falls, creating contradictions for older people who participate in sports on ice. In light of these mixed messages, this paper explores how older men understand their bodies through their participation in the seemingly risky sport of ice hockey. I conducted eighteen semi-structured interviews with older Canadian men who played hockey, identifying common themes related to aging, embodiment, risk and pleasure. Participants were aware that common-sense discourse produced hockey as risky for the old, but often downplayed this risk, privileging pleasure. Discourses associated with pleasure acted as an important way for older men to examine their bodies and contemplate the significance of hockey in their lives. Through the comradery players developed with each other, their interactions with the material objects of hockey, and their emplacement on hockey rinks and arenas, they found ways to celebrate their bodies as both aging and capable of experiencing pleasure - implicitly challenging neoliberal discourses of old age in the process.

Risk factors associated with history of falls in adults with intellectual disability

BACKGROUND

Adults with intellectual disability (ID) have a higher risk for falls than the general population.

AIM

The purpose of this study was to identify risk factors for falls in adults with ID using objective measurements.

METHODS

Eighty adults with ID (men 36 women 44 age 43 ± 13 years) provided data on falls history, health problems or limitations in daily life, physical activity (PA), and physical performance. We conducted independent-samples t-tests, and Chi-square (χ²) tests to examine the difference between fallers and non-fallers. Multivariate logistic regressions were performed to identify the independent effects of risk factors for falls in adults with ID.

RESULTS

Fallers had significantly lower SPPB, mobility, and moderate PA than non-fallers (p <  .05). Fallers were more likely to be older, need support with activities of daily living (ADLs), and have arthritis or rheumatism, walking problem, and limitations to participating in PA than non-fallers (p <  .05). Among these variables, only needing support with ADLs remained a significant independent predictor of falls in a multivariate model.

CONCLUSION

Support need for ADLs can predict falls in individuals with ID. Caregivers may need to closely monitor adults with ID who need support for ADLs.

Center of pressure displacement characteristics differentiate fall risk in older people: A systematic review with meta-analysis

Falling is the second most prevalent cause of accidental death in the world. Currently available clinical tests to assess balance in older people are insufficiently sensitive to screen for fall risk in this population. Laboratory tests that record the center of pressure (COP) trajectory could overcome this problem but despite their widespread use, the choice of COP trajectory features for use as a biomarker of fall risk lacks consensus. This systematic review and meta-analysis aimed at identifying the best COP characteristics to predict risk of falling in older adults. More than 4000 articles were screened; 44 (7176 older adults) were included in this study. Several COP parameters emerged as good indices to discriminate fallers from non-fallers. From sensitivity analysis, Sway area per unit time, anteroposterior mean velocity, and radial mean velocity were the best traditional features. In this study, identification of older people with a high fall risk was demonstrated using quiet-standing recordings. Such screening would also be useful for routine follow-up of balance changes in older fallers in clinical practice.

The Physical Activity and Fall Risk Among Iranian Older Male Adults

Background:

Fall is a major cause of disability and mortality in the elderly.

Objective:

The aim of the present study was to investigate the relationship between the level of physical activity and falls in elderly men in Tehran.

Methods:

The subjects of this study included 434 elderly males over the age of 60 in Tehran, who were randomly selected from parks in different parts of Tehran. The data was collected from August to September, 2019. The demographic characteristics of the subjects were collected and recorded. Then, body composition and anthropometric indices including weight, body mass index (BMI), height and calf circumferences (CC), waist circumferences (WC) and hip circumferences were measured using a digital scale of OMRON and meter tape. The level of physical activity and nutritional status were calculated using the questionnaires of physical activity scale for the elderly (PASE) and mini nutritional assessment (MNA), respectively. The Short Physical Performance Battery (SPPB) test was used to assess the risk of falling. Statistical analysis of data was performed using SPSS21 software.

Results:

The results of statistical analysis of the data showed a positive and significant relationship between global physical activity level (P<0.000) and subscales of its domains (P<0.000) with fall score and a significant inverse relationship between age and fall score (P<0.000). In addition, it was found that age (P<0.000) and physical activity (P<0.000) are two strong factors in predicting falls in the elderly.

Conclusion:

Based on the resulting positive relationship between physical activity and falls, it can be stated that the using strategies such as increasing sports environments with a focus on exercise, physiologists can play an effective role in preventing falls and related complications in the elderly.

Promoting Fall Prevention among Community Dwelling Older Adults through ActivLife: a Physical and Social Activation

Falls have been recognized as the second leading cause of injury or death for older adults. The related economic burden caused by fall related injuries is not negligible. Earlier research has demonstrated that regular participation in appropriate prescribed physical activity by improving upper and lower limb strength, balance, coordination, transfer skills, and reaction to environmental hazards can lower the risk for falls and fall-related fractures and other injuries. Conversely, physical inactivity can significantly double the risk of developing a disability, which will affect mobility as well as the ability to perform even the most basic activities of daily life, therefore, ultimately increases the older adults’ risk for falls.

This paper first presents a technological solution ActivLife that aims at preventing older adults from falling through practicing physical training in a safe and playful manner, followed by a randomized controlled study with 43 older adults with an average age of 77 for a period of 16 weeks in a social activation center het Ontmoet en Groethuys in Eindhoven, the Netherlands to demonstrate to what extent ActivLife could help to prevent falling among older adults.

Strength of Plantar- and Dorsiflexors Mediates Step Regularity During a High Cognitive Load Situation in a Cross-sectional Cohort of Older and Younger Adults

BACKGROUND AND PURPOSE

Completing simultaneous tasks while standing or walking (ie, a high cognitive load situation [HCLS]) is inevitable in daily activities and can lead to interference in task performances. Age-related physical and cognitive changes may confound performance variability during HCLS in older and younger adults. Identification of these confounding effects may reveal therapy targets to maintain optimal physical function later in life. The aim of this study was to investigate the effect of increasing the difficulty levels of an additional motor task and restricting visual information, on gait parameters in younger and older adults while considering the effect of cognitive and physical covariates.

METHODS

Fifteen healthy younger and 14 healthy older adults were asked to complete assessments of cognitive function, balance, and strength. They were then asked to walk on a self-paced treadmill with or without carrying a plastic tray. Opaqueness of the tray (vision) and the presence of water in glasses placed on the tray (increasing task difficulty) were varied. Mean, standard deviation, and regularity (sample entropy) of step width and length were compared across conditions and groups using repeated-measures analyses of variance with and without covariate analysis. Only significantly correlated covariates of cognition, balance, and strength were entered into each model.

RESULTS AND DISCUSSION

Older adults had greater step width irregularity compared with younger adults across all conditions when controlling for concentric plantar- and dorsiflexion strength. A decline in strength may likely alter neuromuscular control of gait, specifically control of step width, which has been associated with fall risk in older adults. Adjusting for the same covariates revealed increased regularity of step length, as visual feedback from the feet was restricted. Specifically, step length was more regular while carrying an opaque tray compared with not carrying a tray. Visual restriction was a contributing factor, which led to more predictable gait kinematics, indicating the role of sensory information to enhance the adaptability during walking under HCLS.

CONCLUSION

The knowledge of the regularity behavior of human movement can expand physical therapists' treatment approaches to promote further interactivity and coordination across body systems that model behavior of healthy young individuals. Targeting strength during therapy may provide additional benefits for gait performance under HCLS.

Associations of Health-Related Quality of Life, Fear of Falling and Objective Measures of Physical Function with Bone Health in Postmenopausal Women with Low Bone Mass

Health-related quality of life (HRQoL) and physical function deteriorate with age and may adversely impact bone health in older adults. We determined associations of objective measures of physical function and HRQoL with bone health in postmenopausal women with low areal bone mineral density (aBMD). Fifty postmenopausal women (64.4 7.7 years old, mean standard deviation) with low spine, hip or femoral neck aBMD (T- or Z-score < -1.0) on dual-energy X-ray absorptiometry (DXA) participated. Femoral surface BMD, trabecular, integral and cortical volumetric BMD (vBMD) measurements were obtained using 3D-SHAPER software on DXA. Distal tibial vBMD and microarchitecture were assessed using high-resolution peripheral quantitative computed tomography (HRpQCT). Participants completed self-administered EuroQol-5D (EQ-5D) and modified falls efficacy scale (MFES) questionnaires, and physical function assessments. Stair climb power was positively associated with bone parameters at the hip, femoral neck, and distal tibia (all p < 0.05) in multivariable linear regression. EQ-5D demonstrated no significant associations with bone parameters and MFES was positively associated only with distal tibial cortical vBMD and cortical von Mises stress (both p < 0.05). Objective measures of physical function, particularly muscle power, are more consistently associated with bone parameters compared with self-administered HRQoL questionnaires.

Cross-cultural adaptation and psychometric properties of the Falls Efficacy Scale - International in Filipino community-dwelling older adults

Purpose: The Falls Efficacy Scale - International is universally used in assessing the level of concern about falling in older adults. The objectives of this study were to conduct a cross-cultural adaptation and to establish psychometric properties of Falls Efficacy Scale - International in Filipino (FES-I F).Methods: The standardized 10-step translation protocol of the Prevention of Falls Network Europe was followed. Community-dwelling older adults aged 60 or above (N = 211) from Manila, Philippines were recruited. The internal consistency and test-retest reliability of the translated tool was assessed. Convergent validity was compared with fall-related factors. The receiver operating characteristics were used to determine the cutoff score.Results: The FES-I F has high internal consistency (α = 0.91) and good test-retest reliability (intraclass correlation coefficient = 0.86). Overall scores were significantly higher among those with subjective report of fear of falling (p < 0.001), lower timed up and go test scores (p = 0.014), slower gait speed (p = 0.003), and lower perceived well-being scores (p = 0.003) indicating acceptable convergent validity. The cutoff score of FES-I F was 22 points.Conclusions: The FES-I F has high internal reliability and acceptable validity, and can be a practical tool to measure the concern about falling in Filipino older adults. Future research is necessary to establish its utilization as an outcome measure in intervention studies.Implications for rehabilitationThe psychometric properties of the Filipino version of the Falls Efficacy Scale - International were good when assessed in older adults living in the community.The cutoff score to demarcate those with fear of falling from those without is 22 points.Falls Efficacy Scale - International in Filipino is recommended for the assessment of fear of falling for research and clinical purposes.

Association between frailty and its individual components with the risk of falls in patients with schizophrenia spectrum disorders

Frailty is common among older people who carry an increased risk for poor outcomes, including falls, physical disabilities, infections, and mortality. However, the prevalence of frailty and the prognostic influence of frailty status are poorly understood in adults with schizophrenia. The present study aimed to assess the predictive ability of frailty and its individual components for the risk of falls in patients with chronic schizophrenia. Frailty status was assessed at baseline by using Fried frailty criteria after the enrollment of 561 patients with chronic schizophrenia. The patients were followed up for 18 months, and the outcome of the study was the incidence of falls. The mean age of the patients was 53.8 years, and a total of 35.3% were females. One-quarter (25.3%) of patients received typical antipsychotics. The prevalence of frailty was 10.2% at baseline. During follow-up, 40 patients (7.1%) experienced falls. Frailty status was associated with increased susceptibility to falling with an unadjusted hazard ratio of 5.27 (95% confidence interval: 2.75-10.10) and a hazard ratio of 4.65 (95% confidence interval: 1.88-11.54) after multivariate adjustment. Among the components of frailty, the most significant association was observed between low physical activity and falls (p < 0.05). In conclusion, frailty is highly prevalent in patients with chronic schizophrenia and is associated with the risk of adverse clinical events. Further studies are needed to explore the mechanisms underlying the relationship between schizophrenia and frailty in an attempt to develop an appropriate treatment plan for improving clinical outcomes for these patients.

Long-Term Health and Economic Value of Improved Mobility among Older Adults in the United States

BACKGROUND

Mobility impairments have substantial physical and mental health consequences, resulting in diminished quality of life. Most studies on the health economic consequences of mobility limitations focus on short-term implications.

OBJECTIVES

To examine the long-term value of improving mobility in older adults.

METHODS

Our six-step approach used clinical trial data to calibrate mobility improvements and estimate health economic outcomes using a microsimulation model. First, we measured improvement in steps per day calibrated with clinical trial data examining hylan G-F 20 viscosupplementation treatment. Second, we created a cohort of patients 51 years and older with osteoarthritis. In the third step, we estimated their baseline quality of life. Fourth, we translated steps-per-day improvements to changes in quality of life using estimates from the literature. Fifth, we calibrated quality of life in this cohort to match those in the trial. Last, we incorporated these data and parameters into The Health Economic Medical Innovation Simulation model to estimate how mobility improvements affect functional status limitations, medical expenditures, nursing home utilization, employment, and earnings between 2012 and 2030.

RESULTS

In our sample of 12.6 million patients, 66.7% were female and 70% had a body mass index of more than 25 kg/m2. Our model predicted that a 554-step-per-day increase in mobility would reduce functional status limitations by 5.9%, total medical expenditures by 0.9%, and nursing home utilization by 2.8%, and increase employment by 2.9%, earnings by 10.3%, and monetized quality of life by 3.2% over this 18-year period.

CONCLUSIONS

Interventions that improve mobility are likely to reduce long-run medical expenditures and nursing home utilization and increase employment.

Identifying Motives of Midlife Black Triathlete Women Using Survey Transformation to Guide Qualitative Inquiry

Demonstrating health disparities related to race, age, and gender, older Black women (BW) are the most sedentary demographic group in the United States. Increasing PA in mid-life is important, as it improves health as BW age into their later years. Advancing our understanding of the exercise motives of BW triathletes presents a "reverse engineering" opportunity to identify motives that could influence sedentary mid-life BW to increase their activity. The purposes of this study were to: (a) utilize an innovative survey transformation method to adapt a measure developed primarily in Caucasian males, i.e., the Motivations of Marathoners Scale for Triathletes (MOMS-T) into a qualitative interview guide for use with BW triathletes; (b) use this interview guide to identify culturally based motives for triathlon participation among BW not previously addressed by the MOMS-T and; (c) interpret the novel motivational domains of the MOMS-T discovered, in order to gain understanding and influence subsequent interventions. Purposive sampling was used to select 12 interview participants from 121 self-identified Black female US residents aged ≥36 years with recent experience completing or training for a triathlon. The interviews identified four culturally based themes, including improving body composition to become "more lean", physical attractiveness, triathlete family, and camaraderie. These novel themes were related to existing MOMS-T scales, but the current MOMS-T questions did not illuminate their culturally distinct aspects. The process of survey transformation provides a viable approach to identify important culturally based characteristics and to adapt surveys to cultural minority populations, particularly when study resources are limited.

Mortality caused by accidental falls among the elderly: a time series analysis

Introduction : The worldwide increase in the elderly population has highlighted the importance of accidental falls and their consequences.Objective: To perform time-trend analysis of the mortality rate from accidental falls in (1) the city of Florianópolis (2) the state of Santa Catarina and (3) Brazil. Method : A time-series study of data from the Sistema de Informação sobre Mortalidade ("the Mortality Information System") was performed. The variation in mortality caused by accidental falls was estimated using the joinpoint regression method, based on the International Disease Classification (ICD-10), chapter XX, codes W00 to W15 and W17 to W19, from 1997 to 2010. Results : It was observed that in the most recent periods (2005/2008; 2002/2008; 2003/2008), there was a significant increase in mortality rates related to accidental falls in all three regions, and that these rates increased with advancing age. Conclusion : Strategies to prevent accidental falls among the elderly should be aimed, mainly, at those who are 80 and over, the age in which accidental falls result in higher death rates.

Circumstances and consequences of falls among the older adults in Florianopolis. Epi Floripa Aging 2009

The objective was to investigate the cir-cumstances and consequences of falling and risk factors associated with limitations in performing activities after falling. The study is part of the cross-sectional population based survey, conducted in 2009/2010, which involved 1,705 older adults (60 years and older) living in Florianopolis, SC. From the affirmative answer to the question of whether any falls occurred in the 12 months preceding the study, we investigated the circumstances and consequences of falls through a structured questionnaire. Descriptive analysis and binary logistic regression were used, with significance level of 5%. The prevalence of fall was 19% (14.3% for men and 21.5% for women). Most older adults fell while walking, 43.2% inside their homes. The main cause of falling was stumbling due to irregularities on the ground. 71% of those who fell reported injury, and 14.8% reported limitations in performing activities after the fall. There was a significant association between limitations in performing activities after the occurrence of falls and fractures. Preventing falls should be a public health concern, given that relatively easy changes can reduce the risk of falls.

Effect of ecological walking training in sedentary elderly people: act on aging study

PURPOSE OF THE STUDY

This study aims to investigate the effects of a walking program on aerobic endurance and function in a sample of sedentary elderly people.

DESIGN AND METHODS

For this study, 126 sedentary individuals were recruited: 63 individuals (mean age = 74.1±6.0 years) for the control group and 63 (mean age = 72.0±4.5 years) for the intervention group. The intervention consisted of walking training including balance exercises and lower limb strength activities twice a week for 4 months. We collected baseline and post-test measurements of aerobic endurance, lower limb strength, and mobility. We also measured aerobic endurance at increments of 4, 8, and 12 weeks between the baseline and the post-test. We used analyses of covariance with baseline value, gender, age, and body mass index scores as covariates (p < . 05) and calculated the effect size for the effects of the intervention. The changeover time of aerobic endurance was also analyzed with the repeated analysis of variance (p < .05).

RESULTS

The intervention group showed steady and significant improvements with respect to the 6-min walk (aerobic endurance) from 447.89 m (SD 73.87) to 561.51 m (SD 83.96), as well as the 30-s chair stand (lower limb strength) from 10 (SD 3) to 13 (SD 3) number of times and the Timed Up and Go Test (mobility) from 8.53 s (SD 2.86) to 7.13 s (SD 1.76) at the post-test, whereas the control group showed significant decrease in all measurements.

IMPLICATION

These results underline that an ecological walking training program can be used to improve physical functioning among sedentary elderly people.

Habitual physical activity as a determinant of the effect of moderate physical exercise on postural control in older men

The aim of the study was to compare the effect of exercise on postural control (PC) among the elderly with lower or higher level of habitual physical activity (HPA). The study involved 17 elderly men (mean age 72.9 ± 4.79 years). Mean velocity of the center of pressure (COP) displacements was measured using a force plate both before and after cycle ergometer exercise. A significantly higher increase in mean velocity of COP displacements and its component in the sagittal plane were observed in the group with lower level of HPA in comparison with the group with higher HPA level. Simultaneously, a relatively similar reaction to the exercise in the frontal plane was observed in both groups, possibly connected to the specific type of used exercise, which mainly activated the sagittal muscles.

Patterns of 12-year change in physical activity levels in community-dwelling older women: can modest levels of physical activity help older women live longer?

Few studies have addressed changes in physical activity participation over time among the elderly. The authors hypothesized that there were distinct trajectories of physical activity level over time and identifiable predictors of such trajectories, as well as that the maintenance of regular physical activity, even below recommended levels, was associated with lower mortality risk. Using longitudinal data (1994-2009) from 433 initially high-functioning older women aged 70-79 years at baseline, a joint latent class and survival mixture model identified 4 activity trajectory classes: always active (16.6%), fast declining (19.2%), stable moderate (32.3%), and always sedentary (31.9%). Obesity, coronary artery disease, chronic obstructive pulmonary disease, depressive symptoms, low self-efficacy, mobility disability, and low energy were associated with sedentary behavior and/or a fast decline in activity. Women in the fast declining and always sedentary classes had hazard ratios for death of 2.34 (95% confidence interval: 1.20, 4.59) and 3.34 (95% confidence interval: 1.72, 6.47), respectively, compared with the always active class; no mortality difference was found between the stable moderate and always active groups (hazard ratio = 1.24, 95% confidence interval: 0.63, 2.47). Our findings suggest that physical activity does not have to be vigorous to be beneficial and that the gain may be the greatest among women who reported the lowest levels of activity.

Increased fall risk is associated with elevated co-contraction about the ankle during static balance challenges in older adults

Falls are a leading contributor to disability in older adults. Increased muscle co-contraction in the lower extremities during static and dynamic balance challenges has been associated with aging, and also with a history of falling. Co-contraction during static balance challenges has not been previously linked with performance on clinical tests designed to ascertain fall risk. The purpose of this study was to investigate the relationship between co-contraction about the ankle during static balance challenges with fall risk on a commonly used dynamic balance assessment, the Four Square Step Test (FSST). Twenty-three volunteers (mean age 73 years) performed a series of five static balance challenges (Romberg eyes open/closed, Sharpened Romberg eyes open/closed, and Single Leg Standing) with continuous electromyography (EMG) of bilateral tibialis anterior and gastrocnemius muscles. Participants then completed the FSST and were categorized as 'at-risk' or 'not-at-risk' to fall based on a cutoff time of 12 s. Co-contraction was quantified with co-contraction index (CCI). CCI during narrow base conditions was positively correlated with time to complete FSST. High CCIs during all static balance challenges with the exception of Romberg stance with eyes closed were predictive of being at-risk to fall based on FSST time, odds ratio 19.3. The authors conclude that co-contraction about the ankle during static balance challenges can be predictive of performance on a dynamic balance test.

Fatores associados às quedas entre idosos praticantes de atividades físicas

Objetivou analisar a incidência e os fatores associados às quedas em idosos praticantes de atividades físicas. A amostra constituiu-se de 28 idosos inseridos no Programa de Atividades Físicas para Terceira Idade do Centro de Desportos da Universidade Federal de Santa Catarina. Trata-se de um estudo descritivo. Para a coleta dos dados utilizou-se entrevista semi-estruturada e estatística descritiva para a análise dos dados. Identificou-se uma baixa porcentagem (7,63%) de quedas entre os idosos. Os fatores associados às quedas foram: ser do sexo feminino, ter entre 70 e 79 anos e apresentar problemas de visão. A maioria das quedas ocorreu dentro de casa e, após a queda, os idosos tiveram restrições nas suas atividades diárias e, a maioria, relatou medo de sofrer nova queda. O estudo indica que a prática de atividades físicas é um fator de proteção para quedas.