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Pantong U, Trapero I, Jareaprapal U. Analysis and prevention of falls among community-dwelling older adults in southern Thailand. J Adv Nurs 2024; 80:2121-2136. [PMID: 37950381 DOI: 10.1111/jan.15945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 10/03/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
AIM To analyse fall prevalence, risk factors and perceptions among Thai older adults to design a prevention model. DESIGN Quantitative and qualitative data were collected using a convergent parallel mixed-methods design. METHODS A cross-sectional analysis was conducted using secondary data from health screenings of older adults in 20 subdistrict hospitals in southern Thailand from January 2018 to September 2019 (n = 12,130). In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with purposively sampled participants who were representatives of older adults and stakeholders (n = 50). RESULTS The quantitative analysis showed that the prevalence of falls was 12.1%. The independent risk factors were female gender, employment status, cognitive impairment, semi-dependent functional ability, balance problems, vision impairment, hearing difficulties, use of medications, reliance on assistive devices and access to outdoor toilets. The qualitative analysis revealed misconceptions on falls and fall prevention measures among older adults and community stakeholders. In Thailand, healthcare providers and community nurses play a crucial role in providing primary advice and conducting interventions, yet they encounter obstacles due to lack of personnel, time constraints, limited resources, inadequate support and unclear policies. Stakeholders stress the urgency of improving practice guidelines, developing evidence-based strategies and aligning with government policies. CONCLUSIONS Fall risk factors and prevention challenges among older adults were identified. Effective fall prevention programmes are needed. IMPACT The identified fall events may guide public health agencies and local administrations in planning fall prevention programmes. For implementation in Thai communities, teamwork among leaders and stakeholders is key. PATIENT OR PUBLIC CONTRIBUTION IDIs and FGDs were conducted with older adults, village health volunteers, nurses, healthcare providers, local organization administrators and village headmen.
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Affiliation(s)
- Uraiwan Pantong
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
| | - Isabel Trapero
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
| | - Urai Jareaprapal
- Nursing Department, Faculty of Nursing and Podiatry, University of Valencia, Valencia, Spain
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2
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Tian X, Mai YH, Guo ZJ, Chen JW, Zhou LJ. Contributing factors and interventions for fear of falling in stroke survivors: a systematic review. Top Stroke Rehabil 2024:1-16. [PMID: 38566465 DOI: 10.1080/10749357.2024.2333172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The purpose of this study was to provide a comprehensive overview of the prevalence, measurement tools, influencing factors, and interventions for fear of falling (FOF) in stroke survivors. METHODS A PRISMA-guided systematic literature review was conducted. PubMed, EMBASE, Cochrane, and Web of Science were systematically searched. The search time was up to February 2023. All observational and experimental studies investigating FOF in stroke patients were included. The assessment tool of the Joanna Briggs Institute was used to assess the quality of the included studies and the risk of bias assessment. (PROSPERO: CRD42023412522). RESULT A total of 25 observational studies and 10 experimental studies were included. The overall quality of the included studies was "low" to "good." The most common tool used to measure the FOF was the Falls Efficacy Scale-International (FES-I). The prevalence of FOF was 42%- 93.8%. Stroke survivors with physical impairments have the highest prevalence of FOF. The main risk factors for the development of FOF in stroke survivors were female gender, use of assistive devices, balance, limb dysfunction, and functional mobility. The combination of cognitive behavioral and exercise interventions is the most effective strategy. CONCLUSIONS This review suggests that the prevalence of FOF in stroke survivors is high and that understanding the factors associated with FOF in stroke patients can help develop multifactorial prevention strategies to reduce FOF and improve quality of life. In addition, a uniform FOF measurement tool should be used to better assess the effectiveness of interventions for stroke survivors. ETHICS APPROVAL PROSPERO registration (CRD42023412522).
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Affiliation(s)
- Xue Tian
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Ying-Hong Mai
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Zai-Jin Guo
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Jia-Wen Chen
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Luo-Jing Zhou
- Science and Technology Division, North Jiangsu People's Hospital of Jiangsu province, Yangzhou, China
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3
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Suri A, Hubbard ZL, VanSwearingen J, Torres-Oviedo G, Brach JS, Redfern MS, Sejdic E, Rosso AL. Fear of falling in community-dwelling older adults: What their gait acceleration pattern reveals. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:108001. [PMID: 38199138 DOI: 10.1016/j.cmpb.2023.108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/08/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Fear of Falling (FOF) is common among community-dwelling older adults and is associated with increased fall-risk, reduced activity, and gait modifications. OBJECTIVE In this cross-sectional study, we examined the relationships between FOF and gait quality. METHODS Older adults (N=232; age 77±6; 65 % females) reported FOF by a single yes/no question. Gait quality was quantified as (1) harmonic ratio (smoothness) and other time-frequency spatiotemporal variables from triaxial accelerometry (Vertical-V, Mediolateral-ML, Anterior-Posterior -AP) during six-minute walk; (2) gait speed, step-time CoV (variability), and walk-ratio (step-length/cadence) on a 4-m instrumented walkway. Mann Whitney U-tests and Random forest classifier compared gait between those with and without FOF. Selected gait variables were used to build Support Vector Machine (SVM) classifier and performance was evaluated using AUC-ROC. RESULTS Individuals with FOF had slower gait speed (103.66 ± 17.09 vs. 110.07 ± 14.83 cm/s), greater step time CoV (4.17 ± 1.66 vs. 3.72 ± 1.24 %), smaller walk-ratio (0.53 ± 0.08 vs. 0.56 ± 0.07 cm/steps/minute), smaller standard deviation V (0.15 ± 0.06 vs. 0.18 ± 0.09 m/s2), and smaller harmonic-ratio V (2.14 ± 0.73 vs. 2.38 ± 0.58), all p<.01. Linear SVM yielded an AUC-ROC of 67 % on test dataset, coefficient values being gait speed (-0.19), standard deviation V (-0.23), walk-ratio (-0.36), and smoothness V (-0.38) describing associations with presence of FOF. CONCLUSION Older adults with FOF have reduced gait speed, acceleration adaptability, walk-ratio, and smoothness. Disrupted gait patterns during fear of falling could provide insights into psychosocial distress in older adults. Longitudinal studies are warranted.
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Affiliation(s)
- Anisha Suri
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zachary L Hubbard
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessie VanSwearingen
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gelsy Torres-Oviedo
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Toronto, Ontario, Canada
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Sotoudeh GR, Mohammadi R, Mosallanezhad Z, Viitasara E, Soares JJF. A population study on factors associated with unintentional falls among Iranian older adults. BMC Geriatr 2023; 23:860. [PMID: 38102576 PMCID: PMC10724897 DOI: 10.1186/s12877-023-04571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Falls among older adults are a significant cause of disability, injury, and death worldwide. The high incidence of falls in older adults, combined with the increased susceptibility to injury of the older adult population, leads to severe global health issues. Further studies are needed to comprehensively evaluate the typical personal and environmental risk factors of falls in the Iranian elderly population. Future preventive strategies and intervention programs will be based on these findings. The study determined the risk factors associated with unintentional falls among a representative sample of older adults living in Tehran, the capital city of Iran. METHODS The study design was cross-sectional. The target population was men/women aged 65 years and over from the general population living in 22 different districts of Tehran who were selected by stratified random sampling. The researchers gathered the data using validated questionnaires and observations. The informed consent was obtained from all participants before starting the interview. Multivariate logistic regression analysis examined the association between falls occurring during the past 12 months with demographics/ socioeconomics and fall-related predictor factors. RESULTS The risk of falls was higher in women (47.0%) and those aged ≥ 75 years (44.1%). Older adults who were married had their fall risk reduced by 36.4% compared with other types of marital status. Older adults who were illiterate (48.1%), housewives (47.0%), and always had concerns about living expenses (53.9%) tended significantly to have a higher risk of falls. Moreover, participants who live with their family were less likely to fall than those who live alone (36.5% vs. 40.4%). Persons with safe homes were less likely to experience falls than persons with unsafe homes (30.9% vs. 41.4%). The logistic regression analysis showed that the female gender, being worried about living expenses, home safety, functional behavior, and function factors, were independently associated with the risk of falls during the past 12 months. CONCLUSIONS Our findings revealed that a wide range of intrinsic and extrinsic risk factors contributed to injurious falls; based on the literature, some are preventable. The present data may be helpful as a starting point and guide future efforts for health providers and policymakers to allocate additional resources and develop proper falls prevention or intervention programs at the community level.
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Affiliation(s)
- Gholam Reza Sotoudeh
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Mohammadi
- Division for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Zahra Mosallanezhad
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Eija Viitasara
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Joaquim J F Soares
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
- Faculdade de Ciências Sociais e Tecnologia da Universidade Europeia, Universidade Europeia, Lisboa, Portugal
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Ko KY, Kwok ZCM, Chan HYL. Effects of yoga on physical and psychological health among community-dwelling older adults: A systematic review and meta-analysis. Int J Older People Nurs 2023; 18:e12562. [PMID: 37577926 DOI: 10.1111/opn.12562] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/15/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES To synthesise and critically appraise the quality of existing evidence about the effects of yoga on physical and psychological outcomes among older adults. DESIGN A systematic review and meta-analysis. PARTICIPANTS Participants aged 60 and above. MEASUREMENTS Nine English and two Chinese electronic bibliographic databases, including MEDLINE OvidSP, PsycINFO, AMED, EMBASE, Global Health, PubMed, Scopus, CINAHL, Cochrane Library, Hyread and WanFang databases, were searched. Randomised controlled trials (RCT) of yoga on physical and psychological outcomes among older adults were included. Meta-analysis was conducted for outcomes studied in three or more studies, otherwise narrative synthesis was performed. RESULTS Fifteen studies were included for review. The results of meta-analysis after sensitivity analysis showed that yoga significantly improved balance (SMD = 0.81, 95% CI: 0.48-1.14, p < .001, II2 = 59%), flexibility (SMD = 0.38, 95% CI: 0.07-0.68, p = .020, II2 34%), muscle strength (SMD = 0.49, 95% CI: 0.18-0.79, p = .002, I2 43%) and depressive symptoms (SMD = 0.50, 95% CI = 0.09-0.91, p = .01, I2 0%). There was insufficient data for meta-analysis on gait and other psychological outcomes. Narrative synthesis suggested that yoga has positive effects on reducing anxiety, but its effects on improving gait and reducing stress among older adults were inconclusive. CONCLUSION The results of this review supported the beneficial effects of yoga on physical outcomes among older adults, but the heterogeneity across studies was relatively high. Evidence related to the effect on psychological outcomes was limited.
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Affiliation(s)
- Ka-Yan Ko
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zoe Ching Man Kwok
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Lee YH, Lin CH, Wu WR, Chiu HY, Huang HC. Virtual reality exercise programs ameliorate frailty and fall risks in older adults: A meta-analysis. J Am Geriatr Soc 2023; 71:2946-2955. [PMID: 37165743 DOI: 10.1111/jgs.18398] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/23/2023] [Accepted: 04/08/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Virtual reality (VR) technology constitutes a promising rehabilitation strategy, but its effect on frailty in older adults remains inconclusive. This study examined the effects of interactive VR training programs on lower-limb muscle strength, walking speed, balance, and fall risks in older adults with frailty. METHODS Various electronic databases comprising PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, Embase, the Chinese Electronic Periodical Service, the Chinese National Knowledge Infrastructure, and gray literature were searched from their inception through December 31, 2022 for relevant studies. Randomized controlled trials that examined the effects of interactive VR training programs on lower-limb muscle strength, balance, walking speed, and fall risks as measured by validated scales or methods. in older adults aged 65 years and older with frailty were included. A random-effects model was employed to examine the overall effect size, and the trim-and-fill method was adopted to examine publication bias. RESULTS For those studies that defined frailty using fall risks, substantial evidence demonstrated that interactive VR training interventions increased lower-limb muscle strength (Hedges' g = 0.35, p = 0.015), walking speed (Hedges' g = 0.29, p = 0.003), balance (Hedges' g = 0.62, p = 0.011), and fall risks (Hedges' g = -0.61, p < 0.001). Studies that defined frailty in accordance with the Fried frailty phenotype criteria indicated that interactive VR training interventions only increased walking speed (Hedges' g = 0.28, p = 0.023) and balance (Hedges' g = 0.27, p = 0.049). CONCLUSIONS Interactive VR training programs may benefit older adults with frailty with respect to walking speed and balance. More studies with good study quality are required to validate the effects of interactive VR exercise training on these frailty-related parameters in older adults.
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Affiliation(s)
- Yueh-Hua Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Chueh-Ho Lin
- International Ph.D. Program in Gerontology and Long-Term Care, Taipei Medical University, Taipei City, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Wan-Ru Wu
- Department of Nursing, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
- Department of Nursing, Taipei Medical University Hospital, Taipei City, Taiwan
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Hui-Chuan Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
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Huang Y, Li C, Lu X, Wang Y. The geographic environment and the frequency of falling: a study of mortality outcomes in elderly people in China. GEOSPATIAL HEALTH 2023; 18. [PMID: 37246537 DOI: 10.4081/gh.2023.1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/28/2023] [Indexed: 05/30/2023]
Abstract
Falling has become the first and second cause of death due to injury among urban and rural residents in China. This mortality is considerably higher in the southern part of the country than in the North. We collected the rate of mortality due to falling for 2013 and 2017 by province, age structure and population density, taking topography, precipitation and temperature into account. 2013 was used as the first year of the study since this year marks the expansion of the mortality surveillance system from 161 counties to 605 counties making available data more representative. A geographically weighted regression was used to evaluate the relationship between mortality and the geographic risk factors. High levels of precipitation, steep topography and uneven land surfaces as well as a higher quantile of the population aged above 80 years in southern China are believed to have led to the significantly higher number of falling compared with that in the North. Indeed, when evaluated by geographically weighted regression, the factors mentioned found a difference between the South and the North with regard to falling of 81% and 76% for the years 2013 and 2017, respectively. Interaction effects were observed between geographic risk factors and falling that, apart from the age factor, could be explained by topographic and climatic differences. The roads in the South are more difficult to negotiate on foot, particularly when it rains, which increases the probability of falling. In summary, the higher mortality due to falling in southern China emphasizes the need to apply more adaptive and effective measures in rainy and mountainous region to reduce this kind of risk.
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Affiliation(s)
- Yi Huang
- School of Geographic Sciences, Nantong University, Nantong.
| | - Chen Li
- School of Management, Shanghai University of Engineering Science, Shanghai.
| | - Xianjing Lu
- School of Geographic Sciences, Nantong University, Nantong.
| | - Yue Wang
- School of Geographic Sciences, Nantong University, Nantong.
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Beck ON, Shepherd MK, Rastogi R, Martino G, Ting LH, Sawicki GS. Exoskeletons need to react faster than physiological responses to improve standing balance. Sci Robot 2023; 8:eadf1080. [PMID: 36791215 PMCID: PMC10169237 DOI: 10.1126/scirobotics.adf1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Maintaining balance throughout daily activities is challenging because of the unstable nature of the human body. For instance, a person's delayed reaction times limit their ability to restore balance after disturbances. Wearable exoskeletons have the potential to enhance user balance after a disturbance by reacting faster than physiologically possible. However, "artificially fast" balance-correcting exoskeleton torque may interfere with the user's ensuing physiological responses, consequently hindering the overall reactive balance response. Here, we show that exoskeletons need to react faster than physiological responses to improve standing balance after postural perturbations. Delivering ankle exoskeleton torque before the onset of physiological reactive joint moments improved standing balance by 9%, whereas delaying torque onset to coincide with that of physiological reactive ankle moments did not. In addition, artificially fast exoskeleton torque disrupted the ankle mechanics that generate initial local sensory feedback, but the initial reactive soleus muscle activity was only reduced by 18% versus baseline. More variance of the initial reactive soleus muscle activity was accounted for using delayed and scaled whole-body mechanics [specifically center of mass (CoM) velocity] versus local ankle-or soleus fascicle-mechanics, supporting the notion that reactive muscle activity is commanded to achieve task-level goals, such as maintaining balance. Together, to elicit symbiotic human-exoskeleton balance control, device torque may need to be informed by mechanical estimates of global sensory feedback, such as CoM kinematics, that precede physiological responses.
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Affiliation(s)
- Owen N Beck
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.,Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA
| | - Max K Shepherd
- Department of Physical Therapy and Rehabilitation Science, Northeastern University, Boston, MA, USA.,Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Rish Rastogi
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA
| | - Giovanni Martino
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA
| | - Lena H Ting
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA.,Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA
| | - Gregory S Sawicki
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.,School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
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Schootemeijer S, Weijer RHA, Hoozemans MJM, Delbaere K, Pijnappels M, van Schooten KS. Responsiveness of Daily Life Gait Quality Characteristics over One Year in Older Adults Who Experienced a Fall or Engaged in Balance Exercise. SENSORS (BASEL, SWITZERLAND) 2022; 23:101. [PMID: 36616698 PMCID: PMC9823409 DOI: 10.3390/s23010101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Gait quality characteristics obtained from daily-life accelerometry are clinically relevant for fall risk in older adults but it is unknown whether these characteristics are responsive to changes in gait quality. We aimed to test whether accelerometry-based daily-life gait quality characteristics are reliable and responsive to changes over one year in older adults who experienced a fall or an exercise intervention. One-week trunk acceleration data were collected from 522 participants (65-97 years), at baseline and after one year. We calculated median values of walking speed, regularity (sample entropy), stability (logarithmic rate of divergence per stride), and a gait quality composite score, across all 10-s gait epochs derived from one-week gait episodes. Intraclass correlation coefficients (ICC) and limits of agreement (LOA) were determined for 198 participants who did not fall nor participated in an exercise intervention during follow-up. For responsiveness to change, we determined the number of participants who fell (n = 209) or participated in an exercise intervention (n = 115) that showed a change beyond the LOA. ICCs for agreement between baseline and follow-up exceeded 0.70 for all gait quality characteristics except for vertical gait stability (ICC = 0.69, 95% CI [0.62, 0.75]) and walking speed (ICC = 0.68, 95% CI [0.62, 0.74]). Only walking speed, vertical and mediolateral gait stability changed significantly in the exercisers over one year but effect sizes were below 0.2. The characteristic associated with most fallers beyond the LOA was mediolateral sample entropy (4.8% of fallers). For the exercisers, this was gait stability in three directions and the gait quality composite score (2.6% of exercisers). The gait quality characteristics obtained by median values over one week of trunk accelerometry were not responsive to presumed changes in gait quality after a fall or an exercise intervention in older people. This is likely due to large (within subjects) differences in gait behaviour that participants show in daily life.
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Affiliation(s)
- Sabine Schootemeijer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Roel H. A. Weijer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Neurology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Marco J. M. Hoozemans
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney 2031, Australia
- School of Population Health, University of New South Wales, Sydney 2052, Australia
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Kimberley S. van Schooten
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney 2031, Australia
- School of Population Health, University of New South Wales, Sydney 2052, Australia
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Zak M, Makara-Studzińska M, Mesterhazy A, Mesterhazy J, Jagielski P, Januszko-Szakiel A, Sikorski T, Jaworski P, Miszczuk R, Brola W. Validation of FES-I and Short FES-I Scales in the Polish Setting as the Research Tools of Choice to Identify the Fear of Falling in Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16907. [PMID: 36554787 PMCID: PMC9779753 DOI: 10.3390/ijerph192416907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Fear of falling is associated with a clear hazard to individual self-reliance, reduced physical activity, as well as a sense of shame and loss of self-confidence. The present study aimed to complete the applicable translation and validation protocol for the Falls Efficacy Scale-International (FES-I) tool, following its prior adaptation to ensure full compatibility with the Polish setting. The FES-I questionnaire, along with its abridged version, was translated in line with the recommended standards of the MAPI Institute, taking into account both the cultural fabric and pertinent language specifics of the country. The survey was attended by 740 individuals (N = 740; 463 women, 277 men), over 60 years old. All respondents were required to complete both the FES-I and FES-I (Short) questionnaires twice, following an intervening period, and subsequently had their responses statistically assessed. The FES-I questionnaire, along with its abridged version, may be recommended as an effective assessment tool for addressing the fear of falling issue among the older adults, consequently allowing the teams of attending physicians, physiotherapists, psychologists, or psychiatrists to complete an unambiguous diagnosis, with a view to helping the patients overcome this particular type of anxiety.
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Affiliation(s)
- Marek Zak
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Ul. Zeromskiego 5, 25-369 Kielce, Poland
| | - Marta Makara-Studzińska
- Institute of Nursing and Midwifery, Department of Health Psychology, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, Ul. Kopernika 25, 31-501 Krakow, Poland
| | - Agnieszka Mesterhazy
- Institute of Nursing and Midwifery, Department of Health Psychology, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, Ul. Kopernika 25, 31-501 Krakow, Poland
| | - Jacek Mesterhazy
- Institute of Nursing and Midwifery, Department of Health Psychology, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, Ul. Kopernika 25, 31-501 Krakow, Poland
| | - Paweł Jagielski
- Department of Nutrition and Drug Research, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, Skawinska 8, 31-066 Krakow, Poland
| | - Aneta Januszko-Szakiel
- Institute of Information Studies, Faculty of Managment and Social Communication, Jagiellonian University, Ul. Lojasiewicza 4, 30-348 Krakow, Poland
| | - Tomasz Sikorski
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Ul. Zeromskiego 5, 25-369 Kielce, Poland
| | - Piotr Jaworski
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Ul. Zeromskiego 5, 25-369 Kielce, Poland
| | - Renata Miszczuk
- Institute of Pedagogy, Jan Kochanowski University, Ul. Zeromskiego 5, 25-369 Kielce, Poland
| | - Waldemar Brola
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Ul. Zeromskiego 5, 25-369 Kielce, Poland
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11
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Gallo da Silva TT, Melo Filho J, Biesek S, Vojciechowski AS, Borba VZC, Gomes ARS. Accuracy of Tools to Differentiate Single From Recurrent Fallers Pre-Frail Older Women. Front Public Health 2022; 10:716851. [PMID: 35655457 PMCID: PMC9152280 DOI: 10.3389/fpubh.2022.716851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The objectives of this study were to analyze and compare musculoskeletal and functional performance and present cutoff points to differentiate pre-frail community-dwelling older women regarding their fall history: non fallers (0 falls), fallers (single fall), and recurrent fallers (≥2 falls). Method This is a cross-sectional, retrospective study on 90 pre-frail community-dwelling older women (71.2 ± 4.49 years) according to Fried criteria. We assessed peak torque (PT) (isokinetic dynamometer), muscle architecture/mass (ultrasound/dual-energy X-ray absorptometry), and the following functional performance: usual gait speed (UGS), fast gait speed (FGS), walking speed reserve (WSR), cadence and step length, and timed up and go. Results The recurrent fallers presented lower UGS (1.12 ± 0.18 vs. 1.29 ± 0.28 m/s; p = 0.05) and isometric PT of knee extensors than the fallers (89.88 ± 20.99 vs. 115.55 ± 23.09 Nm; p = 0.01), and lower FGS than the fallers (1.35 ± 0.26 vs. 1.5 ± 0.29 m/s; p = 0.03) and non-fallers (1.35 ± 0.26 vs. 1.52 ± 0.26 m/s; p = 0.01). The outcomes that differentiated the fallers from the non-fallers were both WSR calculated as a difference (WSRdiff) (≤0.26 m/s) and WSR calculated as a ratio (WSRratio) (≤1.25 m/s), while to differentiate the recurrent fallers from the non-fallers were FGS (≤1.44 m/s) and step length (≤73 cm). The following cutoff points might be used to differentiate recurrent fallers and fallers: UGS (≤1.12 m/s), FGS (≤1.34m/s), step length (≤73 cm), PT knee extension (≤114.2 Nm), PT knee flexion (≤46.3 Nm), and PT ankle dorsiflexion (≤22.1 Nm). Conclusion Recurrent fallers community-dwelling pre-frail older women presented a worse musculoskeletal and functional performance when compared to the non-fallers and fallers. Gait speed, step length, PT of both knee extension and flexion, and ankle dorsiflexion can be used to identify both single and recurrent fallers pre-frail older women, contributing to guide interventions and prevent falls and fractures.
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Affiliation(s)
| | - Jarbas Melo Filho
- Departament of Massage Under Graduation, Federal Institute of Paraná, Curitiba, Brazil
| | - Simone Biesek
- PhD Program in Physical Education, Federal University of Paraná, Curitiba, Brazil
| | | | - Victória Zeghbi Cochenski Borba
- Internal Medicine Department and Masters and PhD Programs, Endocrinology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Anna Raquel Silveira Gomes
- Masters and PhD Programs in Physical Education, Prevention and Rehabilitation in Physiotherapy Department, Federal University of Paraná, Curitiba, Brazil
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12
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Kim N, Park J, Shin H, Bae Y. Gastrocnemius Medial Head Stiffness Is Associated with Potential Fall Risk in Community-Dwelling Older Adults. Healthcare (Basel) 2022; 10:healthcare10050785. [PMID: 35627922 PMCID: PMC9141566 DOI: 10.3390/healthcare10050785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study is to compare the muscle strength, balance ability, thickness, and stiffness of the tibialis anterior and gastrocnemius muscle in the elderly, with (fallers) and without (non-fallers) fall experience, and confirmed the correlation between the variables mentioned above and muscle stiffness in the faller. We selected 122 elderly participants, comprising 40 fallers and 82 non-fallers, and measured the muscle strength of the tibialis anterior (TA) and the gastrocnemius (GA). Balance ability was measured by the functional reach test (FRT), timed up and go test (TUG), short physical performance battery (SPPB), and gait speed (GS). We used shear wave elastography (SWE) to determine the thickness of the TA and the medial (GAmed) and lateral head (GAlat) of the gastrocnemius and the stiffness during relaxation and contraction. Balance ability, except muscle strength, was significantly lower in fallers compared with non-fallers. The GAmed and GAlat thickness were significantly lower in fallers than that in non-fallers. In fallers, the thickness, rest, and contractive stiffness of GAmed were correlated with the FRT, GS, SPPB. Low rest and GAmed contractive stiffness were related to lower balance ability in fallers. The muscle stiffness measurement using SWE was a novel method to assess potential fall risk.
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13
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MacKay S, Ebert P, Harbidge C, Hogan DB. Fear of Falling in Older Adults: A Scoping Review of Recent Literature. Can Geriatr J 2021; 24:379-394. [PMID: 34912493 PMCID: PMC8629501 DOI: 10.5770/cgj.24.521] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Fear of falling (FOF) is prevalent among older adults and associated with adverse health outcomes. Over recent years a substantial body of research has emerged on its epidemiology, associated factors, and consequences. This scoping review summarizes the FOF literature published between April 2015 and March 2020 in order to inform current practice and identify gaps in the literature. Methods A total of 439 articles related to FOF in older adults were identified, 56 selected for full-text review, and 46 retained for data extraction and synthesis. Results The majority of included studies were cross-sectional. Older age, female sex, previous falls, worse physical performance, and depressive symptoms were the factors most consistently associated with FOF. Studies that measured FOF with a single question reported a significantly lower prevalence of FOF than those using the Falls Efficacy Scale, a continuous measure. FOF was associated with higher likelihoods of future falls, short-term mortality, and functional decline. Conclusions Comparisons between studies were limited by inconsistent definition and measurement of FOF, falls, and other characteristics. Consensus on how to measure FOF and which participant characteristics to evaluate would address this issue. Gaps in the literature include clarifying the relationships between FOF and cognitive, psychological, social, and environmental factors.
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Affiliation(s)
- Scott MacKay
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary
| | - Patricia Ebert
- Department of Psychology, University of Calgary, Calgary.,Hotchkiss Brain Institute, University of Calgary, Calgary.,Specialized Geriatric Services, Calgary Regional Health Authority, Calgary
| | - Cathy Harbidge
- Specialized Geriatric Services, Calgary Regional Health Authority, Calgary
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
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14
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Dunsky A, Zeev A, Netz Y. Predictors of Future Walking Speed: A 12-Month Monitoring Program. Int J Aging Hum Dev 2021; 95:205-221. [PMID: 34866427 DOI: 10.1177/00914150211066566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of the current study was to identify significant predictors of walking speed (WS) among community-dwelling older adults, as it is one of the most representative measures of functioning in their daily lives. Seventy-seven (24 adult men, 26 adult women, and 27 older-adult women) community-dwelling older adults (73.7 ± 4.9 years) performed two assessments, over a 12-month period. Several physical, cognitive, and psychological tests were performed, as well as assessing the preferred WS. Multiple linear regression, stratified by gender, was used to identify significant predictors of future WS. For the adult men, walking and functional performances at the first assessment predicted 71.9%; for adult women, reaction time, walking, and balance performance predicted 64.4%; and, for the older-adult women, fast walking and reaction time predicted 48.2% of the variance of future WS. Clinicians should consider including different exercises for each group of older adults to evaluate and preserve functional abilities.
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Affiliation(s)
- Ayelet Dunsky
- 172890The Academic College at Wingate, Netanya, Israel
| | - Aviva Zeev
- 172890The Academic College at Wingate, Netanya, Israel
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15
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SUGIURA H, NOGUCHI T, YOKOYA T, IKARI A, SAMEJIMA Y, YAMAMOTO G, BOLDBAATAR B, SUGITA M. Relationships of the performance in a walking test on an unstable walkway with various motor abilities and fall experiences in active elderly people. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.20.04430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Wang L, Song P, Cheng C, Han P, Fu L, Chen X, Yu H, Yu X, Hou L, Zhang Y, Guo Q. The Added Value of Combined Timed Up and Go Test, Walking Speed, and Grip Strength on Predicting Recurrent Falls in Chinese Community-dwelling Elderly. Clin Interv Aging 2021; 16:1801-1812. [PMID: 34675495 PMCID: PMC8502011 DOI: 10.2147/cia.s325930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/11/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose To determine whether combined performance-based models could exert better predictive values toward discriminating community-dwelling elderly with high risk of any-falls or recurrent-falls. Participants and Methods This prospective cohort study included a total of 875 elderly participants (mean age: 67.10±5.94 years) with 513 females and 362 males, recruited from Hangu suburb area of Tianjin, China. All participants completed comprehensive assessments. Methods We documented information about sociodemographic information, behavioral characteristics and medical conditions. Three functional tests—timed up and go test (TUGT), walking speed (WS), and grip strength (GS) were used to create combined models. New onsets of any-falls and recurrent-falls were ascertained at one-year follow-up appointment. Results In total 200 individuals experienced falls over a one-year period, in which 66 individuals belonged to the recurrent-falls group (33%). According to the receiver operating characteristic curve (ROC), the cutoff points of TUGT, WS, and GS toward recurrent-falls were 10.31 s, 0.9467 m/s and 0.3742 kg/kg respectively. We evaluated good performance as “+” while poor performance as “–”. After multivariate adjustment, we found “TUGT >10.31 s” showed a strong correlation with both any-falls (adjusted odds ratio (OR)=2.025; 95% confidence interval (CI)=1.425–2.877) and recurrent-falls (adjusted OR=2.150; 95%CI=1.169–3.954). Among combined functional models, “TUGT >10.31 s, GS <0.3742 kg/kg, WS >0.9467 m/s” showed strongest correlation with both any-falls (adjusted OR=5.499; 95%CI=2.982–10.140) and recurrent-falls (adjusted OR=8.260; 95%CI=3.880–17.585). And this combined functional model significantly increased discriminating abilities on screening recurrent-fallers than a single test (C-statistics=0.815, 95%CI=0.782–0.884, P<0.001), while not better than a single test in predicting any-fallers (P=0.083). Conclusion Elderly people with poor TUGT performance, weaker GS but quicker WS need to be given high priority toward fall prevention strategies for higher risks and frequencies. Meanwhile, the combined “TUGT–, GS–, WS+” model presents increased discriminating ability and could be used as a conventional tool to discriminate recurrent-fallers in clinical practice.
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Affiliation(s)
- Lu Wang
- Department of Rehabilitation, School of Medical Technology, Tianjin Medical University, Tianjin, People's Republic of China
| | - Peiyu Song
- Department of Rehabilitation, School of Medical Technology, Tianjin Medical University, Tianjin, People's Republic of China
| | - Cheng Cheng
- Department of Rehabilitation, School of Medical Technology, Tianjin Medical University, Tianjin, People's Republic of China.,Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, People's Republic of China
| | - Peipei Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China
| | - Liyuan Fu
- Department of Rehabilitation, School of Medical Technology, Tianjin Medical University, Tianjin, People's Republic of China
| | - Xiaoyu Chen
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China
| | - Hairui Yu
- Department of Rehabilitation, School of Medical Technology, Tianjin Medical University, Tianjin, People's Republic of China
| | - Xing Yu
- Department of Rehabilitation, School of Medical Technology, Tianjin Medical University, Tianjin, People's Republic of China
| | - Lin Hou
- Department of Rehabilitation, School of Medical Technology, Tianjin Medical University, Tianjin, People's Republic of China
| | - Yuanyuan Zhang
- Department of Rehabilitation, School of Medical Technology, Tianjin Medical University, Tianjin, People's Republic of China
| | - Qi Guo
- Department of Rehabilitation, School of Medical Technology, Tianjin Medical University, Tianjin, People's Republic of China.,College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China
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17
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Okabe T, Suzuki M, Goto H, Iso N, Cho K, Hirata K, Shimizu J. Sex Differences in Age-Related Physical Changes among Community-Dwelling Adults. J Clin Med 2021; 10:jcm10204800. [PMID: 34682922 PMCID: PMC8538508 DOI: 10.3390/jcm10204800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/11/2021] [Accepted: 10/16/2021] [Indexed: 12/25/2022] Open
Abstract
The prevalence of physical functioning limitations is positively correlated with age in both men and women. However, whether the appearance of deterioration differs depending on physical function and sex remains unclear. This study aimed to clarify the modes of age-related changes in physical function and sex differences in middle-aged and older adults. This study comprised 124 (46 men and 78 women) healthy adults aged 30 years or older and examined gender differences in physical function. The results of this study showed that one-leg standing time had the highest rate of age-related decline in both men and women, followed by knee extension strength, skeletal muscle mass, the 5 m walking test, and the timed up and go test. The sex-specific points showed a high rate of decline in trunk forward bending in men and a high rate of decline in forced expiratory volume (1 s) and gradual rate of decline in the bone area ratio in women. After middle age, it is desirable to start monitoring and training balance, muscle function, and walking. Men require early intervention for flexibility, and women require early intervention for respiratory function and continued intervention for bone mineral density.
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18
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Joseph A, Muliyil J. Community-based case control study on the risk of fall among elderly in Kaniyambadi block, Vellore, Tamil Nadu, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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19
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Lee D, Tak SH. Fear of Falling and Related Factors in Older Adults With Spinal Diseases. J Gerontol Nurs 2021; 47:29-35. [PMID: 34309452 DOI: 10.3928/00989134-20210624-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fear of falling is common among older adults with spinal diseases. The purpose of the current study was to examine fear of falling and related factors in this population. A total of 138 participants were recruited and completed survey questionnaires along with the Timed Up & Go Test. Participants were 73.7 years old on average, 52% had fall experience, and 56% were taking more than four medications. Multivariate regression analyses revealed that the use of sleeping pills, residence type, pain, activities of daily living, gait ability, and gait efficacy were significant predictors of fear of falling. Findings suggest that a fall prevention intervention for older adults with spinal diseases should include pain management, functional improvement, and gait rehabilitation with a focus on gait performance and gait efficacy. In addition, it is important to improve living environment and sleep hygiene, which are conducive to falls. [Journal of Gerontological Nursing, 47(8), 29-35.].
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20
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Błażkiewicz M, Kędziorek J, Hadamus A. The Impact of Visual Input and Support Area Manipulation on Postural Control in Subjects after Osteoporotic Vertebral Fracture. ENTROPY (BASEL, SWITZERLAND) 2021; 23:375. [PMID: 33804770 PMCID: PMC8004071 DOI: 10.3390/e23030375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/04/2021] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
Osteoporosis is a prevalent health concern among older adults and is associated with an increased risk of falls that may result in fracture, injury, or even death. Identifying the risk factors for falls and assessing the complexity of postural control within this population is essential for developing effective regimes for fall prevention. The aim of this study was to assess postural control in individuals recovering from osteoporotic vertebral fractures while performing various stability tasks. Seventeen individuals with type II osteoporosis and 17 healthy subjects participated in this study. The study involved maintaining balance while standing barefoot on both feet for 20 s on an Advanced Mechanical Technology Inc. (AMTI) plate, with eyes open, eyes closed, and eyes closed in conjunction with a dual-task. Another three trials lasting 10 s each were undertaken during a single-leg stance under the same conditions. Fall risk was assessed using the Biodex Balance platform. Nonlinear measures were used to assess center of pressure (CoP) dynamics in all trials. Reducing the support area or elimination of the visual control led to increased sample entropy and fractal dimension. Results of the nonlinear measurements indicate that individuals recovering from osteoporotic vertebral fractures are characterized by decreased irregularity, mainly in the medio-lateral direction and reduced complexity.
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Affiliation(s)
- Michalina Błażkiewicz
- Department of Physiotherapy, The Józef Piłsudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland;
| | - Justyna Kędziorek
- Department of Physiotherapy, The Józef Piłsudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland;
| | - Anna Hadamus
- Department of Rehabilitation, Faculty of Medical Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland;
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21
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Lu X, Luo Y, Hu B, Park NK, Ahrentzen S. Testing of path-based visual cues on patterned carpet to assist older adults' gait in a continuing care retirement community. Exp Gerontol 2021; 149:111307. [PMID: 33741457 DOI: 10.1016/j.exger.2021.111307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/27/2021] [Accepted: 03/06/2021] [Indexed: 11/15/2022]
Abstract
Fall accidents lead to hospitalization and medical costs among all age groups, especially severe for older adults. Both intrinsic (e.g., visual impairment, fear of falling) and extrinsic (e.g., inappropriate carpet design, poor lighting) factors contribute to fall accidents. Older adults increasingly rely on visual perception to maintain balance as their health conditions decline. Patterned carpet is common in the built environment, which is one of the factors contributing to fall accidents among older adults. This study examined the role of path-based visual cues (provide visual guidance while walking along the patterned carpet) in helping older adults maintain safe movement and overcome the fear of falling. The experimental field study was conducted at a Continuing Care Retirement Community. Thirty-two residents were recruited. Within-subjects design was employed to examine the effects of path-based visual cues (light color and brightness) on the gait characteristics of older adults with and without visual impairment while walking on patterned carpet. Wearable sensors collected older adults' gait characteristics and questionnaires were used to evaluate their perceptions of confidence and safety with different visual cues provided. Individual repeated measures analysis results indicated that older adults significantly decreased stride length and stride velocity under 8.3 fc white and 7.3 fc blue lighting conditions compared to the baseline condition. In addition, the principal component analysis also indicated significant differences in gait performance among lighting colors and lighting brightness. The subjective responses indicated that the path-based visual cues were helpful in improving walking confidence, particularly for older adults with visual impairment.
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Affiliation(s)
- Xiaojie Lu
- Shimberg Center for Housing Studies, University of Florida, Gainesville, FL, USA.
| | - Yue Luo
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL, USA
| | - Boyi Hu
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL, USA
| | - Nam-Kyu Park
- Department of Interior Design, University of Florida, Gainesville, FL, USA
| | - Sherry Ahrentzen
- Shimberg Center for Housing Studies, University of Florida, Gainesville, FL, USA
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22
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Steckhan GMA, Fleig L, Schwarzer R, Warner LM. Perceived Physical Functioning and Gait Speed as Mediators in the Association Between Fear of Falling and Quality of Life in Old Age. J Appl Gerontol 2020; 41:421-429. [PMID: 33305984 DOI: 10.1177/0733464820979188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Preserving Quality of Life (QoL) in old age gains in importance, but Fear of Falling (FoF) considerably limits QoL. The aim of our study was to understand how physical mediators may translate FoF to QoL. At Time 1, FoF, subjective leg strength, balance, QoL, and objective gait speed were assessed. QoL was reassessed after 6 months, at Time 2 (n = 125). A sequential mediation analysis examined whether the relationship between FoF and QoL could be mediated by leg strength, balance, and gait speed. FoF was directly associated with QoL (β = -.27; 95% CI [-0.007, -0.001]) as well as indirectly via leg strength, balance, and gait speed (specific sequential indirect effect: β = -.03; 95% CI [-0.06, -0.001]; R2 = .40 in QoL; controlled for age, QoL at Time 1). An intervention approach could be to address FoF and foster physical functioning and gait speed to maintain QoL.
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Affiliation(s)
| | | | - Ralf Schwarzer
- Freie Universität Berlin, Germany.,SWPS University of Social Sciences and Humanities, Warsaw, Poland
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23
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Choi J, Choi SM, Lee JS, Seo SS, Kim JY, Kim HY, Kim SR. Development and validation of the fall risk perception questionnaire for patients in acute care hospitals. J Clin Nurs 2020; 30:406-414. [PMID: 33141494 DOI: 10.1111/jocn.15550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/05/2020] [Accepted: 10/23/2020] [Indexed: 01/13/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to develop a fall risk perception questionnaire for patients admitted to acute care hospitals and to establish its reliability and validity. BACKGROUND To prevent falls during patients' hospitalisation, it is essential for them to accurately perceive their risk of falling. DESIGN This methodological study was performed to develop a fall risk perception questionnaire. METHODS After generating a preliminary questionnaire, two rounds of content validity testing were performed with nine experts. Following a pilot test, a convenience sample of 236 participants was recruited from an acute care hospital between 2 May 2018 and 15 December 2019. Construct, convergent and known-group validity of the questionnaire was evaluated, and reliability was estimated by calculating the internal consistency reliability coefficients. The study adhered to STROBE guidelines. RESULTS Exploratory factor analysis yielded a three-factor solution with 27 items. The questionnaire showed statistically significant positive correlation with the Korean Falls Efficacy Scale-International and the Morse Fall Scale, thus establishing convergent validity. For known-group comparison, Morse Fall Scale scores were categorised into two groups by cut-off score. The risk for falls group had a significantly higher perceived fall risk than the no risk for falls group, thus establishing known-group validity. Cronbach's alpha values indicated good to excellent reliability for the overall questionnaire with 27 items and for each of the three subfactors. CONCLUSIONS The fall risk perception questionnaire demonstrated satisfactory reliability and validity in an acute care hospital setting. RELEVANCE TO CLINICAL PRACTICE Because understanding patients' perceptions of their fall risk is essential for preventing falls, it is necessary to regularly assess patients' fall risk perception using tools with established reliability and validity.
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Affiliation(s)
- Jieun Choi
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Se Min Choi
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Jeong Sin Lee
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Soon Seok Seo
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Ja Yeon Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Hye Young Kim
- College of Nursing, Jeonbuk Research Institute of Nursing Science, Jeonbuk National University, Jeonju-si, Korea
| | - Sung Reul Kim
- College of Nursing, Korea University Nursing Research Institute, Korea University, Seoul, Korea
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24
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Soares RR, Salgado PDO, Rocha KO, Lima LM. Functional capacity and risk of falls in the elderly with metabolic syndrome. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2020. [DOI: 10.5712/rbmfc15(42)2228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Metabolic syndrome (MetS) is the most common metabolic abnormality in the population that predisposes to cardiovascular events and may be related to poor physical fitness and low functional capacity in the elderly. The objective of this study was to evaluate the interference of metabolic changes in functional capacity and risk of falls in the elderly. Methods: A cross-sectional study was carried out with 126 elderly subjects, 58 presented MetS and 68 without MetS, according to the criteria of the International Diabetes Federation. Katz Index, Tinetti Index, Timed Up and Go test and Berg Scale were applied to evaluate the functional capacity. Falls Efficacy Scale-International scale (FES-I-Brazil) was used to evaluate the fear of falling. For statistical analysis, the Mann-Whitney, Chi-square and Spearman correlation tests were used. Results: There was an association between the MetS and non-MetS groups in relation to the risk strata of the TUG index [p=0.02; OR=0.38; 95%CI (0.16-0.91)]. Between these two groups, there was a significant difference in the mean of the following markers: Berg scale (p=0.03); TUG (p=0.03); FES-I-Brazil (p=0.02). The Kats and IPAQ index did not show any significant association. Conclusions: Elderly patients with MetS presented higher risk and fear of falls when compared to patients without MetS. However, there was no variation in walking ability or balance.
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25
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Vongsirinavarat M, Mathiyakom W, Kraiwong R, Hiengkaew V. Fear of Falling, Lower Extremity Strength, and Physical and Balance Performance in Older Adults with Diabetes Mellitus. J Diabetes Res 2020; 2020:8573817. [PMID: 32587870 PMCID: PMC7293747 DOI: 10.1155/2020/8573817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/21/2020] [Indexed: 12/25/2022] Open
Abstract
Fear of falling (FoF) is known to affect the physical activities and quality of life of older adults with type 2 diabetes mellitus (DM). Many complications of DM, especially ones distressing lower extremity (LE), could lead to increased fall risk and FoF. This study aimed to explore the relationship between FoF, LE muscle strength, and physical performance in older adults without diabetes mellitus (ONDM) and with DM (ODM) with varying degrees of balance impairment. The participants comprised 20 ONDM and 110 ODM. The ODM was grouped by the number of failed performances of the modified clinical test of sensory interaction and balance (mCTSIB). The scores of FoF, balance performance of mCTSIB, physical performance of TUG, and LE muscle strength were compared between groups. The results showed that FoF was present in 30% and 60% of the ONDM and ODM, respectively. Forty percent of the ODM failed one condition of the mCTSIB, while 18% and 16% failed two and three conditions, respectively. As the number of failed performances on the mCTSIB increased, the proportions of participants with FoF significantly increased. The psychosocial domain of FoF, LE muscle strength, and TUG score was significantly different between groups and more affected in the ODM with a greater number of failed performances on the mCTSIB. In conclusion, the mCTSIB can differentiate the varying degrees of balance impairment among ODM. FoF, LE muscle strength, and physical performance are more affected as the degree of balance impairment increases. Comprehensive management related to balance and falls in the ODM should include a regular evaluation and monitoring of standing balance, LE muscle strength, physical performance, and FoF.
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Affiliation(s)
- Mantana Vongsirinavarat
- Faculty of Physical Therapy, Mahidol University, 999, Salaya, Phuttamonthon, Nakhon Pathom 73170, Thailand
| | - Witaya Mathiyakom
- Department of Physical Therapy, California State University, Northridge, 18111 Nordhoff Street, Jacaranda Hall 1513B, Northridge, CA 91330, USA
| | - Ratchanok Kraiwong
- Faculty of Physical Therapy, Mahidol University, 999, Salaya, Phuttamonthon, Nakhon Pathom 73170, Thailand
| | - Vimonwan Hiengkaew
- Faculty of Physical Therapy, Mahidol University, 999, Salaya, Phuttamonthon, Nakhon Pathom 73170, Thailand
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Effect of a Comprehensive Health Care Program on Blood Pressure, Blood Glucose, Body Composition, and Depression in Older Adults Living Alone: A Quasi-Experimental Pretest-Posttest Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010220. [PMID: 31892263 PMCID: PMC6982085 DOI: 10.3390/ijerph17010220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/23/2019] [Accepted: 12/25/2019] [Indexed: 12/02/2022]
Abstract
This study explored the effects of a comprehensive health-care program (CHCP) on blood pressure, blood glucose, body composition, and depression in older adults living alone. We used a quasi-experimental, two-group, pretest–posttest design. The CHCP consisted of open lectures, health counseling, exercise classes, nutrition counseling, and self-help group meetings at a local senior welfare center. Fifty-eight subjects participated in this study, with thirty subjects in the experimental group and twenty-eight subjects in the control group. Data were analyzed by using the descriptive statistics, χ2-test, and t-test. Comparisons of the pretest and posttest systolic blood pressure (t = −2.530, p < 0.016) and blood glucose (t = 3.089, p < 0.004) between the experimental and control groups showed significant differences. In both the experimental (t = 3.949, p < 0.001) and control groups (t = 3.816, p < 0.002), depression symptoms showed a significant decrease posttest, compared with pretest. Our findings infer that older adults require physical and psychosocial health care and that more efforts must be made to improve the general health and well-being of this population group.
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Carrasco C, Tomas‐Carus P, Bravo J, Pereira C, Mendes F. Understanding fall risk factors in community‐dwelling older adults: A cross‐sectional study. Int J Older People Nurs 2019; 15:e12294. [DOI: 10.1111/opn.12294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 10/31/2019] [Accepted: 11/12/2019] [Indexed: 01/10/2023]
Affiliation(s)
| | - Pablo Tomas‐Carus
- Department of Sports and Health University of Évora Évora Portugal
- Comprehensive Health Research Center (CHRC) University of Évora Évora Portugal
| | - Jorge Bravo
- Department of Sports and Health University of Évora Évora Portugal
- Comprehensive Health Research Center (CHRC) University of Évora Évora Portugal
| | - Catarina Pereira
- Department of Sports and Health University of Évora Évora Portugal
- Comprehensive Health Research Center (CHRC) University of Évora Évora Portugal
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Değer TB, Saraç ZF, Savaş ES, Akçiçek SF. The Relationship of Balance Disorders with Falling, the Effect of Health Problems, and Social Life on Postural Balance in the Elderly Living in a District in Turkey. Geriatrics (Basel) 2019; 4:geriatrics4020037. [PMID: 31108836 PMCID: PMC6630729 DOI: 10.3390/geriatrics4020037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 01/13/2023] Open
Abstract
The aim of this study was to determine the prevalence of balance disorders; the effects of sociodemographic, medical, and social conditions on postural balance; and the relationship between balance and falls in elderly individuals. The study design was cross-sectional. A total of 607 community-dwelling elderly individuals with a mean age of 73.99 ± 6.6 years were enrolled after being selected by stratified random sampling. The study was performed as a face-to-face survey in the homes of elderly individuals. Sociodemographic and medical data were obtained from elderly individuals using the Elderly Identification Form. Balance disorders were determined using the Berg Balance Scale (BBS). In this study, the prevalence of balance disorders was found to be 34.3% in the community-dwelling elderly. Older age, physical disability, having four or more chronic illnesses, the presence of incontinence, having a history of falls, not walking regularly, absence of free time activity, and obesity were found to be associated with an increased prevalence of balance disorders. Balance disorders are commonly seen in the elderly and may be triggered by a variety of biological and social factors. It is crucial to develop and implement national health and social policies to eliminate the causes of this problem, as well as to prioritize preventive health services in the ever-increasing elderly population.
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Affiliation(s)
- Tahsin Barış Değer
- Directorate of Health Affairs, Söke Municipality, Söke, Aydın 09200, Turkey.
| | - Zeliha Fulden Saraç
- Geriatrics Section, Faculty of Medicine, Ege University, Bornova, Izmir 35100, Turkey.
| | - Emine Sumru Savaş
- Geriatrics Section, Faculty of Medicine, Ege University, Bornova, Izmir 35100, Turkey.
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Yoo JS, Kim CG, Yim JE, Jeon MY. Risk factors of repeated falls in the community dwelling old people. J Exerc Rehabil 2019; 15:275-281. [PMID: 31111013 PMCID: PMC6509467 DOI: 10.12965/jer.1938086.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/23/2019] [Indexed: 11/23/2022] Open
Abstract
This study aimed to provide evidence for the development of an algorithm to identify older adults with a high risk for repeated falls, along with strategies to prevent repeated falls, by analyzing the known physical, psychological, and environmental factors related to falls in older adults. One hundred fifty-seven community-dwelling older adults aged 65 years or older who experienced a fall within the past year were enrolled in this study. Participants' physical, psychological, environmental, and fall prevention-related characteristics were surveyed using structured questionnaires to identify the risk factors for repeated falls. The use of antidepressants, depression score, and compliance with fall prevention behaviors were found to differ significantly between the two groups, and the use of antidepressants and depression were found to be significant predictors of repeated falls. Depression should be considered as a major variable when developing an algorithm to identify the risk of repeated falls among older adults living at home. Also, the practice of fall prevention behaviors was higher in the repeated-falls group, likely due to that group's efforts to prevent additional falls.
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Affiliation(s)
- Jae Soon Yoo
- Department of Nursing, Chungbuk National University, Cheongju, Korea
| | - Chul Gyu Kim
- Department of Nursing, Chungbuk National University, Cheongju, Korea
| | - Jong Eun Yim
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
| | - Mi Yang Jeon
- College of Nursing, Institute of Health Science, Gyeongsang National University, Jinju, Korea
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