Physical factors underlying the association between lower walking performance and falls in older people: a structural equation model

Differences in Improvement of Physical Function in Older Adults with Long-Term Care Insurance with and without Falls: A Retrospective Cohort Study

(1) Background: This study examined the differences in changes in physical function with and without falls after daycare use among frail older adults with long-term care insurance (LTCI). (2) Methods: In this retrospective cohort study, 82 of 96 consecutive daycare center users met the inclusion criteria. The participants were divided into two groups based on the presence or absence of falls 6-12 months after use. Participant characteristics in the fall and non-fall groups and physical function at baseline and six months in each group were compared. Using analysis of covariance, we analyzed physical function and its changes between the two groups, and cut-off values were calculated using receiver operating characteristic curves. (3) Results: Gait speed, timed up-and-go test, and 30 s chair stand test (CS30) improved significantly over six months in the no-fall group (n = 70) and all participants (n = 82) (p < 0.01). Gait speed in the fall group (n = 12) improved significantly over six months (p = 0.04). The fall group had significantly lower adjusted ΔCS30 scores than the no-fall group (p = 0.03), with a cutoff value of 2 (p = 0.024). (4) Conclusions: In older adults with LTCI, physical function with and without falls after daycare use differed by ΔCS30, with a cutoff value of 2.

Anthropometric Measures, Muscle Resistance, and Balance in Physically Active, Aged Adults

OBJECTIVES

This study aimed to examine the relationship between age, body mass index, muscle strength, and balance in physically active, aged adults.

METHODS

Eighty-five participants were recruited for this study, having an average age of 70.31 years (SD = 9.90), ranging from 50 to 92 years. Twenty-six (30.6%) participants were male and fifty-nine (69.4%) were female. The participants had an average body mass index of 27.30 kg/m² (SD = 3.62), ranging from 20.32 to 38.58 kg/m². Participants undertook the Timed-Up and Go to test balance, and the chair-stand test to assess lower body strength. Hierarchical regression analyses were conducted. Three models (Model 1, 2, and 3) were tested to assess their relationships with balance: M1-Lower body muscle strength; M2-Lower body muscle strength and body mass index; M3-Lower body muscle strength, body mass index, and age.

RESULTS

All hierarchical models displayed significant variance. The third model explained 50.9% of the variance in dynamic balance, [F(3, 81) = 27.94, p < 0.001, R = 0.71, R_a² = 0.51]. The difference in R_a² between the first, second, and third models was statistically significant (p < 0.05). Age, body mass index, and lower body muscle strength had significant (p < 0.05) correlations with balance. In terms of the significant impact of each predictor, age had the strongest association with balance (p < 0.05).

CONCLUSIONS

The results are useful to understand mechanisms or diagnose people at risk of fall.

Effects of Muscle Strength, Agility, and Fear of Falling on Risk of Falling in Older Adults

Falls are a major public health problem among older adults because they lead to premature mortality, loss of autonomy, and increased dependence on others. However, these associations have not been explored using procedures that analyze the sequential effects between risk factors of falling. The present study aimed to examine the effects of muscle strength, agility, and fear of falling on risk of falling using path analysis in community-dwelling older adults. In total, 49 elderly (female = 33, male = 16) participants aged between 65 and 76 years (M = 68.38 years; SD = 6.22) were included for analysis. Muscle strength, agility, fear of falling, and risk of falling were assessed using validated instruments for the older adult population. The proposed model shows that muscle strength was negatively associated with agility. Consequently, agility was negatively associated with fear of falling. The same trend appeared between fear of falling and risk of falling. The effect sizes were between small and medium for agility (R² = 0.16), fear of falling, (R² = 0.29), and risk of falling (R² = 0.03). The main finding of the present study was that muscle strength was significantly correlated with agility, which, in turn, predicted fear of falling. Consequently, lower scores for fear of falling explained lower risk of falling in community-dwelling older adults. While muscle strength is a crucial component of physical fitness, only with adequate levels of agility can older adults possess the efficacy and ability to perform daily tasks.

Gait evaluation in stroke hemiplegic patients using short physical performance battery

OBJECTIVES

Falls can occur daily in stroke patients and appropriate independence assessments for fall prevention are required. Although previous studies evaluated the short physical performance battery (SPPB) in stroke patients, the relationship between SPPB and fall prediction and walking independence remains unclear. Therefore, we aimed to verify whether SPPB is a predictor of walking independence.

MATERIALS AND METHODS

The present study included 105 hemiplegic stroke patients who were admitted to the rehabilitation ward and gave consent to participate. Cross-sectional physical function and functional independence measure cognitive (FIM-C) evaluation were conducted in hemiplegic stroke patients. Logistic regression analysis using the increasing variable method (likelihood ratio) was performed to extract factors for walking independence. Cutoff values were calculated for the extracted items using the receiver operating-characteristic (ROC) curve.

RESULTS

Among 86 participants included in the final analysis, 36 were independent walkers and 50 were dependent walkers. In the logistic regression analysis, SPPB and FIM-C were extracted as factors for walking independence. The cutoff value was 7 [area under the curve (AUC), 0.94; sensitivity, 0.83; specificity, 0.73)] for SPPB and 32 (AUC, 0.83; sensitivity, 0.69; specificity, 0.57) for FIM-C in ROC analysis CONCLUSIONS: SPPB and FIM-C were extracted as factors for walking independence. Although SPPB alone cannot determine independent walking, combined assessment of SPPB with cognitive function may enable more accurate determination of walking independence.

A systematic review of one-legged balance performance and falls risk in community-dwelling adults

OBJECTIVE

The aim of this systematic review was to synthesise all published evidence on associations between one-legged balance performance and falls.

METHODS

Medline, EMBASE, CINAHL and Web of Science were systematically searched (to January 2021) to identify peer-reviewed, English language journal articles examining the association between one-legged balance performance and falls in community-dwelling adults.

RESULTS

Of 4310 records screened, 55 papers were included (n = 36954 participants). There was considerable heterogeneity between studies including differences in study characteristics, ascertainment of balance and falls, and analytical approaches. A meta-analysis of the time that individuals could maintain the one-legged balance position indicated that fallers had worse balance times than non-fallers (standardised mean difference: -0.29 (95%CI:-0.38,-0.20) in cross-sectional analyses; -0.19 (-0.28, -0.09) in longitudinal analyses), although there was no difference in the pooled median difference. Due to between-study heterogeneity, regression estimates between balance and fall outcomes could not be synthesised. Where assessed, prognostic accuracy indicators suggested that one-legged balance was a poor discriminator of fall risk; for example, 5 of 7 studies demonstrated poor prognostic accuracy (Area Under the Curve <0.6), with most studies demonstrating poor sensitivity.

CONCLUSIONS

This systematic review identified 55 papers that examined associations between balance and fall risk, the majority in older aged adults. However, the evidence was commonly of low quality and results were inconsistent. This contradicts previous perceptions of one-legged balance as a useful fall risk tool and highlights crucial gaps that must be addressed in order to translate such assessments to clinical settings.

Rejuvenation of standing and gait balance in community-dwelling older individuals: A comparative study between 2006 and 2019

AIM

The present study investigated the rejuvenation of physical function in terms of walking speed and grip strength. Specifically, it examined the rejuvenation of physical functions in community-dwelling older individuals between 2006 and 2019. The study is novel, because it analyzes this by focusing on gait balance.

METHODS

Data were collected from 339 participants (52 men, 287 women) in 2006, and 382 participants (83 men, 299 women) in 2019. They were categorized according to age: early-stage and late-stage groups for men, and early-stage, late-stage and latest-stage groups for women. These groups were analyzed by participants' walking speed, grip strength, Timed Up and Go test, Functional Reach test and One-Leg Standing test. The results were compared based on two factors: time (2006 to 2019) and age group.

RESULTS

The scores for the Timed Up and Go and One-Leg Standing tests were better in 2019 than in 2006 for all age groups in both older men and women. However, improvement in walking speed was observed only in women. Additionally, the decline in physical function with age was slower for walking speed among men, and Functional Reach and One-Leg Standing tests among women.

CONCLUSIONS

The changes over this 13-year period showed that the physical function of community-dwelling older individuals was rejuvenated in terms of improved standing and walking balance. These rejuvenations will aid in preventing falls among community-dwelling older individuals. Geriatr Gerontol Int 2021; 21: 975-980.

Cognitive and motor slowing mediate the relationship between depression and falls in multiple sclerosis patients

OBJECTIVE

Given the limited research concerning the relationship between depression and falls in multiple sclerosis (MS), this study aimed to examine the direct and indirect association between fall history and depressive symptoms.

METHODS

One hundred and forty seven MS patients had completed at least one neuropsychological assessment that included detailed information regarding fall history, as well as measures of depression, motor function, and cognitive processing speed.

RESULTS

Fall history was associated with higher depressive symptoms and poorer overall motor function. Higher self-reported depressive symptoms were associated with higher odds of falls in the last year (OR = 1.64, 95% CI 1.16, 2.31) in an age adjusted model. Cognitive and motor slowing serially mediated the relationship between depressive symptoms and fall history (estimate = 0.060, 95% CI = 0.01, 0.15).

CONCLUSIONS

With the extensive research on the cognitive and motor correlates of falls in MS, our findings suggest that depressive symptoms are also associated with falls in people with MS. Moreover, this study provides preliminary support for a pathway by which depressive symptoms are related to falls in part through their relationships with cognitive and motor slowing.

Reliability, validity and minimal detectable change of 2-min walk test and 10-m walk test in frail older adults receiving day care and residential care

BACKGROUND

The psychometric properties of the 2-min walk test (2MWT) and 10-m walk test (10MeWT) for frail older adults are unclear.

AIMS

To determine the test-retest and inter-rater reliability, construct and known-group validity, and minimal detectable change at 95% level of confidence (MDC₉₅) of these walk tests in frail older adults receiving day care and residential care services.

METHODS

A cross-sectional study with repeated measures was conducted on frail older adults who could walk independently for at least 15 m. The participants completed the 2MWT and 10MeWT on three separate occasions over a 2-week period under two independent assessors.

RESULTS

Forty-four frail older adults were examined. Excellent test-rest (ICC = 0.95-0.99) and inter-rater reliability (ICC = 0.95-0.97) were shown in both walk tests. Good to strong correlations were found between the walk tests and 6-min walk test (r = 0.89-0.92), Elderly Mobility Scale (r = 0.56-0.57), Berg Balance Scale (r = 0.66-0.66) and Modified Barthel Index (r = 0.55-0.59). The MDC₉₅ were 7.7 m in the 2MWT and 0.13 m/s in the 10MeWT.

DISCUSSION

Although the walking performances of the day care and residential care participants were similar, the validity of the walk tests was different between these two subgroups.

CONCLUSIONS

The 2MWT and 10MeWT are reliable and valid measures in evaluating the walking performances of frail older adults. The MDC₉₅ of the walk tests has been recommended.

Multifactorial Assessment of Risk of Falling in 753 Post-Menopausal Women: A Multicenter Cross-Sectional Study by the Italian Group for the Study of Metabolic Bone Diseases

OBJECTIVE

To assess physical performance, number of falls, previous fragility fractures, and ongoing pharmacological therapy in a cohort of post-menopausal women, according to their risk of falling.

METHODS

In this multicenter cross-sectional study, we recruited in a 3-year period (May 2016 to April 2019), women aged >60 years referred to seven Osteoporosis and Bone Metabolism Outpatient Services of the Italian Group for the Study of Metabolic Bone Diseases. The study population was divided into three groups according to the risk of falling, assessed through the Elderly Fall Screening Test (EFST): low risk (EFST score=0-1); moderate risk (EFST=2-3); high risk (EFST=4-5). Outcome measures were: 4-meter gait speed (4MGS); unipedal stance time (UST); number of falls in the previous year; previous fragility fractures; ongoing pharmacological therapy.

RESULTS

We analyzed 753 women (mean aged 70.1±9.2 years): 378 (50.2%) at low risk of falling, 247 (32.8%) at moderate risk, and 128 (17.0%) at high risk. 4MGS and UST resulted as pathological in the 93.9% and 99.2%, respectively, of women at high risk. There were significant differences among groups for both outcomes (p<0.001). There was also a significant difference among groups (p<0.001) in terms of previous falls and fragility fractures. Lastly, there were significant differences (p<0.05) among groups in using antihypertensive drugs, antiplatelet agents, anticoagulants, antidepressants, anti-osteoporotic drugs, and vitamin D, and/or calcium supplementation.

CONCLUSION

Physical performance, prevalence of falls and fragility fractures, and an assessment of pharmacological therapy should be investigated in post-menopausal women because of their significant correlation with risk of falling.

Falls in institutionalized elderly with and without cognitive decline A study of some factors

Falls in long-stay institutions for elderly people have a high prevalence, contributing to the physical and mental deterioration of institutionalized elderly.

Objective

To determine the prevalence of falls among institutionalized elderly with and without cognitive decline, and to characterize the practices and behaviors of those with and without cognitive decline in managing fall risks, and relate them to some factors.

Methods

The present correlational study was carried out with a sample of 204 institutionalized elderly, 50% of whom had cognitive decline.

Results

The elderly with cognitive decline (40.2%) fell less often than those who did not have cognitive decline (42.2%) (p>0.05). Safety practices and behaviors were better in the elderly with cognitive decline (p<0.05). Most of the elderly with cognitive decline who fell took benzodiazepines (65.9%), in contrast with those without cognitive decline (32.2%). It was observed that 81.4% of the elderly without cognitive decline and 43.9% of those with cognitive decline who fell had a performance of over 12 seconds on the Timed Up and Go Test, where differences reached statistical significance in both groups of elderly.

Conclusion

Data collected in the present study further the knowledge on risk factors in the genesis of falls and on the behavior of elderly with and without cognitive decline in maintaining their safety in self-care and accessibility.

Associations Between Types of Balance Performance in Healthy Individuals Across the Lifespan: A Systematic Review and Meta-Analysis

Background: The objective of this systematic review and meta-analysis was to quantify and statistically compare correlations between types of balance performance in healthy individuals across the lifespan. Methods: Literature search was performed in the electronic databases PubMed, Web of Science, and SPORTDiscus. Studies were included if they investigated healthy individuals aged ≥6 years and reported measures of static/dynamic steady-state, proactive, and/or reactive balance. The included studies were coded as follows: age group, gender, and balance type, test, parameter. Pearson's correlation coefficients were extracted, transformed (i.e., Fisher's z-transformed r _z -value), aggregated (i.e., weighted mean r _z -value), back-transformed to r-values, classified according to their magnitude, and statistically compared. The methodological quality of each study was assessed using the Appraisal tool for Cross-Sectional Studies. Results: We detected twenty-six studies that examined associations between types of balance and exclusively found small-sized correlations, irrespective of the age group considered. More specifically, the weighted mean r _z-values amounted to 0.61 (back-transformed r-value: 0.54) in old adults for the correlation of dynamic steady-state with proactive balance. For correlations between dynamic and static steady-state balance, the weighted mean r _z-values amounted to 0.09 in children (r-value: 0.09) and to 0.32 in old adults (r-value: 0.31). Further, correlations of proactive with static steady-state balance revealed weighted mean r _z-values of 0.24 (r-value: 0.24) in young adults and of 0.31 (r-value: 0.30) in old adults. Additionally, correlations between reactive and static steady-state balance yielded weighted mean r _z-values of 0.21 (r-value: 0.21) in young adults and of 0.19 (r-value: 0.19) in old adults. Moreover, significantly different correlation coefficients (z = 8.28, p < 0.001) were only found for the association between dynamic and static steady-state balance in children (r = 0.09) compared to old adults (r = 0.31). Lastly, we detected trivial to considerable heterogeneity (i.e., 0% ≤ I² ≤ 83%) between studies. Conclusions: Our systematic review and meta-analysis showed exclusively small-sized correlations between types of balance performance across the lifespan. This indicates that balance performance seems to be task-specific rather than a "general ability." Further, our results suggest that for assessment/training purposes a test battery/multiple exercises should be used that include static/dynamic steady-state, proactive, and reactive types of balance. Concerning the observed significant age differences, further research is needed to investigate whether they are truly existent or if they are caused by methodological inconsistencies.

Associations of total amount and patterns of objectively measured sedentary behavior with performance-based physical function

Although greater sedentary time has been found to be associated with negative health impacts, little is known whether the specific pattern of sedentary behavior (i.e. sedentary bouts, breaks and durations) are associated with physical function among older adults. The present study examined the associations between objectively measured sedentary behavior and physical function among older Japanese adults. A total of 174 male and 107 female community-dwelling older Japanese adults aged 65–84 years (mean age: 74.5 ± 5.2 years) were recruited. Sedentary behavior and physical activity were assessed using a triaxial accelerometer. Physical function was measured through hand grip strength, eye-open one leg standing, 5-m walking, and timed up and go tests. Forced-entry multiple linear regression models adjusted for potential confounders were performed. After adjustment, total daily sedentary time and duration of prolonged sedentary bouts (both ≥ 30 min) were positively associated with time spent on the 5-m walking stage and timed up and go tests in older women; however, no significant associations were observed in older men or the whole sample. This paper highlights the importance of developing sedentary behavior change strategies for interventions aiming to improve mobility in in older women. Further evidence from a prospective study is required to establish directions of causality between sedentary behavior and mobility.

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This study used triaxial accelerometers and standardized physical fitness tests.

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Total daily sedentary time was negatively associated with mobility in older women.

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Duration of prolonged sedentary bouts was negatively related to mobility in older women.

Test timed up and go and its correlation with age and functional exercise capacity in asymptomatic women

Abstract Introduction: The Timed Up and Go test (TUG) is widely used and valid in chronic patients, but rarely addressed in asymptomatic individuals. Objective: To assess the reliability, the age-related changes and the correlation between TUG and the Functional Exercise Capacity (FEC) adjusted for non-institutionalized middle-aged and elderly women. Methods: Ninety-eight women (57 ± 10 years) were selected and stratified into age groups. We have performed the tests TUG, Berg Balance Scale (BBS) and evaluation of usual gait speed (UGS). Fifty-eight participants (57 ± 10 years) also performed incremental shuttle walk test (ISWT). Results: Worse performance in TUG (p < 0,05) for participants aged ≥ 70 years for age groups 40-49 and 50-59 years. The reliability of TUG was excellent between the first and second TUG (intraclass correlation coefficient, 0.933; confidence interval of 95%, from 0.901 to 0.955) and between the second and third TUG (0.958, 0.938 to 0.972). The group of 58 participants who underwent further the ISWT, TUG correlated significantly (p <0.05) with ISWT (r = -0.72), VUM (r = -0.54) and BBS (r= 0.58). A multiple linear regression analysis selected TUG (R2 = 0.517) and VUM (R2 = 0.083) as determinants of FEC. Conclusion: TUG adapted for asymptomatic women is reliable and able to assess the decline of physical mobility with advancing age and it also crucial to the FEC.

A Preliminary Study on the Efficacy of a Community-Based Physical Activity Intervention on Physical Function-Related Risk Factors for Falls Among Breast Cancer Survivors

OBJECTIVE

The aim of this study was to examine the effects of a 6-week community-based physical activity (PA) intervention on physical function-related risk factors for falls among 56 breast cancer survivors (BCS) who had completed treatments.

DESIGN

This was a single-group longitudinal study. The multimodal PA intervention included aerobic, strengthening, and balance components. Physical function outcomes based on the 4-meter walk, chair stand, one-leg stance, tandem walk, and dynamic muscular endurance tests were assessed at 6-week pre-intervention (T1), baseline (T2), and post-intervention (T3). T1 to T2 and T2 to T3 were the control and intervention periods, respectively.

RESULTS

All outcomes, except the tandem walk test, significantly improved after the intervention period (P < 0.05), with no change detected after the control period (P > 0.05). Based on the falls risk criterion in the one-leg stance test, the proportion at risk for falls was significantly lower after the intervention period (P = 0.04), but not after the control period.

CONCLUSIONS

A community-based multimodal PA intervention for BCS may be efficacious in improving physical function-related risk factors for falls, and lowering the proportion of BCS at risk for falls based on specific physical function-related falls criteria. Further larger trials are needed to confirm these preliminary findings.

Associations of low-intensity light physical activity with physical performance in community-dwelling elderly Japanese: A cross-sectional study

Background

Physical activity and physical performance relate to quality of life, mortality, and morbidity in elderly people. However, little is known about differences in physical performance related to low-intensity light physical activity (LLPA), high-intensity light physical activity (HLPA), and moderate-intensity physical activity (MPA) and how they are separated by sex in elderly populations.

Aims

This study aimed to determine differences in LLPA, HLPA, MPA, and physical performance, and associations between these measures in community-dwelling elderly men and women.

Methods

Physical activity and physical performance such as timed-up-and-go test, one-leg standing time, and maximum gait speed were measured in 181 community-dwelling elderly men (mean age, 75.1 ± 5.3 years) and 109 women (mean age, 73.4 ± 4.8 years) in 2013. Physical activity was classified as LLPA (1.6~1.9 METs of physical activity), HLPA (2.0~2.9 METs of physical activity), and MPA (over 3 METs of physical activity). The association between the values of these three intensities of physical activity in the participants was assessed by Pearson’s correlation coefficients. Multiple linear regression analyses were used to assess the association of physical performance values with the three groups defined by accelerometer-measured physical activity intensity adjusted for sociographic, behavioral, and multiple diseases in the participants.

Results

MPA was beneficially associated with all physical performance indicators in the men (all P<0.05) and women (all P<0.05). Only HLPA showed significant associations with the timed-up-and-go test (P = 0.001) and maximum gait speed (P = 0.006) in women.

Discussion

These results may support the notion that not only HLPA in women but MPA in both sexes appears to improve physical performance in elderly populations.

Conclusion

The present study findings provide novel epidemiological evidence for the potential benefits of HLPA in women and also reinforce the potential benefits of MPA in both sexes, which is the mainstay of public health recommendations.

Associations Between Measures of Balance and Lower-Extremity Muscle Strength/Power in Healthy Individuals Across the Lifespan: A Systematic Review and Meta-Analysis

BACKGROUND

It has frequently been reported that balance and lower-extremity muscle strength/power are associated with sports-related and everyday activities. Knowledge about the relationship between balance, strength, and power are important for the identification of at-risk individuals because deficits in these neuromuscular components are associated with an increased risk of sustaining injuries and falls. In addition, this knowledge is of high relevance for the development of specifically tailored health and skill-related exercise programs.

OBJECTIVES

The objectives of this systematic literature review and meta-analysis were to characterize and, if possible, quantify associations between variables of balance and lower-extremity muscle strength/power in healthy individuals across the lifespan.

DATA SOURCES

A computerized systematic literature search was performed in the electronic databases PubMed, Web of Science, and SPORTDiscus up to March 2015 to capture all relevant articles.

STUDY ELIGIBILITY CRITERIA

A systematic approach was used to evaluate the 996 articles identified for initial review. Studies were included only if they investigated healthy individuals aged ≥6 years and tested at least one measure of static steady-state balance (e.g., center of pressure [CoP] displacement during one-legged stance), dynamic steady-state balance (e.g., gait speed), proactive balance (e.g., distance in the functional-reach-test), or reactive balance (e.g., CoP displacement during perturbed one-legged stance), and one measure of maximal strength (e.g., maximum voluntary contraction), explosive force (e.g., rate of force development), or muscle power (e.g., jump height). In total, 37 studies met the inclusionary criteria for review.

STUDY APPRAISAL AND SYNTHESIS METHODS

The included studies were coded for the following criteria: age (i.e., children: 6-12 years, adolescents: 13-18 years, young adults: 19-44 years, middle-aged adults: 45-64 years, old adults: ≥65 years), sex (i.e., female, male), and test modality/outcome (i.e., test for the assessment of balance, strength, and power). Studies with athletes, patients, and/or people with diseases were excluded. Pearson's correlation coefficients were extracted, transformed (i.e., Fisher's z-transformed r z value), aggregated (i.e., weighted mean r z value), back-transformed to r values, classified according to their magnitude (i.e., small: r ≤ 0.69, medium: r ≤ 0.89, large: r ≥ 0.90), and, if possible, statistically compared. Heterogeneity between studies was assessed using I2 and Chi-squared (χ2) statistics.

RESULTS

Three studies examined associations between balance and lower-extremity muscle strength/power in children, one study in adolescents, nine studies in young adults, three studies in middle-aged adults, and 23 studies in old adults. Overall, small-sized associations were found between variables of balance and lower-extremity muscle strength/power, irrespective of the age group considered. In addition, small-sized but significantly larger correlation coefficients were found between measures of dynamic steady-state balance and maximal strength in children (r = 0.57) compared with young (r = 0.09, z = 3.30, p = 0.001) and old adults (r = 0.35, z = 2.94, p = 0.002) as well as in old compared with young adults (z = 1.95, p = 0.03).

LIMITATIONS

Even though the reported results provided further insight into the associations between measures of balance and lower-extremity muscle strength/power, they did not allow us to deduce cause and effect relations. Further, the investigated associations could be biased by other variables such as joint flexibility, muscle mass, and/or auditory/visual acuity.

CONCLUSIONS

Our systematic review and meta-analysis showed predominately small-sized correlations between measures of balance and lower-extremity muscle strength/power in children, adolescents, and young, middle-aged, and old adults. This indicates that these neuromuscular components are independent of each other and should therefore be tested and trained complementarily across the lifespan. Significantly larger but still small-sized associations were found between measures of dynamic steady-state balance and maximal strength in children compared with young and old adults as well as in old compared with young adults. These findings imply that age/maturation may have an impact on the association of selected components of balance and lower-extremity muscle strength.

Factors Associated with the Risk of Falls of Nursing Home Residents Aged 80 or Older

BACKGROUND

Falls are the leading cause of mortality and morbidity in older and represents one of the major and most costly public health problems worldwide.

PURPOSE

Evaluate the influences of lower limb muscle performance, static balance, functional independence and quality of life on fall risk as assessed with the timed up and go (TUG) test.

DESIGN

Cross-sectional study.

METHODS

Fifty-two residents aged 80 or older were assessed and distributed in one of the two study groups (no risk of falls; risk of falls) according to the time to complete the TUG test. A Kistler force platform and linear transducer was used to determinate lower limb muscle performance. Postural Stability (static balance) was measured by recording the center of pressure. The EuroQol-5 dimension was used to assess Health-related quality of life and the Barthel index was used to examine functional status. Student's t-test was performed to evaluate the differences between groups. Correlations between variables were analyzed using Spearman or Pearson coefficient. ROC (receiver operating charasteristic) analysis was used to determine the cut-off points related to a decrease in the risk of a fall.

FINDINGS

Participants of no-fall risk group showed better lower limb performance, quality of life, and functional status. Cut-off points were determined for each outcome.

CONCLUSIONS

Risk of falls in nursing home residents over the age of 80 is associated with lower limb muscle performance, functional status, and quality of Life.

CLINICAL RELEVANCE

Cut-off points can be used by clinicians when working toward fall prevention and could help in determining the optimal lower limb muscle performance level for preventing falls.

Measurement of gait speed in older adults to identify complications associated with frailty: A systematic review

Several frailty screening tests in older cancer patients were developed but their statistical performance is low. We aimed to assess whether measurement of usual gait speed (GS) alone could be used as a frailty screening test in older cancer patients. This systematic review was conducted on "pub med" between 1984 and 2014 and included reviews and original studies. Eligibility criteria were: GS over a short distance, alone or included in composite walking tests (Timed Get Up and Go test: TGUG, Short Physical Performance Battery: SPPB) in older people (aged 65 and over) living in a community setting and predictive value of GS on medical complications associated with frailty. 46 articles were finally selected. GS alone is consensual and recommended for screening sarcopenia in elderly. A slow GS is predictive of early death, disability, falls and hospitalization/institutionalization in older people living in a community setting. GS alone is comparable to composite walking tests that do not provide additional information on the medical complications associated with frailty. Despite few studies in geriatric oncology, GS seems to predict overall survival and disability. We suggest GS over 4m (at a threshold of 1m/s) as a new frailty screening test in older cancer patients (65 and over) to guide the implementation of a comprehensive geriatric assessment during the initial management phase or during follow-up. Prospective cohort studies are needed to validate this algorithm and compare it with other screening tool.

Stability of daily home-based measures of postural control over an 8-week period in highly functioning older adults

PURPOSE

The focus of this study was to monitor daily objective measures of standing postural control over an 8-week period, recorded in a person's home, in a population of healthy older adults. Establishing natural patterns of variation in the day-to-day signal, occurring in the relative absence of functional decline or disease, would enable us to determine thresholds for changes in postural control from baseline that could be considered clinically important.

METHODS

Eighteen community-dwelling older adults (3 M, 15 F, 72 ± 6 years) participated in a home-based trial where each day they were asked to complete a technology-enabled routine consisting of a short questionnaire, as well as a quiet standing balance trial. Centre of pressure (COP) excursions were calculated over the course of each daily balance trial to generate variables such as postural sway length and mean sway frequency.

RESULTS

The data demonstrated large differences between subjects in centre of pressure measures (coefficients of variation ranging 37-107 %, depending on the variable). Each participant also exhibited variations in their day-to-day trials (e.g. coefficients of variation across 8 weeks ranging ~17-56 %, within person for mean COP distance). Inter- and intra-subject differences were not strongly related to functional tests, suggesting that these variations were not necessarily aberrant movement patterns, but are seemingly representative of natural movement variability.

CONCLUSIONS

The idea of applying a group-focused approach at an individual level may result in misclassifying important changes for a particular individual. Early detection of deterioration can only be achieved through the creation of individual trajectories for each person, that are inherently self referential.

Sensitivity and specificity of the minimal chair height standing ability test: a simple and affordable fall-risk screening instrument

BACKGROUND AND PURPOSE

Fall-risk screening instruments have been underutilized in clinical settings because of their lengthy administration time, need of cumbersome equipment, and lack of validation. The primary objective of this study was to assess the validity (sensitivity and specificity) of the Minimal Chair Height Standing Ability Test (MCHSAT). The secondary objective was to develop guidelines to provide physical therapists with best-practice recommendations that can easily be implemented in clinical practice.

METHODS

A retrospective cohort study design was used in which falling history, major medical conditions, cognitive status (Mini-Mental State Examination), and level of independence (Independent Activities of Daily Living) were obtained for 167 community-dwelling older adults (mean age = 83.6 ± 7.3 years), residents of British Columbia, Canada. Participants MCHSAT performance was assessed using a chair whose seat height was modifiable by increments of 5 cm, starting at 47 cm and lowering after each successful attempt. Sensitivity and specificity of the MCHSAT at each chair height were calculated and plotted as a receiver operating characteristic curve. A model to identify participants with history of falls was developed using a forward logistic regression (Wald).

RESULTS

Mean MCHSAT performance (cm) was significantly better for participants without history of falls (30.3 cm, 95% CI: 28.1-32.5 cm) than for those with history of falls (37.7 cm, 95% CI: 35.5-40.0 cm) and was the single risk factor associated with fall status (β= 1.087, P < .001). The optimal MCHSAT performance for identifying participants with history of falls was 34 cm (AUC = 0.72, 95% CI: 0.63-0.82). At this threshold, sensitivity and specificity values were 75% and 62%, respectively.

DISCUSSION

Using 34 cm as the optimal performance, the MCHSAT correctly identified 75% of participants with history of falls and 62% of participants without history of falls. This provides evidence that the MCHSAT is a valid screening tool for use with an older Canadian population.

CONCLUSION

As a simple and inexpensive testing instrument, the MCHSAT has potential to enhance the care of our elderly population, improve an understanding of patients' fall-risk status, and substantially reduce fall-related costs to the health care system.

Association between Short Physical Performance Battery and falls in older people: the Progetto Veneto Anziani Study

It is known that weakness in the lower limbs is associated with recurrent falls in old people. Among the tests routinely used to assess lower extremity strength, the Short Physical Performance Battery (SPPB) is one of those used most often, but its relationship with recurrent falls is poorly investigated. We aimed to determine if SPPB scores are related to recurrent falling in a sample of 2710 older-aged people, and to ascertain which test in the SPPB is most strongly associated with a higher rate of falls. In this cross-sectional study, we demonstrated that participants scoring 0-6 in the SPPB were more likely to be recurrent fallers than those scoring 10-12 (odds ratio [OR]=3.46, 95% confidence interval [CI] 2.04-5.88 in women; OR=3.82, 95% CI 1.77- 8.52, in men). SPPB scores of 7-9 were only associated with women being more likely to be recurrent fallers (OR=2.03, 95% CI 1.28-3.22). When the SPPB items were analyzed separately, even a lower score in gait speed for women was significantly associated with the presence of recurrent falls (OR=2.11; 95% CI 1.04-4.30), whereas in men only a significant increase in the time taken to complete the five timed chair stands test was associated with a higher rate of falls (OR=2.75; 95% CI 1.21-6.23). In conclusion, our study demonstrated that SPPB scores ≤6 are associated with a higher fall rate in old people of both genders; in females, even an SPPB score between 7 and 9 identifies subjects at a higher likelihood of being recurrent fallers. Among the single items of the SPPB, the most strongly associated with falls were gait speed in women and the five timed chair stands test in men.

Revisão de dois instrumentos clínicos de avaliação para predizer risco de quedas em idosos

Introdução: Quedas são um problema clínico comum nos idosos, que pode reduzir sua mobilidade e independência. O uso de instrumentos simples para detecção do risco de quedas é fundamental para prevenção e tratamento de tais eventos. Não há, porém, consenso quanto aos testes mais adequados para cada situação. Objetivo: Revisar estudos sobre eficácia, sensibilidade e especificidade dos testes Timed Up and Go Test e Berg Balance Scale, a fim de verificar qual é o mais apropriado para predizer quedas em idosos. Métodos: Realizou-se revisão bibliográfica nas bases de dados MEDLINE, PubMed, ISI, LILACS e Portal de Periódicos CAPES, entre os anos de 2001 e 2011. Resultados: Foram selecionados 37 artigos, sendo 17 sobre a Berg Balance Scale e 20 sobre o Timed Up and Go Test. A revisão mostrou que os dois testes podem ser bons preditores de quedas, mas os artigos diferiram quanto à definição de queda e caidor, tipo de estudo, quantidade e característica da amostra e avaliação de quedas, levando a diferentes resultados quanto a nota de corte, sensibilidade, especificidade e predição de quedas. Há controvérsias quanto à capacidade de predição em perfis específicos, como os idosos ativos. Conclusão: Os testes avaliados são eficazes para predição de quedas, desde que adaptados para cada perfil. Novos estudos devem ser realizados com metodologia homogênea, a fim de favorecer a comparação de resultados sobre a eficácia desses testes.

Physical predictors of cognitive performance in healthy older adults: a cross-sectional analysis

There is ample evidence that physical and cognitive performance are related, but the results of studies investigating this relationship show great variability. Both physical performance and cognitive performance are constructs consisting of several subdomains, but it is presently unknown if the relationship between physical and cognitive performance depends on subdomain of either construct and whether gender and age moderate this relationship. The aim of this study is to identify the strongest physical predictors of cognitive performance, to determine the specificity of these predictors for various cognitive subdomains, and to examine gender and age as potential moderators of the relationship between physical and cognitive performance in a sample of community-dwelling older adults. In total, 98 men and 122 women (average age 74.0±5.6 years) were subjected to a series of performance-based physical fitness and neuropsychological tests. Muscle strength, balance, functional reach, and walking ability (combined score of walking speed and endurance) were considered to predict cognitive performance across several domains (i.e. memory, verbal attention, visual attention, set-shifting, visuo-motor attention, inhibition and intelligence). Results showed that muscle strength was a significant predictor of cognitive performance for men and women. Walking ability and balance were significant predictors of cognitive performance for men, whereas only walking ability was significant for women. We did not find a moderating effect of age, nor did we find support for a differential effect of the physical predictors across different cognitive subdomains. In summary, our results showed a significant relationship between cognitive and physical performance, with a moderating effect of gender.

Measurement of accelerometry-based gait parameters in people with and without dementia in the field: a technical feasibility study

BACKGROUND

Gait analyses are an important tool to diagnose diseases or to measure the rehabilitation process of patients. In this context, sensor-based systems, and especially accelerometers, gain in importance. They are able to improve objectiveness of gait analyses. In clinical settings, there is usually a supervisor who gives instructions to the patients, but this can have an influence on patients' gait. It is expected that this effect will be smaller in field studies.

OBJECTIVE

Aim of this study was to capture and evaluate gait parameters measured by a single waist-mounted accelerometer during everyday life of subjects.

METHODS

Due to missing ground-truth in unsupervised conditions, another external criterion had to be chosen. Subjects of two different groups were considered: patients with dementia (DEM) and active older people (ACT). These groups were chosen, because of the expected difference in gait. The idea was to quantify the expected difference of accelerometric-based gait parameters. Gait parameters were e.g. velocity, step frequency, compensation movements, and variance of the accelerometric signal.

RESULTS

Ten subjects were measured in each group. The number of walking episodes captured was 1,187 (DEM) vs. 1,809 (ACT). The compensation and variance parameters showed an AUC value (Area Under the Curve) between 0.88 and 0.92. In contrast, velocity and step frequency performed poorly (AUC values of 0.51 and 0.55). It was possible to classify both groups using these parameters with an accuracy of 89.2%.

CONCLUSION

The results showed a much higher amount of walking episodes in field studies compared to supervised clinical trials. The classification showed a high accuracy in distinguishing between both groups.

Development of an orthosis for walking assistance using pneumatic artificial muscle: a quantitative assessment of the effect of assistance

In recent years, there is an increase in the number of people that require support during walking as a result of a decrease in the leg muscle strength accompanying aging. An important index for evaluating walking ability is step length. A key cause for a decrease in step length is the loss of muscle strength in the legs. Many researchers have designed and developed orthoses for walking assistance. In this study, we advanced the design of an orthosis for walking assistance that assists the forward swing of the leg to increase step length. We employed a pneumatic artificial muscle as the actuator so that flexible assistance with low rigidity can be achieved. To evaluate the performance of the system, we measured the effect of assistance quantitatively. In this study, we constructed a prototype of the orthosis and measure EMG and step length on fitting it to a healthy subject so as to determine the effect of assistance, noting the increase in the obtained step length. Although there was an increase in EMG stemming from the need to maintain body balance during the stance phase, we observed that the EMG of the sartorius muscle, which helps swing the leg forward, decreased, and the strength of the semitendinosus muscle, which restrains the leg against over-assistance, did not increase but decreased. Our experiments showed that the assistance force provided by the developed orthosis is not adequate for the intended task, and the development of a mechanism that provides appropriate assistance is required in the future.