A comparison of different balance tests in the prediction of falls in older women with vertebral fractures: a cohort study

Effects of home-based specific and comprehensive balance-training programs on balance and functional status in healthy older adults

OBJECTIVE

The elderly population is increasing worldwide, and the decline in physical function resulting from this is a critical issue that, especially, leads to a disorder of balance. To investigate the effect of home-based specific and comprehensive balance training on balance and functional status in older adults.

METHODS

Forty elderly men were randomized to conditions specific (n = 13) and comprehensive (n = 14) balance training or control (n = 13). The exercises were performed individually at each subject's home three times a week for ten weeks. The BESTest total and subsection scores, Activities-specific Balance Confidence (ABC) score, gait speed, timed-up-and-go (TUG), and functional gait assessment were evaluated at baseline, immediately after training and at 4-week follow-up.

RESULTS

After the intervention, both intervention groups showed more significant improvements than the control group in all variables except section II of BESTest. At follow-up, significantly more gains than control were observed in all variables except section II of BESTest in the specific group and sections II and III in the comprehensive group.

CONCLUSIONS

Our findings provide evidence that these home-based balance training regimens can enhance balance and functional status in aged individuals. Therefore, at present, because of the coronavirus disease 19 stay-at-home restrictions, it seems that these interventions are applicable strategies for the elderly when access to facilities or opportunities for physical activity outside the home is restricted for all ages, especially the elderly.

Fitness vs. fatness as determinants of survival in non-institutionalized older adults: The EXERNET multi-center study

BACKGROUND

Physical fitness and body composition are important health indicators, nevertheless their combined pattern inter-relationships and their association with mortality are poorly investigated.

METHODS

This longitudinal study is part of the Spanish EXERNET-Elder project. Person-months follow-up were calculated from the interview date, performed between June 2008 and November 2009, until date of death or censoring on March 2018 (whichever came first). In order to be included, participants had to fulfill the following criteria: 1) be over 65 years old, 2) live independently at home, 3) not suffer dementia and/or cancer and 4) have a BMI above 18.5. Body fat and weight were assessed by a bioelectrical impedance analyzer. Fitness was measured with the Senior Fitness and the one leg static balance tests. The Spanish Death Index was consulted for the death's identification. Cluster analysis was performed to identify Fat-Fit patterns and traditional cut points and percentiles to create the Fat-Fit groups. Cox proportional hazards regression models were used to calculate the hazard ratios of death in clustered Fat-Fit patterns and in traditional Fat-Fit groups.

RESULTS

A total of 2299 older adults (76.8% of women) were included with a baseline mean age of 71.9 ± 5.2 years. A total of 196 deaths (8.7% of the sample) were identified during the 8 years of follow up. Four clustered Fat-Fit patterns (Low fat-Fit, Medium fat-Fit, High fat-Unfit and Low fat-Unfit) and nine traditional Fat-Fit groups emerged. Using the Low fat-Fit pattern as the reference, significantly increased mortality was noted in High fat-Unfit (HR: 1.68, CI: 1.06 - 2.66) and Low fat-Unfit (HR: 2.01, CI: 1.28 - 3.16) groups. All the traditional Fit groups showed lower mortality risk when compared to the reference group (obese-unfit group).

CONCLUSIONS

Physical fitness is a determinant factor in terms of survival in community-dwelling older adults, independently of adiposity levels.

Timed Up and Go (TUG) Reference Values and Predictive Cutoffs for Fall Risk and Disability in Singaporean Community-Dwelling Adults: Yishun Cross-Sectional Study and Singapore Longitudinal Aging Study

OBJECTIVES

The "timed up and go" (TUG) test is a simple and widely used test of overall functional mobility. There is a paucity of TUG normative data among Asian individuals who differ in habitual gait speed and fall risk from Western population. The objectives of this study were to determine TUG reference values and optimum cutoffs predicting prevalent and incident disability for community-dwelling adults.

DESIGN

One cross-sectional (Study 1-Yishun Study) and one longitudinal (Study 2-Singapore Longitudinal Aging Study) study in Singapore.

SETTING AND PARTICIPANTS

Study 1 comprised 538 nondisabled, community-dwelling adults aged between 21 and 90 years. Study 2 comprised 1356 community-dwelling older adults aged ≥55 years followed for 3 years.

METHODS

Study 1 collected TUG reference values and assessed physiological fall risk (PFR) using the Physiological Profile Assessment (PPA). Study 2 assessed association of TUG with disability with the Barthel Index and the Lawton scale at baseline and follow-up.

RESULTS

From Study 1, mean TUG time for individuals aged 60 to 74 years was 9.80 seconds, shorter than values reported for Westerners of 12.30 seconds. It was significantly associated with high PFR [odds ratio (OR) 1.14, 95% confidence interval (CI) 1.03-1.27], 74.0% agreement, Cohen's kappa = 0.314 (95% CI 0.238-0.390); area under the curve = 0.85 (95% CI 0.80-0.90). A TUG cutoff of 10.2 seconds discriminated high PFR from low PFR with 84.4% sensitivity and 72.6% specificity. In Study 2, the threshold for observing significantly increased risk of disability was ≥9.45 seconds for prevalent disability (OR 2.98, 95% CI 1.41-6.78), functional decline (OR 2.68, 95% CI 1.33-5.80), and incidental disability (OR 2.25, 95% CI 1.08-4.97).

CONCLUSIONS AND IMPLICATIONS

TUG reference values and cutoff predicting disability for community-dwelling older adults in Singapore are consistent with Asian data and lower than for Western individuals. TUG could be used to guide development and evaluation of risk screening of adverse health outcomes across the life span in Singapore.

The Effect of Unsupervised Home-Based Exercise Training on Physical Functioning Outcomes in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Exercise training such as balance, aerobic, and resistance training is able to improve physical functioning of older adults. Delivering such exercise regimes at home without supervision may be useful for older adults because they do not have to leave their homes.

OBJECTIVE

This systematic review and meta-analysis of randomized controlled trials aimed to establish the effect of unsupervised home-based exercise training regimes on physical functioning (balance and muscle strength) in older adults.

DATA SOURCES

PubMed, CINAHL, Medline, Google Scholar, and Scopus databases and reference lists of included investigations were searched.

STUDY SELECTION

Thirteen randomized controlled trials (RCTs) of exercise training impact on balance and upper body strength with concurrent control groups were included in the analysis.

RESULTS

Our analyses revealed that in older adults, unsupervised home-based various exercise training was effective in improving measures of proactive balance (mean difference (MD) = -1.37 s; 95% confidence interval (CI), -2.24, -0.51 s; p = 0.002) and balance test battery (MD: 1.80; 95% CI, 0.46, 3.14 s; p = 0.009). There were no significant differences between the experimental and control groups for upper body strength (p > 0.05).

CONCLUSION

Unsupervised home-based exercise training improves balance in older adults. Future investigations are needed to clarify the mechanisms underlying unsupervised home-based exercise training's effect on this population's physical functioning outcomes.

Prediction of Functional Limitations in Balance after Tests of Tandem Walking and Standing Balance in Older Adults

OBJECTIVE

Older adults who may not complain of balance problems may nevertheless be developing subtle balance problems that may affect future functioning. This study sought to determine whether subtle problems could be predicted by standard balance testing.

METHODS

At the geriatric medicine clinic at an academic tertiary-care center, geriatricians referred 27 people who were ambulatory without gait aids and had no apparent neurologic or musculoskeletal impairments affecting their balance or gait performance. Initially, subjects were screened with some questions about vertigo, tests of standing balance on foam with eyes closed (Romberg tests) with head still, and head nodding (pitch) and shaking (yaw) at 0.3 Hz, and tandem walking with eyes closed (TW). Approximately 2 years later, 22 subjects were available to be rescreened.

RESULTS

At the second test date subjects' scores declined slightly but significantly on all three variations of the Romberg tests: with head still, head pitch, and head yaw, P ≥ 0.02, but TW did not change significantly. TW was the best predictor of balance performance; the lowest-scoring subjects at the second test used a cane, had undergone hip surgery, or were scheduled for hip surgery: sensitivity 1.0, specificity 0.84. The second-best predictor was Romberg on foam with eyes closed and head still.

CONCLUSIONS

The data suggest that some older adults may have subtle musculoskeletal impairments that may be indicated by simple balance tests. A finding on these tests may indicate the need for further workup for balance-related problems. These quick, inexpensive tests can be administered by ancillary staff and may add important information to the initial visit and annual follow-up visits.

Association between ground reaction force in sit-to-stand motion and falls in community-dwelling older Japanese individuals

OBJECTIVES

Ground reaction force (GRF) during sit-to-stand motion is associated with lower extremity strength and balance function. The relationship between GRF and experience of falls has been reported; however, there are no reports on whether GRF can predict the incidence of future falls. We aimed to evaluate the ability of GRF to predict falls and compare GRF with existing predictors.

METHODS

This prospective observational cohort study enrolled 456 community-dwelling older adults living in Itabashi ward who participated in health check-ups in 2016 and 2017. Participants' physical and cognitive functions were assessed, and the maximum GRF (F), F/weight (F/W), rate of force development (RFD), RFD/W (RFD/weight), and time taken to stand up were evaluated. The following year, participants were asked to report the number of falls during the year. Cox proportional hazards regression was conducted to analyze the relationship between the lowest quintile of each GRF parameter as a predictive factor for falling and assess the annual incidence of falls.

RESULTS

Twenty-three participants reported having two or more falls in the previous year. Of all GRF parameters evaluated, only F/W was lower in the fallers than in the non-fallers. After adjusting for sex, age, lifestyle, and comorbidities, F/W was associated with falls in 1 year, and the lowest F/W group had higher risks of falls than the highest F/W group (hazard ratio 2.72, 95 % confidence interval 1.11-6.68). Other measures were not associated with falls.

CONCLUSIONS

GRF during the sit-to-stand motion might predict the incidence of future falls.

Modified Timed Up and Go Test for Tendency to Fall and Balance Assessment in Elderly Patients With Gait Instability

Objective: To compare the results from the modified Timed Up and Go Test (TUG) with posturographic variables, the subjective perception of disability due to gait instability, and the number of falls in a sample of the elderly population with imbalance, to confirm that the TUG Test is a useful clinical instrument to assess the tendency to fall in individuals of this age group.

Materials and Methods: Cross-sectional study conducted in a tertiary university hospital, in 174 people aged 65 years or older with gait instability. Modified TUG Test was performed; time, step count and the need for support during the test were the analyzed variables. They were compared with the number of falls, Computerized Dynamic Posturography scores, and questionnaires scores (Dizziness Handicap Inventory and a shortened version of the Falls Efficacy Scale-International).

Results: The average time to complete the TUG Test was 21.24 ± 8.18 s, and the average step count was 27.36 ± 7.93. One hundred two patients (58.6%) required no support to complete the test, whereas the other 72 (41.4%) used supports. The time taken to complete the Test was significantly related with having or not having fallen in the previous year, with the scores of the questionnaires, and with various parameters of dynamic posturography. A higher percentage of patients who took more than 15 s had fallen in the previous year than those who took up to 15 s to complete the test [P = 0.012; OR = 2.378; 95% CI (1.183, 4.780)]. No significant correlation was found between the step count and the number of falls in the previous year, with falling during the test or not, or with being a single or a frequent faller. No relation was found between the need for supports and the number of falls, with having or not having fallen in the previous year, or with being a single or frequent faller.

Conclusion: The modified TUG Test is in relation with the presence or absence of falls. Time is the essential parameter for analyzing the risk of falling and the 15-s threshold is a good value to differentiate elderly patients at high risk of falling.

Unique Identifier: NCT03034655, www.clinicaltrials.gov.

Vertebral fractures and their association with health-related quality of life, back pain and physical function in older women

Studies investigating prevalent vertebral fracture (VF) diagnosed using densitometry-based VF assessment (VFA) and associations with physical function, assessed by performance-based measures, are lacking. In this population-based study of 1027 older women, we found that prevalent VF, identified by VFA, was associated with inferior physical health, back pain and inferior physical function.

PURPOSE

Several studies have investigated the associations between health-related quality of life (HRQL) and back pain with prevalent VF, detected by spine radiographs, but just a few have been population-based and have used vertebral fracture assessment (VFA) for diagnosing VF. The aims of this study were to investigate associations between prevalent VF, detected by VFA, with HRQL, back pain and physical function, and investigate if also mild VFs were associated with these clinical parameters.

METHODS

One thousand twenty-seven women aged 75-80 years participated in this population-based cross-sectional study. VF was identified by VFA using dual-energy X-ray absorptiometry. HRQL was assessed by SF-12, back pain during the past 12 months using a questionnaire, and physical function was tested with one leg standing (OLS), Timed Up and Go (TUG), walking speed, 30-s chair stand test and maximum grip strength.

RESULTS

Physical health (Physical Component Summary, PCS), derived from SF-12, was worse (43.5 ± 11.3 vs. 46.2 ± 10.5, p < 0.001) and back pain more frequent in women with any VF than in women without (69.0 vs. 59.9%, p = 0.008). PCS and physical function (OLS, 30-s chair stand test), were significantly worse for mild VF compared to no VF (43.8 ± 10.9 vs. 46.2 ± 10.5, p < 0.001, 12.7 ± 9.9 vs. 15.3 ± 10.4 s, p = 0.038, 10.7 ± 3.2 vs. 11.4 ± 3.4 times, p = 0.021, respectively). In multivariable adjusted linear regression models, VF prevalence was associated with PCS (β = - 0.079, p = 0.007), TUG (β = 0.067, p = 0.021), walking speed (β = - 0.071, p = 0.009) and 30-s chair stand test (β = - 0.075, p = 0.012).

CONCLUSIONS

In conclusion, prevalent VF, diagnosed by VFA, was associated with inferior physical health, back pain and inferior physical function, indicating VFA is useful for diagnosing clinically relevant vertebral fractures. Also, mild VF was associated with inferior physical health and inferior physical function.

Timed up and go test combined with self-rated multifactorial questionnaire on falls risk and sociodemographic factors predicts falls among community-dwelling older adults better than the timed up and go test on its own

BACKGROUND

Early detection of falls risk among older adults using simple tools may assist in fall prevention strategies. The aim of this study was to identify the best parameters associated with previous falls, either the timed up and go (TUG) test combined with sociodemographic factors and a self-rated multifactorial questionnaire (SRMQ) on falls risk or the TUG on its own. Falls risk was determined based on parameters associated with previous falls.

DESIGN

This was a retrospective cohort study.

SETTING

The study was conducted in a community setting.

PARTICIPANTS

The participants were 1,086 community-dwelling older adults, with mean age of 69.6±5.6 years. Participants were categorized into fallers and nonfallers based on their history of falls in the past 12 months.

METHOD

Participants' sociodemographic data was taken, and SRMQ consisting of five falls-related questions was administered. Participants performed the TUG test twice, and the mean was taken as the result.

RESULTS

A total of 161 participants were categorized as fallers (14.8%). Multivariate logistic regression analysis showed that the model (χ2(6)=61.0, p<0.001, Nagelkerke R2=0.10) consisting of the TUG test, sociodemographic factors (gender, cataract/glaucoma and joint pain), as well as the SRMQ items "previous falls history" (Q1) and "worried of falls" (Q5), was more robust in terms of falls risk association compared to that with TUG on its own (χ2(1)=10.3, p<0.001, Nagelkerke R2=0.02).

CONCLUSION

Combination of sociodemographic factors and SRMQ with TUG is more favorable as an initial falls risk screening tool among community-dwelling older adults. Subsequently, further comprehensive falls risk assessment may be performed in clinical settings to identify the specific impairments for effective management.

Experimental Validation of Depth Cameras for the Parameterization of Functional Balance of Patients in Clinical Tests

In clinical practice, patients’ balance can be assessed using standard scales. Two of the most validated clinical tests for measuring balance are the Timed Up and Go (TUG) test and the MultiDirectional Reach Test (MDRT). Nowadays, inertial sensors (IS) are employed for kinematic analysis of functional tests in the clinical setting, and have become an alternative to expensive, 3D optical motion capture systems. In daily clinical practice, however, IS-based setups are yet cumbersome and inconvenient to apply. Current depth cameras have the potential for such application, presenting many advantages as, for instance, being portable, low-cost and minimally-invasive. This paper aims at experimentally validating to what extent this technology can substitute IS for the parameterization and kinematic analysis of the TUG and the MDRT tests. Twenty healthy young adults were recruited as participants to perform five different balance tests while kinematic data from their movements were measured by both a depth camera and an inertial sensor placed on their trunk. The reliability of the camera’s measurements is examined through the Interclass Correlation Coefficient (ICC), whilst the Pearson Correlation Coefficient (r) is computed to evaluate the correlation between both sensor’s measurements, revealing excellent reliability and strong correlations in most cases.

Mobility and Muscle Strength Together are More Strongly Correlated with Falls in Suburb-Dwelling Older Chinese

Falls are common in older adults and result in adverse outcomes. Impaired mobility and poor muscle strength have been consistently identified as the main contributors to falls. We choose three easy-to-perform tests (i.e. Timed Up and Go test (TUGT), walking speed (WS) and grip strength (GS)) in order to assess mobility and muscle strength to further define their relationship with falls. This study is cross-sectional, consisting of 1092 residents over 60-year-old; 589 were female. 204 (18.68%) participants reported falling at least once in the past year. It was found that, of the three tests evaluated independently, a TUGT < 9.1750 s had the strongest association with fewer falls. When evaluating these tests as pairs, the combination of a TUGT < 9.1750 s and a WS < 0.9963 m/s was the best protective indicator of falls after adjusting for age, sex and other variables. When evaluating all three tests in conjunction with each other, the combination of a TUGT < 9.1750 s, a WS < 0.9963 m/s, and a GS > 0.3816 was most correlated with less possibility of falls. The combination of a better TUGT performance, a stronger GS, and a slower WS is the most strongly correlated with less possibility of falls.

Evaluation of Timed Up and Go Test as a tool to measure postoperative function and prediction of one year walking ability for patients with hip fracture

Objective:

To evaluate if the Timed Up and Go Test is a useful tool to measure postoperative function and to predict one-year results of rehabilitation in patients operated owing to hip fracture.

Design:

Prospective cohort study.

Setting:

The department of orthopaedic surgery at five hospitals in Norway. Patients were assessed five days postoperatively and after one year.

Subjects:

A total of 684 patients over 60 years with trochanteric or subtrochanteric hip fractures were included. A total of 171 (25%) patients died within a year and 373 (73% of patients still alive) attended follow-up one year after surgery.

Main measures:

Timed Up and Go Test and walking ability.

Results:

A total of 258 (38%) patients passed the postoperative Timed Up and Go Test. A total of 217 (56%) patients with a prefracture independent outdoor walking ability, passed the test. The average Timed Up and Go Test score was 71 seconds. A total of 171 (25%) patients could not rise from a chair without assistance; 8% of the patients with cognitive impairment, and 8% of those admitted from nursing homes, were able to pass the postoperative Timed Up and Go Test. The sensitivity and specificity of the Timed Up and Go Test in predicting walking ability one year after the operation were low. At one year follow-up, 38% of the patients not able to perform the postoperative Timed Up and Go Test, passed the test. A total of 81 (21%) patients did not use any walking-aid, 17 of them did not pass the postoperative Timed Up and Go Test.

Conclusion:

The Timed Up and Go Test performed the fifth postoperative day was not a suitable tool to assess functional mobility for the majority of the patients with hip fractures in our study. Neither was the postoperative Timed Up and Go Test a suitable tool to predict the walking ability one year after the operation.

Can we predict the risk of falls in elderly patients with instability?

OBJECTIVE

The aim of this study is to determine whether clinical and instrumental examination of balance can predict the risk of falls in elderly patients with instability.

METHODS

STUDY DESIGN

It is a case control study, with cases defined by falls in the last year, developed in a third level university hospital.

PATIENTS

Seventy patients aged 65 years or more who met at least one of the following inclusion criteria: (a) at least one fall in the last year; (b) spend more than 15s during the timed up and go test (TUG); (c) a score of less than 68% average balance in the sensory organisation test (SOT) of the computerised dynamic posturography (CDP); or (d) at least one fall in the CDP-SOT.

INTERVENTION

TUG test, CDP-SOT, CDP centre of gravity balancing (CG) and limits of stability (LOS), Dizziness Handicap Inventory (DHI) test and short FES-I test.

MAIN OUTCOME MEASURES

Number of steps and time (TUG), average balance and use of sensorial information (CDP-SOT), speed and directional control (CDP-CG and LOS), DHI score and short FES-I score.

RESULTS

Comparing subjects without falls (non-fallers) vs subjects with at least one fall (fallers) in the last year, fallers obtain worse scores than non-fallers in condition 2 (p=0.043) and use of somatosensory information (p=0.039). Comparing subjects with five falls or less (non-multiple-fallers) vs subjects with more than five falls (multiple-fallers), multiple-fallers obtain worse scores than non-multiple-fallers in overall balance (p=0.023), condition 6 (p=0.036), directional control (swaying (p=0.006) and LOS (p=0.023)) and short FES-I score (p=0.007).

CONCLUSION

The three most useful parameters for identifying unstable elderly patients at particularly high risk of repeated falls are mean balance in the CDP SOT, directional control of CDP LOS and short FES-I score.

Postoperative prevention of falls in older adults with fragility fractures

The postoperative period after correction of a fragility fracture is usually associated with functional deconditioning. This deconditioning is caused by multiple factors associated with a higher risk of falls during the immediate postoperative period and after discharge. Identification of risk and appropriate fall prevention interventions in these patients are pivotal. In this article, an overview is presented of the strategies to identify falls risk in postoperative patients after suffering a fragility fracture. Evidence is presented favoring targeted multicomponent intervention for falls prevention rather than a single intervention in fractured older patients at high risk of new falls and fractures.

Effect of Posture Training with Weighted Kypho-Orthosis (WKO) on Improving Balance in Women with Osteoporosis

Objectives. To determine the effect of weighted kypho-orthosis (WKO) on improving balance in women with osteoporosis. In this nonrandomized controlled clinical trial, 31 patients with osteoporosis were included. The patients were assigned to two groups: (1) control group who received 4-week home-based daily exercise program including weight bearing, back strengthening, and balance exercises and (2) intervention group (WKO) who performed aforementioned exercises and wore WKO for one hour twice a day. Patients were assessed using clinical balance tests (timed up and go test, functional reach test, and unilateral balance test) before and 4 weeks after start of treatment. Results. Functional reach and timed up and go test were improved significantly in both groups compared to baseline. The improvement in intervention group was more significant in comparison to control group (P < 0.05). Discussion. Posture training with WKO together with exercise program improved two clinical balance tests in women with osteoporosis. Conclusion. Posture training support (PTS) applied as WKO together with back extension exercises can be prescribed as an intervention in elderly women in order to reduce the risk of falling.

Men older than 50 yrs are more likely to fall than women under similar conditions of health, body composition, and balance

OBJECTIVE

The aim of this study was to analyze the contribution of sex to the occurrence of falls, accounting for comorbidities and differences in physical fitness.

DESIGN

This was a cross-sectional study of 587 community-dwelling adults who were older than 50 yrs. Falls, comorbidities (number of diseases and physical impairments), and physical fitness (body composition, lower and upper body strength and flexibility, agility, aerobic endurance, and balance) were evaluated via questionnaires, bioimpedance, and Fullerton batteries, respectively.

RESULTS

Compared with the men, the women presented a 10% higher fall prevalence, 1.7 more diseases/impairments, 10% more body fat, 26% less lean body mass, and poorer physical capacity (P < 0.05). Multivariate logistic regression revealed that male sex (odds ratio [OR], 2.723; 95% confidence interval [CI], 1.190-6.230) increased the likelihood of falling, after adjustment for comorbidities (OR, 1.213; 95% CI, 1.109-1.328), lean mass (OR, 0.958; 95% CI, 0.927-0.989), fat mass (OR, 1.053; 95% CI, 1.021-1.086), and balance (OR, 0.942; 95% CI, 0.914-0.971), which were the main risk factors of falls.

CONCLUSIONS

Women are more susceptible to falling, presumably because they have poorer health and physical fitness than do men. However, when the values for comorbidities, lean and fat body mass, and balance were similar, the men demonstrated a higher probability of falling. Age is not a significant risk factor of falls under favorable conditions of health, body composition, and balance.

Functional status and prevalence of falls and fractures in population-based sample of postmenopausal women from the RAC-OST-POL Study

BACKGROUND

Prevalence of osteoporotic fractures and falls, and functional status may be related with each other.

OBJECTIVE

The aim of the study was to assess functional status and prevalence of falls and fractures in Polish postmenopausal women in a representative, randomly selected population sample from RAC-OST-POL Study.

DESIGN

Population-based epidemiological study.

SETTING

Raciborz city and district, Poland.

PARTICIPANTS

The study included 618 postmenopausal women aged ≥ 55 years (mean age 66.3 ± 7.8 years).

MEASUREMENTS

Data concerning falls, fractures etc. were collected using on a questionnaire. Functional assessment was carried out using Instrumental Activity of Daily Living (IADL) Lawton's test and 'Stand up & go' (SUG) test. Skeletal status was assessed using DXA at the hip and with phalangeal quantitative ultrasound (QUS).

RESULTS

Fifty-six per cent of studied women have got a reduced mobility estimated using SUG test (time > 10 s). Functional independence level estimated using IADL test is reduced among 14% of women (≤ 23 points). Twenty-eight per cent of women sustained osteoporotic fracture and 34% of women have got a positive fall history in the last year. The number of falls or fractures correlates significantly with results of IADL and SUG tests. Functional status of women who fell or sustained fracture was significantly decreased in comparison with women without falls or fractures. The significant factors increasing the risk of fall are: presence of depression, presence of chronic disease and a reduced functional independence. The significant factors increasing the risk of fractures are: history of fall, age, T-score value for trochanter bone mineral density.

CONCLUSION

Results of the study indicate that functional status plays an important role as a factor increasing the risk of falls and fractures in postmenopausal women.

Hip fractures in persons with stroke

Background. Our aim was to determine the incidence of hip fractures within two years after stroke, to identify associated factors, to evaluate which test instruments that best could identify people at risk, and to describe the circumstances that prevailed when they sustained their hip fractures. Method. A total of 377 persons with first-ever stroke were followed up for a 24-month period. Stroke severity, cognition, and associated medical conditions were registered. The following test instruments were used: National Institutes of Health Stroke Scale, Mini-Mental State Examination, Berg Balance Scale, Timed Up & Go, and Stops Walking When Talking. Result. Sixteen of the persons fractured their hip within the study period, which corresponds to an incidence of 32 hip fractures per 1000 person-years. Persons with fractures more often had impaired vision and cognitive impairment and more had had previous fractures. Of the investigated test instruments, Timed Up & Go was the best test to predict fractures. Conclusion. The incidence of hip fractures in persons with stroke was high in this study. Persons with previous fractures, and visual and cognitive defects are at the greatest risk. Certain test instruments could be used in order to find people at risk, which should be targeted for fall preventive measures.

Sedative load among community-dwelling people aged 75 years or older: association with balance and mobility

Drugs with sedative properties are frequently used among older people. Sedative load is a measure of the cumulative effect of taking multiple drugs with sedative properties. The objective of this study was to investigate the association between sedative load and balance and mobility. A random sample of 1000 people 75 years or older was invited to participate. Seven hundred community-dwelling participants (mean age, 81.3 years; 69% women) were included in the present study. Demographic, diagnostic, and drug use data were elicited during nurse interviews in 2004. Balance and mobility were tested by physiotherapists. Sedative load was calculated using a previously published model for each participant by summing the sedative ratings of primary sedatives (rating 2) and drugs with sedation as a prominent adverse effect (rating 1). Analyses of covariance and logistic regression analyses were used to assess the association between sedative load and balance and mobility. Of the 700 participants, 21% (n = 147) had a sedative load of 1-2, and 8% (n = 58) had sedative load of 3 or greater. After adjusting for covariates, exposure to higher sedative load ranges was associated with slower walking speed (P = 0.0003), longer time to perform Timed Up and Go test (P = 0.005), and lower scores on Berg Balance Scale (P = 0.005), but not with self-reported ability to walk 400 m. In conclusion, having a higher sedative load was associated with impaired balance and mobility among community-dwelling older people. Clinicians should remain cognizant of this association and regularly reevaluate drug therapy prescribed to older people.

Timed Up and Go test and risk of falls in older adults: a systematic review

OBJECTIVE

To assess the association and the predictive ability of the Timed Up and Go test (TUG) on the occurrence of falls among people aged 65 and older.

METHODS

A systematic English Medline literature search was conducted on November 30, 2009 with no limit of date using the following Medical Subject Heading (MeSH) terms "Aged OR aged, 80 and over" AND "Accidental falls" combined with the terms "Timed Up and Go" OR "Get Up and Go". The search also included the Cochrane library and the reference lists of the retrieved articles.

RESULTS

Of the 92 selected studies, 11 met the selection criteria and were included in the final analysis. Fall rate ranged from 7.5 to 60.0% in the selected studies. The cut-off time separating non-fallers and fallers varied from 10 to 32.6 seconds. All retrospective studies showed a significant positive association between the time taken to perform the TUG and a history of falls with the highest odds ratio (OR) calculated at 42.3 [5.1 - 346.9]. In contrast, only one prospective study found a significant association with the occurrence of future falls. This association with incident falls was lower than in retrospective studies.

CONCLUSIONS

Although retrospective studies found that the TUG time performance is associated with a past history of falls, its predictive ability for future falls remains limited. In addition, standardization of testing conditions combined with a control of the significant potential confounders (age, female gender and comorbidities) would provide better information about the TUG predictive value for future falls in older adults.

Effects of an interactive computer game exercise regimen on balance impairment in frail community-dwelling older adults: a randomized controlled trial

BACKGROUND

Due to the many problems associated with reduced balance and mobility, providing an effective and engaging rehabilitation regimen is essential to progress recovery from impairments and to help prevent further degradation of motor skills.

OBJECTIVES

The purpose of this study was to examine the feasibility and benefits of physical therapy based on a task-oriented approach delivered via an engaging, interactive video game paradigm. The intervention focused on performing targeted dynamic tasks, which included reactive balance controls and environmental interaction.

DESIGN

This study was a randomized controlled trial.

SETTING

The study was conducted in a geriatric day hospital.

PARTICIPANTS

Thirty community-dwelling and ambulatory older adults attending the day hospital for treatment of balance and mobility limitations participated in the study.

INTERVENTIONS

Participants were randomly assigned to either a control group or an experimental group. The control group received the typical rehabilitation program consisting of strengthening and balance exercises provided at the day hospital. The experimental group received a program of dynamic balance exercises coupled with video game play, using a center-of-pressure position signal as the computer mouse. The tasks were performed while standing on a fixed floor surface, with progression to a compliant sponge pad. Each group received 16 sessions, scheduled 2 per week, with each session lasting 45 minutes.

MEASUREMENTS

Data for the following measures were obtained before and after treatment: Berg Balance Scale, Timed "Up & Go" Test, Activities-specific Balance Confidence Scale, modified Clinical Test of Sensory Interaction and Balance, and spatiotemporal gait variables assessed in an instrumented carpet system test.

RESULTS

Findings demonstrated significant improvements in posttreatment balance performance scores for both groups, and change scores were significantly greater in the experimental group compared with the control group. No significant treatment effect was observed in either group for the Timed "Up & Go" Test or spatiotemporal gait variables.

LIMITATIONS

The sample size was small, and there were group differences at baseline in some performance measures.

CONCLUSION

Dynamic balance exercises on fixed and compliant sponge surfaces were feasibly coupled to interactive game-based exercise. This coupling, in turn, resulted in a greater improvement in dynamic standing balance control compared with the typical exercise program. However, there was no transfer of effect to gait function.

Dynamic gait stability, clinical correlates, and prognosis of falls among community-dwelling older adults

OBJECTIVE

To establish an accurate measure for prognostic assessment of fall risk in community-dwelling older adults, this study examined the prediction accuracy of a dynamic gait stability measure and common clinical tests for slip-related falls among these adults.

DESIGN

Participants were tested for their fall-risk likelihood on a slip-test.

SETTING

Biomechanics research laboratory.

PARTICIPANTS

Community-dwelling older adults (N=119; ≥65y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants performed a battery of clinical tests, including Berg Balance Scale, Timed Up & Go (TUG) test, static posturography, isometric muscle strength, and bone density. They were then exposed to an unannounced slip during gait. The dynamic stability during unperturbed gait was measured based on the center of mass position and velocity relative to the limits of stability against backward falling. Accuracy of each measure was examined for prediction of slip outcome (fall or recovery).

RESULTS

On the slip, 59 participants fell, 56 recovered their balance, and 4 were harness-assisted. Dynamic stability predicted fall outcome with 69% accuracy. Except for TUG and bone density, no other measure could differentiate fallers from nonfallers; TUG predicted 56% of fall outcomes.

CONCLUSIONS

Reproduction of actual falls provides a new benchmark for evaluating the prognostic power of different performance-based assessment tools. The TUG was able to better predict fall outcome than other clinical measures; however, the new dynamic gait stability measure was more sensitive than TUG in its prediction of falls. Ultrasound bone scan could be used to screen older adults for fall risk.

The effect of 8 mos of twice-weekly low- or higher intensity whole body vibration on risk factors for postmenopausal hip fracture

OBJECTIVE

Whole body vibration is a potential therapy for age-related loss of musculoskeletal competence. Vibration has improved bone in animal models, but evidence in humans is limited. Relative efficacy of low- vs. high-intensity whole body vibration is also unknown. Our goal was to observe the effect of brief low- and higher intensity whole body vibration on risk factors for hip fracture in postmenopausal women.

DESIGN

We used an 8-mo randomized controlled trial design to examine the influence of twice-weekly low-intensity whole body vibration (15 mins, 30 Hz, 0.3 g) or higher intensity whole body vibration (2 × 3 mins, 12.5 Hz, 1 g) on anthropometrics, bone (whole body, hip, spine, forearm, and heel), muscle (wall squat and chair rise), and balance (tandem walk and single leg stance). Physical activity, daily calcium, and compliance were recorded. Effects were examined by repeated-measures analysis of covariance, controlling for age, height, weight, calcium, physical activity, compliance, and baseline values.

RESULTS

Forty-seven women (71.5 ± 9.0 yrs) completed the trial. There were no between-group differences in any measure at 8 mos, but within-group effects were evident. Controls lost bone at the trochanter (-6%, P = 0.03) and lumbar spine (-6.6%, P = 0.02), whereas whole body vibration groups did not. Whole body vibration subjects improved wall squat (up to 120%, P = 0.004) and chair rise performance (up to 10.5%, P = 0.05).

CONCLUSIONS

Eight mos of twice-weekly whole body vibration may reduce bone loss at the hip and spine and improve lower limb muscle function. These changes may translate to a decreased risk of falls and hip fracture.

Reference values for the Timed Up and Go test in healthy Japanese elderly people: determination using the methodology of meta-analysis

AIM

The purpose of this study was to determine the reference value for the Timed Up and Go test (TUG) in healthy Japanese elderly people using the methodology of meta-analysis, and to determine the value for different measurement protocols.

METHODS

Relevant research articles were identified from electronic databases: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Igaku-cyuouzasshi. The search was conducted from January 1991 to June 2010, and the terms "timed up and go" and "elderly" were used in combination in the search. Furthermore, the searches were limited to articles involving Japanese healthy elderly people aged 60years and older. Weighted means of TUG were calculated by a fixed effect model and a random effect model to estimate reference values. Furthermore, the 95% confidence interval (CI) for the weighted mean of TUG was also estimated.

RESULTS

Twelve studies fulfilled the inclusion criteria: eight provided data for maximum effort, and five provided data related to usual pace. When weighted means of TUG were estimated by the fixed effect model, there was significant heterogeneity. Therefore, a random effect model was used for re-estimation. As a result, the weighted mean of TUG with maximum effort was 6.60s (95% CI=6.18-7.02s), and that at usual pace was 8.86s (95% CI=7.99-9.72s).

CONCLUSION

The reference values of TUG in Japanese healthy elderly people calculated in this study are certainly shorter than in African-Americans and Caucasians. The reference values of TUG estimated by our study appear to be specific for healthy, elderly, Japanese people.

Is timed up and go better than gait speed in predicting health, function, and falls in older adults?

OBJECTIVES

To assess whether the Timed Up and Go (TUG) is superior to gait speed in predicting multiple geriatric outcomes.

DESIGN

Prospective cohort study.

SETTING

Medicare health maintenance organization and Veterans Affairs primary care clinics.

PARTICIPANTS

Adults aged 65 and older (N=457).

MEASUREMENTS

Baseline gait speed and TUG were used to predict health decline according to EuroQol and Medical Outcomes Study 36-item Short Form Survey (SF-36) global health; functional decline according to National Health Interview Survey (NHIS) activities of daily living (ADLs) score and SF-36 physical function index; hospitalization; and any falls and multiple falls over 1 year.

RESULTS

Mean age was 74, and 44% of participants were female. Odds ratios for all outcomes were equivalent for gait speed and TUG. Using area under the receiver operating characteristic curve of 0.7 or greater for acceptable predictive ability, gait speed and TUG each alone predicted decline in global health, new ADL difficulty, and falls, with no difference in predictive ability between performance measures. Neither performance measure predicted hospitalization, EuroQol decline, or physical function decline. As a continuous variable, TUG did not add predictive ability to gait speed for any outcome.

CONCLUSION

Gait speed predicts most geriatric outcomes, including falls, as does TUG. The time taken to complete TUG may not add to information provided by gait speed, although its qualitative elements may have other utility.

Relationship between dynamic balance measures and functional performance in community-dwelling elderly people

BACKGROUND

Poor balance control, mobility restrictions, and fall injuries are serious problems for many older adults.

OBJECTIVE

The purpose of this study was to evaluate a new dynamic standing balance assessment test for identifying individuals at risk for falling in a group of community-dwelling older adults.

DESIGN

This was a cross-sectional observational study of 72 community-dwelling older adults who were receiving rehabilitation in a geriatric day hospital.

METHOD

A Dynamic Balance Assessment (DBA) test protocol was developed based on the concept of the Sensory Organization Test and the Clinical Test of Sensory Interaction and Balance. The DBA consists of 6 tasks performed on a normal floor surface and repeated on a sponge surface. A flexible pressure mat was used to record the foot's center of pressure (COP) on both surfaces, and loss of balance was recorded. Balance performance also was evaluated using the Berg Balance Scale, the Timed "Up & Go" Test, gait speed, and the Six-Minute Walk Test. Participants were classified as "fallers" or "nonfallers" based on a self-report.

RESULTS

No significant differences were noted between the faller group (n=47) and the nonfaller group (n=25) for demographic variables or medications. The DBA composite scores, which were derived from analysis of COP excursions of the 6 tasks performed on the sponge surface, were able to distinguish between fallers and nonfallers. Of the clinical tests, only the Timed "Up & Go" Test was able to differentiate between the faller and nonfaller groups. Limitations A prospective study is needed to confirm the current findings and to expand testing to a larger and more diverse sample.

CONCLUSIONS

The findings indicate that analysis of the extent and amount of COP displacements during selected tasks and under different surface conditions is an appropriate method to assess dynamic standing balance controls and can discriminate between fallers and nonfallers among community-dwelling elderly people.

A simple clinical scale to stratify risk of recurrent falls in community-dwelling adults aged 65 years and older

BACKGROUND

Correct identification of people at risk for recurrent falls facilitates the establishment of preventive and rehabilitative strategies in older adults.

OBJECTIVE

The purposes of this study were: (1) to develop and validate a simple clinical scale to stratify risk for recurrent falls in community-dwelling elderly people based on easily obtained social and clinical items and (2) to evaluate the added value of 3 clinical balance tests in predicting this risk.

DESIGN

This was a prospective measurement study.

METHODS

A population of 1,618 community-dwelling people over 65 years of age underwent a health checkup, including performance of 3 clinical balance tests: the One-Leg-Balance Test, the Timed "Up & Go" Test, and the Five-Times-Sit-to-Stand Test. Falls were recorded using a self-administered questionnaire that was completed a mean (SD) of 25+/-5 months after the visit. Participants were randomly divided into either group A (n=999), which was used to develop the scale, or group B (n=619), which was used to prospectively validate the scale.

RESULTS

Logistic regression analysis identified 4 variables that independently predicted recurrent falls in group A: history of falls, living alone, taking >or=4 medications per day, and female sex. Thereafter, 3 risk categories of recurrent falls (low, moderate, and high) were determined. Predicted probability of recurrent falls increased from 4.1% to 30.1% between the first and third categories. This scale subsequently was validated with great accuracy in group B. Only the Five-Times-Sit-to-Stand Test provided added value in the estimation of risk for recurrent falls, especially for the participants who were at moderate risk, in whom failure on the test (duration of >15 seconds) doubled the risk.

LIMITATIONS

Falls were assessed only once, and length of follow-up was heterogeneous (18-36 months).

CONCLUSIONS

Clinicians could easily classify older patients in low-, moderate-, or high-risk groups of recurrent falls by using 4 easy-to-obtain items. The Five-Times-Sit-to-Stand Test provides added value to stratify risk for falls in people at moderate risk.

The relationship between physical performance measures, bone mineral density, falls, and the risk of peripheral fracture: a cross-sectional analysis

BACKGROUND

Several factors, in addition to low bone mineral density (BMD), have been identified as risks for fractures, including reduced levels of physical activity, poor balance and low physical performance. The aim of this study was to evaluate the relationship between physical performance measures, BMD, falls, and the risk of peripheral fracture in a population sample of Moroccan women.

METHODS

484 healthy women were included. Three measures were used to assess physical performance: timed get-up-and-go test 'TGUGT', five-times-sit-to-stand test '5 TSTS' and 8-feet timed walk '8 FTW'. The association between physical performance measures and BMD, peripheral fracture and falls was performed by univariate and multivariate analysis.

RESULTS

The mean age was 55.1 years. Higher 'TGUGT', '5 TSTS', '8 FTW' test scores were associated with lower BMD measured at different sites (p range from < 0.001 to 0.005). The relationship between the three tests and BMD in all measured sites remained significant after multiple linear regression (p range from <0.001 to 0.026). In the group of post-menopausal patients, the scores of 'TGUGT' and '8 FTW' were significantly higher in fractured patients compared with patients without. After logistic regression, a score of 'TGUGT' > 14.2 sec, a score of '5 TSTS' > 12.9 sec and a score of '8 FTW' > 4.6 sec respectively, increased the probability of anterior peripheral fracture by 2.7, 2.2 and 2.3 (OR = 2.7; 95% CI = 1.2-6.4, OR = 2.2; 95% CI = 1.1-5.2; and OR = 2.3; 95% CI = 1.1-5.1). There was a significant positive correlation between the number of fall/year and the 3 tests. This correlation persisted after poisson regression.

CONCLUSION

This study suggested that low physical performance is associated with low BMD, and a high risk of history of falls and fractures.

The Lausanne cohort Lc65+: a population-based prospective study of the manifestations, determinants and outcomes of frailty

Background

Frailty is a relatively new geriatric concept referring to an increased vulnerability to stressors. Various definitions have been proposed, as well as a range of multidimensional instruments for its measurement. More recently, a frailty phenotype that predicts a range of adverse outcomes has been described. Understanding frailty is a particular challenge both from a clinical and a public health perspective because it may be a reversible precursor of functional dependence. The Lausanne cohort Lc65+ is a longitudinal study specifically designed to investigate the manifestations of frailty from its first signs in the youngest old, identify medical and psychosocial determinants, and describe its evolution and related outcomes.

Methods/Design

The Lc65+ cohort was launched in 2004 with the random selection of 3054 eligible individuals aged 65 to 70 (birth year 1934–1938) in the non-institutionalized population of Lausanne (Switzerland). The baseline data collection was completed among 1422 participants in 2004–2005 through questionnaires, examination and performance tests. It comprised a wide range of medical and psychosocial dimensions, including a life course history of adverse events. Outcomes measures comprise subjective health, limitations in activities of daily living, mobility impairments, development of medical conditions or chronic health problems, falls, institutionalization, health services utilization, and death. Two additional random samples of 65–70 years old subjects will be surveyed in 2009 (birth year 1939–1943) and in 2014 (birth year 1944–1948).

Discussion

The Lc65+ study focuses on the sequence "Determinants → Components → Consequences" of frailty. It currently provides information on health in the youngest old and will allow comparisons to be made between the profiles of aging individuals born before, during and at the end of the Second World War.

Vitamin D receptor polymorphisms and falls among older adults living in the community: results from the ilSIRENTE study

Vitamin D receptor (VDR) genotypes were associated with cognitive status, depressive symptoms, strength, and sarcopenia, but, thus far, no study has assessed their relationship with falls. The objective of this study is to evaluate whether, in a population of older adults living in the community, VDR FokI and BsmI genotypes are associated with falls. To this aim, we used data from the baseline evaluation of the ilSIRENTE study, which enrolled older adults >or= 80 yr of age living in the community in Italy. Falls occurring within 90 days of assessment were assessed by study personnel. The mean age of 259 study participants was 85.0 +/- 4.5 (SD) yr; 172 (66.4%) were women. Overall, 33 (12.7%) participants reported one or more falls. The rate of falls was 19.5% in participants with the BB genotype, 11.1% in those with Bb genotype, and 5.9% in those with bb genotype (p for linear trend = 0.02). After adjusting for potential confounders, compared with participants with the BB genotype, those with the bb genotype had a significantly lower OR for falls 0.14 (95% CI, 0.03-0.66). Rate of falls did not differ significantly across FokI genotypes (FF: 14.4%, Ff: 11.9%, ff: 9.1%; p = 0.43). In conclusion, the VDR bb genotype of the BsmI gene is associated with a reduced rate of falls compared with the BB genotype, whereas no effect on falls was shown for FokI polymorphism. Further studies conducted in larger population are needed to confirm the association of BsmI genotype and falls and to understand reasons for these findings.