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Taylor ME, Kerckhaert L, Close JCT, van Schooten KS, Lord SR. The Impact of Misaligned Perceived and Objective Fall Risk in Cognitively Impaired Older People. J Alzheimers Dis 2024:JAD240489. [PMID: 39031366 DOI: 10.3233/jad-240489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
Background Cognitive impairment (CI) may impair the ability to accurately perceive physical capacity and fall risk. Objective We investigated perceived (measured as concern about falls) and physiological fall risk in community-dwelling older people with CI, the characteristics of the aligned and misaligned groups and the impact of misaligned perceptions on falls. Methods Participants (n= 293) with mild-moderate CI were classified into four groups based on validated physiological and perceived fall risk assessments: 1) vigorous: low perceived and physiological fall risk; 2) anxious: high perceived and low physiological fall risk; 3) unaware: low perceived and high physiological fall risk; and 4) aware: high perceived and physiological fall risk. Groups were compared with respect to neuropsychological and physical function, activity and quality of life measures, and prospective falls (12-months). Results The anxious (IRR = 1.70, 95% CI = 1.02-2.84), unaware (IRR = 2.00, 95% CI = 1.22-3.26), and aware (IRR = 2.53, 95% CI = 1.67-3.84) groups had significantly higher fall rates than the vigorous group but fall rates did not significantly differ among these groups. Compared with the vigorous group: the anxious group had higher depression scores and reduced mobility and quality of life; the unaware group had poorer global cognition, executive function and mobility and lower physical activity levels; and the aware group had an increased prevalence of multiple physical and cognitive fall risk factors. Conclusions Fall rates were increased in participants who had increased perceived and/or physiological fall risk. Contrasting fall risk patterns were evident in those who under- and over-estimated their fall risk. Understanding these characteristics will help guide fall risk assessment and prevention strategies in community-dwelling older people with CI.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Ageing Futures Institute, UNSW Sydney, Sydney, Australia
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Luuk Kerckhaert
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Kimberley S van Schooten
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Ageing Futures Institute, UNSW Sydney, Sydney, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
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Lee SC, Tzeng IS, Feng CT, Liang HW, Chien TH, Horng YS. Cross-cultural adaptation and psychometric property testing of the Taiwan Chinese version of the iconographical falls efficacy scale. J Formos Med Assoc 2024; 123:655-663. [PMID: 37996326 DOI: 10.1016/j.jfma.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/27/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The Iconographical Falls Efficacy Scale (Icon-FES) uses short phrases and images to depict activities. This study culturally adapted and validated the Taiwan Chinese version of the 30- and 10-item Icon-FESs (Icon-FESs [TW]) in community-dwelling older individuals. METHODS The Icon-FES (TW) was developed using forward-backward translation. A total of 120 community-dwelling older individuals were recruited. They completed the Taiwan Chinese version of the Falls Efficacy Scale-International (FES-I [TC]), the Icon-FES (TW), the Mini-Mental State Examination, and the World Health Organization Quality of Life Questionnaire Brief Version (WHOQOL-BREF) and were assessed using the Berg Balance Scale and the Short Physical Performance Battery (SPPB). The Icon-FES (TW) was recompleted 1 week later. Confirmatory factor analysis was used to evaluate the overall structure and measurement properties. RESULTS Cronbach's alpha values of 0.97 and 0.91 indicated that the 30- and 10-item Icon-FESs (TW) had high internal consistency. The 30- and 10-item Icon-FESs (TW) exhibited significantly high correlation with the FES-I (r = 0.88 and 0.84, respectively). Both versions of the Icon-FES (TW) exhibited mild correlation with the physical domain of the WHOQOL-BREF. The 30- and 10-item Icon-FESs (TW) discriminated by intensity of concern and SPPB score. Their test-retest reliability was high (intraclass correlation coefficient = 0.79 and 0.80 for the 30- and 10-item Icon-FESs (TW), respectively). Neither floor nor ceiling effects were observed. CONCLUSION The Icon-FES (TW) is a reliable and valid questionnaire useful for assessing the levels of concern regarding falling among older adults in clinical practice and research.
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Affiliation(s)
- Shu-Chun Lee
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; International PhD Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu chi Hospital, Buddhist Tzu chi Medical Foundation, New Taipei, Taiwan
| | - Chi-Tzu Feng
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Huey-Wen Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu, Taiwan
| | - Tzu-Hsuan Chien
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Yi-Shiung Horng
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Lynds ME, Arnold CM. Fall Risk Screening and Assessment for People Living With Dementia: A Scoping Review. J Appl Gerontol 2023; 42:2025-2035. [PMID: 37078271 PMCID: PMC10466966 DOI: 10.1177/07334648231168983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/17/2023] [Accepted: 03/15/2023] [Indexed: 04/21/2023] Open
Abstract
Falls are the leading cause of injury and hospitalization for older adults in Canada and the second leading cause of unintentional injury deaths worldwide. For people living with dementia (PLWD), falls have an even greater impact, but the standard testing methods for fall risk screening and assessment are often not practical for this population. The purpose of this scoping review is to identify and summarize recent research, practice guidelines and gray literature which have considered fall risk screening and assessment for PLWD. Database search results revealed a dearth in the literature that can support researchers and healthcare providers when considering which option/s are the most suitable for PLWD. Further primary studies into the validity of using the various tests with PLWD are needed if researchers and healthcare providers are to be empowered via the literature and clinical practice guidelines to provide the best possible fall risk care for PLWD.
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Affiliation(s)
- Michaela E. Lynds
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, CA
| | - Catherine M. Arnold
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, CA
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Levinger P, Goh AMY, Dunn J, Katite J, Paudel R, Onofrio A, Batchelor F, Panisset MG, Hill KD. Exercise interveNtion outdoor proJect in the cOmmunitY - results from the ENJOY program for independence in dementia: a feasibility pilot randomised controlled trial. BMC Geriatr 2023; 23:426. [PMID: 37438710 DOI: 10.1186/s12877-023-04132-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/25/2023] [Indexed: 07/14/2023] Open
Abstract
The Seniors Exercise Park program is an evidence-based outdoor physical and social activity program designed originally for older people with no cognitive impairment. This study aimed to pilot this program for people living with dementia in residential aged care. We examined the feasibility of delivering the program, evaluating its structure, safety, and supervision needs. In addition, physical, social, health and cognitive benefits of participation were examined. Method This was a feasibility pilot randomised controlled design. Adults aged ≥ 60 years with symptoms of dementia and/or diagnoses of dementia were recruited from an aged care facility in Australia. Participants allocated to the intervention underwent a 12-week structured supervised physical activity program using the outdoor Seniors Exercise Park equipment followed by a 12-week maintenance phase, while the controls received usual care programs. Assessments occurred at baseline, 12 and 24-weeks. Feasibility evaluation included recruitment rate, retention, attendance, overall adherence, dropout rate, adverse events, program delivery modifications and supervision requirements. A suite of cognitive and health-related questionnaires and physical function measures were also collected. Results Sixteen participants were recruited (recruitment rate: 58.6%), eight for the intervention (83.3 ± 7.5 years, 87.5% women) and eight for the control (age 87.5 ± 3.0 years, 87.5% women). Eighty-eight percent completed the 12-week structured program, with 75% retention at 24-weeks. Across the 24-week period, 84.3% participation adherence was reported. No falls or adverse events occurred. Modifications of the program mainly related to method of communication, cueing and adjustments to suit individual personality and characteristics. A ratio of one trainer to two participants was practical and safe. There were no significant changes over time between groups in any of the secondary outcomes. High level of engagement, enjoyment and mood was reported throughout the exercise program. Conclusion The Seniors Exercise Park physical activity program was safe and feasible for people living with dementia in residential care, with high levels of enjoyment, positive attitude, and engagement reported in the intervention group. Individualised communication during program delivery was needed to facilitate motivation and participation. Further research is needed to assess the program effectiveness on physical and cognitive function on a larger scale. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry-Registry Number ACTRN12620000733976 . Registered on the 13/07/2020.
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Affiliation(s)
- Pazit Levinger
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, Victoria, 3050, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia.
| | - Anita M Y Goh
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, Victoria, 3050, Australia
- The University of Melbourne, Melbourne, Australia
| | - Jeremy Dunn
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, Victoria, 3050, Australia
| | | | | | | | - Frances Batchelor
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, Victoria, 3050, Australia
| | | | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
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McGarrigle L, Yang Y, Lasrado R, Gittins M, Todd C. A systematic review and meta-analysis of the measurement properties of concerns-about-falling instruments in older people and people at increased risk of falls. Age Ageing 2023; 52:7174131. [PMID: 37211363 DOI: 10.1093/ageing/afad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND The 16-item Falls Efficacy Scale International (FES-I) is widely used to assess concerns-about-falling. Variants include 7-item Short FES-I, 30-item Iconographical Falls Efficacy Scale (Icon FES) and 10-item short Icon FES. No comprehensive systematic review and meta-analysis has been conducted to synthesise evidence regarding the measurement properties of these tools. OBJECTIVES To conduct a systematic review and meta-analysis of the measurement properties of four FES-I variants. METHODS MEDLINE, Embase, CINAHL Plus, PsycINFO and Web of Science were searched systematically and articles were assessed for eligibility independently. The methodological quality of eligible studies was assessed using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. The quality of measurement properties was assessed using COSMIN criteria for good measurement properties. Where possible, meta-analysis was conducted; otherwise, narrative synthesis was performed. Overall certainty of evidence was rated using a modified Grading of Recommendations, Assessment, Development and Evaluation system approach. RESULTS The review included 58 studies investigating measurement properties of the four instruments. There was high-quality evidence to support internal consistency, reliability and construct validity of all instruments. Moderate- to high-certainty evidence suggests one-factor structure of FES-I with two underlying dimensions, one-factor structure of Short FES-I and two-factor structure of Icon FES. There was high-certainty evidence to support the responsiveness of FES-I, with further research needed for the other instruments. CONCLUSION There is evidence for excellent measurement properties of all four instruments. We recommend the use of these tools with healthy older people and people at a greater risk of falls due to conditions that might affect mobility and balance.
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Affiliation(s)
- Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
| | - Yang Yang
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
- NIHR Applied Research Collaboration Greater Manchester, The University of Manchester, Manchester M13 9PL, UK
| | - Reena Lasrado
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
- NIHR Applied Research Collaboration Greater Manchester, The University of Manchester, Manchester M13 9PL, UK
| | - Matthew Gittins
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
- NIHR Applied Research Collaboration Greater Manchester, The University of Manchester, Manchester M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
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Lithander FE, Tenison E, Ypinga J, Halteren A, Smith MD, Lloyd K, Richfield EW, Brazier DE, Breasail MÓ, Smink AJ, Metcalfe C, Hollingworth W, Bloem B, Munneke M, Ben-Shlomo Y, Darweesh SKL, Henderson EJ. Proactive and Integrated Management and Empowerment in Parkinson's Disease protocol for a randomised controlled trial (PRIME-UK) to evaluate a new model of care. Trials 2023; 24:147. [PMID: 36849987 PMCID: PMC9969590 DOI: 10.1186/s13063-023-07084-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/20/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND People living with Parkinson's disease experience progressive motor and non-motor symptoms, which negatively impact on health-related quality of life and can lead to an increased risk of hospitalisation. It is increasingly recognised that the current care models are not suitable for the needs of people with parkinsonism whose care needs evolve and change as the disease progresses. This trial aims to evaluate whether a complex and innovative model of integrated care will increase an individual's ability to achieve their personal goals, have a positive impact on health and symptom burden and be more cost-effective when compared with usual care. METHODS This is a single-centre, randomised controlled trial where people with parkinsonism and their informal caregivers are randomised into one of two groups: either PRIME Parkinson multi-component model of care or usual care. Adults ≥18 years with a diagnosis of parkinsonism, able to provide informed consent or the availability of a close friend or relative to act as a personal consultee if capacity to do so is absent and living in the trial geographical area are eligible. Up to three caregivers per patient can also take part, must be ≥18 years, provide informal, unpaid care and able to give informed consent. The primary outcome measure is goal attainment, as measured using the Bangor Goal Setting Interview. The duration of enrolment is 24 months. The total recruitment target is n=214, and the main analyses will be intention to treat. DISCUSSION This trial tests whether a novel model of care improves health and disease-related metrics including goal attainment and decreases hospitalisations whilst being more cost-effective than the current usual care. Subject to successful implementation of this intervention within one centre, the PRIME Parkinson model of care could then be evaluated within a cluster-randomised trial at multiple centres.
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Affiliation(s)
- Fiona E. Lithander
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK ,grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, 1142 New Zealand ,grid.9654.e0000 0004 0372 3343Department of Nutrition and Dietetics, University of Auckland, Auckland, 1142 New Zealand
| | - Emma Tenison
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Jan Ypinga
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Angelika Halteren
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Matthew D. Smith
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Katherine Lloyd
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Edward W. Richfield
- grid.416201.00000 0004 0417 1173North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB UK
| | - Danielle E. Brazier
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Mícheál Ó. Breasail
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Agnes J. Smink
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Chris Metcalfe
- grid.5337.20000 0004 1936 7603Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, BS8 2PS UK
| | - William Hollingworth
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK ,grid.5337.20000 0004 1936 7603Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, BS8 2PS UK
| | - Bas Bloem
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marten Munneke
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Sirwan K. L. Darweesh
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Emily J. Henderson
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK ,grid.413029.d0000 0004 0374 2907Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG UK
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Sari YM, Burton E, Lee DCA, Hill KD. A Telehealth Home-Based Exercise Program for Community-Dwelling Older People with Dementia in Indonesia: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3397. [PMID: 36834093 PMCID: PMC9966659 DOI: 10.3390/ijerph20043397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: This study aimed to evaluate the feasibility of a telehealth home-based exercise program for older people with dementia living in Indonesia with support from their informal carers. (2) Methods: Pre-post intervention single group study with three assessment time-points (baseline, 12 and 18 weeks). Participants with dementia underwent a 12-week physiotherapist-delivered telehealth exercise program, with informal carer supervision between supervised online sessions, and continued the exercises for a further six weeks without physiotherapist online supervision. (3) Results: Thirty dyads of older people with dementia and their informal carers were recruited; four (13.3%) withdrew across the 12-week intervention and one (3.3%) in the 6-week self-maintenance period. Median adherence was 84.1% (IQR [25, 75] = 17.1) during the 12-week intervention, and 66.7% (IQR [25, 75] = 16.7) in the self-maintenance period. No falls/adverse events were reported. Physical activity level, some aspects of function and disability, health-related benefits of exercise, exercise enjoyment and quality of life of older people with dementia improved significantly at 12 and 18 weeks. (4) Conclusions: The telehealth exercise program is feasible and safe and may have benefits for the health outcomes of community-living older people with dementia in Indonesia. Additional strategies are necessary to enhance longer-term adherence to the program.
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Affiliation(s)
- Yulisna Mutia Sari
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne 3800, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth 6102, Australia
- enAble Institute, Curtin University, Perth 6845, Australia
| | - Den-Ching A. Lee
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne 3800, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Melbourne 3199, Australia
| | - Keith D. Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne 3800, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Melbourne 3199, Australia
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Hewston P, Bray SR, Kennedy CC, Ioannidis G, Bosch J, Marr S, Hanman A, Grenier A, Hladysh G, Papaioannou A. Does GERAS DANCE improve gait in older adults? AGING AND HEALTH RESEARCH 2023. [DOI: 10.1016/j.ahr.2023.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Valenzuela T, Coombes JS, Liu-Ambrose T, Mavros Y, Kochan N, Sachdev PS, Hausdorff J, Smith EC, Hollings M, Hawkins TC, Ashley NJ, Feter N, Wilson GC, Shih IHE, Guerrero Y, Jiang J, Wen W, Bailey T, Stensvold D, Wisløff U, Falck RS, Fiatarone Singh M. Study protocol for the BRAIN Training Trial: a randomised controlled trial of Balance, Resistance, And INterval training on cognitive function in older adults with mild cognitive impairment. BMJ Open 2022; 12:e062059. [PMID: 36600421 PMCID: PMC9772642 DOI: 10.1136/bmjopen-2022-062059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Epidemiological evidence suggests that both poor cardiovascular fitness and low muscle mass or strength markedly increase the rate of cognitive decline and incident dementia in older adults. Results from exercise trials for the improvement of cognition in older adults with mild cognitive impairment (MCI) have reported mixed results. This is possibly due to insufficient exercise intensities. The aim of the Balance, Resistance, And INterval (BRAIN) Training Trial is to determine the effects of two forms of exercise, high-intensity aerobic interval training (HIIT) and high-intensity power training (POWER) each compared with a sham exercise control group on cognition in older adults with MCI. METHODS AND ANALYSIS One hundred and sixty community-dwelling older (≥ 60 years) people with MCI have been randomised into the trial. Interventions are delivered supervised 2-3 days per week for 12 months. The primary outcome measured at baseline, 6 and 12 months is performance on a cognitive composite score measuring the executive domain calculated from a combination of computerised (NeuroTrax) and paper-and-pencil tests. Analyses will be performed via repeated measures linear mixed models and generalised linear mixed models of baseline, 6-month and 12-month time points, adjusted for baseline values and covariates selected a priori. Mixed models will be constructed to determine the interaction of GROUP × TIME. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Sydney (HREC Ref.2017/368), University of Queensland (HREC Ref. 2017/HE000853), University of British Columbia (H16-03309), and Vancouver Coastal Health Research Institute (V16-03309) Human Research Ethics. Dissemination will be via publications, conference presentations, newsletter articles, social media, talks to clinicians and consumers and meetings with health departments/managers.It is expected that communication of results will allow for the development of more effective evidence-based exercise prescription guidelines in this population while investigating the benefits of HIIT and POWER on subclinical markers of disease. TRIAL REGISTRATION NUMBER ACTRN12617001440314 Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- Trinidad Valenzuela
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Jeff S Coombes
- Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Yorgi Mavros
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicole Kochan
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jeffrey Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience and Department of Physical Therapy, Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel
| | - Emily C Smith
- Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Matthew Hollings
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tess C Hawkins
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas J Ashley
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Natan Feter
- Postgraduate Program of Physical Education, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Guy C Wilson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Isabel Hui En Shih
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Yareni Guerrero
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Wei Wen
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Tom Bailey
- Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
- School of Nursing Midwifery and Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Dorthe Stensvold
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ulrik Wisløff
- Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ryan S Falck
- School of Biomedical Engineering, Faculty of Applied Science, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Maria Fiatarone Singh
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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10
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Levinger P, Goh AMY, Dunn J, Katite J, Paudel R, Onofrio A, Batchelor F, Panisset MG, Hill KD. Exercise interveNtion outdoor proJect in the cOmmunitY-ENJOY program for independence in dementia: a feasibility pilot randomised controlled trial study protocol. Pilot Feasibility Stud 2022; 8:66. [PMID: 35317855 PMCID: PMC8938729 DOI: 10.1186/s40814-022-01027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background While the underlying neuropathology of dementia is not curable, interventions and treatment, such as physical activity, can offer physical and functional gains leading to better mobility, independence and quality of life. The Seniors Exercise Park program is an evidence-based physical and social activity program using an innovative design in outdoor exercise equipment specifically designed for older people. This unique program has never been tested with older people living with dementia. This study will evaluate the feasibility of delivering the Seniors Exercise Park program for people living with mild to moderate dementia in residential aged-care. This study will identify the optimal physical activity program, evaluate the safety of equipment usage and determine optimal supervision needs. The potential physical, social, quality of life and cognitive benefits of participation in the Seniors Exercise Park program will also be examined. Methods This is a feasibility pilot randomised controlled design with pre-post evaluation. Adults aged ≥ 60 years who have symptoms of dementia and/or who have been diagnosed with dementia will be recruited from an aged-care facility in Melbourne. Participants allocated to the intervention group will undergo a 12-week structured supervised physical activity program using the outdoor Seniors Exercise Park equipment followed by a 12-week maintenance phase (unstructured physical activity). Participants will be assessed at baseline, 3 and 6 months. Participants allocated to the control group will attend activities provided by the aged-care facility. A sample of 12 participants per group is the targeted sample size. Feasibility will be evaluated in terms of recruitment rate, retention, attendance, overall adherence, dropout rate, adverse events, modifications to the exercise program delivery and supervision needs. A comprehensive suite of cognitive and health-related questionnaires and physical function measures will also be collected. Discussion The ENJOY program for independence in dementia will determine the suitability of the Seniors Exercise Park program for people diagnosed with mild to moderate dementia. Outcomes could inform future design of dementia-friendly built environments to increase physical activity participation for residential aged-care facilities. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry—Registry Number ACTRN12620000733976. Registered on the 13th of July 2020.
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Affiliation(s)
- Pazit Levinger
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia. .,Institute for Health and Sport, Victoria University, Melbourne, Australia. .,Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia.
| | - Anita M Y Goh
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia.,The University of Melbourne, Melbourne, Australia
| | - Jeremy Dunn
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | | | - Ritu Paudel
- Old Colonists' Association of Victoria, Melbourne, Australia
| | - Adrian Onofrio
- Old Colonists' Association of Victoria, Melbourne, Australia
| | - Frances Batchelor
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia.,The University of Melbourne, Melbourne, Australia
| | | | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
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11
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Khoo I, Close JCT, Lord SR, Delbaere K, Taylor ME. Relationship between Depressive Symptoms and Cognitive, Psychological, and Physical Performance in Community-Dwelling Older People with Cognitive Impairment. Dement Geriatr Cogn Disord 2022; 50:482-490. [PMID: 34937036 DOI: 10.1159/000520853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Dementia and depression often coexist. Understanding how concomitant comorbidities affect function can improve assessment and management strategies. We examined the relationship between cognitive, psychological, and physical function and depressive symptoms in people with cognitive impairment. METHODS Cross-sectional study using baseline data from the iFOCIS randomized controlled trial involving 309 participants with mild-moderate cognitive impairment. The association between cognitive (Addenbrooke's Cognitive Examination-III [ACE-III], Frontal Assessment Battery), psychological (Goldberg Anxiety Scale; Iconographical Falls Efficacy Scale), and physical (Physiological Profile Assessment; Short Physical Performance Battery [SPPB]) function, and quality of life (QoL), physical activity levels and activities of daily living, and depressive symptoms (15-item Geriatric Depression Scale [GDS]) were assessed (adjusted for age, sex, education, and ACE-III as appropriate). RESULTS Participants with depressive symptoms (GDS ≥4) had significantly more falls in the previous year and a higher number of comorbidities than people without depressive symptoms (GDS <4). Each point increase in the GDS was associated with better memory, higher levels of anxiety and concern about falling, poorer balance, slower gait speed, and reduced QoL. The relationship between the GDS and poor balance and QoL withstood additional adjustment for comorbidity tertiles. The relationship between GDS and concern about falls withstood additional adjustment for previous falls (12 months) and SPPB scores. CONCLUSIONS Depressive symptomatology is associated with poorer physical and psychological function and reduced QoL in people with cognitive impairment. These factors should be considered when assessing and intervening in this group. Future research could examine these relationships longitudinally to establish causality and examine intervention efficacy in this group.
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Affiliation(s)
- Isabella Khoo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia.,Population Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia.,Population Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
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12
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Validity and Reliability of the Iconographical Falls Efficacy Scale Short Version in Community-Dwelling Older Adults in Turkey. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Racey M, Markle-Reid M, Fitzpatrick-Lewis D, Ali MU, Gagne H, Hunter S, Ploeg J, Sztramko R, Harrison L, Lewis R, Jovkovic M, Sherifali D. Fall prevention in community-dwelling adults with mild to moderate cognitive impairment: a systematic review and meta-analysis. BMC Geriatr 2021; 21:689. [PMID: 34893027 PMCID: PMC8665555 DOI: 10.1186/s12877-021-02641-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive impairment (CI) increases an individual's risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2-3 times more than cognitively healthy older adults and 60-80% of people with dementia fall annually. Practitioners require evidence-based fall prevention best practices to reduce the risk of falls in cognitively impaired adults living in the community. METHODS We conducted a systematic review and meta-analysis to identify the effectiveness of primary and secondary fall prevention interventions in reducing falls and fear of falling, and improving gait, balance, and functional mobility. We searched 7 databases for fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations, extracted data, and assessed risk of bias and certainty of evidence (GRADE). We assessed statistical and methodological heterogeneity and performed a meta-analysis of studies including subgroup analysis based on intervention and risk of bias groupings. RESULTS Five hundred nine community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate CI from 12 randomized or clinical controlled trials (RCTs/CCTs) were included in this review. Eight studies were exercise interventions, 3 were multifactorial, and 1 provided medication treatment. Fall prevention interventions had significant effects of medium magnitude on fear of falling (standardized mean difference (SMD) -0.73 [- 1.10, - 0.36]), balance (SMD 0.66 [0.19, 1.12]), and functional mobility measured as Timed Up and Go test (SMD -0.56 [- 0.94, - 0.17]) and significant effects of small magnitude on gait control (SMD 0.26 [0.08, 0.43]) all with moderate certainty of evidence. The meta-analysis showed no significant effects for falls (number of events or falls incidence). Sub-analysis showed that exercise and low risk of bias studies remained significant for balance and perceived risk of falls. CONCLUSION The effect of fall prevention interventions on direct outcomes, such as falls, remains unclear in cognitively impaired individuals. Exercise interventions are effective at improving fall risk factors, however, high quality studies with longer follow-up and adequate sample sizes are needed to determine their effectiveness on falls directly. There remains a gap in terms of effective fall prevention interventions for older adults with CI.
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Affiliation(s)
- M Racey
- McMaster Evidence Review and Synthesis Team; and School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
| | - M Markle-Reid
- School of Nursing, Faculty of Health Sciences, McMaster University; and Scientific Director, Aging, Community and Health Research Unit, McMaster University, Hamilton, Canada
| | - D Fitzpatrick-Lewis
- McMaster Evidence Review and Synthesis Team; and School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - M U Ali
- McMaster Evidence Review and Synthesis Team and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - H Gagne
- Injury Prevention, Ontario Neurotrauma Foundation, Toronto, Canada
| | - S Hunter
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - J Ploeg
- School of Nursing, McMaster University and Aging, Community and Health Research Unit, McMaster University, Hamilton, Canada
| | - R Sztramko
- Geriatric Medicine, McMaster University, Hamilton, Canada
| | | | - R Lewis
- McMaster Evidence Review and Synthesis Team, Hamilton, Canada
| | - M Jovkovic
- McMaster Evidence Review and Synthesis Team, Hamilton, Canada
| | - D Sherifali
- McMaster Evidence Review and Synthesis Team; and School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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14
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Lim ML, van Schooten KS, Radford KA, Menant J, Lord SR, Sachdev PS, Brodaty H, Delbaere K. The Iconographical Falls Efficacy Scale (IconFES) in community-dwelling older people-a longitudinal validation study. Age Ageing 2021; 50:822-829. [PMID: 33095852 DOI: 10.1093/ageing/afaa213] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study aimed to develop cut-points for the 30-item and 10-item Iconographical Falls Efficacy Scale (IconFES) in community-dwelling older people and evaluate the psychometric properties, including construct and predictive validity with respect to falls and reduced physical activity over 1 year. METHODS Eight hundred and one participants completed the IconFES and underwent physical, psychological and cognitive measures at baseline. Physical activity was recorded at baseline and 12 months using an activity monitor, and 1-year fall incidence was collected using monthly falls calendars. RESULTS Using receiver-operating characteristic curves and the Youden's index for history of falls, physiological fall risk and depressive symptoms, cut-points were defined to differentiate between low and high concern about falling (30-item: <53; 10-item: <19). For the 30-item IconFES, we additionally defined cut-points for low (≤40), moderate (41-58) and high (≥59) concern about falling. Groups based on these cut-points differed significantly: low coordinated stability, executive function and amount of daily walking, and high level of disability (30-item version) and female gender (low/high 30-item version). Although there were some inconsistencies across IconFES classifications, high concern about falling predicted having had multiple falls or multiple/injurious falls, low amount of daily walking and low movement intensity at 12 months. CONCLUSIONS The developed IconFES cut-points were sensitive to variables associated with concern about falling and predicted fall incidence and physical activity restriction after 12 months. Applying these cut-points appears useful to identify older people with high concern about falling, who are at higher risk of falls and activity curtailment.
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Affiliation(s)
- Mei Ling Lim
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Kimberley S van Schooten
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Kylie A Radford
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Jasmine Menant
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
- Neuropsychiatric Institute, the Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
- Sydney and Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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15
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Ferrer Soler C, Cuvelier C, Hars M, Herrmann FR, Charpiot A, Ducharne Wieczorkiewicz C, Bruyère O, Beaudart C, Zekry D, Gold G, Trombetti A. Validation of the Perform-FES: a new fear of falling scale for hospitalized geriatric patients. Aging Clin Exp Res 2021; 33:67-76. [PMID: 33063292 PMCID: PMC7897618 DOI: 10.1007/s40520-020-01726-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/26/2020] [Indexed: 11/28/2022]
Abstract
Background Fear of falling is highly prevalent in older adults and associated with numerous negative health events. The main objective of this study was to validate a scale to assess fear of falling, based on performance in real situation (Perform-FES), in a hospitalized geriatric population. Methods In this cross-sectional study, 55 patients (mean age: 85.3 years; 58% women) hospitalized in a geriatric hospital in Geneva (Switzerland) were enrolled. The Perform-FES scale was administered to all patients in conjunction with four other fear of falling scales. We determined the floor and ceiling effects, internal consistency, reliability, construct validity, and discriminative power of the Perform-FES scale. Results The Perform-FES scale did not demonstrate any significant floor or ceiling effect. It had a good internal consistency (Cronbach’s alpha = 0.78) and an excellent reliability (intraclass correlation coefficient = 0.94). Regarding convergent validity, good correlations were shown between the score obtained on the Perform-FES scale and those obtained on other fear of falling scales. Also, the Perform-FES scale was able to discriminate patients with severe functional impairments (area under the ROC curve = 0.81) and had significantly better discriminating performance than other fear of falling scales. Conclusion Findings suggest that the Perform-FES scale has good psychometric properties and may be a relevant tool to assess fear of falling in a geriatric hospitalized population. Future research should focus in particular on assessing the sensitivity to change and the predictive value of this scale in longitudinal studies, and its validity in other populations.
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Affiliation(s)
- Cecilia Ferrer Soler
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
| | - Clémence Cuvelier
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
| | - Mélany Hars
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - François R Herrmann
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
| | - Adrienne Charpiot
- Division of Public Health, Epidemiology and Health Economics, World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium
| | - Catherine Ducharne Wieczorkiewicz
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium
| | - Charlotte Beaudart
- Division of Public Health, Epidemiology and Health Economics, World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium
| | - Dina Zekry
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
| | - Gabriel Gold
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
| | - Andrea Trombetti
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland.
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
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16
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Hunter SW, Divine A, Omana H, Madou E, Holmes J. Development, reliability and validity of the Safe Use of Mobility Aids Checklist (SUMAC) for 4-wheeled walker use in people living with dementia. BMC Geriatr 2020; 20:468. [PMID: 33176695 PMCID: PMC7659047 DOI: 10.1186/s12877-020-01865-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Balance and gait problems are common and progressive in dementia. Use of a mobility aid provides physical support and confidence. Yet, mobility aid use in people with dementia increases falls three-fold. An assessment tool of mobility aid safety in people with dementia does not currently exist. The objectives of this study were: 1) to develop a tool for the evaluation of physical function and safe use of a 4-wheeled walker in people with dementia, and 2) to evaluate its construct and criterion validity, inter-rater and test-retest reliability and minimal detectable change. METHODS Healthcare professionals (HCP) experienced in rehabilitation of people with dementia participated in focus groups for item generation of the new tool, The Safe Use of Mobility Aid Checklist (SUMAC). The SUMAC evaluates physical function (PF) and safe use of the equipment (EQ) on nine tasks of daily life. Reliability was evaluated by HCP (n = 5) scored participant videos of people with dementia (n = 10) using a 4-wheeled walker performing the SUMAC. Inter-rater and test-retest reliability was assessed using intra-class correlation coefficients (ICC). Construct validity evaluated scores of the HCPs to a consensus HCP panel using Spearman's rank-order correlations. Criterion validity evaluated SUMAC-PF to the Performance-Oriented Mobility Assessment (POMA) gait subscale using Spearman's rank-order correlations. RESULTS Three focus groups (n = 17) generated a tool comprised of nine tasks and the components within each task for physical function and safe use. Inter-rater reliability was statistically significant for SUMAC-PF (ICC = 0.92, 95%CI (0.81, 0.98), p < 0.001) and SUMAC-EQ. (ICC = 0.82, 95%CI (0.54, 0.95), p < 0.001). Test-retest reliability was statistically significant for SUMAC-PF (ICC = 0.89, 95%CI (0.81, 0.94), p < 0.001) and SUMAC-EQ. (ICC = 0.88, 95%CI (0.79, 0.93), p < 0.001). As hypothesized, the POMA gait subscale correlated strongly with the SUMAC-PF (rs = 0.84), but not EQ (rs = 0.39). CONCLUSIONS The focus groups and research team developed a tool of nine tasks with evaluation on physical function and safe use of a 4-wheeled walker for people with dementia. The SUMAC tool has demonstrated content validity for the whole scale and good construct and criterion validity for the SUMAC-PF and SUMAC-EQ. The subscores of the SUMAC demonstrated excellent to good inter-rater and test-retest reliability.
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Affiliation(s)
- Susan W Hunter
- School of Physical Therapy, University of Western Ontario, Room 1588, Elborn College, London, ON, N6G 1H1, Canada.
| | - Alison Divine
- Faculty of Biological Sciences, Sport and Exercise Science, University of Leeds, Leeds, England
| | - Humberto Omana
- Faculty of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
| | - Ed Madou
- School of Physical Therapy, University of Western Ontario, Room 1588, Elborn College, London, ON, N6G 1H1, Canada
| | - Jeffrey Holmes
- School of Occupational Therapy, University of Western Ontario, London, Ontario, Canada
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17
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Hunter SW, Divine A, Omana H, Wittich W, Hill KD, Johnson AM, Holmes JD. Effect of Learning to Use a Mobility Aid on Gait and Cognitive Demands in People with Mild to Moderate Alzheimer's Disease: Part II - 4-Wheeled Walker. J Alzheimers Dis 2020; 71:S115-S124. [PMID: 31127767 PMCID: PMC6839464 DOI: 10.3233/jad-181170] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cognitive deficits and gait problems are common and progressive in Alzheimer's disease (AD). Prescription of a 4-wheeled walker is a common intervention to improve stability and independence, yet can be associated with an increased falls risk. OBJECTIVES 1) To examine changes in spatial-temporal gait parameters while using a 4-wheeled walker under different walking conditions, and 2) to determine the cognitive and gait task costs of walking with the aid in adults with AD and healthy older adults. METHODS Twenty participants with AD (age 79.1±7.1 years) and 22 controls (age 68.5±10.7 years) walked using a 4-wheeled walker in a straight (6 m) and Figure of 8 path under three task conditions: single-task (no aid), dual-task (walking with aid), and multi-task (walking with aid while counting backwards by ones). RESULTS Gait velocity was statistically slower in adults with AD than the controls across all conditions (all p values <0.025). Stride time variability was significantly different between groups for straight path single task (p = 0.045), straight path multi-task (p = 0.031), and Figure of 8 multi-task (0.036). Gait and cognitive task costs increased while multi-tasking, with performance decrement greater for people with AD. None of the people with AD self-prioritized gait over the cognitive task while walking in a straight path, yet 75% were able to shift prioritization to gait in the complex walking path. CONCLUSION Learning to use a 4-wheeled walker is cognitively demanding and any additional tasks increases the demands, further adversely affecting gait. The increased cognitive demands result in a decrease in gait velocity that is greatest in adults with AD. Future research needs to investigate the effects of mobility aid training on gait performance.
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Affiliation(s)
- Susan W Hunter
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Alison Divine
- Faculty of Sport and Exercise Psychology, University of Leeds, Leeds, England
| | - Humberto Omana
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Walter Wittich
- École d'optométrie, Université de Montréal, Montreal, Quebec, Canada
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Andrew M Johnson
- School of Health Studies, University of Western Ontario, London, Ontario, Canada
| | - Jeffrey D Holmes
- School of Occupational Therapy, University of Western Ontario, London, Ontario, Canada
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18
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Allan LM, Wheatley A, Smith A, Flynn E, Homer T, Robalino S, Beyer FR, Fox C, Howel D, Barber R, Connolly JA, Robinson L, Parry SW, Rochester L, Corner L, Bamford C. An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study. Health Technol Assess 2020; 23:1-208. [PMID: 31661058 DOI: 10.3310/hta23590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Fall-related injuries are a significant cause of morbidity and mortality in people with dementia. There is presently little evidence to guide the management of such injuries, and yet there are potentially substantial benefits to be gained if the outcomes of these injuries could be improved. This study aimed to design an appropriate new health-care intervention for people with dementia following a fall and to assess the feasibility of its delivery in the UK NHS. OBJECTIVES To determine whether or not it is possible to design an intervention to improve outcomes of falls in dementia, to investigate the feasibility and acceptability of the DIFRID (Developing an Intervention for Fall related Injuries in Dementia) intervention and to investigate the feasibility of a future randomised controlled trial and the data collection tools needed to evaluate both the effectiveness and the cost-effectiveness of the DIFRID intervention. DESIGN This was a mixed-methods feasibility study. A systematic review (using Cochrane methodology) and realist review [using Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) methodology] explored the existing evidence base and developed programme theories. Searches were carried out in November 2015 (updated in January 2018) for effectiveness studies and in August 2016 for economic studies. A prospective observational study identified service use via participant diary completion. Qualitative methods (semistructured interviews, focus groups and observation) were used to explore current practice, stakeholder perspectives of the health and social care needs of people with dementia following a fall, ideas for intervention and barriers to and facilitators of change. Each of the resulting data sets informed intervention development via Delphi consensus methods. Finally, a single-arm feasibility study with embedded process evaluation was conducted. SETTING This study was set in the community. PARTICIPANTS The participants were (1) people with dementia presenting with falls necessitating health-care attention in each setting (primary care, the community and secondary care) at three sites and their carers, (2) professionals delivering the intervention, who were responsible for training and supervision and who were members of the intervention team, (3) professionals responsible for approaching and recruiting participants and (4) carers of participants with dementia. INTERVENTIONS This was a complex multidisciplinary therapy intervention. Physiotherapists, occupational therapists and support workers delivered up to 22 sessions of tailored activities in the home or local area of the person with dementia over a period of 12 weeks. MAIN OUTCOME MEASURES (1) Assessment of feasibility of study procedures; (2) assessment of the acceptability, feasibility and fidelity of intervention components; and (3) assessment of the suitability and acceptability of outcome measures for people with dementia and their carers (number of falls, quality of life, fear of falling, activities of daily living, goal-setting, health-care utilisation and carer burden). RESULTS A multidisciplinary intervention delivered in the homes of people with dementia was designed based on qualitative work, realist review and recommendations of the consensus panel. The intervention was delivered to 11 people with dementia. The study suggested that the intervention is both feasible and acceptable to stakeholders. A number of modifications were recommended to address some of the issues arising during feasibility testing. The measurement of outcome measures was successful. CONCLUSIONS The study has highlighted the feasibility of delivering a creative, tailored, individual approach to intervention for people with dementia following a fall. Although the intervention required greater investment of time than usual practice, many staff valued the opportunity to work more closely with people with dementia and their carers. We conclude that further research is now needed to refine this intervention in the context of a pilot randomised controlled trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN41760734 and PROSPERO CRD42016029565. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Louise M Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Alison Wheatley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Amy Smith
- Department of Occupational Therapy, Tees, Esk and Wear Valleys NHS Foundation Trust, Stockton-on-Tees, UK
| | - Elizabeth Flynn
- Department of Physiotherapy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tara Homer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona R Beyer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Robert Barber
- Department of Old Age Psychiatry, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jim Anthony Connolly
- Department of Emergency Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Steve Wayne Parry
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Lynne Corner
- VOICE, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Taylor ME, Wesson J, Sherrington C, Hill KD, Kurrle S, Lord SR, Brodaty H, Howard K, O’Rourke SD, Clemson L, Payne N, Toson B, Webster L, Savage R, Zelma G, Koch C, John B, Lockwood K, Close JCT. Tailored Exercise and Home Hazard Reduction Program for Fall Prevention in Older People With Cognitive Impairment: The i-FOCIS Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2020; 76:655-665. [DOI: 10.1093/gerona/glaa241] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The evidence to support effective fall prevention strategies in older people with cognitive impairment (CI) is limited. The aim of this randomized controlled trial (RCT) was to determine the efficacy of a fall prevention intervention in older people with CI.
Method
RCT involving 309 community-dwelling older people with CI. The intervention group (n = 153) received an individually prescribed home hazard reduction and home-based exercise program during the 12-month study period. The control group (n = 156) received usual care. The primary outcome was rate of falls. Secondary outcomes included faller/multiple faller status, physical function, and quality of life.
Results
Participants’ average age was 82 years (95% CI 82–83) and 49% were female. There was no significant difference in the rate of falls (incidence rate ratio [IRR] 1.05; 95% confidence interval [95% CI] 0.73–1.51). A sensitivity analysis, controlling for baseline differences and capping the number of falls at 12 (4 participants), revealed a nonsignificant reduction in fall rate in the intervention group (IRR 0.78; 95% CI 0.57–1.07). Analyses of secondary outcomes indicated the intervention significantly reduced the number of multiple fallers by 26% (RR 0.74; 95% CI 0.54–0.99) when adjusting for baseline differences. There was a differential impact on falls in relation to physical function (interaction term p-value = .023) with a significant reduction in fall rate in intervention group participants with better baseline physical function (IRR 0.60; 95% CI 0.37–0.98). There were no significant between-group differences for other secondary outcomes.
Conclusions
This intervention did not significantly reduce the fall rate in community-dwelling older people with CI. The intervention did reduce the fall rate in participants with better baseline physical function.
Clinical Trials Registration Number
Australian and New Zealand Trials Registry ACTRN12614000603617.
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Affiliation(s)
- Morag E Taylor
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia
| | - Jacqueline Wesson
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Susan Kurrle
- Department of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sandra D O’Rourke
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Lindy Clemson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre of Excellence for Population Ageing Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Narelle Payne
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Barbara Toson
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Lyndell Webster
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Roslyn Savage
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Genevieve Zelma
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Cecelia Koch
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Beatrice John
- Department of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Keri Lockwood
- Department of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Jacqueline C T Close
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia
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20
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Hunter SW, Meyer C, Divine A, Hill KD, Johnson A, Wittich W, Holmes J. The experiences of people with Alzheimer's dementia and their caregivers in acquiring and using a mobility aid: a qualitative study. Disabil Rehabil 2020; 43:3331-3338. [PMID: 32233813 DOI: 10.1080/09638288.2020.1741700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Cognitive deficits and gait and balance problems are progressive in people with Alzheimer's dementia. Yet, mobility aids are associated with an increased falls risk in people with dementia. Our objectives were to identify the perceptions of people living with mild-to-moderate Alzheimer's dementia, and their caregivers, on the use of mobility aids. METHODS A qualitative study using semi-structured, face-to-face interviews was conducted. Community-dwelling older adults with dementia attending a day hospital program were recruited. Thematic analysis was conducted and the text was coded into broad themes aligned with the research questions. The coded text was examined for patterns and similarities, and grouped to form inductive themes. RESULTS Twenty-four people (12 living with dementia and their 12 caregivers) participated. Five themes were identified: (1) acknowledgement of need; (2) protecting a sense of self; (3) caregiver oversight and relief of burden; (4) healthcare professional involvement; (5) environment and design of aids. CONCLUSIONS The findings suggest that people with Alzheimer's dementia and their caregivers regard mobility aid use as increasing independence. There is a role for healthcare professionals to be involved in the prescription, provision and training for use of mobility aids among people living with dementia to ensure uptake and safety.IMPLICATIONS FOR REHABILITATIONMobility aid use is regarded as increasing independence by people with Alzheimer's disease and their caregivers.Falls risk associated with mobility aid use was not well known and caregivers perceived mobility aids as a means to reduce falls.Most people do not see a healthcare professional when they acquire a mobility aid and there is a role for healthcare professionals to be involved in the prescription, provision and training of people living with dementia in the use of mobility aids in order to increase the uptake of aids and their safe use.
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Affiliation(s)
- Susan W Hunter
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Claudia Meyer
- Bolton Clarke Research Institute, Bentleigh, Australia
| | - Alison Divine
- Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
| | - Andrew Johnson
- School of Health Studies, University of Western Ontario, London, Canada
| | | | - Jeff Holmes
- School of Occupational Therapy, University of Western Ontario, London, Canada
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21
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Van Ooteghem K, Musselman K, Gold D, Marcil MN, Keren R, Tartaglia MC, Flint AJ, Iaboni A. Evaluating Mobility in Advanced Dementia: A Scoping Review and Feasibility Analysis. THE GERONTOLOGIST 2019; 59:e683-e696. [PMID: 29982355 DOI: 10.1093/geront/gny068] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Mobility decline is a symptom of advanced dementia that affects function, safety, caregiving, and quality of life. Monitoring mobility status is essential for initiating timely and targeted interventions aimed at preventing excess disability in people with dementia (PWD). The physical, cognitive, and behavioral symptoms of dementia however, present unique challenges for mobility assessment. The goals of this review were to (a) identify and describe measures of mobility used for PWD and (b) assess measures' feasibility for use in people with advanced dementia; a group whose degree of cognitive impairment results in severe functional deficits. RESEARCH DESIGN AND METHODS Electronic searches of Medline, Embase, CINAHL, and PsychInfo databases were conducted using keywords related to dementia, mobility, measurement, and validation. Descriptive characteristics were extracted and measures coded for mobility components. Tools were also evaluated for feasibility of use in advanced dementia and those deemed feasible, screened for psychometric strength. RESULTS Thirty-eight measures were included and 68% of these tools were performance-based. Elements of mobility evaluated were walking (53% of measures), postural transitions (42%), standing (40%), mobility-related behavioral/psychological symptoms (24%), transfers (10%), bed mobility (5%), and wheeled mobility (3%). 36% of studies included people with advanced dementia. Only 18% of tools received high scores for feasibility. DISCUSSION AND IMPLICATIONS Existing measures provide only partial information regarding mobility and few target elements that become relevant as dementia progresses. Most measures are not feasible for people with advanced dementia, and the psychometric evaluation of these measures is limited. Further research is needed to develop a comprehensive, dementia-specific, mobility assessment tool.
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Affiliation(s)
| | - Kristin Musselman
- Toronto Rehabilitation Institute, University Health Network, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Canada
| | - David Gold
- Neuropsychology Clinic, Krembil Neuroscience Centre-Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
| | - Meghan N Marcil
- Toronto Rehabilitation Institute, University Health Network, Canada
| | - Ron Keren
- Toronto Rehabilitation Institute, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
- Centre for Mental Health, University Health Network, Toronto, Canada
| | - Maria Carmela Tartaglia
- Memory Clinic, University Health Network, Toronto, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, Faculty of Medicine, University of Toronto, Canada
| | - Alastair J Flint
- Department of Psychiatry, University of Toronto, Canada
- Centre for Mental Health, University Health Network, Toronto, Canada
| | - Andrea Iaboni
- Toronto Rehabilitation Institute, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
- Centre for Mental Health, University Health Network, Toronto, Canada
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22
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Hunter SW, Divine A, Omana H, Wittich W, Hill KD, Johnson AM, Holmes JD. Effect of Learning to Use a Mobility Aid on Gait and Cognitive Demands in People with Mild to Moderate Alzheimer’s Disease: Part I – Cane. J Alzheimers Dis 2019; 71:S105-S114. [DOI: 10.3233/jad-181169] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Susan W. Hunter
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Alison Divine
- Faculty of Sport and Exercise Psychology, University of Leeds, Leeds, England
| | - Humberto Omana
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Walter Wittich
- École d’optométrie, Université de Montréal, Montreal, Quebec, Canada
| | - Keith D. Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Andrew M. Johnson
- School of Health Studies, University of Western Ontario, London, Ontario, Canada
| | - Jeffrey D. Holmes
- School of Occupational Therapy, University of Western Ontario, London, Ontario, Canada
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23
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Taylor ME, Close JCT, Lord SR, Kurrle SE, Webster L, Savage R, Delbaere K. Pilot feasibility study of a home-based fall prevention exercise program (StandingTall) delivered through a tablet computer (iPad) in older people with dementia. Australas J Ageing 2019; 39:e278-e287. [PMID: 31538401 DOI: 10.1111/ajag.12717] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the feasibility and safety of StandingTall-an individually tailored, progressive exercise program delivered through tablet computers-in community-dwelling older people with dementia. METHODS Fifteen community-dwelling older people with dementia (mean age = 83 ± 8 years; Montreal Cognitive Assessment 16 ± 5) received StandingTall for 12 weeks with caregiver assistance. Feasibility and safety were assessed using the System Usability Scale (SUS; scores = 0-100; a priori target >65), Physical Activity Enjoyment Scale (PACES-8; scores = 8-56), adherence (exercise minutes) and adverse events. RESULTS Mean SUS scores were 68 ± 21/69 ± 15 (participants/caregivers). The mean PACES-8 score was 44 ± 8. In week 2, week 7 and week 12, mean (bias-corrected and accelerated 95% CI) exercise minutes were 37 (25-51), 49 (30-69) and 65 (28-104), respectively. In week 12, five participants exercised >115 minutes. One participant fell while exercising, without sustained injury. CONCLUSIONS StandingTall had acceptable usability, scored well on enjoyment and was feasible for participants. These results provide support for further evaluation of StandingTall in a randomised controlled trial with falls as the primary outcome.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia.,Cognitive Decline Partnership Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Prince of Wales Clinical School, Medicine, UNSW, Sydney, NSW, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia.,Prince of Wales Clinical School, Medicine, UNSW, Sydney, NSW, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia.,School of Public Health and Community Medicine, Medicine, UNSW, Sydney, NSW, Australia
| | - Susan E Kurrle
- Cognitive Decline Partnership Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Lyndell Webster
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia
| | - Roslyn Savage
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia.,School of Public Health and Community Medicine, Medicine, UNSW, Sydney, NSW, Australia
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24
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Ruggieri M, Palmisano B, Fratocchi G, Santilli V, Mollica R, Berardi A, Galeoto G. Validated Fall Risk Assessment Tools for Use with Older Adults: A Systematic Review. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2019. [DOI: 10.1080/02703181.2018.1520381] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Biagio Palmisano
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Fratocchi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Valter Santilli
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberta Mollica
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Galeoto
- Department of Public Health, Sapienza University of Rome, Rome, Italy
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25
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Williams JM, Nyman SR. Association between the instrumented timed up and go test and cognitive function, fear of falling and quality of life in community dwelling people with dementia. J Frailty Sarcopenia Falls 2018; 3:185-193. [PMID: 32300707 PMCID: PMC7155353 DOI: 10.22540/jfsf-03-185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore relationships between the instrumented timed up and go test (iTUG) and the following risk factors for falls: cognitive functioning, fear of falling (FoF), and quality of life (QoL) in people with dementia. METHODS 83 community-dwelling older adults with dementia (mean±sd age 78.00±7.96 years; 60.2% male) completed an interview to capture global cognition (Mini-Addenbrooke's Cognitive Evaluation), FoF (Iconographical Falls Efficacy Scale) and QoL (ICEpopCAPability measure for Older people). Participants completed an iTUG whilst wearing an inertial sensor on their trunk. Linear accelerations and rotational velocities demarcated sub-phases of the iTUG. Relationships were explored through correlations and regression modelling. RESULTS Cognition was related to duration of walking sub-phases and total time to complete iTUG (r=0.25-0.28) suggesting gait speed was related to cognition. FoF was most strongly related to turning velocity (r=0.39-0.44), but also to sit-to-stand, gait sub-phases and total time to complete iTUG. Sub-phases explained 27% of the variance in FoF. There were no correlations between iTUG and QoL. CONCLUSIONS Cognition and FoF were related to time to complete walking sub-phases but FoF was more closely related to turning velocity and standing acceleration. iTUG may offer unique insights into motor behaviour in people with dementia.
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Affiliation(s)
- Jonathan M. Williams
- Department of Human Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, UK
| | - Samuel R. Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, UK
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26
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Translation and validation study of the Chinese version Iconographical Falls Efficacy Scale-Short Version (Icon-FES). Arch Gerontol Geriatr 2018; 77:1-7. [DOI: 10.1016/j.archger.2018.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/31/2018] [Accepted: 03/07/2018] [Indexed: 11/20/2022]
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Hewston P, Deshpande N. The Short Version of the Activities-Specific Balance Confidence Scale for Older Adults with Diabetes-Convergent, Discriminant and Concurrent Validity: A Pilot Study. Can J Diabetes 2017; 41:266-272. [PMID: 28268190 DOI: 10.1016/j.jcjd.2016.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/07/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The short version of the Activities-Specific Balance Confidence Scale (ABC-6) is advantageous in busy clinical or research settings because it can be administered in less time than the original 16-item Activities-Specific Balance Confidence Scale (ABC-16). This pilot study examined the convergent, discriminant and concurrent validity of the ABC-6 in older adults with diabetes mellitus with and without diagnosed diabetic peripheral neuropathy (DPN). METHODS Thirty older adults (aged ≥65) were age- and sex-matched in 3 groups: 10 with diabetes (DM group), 10 with diagnosed DPN (DPN group) and 10 without diabetes (no-DM group). Balance confidence was quantified by the ABC-16, which includes the ABC-6. Potential correlates were evaluated in physical and psychological domains. RESULTS The ABC-6 and ABC-16 balance confidence scores were strongly correlated (r=0.969; p<0.001; convergent validity). The ABC-6 revealed significant differences in balance confidence between the no-DM and the DM groups (p<0.001; discriminant validity), whereas the ABC-16 did not (p>0.05). The ABC-6 was moderately, but significantly, correlated with physical activity level (r=0.528; p=0.017), mobility (r=-0.520; p=0.027), balance (r=0.633; p=0.003), and depressive symptoms (r=-0.515; p=0.020) in the DM study groups (concurrent validity). CONCLUSIONS The ABC-6 and ABC-16 had excellent convergent validity, and both ABC scales had similar concurrent validity. However, the ABC-6 was more sensitive in detecting subtle differences in balance confidence in older adults with diabetes without diagnosed DPN than the ABC-16. Overall, this pilot study provided evidence of the validity of the ABC-6 in older adults with diabetes. Further exploration involving a larger sample size is recommended to confirm these findings.
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Affiliation(s)
- Patricia Hewston
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Nandini Deshpande
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
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Sousa LMM, Marques-Vieira CMA, Caldevilla MNGND, Henriques CMAD, Severino SSP, Caldeira SMA. Risk for falls among community-dwelling older people: systematic literature review. Rev Gaucha Enferm 2017; 37:e55030. [PMID: 28273251 DOI: 10.1590/1983-1447.2016.04.55030] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/17/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the risk factors for falls of the community-dwelling elderly in order to update the Taxonomy II of NANDA International. METHOD A systematic literature review based on research using the following platforms: EBSCOHost®, CINAHL and MEDLINE, from December 2010 to December 2014. The descriptors used were (Fall* OR Accidental Fall) AND (Community Dwelling OR Community Health Services OR Primary health care) AND (Risk OR Risk Assessment OR Fall Risk Factors) AND (Fall* OR Accidental Fall) AND (Community Dwelling OR older) AND Nurs* AND Fall Risk Factors. RESULTS The sample comprised 62 studies and 50 risk factors have been identified. Of these risk factors, only 38 are already listed in the classification. CONCLUSIONS Two new categories of risk factors are proposed: psychological and socio-economical. New fall risk factors for the community-dwelling elderly have been identified, which can contribute to the updating of this nursing diagnosis of the Taxonomy II of NANDA International.
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Affiliation(s)
- Luís Manuel Mota Sousa
- Centro Hospital Lisboa Central, Polo Hospital Curry Cabral. Lisboa, Portugal
- Universidade Atlântica, Escola Superior de Saúde Atlântica. Barcarena, Oeiras, Portugal
| | | | | | - Cristina Maria Alves Dias Henriques
- Administração Regional de Saúde de Lisboa e Vale do Tejo, Equipa Coordenadora Regional da Rede Nacional de Cuidados Continuados Integrados. Lisboa, Portugal
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A home-based, carer-enhanced exercise program improves balance and falls efficacy in community-dwelling older people with dementia. Int Psychogeriatr 2017; 29:81-91. [PMID: 27692024 DOI: 10.1017/s1041610216001629] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Older people with dementia are at increased risk of physical decline and falls. Balance and mood are significant predictors of falls in this population. The aim of this study was to determine the effect of a tailored home-based exercise program in community-dwelling older people with dementia. METHODS Forty-two participants with mild to moderate dementia were recruited from routine health services. All participants were offered a six-month home-based, carer-enhanced, progressive, and individually tailored exercise program. Physical activity, quality of life, physical, and psychological assessments were administered at the beginning and end of the trial. RESULTS Of 33 participants (78.6%) who completed the six-month reassessment ten (30%) reported falls and six (18%) multiple falls during the follow-up period. At reassessment, participants had better balance (sway on floor and foam), reduced concern about falls, increased planned physical activity, but worse knee extension strength and no change in depression scores. The average adherence to the prescribed exercise sessions was 45% and 22 participants (52%) were still exercising at trial completion. Those who adhered to ≥70% of prescribed sessions had significantly better balance at reassessment compared with those who adhered to <70% of sessions. CONCLUSIONS This trial of a tailored home-based exercise intervention presents preliminary evidence that this intervention can improve balance, concern about falls, and planned physical activity in community-dwelling older people with dementia. Future research should determine whether exercise interventions are effective in reducing falls and elucidate strategies for enhancing uptake and adherence in this population.
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Anderson JG, Lopez RP, Rose KM, Specht JK. Nonpharmacological Strategies for Patients With Early-Stage Dementia or Mild Cognitive Impairment: A 10-Year Update. Res Gerontol Nurs 2017; 10:5-11. [DOI: 10.3928/19404921-20161209-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Lach HW, Harrison BE, Phongphanngam S. Falls and Fall Prevention in Older Adults With Early-Stage Dementia: An Integrative Review. Res Gerontol Nurs 2016; 10:139-148. [PMID: 27665756 DOI: 10.3928/19404921-20160908-01] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/12/2016] [Indexed: 11/20/2022]
Abstract
Older adults with mild cognitive impairment (MCI) and early-stage dementia have an increased risk of falling, with risks to their health and quality of life. The purpose of the current integrative review was to evaluate evidence on fall risk and fall prevention in this population. Studies were included if they examined falls or fall risk factors in older adults with MCI or early-stage dementia, or reported interventions in this population; 40 studies met criteria. Evidence supports the increased risk of falls in individuals even in the early stages of dementia or MCI, and changes in gait, balance, and fear of falling that may be related to this increased fall risk. Interventions included exercise and multifactorial interventions that demonstrated some potential to reduce falls in this population. Few studies had strong designs to provide evidence for recommendations. Further study in this area is warranted. [Res Gerontol Nurs. 2017; 10(03):139-148.].
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Abstract
Falls are the leading cause of injury-related morbidity and mortality among older adults. In addition to the resulting physical injury and potential disability after a fall, there are also important psychological consequences, including depression, anxiety, activity restriction, and fear of falling. Fear of falling affects 20 to 43% of community-dwelling older adults and is not limited to those who have previously experienced a fall. About half of older adults who experience fear of falling subsequently restrict their physical and everyday activities, which can lead to functional decline, depression, increased falls risk, and reduced quality of life. Although there is clear evidence that older adults with visual impairment have higher falls risk, only a limited number of studies have investigated fear of falling in older adults with visual impairment and the findings have been mixed. Recent studies suggest increased levels of fear of falling among older adults with various eye conditions, including glaucoma and age-related macular degeneration, whereas other studies have failed to find differences. Interventions, which are still in their infancy in the general population, are also largely unexplored in those with visual impairment. The major aims of this review were to provide an overview of the literature on fear of falling, its measurement, and risk factors among older populations, with specific focus on older adults with visual impairment, and to identify directions for future research in this area.
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Abstract
SummaryFear of falling (FoF) is a common condition in older age. However, there is a paucity of research on its prevalence, impact and treatment in older people with dementia. People with dementia have an increased risk of falls which present a significant threat to their independence, as well as having a significant economic impact on health and social services. This review outlines the key issues in relation to FoF, current guidelines and assessment tools and their use for people with dementia. Further research needs to be completed in both addressing the specific assessment barriers that people with dementia may face regarding the use of current FoF tools, with further exploration surrounding the individual's experience of FoF and how this may be impacting upon their quality of life and functionality. Until a well-validated method has been developed, clinicians need to utilize available tools as guidelines, seek the assistance of proxies at all stages of the care journey, and use clinical judgement to assess FoF in patients with dementia.
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Schwenk M, Hauer K, Zieschang T, Englert S, Mohler J, Najafi B. Sensor-derived physical activity parameters can predict future falls in people with dementia. Gerontology 2014; 60:483-92. [PMID: 25171300 DOI: 10.1159/000363136] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is a need for simple clinical tools that can objectively assess the fall risk in people with dementia. Wearable sensors seem to have the potential for fall prediction; however, there has been limited work performed in this important area. OBJECTIVE To explore the validity of sensor-derived physical activity (PA) parameters for predicting future falls in people with dementia. To compare sensor-based fall risk assessment with conventional fall risk measures. METHODS This was a cohort study of people with confirmed dementia discharged from a geriatric rehabilitation ward. PA was quantified using 24-hour motion-sensor monitoring at the beginning of the study. PA parameters (percentage of walking, standing, sitting, and lying; duration of single walking, standing, and sitting bouts) were extracted using specific algorithms. Conventional assessment included performance-based tests (Timed Up and Go Test, Performance-Oriented Mobility Assessment, 5-chair stand) and questionnaires (cognition, ADL status, fear of falling, depression, previous faller). Outcome measures were fallers (at least one fall in the 3-month follow-up period) versus non-fallers. RESULTS 77 people were included in the study (age 81.8 ± 6.3; community-dwelling 88%, institutionalized 12%). Surprisingly, fallers and non-fallers did not differ on any conventional assessment (p = 0.069-0.991), except for 'previous faller' (p = 0.006). Interestingly, several PA parameters discriminated between the groups. The 'walking bout average duration', 'longest walking bout duration' and 'walking bout duration variability' were lower in fallers, compared to non-fallers (p = 0.008-0.027). The 'standing bout average duration' was higher in fallers (p = 0.050). Two variables, 'walking bout average duration' [odds ratio (OR) 0.79, p = 0.012] and 'previous faller' (OR 4.44, p = 0.007) were identified as independent predictors for falls. The OR for a 'walking bout average duration' <15 s for predicting fallers was 6.30 (p = 0.020). Combining 'walking bout average duration' and 'previous faller' improved fall prediction (OR 7.71, p < 0.001, sensitivity/specificity 72%/76%). DISCUSSION RESULTS demonstrate that sensor-derived PA parameters are independent predictors of the fall risk and may have higher diagnostic accuracy in persons with dementia compared to conventional fall risk measures. Our findings highlight the potential of telemonitoring technology for estimating the fall risk. RESULTS should be confirmed in a larger study and by measuring PA over a longer period of time.
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Affiliation(s)
- Michael Schwenk
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, College of Medicine, Tucson, Ariz., USA
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Can a tailored exercise and home hazard reduction program reduce the rate of falls in community dwelling older people with cognitive impairment: protocol paper for the i-FOCIS randomised controlled trial. BMC Geriatr 2014; 14:89. [PMID: 25128411 PMCID: PMC4138412 DOI: 10.1186/1471-2318-14-89] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 08/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rate of falls in community dwelling older people with cognitive impairment (CI) is twice that of a cognitively intact population, with almost two thirds of people with CI falling annually. Studies indicate that exercise involving balance and/or a home hazard reduction program are effective in preventing falls in cognitively intact older people. However the potential benefit of these interventions in reducing falls in people with CI has not been established.This randomised controlled trial will determine whether a tailored exercise and home hazard reduction program can reduce the rate of falls in community dwelling older people with CI. We will determine whether the intervention has beneficial effects on a range of physical and psychological outcome measures as well as quality of life of participants and their carers. A health economic analysis examining the cost and potential benefits of the program will also be undertaken. METHODS AND DESIGN Three hundred and sixty people aged 65 years or older living in the community with CI will be recruited to participate in the trial. Each will have an identifiable carer with a minimum of 3.5 hours of face to face contact each week.Participants will undergo an assessment at baseline with retests at 6 and 12 months. Participants allocated to the intervention group will participate in an exercise and home hazard reduction program tailored to their cognitive and physical abilities.The primary outcome measure will be the rate of falls which will be measured using monthly falls calendars. Secondary outcome measures will include the risk of falling, quality of life, measures of physical and cognitive function, fear of falling and planned and unplanned use of health services. Carers will be followed up to determine carer burden, coping strategies and quality of life. DISCUSSION The study will determine the impact of this tailored intervention in reducing the rate of falls in community dwelling older people with CI as well as the cost-effectiveness and adherence to the program. The results will have direct implications for the design and implementation of interventions for this high-risk group of older people. TRIAL REGISTRATION The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry - ACTRN12614000603617.
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Taylor ME, Delbaere K, Lord SR, Mikolaizak AS, Brodaty H, Close JCT. Neuropsychological, Physical, and Functional Mobility Measures Associated With Falls in Cognitively Impaired Older Adults. J Gerontol A Biol Sci Med Sci 2013; 69:987-95. [DOI: 10.1093/gerona/glt166] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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