Does Obesity Increase the Risk and Severity of Falls in People Aged 60 Years and Older? A Systematic Review and Meta-analysis of Observational Studies

The interplay between lying, sitting, standing, moving, and walking on obesity risk in older adults: a compositional and isotemporal substitution analysis

INTRODUCTION

Obesity in older adults is linked to various chronic conditions and decreased quality of life. Traditional physical activity guidelines often overlook the specific postures and movements that older adults engage in daily. This study aims to explore the compositional associations between posture-specific behaviours and obesity risk in younger (M = 67.35 ± 2.03 years) and older (M = 75.73 ± 4.17 years) groups of older adults and investigate the differences in body mass index (BMI) associated with replacing time spent in lying, sitting and standing with moving or walking.

METHODS

This cross-sectional study involved 309 older adults aged 65 and above from Czech Republic. Participants' movement behaviours, including lying, sitting, standing, moving, and walking, were measured using accelerometers. The data were analysed using compositional data analysis (CoDA) and isotemporal substitution models to assess the impact of reallocating time between different activities on self-reported (BMI).

RESULTS

The younger group engaged in more overall movement (193.84 min/day vs. 172.41 min/day) and walking (92.15 min/day vs. 76.62 min/day) than the older group. Significant estimated increases in BMI were associated with reallocating 30 min from movement to lying, sitting, or standing (up to + 3.31 kg/m²), while reallocating the same amount of time from lying, sitting, or standing to movement was associated with estimated reductions in BMI (up to - 2.54 kg/m²). In the older group, reallocating time from slow walking to lying or sitting was associated with estimated increases in BMI (up to + 1.86 kg/m²), while increasing time spent slow walking at the expense of lying or sitting theoretically reduced BMI (up to - 0.95 kg/m²).

CONCLUSIONS

The findings suggest that promoting movement and walking, including both slow and fast walking, may play a role in managing obesity risk in older adults. This study highlights the potential benefits of reducing sedentary time and encouraging low-intensity physical activity tailored to the capabilities of seniors, especially those aged 70+, as a possible strategy to mitigate obesity risk. However, further longitudinal studies are needed to confirm these associations and explore causal relationships.

Perioperative inpatient falls for anterior cervical discectomy and fusion patients are on the rise: risk factors associated with this "never event"

BACKGROUND CONTEXT

Patients undergoing anterior cervical discectomy and fusion (ACDF) often have brief inpatient stays and may be at risk for inpatient falls (IPFs). Such IPFs should be preventable and have been termed a "never event" by the National Quality Forum, an affiliate of The Joint Commission. Despite increasing attention to IPF prevention, no studies have investigated the incidence, trends, and factors associated with IPFs among ACDF patients.

PURPOSE

To characterize the trends in the incidence of ACDF-related IPFs and their risk factors.

STUDY DESIGN/SETTING

Retrospective cohort study.

PATIENT SAMPLE

Adult patients who underwent inpatient ACDF between 2010 and Q3 2022 were abstracted from a large, national, multi-insurance administrative claims database.

OUTCOME MEASURES

Incidence, trends, and factors associated with IPFs.

METHODS

Adult patients who had undergone single or multi-level inpatient ACDF were identified by administrative coding. Exclusion criteria included: patients <18 years of age, those who underwent outpatient ACDF, concurrent posterior cervical procedures, thoracic or lumbar fusion, and those with trauma, neoplasm, or infection diagnosed within 90-days prior to surgery. The subset of patients who suffered an IPF were subsequently identified. The annual incidence of IPFs was analyzed over the study years and various risk factors were assessed for their correlation with IPFs by multivariable logistic regression. To determine the association between IPF and length of stay (LOS), patients with relative to without IPF were matched 1:4 based on age, sex, and Elixhauser Comorbidity Index (ECI) and compared by multivariable logistic regression.

RESULTS

Of the 294,165 inpatient ACDF patients meeting inclusion criteria, IPFs were identified for 5,548 (1.9%). Between 2010 and Q3 2022, the annual incidence of IPFs increased from 309 (1.1%) to 515 (4.8%) for patients undergoing ACDF (p<.001). Independent predictors of an IPF were: hospital-acquired delirium (odds ratio [OR] 4.50), history of prior falls (OR 3.38), hospital-acquired psychosis (OR 3.17), alcohol use disorder (OR 2.68), cervical myelopathy (relative to radiculopathy) (OR 2.66), socioeconomically disadvantaged patients (OR 1.85), history of dementia (OR 1.77), underweight body mass index (BMI <18.5) (OR 1.67), multi-level ACDF (OR 1.43), history of prior cervical surgery (OR 1.41), male sex (OR 1.37), Medicaid insurance (OR 1.34), older age (OR 1.33), patients in the northeast United States (OR 1.15), and obese BMI >30 (OR 1.15) (p<.001 for all). Relative to patients without IPF, patients who suffered an IPF following ACDF demonstrated incrementally increasing odds of extended LOS (4-5 days [OR 2.63], 6 to 7 days [OR 3.85], 7+ days [OR 6.78]) (p<.001 for all).

CONCLUSION

In this robust national sample of patients undergoing inpatient ACDF, IPFs were identified for 1.9%, with an increasing annual incidence over the years. Among these patients, various factors were associated with their occurrence, many of which may be potentially modifiable. These findings have major clinical implications on care pathway optimization regarding early identification of high-risk patients undergoing ACDF and lays a foundation for the refinement of multidisciplinary fall prevention programs.

Bone health in adults with obesity before and after interventions to promote weight loss

Obesity and its associated comorbidities constitute a serious and growing public health burden. Fractures affect a substantial proportion of people with obesity and result from reduced bone strength relative to increased mechanical loading, together with an increased risk of falls. Factors contributing to fractures in people with obesity include adverse effects of adipose tissue on bone and muscle and, in many people, the coexistence of type 2 diabetes. Strategies to reduce weight include calorie-restricted diets, exercise, bariatric surgery, and pharmacological interventions with GLP-1 receptor agonists. However, although weight loss in people with obesity has many health benefits, it can also have adverse skeletal effects, with increased bone loss and fracture risk. Priorities for future research include the development of effective approaches to reduce fracture risk in people with obesity and the investigation of the effects of GLP-1 receptor agonists on bone loss resulting from weight reduction.

Medical weight loss in older persons with obesity

The prevalence of individuals with obesity or overweight has steadily increased over the past decades both worldwide, and in the United States. This trend is also evident in the older adult population, which has experienced a continuous rise in the number of individuals with overweight or obesity. This is relevant due to the impact of obesity in older adults' quality of life, physical function, morbidity, and healthcare costs. This review aims to provide practical guidance and currently available approaches for healthcare professionals in managing this population. Both non-pharmacological methods such as intensive behavioural therapy, nutritional interventions, and physical activity, as well as anti-obesity medications, are discussed, with a focus on their potential positive and negative effects in older adults. Additionally, bariatric therapy is evaluated, including current procedures available and the associated results and risks in the older population.

In Silico Modeling of Stress Distribution in the Diseased Ankle Joint

Background/Objectives: Osteoarthritis is a feature of the aging process. Here, we adopted in silico 2D finite element modeling (FEM) for the simulation of diseased ankle joints. We delved into the influence of body weight intensity on the stress distribution caused by subchondral cysts imitating degenerative age-related arthritic changes. Methods: FEM was performed using virtually generated pictorial schemes of the ankle joint skeletal contour. It included a constellation of scenarios with solitary or multiple cysts, or the lack thereof, located centrally, peripherally, or both in the talus and tibia at increased fixed levels of body weight. Results: The modeling showed that the highest stress was in the presence of a solitary central cyst in the talus and two centrally located cysts in the talus and the tibia, with the averaged values of 1.81 ± 0.52 MPa and 1.92 ± 0.55 MPa, respectively; there was a significant increase compared with the 1.24 ± 0.35 MPa in the control condition without cysts. An increase in body weight consistently increased the strain on the ankle joint. In contrast, peripherally located cysts failed to affect the stress distribution significantly. Conclusions: We conclude that subchondral central cysts substantially enhance the stress exerted on the ankle joint and its vicinity with body weight dependence. FEM's ability to predict the location and magnitude of subchondral stress changes when confirmed in clinical trials might help to optimize the management of age-related degenerative joint changes.

Sarcopenic obesity defined by the ESPEN and EASO consensus statement in older women: Risk of falls and bone mineral density implications

PURPOSE

To apply the ESPEN-EASO diagnostic criteria for Sarcopenic Obesity (SO) in older women and to assess its association with the risk of falls, fear of falls (FOF), and bone mineral density (BMD).

METHODS

After exclusion criteria, 232 women aged ≥60 years (68.2 ± 6.1) were enrolled in the study. Volunteers had handgrip strength (HGS; dynamometer) and body composition assessed by DXA before risk of falls was evaluated using the QuickScreen and FOF evaluated by the Falls Efficiency Scale. SO was defined according to the ESPEN-EASO algorithm, which includes reduced HGS and fat-free mass, and elevated fat mass.

RESULTS

The prevalence of SO was 6.5 %, which was associated with a higher proportion of fallers in the previous year (X2 6.2, P = 0.04), reduced reaction time (X2 6.2, P = 0.04), reduced sit-to-stand performance (X2 6.2, P = 0.04), and a higher probability of falls [ꭓ2(6) = 17.689, p = 0.004]. FOF was lower in the eutrophic group (ꭓ2(2) = 15,662, p < 0,001) than both the obesity (p = 0.001) and SO (p = 0.05) groups. For total and femoral neck BMD, the eutrophic group presented significantly lower values (1.05 and 0.79 g/cm2) than the obesity group (1.10 and 0.87 g/cm2), but similar to the SO group (1.02 and 0.83 g/cm2). These results remained significant after adjustments for potential confounders.

CONCLUSIONS

SO specified by the ESPEN-EASO framework was associated with a higher risk of falls but not with increased FOF than obesity alone. The favorable influence of overweight and obesity on BMD seems to be attenuated in individuals with SO. Our findings support the clinical significance of the ESPEN-EASO definition.

The Impact of Demographics and Comorbidities on Fall Incidence and Prevalence in Older Adults

Introduction

Falls among older adults are more than mere accidents; they are a silent epidemic, profoundly impacting the health and well-being of millions of older adults worldwide. This study examines the incidence and prevalence of falls among individuals aged 65 and above, focusing on the influence of demographic factors and comorbid conditions such as hypertension, diabetes mellitus, cancer, and obesity.

Methods

A retrospective cohort study was conducted using data from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) from 2019 to 2023. The study population included 16,400 individuals aged 65 and above who presented with fall-related trauma. Data on demographics, clinical diagnoses, procedures, and comorbid conditions were analyzed using descriptive statistics to evaluate the incidence and prevalence of falls.

Results

The mean age of the study population was 77.3 years, with a higher proportion of females (60.97%) compared to males (39.02%). Despite the larger number of female participants, incidence and prevalence of falls were highest among individuals aged 65-69 years, and fall rates were notably higher among males compared to females. This suggests that while fewer in number, males in our study experienced falls more frequently. Patients with hypertension had the highest incidence proportion (56.67%) and prevalence (75.75%) among comorbid conditions.

Conclusions

Falls among older adults are significantly influenced by demographic factors and comorbid conditions. Hypertension, in particular, is associated with the highest fall risk. These findings highlight the need for targeted interventions to manage comorbidities and reduce fall risks among older adult patients.

Health literacy and falls among community-dwelling older people in China: is there a sex difference?

BACKGROUND

Health literacy is one of the important determinants of healthy aging, yet few studies have focused on the association between health literacy and falls.

AIMS

This study aims to explore the relationship between health literacy and falls, with a focus on sex differences among older people in China.

METHODS

This cross-sectional study enrolled 2,144 older people aged ≥ 60 years from Shandong Province, China in 2021. We used general health literacy screening scale to assess health literacy, and collected the incidence of falls in the past year. Logistic regression models were employed to analyze the relationship between health literacy and falls. We investigated the sex differences by subgroup analyses.

RESULTS

The prevalence of adequate health literacy and falls was 21.7% (95% CI: 20.0-23.5%) and 25.4% (95% CI: 23.6-27.3%), respectively. In a fully-adjusted model, adequate health literacy was associated with a lower prevalence of falls in older adults (OR = 0.71, 95%CI: 0.52-0.96). Subgroup analysis revealed sex differences in this relationship (Pfor interaction <0.05). Specifically, the female group showed no significant relationship between health literacy and falls (OR = 0.92, 95% CI: 0.59-1.44); however, the male group demonstrated a robust and significant relationship (OR = 0.58, 95% CI: 0.37-0.90).

CONCLUSIONS

Older people with adequate health literacy have lower prevalence of falls, which appears to differ by sex. This relationship was significant among men but not among women. These findings emphasize the need for policymakers and healthcare providers to consider sex differences when designing and implementing programs aimed at improving health literacy and preventing falls in the older population. Improving health literacy among older women could be a strategic component in bridging sex inequality in falls.

Examining the influence of body fat distribution on standing balance and functional performance in overweight female patients with degenerative lumbar disease

Introduction: Degenerative lumbar disease (DLD) is a prevalent disorder that predominantly affects the elderly population, especially female. Extensive research has demonstrated that overweight individuals (categorized by body fat distribution) have a higher susceptibility to developing DLD and an increased risk of falling. However, there is limited research available on the standing balance and functional performance of overweight females with DLD. Aims: To determine the impact of body fat distribution on standing balance and functional performance in overweight females with DLD. Methods: This cross-sectional study evaluated thirty females with DLD were categorized into three types of body fat distribution based on body mass index (BMI) and waist-hip ratio, specifically as android-type, gynoid-type, and normal weight groups. In addition, a control group of ten age-matched females with normal weight was recruited. The Visual Analogue Scale, Roland Morris Disability Questionnaire, Cobb angle (Determined using x-ray), and body composition (Determined using the InBody S10), were conducted only on the DLD groups. All participants were assessed standing balance in the anteroposterior and mediolateral directions. The functional assessments included timed-up-and-go and 5-times-sit-to-stand tests. Results: There were 10 people in each group. Android-type (Age = 65.00 ± 6.34 years; BMI = 26.87 ± 2.05 kg/m2), Gynoid-type (Age = 65.60 ± 4.99 years; BMI = 26.60 ± 1.75 kg/m2), Normal weight (Age = 65.70 ± 5.92 years; BMI = 22.35 ± 1.26 kg/m2), and Control (Age = 65.00 ± 5.23 years; BMI = 22.60 ± 1.12 kg/m2). The android-type group had higher body fat, visceral fat, and lower muscle mass (p < 0.05), along with an increased Cobb angle (p < 0.05). They showed greater ellipse area, total excursion, and mean distance in the anteroposterior direction (p < 0.05). During the functional performance assessments, the android-type group had longer durations in both the 5-times-sit-to-stand and timed-up-and-go tasks (p < 0.05). Conclusion: Our study found that android-type overweight individuals showed postural instability, reduced functional performance, and insufficient lower limb muscle strength and mass. These findings might help physical therapists in planning interventions, as they imply that patients with DLD may require specific types of standing balance training and lower extremities muscle-strengthening based on their body fat distribution. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT05375201.

Age-Related Reduction of Foot Intrinsic Muscle Function and the Relationship with Postural Stability in Old Adults

Introduction

The risk of falls among the elderly significantly increases, which has become a serious public health concern. Falls can not only lead to serious complications such as fractures and brain injuries but also limit their mobility function, reducing quality of life. Foot intrinsic muscles (FIMs) are an essential part of foot core stability even overall postural stability. This study aimed to investigate the effects of aging on the function of FIMs and to explore the influence of FIMs on postural control in the elderly.

Materials and Methods

56 healthy old participants (60-75 years) and 57 healthy young participants (18-29 years) joined this study. An ergoFet dynamometer was used to determine foot muscle strength (Doming, T1, T23 and T2345), and ankle muscle strength (plantarflexion and dorsiflexion). The morphology of FIMs and extrinsic foot muscle was determined using a Doppler ultrasound system, whereas the postural stability was assessed through Limits of Stability test. Independent samples t-test was used to determine the differences in strength and morphological parameters and Spearman correlation analysis was used to determine whether an association existed between muscle strength and postural stability parameters in the elderly.

Results

Compared with young adults, foot muscle strength and ankle muscle strength (Doming, T1, T23, T2345, dorsiflexion, and plantarflexion, all p <0.05) and the morphology of foot muscles (all p <0.05) were significantly reduced in the elderly. The strength of FIMs and the limit of stability (r = 0.302-0.424, all p <0.05) were significantly correlated in the elderly.

Conclusion

Compared with young adults, the weakness of strength as well as the morphological decline of the intrinsic and extrinsic foot muscles were found in the elderly. In addition, a correlation was observed between FIM's strength and postural stability in the elderly, suggesting their potential role in posture stability.

Chemotherapy-Induced Peripheral Neuropathy and Falls in Cancer Survivors Relate to Digital Balance and Gait Impairments

PURPOSE

Chemotherapy-induced peripheral neuropathy (CIPN) and falls can be persistent side effects of cancer treatment. Standing postural sway and gait tests with body-worn, inertial sensors provide objective digital balance and gait measures that represent several different domains controlling mobility. Specific domains of balance and gait that related to neuropathy and falls are unknown. The aim of this study was to determine which domains of balance and gait differed between cancer survivors who report (1) CIPN symptoms versus no symptoms, (2) a history of falls in the past 6 months versus no falls, and (3) prospective falls over 12 months versus no falls.

METHODS

Postural sway during 30 seconds of quiet standing and gait characteristics from a 7-m timed up and go test were recorded with six synchronized inertial sensors (Opals by APDM Wearable Technologies, a Clario Company) in 425 older, female cancer survivors (age: 62 ± 6 years). A principal component analysis (PCA) approach was used to identify independent domains of mobility from 15 balance and gait measures.

RESULTS

PCA analysis revealed five independent domains (PC1 = sway amplitude, PC2 = gait pace, PC3 = sway frequency, PC4 = gait spatial-temporal, and PC5 = turning) that accounted for 81% of the variance of performance. Cancer survivors who reported CIPN symptoms had significantly higher sway frequency (PC3) than asymptomatic survivors. Past fallers had significantly larger sway area (PC1) and slower gait pace (PC2) than nonfallers. Prospective fallers showed a significantly smaller stride length (PC4) than nonfallers.

CONCLUSION

Digital balance and gait measures using wearable sensors during brief standing and walking tests provide objective metrics of CIPN-related mobility impairment and fall risk that could be useful for oncology clinical trials.

Body composition, balance, functional capacity and falls in older women

BACKGROUND

The aim of this study was to examine the association of body composition, muscle strength, balance, and functional capacity on falls and fall injuries among community-dwelling older women.

METHODS

The study comprised of a 2-year randomized controlled trial involving 914 women with an average age of 76.5 (SD = 3.3) years at baseline. The women were assigned to exercise intervention (n = 457) and control groups (n = 457). Clinical measurements were conducted at baseline, 12 months and 24 months.

RESULTS

During the 2-year follow up, total of 546 women (59.7%) sustained a fall. The total number of falls was 1380 and out of these, 550 (40%) of falls were non-injurious and 745 (54%) were injurious. Higher femoral neck bone mineral density (BMD) was associated with a higher overall risk of falls [RR = 2.55 (95% CI = 1.70-3.84, p < 0.001)], but was a protective factor for severe fall injuries [RR = 0.03 (95% CI = 0.003-0.035, p < 0.01)]. Slower Timed Up and Go (TUG) was associated with an increased overall risk of falls [RR = 1.07 (95% CI = 1.05-1.10, p < 0.001)] and injuries requiring medical attention [RR = 1.10 (95% CI = 1.02-1.19, p = 0.02)]. Longer single leg standing time was a protective factor for falls [RR = 0.99 (95% CI = 0.99-1.00, p < 0.01)] and overall injurious falls [RR = 0.99 (95% CI = 0.99-1.00, p = 0.02)].

CONCLUSION

For postmenopausal women with higher femoral neck BMD appear to sustain more falls, but have a lower risk of severe fall injuries. Better TUG and single leg standing time predict lower risk of falls and fall injuries.

Associations of lower-limb muscle strength performance with static and dynamic balance control among older adults in Taiwan

Background

Aging is an inevitable process of life development. These physical changes can cause a decline in the functional adaptability and health status of older adult individuals.

Aims

The purpose of this study was to investigate the association of lower-limb muscle strength performance with static and dynamic balance control among older adults in Taiwan.

Methods

We conducted a cross-sectional study and reviewed data derived from the National Physical Fitness Survey in Taiwan 2015-2016. A total of 20,846 Taiwanese older adult individuals aged 65 years old or older were recruited as study participants. Demographic characteristics, anthropometric assessments, lifestyle habits, and health-related physical fitness measurements from this dataset were analyzed using the chi-square test, one-way analysis of variance, and linear regression analysis. Lower-limb muscle strength performance was classified into 4 groups based on quartile (Quartile 1 [Q1], Quartile 2 [Q2], Quartile 3 [Q3], and Quartile 4 [Q4]) values.

Results

Increased lower-limb muscle strength levels were significantly associated with static balance in men (Q2: β = 2.539, p < 0.0001; Q3: β = 4.590, p < 0.0001; Q4: β = 7.700, p < 0.0001) and women (Q2: β = 2.022, p < 0.0001; Q3: β = 4.179, p < 0.0001; Q4: β = 6.920, p < 0.0001) after adjusting for potential confounders. In addition, we observed that increased lower-limb muscle strength levels were significantly associated with dynamic balance in men (Q2: β = -1.661, p < 0.0001; Q3: β = -2.434, p < 0.0001; Q4: β = -3.091, p < 0.0001) and women (Q2: β = -1.660, p < 0.0001; Q3: β = -2.548, p < 0.0001; Q4: β = -3.196, p < 0.0001) after adjusting for potential confounders.

Conclusion

Lower-limb muscle strength was the most important factor, as it was an improved method for static and dynamic balance control in both genders.

Center of mass motion and plantar pressure distribution during walking in overweight individuals

BACKGROUND

Gait imbalance has been reported in overweight individuals and could further impair their mobility and quality of life. As the feet are the most distal part of the body and sensitively interface with external surroundings, evaluating the plantar pressure distribution can provide critical insights into their roles in regulating gait balance control. Therefore, the purpose of this study was to evaluate the effect of body weight and different gait speeds on the plantar pressure distribution and whole-body center of mass (COM) motion during walking.

METHODS

Eleven overweight individuals (OB) and 13 non-overweight individuals (NB) walked on a 10-meter walkway at three speed conditions (preferred, 80% and 120% of preferred speed). Gait balance was quantified by the mediolateral COM sway. Plantar pressure data were obtained using wireless pressure-sensing insoles that were inserted into a pair of running shoes. Analysis of variance models were used to examine the effect of body size, gait speeds, or their interactions on peak mediolateral COM and peak plantar pressure during walking.

RESULTS

Significant group effects of peak plantar pressure under the lateral forefoot (P = 0.03), lateral midfoot (P = 0.02), and medial heel (P = 0.02) were observed. However, the mediolateral COM motion and spatiotemporal gait parameters only revealed significant speed effects.

SIGNIFICANCE

Findings from this study indicated that overweight individuals exhibited increased plantar pressure under the lateral aspect of the foot, particularly during the late stance phase of walking, in an effort to maintain a comparable mediolateral COM motion to that of non-overweight individuals. Such elevated pressure in overweight individuals may potentially increase the risk of musculoskeletal pathology in the long term. The identified patterns are noteworthy as they have practical implications for designing targeted interventions and improving the overall health of individuals with a high BMI.

Assessment of lower limb muscle strength can predict fall risk in patients with chronic liver disease

Falls are caused by a combination of factors, including loss of lower limb muscle strength (LMS), and associated with declined performance status (PS). Age-related sarcopenia is generally associated with decreased muscle mass and strength of lower limb muscle but without a noticeable loss of those of upper limb or trunk muscle. However, no reports have focused on falls or LMS in chronic liver disease (CLD) patients. This study is the first to analyze the risk factors for falls in patients with CLD, focusing on LMS measurement using the Locomoscan. This study enrolled 315 CLD patients whose LMS was measured. The patients who experienced falls more than 1 year ago or during the observation period were classified as those who experienced falls. We found that risk factors for falls were PS1/2 and decreased LMS (< 0.32 N/kg). The group with sarcopenia had a higher frequency of decreased LMS (54 vs. 26%, p = 0.001) and falls (24 vs. 4.4%, p < 0.001) compared to the non-sarcopenia group. This study found that decreased LMS was an independent risk factor for falls. Assessment of LMS may be used as a better marker associated with the risk of falls in patients with CLD.

Association between obesity and fracture risk in Chinese women above 50 years of age: a prospective cohort study

BACKGROUND

Fractures present serious health challenges for older adults, including premature mortality and reduced quality of life. Obesity has become significantly prevalent in China. However, the association between obesity and fractures remains unclear. This study aimed to assess the association between obesity and fractures among Chinese women above 50 years of age.

METHODS

A prospective cohort study was designed based on the China Health and Nutrition Survey, using data from 1997 to 2015. The average follow-up duration was seven years. Trained investigators measured body mass index (BMI) and waist circumference (WC) at baseline. Obesity was defined according to World Health Organization recommendations. Waist-to-height ratio (W-HtR) was calculated, with 0.5 as the cutoff value. Onset of fractures, self-reported by the participants during the follow-up period, was the primary outcome. Cox hazard regression models were used to assess the association between BMI, WC, W-HtR and subsequent risk of fracture. A sensitivity analysis was conducted by multiple imputation of missing data on the variables at baseline.

RESULTS

A total of 2,641 women aged ≥ 50 years were involved in the study. In all the models, no significant association existed between BMI and fracture risk. However, women with WC ≥ 88 cm had significantly higher risk of fracture than those with WC < 80 cm according to both the unadjusted (HR = 1.744, 95% CI: 1.173-2.591) and adjusted models (HR = 1.796, 95% CI: 1.196-2.695). In addition, W-HtR and fracture risk were positively associated according to both the unadjusted (HR = 1.798, 95% CI: 1.230-2.627) and adjusted models (HR = 1.772, 95% CI: 1.209-2.599). Results of the sensitivity analysis were consistent with those of the above analyses.

CONCLUSIONS

Abdominal obesity increased the risk of all-cause fractures in Chinese women ≥ 50 years old. Intervention strategies and measures to prevent or address abdominal obesity would be helpful to decrease the fracture incidence.

A Clinical Measure of Trunk Neuromuscular Function Predicts Falling in Older Adults With Chronic Low Back Pain

BACKGROUND AND PURPOSE

Older adults with low back pain (LBP) are at risk for falling, but condition-specific mechanisms are unknown. Trunk neuromuscular function is critical for maintaining balance during mobility tasks and is often impaired in older adults with LBP. The purpose of this study was to assess whether aberrant lumbopelvic movements (or aberrant movements), a clinical index of trunk neuromuscular function, were associated with increased fall risk among older adults with chronic LBP over a 12-month follow-up period.

METHODS

This study analyzed data from a prospective cohort study of 250 community-dwelling older adults with chronic LBP. Participants were screened for 4 aberrant movements during 3 trials of forward flexion from a standing position: instability catch, painful arc, altered lumbopelvic rhythm, and Gower's sign. Aberrant movements were totaled to yield a summary score (ie, 0-4). Prospective falls were monitored via monthly fall calendars for 12 months. A generalized linear model with Poisson distribution and log link function was used to evaluate the association between aberrant movements and prospective fall risk. Age, sex, body mass index, LBP intensity, dynamic balance performance, prior falls, anxiolytic medication usage, and hip osteoarthritis characteristics were included as covariates in the model.

RESULTS

Baseline aberrant movements were independently associated with greater fall risk (risk ratio = 1.249, 95% CI = 1.047-1.491, P = .014); each 1-unit increase in aberrant movement score imparted a 24.9% increase in the risk of falling.

CONCLUSIONS

Aberrant movements increased the risk of falling among older adults with chronic LBP over a 1-year span.

Exercise therapy as a digital therapeutic for chronic disease management: consideration for clinical product development

Digital exercise therapies (DET) have the potential to bridge existing care gaps for people living with chronic conditions. Acting as either a standalone, embedded within multi-modal lifestyle therapy, or adjunct to pharmacotherapy or surgery, evidence-based DETs can favorably impact the health of a rapidly growing population. Given the nascent nature of digital therapeutics, the regulatory landscape has yet to mature. As such, in the absence of clear guidelines clinical digital product developers are responsible for ensuring the DET adheres to fundamental principles such as patient risk management and clinical effectiveness. The purpose of this narrative review paper is to discuss key considerations for clinical digital product developers who are striving to build novel digital therapeutic (DTx) solutions and thus contribute towards standardization of product development. We herein draw upon DET as an example, highlighting the need for adherence to existing clinical guidelines, human-centered design and an intervention approach that leverages the Chronic Care Model. Specific topics and recommendations related to the development of innovative and scalable products are discussed which ultimately allow for differentiation from a basic wellness tool and integration to clinical workflows. By embodying a code of ethics, clinical digital product developers can adequately address patients' needs and optimize their own future digital health technology assessments including appropriate evidence of safety and efficacy.

The combination of locomotive syndrome and poor sleep quality is a risk factor of falls among community-dwelling middle-aged and older women: A cross-sectional study

AIM

The combination of locomotive syndrome (LS) and poor sleep quality (PQ) has not yet been shown to result in falls or to affect bone conditions in old age and middle age. [Correction added on 1 December 2023, after first online publication: The preceding sentence has been updated for clarity.] METHODS: This cross-sectional study enrolled 2233 community-dwelling middle-aged to older Japanese women. LS and PSQ were assessed by the stand-up test, two-step test, the 25-question Geriatric Locomotive Function Scale, and the Pittsburgh Sleep Quality Index (PSQI). Participants with both LS 1-3 (any) and a PSQI score ≥6 were classified as belonging to the LS(+)/PSQ(+) group. The incidence of falls in the previous month was collected using a self-administered questionnaire. Bone conditions were evaluated using an ultrasonic bone densitometer.

RESULTS

The LS(+)/PSQ(+) group independently had a higher risk of falls after adjusting for confounding factors than the LS(-)/PSQ(-) group using multiple logistic regression analysis (odds ratio 1.92, 95% confidence interval 1.01-3.65, P < 0.05). No relationships between LS(-)/PSQ(+) and LS(+)/PSQ(-) groups and the incidences of fall were observed (P > 0.05). [Correction added on 1 December 2023, after first online publication: The two preceding sentences have been corrected to provide greater clarity.] The LS(+)/PSQ(+) group had lower trabecular bone density and cortical bone thickness than the LS(-)/PSQ(-) group (P < 0.05).

CONCLUSION

The combination of LS and PSQ is an independent risk factor of falls, indicating that assessing both LS and PSQ could be useful in detecting middle-aged and older women with low bone density and thickness who fall easily at an early stage. Geriatr Gerontol Int 2023; 23: 912-918.

Balance Confidence Modulates the Association of Gait Speed With Falls in Older Fallers: A Prospective Cohort Study

OBJECTIVES

Self-perceived balance confidence (BC) and gait speed influence falls. Whether they modulate each other in fall prediction stays uncertain. This study examined whether and how BC modulated the association between gait speed and falls.

DESIGN

Prospective observational cohort study.

SETTING AND PARTICIPANTS

Older adults who were community-dwelling, ≥65 years old, able to walk for 10 meters independently, and had 1 or more falls in the past year were assessed at a research clinic.

METHODS

Participants were followed up trimonthly for 12 months after the baseline. Optimal cutoff values for gait speed for prospective falls were identified by classification and regression tree analysis. Associations among gait speed, BC, and falls were estimated with negative binomial regression models. Subgroup analyses for high and low BC were performed. Covariates such as basic demographics, generic cognition, fall histories, and other physical functions were adjusted.

RESULTS

During the follow-up period, 65 (14%) of the 461 included participants (median age 69.0 ± 10.0 years, range 60-92) reported 83 falls in total. In both the pooled and subgroup analyses for the low- and high-BC groups, the high-speed subgroup (≥1.30 m/s) showed an increased fall risk compared with the moderate-speed subgroup (≥0.81 and <1.30 m/s) [adjusted odds ratio (OR), 1.84-2.37; 95% CI, 1.26-3.09]. A statistically significant linear association between gait speed and falls was shown in the high-BC group. In the low-BC group, a u-shaped association was evident (adjusted OR, 2.19-2.44; 95% CI, 1.73-3.19) with elevated fall risks in both the high- and low-speed subgroups compared with the moderate-speed subgroup (adjusted OR, 1.84-3.29; 95% CI, 1.26-4.60).

CONCLUSIONS AND IMPLICATIONS

BC modulated the association between gait speed and falls. There were linear and nonlinear associations between gait speed and falls in people with high and low BC, respectively. Clinicians and researchers should consider the effects of BC when predicting falls with gait speed.

Minimum number of inertial measurement units needed to identify significant variations in walk patterns of overweight individuals walking on irregular surfaces

Gait data collection from overweight individuals walking on irregular surfaces is a challenging task that can be addressed using inertial measurement unit (IMU) sensors. However, it is unclear how many IMUs are needed, particularly when body attachment locations are not standardized. In this study, we analysed data collected from six body locations, including the torso, upper and lower limbs, to determine which locations exhibit significant variation across different real-world irregular surfaces. We then used deep learning method to verify whether the IMU data recorded from the identified body locations could classify walk patterns across the surfaces. Our results revealed two combinations of body locations, including the thigh and shank (i.e., the left and right shank, and the right thigh and right shank), from which IMU data should be collected to accurately classify walking patterns over real-world irregular surfaces (with classification accuracies of 97.24 and 95.87%, respectively). Our findings suggest that the identified numbers and locations of IMUs could potentially reduce the amount of data recorded and processed to develop a fall prevention system for overweight individuals.

Safety and Efficacy of Testosterone Therapy on Musculoskeletal Health and Clinical Outcomes in Men: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

OBJECTIVE

Age-related declines in muscle and bone, alongside a shift toward greater adiposity, contribute to falls and fracture risk. Testosterone is osteogenic, myogenic, and catabolic to fat. As such, we examined the effects of testosterone therapy on musculoskeletal health and clinical outcomes in men.

METHODS

Electronic databases (Medline, Embase, Web of Science, Central) were systematically searched for randomized controlled trials (RCTs) reporting on the effects of testosterone therapy versus placebo on any primary outcome (bone density, muscle mass, fat mass, muscle strength/physical performance) or secondary outcome (falls, fractures, disability, adverse events) in men (≥18 years). A random effects meta-regression examined the effects of testosterone on prespecified outcomes.

RESULTS

One thousand seven hundred twenty-eight men across 16 RCTs were included (mean age: 77.1 ± 7.6 years). Baseline mean serum testosterone ranged from 7.5 ± 0.3 to 18.9 ± 1.2 nmol/L. Compared to placebo, 6 months of testosterone therapy increased hip bone density and total lean mass, but effects for handgrip and total fat mass did not reach statistical significance. No significant effects of testosterone therapy on musculoskeletal outcomes were evident at 12 months. The limited number of RCTs reporting on adverse events/clinical outcomes, and the low incidence of these events across RCTs, prohibited statistical comparisons.

CONCLUSION

After 6 months, testosterone effectively increases hip bone density and total lean mass in men, but its effects are unclear for lumbar spine bone density and handgrip strength. Further, RCTs are needed to clarify the safety and efficacy of testosterone on musculoskeletal health and clinical outcomes.

Age-Related Decline in Cervical Proprioception and Its Correlation with Functional Mobility and Limits of Stability Assessed Using Computerized Posturography: A Cross-Sectional Study Comparing Older (65+ Years) and Younger Adults

Cervical proprioception and its implications on postural stability are crucial in older adults. Understanding their relationship is important in understanding and preventing falls in older adults. This research aims to evaluate the proprioceptive, functional mobility, and limits of stability (LOS) variables among two age groups: individuals aged 65 and above and those below 65. A secondary goal of the study is to analyze the relationship between cervical proprioception, functional mobility, and the LOS.

METHODS

In this cross-sectional study, 100 participants each were included in the older and younger groups. Researchers employed the target reposition technique to assess cervical proprioception and measured the joint position error (JPE) in degrees. Functional mobility was estimated using the Berg balance scale (BBS) and timed up-and-go test (TUG). In addition, dynamic posturography was utilized to evaluate variables related to the LOS, including reaction time, maximum excursion, and directional control.

RESULTS

The magnitudes of the mean cervical JPE are larger (p < 0.001), and functional mobility (p < 0.001) and the LOS (p < 0.001) are impaired in older individuals compared to the younger ones. The cervical proprioception is significantly associated with functional mobility (p < 0.001), and the LOS (p < 0.001).

CONCLUSION

In older adults aged above 65 years, cervical proprioception, functional mobility, and the LOS are impaired. Older adults with greater cervical JPE had more impaired functional mobility and LOS parameters. When evaluating or treating older adults with problems with their balance or falls, these factors should be considered.

A Systematic Review of the Influence of Overweight and Obesity across the Lifespan on Obstacle Crossing during Walking

This study aimed to systematically review and summarize the available data regarding the influence of overweight and obesity across the lifespan on obstacle crossing during walking. Four databases were systematically searched with no limitation on publication date following the Cochrane Handbook for Systematic Reviews and PRISMA guidelines. Only full-text English-language articles published in a peer-reviewed journal were eligible. They had to compare obstacle crossing during walking by overweight or obese individuals with individuals of normal body weight. Five studies were considered eligible. All the studies assessed kinematics; only one assessed kinetics, but none investigated muscle activity or obstacle contact. Compared to normal individuals crossing obstacles, overweight or obese individuals exhibited lower velocity, shorter step length, lower cadence, and less time spent in single-limb support. They also exhibited increased step width, more time spent in double support, and greater trailing leg ground force reaction and centre of mass acceleration. Overall, the small number of included studies did not allow us to draw any conclusions. However, being overweight or obese seems to have a potentially negative influence on the kinematics of gait parameters due to a tendency to trip, fall, and suffer severe fall-related injuries when negotiating obstacles on foot in real-life environments.

CT image-based biomarkers acquired by AI-based algorithms for the opportunistic prediction of falls

Objective

Evaluate whether biomarkers measured by automated artificial intelligence (AI)-based algorithms are suggestive of future fall risk.

Methods

In this retrospective age- and sex-matched case-control study, 9029 total patients underwent initial abdominal CT for a variety of indications over a 20-year interval at one institution. 3535 case patients (mean age at initial CT, 66.5 ± 9.6 years; 63.4% female) who went on to fall (mean interval to fall, 6.5 years) and 5494 controls (mean age at initial CT, 66.7 ± 9.8 years; 63.4% females; mean follow-up interval, 6.6 years) were included. Falls were identified by electronic health record review. Validated and fully automated quantitative CT algorithms for skeletal muscle, adipose tissue, and trabecular bone attenuation at the level of L1 were applied to all scans. Uni- and multivariate assessment included hazard ratios (HRs) and area under the receiver operating characteristic (AUROC) curve.

Results

Fall HRs (with 95% CI) for low muscle Hounsfield unit, high total adipose area, and low bone Hounsfield unit were 1.82 (1.65-2.00), 1.31 (1.19-1.44) and 1.91 (1.74-2.11), respectively, and the 10-year AUROC values for predicting falls were 0.619, 0.556, and 0.639, respectively. Combining all these CT biomarkers further improved the predictive value, including 10-year AUROC of 0.657.

Conclusion

Automated abdominal CT-based opportunistic measures of muscle, fat, and bone offer a novel approach to risk stratification for future falls, potentially by identifying patients with osteosarcopenic obesity.

Advances in knowledge

There are few well-established clinical tools to predict falls. We use novel AI-based body composition algorithms to leverage incidental CT data to help determine a patient's future fall risk.

Age-stratified modifiable fall risk factors in Chinese community-dwelling older adults

BACKGROUND

Fall incident is one of the major causes of mortality and injury in older adults. Modifiable fall risk factors are the targets for fall prevention. Since the status of some fall risk factors can change with age, insights into age-stratified fall risk factors can be beneficial for developing tailored fall prevention strategies for older adults at different ages. Therefore, the objective of this study was to identify fall risk factors in different age groups of older people.

METHODS

The current study analysed data of 14,601 community-dwelling older Chinese (aged 65 years or above) recruited from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, wave 2017-2018). 24 modifiable fall risk factors were selected from the CLHLS as candidate risk factors and multivariable logistic regression was used to identify significant risk factors associated with fall incidents by three age groups (65-79 years, 80-94 years, ≥95 years).

RESULTS

Anxiety is identified across all age groups. Hearing impairment, stroke, rain/water leakage were found in both the 65-79 years and the 80-94 years old groups. Interactions between hearing and stroke and between hearing and rain /water leakage were found in these two groups, respectively. Medication use is a shared factor in both the 65-79 years and the ≥95 years old group.

CONCLUSION

Modifiable fall risk factors varied among age groups, suggesting that customised fall prevention strategies can be applied by targeting at fall risk factors in corresponding age groups.

Associations between the impact of menopausal symptoms and fall-related self-efficacy

OBJECTIVE

To analyze the association between the severity of menopausal symptoms and two important fall risk factors, namely balance confidence and fear of falling, among Portuguese and Spanish postmenopausal women 65 years or older.

METHODS

A cross-sectional, observational study was conducted on 363 women (66.21 ± 9.00 y) from several Portuguese and Spanish locations. The Menopause Rating Scale was used to evaluate the severity of menopausal symptoms, while the Falls Efficacy Scale-International and Activities-specific Balance Confidence Scale-16 items were used to assess balance confidence and fear of falling, respectively. Anxiety and depression (evaluated by the Hospital Anxiety and Depression Scale), age, time since the onset of menopause, body mass index, history of falls, osteoporosis, smoking habit, physical activity level, and nocturia were considered as potential confounders. Independent associations were analyzed after adjusting for potential confounding variables. Student's t test, bivariate correlations, and multivariate linear regression analysis were performed.

RESULTS

A total of 363 women (66.21 ± 9.00 y) participated in the study, 192 from Portugal and 171 from Spain. Linear regression analysis indicates that more severe menopausal symptoms at a somatovegetative level (beta coefficient [β] = -0.25; 95% confidence interval [95% CI], -2.09 to -0.81; P = <0.001), a higher body mass index (β = -0.16; 95% CI, -1.22 to -0.22; P = 0.005), and osteoporosis (β = 0.14; 95% CI, 1.36 to 10.08; P = 0.010) were associated with lower balance confidence values. On the other hand, a higher score in the Menopause Rating Scale somatovegetative domain (β = 0.22; 95% CI, 0.27-0.79; P = <0.001), depression (β = 0.36; 95% CI, 0.59-1.08; P = <0.001), and years after the menopause onset (β = 0.15; 95% CI, 0.04-0.22; P = 0.006) were linked to increased fear of falling.

CONCLUSIONS

The findings of our study show that, after taking into account possible confounders, increased severity of menopausal symptoms at a somatic level was associated with heightened fear of falling and diminished balance confidence.

Evaluation and Treatment of Obesity and Its Comorbidities: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity

The goal of the 8th edition of the Clinical Practice Guidelines for Obesity is to help primary care physician provide safe, effective care to patients with obesity by offering evidence-based recommendations to improve the quality of treatment. The Committee for Clinical Practice Guidelines comprised individuals with multidisciplinary expertise in obesity management. A steering board of seven experts oversaw the entire project. Recommendations were developed as the answers to key questions formulated in patient/problem, intervention, comparison, outcomes (PICO) format. Guidelines underwent multi-level review and cross-checking and received endorsement from relevant scientific societies. This edition of the guidelines includes criteria for diagnosing obesity, abdominal obesity, and metabolic syndrome; evaluation of obesity and its complications; weight loss goals; and treatment options such as diet, exercise, behavioral therapy, pharmacotherapy, and bariatric and metabolic surgery for Korean people with obesity. Compared to the previous edition of the guidelines, the current edition includes five new topics to keep up with the constantly evolving field of obesity: diagnosis of obesity, obesity in women, obesity in patients with mental illness, weight maintenance after weight loss, and the use of information and communication technology-based interventions for obesity treatment. This edition of the guidelines features has improved organization, more clearly linking key questions in PICO format to recommendations and key references. We are confident that these new Clinical Practice Guidelines for Obesity will be a valuable resource for all healthcare professionals as they describe the most current and evidence-based treatment options for obesity in a well-organized format.

Associations between bone mass, hormone levels, and body composition in postmenopausal women

OBJECTIVES

The aim of this study was to explore body composition parameters and hormone levels as risk factors for low bone mass (osteopenia/osteoporosis) in postmenopausal women.

METHODS

We analyzed biorepository samples from 139 postmenopausal women with no clinical evidence of cardiovascular disease. Inclusion criteria were menopause occurring after 40 years of age and no use of hormone therapy in the past 3 months. Bone mineral density and body composition were assessed by dual-energy x-ray absorptiometry. Sex hormone-binding globulin (SHBG) and follicle-stimulating hormone (FSH) levels were measured in all participants. Serum estradiol was measured by gas chromatography/tandem mass spectrometry in a subset of 57 participants. Free estrogen index was calculated by dividing estradiol by SHBG × 100.

RESULTS

Body mass index (25.0 [22.5-26.5] vs 27.7 [26.6-31.9] kg/m 2 , P < 0.001), estradiol (3.0 [2.7-4.5] vs 6.0 [2.7-15.0] pg/mL, P = 0.006), waist circumference (84 ± 9 vs 93 ± 12 cm, P < 0.001), appendicular lean mass (ALM) (15.739 ± 2.129 vs 17.184 ± 2.104 kg, P = 0.001), and fat mass index (9.36 [7.29-11.43] vs 11.38 [9.95-15.33] kg/m 2 , P < 0.001) were lower in women with low bone mass by dual-energy x-ray absorptiometry. Univariate analysis showed that free estrogen index, time since menopause, SHBG, and fat mass were significant predictors of low bone mass, and ALM was a significant predictor against low bone mass. Appendicular lean mass persisted as an independent predictor against low bone mass in multivariate models with fat mass and SHBG. In turn, fat mass was no longer significant in this multivariate model after inclusion of SHBG. No association of FSH with low bone mass was observed.

CONCLUSIONS

Appendicular lean mass was a significant independent predictor against low bone mass in postmenopausal women. Further prospective studies are needed to investigate whether lean mass, fat mass, and FSH have a direct effect on bone mass in postmenopausal women, adding to the consequences of hypoestrogenism in this group.

Use of structural models to elucidate the occurrence of falls among older adults according to abdominal obesity: a cross-sectional study

BACKGROUND

Obesity is a risk factor for falls in older adults, but the effects of body fat distribution and its interaction with other factors are not well established.

OBJECTIVES

To verify the occurrence of falls among older adults with and without abdominal obesity and the effects of sociodemographic, health, and behavioral variables on this outcome.

DESIGN AND SETTING

A cross-sectional study in an urban area of Alcobaça, Brazil.

METHODS

Men and women older than 60 years with (270) and without (184) abdominal obesity were included. Sociodemographic, health, and behavioral data were collected using validated questionnaires in Brazil. Descriptive and path analyses were performed (P < 0.05).

RESULTS

The occurrence of falls was high in participants with abdominal obesity (33.0%). In both groups, a higher number of morbidities (β = 0.25, P < 0.001; β = 0.26, P = 0.002) was directly associated with a higher occurrence of falls. Among participants without abdominal obesity, a lower number of medications (β = -0.16; P = 0.04), a higher number of depressive symptoms (β = 0.15; P = 0.04), worse performance on the agility and dynamic balance tests (β = 0.37; P < 0.001), and lower functional disability for basic activities of daily living (β = -0.21; P = 0.006) were directly associated with the occurrence of falls.

CONCLUSION

Adults older than 60 years with abdominal obesity have a higher prevalence of falls. Different factors were associated with the occurrence of falls in both groups.

Prediction model of all-cause death based on balance ability among middle-aged and older Chinese adults of overweight and obesity

Background

Advances in studies using body indicators to predict death risk. Estimating the balance ability of death risk in middle-aged and older Chinese adults with overweight and obesity is still challenging.

Methods

A retrospective analysis of the data from the China Health and Retirement Study from January 2011 to December 2018. A total of 8,632 participants were randomly divided into 7:3 a training group and a verification group, respectively. Univariable Cox analysis was used to prescreen 17 potential predictors for incorporation in the subsequent multivariable Cox analysis. Nine variables were included in the nomogram finally and validated with concordance index (C-index), calibration plots, Hosmer-Lemeshow test, and internal validation population.

Results

287 participants were death in the training group. One hundred and thirteen participants were death in the verification group. A total of nine indicators were included in the modeling group, including gender, age, marriage, hypertension, diabetes, stroke, ADL, IADL, and balance ability to establish a prediction model. The nomogram predicted death with a validated concordance index of (C-index = 0.77, 95% CI: 0.74-0.80). The inclusion of balance ability variables in the nomogram maintained predictive accuracy (C-index = 0.77, 95% CI: 0.73-0.82). The calibration curve graph and Hosmer-Lemeshow test (P > 0.05 for both the modeling group and the verification group) showed the model has a good model consistency.

Conclusion

In the present study, we provide a basis for developing a prediction model for middle-aged and older people with overweight and obesity. In most cases, balance ability is more reversible than other predictors.

Nutrition Strategies Promoting Healthy Aging: From Improvement of Cardiovascular and Brain Health to Prevention of Age-Associated Diseases

BACKGROUND

An increasing number of studies suggest that diet plays an important role in regulating aging processes and modulates the development of the most important age-related diseases.

OBJECTIVE

The aim of this review is to provide an overview of the relationship between nutrition and critical age-associated diseases.

METHODS

A literature review was conducted to survey recent pre-clinical and clinical findings related to the role of nutritional factors in modulation of fundamental cellular and molecular mechanisms of aging and their role in prevention of the genesis of the diseases of aging.

RESULTS

Studies show that the development of cardiovascular and cerebrovascular diseases, neurodegenerative diseases, cognitive impairment and dementia can be slowed down or prevented by certain diets with anti-aging action. The protective effects of diets, at least in part, may be mediated by their beneficial macro- (protein, fat, carbohydrate) and micronutrient (vitamins, minerals) composition.

CONCLUSIONS

Certain diets, such as the Mediterranean diet, may play a significant role in healthy aging by preventing the onset of certain diseases and by improving the aging process itself. This latter can be strengthened by incorporating fasting elements into the diet. As dietary recommendations change with age, this should be taken into consideration as well, when developing a diet tailored to the needs of elderly individuals. Future and ongoing clinical studies on complex anti-aging dietary interventions translating the results of preclinical investigations are expected to lead to novel nutritional guidelines for older adults in the near future.

Evaluating the difference in walk patterns among normal-weight and overweight/obese individuals in real-world surfaces using statistical analysis and deep learning methods with inertial measurement unit data

Unusual walk patterns may increase individuals' risks of falling. Anthropometric features of the human body, such as the body mass index (BMI), influences the walk patterns of individuals. In addition to the BMI, uneven walking surfaces may cause variations in the usual walk patterns of an individual that will potentially increase the individual's risk of falling. The objective of this study was to statistically evaluate the variations in the walk patterns of individuals belonging to two BMI groups across a wide range of walking surfaces and to investigate whether a deep learning method could classify the BMI-specific walk patterns with similar variations. Data collected by wearable inertial measurement unit (IMU) sensors attached to individuals with two different BMI were collected while walking on real-world surfaces. In addition to traditional statistical analysis tools, an advanced deep learning-based neural network was used to evaluate and classify the BMI-specific walk patterns. The walk patterns of overweight/obese individuals showed a greater correlation with the corresponding walking surfaces than the normal-weight population. The results were supported by the deep learning method, which was able to classify the walk patterns of overweight/obese (94.8 ± 4.5%) individuals more accurately than those of normal-weight (59.4 ± 23.7%) individuals. The results suggest that application of the deep learning method is more suitable for recognizing the walk patterns of overweight/obese population than those of normal-weight individuals. The findings from the study will potentially inform healthcare applications, including artificial intelligence-based fall assessment systems for minimizing the risk of fall-related incidents among overweight and obese individuals.

Mechanisms of motoric cognitive risk-Hypotheses based on a systematic review and meta-analysis of longitudinal cohort studies of older adults

We aimed to refine the hypothesis that motoric cognitive risk (MCR), a syndrome combining measured slow gait speed and self-reported cognitive complaints, is prognostic of incident dementia and other major causes of morbidity in older age. We propose mechanisms on the relationship between motor and cognitive function and describe a roadmap to validate these hypotheses. We systematically searched major electronic databases from inception to August 2021 for original longitudinal cohort studies of adults aged ≥60 years that compared an MCR group to a non-MCR group with any health outcome. Fifteen cohorts were combined by meta-analysis. Participants with MCR were at an increased risk of cognitive impairment (adjusted hazard ratio [aHR] 1.76, 95% CI 1.49-2.08; I²  = 24.9%), dementia (aHR 2.12, 1.85-2.42; 33.1%), falls (adjusted Relative Risk 1.38, 1.15-1.66; 62.1%), and mortality (aHR 1.49, 1.16-1.91; 79.2%). The prognostic value of MCR is considerable and mechanisms underlying the syndrome are proposed.

Obesity Status and Physical Rehabilitation in Older Patients Hospitalized With Acute HF: Insights From REHAB-HF

BACKGROUND

In the REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) trial, a novel, early, transitional, multidomain rehabilitation intervention improved physical function, frailty, quality of life (QOL), and depression in older patients hospitalized for acute decompensated heart failure (ADHF), but the potential impact of baseline obesity on this intervention has not been studied.

OBJECTIVES

This study assessed for treatment interactions by body mass index (BMI) subgroups for a novel rehabilitation intervention in ADHF.

METHODS

Three-month outcomes including Short Physical Performance Battery (SPPB) (primary outcome), 6-minute walk distance (6MWD), and Kansas City Cardiomyopathy Questionnaire (KCCQ) were assessed by baseline BMI (≥30 kg/m2 vs <30 kg/m2). Six-month end points included all-cause rehospitalization and death. All analyses were adjusted for age, sex, clinical site, and ejection fraction category, and 3-month outcomes were also adjusted for baseline measure. The prespecified significance level for treatment interaction by BMI category was P ≤ 0.10.

RESULTS

Of 349 trial participants, 204 (58%) had BMI ≥30 kg/m2 and 145 (42%) <30 kg/m2. Compared with patients with BMI <30 kg/m2, participants with BMI ≥30 kg/m2 were younger (age 71 ± 7 years vs 75 ± 9 years), more frequently women (57% vs 46%), and had significantly worse baseline physical function and QOL. Although interaction P values for 3-month outcomes by BMI were not significant (interaction P > 0.15 for overall measures), adjusted SPPB effect sizes were nominally larger for participants with BMI ≥30 kg/m2 compared with those with BMI <30 kg/m2: +1.7 (95% CI: 0.8-2.7) vs +1.1 (95% CI: -0.1 to 2.2). This difference in SPPB effect size was due largely to improvements in the balance component of the SPPB for participants with BMI ≥30 kg/m2: +0.6 (95% CI: 0.2-1.0) vs 0.0 (-0.6 to 0.5) for those with BMI <30 kg/m2 (interaction P = 0.02). In contrast, adjusted 6MWD and KCCQ effect sizes were smaller for participants with BMI ≥30 kg/m2 compared with those with BMI <30 kg/m2: +21 meters (-17 to 59) vs +53 meters (6-100), and +5.0 (-4 to 14) vs +11 (-0.5 to 22), respectively. There was no significant interaction by BMI for 6-month clinical outcomes (all interaction P > 0.30).

CONCLUSIONS

Older patients with ADHF benefit from the rehabilitation therapy regardless of BMI. Benefits for patients with obesity may be more evident in the multidomain measure of physical function (SPPB), compared with the 6MWD or KCCQ, which may be driven, in part, by the unique aspects of the novel rehabilitation intervention. (A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [REHAB-HF]; NCT02196038).

The epidemiological status of osteoporotic hip fractures: A bicentric comparative and retrospective study

BACKGROUND

Osteoporotic hip fractures have posed a significant burden to society, and more epidemiological data is required.

OBJECTIVE

To compare the epidemiological differences of hip fracture patients in Spain and China.

METHOD

This was a retrospective comparative study. Comparisons were made in terms of morbidity, demographic and anthropometric characteristics, length of stay, cost of hospitalization, and mortality by consulting the medical histories of osteoporotic hip fractures in two hospitals. The t test was used for measurement data, and the X2 test was used for count data. The difference is statistically significant when p< 0.05.

RESULTS

A total of 757 patients were enrolled in this study, with 426 from Virgen Macarena University Hospital (HUVM) and 331 from Xi'an Daxing Hospital (XDH). The average age was 81.4 ± 9.26 and 76.0 ± 8.08 years; the proportion of women was 74.9% and 68.0%, respectively. The incidence of osteoporotic hip fractures in Seville residents over 50 years old was approximately 239 per 100,000 residents, compared to 158 per 100,000 residents in Xi'an. The timing of surgery in Spanish patients was significantly longer than in Chinese patients, 78.7 ± 48.2 vs. 60.7 ± 43.1 hours, p= 0.000. There were 81 deaths in Spain and 43 deaths in China during the one-year follow-up period (p= 0.026).

CONCLUSIONS

In terms of incidence, demographics, surgical methods, and mortality, there are significant differences between hip fracture patients in Seville, Spain and Xi'an, China.

Co-occurrences of fall-related factors in adults aged 60 to 85 years in the United States National Health and Nutrition Examination Survey

A broad set of factors are associated with falling (e.g., age, sex, physical activity, vision, health), but their co-occurrence is understudied. Our objectives were to quantify the number and pattern of co-occurring fall-related factors. Data were obtained from the U.S. National Health and Nutrition Examination Survey (N = 1,957, 60–85 years). Twenty fall-related factors were included (based on previous research), covering a wide range including cognitive, motor, sensory, health, and physical activity measures. The number and pattern of co-occurring fall-related factors were quantified with logistic regression and cluster analyses, respectively. Most participants (59%) had ≥4 fall-risk factors, and each additional risk factor increased the odds of reporting difficulty with falling by 1.28. The identified clusters included: (1) healthy, (2) cognitive and sensory impaired, and (3) health impaired. The mean number of co-occurring fall-related factors was 3.7, 3.8, and 7.2, for clusters 1, 2, and 3, respectively (p<0.001). These observations indicate that co-occurrence of multiple fall-risk factors was common in this national sample of U.S. older adults and the factors tended to aggregate into distinct clusters. The findings support the protective effect of physical activity on fall-risk, the association between gait speed and falls, and the detrimental effect of health-related factors on difficulty with falls (e.g., arthritis, prescription medications). Cluster analyses revealed a complex interplay between sex and BMI that may alter the role of BMI in the etiology of falls. Cluster analyses also revealed a large detrimental effect of health-related factors in cluster 3; it is important to extend current fall interventions (typically focused on balance, flexibility, strength, cognitive, fear factors) to include health-related interventions that target factors such as BMI and arthritis.

An Interpretable Machine Learning Approach to Predict Fall Risk Among Community-Dwelling Older Adults: a Three-Year Longitudinal Study

BACKGROUND

Adverse health effects resulting from falls are a major public health concern. Although studies have identified risk factors for falls, none have examined long-term prediction of fall risk. Furthermore, recent evidence suggests that there are additional risk factors, such as psychosocial factors.

OBJECTIVE

In this 3-year longitudinal study, we evaluated a predictive model for risk of fall among community-dwelling older adults using machine learning methods.

DESIGN

A 3-year follow-up prospective longitudinal study (from 2010 to 2013).

SETTING

Twenty-four municipalities in nine of the 47 prefectures (provinces) of Japan.

PARTICIPANTS

Community-dwelling individuals aged ≥65 years who were functionally independent at baseline (n = 61,883).

METHODS

The baseline survey was conducted from August 2010 to January 2012, and the follow-up survey was conducted from October to December 2013. Both surveys were conducted involving self-reported questionnaires. The measured outcome at the follow-up survey was self-reported multiple falls during the previous year. The 142 variables included in the baseline survey were regarded as candidate predictors. The random-forest-based Boruta algorithm was used to select predictors, and the eXtreme Gradient Boosting algorithm with 10 repetitions of nested k-fold cross-validation was used for modeling and model evaluation. Furthermore, we used shapley additive explanations to gain insight into the behavior of the prediction model.

KEY RESULTS

Fourteen out of 142 candidate features were selected as predictors. Among these predictors, experience of falling as of the baseline survey was the most important feature, followed by self-rated health and age. Moreover, sense of coherence was newly identified as a risk factor for falls.

CONCLUSIONS

This study suggests that machine learning tools can be adapted to explore new associative factors, make accurate predictions, and provide actionable insights for fall prevention strategies.

Prevalence of falls in noninstitutionalized people aged 65−80 and associations with sex and functional tests: A multicenter observational study

Falls have a considerable impact on the functional prognosis of older adults. The main focus of this multicenter, retrospective, observational study was to examine the prevalence of falls in Spanish people aged 65−80 years still living at home. The secondary aims included examining the overall sociodemographic and clinical variables associated with a history of falls and then stratifying these findings by sex. We also aimed to determine the differences between sexes with regard to the history and consequences of falls and to evaluate associations between fall history and functional performance tests. The 747 older adults had all participated in the otago exercise program, which is a progressive home program of strength, balance, and endurance exercises. They were recruited by nurses in 21 primary care centers in 10 Spanish provinces between September 2017 to December 2018. The participants' mean age was 72.2 (SD: 4.3) years, and 67% were women. We recorded sociodemographic and clinical variables, functional performance test results, and any falls and/or injuries in the last 12 months. We found that 32% had fallen, 36% of those had fallen more than once, and 48% had sustained injuries when they fell. The bivariate analysis showed that women had more than twice the odds of falling than men and that living alone and being obese or overweight increased the odds of a fall, although living alone was not associated with falls in the multivariable analysis. Our results could guide the development of risk‐specific fall prevention programs to prevent disabilities in older people.

Prospective Association between Multimorbidity and Falls and Its Mediators: Findings from the Irish Longitudinal Study on Ageing

This study including older adults from Ireland aimed to analyze the prospective association between multimorbidity and falls and to identify the mediators in this relationship. The present study used data from two consecutive waves of the Irish Longitudinal Study on Ageing (TILDA) survey. Multimorbidity was assessed at Wave 1 (2009–2011) and was defined as the presence of at least two chronic conditions. Falls occurring at Wave 2 (2012–2013) were self-reported. Mediating variables considered were polypharmacy, cognitive impairment, sleep problems, pain, low handgrip strength, difficulty in activities of daily living (ADL), obesity, and underweight. Multivariable binary logistic regression and mediation analysis using the Karlson Holm Breen method were conducted. This study included 6900 adults aged ≥50 years (51.6% women; mean [SD] age 63.1 [8.9] years). Compared to no chronic conditions at baseline, there was a positive and significant association between multimorbidity and falls at follow-up, with ORs ranging from 1.32 (95% CI = 1.06–1.64) for 2 conditions to 1.92 (95% CI = 1.54–2.38) for ≥4 conditions. Pain (23.5%), polypharmacy (13.3%), and difficulty in ADL (10.7%) explained the largest proportion of the multimorbidity-fall relationship. Multimorbidity increased risk for incident falls in older adults from Ireland. Interventions should be implemented to reduce fall risk in people with multimorbidity, especially targeting the identified mediators.

Subjective Age and Falls in Older Age: Evidence from two Longitudinal Cohorts

OBJECTIVES

Falls are a common and serious health problem. The present study examined the association between subjective age (i.e., feeling younger or older than one's chronological age) and falls in two large national samples.

METHOD

Participants, aged 65 to 105 years old, were drawn from the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Data on falls, subjective age, demographic factors, was available from 2,382 participants in HRS and 3,449 in NHATS. Falls were tracked for up to 8 (HRS) and 7 (NHATS) years.

RESULTS

Cox regression analyses that included demographic covariates indicated that older subjective age increased the risk of falling in HRS (hazard ratio [HR]=1.17, 95% confidence interval [CI]=1.08-1.27), and in NHATS (HR=1.06, 95%CI=1.00-1.13). When compared to people who felt younger, people who reported an older subjective age had a higher risk of fall (HRS: HR=1.65, 95% CI=1.33-2.04; NHATS: HR=1.44, 95% CI=1.15-1.79). The associations remained significant after accounting for depressive symptoms, handgrip strength, chronic diseases, and cognitive impairment in HRS only.

DISCUSSION

These results confirm the role of subjective age as an important health marker in the aging population. Subjective age assessment can help identify individuals at greater risk of falls.

Rapid Inhibition Accuracy and Leg Strength Are Required for Community-Dwelling Older People to Recover Balance From Induced Trips and Slips: An Experimental Prospective Study

BACKGROUND AND PURPOSE

Falls can result in bone fractures and disability, presenting a serious threat to quality of life and independence in older adults. The majority of falls in community-living older adults occur while walking and are often caused by trips and slips. The study aimed to identify the specific sensorimotor and psychological factors required for older adults to recover balance from trips and slips.

METHODS

Forty-one older adults aged 65 to 87 years were assessed on sensorimotor (knee extension strength, proprioception, postural sway, and edge contrast sensitivity), reaction (simple reaction time, stepping, and catching reaction inhibition), and psychological (general anxiety and concern about falling) measures. Using a harness system, participants walked at 90% of their usual pace on a 10-m walkway that could induce trips and slips in concealed and changeable locations. Post-perturbation responses resulting in more than 30% of body weight being recorded by the harness system were defined as falls. Poisson regressions were used to test associations between the sensorimotor, reaction, and psychological measures and number of falls.

RESULTS

Fifty-one falls occurred in 25 of 41 participants. Poisson regression revealed body mass index, lower-limb proprioception, knee extension strength, rapid inhibition accuracy, concern about falling, and anxiety were significantly associated with the rate of falls. Other measures including postural sway were not statistically significant. Using stepwise Poisson regression analyses, normalized knee extension strength (rate ratio [RR]: 0.68, 95% confidence interval [CI]: 0.47-0.98), and rapid inhibition accuracy (RR: 0.64, 95% CI: 0.46-0.87) were independently associated with falls.

CONCLUSION

Our findings suggest rapid inhibition accuracy and adequate leg strength are required for older adults to recover balance from trips and slips. The mechanisms for balance recovery during daily life activities are likely different from those for static balance, suggesting the need for task-specific assessments and interventions for fall prevention in older adults.

The Effects of Overweight and Obesity on Obstacle Crossing During Walking: Protocol for a Systematic Review

BACKGROUND

Overweight and obesity are significant global health concerns that involve deficits in gait and balance that affect daily activities. Although much is reported about the effect of overweight and obesity on gait during unobstructed walking, not much is known about how overweight and obesity could impact gait under more challenging conditions, such as environments with obstacles.

OBJECTIVE

The aim of this study is to systematically review and synthesize the available data regarding the effects of overweight and obesity on obstacle crossing during walking.

METHODS

This review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. PubMed, Web of Science, Scopus, and SPORTDiscus will be systematically searched with no limitations on publication date. Only full-text English-language articles published in a peer-reviewed journal will be included. Included articles must have compared obstacle crossing during walking in individuals with overweight or obesity to individuals of normal body weight. A total of 2 independent reviewers will select the articles and extract the following 4 sets of data: (1) study characteristics, (2) sample description, (3) obstacle crossing task protocol, and (4) main results obtained. If a considerable number of homogeneous papers are included, a meta-analysis will be conducted. A preliminary search was conducted in November 2021.

RESULTS

The results will include the article selection flowchart as well as tables and figures synthesizing the extracted data on the effects of overweight and obesity on obstacle crossing during walking. The preliminary search identified 73 original records, of which 5 articles met the inclusion criteria.

CONCLUSIONS

This review will present researchers and clinicians with an overview of published studies that have compared the performance of obstacle crossing for individuals with overweight and obesity to those of normal body weight. Gaining insight into the control strategies adopted by individuals with overweight and obesity is critical for safe and successful obstacle crossing in this population. We therefore believe that our findings could be useful for identifying people at risk of falls and developing and implementing fall prevention programs for individuals with overweight and obesity.

TRIAL REGISTRATION

PROSPERO CRD42021269949; https://tinyurl.com/3yrwccu4.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/36234.

Trampolining Accidents in an Adult Emergency Department: Analysis of Trampolining Evolution Regarding Severity and Occurrence of Injuries

PURPOSE

Only a few studies have been conducted on trampoline-associated injuries in adults, especially in Switzerland. The aim of the present study was to describe the characteristics of trampoline-related injuries in patients older than 16 years of age and track their development over time by comparing two different time periods.

METHODS AND MATERIALS

Data were gathered from the emergency department (ED) of Bern University Hospital. A retrospective design was chosen to allow analysis of changes in trampolining accidents between 2003-2020.

RESULTS

A total of 144 patients were enrolled. The number of ED presentations due to trampoline-related injury rose significantly over time. The most common injuries were sprains to the extremities (age group 31-62: 58.4% and age group 16-30: 50.8%), followed by fractures (age group 31-62: 33.3% and age group 16-30: 32.5%). Lower extremities appeared to be the most frequently injured body region (age group 31-62: 20.8% and age group 16-30: 10.0%), although the differences were not statistically significant, p = 0.363. BMI was significantly higher for older than for younger patients (p = 0.004).

CONCLUSION

Over the last two decades, trampoline-related injuries have become more common in patients older than 16 years of age. These are most common in the lower extremities. While most of the patients in the present study only suffered minor injuries, the occasional severe injury might result in long-term disability. As trampoline-related injuries in adults are becoming more common, prevention strategies in public education and safety instructions must be optimised.

The association of cardio-metabolic risk factors and history of falling in men with osteosarcopenia: a cross-sectional analysis of Bushehr Elderly Health (BEH) program

Background

Osteosarcopenia, defined as sarcopenia plus osteopenia/osteoporosis, may increase the risk of fractures and affects morbidity and mortality in the older population. Falling is also common in the elderly and increases the risk of fractures and mortality. We examined the association of cardio-metabolic risk factors with a history of falling in osteosarcopenic men.

Methods

We used the baseline data of the Bushehr Elderly Health (BEH) program. Osteosarcopenia was defined as having both sarcopenia (reduced skeletal muscle mass plus low physical performance and/or low muscle strength) and osteopenia/osteoporosis (T-score ≤ − 1.0). Falling was defined as a self-reported history of an unintentional down on the ground during the previous year before the study. We used logistic regression analysis to estimate the adjusted odds ratio (AOR) with a 95% Confidence Interval (CI) to quantify the associations.

Results

All elderly men diagnosed with osteosarcopenia (n = 341), with a mean age of 73.3(±7.4) years, were included. Almost 50(14.7%) participants reported falling. Age showed a positive association with falling (AOR: 1.09, 95%CI: 1.04–1.14). An increase of 10 mmHg in systolic blood pressure(SBP), reduces the odds of falling by 26%(AOR:0.74, 95%CI:0.62–0.89), while a positive association was detected for fasting plasma glucose (FPG), as 10 mg/dl increase in the FPG, raises the chance of falling by 14%(AOR = 1.14, 95%CI:1.06,1.23). Hypertriglyceridemia was inversely associated with falling (AOR = 0.33, 95% CI: 0.12, 0.89).

Conclusions

Falling is a major public health problem in rapidly aging countries, especially in individuals with a higher risk of fragility fractures. Older age-raised fasting plasma glucose and low SBP are associated with falling in osteosarcopenic patients. 

Considering the higher risk of fracture in osteosarcopenic men, comprehensive strategies are needed to prevent fall-related injuries in this high-risk population.

Obesity and Bone: A Complex Relationship

There is a large literature on the relationship between obesity and bone. What we can conclude from this review is that the increase in body weight causes an increase in BMD, both for a mechanical effect and for the greater amount of estrogens present in the adipose tissue. Nevertheless, despite an apparent strengthening of the bone witnessed by the increased BMD, the risk of fracture is higher. The greater risk of fracture in the obese subject is due to various factors, which are carefully analyzed by the Authors. These factors can be divided into metabolic factors and increased risk of falls. Fractures have an atypical distribution in the obese, with a lower incidence of typical osteoporotic fractures, such as those of hip, spine and wrist, and an increase in fractures of the ankle, upper leg, and humerus. In children, the distribution is different, but it is not the same in obese and normal-weight children. Specifically, the fractures of the lower limb are much more frequent in obese children. Sarcopenic obesity plays an important role. The authors also review the available literature regarding the effects of high-fat diet, weight loss and bariatric surgery.

Menopausal Symptoms, Postural Balance, and Functional Mobility in Middle-Aged Postmenopausal Women

The aim of the present study was to determine the associations between the severity of the menopausal symptoms and postural balance and functional mobility in middle-aged postmenopausal women. A cross-sectional study was performed (171 participants, 57.18 ± 4.68 years). Severity of the menopausal symptoms (on the Menopause Rating Scale), postural balance (stabilometric platform) with eyes open and closed, and functional mobility (timed up and go test) were determined. A multivariate linear regression was performed, with body mass index, waist to hip ratio, age and fall history as possible confounders. Our findings showed that a greater severity of the menopausal symptoms at a psychological level was associated, under both eyes open and closed conditions, with worse postural control assessed by the length of the stabilogram (adjusted R2 = 0.093 and 0.91, respectively), the anteroposterior center of pressure displacements (adjusted R2 = 0.051 and 0.031, respectively) and the center of pressure velocity (adjusted R2 = 0.065 for both conditions). Older age was related to greater mediolateral displacements of the center of pressure with eyes open and closed (adjusted R2 = 0.45 and 0.58, respectively). There were no associations between the menopausal symptoms' severity and functional mobility. We can conclude that a greater severity of psychological menopausal symptoms was independently associated with worse postural balance in middle-aged postmenopausal women.

Dynapenic abdominal obesity and the effect on long-term gait speed and falls in older adults

BACKGROUND

Although both dynapenia and abdominal obesity have negative impact on physical function and health, few prospective studies evaluate the association of dynapenic abdominal obesity (D/AO) with gait speed and falls. Our aim was to examine the combined effect of low muscle strength and abdominal obesity on long-term gait speed and falls in older adults.

METHODS

We used longitudinal data from the English Longitudinal Study of Ageing (ELSA), including 4987 individuals aged 60 years and over. Grip strength and waist circumference were measured at baseline. Gait speed and fall events (falls, recurrent falls, and fall-related injury) were evaluated during a 14-year follow-up. The study population were divided into nondynapenic nonabdominal obesity (ND/NAO), nondynapenic abdominal obesity (ND/AO), dynapenic nonabdominal obesity (D/NAO), and D/AO, according to the sex-specific grip strength (<16 kg for women and <26 kg for men) and waist circumference (>88 cm for women and >102 cm for men). We used generalized estimating equation (GEE) model with gait speed as the outcome and cox proportional hazards models with fall events as the outcome.

RESULTS

GEE model showed that gait speed decreased during the 14-year follow-up in all groups (all P_time < 0.001). Participants with ND/AO, D/NAO, and D/AO at baseline exhibited a worse gait speed than those with ND/NAO (all P_group < 0.001). No significant difference in the rate of gait speed decline between four groups was found (P_group×time = 0.062). Cox regression analysis showed that D/NAO and D/AO highly predicted falls, and the hazard ratio (HR) was 1.181 (95% CI: 1.002, 1.392) for D/NAO and 1.195 (95% CI: 1.006, 1.421) for D/AO. D/AO was the unique condition associated with recurrent falls and fall-related injury, and the HRs were 1.276 (95% CI: 1.018, 1.599) and 1.348 (95% CI: 1.066, 1.704), respectively.

CONCLUSION

Dynapenia abdominal obesity, determined by low grip strength and high waist circumference, exhibits worse gait speed and increases the risk of fall events in older adults. Effort to maintain the mobility should focus on improving muscle strength and reducing excess body fat.