Higher Fatigue Prospectively Increases the Risk of Falls in Older Men

Association of real life postural transitions kinematics with fatigue in neurodegenerative and immune diseases

Fatigue is prevalent in immune-mediated inflammatory and neurodegenerative diseases, yet its assessment relies largely on patient-reported outcomes, which capture perception but not fluctuations over time. Wearable sensors, like inertial measurement units (IMUs), offer a way to monitor daily activities and evaluate functional capacity. This study investigates the relationship between sit-to-stand and stand-to-sit transitions and self-reported physical and mental fatigue in participants with Parkinson's, Huntington's, rheumatoid arthritis, systemic lupus erythematosus, primary Sjögren's syndrome and inflammatory bowel disease. Over 4 weeks, participants wore an IMU and reported fatigue levels four times daily. Using mixed-effects models, associations were identified between fatigue and specific kinematic features, such as 5th and 95th percentiles of sit-to-stand performance, suggesting that fatigue alters the control and effort of movement. These kinematic features show promise as indicators for fatigue in these patient populations.

Correlation between postural stability and fall risk in trans-femoral amputees due to muscle fatigue

[Purpose] This study aimed to establish a connection between postural stability and falling in individuals with transfemoral amputation (TFA), particularly with muscle fatigue. [Participants and Methods] Fourteen participants were recruited. Muscle fatigue was induced using a sit-to-stand (STS) fatigue protocol. Pre-fatigue and post-fatigue assessments were conducted using the Biodex Balance System (BBS). [Result] The findings of the study revealed significant increases in the postural stability index between the pre-fatigue and post-fatigue conditions for the TFA group, particularly in the overall stability index (OSI) and anterior-posterior stability index (APSI) components. The mean postural stability index scores for the TFA group exhibited a percentage increase of 65.2% for OSI, 52.7% for APSI, and 50% for medial-lateral stability index (MLSI). Furthermore, the TFA fall risk index surged by 61.4%. Regarding the relationships observed, a significant correlation emerged between fall risk and both OSI and APSI. [Conclusion] These findings underscore the impact of muscle fatigue on postural stability and an increase in fall risk among TFA. By mitigating the effects of muscle fatigue, therapists can play an important role in reducing the risk of falls and promoting better postural stability in this population.

Development, reliability, and validity assessment of a fall concerns scale for people who use wheelchairs and scooters (FCS-WC/S)

PURPOSE

To evaluate the psychometric properties of a Fall Concerns Scale for people who use Wheelchairs and Scooters (FCS-WC/S).

MATERIALS AND METHODS

Developed by fall prevention experts, FCS-WC/S underwent refinement through interdisciplinary reviews and focus groups with researchers, clinicians, and individuals who use WC/S full-time. The psychometric evaluation involved adults who used WC/S for ≥1 year and had ≥1 fall in the previous 3 years, recruited between April and September 2022.

RESULTS

The FCS-WC/S evaluates fall concerns among people with various health conditions who use WC/S full-time across 33 daily activities. One hundred and twenty-four participants responded to the baseline survey. A subgroup of 63 people repeated the FCS-WC/S a week later. The FCS-WC/S demonstrated excellent internal and good test-retest reliability (α ≥ 0.90, ICC = 0.86-0.9), as well as concurrent validity (Spearman's rho = 0.72) with the Spinal Cord Injury Falls Concern Scale (SCI-FCS). It effectively differentiated fear of falling levels from an established measure (ORs 4.1, 25.8, 46.7). Factor and parallel analysis revealed three factors, two of which were retained for further analysis.

CONCLUSIONS

Preliminary findings support FCS-WC/S validity and reliability for assessing fall concerns among individuals with various conditions who use WC/S. Further scale construction analysis is recommended.

Low muscle strength and physical function contribute to falls in hemodialysis patients, but not muscle mass

INTRODUCTION

Patients on hemodialysis (HD) have a higher incidence of fractures than the general population. Sarcopenia is frequently observed in patients on HD; however, the association of falls with sarcopenia and its diagnostic factors, including muscle mass, muscle strength, and physical function, are incompletely understood.

METHODS

This prospective cohort study was conducted at a single center. Sarcopenia was assessed according to the 2019 Asian Working Group for Sarcopenia diagnostic criteria. Muscle mass was measured the bioelectrical impedance method. Grip strength was evaluated to assess muscle strength, while the Short Physical Performance Battery (SPPB) was used to assess physical function. Falls and their detailed information were surveyed every other week.

RESULTS

This study analyzed 65 HD patients (median age, 74.5 [67.5-80.0] years; 33 women [49.2%]). Sarcopenia was diagnosed in 36 (55.4%) patients. During the 1-year observation period, 31 (47.7%) patients experienced accidental falls. The falls group had lower median grip strength than the non-falls group (14.7 [11.4-21.8] kg vs. 22.2 [17.9-27.6] kg; p < 0.001). The median SPPB score was also lower in the falls versus non-falls group (7.0 [5.0-11.0] vs. 11.0 [8.0-12.0]; p = 0.009). In adjusted multiple regression analysis, diagnostic factors, including grip strength (B = 0.96, p = 0.04, R2 = 0.19) and SPPB (B = 1.11, p = 0.006, R2 = 0.23), but not muscle mass, were independently associated with fall frequency.

CONCLUSIONS

The frequency of falls in HD patients was related to muscle strength and physical function, but not muscle mass.

Functional Near-Infrared Spectroscopy-Based Evidence of the Cerebral Oxygenation and Network Characteristics of Upper Limb Fatigue

OBJECTIVE

The objective of this research is to better understand the effects of upper limb fatigue on the cerebral cortex. The aim of this study was to investigate the characteristics of cerebral oxygenation and cortical functional connectivity in healthy adults after upper limb fatigue using functional near-infrared spectroscopy (fNIRS).

METHODS

Nineteen healthy adults participated in this study. The participants began exercising on an arm crank ergometer with no load, which was then increased by 0.2 kg per minute, maintaining a speed of at least 90 revolutions per minute during the exercise. Functional near-infrared spectroscopy covering the prefrontal cortex and motor area was used to monitor brain activity during rest and exercise. Heart rate and RPE were monitored during exercise to evaluate the degree of fatigue. Paired-sample t-tests were used to examine differences in the concentration of oxygenated hemoglobin (HbO2) and functional connectivity before and after fatigue.

RESULTS

All participants completed the exercise test that induced fatigue. We observed a significant decrease in HbO2 levels in the prefrontal and motor areas after exercise. In addition, brain network features showed a significant decrease in functional connectivity between the left and right motor cortices, between the motor and prefrontal cortices, and between both prefrontal cortices after fatigue.

CONCLUSION

This study demonstrates that, in healthy adults, exercise-induced fatigue in the upper limbs significantly affects brain function. In particular, it leads to reduced functional connectivity between the motor cortex and the prefrontal cortex.

Role of Perceived Physical and Mental Fatigability Severity on Prospective, Recurrent, and Injurious Fall Risk in Older Men

BACKGROUND

Falls occur annually in 25% of adults aged ≥65 years. Fall-related injuries are increasing, highlighting the need to identify modifiable risk factors.

METHODS

Role of fatigability on prospective, recurrent, and injurious fall risk was examined in 1 740 men aged 77-101 years in the Osteoporotic Fractures in Men Study. The 10-item Pittsburgh Fatigability Scale measured perceived physical and mental fatigability (0-50/subscale) at Year 14 (2014-16); established cut-points identified men with more severe perceived physical (≥15, 55.7%), more severe mental (≥13, 23.7%) fatigability, or having both (22.8%). Prospective, recurrent (≥2), and injurious falls were captured by triannual questionnaires ≥1 year after fatigability assessment; risk of any fall was estimated with Poisson generalized estimating equations, and likelihood of recurrent/injurious falls with logistic regression. Models adjusted for age, health conditions, and other confounders.

RESULTS

Men with more severe physical fatigability had a 20% (p = .03) increased fall risk compared with men with less physical fatigability, with increased odds of recurrent and injurious falls, 37% (p = .04) and 35% (p = .035), respectively. Men with both more severe physical and mental fatigability had a 24% increased risk of a prospective fall (p = .026), and 44% (p = .045) increased odds of recurrent falling compared with men with less severe physical and mental fatigability. Mental fatigability alone was not associated with fall risk. Additional adjustment for previous fall history attenuated associations.

CONCLUSIONS

More severe fatigability may be an early indicator to identify men at high risk for falls. Our findings warrant replication in women, as they have higher rates of fatigability and prospective falls.

Muscle Endurance and Self-Perceived Fatigue Predict Decline in Gait Speed and Activities of Daily Living After 1-Year Follow-Up: Results From the BUTTERFLY Study

BACKGROUND

Fatigue might influence the losses in activities of daily living (ADL). When fatigue parameters are present before the experience of losses in ADL and gait speed, they can be used as early warning signals. This study aimed to explore the predictive value of muscle endurance and fatigue on changes in ADL and gait speed in community-dwelling older adults aged 80 and older.

METHODS

Three hundred twenty four community-dwelling older adults aged 80 and older of the BUTTERFLY study were assessed after 1 year for muscle endurance, self-perceived fatigue, ADL, and gait speed. Exploratory factor analysis (EFA) was performed to explore, whether there is an underlying arrangement of the fatigue parameters. Mediating logistic regression analyses were used to investigate whether muscle endurance mediated by self-perceived fatigue predicts the decline in gait speed and ADL after 1-year follow-up.

RESULTS

EFA indicated a 2-factor model (muscle endurance factor and self-perceived fatigue factor) and had a moderate fit (X2: 374.81, df: 2, comparative fit index; 0.710, Tucker-Lewis index (TLI): 0.961, root mean square error of approximation [90%]: 0.048 [0.00-0.90]). Muscle endurance mediated by self-perceived fatigue had an indirect effect on the prediction of decline in Basal-ADL (-0.27), Instrumental-ADL (-0.25), and gait speed (-0.28) after 1-year follow-up.

CONCLUSION

This study showed that low muscle endurance combined with high self-perceived fatigue can predict changes in ADL after 1-year follow-up. These parameters might be very suitable for use in evaluating intrinsic capacity and can help to reduce the limitations in clinical usage of the vitality domain in the framework of intrinsic capacity.

Therapeutic dilemmas: cognitive enhancers and risk of falling in older adults-a clinical review

PURPOSE

Cognitive enhancers are the primary pharmacological therapy prescribed to those with dementia, comprising of memantine and the acetylcholinesterase inhibitors (AChEIs). The long-term cognitive and behavioural benefits of these medications, as well as their potential contribution to falls is currently debated, with recent Delphi studies being unable to reach consensus on whether these medications should be deprescribed. In this narrative clinical review, as part of a series on deprescribing in people at risk of falls, we explore the potential falls-related side effects experienced in people taking cognitive enhancers, alongside situations where deprescribing may be appropriate.

METHODS

We undertook a literature search of PubMed and Google Scholar, using terms capturing falls and cognitive enhancers, as well as consulting the British National Formulary and published Summary of Medicinal Product Characteristics. These searches informed the subsequent clinical review.

RESULTS

Cognitive enhancers should be subject to regular review, including confirmation of appropriate treatment indication, and occurrence of side effects in the context of falls. AChEIs, in particular, are associated with a broad range of side effects that can contribute to increased falls risk. These include bradycardia, syncope and neuromuscular effects. Where these have been identified, deprescribing should be considered, as well as alternative treatment options. Deprescribing studies have shown mixed results, likely due to considerable methodological heterogeneity. Several suggested guidelines exist to aid deprescribing decisions, many of which are highlighted in this review.

CONCLUSIONS

The use of cognitive enhancers should be regularly reviewed and decisions to deprescribe made on a case-by-case basis, considering both the risks and benefits of stopping these medications.

Living Alone, Environmental Hazards, and Falls Among U.S. Older Adults

Background and Objectives

Physical conditions of living environments can affect the incidence of falls; however, prior work has focused typically on 1 domain at a time-either neighborhood or home, capturing limited environmental boundaries of older adults. We examined how neighborhood together with the home environment affect the incidence of falls over time and whether living arrangement modifies the influence of the environmental risks on falls.

Research Design and Methods

Using the 2012-2020 waves of the Health and Retirement Study (HRS; N = 1,893), we fitted logistic regression to estimate the incidence of falls over an 8-year study period. We used the neighborhood and housing data that are collected systematically by trained observers in the HRS to assess environmental hazards. Sidewalk quality, neighborhood disorder, and the presence of green space were measured to capture outdoor environmental hazards. Indoor environmental hazards included the presence of housing decay and poorly maintained stairways. All models were stratified by living arrangement.

Results

Neighborhood and housing environment were independently associated with the odds of falls net of demographic characteristics and preexisting health conditions, and effects were significant for people living alone only. The presence of green space and poorly maintained stairways were associated with greater odds of falling, net of covariates during 8 years of follow-up (odds ratios = 2.10 and 2.65, p < .05, respectively). None of the environmental risk factors were significant for those living with others.

Discussion and Implications

Falls in old age may be determined in part by a combination of outdoor and indoor risk factors. More research is needed to understand pathways that lead to greater vulnerability among older adults living alone to environmental hazards.

Exploring impairments and allied health professional utilisation in people with myasthenia gravis: A cross-sectional study

This study aimed to explore how people with myasthenia gravis experience impairments in vision, dizziness, hearing, and fatigue, and how these relate to balance confidence, community participation, and health-related quality of life. Additionally, this study investigated the utilisation and perception of the allied health role in managing these impairments in the Australian context. Visual and hearing impairments, along with fatigue, were found to be correlated with health-related quality of life and community participation to varying degrees, while visual impairment and dizziness were correlated with balance confidence. Perception and utilisation of allied health professionals was variable; common barriers to better utilisation included participant perception of clinicians having poor knowledge around myasthenia gravis, previous poor experiences with clinicians, uncertainty about the clinicians' role, and lack of awareness that symptoms were associated with myasthenia gravis. Further research exploring clinicians' knowledge of myasthenia gravis is recommended, along with education for people with the disease about symptoms associated and how to appropriately access care.

Relationship between postural stability and fall risk in young adult after lower limb muscle fatigue

Introduction: Muscle fatigue can reduce body balance and activity of daily living tasks. Therefore, this study aims to identify the correlation between postural stability and fall risk due to muscle fatigue. The components in postural stability include Overall Stability Index (OSI), Anterior-Posterior Stability Index (APSI), and Mediolateral Stability Index (MLSI). Design and Methods: A total of seven healthy adults aged 31.1±7.4 years were recruited in this study. The sit-to-stand (STS) protocol was used to induce lower limb muscle fatigue, while postural stability and fall risk were assessed using the Biodex Balance System (BBS) before and after muscle fatigue. Result: The result showed a significant increase in postural stability index after fatigue only for OSI with p<0.05, while no significant difference was found on APSI and MLSI with p=0.157 and p=0.109 respectively. However, the mean score for the postural stability index showed an increase in percentage with 47.8% in OSI, 26.3% in APSI and 46.8% in MLSI.  Furthermore,fall risk showed no significant differences with p=0.149, but the mean score data increased by 16.7% after fatigue. The correlation between fall risk and OSI was significant with p<0.05, while MLSI had a significant negative correlation with APSI (p<0.05). Conclusions: Based on the results, the young adults had reduced overall postural stability but were less affected by fall risk after muscle fatigue. The positive correlation between OSI and fall risk indicated that their overall postural stability can induce the fall risk after muscle fatigue. Therefore, young adults need to be aware of their fatigue symptoms during prolonged exercise that can increase fall risk potential.

A Multi-Dimensional Model of Fatigue in Old Age: Implications for Brain Aging

As the most reported symptom in old age, fatigue is understudied in terms of both mechanisms and measures. Population heterogeneity and methodological inconsistency makes understanding the relationship between fatigue and brain aging challenging. The present article comprehensively reviews existing conceptual and operational frameworks of fatigue, as well as mechanistic heterogeneities of fatigue that exist in the aging literature. Then, I propose a Multi-Dimensional Model of fatigue to provide theoretical cohesion to the study of fatigue in old age, along with a "fatigue circuit" addressing brain profiles across dimensions of fatigue. The potential relationships between fatigue dimensions, the fatigue circuit, and brain aging are discussed to inform the direction of future research.

Fetal muscle extract improves muscle function and performance in aged mice

Background: Loss of skeletal muscle mass and function is one of the major musculoskeletal health problems in the aging population. Recent studies have demonstrated differential proteomic profiles at different fetal stages, which might be associated with muscle growth and development. We hypothesized that extract derived from fetal muscle tissues at the stage of hypertrophy could ameliorate the loss of muscle mass and strength in aged mice.

Methods: To allow sufficient raw materials for investigation, skeletal muscle extract from fetal sheep at week 16 of gestation and maternal tissue were used in the present study. iTRAQ (isobaric tags for relative and absolute quantitation) and KEGG pathway analyses identified differentially expressed proteins in fetal sheep muscle extract vs. adult sheep muscle extract. Effects of FSME and ASME on human myoblast proliferation were studied. To examine the effect of FSME in vivo, C57BL/6 male mice at 20 months of age were subjected to intramuscular administration of FSME or vehicle control for 8 weeks. A grip strength test and ex vivo muscle force frequency test were conducted. Finally, serum samples were collected for multiplex analysis to determine potential changes in immunological cytokines upon FSME injection.

Results: Compared with ASME, 697 and 412 peptides were upregulated and downregulated, respectively, in FSME, as indicated by iTRAQ analysis. These peptides were highly related to muscle development, function, and differentiation from GO enrichment analysis. FSME promoted cell proliferation of myoblast cells (+300%, p < 0.01) without causing significant cytotoxicity at the tested concentration range compared with ASME. After 8 weeks of FSME treatment, the percentage of lean mass (+10%, p < 0.05), grip strength (+50%, p < 0.01), and ability in fatigue resistance were significantly higher than those of the control group. Isometric forces stimulated by different frequencies were higher in the control group. Histologically, the control group showed a larger cross-sectional area (+20%, p < 0.01) than the FSME group. The multiplex assay indicated that FSME treatment did not lead to an elevated circulatory level of inflammatory cytokines. Of note, after FSME treatment, we observed a significant drop in the circulating level of IL-12 (p40) from 90.8 ± 48.3 pg/ml to 82.65 ± 4.4 pg/ml, G-CSF from 23476 ± 8341.9 pg/ml to 28.35 ± 24.2 pg/ml, KC from 97.09 ± 21.2 pg/ml to 29.2 ± 7.2 pg/ml, and RANTES from 325.4 ± 17.3 pg/ml to 49.96 ± 32.1 pg/ml.

Conclusion: This is the first study demonstrating the beneficial effect of fetal muscle extract on muscle health in aged mice. Further analysis of the active ingredients of the extract will shed light on the development of a novel treatment for sarcopenia.

Interaction between age and fatigue on antagonist muscle coactivation during an acute post-fatigue recovery phase

This study investigated the age-related changes in antagonist muscle coactivation of the biceps femoris (BF) during an acute recovery period following a leg extensor fatiguing protocol. Twenty-three young (mean ± SD: age = 25.1 ± 3.0 years) and twenty-three old men (age = 71.5 ± 3.9 years) participated. Surface electromyography (sEMG) was recorded from the BF muscles for antagonist muscle coactivation. Testing involved participants performing leg extension isometric maximal voluntary contractions (MVCs) and isokinetic MVCs at 240°·s^-1 at baseline (Pre) and again after the fatigue protocol at 0 (Post0), 7 (Post7), 15 (Post15), and 30 (Post30) minutes post fatigue. Root mean square (RMS) values were computed from the BF sEMG and were calculated as the first 200 ms from onset for the isometric (IsomCoact200ms) and dynamic isokinetic 240°·s^-1 (DynCoact200ms) MVCs, and for the final 10° of the leg extension (DynCoact10°) on the isokinetic 240°·s^-1 MVCs. Two-way ANOVAs [age group (young vs. old) × time (Pre vs. Post0 vs. Post7 vs. Post15 vs. Post30)] showed that DynCoact200ms had an effect for time (p = 0.018), with greater antagonist coactivation in Pre than Post0 (p = 0.009) and recovering by Post7 (p = 0.011) with no group differences. DynCoact10° had no age × time interaction (p = 0.070), but had a main effect for time (p = 0.020) with the Post0 being lower than the Pre. However, for this variable the young group showed a more severe Pre to Post0 fatigue decline (-45.9%) than the old group (-6.7%) indicating this may be a more sensitive variable for capturing age-related antagonist coactivation post-fatigue responses. Leg extensor fatigue affects some BF coactivation sEMG variables more than others, and any altered post-fatigue coactivation response recovers rapidly (<7 min) from baseline levels.

Similar strength gains at lower perceived efforts via cluster set vs. traditional home-based online training: A 6 weeks randomized controlled trial

Cluster Training (CT) has been shown to induce strength at lower perceived efforts compared to traditional training (TRT) with sets performed to repetition failure. These findings have not yet been extended to remote online training in middle-aged to older people. Thus the present study aimed at investigating whether a cluster set online training with bodyweight exercises is similar in its effectiveness a more demanding traditional strength training employed with a traditional set structure. A total of n = 21 participants (14 female, 55 ± 12 years, 76.4 ± 16.1 kg, 1.71 ± 0.10 m, 74 ± 72 min of activity/w) were randomly assigned to either a CT or volume-, load-, and work-to-rest-ratio-matched TRT. After an initial 6-week run-in-phase, all participants were engaged into an online live-instructed full-body workout twice a week (40 min each) for a period of 6 weeks. Rates of perceived efforts (RPE) were assessed for each session (session RPE; sRPE). Changes in maximal voluntary contraction (MVC) at leg press (LP) and abdominal press (AP) as well as one-minute-sit-to-stand and Y-Balance-Test (YBT) were compared between BASELINE and PRE (ΔRUN-IN) and between PRE and POST (ΔINTERVENTION). In LP, TRT showed greater improvements with large effect sizes in ΔINTERVENTION compared to ΔRUN-IN. In CT, greater improvements with moderate effects were found in ΔINTERVENTION compared to ΔRUN-IN. In AP, both CT and TRT showed larger improvements with large effect sizes in ΔINTERVENTION compared to ΔRUN-IN. In YBT, a significant and large main effect for time was found indicating larger improvements for ΔINTERVENTION compared to ΔRUN-IN. CT showed lower sRPE than TRT. Both CT and TRT led to similar adaptations in MVC and balance performance. However, the perceived effort of CT was rated lower than for TRT. Therefore, conducting resistance training with a cluster set structure seems to be a suitable approach for training programs in middle-aged and older people.

Association Between Fatigue and Falls Risk Among the Elderly Aged Over 75 Years in China: The Chain Mediating Role of Falls Efficacy and Lower Limb Function

Background

Although fatigue has been shown to be strongly associated with falls risk, very few studies have focused on its mechanism involved in community-dwelling older subjects. The purpose of this study was to explore the relationship between fatigue and falls risk and its internal mechanism by constructing a chain mediation model.

Methods

A cross-sectional study design was adopted. A convenience sample of 270 older adults was recruited from July to October 2021 in an urban community, in Beijing, China. The participants completed the 14-item Fatigue Scale (FS-14), Falls Efficacy Scale International (FES-I), the Short Physical Performance Battery (SPPB) and Fall-Risk Self-Assessment Questionnaire (FRQ) to measure fatigue, falls efficacy, lower limb function and falls risk. The theory of unpleasant symptoms was used as a conceptual framework. Structural equation modeling (SEM) was utilized to test the hypothetical model.

Results

The overall fit of final model was found to be satisfactory: χ2/df = 1.61, CFI = 0.971, TLI = 0.962, RMSEA = 0.049 (95% CI 0.030/0.066) and SRMR = 0.023. Fatigue had a direct effect on falls risk (β = 0.559, S.E. = 0.089, 95% CI 0.380/0.731), and it also had indirect effects on falls risk (β = 0.303, S.E. = 0.072, 95% CI 0.173/0.460) through mediating factors. Falls efficacy and lower limb function were the main mediating variables, and there was a chain mediating effect (β = 0.015, S.E. = 0.010, 95% CI 0.003/0.046).

Conclusions

Our study suggests that fatigue can influence falls risk among the elderly in China. There are many mediating paths between fatigue and falls risk. These results may help healthcare professionals to better understand the inherent relationship between fatigue and fall risk that may benefit older adults.

Effect of Lower Limb Muscle Fatigue on Fall Risk for Transfemoral Amputee: A Pilot Study

Muscle fatigue is a decline in muscle maximum force during contraction and can influence the fall risk among people. This study is aimed at identifying the effect of fatigue on prospective fall risk in transfemoral amputees (TFA). Fourteen subjects were involved in this study with TFA (34.7 ± 8.1 yrs, n = 7) and normal subjects (31.1 ± 7.4 yrs, n = 7). Fatigue of lower limb muscles was induced with the fatigue protocol. Subjects were tested prefatigue and postfatigue using the standardized fall risk assessment. All results were calculated and compared between pre- and postfatigue to identify fatigue's effect on both groups of subjects. The results showed that the fall risk increased significantly during pre- and postfatigue for TFA (p = 0.018), while there were no significant differences in normal subjects (p = 0.149). Meanwhile, the fall risk between TFA and normal subjects for prefatigue (p = 0.082) and postfatigue (p = 0.084) also showed no significant differences. The percentage (%) of increased fall risk for TFA was 19.2% compared to normal subjects only 16.7%. However, 61.4% increased of % fall risk in TFA after fatigue by using the baseline of the normal subject as the normalized % of fall risk. The increasing fall risks for TFA after fatigue are three times higher than the potential fall risk in normal subjects. The result indicates that they need to perform more precautions while prolonging lower limb activities. These results showed the implications of fatigue that can increase the fall risk due to muscle fatigue from repetitive and prolonged activities. Therefore, rehabilitation programs can be done very safely and precisely so that therapists can pursue fitness without aggravating existing injuries.

Declining energy predicts incident mobility disability and mortality risk in healthy older adults

BACKGROUND

The purpose was to examine whether longitudinal changes in self-reported energy predict incident mobility disability and mortality. We further explored whether changes in energy-related behaviors (physical activity, appetite, or sleep quality) would explain these associations.

METHODS

N = 2021 participants from the Health, Aging and Body Composition Study free from mobility disability and with at least three energy assessments from years 2 to 10.

MEASUREMENTS

The outcomes were time to first self-reported inability to walk a quarter of a mile (mobility disability) and death. Self-reported energy level (SEL) was a single-item indicator over the prior month, ranging from 0 to 10; person-specific slopes measured whether individuals increased or decreased in SEL across the total follow-up time (mean 7.09 years, +1.72, range 2-8 years). Potential energy-related mediators were baseline and change in self-reported physical activity, appetite, and sleep quality. Covariates were baseline levels and change in demographics, health characteristics and behaviors, tiredness, cognition, mood, and gait speed.

RESULTS

A total of 947 developed disability and 567 died over the study follow-up. A one-point change in SEL over the follow-up (or an average 0.125 points/year) was inversely associated with a 35% risk of incident mobility disability (hazard ratio = 0.65, 95% confidence interval [CI] = 0.55, 0.76, p < 0.001) and 35% risk of death (hazard ratio = 0.67, 95% CI = 0.42, 0.87, p = 0.003), independent of covariates. Potential energy-related mediators did not attenuate this association.

CONCLUSIONS

In this longitudinal analysis of community-dwelling older adults, energy decline was common and a significant independent predictor of disability risk and mortality.

Association between self-reported or perceived fatigue and falls among older people: A systematic review

AIM

The aim of the present review was to examine the evidence of the relationship between self-reported or perceived fatigue and falls among older adults.

METHODS

A systematic review, following the PRISMA recommendations, was performed. PubMed, Scopus, Web of Science, and Cinahl were searched from February 2021 until March 2021, without any limitation on publication date. The methodological quality of the recruited studies was assessed with the Newcastle-Ottawa scale.

RESULTS

Of the 2,296 initially retrieved records, 20 met the inclusion criteria; 11 cohort and 9 cross-sectional studies. They were classified as "good or very good" studies. Data on 59,852 older adults was reported. Most studies reported a strong association between fatigue and incidence or risk of falls, with odds ratios ranging from 1.04 to 3.53. Evidence obout the relationship between fatigue and recurrent, as well as injurious, falls is limited.

CONCLUSIONS

Self-reported or perceived fatigue is associated with the incidence of falls or risk of falling among older adults. Nurses could contribute to decreasing the inicdence of falls through prevention and proper geriatric assessment, including the management of fatigue in their daily clinical practice. The evidence about the potential effect of fatigue on falls-related injuries is inconclusive and on recurrent falls remains to be further defined.