Properties of the 'timed up and go' test: more than meets the eye

Functional assessment in patients with castration-resistant prostate cancer treated with darolutamide: results from the DaroAcT study

BACKGROUND

Androgen receptor inhibitors (ARIs) are approved for the treatment of advanced prostate cancer; however, some patients may experience symptoms and side effects that hinder their physical functioning. The Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB) tests are used to assess physical functioning in older adults and are recommended assessments for patients with prostate cancer, despite lacking validation in this setting.

METHODS

DaroAct (NCT04157088) was an open-label, multicenter, phase 2b study designed to evaluate the effects of the ARI darolutamide (lead-in phase) and darolutamide vs enzalutamide (randomized phase) on physical functioning in men with castration-resistant prostate cancer (CRPC). Only the lead-in phase, in which participants received darolutamide 600 mg twice daily, was completed. The TUG and SPPB tests were used to assess physical functioning.

RESULTS

The lead-in phase enrolled 30 participants. During 24 weeks of treatment, 8 (32.0%) of 25 evaluable participants exhibited clinically meaningful worsening in TUG from baseline (primary endpoint). At the week 24 visit, 5 (21.7%) of 23 participants had worsening in TUG time, and 8 (33.3%) of 24 participants had worsening in SPPB score. Because only 48% of participants had the same outcome on the TUG and SPPB tests, the study was terminated without initiating the randomized comparison.

CONCLUSION

Most participants showed no clinically meaningful worsening in physical functioning after 24 weeks of darolutamide treatment, but poor agreement between tests was observed. Tools to accurately and consistently measure the impact of ARIs on physical functioning in patients with CRPC are needed.

Deep learning-based detection of affected body parts in Parkinson's disease and freezing of gait using time-series imaging

We proposed a deep learning method using a convolutional neural network on time-series (TS) images to detect and differentiate affected body parts in people with Parkinson's disease (PD) and freezing of gait (FOG) during 360° turning tasks. The 360° turning task was performed by 90 participants (60 people with PD [30 freezers and 30 nonfreezers] and 30 age-matched older adults (controls) at their preferred speed. The position and acceleration underwent preprocessing. The analysis was expanded from temporal to visual data using TS imaging methods. According to the PD vs. controls classification, the right lower third of the lateral shank (RTIB) on the least affected side (LAS) and the right calcaneus (RHEE) on the LAS were the most relevant body segments in the position and acceleration TS images. The RHEE marker exhibited the highest accuracy in the acceleration TS images. The identified markers for the classification of freezers vs. nonfreezers vs. controls were the left lateral humeral epicondyle (LELB) on the more affected side and the left posterior superior iliac spine (LPSI). The LPSI marker in the acceleration TS images displayed the highest accuracy. This approach could be a useful supplementary tool for determining PD severity and FOG.

Effect of Blood Flow Restriction on Gait and Mobility in Older Adults: A Systematic Review and Meta-Analysis

Older adults demonstrate gait impairments that increase their risk for falls. These age-related mobility impairments are in part due to declines in muscle mass and strength. High-intensity exercise can improve muscle strength and mobility but may not be tolerable for older adults due to musculoskeletal injury and pain. Blood flow restriction (BFR) with lower-intensity exercise offers a strategy that may be more tolerable for older adults, but whether BFR improves gait and mobility in older adults is unclear. The purpose of this systematic review and meta-analysis was to determine the effect of BFR on gait and mobility in healthy older adults. PubMed, Embase, Cochrane Library, and CINAHL were systematically searched for articles utilizing BFR in older adults. Articles were included if adults were over 60 years, did not have chronic health conditions, had undergone randomized controlled trials, and presented objectively measured gait outcomes. The search identified 1501 studies, of which 9 were included in the systematic review and 8 studies in the meta-analysis. Outcome measures included the Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), 400 m walk test, Short Physical Performance Battery (SPPB), and 10 m walk test. Meta-analyses found improvements in the TUG (mean difference (MD) = -0.71; 95% CI = -1.05, -0.37; p < 0.001) and SPPB (MD = -0.94; 95% CI = -1.48, -0.39; p < 0.001) in BFR compared to no BFR. There were no differences in gait speed (MD = 0.59; 95% CI = -0.22, 1.41; p = 0.16). BFR may be effective for gait and mobility tasks over shorter distances. Clinicians may consider incorporating BFR to improve mobility and gait function in older adults.

Older Adult Fall Risk Prediction with Deep Learning and Timed Up and Go (TUG) Test Data

Falls are a major health hazard for older adults; therefore, in the context of an aging population, predicting the risk of a patient suffering falls in the near future is of great impact for health care systems. Currently, the standard prospective fall risk assessment instrument relies on a set of clinical and functional mobility assessment tools, one of them being the Timed Up and Go (TUG) test. Recently, wearable inertial measurement units (IMUs) have been proposed to capture motion data that would allow for the building of estimates of fall risk. The hypothesis of this study is that the data gathered from IMU readings while the patient is performing the TUG test can be used to build a predictive model that would provide an estimate of the probability of suffering a fall in the near future, i.e., assessing prospective fall risk. This study applies deep learning convolutional neural networks (CNN) and recurrent neural networks (RNN) to build such predictive models based on features extracted from IMU data acquired during TUG test realizations. Data were obtained from a cohort of 106 older adults wearing wireless IMU sensors with sampling frequencies of 100 Hz while performing the TUG test. The dependent variable is a binary variable that is true if the patient suffered a fall in the six-month follow-up period. This variable was used as the output variable for the supervised training and validations of the deep learning architectures and competing machine learning approaches. A hold-out validation process using 75 subjects for training and 31 subjects for testing was repeated one hundred times to obtain robust estimations of model performances At each repetition, 5-fold cross-validation was carried out to select the best model over the training subset. Best results were achieved by a bidirectional long short-term memory (BLSTM), obtaining an accuracy of 0.83 and AUC of 0.73 with good sensitivity and specificity values.

Innovative technology-based interventions in Parkinson's disease: A systematic review and meta-analysis

OBJECTIVE

Novel technology-based interventions have the potential to improve motor symptoms and gait in Parkinson's disease (PD). Promising treatments include virtual-reality (VR) training, robotic assistance, and biofeedback. Their effectiveness remains unclear, and thus, we conducted a Bayesian network meta-analysis.

METHODS

We searched the Medline, Embase, Cochrane CENTRAL, and Clinicaltrials.gov databases until 2 April 2024 and only included randomized controlled trials. Outcomes included changes in UPDRS-III/MDS-UPDRS-III score, stride length, 10-meter walk test (10MWT), timed up-and-go (TUG) test, balance scale scores and quality-of-life (QoL) scores. Results were reported as mean differences (MD) or standardized mean differences (SMD), with 95% credible intervals (95% CrI).

RESULTS

Fifty-one randomized controlled trials with 2095 patients were included. For UPDRS (motor outcome), all interventions had similar efficacies. VR intervention was the most effective in improving TUG compared with control (MD: -4.36, 95% CrI: -8.57, -0.35), outperforming robotic, exercise, and proprioceptive interventions. Proprioceptive intervention significantly improved stride length compared to control intervention (MD: 0.11 m, 95% CrI: 0.03, 0.19), outperforming VR, robotic and exercise interventions. Virtual reality improved balance scale scores significantly compared to exercise intervention (SMD: 0.75, 95% CrI: 0.12, 1.39) and control intervention (SMD: 1.42, 95% CrI: 0.06, 2.77). Virtual reality intervention significantly improved QoL scores compared to control intervention (SMD: -0.95, 95% CrI: -1.43, -0.52), outperforming Internet-based interventions.

INTERPRETATION

VR-based and proprioceptive interventions were the most promising interventions, consistently ranking as the top treatment choices for most outcomes. Their use in clinical practice could be helpful in managing motor symptoms and QoL in PD.

Increased physical activity promotes skin clearance, improves cardiovascular and psychological health, and increases functional capacity in patients with psoriasis

Background

Patients with psoriasis are less physically active compared to age-matched controls, due to psoriasis-specific barriers, which significantly limits their ability to benefit from health-promoting levels of physical activity (PA). In addition, long-term health outcomes for people with psoriasis are poor and include depression, metabolic syndrome and cardiovascular disease (CVD); presenting a significant challenge to healthcare services.

Objectives

We designed a PA intervention in partnership with patients with psoriasis hypothesising this may have therapeutic utility in the management of psoriasis.

Methods

Participants with chronic plaque psoriasis were recruited to a single-centre, 20-week, prospective cohort study. A wrist-worn accelerometer (GENEActiv Original; Activinsights Ltd) and a hip-worn pedometer (Onwalk 900; Decathlon Group) were used objectively measure levels of PA. Our 10-week PA intervention comprised twice weekly 60-min walks within three different greenspaces in Greater Manchester, each led by a Sports and Exercise Scientist to deliver a pre-specified volume/dose of activity. During weeks-11-20 of the study, participants followed independent activities. Clinical evaluation, including assessment of psoriasis severity, cardiometabolic parameters, psychological wellbeing and functional capacity was made at baseline, week-10 and -20.

Results

Sixteen patients with psoriasis completed the study. We observed significantly reduced Psoriasis Area and Severity Index at week-10 (p = 0.01) and -20 (p = 0.001) compared to baseline, with 50% of participants achieving PASI-50 at week-20. Dermatology Life Quality Index (DLQI) was significantly reduced at week-20 (p = 0.04), compared to baseline. Significant reduction in blood pressure at week-10 (systolic: -7.4 mmHg, p = 0.002; diastolic: -4.2 mmHg, p = 0.03) and -20 (systolic: -8.8 mmHg, p = 0.001; diastolic: 4.1 mmHg, p = 0.008) was observed and pulse wave velocity was significantly reduced by week-20 (p = 0.02), suggesting improvement in cardiovascular health. Despite high prevalence of anxiety and depression at baseline, we documented a significant improvement in wellbeing and psychological health. Functional capacity was significantly enhanced following completion of the study.

Conclusion

Increasing PA constitutes a promising therapeutic intervention in the management of psoriasis. Evaluation of our intervention in a clinical trial would help determine clinical utility and establish PA guidelines for patients with psoriasis.

The effects of a six-month exercise intervention on white matter microstructure in older adults at risk for diabetes

Older adults with prediabetes or obesity (i.e., those at risk for diabetes) exhibit impaired structural brain networks. Given findings that resistance training (RT) can combat brain impairments in many populations, this study aimed to test the effects of this type of exercise on white matter microstructure in older adults at risk for diabetes. Seventeen community-dwelling older adults (mean age 67.8 ± 5.7, 52.9 % female) with prediabetes or obesity were randomly allocated to thrice weekly RT or balance and tone training (BAT; control group) for six months. Diffusion weighted imaging via a 3T scanner was used to assess changes in white matter parameters -fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) - over time. Participants in the RT group showed no significant changes in FA but had increased MD and RD in various regions related to cognitive function including the cingulate gyrus. Participants in the control group had both increased and decreased FA depending on the specific white matter tracts; increased FA was seen in areas related to motor coordination such as the middle cerebellar peduncle. The control group also exhibited decreased MD and RD in areas responsible for motor function (e.g., left anterior limb of the internal capsule). We conclude that both resistance and balance exercises result in changes in white matter microstructure albeit in divergent tracts that may be linked to the specific exercises performed.

Intraoperative landmark-based genicular nerve block versus periarticular infiltration for postoperative analgesia in total knee arthroplasty: a randomized non-inferiority trial

INTRODUCTION

Genicular nerve blocks (GNBs) are an emerging technique that have been used as a part of multimodal analgesia for total knee arthroplasty. The efficacy of intraoperative landmark-based GNBs, a recently introduced technique, has been established. We hypothesized that it would provide non-inferior postoperative analgesia compared with periarticular infiltration (PAI) when combined with continuous adductor canal block.

METHODS

This study randomized 140 patients undergoing total knee arthroplasty to receive either intraoperative landmark-based GNB (GNB group) or PAI (PAI group), with 139 completing the study. The primary outcomes were the pain scores at rest and during movement at 12 hours postoperatively on an 11-point Numerical Rating Scale; the non-inferiority margin was 1. Pain scores at additional time points, intravenous morphine consumption, time to first rescue analgesia, functional performance and muscle strength tests, and sleep disturbance were also assessed.

RESULTS

At 12 hours postoperatively, the PAI and GNB groups had median resting pain scores of 0 (0-2) and 0 (0-2), respectively. The median difference was 0 (95% CI -0.4 to 0.4, p=1), with the 95% CI upper limit below the prespecified non-inferiority margin. The median pain score during movement was 1.5 (0-2.3) and 2 (1-3.1) in the PAI and GNB groups, respectively. The median difference was 0.9 (95% CI 0.3 to 1.6, p=0.004), failing to demonstrate non-inferiority. The GNB group had higher intravenous morphine consumption at 12 hours postoperatively and a shorter time to first rescue analgesia.

CONCLUSIONS

GNB compared with PAI provides non-inferior resting pain relief. Non-inferiority was not established for pain during movement.

TRIAL REGISTRATION NUMBER

TCTR20220406001 (www.thaiclinicaltrials.org).

Preoperative rehabilitation optimization for spinal surgery: a narrative review of assessment, interventions, and feasibility

PURPOSE

Postoperative physical therapy (PT) is a cornerstone of orthopedic and musculoskeletal rehabilitation, proven to provide various positive clinical benefits. However, there is a paucity of literature evaluating the utility of preoperative rehabilitation specific to spine surgery. Thus, this review article aims to provide an overview of previously published studies discussing the efficacy of preoperative rehabilitation programs and its role in spinal surgery. Special emphasis was given to preoperative frailty assessments, physical performance tests, interventional strategies, feasibility, and future directions.

METHODS

We performed a literature review using PubMed, Google Scholar, EMBASE, and PubMed Central (PMC) using directed search terms. Articles that examined preoperative rehabilitation in adult spine surgery were compiled for this review. Prehabilitation programs focused on exercise, flexibility, and behavioral modifications have been shown to significantly improve pain levels and functional strength assessments in patients undergoing elective spine surgery. In addition, studies suggest that these programs may also decrease hospital stays, return to work time, and overall direct health care expenditure costs. Screening tools such as the FRAIL scale can be used to assess frailty while physical function tests like the timed-up-and go (TUGT), 5 repetition sit-to-stand test (5R-STST), and hand grip strength (HGS) can help identify patients who would most benefit from prehabilitation.

CONCLUSIONS

This review illustrates that prehabilitation programs have the potential to increase quality of life, improve physical function and activity levels, and decrease pain, hospital stays, return to work time, and overall direct costs. However, there is a paucity of literature in this field that requires further study and investigation.

Recovery of Muscular Strength Following Total Hip Replacement: A Narrative Review

This narrative review analyzes muscle strength recovery following total hip replacement (THR) and looks at various factors affecting postoperative muscle function restoration. The review synthesizes evidence from various studies regarding the timing and degree of muscular strength recovery, different rehabilitation protocols, and patient-specific variables such as age, preoperative physical condition, and comorbidities, among others. Overall, it appears that THR is associated with improved hip function and quality of life, but this usually takes a long time due to individualized physical therapy interventions. In addition, postoperative rehabilitation has been found not to exist without any personal factors involved such as age or gender whereby for instance senior citizens have no alternative but to go for THR surgery, making their lower limbs weaker than those who are younger. Based on the findings in this review on muscle recovery after THR surgeries, one may conclude that this endeavor should begin as early as possible and include regular resistance training programs with performance-focused functional training after surgery. In addition, more longitudinal studies should be conducted regarding post-surgical outcomes comparing other traditional medical practices.

Surface electromyography-based biofeedback can facilitate recovery from total knee arthroplasty

Knee osteoarthritis is among the most prevalent chronic diseases. Total knee arthroplasty is a common solution that effectively addresses the continued structural degeneration of the articular cartilage. However, effective physical therapy is critical for recovery. Despite participating in physical therapy, many patients fail to recover. This study investigated the potential efficacy of a behaviorally informed approach to surface electromyographic biofeedback following total knee arthroplasty relative to the clinical standard, neuromuscular electrical stimulation. The surface electromyographic biofeedback procedure incorporated improved techniques for establishing a baseline and individualized and adjusting criteria for feedback. The findings suggest some advantages for surface electromyographic biofeedback over neuromuscular electrical stimulation in quadriceps strength, range of motion, functional recovery, and quality of life. Behaviorally informed surface electromyographic biofeedback holds promise for total knee arthroplasty recovery and these data suggest considerable room for collaboration between behavior analysts and physical therapists.

Evaluation of a multimodal diagnostic algorithm for prediction of cognitive impairment in elderly patients with dizziness

BACKGROUND

The current diagnostic workup for chronic dizziness in elderly patients often neglects neuropsychological assessment, thus missing a relevant proportion of patients, who perceive dizziness as a subjective chief complaint of a concomitant cognitive impairment. This study aimed to establish risk prediction models for cognitive impairment in chronic dizzy patients based on data sources routinely collected in a dizziness center.

METHODS

One hundred patients (age: 74.7 ± 7.1 years, 41.0% women) with chronic dizziness were prospectively characterized by (1) neuro-otological testing, (2) quantitative gait assessment, (3) graduation of focal brain atrophy and white matter lesion load, and (4) cognitive screening (MoCA). A linear regression model was trained to predict patients' total MoCA score based on 16 clinical features derived from demographics, vestibular testing, gait analysis, and imaging scales. Additionally, we trained a binary logistic regression model on the same data sources to identify those patients with a cognitive impairment (i.e., MoCA < 25).

RESULTS

The linear regression model explained almost half of the variance of patients' total MoCA score (R2 = 0.49; mean absolute error: 1.7). The most important risk-predictors of cognitive impairment were age (β = - 0.75), pathological Romberg's sign (β = - 1.05), normal caloric test results (β = - 0.8), slower timed-up-and-go test (β = - 0.67), frontal (β = - 0.6) and temporal (β = - 0.54) brain atrophy. The binary classification yielded an area under the curve of 0.84 (95% CI 0.70-0.98) in distinguishing between cognitively normal and impaired patients.

CONCLUSIONS

The need for cognitive testing in patients with chronic dizziness can be efficiently approximated by available data sources from routine diagnostic workup in a dizziness center.

Relationship between quadriceps muscle architecture and lower limb strength and physical function in older adults community-dwelling individuals: a cross-sectional study

Background and objective

Factors related to muscle architecture may lead to functional limitations in activities of daily living in the older adults. This study aimed to investigate the relationship between quadriceps femoris (QF) architecture and physical function in older adults community-dwelling people.

Methods

The study included 25 community-dwelling older adults participants aged over 60 years (14 women and 11 men) who were not engaged in regular physical activity. The rectus femoris (RF) and vastus intermedius (VI) muscle thicknesses as well as the RF cross-sectional area (CSA) were assessed using 2D ultrasonography. The 30 Seconds Chair Stand test (30sCST) and Timed Up and Go Test (TUG) were used to assess lower body muscle power and functional mobility, respectively.

Results

The QF muscle architecture showed moderate and large correlations with the 30sCST (r range = 0.45-0.67, p < 0.05) and TUG (r range = 0.480-0.60, p < 0.05). RF thickness was a significant (p < 0.01) independent predictor of 30sCST (R 2 = 0.45) and TUG (R 2 = 0.36). VI thickness was a significant (p < 0.05) independent predictor of 30sCST (R 2 = 0.20) and TUG (R 2 = 0.231). RF CSA was a significant independent predictor of the 30sCST (R 2 = 0.250, p < 0.05) and TUG (R 2 = 0.27, p < 0.01). Multiple linear regression models explained 38% of the 30sCST variance and 30% of the TUG variance in the older adults group.

Conclusion

Quadriceps muscle group directly affects basic activities of daily living in the older adults. Ultrasound measurements, which are non-invasive tools, are extremely valuable for understanding the limitations of activities of daily living in the older adults.

The association between dynamic balance and executive function: Which dynamic balance test has the strongest association with executive function? A systematic review and meta-analysis

AIM

The aging global population poses increasing challenges related to falls and dementia. Early identification of cognitive decline, particularly before noticeable symptoms manifest, is crucial for effective intervention. This review aims to determine the dynamic balance test most closely associated with executive function, potentially serving as a biomarker for cognitive decline.

RECENT FINDINGS

Based on recent reviews, inhibitory control, a component of executive function, holds significance in influencing balance performance. Studies suggest that the strength of the correlation between cognition and balance tends to be domain-specific and task-specific. Despite these findings, inconclusive evidence remains regarding the connection between executive function and various dynamic balance assessments. Our review identifies a significant association between all dynamic balance tests and executive function, albeit with varying strengths. Notably, a medium effect size is observed for the Timed Up and Go and Functional Reach Test, a small effect size for balance scales, and a strong effect size for postural sway. This review underscores a clear relationship between dynamic balance task performance and executive function. Dynamic posturography holds potential as a clinical biomarker for early detection of cognitive decline, with a note of caution due to observed heterogeneity and limited studies.

Prognostic Features of Sarcopenia in Older Hospitalized Patients: A 6-Month Follow-Up Study

Background: Sarcopenia is associated with adverse health outcomes. Understanding the association between sarcopenia, multidimensional frailty, and prognosis is essential for improving patient care. The aim of this study was to assess the prevalence and prognostic signature of sarcopenia in an acute hospital setting co-led by internists and geriatricians. Methods: Sarcopenia was assessed by applying the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm, including the SARC-F score, handgrip strength, bioelectrical impedance analysis (BIA), and Timed Up and Go (TUG) test, to 97 older multimorbid inpatients (76.5 ± 6.8 years, 55% women). The patients underwent a Comprehensive Geriatric Assessment (CGA) including an evaluation of Geriatric Syndromes (GSs) and Resources (GR) and prognosis calculation using the CGA-based Multidimensional Prognostic Index (MPI), European Quality of life-5 Dimensions (EQ-5D-5L) scale, Rosenberg Self-Esteem Scale (RSES), and Geriatric Depression Scale (GDS). Information on survival and rehospitalizations was collected 1, 3, and 6 months after discharge. Results: Sarcopenia was present in 63% (95% CI: 54-72%) of patients and categorized as probable (31%), confirmed (13%), and severe sarcopenia (18%). Sarcopenic patients showed significantly higher median MPI-values (p < 0.001), more GSs (p = 0.033), fewer GR (p = 0.003), lower EQ-5D-5L scores (p < 0.001), and lower RSES scores (p = 0.025) than non-sarcopenic patients. Six months after discharge, being sarcopenic at baseline was predictive of falls (p = 0.027) and quality of life (p = 0.043), independent of age, gender, and MPI. Conclusions: Sarcopenia is highly prevalent in older hospitalized multimorbid patients and is associated with poorer prognosis, mood, and quality of life up to 6 months after discharge, independent of age, sex, and MPI as surrogate markers of biological age.

An integrated approach to the assessment of balance and functional mobility in individuals with history of severe traumatic brain injury

Individuals who experienced severe Traumatic Brain Injury (sTBI) are often characterized by relevant motor dysfunctions which are likely to negatively affect activities of daily living and quality of life and often persist for years. However, detailed objective information about their magnitude are scarce. The aim of this study was to quantitatively assess the extent of motor deficits in terms of postural control effectiveness under static and dynamic conditions and to investigate the existence of possible correlations between the results of clinical tests and instrumental measures. Postural sway and functional mobility (i.e., instrumented Timed Up and Go test, iTUG) were objectively measured in 18 individuals with sTBI and 18 healthy controls using a pressure plate and a wearable inertial sensor. Additionally, participants with history of sTBI completed the Rivermead Mobility Index (RMI). One-way ANOVA and Spearman's rank correlation analysis were employed to examine differences between the two groups and determine potential correlations between the instrumental tests and clinical scales. The results show that people with sTBI were characterized by larger sway area and longer iTUG walking sub-phase. Significant correlations were also detected between RMI scores and iTUG total duration, as well as the walking phase. Taken together, these findings suggest that, even years after the initial injury, individuals with sTBI appear characterized by impaired postural control and functional mobility, which appears correlated with the RMI score. The integration of instrumental measures with clinical scales in the routine assessment and treatment of individuals with sTBI would result in more comprehensive, objective, and sensitive evaluations, thus improving precision in treatment planning, enabling ongoing progress monitoring, and highlighting the presence of motor deficits even years after the initial injury. Such integration is of importance for enhancing the long-term quality of life for individuals with sTBI.

Investigating the effects of synbiotic supplementation on functional movement, strength and muscle health in older Australians: a study protocol for a double-blind, randomized, placebo-controlled trial

BACKGROUND

Aging has been associated with a progressive loss of skeletal muscle quality, quantity and strength, which may result in a condition known as sarcopenia, leading to a decline in physical performance, loss of independence and reduced quality of life. While the cause of impaired physical functioning observed in elderly populations appears to be multifactorial, recent evidence suggests that age-associated alterations in gut microbiota could be a contributing factor. The primary objective will be to assess the effects of a dietary synbiotic formulation on sarcopenia-related functional outcomes such as handgrip strength, gait speed and physical performance within older individuals living independently. The secondary objective will be to examine associations between changes in gut microbiota composition, functional performance and lean muscle mass.

METHODS

Seventy-four elderly (60-85 years) participants will be randomized in a double-blind, placebo-controlled fashion to either an intervention or control group. The intervention group (n = 37) will receive oral synbiotic formulation daily for 16 weeks. The control group (n = 37) will receive placebo. Assessments of physical performance (including Short Physical Performance Battery, handgrip strength and timed up-and-go tests) and muscle ultrasonography will be performed at 4 time points (baseline and weeks 8, 16 and 20). Likewise, body composition via bioelectric impedance analysis and blood and stool samples will be collected at each time point. Dual-energy X-ray absorptiometry will be performed at baseline and week 16. The primary outcomes will be between-group changes in physical performance from baseline to 16 weeks. Secondary outcomes include changes in body composition, muscle mass and architecture, fecal microbiota composition and diversity, and fecal and plasma metabolomics.

DISCUSSION

Gut-modulating supplements appear to be effective in modifying gut microbiota composition in healthy older adults. However, it is unclear whether these changes translate into functional and/or health improvements. In the present study, we will investigate the effects of a synbiotic formulation on measures of physical performance, strength and muscle health in healthy older populations.

TRIAL REGISTRATION

This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000652774) in May 2022.

The De Morton Mobility Index (DEMMI) in hospitalized geriatric patients is associated with risk of readmission, mortality, and discharge to a post-acute care facility: A nationwide register-based cohort study

OBJECTIVE

To examine the association between the de Morton Mobility Index (DEMMI) score on admission in geriatric patients and readmission and mortality within 30, 180, and 365 days after discharge, and discharge to a post-acute care facility.

METHODS

A nationwide register-based cohort study including 23,941 geriatric in-patients aged ≥65 years admitted to a geriatric ward between 2014 and 2017 and included in the Danish National Database for Geriatrics. The DEMMI score was categorized into four subcategories: very low mobility (DEMMI=0-24), low mobility (DEMMI=27-39), moderately reduced mobility (DEMMI=41-57), and independent mobility (DEMMI=62-100). Patients were followed 30, 180 and 365 days after discharge for readmission and mortality. Their risk of being discharged to a post-acute care facility was examined. Adjusted hazard ratios (HRs) and odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated.

RESULTS

HRs for readmission within 30-days were 1.36 (1.24-1.48) for very low mobility, 1.30 (1.20-1.42) for low mobility and 1.17 (1.08-1.28) for moderately reduced compared with independent mobility. Similar results were seen for readmission within 180- and 365-days. For mortality, HR for 30-day mortality ranged from1.93 and 5.66, 180-day mortality between 1.62 and 3.19, and 365-day mortality between 1.54 and 2.81 compared with patients with independent mobility. OR for discharge to a post-acute care facility was 8.76 (7.29-10.53) for lowest compared with the highest DEMMI mobility subcategory.

CONCLUSION

In geriatric in-patients, lower DEMMI scores on hospital admission are associated with increased rates of discharge to a post-acute care facility, and for readmission, and mortality within one year.

Assessing the Effect of Data Quality on Distance Estimation in Smartphone-Based Outdoor 6MWT

As a result of technological advancements, functional capacity assessments, such as the 6-minute walk test, can be performed remotely, at home and in the community. Current studies, however, tend to overlook the crucial aspect of data quality, often limiting their focus to idealised scenarios. Challenging conditions may arise when performing a test given the risk of collecting poor-quality GNSS signal, which can undermine the reliability of the results. This work shows the impact of applying filtering rules to avoid noisy samples in common algorithms that compute the walked distance from positioning data. Then, based on signal features, we assess the reliability of the distance estimation using logistic regression from the following two perspectives: error-based analysis, which relates to the estimated distance error, and user-based analysis, which distinguishes conventional from unconventional tests based on users' previous annotations. We highlight the impact of features associated with walked path irregularity and direction changes to establish data quality. We evaluate features within a binary classification task and reach an F1-score of 0.93 and an area under the curve of 0.97 for the user-based classification. Identifying unreliable tests is helpful to clinicians, who receive the recorded test results accompanied by quality assessments, and to patients, who can be given the opportunity to repeat tests classified as not following the instructions.

Frailty in Older Adults with Dengue Fever

Background and objectives: Dengue is one of the most common epidemic infections around the world. Dengue infections in older adults are related to an atypical presentation and a high mortality. Frailty is associated with poor recovery from hospitalization due to infection. However, few studies describe frailty and functional decline after dengue infection. The current case series study aims to investigate the baseline frailty status, functional decline, and time to recovery in older adults after dengue infection. Method: We studied seven patients with post-dengue frailty who had been admitted to the geriatric ward in one tertiary medical center in Taiwan during the 2023 dengue fever outbreak. Result: The mean age was 82 years old. The clinical frailty scale worsened from a mean of 4.7 at baseline to 6.3 at dengue diagnosis. The mean Katz Index of independence in activities of daily living decreased from 10.6 at baseline to 4.7 with dengue, and it recovered to 6.7 one month after discharge. Conclusions: Our preliminary data suggest that there is indeed an increase in frailty in older adults due to dengue. Post-dengue frailty and functional decline might be profound and persistent. Acute geriatric care intervention rehabilitation for frailty after dengue may benefit this population.

Relationship between Timed Up and Go performance and quantitative biomechanical measures of balance

Traumatic brain injury (TBI) impairs sensory-motor functions, with debilitating consequences on postural control and balance, which persist during the chronic stages of recovery. The Timed Up and Go (TUG) test is a reliable, safe, time-efficient, and one of the most widely used clinical measures to assess gait, balance, and fall risk in TBI patients and is extensively used in inpatient and outpatient settings. Although the TUG test has been used extensively due to its ease of performance and excellent reliability, limited research has been published that investigates the relationship between TUG performance and quantitative biomechanical measures of balance. The objective of this paper was to quantify the relationship between biomechanical variables of balance and the TUG scores in individuals with chronic TBI. Regression models were constructed using six biomechanical variables to predict TUG scores. The model that conservatively removed gait speed (i.e., TUG-1/GS) gave the best results, achieving a root-mean-square error of ∼±2 s and explaining over 69% of the variability.

Development of a Cancer Rehabilitation Dashboard to Collect Data on Physical Function in Cancer Patients and Survivors

OBJECTIVE

The aim of the study is to describe the development of a cancer rehabilitation dashboard that collects data on physical function for cancer survivors in a cancer institute.

METHODS

This project was conducted at the Miami Cancer Institute. The cancer rehabilitation dashboard was developed by a team of physicians, biostatistician, and medical informatics teams to record, report and track the physical function of cancer survivors. A multimodal approach to the measurement of physical function was used and included the Patient-Reported Outcome Measurement Information System-Physical Function short form, Patient-Reported Outcome Measurement Information System-Fatigue short form, Timed Up and Go Test, Sit-to-Stand Test in 30-sec test, four-stage balance test, and grip strength. To develop this system, a Cerner Power Form was developed based on the physical function data. To display the data, a dedicated flowsheet was developed and placed within the Oncology Viewpoint in Cerner Millennium. Thus, from inside any patient record, the flowsheet could easily be accessed by providers without leaving normal clinician workflows. Using native functionality, the data can also be shown in graphical format to facilitate dialog with patients and oncology teams. All patient data from the Cerner Power Form discrete task assays were integrated into an existing Oncology Data Warehouse for all patients. The data elements in the Cerner Power Form were identified in the electronic medical record system, loaded into the Oncology Data Warehouse, and related to the other source systems to develop reports and data visualizations such as the cancer rehabilitation dashboard. The cancer rehabilitation dashboard allows visualization of numerous parameters of physical function in cancer survivors evaluated and treated and their change over time. Rendered in Tableau, the cancer rehabilitation dashboard acts as a centralized, interactive data source to analyze and connect clinicians to near real-time data.

RESULTS

The cancer rehabilitation dashboard was successfully developed and implemented into a cancer rehabilitation practice in a cancer institute and used to collect and track physical function data for cancer survivors receiving treatment and cancer survivors. This information has been used to direct the treatment plan and educate individual patients about the impact of the cancer and its treatment on physical function as well as oncology teams in a cancer institute.

CONCLUSIONS

The cancer rehabilitation dashboard provides an insight into the physical function of cancer survivors receiving treatment and cancer survivors using both self-reported and objective metrics. It can be customized to suit the interests of clinicians and researchers wishing to improve the quality of life of this population.

Quantifying Turning Tasks With Wearable Sensors: A Reliability Assessment

OBJECTIVE

The aim of this study was to establish the test-retest reliability of metrics obtained from wearable inertial sensors that reflect turning performance during tasks designed to imitate various turns in daily activity.

METHODS

Seventy-one adults who were healthy completed 3 turning tasks: a 1-minute walk along a 6-m walkway, a modified Illinois Agility Test (mIAT), and a complex turning course (CTC). Peak axial turning and rotational velocity (yaw angular velocity) were extracted from wearable inertial sensors on the head, trunk, and lumbar spine. Intraclass correlation coefficients (ICCs) were established to assess the test-retest reliability of average peak turning speed for each task. Lap time was collected for reliability analysis as well.

RESULTS

Turning speed across all tasks demonstrated good to excellent reliability, with the highest reliability noted for the CTC (45-degree turns: ICC = 0.73-0.81; 90-degree turns: ICC = 0.71-0.83; and 135-degree turns: ICC = 0.72-0.80). The reliability of turning speed during 180-degree turns from the 1-minute walk was consistent across all body segments (ICC = 0.74-0.76). mIAT reliability ranged from fair to excellent (end turns: ICC = 0.52-0.72; mid turns: ICC = 0.50-0.56; and slalom turns: ICC = 0.66-0.84). The CTC average lap time demonstrated good test-retest reliability (ICC = 0.69), and the mIAT average lap time test-retest reliability was excellent (ICC = 0.91).

CONCLUSION

Turning speed measured by inertial sensors is a reliable outcome across a variety of ecologically valid turning tasks that can be easily tested in a clinical environment.

IMPACT

Turning performance is a reliable and important measure that should be included in clinical assessments and clinical trials.

Adapted Home-Based Exercises in Dementia: An Exploratory Pre-post Pilot and Feasibility Study

The goals of this exploratory pre-post pilot and feasibility study (NCT04916964) were to assess the feasibility and effectiveness of an adapted Test-and-Exercise home-based exercise program on basic functional mobility and executive functions in persons with prodromal or mild Alzheimer's disease. Participants followed an 8 week exercise program at home, once per week with a physiotherapist and twice per week with their usual caregiver or independently. Functional mobility and executive functions were assessed before and after the intervention. Feasibility criteria were recruitment opportunity, participation agreement rate, cost adequacy, and drop-out rate. Twelve participants aged 80.83 ± 4.65 years took part in the study. All the basic functional mobility measures showed small effect sizes. Concerning executive functions, 5 measures showed small to moderate effect sizes. The 4 feasibility criteria were met. A larger scale study would, however, need adaptations and prior research on the ability of this population to use touch-screen technology.

Human Umbilical Cord-Derived Mesenchymal Stem Cells in the Treatment of Multiple Sclerosis Patients: Phase I/II Dose-Finding Clinical Study

Multiple sclerosis (MS) is a chronic neuro-inflammatory disease resulting in disabilities that negatively impact patients' life quality. While current treatment options do not reverse the course of the disease, treatment using mesenchymal stromal/stem cells (MSC) is promising. There has yet to be a consensus on the type and dose of MSC to be used in MS. This work aims to study the safety and efficacy of two treatment protocols of MSCs derived from the umbilical cord (UC-MSCs) and their secretome. The study included two groups of MS patients; Group A received two intrathecal doses of UC-MSCs, and Group B received a single dose. Both groups received UC-MSCs conditioned media 3 months post-treatment. Adverse events in the form of a clinical checklist and extensive laboratory tests were performed. Whole transcriptome analysis was performed on patients' cells at baseline and post-treatment. Results showed that all patients tolerated the cellular therapy without serious adverse events. The general disability scale improved significantly in both groups at 6 months post-treatment. Examining specific aspects of the disease revealed more parameters that improved in Group A compared to Group B patients, including a significant increase in the (CD3+CD4+) expressing lymphocytes at 12 months post-treatment. In addition, better outcomes were noted regarding lesion load, cortical thickness, manual dexterity, and information processing speed. Both protocols impacted the transcriptome of treated participants with genes, transcription factors, and microRNAs (miRNAs) differentially expressed compared to baseline. Inflammation-related and antigen-presenting (HLA-B) genes were downregulated in both groups. In contrast, TNF-alpha, TAP-1, and miR142 were downregulated only in Group A. The data presented indicate that both protocols are safe. Furthermore, it suggests that administering two doses of stem cells can be more beneficial to MS patients. Larger multisite studies should be initiated to further examine similar or higher doses of MSCs.

Design and Verification of Integrated Circuitry for Real-Time Frailty Monitoring

In this study, a new wireless electronic circuitry to analyze weight distribution was designed and incorporated into a chair to gather data related to common human postures (sitting and standing up). These common actions have a significant impact on various motor capabilities, including gait parameters, fall risk, and information on sarcopenia. The quality of these actions lacks an absolute measurement, and currently, there is no qualitative and objective metric for it. To address this, the designed analyzer introduces variables like Smoothness and Percussion to provide more information and objectify measurements in the assessment of stand-up/sit-down actions. Both the analyzer and the proposed variables offer additional information that can objectify assessments depending on the clinical eye of the physicians.

Effectiveness of a cardiac rehabilitation program on biomechanical, imaging, and physiological biomarkers in elderly patients with heart failure with preserved ejection fraction (HFpEF): FUNNEL + study protocol

BACKGROUND

Patients with heart failure with preserved ejection fraction (HFpEF) have a low functional status, which in turn is a risk factor for hospital admission and an important predictor of survival in HFpEF. HFpFE is a heterogeneous syndrome and recent studies have suggested an important role for careful, pathophysiological-based phenotyping to improve patient characterization. Cardiac rehabilitation has proven to be a useful tool in the framework of secondary prevention in patients with HFpEF. Facilitating decision-making and implementing cardiac rehabilitation programs is a challenge in public health systems for HFpEF management. The FUNNEL + study proposes to evaluate the efficacy of an exercise and education-based cardiac rehabilitation program on biomechanical, physiological, and imaging biomarkers in patients with HFpEF.

METHODS

A randomised crossover clinical trial is presented among people older than 70 years with a diagnosis of HFpEF. The experimental group will receive a cardiac rehabilitation intervention for 12 weeks. Participants in the control group will receive one educational session per week for 12 weeks on HFpEF complications, functional decline, and healthy lifestyle habits. VO2peak is the primary outcome. Biomechanical, imaging and physiological biomarkers will be assessed as secondary outcomes. Outcomes will be assessed at baseline, 12 weeks, and 24 weeks.

DISCUSSION

Identifying objective functional parameters indicative of HFpEF and the subsequent development of functional level stratification based on functional impairment ("biomechanical phenotypes") may help clinicians identify cardiac rehabilitation responders and non-responders and make future clinical decisions. In this way, future pharmacological and non-pharmacological interventions, such as exercise, could be improved and tailored to improve quality of life and prognosis and reducing patients' hospital readmissions, thereby reducing healthcare costs.

TRIAL REGISTRATION

NCT05393362 (Clinicaltrials.gov).

The Association Between Cognitive Domains and Postural Balance among Healthy Older Adults: A Systematic Review of Literature and Meta-Analysis

PURPOSE OF REVIEW

This review aims to explore which cognitive domain is more closely associated with which type of balance (static or dynamic).

RESENT FINDING

Based on recent reviews, inhibitory control, a part of cognition, plays a crucial role in balance performance. Previous reviews report significant links between cognition, mobility, and physical function in older adults. However, evidence regarding the relationship between cognition and balance scores remains inconclusive. The strength of association between cognition and balance appears to be domain-specific and task-specific. Executive function exhibits the strongest correlation with balance, while episodic memory shows a small link with dynamic balance. Processing speed and global cognition demonstrate moderate correlations. Additionally, there is a slight association between cognitive domains and static balance. Further research is needed to elucidate the underlying mechanisms and develop targeted interventions for managing balance-related concerns that are domain-specific and task-specific.

Prediction of conversion to dementia disorders based on timed up and go dual-task test verbal and motor outcomes: a five-year prospective memory-clinic-based study

BACKGROUND

While assessment tools can increase the detection of cognitive impairment, there is currently insufficient evidence regarding clinical outcomes based on screening for cognitive impairment in older adults.

METHODS

The study purpose was to investigate whether Timed Up and Go dual-task test (TUGdt) results, based on TUG combined with two different verbal tasks (name different animals, TUGdt-NA, and recite months in reverse order, TUGdt-MB), predicted dementia incidence over a period of five years among patients (N = 186, mean = 70.7 years; 45.7% female) diagnosed with Subjective Cognitive Impairment (SCI) and Mild Cognitive Impairment (MCI) following assessment at two memory clinics. Associations between TUG parameters and dementia incidence were examined in Cox regression models.

RESULTS

During follow-up time (median (range) 3.7 (0.1-6.1) years) 98 participants converted to dementia. Novel findings indicated that the TUGdt parameter words/time, after adjustment for age, gender, and education, can be used for the prediction of conversion to dementia in participants with SCI or MCI over a period of five years. Among the TUG-related parameters investigated, words/time showed the best predictive capacity, while time scores of TUG and TUGdt as well as TUGdt cost did not produce significant predictive results. Results further showed that the step parameter step length during TUGdt predicts conversion to dementia before adjustment for age, gender, and education. Optimal TUGdt cutoffs for predicting dementia at 2- and 4-year follow-up based on words/time were calculated. The sensitivity of the TUGdt cutoffs was high at 2-year follow-up: TUGdt-NA words/time, 0.79; TUGdt-MB words/time, 0.71; reducing respectively to 0.64 and 0.65 at 4-year follow-up.

CONCLUSIONS

TUGdt words/time parameters have potential as cost-efficient tools for conversion-to-dementia risk assessment, useful for research and clinical purposes. These parameters may be able to bridge the gap of insufficient evidence for such clinical outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05893524: https://www.

CLINICALTRIALS

gov/study/NCT05893524?id=NCT05893524&rank=1 .

Useful outcome measures in INPH patients evaluation

Introduction

Idiopathic normal pressure hydrocephalus (INPH) is a neurological disorder that is potentially reversible and clinically characterized by a specific triad of symptoms, including gait disturbance, cognitive disorders, and urinary incontinence. In INPH assessment, the most commonly used test is the Timed Up and Go test (TUG), but a more comprehensive assessment would be necessary. The first aim of the present study is to verify the sensitivity of a protocol with both clinical and instrumental outcome measures for gait and balance in recognizing INPH patients. The second aim is to verify the most important spatio-temporal parameters in INPH assessment and their possible correlations with clinical outcome measures.

Methods

Between January 2019 and June 2022, we evaluated 70 INPH subjects. We assessed balance performances with the Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), and TUG, both single (ST) and dual task (DT). We also performed an instrumental gait assessment with the GAITRite electronic walkway system, asking the patients to walk on the carpet for one minute at normal speed, fast speed, and while performing a dual task. We compared the results with those of 20 age-matched healthy subjects (HS).

Results

INPH patients obtained statistically significant lower scores at the BBS, SPPB, and TUG DT but not at the TUG ST, likely because the DT involves cognitive factors altered in these subjects. Concerning instrumental gait evaluation, we found significant differences between HS and INPH patients in almost all spatio-temporal parameters except cadence, which is considered a relevant factor in INPH guidelines. We also found significant correlations between balance outcome measures and gait parameters.

Discussion

Our results confirm the usefulness of BBS and suggest improving the assessment with SPPB. Although the TUG ST is the most commonly used test in the literature to evaluate INPH performances, it does not identify INPH; the TUG DT, instead, might be more useful. The GAITRite system is recognized as a quick and reliable tool to assess walking abilities and spatio-temporal parameters in INPH patients, and the most useful parameters are stride length, stride width, speed, and the percentage of double support. Both clinical and instrumental evaluation may be useful in recognizing subjects at risk for falls.

Group-Based Trajectory Modelling of Changes in Mobility over Six Years in Type 2 Diabetes: The Fremantle Diabetes Study Phase II

To investigate temporal changes in mobility in community-based people with type 2 diabetes, Fremantle Diabetes Study Phase II (FDS2) data were analysed. The baseline assessment included the Timed Up and Go (TUG) test, which was repeated biennially for up to six years. Group-based trajectory modelling (GBTM) identified TUG trajectory groups in participants with ≥2 tests. Independent associates of group membership were assessed using multinomial regression. Of 1551 potential FDS2 participants, 1116 (72.0%; age 64.9 ± 11.0 years, 45.6% female) were included in the modelling. The best-fitting GBTM model identified two groups with linear, minimally changing trajectories (76.2% and 19.4% of participants; baseline TUG times 8 ± 2 and 12 ± 3 s, respectively), and a third (4.5%; baseline TUG 17 ± 5 s) with a TUG that increased over time then fell at Year 6, reflecting participant attrition. Both slower groups were older, more likely to be female, obese, and had greater diabetes-associated complications and comorbidities. Almost one-quarter of the FDS2 cohort had clinically relevant mobility impairment that persisted or worsened over six years, was multifactorial in origin, and was associated with excess late withdrawals and deaths. The TUG may have important clinical utility in assessing mobility and its consequences in adults with type 2 diabetes.

Effects of early aquatic exercise intervention on trunk strength and functional recovery of patients with lumbar fusion: a randomized controlled trial

This study investigated the effectiveness of an early aquatic exercise program on trunk muscle function and functional recovery of patients with lumbar fusion. Twenty-eight subjects were divided into two equal groups. Patients in the aquatic group performed two 60-min aquatic exercise sessions and three 60-min home exercise sessions per week for 6 weeks, whereas those in the control group performed five sessions of 60-min home exercises per week for 6 weeks. The primary outcomes were the Numerical Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI), and the secondary outcomes were Timed Up and Go Test (TUGT), trunk flexor and extensor muscle strength, lumbopelvic stability, and lumbar multifidus muscle thickness measured pre- and post-intervention. Compared with participants in the control group, those in the experimental group showed significant improvement in NPRS, ODI, trunk extensor strength, lumbopelvic control, lumbar multifidus muscle thickness, and relative change in multifidus muscle thickness (significant time by group interactions, P < 0.05). Participants in both groups showed significant time effects (P < 0.001) for TUGT and trunk flexor strength outcome. Aquatic exercise combined with home exercise was superior to home exercise alone in reducing pain, disability and improving muscle strength, lumbopelvic stability, and lumbar multifidus muscle thickness.

Automation of the Timed Up and Go Test Using a Doppler Radar System for Gait and Balance Analysis in Elderly People

The timed up and go (TUG) test is a simple, valid, and reliable clinical tool that is widely used to assess mobility in elderly people. Several research studies have been conducted to automate the TUG test using wearable sensors or motion-tracking systems. Despite their promising results, the adopted technological systems present inconveniences in terms of acceptability and privacy protection. In this work, we propose to overcome these problems by using a Doppler radar system set into the backrest of a chair in order to automate the TUG test and extract additional information from its phases (i.e., transfer, walk, and turn). We intend to segment its phases and extract spatiotemporal gait parameters automatically. Our methodology is mainly based on a multiresolution analysis of radar signals. We proposed a segmentation technique based on the extraction of limbs oscillations signals through a semisupervised machine learning approach, on the one hand, and the application of the DARC algorithm on the other hand. Once the speed signals of torso and limbs oscillations were detected, we suggested estimating 14 gait parameters. All our approaches were validated by comparing outcomes to those obtained from a reference Vicon system. High correlation coefficients were obtained by comparing the speed signals of the torso (ρ=0.8), the speed signals of limbs oscillations (ρ=0.91), the initial and final indices of TUG phases (ρ=0.95), and the extracted parameters (percentage error < 4.8) obtained after radar signal processing to those obtained from the Vicon system.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Older adults with slow sit to stand times show reduced temporal precision of audio-visual integration

Sustained integration of sensory inputs over increased temporal delays is associated with reduced cognitive and physical functioning in older adults and adverse outcomes such as falls. Here, we explored the relationship between multisensory integration and a clinically relevant measure of balance/postural control; Sit-to-Stand Time, the efficiency with which an older adult can transition between a seated and a standing posture. We investigated whether temporal multisensory integration was associated with performance on the Five-Times Sit-to-Stand Test (FTSST) in a large sample of 2556 older adults (mean age = 63.62 years, SD = 7.50; 55% female) drawn from The Irish Longitudinal Study on Ageing (TILDA). K-means clustering was applied to FTSST data, yielding three clusters characterised by fast (mean = 10.88 s; n = 1122), medium (mean = 14.34 s; n = 1133) and slow (mean = 18.97 s; n = 301) sit-to-stand times. At wave 3 of TILDA, older adults participated in the Sound Induced Flash Illusion (SIFI), a measure of the precision of temporal audio-visual integration, which included three audio-visual stimulus onset asynchronies (SOAs): 70, 150 and 230 ms. Older adults with the slowest sit-to-stand times were more susceptible to the SIFI at the longest SOA (230 ms) compared to the shortest SOA (70 ms) relative to those with the fastest times (p = 0.02). Older adults who take longer to repeatedly transition from a seated to a standing posture exhibit an expanded temporal binding window for audio-visual events, supporting a link between multisensory perception and balance/postural control in ageing.

The temporal precision of audiovisual integration is associated with longitudinal fall incidents but not sensorimotor fall risk in older adults

Sustained multisensory integration over long inter-stimulus time delays is typically found in older adults, particularly those with a history of falls. However, the extent to which the temporal precision of audio-visual integration is associated with longitudinal fall or fall risk trajectories is unknown. A large sample of older adults (N = 2319) were grouped into longitudinal trajectories of self-reported fall incidents (i.e., decrease, stable, or increase in number) and, separately, their performance on a standard, objective measure of fall risk, Timed Up and Go (TUG; stable, moderate decline, severe decline). Multisensory integration was measured once as susceptibility to the Sound-Induced Flash Illusion (SIFI) across three stimulus onset asynchronies (SOAs): 70 ms, 150 ms and 230 ms. Older adults with an increasing fall number showed a significantly different pattern of performance on the SIFI than non-fallers, depending on age: For adults with increasing incidents of falls, those aged 53-59 years showed a much smaller difference in illusion susceptibility at 70 ms versus 150 ms than those aged 70 + years. In contrast, non-fallers showed a more comparable difference between these SOA conditions across age groups. There was no association between TUG performance trajectories and SIFI susceptibility. These findings suggests that a fall event is associated with distinct temporal patterns of multisensory integration in ageing and have implications for our understanding of the mechanisms underpinning brain health in older age.

Reference Values, Determinants and Regression Equation for the Timed-Up and Go Test (TUG) in Healthy Asian Population Aged 21 to 85 Years

The "Timed-Up-and-Go" test (TUG) is a standard assessment tool for functional mobility as it assesses several functional components, including balance, gait, and lower-extremity strength. It has good reliability and validity and is cost-effective and safe, making it an ideal screening tool for falls in various populations, such as older adults or various conditions. However, TUG interpretation relies on comparisons against local normative reference values (NRV), which few studies established for the Asian or younger population. Hence, this study aims to: (1) establish the normative reference values NRV for the population aged 21 to 85 years; (2) determine demographic and anthropometric variables that influence the TUG results; and (3) establish the regression equation of the TUG. A prospective, convenience sampling cross-sectional study recruited subjects aged 21-85 from the community to complete two TUG trials in various parts of Singapore. Variables collected include gender, age, height (meters, m), weight (kilograms, kg), and hand grip strength (HGS) (kg). The intraclass correlation coefficient (ICC) and 95% confidence interval (95% CI) determined test-retest, intra- and inter-rater reliabilities. TUG and variables were analyzed with descriptive statistics and multiple linear regression. p < 0.05 was accepted as statistical significance. Further, 838 subjects (542 females, 296 males) completed the data collection. The mean TUG time was 9.16 s (95% CI 9.01-9.3). Slower TUG was observed with advanced age and female gender. Multiple linear regression analysis demonstrated that age, height, and weight were the best variables to predict TUG scores. The regression formula presented as: TUG (second) = 9.11 + 0.063 (Age, years)-3.19 (Height, meters) + 0.026 (Weight, Kilograms) (R² = 0.374, p < 0.001). This study provided the TUG NRV and regression formula for healthy Asian adults aged 21 to 85. The information may provide a quick reference for the physical function to interpret assessment findings and guide decision-making in various health and healthcare settings.

Factors associated with unrecovered falls among older adults

This cross-sectional exploratory study investigated factors associated with unrecovered falls among older patients with a history of falls in the previous year participating in a clinical trial on fall prevention by asking them about their inability to get up independently after the fall. Participants' sociodemographic, clinical, functional (ADL/IADL, TUG, chair-stand test, hand grip, risk of falling) and fall location were investigated. We conducted a multivariate regression analysis adjusted for covariates to identify the main factors associated with unrecovered falls. Out of 715 participants (mean age: 73.4 years; 86% women), 51.6% (95% IC; 47.9 - 55.3%) experienced unrecovered falls. Depressive symptoms, ADL/IADL limitation, mobility limitation, undernutrition, and outdoor falls were associated with unrecovered falls. While assessing the risk of falling, professionals should consider preventive strategies and preparedness procedures for those who are more likely to experience unrecovered falls, such as training to get up from the floor, alarms, and support services.

EFFECTS OF TWENTY-EIGHT MONTHS OF DETRAINING IMPOSED BY THE COVID-19 PANDEMIC ON THE FUNCTIONAL FITNESS OF OLDER WOMEN EXPERIENCED IN CONCURRENT AND FUNCTIONAL TRAINING

Purpose

To assess the impacts of 28 months of detraining imposed by the COVID-19 pandemic on the functional fitness of older women practicing functional or concurrent training.

Material and Methods

A clinical trial with 16 weeks of intervention and 28 months of detraining imposed by the COVID-19 pandemic was conducted. Ninety-five participants were allocated to functional training (FT - 32), concurrent training (CT - 31), or the control group (CG - 32). All the dependent variables were measured pre-training, post-training, and after the detraining period. The functional fitness was assessed by the put on and take off a t-shirt (PTS - upper limbs), timed up and go (TUG - dynamic balance), five times sit-to-stand (FTSST - lower-limb muscle power), gallon-jug shelf-transfer (GJST - global function), and 10 meters walk (W10 m - walking ability) tests.

Results

Sixty-three women remained after the detraining period, twenty-four in the FT (66.0±3.8 years), twenty in the CT (65.0±4.3 years), and nineteen in the CG (69.6±5.9 years). Comparing the detraining vs. the pre-intervention, the FT and CT showed a smaller reduction than CG for the PTS (β_FT=-2.296; β_CT=-1.914), timed up and go (β_FT=-0.705; β_CT=-0.600), five times sit-to-stand (β_FT=-1.970; β_CT=-2.970), gallon-jug shelf-transfer (β_FT=-1.512; β_CT=-1.003), without differences in the 10 meters walk. Also, the concurrent training showed a smaller reduction than the functional training in the FTSST (β = 1.000).

Conclusion

Even after a long detraining period imposed by the COVID-19 pandemic, FT and CT practices were effective strategies for maintaining the functional fitness of older women.

Effect of isotemporal substitution of sedentary behavior with different intensities of physical activity on the muscle function of older adults in the context of a medical center

BACKGROUND

Engaging in physical activity and reducing sedentary time in daily life may enable older individuals to maintain muscle mass. This study aimed to investigate the effects of replacing sedentary behavior with light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) on the muscle function of older adults at a medical center in Taiwan.

METHODS

We recruited 141 older adults (51.1% men; 81.1 ± 6.9 years old) and asked them to wear a triaxial accelerometer on the waist to measure their sedentary behavior and physical activity. Functional performance was assessed based on handgrip strength, Timed Up and Go (TUG) test, gait speed, and five-times-sit-to-stand test (5XSST). Isotemporal substitution analysis was performed to examine the effect of substituting 60 min of sedentary time with 60 min of LPA, MVPA, and combined LPA and MVPA in different proportions.

RESULTS

Reallocating 60 min of sedentary behavior per day to LPA was associated with better handgrip strength (Beta [B] = 1.587, 95% confidence interval [CI] = 0.706, 2.468), TUG test findings (B = -1.415, 95% CI = -2.186, -0.643), and gait speed (B = 0.042, 95% CI = 0.007, 0.078). Reallocating 60 min of sedentary behavior per day to MVPA was associated with better gait speed (B = 0.105, 95% CI = 0.018, 0.193) and 5XSST findings (B = -0.060, 95% CI = -0.117, -0.003). In addition, each 5-min increment in MVPA in the total physical activity replacing 60 min of sedentary behavior per day resulted in greater gait speed. Replacing 60 min of sedentary behavior with 30-min of LPA and 30-min of MVPA per day significantly decreased the 5XSST test time.

CONCLUSION

Our study indicates that introducing LPA and a combination of LPA and MVPA to specifically replace sedentary behavior may help maintain muscle function in older adults.

Prefrailty subtypes differentially predict 5-year mortality in the functionally independent geriatric population

INTRODUCTION

Both frailty and prefrailty (PF) are related to mortality. However, there is no consensus about the PF subtypes for prediction of the mortality risk. We aimed to compare the 5-year mortality of functionally independent geriatric outpatients with nonfrailty, different PF subtypes and frailty.

METHODS

This was a single-center, retrospective cohort study. Community-dwelling older adults who visited the geriatric outpatient clinic in a healthcare institution in Taiwan were enrolled. PF1 was defined based on exhaustion and/or body weight loss whereas PF2 was defined by one or two of the following criteria: weakness, slowness, and low physical activity. Frailty was defined by three or more above criteria. Demographics and results of comprehensive geriatric assessment were compared and Kaplan-Meier survival analysis was used to determine the 5-year survival among the nonfrail, PF1, PF2 and frail groups.

RESULTS

Of the 982 participants, the proportion of PF and frailty was high (PF 45.7% and frailty 24.5%). The cumulative 5-year survival rate of the nonfrail group, PF1, PF2 subgroups and frail group was 98.6%, 95.8%, 89.1% and 81.3% respectively. Age, male sex, PF2 subtype and frailty were significantly associated with 5-year mortality [hazard ratio (95% confidence interval) 1.05 (1.01-1.08), 1.96 (1.08-3.57), 5.18 (1.57-17.09), and 6.87 (2.05-23.04), respectively].

DISCUSSION AND CONCLUSION

The proportion of PF and frailty was high in old outpatient population with functional independence. PF2 subtypes and frailty could influence the 5-year mortality risk in these participants. Identifying PF2 participants earlier and instituting prompt intervention may be beneficial in older patients.

Digital Health Service for Identification of Frailty Risk Factors in Community-Dwelling Older Adults: The SUNFRAIL+ Study Protocol

This article reports the study protocol of a nationwide multicentric study in seven Italian regions aimed at assessing the effectiveness of a digitally supported approach for the early screening of frailty risk factors in community-dwelling older adults. SUNFRAIL+ is a prospective observational cohort study aimed at carrying out a multidimensional assessment of community-dwelling older adults through an IT platform, which allows to connect the items of the SUNFRAIL frailty assessment tool with a cascading multidimensional in-depth assessment of the bio-psycho-social domains of frailty. Seven centers in seven Italian regions will administer the SUNFRAIL questionnaire to 100 older adults. According to the answers provided by older adults, they will be subjected to one or more validated in-depth scale tests in order to perform further diagnostic or dimensional evaluations. The study aims to contribute to the implementation and validation of a multiprofessional and multistakeholder service model for the screening of frailty in community-dwelling older adult population.

Protocol for a randomised, placebo-controlled, double-blinded clinical trial on the effect of oestrogen replacement on physical performance to muscle resistance exercise for older women with osteoarthritis of knee joint: the EPOK trial

BACKGROUND

Knee osteoarthritis (KOA) is highly prevalent in older women, and previous studies suggest the involvement of hormonal factors play a role in the pathogenesis of osteoarthritis. KOA causes musculoskeletal impairment, resulting in decreased physical activity, muscle mass, and strength, which leads to sarcopenia and further increases the burden on healthcare systems. Oestrogen replacement therapy (ERT) improves joint pain and muscle performance in early menopausal women. Muscle resistance exercise (MRE) is a non-pharmacological method that preserves the physical functions of patients with KOA. However, data on short-term oestrogen administration combined with MRE in postmenopausal women, especially in those aged > 65 years, are limited. Therefore, this study presents a protocol of a trial aimed to examine the synergistic effect of ERT and MRE on lower-limb physical performance in older women with KOA.

METHODS

We will conduct a double-blinded, randomised placebo-controlled trial in 80 Japanese women aged > 65 years living independently with knee pain. The participants will be randomly categorised into two groups: (1) 12-week MRE programme with transdermal oestrogen gel containing 0.54 mg oestradiol per push and (2) 12-week MRE programme with placebo gel. The primary outcome measured using the 30-s chair stand test, and secondary outcomes (body composition, lower-limb muscle strength, physical performance, self-reported measure of knee pain, and quality of life) will be measured at baseline, 3 months, and 12 months, and these outcomes will be analysed based on the intention-to-treat.

DISCUSSION

The EPOK trial is the first study to focus on the efficacy of ERT on MRE among women aged > 65 years with KOA. This trial will provide an effective MRE to prevent KOA-induced lower-limb muscle weakness, confirming the benefit of short-term oestrogen administration.

TRIAL REGISTRATION

Japan Registry of Clinical Trials: jRCTs061210062. Registered 17th December 2021, https://jrct.niph.go.jp/en-latest-detail/jRCTs061210062 .

Sensor based assessment of turning during instrumented Timed Up and Go Test for quantifying mobility in chronic stroke patients

BACKGROUND

Turning may be particularly challenging for stroke patients leading to decreased mobility and increased functional restriction. Timed up and go instrumentation using a simple technology in the clinical context could allow for the collection of both traditional and potentially more discriminatory variables in turning ability.

AIM

Determine whether the speed turning metrics obtained by a single inertial sensor are suitable for differentiating between stroke patients with varying levels of mobility and disability.

DESIGN

Cross-sectional study.

SETTING

Outpatients setting.

POPULATION

Chronic stroke patients.

METHODS

A total of 48 chronic stroke patients and 23 healthy controls were included. Stroke patients were divided in two groups based on the total iTUG score: an impaired mobility (> 20 seconds) and an available mobility (<20 seconds) group. All subjects performed an instrumented Timed Up and Go (iTUG) wearing a single IMU sensor on the lower back. Time of subcomponents of the timed up and go test and kinematic parameters of turning were quantified. Other clinical outcomes were: 10 meters walk test, Functional Ambulation Categories Scale (FAC), the Rivermead Mobility Index (RMI), Modified Rankin Scale and the Saltin-Grimby Physical Activity Level Scale (SGPALS).

RESULTS

There were significant differences (P<0.01) in iTUG phases and turning speeds among groups. Low to strong significant correlations were found between measures derived from the turning speeds and clinical measures. The area under the curve (AUC) of Receiver Operating Characteristic (ROC) turning speeds was demonstrated to be able to discriminate (AUC: 0.742-0.912) from available to impaired stroke patients.

CONCLUSIONS

This study provides evidence that turning speeds during timed up and go test are accurate measures of mobility and capable of discriminating stroke patients with impaired mobility from those with normal mobility.

CLINICAL REHABILITATION IMPACT

The turning metrics are related to impairment and mobility in chronic stroke patients; hence they are important to include during clinical evaluation and may assist in creating a customized strategy, assess potential treatments, and effectively organize recovery.

Hand Grip Strength Relative to Waist Circumference as a Means to Identify Men and Women Possessing Intact Mobility in a Cohort of Older Adults with Type 2 Diabetes

Possessing intact mobility in older adults assures their continued independence. The early identification of reduced mobility in older adults with type 2 diabetes (T2DM) is paramount for preventing their future physical deterioration. Hand grip strength (HGS), relative to body size, is associated with mobility in older T2DM patients. This study aims to identify an HGS index that best identifies mobilityintact older T2DM patients, along with its optimal cut-off point. The baseline data are from a cohort of 122 older T2DM patients (59% women) (mean age of 70.2 ± 4.4 years). Three mobility tests encompassing three main mobility domains were measured, including usual gait speed (UGS), timed up and go (TUG), and a two-minute walk test (2MWT). Passing scores were defined as those either above the established cut-off points or above the 25th percentile of population norms. Passing all three tests was considered as possessing intact mobility. Receiver operating characteristic (ROC) curves of the most relevant HGS indices were constructed to determine the area under the curve (AUC) that best identifies patients with intact mobility. In a sample of 122 older adults with T2DM, 63.9% of women and 60% of men were found to possess intact mobility. HGS relative to waist circumference (WC) was found to have the strongest association with intact mobility, presenting the highest AUC in both men (0.78) and women (0.72) for discriminating mobility status, with an optimal cut-off of 0.355 (kg/cm) and 0.245 (kg/cm) in men and women, respectively. HGS relative to WC best differentiated between mobility-intact older adults with T2DM and those with mobility limitations, especially in men. Using HGS/WC as a simple and safe screening mode for mobility in a clinical setting could potentially identify older patients with T2DM that require therapeutic interventions.

Relationship between fall history and toe grip strength in older adults with knee osteoarthritis in Japan: A cross-sectional study

BACKGROUND

Knee osteoarthritis (KOA), one of the most common musculoskeletal diseases in older adults, is associated with a high incidence of falls. Similarly, toe grip strength (TGS) is associated with a history of falls in older adults; however, the relationship between TGS and falls in older adults with KOA who are at risk of falling is not known. Therefore, this study aimed to determine if TGS is associated with a history of falls in older adults with KOA.

METHODS

The study participants, older adults with KOA scheduled to undergo unilateral total knee arthroplasty (TKA), were divided into two groups: non-fall (n = 256) and fall groups (n = 74). Descriptive data, fall-related assessments, modified Fall Efficacy Scale (mFES), radiographic data, pain, and physical function including TGS were evaluated. The assessment was conducted on the day before performing TKA. Mann-Whitney and chi-squared tests were performed to compare the two groups. Multiple logistic regression analysis was performed to determine the association of each outcome with the presence or absence of falls.

RESULTS

Mann-Whitney U test revealed that the fall group had statistically significantly lower height, TGS on the affected and unaffected sides, and mFES. Multiple logistic regression analysis revealed that the incidence of fall history is associated with TGS on the affected side; the weaker the affected TGS of the KOA, the more likely the individual is to fall.

CONCLUSIONS

Our results indicate that TGS on the affected side is related to a history of falls in older adults with KOA. The significance of evaluating TGS among patients with KOA in routine clinical practice was demonstrated.

Can Gait Features Help in Differentiating Parkinson's Disease Medication States and Severity Levels? A Machine Learning Approach

Parkinson's disease (PD) is one of the most prevalent neurological diseases, described by complex clinical phenotypes. The manifestations of PD include both motor and non-motor symptoms. We constituted an experimental protocol for the assessment of PD motor signs of lower extremities. Using a pair of sensor insoles, data were recorded from PD patients, Elderly and Adult groups. Assessment of PD patients has been performed by neurologists specialized in movement disorders using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS)-Part III: Motor Examination, on both ON and OFF medication states. Using as a reference point the quantified metrics of MDS-UPDRS-Part III, severity levels were explored by classifying normal, mild, moderate, and severe levels of PD. Elaborating the recorded gait data, 18 temporal and spatial characteristics have been extracted. Subsequently, feature selection techniques were applied to reveal the dominant features to be used for four classification tasks. Specifically, for identifying relations between the spatial and temporal gait features on: PD and non-PD groups; PD, Elderly and Adults groups; PD and ON/OFF medication states; MDS-UPDRS: Part III and PD severity levels. AdaBoost, Extra Trees, and Random Forest classifiers, were trained and tested. Results showed a recognition accuracy of 88%, 73% and 81% for, the PD and non-PD groups, PD-related medication states, and PD severity levels relevant to MDS-UPDRS: Part III ratings, respectively.

Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review

Frailty is a complex interplay between several factors, including physiological changes in ageing, multimorbidities, malnutrition, living environment, genetics, and lifestyle. Early screening for frailty risk factors in community-dwelling older people allows for preventive interventions on the clinical and social determinants of frailty, which allows adverse events to be avoided. By conducting a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aimed to develop an updated framework for the main measurement tools to assess frailty risks in older adults, paying attention to use in the community and primary care settings. This search focused on the biopsychosocial domains of frailty that are covered in the SUNFRAIL tool. The study selected 178 reviews (polypharmacy: 20; nutrition: 13; physical activity: 74; medical visits: 0; falls: 39; cognitive decline: 12; loneliness: 15; social support: 5; economic constraints: 0) published between January 2010 and December 2021. Within the selected reviews, 123 assessment tools were identified (polypharmacy: 15; nutrition: 15; physical activity: 25; medical visits: 0; falls: 26; cognitive decline: 18; loneliness: 9; social support: 15; economic constraints: 0). The narrative review allowed us to evaluate assessment tools of frailty domains to be adopted for multidimensional health promotion and prevention interventions in community and primary care.

Advanced aging effects on implicit motor imagery and its links to motor performance: An investigation via mental rotation of letters, hands, and feet

This study focuses on changes in implicit motor imagery during advanced aging and these changes’ co-occurrences with physical motor deficits. We administered a mental rotation (MR) task with letters, hands, and feet to 28 young adults (20–27 years) and to 71 older adults (60–87 years), and assessed motor skills (gait mobility and hand dexterity) and neuropsychological performance. Compared to young adults, older adults showed lower MR performance for all stimuli and stronger biomechanical constraint effects on both hand and foot rotation. Moreover, the foot biomechanical constraint effect continued to increase during late adulthood, and declines in hand and foot motor imagery emerged at earlier old ages than declines in visual imagery. These results first demonstrated distinct aging trajectories of hand motor imagery, foot motor imagery, and visual imagery. Exploratory partial correlation analysis for older adults showed positive associations of low-level perceptual-motor skills (Trail Making Test-A performance) with hand and foot MR performance and positive associations of mobility (Timed Up and Go test performance) with foot and letter MR performance. These associations exhibited somewhat different patterns from those of young adults and raised the possibility that age-related declines in motor (and visual) imagery co-occur with declines in motor functioning.

Use of health care services according to functional performance in community-dwelling older adults in Spain. An approach using GAMLSS models

Functional performance in older adults is a predictor of survival and other health outcomes and its measurement is highly recommended in primary care settings. Functional performance and frailty are closely related concepts, and frailty status is associated with the use of health care services. However, there is insufficient evidence on the utilization of services profile according to the functional performance of older adults. The aim of this study was to assess the relationship between functional performance and the use of a wide range of health services in community-dwelling older adults. Generalized additive models for location, scale and shape were used to study these complex data of services utilization, from primary to hospital care. A total of 749 participants from two Spanish regions were followed up for 2 years. Of those, 276 (37%) presented low functional performance and 473 (63%) normal performance according to the Timed Up and Go test. The results showed that even after adjusting for burden of comorbidity and polypharmacy, participants with low functional performance used primary and secondary care health services more intensively, visited emergency rooms more often, and were hospitalized more frequently and for longer periods of time. A negative binomial distribution and a variant thereof were found to be the best models to describe health service utilization data. In conclusion, functionality should be considered as an important health indicator for tailoring the provision of health services for older adults.