Relationship between muscle strength and fall episodes among the elderly: the Yilan study, Taiwan

Risk factors for falls in older adults with type 2 diabetes: A cross-sectional study

The study was to estimate the prevalence of falls with type 2 diabetes (T2D) and investigate the associated risk factors. The study design employed was cross-sectional. The participants for this study were recruited from a community-based diabetes specialist clinic. Data were collected from medical records and structured questionnaires, which included assessments of activities of daily living, instrumental activities of daily living, the Mini-Mental State Examination, the Taiwan Geriatric Depression Scale, and Chinese version of the Tilburg frailty indicator. Multivariate logistic regression was used to analyze the related factors. The study analyzed a total of 242 T2D patients with a mean age of 73.9 ± 5.9 years. The overall fall prevalence rate was 19.7%. The faller trait tendency to female, lower education, history of falls, body mass index ≥ 29 kg/m2, instrumental activities of daily living ≥ 1 task disability, cognitive impairment, depression, poor grip strength, and longer walking time. After adjusting for confounding, showed each additional unit on the depression score increases the fall risk by 11.9% (AOR, 1.19; 95% CI, 1.02-1.38, P = .027). Depression was a significant factor for falls in older adults with T2D. The study highlights the importance of targeted, multifaceted clinical interventions focusing on gender, age, and mental health to effectively reduce fall probability and improve the quality of life for the older adults.

Impacts of Square Stepping Exercise on Physical-Cognitive Function, Biomarkers, Body Composition and Mental Health in Healthy Senior Aged 60 and Above: A Systematic Review

Background: The aim of this systematic review is to analyze the effects of Square Stepping Exercise (SSE) on physical and cognitive function in older people, including its effects on biomarkers, body composition and mental health, focusing only on research that assessed the efficacy of SSE-based interventions. Methods: PubMed, Web of Science, Scopus and Cochrane databases were searched from June 2006 to June 2024 according to the PRISMA guidelines. The main search terms used were related to "older people" and "square-stepping exercise". Controlled trials that included at least one intervention group focused on SSE were included. Participants had to be healthy, without physical or cognitive impairment, and the studies published in English or Spanish. The methodological quality of the selected research was assessed using the Physiotherapy Evidence Database (PEDro). Results: Twelve studies were selected from a total of 444 original records, with a total sample size of 577 participants. The health parameters of the participants were homogeneous, with ages ranging from 60 to 80 years. Significant gains were reported in certain physical function assessments, including balance, lower body strength and power, gait speed and flexibility. There were also significant findings in cognitive function, particularly in general cognitive status, focused attention, response time, basic task performance, and executive function. In addition, SSE can improve metrics such as body composition, brain-derived neurotrophic factor (BDNF), and mental health characteristics. Conclusions: SSE has the potential to significantly improve physical function, cognitive performance and body composition, as well as provide mental health benefits and have variable effects on biomarkers and cardiovascular health.

Adverse childhood experiences and falls in older adults: The mediating role of depression

OBJECTIVES

To explore the relationship between adverse childhood experiences and falls in older adults, and the mediating effects of depression on such associations.

METHODS

This is a prospective study used survey data from the China Health and Retirement Longitudinal Study. Twelve expanded ACEs obtained from the 2014 Life History Survey. Depression levels were assessed using the Centre for Epidemiologic Studies Depression Scale-10. Self-reported outcomes of falling evaluated based on "Have you fallen down since the last survey?" and "How many times have you fallen down seriously enough to need medical treatment?" Logistic regression models were used to explore the relationship between ACEs with falls and recurrent falls. Poisson regression models were used to explore the relationship between ACEs and number of severe falls. Besides, mediation analysis was used to explore whether depression mediates the relationship between ACEs and falls in older adults.

RESULTS

The more adverse childhood experiences experienced, the higher the risk of fall and recurrent falls, and the more severe the falls. Additionally, depression partially mediated the relationship between adverse childhood experiences and falls. Besides, middle-aged individuals were more susceptible to the impact of adverse childhood experiences on falls than older individuals, especially males.

CONCLUSIONS

Exposure to adverse childhood experiences is associated with falls in older adults, and depression partially mediates this association. Middle-aged adults were more susceptible to the impact of adverse childhood experiences on falls. These offer important information for clinical practice and public health interventions to prevent falls and reduce fall-related injuries among older adults.

Sarcopenia definitions and their association with injurious falls in older Swedish women from the Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone fractures (SUPERB) study

Associations between different sarcopenia definitions and the risk of injurious falls were investigated in 75-80-year-old women in the Swedish SUPERB cohort. Only sarcopenia according to the Sarcopenia Definitions and Outcomes Consortium (SDOC) definition was associated with incident injurious falls with and without fractures in older women.

PURPOSE

To investigate the association between three commonly used sarcopenia definitions and the risk of injurious falls in a population of older Swedish women.

METHODS

A total of 2,883 75-80-year-old women with complete data on relevant sarcopenia definitions from the Swedish SUPERB cohort were studied. Sarcopenia was defined based on the Sarcopenia Definitions and Outcomes Consortium (SDOC: low handgrip strength and gait speed), revised European Working Group on Sarcopenia in Older People (EWGSOP2: low appendicular lean mass index (ALMI, dual-energy X-ray absorptiometry (DXA)-derived), appendicular lean mass (kg)/height (m2), hand grip strength (kg), or low chair stand time (s)), and Asian Working Group for Sarcopenia (AWGS: low ALMI and hand grip strength (kg) or low gait speed (m/s)). Questionnaires captured the occurrence of falls in the past 12 months. Incident injurious falls were identified using national registers. Cox regression (hazard ratios (HR) and 95% confidence intervals (CI)) analyses were performed without adjustment and after adjustment for age, body mass index, previous falls, and the Charlson comorbidity index.

RESULTS

During a median (IQR) follow-up time of 7.06 (6.2-7.9) years, there were 491 injurious falls without fracture and 962 injurious falls when also including falls resulting in a fracture. Sarcopenia according to EWGSOP2 and AWGS was not associated with an increased risk of injurious falls. Individuals with sarcopenia defined by SDOC had a higher risk of injurious falls with and without fracture (HR 2.11; 95% CI, 1.63-2.73 and HR, 2.16; 95% CI, 1.55-3.02, respectively).

CONCLUSION

Sarcopenia definitions confined to muscle function and strength such as SDOC, rather than including DXA-determined ALMI (EWGSOP2 and AWGS), are associated with incident injurious falls with and without fractures in older women.

Association of Obesity, Sarcopenia, and Functional Mobility with Risk of Fall: A Cross-Sectional Study from Ardakan Cohort Study on Aging (ACSA)

Background

Falls are considered one of the leading causes of accidental deaths and nonfatal accidental injuries in older adults. Previous research indicates a 1-in-5 yearly fall incidence among Iranian older adults. To examine specific risk factors within this population, our study aimed to evaluate fall risk factors such as obesity, sarcopenia, functional mobility, and activities of daily living (ADL) scores.

Methods

This cross-sectional study used data from the first wave of the Ardakan Cohort Study on Aging (ACSA), involving participants ˃50 years who lived in Ardakan, Iran. The primary outcome was fall history in the past 12 months. The main biomechanical variables included body mass index (BMI), muscle strength, gait speed, static balance, and mobility-assisting devices. Sarcopenia was assessed based on the ratio of hand grip strength to BMI. Multiple logistic regressions assessed associations by odds ratio (OR) and 95% confidence interval.

Results

The final analysis included 4983 participants, 994 of whom reported at least 1 fall. Participants had a mean age of 62.21 ± 4.47 years (50-86 years), with a 48% male distribution. The results of multivariable logistic regression indicated that obesity (OR, 1.02 [95% CI, 0.70- 1.47]; P = 0.910), waist-to-hip ratio (OR, 1.02 [95% CI, 0.74-1.40]; P = 0.903), hand grip strength (OR, 1.20 [95% CI, 0.87-1.66]; P = 0.255), and sarcopenia (OR, 1.11 [95% CI, 0.82- 1.51]; P = 0.474) did not have significant associations with falls. However, impaired standing balance test (OR: 1.64 [95% CI, 1.09-2.47]; P = 0.017) and dependency on ADL (OR, 1.94 [95% CI, 1.05-3.56]; P = 0.032) increased falling.

Conclusion

Impaired balance tests and dependency on ADL increase the risk of falls in older adults. However, obesity indicators, sarcopenia, and gait speed were not associated with the risk of falls.

Feasibility of hand grip tests during and after hospitalization in geriatric patients: an observational study

BACKGROUND

Monitoring the recovery trajectory during and after hospitalization can be a valuable method to observe whether additional care is needed to optimize recovery. Hand grip strength tests are commonly used to measure an individual's physical condition. Eforto® is a system to monitor hand grip strength and grip work as measures of recovery. We examined the feasibility of daily repeated hand grip tests measured with Eforto® in geriatric inpatients, during hospitalization and at home after discharge.

METHODS

Geriatric inpatients (n = 191) were evaluated for grip strength and grip work with Eforto®, twice daily during their admission. We calculated attempt and success rates. Participants were divided into complete, high, moderate, and low attempt/success rate groups to study differences in patient characteristics. Reasons for non-attempt and unsuccessful tests were categorized and analyzed. Nine participants were interviewed about acceptability and user experience within the hospital setting. Four out of twenty participants accepted the invitation to continue the measurements after discharge at home for 4 weeks and were interviewed about acceptability and user experience.

RESULTS

Across the 191 participants, the attempt rate was 85% and 86% of the attempted tests was successful. The main reasons for non-attempt were that the patient felt physically unwell (41%), and that the patient was otherwise engaged, for example receiving care or undergoing medical tests (40%). Measurements were unsuccessful mostly because of the patient not having enough strength to reach the 80% threshold needed for the grip work test (60%). Participants in the complete and high attempt/success rate groups had a shorter length of stay (p<0.05) and a lower mortality (p<0.05) than participants in the moderate/low groups. The interview data showed good acceptability and user experience during hospitalization. The acceptability was strengthened by experienced usefulness. Self-monitoring at home resulted in low inclusion rate (20%) and low success rate (25%), with the uncertain time after discharge from the hospital as the main barrier.

CONCLUSIONS

For most patients, the tests were feasible in the supervised hospital setting. At-home testing with Eforto® is challenging, primarily because of the uncertain time after discharge from the hospital.

Implementing Tai Chi Exercise in Long-Term Care to Reduce Falls

BACKGROUND

Falls are a frequent occurrence in older adults in long-term care facilities.

LOCAL PROBLEM

At our long-term care facility, the percentage of patients who fell increased from 45% in 2021 to 68% in 2022, indicating a need for an evidence-based solution.

METHODS

We used an evidence-based quality improvement framework to pilot a tai chi exercise program.

INTERVENTIONS

Residents were invited to participate in the Tai Ji Quan: Moving for Better Balance program for 12 weeks. Classes were 30 minutes long and included a 5-minute warm-up and 5-minute cooldown.

RESULTS

Seventy-five residents participated in the tai chi program. There was a significant 32.3% reduction in falls ( P =.001). Residents' fall risk scores decreased 14% ( P < .001).

CONCLUSIONS

Implementing a tai chi exercise project may affect falls and decrease the overall fall risk.

Evaluation of Factors Influencing Handgrip Strength Asymmetry in Older Peruvian Adults

BACKGROUND

Sarcopenia is a musculoskeletal disease involving the reduction of muscle mass, strength, and performance. Handgrip strength (HGS) measurements included in frailty assessments are great biomarkers of aging and are related to functional deficits. We assessed the association between potential influencing factors and HGS asymmetry in older Peruvian adults.

METHODS

We used a database of the Peruvian Naval Medical Center "Cirujano Santiago Távara" located in Callao, Peru. All the patients included were ≥60 years old and had an HGS measurement in the dominant and non-dominant hand.

RESULTS

From a total of 1,468 patients, 74.66% had HGS asymmetry. After adjustment, calf circumference weakness (adjusted prevalence ratio [aPR]=1.08; 95% confidence interval [CI], 1.01-1.15), falls risk (aPR = 1.08; 95% CI, 1.02-1.16), and an altered Lawton index (aPR=0.92; 95% CI, 0.84-0.99) were associated with HGS asymmetry.

CONCLUSION

Our findings suggest that HGS asymmetry should be measured along with other geriatric assessments used to evaluate health outcomes in the elderly to enhance health promotion and prevention aimed at preserving muscle strength to curb functional limitations in the elderly.

Development and validation of prediction model for fall accidents among chronic kidney disease in the community

Background

The population with chronic kidney disease (CKD) has significantly heightened risk of fall accidents. The aim of this study was to develop a validated risk prediction model for fall accidents among CKD in the community.

Methods

Participants with CKD from the China Health and Retirement Longitudinal Study (CHARLS) were included. The study cohort underwent a random split into a training set and a validation set at a ratio of 70 to 30%. Logistic regression and LASSO regression analyses were applied to screen variables for optimal predictors in the model. A predictive model was then constructed and visually represented in a nomogram. Subsequently, the predictive performance was assessed through ROC curves, calibration curves, and decision curve analysis.

Result

A total of 911 participants were included, and the prevalence of fall accidents was 30.0% (242/911). Fall down experience, BMI, mobility, dominant handgrip, and depression were chosen as predictor factors to formulate the predictive model, visually represented in a nomogram. The AUC value of the predictive model was 0.724 (95% CI 0.679-0.769). Calibration curves and DCA indicated that the model exhibited good predictive performance.

Conclusion

In this study, we constructed a predictive model to assess the risk of falls among individuals with CKD in the community, demonstrating good predictive capability.

Sarcopenia definitions and their association with fracture risk in older Swedish women

The purpose of this study was to investigate the prevalence of three sarcopenia definitions and their associations with fracture risk in older Swedish women when adjusted for fracture risk assessment (FRAX)-based risk factors; 2,883 women with a mean age of 77.8 years were included. Sarcopenia was defined based on the Sarcopenia Definitions and Outcomes Consortium (SDOC; low handgrip strength [kg] and gait speed (m/s)), revised European Working Group on Sarcopenia in Older People (EWGSOP2; low appendicular lean mass index, appendicular lean mass [ALM]/height; kg/m2], and hand grip strength [kg]), and Asian Working Group for Sarcopenia (AWGS; low ALM (kg), and hand grip strength [kg]) definitions. Femoral neck T-score was obtained from dual-energy X-ray absorptiometry. All fractures, confirmed by X-ray or medical record review, were subsequently categorized as major osteoporotic fractures (MOFs) and hip fractures. Deaths were verified through regional registers. The total follow-up time was 6.4 ± 1.3 (mean ± SD) yr. Cox regression (hazard ratios [HR] and 95% CIs) analyses were performed with adjustment for age, FRAX variables, and femoral neck T-score. Sarcopenia prevalence was 4.5% (n = 129) according to SDOC, 12.5% (n = 360) for EWGSOP2, and 10.3% (n = 296) defined by AWGS. Individuals with sarcopenia defined by SDOC had a higher mortality risk than individuals without sarcopenia (HR: 3.41; 95% CI: 2.51, 4.62) after adjusting for age and FRAX variables. Sarcopenia according to EWGSOP2 and AWGS was not associated with an increased fracture risk after adjusting for age and FRAX variables. Individuals with sarcopenia defined by SDOC had a higher risk for any fractures (HR: 1.48; 95% CI: 1.10, 1.99) and MOF (HR: 1.42; 95% CI: 1.03, 1.98) compared with individuals without sarcopenia after adjusting for clinical risk factors used in FRAX. In conclusion, sarcopenia defined by SDOC, incorporating muscle function/strength, was the only sarcopenia definition associated with fracture risk in older women.

Home Environmental Factors Associated with Falls Among Elderly in Ubon Ratchathani, Thailand

Purpose

The demographics of the world's population have changed over time. Previous research demonstrated the high rate of falls among elderly people living in rural areas in their own houses. This study aimed to use the Thai-Home Fall Hazard Assessment Tool (Thai-HFHAT) to look into the environmental factors inside and outside of residential homes connected to falls among elderly living in rural Thailand.

Methods

Data was gathered between August and October 2023 using a questionnaire to obtain demographic data and the 44-question Thai-HFHAT survey. The survey was divided into seven sections covering the areas inside and outside the elderly home facility. Descriptive statistics were used in the data analysis, and statistical tests, including Fisher's exact test and the Chi-square test, were used to examine the relationship between environmental factors and falls in elderly people.

Results

The study found that issues with an elderly rural home included split-level flooring in the living room, bathroom, and bedroom, an insecurely attached carpet in the kitchen and bedroom, and a shower area not separated from the toilet. The environmental factors linked to falls among the elderly encompass insufficient lighting in the living room, bathroom, bedroom, and parking garage, debris and obstacles such as wires along the path in the living room and parking garage, and the poor condition of the staircase, characterized by inconsistent step heights or a slippery surface.

Conclusion

Community agencies should consider the living conditions of elderly people in rural areas to effectively reduce the occurrence of falls among this population.

Falls among community-dwelling older adults in the Philippines and Viet Nam: Results from nationally representative samples

Falls are a significant public health issue globally. However, studies with nationally representative samples have yet to be done to understand falls among older adults in the Philippines and Viet Nam. Using a biopsychosocial perspective, this study investigated the prevalence of falls and their associated factors among community-dwelling older adults in these countries. Cross-sectional data were drawn from the baseline survey of the Longitudinal Study of Ageing and Health in the Philippines (2018, N = 4,606) and the Longitudinal Study of Ageing and Health in Viet Nam (2018, N = 4,378). The outcome variables were any falls in the past year. Independent variables included sociodemographic factors (age, sex, education, living in urban areas, living alone, social network size), biophysical factors (vision, chronic conditions, functional impairments, pain locations, insomnia symptoms, sleep medications, grip strength, walking speed, postural control), and psychological factors (depressive symptoms). Descriptive analysis and logistic regression analysis were used to analyze the data. The results showed that 17.7 % and 7.3 % of older Filipino and Vietnamese adults fell in the year before the study. Significant factors associated with the odds of any falls among Filipino older adults were having a higher level of education, living in urban areas, living with others, experiencing more functional impairments, reporting one or more pain locations, and having poor grip strength. In Viet Nam, having more chronic conditions, experiencing more functional impairments, and reporting two or more pain locations were found to be associated with higher odds of any falls. The population in the Philippines and Viet Nam is aging rapidly. Findings from this study are timely in identifying at-risk individuals and preparing for effective fall prevention strategies.

Association of affected and non-affected side ability with postoperative outcomes in patients undergoing total hip arthroplasty

BACKGROUND

Although several reports have examined the association between preoperative function and postoperative outcomes in patients undergoing total hip arthroplasty (THA), it is unclear whether the ability of the affected or non-affected side particularly impacts on outcomes. We aimed to investigate the association between affected and non-affected side ability and walking independence.

METHODS

We prospectively enrolled 721 consecutive patients who underwent THA. Preoperatively, quadriceps isometric strength (QIS) and one-leg standing time (OLST) were measured. The endpoints were walking independence within 3, 5, 7, 10, and 14 days postoperatively. The associations between preoperative abilities and outcomes were examined using multivariate Cox hazard model, and the area under the curves (AUCs) for outcomes were compared.

RESULTS

We analysed 540 patients after excluding patients who met the exclusion criteria. Both affected and non-affected QIS predicted walking independence within 3 (p = 0.006 and 0.001, respectively), 5, 7, 10, and 14 (both p < 0.001) days postoperatively. For OLST, only the affected side did not predict walking independence within 3 days postoperatively (p = 0.154 and 0.012, respectively), and both sides did at days 5 (p = 0.019 and <0.001, respectively), 7, 10, and 14 (both p < 0.001). The AUCs of the non-affected side ability for walking independence were significantly greater than those of the affected side on postoperative days 3 (0.66 vs. 0.73; p = 0.021) and 5 (0.67 vs. 0.71; p = 0.040), with no significant difference after day 7.

CONCLUSIONS

Both sides abilities were associated with walking independence after THA, but non-affected side was found to be particularly crucial for early walking independence.

Physical exercise habits are related with reduced prevalence of falling among elderly women in China

BACKGROUND

Although some studies have examined the association between exercise and falls, most have focused on specific exercises, and the results have been inconsistent. In addition, there is a lack of evidence on elderly Chinese women who have different living and exercise habits compared to those in other countries. Therefore, this study aimed to investigate whether physical exercise is associated with falls in elderly Chinese women.

METHODS

This cross-sectional study included 1429 elderly Chinese women with a mean age of 69.2 years. Information on physical exercise habits and fall experiences was collected using a self-report questionnaire. Logistic regression models were used to analyze the association between physical exercise habits and falls.

RESULTS

The results showed that 15% participants had a fall in the past year. After adjusting for confounding factors, the odd ratios (ORs) and 95% Confidence Intervals (CIs) for fall experiences across categories of exercise frequency were as follow: 1 (reference) for no exercise behavior, 0.50 (0.29, 0.85) for exercise 1 to 5 times a week, and 0.37 (0.25, 0.55) for exercise more than 6 times a week. Furthermore, the ORs (95% CIs) across categories of exercise insistence were 1 (reference) for less than 1 year, 0.78 (0.37, 1.65) for 1 to 3 years, and 0.38 (0.20, 0.74) for more than 3 years. In terms of exercise duration, the ORs (95% CIs) for < 1 h/day, 1-2 h/day, and > 2 h/day were 1 (reference), 0.85 (0.53, 1.36), and 2.80 (1.30, 6.05). Unlike other variables, longer exercise duration was associated unfavorably with falls.

CONCLUSION

Physical exercise habits were associated with falls in elderly Chinese women. Keeping a proper exercise habit may contribute to lower risk of falling in elderly women.

Handgrip strength is associated with mortality in community-dwelling older adults: the Yilan cohort study, Taiwan

INTRODUCTION

Hand grip strength (HGS) is one of the methods to help early identification of physical frailty and sarcopenia, the major concerns in the aging societies. It is also crucial to evaluate its impact on mortality. However, the available evidence regarding such impact among specific age cohorts (65 to 74 years and above) is limited. This study tried to investigate the relationship between HGS and mortality among specific cohorts of the community-dwelling older individuals in Yilan, Taiwan.

METHODS

A seven-year longitudinal follow-up study was conducted involving 2,468 community-dwelling older individuals in Yilan. The participants were divided into two groups based on their quartiles of hand grip strength: with poor HGS and with good HGS. The association between HGS and mortality was examined using Cox proportional hazards models.

RESULTS

The analysis revealed that age, HGS, gender, medical history of cardiovascular diseases, body mass index, and wrist-hip ratio had significant impacts on seven-year survival. Specifically, individuals with poor HGS exhibited increased mortality, with an adjusted hazard ratio (HR) of 1.87 (95% CI: 1.52-2.30). Furthermore, the adverse effect of poor HGS on mortality was more pronounced in males aged 65-74 years (adjusted HR 4.12, 95% CI: 2.16-7.84), females aged 75 years or older (2.09, 1.43-3.04) and males aged 75 years or older (1.49, 1.07-2.07).

CONCLUSION

Poor hand grip strength is an independent risk factor for mid-term mortality among community-dwelling older individuals in Yilan. The assessment of HGS can serve as a valuable tool in identifying older individuals at higher risk of death.

Handgrip strength asymmetry as a new biomarker for sarcopenia and individual sarcopenia signatures

BACKGROUND

Although handgrip strength (HGS) asymmetry has clinical screening utility, its relevance to sarcopenia is unknown. This study examined the relationship between HGS asymmetry and sarcopenia signatures, and explored the relevance of circulating neural/neuromuscular markers.

METHODS

9403 individuals aged 18-92 years participated in this study. Maximal HGS and skeletal muscle index (SMI) were determined using hand dynamometry and DXA. Sarcopenia was diagnosed upon the presence of low HGS and low SMI, according to cohort-specific thresholds. Plasma biomarkers were measured by ELISA in a sub-group of 269 participants aged 50-83 years. Asymmetry was determined as the highest recorded HGS divided by the highest recorded HGS of the opposite hand. Individuals with a ratio > 1.10 were classified as having asymmetrical HGS.

RESULTS

Subjects with asymmetrical HGS had significantly lower SMI (7.67 kg/m2 vs 7.71 kg/m2, p = 0.004) and lower HGS (37.82 kg vs 38.91 kg, p < 0.001) than those with symmetrical HGS. In those aged ≥ 50 years asymmetrical HGS was associated with 2.67 higher odds for sarcopenia [95% confidence interval: (CI) = 1.557-4.561, p < 0.001], 1.83 higher odds for low HGS only (CI 1.427-2.342, p < 0.001), and 1.79 higher odds for low SMI only (CI 1.257-2.554, p = 0.001). HGS asymmetry demonstrated acceptable diagnostic accuracy for sarcopenia (AUC = 0.727, CI 0.658-0.796, p < 0.001). Plasma neural cell adhesion molecule concentrations were 19.6% higher in individuals with asymmetrical HGS (185.40 ng/mL vs 155.00 ng/mL, p < 0.001) than those with symmetrical HGS.

DISCUSSION

Our findings demonstrate the utility of HGS asymmetry as a screening tool that may complement existing strategies seeking to combat sarcopenia. Biomarker analyses suggest that heightened denervation may be an important aetiological factor underpinning HGS asymmetry.

Skeletal muscle atrophy, regeneration, and dysfunction in heart failure: Impact of exercise training

This review highlights some established and some more contemporary mechanisms responsible for heart failure (HF)-induced skeletal muscle wasting and weakness. We first describe the effects of HF on the relationship between protein synthesis and degradation rates, which determine muscle mass, the involvement of the satellite cells for continual muscle regeneration, and changes in myofiber calcium homeostasis linked to contractile dysfunction. We then highlight key mechanistic effects of both aerobic and resistance exercise training on skeletal muscle in HF and outline its application as a beneficial treatment. Overall, HF causes multiple impairments related to autophagy, anabolic-catabolic signaling, satellite cell proliferation, and calcium homeostasis, which together promote fiber atrophy, contractile dysfunction, and impaired regeneration. Although both wasting and weakness are partly rescued by aerobic and resistance exercise training in HF, the effects of satellite cell dynamics remain poorly explored.

Effectiveness of an enhanced simultaneous cognitive-physical dual-task training based on fairy tales (ESCARF) in older adults with mild cognitive impairment

The aim of this study was to provide a dual-task program that included cognitive and physical training to older adults with mild cognitive impairment (MCI) and evaluate its effects. A single-group pretest-posttest design was performed using 15 older adults with MCI. A 12-week enhanced simultaneous cognitive-physical dual-task training based on fairy tales (ESCARF) program was conducted from September 2019 to December 2019. Participants were assessed using the Korean version of the Montreal Cognitive Assessment, electroencephalography (EEG), muscle strength, flexibility, agility, memory self-efficacy questionnaire, physical self-efficacy scale, and quality of life before and after 6 and 12 weeks of the intervention. The ESCARF program significantly improved cognitive function, physical function, self-efficacy, and quality of life in older adults with MCI. These findings will provide insights into the development and implementation of customized cognitive interventions to prevent or delay the onset of cognitive decline in older adults with MCI.

Cost-effectiveness analysis of sarcopenia management interventions in Iran

OBJECTIVES

Identification the optimal management intervention of sarcopenia is a concern of health systems. We aimed to analyze the cost-effectiveness of sarcopenia management strategies in Iran.

METHODS

We constructed a lifetime Markov model based on natural history. The strategies comparedincluded exercise training, nutritional supplements, whole body vibration (WBV), and various exercise interventions and nutritional supplement combinations. A total of 7 strategies was evaluated in addition to the non-intervention strategy. Parameter values were extracted from primary data and the literature, and the costs and Quality-adjusted life years (QALYs) were calculated for each strategy. Deterministic and probabilistic sensitivity analysis, including the expected value of perfect information (EVPI), was also performed to determine the robustness of the model. Analyses were performed using the 2020 version of TreeAge Pro software.

RESULTS

All seven strategies increased lifetime effectiveness (QALYs). The protein and Vitamin D₃ (P + D) strategy had the highest effectiveness values among all strategies. After removing the dominated strategies, the estimated ICER for the P + D compared to Vitamin D₃ alone (D) strategy was calculated as $131,229. Considering the cost-effectiveness threshold ($25,249), base-case results indicated that the D strategy was the most cost-effective strategy in this evaluation. Sensitivity analysis of model parameters also demonstrated the robustness of results. Also, EVPI was estimated at $273.

CONCLUSIONS

Study results, as the first economic evaluation of sarcopenia management interventions, showed that despite the higher effectiveness of D + P, the D strategy was the most cost-effective. Completing clinical evidence of various intervention options can lead to more accurate results in the future.

The Nebulous Association between Cognitive Impairment and Falls in Older Adults: A Systematic Review of the Literature

BACKGROUND

In older people, dementia is a well-established risk factor for falls. However, the association and the causal relationship between falls and the earlier stages of cognitive impairment remains unclear. The purpose of the study was to review the literature data on the association between falls and cognitive impairment, no dementia, including Mild Cognitive Impairment.

METHODS

According to PRISMA guidelines, we searched five electronic databases (EMBASE, Web of Science, Medline, CINAHL, and PsychINFO) for articles published between January 2011 and August 2022 on observational studies of older people with a cognitive assessment and/or cognitive impairment diagnosis and a recording of falls. Their quality was reviewed according to the STROBE checklist.

RESULTS

We selected 42 of the 4934 initially retrieved publications. In 24 retrospective studies, a statistically significant association between falls and cognitive status was found in only 15 of the 32 comparisons (47%). Of the 27 cross-sectional analyses in prospective studies, only eight (30%) were positive and significant. We counted four longitudinal analyses, half of which suggested a causal relationship between falls and cognitive impairment. The investigational methods varied markedly from one study to another.

CONCLUSION

It is still not clear whether falls are associated with cognitive impairment, no dementia. Data in favor of a causal relationship are scarce. Further studies are needed to clarify their relationship.

Relationship between proprioception and balance control among Chinese senior older adults

Background: Balance impairment is the most common risk factor for falls among older adults, with three potential factors (tactile sensation, proprioception, and muscle strength) being responsible for their balance control. However, controversies remain on whether or not balance control is related to the three contributors among older adults. Therefore, clarifying the above questions helps explain the mechanisms of increased falls among senior older adults. This study compares the balance control and the three factors and investigates their relationships among older adults of different ages. Methods: 166 participants ultimately passed the qualification assessment and were categorized into younger (YG, 60-69 years, n = 56), middle (MG, 70-79 years, n = 57), or older (OG, ≥80 years, n = 53) aged groups. Berg Balance Scale (BBS) performance, tactile sensation, proprioception, and muscle strength were tested. One-way ANOVA and partial correlation were performed to explore the differences between groups in BBS and its three potential contributors, along with the correlations between them within each age group. Results: Significant differences among the three groups were detected in BBS scores (p < 0.001), tactile sensation at the great toe (p = 0.015) and heel (p = 0.025), proprioception of knee flexion (p < 0.001) and extension (p < 0.001), and ankle plantarflexion (p < 0.001) and dorsiflexion (p < 0.001), and muscle strength of ankle plantarflexion (p < 0.001) and dorsiflexion (p < 0.001), and hip abduction (p < 0.001). Proprioception of knee flexion (r = -0.351, p = 0.009) and extension (r = -0.276, p = 0.041), and ankle plantarflexion (r = -0.283, p = 0.036), and muscle strength of ankle plantarflexion (r = 0.326, p = 0.015) and hip abduction (r = 0.415, p = 0.002) were correlated with BBS among the YG. Proprioception of ankle plantarflexion (r = -0.291, p = 0.030) and muscle strength of ankle plantarflexion (r = 0.448, p = 0.001) and dorsiflexion (r = 0.356, p = 0.007) were correlated with BBS among the MG. Muscle strength of ankle plantarflexion (r = 0.276, p = 0.039) and hip abduction (r = 0.324, p = 0.015) were correlated with BBS among the OG. Conclusion: YG and MG had better balance control, tactile sensation, proprioception, and muscle strength compared to OG. Proprioception correlated with balance control in YG and MG, but not in the OG. The worsen proprioception among the OG could be the key for increased falls. Exercise should be recommended to improve proprioception among senior older adults.

Development of an effective clustering algorithm for older fallers

Falls are common and often lead to serious physical and psychological consequences for older persons. The occurrence of falls are usually attributed to the interaction between multiple risk factors. The clinical evaluation of falls risks is time-consuming as a result, hence limiting its availability. The purpose of this study was, therefore, to develop a clustering-based algorithm to determine falls risk. Data from the Malaysian Elders Longitudinal Research (MELoR), comprising 1411 subjects aged ≥55 years, were utilized. The proposed algorithm was developed through the stages of: data pre-processing, feature identification and extraction with either t-Distributed Stochastic Neighbour Embedding (t-SNE) or principal component analysis (PCA)), clustering (K-means clustering, Hierarchical clustering, and Fuzzy C-means clustering) and characteristics interpretation with statistical analysis. A total of 1279 subjects and 9 variables were selected for clustering after the data pre-possessing stage. Using feature extraction with the t-SNE and the K-means clustering algorithm, subjects were clustered into low, intermediate A, intermediate B and high fall risk groups which corresponded with fall occurrence of 13%, 19%, 21% and 31% respectively. Slower gait, poorer balance, weaker muscle strength, presence of cardiovascular disorder, poorer cognitive performance, and advancing age were the key variables identified. The proposed fall risk clustering algorithm grouped the subjects according to features. Such a tool could serve as a case identification or clinical decision support tool for clinical practice to enhance access to falls prevention efforts.

Different item characteristics of a mild cognitive impairment screening tool in the community-based Yilan Study: application of the item response theory

BACKGROUND

This study aimed to use item response theory (IRT) to explore the item-by-item characteristics of a mild cognitive impairment (MCI) screening tool using community-based data.

METHODS

The Yilan Study is a community-based study that has been conducted since 2012. Until March 2020, 2230 older adults were interviewed according to the household registration data. IRT was applied to determine the item-by-item distinctive characteristics of the Eight-item Interview to Differentiate Aging and Dementia (AD8).

RESULTS

The MCI characteristics in the AD8 items have varying degrees of item response threshold. In all circumstances, item AD8-8, which is related to self-rated memory ability, had a low item response threshold. AD8-5 and AD8-7, which are related to the comparisons of time-oriented functional status, had slightly lower thresholds, especially for those aged 65-79 years or without activity limitations. Conversely, AD8-1, AD8-2, AD8-3, AD8-4, and AD8-6 had similar item response thresholds and discriminative power; these items have more detailed functional descriptions or examples for illustration.

CONCLUSIONS

Concise and understandable elements are often expected in community-based screening tools. For community-based health screening and population empowerment in the early detection of MCI, assessment tool items with detailed functional descriptions and examples for illustration have similar validities in most of the population. Items related to self-rated memory ability might be less valid. More examples may be needed for items constructed for comparing time-oriented functional status, especially in extremely old adults and individuals with activity limitations.

The Relationship Between Duration of General Anesthesia and Postoperative Fall Risk During Hospital Stay in Orthopedic Patients

OBJECTIVES

We performed a retrospective observational study to investigate the relationship between general anesthesia duration and postoperative falls of hospitalized patients who underwent orthopedic surgery.

METHODS

We used electronic medical record data and incident report data from the Osaka Medical and Pharmaceutical University Hospital. The study included 4,042 patients admitted to the Department of Orthopedic Surgery from 2014 to 2018, and the following exclusion criteria were applied: no surgery, less than 18 years of age, and fall between admission and surgery. This study only considered falls that occurred within 21 days of surgery. The multivariate logistic regression model adjusted for patient background was used to determine the risk of falling according to the duration of general anesthesia.

RESULTS

After exclusions, 3,398 patients were included in the analysis. Among them, 45 patients (1.32%) had fallen, of whom 7 (15.6%) were injured and 2 (4.4%) experienced fractures. Multivariate logistic regression analysis to determine the adjusted odds ratio showed that longer general anesthesia duration was an independent risk factor for postoperative falls. In addition, cardiovascular disease had significantly higher associations with postoperative falls.

CONCLUSIONS

In the postoperative care of orthopedic patients, the risk of falling should be assessed by considering the duration of general anesthesia in addition to the traditional fall risk factors. Furthermore, falls could be prevented by educating patients and their caregivers about the risk and mobilizing staff to support postoperative patients at a higher risk of falls when they walk in the hospital.

Acute Responses to Resistance Training on Body Composition, Muscular Fitness and Flexibility by Sex and Age in Healthy War Veterans Aged 50-80 Years

Background: Although evidence suggests that resistance training should be prescribed as a method to enhance or maintain physical fitness, these findings are mostly based on research on younger men. Studies investigating responses by sex and age to resistance training, especially in war veterans aged ≥50 years, are lacking. Therefore, the main purpose of this study was to examine whether a 4-week resistance training program would have similar effects on body composition, muscular fitness, and flexibility in men and women aged 50−80 years. Methods: Seven-hundred and sixty-four participants were recruited and categorized into two groups each of men and women aged 50−64 and 65−80 years. The training intervention lasted 4 weeks and consisted of three 60 min sessions per week. All participants were tested for each of the following physical fitness components: body composition, push-ups in 30 s, chair-stands in 30 s, sit-ups in 30 s, and a sit-and-reach test. Results: Over the intervention period of 4 weeks, body weight (p = 0.002) and the percent of fat mass (p < 0.001) decreased, while the percent of lean mass (p < 0.001) in push-ups in 30 s (p < 0.001), chair-stands in 30 s (p < 0.001), sit-ups in 30 s (p < 0.001), and sit-and-reach (p < 0.001) increased. Significant time*age interactions were shown for push-ups in 30 s (F1,763 = 4.348, p = 0.038) and chair-stands in 30 s (F1,763 = 9.552, p = 0.002), where men and women aged 50−64 years exhibited larger time-induced changes compared to their older (65−80 yr) counterparts. Effect sizes were similar between sex- and age-specific groups. Conclusions: The 4-week resistance training produced similar pronounced positive effects on body composition, muscular fitness, and flexibility, while men and women aged 50−64 years displayed significantly larger improvements in upper and lower muscular fitness compared with their 65−80-year-old counterparts.

Fast walking and physical activity are independent contributors to improved physical function

BACKGROUND AND OBJECTIVES

To clarify whether the presence or absence of fast walking and habitual physical activity are independently associated with the incidence of functional disability.

METHODS

This historical cohort study was comprised of 9,652 (4,412 men, mean age 65 years) individuals aged 39-98 years without functional disability at baseline. Functional disability was determined based on the Japanese long-term care insurance system, which specified requirements for assistance in the activities of daily living. The impact of fast walking and habitual physical activity on the incidence of functional disability was analysed by Cox proportional hazards models.

RESULTS

The follow-up period was a median of 3.7 years during which 165 patients were newly certified as having functional disability. In the multivariate analysis, baseline age in 5-year increments (hazard ratio 2.42 [95% confidence interval 2.18-2.69]), no habitual physical activity (1.56 [1.07-2.27]), and not fast walking (1.89 [1.32-2.69]) significantly increased the risk of functional disability after adjustment for covariates. The stratified analysis showed that compared with physical activity (+), the impact of physical activity (-) on the incidence of functional disability was observed in those aged ≥75 years regardless of fast walking (+). Fast walking (-) significantly increased the risk of disability compared with fast walking (+) in those aged <75 years regardless of a physical activity habit.

CONCLUSION

In Japanese, slow walking speed and lack of a physical activity habit were shown to be independent risk factors for incident functional disability, with their impact differing according to age.

Falls risk screening tools intended to reduce fall risk among independent community‐dwelling older adults: A systematic review

AIMS

The aim of this study is to evaluate an evidence-based fall risk screening tool to predict the risk of falls suitable for independent community-dwelling older adults guided by the World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) components, and to examine the reliability and validity of the fall risk screening tool to predict fall risks, and to examine the feasibility of tools among independent community-dwelling older adults.

METHODS

A systematic literature search guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed using the EBSCOHost® platform, ScienceDirect, Scopus and Google Scholar between July and August 2021. Studies from January 2010 to January 2021 were eligible for review. Nine articles were eligible and included in this systematic review. The risk of bias assessment used the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. The WHO-ICF helped to guide the categorization of fall risk factors.

RESULTS

Seven screening tools adequately predicted fall risk among community-dwelling older adults. Six screening tools covered most of the components of the WHO-ICF, and three screening tools omitted the environmental factors. The modified 18-item Stay Independent Brochure demonstrated most of the predictive values in predicting fall risk. All tools are brief and easy to use in community or outpatient settings.

CONCLUSION

The review explores the literature evaluating fall risk screening tools for nurses and other healthcare providers to assess fall risk among independent community-dwelling older adults. A fall risk screening tool consisting of risk factors alone might be able to predict fall risk. However, further refinements and validations of the tools before use are recommended.

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

OBJECTIVES

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

METHOD

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

RESULTS

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

DISCUSSION

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

The Value of Cognitive and Physical Function Tests in Predicting Falls in Older Adults: A Prospective Study

Introduction

Previous studies suggested that physical and cognitive function can be indicators to assess the risk of falls in the elderly. Various tests are widely used in geriatric clinical studies as assessment tools of physical and cognitive function. However, large sample studies comparing the fall predictive value of these tests are still sparse. This study was conducted to investigate the value of cognitive and physical function tests in predicting the risk of subsequent falls in the elderly, with the overarching goal of providing more evidence on fall-risk assessment.

Methods

The current study was based on the data of respondents aged 60 and above from the China Health and Retirement Longitudinal Study (CHARLS). Data from the 2015 CHARLS national survey were used as the baseline data, and the fall data in 2018 were used as the follow-up data. Physical function tests included balance, walking speed, the five times sit-to-stand test (FTSST), and grip strength. The value of cognitive and physical function tests in predicting falls was evaluated by logistic regression analysis and receiver operating characteristic (ROC) curves.

Results

The incidence of falls among the 4,857 subjects included in this study was 20.86%. Results showed that cognition (OR = 0.83, 95% CI: 0.70–0.98), the FTSST (OR = 3.51, 95% CI: 1.66–7.46), and grip strength (OR = 1.02, 95% CI: 1.01–1.03) were independent predictors of falls in the full sample after adjusting for various confounders. Notably, the above tests showed better predictive value for falls for the oldest-old (≥ 80 years) subjects.

Conclusion

Overall, results showed that grip strength, the FTSST, and cognition tests are simple and practicable tools for identifying individuals at higher risk of falls in the community. Moreover, the fall predictive performance of physical and cognitive function tests was age-dependent, with a higher predictive value in older adults aged 80 and above.

Gait Biomechanics for Fall Prevention among Older Adults

In our currently ageing society, fall prevention is important for better healthy life expectancy and sustainable healthcare systems. While active outdoor walking is recommended as adequate exercise for the senior population, falls due to tripping and slipping exist as the primary causes of severe injuries. Minimum foot clearance (MFC) is the lowest vertical height of the foot during the mid-swing phase and indicates the risk of tripping. In contrast, coefficient of friction (COF) factors determine the occurrence of falls from slipping. Optimisation of the MFC and the COF for every step cycle prevents tripping and slipping, respectively. Even after the initiation of hazardous balance loss (i.e., tripping and slipping), falls can still be prevented as long as the requirements for balance are restored. Biomechanically, dynamic balance is defined by the bodily centre of mass and by the base of support: spatially—margin of stability and temporally—available response time. Fall prevention strategies should, therefore, target controlling the MFC, the COF and dynamic balance. Practical intervention strategies include footwear modification (i.e., shoe-insole geometry and slip-resistant outsoles), exercise (i.e., ankle dorsiflexors and core stabilisers) and technological rehabilitation (i.e., electrical stimulators and active exoskeletons). Biomechanical concepts can be practically applied to various everyday settings for fall prevention among the older population.

Correlation analysis of physical fitness and its impact on falls in 2130 community- dwelling older adults: a retrospective cross-sectional study

BACKGROUND

As the community-dwelling population ages in Taiwan, concerns regarding long-term care have grown more urgent. Physical fitness plays a key role in enabling community-dwelling older adults to independently complete daily tasks and avoid falling accidents. However, the effect of physical fitness on falls and other fitness-related factors remains poorly understood.

METHODS

In this retrospective cross-sectional study, 2130 community-dwelling older adults were recruited from a rural region of Taiwan. Each of these participants completed a demographics interview and frailty questionnaire and reported their history of falls. We evaluated each participant's height and body weight measurements, calf circumference, bone mass density, and results on the grip strength, single-leg standing, chair sit-and-reach, 8-ft up-and-go, 30-second chair stand, 2-minute step, 30-second arm curl, 6-m walk, and back scratch tests to determine their overall physical fitness, which consisted of their body composition, muscular strength and endurance, flexibility, and cardiopulmonary fitness.

RESULTS

The prevalence of falls in the preceding year among the older adults surveyed was 20.8%, and the resultant hospitalization rate was 10.9%. The older adults who were more physically active in the past week, had regular exercise habits, lived with family, and had no history of hospitalization due to falls, exhibited greater performance on the physical fitness tests. Three time fallers exhibited lower levels of overall physical fitness than did those who had not fallen. The nonfallers outperformed the fallers in grip strength (participants who had not fallen and those who had fallen once, twice, or three times in the preceding year: 24.66 ± 0.19 vs. 23.66 ± 0.35 vs. 20.62 ± 0.71 vs. 22.20 ± 0.90 kg) and single-leg standing duration (19.38 ± 0.39 vs. 16.33 ± 0.78 vs. 13.95 ± 1.67 vs. 12.34 ± 1.82 seconds).

CONCLUSIONS

Exercise habits, living status, hospitalization due to falls, and amount of exercise were all associated with physical fitness in community-dwelling older adults. The results of all of the assessments indicated that the participants who had fallen three times exhibited lower levels of physical fitness than did those who had not fallen in the previous year. Physical measurements, including grip strength and single-leg standing duration, are associated with an individual's risk of falling, which indicates that they should be considered in the development of geriatric physical fitness and fall-prevention programs.

Canine Mobility Maintenance and Promotion of a Healthy Lifestyle

This article highlights the recommendations and considerations for maintaining a healthy canine lifestyle. A key component of a healthy lifestyle is the enhancement and optimization of mobility. Mobility is essential in maintaining a high quality of life and involves the interplay of a dog's structure, posture, body condition score, physical exercise, and a healthy human-animal bond throughout a dog's lifetime.

Injury Patterns after Falling down Stairs-High Ratio of Traumatic Brain Injury under Alcohol Influence

Falling down a staircase is a common mechanism of injury in patients with severe trauma, but the effect of varying fall height according to the number of steps on injury patterns in these patients has been little studied. In this retrospective study, prospectively collected data from a Level 1 Trauma Center in Germany were analyzed regarding the injury patterns of patients admitted through the trauma room with suspicion of multiple injuries following a fall down a flight of stairs between January 2016 and December 2019. In total 118 patients were examined which where consecutively included in this study. More than 80% of patients suffered a traumatic brain injury, which increased as a function of the number of stairs fallen. Therefore, the likelihood of intracranial hemorrhage increased with higher numbers of fallen stairs. Fall-associated bony injuries were predominantly to the face, skull and the spine. In addition, there was a high coincidence of staircase falls and alcohol intake. Due to a frequent coincidence of staircase falls and alcohol, the (pre-)clinical neurological assessment is complicated. As the height of the fall increases, severe traumatic brain injury should be anticipated and diagnostics to exclude intracranial hemorrhage and spinal injuries should be performed promptly to ensure the best possible patient outcome.

Sex differences in impact of sarcopenia on falls in community-dwelling Korean older adults

BACKGROUND

Falls are one of the most serious health problems among older adults. Sarcopenia is characterized by a decrease in muscle mass, strength, and physical function. Due to potentially age-related conditions, both falls and sarcopenia have common risk factors. However, the association between sarcopenia and falls is controversial. Moreover, the sex differences in the impact of sarcopenia on falls is not yet clear. This study aimed to investigate the sex differences in the impact of sarcopenia, defined by the Asian Working Group for Sarcopenia (AWGS), on falls in Korean older adults.

METHODS

In this cross-sectional study, we used data from the Korean Frailty and Aging Cohort Study; 2323 community-dwelling older adults (1111 males and 1212 females) aged 70-84 years were recruited in this cross-sectional study. To evaluate sarcopenia, the AWGS diagnostic algorithm was used. We compared the faller and non-faller groups. We performed unadjusted and fully adjusted logistic regression analyses to evaluate the relationship between sarcopenia, falls, and fall-related fractures.

RESULTS

A total of 239 (24.1%) females in the faller group had a history of falls in the past year, which was statistically higher than that in males (176, 15.8%). In the fully adjusted model, handgrip strength (odds ratio [OR] = 1.508, 95% confidence interval [CI] = 1.028-2.211), and short physical performance battery (OR = 2.068, 95% CI = 1.308-3.271) were significantly lower in the male faller group. However, in the fully adjusted model, the female faller group only showed a significantly low appendicular skeletal muscle mass index (OR = 1.419, 95% CI = 1.058-1.903).

CONCLUSIONS

This large cohort study aimed to identify the sex differences in the incidence of sarcopenia in the older Korean population, using the AWGS diagnostic algorithm, and its correlation with falls and fall-related fractures. The incidence of falls did not increase in the sarcopenia group. Among the sarcopenia components, sex differences affect the history of falls. Therefore, when studying the risk of falls in old age, sex differences should be considered.

Assessment of Fall Risk in Elderly Rural Population

Background: Fall risk assessment is an essential component of a comprehensive fall reduction and prevention program. Fall risk assessment is done to identify patients' risk for falls and ultimately prevent falls from occurring. The aim of the study was to identify the risk factors for fall in the elderly population. Methods:This study included 250 elderly patients > 60 years (105 males, 145 females) attending Medicine OPD in a tertiary care hospital. Detailed history including the previous h/o falls, medication history elicited and divided study subjects into two groups: fallers and non-fallers. Cardiovascular, neurological, and musculoskeletal system examinations were done. Handgrip, 30 seconds chair standing test (CST), "timed up and go" test (TUG), and performance-oriented mobility assessment (POMA) were performed. Results:The prevalence of falls in our study was 27.6%. The mean age of fallers was 72.22±6.219 years (P 0.002). Females had significant falls compared to males (p < 0.001). In binary logistic regression, age >80 [OR-3.8, CI (1.8-8.1); p 0.016], female gender [OR-19.2, CI (3.03-122.2); p 0.002], visual impairment [OR-8.9, CI (1.4-55.4); p 0.019], postural hypotension [OR-59.8, CI (3.3-1.07); p 0.006] and presence of more than three risk factors [OR-9.6, CI (4.6-2.01); p 0.000] were significantly associated with fall in our study. Conclusion:Falls among older people were common, especially among individuals aged over 80. Females were more prone to fall. The number of risk factors, visual impairment, and postural hypotension increased the fall risk. Simple clinical assessment can identify high-risk patients.

Effects of square-stepping exercise on motor and cognitive function in older adults - A systematic review and meta-analysis

OBJECTIVES

To document the effects of square-stepping exercise (SSE) on motor and cognitive function in older adults.

METHODS

Five online databases were searched in May 2021. Controlled studies published from 2006 to May 2021 were included. The experimental group received SSE alone or SSE combined with other exercise(s), whereas the control group received no training or other exercise(s). Motor and cognitive outcomes included balance, fall risk, agility, endurance, gait speed, flexibility, muscle strength, reaction time, global cognitive function, memory, and executive function.

RESULTS

Ten articles with a total of 920 participants were included. Static balance (p=0.0009), dynamic balance (p=0.0008), fall risk (p<0.00001), and agility (p=0.02) improved more in the intervention group than in the control group. However, SSE did not seem to exert beneficial effects on cognitive function.

CONCLUSION

In older adults, SSE provided beneficial effects on motor function, including static and dynamic balance, risk of falls, and agility. However, positive effects on cognitive function were not observed and require further investigation.

Gait Ability and Muscle Strength in Institutionalized Older Persons with and without Cognitive Decline and Association with Falls

Falls are a complex problem, given their multifactorial nature, the comorbidities involved, and due to the dependency of older persons living in nursing homes. Risk, fear of falling, falls themselves, and their recurrence are the main factors behind fragility fractures, lack of independence, and increases in pain prevalence, and other comorbidities in older populations. The objectives of the present quantitative and longitudinal study were: (a) to characterize the cognitive state and fall frequency of older persons living in nursing homes; (b) to analyze the relationship between cognitive status and some fall risk factors; and (c) to associate cognitive decline, gait ability, and muscle strength of the examined institutionalized older persons with fall occurrence and recurrence over 12 months. The participants were 204 older persons who lived in Portuguese nursing homes, and data were collected from January 2019 to February 2020 by consulting medical records and applying the following instruments: the Mini-Mental State Examination, Timed Up and Go Test, and Medical Research Council Manual Muscle Testing Scale. Fall prevalence, assessed in two periods, 12 months apart, was similar in both samples (with and without cognitive decline) and close to 42%, and the annual recurrence rate was 38.3%. Older persons with no cognitive decline showed an association between gait speed and occurrence of first fall and recurrent fall (p < 0.05). Muscle strength and use of gait aid devices were not related to falls and their recurrence, regardless of mental state.

Reliability and Validity of the Function Impairment Screening Tool in Chinese Older Adults

Background: Physical function gradually decreases with age in older adults, affecting their independence and quality of life and leaving them prone to adverse outcomes. Despite the importance of assessing function for older adults, most studies have focused on disability and paid less attention to functional impairment. Thus, given the lack of valid and practical methods for evaluating functional impairment for older adults, we developed the function impairment screening tool (FIST) using the Delphi method.

Objective: This study aimed to evaluate the reliability and validity of the FIST in Chinese older adults.

Methods: A total of 489 participants aged 60 years or older, and who had completed the FIST were included. A subgroup of 50 participants completed the FIST a second time, 1 week after the first round, and the test–retest reliability was evaluated using the intraclass correlation coefficient (ICC). Reliability was tested using Cronbach's alpha. Validity was examined using exploratory factor analysis. Criterion-related validity was assessed using correlations between the FIST and the Barthel Index activities of daily living (ADL), Lawton, and Brody instrumental activities of daily living (LB-IADL).

Results: The Cronbach's alpha coefficient for the FIST was 0.930 (P < 0.001). The test–retest reliability was good, with an ICC of 0.928 (95% confidence interval [0.874, 0.960]). Exploratory factor analyses revealed one factor accounting for 60.14% of the scale's variance and the load values of every item were >0.4 (0.489–0.872). The correlation coefficient was 0.572 (P < 0.001) between the FIST score and ADL, and was 0.793 (P < 0.001) between the FIST score and IADL. The FIST score was positively correlated with walking speed (r = 0.475, P < 0.001) and grip strength (r = 0.307, P < 0.001), and negatively correlated with age (r = −0.588, P < 0.001) and Fried frailty phenotype (r = −0.594, P < 0.001).

Conclusion: The FIST is a reliable and valid instrument for assessing physical function impairment in older adults.

Cognitive Dispersion Predicts Grip Strength Trajectories in Men but not Women in a Sample of the Oldest Old Without Dementia

Background and Objectives

Grip strength is a reliable marker of biological vitality and it typically demonstrates an expected decline in older adults. According to the common-cause hypothesis, there is also a significant association between cognitive and physical function in older adults. Some specific cognitive functions have been shown to be associated with grip strength trajectories with most research solely focused on cutoff points or mean cognitive performance. In the present study, we examine whether a measure of cognitive dispersion might be more informative. We therefore used an index that quantifies dispersion in cognitive scores across multiple cognitive tests, shown to be associated with detrimental outcomes in older adults.

Research Design and Methods

Using repeated grip strength measures from men and women aged 80 and older, free of dementia in the OCTO-Twin study, we estimated aging-related grip strength trajectories. We examined the association of cognitive dispersion and mean cognitive function with grip strength level and aging-related rate of change, accounting for known risk factors.

Results

Cognitive dispersion was associated with grip strength trajectories in men and the association varied by mean cognitive performance, whereas we found no association in women.

Discussion and Implications

Our results provide evidence of a sex-specific vitality association between cognitive dispersion and aging-related trajectories of grip strength. Our results support the call for integration of sex and gender in health promotion and intervention research.

Effectiveness of a 3-month antifalling program in the mobility, balance confidence, and muscle performance of older adults

This study determined the effectiveness of a 3-month group-based multicomponent exercise program in the mobility, balance confidence, and muscle performance of older adults. A total of 40 participants (mean age=70.60±6.25 years completed pre- and posttest clinical intervention measures of mobility using the Timed Up and Go (TUG) test, balance confidence using the Activities-specific Balance Confidence scale, upper limb strength (handgrip dynamometer), and lower limb function (30-sec chair rise test). Data were analyzed using paired t-test and based on TUG criteria for risk of fall (low- and high-risk groups). Significant improvements were found in all measures (All P<0.05) following the 3-month program. Measures according to the risk of fall categories were also significantly improved (P<0.01), except the left handgrip strength (P>0.05). The low-risk group showed a higher improvement in mobility (14.87% vs. 11.74%), balance confidence (34.21% vs. 26.08%), and lower limb function (96.87% vs. 21.20%) but was not significantly different from the high-risk group (P>0.05). A group-based multicomponent exercise program benefited the physical functions of older adults at low- or high risk of falls.

Predictors of Falls in Patients with Degenerative Cervical Myelopathy: A Prospective Multi-institutional Study

STUDY DESIGN

Prospective multicenter study.

OBJECTIVES

The purpose of this study was to characterize a population of patients with degenerative cervical myelopathy (DCM) combined with a history of falling, and to identify the predictors associated with those falls.

SUMMARY OF BACKGROUND DATA

Falls among patients with DCM are common and can lead to the worsening of neurological symptoms. However, there are no prospective studies that have investigated the risk factors for falls in these patients.

METHODS

We prospectively enrolled patients scheduled for surgery for DCM and evaluated the significance of various preoperative measures for predicting falls. We then examined the correlation between the number of falls and the preoperative factors. Lastly, we performed stepwise logistic regression analysis to assess the concurrent effects of various factors on the occurrence of falls.

RESULTS

Among the 135 patients analyzed, 64 experienced one or more falls from the time of enrollment to 1 year postoperatively. Univariate analysis showed that the preoperative potassium and albumin levels, handgrip strength, and the Japanese Orthopaedic Association score for the assessment of cervical myelopathy (C-JOA score) were lower and Nurick grade was higher in the fallers group. Serum potassium level, handgrip strength, C-JOA score, Nurick grade, European Quality of Life-5 Dimensions (EQ-5D) score, t1 pelvic angle, and sagittal vertical axis had weak correlations with the number of falls. The fallers group had a lower C-JOA and EQ-5D scores and a lower recovery rate at one year postoperatively. Stepwise multiple logistic regression analysis identified preoperative potassium level and handgrip strength as the independent preoperative predictors for falling.

CONCLUSION

We identified preoperative lower serum potassium level and weaker handgrip strength as significant predictors of falls in patients with DCM. Therefore, DCM patients with these risk factors should be cautious about falls and might be candidates for immediate surgical intervention.Level of Evidence: 3.

Association of polypharmacy with falls among older Chinese inpatients: A nationwide cohort study

AIM

Polypharmacy is prevalent among older adults and has been mainly reported to be associated with falls among community-dwelling or nursing home residents. Our study aimed to investigate the relationship between polypharmacy and falls among older Chinese hospitalized patients.

METHODS

A nationwide prospective cohort study included 9062 participants in six hospitals from China aged ≥65 years, with a 1-year follow-up period. Baseline polypharmacy and other health-related variables were collected when older inpatients were recruited on hospital admission. Polypharmacy was defined as patients who have taken five medications or more. Well-trained nurses assessed falls by telephone at follow up. We used multivariate logistic regression analysis to examine the association between polypharmacy and the risk of falls based on cross-sectional analyses and longitudinal analyses.

RESULTS

Of 9062 participants, the mean age was 72.42 years (SD= 5.69), and 5228 (57.69%) were men. After fully adjusted for age, sex, education, depression, cognitive impairment, low handgrip strength, frailty, various hospitals, and nutritional status, the cross-sectional and longitudinal analyses showed that inpatients with polypharmacy had an increased risk of falls (OR 1.37, 95%CI 1.17-1.56 for the cross-sectional association; OR 1.43, 95% CI 1.01-2.03 for the longitudinal association, respectively), compared with those without polypharmacy. In addition, subgroup analyses of the association between polypharmacy and 1-year falls, or history of falls was unchanged.

CONCLUSIONS

Polypharmacy was prevalent among older Chinese hospitalized patients and was an independent risk factor of 1-year falls, suggesting that clinicians should make a comprehensive assessment of medications, and deprescribing strategies should be implemented to reduce unnecessary medications for decreasing the rate of falls. Geriatr Gerontol Int 2021; 21: 810-817.

A Description of Handgrip Strength in the Very Older Adult People Living in Rural Vietnam and Its Association with Daily Functions

Objective

To describe handgrip strength (HGS) and identify associated factors in community-dwelling older adults in rural Vietnam.

Methods

A cross-sectional study was conducted in community-dwelling older adults 80 years and over in five rural communities in Hanoi, Vietnam. Age-gender-BMI stratified HGS values were reported as means and standard deviations. Demographic characteristics, malnutrition, risk of fall, basic activities of daily living (ADL), and instrumental activities of daily living (IADL) were investigated. Multivariate linear regression explored the association between HGS and these factors.

Results

In 308 participants, mean age was 85.4 ± 4.2 years. Mean HGS was 21.6 ± 6.1 kg for males and 15.3 ± 4.3 kg for females. HGS in our sample was generally lower than that in other European countries and Asian threshold. Low HGS was correlated with older age (β = -0.196, p < 0.001), female (β = -0.443, p < 0.001), low education (β = -0.130, p < 0.05), risk of falls (β = -0.114, p < 0.05), and lower IADL (β = 0.153, p = 0.001).

Conclusions

The age-gender-BMI stratified HGS values of 80 years and over community-dwellers in rural Vietnam were described. HGS decreased with advanced age, female, low education, high risk of falls, and impaired IADLs. The results could provide useful reference data for further investigations and measures in clinical practice.

Physical Fitness among Community-Dwelling Older Women with and without Risk of Falling-The Taipei Study, Taiwan

The purposes of this study were to compare the differences in physical fitness between community-dwelling older women fallers and non-fallers, with and without a risk of falling, and to investigate the relation between physical fitness and falling risk factors. This study was a secondary data analysis from a community- and exercise-based fall-prevention program. Baseline assessments pertaining to body weight and height, self-reported chronic diseases, the 12-item fall risk questionnaire (FRQ), senior fitness test, single-leg stand test, and handgrip strength test were extracted. Participants (n = 264) were classified into fallers and non-fallers, and sub-classified according to the risk of falling (FRQ ≥4 and <4). While controlling for the effect of age, body mass index (BMI), and multimorbidity, one-way analysis of covariance indicated that older women with a risk of falling showed poorer performances of the 8-foot up-and-go, 2-min step and 30-s chair stand compared with those without a risk of falling, regardless of the history of falls. Additionally, weaker grip strength was found in non-fallers with falling risk. Some significant, but low-to-moderate, correlations were found between physical fitness tests and fall risk factors in the FRQ, particularly in gait/balance problem and leg muscle weakness. Proactive efforts are encouraged to screen and manage deterioration in the identified physical fitness.

Grip strength performance from 9431 participants of the GenoFit study: normative data and associated factors

Weak grip strength is a strong predictor of multiple adverse health outcomes and an integral diagnostic component of sarcopenia. However, the limited availability of normative data for certain populations impedes the interpretation of grip performance across adulthood. This study aimed to establish normative data and low grip strength thresholds in a large adult population, and to examine associations between grip strength and clinically relevant health variables. A total of 9431 adults aged between 18 and 92 years participated in this study (mean age: 44.8 ± 13.4 years; 57% females). Grip strength, body composition, and cardiorespiratory (CR) fitness were assessed using hand dynamometry, dual-energy x-ray absorptiometry and physical work capacity tests, respectively. Low grip strength was established according to criteria of the European Working Group on Sarcopenia in Older People. Normative data and t-scores, stratified by sex and age groups, are presented. Grip performance was associated with lean mass, skeletal muscle index (SMI), fat mass, CR fitness, bone mineral density (BMD), android/gynoid ratio, disease prevalence and physical activity levels (all p < 0.001) after controlling for multiple potential confounders. Individuals with weak grip strength had lower lean mass, SMI, CR fitness (all p < 0.001) and BMD (p = 0.001), and higher disease prevalence (p < 0.001), compared to healthy controls, although sex-specific differences were observed. Grip strength has practical screening utility across a range of health domains. The normative data and grip strength thresholds established in this study can guide the clinical interpretation of grip performance and facilitate timely therapeutic strategies targeting sarcopenia.

Sports Medicine and Rehabilitation in Working Dogs

Canine sports medicine and rehabilitation recently have evolved to embody the optimization of performance, injury prevention, and mitigation of musculoskeletal degeneration. This article discusses the diverse factors and considerations of working dog wellness and injury prevention and the importance of recognizing normal and abnormal posture and anatomic structure for performance evaluation and early indication of musculoskeletal injury. The importance of a canine physical fitness program is highlighted and the need for a 4-phase recovery plan to determine if a working dog can safely return to work after injury discussed.

Risk of falls in 4 years of follow-up among Chinese adults with diabetes: findings from the China Health and Retirement Longitudinal Study

OBJECTIVES

This study was to determine the incidence of falls and identify baseline factors increased risk for incident falls over time among people with diabetes.

DESIGN

This study was a secondary analysis using the baseline and 4 years of follow-up data from the China Health and Retirement Longitudinal Study (CHARLS).

SETTING

A nationally representative survey of 17 500 Chinese residents aged 45 years and older were recruited in the baseline national survey in 2011. These participants were followed up every 2 years.

PARTICIPANTS

A total of 1238 middle-aged and older adults with diabetes and no history of falls at baseline were included in the current study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Information on incidence of falls and medical treatment resulting from falls were determined by self-report.

RESULTS

The findings showed that the incidence of falls was 29.4% during 4 years of follow-up. Participants with incident falls were younger, were more likely to be women, had lower education level and were less likely to be current drinkers. In addition, former drinkers were 2.22 times more likely to fall. Socially active individuals were 47% less likely to fall compared with those without social activities. Every 5 kg increase in grip strength was associated with a 13% lower risk of falls. A 10 mg/dL higher total cholesterol and 1 mg/dL higher blood urea nitrogen were associated with a 4% and 6% higher risk of falls. Finally, participants with depressive symptoms were 1.47 times more likely to fall compared with those without depressive symptoms.

CONCLUSIONS

These findings underscore the importance of developing a fall prevention programme for those with diabetes, and this programme should address potentially modifiable risk factors, including levels of total cholesterol, blood urea nitrogen, social activity, depressive symptoms and grip strength.

Relationship between personality and physical capacities in older adults: The mediating role of subjective age, aging attitudes and physical self-perceptions

Walking speed and muscular strength are two main markers of health in adulthood. Previous studies have shown that personality traits may predict these two outcomes. However, little is known about the mechanisms underlying these relationships. Thus, the present study examined whether personality traits are associated with walking speed and muscular strength through the mediating role of subjective age (how young or old individuals experience themselves to be), attitudes toward aging and physical self-perceptions. Community-dwelling older women (N = 243; M_age = 73.0; SD_age = 6.5) were recruited. For reasons of recruitment feasibility, participants were only older women. They were requested to complete a questionnaire measuring personality, subjective age, attitudes toward aging and physical self-perceptions. Following this, their walking speed and their muscular strength were investigated. Data were analyzed using structural equation modeling. In line with the literature, we extended the associations between extraversion, neuroticism, conscientiousness and walking speed and between conscientiousness, neuroticism, openness and muscular strength. Physical self-perceptions appear to be a robust mediator between personality traits and walking speed whereas attitudes toward aging and subjective age mediated the personality traits/muscular strength relationship. This study provides evidence, for the first time, that the associations between personality traits and physical capacities are different according to the physical capacities investigated. Based on these results, it could be interesting to adapt physical activity interventions to the psychological profile of older adults.