Balance, gait, functionality and strength: comparison between elderly fallers and non-fallers

Developing a rapid predictive model for falls in older hospitalized patients

Background

This study was aimed to identify the independent risk factors for falls n hospitalized older patients and develop a corresponding predictive model.

Methods

A retrospective observational study design was adopted, comprising 440 older patients with falls history and 510 older patients without falls history during hospitalization. Data collected included demographic information, vital signs, comorbidities, psychiatric disorder, function absent, current medication, other clinical indicators.

Results

Mobility disability, high-risk medications use, frequency of hospitalizations, psychiatric disorder, visual impairment are independent risk factors for falls in older patients. The A-M2-HPV scoring system was developed. The AUC value of the nomogram was 0.884, indicating the model has excellent discriminative ability. The AUC value of the A-M2-HPV score was 0.788, demonstrating better discrimination and stratification capabilities.

Conclusion

The A-M2-HPV scoring system provides a valuable tool to assess the risk of falls in hospitalized older patients and to aid in the implementation of preventive measures.

Importance of muscle strength to maintain mobility, but not to maintain postural balance in older women: Cross-sectional study

BACKGROUND

Acknowledging the relationship between postural control and muscle strength in lower limbs is important to find persons with high fall risk and to design fall prevention exercise programs.

OBJECTIVE

To investigate the connection between knee muscle strength, semi-static postural balance, and functional mobility in irregularly active older women.

METHODS

One hundred and ten older women aged 60 to 85 years underwent a semi-static postural balance test in a force and functional mobility measured by Timed Up & Go (TUG) with and without Cognitive Tasks (CT). Muscle strength of the knee was assessed by isokinetic dynamometry at 60°/s.

RESULTS

A negative correlation between the functional mobility (TUG with and without CT) and the muscular strength of the knee was observed. Regarding semi-static balance, there was a low negative correlation with peak torque corrected for body weight of the extensors with the following variables with eyes open: Mean Velocity Dominant limb (D) (r = -0.19; p = 0.03); and anteroposterior range Non-Dominant limb (ND) (r = -0.19; p = 0.04); with eyes closed: mediolateral range ND limb (r = -0.21; p = 0.02) and Mean Velocity ND limb (r = -0.18; p = 0.05).

CONCLUSIONS

This study found that better functional mobility was associated with greater muscle strength in the knee in elderly women. There were weak negative correlations between knee extensor strength and some measures of semi-static postural balance, suggesting that different motor control actions are required to maintain semi-static balance and mobility. In the case of semi-static balance, a lower level of muscle response is required than in functional mobility.

Ubiquitous Gait Analysis through Footstep-Induced Floor Vibrations

Quantitative analysis of human gait is critical for the early discovery, progressive tracking, and rehabilitation of neurological and musculoskeletal disorders, such as Parkinson's disease, stroke, and cerebral palsy. Gait analysis typically involves estimating gait characteristics, such as spatiotemporal gait parameters and gait health indicators (e.g., step time, length, symmetry, and balance). Traditional methods of gait analysis involve the use of cameras, wearables, and force plates but are limited in operational requirements when applied in daily life, such as direct line-of-sight, carrying devices, and dense deployment. This paper introduces a novel approach for gait analysis by passively sensing floor vibrations generated by human footsteps using vibration sensors mounted on the floor surface. Our approach is low-cost, non-intrusive, and perceived as privacy-friendly, making it suitable for continuous gait health monitoring in daily life. Our algorithm estimates various gait parameters that are used as standard metrics in medical practices, including temporal parameters (step time, stride time, stance time, swing time, double-support time, and single-support time), spatial parameters (step length, width, angle, and stride length), and extracts gait health indicators (cadence/walking speed, left-right symmetry, gait balance, and initial contact types). The main challenge we addressed in this paper is the effect of different floor types on the resultant vibrations. We develop floor-adaptive algorithms to extract features that are generalizable to various practical settings, including homes, hospitals, and eldercare facilities. We evaluate our approach through real-world walking experiments with 20 adults with 12,231 labeled gait cycles across concrete and wooden floors. Our results show 90.5% (RMSE 0.08s), 71.3% (RMSE 0.38m), and 92.3% (RMSPE 7.7%) accuracy in estimating temporal, spatial parameters, and gait health indicators, respectively.

A machine learning approach to identify important variables for distinguishing between fallers and non-fallers in older women

Falls are a significant ongoing public health concern for older adults. At present, few studies have concurrently explored the influence of multiple measures when seeking to determine which variables are most predictive of fall risks. As such, this cross-sectional study aimed to identify those functional variables (i.e. balance, gait and clinical measures) and physical characteristics (i.e. strength and body composition) that could best distinguish between older female fallers and non-fallers, using a machine learning approach. Overall, 60 community-dwelling older women (≥65 years), retrospectively classified as fallers (n = 21) or non-fallers (n = 39), attended three data collection sessions. Data (281 variables) collected from tests in five separate domains (balance, gait, clinical measures, strength and body composition) were analysed using random forest (RF) and leave-one-variable-out partial least squares correlation analysis (LOVO PLSCA) to assess variable importance. The strongest discriminators from each domain were then aggregated into a multi-domain dataset, and RF, LOVO PLSCA, and logistic regression models were constructed to identify the important variables in distinguishing between fallers and non-fallers. These models were used to classify participants as either fallers or non-fallers, with their performance evaluated using receiver operating characteristic (ROC) analysis. The study found that it is possible to classify fallers and non-fallers with a high degree of accuracy (e.g. logistic regression: sensitivity = 90%; specificity = 87%; AUC = 0.92; leave-one-out cross-validation accuracy = 63%) using a combination of 18 variables from four domains, with the gait and strength domains being particularly informative for screening programmes aimed at assessing falls risk.

Risk factors for fall among the elderly with diabetes mellitus type 2 in Jeddah, Saudi Arabia, 2022: a cross-sectional study

Diabetes mellitus type 2 is a major chronic condition that is considered common among elderly people, with multiple potential complications that could contribute to falls. However, this concept is not well understood; thus, the aim of this study is to estimate the prevalence of falls among diabetes patients.

Methods

In this observational cross-sectional study, 309 diabetic patients aged 60 years or more who visited the primary healthcare centers of the Ministry of National Guard - Health Affairs in Jeddah were chosen via convenience sampling method. To collect the data, a structured Fall Risk Assessment questionnaire and Fall Efficacy Score scale were used.

Results

The mean age of the participants was estimated to be 68.5 (SD: 7.4) years. Among the participants, 48.2% have fallen before, and 63.1% of them suffered falls in the past 12 months. The results showed that gait problems were independently associated with a higher likelihood of falls among elderly patients [odds ratio (OR)=1.98; 95% CI: 1.08-3.62; P=0.026]. Based on the linear regression analysis, we identified the following risk factors for lower falls efficacy: having gait problems (β=12.50; 95% CI: 7.38-17.6; P<0.001), balance difficulties (β=6.58; 95% CI: 1.35-11.8; P=0.014), and neurological/cognitive impairments (β=9.62; 95% CI: 3.89-15.4; P=0.001), as well as having poor sleep quality (β=8.11, 95% CI: 3.32-12.9; P<0.001).

Conclusion

This paper suggests that diabetes mellitus is an independent fall risk factor among the elderly. Therefore, identifying such patients as being at higher risk and prompt referral to a specialist falls clinic is recommended.

Identification of characteristics of foot position and angle during swing phase in fallers using principal component analysis

Identifying the characteristics of fallers is important for preventing falls because such events may reduce quality of life. It has been reported that several variables related to foot positions and angles during gait (e.g., sagittal foot angle and minimum toe clearance) differ between fallers and non-fallers. However, examining such representative discrete variables may not be sufficient to detect crucial information, which may be contained in the large portions of unanalyzed data. Therefore, we aimed to identify the comprehensive characteristics of foot position and angle during the swing phase of gait in non-fallers and fallers using principal component analysis (PCA). Thirty non-fallers and 30 fallers were recruited for this study. We performed PCA to reduce the dimensions of foot positions and angles during the swing phase and obtained principal component scores (PCSs) for each principal component vector (PCV), which were then compared between groups. The results revealed that the PCS of PCV3 in fallers was significantly larger than that in non-fallers (p = 0.003, Cohen's d = 0.80). We reconstructed waveforms of foot positions and angles during the swing phase using PCV3 and our main findings can be summarized as follows. Compared to non-fallers, fallers have a 1) low average foot position in the z-axis (i.e., height) during the initial swing phase 2) small average foot angle in the x-axis (i.e., rotation in the sagittal plane), during the initial swing phase, and 3) large variability in foot position in the y-axis (i.e., anterior/posterior position) during the initial swing phase. We can conclude that these are characteristics of gait related to fallers. Therefore, our findings may be beneficial for evaluating fall risk during gait using a device such as a shoe- or insole-embedded inertial measurement unit.

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.

Determination of the Predictors with the Greatest Influence on Walking in the Elderly

Background and Objectives: Previous studies have revealed that independent variables (lower extremity strength, postural control ability, and body composition) influence gait performance and variability, but the difference in the relative influence between these variables is unclear. Hence, this study determines the variable that is the most influential predictor of gait performance and variability among potential independent variables in the elderly. Materials and Methods: Seventy-eight subjects aged ≥60 years participated. For each subject, the gait variables and lower extremity muscle strength were measured using an accelerometer worn on both feet during a 6-minute walk and a manual force sensor, respectively. The static balance ability was measured through two force plates, and the body composition was measured by applying bioelectrical impedance analysis. Linear regression analyses were performed stepwise to determine whether these variables affect gait performance and variability. Results: After adjusting for sex and gait performance, the ankle strength, body fat mass, mean velocity in the medial-lateral direction, ankle plantar flexion strength, and girth were predictors of gait speed dorsiflexion, gait performance, swing width of the gait performance, walking speed, and gait variability, respectively. Conclusions: Overall, gait performance in the elderly is related to muscle strength, postural control, and body composition in a complex manner, but gait variability appears to be more closely related to ankle muscle strength. This study provides further evidence that muscle strength is important in motor function and stability.

Exploring Mediation Effects of Gait Speed, Body Balance, and Falls in the Relationship between Physical Activity and Health-Related Quality of Life in Vulnerable Older Adults

The present study aimed to examine whether gait speed (GS), body balance (BB), and falls mediated the relationship between physical activity (PA) and health-related quality of life (HRQoL) in community-dwelling older adults. This is a cross-sectional study that included 305 men and 314 women (69.5 ± 5.6 years), residing in the Autonomous Region of Madeira, Portugal. HRQoL and PA were assessed using the SF-36 and Baecke Questionnaires, respectively. While BB was obtained by the Fullerton Advance Balance (FAB) scale, GS by the 50-foot (15 m) walk test, and the frequency of falls was obtained by self-report. According to the analyses, when GS and BB were placed concomitantly as mediators, the direct effect revealed by the model revealed a non-significant relationship between PA and falls. Thus, in the context of falls, GS and BB partially mediated the association between PA and HRQoL in approximately 29.7%, 56%, and 49.2%, respectively. The total HRQoL model explained a variance of 36.4%. The results can help to understand the role that GS, BB, and falls play in the relationship between PA and HRQoL of the vulnerable older adult population.

Analysis of Fall Events, Physical Fitness, and Gait Speed According to Fall Risk in Older Korean Women

The present study aimed to investigate the associations between fall risk and previous fall events, physical fitness, and gait speeds on flat ground and during obstacle avoidance in older adult women in Korea. Data were analyzed for 148 women over 65 years of age, divided into low (n = 52) and high Berg Balance Scale (BBS) score groups (n = 96). Physical fitness was assessed using arm curl, chair stand, 2 min step, chair sit-and-reach, timed up-and-go, and single-leg stance tests. Gait speed was measured on flat ground and during obstacle avoidance (5 cm, 10% of height, 30 cm). The incidence of falls was 18.2% lower among participants with BBS scores above the mean than in those with scores below the mean (p < 0.05). Furthermore, the two groups exhibited significant differences in the chair stand, chair sit-and-reach, timed up-and-go, and single-leg stance test results. The upper BBS group appeared faster at all four gait speeds, and participants in the upper BBS group were less likely to exhibit lower physical fitness in each test, with odds ratios (ORs) ranging from 0.227 to 0.447. The upper BBS group was also less likely to exhibit lower gait speed in most conditions, with ORs ranging from 0.327 to 0.516. Further studies should consider exercise programs that promote balance, muscular strength, and proprioception to lower the risk of falling in older adults.

The Relationship between the Activity Balance Confidence and Mobility Tests among Older Adults in Indonesia

Introduction. Unsteady gait, instability, and lower extremity muscle weakness are some of the risk factors for falls. Reduced balance is a further precursor of falls, and injuries adversely affect the instability. In doing an activity without losing their balance, confidence among older adults is also crucial because it will influence their mobility. Objectives. The objective of this study is to examine the association between activity balance confidence and functional mobility, including gait, balance, and strength, among older adults. Methods. A cross-sectional study was conducted among older adults living in long-term care facilities and community dwellings. A total of 326 older adults (>60 years old) participated in this study from three provinces in Java Island, Indonesia. The inclusion criteria were older adults living independently and without obstacles in communication, who have no hearing loss, and who agreed to be respondents. The activity-specific balance confidence (ABC) scale determines the level of confidence. The participants were asked about their balance confidence not to lose their balance while doing 16 activities. The dependent variable is the mobility test, including a gait test using TUG (times up and go) to see how the subjects stand, walk, and turn around; a balance test (four stages); and a strength test (30-second chair stand). Results. The results of the ABC scale showed the respondents felt the most confidence not to lose their balance when they walk around the house (82.01%) and the less confidence when they stepped onto or off an escalator while holding onto a railing (37.7%). The gait, balance, and strength test revealed that 51.2% of the respondents showed an unsteady gait, 63.8% showed instability that felt awkward and unusual when standing on one leg, and 60.1% of the participants showed muscle weakness. The bivariate analysis significantly correlated the ABC scale test and all mobility tests. The older adult participants who are not confident will have 12.03 times higher the unstable result of the gait test, 8.4 times higher the unstable result of the balance test, and 7.47 times higher the less strength result of the strength test who are confident. Conclusion. Older adults who lack balance confidence showed significantly poorer results in mobility tests.

Predicting risk of falls in elderly using a single Inertial Measurement Unit on the lower-back by estimating spatio-temporal gait parameters

One of the consequences of aging is the increased risk of falls, especially when someone walks in unknown or uncontrolled environments. Usually, gait is evaluated through observation and clinical assessment scales to identify the state and deterioration of the patient's postural control. Lately, technological systems for bio-mechanical analysis have been used to determine abnormal gait states being expensive, difficult to use, and impossible to apply in real conditions. In this article, we explore the ability of a system based on a single inertial measurement unit located in the lower back to estimate spatio-temporal gait parameters by analyzing the signals available in the Physionet repository "Long Term Movement Monitoring Database" which, together with automatic classification algorithms, allow predicting the risk of falls in the elderly population. Different classification algorithms were trained and evaluated, being the Support Vector Machine classifier with a third-degree polynomial kernel, cost function C = 2 with the best performance, with an Accuracy = 59%, Recall = 91%, and F1- score = 71%, providing promising results regarding a proposal for the quantitative, online and realistic evaluation of gait during activities of daily living, which is where falls actually occur in the target population. Clinical Relevance - This work proposes an early risk of falls detection tool, essential to start preventive treatment strategies to maintain the independence of the elderly through a non-invasive, simple, and low-cost alternative.

A Novel Privacy Preservation and Quantification Methodology for Implementing Home-Care-Oriented Movement Analysis Systems

Human movement is generally evaluated through both observations and clinical assessment scales to identify the state and deterioration of a patient's motor control. Lately, technological systems for human motion analysis have been used in clinics to identify abnormal movement states, while they generally suffer from privacy challenges and concerns especially at home or in remote places. This paper presents a novel privacy preservation and quantification methodology that imitates the forgetting process of human memory to protect privacy in patient-centric healthcare. The privacy preservation principle of this methodology is to change the traditional data analytic routines into a distributed and disposable form (i.e., DnD) so as to naturally minimise the disclosure of patients' health data. To help judge the efficacy of DnD-based privacy preservation, the researchers further developed a risk-driven privacy quantification framework to supplement the existing privacy quantification techniques. To facilitate validating the methodology, this research also involves a home-care-oriented movement analysis system that comprises a single inertial measurement sensor and a mobile application. The system can acquire personal information, raw data of movements and indexes to evaluate the risk of falls and gait at homes. Moreover, the researchers conducted a technological appreciation survey of 16 health professionals to help understand the perception of this research. The survey obtains positive feedback regarding the movement analysis system and the proposed methodology as suitable for home-care scenarios.

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

Background

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

Methods

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

Results

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

Conclusions

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

Differences in walking-to-turning characteristics between older adult fallers and nonfallers: a prospective and observational study using wearable inertial sensors

Wearable inertial sensors have gradually been used as an objective technology for biomechanical assessments of both healthy and pathological movement patterns. This paper used foot-worn sensors for characterizing the spatiotemporal characteristics of walking and turning between older fallers and nonfallers. Thirty community-dwelling older fallers and 30 older nonfallers performed 10-m straight walking, turned 180° around a cone, and then walked 10-m back to the starting point. Specific algorithms were used to measure spatiotemporal gait (double support phase of the gait cycle, swing width, and minimal toe clearance) and turning parameters (turn duration and turn steps) using two foot-worn Physiolog inertial sensor system. The researchers directly exported data as reported by the system. Our findings indicated that older fallers showed 26.58% longer time (P = 0.036) and 13.21% more steps (P = 0.038) compared to nonfallers during turning. However, both groups decreased their walking velocity (both P < 0.001), increased double support (both P = 0.001), and increased the swing width (both P = 0.001) during the transition from walking to turning. The older nonfallers additionally increased toe clearance (P = 0.001). Compared with the fallers, the older nonfallers showed a larger change in the swing width (P = 0.025) and toe clearance (P = 0.025) in walking to turning. Older fallers may adopt a cautionary strategy while turning to reduce the risk of falls. Wearable sensors can provide the temporospatial characteristics of turning and reveal significant differences by fall status, indicating the potential of turning measures as possible markers for identifying those at fall risk.

Risk factors of falls in elderly patients with visual impairment

OBJECTIVE

To examine the risk factors for falls in elderly patients with visual impairment (VI) and assess the predictive performance of these factors.

METHODS

Between January 2019 and March 2021, a total of 251 elderly patients aged 65-92 years with VI were enrolled and then prospectively followed up for 12 months to evaluate outcomes of accidental falls via telephone interviews. Information of demographics and lifestyle, gait and balance deficits, and ophthalmic and systemic conditions were collected during baseline visits. Forward stepwise multivariable logistic regression analysis was performed to identify independent risk factors of falls in elderly patients with VI, and a derived nomogram was constructed.

RESULTS

A total of 143 falls were reported in 251 elderly patients during follow-up, with an incidence of 56.97%. The risk factors for falls in elderly patients with VI identified by multivariable logistic regression were women [odds ratio (OR), 95% confidence interval (CI): 2.71, 1.40-5.27], smoking (3.57, 1.34-9.48), outdoor activities/3 months (1.31, 1.08-1.59), waking up frequently during the night (2.08, 1.15-3.79), disorders of balance and gait (2.60, 1.29-5.24), glaucoma (3.12, 1.15-8.44), other retinal degenerations (3.31, 1.16-9.43) and best-corrected visual acuity (BCVA) of the better eye (1.79, 1.10-2.91). A nomogram was developed based on the abovementioned multivariate analysis results. The area under receiver operating characteristic curve of the predictive model was 0.779.

CONCLUSIONS

Gender, smoking, outdoor activities, waking up at night, disorders of balance and gait, glaucoma, other retinal degeneration and BCVA of the better eye were independent risk factors for falls in elderly patients with VI. The predictive model and derived nomogram achieved a satisfying prediction of fall risk in these individuals.

A Scoping Review on Minimum Foot Clearance: An Exploration of Level-Ground Clearance in Individuals with Abnormal Gait

Background: Falls are a major health concern, with one in three adults over the age of 65 falling each year. A key gait parameter that is indicative of tripping is minimum foot clearance (MFC), which occurs during the mid-swing phase of gait. This is the second of a two-part scoping review on MFC literature. The aim of this paper is to identify vulnerable populations and conditions that impact MFC mean or median relative to controls. This information will inform future design/maintenance standards and outdoor built environment guidelines. Methods: Four electronic databases were searched to identify journal articles and conference papers that report level-ground MFC characteristics. Two independent reviewers screened papers for inclusion. Results: Out of 1571 papers, 43 relevant papers were included in this review. Twenty-eight conditions have been studied for effects on MFC. Eleven of the 28 conditions led to a decrease in mean or median MFC including dual-task walking in older adults, fallers with multiple sclerosis, and treadmill walking. All studies were conducted indoors. Conclusions: The lack of standardized research methods and covariates such as gait speed made it difficult to compare MFC values between studies for the purpose of defining design and maintenance standards for the outdoor built environment. Standardized methods for defining MFC and an emphasis on outdoor trials are needed in future studies.

Acute effects of acupuncture in balance and gait of Parkinson disease patients - A preliminary study

INTRODUCTION

Balance and gait disorders are relevant symptoms in the quality of life of Parkinson's patients. Currently, there is no therapy to reverse or treat this condition. Acupuncture treatment is believed to improve motor ability through the cortico-basal-thalamus-cortical-ganglia.

AIM

To investigate qualitatively the acute effect of acupuncture on balance and gait in Parkinson's disease in 7 patients.

METHODS

This is a randomized and controlled crossover study. The same individual patient was part of both, experimental (real acupuncture) and control group (false acupuncture/sham), and the sequence was randomized. Balance and gait parameters were measured at two different moments, before and after treatment, using four force platforms as well as the collection of 3D markers positions taken by 11 cameras. Images were analyzed using Qualisys Track Manager software that let us extract data related to the quality of gait and balance.

RESULTS

Statistically significant differences were found in gait speed (p = 0.016), gait cadence (p = 0.006), support base width (p = 0.0001), medio-lateral oscillation (p = 0.017), left-right step length (p = 0.0002), and stride length: right-right (p = 0.0000) and left-left (p = 0.0018), time of left support phase (p = 0.029), right support phase (p = 0.025) and double support phase (p = 0.015), between the initial and final moments for the experimental group. Differences in right-left stride length were found for both groups.

CONCLUSION

Our results suggest that the acupuncture protocol used objectively could improve gait in Parkinson disease patients. A deep research involving a statistical evaluation supported on a larger number of voluntaries should be accomplished to confirming these promising preliminary results.

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.

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.

Lower-Extremity Intra-Joint Coordination and Its Variability between Fallers and Non-Fallers during Gait

Falling is one of the most common causes of hip fracture and death in older adults. A comparison of the biomechanics of the gait in fallers and non-fallers older adults, especially joint coordination and coordination variability, enables the understanding of mechanisms that underpin falling. Therefore, we compared lower-extremity intra-joint coordination and its variability between fallers and non-fallers older adults during gait. A total of 26 older adults, comprising 13 fallers, took part in this study. The participants walked barefoot at a self-selected speed on a 10-m walkway. Gait kinematics in the dominant leg during 10 cycles were captured with 10 motion tracking cameras at a sampling rate of 100 Hz. Spatiotemporal gait parameters, namely, cadence, walking speed, double support time, stride time, width, and length, as well as intra-joint coordination and coordination variability in the sagittal plane were compared between the two groups. Results showed that fallers walked with significant lower cadence, walking speed, and stride length but greater double support and stride time than non-fallers. Significant differences in the ankle-to-knee, knee-to-hip, and ankle-to-hip coordination patterns between fallers and non-fallers and less coordination variability in fallers compared to non-fallers in some instants of the gait cycles were observed. The differences in spatiotemporal gait parameters in fallers compared to non-fallers may indicate an adaptation resulting from decreased efficiency to decrease the risk of falling. Moreover, the differences in segment coordination and its variability may indicate an inconsistency in neuromuscular control. It may also indicate reduced ability to control the motion of the leg in preparation for foot contact with the ground and the knee and ankle motions during loading response. Finally, such differences may show less control in generating power during the push-off phase in fallers.

Benefits of STRENOLD Program on Health-Related Quality of Life in Adults Aged 60 Years or Older. In Common Sport Study

Background: The proportion of older adults is increasing worldwide and, with it, the physical inactivity common to this age group. Therefore, the promotion of active aging is a strategic factor in health policies for older people. The aim of this study was to identify the benefits and viability of the strength training program (STRENOLD) in health-related quality of life in adults over 60. Methods: A controlled experimental study was carried out with a sample of 181 people over 60 years old from different European countries belonging to the European project IN COMMON SPORTS. A pair work strength program was administered (STRENOLD) over a period of 24 months, consisting of two single sessions per week. Their health status was evaluated (EQ-5D-5L) before and after the interventions. Results: The adherence rate was over 89% and the tolerability rate over 100% in all participating countries. Significant improvements in the participants’ health were demonstrated in the areas of mobility, usual activities, pain/discomfort, and anxiety/depression. Conclusions: The regular practice of physical exercise, through the partnered STRENOLD strength program, has benefits on mobility, usual activities, pain/discomfort, and anxiety/depression, in short, health benefits for older adults.

DYNAMIC POSTURAL BALANCE IS MEDIATED BY ANTHROPOMETRY AND BODY COMPOSITION IN OLDER WOMEN

OBJECTIVE

To investigate the relationship between anthropometry and body composition with dynamic postural balance in elderly women with low bone mineral density (BMD).

METHODS

45 older women (≥ 60 years), low BMD and nutritional diagnosis of low weight to overweight. For the assessment of body composition, Dual energy X-ray emission densitometry and anthropometric examination were used to measure: body mass (kg), height (cm) and BMI (k/m2). The assessment of dynamic postural balance was performed by the mini Balance Master Evaluation System clinical test and the computerized Balance Master® System test by the Sit to Stand and Step Up/Over tests.

RESULTS

There was a negative correlation between miniBESTest (r = - 0.566; p ≤ 0.001) and time to ascend and descend step (r = - 0.393; p ≤ 0.007) with fat mass, and positive correlation with miniBESTest (r = 0.526; p ≤0.001) and time to go up and down a step with muscle mass (r = 0.297; p ≤ 0.04). As for anthropometric variables, only height showed a positive correlation (r = 0.296; p ≤ 0.04) with the speed in the sit and stand test.

CONCLUSION

Lean mass reduces postural oscillations; in contrast, fat mass negatively interfered with dynamic postural balance in women with low BMD. Height was related to dynamic postural balance, the taller the elderly, the worse their balance. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

The Association of Falls with Instability: An Analysis of Perceptions and Expectations toward the Use of Fall Detection Devices Among Older Adults in Malaysia

Background: Falls are a significant incident among older adults affecting one in every three individuals aged 65 and over. Fall risk increases with age and other factors, namely instability. Recent studies on the use of fall detection devices in the Malaysian community are scarce, despite the necessity to use them. Therefore, this study aimed to investigate the association between the prevalence of falls with instability. This study also presents a survey that explores older adults' perceptions and expectations toward fall detection devices.

Methods: A cross-sectional survey was conducted involving 336 community-dwelling older adults aged 50 years and older; based on randomly selected participants. Data were analyzed using quantitative descriptive analysis. Chi-square test was conducted to investigate the associations between self-reported falls with instability, demographic and walking characteristics. Additionally, older adults' perceptions and expectations concerning the use of fall detection devices in their daily lives were explored.

Results: The prevalence of falls was 28.9%, where one-quarter of older adults fell at least once in the past 6 months. Participants aged 70 years and older have a higher fall percentage than other groups. The prevalence of falls was significantly associated with instability, age, and walking characteristics. Around 70% of the participants reported having instability issues, of which over half of them fell at least once within 6 months. Almost 65% of the participants have a definite interest in using a fall detection device. Survey results revealed that the most expected features for a fall detection device include: user-friendly, followed by affordably priced, and accurate.

Conclusions: The prevalence of falls in community-dwelling older adults is significantly associated with instability. Positive perceptions and informative expectations will be used to develop an enhanced fall detection incorporating balance monitoring system. Our findings demonstrate the need to extend the fall detection device features aiming for fall prevention intervention.

Physical activity, sedentary behavior and functionality in older adults: A cross-sectional path analysis

Disability is negatively associated with the health of older adults, and it can be mediated by healthy lifestyles and behaviors throughout one's life. In this context, understanding the interrelationships between sedentary behavior, physical activity and functionality may assist in the implementation of effective public health actions. Thus, the aim of the present study was to investigate the relationships between both physical activity and sedentary behavior and functionality in older adults and the possible mediators. The variables analyzed were selected according to the content analysis of International Classification of Functioning, Disability and Health model, and included activity, participation, health conditions, body functions and structures, environmental factors and personal factors. 419 individuals participated in the study. Physical activity was directly associated with disability in instrumental activities of daily living (IADL), and the association was mediated by self-esteem, aerobic endurance, and agility/balance. Sedentary behavior was indirectly associated with IADL disability, and the association was mediated by aerobic resistance, nutritional status, and agility/balance. Regarding the basic activities of daily living (BADL), physical activity showed an indirect association mediated by aerobic resistance and IADL. The association of sedentary behavior with BADL was mediated by aerobic resistance and lower limb flexibility. These results reinforce the idea that functionality is multidimensional, and the mediating factors must be considered when strategies for promoting physical activity and reducing sedentary behavior are designed.

Can Age Influence Functional Tests Differently to Predict Falls in Nursing Home and Community-Dwelling Older Adults?

Aim: The aim of this cross-sectional study was to determine which functional tests are able to predict falls in nursing home residents (NHR) and community-dwelling (CDW) older adults grouped by age. Methods: Two hundred and fifty-two older adults were assessed in the following tests, Mini-Mental State Examination, anthropometric characteristics, fall history and functional tests. The participants were assigned to one of the following groups: Young Older Adults (YOA; 60-69 years, n = 102; 27.5% NHR), Old Older Adults (OOA; 70-79 years; n = 100; 23.5% NHR) and Very Older Adults (VOA, ≥80 years; n = 50; 52% NHR). Results: The five times sit-to-stand showed 1.41 odds to experience a fall in the NHR of the VOA. In the CDW, the handgrip strength score decreased the odds to fall occurrence (0.92 odds) in the YOA, while the low score in timed up and go test of the OOA showed 1.21 odds to experience a fall. Conclusions: Therefore, the five times sit-to-stand test can predict falls in NHR of VOA groups, while handgrip strength and timed up and go tests can predict falls in CDW of YOA and OOA groups, respectively.

[Design and validation of a balance test with context characteristics for older adults]

BACKGROUND

Balance impairment is multifactorial in older adults and increases risk of falls in this population. There are tests to evaluate balance; nevertheless, they are focused on the evaluation of a single task, in static environments, without representing postural control demands in everyday life situations, such as person interaction-context and multi-tasking activities.

OBJECTIVES

Design and validate a balance test with ecological validity for older adults.

MATERIALS AND METHODS

A mixed data collection methodology was developed, with an exploratory sequential DEXPLOX methodological design derived from a DITRIAC concurrent triangulation design.

RESULTS

The results from the first 3phases permitted constructing the items of the balance assessment test to, then, conduct the first validation by experts, determining a Fleiss' kappa of 0.4 and a Lawshe content validity ratio of 0.95. The second validation by experts yielded as a result in face validity an excellent strength of inter-rater agreement and a Lawshe content validity ratio of 0.95 in relevance and 0.97 in pertinence.

CONCLUSIONS

The test designed showed strong characteristics of ecological validity and can be applied to older adults, given that it includes items requiring somatosensory responses, like those performed in activities of daily living and items with cognitive dual task activities used in daily routines.

Multicomponent Exercise Training Improves Gait Ability of Older Women Rather than Strength Training: A Randomized Controlled Trial

Objective

The aim of this study was to compare the effects of multicomponent and strength training programs on dynamic balance, functional capacity, and gait ability in older women.

Methods

Thirty individuals (67 ± 4.3 years; 30.6 ± 3.9 kg/m²) were trained for 12 weeks (3 times per week), following multicomponent (MG: exercises focusing on agility, balance, muscle strength, and aerobic) and strength programs (SG: lower limbs strength exercise).

Results

Peak torque of hip flexors (p=0.020) and extensors (p=0.009) and knee flexors (p=0.001) of SG was greater than that of MG at posttraining. In addition, both groups increased peak torque of knee extensors (p=0.002) and plantar extensors with higher effect size for SG (d = -0.41 and -0.48), whereas MG presented higher effect size for plantar flexors muscles (d = -0.55). Only the SG improved the rate of torque development of knee extensors (29%; p=0.002), and this variable was also greater to SG than MG at posttraining (106%). The SG and MG improved dynamic balance although SG presented higher effect size (d = 0.61). Both groups improved the performance on 30 s sit to stand test (p=0.010) with higher effect size for MG (d = -0.54). Only the MG improved the stride length (4%; p=0.011) and gait speed (10%; p=0.024). In addition, the groups improved toe clearance (p=0.035) and heel contact (p=0.010) with higher effect sizes for MG (d = -0.066 and 1.07).

Conclusion

Strength training should be considered to increase muscle function and dynamic balance in older women, whereas multicomponent training should be considered to increase functional capacity and gait ability in this population.

Minimum toe clearance and tripping probability in people with unilateral transtibial amputation walking on ramps with different prosthetic designs

BACKGROUND

Minimum Toe Clearance (MTC) is defined as the minimum vertical distance between the lowest point under the front part of the foot and the ground, during mid-swing. Low values of MTC and walking on inclines are both related to higher probability of tripping and falling in lower limb amputees. New prosthetic designs aim at improving MTC, especially on ramps, however the real effect on MTC still needs investigation. The objective of this study was then to evaluate the effect of different prosthetic designs on MTC in inclined walking.

METHODS

Thirteen transtibial amputees walked on a ramp using three different prostheses: non articulating ankle (NAA), articulating hydraulic ankle (AHA), and articulating hydraulic ankle with microprocessor (AHA-MP). Median MTC, coefficient of variation (CV), and tripping probability (TP) for obstacles of 10 and 15 mm were compared across ankle type in ascent and descent.

FINDINGS

When using AHA-MP, larger MTC median values for ascending (P ≤ 0.001, W = 0.58) and descending the ramp (P = 0.003, W = 0.47) were found in the prosthetic limb. Also significantly lower CV was found on the prosthetic limb for both types of AHA feet when compared to NAA for descending the ramp (P = 0.014, W = 0.45). AHA-MP showed the lowest TP for the prosthetic leg in three conditions evaluated. On the sound limb results showed the median MTC was significantly larger (P = 0.009, W = 0.43) and CV significantly lower (P = 0.005, W = 0.41) when using an AHA in ascent.

INTERPRETATION

Both AHA prosthetic designs help reduce the risk of tripping of the prosthetic limb by increasing the median MTC, lowering its variability and reducing TP for both legs when ascending and descending the ramp. For most of the conditions, AHA-MP showed the lowest TP values. Findings suggest that AHA prostheses, especially AHA-MP could reduce the risk of tripping on ramps in amputees.

Frailty syndrome in Brazilian older people: a population based study

This article aims to categorize elderly non-frail (NF), pre-frail (PF) and frail (FF) as to fast and slow gait speed. Compare NF, PF and FF, and analyze associations between fast or slow gait speed with clinical, functional and mental factors. 5,501 elderly (65 years or over; to the Frailty in Brazilian Older People Study), classified as NF, PF and FF (Fried´s frailty phenotype) and, in relation to fast gait speed (≥ 0.8m/s) and slow (< 0.8m/s). Age, sex, body mass index, muscular strength, advanced, instrumental and basic activities of daily living, falls, fear of falling and depressive symptoms were evaluated. Logistic regression analysis investigated associations between variables. The proportion of the slow elderly increased with fragility (NF = 12.39%, PF = 37.56%, FF = 88.83%, p < 0.01). Be woman, performance in activities of daily living, muscle strength and fall were associated with fragility syndrome. The association between frailty and adverse health outcomes reinforces its primacy as an indicator of the functional health of the elderly. Functional capacity, muscular strength, and falls should be evaluated considering their potential for reversibility.

The effects of toe grip training on physical performance and cognitive function of nursing home residents

Background

Toe grip-related training requires individuals to actively exercise muscles that are not frequently used; therefore, it may improve not only toe grip strength but also cognitive function. The purpose of this study was to examine the effects of toe grip-related training on predictors of physical performance and cognitive function in nursing home residents.

Methods

A total of 35 nursing home residents (35 left and 35 right feet; mean age, 82.1 ± 7.9 years) were included in this study. The participants were divided into two groups: a training group and a control group. The Mini-Mental State Examination (MMSE) was used to assess the cognitive function of the participants, and the Fall Risk Index (FRI) was used to evaluate the risk of falls. Toe grip-related physical function was also assessed. Baseline endpoints were evaluated and the effects of toe grip-related training were examined following a 12-week training intervention.

Results

The training group showed significant improvements in MMSE score, FRI score, toe grip strength, and the toe skill (TS) test; however, the control group did not show these changes. The training group showed significant increases in Δ MMSE, Δ toe grip strength, and Δ TS (right foot) than the control group. Stepwise regression analysis revealed that Δ toe grip strength is an independent factor of Δ MMSE.

Conclusions

Toe grip training improves not only toe grip strength itself, but also cognitive function. Furthermore, change in toe grip strength was an independent factor of change in MMSE in those populations.

Trial registration

UMIN, UMIN000027437. Registered on 26 May 2017.

Factors affecting exercise program adherence in patients with acute hip fracture and impact on one-year survival

OBJECTIVE

To study the adherence of an Early Inpatient Exercise Program in patients with acute hip fracture, identify variables associated with its performance, and its association to one-year survival.

METHODS

Observational longitudinal study of a cohort of 509 patients, admitted consecutively with a hip fracture in La Paz University Hospital (Madrid, Spain). Data included sociodemographic variables, pre-fracture physical functioning, cognitive impairment, comorbidities, measure of exercise adherence (pre-surgery exercise, post-surgery exercise, and rehabilitation sessions) and vital status at follow-up. One year after the fracture, either patients or relatives were contacted by telephone to ascertain their vital status. Data were analyzed using logistic regressions and multivariate Cox proportional hazards regression.

RESULTS

Three quarters of patients (76.0%) were able to comply with the Early Inpatient Exercise Program. Factors associated with adherence were: living at home (Odds Ratio (OR)=3.39; 95% Confidence Interval (CI): 2.03, 5.64), absence of pre-fracture disability (OR=3.78; 95% CI: 2.21, 6.47), absence of pre-fracture cognitive impairment (OR=2.36; 95% CI: 1.36, 4.07) and comorbidities (OR=1.66; 95% CI: 1.03, 2.67). Early Inpatient Exercise Program adherence was associated with one-year survival (HR=1.62; 95% CI: 1.06, 2.49).

CONCLUSIONS

The adherence with an Early Inpatient Exercise Program is high and is associated with 1-year survival. It is important to make a stronger effort to encourage participation in Early Inpatient Exercise Program in the 24% currently non-compliant, and in those with cognitive and physical impairments.

Risk factors for fall in elderly with diabetes mellitus type 2

AIMS

Diabetes mellitus type 2 (DMT2) is a major chronic condition that also common in older people, and associated with an increased risk of falling. This study aimed to determine the risk factor of fall in elderly with DMT2.

METHODS

In this cross-sectional study, 220 elderly diabetic patients who had referred to diabetes center in Kerman were chosen via convenience sampling method. To collect data, Semi-structured Fall Risk questionnaire and the Pittsburgh Sleep Quality Index (PSQI) were used.

FINDINGS

The mean age was estimated to be 69.82 (SD: 9.9) years. Among the participants, 38.5% suffered falls in the past one year. Good sleep quality (OR = 0.45, 95% CI = 0.1-0.85) and appropriate environment (OR = 0.6, 95% CI = 0.1-0.77) were significantly associated with a lesser odd of having recurrent falls. Gait problem (OR = 1.8, 95% CI = 1.1-4.9), balance difficulties (OR = 2.1, 95% CI = 1.24-7.12), hypotension (OR = 1.7, 95% CI = 1.2-5.6), and medication above three medicine (OR = 1.55, 95% CI = 1.12-6.34) were significantly associated with a greater odd of having recurrent falls.

CONCLUSION

It would therefore appear that older diabetic patients would be a suitable target group for a strategy aimed at preventing falls. Early recognition of the multiple causes of falls in the older diabetic patient and prompt referral of this group of patients to a specialist falls clinic is recommend.

Postural instability and the condition of physical frailty in the elderly

OBJECTIVE

to analyze the relationship between postural instability and the condition and markers of physical frailty of the elderly people in outpatient geriatric and gerontology care.

METHOD

a cross-sectional study with a sample of 381 elderly subjects. Physical frailty was evaluated by the frailty phenotype and postural instability through the Berg Balance Scale. Univariate analyses consisted in Chi-square tests, and multivariate analyses used the Forward Stepwise method, which resulted in a model of physical frailty associated with postural instability.

RESULTS

among the participants, 56 (14.7%) were frail, 217 (57%) pre-frail, and 68 (28.3%) non-frail. Pre-frailty (p < 0.001), frailty (p = 0.000), and the markers hand grip strength (p = 0.0008), unintentional weight loss (p = 0.0094), level of physical activity (p = 0.0001), fatigue/exhaustion (p = 0.0001), and gait speed (p = 0.0001) were associated with postural instability.

CONCLUSION

the presence of postural instability determines a greater chance of the elderly being frail or pre-frail. This result favors the planning of gerontological nursing care and strengthens the treatment plan under a specific approach.

Foot-ground clearance characteristics in women: A comparison across different ages

BACKGROUND

Tripping is a common event leading to falls amongst elderly. Minimum foot clearance (MFC) is a critical swing phase control factor associated with tripping and falls.

RESEARCH QUESTION

Are there differences in MFC characteristics among three age groups of women and are there association between MFC and lower limb kinematics?

METHODS

Cross-sectional observational study. Three-dimensional gait analysis of 55 healthy women. ANOVA was used to compare (p<0.05) MFC characteristics among young, middle-aged and elderly groups. Multiple Linear Regression Analysis was used to test prediction over MFC.

RESULTS

Elderly women walked slower, with lower MFC and lower maximum foot velocity during swing (MFV) than young and middle-aged women. There were more hip flexion and less ankle dorsiflexion during MFC among elderly. There is a strong positive relationship between dorsiflexion and MFC. And ankle dorsiflexion was the most predictive variable over MFC.

SIGNIFICANCE

Elderly women walk slower with lower MFC value and less ankle dorsiflexion than gender-matched young controls. Increased hip flexion may represent a gait adaptation to avoid tripping. Gait speed had no effect on those findings.

The Role of Physical Frailty Independent Components on Increased Disabilities in Institutionalized Older Women

The purpose of this study was to identify the independent components of physical frailty that most influence disability indicators in institutionalized older women. A cross-sectional study with 319 participants (81.96±7.89 years old) was performed. Disability was assessed through dynamic and static balance tests, activities of daily life and falls risk screen. Fried physical frailty protocol was used to access physical frailty. The frail subgroup displayed the weakest results for all disability indicators (p < 0.05). Regression analysis showed that in the two models tested, low physical activity levels and slowness were the physical frailty independent components that better associated with the disability indicators. More studies with larger samples will help to better understand the independent relationship of each physical frailty component with disability outcomes and assist to design a co-adjuvant treatment to reverse physical frailty.

Age and falls history effects on antagonist leg muscle coactivation during walking with balance perturbations

BACKGROUND

Inspired by a reliance on visual feedback for movement control in older age, optical flow perturbations provide a unique opportunity to study the neuromuscular mechanisms involved in walking balance control, including aging and falls history effects on the response to environmental balance challenges. Specifically, antagonist leg muscle coactivation, which increases with age during walking, is considered a neuromuscular defense against age-associated deficits in balance control. The purpose of this study was to investigate the effects of age and falls history on antagonist leg muscle coactivation during walking with and without optical flow perturbations of different amplitudes.

METHODS

Eleven young adults [mean (standard deviation) age: 24.8 (4.8) years], eleven older non-fallers [75.3 (5.4) years] and eleven older fallers [age: 78 (7.6) years] participated in this study. Participants completed 2-minute walking trials while watching a speed-matched virtual hallway that, in some conditions, included mediolateral optical flow perturbations designed to elicit the visual perception of imbalance.

FINDINGS

We first found that lower leg antagonist muscle coactivation during normal walking increased with age, independent of falls history. We also found that older but not young adults increased antagonist leg muscle coactivation in the presence of optical flow perturbations, with more pervasive effects in older adults with a history of falls.

INTERPRETATION

Our findings allude to a greater susceptibility to optical flow perturbations in older fallers during walking, which points to a higher potential for risk of instability in more complex and dynamic everyday environments. These findings may also have broader impacts related to the design of innovative training paradigms and neuromuscular targets for falls prevention.

Falls and associated factors among elderly persons residing in the community

Abstract Objective: to identify the prevalence of falls among elderly persons and analyze fall-related factors. Method: a cross-sectional, population-based study conducted by household survey of 400 elderly subjects (aged 60 years or older) living in the city of Juiz de Fora, Minas Gerais, Brazil was carried out. The occurrence of falls in the last 12 months, sociodemographic factors, health profile and geriatric syndromes were observed. The crude and adjusted prevalence ratios (PR) were obtained using Poisson regression. A three-model hierarchical approach was applied in the multivariate analysis. In all the multivariate models, gender and age were defined as confounding variables. Variables which reached a level of p<0.05 in the first model were retained in the subsequent models. For all models the significance threshold was set at 0.05 and the variables which remained associated with the occurrence of falls in the 3rd model were retained in the final analysis. Result: the prevalence of falls was 35.3% (CI 95% = 30.7;40.0). Among the elderly persons who reported falls, 44% reported that they had fallen more than once. The majority of falls occurred at home (69.2%) and in the morning (46.7%). Age a reported difficulty walking remained significantly associated with the outcome after adjustments (3rd model). Conclusion: falls are frequent and are associated with increasing age and difficulty walking. The recognition of these factors is important for strategies to reduce falls and the promotion of a healthy aging by means of preventive and rehabilitation actions that target more vulnerable groups.

Multifactorial Screening Tool for Determining Fall Risk in Community-Dwelling Adults Aged 50 Years or Over (FallSensing): Protocol for a Prospective Study

Background

Falls are a major health problem among older adults. The risk of falling can be increased by polypharmacy, vision impairment, high blood pressure, environmental home hazards, fear of falling, and changes in the function of musculoskeletal and sensory systems that are associated with aging. Moreover, individuals who experienced previous falls are at higher risk. Nevertheless, falls can be prevented by screening for known risk factors.

Objective

The objective of our study was to develop a multifactorial, instrumented, screening tool for fall risk, according to the key risk factors for falls, among Portuguese community-dwelling adults aged 50 years or over and to prospectively validate a risk prediction model for the risk of falling.

Methods

This prospective study, following a convenience sample method, will recruit community-dwelling adults aged 50 years or over, who stand and walk independently with or without walking aids in parish councils, physical therapy clinics, senior’s universities, and other facilities in different regions of continental Portugal. The FallSensing screening tool is a technological solution for fall risk screening that includes software, a pressure platform, and 2 inertial sensors. The screening includes questions about demographic and anthropometric data, health and lifestyle behaviors, a detailed explanation about procedures to accomplish 6 functional tests (grip strength, Timed Up and Go, 30 seconds sit to stand, step test, 4-Stage Balance test “modified,” and 10-meter walking speed), 3 questionnaires concerning environmental home hazards, and an activity and participation profile related to mobility and self-efficacy for exercise.

Results

The enrollment began in June 2016 and we anticipate study completion by the end of 2018.

Conclusions

The FallSensing screening tool is a multifactorial and evidence-based assessment which identifies factors that contribute to fall risk. Establishing a risk prediction model will allow preventive strategies to be implemented, potentially decreasing fall rate.

Registered Report Identifier

RR1-10.2196/10304

Social representation of elderly people on falls: structural analysis and in the light of Neuman

OBJECTIVE

To understand the symbolic elements and the hierarchical system of representations of elderly people on falls, according to Abric's structural analysis and Neuman's theory.

METHOD

Abric structural approach developed at the home of primary care users in a city of Minas Gerais. A free evocation technique of images triggered by images was performed in 2016 with elderly individuals (≥65 years old). Data treated by dictionary of equivalent terms; processed in Evoc 2000 software converging, analytically, according to Neuman. Ethical/legal criteria were met.

RESULTS

195 people participated, 78.5% were women, and 45.1% were aged ≥75 years. Summarized 897 words; 155 different ones. Central nucleus containing cognates: dizziness-vertigo-labyrinthitis and slipper-shoes (behavioral and objective dimension). The word disease integrated the area of contrast. Environmental and personal stressors were identified according to Neuman. Final considerations: Objects and risk behaviors for falls integrated the representations, although environmental and personal stressors indicate the need for preventive interventions in the environment and in the intrapersonal dimension.

Impact of cognitive fatigue on gait and sway among older adults: A literature review

Cognitive fatigue is an alteration in central nervous system (CNS) processing due to prolonged performance of mentally demanding tasks. Decreased gait speed and increased stride length variability have been noted in cognitively fatigued older adults (≥ 65 years). Further, cognitive fatigue may weaken the visual, vestibular, and proprioceptive systems of the CNS, contributing to increased postural sway. Detriments in gait and sway caused by cognitive fatigue could increase fall risk. The objective of this literature review was to evaluate the impact of cognitive fatigue on changes in gait and postural sway and its role in fall risk.

•

Cognitive fatigue may cause gait disturbances in older adults (≥ 65 years).

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Cognitive fatigue may increase postural sway in older adults.

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Cognitive fatigue may be considered a fall risk for older adults.

•

Interventions to attenuate cognitive fatigue should be further explored.

•

Studies should explore the role of cognitive fatigue in fall risk.

Old adult fallers display reduced flexibility of arm and trunk movements when challenged with different walking speeds

Specific patterns of pelvic and thorax motions are required to maintain stability during walking. This cross-sectional study explored older-adults' gait kinematics and their kinematic adaptations to different walking speeds, with the purpose of identifying mechanisms that might be related to increased risk for falls. Fifty-eight older adults from self-care residential facilities walked on a treadmill, whose velocity was systematically increased with increments of 0.1meters/second (m/s) from 0.5 to 0.9m/s, and then similarly decreased. Thorax, pelvis, trunk, arms, and legs angular total range of motion (tROM), stride time, stride length, and step width were measured. Twenty-one of the subjects reported falling, and 37 didn't fall. No significant effect of a fall history was found for any of the dependent variables. A marginally significant interaction effect of fall history and walking speed was found for arms' tROM (p=0.098). Speed had an effect on many of the measures for both groups. As the treadmill's velocity increased, the non-fallers increased their arm (15.9±8.6° to 26.6±12.7°) and trunk rotations (4.7±1.9° to 7.2±2.8°) tROM, whereas for the fallers the change of arm (14.7±14.8° to 20.8±13°) and trunk (5.5±2.9° to 7.3±2.3°) rotations tROM were moderate between the different walking speeds. We conclude that walking speed manipulation exposed different flexibility trends. Only non-fallers demonstrated the ability to adapt trunk and arm ROM to treadmill speed i.e., had a more flexible pattern of behavior for arm and trunk motions, supporting the upper-body's importance for stability while walking.