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Hsu HH, Chiu CY, Chen WC, Yang YR, Wang RY. Effects of exercise on bone density and physical performance in postmenopausal women: A systematic review and meta-analysis. PM R 2024. [PMID: 39032163 DOI: 10.1002/pmrj.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 03/04/2024] [Accepted: 04/04/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Postmenopausal bone loss and decreased physical performance are commonly presented issues. This study aimed through systematic review and meta-analysis to examine the benefits of adding exercise to medicine/supplements in postmenopausal women. METHODS A systematic search was conducted of four electronic databases for articles published from inception to December 2023. Clinical controlled trials comparing the effect of additional exercise and medicine/supplements alone in postmenopausal women were included. The outcomes studied were bone mineral density (BMD) and physical performance. The quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS Nineteen articles with 1249 participants were included in this study for systematic review and meta-analysis. The results showed that additional exercise was not associated with significantly improved BMD at the lumbar spine and hip joint compared with medicine/supplements only. However, results of subgroup analysis of exercise types showed a significant improvement in lumbar spine BMD by combining multiple types of exercise training (SMD = 0.37; 95% confidence interval [CI] = 0.01-0.72; p = .04). Furthermore, additional exercise significantly improved lower extremity muscle strength (Standard Mean Difference [SMD] = 1.77; 95% CI = 0.56-2.98; p = .004), Berg's Balance Scale (SMD = 0.72; 95% CI = 0.12-1.32; p = .02), Timed Up and Go (SMD = -1.07; 95% CI = -1.35--0.78; p < .001), fear of falling (SMD = 1.32; 95% CI = 0.89-1.75; p < .001), and the quality of life (SMD = 1.39; 95% CI = 0.74-2.05; p < .001). The quality level of the evidence was between low to very low. CONCLUSIONS The significant value of the exercise was demonstrated through enhancing physical performance and quality of life. Moreover, combining various exercise training programs has shown a positive effect on BMD at the lumbar spine. Therefore, for postmenopausal women, combining exercise with medicine/supplements is recommended to further improve physical function and specific areas of BMD. (PROSPERO: CRD42023390633).
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Affiliation(s)
- Hsin-Hui Hsu
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ching-Ya Chiu
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Chen Chen
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Taylor ME, Kerckhaert L, Close JCT, van Schooten KS, Lord SR. The Impact of Misaligned Perceived and Objective Fall Risk in Cognitively Impaired Older People. J Alzheimers Dis 2024:JAD240489. [PMID: 39031366 DOI: 10.3233/jad-240489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
Background Cognitive impairment (CI) may impair the ability to accurately perceive physical capacity and fall risk. Objective We investigated perceived (measured as concern about falls) and physiological fall risk in community-dwelling older people with CI, the characteristics of the aligned and misaligned groups and the impact of misaligned perceptions on falls. Methods Participants (n= 293) with mild-moderate CI were classified into four groups based on validated physiological and perceived fall risk assessments: 1) vigorous: low perceived and physiological fall risk; 2) anxious: high perceived and low physiological fall risk; 3) unaware: low perceived and high physiological fall risk; and 4) aware: high perceived and physiological fall risk. Groups were compared with respect to neuropsychological and physical function, activity and quality of life measures, and prospective falls (12-months). Results The anxious (IRR = 1.70, 95% CI = 1.02-2.84), unaware (IRR = 2.00, 95% CI = 1.22-3.26), and aware (IRR = 2.53, 95% CI = 1.67-3.84) groups had significantly higher fall rates than the vigorous group but fall rates did not significantly differ among these groups. Compared with the vigorous group: the anxious group had higher depression scores and reduced mobility and quality of life; the unaware group had poorer global cognition, executive function and mobility and lower physical activity levels; and the aware group had an increased prevalence of multiple physical and cognitive fall risk factors. Conclusions Fall rates were increased in participants who had increased perceived and/or physiological fall risk. Contrasting fall risk patterns were evident in those who under- and over-estimated their fall risk. Understanding these characteristics will help guide fall risk assessment and prevention strategies in community-dwelling older people with CI.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Ageing Futures Institute, UNSW Sydney, Sydney, Australia
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Luuk Kerckhaert
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Kimberley S van Schooten
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Ageing Futures Institute, UNSW Sydney, Sydney, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
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Ma W, Liang X, Wang H, Wen Z, Liu L, Fan L, Zhang X. Association between fear of falling and mortality in middle-aged and older adults: A systematic review and meta-analysis. Geriatr Nurs 2024; 59:113-120. [PMID: 38996768 DOI: 10.1016/j.gerinurse.2024.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/17/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Fear of falling (FOF) has emerged as a significant public health issue, contributing to excess disability among middle-aged and older adults. The association between FOF and mortality remains unclear. METHODS Prominent electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycINFO, Scopus, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang Database) were searched from inception until October 21, 2023 (data updated on June 9, 2024), for cohort or longitudinal studies investigating the association between FOF and mortality. The heterogeneity between studies was quantitatively assessed using I2. A fixed-effect model calculated the pooled effect size. RESULTS A total of seven cohort studies, including 27,714 participants, were analyzed in this systematic review and meta-analysis. The meta-analysis results demonstrated a positive association between FOF and mortality, with a significant increase in the risk of mortality for those with FOF (hazard ratio [HR]:1.29, 95 % confidence interval [CI]: 1.19-1.41, p < 0.05). Subgroup analysis indicated that age, male sex, clinical diagnosis of depression, number of chronic diseases, activity restriction due to FOF, and FOF levels were associated with mortality. CONCLUSIONS FOF and mortality have a positive association, which needs to be confirmed by further prospective studies with large samples and long-term follow-up to provide evidence for clinicians to intervene in FOF to reduce mortality in middle-aged and older adults.
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Affiliation(s)
- Wenlian Ma
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoli Liang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Hongyan Wang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Zhifei Wen
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linfeng Liu
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Liangliang Fan
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiangeng Zhang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China.
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Voß M, Zieschang T, Schmidt L, Hackbarth M, Koschate J, Stuckenschneider T. Reduced adaptability to balance perturbations in older adults with probable cognitive impairment after a severe fall. PLoS One 2024; 19:e0305067. [PMID: 38985810 PMCID: PMC11236103 DOI: 10.1371/journal.pone.0305067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/22/2024] [Indexed: 07/12/2024] Open
Abstract
Falls in older individuals often result from unexpected balance disturbances during walking, necessitating the analysis of recovery strategies for effective falls prevention. This becomes particularly crucial for individuals with cognitive impairment, who face a higher fall risk compared to cognitively healthy adults. Hence, our study aimed to compare the recovery response to standardized walking perturbations on a treadmill between older adults with cognitive impairment and cognitively healthy older adults. 36 individuals with a recent history of a severe fall, leading to an emergency department visit without subsequent admission, were stratified into two groups (with and without probable cognitive impairment) based on scores of the Montreal Cognitive Assessment. Recovery performance was quantified using force plate data from a perturbation treadmill (M-Gait, Motek Medical B.V., Amsterdam, the Netherlands), specifically evaluating the number of steps needed to restore step length and width to pre perturbation baseline across two trials of nine different perturbations. Individuals with cognitive impairment (n = 18, mean age: 74.7) required significantly (p = 0.045, Cohen's d = 0.69) more steps to recover total steps after perturbations compared to cognitively healthy individuals (n = 18, mean age: 69.7). While step width recovery was similar between the groups, those with probable cognitive impairment required significantly more steps to recover their step length (p = 0.039, Cohen's d = 0.72). Thus, our findings indicate that older adults with probable cognitive impairment manifest inferior gait adaptability, especially in adapting step length, potentially underscoring a critical aspect for effective falls prevention in this population.
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Affiliation(s)
- Malte Voß
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Oldenburg, Lower Saxony, Germany
| | - Tania Zieschang
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Oldenburg, Lower Saxony, Germany
| | - Laura Schmidt
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Oldenburg, Lower Saxony, Germany
| | - Michel Hackbarth
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Oldenburg, Lower Saxony, Germany
| | - Jessica Koschate
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Oldenburg, Lower Saxony, Germany
| | - Tim Stuckenschneider
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Oldenburg, Lower Saxony, Germany
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Özata Değerli MN, Şahİn S, Altuntaş O, Uyanık M, Yılmaz AA, Yiğit AY, Uçan A, Yapar IL. The effect of CLOSER-computer-based exercise program in older adults with a history of falls: A pilot study. Assist Technol 2024; 36:302-308. [PMID: 38381129 DOI: 10.1080/10400435.2024.2315412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/22/2024] Open
Abstract
CLOSER is a computer-based exercise program that aims to improve older adults' health, fitness and social lives. This pilot study aimed to examine the effect of CLOSER, the first computer-based exercise program developed for older adults on a national scale, on those with a history of falls. Forty-eight older adults (71.33 ± 7.47) with a history of falling at least once in the last year were included in the study. Older adults performed CLOSER exercises for (balance maintenance, neck rotation, rhythmic walking, knee flexion and trunk rotation) 2 sessions per week for eight weeks. All individuals were evaluated at baseline and the end of the eighth week. The primary outcome measures were the 30-s Chair-Stand Test (p = 0.002), the Berg Balance Scale (p = 0.002), the Falls Efficacy Scale International (p = 0.003), the Timed Up and Go Test (p = 0.008) and the motivation level (p = 0.007) statistically significant improvements were observed. The results show that a CLOSER-computer-based exercise program effectively increases balance and reduces the risk and fear of falling. In the future, CLOSER could significantly contribute to the healthcare system as an alternative aid for home-based exercise.
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Affiliation(s)
- Medine Nur Özata Değerli
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Turkey
| | - Sedef Şahİn
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Turkey
| | - Onur Altuntaş
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Turkey
| | - Mine Uyanık
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Turkey
| | - Adem Ali Yılmaz
- Health Information Science and Systems, Tiga Information Technologies Inc, Ankara, Turkey
| | - Ali Yaşar Yiğit
- Health Information Science and Systems, Tiga Information Technologies Inc, Ankara, Turkey
| | - Alaettin Uçan
- Health Information Science and Systems, Tiga Information Technologies Inc, Ankara, Turkey
| | - I Lyas Yapar
- Health Information Science and Systems, Tiga Information Technologies Inc, Ankara, Turkey
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Afacan Y, Barshan B. Exploring the Importance and Performance Priorities of Older Adults With a User-Centred Approach to Create a Fall-Free Bathroom. Int J Older People Nurs 2024; 19:e12623. [PMID: 38895910 DOI: 10.1111/opn.12623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/15/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Fall hazards in bathroom spaces constitute one of the most critical issues in the daily lives of older adults. Bathroom falls are somewhat different and constrained in nature than those in other parts of a home environment. OBJECTIVES This study aimed to adopt a user-centred approach to explore older adults' general bathroom needs, with a specific focus on showers and bathtubs as the designated activity area. METHODS The authors employed an extended importance-performance analysis (IPA) with a mixed-method research design. Three hundred and eleven older adults participated in a face-to-face IPA questionnaire for the quantitative phase of the study. The authors gathered the qualitative data through open-ended questions from 59 older adults. RESULTS The authors found positive correlation between older adults' attitudes towards an older-friendly bathroom and the potential for their bathrooms to be fall-free. The IPA calculations identify three key items with higher ratings in both importance and performance: The presence of appropriate artificial lighting, efficient mechanical ventilation and an accessible inside towel rail. Thematic analysis yields four themes: comfort, ease of access, error-proof design and emergency management. CONCLUSIONS The IPA calculations and thematic analysis confirm that older adults' rankings of importance and performance and their corresponding priority levels within the overarching themes indicate the need for these aspects to perform well and justify ongoing investments. The study concludes that addressing fall prevention requires not only designing specific solutions but also utilising appropriate technology in bathing and toileting activities. IMPLICATIONS FOR PRACTICE Practitioners in geriatric and gerontological nursing, design, architecture and health care can use the importance and performance priority levels of older adults to guide the development and implementation of fall-free bathroom design. Policymakers can leverage the insights from this research to inform guidelines and regulations related to building codes, accessibility standards and healthcare policies.
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Affiliation(s)
- Yasemin Afacan
- Department of Interior Architecture & Environmental Design and Department of Neuroscience, Bilkent University, Ankara, Türkiye
| | - Billur Barshan
- Department of Electrical and Electronics Engineering, Bilkent University, Ankara, Türkiye
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Arruda MS, Curiati PK, Aliberti MJR, Morinaga CV, Avelino-Silva TJ, Marques APDO, Melo HMDA. The First Step Is the Hardest: Understanding Posthospital Fall Risks in Brazilian Older Adults. J Am Med Dir Assoc 2024; 25:105038. [PMID: 38796170 DOI: 10.1016/j.jamda.2024.105038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/28/2024]
Affiliation(s)
- Marcela S Arruda
- Geriatric Emergency Department Research Group (ProAGE), Hospital Sirio-Libanes, Sao Paulo, Sao Paulo, Brazil; Postgraduate Program in Gerontology (PPGERO), Federal University of Pernambuco, Recife, Brazil.
| | - Pedro K Curiati
- Geriatric Emergency Department Research Group (ProAGE), Hospital Sirio-Libanes, Sao Paulo, Sao Paulo, Brazil; Geriatric Center for Advanced Medicine, Hospital Sirio-Libanes, São Paulo, Sao Paulo, Brazil
| | - Marlon J R Aliberti
- Geriatric Emergency Department Research Group (ProAGE), Hospital Sirio-Libanes, Sao Paulo, Sao Paulo, Brazil; Geriatric Center for Advanced Medicine, Hospital Sirio-Libanes, São Paulo, Sao Paulo, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Christian V Morinaga
- Geriatric Emergency Department Research Group (ProAGE), Hospital Sirio-Libanes, Sao Paulo, Sao Paulo, Brazil
| | - Thiago J Avelino-Silva
- Geriatric Emergency Department Research Group (ProAGE), Hospital Sirio-Libanes, Sao Paulo, Sao Paulo, Brazil; Geriatric Center for Advanced Medicine, Hospital Sirio-Libanes, São Paulo, Sao Paulo, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Ana Paula de O Marques
- Postgraduate Program in Gerontology (PPGERO), Federal University of Pernambuco, Recife, Brazil; Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE)/Ebserh, Recife, Pernambuco, Brazil
| | - Hugo M de A Melo
- Postgraduate Program in Gerontology (PPGERO), Federal University of Pernambuco, Recife, Brazil; Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE)/Ebserh, Recife, Pernambuco, Brazil
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8
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Farber AE, Menascu S, Kalron A. The association of fear of falling and falls with sedentary behavior in people with multiple sclerosis. J Psychosom Res 2024; 181:111675. [PMID: 38652979 DOI: 10.1016/j.jpsychores.2024.111675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/25/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Sedentary behavior, falls, and fear of falling (FoF) are specific concerns for people with MS (pwMS). Considering the relatively high incidence and potential linkage, it is surprising that this triple relationship has as yet not been extensively investigated in pwMS. Thus, the present study aimed to examine the correlates of sedentary behavior with FoF and falls in pwMS. METHODS Fifty pwMS, 30 women, were admitted to this cross-sectional study. Primary outcome measures included physical activity and sedentary behavior metrics measured by accelerometry, fall status, and FoF. Additional measures included mobility clinical tests, cognition, perceived fatigue, depression, and anxiety. The sample was divided into two subgroups according to the daily Metabolic Equivalent of Task (MET) rate scores; <1.5 was defined as sedentary, ≥1.5 were defined as non-sedentary. Multivariate analysis of variance and linear regression analyses assessed the relationships by using an alpha of 0.05. RESULTS Sixty-four percent of the sample were classified as sedentary. The sedentary subgroup reported more FoF than the non-sedentary subgroup (32.5 (S·D. = 11.3) vs. 29.9 (S.D. = 9.5); however, no differences were found in fall status between the subgroups. No differences were found for depression, anxiety, cognition, and perceived fatigue between the subgroups. Furthermore, according to the linear regression analysis, FoF explained 23.9% of the variance pertaining to the daily MET rate when controlling for age, gender, disease duration, and disability. CONCLUSIONS Clinicians are encouraged to incorporate the issue of FoF during standard management, which may represent an opportunity to improve care and reduce sedentary behavior in pwMS.
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Affiliation(s)
- Adi Einav Farber
- Department of Physical Therapy, School of Health Professions, Faculty of Medicine and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Faculty of Medicine and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel; Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.
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Bégin D, Janecek M, Macedo LG, Richardson J, Wojkowski S. The relationship between fear of falling and functional ability following a multi-component fall prevention program: an analysis of clinical data. Physiother Theory Pract 2024; 40:1121-1132. [PMID: 36305706 DOI: 10.1080/09593985.2022.2137384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The first objective was to evaluate clinical data from a multi-component fall prevention program. The second objective was to explore the relationship between physical function and fear of falling (FoF). METHODS Adults (N = 287, mean age = 76 years) who participated in the Building Balance Program between 2011-2020 were assessed with five physical function measures and two FoF measures. Repeated measures ANOVA controlling for age and sex were performed to assess change from baseline. Linear regressions were conducted to evaluate how physical function explained variations in FoF. RESULTS There were significant improvements between pre and post-program Berg Balance Scale (BBS) scores (p < .001), Timed-Up and Go (TUG) times (p < .001), 30 second Chair-Stand (30 CST repetitions) (p < .001), Functional Reach (FR) distance (p < .001), gait speed (p < .001), single item-FoF score (p < .001), and short Falls Efficacy Scale-International (FES-I score) (p < .001). After controlling for sex on all regression analyses, age, and pre-program gait speed explained variations in pre-program short FES-I scores (Adjusted R2 = 0.19). Age, pre-program BBS and 30 CST repetitions explained variations in pre-program level of FoF (Adjusted R2 = 0.25). Variations in post-program short FES-I scores (Adjusted R2 = 0.17) were explained by age, post-program TUG times and FR distance after controlling for age and sex. Robust regressions indicated variations in post-program level of FoF explained by age, post-program TUG and FR distance with a two-way interaction between age and FR. CONCLUSION A multi-component fall prevention program improved physical function and decreased FoF. A small association between physical function and FoF similar between pre- and post-program conditions was identified.
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Affiliation(s)
- Diane Bégin
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, Canada
| | - Marci Janecek
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, Canada
| | - Luciana G Macedo
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, Canada
| | - Sarah Wojkowski
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, Canada
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10
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Hughes LD. Commentary on: Are multimorbidity patterns associated with fear of falling in community-dwelling older adults? J Frailty Sarcopenia Falls 2024; 9:161-165. [PMID: 38835625 PMCID: PMC11145098 DOI: 10.22540/jfsf-09-161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Lloyd D. Hughes
- GP Partner, Tayview Medical Practice, NHS Fife, University of St. Andrews, Scotland, UK
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Marmamula S, Kumbham TR, Modepalli SB, Barrenkala NR, Keeffe JE, Friedman DS. Cross-sectional study of prevalence and correlates of fear of falling in the older people in residential care in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES). BMJ Open 2024; 14:e080973. [PMID: 38806424 PMCID: PMC11138276 DOI: 10.1136/bmjopen-2023-080973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/25/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE To report the prevalence and risk factors for the fear of falling (FOF) among older individuals living in residential care facilities in India. DESIGN Cross-sectional study. SETTING Homes for the aged centres in Hyderabad, India. PARTICIPANTS The study included individuals aged ≥60 years from homes for the aged centres. The participants underwent a comprehensive eye examination in make-shift clinics setup in homes. Trained investigators collected the personal and demographic information of the participants and administered the Patient Health Questionnaire-9 and Hearing Handicap Inventory for Elderly questionnaire in the vernacular language. FOF was assessed using the Short Falls Efficacy Scale. The presence of hearing and visual impairment in the same individual was considered dual sensory impairment (DSI). A multiple logistic regression analysis was done to assess the factors associated with FOF. PRIMARY OUTCOME MEASURE FOF. RESULTS In total, 867 participants were included from 41 homes for the aged centres in the analyses. The mean (±SD) age of the participants was 74.2 (±8.3) years (range 60-96 years). The prevalence of FOF was 56.1% (95% CI 52.7% to 59.4%; n=486). The multivariate analysis showed that those with DSI had eleven times higher odds of reporting FOF than those with no impairment (OR 11.14; 95% CI 3.15 to 41.4.) Similarly, those with moderate depression had seven times higher odds (OR 6.85; 95% CI 3.70 to 12.70), and those with severe depression had eight times higher odds (OR 8.13; 95% CI 3.50 to 18.90) of reporting FOF. A history of falls in the last year was also associated with increased odds for FOF (OR 1.52; 95% CI 1.03 to 2.26). CONCLUSION FOF is common among older individuals in residential care in India. Depression, falling in the previous year and DSI were strongly associated with FOF. A cross-disciplinary approach may be required to address FOF among the older people in residential care in India.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Wellcome Trust / Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Thirupathi Reddy Kumbham
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Satya Brahmanandam Modepalli
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Navya Rekha Barrenkala
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jill Elizabeth Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - David S Friedman
- Harvard Medical School Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
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Tran LV, Nguyen TX, Nguyen TTH, Nguyen HTT, Nguyen TN, Nguyen TTP, Nguyen HTT, Pham T, Nguyen AT, Vu HTT. Fear of Falling: Exploring Associated Factors among Elderly Residents in the Rural Communities of Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:691. [PMID: 38928938 PMCID: PMC11203546 DOI: 10.3390/ijerph21060691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
This research aimed to explore factors associated with the fear of falling (FOF) among community-dwelling older adults in Vietnam. A cross-sectional study was conducted in five communes in Soc Son, Hanoi, Vietnam, from March to June 2017. We recruited a total of 487 participants, which provided sufficient data for analysis. The outcome variable was fear of falling. Several covariates, including demographics, medical history, general health status, geriatric syndromes, eye diseases, assessment of fall risk environment, timed up-and-go test, and number of standing up in 30 s, were collected. A multivariable logistic regression model was performed to determine predictors associated with FOF. The results showed that 54.6% of the participants had FOF. Furthermore, the logistic multivariable regression model revealed several factors associated with FOF among participants in the research sites, including polypharmacy status (OR: 1.79; 95%CI 1.07-2.99), higher scores in quality of life according to the EQ-5D-5L index (OR:6.27; 95%CI: 2.77-14.17), and having fallen during the past 12 months (OR:4.4; 95%CI: 2.39-8.11). These findings contribute to a comprehensive understanding of the intricate relationship between FOF and several associated factors, notably polypharmacy status, quality of life, and having a fall during the past 12 months.
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Affiliation(s)
- Luc Viet Tran
- Neurology Department, Hanoi Medical University, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (A.T.N.); (H.T.T.V.)
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Thanh Xuan Nguyen
- Neurology Department, Hanoi Medical University, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (A.T.N.); (H.T.T.V.)
- Geriatrics Department, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Thu Thi Hoai Nguyen
- Neurology Department, Hanoi Medical University, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (A.T.N.); (H.T.T.V.)
- Geriatrics Department, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Huong Thi Thu Nguyen
- Neurology Department, Hanoi Medical University, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (A.T.N.); (H.T.T.V.)
- Geriatrics Department, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Tam Ngoc Nguyen
- Neurology Department, Hanoi Medical University, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (A.T.N.); (H.T.T.V.)
- Geriatrics Department, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Thao Thi Phuong Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
- Academy of Medical Sciences, Ho Chi Minh 700000, Vietnam
| | - Huong Thi Thanh Nguyen
- Dinh Tien Hoang Institute of Medicine, Hanoi 100000, Vietnam;
- Physiology Department, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Thang Pham
- Neurology Department, Hanoi Medical University, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (A.T.N.); (H.T.T.V.)
- Geriatrics Department, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Anh Trung Nguyen
- Neurology Department, Hanoi Medical University, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (A.T.N.); (H.T.T.V.)
- Geriatrics Department, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Huyen Thi Thanh Vu
- Neurology Department, Hanoi Medical University, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (A.T.N.); (H.T.T.V.)
- Geriatrics Department, Hanoi Medical University, Hanoi 100000, Vietnam
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Czuber NK, Garabedian PM, Rice H, Tejeda CJ, Dykes PC, Latham NK. Human-Centered Design and Development of a Fall Prevention Exercise App for Older Adults in Primary Care Settings. Appl Clin Inform 2024; 15:544-555. [PMID: 38350643 PMCID: PMC11236445 DOI: 10.1055/a-2267-1727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Falls in older adults are a serious public health problem that can lead to reduced quality of life or death. Patients often do not receive fall prevention guidance from primary care providers (PCPs), despite evidence that falls can be prevented. Mobile health technologies may help to address this disparity and promote evidence-based fall prevention. OBJECTIVE Our main objective was to use human-centered design to develop a user-friendly, fall prevention exercise app using validated user requirements. The app features evidence-based behavior change strategies and exercise content to support older people initiating and adhering to a progressive fall prevention exercise program. METHODS We organized our multistage, iterative design process into three phases: gathering user requirements, usability evaluation, and refining app features. Our methods include focus groups, usability testing, and subject-matter expert meetings. RESULTS Focus groups (total n = 6), usability testing (n = 30) including a posttest questionnaire [Health-ITUES score: mean (standard deviation [SD]) = 4.2 (0.9)], and subject-matter expert meetings demonstrate participant satisfaction with the app concept and design. Overall, participants saw value in receiving exercise prescriptions from the app that would be recommended by their PCP and reported satisfaction with the content of the app. CONCLUSION This study demonstrates the development, refinement, and usability testing of a fall prevention exercise app and corresponding tools that PCPs may use to prescribe tailored exercise recommendations to their older patients as an evidence-based fall prevention strategy accessible in the context of busy clinical workflows.
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Affiliation(s)
- Nichole K. Czuber
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Pamela M. Garabedian
- Clinical and Quality Analysis, Mass General Brigham, Inc., Boston, Massachusetts, United States
| | - Hannah Rice
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Christian J. Tejeda
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Patricia C. Dykes
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States
| | - Nancy K. Latham
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States
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Xu D, Wang Y, Zhu S, Zhao M, Wang K. Relationship between fear of falling and quality of life in nursing home residents: The role of activity restriction. Geriatr Nurs 2024; 57:45-50. [PMID: 38520817 DOI: 10.1016/j.gerinurse.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/25/2024] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
This study investigates the mediating role of activity restriction in the relationship between the fear of falling and health outcomes. This was a cross-sectional study with convenience sampling of 316 nursing home residents. Generalized structural equation modeling was conducted to test the mediating role. The results showed that residents with fear of falling were more likely to restrict their activities and residents who often or always restricted activities reported lower levels of quality of life and higher levels of depression. Severe activity restriction accounted for 75 % of the total effect of fear of falling on quality of life and 69 % of the total effect of fear of falling on depression. Fall prevention efforts should focus on strategies or interventions to reduce residents' excessive fear of falling and promote activity engagement. Physical and social activities will not only prevent future falls but also improve residents' quality of life and mental health.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China; School of Nursing, Purdue University, West Lafayette, IN 47907 USA
| | - Yaqi Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Shanshan Zhu
- Geriatrics Department, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Meng Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Kefang Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.
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Miri S, Norasteh AA. Fear of falling, quality of life, and daily functional activity of elderly women with and without a history of falling: a cross-sectional study. Ann Med Surg (Lond) 2024; 86:2619-2625. [PMID: 38694291 PMCID: PMC11060224 DOI: 10.1097/ms9.0000000000001977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/06/2024] [Indexed: 05/04/2024] Open
Abstract
Background This study aimed to evaluate the fear of falling, quality of life, and daily functional activity of older women aged 60 years or older with or without a history of falling. Materials and methods Two hundred older adult women were recruited for the cross-sectional study in Iran. This cross-sectional study collected data from July to August 2023 through convenience sampling. The researchers collected data using a five-part questionnaire, that collected information that included demographic characteristics, the Fall Efficacy Scale in the Elderly-International Version (FES-I), 12-item Quality of Life assessment (SF-12), Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL). Results FES-I score in older women with a history of falls was significantly higher than those without a history of falls [median: 38.0, interquartile range (IQR): 31.5-44.0 versus median: 22.0, IQR: 20.0-30.0; P<0.001]. The median quality-of-life score using the SF-12 was significantly lower in women with a history of falls than in those without a history of falls (median: 25.0, IQR: 21.0-30.0 versus median: 35.0, IQR: 31.0-39.0; P<0.001). The ADL scores were significantly lower among women with a history of falls than those without (P<0.001). A similar result was obtained for IADL scores (P<0.001). Conclusion Overall, this study's findings highlight the adverse impact of a history of falls on three key factors: fear of falling, quality of life, and daily functional activity (including both basic and instrumental activities). The findings delineate that, ultimately, the history of falls can serve as a valuable indicator for better understanding trends in elderly care and addressing the associated challenges.
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Affiliation(s)
- Sahar Miri
- Department of Corrective Exercise and Sport Injury, Faculty of Sport Sciences, University of Guilan, Rasht, Iran
| | - Ali Asghar Norasteh
- Department of Physiotherapy, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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16
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Tian X, Mai YH, Guo ZJ, Chen JW, Zhou LJ. Contributing factors and interventions for fear of falling in stroke survivors: a systematic review. Top Stroke Rehabil 2024:1-16. [PMID: 38566465 DOI: 10.1080/10749357.2024.2333172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The purpose of this study was to provide a comprehensive overview of the prevalence, measurement tools, influencing factors, and interventions for fear of falling (FOF) in stroke survivors. METHODS A PRISMA-guided systematic literature review was conducted. PubMed, EMBASE, Cochrane, and Web of Science were systematically searched. The search time was up to February 2023. All observational and experimental studies investigating FOF in stroke patients were included. The assessment tool of the Joanna Briggs Institute was used to assess the quality of the included studies and the risk of bias assessment. (PROSPERO: CRD42023412522). RESULT A total of 25 observational studies and 10 experimental studies were included. The overall quality of the included studies was "low" to "good." The most common tool used to measure the FOF was the Falls Efficacy Scale-International (FES-I). The prevalence of FOF was 42%- 93.8%. Stroke survivors with physical impairments have the highest prevalence of FOF. The main risk factors for the development of FOF in stroke survivors were female gender, use of assistive devices, balance, limb dysfunction, and functional mobility. The combination of cognitive behavioral and exercise interventions is the most effective strategy. CONCLUSIONS This review suggests that the prevalence of FOF in stroke survivors is high and that understanding the factors associated with FOF in stroke patients can help develop multifactorial prevention strategies to reduce FOF and improve quality of life. In addition, a uniform FOF measurement tool should be used to better assess the effectiveness of interventions for stroke survivors. ETHICS APPROVAL PROSPERO registration (CRD42023412522).
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Affiliation(s)
- Xue Tian
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Ying-Hong Mai
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Zai-Jin Guo
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Jia-Wen Chen
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Luo-Jing Zhou
- Science and Technology Division, North Jiangsu People's Hospital of Jiangsu province, Yangzhou, China
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17
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Walter CS, Narcisse MR, Felix HC, Rowland B, Selig JP, McElfish PA. Association Between Physical Activity and Physical Function in a Marshallese Population with Type 2 Diabetes. J Immigr Minor Health 2024; 26:361-370. [PMID: 37864639 PMCID: PMC10983015 DOI: 10.1007/s10903-023-01551-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/23/2023]
Abstract
Physical activity can delay functional decline in people with type 2 diabetes (T2D), but these associations have not been studied within a sample of Native Hawaiian or Pacific Islander adults with T2D. Using data from a randomized control trial in which 218 Marshallese adults with T2D participated in a 10-week diabetes self-management education intervention, this study tested our hypothesis that physical activity would predict physical function when controlling for time and other variables. Levels of physical activity were positively associated with levels of physical function, even after controlling for time and other covariates. These findings provide a more robust understanding of the relationship between physical activity and physical function in a sample of minority adults with T2D. Future studies should further explore levels of physical activity needed to maintain and improve physical function so that culturally appropriate physical activity interventions can be developed.
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Affiliation(s)
- Christopher S Walter
- Department of Physical Therapy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA.
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - James P Selig
- Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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Fula V, Moreno P. Wrist-Based Fall Detection: Towards Generalization across Datasets. SENSORS (BASEL, SWITZERLAND) 2024; 24:1679. [PMID: 38475215 DOI: 10.3390/s24051679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
Increasing age is related to a decrease in independence of movement and with this decrease comes falls, millions of falls occur every year and the most affected people are the older adults. These falls usually have a big impact on health and independence of the older adults, as well as financial impact on the health systems. Thus, many studies have developed fall detectors from several types of sensors. Previous studies related to the creation of fall detection systems models use only one dataset that usually has a small number of samples. Training and testing machine learning models in this small scope: (i) yield overoptimistic classification rates, (ii) do not generalize to real-life situations and (iii) have very high rate of false positives. Given this, the proposal of this research work is the creation of a new dataset that encompasses data from three different datasets, with more than 1300 fall samples and 28 K negative samples. Our new dataset includes a standard way of adding samples, which allow the future addition of other data sources. We evaluate our dataset by using classic cost-sensitive Machine Leaning methods that deal with class imbalance. For the training and validation of this model, a set of temporal and frequency features were extracted from the raw data of an accelerometer and a gyroscope using a sliding window of 2 s with an overlap of 50%. We study the generalization properties of each dataset, by testing on the other datasets and also the performance of our new dataset. The model showed a good ability to distinguish between activities of daily living and falls, achieving a recall of 90.57%, a specificity of 96.91% and an Area Under the Receiver Operating Characteristic curve (AUC-ROC) value of 98.85% against the combination of three datasets.
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Affiliation(s)
- Vanilson Fula
- Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisboa, Portugal
| | - Plinio Moreno
- Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisboa, Portugal
- Institute for Systems and Robotics, LARSyS, Torre Norte Piso 7, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
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Almeida AS, Paguia A, Neves AP. Nursing Interventions to Empower Family Caregivers to Manage the Risk of Falling in Older Adults: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:246. [PMID: 38541248 PMCID: PMC10970157 DOI: 10.3390/ijerph21030246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 07/23/2024]
Abstract
Falls pose a significant risk to older adults, resulting in injuries and declining quality of life. The psychological impact, particularly the fear of falling, impairs their well-being. This pervasive fear affects daily activities, leading to self-imposed limitations and reduced engagement. This review aimed to identify nursing interventions to empower family caregivers to manage the risk of falling in older adults. A scoping review was developed following the JBI framework. We searched the CINAHL, MEDLINE, Nursing & Allied Health Collection, Cochrane Central Register of Controlled Trials, MedicLatina, and Cochrane Database of Systematic Reviews. The findings of this review revealed that out of 460 initially identified records, nine articles met the eligibility criteria and were retained for further in-depth analysis. These articles provided insights into nine distinct categories of nurse interventions: Therapeutic Relationships, Family Involvement, Personalized Care, Health Education, Multifactorial Falls Risk Assessment, Home Modifications, Referral, Transition Between Healthcare Services, and Health Care Consultants. The findings of this review have significant implications for clinical practice, particularly in emphasizing the crucial role of nurses in empowering family caregivers and older adults to manage the risk of falling at home. Healthcare professionals, policymakers, and researchers can benefit from this informative resource to develop strategies and guidelines.
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Affiliation(s)
- Ana Silva Almeida
- Setúbal Hospital Center E.P.E., 2910-446 Setúbal, Portugal
- Nursing School of Lisbon, 1900-160 Lisbon, Portugal;
| | - Ana Paguia
- Sado Family Healthcare Unit, 2910-363 Setúbal, Portugal;
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Sebastião E, Siqueira V, Bakare J, Bohn L, Gallo LH. Fear of Falling in Older Adults Living in a Community-Dwelling Facility: Prevalence and Its Impact on Activity Behavior and Physical Function. J Appl Gerontol 2024:7334648241230403. [PMID: 38323893 DOI: 10.1177/07334648241230403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
This study examined the prevalence and the impact of fear of falling (FOF) on physical activity (PA), sedentary behavior (PA), and physical function in older adults living in a continuing care retirement community (CCRC). Ninety-three older adults were included and self-reported assessed on PA and SB. Further, participants' physical function was assessed using a collection of measures of valid objective tests. Independent t test was used to compare the dependent variables between FOF groups, and analysis of covariance (ANCOVA) was used to control for assistive device usage. FOF was prevalent in 47.3% of the sample and PA and SB did not differ between FOF groups (p > .05). ANCOVA revealed that performance on several physical function tests remained significantly better (p < .05) for the no FOF group compared to the yes group. Our findings demonstrated similar levels of PA and SB between FOF groups, but worse physical function for older adults reporting FOF.
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Affiliation(s)
- Emerson Sebastião
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Vitor Siqueira
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Jemimah Bakare
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Lucimere Bohn
- Faculty of Psychology, Education and Sport, Lusófona University of Porto, Porto, Portugal
- Research Center in Physical Activity, Health and Leisure (CIAFEL) and Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
- Faculty of Sports, University of Porto, Porto, Portugal
| | - Luiza Herminia Gallo
- Department of Physical Education, State University of Ponta Grossa, Paraná, Brazil
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21
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Lim ML, Perram A, Radford K, Close J, Draper B, Lord SR, Anstey KJ, O'Dea B, Ambrens M, Hill TY, Brown A, Miles L, Ngo M, Letton M, van Schooten KS, Delbaere K. Protocol of a 12-week eHealth programme designed to reduce concerns about falling in community-living older people: Own Your Balance randomised controlled trial. BMJ Open 2024; 14:e078486. [PMID: 38309754 PMCID: PMC10840028 DOI: 10.1136/bmjopen-2023-078486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/03/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION Concerns about falling (CaF) are common in older people and have been associated with avoidance of activities of daily life. Exercise designed to prevent falls can reduce CaF, but the effects are usually short-lived. Cognitive behavioural therapy (CBT) can reduce CaF for longer but is not readily available in the community and unlikely to prevent falls. A multidomain intervention that combines CBT, motivational interviewing and exercise could be the long-term solution to treat CaF and reduce falls in older people with CaF. This paper describes the design of a randomised controlled trial to test the effectiveness of two different 12 week self-managed eHealth programmes to reduce CaF compared with an active control. METHODS A total of 246 participants (82 per group) aged 65 and over, with substantial concerns about falls or balance will be recruited from the community. They will be randomised into: (1) myCompass-Own Your Balance (OYB) (online CBT programme) intervention or (2) myCompass-OYB plus StandingTall intervention (an eHealth balance exercise programme), both including motivational interviewing and online health education or (3) an active control group (online health education alone). The primary outcome is change in CaF over 12 months from baseline of both intervention groups compared with control. The secondary outcomes at 2, 6 and 12 months include balance confidence, physical activity, habitual daily activity, enjoyment of physical activity, social activity, exercise self-efficacy, rate of falls, falls health literacy, mood, psychological well-being, quality of life, exercise self-efficacy, programme adherence, healthcare use, user experience and attitudes towards the programme. An intention-to-treat analysis will be applied. The healthcare funder's perspective will be adopted for the economic evaluation if appropriate. ETHICS AND DISSEMINATION Ethical approval was obtained from the South Eastern Sydney Local Health District Human Research Ethics Committee (2019/ETH12840). Results will be disseminated via peer-reviewed journals, local and international conferences, community events and media releases. TRIAL REGISTRATION NUMBER ACTRN12621000440820.
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Affiliation(s)
- Mei Ling Lim
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Amy Perram
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Kylie Radford
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jacqueline Close
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, University of New South Wales, Randwick, New South Wales, Australia
- Eastern Suburbs Older Persons' Mental Health Service, Randwick, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Bridianne O'Dea
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Meghan Ambrens
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Thi-Yen Hill
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
- Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alicia Brown
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Lillian Miles
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Michelle Ngo
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Meg Letton
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Kimberley S van Schooten
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
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22
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Lindell E, Odhagen E, Tuomi L. Living with dizziness impacts health-related quality of life among older adults. Laryngoscope Investig Otolaryngol 2024; 9:e1194. [PMID: 38362202 PMCID: PMC10866590 DOI: 10.1002/lio2.1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/16/2023] [Accepted: 11/26/2023] [Indexed: 02/17/2024] Open
Abstract
Objective This study aimed to compare older adults reporting dizziness to those not reporting dizziness regarding health-related quality of life (HRQL), distress due to dizziness, and balance confidence. A secondary aim was to investigate potential association between HRQL, number of falls, balance confidence, and distress due to dizziness. Methods Patients coming for bone density measurements answered questions regarding occurrence of dizziness. Patients reporting dizziness on a daily or weekly basis were considered eligible and invited for investigation at the Ear, Nose and Throat clinic at Södra Älvsborg Hospital, Sweden. Patients not reporting dizziness were considered eligible as controls. All patients answered the Dizziness Handicap Inventory (DHI), Activity Balance Confidence Scale (ABC-scale), and Euro-QoL-5D-3L questionnaires. Results A total of 55 dizzy patients came for physical investigation and answered the questionnaires and 47 non-dizzy participants only answered the questionnaires. The dizzy participants reported lower levels of balance confidence, lower HRQL, more prior falls, and higher levels of distress due to dizziness than the non-dizzy controls. Lower levels of balance confidence and higher level of distress due to dizziness were each associated with lower HRQL. Conclusion Dizziness, unsteadiness, and low balance confidence are associated with HRQL in a negative way. This is important to consider when measuring HRQL in a senior population, since a sensation of unsteadiness may indirectly contribute to low HRQL together with other symptoms. Level of evidence 2b.
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Affiliation(s)
- Ellen Lindell
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of Gothenburg, Sahlgrenska Academy, Institute of Clinical SciencesGothenburgSweden
- Department of OtorhinolaryngologyRegion Västra Götaland, Södra Älvsborg HospitalBoråsSweden
- Department of Research, Education and InnovationRegion Västra Götaland, Södra Älvsborg HospitalBoråsSweden
| | - Erik Odhagen
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of Gothenburg, Sahlgrenska Academy, Institute of Clinical SciencesGothenburgSweden
- Department of OtorhinolaryngologyRegion Västra Götaland, Södra Älvsborg HospitalBoråsSweden
- Department of Research, Education and InnovationRegion Västra Götaland, Södra Älvsborg HospitalBoråsSweden
| | - Lisa Tuomi
- Institute of Neuroscience and Physiology, Speech and Language Pathology UnitUniversity of Gothenburg, Sahlgrenska AcademyGothenburgSweden
- Department of Otorhinolaryngology, Head and Neck SurgeryRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
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23
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Hasan S, Chevidikunnan MF, Khan F. Reliability and validity of the Arabic version of the modified falls efficacy scale. Disabil Rehabil 2024; 46:793-801. [PMID: 36727527 DOI: 10.1080/09638288.2023.2175045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to adapt Modified Falls Efficacy Scale (MFES) into Arabic and determine the reliability and validity of the instrument. MATERIALS AND METHODS The study was conducted in two phases: (i) translation and adaptation by the systematic approach of the 'forward-back' translation method and (ii) psychometric testing of the Arabic version of the Modified Falls Efficacy Scale among 207 community-dwelling older adults (≥ 60 years). RESULTS The Arabic version of the Modified Falls Efficacy Scale demonstrated excellent internal consistency (Cronbach's alpha = 0.98) and test-retest reliability scores (ICC = 0.96, 95% CI; 0.95-0.97). And also showed strong correlations with both the Falls Efficacy International (r = -0.82) and the activities-specific Balance Confidence Scale (r = 0.87). Sampling adequacy for factor analysis was proven by a Kaiser-Meyer-Olkin value of 0.962. Goodness-of-fit (GFI) statistics for the model were in the acceptable range (Chi-Square/Degree of Freedom (CMIN/DF) = 2.59, Goodness-of-fit index (GFI) = 0.9, Comparative Fit Index (CFI) = 0.97, Root Mean Square Error of Approximation (RMSEA) = 0.79). CONCLUSION The Arabic version of the Modified Falls Efficacy Scale has demonstrated excellent psychometric qualities to measure the level of fear of falling.
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Affiliation(s)
- Sami Hasan
- Department of occupational therapy, Faculty of medical rehabilitation sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Mohamed Faisal Chevidikunnan
- Department of physical therapy, Faculty of medical rehabilitation sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Fayaz Khan
- Department of physical therapy, Faculty of medical rehabilitation sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia
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24
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Adandom HC, Nwankwo HC, Adandom II, Akinrolie O, Odole AC, Scott DR, Awosoga OA. Exploring the relationship between falls, fall-related psychological concerns, and personality traits in adults: A scoping review protocol. Health Sci Rep 2024; 7:e1848. [PMID: 38299208 PMCID: PMC10826239 DOI: 10.1002/hsr2.1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/08/2023] [Accepted: 12/19/2023] [Indexed: 02/02/2024] Open
Abstract
Background and Aims Personality traits, such as neuroticism and extraversion, are emerging as important predictors of falls. Despite their significance, existing fall prevention programs often overlook these traits, creating a notable research gap. This study aims to conduct a comprehensive scoping review to explore the existing literature on the relationships among personality traits, falls, and fall-related psychological concerns (FrPCs). Methods This scoping review will adhere to the framework established by Arksey and O'Malley, incorporating extensions recommended by the Joanna Briggs Institute and using the PRISMA-ScR checklist. A thorough search strategy will be employed, aligning with the population, concept, and context (PCC) selection criteria. Electronic databases, including MEDLINE, APA PsycINFO, Web of Science, CINAHL, and SPORTDiscus, will be searched from their inception to the present. Additionally, a manual search of the reference lists of identified and relevant full-text articles will be conducted. Two independent reviewers will screen titles and abstracts, perform full-text reviews, and extract data from pertinent articles. Discussion Personality traits are increasingly recognized as influential predictors of falls and related psychological concerns. This review aims to make a substantial contribution to the existing literature by being the first to comprehensively explore and provide a descriptive synthesis of the relationship between personality traits and falls, as well as FrPCs in adults. It is hoped that the outcomes of this review will enhance our comprehension of the role of personality traits in falls, potentially informing future research and strategies for this critical area of study. Scoping Review Registration This scoping review protocol was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/KR74X).
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Affiliation(s)
| | - Henry C. Nwankwo
- Warwick Medical SchoolUniversity of WarwickCoventryUnited Kingdom
| | | | - Olayinka Akinrolie
- Applied Health Science, Faculty of Graduate StudiesUniversity of ManitobaWinnipegManitobaCanada
| | - Adesola C. Odole
- Department of Physiotherapy, College of MedicineUniversity of IbadanIbadanNigeria
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Suri A, Hubbard ZL, VanSwearingen J, Torres-Oviedo G, Brach JS, Redfern MS, Sejdic E, Rosso AL. Fear of falling in community-dwelling older adults: What their gait acceleration pattern reveals. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:108001. [PMID: 38199138 DOI: 10.1016/j.cmpb.2023.108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/08/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Fear of Falling (FOF) is common among community-dwelling older adults and is associated with increased fall-risk, reduced activity, and gait modifications. OBJECTIVE In this cross-sectional study, we examined the relationships between FOF and gait quality. METHODS Older adults (N=232; age 77±6; 65 % females) reported FOF by a single yes/no question. Gait quality was quantified as (1) harmonic ratio (smoothness) and other time-frequency spatiotemporal variables from triaxial accelerometry (Vertical-V, Mediolateral-ML, Anterior-Posterior -AP) during six-minute walk; (2) gait speed, step-time CoV (variability), and walk-ratio (step-length/cadence) on a 4-m instrumented walkway. Mann Whitney U-tests and Random forest classifier compared gait between those with and without FOF. Selected gait variables were used to build Support Vector Machine (SVM) classifier and performance was evaluated using AUC-ROC. RESULTS Individuals with FOF had slower gait speed (103.66 ± 17.09 vs. 110.07 ± 14.83 cm/s), greater step time CoV (4.17 ± 1.66 vs. 3.72 ± 1.24 %), smaller walk-ratio (0.53 ± 0.08 vs. 0.56 ± 0.07 cm/steps/minute), smaller standard deviation V (0.15 ± 0.06 vs. 0.18 ± 0.09 m/s2), and smaller harmonic-ratio V (2.14 ± 0.73 vs. 2.38 ± 0.58), all p<.01. Linear SVM yielded an AUC-ROC of 67 % on test dataset, coefficient values being gait speed (-0.19), standard deviation V (-0.23), walk-ratio (-0.36), and smoothness V (-0.38) describing associations with presence of FOF. CONCLUSION Older adults with FOF have reduced gait speed, acceleration adaptability, walk-ratio, and smoothness. Disrupted gait patterns during fear of falling could provide insights into psychosocial distress in older adults. Longitudinal studies are warranted.
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Affiliation(s)
- Anisha Suri
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zachary L Hubbard
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessie VanSwearingen
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gelsy Torres-Oviedo
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Toronto, Ontario, Canada
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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26
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Grede N, Trampisch U, Weissbach S, Heinzel-Gutenbrunner M, Freiberger E, Sönnichsen A, Donner-Banzhoff N. A volunteer-supported walking programme to improve physical function in older people with restricted mobility (the POWER Study): a randomised controlled trial. BMC Geriatr 2024; 24:60. [PMID: 38221605 PMCID: PMC10789062 DOI: 10.1186/s12877-024-04672-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Regular physical activity has multiple health benefits, especially in older people. Therefore, the World Health Organization recommends at least 2.5 h of moderate physical activity per week. The aim of the POWER Study was to investigate whether volunteer-assisted walking improves the physical performance and health of older people. METHODS We approached people aged 65 years and older with restricted mobility due to physical limitations and asked them to participate in this multicentre randomised controlled trial. The recruitment took place in nursing homes and the community setting. Participants randomly assigned to the intervention group were accompanied by volunteer companions for a 30-50 min walk up to three times a week for 6 months. Participants in the control group received two lectures that included health-related topics. The primary endpoint was physical function as measured with the Short Physical Performance Battery (SPPB) at baseline and 6 and 12 months. The secondary and safety endpoints were quality of life (EQ-5D-5L), fear of falling (Falls Efficacy Scale), cognitive executive function (the Clock Drawing Test), falls, hospitalisations and death. RESULTS The sample comprised 224 participants (79% female). We failed to show superiority of the intervention with regard to physical function (SPPB) or other health outcomes in the intention-to-treat analyses. However, additional exploratory analyses suggest benefits in those who undertook regular walks. The intervention appears to be safe regarding falls. CONCLUSIONS Regular physical activity is essential to preserve function and to improve health and quality of life. Against the background of a smaller-than-planned sample size, resulting in low power, and the interference of the COVID-19 pandemic, we suggest that community based low-threshold interventions deserve further exploration. TRIAL REGISTRATION The trial was registered with the German Clinical Trials Register ( www.germanctr.de ), with number DRKS00015188 on 31/08/2018.
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Affiliation(s)
- Nina Grede
- Institute of General Practice/Family Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - Ulrike Trampisch
- Department of Human Medicine, Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Sabine Weissbach
- Department of Human Medicine, Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Department of General Practice, Ruhr-University Bochum, Medical Faculty, Bochum, Germany
| | | | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - Andreas Sönnichsen
- Research Initiative Health for Austria, Wissenschaftliche Initiative Gesundheit Für Österreich, Vienna, Austria
| | - Norbert Donner-Banzhoff
- Institute of General Practice/Family Medicine, Philipps-University of Marburg, Marburg, Germany
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Block VJ, Koshal K, Wijangco J, Miller N, Sara N, Henderson K, Reihm J, Gopal A, Mohan SD, Gelfand JM, Guo CY, Oommen L, Nylander A, Rowson JA, Brown E, Sanders S, Rankin K, Lyles CR, Sim I, Bove R. A Closed-Loop Falls Monitoring and Prevention App for Multiple Sclerosis Clinical Practice: Human-Centered Design of the Multiple Sclerosis Falls InsightTrack. JMIR Hum Factors 2024; 11:e49331. [PMID: 38206662 PMCID: PMC10811573 DOI: 10.2196/49331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/14/2023] [Accepted: 10/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Falls are common in people with multiple sclerosis (MS), causing injuries, fear of falling, and loss of independence. Although targeted interventions (physical therapy) can help, patients underreport and clinicians undertreat this issue. Patient-generated data, combined with clinical data, can support the prediction of falls and lead to timely intervention (including referral to specialized physical therapy). To be actionable, such data must be efficiently delivered to clinicians, with care customized to the patient's specific context. OBJECTIVE This study aims to describe the iterative process of the design and development of Multiple Sclerosis Falls InsightTrack (MS-FIT), identifying the clinical and technological features of this closed-loop app designed to support streamlined falls reporting, timely falls evaluation, and comprehensive and sustained falls prevention efforts. METHODS Stakeholders were engaged in a double diamond process of human-centered design to ensure that technological features aligned with users' needs. Patient and clinician interviews were designed to elicit insight around ability blockers and boosters using the capability, opportunity, motivation, and behavior (COM-B) framework to facilitate subsequent mapping to the Behavior Change Wheel. To support generalizability, patients and experts from other clinical conditions associated with falls (geriatrics, orthopedics, and Parkinson disease) were also engaged. Designs were iterated based on each round of feedback, and final mock-ups were tested during routine clinical visits. RESULTS A sample of 30 patients and 14 clinicians provided at least 1 round of feedback. To support falls reporting, patients favored a simple biweekly survey built using REDCap (Research Electronic Data Capture; Vanderbilt University) to support bring-your-own-device accessibility-with optional additional context (the severity and location of falls). To support the evaluation and prevention of falls, clinicians favored a clinical dashboard featuring several key visualization widgets: a longitudinal falls display coded by the time of data capture, severity, and context; a comprehensive, multidisciplinary, and evidence-based checklist of actions intended to evaluate and prevent falls; and MS resources local to a patient's community. In-basket messaging alerts clinicians of severe falls. The tool scored highly for usability, likability, usefulness, and perceived effectiveness (based on the Health IT Usability Evaluation Model scoring). CONCLUSIONS To our knowledge, this is the first falls app designed using human-centered design to prioritize behavior change and, while being accessible at home for patients, to deliver actionable data to clinicians at the point of care. MS-FIT streamlines data delivery to clinicians via an electronic health record-embedded window, aligning with the 5 rights approach. Leveraging MS-FIT for data processing and algorithms minimizes clinician load while boosting care quality. Our innovation seamlessly integrates real-world patient-generated data as well as clinical and community-level factors, empowering self-care and addressing the impact of falls in people with MS. Preliminary findings indicate wider relevance, extending to other neurological conditions associated with falls and their consequences.
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Affiliation(s)
- Valerie J Block
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, United States
| | - Kanishka Koshal
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Jaeleene Wijangco
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Nicolette Miller
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Narender Sara
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Kyra Henderson
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Jennifer Reihm
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Arpita Gopal
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, United States
| | - Sonam D Mohan
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Jeffrey M Gelfand
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Chu-Yueh Guo
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Lauren Oommen
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Alyssa Nylander
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - James A Rowson
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Ethan Brown
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Stephen Sanders
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Katherine Rankin
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Courtney R Lyles
- University of California San Francisco Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States
| | - Ida Sim
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Riley Bove
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
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Fisher SR, Villasante-Tezanos A, Allen LM, Pappadis MR, Kilic G. Comparative effectiveness of pelvic floor muscle training, mirabegron, and trospium among older women with urgency urinary incontinence and high fall risk: a feasibility randomized clinical study. Pilot Feasibility Stud 2024; 10:1. [PMID: 38178267 PMCID: PMC10765875 DOI: 10.1186/s40814-023-01440-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Untreated, urgency urinary incontinence (UUI) and overactive bladder (OAB) can precipitate a vicious cycle of decreasing physical activity, social isolation, fear of falling, and falls. Structured behavioral interventions and medications are common initial treatment options, but they elicit their effects through very different mechanisms of action that may influence fall-related outcomes differently. This study will determine the feasibility of conducting a comparative effectiveness, three-arm, mixed methods, randomized clinical trial of a behaviorally based pelvic floor muscle training (PFMT) intervention versus two recent drug options in older women with UUI or OAB who are also at increased risk of falling. METHODS Forty-eight women 60 years and older with UUI or OAB who screen positive for increased fall risk will be recruited through the urogynacology and pelvic health clinics of our university health system. Participants will be randomly assigned to one of three 12-week treatment arms: (1) a course of behavioral and pelvic floor muscle training (PFMT) provided by physical therapists; (2) the beta-3 agonist, mirabegron; and (3) the antimuscarinic, trospium chloride. Study feasibility will be established through objective metrics of evaluability, adherence to the interventions, and attrition. We will also assess relevant measures of OAB symptom severity, quality of life, physical activity, incident falls, and concern about falling. DISCUSSION The proposed research seeks to ultimately determine if linkages between reduction in UI symptoms through treatment also reduce the risk of falling in this patient population. TRIAL REGISTRATION NCT05880862. Registered on 30 May 2023.
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Affiliation(s)
- Steve R Fisher
- Department of Physical Therapy, University of Texas Medical Branch at Galveston, Galveston, USA.
| | | | - Lindsay M Allen
- Department of Physical Therapy, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Monique R Pappadis
- Department of Population Health and Health Disparities, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Gokhan Kilic
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, USA
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29
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Iriarte E, Araya AX. Walking to Prevent Fear of Falling Among Community-Dwelling Older Adults: A Scoping Review. J Gerontol Nurs 2024; 50:15-21. [PMID: 38170459 DOI: 10.3928/00989134-20231211-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The current review sought to identify and synthesize the evidence on available interventions that include walking and their impact on fear of falling (FOF) among community-dwelling older adults without cognitive impairment. A 10-year search was conducted (January 2012 to January 2022) in two peer-reviewed databases. A total of 116 articles were identified, and 22 articles were reviewed. Most studies included multicomponent walking interventions, such as walking and another type of intervention or exercise. Among the different questionnaires to assess FOF, the Falls Efficacy Scale-International was the most used in 77.3% (n = 17) of studies. In addition to walking, interventions to reduce FOF mainly included balance training, lower extremity strengthening, cardio or aerobic exercises, or a combination of these exercises. Further research is needed to evaluate the impact of unidimensional walking interventions, as well as those that incorporate psychological and technological elements targeted to FOF prevention and management. [Journal of Gerontological Nursing, 50(1), 15-21.].
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30
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Arkkukangas M. Involvement of Older Adults, the Golden Resources, as a Primary Measure for Fall Prevention. Clin Interv Aging 2023; 18:2165-2170. [PMID: 38149083 PMCID: PMC10751217 DOI: 10.2147/cia.s430309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023] Open
Abstract
Falls remain the second leading cause of injury-related deaths worldwide; therefore, longstanding practical fall-prevention efforts are needed. Falls can also lead to a reduction in independence and quality of life among older adults. Fall-prevention research has found that early prevention promotes a prolonged independence. However, it remains unknown which intervention is most beneficial for early prevention and how these interventions should be implemented for long-term effects. In addition, the present and future burden on social and healthcare services contributes to a gap in needs and requires an evidence-based fall prevention. Research suggests that strength, balance, and functional training are effective in reducing falls and fall-related injuries. Such training could greatly impacting independence. Fear of falling and strategies for managing falls are the suggested components to be included when evaluating fall-prevention programs. Thus, the preservation of physical functions is highly relevant for both independence and quality of life. It also contributes to psychological and social well-being, which are important factors for enabling individuals to stay at home for as long as possible. To meet future challenges associated with the expected increase in the older population, older adults should be viewed as a golden resource. With assistance from professionals and researchers, they can learn and gain the ability to institute fall-prevention programs in their own environments. These environments are primarily beyond the responsibilities of the healthcare sector. Therefore, programs comprising current knowledge about fall prevention should be developed, evaluated, and implemented with older adults by using a "train-The-trainer" approach, where a natural collaboration is established between civil society and/or volunteers, healthcare professionals, and researchers. For sustainable and effective fall-prevention programs, a co-design and early collaborative approach should be used in the natural environment, before social and healthcare services are required.
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Affiliation(s)
- Marina Arkkukangas
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Medicine, Sport and Fitness Science, Dalarna University, Falun, Sweden
- Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Vasteras, Sweden
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31
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Heo KN, Seok JY, Ah YM, Kim KI, Lee SB, Lee JY. Development and validation of a machine learning-based fall-related injury risk prediction model using nationwide claims database in Korean community-dwelling older population. BMC Geriatr 2023; 23:830. [PMID: 38082380 PMCID: PMC10712099 DOI: 10.1186/s12877-023-04523-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Falls impact over 25% of older adults annually, making fall prevention a critical public health focus. We aimed to develop and validate a machine learning-based prediction model for serious fall-related injuries (FRIs) among community-dwelling older adults, incorporating various medication factors. METHODS Utilizing annual national patient sample data, we segmented outpatient older adults without FRIs in the preceding three months into development and validation cohorts based on data from 2018 and 2019, respectively. The outcome of interest was serious FRIs, which we defined operationally as incidents necessitating an emergency department visit or hospital admission, identified by the diagnostic codes of injuries that are likely associated with falls. We developed four machine-learning models (light gradient boosting machine, Catboost, eXtreme Gradient Boosting, and Random forest), along with a logistic regression model as a reference. RESULTS In both cohorts, FRIs leading to hospitalization/emergency department visits occurred in approximately 2% of patients. After selecting features from initial set of 187, we retained 26, with 15 of them being medication-related. Catboost emerged as the top model, with area under the receiver operating characteristic of 0.700, along with sensitivity and specificity rates around 65%. The high-risk group showed more than threefold greater risk of FRIs than the low-risk group, and model interpretations aligned with clinical intuition. CONCLUSION We developed and validated an explainable machine-learning model for predicting serious FRIs in community-dwelling older adults. With prospective validation, this model could facilitate targeted fall prevention strategies in primary care or community-pharmacy settings.
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Affiliation(s)
- Kyu-Nam Heo
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea
| | - Jeong Yeon Seok
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsan-si, 38541, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Seung-Bo Lee
- Department of Medical Informatics, Keimyung University School of Medicine, Dalgubeol-Daero 1095, Dalseo-Gu, Daegu, 42601, Republic of Korea.
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea.
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Shafi H, Awan WA, Olsen S, Siddiqi FA, Tassadaq N, Rashid U, Niazi IK. Assessing Gait & Balance in Adults with Mild Balance Impairment: G&B App Reliability and Validity. SENSORS (BASEL, SWITZERLAND) 2023; 23:9718. [PMID: 38139564 PMCID: PMC10747653 DOI: 10.3390/s23249718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/24/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Smartphone applications (apps) that utilize embedded inertial sensors have the potential to provide valid and reliable estimations of different balance and gait parameters in older adults with mild balance impairment. This study aimed to assess the reliability, validity, and sensitivity of the Gait&Balance smartphone application (G&B App) for measuring gait and balance in a sample of middle- to older-aged adults with mild balance impairment in Pakistan. Community-dwelling adults over 50 years of age (N = 83, 50 female, range 50-75 years) with a Berg Balance Scale (BBS) score between 46/56 and 54/56 were included in the study. Data collection involved securing a smartphone to the participant's lumbosacral spine. Participants performed six standardized balance tasks, including four quiet stance tasks and two gait tasks (walking looking straight ahead and walking with head turns). The G&B App collected accelerometry data during these tasks, and the tasks were repeated twice to assess test-retest reliability. The tasks in quiet stance were also recorded with a force plate, a gold-standard technology for measuring postural sway. Additionally, participants completed three clinical measures, the BBS, the Functional Reach Test (FRT), and the Timed Up and Go Test (TUG). Test-retest reliability within the same session was determined using intraclass correlation coefficients (ICCs) and the standard error of measurement (SEM). Validity was evaluated by correlating the G&B App outcomes against both the force plate data and the clinical measures using Pearson's product-moment correlation coefficients. To assess the G&B App's sensitivity to differences in balance across tasks and repetitions, one-way repeated measures analyses of variance (ANOVAs) were conducted. During quiet stance, the app demonstrated moderate reliability for steadiness on firm (ICC = 0.72) and compliant surfaces (ICC = 0.75) with eyes closed. For gait tasks, the G&B App indicated moderate to excellent reliability when walking looking straight ahead for gait symmetry (ICC = 0.65), walking speed (ICC = 0.93), step length (ICC = 0.94), and step time (ICC = 0.84). The TUG correlated with app measures under both gait conditions for walking speed (r -0.70 and 0.67), step length (r -0.56 and -0.58), and step time (r 0.58 and 0.50). The BBS correlated with app measures of walking speed under both gait conditions (r 0.55 and 0.51) and step length when walking with head turns (r = 0.53). Force plate measures of total distance wandered showed adequate to excellent correlations with G&B App measures of steadiness. Notably, G&B App measures of walking speed, gait symmetry, step length, and step time, were sensitive to detecting differences in performance between standard walking and the more difficult task of walking with head turns. This study demonstrates the G&B App's potential as a reliable and valid tool for assessing some gait and balance parameters in middle-to-older age adults, with promise for application in low-income countries like Pakistan. The app's accessibility and accuracy could enhance healthcare services and support preventive measures related to fall risk.
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Affiliation(s)
- Hina Shafi
- Riphah College of Rehabilitation & Allied Health Sciences, Riphah International University, Islamabad 46000, Pakistan
- Foundation Institute of Rehabilitation Sciences, Foundation University, Islamabad 44000, Pakistan
| | - Waqar Ahmed Awan
- Riphah College of Rehabilitation & Allied Health Sciences, Riphah International University, Islamabad 46000, Pakistan
| | - Sharon Olsen
- Health & Rehabilitation Research Institute, Faculty of Health & Environmental Sciences, AUT University, Auckland 1010, New Zealand
| | - Furqan Ahmed Siddiqi
- Foundation Institute of Rehabilitation Sciences, Foundation University, Islamabad 44000, Pakistan
| | - Naureen Tassadaq
- Foundation Institute of Rehabilitation Sciences, Foundation University, Islamabad 44000, Pakistan
| | - Usman Rashid
- Health & Rehabilitation Research Institute, Faculty of Health & Environmental Sciences, AUT University, Auckland 1010, New Zealand
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
| | - Imran Khan Niazi
- Health & Rehabilitation Research Institute, Faculty of Health & Environmental Sciences, AUT University, Auckland 1010, New Zealand
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
- Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
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Tung C, Lord SR, Pelicioni PHS, Sturnieks DL, Menant JCC. Prefrontal and Motor Planning Cortical Activity during Stepping Tasks Is Related to Task Complexity but Not Concern about Falling in Older People: A fNIRS Study. Brain Sci 2023; 13:1675. [PMID: 38137123 PMCID: PMC10742256 DOI: 10.3390/brainsci13121675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
This study investigated the effect of concern about falling on neural efficiency during stepping in older people. Community-dwellers aged >65 years were categorised as having low (n = 71) and high (n = 28) concerns about falling based on the Iconographical Falls Efficacy Scale (IconFES 10-item, scores <19 and ≥19, respectively). Participants performed a choice stepping reaction time test (CSRT), an inhibitory CSRT (iCSRT), and a Stroop stepping test (SST)) on a computerised step mat. Cortical activity was recorded using functional near-infrared spectroscopy. There were no significant differences in stepping response times or cortical activity in the dorsolateral prefrontal cortex (DLPFC), supplementary motor area (SMA), and premotor cortex (PMC) between those with and without concern about falling. However, stepping response times and cortical activity in the PFC, SMA, and PMC were significantly higher in the SST compared with the CSRT in the whole sample. PMC activity was also higher in the SST compared to the iCSRT. These findings demonstrate that cortical activity is higher in cognitively demanding stepping tasks that require selective attention and inhibition in healthy older people. The lack of association between concern about falling and neural efficiency during stepping in this older sample may reflect their only moderate scores on the IconFES.
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Affiliation(s)
- Carmen Tung
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia; (C.T.); (S.R.L.); (P.H.S.P.); (D.L.S.)
| | - Stephen Ronald Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia; (C.T.); (S.R.L.); (P.H.S.P.); (D.L.S.)
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Paulo Henrique Silva Pelicioni
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia; (C.T.); (S.R.L.); (P.H.S.P.); (D.L.S.)
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Daina Louise Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia; (C.T.); (S.R.L.); (P.H.S.P.); (D.L.S.)
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia
- Ageing Future Institute, University of New South Wales, Kensington, NSW 2052, Australia
| | - Jasmine Charlotte Christiane Menant
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia; (C.T.); (S.R.L.); (P.H.S.P.); (D.L.S.)
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia
- Ageing Future Institute, University of New South Wales, Kensington, NSW 2052, Australia
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Jehu DA, Skelton DA. The measurement and reporting of falls: Recommendations for research and practice on defining faller types. J Frailty Sarcopenia Falls 2023; 8:200-203. [PMID: 38046444 PMCID: PMC10690127 DOI: 10.22540/jfsf-08-200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
- Deborah A. Jehu
- Department of Community & Behavioral Health Sciences, Institute of Public and Preventative Health, Augusta University, Augusta, Georgia, USA
| | - Dawn A. Skelton
- Department of Physiotherapy and Paramedicine, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
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Najafpour Z, Arab M, Rashidian A, Shayanfard K, Yaseri M, Biparva-Haghighi S. A Stepped-Wedge Cluster-Randomized Controlled Trial of Multi-interventional Approach for Fall Prevention. Qual Manag Health Care 2023:00019514-990000000-00066. [PMID: 38031258 DOI: 10.1097/qmh.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Falls are one of the most common adverse events at hospitals that may result in injury and even death. They are also associated with raised length of stay (LOS) and hospitalization costs. This experiment aimed to examine the effectiveness of multiple interventions in reducing inpatient fall rates and the consequent injuries. METHODS The present study was a stepped-wedge cluster-randomized controlled trial. It was done in 18 units in a public university hospital over 36 weeks. Patients included in this research were at risk of falls. Overall, 33 856 patients were admitted, of whom 4766 were considered high-risk patients. During the intervention phases, a series of preventive and control measures were considered, namely staff training; patient education; placement of nursing call bells; adequate lighting; supervision of high-risk patients during transmission and handovers; mobility device allocation; placement of call bell and safe guard in bathrooms; placing "fall alert" signs above patients' beds; nurses informing physicians timely about complications such as delirium and hypoxia; encouraging appropriate use of eyeglasses, hearing aids and footwear; keeping side rails up; and reassessing patients after each fall. The primary outcome was participant falls per 1000 patient-days. Secondary outcomes were fall-related injuries and LOS. RESULTS The results revealed a decrease in fall rate (n = 4 per 1000 patient-days vs 1.34 per 1000 patient-days, incidence rate ratio (IRR) = 0.19 [95% confidence interval (CI), 0.14-0.26]; P = .001) and injuries (n = 2.4 per 1000 patient-days vs 0.79 per 1000 patient-days, IRR = 0.22 [95% CI, 0.15-0.32]; P = .001) in exposed compared with unexposed phases. There was not a significant difference in LOS (exposed mean 10.63 days [95% CI, 10.26-10.97], unexposed mean 10.84 days [95% CI, 10.59-11.09], mean difference = -0.13 [95% CI, -0.53 to 0.27], P = .52). CONCLUSIONS This multi-interventional trial showed a reduction in falls and fall rates with injury but without an overall effect on LOS. Further research is needed to understand the sustainability of multiple fall prevention strategies in hospitals and their long-term impacts.
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Affiliation(s)
- Zhila Najafpour
- Department of Health Care Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Dr Najafpour); School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (Drs Arab and Rashidian); University of Luxembourg, Luxembourg (Dr Shayanfard); Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Yaseri); and Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Dr Biparva-Haghighi)
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Lenouvel E, Ullrich P, Siemens W, Dallmeier D, Denkinger M, Kienle G, Zijlstra GAR, Hauer K, Klöppel S. Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community. Cochrane Database Syst Rev 2023; 11:CD014666. [PMID: 37965937 PMCID: PMC10646947 DOI: 10.1002/14651858.cd014666.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Fear of falling (FoF) is a lasting concern about falling that leads to an individual avoiding activities that he/she remains capable of performing. It is a common condition amongst older adults and may occur independently of previous falls. Cognitive behavioural therapy (CBT), a talking therapy that helps change dysfunctional thoughts and behaviour, with and without exercise, may reduce FoF, for example, by reducing catastrophic thoughts related to falls, and modifying dysfunctional behaviour. OBJECTIVES To assess the benefits and harms of CBT for reducing FoF in older people living in the community, and to assess the effects of interventions where CBT is used in combination with exercise. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1, 2023), MEDLINE Ovid (from 1946 to 11 January 2023), Embase Ovid (from 1980 to 11 January 2023), CINAHL Plus (Cumulative Index to Nursing and Allied Health Literature) (from 1982 to 11 January 2023), PsycINFO (from 1967 to 11 January 2023), and AMED (Allied and Complementary Medicine from 1985 to 11 January 2023). We handsearched reference lists and consulted experts for identifying additional studies. SELECTION CRITERIA This review included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs assessing CBT with and without exercise interventions compared to control groups with sham-treatment, or treatment as usual. We defined CBT as a collaborative, time-limited, goal-oriented, and structured form of speaking therapy. Included studies recruited community-dwelling older adults, with a mean population age of at least 60 years minus one standard deviation, and not defined by a specific medical condition. DATA COLLECTION AND ANALYSIS Two review authors used standard methodological procedures expected by Cochrane. For continuous data, as assessed by single- or multiple-item questionnaires, we report the mean difference (MD) with 95% confidence interval (CI) when studies used the same outcome measures, and standardised mean difference (SMD) when studies used different measures for the same clinical outcome. For dichotomous outcomes, we reported the treatment effects as risk ratios (RR) with 95% CIs. We measured the primary outcome, FoF, immediately, up to, and more than six months after the intervention. We analysed secondary outcomes of activity avoidance, occurrence of falls, depression, and quality of life when measured immediately after the intervention. We assessed risk of bias for each included study, using the GRADE approach to assess the certainty of evidence. MAIN RESULTS We selected 12 studies for this review, with 11 studies included for quantitative synthesis. One study could not be included due to missing information. Of the 11 individual studies, two studies provided two comparisons, which resulted in 13 comparisons. Eight studies were RCTs, and four studies were cluster-RCTs. Two studies had multiple arms (CBT only and CBT with exercise) that fulfilled the inclusion criteria. The primary aim of 10 studies was to reduce FoF. The 11 included studies for quantitative synthesis involved 2357 participants, with mean ages between 73 and 83 years. Study total sample sizes varied from 42 to 540 participants. Of the 13 comparisons, three investigated CBT-only interventions while 10 investigated CBT with exercise. Intervention duration varied between six and 156 hours, at a frequency between three times a week and monthly over an eight- to 48-week period. Most interventions were delivered in groups of between five and 10 participants, and, in one study, up to 25 participants. Included studies had considerable heterogeneity, used different questionnaires, and had high risks of bias. CBT interventions with and without exercise probably improve FoF immediately after the intervention (SMD -0.23, 95% CI -0.36 to -0.11; 11 studies, 2357 participants; moderate-certainty evidence). The sensitivity analyses did not change the intervention effect significantly. Effects of CBT with or without exercise on FoF may be sustained up to six months after the intervention (SMD -0.24, 95% CI -0.41 to -0.07; 8 studies, 1784 participants; very low-certainty evidence). CBT with or without exercise interventions for FoF probably sustains improvements beyond six months (SMD -0.28, 95% CI -0.40 to -0.15; 5 studies, 1185 participants; moderate-certainty of evidence). CBT interventions for reducing FoF may reduce activity avoidance (MD -2.57, 95% CI -4.67 to -0.47; 1 study, 312 participants; low-certainty evidence), and level of depression (SMD -0.41, 95% CI -0.60 to -0.21; 2 studies, 404 participants; low-certainty evidence). We are uncertain whether CBT interventions reduce the occurrence of falls (RR 0.96, 95% CI 0.66 to 1.39; 5 studies, 1119 participants; very low-certainty evidence). All studies had a serious risk of bias, due to performance bias, and at least an unclear risk of detection bias, as participants and assessors could not be blinded due to the nature of the intervention. Downgrading of certainty of evidence also occurred due to heterogeneity between studies, and imprecision, owing to limited sample size of some studies. There was no reporting bias suspected for any article. No studies reported adverse effects due to their interventions. AUTHORS' CONCLUSIONS CBT with and without exercise interventions probably reduces FoF in older people living in the community immediately after the intervention (moderate-certainty evidence). The improvements may be sustained during the period up to six months after intervention (low-certainty evidence), and probably are sustained beyond six months (moderate-certainty evidence). Further studies are needed to improve the certainty of evidence for sustainability of FoF effects up to six months. Of the secondary outcomes, we are uncertain whether CBT interventions for FoF reduce the occurrence of falls (very low-certainty evidence). However, CBT interventions for reducing FoF may reduce the level of activity avoidance, and may reduce depression (low-certainty evidence). No studies reported adverse effects. Future studies could investigate different populations (e.g. nursing home residents or people with comorbidities), intervention characteristics (e.g. duration), or comparisons (e.g. CBT versus exercise), investigate adverse effects of the interventions, and add outcomes (e.g. gait analysis). Future systematic reviews could search specifically for secondary outcomes.
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Affiliation(s)
- Eric Lenouvel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern (UPD), Bern, Switzerland
- Graduate School for Health Science, University of Bern, Bern, Switzerland
| | - Phoebe Ullrich
- Geriatrisches Zentrum am Universitätsklinikum Heidelberg, AGAPLESION Bethanien Krankenhaus, Heidelberg, Germany
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany
| | - Waldemar Siemens
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Dhayana Dallmeier
- AGAPLESION Bethesda Clinic Ulm, Research Unit on Ageing, Ulm, Germany
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Michael Denkinger
- Institute for Geriatric Research, University of Ulm Medical Center, Ulm, Germany
- AGAPLESION Bethesda Clinic Ulm, Geriatric Centre Ulm/Alb-Donau, Ulm, Germany
| | - Gunver Kienle
- Department of Medicine II, Medical Center, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - G A Rixt Zijlstra
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, Netherlands
- Public Health Service Flevoland (GGD Flevoland), Department of Health Policy & Research, Lelystad, Netherlands, Netherlands
- Health Care and Social Work Division, Windesheim University of Applied Sciences, Almere The Netherlands, Netherlands
| | - Klaus Hauer
- Geriatrisches Zentrum am Universitätsklinikum Heidelberg, AGAPLESION Bethanien Krankenhaus, Heidelberg, Germany
- Robert Bosch Gesellschaft für Medizinische Forschung mbH, Stuttgart, Germany
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern (UPD), Bern, Switzerland
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Alshehre YM, Almutairi SM. Prevalence of falls among adult mothers in Saudi Arabia: a cross-sectional study. BMC Womens Health 2023; 23:587. [PMID: 37946121 PMCID: PMC10636813 DOI: 10.1186/s12905-023-02760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The prevalence of falls among mothers (18-49 years old) in Saudi Arabia has been overlooked and understudied. Therefore, the study aimed to identify the 1-year prevalence, rate of falls, and consequent injuries among mothers in Saudi Arabia. METHODS In this cross-sectional study, a self-administered online questionnaire, including sociodemographic data and questions related to the history of falls and consequent injuries during the past 12 months, was disseminated through social media in Saudi Arabia. RESULTS A convenience sample of 986 mothers were voluntarily recruited for this study with a median age of 33 years and an interquartile range of 10 years. The 1-year prevalence of falls among mothers was 14.1 % (n = 139), and 52.5 % (n = 73/139) of the fallers experienced more than one fall. Among mothers who had experienced a fall, 25.4 % (n = 33/139) experienced a fall incident during pregnancy. The reported consequences of falls were pain in 37.4 % (n = 52/139), muscle and ligament injuries in 7.2 % (n = 10/139), and fractures in 2.2 % (n = 3/139) of participants. The study's findings indicate that asthma and high cholesterol level predicts the risk of falls in mothers. CONCLUSIONS According to our convenience sampling, 14.1% of mothers had experienced one or more falls in the past 12 months. The increased prevalence of falls among this age group of women supports the idea that falls are not only an issue for the older adult population, but fall prevention strategies for this age range are also needed.
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Affiliation(s)
- Yousef M Alshehre
- Department of Physiotherapy, Faculty of Applied Medical Sciences, University of Tabuk, 71491 University of Tabuk, Tabuk, 47713, Saudi Arabia.
| | - Sattam M Almutairi
- Physiotherapy Department, College of Medical Rehabilitation Science, Qassim University, Buraydah, Saudi Arabia
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Jacob L, Kostev K, Shin JI, Smith L, Oh H, Abduljabbar AS, Haro JM, Koyanagi A. Falls increase the risk for incident anxiety and depressive symptoms among adults aged ≥50 years: An analysis of the Irish longitudinal study on ageing. Arch Gerontol Geriatr 2023; 114:105098. [PMID: 37315378 DOI: 10.1016/j.archger.2023.105098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Little is known about the potential impact of falls on the onset of common mental disorders in older adults. Thus, we aimed to investigate the longitudinal association between falls and incident anxiety and depressive symptoms in adults aged ≥50 years living in Ireland. METHODS Data from the Irish Longitudinal Study on Ageing were analyzed (Wave 1: 2009-2011; and Wave 2: 2012-2013). The presence of falls and injurious falls in the past 12 months was assessed at Wave 1. Anxiety and depressive symptoms were assessed at Wave 1 and Wave 2 using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A) and the 20-item Center for Epidemiologic Studies Depression (CES-D), respectively. Covariates included sex, age, education, marital status, disability, and the number of chronic physical conditions. The association of falls at baseline with incident anxiety and depressive symptoms at follow-up was estimated by multivariable logistic regression. RESULTS This study included 6,862 individuals (51.5% women; mean [SD] age 63.1 [8.9] years). After adjusting for covariates, falls were significantly associated with anxiety (OR = 1.58, 95%CI = 1.06-2.35) and depressive symptoms (OR = 1.43, 95%CI = 1.06-1.92). These associations were no longer significant after including fear of falling in the models. Similar findings were obtained for injurious falls, although the relationship with anxiety symptoms was not statistically significant. CONCLUSIONS This prospective study of older adults from Ireland found significant associations between falls and incident anxiety and depressive symptoms. Future research may focus on whether interventions to reduce fear of falling could also alleviate anxiety and depressive symptoms.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, Université Paris Cité, Paris, France.
| | - Karel Kostev
- Philipps University of Marburg, Marburg, Germany
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, United States of America
| | | | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; King Saud University, Riyadh, Saudi Arabia
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys 23, Barcelona, Spain
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Fang Y, Lerner ZF. How Adaptive Ankle Exoskeleton Assistance Affects Stability During Perturbed and Unperturbed Walking in the Elderly. Ann Biomed Eng 2023; 51:2606-2616. [PMID: 37452214 DOI: 10.1007/s10439-023-03310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Slowing the decline in walking mobility in the elderly is critical for maintaining the quality of life. Wearable assistive devices may 1 day facilitate mobility in older adults; however, we need to ensure that such devices do not impair stability in this population that is predisposed to fall-related injuries. This study sought to quantify the effects of untethered ankle exoskeleton assistance on measures of stability, whole-body dynamics, and strategies to maintain balance during normal and perturbed walking in older adults. Eight healthy participants (69-84 years) completed a treadmill-based walking protocol that included perturbations from unexpected belt accelerations while participants walked with and without ankle exoskeleton assistance. Exoskeleton assistance increased frontal plane range of angular momentum (8-14%, p ≤ 0.007), step width (18-34%, p ≤ 0.006), and ankle co-contraction (21-29%, p ≤ 0.039), and decreased biological ankle moment (16-27%, p ≤ 0.001) during unperturbed and perturbed walking; it did not affect the anteroposterior margin-of-stability, step length, trunk variability, or soleus activity during unperturbed and perturbed walking. Our finding that ankle exoskeleton assistance did not affect the anteroposterior margin-of-stability supports additional investigation of assistive exoskeletons for walking assistance in the elderly.
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Affiliation(s)
- Ying Fang
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, 86011, USA
- Department of Physical Therapy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA
| | - Zachary F Lerner
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, 86011, USA.
- Department of Orthopedics, The University of Arizona College of Medicine-Phoenix, Phoenix, AZ, 85004, USA.
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Kolpashnikova K, Harris LR, Desai S. Fear of falling: Scoping review and topic analysis using natural language processing. PLoS One 2023; 18:e0293554. [PMID: 37906616 PMCID: PMC10617702 DOI: 10.1371/journal.pone.0293554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/13/2023] [Indexed: 11/02/2023] Open
Abstract
Fear of falling (FoF) is a major concern among older adults and is associated with negative outcomes, such as decreased quality of life and increased risk of falls. Despite several systematic reviews conducted on various specific domains of FoF and its related interventions, the research area has only been minimally covered by scoping reviews, and a comprehensive scoping review mapping the range and scope of the research area is still lacking. This review aims to provide such a comprehensive investigation of the existing literature and identify main topics, gaps in the literature, and potential opportunities for bridging different strains of research. Using the PRISMA-ScR guidelines, we searched the Cochrane Database of Systematic Reviews, CINAHL, Embase, MEDLINE, PsycInfo, Scopus, and Web of Science databases. Following the screening process, 969 titles and abstracts were chosen for the review. Pre-processing steps included stop word removal, stemming, and term frequency-inverse document frequency vectorization. Using the Non-negative Matrix Factorization algorithm, we identified seven main topics and created a conceptual mapping of FoF research. The analysis also revealed that most studies focused on physical health-related factors, particularly balance and gait, with less attention paid to cognitive, psychological, social, and environmental factors. Moreover, more research could be done on demographic factors beyond gender and age with an interdisciplinary collaboration with social sciences. The review highlights the need for more nuanced and comprehensive understanding of FoF and calls for more research on less studied areas.
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Affiliation(s)
| | | | - Shital Desai
- Social and Technological Systems Lab, York University, Toronto, Ontario, Canada
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Chen Y, Du H, Song M, Liu T, Ge P, Xu Y, Pi H. Relationship between fear of falling and fall risk among older patients with stroke: a structural equation modeling. BMC Geriatr 2023; 23:647. [PMID: 37821821 PMCID: PMC10568824 DOI: 10.1186/s12877-023-04298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/08/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND With reduced balance and mobility, older patients with stroke are more susceptible to fear of falling (FOF). A maladaptive form of FOF can cause excessive activity restriction, poor balance, and recurrent falls, forming a self-reinforcing vicious cycle. This study applied and adapted the FOF model to investigate the interaction between FOF and fall risk in older stroke patients. METHODS A cross-sectional study was conducted among 302 older stroke patients aged 60 and over. All participants were invited to complete the FOF, fall risk, physical activity, and balance tests, which were measured by the Falls Efficacy Scale International (FES-I), Self-Rated Fall Risk Questionnaire (FRQ), the long-form International Physical Activity Questionnaire (IPAQ-LF) and the Four-Stage Balance Test (FSBT) respectively. Data were analyzed using structural equation modeling. RESULTS The mean age of the respondents was 68.62 ± 7.62 years; 8.94% reported a high level of FOF, and 18.21% reported a moderate level of FOF. The structural equation model showed that FOF was directly associated with fall risk (β=-0.38, p < 0.001), and was indirectly associated with fall risk via physical activity (β=-0.075, p < 0.05) and balance ability (β=-0.123, p < 0.05). Depression (β=-0.47, p < 0.001), fall history (β=-0.13, p < 0.05), and female sex (β=-0.16, p < 0.05) affected FOF, while anxiety was not associated with FOF. CONCLUSIONS The increased risk of falling in older stroke patients results from a maladaptive FOF affected by depression, fall history, poor balance ability, and limited physical activity. Our results suggest that greater attention should be paid to FOF during stroke recovery and fall prevention. A multifaced intervention program encompassing physiological and psychological factors should be designed to address FOF and prevent falls.
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Affiliation(s)
- Yuanyuan Chen
- Medical School of Chinese PLA, Beijing, People's Republic of China
- Department of Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hui Du
- Department of Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Mi Song
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Ting Liu
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Pei Ge
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Yue Xu
- Department of Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hongying Pi
- Medical Service Training Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, People's Republic of China.
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Percy D, Phillips T, Torres F, Chaleunphonh M, Sung P. Effectiveness of virtual reality-based balance and gait in older adults with fear of movement: A systematic review and meta-analysis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e2037. [PMID: 37427539 DOI: 10.1002/pri.2037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE To summarize the current evidence from randomized controlled trials (RCTs) regarding the effectiveness of Virtual Reality (VR) training and functional mobility in older adults with fear of movement. TYPE: Systematic review and meta-analysis of randomized clinical trials. METHODOLOGY An electronic search was performed using PubMed, Embase, Medline, SPORTDiscus, Scopus, and CINAHL. A data search from January 2015 to December 2022 and a manual electronic literature search were conducted to identify published RCTs. The effectiveness of VR-based balance training for balance and gait was evaluated in older adults with a fear of movement, which was measured by the Timed Up and Go (TUG) test and the Falls Efficacy Scale (FES). Three reviewers independently performed the study selection, and the quality assessment of the included studies was performed using the Physiotherapy Evidence Database (PEDro) scale. The reporting was based on the new Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. SYNTHESIS The search product produced 345 results, from which 23 full text articles were studied. Seven RCTs of good methodological quality, including 265 participants, were included in the review. Overall, the studies reported that VR had a significant improvement on the TUG (Cohen's d = -0.91 [-1.38; -0.44], p = 0.001), while the FES was not significantly different (Cohen's d = -0.54 [-1.80; 0.71] p = 0.40). The average for PEDro scores (6.14) was good, and the risk of bias revealed that more than one-third of the studies correctly described the random sequence generation and allocation concealment procedures. CONCLUSION VR-based training is effective on balance or gait training based on the TUG; however, there were mixed results to improve FES scores following VR intervention. These inconsistent results might be limited due to variations in the studies, including heterogeneous training paradigms, sensitive outcome measures, small sample sizes, and short intervention durations, which limit the validity of our findings. Future investigations should compare different VR protocols to help establish better guidelines for clinicians.
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Affiliation(s)
- David Percy
- Department of Physical Therapy, School of Nursing and Health Sciences, Indiana Wesleyan University, Marion, Indiana, USA
| | - Tyler Phillips
- Department of Physical Therapy, School of Nursing and Health Sciences, Indiana Wesleyan University, Marion, Indiana, USA
| | - Fabian Torres
- Department of Physical Therapy, School of Nursing and Health Sciences, Indiana Wesleyan University, Marion, Indiana, USA
| | - Michele Chaleunphonh
- Department of Occupational Therapy, School of Nursing and Health Sciences, Indiana Wesleyan University, Marion, Indiana, USA
| | - Paul Sung
- Department of Physical Therapy, School of Nursing and Health Sciences, Indiana Wesleyan University, Marion, Indiana, USA
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Yu J, Wu J, Lu J, Wei X, Zheng K, Liu B, Xiao W, Shi Q, Xiong L, Ren Z. Efficacy of virtual reality training on motor performance, activity of daily living, and quality of life in patients with Parkinson's disease: an umbrella review comprising meta-analyses of randomized controlled trials. J Neuroeng Rehabil 2023; 20:133. [PMID: 37777748 PMCID: PMC10544145 DOI: 10.1186/s12984-023-01256-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVE There are several meta-analyses of randomized controlled trials (RCTs) demonstrating the benefits of virtual reality (VR) training as an intervention for motor performance, activity of daily living (ADL) and quality of life (QoL) outcomes in patients with Parkinson's disease (PD). However, the aggregate evidence collected to date has not been thoroughly evaluated for strength, quality, and reproducibility. An umbrella review from published meta-analyses of RCTs was conducted to evaluate the strength and quality of existing evidence regarding the efficacy of VR training in improving the motor performance, ADL and QoL outcomes of patients with PD. METHODS PubMed, PsychInfo, Web of Science, and Scopus were searched to identify relevant meta-analysis of RCTs examining the effects of VR training on motor performance and quality of life outcomes in PD patients. We recalculated the effect sizes (Hedges'g) for VR training using DerSimonian and Laird (DL) random effects models. We further assessed between-study heterogeneity, prediction interval (PI), publication bias, small-size studies, and whether the results of the observed positive studies were better than would be expected by chance. Based on these calculations, the quality of evidence for each outcome was assessed by using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. RESULTS Four meta-analysis with eight outcomes included in the umbrella review was recalculated effect size. Pooled results found VR training can large improve the basic balance ability, moderate improve the overall balance capacity and moderate improve the stride length in PD patients. For ADL and QoL, the effect sizes were pooled that suggested VR training can moderate improve ADL and QoL for PD patients. However, no statistically clear evidence was found in walking speed, motor function and gait function during VR training. The analyzed meta-analyses showed low-to-moderate methodological quality (AMSTAR2) as well as presented evidence of moderate-to-very low quality (GRADE). Tow adverse reactions were reported in the included meta-analyses. CONCLUSIONS In this umbrella review, a beneficial correlation between VR and balance ability, stride length, ADL and QoL in PD patients was discovered, especially for the very positive effect of VR on balance because of two of the eight outcomes related to balance ability showed large effect size. The observations were accompanied by moderate- to very low-quality rating evidence, supporting VR training as a practical approach to rehabilitation.
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Affiliation(s)
- Jingxuan Yu
- College of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Jinlong Wu
- College of Physical Education, Southwest University, Chongqing, 400000, China
| | - Jiancong Lu
- Department of Neurology, Foshan First People's Hospital, Foshan, 528000, China
| | - Xijun Wei
- Department of Rehabilitation Medicine, Shenzhen Hospital of Southern Medical University, Shenzhen, 518101, China
| | - Kangyong Zheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, 999077, China
| | - Bowen Liu
- College of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Wen Xiao
- College of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Qiuqiong Shi
- Laboratory for Artificial Intelligence in Design, Hong Kong, 999077, China
| | - Lilin Xiong
- College of Physical Education, Kookmin University, Seoul, 02707, South Korea
| | - Zhanbing Ren
- College of Physical Education, Shenzhen University, Shenzhen, 518060, China.
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Pitluk Barash M, Elboim-Gabyzon M, Shuper Engelhard E. Investigating the emotional content of older adults engaging in a fall prevention exercise program integrated with dance movement therapy: a preliminary study. Front Psychol 2023; 14:1260299. [PMID: 37790228 PMCID: PMC10543662 DOI: 10.3389/fpsyg.2023.1260299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Fall prevention interventions for older adults have primarily focused on the physical aspects, overlooking the emotional aspects inherent in falls. This qualitative study presents a novel fall prevention intervention that integrates physical therapy exercise (PTE) based on the Otago Exercise Program with Dance Movement Therapy (DMT) to address the emotional experience during PTE. The aim of this study is to explore the emotional content expressed by older adults during balance-focused exercises and the unique emotional content expressions following the PTE + DMT intervention compared to the PTE intervention. Eleven older adults (aged 81-91 years) from a day center were randomly assigned to either the PTE + DMT group (n = 6) or the PTE group (n = 5). Interpretative phenomenological analysis of the instructors' observations and process diary identified three themes that emerged during the sessions: (1) self-image and self-worth, (2) the individual in relation to others, and (3) past memories. These themes highlight both similarities and differences between the groups. These findings provide valuable insights into the emotional experiences encountered by older adults, particularly in the context of falls prevention practices. Recognizing, understanding, and facilitating the expression of these experiences can enhance the effectiveness of fall prevention interventions and contribute to the overall health of older adults.
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Affiliation(s)
- Michal Pitluk Barash
- The Graduate School of Creative Art Therapies, Faculty of Humanities & Social Sciences, Kibbutzim College of Education, Tel Aviv, Israel
- The Graduate School of Creative Art Therapies, Faculty of Social Welfare & Health Sciences, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa, Israel
| | - Michal Elboim-Gabyzon
- Physical Therapy Department, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Einat Shuper Engelhard
- The Graduate School of Creative Art Therapies, Faculty of Humanities & Social Sciences, Kibbutzim College of Education, Tel Aviv, Israel
- The Graduate School of Creative Art Therapies, Faculty of Social Welfare & Health Sciences, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa, Israel
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Portlock GE, Smith MD, van Poelgeest EP, Welsh TJ. Therapeutic dilemmas: cognitive enhancers and risk of falling in older adults-a clinical review. Eur Geriatr Med 2023; 14:721-732. [PMID: 37418063 PMCID: PMC10447592 DOI: 10.1007/s41999-023-00821-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/14/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Cognitive enhancers are the primary pharmacological therapy prescribed to those with dementia, comprising of memantine and the acetylcholinesterase inhibitors (AChEIs). The long-term cognitive and behavioural benefits of these medications, as well as their potential contribution to falls is currently debated, with recent Delphi studies being unable to reach consensus on whether these medications should be deprescribed. In this narrative clinical review, as part of a series on deprescribing in people at risk of falls, we explore the potential falls-related side effects experienced in people taking cognitive enhancers, alongside situations where deprescribing may be appropriate. METHODS We undertook a literature search of PubMed and Google Scholar, using terms capturing falls and cognitive enhancers, as well as consulting the British National Formulary and published Summary of Medicinal Product Characteristics. These searches informed the subsequent clinical review. RESULTS Cognitive enhancers should be subject to regular review, including confirmation of appropriate treatment indication, and occurrence of side effects in the context of falls. AChEIs, in particular, are associated with a broad range of side effects that can contribute to increased falls risk. These include bradycardia, syncope and neuromuscular effects. Where these have been identified, deprescribing should be considered, as well as alternative treatment options. Deprescribing studies have shown mixed results, likely due to considerable methodological heterogeneity. Several suggested guidelines exist to aid deprescribing decisions, many of which are highlighted in this review. CONCLUSIONS The use of cognitive enhancers should be regularly reviewed and decisions to deprescribe made on a case-by-case basis, considering both the risks and benefits of stopping these medications.
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Affiliation(s)
| | - Matthew D Smith
- Bristol Medical School, University of Bristol, Bristol, UK
- The Research Institute for the Care of Older People (RICE), The RICE Centre Royal United Hospital, Combe Park, Bath, BA1 3NG, UK
| | | | - Tomas James Welsh
- Bristol Medical School, University of Bristol, Bristol, UK.
- The Research Institute for the Care of Older People (RICE), The RICE Centre Royal United Hospital, Combe Park, Bath, BA1 3NG, UK.
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
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Takahashi H, Inukai Y, Miyaguchi S, Otsuru N, Kawakami S, Onishi H. Effects of noisy galvanic vestibular stimulation on functional reach test. Neurosci Lett 2023; 810:137336. [PMID: 37315733 DOI: 10.1016/j.neulet.2023.137336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/16/2023]
Abstract
Balance disorders are a risk factor for falls in older individuals, and an increased center of pressure (COP) sway path length during standing and decreased reach distance in the functional reach test (FRT) predispose them to falls. Reportedly, noisy galvanic vestibular stimulation (nGVS) reduces COP sway path length during standing in young and community-dwelling older individuals and suggested to be a promising approach to improve balance function. However, the effect of nGVS on FRT remains unclear. Therefore, this study aimed to clarify the effect of nGVS on the FRT reach distance. This study has a cross-over design and included 20 healthy young adults. Interventions under nGVS (stimulation intensity: 0.2 mA) and sham (stimulation intensity: 0 mA) conditions were randomly administered to each participant. The participants underwent COP sway during standing measurements and FRT pre-intervention and post-intervention under each condition, and COP sway path length and the FRT reach distance were calculated. Statistical analysis revealed a significant decrease in post-intervention COP sway path length compared with pre-intervention COP sway path length under the nGVS condition. Conversely, the FRT reach distance remained the same under both nGVS and sham conditions. Thus, nGVS may improve the standing balance function but cannot change the FRT reach distance in healthy young individuals.
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Affiliation(s)
- Hirona Takahashi
- Graduate School, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan.
| | - Yasuto Inukai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata-shi, Niigata 950-3198, Japan.
| | - Shota Miyaguchi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata-shi, Niigata 950-3198, Japan.
| | - Naofumi Otsuru
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata-shi, Niigata 950-3198, Japan.
| | - Saki Kawakami
- Graduate School, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan.
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata-shi, Niigata 950-3198, Japan.
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Lektip C, Chaovalit S, Wattanapisit A, Lapmanee S, Nawarat J, Yaemrattanakul W. Home hazard modification programs for reducing falls in older adults: a systematic review and meta-analysis. PeerJ 2023; 11:e15699. [PMID: 37489124 PMCID: PMC10363339 DOI: 10.7717/peerj.15699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/14/2023] [Indexed: 07/26/2023] Open
Abstract
Objective This study aims to assess the effect of home modification in preventing falls in older adults. Methods A systematic review and meta-analysis of randomized studies were performed. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered prospectively. Five electronic databases were systematically searched for related articles. The titles and abstracts of the articles found using the key search phrases-home modification and falling-were screened using inclusion and exclusion criteria. The Cochrane risk of bias tool was used to evaluate the studies' methodology. Results A total of 12 trials were included. A meta-analysis was conducted using 10 studies with n = 1, 960 participants showing a clinically meaningful 7% reduction in falls (risk ratio = 0.93; 0.87-1). Conclusions Falls can be significantly reduced with the use of home modification interventions that are thorough, well-focused, have an environmental-fit perspective, and have adequate follow-up.
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Affiliation(s)
- Charupa Lektip
- Movement Sciences and Exercise Research Center, Walailak University, Nakhon Si Thammarat, Thailand
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Sirawee Chaovalit
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Apichai Wattanapisit
- School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
- Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | - Sarawut Lapmanee
- Department of Basic Medical Sciences, Faculty of Medicine, Siam University, Bangkok, Thailand
| | - Jiraphat Nawarat
- Movement Sciences and Exercise Research Center, Walailak University, Nakhon Si Thammarat, Thailand
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Weeranan Yaemrattanakul
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Pettersson B, Lundell S, Lundin-Olsson L, Sandlund M. 'Maintaining balance in life'-exploring older adults' long-term engagement in self-managed digital fall prevention exercise. Eur Rev Aging Phys Act 2023; 20:12. [PMID: 37464299 DOI: 10.1186/s11556-023-00322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Accidental falls are one of the greatest threats to older adults' health and well-being. The risk of falling can be significantly reduced with strength and balance interventions. However, there needs to be further knowledge into how older adults can be supported to achieve a maintained exercise behaviour. Therefore, the aim of this study was to explore factors that enabled older adults to maintain their exercise during a 1-year self-managed digital fall prevention exercise intervention. METHODS This study used a grounded theory methodology. Semi-structured individual interviews were conducted by phone or conference call. Eighteen community-dwelling older adults aged 70 years or more participated. The participants had a self-reported exercise dose of 60 min or more per week during the last three months of participation in a 12-months intervention of self-managed digital fall prevention exercise, the Safe Step randomized controlled trial. Open, axial, and selective coding, along with constant comparative analysis, was used to analyze the data. RESULTS The analysis resulted in a theoretical model. We found that the fall prevention exercise habits of adults were developed through three stages: Acting against threats to one's own identity, Coordinating strategies to establish a routine, and Forming habits through cues and evaluation. The main category of Maintaining balance in life encases the participants transition through the three stages and reflects balance in both physical aspects and in between activities in daily life. The process of maintaining balance in life and desire to do so were mediated both by intrinsic person-dependent factors and the Safe Step application acting as an external mediator. CONCLUSION This study identified three stages of how older adults developed self-managed fall prevention exercise habits, supported by a digital application. The generated theoretical model can inform future interventions aiming to support long-term engagement in digitally supported and self-managed fall prevention interventions.
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Affiliation(s)
- Beatrice Pettersson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 90187, Umeå, Sweden.
| | - Sara Lundell
- Department of Sociology, Umeå University, Umeå, Sweden
| | - Lillemor Lundin-Olsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 90187, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 90187, Umeå, Sweden
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Wu KY, Chen DR, Chan CC, Yeh YP, Chen HH. Fear of falling as a mediator in the association between social frailty and health-related quality of life in community-dwelling older adults. BMC Geriatr 2023; 23:421. [PMID: 37430231 DOI: 10.1186/s12877-023-04144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Social frailty is associated with Fear of Falling (FoF) and health-related quality of life (HrQoL). However, how social frailty simultaneously influences FoF and HrQoL remains unclear. The study aims to understand the links between social frailty, FoF, and HrQoL in older adults and the mediating role of FoF in the relations between social frailty and HrQoL. METHODS In this cross-sectional survey, 1,933 community-dwelling older adults from Changhua County, Taiwan, were interviewed using a self-administrated questionnaire. In total, 1,251 participants with complete data were included for analysis. Data were analyzed using the SPSS PROCESS macro. A simple mediation was employed using social frailty as the independent variable, FoF as the mediator variable, and HrQoL as the outcome variable. RESULTS Social frailty was associated with HrQoL and indirectly with HrQoL through FoF, and FoF was directly associated with HrQoL. Of the 5-item social frailty index, "going out less frequently" was correlated with HrQoL and indirectly with HrQoL through FoF. Individuals who felt unhelpful toward family or friends had the worst physical HrQoL and did not talk to someone daily had the most negative influence on mental HrQoL. CONCLUSIONS Social frailty can directly and indirectly, through FoF decrease HrQoL. It also emphasizes the importance of social connectivity in reducing the risk of falls. This study points to the need for social connectivity and fall prevention programs as essential components of strategies to enhance the health and well-being of community-dwelling older adults.
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Affiliation(s)
- Kuan-Ying Wu
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Duan-Rung Chen
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Population Health Research Center, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Chang-Chuan Chan
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Environmental and Occupational Health Science, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yen-Po Yeh
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Changhua County Public Health Bureau, Changhua County, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Gadhvi C, Bean D, Rice D. A systematic review of fear of falling and related constructs after hip fracture: prevalence, measurement, associations with physical function, and interventions. BMC Geriatr 2023; 23:385. [PMID: 37353752 PMCID: PMC10288814 DOI: 10.1186/s12877-023-03855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/28/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Hip fracture is a common and debilitating injury amongst older adults. Fear of falling (FoF) and related constructs (balance confidence and falls efficacy) may impede rehabilitation after hip fracture. An updated systematic review to synthesize existing literature on FoF after hip fracture is needed. This review focussed on four research questions: In the hip fracture population: (1) What is the prevalence of FoF?; (2) What FoF assessment tools are validated? (3) What is the relationship between FoF and physical function?; (4) What interventions are effective for reducing FoF? METHODS A systematic search was undertaken in EBSCO Health, Scopus and PsychINFO in January 2021 (and updated December 2022) for articles on FoF after hip fracture. Data in relation to each research question was extracted and analysed. The quality of the studies was appraised using the 'Risk of Bias Tool for Prevalence Studies', 'COSMIN Risk of Bias checklist for Patient-reported outcome measures', modified version of the 'Appraisal Tool for Cross-sectional studies', and the 'Cochrane Risk of Bias 2' tools for each research question, respectively. RESULTS 36 studies (37 articles) with 5099 participants were included (mean age 80.2 years and average 78% female). Prevalence rates for FoF after hip fracture ranged between 22.5% and 100%, and prevalence tended to decrease as time progressed post hip fracture. The 'Falls Efficacy Scale - International' (FES-I) and 'Fear of Falling Questionnaire - Revised' (FFQ-R) were found to be reliable, internally consistent, and valid tools in hip fracture patients. FoF after hip fracture was consistently associated with measures of physical function including balance, gait speed, composite physical performance measures and self-reported function. Ten of 14 intervention studies were considered high risk of bias. Exercise-based interventions with or without a psychological component were not effective in reducing FoF after hip fracture compared to a control condition. CONCLUSION FoF is prevalent after hip fracture and is consistently associated with poorer physical function. Only two instruments (FES-I and FFQ-R) have been validated for measuring FoF in the hip fracture population. However, there remains a need for larger, higher quality randomised controlled trials targeting FoF after hip fracture in order to guide clinical practice. TRIAL REGISTRATION PROSPERO registration: CRD42020221836.
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Affiliation(s)
- Chandini Gadhvi
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Allied Health - Physiotherapy, Te Whatu Ora Health New Zealand - Te Toka Tumai, Auckland, New Zealand
| | - Debbie Bean
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
- Department of Anaesthesiology & Perioperative Medicine, Te Whatu Ora Health New Zealand - Waitematā, Auckland, New Zealand.
| | - David Rice
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Department of Anaesthesiology & Perioperative Medicine, Te Whatu Ora Health New Zealand - Waitematā, Auckland, New Zealand
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