Experience Using Multi-Technology for Fall Risk Assessments Among Low-Income Community-Dwelling Older Adults With Mild Cognitive Impairment

PURPOSE

To explore the experiences of low-income community-dwelling older adults with mild cognitive impairment (MCI) in using multi-technology.

METHOD

We conducted individual interviews with 14 low-income community-dwelling older adults with MCI aged ≥60 years who participated in a technology-based fall risk assessment study. Interviews were recorded, transcribed, and coded. Two researchers worked together using thematic analysis.

RESULTS

Five themes were generated: Satisfaction With Technology, Benefits of Using Technology, Challenges of Using Technology, Facilitators of Using Technology, and Recommendations for Other Older Adults. All participants acknowledged obtaining information about fall risk, physical activities, and balance performance.

CONCLUSION

Older adults with MCI were able to follow instructions by completing fall risk assessments. They found technology enjoyable and beneficial considering the tracking capacity and feedback obtained from the technology used. These were vital objective data that encouraged fall prevention efforts. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Recreating Fall Risk Appraisal matrix using R to support fall prevention programs

Objective

This study aimed to optimize Fall Risk Appraisal (FRA) graphing for use in intervention programs tailored toward reducing the fall risk of older adults by using computing graphic functions in the R language.

Materials and Methods

We utilized RStudio, a free development environment for the R language, as well as the functions within the "ggplot2" and "grid" packages, to develop a code that would recreate the FRA matrix for use in data visualization and analysis, as well as feedback for older adults.

Results

The developed code successfully recreates the FRA matrix in R and allows researchers and clinicians to graph participant data onto the matrix itself.

Discussion

The use of an R code allows for a streamlined approach to manipulating the FRA matrix for use in data visualization and feedback for older adults, which improves upon the traditional paper-pencil method that has been previously used.

Conclusions

The code presented in this study recreates the FRA matrix instrument in the R language and gives researchers the ability to instantaneously add, remove, or change different aspects of the instrument to improve its readability for researchers and older adults.

Associations between monitor-independent movement summary (MIMS) and fall risk appraisal combining fear of falling and physiological fall risk in community-dwelling older adults

Introduction: Fall Risk Appraisal (FRA), a process that integrates perceived and objective fall risk measures, serves as a crucial component for understanding the incongruence between fear of falling (FOF) and physiological fall risk in older adults. Despite its importance, scant research has been undertaken to investigate how habitual physical activity (PA) levels, quantified in Monitor-Independent Movement Summary (MIMS), vary across FRA categories. MIMS is a device-independent acceleration summary metric that helps standardize data analysis across studies by accounting for discrepancies in raw data among research-grade and consumer devices. Objective: This cross-sectional study explores the associations between MIMS (volume and intensity) and FRA in a sample of older adults in the United States. Methods: We assessed FOF (Short Falls Efficacy Scale-International), physiological fall risk (balance: BTrackS Balance, leg strength: 30-s sit-to-stand test) and 7-day free-living PA (ActiGraph GT9X) in 178 community-dwelling older adults. PA volume was summarized as average daily MIMS (MIMS/day). PA intensity was calculated as peak 30-min MIMS (average of highest 30 non-consecutive MIMS minutes/day), representing a PA index of higher-intensity epochs. FRA categorized participants into following four groups: Rational (low FOF-low physiological fall risk), Irrational (high FOF-low physiological fall risk), Incongruent (low FOF-high physiological fall risk) and Congruent (high FOF-high physiological fall risk). Results: Compared to rational group, average MIMS/day and peak 30-min MIMS were, respectively, 15.8% (p = .025) and 14.0% (p = .004) lower in irrational group, and 16.6% (p = .013) and 17.5% (p < .001) lower in congruent group. No significant differences were detected between incongruent and rational groups. Multiple regression analyses showed that, after adjusting for age, gender, and BMI (reference: rational), only irrational FRA was significantly associated with lower PA volume (β = -1,452.8 MIMS/day, p = .034); whereas irrational and congruent FRAs were significantly associated with lower "peak PA intensity" (irrational: β = -5.40 MIMS/day, p = .007; congruent: β = -5.43 MIMS/day, p = .004). Conclusion: These findings highlight that FOF is a significant barrier for older adults to participate in high-intensity PA, regardless of their balance and strength. Therefore, PA programs for older adults should develop tailored intervention strategies (cognitive reframing, balance and strength exercises, or both) based on an individual's FOF and physiological fall risk.

Comparing Sensitivity, Specificity, and Accuracy of Fall Risk Assessments in Community-Dwelling Older Adults

Purpose

The US Centers for Disease Control and Prevention (CDC) has implemented the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. This initiative provides an algorithm for fall risk screening. However, the algorithm has the potential to overcategorize individuals as high risk for falling upon initial screening, which may burden clinicians with the task of recategorizing individuals after follow-up testing. Therefore, this study aimed to compare the accuracy, sensitivity, and specificity of fall risk appraisal between the STEADI, Short Fall-Efficacy Scale International (FES-I), and portable balance system (BTrackS) assessments in community-dwelling older adults.

Patients and Methods

This cross-sectional analysis included 122 community-dwelling older adults, comprising 94 women and 28 men. Center-of-pressure postural sway was assessed using the BTrackS, fear of falling was assessed using the Short FES-I questionnaire, and all participants completed the STEADI checklist. Each assessment categorized participants as either high or low fall risk and fall risk appraisal was compared between groups using McNemar tests.

Results

The STEADI checklist (high risk: n = 62; low risk: n = 60) significantly differed in fall risk appraisal compared to the BTrackS (high risk: n = 44; low risk: n = 78; p = 0.014) and the Short FES-I (high risk: n = 42; low risk: n = 80; p = 0.002). Compared to the BTrackS, the STEADI checklist had a specificity of 62.8%, sensitivity of 70.5%, and accuracy of 65.6%. Compared to the Short FES-I, the STEADI checklist had a specificity of 67.5%, sensitivity of 81.0%, and accuracy of 72.1%.

Conclusion

The STEADI checklist appears to overcategorize individuals as high fall risk more frequently than direct assessments of postural sway and fear of falling. Further research is needed to examine potential improvements in accuracy when combining the STEADI checklist with direct assessments of postural sway and/or fear of falling.

Higher Dynamic Balance Performance Was Associated With Cognitive Function Among U.S. Community-Dwelling Low-Income Older Adults

Introduction

Multiple studies have reported the association between balance performance and cognitive function among older adults. However, few studies have been conducted in low-income settings.

Objectives

This cross-sectional study examined the relationships of dynamic and static balance with cognitive function in community-dwelling low-income older adults in Orlando, Florida.

Methods

Dynamic balance was assessed with a Short Physical Performance Battery (SPPB) and static balance with BTracks Balance System. Rowland Universal Dementia Assessment Scale (RUDAS) assessed cognition and Patient Health Questionnaire-9 assessed depressive symptoms.

Results

Multiple regression analysis showed dynamic balance was significantly associated with cognition, but static balance was not, controlling for depressive symptoms (N = 89, M age  = 72.70, SD ± 6.95; females = 79). Specifically, higher dynamic balance was associated with better cognitive function. Cognitively healthy participants (RUDAS scores ≥23) scored 2.526 points higher in SPPB than those with possible cognitive impairment (RUDAS scores <23).

Conclusions

Findings provide the evidence to suggest dynamic balance and cognitive function health disparities affecting older adults from low-income community. By implication, dynamic balance and cognitive function should be part of routine screening with older adults living in low-income communities.

The willingness to continue using wearable devices among the elderly: SEM and FsQCA analysis

BACKGROUND

With population aging and the scarcity of resources for elderly individuals, wearable devices pose opportunities and challenges for elderly care institutions. However, few studies have examined the effects of technical characteristics, personal characteristics, and health promotion on the willingness of elderly individuals to continue using wearable devices.

OBJECTIVE

This study explored the effects of technical characteristics and personal characteristics on the willingness of elderly individuals to continue using wearable devices through health promotion, drawing on the technology acceptance model and the value attitude behaviour model.

METHODS

We obtained 265 valid samples through questionnaire surveys and used structural equation modelling (SEM) and fuzzy set qualitative comparative analysis (FsQCA) to clarify the complex causal patterns of elderly people's willingness to continue using wearable devices.

RESULTS

The SEM results showed that perceived usefulness, perceived reliability, self-perceived ageing, and health promotion affected willingness to continue using wearable devices. However, perceived ease of use had no effect. FsQCA showed that elderly individuals are highly willing to continue using wearable devices, yielding five solutions. Perceived ageing was essential in four of these solutions. The impact of perceived ease of use on continued use intention was dynamic and complex.

CONCLUSIONS

This study used two methods to provide insight into the willingness of elderly individuals to continue using wearable devices. In addition, this study discussed associated implications, limitations, and future research directions.

Optimizing a Technology-Based Body and Mind Intervention to Prevent Falls and Reduce Health Disparities in Low-Income Populations: Protocol for a Clustered Randomized Controlled Trial

BACKGROUND

The lack of health care coverage, low education, low motivation, and inconvenience remain barriers to participating in fall prevention programs, especially among low-income older adults. Low-income status also contributes to negative aging self-perceptions and is associated with a high perceived barrier to care. Existing fall prevention intervention technologies do not enable participants and practitioners to interact and collaborate, even with technologies that bring viable strategies to maintain independence, prevent disability, and increase access to quality care. Research is also limited on the use of technology to enhance motivation and help individuals align their perception with physiological fall risk. We developed a novel, 8-week Physio-Feedback Exercise Program (PEER), which includes (1) technology-based physio-feedback using a real-time portable innovative technology-the BTrackS Balance Tracking System, which is reliable and affordable, allows for home testing, and provides feedback and tracks balance progression; (2) cognitive reframing using the fall risk appraisal matrix; and (3) peer-led exercises focusing on balance, strength training, and incorporating exercises into daily activities.

OBJECTIVE

This study consists of 3 aims. Aim 1 is to examine the effects of the technology-based PEER intervention on fall risk, dynamic balance, and accelerometer-based physical activity (PA). Aim 2 is to examine the effects of the PEER intervention on fall risk appraisal shifting and negative self-perceptions of aging. Aim 3 is to explore participants' experiences with the PEER intervention and potential barriers to accessing and adopting the technology-based PEER intervention to inform future research.

METHODS

This is an intention-to-treat, single-blinded, parallel, 2-arm clustered randomized controlled trial study. We will collect data from 340 low-income older adults at baseline (T1) and measure outcomes after program completion (T2) and follow-up at 3 months (T3) and 6 months (T4). Participants will be enrolled if they meet all the following inclusion criteria: aged ≥60 years, cognitively intact, and able to stand without assistance. Exclusion criteria were as follows: a medical condition precluding exercise or PA, currently receiving treatment from a rehabilitation facility, plan to move within 1 year, hospitalized >3 times in the past 12 months, and does not speak English or Spanish.

RESULTS

As of August 2023, the enrollment of participants is ongoing.

CONCLUSIONS

This study addresses the public health problem by optimizing a customized, technology-driven approach that can operate in low-resource environments with unlimited users to prevent falls and reduce health disparities in low-income older adults. The PEER is a novel intervention that combines concepts of physio-feedback, cognitive reframing, and peer-led exercise by motivating a shift in self-estimation of fall risk to align with physiological fall risk to improve balance, PA, and negative aging self-perception.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05778604; https://www.clinicaltrials.gov/ct2/show/study/NCT05778604.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51899.

Body composition, fear of falling and balance performance in community-dwelling older adults

Objectives

We aimed to 1) assess body composition using a portable technology, bioelectrical impedance analysis, (BIA) and 2) examine the associations between body composition and the discrepancy of fear of falling (FOF) and balance performance.

Methods

A cross-sectional study included 121 older adults 60 years and older, 78% were female, 41% lived alone, and 71% had no history of falls. The discrepancy between fear of falling and balance performance was categorized into four groups. We found 47% rational (low FOF and normal balance), 19% incongruent (low FOF despite poor balance), 18% irrational (high FOF despite normal balance), and 16% congruent (high FOF and poor balance).

Results

Body Fat Mass (BFM), Percent Body Fat (PBF), and Body Mass Index (BMI) were correlated with fear of falling and balance performance. BMI was significantly different in the rational group (p = 0.004) and incongruent group (p = 0.02) compared to the congruent group. PBF was significantly different between the incongruent (p = 0.002), irrational (p = 0.014), and rational (p < 0.001) groups, compared to the congruent group.

Conclusions

The study found that body BFM, PBF, and BMI were correlated with fear of falling and balance impairment. High Body Mass Index and Body Fat Mass were associated with a discrepancy between FOF and balance. Body composition analysis devices, such as BIA and other portable technologies, could be taken to underserved communities and may help identify community-dwelling older adults who are frail and may be at high risk of falling.

Levels of Accelerometer-Based Physical Activity in Older Adults With a Mismatch Between Physiological Fall Risk and Fear of Falling

We examined the associations between levels of accelerometer-based physical activity and the mismatch of physiological fall risk and fear of falling (FOF) in community-dwelling older adults. We assessed 123 participants who received 7-day wrist-worn accelerometry. Physiological fall risk was assessed using the portable BTrackS™ balance system and FOF was assessed using a short version of the Falls Efficacy Scale-International. Participants were categorized into four groups: rational (low FOF/normal balance), irrational (high FOF/normal balance), incongruent (low FOF/poor balance), and congruent (high FOF/poor balance). One third of older adults had a mismatch between their FOF and actual fall risk. Accelerometer-based moderate to vigorous physical activity (MVPA) was significantly different in the irrational group compared to the rational group (p = 0.023) and the congruent group compared to the rational group (p = 0.032). Encouraging older adults to improve MVPA may prevent them from shifting from rational to irrational or congruent groups, thereby reducing the risk of injurious falls. [Journal of Gerontological Nursing, 49(6), 41-49.].

A Multidimensional Approach for Nurse Practitioners to Screen Fall Risk and Fear of Falling in Community-Dwelling Older Adults

Nurse practitioners are essential in the care of the older adult population. Older adults are at high risk for falls; therefore, nursing assessment should include psychological and physiological measures. Fear of falling is a primary psychological contributor to fall risk. The Falls Efficacy Scale International short; Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths, and Injuries fall risk scale; and Balance Tracking System (BTrackS) balance test are reliable, efficient tools for assessment. Data obtained from these multifactoral tools may inform mobility interventions and education for the patient, further meeting a national safety goal of reducing falls in the older adult population.

Future Nursing Research of Older Adults: Preserving Independence and Reducing Health Disparities

Nursing professionals are at the forefront of primary care and the largest segment of the health workforce, and nurse researchers can bring vital perspectives to aging research and clinical practice. Although healthcare systems are experiencing more work from the aging of populations, unfortunately there are limited nurse researchers trained in gerontological nursing. Future research in older adults needs to be based on the current needs of and for older adults. In this article, I identify potential future research of aspects for older adults by highlighting opportunities and examples to conduct culturally appropriate interventions that aim to reduce health disparities and preserve independence. Because there is a complexity of health issues in older adults, nurse researchers need to pursue the best ways to address their needs, investigate and disseminate technology-based assessments, provide culturally appropriate interventions to promote independence, prevent chronic conditions, and enhance health equality. Nurses and nurse researchers also need to monitor the changes in functional status and health of older adults, especially as the global burden and costs of diseases and disability of this population grows, and to save unnecessary health care expenditure. To create new knowledge and discover best practices in aging care, nurse researchers lead multidisciplinary teams, develop innovative ideas with the potential for significant clinical impact, and use appropriate research approaches that steer to successful grant applications to national funding agencies. It is essential to establish a program for training or mentoring nurse researchers dedicated to caring for older adults, advocating, and disseminating innovative care to maximize the independence of older adults.

Maladaptive Fall Risk Appraisal and Falling in Community-Dwelling Adults Aged 60 and Older: Implications for Screening

OBJECTIVES

We aimed to examine the characteristics of maladaptive fall risk appraisal (FRA), discrepancies between physical and perceived-fall risk, and their associations with falls.

METHODS

Fall risk appraisal was determined using the full-tandem stand test as an objective measure and the Fall Efficacy Scale-International as a subjective measure, and 433 adults aged ≥60 years from Thailand were classified into four groups: irrational (low physical/high perceived risk), incongruent (high physical/low perceived risk), congruent (high physical/high perceived risk) and rational (low physical/low perceived risk) FRAs.

RESULTS

Only 20.8% of adults aged ≥60 years had rational FRA. The rest of the participants had either irrational (57.3%) or incongruent (2.3%), or congruent (19.6%) FRAs. Approximately 74% of those with congruent FRA reported experiencing a fall last year, followed by incongruent (60%), irrational (41.1%), and rational FRAs (27.8%, p < .001). After covariates adjustment, participants with congruent FRA were 3.06 times more likely of falling than those with rational FRA (p = .011).

CONCLUSIONS

Maladaptive FRA is highly prevalent among adults aged ≥60. Identifying maladaptive FRA is essential for ensuring that adults aged ≥60 receiving early treatment associated with falls.

CLINICAL IMPLICATIONS

Preventing a transition from rational to irrational, incongruent, and congruent fall risk appraisals is vital to prevent falls and mitigate this problematic health condition.

A systematic review of factors influencing attitudes towards and intention to use the long-distance caregiving technologies for older adults

PURPOSE

Long-distance caregiving (LDC) technologies play a significant role in enabling distant care and facilitating living-alone older adults to keep socially connected. However, there is scarce research exploring the older adults' attitudes towards and intention to use such technologies. This paper is based on a systematic review of existing literature to explore the multifarious factors influencing independent community-living older adults' attitudes towards and intention to use LDC technologies.

METHODS

Articles published in English between 2006 and 2020 were reviewed by searching electronic databases of PubMed, ProQuest, EBSCOhost. The inclusion criteria were limited to quantitative, qualitative, or mixed-methods studies that involved: 1) distant caregiving; 2) older adults aged 60 years or above, who were living alone or with only their spouse in the community (even though the samples might also involve other non-older adults); 3) technologies including ICT-based devices, systems, or programs enabling data transmission were used; 4), intention to use or behavioral usage in regard to the technologies were reported or discussed.

RESULTS

In total, 41 out of 8674 articles were included. Both determinants and moderators of affecting the use of the ICT-based LDC technologies were identified with theoretical guidance. To summarize, there are personal factors involved, such as personality, concerns regarding security and privacy, health conditions, requisite knowledge, financial conditions, and influence from significant others, encompassing formal and informal caregivers; and factors related to the devices, in terms of their user-friendliness and functionality.

CONCLUSION

This review highlights the importance of striking a good balance between functionality and privacy concerns, besides considering the direct and indirect cost to users. LDC technology education should be promoted at the societal level to facilitate older adults' better understanding of the device utilities by enhancing their technological literacy. Implications for various stakeholders to cope with the challenges of an aging population are also discussed.

Technology-Based Fall Risk Assessments for Older Adults in Low-Income Settings: Protocol for a Cross-sectional Study

Background

One-third of older adults have maladaptive fall risk appraisal (FRA), a condition in which there is a discrepancy between the level of fear of falling (FOF) and physiological fall risk (balance performance). Older adults who overestimate their physiological fall risk and report a high FOF are less likely to participate in physical activity. Limited data suggest that the association among FOF, body composition, and physical activity intensity differs by fear severity.

Objective

This study aims to examine the associations among FRA, body composition, and physical activity using assistive health technology, including the BTrackS balance system, bioelectrical impedance analysis, and activity monitoring devices. This study also aims to examine the feasibility of recruitment and acceptability of technologies and procedures for use among older adults in low-income settings.

Methods

This cross-sectional study will be conducted in older adults’ homes or apartments in low-income settings in Central Florida, United States. Following consent, participants will be contacted, and our team will visit them twice. The first visit includes questionnaire completion (eg, sociodemographic or FOF) and balance performance test using the BTrackS balance system. The participants will be stratified by the FRA matrix. In addition, they will perform hand grip strength and dynamic balance performance tests. Participants will then be asked to wear the ActiGraph GT9X Link wireless activity monitor on the nondominant wrist for 7 consecutive days. The second visit includes body composition testing and a structured interview about the acceptability of the technologies and procedures.

Results

Ethical approval was obtained from the institutional review board of the University of Central Florida (protocol number 2189; September 10, 2020). As of December 2020, participation enrollment is ongoing and the results are expected to be published in Summer 2022.

Conclusions

Accurate FRA is essential for implementing physical activity programs, especially in older adults with low income. This study will provide data for developing technology-based fall risk assessments to improve participation in physical activity, thus enhancing healthy longevity among older adults in low-income settings.

International Registered Report Identifier (IRRID)

PRR1-10.2196/27381

Older Adults' Experiences With the Visual Physio-Feedback Technology and Peer-Led Combined Group and Home-Based Exercises

This study aimed to explore older adults' experience with an in-home Physio-feEdback and Exercise pRogram and explore whether the Physio-feEdback and Exercise pRogram intervention influenced their physical activity adherence. A qualitative study approach was employed, and data were collected using exercise logs, observations, focus groups, and open-ended questions after the program completion. Nineteen participants who engaged in an 8-week Physio-feEdback and Exercise pRogram intervention participated in this study. Thematic analysis was used. Three major concepts of the self-determination theory, including competence, relatedness, and autonomy, were used as guidelines for coding. Results reveal three themes, including: (a) competence-alignment of body and mind and increased awareness about fall risk, (b) relatedness-relationship with peer coach and having fun with friends, and (c) autonomy-integration of exercise into daily activities for staying physically and socially active. Individuals' need for competence and autonomy can be supported by giving physio-feedback, cognitive reframing, and peer-led exercise, which can enhance physical activity and prevent falls.

Physio-Feedback and Exercise Program (PEER) Improves Balance, Muscle Strength, and Fall Risk in Older Adults

A one-group pre/posttest study was conducted to examine the feasibility and effect size of an 8-week physio-feedback and exercise program (PEER) on improving balance, muscle strength, and fall risk. Nineteen participants (mean age = 76 years) received the intervention, which included visual physio-feedback by the BTrackS™ Assess Balance System, cognitive reframing, and a combined group- and home-based exercise program by a trained peer coach. Pre- and post-measurement outcomes were evaluated for balance, handgrip strength, and fall risk. Feasibility was assessed by dropout rate, safety, and adherence to exercise. Significant improvements were noted in dynamic balance (Sit-to-Stand, Timed Up & Go tests), handgrip strength, and fall risk. Participants' attendance was 87.5%, with no fall incidence. The physio-feedback, cognitive reframing, and peer coaching facilitate older adults to align their perceived fall risk with physiological fall risk and motivate them to stay active. PEER intervention is feasible; safe; improves balance, muscle strength, and fall risk; and may enhance activity engagement.

TARGETS

Community-dwelling older adults.

INTERVENTION DESCRIPTION

Provide visual physio-feedback and cognitive reframing based on the fall risk appraisal matrix and participate in combined group- and home-based exercises by a trained peer coach.

MECHANISM OF ACTION

Align perceived and physiological fall risk, peer coaching to exercise.

OUTCOMES

Balance, handgrip strength, fall risk, and activity engagement. [Research in Gerontological Nursing, 13(6), 289-296.].