Short-term changes in protective stepping for lateral balance recovery in older adults

Background

Fall prevention for older adults is dependent on the ability to maintain protective balance. This study measured the short-term changes of protective stepping following waist-pull perturbations in the medio-lateral direction, to identify what, if any, properties of protective stepping are improved with repeated perturbation exposures.

Methods

Sixty waist-pulls (2 directions × 5 intensities × 6 repetitions) from a single session were analyzed separately as early, middle, and late testing periods, for a comparison over time of typical responses. Outcome measures included the number of evoked steps, type of step, incidence of interlimb collisions, and kinematic and kinetic properties of the first step in frequently used crossover-type responses.

Findings

Improvements were evident as significantly reduced number of steps and collisions. However, these improvements could not be completely accounted for by significant changes in first step kinematic or kinetic properties.

Interpretation

We infer that older individuals experiencing repeated lateral waist-pull perturbations optimize the predictive or feed-forward motor control for balance recovery through stepping.     

Leg preference associated with protective stepping responses in older adults

Background

Asymmetries in dynamic balance stability have been previously observed. The goal of this study was to determine whether leg preference influenced the stepping response to a waist-pull perturbation in older adult fallers and non-fallers.

Methods

39 healthy, community-dwelling, older adult (> 65 years) volunteers participated. Participants were grouped into non-faller and faller cohorts based on fall history in the 12 months prior to the study. Participants received 60 lateral waist-pull perturbations of varying magnitude towards their preferred and non-preferred sides during quiet standing. Outcome measures included balance tolerance limit, number of recovery steps taken and type of recovery step taken for perturbations to each side.

Findings

No significant differences in balance tolerance limit (P ≥ 0.102) or number of recovery steps taken (η²_partial ≤ 0.027; P ≥ 0.442) were observed between perturbations towards the preferred and non-preferred legs. However, non-faller participants more frequently responded with a medial step when pulled towards their non-preferred side and cross-over steps when pulled towards their preferred side (P = 0.015).

Interpretation

Leg preference may influence the protective stepping response to standing balance perturbations in older adults at risk for falls, particularly with the type of recovery responses used. Such asymmetries in balance stability recovery may represent a contributing factor for falls among older individuals and should be considered for rehabilitation interventions aimed at improving balance stability and reducing fall risk.     

Lateral Balance Factors Predict Future Falls in Community-Living Older Adults

Hilliard MJ, Martinez KM, Janssen I, Edwards B, Mille M-L, Zhang Y, Rogers MW. Lateral balance factors predict future falls in community-living older adults.

Objective

To prospectively determine the capacity of measures of mediolateral (ML) protective stepping performance, maximum hip abduction torque, and trunk mobility, in order to predict the risk of falls among community-living older people.

Design

Cross-sectional study.

Setting

A balance and falls research laboratory.

Participants

Medically screened and functionally independent community-living older adult volunteers (N=51).

Interventions

Not applicable.

Main Outcome Measures

Measures included: (1) protective stepping responses: percentage of trials with multiple balance recovery steps and sidestep/crossover step recovery patterns, and first step length following motor-driven waist-pull perturbations of ML standing balance; (2) hip abduction strength and axial mobility: (3) peak isokinetic hip abduction joint torque and trunk functional axial rotation (FAR) range of motion; and (4) fall incidence: monthly mail-in reporting of fall occurrences with follow-up contact for 1 year post-testing. One- and 2-variable logistic regression analysis models determined which single and combined measures optimally predicted fall status.

Results

The single variable model with the strongest predictive value for falls was the use of multiple steps in all trials (100% multiple steps) (odds ratio, 6.2; P=.005). Two-variable models, including 100% multiple steps and either hip abduction torque or FAR variables, significantly improved fall prediction over 100% multiple steps alone. The hip abduction and FAR logistic regression optimally predicted fall status.

Conclusions

The findings identify new predictor variables for risk of falling that underscore the importance of dynamic balance recovery performance through ML stepping in relation to neuromusculoskeletal factors contributing to lateral balance stability. The results also highlight focused risk factors for falling that are amenable to clinical interventions for enhancing lateral balance function and preventing falls.     

Stepping in Persons Poststroke: Comparison of Voluntary and Perturbation-Induced Responses

Objectives

To examine the stepping performance during voluntary and waist-pull perturbation-induced step initiation in people with chronic stroke.

Design

Repeated-measures single-case design.

Setting

University-based research laboratory.

Participants

Community-dwelling stroke survivors (N=10).

Interventions

Not applicable.

Main Outcome Measures

Ground reaction forces and kinematic data were recorded to assess anticipatory postural adjustments (APAs) and step characteristics for both voluntary and induced stepping conditions.

Results

Induced stepping was performed with both the paretic (35% trials) and nonparetic legs (65% trials). Induced first steps occurred earlier and were executed faster than rapid voluntary steps. Compared with voluntary stepping, induced first step APAs were shorter in duration. Step height was higher with the nonparetic leg for both stepping conditions. Use of the paretic leg increased (52%) during the diagonal perturbations that passively unloaded the stepping limb compared with the use of the paretic leg (33%) for forward perturbations.

Conclusions

The results indicated differences in executing voluntary and induced stepping, and between the paretic and nonparetic limbs in individuals with chronic stroke. The findings suggested guidelines for using stepping as a component of neurorehabilitation programs for enhancing balance and mobility. Additional larger-scale studies remain to be undertaken to further investigate these issues.     

Is Highly Challenging and Progressive Balance Training Feasible in Older Adults With Parkinson's Disease?

Objective

To develop a highly challenging and progressive group balance training regime specific to Parkinson's disease (PD) symptoms and to investigate its feasibility in older adults with mild to moderate PD.

Design

Intervention study, before-after trial with a development and feasibility design.

Setting

University hospital setting.

Participants

Feasibility was evaluated in older adults (N=5; mean age, 72y; age range, 69–80y) with mild to moderate idiopathic PD.

Intervention

A balance training regime emphasizing specific and highly challenging exercises, performed 3 times per week for 12 weeks, was developed through discussion and workshops by a group of researchers and physiotherapists.

Main Outcome Measures

Indicators of feasibility included attendance rate, safety (adverse events, physical function, and pain), participants' perceptions of the intervention (level of difficulty of the exercises, motivation level, and appreciation), and efficacy of the intervention (balance performance assessed with the Mini-Balance Evaluation Systems Test [Mini-BESTest]).

Results

The incidence rate was high (93%) for attendance and low (1.2%) for adverse events. Ratings by the participants indicated progression throughout the training period. All participants considered the training motivational and stated that they would recommend it to others. The efficacy of the intervention measured with the Mini-BESTest showed that 4 out of 5 participants improved their balance performance.

Conclusions

These findings support the overall feasibility of this novel balance program in older adults with mild to moderate PD. However, to further evaluate the efficacy of the program, a larger randomized controlled trial is required.     

The role of strategy selection,limb force capacity and limb positioning in successful trip recovery

Background

Fall occurrence, mainly due to tripping, increases with age. There are two main strategies of trip recovery: elevating and lowering. Strategy selection depends on trip stimulus timing within the swing phase of walking, but the choice and ultimate success of a strategy selection may also depend on individual physical characteristics.The aim of this study was to investigate: 1) recovery strategy choice by younger and older adults when perturbed in the ‘strategy overlap’ mid-swing phase, and 2) whether the interaction between recovery limb positioning and recovery limb force capacity determines recovery success in elevating strategy recoveries and accounts for strategy selection.

Methods

A group of older (65–75 years) and a group of younger adults (20–35 years) completed a trip recovery protocol in a laboratory environment.An inverted pendulum model was developed to investigate how walking speed, recovery limb positioning and recovery limb force interacted and influenced successful trip recovery when perturbed in different swing phases.

Findings

Older adults always adopted a lowering strategy when perturbed in late mid-swing (60–80%), while younger adults also adopted elevating strategies. Simulations showed that, when perturbed later in swing, a larger recovery step and higher recovery limb force were required for successful recovery.

Interpretation

We suggested that a combination of insufficient recovery limb strength, response time and movement speed make it difficult for older adults to achieve a large enough recovery step for a successful elevating strategy recovery when perturbed later in mid-swing.     

Effects of step length,age, and fall history on hip and knee kinetics and knee co-contraction during the maximum step length test

Background

Maximum step length is a brief clinical test involving stepping out and back as far as possible with the arms folded across the chest. This test has been shown to predict fall risk, but the biomechanics of this test are not fully understood. Knee and hip kinetics (moments and powers) are greater for longer steps and for younger subjects, but younger subjects also step farther.

Methods

To separate the effects of step length, age, and fall history on joint kinetics; healthy younger (age=27(5), N=14), older non-fallers (age=72(5), N=14), and older fallers (age=75(6), N=11) all stepped to the same relative target distances of 20–80% of their height. Knee and hip kinetics and knee co-contraction were calculated.

Findings

Hip and knee kinetics and knee co-contraction all increased with step length, but older non-fallers and fallers utilized greater stepping hip and less stepping knee extensor kinetics. Fallers had greater stepping knee co-contraction than non-fallers. Stance knee co-contraction of non-fallers was similar to young for shorter steps and similar to fallers for longer steps.

Interpretation

Age had minimal effects and fall history had no effects on joint kinetics of steps to similar distances. Effects of age and fall history on knee co-contraction may contribute to age-related kinetic differences and shorter maximal step lengths of older non-fallers and fallers, but step length correlated with every variable tested. Thus, declines in maximum step length could indicate declines in hip and knee extensor kinetics and impaired performance on similar tasks like recovering from a trip.     

Age-Related Hip Proprioception Declines: Effects on Postural Sway and Dynamic Balance

Objective

To evaluate the effects of age on hip proprioception, and determine whether age-related hip proprioception declines disrupt balance.

Design

Survey of proprioception and balance differences between 3 age groups.

Setting

University balance laboratory.

Participants

Volunteer sample of independent community-dwelling adults (N=102) without sensory or other neurologic impairments in 3 age groups: younger (mean age, 24.6y; range, 19–37y), mid-aged (mean age, 53.3y; range, 40–64y), and older adults (mean age, 76.3y; range, 65–94y).

Interventions

Not applicable.

Main Outcome Measures

Hip joint position sense (JPS) and kinesthesia were measured using a custom-built device. JPS error was determined by the magnitude of matching errors during vision and no-vision conditions. Kinesthesia was evaluated by the ability to detect passive limb rotation without vision. Postural sway was assessed during static stance and measured using root mean square of center of pressure (COP) displacement and velocity of COP displacement. Clinical balance and fear of falling were assessed with the mini-Balance Evaluation Systems Test (mini-BESTest) and Activities-specific Balance Confidence Scale, respectively.

Results

Both older and mid-aged adults had significantly increased JPS error compared with younger adults (P<.05). Kinesthesia accuracy was significantly decreased in older adults compared with mid-aged and younger adults (P≤.01). Both measures of proprioception error correlated with age (P≤.001). There were no relationships between hip proprioception error and postural sway during static stance. However, older adults with lower proprioceptive error had significantly higher mini-BESTest scores of dynamic balance abilities (P=.005).

Conclusions

These results provide evidence of significant hip proprioception declines with age. Although these declines are not related to increases in postural sway, participants with hip proprioception declines demonstrated disrupted dynamic balance, as indicated by decreased mini-BESTest scores.     

Systematic Review of High-Intensity Progressive Resistance Strength Training of the Lower Limb Compared With Other Intensities of Strength Training in Older Adults

Objective

To examine the effect of high-intensity progressive resistance strength training (HIPRST) on strength, function, mood, quality of life, and adverse events compared with other intensities in older adults.

Data Sources

Online databases were searched from their inception to July 2012.

Study Selection

Randomized controlled trials of HIPRST of the lower limb compared with other intensities of progressive resistance strength training (PRST) in older adults (mean age ≥65y) were identified.

Data Extraction

Two reviewers independently completed quality assessment using the Physiotherapy Evidence Database (PEDro) scale and data extraction using a prepared checklist.

Data Synthesis

Twenty-one trials were included. Study quality was fair to moderate (PEDro scale range, 3–7). Studies had small sample sizes (18–84), and participants were generally healthy. Meta-analyses revealed HIPRST improved lower-limb strength greater than moderate- and low-intensity PRST (standardized mean difference [SMD]=.79; 95% confidence interval [CI], .40 to 1.17 and SMD=.83; 95% CI, −.02 to 1.68, respectively). Studies where groups performed equivalent training volumes resulted in similar improvements in leg strength, regardless of training intensity. Similar improvements were found across intensities for functional performance and disability. The effect of intensity of PRST on mood was inconsistent across studies. Adverse events were poorly reported, however, no correlation was found between training intensity and severity of adverse events.

Conclusions

HIPRST improves lower-limb strength more than lesser training intensities, although it may not be required to improve functional performance. Training volume is also an important variable. HIPRST appears to be a safe mode of exercise in older adults. Further research into its effects on older adults with chronic health conditions across the care continuum is required.     

Effects of Age and Gender on Dynamic Stability During Stair Descent

Objective

To determine the effects of age and sex and their interaction effects on dynamic postural stability during stair descent.

Design

Cross sectional.

Setting

Laboratory.

Participants

Healthy younger adults (N=28) and healthy older adults (N=21).

Interventions

Not applicable.

Main Outcome Measures

Spatiotemporal gait parameters, displacement of center of mass (COM), instantaneous velocity of the COM, divergence between vertical projection of the COM, and center of pressure (COP).

Results

Interaction effects of age and sex were found in stride duration, COM displacement, and instantaneous velocity of the COM in the mediolateral direction. Older adults demonstrated longer stride duration with shorter double-limb stance and longer single-limb stance during stair descent. Women have significantly longer stride duration than men. The effects of sex and age were significant in the data normalized by height. Older adults and women demonstrated larger peak-to-peak COM displacement, peak instantaneous velocity of the COM, and COM-COP divergence than the younger individuals and men, respectively. Peak instantaneous velocity of the COM was significant different in most pairwise comparisons, but the COM-COP divergence was significantly different in several comparisons.

Conclusions

This study examined the COM and COP parameters to quantify dynamic stability during stair descent across sex and age. Although older women descended stairs successfully, they demonstrated differences in control of instantaneous velocity of the COM compared with the other participants. Dynamic instability could be detected by examining the control of instantaneous velocity of the COM. In developing a better understanding of the balance control of stair descent in healthy older adults, aging patients with various pathologies can be better assessed, appropriately treated, and provided with proper assistive devices.     

Comparison of gluteus medius muscle activity during functional tasks in individuals with and without osteoarthritis of the hip joint

Background

Neuromuscular alterations have been reported for patients with osteoarthritis of the hip joint; however, the underlying cause associated with altered gluteus medius muscle function has not been examined. This study assessed electromyographic amplitudes of the gluteus medius muscles during function in patients with unilateral end-stage osteoarthritis of the hip joint compared to controls.

Methods

Patients with unilateral end-stage hip joint osteoarthritis (n = 13) and asymptomatic control participants (n = 17) participated. Average root-mean squared muscle amplitudes represented as a percent of maximum voluntary isometric contraction for both the involved and uninvolved limb gluteus medius muscles were analyzed during step up, step down, and gait. The association between muscle activation and impact forces during stepping tasks was assessed.

Findings

Patients with hip osteoarthritis exhibited increased gluteus medius muscle electromyographic amplitudes bilaterally during stair ascent, stair descent, and gait compared to controls, regardless of which limb they led. Involved limb muscle activity was inversely related to impact force during step down onto the ipsilateral limb.

Interpretation

Patients with hip osteoarthritis demonstrated increased gluteus medius muscle activation levels during stepping tasks and gait when compared to controls. The increased activation is most likely a compensatory response to muscle weakness. Therefore, application of strengthening exercises which target the gluteal muscles should assist in neuromuscular control and result in improved strength for patients with hip joint osteoarthritis.     

Age-related differences in lower-limb force–time relation during the push-off in rapid voluntary stepping

Background

This study investigated the force–time relationship during the push-off stage of a rapid voluntary step in young and older healthy adults, to study the assumption that when balance is lost a quick step may preserve stability. The ability to achieve peak propulsive force within a short time is critical for the performance of such a quick powerful step. We hypothesized that older adults would achieve peak force and power in significantly longer times compared to young people, particularly during the push-off preparatory phase.

Methods

Fifteen young and 15 older volunteers performed rapid forward steps while standing on a force platform. Absolute anteroposterior and body weight normalized vertical forces during the push-off in the preparation and swing phases were used to determine time to peak and peak force, and step power. Two-way analyses of variance (‘Group’ [young–older] by ‘Phase’ [preparation-swing]) were used to assess our hypothesis (P ≤ 0.05).

Findings

Older people exerted lower peak forces (anteroposterior and vertical) than young adults, but not necessarily lower peak power. More significantly, they showed a longer time to peak force, particularly in the vertical direction during the preparation phase.

Interpretations

Older adults generate propulsive forces slowly and reach lower magnitudes, mainly during step preparation. The time to achieve a peak force and power, rather than its actual magnitude, may account for failures in quickly performing a preventive action. Such delay may be associated with the inability to react and recruit muscles quickly. Thus, training elderly to step fast in response to relevant cues may be beneficial in the prevention of falls.     

Biomechanical demands differentiate transitioning vs. continuous stair ascent gait in older women

Background

Stair ascent mechanics change with age, but little is known about the differing functional demands of transitioning and continuous ascent. Work investigating the risky transition from gait to ascent is sparse, and the strategies that older adults adopt to achieve these demanding tasks have not been investigated.

Methods

This study compared the biomechanics of a 2-step transitional (floor-to-step2) and continuous ascent cycle (step1-to-step3) and investigated the role of limb preference in relation to dynamometer-derived knee strength during this transition. A biomechanical analysis of 36 women (60–83 years) ascending a 3-step staircase was conducted.

Findings

The 2-step transitioning cycle was completed quicker, with a larger range of motion, increased forces, larger knee flexor and dorsiflexor moments and ankle powers (P ≤ 0.05), but reduced hip and knee flexion, smaller hip extensor moments and hip and knee powers compared to continuous ascent. During the transition, 44% of the participants demonstrated a consistent limb preference. In these cases large between-limb extensor strength differences existed (13.8%) and 71% of these participants utilised the stronger limb to execute the 2-step transitional cycle.

Interpretation

The preferential stronger-limb 2-step transitioning strategy conflicts with previous recommendations of a stronger lead limb for frail/asymmetric populations. Our findings suggest that most healthy older women with large between-limb differences utilise the stronger limb to achieve the considerable propulsion required to redirect momentum during the 2-step transition. The biomechanical demands of ascent, relative to limb strength, can inform exercise programmes by targeting specific muscle groups to help older adults maintain/improve general functioning.     

Sagittal plane center of mass movement strategy and joint kinetics during sit-to-walk in elderly fallers

Background

Biomechanical studies have shown that the horizontal center of mass momentum at seat-off during sit-to-walk is reduced among elderly adults. However, the underlying mechanism of this phenomenon is still lacking. The purpose of this study was to examine differences in center of mass movement strategies and lower extremity joint kinetics in the elderly during sit-to-walk.

Methods

Fifteen healthy young adults, fifteen healthy elderly adults (70 years or older) and fifteen elderly fallers performed Timed Up and Go test. Biomechanical data collected from sit-to-walk phase of Timed Up and Go test were analyzed. Outcome measures included center of mass-ankle inclination angles, hip, knee and ankle joint moments, and ground reaction forces of the stance limb.

Findings

Results reported here are from 10 participants in each group due to missing force place data. Elderly fallers adopted a movement strategy that included a posterior foot placement at seat-off, a longer duration, and a shorter initial step length. When compared to healthy individuals, elderly fallers demonstrated a greater ankle plantarflexor moment at seat-off.

Interpretation

Increased ankle plantarflexor moment in elderly fallers could be a movement strategy to improve stability during sit-to-walk and may be related to the reduced ankle dorsiflexor strength commonly reported in elderly fallers. Results of this study enhance our understanding on the underlying mechanisms of the altered sit-to-walk movement and could aid in developing effective screening and rehabilitation programs to prevent falling in the elderly.     

Health-Related Physical Fitness Measures: Reference Values and Reference Equations for Use in Clinical Practice

Objective

To provide reference values and reference equations for frequently used clinical field tests of health-related physical fitness for use in clinical practice.

Design

Cross-sectional design.

Setting

General community.

Participants

Convenience sample of volunteers (N=370) between 18 and 90 years of age were recruited from a wide range of settings (ie, work sites, schools, community centers for older adults) and different geographic locations (ie, urban, suburban, rural) in southeastern Norway.

Interventions

Not applicable.

Main Outcome Measures

The participants conducted 5 clinical field tests (6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, fingertip-to-floor test).

Results

The results of the field tests showed that performance remained unchanged until approximately 50 years of age; after that, performance deteriorated with increasing age. Grip strength (79%), meters walked in 6 minutes (60%), and seconds used on the stair test (59%) could be well predicted by age, sex, height, and weight in participants ≥50 years of age, whereas the performance on all tests was less well predicted in participants <50 years of age.

Conclusions

The reference values and reference equations provided in this study may increase the applicability and interpretability of the 6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, and fingertip-to-floor test in clinical practice.     

Effects of Holding an External Load on the Standing Balance of Older and Younger Adults With and Without Chronic Low Back Pain

Objective

The purpose of this study was to assess the effect of holding an external load on the standing balance of younger and older adults with and without chronic low back pain (CLBP).

Functional Outcomes in Traumatic Disorders of Consciousness: 5-Year Outcomes From the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems

Objective

To characterize the 5-year outcomes of patients with traumatic brain injury (TBI) not following commands when admitted to acute inpatient rehabilitation.

Design

Secondary analysis of prospectively collected data from the National Institute on Disability and Rehabilitation Research–funded Traumatic Brain Injury Model Systems (TBIMS).

Setting

Inpatient rehabilitation hospitals participating in the TBIMS program.

Participants

Patients (N=108) with TBI not following commands at admission to acute inpatient rehabilitation were divided into 2 groups (early recovery: followed commands before discharge [n=72]; late recovery: did not follow commands before discharge [n=36]).

Interventions

Not applicable.

Main Outcome Measures

FIM items.

Results

For the early recovery group, depending on the FIM item, 8% to 21% of patients were functioning independently at discharge, increasing to 56% to 85% by 5 years postinjury. The proportion functioning independently increased from discharge to 1 year, 1 to 2 years, and 2 to 5 years. In the late recovery group, depending on the FIM item, 19% to 36% of patients were functioning independently by 5 years postinjury. The proportion of independent patients increased significantly from discharge to 1 year and from 1 to 2 years, but not from 2 to 5 years.

Conclusions

Substantial proportions of patients admitted to acute inpatient rehabilitation before following commands recover independent functioning over as long as 5 years, particularly if they begin to follow commands before hospital discharge.     

Preparation for Compensatory Forward Stepping in Parkinson's Disease

King LA, St George RJ, Carlson-Kuhta P, Nutt JG, Horak FB. Preparation for compensatory forward stepping in Parkinson's disease.

Objective

To characterize preparation for compensatory stepping in people with Parkinson's disease (PD) compared with healthy control subjects, and to determine whether levodopa medication improves preparation or the execution phases of the step.

Design

Observational study.

Setting

Outpatient neuroscience laboratory.

Participants

Nineteen participants with idiopathic PD tested both in the on and off levodopa states and 17 healthy subjects.

Intervention

Moveable platform with posterior translations of 24cm at 56cm/s.

Main Outcome Measures

Compensatory steps forward, in response to a backward surface translation (24cm amplitude at 56cm/s), were categorized according to the presence of an anticipatory postural adjustment (APA) before stepping: no APA, single APA, or multiple APAs. The following step parameters were calculated: step latency, step length, center of mass (CoM) average velocity, and CoM displacement at the step initiation.

Results

Lateral APAs were evident in 57% and 42% of trials for people with PD in the off and on medication states, respectively, compared with only 10% of trials for control subjects. Compared with subjects with PD who did not have APAs, those subjects with PD who did make an APA prior to stepping had significantly later (mean ± SEM, 356±16ms vs 305±8ms) and shorter (mean ± SEM, 251±27mm vs 300±16mm) steps, their CoM was significantly farther forward (185±7mm vs 171±5mm) at foot-off, and they took significantly more steps to regain equilibrium. Levodopa did not affect the preparation or execution phase of compensatory stepping. Poor axial scores and reports of freezing in the United Parkinson's Disease Rating Scale were associated with use of 1 or more APAs before compensatory stepping.

Conclusions

Lateral postural preparation prior to compensatory stepping in subjects with PD was associated with inefficient balance recovery from external perturbations.     

Social welfare utilization and needs of older adults in Taiwan: Survey research

Background

The demand for long-term care for older adults has escalated sharply. A good policy dedicated to the welfare of older adults has improved their quality of life. The purpose of this study was to explore the social welfare utilization and needs of older adults and compare their differences among age groups, genders, and functional dependency levels.

Methods

Three hundred eighty-four stratified, random-sampled Taiwanese community-dwelling older adults were recruited for this survey research. Participants rated their utilization of and needs for the 30 social welfare services provided by the government on a Likert-type scale.

Results

The most widely used and needed social welfare services by the older adults were senior monetary stipend and a subsidy for the national health insurance premium. Young-old, male, and functionally independent older adults had more knowledge of the social welfare services than their counterparts.

Conclusions

While designing a comprehensive social welfare system, differing needs of different age groups, genders, and functional dependency levels should be taken into consideration.     

Psychometric Properties of the Brief Fatigue Inventory in Community-Dwelling Older Adults

Objective

To investigate the psychometric properties of the Brief Fatigue Inventory (BFI) in community-dwelling older adults.

Design

Cross-sectional validation study.

Setting

Community based.

Participants

Subjects (N=302) were nondemented older adults (mean age, 76.44y; 54% women).

Interventions

Not applicable.

Main Outcome Measures

BFI total, severity, and interference summation scores.

Results

A principal component analysis (PCA) yielded 2 factors, fatigue severity and interference, explaining 65.94% of the variance. Both factors had good reliability, with Cronbach alpha values of .867 for fatigue interference and .818 for fatigue severity. Higher fatigue scores were associated with older age and worse physical and cognitive functions.

Conclusions

Fatigue is a common and debilitating symptom in the aging population. The current study provides novel findings in validating and establishing a bidimensional factor structure for the BFI in older adults. Severity and interference were differentially related to important health outcomes; therefore, using these subscales in addition to the total BFI score is recommended with older adults. Because of its relatively short administration time and established psychometric properties, the BFI can be successfully incorporated into longitudinal studies and clinical trials.