Recurrent Falls and Dual Task–Related Decrease in Walking Speed: Is There a Relationship?

OBJECTIVES: To determine whether dual task–related changes in walking speed were associated with recurrent falls in frail older adults.
DESIGN: Twelve-month prospective cohort study.
SETTING: Thirteen senior housing facilities.
PARTICIPANTS: Two hundred thirteen subjects (mean age 84.4±5.5).
MEASUREMENTS: Usual and dual-tasking walking speeds (m/s) were calculated on a 10-m straight walkway at baseline. Information on incident falls during the follow-up year was collected monthly, and participants were divided into three groups based on the occurrence of falls (0, 1, and ≥2). Recurrent falls were defined as two or more falls during the 12-month follow-up period.
RESULTS: Twenty subjects (9.4%) were classified as recurrent fallers. The occurrence of recurrent falls was associated with age (crude odds ratio (OR)=1.11, P =.02), number of drugs (crude OR=1.28, P =.002), and walking speed under both walking conditions (crude OR=0.96, P =.002 for usual walking and crude OR=0.60, P =.005 for walking while counting backward). Multiple Poisson regression showed that only walking speed while dual tasking and number of drugs were associated with incident falls (incident rate ratio (IRR)=0.84, P =.045 and IRR=1.10, P =.004).
CONCLUSION: Slower walking speed while counting backward was associated with recurrent falls, suggesting that changes in gait performance while dual tasking might be an inexpensive way of identifying frail older adults prone to falling.     

Are Changes in Cognitive Functioning in Older Adults Related to Changes in Subjective Complaints?

In many areas of intellectual functioning, age-related declines in older adults' performance and increases in subjective complaints about intellectual performance are observed. However, the literature mostly reports very low relations between functioning and respective complaints. This finding could be the consequence of examining the relation between subjective complaints and the perceived level of functioning. If, however, persons are sensitive to relative changes in performance, they might base their subjective judgment on changes in the level of cognitive functioning. With 202 subjects (mean age=63 years) and two measurements, the authors examine (a) the relation between functioning and complaints at each measurement point, and (b) the relation between changes in functioning and changes in complaints between the measurement points with latent difference variables. The results indicate that there is no relation between level of functioning and level of complaints, but that there is a substantial relation between changes in functioning and complaints.     

Is Timed Up and Go Better Than Gait Speed in Predicting Health,Function, and Falls in Older Adults?

OBJECTIVES: To assess whether the Timed Up and Go (TUG) is superior to gait speed in predicting multiple geriatric outcomes. DESIGN: Prospective cohort study. SETTING: Medicare health maintenance organization and Veterans Affairs primary care clinics. PARTICIPANTS: Adults aged 65 and older (N=457). MEASUREMENTS: Baseline gait speed and TUG were used to predict health decline according to EuroQol and Medical Outcomes Study 36‐item Short Form Survey (SF‐36) global health; functional decline according to National Health Interview Survey (NHIS) activities of daily living (ADLs) score and SF‐36 physical function index; hospitalization; and any falls and multiple falls over 1 year. RESULTS: Mean age was 74, and 44% of participants were female. Odds ratios for all outcomes were equivalent for gait speed and TUG. Using area under the receiver operating characteristic curve of 0.7 or greater for acceptable predictive ability, gait speed and TUG each alone predicted decline in global health, new ADL difficulty, and falls, with no difference in predictive ability between performance measures. Neither performance measure predicted hospitalization, EuroQol decline, or physical function decline. As a continuous variable, TUG did not add predictive ability to gait speed for any outcome. CONCLUSION: Gait speed predicts most geriatric outcomes, including falls, as does TUG. The time taken to complete TUG may not add to information provided by gait speed, although its qualitative elements may have other utility.     

Are Changes in Leg Power Responsible for Clinically Meaningful Improvements in Mobility in Older Adults?

OBJECTIVES: From among physiological attributes commonly targeted in rehabilitation, to identify those in which changes led to clinically meaningful differences (CMDs) in mobility outcomes. DESIGN: Secondary analysis of data collected for a randomized controlled trial of exercise using binary outcomes defined by recording a large CMD (Short Physical Performance Battery (SPPB)=1 unit; gait speed (GS)=0.1 m/s). Iterative models were performed to evaluate possible confounding between physiological variables and relevant covariates. SETTING: Outpatient rehabilitation centers. PARTICIPANTS: Community‐dwelling mobility‐limited older adults (n=116) participating in a 16‐week randomized controlled trial of two modes of exercise. MEASUREMENTS: Physiological measures included leg power, leg strength, balance as measured according to the Performance‐Oriented Mobility Assessment (POMA), and rate pressure product at the maximal stage of an exercise tolerance test. Outcomes included GS and SPPB. Leg power and leg strength were measured using computerized pneumatic strength training equipment and recorded in Watts and Newtons, respectively. RESULTS: Participants were 68% female, had a mean age of 75.2, a mean of 5.5 chronic conditions, and a baseline mean SPPB score of 8.7. After controlling for age, site, group assignment, and baseline outcome values, leg power was the only attribute in which changes were significantly associated with a large CMD in SPPB (odds ratio (OR)=1.48, 95% confidence interval (CI)=1.09–2.02) and GS (OR=1.31, 95% CI=1.01–1.70). CONCLUSION: Improvements in leg power, independent of strength, appear to make an important contribution to clinically meaningful improvements in SPPB and GS.     

A Positivity Effect in Older Adults’ Memorability Judgments of Pictures

Background/Study Context: A growing literature suggests that older adults are biased to preferentially cognitively process positively valenced information. The authors investigated whether this bias extended to preferential selection of information to remember, and also examined whether the arousal invoked by stimuli biased item selection and memory.

Methods: Thirty older (63–88 years of age) and 30 younger (18–25 years of age) adults viewed emotional (positive, negative) and neutral pictures that varied in arousal (low, high), and were asked to select a subset they deemed memorable (memorability judgments), before recalling pictures. Repeated-measures analyses of variance were conducted to examine aging-related differences in selection and recall of positive, negative, and neutral pictures, and of low- and high-arousal pictures.

Results: Older adults selected more positive pictures as memorable, whereas in younger adults selection did not differ by valence. In both age groups, recall of positive pictures was highest. Older adults selected more low- than high-arousal pictures as memorable, although recall was greater for high- than low-arousal pictures in both age groups.

Conclusion: Findings are consistent with the view that the aging-related positivity bias is under cognitive control, and suggest an awareness of this in older adults. Future investigations should seek to disentangle the influence of positive valence from other factors (e.g., perceptual, semantic, arousal level) on older adults’ memorability judgments.     

Nonsurgical Treatment of Lumbar Disk Herniation: Are Outcomes Different in Older Adults?

OBJECTIVES: To determine whether older adults (aged ≥60) experience less improvement in disability and pain with nonsurgical treatment of lumbar disk herniation (LDH) than younger adults (<60). DESIGN: Prospective longitudinal comparative cohort study. SETTING: Outpatient specialty spine clinic. PARTICIPANTS: One hundred thirty‐three consecutive patients with radicular pain and magnetic resonance–confirmed acute LDH (89 younger, 44 older). INTERVENTION: Nonsurgical treatment customized for the individual patient. MEASUREMENTS: Patient‐reported disability on the Oswestry Disability Index (ODI), leg pain intensity, and back pain intensity were recorded at baseline and 1, 3, and 6 months. The primary outcome was the ODI change score at 6 months. Secondary longitudinal analyses examined rates of change over the follow‐up period. RESULTS: Older adults demonstrated improvements in ODI (range 0–100) and pain intensity (range 0–10) with nonsurgical treatment that were not significantly different from those seen in younger adults at 6 month follow‐up, with or without adjustment for potential confounders. Adjusted mean improvement in older and younger adults were 31 versus 33 (P=.63) for ODI, 4.5 versus 4.5 (P=.99) for leg pain, and 2.4 versus 2.7 for back pain (P=.69). A greater amount of the total improvement in leg pain and back pain in older adults was noted in the first month of follow‐up than in younger adults. CONCLUSION: These preliminary findings suggest that the outcomes of LDH with nonsurgical treatment were not worse in older adults (≥60) than in younger adults (<60). Future research is warranted to examine nonsurgical treatment for LDH in older adults.     

Road Test and Naturalistic Driving Performance in Healthy and Cognitively Impaired Older Adults: Does Environment Matter?

Objectives

To relate the standardized road test to video recordings of naturalistic driving in older adults with a range of cognitive impairment.

Design

Cross‐sectional observational study.

Setting

Academic medical center memory disorders clinic.

Participants

One hundred three older drivers (44 healthy, 59 with cognitive impairment) who passed a road test.

Measurements

Error rate and global ratings of safety (pass with and without recommendations, marginal with restrictions or training, or fail) made by a professional driving instructor.

Results

There was fair agreement between global ratings on the road test and naturalistic driving. More errors were detected in the naturalistic environment, but this did not affect global ratings. Error scores between settings were significantly correlated, and the types of errors made were similar. History of crashes corrected for miles driven per week was related to road test error scores but not naturalistic driving error scores. Global cognition (Mini‐Mental State Examination) was correlated with road test and naturalistic driving errors. In healthy older adults, younger age was correlated with fewer errors on the road test and more errors in naturalistic driving.

Conclusion

Road test performance is a reasonable proxy for estimating fitness to drive in older individuals' typical driving environments, but differences between performance assessed using these two methods remain poorly understood and deserve further study.