Impaired perceived timing of falls in the elderly

Falls are the leading cause of injury-related deaths and hospitalizations, with older adults at an increased risk. As humans age, physical changes and health conditions make falls more likely. While we know how the body reflexively responds to prevent injury during a fall, we know little about how people perceive the fall itself. We previously found that young adults required a fall to precede a comparison sound stimulus by approximately 44 ms to perceive the two events as simultaneous. This may relate to common anecdotal reports suggesting that humans often describe distortions in their perception of time − time seems to slow down during a fall – with very little recollection of how and when the fall began. Here we examine whether fall perception changes with age. Young (19–25y) and older (61–72y) healthy adults made temporal order judgments identifying whether the onset of their fall or the onset of a comparison sound came first to measure the point of subjective simultaneity. Results show that fall perception is nearly twice as slow for older adults, where perturbation onset has to precede sound onset by ∼88 ms to appear coincident, compared to younger adults (∼44 ms). We suggest that such age-related differences in fall perception may relate to increased fall rates in older adults. We conclude that a better understanding of how younger versus older adults perceive falls may identify important factors for innovative fall prevention strategies and rehabilitative training exercises to improve fall awareness.     

Barriers to and facilitators of sports participation for people with physical disabilities: A systematic review

Most people with physical disabilities do not participate in sports regularly, which could increase the chances of developing secondary health conditions. Therefore, knowledge about barriers to and facilitators of sports participation is needed. Barriers and facilitators for people with physical disabilities other than amputation or spinal cord injuries (SCI) are unknown. The aim of this study was to provide an overview of the literature focusing on barriers to and facilitators of sports participation for all people with various physical disabilities. Four databases were searched using MeSH terms and free texts up to April 2012. The inclusion criteria were articles focusing on people with physical disabilities, sports and barriers and/or facilitators. The exclusion criteria were articles solely focusing on people with cognitive disabilities, sensory impairments or disabilities related to a recent organ transplant or similar condition. Fifty‐two articles were included in this review, with 27 focusing on people with SCI. Personal barriers were disability and health; environmental barriers were lack of facilities, transport and difficulties with accessibility. Personal facilitators were fun and health, and the environmental facilitator was social contacts. Experiencing barriers to and facilitators of sports participation depends on age and type of disability and should be considered when advising people about sports. The extent of sports participation for people with physical disabilities also increases with the selection of the most appropriate sport.     

Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials

Objective—To assess the effectiveness of exercise programmes in preventing falls (and/or lowering the risk of falls and fall related injuries) in older people.

Design—A review of controlled clinical trials designed with the aim of lowering the risk of falling and/or fall injuries through an exercise only intervention or an intervention that included an exercise component

Main outcome measures—Falls, fall related injuries, time between falls, costs, cost effectiveness.

Subjects—A total of 4933 men and women aged 60 years and older.

Results—Eleven trials meeting the criteria for inclusion were reviewed. Eight of these trials had separate exercise interventions, and three used interventions with an exercise programme component. Five trials showed a significant reduction in the rate of falls or the risk of falling in the intervention group.

Conclusions—Exercise is effective in lowering falls risk in selected groups and should form part of falls prevention programmes. Lowering fall related injuries will reduce health care costs but there is little available information on the costs associated with programme replication or the cost effectiveness of exercise programmes aimed at preventing falls in older people.

Key Words: exercise; elderly; falls; cost effectiveness

     

Walking ability of children with a hexapod external ring fixator (TSF®) and foot plate mounting at the lower leg

Falling is a common accident among older people. Automatic fall detectors are one method of improving security. However, in most cases, fall detectors are designed and tested with data from experimental falls in younger people. This study is one of the first to provide fall-related acceleration data obtained from real-life falls. Wireless sensors were used to collect acceleration data during a six-month test period in older people. Data from five events representing forward falls, a sideways fall, a backwards fall, and a fall out of bed were collected and compared with experimental falls performed by middle-aged test subjects. The signals from real-life falls had similar features to those from intentional falls. Real-life forward, sideways and backward falls all showed a pre impact phase and an impact phase that were in keeping with the model that was based on experimental falls. In addition, the fall out of bed had a similar acceleration profile as the experimental falls of the same type. However, there were differences in the parameters that were used for the detection of the fall phases. The beginning of the fall was detected in all of the real-life falls starting from a standing posture, whereas the high pre impact velocity was not. In some real-life falls, multiple impacts suggested protective actions. In conclusion, this study demonstrated similarities between real-life falls of older people and experimental falls of middle-aged subjects. However, some fall characteristics detected from experimental falls were not detectable in acceleration signals from corresponding heterogeneous real-life falls.     

Adults with knee osteoarthritis use different coordinative strategies to transition from swing to stance compared to young asymptomatic adults

BackgroundNeuromuscular changes that occur with aging or joint pathology likely alter the coordinative strategies that adults use to walk and to recover from perturbations during gait. Differences in coordination patterns or in how coordination changes in response to a challenge may provide insight into neuromuscular targets for falls prevention interventions.Research questionDo young asymptomatic adults, older asymptomatic adults, and older adults with knee OA alter their lower extremity segment coordination differently in response to an increase in walking speed?.MethodsWe captured lower extremity kinematics using inertial measurement units as 29 participants (10 young, 10 older, 9 older with knee osteoarthritis) walked on a treadmill at self-selected preferred and faster speeds. We calculated lower extremity segment coordination and coordination variability using vector coding. We compared coordination and its variability among groups and speeds.ResultsThere were no significant interactions between group and speed. Overall group or speed differences in coordination or variability occurred mostly during terminal swing or early stance. Coordination patterns differed between young adults and adults with knee osteoarthritis in all segment couples during terminal swing and at the foot vs. shank during early stance. During these same gait cycle phases for the foot vs. shank and shank vs. thigh segment couples, coordination patterns shifted towards those of young adults when participants walked faster. Where coordination variability differed by group or speed, it was lower in the young adults than in the older adults with or without knee osteoarthritis and at faster walking speed.SignificanceOur results identified that older adults with knee osteoarthritis have a different strategy for transitioning from swing to stance compared to young adults, especially at distal limb segments. These results may help target fall prevention interventions to specific gait cycle phases or strategies.     

A systematic review of upper extremity responses during reactive balance perturbations in aging

BackgroundBalance responses to perturbations often involve the arms in an attempt to either restore balance or protect against impact. Although a majority of research has been dedicated to understanding age-related changes in lower limb balance responses, there is a growing body of evidence supporting age-related changes in arm responses. This systematic review aimed to summarize differences in arm responses between older and younger adults under conditions requiring counterbalancing, reaching to grasping, and protection against impact.MethodsFollowing a systematic review and critical appraisal of the literature, data regarding the arm response in studies comparing young and older adults was extracted. The resulting articles were also assessed for quality to determine risk of bias.ResultsFifteen high quality studies were identified. The majority of these studies reported delayed onsets in muscle activation, differences in arm movement strategies, delayed movement timing, increased impact forces, and greater grasp errors in older compared to young adults. These differences were also identified under varied visual and cognitive conditions.ConclusionsThe studies included in this review demonstrate age-related differences in arm responses regardless of the direction and nature of the perturbation. These differences could provide insight into developing more targeted rehabilitation and fall prevention strategies. More research is needed to assess whether the identified age-related differences are a necessary compensation or a contributory factor to balance impairments and fall risk in older adults     

Australian golfers with and without osteoarthritis report reduced psychological distress and improved general health compared to a general population-based sample

ObjectivesTo (i) evaluate psychological distress and general health in Australian golfers and compare with a general population-based sample, and (ii) explore the relationship between playing golf, psychological distress and general health in individuals with osteoarthritis.DesignCross sectional.MethodsA cross-sectional survey collected outcomes in 459 Australian Golfers (Kessler-10 Psychological Distress Scale, Short-Form 12 (Health Status), International Physical Activity Questionnaire, osteoarthritis status). Outcomes were compared between Australian golfers and a general population-based sample (Australian Health Survey, n = 16,370).Modified Poisson regression estimated the relationship between playing golf and general health in all participants and a subgroup with osteoarthritis (n = 128 golfers, n = 2216 general population). All analyses were adjusted for age, sex, education and smoking status.ResultsPlaying golf was associated with lower psychological distress (adjusted mean difference (95 % confidence interval) − 2.5 (− 4.1 to − 0.9)) and a greater likelihood of reporting good to excellent general health (adjusted relative risk (95 % confidence interval) 1.09 (1.05 to 1.13)) compared to the general population. Amongst people with osteoarthritis, playing golf was associated with lower psychological distress (adjusted mean difference − 4.0 (95 % confidence interval − 6.5 to − 1.5)) and a greater likelihood of reporting good to excellent general health (adjusted relative risk (95 % confidence interval) 1.3 (1.2 to 1.4)).ConclusionsGolfers had lower levels of psychological distress and better general health than the general population, and this relationship was strongest in individuals with osteoarthritis.     

Sensitivity and specificity of fall detection in people aged 40 years and over

About one third of home-dwelling people over 65 years of age fall each year. Falling, and the fear of falling, is one of the major health risks that affects the quality of life among older people, threatening their independent living. In our pilot study, we found that fall detection with a waist-worn triaxial accelerometer is reliable with quite simple detection algorithms. The aim of this study was to validate the data collection of a new fall detector prototype and to define the sensitivity and specificity of different fall detection algorithms with simulated falls from 20 middle-aged (40–65 years old) test subjects. Activities of daily living (ADL) performed by the middle-aged subjects, and also by 21 older people (aged 58–98 years) from a residential care unit, were used as a reference. The results showed that the hardware platform and algorithms used can discriminate various types of falls from ADL with a sensitivity of 97.5% and a specificity of 100%. This suggests that the present concept provides an effective method for automatic fall detection.     

Impact of isolated aerobic exercise in obese adolescents: systematic review

The juvenile obesity is currently one of the most serious public health problems. Changes in lifestyle, involving a combination of diet and physical activity, are essential elements in the management of obesity. However, it has been suggested that the prevention and treatment should emphasize the increase of physical activity rather than dietary treatments. To present the best available evidence from the controlled randomized studies to screen the impact of isolated aerobic exercise on cardiovascular and metabolic parameters in obese adolescents. Methods: Systematic review according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Were included randomized and controlled clinical trials of electronic databases: MEDLINE (via OvidSP), LILACS, and SciELO. Results: Four articles were identified, showing improvement in anthropometric measures, lipid and glycemic profiles. One of the articles demonstrated improvement in the systolic blood pressure (SBP) and diastolic (DBP), the maximum oxygen uptake. Conclusions: This systematic review has provided evidence on the impact of the interventions in isolated aerobic exercise in improving cardiovascular and metabolic parameters in obese adolescent population. Only four articles were identified, and further studies with greater scientific rigor are needed to confirm the scientific evidence.     

The impact of deployment on the psychological health status, level of alcohol consumption, and use of psychological health resources of postdeployed U.S. Army Reserve soldiers

This study was conducted to investigate the impact of deployment on the psychological health status, level of alcohol consumption, and use of psychological health resources of postdeployed Army Reserve (AR) soldiers. Data were collected from 51,078 postdeployed AR soldiers via DD Form 2900 to detect existing psychological and medical issues. As predicted, findings indicate that AR soldiers screened 7 or more months post redeployment are significantly more likely than those screened 3 to 6 months post redeployment to screen positive for moderate (chi2 (1, N = 44,319) = 15.75, p < 0.001) and severe (chi2 (1, N = 44,319) = 7.82, p < 0.05) functional impairment and PTSD (chi2 (1, N = 51,017) = 14.43, p < 0.001). Present findings are consistent with previous research, suggesting that adverse psychological health issues can be detected during their mild stages and resolved to prevent further degradation when screenings are performed according to military policy.     

Exercise in the prevention of falls in older people: a systematic literature review examining the rationale and the evidence

Falls are a major source of death and injury in elderly people. For example, they cause 90% of hip fractures and the current cost of hip fractures in the US is estimated to be about 10 billion dollars. Age-related changes in the physiological systems (somatosensory, vestibular and visual) which contribute to the maintenance of balance are well documented in older adults. These changes coupled with age-related changes in muscle and bone are likely to contribute to an increased risk of falls in this population. The integrated rehabilitation-based model of fall risk factors reveals multiple sites for interventions that may reverse fall risk factors. Regular exercise may be one way of preventing falls and fall-related fractures. The evidence for this contention comes from a variety of sources. On the basis of 9 randomised controlled studies conducted since 1996, exercise appears to be a useful tool in fall prevention in older adults, significantly reducing the incidence of falls compared with control groups. However, current limitations such as inconsistencies in the measurement of key dependent and independent variables do not, at present, permit a meta-analysis of intervention trials. Further investigation, using trials designed with the current limitations in mind, is necessary to establish the optimum exercise programme to maximise fall prevention in older adults.     

A systematic review of the effects of shoes and other ankle or foot appliances on balance in older people and people with peripheral nervous system disorders

The objective of this paper is to identify and review all publications on effects ankle and/or foot appliances (AFA) on balance in older people (>or=60 years) and patients with peripheral nervous system disorders (PNSD). These two groups account for the majority of the population with deteriorated balance due to peripheral somatosensory feedback problems. To provide a context for understanding and interpreting the studies that have been published to date, we will briefly summarize current theories on the role of somatosensory mechanisms in control of balance and how balance can be affected by AFA. A systematic literature review is presented in which publications were searched in Medline, Embase and Recal. In total 146 papers were identified and 18 were selected based on title and abstract for qualitative assessment by two independent reviewers. Based on assessment of the total articles, seven of the 18 papers fulfilled predetermined qualitative criteria and were selected for detailed review. No definitive conclusions can be drawn concerning the effects of AFA on balance in older people or in patients with PNSD because of the small number of studies and the weak level of evidence. The available literature seems to indicate that a training program may be helpful in ensuring the effectiveness of an appliance. Insoles with tubing or vibrating elements may improve balance, whereas thick or soft soles may deteriorate balance. The effects of these different types of insoles or soles are consistent with theories about somatosensory mechanisms that play a role in control of balance. More and better quality research is needed to support the prevalent use of appliances in these populations.     

Obstacle crossing deficits in older adults: A systematic review

This systematic review and critical evaluation of the literature investigates whether advanced age compromises obstacle crossing for unconstrained and time-constrained conditions. Eight electronic databases were searched for articles with terms relating to obstacle crossing during walking in their title, abstract or keywords. 15 articles were reviewed from an initial yield of 727 articles. The methodological quality of each article was critiqued and data extracted by two reviewers. Young and older adults were shown to contact obstacles infrequently when adequate time was available to adapt foot placement in relation to the obstacle. When less time was available to adjust the foot trajectory, older adults contacted obstacles more often than younger people. Older adults adopted a slower, more conservative obstacle crossing strategy. They demonstrated greater hip flexion during the swing phase of gait for the lead and trail limbs as well as greater hip flexion, hip adduction and ankle dorsiflexion during the stance phase for the lead and trail limbs. There was also evidence of reduced internal moments across the hip and ankle during key events in the obstacle crossing gait cycle in older adults. Despite using a more conservative obstacle crossing strategy, older adults are at greater risk of contacting obstacles for time-constrained conditions.     

Estimating fall risk with inertial sensors using gait stability measures that do not require step detection

Falls have major consequences both at societal (health-care and economy) and individual (physical and psychological) levels. Questionnaires to assess fall risk are commonly used in the clinic, but their predictive value is limited. Objective methods, suitable for clinical application, are hence needed to obtain a quantitative assessment of individual fall risk. Falls in older adults often occur during walking and trunk position is known to play a critical role in balance control. Therefore, analysis of trunk kinematics during gait could present a viable approach to the development of such methods. In this study, nonlinear measures such as harmonic ratio (HR), index of harmonicity (IH), multiscale entropy (MSE) and recurrence quantification analysis (RQA) of trunk accelerations were calculated. These measures are not dependent on step detection, a potentially critical source of error. The aim of the present study was to investigate the association between the aforementioned measures and fall history in a large sample of subjects (42 fallers and 89 non-fallers) aged 50 or older. Univariate associations with fall history were found for MSE and RQA parameters in the AP direction; the best classification results were obtained for MSE with scale factor τ = 2 and for maximum length of diagonals in RQA (72.5% and 71% correct classifications, respectively). MSE and RQA were found to be positively associated with fall history and could hence represent useful tools in the identification of subjects for fall prevention programs.     

Managing Diabetes in Older Adults

In brief Exercising regularly can have important benefits for older adults with diabetes, including improving insulin sensitivity and cardiovascular fitness. When embarking on a new exercise program, all older diabetic patients should seek the help of health professionals who can determine an appropriate and safe regimen. Special precautions should be taken to lower the risk of developing exercise-induced hypoglycemia or injury due to neuropathy or retinopathy. However, the psychological and physiologic benefits of a regular exercise routine far outweigh any risk to the older person who has diabetes.     

Voluntary step execution in patients with knee osteoarthritis: Symptomatic vs. non-symptomatic legs

BackgroundIndividuals with osteoarthritis fall at a greater rate than the general population, likely as a result of weakness, pain, movement limitations, and a decline in balance. Due to the high prevalence of osteoarthritis in the population, understanding the mechanisms leading to greater fall risk is an important issue to better understand.Research questionWhat is the influence of unilateral knee osteoarthritis on the characteristics of performing a voluntary step (i.e., similar to that performed to avoid a fall after a perturbation), compared to healthy age-matched controls?MethodsCase-control study performed in a Health maintenance organization physical therapy clinic. The research group consisted of a referred sample of 21 patients with unilateral knee osteoarthritis. The control group consisted of 22 age-matched healthy individuals. All participants were over 65 years of age. Participants were excluded if they had a surgical procedure to back or lower limb within one year before testing, oncological or neurological disease or a deficit in tactile sense. Movements were performed with and without dual tasking.MeasurementsDuration of the initiation phase (cue to step initiation), preparatory phase (step initiation to foot off) and swing phase (foot off to foot contact).ResultsIn the preparatory phase and swing phase, the osteoarthritis group moved more slowly than the control group, and these differences were larger for forward compared to backward movements. Dual-tasking slowed responses in the pre-movement initiation stage across groups.SignificanceThe differences in basic parameters, and the slower movements in the osteoarthritis group, are consistent with known features of osteoarthritis, being a disease commonly regarded as primarily "mechanical", and are likely to increase fall risk. These response deficits suggest we should take advantage of advanced rehabilitation techniques, including cognitive loading, to help prevent falls in older adults with osteoarthritis.     

Interventions for preventing falls in people post-stroke: A meta-analysis of randomized controlled trials

BackgroundFalls are a serious challenge facing individuals post-stroke. In the past decades, various fall prevention interventions have been developed. It remains unknown if any of these interventions are effective in reducing falls in this population. Such a knowledge gap could impede the effort of preventing falls in people post-stroke.Research questions1) Are there effective interventions to prevent falls among people in the post-acute and chronic stages of stroke? and 2) How do fall prevention interventions change three key fall risk factors in this population: balance, mobility, and lower limb strength?MethodsEleven databases were searched for randomized controlled trials which included falls in people post-stroke as an outcome measure. Information on the participants, training protocol, and outcome measures were collected for each study. The primary outcome is the number of fallers and the explanatory variables included mean difference and standard deviation for fall risk factors. Studies were quality appraised using the Physiotherapy Evidence Database scale and the funnel plot.ResultsThirteen studies enrolling 1352 participants were identified. Effect size quantified by the odds ratio (OR) for falls and standardized mean difference (SMD) for fall risk factors were calculated. Overall no intervention appears to be significantly more effective in preventing falls than placebo training (OR = 0.88 with a range of [0.23 3.66]; 95 % confidence interval = [0.64 1.21], p = 0.44). All interventions showed little effect in improving the fall risk factors (SMD = −0.01 to 0.06 and p-value = 0.38–0.86), except one (the combined treadmill and overground walking) which significantly improved mobility.SignificanceCurrently no program is effective in reducing falls in people post-stroke. Future studies should measure falls as a primary outcome based on a consistent definition of falls and reliable approaches to collect falls data.     

The effects of pole walking on health in adults: A systematic review

The aim of this systematic review was to summarize the effects of pole walking (PW) programs on physical and psychosocial health. Randomized controlled and controlled trials were identified from literature searches in PubMed, Cochrane library, EMBASE, SPORTdiscuss, CINAHL and PEDRO. A total of 14 articles from 13 studies met the inclusion criteria. Eleven of the included studies had a quality score of 50% or higher. Most studies included mid to older aged men and women in clinical populations with various medical conditions. Only two studies included nonclinical populations. The majority of the PW programs consisted of supervised group sessions performed two to three times weekly for 8 weeks or longer. Most studies investigated the effects of PW on both physical and psychosocial health and the majority examined effects on four to five outcomes. The effects of PW on cardiorespiratory fitness were most extensively studied. The most frequently examined psychosocial measure was quality of life. All studies reported at least one beneficial effect of PW compared with the control group. The results of this systematic review indicate that PW programs have some beneficial effects on both physical and psychosocial health in adults with and without clinical conditions.