Investigating the predictive ability of gait speed and quadriceps strength for incident falls in community-dwelling older women at high risk of fracture

Gait speed is a recommended geriatric assessment of physical performance, but may not be regularly examined in clinical settings. We aimed to investigate whether quadriceps strength tests demonstrate similar predictive ability for incident falls as gait speed in older women. We investigated 135 female volunteers aged mean ± SD 76.7 ± 5.0 years (range 70–92) at high risk of fracture. Participants completed gait speed assessments using the GAITRite Electronic Walkway System, and quadriceps strength assessments using a hand-held dynamometer (HHD). Participants reported incident falls monthly for 3.7 ± 1.2 years. N = 99 (73%) participants fell 355 times during the follow-up period (mean fall rate 83 per 100 person years). We observed a reduced odds ratio for multiple falls (0.83, 95% CI 0.70–0.98) and a reduced hazard ratio for time to first fall (0.90, 95% CI 0.83–0.98), according to quadriceps strength. There was also a significantly shorter time to first fall for those with low quadriceps strength (<7.0 kg; lowest tertile) compared with those with normal quadriceps strength (estimated means [95% CI] 1.54 [1.02, 2.06] vs. 2.23 [1.82, 2.64] years; P = 0.019), but not for those with low (<1.0 m/s) vs. normal gait speed (P = 0.15). Quadriceps strength is a significant predictor of incident falls over three years amongst community-dwelling older women at high risk of fracture. Quadriceps strength tests may be an acceptable alternative to gait speed for geriatric assessments of falls risk.     

Contributions of mild parkinsonian signs to gait performance in the elderly

Mild parkinsonian signs (MPS) and gait abnormalities are common in aging, but the association between MPS and objective gait measures is not established in the elderly. This study aims to identify the link between MPS and quantitative gait measures, as well as to determine the pathogenesis of MPS in non-demented community-dwelling older adults without idiopathic Parkinson’s disease or other parkinsonian syndromes. Three hundred seventy-four non-demented older adults (mean age, 76.44 ± 6.71 years, 57 % women) participated in this study, where comprehensive neurological and medical assessments were conducted. We defined MPS based on the presence of any one of bradykinesia, rigidity, or rest tremor. Velocity and spatial, temporal, and variability gait parameters were recorded using an instrumented walkway. The associations of MPS and gait parameters as well as the relationship of individual MPS with medical illnesses were assessed with linear regressions controlling for key covariates. Participants with MPS walked slower and with disturbed spatial and variability components of gait compared to those without MPS. Bradykinesia was associated with worse spatial and variability gait parameters. This association was only significant for axial bradykinesia, but not for the presence of bradykinesia in the limbs. Cerebrovascular disease (β = .20, p < .01) was associated with bradykinesia, whereas cardiovascular disease (β = .15, p < .05) was associated with rigidity. Among MPS, bradykinesia but not rigidity or tremor was associated with worse quantitative gait performance in older adults. Cerebrovascular disease, a preventable condition, was specifically associated with bradykinesia.     

The short version of the Activities-specific Balance Confidence (ABC) scale: Its validity, reliability, and relationship to balance impairment and falls in older adults

A shortened version of the ABC 16-item scale (ABC-16), the ABC-6, has been proposed as an alternative balance confidence measure. We investigated whether the ABC-6 is a valid and reliable measure of balance confidence and examined its relationship to balance impairment and falls in older adults. Thirty-five community-dwelling older adults completed the ABC-16, including the 6 questions of the ABC-6. They also completed the following clinical balance tests: unipedal stance time (UST), functional reach (FR), Timed Up and Go (TUG), and maximum step length (MSL). Participants reported 12-month falls history. Balance confidence on the ABC-6 was significantly lower than on the ABC-16, however scores were highly correlated. Fallers reported lower balance confidence than non-fallers as measured by the ABC-6 scale, but confidence did not differ between the groups with the ABC-16. The ABC-6 significantly correlated with all balance tests assessed and number of falls. The ABC-16 significantly correlated with all balance tests assessed, but not with number of falls. Test-retest reliability for the ABC-16 and ABC-6 was good to excellent. The ABC-6 is a valid and reliable measure of balance confidence in community-dwelling older adults, and shows stronger relationships to falls than does the ABC-16. The ABC-6 may be a more useful balance confidence assessment tool than the ABC-16.     

Development and evaluation of the GEMS (gait,eyesight, mental state,sedation) tool as an aid to predict outcome after hospitalization

Aim: Discharge planning can be a lengthy process. Prediction of a patient's rehabilitation potential and likely discharge destination, early on in their admission, could be a useful guide for medics, therapists, patients and their carers. Reliable prediction could be used to improve efficiency of discharge planning. The aim of the present study was to identify factors linked to discharge to a residential or nursing home placement and to develop a tool to guide rehabilitation requirements. Methods: This was a three‐phase prospective observational study with blinded end‐point evaluation in two non‐acute rehabilitation hospitals. The study recruited 1174 patients admitted for rehabilitation, over 65 years of age. Phase 1 evaluated 200 patients to identify factors predisposing to institutional discharge. The GEMS (gait, eyesight, mental state, sedation) tool was formulated and validated on the ward in which it was developed (phase 2a) and on two other wards at the same rehabilitation hospital (phase 2b). In phase 3, the tool was evaluated remotely. Results: Patients discharged to a nursing or residential home placement were significantly more likely to have abnormal vision (P = 0.01, 95% confidence interval [CI] = 0.18–0.81), impaired cognitive function (P = 0.012, 95% CI = 0.19–0.81), gait abnormalities (P = 0.01, 95% CI = 0.18–0.79), and more likely to be taking tranquillizers (sedation) (P = 0.0001, 95% CI = 0.01–0.45). Over the three phases, the GEMS tool had a sensitivity of 61.4–88.1% and a specificity of 28.9–61.0%. Conclusion: A GEMS score of 2 or more is significantly associated with discharge to a residential or nursing home placement. This could be used to aid discharge planning and direct rehabilitation service provision. Geriatr Gerontol Int 2011; 11: 8–15.