Association Between Falls Experience and Physical Performance Measures in Community-Living Older Adults

Abstract

Aims: To determine if various physical performance tests are able to adequately discriminate older adults based on their experience with falls and assess the concurrent validity of the “Barthel index” against these tests.

Methods: Fifty-four older adults above 60?years of age were divided into three groups: those who suffered a fall, have fear of fall (FoF), or were part of an age-matched control group. Performance measures that quantified balance impairments, the strength of the trunk, and respiratory muscles along with the Barthel index were evaluated.

Results: Older people who have experienced falls have lower scores in all the variables measured compared to the other two groups. Though certain measures were able to discriminate the scores between the three groups, not all of these measures were related to Barthel index scores.

Conclusion: The Berg Balance Scale (BBS) seems to be more appropriate for discriminating balance impairment and performance among elders.     

Incidence and risk factors of falls in older adults after discharge: A prospective study

ObjectivesThis study aimed to determine the incidence of falls and risk factors associated with falling in discharged older adults.MethodsA prospective study was conducted on older adults who had been issued a discharge order in a Class A tertiary hospital in Chongqing, China, from May 2019 to August 2020. The risk of falling, depression, frailty, and daily activities were evaluated at discharge using the mandarin version of the fall risk self-assessment scale, Patient Health Questionnaire-9 (PHQ-9), FRAIL scale, and Barthel Index, respectively. The cumulative incidence function estimated the cumulative incidence of falls in older adults after discharge. And the risk factors of falls were explored using the sub-distribution hazard function in the competing risk model.ResultsIn a total of 1,077 participants, the total cumulative incidence of falls at 1, 6 and 12 months after discharge was 4.45%, 9.03%, and 10.80%, respectively. The cumulative incidence of falls in older adults with depression (26.19%, 49.93%, and 58.53%, respectively) and those with physical frailty (21.59%, 41.67%, and 48.73%, respectively) was much higher than that in those without depression and physical frailty (P < 0.05). Depression, physical frailty, Barthel Index, length of hospital stay, re-hospitalization, being cared for by others, and the self-assessed risk of falling were directly associated with falls.ConclusionsThe incidence of falls among older adults discharged from the hospital has a cumulative effect with the lengthening of the discharge time. It is affected by several factors, especially depression and frailty. We should develop targeted intervention strategies to reduce falls for this group.     

People With Multiple Sclerosis Use Many Fall Prevention Strategies but Still Fall Frequently

Objective

To compare the use of fall prevention strategies by people with multiple sclerosis (MS) who do or do not fall.

Design

Prospective cohort. All assessments were completed between January 2011 and December 2011. Data used in this analysis were collected as part of an observational study that included baseline assessment followed by prospective counting of falls using fall calendars.

Setting

Veterans Affairs and university medical centers.

Participants

People with MS (N=58) of any subtype, aged 18 to 50 years, with Expanded Disability Status Scale score ≤6.0, recruited from MS clinics at the Portland VA Medical Center and Oregon Health and Science University and from the surrounding areas.

Interventions

Not applicable.

Main Outcome Measures

Measures included the occurrence of falls over 3 months and scores on the Fall Prevention Strategy Survey (FPSS) and the relations between fall prevention strategy use reported on the FPSS and falls.

Results

A total of 52 subjects completed the study. Of these, 33 (63%) subjects fell at least once in the 3-month period, and 19 (36%) subjects did not fall. The mean total FPSS score for the fallers was significantly higher than the nonfallers (mean ± SD, 8.1±6.4 vs 4.0±4.1; range, 0–20 vs 0–15; P=.007), and FPSS scores correlated with monthly fall rates (ρ=.49, P=.01). A higher proportion of fallers than nonfallers used the strategies of turning on lights at home, asking others for help, and talking to a health care professional about fall prevention. However, both groups rarely talked to a health care professional about fall prevention or asked a provider to check whether any medications might increase fall risk.

Conclusions

People with MS who fall use more fall prevention strategies than those who do not fall.     

Neuropsychological,Balance, and Mobility Risk Factors for Falls in People With Multiple Sclerosis: A Prospective Cohort Study

Objectives

To determine whether impaired performance in a range of vision, proprioception, neuropsychological, balance, and mobility tests and pain and fatigue are associated with falls in people with multiple sclerosis (PwMS).

Design

Prospective cohort study with 6-month follow-up.

Setting

A multiple sclerosis (MS) physiotherapy clinic.

Participants

Community-dwelling people (N=210; age range, 21–74y) with MS (Disease Steps 0–5).

Interventions

Not applicable.

Main Outcome Measures

Incidence of falls during 6 months' follow-up.

Results

In the 6-month follow-up period, 83 participants (39.7%) experienced no falls, 57 (27.3%) fell once or twice, and 69 (33.0%) fell 3 or more times. Frequent falling (≥3) was associated with increased postural sway (eyes open and closed), poor leaning balance (as assessed with the coordinated stability task), slow choice stepping reaction time, reduced walking speed, reduced executive functioning (as assessed with the difference between Trail Making Test Part B and Trail Making Test Part A), reduced fine motor control (performance on the 9-Hole Peg Test [9-HPT]), and reported leg pain. Increased sway with the eyes closed, poor coordinated stability, and reduced performance in the 9-HPT were identified as variables that significantly and independently discriminated between frequent fallers and nonfrequent fallers (model χ²₃=30.1, P<.001). The area under the receiver operating characteristic curve for this model was .712 (95% confidence interval, .638–.785).

Conclusions

The study reveals important balance, coordination, and cognitive determinants of falls in PwMS. These should assist the development of effective strategies for prevention of falls in this high-risk group.     

Frequency,Characteristics, and Consequences of Falls in Multiple Sclerosis: Findings From a Cohort Study

Objective

To evaluate falls rate and the characteristics of falls (including fall-related injuries) in a multiple sclerosis (MS) cohort.

Design

As part of a study evaluating falls risk, a cohort of 150 participants prospectively recorded actual and near fall events using a daily diary over 3 months, as well as the circumstances of each fall including related injuries.

Setting

Community setting.

Participants

A population-based sample of people (N=150) with a confirmed diagnosis of MS (Expanded Disability Status Scale, 3.5–6.5) was recruited via a patient-centered longitudinal study database of disease course in people with MS.

Interventions

Not applicable.

Main Outcome Measures

Rate of actual and near falls, circumstances and consequences of falls (including rates and type of injury plus follow-up care).

Results

The response rate for the falls diary was 92.7%. A total of 672 actual falls and 3785 near falls were recorded, with a moderate correlation between the numbers of actual and near falls per person (ρ=.474; 95% confidence interval, .34–.59). Men recorded significantly more falls than women. Falls were associated with a range of activities, although 27.6% occurred during general mobility activities such as walking, turning, and moving between positions. Injuries occurred in 11.1% of falls, with 6 individuals requiring medical attention.

Conclusions

People with MS experience high numbers of falls, with associated injuries. Falls occur during a wide range of activities, reflecting their potential impact on daily life. Evaluating the characteristics of individuals who experience frequent near falls but few actual falls may be valuable for research and clinical practice.     

Comparison of the Responsiveness of the FIM and the interRAI Post Acute Care Assessment Instrument in Rehabilitation of Older Adults

Glenny C, Stolee P, Husted J, Thompson M, Berg K. Comparison of the responsiveness of the FIM and the interRAI Post Acute Care Assessment Instrument in rehabilitation of older adults.

Objective

To compare the responsiveness of 2 major systems developed for rehabilitation settings—the FIM and the interRAI Post Acute Care (PAC) assessment—in older patients.

Design

Trained raters assessed patients with both tools at admission and discharge.

Setting

Musculoskeletal (MSK) and geriatric rehabilitation units (GRUs) in 2 rehabilitation hospitals.

Participants

Older adults receiving rehabilitation (N=208; mean age ± SD, 78.5±9.3; 67% women).

Interventions

Not applicable.

Main Outcome Measures

Responsiveness was evaluated using effect size (ES) and standardized response mean (SRM).

Results

ES and SRM were somewhat higher for the FIM motor (GRU ES=1.68, SRM=1.31; MSK ES=2.12, SRM=2.25) than the PAC (GRU ES=1.64, SRM=1.29; MSK ES=1.57, SRM=1.89) in both patient groups. Both tools were more responsive in MSKs than GRUs. This may reflect the greater frailty and clinical complexity of GRU patients.

Conclusions

Both the FIM motor and the PAC were able to detect clinically relevant improvement in functional ability in older rehabilitation inpatients.     

Validity of Simple Gait-Related Dual-Task Tests in Predicting Falls in Community-Dwelling Older Adults

Objective

To investigate the predictive validity of simple gait-related dual-task (DT) tests in predicting falls in community-dwelling older adults.

Design

A validation cohort study with 6 months' follow-up.

Setting

General community.

Participants

Independently ambulant community-dwelling adults (N=66) aged ≥65 years, with normal cognitive function. Sixty-two completed the follow-up. No participants required frames for walking.

Interventions

Not applicable.

Main Outcome Measures

Occurrence of falls in the follow-up period and performance on primary and secondary tasks of 8 DT tests and 1 triple-task (TT) test.

Results

A random forest classification analysis identified the top 5 predictors of a fall as (1) absolute difference in time between the Timed Up & Go (TUG) as a single task (ST) and while carrying a cup; (2) time required to complete the walking task in the TT test; (3 and 4) walking and avoiding a moving obstacle as an ST and while carrying a cup; and (5) performing the TUG while carrying a cup. Separate bivariate logistic regression analyses showed that performance on these tasks was significantly associated with falling (P<.01). Despite the random forest analysis being a more robust approach than multivariate logistic regression, it was not clinically useful for predicting falls.

Conclusions

This study identified the most important outcome measures in predicting falls using simple DT tests. The results showed that measures of change in performance were not useful in a multivariate model when compared with an “allocated all to falls” rule.     

Falls efficacy among stroke survivors living in the community

Purpose.?The study focused on the falls efficacy of stroke survivors in the community and its association with the related factors.

Method.?The study was conducted through a cross-sectional design in the community setting. One hundred seven stroke survivors were recruited. Falls efficacy was measured by the 7-item Falls Efficacy Scale International version, where the higher mean score showed more concern about falling in daily life.

Results.?Activities of daily living (ADL) dependency levels, including mild, moderate and severe, contributed to 33.5%% of the explained variance. Women were over 7.5 times more likely to have high falls efficacy than men. Moderate and severe ADL dependency participants were 10.8 and 13.6 times more likely to have high falls efficacy than ADL independent participants. Single fall participants were also nearly 13 times more likely to have high falls efficacy than others who had either recurrent falls or no falls.

Conclusions.?Female gender, strong ADL dependency, and single falls were associated with high falls efficacy. The levels of ADL dependency were the most correlated with falls efficacy than with other related factors. Rehabilitation interventions should also be incorporated to minimise ADL dependency, and to improve falls efficacy for stroke survivors.     

Effects of Tai Chi Intervention on Dual-Task Ability in Older Adults: A Pilot Study

Hall CD, Miszko T, Wolf SL. Effects of Tai Chi intervention on dual-task ability in older adults: a pilot study.

Objective

To determine if a 12-week program of Tai Chi that has been shown to reduce falls incidence in older adults would improve the ability to allocate attention to balance under dual-task conditions.

Design

Pre-/posttest experimental research design.

Setting

Movement studies research laboratory.

Participants

Community dwelling older adults (N=15; range, 62-85y) participated in either Tai Chi training or health education classes (controls) for 12 weeks.

Interventions

Participants in the Tai Chi group attended a twice-weekly, 1.5-hour class taught by an experienced instructor. The control group attended a biweekly, 1-hour class for lectures on health-related topics.

Main Outcome Measures

Two cognitive tasks (responding to auditory or visual stimulus as quickly as possible) were performed concurrently while maintaining static balance during the Sensory Organization Test (SOT) and while avoiding obstacles while walking. The percent change in performance relative to the single-task condition was calculated and defined as the dual-task cost. The dual-task cost was calculated for both the postural and cognitive measures.

Results

There was no improvement in the performance of postural stability or cognitive task under dual-task conditions for the SOT for Tai Chi versus controls. There was no improvement in avoiding obstacles under dual-task conditions for Tai Chi versus controls.

Conclusions

Contrary to our hypothesis, the findings of this study did not support a benefit of Tai Chi on the ability to allocate attention to balance under dual-task conditions.     

Upper Extremity Kinematics and Muscle Activation Patterns in Subjects With Facioscapulohumeral Dystrophy

Objective

To compare the kinematics and muscle activity of subjects with facioscapulohumeral dystrophy (FSHD) and healthy control subjects during the performance of standardized upper extremity tasks.

Design

Exploratory case-control study.

Setting

A movement laboratory.

Participants

Subjects (N=19) with FSHD (n=11) and healthy control subjects (n=8) were measured.

Interventions

Not applicable.

Main Outcome Measures

Kinematic data were recorded using a 3-dimensional motion capturing system. Muscle activities, recorded using electromyography, were obtained from 6 superficial muscles around the glenohumeral joint. Shoulder elevation and elbow flexion angles, and maximum electromyographic activity during the movements as a percentage of maximum voluntary contraction (MVC) were calculated.

Results

Kinematic differences between the FSHD group and the healthy control group were found in the shoulder elevation angle during single shoulder movements and both reaching tasks. In general, subjects with FSHD had higher percentages of muscle activation. The median activity of the trapezius was close to the MVC activity during the single shoulder movements. Moreover, deltoid and pectoralis muscles were also highly active.

Conclusions

Higher activation of the trapezius in subjects with FSHD indicates a mechanism that could help relieve impaired shoulder muscles during arm elevation around shoulder height. Compared with healthy subjects, persons with FSHD activated their shoulder muscles to a greater extent during movements that required arm elevation.     

行为学习对提高阿尔茨海默病患者自理能力的探讨

目的 探讨行为学习训练能否提高阿尔茨海默病患的日常生活和认知能力，能否激发其思维活动，从而提高其生活质量。方法 选择住院的56例阿尔茨海默病患，随机分为实验组和对照组各28例，除进行常规治疗护理外，实验组再接受行为学习训练。以日常生活能力量表(ADL)和简易智力筛选量表(MMSE)为评定工具。结果 实验组经行为学习训练后ADL量表中(除洗澡和打电话两项外)，其余各项均P＜0．05，差异有显性；而对照组ADL各项均P＞0．05，差异无显性。实验组MMSE比较有6项P＜0．05，差异有显性，而对照组MMSE仅在语言理解和定向方面有改善，P＜0．05。结论 行为学习训练能提高阿尔茨海默病患的生活自理能力，有利于改善患的认知障碍及激发其思维活动和增强其社交能力，从而提高其生活质量。     

A Comparison of 3-D Shoulder Kinematics to Perform ADLs Between Older and Younger Adults

ABSTRACT

The primary purpose of this study was to compare the 3-D kinematics of older and younger adults during activities of daily living. Twenty-five older and 27 younger asymptomatic participants were evaluated. The MotionMonitor was used to collect humerus, scapula, and trunk kinematic data. Multivariate analyses of variance (MANOVA) were used to analyze kinematic differences. Significant differences between groups were found. In several comparisons, the older participants had significantly less shoulder joint complex motion than the younger participants. For feeding, the older participants had 16.3° less glenohumeral external rotation, 5.0° less scapular upward rotation, and 8.6° less scapular internal rotation. For reaching an overhead shelf, the older group had 8.1° less glenohumeral flexion, 11.8° less external rotation and 16.0° less scapular internal rotation. For hair combing, the older participants had 13.3° less glenohumeral external rotation, and 6.6° less scapular internal rotation. For washing the contralateral axilla, the older group had 7.7° less scapular internal rotation. In several other comparisons, the older group had significantly more shoulder complex motion than the younger participants. For hair combing, the older group had 14.6° more glenohumeral flexion. For washing the contralateral axilla, the older group demonstrated 7.8° more glenohumeral flexion and 13.0° more glenohumeral internal rotation. Overall, older and younger participants demonstrated significantly different shoulder joint complex kinematics. Age specific values should be considered when interacting with a patient presenting with shoulder dysfunction.     

Life Habits and Prosthetic Profile of Persons With Lower-Limb Amputation During Rehabilitation and at 3-Month Follow-Up

Zidarov D, Swaine B, Gauthier-Gagnon C. Life habits and prosthetic profile of persons with lower-limb amputation during rehabilitation and at 3-month follow-up.

Objective

To assess performance of life habits among persons with lower-limb amputation at admission, at discharge, and 3 months after rehabilitation discharge and describe their prosthetic profile at discharge and follow-up.

Design

Case series.

Setting

Inpatient rehabilitation.

Participants

Unilateral persons with lower-limb amputation (N=19; 14 men; mean age, 53.4±14.6y).

Intervention

Interdisciplinary rehabilitation.

Main Outcome Measures

Life habits performance and prosthetic profile.

Results

In the daily activities subdomain, the lowest performances were observed for mobility and housing at all evaluation times. Within the social role subdomain, employment, recreation, and community life scores were the lowest for the 3 evaluations. Mean scores for all activities of daily living subdomain categories significantly increased (P<.05) during rehabilitation except for personal care and communication. Only community life (social roles subdomain) significantly increased during rehabilitation; life habits remained unchanged after discharge. Fifty-eight percent of patients at discharge versus 68.4% at follow-up used their prosthesis for more than 9 hours a day, and this increased significantly postdischarge (P=.017). Locomotor capability with prosthesis was similarly high at discharge and follow-up.

Conclusions

Among persons with lower-limb amputation, social role life habits appear to be more disturbed than those associated with activities of daily living. At discharge, prosthetic wear and locomotor capabilities with prosthesis were high and tended to improve on return to the community.     

Aging with a spinal cord injury: factors associated with the need for more help with activities of daily living

OBJECTIVES: To determine (1) the frequency of the need for more help with activities of daily living (ADLs), (2) the frequency of medical complications, and (3) the association between medical, injury-related, and sociodemographic factors and the need for more help with ADLs among those aging with spinal cord injury (SCI). DESIGN: Cross-sectional survey. SETTING: General community, international. PARTICIPANTS: Volunteers (N=352) with SCI for more than 20 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The need for more help with ADLs. RESULTS: The need for more help with ADLs during the last 3 years was reported by 32.1% of participants. At least 1 medical complication was reported by 85%. Constipation (47.9%), diarrhea/bowel accidents (41.8%), and pressure ulcers (38.7%) were common. Constipation, pressure ulcers, female gender, and years postinjury were associated with needing more help with ADLs. Constipation and pressure ulcers were associated with a 97% and a 76% increase, respectively, in the likelihood of needing more help with ADLs during a 3-year time period. Female gender was associated with a 96% increased odds of needing more help with ADLs. There was a 42% increased odds of needing more help with ADLs per decade after SCI. CONCLUSIONS: People aging with SCI are vulnerable to medical complications, and additional help is required to function. Knowledge of the effect of these factors, particularly the tetrad of constipation, pressure ulcers, female gender, and number of years postinjury, should increase awareness that more help with ADLs may be needed over time.     

Reducing Risk of Falling in Older People Discharged From Hospital: A Randomized Controlled Trial Comparing Seated Exercises, Weight-Bearing Exercises, and Social Visits

Vogler CM, Sherrington C, Ogle SJ, Lord SR. Reducing risk of falling in older people discharged from hospital: a randomized controlled trial comparing seated exercises, weight-bearing exercises, and social visits.

Objective

To compare the efficacy of seated exercises and weight-bearing (WB) exercises with social visits on fall risk factors in older people recently discharged from hospital.

Design

Twelve-week randomized, controlled trial.

Setting

Home-based exercises.

Participants

Subjects (N=180) aged 65 and older, recently discharged from hospital.

Interventions

Seated exercises (n=60), WB exercises (n=60), and social visits (n=60).

Main Outcome Measures

Primary outcome factors were Physiological Profile Assessment (PPA) fall risk score, and balance while standing (Coordinated Stability and Maximal Balance Range tests). Secondary outcomes included the component parts of the PPA and other physical and psychosocial measures.

Results

Subjects were tested at baseline and at completion of the intervention period. After 12 weeks of interventions, subjects in the WB exercise group had significantly better performance than the social visit group on the following: PPA score (P=.048), Coordinated Stability (P<.001), Maximal Balance Range (P=.019); body sway on floor with eyes closed (P=.017); and finger-press reaction time (P=.007) tests. The seated exercise group performed better than the social visit group in PPA score (P=.019) but for no other outcome factor. The seated exercise group had the highest rate of musculoskeletal soreness.

Conclusions

In older people recently discharged from the hospital, both exercise programs reduced fall risk score in older people. The WB exercises led to additional beneficial impacts for controlled leaning, reaction time, and caused less musculoskeletal soreness than the seated exercises.     

Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Stroke: 2- and 3-Year Follow-up From the Pilot Study

ObjectiveTo assess whether a long-term home-based intervention using Paired VNS therapy is feasible and whether the benefits of Paired VNS therapy are maintained beyond 1 year.DesignA long-term follow-up study.SettingThree centers in the United States and 1 in the United Kingdom.ParticipantsAdults with chronic ischemic stroke (n=15) with moderate to severe arm and hand impairment.InterventionsParticipants were implanted with a VNS device followed by 6 weeks of in-clinic therapy with Paired (Active) or control VNS followed by home-based rehabilitation through day 90 (blinded phase). The control VNS group then crossed over to receive 6 weeks of in-clinic Active VNS. Participants in both groups then continued a long-term home exercise program with self-administered Active VNS.Main Outcome MeasuresFugl-Meyer Assessment for Upper Extremity (FMA-UE) and Wolf Motor Function Test (WMFT) Functional scores were evaluated at the end of in-clinic therapy and day 90. Since both groups were subsequently receiving home-based rehabilitation with Active VNS during the long term, follow-up outcome assessments were pooled for the analyses at 6, 9, and 12 months, as previously reported. Here, we report pooled analysis of outcomes beyond 1 year.ResultsOne year after Paired VNS therapy, FMA-UE improved by an average of 9.2±8.2 points, as previously reported. Overall, the 2- and 3-year FMA-UE gain from baseline was 11.4±8.7 (P<.001) and 14.8±10.2 points (P<.001), respectively. At years 2 and 3, FMA-UE improved by an additional 2.9 (P=.03 for change vs year 1, n=14) and 4.7 (P=.02 for change vs year 1, n=14) points, respectively. At year 1, 73% (11/15) of participants were responders (FMA-UE change ≥6) and by year 3, 85.7% (12/14) were responders. At years 2 and 3, the WMFT score improved by an additional 0.21 points (P=.03 for change vs year 1, n=15) and 0.42 points (P=.01 for change vs year 1, n=13), respectively. Responder rate (WMFT change ≥0.4) was 46.6% (7/15), 73.3% (11/15), and 69.2% (9/13) at years 1, 2, and 3, respectively. Long-term significant improvements were also observed for Motor Activity Log (MAL) and Stroke Impact Scale, Hand section (SIS-Hand). There were no serious long-term adverse events from the stimulation.ConclusionsSignificant effects of Paired VNS therapy at 1 year were maintained at years 2 and 3, and further improvements in both impairment and function were observed in years 2 and 3. These changes were associated with improvements in measures of activity and participation.     

Effect of a 12-Week Yoga Intervention on Fear of Falling and Balance in Older Adults: A Pilot Study

Schmid AA, Van Puymbroeck M, Koceja DM. Effect of a 12-week yoga intervention on fear of falling and balance in older adults: a pilot study.

Objective

To determine whether fear of falling (FoF) and balance improved after a 12-week yoga intervention among older adults.

Design

A 12-week yoga intervention single-armed pilot study.

Setting

A retirement community in a medium-sized university town in the Midwest.

Participants

A convenience sample of adults (N=14) over the age of 65 years who all endorsed an FoF.

Intervention

Each participant took part in a biweekly 12-week yoga intervention. The yoga sessions included both physical postures and breathing exercises. Postures were completed in sitting and standing positions.

Main Outcome Measures

We measured FoF with the Illinois FoF Measure and balance with the Berg Balance Scale. Upper- and lower-body flexibility were measured with the back scratch test and chair sit and reach test, respectively.

Results

FoF decreased by 6%, static balance increased by 4% (P=.045), and lower-body flexibility increased by 34%.

Conclusions

The results indicate that yoga may be a promising intervention to manage FoF and improve balance, thereby reducing fall risk for older adults. Rehabilitation therapists may wish to explore yoga as a modality for balance and falls programming; however, future research is needed to confirm the use of yoga in such programming.