Does chair type influence outcome in the timed "Up and Go" test in older persons?

Pilot study: Comparison of Timed Up and Go test with and without walking aid in stroke patients

This pilot study compared Timed Up and Go (TUG) test results with and without walking aids and their correlation with balance. Twenty-five stroke patients (mean age 59.72 ± 13.0 years; 17 male, 8 female) were included in this cross-sectional study. Patients at least 2 months post-stroke, Mini-Mental State Test > 24, and able to walk 10 meters with or without walking aids were included. Functional mobility was assessed with Timed Up and Go. Participants completed TUG twice: with and without walking aids. Balance was measured using the Berg Balance Scale. The mean Timed Up and Go value without aids was 50.44 ± 18.22 sec, and with aids was 42.32 ± 14.97 sec. Paired-sample T-test revealed a significant difference between Timed Up and Go values with and without aids (p = 0.01). TUG scores with and without aids and Berg Balance Scale scores showed high negative correlations (r = -0.534, r = -0.789). The use of walking aids improves Timed Up and Go scores in stroke patients. Based on these results, whether the patient uses a walking aid should be considered for accurate assessment, interpretation, and treatment of mobility and balance.

Methodological challenges in a study on falls in an older population of Cape Town, South Africa

BACKGROUND

Falls are a major cause of disability, morbidity and mortality in older persons, but have been under researched in developing countries.

OBJECTIVE

To describe challenges encountered in a community-based study on falls in a multi-ethnic population aged ≥65 years in a low-income setting.

METHODS

The study was conducted in four stages: A pilot study (n=105) to establish a sample size for the survey. An equipment validation study (n=118) to use for fall risk determination. A cross-sectional baseline (n=837) and a 12-month follow-up survey (n=632) to establish prevalence and risk factors for falls.

RESULTS

Prevalence rate of 26.4% (95% CI 23.5-29.5%) and risk factors for recurrent falls: previous falls, self-reported poor mobility and dizziness were established. Adaptations to the gold standard prospective fall research study design were employed: 1) to gain access to the study population in three selected suburbs, 2) to perform assessments in a non-standardised setting, 3) to address subjects' poverty and low literacy levels, and high attrition of subjects and field workers.

CONCLUSION

Studies on falls in the older population of low- to middle-income countries have methodological challenges. Adaptive strategies used in the Cape Town study and the research experience reported may be instructive for investigators planning similar studies in such settings.

Risk factors for falls in older adults in a South African Urban Community

Background

Studies on falls in older adults have mainly been conducted in high income countries. Scant, if any, information exists on risk factors for falls in the older population of sub-Saharan African countries.

Methods

A cross-sectional survey and a 12-month follow-up study were conducted to determine risk factors for falls in a representative multi-ethnic sample of 837 randomly selected ambulant community-dwelling subjects aged ≥65 years in three suburbs of Cape Town, South Africa. Logistic regression models were fitted to determine the association between (1) falls and (2) recurrent falls occurring during follow-up and their potential socio-demographic, self-reported medical conditions and physical assessment predictors.

Results

Prevalence rates of 26.4 % for falls and 11 % for recurrent falls at baseline and 21.9 % for falls and 6.3 % for recurrent falls during follow-up. In both prospective analyses of falls and recurrent falls, history of previous falls, dizziness/vertigo, ethnicity (white or mixed ancestry vs black African) were significant predictors. However, poor cognitive score was a significant predictor in the falls analysis, and marital status (unmarried vs married) and increased time to perform the timed Up and Go test in the recurrent fall analysis but not in both. Other than the timed Up and Go test in recurrent falls analysis, physical assessment test outcomes were not significant predictors of falls.

Conclusion

Our study provides simple criteria based on demographic characteristics, medical and physical assessments to identify older persons at increased risk of falls. History taking remains an important part of medical practice in the determination of a risk of falls in older patients. Physical assessment using tools validated in developed country populations may not produce results needed to predict a risk of falls in a different setting.