The effect of the interaction between fall-related self-efficacy and gait function on the occurrence of falls in community-dwelling older people

Does concern about falling predict future falls in older adults? A systematic review and meta-analysis

BACKGROUND

The 2022 World Falls Guidelines recommend assessing concerns (or 'fears') about falling in multifactorial fall risk assessments. However, the evidence base for this recommendation is limited. This review evaluated the evidence for concerns about falling as an independent predictor of future falls, applying the Bradford Hill criteria for causality.

METHODS

Systematic review and meta-analyses were conducted (PROSPERO registration ID: CRD42023387212). MEDLINE, CINAHL Plus, Web of Science and PsycINFO were searched for studies examining associations between baseline concerns about falling and future falls in older adults (minimum 6-month follow-up). Meta-analyses examined associations between concerns about falling and future falls. Risk of bias was assessed using an adapted Newcastle Ottawa Scale for cohort studies, and evidence certainty was rated with GRADE.

RESULTS

About 53 studies, comprising 75,076 participants, were included. Meta-analysis showed significant independent association between baseline concerns and future falls when using the Falls Efficacy Scale-International to assess concerns (full scale version, pooled OR = 1.03 [95% CI = 1.02-1.05] per 1-point increase; short scale version, pooled OR = 1.08 [95% CI = 1.05-1.11]). Significant associations were also observed when using single-item measures of concerns (pooled OR = 1.60 [95% CI = 1.36-1.89] for high vs. low concerns). In contrast, balance confidence (Activities-Specific Balance Confidence Scale) did not predict future falls (pooled OR = 0.97 [95% CI = 0.93-1.01]). Despite 26 studies rated as poor quality, associations were consistent across studies of different quality. The overall certainty of the evidence was rated as moderate.

CONCLUSIONS

Baseline concern about falling is a clear predictor of future falls in older adults, supporting its inclusion in fall risk assessments. Regular assessment of concerns about falling, along with targeted interventions, could help reduce the risk of falls in older adults.

Association of Moderate-to-Vigorous Physical Activity, Sedentary Time, Fat Percentage, and Physical Fitness with Gait Parameters in Women with Fibromyalgia: The Al-Ándalus Project

Gait impairments have been found in women with fibromyalgia, reducing the physical activity possibilities in this population and leading to a negative correlation with fibromyalgia impact. The aim of this study was to analyze the individual and independent associations of moderate-to-vigorous physical activity (MVPA), sedentary time, fat percentage, and physical fitness with gait parameters in women with fibromyalgia. A total of 84 women with fibromyalgia were included. MVPA and sedentary time were assessed with accelerometry, fat percentage with bioimpedance analysis, and physical fitness with field-based fitness tests. Gait was assessed during a "6 min walk test" and categorized in velocity, cadence, step length, step cycle duration, unipedal stance phase, and bipedal stance phase. Individual relationships were analyzed by partial correlations and independent relationships by linear regressions, adjusting by age and height. MVPA, sedentary time, fat percentage, and physical fitness were correlated with most gait parameters (rpartial between |0.842| and |0.219|; p ≤ 0.05). Physical fitness was independently associated with all gait parameters (β between |0.346| and |0.761|; p ≤ 0.002). In addition, MVPA was independently associated with velocity and step length (β = 0.241 and 0.292; both p = 0.004), and fat percentage was associated with bipedal stance phase (β = 0.242; p = 0.049). Good levels of MVPA, physical fitness, and adequate weight balance are associated with improved gait parameters in women with fibromyalgia.

Detecting differences in limb load asymmetry during walking between older adult fallers and non-fallers using in-shoe sensors

BACKGROUND

Previous studies have reported that clinical walk tests could not detect differences between fallers and non-fallers in older adults. With advancements in wearable technology, it may be possible to assess differences in loading parameters in clinical settings using portable data collection methods.

RESEARCH QUESTION

The purpose of this study was to determine if wearable sensors (loadsol®) are reliable for assessing asymmetry of contact time, peak force, loading rate (LR), and impulse in older adults and determine if the insole can detect differences in these parameters between fallers and non-fallers during walking.

METHODS

Fifty-five older adults (74.1 ± 6.1 years) walked at their maximum speed on a flat floor. Force data were collected from insoles (100 Hz) during a 10-m walk test. To assess reliability, an intraclass correlation coefficient [ICC(2,k)] was generated for each asymmetry variable. To determine differences between fallers and non-fallers, analysis of covariance (ANCOVA; covariate: body mass index) was completed for each variable.

RESULTS

The ICC of peak force asymmetry (PFA) was 0.942, but other ICCs were less than 0.75. The ANCOVA results indicate that the loadsol® can detect differences in PFA between fallers and non-fallers. The PFA was significantly greater in fallers than in non-fallers.

SIGNIFICANCE

The ability to collect force data while walking using loadsol® has the potential to broaden the research questions investigated, explore clinical applications, and increase generalizability.

Balance Confidence Modulates the Association of Gait Speed With Falls in Older Fallers: A Prospective Cohort Study

OBJECTIVES

Self-perceived balance confidence (BC) and gait speed influence falls. Whether they modulate each other in fall prediction stays uncertain. This study examined whether and how BC modulated the association between gait speed and falls.

DESIGN

Prospective observational cohort study.

SETTING AND PARTICIPANTS

Older adults who were community-dwelling, ≥65 years old, able to walk for 10 meters independently, and had 1 or more falls in the past year were assessed at a research clinic.

METHODS

Participants were followed up trimonthly for 12 months after the baseline. Optimal cutoff values for gait speed for prospective falls were identified by classification and regression tree analysis. Associations among gait speed, BC, and falls were estimated with negative binomial regression models. Subgroup analyses for high and low BC were performed. Covariates such as basic demographics, generic cognition, fall histories, and other physical functions were adjusted.

RESULTS

During the follow-up period, 65 (14%) of the 461 included participants (median age 69.0 ± 10.0 years, range 60-92) reported 83 falls in total. In both the pooled and subgroup analyses for the low- and high-BC groups, the high-speed subgroup (≥1.30 m/s) showed an increased fall risk compared with the moderate-speed subgroup (≥0.81 and <1.30 m/s) [adjusted odds ratio (OR), 1.84-2.37; 95% CI, 1.26-3.09]. A statistically significant linear association between gait speed and falls was shown in the high-BC group. In the low-BC group, a u-shaped association was evident (adjusted OR, 2.19-2.44; 95% CI, 1.73-3.19) with elevated fall risks in both the high- and low-speed subgroups compared with the moderate-speed subgroup (adjusted OR, 1.84-3.29; 95% CI, 1.26-4.60).

CONCLUSIONS AND IMPLICATIONS

BC modulated the association between gait speed and falls. There were linear and nonlinear associations between gait speed and falls in people with high and low BC, respectively. Clinicians and researchers should consider the effects of BC when predicting falls with gait speed.

Subjective Age and Falls in Older Age: Evidence from two Longitudinal Cohorts

OBJECTIVES

Falls are a common and serious health problem. The present study examined the association between subjective age (i.e., feeling younger or older than one's chronological age) and falls in two large national samples.

METHOD

Participants, aged 65 to 105 years old, were drawn from the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Data on falls, subjective age, demographic factors, was available from 2,382 participants in HRS and 3,449 in NHATS. Falls were tracked for up to 8 (HRS) and 7 (NHATS) years.

RESULTS

Cox regression analyses that included demographic covariates indicated that older subjective age increased the risk of falling in HRS (hazard ratio [HR]=1.17, 95% confidence interval [CI]=1.08-1.27), and in NHATS (HR=1.06, 95%CI=1.00-1.13). When compared to people who felt younger, people who reported an older subjective age had a higher risk of fall (HRS: HR=1.65, 95% CI=1.33-2.04; NHATS: HR=1.44, 95% CI=1.15-1.79). The associations remained significant after accounting for depressive symptoms, handgrip strength, chronic diseases, and cognitive impairment in HRS only.

DISCUSSION

These results confirm the role of subjective age as an important health marker in the aging population. Subjective age assessment can help identify individuals at greater risk of falls.

Gait characteristics in community-dwelling older persons with low skeletal muscle mass and low physical performance

Background

Demographic changes in the western world entail new clinical approaches and challenges in older persons. Low skeletal muscle mass and low physical performance in older persons are both predisposing conditions for disability and obtaining knowledge in this cohort is essential.

Aim

The primary aim of the study was to analyze a broader spectrum of gait characteristics within this specific population and differentiate them across different test conditions.

Methods

Two centers participating at the SPRINTT project with hi-tech gait analysis available conducted a cross-sectional descriptive study on N = 115 community-dwelling older persons with low muscle mass and physical performance.

Reference values of 13 gait parameters were collected across different conditions: usual gait speed, fast gait speed, and usual gait speed while simultaneously naming animals.

Results and discussion

This study shows the first spatio-temporal reference values in a community-dwelling older population composed of individuals with low skeletal muscle mass and low physical performance. In comparison to the normative spatio-temporal gait parameters in older persons reported in the literature, this population showed some differences. The mean gait speed was lower than 1 m/s, considered as a cutoff for vulnerable community-dwelling individuals, which corresponds to a greater risk of falls, hospitalization, and mortality. The stride length variability was higher, exposing to a greater risk of falling, and was also associated with a higher risk of developing cognitive decline.

Conclusion

This study represents the first step in the development of quantitative reference values in community-dwelling older persons with low physical performance and low skeletal muscle mass.

Movement-Specific Reinvestment in Older People Explains Past Falls and Predicts Future Error-Prone Movements

The tendency to think about or consciously control automated movements (i.e., movement-specific reinvestment) is a crucial factor associated with falling in the elderly. We tested whether elderly people's movement-specific reinvestment depended on their past falling history and whether it can predict future error-prone movements. In a longitudinal pre-post design, we assessed n = 21 elderly people's (M_age = 84.38 years, SD = 5.68) falling history, movement-specific reinvestment (i.e., Movement-Specific Reinvestment Scale), and physical functioning (i.e., Short-Physical-Performance Battery). Following a baseline assessment, participants reported their movement behavior in a daily diary for 2 months, after which we assessed their movement-specific reinvestment and physical functioning again (longitudinal, pre-post design). Results revealed, first, that participants' movement self-consciousness score was fairly stable, while their conscious-motor-processing score was less stable. Second, conscious motor processing was higher in participants who had fallen as opposed to those who had not fallen in the past. Third, conscious motor processing predicted error-prone future movement behavior reported in the daily diary. For identifying individuals who are more prone to fall, caregivers, rehabilitation staff, or doctors could apply the Movement-Specific Reinvestment Scale to screen elderly people's psychomotor behavior. Based on conscious motor processing, monitoring cognitions could be tailored in theory-based, individual interventions involving both cognitive and motor training.