Associations between physical function, falls, and the fear of falling among older adults participating in a community-based physical exercise program: A longitudinal multilevel modeling study

Physical activity six months after a severe fall - moderating factors in older individuals

BACKGROUND

Severe falls in older individuals are a leading cause of emergency department (ED) visits and often result in long-term impairments that reduce physical activity (PA). Limited information exists on the characteristics of individuals who suffer from physical inactivity after such falls and the factors that influence it. This study investigates the association between potential moderators and changes in PA in older adults six months after a severe fall.

METHODS

Participants were recruited from the SeFallED study (German Clinical Trials Register ID: 00025949). Moderators were evaluated through a home-based geriatric assessment conducted within four weeks of a severe fall with presentation to the ED. PA was quantified using both sensor-based (n = 72 men (75 years), n = 106 women (74 years) and self-reported (n = 105 men (74 years), n = 174 women (73 years) assessments. A Linear Mixed Model was used for analysis.

RESULTS

Sensor-based PA revealed a significant time effect for step count (p = 0.006), indicating an increase in PA six months after a severe fall. Fall history (95% CI: -1,009.5 - (-207.4), p = 0.003) and age (95% CI: -315.8 - (-82.5), p < 0.01) were significant negative moderators for changes in PA, only in women. No significant changes in self-reported PA were observed after six months (p = 0.109).

CONCLUSION

Participants showed an increase in sensor-based PA six months after a severe fall, though this was negatively associated with age and fall history. Early identification of factors that affect PA recovery may help stratify individuals by risk and target those in need of secondary prevention.

TRIAL REGISTRATION

DRKS (Deutsches Register für klinische Studien, DRKS0 00259 49). Prospectively registered on 4th November, 2021.

Physical Activity and Falls From Midlife: Patterns and Bidirectional Associations

INTRODUCTION

The relationship between physical activity behavior and subsequent falls in adults from midlife to older age is unclear. Falls and fall-related injuries could lessen physical activity participation. This study examined patterns and bidirectional associations between physical activity and falls from midlife to older age.

METHODS

In the Australian Longitudinal Study on Women's Health, women born 1946-1951 (n=11,759, mean age: 56 years at baseline in 2004) self-reported weekly physical activity amounts (0, 1-<150, 150-<300, ≥300 minutes/week) and noninjurious and injurious falls every 3 years between 2004 survey and 2019 survey. Bidirectional prospective 3-year associations between physical activity and falls were examined using generalized estimating equations to estimate ORs and 95% CIs, adjusting for directed acyclic graph-informed covariates. Analyses were conducted in 2023.

RESULTS

Participation in any amount of physical activity was associated with a reduced risk of injurious falls (OR1-<150 min=0.87; 95% CI=0.80, 0.96; OR150-<300 min=0.87; 95% CI= 0.79, 0.96; OR≥300 min=0.85; 95% CI=0.78, 0.93) in the next 3 years, compared with women with no physical activity. Women who reported noninjurious falls had lower odds of undertaking ≥300 minutes/week of physical activity 3 years later (OR=0.84; 95% CI=0.77, 0.92), compared with women without falls. Women who reported injurious falls had lower odds of subsequently undertaking various amounts of physical activity (OR=0.83, 95% CI=0.75, 0.91 for 1-<150; OR=0.82, 95% CI=0.74, 0.90 for 150-<300; OR=0.83, 95% CI=0.76, 0.90 for ≥300 minutes/week).

CONCLUSIONS

The prospective bidirectional association between physical activity and falls supports addressing falls by promoting activity and highlighting the impact of injurious falls on reduced physical activity participation.

The effect of proprioceptive neuromuscular facilitation techniques compared to general aerobic exercise on balance, fear of falling, and quality of life in older adults living in nursing homes: a randomized controlled trial

BACKGROUND

With aging, changes occur in various body systems, such as cardiovascular, respiratory, neuromusculoskeletal, and vestibular, leading to a decreased quality of life (QOL) and an increased fear of falling (FOF). Exercise and physical activity reduce the progression of aging complications. Therefore, we examined the effect of proprioceptive neuromuscular facilitation techniques compared to aerobic exercise on balance, fear of falling, and quality of life in older adults living in nursing homes.

METHODS

Fifty-two older adults aged over 60 (31 males, 21 females) living in nursing homes were included. After initial evaluation, individuals were randomly assigned to two treatment groups (PNF techniques and aerobic exercise). Both treatment groups received 12 treatment sessions over 4 weeks. Balance, fear of falling, and quality of life were assessed at baseline and after a 4-week intervention. Analysis of covariance (ANCOVA) and paired samples t-test were utilized to between and within-group changes of variables.

RESULTS

The results showed no significant differences in balance, fear of falling, and quality of life between groups after the intervention (P > 0.05). In the within-group comparison, only the PNF techniques group showed significant improvement in the Berg Balance Scale (BBS) after the intervention (P < 0.05).

CONCLUSION

The findings suggest that PNF techniques compared with aerobic exercise could not contribute to improved balance, fear of falling, and quality of life. Therefore, more clinical trial studies with a control group are needed to determine the exact effects of these techniques.

TRIAL REGISTRATION NUMBER (TRN) AND DATE OF REGISTRATION

The trial was registered at the ( https://www.irct.ir ), (IRCT20210505051181N4) on 9/2/2023.

A multiple correspondence analysis of the fear of falling, sociodemographic, physical and mental health factors in older adults

Fear of falling (FoF) is a disabling condition due to different factors. The present study assessed potential FoF predictors, among sociodemographic, physical, and mental health domains, and explored their structural patterns. This cross-sectional study is part of the Physical Activity Promotion & Domestic Accidents Prevention (PAP & DAP) project, and was targeted to a sample of 229 independent older people (M 14.0%, F 86.0%) aged over 60 (mean 70.5 ± 5.96), both normal and overweight (median BMI 25.8 kg/m2, Interquartile Range 5.24). Standardized tools were used to assess the variables: the Short Falls Efficacy Scale International for the FoF; an information questionnaire for the socio-demographic variables, the presence of diseases, and previous falls; the International Physical Activity Questionnaire for the PA level; the Senior Fitness Test for physical fitness data; the Short Form 12 questionnaire for variables in the mental domain; and the Psychological Well-Being Scale 24 for the psychological well-being. Correlation/regression analyses were used to explore relationships between FoF and the considered variables. A Multiple Correspondence Analysis (MCA) was conducted to show graphical patterns projected into space dimensions. A percentage of 59.0 of the sample showed moderate/high concern of falling. The multiple regression model showed the following variables being significant predictors (p < 0.05) of the FoF: BMI (coeff 0.44, SE 0.104), musculoskeletal disease (1.55, 0.681), upper body strength (0.33, 0.117), mobility and balance (0.76, 0.320), perceived physical health (- 0.21, 0.047), and self-acceptance (- 0.52, 0.190). MCA evidenced two dimensions: the first one explained 41.8% of the variance and was described mostly by FoF (square residuals 0.721), gender (0.670), leg strength (0.617), perceived mental health (0.591), musculoskeletal diseases (0.572), and PA level (0.556); the second dimension (12.3% of the variance), was characterized mainly by perceived physical health (0.350), life objectives (0.346), education (0.301), upper body strength (0.278), and living in family/alone (0.260). The pattern elicited by MCA was characterized by older subjects with moderate/high FoF having low education or no occupation, being overweight and inactive, suffering from different diseases, having low physical fitness, and declaring low perceived physical and mental health. These results suggest that interventions aimed at reducing FoF should be addressed to this specific profile of older people.

Effectiveness Evaluation of Smart Home Technology in Preventing and Detecting Falls in Community and Residential Care Settings for Older Adults: A Systematic Review and Meta-Analysis

OBJECTIVES

To assess the effectiveness of smart home technologies (SHTs) in preventing and detecting falls among older adults in community and residential care settings.

DESIGN

Systematic review and meta-analysis of controlled trials on SHTs, which reported fall incidence, fear of falling, or hospitalization outcomes, was conducted. Searches were conducted across 6 academic databases for scholarly articles (PubMed, Cochrane, CINAHL, Scopus, Embase, and IEEE Xplore) and 2 databases for gray literature (ProQuest and ClinicalTrials.gov) in August 2023.

SETTING AND PARTICIPANTS

Residents of long-term residential settings ≥60 years of age.

METHODS

Eight databases were searched in August 2023 for controlled trials on SHT which reported fall incidence, fear of falling, or hospitalization outcomes. Two reviewers independently screened for studies, performed data extraction, and performed quality assessment using the Joanna Briggs Institute critical appraisal checklists. The RevMan Web was used for meta-analysis.

RESULTS

A total of 12,756 studies were retrieved from the databases search; after removing duplicates and irrelevant title/abstracts, 46 full texts were examined. Overall, 13 studies comprising 1941 participants were included. Two were classified as low quality, 5 were classified as moderate quality, and 6 were classified as high quality. SHTs were found to significantly decrease fall incidences (relative risk, 0.72; 95% CI, 0.57-0.93; z = 2.55; P = .01) but have no significant impact in influencing the fear of falling (standardized mean difference, 0.19; 95% CI, -0.15 to 0.53; z = 1.11; P = .27), and their effect on hospitalization was inconclusive.

CONCLUSIONS AND IMPLICATIONS

SHTs may be beneficial in reducing fall incidence, enhancing the safety and supporting independent living among older adults in community and residential care settings. Future research should conduct more high-quality studies and use standardized outcome measurements. Long-term residential settings could also consider adopting SHTs for fall prevention and detection to enhance the well-being of older adults.

Effectiveness of community-based Baduanjin exercise intervention for older adults with varying frailty status: a randomized controlled trial

BACKGROUND

Due to poorer exercise tolerance, it may be challenging for frail older adults to engage in moderate- or vigorous-intensity exercise. While low-intensity exercise interventions may be more feasible, its effectiveness for such population group remains unclear. We examined the effectiveness and implementation of community-based Baduanjin Qigong, a low-intensity exercise program in older adults with varying frailty status.

METHODS

A two-arm, multicenter assessor-blind parallel group randomized controlled trial was conducted at three local senior activity centers. Fifty-six community-dwelling older adults with low handgrip strength were randomly allocated to either the intervention (IG) or wait-list control (CG) group. The IG underwent a supervised 16-week Baduanjin exercise program at a frequency of 2-3 × 60 min sessions/week. The CG was instructed to maintain their usual activity and received a monthly health education talk. The primary outcome measures were knee extension strength, vital exhaustion, and fear of falling. Secondary outcome measures include physiological falls risk, handgrip strength, gait speed, timed up and go test, 30-second sit-to-stand, quality of life, depression, and frailty. All outcome measures were assessed at baseline and 4-month follow-up.

RESULTS

Overall, there were no statistically significant differences in all outcome measures between CG and IG at 4-month follow-up. However, in exploratory compliance analysis, a statistically significant group x time interaction was found for vital exhaustion (B = -3.65, 95% CI [-7.13, -0.16], p = .047) among participants with at least 75% attendance. In post-hoc within-group comparisons, IG showed improved vital exhaustion by 4.31 points (95% CI [1.41, 7.20], d = 0.60). The average participant attendance rate was 81.3%. No major adverse events occurred, and all participants reported positive experiences with the exercise intervention.

CONCLUSIONS

Our study demonstrated that Baduanjin is a safe, feasible, and acceptable exercise program that can be successfully implemented in community settings for older adults with varying frailty status. With good adherence, Baduanjin exercise could potentially be effective in alleviating vital exhaustion. However, the effectiveness of Baduanjin on physical performance, psychological measures and frailty in community-dwelling older adults remains equivocal.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04549103. Registered September 16, 2020.

Development and validation of a prediction model for falls among older people using community-based data

This is the first study to employ multilevel modeling analysis to develop a predictive tool for falls in individuals who have participated in community group exercise over a year. The tool may benefit healthcare workers in screening community-dwelling older adults with various levels of risks for falls.

PURPOSE

The aim of this study was to develop a calculation tool to predict the risk of falls 1 year in the future and to find the cutoff value for detecting a high risk based on a database of individuals who participated in a community-based group exercise.

METHODS

We retrospectively reviewed a total of 7726 physical test and Kihon Checklist data from 2381 participants who participated in community-based physical exercise groups. We performed multilevel logistic regression analysis to estimate the odds ratio of falls for each risk factor and used the variance inflation factor to assess collinearity. We determined a cutoff value that effectively distinguishes individuals who are likely to fall within a year based on both sensitivity and specificity.

RESULTS

The final model included variables such as age, sex, weight, balance, standing up from a chair without any aid, history of a fall in the previous year, choking, cognitive status, subjective health, and long-term participation. The sensitivity, specificity, and best cutoff value of our tool were 68.4%, 53.8%, and 22%, respectively.

CONCLUSION

Using our tool, an individual's risk of falls over the course of a year could be predicted with acceptable sensitivity and specificity. We recommend a cutoff value of 22% for use in identifying high-risk populations. The tool may benefit healthcare workers in screening community-dwelling older adults with various levels of risk for falls and support physicians in planning preventative and follow-up care.

V. Confirmatory factor analysis of the effect of daily-living on the happiness of community-dwelling older adults in Chile

This study examined the effect of the human-functioning dimension on happiness among community-dwelling older adults (OAs) in Chile. Questionnaires were used for data collection from a sample of 785 OAs of both sexes attending healthcare institutions. Exploratory factor analysis was performed using parallel analysis and oblique rotation. Confirmatory factor analysis and structural equation modeling were conducted using the maximum likelihood and unweighted least squares methods. Goodness-of-fit analyses were performed by considering absolute and respective incremental fit indices. The relationships between the functioning and happiness factors were all significant at the 1% level, indicating that functioning impacts happiness. The ratios of the variances between both constructs were identical to those of the covariances, indicating consistency between the models, with similarities and equalities in the estimation of their parameters. The modeling confirms a direct relationship between activities of daily living functioning and happiness. Given that a lack of functioning significantly affects OAs' happiness and quality of life, this relationship is consistent with the available theory. These findings may contribute to the formulation of social and health policies regarding OAs in Chile and other Latin American countries.

Leisure-Time Physical Activity and Falls With and Without Injuries Among Older Adult Women

Importance

Falls and fall-related injuries are common among older adults. Older adults are recommended to undertake 150 to 300 minutes of physical activity per week for health benefits; however, the association between meeting the recommended level of physical activity and falls is unclear.

Objectives

To examine whether associations exist between leisure-time physical activity and noninjurious and injurious falls in older women.

Design, Setting, and Participants

This population-based cohort study used a retrospective analysis of the Australian Longitudinal Study on Women's Health (ALSWH). ALSWH participants born from 1946 to 1951 who completed follow-up questionnaires in 2016 (aged 65-70 years) and 2019 (aged 68-73 years) were included. Statistical analysis was performed from September 2022 to February 2023.

Exposure

Self-reported weekly amounts (0, 1 to <150, 150 to <300, ≥300 minutes) and types of leisure-time physical activity, including brisk walking and moderate- and vigorous-intensity physical activity, in the 2016 survey.

Main outcome and measures

Noninjurious and injurious falls in the previous 12 months reported in the 2019 survey. Associations between leisure-time physical activity and falls were quantified using directed acyclic graph-informed multinomial logistic regression and presented in odds ratios (ORs) and 95% CIs.

Results

This study included 7139 women (mean [SD] age, 67.7 [1.5] years). Participation in leisure-time physical activity at or above the level recommended by the World Health Organization (150 to <300 min/wk) was associated with reduced odds of noninjurious falls (150 to <300 min/wk: OR, 0.74 [95% CI, 0.59-0.92]; ≥300 min/wk: OR, 0.66 [95% CI, 0.54-0.80]) and injurious falls (150 to <300 min/wk: OR, 0.70 [95% CI, 0.56-0.88]; ≥300 min/wk: OR, 0.77 [95% CI, 0.63-0.93]). Compared with women who reported no leisure-time physical activity, those who reported brisk walking (OR, 0.83 [95% CI, 0.70-0.97]), moderate leisure-time physical activity (OR, 0.81 [95% CI, 0.70-0.93]), or moderate-vigorous leisure-time physical activity (OR, 0.84 [95% CI, 0.70-0.99]) had reduced odds of noninjurious falls. No statistically significant associations were found between the types of leisure-time physical activity and injurious falls.

Conclusions and Relevance

Participation in leisure-time physical activity at the recommended level or above was associated with lower odds of both noninjurious and injurious falls. Brisk walking and both moderate and moderate-vigorous leisure-time physical activity were associated with lower odds of noninjurious falls.

Frailty trajectory predicts subsequent cognitive decline: A 26-year population-based longitudinal cohort study

Frailty refers to a decline in the physiological functioning of one or more organ systems. It remained unclear whether variations in the trajectory of frailty over time were associated with subsequent cognitive change. The aim of the current study was to investigate the association between frailty trajectories and subsequent cognitive decline based on the Health and Retirement Study (HRS). A total of 15,454 participants were included. The frailty trajectory was assessed using the Paulson-Lichtenberg Frailty Index, while the cognitive function was evaluated using the Langa-Weir Classification. Results showed that severe frailty was significantly associated with the subsequent decline in cognitive function (β [95% CI] = -0.21 [-0.40, -0.03], p = 0.03). In the five identified frailty trajectories, participants with mild frailty (inverted U-shaped, β [95% CI] = -0.22 [-0.43, -0.02], p = 0.04), mild frailty (U-shaped, β [95% CI] = -0.22 [-0.39, -0.06], p = 0.01), and frailty (β [95% CI] = -0.34 [-0.62, -0.07], p = 0.01) were all significantly associated with the subsequent cognition decline in the elderly. The current study suggested that monitoring and addressing frailty trajectories in older adults may be a critical approach in preventing or mitigating cognitive decline, which had significant implications for healthcare.

The Effect of Diagonal Exercise Training for Neurorehabilitation on Functional Activity in Stroke Patients: A Pilot Study

Functional movements of the human body occur multifacetedly. This pilot study investigated the effects of neurorehabilitation training, including diagonal movements, balance, gait, fall efficacy, and activities of daily living in stroke patients. Twenty-eight patients diagnosed with stroke by a specialist were divided into experimental groups applying diagonal exercise training and control groups applying sagittal exercise training. The five times sit-to-stand test (FTSST), timed up and go (TUG) test, and Berg balance scale (BBS) were used to evaluate balance ability, the falls efficacy scale (FES) was used to evaluate fall efficacy, and the modified Barthel index (MBI) was used to evaluate activities of daily living. All evaluations were conducted once prior to intervention implementation and again six weeks after the final intervention. In the study results, the experimental group to which the diagonal exercise training was applied had statistically significant changes in FTSST, BBS, and FES compared to the control group. In conclusion, the rehabilitation program, including diagonal exercise training, increased the patient's balance and reduced the fear of falling.

Risk factors for fracture by same-level falls among workers across sectors: a cross-sectional study of national open database of the occupational injuries in Japan

OBJECTIVES

The hospitalisation rate for work-related injuries among older workers is double that of younger workers; however, the risk factors for same-level fall fractures sustained during industrial accidents remain unclear. This study aimed to estimate the influence of worker age, time of day and weather conditions on the risk of same-level fall fractures in all industrial sectors in Japan.

STUDY DESIGN

This was a cross-sectional study.

METHODS

This study used the population-based national open database of worker death and injury reports in Japan. In total, 34,580 reports of occupational same-level falls between 2012 and 2016 were used in this study. Multiple logistic regression analysis was performed.

RESULTS

In primary industries, workers aged ≥55 years had a 1.684 times greater risk of fracture (95% confidence interval [CI]: 1.167-2.430) compared with workers aged ≤54 years. In tertiary industries, relative to the odds ratio (OR) of injuries recorded at 0:00-2:59 a.m., the ORs recorded at 6:00-8:59 p.m., 6:00-8:59 a.m., 9:00-11:59 p.m. and 0:00-2:59 p.m. were 1.516 (95% CI: 1.202, 1.912), 1.502 (95% CI: 1.203-1.876), 1.348 (95% CI: 1.043-1.741) and 1.295 (95% CI: 1.039-1.614), respectively. The risk of fracture increased with a 1-day increase in the number of snowfall days were per month in secondary (OR = 1.056, 95% CI: 1.011-1.103) and tertiary (OR = 1.034, 95% CI: 1.009-1.061) industries. The risk of fracture decreased with every 1-degree increase in the lowest temperature in primary (OR = 0.967, 95% CI: 0.935-0.999) and tertiary (OR = 0.993, 95% CI: 0.988-0.999) industries.

CONCLUSIONS

With the increasing number of older workers and changing environmental conditions, the risk of falls in the tertiary sector industries is increasing, particularly just before and just after shift change hours. These risks may be associated with environmental obstacles during work migration. It is also important to consider the weather-associated risks of fracture.

Sex-Related Differences in Functional Fitness Outcomes in Older Adults

Sex-related differences in changes in functional fitness over time were longitudinally assessed in older adults participating in a group-based multimodal exercise program. From a database, functional fitness scores were obtained for 89 older adults (71.6 ± 6.5 years old) who had completed two assessments, 5-8 years apart. Lower body strength, upper body strength, aerobic endurance, flexibility, and change of direction performances were compared over time and with normative values. Females (p = .02), but not males, had an improvement in upper body strength over time. Females were also more flexible than males at both assessments (p ≤ .02). Of those who had five consecutive assessments, females were more flexible than males (p ≤ .05) and had a faster change of direction ability (p < .001). When compared with normative values, our results indicate that typical time-related functional fitness loss can be attenuated with group exercise. Our results further support the need to tailor exercise prescription according to the individual.