The effect of fear of falling on balance and dual task performance in the elderly

Functional task kinematics in older adults: The role of fear of falling and fall history as measured by themovement deviation profile

BACKGROUND

Most falls at home of older adults occur during activities of daily living, with fear of falling (FOF) heightening the risk.

RESEARCH QUESTION

How does the fear of falling influence the kinematics of functional tasks in faller and non-faller older people?

METHODS

A total of 68 participants aged 60 and older were divided into four groups: NF-lowFOF (non-faller with low fear, control group), NF-highFOF (non-faller with high fear), F-lowFOF (faller with low fear), and F-highFOF (faller with high fear), with 17 individuals in each group. The three-dimensional kinematics data were analyzed using a single number gait deviation index, the mean Movement Deviation Profile (MDPmean), to identify which task and group had the greatest difference by comparing the Z-scores of the MDPmean. Multivariate analysis and Bonferroni post hoc tests (p < 0.05) were employed to analyze group interactions.

RESULTS

Significant differences in kinematics were observed across all functional tasks. The largest effect size between the control group and the other groups for each functional task were descending and ascending stairs, sitting to stand, walking turn and gait in F-highFOF, and standing to sit in F-lowFOF. The time to perform each task didn't differ between the groups.

SIGNIFICANCE

FOF (whether high or low) can significantly impact the kinematics of functional tasks in both faller and non-faller older adults. Therefore, assessing FOF in this population is crucial to prevent falls and promote rehabilitation, especially in non-faller older adults with high FOF.

Influence of cognitive and emotional factors on motor dual-task performance in nursing home residents. The mediating and moderating roles of cognition, concerns about falling, well-being, and depressive symptoms. A cross-sectional observational study

BACKGROUND

This study aimed (1) to compare walking performance under single (ST) and dual-task (DT) conditions with varying cognitive tasks and degrees of difficulty, (2) to investigate the association of concerns about falling, depressive symptomatology, and psychological and physical well-being with ST and DT walking performance as well as cognitive and motor DT costs (cDTC; mDTC); and (3) to examine whether depressive symptomatology and well-being mediate or moderate the association between concerns about falling and DT performance in a large sample of German nursing home residents.

METHODS

We analyzed data from a cross-sectional study with 449 ambulatory nursing home residents (mean age 84.1 ± 7.87 years). Performance on three cognitive tasks with different cognitive loads (serial subtraction in one's [SST_1] and three's [SST_3]; verbal fluency [VFT]; number of correctly reproduced responses) and (walking speed) was recorded each under ST and DT conditions (walking plus additional cognitive task). In addition, we assessed concerns about falling, depressive symptomatology, and psychological and physical well-being using the Falls Efficacy Scale - International (FESI), the Center for Epidemiologic Studies Depression Scale (CESD), and the Short-Form-Health Survey (SF-12), respectively.

RESULTS

We observed significant differences in ST walking and walking while performing an additional cognitive task. Walking speed was higher in ST walking than walking during the SST_1, SST_3, and VFT (all p < 0.001). In both the ST walking and the SST_1 DT condition, the concerns about falling (and physical well-being) explained a low proportion of variance in walking speed. Physical well-being had a minor but significant mediating effect on the relationship between concerns about falling and walking speed in the ST walking and SST_1 DT condition.

CONCLUSIONS

Concerns about falling and physical well-being seem to exert a small yet statistically significant effect on ST walking under conditions of lower cognitive demand. The effect is diminished by increasing the cognitive load, as compensation becomes impossible. Interventions focusing on decreasing concerns about falling and maintaining physical well-being might compensate for limitations in walking performance of nursing home residents in ST and DT situations. Reducing fall concerns, promoting physical well-being, and adjusting cognitive demands can improve nursing home residents' walking performance.

TRIALS REGISTRATION

DRKS00014957 (BfArM - Deutsches Register Klinischer Studien (DRKS)).

Investigation of the relationship between dual-task performance and functionality and psychosocial features in children with Duchenne Muscular Dystrophy: A controlled study

AIMS

The aim of this study is to investigate the variations in dual-task performance between children with Duchenne Muscular Dystrophy (DMD) and their typically developed peers. Simultaneously, we explored the impact of psychosocial features and functional parameters on dual-task performance in children with DMD.

METHODS AND PROCEDURES

A total of 45 children with DMD and 49 typically developed peers were included in the study. After recording the demographic information of the children, the motor-motor and cognitive-motor dual-task performances of all children were assessed by adding motor (carrying a half-filled bottle of water in both hands) and cognitive tasks (mental practice and memory) to the 10 Meter Walk Test (10MWT). Then Brooke Lower Extremity Functional Classification (BLEFC), 6-Minute Walk Test (6MWT), North Star Ambulatory Assessment (NSAA), Gait Assessment Scale for Duchenne Muscular Dystrophy (DMD-GAS), Four Square Step Test (FSST), Modified Mini-Mental State Examination (MMSE), Pediatric Quality of Life Inventory (PedsQL)-Neuromuscular Module, and Pediatric Fear of Falling Questionnaire (Ped-FOF) were assessed for motor performance, ambulation levels, walking abilities, balance, cognitive levels, quality of life, and fear of falling, respectively.

RESULTS

In our study, a significant difference was found between the dual-task performances of children with DMD and their typically developed peers, with typically developed children performing better in motor-motor, cognitive motor/mental, and cognitive motor/memory tasks (p < 0.001). Relationships were identified between the dual-task performances of DMD children and the 6MWT (r: -0.715; -0.651; -0.641; respectively), NSAA (r: -0.669; -0.434; -0.451; respectively) DMD-GAS (r: -0.626; -0.409; -0.424; respectively), FSST (r: 0.747; 0.534; 0.503; respectively), PedsQL-Neuromuscular Module (parent report) (r: -0.432; -0.340; -0.357; respectively), and Ped-FOF (r: 0.512; 0.449; 0.436; respectively), (p < 0.05).

CONCLUSIONS AND IMPLICATIONS

Our study indicated that dual-task performance in children with DMD is lower than that of their peers, and it is related to the children's motor skills, ambulation levels, and psychosocial features. These findings suggest that incorporating assessments and approaches for dual-task performance into rehabilitation programs aimed at preserving or improving motor functions, ambulation levels, and quality of life may be important for a holistic approach to managing the disease.

Effect of Balance Capacity on Fear of Falling in Older Adults: The Mediating Role of Activities of Daily Living and Depressive Symptoms

PURPOSE

To explore the relationship between postural balance and fear of falling (FoF) in older adults, examining the chain mediating roles of activities of daily living (ADLs) and depressive symptoms.

METHOD

The chain mediating role of ADLs and depressive symptoms between postural balance and FoF was tested using the PROCESS macro for SPSS 26.0.

RESULTS

ADLs and depressive symptoms play a chain mediating role in the relationship between postural balance and FoF. Impaired postural balance is associated with poorer ADLs in older adults and an increased risk of depressive symptoms and FoF.

CONCLUSION

Targeted interventions can be developed to reduce FoF in older adults by improving postural balance, increasing ADLs, and alleviating depressive symptoms. [Research in Gerontological Nursing, xx(x), xx-xx.].

Fear of Falling Avoidance Behavior on Daily Living Activities and Physical Activity in Older Adults: A Cross-Sectional Study

The aim of this study was to investigate the effect of avoidance behavior due to fear of falling on dependency levels in activities of daily living and physical activity levels in older adults. This study is a cross-sectional research design. Data were collected between November 2023 and March 2024. A total of 506 individuals aged 65 years and over participated in the study (mean age 71.26). It was determined that the older adults had low level of fear of falling avoidance behaviors were fully independent in activities of daily living and had low level of physical activity. The multiple linear regression analysis showed that age, marital status, education, living with and fear of falling avoidance behavior affected daily living activities; age, place of residence, gender, income status, chronic disease status, and fear of falling avoidance behavior affected physical activity level (R2 = 0.183; R2 = 0.197, respectively). This study revealed the necessity of interventions to prevent fear of falling avoidance behaviors in order to increase the activities of daily living and physical activity levels among older adults.

Assessment tools of the fear of falling: A scoping review

AIM

To comprehensively evaluate and synthesize fear of falling assessment tools and their psychometric properties.

METHODS

The literature in PubMed, Web of Science Core Collection, Cochrane Library, Embase, Google Scholar, CNKI, Wanfang, VIP, and CBM was systematically searched, and the search period was from the establishment of the database to September 1, 2023, and updated on September 1, 2024.

RESULTS

A total of 104 documents covering 19 assessment tools were included. Of the 19 instruments, the Falls Efficacy Scale-International was the most widely used and had been tested for reliability and validity in different countries and populations. A total of 18 studies focused on tool development and validation, and the remaining 86 were related to tool validation.

CONCLUSION

Scientific and reliable assessment instruments for FOF are an important part of future targeted intervention research. The future research direction of tools should be based on local demographic characteristics and qualitative interview results, combined with objective quantitative indicators measured by professional instruments.

Are history of falls and fear of falling associated with mobility in community-dwelling older adults?

Evidence has suggested that a history of falls and fear of falling (FOF) are associated with reduced mobility among older adults. Although many studies have explored the association between the history of falls and FOF in the context of decreased mobility, most have had small sample sizes, limiting the generalizability of the results. Therefore, this study sought to contribute to the body of knowledge around these constructs to further support the previous findings. To investigate the association between a history of falls and FOF with low mobility in community-dwelling older adults. This cross-sectional study included 308 older adults (69.9 ± 7.1 years, 57.8% female). The Timed Up and Go (TUG) test was used to classify mobility limitations in participants and the Falls Efficacy Scale-International - Brazil was used to quantify FOF. Participants were also asked if they had fallen in the previous 12 months. Multivariable logistic regression was used. The prevalence rates of a history of falls and FOF were 32.7 and 48.4%, respectively. Older adults with a history of falls and FOF had 2.20 (95%CI: 1.20; 4.02) and 3.80 (95%CI: 1.90; 7.58) greater odds of presenting low mobility than older adults without these health problems, respectively. History of falls and FOF are associated with higher odds of low mobility in community-dwelling older adults. Therefore, it is of the utmost importance to introduce public health programs aimed at preventing falls in older adults to reduce possible adverse health outcomes, including low mobility.

Is There an Association Between Self-Reported Dual-Task Performance and Fear of Falling in Older Adults?

INTRODUCTION

Is there an association between self-reported dual-task performance and fear of falling in older adults?

BACKGROUND/OBJECTIVES

Fear of falling tends to increase with age and can negatively impact dual-task abilities, leading to potential declines in overall quality of life. Therefore, it becomes crucial to evaluate dual-task performance in older adults, particularly prior to the onset of fear of falling. This study aims to investigate the potential association between self-reported dual-task performance and fear of falling in older adults.

METHODS

A total of 51 individuals (19 females and 32 males) were recruited. The participants met the inclusion criteria were administered the Dual-Task Questionnaire (DTQ), Falls Efficiency Scale International, and Physical Activity Scale for the Elderly. Multiple linear regression was performed to predict DTQ scores based on age, body mass index, and Physical Activity Scale for the Elderly.

RESULTS

A moderate positive correlation was found between Falls Efficiency Scale International scores and self-reported DTQ scores (r: .448, p: .001). Age, body mass index, and Physical Activity Scale for the Elderly were not found to be significant predictors of DTQ scores.

CONCLUSIONS

Our study reveals a moderate positive association between fear of falling and self-reported dual-task performance in older adults. A direct relationship between physical activity performance, fear of falling, and self-reported dual-task performance was observed among older adults. Significance/Implications: Integrating self-reported measures like the DTQ in clinical evaluations can provide valuable insights into dual-task abilities of older adults.

Dual Tasking Affects the Outcomes of Instrumented Timed up and Go, Sit-to-Stand, Balance, and 10-Meter Walk Tests in Stroke Survivors

Stroke can impair mobility, with deficits more pronounced while simultaneously performing multiple activities. In this study, common clinical tests were instrumented with wearable motion sensors to study motor-cognitive interference effects in stroke survivors (SS). A total of 21 SS and 20 healthy controls performed the Timed Up and Go (TUG), Sit-to-Stand (STS), balance, and 10-Meter Walk (10MWT) tests under single and dual-task (counting backward) conditions. Calculated measures included total time and gait measures for TUG, STS, and 10MWT. Balance tests for both open and closed eyes conditions were assessed using sway, measured using the linear acceleration of the thorax, pelvis, and thighs. SS exhibited poorer performance with slower TUG (16.15 s vs. 13.34 s, single-task p < 0.001), greater sway in the eyes open balance test (0.1 m/s2 vs. 0.08 m/s2, p = 0.035), and slower 10MWT (12.94 s vs. 10.98 s p = 0.01) compared to the controls. Dual tasking increased the TUG time (~14%, p < 0.001), balance thorax sway (~64%, p < 0.001), and 10MWT time (~17%, p < 0.001) in the SS group. Interaction effects were minimal, suggesting similar dual-task costs. The findings demonstrate exaggerated mobility deficits in SS during dual-task clinical testing. Dual-task assessments may be more effective in revealing impairments. Integrating cognitive challenges into evaluation can optimize the identification of fall risks and personalize interventions targeting identified cognitive-motor limitations post stroke.

A concept analysis of fear of falling in older adults: insights from qualitative research studies

BACKGROUND

Fear of falling is a persistent concern about falls that commonly occur in older adults. Recently, it has been argued that fear of falling doesn't simply mean a state of low falls efficacy, but is a concept distinct from falls efficacy. However, the two concepts are still indistinguishable. Therefore, it is necessary to understand the unique characteristics of the fear of falling. This study aims to analyze the concept of 'fear of falling' faced by older adults.

METHODS

This study is designed as a concept analysis. A concept analysis was conducted by Walker & Avant's eight-step concept analysis method. A total of 16 pieces of literature were selected by inclusion and exclusion criteria from those published in Pubmed and Scopus between 1993 and 2022 on 8 November 2022.

RESULTS

Two antecedents, four attributes, and five consequences were identified. Apprehension caused by the unpredictable nature of falls, unease related to one's vulnerability, high vigilance-related to the environment, and concern about potential harm after fall events were presented as attributes of fear of falling in older adults. There were two antecedents of fear of falling which were awareness of falls and near falls, and direct/indirect experience about falls and near falls. As consequences of fear of falling, protective effect, activities curtailment, reduction in radius of living, restricted freedom, and limited social activities were reported.

CONCLUSION

It was confirmed that falls and the fear-inducing process were fused to constitute the unique characteristics of the fear of falling. This can be presented as an important basis for future research on the fear of falling or dealing with various aspects of the fear of falling in the clinical field.

The association between physical activity and fear of falling among community-dwelling older women in China: the mediating role of physical fitness

Background

This study aimed to explore the association between physical activity (PA) and fear of falling (FOF) and to determine whether this relationship was mediated by physical fitness (PF) in community-dwelling older women.

Methods

For this cross-sectional study, a total of 1,108 older women were recruited. Moderate-to-vigorous physical activity (MVPA) and light physical activity (LPA) were objectively measured by accelerometers. Physical fitness indicators including body mass index (BMI), forced vital capacity, choice reaction time, grip strength, sit and reach, and five times sit-to-stand were measured. FOF was evaluated by the Chinese version of the activities-specific balance confidence scale. A stepwise linear regression model analysis was used for mediation analysis, and bootstrap analysis was used to verify the mediation effects.

Result

The Pearson correlation coefficient results suggested that MVPA was significantly and negatively correlated with FOF while LPA was not correlated with FOF. Logistic regression analysis suggested a significant association between MVPA, BMI, forced vital capacity, choice reaction time, sit and reach, grip strength, five times sit-to-stand, and FOF. The mediation analysis showed a negative relationship between MVPA and FOF. BMI completely mediated the relationship between MVPA and FOF while sit and reach, five times sit-to-stand, and forced vital capacity partially mediated the relationship between MVPA and FOF.

Conclusion

Accumulation of more daily MVPA was associated with reducing the odds of FOF in community-dwelling older women. PF indicators fully or partially mediate the relationship between MVPA and FOF. Therefore, more intervention efforts should focus on the promotion of MVPA to improve PF and thus reduce FOF among older women.

Daily Posture Behavior Patterns Derived From Multitime-Scale Topic Models Using Wearable Triaxial Acceleration for Assessment of Concern About Falling

Concern about falling is prevalent in older population. This condition would cause a series of adverse physical and psychological consequences for older adults' health. Traditional assessment of concern about falling is relied on self-reported questionnaires and thus is too subjective. Therefore, we proposed a novel multi-time-scale topic modelling approach to quantitatively evaluate concern about falling by analyzing triaxial acceleration signals collected from a wearable pendent sensor. Different posture segments were firstly recognized to extract their corresponding feature subsets. Then, each selected feature related to concern about falling was clustered into discrete levels as feature letters of artificial words in different time scales. As a result, all older participants' signal recordings were converted to a collection of artificial documents, which can be processed by natural language processing methodologies. The topic modelling technique was used to discover daily posture behavior patterns from these documents as discriminants between older adults with different levels of concern about falling. The results indicated that there were significant differences in distributions of posture topics between groups of older adults with different levels of concern about falling. Additionally, the transitions of posture topics over daytime and nighttime revealed temporal regularities of posture behavior patterns of older adult's active and inactive status, which were substantially different for older adults with different levels of concern about falling. Finally, the level of concern about falling was accurately determined with accuracy of 71.2% based on the distributions of posture topics combined with the mobility performance metrics of walking behaviors and demographic information.

Fear of falling from the perspective of affected persons-A systematic review and qualitative meta-summary using Sandelowski and Barroso's method

BACKGROUND

Fear of falling (FoF) affects a large number of older people, whether they have a history of falls or not. This has an impact on their lives. FoF is a potentially modifiable factor, which has been identified as one of the most important threats to older people's autonomy.

OBJECTIVES

To gain a comprehensive understanding of the phenomenon, we conducted a systematic review and meta-summary. The available evidence from qualitative research exploring how people experience FoF and how FoF affects daily living was aggregated.

METHODS

We followed the approach by Sandelowski and Barroso (2007) as a method to aggregate knowledge based on an exhaustive literature search. We searched the databases CINAHL, MEDLINE, PsycINFO and SSCI systematically for relevant articles as well as grey literature until September 2020. Out of the included studies, findings were extracted, edited, grouped and abstracted into meta-findings. Finally, the manifest frequency effect size of each abstracted meta-finding was calculated.

RESULTS

Out of 2978 identified studies, 15 met our inclusion criteria, which were published between 1993 and 2017 and included a total of 276 participants. We extracted 578 findings, and the abstraction process resulted in 183 meta-findings. We identified three main topics: 'Triggers and reasons for FoF identified by affected people', 'Consequences attributed to FoF' and 'Strategies to manage FoF in daily life'.

CONCLUSION

Our findings demonstrate that FoF has a far-reaching impact on the lives of those affected. With the aggregation of the existing qualitative data with the application of the frequency effect size, we were able to identify three areas of particular importance to those affected: (1) controlling the risk, (2) creating a safe environment and (3) staying independent. Implications for practice these three areas of particular importance to those affected should be taken into account when revisiting or creating new interventions to prevent or reduce FoF.

The Effect of Dual-Task Motor-Cognitive Training in Adults with Neurological Diseases Who Are at Risk of Falling

Falls are common in patients with neurological diseases and can be very problematic. Recently, there has been an increase in fall prevention research in people with neurological diseases; however, these studies are usually condition-specific (e.g., only MS, PD or stroke). Here, our aim was to evaluate and compare the efficacy of an advanced and innovative dual-task, motor-cognitive rehabilitation program in individuals with different neurological diseases who are at risk of falling. We recruited 95 consecutive adults with neurological diseases who are at risk of falling and divided them into four groups: 31 with cerebrovascular disease (CVD), 20 with Parkinson’s disease (PD), 23 with traumatic brain injury (TBI) and 21 with other neurological diseases (OND). Each patient completed a dual-task, motor-cognitive training program and underwent two test evaluations to assess balance, gait, fear of falling and walking performance at the pre-and post-intervention. We found that our experimental motor-cognitive, dual-task rehabilitation program was an effective method for improving walking balance, gait, walking endurance and speed, and fear of falling, and that it reduced the risk of falls in patients with different neurological diseases. This study presents an alternative approach for people with chronic neurological diseases and provides innovative data for managing this population.

Feasibility, Psychosocial Effects, Influence, and Perception of Elastic Band Resistance Balance Training in Older Adults

This study utilised feedback from older adults during balance-challenging, elastic band resistance exercises to design a physical activity (PA) intervention.

METHODS

Twenty-three active participants, aged 51-81 years, volunteered to perform a mini balance evaluation test and falls efficacy scale, and completed a daily living questionnaire. Following a 10 min warm-up, participants performed eight pre-selected exercises (1 × set, 8-12 repetitions) using elastic bands placed over the hip or chest regions in a randomised, counterbalanced order with 15 min seated rests between interventions. Heart rate (HR) and rate of perceived exertion (RPE) were measured throughout. Participant interview responses were used to qualify the experiences and opinions of the interventions including likes, dislikes, comfort, and exercise difficulty.

RESULTS

Similar significant (p < 0.01) increases in HR (pre- = 83-85 bpm, mid- = 85-88 bpm, post-intervention = 88-89 bpm; 5-6%) and RPE (pre- = 8-9, mid- = 10, post-intervention = 10-11) were detected during the PA interventions (hip and chest regions). Interview data revealed that participants thought the PA interventions challenged balance, that the exercises would be beneficial for balance, and that the exercises were suitable for themselves and others. Participants reported a positive experience when using the PA interventions with an elastic band placed at the hip or chest and would perform the exercises again, preferably in a group, and that individual preference and comfort would determine the placement of the elastic band at either the hip or chest.

CONCLUSION

These positive outcomes confirm the feasibility of a resistance band balance program and will inform intervention design and delivery in future studies.

Prediction of balance function for stroke based on EEG and fNIRS features during ankle dorsiflexion

Balance rehabilitation is exceedingly crucial during stroke rehabilitation and is highly related to the stroke patients’ secondary injuries (caused by falling). Stroke patients focus on walking ability rehabilitation during the early stage. Ankle dorsiflexion can activate the brain areas of stroke patients, similar to walking. The combination of electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) was a new method, providing more beneficial information. We extracted the event-related desynchronization (ERD), oxygenated hemoglobin (HBO), and Phase Synchronization Index (PSI) features during ankle dorsiflexion from EEG and fNIRS. Moreover, we established a linear regression model to predict Berg Balance Scale (BBS) values and used an eightfold cross validation to test the model. The results showed that ERD, HBO, PSI, and age were critical biomarkers in predicting BBS. ERD and HBO during ankle dorsiflexion and age were promising biomarkers for stroke motor recovery.

Association between Fear of Falling and Seven Performance-Based Physical Function Measures in Older Adults: A Cross-Sectional Study

Fear of falling (FOF), a common phenomenon among older adults, may result in adverse health consequences. The strength of the association between FOF and physical function among older adults has not been well compared in previous studies. Therefore, a cross-sectional study was performed on 105 older adults to determine and compare the strength of the association between FOF and seven common physical function measures. After controlling for age, logistic regression models were fitted for each physical function measure. According to odds ratios, the Berg Balance Scale (BBS), Short Physical Performance Battery, gait speed, and Timed Up & Go Test were associated with the identification of FOF. Based on a c-statistic value of 0.76, the BBS, a common and quick assessment of functional balance tasks, was found to be able to distinguish between fearful and non-fearful older adults. Interventions targeted to improve lower-extremity physical functions, especially functional balance ability, may help prevent or delay the adverse consequences of FOF.

Fear of Falling and Environmental Factors: A Scoping Review

Fear of falling is a geriatric condition that must be understood from both a clinical perspective and from the environment in which older adults live. This review aimed to describe the scientific evidence reported in the last 5 years regarding the fear of falling in older adults and its relationship with environmental factors. The relationships between fear of falling and environmental factors are mainly evidenced in the built environment. Older adults with a fear of falling are described as perceiving the built environment as dangerous when they do not meet the requirements of safety, accessibility, and comfort; they also report the importance of living in communities with controlled crime levels and available social support for older adults to improve their insecurity and feelings of vulnerability.

The angiotensin-converting enzyme gene insertion/deletion polymorphism interacts with fear of falling in relation to stepping speed in community-dwelling older adults

BACKGROUND

Despite the association of genetic factors with falls, balance, and lower extremity functioning, interaction of the angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism with fear of falling (FOF) in relation to stepping performance has, to the best of our knowledge, not been investigated in older adults.

OBJECTIVE

The purpose of this study was to examine the interaction effects of the ACE I/D polymorphism with FOF in relation to stepping performance in older adults.

METHODS

Eighty-eight community-dwelling adults 60 years or older participated in a cross-sectional observational study. Participants completed tests of rapid and distance stepping, and self-reported FOF (yes/no). Participants provided saliva for ACE genotyping. General linear models evaluated ACE genotype × FOF interaction effects in relation to stepping performance. The α level was set at 0.05.

RESULTS

The ACE I/D polymorphism exhibited significant interaction effects (p for interactions 0.002 ≤ p ≤ .04) with FOF in relation to stepping speed. Relationships between FOF and stepping speed varied among ACE genotypes. The insertion/insertion (II) genotype was significantly associated (p = .01) with slow stepping in individuals with, but not without FOF (p > .05).

CONCLUSION

Variation in relationships between FOF and stepping speed among ACE genotypes suggests a role for the ACE I/D polymorphism in modifying relationships between FOF and stepping speed in older adults. The association of the ACE II genotype with slow stepping performance in individuals with, but not without FOF, suggests that older adults with the ACE II genotype and FOF may be at increased risk for poor stepping performance and associated functional declines.

Association Between Fatigue and Falls Risk Among the Elderly Aged Over 75 Years in China: The Chain Mediating Role of Falls Efficacy and Lower Limb Function

Background

Although fatigue has been shown to be strongly associated with falls risk, very few studies have focused on its mechanism involved in community-dwelling older subjects. The purpose of this study was to explore the relationship between fatigue and falls risk and its internal mechanism by constructing a chain mediation model.

Methods

A cross-sectional study design was adopted. A convenience sample of 270 older adults was recruited from July to October 2021 in an urban community, in Beijing, China. The participants completed the 14-item Fatigue Scale (FS-14), Falls Efficacy Scale International (FES-I), the Short Physical Performance Battery (SPPB) and Fall-Risk Self-Assessment Questionnaire (FRQ) to measure fatigue, falls efficacy, lower limb function and falls risk. The theory of unpleasant symptoms was used as a conceptual framework. Structural equation modeling (SEM) was utilized to test the hypothetical model.

Results

The overall fit of final model was found to be satisfactory: χ2/df = 1.61, CFI = 0.971, TLI = 0.962, RMSEA = 0.049 (95% CI 0.030/0.066) and SRMR = 0.023. Fatigue had a direct effect on falls risk (β = 0.559, S.E. = 0.089, 95% CI 0.380/0.731), and it also had indirect effects on falls risk (β = 0.303, S.E. = 0.072, 95% CI 0.173/0.460) through mediating factors. Falls efficacy and lower limb function were the main mediating variables, and there was a chain mediating effect (β = 0.015, S.E. = 0.010, 95% CI 0.003/0.046).

Conclusions

Our study suggests that fatigue can influence falls risk among the elderly in China. There are many mediating paths between fatigue and falls risk. These results may help healthcare professionals to better understand the inherent relationship between fatigue and fall risk that may benefit older adults.

Effect of Dual-Task Motor-Cognitive Training in Preventing Falls in Vulnerable Elderly Cerebrovascular Patients: A Pilot Study

Falling is a frequent and major clinical problem among older adults, as well as in patients with chronic cerebrovascular diseases (CVD). At present, sequential (mixed) and simultaneously (dual-task) motor-cognitive trainings are the best approaches to affording patients more autonomy in their everyday motor independence while reducing fall risks and consequences. The objective of this study was to evaluate the efficacy of an advanced and innovative dual-task motor-cognitive rehabilitation program on fall risks in vulnerable older persons with chronic CVD. To this purpose, 26 consecutive older fallers with chronic CVD were recruited, and completed a mixed motor-cognitive or a dual-task motor-cognitive training program. Each patient also underwent two test evaluations to assess balance, gait, fear of falling, and walking performance at pre-and post-intervention. We found that our experimental motor-cognitive dual-task rehabilitation program could be an effective method to improve walking balance, gait, walking speed, and fear of falling, while reducing the risk of falls in older people with chronic CVD. Furthermore, results show that the simultaneous motor-cognitive training is more effective than the sequential motor-cognitive training. Therefore, our study brings innovative data, which can contribute positively to the management of this population.

Correlation Between Poststroke Balance Function and Brain Symmetry Index in Sitting and Standing Postures

Balance problems are the main sequelae of stroke, which increases the risk of falling. The assessment of balance ability can guide doctors to formulate rehabilitation plans, thereby reducing the risk of falls. Studies have reported the role of resting-state EEG during sitting in the motor assessment of the upper extremity and prognosis of stroke patients. However, the above research in the sitting posture lacks specificity in evaluating the balance ability of the lower limbs. Herein, this article investigated whether EEG was different in sitting and standing positions with different difficulty levels and validated the feasibility of EEG in assessing body balance ability. The resting-state EEG signals were collected from 11 stroke patients. The pairwise-derived brain symmetry index (pdBSI) was used to identify the differences in EEG-quantified interhemispheric cortical power asymmetry observable in healthy versus cortical and subcortical stroke patients by calculating the absolute value of the difference in power at each pair of electrodes. Subsequently, we computed the pdBSI over different frequency bands. Balance function was assessed using the BBS (Berg Balance Scale). Stroke survivors showed higher pdBSI (1-25 Hz) values in standing posture compared to sitting (p <0.05) and the pdBSI was significantly negatively correlated with BBS (r = -0.671, p =0.034). Additionally, the pdBSI within beta band was also significantly negatively correlated with BBS (r = -0.711, p=0.017). In conclusion, stroke brain asymmetry in standing posture was significantly more severe and the pdBSIs in 1-25Hz and beta hand were related to balance function. BBS and NIHSS was significantly negatively correlated (r = -0.701, p = 0.024), and NIHSS was significantly correlated with age (r = 0.822, p = 0.004). The present study suggests that stroke can seriously affect the body's balance ability. Compared with the sitting posture, the asymmetry of cortical energy in the standing posture can better assess the patient's balance ability.