The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis

Association of motoric cognitive risk syndrome with falls in older adults: findings from three longitudinal studies

BACKGROUND

Falls pose a significant threat to older adults' health, affecting one-third of individuals aged over 65 annually and resulting in severe injuries despite numerous screening tools. While motoric cognitive risk syndrome (MCR) is established as a dementia risk factor, its utility as a fall prediction tool remains unclear due to inconsistent findings across populations. This study therefore aims to elucidate the associations between motoric cognitive risk syndrome and falls among older adults.

METHODS

Participants aged ≥ 60 years were selected from the English Longitudinal Study of Aging (ELSA), the Health and Retirement Study (HRS), and the China Health and Retirement Longitudinal Study (CHARLS). Subjective cognitive complaints (SCC) were assessed based on participants' responses to standardized questionnaire items. Slow gait was defined as a gait speed of more than one standard deviation below the age- and gender-specific mean values. MCR was diagnosed when both SCC and slow gait were present. Outcomes for investigation included falls, multiple falls, and fall-related injuries. Logistic regression analysis was conducted to examine the longitudinal association between MCR, its components, and the occurrence of falls over the following four years.

RESULTS

Ultimately, 10,373 participants were included in the analysis. After adjusting for covariates, MCR was associated with an increased risk of falls over the next four years, with relative increases of 60.0%, 50.5%, and 34.1% observed in the ELSA, HRS, and CHARLS cohorts, respectively. MCR was also linked to an elevated risk of multiple falls, although no significant association was found with fall-related injuries.In the fully adjusted models, slow gait alone did not show an independent association across all cohorts. Only MCR emerged as a significant and stable predictor of future falls, while further research is needed to clarify the role of SCC.

CONCLUSIONS

This large-scale prospective study found that MCR significantly predicts falls in older adults, highlighting its potential as a clinically useful screening tool integrating cognitive and motor parameters for improved fall risk identification.

The role of impaired vision and declined cognition in falls and fall-related risk factors among older people receiving home care in Finland-a cross-sectional register study

The risk of vision impairment and cognitive decline increases with age and can jeopardize safe ageing at home. Our aim was to investigate the association of impaired vision and cognitive decline with falls among older adults receiving home care. Additionally, we examined how previously identified fall-related risk factors are linked to vision impairment and cognitive decline. We used register data (n = 26 353) from the Finnish Resident Assessment Instrument (RAI) database. Four groups were created based on vision and cognition status: 1) no vision impairment or cognitive decline, 2) vision impairment alone, 3) cognitive decline alone, and 4) co-occurring vision impairment and cognitive decline. Multinomial logistic regression was used to examine the association of impaired vision and cognitive decline with falls. Based on results among older adults receiving home care, 12% had vision impairment alone, 37% had cognitive decline alone, and 18% had co-occurring vision impairment and cognitive decline. Vision impairment and cognitive decline, both individually and when co-occurring, were associated with experienced falls. Previously identified fall-related risk factors appeared to accumulate especially for older adults with co-occurring vision impairment and cognitive decline. Our study showed that vision impairment and cognitive decline play a significant role in the ability to live safely at home, particularly when they co-occur. Special attention should be paid to this vulnerable group to ensure safe and independent ageing in place. Timely identification and management of vision impairment may be crucial in preventing co-occurring vision impairment and cognitive decline.

An Exploratory Study on Virtual Reality Technology for Fall Prevention in Older Adults with Mild Cognitive Impairment

INTRODUCTION

Virtual Reality (VR) training has potential evidence for reducing the risks of falls of older adults with mild cognitive impairment (MCI). There are indications of a positive training effect of a cognitive-motor intervention method to improve the postural balance and cognition for safer walking. This study aimed to evaluate the training effects of VR training for reducing the risks of falls among older adults with mild cognitive impairment (MCI).

METHODS

An experimental design was employed to evaluate how the participants attended a full-immersive VR Cave Automatic Virtual Environment (CAVE) training program. Fifty-five participants were randomly assigned to the VR group or the control group. The VR group received 16 training sessions over 8-10 weeks, while the control group received a non-VR falls prevention program. The primary outcome assessed any falls after the study, and the secondary outcomes assessed changes in cognition and executive function, walk speed and balance performances, and the psychological factor such as fear of falling relating to the risk factors of fall.

RESULTS

The VR group showed significantly greater improvement than the control group in terms of measures of cognitive-motor performance across group and time interaction. However, there were inconsistent results in functional mobility and fall efficacy between the two groups.

CONCLUSION

This study provides promising evidence on the VR CAVE training for reducing the risks of falls among older adults with MCI from Hong Kong. VR technology-based applications are an emerging area in current aged care and rehabilitation services.

Neurodegenerative disease findings in Finnish neuropathologically examined medico-legal autopsy cases with acute head injuries

Neurodegenerative diseases present diagnostic challenges due to their diverse clinical presentations, which emphasizes the importance of postmortem neuropathological examination. As neurodegenerative diseases become more common with age, they contribute to a higher risk of falls, accidents and head injuries. Our aims were to, first, report the prevalence of neurodegenerative disease findings in Finnish neuropathologically examined medico-legal autopsy cases with acute head injuries and, second, report the prevalence, injury circumstances, and types of specific brain injuries in the most common disease entities. We analyzed cases from the Helsinki office of the Forensic Medicine Unit, Finnish Institute for Health and Welfare, over the period 2016-2022. Cases were included if they had a suspected or confirmed head injury, and underwent a full neuropathological examination with neurodegenerative immunohistochemistry. Data on background characteristics, neurodegenerative immunostains and diagnoses, and head injuries were collected from cause-of-death investigation documents and neuropathology reports. Prevalences of neurodegenerative diagnoses were calculated, and head injury findings were presented for the most common disease entities. During the study period, there were a total of 128 neuropathologically examined cases with suspected or confirmed acute head injuries. Neurodegenerative immunohistochemistry was performed in 57 of them, and a neurodegenerative diagnosis was established in 47 cases. The most prevalent diagnoses were Alzheimer's disease neuropathologic change (ADNPC) (n = 34), cerebrovascular disease (CVD) (n = 34) and Lewy body disease (LBD) (n = 9). Old head injuries were common among cases with any neurodegenerative diagnosis (36.2 %). Of specific findings, subdural haemorrhage and hypoxic-ischaemic neuronal injury had the highest absolute prevalence in cases with ADNPC, although there were no major differences between ADNPC, CVD and LBD. In conclusion, the most prevalent neurodegenerative disease entities in this dataset were ADNPC, CVD and LBD. A history of head injuries was common regardless of the neurodegenerative entity.

Hearing Loss and Falls: A Systematic Review and Meta-Analysis

Importance

Falls constitute a significant public health concern worldwide and have been associated with increased morbidity and mortality across all ages. Identifying potentially modifiable risk factors for falls is a key public health priority. Literature surrounding the association between hearing loss (HL) and falls remains inconclusive.

Objective

To conduct a systematic review and meta-analysis to comprehensively synthesize evidence surrounding the impact of HL on falls.

Data Sources

PubMed, Embase, and Cochrane Library from database inception through April 9, 2024.

Study Selection

Observational studies investigating the association between HL and falls were selected. Only studies reporting covariate-adjusted estimates were included to minimize confounding.

Data Extraction and Synthesis

Two independent reviewers evaluated studies for eligibility, extracted data, and assessed the risk of bias of included studies. Using a random-effects model, adjusted estimates were pooled in meta-analyses. Heterogeneity was evaluated using subgroup and sensitivity analyses, and publication bias was assessed.

Main Outcomes and Measures

The cross-sectional odds and longitudinal risk of falls among patients with HL compared with those without HL.

Results

A total of 5 071 935 participants were included from 27 studies; approximately 49.2% of participants were female, and 14 studies were conducted in Asia, 7 in North America, 3 in Europe, and 3 in Oceania, represented by Australia. Patients with HL exhibited an increased cross-sectional odds of falls (odds ratio, 1.51; 95% CI, 1.37-1.67; I2 = 64%) and longitudinal risk of falls (risk ratio, 1.17; 95% CI, 1.06-1.29; I2 = 69%) than those without HL. Further stratification by self-reported or validated hearing assessments, fall reporting duration, continent, community-dwelling adults, and studies adjusting for other sensory deficits identified as fall risk factors by the World Falls Guideline did not change significance. These results remained robust to sensitivity analyses, and publication bias was absent.

Conclusions and Relevance

This systematic review and meta-analysis found that overall, HL may be a risk factor for falls. With a rapidly aging global population, it is crucial to acknowledge the public health concerns surrounding falls and consider if HL could be a potentially modifiable risk factor. Nonetheless, further randomized clinical trials are needed to elucidate any benefit of treating HL on fall prevention.

Global Prevalence, Incidence, and Factors Influencing Falls in Older Adults With Dementia: Implications for Nursing and Healthy Aging

INTRODUCTION

Dementia notably increases fall risk in older adults, leading to major injuries and considerable concerns from health-care professionals. However, comprehensive evidence regarding the prevalence, incidence rate, and moderating factors of falls in institutional settings is limited. This study aimed to evaluate the prevalence, incidence rates, and moderating factors of falls among older adults with dementia in nursing homes and dementia-specialized care units.

DESIGN

A meta-analysis.

METHODS

We searched CINAHL, PubMed, Embase, ProQuest, Scopus, Web of Science, and PsycINFO from database inception to April 30, 2024. Older adults with dementia in nursing homes or dementia-specialized care units were included. The pooled prevalence was analyzed using a generalized linear mixed model with random effects using R software. Incidence rates were reported per person-year using comprehensive meta-analysis software. Study quality was assessed using Hoy's criteria. Variations in the pooled prevalence of falls were explored through moderator analyses.

RESULTS

This meta-analysis included 21 studies involving 35,449 participants. The pooled prevalence of falls was 45.6%, with subtypes showing 39.2%, 35.2%, and 29.0% among Alzheimer's dementia, vascular dementia, and mixed dementia subtypes, respectively. Falls were more prevalent in dementia-specialized care units (53.0%) than in nursing homes (42.6%). The overall incidence rate was 3.61 per person-year, higher in dementia-specialized care units (5.80) than in nursing homes (3.17). Subgroup analyses revealed higher fall prevalence in women (70.0%) than in men (30.6%). Meta-regression indicated that comorbidities, including delirium, visual impairment, and arthritis, increased fall risk.

CONCLUSIONS

This meta-analysis revealed a high incidence of falls in nearly half of older adults with dementia, particularly among those in dementia specialized care units.

CLINICAL RELEVANCE

Healthcare professionals should prioritize regular fall risk assessments, tailored interventions, and environmental safety modifications, particularly in dementia-specialized care units, to reduce fall-related injuries and improve patient outcomes.

Trends and determinants of falls: A generalized estimating equations modelling approach using serial data from the Geelong Osteoporosis Study

BACKGROUND

With Australia's aging population, the incidence of falls is expected to rise. The proportion of adults aged ≥65 years is projected to increase from 15 % in 2017 to 22 % by 2057, highlighting the growing need for effective fall prevention measures. Therefore, this study aimed to assess fall trends and determinants using repeated follow-up data from a population-based study.

METHODS

This study utilized data from the Geelong Osteoporosis Study (GOS) to analyse fall trends in men and women. Men's data were collected at baseline (2001-2006; n = 1533), 5 years (2006-2011; n = 968), and 15 years (2016-2021; n = 627), while women's data were from 6 years (2001-2003; n = 1014), 10 years (2004-2008; n = 1098), and 15 years (2011-2014; n = 844). Falls data, self-reported for the past 12 months, were age-standardised to the Australian population. Data included self-reported prior fractures, medications, comorbidities, alcohol use, and smoking, along with measured anthropometrics, muscle strength, biochemical tests, and imaging. A multivariable Generalised Estimating Equation model identified fall determinants, reporting adjusted odds ratios (AORs) and 95 % confidence intervals.

RESULTS

In men, the age-adjusted prevalence of falls declined over time, while in women, it initially dropped by 4.2 % before a slight 0.6 % increase. After adjusting for confounders, each additional year of age raised the fall risk by 1 % (AOR = 1.01, 95 % CI: 1.00-1.02). Women had a 52 % higher likelihood of falling than men (AOR = 1.52, 95 % CI: 1.22-1.88). Diabetes increased the risk by 69 % (AOR = 1.69, 95 % CI: 1.23-2.31), while a 1 N/kg increase in hip flexion strength lowered the risk by 3 % (AOR = 0.97, 95 % CI: 0.95-0.99).

CONCLUSION

Men experienced a steady decrease in fall prevalence over time, whereas women displayed a more intricate trend, with falls initially declining before subsequently rising, following a polynomial pattern. The key predictors of falls included age, sex, diabetes and hip flexion strength. Policies should prioritize tailored fall prevention, strength training, and diabetes care integration.

Is the FAB test associated with fall occurrence in older adults? A retrospective analysis of outpatient fall risk assessment

METHODS

We conducted a single-center, retrospective cohort study of French older adults. Participants with Mini-Mental State Examination (MMSE) ≥ 24 were recruited from a fall clinic in a geriatrics department. We recorded history of falls in the preceding 6 months, as well as Timed Up and Go test and mobility assessment at baseline and at 6- and 12-month follow-up.

RESULTS

We included 199 participants at baseline (mean age 83.1 years; 70.3% of females), of which 50.8% (101) had abnormal FAB scores (indicating executive impairment). Participants with executive impairment were more likely to have a history of falls. 125 and 96 participants completed 6- and 12-month follow-up visits, respectively. There was no association between abnormal FAB score at baseline and any or serious falls. Abnormal baseline FAB score was only associated with repeated (≥ 2) falls at 6 months, after adjusting for age, education, and polypharmacy (OR = 3.1 95% CI [1.0, 9.9]). Moreover, participants with abnormal FAB scores had significantly lower Timed Up and Go test scores.

CONCLUSION

Abnormal FAB score was associated with repeated falls at 6 months, but not with total incident falls during the follow-up period. Our results highlight the potential utility of FAB in fall risk assessment, particularly for repeated falls, but further studies are needed to clarify this association.

Association of falls with risk of dementia and all-cause mortality: a cohort study of Japanese older adults with a 9-year follow-up

OBJECTIVE

Many risk factors affect dementia and all-cause mortality. However, whether falls are a risk factor for dementia and all-cause mortality is unclear. The study examines the association of falls with the risk of dementia and all-cause mortality, and whether dementia mediates the association of falls with all-cause mortality.

METHODS

Data were taken from the Japanese Gerontological Evaluation Study (JAGES) with a 9-year follow-up. Falls information was collected through a questionnaire and categorized into no falls, single and multiple falls. Dementia and all-cause mortality data were obtained from the long-term care insurance (LTCI) system. The Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs), and causal mediation analysis (CMA) was used to assess the mediating effects of dementia.

RESULTS

A total of 52,076 participants were included in the study. Compared to participants with no falls, participants with single and multiple falls had an increased risk of dementia (single fall, HRs = 1.18, 95% CIs 1.12-1.24; multiple falls, HRs = 1.66, 95% CIs 1.56-1.77) and all-cause mortality (single fall, HRs = 1.09, 95% CIs 1.04-1.15; multiple falls, HRs = 1.34, 95% CIs 1.26-1.43), and the risk increased with the number of falls (P for trend < 0.01). In addition, dementia significantly mediated the association between falls and risk of all-cause mortality (NIE: HRs = 1.02, 95% CIs 1.00-1.04, PM = 15.0%).

CONCLUSION

Falls are associated with the risk of dementia and all-cause mortality. Dementia has important mediating effects in the association between falls and the risk of all-cause mortality.

Automated abdominal aortic calcification scoring from vertebral fracture assessment images and fall-associated hospitalisations: the Manitoba Bone Mineral Density Registry

Abdominal aortic calcification (AAC), a subclinical measure of cardiovascular disease (CVD) that can be assessed on vertebral fracture assessment (VFA) images during osteoporosis screening, is reported to be a falls risk factor. A limitation to incorporating AAC clinically is that its scoring requires trained experts and is time-consuming. We examined if our machine learning (ML) algorithm for AAC (ML-AAC24) is associated with a higher fall-associated hospitalisation risk in the Manitoba Bone Mineral Density (BMD) Registry. A total of 8565 individuals (94.0% female, age 75.7 ± 6.8 years) who had a BMD and VFA image from DXA between February 2010 and December 2017 were included. ML-AAC24 was categorised based on established categories (ML-AAC24 = low < 2; moderate 2 to < 6; high ≥ 6). Cox proportional hazards models assessed the relationship between ML-AAC24 categories and incident fall-associated hospitalisations obtained from linked health records (mean ± SD follow-up, 3.9 ± 2.2 years). Individuals with moderate (9.6%) and high ML-AAC24 (11.7%) had a greater proportion of fall-associated hospitalisations, compared to those with low ML-AAC24 (6.0%). In age and sex-adjusted models, compared to low ML-AAC24, moderate (HR 1.49, 95% CI 1.24-1.79) and high ML-AAC24 (HR 1.89, 95% CI 1.56-2.28) were associated with greater hazards for a fall-associated hospitalisation. Results were comparable (HR 1.37, 95% CI 1.13-1.65 and HR 1.60, 95% CI 1.31-1.95, respectively) after multivariable adjustment, including prior falls and CVD, as well as medication use. Integrating ML-AAC24 into bone density machine software to identify high risk individuals would opportunistically provide important information on fall and cardiovascular disease risk to clinicians for evaluation and intervention.

A fall risk prediction model based on the CHARLS database for older individuals in China

BACKGROUND

Falls represent the second leading cause of injury-related mortality among older adults globally. The occurrence of falls is the consequence of the interaction of numerous complex risk factors. The objective of this study was to develop a validated fall risk prediction model for the Chinese older individuals.

METHODS

The study used data from the China Health and Retirement Longitudinal Study (CHARLS), a dataset representative of the Chinese population. Thirty-eight indicators including biological factors, behavioral factors and health status were analyzed in this study. The study cohort was randomly divided into the training set (70%) and the validation set (30%). Variables were screened using LASSO regression analysis, the best predictive model based on 10-fold cross-validation, logistic regression model was applied to explore the correlates of fall risk in the older individuals, a nomogram was constructed to develop the predictive model, calibration curves were applied to assess the accuracy of the nomogram model, and predictive performance was assessed by area under the receiver operating characteristic curve and decision curve analysis.

RESULT

A total of 4,913 cases from the 2015 CHARLS database for people aged 60 years and older were ultimately included, and a total of 1,082 (22.02%) of the older individuals had experienced a fall within two years. Multivariate logistic regression analysis showed that Sleeping time, Hearing, Grip strength, ADL score, Cognition, Depression, Health, KD, and Pain DRUG were predictors of fall risk in the older individuals. These factors were used to construct nomogram models that showed good agreement and accuracy. The AUC value for the predictive model was 0.644 (95% CI = 0.621-0.666), with a specificity of 0.695 and a sensitivity of 0.522. For the internal validation set, the AUC value was 0.644 (95% CI = 0.611-0.678), with a specificity of 0.629 and a sensitivity of 0.577. The Hosmer-Lemeshow test value of the model for the training set is p = 0.9368 and for the validation set is p = 0.8545 (both > 0.05). The calibration curves show a more significant agreement between the nomogram model and the actual observations. The ROC and DCA indicate a better predictive performance of the nomogram.

CONCLUSION

The comprehensive nomogram constructed in this study is a promising and convenient tool for assessing the risk of falls in the Chinese older individuals and to help older adults understand the risk level of falls, avoid and eliminate modifiable risk factors, and reduce the incidence of falls.

CLINICAL TRIAL NUMBER

Not applicable.

Examination of Factors Associated with Self-Reported Cane Use among Community-Dwelling Older Adults

BACKGROUND

This study investigates factors influencing cane use among older adults and identifies most significant determinants.

METHODS

This study is a cross-sectional study. A total of 160 community-dwelling older adults (mean age, 79±7 years) were included in the analysis. Binomial logistic regression analysis was conducted using the presence or absence of cane use as the dependent variable, and the associated factors were investigated.

RESULTS

There were 108 participants (mean age, 77±7 years) in the cane-non-using group and 52 (mean age, 83±6 years) in the cane-using group. Factors associated with the presence or absence of cane use were open-eyed one-leg standing time (odds ratio [OR]=0.81; 95% confidence interval [CI], 0.70-0.93; p=0.003) and depressed mood (OR=2.78; 95% CI, 1.31-5.91; p=0.008).

CONCLUSION

Older adults with reduced balance ability and depressive mood need to use a cane. This highlights the need to assess balance ability and depressed mood in prescribing a cane to older adults. Appropriate prescription of canes has the potential to enrich the lives of older adults by contributing to their safe range of activities.

The association between cognitive frailty and the risk of fall occurrence in older adults: a meta-analysis of cohort studies

Background

Cognitive frailty increases the risk of fall occurrence. However, previous studies have shown inconsistent correlations between cognitive frailty and the risk of fall occurrence.

Objective

To systematically review studies and explore the association between cognitive frailty and the risk of fall occurrence.

Methods

Databases were systematically searched. Meta-analysis was performed using RevMan 5.4 software after evaluation of the quality of the included studies by 2 researchers.

Results

A total of five studies including 16,962 patients were included. The results of Meta-analysis showed that the cognitive frailty group increased the risk of occurrence of falls in older adults [OR = 1.38, 95% CI (1.09, 1.73), p = 0.006]. Subgroup analyses showed that cognitive frailty in older adults increased the risk of fall occurrence using different cognitive frailty assessment tools, study participants from the community, different regions, and different sample sizes.

Conclusion

The results of this study suggest that cognitive frailty in older adults is an independent risk factor for the occurrence of falls, and it is recommended that caregivers strengthen the assessment of cognitive aspects of older adults admitted to the hospital.

Relationship Between Executive Function Subdomains and Postural Balance in Community-Dwelling Older Adults

BACKGROUND

Executive function (EF) deficits are a significant risk factor for falls among older adults (OAs). However, relationship between EF subdomains (shifting, updating, and inhibition), postural balance (PB), and fall risk in healthy OAs, remains poorly understood.

OBJECTIVE

This study aimed to investigate the relationship between EF subdomains (shifting, updating, and inhibition) and PB, and to assess their impact on risk of falls in community-dwelling OAs.

METHODS

A cross-sectional study involving 50 OAs aged over 60 years (average age of 72 years) was conducted. Participants underwent assessments of EF subdomains and PB using validated tests. A correlation analysis was employed to examine the relationships between EF and PB.

RESULTS

The study revealed significant correlations between subdomains and PB. Mental set shifting (r = -.539; p < .001) and inhibition (r = -.395; p = .050) exhibited inverse relationships with PB. Stepwise multiple linear regression showed that Trail Making Test Part B was associated with the PB (R2 = .42, p < .001).

CONCLUSION

These findings highlight the importance of assessing EF subdomains, particularly shifting and inhibition, to identify risk of falls. Trail Making Test Part B largely explains the variability of the PB. Integrating PB assessments and EF training, such as the Mini-BESTest, into routine care can be vital for fall prevention strategies. Significance/Implications: This knowledge underscores the need for cognitive training interventions focusing on shifting and inhibition to enhance PB and potentially reduce falls. Additionally, incorporation of EF assessment tools as Trail Making Test Part B and the Mini-BESTest into routine clinical practice for community-dwelling OAs is recommended to address fall prevention strategies.

Assessing the fall risk with Stay Independent Questionnaire in people with stroke

Objectives

This study aimed to assess the psychometric properties of the Chinese version of the Stay Independent Questionnaire (C-SIQ) in evaluating individuals with stroke.

Design

The study adopted a cross-sectional design.

Setting

The research was conducted at a university-based neurorehabilitation center.

Participants

The study included a total of 100 individuals with stroke and 49 healthy older adults.

Methods

On Day 1, both individuals with stroke and healthy older adults underwent assessments using the C-SIQ. Additionally, individuals with stroke were evaluated using the Fugl-Meyer Assessment of Lower Extremity (FMA-LE), ankle dorsiflexion and plantarflexion strength, Berg Balance Scale (BBS), Timed-Up and Go Test (TUG), 10-meter walk test (10 mWT), Activities-specific Balance Confidence (ABC) Scale, Stroke Impact Scale (SIS), and Community Integration Measure (CIM). On Day 2 (7 days after Day 1), individuals with stroke were reassessed using the C-SIQ.

Results

Individuals with stroke exhibited a higher C-SIQ score (6.22 ± 2.98) compared to healthy older adults (1.59 ± 2.01). The C-SIQ demonstrated good test-retest reliability (intraclass correlation coefficient = 0.847) and internal consistency (Cronbach's alpha = 0.709). The Minimal Detectable Change in C-SIQ score was calculated as 3.05. Exploratory factor analysis revealed four factors with eigenvalues ≥1.0, explaining 57.17% of the total variance. The C-SIQ score exhibited significant correlations (ranging from -0.553 to 0.362) with completion times of the TUG and 10 mWT, FMA-LE, BBS, ABC, SIS, CIM score, paretic ankle dorsiflexion strength, and 6 mWT distance. A cut-off score of 2.5 was identified as the optimal threshold for discriminating fall risk between individuals with stroke and healthy controls.

Conclusion

The C-SIQ emerges as a reliable and valid tool for evaluating fall risk in individuals with stroke, showcasing strong correlations with key measures such as TUG times, 10 mWT, FMA-LE, BBS, ABC, SIS, CIM score, paretic ankle dorsiflexion strength, and 6 mWT distance. The C-SIQ demonstrated good test-retest reliability and internal consistency. Exploratory factor analysis revealed that this is a four factors assessment tool. The identified cut-off score of 2.5 effectively distinguishes fall risk between individuals with stroke and healthy controls.

Effects of global cognitive function on the prevalence of fear of falling in older adults

This study aimed to investigate the association between global cognitive functioning (GCF) and fear of falling (FOF) in a large population-based sample of adults aged 45 years and older. A total of 2997 and 2012 participants from the original sample were included in the cross-sectional and prospective models, respectively. Participants were re-coded to 'no FOF' and 'FOF' based on their self-reported responses, and those who reported FOF at follow-up were defined as the newly-developed FOF group. GCF was evaluated at baseline and follow-up (2006 and 2020) using the Korean Mini-Mental State Examination (K-MMSE). Multivariable logistic regression models were used to examine the association between GCF at baseline and risk of FOF. In our study, 23.6% (706/2997) of the participants reported FOF at baseline, and 80.3% (1615/2012) reported newly-developed FOF in the follow-up cohort. Importantly, the negative association between GCF and FOF was observed not only in the cross-sectional analyses (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.96-0.99) but also in the prospective analyses (OR 0.93, 95% CI 0.87-0.99). Furthermore, GCF was associated with lower odds of recurrent newly-developed FOF in the stable group than in the original sample (OR 0.87, 95% CI 0.78-0.97 vs OR 0.92, 95% CI 0.86-0.98). Thus, GCF was negatively associated with FOF at baseline and newly-developed FOF in the long-term follow-up cohort, and persistent deficits in GCF may increase the risk of newly-developed FOF. Further research should explore the mechanisms underlying the longitudinal relationship between GCF and newly-developed FOF.

Cognitive functioning and falls in older people: A systematic review and meta-analysis

OBJECTIVE

To identify which cognitive functions and specific neuropsychological assessments predict falls in older people living in the community.

METHODS

Five electronic databases were searched until 30/08/2022 for studies assessing the association between specific cognitive functions and faller status (prospective and retrospective), in community-dwelling older people. Risk of bias was assessed with the Newcastle-Ottawa Scale. Meta-analyses synthesised the evidence regarding the associations between different neurocognitive subdomains and faller status.

RESULTS

Thirty-eight studies (20 retrospective, 18 prospective) involving 37,101 participants were included. All but one study was rated high or medium quality. Meta-analyses were performed with data from 28 studies across 11 neurocognitive subdomains and four specific neuropsychological tests. Poor cognitive flexibility, processing speed, free recall, working memory and sustained attention were significantly associated with faller status, but poor verbal fluency, visual perception, recognition memory, visuo-constructional reasoning and language were not. The Trail Making Test B was found to have the strongest association with faller status.

CONCLUSION

Poor performance in neurocognitive subdomains spanning processing speed, attention, executive function and aspects of memory are associated with falls in older people, albeit with small effect sizes. The Trail Making Test, a free-to-use, simple assessment of processing speed and mental flexibility, is recommended as the cognitive screening test for fall risk in older people.

Relationship between falls and the use of hypnotics, antidepressants, antipsychotics, and anxiolytics in patients with rheumatoid arthritis: A cross-sectional study

OBJECTIVES

This cross-sectional study aimed to determine the relationship between falls and the use of psychotropic medications in patients with rheumatoid arthritis (RA).

METHODS

The psychotropic medication group included patients with RA prescribed psychotropic medications [hypnotics/sedatives, antidepressants, antipsychotics, and anxiolytic (benzodiazepines) drugs]. Poisson regression with robust variance was performed to investigate the relationship between falls and the use of psychotropic medications, with adjustment for age, sex, RA disease activity, stroke, dementia, diabetes mellitus, and osteoarthritis.

RESULTS

Of the 307 patients enrolled, 49 (16.0%) used psychotropic medications and 70 (22.8%) experienced at least one fall per year. Nineteen of the 49 patients (38.8%) taking psychotropic medications and 51 of 258 (19.8%) not taking psychotropic medications experienced at least one fall per year. Falls were significantly more frequent in the group with psychotropic medications than in the group without psychotropic medications (adjusted incidence rate ratio, 1.63; 95% confidence interval, 1.08-2.48; P = .02). No relationship was found between the number of falls and the use of psychotropic medications (adjusted incidence rate ratio, 1.16; 95% confidence interval, 0.39-3.44; P = .78).

CONCLUSIONS

There may be a relationship between psychotropic medication use and falls in patients with RA.

Risk factors for falls in older adults with type 2 diabetes: A cross-sectional study

The study was to estimate the prevalence of falls with type 2 diabetes (T2D) and investigate the associated risk factors. The study design employed was cross-sectional. The participants for this study were recruited from a community-based diabetes specialist clinic. Data were collected from medical records and structured questionnaires, which included assessments of activities of daily living, instrumental activities of daily living, the Mini-Mental State Examination, the Taiwan Geriatric Depression Scale, and Chinese version of the Tilburg frailty indicator. Multivariate logistic regression was used to analyze the related factors. The study analyzed a total of 242 T2D patients with a mean age of 73.9 ± 5.9 years. The overall fall prevalence rate was 19.7%. The faller trait tendency to female, lower education, history of falls, body mass index ≥ 29 kg/m2, instrumental activities of daily living ≥ 1 task disability, cognitive impairment, depression, poor grip strength, and longer walking time. After adjusting for confounding, showed each additional unit on the depression score increases the fall risk by 11.9% (AOR, 1.19; 95% CI, 1.02-1.38, P = .027). Depression was a significant factor for falls in older adults with T2D. The study highlights the importance of targeted, multifaceted clinical interventions focusing on gender, age, and mental health to effectively reduce fall probability and improve the quality of life for the older adults.

Effects of BMI and grip strength on older adults' falls-A longitudinal study based on CHARLS

Background

Body Mass Index (BMI) and grip strength are potentially important risk factors for falls among the older adults. Currently, there is no consensus on the combined effects of grip strength and BMI on falls in the older adults, particularly among the Chinese older adults.

Objective

To investigate the incidence of falls among older adults in China and explore the association between BMI and grip strength and the risk of falls in older adults.

Methods

Data of participants over 60 in China Health and Retirement Longitudinal Study in 2011 and 2013 were collected. Sociodemographic variables, lifestyle, chronic disease status, history of falls and depression and cognitive status were obtained through the 2011 baseline questionnaire. Height, weight and grip strength were collected from a unified physical examination in 2011. Falls during the follow-up period were obtained through the follow-up questionnaire in 2013. Logistic regression was used to explore the association between BMI and grip strength and the risk of falls.

Results

Three thousand six hundred and eighty-five participants over 60 (67.14 ± 6.08) were included, with a fall incidence rate of 17.37%. The fall incidence rate in females (21.15%) was higher than that in male (13.46%). After adjusting covariates, high grip strength was associated with lower falls risks in general population (OR = 0.76; 95 CI: 0.630-0.923) and males (OR = 0.68; 95 CI: 0.503-0.919). Underweight was associated with lower falls risks in general population (OR = 0.77; 95 CI: 0.595-0.981) and females (OR = 0.69; 95 CI: 0.486-0.962) compared to the normal BMI group. Compared with the low grip strength group, females with high grip strength (OR = 0.54; 95 CI: 0.29-0.98) had a lower risk of falls in the underweight BMI group and males with high grip strength (OR = 0.63; 95 CI: 0.43-0.92) had lower risk of falls in the normal BMI group.

Conclusions

High grip strength and underweight BMI are independently correlated with a lower fall risk, which varies between males and females.

Effects of home-based exercise alone or combined with cognitive training on cognition in community-dwelling older adults: A randomized clinical trial

BACKGROUND

Structured and supervised physical exercise and cognitive training are two efficient ways to enhance cognition in older adults. Performing both within a combined intervention could maximize their effect on cognition due to their potential synergy on brain functions. During the COVID-19 pandemic, these interventions were particularly relevant due to the collateral impact of social restrictions regarding physical activity and the level of cognitive stimulation. However, the benefits of remotely monitored intervention combining physical exercise and cognitive training for older adult cognition remain to be demonstrated.

METHODS

127 older adults (age: 65.20 ± 7.95) were randomized in two arms, encouraging self-engagement in six months of home-based physical exercise alone or combined with cognitive training, monitored by phone once a week. Neuropsychological assessment was performed under videoconference supervision at baseline and after three and six months. Composite Z-scores were calculated for processing speed, executive functioning, working, and episodic memory to assess changes after three and six months of training. The weekly metabolic expenditure of self-reported activities was estimated using the compendium of physical activity to distinguish participants performing higher and lower doses of exercise (median split).

RESULTS

106 participants (83.46 %) completed the 6-month training. Results showed a greater Z-score change in executive functioning for participants in the combined arm than those who only exercised (F = 4.127, p = 0.046, ηp2 = 0.050). Group x Exercise dose interaction was observed for episodic memory Z-score change (F = 6.736, p = 0.011, ηp2 = 0.070), with a greater improvement for participants performing higher doses of exercise compared to those who performed a lower dose, only in exercise alone arm. Performing a higher dose of exercise increased the working memory Z-score change in both intervention arms compared to a lower dose (F = 7.391, p = 0.008, η p2 = 0.076).

CONCLUSION

Remote combined training may lead to larger improvement in executive functioning than exercise alone. Physical exercise showed a dose-related improvement in working and episodic memory performances. The combination of cognitive interventions mitigated the effects of exercise on episodic memory. These results suggest that home-based exercise and cognitive training may help improve older adults' cognition.

TRIAL REGISTRATION

COVEPIC was retrospectively registered on December 03, 2020.

CLINICAL TRIALS IDENTIFIER

NCT04635462 - https://clinicaltrials.gov/ct2/show/record/NCT04635462?term=NCT04635462&draw=2&rank=1.

Trajectories of polysubstance use: Are past-year internalizing and externalizing problems associated with trajectories of polysubstance use over time?

OBJECTIVE

Polysubstance use among adults has been a public health concern in the U.S. and is associated with adverse consequences. This study aimed to identify the longitudinal trajectory of polysubstance use and test whether internalizing and externalizing problems predict it.

METHODS

Data of adults aged 18 and older (N = 15076) were extracted from the Waves 1-5 Population Assessment of Tobacco and Health Study (2013-2019). Group-Based Trajectory Modeling was performed to identify the trajectory of polysubstance use. Examined substances included use of cigarettes, e-cigarettes, excessive alcohol, cannabis, painkillers, and cocaine in past 30 days from all waves. Weighted multinomial logistic regressions were conducted to investigate the associations between internalizing and externalizing problems and the trajectory of polysubstance use, controlling for demographic variables.

RESULTS

Five trajectory groups were identified: (1) No to minimal polysubstance use risk (45.6 %); (2) Polysubstance use-low risk (10.7 %); (3) Cigarette-leading polysubstance use-high risk (23.5 %); (4) Cigarette-cannabis co-leading polysubstance use-high risk (12.3 %); and (5) Cannabis-leading polysubstance use-high risk (7.8 %). Compared with Group 1, higher internalizing problems predicted the membership of Group 3 [Relative risk ratio (RRR) range: 1.07-1.17] and Group 4 (RRR range: 1.04-1.21). Compared with Group 1, higher externalizing problems predicted the membership of Group 5 (RRR range: 1.01-1.10).

CONCLUSIONS

Prevention efforts should consider internalizing problems and associated trajectories of high-risk polysubstance use (e.g., cigarette-leading and cigarette-cannabis co-leading) as well as externalizing problems and associated trajectories of high-risk polysubstance use (e.g., cannabis-leading), when designing interventions to prevent polysubstance use.

Identifying latent subgroups of primary head injury: an explorative latent class analysis on neuropathologically examined medico-legal autopsy cases

Traumatic brain injury (TBI) is a significant global health concern and frequently encountered in medico-legal autopsies. Previous studies suggest that certain TBI subtypes are more likely to co-occur than others. Therefore, we aimed to explore the potential of latent class analysis (LCA) to identify and characterize primary head injury combinations in neuropathologically examined medico-legal autopsy cases. The dataset comprised 78 cases from the Forensic Medicine Unit of the Finnish Institute for Health and Welfare over the period of 2016-2022. Data on background and circumstantial characteristics as well as primary and secondary head and brain injuries were collected from police documents, medical records, general autopsy reports and neuropathology reports. Latent class solutions with two to five classes were explored to identify clustering of primary head injuries among the sample. The dataset comprised 69.2% males and the median age was 49 years. In LCA, the solutions appeared reasonable, and each class appeared to represent a distinct TBI profile. The two-class solution was found to fit the present dataset best. Class 1 was characterized by older age, presence of an underlying CNS disease, and less diverse primary head injuries; these were interpreted as suggestive of lower traumatic forces. Class 2 was characterized by male sex and assaults as a prominent injury circumstance; subarachnoid and intracerebral/ventricular haemorrhages and contusions were classified exclusively into this class. In conclusion, this study identified two distinct subgroups of primary head injuries. Understanding typical injury combinations related to distinct circumstances could assist not only forensic pathologists but also clinicians treating TBI patients. However, the present latent class solution should not be interpreted as "ground truth", but instead further research is needed.

Clinician's Guide to Geriatric Assessment

The population of older adults is rapidly growing worldwide. Because of the substantial shortage of geriatricians, all clinicians need basic fluency in older adult care. In our approach to evaluating an older adult in the clinic or at the bedside, we apply the "Geriatric 5Ms" framework to manage the patient's care. The Geriatric 5Ms consist of the following key steps. First, consider the mind: the cognitive and psychological domains of a patient's health. Second, evaluate mobility and fall risk. Third, review and reconcile medications, particularly high-risk medications. Fourth, ask what matters most to the patient. Fifth, assess multicomplexity: how the intersection of multiple chronic conditions and social determinants of health influence the patient's health care management. Herein, we provide clinicians with practical suggestions and resources for quickly and effectively applying the Geriatric 5Ms to the care of older adults.

Clinical features of fallers and non-fallers: finding best-performing combinations of physical performance measurements to discriminate physical impairments between fallers and non-fallers among older adults with and without osteoporosis

Is osteoporosis related to worst outcomes after fall accidents? After a fall accident, there were no differences in walking and balance between individuals with/without osteoporosis. Gains in fat tissue, higher pain, and difficulty to walk were related to previous falls, regardless of osteoporosis.

PURPOSE

Impairments are expected after an accidental fall in the older age; whoever, it is still unclear if patients suffering from osteoporosis are in higher risks of fall accidents and if such accidents would cause worst outcomes compared with older adults without osteoporosis. The objective of this study was to discriminate fallers and non-fallers via a combination of physical performance measurements of older adults (65 + years) with and without osteoporosis.

METHODS

Older adults (n = 116) were screened for a previous fall accident and tested during (i) quiet stance; (ii) single- and dual-task walking; (iii) 8-Foot Up-and-Go; (iv) Mini BESTest; (v) 2-min step-in-place and (vi) 30-s chair stand. Evaluation of average daily pain intensity and total body fat% were obtained.

RESULTS

Forty-four subjects (38%) reported a previous fall accident. There was, however, no association between osteoporosis and previous fall. Fallers had a higher daily pain intensity, higher body fat%, slower walking speed during a cognitive dual-task test and worse performance at the 8-Foot Up-and-Go test and the Mini BESTest compared to non-fallers.

CONCLUSIONS

Although the presence of osteoporosis might not increase the risk of fall accidents, healthcare professionals should expect that accidental falls in older adults are associated with higher body fat%, higher daily pain intensity and problems performing daily activities such as walking.

Cognitive functions explain discrete parameters of normal walking and dual-task walking, but not postural sway in quiet stance among physically active older people

BACKGROUND

Postural control is dependent on the central nervous system's accurate interpretation of sensory information to formulate and execute adequate motor actions. Research has shown that cognitive functions are associated with both postural control and fall risk, but specific associations are not established. The aim of this study was to explore how specific components of everyday postural control tasks are associated with both general and specific cognitive functions.

METHODS

Forty-six community-dwelling older adults reported their age, sex, physical activity level, falls and fall-related concerns. The following cognitive aspects were assessed: global cognition, executive functions, processing speed and intraindividual variability. Postural control was quantified by measuring postural sway in quiet stance, walking at a self-selected pace, and walking while performing a concurrent arithmetical task. Separate orthogonal projections of latent structures models were generated for each postural control outcome using descriptive and cognitive variables as explanatory variables.

RESULTS

Longer step length and faster gait speed were related to faster processing speed and less intraindividual variability in the choice reaction test. Moreover, longer step length was also related to less fall-related concerns and less severe fall-related injuries, while faster gait speed was also related to female sex and poorer global cognition. Lower dual-task cost for gait speed was explained by the executive function inhibition and faster processing speed. Postural sway in quiet stance was not explained by cognitive functions.

CONCLUSIONS

Cognitive functions explained gait speed and step length during normal walking, as well as the decrease of gait speed while performing a concurrent cognitive task. The results suggest that different cognitive processes are important for different postural control aspects. Postural sway in quiet stance, step time and gait variability seem to depend more on physical and automatic processes rather than higher cognitive functions among physically active older people. The relationships between cognitive functions and postural control likely vary depending on the specific tasks and the characteristics of different populations.

Association between self-reported visual symptoms (suggesting cataract) and self-reported fall-related injury among adults aged ≥ 65 years from five low- and middle-income countries

BACKGROUND

Cataracts may increase risk for falls but studies on this topic from low- and middle-income countries (LMICs) are scarce. Therefore, we examined the cross-sectional association between self-reported visual symptoms (suggesting cataract) and self-reported injurious falls in nationally representative samples of adults aged ≥ 65 years from five LMICs (China, Ghana, India, Mexico, and Russia).

METHODS

Data from the WHO Study on global AGEing and adult health (SAGE) were analysed. Self-reported information on past 12-month fall-related injury and cataract based on symptoms were collected. Multivariable logistic regression and meta-analyses were conducted to assess associations.

RESULTS

Data on 13,101 people aged ≥ 65 years were analysed [mean (SD) age 72.5 (11.3) years; 45.2% males]. The overall prevalence of self-reported fall-related injury and visual symptoms (suggesting cataract) were 4.9% and 29.4%, respectively. There was a positive association between self-reported visual symptoms (suggesting cataract) and fall-related injury (i.e., OR > 1) in all five countries but statistical significance was reached in three: China (OR = 1.60; 95% CI = 1.08-2.35), India (OR = 1.96; 95% CI = 1.15-3.35), and Russia (OR = 3.58; 95% CI = 2.06-6.24). The pooled OR including all five countries based on a meta-analysis was OR = 1.88 (95% CI = 1.32-2.68).

CONCLUSIONS

Self-reported visual symptoms (suggesting cataract) were associated with higher odds for self-reported injurious falls among older adults in LMICs. Expanding availability of cataract surgery in LMICs may also have the additional benefit of reducing falls among older people.

Impact of Reactive Balance Training on a Perturbation Treadmill on Physical Performance in Geriatric Patients:Results of a Single-Center, Assessor Blinded Randomized Controlled Trial

Background/Objectives: Falls and related injuries are a frequent and serious health problem in older persons. Among the various strategies, different forms of active physical training, in particular, have demonstrated success in reducing fall risk. A task-specific training approach is perturbation-based training of reactive balance. Performing this training modality on a perturbation treadmill, secured with a safety harness, is an innovative new approach facilitating task-specific training with unannounced perturbations in a safe environment. The aim of this study was to investigate the feasibility and effectiveness of this specific training in multimorbid older hospitalized patients with prefrailty and frailty. Methods: The trial was conducted as a prospective single-center, assessor-blinded randomized controlled trial. A total of 127 acute-care geriatric hospitalized patients were enrolled in a program either involving a minimum of 60 min perturbation-based treadmill training or treadmill training without perturbations on the identical device and for a comparable training period. Results: Participants were 81 ± 6 years old (64% female) with a baseline FRAIL Scale, SPPB, and MoCA scores of 3.5 ± 1.6, 8.3 ± 2.6, and 21 ± 5 points, respectively. The training was performed on six occasions with an average total training period of 89 min during a mean hospital stay of 17 ± 3 days. Between the baseline and up to 2 days after the last training, the Short Physical Performance Battery score, which was considered the primary endpoint, improved by 1.4 ± 2.1 points in the intervention group compared to 0.5 ± 1.7 in the control group, with a 0.9-point difference between the groups (p < 0.001). Conclusions: a relatively short training period of approximately 90 min on a perturbation treadmill led to a significant and clinically meaningful increase in the physical performance of frail and prefrail hospitalized geriatric patients. However, its effectiveness in reducing fall risk is yet to be proven in this population.

Risk of Dementia Diagnosis After Injurious Falls in Older Adults

Importance

Emerging evidence suggests that mild cognitive impairment, which is a precursor to Alzheimer disease and related dementias (ADRD), places older adults at increased risk for falls. However, the risk that an older adult develops dementia after experiencing a fall is unknown.

Objective

To determine the risk of new ADRD diagnosis after a fall in older adults.

Design, Setting, and Participants

This retrospective cohort study examined Medicare Fee-for-Service data from 2014 to 2015, with follow-up data available for at least 1 year after the index encounter. Participants included adults aged 66 years and older who experienced a traumatic injury that resulted in an emergency department (ED) or inpatient encounter and did not have a preexisting diagnosis of dementia. Data analysis was performed from August 2023 to July 2024.

Exposures

Experiencing a fall compared with other mechanisms of injury, defined by International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 external cause of injury codes.

Main Outcomes and Measures

The hazard of new ADRD diagnosis within 1 year of a fall, assessed by performing a Cox multivariable competing risk model that controlled for potential confounders while accounting for the competing risk of death.

Results

The study included 2 453 655 older adult patients who experienced a traumatic injury; 1 522 656 (62.1%) were female; 124 396 (5.1%) were Black and 2 232 102 (91.0%) were White; and the mean (SD) age was 78.1 (8.1) years. The mechanism of injury was a fall in 1 228 847 incidents (50.1%). ADRD was more frequently diagnosed within 1 year of a fall compared with other injury mechanisms (10.6% [129 910 of 1 228 847] vs 6.1% [74 799 of 1 224 808]; P < .001). The unadjusted hazard ratio (HR) of incident dementia diagnosis after a fall was 1.63 (95% CI, 1.61-1.64; P < .001). On multivariable Cox competing risk analysis, falling was independently associated with an increased risk of dementia diagnosis among older adults (HR, 1.21 [95% CI, 1.20-1.21]; P < .001) after controlling for patient demographics, medical comorbidities, and injury characteristics, while accounting for the competing risk of death. Among the subset of older adults without a recent skilled nursing facility admission, the HR was 1.27 (95% CI, 1.26-1.28; P < .001).

Conclusions and Relevance

In this cohort study, new ADRD diagnoses were more common after falls compared with other mechanisms of injury, with 10.6% of older adults being diagnosed with ADRD in the first year after a fall. To improve the early identification of ADRD, this study's findings suggest support for the implementation of cognitive screening in older adults who experience an injurious fall that results in an ED visit or hospital admission.

Effects of a case management-based intervention on non-motor risk factors for falls in older people with history of falls: a randomised clinical trial

BACKGROUND

Falls are directly related to morbidity and mortality of older people. Multifactorial approaches that are individualised and based on fall risk factors are necessary. This study aims to verify the effects of a case management-based intervention on non-motor risk factors for falls in community-dwelling older people with a history of falls.

METHODS

The intervention applied a multidimensional assessment of risk factors for falls, a discussion about the identified risk factors, the preparation of an individualised plan with the participant, and the application, monitoring and review of the plan.

RESULTS

There was a significant interaction between groups and assessments only in the visuospatial domain (P = 0.031). After simple main effects analysis, differences between groups and assessments were not significant, although there was a tendency of worse visuospatial performance in the control group in the follow-up assessment (P = 0.099). There were no significant differences between groups or between assessments in other variables.

CONCLUSION

The intervention has the potential to maintain non-motor risk factors for falls in community-dwelling older people with a history of falls. However, more clinical trials are needed to prove its effects.

Development and psychometric properties of the Balance in Daily Life (BDL) scale in a population of frail older people

BACKGROUND

Balance disorders in older people cause falls, which can have serious functional and economic consequences. No existing scale relates fall risk to daily life situations. This study describes the development, psychometric properties and construct validity of the Balance in Daily Life (BDL) scale, comprising seven routine tasks including answering a phone, carrying a heavy bag, and sitting down and getting up from a chair.

METHODS

Frail patients aged 65 years or more were prospectively recruited from the geriatric rehabilitation department of a French university hospital. Inclusion criteria included autonomous walking over 20 m and modified Short Emergency Geriatric Assessment score 8-11. Patients with motor skills disorders and comprehension or major memory difficulties were excluded. Patients were assessed on Day 3 and Day 30 with the Balance in Daily Life scale, Timed Up and Go, one-leg stance time, sternal nudge and walking-while-talking tests. The scale was assessed for acceptability, quality, unidimensionality, internal consistency, reliability, temporal stability, responsiveness and construct validity.

RESULTS

140 patients (83 ± 6 years) were recruited, of whom 139 were assessed at Day 0 and 133 at Day 30. Acceptability was satisfactory (134/139 patients completed the test), quality assessment showed a slight floor effect (6 % of patients with minimal score) and evaluation of item redundancy found no strong correlation (Spearman <0.7). Unidimensionality was verified (Loevinger H coefficient > 0.5 for all items except item 6 = 0.4728). Internal consistency was good (Cronbach alpha = 0.86). Reliability and temporal stability were excellent (ICC = 0.97 and ICC = 0.92). Responsiveness was verified by significant score change p < 0.0001 between Day 0 and Day 30 (decreased by 1 [0; 2] point), in line with other score changes. Construct validity revealed that the Balance in Daily Life scale was convergent with results of the timed up-and-go and one-leg stance time (p < 0.0001 for both) and tended to be higher for participants who had not fallen in the previous 6 months (p = 0.0528). The new questionnaire was divergent to sternal nudge tests (p = 0.0002) and not related to the walking-while-talking test (p = 0.5969).

CONCLUSION

The Balance in Daily Life scale has good psychometric properties for this population. Its simplicity and innovative nature mean that it can be applied in institutions while being easily modifiable to domestic settings. Study registration on clinicaltrials.gov: NCT0334382.

Associations between type 2 diabetes mellitus and risk of falls among community-dwelling elderly people in Guangzhou, China: a prospective cohort study

BACKGROUND

Several studies have demonstrated that older adults with type 2 diabetes mellitus (T2DM) have a higher risk of falls compared to those without T2DM, which may lead to disability and a lower quality of life. While, limited prospective studies have quantified the associations in southern China. We conducted a longitudinal cohort study to quantify the associations between T2DM and falls and investigate the risk factors of falls among community-dwelling elderly people in Guangzhou, China.

METHODS

The population-based study included 8800 residents aged 65 and over in 11 counties of Guangzhou at baseline in 2020 and then prospectively followed up through 2022. Of 6169 participants had complete follow-up and were included in the present study. A fall event was identified by self-reported. The Cox regression was applied to quantify the associations between T2DM and falls, and hazard ratios (HRs) were calculated to the factors associated with falls among participants.

RESULTS

The median follow-up time for participants was 2.42 years. During the follow-up period, the incidence of falls among all participants was 21.96%. After adjusting for covariates in Cox regression models, T2DM remained a significant risk factor for falls, with HR of 1.781 (95% CI: 1.600-1.983) in the unadjusted covariates model and 1.757 (1.577-1.957) in the adjusted covariates model. Female (1.286, 1.136-1.457), older age (≥ 80: 1.448, 1.214-1.729), single marital status (1.239, 1.039-1.477), lower education level (primary school and below: 1.619, 1.004-1.361), hypertension (1.149, 1.026-1.286) and stroke (1.619, 1.176-2.228) were associated with a higher risk of falls, whereas everyday physical exercise (0.793, 0.686-0.918) was associated with a lower risk of falls.

CONCLUSION

Falls are common, with risks between T2DM and falls quantified and several factors investigated in the longitudinal cohort study among community-dwelling elderly people in Guangzhou, China. Targeted action on the risk factors may reduce the burden of falls in elderly people with T2DM in the future.

A study on the falls factors among the older adult with cognitive impairment based on large-sample data

Introduction

This study explored the correlative factors of falls among the older adult with cognitive impairment, to provide distinct evidence for preventing falls in the older adult with cognitive impairment compared with the general older adult population.

Methods

This study was based on a cross-sectional survey, with an older adult population of 124,124 was included. The data was sourced from the Elderly Care Unified Needs Assessment for Long-Term Care Insurance in Shanghai. Binary and multivariable logistic regression analyses were conducted sequentially on the correlative factors of falls. Multivariable logistic regression was performed on variables that were significant, stratified by cognitive function levels.

Results

The incidence of fall in the past 90 days was 17.67% in this study. Specific variables such as gender (male), advanced age (≥80), residence with a elevator (or lift), mild or moderate disability, quality of sleep (acceptable/poor) were negatively correlated with falls, while higher education level, living alone, residence with indoor steps, unclean and untidy living environment, MCI or dementia, chronic diseases, restricted joints, impaired vision, and the use of diaper were positively correlative factors of falls. Comparing with older adult with normal cognitive functions, older adult with dementia faced a higher risk of falling due to accessibility barrier in the residence. For general older adults, less frequency of going outside and poor social interactions were positively correlated with falls, while for older adult with cognitive impairments, going outside moderately (sometimes) was found positively correlated with falls. Older adults with cognitive impairments have increased fall risks associated with chronic diseases, restricted joints, and the use of diaper. The risk of falling escalated with the greater number of chronic diseases.

Discussion

For older adult with cognitive impairments, it is advisable to live with others. Additionally, creating an accessible living environment and maintaining the cleanness and tidiness can effectively reduce the risk of falls, particularly for those with MCI or dementia. Optimal outdoor activity plans should be developed separately based on the cognitive function of older adults. Older adult with dementia who have comorbidities should be paid special attention in fall prevention compared to the general older adult population.

A novel multistep approach to standardize the reported risk factors for in-hospital falls: a proof-of-concept study

Background

Uncertainty and inconsistency in terminology regarding the risk factors (RFs) for in-hospital falls are present in the literature.

Objective

(1) To perform a literature review to identify the fall RFs among hospitalized adults; (2) to link the found RFs to the corresponding categories of international health classifications to reduce the heterogeneity of their definitions; (3) to perform a meta-analysis on the risk categories to identify the significant RFs; (4) to refine the final list of significant categories to avoid redundancies.

Methods

Four databases were investigated. We included observational studies assessing patients who had experienced in-hospital falls. Two independent reviewers performed the inclusion and extrapolation process and evaluated the methodological quality of the included studies. RFs were grouped into categories according to three health classifications (ICF, ICD-10, and ATC). Meta-analyses were performed to obtain an overall pooled odds ratio for each RF. Finally, protective RFs or redundant RFs across different classifications were excluded.

Results

Thirty-six articles were included in the meta-analysis. One thousand one hundred and eleven RFs were identified; 616 were linked to ICF classification, 450 to ICD-10, and 260 to ATC. The meta-analyses and subsequent refinement of the categories yielded 53 significant RFs. Overall, the initial number of RFs was reduced by about 21 times.

Conclusion

We identified 53 significant RF categories for in-hospital falls. These results provide proof of concept of the feasibility and validity of the proposed methodology. The list of significant RFs can be used as a template to build more accurate measurement instruments to predict in-hospital falls.

Performance of digital technologies in assessing fall risks among older adults with cognitive impairment: a systematic review

Older adults with cognitive impairment (CI) are twice as likely to fall compared to the general older adult population. Traditional fall risk assessments may not be suitable for older adults with CI due to their reliance on attention and recall. Hence, there is an interest in using objective technology-based fall risk assessment tools to assess falls within this population. This systematic review aims to evaluate the features and performance of technology-based fall risk assessment tools for older adults with CI. A systematic search was conducted across several databases such as PubMed and IEEE Xplore, resulting in the inclusion of 22 studies. Most studies focused on participants with dementia. The technologies included sensors, mobile applications, motion capture, and virtual reality. Fall risk assessments were conducted in the community, laboratory, and institutional settings; with studies incorporating continuous monitoring of older adults in everyday environments. Studies used a combination of technology-based inputs of gait parameters, socio-demographic indicators, and clinical assessments. However, many missed the opportunity to include cognitive performance inputs as predictors to fall risk. The findings of this review support the use of technology-based fall risk assessment tools for older adults with CI. Further advancements incorporating cognitive measures and additional longitudinal studies are needed to improve the effectiveness and clinical applications of these assessment tools. Additional work is also required to compare the performance of existing methods for fall risk assessment, technology-based fall risk assessments, and the combination of these approaches.

White matter fibre density in the brain's inhibitory control network is associated with falling in low activity older adults

Recent research has indicated that the relationship between age-related cognitive decline and falling may be mediated by the individual's capacity to quickly cancel or inhibit a motor response. This longitudinal investigation demonstrates that higher white matter fibre density in the motor inhibition network paired with low physical activity was associated with falling in elderly participants. We measured the density of white matter fibre tracts connecting key nodes in the inhibitory control network in a large sample (n = 414) of older adults. We modelled their self-reported frequency of falling over a 4-year period with white matter fibre density in pathways corresponding to the direct and hyperdirect cortical-subcortical loops implicated in the inhibitory control network. Only connectivity between right inferior frontal gyrus and right subthalamic nucleus was associated with falling as measured cross-sectionally. The connectivity was not, however, predictive of future falling when measured 2 and 4 years later. Higher white matter fibre density was associated with falling, but only in combination with low levels of physical activity. No such relationship existed for selected control brain regions that are not implicated in the inhibitory control network. Albeit statistically robust, the direction of this effect was counterintuitive (more dense connectivity associated with falling) and warrants further longitudinal investigation into whether white matter fibre density changes over time in a manner correlated with falling, and mediated by physical activity.

Effects of Dalcroze Eurhythmics Exercise Versus Multicomponent Exercise on Physical and Cognitive Function, and Falls in Older Adults: The EPHYCOS Randomized Controlled Trial

Currently, robust evidence is lacking to support one exercise type over another in the prevention of physical and cognitive decline and falls among older adults, primarily because of the lack of comparative trials of proven interventions. Therefore, a 12-month randomized, single-blind, comparative effectiveness trial is conducted, in which 142 older adults at high risk for falls are randomized (1:1) to receive an evidence-based Dalcroze Eurhythmics (DE) exercise program (once weekly, group-based) or an evidence-based multicomponent (MULTI) exercise program incorporating balance, functional, and strength training activities (twice weekly, group- and home-based), for 12 months. The primary outcome is gait variability under dual-task at 12 months. At 12 months, the DE group has significant improvements compared with MULTI group on gait under both dual-task (adjusted β for stride variability: -2.3, 95%CI, -3.1 to -1.4; p < 0.001) and single-task, and on a variety of secondary physical and cognitive/executive function outcomes. The adjusted hazard ratio for falls is 0.58 (95%CI, 0.37 to 0.93) for the DE group compared with MULTI group. In conclusion, DE exercise is more effective than MULTI exercise in improving physical and cognitive function and reducing falls in older adults. The mechanisms underlying DE exercise-induced benefits remain to be fully elucidated.

A Meta-Analysis of Fall Risk in Older Adults With Alzheimer's Disease

OBJECTIVES

Falls are the leading cause of injuries in older adults. Although it is well recognized that Alzheimer's disease (AD) increases the fall risk of older adults, the reported fall risk in people with AD varies drastically. The principal purpose of this study was to summarize and synthesize previous studies reporting fall risk-related metrics in people with AD.

DESIGN

This was a meta-analysis.

SETTING AND PARTICIPANTS

Thirty-one studies reporting relevant fall data among 4654 older adults with AD were included.

METHODS

The fall prevalence, average number of falls, rate of recurrent fallers, and rate of injured fallers of included studies were meta-analyzed using random-effects models with inverse variance weights.

RESULTS

The pooled annual fall prevalence in older people with AD is 44.27% with an average annual number of falls of 1.30/person and a yearly rate of recurrent fallers of 42.08%. The reported rate of injured fallers was 45.0%.

CONCLUSIONS AND IMPLICATIONS

Our results reinforce that people with AD experience a higher fall risk than their cognitively healthy counterparts. The pooled fall metrics in this meta-analysis extend our understanding of the fall risk in people with AD. In addition, standardized approaches are needed to report fall-related data for people with AD.

Impaired Standing Balance in Older Adults with Cognitive Impairment after a Severe Fall

INTRODUCTION

Fall-related sequelae as well as balance and gait impairments are more pronounced in older adults who are cognitively impaired (OACI) compared to older adults who are cognitively healthy (OACH). Evidence is scarce about differences in standing balance and gait in OACH and OACI after a fall, even though these are major risks for recurrent falls. Thus, the aim of this study was to investigate early impairments in gait and balance, by adding inertial measurement units (IMUs) to a functional performance test in OACH and OACI after a severe fall with a presentation to the emergency department (ED) and immediate discharge.

METHODS

The study sample was stratified into participants with and without probable cognitive impairment using the result of the Montreal Cognitive Assessment total score (maximum of 30 points). The cutoff for probable cognitive impairment was set at ≤ 24. Standing balance and gait parameters were measured using three IMUs in n = 69 OACH (72.0 ± 8.2 years) and n = 76 OACI (78.7 ± 8.1 years). Data were collected at participants' homes as part of a comprehensive geriatric assessment in the "SeFallED" study within 4 weeks after presentation to the ED after a severe fall (German Clinical Trials Register ID: 00025949). ANCOVA was used for statistical analysis, adjusted for age.

RESULTS

The data indicated significantly more sway for OACI compared to OACH during balance tasks, whereas no differences in gait behavior were found. In detail, differences in standing balance were revealed for mean velocity (m/s) during parallel stance with eyes open (ηp2 = 0.190, p < 0.001) and eyes closed on a balance cushion (ηp2 = 0.059, p = 0.029), as well as during tandem stance (ηp2 = 0.034, p = 0.044) between OACI and OACH. Further differences between the two groups were detected for path length (m/s2) during parallel stance with eyes open (ηp2 = 0.144, p < 0.001) and eyes closed (ηp2 = 0.044, p < 0.027) and for range (m/s2) during tandem (ηp2 = 0.036, p = 0.036) and parallel stance with eyes closed (ηp2 = 0.045, p = 0.032).

CONCLUSION

Even though both groups have experienced a severe fall with presentation to the ED in the preceding 4 weeks, balance control among OACI indicated a higher fall risk than among OACH. Therefore, effective secondary fall prevention efforts have to be established, particularly for OACI.

Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults: A Review

Importance

Falls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures.

Observations

Falls result from age-related physiologic changes compounded by multiple intrinsic and extrinsic risk factors. Major modifiable risk factors among community-dwelling older adults include gait and balance disorders, orthostatic hypotension, sensory impairment, medications, and environmental hazards. Guidelines recommend that individuals who report a fall in the prior year, have concerns about falling, or have gait speed less than 0.8 to 1 m/s should receive fall prevention interventions. In a meta-analysis of 59 randomized clinical trials (RCTs) in average-risk to high-risk populations, exercise interventions to reduce falls were associated with 655 falls per 1000 patient-years in intervention groups vs 850 falls per 1000 patient-years in nonexercise control groups (rate ratio [RR] for falls, 0.77; 95% CI, 0.71-0.83; risk ratio for number of people who fall, 0.85; 95% CI, 0.81-0.89; risk difference, 7.2%; 95% CI, 5.2%-9.1%), with most trials assessing balance and functional exercises. In a meta-analysis of 43 RCTs of interventions that systematically assessed and addressed multiple risk factors among individuals at high risk, multifactorial interventions were associated with 1784 falls per 1000 patient-years in intervention groups vs 2317 falls per 1000 patient-years in control groups (RR, 0.77; 95% CI, 0.67-0.87) without a significant difference in the number of individuals who fell. Other interventions associated with decreased falls in meta-analysis of RCTs and quasi-randomized trials include surgery to remove cataracts (8 studies with 1834 patients; risk ratio [RR], 0.68; 95% CI, 0.48-0.96), multicomponent podiatry interventions (3 studies with 1358 patients; RR, 0.77; 95% CI, 0.61-0.99), and environmental modifications for individuals at high risk (12 studies with 5293 patients; RR, 0.74; 95% CI, 0.61-0.91). Meta-analysis of RCTs of programs to stop medications associated with falls have not found a significant reduction, although deprescribing is a component of many successful multifactorial interventions.

Conclusions and Relevance

More than 25% of older adults fall each year, and falls are the leading cause of injury-related death in persons aged 65 years or older. Functional exercises to improve leg strength and balance are recommended for fall prevention in average-risk to high-risk populations. Multifactorial risk reduction based on a systematic clinical assessment for modifiable risk factors may reduce fall rates among those at high risk.

The tool effect is lower in older adults with or without cognitive impairments than in young adults

Grabbing a phone from a table or stepping over an obstacle on the ground are daily activities that require the brain to take account of both object and the body's parameters. Research has shown that a person's estimated maximum reach is temporarily overestimated after using a tool, even when the tool is no longer in hand. This tool effect reflects the high plasticity of the perceptual-motor system (e.g., body schema updating)-at least in young individuals. The objective of the present study was to determine whether the tool effect is smaller in older adults. Forty-four young adults, 37 older adults without cognitive impairment and 30 older adults with cognitive impairment took part in the experiment. The task consisted in visually estimating the ability to reach (using the index finger) a target positioned at different locations on a table, both before and after using a rake. We observed a strong after-effect of tool use in the young adults only. Conversely, a tool effect was similarly absent in the older adults without and with cognitive impairment. Moreover, even before the tool was used, the maximum reach was overestimated in each of the three groups, although the overestimation was greatest in the two groups of older adults. In summary, we showed that the tool effect, observed in young adults, was absent in older adults; this finding suggests that with advancing age, the perceptual-motor system is less able to adapt to novel sensorimotor contexts. This lack of adaptation might explain (at least in part) the overestimation of motor skills often reported in the elderly.

Animal naming test stratifies the risk of falls and fall-related fractures in patients with cirrhosis

This study aimed to determine the relationship between animal naming test (ANT), falls, and fall-related fractures in patients with cirrhosis. Cognitive impairment and frailty were assessed using ANT and Karnofsky performance status (KPS), respectively. Factors stratifying the risk of previous falls and fall-related fractures within 1 year were assessed using a logistic regression model. Factors affecting patient performance in ANT were evaluated using multiple regression analysis. Of the 94 patients, 19% and 5% experienced falls and fall-related fractures, respectively. The performance in ANT was worse in patients who experienced falls (11 vs. 18; p < 0.001) and fall-related fractures (8 vs. 16; p < 0.001) than in those who did not. After adjustment, females, KPS, and ANT (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.65-0.93; p = 0.005) were associated with falls, while ANT was significantly associated with fall-related fractures (OR, 0.56; 95% CI 0.35-0.88; p = 0.012). Age and education affected the performance in ANT, whereas the use of Oriental zodiac did not. The ANT is useful for stratifying the risk of falls and fall-related fractures in patients with cirrhosis. The effects of age and education should be considered when applying ANT in the Japanese population.

Risk of fall in patients with chronic kidney disease: results from the China health and retirement longitudinal study (CHARLS)

BACKGROUND

Chronic kidney disease (CKD), often coexisting with various systemic disorders, may increase the risk of falls. Our study aimed to assess the prevalence and risk of falls among patients with CKD in China.

METHODS

We included patients with/without CKD from China Health and Retirement Longitudinal Study (CHARLS). Our primary outcome was the occurrence of fall accidents within the past 2 years. To enhance the robustness of our findings, we employed a multivariable logistic regression model, conducted propensity score analysis, and applied an inverse probability-weighting model.

RESULTS

A total of 12,658 participants were included, the prevalence of fall accident rates were 17.1% (2,028/11,837) among participants without CKD and 24.7% (203/821) among those with CKD. In the inverse probability-weighting model, participants with CKD exhibited higher fall accident rates (OR = 1.28, 95% CI: 1.08-1.53, p = 0.005 ). Sensitivity and subgroup analysis showed the results still stable.

CONCLUSIONS

The population in China afflicted with CKD has a significantly heightened risk of experiencing falls, underscoring the crucial importance of intensifying efforts in assessing and preventing fall risks.

Epidemiology of work-related fall injuries resulting in hospitalisation: individual and work risk factors and severity

OBJECTIVES

Injuries at work are common and costly for individuals and employers. A common mechanism of workplace injury is through falls, but there have been few epidemiological studies of risk factors. This study aimed to identify patient, work and injury factors associated with injuries causing hospitalisation after falling at work in Victoria, Australia.

METHODS

Data came from work-related hospitalised injury admissions, identified by International Classification of Diseases and Related Health Problems, Tenth Revision Australian Modification codes and compensation status, from Victorian Admitted Episodes Dataset between 1 July 2017 and 30 June 2022. Multivariate logistic regression analyses were conducted to identify factors associated with same-level falls and falls from height.

RESULTS

This study included 42 176 work-related injury admissions: 8669 (20.6%) fall injuries and 33 507 (79.4%) other injuries. Rates of high falls were more common in males than females (0.44 (95% CI: 0.43, 0.46) vs 0.08 (0.08, 0.09) admissions per 1000 employed), while same-level falls were more common in females than males (0.21 (0.20, 0.22) vs 0.18 (0.17, 0.18)). Patients with same-level fall injuries, relative to all other work injuries, were more likely to be older women, and have at least one chronic condition; falls from height were associated with male sex and construction work and more likely to result in intracranial, internal organ injuries and fractures and longer hospital stay than non-fall injuries.

CONCLUSION

Work-related falls were common and relatively severe. Same-level falls are relatively likely to occur in older women, the fastest-growing workplace demographic, and therefore the incidence is expected to increase. Comorbidities are an important fall risk factor. Employers could consider industry-relevant high and same-level fall prevention strategies for reducing the workplace injury burden.

Childhood Emotional Neglect and Cognitive Function Among Middle-Aged and Older Adults: Mediating Role of Social Engagement

Studies have demonstrated that childhood maltreatment and adverse experiences lead to impaired cognitive function. However, relatively few studies have examined the independent effect of childhood emotional neglect on cognitive function in middle-aged and older adults, and the role of social engagement in this relationship. Using a sample from the China Health and Retirement Longitudinal Study, the current study examined the mediating role of social engagement in the association between childhood emotional neglect and cognitive function among middle-aged and older adults. Participants were 32,540 middle-aged and older adults (Mage = 63.45, SD = 8.83). Data were analyzed using a fixed effects model for panel data and bootstrap resampling method. Results showed that participants who experienced emotional neglect had poorer cognitive function (β = -.068, p < .001). Social engagement mediated 7.55% of the association between emotional neglect and cognitive function (β = -.004, 95% CI [-0.006, -0.002], p < .05). The results indicated that interventions are required to improve awareness of emotional neglect and facilitate healthy parenting practices. Further research on how to motivate adults who experienced emotional neglect to engage in social activities is necessary.

Reduced Proactive and Reactive Cognitive Flexibility in Older Adults Underlies Performance Costs During Dual-Task Walking: A Mobile Brain/Body Imaging (MoBI) Study

Age-related reductions in cognitive flexibility may limit modulation of control processes during systematic increases to cognitive-motor demands, exacerbating dual-task costs. In this study, behavioral and neurophysiologic changes to proactive and reactive control during progressive cognitive-motor demands were compared across older and younger adults to explore the basis for age-differences in cognitive-motor interference (CMI). 19 younger (19 - 29 years old, mean age = 22.84 +/- 2.75 years, 6 male, 13 female) and 18 older (60 - 77 years old, mean age = 67.89 +/- 4.60 years, 9 male, 9 female) healthy adults completed cued task-switching while alternating between sitting and walking on a treadmill. Gait kinematics, task performance measures, and brain activity were recorded using electroencephalography (EEG) based Mobile Brain/Body Imaging (MoBI). Response accuracy on easier trial types improved in younger, but not older adults when they walked while performing the cognitive task. As difficulty increased, walking provoked accuracy costs in older, but not younger adults. Both groups registered faster responses and reduced gait variability during dual-task walking. Older adults exhibited lower amplitude modulations of proactive and reactive neural activity as cognitive-motor demands systematically increased, which may reflect reduced flexibility for progressive preparatory and reactive adjustments over behavioral control.

Adapted Home-Based Exercises in Dementia: An Exploratory Pre-post Pilot and Feasibility Study

The goals of this exploratory pre-post pilot and feasibility study (NCT04916964) were to assess the feasibility and effectiveness of an adapted Test-and-Exercise home-based exercise program on basic functional mobility and executive functions in persons with prodromal or mild Alzheimer's disease. Participants followed an 8 week exercise program at home, once per week with a physiotherapist and twice per week with their usual caregiver or independently. Functional mobility and executive functions were assessed before and after the intervention. Feasibility criteria were recruitment opportunity, participation agreement rate, cost adequacy, and drop-out rate. Twelve participants aged 80.83 ± 4.65 years took part in the study. All the basic functional mobility measures showed small effect sizes. Concerning executive functions, 5 measures showed small to moderate effect sizes. The 4 feasibility criteria were met. A larger scale study would, however, need adaptations and prior research on the ability of this population to use touch-screen technology.

Exergame and cognitive training for preventing falls in community-dwelling older people: a randomized controlled trial

Exergame training, in which video games are used to promote exercise, can be tailored to address cognitive and physical risk factors for falls and is a promising method for fall prevention in older people. Here, we performed a randomized clinical trial using the smart±step gaming system to examine the effectiveness of two home-based computer game interventions, seated cognitive training and step exergame training, for fall prevention in community-dwelling older people, as compared with a minimal-intervention control group. Participants aged 65 years or older (n = 769, 71% female) living independently in the community were randomized to one of three arms: (1) cognitive training using a computerized touchpad while seated, (2) exergame step training on a computerized mat or (3) control (provided with an education booklet on healthy ageing and fall prevention). The rate of falls reported monthly over 12 months-the primary outcome of the trial-was significantly reduced in the exergame training group compared with the control group (incidence rate ratio = 0.74, 95% confidence interval = 0.56-0.98), but was not statistically different between the cognitive training and control groups (incidence rate ratio = 0.86, 95% confidence interval = 0.65-1.12). No beneficial effects of the interventions were found for secondary outcomes of physical and cognitive function, and no serious intervention-related adverse events were reported. The results of this trial support the use of exergame step training for preventing falls in community-dwelling older people. As this intervention can be conducted at home and requires only minimal equipment, it has the potential for scalability as a public health intervention to address the increasing problem of falls and fall-related injuries. Australian and New Zealand Clinical Trial Registry identifier: ACTRN12616001325493 .