The association between muscle mass quantity and its quality in physically active older women

In this study, the authors aim to determine whether lower limb strength is related to lower limb lean mass and whether this relationship is affected by lower limb functionality in physically active older women. Twenty-six women underwent measures of knee muscles strength and lean mass of lower limbs. Bilateral strength of the knee flexors and extensors was measured by an isokinetic dynamometer. The concentric peak torque was measured at an angular velocity of 60°/s. Lean mass of the lower limbs was measured by bio-impedance analysis. Pearson's correlation analysis revealed significant association between the strength of the knee flexors and lean mass on non-dominant limb only (r = .427, p = .03). Researchers revealed that strategies aiming to prevent lean mass and muscle strength losses should be specifically targeted to individual muscles or muscle groups, even in physically active older women. To improve overall mobility, the strengthening of larger muscle such as hamstring is crucial.

Advancing age is associated with more impaired mediolateral balance control after step down task

BACKGROUND

To prevent the risk of stair descent falls and associated injuries in the older adults, it is important to understand the factors that affect this frequent locomotion of daily living. The fact that falls are in most cases the result of the interaction between intrinsic and extrinsic factors is very often underestimated when designing test protocols.

RESEARCH QUESTION

This study aimed at evaluating balance control during and immediately after step down onto an unstable surface.

METHODS

Physically active men and women aged 60-69 years (n = 28) and 70-79 years (n = 18) were asked to perform a step down onto a foam pad and stand still for 30 s (restabilization phase). Centre of pressure (CoP) velocity and standard deviation of CoP sway in anteroposterior and mediolateral direction were evaluated during the step down (CoP V_AP, CoP V_ML, CoP SD_AP, CoP SD_ML) and in the first 5 s of restabilization (CoP V_AP5, CoP V_ML5, CoP SD_AP5, CoP SD_ML5). In addition, time to complete step was investigated.

RESULTS

Participants aged 70-79 years presented worse ML balance control after step down onto an unstable surface than their younger counterparts. This was represented by the significantly higher values of CoP SD_ML5 and CoP V_ML5 (p = 0.022 and p = 0.017). No other significant differences were detected.

SIGNIFICANCE

Age is associated with a more significant ML center of pressure velocity and sway after step down onto a foam pad in physically active older adults. Exercises aimed at improving ML balance control in unstable conditions should be the subject of physical interventions even in older adults with overall good state of health and physical fitness.

Protective responses of older adults for avoiding injury during falls: evidence from video capture of real-life falls in long-term care

BACKGROUND

falls are common in older adults, and any fall from standing height onto a rigid surface has the potential to cause a serious brain injury or bone fracture. Safe strategies for falling in humans have traditionally been difficult to study.

OBJECTIVE

to determine whether specific 'safe landing' strategies (body rotation during descent, and upper limb bracing) separate injurious and non-injurious falls in seniors.

DESIGN

observational cohort study.

SETTING

two long-term care homes in Vancouver BC.

METHODS

videos of 2,388 falls experienced by 658 participants (mean age 84.0 years; SD 8.1) were analysed with a structured questionnaire. General estimating equations were used to examine how safe landing strategies associated with documented injuries.

RESULTS

injuries occurred in 38% of falls, and 4% of falls caused injuries treated in hospitals. 32% of injuries were to the head. Rotation during descent was common and protective against injury. In 43% of falls initially directed forward, participants rotated to land sideways, which reduced their odds for head injury 2-fold. Upper limb bracing was used in 58% of falls, but rather than protective, bracing was associated with an increased odds for injury, possibly because it occurred more often in the demanding scenario of forward landings.

CONCLUSIONS

the risk for injury during falls in long-term care was reduced by rotation during descent, but not by upper limb bracing. Our results expand our understanding of human postural responses to falls, and point towards novel strategies to prevent fall-related injuries.

World guidelines for falls prevention and management for older adults: a global initiative

BACKGROUND

falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present.

OBJECTIVES

to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries.

METHODS

a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting.

RECOMMENDATIONS

all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations.

CONCLUSIONS

the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

Age-related changes in protective arm reaction kinematics, kinetics, and neuromuscular activation during evoked forward falls

Fall related injuries in older adults are a major healthcare concern. During a fall, the hands and arms play an important role in minimizing trauma from ground impact. Although older adults are able to orient the hands and arms into a protective orientation after falling and prior to ground impact, an inability to avoid increased body impact occurs with age. Previous investigations have generally studied rapid arm movements in the pre-impact phase or absorbing energy in the post-impact phase. There are no known studies that have directly examined both the pre-impact and post-impact phase in sequence in a forward fall. The aim of this study was to identify age-related biomechanical and neuromuscular changes in evoked arm reactions in response to forward falls that may increase fall injury risk. Fourteen younger and 15 older adults participated. Falls were simulated while standing with torso and legs restrained via a moving pendulum system from 4 different initial lean angles. While there was not a significant age-related difference in the amount of energy absorbed post-impact (p = 0.68), older adults exhibited an 11% smaller maximum vertical ground reaction force when normalized to body weight (p = 0.031), and 8 degrees less elbow extension at impact (p = 0.045). A significant interaction between age and initial lean angle (p = 0.024), indicated that older adults required 54%, 54%, 41%, and 57% greater elbow angular displacement after impact at the low, medium, medium-high, and high initial lean angles compared to younger adults. These results suggested older adults may be at greater risk of increased body impact due to increased elbow flexion angular displacement after impact when the hands and arms are able to contact the ground first. Both groups exhibited robust modulation to the initial lean angle with no observed age-related differences in the initial onset timing or amplitude of muscle activation levels. There were no significant age-related differences in the EMG timing, amplitude or co-activation of muscle activation preceding impact or following impact indicating comparable neuromotor response patterns between older and younger adults. These results suggest that aging changes in muscular elements may be more implicated in the observed differences than changes in neuromuscular capacity. Future work is needed to test the efficacy of different modalities (e.g. instruction, strength, power, perturbation training, fall landing techniques) aimed at reducing fall injury risk.

A systematic review of one-legged balance performance and falls risk in community-dwelling adults

OBJECTIVE

The aim of this systematic review was to synthesise all published evidence on associations between one-legged balance performance and falls.

METHODS

Medline, EMBASE, CINAHL and Web of Science were systematically searched (to January 2021) to identify peer-reviewed, English language journal articles examining the association between one-legged balance performance and falls in community-dwelling adults.

RESULTS

Of 4310 records screened, 55 papers were included (n = 36954 participants). There was considerable heterogeneity between studies including differences in study characteristics, ascertainment of balance and falls, and analytical approaches. A meta-analysis of the time that individuals could maintain the one-legged balance position indicated that fallers had worse balance times than non-fallers (standardised mean difference: -0.29 (95%CI:-0.38,-0.20) in cross-sectional analyses; -0.19 (-0.28, -0.09) in longitudinal analyses), although there was no difference in the pooled median difference. Due to between-study heterogeneity, regression estimates between balance and fall outcomes could not be synthesised. Where assessed, prognostic accuracy indicators suggested that one-legged balance was a poor discriminator of fall risk; for example, 5 of 7 studies demonstrated poor prognostic accuracy (Area Under the Curve <0.6), with most studies demonstrating poor sensitivity.

CONCLUSIONS

This systematic review identified 55 papers that examined associations between balance and fall risk, the majority in older aged adults. However, the evidence was commonly of low quality and results were inconsistent. This contradicts previous perceptions of one-legged balance as a useful fall risk tool and highlights crucial gaps that must be addressed in order to translate such assessments to clinical settings.

Persistent polypharmacy and fall injury risk: the Health, Aging and Body Composition Study

BACKGROUND

Older adults receive treatment for fall injuries in both inpatient and outpatient settings. The effect of persistent polypharmacy (i.e. using multiple medications over a long period) on fall injuries is understudied, particularly for outpatient injuries. We examined the association between persistent polypharmacy and treated fall injury risk from inpatient and outpatient settings in community-dwelling older adults.

METHODS

The Health, Aging and Body Composition Study included 1764 community-dwelling adults (age 73.6 ± 2.9 years; 52% women; 38% black) with Medicare Fee-For-Service (FFS) claims at or within 6 months after 1998/99 clinic visit. Incident fall injuries (N = 545 in 4.6 ± 2.9 years) were defined as the initial claim with an ICD-9 fall E-code and non-fracture injury, or fracture code with/without a fall code from 1998/99 clinic visit to 12/31/08. Those without fall injury (N = 1219) were followed for 8.1 ± 2.6 years. Stepwise Cox models of fall injury risk with a time-varying variable for persistent polypharmacy (defined as ≥6 prescription medications at the two most recent consecutive clinic visits) were adjusted for demographics, lifestyle characteristics, chronic conditions, and functional ability. Sensitivity analyses explored if persistent polypharmacy both with and without fall risk increasing drugs (FRID) use were similarly associated with fall injury risk.

RESULTS

Among 1764 participants, 636 (36%) had persistent polypharmacy over the follow-up period, and 1128 (64%) did not. Fall injury incidence was 38 per 1000 person-years. Persistent polypharmacy increased fall injury risk (hazard ratio [HR]: 1.31 [1.06, 1.63]) after adjusting for covariates. Persistent polypharmacy with FRID use was associated with a 48% increase in fall injury risk (95%CI: 1.10, 2.00) vs. those who had non-persistent polypharmacy without FRID use. Risks for persistent polypharmacy without FRID use (HR: 1.22 [0.93, 1.60]) and non-persistent polypharmacy with FRID use (HR: 1.08 [0.77, 1.51]) did not significantly increase compared to non-persistent polypharmacy without FRID use.

CONCLUSIONS

Persistent polypharmacy, particularly combined with FRID use, was associated with increased risk for treated fall injuries from inpatient and outpatient settings. Clinicians may need to consider medication management for FRID and other fall prevention strategies in community-dwelling older adults with persistent polypharmacy to reduce fall injury risk.

Videoconference-Based Adapted Physical Exercise Training Is a Good and Safe Option for Seniors

Videoconference-based adapted physical exercise combines the benefits of supervised exercise training with staying at home, when conventional training is inaccessible. However, exercising with the use of a screen can be considered an optokinetic stimulation, and could therefore induce changes in sensory processing, affecting postural stability. The objectives of this study were to compare the effectiveness of the training delivered Face-to-Face and by Videoconferencing in improving physical capacities of older adults, and to evaluate the possible effects of the Videoconference mode on the processing of sensory information that could affect postural control. Twenty eight older adults underwent the supervised exercise program for sixteen weeks either Face-to-Face or by Videoconference. Muscular strength of knee and ankle flexors and extensors, maximum oxygen uptake, postural stability and horizontal rotational vestibulo-ocular reflex were evaluated before and after the training. Both modes of training similarly increased the VO₂ peak and strength of the motor muscles of lower limbs in all participants. The use of the Videoconference did not modify the vestibulo-ocular reflex in subjects or the importance of vision for postural control. Therefore, the Videoconference-based exercise training can be considered a safe and effective way to maintain good functional capacity in seniors.

Chronic Pain and Risk of Injurious Falls in Community-Dwelling Older Adults

BACKGROUND

Fall injuries are a leading cause of death in older adults. The potential impact of chronic pain characteristics on risk for injurious falls is not well understood. This prospective cohort study examined the relationship between chronic pain and risk for injurious falls in older adults.

METHOD

The MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older living in and around Boston, Massachusetts. Chronic pain characteristics, including pain severity, pain interference, and pain distribution, were measured at baseline using the Brief Pain Inventory subscales and a joint pain questionnaire. Occurrence of falls and fall-related injuries were recorded using monthly fall calendar postcards and fall follow-up interviews during the 4-year follow-up period.

RESULTS

Negative binomial regression models showed that pain interference and pain distribution, but not pain severity, independently predicted injurious falls adjusting for potential confounders. Participants in the highest third of pain interference scores had a 61% greater risk of injurious falls compared to those reporting little or no pain interference. Compared to no pain, multisite pain was associated with a 57% greater risk of injurious falls. Stratified by gender, the association was only significant in women. In the short term, moderate-to-severe pain in a given month was associated with increased risk of injurious falls in the subsequent month.

CONCLUSIONS

Global pain measures are associated with increased risk of injurious falls in older adults. Pain assessment should be incorporated into fall risk assessments. Interventions are needed to prevent fall injuries among elders with chronic pain.

Decreased Time on the Nondominant One-Leg Standing Test Associated with Repeated Falls in Older Residents with Healthy Aging, Mild Cognitive Impairment, and Dementia: The Wakuya Project

Introduction

The aim of this study is to clarify the association between repeated falls and the dominant/nondominant side in the open-eyed one-leg standing (OLS) test among people who are healthy or have mild cognitive impairment (MCI) or dementia in a community setting. We recruited 180 participants from 39 areas in the town of Wakuya.

Methods

This is a cross-sectional study. Participants were classified into 3 Clinical Dementia Rating (CDR) groups, i.e., CDR 0 (healthy, n = 71), CDR 0.5 (MCI, n = 85), and CDR 1+ (n = 23), and they were investigated for motor function (grip strength, 6-m normal gait speed, timed up and go test, and OLS test) and falls during the past year.

Results

Subjects with a CDR of 0.5 had higher rates of single and repeated falls (13.0 and 23.4%, respectively) than the CDR 0 group (12.1 and 4.5%, respectively), as did those in CDR 1+ group (15.0 and 30.0%). For the CDR 0.5 group, the frequency of falls was negatively (biologically meaningful direction) correlated with the left OLS time. No significant correlations with falls were found for other motor function tests. Another analysis separating the CDR 0.5 group into 2 subgroups (repeated falls vs. no or a single fall) also showed that the left OLS time was lower in subjects with repeated falls.

Conclusion

People with MCI who had fallen repeatedly in the year before the assessment had a significantly lower left OLS time compared to those who had not fallen or had had 1 fall with MCI. None of the other physical measures were associated with past repeat falls including OLS on the dominant right side. No such findings were noted in the CDR 0 and CDR 0+ groups.

[Evaluation of a simple screening tool for ambulant fall prevention]

BACKGROUND

An individual's risk of falling is generally difficult to detect and it is likely to be underestimated. Thus, preventive measures are challenging and they demand sufficient integration and implementation into aftercare and outpatient management. The Aachen Falls Prevention Scale (AFPS) is a quick and easy tool for patient-driven fall risk assessment. Older adults' risk of falling is identified in a suitable manner and they then have the opportunity to independently assess and monitor their risk of falling.

OBJECTIVES

The aim of the current study was to evaluate the AFPS as a simple screening tool in geriatric trauma patients via the identification of influencing factors, e.g. objective or subjective fall risk, fear of falling (FOF) and demographic data. In this context, we investigated older adults' willingness to take part in special activities concerning fall prevention.

METHODS

Retrospectively, all patients over 70 years of age who received in-hospital fracture treatment between July 2014 and April 2016 were analyzed at a level I trauma center. After identification of 884 patients, participants completed a short questionnaire (47 questions, yes/no, Likert scale) comprising the AFPS. A history of falls in the past year was considered an indicator of a balance disorder. In addition, ambulant patients were invited to participate between July and August 2016.

RESULTS

In total, 201 patients (mean 80.4 years, range 63-97 years) performed a self-assessment based on the AFPS. After steps 1 and 2 of the AFPS had been completed, 95 (47%) participants rated their subjective risk of falling as high (more than 5 points). Of the participants 84 (42%) were objectively classified as "fallers" with significant effects on their AFPS evaluation and rating of their subjective risk of falling. Furthermore, 67% of the participants identified a general practitioner as their main contact person, and 43% of the respondents viewed the AFPS as a beneficial screening tool in fall risk evaluation (8% negative attitudes). Only 12% of the participants could imagine using the AFPS app version as a feasible option.

CONCLUSION

It would be advantageous to pretest at-risk individuals in their environment using a simple self-assessment approach, with the main purpose of identifying potential balance problems. With this approach, cost savings in the healthcare system are possible, combined with a higher health-related quality of life in the geriatric population.

Nutritional Status, Body Mass Index, and the Risk of Falls in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

OBJECTIVES

To evaluate the association between nutritional status, defined on the basis of a multidimensional evaluation, and body mass index (BMI) with the risk of falls and recurrent falls in community-dwelling older people.

DESIGN

Systematic literature review and meta-analysis.

SETTING AND PARTICIPANTS

Community-dwelling older adults.

MEASURES

A systematic literature review was conducted on prospective studies identified through electronic and hand searches until October 2017. A random effects meta-analysis was used to evaluate the relative risk (RR) of experiencing falls and recurrent falls (≥2 falls within at least 6 months) on the basis of nutritional status, defined by multidimensional scores. A random effects dose-response meta-analysis was used to evaluate the association between BMI and the risk of falls and recurrent falls.

RESULTS

People who were malnourished or those at risk for malnutrition had a pooled 45% higher risk of experiencing at least 1 fall than were those well-nourished (9510 subjects). Increased falls risk was observed in subjects malnourished versus well-nourished [RR 1.64, 95% confidence interval (CI) 1.18-2.28; 3 studies, 8379 subjects], whereas no substantial results were observed for risk of recurrent falls. A U-shaped association was detected between BMI and the risk for falls (P < .001), with the nadir between 24.5 and 30 (144,934 subjects). Taking a BMI of 23.5 as reference, the pooled RR of falling ranged between 1.09 (95% CI 1.04-1.15) for a BMI of 17, to 1.07 (95% CI 0.92-1.24) for a BMI of 37.5. No associations were observed between BMI and recurrent falls (120,185 subjects).

CONCLUSIONS/IMPLICATIONS

The results of our work suggest therefore that nutritional status and BMI should be evaluated when assessing the risk for falls in older age.

Acute effects of static stretching on passive stiffness and postural balance in healthy, elderly men

OBJECTIVES

This study aimed to examine the acute effects of straight-leg raise (SLR) static stretching on passive stiffness and postural balance in healthy, elderly men. An additional aim of this study was to examine the relationships between stiffness and balance at baseline (prior to stretching) and the relationships between the stretch-induced changes in these variables.

METHODS

Eleven elderly men (age = 69 ± 6 years; height = 177 ± 7 cm; mass = 83 ± 13 kg) underwent postural balance and passive stiffness assessments before and after: 1) a stretching treatment consisting of four, 15-s SLR static stretches performed by the primary investigator and 2) a control treatment consisting of no static stretching. Passive stiffness was calculated from the slopes of the initial (phase 1) and final (phase 2) portions of the angle-torque curve. Unilateral postural balance was assessed on the right leg using a commercially designed balance testing device, which provides a measurement of static stability based on the overall stability index (OSI).

RESULTS

The slope coefficients and OSI values decreased from pre- to post-treatment for the stretching intervention (P = 0.015 and 0.018, respectively); however, there were no changes for the control (P = 0.654 and 0.920). For the stretching intervention, a significant positive relationship was observed between OSI and the slope coefficient of phase 1 at baseline (r = 0.619; P = 0.042). A significant positive relationship was also observed between the stretched-induced changes in OSI and the slope coefficient of phase 1 (r = 0.731; P = 0.011). No relationship was observed between OSI and the slope coefficient of phase 2 at baseline (r = 0.262; P = 0.437) nor was there a relationship between the changes in these variables (r = 0.419; P = 0.200).

CONCLUSION

A short, practical bout of SLR static stretching may be an effective intervention for reducing passive stiffness and improving postural balance in healthy, elderly men.

Stroke

Stroke, or cerebrovascular accident, involves injury to the central nervous system as a result of a vascular cause, and is a leading cause of disability worldwide. People with stroke often experience sensory, cognitive, and motor sequelae that can lead to difficulty walking, controlling balance in standing and voluntary tasks, and reacting to prevent a fall following an unexpected postural perturbation. This chapter discusses the interrelationships between stroke-related impairments, problems with control of balance and gait, fall risk, fear of falling, and participation in daily physical activity. Rehabilitation can improve balance and walking function, and consequently independence and quality of life, for those with stroke. This chapter also describes effective interventions for improving balance and walking function poststroke, and identifies some areas for further research in poststroke rehabilitation.

The association of falls with loneliness and social exclusion: evidence from the DEAS German Ageing Survey

BACKGROUND

It remains an open question whether falls are related with social relations, covering subjective (e.g., perceived loneliness) and more objective dimensions (e.g., number of important individuals in regular contact). Consequently, we aimed at examining the association between falls and social ties comprehensively, including loneliness, social exclusion and the number of important people in regular contact.

METHODS

Cross-sectional data were used from a population-based sample of community-dwelling individuals aged 40 and over (n = 7808) in Germany. Self-rated loneliness was quantified using a short version of the De Jong Gierveld Loneliness Scale. Perceived social exclusion was measured using a scale developed by Bude and Lantermann. Furthermore and in contrast to the subjective outcome measures, the more objective number of important people in regular contact was also used as outcome variable. The experience of a fall in the preceding 12 months (yes; no) was assessed.

RESULTS

Controlling for various possible confounding variables, linear regressions showed that experiencing a fall in the past 12 months was associated with higher social exclusion (β = .08, p < .001), and increased loneliness (β = .08, p < .001), whereas it was not associated with the number of important people in regular contact.

CONCLUSIONS

Findings stress the relation between falls and feelings of loneliness and social exclusion, whereas falls were unrelated to the more objective measure of number of important people in regular contact, suggesting that falls are particularly related to subjective measures of social ties and relations. This underlines the importance of interventions to prevent falls. Preventing falls in turn might help to prevent loneliness and social exclusion.

The Association Between Fall History and Physical Performance Tests in the Community-Dwelling Elderly: A Cross-Sectional Analysis

Objective

To evaluate the association between baseline characteristics, three physical performance tests and fall history in a sample of the elderly from Korean population.

Methods

A total of 307 participants (mean age, 76.70±4.85 years) were categorized into one of two groups, i.e., fallers and non-fallers. Fifty-two participants who had reported falling unexpectedly at least once in the previous 12 months were assigned to the fallers group. Physical performance tests included Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Timed Up and Go test. The differences between the two study groups were compared and we analyzed the correlations between fall histories and physical performance tests.

Results

SPPB demonstrated a significant association with fall history. Although the BBS total scores did not show statistical significance, two dynamic balance test items of BBS (B12 and B13) showed a significant association among fallers.

Conclusion

This study suggests that SPPB and two dynamic balance test items of the BBS can be used in screening for risk of falls in an ambulatory elderly population.

Reducing falls after hospital discharge: a protocol for a randomised controlled trial evaluating an individualised multimodal falls education programme for older adults

INTRODUCTION

Older adults frequently fall after discharge from hospital. Older people may have low self-perceived risk of falls and poor knowledge about falls prevention. The primary aim of the study is to evaluate the effect of providing tailored falls prevention education in addition to usual care on falls rates in older people after discharge from hospital compared to providing a social intervention in addition to usual care.

METHODS AND ANALYSES

The 'Back to My Best' study is a multisite, single blind, parallel-group randomised controlled trial with blinded outcome assessment and intention-to-treat analysis, adhering to CONSORT guidelines. Patients (n=390) (aged 60 years or older; score more than 7/10 on the Abbreviated Mental Test Score; discharged to community settings) from aged care rehabilitation wards in three hospitals will be recruited and randomly assigned to one of two groups. Participants allocated to the control group shall receive usual care plus a social visit. Participants allocated to the experimental group shall receive usual care and a falls prevention programme incorporating a video, workbook and individualised follow-up from an expert health professional to foster capability and motivation to engage in falls prevention strategies. The primary outcome is falls rates in the first 6 months after discharge, analysed using negative binomial regression with adjustment for participant's length of observation in the study. Secondary outcomes are injurious falls rates, the proportion of people who become fallers, functional status and health-related quality of life. Healthcare resource use will be captured from four sources for 6 months after discharge. The study is powered to detect a 30% relative reduction in the rate of falls (negative binomial incidence ratio 0.70) for a control rate of 0.80 falls per person over 6 months.

ETHICS AND DISSEMINATION

Results will be presented in peer-reviewed journals and at conferences worldwide. This study is approved by hospital and university Human Research Ethics Committees.

TRIAL REGISTRATION NUMBER

ACTRN12615000784516.

Effects of Home-Based Tai Chi and Lower Extremity Training and Self-Practice on Falls and Functional Outcomes in Older Fallers from the Emergency Department-A Randomized Controlled Trial

OBJECTIVES

To compare the effects of guided home-based tai chi chuan (TCC) and lower extremity training (LET) and of levels of self-practice on falls and functional outcomes in older fallers.

DESIGN

Randomized controlled trial.

SETTING

Taipei, Taiwan.

PARTICIPANTS

Individuals aged 60 and older who had fall-related emergency department visits at least 6 months before participating in the study and ambulated independently at baseline (N = 456).

INTERVENTION

Six months of TCC or LET.

MEASUREMENTS

Four types of fall measures (falls, time to first fall, fallers, recurrent fallers) and six functional measures (handgrip strength, balance, mobility, fear of falling, depression, cognitive function).

RESULTS

The TCC group was significantly less likely than the LET group to experience any falls during the 6-month intervention (incidence rate ratio (IRR) = 0.30, 95% confidence interval (CI) = 0.15-0.60), and the effects remained significant after 12 months of follow-up (IRR = 0.32, 95% CI = 0.14-0.71). These effects remained significant for injurious falls during the 6-month intervention (IRR = 0.33, 95% CI = 0.16-0.68) and the entire 18-month study (IRR = 0.39, 95% CI = 0.18-0.83). Similar results were obtained when another two fall measures (time to first fall, number of fallers) were used. Moreover, participants who independently practiced TCC or LET seven times per week or more were significantly less likely to experience injurious falls during the 6-month intervention (IRR = 0.41, 95% CI = 0.20-0.83) and the 18-month study (IRR = 0.43, 95% CI = 0.21-0.87) than their counterparts, had a significantly longer time to first injurious fall, and were significantly less likely to have an injurious fall during the 6-month intervention. Cognitive function improved to a greater extent in the TCC group than in the LET group over the 18-month study.

CONCLUSION

Home-based TCC may reduce the incidence of falls and injurious falls more than conventional LET in older fallers, and the effects may last for at least 1 year.

Equivalent Fall Risk in Elderly Patients on Hemodialysis and Peritoneal Dialysis

♦

BACKGROUND

Accidental falls are common in the hemodialysis (HD) population. The high fall rate has been attributed to a combination of aging, kidney disease-related morbidity, and HD treatment-related hazards. We hypothesized that patients maintained on peritoneal dialysis (PD) would have fewer falls than those on chronic HD. The objective of this study was to compare the falls risk between cohorts of elderly patients maintained on HD and PD, using prospective data from a large academic dialysis facility. ♦

METHODS

Patients aged 65 years or over on chronic in-hospital HD and PD at the University Health Network were recruited. Patients were followed biweekly, and falls occurring within the first year recorded. Fall risk between the 2 groups was compared using both crude and adjusted Poisson lognormal random effects modeling. ♦

RESULTS

Out of 258 potential patients, 236 were recruited, assessed at baseline, and followed biweekly for falls. Of 74 PD patients, 40 (54%) experienced 86 falls while 76 out of 162 (47%) HD patients experienced a total of 305 falls (crude fall rate 1.25 vs 1.60 respectively, odds ratio [OR] falls in PD patients 0.78, 95% confidence interval [CI] 0.61 - 0.92, p = 0.04). After adjustment for differences in comorbidity, number of medications, and other demographic differences, PD patients were no less likely to experience accidental falls than HD patients (OR 1.63, 95% CI 0.88 - 3.04, p = 0.1). ♦

CONCLUSIONS

We conclude that accidental falls are equally common in the PD population and the HD population. These data argue against post-HD hypotension as the sole contributor to the high fall risk in the dialysis population.

A long-recommended but seldom-used method of analysis for fall injuries found a unique pattern of risk factors in the youngest-old

Background

Few studies on fall risk factors use long-recommended methods for analysis of recurrent events. Previous falls are the biggest risk factor for future falls, but few fall studies focus on the youngest-old.

Aims

This study’s objective was to apply Cox regression for recurrent events to identify factors associated with injurious falls in the youngest-old.

Methods

Participants were community-dwelling residents of southern Sweden (n = 1,133), aged 59–67 at baseline (median 61.2), from the youngest cohorts of the larger Good Aging in Skåne (GÅS) study. Exposure variable data were collected from baseline study visits and medical records. Injurious falls, defined as emergency, inpatient, or specialist visits associated with ICD-10 fall codes during the follow-up period (2001–2011), were gathered from national and regional registries. Analysis was conducted using time to event Cox Regression for recurrent events.

Results

A majority (77.1 %) of injurious falls caused serious injuries such as fractures and open wounds. Exposure to nervous system medications [hazard ratio (HR) 1.40, 95 % confidence interval (CI) 1.03–1.89], central nervous system disease (HR 1.79, CI 1.18–2.70), and previous injurious fall(s) (HR 2.00, CI 1.50–2.68) were associated with increased hazard of injurious fall.

Conclusions

Regression for recurrent events is feasible with typical falls’ study data. The association of certain exposures with increased hazard of injurious falls begins earlier than previously studied. Different patterns of risk factors by age can provide insight into the progression of frailty. Tailored fall prevention screening and intervention may be of value in populations younger than those traditionally screened.

RAD. Elderly individuals with increased risk of falls show postural balance impairment

Introduction Falls are a serious public health problem. Objective The aim of this study was to evaluate whether elderly individuals with increased risk of falls have a postural balance deficit, evaluated using a force platform during a one-leg stance. Materials and methods The sample consisted of 94 physically independent elderly individuals from the EELO project. The instruments used were the Downton scale, in order to assess the risk as well as the history of falls, and the force platform to measure postural balance through parameters from the center of pressure (COP). Results Elderly individuals were split into two groups according to the score observed with the Downton scale: G1 — low fall risk (score ≤ 2) — and G2 — high fall risk (score > 2). No differences were observed between the groups concerning gender (P > 0.05, Chi Square test). On the other hand, individuals from G2 showed postural instability when compared to individuals from G1, and individuals from G2 showed higher values in all COP parameters analysed (Mann-Whitney test, P < 0.05). Conclusion It can be concluded that the Downton scale has sensitivity for identifying individuals with balance impairment as well as a risk of falls. Therefore, it may be suggested that this scale may be useful in primary health care for detecting falls in the elderly.

Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review

OBJECTIVES

To summarize evidence regarding the health outcomes associated with polypharmacy, defined as number of prescribed medications, in older community-dwelling persons.

DESIGN

Systematic review of MEDLINE (OvidSP 1946 to May, Week 3, 2014).

SETTING

Community.

PARTICIPANTS

Observational studies examining health outcomes according to number of prescription medications taken.

MEASUREMENTS

Association between number of medications and health outcomes. Because of the importance of comorbidity as a potential confounder of the relationship between polypharmacy and health outcomes, articles were assessed regarding the quality of their adjustment for confounding.

RESULTS

Of the 50 studies identified, the majority that were rated good in terms of their adjustment for comorbidity demonstrated relationships between polypharmacy and a range of outcomes, including falls, fall outcomes, fall risk factors, adverse drug events, hospitalization, mortality, and measures of function and cognition. However, a number of these studies failed to demonstrate associations, as did a substantial proportion of studies rated fair or poor.

CONCLUSION

Data are mixed regarding the relationship between polypharmacy, considered in terms of number of medications, and adverse outcomes in community-dwelling older persons. Because of the challenge of confounding, randomized controlled trials of medication discontinuation may provide more-definitive evidence regarding this relationship than observational studies can provide.

[Prevalence and associated factors of falls in community-dwelling elderly]

Objetivo

Estimar la prevalencia de caídas e identificar los factores asociados a ellas en la población mayor comunitaria.

Diseño

Estudio descriptivo, transversal.

Emplazamiento Atención Primaria de Salud, Lleida.

Participantes

Se incluyó a 640 personas de 75 o más años de edad, que disponían de tarjeta sanitaria y residían en viviendas unifamiliares, a través de un muestreo aleatorizado.

Mediciones principales

La fuente de datos proviene de la encuesta de fragilidad en Lleida (Encuesta FRALLE). Las variables utilizadas fueron la presencia de caídas en el último año, factores sociodemográficos, estado de salud, calidad de vida relacionada con la salud y miedo a caer.

Resultados

La prevalencia de caídas fue del 25,0% (IC 95% 24,8-25,1). Tras el análisis multivariado, la discapacidad básica (OR = 2,17; IC 95% 1,32-3,58), los síntomas depresivos (OR = 1,67; IC 95% 1,07-2,59) y el miedo a caer (OR = 2,53; IC 95% 1,63-3,94) fueron los únicos factores asociados de forma independiente a las caídas en el último año.

Conclusiones

Una de cada 4 personas mayores presentaron al menos una caída en el último año. Este estudio demuestra que el miedo a caer, los síntomas depresivos y la discapacidad básica son variables independientes asociadas a caídas previas. Estos 3 factores pueden dar lugar a una espiral favorecedora de caídas, pudiendo ser posibles objetivos para la actuación eficaz en el contexto de caídas.

Effects of Age, Gender and Level of Co-contraction on Elbow and Shoulder Rotational Stiffness and Damping in the Impulsively End-Loaded Upper Extremity

Whether an arm will buckle under an impulsive end-load should partly depend on the elastic and viscous properties of the pretensed arm muscles. In measuring these properties we hypothesized that neither age, gender, nor muscle pre-contraction level would affect the bilinear elbow or shoulder lumped rotational stiffness or damping parameters in the impulsively end-loaded upper extremity of 38 healthy men and women. Subjects were instructed to preactivate triceps to either 25, 50 or 75% of maximum myoelectric activity levels. Then a standardized impulsive end-load was applied via a 6-axis load cell to the wrist of the slightly flexed arm in the prone posture. Arm kinematic responses were acquired at 280 Hz and an inverse dynamics analysis was used to estimate the bilinear rotational stiffnesses and damping parameters at the elbow and shoulder. The results show that pre-contraction level affected normalized joint rotational stiffness and damping coefficients (p < 0.02). Age affected the initial stiffness for the elbow (p < 0.05), and gender affected that of the shoulder in the sagittal plane (p < 0.006). Arm muscle strength was positively related to normalized stiffness at the elbow, but not the shoulder. We conclude that age, gender and pre-contraction level each affect the viscoelastic behavior of the end-loaded upper extremity in healthy adults.

Risk factors for falls in older Korean adults: the 2011 Community Health Survey

Falls are a major health problem for elderly populations worldwide. We analyzed data from the 2011 Korean Community Health Survey to identify potential risk factors for falls in a representative population-based sample of community-dwelling older Korean adults. Risk factors for falls were assessed by multivariate survey logistic regression models. The prevalence of falls was 16.9% in males and 24.3% in females [Corrected]. Age and female sex were associated with a higher risk of falls. Similarly, living alone, living in an urban area, poor self-rated health, and high stress were associated with a high risk of falls. Subjects with diabetes mellitus, stroke, osteoarthritis, osteoporosis, urinary incontinence, cataracts, or depression had a high risk of falls. However, subjects with hypertension were at low risk for falls. In conclusion, age, female sex, marital status, residence location, self-rated health, stress, and several chronic conditions were significantly associated with the risk for falls in the older Korean adults. Our findings suggest that these risk factors should be addressed in public health policies for preventing falls.

Fall incidence in Germany: results of two population-based studies, and comparison of retrospective and prospective falls data collection methods

Background

Fall incidence differs considerably between studies and countries. Reasons may be differences between study samples or different assessment methods. The aim was to derive estimates of fall incidence from two population-based studies among older community-living people in Germany and compare retrospective and prospective falls data collection methods.

Methods

Data were derived from the 2008–11 wave of the German health interview and examination survey for adults (DEGS1), and the Activity and Function of the Elderly in Ulm study (ActiFE-Ulm). Data collection took place in community facilities (DEGS1) or participants’ homes (ActiFE-Ulm). Participation rates were 42% (newly recruited) and 64% (panel component) in DEGS1 and 19.8% in ActiFE-Ulm. Self-report retrospective fall data covering the previous 12 month period in DEGS1 and ActiFE-Ulm were collected, but only ActiFE-Ulm used prospective 12 month fall calendars. The incidence of ‘any fall’ and ‘recurrent falls’ were calculated for both methods.

Results

Fall rates increased with age in men but not women. The ActiFE-Ulm prospectively assessed incidence (95% confidence interval) in women and men aged 65- < 90 years were 38.7 (36.9-40.5) and 29.7 (28.1-31.3) fallers/year and 13.7 (12.5-14.9) and 10.9 (9.9-12.0) recurrent fallers/year, respectively. Retrospective and prospective fall incidence in ActiFE-Ulm did not differ.The retrospectively assessed incidence of ‘any fall’ among persons 65- < 80 years were significantly lower in DEGS1 than ActiFE-Ulm (women: 25.7% (22.4-29.2) versus 37.4% (34.8-39.9); men: 16.3% (13.6-19.3) versus 28.9% (26.6-31.1). Retrospective incidence estimates of recurrent falls were similar in both studies for women (10.4% (8.3-12.9) versus 10.2% (8.5-11.8)) and men (6.1% (4.3-8.5) versus 8.4% (7.1-9.8)).

Conclusion

Both studies were population-based, but retrospective self-reported fall incidence differed between studies. Study design influences retrospective reported fall incidence considerably. Costly collection of prospective data gives similar rates to the cheaper retrospective report method.

Nutritional status and falls in community-dwelling older people: a longitudinal study of a population-based random sample

Background

Falls are common in older people and may lead to functional decline, disability, and death. Many risk factors have been identified, but studies evaluating effects of nutritional status are limited. To determine whether nutritional status is a predictor of falls in older people living in the community, we analyzed data collected through the Survey of Health and Living Status of the Elderly in Taiwan (SHLSET).

Methods

SHLSET include a series of interview surveys conducted by the government on a random sample of people living in community dwellings in the nation. We included participants who received nutritional status assessment using the Mini Nutritional Assessment Taiwan Version 2 (MNA-T2) in the 1999 survey when they were 53 years or older and followed up on the cumulative incidence of falls in the one-year period before the interview in the 2003 survey.

Results

At the beginning of follow-up, the 4440 participants had a mean age of 69.5 (standard deviation  = 9.1) years, and 467 participants were “not well-nourished,” which was defined as having an MNA-T2 score of 23 or less. In the one-year study period, 659 participants reported having at least one fall. After adjusting for other risk factors, we found the associated odds ratio for falls was 1.73 (95% confidence interval, 1.23, 2.42) for “not well-nourished,” 1.57 (1.30, 1.90) for female gender, 1.03 (1.02, 1.04) for one-year older, 1.55 (1.22, 1.98) for history of falls, 1.34 (1.05, 1.72) for hospital stay during the past 12 months, 1.66 (1.07, 2.58) for difficulties in activities of daily living, and 1.53 (1.23, 1.91) for difficulties in instrumental activities of daily living.

Conclusion

Nutritional status is an independent predictor of falls in older people living in the community. Further studies are warranted to identify nutritional interventions that can help prevent falls in the elderly.

Instrumental activities of daily living staging as a possible clinical tool for falls risk assessment in physical medicine and rehabilitation

OBJECTIVE

To determine whether instrumental activity of daily living (IADL) limitation stages can distinguish among elderly, community-dwelling persons with high likelihoods to have fallen once and more than once.

DESIGN

A cross-sectional survey.

SETTING

A nationally representative sample from the Second Longitudinal Study of Aging (LSOA II).

PARTICIPANTS

Included were 7401 community-dwelling persons 70 years of age and older.

METHODS

The association of falling once and more than once within the past 12 months and 5 stages of increasing IADL limitation were explored by using a multinomial logistic regression model that controlled for demographics, education, perceived lack of home accessibility features, and health conditions. Sample proportions were weighted to reflect the prevalence in the U.S. population of 1994.

MAIN OUTCOME MEASUREMENTS

Subject recall of fall history. There were 3 categories for this variable: no fall, falling once, and falling more than once in the past 12 months.

RESULTS

Compared with IADL stage 0, the adjusted relative risk ratio of falling once peaked in individuals at IADL stage II at 2.0 (95% confidence interval [CI], 1.5-2.6), and those at IADL stage III had a relative risk ratio of 1.8 (95% CI, 1.3-2.6). The relative risk ratio of falling more than once was 2.1 (95% CI, 1.7-2.6), 4.0 (95% CI, 3.0-5.3), 3.7 (95% CI, 2.8-5.0), and 2.7 (95% CI, 1.5-4.9) for IADL stages I, II, III, and IV, respectively, when treating IADL stage 0 as reference.

CONCLUSIONS

IADL limitation stages could represent a powerful and practical tool for screening patients in the U.S. elderly population according to fall risk. Clinical implementation and prospective testing for validation as a screening tool would be necessary.

More radial shortening after low-energy Colles' fractures is associated with type 2 diabetes mellitus among postmenopausal women, irrespective of bone mineral density

BACKGROUND

Recent meta-analysis data reveal that patients with type 2 diabetes mellitus (DM) have a higher risk of fracture, despite higher bone mineral density (BMD), than patients without type 2 DM. The purpose of this study was to compare BMD and distal radial shortening after low-energy Colles' fractures among Japanese postmenopausal women aged ≥50 years with type 2 DM with those in women without it (non-DM).

METHODS

One-hundred and ten postmenopausal women aged ≥50 years with distal radius fractures resulting from a fall were enrolled in this study. Twelve patients had DM. BMD, type I collagen cross-linked N-telopeptide (NTX), undercarboxylated osteocalcin (ucOC), estimated glomerular filtration rate (eGFR), grip strength of the unfractured hand, unipedal standing time, and the degree of radial shortening were measured.

RESULTS

There were no significant differences in age and body height between the two groups. The DM group had significantly greater body weight and body mass index than the non-DM group. BMDs of the lumbar spine and proximal hip were significantly higher in the DM group than in the non-DM group. NTX, ucOC, grip strength, and the percentage of women with unipedal standing time <15 s did not differ between the two groups. Stepwise regression analysis identified DM and shorter unipedal standing time as significant factors associated with more radial shortening, and identified more radial shortening and lower eGFR as significant factors associated with DM.

CONCLUSIONS

More radial shortening after low-energy Colles' fractures was significantly associated with type 2 DM among postmenopausal women aged ≥50 years, irrespective of BMD.

Circumstances of falls and falls-related injuries in a cohort of older patients following hospital discharge

Background

Older people are at increased risk of falls after hospital discharge. This study aimed to describe the circumstances of falls in the six months after hospital discharge and to identify factors associated with the time and location of these falls.

Methods

Participants in this randomized controlled study comprised fallers (n = 138) who were part of a prospective observational cohort (n = 343) nested within a randomized controlled trial (n = 1206). The study tested patient education on falls prevention in hospital compared with usual care in older patients who were discharged from hospital and followed for six months after hospital discharge. The outcome measures were number of falls, falls-related injuries, and the circumstances of the falls, measured by use of a diary and a monthly telephone call to each participant.

Results

Participants (mean age 80.3 ± 8.7 years) reported 276 falls, of which 150 (54.3%) were injurious. Of the 255 falls for which there were data available about circumstances, 190 (74.5%) occurred indoors and 65 (25.5%) occurred in the external home environment or wider community. The most frequent time reported for falls was the morning (between 6 am and 10 am) when 79 (28.6%) falls, including 49 (32.7%) injurious falls, occurred. The most frequently reported location for falls (n = 80, 29.0%), including injurious falls (n = 42, 28.0%), was the bedroom. Factors associated with falling in the bedroom included requiring assistance with activities of daily living (adjusted odds ratio 2.97, 95% confidence interval (CI) 1.57–5.60, P = 0.001) and falling in hospital prior to discharge (adjusted odds ratio 2.32, 95% CI 1.21–4.45, P = 0.01). Fallers requiring assistance with activities of daily living were significantly less likely to fall outside (adjusted odds ratio 0.28, 95% CI 0.12–0.69, P = 0.005).

Conclusion

Older patients who have been recently discharged from hospital and receive assistance with activities of daily living are at high risk of injurious falls indoors, most often in the bedroom. These data suggest that targeted interventions may be needed to reduce falls in this population.

Tailored education for older patients to facilitate engagement in falls prevention strategies after hospital discharge--a pilot randomized controlled trial

Background

The aims of the study were to evaluate the effect of providing tailored falls prevention education in hospital on: i) engagement in targeted falls prevention behaviors in the month after discharge: ii) patients’ self-perceived risk and knowledge about falls and falls prevention strategies after receiving the education.

Methods

A pilot randomized controlled trial (n = 50): baseline and outcome assessments conducted by blinded researchers. Participants: hospital inpatients 60 years or older, discharged to the community. Participants were randomized into two groups. The intervention was a tailored education package consisting of multimedia falls prevention information with trained health professional follow-up, delivered in addition to usual care. Outcome measures were engagement in falls prevention behaviors in the month after discharge measured at one month after discharge with a structured survey, and participants’ knowledge, confidence and motivation levels before and after receiving the education. The feasibility of providing the intervention was examined and falls outcomes (falls, fall-related injuries) were also collected.

Results

Forty-eight patients (98%) provided follow-up data. The complete package was provided to 21 (84%) intervention group participants. Participants in the intervention group were significantly more likely to plan how to safely restart functional activities [Adjusted odds ratio 3.80, 95% CI (1.07, 13.52), p = 0.04] and more likely to complete other targeted behaviors such as completing their own home exercise program [Adjusted odds ratio 2.76, 95% CI (0.72, 10.50), p = 0.14] than the control group. The intervention group was significantly more knowledgeable, confident and motivated to engage in falls prevention strategies after receiving the education than the control group. There were 23 falls (n = 5 intervention; n = 18 control) and falls rates were 5.4/1000 patient days (intervention); 18.7/1000 patient days (control).

Conclusion

This tailored education was received positively by older people, resulted in increased engagement in falls prevention strategies after discharge and is feasible to deliver to older hospital patients.

Trial registration

The study was registered with the Australian New Zealand Clinical Trials Registry; ACTRN12611000963921 on 8th November 2011.

Correlação entre o risco de queda e autonomia funcional em idosos institucionalizados

Uma importante consequência do envelhecimento é o aumento do número de idosos com dependência funcional e propensão a quedas. Esta pesquisa teve por objetivo correlacionar o risco de quedas com a autonomia funcional em idosos institucionalizados na cidade de Teresina-PI. O modelo de estudo adotado foi observacional, descritivo e transversal, tendo sido realizado em três instituições de longa permanência, com 47 idosos. Os instrumentos da pesquisa foram a escala de equilíbrio de Berg (EEB) e o índice de Katz. Observou-se que o gênero feminino apresentou pior desempenho funcional médio quando comparado ao masculino (34,95 ± 16,22 vs 47,07 ± 11,67; p<0,01) e houve correlação positiva e forte (r=0,735 e p<0,001) entre os escores da EEB e o índice de Katz. Houve forte correlação entre as duas escalas no estudo, ou seja, quanto melhor o resultado da escala de equilíbrio de Berg, melhor o desempenho nas atividades básicas de vida diária e vice-versa.

The relationship between body weight, frailty, and the disablement process

OBJECTIVES

To prospectively examine the relationship between body weight, frailty, and the disablement process.

METHOD

Longitudinal data from the Health and Retirement Study (1998-2006) were used to examine the relationship between being underweight, overweight, or obese (compared with normal weight) and the onset and progression of functional limitations and disabilities in instrumental activities of daily living (IADL) and activities of daily living (ADL) among a nationally representative sample of community-dwelling older adults (aged 50 and older) with characteristics of frailty (n= 11,491). Nonlinear multilevel models additionally adjusted for demographic characteristics and intra-individual changes in body weight, socioeconomic status, health behaviors, and health conditions over the course of 8 years.

RESULTS

Compared with their nonfrail normal weight counterparts, prefrail obese respondents have a 16% (p ≤ 0.001) reduction in the expected functional limitations rate and frail overweight and obese respondents have a 10% (p ≤ 0.01) and 36% (p ≤ 0.001) reduction in the expected functional limitations rate, respectively. In addition, frail obese respondents have a 27% (p ≤ 0.05) reduction in the expected ADL disability rate.

DISCUSSION

This study's findings suggest that underweight, overweight, and obese status differentially affect the risk for functional limitations and disabilities in IADL and ADL. Among prefrail and frail adults, some excess body weight in later life may be beneficial, reducing the rate of functional limitations and disability.

Fall detection algorithm for the elderly using acceleration sensors on the shoes

The rate of increase in the number of aging population in Korea is very rapid among OECD-member countries. And fall accident is one of the most common factors that threaten the health of the elderly. Therefore, it is needed to develop a fall detection system for the elderly. Most fall detection systems use accelerometers attached on the torso. And in various studies, it was verified that these systems have high sensitivity and high specificity. However, the elderly would feel uncomfortable when banding a sensor on the chest every day. Therefore, in this study, we attached an accelerometer on the shoes to detect fall in the elderly. This prototype system would be improved as a smaller, low-power system in the next study. Also, applying energy harvesting device to this shoe system is being developed to reduce the weight of battery.

Fall risk-relevant functional mobility outcomes in dementia following dyadic tai chi exercise

Whether persons with dementia benefit from fall prevention exercise is unclear. Applying the Positive Emotion-Motivated Tai Chi protocol, preliminary findings concerning adherence and effects of a dyadic Tai Chi exercise program on persons with Alzheimer's disease (AD) are reported. Using pre/posttest design, 22 community-dwelling AD-caregiver dyads participated in the program. Fall-risk-relevant functional mobility was measured using Unipedal Stance Time (UST) and Timed Up and Go (TUG) tests. Results showed that 19/22 (86.4%) AD patients completed the 16-week program and final assessment; 16/19 dyads (84.2%) completed the prescribed home program as reported by caregivers. UST adjusted mean improved from 4.0 to 5.1 (Week 4, p < .05) and 5.6 (Week 16, p < .05); TUG improved from 13.2 to 11.6 (Week 4, p < .05) and 11.6 (Week 16, p > .05) post intervention. Retaining dementia patients in an exercise intervention remains challenging. The dyadic Tai Chi approach appears to succeed in keeping AD-caregiver dyads exercising and safe.

Use of a standard cane increases unipedal stance time during static testing

The records of 11 consecutive qualifying patients were reviewed to evaluate whether use of a cane increased unipedal balance time during static testing. Measured with a stopwatch, the maximum unipedal balance time increased significantly with use of a single-point cane, whether standing on the left (M = 14.4 sec.) or right (M = 16.7 sec.) lower limb. The results indicate that in clinical situations, sophisticated instruments are not needed to demonstrate the effects of a cane and that unipedal stance times obtained with a stopwatch can confirm the effectiveness of canes for increasing unipedal balance of patients and caregivers.

Increased fall risk is associated with elevated co-contraction about the ankle during static balance challenges in older adults

Falls are a leading contributor to disability in older adults. Increased muscle co-contraction in the lower extremities during static and dynamic balance challenges has been associated with aging, and also with a history of falling. Co-contraction during static balance challenges has not been previously linked with performance on clinical tests designed to ascertain fall risk. The purpose of this study was to investigate the relationship between co-contraction about the ankle during static balance challenges with fall risk on a commonly used dynamic balance assessment, the Four Square Step Test (FSST). Twenty-three volunteers (mean age 73 years) performed a series of five static balance challenges (Romberg eyes open/closed, Sharpened Romberg eyes open/closed, and Single Leg Standing) with continuous electromyography (EMG) of bilateral tibialis anterior and gastrocnemius muscles. Participants then completed the FSST and were categorized as 'at-risk' or 'not-at-risk' to fall based on a cutoff time of 12 s. Co-contraction was quantified with co-contraction index (CCI). CCI during narrow base conditions was positively correlated with time to complete FSST. High CCIs during all static balance challenges with the exception of Romberg stance with eyes closed were predictive of being at-risk to fall based on FSST time, odds ratio 19.3. The authors conclude that co-contraction about the ankle during static balance challenges can be predictive of performance on a dynamic balance test.

Age-related changes of arm movements in dual task condition when walking on different surfaces

The purpose of this study was to investigate whether the dual task paradigm would influence arm movements during walking. Furthermore, we examined the effects of different walking surfaces on arm movements while performing dual tasks. The effects of age and gender were also investigated. Fifteen young adults and 15 older adults were included in this study. Subjects were asked to perform the walking task alone (single-task trial) and walking in combination with a cognitive task (dual-task trial). Four walking conditions (1 single task and 3 dual task trials)×two walking surfaces were encountered. Both age groups had greater elbow and trunk movement in the sagittal plane under the dual task trials as compared to the single task trial (p<.05). Subjects had greater upper extremity and upper body movement on the soft floor than on the hard floor (p<.05). Subjects had greater movement amplitude when confronting a challenging environment, especially in the contralateral side. Among gender, there was a group-gender interaction: the older females had smaller upper extremity movement than the older males (p<.05) but the opposite was true for the young adults. The results suggest that different age groups of males and females use different balance control strategy to deal with the challenging conditions.

High yield research opportunities in geriatric emergency medicine: prehospital care, delirium, adverse drug events, and falls

Emergency services constitute crucial and frequently used safety nets for older persons, an emergency visit by a senior very often indicates high vulnerability for functional decline and death, and interventions via the emergency system have significant opportunities to change the clinical course of older patients who require its services. However, the evidence base for widespread employment of emergency system-based interventions is lacking. In this article, we review the evidence and offer crucial research questions to capitalize on the opportunity to optimize health trajectories of older persons seeking emergency care in four areas: prehospital care, delirium, adverse drug events, and falls.

Percentage height of center of mass is associated with the risk of falls among elderly women: A case-control study

Falls are a serious health problem for aged people, causing social and economic burden. Despite being an important determinant of balance, the positioning of the center of mass (COM) has not been evaluated as a risk factor for falls. This study examined the association between the percentage height of COM (%COM) and the risk of falls in the elderly. Healthy women aged 60 years and older were consecutively selected in a case-control study. Forty-eight individuals classified as "fallers" (having suffered two or more falls in the previous year) were the cases while 48 age and weight-matched women with one fall or no falls in the previous year were the controls ("non-fallers"). Body composition and bone mineral density (BMD) by DXA, 30-second chair stand test, abdominal circumference, Berg's balance scale and %COM using the reaction board method were evaluated in all participants. Body composition parameters were not significantly different between groups. Spine and hip BMD tended to be lower in the fallers, but the difference was significant only at the femoral neck (0.80±0.10g/cm(2) versus 0.87±0.76g/cm(2); p<0.01). Berg's balance scale scores were lower among fallers than non-fallers (p<0.05). Percentage height of COM was significantly higher among fallers (p<0.001) and this was associated with a higher number of fractures (p<0.05). Percentage height of COM is significantly higher in the elderly with frequent falls. Further work is needed in order to determine the value of board reaction measurements in a clinical setting to identify patients at high risk.

The effects of gender, level of co-contraction, and initial angle on elbow extensor muscle stiffness and damping under a step increase in elbow flexion moment

Flexion buckling of an arm under the large ground reaction loads associated with arresting a fall to the ground increases the risk for head and thorax injuries. Yet, the factors that determine the arm buckling load remain poorly understood. We tested the hypothesis in 18 healthy young adults that neither gender, triceps co-contraction level (i.e., 25, 50, or 75% MVC) nor elbow angle would affect the rotational stiffness and damping resistance to step changes in elbow flexion loading. Data on the step response were gathered using optoelectronic markers (150 Hz) and myoelectric activity measurements (2 kHz), and an inverse dynamics analysis was used to estimate elbow extensor stiffness and damping coefficients. A repeated-measures analysis of variance showed that gender (p = 0.032), elbow flexion angle and co-contraction level (both p < 0.001) affected stiffness, but only the latter affected the damping coefficient (p = 0.035). At 25° of initial elbow flexion angle and maximum co-contraction, female stiffness and damping coefficients were 18 and 30% less, respectively, than male values after normalization by body height and weight. We conclude that the maximum extensor rotational stiffness and damping at the elbow is lower in women than in men of the same body size, and varies with triceps co-contraction level and initial elbow angle.

A new washable low-cost garment for everyday fall detection

In this paper, a new garment for automatic fall detection and alert is presented for the first time. It includes a washable pullover with integrated acceleration sensors, evaluation and control electronics. The system measures the accelerations at the torso and on the arms in three directions in space. The fall detection is based on recognizing, by means of the sensors, the posture and abnormal acceleration magnitudes usually associated to a fall. The alarm as well as the movement information is sent via a wireless radio link. A fall will be detected within the pullover's electronics. The fall detection system was tested on ten volunteers. The daily life movements are also stored on a memory card. The latter can be read in on a PC. Thanks to an optimized production process, the system can be affordably reproduced in low volume productions and can be adjusted for any usage. The power supply of the system is realized with rechargeable batteries.

Association of Religious Participation With Mortality Among Chinese Old Adults

This research examines the association of religious participation with mortality using a longitudinal data set collected from 9,017 oldest-old aged 85+ and 6,956 younger elders aged 65 to 84 in China in 2002 and 2005 and hazard models. Results show that adjusted for demographics, family/social support, and health practices, risk of dying was 24% (p < 0.001) and 12% (p < 0.01) lower among frequent and infrequent religious participants than among nonparticipants for all elders aged 65+. After baseline health was adjusted, the corresponding risk of dying declined to 21% (p < 0.001) and 6% (not significant), respectively. The authors also conducted hazard models analysis for men versus women and for young-old versus oldest-old, respectively, adjusted for single-year age; the authors found that gender differentials of association of religious participation with mortality among all elderly aged 65+ were not significant; association among young-old men was significantly stronger than among oldest-old men, but no such significant young-old versus oldest-old differentials in women were found.

Shorter unipedal standing time and lower bone mineral density in women with distal radius fractures

Unipedal standing time was shorter and bone mineral density was lower in Japanese women aged 50 years and over with low-energy distal radius fractures resulting from falls than those in age-matched community-dwelling Japanese women without distal radius fractures.

INTRODUCTION

The aim of this study was to compare unipedal standing time and bone mineral density (BMD) of women >or=50 years of age with distal radius fractures with those of age-matched women without fractures.

METHODS

Fracture group was 54 Japanese women with low-energy distal radius fractures resulting from fall. Non-fracture group was 52 community-dwelling Japanese women without fractures. Unipedal standing time and BMD were measured.

RESULTS

There were no significant differences in age and body mass index between the two groups. The percentage of women with unipedal standing time <15 s was 44.4% in the fracture group and 13.5% in the non-fracture group, while the respective frequencies for >120 s were 20.4% and 50.0%. The T-score of BMD was significantly lower in the fracture than non-fracture group. Logistic regression analysis identified unipedal standing time <15 s and T-score <70% as significant factors associated with distal radius fractures. Notably, T-score <70% was significant in subjects <65 years, and unipedal standing time <15 s was significant in those >or=65 years.

CONCLUSION

Unipedal standing time was shorter and BMD was lower in women >or=50 years of age with distal radius fractures than those in age-matched women without fractures.

Neovascular AMD: an overlooked risk factor for injurious falls

While those with neovascular age-related macular degeneration (NV-AMD) may be at increased risk of injurious falls risk due to poor central vision and suboptimal responses when falling, preserved peripheral vision and decreased activity levels may actually be protective. Compared with control participants, patients with NV-AMD had a significantly greater number of falls and almost twice the risk of injurious falls.

INTRODUCTION

Impaired vision, particularly peripheral visual function, is a key risk factor for injurious falls. NV-AMD is a leading cause of severely impaired vision among older adults but is associated with a profound central, rather than peripheral, deficit. The objective was to determine whether older women with NV-AMD are at an increased risk of falls or injurious falls.

METHODS

We conducted a 12-month prospective cohort study of community-dwelling older (>or=70 years) women, enrolling 114 with NV-AMD and 132 without from a retinal clinic in Vancouver, Canada. Fall incidence was determined through monthly telephone follow-up, with fall severity classified by a blinded reviewer. We compared mean injurious falls per person-year between groups using negative binomial regression.

RESULTS

A mean of 0.37 injurious falls per person-year were experienced among NV-AMD participants, compared to 0.16 injurious falls per person-year among non-NV-AMD participants (p = 0.006). The age-adjusted incidence rate ratio for injurious falls, for an individual with NV-AMD compared to without, was 1.77 (1.07-3.02).

CONCLUSIONS

Older women with NV-AMD are at almost twice the risk of injurious falls compared to those without. Clinicians caring for older adults should recognise NV-AMD as an important risk factor for injurious falls.

Incidence and seasonal variation in hip fracture incidence among elderly women in Norway. The HUNT Study

There is a substantial variation in hip fracture incidence between populations. The Scandinavian countries have the highest incidence of hip fractures worldwide, and latitude and seasonal variation have been discussed as possible reasons for the high fracture incidences. The purpose of this study was to investigate time dependent and seasonal variation of hip fractures in a population based cohort of women aged 65+ residing in a rural county in Norway and followed for 9.3 years. Information at baseline was collected as part of The Nord-Trøndelag Health Study (HUNT) during 1995-97, and 8362 women with no previous hip fracture and with a mean age of 74.3 years were included in the study. All hip fractures occurring after inclusion in the health study were registered (mean follow-up: 9.3 years) by medical journals and x-ray reports. A total of 5661 of the women had their forearm bone mineral density (BMD) measured by single energy x-ray bone densitometers (SXA) as part of HUNT. In total, 782 women sustained a first hip fracture during follow-up, and the overall hip fracture incidence rate per 1000 person-years was 13.1 (95 % CI: 12.2-14.1). The hip fracture incidence increased exponentially by age from 2.1 (95% CI: 1.2-3.8) in the age group 65-69 years to 49.7 (95% CI: 41.2-59.8) among the women aged 90+, respectively. In age-stratified analyses no changes in the incidence of hip fractures were observed during the nine years of follow up. The occurrence of fractures varied by season of the year, characterized by higher fracture rates during the winter months. In conclusion, the hip fracture rates in this population of elderly women are highest in the winter months. There was, however, no indication of an increasing hip fracture incidence in this rural area. Compared to similar studies from more urban areas in Norway, the hip fracture rates in this population seem somewhat lower.

Fall Prevention: Core Characteristics and Practical Interventions

The article explores the range of core characteristics that make up the construct of falls. It seeks to magnify what these core elements are in the concept of fall prevention. The article provides practical interventions regarding home safety issues and how to correctly get up after a fall.