Prediction of Balance Perturbations and Falls on Stairs in Older People Using a Biomechanical Profiling Approach: A 12-Month Longitudinal Study

Biomechanical Balance Measures During Timed Up and Go Test Improve Prediction of Prospective Falls in Older Adults

OBJECTIVE

To assess the feasibility of using biomechanical gait balance measures, the frontal and sagittal plane center of mass (COM)-Ankle angles, to prospectively predict recurrent falls in community-dwelling older adults.

DESIGN

A cohort study with a 1-year longitudinal follow-up. Logistic regression was used to test the ability of the COM-Ankle angles to predict prospective falls.

SETTING

General community.

PARTICIPANTS

Sixty older adults over the age of 70 years were recruited using a volunteer sample.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

Biomechanical balance parameters: the sagittal and frontal plane COM-Ankle angles during the sit-to-walk and turning phases of the timed Up and Go test. The COM-Ankle angles are the inclination angles of the line formed by the COM and lateral ankle (malleolus) marker of the stance foot in the sagittal and frontal planes. We also included the following clinical balance tests in the analysis: Activity-Specific Balance Confidence, Berg Balance Scale, Fullerton Advanced Balance scale, and timed Up and Go test. Their abilities to predict falls served as a reference for the biomechanical balance parameters.

RESULTS

When the biomechanical gait balance measures were added to all the confounders, the explained variance was increased from 25.3% to 50.2%. Older adults who have a smaller sagittal plane COM-Ankle angle at seat-off, a greater frontal plane COM range of motion during STW and a smaller frontal plane angle during turning were more likely to become recurrent fallers.

CONCLUSION(S)

Our results indicated that dynamic biomechanical balance parameters could provide valuable information about a participant's future fall risks beyond what can be explained by demographics, cognition, depression, strength, and past fall history. Among all biomechanical parameters investigated, frontal plane COM motion measures during STW and turning appear to be the most significant predictors for future falls.

Home Environmental Factors Associated with Falls Among Elderly in Ubon Ratchathani, Thailand

Purpose

The demographics of the world's population have changed over time. Previous research demonstrated the high rate of falls among elderly people living in rural areas in their own houses. This study aimed to use the Thai-Home Fall Hazard Assessment Tool (Thai-HFHAT) to look into the environmental factors inside and outside of residential homes connected to falls among elderly living in rural Thailand.

Methods

Data was gathered between August and October 2023 using a questionnaire to obtain demographic data and the 44-question Thai-HFHAT survey. The survey was divided into seven sections covering the areas inside and outside the elderly home facility. Descriptive statistics were used in the data analysis, and statistical tests, including Fisher's exact test and the Chi-square test, were used to examine the relationship between environmental factors and falls in elderly people.

Results

The study found that issues with an elderly rural home included split-level flooring in the living room, bathroom, and bedroom, an insecurely attached carpet in the kitchen and bedroom, and a shower area not separated from the toilet. The environmental factors linked to falls among the elderly encompass insufficient lighting in the living room, bathroom, bedroom, and parking garage, debris and obstacles such as wires along the path in the living room and parking garage, and the poor condition of the staircase, characterized by inconsistent step heights or a slippery surface.

Conclusion

Community agencies should consider the living conditions of elderly people in rural areas to effectively reduce the occurrence of falls among this population.

Preoperative high-intensity strength training combined with balance training can improve early outcomes after total knee arthroplasty

BACKGROUND

To investigate the effect of preoperative high-intensity strength training combined with balance training on the knee function of end-stage knee osteoarthritis (KOA) patients after total knee arthroplasty (TKA).

METHODS

A prospective study was conducted on end-stage KOA patients awaiting TKA. The patients were divided into an experimental group and a control group according to whether they received a preoperative training intervention. The differences in knee flexor-extensor strength, knee range of motion (ROM), timed up and go (TUG) test result, stair ascend/descend test result, Knee Society score (KSS) and Berg balance scale (BBS) score were assessed in both groups at baseline (T1), before operation (T2), 3 months after operation (T3), and 1 year after operation (T4).

RESULTS

After high-intensity strength training and balance training, the knee flexor-extensor strength, TUG test result, stair ascend/descend test result, and KSS were all significantly improved at T2 in the experimental group over the control group. At T3, the knee ROM, knee flexor-extensor strength, TUG test result, BBS score, and KSS clinical and functional scores were all significantly superior in the experimental group. The experimental group enjoyed a superiority in KSS clinical and functional scores until T4. Group × time and between-group interactions were found in all assessment indicators in both groups (p < 0.01).

CONCLUSION

Preoperative high-intensity strength training combined with balance training can enhance the knee flexor-extensor strength and balance of patients with end-stage KOA in the short term and help improve early outcomes after KOA. Trial registration ChiCTR2000032857, 2020-05-13.

Outcomes after stairway falls in a rural Appalachian trauma center

BACKGROUND

Injuries due to falls represent one of the most common etiologies of traumatic injury in the United States. Stairway-related falls in particular can lead to significant morbidity, mortality, and concomitant long-term disability and economic costs. Our study aims to evaluate the outcomes of patients presenting to a rural academic trauma center after experiencing a fall down stairs.

METHODS

This was a single institution retrospective analysis of data extracted from our trauma registry. The study was considered exempt by Ballad Health Institutional Review Board. The data included patients aged 18 years or older who presented to the emergency department after a fall down stairs between January 1, 2017, and June 17, 2022. Patients who experienced falls other than those involving stairs were excluded.

RESULTS

Of the 439 patients evaluated for falls down stairs, 259 (58.9%) were aged ≥65 years. Compared with younger patients, older patients required significantly longer hospital admissions (4.8 vs 3.6 days, P < .003), had significantly higher injury severity scores (9.1 vs 6.8, P < .05), and were more likely to be discharged to a posthospital care facility (51% vs 14.9%, P < .05). There was no difference in length of intensive care unit stay (3.8 vs 3.6 days, P < .72), ventilator days (3.3 vs 3.3 days, P < .97), or mortality (7% vs 3%, P < .08). When considering sex, male patients had significantly worse outcomes in injury severity score (9.0 vs 7.6, P < .02) and mortality (10% vs 2%, P < .0002) but no difference in hospital (4.5 vs 4.0 days, P < .20), intensive care unit (3.8 vs 3.5 days, P < .59) or ventilator days (2.8 vs 4.3 days, P < .27) when compared with female patients.

CONCLUSION

Patients aged 65 years or older who experience a fall down stairs are more severely injured and require more posthospital care. Our findings demonstrate that males have an elevated risk of mortality and increased injury severity compared to female patients. Previous findings from our institution examining injuries from falls, including a sub-analysis on ground-level falls, have shown similar sex disparity. This study shows the necessity of preventing stair-related falls, especially in the older population.

The Movement Deviation Profile Can Differentiate Faller and Non-Faller Older Adults

BACKGROUND

The World Health Organization considers falls the second leading cause of death by accidental injury worldwide and one of the most frequent complications in older adults during activities of daily living. Several tasks related to fall risk have been individually assessed describing kinematic changes in older adults. The study proposal was to identify which functional task differentiates faller and non-faller older adults using the movement deviation profile (MDP).

METHODS

This cross-sectional study recruited 68 older adults aged ≥60 years by convenience sampling. Older adults were divided into 2 groups: with and without a history of falls (34 older adults in each group). The MDP analyzed the 3-dimensional angular kinematics data of tasks (ie, gait, walking turn, stair ascent and descent, sit-to-stand, and stand-to-sit), and the Z score of the mean MDP identified which task presented the greatest difference between fallers and non-fallers. A multivariate analysis with Bonferroni post hoc verified the interaction between groups considering angular kinematic data and the cycle time of the task. Statistical significance was set at 5% (p < .05).

RESULTS

Z score of the MDPmean showed an interaction between groups (λ = 0.67, F = 5.085, p < .0001). Fallers differed significantly from non-fallers in all tasks and the greatest difference was in stair descent (Z score = 0.89). The time to complete each task was not different between groups.

CONCLUSIONS

The MDP distinguished older adult fallers from non-fallers. The stair descent task should be highlighted because it presented the greatest difference between groups.

Systematic review of candidate prognostic factors for falling in older adults identified from motion analysis of challenging walking tasks

The objective of this systematic review is to identify motion analysis parameters measured during challenging walking tasks which can predict fall risk in the older population. Numerous studies have attempted to predict fall risk from the motion analysis of standing balance or steady walking. However, most falls do not occur during steady gait but occur due to challenging centre of mass displacements or environmental hazards resulting in slipping, tripping or falls on stairs. We conducted a systematic review of motion analysis parameters during stair climbing, perturbed walking and obstacle crossing, predictive of fall risk in healthy older adults. We searched the databases of Pubmed, Scopus and IEEEexplore.A total of 78 articles were included, of which 62 simply compared a group of younger to a group of older adults. Importantly, the differences found between younger and older adults did not match those found between older adults at higher and lower risk of falls. Two prospective and six retrospective fall history studies were included. The other eight studies compared two groups of older adults with higher or lower risk based on mental or physical performance, functional decline, unsteadiness complaints or task performance. A wide range of parameters were reported, including outcomes related to success, timing, foot and step, centre of mass, force plates, dynamic stability, joints and segments. Due to the large variety in parameter assessment methods, a meta-analysis was not possible. Despite the range of parameters assessed, only a few candidate prognostic factors could be identified: older adults with a retrospective fall history demonstrated a significant larger step length variability, larger step time variability, and prolonged anticipatory postural adjustments in obstacle crossing compared to older adults without a fall history. Older adults who fell during a tripping perturbation had a larger angular momentum than those who did not fall. Lastly, in an obstacle course, reduced gait flexibility (i.e., change in stepping pattern relative to unobstructed walking) was a prognostic factor for falling in daily life. We provided recommendations for future fall risk assessment in terms of study design.In conclusion, studies comparing older to younger adults cannot be used to explore relationships between fall risk and motion analysis parameters. Even when comparing two older adult populations, it is necessary to measure fall history to identify fall risk prognostic factors.

Nutrition Strategies Promoting Healthy Aging: From Improvement of Cardiovascular and Brain Health to Prevention of Age-Associated Diseases

BACKGROUND

An increasing number of studies suggest that diet plays an important role in regulating aging processes and modulates the development of the most important age-related diseases.

OBJECTIVE

The aim of this review is to provide an overview of the relationship between nutrition and critical age-associated diseases.

METHODS

A literature review was conducted to survey recent pre-clinical and clinical findings related to the role of nutritional factors in modulation of fundamental cellular and molecular mechanisms of aging and their role in prevention of the genesis of the diseases of aging.

RESULTS

Studies show that the development of cardiovascular and cerebrovascular diseases, neurodegenerative diseases, cognitive impairment and dementia can be slowed down or prevented by certain diets with anti-aging action. The protective effects of diets, at least in part, may be mediated by their beneficial macro- (protein, fat, carbohydrate) and micronutrient (vitamins, minerals) composition.

CONCLUSIONS

Certain diets, such as the Mediterranean diet, may play a significant role in healthy aging by preventing the onset of certain diseases and by improving the aging process itself. This latter can be strengthened by incorporating fasting elements into the diet. As dietary recommendations change with age, this should be taken into consideration as well, when developing a diet tailored to the needs of elderly individuals. Future and ongoing clinical studies on complex anti-aging dietary interventions translating the results of preclinical investigations are expected to lead to novel nutritional guidelines for older adults in the near future.

Force Plate with Simple Mechanical Springs and Separated Noncontact Sensor Elements

This paper reports on a force plate (FP) using mechanical springs and noncontact distance sensors. The ground reaction force (GRF) is one of the factors for clarify biomechanics, and FPs are widely used to measure it. The sensor elements of conventional FPs are mainly strain gauges. Thus, the mechanical properties of FP depend on the sensor element performance. If the FP performance must change, we must redesign the FP, including changing the sensor elements. Here, we proposed an FP that uses a measuring principle based on simple springs and noncontact sensors. The shape and performance of the proposed FP are expected to change easily. As a prototype device, we designed and fabricated an FP installed with 12 springs and four sensors for human walking. A planar coil and magnet were used as the sensor elements, and the sensor output was proportional to the vertical and horizontal displacements. The FP resonance frequency was 123 Hz, which was larger than the required specification. The calibration experiments showed that vertical and horizontal forces and moments could be measured independently. The FP’s resolutions were 1.9 N and 1.4 N in the anterior–posterior and vertical directions, respectively. Furthermore, the fabricated FP measured GRF similarly to the commercial FP when a human walked on the plate. These results suggest that the proposed method will be helpful for FPs with custom-made requirements.