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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effects of home-based tele-exercise on sarcopenia among community-dwelling elderly adults: Body composition and functional fitness

OBJECTIVES

This study aims to develop a form of tele-exercise that would enable real-time interactions between exercise instructors and community-dwelling elderly people and to investigate its effects on improvement of sarcopenia-related factors of body composition and functional fitness among the elderly.

DESIGN

Randomized, controlled trial, with a 12-week intervention period.

SETTING

Community-dwelling senior citizens in Gangseo-gu, Seoul, South Korea.

PARTICIPANTS

The participants were 23 elderly individuals (tele-exercise group: 11, control group: 12), aged 69 to 93years.

INTERVENTION

The tele-exercise program was developed utilizing a 15-in. all-in-one PC and video conferencing software (Skype™), with broadband Internet connectivity. The tele-exercise group performed supervised resistance exercise at home for 20-40min a day three times per week for 12weeks. The remote instructor provided one-on-one instruction to each participant during the intervention. The control group maintained their lifestyles without any special intervention.

MEASUREMENTS

The sarcopenia-related factors of body composition and functional fitness were examined prior to, as well as following, a 12-week intervention period. The data were analyzed with a two-way repeated measures ANOVA.

RESULTS

There were significant improvements in lower limb muscle mass (p=0.017), appendicular lean soft tissue (p=0.032), total muscle mass (p=0.033), and chair sit-and-reach length (p=0.019) for the tele-exercise group compared to the control group. No group×time interaction effects were detected for the 2-min step, chair stand, and time effects (p<0.05).

CONCLUSION

Video conferencing-based supervised resistance exercise had positive effects on sarcopenia-related factors such as total-body skeletal muscle mass, appendicular lean soft tissue, lower limb muscle mass, and the chair sit-and-reach scores among community-dwelling elderly adults. These results imply that tele-exercise can be a new and effective intervention method for increasing skeletal muscle mass and the physical functioning of the lower limbs from the perspective of sarcopenia improvement among the elderly.

Evaluation of the Wii Balance Board for walking aids prediction: proof-of-concept study in total knee arthroplasty

BACKGROUND AND OBJECTIVES

To provide proof-of-concept for the validity of the Wii Balance Board (WBB) measures to predict the type of walking aids required by inpatients with a recent (≤4 days) total knee arthroplasty (TKA).

METHODS

A cross-sectional sample of 89 inpatients (mean age, 67.0±8 years) with TKA was analyzed. A multivariable proportional odds prediction model was constructed using 8 pre-specified predictors – namely, age, sex, body mass index, knee pain, knee range-of-motion, active knee lag, and WBB-derived standing balance. The type of walking aids prescribed on day 4 post-surgery was the outcome of interest – an ordinal variable with 4 categories (walking stick, narrow- and broad-base quadstick, and walking frame).

RESULTS

Women, increasing body mass index, and poorer standing balance were independently associated with greater odds for requiring walking aids with a larger base-of-support. The concordance-index of the prediction model was 0.74. The model comprising only WBB-derived standing balance had nearly half (44%) the explanatory power of the full model. Adding WBB-derived standing balance to conventional demographic and knee variables resulted in a continuous net reclassification index of 0.60 (95%CI,0.19-1.01), predominantly due to better identification of patients who required walking aids with a large base-of-support (sensitivity gain).

CONCLUSIONS

The WBB was able to provide quantitative measures of standing balance which could assist healthcare professionals in prescribing the appropriate type of walking aids for patients. Further investigation is needed to assess whether using the WBB could lead to meaningful changes in clinical outcomes such as falls.

Effect of whole body vibration exercise in the horizontal direction on balance and fear of falling in elderly people: a pilot study

[Purpose] The purpose of the present study was to investigate the effects of whole body vibration exercise in the horizontal direction on balance and fear of falling in the elderly. [Methods] This study was a case series of 17 elderly individuals. Participants performed whole body vibration exercise in the horizontal direction using a whole body vibration device for 15 minutes a day, 3 times a week, for 6 weeks. At baseline and after the 6-week intervention, balance was measured using the Berg Balance Scale and Timed Up and Go test, and fear of falling was assessed using the Falls Efficacy Scale. [Results] After the intervention, significant improvements from baseline values in the Berg Balance Scale, Timed Up and Go test, and Falls Efficacy Scale were observed in the study participants. [Conclusion] Elderly individuals who performed whole body vibration exercise in the horizontal direction showed significant improvements in balance and fear of falling. However, the observed benefits of whole body vibration exercise in the horizontal direction need to be confirmed by additional studies.

The effects of obesity on fall efficacy in elderly people

[Purpose] The aim of this study was to identify the effects of obesity on falls as a practical verification of the importance of obesity-targeting interventions as part of future fall prevention programs. [Subjects and Methods] The study involved 351 elderly people (172 men, 179 women) living in rural areas. The dependent variable, fall efficacy, was measured using the Falls Efficacy Scale, while the independent variables, body mass index (BMI) and visceral fat, were measured using the InBody 720. The Faces Pain Scale was used to measure pain. Mobility was measured using the Timed Up and Go Test, and balance ability was measured according to the duration subjects could stand on one foot with their eyes closed. Hierarchical multiple regression analysis was performed for the final data analysis. [Results] Investigation of the correlations between the variables revealed a negative correlation between fall efficacy and the other variables. Ultimatley, investigation of the causality of fall efficacy revealed that the BMI, pain, and mobility were influential factors. In other words, fall efficacy tends to be lower when there are higher degrees of obesity, increased pain, and decreased mobility. [Conclusion] To improve the fall efficacy of elderly people living in rural areas, pain management and the maintenance of physical functionality are required. The present study confirms that the elderly need continuous obesity management to lead healthy lives.

Improving Staff Reports of Falls in Assisted Living

This study examined falls data reported by staff to (a) describe characteristics of falls in this population and (b) analyze the quality and utility of the data available from incident reports (IRs) to improve fall prevention. Data from 34 incident reports were analyzed. Descriptive and frequency analyses were conducted to describe fall characteristics, use of assistive devices, high-risk medication use, and prevalence of omitted data on IRs. Thirty-four falls occurred among 15 residents (age, M = 84 years). More than half resulted in injury. Significant omissions of data were noted in the IRs, which may have limited full analysis of fall events and the ability to communicate about health outcomes of these events and the prevention of subsequent falls. This study provides data about falls in assisted living and recommendations for enhanced data collection to support the monitoring of falls risk and the prevention of future falls.

Public provision of four-wheeled walkers: contingent valuation study of economic benefit

OBJECTIVE

To quantify the economic value of publicly provided four-wheeled walkers as judged by recipients in Queensland, Australia.

METHOD

Contingent valuation study using willingness-to-pay approach. A sample of 49 Australian older adults who received a publicly funded four-wheeled walker in the past 3 months completed the survey via telephone. A discrete choice bidding response format with a randomly selected starting bid was employed to glean valuations.

RESULTS

This approach yielded only one non-response, and one zero dollar response. The mean (standard deviation) valuation provided was $ A 290 ($ A 167), which was $ A 84 in excess of the price paid by the public provider agency to purchase the equipment. Starting bid was significantly associated with values provided.

CONCLUSION

The current public provision program of four-wheeled walkers is likely to generate net societal benefit. These findings coupled with arguments based on equity build a moderate case for the continuation of this program.