Falls and EQ-5D rated quality of life in community-dwelling seniors with concurrent chronic diseases: a cross-sectional study

Analysis of fall risk factors and environmental hazards for older adults in Japan: assessing fall situations and locations

[Purpose] This study aimed to examine falls among older adults in Japanese households and determine the risk associated with each fall location. [Participants and Methods] This study included 99 participants (249 fall events) who received daycare rehabilitation at a nursing care facility. Data on fall circumstances were collected from the medical records and accident reports. The analyzed variables included age, medical status, level of care required, fall history, location, and mode of transportation during the falls. [Results] Falls occurred most commonly in bedrooms. Falls at an entrance were associated with no assistive device (OR: 1.76, 95% CI: 1.06-1.80) and 1 history of falls (OR: 1.22, 95% CI: 1.03-3.10). Risk factors for falls in bedrooms included Parkinson's disease (OR: 1.83, 95% CI: 1.11-1.87), orthopedic disease (OR: 1.11, 95% CI: 1.15-3.43), and cane walking (OR: 1.08, 95% CI: 1.33-4.13). Falls in a hallway were associated with no assistive device (OR: 1.75, 95% CI: 1.15-1.91). [Conclusion] Bedrooms and hallways in Japanese households were identified as locations with a high risk of falls. The unique architectural and cultural features of Japanese homes may contribute to this risk. Rehabilitation programs should consider individual fall histories, medical conditions, and differences in mobility.

Body composition, balance, functional capacity and falls in older women

BACKGROUND

The aim of this study was to examine the association of body composition, muscle strength, balance, and functional capacity on falls and fall injuries among community-dwelling older women.

METHODS

The study comprised of a 2-year randomized controlled trial involving 914 women with an average age of 76.5 (SD = 3.3) years at baseline. The women were assigned to exercise intervention (n = 457) and control groups (n = 457). Clinical measurements were conducted at baseline, 12 months and 24 months.

RESULTS

During the 2-year follow up, total of 546 women (59.7%) sustained a fall. The total number of falls was 1380 and out of these, 550 (40%) of falls were non-injurious and 745 (54%) were injurious. Higher femoral neck bone mineral density (BMD) was associated with a higher overall risk of falls [RR = 2.55 (95% CI = 1.70-3.84, p < 0.001)], but was a protective factor for severe fall injuries [RR = 0.03 (95% CI = 0.003-0.035, p < 0.01)]. Slower Timed Up and Go (TUG) was associated with an increased overall risk of falls [RR = 1.07 (95% CI = 1.05-1.10, p < 0.001)] and injuries requiring medical attention [RR = 1.10 (95% CI = 1.02-1.19, p = 0.02)]. Longer single leg standing time was a protective factor for falls [RR = 0.99 (95% CI = 0.99-1.00, p < 0.01)] and overall injurious falls [RR = 0.99 (95% CI = 0.99-1.00, p = 0.02)].

CONCLUSION

For postmenopausal women with higher femoral neck BMD appear to sustain more falls, but have a lower risk of severe fall injuries. Better TUG and single leg standing time predict lower risk of falls and fall injuries.

Prevalent falls, fall frequencies and health-related quality of life among community-dwelling older Chinese adults

PURPOSE

Fall is a serious health hazard to older adults. The aim of our study was to investigate the relationship between falls and health-related quality of life (HRQOL) in mainland China.

METHODS

Data from 4579 Chinese community-dwelling older adults was analyzed. Data of falls was self-reported by participants, the HRQOL of older adults was measured by the 3-Level EQ-5D (EQ-5D-3L, 3L). Regression models were built to explore the associations of falls (experience and frequency) with the 3L data (index score, EQ-VAS score and health problems). The potential interaction effects between falls and gender on HRQOL were assessed using a likelihood ratio test, sex-stratified analysis was also performed to separately investigate the associations in men and women.

RESULTS

A total of 368 (8.0%) participants had the experience of fall during the last year. Falls (experience and frequency) were significantly related to EQ-5D-3L index and EQ-VAS scores, fall experience contributed to pain/discomfort and anxiety/depression problems, while fall frequency was associated with physical-related problems and pain/discomfort. Significant interactions between falls and sex in several EQ-5D measures were also observed, and men had lager magnitude of associations than women.

CONCLUSION

Falls were negative associated with overall HRQOL as well as separate HRQOL dimensions among older adults. It also appears that the HRQOL influence on older men is more evident than older women.

Health-related quality of life in older women with injuries: a nationwide study

Objectives

This study aims to describe the health-related quality of life (HRQoL) and influencing factors of older women who experienced injuries.

Methods

This study is a secondary analysis of data from 4,217 women aged 65 years or older sampled from the Korea National Health and Nutrition Examination Survey (KNHANES) (2016-2020) database. Two-way analysis of variance was used to analyze the data.

Results

The mean HRQoL scores of older women with and without injuries were 0.81 ± 0.19 (n = 328) and 0.85 ± 0.17 (n = 3,889), respectively, which were significantly different (p < 0.001). The results of multiple regression analysis revealed that working, physical activity, BMI, osteoarthritis, stress, and subjective health status significantly affected the HRQoL of older women with injuries, and the explanatory power of the model was 29%.

Conclusion

The results of this study on factors affecting HRQoL can contribute to the understanding of the experience of older women with injuries and can be used as a reference to develop health promotion programs.

Evaluation of quality of life in the elderly who have fallen

Background/Aim: Approximately 30% of older adults fall at least once per year; consequently, falls are a significant public health concern in the elderly. The most common outcomes are fractures, immobility, high morbidity, and mortality rates. In recent years, quality of life (QoL) is used as a criterion to guide social policies for the elderly. The high prevalence of falls can have serious consequences on the QoL of older people, resulting in prolonged hospitalization, institutionalization, need for care, social isolation, anxiety, and depression. Therefore, it is essential to understand the effect of falls on QoL and influencing factors. In light of this study’s results, it is intended to provide recommendations for social policy that will protect the elderly from falls and maintain their high QoL. This study aimed to determine the QoL and the factors affecting the elderly who have fallen. Methods: The research was a cross-sectional study. The study sample consisted of 90 elderly individuals who applied to the hospital due to falls. The inclusion criteria were being 65 years of age or older, applying to the hospital's emergency department, orthopedic or orthopedic surgery clinic due to a fall, not having passed 6 months from the date of discharge, and agreeing to participate in the study voluntarily. Data were collected through face-to-face interviews in January–June 2021 using the purposive sampling method. The Elderly Introduction Form was used to obtain sociodemographic data of the participants, as well as data on falls and their experiences after falls. The Quality of Life Scale for the Elderly was used to determine QoL. The student’s t-test was used to compare two categorical variables. ANOVA was used for more than two variables, and logistic regression analysis was also applied. Results: QoL levels were classified as poor, fair, and good, and 58.9% of the participants were found to have a fair QoL. In addition, according to the scale’s total score average of 3.17 (0.473), the general quality of life was found to be fair for all participants. According to the t-test and ANOVA results, the QoL was higher for those with higher education levels and those living with their spouses (P˂0.05). The QoL was low in those who had fractures, had surgery, were hospitalized for more than 4 days, and had chronic diseases (P˂0.05). In the regression analysis model, age, economic status, and the number of drugs used were effective on QoL. Conclusion: The quality of life was poor in the elderly who experienced fractures and were hospitalized. Balance-enhancing exercises in the elderly can prevent falls and associated complications. Low education level, chronic illness, and drug use reduced the quality of life. For education, literacy courses and lifelong learning programs can be applied to the elderly. For diseases, healthy aging policies can be implemented.

Determinants of Health-Related Quality of Life Among Community-Dwelling Thai Older Adults in Chiang Mai, Northern Thailand

Background

Population aging has been growing worldwide and Thailand has become an aged society with 20% of its population aged 60 and over. Age-related decline in physical and mental health impacts the health-related quality of life (HRQOL) of older adults.

Purpose

We aimed to describe the HRQOL of Thai older adults, residing in the community.

Methods

This cross-sectional survey was part of a Community-Integrated Intermediary Care project (CIIC), TCTR20190412004. A total of 1509 participants from an intervention arm of a cluster randomized controlled trial were included. A Thai version of the Euro-Qol questionnaire (EQ-5D-5L) was used to determine the HRQOL and associated sociodemographic background, health behaviors and underlying diseases of a representative sample from Maehia, Chiang Mai, Thailand. SPSS version 24 was used to analyze data via descriptive analysis and binary logistic regression.

Results

The mean age of the participants was 69.31±7.10 years, and nearly a quarter (23.8%) was older than 75 years. The mean EQ index score was 0.81±0.23 and older age, lower educational attainment, unemployment, lack of exercise habits, current smokers, having history of a fall in the last 6 months, diabetes, hyperlipidemia, dependency assessed using Barthel's Activity of Daily Living (ADL) Index, and depression using the Geriatric Depression Scale (GDS) were more likely to represent HRQOL-related problems.

Conclusion

Our findings have highlighted the factors affecting the HRQOL of community-dwelling older adults which could be of importance in preparing for active and healthy aging communities. The routine dependency assessment using the ADL index will be useful in estimating the HRQOL of the aging population. Fall prevention programs are also recommended to reduce dependency. Moreover, the association of having diabetes and hyperlipidemia with problems in HRQOL dimensions highlight the need for public health intervention not only to prevent the increasing burden of non-communicable diseases but also to improve the HRQOL of older adults.

Physical Exercise Program on Fall Prevention Using Technological Interface: Pretest Study

BACKGROUND

Prevention of falls among older adults has boosted the development of technological solutions, requiring testing in clinical contexts and robust studies that need prior validation of procedures and data collection tools.

OBJECTIVE

The objectives of our study were to test the data collection procedure, train the team, and test the usability of the FallSensing Games app by older adults in a community setting.

METHODS

This study was conducted as a pretest of a future pilot study. Older adults were recruited in a day care center, and several tests were applied. Physical exercise sessions were held using the interactive FallSensing Games app. Nurse training strategies was completed.

RESULTS

A total of 11 older adults participated. The mean age was 75.08 (SD 3.80) years, mostly female (10/11, 91%) and with low (3-6 years) schooling (10/11, 91%). Clinically, the results show a group of older adults with comorbidities. Cognitive evaluation of the participants through the Mini Mental State Examination showed results with an average score of 25.64 (SD 3.5). Functional capacity assessed using the Lawton Instrumental Activities of Daily Living Scale (overall score from 0-23, with lower scores reflecting worse capacity to perform activities) showed impairment in different instrumental activities of daily living (average score 14.27). The data collection tool proved to enable easy interpretation; however, its structure needed small adjustments to facilitate the data collection process. Despite the length of the questionnaire, its implementation took an average of 21 minutes. For the assessment of the prevalence of fear of falling, the need to add a question was identified. The performance of functional tests under the guidance and presence of rehabilitation nurses ensured the safety of the participants. The interactive games were well accepted by the participants, and the physical exercises allowed data collection on the functionality of the older adults, such as the number of repetitions in the tests, range of movement (angle), duration of the movements, and execution of each cycle. Concerning the training of the nurses, it was crucial that they had experience with the platform, specifically the position of the chair facing the platform, the position of the feet, the posture of participants, and the use of sensors.

CONCLUSIONS

In the future pilot study, the researchers point out the need to design a study with mixed methods (quantitative and qualitative), thus enriching the study results.

Predicting falls within 3 months of emergency department discharge among community-dwelling older adults using self-report tools versus a brief functional assessment

BACKGROUND

Identifying older adults with risk for falls prior to discharge home from the Emergency Department (ED) could help direct fall prevention interventions, yet ED-based tools to assist risk stratification are under-developed. The aim of this study was to assess the performance of self-report and functional assessments to predict falls in the 3 months post-ED discharge for older adults.

METHODS

A prospective cohort of community-dwelling adults age 60 years and older were recruited from one urban ED (N = 134). Participants completed: a single item screen for mobility (SIS-M), the 12-item Stay Independent Questionnaire (SIQ-12), and the Timed Up and Go test (TUG). Falls were defined through self-report of any fall at 1- and 3-months and medical record review for fall-related injury 3-months post-discharge. We developed a hybrid-convolutional recurrent neural network (HCRNN) model of gait and balance characteristics using truncal 3-axis accelerometry collected during the TUG. Internal validation was conducted using bootstrap resampling with 1000 iterations for SIS-M, FRQ, and GUG and leave-one-out for the HCRNN. We compared performance of M-SIS, FRQ, TUG time, and HCRNN by calculating the area under the receiver operating characteristic area under the curves (AUCs).

RESULTS

14 (10.4%) of participants met our primary outcome of a fall or fall-related injury within 3-months. The SIS-M had an AUC of 0.42 [95% confidence interval (CI) 0.19-0.65]. The SIQ-12 score had an AUC of 0.64 [95% confidence interval (CI) 0.49-0.80]. The TUG had an AUC of 0.48 (95% CI 0.29-0.68). The HCRNN model using generated accelerometer features collected during the TUG had an AUC of 0.99 (95% CI 0.98-1.00).

CONCLUSION

We found that self-report and functional assessments lack sufficient accuracy to be used in isolation in the ED. A neural network model using accelerometer features could be a promising modality but research is needed to externally validate these findings.

Exercise in preventing falls for men with prostate cancer: a modelled cost-utility analysis

INTRODUCTION

Men who receive androgen deprivation therapy (ADT) for prostate cancer (PCa) are a vulnerable falls population due to the side effects of treatment. The purpose of this paper is to determine the cost-effectiveness of exercise in preventing falls and fractures for this high-risk population in Australia.

METHODS

A decision analytic model was constructed to evaluate the cost utility of an exercise intervention compared to usual care from a health system perspective. The intervention comprised two 1-h sessions of supervised exercise per week over 1 year for men with non-metastatic PCa receiving curative radiation therapy and ADT. A Markov model simulated the transition between five health states: (1) at risk of falling; (2) at recurrent risk of falling; (3) fracture (minor or major); (4) non-fracture injury (minor or major); and (5) death. Model inputs including transition probabilities and utility scores were obtained from published meta-analyses, and costs were drawn from Australian data sources (e.g. Medical Benefits Schedule). The model time horizon was 3 years, and costs and effects were discounted at 5% annual rate. Costs and quality-adjusted life years (QALYs) were aggregated and compared between the intervention and control to calculate incremental net monetary benefit (iNMB). Uncertainty in the results was explored using deterministic and probabilistic sensitivity analyses (PSA).

RESULTS

At a willingness-to-pay of AU$50,000 per QALY, the exercise intervention dominated, as it was less costly and more effective than usual care. The iNMB was $3010 per patient. The PSA showed a 58% probability the intervention was cost-effective.

CONCLUSION

This is the first modelled economic evaluation of exercise for men with PCa. Our results suggest supervised exercise is cost-effective in reducing the risks of falls and fractures in this population.

Physical Activity Dimensions Differentially Predict Physical and Mental Components of Health-Related Quality of Life: Evidence from a Sport for All Study

The present cross-sectional study aimed to investigate the relationship between different dimensions of physical activity (PA) (i.e., work, sport, leisure) and health-related quality of life (HRQoL) (i.e., overall, physical component, mental component) in an adult lifespan sample of 381 active individuals (age range: 18–88 years; 38.8% men), while controlling for important covariates in terms of sex, age, education, and health profile regarding medical history. HRQoL was assessed using the 12-item Short-Form Health Survey (SF-12). Usual (i.e., previous 12 months) PA was assessed during face-to-face interviews using the Baecke questionnaire. Hierarchical regression analyses showed in Step 1 that the three PA dimensions work, sport, and leisure (entered simultaneously) together predicted 8%, 10%, and 4% of the variance in SF-12 total score, SF-12 physical component, and SF-12 mental component, respectively. In the final model, adjusting for sex, age, education, and health profile regarding medical history, sport emerged as the only PA dimension predicting SF-12 total score and the SF-12 physical component. In conclusion, health-policy targets at the community level should include the promotion of lifelong engagement in PA, especially sport, to allow the sustainability of HRQoL across the lifespan of our society.

[Falls and health-related quality of life: influence of frequency and location type of falls]

This article aims to evaluate health-related quality of life (HRQOL) according to the frequency and characteristics of falls in the elderly. A cross-sectional study was carried out with data from a household health survey conducted in 2014 and 2015, in Campinas, SP. The dependent variables were the SF-36 domains and, the independent ones, the occurrence and the characteristics of the falls. The mean and mean differences of the SF-36 scores were estimated by simple and multiple linear regression. The study reveals that the impact on HRQOL depends significantly on the characteristics of falls. Larger declines and a greater number of SF-36 domains were observed in the elderly who suffered three or more falls (compared to those with one or two falls), reporting falls from fainting/dizziness (compared to falls due to tripping), those who fell at home (versus falls occurring elsewhere) and reported falling limitation in daily activities. Only in the falls with these characteristics did the domain of emotional aspects be affected. The impact on HRQoL, including emotional aspects, depends on the characteristics of the falls that need to be considered in prevention actions and in the control of the consequences of falls in the quality of life of the elderly.

Support Vector Machine Classifiers Show High Generalizability in Automatic Fall Detection in Older Adults

Falls are a major cause of morbidity and mortality in neurological disorders. Technical means of detecting falls are of high interest as they enable rapid notification of caregivers and emergency services. Such approaches must reliably differentiate between normal daily activities and fall events. A promising technique might be based on the classification of movements based on accelerometer signals by machine-learning algorithms, but the generalizability of classifiers trained on laboratory data to real-world datasets is a common issue. Here, three machine-learning algorithms including Support Vector Machine (SVM), k-Nearest Neighbors (kNN), and Random Forest (RF) were trained to detect fall events. We used a dataset containing intentional falls (SisFall) to train the classifier and validated the approach on a different dataset which included real-world accidental fall events of elderly people (FARSEEING). The results suggested that the linear SVM was the most suitable classifier in this cross-dataset validation approach and reliably distinguished a fall event from normal everyday activity at an accuracy of 93% and similarly high sensitivity and specificity. Thus, classifiers based on linear SVM might be useful for automatic fall detection in real-world applications.

Malnutrition Is an Independent Risk Factor for Low Health-Related Quality of Life Among Centenarians

Background: To explore the association and understand gender disparities between nutritional status and quality of life among centenarians. Methods: It was a full-sample survey of centenarians conducted in Hainan that included a total of 1,002 eligible centenarians whose age had been verified. The Mini Nutritional Assessment - Short Form (MNA-SF) questionnaire and the EuroQol five dimensions visual analog scale (EQ-5D-VAS) were used to measure participants' nutritional status and quality of life, respectively. Findings: In the 1002 centenarians (822 women and 180 men), 797 (79.5%) (79.5%) reported multimorbidity. The adjusted standardized β estimate association between the MNA-SF and EQ-5D scores was 0.508 in the complete sample. With reference to the normal nutrition group, the standardized β estimate of the association between EQ-5D score and nutritional status were -0.179 and -0.583 for the at risk of malnutrition and malnutrition groups, respectively (both P <0.001). Nutritional status significantly affected the five dimensions of quality of life, particularly mobility and self-care. Compared with the normal nutrition group, the malnutrition group had greater odds of low mobility [Odds ratio (OR)=23.15; 95% CI: 9.81-54.64] and low self-care (OR=24.58; 95% CI: 12.62-47.89). Among males, nutritional status was significantly associated with the usual activities and anxiety/depression dimensions after adjustment. Female participants had results similar to the general population. Interpretation: Malnutrition and being at risk of malnutrition is prevalent among centenarians. Maintaining normal nutritional status is an important protective factor and should receive more attention to improve centenarians' quality of life.

The influence of age and fall history on single transition step kinematics

Background The risk of falls during locomotion increases with age, and step negotiation is one of the most hazardous types of gait for older adults. Further, a history of a fall is one of the strongest predictors of a future fall; and women fall more frequently, and incur greater medical costs, compared to men. The purpose of the study was to identify lower extremity kinematic factors associated with transition step clearance and foot placement in young women and older women with and without a fall history. Methods Forty-five female participants (15 per group) completed trials that consisted of walking barefoot along a raised walkway at a self-selected speed, descending a 17 cm step, and continued level ground walking. Variables of interest included lead and trail limb minimum step clearance and foot placement, and bilateral lower extremity joint positions at step clearance and at lead foot initial contact. Findings Significant group differences, with large effect sizes, were found in lead foot placement and knee flexion position at initial contact. Both older groups landed more closely to the step and made initial contact with the lead knee in a more flexed position compared to the young group. Interpretation The kinematic differences may be a strategy utilized by older adults to create an early landing to minimize time in single limb stance and compensate for age-related loss of lower extremity strength, range of motion, and/or balance. However, the greater knee flexion may also increase the risk a fall due to lead limb collapse.

A Technological-Based Platform for Risk Assessment, Detection, and Prevention of Falls Among Home-Dwelling Older Adults: Protocol for a Quasi-Experimental Study

BACKGROUND

According to the United Nations, it is estimated that by 2050, the number of people aged 80 years and older will have increased by 3 times. Increased longevity is often accompanied by structural and functional changes that occur throughout an individual's lifespan. These changes are often aggravated by chronic comorbidities, adopted behaviors or lifestyles, and environmental exposure, among other factors. Some of the related outcomes are loss of muscle strength, decreased balance control, and mobility impairments, which are strongly associated with the occurrence of falls in the elderly. Despite the continued undervaluation of the importance of knowledge on fall prevention among the elderly population by primary care health professionals, several evidence-based (single or multifaceted) fall prevention programs such as the Otago Exercise Program (OEP) have demonstrated a significant reduction in the risk of falls and fall-related injuries in the elderly within community settings. Recent studies have strived to integrate technology into physical exercise programs, which is effective for adherence and overcoming barriers to exercise, as well as improving physical functioning.

OBJECTIVE

This study aims to assess the impact of the OEP on the functionality of home-dwelling elderly using a common technological platform. Particularly, the impact on muscle strength, balance, mobility, risk of falling, the perception of fear of falling, and the perception of the elderly regarding the ease of use of technology are being examined in this study.

METHODS

A quasi-experimental study (before and after; single group) will be conducted with male and female participants aged 65 years or older living at home in the district of Porto. Participants will be recruited through the network COLABORAR, with a minimum of 30 participants meeting the study inclusion and exclusion criteria. All participants will sign informed consent forms. The data collection instrument consists of sociodemographic and clinical variables (self-reported), functional evaluation variables, and environmental risk variables. The data collection tool integrates primary and secondary outcome variables. The primary outcome is gait (timed-up and go test; normal step). The secondary outcome variables are lower limb strength and muscle resistance (30-second chair stand test), balance (4-stage balance test), frequency of falls, functional capacity (Lawton and Brody - Portuguese version), fear of falling (Falls Efficacy Scale International - Portuguese version), usability of the technology (System Usability Scale - Portuguese version), and environmental risk variables (home fall prevention checklist for older adults). Technological solutions, such as the FallSensing Home application and Kallisto wearable device, will be used, which will allow the detection and prevention of falls. The intervention is characterized by conducting the OEP through a common technological platform 3 times a week for 8 weeks. Throughout these weeks, the participants will be followed up in person or by telephone contact by the rehabilitation nurse. Considering the COVID-19 outbreak, all guidelines from the National Health Service will be followed. The project was funded by InnoStars, in collaboration with the Local EIT Health Regional Innovation Scheme Hub of the University of Porto.

RESULTS

This study was approved on October 9, 2020 by the Ethics Committee of Escola Superior de Enfermagem do Porto (ESEP). The recruitment process was meant to start in October, but due to the COVID-19 pandemic, it was suspended. We expect to restart the study by the beginning of the third quarter of 2021.

CONCLUSIONS

The findings of this study protocol will contribute to the design and development of future robust studies for technological tests in a clinical context.

TRIAL REGISTRATION

ISRCTN 15895163; https://www.isrctn.com/ISRCTN15895163.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/25781.

Health-Related Quality of Life of Elderly Women with Fall Experiences

This study aimed to describe the health-related quality of life of elderly women with experience in fall treatment as well as to prepare basic data for the development of interventions to improve the quality of life for this group. The study was based on raw data from the 2019 Korea Community Health Survey. Using the SPSS program, the characteristics of the subjects were tested by frequency, percentage, and chi-square test. To establish the impact of fall experience on the health-related quality of life of elderly women, the OR and 95% CI were calculated using multiple logistic regression analysis. Of the 4260 people surveyed, 44.7% of the elderly women said they had a high quality of life, whereas 55.3% of the elderly women said they had a low quality of life. A younger age was associated with a better-rated health-related quality of life. Those who lived in a city and had a high level of education tended to describe a high quality of life. The quality of life was considered high by those who exercised, but low by those who were obese or diabetic. The results of this study can lead to a better understanding of the experiences of elderly women who have experienced falls, and they can be used as basic data for the development of related health programs.

Evaluation of Three Machine Learning Algorithms for the Automatic Classification of EMG Patterns in Gait Disorders

Gait disorders are common in neurodegenerative diseases and distinguishing between seemingly similar kinematic patterns associated with different pathological entities is a challenge even for the experienced clinician. Ultimately, muscle activity underlies the generation of kinematic patterns. Therefore, one possible way to address this problem may be to differentiate gait disorders by analyzing intrinsic features of muscle activations patterns. Here, we examined whether it is possible to differentiate electromyography (EMG) gait patterns of healthy subjects and patients with different gait disorders using machine learning techniques. Nineteen healthy volunteers (9 male, 10 female, age 28.2 ± 6.2 years) and 18 patients with gait disorders (10 male, 8 female, age 66.2 ± 14.7 years) resulting from different neurological diseases walked down a hallway 10 times at a convenient pace while their muscle activity was recorded via surface EMG electrodes attached to 5 muscles of each leg (10 channels in total). Gait disorders were classified as predominantly hypokinetic (n = 12) or ataxic (n = 6) gait by two experienced raters based on video recordings. Three different classification methods (Convolutional Neural Network-CNN, Support Vector Machine-SVM, K-Nearest Neighbors-KNN) were used to automatically classify EMG patterns according to the underlying gait disorder and differentiate patients and healthy participants. Using a leave-one-out approach for training and evaluating the classifiers, the automatic classification of normal and abnormal EMG patterns during gait (2 classes: "healthy" and "patient") was possible with a high degree of accuracy using CNN (accuracy 91.9%), but not SVM (accuracy 67.6%) or KNN (accuracy 48.7%). For classification of hypokinetic vs. ataxic vs. normal gait (3 classes) best results were again obtained for CNN (accuracy 83.8%) while SVM and KNN performed worse (accuracy SVM 51.4%, KNN 32.4%). These results suggest that machine learning methods are useful for distinguishing individuals with gait disorders from healthy controls and may help classification with respect to the underlying disorder even when classifiers are trained on comparably small cohorts. In our study, CNN achieved higher accuracy than SVM and KNN and may constitute a promising method for further investigation.

Experiences of falling and depression: Results from the Korean Longitudinal Study of Ageing

OBJECTIVE

This study estimates the association between fall experiences during the last two years and risk of depression.

METHODS

Data from 9,355 subjects of the Korean Longitudinal Study of Ageing from 2006 to 2016 were included with baseline at 2006. To analyze the association between fall experiences during the last two years and depression, a generalized estimating equation (GEE) model and chi-square tests were used.

RESULTS

At baseline 2006, the odds ratio (OR) of depressive symptoms in those with fall experiences was 1.36 times higher (p < .0001) than those with non-fall experience. In those 64 years or younger and 65 years or older, the OR of depressive symptoms in fall experience was 1.45 times higher (p =0.003) and 1.34 times higher (p =0.000) than those with non-fall experience, respectively. In males and females, the OR of depressive symptoms in those with fall experience was 1.47 times higher (p 0.008) and 1.34 times higher (p =0.000) than those with non-fall experience, respectively.

CONCLUSION

Fall experiences during the last two years are associated with depressive symptoms. Therefore, self-reported screening for fall experiences might aid in population-based prevention strategies for depressive symptoms.

Effects of a resistance training community programme in older adults

Ageing is associated with reduced muscle mass, strength, flexibility and balance, resulting in a poor quality of life (QOL). Past studies have occurred in highly controlled laboratory settings which provide strong support to determine whether similar gains can be made in community programmes. Twenty participants were enrolled in an eight-week community-based resistance training programme (mean age = 61.3 (standard error (SE) = 0.9) years); Body Mass Index = 32.0 (SE = 1.3) kg/m2). All participants completed surveys to assess outcomes associated with QOL. Given the relationship between muscle function and nerve health, nerve conduction studies (NCS) were also conducted in a separate group of participants (mean age = 64.9 (SE = 2.0) years; Body Mass Index = 32.6 (SE = 1.9) kg/m2). This community-based training programme significantly improved QOL measures in older adults (p< 0.001). Although weight loss was not the primary outcome of the study, participants reduced their body weights (p< 0.001), by primarily reducing fat mass (p= 0.007) while maintaining muscle mass. Significant improvements were observed in muscle strength (2.2%), flexibility and balance (3.2–464.2%,p⩽ 0.05 for all). Improvements were also observed in plasma glucose (p= 0.05), haemoglobin A1C (p= 0.06) and aldolase enzyme levels (p< 0.001). Scores for surveys on memory and sleep improved (p< 0.05). Improved QOL was associated with increased lean mass (r= −0.714,p= 0.002), decreased fat mass (r= −0.702,p= 0.003) and improved flexibility and balance (r= −0.627,p= 0.008). An eight-week, community-based resistance training programme significantly improved QOL in older adults. Influence on the lipid profile and NCS still needs further investigation.

Cost-effectiveness of Screening for Osteoporosis in Older Men With a History of Falls

Importance

Falls and osteoporosis share the potential clinical end point of fractures among older patients. To date, few fall prevention guidelines incorporate screening for osteoporosis to reduce fall-related fractures.

Objective

To assess the cost-effectiveness of screening for osteoporosis using dual-energy x-ray absorptiometry (DXA) followed by osteoporosis treatment in older men with a history of falls.

Design, Setting, and Participants

In this economic evaluation, a Markov model was developed to simulate the incidence of major osteoporotic fractures in a hypothetical cohort of community-dwelling men aged 65 years who had fallen at least once in the past year. Data sources included literature published from January 1, 1946, to July 31, 2020. The model adopted a societal perspective, a lifetime horizon, a 1-year cycle length, and a discount rate of 3% per year for both health benefits and costs. The analysis was designed and conducted from October 1, 2019, to September 30, 2020.

Interventions

Screening with DXA followed by treatment for men diagnosed with osteoporosis compared with usual care.

Main Outcomes and Measures

Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained.

Results

Among the hypothetical cohort of men aged 65 years, the screening strategy had an ICER of $33 169/QALY gained and was preferred over usual care at the willingness-to-pay threshold of $100 000/QALY gained. The number needed to screen to prevent 1 hip fracture was 1876; to prevent 1 major osteoporotic fracture, 746. The screening strategy would become more effective and less costly than usual care for men 77 years and older. The ICER for the screening strategy did not substantially change across a wide range of assumptions tested in all other deterministic sensitivity analyses. At a willingness-to-pay threshold of $50 000/QALY gained, screening was cost-effective in 56.0% of simulations; at $100 000/QALY gained, 90.8% of simulations; and at $200 000/QALY gained, 99.6% of simulations.

Conclusions and Relevance

These findings suggest that for older men who have fallen at least once in the past year, screening with DXA followed by treatment for those diagnosed with osteoporosis is a cost-effective use of resources. Fall history could be a useful cue to trigger assessment for osteoporosis in men.

Mediating factors on the association between fear of falling and health-related quality of life in community-dwelling German older people: a cross-sectional study

Background

Previous research has shown that not only falls, but also fear of falling (FoF) influences health-related quality of life (HrQoL) negatively. The EQ-5D (consisting of an index and a visual analogue scale [EQ-VAS]) is a frequently used instrument to determine HrQoL in clinical studies and economic evaluations, but no previous study compared the association between FoF and the EQ-5D index with the association between FoF and the EQ-VAS. Moreover, factors that influence the association between FoF and HrQoL are rarely examined. Thus, this study aimed to examine the association between FoF and HrQoL and to examine factors that mediate the association.

Methods

FoF (Short Falls Efficacy Scale International) and HrQoL (EQ-5D descriptive system, EQ-5D index, and EQ-VAS) were assessed in a sample of community-dwelling older persons (≥70 years) participating in the baseline assessment of a randomized controlled trial (N = 309). Linear and logistic regression analyses were performed, adjusting for sociodemographic variables, frequency of falls, number of chronic conditions, functional mobility (Timed up-and-go test), and subjective functional capacity (LLFDI function and disability scales). Multiple regression models were used to test the mediating effects.

Results

Moderate or high FoF was prevalent in 66% of the sample. After adjusting for covariates, FoF was negatively associated with the EQ-5D index, but not with the descriptive system or the EQ-VAS. Subjective functional capacity partly mediated the association between FoF and the EQ-5D index and completely mediated the association between FoF and the EQ-VAS.

Conclusion

FoF was negatively associated with the EQ-5D index. As subjective functional capacity mediated the association between FoF and HrQoL, future interventions should account for subjective functional capacity in their design.

Social inequalities in the impact of falls on health-related quality of life among older adults

The aim of the present study was to determine the association between falls and health-related quality of life (HRQoL) among older adults considering different demographic and socioeconomic characteristics. This study was developed with data from the Household Health Survey conducted in the city of Campinas, Brazil, in 2014 and 2015. HRQoL was investigated using the eight domains and two components of the SF-36 questionnaire. Simple and multiple linear regression analyses were performed with the aid of the Stata 15.0 program to determine the association between falls and HRQoL according to sex, age, income and schooling. Significant declines in the scores of the physical functioning, role physical and bodily pain domains as well as the physical component were found among women (not men) and individuals with a lower income. Among individuals aged 75 years or older and those with less schooling, declines occurred in these same domains as well as in the role emotional and mental health domains. The results reveal that the impact of falls on HRQoL differs depending on the socioeconomic and demographic characteristics of older adults, indicating that specific care strategies should target more vulnerable subgroups, with attention given to emotional aspects.

Fall experience and cognitive function in middle aged and elderly population

This study estimates the association between the fall experience in the last 2 years and cognitive function and further evaluate the differences in this association between men and women and across different age groups. Data from the Korean Longitudinal Study of Ageing from 2006 to 2016 was used and 9279 research samples were included at baseline in 2006. To analyze the association between fall experience for the last 2 years and cognitive function, generalized estimating equation model and chi-square test were used. After adjusting for all confounders, those with fall experience were significantly associated with cognitive decline. With non-fall experience as reference: fall experience, B = -0.013 (P = .017). In the 64 years or less group, fall experience was significantly associated with cognitive decline (P-value: 0.006) to those with non-fall experience. In male group, with non-fall experience as reference: fall experience, B = -0.017 (P = .041). Fall experience in the last 2 years is associated with cognitive decline, especially in those 64 years or less and male group. Therefore, self-reported screening for fall experience might aid population-based prevention strategies for cognitive decline, especially in 64 years or less and male.

Fear of Falling among Older Patients Admitted to Hospital after Falls in Vietnam: Prevalence, Associated Factors and Correlation with Impaired Health-Related Quality of Life

Fear of falling (FOF) diminishes older people’s independence in daily activities, as well as causes serious health and economic consequences. This study examined the prevalence of FOF in older patients hospitalized due to fall-injuries, its effect on health-related quality of life (HRQOL), and its associated factors. We conducted a cross-sectional study in seven hospitals in Thai Binh, Vietnam. FOF was assessed using a single close-ended question. HRQOL was evaluated by the EQ-5D-5L instrument. Multilevel logistic regression and Tobit regression models were utilized. The prevalence of FOF in 405 older patients admitted to hospitals after fall injuries was 88.2%, with a mean EQ-5D index and EQ-VAS of 0.34 (SD = 0.38) and 61.6 (SD = 15.2), respectively. Factors associated with FOF included living alone (OR = 0.13, 95%CI = 0.04; 0.50.,), history of eye diseases (OR = 4.12; 95%CI = 1.91; 8.89), and experiencing psychological distress (OR= 3.56, 95% CI = 1.05; 12.00). After adjusting for confounders, the EQ-5D index in the FOF group reduced by 0.15 points (Coef. = −0.15; 95%CI= −0.24; −0.05) compared to that of non-FOF group. Our study shows that FOF had an independent negative relationship with HRQOL of patients. Improving knowledge about fall prevention in patients and caregivers could reduce the burden of falls in older people.

Waist-Calf Circumference Ratio Is an Independent Risk Factor of HRQoL in Centenarians

PURPOSE

To analyze the associations between waist circumference (WC), body mass index (BMI), waist-hip ratio (WHR), waist-height ratio (WHtR), calf circumference, waist-calf circumference ratio (WCR), and quality of life in Hainan centenarians.

PATIENTS AND METHODS

A total of 1002 centenarians in Hainan were selected by a full sample survey. The EQ-5D visual analogue scale (EQ-5D-VAS) was used to investigate the quality of life. Restricted cubic splines were used to analyze and visualize the linear relationships.

RESULTS

After adjustment, the standard β values for BMI, WC, WHR, WHtR, calf circumference, and WCR associated with EQ-5D score were 0.101, 0.126, -0.018, 0.100, 0.302, and -0.219, respectively; all associations except for WHR were significant (P < 0.01). With increasing BMI, WC, and calf circumference, the risk of EQ-5D score <1 decreased (odds ratios [ORs] 0.91 [95% confidence interval (CI): 0.86-0.97), 0.97 [95% CI: 0.95-0.99], and 0.87 [95% CI: 0.82-0.92] after adjustment, respectively). With increasing WCR, the risk also increased (OR 2.70 [95% CI: 1.54-4.75]).

CONCLUSION

After excluding nutritional and muscle retention factors, fat central distribution negatively impacted the health-related quality of life of the oldest old population.

Relationships of Lipids Profile with Health-Related Quality of Life in Chinese Centenarians

OBJECTIVES

With the acceleration of the process of aging population, to enjoy a higher health-related quality of life (HRQoL) is the goal of the elderly population and public health. Studies on relationship between HRQoL and lipid profile through a large sample of representative elderly population are scare.

OBJECTIVE

This study was conducted to firstly explore the relationships of lipid profile with HRQoL in Chinese centenarian population.

PARTICIPANTS

A complete sample of 1002 participants aged over 100 years from Hainan province were recruited in the current study.

MAIN MEASURE

Questionnaire investigation, physical examination and blood specimen collection were carried out by family survey. The EuroQol-5 Dimensions(EQ-5D, and EQ-VAS were used to assess HRQoL.

RESULTS

In multivariate linear regression analyses, a significant association was found between EQ-5D and lipid profile, including total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and similar association was also existed between EQ-VAS and TC, LDL-C HDL-C, after adjustment. The score of EQ-5D and EQ-VAS in male centenarian was higher than that of the female centenarian.

CONCLUSION

Lipid profile was positively associated with the HRQoL in Chinese centenarians.

A Review of the Development and Application of Generic Preference-Based Instruments with the Older Population

Older people (aged 65 years and over) are the fastest growing age cohort in the majority of developed countries, and the proportion of individuals defined as the oldest old (aged 80 years and over) living with physical frailty and cognitive impairment is rising. These population changes put increasing pressure on health and aged care services, thus it is important to assess the cost effectiveness of interventions targeted for older people across health and aged care sectors to identify interventions with the strongest capacity to enhance older peoples' quality of life and provide value for money. Cost-utility analysis (CUA) is a form of economic evaluation that typically uses preference-based instruments to measure and value health-related quality of life for the calculation of quality-adjusted life-years (QALYS) to enable comparisons of the cost effectiveness of different interventions. A variety of generic preference-based instruments have been used to measure older people's quality of life, including the Adult Social Care Outcomes Toolkit (ASCOT); Health Utility Index Mark 2 (HUI2); Health Utility Index Mark 3 (HUI3); Short-Form-6 Dimensions (SF-6D); Assessment of Quality of Life-6 dimensions (AQoL-6D); Assessment of Quality of Life-8 dimensions (AQoL-8D); Quality of Wellbeing Scale-Self-Administered (QWB-SA); 15 Dimensions (15D); EuroQol-5 dimensions (EQ-5D); and an older person specific preference-based instrument-the Investigating Choice Experiments Capability Measure for older people (ICECAP-O). This article reviews the development and application of these instruments within the older population and discusses the issues surrounding their use with this population. Areas for further research relating to the development and application of generic preference-based instruments with populations of older people are also highlighted.

A modelling-based economic evaluation of primary-care-based fall-risk screening followed by fall-prevention intervention: a cohort-based Markov model stratified by older age groups

Background

fall-risk assessment with fall-prevention intervention referral for at-risk groups to avoid falls could be cost-effective from a care-payer perspective.

Aims

to model the cost-effectiveness of a fall-risk assessment (QTUG compared to TUG) with referral to one of four fall-prevention interventions (Otago, FaME, Tai Chi, home safety assessment and modification) compared to no care pathway, when the decision to screen is based on older age in a primary care setting for community-dwelling people.

Methods

a cohort-based, decision analytic Markov model was stratified by five age groupings (65–70, 70–75, 65–89, 70–89 and 75–89) to estimate cost per quality-adjusted life years (QALYs). Costs included fall-risk assessment, fall-prevention intervention and downstream resource use (e.g. inpatient and care home admission). Uncertainty was explored using univariate, bivariate and probabilistic sensitivity analyses.

Results

screening with QTUG dominates (>QALYs; <costs) screening with TUG irrespective of subsequent fall-prevention intervention. The QTUG-based care pathways relative to no care pathway have a high probability of cost-effectiveness in those aged 75–89 (>85%), relative to those aged 70–74 (~10 < 30%) or 65–69 (<10%). In the older age group, only a 10% referral uptake is required for the QTUG with FaME or Otago modelled care pathways to remain cost-effective.

Conclusion

the highest probability of cost-effectiveness observed was a care pathway incorporating QTUG with FaME in those aged 75–89. Although the model does not fully represent current NICE Falls guidance, decision makers should still give careful consideration to implementing the aforementioned care pathway due to the modelled high probability of cost-effectiveness.

Orthostatic hypotension and health-related quality of life among community-living older people in Korea

PURPOSE

To investigate the association of orthostatic hypotension (OH) with health-related quality of life (HRQoL) in older people living in the community.

METHODS

A cross-sectional design was used. A total of 217 participants aged 65 and older were classified as having OH if their systolic or diastolic blood pressure showed a drop of ≥ 20 mmHg systolic blood pressure or ≥ 10 mmHg diastolic blood pressure, respectively, within 3 min of standing. Participants provided demographic and medical information and responded to questionnaires about their HRQoL (EuroQoL-5D-3L), as well as depression, anxiety, cognitive function, and recent physical activities.

RESULTS

The number of participants with OH was 117, and those without OH numbered 100. The mean HRQoL levels were 0.56 (SD 0.29) in the OH group and 0.74 (SD 0.25) in the non-OH group (p < .001). Participants with OH were more likely to be older, women, and smokers. These participants had fewer years of education, a greater history of stroke and hypertension, and a greater number of comorbidities. The absence of OH, a higher physical activity level, a lower degree of depression, an absence of stroke history, and younger age were all significant determinants of greater HRQoL.

CONCLUSIONS

The level of HRQoL of older people with OH was significantly lower than that of older people without. The presence of OH was an independent determinant of HRQoL in older adults after adjusting for covariates. This finding suggests that strategies for relieving OH could improve HRQoL in affected older adults.

Using supervised learning machine algorithm to identify future fallers based on gait patterns: A two-year longitudinal study

INTRODUCTION

Given their major health consequences in the elderly, identifying people at risk of fall is a major challenge faced by clinicians. A lot of studies have confirmed the relationships between gait parameters and falls incidence. However, accurate tools to predict individual risk among independent older adults without a history of falls are lacking.

OBJECTIVE

This study aimed to apply a supervised learning algorithm to a data set recorded in a two-year longitudinal study, in order to build a classification tree that could discern subsequent fallers based on their gait patterns.

METHODS

A total of 105 adults aged >65 years, living independently at home and without a recent fall history were included in a two-year longitudinal study. All underwent physical and functional assessment. Gait speed, stride length, frequency, symmetry and regularity, and minimum toe clearance were recorded in comfortable, fast and dual task walking conditions in a standardized laboratory environment. Fall events were recorded using personal falls diaries. A supervised machine learning algorithm (J48) has been applied to the data recorded at inclusion in order to obtain a classification tree able to identify future fallers.

RESULTS

Based on fall information from 96 volunteers, a classification tree correctly identifying 80% of future fallers based on gait patterns, gender, and stiffness, was obtained, with accuracy of 84%, sensitivity of 80%, specificity of 87%, a positive predictive value of 78%, and a negative predictive value of 88%.

DISCUSSION

While the performances of the classification tree warrant further confirmation, it is the first predictive tool based on gait parameters that are identified (not clustered) allowing its use by other research teams.

CONCLUSION

This original longitudinal pilot study using a supervised machine learning algorithm, shows that gait parameters and clinical data can be used to identify future fallers among independent older adults.

Gait symmetry in the dual task condition as a predictor of future falls among independent older adults: a 2-year longitudinal study

BACKGROUND

Given the potential consequences of falls among older adults, a major challenge is to identify people at risk before the first event. In this context, gait parameters have been suggested as markers of fall risk.

AIM

To examine, among older people, the prospective relationship between gait patterns assessed in comfortable and challenging walking conditions, and future fall(s).

METHOD

A total of 105 adults older than 65 years, living independently at home and without a recent fall history were included in a 2-year, longitudinal, observational study. All underwent physical and functional assessment. Gait speed, stride length, frequency, symmetry and regularity and Minimum Toe Clearance (MTC) were recorded in comfortable (CW), fast (FW) and dual task walking (DTW) conditions. Gait parameter changes occurring between CW and FW and between CW and DTW were calculated and expressed in percent. DTW cost was calculated as the change of DTW relative to CW. Fall events were recorded using fall diaries. Comparisons according to fall occurrence were performed by means of univariate analysis and multivariate binary logistic regression analysis.

RESULTS

Two-year follow-up was available for 96 participants, of whom 35 (36.5%) fell at least once. Comparative analysis showed that future fallers had shorter FW stride length and higher symmetry DTW cost than non-fallers (p < 0.05). Binary logistic regression analysis showed that each additional percent of stride symmetry cost was associated with an increase in future fall risk (odds ratio 1.018, 95% Confidence Interval (CI) 1.002-1.033; p = 0.027).

DISCUSSION

Our results confirm the association between a symmetry decrease in DTW and future fall(s). Indeed in this study, the mean symmetry DTW cost in fallers is almost 20% higher than in non-fallers, meaning a fall risk that is around 36% higher than among non-fallers.

CONCLUSION

This exploratory study shows the usefulness of considering gait parameters, particularly symmetry in challenging walking conditions, for early identification of future fallers.

Drug Treatment, Postural Control, and Falls: An Observational Cohort Study of 504 Patients With Acute Stroke, the Fall Study of Gothenburg

OBJECTIVE

To identify whether, and to what extent, treatment with cardiovascular drugs and neurotropic drugs are associated with postural control and falls in patients with acute stroke.

DESIGN

Observational cohort study.

SETTING

A stroke unit at a university hospital.

PARTICIPANTS

A consecutive sample of patients (N=504) with acute stroke.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Postural control was assessed using the modified version of the Postural Assessment Scale for Stroke Patients. Data including baseline characteristics, all drug treatments, and falls were derived from medical records. Univariable and multivariable logistic regression and Cox proportional hazards models were used to analyze the association of drug treatment and baseline characteristics with postural control and with falls.

RESULTS

In the multivariable logistic regression analysis, factors significantly associated with impaired postural control were treatment with neurotropic drugs (eg, opioids, sedatives, hypnotics, antidepressants) with an odds ratio (OR) of 1.73 (95% confidence interval [CI], 1.01-2.97, P=.046); treatment with opioids (OR 9.23, 95% CI, 1.58-54.00, P=0.014); age (OR 1.09, 95% CI, 1.07-1.12, P<.0001), stroke severity, which had a high National Institutes of Health Stroke Scale-score (OR 1.29, 95% CI, 1.15-1.45, P<.0001), and sedentary life style (OR 4.32, 95% CI, 1.32-14.17, P=.016). No association was found between neurotropic drugs or cardiovascular drugs and falls.

CONCLUSIONS

Treatment with neurotropic drugs, particularly opioids, in the acute phase after stroke, is associated with impaired postural control. Since impaired postural control is the major cause of falls in patients with acute stroke, these results suggest opioids should be used with caution in these patients.

PrevenTing Falls in a high-risk, vision-impaired population through specialist ORientation and Mobility services: protocol for the PlaTFORM randomised trial

BACKGROUND

Older people with vision impairment have significant ongoing morbidity, including risk of falls, but are neglected in fall prevention programmes. PlaTFORM is a pragmatic evaluation of the Lifestyle-integrated Functional Exercise fall prevention programme for older people with vision impairment or blindness (v-LiFE). Implementation and scalability issues will also be investigated.

METHODS

PlaTFORM is a single-blinded, randomised trial designed to evaluate the v-LiFE programme compared with usual care. Primary outcomes are fall rate over 12 months, measured using prospective monthly fall calendars, and function and participation assessed by the Late-Life Function and Disability Instrument (Late-Life FDI) Function component. The secondary outcome is rate of falls requiring medical care. Activity-normalised fall rate will be estimated using accelerometer-measured physical activity data. EuroQol 5-dimension 5-level questionnaire will measure quality of life and impact of falls. Health record linkage will estimate resource use associated with falls. v-LiFE cost-effectiveness will be determined compared with usual care. 500 participants (250 per group) can provide 90% power to detect a significant between-group difference in fall rates; 588 will be recruited to allow for drop-out. Falls per person-year and Late-Life FDI will be compared between groups.

DISCUSSION

PlaTFORM will determine if falls can be prevented among older people with vision loss through a home-based exercise programme. v-LiFE embeds balance and strength training within everyday activities with the aim of preventing falls. The study will also determine whether the programme can be effectively delivered by personnel who provide Orientation and Mobility training for people with vision impairment.

TRIAL REGISTRATION NUMBER

ACTRN12616001186448p.

Effect of the Physical Environment on the Health-related Quality of Life of the Low-income Korean Elderly Population

BACKGROUND

The increasing number of elderly citizens due to changes in the social structure is of national interest. This study aimed to provide basic data for devising policies to promote the quality of life of elderly National Basic Livelihood Security System (NBLSS) beneficiaries in South Korea by identifying the effects of their general characteristics and physical environment on their health-related quality of life (HRQoL).

METHODS

Using the 2013 Korean Community Health Survey (KCHS) raw data, we analyzed 3537 NBLSS beneficiaries aged 65 yr and older. HRQoL was measured using the Euro QoL five-dimension questionnaire (EQ-5D). Hierarchical multiple regression analyses were used to predict the EQ-5D scores.

RESULTS

The explanatory power for HRQoL increased to 21.4% when the general characteristics and physical environment were included. HRQoL showed statistically significant differences in the environmental variable, level of safety (P=0.001), natural environment (P=0.001), living environment (P=0.001), traffic condition (P<0.001), and access to health services (P<0.001). Physical environment positively correlated with HRQoL(r=.119, P<0.001), thus confirming its influence (ß=.092, P<0.001).

CONCLUSION

We should strive to manage the physical environment to improve the quality of life of elderly NBLSS beneficiaries.

Sex differences in relation patterns between health-related quality of life of older adults and its correlates: a population-based cross-sectional study in Madeira, Portugal

A population-based cross-sectional study aimed to examine sex differences in health-related quality of life (HRQoL) of older adults, and investigate whether the relation patterns between HRQoL and its correlates differed between sexes. A stratified proportional and representative sample included 802 volunteers, aged 60–79. HRQoL (36-item Short Form Health Survey), functional fitness (Senior Fitness Test), physical activity (PA) (Baecke questionnaire), demographic information and health features (questionnaires) were assessed. Men showed significantly higher HRQoL (P<0.001). Body mass index, body strength, aerobic endurance, PA, depressive symptoms, falls, and living alone were significantly related to HRQoL. With sex as moderator, these relations were not significant, except for PA (β=0.12, P=0.004). A significant interaction of sex with PA on HRQoL (β=0.08, P=0.037) was found, indicating that this relation was higher in men. A similar relation pattern was found for HRQoL physical component. HRQoL and its correlates differed between sexes, demanding a sex specific approach to promote HRQoL.

The association between depressive symptoms and fall accidents among middle-aged and elderly people in China

Background

Depressive symptoms are a worldwide health problem. However, the research about the effect of depressive symptoms on the fall among the Chinese mid-aged and elderly people is lacking. Therefore, this study aims to investigate the association between depressive symptoms and fall accidents among middle-aged and elderly people in China.

Methods

This study was conducted based on 12,527 sets of data from China Health and Retirement Longitudinal Survey (CHARLS). The 2011 depressive symptoms data and the 2013 fall data were chosen for this study. The depressive symptom-related data was assessed by the Chinese version of Center for Epidemiologic Studies Depression scales (CES-D). Individuals were divided into subgroups according to gender (male or female), age (45–59, middle-aged or ≥ 60, elderly people), and residence (rural or urban). The odds ratios (ORs) were compared between subgroups using multivariable logistic regression analysis method.

Results

The adjusted OR value (OR = 1.19 [95% CI 1.07–1.33]) shows there is a significant association between depressive symptoms and subsequent fall accidents. The ORs of the female, elderly people, rural, and urban subgroups are 1.31 (95% CI 1.11–1.55), 1.24 (95% CI 1.08–1.43), 1.17 (95% CI 1.02–1.33), and 1.25 (95% CI 1.04–1.49), respectively, which reveals that this association is also statistically significant in these subgroups.

Conclusions

This study shows that there is a significant association between depressive symptoms and their subsequent fall accidents among the Chinese middle-aged and elderly people.

Assessing gait parameters with accelerometer-based methods to identify older adults at risk of falls: a systematic review

PURPOSE

The purpose of this study was to perform a systematic review to assess the utility of accelerometric methods to identify older adults at risk of falls.

METHODS

The Preferred Reporting Item for Systematic review and Meta-Analysis (PRISMA) guidelines were followed during all steps of this systematic review. Cross sectional and longitudinal studies assessing gait parameters in older adults using accelerometric devices, and comparing groups based on the risk of falls or fall history were identified from studies published in the MEDLINE, SCOPUS and Cochrane Database of Systematic Reviews databases between January 1996 and January 2017. Study selection and data extraction were performed independently by two reviewers. The quality of the methodology used in the studies included was assessed using the Newcastle-Ottawa Scale.

RESULTS

In total, 354 references were identified through the database search. After selection, ten studies were included in this systematic review. According to the cross sectional studies, people who fall or are at risk of fall are slower, and walk with shorter steps, lower step frequency, worse stride and step regularity in terms of time, position and acceleration profiles. One longitudinal study suggests considering harmonic ratio of upper trunk acceleration in the vertical plane. Two other longitudinal studies highlight the importance of considering more than one gait parameter, and sophisticated statistical tools to discern older adults at risk for future fall(s).

CONCLUSION

This systematic review essentially highlights the lack of available literature providing strong evidence that gait parameters obtained using acceleration-based methods could be useful to discern older people at risk of fall. Available literature is encouraging, but further high quality studies are needed to highlight the cross-sectional and longitudinal relationships between gait parameters and falls in older adults.

The mediating role of psychological symptoms on falls risk among older adults with osteoarthritis

The purpose of this study was to investigate the role of fear of falling (FoF) and psychological symptoms in explaining the relationship between osteoarthritis (OA) symptom severity and falls. Individuals aged ≥65 years with ≥2 falls or ≥1 injurious fall over the past 12 months were included in the falls group, while volunteers aged ≥65 years with no history of falls over 12 months were recruited as controls. The presence of lower extremity OA was determined radiologically and clinically. Severity of symptoms was assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. FoF and psychological status were measured with the shortened version of the Falls Efficacy Scale-International and the 21-item Depression, Anxiety and Stress Scale (DASS-21), respectively. Of 389 (229 fallers, 160 non-fallers) potential participants, mean (SD) age: 73.74 (6.60) years, 141 had clinical OA and 171 had radiological OA. Fallers with both radiological OA and clinical OA had significantly higher FoF and DASS-21 scores than non-fallers. FoF was significantly positively correlated with symptom severity in fallers and non-fallers with radiological and clinical OA. Depression, anxiety, and stress scores were only significantly correlated with symptom severity among fallers but not non-fallers in both clinical and radiological OA. The relationship between mild symptoms and reduced risk of falls compared to no symptoms in those with radiological OA was attenuated by increased anxiety. The increased falls risk associated with severe symptoms compared to mild symptoms in clinical OA was attenuated by FoF. FoF may, therefore, be a potentially modifiable risk factor for OA-associated falls which could be considered in future intervention studies.

Health-related quality of life, handgrip strength and falls during detraining in elderly habitual exercisers

BACKGROUND

The effects of regular exercise on physical functioning and health-related quality of life (HRQOL) have been thoroughly studied. In contrast, little is known about the changes which occur following cessation of activity (detraining). Here, we have investigated the effect of a 3 month detraining period on HRQOL and on handgrip strength in elderly people who had regularly exercised, and examined the association of these variables with falls.

METHODS

Thirty-eight women and 11 men (mean age, 75.5±5.7 years) took part in a supervised physical exercise program for 9 months, followed by a 3 month detraining period. Participants completed the SF-36 HRQOL questionnaire at the beginning of detraining (baseline) and 3 months later. Handgrip strength and number of falls were also recorded.

RESULTS

Participants had been exercising for 12.1±8.7 years. After the detraining period, we found a significant (p < 0.001--0.05) decline in all SF-36 dimensions, with the exception of handgrip strength. Women presented a larger decline (p < 0.05) in more items than men. During the detraining period, 18.4% participants had a fall incident. HRQOL declined in both fallers and non-fallers during detraining. Interestingly, fallers already had at baseline significantly lower values in physical functioning (p < 0.05), emotional role (p < 0.05) and mental health (p < 0.01), than non-fallers.

CONCLUSIONS

An important decline was found in most items of the SF-36 following a 3 month detraining period, particularly in women. In contrast, strength of the upper limb was not affected by the detraining. The prior lower HRQOL values of those who will subsequently fall suggest that this criterion should be studied as a candidate risk factor for falls. Efforts should be made to encourage the elderly to continue with exercise activities and/or to shorten holiday break periods, in order to maintain their quality of life.

TRIAL REGISTRATION

The protocol was registered as a clinical trial in the ANZCTR (trial ID: ACTRN12617000716369 ).

Short-term effectiveness of a community-implemented falls prevention referral service

PURPOSE

To evaluate the effectiveness of the 16-week evidence-based Steady Steps exercise referral scheme at improving physical function, balance confidence, and quality of life (QoL) of community-dwelling older adults at risk of falling.

METHOD

A non-experimental, practice-based study involving a retrospective analysis of participant outcomes. Pre-post comparisons of three performance-based measures of gait and balance and of person-reported outcomes for balance confidence and QoL were performed. Effectiveness was evaluated in terms of statistically significant changes and relative to published fall-risk thresholds and minimal detectable changes (MDCs) or minimum clinically important differences.

RESULTS

One hundred and thirty-six participants completed the program over 19 months. Statistically significant differences were observed for all outcomes (p < 0.001), translating to an overall 42.6% reduction in falls-related risk. Approximately 63% of participants achieved an improvement ≥MDC in at least one of the performance-based tests. Greater than 55% achieved self-reported improvements in balance confidence ≥ MDC, while >40% reported clinically important improvements in QoL.

CONCLUSIONS

While the non-experimental design precludes conclusive evidence of causation, the highly significant and clinically meaningful improvements observed in individuals who completed the evidence-based Steady Steps program support its translation of evidence into effective practice. Continued implementation and evaluation of such practices and their longer-term effects are warranted. Implications for Rehabilitation Falls in older adults represent an escalating public health problem, and rehabilitation professionals are charged with developing and/or identifying feasible and effective evidence-based programs that target and reduce falls risk in this population. Our findings support Steady Steps as an effective third-sector referral rehabilitation service that successfully translates research evidence-based exercise interventions into effective practice, positively impacting physical function, balance confidence and quality of life (QoL) in community-dwelling older adults. Our study provides practice-based evidence of the effectiveness of exercise interventions that are progressively challenging, deliver a high dose of moderate to high intensity and target the main falls risk factors of muscle weakness and gait and balance impairment. In spite of their limitations, non-experimental, practice-based approaches provide rehabilitation professionals with feasible opportunities for evaluating existing services, such as Steady Steps, and contributing to the overall evidence-base for falls prevention and management.

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.

[Frequency of falls among clients of home care services : The importance of care-related and social risk factors]

BACKGROUND

Among the elderly falls frequently result in injuries, increase the need for long-term care and pose a challenge for the quality assurance in nursing care. We describe the frequency and risk factors of falls among care-dependent persons using home care services in Germany.

METHODS

The participants of the study "Nursing-related health problems in home care" (n = 880) were recruited based on a list of the officially accredited nursing services. Data collection followed a standardized study protocol. Proportions were calculated and adjusted odds ratios and predicted probabilities were estimated using binary logistic regression.

RESULTS

Falls are a frequent occurrence among care-dependent persons who are cared for by home care services: Almost every tenth care-dependent person suffers from a fall within a period of 2 weeks. Falls are mainly associated with social and care-related factors. Besides a low educational status this comprises certain living and care arrangements: People living alone or having infrequent contact to their nursing service as well as clients that, according to their carers, should receive more support have a significantly higher chance of falling. Multimorbidity is a medical risk factor while neurological diseases as well as polypharmacy present increased risks only in interaction with living and care arrangements.

CONCLUSION

Nursing staff and physicians should maintain an overview of the social and health conditions of people in need of long-term care. If care-dependent persons live alone or are infrequently cared for, additional medical problems considerably increase the risk for falling; therefore, preventive interventions and follow-up assessments of actual need levels should be promptly considered if health conditions or living arrangements change.

Correlates of health-related quality of life in young-old and old-old community-dwelling older adults

PURPOSE

This study aimed (1) to examine the role of potential correlates of HRQoL in a large representative sample of older adults, and (2) to investigate whether the relationships between HRQoL and potential factors differ as a function of HRQoL component (physical vs. mental) and/or age cohort (young-old vs. old-old).

METHODS

This cross-sectional study included 802 older adults aged 60-79 years old. HRQoL was assessed using the SF-36 questionnaire. Functional fitness was assessed using the Senior Fitness Test. Physical activity was measured via the Baecke questionnaire. Demographic information, mental and health features were obtained through questionnaires.

RESULTS

A multiple regression analysis showed that BMI (β = -0.15, p = 0.001), body strength (β = 0.21, p < 0.001), aerobic endurance (β = 0.29, p < 0.001), physical activity (β = 0.11, p = 0.007), depressive symptoms (β = -0.19, p < 0.001), falls (β = -0.19, p < 0.001), and living alone (β = -0.16, p < 0.001) were all significantly related to HRQoL-SF-36 total score. The positive relation with aerobic endurance was significantly higher for the physical component of HRQoL, while the negative relation with living alone was significantly higher for the mental component. The positive relation of HRQoL with physical activity was significantly higher in old-old compared to young-old adults.

CONCLUSION

This data suggest that body composition, functional fitness, psycho-social factors, and falls are important correlates of HRQoL in old age. There are HRQoL-component and age-cohort differences regarding these correlates, underlying the need for specific strategies at the community level to promote HRQoL in older adults.

The effects of physical training without equipment on pain perception and balance in the elderly: A randomized controlled trial

BACKGROUND

Research supports a link between exercise and falls prevention in the older population.

OBJECTIVES

Our aims were to evaluate pain perception and balance skills in a group of elderly subjects and to examine the consequences of a standardized equipment-free exercise program intervention on these variables. The study utilized a randomized controlled trial method.

METHODS

92 subjects were recruited from a rural Sicilian village (Resuttano, Sicily, Italy). Subjects were randomly split into two groups, an experimental group (EG; n = 49) and a control group (CG; n = 43). Qualified fitness instructors delivered the standardized physical exercise program for the EG whilst the CG did not receive this exercise intervention. The Berg Balance Scale and the Oswestry Disability Index were administered in both groups before (T0) and after the intervention (T1).

RESULTS

At T1, the EG group significantly improvement in balance (p < 0.0001) and pain perception (p < 0.0001). No significant differences were found within the CG both in BBS and ODI, respectively.

CONCLUSIONS

Our findings suggest that a 13-weeks standardized exercise equipment-free program is effective in improving balance and perception of pain in the elderly. This type of intervention can consequently provide a low cost strategy to counteract the rate of disability in elderly.

Association of falls with health-related quality of life (HRQOL) in older cancer survivors: A population based study

OBJECTIVE

To examine the association between falls and health-related quality of life (HRQOL) in older cancer survivors.

MATERIALS AND METHODS

Using the 2006-2011 Surveillance, Epidemiology, and End Results cancer registry system and the Medicare Health Outcomes Survey (SEER-MHOS) linkage database, a cross-sectional analysis was performed including 17,958 older cancer survivors. Multivariable regression models were used to evaluate the association of falls with HRQOL measured by the physical component summary (PCS) and mental component summary (MCS) scores on the Veteran RAND 12-item health survey after controlling for demographic, health- and cancer-related factors. A longitudinal analysis using the analysis of covariance (ANCOVA) models was also conducted comparing changes in HRQOL of older cancer survivors who fell with HRQOL of older patients with cancer who did not fall.

RESULTS

In the cross-sectional analysis, 4524 (25%) cancer survivors who fell reported a significantly lower PCS (-2.18; SE=0.16) and MCS (2.00; SE=0.17) scores compared to those who did not (N=13,434). In the longitudinal analysis, after adjusting for baseline HRQOL scores and covariates, patients who fell reported a decline in mean HRQOL scores of both PCS (-1.54; SE=0.26) and MCS (-1.71; SE=0.27). Presence of depression, functional impairment and comorbidities was significantly associated with lower HRQOL scores.

CONCLUSION

Falls are associated with lower HRQOL scores and are associated with a significant prospective decline in HRQOL in older cancer survivors. Further research is necessary to determine if assessment and intervention programs can help improve HRQOL by reducing the likelihood of falls.

A systematic review of instruments for measuring outcomes in economic evaluation within aged care

BACKGROUND

This paper describes the methods and results of a systematic review to identify instruments used to measure quality of life outcomes in older people. The primary focus of the review was to identify instruments suitable for application with older people within economic evaluations conducted in the aged care sector.

METHODS

Online databases searched were PubMed, Medline, Scopus, and Web of Science, PsycInfo, CINAHL, Embase and Informit. Studies that met the following criteria were included: 1) study population exclusively above 65 years of age 2) measured health status, health related quality of life or quality of life outcomes more broadly through use of an instrument developed for this purpose, 3) used a generic preference based instrument or an older person specific preference based or non-preference based instrument or both, and 4) published in journals in the English language after 2000.

RESULTS

The most commonly applied generic preference based instrument in both the community and residential aged care context was the EuroQol - 5 Dimensions (EQ-5D), followed by the Adult Social Care Outcomes Toolkit (ASCOT) and the Health Utilities Index (HUI2/3). The most widely applied older person specific instrument was the ICEpop CAPability measure for Older people (ICECAP-O) in both community and residential aged care.

CONCLUSION

In the absence of an ideal instrument for incorporating into economic evaluations in the aged care sector, this review recommends the use of a generic preference based measure of health related quality of life such as the EQ-5D to obtain quality adjusted life years, in combination with an instrument that has a broader quality of life focus like the ASCOT, which was designed specifically for evaluating interventions in social care or the ICECAP-O, a capability measure for older people.

Cost-effectiveness and budget impact of Empirical vitamin D therapy on unintentional falls in older adults in the UK

OBJECTIVES

To evaluate the health outcomes and economics associated with the current guidance relating to the prevention of falls in the elderly through vitamin D supplementation.

SETTING

UK.

PARTICIPANTS

UK population aged 60 years and above.

INTERVENTIONS

A Markov health state transition model simulated patient transitions between key fall-related outcomes using a 5-year horizon and annual cycles to assess the costs and benefits of empirical treatment with colecalciferol 800 iu daily.

PRIMARY AND SECONDARY OUTCOME MEASURES

Costs and health outcomes attributable to fall prevention following vitamin D supplementation.

RESULTS

Our model shows that treating the UK population aged 60 years and above with 800 iu colecalciferol would, over a 5-year period: (1) prevent in excess of 430,000 minor falls; (2) avoid 190,000 major falls; (3) prevent 1579 acute deaths; (4) avoid 84,000 person-years of long-term care and (5) prevent 8300 deaths associated with increased mortality in long-term care. The greatest gains are seen among those 75 years and older. Based on reduction in falls alone, the intervention in all adults aged 65+ is cost-saving and leads to increased quality adjusted life years. Treating all adults aged 60+ incurs an intervention cost of £2.70bn over 5 years, yet produces a -£3.12bn reduction in fall-related costs; a net saving of £420M. Increasing the lower bound age limit by 5-year increments increases budget impact to -£1.17bn, -£1.75bn, and -£2.06bn for adults 65+, 70+ and 75+, respectively.

CONCLUSIONS

This study shows that treatment of the elderly UK population with colecalciferol 800 iu daily would be associated with reductions in mortality and substantial cost-savings through fall prevention.

Association between physiological falls risk and physical performance tests among community-dwelling older adults

BACKGROUND

Physical performance and balance declines with aging and may lead to increased risk of falls. Physical performance tests may be useful for initial fall-risk screening test among community-dwelling older adults. Physiological profile assessment (PPA), a composite falls risk assessment tool is reported to have 75% accuracy to screen for physiological falls risk. PPA correlates with Timed Up and Go (TUG) test. However, the association between many other commonly used physical performance tests and PPA is not known. The aim of the present study was to examine the association between physiological falls risk measured using PPA and a battery of physical performance tests.

METHODS

One hundred and forty older adults from a senior citizens club in Kuala Lumpur, Malaysia (94 females, 46 males), aged 60 years and above (65.77±4.61), participated in this cross-sectional study. Participants were screened for falls risk using PPA. A battery of physical performance tests that include ten-step test (TST), short physical performance battery (SPPB), functional reach test (FRT), static balance test (SBT), TUG, dominant hand-grip strength (DHGS), and gait speed test (GST) were also performed. Spearman's rank correlation and binomial logistic regression were performed to examine the significantly associated independent variables (physical performance tests) with falls risk (dependent variable).

RESULTS

Approximately 13% older adults were at high risk of falls categorized using PPA. Significant differences (P<0.05) were demonstrated for age, TST, SPPB, FRT, SBT, TUG between high and low falls risk group. A significant (P<0.01) weak correlation was found between PPA and TST (r=0.25), TUG (r=0.27), SBT (r=0.23), SPPB (r=-0.33), and FRT (r=-0.23). Binary logistic regression results demonstrated that SBT measuring postural sways objectively using a balance board was the only significant predictor of physiological falls risk (P<0.05, odds ratio of 2.12).

CONCLUSION

The reference values of physical performance tests in our study may be used as a guide for initial falls screening to categorize high and low physiological falls risk among community-dwelling older adults. A more comprehensive assessment of falls risk can be performed thereafter for more specific intervention of underlying impairments.