Is functional fitness performance a useful predictor of risk of falls among community-dwelling older adults?

The Effects of Physiotherapy Programmes, Aided by Virtual Reality Solutions, on Balance in Older Women: A Randomised Controlled Trial

Background: Modern technologies are being applied to maintain and improve the functional performance of older adults. Fully immersive virtual reality (VR) combined with a scope of dual-task (DT) activities may effectively complement conventional physiotherapy programmes for seniors. The study aimed to compare the effectiveness of a fully immersive virtual reality (VR) environment combined with a scope of dual-task activities regarding balance in older women. Methods: Eighty women were recruited to the study protocol and, following randomisation, allocated to two equally sized groups, one pursuing conventional OTAGO exercises, the other one the VR-solutions-aided exercise programme combined with a scope of DT activities. Physiotherapy sessions spanned 6 weeks, each one lasting 60 min, three times a week, in both groups. Results: Homogeneity analysis of both study groups indicated no statistically significant differences at the first measurement point. After the intervention, both study groups achieved significantly improved scores on all tests. The VR + DT group obtained better results in dual-task gait and single-leg standing, whereas the greatest difference was observed during SLS CL (1.52 s vs. 2.33 s-difference 0.81 s 53.2% change, p = 0.001). The OTAGO group performed better in the TUG single-task gait (11.35 s vs. 12.60 s, p < 0.001) and in the Berg balance scale. Conclusions: The VR + DT training is effective in improving individual balance as well as in reducing fall risks. VR-assisted physiotherapy should complement conventional physiotherapy programmes (e.g., OTAGO). The benefits of applying VR solutions indicate that older women might well use this form of activity regularly under the guidance of a therapist or a family member.

Translation, validity and reliability of the fall risk scale for older adults

INTRODUCTION

Falls in older adults are a common and serious threat to health and functional independence. It can cause psychological distress, inability to participate in activities of daily living, brain injury, fractures, and even death. The aim was to analyze the psychometric properties of the self-assessed fall risk scale (FRS) that measures the risk of falls in older adults in a central region of Chile, as well as to verify the concurrent validity against functional fitness tests.

MATERIALS AND METHODS

A descriptive cross-sectional study was carried out in 222 older adults (OA) [34 males and 188 females] with an age range of 65 to 85 years. The 13-item self-perceived fall risk scale (FRS) was validated. Anthropometric measures (weight, height and waist circumference) were assessed. Five functional fitness tests were measured (right and left hand grip strength, biceps curl, up-and-go, agility and 6-minute walk test). Validation was performed by construct validation [(exploratory factor analysis (EFA) and confirmatory factor analysis (CFA)] and concurrent validity.

RESULTS

The EFA revealed 4 factors in the FRS scale [1: fear of falling (variance 27.1%), 2: use of assistive devices (variance 10.6%), 3: loss of sensation (variance 9.3%), and 4: limited mobility (variance 8.3%)]. Factor loadings ranged from ∼ 0.50 to 0.83 across the 4 components. The Kaiser-Meyer Olkin sample adequacy test (KMO) reflected adequate adequacy (KMO = 0.79, chi-square (X2) = 498.806, gl = 78, p = 0.00). The CFA showed a satisfactory final fit [chi-square (X2) = 126.748, Root mean squared error of approximation (RMSEA) = 0.042, Tucker-Lewis Index (TLI) = 0.946, Comparative fit index (CFI) = 0.935 y Normed fit index (NFI) = 0.90. The relationships between the FRS scale and functional fitness tests (right and left hand grip strength, biceps curl, up-and-go, agility and 6-minute walk test) ranged from low to moderate (r= -0.23 to 0.41).

CONCLUSION

The FRS scale showed acceptable validity and reliability in older adults in central region of Chile. It is expected that this scale will be useful for assessing fall risk in clinical and epidemiological settings in the aging Chilean population.

Acceptability, feasibility, and effectiveness of WE-SURF™: a virtual supervised group-based fall prevention exercise program among older adults

Conducted physically, supervised group-based falls prevention exercise programs have demonstrated effectiveness in reducing the risk of falls among older adults. In this study, we aimed to assess the acceptability, feasibility, and effectiveness of a virtual supervised group-based falls prevention exercise program (WE-SURF™) for community-dwelling older adults at risk of falls.

METHOD

A preliminary study utilizing virtual discussions was conducted to assess the acceptability of the program among six older adults. Effectiveness was evaluated in a randomized controlled feasibility study design, comprising 52 participants (mean age: 66.54; SD: 5.16), divided into experimental (n = 26) and control (n = 26) groups. The experimental group engaged in a 6-month WE-SURF™ program, while the control group received standard care along with a fall's prevention education session. Feasibility of the intervention was measured using attendance records, engagement rates from recorded videos, dropouts, attrition reasons, and adverse events.

RESULTS

Preliminary findings suggested that WE-SURF™ was acceptable, with further refinements. The study revealed significant intervention effects on timed up and go (TUG) (η2p:0.08; p < 0.05), single leg stance (SLS) (η2p:0.10; p < 0.05), and lower limb muscle strength (η2p:0.09; p < 0.05) tests. No adverse events occurred during the program sessions, and both attendance and engagement rates were high (> 80% and 8/10, respectively) with minimal dropouts (4%). The WE-SURF™ program demonstrated effectiveness in reducing the risk of falls while enhancing muscle strength and balance.

CONCLUSION

In conclusion, WE-SURF™ was demonstrated to be an acceptable, feasible, and effective virtual supervised group-based exercise program for fall prevention in community-dwelling older adults at risk of falls. With positive outcomes and favourable participant engagement, WE-SURF™ holds the potential for wider implementation. Further research and scaling-up efforts are recommended to explore its broader applicability. (Registration number: ACTRN 12621001620819).

Adverse outcomes of intrinsic capacity in older adults: A scoping review

Background and Purpose Intrinsic capacity (IC) has been shown to have the greatest impact on an individual's health status and health trajectory and can independently predict adverse outcomes such as mortality and care dependency in older adults. However, the current understanding of adverse outcomes associated with IC is incomplete. Methods A scoping review of the literature from PubMed, Web of Science (WOS), The Cochrane Library, CINAHL, and Embase databases was conducted from January 2015 to March 2023 to identify articles related to the adverse outcomes associated with IC in older adults. Results 711 studies met screening criteria, and 25 studies met inclusion criteria. These studies reported a total of 17 adverse outcomes related to IC across four domains. (1) Adverse outcomes in the physiological function domains included frailty, pneumonia onset, memory impairment, polypharmacy, incontinence, and poor/fair self-rated health. (2) Clinical outcomes domains included IADL disability, ADL disability, mortality, falls, autonomy decline, and incident dependence. (3) The resource utilization domains included hospitalization, nursing home stays, polypharmacy healthcare costs, and emergency department visits. (4) The other domains mainly included poor quality of life. Conclusion It is evident that IC decline in older adults is associated with a broad spectrum of adverse outcomes spanning cognitive function, activity ability, sensory perception, physical and mental health and living standards. Future studies should further deepen the exploration of IC.

Effect of elastic resistance training on functional capacity in older adults: a systematic review with meta-analysis

PURPOSE

This systematic review and meta-analysis investigated the effects of Elastic Resistance Training (ERT) on functional capacity (FC) in older adults.

METHODS

The databases used were Embase, Virtual Health Library, PubMed, SciElo, Scopus, SPORTS Discus, and Web of Science. Eligibility criteria: aged ≥ 60 years; both sexes; intervention of at least 8 weeks; structured ERT; comparator group that performed other types of training or without any intervention; at least one functional test measurement. Functional tests were grouped according to their specificity for the sub-group meta-analyses.

RESULTS

Twenty-six studies were considered eligible for qualitative synthesis, of which 16 were used for quantitative analysis. Favorable effects (p < .001) of ERT compared to the control group without intervention were observed in the 30-second sit to stand test, Timed Up and Go test, arm curl test, handgrip strength test, 6-minute walk test, lower and upper limb flexibility, and Short Physical Performance Battery (p = .007). Comparisons between ERT and other types of training were not performed because of the high heterogeneity of the studies.

CONCLUSIONS

Our findings suggest that ERT is able to improve the FC of older adults when compared to older adults not involved in any type of training.

Effects of Exergames and Conventional Physical Therapy on Functional Physical Performance in Older Adults: A Randomized Controlled Trial

Objective: To evaluate the effects of exergames added to a conventional physical therapy (CPT) program on functional fitness and dynamometric muscle performance for the sit-to-stand (STS) maneuver in older adults and to compare their results concerning a CPT-only intervention. Materials and Methods: Fifty independent older adults were randomly assigned to CPT and exergames (CPT+ExG group; n = 25; age = 71.8 ± 6.8 years) or CPT alone (CPT group; n = 25; age = 71.3 ± 7.4 years). CPT was performed twice a week (60 min/session) for 8 weeks. The CPT+ExG group added exergames for 30 minutes in each session. The Senior Fitness Test was applied, considering the 30-second chair stand test as the primary outcome. Additionally, dynamometric muscle performance during the STS maneuver was assessed. Results: The CPT+ExG group improved the 30-second chair stand (lower body strength), back scratch (upper body flexibility), and 8-foot up-and-go (agility/dynamic balance) tests (all P < 0.05). Both groups improved the kinetic dynamometric variables peak force, peak power, and total work (all P < 0.05). Also, both groups improved the 30-second arm curl test (upper body strength) (P < 0.05), although the increase was higher in the CPT+ExG group compared with the CPT group (time × group; P < 0.05). Conclusion: Adding exergames to a CPT program only significantly increases upper limb strength compared with CPT alone. The findings of this study have implications for the design of future exergame interventions focused on improving STS maneuver performance in older adults.

Cultural and Linguistic Adaptation of the Fall Risk Questionnaire-Portuguese Version

Falls are a major problem among older adults worldwide. Early detection of risk factors is important to decrease the burden of falls. The “Fall Risk Questionnaire” (FRQ) is a screening tool used to assess personal fall risk awareness in older populations, and it is also used as a behavior change tool. The aim of the present study was to undertake a cultural and linguistic adaptation of the FRQ to allow its use in the Portuguese population. To achieve this, we used the sequential method proposed by Beaton and colleagues. Statistical analysis was conducted by computing the intraclass correlation coefficient and Cronbach’s alpha score for intra-observer reliability. The panel revision demonstrated high concordance for all assessed items. The pretesting results indicated that, in general, the FRQ—Portuguese Version (FRQ-VP) was well accepted, and all items were adequate and easy to comprehend. The ICC and Cronbach’s alpha scores indicated high consistency between assessments (p < 0.01; alfa = 0.992). The FRQ-VP seemed to have good reliability and internal consistency. Because the definition of a fall experience may not be clear to the older population, a careful explanation of this item can lead to a better score computation.

Use of structural models to elucidate the occurrence of falls among older adults according to abdominal obesity: a cross-sectional study

BACKGROUND

Obesity is a risk factor for falls in older adults, but the effects of body fat distribution and its interaction with other factors are not well established.

OBJECTIVES

To verify the occurrence of falls among older adults with and without abdominal obesity and the effects of sociodemographic, health, and behavioral variables on this outcome.

DESIGN AND SETTING

A cross-sectional study in an urban area of Alcobaça, Brazil.

METHODS

Men and women older than 60 years with (270) and without (184) abdominal obesity were included. Sociodemographic, health, and behavioral data were collected using validated questionnaires in Brazil. Descriptive and path analyses were performed (P < 0.05).

RESULTS

The occurrence of falls was high in participants with abdominal obesity (33.0%). In both groups, a higher number of morbidities (β = 0.25, P < 0.001; β = 0.26, P = 0.002) was directly associated with a higher occurrence of falls. Among participants without abdominal obesity, a lower number of medications (β = -0.16; P = 0.04), a higher number of depressive symptoms (β = 0.15; P = 0.04), worse performance on the agility and dynamic balance tests (β = 0.37; P < 0.001), and lower functional disability for basic activities of daily living (β = -0.21; P = 0.006) were directly associated with the occurrence of falls.

CONCLUSION

Adults older than 60 years with abdominal obesity have a higher prevalence of falls. Different factors were associated with the occurrence of falls in both groups.

Association of Intrinsic Capacity with Frailty, Physical Fitness and Adverse Health Outcomes in Community-Dwelling Older Adults

BACKGROUND

Intrinsic capacity (IC) and frailty are complementary in advancing disability prevention through maintaining functionality.

OBJECTIVES

We examined the relationship between IC and frailty status at baseline and 1-year, and evaluated if IC decline predicts frailty onset among robust older adults. The secondary objectives investigated associations between IC, physical fitness and health-related outcomes.

DESIGN

Prospective cohort study.

SETTING

Community-based assessments.

PARTICIPANTS

Older adults aged>55 years, who were independent in ambulation (walking aids permitted).

MEASUREMENTS

5 domains of IC were assessed at baseline: locomotion (Short Physical Performance Battery, 6-minute walk test), vitality (nutritional status, muscle mass), sensory (self-reported hearing and vision), cognition (self-reported memory, age- and education adjusted cognitive performance), psychological (Geriatric Depression Scale-15, self-reported anxiety/ depression). Composite IC (0-10) was calculated, with higher scores representing greater IC. Frailty status was based on modified Fried criteria, with frailty progression defined as incremental Fried score at 1-year.

RESULTS

809 participants (67.6+6.8 years) had complete data for all 5 IC domains. 489 (60.4%) participants were robust but only 213 (26.3%) had no decline in any IC domain. Pre-frail and frail participants were more likely to exhibit decline in all 5 IC domains (p<0.05), with decremental composite IC [9 (8-9), 8 (6-9), 5.5 (4-7.5), p<0.001] across robust, prefrail and frail. IC was significantly associated with fitness performance, independent of age and gender. Higher composite IC reduced risk for frailty progression (OR=0.62, 95% CI 0.48-0.80), and reduced frailty onset among robust older adults (OR=0.53, 95% CI 0.37-0.77), independent of age, comorbidities and social vulnerability. Participants with higher IC were less likely to experience health deterioration (OR=0.70, 95% CI 0.58-0.83), falls (OR=0.76, 95% CI 0.65-0.90) and functional decline (OR=0.64, 95% CI 0.50-0.83) at 1-year.

CONCLUSION

Declining IC may present before frailty becomes clinically manifest, increasing risk for poor outcomes. Monitoring of IC domains potentially facilitates personalized interventions to avoid progressive frailty.

Health-Related Physical Fitness as a Risk Factor for Falls in Elderly People Living in the Community: A Prospective Study in China

Objectives

Health-related physical-fitness (HRPF) involves multi-components of physical functional tests and is reported to be associated with the risk of fall. The study sought to determine whether specific physical fitness components were stronger predictors of falls among elderly people.

Methods

This prospective cohort study involved 299 community residents age ≥60 years from Shanghai, China. The baseline data included comprehensive assessment of sociodemographic, clinical, and HRPF test. Subjects were followed for 1 year and were contacted by telephone to report falls. LASSO regression and Multivariate regression analysis were used to identify risk predictors of fall. In addition, we used receiver operating characteristic (ROC) curve analyses to determine whether the predictors have diagnostic.

Results

During the 1-year prospective fall assessment, 11.7% of these subjects experienced one or frequent falls. LASSO models revealed that age (=0.01) and 8-ft up-and-go test score (=0.06) were positively associated with falls, while activity-specific balance confidence (ABC; = −0.007) and 2-min step test score (= −0.005) were inversely related. The Area Under roc Curve (AUC) for a linear combination of age, ABC scale score, 2-min step test and 8-ft up-and-go test was 0.778 (95% confidence interval: 0. 700–0.857), which was superior to any of the variables taken alone.

Conclusion

Age, activity-specific balance confidence and fitness abnormalities were determined to contribute to the incident of falls. The value of 2-min step test score, and 8-ft up-and-go test score were the key HRPF components in predicting falls among elderly people.

Muscle Strength Moderates the Relationship between Nutritional Health Risk and Depression in Korean Older Adults

Background: Little is known about the relationships between muscle strength and nutritional health risk with late-in-life depression. This study aimed to investigate the moderating effect of lower-extremity muscle strength on the relationship between nutritional health risk and depression in Korean older adults. Methods: Data obtained from 5949 women and 3971 men aged ≥ 65 years in the 2020 Korea Longitudinal Study on Aging were used in this study. Exposures included lower-extremity muscle strength and nutritional health risk. Lower-extremity muscle strength was measured with a modified sit-to-stand test. The nutritional health risk was assessed using a screening tool. Depression was defined as a score ≥ 8 points on the Geriatric Depression Scale (GDS). Results: Logistic regression analyses showed that depression was positively associated with nutritional health risk (p < 0.001) and inversely associated with lower-extremity muscle strength (p < 0.001). A moderation analysis with Andrew Hayes’ PROCESS macro showed a significant moderating effect of lower-extremity muscle strength (β = −0.119; 95% confidence interval, −0.172 to −0.066; p < 0.001) on the relationship between nutritional health risk and depression; the weaker was the muscle strength, the steeper was the slope of the GDS score for nutritional health risk. Conclusions: The current findings suggest the need for an intervention targeting both high nutritional risk and weak muscle strength as a therapeutic strategy against depression in Korean older adults.

The Added Value of Combined Timed Up and Go Test, Walking Speed, and Grip Strength on Predicting Recurrent Falls in Chinese Community-dwelling Elderly

Purpose

To determine whether combined performance-based models could exert better predictive values toward discriminating community-dwelling elderly with high risk of any-falls or recurrent-falls.

Participants and Methods

This prospective cohort study included a total of 875 elderly participants (mean age: 67.10±5.94 years) with 513 females and 362 males, recruited from Hangu suburb area of Tianjin, China. All participants completed comprehensive assessments.

Methods

We documented information about sociodemographic information, behavioral characteristics and medical conditions. Three functional tests—timed up and go test (TUGT), walking speed (WS), and grip strength (GS) were used to create combined models. New onsets of any-falls and recurrent-falls were ascertained at one-year follow-up appointment.

Results

In total 200 individuals experienced falls over a one-year period, in which 66 individuals belonged to the recurrent-falls group (33%). According to the receiver operating characteristic curve (ROC), the cutoff points of TUGT, WS, and GS toward recurrent-falls were 10.31 s, 0.9467 m/s and 0.3742 kg/kg respectively. We evaluated good performance as “+” while poor performance as “–”. After multivariate adjustment, we found “TUGT >10.31 s” showed a strong correlation with both any-falls (adjusted odds ratio (OR)=2.025; 95% confidence interval (CI)=1.425–2.877) and recurrent-falls (adjusted OR=2.150; 95%CI=1.169–3.954). Among combined functional models, “TUGT >10.31 s, GS <0.3742 kg/kg, WS >0.9467 m/s” showed strongest correlation with both any-falls (adjusted OR=5.499; 95%CI=2.982–10.140) and recurrent-falls (adjusted OR=8.260; 95%CI=3.880–17.585). And this combined functional model significantly increased discriminating abilities on screening recurrent-fallers than a single test (C-statistics=0.815, 95%CI=0.782–0.884, P<0.001), while not better than a single test in predicting any-fallers (P=0.083).

Conclusion

Elderly people with poor TUGT performance, weaker GS but quicker WS need to be given high priority toward fall prevention strategies for higher risks and frequencies. Meanwhile, the combined “TUGT–, GS–, WS+” model presents increased discriminating ability and could be used as a conventional tool to discriminate recurrent-fallers in clinical practice.