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Raffegeau TE, Brinkerhoff SA, Clark M, McBride AD, Mark Williams A, Fino PC, Fawver B. Walking (and talking) the plank: dual-task performance costs in a virtual balance-threatening environment. Exp Brain Res 2024; 242:1237-1250. [PMID: 38536454 PMCID: PMC11078829 DOI: 10.1007/s00221-024-06807-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/13/2024] [Indexed: 05/12/2024]
Abstract
We evaluated the effects of engaging in extemporaneous speech in healthy young adults while they walked in a virtual environment meant to elicit low or high levels of mobility-related anxiety. We expected that mobility-related anxiety imposed by a simulated balance threat (i.e., virtual elevation) would impair walking behavior and lead to greater dual-task costs. Altogether, 15 adults (age = 25.6 ± 4.7 yrs, 7 women) walked at their self-selected speed within a VR environment that simulated a low (ground) and high elevation (15 m) setting while speaking extemporaneously (dual-task) or not speaking (single-task). Likert-scale ratings of cognitive and somatic anxiety, confidence, and mental effort were evaluated and gait speed, step length, and step width, as well as the variability of each, was calculated for every trial. Silent speech pauses (> 150 ms) were determined from audio recordings to infer the cognitive costs of extemporaneous speech planning at low and high virtual elevation. Results indicated that the presence of a balance threat and the inclusion of a concurrent speech task both perturbed gait kinematics, but the virtual height illusion led to increased anxiety and mental effort and a decrease in confidence. The extemporaneous speech pauses were longer on average when walking, but no effects of virtual elevation were reported. Trends toward interaction effects arose in self-reported responses, with participants reporting more comfort walking at virtual heights if they engaged in extemporaneous speech. Walking at virtual elevation and while talking may have independent and significant effects on gait; both effects were robust and did not support an interaction when combined (i.e., walking and talking at virtual heights). The nature of extemporaneous speech may have distracted participants from the detrimental effects of walking in anxiety-inducing settings.
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Affiliation(s)
- Tiphanie E Raffegeau
- George Mason University, School of Kinesiology, 10890 George Mason Circle, Katherine Johnson Hall 201G, MSN 4E5, Manassas, VA, 20110, USA.
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA.
| | - Sarah A Brinkerhoff
- George Mason University, School of Kinesiology, 10890 George Mason Circle, Katherine Johnson Hall 201G, MSN 4E5, Manassas, VA, 20110, USA
| | - Mindie Clark
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
- Department of Health and Human Performance, Rocky Mountain College, Billings, MT, USA
| | - Ashlee D McBride
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - A Mark Williams
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
- Institute for Human and Machine Cognition, Human Health, Resilience and Performance, Pensacola, FL, USA
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Bradley Fawver
- Walter Reed Army Institute of Research-West, Joint Base Lewis-McChord, Tacoma, WA, USA
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Kaczorowska A, Kaczorowska A, Kowalska J. Associations Between Physical Fitness, Cognitive Function, and Depression in Nursing Homes Residents Between 60-100 Years of Age in South-Western Poland. Med Sci Monit 2024; 30:e942729. [PMID: 38185903 PMCID: PMC10785523 DOI: 10.12659/msm.942729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Healthy aging depends on physical fitness, cognitive function, and emotional well-being. Reduced physical activity in the elderly impacts daily activities, increasing morbidity risk. Cognitive decline affects learning, attention, and independence. Depression, prevalent among the elderly, correlates with loneliness and affects overall health. Physical fitness positively influences cognitive health and mood. This study examines these associations in Polish nursing homes residents. MATERIAL AND METHODS We assessed 93 people aged 60-100 years living in nursing homes. The Short Physical Performance Battery (SPPB) test was used to assess physical fitness. The Abbreviated Mental Test Score (AMTS) was used to assess cognitive functions. The Geriatric Depression Scale (GDS) was used to assess depression. RESULTS In the SPPB test, the mean score was 4.85 points, indicating moderate limitations. On the AMTS, 55% of subjects had cognitive impairment. On the GDS scale, 44% of respondents had depressive symptoms. Seniors without mood disorders were characterized by faster gait compared to those with suspected depressive disorders (P=0.036). Men performed significantly better in the whole SPPB test (P=0.024) and in the standing up from a chair and gait speed tests (P=0.046, P<0.001) compared to women. We found a negative correlation between the AMTS test scores and the SPPB gait test scores and age (P<0.05) and a positive correlation between the SPPB gait test scores and the GDS scores (P<0.05). CONCLUSIONS Older nursing homes' residents in better emotional and cognitive state tended to have faster gait. Men tended to have a higher level of physical fitness compared to women. Older age was associated with worse cognitive state of the examined seniors.
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Affiliation(s)
- Agnieszka Kaczorowska
- Faculty of Physiotherapy, Wrocław University of Health and Sport Sciences, Wrocław, Poland
| | | | - Joanna Kowalska
- Faculty of Physiotherapy, Wrocław University of Health and Sport Sciences, Wrocław, Poland
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Kaczorowska A, Sebastjan A, Kołodziej M, Fortuna M, Ignasiak Z. The level of actual functional fitness of men from different living environments in Poland and associations with health - a cross-sectional study. BMC Geriatr 2023; 23:842. [PMID: 38087228 PMCID: PMC10717969 DOI: 10.1186/s12877-023-04577-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The study aimed to assess the differences in functional fitness between older men living in social welfare homes (SWH) and men living in society. METHODS The study involved 474 men aged 60-84, including 134 men living in social welfare homes and 340 men living in community. The Senior Fitness Test was used to assess functional fitness. Body weight and height were measured. Moreover, data on age, education, taking up physical activity and place of residence were collected. RESULTS A significantly lower level of functional fitness of SWH residents was demonstrated compared to men living in the society (p < 0.001). A significant percentage of seniors living in SWH did not reach the normal range for the Polish population. Also, the level of education, physical activity and health self-assessment differentiated the institutionalized men from those living in the community. CONCLUSIONS The place of residence is a factor that differentiates seniors' functional fitness levels. The reduced fitness of social welfare home residents may also result from the low level of their daily physical activity, education and health. Introducing physical activity programs for elderly residents in social welfare homes seems reasonable. TRIAL REGISTRATION ISRCTN platform as 18,225,729; December 2020.
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Affiliation(s)
- Antonina Kaczorowska
- Institute of Health Sciences, University of Opole, ul. Katowicka 68, Opole, 45-060, Poland.
| | - Anna Sebastjan
- Department of Biostructure, Wrocław University of Health and Sport Sciences, Wrocław, Poland
| | - Małgorzata Kołodziej
- Department of Biomechanics, Wrocław University of Health and Sport Sciences, Wrocław, Poland
| | - Małgorzata Fortuna
- Faculty of Health and Physical Culture Sciences, The Witelon State University of Applied Sciences in Legnica, Legnica, Poland
| | - Zofia Ignasiak
- Department of Biostructure, Wrocław University of Health and Sport Sciences, Wrocław, Poland
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Le Rossignol S, Fraser E, Grant A, Doma K, Wilkinson M, Morse L, McEwen P, Hazratwala K, Connor J. Patients with knee osteoarthritis have altered gait and gaze patterns compared to age-matched controls: A pilot study. PLoS One 2023; 18:e0283451. [PMID: 38011143 PMCID: PMC10681189 DOI: 10.1371/journal.pone.0283451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/07/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Although knee Osteoarthritis (KOA) sufferers are at an increased risk of falls, possibly due to impaired gait function, the associated gaze behaviour in patients with KOA are largely unknown. Thus, we compared gait and gaze behaviours characteristics between KOA patients and asymptomatic age-matched controls. RESULTS For Timed Up and Go (TUG) and stair climb tasks, the KOA group demonstrated longer periods of gaze fixations with less frequency of fixations compared to the control group. Conversely, for the Timed up and Go Agility (TUGA) test shorter fixation and frequency patterns were observed. The KOA group presented a shorter final stride length prior to the initiation of the first step in the Stair climb assessment. In addition, for the 30m walk and dual task assessments, the average step length was significantly shorter in the KOA group compared to controls. CONCLUSION Overall, we found altered gait and gaze behaviours are evident in KOA patients which could relate to their increased falls risk.
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Affiliation(s)
- Scott Le Rossignol
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Ewen Fraser
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Kenji Doma
- School of Exercise Science, James Cook University, Townsville, Queensland, Australia
| | - Matthew Wilkinson
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Levi Morse
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Peter McEwen
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Kaushik Hazratwala
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Jonathan Connor
- School of Exercise Science, James Cook University, Townsville, Queensland, Australia
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Li F, Harmer P, Eckstrom E, Fitzgerald K, Winters-Stone K. Clinical Effectiveness of Cognitively Enhanced Tai Ji Quan Training on Global Cognition and Dual-Task Performance During Walking in Older Adults With Mild Cognitive Impairment or Self-Reported Memory Concerns : A Randomized Controlled Trial. Ann Intern Med 2023; 176:1498-1507. [PMID: 37903365 DOI: 10.7326/m23-1603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) negatively impacts cognition and dual-task abilities. A physical-cognitive integrated treatment approach could mitigate this risk for dementia. OBJECTIVE To compare the effectiveness of cognitively enhanced tai ji quan versus standard tai ji quan or stretching exercise in improving global cognition and reducing dual-task walking costs in older adults with MCI or self-reported memory concerns. DESIGN 3-group, randomized (1:1:1), superiority trial. (ClinicalTrials.gov: NCT04070703). SETTING Community residential homes. PARTICIPANTS 318 older adults with self-reported memory decline or concern and a Clinical Dementia Rating (CDR) global score of 0.5 or lower at baseline. INTERVENTION Cognitively enhanced tai ji quan (n = 105), standard tai ji quan (n = 107), or stretching (n = 106). All groups exercised at home via real-time videoconferencing, 1 hour semiweekly for 24 weeks. MEASUREMENTS The co-primary endpoints were change in Montreal Cognitive Assessment (MoCA; range, 0 to 30) and dual-task walking costs (difference between single- and dual-task gait speed, expressed in percentage) from baseline to 24 weeks. Secondary outcomes included CDR-Sum of Boxes (CDR-SB), Trail Making Test B, Digit Span Backward (DSB), and physical performance tests. Outcomes were assessed at 16, 24 (primary endpoint), and 48 weeks (6 months after intervention). RESULTS A total of 304 participants (96%) completed the 24-week assessment. Cognitively enhanced tai ji quan outperformed standard tai ji quan and stretching with a greater improvement in MoCA score (mean difference, 1.5 points [98.75% CI, 0.7 to 2.2 points] and 2.8 points [CI, 2.1 to 3.6 points], respectively) and in dual-task walking (mean difference, 9.9% [CI, 2.8% to 16.6%] and 22% [CI, 13% to 31%], respectively). The intervention effects persisted at 48-week follow-up. LIMITATION There was no nonexercise control group; participants had subjective or mild cognitive impairment. CONCLUSION Among community-dwelling older adults with MCI, cognitively enriched tai ji quan therapy was superior to standard tai ji quan and stretching exercise in improving global cognition and reducing dual-task gait interference, with outcomes sustained at 48 weeks. PRIMARY FUNDING SOURCE National Institute on Aging.
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Affiliation(s)
- Fuzhong Li
- Oregon Research Institute, Springfield, Oregon (F.L., P.H.)
| | - Peter Harmer
- Oregon Research Institute, Springfield, Oregon (F.L., P.H.)
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, Oregon (E.E.)
| | | | - Kerri Winters-Stone
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon (K.W.)
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Cui Y, Liu B, Zhou J, Liu Q, Ye H. Quantitative analysis of balance function characteristics in older patients with mild to moderate cognitive impairment. Exp Gerontol 2023; 182:112302. [PMID: 37776986 DOI: 10.1016/j.exger.2023.112302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Cognitive decline in older adults may affect balance function, but the relationship between the two is not fully understood, especially in the early stages of cognitive impairment. Mild to moderate cognitive impairment can be assessed with the Montreal Cognitive Assessment (MOCA). AIM This study quantitatively analyzed balance function in older adults with mild to moderate cognitive impairment using computerized dynamic posturography (CDP) testing. METHODS 248 older patients were divided into a cognitive impaired group (MOCA <26, n = 126) and a normal group (MOCA ≥26, n = 122) based on the Montreal Cognitive Assessment (MOCA) Beijing Version. Patients underwent CDP testing, which included the sensory organization test (SOT) and the limits of stability test (LOS). RESULTS The cognitive impaired group had significantly lower SOT composite and visual scores, as well as reaction time (RT), movement velocity (MVL), endpoint excursion (EPE), maximum excursion (MXE), and directional control (DCL) of the LOS test. Binary logistic regression analysis revealed that RT and MXE were independent factors significantly associated with MOCA, even after adjustment for age and sex. CONCLUSIONS Older patients with mild to moderate cognitive impairment may have reduced sensory integration and balance stability limits, mainly manifested as prolonged motor reaction time and shortened maximum movement distance.
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Affiliation(s)
- Yao Cui
- Department of Geriatrics, Beijing Tongren Hospital, China Capital Medical University, Beijing 100730, China
| | - Bo Liu
- Department of Geriatrics, Beijing Tongren Hospital, China Capital Medical University, Beijing 100730, China; Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, China Capital Medical University, Beijing 100730, China; Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing 100730, China.
| | - Jian Zhou
- Department of Geriatrics, Beijing Tongren Hospital, China Capital Medical University, Beijing 100730, China
| | - Qian Liu
- Department of Geriatrics, Beijing Tongren Hospital, China Capital Medical University, Beijing 100730, China
| | - Hui Ye
- Department of Geriatrics, Beijing Tongren Hospital, China Capital Medical University, Beijing 100730, China
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Abit Kocaman A, Aydoğan Arslan S. Comparison of gait speed, dynamic balance, and dual-task balance performance according to kinesiophobia level in older adults. Somatosens Mot Res 2023; 40:83-89. [PMID: 36632782 DOI: 10.1080/08990220.2023.2165056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE The presence of kinesiophobia was identified in older adults. Studies have examined the effects of kinesiophobia in older adults with chronic pain. Studies examining the effect of kinesiophobia on gait and balance performance in older adults without pain are insufficient. The aim of this study was to compare gait speed, dynamic balance, dual-task balance performance according to kinesiophobia level in community dwelling older adults without pain. MATERIALS AND METHODS Seventy-five older adults were included. The socio-demographic data (age, height, weight, fall history, etc.) was recorded. Older adults were divided into two groups based on Tampa Kinesiophobia Scale scores. Scores below 37 were grouped as low level, scores above 37 were grouped as high level. The mini-mental state examination (MMSE), gait speed test, modified Four Square Step Test (mFSST), Five Times Sit-to-Stand Test, dual-mFSSt test (additional cognitive and motor task) were applied for dual-task balance performance. RESULTS Thirty-six participants(mean age 70.58 ± 5.59 years) had low kinesiophobia, the other 39 individuals(mean age70.94 ± 7.45 years) had high kinesiophobia. The age, gender, body mass index, cognitive status, and fall history were similar between groups (p > 0.05). The participants with low kinesiophobia were found to have better gait speed, dynamic balance, dual-task balance performance (p < 0.001). CONCLUSION This study results showed that the presence of high level of kinesiophobia affects gait speed, dynamic balance, dual-task balance performance, and dual-task cost in older adults. Therefore, a high level of kinesiophobia can lead to falls. It may be important to investigate the effects of kinesiophobia in older adults.
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Affiliation(s)
- Ayşe Abit Kocaman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kırıkkale University, Kırıkkale, Turkey
| | - Saniye Aydoğan Arslan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kırıkkale University, Kırıkkale, Turkey
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Leah V, Ngwu L. Identifying the relationship between delirium and falls. Nurs Older People 2023; 35:22-27. [PMID: 36810921 DOI: 10.7748/nop.2023.e1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 02/24/2023]
Abstract
Delirium, which may present as acute fluctuation in arousal and attention and changes in a person's behaviours, can increase the risk of falls, while a fall can increase the risk of developing delirium. There is, therefore, a fundamental relationship between delirium and falls. This article describes the main types of delirium and the challenges associated with recognition of the condition and discusses the relationship between delirium and falls. The article also describes some of the validated tools used to screen patients for delirium and includes two brief case studies to illustrate this in practice.
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Affiliation(s)
- Vicki Leah
- University of East London, London, England
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Leroy V, Martinet V, Nunkessore O, Dentel C, Durand H, Mockler D, Puisieux F, Fougère B, Chen Y. The Nebulous Association between Cognitive Impairment and Falls in Older Adults: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2628. [PMID: 36767992 PMCID: PMC9915123 DOI: 10.3390/ijerph20032628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND In older people, dementia is a well-established risk factor for falls. However, the association and the causal relationship between falls and the earlier stages of cognitive impairment remains unclear. The purpose of the study was to review the literature data on the association between falls and cognitive impairment, no dementia, including Mild Cognitive Impairment. METHODS According to PRISMA guidelines, we searched five electronic databases (EMBASE, Web of Science, Medline, CINAHL, and PsychINFO) for articles published between January 2011 and August 2022 on observational studies of older people with a cognitive assessment and/or cognitive impairment diagnosis and a recording of falls. Their quality was reviewed according to the STROBE checklist. RESULTS We selected 42 of the 4934 initially retrieved publications. In 24 retrospective studies, a statistically significant association between falls and cognitive status was found in only 15 of the 32 comparisons (47%). Of the 27 cross-sectional analyses in prospective studies, only eight (30%) were positive and significant. We counted four longitudinal analyses, half of which suggested a causal relationship between falls and cognitive impairment. The investigational methods varied markedly from one study to another. CONCLUSION It is still not clear whether falls are associated with cognitive impairment, no dementia. Data in favor of a causal relationship are scarce. Further studies are needed to clarify their relationship.
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Affiliation(s)
- Victoire Leroy
- Division of Geriatric Medicine, Tours University Hospital, 37000 Tours, France
- EA 7505 (Education, Ethics, Health), University of Medicine of Tours, 37000 Tours, France
- Memory Clinic, Tours University Hospital, 37000 Tours, France
| | - Valérie Martinet
- Department of Geriatrics, Saint-Pierre Hospital, ULB, 1000 Brussels, Belgium
| | | | | | - Hélène Durand
- Department of Neurology, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - David Mockler
- Medical Library, Trinity Centre for the Health Sciences, St James’ Hospital, D08 W9RT Dublin, Ireland
| | - François Puisieux
- Department of Gerontology, Lille University Hospital, 59000 Lille, France
- EA2694, Lille University, 59000 Lille, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, 37000 Tours, France
- EA 7505 (Education, Ethics, Health), University of Medicine of Tours, 37000 Tours, France
| | - Yaohua Chen
- Department of Gerontology, Lille University Hospital, 59000 Lille, France
- INSERM UMR-S 1172, Vascular and Degenerative Cognitive Disorders, University of Lille, 59000 Lille, France
- Global Brain Health Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
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Six-month change in gait speed to discriminate between those with and without falls history in older people with Mild Cognitive Impairment and mild Alzheimer disease. Geriatr Nurs 2022; 48:274-279. [PMID: 36335854 DOI: 10.1016/j.gerinurse.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE The purposes of this study were to identify differences in gait speed performance over 6 months between older people with Preserved Cognition (PrC), with Mild Cognitive Impairment (MCI) and with Alzheimer disease (AD) in mild stage; and to verify if the change in gait speed could discriminate fallers in older people with MCI and AD in a mild stage METHODS: A longitudinal study was conducted with community-dwelling older adults, including 40 with PrC, 36 with MCI and 34 with AD in the mild stage. Gait speed (in m/s) changes were captured through a 10-meter walk test. We documented the number of self-reported falls by monthly calendars that were returned after a 6-month follow-up. During this period, the participants received monthly telephone calls to remind them to fill in the calendar RESULTS: There was a significant difference in terms of sex and age between the groups: 23%, 31% and 19% were female and had a mean age of 72.8, 75.9 and 76.9 years in the PrC, MCI and AD groups respectively. During the follow-up, 45%, 52.7% and 52.9% of the PrC, MCI and AD groups fell. The MCI and AD groups presented lower gait speed compared to the PrC Group at both moments. There was no significant difference in the change of gait speed between groups. In the model adjusted by age, the change in gait speed failed to discriminate fallers in older people with MCI and with AD CONCLUSION: Older people with MCI and AD in the mild stage present lower gait speed compared to older people with PrC. Changes in gait speed over a short period of time do not discriminate fallers in older people with MCI or AD in a mild stage.
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Alzaabi HS, Walton LM, Arumugam A. Association between demographic characteristics, lower limb range of motion, functional performance, ability to dual task, quality of life and risk of falls in older adults of the United Arab Emirates - A cross-sectional study. Heliyon 2022; 8:e08869. [PMID: 35141442 PMCID: PMC8814690 DOI: 10.1016/j.heliyon.2022.e08869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/09/2022] [Accepted: 01/27/2022] [Indexed: 11/01/2022] Open
Abstract
Background Methods Results Conclusions
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12
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Sleep efficiency affecting the occurrence of falls among the frail older adults. Geriatr Nurs 2021; 42:1461-1466. [PMID: 34656862 DOI: 10.1016/j.gerinurse.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this study is to clarify whether reduced sleep efficiency affects the occurrence of falls among the frail older adults. This was a prospective cohort study. The subjects were frail older adult individuals living within a community, attending an older adult care center. Variables assessed include sleep efficiency, walking ability, history of cerebrovascular disease, depressive symptoms, cognitive impairment, chronic pain, frequency of sleeping medication use, and frequency of nocturnal urination. A fall calendar was used to record daily falls over a 6-month period beginning after administering a baseline survey. The Mann-Whitney U test was used to analyze the association between sleep efficiency and the occurrence of falls. Logistic regression analysis showed a significant association between falls and sleep efficiency. In conclusion, after adjusting for multiple confounders, reduced sleep efficiency did affect the occurrence of falls. Accordingly, approaches for improving sleep efficiency could offer new strategies toward fall prevention.
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Wang SC, Lee DC, Lee YH, Chang YP, Chu IL. Effects of multimedia-based fall prevention education on the knowledge, attitudes, or behaviors of patients. Jpn J Nurs Sci 2021; 19:e12455. [PMID: 34558193 DOI: 10.1111/jjns.12455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/30/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Patient safety is regarded as a critical quality monitoring indicator for medical institutions. The effects of a multimedia-based patient education intervention on knowledge, attitudes, and behaviors regarding fall prevention were observed. METHODS The study had a quasi-experimental research design and enrolled 140 participants. Seventy participants in the experimental group received multimedia-based patient education and a health education leaflet, while those in the control group received only the health education leaflet. A structured questionnaire was used for data collection at baseline, and a posttest was applied after the intervention. RESULTS The participants were predominantly treated in the gastroenterology department (45.7%), followed by the pulmonology department (33.6%). A total of 86.4% of patients had not experienced a fall within 3 months. After the intervention, the average scores for all variables in the experimental group were higher than those in the control group. The results indicate that attitudes, knowledge, and behaviors regarding fall prevention among patients in the pulmonology department were higher than those among patients in the gastroenterology department; the differences were statistically significant. CONCLUSION The individualized health education content was of substantial significance for patients with different disease backgrounds and facilitated changes in their knowledge, attitudes, and behaviors regarding falls. RELEVANCE TO CLINICAL PRACTICE Multimedia-based patient education influenced inpatients' knowledge, attitudes, and behaviors for preventing falls.
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Affiliation(s)
- Su-Ching Wang
- Department of Nursing, St. Martin De Porres Hospital, Chiayi City, Taiwan
| | - De-Chih Lee
- Department of Information Management, Da-Yeh University, Changhua, Taiwan
| | - Yi-Hua Lee
- National Health Research Institutes, Zhunan, Taiwan
| | - Yuan-Ping Chang
- Department of Nursing, Fooyin University, Kaohsiung City, Taiwan
| | - I-Lien Chu
- Health Evaluation Center, St. Martin De Porres Hospital, Chiayi City, Taiwan
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de Barros GM, Melo F, Domingos J, Oliveira R, Silva L, Fernandes JB, Godinho C. The Effects of Different Types of Dual Tasking on Balance in Healthy Older Adults. J Pers Med 2021; 11:jpm11090933. [PMID: 34575710 PMCID: PMC8466690 DOI: 10.3390/jpm11090933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 01/14/2023] Open
Abstract
Numerous of our daily activities are performed within multitask or dual task conditions. These conditions involve the interaction of perceptual and motor processes involved in postural control. Age-related changes may negatively impact cognition and balance control. Studies identifying changes related to dual-task actions in older people are need. This study aimed to determine the effects of different types of dual-tasking on the balance control of healthy older adults. The sample included 36 community-living older adults, performing two tests—a sway test and a timed up-and-go test—in three conditions: (a) single motor task; (b) dual motor task; and (c) dual motor task with cognitive demands. Cognitive processes (dual-task and cognition) affected static balance, increasing amplitude (p < 0.001) and frequency (p < 0.001) of the center of mass displacements. Dynamic balance revealed significant differences between the single motor condition and the other two conditions during gait phases (p < 0.001). The effect of dual-tasking in older adults suggests that cognitive processes are a main cause of increased variability in balance and gait when under an automatic control. During sit-to-stand, turning, and turn-to-sit movements under dual-tasking, the perceptive information becomes the most important focus of attention, while any cognitive task becomes secondary.
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Affiliation(s)
- Graça Monteiro de Barros
- Fisio-Lógica Centro de Fisioterapia, Lda, 1350-275 Lisboa, Portugal;
- Escola Superior de Saúde Atlântica, 2730-036 Barcarena, Portugal
| | - Filipe Melo
- Laboratório de Comportamento Motor, Faculdade de Motricidade Humana, Universidade de Lisboa, 1495-688 Cruz Quebrada, Portugal;
| | - Josefa Domingos
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal; (J.D.); (J.B.F.)
| | - Raul Oliveira
- Neuromuscular Research Lab, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1495-688 Cruz Quebrada, Portugal;
| | - Luís Silva
- Physics Department, LIBPhys-UNL, Nova School of Science and Technology, Universidade Nova de Lisboa, Caparica, 2829-516 Almada, Portugal;
| | - Júlio Belo Fernandes
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal; (J.D.); (J.B.F.)
| | - Catarina Godinho
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal; (J.D.); (J.B.F.)
- Correspondence: ; Tel.: +351-910077492
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Li F, Harmer P, Eckstrom E, Ainsworth BE, Fitzgerald K, Voit J, Chou LS, Welker FL, Needham S. Efficacy of exercise-based interventions in preventing falls among community-dwelling older persons with cognitive impairment: is there enough evidence? An updated systematic review and meta-analysis. Age Ageing 2021; 50:1557-1568. [PMID: 34120175 PMCID: PMC8437077 DOI: 10.1093/ageing/afab110] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Indexed: 12/11/2022] Open
Abstract
Objective Exercise prevents falls in the general older population, but evidence is inconclusive for older adults living with cognitive impairment. We performed an updated systematic review and meta-analysis to assess the potential effectiveness of interventions for reducing falls in older persons with cognitive impairment. Methods PubMed, EMBASE, CINAHL, Scopus, CENTRAL and PEDro were searched from inception to 10 November 2020. We included randomised controlled trials (RCTs) that evaluated the effects of physical training compared to a control condition (usual care, waitlist, education, placebo control) on reducing falls among community-dwelling older adults with cognitive impairment (i.e. any stage of Alzheimer’s disease and related dementias, mild cognitive impairment). Results We identified and meta-analysed nine studies, published between 2013 and 2020, that included 12 comparisons (N = 1,411; mean age = 78 years; 56% women). Overall, in comparison to control, interventions produced a statistically significant reduction of approximately 30% in the rate of falls (incidence rate ratio = 0.70; 95% CI, 0.52-0.95). There was significant between-trial heterogeneity (I2 = 74%), with most trials (n = 6 studies [eight comparisons]) showing no reductions on fall rates. Subgroup analyses showed no differences in the fall rates by trial-level characteristics. Exercise-based interventions had no impact on reducing the number of fallers (relative risk = 1.01; 95% CI, 0.90–1.14). Concerns about risk of bias in these RCTs were noted, and the quality of evidence was rated as low. Conclusions The positive statistical findings on reducing fall rate in this meta-analysis were driven by a few studies. Therefore, current evidence is insufficient to inform evidence-based recommendations or treatment decisions for clinical practice. PROSPERO Registration number: CRD42020202094.
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Affiliation(s)
- Fuzhong Li
- Oregon Research Institute, Eugene, OR 97403, USA
- Shanghai University of Sport, Shanghai, China
| | - Peter Harmer
- Willamette University, Department of Exercise and Health Science, Salem, OR 97301, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | | | | | - Jan Voit
- Voit Better Balance, Seattle, WA 98104, USA
| | - Li-Shan Chou
- Iowa State University, Department of Kinesiology, Ames, IA 50011, USA
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The Significance of Posterior Occlusal Support of Teeth and Removable Prostheses in Oral Functions and Standing Motion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136776. [PMID: 34202488 PMCID: PMC8297000 DOI: 10.3390/ijerph18136776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to evaluate the effect of posterior occlusal support of natural teeth and artificial teeth on oral functions and standing motion. Patients who had been treated with removable prostheses were enrolled as the subjects. Their systemic conditions (body mass index (BMI) and skeletal muscle mass index (SMI)) were recorded. The subjects were classified into two groups according to a modified Eichner index: B1-3 (with posterior occlusal support) and B4C (without posterior occlusal support). Maximum occlusal force (MOF), masticatory performance (MP), and standing motion (sway and strength) were evaluated for cases with and without removable prostheses. There were no significant differences in BMI and SMI between the B1-3 group and the B4C group. The subjects with removable prostheses demonstrated significantly higher values in MOF, MP, and sway and strength than the subjects without removable prostheses. The comparison of oral functions between the B1-3 group and the B4C group revealed that the positive effect of posterior occlusal support of natural teeth and removable prostheses and the significant positive effects of posterior occlusal support on standing motion were partly observed in these comparisons. Posterior occlusal support of natural teeth and even of removable prostheses may contribute to the enhancement of oral functions and standing motion.
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Li F, Harmer P, Voit J, Chou LS. Implementing an Online Virtual Falls Prevention Intervention During a Public Health Pandemic for Older Adults with Mild Cognitive Impairment: A Feasibility Trial. Clin Interv Aging 2021; 16:973-983. [PMID: 34079243 PMCID: PMC8164667 DOI: 10.2147/cia.s306431] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/24/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study evaluates the feasibility of delivering a virtual (online) falls prevention intervention for older adults with mild cognitive impairment (MCI). METHODS Community-dwelling older adults with MCI (mean age = 76.2 years, 72% women) were randomized to either a Tai Ji Quan (n = 15) or stretching group (n = 15) and participated in 60-minute virtual exercise sessions, via Zoom, twice weekly for 24 weeks. The primary outcome was the incidence of falls. Secondary outcomes were the number of fallers and changes from baseline in the 4-Stage Balance Test, 30-second chair stands, and Timed Up and Go Test under both single- and dual-task conditions. RESULTS The intervention was implemented with good fidelity, an overall attendance rate of 79%, and 13% attrition. Compared with stretching, Tai Ji Quan did not reduce falls (incidence rate ratio = 0.58; 95% confidence interval [CI], 0.32 to 1.03) or the number of fallers (relative risk ratio = 0.75; 95% CI, 0.46 to 1.22) at week 24. The Tai Ji Quan group, however, performed consistently better than the stretching group in balance (between-group difference in change from baseline, 0.68 points; 95% CI, 0.12 to 1.24), 30-second chair stands (1.87 stands; 95% CI, 1.15 to 2.58), and Timed Up and Go under single-task (-1.15 seconds; 95% CI, -1.85 to -0.44) and dual-task (-2.35; 95% CI, -3.06 to -1.64) conditions. No serious intervention-related adverse events were observed. CONCLUSION Findings from this study suggest the feasibility, with respect to intervention fidelity, compliance, and potential efficacy, of implementing an at-home, virtual, interactive Tai Ji Quan program, delivered in real-time, as a potential balance training and falls prevention intervention for older adults with MCI. The study provides preliminary data to inform future trials.
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Affiliation(s)
- Fuzhong Li
- Oregon Research Institute, Eugene, OR, USA
| | - Peter Harmer
- Willamette University, Department of Exercise and Health Science, Salem, OR, USA
| | - Jan Voit
- Voit Better Balance, Seattle, WA, USA
| | - Li-Shan Chou
- Iowa State University, Department of Kinesiology, Ames, IA, USA
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Sheshadri A, Kittiskulnam P, Delgado C, Sudore RL, Lai JC, Johansen KL. Association of Cognitive Function Screening Results with Adherence and Performance in a Pedometer-Based Intervention. Am J Nephrol 2021; 52:420-428. [PMID: 33979802 DOI: 10.1159/000516130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/18/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION A randomized, controlled trial of a pedometer-based walking intervention with weekly activity goals led to increased walking among dialysis patients. We examined whether impairment per cognitive function screening is associated with adherence and performance in the intervention. METHODS Thirty dialysis patients were randomly assigned to a 3-month pedometer-based intervention with weekly goals. Participants were administered the Telephone Interview of Cognitive Status (TICS), a test of global mental status. We examined the association of levels of impairment on the TICS (≥33: unimpaired, 26-32: ambiguous impairment, 21-25: mild cognitive impairment [MCI]) with adherence, achieving weekly goals, and increasing steps, physical performance (Short Physical Performance Battery, SPPB), and self-reported physical function (PF) through multivariable linear mixed-model and logistic regression analyses adjusted for age, sex, BMI, dialysis modality, baseline steps, baseline SPPB, and stroke status. RESULTS One-third of participants were unimpaired, and 13% had MCI. Participants with worse results on cognitive function screening missed more calls and completed fewer weekly goals than participants with better results. During the intervention, a worse result on cognitive function screening was associated with smaller increases in steps compared to those without impairment: (ambiguous: -620 [95% CI -174, -1,415], MCI: -1,653 [95% CI -120, -3,187]); less improvement in SPPB (ambiguous: -0.22 points [95% CI -0.08, -0.44], MCI: -0.45 [95% CI -0.13, -0.77]); and less improvement in PF (ambiguous: -4.0 points [95% CI -12.2, 4.1], MCI: -14.0 [95% CI -24.9, -3.1]). During the postintervention period, a worse result on cognitive function screening was associated with smaller increases in SPPB (ambiguous: -0.54 [95% CI -1.27, 0.19], MCI: -0.97 [95% CI -0.37, -1.58]) and PF (ambiguous: -3.3 [95% CI -6.5, -0.04], MCI: -10.5 [95% CI -18.7, -2.3]). DISCUSSION/CONCLUSION Participants with worse results on cognitive function screening had worse adherence and derived less benefit from this pedometer-based intervention. Future exercise interventions should be developed incorporating methods to address cognitive impairment, for example, by including caregivers when planning such interventions.
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Affiliation(s)
- Anoop Sheshadri
- Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
| | - Piyawan Kittiskulnam
- Division of Internal Medicine-Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
- Special Task Force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand
| | - Cynthia Delgado
- Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, California, USA
| | - Jennifer C Lai
- Division of Gastroenterology/Hepatology, Department of Medicine, University of California, San Francisco, California, USA
| | - Kirsten L Johansen
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA
- Division of Nephrology, University of Minnesota, Minneapolis, Minnesota, USA
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Wang S, Yin H, Meng Q, Yan M, Wang L, Chen L. Experiences of nursing home-dwelling older adults with mild cognitive impairment participating in a Chinese square dancing program: A qualitative study. Geriatr Nurs 2021; 42:405-411. [PMID: 33639544 DOI: 10.1016/j.gerinurse.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
To explore the experiences of older adults with mild cognitive impairment participating in a Chinese square dancing program, we conducted a qualitative study through individual semistructured interviews between September 2019 and November 2019 in the nursing home where the program was implemented. Purposive sampling was used to select participants from those completing the dancing program. The sample size was determined by data saturation. Thirteen participants were included. The data were analyzed using content analysis. Three main categories, including benefits associated with exercise, facilitators of adherence, and barriers to adherence, emerged. In conclusion, participants reported multiple positive experiences; thus, square dancing may be an acceptable and desirable intervention for older adults with mild cognitive impairment. In future promotion processes, attention should be paid to the progressive nature of the activity, the use of professionally trained instructors, participants' awareness of the benefits gained, and the forgetfulness of participants.
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Affiliation(s)
- Shuo Wang
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Huiru Yin
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Qiuyan Meng
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Mingli Yan
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Lisheng Wang
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Li Chen
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China.
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