Standing Balance and Spatiotemporal Aspects of Gait Are Impaired Upon Nocturnal Awakening in Healthy Late Middle-Aged and Older Adults

Cognitive function influences cognitive-motor interference during dual task walking in multiple sclerosis

BACKGROUND

Both physical and cognitive impairments are common in people with multiple sclerosis (PwMS). Performing a cognitive task while walking (i.e., dual-task walking) can introduce cognitive-motor interference (CMI), resulting in changes in walking performance. The association between the levels of cognitive impairment and of CMI in MS remains unclear.

OBJECTIVES

To examine the association between cognitive functioning and differences in walking performance arise between single- and dual-task walking.

METHODS

Ninety-five PwMS performed self-preferred pace walking and dual-task walking. The gait parameters recorded were used to compute dual task costs (DTC) as a metric of CMI. Cognitive functioning was assessed using Match, an unsupervised test developed based on the Symbol Digit Modalities Test. Participants were categorized as higher (HCF) and lower cognitive functioning (LCF) based on a Match z-score < -1.5.

RESULTS

LCF group had elevated DTC for stride velocity, relative to the HCF group. Higher DTC for stride velocity was associated with lower cognition, as assessed by Match test.

CONCLUSION

The findings support the hypothesis that CMI is associated with cognitive functioning in PwMS.

Determinants of Bladder Care at Night in a Subacute Ward for Aged Patients: An Observational Study

PURPOSE

The purpose of this study was to evaluate how bladder care at night correlates to patients' mobility status.

DESIGN

This was an observational study.

SUBJECTS AND SETTING

The sample comprises 63 aged care subacute patients who were observed over 3 consecutive nights in an inpatient subacute aged care ward located in Melbourne, Australia. Half of the participants were female; their mean age was 82.0 (standard deviation 8.2) years. Data were collected from December 2020 to March 2021.

METHODS

Outcome variables included demographic and pertinent clinical characteristics, type and timing of toileting and/or bladder care provided, and mobility classification. Descriptive statistics were used to summarize the frequency of nocturnal bladder care provided each night and as a mean over the 3 nights. The relationship between the type of care units provided and other variables was explored using a 1-way analysis of variance; values ≤.05 were deemed statistically significant.

RESULTS

Findings indicate that 27% (n = 17), 41% (n = 26), and 48% (n = 30) of participants required assistance to move in bed, sit up in bed, and stand from sitting, respectively. Care episodes for both incontinence and assistance with voiding were significantly associated with functional mobility in bed ( F = 5.52, P < .001; F = 2.14, P = .02) and with ambulation independence ( F = 3.52, P = .001; F = 2.04, P = .03) but not with age or ambulation distance.

CONCLUSIONS

Care provided for urinary incontinence during the night was related to the need for physical support of ambulation and poor mobility in bed. Targeted input from a multidisciplinary team is warranted to facilitate change of practice at night.

Low Light Exposure and Physical Activity in Older Adults With and Without Age-Related Macular Degeneration

Purpose

To investigate the extent of low light exposure and associated physical activity in older adults with and without age-related macular degeneration (AMD).

Methods

Light exposure (lux) and physical activity (counts per minute, CPM) were measured in 28 older adults (14 bilateral AMD and 14 normally sighted controls) using a wrist-worn actigraphy device (Actiwatch) for 7 days and nights. Exposure to low light levels (≤10 lux) and physical activity during waking hours were determined, as well as number of brief active periods during sleeping hours (e.g., going to the bathroom). Assessments included visual acuity and the Low Luminance Questionnaire (LLQ).

Results

No significant differences were found in low light exposure (39 ± 14% vs. 34 ± 10%) or physical activity (200 ± 82 CPM vs. 226 ± 55 CPM) during waking hours between the AMD and control group. However, the AMD group had more brief active periods during sleeping hours than controls (1.8 ± 1.3 vs. 1.1 ± 0.4; P = 0.007). Reduced physical activity under low light levels was significantly associated with lower LLQ scores (P = 0.012).

Conclusions

Exposure to low light levels and associated physical activity were similar in older adults with and without AMD. This has important implications for older adults with AMD, given the impact of low light levels on visual function and mobility, suggesting the need for including lighting advice in rehabilitation programs for this population.

Translational Relevance

Older adults with and without AMD spend over a third of waking hours under low light levels, which are an environmental falls hazard. Findings suggest the need for interventions to improve lighting levels for older adults.

Effect of artificial dawn light on cardiovascular function, alertness, and balance in middle-aged and older adults

STUDY OBJECTIVES

When arising in the morning, many older people experience dizziness and difficulty maintaining proper balance, as the cardiovascular system is not able to compensate to the postural shift (standing) and maintain sufficient blood flow to the brain. Such changes in cardiovascular function are observed in young individuals exposed to a dawn simulation light. In this study, we examined whether exposure to a dawn simulation light could impact cardiovascular function and consequent changes in balance in middle-aged and older adults.

METHODS

Twenty-three participants (67.3 ± 8.8 y), 12 of whom reported a history of dizziness in the morning, underwent two overnight stays in our laboratory. During both nights, they slept in complete darkness, except for the last 30 minutes of one of the nights during which a dawn simulation light was used. Continuous blood pressure (BP) and heart rate (HR) were monitored. Subjective and objective alertness, salivary cortisol, and mobile and standing balance were examined upon arising.

RESULTS

Dawn simulation light decreased (33%) the amount of sleep before morning awakening, lowered BP (6.24 mmHg), and increased HR (0.93 bpm). Despite these changes in physiology, there was no significant impact of dawn simulation on subjective or objective alertness, measures of standing or ambulatory balance, morning cortisol awakening response, or cardiovascular function after awakening.

CONCLUSION

While the dawn simulation did cause an increase in wake and a change in cardiovascular function prior to morning arousal in older adults, we could find no evidence of a functional change in either cardiovascular function or balance upon standing.

CLINICAL TRIAL

Registered on Clinicaltrials.gov, #NCT02632318, https://clinicaltrials.gov/ct2/show/NCT02632318.

Effects of Home- and Center-Based Exercise Programs on the Strength, Function, and Gait of Prefrail Older Women: A Randomized Control Trial

The aims of this study were to compare the effects of a multicomponent exercise program provided at a center (CB) versus done part at home and part at a center (H+CB) on frailty status, strength, physical function, and gait of prefrail older women. Twenty-five women were randomly allocated into the CB (n = 14; 69 ± 6 years) and the H+CB (n = 11; 69 ± 7 years) groups. Both groups completed an exercise program including strengthening, balance, and gait exercises. The program was 12 weeks long, done three times per week, for 60 min per session. Frailty, knee and hip muscle strength, spatiotemporal parameters of the usual and maximum speed dual-task gait, and physical function were assessed at baseline and after program completion. The exercise program reversed the prefrail status of most participants independently of the mode of delivery. Strength increased in both groups, but the CB group had more pronounced improvements in gait and physical function. H+CB exercise programs are good options for prefrail older women.

Toileting-related falls at night in hospitalised patients: The role of nocturia

OBJECTIVE

The purpose of this study was to describe the prevalence and characteristics of toileting-related falls in hospitalised older people.

METHODS

Retrospective analysis of falls related to night-time toileting in patients 60 years or over in a tertiary hospital during a one-year period.

RESULTS

Overall 34% of falls were related to toileting with at least 44% of these falls occurring during the night. Toilet-related falls peaked between 11 pm and 1 am, a period that coincides with maximum supine-induced diuresis. Almost half of night falls occurred at the bedside. In 80% of night toileting-related falls, patients were mobilising without the recommended level of assistance. Half of all patients had no strategies for toileting documented in their care plan.

CONCLUSION

Findings support screening for nocturia in older inpatients and implementation of strategies to reduce both the need for toileting at night and risk factors for falling.