Cognition, Gait Disorders, and Fall Risk in Healthy Neurological Older Individuals

Abstract Background: Normal aging is associated with balance, mobility and working memory decline that increase fall risk and influence activity of daily living functions. Mounting evidence suggests that physical activity is beneficial for decreasing aging effects. Previous studies have focused on land-based physical activity. Research concerning the aquatic environment is scarce. The primary objectives of this three arm intervention pilot study were to examine the effects of an aquatic physical intervention program on balance, gait, fall risk and working memory among community-dwelling older individuals. The secondary objective was to examine the effects of an aquatic physical intervention program on safety of street–crossing among community-dwelling older individuals. Methods: Forty-two healthy participants aged 65 or older were enrolled into one of three intervention groups: aquatic physical intervention (API) (N=13), on-land physical intervention (OLPI) (N=14) or non-physical intervention (NPI) (N=15). The intervention took place from 2018 until 2019 at Tel-Aviv University, Sheba medical center and Reich Center. The protocol included 30-minute sessions twice a week for 12 weeks. Balance, gait and fall risk were assessed by the Tinneti test, working memory abilities were assessed by digit span and Corsi blocks tests and simulated safe streets-crossing was assessed by the hazard perception test for pedestrians.Testing and data collection was conducted at baseline, after six weeks and 12 weeks of intervention. All members of the professional team involved in evaluating participants were blind to the intervention group to which participants were allocated. Results: The differences in Tinetti balance (F(2,39)=10.03, p<0.01), fall risk (F(2,39)=5.62, p0>.05), digit span forward (F(2,39)=8.85, p<0.01) and Corsi blocks forward (F(2,39)=3.54, p<0.05) and backward (F(2,39)=6.50, p<0.05) scores after 12 weeks between the groups were significant. The API group showed improved scores. The differences in hazard perception test for pedestrians scores after 12 weeks of intervention between the groups were marginally significant (F(2,39)=3.13, p=0.055). The API group showed improved scores. Conclusions: These findings may affect experts working with the elderly population when making decisions concerning therapeutic prevention interventions for the deficiencies of elderly patients. Older adults practicing aquatic physical activity could contribute to their increased safety. Trial registrationTrial registration number: ClinicalTrials.gov Registry NCT03510377. Date of registration: 10/31/2017

Download Full-text

Beta-blocker use and fall risk in older individuals: Original results from two studies with meta-analysis

British Journal of Clinical Pharmacology ◽

10.1111/bcp.13328 ◽

2017 ◽

Vol 83 (10) ◽

pp. 2292-2302 ◽

Cited By ~ 7

Author(s):

Annelies C. Ham ◽

Suzanne C. van Dijk ◽

Karin M. A. Swart ◽

Anke W. Enneman ◽

Nikita L. van der Zwaluw ◽

...

Keyword(s):

Beta Blocker ◽

Fall Risk ◽

Meta Analysis ◽

Older Individuals

Download Full-text

Prevention of falls in old people – a review

Reviews in Clinical Gerontology ◽

10.1017/s0959259813000051 ◽

2013 ◽

Vol 23 (3) ◽

pp. 206-222 ◽

Cited By ~ 2

Author(s):

Magnus K. Karlsson ◽

Caroline Karlsson ◽

Maria Cöster ◽

Håkan Magnusson ◽

Björn E. Rosengen

Keyword(s):

Vitamin D ◽

Older People ◽

Fall Risk ◽

Risk Groups ◽

Vitamin D Supplementation ◽

Community Dwelling ◽

Older Individuals ◽

Surgical Interventions ◽

Healthy Community ◽

Training Modalities

SummaryPhysical training, if including specific different training modalities, reduces the fall risk in healthy community-dwelling older people, as does a home hazards modification programme. Vitamin D supplementation in older individuals with low levels of vitamin D, adjustment of psychotropic medication, and structured modification of multi-pharmacy are all drug-focused programmes that reduce the number of falls. Anti-slip shoe devices during icy conditions for older people who walk outdoors and multifaceted podiatry in patients with specific foot disability reduce the fall risk. First eye cataract surgery and pacemakers in patients with cardio-inhibitory carotid sinus hypersensitivity are surgical interventions that reduce the fall risk. Multi-factorial preventive programmes that include training, both individually designed and generally prescribed, also reduce the fall frequency. With this in mind, we ought to initiate fall preventive programmes in older people, especially in high- risk groups, to reduce the number of falls and fallers in society.

Download Full-text

Fall prediction in neurological gait disorders: differential contributions from clinical assessment, gait analysis, and daily-life mobility monitoring

Journal of Neurology ◽

10.1007/s00415-021-10504-x ◽

2021 ◽

Author(s):

Roman Schniepp ◽

Anna Huppert ◽

Julian Decker ◽

Fabian Schenkel ◽

Cornelia Schlick ◽

...

Keyword(s):

Clinical Assessment ◽

Fall Risk ◽

Inertial Sensor ◽

Early Stage ◽

Neurological Diseases ◽

Risk Estimation ◽

Multivariate Regression Analysis ◽

Gait Disorders ◽

Patients At Risk ◽

Neurological Gait Disorders

Abstract Objective To evaluate the predictive validity of multimodal clinical assessment outcomes and quantitative measures of in- and off-laboratory mobility for fall-risk estimation in patients with different forms of neurological gait disorders. Methods The occurrence, severity, and consequences of falls were prospectively assessed for 6 months in 333 patients with early stage gait disorders due to vestibular, cerebellar, hypokinetic, vascular, functional, or other neurological diseases and 63 healthy controls. At inclusion, participants completed a comprehensive multimodal clinical and functional fall-risk assessment, an in-laboratory gait examination, and an inertial-sensor-based daily mobility monitoring for 14 days. Multivariate logistic regression analyses were performed to identify explanatory characteristics for predicting the (1) the fall status (non-faller vs. faller), (2) the fall frequency (occasional vs. frequent falls), and (3) the fall severity (benign vs. injurious fall) of patients. Results 40% of patients experienced one or frequent falls and 21% severe fall-related injuries during prospective fall assessment. Fall status and frequency could be reliably predicted (accuracy of 78 and 91%, respectively) primarily based on patients' retrospective fall status. Instrumented-based gait and mobility measures further improved prediction and provided independent, unique information for predicting the severity of fall-related consequences. Interpretation Falls- and fall-related injuries are a relevant health problem already in early stage neurological gait disorders. Multivariate regression analysis encourages a stepwise approach for fall assessment in these patients: fall history taking readily informs the clinician about patients' general fall risk. In patients at risk of falling, instrument-based measures of gait and mobility provide critical information on the likelihood of severe fall-related injuries.

Download Full-text

Prediction of Fall Risk Among Community-Dwelling Older Adults Using a Wearable System

10.21203/rs.3.rs-142249/v1 ◽

2021 ◽

Author(s):

Thurmon Lockhart ◽

Rahul Soangra ◽

Hyunsoo Yoon ◽

Teresa Wu ◽

Christopher Frames ◽

...

Keyword(s):

Older Adults ◽

Fall Risk ◽

Risk Identification ◽

Community Dwelling ◽

Detection Methods ◽

Measurement Unit ◽

Older Individuals ◽

Wearable System ◽

Gait Parameters ◽

Community Dwelling Older Adults

Abstract Falls are among the most common cause of decreased mobility and independence in older adults and rank as one of the most severe public health problems with frequent fatal consequences. In the present study, gait characteristics from 171 community-dwelling older adults were evaluated to determine their predictive ability for future falls using a wearable system. Participants wore a wearable sensor (inertial measurement unit (IMU)) affixed to the sternum and performed a 10-meter walking test. Measures of gait variability, complexity, and smoothness were extracted from each participant, and prospective fall incidence was evaluated over the following 6-months. Gait parameters were refined to better represent features for a random forest classifier for the fall-risk classification utilizing three experiments. The results show that the best-trained model for faller classification used both linear and nonlinear gait parameters and achieved an overall 82.4% accuracy, 86.8% sensitivity, 81.2% specificity in the blind test. These findings augment the wearable sensor's potential as an ambulatory fall risk identification tool in community-dwelling settings. Furthermore, they highlight the importance of gait features that rely less on event detection methods, and more on time series analysis techniques. Fall prevention is a critical component in older individuals’ healthcare, and simple models based on gait-related tasks and a wearable IMU sensor can determine the risk of future falls.

Download Full-text

40 The Association between Apathy, Decline in Physcal Performance, and Falls

Age and Ageing ◽

10.1093/ageing/afz164.40 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv9-iv12

Author(s):

Marieke Henstra ◽

Didi Rhebergen ◽

Lisette De Groot ◽

Natasja Van Schoor ◽

Nathalie Van der Velde

Keyword(s):

Physical Performance ◽

Fall Risk ◽

Older Persons ◽

Osteoporotic Fractures ◽

Community Dwelling ◽

Older Individuals ◽

Negative Effects ◽

Age And Gender ◽

And Gender ◽

The Impact

Abstract Background Symptoms of apathy are common in older persons. Negative effects on physical performance and fall risk are plausible, considering the pathophysiology of apathy. However, literature is scarce. Aim To longitudinally assess the association between apathy and 1) decline of physical performance and 2) the number of falls in older community-dwelling persons. Methods The ‘B-vitamins for the PRevention Of Osteoporotic Fractures’ study (B-PROOF) provided data on 2919 older persons over a period of two years. Apathy was assessed using the Geriatric Depression Scale3. A physical performance score (PPS) was calculated using three performance tests. Falls were registered prospectively. We calculated adjusted odds ratios (ORs), Incidence Rate Ratios (IRRs) their 95% confidence intervals (CI). Effect-modification by age and gender was investigated. We also investigated mediation by baseline PPS for the association between apathy and the number of falls. Results Apathy and decline of PPS were independently associated. After stratification, the effect only remained in men. Age was an effect modifier; higher ORs for decreasing age. Apathy was also independently associated with the number of falls. After stratification, women had higher IRRs than men. Age modified the association in the opposite direction: higher IRRs for increasing age. Baseline PPS was a mediator in the association. Conclusion The impact of apathy on physical performance and fall-incidents varied with age and gender. Potentially, in older individuals with apathy, fall risk is preceded by a decline in physical performance. In clinical practice, identifying apathy in older persons might be useful to target mobility preserving interventions.

Download Full-text