Impact of pain on reactive balance and falls in community-dwelling older adults: a prospective cohort study

Abstract Background pain is associated with increased postural sway and falls in older adults. However, the impact of pain on reactive balance induced by postural perturbations and how this might predispose older adults to falls is not known. Objective to investigate whether any pain, back/neck pain and lower limb pain are associated with poor reactive balance and prospective fall outcomes in older adults. Design 12-month prospective cohort study. Setting community. Subjects 242 community-dwelling older adults aged 70+ years. Methods participants completed a questionnaire on the presence of pain and underwent force-controlled waist-pull postural perturbations while standing. Force thresholds for stepping, step initiation time, step velocity and step length were quantified. Falls were monitored with monthly falls calendars for 12-months. Results participants with lower limb pain had significantly lower force thresholds for stepping. Those with any pain or pain in the back/neck had longer step initiation time, slower step velocity and shorter step length. The three pain measures (any pain, back/neck pain, lower limb pain) were significantly associated with multiple falls when adjusted for age, sex, body mass index, use of polypharmacy, strength and walking speed. In mediation analyses, there was a significant indirect effect of reactive balance for the relationship between back/neck pain and falls with fractures. Conclusions older people with pain have impaired reactive balance and an increased risk of falls. Reactive balance partially mediated the association between pain and fall-related fractures. Further research is required to confirm the findings of this study.

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Serum Endostatin Concentrations Are Higher in Men with Symptoms of Intermittent Claudication

Disease Markers ◽

10.1155/2014/298239 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Jonathan Golledge ◽

Paula Clancy ◽

Graeme J. Hankey ◽

Bu B. Yeap ◽

Paul E. Norman

Keyword(s):

Intermittent Claudication ◽

Peripheral Artery Disease ◽

Lower Limb ◽

Older Men ◽

Community Dwelling ◽

Peripheral Artery ◽

Limb Pain ◽

Collagen Xviii ◽

Lower Limb Pain ◽

Artery Disease

Objectives. A cleavage fragment of collagen XVIII, endostatin, is released into the circulation and has been demonstrated to have antiangiogenic effects in animal models. We hypothesized that circulating endostatin would be increased in patients with symptoms of lower limb peripheral artery disease.Design. Cross-sectional study.Participants. Community dwelling older men.Measurements. Intermittent claudication was defined using the Edinburgh Claudication Questionnaire (ECQ). Serum endostatin was measured by a commercial ELISA. The association of serum endostatin with intermittent claudication was examined using logistic regression adjusting for age, diabetes, hypertension, dyslipidemia, coronary heart disease, and stroke.Results. Serum endostatin was measured in 1114 men who completed the ECQ. 106 men had intermittent claudication, 291 had atypical pain, and 717 had no lower limb pain. Mean (±standard deviation) serum endostatin concentrations (ng/mL) were 145.22 ± 106.93 for men with intermittent claudication, 129.11 ± 79.80 for men with atypical pain, and 116.34 ± 66.57 for men with no lower limb pain;P<0.001. A 70 ng/mL increase in endostatin was associated with a 1.17-fold rise in the adjusted odds of having intermittent claudication (OR 1.17, 95% confidence interval 1.00–1.37, andP=0.050).Conclusions. Serum endostatin is raised in older men who have symptoms of intermittent claudication. The role of endostatin in the genesis and outcome of peripheral artery disease requires further investigation.

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RISK FACTORS FOR FALLS IN OLDER ADULTS WITH TYPE 2 DIABETES

Innovation in Aging ◽

10.1093/geroni/igz038.1752 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S469-S470

Author(s):

Edgar R Vieira ◽

Fabieli Fontes ◽

Bartolomeu Filho ◽

Fabricia Cavalcanti ◽

Juliana Gazzola

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Lower Limb ◽

Functional Performance ◽

Cognitive Status ◽

Limb Pain ◽

Falls Risk ◽

Lower Limb Pain ◽

Risk Factors For Falls

Abstract The objective of this study was to evaluate the probability of the risk of falls in the older adults with type 2 diabetes. One-hundred and eleven older adults (age: 69±7 years) with type 2 diabetes participated in this cross-sectional observational study. The participants sociodemographics, physical function, cognitive status (Mini Mental State Exam – MEEM and Geriatric Depression Scale – GDS), balance (Mini BEST test), functional performance (WHODAS 2.0) and falls risk (Quick Screen Clinical Falls Risk Assessment – QuickScreen) were evaluated. The data was analyzed using the Kruskall-Wallis, Chi-square, and Fisher’s exact tests (p<0.05). Thirty percent of the participants had fallen during the previous 12 months, and 80% of the participants reported fear of falling. The average number of falls risks was 3.5±2. Increased number of falls risks were associated with lower educational level (p=0.005), poorer general health (p=0.001), vision impairment (p=0.017), higher number of diseases (p<0.0001), higher number of medications (p<0.0001), longer diabetes duration (p<0.0001), lower limb pain (p<0.0001), depression (p<0.001), worse functional performance (p<0.0001), and worse balance (p<0.0001). Older adults with type 2 diabetes with lower education, worse health and vision, greater number of diseases and medications, longer diagnosis of diabetes, lower limb pain, depressive symptoms, worse functional performance and balance presented more risks for falls.

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Perturbation-based balance assessment: Examining reactive balance control in older adults with mild cognitive impairments

Physiology International ◽

10.1556/2060.2021.00181 ◽

2021 ◽

Author(s):

Lakshmi N Kannan ◽

Tanvi S Bhatt

Keyword(s):

Older Adults ◽

Young Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Balance Control ◽

Step Length ◽

Subjective Memory ◽

Step Initiation ◽

Risk Of Falls ◽

Reactive Balance

Abstract Background Older adults with mild cognitive impairment (OAwMCI) present subtle balance and gait deficits along with subjective memory decline. Although these presentations might not affect activities of daily living (ADLs), they attribute to a two-folded increase in falls. While changes occurring in volitional balance control during ADLs have been extensively examined among OAwMCI, reactive balance control, required to recover from external perturbations, has received little attention. Therefore, this study examined reactive balance control in OAwMCI compared to their healthy counterparts. Methods Fifteen older adults with mild cognitive impairment (OAwMCI), fifteen cognitively intact older adults (CIOA) (>55 years), and fifteen young adults (18–30 years) were exposed to stance perturbations at three different intensities. Behavioral outcomes postural COM state stability, step length, step initiation, and step execution were computed. Results Postural COM state stability was the lowest in OAwMCI compared to CIOA and young adults, and it deteriorated at higher perturbation intensities (P < 0.001). Step length was the lowest among OAwMCI and was significantly different from young adults (P < 0.001) but not from CIOA. Unlike OAwMCI, CIOA and young adults increased their step length at higher perturbation intensities (P < 0.001). OAwMCI showed longer recovery step initiation times and shorter execution times compared to CIOA and young adults at higher perturbation intensities (P < 0.001). Conclusion OAwMCI exhibit exacerbated reactive instability and are unable to modulate their responses as the threat to balance control altered. Thus, they are at a significantly higher risk of falls than their healthy counterparts.

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Sarcopenia and lower limb pain are additively related to motor function and a history of falls and fracture in community-dwelling elderly people

Osteoporosis and Sarcopenia ◽

10.1016/j.afos.2019.03.002 ◽

2019 ◽

Vol 5 (1) ◽

pp. 23-26 ◽

Cited By ~ 3

Author(s):

Kohei Maruya ◽

Hiroaki Fujita ◽

Tomoyuki Arai ◽

Ryoma Asahi ◽

Yasuhiro Morita ◽

...

Keyword(s):

Elderly People ◽

Motor Function ◽

Lower Limb ◽

Community Dwelling ◽

Limb Pain ◽

Lower Limb Pain ◽

History Of

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Promoting Generalized Learning in Balance Recovery Interventions

Brain Sciences ◽

10.3390/brainsci11030402 ◽

2021 ◽

Vol 11 (3) ◽

pp. 402

Author(s):

Sara A. Harper ◽

Anne Z. Beethe ◽

Christopher J. Dakin ◽

David A. E. Bolton

Keyword(s):

Older Adults ◽

Motor Learning ◽

Daily Life ◽

Balance Training ◽

Community Dwelling ◽

Specific Training ◽

Balance Recovery ◽

Parallel Streams ◽

Postural Perturbations ◽

Community Dwelling Older Adults

Recent studies have shown balance recovery can be enhanced via task-specific training, referred to as perturbation-based balance training (PBT). These interventions rely on principles of motor learning where repeated exposure to task-relevant postural perturbations results in more effective compensatory balance responses. Evidence indicates that compensatory responses trained using PBT can be retained for many months and can lead to a reduction in falls in community-dwelling older adults. A notable shortcoming with PBT is that it does not transfer well to similar but contextually different scenarios (e.g., falling sideways versus a forward trip). Given that it is not feasible to train all conditions in which someone could fall, this limited transfer presents a conundrum; namely, how do we best use PBT to appropriately equip people to deal with the enormous variety of fall-inducing scenarios encountered in daily life? In this perspective article, we draw from fields of research that explore how general learning can be promoted. From this, we propose a series of methods, gleaned from parallel streams of research, to inform and hopefully optimize this emerging field where people receive training to specifically improve their balance reactions.

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Comparison of Lateral Perturbation-Induced Step Training and Hip Muscle Strengthening Exercise on Balance and Falls in Community-Dwelling Older Adults: A Blinded Randomized Controlled Trial

The Journals of Gerontology Series A ◽

10.1093/gerona/glab017 ◽

2021 ◽

Author(s):

Mark W Rogers ◽

Robert A Creath ◽

Vicki Gray ◽

Janice Abarro ◽

Sandy McCombe Waller ◽

...

Keyword(s):

Older Adults ◽

Controlled Trial ◽

Step Length ◽

Community Dwelling ◽

Controlled Study ◽

Balance Performance ◽

Muscle Strengthening ◽

Hip Muscle ◽

Hip Abduction ◽

Community Dwelling Older Adults

Abstract Background This factorial, assessor-blinded, randomized, and controlled study compared the effects of perturbation-induced step training (lateral waist-pulls), hip muscle strengthening, and their combination, on balance performance, muscle strength, and prospective falls among older adults. Methods Community-dwelling older adults were randomized to 4 training groups. Induced step training (IST, n = 25) involved 43 progressive perturbations. Hip abduction strengthening (HST, n = 25) utilized progressive resistance exercises. Combined training (CMB, n = 25) included IST and HST, and the control performed seated flexibility/relaxation exercises (SFR, n = 27). The training involved 36 sessions for a period of 12 weeks. The primary outcomes were the number of recovery steps and first step length, and maximum hip abduction torque. Fall frequency during 12 months after training was determined. Results Overall, the number of recovery steps was reduced by 31% and depended upon the first step type. IST and CMB increased the rate of more stable single lateral steps pre- and post-training than HST and SFR who used more multiple crossover and sequential steps. The improved rate of lateral steps for CMB exceeded the control (CMB/SFR rate ratio 2.68). First step length was unchanged, and HST alone increased hip torque by 25%. Relative to SFR, the fall rate ratios (falls/person/year) [95% confidence interval] were CMB 0.26 [0.07–0.90], IST 0.44 [0.18–1.08], and HST 0.30 (0.10–0.91). Conclusions Balance performance through stepping was best improved by combining perturbation and strength training and not strengthening alone. The interventions reduced future falls by 56%–74% over the control. Lateral balance perturbation training may enhance traditional programs for fall prevention.

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