160 Gait Adaptability in Older People and People with PD

Abstract The ability to adapt gait when negotiating unexpected hazards is crucial to maintain stability and avoid falling. This presentation will present findings from a series of studies that have investigated cognitive, physical and psychological factors associated with gait adaptability required for obstacle and stepping target negotiation in older people and people with Parkinson’s disease (PD). The first studies involved fifty healthy older adults (mean±SD: 74±7 years). The gait adaptability protocol required them to either (a) avoid an obstacle at usual step distance or (b) step onto a target at either a short or long step distance projected on a walkway two heel strikes ahead and then continue walking. The primary findings were that gait adaptability was significantly associated with high risk of falls and that executive function, increased concern about falling and weaker quadriceps strength contributed significantly to this relationship. The second studies involved 54 people with PD (mean±SD: 67±67 years) who also completed the gait adaptability protocol. In this group, superior executive function, effective reactive balance and good muscle power were associated with successful gait adaptability. Furthermore, executive function and reactive balance appeared to be particularly important for precise foot placements; and cognitive capacity for step length adjustments for avoiding obstacles. These findings help elucidate mechanisms for why older people and people with PD fall. Training gait adaptability directly, as well as addressing the above associated factors through cognitive, behavioural and physical training may maximise fall prevention efficacy for these populations.

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Reaction Time and Postural Sway Modify the Effect of Executive Function on Risk of Falls in Older People with Mild to Moderate Cognitive Impairment

American Journal of Geriatric Psychiatry ◽

10.1016/j.jagp.2016.10.010 ◽

2017 ◽

Vol 25 (4) ◽

pp. 397-406 ◽

Cited By ~ 19

Author(s):

Morag E. Taylor ◽

Stephen R. Lord ◽

Kim Delbaere ◽

Susan E. Kurrle ◽

A. Stefanie Mikolaizak ◽

...

Keyword(s):

Cognitive Impairment ◽

Executive Function ◽

Reaction Time ◽

Older People ◽

Postural Sway ◽

Moderate Cognitive Impairment ◽

Risk Of 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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Ladder Use in Older People: Type, Frequency, Tasks and Predictors of Risk Behaviours

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189799 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9799

Author(s):

Cameron Hicks ◽

Erika M. Pliner ◽

Stephen R. Lord ◽

Daina L. Sturnieks

Keyword(s):

Executive Function ◽

Older People ◽

Injury Risk ◽

Fear Of Falling ◽

Older Men ◽

Quadriceps Strength ◽

Frequency Of Use ◽

Type Frequency ◽

Use Factors ◽

Older Men And Women

Ladder fall and injury risk increases with age. People who present to a hospital after an injurious ladder fall have been surveyed, but little is known about ladder use in the community. The purpose of this study was to: (1) document salient factors related to ladder safety, and (2) determine physical, executive function, psychological and frequency-of-use factors associated with unsafe ladder use in older people. One hundred and two older people (aged 65+ years) were recruited. Participants completed questionnaires on demographics, health, and ladder use (type, frequency, task, behaviours) and underwent assessments of physical and executive function ability. Results showed both older men and women commonly use step ladders (61% monthly, 96% yearly), mostly inside the home for tasks such as changing a lightbulb (70%) and decorating (43%). Older men also commonly use straight ladders (27% monthly, 75% yearly), mostly outside the home for tasks such as clearing gutters (74%) and pruning trees (40%). Unsafe ladder use was more common in males and individuals with greater ladder use frequency, greater quadriceps strength, better upper limb dexterity, better balance, better stepping ability, greater self-reported everyday risk-taking, a lower fear of falling, and fewer health problems compared to their counterparts (all p < 0.05). These findings document ladder use by older people and provide insight into unsafe ladder behaviours that may be amenable to interventions to reduce ladder falls and associated injuries.

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Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy

Medicina ◽

10.3390/medicina57050457 ◽

2021 ◽

Vol 57 (5) ◽

pp. 457

Author(s):

Neil D. Reeves ◽

Giorgio Orlando ◽

Steven J. Brown

Keyword(s):

Peripheral Neuropathy ◽

Diabetic Peripheral Neuropathy ◽

Motor Nerve ◽

Step Length ◽

Falls Prevention ◽

Motor Deficits ◽

Falls Risk ◽

Walking Gait ◽

Risk Of Falls ◽

Diabetes Patients

Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This review describes how the sensory and motor deficits associated with DPN underpin biomechanical alterations to the pattern of walking (gait), which contribute to balance impairments underpinning falls. Changes to gait with diabetes occur even before the onset of measurable DPN, but changes become much more marked with DPN. Gait impairments with diabetes and DPN include alterations to walking speed, step length, step width and joint ranges of motion. These alterations also impact the rotational forces around joints known as joint moments, which are reduced as part of a natural strategy to lower the muscular demands of gait to compensate for lower strength capacities due to diabetes and DPN. Muscle weakness and atrophy are most striking in patients with DPN, but also present in non-neuropathic diabetes patients, affecting not only distal muscles of the foot and ankle, but also proximal thigh muscles. Insensate feet with DPN cause a delayed neuromuscular response immediately following foot–ground contact during gait and this is a major factor contributing to increased falls risk. Pronounced balance impairments measured in the gait laboratory are only seen in DPN patients and not non-neuropathic diabetes patients. Self-perception of unsteadiness matches gait laboratory measures and can distinguish between patients with and without DPN. Diabetic foot ulcers and their associated risk factors including insensate feet with DPN and offloading devices further increase falls risk. Falls prevention strategies based on sensory and motor mechanisms should target those most at risk of falls with DPN, with further research needed to optimise interventions.

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Cognitive behavioural therapy and third wave approaches for anxiety and related disorders in older people

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd007674.pub2 ◽

2021 ◽

Author(s):

Gert-Jan Hendriks ◽

Willeke H van Zelst ◽

Anton J van Balkom ◽

Eleonora Uphoff ◽

Lindsay Robertson ◽

...

Keyword(s):

Older People ◽

Cognitive Behavioural Therapy ◽

Behavioural Therapy ◽

Third Wave ◽

Cognitive Behavioural

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154 The Feasibility of Assessing Sarcopenia Among Older People with Arm Fracture Using Different Criteria

Age and Ageing ◽

10.1093/ageing/afab030.115 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

K Ibrahim ◽

M A Mullee ◽

G Lily Yao ◽

S Zhu ◽

M Baxter ◽

...

Keyword(s):

Older People ◽

Grip Strength ◽

Sensitivity And Specificity ◽

Gait Speed ◽

Speed Test ◽

Increased Risk ◽

European Working ◽

Hand Dynamometer ◽

Risk Of Falls ◽

And Gender

Abstract Introduction Osteoporosis and sarcopenia often co-exist (osteo-sarcopenia) and both are associated with increased risk of falls and fractures. Early identification and treatment of sarcopenia among older people with fragility arm fractures could prevent further fractures. This study evaluated the feasibility of assessing sarcopenia in a fracture clinic. Methods People aged 65+ years with arm fracture attending fracture clinics in one acute trust were recruited. Sarcopenia was assessed using gait speed, grip strength with unfractured arm (hand dynamometer using appropriate cut off adjusted for age and gender), skeletal muscle mass index SMI (Bioimpedance BIA), SARC-F questionnaire, the European Working Group on Sarcopenia in Older People (EWGSOP) I and II criteria. The sensitivity and specificity of each measure was calculated against the EWGSOP II criteria as the standard reference. Results 100 patients (Mean age 75 years±7.2; 80 female) were recruited. Sarcopenia was identified among 4% (EWGSOP I), 5% (SMI), 13% (EWGSOP II), 16% (gait speed test), 18% (SARC-F) and 39% (grip strength) and was more prevalent among men. SARC-F had the best sensitivity and specificity (100% and 96% respectively) when compared to the EWGSOP II criteria. Sensitivity and specificity for the remaining measures were respectively (100%, 71%) for grip strength, (75%, 94%) for gait speed, (25%, 97%) with SMI and (25%, 99%) for EWGSOP I. Time needed to complete the assessments was 1–2 minutes for gait speed, grip strength and SARC-F; five minutes for BIA test, and nine minutes when EWGSOP I and II criteria were applied. Data were complete for grip strength and SARC-F. Missing data was reported among 2% for gait speed, 8% for BIA test, 8% for EWGSOP II and 10% for EWGSOP I. Conclusion It was feasible to assess sarcopenia in fracture clinics and SARC-F was a quick, simple and sensitive tool suitable for routine use.

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Cognitive–behavioural therapy with older people

Advances in Psychiatric Treatment ◽

10.1192/apt.bp.106.003020 ◽

2007 ◽

Vol 13 (2) ◽

pp. 111-118 ◽

Cited By ~ 34

Author(s):

Ceri Evans

Keyword(s):

Older People ◽

Effective Treatment ◽

Psychiatric Disorders ◽

Cognitive Behavioural Therapy ◽

Historical Context ◽

Behavioural Therapy ◽

Age Group ◽

The Core ◽

Cognitive Behavioural ◽

The Individual

Cognitive–behavioural therapy (CBT) is an effective treatment for a number of psychiatric disorders in adults of all ages. With the proportion of the population aged 65 or over increasing steadily, it is important to be aware of how the CBT needs of this age group can be best met. This article provides an overview of CBT and the historical context of using it with older people. Although an understanding of the individual, irrespective of age, is at the core of CBT, potential modifications to the procedure and content aimed at optimising its effectiveness for older people are discussed.

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‘Fat but powerful’ paradox: association of muscle power and adiposity markers with all-cause mortality in older adults from the EXERNET multicentre study

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-103720 ◽

2021 ◽

pp. bjsports-2020-103720

Author(s):

Julian Alcazar ◽

David Navarrete-Villanueva ◽

Asier Mañas ◽

Alba Gómez-Cabello ◽

Raquel Pedrero-Chamizo ◽

...

Keyword(s):

Older Adults ◽

Waist Circumference ◽

Older People ◽

Multicentre Study ◽

Mortality Risk ◽

Muscle Power ◽

Smoking Status ◽

Relative Power ◽

Fat Percentage ◽

All Cause Mortality

ObjectivesTo assess the influence of muscle power and adiposity on all-cause mortality risk and to evaluate the ‘fat but powerful’ (F+P) (or ‘fat but fit’) paradox in older adults.MethodsA total of 2563 older adults (65‒91 years old) from the EXERNET multicentre study were included. Adiposity (body mass index (BMI), waist circumference, body fat percentage (BF%) and fat index), allometric and relative power (sit-to-stand muscle power test) and various covariates (age, sex, hypertension, smoking status and walking and sitting times per day) were registered at baseline. All-cause mortality was recorded during a median follow-up of 8.9 years. Participants were classified into four groups: lean and powerful (L+P), F+P, lean but weak and fat and weak (F+W). Cox proportional hazard regression models and adjusted HRs were calculated.ResultsAccording to BMI and waist circumference, all-cause mortality risk was reduced in the F+P (HR=0.55 and 0.63, p=0.044 and 0.049, respectively) and L+P (HR=0.57 and 0.58, p=0.043 and 0.025, respectively) groups. According to BF%, all-cause mortality decreased in the L+P group (HR=0.53; p=0.021), and a trend for a reduction was reported in the F+P group (HR=0.57; p=0.060). According to fat index, a survival benefit was only noted in the L+P group (HR=0.50; p=0.049). Higher levels of relative power reduced all-cause mortality risk among older people (HR=0.63 and 0.53, p=0.006 and 0.011, respectively).ConclusionPowerful older people exhibited a reduced 9-year all-cause mortality regardless of BMI, waist circumference and BF%. Obesity according to fat index blunted the survival benefits of being powerful.

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Mild Cognitive Impairment Affects Obstacle Negotiation in Older Adults: Results from “Gait and Brain Study”

Gerontology ◽

10.1159/000492931 ◽

2018 ◽

Vol 65 (2) ◽

pp. 164-173 ◽

Cited By ~ 13

Author(s):

Frederico Pieruccini-Faria ◽

Yanina Sarquis-Adamson ◽

Manuel Montero-Odasso

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Executive Function ◽

Mild Cognitive Impairment ◽

Dual Task ◽

Gait Speed ◽

Step Length ◽

Gait Control ◽

Dual Tasking ◽

Brain Study

Background: Older adults with Mild Cognitive Impairment (MCI) are at higher risk of falls and injuries, but the underlying mechanism is poorly understood. Inappropriate anticipatory postural adjustments to overcome balance perturbations are affected by cognitive decline. However, it is unknown whether anticipatory gait control to avoid an obstacle is affected in MCI. Objective: Using the dual-task paradigm, we aim to assess whether gait control is affected during obstacle negotiation challenges in older adults with MCI. Methods: Seventy-nine participants (mean age = 72.0 ± 2.7 years; women = 30.3%) from the “Gait and Brain Study” were included in this study (controls = 27; MCI = 52). In order to assess the anticipatory control behaviour for obstacle negotiation, a 6-m electronic walkway embedded with sensors recorded foot prints to measure gait speed and step length variability, during early (3 steps before the late phase) and late (3 steps before the obstacle) pre-crossing phases of an ad hoc obstacle, set at 15% of participant’s height. Participants walked under single- and dual-task gait (counting backwards by 1’s from 100 while walking) conditions. Three-way mixed repeated-measures analysis of variance models examined differences in gait performance between groups when transitioning between pre-crossing phases towards an obstacle during single- and dual-task conditions. Analyses were adjusted for age, sex, years of education, lower limb function, fear of falling, medical status, depressive symptoms, baseline gait speed and executive function. Results: A significant three-way interaction among groups, pre-crossing phases and task showed that participants with MCI attenuated the gait deceleration (p = 0.02) and performed fewer step length adjustments (p = 0.03) when approaching the obstacle compared with controls while dual-tasking. These interactions were attenuated when executive function performance was added as a covariate in the adjusted statistical model. Conclusion: Older adults with MCI attenuate the anticipatory gait adjustments needed to avoid an obstacle when dual-tasking. Deficits in higher-order cognitive processing may limit obstacle negotiation capabilities in MCI populations, being a potential falls risk factor.

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