When Will My Patient Fall? Sensor-Based In-Home Walking Speed Identifies Future Falls in Older Adults

Abstract Background Although there are known clinical measures that may be associated with risk of future falls in older adults, we are still unable to predict when the fall will happen. Our objective was to determine whether unobtrusive in-home assessment of walking speed can detect a future fall. Method In both ISAAC and ORCATECH Living Laboratory studies, a sensor-based monitoring system has been deployed in the homes of older adults. Longitudinal mixed-effects regression models were used to explore trajectories of sensor-based walking speed metrics in those destined to fall versus controls over time. Falls were captured during a 3-year period. Results We observed no major differences between those destined to fall (n = 55) and controls (n = 70) at baseline in clinical functional tests. There was a longitudinal decline in median daily walking speed over the 3 months before a fall in those destined to fall when compared with controls, p < .01 (ie, mean walking speed declined 0.1 cm s−1 per week). We also found prefall differences in sensor-based walking speed metrics in individuals who experienced a fall: walking speed variability was lower the month and the week just before the fall compared with 3 months before the fall, both p < .01. Conclusions While basic clinical tests were not able to differentiate who will prospectively fall, we found that significant variations in walking speed metrics before a fall were measurable. These results provide evidence of a potential sensor-based risk biomarker of prospective falls in community living older adults.

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Episodic Memory in Later Life: Benefits of Prayer and Meditation

Journal of Holistic Nursing ◽

10.1177/0898010119898547 ◽

2020 ◽

Vol 38 (1) ◽

pp. 30-40

Author(s):

Nirmala Lekhak ◽

Tirth R. Bhatta ◽

Jaclene A. Zauszniewski

Keyword(s):

Older Adults ◽

Episodic Memory ◽

Regression Models ◽

Secondary Analysis ◽

Later Life ◽

Estimating Equation ◽

Generalized Estimating Equation ◽

Positive Effect ◽

Retirement Study ◽

Over Time

Purpose: To examine the effects of prayer and meditation on the episodic memory of older adults. Design: Secondary analysis of Health and Retirement Study (HRS). Method: Drawing from a subsample of HRS ( n = 1,135), this study utilized generalized estimating equation regression models to examine the effects of meditation and prayer on changes in episodic memory of older adults over time. Findings: Findings show a statistically significant positive effect of the use of prayer (0.50, p < .05) on episodic memory score at baseline. We also observed a slight gain in episodic memory over time for older adults who used prayer (0.04, p = .05). Meditation was not found to have a statistically significant effect on changes in memory in later life. Conclusion: This study illustrates the benefits of prayer in preserving memory and provides much needed empirical basis for community-level interventions to enhance memory in later life.

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UNOBTRUSIVE, SENSOR-BASED MEASUREMENT OF IN-HOME WALKING SPEED AND ITS DAY-TO-DAY VARIABILITY IDENTIFIES FUTURE FALLS IN OLDER ADULTS

Alzheimer s & Dementia ◽

10.1016/j.jalz.2019.06.4355 ◽

2019 ◽

Vol 15 (7) ◽

pp. P173

Author(s):

Antoine Piau ◽

Nora Mattek ◽

Zachary Beattie ◽

Hiroko H. Dodge ◽

Jeffrey A. Kaye

Keyword(s):

Older Adults ◽

Walking Speed ◽

Falls In Older Adults

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Longitudinal and reciprocal associations between financial strain, home characteristics and mobility in the National Health and Aging Trends Study

BMC Geriatrics ◽

10.1186/s12877-019-1340-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

L. J. Samuel ◽

S. L. Szanton ◽

C. L. Seplaki ◽

T. K. M. Cudjoe ◽

R. J. Thorpe ◽

...

Keyword(s):

Older Adults ◽

National Health ◽

Walking Speed ◽

Structural Equation Models ◽

Financial Strain ◽

Sampling Weights ◽

Lower Odds ◽

Home Modifications ◽

Reduced Mobility ◽

Over Time

Abstract Background Older adults need homes that suit their physical capacity. Financial strain may limit home repairs and modifications and prompt relocations; repairing, relocating or modifying may increase financial strain. Likewise, reciprocal relationships may exist between financial strain and home characteristics and mobility; financial strain and home characteristics may influence mobility and mobility declines may increase financial strain, limit home repairs and modifications and prompt relocations. We test cross-lagged associations between financial strain, home disorder, relocation, home modifications and mobility. Methods In the National Health and Aging Trends Study, ability to complete a walking test, speed among those able to complete, financial strain, home disorder, relocating and modifying the home were recorded annually for 3 years (2012–2014). Structural equation models separately examined ability to walk and walking speed among those able, accounting for sociodemographic characteristics, social support, health prior health characteristics and autoregressive effects. Sampling weights accounted for the complex survey design and non-response over time. Results In both models (n = 3234 and n = 2467), financial strain predicted greater home disorder and vice versa, but cross-lagged associations were not found with relocating and modifications. Greater home disorder predicted lower odds of ability to walk and slower speed among those able. Financial strain and home modifications predicted lower odds of ability to walk. Also, faster walking speed predicted lower odds of subsequent financial strain and lower subsequent home disorder scores and ability to walk predicted less subsequent home disorder and lower odds of relocating. Conclusions Home disorder links financial strain with reduced mobility in a national sample of U.S. older adults. Cross-lagged associations between financial strain and home disorder and between home disorder and mobility suggest reciprocal effects that may accumulate over time. Also, financial strain, reduced mobility, relocations and modifications predicted greater home disorder. Together, these results highlight home disorder as a social determinant of mobility for older adults. Greater attention should be given to repairing and modifying home environments and supporting stable housing for older adults with financial strain.

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Satisfaction with aging results in reduced risk for falling

International Psychogeriatrics ◽

10.1017/s1041610215001969 ◽

2015 ◽

Vol 28 (5) ◽

pp. 741-747 ◽

Cited By ~ 4

Author(s):

Liat Ayalon

Keyword(s):

Older Adults ◽

Walking Speed ◽

Functional Decline ◽

Psychosocial Interventions ◽

Protective Mechanism ◽

Gender Education ◽

Falls In Older Adults ◽

Nationally Representative ◽

Retirement Study

ABSTRACTBackground:Falls are highly frequent in older adults and are associated with increased morbidity and mortality. The present study was designed to assess the role of satisfaction with one's aging process as a predictor of the risk for falling over a four-year period and to identify potential mediators of this relationship.Methods:The Health and Retirement Study (HRS) is a US nationally representative sample of individuals over the age of 50 years and their spouse of any age. The present study was based on the 2008–2012 waves of the HRS. Analyses were restricted to 4,121 respondents over the age of 50 years, who had fall data in 2008 and 2012 and were eligible to complete the satisfaction with aging measure as part of the 2008 psychosocial questionnaire.Results:Overall, 38.1% of the sample reported having fallen at least once between 2006 and 2008 and 40.7% reported having fallen at least once between 2010 and 2012. Higher levels of satisfaction with aging in 2008 were found to be protective against falls assessed in 2012 (OR[95%CI] = 0.88[0.79–0.98]) even after adjustment for age, gender, education, ethnicity, medical status, functional status, cognitive functioning, walking speed, balance, vision, depressive symptoms, physical activities, and past falls. Bootstrap procedures have shown that the effect of satisfaction with aging on falls is partially accounted for through its effect on functional decline.Conclusions:The findings point to the important role of satisfaction with aging as a potential protective mechanism against falls. The results call for the development of psychosocial interventions to reduce falls in older adults.

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Dopamine-Related Genotype Predicts Trajectories of Gait Reserve in Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.2728 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 756-757

Author(s):

Briana Sprague ◽

Andrea Rosso ◽

Xiaonan Zhu ◽

Caterina Rosano

Keyword(s):

Older Adults ◽

Mixed Models ◽

Gait Speed ◽

Regression Models ◽

Physical Factors ◽

Community Ambulation ◽

Related Genotype ◽

Comt Polymorphism ◽

Task Adaptation ◽

Over Time

Abstract The capacity to increase one’s gait speed is critical for maintaining safe community ambulation. There is limited work on the longitudinal changes in this capacity and its predictors. Because lower dopamine is associated with lower task adaptation and motivation, we hypothesized that lower dopamine would predict more decline in rapid gait speed. Catechol-O-methyltransferase (COMT) polymorphism and at least 3 repeated rapid and usual pace gait speed assessments were obtained over 10 years in 1,261 older adults (mean age=75.2, 867 White, 659 women). Linear mixed models computed person-specific rapid and usual pace gait speed trajectories. Regression models adjusted for usual gait trajectory tested whether COMT predicted rapid gait trajectory; covariates included, demographic, psychological, cognitive, and physical factors. Val/Val carriers (lower dopamine) declined more in rapid gait compared to Met/Met carriers (higher dopamine; adjusted b=-.002, SE=.001, p=.042). Modifying dopamine may positively influence the ability to maintain rapid gait over time.

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Abstract P159: In-Hospital Lifestyle Interventions to Prevent Secondary Stroke Among At-Risk Patients Varies by Patient Characteristics and Over Time: Analyses From a Large, Multi-Hospital Network

Circulation ◽

10.1161/circ.135.suppl_1.p159 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Elizabeth Baraban ◽

Lindsay Lucas ◽

Kateri Spinelli

Keyword(s):

At Risk ◽

Logistic Regression ◽

Weight Management ◽

Regression Models ◽

Risk Groups ◽

Mixed Effects ◽

Logistic Regression Models ◽

Risk Patients ◽

To Receive ◽

Over Time

Introduction/Objective: Recent studies show that targeted interventions on lifestyle factors such as weight management and diet can be successful in reducing ischemic stroke (ISC) and transient ischemic attack (TIA) rates. The objective of this study was to examine which subpopulations of patients at risk for secondary stroke presenting to a hospital with an ISC or TIA were more likely to receive interventions in a multi-hospital health system. Methods: Data from 26 hospitals participating in a multi-state healthcare system stroke registry, from January 2009 to December 2015, were used. Patients admitted with a diagnosis of ISC or TIA discharged to home were included. Patients on comfort care or those not discharged home were excluded. At-risk groups included patients with Body Mass Index (BMI) ≥ 25 and those prescribed medication for hypertension or high cholesterol in-hospital. Risk-related interventions included educational material given to patients during admission. Mixed effects logistic regression models with backward elimination were used to identify significant predictors of receiving the intervention from the following variables: year of discharge, age, insurance (private, Medicare, other/self-pay), BMI grouping, ambulation status, length of stay, stroke severity, and medical histories of family stroke, previous stroke or TIA, atrial fibrillation, coronary artery disease, heart failure, dyslipidemia, hypertension, and drug/alcohol abuse. Results: A total of 19,661 patients met the inclusion criteria. Of the 8,334 patients with a BMI ≥ 25, 57% (n=4,717) received weight management intervention. Of the 9,676 prescribed medication for hypertension, 55% (n=5,348) received information on antihypertensive diet. Of the 10,999 patients prescribed medication to lower cholesterol, 64% (n=7,088) received cholesterol lowering diet information. From 2009 to 2015, interventions increased for patients with a BMI ≥ 25 (40% to 66%), prescribed medication for hypertension (37% to 53%), and prescribed medication to lower cholesterol (39% to 67%). The mixed effects logistic regression models showed that all risk groups were significantly less likely to receive intervention if they had lower BMIs, were unable to ambulate versus able to ambulate alone, and had no family history of stroke. For those on medication for cholesterol, patients with Medicare were significantly less likely to receive the intervention compared to those on private insurance or other payment types (AOR=0.78, p<0.001). Conclusions: This large patient cohort demonstrates there are improvement opportunities for in-hospital secondary stroke prevention efforts. Over time, prevention efforts have increased for at-risk patients, but many are still not receiving it. The disparity in intervention rates suggest that a more targeted strategy to educate at-risk populations may need to be developed.

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Impact of tooth loss on walking speed decline over time in older adults: a population-based cohort study

Aging Clinical and Experimental Research ◽

10.1007/s40520-016-0630-6 ◽

2016 ◽

Vol 29 (4) ◽

pp. 793-800 ◽

Cited By ~ 9

Author(s):

Anna-Karin Welmer ◽

Debora Rizzuto ◽

Marti G. Parker ◽

Weili Xu

Keyword(s):

Older Adults ◽

Cohort Study ◽

Tooth Loss ◽

Walking Speed ◽

Population Based ◽

Over Time

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The impact of COVID-19 restrictions on older adults' loneliness: Evidence from high-frequency panel data

10.1101/2021.12.15.21267860 ◽

2021 ◽

Author(s):

Erwin Stolz ◽

Hannes Mayerl ◽

Wolfgang Freidl

Keyword(s):

Older Adults ◽

Panel Data ◽

High Frequency ◽

Regression Models ◽

Repeated Observations ◽

Mixed Regression ◽

The Impact ◽

Over Time

BACKGROUND: It is unclear how strong and long lasting the effects of recurring COVID-19 restrictions on older adults' loneliness are. METHODS: 469 retired older adults (60+) provided 8,814 repeated observations of loneliness (27 waves) in the Austrian Corona Panel Project between March 2020 and December 2021. Ordinal mixed regression models were used to estimate the effect of the stringency of COVID-19 restrictions (SI) on loneliness. RESULTS: The proportion of older adults who reported to be often lonely correlated closely (r=0.63) with the SI over time: both peaked during lockdowns (SI=82, often lonely=10-12%) and were lowest during the summer of 2020 (SI=36, often lonely=5- 6%). Results from regression models indicate, that when the SI increased above 60 (=strict lockdown), an increase in loneliness followed. Older adults who lived alone were more affected than those living with others. CONCLUSIONS: Stringent COVID-19 restrictions lead to situational loneliness, par- ticularly among those who lived alone. Efforts should be made to enable older adults who live alone to have save in-person contact during lockdown periods.

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Identification of Disability Risk in Addition to Slow Walking Speed in Older Adults

Gerontology ◽

10.1159/000516966 ◽

2021 ◽

pp. 1-10

Author(s):

Hiroyuki Shimada ◽

Takehiko Doi ◽

Sangyoon Lee ◽

Kota Tsutsumimoto ◽

Seongryu Bae ◽

...

Keyword(s):

Older Adults ◽

Regression Models ◽

Walking Speed ◽

Word List ◽

Normal Walking ◽

Slow Walking ◽

List Memory ◽

Walking Speeds ◽

Walking Group ◽

Slow Walking Speed

Introduction: A cutoff speed of 1.0 m/s for walking at a comfortable pace is critical for predicting future functional decline. However, some older adults with walking speeds below the cutoff point maintain an independent living. We aimed to identify specific predictors of disability development in older adults with slow walking speeds in contrast to those with a normal walking speed. Methods: This prospective cohort study on 12,046 community-dwelling independent Japanese older adults (mean age, 73.6 ± 5.4 years) was conducted between 2011 and 2015. Participants were classified into slow walking speed (comfortable walking speed slower than 1.0 m/s) and normal walking speed (speed of 1.0 m/s or faster) groups and followed up to assess disability incidence for 24 months after baseline assessments. Cox proportional hazards regression models were used to identify predictors of disability development in the slow and normal walking groups. Results: Overall, 26.8% of participants had a slow walking speed. At follow-up, 17.3% and 5.1% of participants in the slow and normal walking groups, respectively, developed disability (p < 0.01). Cox regression models revealed that age (hazard ratio 1.07, 95% confidence interval 1.05–1.09), walking speed (0.12, 0.07–0.22), grip strength (0.97, 0.95–0.99), Parkinson’s disease (4.65, 2.59–8.33), word list memory-immediate recognition score (0.90, 0.85–0.97), word list memory-delayed recall score (0.94, 0.89–1.00), Symbol Digit Substitution Test (SDST) score (0.98, 0.96–0.99), and 15-item Geriatric Depression Scale (GDS) score (1.04, 1.01–1.07) were significantly associated with disability incidence in the slow walking group. In the normal walking group, age, grip strength, depression, diabetes, cognition, GDS score, and reduced participation in outdoor activity were significantly associated with disability incidence; however, there was no significant association with walking speed. Conclusions: Decreased walking speeds have considerably greater impact on disability development in older adults with a slow walking speed than in those with a normal walking speed. Health-care providers should explore modifiable factors for reducing walking speed; they should also encourage improvement of risk factors such as muscle weakness and depression to reduce disability risk in older adults with slow walking speeds.

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When the Kids Live at Home: Coresidence, Parental Assets, and Economic Insecurity

10.31235/osf.io/rw7cj ◽

2019 ◽

Author(s):

Michelle Lee Maroto

Keyword(s):

Young Adults ◽

Adult Children ◽

Regression Models ◽

Mixed Effects ◽

Longitudinal Survey ◽

Financial Hardship ◽

Financial Assets ◽

Economic Insecurity ◽

Over Time ◽

At Home

This study uses National Longitudinal Survey of Youth 1979 cohort data from 1994 through 2012 (N = 16,108 person-years, 4,671 individuals) to investigate how coresidence with adult children influences asset levels among parents. It applies hybrid mixed effects regression models that partition between- and within-person variation to estimate parental savings and financial assets over time and across different households. The results suggest that coresidence with adult children led to decreases in parental assets and savings. In the years in which their children lived at home, parents held 24% less in financial assets and 23% less in savings compared to years when adult children were not present. By expanding previous research that shows a relationship between increasing economic insecurity, limited wealth, and the rise in coresidence among young adults, this study also offers broader implications for the interconnectivity of financial hardship across generations.

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