Association of In-Lab and Free-Living Mobility Measures With Falls and Fear of Falling in Underactive Older People

Abstract Falls in older adults have significant consequences—a single fall can lead to serious injury, psychological trauma, activity restriction, and increased mortality. This study describes differences in mobility-related characteristics of underactive (<150 minutes/week of physical activity), racially diverse, older adults (65–84 years) classified by self-reported fall status (0, 1, 2+ falls in previous 12mo) and fear of falling (yes/no). We analyzed baseline data from 105 individuals (mean age=72.1 years; 73% female; 64% white, 29% Black, 12% Asian) who participated in a trial of a physical activity smartphone intervention for older people. Total minutes of daily stepping and medium-to-brisk (≥75 steps/min) and brisk (≥100) cadence bouts in free-living conditions was gathered over 3 days via ActivPal activity monitor. Gait speed was determined from a 4-meter walk test for those pretested prior to COVID-19 mandates (n=60). Of the median 81.8 minutes spent stepping daily, very few minutes involved moderate-to-brisk (14.0) or brisk cadence (10.1). Groups classified by fall status (non-fallers n=74, 1x fallers n=18, repeat fallers n=13) differed significantly in daily minutes spent in medium-to-brisk (p=0.04) and brisk cadence (p=0.02), but not in 4-meter gait speed or total minutes stepping. Individuals who reported fear of falling versus those with no fear did not differ significantly on any mobility-related parameters. Four-meter gait speed was significantly negatively correlated with both cadence measures (p=0.02) but not total minutes stepping. This study indicates that faster walking behaviors in everyday activity may be a useful target for intervention to prevent falls in underactive older adults.

Download Full-text

The Benefits of Physical Activity in Individuals with Cardiovascular Risk Factors: A Longitudinal Investigation Using fNIRS and Dual-Task Walking

Journal of Clinical Medicine ◽

10.3390/jcm10040579 ◽

2021 ◽

Vol 10 (4) ◽

pp. 579

Author(s):

Deborah Talamonti ◽

Thomas Vincent ◽

Sarah Fraser ◽

Anil Nigam ◽

Frédéric Lesage ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Older Adults ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cognitive Performance ◽

Dual Task ◽

Gait Speed ◽

Regular Physical Activity ◽

Cortical Response

Cardiovascular fitness is linked to better executive functions, preserved gait speed, and efficient cortical activity. Older adults with cardiovascular risk factors (CVRFs) typically show poor cognitive performance, low physical fitness, and altered brain functioning compared with healthy individuals. In the current study, the impact of regular physical activity on cognition, locomotion, and brain functions was explored in a cohort of older adults with low or high CVRFs. Cortical activation of the frontal areas was investigated using functional Near-Infrared Spectroscopy (fNIRS) at baseline, at 6 months and at 12 months. Evoked cortical response and behavioral performance were assessed using the dual-task walking paradigm, consisting of three conditions: single cognitive task (2-back task), single walking task (walking), and dual-task (2-back whilst walking). Results show greater task-related cortical response at baseline in individuals with high CVRFs compared to those with low CVRFs. Moreover, participants with high CVRFs benefitted the most from participating in regular physical activity, as their cortical response decreased at the 12-month follow-up and became comparable to that of participants with low CVRFs. These changes were observed in conjunction with improved cognitive performance and stable gait speed throughout the 12-month period in both groups. Our findings provide evidence that participation in regular physical activity may be especially beneficial in individuals with CVRFs by promoting brain and cognitive health, thus potentially contributing to prevention of cognitive decline. Future research may explore whether such effects are maintained in the long-term in order to design ad-hoc interventions in this specific population.

Download Full-text

Strategies Older New Zealanders Use to Participate in Day-To-Day Occupations

British Journal of Occupational Therapy ◽

10.4276/030802211x13204135680820 ◽

2011 ◽

Vol 74 (11) ◽

pp. 509-516 ◽

Cited By ~ 4

Author(s):

Clare Hocking ◽

Juanita Murphy ◽

Kirk Reed

Keyword(s):

Public Health ◽

Physical Activity ◽

Older Adults ◽

New Zealand ◽

Older People ◽

Exploratory Study ◽

Occupational Therapists ◽

Falls Prevention ◽

Public Health Messages ◽

The Impact

Aim: This exploratory study aimed to uncover the strategies that older adults employ to ameliorate the impact of impairments and barriers to participation. Method: Eight participants were interviewed in their own homes, in a town or city in New Zealand. Findings: Inductive analysis of data revealed four main categories of strategies: strategies to keep safe, to recruit and accept help, to meet social and biological needs (nutritional and medical), and to conserve financial, material and bodily resources. Discussion: The study supports some previous findings of strategies used by older people, and demonstrates that enquiring into the strategies that older people devise and adopt into their own lives is a productive line of inquiry. The strategies described differ from those that occupational therapists recommend, and do not incorporate public health messages about the benefits of physical activity or recommendations about falls prevention. Conclusion: The findings suggest that asking older clients about the strategies that they use will uncover valuable information for therapists giving advice or issuing equipment to help older adults to manage in the community.

Download Full-text

Effectiveness of Daily Use of Bilateral Custom-Made Ankle-Foot Orthoses on Balance, Fear of Falling, and Physical Activity in Older Adults: A Randomized Controlled Trial

Gerontology ◽

10.1159/000494114 ◽

2018 ◽

Vol 65 (3) ◽

pp. 299-307 ◽

Cited By ~ 9

Author(s):

Changhong Wang ◽

Rahul Goel ◽

Hadi Rahemi ◽

Qianzi Zhang ◽

Brian Lepow ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Fear Of Falling ◽

Controlled Trial ◽

Foot Orthoses ◽

Female Age ◽

Randomized Controlled ◽

Custom Made ◽

Ankle Foot Orthoses

Background: Foot problems are prevalent in older adults, which may increase the risk and concern for falls. Ankle-foot orthoses (AFO) have been shown to be effective in the stabilization of lower extremities, but their long-term effectiveness in improving balance and their potential to encourage older adults to become more physically active are still debated. Objective: This randomized controlled trial investigated the effectiveness of daily use of a custom-made AFO on balance, fear of falling, and physical activity in older adults. Study Design: Forty-four older adults with concern about or at risk for falling were randomly allocated to either the control group (CG; 77.3% female, age 75.6 ± 6.5 years, BMI 29.3 ± 6.4) or the intervention group (IG; 63.6% female, age 73.7 ± 6.3 years, BMI = 27.8 ± 4.8). The IG received walking shoes and bilateral custom-made AFO. The CG received only walking shoes. At the baseline and 6-month follow-ups, balance and physical activity were assessed using validated wearable instrumentation and fear of falling was assessed using the Fall Efficacy Scale-International (FES-I). Adherence and acceptability toward wearing the AFO were assessed using self-reported questionnaires at the 6-month follow-up. Results: No significant between-group difference was observed at baseline (p = 0.144–0.882). Compared to baseline and the CG, hip, ankle, and center-of-mass (COM) sways were significantly reduced at the 6-month follow-up in the IG while standing with the feet together during the eyes-open condition (p = 0.005–0.040). Within the IG, the FES-I was reduced significantly (p = 0.036) and there was an increasing trend in the number of walking bouts with a medium effect size (d = 0.52, p = 0.440) compared to baseline. However, there were no significant changes in FES-I and physical activity measures in the CG (p = 0.122–0.894). The reduction in COM sway in the IG was moderately correlated with adherence (r = –0.484, p = 0.047) and strongly correlated with baseline COM sway (r = –0.903, p < 0.001). Conclusion: Results suggest that bilateral custom-made AFO plus walking shoes is effective in improving balance compared to walking shoes alone, and it significantly reduces the fear of falling, with a nonsignificant but noticeable positive trend in physical activity, compared to baseline. The results also suggest that older adults with poor balance at baseline and higher daily adherence to using the AFO will gain more benefit from the AFO intervention.

Download Full-text

Participation in Two Evidence-Based Falls Prevention Programs by Adults Aging With a Long-Term Disability: Case-Control Study of Reach and Effectiveness

Journal of Aging and Health ◽

10.1177/0898264318808918 ◽

2018 ◽

Vol 31 (10_suppl) ◽

pp. 39S-67S ◽

Cited By ~ 1

Author(s):

Thomas J. Eagen ◽

Salom M. Teshale ◽

Angelica P. Herrera-Venson ◽

Anne Ordway ◽

Joe Caldwell

Keyword(s):

Older Adults ◽

Fear Of Falling ◽

Prevention Programs ◽

Preliminary Evidence ◽

Case Control ◽

Falls Prevention ◽

Evidence Based ◽

Activity Restriction ◽

Increased Risk

Objective: Adults aging with a long-term disability (LTD) are at an increased risk for falls. The Older Americans Act Title III-D and Prevention and Public Health Fund (PPHF) support several organizations to deliver falls prevention evidence-based programs designed to reduce risk factors; however, little is understood about the reach and effectiveness of these fall prevention programs for those with LTD compared to those without LTD. This study compared the reach and effectiveness of two evidence-based falls prevention programs between older adults with and without LTD. Method: Using a matched case-control design, 105 LTD older adults enrolled in A Matter of Balance (AMOB) or Stepping On were matched to 315 non-LTD older adults on age, sex, race, and education. Results: On average, LTD older adults attended a higher number of class sessions and were significantly more likely to complete the program compared with the matched-sample of non-LTD older adults. LTD older adults were equally likely as non-LTD older adults to report significant reductions in self-reported fear of falling, falls-related activity restriction, and improvement in falls self-efficacy following completion of the programs. Discussion: These findings provide preliminary evidence for the effectiveness of these evidence-based falls prevention programs for LTD older adults; however, more research is needed to extend these findings.

Download Full-text

Analyzing Free-Living Physical Activity of Older Adults in Different Environments Using Body-Worn Activity Monitors

Journal of Aging and Physical Activity ◽

10.1123/japa.18.2.171 ◽

2010 ◽

Vol 18 (2) ◽

pp. 171-184 ◽

Cited By ~ 35

Author(s):

P. Margaret Grant ◽

Malcolm H. Granat ◽

Morag K. Thow ◽

William M. Maclaren

Keyword(s):

Physical Activity ◽

Older Adults ◽

Sedentary Time ◽

Likelihood Estimation ◽

Day Hospital ◽

Free Living ◽

Activity Monitors ◽

The Third ◽

Patient Groups ◽

Restricted Maximum Likelihood Estimation

This study measured objectively the postural physical activity of 4 groups of older adults (≥65 yr). The participants (N= 70) comprised 3 patient groups—2 from rehabilitation wards (cityn= 20, 81.8 ± 6.7 yr; ruraln= 10, 79.4 ± 4.7 yr) and the third from a city day hospital (n= 20, 74.7 ± 7.9 yr)—and a healthy group to provide context (n= 20, 73.7 ± 5.5 yr). The participants wore an activity monitor (activPAL) for a week. A restricted maximum-likelihood-estimation analysis of hourly upright time (standing and walking) revealed significant differences between day, hour, and location and the interaction between location and hour (p< .001). Differences in the manner in which groups accumulated upright and sedentary time (sitting and lying) were found, with the ward-based groups sedentary for prolonged periods and upright for short episodes. This information may be used by clinicians to design appropriate rehabilitation interventions and monitor patient progress.

Download Full-text

Validity, Reliability and Sensitivity to Change of Three Consumer-grade Activity Trackers in Controlled and Free-living Conditions among Older Adults (Preprint)

10.2196/preprints.27155 ◽

2021 ◽

Author(s):

Kaja Kastelic ◽

Marina Dobnik ◽

Stefan Loefler ◽

Christian Hofer ◽

Nejc Šarabon

Keyword(s):

Physical Activity ◽

Older Adults ◽

Intraclass Correlation ◽

Sleep Time ◽

Living Conditions ◽

Percentage Error ◽

Sensitivity To Change ◽

Free Living ◽

Activity Trackers ◽

Free Living Conditions

BACKGROUND Wrist worn consumer-grade activity trackers are popular devices, developed mainly for personal use, but with the potential to be used also for clinical and research purposes. OBJECTIVE The objective of this study was to explore the validity, reliability and sensitivity to change of movement behaviours metrics from three popular activity trackers (POLAR Vantage M, Garmin Vivosport and Garmin Vivoactive 4s) in controlled and free-living conditions when worn by older adults. METHODS Participants (n = 28; 74 ± 5 years) underwent a videotaped laboratory protocol while wearing all three activity trackers. On a separate occasion, participants wore one (randomly assigned) activity tracker and a research grade physical activity monitor ActiGraph wGT3X-BT simultaneously for six consecutive days for comparisons. RESULTS Both Garmin activity trackers showed excellent performance for step counts, with mean absolute percentage error (MAPE) below 20 % and intraclass correlation coefficient (ICC2,1) above 0.90 (P < .05), while Polar Vantage M substantially over counted steps (MAPE = 84 % and ICC2,1 = 0.37 for free-living conditions). MAPE for sleep time was within 10 % for all the trackers tested, while far beyond 20 % for all the physical activity and calories burned outputs. Both Garmin trackers showed fair agreement (ICC2,1 = 0.58–0.55) for measuring calories burned when compared with ActiGraph. CONCLUSIONS Garmin Vivoactive 4s showed overall best performance, especially for measuring steps and sleep time in healthy older adults. Minimal detectible change was consistently lower for an average day measures than for a single day measure, but still relatively high. The results provided in this study could be used to guide choice on activity trackers aiming for different purposes – individual use/care, longitudinal monitoring or in clinical trial setting.

Download Full-text

Evaluation of the Bidirectional Relations of Perceived Physical Fatigability and Physical Activity on Slower Gait Speed

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa281 ◽

2020 ◽

Author(s):

Yujia (Susanna) Qiao ◽

Theresa Gmelin ◽

Sharon W Renner ◽

Robert M Boudreau ◽

Sarah Martin ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Gait Speed ◽

Activity Index ◽

Oldest Old ◽

Mixed Effect ◽

Direct Association ◽

Bidirectional Relations ◽

The Impact ◽

Lower Physical Activity

Abstract Background Lower physical activity levels and greater fatigability contribute independently to slower gait speed in older adults. To fully understand the bidirectional relations between physical activity and fatigability, and to inform potential intervention strategies, we examined whether physical activity or fatigability explains more of the other factor’s association on slower gait speed. Methods Two generations (probands and offspring) of older adults (N = 2079, mean age 73.0 ± 10.0 years, 54.2% women, 99.7% White) enrolled in the Long Life Family Study were assessed at Visit 2 (2014–2017). Self-reported physical activity was measured with the Framingham Physical Activity Index and perceived physical fatigability using the Pittsburgh Fatigability Scale. Statistical mediation analyses were conducted separately by generation with linear mixed-effect models accounting for family relatedness and adjusted for demographics, health conditions, and field center. Results Greater perceived physical fatigability explained the association of lower physical activity on slower gait speed via a 22.5% attenuation of the direct association (95% confidence interval [CI]: 15.0%–35.2%) for the probands and 39.5% (95% CI: 22.8%–62.6%) for the offspring. Whereas lower physical activity explained the association of greater perceived fatigability on slower gait speed via a 22.5% attenuation of the direct association (95% CI: 13.4%–32.8%) for the probands and 6.7% (95% CI: 3.8%–15.4%) for the offspring. Conclusions Our findings suggest that the impact of greater perceived physical fatigability on the association between lower physical activity and slower gait speed differs between younger-old and middle-to-oldest-old adults, indicating perceived physical fatigability as a potential mediator in the disablement pathway.

Download Full-text

There's no apprenticeship for Alzheimer's: the caring relationship when an older person experiencing dementia falls

Ageing and Society ◽

10.1017/s0144686x11000699 ◽

2011 ◽

Vol 32 (5) ◽

pp. 873-896 ◽

Cited By ~ 16

Author(s):

ANNE MCINTYRE ◽

FRANCES REYNOLDS

Keyword(s):

Older People ◽

Interpretative Phenomenological Analysis ◽

Care Recipient ◽

Term Care ◽

Everyday Activity ◽

Carer Burden ◽

People With Dementia ◽

Caring Relationship ◽

Serious Injury ◽

The Impact

ABSTRACTOlder people experiencing dementia are twice as likely to fall with consequences of serious injury, reduction in everyday activity, admission to long-term care and mortality. Carers of people with dementia are themselves at greater risk of physical and mental ill health, which increases as the dementia progresses. Unsurprisingly, carer burden also increases when a care-recipient falls. The aim of this study was to explore the experiences of falling of community-living older people with dementia and their carers. A qualitative approach was taken using interpretative phenomenological analysis. Nine older people with predominantly Alzheimer's disease and their ten carers were recruited from a large mental health National Health Service trust and participated in one-to-one and joint in-depth interviews. Three dyads participated in repeat interviews. Three focus groups were also carried out, with nine older people experiencing memory problems and 12 carers from a local Alzheimer's Society branch. The antecedents, falls events and consequences of falls were discussed. This paper reports specifically on the impact of falls on the caring relationship. Three themes emerged: ‘learning as you go’, ‘we're always together’, ‘nobody was interested’. The findings demonstrate how falling accentuates the impact of dementia on the dyad. Spouse-carers' discussion of their own falls emphasise the need for joint assessment of health and wellbeing to reduce carer burden and preserve the couplehood of the dyad.

Download Full-text

Cultural adaptation and validation of the Polish version of the physical activity scale for older people living in a community: a cross-sectional study

European Review of Aging and Physical Activity ◽

10.1186/s11556-020-00252-8 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Agnieszka Wiśniowska-Szurlej ◽

Agnieszka Ćwirlej-Sozańska ◽

Natalia Wołoszyn ◽

Bernard Sozański ◽

Anna Wilmowska-Pietruszyńska ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Older People ◽

Cultural Adaptation ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Polish Version ◽

Activity Scale ◽

Physical Activity Scale

Abstract Background Polish clinicians and researchers face challenges in selecting physical activity tools appropriate and validated for older people. The aim of this study is to provide cultural adaptation and validation of the Polish version of the Physical Activity Scale for Elderly (PASE-P). Methods This cross-sectional study was carried out among 115 older adults living in south-eastern Poland. The original version of the scale has been translated into the Polish language following standardized translation procedures. Validation was evaluated by Pearson’s rank correlation coefficients between PASE-P, the normal Timed Up and Go test and that with a cognitive task (TUG and TUG cog, respectively), grip strength, basic and instrumental activities of daily living (ADL and IADL, respectively), Five Times Sit to Stand (5x STS), 10-m Walk Test (10MWT), the Berg Balance Scale (BBS) and the International Physical Activity Questionnaire (IPAQ). Results The mean PASE-P was 91.54 (SD 71.15). Sufficient reliability of the test-retest of the PASE-P questionnaire components was found between the trials. The ICC test was strong and ranged from 0.988 to 0.778 for both major domains and the total scale score. A significant correlation was found between the total PASE-P score and the shorter TUG, TUG cog (r = − 0.514, p < 0.001; r = − 0.481, p < 0.001) and 10MWT (r = 0.472, p < 0.001). The total PASE-P score was also positively correlated with ADL and IADL (r = 0.337, p < 0.001; r = 0.415 p < 0.001), BBS (r = 0.537, p < 0.001) and 5xSTS (r = 0.558, p < 0.001). Conclusions The results obtained in the study confirm that the Polish version of the PASE scale is a valid and reliable tool for assessing the level of physical activity in older adults living in a community.

Download Full-text

PARTICIPATION IN TWO EVIDENCE-BASED FALLS PREVENTION PROGRAMS AMONG OLDER ADULTS WITH AND WITHOUT A DISABILITY

Innovation in Aging ◽

10.1093/geroni/igz038.452 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S123-S124

Author(s):

Thomas J Eagen ◽

Ellen McGough ◽

Tracy Mroz ◽

Deborah Kartin ◽

Anjum Hajat ◽

...

Keyword(s):

Older Adults ◽

Program Effectiveness ◽

Fear Of Falling ◽

Prevention Programs ◽

Falls Prevention ◽

Original Research ◽

Evidence Based ◽

National Council ◽

Activity Restriction ◽

Using Data

Abstract Older adults with a disability are at greater risk for falls and injury due to falling compared to those without a disability. Evidence-based falls prevention programs (EBFPPs) have been developed and disseminated broadly, however individuals with disabilities were excluded from original research on effectiveness. Using data from the National Falls Prevention Database from the National Council on Aging, we compared the reach and effectiveness of two EBFPPs, A Matter of Balance (MOB) or Stepping On, between those with and without a disability. Program reach was measured using attendance percentage. Program effectiveness was measured using change in fear of falling (FOF), fall-related activity restriction (FAR), and falls self-efficacy (FSE) post-program. A total of 12,667 participants were analyzed. Participants were, on average, 76 years old (M = 76.18, SD = 9.86), largely female (75%), well educated (80% some college or higher), and white (90%). Nearly half self-reported a disability (40%). Older adults with a disability were as likely to attend (M = 0.88, SD = 0.14) the program compared to those without a disability (M = 0.88, SD = 0.14, p =.30). Older adults with a disability reported greater FOF and FAR and lower FSE compared to participants without a disability at baseline. Significant improvements were made across effectiveness measures, irrespective of disability status. MOB and Stepping On are effective programs, well attended by older adults with and without disabilities, however older adults with a disability continued to report higher FOF and FAR, and lower FSE compared to those without a disability.

Download Full-text