Choice stepping reaction time test using exergame technology for fall risk assessment in older people

Background: Choice stepping reaction time tasks are underpinned by neuropsychological, sensorimotor, and balance systems and therefore offer good indices of fall risk and physical and cognitive frailty. However, little is known of the neural mechanisms for impaired stepping and associated fall risk in older people. We investigated cognitive and motor cortical activity during cognitively demanding stepping reaction time tasks using functional near-infrared spectroscopy (fNIRS) in older people at low and high fall risk.Methods: Ninety-five older adults [mean (SD) 71.4 (4.9) years, 23 men] were categorized as low or high fall risk [based on 12-month fall history (≥2 falls) and/or Physiological Profile Assessment fall risk score ≥1]. Participants performed a choice stepping reaction time test and a more cognitively demanding Stroop stepping task on a computerized step mat. Cortical activity in cognitive [dorsolateral prefrontal cortex (DLPFC)] and motor (supplementary motor area and premotor cortex) regions was recorded using fNIRS. Stepping performance and cortical activity were contrasted between the groups and between the choice and Stroop stepping conditions.Results: Compared with the low fall risk group (n = 71), the high fall risk group (n = 24) exhibited significantly greater DLPFC activity and increased intra-individual variability in stepping response time during the Stroop stepping task. The high fall risk group DLPFC activity was greater during the performance of Stroop stepping task in comparison with choice stepping reaction time. Regardless of group, the Stroop stepping task elicited increased cortical activity in the supplementary motor area and premotor cortex together with increased mean and intra-individual variability of stepping response times.Conclusions: Older people at high fall risk exhibited increased DLPFC activity and stepping response time variability when completing a cognitively demanding stepping test compared with those at low fall risk and to a simpler choice-stepping reaction time test. This increased hemodynamic response might comprise a compensatory process for postural control deficits and/or reflect a degree of DLPFC neural inefficiency in people with increased fall risk.

Download Full-text

Reducing waste in evaluation studies on fall risk assessment tools for older people

Journal of Clinical Epidemiology ◽

10.1016/j.jclinepi.2018.05.005 ◽

2018 ◽

Vol 102 ◽

pp. 139-143 ◽

Cited By ~ 1

Author(s):

Gabriele Meyer ◽

Ralph Möhler ◽

Sascha Köpke

Keyword(s):

Risk Assessment ◽

Older People ◽

Fall Risk ◽

Evaluation Studies ◽

Assessment Tools ◽

Fall Risk Assessment ◽

Risk Assessment Tools

Download Full-text

Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach

BMC Public Health ◽

10.1186/s12889-021-10813-w ◽

2021 ◽

Vol 21 (S2) ◽

Author(s):

Jorge Bravo ◽

Hugo Rosado ◽

Pablo Tomas-Carus ◽

Cristina Carrasco ◽

Nuno Batalha ◽

...

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Clinical Practice ◽

Older People ◽

Risk Score ◽

Fall Risk ◽

Community Dwelling ◽

Fall Risk Assessment ◽

Standardized Residuals ◽

Community Dwelling Older People

Abstract Background Fall risk assessment in older people is of major importance for providing adequate preventive measures. Current predictive models are mainly focused on intrinsic risk factors and do not adjust for contextual exposure. The validity and utility of continuous risk scores have already been demonstrated in clinical practice in several diseases. In this study, we aimed to develop and validate an intrinsic-exposure continuous fall risk score (cFRs) for community-dwelling older people through standardized residuals. Methods Self-reported falls in the last year were recorded from 504 older persons (391 women: age 73.1 ± 6.5 years; 113 men: age 74.0 ± 6.1 years). Participants were categorized as occasional fallers (falls ≤1) or recurrent fallers (≥ 2 falls). The cFRs was derived for each participant by summing the standardized residuals (Z-scores) of the intrinsic fall risk factors and exposure factors. Receiver operating characteristic (ROC) analysis was used to determine the accuracy of the cFRs for identifying recurrent fallers. Results The cFRs varied according to the number of reported falls; it was lowest in the group with no falls (− 1.66 ± 2.59), higher in the group with one fall (0.05 ± 3.13, p < 0.001), and highest in the group with recurrent fallers (2.82 ± 3.94, p < 0.001). The cFRs cutoff level yielding the maximal sensitivity and specificity for identifying recurrent fallers was 1.14, with an area under the ROC curve of 0.790 (95% confidence interval: 0.746–0.833; p < 0.001). Conclusions The cFRs was shown to be a valid dynamic multifactorial fall risk assessment tool for epidemiological analyses and clinical practice. Moreover, the potential for the cFRs to become a widely used approach regarding fall prevention in community-dwelling older people was demonstrated, since it involves a holistic intrinsic-exposure approach to the phenomena. Further investigation is required to validate the cFRs with other samples since it is a sample-specific tool.

Download Full-text

Chair rise transfer detection and analysis using a pendant sensor: An algorithm for fall risk assessment in older people

2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society ◽

10.1109/embc.2014.6943965 ◽

2014 ◽

Cited By ~ 5

Author(s):

Wei Zhang ◽

G. Ruben H. Regterschot ◽

Fabian Wahle ◽

Hilde Geraedts ◽

Heribert Baldus ◽

...

Keyword(s):

Risk Assessment ◽

Older People ◽

Fall Risk ◽

Fall Risk Assessment ◽

Chair Rise

Download Full-text

Fall Risk Assessment in Older People

The International Journal of Engineering and Science ◽

10.9790/1813-05110114 ◽

2016 ◽

Vol 5 (11) ◽

pp. 01-14 ◽

Cited By ~ 3

Author(s):

Maryam Ghahramani

Keyword(s):

Risk Assessment ◽

Older People ◽

Fall Risk ◽

Fall Risk Assessment

Download Full-text

The meaning of the experience of anticipating falling

Ageing and Society ◽

10.1017/s0144686x14000798 ◽

2014 ◽

Vol 35 (9) ◽

pp. 1839-1863 ◽

Cited By ~ 2

Author(s):

JAMES A. SHAW ◽

DENISE M. CONNELLY ◽

CAROL L. MCWILLIAM

Keyword(s):

Risk Assessment ◽

Older People ◽

Health Care Providers ◽

Fall Prevention ◽

Fall Risk ◽

Phenomenological Study ◽

Later Life ◽

Care Providers ◽

Structured Interviews ◽

Fall Risk Assessment

ABSTRACTFalling in later life continues to be a critical issue in gerontology research, health professional practice and ageing health policy. However, much research in the area of fall risk and fall prevention neglects the meaning of the experiences of older people themselves. This humanistic interpretive phenomenological study explored the meaning of the experience of anticipating falling from the perspective of older people in order to foster a more person-focused approach to fall risk assessment and fall prevention. Individual semi-structured interviews were conducted with nine participants over the age of 65 living independently in the community. Follow-up interviews with two key informants were completed to inform the emerging interpretations. For older participants residing in the community, the experience of anticipating falling meant confronting their embodied lived-identity in the context of ageing. Experiential learning shaped how participants understood the meaning of falling, which constituted tacit, pathic knowledge of vulnerability and anxiety with respect to falling. Findings emphasise the importance of critically reflecting on the social experience of anticipating falling to develop effective and relevant fall prevention interventions, programmes and policies. A lifeworld-led approach to fall risk assessment and fall prevention resonates with these findings, and may encourage health-care providers to adopt a sustained focus on embodied lived-identity and quality of life when engaging older people in fall prevention activities.

Download Full-text