Safety, Feasibility, and Reliability of the Maximal Step Length, Gait Speed, and Chair Test Measured by Seniors Themselves: The Senior Step Study

Self-management of mobility and fall risk might be possible if older adults could use a simple and safe self-test to measure their own mobility, balance, and fall risk at home. The aim of this study was to determine the safety, feasibility, and intraindividual reliability of the maximal step length (MSL), gait speed (GS), and chair test (CT) as potential self-tests for assessing mobility and fall risk. Fifty-six community-dwelling older adults performed MSL, GS, and CT at home once a week during a four-week period, wherein the feasibility, test-retest reliability, coefficients of variation, and linear mixed models with random effects of these three self-tests were determined. Forty-nine subjects (mean age 76.1 years [SD: 4.0], 19 females [42%]) completed the study without adverse effects. Compared with the other self-tests, MSL gave the most often (77.6%) valid measurement results and had the best intraclass correlation coefficients (0.95 [95% confidence interval: 0.91−0.97]). MSL and GS gave no significant training effect, whereas CT did show a significant training effect (p < .01). Community-dwelling older adults can perform MSL safely, correctly, and reliably, and GS safely and reliably. Further research is needed to study the responsiveness and beneficial effects of these self-tests on self-management of mobility and fall risk.

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A Prediction Model for Falls in Community-Dwelling Older Adults in Podiatry Practices

Gerontology ◽

10.1159/000520962 ◽

2022 ◽

pp. 1-10

Author(s):

Danique J.J. van Gulick ◽

Sander I.B. Perry ◽

Marike van der Leeden ◽

Jolan G.M. van Beek ◽

Cees Lucas ◽

...

Keyword(s):

Older Adults ◽

Prediction Model ◽

Gait Speed ◽

Fall Risk ◽

Model Building ◽

Characteristic Curve ◽

External Validation ◽

Community Dwelling ◽

Internal Validation ◽

Community Dwelling Older Adults

Introduction: Falls are a worldwide health problem among community-dwelling older adults. Emerging evidence suggests that foot problems increase the risk of falling, so the podiatrist may be crucial in detecting foot-related fall risk. However, there is no screening tool available which can be used in podiatry practice. The predictive value of existing tools is limited, and the implementation is poor. The development of risk models for specific clinical populations might increase the prediction accuracy and implementation. Therefore, the aim of this study was to develop and internally validate an easily applicable clinical prediction model (CPM) that can be used in podiatry practice to predict falls in community-dwelling older adults with foot (-related) problems. Methods: This was a prospective study including community-dwelling older adults (≥65 years) visiting podiatry practices. General fall-risk variables, and foot-related and function-related variables were considered as predictors for the occurrence of falls during the 12-month follow-up. Logistic regression analysis was used for model building, and internal validation was done by bootstrap resampling. Results: 407 participants were analyzed; the event rate was 33.4%. The final model included fall history in the previous year, unsteady while standing and walking, plantarflexor strength of the lesser toes, and gait speed. The area under the receiver operating characteristic curve was 0.71 (95% CI: 0.66–0.76) in the sample and estimated as 0.65 after shrinkage. Conclusion: A CPM based on fall history in the previous year, feeling unsteady while standing and walking, decreased plantarflexor strength of the lesser toes, and reduced gait speed has acceptable accuracy to predict falls in our sample of podiatry community-dwelling older adults and is easily applicable in this setting. The accuracy of the model in clinical practice should be demonstrated through external validation of the model in a next study.

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Differences in fear of falling and fall risk indicators among white and black older adults: a cross sectional study

10.21203/rs.2.15996/v1 ◽

2019 ◽

Author(s):

Allison Anne Bay ◽

Smrithi Ramachandran ◽

Hayley A. Silverstein ◽

Jiayang Song ◽

Ariel R. Hart ◽

...

Keyword(s):

Older Adults ◽

Gait Speed ◽

Fall Risk ◽

Fear Of Falling ◽

Community Dwelling ◽

Wilcoxon Test ◽

Risk Indicators ◽

Physical Component Score ◽

Component Score ◽

Community Dwelling Older Adults

Abstract Background Falling among older adults is common and can cause chronic health complications. This study investigated differences between White and Black community-dwelling older adults in fall history, fear of falling, and indicators of fall risk.Methods All assessments and analyses were conducted in a clinical laboratory at Emory University in the Department of General Medicine and Geriatrics on 84 diverse community-dwelling older adults (White, n=37; Black, n=47). Statistical analyses included one-way ANOVA for continuous variables, the Fisher exact test for categorical variables, the Mann-Whitney-Wilcoxon test for ordinal variables, and an ordinal logistic regression model to examine which factors predicted fear of falling. Measures included fall history, fear of falling, and fall risk indicators. The Montreal Cognitive Assessment, Activities-Specific Balance Confidence Score, Gait Speed, Short Form 12 Physical Component Score and Mental Component Score, fear of falling and quality of life rating scales and demographics questionnaires were administered.Results Falls history was not significantly different between groups. Black participants had significantly fewer years of education (p=.007), lower MoCA scores (p=0.002), and slower fast gait speed (p=0.032) than White participants. However, Black participants reported significantly less fear of falling (p=0.043). Race (Black/White) (p=<0.001), sex (p=0.028), preferred gait speed (p=0.036), and a dichotomous variable of use of assistive device for walking (p=0.023) were significant predictors of fear of falling in the logistical model.Conclusions These factors may explain the observed differences in fear of falling observed between white and black groups in this study. This work offers an explanation of possible factors related to the well-documented yet poorly understood fact that while Black older adults have more risk factors for falling, White older adults tend to fall more frequently and are more afraid of falling.

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Associations between gait speed and well-known fall risk factors among community-dwelling older adults

Physiotherapy Research International ◽

10.1002/pri.1743 ◽

2018 ◽

Vol 24 (1) ◽

pp. e1743 ◽

Cited By ~ 22

Author(s):

Ingebjørg Lavrantsdatter Kyrdalen ◽

Pernille Thingstad ◽

Leiv Sandvik ◽

Heidi Ormstad

Keyword(s):

Risk Factors ◽

Older Adults ◽

Gait Speed ◽

Fall Risk ◽

Community Dwelling ◽

Fall Risk Factors ◽

Community Dwelling Older Adults

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Dual Decline in Gait and Cognition Is Associated With Future Dementia: Evidence for a Phenotype

Innovation in Aging ◽

10.1093/geroni/igaa057.846 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 264-264

Author(s):

Manuel Montero Odasso ◽

Mark Speechley ◽

Richard Camicioli ◽

Nellie Kamkar ◽

Qu Tian ◽

...

Keyword(s):

Older Adults ◽

Gait Speed ◽

Regression Models ◽

Community Dwelling ◽

Hierarchical Regression ◽

Chi Square ◽

Cox Models ◽

Incident Dementia ◽

Risk Of Progression ◽

Community Dwelling Older Adults

Abstract BACKGROUND: The concurrent decline in gait speed and cognition are associated with future dementia. However, the clinical profile of those who present with dual-decline has not yet been described. We aimed to describe the phenotype and risk for incident dementia of individuals who present a dual-decline in comparison with non dual-decliners. METHODS: Prospective cohort of community-dwelling older adults free of dementia at baseline. We evaluated participants’ gait speed, cognition, medical status, functionality, incidence of adverse events, and dementia biannually over 7 years. Gait speed was assessed with a 6-meter electronic-walkway, and global cognition was assessed using the MoCA test. We compared characteristics between dual-decliners and non dual-decliners using t-test, Chi-square, and hierarchical regression models. We estimated incident dementia using Cox models. RESULTS: Among 144 participants (mean age 74.23 ± 6.72 years, 54% women), 17% progressed to dementia. Dual-decliners had a three-fold risk (HR: 3.12, 95%CI:1.23-7.93, p=0.017) of progression to dementia compared with non dual-decliners. Dual-decliners were significantly older with a higher prevalence of hypertension and dyslipidemia (p=0.002). Hierarchical regression models show that age and sex alone explained 3% of the variation in the dual-decliners group, while adding hypertension and dyslipidemia increased the explained variation to 8% and 10 %, respectively. The risk of becoming a dual-decliner was 4-fold if hypertension was present. CONCLUSION: Older adults with concurrent decline in gait speed and cognition represent a group at the highest risk of progression to dementia. These dual-decliners have a distinct phenotype with a higher prevalence of hypertension, a potentially treatable condition.

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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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Association between Physical Frailty Subdomains and Oral Frailty in Community-Dwelling Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062931 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2931

Author(s):

Ryo Komatsu ◽

Koutatsu Nagai ◽

Yoko Hasegawa ◽

Kazuki Okuda ◽

Yuto Okinaka ◽

...

Keyword(s):

Older Adults ◽

Gait Speed ◽

Community Dwelling ◽

Health Study ◽

Cardiovascular Health Study ◽

Physical Frailty ◽

Cross Sectional ◽

Important Indicator ◽

Community Dwelling Older Adults ◽

Oral Frailty

This cross-sectional study aimed to demonstrate the association between physical frailty subdomains and oral frailty. This study involved community-dwelling older adults (aged ≥65 years). Physical frailty was assessed with the Japanese version of the Cardiovascular Health Study criteria. Oral frailty was defined as limitations in at least three of six domains. Logistic regression analysis was used to analyze the association between physical frailty risk and oral frailty. In addition, we examined the association between physical frailty subdomains (gait speed, grip strength, exhaustion, low physical activity, and weight loss) and oral frailty. A total of 380 participants were recruited for this study. Overall, 18% and 14% of the participants were at risk of physical frailty and had oral frailty, respectively. Physical frailty risk (odds ratio (OR) = 2.40, 95% confidence interval (CI): 1.22–4.75, p = 0.012) was associated with oral frailty in multivariate analysis. In secondary analysis, among physical frailty subdomains, gait speed (OR = 0.85, 95% CI: 0.73–0.97, p = 0.019) was associated with oral frailty. The present findings suggest that physical frailty is closely related to oral frailty. Among physical frailty subdomains, decreased gait speed in particular is an important indicator related to the development of oral frailty.

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How wearable sensors have been utilised to evaluate frailty in older adults: a systematic review

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00909-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Grainne Vavasour ◽

Oonagh M. Giggins ◽

Julie Doyle ◽

Daniel Kelly

Keyword(s):

Systematic Review ◽

Older Adults ◽

Gait Speed ◽

Outcome Measurement ◽

Wearable Sensors ◽

Adverse Outcomes ◽

Community Dwelling ◽

Ageing Population ◽

Application Development ◽

Community Dwelling Older Adults

Abstract Background Globally the population of older adults is increasing. It is estimated that by 2050 the number of adults over the age of 60 will represent over 21% of the world’s population. Frailty is a clinical condition associated with ageing resulting in an increase in adverse outcomes. It is considered the greatest challenge facing an ageing population affecting an estimated 16% of community-dwelling populations worldwide. Aim The aim of this systematic review is to explore how wearable sensors have been used to assess frailty in older adults. Method Electronic databases Medline, Science Direct, Scopus, and CINAHL were systematically searched March 2020 and November 2020. A search constraint of articles published in English, between January 2010 and November 2020 was applied. Papers included were primary observational studies involving; older adults aged > 60 years, used a wearable sensor to provide quantitative measurements of physical activity (PA) or mobility and a measure of frailty. Studies were excluded if they used non-wearable sensors for outcome measurement or outlined an algorithm or application development exclusively. The methodological quality of the selected studies was assessed using the Appraisal Tool for Cross-sectional Studies (AXIS). Results Twenty-nine studies examining the use of wearable sensors to assess and discriminate between stages of frailty in older adults were included. Thirteen different body-worn sensors were used in eight different body-locations. Participants were community-dwelling older adults. Studies were performed in home, laboratory or hospital settings. Postural transitions, number of steps, percentage of time in PA and intensity of PA together were the most frequently measured parameters followed closely by gait speed. All but one study demonstrated an association between PA and level of frailty. All reports of gait speed indicate correlation with frailty. Conclusions Wearable sensors have been successfully used to evaluate frailty in older adults. Further research is needed to identify a feasible, user-friendly device and body-location that can be used to identify signs of pre-frailty in community-dwelling older adults. This would facilitate early identification and targeted intervention to reduce the burden of frailty in an ageing population.

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Physical Restraint of Older Adults at Home: Preliminary Analysis of a Prospective Cohort Study

Innovation in Aging ◽

10.1093/geroni/igaa057.2380 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 683-683

Author(s):

Asa Inagaki ◽

Ayumi Igarashi ◽

Maiko Noguchi-Watanabe ◽

Mariko Sakka ◽

Chie Fukui ◽

...

Keyword(s):

Older Adults ◽

Online Survey ◽

Physical Restraint ◽

Community Dwelling ◽

Physical Restraints ◽

Care Nurse ◽

Factors Associated ◽

Home Care Nurse ◽

Community Dwelling Older Adults ◽

At Home

Abstract Our study aimed to explore the prevalence and factors of physical restraints among frail to dependent older adults living at home. We conducted an online survey to ask about the physical/mental conditions, demographics, service utilization, and physical restraints of community-dwelling older adults. Either home care nurse or care managers who were responsible for the older adult answered the survey that were conducted at baseline and one month later. We obtained data from 1,278 individuals. Physical restraint was reported for 53 (4.1%) participants. Multiple logistic regression revealed the factors associated with physical restraints at home: having been restrained at baseline, having pneumonia or heart failure, receiving home bathing, or using rental assistive devices were associated with physical restraints at one month. The findings could be used to promote discussion about which services prevent physical restraints and what we should do to support clients and their family to stay at home safely.

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Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults

BMC Geriatrics ◽

10.1186/s12877-020-01936-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Teuni H. Rooijackers ◽

G. A. Rixt Zijlstra ◽

Erik van Rossum ◽

Ruth G. M. Vogel ◽

Marja Y. Veenstra ◽

...

Keyword(s):

Older Adults ◽

Training Program ◽

Process Evaluation ◽

Community Dwelling ◽

Team Approach ◽

Staff Members ◽

Care Plans ◽

Lump Sum ◽

Community Dwelling Older Adults ◽

At Home

Abstract Background Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults’ self-care skills and jeopardizing their ability to continue living at home. Reablement is an innovative care approach aimed at optimizing independence. The reablement training program ‘Stay Active at Home’ for homecare staff was designed to support the implementation of reablement in the delivery of homecare services. This study evaluated the implementation, mechanisms of impact and context of the program. Methods We conducted a process evaluation alongside a 12-month cluster randomized controlled trial, using an embedded mixed-methods design. One hundred fifty-four homecare staff members (23 nurses, 34 nurse assistants, 8 nurse aides and 89 domestic workers) from five working areas received the program. Data on the implementation (reach, dose, fidelity, adaptations and acceptability), possible mechanisms of impact (homecare staff's knowledge, attitude, skills and support) and context were collected using logbooks, registration forms, checklists, log data and focus group interviews with homecare staff (n = 23) and program trainers (n = 4). Results The program was largely implemented as intended. Homecare staff's average compliance to the program meetings was 73.4%; staff members accepted the program, and particularly valued its practical elements and team approach. They experienced positive changes in their knowledge, attitude and skills about reablement, and perceived social and organizational support from colleagues and team managers to implement reablement. However, the extent to which homecare staff implemented reablement in practice, varied. Perceived facilitators included digital care plans, the organization’s lump sum funding and newly referred clients. Perceived barriers included resistance to change from clients or their social network, complex care situations, time pressure and staff shortages. Conclusions The program was feasible to implement in the Dutch homecare setting, and was perceived as useful in daily practice. Nevertheless, integrating reablement into homecare staff's working practices remained challenging due to various personal and contextual factors. Future implementation of the program may benefit from minor program adaptations and a more stimulating work environment. Trial registration ClinicalTrials.gov (Identifier NCT03293303). Registered 26 September 2017.

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