scholarly journals The Stepping Threshold Test for Reactive Balance: Validation of Two Observer-Based Evaluation Strategies to Assess Stepping Behavior in Fall-Prone Older Adults

2021 ◽  
Vol 3 ◽  
Author(s):  
Michael Adams ◽  
Leon Brüll ◽  
Monika Lohkamp ◽  
Michael Schwenk
Keyword(s):  
Older Adults ◽  
Clinical Setting ◽  
Ceiling Effect ◽  
Floor Effect ◽  
Threshold Test ◽  
Evaluation Strategies ◽  
Study Results ◽  
Sum Scores ◽  
Perturbation Direction ◽  
Reactive Balance

Introduction: Measurement of reactive balance is critical for fall prevention but is severely underrepresented in the clinical setting due to the lack of valid assessments. The Stepping Threshold Test (STT) is a newly developed instrumented test for reactive balance on a movable platform, however, it has not yet been validated for fall-prone older adults. Furthermore, different schemes of observer-based evaluation seem possible. The aim of this study was to investigate validity with respect to fall risk, interpretability, and feasibility of the STT using two different evaluation strategies.Methods: This study involved 71 fall-prone older adults (aged ≥ 65) who underwent progressively increasing perturbations in four directions for the STT. Single and multiple-step thresholds for each perturbation direction were determined via two observer-based evaluation schemes, which are the 1) consideration of all steps (all-step-count evaluation, ACE) and 2) consideration of those steps that extend the base of support in the direction of perturbation (direction-sensitive evaluation, DSE). Established balance measures including global (Brief Balance Evaluations Systems Test, BriefBEST), proactive (Timed Up and Go, TUG), and static balance (8-level balance scale, 8LBS), as well as fear of falling (Short Falls Efficacy Scale—International, FES-I) and fall occurrence in the past year, served as reference measurements.Results: The sum scores of STT correlated moderately with the BriefBEST (ACE: r = 0.413; DSE: r = 0.388) and TUG (ACE: r = −0.379; DSE: r = −0.435) and low with the 8LBS (ACE: r = 0.173; DSE: r = 0.246) and Short FES-I (ACE: r = −0.108; DSE: r = −0.104). The sum scores did not distinguish between fallers and non-fallers. No floor/ceiling effects occurred for the STT sum score, but these effects occurred for specific STT thresholds for both ACE (mean floor effect = 13.04%, SD = 19.35%; mean ceiling effect = 4.29%, SD = 7.75%) and DSE (mean floor effect = 7.86%, SD = 15.23%; mean ceiling effect = 21.07%, SD = 26.08). No severe adverse events occurred.Discussion: Correlations between the STT and other balance tests were in the expected magnitude, indicating convergent validity. However, the STT could not distinguish between fallers and non-fallers, referring to a need for further studies and prospective surveys of falls to validate the STT. Current results did not allow a definitive judgment on the advantage of using ACE or DSE. Study results represented a step toward a reactive balance assessment application in a clinical setting.

scholarly journals HIT-6 and EQ-5D-5L in patients with migraine: assessment of common latent constructs and development of a mapping algorithm

2021 ◽  
Author(s):  
Ana Sofia Oliveira Gonçalves ◽  
Dimitra Panteli ◽  
Lars Neeb ◽  
Tobias Kurth ◽  
Annette Aigner
Keyword(s):  
Factor Analysis ◽  
Exploratory Factor Analysis ◽  
Controlled Trial ◽  
Ceiling Effect ◽  
Repeated Measurements ◽  
Economic Evaluations ◽  
Floor Effect ◽  
Mapping Algorithm ◽  
Latent Constructs ◽  
Randomised Controlled

Abstract Objective The aims of this study were to assess whether there is a conceptual overlap between the questionnaires HIT-6 and EQ-5D and to develop a mapping algorithm allowing the conversion of HIT-6 to EQ-5D utility scores for Germany. Methods This study used data from an ongoing randomised controlled trial for patients suffering from migraine. We assessed the conceptual overlap between the two instruments with correlation matrices and exploratory factor analysis. Linear regression, tobit, mixture, and two-part models were used for mapping, accounting for repeated measurements, tenfold cross-validation was conducted to validate the models. Results We included 1010 observations from 410 patients. The EQ-5D showed a substantial ceiling effect (47.3% had the highest score) but no floor effect, while the HIT-6 showed a very small ceiling effect (0.5%). The correlation between the instruments’ total scores was moderate (− 0.30), and low to moderate among each domain (0.021–0.227). The exploratory factor analysis showed insufficient conceptual overlap between the instruments, as they load on different factors. Thus, there is reason to believe that the instruments’ domains do not capture the same latent constructs. To facilitate future mapping, we provide coefficients and a variance–covariance matrix for the preferred model, a two-part model with the total HIT-6 score as the explanatory variable. Conclusion This study showed that the German EQ-5D and the HIT-6 lack the conceptual overlap needed for appropriate mapping. Thus, the estimated mapping algorithms should only be used as a last resort for estimating utilities to be employed in economic evaluations.

Variants of the Circle of Willis as seen on magnetic resonance angiography and carotid siphon calcifications in community-dwelling older adults

2021 ◽  
pp. 197140092110428
Author(s):  
Oscar H Del Brutto ◽  
Bettsy Y. Recalde ◽  
Robertino M Mera
Keyword(s):  
Older Adults ◽  
Magnetic Resonance ◽  
Calcium Content ◽  
Circle Of Willis ◽  
Community Dwelling ◽  
Anatomical Variants ◽  
Study Results ◽  
High Calcium ◽  
Independent Association ◽  
Community Dwelling Older Adults

Background and purpose Information on the association between anatomical variants of the Circle of Willis (CoW) and intracranial atherosclerotic disease (ICAD) is limited and results are controversial. In this population-based study, we aimed to assess whether an incomplete CoW is associated with high calcium content in carotid siphons (a reliable biomarker of ICAD) in community-dwelling older adults of Amerindian ancestry. Methods Individuals aged ≥60 years enrolled in the Three Villages Study received a head computed tomography (CT) and magnetic resonance angiogram (MRA) of intracranial vessels. The CoW was classified in complete or incomplete according to the presence or absence of one A1 segment of the anterior cerebral artery or one or both P1 segments of posterior cerebral arteries. Calcium content in carotid siphons was rated as low or high. A multivariate logistic model was fitted to assess the independent association between incompleteness of the CoW and high calcium content in carotid siphons, after adjusting for demographics and cardiovascular risk factors. Results A total of 581 individuals were enrolled (mean age: 71 ± 8.4 years; 57% women). MRA revealed an incomplete CoW in 227 (39%) individuals, and high-resolution CT disclosed high calcium content in carotid siphons in 185 (32%). A risk factor logistic regression model showed no independent association between incompleteness of the CoW and high calcium content in carotid siphons (odds ratio: 0.91; 95% confidence interval: 0.62–1.34; p = 0.631). Conclusion Study results disclosed no association between anatomical variants of the CoW and the presence of high calcium content in carotid siphons.

scholarly journals Examining Rural and Racial Disparities in the Relationship Between Loneliness and Social Technology Use Among Older Adults

2021 ◽  
Vol 9 ◽  
Author(s):  
Kaileigh A. Byrne ◽  
Reza Ghaiumy Anaraky ◽  
Cheryl Dye ◽  
Lesley A. Ross ◽  
Kapil Chalil Madathil ◽  
...  
Keyword(s):  
Older Adults ◽  
Racial Disparities ◽  
Technology Use ◽  
Social Engagement ◽  
Social Contact ◽  
Primary Study ◽  
Social Technology ◽  
Study Results ◽  
The Relationship ◽  
Rural Older Adults

Loneliness, the subjective negative experience derived from a lack of meaningful companionship, is associated with heightened vulnerability to adverse health outcomes among older adults. Social technology affords an opportunity to cultivate social connectedness and mitigate loneliness. However, research examining potential inequalities in loneliness is limited. This study investigates racial and rural-urban differences in the relationship between social technology use and loneliness in adults aged 50 and older using data from the 2016 wave of the Health and Retirement Study (N = 4,315). Social technology use was operationalized as the self-reported frequency of communication through Skype, Facebook, or other social media with family and friends. Loneliness was assessed using the UCLA Loneliness scale, and rural-urban differences were based on Beale rural-urban continuum codes. Examinations of race focused on differences between Black/African-American and White/Caucasian groups. A path model analysis was performed to assess whether race and rurality moderated the relationship between social technology use and loneliness, adjusting for living arrangements, age, general computer usage. Social engagement and frequency of social contact with family and friends were included as mediators. The primary study results demonstrated that the association between social technology use and loneliness differed by rurality, but not race. Rural older adults who use social technology less frequently experience greater loneliness than urban older adults. This relationship between social technology and loneliness was mediated by social engagement and frequency of social contact. Furthermore, racial and rural-urban differences in social technology use demonstrated that social technology use is less prevalent among rural older adults than urban and suburban-dwelling older adults; no such racial differences were observed. However, Black older adults report greater levels of perceived social negativity in their relationships compared to White older adults. Interventions seeking to address loneliness using social technology should consider rural and racial disparities.

scholarly journals Cortical Engagement Metrics During Reactive Balance Are Associated With Distinct Aspects of Balance Behavior in Older Adults

2021 ◽  
Vol 13 ◽  
Author(s):  
Jacqueline A. Palmer ◽  
Aiden M. Payne ◽  
Lena H. Ting ◽  
Michael R. Borich
Keyword(s):  
Older Adults ◽  
Balance Control ◽  
Network Activity ◽  
Beta Activity ◽  
Balance Function ◽  
Potential Biomarker ◽  
Beta Power ◽  
Wide Range ◽  
Motor Cortical ◽  
Reactive Balance

Heightened reliance on the cerebral cortex for postural stability with aging is well-known, yet the cortical mechanisms for balance control, particularly in relation to balance function, remain unclear. Here we aimed to investigate motor cortical activity in relation to the level of balance challenge presented during reactive balance recovery and identify circuit-specific interactions between motor cortex and prefrontal or somatosensory regions in relation to metrics of balance function that predict fall risk. Using electroencephalography, we assessed motor cortical beta power, and beta coherence during balance reactions to perturbations in older adults. We found that individuals with greater motor cortical beta power evoked following standing balance perturbations demonstrated lower general clinical balance function. Individual older adults demonstrated a wide range of cortical responses during balance reactions at the same perturbation magnitude, showing no group-level change in prefrontal- or somatosensory-motor coherence in response to perturbations. However, older adults with the highest prefrontal-motor coherence during the post-perturbation, but not pre-perturbation, period showed greater cognitive dual-task interference (DTI) and elicited stepping reactions at lower perturbation magnitudes. Our results support motor cortical beta activity as a potential biomarker for individual level of balance challenge and implicate prefrontal-motor cortical networks in distinct aspects of balance control involving response inhibition of reactive stepping in older adults. Cortical network activity during balance may provide a neural target for precision-medicine efforts aimed at fall prevention with aging.

scholarly journals Body Composition in Community-Dwelling Older Adults Before and After SARS-CoV-2 Infection: A Longitudinal Prospective Study in a Rural Village Struck by the Pandemic

2021 ◽  
Vol 12 ◽  
pp. 215013272110477
Author(s):  
Oscar H. Del Brutto ◽  
Robertino M. Mera ◽  
Denisse A. Rumbea ◽  
Pedro Pérez ◽  
Bettsy Y. Recalde ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Body Composition ◽  
Regression Models ◽  
Community Dwelling ◽  
The Body ◽  
Study Results ◽  
The Impact ◽  
Community Dwelling Older Adults

Background: Information on the body composition of inhabitants of remote communities during the SARS-CoV-2 pandemic is limited. Using a longitudinal population-based study design, we assessed the association between SARS-CoV-2 infection and changes in body composition. Methods: Community-dwelling older adults living in a rural Ecuadorian village received body composition determinations before and 1 year after the pandemic as well as serological tests for detection of SARS-CoV-2 antibodies. The independent association between SARS-CoV-2 infection and abnormalities in body composition at follow-up was assessed by fitting linear mixed models for longitudinal data. Results: Of 327 enrolled individuals, 277 (85%) received baseline and follow-up body composition determinations, and 175 (63%) of them became SARS-CoV-2 seropositive. Overall, diet and physical activity deteriorated during the follow-up. Multivariate random-effects generalized least squares regression models that included the impact of time and seropositivity on follow-up body composition, showed that neither variable contributed to a worsening in body composition. Multivariate logistic regression models disclosed that the serological status at follow-up cannot be predicted by differences in body composition and other baseline covariates. Conclusions: Study results suggest no increased susceptibility to SARS-CoV-2 infection among older adults with abnormal body composition and no significant changes as a result of worse physical activity and dietary habits or seropositivity during the length of the study. Together with a previous study in the same population that showed decrease in hand-grip strength after SARS-CoV-2, results confirm that dynapenia (and not sarcopenia) is associated with SARS-CoV-2 infection in older adults.

scholarly journals Frailty Indexed Classification of Bangladeshi Older Adults’ Physio-psychosocial Health and Associated Risk Factors- A Cross-sectional Survey Study

2020 ◽  
Author(s):  
Mohammad Meshbahur Rahman ◽  
Mohammad Hamiduzzaman ◽  
Saleha Akter ◽  
Zaki Farhana ◽  
Mohammad Kamal Hossain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Health Status ◽  
Family Income ◽  
Psychosocial Health ◽  
Poor Health ◽  
Medical Conditions ◽  
Cross Sectional ◽  
Study Results ◽  
Associated Risk Factors

Abstract Background: Frailty is associated with healthy ageing, and it has been identified as a means of measuring older adults’ physio-psychosocial health. We know about the ageing trends and common diseases of older adults living in South Asia, but literature to date does not widely feature their health status based on frailty, especially in Bangladesh. This study aims to understand the prevalence of frailty in Bangladeshi older adults; classify their health status; and investigate associated risk factors.Methods: A cross-sectional study was conducted in the north-eastern region (i.e. Sylhet City Corporation) of Bangladesh. Four hundred participants aged 55 years and above were randomly selected, attended a health assessment session and completed a multi-indicator survey questionnaire. We developed a 30-indicator Frailty Index (FI30) to assess the participant’s health status and categorized: good health (no-frailty/Fit); slightly poor health (mild frailty); poor health (moderate frailty); and very poor health (severe frailty). Pearson chi-square test and binary logistic regression analysis were conducted.Results: The participants’ mean age was 63.6 years, and 61.6% of them were assessed in poor to very poor health (moderate frailty/36.3% - severe frailty/25.3%). The eldest, female and participants from lower family income were found more frailty than their counterparts. Participants aged 70 years and above were more likely (adjusted OR: 4.23, 95 % CI: 2.26–7.92, p < 0.0001) to experience frailty (medical conditions) than the pre-elderly age group (55-59 years). Female participants were more vulnerable (adjusted OR=1.487, 95% CI: 0.84-2.64, p < 0.0174) to frailty (medical conditions) than male. Also, older adults who had higher family income (Income>$473.3) found a lower risk (adjusted OR: 0.294, 95% CI: 0.11-0.76, p<0.011) of frailty (poor health).Conclusion: Our study results confirm the prevalence of frailty-related disorders in Bangladeshi older adults and highlight the importance of targeted clinical and community-led preventive care programs.

scholarly journals eMSQOL-29: Prospective validation of the abbreviated, electronic version of MSQOL-54

2018 ◽  
Vol 25 (6) ◽  
pp. 856-866 ◽  
Author(s):  
Rosalba Rosato ◽  
Silvia Testa ◽  
Antonio Bertolotto ◽  
Francesco Scavelli ◽  
Ambra M Giovannetti ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Sexual Function ◽  
Depression Scale ◽  
Social Function ◽  
Criterion Validity ◽  
Electronic Version ◽  
Ceiling Effect ◽  
Floor Effect

Background: We recently devised a shortened version of the 54-item Multiple Sclerosis Quality of Life (MSQOL-54) in paper (MSQOL-29, consisting of 25 items forming 7 subscales and 4 single items, and one filter question for 3 ‘sexual function’ items) and electronic format (eMSQOL-29). Objectives: To prospectively assess eMSQOL-29 psychometric properties, acceptability/equivalence versus MSQOL-29. Methods: Multiple sclerosis (MS) patients ( n = 623; Expanded Disability Status Scale (EDSS) range 0.0–9.0) completed eMSQOL-29, Hospital Anxiety and Depression Scale, Functional Assessment of MS (FAMS), European Quality of life Five Dimensions-3L, and received EDSS and Symbol Digit Modalities Test (SDMT). Equivalence versus MSQOL-29 was assessed in 242 patients (randomized cross-over design). Results: ‘Sexual function’ items were filtered out by 273 patients (47%). No multi-item scale had floor effect, while five had ceiling effect. Cronbach’s alpha range was 0.88–0.90. Confirmatory factor analysis showed good overall fit and the two-factor solution for composite scores was confirmed. Criterion validity was sub-optimal for ‘cognitive function’ (vs SDMT, r = 0.25) and ‘social function’ (vs FAMS social function, r = 0.38). eMSQOL-29 equivalence was confirmed and its acceptability was good. Conclusion: eMSQOL-29 showed good internal consistency, factor structure and no floor effect, while most subscales had some ceiling effect. Criterion validity was sub-optimal for two subscales. Equivalence and acceptability were good.

scholarly journals Factors Associated with Successful Aging among Community-Dwelling Older Adults Based on Ecological System Model

2020 ◽  
Vol 17 (9) ◽  
pp. 3220 ◽  
Author(s):  
Hye-Young Jang
Keyword(s):  
Older Adults ◽  
Successful Aging ◽  
Living Arrangement ◽  
Individual Characteristics ◽  
Community Dwelling ◽  
Ecological System ◽  
System Model ◽  
Healthcare Intervention ◽  
Factors Associated ◽  
Study Results

This study was conducted to identify the factors associated with successful aging in older adults based on the ecological system model. Data from the 2017 National Survey of the Living Conditions of Korean Elderly were used. Participants comprised 10,074 older adults. The three principal components in the successful aging model developed by Rowe and Kahn, “absence of disease and disease-related disability,” “maintenance of high mental and physical function,” and “continued engagement with life,” were used to determine successful aging. The collected data were analyzed using descriptive statistics, chi-squared test, t-test, and logistic regression. The study results showed that the correlation factors were age, sex, educational level, economic status, heavy drinking, subjective health status, and health screening in the individual system; living arrangement, satisfaction with spouse, and frequency of contacting family, siblings, and relatives in the family system; and the frequency of contacting neighbors and friends, number of close neighbors and friends, and accessibility of neighborhood facilities in the community system. This study is significant because it confirms that individual characteristics and the environmental systems surrounding older adults should be considered for successful aging; it is necessary to develop and apply healthcare intervention programs that consider both of these aspects.

scholarly journals Exploring the Influencing Factors of Health Literacy among Older Adults: A Cross-Sectional Survey

Medicina ◽  
2020 ◽  
Vol 56 (7) ◽  
pp. 330
Author(s):  
Hsiao-Ting Chiu ◽  
Han-Wei Tsai ◽  
Ken N. Kuo ◽  
Angela Y.M. Leung ◽  
Yao-Mao Chang ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Literacy ◽  
Influencing Factors ◽  
Situational Factors ◽  
Personal Factors ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Study Results ◽  
Literacy Survey ◽  
European Health

Background and Objectives: To investigate the health literacy (HL) among older adults in Taiwan, we referenced an existing integrated model of HL to confirm the influencing factors of HL in older adults. We propose this study to examine the personal, situational, and socioenvironmental factors influencing HL among older adults. Materials and Methods: A cross-sectional survey was conducted at a district hospital and affiliated community center in northern Taiwan from August 2016 to May 2017. This study used the Mandarin Chinese version of the European Health Literacy Survey Questionnaire (EU-Q47). We designed three models based on the three domains of HL. Model 1 assesses personal factors. Model 2 incorporates situational factors. Model 3 adds the socioenvironmental factor. Results: We recruited 161 participants aged over 65 years. Most adults in this study had limited overall HL. The final regression model revealed that age >85 years, unknown insurance status, and dominant spoken dialect of Hakka or Taiwanese were significantly associated with higher scores of HL. Conclusions: Our study results may help clinicians with early identification of older adults at high risk for poor HL and help health administrators establish geriatric policies and health education plans.

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