Free-living gait cadence measured by wearable accelerometer: a promising alternative to traditional measures of mobility for assessing fall risk

Background Wearable devices have become widespread in research applications, yet evidence on whether they are superior to structured clinic-based assessments is sparse. In this manuscript, we compare traditional, lab-based metrics of mobility with a novel accelerometry-based measure of free-living gait cadence for predicting fall rates. Methods Using negative binomial regression, we compared traditional in-clinic measures of mobility (6-minute gait cadence, speed, and distance, and 4-meter gait speed) with free-living gait cadence from wearable accelerometers in predicting fall rates. Accelerometry data were collected with wrist-worn Actigraphs (GT9X) over 7 days in 432 community-dwelling older adults (aged 77.29±5.46 yrs, 59.1% men, 80.2% White) participating in the Study to Understand Fall Reduction and Vitamin D in You (STURDY). Falls were ascertained using monthly calendars, quarterly contacts, and ad-hoc telephone reports. Accelerometry-based free-living gait cadence was estimated with the Adaptive Empirical Pattern Transformation algorithm. Results Across all participants, free-living cadence was significantly related to fall rates; every 10 steps/min. higher cadence was associated with a 13.2% lower fall rate (p=0.036). Clinic-based measures of mobility were not related to falls (p>0.05). Among higher-functioning participants (cadence ≥100 steps/min.), every 10 steps/min higher free-living cadence was associated with a 27.7% lower fall rate (p=0.01). In participants with slow baseline gait (gait speed <0.8 m/s), all metrics were significantly associated with fall rates. Conclusion Data collected from biosensors in the free-living environment may provide a more sensitive indicator of fall risk than in-clinic tests, especially among higher functioning older adults who may be more responsive to intervention.

Intra-trial mean 25(OH)D and PTH levels and risk of falling in older men and women in the Boston STOP IT trial

Context Supplementation with vitamin D has the potential to both reduce and increase risk of falling, and parathyroid hormone (PTH) may contribute to fall risk. Objective To assess the associations of intra-trial mean circulating levels of 25-hydroxyvitamin D [25(OH)D] and PTH on incident falls in healthy older adults. Design Observational within a clinical trial. Setting The Bone Metabolism Laboratory at the USDA Nutrition Center at Tufts University. Participants 410 men and women age 65 years and older who participated in the 3-year Boston STOP IT trial to determine the effect of supplementation with 700 IU of vitamin D3 plus calcium on incident falls (secondary endpoint). Intra-trial exposures of 25(OH)D and PTH were calculated as the mean of biannual measures up to and including the first fall. Main outcome measures: incidence of first fall Results Intra-trial mean 25(OH)D was significantly associated with risk of falling in a U-shaped pattern; the range associated with minimal risk of falling was approximately 20-40 ng/ml. PTH was not significantly associated with risk of falling. Conclusions The findings highlight the importance of maintaining the circulating 25(OH)D level between 20 and 40 ng/ml, the range that is also recommended for bone health. At PTH levels within the normal range, there was no detectible independent association of PTH with fall risk.

How Accurate are Geriatricians’ Fall Predictions?

Background: Older patients are at increased risk of falling and of serious morbidity and mortality resulting from falls. The ability to accurately identify older patients at increased fall risk affords the opportunity to implement interventions to reduce morbidity and mortality. Geriatricians are trained to assess older patients for fall risk. If geriatricians can accurately predict fallers (as opposed to evaluating for individual risk factors for falling), more aggressive and earlier interventions could be employed to reduce falls in older adult fallers. However, there is paucity of knowledge regarding the accuracy of geriatrician fall risk predictions. This study aims to determine the accuracy of geriatricians in predicting falls. Methods: Between October 2018 and November 2019, a convenience sample of 100 subjects was recruited from an academic geriatric clinic population seeking routine medical care. Subjects performed a series of gait and balance assessments, answered the Stay Independent Brochure and were surveyed about fall incidence 6-12 months after study entry. Five geriatricians, blinded to subjects and fall outcomes, were provided the subjects’ data and asked to categorize each as a faller or non-faller. No requirements were imposed on the geriatricians’ use of the available data. These predictions were compared to predictions of an examining geriatrician who performed the assessments and to fall outcomes reported by subjects. Results: Kappa values for the 5 geriatricians who used all the available data to classify participants as fallers or non-fallers compared with the examining geriatrician were 0.42 to 0.59, indicating moderate agreement. Compared to screening tools’ mean accuracy of 66.6% (59.6-73.0%), the 5 geriatricians had a mean accuracy for fall prediction of 67.4% (57.3-71.9%).Conclusions: This study adds to the scant knowledge available in the medical literature regarding the abilities of geriatricians to accurately predict falls in older patients. Studies are needed to characterize how geriatrician assessments of fall risk compare to standardized assessment tools.

Motor–Cognitive Treadmill Training With Virtual Reality in Parkinson’s Disease: The Effect of Training Duration

Treadmill training with virtual reality (TT + VR) has been shown to improve gait performance and to reduce fall risk in Parkinson’s disease (PD). However, there is no consensus on the optimal training duration. This study is a sub-study of the V-TIME randomized clinical trial (NCT01732653). In this study, we explored the effect of the duration of training based on the motor–cognitive interaction on motor and cognitive performance and on fall risk in subjects with PD. Patients in Hoehn and Yahr stages II–III, aged between 40 and 70 years, were included. In total, 96 patients with PD were assigned to 6 or 12 weeks of TT + VR intervention, and 77 patients completed the full protocol. Outcome measures for gait and cognitive performance were assessed at baseline, immediately after training, and at 1- and 6-month follow-up. The incident rate of falls in the 6-month pre-intervention was compared with that in the 6-month post-intervention. Dual-task gait performance (gait speed, gait speed variability and stride length under cognitive dual task and obstacle negotiation, and the leading foot clearance in obstacle negotiation) improved similarly in both groups with gains sustained at 6-month follow-up. A higher decrease in fall rate and fear of falling were observed in participants assigned to the 12-week intervention than the 6-week intervention. Improvements in cognitive functions (i.e., executive functions, visuospatial ability, and attention) were seen only in participants enrolled in 12-week training up to 1-month follow-up but vanished at the 6-month evaluation. Our results suggest that a longer TT + VR training leads to greater improvements in cognitive functions especially those directly addressed by the virtual environment.

Effectiveness of Olympic Combat Sports on Balance, Fall Risk or Falls in Older Adults: A Systematic Review

This systematic review and meta-analysis aimed to assess the available body of published peer-reviewed articles related to the effects of Olympic combat sports (OCS), compared with active/passive controls, on balance, fall risk, or falls in older adults. The TESTEX and GRADE scales assessed the methodological quality and certainty of the evidence. The protocol was registered in PROSPERO (code: CRD42020204034). From 1496 records, eight studies were included, involving 322 older adults (64% female; mean age = 71.1 years). The TESTEX scale revealed all studies with a score ≥ 60% (moderate-high quality). The GRADE scale indicated all studies with at least some concerns, up to a high risk of bias (i.e., was rated very low). Meta-analyses were planned, although the reduced number of studies precluded its incorporation in the final manuscript. Only two from six studies that assessed balance found improvements after OCS compared to controls. No differences were found between OCS vs. control groups for fall risk or falls. The available evidence does not allow a definitive recommendation for or against OCS interventions as an effective strategy to improve balance and reduce the fall risk or falls in older adults. Therefore, more high-quality studies are required to draw definitive conclusions.

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

<b><i>Introduction:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusion:</i></b> 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.

The Impact of Pain on Functionality, Postural Control and Fall Risk in Woman Aged 45 to 64 Years Old

Background: Ageing in women is associated with chronic degenerative pain leading to a functional decrease and therefore increase fall risk. It is therefore essential to detect early functional decreases in the presence of pain related to osteoarthritis. Objective: This cross-sectional study aimed to assess the impact of pain on functionality, postural control and fall risk in women aged between 45 to 64 years old. Methods: Twenty-one (21) women aged 45 to 64 were evaluated by clinical and functional measures such as a pain questionnaire (Lequesne Index), functional tests (Stair Step Test, 5 times sit-to-stand, 6MWD, Timed-up and Go) and postural performance (under force platform). Women were classified into 2 groups from the Lequesne Pain Index (PI): low pain (score ≤ 9) and strong pain (score ≥ 10) for subsequent comparisons on functionality (physical and postural control performance). Results: A significant impact was observed between the pain index (strong PI) and 3 of the 4 functional tests carried out including Stair Step Test (p = 0.001; g = 1.44), walking distance (p = 0.003; g = 1.31) and Timed-up and Go (p = 0.04; g = −0.93). The group with a strong PI score reported further poor postural control under force platform compared to the weak pain group. Conclusion: Pain and severity based on the PI index negatively modulate physical and postural control performance in women aged 45 to 64 years old.