Factors associated with use of assistive walking devices among older adults in Brazil

Background Walking devices and other forms of assistive technology (AT) can benefit older adults by supporting mobility and social interactions, but usage outside of high-income countries is generally low. Objective To examine the factors associated with AT use and whether AT use is associated with higher levels of social participation among older adults in Brazil. Method The 2013 Brazilian National Health Survey interviewed 23,815 individuals 60 years or older. Descriptive and logistic regression analyses were used to examine AT use, including canes and walkers, to assist with walking and social participation. Results Among older adults with mobility difficulty, 34.0% (95% CI 31.2- 36.9) reported using AT. Prevalence of the use of AT for walking increases with age: 21.4% of those 60-69 years reported using AT while 58.5% of those 90 years or older did. AT was negatively associated with participation in social activities. Conclusion Our analyses focused on older adults with mobility limitations who need appropriate transportation and environment adaptations to engage socially. Contrary to studies in more developed countries, among Brazilians, AT use is negatively associated with social interactions. The resulting confinement seems to lead to social isolation.

Motor and Physical Function Impairments as Contributors to Slow Gait Speed and Mobility Difficulty in Middle-Aged and Older Adults

Background Motor function impacts ability to perform daily activities and maintain independence. Yet, the interrelatedness of upper and lower extremity motor impairments and the magnitude of their contribution to slow gait and mobility difficulty are not well investigated. Methods Participants in the Baltimore Longitudinal Study of Aging (N=728, aged 50-99) completed motor and physical function tests including grip and knee extension strength, pegboard, finger tapping, standing balance, chair stands, fast-paced 400m walk, and usual gait speed. Slow gait was defined as usual gait speed <1.0m/s. Mobility difficulty was defined as self-reported difficulty walking ¼ mile or climbing stairs. Structural equation modeling (SEM) examined the interrelationships of motor measures and their contributions to slow gait and mobility difficulty, adjusting for demographics and comorbidities. Results Poorer manual dexterity (-0.571 standard deviation (SD) units, p<0.001) and lower muscle strength (upper and lower extremity) (-0.447 SD units, p=0.014) were most strongly associated with slow gait speed, followed by slower chair stand pace (-0.195 SD units, p=0.002) and greater lap time variation (0.102 SD units, p=0.028). Lower muscle strength (-0.582 SD units, p=0.001) was most strongly associated with mobility difficulty, followed by slower chair stand pace (-0.322 SD units, p<0.001), slower gait speed (-0.247 SD units, p<0.001), and poorer standing balance (-0.190 SD units, p=0.043). Conclusions Components of manual dexterity and strength were the strongest correlates of slow gait and mobility difficulty in mid-to-late life. Longitudinal studies examining relationships between changes in these motor parameters and mobility are needed to elucidate possible causal effects.

Symptoms Contributing to Mobility Limitations and Fear of Falls in Older Adults

Mobility limitations in older adults are associated with negative outcomes including fear of falls (FOF) and poorer quality of life. However, self-reported symptoms contributing to mobility difficulty have not been fully explored as an area for intervention. The study aimed to identify the prevalence of self-reported symptom causes of difficulty walking and stair-climbing. In addition, we examined associations between symptoms and FOF in a population-based cohort of community-dwelling older adults in the MOBILIZE Boston Study. Of the 243 older adults who reported difficulty with walking one quarter of a mile or climbing stairs, 67% were women, 72% were white, average age=79.4y (SD=5.7). FOF was measured with the Tinetti Falls Efficacy Scale. Pain was most commonly reported as the primary symptom responsible for mobility difficulty (38.4%) followed by endurance (21.1%), multiple symptoms (15.6%), weakness (13.2%), balance (8.7%), other symptoms (2.9%). Factorial ANCOVA determined gender differences in associations between symptoms and FOF, adjusting for age. In pairwise comparisons, women who identified balance as their primary symptom had higher FOF than women identifying endurance (p=.017), pain (p=.015), other (p=.017), or multiple (p=.050) symptoms. There were no FOF differences for women identifying balance compared to weakness as the primary issue (p=.395). Men who identified balance as their primary symptom had higher FOF than those who identified pain (p=.036); no other FOF differences were noted in men identifying balance compared to other symptoms. Understanding common symptoms experienced by older adults, and symptoms associated with greatest FOF, will assist in developing tailored interventions for mobility improvement.

Association of Dual Sensory Impairment with Incident Mobility and ADL Difficulty

Hearing and vision impairment are each independently associated with incident mobility disability and disability in activities of daily living (ADL). Whether dual sensory impairment (DSI) in both hearing (pure-tone average >25 dB) and vision (impaired visual acuity and/or impaired contrast sensitivity) is associated with greater risk of incident mobility and ADL difficulty, as compared to single or no sensory impairments, has not been well-studied. To examine these associations, we used data from 2,020 Health Aging and Body Composition Study participants aged 70-79 years without mobility limitations. Incident mobility difficulty was defined as the first instance of a lot of problems or inability to walk ¼ mile and/or climb 10 steps, and incident ADL difficulty was defined as the first instance of problems with any ADL. Cox proportional hazards models adjusted by demographic covariates, diabetes, hypertension, and depressive symptoms were used to model these associations. Approximately 22.7% of the study had DSI. DSI was associated with increased risk of both incident mobility (Hazard Ratio [HR]=2.43, 95% Confidence Interval [CI]: 1.60, 3.69) and ADL difficulty (HR=2.39, 95% CI: 1.60, 3.56). Vision impairment only was associated with risk of incident mobility difficulty (HR=1.74, 95% CI: 1.09, 2.78), but not incident ADL difficulty (HR=1.45, 95% CI: 0.91, 2.32). Hearing impairment only was not associated with risk of either outcome. Synergistic effects of DSI on the additive scale were present. Sex and race did not modify associations. Monitoring of DSI may be beneficial in delaying incident difficulty.

Adaptive Admittance Control Scheme with Virtual Reality Interaction for Robot-Assisted Lower Limb Strength Training

Muscle weakness is the primary impairment causing mobility difficulty among stroke survivors. Millions of people are unable to live normally because of mobility difficulty every year. Strength training is an effective method to improve lower extremity ability but is limited by the shortage of medical staff. Thus, this paper proposes a robot-assisted active training (RAAT) by an adaptive admittance control scheme with virtual reality interaction (AACVRI). AACVRI consists of a stiffness variable admittance controller, an adaptive controller, and virtual reality (VR) interactions. In order to provide human-robot reality interactions corresponding to virtual scenes, an admittance control law with variable stiffness term was developed to define the mechanics property of the end effector. The adaptive controller improves tracking performances by compensating interaction forces and dynamics model deviations. A virtual training environment including action following, event feedback, and competition mechanism is utilized for improving boring training experience and engaging users to maintain active state in cycling training. To verify controller performances and the feasibility of RAAT, experiments were conducted with eight subjects. Admittance control provides desired variable interactions along the trajectory. The robot responds to different virtual events by changing admittance parameters according to trigger feedbacks. Adaptive control ensures tracking errors at a low level. Subjects were maintained in active state during this strength training. Their physiological signals significantly increased, and interaction forces were at a high level. RAAT is a feasible approach for lower limb strength training, and users can independently complete high-quality active strength training under RAAT.

Association between physical limitations and depressive symptoms among Indian elderly: marital status as a moderator

Background Depression among the elderly is well-documented and associated with socio-economic factors, physical and mental health conditions. Few studies have focused on older adults’ physical limitations and depressive symptoms. However, very little is known about marital status’ role in such associations, especially in India. The present study examines the association between physical limitations and self-reported depressive symptoms and moderating role of marital status in such association separately for men and women. Methods The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1, 2017–2018, a nationally and state representative longitudinal large-scale survey of ageing and health. For the present research, a total sample of 20,806 older adults aged 60+ years was selected after excluding missing values. Along with descriptive statistics, binary logistic regression analysis and interaction effect of marital status were applied to examine the association between physical limitations (functional limitations and mobility difficulty) with the depressive symptoms separately for men and women. Results About 58, 50, and 45% elderly reported having depressive symptoms and had difficulty in 2+ ADLs, 2+ IADLs, and 2+ mobility difficulties, respectively. By the marital status, the prevalence of depressive symptoms was higher among currently unmarried than currently married, irrespective of type and number of physical limitations. The unadjusted, marital and multivariate-adjusted association suggested that elderly with more than two ADLs, IADLs, and mobility difficulty had higher odds of depressive symptoms. The gender stratified interaction effect of marital status and physical limitations on depressive symptoms indicated that currently unmarried elderly, particularly unmarried older women with 2+ ADLs (OR = 2.85; CI 95% = 1.88–3.09), 2+ IADLs (OR = 2.01; CI 95% = 1.74–2.31) and 2+ mobility difficulty (OR = 2.20; CI 95% = 1.86–2.60) had higher odds of depressive symptoms. However, such association was only valid for unmarried men having mobility difficulty. Conclusion The study highlights that the elderly with physical limitations such as ADLs, IADLs, and mobility difficulty require attention and care. Although married elderly are less likely to have depressive symptoms even with all the mentioned physical limitations, unmarried women are more vulnerable to have depressive symptoms with physical limitations.

Motor and Physical Function Impairments in Middle-Aged and Older Adults in the Baltimore Longitudinal Study of Aging

Older adults experience motor function decline early in the disablement process, impacting daily activities and contributing to adverse health outcomes. Few studies have comprehensively examined the interrelationships among motor and functional impairments and investigated whether their contributions to mobility difficulty vary in well-functioning older adults. We examined direct and indirect associations of motor and physical function impairments with slow gait speed (<1.0m/s) and mobility difficulty using structural equation modeling (SEM) among 858 participants aged ≥50 years in the BLSA (mean age=74.1±10.6, 55% women). Motor and physical function tests included grip strength, knee extension strength, proprioception, finger tapping, standing balance (semi-, full-tandem, single-leg), repeated chair stands, and usual gait speed. Mobility difficulty was defined as self-reported difficulty in walking ¼ mile or climbing stairs. Motor and physical function impairments increased linearly with age, with 27.6% of participants having slow gait speed and 10.4% having mobility difficulty. Age-adjusted SEMs identified chair stands pace as the strongest predictor of slow gait speed, followed by latent factors of upper and lower extremity muscle strength and standing balance. Chair stands pace was the strongest predictor of mobility difficulty, followed by gait speed. Latent factors of muscle strength, proprioception, finger tapping, and standing balance were indirectly associated with mobility difficulty via gait speed. All models showed good model fit (RMSEA<0.05, CFI>0.95). These findings suggest components of strength and balance are among the most important contributors to poorer functional performance in mid-to-late life. Future longitudinal studies gauging the effect of change in these factors are warranted.

The Use of Mobility Devices and Personal Assistance: A Joint Modeling Approach

Objective: To examine whether mobility device use substitutes for personal assistance among U.S. older adults. Method: Using the National Health and Aging Trends Study, we identified 3,211 community-living older adults (aged 65 and older) who reported mobility difficulties at baseline. We used recursive bivariate probit models to simultaneously estimate the effect of covariates on the likelihood of using (a) mobility devices and (b) personal assistance to accommodate mobility difficulty. Independent variables included age, gender, race, physical/mental health status, cognition, and comorbidities. Results: Predictors of the use of personal assistance and mobility devices exhibit important similarities and differences. Device use reduced the odds of receiving personal assistance by 50% (odds ratio [OR] = 0.50, 95% confidence interval [CI] = [0.29, 0.86]). Discussion: Findings suggest device use substitutes for personal assistance. Practitioners and policymakers should promote the appropriate use of mobility devices while recognizing the importance of assistance with some groups and the potential of increasing mobility device use.

Functional visual fields: a cross-sectional UK study to determine which visual field paradigms best reflect difficulty with mobility function

ObjectivesTo develop an appropriate method of assessing visual field (VF) loss which reflects its functional consequences, this study aims to determine which method(s) of assessing VF best reflect mobility difficulty.SettingThis cross-sectional observational study took place within a single primary care setting. Participants attended a single session at a University Eye Clinic, Cambridge, UK, with data collected by a single researcher (HS), a qualified optometrist.Participants50 adult participants with peripheral field impairment were recruited for this study. Individuals with conditions not primarily affecting peripheral visual function, such as macular degeneration, were excluded from the study.Primary and secondary outcome measuresParticipants undertook three custom and one standard binocular VF tests assessing VF to 60°, and also integrated monocular threshold 24–2 visual fields (IVF). Primary VF outcomes were average mean threshold, percentage of stimuli seen and VF area. VF outcomes were compared with self-reported mobility function assessed with the Independent Mobility Questionnaire, and time taken and patient acceptability were also considered. Receiver operating characteristic (ROC) curves determined which tests best predicted difficulty with mobility tasks.ResultsGreater VF loss was associated with greater self-reported mobility difficulty with all field paradigms (R20.38–0.48, all P<0.001). All four binocular tests were better than the IVF at predicting difficulty with at least three mobility tasks in ROC analysis. Mean duration of the tests ranged from 1 min 26 s (±9 s) for kinetic assessment to 9 min 23 s (±24 s) for IVF.ConclusionsThe binocular VF tests extending to 60° eccentricity all relate similarly to self-reported mobility function, and slightly better than integrated monocular VFs. A kinetic assessment of VF area is quicker than and as effective at predicting mobility function as static threshold assessment.