Associations Between Childhood Motor Clumsiness and the Risk of Falls and Stumbles in Older Adults: A Preliminary Investigation from a Lifespan Developmental Perspective

To the Editor: Nearly one-third of community-dwelling older adults aged 65 and older fall each year, and about 10% of these falls result in a serious injury, rendering falls a common and potentially devastating health problem.1 Cognitive assessments are currently a part of the multi-factorial fall risk assessment recommended by the American and British Geriatric Societies’ Clinical Practice Guideline for Prevention of Falls in Older Persons;2 however, there is a need for reliable, valid and time-efficient screening tools. The aim of this study was to determine whether a brief, telephone-administered screening for dementia, the Memory Impairment Screen by Telephone (MIS-T),3 could be used to determine fall risk over one year in a large sample of community-dwelling older adults.

This article presents a life-span developmental (LSD) perspective on the linkages between social status and health. The objective is to develop a conceptual framework that is useful in understanding why people are differentially exposed to risks of disease or protective factors and the social conditions that link the effects of risk and protective factors to the social environment over the life span. The discussion distinguishes between the complementary concepts of "life span," "life cycle," and "life course," critical theoretical distinctions that may help refine hypotheses about the relationship between health and social status. We argue that life-cycle and life-course concepts can be viewed as embedded in a more general LSD perspective. Using the theoretical principles derived from this perspective, the review examines (a) gender differences, (b) race-ethnic experiences, (c) childhood experiences, (d) educational levels, (e) socioeconomic differences, and (f) age differences. The emphasis in the review is to highlight the value of a broader LSD perspective in the study of health inequalities. The article ends with a brief summary of where future research is headed and novel developments in the study of social status and health.

Infants born preterm are at risk of cerebral palsy (CP) and motor or cognitive developmental delay. For clinicians, it is essential to know the relative predictive accuracy of the most commonly used neuroimaging and neurophysiological tests for the early prediction of adverse neurodevelopmental outcome. The aim of this study was to compare the accuracy of these tests in survivors of a population of infants born very preterm. A retrospective cohort study was performed in 163 children born before 32 weeks gestational age. We compared the accuracy in predicting adverse neurodevelopmental outcome at the age of 2 years 6 months of early and late cranial ultrasound (CUS), magnetic resonance imaging, somatosensory evoked potentials after stimulation of the posterior tibial nerve, and electroencephalography by calculating positive and negative likelihood ratios. An abnormal early CUS is the best predictor of the presence of CP (positive likelihood ratio 6.09), motor developmental delay (positive likelihood ratio 3.11), and cognitive developmental delay (positive likelihood ratio 5.66). Overall, negative likelihood ratios were poor, ranging between 0.49 and 0.98, meaning that a normal test result had only minimal influence on the probability of adverse neurological outcome. None of the diagnostic tests had a good performance in predicting future neurodevelopmental problems in infants born preterm. A normal test result provided very little clinically useful information. An abnormal early cranial ultrasound (positive test result) is the best predictor of adverse neurodevelopmental outcome. All negative results have poor predictive value of future neurodevelopmental problems.

In a variation of Deese's (1959, Journal of Experimental Psychology, 58, 17-22) list-learning paradigm, 32 first-graders, 32 younger adults, and 24 older adults self-generated words that were semantically related to study items prior to recall. This manipulation increased false recollection for children and older adults, but not for younger adults. These data suggest that source-monitoring deficits underlie children's and older adults' illusory memories within the list-learning format. The differential roles played by source monitoring versus declarative memory in the production of false memories are discussed from a life span developmental perspective.

Community-dwelling older adults. Provide visual physio-feedback and cognitive reframing based on the fall risk appraisal matrix and participate in combined group- and home-based exercises by a trained peer coach. Align perceived and physiological fall risk, peer coaching to exercise. Balance, handgrip strength, fall risk, and activity engagement. [Research in Gerontological Nursing, 13(6), 289-296.].

Influence of Studies Published by the Journal of the American Geriatrics Society: Top 20 Articles from 2000-2015.

Our primary goal was to test the idea that the link between negative emotions and chronic physical illness will become stronger as individuals age and their resources become increasingly limited. The data came from a 4-wave longitudinal study obtained from a sample of middle-aged (n = 500, mean age = 44.17, SD = .91) and older (n = 502, mean age = 62.87, SD = .89) adults who were observed for, on average, 13.59 years (SD = 7.32). Negative emotions were assessed by a subscale of the Zung depression scale and chronic illness severity was operationalized as a physician-rating. Among older adults the association between changes in negative emotions and changes in physical illness status emerged over time (first retest interval: r = .02; p = .42; second interval: r = .11; p = .01; third interval: r = .22; p < .01), whereas such dynamics were not observed among middle-aged adults (first retest interval: r = .01; p = .77; second interval: r = .06; p = .12; third interval: r = -.01; p = .79). In addition, among older adults, negative emotions were generally higher and illness severity worse than in middle-aged adults. Negative emotions and chronic physical illness increased over time only in the older subsample. Research interested in linking negative emotions and poor physical health will benefit from a lifespan developmental perspective. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

To summarize current evidence for early identification and motor-based intervention for children aged 5 years and younger of age with/at risk of developmental coordination disorder (DCD). Using scoping review methodology, we independently screened over 11 000 articles and selected those that met inclusion criteria. Of the 103 included articles, 78 articles were related to early identification and are summarized in a companion article. Twenty-two articles focused on early intervention, with an additional three articles covering both early identification and intervention. Most intervention studies were at a low level of evidence, but provide encouraging evidence that early intervention is beneficial for young children with/at risk of DCD. Direct intervention can be provided to whole classes, small groups, or individuals according to a tiers of service delivery model. Educating and building the capacity of parents and early childhood educators are also key elements of early intervention. Evidence for early intervention for children with/at risk of DCD is emerging with promising results. Further studies are needed to determine best practice for early intervention and whether intervening early can prevent the negative developmental trajectory and secondary psychosocial consequences associated with DCD.

Thailand has transitioned from an aging society to an aged society, which implies that the prevalence of age-related disorders will increase; however, epidemiological data specific to the prevalence of age-related degenerative musculoskeletal disorders among Thai older adults remain limited. Accordingly, the aim of this study was to investigate the prevalence of age-related musculoskeletal diseases, including osteoporosis, sarcopenia, and high falls risk among healthy community-dwelling Thai older adults. This cross-sectional nationwide study enrolled Thai adults aged ≥60yr from 2 randomly selected provinces from each of the 6 regions of Thailand via stratified multistage sampling during March 2021 to August 2022. All enrolled participants were evaluated for BMD, skeletal muscle mass, grip strength, and gait speed. Osteoporosis was diagnosed according to the World Health Organization definition, and sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Falls risk was determined using the self-rated Fall Risk Questionnaire. A total of 2991 eligible participants were recruited. The mean age of participants was 69.2 ± 6.5yr (range: 60-107), and 63.1% were female. The prevalence of osteoporosis, sarcopenia, and high falls risk was 29.7%, 18.1%, and 38.5%, respectively. Approximately one-fifth of subjects (19.1%) had at least 2 of 3 risk factors (ie, osteoporosis, sarcopenia, and high falls risk) for sustaining a fragility fracture, and 3.4% had all 3 risk factors. In conclusion, the results of this study revealed a high and increasing prevalence of osteoporosis, sarcopenia, and high falls risk in healthy community-dwelling Thai older adults. Since these conditions are all major risk factors for fragility fracture, modification of Thailand's national health care policy is urgently needed to address the increasing prevalence of these conditions among healthy community-dwelling older adults living in Thailand.

Falling among older adults is common and can cause chronic health complications. Fear of falling, a lasting concern about falling that can lead an individual to avoid activities he or she can perform, is strongly associated with falling and fall risk. Although White older adults fall more often, Black older adults have more fall risk factors. The purpose of this study was to investigate factors that explain fear of falling and differences between White and Black community-dwelling older adults in fear of falling, balance confidence, and fall risk factors. Using a cross-sectional, retrospective design, 84 community-dwelling older adults (mean age [SD] = 69.0 [5.2], range: 55-80; White, n = 37, 44%; Black, n = 47, 56%, M/F = 20/64) were assessed. Assessments were conducted in a laboratory for human studies. Fall history and risk factors, and subjective fear of falling, were collected. The Montreal Cognitive Assessment (MoCA), Activities-Specific Balance Confidence (ABC) score, preferred, backward, and fast Gait Speed, Short Form-12 Physical and Mental Component Scores, fear of falling rating scale, and demographics questionnaires were administered. Analyses included a proportional odds logistic regression model to examine which factors predicted ABC score and which factors were associated with subjective fear of falling, 1-way analysis of variance for continuous variables, the Fisher exact test for categorical variables, and the Mann-Whitney-Wilcoxon test for ordinal variables. Black participants had significantly fewer years of education ( P = .007), lower MoCA scores ( P = .002), and slower fast gait speed ( P = .032) than White participants. Black participants reported less subjective fear of falling ( P = .043). In the final ABC model (Akaike information criterion 208.26), lower ABC scores were predicted by White race, slower preferred and fast gait speeds, and worse Short Form-12 Mental Composite Scores. Despite Black participants demonstrating typical characteristics of higher fall risk including lower cognitive scores, slower gait speed, and lower ABC scores, Black participants reported fewer falls. Understanding racial differences is an important factor in fear of falling and balance confidence. Reasons for racial differences should be examined further in fear of falling and balance confidence to facilitate the development of patient-centered falls prevention physical therapy programs.

In 2019, international clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder (DCD) were published. Informing our understanding of mechanisms, recent systematic reviews have shown that children with DCD have difficulties with the predictive control of movements, including aspects of motor planning, which is expressed as the internal modeling deficit hypothesis. This motor control deficit is most evident when the spatial and temporal demands of a task increase. An increasing number of empirical studies suggest that motor planning problems can be remediated through training based on one or a combination of motor imagery and action observation. In this review, we show evidence of motor planning problems in children with DCD and show that task demands or complexity affects its appearance. Implications of these findings are treatments based on motor imagery and action observation to remediate motor planning issues. The article concludes with recommendations for future research.

Introduction Frailty is a condition in older adults with decreased physical and cognitive performance that can affect health outcomes associated with fracture, disability, and falls. The aim of this study was to compare fall risk with different physical frailty statuses and investigate factors associated with fall risk in community-dwelling older adults. Methods The population studied included 367 older adults (mean age = 73.2 years ± 7.0; 237 females (64.6%) and 130 males (35.4%)) who live in Chiang Mai, Thailand. This study was of cross-sectional design. Fried's phenotype was used to screen the physical frailty status. The physiological profile assessment (PPA) was used to screen for fall risk. One-way ANOVA analysis was used to compare the fall risk between the different levels of frailty status. Linear regression analysis was used to assess the association between frailty status and fall risk. Results The prevalence of the frailty group was 8.7% and that of the prefrailty group was 76.8%. The three statuses of frailty identified were found to have different levels of risk of falling. The frailty group had a higher fall risk than the nonfrailty group and the prefrailty group. In addition, the nonfrailty group had a lower fall risk than the prefrailty group. Conclusion The frailty group had the highest fall risk in this cohort of older adults living in a community-dwelling facility. Therefore, it is important to assess the frailty status among older adults as it can be a predictor for fall risk. This assessment will therefore lead to a reduction in the rate of disability and death in the community.

Difficulty performing concurrent tasks while walking, or dual-task walking, may have negative consequences for safe and independent functional mobility among older adults. Older adults with amnestic mild cognitive impairment (aMCI) may demonstrate slower gait and worse cognitive task speed or accuracy during dual-task conditions. However, prior research has not consistently quantified cognitive performance during dual-task walking, and it is unclear whether changes in dual-task performance are consistent across different task combinations. The purpose of this study was to compare cognitive and gait performance during dual-task conditions in older adults with aMCI and those with normal cognition (NC). An observational cross-sectional study was conducted with 40 community-dwelling older adults, aged 70-95years with aMCI (n=18) and NC (n=22). Gait (self-paced, fast-paced) and cognitive task performance (serial 3, serial 7 subtraction) were quantified during single-task and dual-task conditions. Linear mixed-effects models with a random effect for participants were used to quantify differences between groups (aMCI vs NC) and task conditions (single-task vs dual-task). Further analysis was performed to quantify cognitive performance and gait changes during more challenging dual-task combinations. Across task combinations, gait performance declined for both groups during dual-task conditions. Gait speed was slower during dual-task conditions than single-task conditions in both the NC and aMCI groups for all task combinations. Older adults with aMCI performed worse on cognitive tasks than those with NC during both single-task and dual-task conditions. Correct response rate was slower for people with aMCI than NC during both single-task and dual-task conditions. Dual-task activities, combining gait and cognitive processes, are associated with fall risk and are therefore commonly evaluated in physical therapy care for older adults. Both aMCI and NC groups walked slower during dual-task conditions, but the aMCI group experienced changes with a lower cognitive load. This highlights the importance of quantifying both cognitive and gait performance during dual-task assessments. Changes in cognitive task and gait performance were consistent across different dual-task combinations, which could inform dual-task interventions.

Falls are frequent and often devastating events among older adults. Cardiovascular disease (CVD) is associated with greater fall risk; however, it is unknown if pathways that contribute to CVD, such as subclinical myocardial damage or wall strain, are related to future falls. We hypothesized that elevations in high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), measured in older adults, would be associated with greater fall risk. Prospective cohort study. Atherosclerosis Risk in Communities Study participants without known coronary heart disease, heart failure, or stroke. We measured hs-cTnT or NT-proBNP in 2011 to 2013. Falls were identified from hospital discharge International Classification of Diseases, Ninth Revision (ICD-9), codes or Centers for Medicare and Medicaid Services claims. We used Poisson models adjusted for age, sex, and race/study center to quantify fall rates across approximate quartiles of hs-cTnT (less than 8, 8-10, 11-16, and 17 or greater ng/L) and NT-proBNP (less than 75, 75-124, 125-274, and 275 or greater pg/mL). We used Cox models to determine the association of cardiac markers with fall risk, adjusted for age, sex, race/center, and multiple fall risk factors. Among 3973 participants (mean age = 76 ± 5 years, 62% women, 22% black), 457 had a subsequent fall during a median follow-up of 4.5 years. Incidence rates across quartiles of hs-cTnT and NT-proBNP were 17.1, 20.0, 26.2, and 36.4 per 1000 person-years and 12.8, 22.2, 28.7, and 48.4 per 1000 person-years, respectively. Comparing highest vs lowest quartiles of either hs-cTnT or NT-proBNP demonstrated a greater than two-fold higher fall risk, with hazard ratios of 2.17 (95% confidence interval {CI} = 1.60-2.95) and 2.34 (95% CI = 1.73-3.16), respectively. In a joint model, the relationships of hs-cTnT and NT-proBNP with falls were significant and independent. Subclinical elevations of cardiac damage and wall strain were each associated with a higher fall risk in older adults. Further research is needed to determine whether interventions that lower hs-cTnT or NT-proBNP also lower fall risk. J Am Geriatr Soc 67:1795-1802, 2019.

Background/ObjectiveThe relationship between frailty and sarcopenia is well-known in older adults, but the factors associated with frailty were not adequately investigated. This study aimed to investigate the relationship between frailty levels and balance, fall risk, and kinesiophobia in older adults with primary sarcopenia and to compare them by sex.MethodsThis cross-sectional study included 68 (32 female, mean age 71.56 ± 5.04 years; 36 male, mean age 71.97 ± 4.86 years) older adults with primary sarcopenia. Sarcopenia was assessed based on grip strength, skeletal muscle mass, and physical performance. Frailty levels (Edmonton Frailty Scale (EFS)), dynamic and static balance (Force plate), fall risk (Denn Fall Risk Assessment Scale), and kinesiophobia (Tampa Kinesiophobia Scale (TSK)) of the individuals were assessed.ResultsSarcopenic females had statistically significantly higher levels of frailty, fall risk, kinesiophobia, and decreased balance stability areas than males (p < 0.05). The prevalence of frailty among older adults with sarcopenia was 51.5%, with a mean EFS score of 6.54 ± 2.51. Females had significantly higher frailty levels than males (7.53 ± 2.81 vs. 5.67 ± 1.83, p = 0.002). Fall risk was also higher in females (10.66 ± 5.83 vs. 7.17 ± 4.29, p = 0.007), as was kinesiophobia (47.59 ± 6.37 vs. 41.81 ± 5.09, p < 0.001). Frailty showed a moderate positive correlation with fall risk (r = 0.603, p < 0.001) and kinesiophobia (r = 0.510, p < 0.001), and a weak negative correlation with balance stability in the anterior direction (r=-0.249, p = 0.040) and to the right (r=-0.265, p = 0.030).ConclusionSarcopenic females have higher levels of frailty and have a higher risk of falling and kinesiophobia than males. Sarcopenic females also have more impaired balance. Increased frailty levels in older sarcopenic adults are associated with increased fear of falling and kinesiophobia, and impaired balance. Therefore, assessment of frailty and associated factors in older adults with sarcopenia is essential in planning rehabilitation.