Fall Risk In Older Adults Research Articles

Association between advanced glycation end-products and fall risk in older adults: The Yakumo Study.

Advanced glycation end-products (AGEs) are irreversibly and heterogeneously formed compounds during the non-enzymatic modification of macromolecules, such as proteins. Aging and lifestyle habits, such as high-fat and high-protein diets, and smoking, promote AGEs accumulation. This study aimed to investigate the relationship between fall risk and AGEs in community-dwelling older adults. This cross-sectional study included patients from the 2022 Yakumo Study who were evaluated for fall risk index 5-items version, locomotive syndrome stage and AGEs. AGEs were evaluated using Skin autofluorescence (SAF) measured by the AGE reader (DiagnOptics Technologies BV, Groningen, the Netherlands). We divided the participants into two groups according to the presence or absence of fall risk (fall risk index 5-items version ≥6 or not), and investigated the factors associated with fall risk. The fall risk group had a higher age and SAF, and a higher proportion of locomotive syndrome stage >2 than the without fall risk group in patients aged ≥65 years (P < 0.01). The multivariate logistic regression analysis after adjustment of age, sex and body mass index showed that locomotive syndrome stage ≥2 and SAF were independent associators of fall risk in older adults (odds ratio 3.26, P < 0.01, odds ratio 2.96, P < 0.05, respectively). The optimal cutoff value of the SAF for fall risk was 2.4 (area under the curve 0.631; 95% CI 0.53-0.733; sensitivity 0.415; specificity 0.814; P < 0.05). The accumulation of AGEs in skin tissues can be used to screen for fall risk comprehensively. Geriatr Gerontol Int 2024; 24: 517-522.

Associations between monitor-independent movement summary (MIMS) and fall risk appraisal combining fear of falling and physiological fall risk in community-dwelling older adults.

Introduction: Fall Risk Appraisal (FRA), a process that integrates perceived and objective fall risk measures, serves as a crucial component for understanding the incongruence between fear of falling (FOF) and physiological fall risk in older adults. Despite its importance, scant research has been undertaken to investigate how habitual physical activity (PA) levels, quantified in Monitor-Independent Movement Summary (MIMS), vary across FRA categories. MIMS is a device-independent acceleration summary metric that helps standardize data analysis across studies by accounting for discrepancies in raw data among research-grade and consumer devices. Objective: This cross-sectional study explores the associations between MIMS (volume and intensity) and FRA in a sample of older adults in the United States. Methods: We assessed FOF (Short Falls Efficacy Scale-International), physiological fall risk (balance: BTrackS Balance, leg strength: 30-s sit-to-stand test) and 7-day free-living PA (ActiGraph GT9X) in 178 community-dwelling older adults. PA volume was summarized as average daily MIMS (MIMS/day). PA intensity was calculated as peak 30-min MIMS (average of highest 30 non-consecutive MIMS minutes/day), representing a PA index of higher-intensity epochs. FRA categorized participants into following four groups: Rational (low FOF-low physiological fall risk), Irrational (high FOF-low physiological fall risk), Incongruent (low FOF-high physiological fall risk) and Congruent (high FOF-high physiological fall risk). Results: Compared to rational group, average MIMS/day and peak 30-min MIMS were, respectively, 15.8% (p = .025) and 14.0% (p = .004) lower in irrational group, and 16.6% (p = .013) and 17.5% (p < .001) lower in congruent group. No significant differences were detected between incongruent and rational groups. Multiple regression analyses showed that, after adjusting for age, gender, and BMI (reference: rational), only irrational FRA was significantly associated with lower PA volume (β = -1,452.8 MIMS/day, p = .034); whereas irrational and congruent FRAs were significantly associated with lower "peak PA intensity" (irrational: β = -5.40 MIMS/day, p = .007; congruent: β = -5.43 MIMS/day, p = .004). Conclusion: These findings highlight that FOF is a significant barrier for older adults to participate in high-intensity PA, regardless of their balance and strength. Therefore, PA programs for older adults should develop tailored intervention strategies (cognitive reframing, balance and strength exercises, or both) based on an individual's FOF and physiological fall risk.

Association between vision impairment and increased prevalence of falls in older US adults.

Vision impairment (VI) is associated with falls in older adults. However, past studies have relied on geographically constrained samples with limited generalizability or self-reports of visual difficulty. To date, there have not been nationally representative studies on the association of objective measures of visual function and falls outcomes. We used cross-sectional data from Round 11 of National Health and Aging Trends Study (NHATS), a nationally representative panel study of age-eligible Medicare beneficiaries (N = 2951). We performed Poisson regression to calculate the prevalence and prevalence ratio (PR) of >1 fall in the past year, any fall in the past month, fear of falling (FoF), and activity limitation due to FoF as a function of distance visual acuity, near visual acuity, and contrast sensitivity. Models were adjusted for demographic and health covariates and were weighted to make nationally representative parameter estimates. The weighted proportion of participants with VI was 27.6% (95% CI, 25.4%-29.9%). Individuals with any VI had a higher prevalence of falls compared with those without VI (18.5% vs. 14.1%, PR = 1.25, 95% CI 1.02-1.53). Specifically, contrast sensitivity impairment was associated with a higher prevalence of recurrent falls (20.8% vs. 14.7%; PR = 1.30, 95% CI 1.01-1.67) and recent falls (17.1% vs. 9.9%; PR = 1.40, 95% CI 1.01-1.94). This relationship existed even independent of near and distance visual acuity. Distance and near visual acuity were not significantly associated with falls. Having any VI was also associated with a higher prevalence of FoF (38.4% vs. 30.5%, PR = 1.17, 95% CI 1.02-1.34). The prevalence of falls is associated with poor contrast sensitivity but not with near or distance visual acuity. Findings suggest greater collaboration between geriatricians and eye care providers may be warranted to assess and address fall risk in older adults with VI.

Mobile Data Gathering and Preliminary Analysis for the Functional Reach Test.

The functional reach test (FRT) is a clinical tool used to evaluate dynamic balance and fall risk in older adults and those with certain neurological diseases. It provides crucial information for developing rehabilitation programs to improve balance and reduce fall risk. This paper aims to describe a new tool to gather and analyze the data from inertial sensors to allow automation and increased reliability in the future by removing practitioner bias and facilitating the FRT procedure. A new tool for gathering and analyzing data from inertial sensors has been developed to remove practitioner bias and streamline the FRT procedure. The study involved 54 senior citizens using smartphones with sensors to execute FRT. The methods included using a mobile app to gather data, using sensor-fusion algorithms like the Madgwick algorithm to estimate orientation, and attempting to estimate location by twice integrating accelerometer data. However, accurate position estimation was difficult, highlighting the need for more research and development. The study highlights the benefits and drawbacks of automated balance assessment testing with mobile device sensors, highlighting the potential of technology to enhance conventional health evaluations.

Fall risk classification with posturographic parameters in community-dwelling older adults: a machine learning and explainable artificial intelligence approach

BackgroundComputerized posturography obtained in standing conditions has been applied to classify fall risk for older adults or disease groups. Combining machine learning (ML) approaches is superior to traditional regression analysis for its ability to handle complex data regarding its characteristics of being high-dimensional, non-linear, and highly correlated. The study goal was to use ML algorithms to classify fall risks in community-dwelling older adults with the aid of an explainable artificial intelligence (XAI) approach to increase interpretability.MethodsA total of 215 participants were included for analysis. The input information included personal metrics and posturographic parameters obtained from a tracker-based posturography of four standing postures. Two classification criteria were used: with a previous history of falls and the timed-up-and-go (TUG) test. We used three meta-heuristic methods for feature selection to handle the large numbers of parameters and improve efficacy, and the SHapley Additive exPlanations (SHAP) method was used to display the weights of the selected features on the model.ResultsThe results showed that posturographic parameters could classify the participants with TUG scores higher or lower than 10 s but were less effective in classifying fall risk according to previous fall history. Feature selections improved the accuracy with the TUG as the classification label, and the Slime Mould Algorithm had the best performance (accuracy: 0.72 to 0.77, area under the curve: 0.80 to 0.90). In contrast, feature selection did not improve the model performance significantly with the previous fall history as a classification label. The SHAP values also helped to display the importance of different features in the model.ConclusionPosturographic parameters in standing can be used to classify fall risks with high accuracy based on the TUG scores in community-dwelling older adults. Using feature selection improves the model’s performance. The results highlight the potential utility of ML algorithms and XAI to provide guidance for developing more robust and accurate fall classification models.Trial registration Not applicable

The Association of Skeletal Muscle Energetics With Recurrent Falls in Older Adults Within the Study of Muscle, Mobility and Aging.

Falls in the older population are a major public health concern. While many physiological and environmental factors have been associated with fall risk, muscle mitochondrial energetics has not yet been investigated. In this analysis, 835 Study of Muscle, Mobility and Aging (SOMMA) participants aged 70-94 were surveyed for number of falls (total), recurrent falls (2+), and fall-related injuries over the past 12 months at baseline and again after 1 year. Skeletal muscle energetics were assessed at baseline in vivo using 31P Magnetic Resonance Spectroscopy for the maximal rate of adenosine triphosphate recovery (ATPmax)after an acute bout of exercise, and ex vivo by High-Resolution Respirometry for the maximal rate of complex I and II supported oxygen consumption (MaxOXPHOS) in permeabilized muscle fibers from the vastus lateralis. At least 1 fall was reported in 28.7% of SOMMA participants in the first year of the study, with 12% of older adults reporting recurrent falls (2+). Individuals who experienced recurrent falls had a slower 400-m walk gait speed (1.0±0.2 vs 1.1±0.2, p < .001), reported fewer alcoholic drinks per week in the past year (2.4±4.3 vs 2.8±4.4, p = .054), and took a significantly greater number of medication in the 30 days before their baseline visit (5.6±4.4 vs 4.2±3.4, p < .05). A history of falls was reported in 63% of individuals who experienced recurrent falls in the first year of the study compared to 22.8% who experienced 1 or fewer falls. MaxOXPHOS was significantly lower in those who reported recurrent falls (p = .008) compared to those with 1 or fewer falls, but there was no significant difference in ATPmax (p = .369). Neither muscle energetics measure was significantly associated with total number of falls or injurious falls, but recurrent falls were significantly higher with lower MaxOXPHOS (risk ratio = 1.33, 95% confidence interval = 1.02-1.73, p = .033). However, covariates accounted for the increased risk. Mitochondrial energetics were largely unrelated to fall risk in older adults when accounting for variables, suggesting that the complex etiology of falls may not be related to a single "hallmark of aging" biological pathway.

American Geriatrics Society response to the World Falls Guidelines.

Falls are a major cause of preventable death, injury, and reduced independence in adults aged 65 years and older. The American Geriatrics Society and British Geriatrics Society (AGS/BGS) published a guideline in 2001, revised in 2011, addressing common risk factors for falls and providing recommendations to reduce fall risk in community-dwelling older adults. In 2022, the World Falls Guidelines (WFG) Task Force created updated, globally oriented fall prevention risk stratification, assessment, management, and interventions for older adults. Our objective was to briefly summarize the new WFG, compare them to the AGS/BGS guideline, and offer suggestions for implementation in the United States. We reviewed 11 of the 12 WFG topics related to community-dwelling older adults and agree with several additions to the prior AGS/BGS guideline, including assessment and intervention for hearing impairment and concern for falling, assessment and individualized exercises for older adults with cognitive impairment, and performing a standardized assessment such as STOPPFall before prescribing a medication that couldpotentially increase fall risk. Notable areas of difference include: (1) AGS continues to recommend screening all patients aged 65+ annually for falls, rather than just those with a history of falls or through opportunistic case finding; (2) AGS recommends continued use of the Timed Up and Go as a gait assessment, rather than relying on gait speed; and (3) AGS recommends clinical judgment on whether or not to check an ECG for those at risk for falling. Our review and translation of the WFG for a US audience offers guidance for healthcare and other providers and teams to reduce fall risk in older adults.

Evaluation of Forward Head Posture, Balance, and Risk for Falls in Community-Dwelling Older Adults

Objective: This study investigated the influence of fear of falling, forward head posture (FHP), cervical proprioception, dynamic balance, and sensory integration on fall risk in older adults. Methods: Thirty-one participants were evaluated using tests designed to detect fall risk. FHP was assessed using a cervical range of motion device and craniovertebral angle (CVA) measurement. Results: Independent t tests were significant for Sensory Organization Test conditions 2 (P = .031) and 5 (P = .043) for FHP versus non-FHP groups. Regression analysis revealed that CVA could predict 16.7% variance in fall risk. Conclusion: CVA is a practical measure for measuring FHP and identifying fall risk in older adults.

Graded Motor Imagery and Fall Risk in Older Adults: An Exploratory Case Series

Background: Altered cortical maps can initiate and maintain a pain experience and older adults who move less may be at increased risk for pain, balance and fall risk issues. Purpose: To determine if a brief graded motor imagery (GMI) session to the plantar surface of the foot in older adults can influence self-reported pain, sensitivity of the nervous system and fall risk. Methods: Forty-one older adults (mean age 76.8) received pain neuroscience education, and GMI to the plantar surface of their feet. Measurements pre- and immediately post- intervention included self-reported pain (Numeric pain rating scale), laterality, fall risk (Brief-BESTest), gait speed (40-meter self-paced walk test - SPWT), and nerve sensitivity (Pressure Pain Thresholds - PPT) to the dorsum of the foot and web space dominant hand. Results: Immediately following treatment, mean self-reported pain improved by 1.24 points (p &lt; 0.001), with a large sub-group meeting the minimal clinically important difference (MCID) for self-reported pain (1.7). Gait speed improved significantly (p &lt; 0.001) meeting MCID (0.1 m/s). Left-right judgement task speed (p &lt; 0.001) and accuracy (p = 0.04) improved. None of the PPT measurements improved. While mean composite Briefest test scores did not reach MCID values (9 points), statistically significant improvements were noted in the biomechanical constraints (p = 0.007) and sensory orientation (p = 0.009) subcomponent scores. Conclusion: A brief, one-time GMI session in older adults can decrease pain and improve scores on tests associated with fall risk but fail to decrease sensitivity of the nervous system. More research is needed to validate the results of this exploratory study.

Effects of additional functional strength training on mobility in children with hemiplegic cerebral palsy

Background: Cerebral palsy (CP) affects the mobility and functional strength of children which leads to a decline in the quality of life of children. Functional strength training may considered objective-oriented to achieve some specific activity level and improve the overall performance of children. Objective: To determine the effects of additional functional strength training on mobility in Children with Hemiplegic Cerebral Palsy (HCP). Method: A single-blind randomized control trial (NCT05878756) was conducted on (n=40) children with hemiplegic cerebral palsy (HCP) at the National Institute of Rehabilitation Science, Islamabad. Children who can follow commands, not using assistive devices, and are not being treated in any other rehabilitation services were included. Children aged 4-12 years were recruited through a non-probability convenient sampling technique and a total of n=40 participants were randomly divided into Group A (n=20) which received conventional therapy along with functional strength training for 4 weeks, while Group B (n=20) only received conventional physical therapy. Both groups received intervention for 4weeks. The tools, Gross Motor Function Measure (GMFM) used for the severity of mobility and, five times sit to stand (FTSST) to assess functional lower extremity strength, transitional movement balance, and fall risk in older adults, were used at baseline and post-treatment assessment. Results: Both groups had improvements in strength and mobility but there was significant improvement in strength and mobility in Group A after 4th week (p≤ 0.05). However, no significant increase in the dimension of lying and kneeling was observed. Comparison between both groups (pre and post-treatment) for dimensions of walking, running, and jumping in both groups showed significant improvement (p=0.045). According to the result of GMFM scoring, a significant improvement in the interventional group (A) as compared to Group B (p=0.003). So, there is a considerable increase in GMFM score for Group A than Group B group. Conclusion: It is concluded that additional functional therapy has a better outcome as compared to conventional therapy on mobility and strength of children with CP. Keywords Cerebral palsy; functional strength training; mobility; Gross Motor Function Measure; Gross Motor Function Classification System

OLDER ADULT FALLS IN THE COMMUNITY: DOES UNSAFE HOME ENVIRONMENT HAVE A RISK ROLE?

Abstract Hazardous environmental conditions are frequent in older adult homes and are linked to a majority of the older adult falls in the community. However it is unclear whether it is the presence/absence of home hazards per se, or the interaction between unsafe home conditions and physical functioning that is of salience to older adults’ fall risk. To address this gap, we conduct a mediation analysis using the Karlson–Holm–Breen methodology to estimate: 1) whether home disorder (peeling/flaking paint, pests: cockroaches/rodents, broken furniture/lamp, unsafe flooring/tripping hazards, room clutter) and unsafe bathroom features (absence of bathtub/shower stall, grab bar, seat in shower/tub, raised toilet) adversely associated with subsequent fall risk of older adults, and 2) what proportion of those influences were mediated through limitations in daily and instrumental activities of daily living (ADL/IADL). Using a nationally representative large sample of Medicare beneficiaries (≥65 years) living in the community who were respondents in the 2018-2019 National Health and Aging Trends Study (NHATS; n=2,599), we examined baseline home environment in 2018 and its relation with subsequent falls in 2019, after controlling for covariates. Results indicate while home disorder had both a direct (adjusted Odds Ratio [aOR]: 1.11, 95% Confidence Interval [CI]:1.01,1.22) and an indirect (aOR: 1.01; 95% CI: 1.00,1.02) effect on subsequent falls through limitations in ADL and IADL, unsafe bathroom features did not significantly predict subsequent fall risk of older adults. Given these findings, addressing home disorder through policy/housing assistance initiatives and educational programs highlighting home environmental safety would be essential.

INVESTIGATING PSYCHOLOGICAL FACTORS AS A PREDICTOR OF FEAR OF FALLING AND FALL RISK IN OLDER ADULTS

Abstract Psychological factors related to appetitive and avoidant motivation, perceptions of aging, and regulatory focus (promotion focus on gains versus a prevention focus on non-losses) are likely to play an important role in predicting one’s fear of falling (FOF) and resulting impact on physical activity engagement. This pilot study aimed to investigate the gap in current research related to these psychological factors as predictors of older adults’ Fear of Falling and Fall Risk Appraisal (FRA). The study assessed positive and negative perceptions about aging in regards to control and consequences of aging (Brief Aging Perceptions Questionnaire [B-APQ]), motivation (Behavioral Inhibition System/Behavioral Activation system [BIS/BAS]), regulatory focus in goal achievement (Regulatory Focus Questionnaire [RFQ]), FOF (Fall-Efficacy Scale-International [FES-I]), and static balance levels (BTracks Balance system [BBS]). Participants (n=48) were categorized into four FRA groups: rational (low FOF/normal balance), irrational (high FOF/normal balance), incongruent (low FOF/poor balance), and congruent (high FOF/poor balance). A Spearman Rho correlation found that FOF was positively correlated with two of the BAPQ sub-domains of Control-Positive (ρ = 0.46, p&amp;lt;.001) and Consequences and Control Negative (ρ = 0.43, p =.002),. A Kruskal-Wallis test found the relationship between BAPQ Control Positive and the Irrational and Rational FRA group baselines to be significant. The results suggest that among other psychological factors, perceptions about aging may be predictive of FOF and FRA in aging. These results highlight the importance of clinicians addressing not only the physiological factors of fall risk, but also the psychological factors underlying fall risk in older adults.

COGNITIVE IMPAIRMENT, FALLS, AND DEMENTIA: NOVEL APPROACHES FOR EARLIER DETECTION AND MORE EFFECTIVE INTERVENTION

Abstract This symposium will discuss novel digital approaches for the remote assessment of cognitive status and detection of fall risk in older adults. We will then describe several emerging digital exercise, ballroom dancing, and other non-invasive intervention strategies targeted for vulnerable older populations at increased risk for falling, or developing cognitive impairment and dementia. Collectively, we posit that these innovative detection and intervention strategies hold significant potential as more effective and scalable approaches for identifying cognitive impairment, preventing falls, and mitigating cognitive decline in high-risk older adults. In presentation 1, Roque et al. examines the utility of ecological momentary cognitive assessment and its potential as a digital biomarker of cognitive impairment in community-dwelling older adults. In presentation 2, Mahoney et al. discusses the development and clinical potential of a novel digital health app, CatchU®, that remotely captures visual-somatosensory integration performance to detect fall propensity in older adults. In presentation 3, Bajdek et al. describes the feasibility of a 12-week digitally delivered home-based fall prevention exercise program for older adults with elevated fall risk. In presentation 4, Blumen et al. report preliminary efficacy and mechanistic findings from a randomized trial of social ballroom dancing in older adults at increased risk for dementia. In presentation 5, Reid et al. describes the feasibility of a real-world community-level physical activity intervention for older adults with motoric cognitive risk syndrome. The discussant, Dr. Verghese, will integrate the key findings from these studies, discuss their theoretical and methodological contributions, and consider future research directions.

Feasibility of Implementing Patient-Reported and Physical Performance Measures to Identify and Manage Fall Risk in Older Adults Within a Secondary Fracture Clinic.

The purpose of this study was to assess the feasibility of implementing both electronic and in-person assessments to assess falls risk in an older adult secondary fracture clinic. Electronic data capture feasibility was defined as the proportion of patients that completed the electronic questionnaires prior to their clinic visit. In-clinic feasibility was defined in two ways: (1) the proportion of patients that consented to participate at their clinic visit; (2) time to complete testing. Patients were contacted electronically through their health system portal for electronic consent. Patients were invited to complete consent, the STopping Elderly Accidents, Deaths, and Injuries (STEADI) falls risk assessment tool, and the visual analog scale (VAS) for pain. The Short Physical Performance Battery (SPPB) was performed at the clinic visit. A total of 310 patients were contacted electronically. No patients (0%) provided consent through their health portal. Of the 310 patients, 200 (65%) consented in person (Ineligible: 67 [21%]; Declined: 43 [14%]), resulting in an 82% response rate. In-person data collection took a median of 38.48 (Range: 12.34-54.30) minutes to complete. It was not feasible to contact and collect older adult patient data electronically prior to clinic; but, was feasible to obtain these patient-reported outcomes and physical performance data in person.

Fear-related visual stimuli do not promote internal focus of attention in older adults

BackgroundThe influence of internal focus (IF) on postural balance needs to be determined when assessing fall risk in older adults. Moreover, the mechanism through which IF is triggered should be elucidated. Research questionDoes fear unrelated to threats to postural balance modulate IF during postural control? MethodsThe participants were 16 community-dwelling older adults. We generated visual stimuli for neutral and fear conditions using the International Affective Picture System. Participants were assessed for postural control while standing on a stabilometer and looking at projected images. The IF allocated to postural control during task was assessed immediately after the task using the Conscious Movement Processing subscale of the Movement-Specific Reinvestment Scale (MSRS-CMP). Sympathetic activity was assessed using the mean low-frequency/high-frequency ratio (LF/HF), and posture was evaluated using the root mean square area (RMS-A), anteroposterior mean power frequency (MPF-AP), mediolateral MPF, and co-contraction index. Differences (Δ) in the MSRS-CMP, RMS-A and MPF between the neutral/fear conditions and control condition were calculated. Each index was also compared among the control, neutral, and fear conditions. The correlations between ΔMSRS-CMP and postural measures were evaluated. Equivalence tests were conducted to determine whether change of IF was different among conditions. ResultsThe MSRS-CMP score did not differ significantly among conditions; equivalence was observed. The LF/HF and MPF-AP in the fear condition were higher than in the other conditions. The RMS-A in the fear condition was lower than in the neutral condition. ΔMSRS-CMP and ΔMPF-AP were significantly negatively correlated. SignificanceThe results of this study suggest that feelings of fear affect postural control but not the IF of attention. Taken together with previous research, the findings of this study suggest that consideration of the fear-inducing context may be useful in assessments of, and interventions for, older adults with a fall risk.

Application of the Barany Society's Presbyvestibulopathy Criteria in Older Adults With Chronic Dizziness.

To evaluate the older adults with chronic dizziness using the Barany Society's presbyvestibulopathy (PVP) diagnostic criteria and to assess the clinical usability of the criteria. Retrospective study. Single tertiary medical center. Among a total of 1964 patients aged 60 years or older, 55 patients who had symptoms suitable for the PVP criteria and who underwent all 3 vestibular function tests were analyzed. Of these 55 patients, 13 patients were diagnosed with PVP based on the peripheral vestibular hypofunction criteria; the remaining 42 patients were categorized as patients without PVP. In both patients with PVP and patients without PVP, postural imbalance or unsteadiness was the most frequently reported vestibular symptom. The rotatory chair test contributed the most to the quantitative diagnosis of PVP (6 of 13), followed by the caloric response test (3 of 13) and video head impulse test (vHIT; 2 of 13). When we included the presence of catch-up saccades in addition to the vHIT gain in the diagnostic criteria, 5 patients without PVP were additionally diagnosed with PVP. Furthermore, when accounting for the inclusion of catch-up saccades, patients who experienced recurrent falls demonstrated a significantly higher rate of impairments in the lateral and posterior semicircular canals according to the multivariate analysis. Considering the catch-up saccades in addition to vHIT gain seemed to contribute to the diagnosis of PVP and prediction of recurrent fall risks in older adults. Further studies are needed to solidify the diagnostic criteria for PVP.

The Effectiveness of Home-Based Exergames Training on Cognition and Balance in Older Adults: A Comparative Quasi-Randomized Study of Two Exergame Interventions

Abstract Background and Objectives The effectiveness of exergames on fall risk and related physical and cognitive function in older adults is still unclear, with conflicting findings. The discrepancy in these results could be due to the different components and task-specific demands of individual exergame interventions. This open-label quasi-randomized study aimed to compare the efficacy of 2 different home-based dual-task exergame treatments on cognition, mobility, and balance in older people. Research Design and Methods Fifty older adults (65–85 years of age) were allocated to one of two 8-week exergame interventions: Cognitive-Intensive Exergame Training (CIT) or Physical-Intensive Exergame Training (PIT). Cognitive functions, balance, and mobility were assessed at baseline and after 8 weeks. Group × time interaction was measured by repeated-measure ANOVA, and both intention-to-treat (ITT) and per-protocol (PP) analyses were performed to assess the effectiveness of exergame interventions. Results ITT analyses showed that improvement in visual processing speed and visuospatial working memory was greater in the CIT group, with a medium effect size (p = .04; η2 = 0.09 and p = .01; η2 = 0.12). The improvement in verbal memory and attention was significant within both groups (p &amp;lt; .05), but this improvement was not different between the groups (p &amp;gt; .05). A significant improvement in balance was also observed in the PIT group, with a medium effect size (p = .04; η2 = 0.09). Although mobility improved significantly in both groups (p &amp;lt; .01), there was no significant difference between groups (p = .08). These results were largely supported by the PP analysis. Discussion and Implications Dual-task exergame training can improve mobility and cognition in older adults. However, the different cognitive and physical demands of these interventions may have varying impacts on fall risk and related physical or cognitive functions. Therefore, a training program that includes both cognitive and physical domains with appropriate intensity is essential for the development of tailored exergame interventions to reduce fall risk in older adults.

In older adults with frailty, virtual reality exercise training improves walking speed and balance.

Lee YH, Lin CH, Wu WR, et al. Virtual reality exercise programs ameliorate frailty and fall risks in older adults: a meta-analysis. J Am Geriatr Soc. 2023 May 10. [Epub ahead of print.] 37165743.

Effect of Robotic Delivery of Physical Activity and Fall Prevention Exercise in Older Adults: A Pilot Cohort Study.

Introduction The high prevalence of falls, lack of stability and balance, and general physical deconditioning are concerning issues for longevity and quality of life for adults aged 65 years and older. Although supervised delivery of the Otago Exercise Program (OEP) has demonstrated evidence of effectiveness in reducing fall risk of older adults, opportunities for ongoing unsupervised exercise performance are warranted. An option to facilitate exercise and performance of health behaviors may be via a social robot. The purpose of this study was to examine feasibility and initial outcomes of a robot-delivered fall prevention exercise program for community-dwelling older adults. Methods Five participants aged 65 years and older were recruited to receive robot-delivered modified OEP and walking program three times per week for four weeks. Outcomes of demographics, self-reported performance measures (Modified Falls Self-Efficacy Scale, Activities-specific Balance Confidence, and Almere Model assessing various constructs of acceptance of use of robotic technology), and physical performance measures (Timed Up and Go Test, Short Physical Performance Battery, Balance Tracking System [BTrackS] center of pressure sway) were collected. Data were analyzed descriptively and examined for trends in change. Measures of central tendency and distribution were used according to the distribution of the data. Results The mean age of the participants was 75 years (range: 66-83 years; four females and one male). The range of participant exercise session completion was 7-12 (mode=11, n=3). Constructs on the Almere Model that started and remained positive were Attitudes Toward Technology and Perceived Enjoyment with the robot. Anxiety improved from 3.80 to 4.68, while Social Presence of the robot improved from 2.80 to 3.56. The construct of Trust was somewhat negative among participants upon commencing the program and did not substantially change over time. Two participants improved their confidence on the Activities-specific Balance Confidence scale by more than 10%, while all participants showed some improvement in confidence in their balance. Mixed results were found with the Modified Falls Self-Efficacy Scale. Mean gait speed for the participants improved by 0.76 seconds over 3 meters. Improvement was also demonstrated for the Short Physical Performance Battery, with two participants improving scores by 2-3 points out of 12. No appreciable changes were found with the Timed Up and Go test and the BTrackS assessment. Conclusion Using a robot-led exercise program is an accessible and feasible way to deliver exercise to community-dwelling older adults in the home, but some technical constraints remain. Outcomes suggest that a four-week program is sufficient to elicit some positive trends in health outcomes and has the potential to reduce fall risk.

Fall risk in older adults hospitalized with tumours: Contributing factors and prediction model.

Rates vary widely across hospitals globally and typically range from 3 to 11 falls per 1000 bed days and as 7-11 in Affiliated Hospital of Nantong University. This study determined to explore contributing factors and poor prognosis of fall in elderly tumour patients in China. A cross-sectional study. 161 older adults were invited to participate in this study and completed a self-reported questionnaire, took blood tests, and received the exam of musculoskeletal ultrasound. Among 161 patients, falls occurred in 41 cases, accounting for 24.8%. 51.6% of older adults suffered from intermediate-to-high risk of falls. Fall history, reduced self-care ability, sleep disturbance, hearing impairment, hyperkyphosis, chronic disease, platelet count, and the thickness of left muscle rectus femoris (LF-MLT), and left cross-sectional area (LF-CSA) were all contributing factors of fall, and higher risk of fall indicating lower quality of life. A fall prediction model was established in this study based on above contributing factors with good prediction efficiency (AUC = 0.920). The patient volunteers participated in this study and provided valuable data for the final analysis and the acquisition of conclusion.