Falls Efficacy Scale-International Research Articles

Fear of falling as a psychological consequence of fall in older adults

Abstract Background Falls is one of geriatric syndromes that impact active ageing. It is a major public health problem as falls can lead to irreversible health, social, and psychological consequences, and a large economic burden. Methods Elderly women, aged 65 years and above, who attended the National Osteoporosis Center for diagnostic or treatment purposes, participated in telephone interviews. These interviews aimed to document the outcomes and healthcare measures associated with any falls they experienced in the preceding 12 months. There was used a specially prepared questionnaire for demographic and falls data, fear of falling questionnaire “Falls Efficacy Scale International” (FES-I) and physical activity questionnaire “Physical Activity Scale for the Elderly” (PASE). Results The study population consisted of 339 community-dwelling women (mean age 72.9±5.3 years) all of whom reported experiencing one or more falls. One in three of these women had fallen two or more times. Most of all their fall resulted in an injury, and 79 (23.3%) reported falls led to bone fractures. Fear of falling was reported as a consequence of experienced fall by 251 (74.1%) women. Almost half of fallers restricted their everyday activities. The primary cause for limiting everyday activities was identified as pain. Conclusions Fear of falling was reported by 74.1% of women who fell during the previous 12 months. Every woman who experienced hip or vertebral fractures subsequently restricted their daily activities. Key messages • Fear of falling is common among elderly women who has fallen once or more. • The restriction of everyday activities is usually reported by women who feel pain and are afraid to fall again.

Exploring the feasibility of using a bedside device to help prevent nighttime falls.

Older people living in the community are at risk of preventable nighttime falls. Technology can support falls interventions but there is a lack of research into this area. A new bedside device called Bide senses movement and changes in light levels and plays a prerecorded message encouraging the user to follow falls prevention advice when trying to mobilise at night. To test the feasibility of using the Bide device in a community health service. Healthcare workers were trained in the use of the Bide device and asked to identify potential participants. The research team subsequently recruited participants, provided them with a device and explained how to use it. After four weeks, participants took part in face-to-face semi-structured interviews regarding the acceptability of the device. Participants' fear of falling was calculated before and after the intervention using the Falls Efficacy Scale-International. The Bide device appeared to increase patients' confidence to mobilise at night and no adverse events were reported from its use. The device was generally found to be acceptable and easy to use, although one participant found it irritating. Healthcare workers flagged up very few potential participants to the research team, which may have been due to workload pressures and a disconnect between healthcare workers and technology. It appears feasible to study the use of the Bide device for nighttime falls prevention in the community. To enhance recruitment, a member of the research team may be embedded in the clinical team with the aim of proactively identifying potential participants.

Effectiveness of website-based education program on activities of daily living and fear of falls among sub-acute stroke survivors: a pilot study in South Gujarat Region of India

BackgroundStroke survivors and their caregivers have numerous and diverse educational needs, many of which are unmet because of inadequate training from healthcare professionals. As stroke recovery and rehabilitation can continue for years post-stroke, it is critical that stroke survivors are provided with and have access to a range of support options and evidence-based information. Website-based education programs (WEP) have been adopted in recent years to manage health problems. The present pilot study aims to evaluate the effect of WEP on activities of daily living (ADLs) and the fear of falls among sub-acute stroke survivors.MethodsA total of 16 eligible post-stroke survivors were recruited from multiple study settings across Surat City of Gujarat state in western India and were randomly assigned using a lottery method to either the experimental group (n = 8) receiving WEP or the control group (n = 8) receiving conventional physiotherapy for 4 weeks. Outcome measures were the Indian Stroke Scale (ISS), Modified Barthel Index (MBI), and Falls Efficacy Scale-International (FES-I).ResultsBoth groups showed statistically significant improvements in all outcomes but the experimental group showed more significant improvements in ADLs and fear of falls among sub-acute stroke survivors (p < 0.05).ConclusionWEP for sub-acute stroke survivors is an effective intervention. It improves the performance of ADLs for stroke survivors and helps in better fall management indicating that web-based education programs shall be implemented on a regular basis to improve patient care.

Concern about falling is related to threat-induced changes in emotions and postural control in older adults

BackgroundConcern about falling is reportedly related to mobility and balance in older adults. While increased concern about falling may be directly related to balance deficits, establishing a causal relationship remains limited. This study aimed to investigate whether concern about falling affects threat-induced changes in emotions and postural control in older adults. Research questionHow does concern about falling affect threat-induced changes in emotions and postural control among older adults? MethodsSixty-two older adults (age; 78.8 ± 5.7 years, height; 152.7 ± 6.3 cm) were exposed to height-related fear while standing, leaning forward, and leaning backward on the floor and a higher surface. The mean position, root mean square, and mean velocity of the center of pressure (COP) displacement were measured during the standing task, as well as the forward and backward limits of stability (LOS) tasks. The degree of self-reported fear of falling (FoF) was also obtained during the standing and LOS tasks. The participants were categorized into lower and higher concerns about falling based on the short form of the Falls Efficacy Scale International (FESI). ResultsLower and higher concern about falling groups scored 10.2 ± 2.2 and 17.3 ± 3.3 in the short FESI. Both groups experienced increased FoF during the standing and forward LOS tasks on a higher surface. Leaning away from the edge of the surface resulted in increased COP velocity, decreased COP amplitude while standing, and decreased forward LOS. Participants with higher concern about falling had increased FoF during the backward LOS task and decreased backward LOS on a higher surface, while those with lower concern about falling did not. SignificanceConcern about falling can directly affect emotions and balance control owing to the occurrence of threat-related changes.

Prevalence of concerns about falling in people with knee or hip osteoarthritis and the association with pain, function, and psychological factors-a cross-sectional study of 7442 patients treated in primary care.

Concerns about falling (CaF) are common in older people and can lead to avoidance of activities, social isolation and reduced physical function. However, there is limited knowledge about CaF in people with osteoarthritis (OA); yet, symptoms may increase CaF. We aimed to evaluate the prevalence of CaF and associated factors in people with knee or hip OA. This cross-sectional study used data from the Good Life with osteoArthritis in Denmark registry including patients with OA treated in primary care. CaF was assessed with the Short Falls Efficacy Scale International (Short FES-I, range 7-28, low to high). Associations between CaF and pain, function and psychological factors were evaluated using multivariable linear Tobit regression. In total, 7442 patients were included [mean age 67years (SD: 9.6), 67% females]. Mean Short FES-I was 9.8 [95% confidence interval (CI): 9.7; 9.8]. Moderate CaF was observed in 48.1% (95% CI: 46.7; 48.9) of participants, whilst 11.3% (95% CI: 10.7; 12.1) had a high level of CaF. CaF was more prevalent in the oldest participants and in females. Pain intensity [β-value (95% CI): 0.52 (0.48; 0.55)], chair stand test [-0.21 (-0.22; -0.19)] and fear of movement [1.38 (1.19; 1.56)] were significantly associated with increased CaF across age groups and sex. CaF is common in people with OA, especially in the oldest participants and in females. Higher pain, lower function and psychological distress are associated with CaF; yet, the causality of the associations remain to be determined. Integrating CaF assessments and interventions into OA management in primary care seems highly relevant.

A Study To Investigate Fear Of Falling On An Age-Related Rehabilitation Unit

Abstract Background Fear of falling (FOF) is a lasting concern about falling that can lead an individual to avoid activities that he/she remains capable of preforming. Due to a FOF many older adults restrict their activities and subsequently increase their risk of falls. The aim of this study was to 1. Obtain a profile of FOF in an age-related inpatient population 2. Determine the severity of their FOF 3. Collect mobility status and falls history. Methods All current inpatients on two age-related rehabilitation units (age &amp;gt;/= 65 years) with sufficient communication were included. Patients were facilitated to complete The Falls Efficacy Scale International (FES-I) which is a 16-point scale that is valid and reliable. A score of 16-19 indicates a low concern, 20-27 moderate concern and 28-64 a high concern about falling. A two-point convenience sampling at summer and winter period was used. Data was anonymized and recorded using Microsoft excel. Results 68 questionnaires were collected. 40% of patients were independently mobile (+/- a walking aid), 16% required supervision, 26% assistance of one and 18% assistance of two. 100% of patients had a FOF (FES-I score &amp;gt;16). 80% (N=54) of patients had a high FOF, 13% (N=9) had a medium FOF, and 7% (N=5) a low FOF. 75% (N=51) of patients had a documented falls history. 80% (N=41) of people with a falls history had a high FOF. 76% (N=13) of those with no falls history had a high FOF. Conclusion This the first profile of FOF in our age-related rehabilitation unit. 93% of patients reported a high or medium FOF with high rates reported independent of a history of falling. Addressing FOF with evidence-based interventions and psychological support may reduce length of stay and increase successful discharges from older person rehabilitation units.

Chronic stress and functional health in older adults with concerns about falling: a study protocol of a randomized controlled trial with multicomponent exercise intervention (FEARFALL)

BackgroundMaintenance of physical function, mobility, and independent living are important goals for older adults. However, concerns about falling (CaF) play a central role in the vicious cycle of CaF, inflammation, loss of muscle mass, and decreasing physical function ultimately resulting in negative health outcomes. CaF, like other states of chronic stress and anxiety, can be considered as enduring adverse stimuli affecting the stress systems and the inflammatory system. Therefore, the aim of this study is to investigate whether a reduction of CaF leads to a reduction of stress and therefore possibly reduces chronic low-grade inflammation. Understanding the role and directionality of the effects of inflammation on CaF increases our understanding of age-related loss of mobility and physical function.MethodsIn this study, community-dwelling older adults, aged 70 years and older, will be randomly assigned to either a 4-month, multi-component intervention with exercise training and cognitive-behavioral components or to a sham control group with light stretching exercises, cognitive training, and educational health lectures. For the operationalization of specific CaF, the Falls Efficacy Scale—International will be used. Stress and related psychological symptoms will be monitored using established self-reports and by measuring salivary cortisol. Concentrations of C-reactive protein, interleukin 6, interleukin 10, and tumor-necrosis-factor-alpha, as well as gene expression of selected inflammatory transcripts, will be used as surrogate parameters of the inflammatory status at baseline, after the 4-month intervention and 8-month follow-up.DiscussionThis study will be the first to test whether CaF are related with stress system activity or reactivity or with markers of inflammation in the context of a multi-component intervention with exercise training and cognitive-behavioral components addressing CaF. The reduction of specific CaF or general psychological symptoms should reverse alterations in stress systems, and / or slow down low-grade inflammation. Changes in activity, as well as psychological and biological pathways leading from CaF to muscle loss will be measured, to disentangle the individual contribution to sarcopenia, and to provide an additional pathway to break or slow-down the vicious cycle of CaF and sarcopenia.Trial registrationGerman Clinical Trials Register (DRKS): DRKS00029171. Registered 22 July 2022.

Fear of falling and associated influencing factors in patients on maintenance hemodialysis.

This cross-sectional study analyzed the fear of falling (FOF) and associated influencing factors in patients undergoing maintenance hemodialysis (MHD). Patients on MHD (n = 131) were assessed using the short Falls Efficacy Scale International, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Perceived Social Support Scale, and Barthel Index questionnaires. The total FOF score was positively correlated with total anxiety and depression scores but negatively correlated with the total score of activities of daily living. There were significant differences in FOF among different age groups, employment status, the use of walkers, living arrangements (living alone), and having a history of falling in the past year. Age, employment status, history of falls in the past year, and anxiety score were significant risk factors for FOF in MHD patients. FOF in MHD patients is strongly associated with age, employment status, history of falls in the past year, and anxiety level.

Association between Multimorbidity and Risk of Falls and Fear of Falling among Older Adults: The Mediation Effect of Physical Function, Use of Sleeping Pills, and Pain Relievers

ObjectiveFalls and fear of falling (FoF) are relevant contributors to disability and institutionalization among older adults. The aim was to examine the association between multimorbidity and falls/FoF among community-dwelling older adults, exploring the mediating effect of physical function and the use of sleeping pills and pain relievers. DesingLongitudinal analyses. Setting and ParticipantsA total of 1824 adults aged ≥65 years from the Seniors-ENRICA II cohort (Spain). MethodsMultimorbidity was defined as having ≥2 diseases from a predefined list of 13 chronic conditions extracted from clinical records. Falls were self-reported and FoF was estimated using the Short Falls Efficacy Scale International. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the association between multimorbidity/duration of multimorbidity and incident falls/FoF using logistic regression models. The mediating effects of physical function, the use of sleeping pills, and pain relievers were explored using the Karlson Holm Breen method. ResultsMultimorbidity was associated with a higher risk of falls (OR, 1.44; 95% CI, 1.14–1.82) and FoF (OR, 1.88; 95% CI, 1.48–2.39). Positive dose-response associations were found between the duration of multimorbidity and the risk of falls (P-trend = .003) and FoF (P-trend = .001). Physical function mediated 5.67% and 5.25% of these associations, respectively, and the use of sleeping pills explained a larger proportion of the associations (9.27% and 11.61%). Last, the mediation effect of pain relievers on the association between multimorbidity and falls was 3.05% and 9.31% in the multimorbidity-FoF association. Conclusions and ImplicationsMultimorbidity was associated with a higher risk of falls/FoF among Spanish community-dwelling older adults. Use of sleeping pills was a relevant mediator, suggesting that interventions on sleep problems have the potential to reduce the burden of falls/FoF and their consequences among older adults with multimorbidity.

Study of knee pain, fear of falling, and quality of life among community-dwelling older adults, Northern Thailand.

Fall is the leading cause of disability and mortality due to unintentional injury in older adults. The aim of this study was to determine the prevalence and risk factors associated with knee pain, fear of falling, and quality of life among community-dwelling older adults in Northern Thailand. A cross-sectional study was conducted among older adults aged 60 and over. A total of 369 participants were enrolled from April to May 2024. Oxford knee score, a short version of the Falls Efficacy Scale International (FES-I) and World Health Organization quality of life-BREF-Thai, was measured. The results showed that the mean age was 69.4 years and 47 (12.7%) had a history of falls in the previous year. The prevalence of fear of falling was 39.3% for low, 22.5% for moderate, and 38.2% for high concern. Age, marital status, alcohol, history of falls, hypertension, arthritis, and osteoporosis were associated with fear of falling. After adjusting to age, gender, body mass index, education, marital status, smoking, alcohol, history of falls, and chronic disease, osteoarthritis of the knee was positively associated with increasing fear of falling (β: 0.361; p<0.001), while quality of life was negatively associated with fear of falling (β: -0.064; p<0.011). In conclusion, the identified determinants of fear of falling among the elderly indicated the need for fear of falling prevention programs targeting not only individual lifestyles but also chronic diseases. This study provides useful information that might help to develop and adopt effective policies for fear of falling control in Thailand.

Moving the needle on implementing fall prevention programs in Saudi Arabia: assessing knowledge and perceptions of fall risk among community-dwelling older women

BackgroundSaudi Arabia, like many nations globally, is experiencing a demographic shift towards an aging population. With this demographic shift, falls and the fear of falling (FOF) emerge as serious public health concerns among community-dwelling older adults. Addressing misconceptions and enhancing awareness regarding fall risks among older adults holds significant importance, offering insights for informing targeted interventions and enhancing well-being. This study aimed to examine knowledge and perceptions of fall risk among community-dwelling older women in Saudi Arabia.MethodsA cross-sectional study was conducted with 150 Saudi older women, with a mean age (SD) of 63.98 (4.90) years. Participants completed questionnaires assessing fall history, fall knowledge, fall perception, the Falls Efficacy Scale-International (FES-I), Timed Up and Go (TUG), and the Barthel Index. Fall knowledge and perception were assessed using previously constructed statements translated into Arabic and carried out in interviewer-administered forms.ResultsNearly half of the participants reported experiencing at least one fall in the previous 12 months. Despite good knowledge of falls, some gaps were identified, particularly regarding the awareness of social isolation as a consequence of falls. Participants demonstrated positive perceptions towards fall prevention programs but also highlighted misconceptions regarding aging and falls. FOF was prevalent, with higher levels identified among participants without a history of falls.ConclusionMultidimensional strategies are needed to address falls and FOF among community-dwelling older women in Saudi Arabia. Leveraging existing knowledge and perceptions towards fall prevention and implementing evidence-based interventions can reduce the burden of falls and enhance health outcomes in older adults. Future research should focus on diverse samples and evaluate the feasibility of implementing fall prevention interventions within Saudi Arabia's healthcare systems.

Association of fear of falling with performance-based physical function and low back pain in older adults: a cross-sectional study in Iran

ObjectivesThis study investigated the association of fear of falling with performance-based physical function and low back pain (LBP) among older adults.DesignCross-sectional study.SettingParticipants were selected via convenient sampling from Iran University...

Association between Chronic Pain and Sarcopenia in Greek Community-Dwelling Older Adults: A Cross-Sectional Study.

(1) Background: Sarcopenia and chronic pain are prevalent syndromes among older adults that negatively affect their quality of life. The present study aimed to investigate the relationship between chronic pain and sarcopenia among Greek community-dwelling older adults. (2) Methods: Older adults >60 years of age were enrolled in this descriptive, cross-sectional study. Sarcopenia status was assessed according to the EWGSOP2 2019 algorithm. This assessment included the evaluation of muscle strength, body composition and gait speed. Pain location and pain characteristics were assessed using a self-reported questionnaire. Pain severity was assessed via the visual analog scale. The participants were also asked to fill out the SARC-F, the Hospital Anxiety and Depression Scale (HADS) and the Falls Efficacy Scale-International (FES-I) questionnaire. (3) Results: This study included 314 participants with a mean age of 71.3 ± 7.4 years. The prevalence of sarcopenia was 19.4 (n = 61), and 44.26% of the sarcopenic participants recorded chronic pain. Chronic pain was associated with sarcopenia, comorbidities, the number of drugs and HADS. (4) Conclusions: The results demonstrated a high percentage of chronic pain in the sarcopenic population. The results also highlight the importance of the detection of chronic pain in older patients with sarcopenia in order to develop effective preventive and therapeutic strategies.

Effect of fear of falling on turning performance among patients with chronic stroke

BackgroundTurning difficulties have been reported in stroke persons, but studies have indicated that fall history might not significantly affect turning performance. Fear of falling (FOF) is common after a fall, although it can occur in individuals without a fall history. Research questionCould FOF have an impact on turning performance among chronic stroke patients? MethodsThis cross-sectional study recruited 97 stroke persons. They were instructed to perform 180° and 360° turns, and their performance was represented by angular velocity. FOF was evaluated using the Falls Efficacy Scale-International (FES-I). Falls that occurred 12 months prior to the study assessment were recorded. ResultsA higher FES-I score was significantly correlated with a decline in angular velocity in all turning tasks after adjustment for demographic data. The correlation remained significant after controlling for falls history. Participants with a high level of FOF exhibited significantly slower angular velocities during all turning tasks compared with those with a low level of FOF. Participants with a moderate level of FOF had a significantly slower angular velocity than did those with a low level of FOF during the 360° turn to the paretic side only. SignificanceA higher level of FOF, regardless of fall history, was significantly associated with a reduced angular velocity during turning. A high level of FOF affected turning performance in all tasks. Turning performance may not be affected by fall experience. Anxiety about falling may have a greater effect on turning performance than does fall history.

Comparison of effects of Otago exercise program vs gaze stability exercise on balance and fear of fall in older adults: A randomized trial.

Fall occurrences and the associated risk of injury are debilitating and major health concerns in the older population. Several interventions have been investigated and implemented to address the needs of balance impairments and to reduce the increased risk of falls. This study aimed to compare the effectiveness of the Otago exercise program (OEP) and gaze stability exercises (GSE) on balance and the risk of falls in older adults residing at an old age home facility. Thirty elderly participants were equally and randomly divided into 2 groups: Group OEP received the OEP, and group GSE received GSE for 8 weeks (thrice a week). In addition, both groups also performed core muscle-strengthening exercises. The outcome measures were the Berg balance scale (BBS) and the Fall efficacy scale-International (FES-I). The interventions resulted in significant improvements (P < .001) in both outcome measures in both groups. The mean pretest BBS scores of groups OEP and GSE increased from 40.4 and 39.2 to the mean post-test scores of 48 and 45.2, respectively. Similarly, the mean pretest FES-I scores of groups OEP and GSE also improved from 39.47 and 40.4 to the mean post-test scores of 32.73 and 36.07. The between-group comparison showed greater improvement (P < .05) in OEP group in both variables. OEP and GSE were found to be beneficial rehabilitation programs in improving balance and fear of falls in healthy older adults. However, the OEP was found to be a more effective intervention and may allow better balance and fall prevention improvements. The study has been registered in clinicaltrials.gov (ID: NCT05781776; on 23/03/2023).

Sarcopenia in older adults is associated with static postural control, fear of falling and fall risk: A study of Romberg test

BackgroundAs a geriatric syndrome, sarcopenia may exacerbate static postural control and increase fall risk among older adults. The Romberg test, a simple method to assess static postural control, has the potential to predict fall, but has rarely been used to assess static postural control and fall risk in sarcopenic older adults. Research questionHow does sarcopenia increase fall risk by affecting static postural control? MethodsForty-four older adults performed the Romberg test and were included for analyses. Romberg parameters, including Center of Pressure (CoP), Center of Mass (CoM) and Displacement Angle (DA), were collected under eyes-open/eyes-closed conditions. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Fall risk was assessed using the Morse Elderly Fall Risk Assessment Scale (MFS), and fear of falling was evaluated using the Falls Efficacy Scale-International (FES-I). Multivariate linear regression models were conducted to examine the associations of sarcopenia with Romberg test parameters, fear of falling, and fall risk. ResultsSarcopenic older adults had higher scores of both fear of falling and fall risk (P<0.001 and =0.006, respectively), and worse static postural control parameters (P values ranging from <0.001–0.043) than healthy controls, demonstrated by the multivariate linear regression models. Most of the Romberg test parameters were significantly associated with fear of falling score, especially under eyes-closed condition, and fear of falling was further associated with higher fall risk score (β=0.90, P=0.001). Meanwhile, the presence of sarcopenia also significantly increased fall risk score (β=10.0, P<0.001). SignificanceSarcopenia may increase fall risk in older adults via worsen static postural control ability and increase fear of falling. Paying attention and making efforts to prevent sarcopenia may help to alleviate postural control dysfunction, decrease fear of falling, so as to reduce fall risk and prevent severe injuries caused by fall accidents.

Effect of adding systematic desensitization to goal-directed paradigm on risk of falling in patients with stroke: a randomized controlled trial.

Improvement in rehabilitation outcomes for patients suffering from chronic stroke can be attained through systematic desensitization of their fear of falling, which in turn reduces the risk of falling. This study aimed to examine the effect of adding systematic desensitization to a goal-directed paradigm on functional performance, balance, risk of falling, and fear of falling among chronic ischemic stroke patients. Two equally sized groups, each comprising 40 stroke patients of both sexes, were randomly divided. For 8 weeks, Group A received three sessions per week of combined treatment consisting of systematic desensitization and a goal-directed paradigm, while Group B received only the goal-directed paradigm. The Timed Up and Go (TUG) test and Dynamic Gait Index (DGI) were used to assess function performance; the Berg Balance Scale (BBS) and the Biodex Fall Risk Index (FRI) were used to evaluate balance; and the 16-item Fall Efficacy Scale-International (FES-I) was used to evaluate fear of falling. At baseline and after the treatment, all measurements were obtained. Both groups (A and B) revealed a substantial increase in functional performance through a decrease in TUG scores and an increase in DGI. Additionally, there was a decrease in the risk of falling through an increase in the BBS scores and a decrease in the FRI. Furthermore, there was a decrease in the fear of falling, as measured using the FES-I, after treatment, with superior improvement in Group A with a p-value of <0.001. Systematic desensitization combined with a goal-directed paradigm has a superior effect on improving functional performance and reducing the risk of falling and the fear of falling in patients with stroke compared to a goal-directed paradigm alone.

Relationship Among Falls, Fear of Falling, and Physical Activity Level in Patients on Hemodialysis.

Patients on hemodialysis are highly susceptible to falls and fractures. Amplified apprehension regarding the fear of falling (FOF) constitutes a risk factor that restricts physical activity and escalates the probability of falls among the elderly population. This study aimed to elucidate the association between falls and FOF and physical activity in patients on hemodialysis. A prospective cohort study was conducted across 9 centers. FOF was assessed using the Falls Efficacy Scale-International (FES-I). Physical activity was assessed using the Japanese version of the International Physical Activity Questionnaire short form. Subsequently, falls were monitored over a duration of 1year. Logistic regression analysis was performed to evaluate the relationship between falls and FOF and physical activity. In addition, in the receiver operating characteristic analysis, the cutoff value of FES-I that predicts falls was determined using the Youden Index. A restricted cubic spline curve was utilized to analyze the nonlinear association between falls and the FES-I. A total of 253 patients on hemodialysis (70.0 [59.0-77.0] years old; 105 female [41.5%]) were included in the analysis. During the 1-year observation period, 90 (35.6%) patients experienced accidental falls. The median FES-I score was 36.0 (24.0-47.0) points, and patients with higher FES-I scores had more falls. Following adjusted logistic regression analysis, FES-I exhibited an independent association with falls (OR = 1.04; 95% CI = 1.01-1.06), but physical activity was not. The area under the receiver operating characteristic curve was 0.70 (95% CI = 0.64-0.77), and the FES-I threshold value for distinguishing fallers from non-fallers was determined as 37.5 points (sensitivity 65.6%, specificity 35.0%). A nonlinear relationship between falls and FES-I was observed. FOF was associated with the incidence of falls in patients on hemodialysis. The evaluation and implementation of interventions targeting the FOF may mitigate the risk of falls.

Information processing speed and disease severity predict real-world ambulation in persons with multiple sclerosis

BackgroundImpairments in real-world gait quality and quantity are multifaceted for individuals with multiple sclerosis (MS), encompassing mobility, cognition, and fear of falling. However, these factors are often examined independently, limiting insights into the combined contributions they make to real-world ambulation. Research questionHow do mobility, cognition, and fear of falling contribute to real-world gait quality and quantity in individuals with MS? MethodsTwenty individuals with MS underwent a series of cognitive assessments, including the Paced Auditory Serial Addition Test (PASAT), Symbol Digits Modalities Test (SDMT), Stroop Test, and the Selective Reminding Test (SRT). Participants also completed the Falls Efficacy Scale – International (FES-I) and walking impairment using the Patient Determined Disease Steps (PDDS). Following the in-lab session, participants wore an inertial sensor on their lower back and asked to go about their typical daily routines for three days. Metrics of gait speed, stride regularity, time spent walking, and total bouts were extracted from the real-world data. ResultsSignificant correlations were found between both real-world gait speed and stride regularity and the SDMT, FES-I, and PDDS. Backward linear regression analysis was conducted for gait speed and stride regularity, with PDDS and SDMT included in the final model for both metrics. These variables explained 63% of the variance in gait speed and 69% of the variance in stride regularity. Results were not significant for gait quantity after adjusting for age and sex. SignificanceThe study's results provide insight regarding the roles of cognition, walking impairment, and fear of falling on real-world ambulation. Deeper understanding of these contributions can inform the development of targeted interventions that aim to improve walking. Additionally, the absence of significant correlations between gait metrics, cognition, and fear of falling with gait quantity underscores the need for further research to identify factors that increased walking in this population.

Effectiveness of a sensorimotor exercise program on proprioception, balance, muscle strength, functional mobility and risk of falls in older people.

Sensory systems provide the necessary information for a motor response to be provided. In this sense, the objective of this study is to evaluate the effectiveness of a sensorimotor exercise program on proprioceptive acuity, balance, muscle strength, functional mobility and risk of falls in institutionalized elderly. 56 participants (84.6 ± 8.4years) were randomly distributed between the control (CG, n = 28) and intervention groups (IG, n = 28). The CG performed a protocol based on warm-up, muscle strengthening and warm down and the IG performed the same intervention, with the addition of sensorimotor exercises. Joint Position Sensation (JPS) was evaluated in both limbs at angles of 20° and 45°, balance, functional mobility, fear of falling in the elderly and muscle strength of quadriceps, hamstrings, adductors and abductors in both limbs, before and after the 12weeks of intervention. Both groups showed gains in muscle strength. When analyzing functionality through Timed Up and Go (TUG), before and after for each group separately, both showed a significant difference (CG p = 0.002; IG p < 0.001). For the Short Physical Performance Battery (SPPB) variable, there were significant differences in IG in balance (p < 0.001), gait speed time (s) (p = 0.004) and sit-to-stand (p = 0.002). In JPS, significant differences were recorded for Absolute Error 45° Non-Dominant (p = 0.045) and Relative Error 45° Non-Dominant (p = 0.045) in the CG and Relative Error 45° Non-Dominant for IG (p = 0.018). In the Falls Efficacy Scale International (FES-I) variable there were significant improvements in the CG (p = 0.006) and in the GI (p = 0.002). However, only IG showed significant improvements (p = 0.013) for Activities-Specific Balance Confident (ABC) in a comparison between before and after the 12-week research period. When comparing the differences verified with the intervention between CG and IG, only balance SPPB (p < 0.001) and sit-to-stand SPPB (p = 0.022) showed significant values. He effectiveness of sensorimotor exercises provides balance gain in the elderly (p < 0.001) and positively impacts their confidence (p = 0.013) when performing their duties. It is concluded that the protocol presented in its different levels of difficulty is effective and important for the quality of life of the institutionalized sedentary elderly.