Fear Of Falling Research Articles

Effectiveness of Tai Chi exercise on fear of falling and balance in older adults: A meta-analysis

ObjectiveTo assess the effect of Tai Chi exercise on fear of falling (FOF) and balance in older adults. MethodChinese and English databases were searched for randomized controlled trials (RCTs) on the effect of Tai Chi on the fear of falling and balance of older adults. The search time limit was from inception until 13 December 2022. ResultsA total of 13 RCTs were included and the overall quality was moderate. The results showed that Tai Chi exercise could significantly improve fear of falling [SMD = -0.54, 95%CI(-1.09, 0.01), Z =1.94, P = 0.05], dynamic balance [SMD = -2.23, 95%CI(-3.89, -0.75), Z=2.90, P = 0.004] and fall incidence [RR = 0.48, 95%CI(0.35, 0.65), Z =4.67, P <0.001] in older adults. However, its significant benefits in improving the static balance [MD = 4.16, 95%CI(-3.71, 12.04), Z =1.04, P = 0.30] in older adults were not found. The results of the subgroup analysis showed that the short-term effect of Tai Chi in reducing the fear of falling was more significant (P = 0.002). ConclusionTai Chi could alleviate the FOF of older adults, improve balance and reduce fall incidence. However, large-sample, multi-center, high-quality randomized controlled studies are still verified in the future.

Factors Associated with Fear of Falling by Fall Experience in the Community-dwelling Elderly

Purpose: This study aimed to identify factors associated with fear of falling(FOF) by fall experience in the community-dwelling elderly. Methods: Multivariate logistic regression with complex samples was used to analyze the data of 74,475 elders aged 65 and over from the Community Health Survey in 2019. Results: Factors associated with FOF included gender, age, education level, smoking, high-risk drinking, physical activity, stress, depression, cognitive impairment, subjective health status, hypertension, and diabetes mellitus in the non-fall group. In the single fall group, the associated factors were gender, age, physical activity, stress, depression, cognitive impairment, and subjective health status. Related factors in the recurrent fall group included gender, age, physical activity, cognitive impairment, and subjective health status. Conclusion: The study’s findings suggest that it is necessary to develop different strategies to prevent FOF by understanding the contributing factors of FOF in each group of fall experience.

Course of fear of falling after hip fracture: findings from a 12-month inception cohort

ObjectivesTo examine the course of fear of falling (FoF) up to 1 year after hip fracture, including the effect of prefracture FoF on the course.DesignObservational cohort study with assessment of...

Is waist circumference associated with fear of falling in community-dwelling older adults? A cross-sectional study.

Fear of falling (FOF) is a prevalent condition among older adults and several variables have been pointed out as risk factors. To identify the cut-off point on waist circumference (WC), capable of discriminating between older adults with and without FOF, and to test the association between WC and FOF. A cross-sectional observational study was carried out with older adults of both sexes from Balneário Arroio do Silva, Brazil. We used Receiver Operating Characteristic (ROC) curves to determine the cut-off point on WC and logistic regression adjusted for potential confounding variables to test the association. Older women with WC >93.5cm [area under the curve: 0.61 (95%CI 0.53; 0.68)] had 3.30 (95%CI 1.53; 7.14) greater chances of having FOF compared with older women with WC ≤93.5cm. WC was not able to discriminate FOF in older men. WC values >93.5cm are associated with higher chances of FOF in older women.

Tridirectional association between probable depression, fear of falling and falls among middle-aged and older adults in Thailand

PurposeDepression is a major issue in the aging population, which may be related to fear of falling (FOF) and falls contributing to increased morbidity and mortality. The aim of the study was to assess the tridirectional associations between probable depression (PD), FOF and falls in a longitudinal study in Thailand. MethodsLongitudinal data of participants (≥45 years; N = 3708) from two consecutive waves (in 2015 and 2017) of the Health, Aging and Retirement in Thailand (HART) study were analysed. PD was assessed with the Center for Epidemiologic Studies Depression Scale, self-reported FOF and history of falls. ResultsHaving no PD in 2015 and PD in 2017 (aOR: 2.35, 95% CI: 1.67 to 3.30), and having both PD in 2015 and 2017 (aOR: 3.46, 95% CI: 1.92 to 6.23) were positively associated with incident FOF with activity avoidance, and no FOF in 2015 and FOF in 2017 (aOR: 2.29, 95% CI: 1.77 to 2.95), and both FOF in 2015 and 2017 (aOR: 2.38, 95% CI: 1.69 to 3.36) were positively associated with incident PD. Two or more falls in 2015 (aOR: 2.03, 95% CI: 1.29 to 3.19) was positively associated with incident PD, and both PD in 2015 and 2017 (aOR: 3.10, 95% CI: 1.40 to 6.48) were positively associated with incident multiple (≥2) falls. ConclusionsWe found tridirectional associations between PD, FOF and falls. It is suggested to screen and manage older adults for PD, FOF and fall history simultaneously.

The Impact of Fear of Falling (FOF) on the Quality of Life of the Elderly: A Cross-Sectional Clinical Study in a Regional Health Center

As life expectancy around the world has been steadily increasing, the geriatric syndrome of Frailty and Fear of Falling (FOF) have emerged as key factors correlating with the physical and mental health of the elderly as well as their quality of life. A number of studies have revealed that gender, age, chronic diseases, polypharmacy, family status, educational level, occupation and comorbidity are domains closely linked to frailty and the feeling of fear of falling, while aging-associated decline and psychosocial factors such as depression, stressful events and anxiety adversely affect the ability of seniors to perform their daily activities. This study investigates how the fear of falling affects the quality of life of the elderly who receive health care services at the Moira Health Centre in Heraklion, Crete, and how FOF correlates with frailty and other biopsychosocial factors. In response to the increasing number of publications on FOF and frailty among the elderly, the evidence-based information of the study attempts to provide useful knowledge regarding the optimal management of the physical and psychosocial needs of the elderly and facilitate the investigative efforts for an active and healthy ageing process.

Gait Characteristics Associated with Fear of Falling in Hospitalized People with Parkinson's Disease.

Fear of falling (FOF) is common in Parkinson's disease (PD) and associated with distinct gait changes. Here, we aimed to answer, how quantitative gait assessment can improve our understanding of FOF-related gait in hospitalized geriatric patients with PD. In this cross-sectional study of 79 patients with advanced PD, FOF was assessed with the Falls Efficacy Scale International (FES-I), and spatiotemporal gait parameters were recorded with a mobile gait analysis system with inertial measurement units at each foot while normal walking. In addition, demographic parameters, disease-specific motor (MDS-revised version of the Unified Parkinson's Disease Rating Scale, Hoehn & Yahr), and non-motor (Non-motor Symptoms Questionnaire, Montreal Cognitive Assessment) scores were assessed. According to the FES-I, 22.5% reported low, 28.7% moderate, and 47.5% high concerns about falling. Most concerns were reported when walking on a slippery surface, on an uneven surface, or up or down a slope. In the final regression model, previous falls, more depressive symptoms, use of walking aids, presence of freezing of gait, and lower walking speed explained 42% of the FES-I variance. Our study suggests that FOF is closely related to gait changes in hospitalized PD patients. Therefore, FOF needs special attention in the rehabilitation of these patients, and targeting distinct gait parameters under varying walking conditions might be a promising part of a multimodal treatment program in PD patients with FOF. The effect of these targeted interventions should be investigated in future trials.

1192 FALLS PREVENTION: COMMUNITY EXERCISE PROGRAMME; REDUCING RISK OF FALLS, DECONDITIONING AND LONELINESS IN FRAIL ELDERLY PATIENTS

Abstract Introduction Covid has had a devastating effect on the Elderly, resulting in deconditioning, increased falls and loneliness. Tailored exercises can reduce falls in people aged over 65 by 54% and participation in physical activity reduces the risk of hip fractures by 50%, currently costing the NHS £1.7 billion per year in England. This 8-week intervention delivered by trained volunteers in patient’s homes, aims to reduce deconditioning, loneliness and the risk, incidence and fear of falling (FOF) amongst frail patients post-discharge from hospital. Method A gap in service was identified in Frail patients discharged from hospital, at risk of falling and awaiting community physiotherapy. A steering group was set up including acute and community therapists, volunteers and carers to design a collaborative intervention to bridge the gap. At risk patients were identified and referred by ward therapists supported by the hospital volunteering team. Volunteers were trained to deliver an 8 weeks programme of progressive exercises in patients’ homes with additional signposting to appropriate statutory and voluntary services. Qualitative and quantitative outcome measures were taken at week 1 and week 8 of the intervention Results 91.5% total health outcomes improved or maintained by average: - FOF reduced by 22.5% - 180 degree turn improved by 43% - 60 sec Sit to Stand improved by 14.75% - Timed Up And Go improved by 15.5% - Confidence to cope at home improved by 15% - Pain / discomfort (self-reported) improved by 18.75% - Overall health (self-reported) improved by 8.5% Conclusion(s) Targeted exercise at home with skilled volunteers can improve functional fitness and health outcomes in a frail elderly population at risk of falls when discharged home from hospital. The programme increases patients’ connectivity to local voluntary and community sector services. Volunteers’ mental health improves by engaging in meaningful service.

Body composition, fear of falling and balance performance in community-dwelling older adults

ObjectivesWe aimed to 1) assess body composition using a portable technology, bioelectrical impedance analysis, (BIA) and 2) examine the associations between body composition and the discrepancy of fear of falling (FOF) and balance performance. MethodsA cross-sectional study included 121 older adults 60 years and older, 78% were female, 41% lived alone, and 71% had no history of falls. The discrepancy between fear of falling and balance performance was categorized into four groups. We found 47% rational (low FOF and normal balance), 19% incongruent (low FOF despite poor balance), 18% irrational (high FOF despite normal balance), and 16% congruent (high FOF and poor balance). ResultsBody Fat Mass (BFM), Percent Body Fat (PBF), and Body Mass Index (BMI) were correlated with fear of falling and balance performance. BMI was significantly different in the rational group (p = 0.004) and incongruent group (p = 0.02) compared to the congruent group. PBF was significantly different between the incongruent (p = 0.002), irrational (p = 0.014), and rational (p < 0.001) groups, compared to the congruent group. ConclusionsThe study found that body BFM, PBF, and BMI were correlated with fear of falling and balance impairment. High Body Mass Index and Body Fat Mass were associated with a discrepancy between FOF and balance. Body composition analysis devices, such as BIA and other portable technologies, could be taken to underserved communities and may help identify community-dwelling older adults who are frail and may be at high risk of falling.

Design of SmartWalk for Estimating Implication of Pathway With Turn and Task Condition on Postural and Gait Indices: Relevance to Fear of Fall.

Fear of Fall (FoF) is often associated with postural and gait abnormalities leading to decreased mobility in individuals with Parkinson's Disease (PD). The variability in knee flexion (postural index) during heel-strike and toe-off events while walking can be related to one's FoF. Depending on the progression of the disease, gait abnormality can be manifested as start/turn/stop hesitation, etc. adversely affecting one's cadence along with an inability to transfer weight from one leg to the other. Also, task demands can have implications on one's gait and posture. Given that individuals with PD often suffer from FoF and their dynamic balance is affected by task conditions and pathways, in- depth investigation is warranted to understand the implications of task condition and pathways on one's gait and posture. This necessitates use of portable, wearable device that can capture one's gait-related indices and knee flexion in free-living conditions. Here, we have designed a portable, wearable and cost-effective device (SmartWalk) comprising of instrumented Shoes integrated with knee flexion recorder units. Results of our study with age-matched groups of healthy individuals (GrpH) and those with PD (GrpPD) showed the potential of SmartWalk to estimate the implication of task condition, pathways (with and without turn) and pathway segments (straight and turn) on one's knee flexion and gait with relevance to FoF. The knee flexion and gait-related indices were found to strongly corroborate with clinical measure related to FoF, particularly for GrpPD, serving as pre-clinical inputs for clinicians.

Composite measures of motor performance and self-efficacy are better determinants of postural instability and gait difficulties than individual clinical measures in Parkinson's disease

BackgroundPostural instability and gait difficulties (PIGD) are a significant cause of disability and loss of quality of life (QoL) in Parkinson's Disease. Most research on clinical predictors of PIGD measures have focused on individual clinical often motor performance variables, However, PIGD motor features often result in fear of falling (FoF) lowering a patient's mobility self-efficacy. The purpose of this study was to assess composite measures of motor and self-efficacy determinants PIGD motor features in PD and compare these to analysis of individual clinical metrics. Methods75 PD participants underwent detailed motor and non-motor test batteries. Principal component analysis (PCA) was used to identify clusters of covarying correlates of slow walking, imbalance, falls, freezing of gait, FoG and compare these to traditional univariate analyses. ResultsA single PCA-derived composite measure of motor performance and self-efficacy of mobility was the most robust determinant of all PIGD motor features except for falls. In contrast, analysis of the individual clinical variables showed more limited and diverging findings, including evidence of better cognitive performance but more severe motor parkinsonian ratings in the fall group. ConclusionThere are robust associations between composite measures of motor performance and self-efficacy of mobility and all PIGD motor features except for falls. Univariate analysis of individual clinical measures showed limited correlates of PIGD motor features. Patient's own perception of motor performance, FoF, and QoL deserve more attention as PIGD therapeutic targets in PD.

PREVIOUS FALLS AND FEAR OF FALLING ON FUNCTIONAL LIMITATIONS: A LONGITUDINAL STUDY

Abstract Previous falls and fear of falling (FoF) are risk factors that affect older adults’ daily activities. However, it remains unclear about their combined effects on functional limitations. Using Round 1 (R1) and Round 2 (R2) data from the National Health and Aging Trends Study, we examined whether falls and FoF in R1 independently and jointly predict functional limitations in R2 and the moderating role of demographic factors in this relationship among community-dwelling older adults aged 65 years and older. Previous falls and FoF were ascertained by asking participants whether they had fallen down in the last year and worried about falling in the last month. Functional limitations included any difficulties with mobility, self-care, or household activities. Poisson regression models were used to analyze data. Of 5,956 participants, 16.4% had falls only, 14.3% had FoF only, 14.5% had both, and 54.8% had neither. In the full adjusted model, those who experienced concurrent falls and FoF had a higher risk of functional limitations than those without falls and FoF (Mobility: Incidence risk ratio, IRR=1.44, 95% CI: 1.33-1.57; Self-care: IRR=1.29, 95% CI: 1.20-1.38; Household tasks: IRR=1.32, 95% CI: 1.21-1.44), as well as those with falls only (Mobility: IRR=1.32, 95% CI: 1.21-1.44; Self-care: IRR=1.26, 95% CI: 1.17-1.35; Household tasks: IRR=1.18, 95% CI: 1.08-1.29) and FoF only (Mobility: IRR=1.38, 95% CI: 1.27-1.51; Self-care: IRR=1.26, 95% CI: 1.17-1.35; Household tasks: IRR=1.31, 95% CI: 1.20-1.43). The findings suggest that strategies to improve falls and FoF together could potentially help prevent functional limitations.

THE RELATIONSHIP BETWEEN THE FEAR OF FALLING AND QUALITY OF LIFE IN NURSING HOME RESIDENTS: THE ROLE OF ACTIVITY RESTRICTION

Abstract Falls among older adults are a significant later life course event with detrimental impacts on health, quality of life (QOL), and mortality. Fear of falling (FOF) is a common problem, which can lead to physical and social activity restriction and poor QOL. However, few studies have comprehensively explored the relationships among FOF, activity restriction, and QOL among nursing home residents. This study aimed to investigate: 1) whether FOF is negatively associated with QOL; and 2) the mediating role of activity restriction in the relationship between FOF and QOL among nursing home residents in mainland China. This is a cross-sectional study. A total of 316 residents from 27 nursing homes participated in this study. The mixed-effects multivariate linear or ordinal logistic regression models were conducted. All statistical models were adjusted for resident- and facility-level variables. More than half of nursing home residents (55.4%) reported they often or always reduced their activities. As expected, FOF was directly associated with lower levels of QOL (β = -0.19, p = 0.010). However, the strength of this association was attenuated and no longer significant with the inclusion of activity restriction in the model. FOF was positively associated with activity restriction (β = 0.33, p &amp;lt; 0.001) and activity restriction was negatively associated with QOL (rarely/sometimes reduced activity: β = -1.23, p = 0.386; often/always reduced activity: β = -3.85, p = 0.014). Given the aging of our populations, it is important to take FOF and activity restriction into account when caring for older people.

FALL RISK, FEAR OF FALLING, PHYSICAL ACTIVITY, AND SELF-PERCEPTIONS IN ETHNICALLY DIVERSE LOW-INCOME OLDER ADULTS

Abstract Falls and fear of falling (FOF) are the leading cause of disability, and hospitalization in ethnically diverse low-income older adults. The present study included an ethnically diverse sample of low-income older adults (N=121) to examine ethnic and income-based group differences in risk factors for falls (high FOF, depression, avoidance of physical activity) and the role of negative self-perceptions of aging in driving these risk factors. Results revealed the highest levels of fall risk among Hispanics and Asian Americans, FOF among African Americans, and depression among Hispanics. Accelerometer-based physical activity measures confirmed that low-income older adults had lower levels of moderate to vigorous physical activity (MVPA) compared with their high-income counterparts (p=0.04). Further, financial difficulty was related to MVPA (p&amp;lt;0.001), depression, anxiety, and fall risk (p=0.01). Critically, we also found a strong relationship between negative self-perceptions of aging and FOF (p = 0.002) across groups.

DEMOGRAPHIC DIFFERENCES IN THE LONGITUDINAL EFFECTS OF SYMPTOMS ON FALLS AND FALL-RELATED OUTCOMES

Abstract Research has shown an association between symptoms and falls and fall-related outcomes among older adults. However, this association was primarily drawn from cross-sectional studies or studies with a single symptom. Using the 2011-2018 waves of the National Health and Aging Trends Study, we examined whether 1) prior-wave common co-occurring symptoms predicted later-wave fall-related outcomes and 2) demographics moderated the longitudinal effects of symptoms on fall-related outcomes among community-dwelling older adults. Falls and fall-related outcomes were self-reported falls, multiple falls, fear of falling (FOF), and FOF limiting activity. The number of symptoms (from 0 to 6) was calculated based on the presence of pain, insomnia, breathing difficulty, depressive symptoms, anxiety, and fatigue. Binomial logistic regression was used for data analyses. Our sample consisted of 9,060 participants who contributed 34,327 observations. These observations were aged between 65 and 79 years old (57.7%), female (58.4%), and non-Hispanic White (70.5%). Each additional symptom was associated with an increased risk of falls (Adjusted Odds Ratio [AOR]: 1.13, 95% CI: 1.11-1.15), multiple falls (AOR: 1.15, 95% CI: 1.12-1.18), FOF (AOR: 1.21, 95% CI: 1.18-1.24) and FOF limiting activity (AOR: 1.25, 95% CI: 1.21-1.29). Age, race/ethnicity, education, and living arrangement significantly moderated the relationships between symptoms and falls and fall-related outcomes. However, gender did not moderate the effects of symptoms on any outcomes. These findings suggest that symptoms longitudinally predict falls and fall-related outcomes. Common symptoms assessment and individual demographics should be incorporated into fall risk assessments and interventions.

A longitudinal study of disability in activities of daily living andactivity restriction-induced fear of falling among Korean older people.

This study examined the effects of the fear of falling (FOF) alone and fear-associated activity restriction (FAR) on future activities of daily living (ADL) disability and analysed predictors of ADL disability among community-dwelling older people with and without FAR. This prospective study involved secondary data analysis of the Korean Longitudinal Study of Aging. We obtained data from 5074 community-dwelling older adults. Generalized estimating equations were used to identify the predictors of changes in ADL disability between 2008 and 2018. Compared with FOF alone, FAR was significantly related to changes in ADL disability. Being older, living with others and having poor self-rated health status were associated with future ADL disability in participants without FAR. Weakened grip strength and social engagement were associated with future ADL disability in those with FAR. Nurses must consider the impact of FAR on future ADL decline and implement tailored interventions. No Patient or Public Contribution.

Characterisation of institutionalised Portuguese older adult fallers: is there a place for pharmacist intervention? A preliminary study.

Falls are a major public health issue, given their prevalence and social impact. Older adults living in long-term care facilities (LTCF) are at greater risk of injury resulting from a fall due to multiple factors, such as nutritional, functional/cognitive impairment, postural instability, polypharmacy, and the presence of potentially inappropriate medications (PIMs). Medication management in LTCF is complex and often sub-optimal and might be crucial for falls. Pharmacist intervention is important, since they have a unique knowledge of medication. However, studies mapping the impact of pharmaceutical activities in Portuguese LTC settings are scarce. This study aims to assess the characteristics of older adult fallers living in LTFCs and examine the relationship between falling and several factors in this population. We also intend to explore the prevalence of PIMs and their relationship with the occurrence of falls. The study was conducted in two long-term care facilities for elderly people, in the central region of Portugal. We included patients aged 65 and older with no reduced mobility or physical weakness and with the ability to understand spoken and written Portuguese. The following information was assessed: sociodemographic characteristics, comorbidities, polypharmacy, fear of falling, functional, nutritional and cognitive status. PIMs were evaluated according to the Beers criteria (2019). A total of 69 institutionalised older adults, 45 women and 24 men, with a mean age of 83.14 ± 8.87 years were included. The prevalence of falls was 21.74% Out of these, 46.67% (n=7) fell once, 13.33% (n=2) fell twice, and 40% (n=6) fell 3 or more times. Fallers were mainly women, had lower levels of education, were well nourished, had moderate to severe levels of dependence, and displayed moderate cognitive impairment. All adult fallers had a fear of falling. The main comorbidities of this population were related to the cardiovascular system. Polypharmacy was present in every patient, and at least one PIM was identified in 88.41% of the subjects. Fear of falling (FOF) and cognitive impairment (in subjects with 1 to 11 years of education) showed statistically significant associations with the occurrence of falls (p=0.005 and p=0.05, respectively). No significant differences were found between fallers and non-fallers for any other factors. This present study is a preliminary contribution to characterise a group of older adult fallers living in Portuguese LTCFs and demonstrated that fear of falling and cognitive impairment are associated with the occurrence of falls in this population. The high prevalence of polypharmacy and PIMs emphasises the need for tailored interventions featuring the collaboration of a pharmacist to optimise medication management in this population.

The effect of Tai Chi in elderly individuals with sarcopenia and frailty: A systematic review and meta-analysis of randomized controlled trials.

The potential role of Tai Chi in improving sarcopenia and frailty has been shown in randomized controlled trials (RCTs). This systematic review and meta-analysis aimed to examine the effect of Tai Chi on muscle mass, muscle strength, physical function, and other geriatric syndromes in elderly individuals with sarcopenia and frailty. Systematic searches of the PubMed, Cochrane Library, PEDro, EMBASE, Web of Science, CINAHL, and Medline databases for RCTs published between 1989 and 2022 were conducted; the database searchers were supplemented with manual reference searches. The inclusion criteria were as follows: (1) the study was designed as a RCT; (2) Tai Chi was one of the intervention arms; (3) the participants had a minimum age of ≥60 years and were diagnosed with frailty or sarcopenia, and the diagnostic guidelines or criteria were mentioned; (4) the number of participants in each arm was ≥10; and (5) the outcome reports included ≥1 item from the following primary or secondary outcomes. The exclusion criteria were as follows: (1) non-RCT studies; (2) nonhuman subjects; (3) participants aged <60 years; (4) no description of the diagnostic guidelines or criteria for frailty or sarcopenia in the text; and (5) reported outcomes not among the following primary or secondary outcomes. The primary outcomes were muscle mass, grip strength and muscle performance (gait speed, 30-second chair stand test (30CST), sit-to-stand test (SST), Timed up and go test (TUGT), balance, and the Short Physical Performance Battery (SPPB)). The secondary outcomes included the number of falls and fear of falling (FOF), diastolic blood pressure (DBP), Mini-Mental State Examination (MMSE) score, and depression and quality of life (QOL) assessments. Eleven RCTs were conducted from 1996 to 2022 in 5 countries that investigated 1676 sarcopenic or frail elderly individuals were included in the review. There were 804 participants in the Tai Chi exercise cohort and 872 participants in the control cohort (nonexercised (n=5)/ exercise (n=8)). The mean age of participants was 70-89.5 years and the numbers of participants from each arm in each study were 10-158. The majority of the participants practiced Yang-style Tai Chi (n=9), and the numbers of movement ranged from 6 to 24. The prescriptions of training were 8-48 weeks, 2-7 sessions per weeks, and 30-90min per session. Most studies used Tai Chi expert as instructor (n=8). The lengths of follow-up period were 8-48 weeks. The results from our meta-analysis revealed significant improvements for Tai Chi compared to control group (nonexercise/ exercise) on measures of the 30CST (weighted mean difference (WMD): 2.36, 95% confidence interval (CI) 1.50-3.21, p<0.00001, I2 =87%), the TUGT (WMD: -0.72, 95% CI -1.10 to -0.34, p=0.0002, I2 =0%), numbers of fall (WMD: -0.41, 95% CI -0.64 to -0.17, p=0.0006, I2 =0%) and FOF (standardized MD (SMD): -0.50, 95% CI -0.79 to -0.22, p=0.0006, I2 =57%); and for Tai Chi compared to 'nonexercise' controls on measures of SST (WMD: -2.20, 95% CI -2.22 to -2.18, p<0.00001), balance (SMD: 9.85, 95% CI 8.88-10.82, p<0.00001), DBP (WMD: -7.00, 95% CI -7.35 to -6.65, p<0.00001), MMSE (WMD: 1.91, 95% CI 1.73-2.09, p<0.00001, I2 =0%), depression (SMD: -1.37, 95% CI -1.91 to -0.83, p<0.00001) and QOL (SMD: 10.72, 95% CI 9.38-12.07, p<0.00001). There were no significant differences between Tai Chi and control groups on any of the remaining 4 comparisons: body muscle mass (WMD: 0.53, 95% CI -0.18 to 1.24; P=0.14; I2 =0%), grip strength (WMD: -0.06, 95% CI -1.98 to 1.86; P=0.95; I2 =0%), gait speed (WMD: 0.05, 95% CI -0.11 to 0.20; P=0.55; I2 =99%), and SPPB (WMD: 0.55, 95% CI -0.04 to 1.14; P=0.07). The variables of bias summary, Tai Chi instructor, Tai Chi movements, and Tai Chi training duration without significant association with the 30CST or the TUGT through meta-regression analyses. Our results demonstrated that patients with frailty or sarcopenia who practiced Tai Chi exhibited improved physical performance in the 30-second chair stand test, the Timed up and go test, number of falls and fear of falling. However, there was no difference in muscle mass, grip strength, gait speed, or Short Physical Performance Battery score between the Tai Chi and control groups. Improvements in the sit-to-stand test, balance, diastolic blood pressure, Mini-Mental State Examination score, and depression and quality of life assessments were found when comparing the Tai Chi cohort to the nonexercise control cohort rather than the exercise control cohort. To explore the effectiveness of Tai Chi in sarcopenic and frail elderly individuals more comprehensively, a standardized Tai Chi training prescription and a detailed description of the study design are suggested for future studies.

Is fear of falling key to identifying gait and balance abnormalities in community-dwelling older adults? Protocol of a mixed-methods approach

IntroductionThe ageing population poses an increasing burden to public health systems, particularly as a result of falls. Falls have been associated with poor gait and balance, as measured by commonly...

Pilot Study of a Fall Prevention and Management Intervention Program for People With Multiple Sclerosis Who Use a Wheelchair or Scooter Full-Time

To examine the efficacy of a fall prevention/management intervention among persons with multiple sclerosis (PwMS) who use a wheelchair (WC) or scooter full-time. Pre-post/follow-up trial. Community and research laboratory. Twenty-one PwMS who used a WC or scooter full-time, self-reported at least 1 fall/12 months, and could transfer independently or with minimal/moderate assistance (N=21). Six-week, group and community-based fall prevention and management intervention. The intervention included six 2-hour in-person weekly sessions led by a physical or occupational therapist featuring interactive group discussions, skill practice, and action planning opportunities. Fall frequency tracked 12 weeks pre- and 24 weeks post intervention. Outcomes were assessed pre- and post intervention and 12 weeks post intervention. Measures included surveys to examine fear of falling (FOF), fall prevention/management, quality of life, community participation, and assessment of functional mobility skills. Semistructured interviews were administered post intervention to ascertain overall experiences with the program and effect on daily life. A Friedman test with signed-rank post hoc analysis was run to determine differences across the 3 study visits. After the intervention, fall incidence did not significantly change, but fall management strategies (P=.01-0.05), importance of community participation (P=.01), and transfer quality (P=.02) significantly improved. Moderate effect sizes were noted among concerns about falling, activity curtailment because of to FOF, and WC skills. Qualitative results indicate that participants found the intervention beneficial and applied intervention content in their daily lives. This study is the first to describe the effect of a multicomponent fall prevention/management intervention designed specifically for PwMS who use a WC or scooter full-time. Results indicate the program has potential to reduce fall risk; however, further testing is needed to fully examine the effect of the program.