High Fall Risk Research Articles

Predicting future falls in older people using natural language processing of general practitioners' clinical notes.

Falls in older people are common and morbid. Prediction models can help identifying individuals at higher fall risk. Electronic health records (EHR) offer an opportunity to develop automated prediction tools that may help to identify fall-prone individuals and lower clinical workload. However, existing models primarily utilise structured EHR data and neglect information in unstructured data. Using machine learning and natural language processing (NLP), we aimed to examine the predictive performance provided by unstructured clinical notes, and their incremental performance over structured data to predict falls. We used primary care EHR data of people aged 65 or over. We developed three logistic regression models using the least absolute shrinkage and selection operator: one using structured clinical variables (Baseline), one with topics extracted from unstructured clinical notes (Topic-based) and one by adding clinical variables to the extracted topics (Combi). Model performance was assessed in terms of discrimination using the area under the receiver operating characteristic curve (AUC), and calibration by calibration plots. We used 10-fold cross-validation to validate the approach. Data of 35,357 individuals were analysed, of which 4,734 experienced falls. Our NLP topic modelling technique discovered 151 topics from the unstructured clinical notes. AUCs and 95% confidence intervals of the Baseline, Topic-based and Combi models were 0.709 (0.700-0.719), 0.685 (0.676-0.694) and 0.718 (0.708-0.727), respectively. All the models showed good calibration. Unstructured clinical notes are an additional viable data source to develop and improve prediction models for falls compared to traditional prediction models, but the clinical relevance remains limited.

Turning When Using Smartphone in Persons With and Those Without Neurologic Conditions: Observational Study.

Turning during walking is a relevant and common everyday movement and it depends on a correct top-down intersegmental coordination. This could be reduced in several conditions (en bloc turning), and an altered turning kinematics has been linked to increased risk of falls. Smartphone use has been associated with poorer balance and gait; however, its effect on turning-while-walking has not been investigated yet. This study explores turning intersegmental coordination during smartphone use in different age groups and neurologic conditions. This study aims to evaluate the effect of smartphone use on turning behavior in healthy individuals of different ages and those with various neurological diseases. Younger (aged 18-60 years) and older (aged >60 years) healthy individuals and those with Parkinson disease, multiple sclerosis, subacute stroke (<4 weeks), or lower-back pain performed turning-while-walking alone (single task [ST]) and while performing 2 different cognitive tasks of increasing complexity (dual task [DT]). The mobility task consisted of walking up and down a 5-m walkway at self-selected speed, thus including 180° turns. Cognitive tasks consisted of a simple reaction time test (simple DT [SDT]) and a numerical Stroop test (complex DT [CDT]). General (turn duration and the number of steps while turning), segmental (peak angular velocity), and intersegmental turning parameters (intersegmental turning onset latency and maximum intersegmental angle) were extracted for head, sternum, and pelvis using a motion capture system and a turning detection algorithm. In total, 121 participants were enrolled. All participants, irrespective of age and neurologic disease, showed a reduced intersegmental turning onset latency and a reduced maximum intersegmental angle of both pelvis and sternum relative to head, thus indicating an en bloc turning behavior when using a smartphone. With regard to change from the ST to turning when using a smartphone, participants with Parkinson disease reduced their peak angular velocity the most, which was significantly different from lower-back pain relative to the head (P<.01). Participants with stroke showed en bloc turning already without smartphone use. Smartphone use during turning-while-walking may lead to en bloc turning and thus increase fall risk across age and neurologic disease groups. This behavior is probably particularly dangerous for those groups with the most pronounced changes in turning parameters during smartphone use and the highest fall risk, such as individuals with Parkinson disease. Moreover, the experimental paradigm presented here might be useful in differentiating individuals with lower-back pain without and those with early or prodromal Parkinson disease. In individuals with subacute stroke, en bloc turning could represent a compensative strategy to overcome the newly occurring mobility deficit. Considering the ubiquitous smartphone use in daily life, this study should stimulate future studies in the area of fall risk and neurological and orthopedic diseases. German Clinical Trials Register DRKS00022998; https://drks.de/search/en/trial/DRKS00022998.

The effects of optic flow on postural stability: Influence of age and fall risk

BackgroundOptic flow provides dynamic information relating to body position and motion with respect to visual frames of reference. This study investigated the effects of optic flow stimuli presented in four directions on postural stability in young and older adults. MethodsTwenty-five young (20–40 years) and 51 older (≥65 years) people participated in this study, with the older group classified into low fall risk (n = 27), and high fall risk (n = 24) sub-groups. While standing in a dark room, participants viewed static scattered white dots for 30 s, followed by 30 s periods of optic flow consisting of white dots “moving” in one of four flow directions, randomised: radial expansion and contraction, circular anti-clockwise and clockwise. Centre of pressure (CoP) position, postural sway in anteroposterior (AP) and mediolateral (ML) axes, and muscle activity of tibialis anterior (TA), gastrocnemius medialis (GM) and tensor fascia latae (TFL) were recorded. ResultsAcross groups, the four optic flow stimuli induced increased AP sway and three of the four optic flow stimuli induced increased ML sway, with concomitant increases in muscle activity, indicating optic flow stimuli induced a generalised destabilising, rather than a direction-specific, effect. Only one optic flow condition (radial contraction) induced a change in average CoP position, and this may reflect the adoption of a protective stance position to avoid a backward fall. Optic flow destabilised postural control more in older people compared with younger people, and radial expansion stimuli destabilised ML postural control more in the older high fall risk group compared with the older low fall risk group. ConclusionOptic flow stimuli have a generalised destabilising effect on postural control across groups as shown by non-directional specific increases in postural sway and muscular activity. Optic flow stimuli have a greater impact on postural stability in older compared with younger adults and this is more pronounced in the ML plane for older people at increased risk of falls.

Characterization of Postural Sway in Women with Osteoporosis and a Control Group by Means of Linear and Nonlinear Methods.

The mechanisms underlying the altered postural control and risk of falling in patients with osteoporosis are not yet fully understood. The aim of the present study was to investigate postural sway in women with osteoporosis and a control group. The postural sway of 41 women with osteoporosis (17 fallers and 24 non-fallers) and 19 healthy controls was measured in a static standing task with a force plate. The amount of sway was characterized by traditional (linear) center-of-pressure (COP) parameters. Structural (nonlinear) COP methods include spectral analysis by means of a 12-level wavelet transform and a regularity analysis via multiscale entropy (MSE) with determination of the complexity index. Patients showed increased body sway in the medial-lateral (ML) direction (standard deviation in mm: 2.63 ± 1.00 vs. 2.00 ± 0.58, p = 0.021; range of motion in mm: 15.33 ± 5.58 vs. 10.86 ± 3.14, p = 0.002) and more irregular sway in the anterior-posterior (AP) direction (complexity index: 13.75 ± 2.19 vs. 11.18 ± 4.44, p = 0.027) relative to controls. Fallers showed higher-frequency responses than non-fallers in the AP direction. Thus, postural sway is differently affected by osteoporosis in the ML and AP directions. Clinically, effective assessment and rehabilitation of balance disorders can benefit from an extended analysis of postural control with nonlinear methods, which may also contribute to the improvement of risk profiles or a screening tool for the identification of high-risk fallers, thereby prevent fractures in women with osteoporosis.

Correlation of Balance and Functional Ankle Instability in Elderly Women

Objectives: To evaluate and find the correlation of balance and functional ankle instability in elderly women. Methodology: A cross-sectional correlation study was conducted from June 2020 to December 2020, in which 61 participants (i.e., elderly women) were included. In the selected old age homes the self-reported questionnaire (Identification of Functional Ankle Instability [IdFAI]) had been distributed to the participants fulfilling the inclusion criteria as hand-outs and the performance-based questionnaire (Performance Oriented Mobility Assessment [POMA]) have been assessed and filled by the researcher. Chi square was used for associations and Pearson correlation for balance score and functional instability score. Results: The mean age of the participants was 64.89±4.30 years. According to the result of Tinetti Balance score, 31.1% elderly women with low risk of fall, medium risk of fall was 32.8% whereas with high risk of fall was 36.1%. The IdFAI showed, elderly women with Ankle Instability 62.3% while elderly women with No Ankle Instability were 37.7%. There was negative (inverse) Pearson linear correlation (r = -0.550) between age and balance (p ≤ 0.05) which means when the age increases, the balance decreases and also a weak association between age and functional ankle instability (p ≥ 0.05). Conclusion: This study concluded that there was not adequate evidence to propose an association between Balance and self-reported functional ankle instability.

Profound prospective assessment of radiological and functional outcome 6months after TBI in elderly.

Recovery after traumatic brain injury (TBI) in older adults is usually affected by the presence of comorbidities, leading to more severe sequelae in this age group than in younger patients. However, there are only few reports that prospectively perform in-depth assessment of outcome following TBI in elderly. This study aims at documenting structural brain characteristics and functional outcome and quality of life in elderly patients 6months after TBI and comparing these data with healthy volunteers undergoing the same assessments. Thirteen TBI patients ≥ 65years old, admitted to the University Hospitals Leuven (Belgium), between 2019 and 2022 due to TBI, including all injury severities, and a group of 13 healthy volunteers with similar demographic characteristics were prospectively included in the study. At admission, demographic, injury, and CT scan data were collected in our database. Six months after the accident, a brain MRI scan and standardized assessments of frailty, sleep quality, cognitive function, motor function, and quality of life were conducted. A total of 13 patients and 13 volunteers were included in the study, with a median age of 74 and 73years, respectively. Nine out of the 13 patients presented with a mild TBI. The patient group had a significantly higher level of frailty than the control group, presenting a mean Reported Edmonton Frailty Scale score of 5.8 (SD 2.7) vs 0.7 (SD 1.1) (p < 0.01). No statistically significant differences were found between patient and control brain volumes, fluid attenuated inversion recovery white matter hyperintensity volumes, number of lesions and blackholes, and fractional anisotropy values. Patients demonstrated a significantly higher median reaction time in the One Touch Stockings of Cambridge (22.3s vs 17.6, p = 0.03) and Reaction Time (0.5s vs 0.4s, p < 0.01) subtests in the Cambridge Neuropsychological Test Automated Battery. Furthermore, patients had a lower mean score on the first Box and Blocks test with the right hand (46.6 vs 61.7, p < 0.01) and a significantly higher mean score in the Timed-Up & Go test (13.1s vs 6.2s, p = 0.02) and Timed Up & Go with cognitive dual task (16.0s vs 10.2s, p < 0.01). Substantially lower QOLIBRI total score (60.4 vs 85.4, p < 0.01) and QOLIBRI-OS total score (53.8 vs 88.5, p < 0.01) were also observed in the patients' group. In this prospective study, TBI patients ≥ 65years old when compared with elder controls showed slightly worse cognitive performance and poorer motor function, higher fall risk, but a substantially reduced QoL at 6months FU, as well as significantly higher frailty, even when the TBI is classified as mild. No statistically significant differences were found in structural brain characteristics on MRI. Future studies with larger sample sizes are needed to refine the impact of TBI versus frailty on function and QoL in elderly.

Cumulative Effects of Comorbid Burden and Overactive Bladder Symptoms on Fall Risk Among Older Women Seeking Treatment for Urogynecologic Conditions.

Overactive bladder (OAB) syndrome and urinary incontinence, age, and comorbid burden are strong risk factors for falls in women. Less is known about their cumulative effects on fall risk in a urogynecologic population. The purpose of this study was to investigate the effects of coexisting OAB, older age, and comorbidities on risk of falling among treatment seeking women with pelvic floor disorders. We conducted a retrospective medical records review of 348 consecutive women presenting to a urogynecology clinic over 6 months. Fall risk was determined by the Centers for Disease Control and Prevention's, Stopping Elderly Accidents, Deaths, and Injuries screening tool. Clinical and sociodemographic measures were abstracted from the electronic medical record. Odds of screening positive for high fall risk based on different patient profiles were calculated. We then used a classification and regression tree analysis to determine the relative importance of the different variables on fall risk within the homogeneous subgroups. Of the 348 women (mean age, 58.7 ± 15.8 years) who completed the fall risk screen, 124 (36%) screened positive for increased fall risk. Overactive bladder symptoms increased the likelihood of a positive fall risk screen across all combinations of age and comorbid burden. The patient profile of ≥3 OAB symptoms, ≥4 comorbid conditions, and age 65 years or older increased the odds of screening positive for high fall risk more than 6-fold (odds ratio, 6.4; 95% confidence interval, 3.1-12.9). In the following order of importance, the combination of high comorbid burden, OAB, and older age identified approximately 3 in 4 patients (73.3%) at high risk of falling. The presence of 3 easily identifiable patient characteristics is strongly associated with a risk of falls in women seeking care for pelvic floor disorders.

Serum Irisin level is associated with fall risk, muscle strength, and cortical porosity in postmenopausal women.

Irisin plays a role in bone-muscle crosstalk, but the relationship between the serum irisin level and bone microarchitecture remains unknown. This study aimed to investigate the relationships between serum irisin level and fall risk, muscle strength, bone mineral density (BMD), and bone microarchitecture among Chinese postmenopausal women. In all 138 postmenopausal women, handgrip strength, short physical performance battery (SPPB), and the timed up-and-go test were performed to evaluate muscle strength, physical performance, and fall risk, respectively. The serum irisin was measured. High-resolution peripheral quantitative computed tomography (HR-pQCT) was performed to acquire volumetric BMD and bone microarchitecture. Bivariate analysis was used to explore relationships between serum irisin level and muscle strength and HR-pQCT parameters. Univariate and multivariate linear regression analyses were performed to determine associations between serum irisin level and vBMD and cortical porosity (Ct.Po). All participants had a median serum irisin level of 3.91 μg/ml. Participants with high fall risk had significantly lower serum irisin levels than those with low fall risk (2.22 μg/ml vs. 4.16 μg/ml, p=0.024). Irisin level was positively related to handgrip strength (rs=0.185, p=0.030) and SPPB performance. In univariate linear regression, serum irisin level was positively associated with cortical volumetric BMD (Ct.vBMD, radius: standardized β=0.184, p=0.031; tibia: standardized β=0.242, p=0.004), but it had no significant associations with Ct.vBMD after multivariate adjustment. After adjusting by age, height, serum sclerostin level, and body fat ratio, only Ct.Po at the distal radius had a significantly negative association with serum irisin level (standardized β=-0.276, p=0.003). Postmenopausal women with lower serum irisin levels have a higher fall risk, weaker muscle strength, and higher cortical porosity. Moreover, serum irisin level has a positive association with Ct.vBMD, but it is affected by factors such as age.

Real world validation of activity recognition algorithm and development of novel behavioral biomarkers of falls in aged control and movement disorder patients.

The use of wearable sensors in movement disorder patients such as Parkinson's disease (PD) and normal pressure hydrocephalus (NPH) is becoming more widespread, but most studies are limited to characterizing general aspects of mobility using smartphones. There is a need to accurately identify specific activities at home in order to properly evaluate gait and balance at home, where most falls occur. We developed an activity recognition algorithm to classify multiple daily living activities including high fall risk activities such as sit to stand transfers, turns and near-falls using data from 5 inertial sensors placed on the chest, upper-legs and lower-legs of the subjects. The algorithm is then verified with ground truth by collecting video footage of our patients wearing the sensors at home. Our activity recognition algorithm showed >95% sensitivity in detection of activities. Extracted features from our home monitoring system showed significantly better correlation (~69%) with prospectively measured fall frequency of our subjects compared to the standard clinical tests (~30%) or other quantitative gait metrics used in past studies when attempting to predict future falls over 1 year of prospective follow-up. Although detecting near-falls at home is difficult, our proposed model suggests that near-fall frequency is the most predictive criterion in fall detection through correlation analysis and fitting regression models.

Comparison of the predictive value of intrinsic capacity and comorbidity on adverse health outcome in community-dwelling older adults

ObjectivesTo compare the predictive value of intrinsic capacity (IC) and comorbidity on all-cause mortality and falls. MethodsThis prospective cohort study included 220 older adults (84.0±4.4 years) followed for 3 years in a community in Beijing. The methodology recommended by the World Health Organization was used to assess IC, and comorbidity was assessed by the Cumulative Illness Rating Scale for Geriatrics. ResultsThe areas under the characteristic curve of IC and comorbidity were 0.78 vs. 0.67 (p=0.033), respectively, in predicting all-cause mortality, and 0.69 vs. 0.61 in predicting falls (p=0.032). The vitality domain impairment (odds ratio [OR]=3.28, p=0.013), and cognition domain impairment (OR=3.97, p=0.004) were significantly associated with all-cause mortality. Locomotion domain impairment (OR=2.35, p=0.010) was associated with higher fall risk. ConclusionIC might be a better predictor than comorbidity in community-dwelling older adults, in which the vitality, locomotion and cognition domains should be given more attention.

Exercise at home program “DomiGym” contributes to the prevention of falls in vulnera-ble elderly people

Background Eighty-eight thousand fall accidents occur each year in Switzerland among people aged 65 and over, which cause a lot of personal suffering and economic costs Beratungsstelle für Unfallverhütung BFU, 2019). The exercise at home program “DomiGym - Bewegungsangebot zu Hause” (in short: DomiGym) of Pro Senectute Switzerland aims to maintain mobility, counteract the risk of falls and promote social contacts as well as social participation and psychosocial health. Vulnerable, elderly people enjoy with DomiGym an adapted, regular training program focused on strength and balance, in their own homes or in their neighborhoods. Methodology The implementation and effects of the DomiGym offers in the cantons of Zug and Zurich were evaluated using various methodological approaches: tests of strength (Chair-Stand-Test; Mehmet et al., 2019), of balance (Modified Romberg; Agrawa et al., 2011) and of functional mobility (Timed-Up-and-Go-Test; Marks, 2016) as well as written surveys of participants (based on standardized scales used in the Swiss Health Survey). Results On average participants reduced fall risk and improved functional mobility and leg strength (p &lt; 0.05). In a subsample of the canton of Zug, the Timed-Up-and-Go-Test (functional mobility and fall risk) improved by an average of 2.3 seconds (p &lt; 0.005) and the balance test (Romberg) improved by 1.8 seconds (p = 0.005). Over the course of a training series the reduction in fall risk proved clinically relevant in both cantons. Scores on the Timed-Up-and-Go-Test fell on average below the threshold of 13.5 seconds discriminating between fallers and non-fallers. Chair-stand test: Participants improved on average from an initial very high fall risk to an increased fall risk (below 15 seconds). In fact the subsample of canton Zug improved by an average of 3.96 seconds (clinically relevant with regard to the reduction of falls) and the subsample of canton Zurich improved by an average of 2.17 seconds (approximately clinically relevant; threshold value 2.3 seconds; Meretta et al., 2006). DomiGym improved the general health (67%) of most participants and either maintained the original walking level (80%) or even improved it (15%). The majority of DomiGym participants do gymnastic exercises at least weekly outside of DomiGym training. DomiGym participants positively change their movement behavior in everyday life. Conclusions Pro Senectute’s DomiGym reaches older people who cannot or do not want to attend out-of-home physical activity programs. The implementation of DomiGym improves the physical functions of leg strength, functional mobility, and balance, as well as the risk of falls in vulnerable elderly people. It can be assumed that DomiGym reduces the frequency of falls in the long term, contributes to the preservation of mobility and independence in everyday life, including a longer stay in their own homes.

The Dynamic Interplay of Objective and Subjective Balance and Subsequent Task Performance: Implications for Fall Risk in Older Adults

Introduction: Falls occur in daily life when an activity results in a loss of balance that is too great to recover from. Our purpose in this study was to examine how fall risk differentiates the dynamic interplay of objective and subjective balance on a given day and subsequent task performance on that day. Methods: For 30 consecutive days, following a baseline fall risk assessment, 41 older adults (56% female, Age M = 75.22, SD = 6.75) self-assessed balance and task performance using a smartphone. The Activity-specific Balance Confidence scale measured subjective balance. Postural sway and chair-stand performance were measured within a smartphone using accelerometry. Data were analyzed using multilevel random coefficient models. Results: Tests of heterogeneity in level one residuals showed day-to-day variability in balance confidence and postural sway to be greater in individuals with higher fall risk at baseline. Baseline fall risk differentiated how the interplay of balance confidence and postural sway on a given day related to chair-stand performance on that day. For those with higher fall risk, on days that balance confidence was higher, greater postural sway was followed by greater chair-stand performance. Conclusion: Findings indicate that older adults, especially those with higher fall risk, may be unaware of subtle fluctuations in balance, which could lead to engaging in activities that exceed the capacity to maintain balance at that moment. Fall prevention efforts should address older adults’ understanding of and responses to fluctuations of physical function in daily life.

Revealing the tension: The relationship between high fall risk categorization and low patient mobility.

Using an inpatient fall risk assessment tool helps categorize patients into risk groups which can then be targeted with fall prevention strategies. While potentially important in preventing patient injury, fall risk assessment may unintentionally lead to reduced mobility among hospitalized patients. Here we examined the relationship between fall risk assessment and ambulatory status among hospitalized patients. We conducted a retrospective cohort study of consecutively admitted adult patients (n=48,271) to a quaternary urban hospital that provides care for patients of broad socioeconomic and demographic backgrounds. Non-ambulatory status, the primary outcome, was defined as a median Johns Hopkins Highest Level of Mobility <6 (i.e., patient walks less than 10 steps) throughout hospitalization. The primary exposure variable was the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) category (Low, Moderate, High). The capacity to ambulate was assessed using the Activity Measure for Post-Acute Care (AM-PAC). Multivariable regression analysis controlled for clinical demographics, JHFRAT items, AM-PAC, comorbidity count, and length of stay. 8% of patients at low risk for falls were non-ambulatory, compared to 25% and 54% of patients at moderate and high risk for falls, respectively. Patients categorized as high risk and moderate risk for falls were 4.6 (95% CI: 3.9-5.5) and 2.6 (95% CI: 2.4-2.9) times more likely to be non-ambulatory compared to patients categorized as low risk, respectively. For patients with high ambulatory potential (AM-PAC 18-24), those categorized as high risk for falls were 4.3 (95% CI: 3.5-5.3) times more likely to be non-ambulatory compared to patients categorized as low risk. Patients categorized into higher fall risk groups had decreased mobility throughout their hospitalization, even when they had the functional capacity to ambulate.

Executive function and relation to static balance metrics in chronic mild TBI: A LIMBIC-CENC secondary analysis.

Among patients with traumatic brain injury (TBI), postural instability often persists chronically with negative consequences such as higher fall risk. One explanation may be reduced executive function (EF) required to effectively process, interpret and combine, sensory information. In other populations, a decline in higher cognitive functions are associated with a decline in walking and balance skills. Considering the link between EF decline and reduction in functional capacity, we investigated whether specific tests of executive function could predict balance function in a cohort of individuals with a history of chronic mild TBI (mTBI) and compared to individuals with a negative history of mTBI. Secondary analysis was performed on the local LIMBIC-CENC cohort (N = 338, 259 mTBI, mean 45 ± STD 10 age). Static balance was assessed with the sensory organization test (SOT). Hierarchical regression was used for each EF test outcome using the following blocks: (1) the number of TBIs sustained, age, and sex; (2) the separate Trail making test (TMT); (3) anti-saccade eye tracking items (error, latency, and accuracy); (4) Oddball distractor stimulus P300 and N200 at PZ and FZ response; and (5) Oddball target stimulus P300 and N200 at PZ and FZ response. The full model with all predictors accounted for between 15.2% and 21.5% of the variability in the balance measures. The number of TBI's) showed a negative association with the SOT2 score (p = 0.002). Additionally, longer times to complete TMT part B were shown to be related to a worse SOT1 score (p = 0.038). EEG distractors had the most influence on the SOT3 score (p = 0.019). Lastly, the SOT-composite and SOT5 scores were shown to be associated with longer inhibition latencies and errors (anti-saccade latency and error, p = 0.026 and p = 0.043 respectively). These findings show that integration and re-weighting of sensory input when vision is occluded or corrupted is most related to EF. This indicates that combat-exposed Veterans and Service Members have greater problems when they need to differentiate between cues when vision is not a reliable input. In sum, these findings suggest that EF could be important for interpreting sensory information to identify balance challenges in chronic mTBI.

Plantar pressure and falling risk in older individuals: a cross-sectional study

BackgroundFalls are commonplace among elderly people. It is urgent to prevent falls. Previous studies have confirmed that there is a difference in plantar pressure between falls and non-falls in elderly people, but the relationship between fall risk and foot pressure has not been studied. In this study, the differences in dynamic plantar pressure between elderly people with high and low fall risk were preliminarily discussed, and the characteristic parameters of plantar pressure were determined.MethodsTwenty four high-fall-risk elderly individuals (HR) and 24 low-fall-risk elderly individuals (LR) were selected using the Berg Balance Scale 40 score. They wore wearable foot pressure devices to walk along a 20-m-long corridor. The peak pressure (PP), pressure time integral (PTI), pressure gradient (maximum pressure gradient (MaxPG), minimum pressure gradient (MinPG), full width at half maximum (FWHM)) and average pressure (AP) of their feet were measured for inter-group and intra-group analysis.ResultsThe foot pressure difference comparing the high fall risk with low fall risk groups was manifested in PP and MaxPG, concentrated in the midfoot and heel (p < 0.05), while the only time parameter, FWHM, was manifested in the whole foot (p < 0.05). The differences between the left and right foot were reflected in all parameters. The differences between the left and right foot in LR were mainly reflected in the heel (p < 0.05), while it in the HR was mainly reflected in the forefoot (p < 0.05).ConclusionsThe differences comparing the high fall risk with low fall risk groups were mostly reflected in the midfoot and heel. The HR may have been more cautious when landing. In the intra-group comparison, the difference between the right and left foot of the LR was mainly reflected during heel striking, while it was mainly reflected during pedalling in the HR. The sensitivity of PP, PTI and AP was lower and the newly introduced pressure gradient could better reflect the difference in foot pressure between the two groups. The pressure gradient can be used as a new foot pressure parameter in scientific research.

Novel Approach to Analyze All-Round Kinematic Stability During Curving Steps

From the viewpoint of the stability of biped walking, the stability for both anteroposterior, lateral, and diagonal directions should be considered owing to the frequent occurrence of turning and curving motions in the daily environment. In this study, a measure called the all-round margin of stability (MoS) is proposed to evaluate the kinematic balance of the all-round direction. A curving experiment was performed to analyze the characteristics of the all-round MoS. The curving gait was recorded with and without the restriction of hip rotation. The all-round MoS of trials were classified using cluster analysis, and the characteristics of curving motion were extracted from gait parameters using factor analysis. By comparing the characteristics of the all-round MoS and factor scores, the features of the all-round MoS were discussed. The results suggest that the effect of the parameters on the MoS, such as the velocity of the center of gravity and step width, matched the characteristics of the all-round MoS. Thus, the effect of the range of motion of hip rotation on curving gait was analyzed using an all-round MoS. The all-round MoS helps visualize the anisotropy of balance, which then enables estimation of the direction with high fall risk. Furthermore, the all-round MoS enables to evaluate and improve the performance of gait assist devices such as exoskeletons. This study proposes the concept of all-round MoS as the method to evaluate balance in diagonal direction especially for complex gait.

Comparison of Physical Activity, Exercise Barriers, Physical Performance, and Fall Risks in Frail and Nonfrail Older Adults

Objectives: The present research aimed to identify the difference between physical activity, physical performance, balance, fall risk, and exercise barriers in frail and nonfrail older adults. Methods: One hundred nineteen voluntary individuals older than 65 years and living in Kırıkkale were enrolled in the research. The Clinical Frailty Scale was employed to evaluate the frailty level of the individuals included in the study. In line with the data obtained after the evaluation, individuals were separated into 2 groups as frail and nonfrail individuals. Exercise barriers were evaluated with the Exercise Benefits/Barriers Scale (EBBS), physical activity level was evaluated with the Physical Activity Scale for the Elderly (PASE), lower extremity physical performance was assessed with the Short Physical Performance Battery (SPPB) test, and fall risk was assessed with the Self-Rated Fall Risk Questionnaire (FRQ). Results: Ninety-three of the individuals enrolled in the study were found to be nonfrail and 26 to be frail older adults. The mean age of the individuals in the nonfrail group was 70.36 ± 6.10 years, and the mean age of the individuals in the frail group was 76.53 ± 7.37 years. In the statistical analysis, the difference was revealed between the groups in terms of the exercise barriers subscore, EBBS total score, PASE leisure activity score, PASE total score, FRQ total score, and SPPB total result (P &lt; .05). In the correlation analysis, there was a negative correlation between the frailty scale score and SPPB and a positive correlation between the frailty scale score and FRQ in nonfrail older adults (P &lt; .05). However, there was a positive correlation between the frailty scale score and exercise barriers subscore, EBBS and FRQ total scores, and a negative correlation between the PASE leisure activities, work activities and PASE total score, and SPPB score in frail individuals (P &lt; .05). Conclusions: Our results demonstrated that the physical activity levels of frail older adults were poorer, they had a higher fall risk, and their activity performance, including the lower extremity, was poorer than that of nonfrail older adults.

Reference Values for 3-Meter Backward Walk Test among Apparently Healthy Adults

Objective: The 3-meter backward walk (3MBW) test is an outcome performance measure to assess backward walking mobility, balance, and risk of fall. However, the lack of baseline values is a potential limitation for its use as a rehabilitation target value or predictor of outcomes. This study aimed at ascertaining a gender- and age-reference value of 3MBW and determining its correlation with sociodemographic and anthropometric variables. Methods: A total of 1,601 Nigerian healthy adults participated in this cross-sectional study. 3MBW was measured following standardized procedure on a marked 3-m floor. Anthropometric and sociodemographic parameters were taken. Data were summarized using the descriptive statistics of mean, standard deviation, and percentile (less than the 25th, between the 25th and 75th, and above the 75th percentiles were regarded as low, average, and high 3MBW, respectively). Results: From this study, less than 2.23 s and 2.60 s were regarded as low risk of fall for males and females, respectively; 2.23–3.00 s and 2.60–3.50 s were regarded as average risk of fall for males and females, respectively, while greater than 3.00–3.9 s and 3.50–3.90 s were regarded as high risk of fall for males and females, respectively. 3MBWT was significantly associated with age (r = 0.51, p = 0.001), sex (r = 0.315, p = 0.001), weight (r = 0.14, p = 0.001), BMI (r = 0.28, p = 0.001), but not height (r = −0.03; p = 0.250). Conclusion: This study provided a reference set of values according to age and gender for 3MBW in healthy individuals. Males have shorter 3MBW than females, and the time taken to accomplish 3MBW increases with age.

The Identification of Elderly People with High Fall Risk Using Machine Learning Algorithms.

Falling is an important public health issue, and predicting the fall risk can reduce the incidence of injury events in the elderly. However, most of the existing studies may have additional human and financial costs for community workers and doctors. Therefore, it is socially important to identify elderly people who are at high fall risk through a reasonable and cost-effective method. We evaluated the potential of multifractal, machine learning algorithms to identify the elderly at high fall risk. We developed a 42-point calibration model of the human body and recorded the three-dimensional coordinate datasets. The stability of the motion trajectory is calculated by the multifractal algorithm and used as an input dimension to compare the performance of the six classifiers. The results showed that the instability of the faller group was significantly greater than that of the no-faller group in the male and female cohorts (p &lt; 0.005), and the Gradient Boosting Decision Tree classifier showed the best performance. The findings could help elderly people at high fall risk to identify individualized risk factors and facilitate tailored fall interventions.

A COMPARATIVE STUDY OF FALL RISK ASSESSMENT IN COMMUNITY DWELLING OLDER ADULTS IN INDIA

Abstract Falls in older adults can be prevented with early identification. Recent research investigates the use of wearable sensors to provide quantitative data on mobility parameters to assess risk of fall. However, the efficiency of these new methods in comparison to conventional fall risk assessment tools is unknown. Therefore, the current study compares the sensor-based fall risk assessment with conventional fall risk measures. The study included 659 community-dwelling older adults (&amp;gt;60 years) who were followed for 12 months after baseline. The American Geriatric Society Fall Risk Assessment tool was used to assess risk of fall conventionally and Kinesis QTUG was used to assess the fall risk using sensors. Receiver operating characteristics curve (ROC) was used to compare the sensor-based method and the conventional method of assessing fall risk. Out of the 659 community-dwelling older adults, 24% (163) of older adults reported a fall in 12 months. According to the sensor-based assessment, 23% of older adults had low risk, 50% had medium risk and 27% had high risk of fall and according to the conventional method 66.1% were in low risk, 27.1% were in medium risk and 6.8% were in high risk. The ROC analysis showed that the sensor-based methods (AUC-78%; sensitivity- 93.8% specificity – 56.3%) outperformed the conventional method (AUC – 61.2%; sensitivity – 82.8% and specificity - 67.2%) of identifying older adults at risk of fall. Therefore, use of simple wearable sensors can determine the risk of future falls.