Mobility Aids Research Articles

EXPANDING CDC’S STILL GOING STRONG CAMPAIGN TO INCLUDE TRIBAL POPULATIONS AND PROMOTE SOCIAL CONNECTEDNESS

Abstract The Centers for Disease Control and Prevention (CDC) launched the Still Going Strong (SGS) campaign in 2021 to promote ways older adults (65+) can age without injury. The goal was to encourage older adult participation in lifelong activities while taking steps to prevent injuries. Based on initial campaign evaluation, CDC plans to expand SGS to include social connectedness content and reflect greater diversity. To inform this expansion, CDC conducted spring 2023 focus groups with Tribal elders (n=8) and differently-abled older adults (n=9) and presented different concepts depicting older adults engaging in activities with others. Tribal elders were affiliated with five tribes: Navajo, Ojibwa, Citizen Potawatomi, Lumbee Indian, and Wailaki. Half were female (n=4), and majority were 63–70 years of age (n=5). This group tested two new radio concepts: (1) Walking and Talking and (2) Sharing Lessons. Themes across Tribal participants included the importance of connecting with loved ones, sharing culture and spirituality through service, and connecting with younger generations. The differently abled focus group was majority female (n=6), white, (n=5), 70–75 years of age (n=5) and reported using a mobility aid (n=6). This group tested two new video concepts: (1) Best Friends and (2) Health in Numbers. Participants identified social connection and being with others as important for their overall health. Using these data, we will create and refine campaign materials targeting both populations, which will be disseminated and further evaluated. By creating culturally relevant and respectful health promotion messages, we can better engage disproportionately affected persons and reduce injuries.

METHODS AND BASELINE CHARACTERISTICS FOR THE TECHSAGE TELE TAI CHI CLINICAL TRIAL

Abstract Individuals aging with long-term mobility disabilities encounter a range of significant barriers to participating in physical and social activities, from challenges with transportation, to lack of accessibility and access to appropriate instruction. We developed a Tai Chi telewellness intervention to facilitate both physical and social wellness through accessible, virtual group classes. The intervention translated an in-person, evidence-based tai chi program (Tai Chi for Health Institute’s Tai Chi for Arthritis) to be 1) a virtual experience (via Zoom) that includes a social component and 2) accessible and appropriate for those aging with mobility disabilities. We conducted the TechSAge Tele Tai Chi clinical trial to examine the effect of the intervention on physical activity and social connectedness (primary outcomes), as well as exercise self-efficacy, falls efficacy, depression, quality of life, and pain (secondary outcomes) for this population. The participant sample was community-dwelling adults (60-80 years of age) with a self-identified mobility disability (i.e., using a mobility aid or having serious difficulty walking or climbing stairs) for at least 10 years. The presentation will describe the rationale for the study, as well as the study design, methodology, and baseline data for the trial. We will also highlight the user-centered, iterative design approach we used in the design and evaluation of the intervention protocol.

Dementia and Postoperative Delirium in Surgical Hip Fracture Patients: Unveiling Contrasting Risk Factors and Implications.

Postoperative delirium is a serious complication, particularly in older adults with hip fractures. Using the 2019 American College of Surgeons National Surgical Quality Improvement Program data file, we performed multiple regression analyses to compare risk factors for postoperative delirium in hip fracture patients with and without dementia. Preoperative delirium and mobility aid use were common risk factors in both groups. However, differential effects were observed for other factors. Pathological fracture increased delirium risk in patients with dementia but had a protective effect in those without dementia. In patients with dementia, American Society of Anesthesiology score IV/V was identified as a risk factor, whereas advanced age, severe chronic obstructive pulmonary disease, weight loss, sepsis, elevated international normalized ratio, and serum creatinine level were additional risk factors in patients without dementia. These findings enhance our understanding of the complex relationship among dementia, hip fractures, and postoperative delirium. Identifying specific risk factors for each group can inform tailored interventions and preventive strategies. Further research is needed to validate and expand these findings, ultimately improving care and outcomes. [Journal of Gerontological Nursing, 49(12), 25-30.].

Taking Control: A Novel Galvanic Stimulation Device for the Visually Impaired.

The white cane has been the prominent and widely used mobility aid by visually impaired persons for many years, however, there are some limitations associated with the white cane mobility aid device. Primarily, the white cane exhibits restricted capability in detecting ground-level obstacles in proximity and does not provide reliable detection of aerial obstacles. Our work proposes a device for the safe navigation of visually impaired persons utilizing a non-invasive galvanic vestibular stimulation (GVS) technique. By delivering a signal (1-1.2mA) delivered behind the ear via electrode pads to the vestibular system, we induce a sensation of steering thereby facilitating navigation. Our proposed device utilizes a combination of Intel’s D435 depth camera and an object detection model, YOLOv5, to identify and process the detection of obstacles within a 3-meter range. Within 0.2 seconds, the object is detected, and the algorithm assesses the situation and sends instructions via User Datagram Protocol (UDP) packets wirelessly to the GVS device. The device receives the packets and steers the subject (human) autonomously. In total, four tests with different scenarios have been conducted, through experimentation, it was found that the system could successfully detect, process, and transmit geospatial information to the GVS module; and steers the user into the correct trajectory to avoid any hazards obstructing the user’s path.

Cost consequence analysis of transcutaneous tibial nerve stimulation (TTNS) for urinary incontinence in care home residents alongside a randomised controlled trial

BackgroundUrinary incontinence (UI) is prevalent in more than half of residents of nursing and residential care homes and can have a detrimental impact on dignity and quality of life. Care homes predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous tibial nerve stimulation (TTNS) is a non-invasive, safe, low-cost intervention with demonstrated effectiveness for reducing UI in adults. We examined the costs and consequences of delivering TTNS to care home residents in comparison to sham (inactive) electrical stimulation.MethodsA cost consequence analysis approach was used to assemble and present the resource use and outcome data for the ELECTRIC trial which randomised 406 residents with UI from 37 care homes in the United Kingdom to receive 12 sessions of 30 min of either TTNS or sham (inactive) TTNS. TTNS was administered by care home staff over 6 weeks. Health state utility was measured using DEMQOL-U and DEMQOL-PROXY-U at baseline, 6 weeks and 18 weeks follow-up. Staff completed a resource use questionnaire at baseline, 6 weeks and 18 weeks follow-up, which also assessed use of absorbent pads.ResultsHRQoL did not change significantly in either randomised group. Delivery of TTNS was estimated to cost £81.20 per participant, plus training and support costs of £121.03 per staff member. 85% of participants needed toilet assistance as routine, on average requiring one or two staff members to be involved 4 or 5 times in each 24 h. Daily use of mobility aids and other assistive devices to use the toilet were reported. The value of staff time to assist residents to use the toilet (assuming an average of 5 min per resident per visit) was estimated as £19.17 (SD 13.22) for TTNS and £17.30 (SD 13.33) for sham (per resident in a 24-hour period).ConclusionsUse of TTNS to treat UI in care home residents did not lead to changes in resource use, particularly any reduction in the use of absorbent pads and no cost benefits for TTNS were shown. Managing continence in care homes is labour intensive, requiring both high levels of staff time and use of equipment aids.Trial registrationISRCTN98415244, registered 25/04/2018. NCT03248362 (Clinical trial.gov number), registered 14/08//2017.

Meta-Analysis of Different Mobility Devices for Rehabilitation of Persons with Disabilities

Loss of physical mobility poses significant challenges to full participation in daily activities and can even lead to complete limitations. In India alone, based on census data from 2011, there are over 5.5 million individuals with lower limb disabilities who rely on manually propelled wheelchairs for their mobility needs. While wheelchairs, crutches, and tricycles are commonly used mobility aids in India, this paper explores mobility technologies that have been conceptualized and developed in other parts of the world to assess their potential applicability in the Indian context.

Should foreign aid consider inter‐Pacific Islands migration in the context of climate change? Evidence from Fiji

AbstractMotivationThis research brings a Pacific Islands‐centred perspective into the discussion of foreign aid and climate mobility. Climate‐related migration is a crucial issue in Oceania as climate change is increasingly affecting Pacific Islanders. In this context, the Pacific Islands are typically seen as migrant‐sending countries to places outside the region. Inter‐Pacific Islands migration (IPIM) is barely recognized.PurposeShould foreign aid consider climate‐related IPIM? This article focuses on Fiji to: (1) assess current knowledge on migration between the Pacific Island Countries and Territories (PICTs) and Fiji's role therein; (2) maps aid‐funded climate mobility initiatives in the Pacific Islands; and (3) explores Fiji's national polices and local Fijian perspectives on regional climate‐related immigration to Fiji.Methods and approachThis study draws on a combination of statistical analysis, policy document analysis, expert interviews, and semi‐structured interviews and an in‐depth online survey involving local Fijians. Additionally, it incorporates the author's personal work experience as a Pacific Islander and a Fijian traversing climate mobility aid and policy spaces relating to Oceania.FindingsCurrent aid policies and initiatives addressing climate mobility have insufficiently considered IPIM. Migration from other PICTs to Fiji is significant, both in terms of numbers and in its current and potential impacts on local Fijians. Neither research, nor Fiji's national policies, nor donors have sufficiently considered this issue to date.Policy implicationsAid policies and initiatives targeting climate‐related migration in PICTs need to be refocused to give more attention to IPIM. Donors must expand their support to migrant‐receiving communities in PICTs such as Fiji. By recognizing and investing in IPIM, donors can foster mutual benefits for Fiji, other PICTs, and donor countries.

Human-machine symbiosis: ambivalent intuitions regarding gain and loss of personal control explain acceptance of smart mobility aids

ABSTRACT Smart mobility aids invoke conflicting impressions of enhanced mobility and being restricted and dependent. This ambivalence between perceived gain and loss of personal control might affect the acceptance of these devices. In a preregistered study (N = 194), we investigated people’s expectations on how using a flexible exosuit and a rigid exoskeleton would affect their personal control and tested how this influenced their acceptance of those devices. Overall, participants anticipated a net gain of personal control by using smart mobility aids. There was no difference in anticipations of gain of control between devices, but anticipations of loss of control were higher for the rigid exoskeleton than for the flexible exosuit. Anticipated gain and loss of control explained more than 50% of the variance in the acceptance of the investigated devices. The belief that a smart mobility aid would increase the user’s personal control was more predictive of overall acceptance than the belief that such a device would limit the user’s personal control. Overall, the current findings reveal that potential users’ expectations regarding changes in personal control, in particular the degree to which positive changes are expected, are a key determinant of acceptance of smart mobility aids.

Unveiling Seniors' Perception of Mobility: Urbanization, Region, and Physical Activity.

Maintaining mobility is fundamental to active aging, allowing older adults to lead dynamic and independent lives. The perception of mobility among older adults significantly impacts their overall well-being and quality of life. Given the aging population, mobility has become an increasingly pressing issue. This study focused on the perception of urban neighborhoods, including considerations of urban tissue (crossings and sidewalk maintenance), urban scenes (benches and traffic), and safety (fears and street lighting quality). We investigated the differences in the perception of the surroundings of residences by urban and rural seniors concerning their demographic and social characteristics and environmental determinants. A quantitative study design utilizing a questionnaire survey was employed. Data were collected mainly through face-to-face interviews in the field (PAPI) and via an online questionnaire (CAWI). The final sample comprised 525 participants. Hypotheses regarding the influence of gender, age, social status, level of physical activity, degree of urbanization, and region on environmental perception were tested using ordinal regression. The hypothesis regarding the dependence of the perception of the surroundings on the level of urbanization was confirmed; that regarding the dependence of the perception of the residence surroundings on seniors' age was not confirmed. The other hypotheses were partially confirmed. For the seven investigated environmental attributes, gender was significant in two cases, social status and physical activity in three cases, and region in four cases. While most studies have focused on urban settings, this study highlights the situation in rural municipalities. Substantially worse pedestrian conditions in availability of pedestrian crossings, benches, and lighting were recognized in rural municipalities versus cities. Understanding the complexity of mobility and the spatial locations relevant for older persons concerning potential barriers and facilitators for mobility aids in planning and adapting neighborhood environments to promote active and healthy aging in place.

Advances in mobility aid use reporting: situational context and objective measurement improve understanding of daily aid use in older adults

Advances in mobility aid use reporting: situational context and objective measurement improve understanding of daily aid use in older adults

Synergistic Impact of Visual and Cognitive Impairments on Health-Related Quality of Life in a Multiethnic Asian Population

Introduction: The concomitant impact of visual impairment (VI) and cognitive impairment (CI) on health-related quality of life (HRQoL) in older adults is unclear. We aimed to determine the synergistic effect of baseline VI and CI on HRQoL decline at 6 years in multiethnic Asians. Methods: We included Chinese, Malay, and Indian adults aged ≥60 years who participated in baseline (2004–2011) and 6-year (2011–2017) follow-up visits of the Singapore Epidemiology of Eye Diseases Study, a population-based cohort study in Singapore. Visual acuity (VA) was objectively measured at both visits, with VI defined as presenting VA >0.3 LogMAR in the better eye. CI was defined as Abbreviated Mental Test scores of ≤6 and ≤8 for individuals with ≤6 and >6 years of formal education, respectively. HRQoL was measured using the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. HRQoL decline was defined as the difference in the composite EQ-5D scores at baseline and 6-year follow-up and deemed clinically meaningful if the reduction was equal to or larger than the minimal clinically important difference. Multivariable linear regression assessed the independent associations and synergism (β interaction) between baseline VI and CI on EQ-5D decline. Results: Of the 2,433 participants (mean [SD] age: 67.6 [5.5]) at baseline, 559, 120, and 151 had VI only, CI only, and both impairments, respectively. HRQoL decline in individuals with baseline comorbid VI-CI was clinically meaningful and was 2.0 times (β = −0.044, 95% confidence interval: −0.077 to −0.010) and 3.7 times (β = −0.065, 95% confidence interval: −0.11 to −0.022) larger than those with VI only and CI only, respectively. Importantly, there was a significant synergism (β interaction = −0.048, 95% confidence interval: −0.095 to −0.001) between baseline VI and CI as predictors of HRQoL decline, suggesting that individuals having both conditions concurrently had a greater HRQoL reduction than the sum in those with VI alone and CI alone. The affected HRQoL domains included mobility and usual activities. Conclusions: Concomitant VI-CI potentiated HRQoL decline to a greater extent than the sum of individual contributions of VI and CI, suggesting synergism. Our results suggest that rehabilitative interventions such as the use of mobility aids and occupational therapy are needed to maintain HRQoL in older adults with concomitant VI-CI. Moreover, preventive interventions targeting at early detection and management of both VI and CI may also be beneficial.

Technology for SMS-based assistive device for the visually impaired

The term "tunanetra" is used to refer to someone who experiences total blindness or visual impairment. Such visual limitations result in visually impaired individuals facing difficulties in accessing information quickly and performing daily activities like walking, driving, and more. Walking is one of the crucial activities for visually impaired individuals because it is one way to explore the world and engage in daily activities. Based on this issue, an assistive device for the visually impaired was designed using embedded system technology. In 2022, Serly Juliana Taneo, Jonshon Tarigan, Frederika Rambu Ngana, and Andreas Ch. Louk developed a mobility aid device for individuals with visual impairments using ultrasonic sensors for distance detection and Arduino as the microcontroller. However, the device primarily focused on mobility, and there is a need to add new features, such as emergency information using SMS technology that can send messages with the press of a button. The research results indicate that the ultrasonic sensor successfully triggers vibrations within a range of 1-100 cm, and the button can send emergency notifications via SMS when pressed. Therefore, it can be concluded that all connected components can function as intended. By combining SMS technology and ultrasonic sensors, this assistive device is expected to enhance the safety and independence of individuals with visual impairments as they navigate their surroundings.

Prevalence of Impaired Physical Mobility in Dialysis Patients: A Single-Centre Cross-Sectional Study.

Impaired physical mobility in hemodialysis (HD) patients is considered an important modifiable risk factor of increased all-cause morbidity and mortality. To our knowledge, no study to date has determined the overall burden of limited physical mobility in prevalent HD patients. The aim of this research is to investigate impaired physical mobility and its clinical correlates. We conducted a cross-sectional observational study in all patients of the Centre for Acute and Complicated Dialysis at the University Medical Centre of Ljubljana, where the most complex patients receive HD on average three times per week. The data were collected through interviews based on a prepared questionnaire and medical history review. A total of 205 patients were included in this study (63.9 ± 15.4 years). Sixty percent (122/205) of the patients had little or no physical mobility impairment, and others were categorized with a minor or severe mobility limitation. A minor mobility impairment was found in 21% (43/205) of patients: 10 patients (5%) used a mobility aid in the form of a crutch, 9 patients (4%) were dependent on two crutches or a walker, and 24 patients (12%) were temporarily dependent on the assistance of a third person. Severe mobility limitations were observed in 22% (40/205) of patients, ranging from being confined to bed (19/205, 9%), confined to bed but able to perform some movements (19/205, 9%), and ambulatory but dependent on the assistance of a third person for locomotion (2/205, 1%). The most common causes of the limitation of mobility were neurological (19/40, 47.5%), cardiovascular (9/40, 22.5%), musculoskeletal (8/40, 20%), and other causes (4/40, 10%). A significant, moderate positive correlation was observed between mobility problems and the age of the participants (r = 0.36, p < 0.001), while a significant, small positive correlation was obtained between the mobility problems and C-reactive protein (r = 0.15, p = 0.044). Moreover, mobility problems had a small but significant negative correlation with albumin levels (r = -0.15, p = 0.042). When controlling for age, results yield no significant correlations, and, in regression analysis, only the age (p < 0.001) and male gender (p = 0.007) of the participants were independent predictors of mobility impairment. We conclude that impaired mobility has a high overall prevalence among chronic HD patients. Strategies to prevent and improve mobility limitations are strongly needed.

Rollator related pedestrian single accidents and collision events in Sweden

Rollators (four-wheel walkers in USA; zimmer frames in UK) are commonly used as mobility aids for the elderly and people with a variety of disabilities. Pedestrian rollator users are a sub-group of Vulnerable Road Users (VRUs), although this group is rarely recognised in traffic safety contexts. The aim of this study is to extract and analyse rollator related pedestrian accident and injury data in Sweden. The results will provide valuable insight into the risks and obstacles rollator users are exposed to in the traffic environment and may in the long term contribute to improving the mobility of this group. The current study is based on data from 2,020 accidents involving 2,305 persons extracted from the Swedish Traffic Accident Data Acquisition (STRADA) database. For consistency reasons, a subset of data (N = 745) was analysed in order to investigate the development of accidents over a period of 10 years. Thereafter, each accident in the whole data set was registered as either single or collision. The results show that the number of rollator accidents in Sweden increased by approximately 80% during 2007–2016. Females dominate the injury statistics of single accidents, collisions, as well as fatal outcome, which may be due to exposure and/or differences in physical characteristics. Single accidents are much more common than collisions (n=1,668 and n=352, respectively) and the injury consequences are at least as serious. Data from the present study have revealed that the frequency of minor injuries (ISS 1–3) is 4.3 times, moderate (ISS 4–8) 6.0 times and serious injuries (ISS 9–15) 8.9 times higher in single accidents than in collisions. Fatal injuries are, however, more common in collision events (33 in comparison to 8). The vast majority of single accidents (99%) was due to falls. Many of the single accidents (29%) were caused by ground level differences (typically a curb) or due to surface conditions (19%). Collisions involved cars, trucks or buses in 91% of cases, occurring predominantly in car parks (31%) and on (zebra) crossings (30%). In 54% of cases the vehicles reversed into the rollator. Abbreviated Injury Scale (AIS) 3+ injuries were dominated by head (36%) and torso (33%) injuries in collision events, and hip fractures (71%) in single accidents. The present study shows that further research into rollator user related accidents, both single accidents and collision events, is required. In order to introduce appropriate measures, future work should follow up on accident and injury developments and further improve the quality of mobility aid related accident data in general. Improved stability and design, proper training programmes, effective maintenance services, development of a supporting infrastructure would contribute to increased safety for rollator users.

Hurdling Barriers: Exploring Inaccessibility in Higher Education Institutions for Mobility Assistive Device Users

This article explores the challenges faced by students with disabilities using mobility assistive devices (i.e. wheelchairs or crutches) in a large public sector urban higher education institution. Cities are characterized by rapid pace and complex infrastructure including buildings, roads, and public spaces that present unique obstacles that hinder these individuals' mobility and overall experience. For this qualitative study, the locale chosen was a large public sector university, and data was collected from 10 students with disabilities who use wheelchairs and other mobility assistive devices and reside in the campus student accommodation. The data was collected through in-depth interviews and analyzed using thematic analysis. The findings indicate that the infrastructure on campus is not accommodating for students with disabilities who use mobility aids, which directly and indirectly impacts their educational experiences. In addition, the university lacks a uniform policy for providing services and allocating resources for students with disabilities. The participants believe that the university is indifferent to their needs; however, the facilities and behaviors within departments vary and at times can be quiteenabling. This study contributes to the ongoing dialogue on enhancing accessibility, inclusivity, and equity within our urban educational landscapes.

Acoustically-mediated orientation and navigation in rooms

While the visual system provides the dominating sensory input in sighted humans for awareness, orientation, and navigation, in low-light conditions, smoke, or in visually-impaired and blind individuals, auditory perception becomes important. Acoustic information about the environment includes sounds radiated from sources, as well as reflections and reverberation in enclosed spaces in response to either external sound sources or self-produced sounds (e.g., mouth clicks), referred to as echolocation. Here, we investigated orientation and navigation in typical corridors based on acoustic cues only, using sighted humans without training and real-time virtual acoustics. Virtual sound sources and echo-location with predefined sounds as well as own vocalizations were used with the goal to identify suitable techniques for an acoustically augmented reality (AAR) based mobility aid. A hand-held acoustic pointer, rendering virtual sound sources at the closest wall in the pointing direction was best suited for orientation and navigation. For identification of the room shape, a performance similar to that obtained with a reference (visual) laser pointer could be achieved with the acoustic pointer in specific conditions. In addition to the above acoustic pointer, an AAR-based echolocation pointer with highly directed sound radiation, as achievable in the ultrasonic range, was additionally suggested.

Hurdling Barriers: Exploring Inaccessibility in Higher Education Institutions for Mobility Assistive Device Users

This article explores the challenges faced by students with disabilities using mobility assistive devices (i.e. wheelchairs or crutches) in a large public sector urban higher education institution. Cities are characterized by rapid pace and complex infrastructure including buildings, roads, and public spaces that present unique obstacles that hinder these individuals' mobility and overall experience. For this qualitative study, the locale chosen was a large public sector university, and data was collected from 10 students with disabilities who use wheelchairs and other mobility assistive devices and reside in the campus student accommodation. The data was collected through in-depth interviews and analyzed using thematic analysis. The findings indicate that the infrastructure on campus is not accommodating for students with disabilities who use mobility aids, which directly and indirectly impacts their educational experiences. In addition, the university lacks a uniform policy for providing services and allocating resources for students with disabilities. The participants believe that the university is indifferent to their needs; however, the facilities and behaviors within departments vary and at times can be quite enabling. This study contributes to the ongoing dialogue on enhancing accessibility, inclusivity, and equity within our urban educational landscapes

Translation, reliability, and validation of the Dutch Safe Use of Mobility Aid Checklist (SUMAC-NL) for walker use in people living with dementia

Background: People with dementia have a yearly risk of falling of 60 to 80 percent. Therefore, a walker is often recommended. However, the use of a walker in people with dementia is associated with a threefold increased odds of falls compared to their healthy peers. Better advice and training could reduce fall risk. Therefore, a tool to assess functional walking skills with a walker is needed. The SUMAC was developed to fill this gap. So far, there is no Dutch instrument available that can assess functional walking skills with a walker in people with dementia. Methods: Reliability was evaluated by scoring videos of people with dementia (n = 9) using a walker performing the SUMAC-NL. ICC was used to assess inter-rater and test-retest reliability. An expert panel (n = 8) evaluated the content validity using the content validity index (CVI) and the content validity ratio (CVR). Results: Inter-rater reliability of the SUMAC-NL was statistically significant for the PF domain (ICC = 0.94, 95%CI (0.84, 0.98, p &lt; 0.001) and for the EQ domain (ICC = 0.79, 95%CI (0.49 – 0.95), p &lt; 0.001). Test-retest reliability was statistically significant for both the PF domain (ICC = 0.95, 95%CI (0.89, 0.99), p &lt; 0.001) and EQ domain (ICC = 0.92, 95%CI (0.82, 0.98), p &lt; 0.001). The SUMAC-NL shows content validity with a CVI &gt;0.79 for both domains and a CVR of 0.53 on the PF domain and 0.78 on the EQ domain. Conclusions: The SUMAC-NL shows good to excellent reliability and content validity for both the PF and the EQ domain. The SUMAC-NL seems to be a promising tool to assess walking with a walker in people with dementia in the Netherlands.

Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip.

Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade. Using a multicentre collaborative study design, independent of registry data, we identified adults from 29 centres with PPFs around the hip between January 2010 and December 2019. Radiographs were assessed for the Unified Classification System (UCS) grade. Patient and injury characteristics, management, and outcomes were compared between UCS grades. A multinomial logistic regression was performed to estimate relative risk ratios (RRR) of variables on UCS grade. A total of 1,104 patients were included. The majority were female (57.9%; n = 639), ethnically white (88.5%; n = 977), used mobility aids (67%; n = 743), and had a median age of 82 years (interquartile range (IQR) 74 to 87). A total of 77 (7%) had pain prior to the PPF. The most common UCS grade was B2 (33%; n = 368). UCS type D fractures had the longest length of stay (median 19 days (IQR 11 to 26)), highest readmission to hospital (21%; n = 9), and highest rate of discharge to step-down care (52%; n = 23). Multinomial regression suggests that uncemented femoral stems are associated with a reduced risk of UCS C (RRR 0.36 (95% confidence interval (CI) 0.2 to 0.7); p = 0.002) and increased risk of UCS A (RRR 3.3 (95% CI 1.9 to 5.7); p < 0.001), compared to UCS B fracture. The most common PPF type in elderly frail patients is UCS B2. Uncemented stems have a lower risk of UCS C fractures compared to cemented stems. A national PPF database is needed to further identify correlation between implants and fracture subtypes.

Use of a clustering method to describe the clinical profiles of older fallers: the value of a multidisciplinary consultation.

The population of older adults is particularly heterogeneous with regard to frailty and the risk of falling, the two of which are linked. We conducted an exploratory, analysis (with no preconceived ideas) of data collected during multidisciplinary falls consultations (MFCs), to identify people with similar profiles. We performed an observational, multicentre study of older patients (aged 75 and over) having been evaluated in an MFC. We excluded adults with a Mini Mental State Examination score < 14/30, an activities of daily living score < 4/6, or an unstable medical condition. Each participant underwent a clinical interview, impedancemetry, and a physical activity assessment (a questionnaire, and use of an activity tracker on 5 consecutive days). The K-means method and ascending hierarchical clustering were used to identify clusters of people with common characteristics. Of the 106 participants, the median [IQR] mean number of falls in the previous 6months was 1 [2]. Three functional clusters were identified: (i) fallers with poor mobility, difficulty getting up off the ground after a fall, and using a mobility aid for walking; (ii) an intermediate sedentary group with a gait speed of ~ 0.6ms-1, and (iii) active people with a timed "up and go" test time below 15s and a gait speed above 0.8ms-1. The population of older fallers referred for an MFC is heterogeneous. The presence of certain clinical characteristics enabled the definition of three patient clusters, which might help physicians to determine the most appropriate care objectives and pathways.