Performance Oriented Mobility Assessment Scores Research Articles

Validity, Reliability, and Responsiveness of the Dubousset Functional Test in Older Adults

Objective: The aim of our study was to examine the test-retest reliability and validity of the Dubousset Functional Test (DFT) in older adults. Methods: The DFT, 3-m Backward Walk Test (3MBWT), Timed Up and Go (TUG) test, and Tinetti Performance-Oriented Mobility Assessment (POMA) were administered to 80 older adults. Results: Intraclass correlation coefficient (ICC) values were between 0.819 and 0.965 (excellent agreement). A correlation was found between DFT parameters and the TUG test, 3MBWT, and POMA scores. A low correlation was found between the TUG test and 3MBWT with the dual-task test; no correlation was determined between the POMA scores with the dual-task test. Conclusion: It was concluded that the DFT is a valid and reliable test for older adults.

Tinetti balance performance is associated with mortality in older adults with late-onset Parkinson’s disease: a longitudinal study

BackgroundParkinson’s disease (PD) is associated with a 3-fold mortality risk, which is closely related to advancing age. Evidence is lacking regarding the factors associated with the risks of mortality or nursing-home (NH) admission, in elderly patients with PD. We aimed at identifying the clinical characteristics associated with these outcomes, in older community-dwelling patients with late-onset PD.MethodsRetrospective, observational analysis of data from geriatric day hospital patients. Motor assessment included Unified Parkinson Disease Rating Scale (UPDRS) part III score, Tinetti Performance Oriented Mobility Assessment (POMA) balance and gait tests, and gait speed. Levodopa equivalent dose, comorbidity, cognitive performance, Activities of Daily Living performance were examined. Cox proportional hazards models were performed to identify the factors associated with mortality and NH admission rate (maximum follow-up time = 5 years).ResultsWe included 98 patients, mean age 79.4 (SD = 5.3) of whom 18 (18.3%) died and 19 (19.4%) were admitted into NH, over a median follow-up of 4 years. In multivariate Cox models, poor balance on the Tinetti POMA scale (HR = 0.82 95%CI (0.66–0.96), p = .023) and older age (HR = 1.12 95%CI (1.01–1.25), p = .044) were the only variables significantly associated with increased mortality risk. A Tinetti balance score below 11/16 was associated with a 6.7 hazard for mortality (p = .006). No specific factor was associated with NH admissions.ConclusionsAge and the Tinetti POMA score were the only factors independently associated with mortality. The Tinetti POMA scale should be considered for balance assessment and as a screening tool for the most at-risk individuals, in this population.

Predicting The Risk of Fall in Community-Dwelling Older Adults in Iran

Background The European Assessment System (EASY) Care Standard is a self-report fall screening tool for the community-dwelling older adults. A study demonstrated that the EASY-Care Standard 2010’s fall subscale (ECSF) is a valid tool for predicting the risk of fall in a nursing home; however, the validity of ECSF in community-dwelling older adults is still not clear. We aimed to evaluate the performance of the instrument as a screening tool to predict the risk of fall among community-dwelling older adults in Iran for a six-month follow-up period. If this tool is useful for the prediction of fall, it can be used for primary health-care services to detect subjects at a higher risk of fall. Method This is a longitudinal validation study that was carried out among 101 community residents ≥60 in Tehran, Iran. The participants were selected using a convenience cluster sampling based on Performance-Oriented Mobility Assessment (POMA) score categorization. The follow-up period of this study was 6 months. The ECFS scores at the baseline of the study were compared between subjects who had fallen and those who had not fallen during the six-month follow-up period. The cutoff was determined using a Receiver Operating Characteristics (ROC) curve analysis. Internal consistency and the sufficient intra-rater reliability were determined. Results The mean age of the participants was 71.87 years. The Spearman’s correlation coefficient between ECSF and POMA scores was equal to 0.829. There was also a correlation coefficient >0.8 between ECFS scores and Timed Up and Go test (TUG) seconds. Two components were detected in the factor analysis of the ECSF. The ECSF cutoff point was four out of eight with the sensitivity and specificity of 76.6 and 87.5%, respectively. The total Kuder-Richardson 20 (KR-20) coefficient was calculated as 0.852. Conclusion It seems that the EASY-Care Standard 2010 is a valid and reliable tool to predict the risk of fall in the next 6 months in the community-dwelling older adults. A valid simple and useful tool that is a good predictor of fall might help the health providers at primary health care level to easily recognize the older adults who are at a high risk of falling. What is already known about this topic? (Including key points and/or knowledge gaps Several tools exist for the predication of fall among older people. The ESAY–Care has been translated into numerous languages. In Iran, there is not a report assessing the validity and reliability of this tool. What this paper adds: (research findings/key new information The Persian version of ESAY-Care tool has a high inter-rater reliability and specificity. The Persian version of ESAY-Care tool could predict the risk of fall for the next six months. The ESAY Care tool is used to identify the risk of fall for the older adults who live in the community. The implications of this paper ESAY-Care can be incorporated into health providers and family caregivers’ measures, especially at primary prevention levels. Falling in older adults can be predicted in every community in the future. ESAY-Care will provide an efficient method to identify older people at the risk of fall during a routine community level assessment.

Effect of Antigravity Treadmill Gait Training on Gait Function and Fall Risk in Stroke Patients.

Objective To investigate the effect of antigravity treadmill gait training (AGT) on gait function, balance, and fall risk in stroke patients.MethodsThis study included 30 patients with stroke (mean age, 73 years). All subjects were randomly divided into two groups. The intervention group (n=15) performed AGT for 20 minutes, five times per week for 4 weeks. The control group (n=15) received conventional gait training for the same duration. To assess fall risk, the Tinetti Performance-Oriented Mobility Assessment (POMA) was measured. The Berg Balance Scale (BBS), Timed Up and Go test (TUG), and 10-m walk test (10mWT) were measured to assess dynamic balance. All scales were measured before intervention (T0) and at 4 weeks (T1) and 12 weeks (T2) after intervention.ResultsResults showed that the total POMA score, BBS, and 10mWT scores improved significantly (p<0.05) at T1 and T2 in both groups. The POMA gait score (4.20±1.37 at T1, 4.87±1.36 at T2) and TUG (4.52±4.30 at T1, 5.73±4.97 at T2) significantly improved (p<0.05) only in the intervention group. The changes in total POMA score and BBS of the intervention group (7.20±2.37, 7.47±3.07) improved more significantly (p<0.05) between T0 and T2 than the control group (2.53±2.10, 2.87±2.53).ConclusionOur study showed that AGT enhances dynamic balance and gait speed and effectively lowers fall risk in stroke patients. Compared to conventional gait therapy, AGT would improve gait function and balance in stroke patients more effectively.

Effects of Robotic Interactive Gait Training Combined with Virtual Reality and Augmented Reality on Balance, Gross Motor Function, Gait Kinetic, and Kinematic Characteristics in Angelman Syndrome: A Case Report

Angelman syndrome (AS) is a genetic neurological disorder resulting in cognitive and neuromuscular impairments, such as lack of safety awareness and attention, as well as lack of balance and locomotor control. The robotic interactive gait training (RIGT) system is designed to provide accurate proprioceptive, kinematic, and kinetic feedback, and facilitate virtual reality and augmented reality (VR-AR) interactive exercises during gait training. In the present case report, we examined the effect of an innovative hip-knee-ankle interlimb-coordinated RIGT system. We utilized this therapeutic modality in a participant with Angelman syndrome (AS). Gross motor function measures, risk of fall, and gait-related kinetic (force), and kinematic (joint angle) biomechanical characteristics were assessed before and after 20 sessions of RIGT with VR-AR. We found RIGT with VR-AT improved gait ability, as shown by Performance-Oriented Mobility Assessment score, gross motor function by Gross Motor Function Measure score, balance by Pediatric Balance Scale score, knee and hip joint kinetics, and kinematics during gait. Our clinical and biomechanical evidence provide important clinical insights to improve the effectiveness of current neurorehabilitation approaches for treating patients with AS in balance and locomotor control and reduce the risk of falling.

Association Between Dynapenic Abdominal Obesity and Fall Risk in Older Adults.

BackgroundIn recent years, dynapenic abdominal obesity has received more and more attention. This article aimed to explore the relationship between dynapenic abdominal obesity and fall risk in older adults.MethodsIn this cross-sectional study, according to waist circumference (≥90 cm for men and ≥85 cm for women) and handgrip strength (<28 kg for men and <18 kg for women), 551 older adults were divided into four groups: dynapenic abdominal obese (D/AO), dynapenic nonabdominal obese (D/NAO), nondynapenic abdominal obese (ND/AO) and nondynapenic nonabdominal obese (ND/NAO). Fall risk was measured by the Tinetti performance-oriented mobility assessment (POMA). Binary logistic regression was used to explore the relationship between D/AO and fall risk.ResultsD/AO was related to POMA score (odds ratio [OR]=3.39; 95% confidence interval [CI]: 1.47–7.81; P=0.004) after adjusting the confounding variables. However, D/NAO (OR=1.51; 95% CI:0.69–3.32; P=0.302) and ND/AO (OR=1.48; 95% CI:0.74–2.99; P=0.272) were not associated with POMA score.ConclusionThis study suggests that older adults with D/AO have a higher risk of falls. Therefore, it is necessary to strengthen the attention to D/AO and relevant interventions should be implemented.

Comparison of Kinesio Taping and Nerve Flossing Technique on Balance, Gait and Ankle Flexibility in Diabetic Neuropathy

Introduction: Diabetic Neuropathy (DN) is the most frequent neuropathy in developed countries, with a wide spectrum of clinical symptoms. Kinesiology Tape (KT) is a thin, stretchy, elastic cotton strip with an acrylic adhesive almost identical to human skin in both thickness and elasticity. Nerve Flossing Technique (NFT) is an alternation of combined movements of atleast two joints. Aim: To assess and compare the effects of KT and NFT on diabetic neuropathy patients’ balance, gait and ankle flexibility. Materials and Methods: This experimental study was conducted in Outpatient Department of Physiotherapy at SGT University, Gurugram, Haryana, India, from March 2021 to May 2021. Total 20 diabetic neuropathy patients were conveniently included from the hospital environment and were divided into two treatment groups. Group A (KT) included 10 patients, kinesio taping along with conventional physiotherapy and group B (NFT) included 10 patients, nerve flossing technique along with conventional physiotherapy. In both the groups, treatment was provided for three days a week for two weeks to improve their balance, gait and ankle flexibility. Performance Oriented Mobility Assessment (POMA) scores were utilised to assess balance and gait, and a universal goniometer was used to assess ankle Range Of Motion (ROM). Data was analysed by using Independent and Paired t-test. Results: The mean age in group A was 55.3±5.056 years and in group B was 55±4.714 years and there was no significant difference (t=0.137, p-value=0.892). There was a significant difference in POMA score in both the groups (t=-5.344, p-value&lt;0.001) after two weeks of treatment. Ankle joint ROM was improved in group B than group A. Conclusion: The study concludes that KT improves balance and gait more than NFT, whereas NFT improves ankle range of motion more than KT in diabetic neuropathic patients.

Planning for Safe Hospital Discharge by Identifying Patients Likely to Fall After Discharge.

Acute care physical therapists recommend discharge locations and services in part to help prevent falls during post-discharge recovery. Therapists may use standardized tests to inform their recommendation decisions, but evidence linking test scores with fall risk after discharge is lacking. The primary purpose of this study was to explore the associations between Tinetti Performance-Oriented Mobility Assessment (POMA) and Activity Measure for Post-Acute Care Inpatient Mobility Short Form (AM-PAC IMSF) scores and falls in the first 30days after hospital discharge. Anticipating that agreement between therapist recommendations and discharge locations and services (discharge agreement), age, and sex could impact those associations, these factors were included in this investigation. In this observational cohort study, 258 hospitalized patients consented to medical record data extraction and answered a phone survey 30days after discharge to report whether they had experienced a fall since leaving the hospital. POMA and AM-PAC IMSF tests were administered for every patient. Participants' age, sex, diagnosis, last POMA score, last AM-PAC IMSF score, physical therapist discharge recommendations, actual discharge location and services, discharge date, and phone number were collected from their medical records. When analyzed alone, higher POMA scores were associated with lower odds of falling, but the association was not significant after adjustment for other factors. Neither AM-PAC IMSF scores, age, nor sex were associated with falls. Discharge agreement, however, was associated with 59% lower odds of falling after adjustment for other factors. Participants, who were discharged to the location with the services recommended by their physical therapist, were less likely to fall. Tinetti POMA and AM-PAC IMSF scores did not discriminate well participants who would fall. Findings in this study inform those involved in discharge planning on the value of implementing physical therapist recommendations in reducing fall risk after hospital discharge. If physical therapist discharge recommendations are implemented, patients are less likely to fall during the month after hospital discharge. Balance and mobility test scores may provide therapists valuable information, but they are limited in their ability to identify who will fall after discharge.

Older Adults with Hypertension: Prevalence of Falls and Their Associated Factors.

Falls are prominent health issues among older adults. Among hypertensive older adults, falls may have a detrimental effect on their health and wellbeing. The purpose of this study is to determine the prevalence of falls among hypertensive older adults and to identify the associated factors that contribute to their falls. This was a cross-sectional study conducted among two hundred and sixty-nine hypertensive older adults who were selected via systematic random sampling in two primary health clinics in Kuala Terengganu, Malaysia. Data on their socio-demographic details, their history of falls, medication history and clinical characteristics were collected. Balance and gait were assessed using the Performance Oriented Mobility Assessment (POMA). It was found that 32.2% of participants reported falls within a year. Polypharmacy (adjusted OR 2.513, 95% CI 1.339, 4.718) and diuretics (adjusted OR 2.803, 95% CI 1.418, 5.544) were associated with an increased risk of falls. Meanwhile, a higher POMA score (adjusted OR 0.940, 95% CI 0.886, 0.996) and the number of antihypertensives (adjusted OR 0.473, 95% CI 0.319, 0.700) were associated with a low incidence of falling among hypertensive older adults. Falls are common among hypertensive older adults. Older adults who are taking diuretics and have a polypharmacy treatment plan have a higher incidence of falls. However, older adults taking a higher number of anti-hypertensive medications specifically were not associated with an increased prevalence of falls.

Impacts of Stroke on Muscle Perceptions and Relationships with the Motor and Functional Performance of the Lower Extremities.

Stroke results in paretic limb disabilities, but few studies have investigated the impacts of stroke on muscle perception deficits in multiaxis movements and related functional changes. Therefore, this study aimed to investigate stroke-related changes in muscle perceptions using a multiaxis ankle haptic interface and analyze their relationships with various functions. Sixteen stroke patients and 22 healthy participants performed active reproduction tests in multiaxis movements involving the tibialis anterior (TA), extensor digitorum longus (EDL), peroneus longus, and flexor digitorum longus (FDL) of the ankle joint. The direction error (DE), absolute error (AE), and variable error (VE) were calculated. The lower extremity of Fugl-Meyer Assessment (FMA-LE), Barthel Index (BI), Postural Assessment Scale for Stroke Patients, Tinetti Performance-Oriented Mobility Assessment (POMA), and 10-m walk test (10MWT) were evaluated. VE of EDL for the paretic ankle was significantly lower than that for the nonparetic ankle (p = 0.009). AE of TA, EDL, and FDL and VE of EDL and FDL of muscle perceptions were significantly lower in healthy participants than in stroke patients (p < 0.05 for both). DE of TA for the paretic ankle was moderately correlated with FMA-LE (r = −0.509) and POMA (r = −0.619) scores. AE and VE of EDL for the paretic ankle were moderately correlated with the 10MWT score (r = 0.515 vs. 0.557). AE of FDL for the paretic ankle was also moderately correlated with BI (r = −0.562). This study indicated poorer accuracy and consistency in muscle perception for paretic ankles, which correlated with lower limb functions of stroke patients.

Efficacy of Traditional Physical Therapy Versus Otago-Based Exercise in Fall Prevention for ALF-Residing Older Adults.

Falls are a leading cause of morbidity, mortality, loss of independence, and significant functional decline in aging populations. Effective interventions aimed at reducing the risk of falls, and preventing associated disability and functional decline, are needed to promote the health and wellness of older adults. Recent literature has found that an Otago-based exercise program (OBEP), which incorporates strengthening, balance, and walking, may not only decrease falls and fall risk among community-dwelling older adults but may also be effective among older adults residing in assisted living facilities (ALFs). The purpose of this study is to expand upon current research by comparing the outcomes of an OBEP and traditional physical therapy (TPT) in decreasing falls and the risk of falls among older adults living in an ALF. The authors hypothesized that traditional physical therapy would reduce fall risk and the number of falls in older adults residing in ALFs more than an OBEP. This study conducted a 2-group retrospective chart review of 59 older adults living in an ALF from January 2013 to October 2018 who received either TPT (n = 29) or the OBEP (n = 30). Participants were a mean of 87 years old and were classified at risk for falls by the Tinetti Performance-Oriented Mobility Assessment (POMA). Primary variables included the number of falls prior to intervention, during intervention, and 1 year following intervention, as well as pre- and posttreatment Tinetti POMA scores. Efficacy was examined using multiple linear regression analysis. Both groups achieved reduced falls and increased POMA scores. Group assignment did not significantly predict performance in key outcome measures, namely the number of falls (P = .199) and Tinetti POMA scores (P = .063) following treatment. These findings indicated that both an OBEP and tpt may be effective interventions for reducing falls and fall risk in the ALF setting.

Role of gait and speed performance in predicting cognitive decline and dementia in people with Down syndrome: Preliminary findings

AbstractBackgroundThe longevity of people with DS has increased substantially in recent decades. This population shows signs of premature aging in many organs and systems. The neuropathology of Alzheimer's disease (AD) is overexpressed in DS. Cognitive and functional losses, such as decline in executive function and apraxia, interfere with the sequencing of movements and the integrity of gait. There is evidence that a decrease in gait may precede other clinical symptoms of dementia in AD in the general population, but we found no studies investigating gait performance and decline in DS. The aim of this study is to characterize gait and speed performance in a sample of adults with DS divided into three groups by diagnosis: stable cognition, prodromal dementia and AD.MethodsWe used the Performance Oriented Mobility Assessment (POMA) to address balance, gait and the risk of falls and the Timed “Up and Go” test (TUG) to assess gait speed in a sample of 35 individuals with DS over 35 years of age. Dementia diagnosis was based on the Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities (CAMDEX‐DS). The 1‐factor, 3‐level ANOVA model was used in the 3 groups.Results9 participants (25.7%) had AD (mean POMA 12.0 ± 7.1; mean TUG 18.0 ±5.8), 8 (22.9%) were classified as prodromal dementia (mean POMA 19.0 ± 5.6; mean TUG 21.0± 6.1) and 18 (51.4%) were in the stable cognition group (mean POMA score 20 ± 4.5; mean TUG 17.0 ±5.5). Mean POMA scores were significant different among the groups (p&lt;0.05) with higher impairment in the group with AD relative to those with prodromal dementia and stable cognition. We did not find difference for the TUG scores among the groups.ConclusionsPOMA results indicates that those with AD have worse balance, gait performance and higher risk of falls relative to those with prodromal dementia and stable cognition, suggesting that gait performance may be more affected in later stages of neurodegeneration. Gait speed does not seem to be useful differentiating the groups. Further longitudinal studies with bigger samples are needed to confirm our results.

Effects of mechanical perturbation gait training on gait and balance function in patients with stroke: A pre-post research study

Patients with stroke (PwS) demonstrate impaired gait and balance, and asymmetric gait, placing them at high risk of falls. We aimed to investigate the effects of a single training session that included mechanical external perturbation which resists forward movement of the paretic leg during its swing phase of walking on gait and balance in PwS. In a pre-post pilot study, gait asymmetry and balance function were assessed in 22 first-event chronic PwS (i.e., unilateral hemiparesis). PwS underwent tests during baseline and one week later, after participating in a single training session that resisted forward stepping during the swing phase of walking with a device secured around the patient's waist and connected diagonally to the patient’s foot by a tension cord. Ground reaction forces and center of pressure were sampled during treadmill gait to assess step length asymmetry. Performance-oriented mobility assessment (POMA), a two-minute walk test (2MWT), and the voluntary step execution test were also measured. We found no significant improvement in step length asymmetry. However, POMA scores, as well as voluntary step execution tests improved with a moderate effect size. It seems that applying diagonal resistance force to the swinging leg resulted in insufficient horizontal force. However, the improvement in the preparation phase, i.e., better weight-bearing abilities during the voluntary stepping, may be due to the compression force applied to the lower limb joints thus providing proprioceptive training. This suggests that proprioceptive training may improve gait performance in stroke patients in a very short training period.

Contribution of lower limb muscle strength to walking, postural sway and functional performance in elderly women

BACKGROUND: Aging-related deterioration of the lower limb muscle strength could highly influence the functional performance of elderly individuals. OBJECTIVE: To investigate how advancing age impacts the lower limb muscle strength and consequently affects the balance and walking performance. METHODS: Twenty-seven community-dwelling elderly females underwent isokinetic ankle dorsi/plantar flexion (ADF/APF), inversion/eversion (AIN/AEV), knee flexion/extension (KFL/KEX), hip flexion/extension (HFL/HEX), and abduction/adduction (HAB/HAD) tests, the six-minute walk test, open-eyed biped balance test on foam rubber and the performance-oriented mobility assessment (POMA). RESULTS: The Pearson’s product-moment correlation coefficients demonstrated that advancing age negatively influenced the relative work and moment produced in all the muscle groups, the POMA score (r=-0.51), walking speed (r=-0.62), and the vertical (r= 0.55) and anteroposterior (r= 0.54) postural sway velocities. The peak moment and work values of AINs and APFs; KFLs and KEXs; and HABs, HFLs, and HEXs showed a significantly positive correlation with the walking speed (α⩽ 0.05). CONCLUSION: The strength of HFLs, HEXs and HABs, as the important contributors to the walking performance, underwent attenuation as the age increased, consequently resulting in impairments of stepping profiles of elderly females. Elderly females are needed to be trained to reach the optimum levels of lower limb muscular strength to overcome premature incapacitation and have control over their independence in daily activities.

Relationship of serum vitamin D level on the possibility of geriatric syndrome in elderly persons

Background This study aimed at evaluating serum level of vitamin D in normal elderly persons above or equal to 65 years of age and its relation to geriatric syndrome. Patients and methods A prospective study was done on 50 normal elderly persons above 65 years (23 persons from nursery home and 27 persons from geriatric outpatient clinic in Alexandria Main University Hospital). All the participants were subjecting to full history taking, complete physical examination, laboratory assessment including serum 25-hydroxyvitamin D (OH)D by enzyme-linked immunosorbent assay, and geriatric syndrome assessment using five methods, namely, fall risk assessment using timed up and go test, mini-mental state examination, geriatric depressive scale, mini-nutritional assessment, and Tinetti performance-oriented mobility assessment. Results According to vitamin D level (ng/ml), the number of patients who were deficient ( 20) was 11, 24, and 15, respectively. The mean±SD vitamin D level was 18.44±10.71 for all patients. According to the relation between vitamin D level and demographic data for the studied group, there were significant positive associations between low vitamin D level on one side and female sex (P=0.024), advanced age (P=0.026), no sun-exposure jobs (P=0.001), and nursing home residency on the other side. Mini-mental state examination (P=0.006) and geriatric depressive scale (P=0.002) had a significant positive correlation with low vitamin D level, whereas mini-nutritional assessment (P=1.000), timed up and go test (P=0.225), and performance-oriented mobility assessment score (P=0.133) had no significant correlation with low vitamin D level. Conclusion There is a correlation between vitamin D deficiency and advanced age, cognitive dysfunction, and depression, whereas no correlation was found between vitamin D deficiency and nutritional state and risk of falling.

Relation between vitamin D and geriatric syndrome

Vitamin D level is a common health problem for elderly persons and it is associated with a decrease in physical performance, furthermore, it has been demonstrated that those with low serum vitamin D level has more risk of cognitive impairment, depression and anxiety. The aim of the study was to estimate relation of vitamin D and geriatric syndrome. A prospective study was done on 50 subjects who were normal elderly persons above 65 years. All the participants were subjected to full history taking, complete physical examination, laboratory assessment including serum 25-hydroxyvitamin D (OH)D by enzyme linked immunosorbent assay (ELISA) and geriatric syndrome assessment using 5 methods namely fall risk assessment using timed up &go test, mini-mental state examination (MMSE), geriatric depressive scale, mini nutritional assessment and Tinetti performance - oriented mobility assessment (POMA). The number of patients who were vitamin D deficient (<12ng/ml), insufficient (12-20ng/ml) and sufficient (>20ng/ml) were 11, 24 and 15 respectively. There was significant p association between low vitamin D level and female gender (p=0.024), advanced age (p=0.026), no-sun exposure jobs (p=0.001) and nursing home residency. Mini mental state examination (p=0.006) and geriatric depressive scale (p=0.002) had a significant positive correlation with low vitamin D level while mini nutritional assessment (p=1.000), timed up and go test (p=0.225) and POMA score (p=0.133) had no significant correlation with low vitamin D level. There is correlation finding between vitamin D deficiency and advanced age, cognitive dysfunction, and depression.

The Outcomes Of Serial Cerebrospinal Fluid Removal In Elderly Patients With Idiopathic Normal Pressure Hydrocephalus.

PurposeElderly patients with iNPH (idiopathic normal pressure hydrocephalus) might be potentially high-risk surgical patients. Our purpose was to investigate the outcome of serial removal of cerebrospinal fluid (CSF) in the patients with iNPH who refused to have the ventriculoperitoneal or lumboperitoneal shunt surgery or had contraindications to them.Patients and methodsThere were 42 patients, with a median age of 78 years. Recurrent CSF removal was performed when the patients had deteriorated gait which was defined as >10% pre-removal change on the average of two walking trials during timed up and go (TUG). All the patients underwent mini-mental status examination (MMSE), frontal assessment battery (FAB), Stroop test, Tinetti Performance Oriented Mobility Assessment (POMA), TUG and nine-hole peg test (NHPT) with the dominant hand, before and after CSF removal.ResultsThirty-five patients had two CSF removal procedures with a mean interim period of 7.4 months ranging from 1.5 to 35 months. Thirteen patients had three CSF removal procedures. The mean TUG scores were decreased after the first, second and third procedures (p<0.001; p<0.001; p=0.007; respectively). The POMA scores including both gait and balance components improved after the first and second procedures (p<0.05; for each). After the third procedure, the increase in POMA-balance score was statistically significant (p<0.05). After the first procedure, the FAB scores and NHPT scores were significantly improved (p<0.02). The median follow-up duration of the patients was 34.5 months.ConclusionThe deterioration of gait disturbance may be improved, and cognitive decline may be stabilized, at least postponed, by applying recurrent CSF removal in those unshunted patients with iNPH.

Examining the Effects of an Otago-Based Home Exercise Program on Falls and Fall Risks in an Assisted Living Facility.

The Otago exercise program is a strengthening, balance, and walking program designed to decrease falls among community-dwelling older adults. Few studies have examined the effects of the Otago program in an assisted living environment. The purpose of the current study was to assess the effects of an Otago-based home exercise program in decreasing falls and the risk of falls among older adults living in an assisted living facility. A retrospective chart review of 30 individuals residing at either of 2 assisted living facilities in central Florida was undertaken. Participants had a mean age of 87 years, were at risk for falls as determined by the Tinetti Performance-Oriented Mobility Assessment (POMA), and were provided with an Otago-based intervention by home health physical therapy. The outcome measures were the number of falls in the previous year, the number of falls in the year following the intervention, and Tinetti POMA scores pre- and post-intervention. The mean (SD) number of falls significantly decreased from 1.4 (0.9) to 0.5 (0.7) fall per person per year after home health physical therapy with the tailored Otago based-exercise intervention. The intervention resulted in a statistically significant improvement in Tinetti POMA scores from 11.8 (2.5) to 17.6 (3.8). An Otago-based strengthening, balance, and walking home exercise program can potentially be used to decrease the number of falls and the risk of falling among older adults residing in an assisted living facility.

Short-Physical Performance Battery (SPPB) score is associated with falls in older outpatients.

The capacity of Short-Physical Performance Battery (SPPB) test to discriminate between fallers and non-fallers is controversial, and has never been compared with fall risk assessment-specific tools, such as Performance-Oriented Mobility Assessment (POMA). To verify the association of SPPB and POMA scores with falls in older outpatients. 451 older subjects (150 males, mean age 82.1 ± 6.8) evaluated in a geriatric outpatient clinic for suspected frailty were enrolled in this cross-sectional study. Self-reported history of falls and medication history were carefully assessed. Each participant underwent comprehensive geriatric assessment, including SPPB, POMA, Geriatric Depression Scale (GDS), mini-mental state examination (MMSE) and mini-nutritional assessment-short form (MNA-SF). Multivariate logistic regression and receiver-operating characteristic (ROC) analyses were performed to determine the factors associated with the status of faller. 245 (54.3%) subjects were identified as fallers. They were older and had lower SPPB and POMA test scores than non-fallers. At ROC analysis, SPPB (AUC 0.676, 95% CI 0.627-0.728, p < 0.001) and POMA (AUC 0.677, 95% CI 0.627-0.726, p < 0.001) scores were both associated with falls. At multivariate logistic regression models, SPPB total score (OR 0.83, 95% CI 0.76-0.92, p < 0.001), POMA total score (OR 0.94, 95% CI 0.91-0.98, p = 0.002) and SPPB balance score alteration (OR 2.88, 95% CI 1.42-5.85, p = 0.004), but not POMA balance subscale score alteration, were independently associated with recorded falls, as also GDS, MMSE and MNA-SF scores. SPPB total score was independently associated with reported falls in older outpatients, resulting non-inferior to POMA scale. The use of SPPB for fall risk assessment should be implemented.

A STUDY OF GAIT AND FALLS IN OLDER INDIANS

Gait and balance changes with ageing and these changes predispose to falls. In this ongoing cross sectional study we are looking at the Gait and balance parameters in older adults and their association with falls. Gait parameters of ambulatory older patients (> 60 years) were assessed at their usual pace, using Biodex gait trainer-3, a validated electronic walkway.The patients also underwent comprehensive geriatric assessment and were further assessed for fall risk using the Tinetti POMA Scale .28 Subjects (22 males and 6 females) were included in this preliminary analysis. Mean age was 74.53(± 10.05) years. Mean (±SD) values of gait speed was 0.48metre/second (±0.17), Step Cycle time0.83 cycle/second,(±0.16), Stride Length (Right) 64.64 centimeter (±29.20),Stride Length (Left) 59.85 centimeter (+ 29.57).Around 1/5th of the patients had one or more indoor fall in past year and less than half(42.86%) also had Polypharmacy.The mean TUG score was 15.63 seconds (+ 5.08) and mean Performance Oriented Mobility Assessment score was 20.71(± 3.78). 20 subjects were having difficulty in balance and at risk of fall. The Hindi Mental State Examination score was 26.89 (±3.74) and 18 were Frail.This study group was having slow gait speed, low TUG score and polypharmacy which increases the risk of having a fall.