Physical Fall Risk Research Articles

Capturing Change in Balance Confidence over 30 Days: Insights Gained from a Micro-Longitudinal Study

Balance confidence reflects one’s estimate of their ability to maintain balance and avoid falls. Extensive literature has shown the relationships between balance confidence, functional limitations, and falls in later life. However, change in balance confidence, especially within short timescale, remains largely unknown and deserves further research. In this study, we aimed to investigate how older adults’ balance confidence would change over 30 days and explore whether baseline characteristics would explain the individual differences in change. We used data from the Daily Balance Project that employed intensive-repeated measurements to examine the dynamics of subjective and objective fall risk across a month. Twenty-one participants (age=78.6±5.8, 48%female) were enrolled, and individual characteristics were measured upon recruitment. Throughout the study, participants self-reported their daily balance confidence using the Activity-Specific Balance Confidence (ABC) Scale. We performed growth modeling techniques to examine change within a multilevel framework. Our results showed that overall, ABC scores were high (79.9±17.4) at first, but the linear change was non-significant (b=0.03, SE=0.21, p=.89) on average. However, we found that balance confidence increased in individuals with higher educational attainment (b=0.37, SE=0.13, p<.01) and decreased among those with greater physical fall risk (b=-0.18, SE=0.07, p<.01) and accurate understanding of fall risk at baseline (b=-0.24, SE= 0.12, p=.04). Although ABC scores were stable within the period of one month, our study highlights the distinction of individual characteristics in the process of balance confidence appraisal. We suggest that these nuances should be taken into account when developing more fine-grained fall risk assessments and interventions.

Abstract P501: Mobile Daily Physical Activity and Fall Risk Monitor for Lifestyle Management, Disease Prevention and Risk Alert Generation

Mobile health monitoring is driving many smart health innovations. In this research, we focus on the daily physical activity and fall risk monitoring, for intelligent activity tracking and fall risk detection purpose. Physical activity is of a tremendous value to cardiac and brain health, and has been widely agreed as a metric to improve human health, foster healthy lifestyle, and mine the impacts on diverse health issues. The risk of death can actually be lowered by 20 to 30% with moderate activities for one and half an hour per week (WHO). Besides, fall risk detection is also of huge importance since each year, there are 29% of older adults having around 29 million falls and causing 7 million fall injuries (CDC). The challenge we target is how to accurately recognize diverse physical activities and fall patterns from the biomechanical dynamics sensed by the phone. More specifically, the phone sensor is leveraged to provide real-time always-on streaming of biomechanical dynamics. Then, the data is learned by a deep learning framework (long short-term memory) for activity type and fall pattern recognition. To consider real-world scenarios, the users can put the phone in either left or write waist pockets. The users have performed 9 different kinds of activities such as walking, standing up, going upstairs and jumping, as well as 8 different kinds of fall patterns such as falling backward, sitting and falling, and falling forward with protection. A total of 11,770 activities performed by 30 subjects aging from 18 to 60 have been used to evaluate the framework, yielding an accuracy as high as 95.4%. This encouraging result shows the potential of the mobile monitor in real-world application scenarios.

CHARACTERISTICS OF MALADAPTIVE FALL RISK APPRAISAL AMONG OLDER ADULTS AGES 60 YEARS AND OLDER

Even though one-third of older adults have maladaptive fall risk appraisal (FRA), no studies has examined this discrepancy between perceived fall risk and physical fall risk among older adults in Thailand. We examined the characteristics of fall risk appraisal (FRA). 433 community-dwelling older adults were randomly selected from two provinces in Southern Thailand. Physical fall risk was assessed by a full tandem stand test and perceived fall risk was assessed by the Fall-Efficacy Scale International. We classified FRA into: 1) Rational FRA means low physical fall risk and low perceived fall risk; 2) Irrational FRA means low physical fall risk but high-perceived fall risk; 3) Congruent FRA means high physical fall risk and high-perceived fall risk; and 4) Incongruent FRA means high physical fall risk but low perceived fall risk. Irrational FRA and Incongruent FRA are a maladaptive FRA. About 60% of the participants had maladaptive FRA, which consisted of irrational FRA (57.3%) and incongruent FRA (2.3%). 20.8% were in rational FRA and 19.6% in congruent FRA. Among those with rational FRA, incongruent FRA, irrational FRA, and congruent FRA, 27.8%, 60%, 41.1%, and 74.1% reported having at least one fall in the past year, respectively. After covariate adjustment, participants in the congruent FRA group were 3.29 times more likely (p=0.006) to fall than those in rational FRA. High proportion of participants had maladaptive FRA so screening individuals with maladaptive FRA and prevent them to transition into the congruent FRA group is important efforts to mitigate health and economic burdens.

Feasibility and preliminary efficacy of Ai Chi aquatic exercise training in Hong Kong's older adults with risk of falling: Design and methodology of a randomized controlled trial.

Falls in older adults are a major global public health concern. Group exercise could mitigate fall risk but the traditional land-based group exercise may not be always suitable for older adults at risk of falling, especially for those with musculoskeletal problems. Ai Chi aquatic exercise program could provide a safe and low-impact exercise training for older adults. However, the feasibility and efficacy of the program has not been well-investigated. The objective of this study is to investigate the feasibility and efficacy of the Ai Chi aquatic exercise program, compared to the land-based exercise program for older adults with moderate to high risk of falling. Forty community-dwelling older adults aged 65 or above with moderate to high fall risk will be recruited. They will be randomly allocated in the Ai Chi Aquatic Exercise Group (intervention) or the Land-based Exercise Group (active control) receiving 16 sessions (8 weeks) of specific exercise training. Feasibility of both exercise groups will be examined by recruitment, adherence, retention, feedback, subjective exercise experiences and satisfaction. Preliminary efficacy will be determined by whether physical and psychological fall risk factors could be mitigated. Physical fall risk assessment will include tests for flexibility, muscle strength, gait and balance. Psychological fall risk will be evaluated by preliminary cognitive function, anxiety level, level of depression and fear of falling. The results could establish a solid foundation for worldwide development of a feasible, safe and effective Ai Chi aquatic exercise program for prevention of falls in older adults with risk of falling.

Vitamin D and parathyroid hormone are associated with gait instability and poor balance performance in mid-age to older aged women

ContextVitamin D status and parathyroid hormone (PTH) levels influence the risk of accidental falls in older people, but the mechanisms underlying this effect remain unclear. ObjectiveInvestigate the relationship between circulating PTH and 25 hydroxyvitamin D (25-OHD) levels and clinical tests of gait stability and balance as physical fall risk factors. We hypothesized that high levels of PTH and low 25-OHD levels would be significantly associated with gait stability and decreased balance performance. DesignObservational cohort study. SettingAustralian community. Participants119 healthy, ambulatory female twin adults aged 47–80 years residing in Victoria, Australia. Outcome measuresSerum PTH and 25-OHD levels with clinical tests of gait stability [double support duration (DSD)] and dynamic balance (Step Test). Associations were investigated by regression analysis and by comparing groups divided by tertiles of PTH (<3.5, 3.5–4.9, >4.9pmol/L) and 25-OHD (<53, 53–75, >75 nmol/L) using analysis of variance. ResultsSerum PTH was associated positively with DSD, with an increase of 10.6–15.7% when the mid and highest PTH tertiles were compared to the lowest tertile (p <0.025) when 25-OHD was included in the regression analysis. 25-OHD was significantly associated with DSD (greater by 10.6–11.1% when lowest and mid-tertiles compared with the highest 25-OHD tertile) (p <0.025) and dynamic balance (better performance by 12.6% in the highest compared with the lowest 25OHD tertile) (p <0.025). ConclusionThese findings reveal an important new relationship between parathyroid hormone and gait stability parameters and add to understanding of the role of 25-OHD in motor control of gait and dynamic balance in community-dwelling women across a wide age span.

Test-retest reliability and agreement of physical fall risk assessment tools in adults with intellectual disabilities.

Physical decline and high rates of inactivity lead to an increased risk of falling in the intellectual disability (ID) population. It is important therefore to develop interventions to prevent falls and to develop valid and reliable assessment tools, which are suitable for use with people with ID. Targeting the most important fall risk factors such as strength, balance and gait measurement is important, yet there is a paucity of previous research on testing the feasibility and reliability of strength, balance and gait assessments with people with ID. The aims of this study are (i) to describe the test-retest reliability and agreement [standard error of measurement (SEM)] of slightly adapted fall risk assessments and (ii) to describe the test-retest reliability and SEM of these tests in younger and older age groups and mild/moderate and severe/profound ID-level groups. Residents of a German residential facility for people with ID were asked to take part. The study has a test-retest design, whereby all participants were tested twice, with 7 days in-between the first (T1) and second (T2) testing days. The 'timed up and go', '30-second chair stand', 'handgrip' and 'Romberg balance test' were all performed. Intraclass correlation coefficient (ICC) (2,1) values and SEM were calculated for the full sample, two age groups (split at the age of 60 years) and mild/moderate and severe/profound ID-level groups. A total of 37 residents with a mean age of 59.3 years (standard deviation = 17.7) performed the tests on both testing days. Mainly moderate to excellent ICC values were found for all tests for the full sample and in all groups (0.59-0.97). Different SEM values were found for full sample and sub-groups. Strength, balance and gait assessment tools, which are easy to use and understand, were found to be reliable in adults with ID. The SEM is most important for interpreting the real effects of an intervention. Further analyses will be required to gain more information about the SEM in different age groups or ID-level groups.

Relationship Between Level of Physical Activity and Fall Risk Factors in Older Women at Risk of Falling

Abstract Date Presented 4/16/2015 This cross-sectional study found levels of physical activity—in terms of overall activity, physical exercise, and walking—that correspond to lowest risk of falling. This study provides evidence to strengthen occupational therapy’s philosophy of activity promotion and ideas for future research.

Regional Gray Matter Volumes Are Related to Concern About Falling in Older People: A Voxel-Based Morphometric Study.

Concern about falling is common in older people. Various related psychological constructs as well as poor balance and slow gait have been associated with decreased gray matter (GM) volume in old age. The current study investigates the association between concern about falling and voxel-wise GM volumes. A total of 281 community-dwelling older people aged 70-90 years underwent structural magnetic resonance imaging. Concern about falling was assessed using Falls Efficacy Scale-International (FES-I). For each participant, voxel-wise GM volumes were generated with voxel-based morphometry and regressed on raw FES-I scores (p < .05 family-wise error corrected on cluster level). FES-I scores were negatively correlated with total brain volume (r = -.212; p ≤ .001), GM volume (r = -.210; p ≤ .001), and white matter volume (r = -.155; p ≤ .001). Voxel-based morphometry analysis revealed significant negative associations between FES-I and GM volumes of (i) left cerebellum and bilateral inferior occipital gyrus (voxels-in-cluster = 2,981; p < .001) and (ii) bilateral superior frontal gyrus and left supplementary motor area (voxels-in-cluster = 1,900; p = .004). Additional adjustment for vision and physical fall risk did not alter these associations. After adjustment for anxiety, only left cerebellum and bilateral inferior occipital gyrus remained negatively associated with FES-I scores (voxels-in-cluster = 2,426; p < .001). Adjustment for neuroticism removed all associations between FES-I and GM volumes. Our study findings show that concern about falling is negatively associated with brain volumes in areas important for emotional control and for motor control, executive functions and visual processing in a large sample of older men and women. Regression analyses suggest that these relationships were primarily accounted for by psychological factors (generalized anxiety and neuroticism) and not by physical fall risk or vision.

New methods for fall risk prediction.

Accidental falls are the leading cause of injury-related death and hospitalization in old age, with over one-third of the older adults experiencing at least one fall or more each year. Because of limited healthcare resources, regular objective fall risk assessments are not possible in the community on a large scale. New methods for fall prediction are necessary to identify and monitor those older people at high risk of falling who would benefit from participating in falls prevention programmes. Technological advances have enabled less expensive ways to quantify physical fall risk in clinical practice and in the homes of older people. Recently, several studies have demonstrated that sensor-based fall risk assessments of postural sway, functional mobility, stepping and walking can discriminate between fallers and nonfallers. Recent research has used low-cost, portable and objective measuring instruments to assess fall risk in older people. Future use of these technologies holds promise for assessing fall risk accurately in an unobtrusive manner in clinical and daily life settings.

Effects of Mild and Severe Knee Joint Pain on the Frequency of Falls and Fall Risk in Elderly Females

This study aimed to examine differences in the frequency of falls during the past year and fall risk among 392 elderly females was categorized into five groups on the basis of the knee pain expe-rienced: no knee pain, mild unilateral knee pain, mild bilateral knee pain, severe unilateral knee pain, and severe bilateral knee pain. The subjects participated in a fall risk survey comprising 50 items representing five risk factors: “symptoms of falling”, “disease and physical symptoms”, “en-vironment”, “behavior and character”, and “physical function”. The frequency of falls during the past year, score for each risk factor, and the total fall risk score were not significantly different between the mild unilateral and mild bilateral knee pain groups, and between the severe unilateral and severe bilateral knee pain groups. Therefore, these groups were pooled to form a mild knee pain group and a severe knee pain group and analyzed. The severe knee pain group had experienced a significantly greater number of falls during the past year compared with the no knee pain group. Furthermore, the symptom of falling score was significantly higher in the severe knee pain group than in the no knee pain group, while the disease and physical symptoms score was significantly higher in the mild and severe knee pain groups than in the no knee pain group. The physical function score and total fall risk score were significantly higher in the following order: the severe knee pain group, the mild knee pain group, and the no knee pain group. Our results indicate that for elderly females who can achieve ADL independently, the degree of knee pain (mild or severe) has a marked effect on fall risk, irrespective of laterality of the pain (unilateral or bilateral). Factors such as symptoms of falling, disease and physical symptoms, and physical function are also related to fall risk in this population. Furthermore, elderly individuals with severe knee pain experience frequent falls.

Age-Related Changes in Physical Fall Risk Factors: Results from a 3 Year Follow-up of Community Dwelling Older Adults in Tasmania, Australia

As the population ages, fall rates are expected to increase, leading to a rise in accidental injury and injury-related deaths, and placing an escalating burden on health care systems. Sixty-nine independent community-dwelling adults (60–85 years, 18 males) had their leg strength, physical activity levels and their annual fall rate assessed at two timepoints over three years, (summer 2010 and summer 2013) monitoring balance. Force platform measures of medio-lateral sway range increased significantly under conditions of eyes open (mean difference MD 2.5 cm; 95% CI 2.2 to 2.8 cm) and eyes closed (MD 3.2 cm; 95% CI 2.8 to 3.6 cm), respectively (all p < 0.001) indicating worsening static balance control. Dynamic balance showed similar changes (p < 0.036). Leg strength was not significantly different between visits (p > 0.26). Physical activity reduced significantly (MD −909 Cal/week; 95% CI −347 to −1,470 Cal/week; p = 0.002) during the course of the study. Participants maintained aerobic activities, however resistance and balance exercise levels decreased non-significantly. The likelihood of falling was higher at the end of the study compared to the first timepoint (odds ratio 1.93, 95% CI 0.94 to 3.94; p = 0.07). Results of this study indicate that despite maintenance of leg strength there was an increase in medio-lateral sway over a relatively short time frame, with higher than expected increases in fall rates.

Vibration perception threshold in relation to postural control and fall risk assessment in elderly

Purpose: This study investigates (i) the potential discriminative role of a clinical measure of peripheral neuropathy (PN) in assessing postural performance and fall risk and (ii) whether the integration of a simple screening vibration perception threshold (VPT) for PN in any physical (fall risk) assessment among elderly should be recommended, even if they do not suffer from DM. Method: One hundred and ninety-five elderly were entered in a four-group model: DM with PN (D+; n = 75), DM without PN (D−; n = 28), non-diabetic elderly with idiopathic PN (C+; n = 31) and non-diabetic elderly without PN (C−; n = 61). Posturographic sway parameters were captured during different static balance conditions (AMTI AccuGait, Watertown, MA). VPT, fall data, Mini-Mental State Examination and Clock Drawing Test were registered. Two-factor repeated-measures ANOVA was used to compare between groups and across balance conditions. Results: The groups with PN demonstrated a strikingly comparable, though bigger sway, and a higher prospective fall incidence than their peers without PN. Conclusions: The indication of PN, irrespective of its cause, interferes with postural control and fall incidence. The integration of a simple screening for PN (like bio-thesiometry) in any fall risk assessment among elderly is highly recommended.Implications for RehabilitationThe indication of peripheral neuropathy (PN), irrespective of its cause, interferes with postural control and fall incidence.Therefore, the integration of a simple screening for PN (like bio-thesiometry) in any fall risk assessment among elderly is highly recommended.It might be useful to integrate somatosensory stimulation in rehabilitation programs designed for fall prevention.

Relationships between Physical Activity, ADL Capability and Fall Risk in Community-Dwelling Japanese Elderly Population

Relationships between Physical Activity, ADL Capability and Fall Risk in Community-Dwelling Japanese Elderly Population

Increased Prevalence of Fall Risk Factors in Older People following Hip Fracture

Background: Many people who suffer a hip fracture do not achieve full functional recovery. Simple tests of physical function such as quadriceps strength and postural sway may provide insight into why this population is at increased risk of experiencing further falls and fractures and assist in developing rehabilitation strategies for preventing falls. Objective: To determine whether impairments in a range of physiological measures and specific medical conditions are more prevalent in people who have suffered a fall-related hip fracture than in a matched sample of community-dwelling people without a history of falls. Methods: This case-control study involved 88 older people. The hip fracture group comprised 44 persons aged 64–94 years, assessed on average 7 months following a fall-related hip fracture. An age- and sex-matched control group (older persons who had not fallen in a 12-month period before recruitment) was drawn randomly from community samples. Results: Compared with the control group, the hip fracture group had markedly reduced quadriceps strength and increased body sway when tested on firm and compliant (foam rubber) surfaces. Patients in the hip fracture group also had higher prevalence rates of poor vision, arthritis and stroke, were taking more medications, were less physically active and perceived themselves to be at greater risk of falling than the control group. No significant differences were apparent for cardiovascular conditions, subjective health status and psychoactive medication use between the groups. Multivariate analyses identified quadriceps strength and body sway on the compliant surface as the most important variables for distinguishing between the hip fracture and no hip fracture groups. These two variables correctly classified 92% of the cases, with equal sensitivity and specificity. Conclusion: The findings identify an increased prevalence of certain physical fall risk factors among older persons who have suffered a hip fracture. Decreased quadriceps strength and increased postural sway are potentially modifiable. Intervention programs designed to improve performance on these variables among this population require investigation.