Physiological Fall Research Articles

TECHNOLOGY-BASED PHYSIO-FEEDBACK EXERCISE PROGRAM (PEER) TO PREVENT FALLS AND ENHANCE HEALTH EQUITY

Abstract Only a few studies have focused on low-income older adults with a mismatch between perceived fall risk and physiological fall risk. We developed a Physio-fEedback Exercise pRogram (PEER) which includes a) physio-feedback using a real-time portable innovative technology—the BTrackS Balance System: BBS; b) cognitive reframing based on a novel fall risk appraisal matrix; and c) peer-led exercise by focusing on balance and strength training. This NIH-funded clustered randomized control trial is led by an interdisciplinary team representing nursing, kinesiology, cognitive psychology, engineering, and data science. We aim to prevent falls and reduce health disparities by facilitating shifts from maladaptive to adaptive fall risk appraisal (i.e., moving from irrational, incongruent, or congruent to the rational quadrant) The 8-week PEER intervention is offered at low-income independent living communities/units in Central Florida through our partnership with community-based and public health organizations. We collected data at baseline and measured outcomes after program completion and found that 17.78 % of the participants in the PEER group (n=45) had adaptive shifting compared to 13.46 % in the control group (n=52). Up to 24.99% of the control group had maladaptive shifting compared to only 12.73% of the PEER group. The PEER intervention results in a shift from maladaptive to adaptive as a way of preventing falls, which is novel, and PEER may slow down the maladaptive shifting process. Integrating technology into fall risk assessments could increase engagement in fall interventions in low-income settings due to barriers faced by older adults regarding accessibility, knowledge, and healthcare costs.

The relationship between physiological biomarkers, physical function, and fall‐risk among people living with dementia

AbstractBackgroundPeople living with dementia (PWD) have upregulated inflammatory pathways, exaggerated metabolic aging, and cellular aging. They also have declines in physical function and heightened fall‐risk. Understanding the physiologic factors that influence physical decline and fall‐risk in PWD is vital to assess and prevent adverse health outcomes, such as future falls. The purpose of this study was to explore the association between physiological biomarkers, physical decline, and fall‐risk in PWD.MethodIn this cross‐sectional study, we used the baseline data of n=42 PWD in residential care facilities from our pilot randomized controlled trial [NCT05488951]. We assessed fall‐risk with the Morse Fall Scale and pulled fall history in the last 6 months from incident reports in medical charts. Participants completed two 4‐meter usual pace walking trials. We assessed two trials of maximum quadriceps strength on each leg with a portable dynamometer. We drew fasted blood and measured inflammatory biomarkers (Interleukin(IL)‐1b, IL‐6, IL‐8, IL‐10, IL‐12p70, IL‐17A, IL‐18, IL23, IL‐33, chemokine ligand 2, tumor necrosis factor‐a, human interferon (INF)‐a2, INFg), metabolic aging (kynurenine), and cellular aging (telomere length). Separate multiple linear regressions were performed for each biomarker, with gait speed, leg strength, fall history, and the Morse Fall Scale as variables of interest. We controlled for age, sex, and the Montreal Cognitive Assessment in each model.ResultFall history (β=5.61, p=0.03) and older age (β=0.49, p=0.005) were associated with greater INF‐a2 (R2=0.49, p=0.07). Fall history (β=4.93, p=0.07) showed a trend for a relationship with greater IL‐10 (R2=0.50, p=0.04). Older age (β=0.28, p=0.009) and lower MOCA scores (β=‐0.40, p=0.04) were related to greater IL‐12p70 (R2=0.64, p=0.003). Older age (β=9.26, p=0.01), fall history (β=74.42, p=0.04), and poorer leg strength (β=‐7.40, p=0.06) were related to greater kynurenine (R2=0.49, p=0.02).ConclusionOur exploratory findings suggest that there may be a relationship between certain physiological biomarkers (INF‐a2, IL‐10, kynurenine), physical function, and fall history. These inflammatory and metabolic aging biomarkers may play an important role for physical function and fall‐risk in PWD. This preliminary research may have implications for screening and monitoring of physical decline and fall‐risk among PWD.

The Impact of Misaligned Perceived and Objective Fall Risk in Cognitively Impaired Older People.

Cognitive impairment (CI) may impair the ability to accurately perceive physical capacity and fall risk. We investigated perceived (measured as concern about falls) and physiological fall risk in community-dwelling older people with CI, the characteristics of the aligned and misaligned groups and the impact of misaligned perceptions on falls. Participants (n= 293) with mild-moderate CI were classified into four groups based on validated physiological and perceived fall risk assessments: 1) vigorous: low perceived and physiological fall risk; 2) anxious: high perceived and low physiological fall risk; 3) unaware: low perceived and high physiological fall risk; and 4) aware: high perceived and physiological fall risk. Groups were compared with respect to neuropsychological and physical function, activity and quality of life measures, and prospective falls (12-months). The anxious (IRR = 1.70, 95% CI = 1.02-2.84), unaware (IRR = 2.00, 95% CI = 1.22-3.26), and aware (IRR = 2.53, 95% CI = 1.67-3.84) groups had significantly higher fall rates than the vigorous group but fall rates did not significantly differ among these groups. Compared with the vigorous group: the anxious group had higher depression scores and reduced mobility and quality of life; the unaware group had poorer global cognition, executive function and mobility and lower physical activity levels; and the aware group had an increased prevalence of multiple physical and cognitive fall risk factors. Fall rates were increased in participants who had increased perceived and/or physiological fall risk. Contrasting fall risk patterns were evident in those who under- and over-estimated their fall risk. Understanding these characteristics will help guide fall risk assessment and prevention strategies in community-dwelling older people with CI.

Associations between monitor-independent movement summary (MIMS) and fall risk appraisal combining fear of falling and physiological fall risk in community-dwelling older adults.

Introduction: Fall Risk Appraisal (FRA), a process that integrates perceived and objective fall risk measures, serves as a crucial component for understanding the incongruence between fear of falling (FOF) and physiological fall risk in older adults. Despite its importance, scant research has been undertaken to investigate how habitual physical activity (PA) levels, quantified in Monitor-Independent Movement Summary (MIMS), vary across FRA categories. MIMS is a device-independent acceleration summary metric that helps standardize data analysis across studies by accounting for discrepancies in raw data among research-grade and consumer devices. Objective: This cross-sectional study explores the associations between MIMS (volume and intensity) and FRA in a sample of older adults in the United States. Methods: We assessed FOF (Short Falls Efficacy Scale-International), physiological fall risk (balance: BTrackS Balance, leg strength: 30-s sit-to-stand test) and 7-day free-living PA (ActiGraph GT9X) in 178 community-dwelling older adults. PA volume was summarized as average daily MIMS (MIMS/day). PA intensity was calculated as peak 30-min MIMS (average of highest 30 non-consecutive MIMS minutes/day), representing a PA index of higher-intensity epochs. FRA categorized participants into following four groups: Rational (low FOF-low physiological fall risk), Irrational (high FOF-low physiological fall risk), Incongruent (low FOF-high physiological fall risk) and Congruent (high FOF-high physiological fall risk). Results: Compared to rational group, average MIMS/day and peak 30-min MIMS were, respectively, 15.8% (p = .025) and 14.0% (p = .004) lower in irrational group, and 16.6% (p = .013) and 17.5% (p < .001) lower in congruent group. No significant differences were detected between incongruent and rational groups. Multiple regression analyses showed that, after adjusting for age, gender, and BMI (reference: rational), only irrational FRA was significantly associated with lower PA volume (β = -1,452.8 MIMS/day, p = .034); whereas irrational and congruent FRAs were significantly associated with lower "peak PA intensity" (irrational: β = -5.40 MIMS/day, p = .007; congruent: β = -5.43 MIMS/day, p = .004). Conclusion: These findings highlight that FOF is a significant barrier for older adults to participate in high-intensity PA, regardless of their balance and strength. Therefore, PA programs for older adults should develop tailored intervention strategies (cognitive reframing, balance and strength exercises, or both) based on an individual's FOF and physiological fall risk.

Abstract 17563: Serial ABPM, Antihypertensive Drug Treatment, and Pregnancy Outcomes in Women With Hypertension Found Early During Pregnancy

Introduction: Few data are available on serial ambulatory blood pressure monitoring (ABPM) throughout pregnancyand antihypertensive drug treatment required for good blood pressure (BP) control in hypertensivepregnant women. Hypothesis: Evaluation of BP control, antihypertensive drug treatment intensity, and pregnancy outcomes in patients with hypertension (HTN) found early during pregnancy. Methods: We studied 49 consecutive pregnant patients (mean age 33.4±4.8 years, BMI before pregnancy24.5±3.7 kg/m2) referred for office HTN found early during pregnancy who gave birth to 50 children (1 twin pregnancy) in 2011-2015. Gestational HTN was previouslydiagnosed in 39 women, and 9 women had a history of previous miscarriage or stillbirth, with multipleprevious pregnancies lost in some patients. ABPM was repeated at 5-10-15-20-25-30-33-35-37 weeksof pregnancy. We calculated overall antihypertensive treatment intensity in standard daily drug doses per patient (standard doses: labetalol 200 mg, methyldopa 750 mg, metoprolol 50 mg, nifedipine 20mg, verapamil 120 mg). Statistical analysis was performed using ANOVA. Results: All children were born alive (24 vaginal delivery, 26 cesarean section) and are well at follow-up.Gestational age was 38.0±2.5 (range 29-40) weeks, and birth weight was 3215±653g (range 955-4200). Preeclampsia/eclampsia occurred in 10/3 patients. Four patients had normal BP values by ABPM throughout pregnancy and did not receive antihypertensive drugs. Most patients were treatedwith labetalol and methyldopa. Throughout pregnancy, BP remainedwell controlled (24h mean SBP/DBP 120.3-126.0/75.3-77.1 mmHg), the number of treated patientsincreased from 25 at 5 weeks to 42 at 25-35 weeks, and the average number of daily antihypertensivedrug doses in treated pts increased from 1.82 at 5 weeks to 2.98 at 37 weeks. Conclusions: Serial ABPM-guided antihypertensive drug treatment started early during pregnancywas associated with favorable outcomes. The number of patients requiring treatment increased throughout the pregnancy. No physiological BP fall atthe end of 1 st trimester was observed. Our findings help estimate the expected treatment intensity required in pregnant patients with preexisting hypertension.

Optimizing a Technology-Based Body and Mind Intervention to Prevent Falls and Reduce Health Disparities in Low-Income Populations: Protocol for a Clustered Randomized Controlled Trial.

The lack of health care coverage, low education, low motivation, and inconvenience remain barriers to participating in fall prevention programs, especially among low-income older adults. Low-income status also contributes to negative aging self-perceptions and is associated with a high perceived barrier to care. Existing fall prevention intervention technologies do not enable participants and practitioners to interact and collaborate, even with technologies that bring viable strategies to maintain independence, prevent disability, and increase access to quality care. Research is also limited on the use of technology to enhance motivation and help individuals align their perception with physiological fall risk. We developed a novel, 8-week Physio-Feedback Exercise Program (PEER), which includes (1) technology-based physio-feedback using a real-time portable innovative technology-the BTrackS Balance Tracking System, which is reliable and affordable, allows for home testing, and provides feedback and tracks balance progression; (2) cognitive reframing using the fall risk appraisal matrix; and (3) peer-led exercises focusing on balance, strength training, and incorporating exercises into daily activities. This study consists of 3 aims. Aim 1 is to examine the effects of the technology-based PEER intervention on fall risk, dynamic balance, and accelerometer-based physical activity (PA). Aim 2 is to examine the effects of the PEER intervention on fall risk appraisal shifting and negative self-perceptions of aging. Aim 3 is to explore participants' experiences with the PEER intervention and potential barriers to accessing and adopting the technology-based PEER intervention to inform future research. This is an intention-to-treat, single-blinded, parallel, 2-arm clustered randomized controlled trial study. We will collect data from 340 low-income older adults at baseline (T1) and measure outcomes after program completion (T2) and follow-up at 3 months (T3) and 6 months (T4). Participants will be enrolled if they meet all the following inclusion criteria: aged ≥60 years, cognitively intact, and able to stand without assistance. Exclusion criteria were as follows: a medical condition precluding exercise or PA, currently receiving treatment from a rehabilitation facility, plan to move within 1 year, hospitalized >3 times in the past 12 months, and does not speak English or Spanish. As of August 2023, the enrollment of participants is ongoing. This study addresses the public health problem by optimizing a customized, technology-driven approach that can operate in low-resource environments with unlimited users to prevent falls and reduce health disparities in low-income older adults. The PEER is a novel intervention that combines concepts of physio-feedback, cognitive reframing, and peer-led exercise by motivating a shift in self-estimation of fall risk to align with physiological fall risk to improve balance, PA, and negative aging self-perception. ClinicalTrials.gov NCT05778604; https://www.clinicaltrials.gov/ct2/show/study/NCT05778604. DERR1-10.2196/51899.

Levels of Accelerometer-Based Physical Activity in Older Adults With a Mismatch Between Physiological Fall Risk and Fear of Falling.

We examined the associations between levels of accelerometer-based physical activity and the mismatch of physiological fall risk and fear of falling (FOF) in community-dwelling older adults. We assessed 123 participants who received 7-day wrist-worn accelerometry. Physiological fall risk was assessed using the portable BTrackS™ balance system and FOF was assessed using a short version of the Falls Efficacy Scale-International. Participants were categorized into four groups: rational (low FOF/normal balance), irrational (high FOF/normal balance), incongruent (low FOF/poor balance), and congruent (high FOF/poor balance). One third of older adults had a mismatch between their FOF and actual fall risk. Accelerometer-based moderate to vigorous physical activity (MVPA) was significantly different in the irrational group compared to the rational group (p = 0.023) and the congruent group compared to the rational group (p = 0.032). Encouraging older adults to improve MVPA may prevent them from shifting from rational to irrational or congruent groups, thereby reducing the risk of injurious falls. [Journal of Gerontological Nursing, 49(6), 41-49.].

Seasonal Plant Nitrogen Use and Soil N pools in Intermediate Wheatgrass (Thinopyrum intermedium)

Intermediate wheatgrass (Thinopyrum intermedium; IWG) is a perennial grass under development as a grain and forage crop. Although IWG is known for its ability to take up nitrate and improve water quality, seasonal nitrogen (N) demand and uptake by IWG is not well known. We measured IWG shoot, root, and grain production, tissue N concentration, and soil mineral N at multiple plant growth stages in 1- and 2-year-old IWG stands fertilized with various rates of N: (1) 80 kg N ha−1 applied at spring regrowth (spring), (2) 40–40 kg N ha−1 applied at spring regrowth and anthesis (split), and (3) an unfertilized control. We also calculated nitrogen use efficiency and biomass N yield. Soil mineral N, N-mineralization rates, and plant N concentration increased with fertilization, and lodging increased with spring fertilization, while root physiological N use efficiency (PNUE) declined with fertilization. Seasonally, shoot and root N concentration declined at physiological maturity, while shoot PNUE was highest at maturity, suggesting either that surplus N was allocated to grain or that more biomass was being produced per unit N taken up. In the 1-year-old stand, during fall regrowth, soil mineral N levels were among the lowest; however, the total soil N was highest compared with other sampling times, suggesting a large influx of organic N between physiological maturity and fall regrowth. Based on our results, IWG is well suited to use nitrogen inputs and avoid excess N leaching into groundwater, but it is also clear that IWG has strong seasonal N allocation patterns that should be taken into consideration with N recommendations and best practices.

A TECHNOLOGY-BASED BODY-MIND INTERVENTION FOR LOW-INCOME AMERICAN OLDER ADULTS

Abstract Research is limited on the use of technology to help individuals who have a mismatch between physiological fall risk (Body) and perceived fall risk (Mind) and are unable to access traditional fall interventions. We examined the feasibility and acceptability of a technology-based body-mind intervention in low-income older adults during the COVID-19 pandemic and explored barriers to access and adopting the technology. Data were collected using a survey, balance test, accelerometer-based physical activity (PA), and semi-structured interviews with twenty participants who engaged in an 8-week intervention at a low-income setting in Florida. We found that: 1) the technology-based intervention is feasible, 2) participants tend to accept technology to alter their perceptions of fall risk and balance capacity, 3) tailored activities to each component are not a one-size-fits-all approach. There were no statistically significant changes in sedentary time, light PA, and moderate to vigorous PA between pre and post-intervention.

CANNABIS USE AND RISK OF FALLING IN OLDER ADULTS

Abstract The prevalence of cannabis use has significantly increased among US adults ≥ 50 years. However, the effect of chronic cannabis use on fall risk in older adults is unclear. A series of investigations were conducted to examine the intersection between cannabis use and fall risk in older adults. The findings indicated that: 1) Older (≥ 50 years) chronic cannabis users have a higher fall risk and walking impairments, 2) cannabis users might have a discrepancy between perceptual and physiological fall risk, and 3) chronic use of Δ-9-tetrahydrocannabinol (THC) might have negative influences on inhibitory control and brain activity. Future mechanistic (e.g., neuroimaging) investigations of the short- and long-term effects a variety of cannabis products (e.g., THC/CBD ratios, routes of administration) on cognitive/motor function, and fall incidence in older adults are suggested.

Enhanced Gait Variability Index in older Asian Adults and Increased Physiological Fall Risk: Results from the Yishun Study

Enhanced Gait Variability Index in older Asian Adults and Increased Physiological Fall Risk: Results from the Yishun Study

Disparity between Perceptual Fall Risk and Physiological Fall Risk in Older Cannabis Users: A Pilot Study.

Aging is associated with cognitive decline and increased fall risk. Cognitive impairment is associated with cannabis use, which is increasing among older adults. Perceptual and physiological fall risk are discordant in some older adults, but whether cannabis use influences this association is unknown. The purpose of this study was to investigate possible disparities between perceptual and physiological fall risk in older cannabis users. Eight older medical cannabis users and eight sex- and age-matched non-users provided data on perceptual and physiological fall risk. Group differences were assessed, and perceptual fall risk was correlated with physiological fall risk. Perceptual risk and most of the physiological fall risk variables were equivalent between the groups. However, cannabis users performed significantly worse on unipedal stance than non-users. In addition, perceptual fall risk had weak correlations with physiological fall risk in the users (Spearman’s rho = 0.17–0.41) and moderate-strong correlations in non-users (rho = −0.18–0.67). Cannabis users might have a discrepancy between perceptual and physiological fall risk. Because both concepts play a role in quality of life, identifying strategies to improve them may have significant benefits. Future studies investigating additional perceptual (e.g., cognition, fear of falling, depression, anxiety), physiological (e.g., more challenging static and dynamic balance conditions), and general fall risk are warranted.

Using Assistive Health Technology to Assess Fall Risk Appraisal, Body Composition, and Physical Activity

One-third of older adults have a discrepancy between perceived and physiological fall risks or maladaptive fall risk appraisal (FRA). Older adults who report high fear of falling and overestimate their physiological fall risk are less likely to participate in physical activity (PA). Limited data suggest the interrelation between fall risk appraisal, body composition, and objective measured PA. This cross-sectional study examines the feasibility of recruitment and acceptability of Assistive Health Technology (AHT), including the BTrackS Balance System (BBS), Bioelectrical Impedance Analysis (InBody s10), and ActiGraph GT9X Link wireless activity monitor. This study demonstrates the benefits of using AHT to study the associations among FRA, body composition, and PA in older adults. We hypothesize that rational FRA is associated with higher levels of PA and skeletal muscle mass and lower levels of percent of body fat and body mass index. Topics presentation included research protocol and preliminary results.

Associations among Fall Risk Appraisal, Body Composition, and Physical Activity in Older Adults

One-third of older adults have maladaptive fall risk appraisal (FRA), a condition in which there is a discrepancy between perceived fall risk or levels of fear of falling (FOF) and physiological fall risk (balance performance). We aimed to examine the associations among FRA, body composition, and physical activity (PA) using Assistive Health Technology, including the Bioelectrical Impedance Analysis, BTrackS Balance System, and activity monitoring devices. We evaluated 124 older adults with a mean age of 74.81 (SD=7.31, range 60 to 96), 77% were female, and 72% had no history of falls. The multinomial logistic regression was used to analyze the data. FRA was classified into 4 quadrants, and we found 47% of rational FRA (low FOF and normal balance), 19% of incongruent FRA (low FOF despite poor balance), 18% of irrational FRA (high FOF despite normal balance), and 16% congruent FRA (high FOF and poor balance). We found these following variables are associated with FRA: accelerometer-based moderate to vigorous physical activity (MVPA: mins), self-reported PA score (strength & flexibility), had difficulty walking up 10 steps without resting (resistance), had difficulty walking several city blocks (ambulation), left-hand average handgrip strength, CDC fall risk score, Senior Technology Acceptance (STA) score and body composition including Body Fat Mass (BFM), Percent Body Fat (PBF), Body Mass Index (BMI), Whole Body Phase Angle, Skeletal Muscle Mass (SMM) and Skeletal Muscle Index (SMI). Our results support the efficacy of using Assistive Health Technology on screening individuals with maladaptive FRA with targeted interventions to reduce fall risk.

Cognitive and Motor Cortical Activity During Cognitively Demanding Stepping Tasks in Older People at Low and High Risk of Falling.

Background: Choice stepping reaction time tasks are underpinned by neuropsychological, sensorimotor, and balance systems and therefore offer good indices of fall risk and physical and cognitive frailty. However, little is known of the neural mechanisms for impaired stepping and associated fall risk in older people. We investigated cognitive and motor cortical activity during cognitively demanding stepping reaction time tasks using functional near-infrared spectroscopy (fNIRS) in older people at low and high fall risk.Methods: Ninety-five older adults [mean (SD) 71.4 (4.9) years, 23 men] were categorized as low or high fall risk [based on 12-month fall history (≥2 falls) and/or Physiological Profile Assessment fall risk score ≥1]. Participants performed a choice stepping reaction time test and a more cognitively demanding Stroop stepping task on a computerized step mat. Cortical activity in cognitive [dorsolateral prefrontal cortex (DLPFC)] and motor (supplementary motor area and premotor cortex) regions was recorded using fNIRS. Stepping performance and cortical activity were contrasted between the groups and between the choice and Stroop stepping conditions.Results: Compared with the low fall risk group (n = 71), the high fall risk group (n = 24) exhibited significantly greater DLPFC activity and increased intra-individual variability in stepping response time during the Stroop stepping task. The high fall risk group DLPFC activity was greater during the performance of Stroop stepping task in comparison with choice stepping reaction time. Regardless of group, the Stroop stepping task elicited increased cortical activity in the supplementary motor area and premotor cortex together with increased mean and intra-individual variability of stepping response times.Conclusions: Older people at high fall risk exhibited increased DLPFC activity and stepping response time variability when completing a cognitively demanding stepping test compared with those at low fall risk and to a simpler choice-stepping reaction time test. This increased hemodynamic response might comprise a compensatory process for postural control deficits and/or reflect a degree of DLPFC neural inefficiency in people with increased fall risk.

Technology-Based Fall Risk Assessments for Older Adults in Low-Income Settings: Protocol for a Cross-sectional Study.

BackgroundOne-third of older adults have maladaptive fall risk appraisal (FRA), a condition in which there is a discrepancy between the level of fear of falling (FOF) and physiological fall risk (balance performance). Older adults who overestimate their physiological fall risk and report a high FOF are less likely to participate in physical activity. Limited data suggest that the association among FOF, body composition, and physical activity intensity differs by fear severity. ObjectiveThis study aims to examine the associations among FRA, body composition, and physical activity using assistive health technology, including the BTrackS balance system, bioelectrical impedance analysis, and activity monitoring devices. This study also aims to examine the feasibility of recruitment and acceptability of technologies and procedures for use among older adults in low-income settings. MethodsThis cross-sectional study will be conducted in older adults’ homes or apartments in low-income settings in Central Florida, United States. Following consent, participants will be contacted, and our team will visit them twice. The first visit includes questionnaire completion (eg, sociodemographic or FOF) and balance performance test using the BTrackS balance system. The participants will be stratified by the FRA matrix. In addition, they will perform hand grip strength and dynamic balance performance tests. Participants will then be asked to wear the ActiGraph GT9X Link wireless activity monitor on the nondominant wrist for 7 consecutive days. The second visit includes body composition testing and a structured interview about the acceptability of the technologies and procedures. ResultsEthical approval was obtained from the institutional review board of the University of Central Florida (protocol number 2189; September 10, 2020). As of December 2020, participation enrollment is ongoing and the results are expected to be published in Summer 2022. ConclusionsAccurate FRA is essential for implementing physical activity programs, especially in older adults with low income. This study will provide data for developing technology-based fall risk assessments to improve participation in physical activity, thus enhancing healthy longevity among older adults in low-income settings. International Registered Report Identifier (IRRID)PRR1-10.2196/27381

Timed Up and Go (TUG) Reference Values and Predictive Cutoffs for Fall Risk and Disability in Singaporean Community-Dwelling Adults: Yishun Cross-Sectional Study and Singapore Longitudinal Aging Study

The "timed up and go" (TUG) test is a simple and widely used test of overall functional mobility. There is a paucity of TUG normative data among Asian individuals who differ in habitual gait speed and fall risk from Western population. The objectives of this study were to determine TUG reference values and optimum cutoffs predicting prevalent and incident disability for community-dwelling adults. One cross-sectional (Study 1-Yishun Study) and one longitudinal (Study 2-Singapore Longitudinal Aging Study) study in Singapore. Study 1 comprised 538 nondisabled, community-dwelling adults aged between 21 and 90years. Study 2 comprised 1356 community-dwelling older adults aged ≥55years followed for 3years. Study 1 collected TUG reference values and assessed physiological fall risk (PFR) using the Physiological Profile Assessment (PPA). Study 2 assessed association of TUG with disability with the Barthel Index and the Lawton scale at baseline and follow-up. From Study 1, mean TUG time for individuals aged 60 to 74years was 9.80seconds, shorter than values reported for Westerners of 12.30seconds. It was significantly associated with high PFR [odds ratio (OR) 1.14, 95% confidence interval (CI) 1.03-1.27], 74.0% agreement, Cohen's kappa=0.314 (95% CI 0.238-0.390); area under the curve=0.85 (95% CI 0.80-0.90). A TUG cutoff of 10.2seconds discriminated high PFR from low PFR with 84.4% sensitivity and 72.6% specificity. In Study 2, the threshold for observing significantly increased risk of disability was ≥9.45seconds for prevalent disability (OR 2.98, 95% CI 1.41-6.78), functional decline (OR 2.68, 95% CI 1.33-5.80), and incidental disability (OR 2.25, 95% CI 1.08-4.97). TUG reference values and cutoff predicting disability for community-dwelling older adults in Singapore are consistent with Asian data and lower than for Western individuals. TUG could be used to guide development and evaluation of risk screening of adverse health outcomes across the life span in Singapore.

Sensorimotor Performance and Reference Values for Fall Risk Assessment in Community-Dwelling Adults: The Yishun Study.

This study sought to answer the following questions: What are the reference values of sensorimotor performance for fall risk in community-dwelling adults? How do population norms compare with that of other populations? Are younger adults at risk of falls? In a cross-sectional study design, sensorimotor functions and fall risk scores of community-dwelling adults were assessed and calculated to derive corresponding fall risk categories. Reference values were determined using the average scores by age group. A total of 542 community-dwelling adults were recruited (21-90years old) across 10-year (21-60years) and 5-year age groups (>60years) to obtain a representative sample of community-dwelling adults in Singapore. Five physiological domains were assessed: vision, proprioception, muscle strength, reaction time, and postural balance according to the Physiological Profile Assessment (PPA). Fall risk scores and the corresponding fall risk profiles were generated from an online calculator. Sensorimotor performance and PPA fall risk scores were significantly worse for increasing age categories. Females had significantly slower reaction time, lower muscle strength, and higher fall risk. The representative sample of older adults (≥65years) performed poorer in postural sway (z=-0.50) and reaction time (z=-0.55), but better in proprioception (z=0.29) and vision (z=0.23) compared with Caucasian norms. Among younger adults (21-59years), 36.8% appeared to exhibit higher fall risk. This study presents important reference data and compared sensorimotor functions and physiological fall risk across age groups of community-dwelling adults in a Southeast Asian population. Poor sensorimotor performance and fall risk appear already pertinent in younger adults. Further studies are warranted to improve understanding of fall risk among younger adults. In physical therapist practice, PPA reference values can aid clinicians in the development of targeted interventions tailored towards an individual's physiological risk profile, addressing specific physiological systems that require particular attention.

Discrepancies between Perceived and Physiological Fall Risks and Repeated Falls among Community-Dwelling Medicare Beneficiaries Aged 65 Years and Older

ABSTRACT Objectives This study examined the associations of discrepancies between perceived and physiological fall risks with repeated falls. Methods We analyzed the 2016 Medicare Current Beneficiary Survey of 2,487 Medicare beneficiaries aged ≥ 65 years with ≥ 1 fall. The outcome variable was repeated falls (≥ 2 falls), the key independent variable was a categorical variable of discrepancies between perceived (fear of falling) and physiological fall risks (physiological limitations), assessed using multivariate logistic regression. Results Among Medicare beneficiaries with ≥ 1 fall, 25.1% had low fear of falling but high physiological fall risk (Low Fear-High Physiological), 9.4% had high fear of falling but low physiological fall risk (High Fear-Low Physiological), 23.5% had low fear of falling and low physiological fall risks (Low Fear-Low Physiological), and 42.0% had high fear of falling and high physiological fall risks (High Fear-High Physiological). Having High Fear-High Physiological was associated with repeated falls (OR = 2.14; p < .001) compared to Low Fear-Low Physiological. Having Low Fear-High Physiological and High Fear-LowPhysiological were not associated with repeated falls. Conclusions Given that High Fear-High Physiological was associated with repeated falls and that many at-risk Medicare beneficiaries had High Fear-High Physiological, prevention efforts may consider targeting those most at-risk including Medicare beneficiaries with High Fear-High Physiological. Clinical Implications Assessing both perceived and physiological fall risks is clinically relevant, given it may inform targeted interventions for different at-risk Medicare beneficiaries among clinicians and other stakeholders.

The Iconographical Falls Efficacy Scale (IconFES) in community-dwelling older people-a longitudinal validation study.

This study aimed to develop cut-points for the 30-item and 10-item Iconographical Falls Efficacy Scale (IconFES) in community-dwelling older people and evaluate the psychometric properties, including construct and predictive validity with respect to falls and reduced physical activity over 1year. Eight hundred and one participants completed the IconFES and underwent physical, psychological and cognitive measures at baseline. Physical activity was recorded at baseline and 12months using an activity monitor, and 1-year fall incidence was collected using monthly falls calendars. Using receiver-operating characteristic curves and the Youden's index for history of falls, physiological fall risk and depressive symptoms, cut-points were defined to differentiate between low and high concern about falling (30-item: <53; 10-item: <19). For the 30-item IconFES, we additionally defined cut-points for low (≤40), moderate (41-58) and high (≥59) concern about falling. Groups based on these cut-points differed significantly: low coordinated stability, executive function and amount of daily walking, and high level of disability (30-item version) and female gender (low/high 30-item version). Although there were some inconsistencies across IconFES classifications, high concern about falling predicted having had multiple falls or multiple/injurious falls, low amount of daily walking and low movement intensity at 12months. The developed IconFES cut-points were sensitive to variables associated with concern about falling and predicted fall incidence and physical activity restriction after 12months. Applying these cut-points appears useful to identify older people with high concern about falling, who are at higher risk of falls and activity curtailment.