Physiological Fall Research Articles

A sensitive data analysis approach for detecting changes in dynamic postural stability

Understanding the mechanisms of instability can aid in reducing fall risk. As a sensitive measure of fall risk, the distance between the center of pressure (COP) and center of mass (COM) is currently assessed through discrete points assumed to represent physiological important fall mechanisms. However, it is unclear if these discrete points are appropriate measures of fall risk. Statistical parametric mapping (SPM) is a waveform analysis technique that removes this possibly biased a priori approach. Sixteen healthy young adults (8 males, 8 females; Age: 29 ± 3.6 years, Height: 1.7 ± 0.9 m, Mass: 75 ± 16 kg) performed two tasks that disturbed dynamic stability: voluntary stepping at different step lengths, and forward perturbations at different accelerations. COP-COM distance magnitudes were extracted during the first step in both tasks at discrete points typically assessed in previous research. Discrete point analysis (DPA) was performed on these discrete points and SPM analysis was completed on the COP-COM distance waveform. The results from the study found that SPM analysis identified equivalent significant differences to DPA and identified additional significant differences elsewhere in the COP-COM distance waveform that were not able to be detected by DPA. Two key advantages from using SPM: (1) reduction of possibly biased a priori selection, and (2) increased efficiency and reduced time-cost in data post-processing as inherent variability can limit the detection of discrete points resulting in identifying physiologically different discrete points across trials. This study suggests the use of SPM as a sensitive data analysis approach in detecting fall risk as an alternative to DPA.

Sensorimotor impairments, postural instability, and risk of falling in older adults with diabetic peripheral neuropathy

Older adults with type 2 diabetes mellitus (DM) have high incidence of falls. The aim of this study was to compare sensorimotor functions, balance, mobility, fear of falling, and fall history in older people with DM (with and without neuropathy) and non-diabetic healthy controls. We enrolled 153 participants aged 50–70 years: 51 people with diabetic peripheral neuropathy (D-PN), 52 with diabetes without neuropathy (D-noPN), and 50 healthy controls (HC). Participants completed a fear of falling assessment and detailed test battery comprising sensorimotor functions, lower limb strength, contrast vision, reaction time, balance, and mobility from which a composite physiological fall risk score (PFRS) was derived. In addition, a fall history of the past 3 months was recorded. Post hoc comparisons of ANOVA test revealed the D-PN had significant deficits than the other two groups in tests of lower limb sensation, knee extension strength, reaction time, postural sway, one leg standing, sit-to-stand and the timed up and go test. The D-PN had the highest fear of falling (30.18 ± 6.75) and the highest PFRS (1.68 ± 1.13). PFRS for the D-noPN (0.74 ± 0.80) was intermediate between HC (0.49 ± 0.96) and DP-N groups. Thirty-four D-PN participants (66.7%), 19 D-noPN participants (36.5%), and 7 HC (14.0%) reported one or more falls in the past 3 months (Chi2 test for trend = 28.1, df = 2, p < 0.001). Older people with diabetic neuropathy have impaired sensorimotor function, balance, mobility, and associated increased fear of falling and fall rates. This population may benefit from fall risk assessments involving the above measures, and subsequent interventions targeted to deficits amenable to correction.

Absence of Nocturnal Fall in Blood Pressure Detected by Ambulatory Blood Pressure Monitoring in Acute Chagas Disease Patients with Oral Infection.

Background The involvement of the autonomic nervous system is one of the mechanisms proposed to explain the progression of myocardial lesion in Chagas disease. Evidences have shown changes in sympathetic and parasympathetic nervous system since the acute phase of the disease, and studies to clarify the pathophysiological and prognostic value of these changes are needed. Objetives To assess blood pressure profile by ambulatory blood pressure monitoring (ABPM) in normotensive patients with acute Chagas disease (ACD) without apparent cardiac damage, and the influence of the infection on nocturnal blood pressure fall. Methods ABPM was performed with 54 patients with ACD and a control group composed of 54 age- and sex-matched normotensive individuals. The alpha level of significance (type I error rate) was set at 5%. Results In the total of 54 patients, 74.0% did not show nocturnal fall in systolic blood pressure, 53.7% did not show nocturnal fall in diastolic blood pressure, and lack of both nocturnal fall in SBP and DBP was observed in 51.8% (*p<0.05). In 12.9% of patients, there was an increase in SBP and in 18.5% increase in DBP (p<0.05). Conclusions In patients with acute Chagas disease, a significant absence of the physiological fall in both systolic and diastolic blood pressure was observed during sleep, and some of the patients showed nocturnal increase in these parameters. These findings suggest autonomic changes in the acute phase of Chagas disease. (Arq Bras Cardiol. 2020; 114(4):711-715).

Physio-Feedback and Exercise Program (PEER) Improves Balance, Muscle Strength, and Fall Risk in Older Adults.

Community-dwelling older adults. Provide visual physio-feedback and cognitive reframing based on the fall risk appraisal matrix and participate in combined group- and home-based exercises by a trained peer coach. Align perceived and physiological fall risk, peer coaching to exercise. Balance, handgrip strength, fall risk, and activity engagement. [Research in Gerontological Nursing, 13(6), 289-296.].

Assessing Fall Risk Appraisal Through Combined Physiological and Perceived Fall Risk Measures Using Innovative Technology

The current study aimed to categorize fall risk appraisal and quantify discrepancies between perceived fall risk measured subjectively using the short Fall Efficacy Scale-International and physiological fall risk measured objectively using the portable BTrackS™ Assess Balance System. One hundred two community-dwelling older adults were evaluated in this cross-sectional study. Approximately 40% of participants had maladaptive fall risk appraisals, which were either irrational (high perceived risk despite low physiological fall risk) or incongruent (low perceived risk but high physiological fall risk). The remaining 60% of participants had adaptive fall risk appraisals, which were either rational (low perceived risk aligned with low physiological fall risk) or congruent (high perceived risk aligned with high physiological fall risk). Among participants with rational, congruent, irrational, and incongruent appraisals, 21.7%, 66.7%, 28%, and 18.8%, respectively, reported having a history of falls (p < 0.01). Using technology to identify discrepancies in perceived and physiological fall risks can potentially increase the success of fall risk screening and guide fall interventions to target perceived or physiological components of balance. [Journal of Gerontological Nursing, 46(4), 41-47.].

83 Trip Versus Slip: Implication of the Triggers of Falls on Physiological Fall Risk

Abstract Introduction Early identification of fallers with intrinsic fall risk factors could facilitate the delivery of timely and appropriate treatment. This study aims to see if the two most common triggers of falls – trip and slip, have an implication on the physiological profile of older fallers. Methods One thousand one hundred and forty-one community-dwelling older adults aged 60 years or above who had a fall in the past year were recruited in Hong Kong. Details on the falls experienced by the elderly were recorded in an interview. Physiological fall risk of the participants was measured by the short-form Physiological Profile Assessment (PPA). It assesses vision, reaction time, proprioception, balance, and knee extension strength. Mobility was assessed by the 10-meter walk test at comfortable speed. Analysis of Co-variance (ANCOVA) was used to compare the assessment results between those who only experienced trip and falls (n=378; 316 female; mean age=70.4±7.2) and those who only experienced slip and falls (n=204; 159 female; mean age=70.1±7.1) while adjusting for gender proportion. Chi-square test was used to evaluate the difference in the proportion of recurrent fallers across groups. Results Elderly who experienced only trip and falls have a significantly lower knee extension strength (22.9±8.3kg) compare with those who experienced only slip and falls (25.0±9.18 kg; p=0.031). They also tend to take longer to complete the 10-meter walk test (Trip only: 10.17±2.88; Slip only: 9.72±2.63; p=0.085). A higher percentage of those who tripped were recurrent fallers but the difference was insignificant (Trip only: 11.6%; Slip only: 8.3%; p=0.214). No other outcome measure was found to be significantly different across groups (p≥0.418). Conclusion Elderly who tripped and fell have worse physical ability than those who slipped. They are potentially better candidates for fall prevention exercise intervention.

Fear of Falling Assessment and Interventions in Community-Dwelling Older Adults: A Mixed Methods Case-Series

ABSTRACT Objectives (1) assess fear of falling (FOF) in community-dwelling older adults using subjective and objective measures and, (2) explore older adults’ perceptions of FOF assessments and interventions. Methods A mixed methods case-series was utilized. It consisted of quantitative data collection by objective measures including the BTrackSTM Balance Test (BBT) and a dynamometer to assess physiological fall risk, and in-depth interviews from four older adults in Orlando, Florida. A single Fear of Falling Scale and Falls Efficacy Scale-International (FES-I) were used to assess FOF. To combine quantitative and qualitative data, a case-specific analysis was used and followed by a cross-case analysis to gain a more comprehensive understanding of FOF. Results We found an incongruent fear of falling with physiological fall risk. Four themes emerged: (1) Fluctuating definitions of “fear” contribute to difficulty in assessments and interventions, (2) Fundamental assessments for fear of falling are missing, (3) Feedback from an objective measure is valuable, and (4) Family experiences with fear of falling drive personal interventions. Conclusions The integrated viewpoints from quantitative and qualitative data suggest a need for FOF assessment based on older adults’ perceptive and physiological measures. Clinical Implications Healthcare providers should assess FOF using subjective and objective measures.

A hybrid concept analysis of fall risk appraisal: Integration of older adults' perspectives with an integrative literature review.

This study aimed to define the concept of fall risk appraisal (FRA) and its measures by integrating the older adults' perspectives with an integrative literature review. Appraised fall risk is based mainly on either subjective or objective measures, which may result in inaccurate predictions of fall risk. This study was developed based on three phases of the hybrid concept analysis including a theoretical phase, a fieldwork phase, and an analytic phase. Eleven articles were selected to review in the theoretical phase. Qualitative data from in-depth interviews and focus groups in the fieldwork phase were used to compare and integrate into the analytic phase. FRA is a two-dimensional assessment of fall risk in older adults. Two independent dimensions were defined as (a) physiological fall risk dimension reflecting physical or body function, which may decline with age, and (b) perceived fall risk dimension reflecting the older adults' perception of their likelihood to fall. FRA consists of two categories including adaptive fall risk appraisal and maladaptive fall risk appraisal. A practical definition of FRA and its measures could be extremely valuable for supporting the need for fall risk assessments and would be integral to nursing practice.

Shifting Maladaptive Fall Risk Appraisal in Older Adults through an in-Home Physio-fEedback and Exercise pRogram (PEER): A Pilot Study

ABSTRACT Objectives 1) examine the preliminary effectiveness of the Physio-feEdback and Exercise pRogram (PEER) for shifting maladaptive to adaptive fall risk appraisal and reducing fall risk, 2) determine the participants’ feedback and acceptability of the program. Methods Forty-one older adults were assigned to either PEER intervention or attention control group. The 8-week PEER intervention consists of a visual physio-feedback, cognitive reframing, and combined group and home-based exercise led by a trained peer coach. The attention control group read fall prevention brochures and continued their normal activities. BTrackS Balance Test (BBT), short version of Fall Efficacy Scale International (short FES-I) and CDC fall risk checklist were measured from pre- to post-intervention. The feedback and acceptability were conducted at the program conclusion. Results About 11% of participants in the PEER group had positive shifting but none in the attention control group. Up to 32% of the participants in attention control had negative shifting compared to 5.3% in the PEER group. PEER group reported significant decreases in fall risk and high acceptability of the program. Conclusions PEER intervention facilitates a shift from maladaptive to adaptive fall risk appraisal and reduces fall risk. Clinical Implications Preventive interventions promoting alignment between perceive and physiological fall risk may contribute to reducing falls and increasing exercise adherence.

Fall Risk Prediction in Multiple Sclerosis Using Postural Sway Measures: A Machine Learning Approach

Numerous postural sway metrics have been shown to be sensitive to balance impairment and fall risk in individuals with MS. Yet, there are no guidelines concerning the most appropriate postural sway metrics to monitor impairment. This investigation implemented a machine learning approach to assess the accuracy and feature importance of various postural sway metrics to differentiate individuals with MS from healthy controls as a function of physiological fall risk. 153 participants (50 controls and 103 individuals with MS) underwent a static posturography assessment and a physiological fall risk assessment. Participants were further classified into four subgroups based on fall risk: controls, low-risk MS (n = 34), moderate-risk MS (n = 27), high-risk MS (n = 42). Twenty common sway metrics were derived following standard procedures and subsequently used to train a machine learning algorithm (random forest – RF, with 10-fold cross validation) to predict individuals’ fall risk grouping. The sway-metric based RF classifier had high accuracy in discriminating controls from MS individuals (>86%). Sway sample entropy was identified as the strongest feature for classification of low-risk MS individuals from healthy controls. Whereas for all other comparisons, mediolateral sway amplitude was identified as the strongest predictor for fall risk groupings.

Property of Melatonin of Acting as an Antihypertensive Agent to Antagonize Nocturnal High Blood Pressure: A Meta-Analysis

Therapy of hypertension persisting in the course of nocturnal sleep has yielded rather disappointing results . Therefore, the research has focused on drugs such as melatonin acting in such a way so as to counteract the lack of fall in blood pressure during night time sleep. A meta-analysis has been planned by gathering only randomized controlled trials( RCTs), where melatonin was administered as a single dose at bedtime and compared with placebo. The efficacy was the "night time variation in systolic blood pressure" and the "night time variation in diastolic blood pressure". Safety endpoint was the possible occurrence of serious adverse events. Seven studies with 221 participants were pooled in the meta-analysis. Melatonin use was a predictor of significant decrease in nocturnal systolic blood pressure[SBP]( difference in means[MD]= -5.74 mm Hg; 95% CI: -6.07 to- 5.41 mm Hg; p&lt;0.00001).This change was generated by the very steep decrease in nocturnal SBP detected in patients treated with controlled-release(CR) melatonin ( MD=-8.42 mm Hg; 95% CI: -8.82 to- 8.02 mm Hg; p&lt;0.00001); whereas the mean change in nocturnal SBP, found in patients taking fast -release (FR)melatonin, was nonsignificant (MD=-0.06 mm Hg; 95% CI: -0.64 to 0.52 mm Hg; p=0.84). Likewise, use of melatonin was associated with a fall in DBP( MD= -0.60 mm Hg; 95% CI=-1.12 to -0.08 mm Hg), driven by the pressure changes attained by the CR melatonin. No major adverse events occurred in the examined trials. Evening administration of CR melatonin has been shown to cause a significant pressure decrease over the nocturnal sleep. Thus, the CR melatonin preparations could find a place in the antihypertensive armamentarium for promoting the physiological fall of blood pressure levels during night time sleep.

The change in haemoglobin concentration between the first and third trimesters of pregnancy: a population study

BackgroundThe physiological fall in haemoglobin concentration from the 1st to the 3rd trimester of pregnancy is often quoted as 5 g/L. However, other studies have suggested varying levels of fall between 8 and 13 g/L. We evaluated the change in haemoglobin concentration between the 1st and 3rd trimesters of pregnancy in a multi-ethnic population of pregnant women.MethodsA retrospective cohort analysis of 7054 women with singleton pregnancies, giving birth during 2013–15 in a single urban maternity unit in England.We calculated the changes in haemoglobin concentration from 1st to 3rd trimester using the first trimester haemoglobin as the reference point. The population was stratified into sub-groups to explore any differences that existed within the population.ResultsIn general the fall in haemoglobin concentration was in the order of 14 g/L or 11% of the first trimester value. This fall was consistent for the majority of sub-groups of the population. The fall was lower (7.7%) in the most deprived section of the population, IMD1, but it increased to 11.7% when we restricted that sub-group to pregnant women without health problems during the index pregnancy. Conversely, there was an increase in haemoglobin of 10.2% in women whose first trimester haemoglobin concentration was in the lowest 5% of the total study population. The population fall in haemoglobin was 10.2 g/L (7.8%), after excluding cases above the 95th and below the 5th centiles, and women with a medical and/or obstetric disorder during the pregnancy.ConclusionThe fall in haemoglobin during pregnancy is in the order of 14 g/L or 11% of the first trimester level. This is 2 to 3 times higher than suggested by some guidelines and higher than previously published work. The results challenge the current accepted thresholds for practice, and have broader implications for diagnosis and managment of antenatal anaemia.Tweetable abstractFall in haemoglobin across pregnancy is around 14 g/L (11%) and significantly higher than previously stated in the pregnant population. This poses questions over currently accepted thresholds for anaemia in pregnancy.

RELATIONSHIP BETWEEN SLEEP BREATHING PATTERNS AND BLOOD PRESSURE CHANGES DURING ACUTE HIGH ALTITUDE EXPOSURE. DATA FROM HIGHCARE STUDIES

Objective: Acute exposure to high/moderate altitude (HMA) induces increase in ambulatory blood pressure (BP), which may be particularly pronounced during the night, leading to reduced nocturnal BP dipping. Occurrence of central sleep apneas (CSA) is also typical for HMA exposure. Aim of this study was to investigate the relationship between variables characterizing respiration during sleep with nocturnal BP in subjects acutely exposed to HMA. Design and method: Aggregate data from several studies performed in the framework of HIGHCARE projects were analysed (HIGHCARE-Himalaya – 5400 m, Alps - 4559 m, Sestriere 2035 m, all in healthy volunteers; Andes – 3260 m, hypertensive subjects). HMA exposure duration ranged between 1 and 15 days. Data of subjects with at least 1 ambulatory BP monitoring at sea level (SL) and HMA (validated oscillometric device) and at least 1 cardio-respiratory sleep study (CSS) were analysed. Study variables included: mean nocturnal systolic(S) and diastolic (D)BP; size of nocturnal BP fall (%), apnea-hypopnea index (AHI), central apnea index (cAI), mean and minimum nocturnal oxygen saturation (SpO2mean and SpO2 min). Mixed linear models adjusting for age, sex, BMI, study, treatment were used to assess the relationship between variables of interest. Results: After excluding participants with incomplete data, 178 subjects were included (52.8% male, age 45.6 ± 11.7, BMI 25.3 ± 4.3). During HMA exposure we observed an increase in nocturnal SBP/DBP by 10.8 ± 12.9 mmHg, a reduction in nocturnal SBP/DBP fall by 2.5 ± 7.9%. Median SpO2mean was 82.6%, SpO2 min 70%, AHI 22.5, cAI 1.1. 82% of participants had AHI > 5. After adjusting for covariates no association was found between changes in nocturnal BP/dipping and AHI or cAI. We observed a direct relationship between SpO2mean and the change in nocturnal SBP fall (β=0.21 [0.04–0.39], p = 0.017). In categorical analysis participants who at HMA became nondippers (SBP fall < 10%) had lower SpO2mean than those who maintained nocturnal dipping (77.9 vs. 84.2%, adjusted p = 0.044). Conclusions: Attenuation of physiological nocturnal BP fall at HMA is associated with the degree of nocturnal hypoxemia but not with the severity of sleep breathing disorders induced by HMA exposure. These results may be relevant in conditions associated with nocturnal hypoxia and/or CSA.

Concern About Falling Is Associated With Gait Speed, Independently From Physical and Cognitive Function.

Higher levels of concern about falling in older people have been associated with slower walking speed and an increased risk of falls. However, it is unclear whether this relationship is independent or confounded by other fall risk factors, such as physical and cognitive function. The aim of this study was to examine the effects of concern about falling on gait speed, adjusted for physiological fall risk and cognitive function. This was an observational, cross-sectional study. A total of 204 community-dwelling older people aged 70 years or older were recruited from 2 sites (Germany, n=94; Australia, n=110). Walking speed was measured over 6 m under 4 conditions: preferred speed, fast speed, speed while carrying a tray (functional dual task), and speed while answering a question (cognitive dual task). The Falls Efficacy Scale-International was used to assess concern about falling, the Physiological Profile Assessment was used to assess physiological fall risk, and the Digit Symbol Substitution Test and Trail Making Test were used to assess attention and executive function. Higher levels of concern about falling were associated with slower gait speed. Following adjustment for age, history of falls, and female sex, and further adjustment for physical and cognitive function, the association between concern about falling and walking speed remained significant, with a considerable effect size (standardized β=0.18±0.08; P=.037). The use of walking speed as a sole measure of gait was a limitation of this study. Gait speed, especially under dual-task conditions, was affected by concern about falling. Concern about falling was the strongest predictor of gait speed under all 4 conditions and should be included in routine geriatric assessments.

Native amphibian larvae exhibit higher upper thermal limits but lower performance than their introduced predator Gambusia affinis

Information on the thermal limits and physiology of ectothermic amphibians is crucial to our understanding of their ecology in the natural environment, particularly with predicted global changes in climate. We documented the thermal limits of larvae of three amphibian species native to Hong Kong, and their introduced, invasive predator, the mosquitofish (Gambusia affinis). We then used larvae of the brown tree frog Polypedates megacephalus as a model amphibian to further investigate growth, oxygen consumption rate and heat shock protein expression with changes in thermal regime. We found that G. affinis was the most tolerant of low temperatures but also the least tolerant of high temperatures. Despite the higher thermal tolerance of the amphibian larvae, further investigation on P. megacephalus demonstrated that optimal temperatures for physiological performance fall within a range of 18.0–21.6 °C, which is far lower than its upper thermal limit, implying that thermal stress occurs during part of the larval stage under natural environmental conditions. This could mean a reduction in their capacity to deal with other stressors such as pollution and predators, and that G. affinis may have an advantage over native amphibians.

Deletion of insulin receptor in the proximal tubule and fasting augment albumin excretion.

The contribution of proximal tubules (PT) to albumin uptake is now well recognized, however, its regulation is understudied area. There are reports suggesting that insulin resistance is associated with the development of albuminuria in nondiabetic individuals. We have previously reported reduced insulin receptor (IR) expression in renal-tubular-epithelial cells, including PT in various models of insulin resistance. However, the effect of a physiological fall in insulin levels and the role for IR in PT in tubular albumin uptake is not clear. To address these gaps in our understanding, we estimated urine excretion and renal uptake of albumin in fasted and fed C57Bl/6 mice injected with fluorescein isothiocyanate (FITC)-albumin (5 µg/mL/kg body weight, intraperitoneal, n = 6 per group). In addition, we compared spot urine analysis from 33 clinically healthy humans after overnight fasting (when insulin levels are lower than in the fed state) and then at 2 hours after 75 g oral glucose challenge (postprandial). Fasted mice had attenuated renal uptake of FITC-albumin and higher excretion in urine, relative to fed mice ( P = 0.04). Moreover, a significant drop in urine albumin-to-creatinine ratio (ACR) and urine albumin concentration (UAC) was observed in the postprandial state in these subjects ( P = 0.001 and P = 0.017, for ACR and UAC, respectively). The drop was negatively associated with postprandial blood glucose levels (ρ = -0.36, P = 0.03 for ΔUAC and ρ = -0.34, P = 0.05 for ΔACR). To test the role of IR in PT, we analyzed 24-hour urine albumin excretion in male mice with targeted deletion of IR from PT (insulin receptorknockout [IRKO]) and their wild-type (WT) littermates ( n = 7 per group). IRKO mice had significantly higher 24-hour urine albumin excretion relative to WT. Moreover, kidneys from KO mice revealed reduced expression of megalin and cubulin proteins in the PT relative to the WT. We also demonstrated insulin (100 nM) induced albumin internalization in human proximal tubule cells (hPT) and this effect of insulin was attenuated in hydroxy-2-naphthalenylmethylphosphonic acid (100 µM), a tyrosine kinase inhibitor, pretreated hPT. Our findings revealed albumin excretion was attenuated by glucose administration to fasting individuals implying a regulatory role for insulin in PT albumin reabsorption. Thus albuminuria associated with insulin resistance/diabetes may relate not only to glomerular dysfunction but also to impairment in insulin-mediated reabsorption.

Disparity between perceived and physiological risks of falling among older patients in an acute care hospital

BackgroundFalls are the most frequent adverse events among hospitalised older adults. Previous studies highlighted that older adults might not understand the risk factors associated with falls and may have an altered perception of their actual risk. AimTo describe differences between perceived and actual physiological risk of falling among older adults and to explore factors associated with the differences. Methods: A prospective cohort study was done. Older adults (age 65 years and above) were interviewed one-to-one at bedside. Morse Fall Scale (MFS) and other risk factors for falls were used to identify the patients’ physiological fall risks. Patients’ perceived risk of falls were assessed using the Falls Efficacy Scale-International (FES-I). ResultsThree hundred patients were recruited. Patients’ mean age was 75.3 (SD = ± 6.2). Majority were males (51.7%), lived with others (91.7%), and had received primary school education (35.3%). Based on the MFS, most patients had moderate fall risk (59.7%). Using the FES-I, more than half the patients (59%) interviewed had high concerns about falling. About one-third of the patients’ (31.3%) perceived risk matched with their physiological fall risk (Risk-Aware). Half of the patients’ perceived risks was higher than their physiological fall risk (50.7%) (Risk-Anxious), while the remaining patients’ perceived risks was reported to be lower than their physiological fall risk (18%) (Risk-Taker). ConclusionOlder patients are poor at recognizing their fall risks. Both patients’ perceived and actual fall risks should be evaluated in the inpatient setting in order to inform individualized fall prevention education and strategies.

Relationship Between Physiological and Perceived Fall Risk in People With Multiple Sclerosis: Implications for Assessment and Management

ObjectiveThis study evaluated the relationship between physiological and perceived fall risk in people with multiple sclerosis (MS). DesignSecondary analysis of data from prospective cohort studies undertaken in Australia, the United Kingdom, and the United States. SettingCommunity. ParticipantsAmbulatory people with MS (N=416) (age 51.5±12.0 years; 73% female; 62% relapsing-remitting MS; 13.7±9.9 years disease duration). InterventionsNot applicable. Main Outcome MeasuresAll participants completed measures of physiological (Physiological Profile Assessment [PPA]) and perceived (Falls Efficacy Scale-international [FESi]) fall risk and prospectively recorded falls for 3 months. Results155 (37%) of the participants were recurrent fallers (≥2 falls). Mean PPA and FESi scores were high (PPA 2.14±1.87, FESi 34.27±11.18). The PPA and the FESi independently predicted faller classification in logistic regression, which indicated that the odds of being classified as a recurrent faller significantly increased with increasing scores (PPA odds ratio [OR] 1.30 [95% CI 1.17-1.46], FESi OR 1.05 [95% CI 1.03-1.07]). Classification and regression tree analysis divided the sample into four groups based on cutoff values for the PPA: (1) low physiological/low perceived risk (PPA <2.83, FESi <27.5), (2) low physiological/high perceived risk (PPA <2.83, FESi >27.5), (3) high physiological/low perceived risk (PPA >2.83, FESi <35.5), and (4) high physiological/high perceived risk (PPA <2.83, FESi >35.5). Over 50% of participants had a disparity between perceived and physiological fall risk; most were in group 2. It is possible that physiological risk factors not detected by the PPA may also be influential. ConclusionsThis study highlights the importance of considering both physiological and perceived fall risk in MS and the need for further research to explore the complex interrelationships of perceptual and physiological risk factors in this population. This study also supports the importance of developing behavioral and physical interventions that can be tailored to the individual’s needs.

Use of a Short Version of the Activities-specific Balance Confidence Scale in Multiple Sclerosis.

Multiple sclerosis (MS) is a neurologic disease that results in balance and mobility impairments that are associated with elevated fall risk. One common patient-reported outcome measure of balance is the 16-item Activities-specific Balance Confidence (ABC) scale. The ABC scale is valid and reliable in assessing balance confidence in people with MS. However, a shorter, six-question version of the ABC scale, the ABC-6 scale, has been proposed to save time in a clinical setting. Thus, we assessed the convergent validity and internal consistency reliability of the ABC-6 scale in people with MS. A total of 221 participants were included in this secondary analysis to compare the ABC-6 scale with the ABC scale. Convergent validity and internal consistency reliability were applied to participants based on fall history and physiological fall risk. Statistical analysis indicated a main effect of group of the ABC and ABC-6 scales (P < .001). Both scales showed good to very good internal consistency (Cronbach α range, 0.832-0.975) and good reliability (intraclass correlation coefficient score range, 0.888-0.941). Furthermore, both versions had moderate convergent validity. Sensitivity ranged from 30% to 97%, and specificity ranged from 64% to 100% across groups tested. The ABC and ABC-6 scales demonstrated good internal consistency reliability and moderate convergent validity in predicting balance confidence in people with MS. However, poor sensitivity of both versions in distinguishing between MS groups at risk for falls may call into question the usefulness of this self-report measure.

Deep white matter hyperintensities, microstructural integrity and dual task walking in older people

To examine neural, physiological and cognitive influences on gait speed under single and dual-task conditions. Sixty-two community-dwelling older people (aged 80.0 ± 4.2years) participated in our study. Gait speed was assessed with a timed 20-meter walk under single and dual-task (reciting alternate letters of the alphabet) conditions. Participants also underwent tests to estimate physiological fall risk based on five measures of sensorimotor function, cognitive function across five domains, brain white matter (WM) hyperintensities and WM microstructural integrity by measuring fractional anisotropy (FA). Univariate linear regression analyses showed that global physiological and cognitive measures were associated with single (β = 0.594 and β=-0.297, respectively) and dual-task gait speed (β = 0.306 and β=-0.362, respectively). Deep WMHs were associated with dual-task gait speed only (β = 0.257). Multivariate mediational analyses showed that global and executive cognition reduced the strength of the association between deep WMHs and dual-task gait speed by 27% (β = 0.188) and 44% (β = 0.145) respectively. There was a significant linear association between single-task gait speed and mean FA values of the genu (β=-0.295) and splenium (β=-0.326) of the corpus callosum, and between dual-task gait speed and mean FA values of Superior Cerebellar Peduncle (β=-0.284), splenium of the Corpus Callosum (β=-0.286) and Cingulum (β=-0.351). Greater deep WMH volumes are associated with slower walking speed under dual-task conditions, and this relationship is mediated in part by global cognition and executive abilities specifically. Furthermore, both cerebellum and cingulum are related to dual-task walking due to their role in motor skill performance and attention, respectively.