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Balance, Gait, and Falls Prevention

Works Count: 45450

Wikipedia

Description

This cluster of papers focuses on gait analysis, fall risk assessment, and interventions for fall prevention in the elderly population. It covers topics such as gait speed, balance control, physical performance measures, and the impact of various factors on fall risk, including age-related changes, neurological conditions like Parkinson's disease, and muscle strength. The cluster also addresses the reliability and validity of assessment tools and the effectiveness of exercise programs for reducing fall incidence.

Keywords

Gait Speed; Fall Risk; Elderly; Balance Control; Falls Prevention; Physical Performance; Parkinson's Disease; Postural Stability; Timed Up & Go Test; Muscle Strength

Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons

2011-01-01

The following article is a summary of the American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons (2010). This article provides additional discussion of … The following article is a summary of the American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons (2010). This article provides additional discussion of the guideline process and the differences between the current guideline and the 2001 version and includes the guidelines' recommendations, algorithm, and acknowledgments. The complete guideline is published on the American Geriatrics Society's Web site (http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010/).

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Measuring balance in the elderly: validation of an instrument.

1992-07-01

Katherine Berg , Sharon Wood-Dauphinée , Jack I. Williams +1 more

This study assessed the validity of the Balance Scale by examining: how Scale scores related to clinical judgements and self-perceptions of balance, laboratory measures of postural sway and external criteria … This study assessed the validity of the Balance Scale by examining: how Scale scores related to clinical judgements and self-perceptions of balance, laboratory measures of postural sway and external criteria reflecting balancing ability; if scores could predict falls in the elderly; and how they related to motor and functional performance in stroke patients. Elderly residents (N = 113) were assessed for functional performance and balance regularly over a nine-month period. Occurrence of falls was monitored for a year. Acute stroke patients (N = 70) were periodically rated for functional independence, motor performance and balance for over three months. Thirty-one elderly subjects were assessed by clinical and laboratory indicators reflecting balancing ability. The Scale correlated moderately with caregiver ratings, self-ratings and laboratory measures of sway. Differences in mean Scale scores were consistent with the use of mobility aids by elderly residents and differentiated stroke patients by location of follow-up. Balance scores predicted the occurrence of multiple falls among elderly residents and were strongly correlated with functional and motor performance in stroke patients.

The biomechanics and motor control of human gait : normal, elderly and pathological

1991-01-01

David A. Winter

Clinical and laboratory measures of postural balance in an elderly population.

1992-11-01

Katherine Berg , Brian E. Maki , Jack I. Williams +2 more

Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus

2005-09-01

Sarah E Lamb , Ellen C. Jørstad‐Stein , Klaus Hauer +1 more

The prevention of injury associated with falls in older people is a public health target in many countries around the world. Although there is good evidence that interventions such as … The prevention of injury associated with falls in older people is a public health target in many countries around the world. Although there is good evidence that interventions such as multifactorial fall prevention and individually prescribed exercise are effective in reducing falls, the effect on serious injury rates is unclear.1,2 Historically, trials have not been adequately powered to detect injury endpoints, and variations in case definition across trials have hindered meta-analysis.1 It is possible that fall-prevention strategies have limited effect on falls that result in injuries or are ineffective in populations who are at a higher risk of injury. Further research is required to determine whether fall-prevention interventions can reduce serious injuries. Prevention of Falls Network Europe (ProFaNE) is a collaborative project to reduce the burden of fall injury in older people through excellence in research and promotion of best practice (http://www.profane.eu.org). The European Commission funds the network, which links clinicians, members of the public, and researchers worldwide. The aims are to identify major gaps in knowledge in fall injury prevention and to facilitate the collaboration necessary for large-scale clinical research activity, including clinical trials, comparative research, and prospective meta-analysis. Work is being undertaken in a 4-year program. As a first step, the development of a common set of outcome definitions and measures for future trials or meta-analysis was considered.

Stiffness Control of Balance in Quiet Standing

1998-09-01

David A. Winter , Aftab E. Patla , François Prince +2 more

Our goal was to provide some insights into how the CNS controls and maintains an upright standing posture, which is an integral part of activities of daily living. Although researchers … Our goal was to provide some insights into how the CNS controls and maintains an upright standing posture, which is an integral part of activities of daily living. Although researchers have used simple performance measures of maintenance of this posture quite effectively in clinical decision making, the mechanisms and control principles involved have not been clear. We propose a relatively simple control scheme for regulation of upright posture that provides almost instantaneous corrective response and reduces the operating demands on the CNS. The analytic model is derived and experimentally validated. A stiffness model was developed for quiet standing. The model assumes that muscles act as springs to cause the center-of-pressure (COP) to move in phase with the center-of-mass (COM) as the body sways about some desired position. In the sagittal plane this stiffness control exists at the ankle plantarflexors, in the frontal plane by the hip abductors/adductors. On the basis of observations that the COP-COM error signal continuously oscillates, it is evident that the inverted pendulum model is severely underdamped, approaching the undamped condition. The spectrum of this error signal is seen to match that of a tuned mass, spring, damper system, and a curve fit of this "tuned circuit" yields omega n the undamped natural frequency of the system. The effective stiffness of the system, Ke, is then estimated from Ke = I omega n2, and the damping B is estimated from B = BW X I, where BW is the bandwidth of the tuned response (in rad/s), and I is the moment of inertia of the body about the ankle joint. Ten adult subjects were assessed while standing quietly at three stance widths: 50% hip-to-hip distance, 100 and 150%. Subjects stood for 2 min in each position with eyes open; the 100% stance width was repeated with eyes closed. In all trials and in both planes, the COP oscillated virtually in phase (within 6 ms) with COM, which was predicted by a simple 0th order spring model. Sway amplitude decreased as stance width increased, and Ke increased with stance width. A stiffness model would predict sway to vary as Ke-0.5. The experimental results were close to this prediction: sway was proportional to Ke(-0.55). Reactive control of balance was not evident for several reasons. The visual system does not appear to contribute because no significant difference between eyes open and eyes closed results was found at 100% stance width. Vestibular (otolith) and joint proprioceptive reactive control were discounted because the necessary head accelerations, joint displacements, and velocities were well below reported thresholds. Besides, any reactive control would predict that COP would considerably lag (150-250 ms) behind the COM. Because the average COP was only 4 ms delayed behind the COM, reactive control was not evident; this small delay was accounted for by the damping in the tuned mechanical system.

Gait Changes in Older Adults: Predictors of Falls or Indicators of Fear?

1997-03-01

Brian E. Maki

OBJECTIVE : To determine, in a cohort of ambulatory older adults, whether spatial‐temporal measures of foot placement during gait can predict the likelihood of future falls or whether these measures … OBJECTIVE : To determine, in a cohort of ambulatory older adults, whether spatial‐temporal measures of foot placement during gait can predict the likelihood of future falls or whether these measures are more likely to be indicative of adaptations associated with pre‐existing fear of falling. DESIGN : Prospective cohort study. SETTING : Baseline gait measurements were performed in a gait and balance laboratory; subsequent history of falling was monitored prospectively for 1 year in two self‐care facilities. PARTICIPANTS : Fourteen male and 61 female consecutive volunteers (mean age = 82, SD = 6) who were independent in activities of daily living and able to walk 10 m unaided. MEASUREMENTS : Spatial gait parameters were derived from digitized “footprints”; temporal parameters were derived using footswitches. A clinical activity‐based gait assessment was also performed. The dependent variables were pre‐existing fear of falling (reported at baseline) and future falling (experiencing one or more falls during the 1‐year follow‐up). MAIN RESULTS : Reduced stride length, reduced speed, increased double‐support time, and poorer clinical gait scores were associated with fear but showed little evidence of an independent association with falling. Conversely, increased stride‐to‐stride variability in stride length, speed, and double‐support was associated independently with falling but showed little evidence of relationship to fear. Increased stride width showed some evidence of association with both falling and fear. Stride‐to‐stride variability in speed was the single best independent predictor of falling. CONCLUSIONS : Changes in gait cited previously as risk factors for falling, i.e., decreased stride length and speed and prolonged double support, may in fact be stabilizing adaptations related to fear of falling. Stride‐to‐stride variability in the control of gait is an independent predictor of falling and may be a useful measure for identifying high‐risk individuals and evaluating preventive interventions. Stride width may also be a useful outcome measure. Contrary to common expectation, a wider stride does not necessarily increase stability but instead seems to predict an increased likelihood of experiencing falls.

The role of executive function and attention in gait

2007-12-03

Galit Yogev‐Seligmann , Jeffrey M. Hausdorff , Nir Giladi

Abstract Until recently, gait was generally viewed as a largely automated motor task, requiring minimal higher‐level cognitive input. Increasing evidence, however, links alterations in executive function and attention to gait … Abstract Until recently, gait was generally viewed as a largely automated motor task, requiring minimal higher‐level cognitive input. Increasing evidence, however, links alterations in executive function and attention to gait disturbances. This review discusses the role of executive function and attention in healthy walking and gait disorders while summarizing the relevant, recent literature. We describe the variety of gait disorders that may be associated with different aspects of executive function, and discuss the changes occurring in executive function as a result of aging and disease as well the potential impact of these changes on gait. The attentional demands of gait are often tested using dual tasking methodologies. Relevant studies in healthy adults and patients are presented, as are the possible mechanisms responsible for the deterioration of gait during dual tasking. Lastly, we suggest how assessments of executive function and attention could be applied in the clinical setting as part of the process of identifying and understanding gait disorders and fall risk. © 2007 Movement Disorder Society

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The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons

1991-02-01

Diane Podsiadlo , Sandra Richardson

This study evaluated a modified, timed version of the "Get-Up and Go" Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). … This study evaluated a modified, timed version of the "Get-Up and Go" Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. The results indicate that the time score is (1) reliable (inter-rater and intra-rater); (2) correlates well with log-transformed scores on the Berg Balance Scale (r = -0.81), gait speed (r = -0.61) and Barthel Index of ADL (r = -0.78); and (3) appears to predict the patient's ability to go outside alone safely. These data suggest that the timed "Up & Go" test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.

A 30-s Chair-Stand Test as a Measure of Lower Body Strength in Community-Residing Older Adults

1999-06-01

C. Jessie Jones , Roberta E. Rikli , William Beam

Measuring lower body strength is critical in evaluating the functional performance of older adults. The purpose of this study was to assess the test-retest reliability and the criterion-related and construct … Measuring lower body strength is critical in evaluating the functional performance of older adults. The purpose of this study was to assess the test-retest reliability and the criterion-related and construct validity of a 30-s chair stand as a measure of lower body strength in adults over the age of 60 years. Seventy-six community-dwelling older adults (M age = 70.5 years) volunteered to participate in the study, which involved performing two 30-s chair-stand tests and two maximum leg-press tests, each conducted on separate days 2-5 days apart. Test-retest intraclass correlations of .84 for men and .92 for women, utilizing one-way analysis of variance procedures appropriate for a single trial, together with a nonsignificant change in scores from Day 1 testing to Day 2, indicate that the 30-s chair stand has good stability reliability. A moderately high correlation between chair-stand performance and maximum weight-adjusted leg-press performance for both men and women (r = .78 and .71, respectively) supports the criterion-related validity of the chair stand as a measure of lower body strength. Construct (or discriminant) validity of the chair stand was demonstrated by the test's ability to detect differences between various age and physical activity level groups. As expected, chair-stand performance decreased significantly across age groups in decades--from the 60s to the 70s to the 80s (p < .01) and was significantly lower for low-active participants than for high-active participants (p < .0001). It was concluded that the 30-s chair stand provides a reasonably reliable and valid indicator of lower body strength in generally active, community-dwelling older adults.

White Paper: “Walking Speed: the Sixth Vital Sign”

2009-01-01

Stacy L. Fritz , Michelle M. Lusardi

Walking speed is "almost the perfect measure."1 A reliable, valid,2,3 sensitive4 and specific5 measure, self-selected walking speed (WS), also termed gait velocity, correlates with functional ability,6 and balance confidence.7 It … Walking speed is "almost the perfect measure."1 A reliable, valid,2,3 sensitive4 and specific5 measure, self-selected walking speed (WS), also termed gait velocity, correlates with functional ability,6 and balance confidence.7 It has the potential to predict future health status,8,9 and functional decline10 including hospitalization,11 discharge location,12,13 and mortality.14 Walking speed reflects both functional and physiological changes,6 is a discriminating factor in determining potential for rehabilitation,15 and aids in prediction of falls16 and fear of falling.17 Furthermore, progression of WS has been linked to clinical meaningful changes in quality of life18 and in home and community walking behavior.19 Due to its ease of use20 and psychometric properties, WS has been used as a predictor and outcome measure across multiple diagnoses.8,9,19,21–26 In addition, WS was chosen by a panel of experts as the standardized assessment to measure locomotion for the Motor Function Domain of the NIH Toolbox.27 Walking speed, like blood pressure, may be a general indicator that can predict future events and reflect various underlying physiological processes.8 While WS cannot stand alone as the only predictor of functional abilities, just at blood pressure is not the only sign of heart disease; WS can be used as a functional "vital sign" to help determine outcomes such as functional status,6,8 discharge location,12 and the need for rehabilitation11 (Figure 1).Figure 1. A collection of walking speed times that are linked to dependence, hospitalization, rehabilitation needs, discharge locations, and ambulation category.Walking is a complex functional activity; thus, many variables contribute to or influence WS. These include, but are not limited to, an individual's health status,28 motor control,29 muscle performance and musculoskeletal condition,30,31 sensory and perceptual function,32 endurance and habitual activity level,33 cognitive status,34 motivation and mental health,35,36 as well as the characteristics of the environment in which one walks.37 While performance measures used in conjunction with WS are often better able to predict health status,28 the use of WS alone can be an excellent predictor.11,20 For example, WS predicts the post hospital discharge location 78% of the time, and the addition of cognition or initial FIM scores does not significantly strengthen the ability of defining if a patient will be discharged to home or to a skilled nursing facility.12 Several standardized assessments and physical performance tests reliably predict function and health related events. Yet the consistent use of measures in physical therapy and other clinical settings is not widely practiced.38 Factors contributing to this non-use of standardized assessments may include insufficient time, inadequate equipment or space, or lack of knowledge in interpreting the assessment.39 Walking speed is one standardized measure that can be quickly and easily incorporated into the PT examination/evaluation process. Determining feasibility is the first essential step in deciding to use a test or measure in the clinic. The main questions clinicians should pose regarding a test's or measure's feasibility are: Is the test safe? Is it cost effective? How easy is the test to administer? and How easily are the results of the test graded and interpreted? An affirmative answer to all these questions, as there is with WS, lends to feasibility of use in a clinical setting. Walking speed is safe, requires no special equipment, adds no significant cost to an assessment, requires little additional time (can be administered in less than 2 minutes8), is easy to calculate (distance/time), and is easy to interpret based on published norms3,40–42 (Figure 2).Figure 2. Self selected walking speed categorized by gender and age (6–12 and teens,: 47 20s-50s, 42 & 60s-80s 48 .Walking speed can be quickly and accurately assessed in the majority of physical therapy practice settings, including home care, subacute and acute rehabilitation facilities, long-term care facilities, out-patient offices, and schools, as well as during community wellness/screening activities.43 Measurements of walking speed are highly reliable, regardless of the method for measurement, for different patient populations and for individuals with known impairments affecting gait.3,42 Examination of WS requires a stopwatch and as little as a 20 foot space to walk forward.3 While most reported normative values are based on measuring in the middle two-thirds of a longer walkway, allowing walking speed to reach a steady state, others have used shorter distances.44,45 If possible, timing WS three times during the examination (with a few minutes of rest between trials) and developing a mean WS value will provide a more accurate estimate of actual self-selected walking speed than a single trial would.3,41,43 Figure 3 displays a suggested reliable, inexpensive method to collect WS by using the 10 meter (m) walk test.25 It requires a 20 m straight path, with 5 m for acceleration, 10 m for steady-state walking, and 5 m for deceleration. Markers are placed at the 5 and 15 m positions along the path. The patient begins to walk "at a comfortable pace" at one end of the path, and continues walking until he or she reaches the other end. The Physical Therapist uses a stopwatch to determine how much time it takes for the patient to traverse the 10 m center of the path, starting the stopwatch as soon as the patient's limb crosses the first marker and stopping the stopwatch as soon as the patient's limb crosses the second marker. If a full 20 m walkway is not available, shorter distances can be used, as long as there is adequate room for acceleration and deceleration (eg, 5 ft acceleration, 10 ft. steady state, 5 ft. deceleration).Figure 3. Suggested methods for collecting 10 meter walk test times.While WS varies by age, gender, and anthropometrics, the range for normal WS is 1.2–1.4m/sec.46 This general guideline can help in monitoring our patients, along with norms by age42,47,48 (Figure 2), and other cited cutoff points6,8,11,12,46 (Figure 1). Interpretation of WS also includes understating what constitutes true change and what change may be due to measurement error.49 In a recent study, with a diverse group of older participants with varying diagnoses, 0.05 m/s was calculated as the needed change for a small but meaningful improvement in WS.25 In addition, for patients who do not have normal walking speed, an improvement in WS of at least 0.1 m/s is a useful predictor for well-being,9,14 while a decrease in the same amount is linked with poorer health status, more disability, longer hospital stays, and increased medical costs.9 The MDC scores are specific to the population and will vary according to your client's presentation.26,50 Walking speed is an easily accessible screening tool11 that should be performed to offer insight into our patients functional capacity and safety. Physical therapists, as specialists in movement and function, can use WS as a practical and informative functional sixth "vital sign" for all patients; examining walking speed in the same way that we routinely monitor blood pressure, pulse, respiration, temperature, and pain.51 This sixth "vital sign" provides a relevant functional perspective to the health status provided by the system-level vital signs assessed on most visits to physicians' offices. This review summarizes the strong psychometric properties of WS and robust evidence for using this clinical measurement. Walking speed is easily measurable, clinically interpretable,14 and a potentially modifiable risk factor.52 For these reasons, using WS as the sixth vital sign is both pragmatic and essential.

The condition for dynamic stability

2004-07-23

At L. Hof , Marnix G.J. Gazendam , W.E. Sinke

Preventing Falls in Elderly Persons

2003-01-01

Mary E. Tinetti

A 79-year-old woman with a history of congestive heart failure, arthritis, depression, and difficulty sleeping presents for a follow-up visit. She takes several prescription medications, including an antidepressant, a diuretic, … A 79-year-old woman with a history of congestive heart failure, arthritis, depression, and difficulty sleeping presents for a follow-up visit. She takes several prescription medications, including an antidepressant, a diuretic, an angiotensin-converting–enzyme inhibitor, and a beta-blocker, as well as over-the-counter sleep and allergy medications. Her chronic conditions appear to be stable. Her daughter reports that the patient has fallen twice during the past six months. What can be done to prevent future falls?

Guideline for the Prevention of Falls in Older Persons

2001-05-01

American Geriatrics Society , Geriatrics Society , American Academy Of +1 more

A Prospective Study of Postural Balance and Risk of Falling in An Ambulatory and Independent Elderly Population

1994-03-01

Brian E. Maki , P. J. Holliday , ANNE TOPPER

An ability to predict risk of future falling is needed in order to target high-risk individuals for preventive intervention. The purpose of this study was to compare the ability of … An ability to predict risk of future falling is needed in order to target high-risk individuals for preventive intervention. The purpose of this study was to compare the ability of different measures of postural balance to predict risk of falling prospectively in an ambulatory and independent elderly population. Balance tests were performed on 100 volunteers (aged 62–96), and falling was then monitored prospectively over a one-year period. The balance testing comprised measurements of: (a) spontaneous postural sway, (b) induced anterior-posterior sway, (c) induced medial-lateral sway, (d) anticipatory adjustments preceding volitional arm movements, (e) timed one-leg stance, and (f) performance on a clinical balance assessment scale. Small pseudorandom platform motions were used to perturb balance in the induced-sway tests. Using force plates, the spontaneous- and induced-sway responses were quantified in terms of the amplitude, speed, and mean frequency of the center-of-pressure displacement; input-output models were also used to parameterize the induced-sway performance. Although a number of measures showed evidence of significant differences between fallers and nonfallers, the differences were most pronounced for measures related to the control of lateral stability. Lateral spontaneous-sway amplitude (blindfolded conditions) was found to be the single best predictor of future falling risk, particularly for the large group of falls that were precipitated by a biomechanical perturbation. This measure was able to predict future falling risk with moderate accuracy, even in those individuals with no recent history of falling. The results suggest that control of lateral stability may be an important area for fall-preventative intervention. The ability of a simple and safe force-plate measure of spontaneous postural sway to predict future falling risk suggests a possible clinical application as a preliminary screening tool for risk of falling

Risk Factors for Falls in Community-dwelling Older People

2010-06-26

Silvia Deandrea , Ersilia Lucenteforte , Francesca Bravi +3 more

Background: Falls are the main cause of accidental death in persons aged 65 years or older. Methods: Using MEDLINE and previous reviews, we searched for prospective studies investigating risk factors … Background: Falls are the main cause of accidental death in persons aged 65 years or older. Methods: Using MEDLINE and previous reviews, we searched for prospective studies investigating risk factors for falls among community-dwelling older people. For risk factors investigated by at least 5 studies in a comparable way, we computed pooled odds ratios (ORs) using random-effects models, with a test for heterogeneity. Results: A total of 74 studies met the inclusion criteria and 31 risk factors were considered, including sociodemographic, mobility, sensory, psychologic, and medical factors and medication use. The strongest associations were found for history of falls (OR = 2.8 for all fallers; OR = 3.5 for recurrent fallers), gait problems (OR = 2.1; 2.2), walking aids use (OR = 2.2; 3.1), vertigo (OR = 1.8; 2.3), Parkinson disease (OR = 2.7; 2.8), and antiepileptic drug use (OR = 1.9; 2.7). For most other factors, the ORs were moderately above 1. ORs were generally higher for recurrent fallers than for all fallers. For some factors, there was substantial heterogeneity among studies. For some important factors (eg, balance and muscle weakness), we did not compute a summary estimate because the measures used in various studies were not comparable. Conclusions: This meta-analysis provides comprehensive evidence-based assessment of risk factors for falls in older people, confirming their multifactorial etiology. Some nonspecific indicators of high baseline risk were also strong predictors of the risk of falling.

Human balance and posture control during standing and walking

1995-12-01

DA Winter

Gait variability and fall risk in community-living older adults: A 1-year prospective study

2001-08-01

Jeffrey M. Hausdorff , Dean A. Rios , Helen K. Edelberg

Risk Factors for Falls in a Community-Based Prospective Study of People 70 Years and Older

1989-07-01

A. J. Campbell , Michael Borrie , G. F. S. Spears

We investigated factors associated with falls in a community-based prospective study of 761 subjects 70 years and older. The group experienced 507 falls during the year of monitoring. On entry … We investigated factors associated with falls in a community-based prospective study of 761 subjects 70 years and older. The group experienced 507 falls during the year of monitoring. On entry to the study a number of variables had been assessed in each subject. Variables associated with an increased risk of falling differed in men and women. In men, decreased levels of physical activity, stroke, arthritis of the knees, impairment of gait, and increased body sway were associated with an increased risk of falls. In women, the total number of drugs, psychotropic drugs and drugs liable to cause postural hypotension, standing systolic blood pressure of less than 110 mmHg, and evidence of muscle weakness were also associated with an increased risk of falling. Most falls in elderly people are associated with multiple risk factors, many of which are potentially remediable. The possible implications of this in diagnosis and prevention are discussed.

Risk factors for falls among older adults: A review of the literature

2013-03-22

Anne Felicia Ambrose , Geet Paul , Jeffrey M. Hausdorff

Fall risk index for elderly patients based on number of chronic disabilities

1986-03-01

Mary E. Tinetti , T. Franklin Williams , Raymond J. Mayewski

A Short Physical Performance Battery Assessing Lower Extremity Function: Association With Self-Reported Disability and Prediction of Mortality and Nursing Home Admission

1994-03-01

Jack M. Guralnik , E. M. Simonsick , Luigi Ferrucci +5 more

Journal Article A Short Physical Performance Battery Assessing Lower Extremity Function: Association With Self-Reported Disability and Prediction of Mortality and Nursing Home Admission Get access Jack M. Guralnik, Jack M. … Journal Article A Short Physical Performance Battery Assessing Lower Extremity Function: Association With Self-Reported Disability and Prediction of Mortality and Nursing Home Admission Get access Jack M. Guralnik, Jack M. Guralnik 1Epidemiology, Demography, and Biometry Program, National Institutes on Aging, National Institutes of Health, BethesdaMaryland Search for other works by this author on: Oxford Academic PubMed Google Scholar Eleanor M. Simonsick, Eleanor M. Simonsick 1Epidemiology, Demography, and Biometry Program, National Institutes on Aging, National Institutes of Health, BethesdaMaryland Search for other works by this author on: Oxford Academic PubMed Google Scholar Luigi Ferrucci, Luigi Ferrucci 2Geriatric Department, Hospital I Fraticini, INRCAFlorence, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar Robert J. Glynn, Robert J. Glynn 3Channing Laboratory, Department of Medicine, Harvard Medical School Search for other works by this author on: Oxford Academic PubMed Google Scholar Lisa F. Berkman, Lisa F. Berkman 4Department of Epidemiology, Yale University School of Medicine Search for other works by this author on: Oxford Academic PubMed Google Scholar Dan G. Blazer, Dan G. Blazer 5Department of Psychiatry, Duke University School of Medicine Search for other works by this author on: Oxford Academic PubMed Google Scholar Paul A. Scherr, Paul A. Scherr 6Aging Studies Branch, National Centers for Disease Prevention and Health Promotion, Centers for Disease ControlAtlanta, Georgia Search for other works by this author on: Oxford Academic PubMed Google Scholar Robert B. Wallace Robert B. Wallace 7Department of Preventive Medicine and Environmental Health, University of Iowa Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Gerontology, Volume 49, Issue 2, March 1994, Pages M85–M94, https://doi.org/10.1093/geronj/49.2.M85 Published: 01 March 1994 Article history Accepted: 17 June 1993 Received: 03 August 1993 Published: 01 March 1994

Development and initial validation of the Falls Efficacy Scale-International (FES-I)

2005-11-01

Lucy Yardley , Nina Beyer , Klaus Hauer +3 more

Background: there is a need for a measure of fear of falling that assesses both easy and difficult physical activities and social activities and is suitable for use in a … Background: there is a need for a measure of fear of falling that assesses both easy and difficult physical activities and social activities and is suitable for use in a range of languages and cultural contexts, permitting direct comparison between studies and populations in different countries and settings.

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Interventions for preventing falls in older people living in the community

2012-09-04

Lesley D Gillespie , M. Clare Robertson , William J. Gillespie +4 more

Falls in older people: epidemiology, risk factors and strategies for prevention

2006-08-22

Laurence Z. Rubenstein

Falls are a common and often devastating problem among older people, causing a tremendous amount of morbidity, mortality and use of health care services including premature nursing home admissions. Most … Falls are a common and often devastating problem among older people, causing a tremendous amount of morbidity, mortality and use of health care services including premature nursing home admissions. Most of these falls are associated with one or more identifiable risk factors (e.g. weakness, unsteady gait, confusion and certain medications), and research has shown that attention to these risk factors can significantly reduce rates of falling. Considerable evidence now documents that the most effective (and cost-effective) fall reduction programmes have involved systematic fall risk assessment and targeted interventions, exercise programmes and environmental-inspection and hazard-reduction programmes. These findings have been substantiated by careful meta-analysis of large numbers of controlled clinical trials and by consensus panels of experts who have developed evidence-based practice guidelines for fall prevention and management. Medical assessment of fall risks and provision of appropriate interventions are challenging because of the complex nature of falls. Optimal approaches involve interdisciplinary collaboration in assessment and interventions, particularly exercise, attention to co-existing medical conditions and environmental inspection and hazard abatement.

Falls Efficacy as a Measure of Fear of Falling

1990-11-01

Mary E. Tinetti , David M. Richman , Leah Powell

We developed the Falls Efficacy Scale (FES), an instrument to measure fear of falling, based on the operational definition of this fear as “low perceived self-efficacy at avoiding falls during … We developed the Falls Efficacy Scale (FES), an instrument to measure fear of falling, based on the operational definition of this fear as “low perceived self-efficacy at avoiding falls during essential, nonhazardous activities of daily living.” The reliability and validity of the FES were assessed in two samples of community-living elderly persons. The FES showed good test-retest reliability (Pearson's correlation 0.71). Subjects who reported avoiding activities because of fear of falling had higher FES scores, representing lower self-efficacy or confidence, than subjects not reporting fear of falling. The independent predictors of FES score were usual walking pace (a measure of physical ability), anxiety, and depression. The FES appears to be a reliable and valid method for measuring fear of falling. This instrument may be useful in assessing the independent contribution of fear of falling to functional decline among elderly people.

Age- and Gender-Related Test Performance in Community-Dwelling Elderly People: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and Gait Speeds

2002-02-01

Teresa M Steffen , Timothy A. Hacker , L A Mollinger

Abstract Background and Purpose. The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without … Abstract Background and Purpose. The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities. The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults. Subjects. Ninety-six community-dwelling elderly people (61–89 years of age) with independent functioning performed 4 clinical tests. Methods. Data were collected on the Six-Minute Walk Test (6MW), Berg Balance Scale (BBS), and Timed Up & Go Test (TUG) and during comfortable- and fast-speed walking (CGS and FGS). Intraclass correlation coefficients (ICCs) were used to determine the test-retest reliability for the 6MW, TUG, CGS, and FGS measurements. Data were analyzed by gender and age (60–69, 70–79, and 80–89 years) cohorts, similar to previous studies. Means, standard deviations, and 95% confidence intervals for each measurement were calculated for each cohort. Results. The 6MW, TUG, CGS, and FGS measurements showed high test-retest reliability (ICC [2,1]=.95–.97). Mean test scores showed a trend of age-related declines for the 6MW, BBS, TUG, CGS, and FGS for both male and female subjects. Discussion and Conclusion. Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW, BBS, TUG, CGS and FGS. Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons.

Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?

2006-08-22

Fay B. Horak

Postural control is no longer considered simply a summation of static reflexes but, rather, a complex skill based on the interaction of dynamic sensorimotor processes. The two main functional goals … Postural control is no longer considered simply a summation of static reflexes but, rather, a complex skill based on the interaction of dynamic sensorimotor processes. The two main functional goals of postural behaviour are postural orientation and postural equilibrium. Postural orientation involves the active alignment of the trunk and head with respect to gravity, support surfaces, the visual surround and internal references. Sensory information from somatosensory, vestibular and visual systems is integrated, and the relative weights placed on each of these inputs are dependent on the goals of the movement task and the environmental context. Postural equilibrium involves the coordination of movement strategies to stabilise the centre of body mass during both self-initiated and externally triggered disturbances of stability. The specific response strategy selected depends not only on the characteristics of the external postural displacement but also on the individual's expectations, goals and prior experience. Anticipatory postural adjustments, prior to voluntary limb movement, serve to maintain postural stability by compensating for destabilising forces associated with moving a limb. The amount of cognitive processing required for postural control depends both on the complexity of the postural task and on the capability of the subject's postural control system. The control of posture involves many different underlying physiological systems that can be affected by pathology or sub-clinical constraints. Damage to any of the underlying systems will result in different, context-specific instabilities. The effective rehabilitation of balance to improve mobility and to prevent falls requires a better understanding of the multiple mechanisms underlying postural control.

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Predicting the Probability for Falls in Community-Dwelling Older Adults

1997-08-01

Anne Shumway‐Cook , Margaret Baldwin , Nayak L. Polissar +1 more

Background and Purpose. The objective of this retrospective case-control study was to develop a model for predicting the likelihood of falls among community-dwelling older adults. Subjects. Forty-four community-dwelling adults (≥65 … Background and Purpose. The objective of this retrospective case-control study was to develop a model for predicting the likelihood of falls among community-dwelling older adults. Subjects. Forty-four community-dwelling adults (≥65 years of age) with and without a history of falls participated. Methods. Subjects completed a health status questionnaire and underwent a clinical evaluation of balance and mobility function. Variables that differed between fallers and nonfallers were identified, using t tests and cross tabulation with chi-square tests. A forward stepwise regression analysis was carried out to identify a combination of variables that effectively predicted fall status. Results. Five variables were found to be associated with fall history. These variables were analyzed using logistic regression. The final model combined the score on the Berg Balance Scale with a self-reported history of imbalance to predict fall risk. Sensitivity was 91%, and specificity was 82%. Conclusion and Discussion. A simple predictive model based on two risk factors can be used by physical therapists to quantify fall risk in community-dwelling older adults. Identification of patients with a high fall risk can lead to an appropriate referral into a fall prevention program. In addition, fall risk can be used to calculate change resulting from intervention.

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Functional Reach: A New Clinical Measure of Balance

1990-11-01

Pamela W. Duncan , D. Weiner , Julie Chandler +1 more

A new clinically accessible measure of balance, functional reach (FR), is the difference between arm's length and maximal forward reach, using a fixed base of support. The purposes of this … A new clinically accessible measure of balance, functional reach (FR), is the difference between arm's length and maximal forward reach, using a fixed base of support. The purposes of this study were to (a) establish FR as a measure of the margin of stability versus the laboratory measure, center of pressure excursion (COPE); (b) test reliability and precision, and (c) determine factors that influence FR, including age and anthropometrics. We evaluated FR in 128 volunteers (age 21-87 years). FR was determined with a precise electronic device and a simple clinical apparatus (yardstick). FR correlates with COPE (Pearson r = .71) and is precise (coefficient of variation = 2.5%) and stable (intraclass correlation coefficient across days = .81). Age and height influence FR. FR is portable, inexpensive, reliable, precise, and a reasonable clinical approximator of the margin of stability. FR may be useful for detecting balance impairment, change in balance performance over time, and in the design of modified environments for impaired older persons.

Predicting the Probability for Falls in Community-Dwelling Older Adults Using the Timed Up & Go Test

2000-09-01

Anne Shumway‐Cook , Sandra Brauer , Marjorie Woollacott

Abstract Background and Purpose. This study examined the sensitivity and specificity of the Timed Up & Go Test (TUG) under single-task versus dual-task conditions for identifying elderly individuals who are … Abstract Background and Purpose. This study examined the sensitivity and specificity of the Timed Up & Go Test (TUG) under single-task versus dual-task conditions for identifying elderly individuals who are prone to falling. Subjects. Fifteen older adults with no history of falls (mean age=78 years, SD=6, range=65–85) and 15 older adults with a history of 2 or more falls in the previous 6 months (mean age=86.2 years, SD=6, range=76–95) participated. Methods. Time taken to complete the TUG under 3 conditions (TUG, TUG with a subtraction task [TUGcognitive], and TUG while carrying a full cup of water [TUGmanual]) was measured. A multivariate analysis of variance and discriminant function and logistic regression analyses were performed. Results. The TUG was found to be a sensitive (sensitivity=87%) and specific (specificity=87%) measure for identifying elderly individuals who are prone to falls. For both groups of older adults, simultaneous performance of an additional task increased the time taken to complete the TUG, with the greatest effect in the older adults with a history of falls. The TUG scores with or without an additional task (cognitive or manual) were equivalent with respect to identifying fallers and nonfallers. Conclusions and Discussion. The results suggest that the TUG is a sensitive and specific measure for identifying community-dwelling adults who are at risk for falls. The ability to predict falls is not enhanced by adding a secondary task when performing the TUG.

Lower Extremity Function and Subsequent Disability: Consistency Across Studies, Predictive Models, and Value of Gait Speed Alone Compared With the Short Physical Performance Battery

2000-04-01

Jack M. Guralnik , Luigi Ferrucci , Carl F. Pieper +6 more

Background. Although it has been demonstrated that physical performance measures predict incident disability in previously nondisabled older persons, the available data have not been fully developed to create usable methods … Background. Although it has been demonstrated that physical performance measures predict incident disability in previously nondisabled older persons, the available data have not been fully developed to create usable methods for determining risk profiles in community-dwelling populations. Using several populations and different follow-up periods, this study replicates previous findings by using the Established Populations for the Epidemiologic Study of the Elderly (EPESE) performance battery and provides equations for the prediction of disability risk according to age, sex, and level of performance.

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Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons

2008-01-01

Alice C. Scheffer , Marieke J. Schuurmans , Nynke van Dijk +2 more

Background fear of falling (FOF) is a major health problem among the elderly living in communities, present in older people who have fallen but also in older people who have … Background fear of falling (FOF) is a major health problem among the elderly living in communities, present in older people who have fallen but also in older people who have never experienced a fall. The aims of this study were 4-fold: first, to study methods to measure FOF; second, to study the prevalence of FOF among fallers and non-fallers; third, to identify factors related to FOF; and last, to investigate the relationship between FOF and possible consequences among community-dwelling older persons.

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Risk Factors for Falls among Elderly Persons Living in the Community

1988-12-29

Mary E. Tinetti , Mark Speechley , Sandra Ginter

To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. … To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P<0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling. (N Engl J Med 1988; 319:1701–7.)

Central programming of postural movements: adaptation to altered support-surface configurations

1986-06-01

Fay B. Horak , Lewis M. Nashner

We studied the extent to which automatic postural actions in standing human subjects are organized by a limited repertoire of central motor programs. Subjects stood on support surfaces of various … We studied the extent to which automatic postural actions in standing human subjects are organized by a limited repertoire of central motor programs. Subjects stood on support surfaces of various lengths, which forced them to adopt different postural movement strategies to compensate for the same external perturbations. We assessed whether a continuum or a limited set of muscle activation patterns was used to produce different movement patterns and the extent to which movement patterns were influenced by prior experience. Exposing subjects standing on a normal support surface to brief forward and backward horizontal surface perturbations elicited relatively stereotyped patterns of leg and trunk muscle activation with 73- to 110-ms latencies. Activity began in the ankle joint muscles and then radiated in sequence to thigh and then trunk muscles on the same dorsal or ventral aspect of the body. This activation pattern exerted compensatory torques about the ankle joints, which restored equilibrium by moving the body center of mass forward or backward. This pattern has been termed the ankle strategy because it restores equilibrium by moving the body primarily around the ankle joints. To successfully maintain balance while standing on a support surface short in relation to foot length, subjects activated leg and trunk muscles at similar latencies but organized the activity differently. The trunk and thigh muscles antagonistic to those used in the ankle strategy were activated in the opposite proximal-to-distal sequence, whereas the ankle muscles were generally unresponsive. This activation pattern produced a compensatory horizontal shear force against the support surface but little, if any, ankle torque. This pattern has been termed the hip strategy, because the resulting motion is focused primarily about the hip joints. Exposing subjects to horizontal surface perturbations while standing on support surfaces intermediate in length between the shortest and longest elicited more complex postural movements and associated muscle activation patterns that resembled ankle and hip strategies combined in different temporal relations. These complex postural movements were executed with combinations of torque and horizontal shear forces and motions of ankle and hip joints. During the first 5-20 practice trials immediately following changes from one support surface length to another, response latencies were unchanged. The activation patterns, however, were complex and resembled the patterns observed during well-practiced stance on surfaces of intermediate lengths.(ABSTRACT TRUNCATED AT 400 WORDS)

Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study.

2010-08-18

Kim Delbaere , Jacqueline Close , Henry Brodaty +2 more

To gain an understanding of elderly people's fear of falling by exploring the prevalence and determinants of perceived and physiological fall risk and to understand the role of disparities in … To gain an understanding of elderly people's fear of falling by exploring the prevalence and determinants of perceived and physiological fall risk and to understand the role of disparities in perceived and physiological risk in the cause of falls.Prospective cohort study.Community sample drawn from eastern Sydney, Australia.500 men and women aged 70-90 years.Baseline assessment of medical, physiological, and neuropsychological measures, with physiological fall risk estimated with the physiological profile assessment, and perceived fall risk estimated with the falls efficacy scale international. Participants were followed up monthly for falls over one year.Multivariate logistic regression analyses showed that perceived and physiological fall risk were both independent predictors of future falls. Classification tree analysis was used to split the sample into four groups (vigorous, anxious, stoic, and aware) based on the disparity between physiological and perceived risk of falling. Perceived fall risk was congruent with physiological fall risk in the vigorous (144 (29%)) and aware (202 (40%)) groups. The anxious group (54 (11%)) had a low physiological risk but high perceived fall risk, which was related to depressive symptoms (P=0.029), neurotic personality traits (P=0.026), and decreased executive functioning (P=0.010). The stoic group (100 (20%)) had a high physiological risk but low perceived fall risk, which was protective for falling and mediated through a positive outlook on life (P=0.001) and maintained physical activity and community participation (P=0.048).Many elderly people underestimated or overestimated their risk of falling. Such disparities between perceived and physiological fall risk were primarily associated with psychological measures and strongly influenced the probability of falling. Measures of both physiological and perceived fall risk should be included in fall risk assessments to allow tailoring of interventions for preventing falls in elderly people.

Effective Exercise for the Prevention of Falls: A Systematic Review and Meta‐Analysis

2008-10-31

Catherine Sherrington , Julie Whitney , Stephen R. Lord +3 more

To determine the effects of exercise on falls prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated with larger reductions in falls.Systematic … To determine the effects of exercise on falls prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated with larger reductions in falls.Systematic review with meta-analysis. Randomized controlled trials that compared fall rates in older people who undertook exercise programs with fall rates in those who did not exercise were included.Older people.General community and residential care.Fall rates.The pooled estimate of the effect of exercise was that it reduced the rate of falling by 17% (44 trials with 9,603 participants, rate ratio (RR)=0.83, 95% confidence interval (CI)=0.75-0.91, P<.001, I(2)=62%). The greatest relative effects of exercise on fall rates (RR=0.58, 95% CI=0.48-0.69, 68% of between-study variability explained) were seen in programs that included a combination of a higher total dose of exercise (>50 hours over the trial period) and challenging balance exercises (exercises conducted while standing in which people aimed to stand with their feet closer together or on one leg, minimize use of their hands to assist, and practice controlled movements of the center of mass) and did not include a walking program.Exercise can prevent falls in older people. Greater relative effects are seen in programs that include exercises that challenge balance, use a higher dose of exercise, and do not include a walking program. Service providers can use these findings to design and implement exercise programs for falls prevention.

The costs of fatal and non-fatal falls among older adults

2006-10-01

Jennifer A. Stevens , Phaedra S. Corso , Eric Finkelstein +1 more

To estimate the incidence and direct medical costs for fatal and non-fatal fall injuries among US adults aged >or=65 years in 2000, for three treatment settings stratified by age, sex, … To estimate the incidence and direct medical costs for fatal and non-fatal fall injuries among US adults aged >or=65 years in 2000, for three treatment settings stratified by age, sex, body region, and type of injury.Incidence data came from the 2000 National Vital Statistics System, 2001 National Electronic Injury Surveillance System-All Injury Program, 2000 Health Care Utilization Program National Inpatient Sample, and 1999 Medical Expenditure Panel Survey. Costs for fatal falls came from Incidence and economic burden of injuries in the United States; costs for non-fatal falls were based on claims from the 1998 and 1999 Medicare fee-for-service 5% Standard Analytical Files. A case crossover approach was used to compare the monthly costs before and after the fall.In 2000, there were almost 10 300 fatal and 2.6 million medically treated non-fatal fall related injuries. Direct medical costs totaled 0.2 billion dollars for fatal and 19 billion dollars for non-fatal injuries. Of the non-fatal injury costs, 63% (12 billion dollars ) were for hospitalizations, 21% (4 billion dollars) were for emergency department visits, and 16% (3 billion dollars) were for treatment in outpatient settings. Medical expenditures for women, who comprised 58% of the older adult population, were 2-3 times higher than for men for all medical treatment settings. Fractures accounted for just 35% of non-fatal injuries but 61% of costs.Fall related injuries among older adults, especially among older women, are associated with substantial economic costs. Implementing effective intervention strategies could appreciably decrease the incidence and healthcare costs of these injuries.

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Interventions for preventing falls in elderly people

2003-10-20

Lesley D Gillespie , William J. Gillespie , M. Clare Robertson +3 more

Background Approximately 30 per cent of people over 65 years of age and living in the community fall each year; the number is higher in institutions. Although less than one … Background Approximately 30 per cent of people over 65 years of age and living in the community fall each year; the number is higher in institutions. Although less than one fall in 10 results in a fracture, a fifth of fall incidents require medical attention. Objectives To assess the effects of interventions designed to reduce the incidence of falls in elderly people (living in the community, or in institutional or hospital care). Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2003), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to 2003 Week 19), CINAHL (1982 to April 2003), The National Research Register, Issue 2, 2003, Current Controlled Trials (www.controlled‐trials.com accessed 11 July 2003) and reference lists of articles. No language restrictions were applied. Further trials were identified by contact with researchers in the field. Selection criteria Randomised trials of interventions designed to minimise the effect of, or exposure to, risk factors for falling in elderly people. Main outcomes of interest were the number of fallers, or falls. Trials reporting only intermediate outcomes were excluded. Data collection and analysis Two reviewers independently assessed trial quality and extracted data. Data were pooled using the fixed effect model where appropriate. Main results Sixty two trials involving 21,668 people were included. Interventions likely to be beneficial: Multidisciplinary, multifactorial, health/environmental risk factor screening/intervention programmes in the community both for an unselected population of older people (4 trials, 1651 participants, pooled RR 0.73, 95%CI 0.63 to 0.85), and for older people with a history of falling or selected because of known risk factors (5 trials, 1176 participants, pooled RR 0.86, 95%CI 0.76 to 0.98), and in residential care facilities (1 trial, 439 participants, cluster‐adjusted incidence rate ratio 0.60, 95%CI 0.50 to 0.73) A programme of muscle strengthening and balance retraining, individually prescribed at home by a trained health professional (3 trials, 566 participants, pooled relative risk (RR) 0.80, 95% confidence interval (95%CI) 0.66 to 0.98) Home hazard assessment and modification that is professionally prescribed for older people with a history of falling (3 trials, 374 participants, RR 0.66, 95% CI 0.54 to 0.81) Withdrawal of psychotropic medication (1 trial, 93 participants, relative hazard 0.34, 95%CI 0.16 to 0.74) Cardiac pacing for fallers with cardioinhibitory carotid sinus hypersensitivity (1 trial, 175 participants, WMD ‐5.20, 95%CI ‐9.40 to ‐1.00) A 15 week Tai Chi group exercise intervention (1 trial, 200 participants, risk ratio 0.51, 95%CI 0.36 to 0.73). Interventions of unknown effectiveness: Group‐delivered exercise interventions (9 trials, 1387 participants) Individual lower limb strength training (1 trial, 222 participants) Nutritional supplementation (1 trial, 46 participants) Vitamin D supplementation, with or without calcium (3 trials, 461 participants) Home hazard modification in association with advice on optimising medication (1 trial, 658 participants), or in association with an education package on exercise and reducing fall risk (1 trial, 3182 participants) Pharmacological therapy (raubasine‐dihydroergocristine, 1 trial, 95 participants) Interventions using a cognitive/behavioural approach alone (2 trials, 145 participants) Home hazard modification for older people without a history of falling (1 trial, 530 participants) Hormone replacement therapy (1 trial, 116 participants) Correction of visual deficiency (1 trial, 276 participants). Interventions unlikely to be beneficial: Brisk walking in women with an upper limb fracture in the previous two years (1 trial, 165 participants). Authors' conclusions Interventions to prevent falls that are likely to be effective are now available; less is known about their effectiveness in preventing fall‐related injuries. Costs per fall prevented have been established for four of the interventions and careful economic modelling in the context of the local healthcare system is important. Some potential interventions are of unknown effectiveness and further research is indicated.

Measures of postural steadiness: differences between healthy young and elderly adults

1996-01-01

Thomas Prieto , Joel B. Myklebust , Raymond G. Hoffmann +2 more

Measures of postural steadiness are used to characterize the dynamics of the postural control system associated with maintaining balance during quiet standing. The objective of this study was to evaluate … Measures of postural steadiness are used to characterize the dynamics of the postural control system associated with maintaining balance during quiet standing. The objective of this study was to evaluate the relative sensitivity of center-of-pressure (COP)-based measures to changes in postural steadiness related to age. A variety of time and frequency domain measures of postural steadiness were compared between a group of twenty healthy young adults (21-35 years) and a group of twenty healthy elderly adults (66-70 years) under both eyes-open and eyes-closed conditions. The measures that identified differences between the eyes-open and eyes-closed conditions in the young adult group were different than those that identified differences between the eye conditions in the elderly adult group. Mean velocity of the COP was the only measure that identified age-related changes in both eye conditions, and differences between eye conditions in both age groups. The results of this study will be useful to researchers and clinicians using COP-based measures to evaluate postural steadiness.

FALLS BY ELDERLY PEOPLE AT HOME: PREVALENCE AND ASSOCIATED FACTORS

1988-01-01

Austin J. Blake , Kelly Morgan , M. J. Bendall +5 more

Of 1042 individuals aged 65 years and over who were successfully interviewed in a community survey of health and physical activity, 35% (n = 356) reported one or more falls … Of 1042 individuals aged 65 years and over who were successfully interviewed in a community survey of health and physical activity, 35% (n = 356) reported one or more falls in the preceding year. Although the overall ratio of female fallers to male fallers was 2.7:1, this ratio approached unity with advancing age. Mobility was significantly impaired in those reporting falls. Asked to provide a reason for their falls, 53% reported tripping, 8% dizziness and 6% reported blackouts. A further 19% were unable to give a reason. There was no association between falls and the use of diuretics, antihypertensives or tranquilizers, but a significant association between falls and the use of hypnotics and antidepressants was found. Discriminant analysis of selected medical and anthropometric variables indicated that handgrip strength in the dominant hand and reported symptoms of arthritis, giddiness and foot difficulties were most influential in predicting reports of recent falls.

Attention and the control of posture and gait: a review of an emerging area of research

2002-08-01

Marjorie Woollacott , Anne Shumway‐Cook

The Activities-specific Balance Confidence (ABC) Scale

1995-01-01

Leah Powell , Anita M. Myers

Journal Article The Activities-specific Balance Confidence (ABC) Scale Get access Lynda Elaine Powell, Lynda Elaine Powell University of WaterlooOntario, Department of Health Studies and Gerontology Search for other works by … Journal Article The Activities-specific Balance Confidence (ABC) Scale Get access Lynda Elaine Powell, Lynda Elaine Powell University of WaterlooOntario, Department of Health Studies and Gerontology Search for other works by this author on: Oxford Academic PubMed Google Scholar Anita M. Myers Anita M. Myers University of WaterlooOntario, Department of Health Studies and Gerontology Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journals of Gerontology: Series A, Volume 50A, Issue 1, January 1995, Pages M28–M34, https://doi.org/10.1093/gerona/50A.1.M28 Published: 01 January 1995 Article history Received: 15 November 1993 Accepted: 18 February 1994 Published: 01 January 1995

Balance in elderly patients: the "get-up and go" test.

1986-06-01

Susan D. Mathias , U. S. Nayak , Bernard Isaacs

Lower-Extremity Function in Persons over the Age of 70 Years as a Predictor of Subsequent Disability

1995-03-02

Jack M. Guralnik , Luigi Ferrucci , Eleanor M. Simonsick +2 more

Functional assessment is an important part of the evaluation of elderly persons. We conducted this study to determine whether objective measures of physical function can predict subsequent disability in older … Functional assessment is an important part of the evaluation of elderly persons. We conducted this study to determine whether objective measures of physical function can predict subsequent disability in older persons.

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A Multifactorial Intervention to Reduce the Risk of Falling among Elderly People Living in the Community

1994-09-29

Mary E. Tinetti , Dorothy I. Baker , Gail McAvay +6 more

Since falling is associated with serious morbidity among elderly people, we investigated whether the risk of falling could be reduced by modifying known risk factors. Since falling is associated with serious morbidity among elderly people, we investigated whether the risk of falling could be reduced by modifying known risk factors.

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Falls, Injuries Due to Falls, and the Risk of Admission to a Nursing Home

1997-10-30

Mary E. Tinetti , Christopher S. Williams

Falls warrant investigation as a risk factor for nursing home admission because falls are common and are associated with functional disability and because they may be preventable. Falls warrant investigation as a risk factor for nursing home admission because falls are common and are associated with functional disability and because they may be preventable.

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High-Intensity Strength Training in Nonagenarians

1990-06-13

M. A. Fiatarone

Muscle dysfunction and associated mobility impairment, common among the frail elderly, increase the risk of falls, fractures, and functional dependency. We sought to characterize the muscle weakness of the very … Muscle dysfunction and associated mobility impairment, common among the frail elderly, increase the risk of falls, fractures, and functional dependency. We sought to characterize the muscle weakness of the very old and its reversibility through strength training. Ten frail, institutionalized volunteers aged 90 ± 1 years undertook 8 weeks of high-intensity resistance training. Initially, quadriceps strength was correlated negatively with walking time (r= -.745). Fat-free mass (r=.732) and regional muscle mass (r=.752) were correlated positively with muscle strength. Strength gains averaged 174% ±31% (mean ± SEM) in the 9 subjects who completed training. Midthigh muscle area increased 9.0%± 4.5%. Mean tandem gait speed improved 48% after training. We conclude that high-resistance weight training leads to significant gains in muscle strength, size, and functional mobility among frail residents of nursing homes up to 96 years of age. (JAMA. 1990;263:3029-3034)

Risk factors for recurrent nonsyncopal falls. A prospective study

1989-05-12

Michael C. Nevitt

Falls are a major threat to the health of older persons. We evaluated potential risk factors for falls in 325 community-dwelling persons aged 60 years or older who had fallen … Falls are a major threat to the health of older persons. We evaluated potential risk factors for falls in 325 community-dwelling persons aged 60 years or older who had fallen during the previous year, then followed up weekly for 1 year to ascertain nonsyncopal falls and their consequences. Risk factors for having a single fall were few and relatively weak, but multiple falls were more predictable. In multivariate analyses, we found increased odds of two or more falls for persons who had difficulty standing up from a chair, difficulty performing a tandem walk, arthritis, Parkinson's disease, three or more falls during the previous year, and a fall with injury during the previous year, and for whites. The proportion of subjects with two or more falls per year increased from 0.10 for those with none or one of these risk factors to 0.69 for those with four or more risk factors. Among older persons with a history of a recent fall, the risk of multiple nonsyncopal falls can be predicted from a few simple questions and examinations. (JAMA. 1989;261:2663-2668)

High-intensity strength training in nonagenarians. Effects on skeletal muscle

1990-06-13

M. A. Fiatarone

Understanding Barriers to Home Safety Assessment Adoption in Older Adults: Qualitative Human-Centered Design Study

2025-06-24

Jonathan J. Lee , Devika Patel , Meghana A. Gadgil +3 more | JMIR Human Factors

Abstract Background Falls are the leading cause of injury-related death among adults aged 65 and older. The fear of falling can further limit older adults’ independence by contributing to activity … Abstract Background Falls are the leading cause of injury-related death among adults aged 65 and older. The fear of falling can further limit older adults’ independence by contributing to activity restriction, social isolation, and physical decline—ironically increasing the risk of mechanical falls. Although home safety assessments have been shown to reduce fall risk by up to 36% and decrease serious injuries such as hip fractures, their adoption remains low. Understanding the barriers to implementing these assessments is critical to improving their uptake and effectiveness. Objective This study aimed to (1) identify specific barriers perceived by older adults in implementing home safety assessments and modifications to reduce the risk of mechanical falls, (2) explore the attitudes of health care professionals and other stakeholders toward these assessments, and (3) identify novel design opportunities to guide the development and implementation of more effective home safety assessment techniques and practices to reduce mechanical fall risk. Methods This explanatory qualitative study drew on the “inspiration” phase of the human-centered design (HCD) research process. We conducted 35 interviews (28 initial and 7 follow-up) with 28 purposefully sampled participants in the San Francisco Bay Area between February and June 2021. Participants included community-dwelling older adults (n=3), geriatricians (n=4), therapists (n=6), product developers (n=2), older health researchers (n=8), and community program leaders (n=5). Interview notes were analyzed inductively by the research team to extract themes and generate insight statements and design opportunities. Results Analysis yielded three key insights: (1) older adults often experience a conflict between maintaining independence and implementing safety modifications. One participant described living with a “repeating mantra in my head throughout the day saying ‘above all, don’t fall.’” (2) aesthetic and privacy concerns frequently override safety benefits. Participants rejected modifications that made their homes feel “institutional.” (3) access to occupational therapy services—already limited in rural areas—was further constrained by the COVID-19 pandemic, with some providers reporting that travel time “took up the majority of their day just assessing one home.” These barriers help explain the low adoption of home safety assessments despite strong supporting evidence. The study identified design opportunities to address these challenges, including customizable, user-friendly safety solutions, dignity-preserving approaches to assessment, and technology-enabled remote alternatives. Conclusions This study identified specific emotional, aesthetic, logistical, and access-related barriers to the adoption of home safety assessments among older adults. The proposed design solutions offer promising directions to increase uptake, improve user experience, and enhance safety. However, further validation through co-design with a larger and more diverse group of older adults is needed. Future research should pilot test these ideas across varied contexts and evaluate their implementation and impact.

The Effects of Delayed Visual Feedback on Dynamic Postural Control

2025-06-23

Nora Pourhashemi , Kayton Jaksic , Behrang Keshavarz +1 more | Investigative Ophthalmology & Visual Science

Vision provides essential sensory feedback to maintain upright stance yet is affected by inherent processing delays within the central nervous system. Mismatches between visual and motor responses caused by visual … Vision provides essential sensory feedback to maintain upright stance yet is affected by inherent processing delays within the central nervous system. Mismatches between visual and motor responses caused by visual delays may also result in motion sickness. In the current study, virtual reality (VR)-generated visual delays were used to examine the relationships among delayed visual feedback, postural responses, and visually induced motion sickness during a dynamic balance task. Young healthy adults stood on a force plate mounted to a motorized platform that sinusoidally translated continuously in the anteroposterior (AP) direction for 60 seconds; they wore a VR head-mounted display, surface electromyography (EMG), and full-body motion capture markers. Center of pressure (CoP) was recorded through ground reaction forces using the force plate, kinematics were collected to observe whole-body responses, and surface EMG was used to record muscle activity. Questionnaires were completed after each trial to evaluate subjective measures of perceived stability and visually induced motion sickness. The amplitude of kinetic, kinematic responses, and muscle activity increased with visual delay and returned to baseline levels when participants were re-exposed to the visual delay conditions. Strategies used to maintain postural stability under delayed feedback conditions can adapt to sensory delays, without experiencing motion sickness, even if the perceived stability is initially compromised.

Determinants of Harm in Fall Incidents in Hospital Settings With 200 or More Beds in Korea

2025-06-23

Youngmi Kang , Eunyoung Hong | Journal of Patient Safety

Falls are a significant patient safety concern in hospital settings, often resulting in unintended harm. This study aimed to investigate the prevalence and risk factors for falls in Korean hospitals … Falls are a significant patient safety concern in hospital settings, often resulting in unintended harm. This study aimed to investigate the prevalence and risk factors for falls in Korean hospitals with 200 or more beds, analyzing 13,034 incidents reported to the Korean Patient Safety Reporting and Learning System from 2017 to 2021. The level of harm was classified into 3 categories: near-miss, adverse, and sentinel events. Hospital-related factors (hospital type, bed capacity, and location and time of fall incident) and patient-related factors (sex, age group, and admitting medical department) were included in the analysis. χ2 tests were used to evaluate differences in fall severity, and binary logistic regression identified factors associated with harmful incidents. The study found that harmful falls were more likely to occur in nontertiary hospitals, particularly those with >500 beds, as well as in emergency departments. Furthermore, older female patients and those admitted to the internal medicine department are especially at risk. Based on the results of this study, especially in nontertiary hospitals with >500 beds, comprehensive strategies for preventing falls, including the promotion of patient safety culture, are needed to reduce fall occurrence and its associated disabilities.

Exploration of the effects of Tai Chi practice on lower limb corticomuscular coherence during balance-demanding virtual reality conditions in older adults

2025-06-23

Yang Hu , Elizabeth T. Hsiao-Wecksler , Manuel E. Hernandez | Frontiers in Aging Neuroscience

Tai Chi practice has been widely adopted to improve balance and prevent falls in older adults. However, the neural mechanisms underlying the benefits of Tai Chi are difficult to evaluate … Tai Chi practice has been widely adopted to improve balance and prevent falls in older adults. However, the neural mechanisms underlying the benefits of Tai Chi are difficult to evaluate during traditional balance assessments. The goal of this study was to evaluate the effects of Tai Chi and healthy aging on corticomuscular coherence (CMC) while standing in virtual balance-demanding environments. We recorded neural, muscular, and behavioral data in an immersive virtual reality environment while implementing sensory and mechanical perturbations to introduce high postural threats. Through the acquisition of electroencephalography and electromyography signals, we examined β and γ CMC changes in frontal, central, parietal, and occipital cortical areas and ankle plantar- and dorsi-flexors in older adults ( n = 10), older adults with Tai Chi practice ( n = 10), and young adults ( n = 10). The results showed that older adults have higher γ CMC in comparison with Tai Chi practitioners and young adults as evaluated by the magnitude square coherence. Increased β and γ CMC correlated with decreased mediolateral postural sway in older adults, while young adults demonstrated the opposite relationship. Furthermore, lower tibialis anterior and soleus β CMC were found in older adults during ground conditions compared to Tai Chi practitioners and young adults. The results demonstrate the effects of aging and Tai Chi on CMC during balance-demanding standing tasks, and the potential application of the novel system to quantify cortical and muscular adaptation after rehabilitation.

Incidence and risk factors for falls among nursing home residents in Italy: a retrospective cohort study

2025-06-23

Pietro Ferrara , Chiara Carla Monti , Davide Rozza +7 more | Aging Clinical and Experimental Research

From First Slip to Second Setback: Intracranial Injury Risk after Recurrent Falls in Older Adults: A Retrospective Cohort Study

2025-06-23

| Advances in Geriatric Medicine and Research

Arm and Leg Dominance Does Not Affect Functional Balance Tests

2025-06-23

Emre Söylemez , Mehmet Can | Meandros Medical And Dental Journal

Objective: Functional balance tests are frequently used to evaluate individuals' balance, monitor rehabilitation outcomes, and determine fall risk. Motor tasks requiring strength and accuracy are performed with the dominant extremities. … Objective: Functional balance tests are frequently used to evaluate individuals' balance, monitor rehabilitation outcomes, and determine fall risk. Motor tasks requiring strength and accuracy are performed with the dominant extremities. Therefore, there is a possibility that limb dominance may affect functional balance tests. The purpose of this study is to investigate whether the dominant leg affects the one-leg standing test (OLST) and tandem stance test (TST), while the dominant arm affects the functional reach test (FRT). Methods: One hundred healthy young adults were included in this prospective cross-sectional study. Participants' age, height, and weight were noted, and their body mass index (BMI) was calculated. Participants underwent OLST and TST on the dominant and non-dominant legs. FRT was applied with the dominant and non-dominant arms. Results: While 93 (93.0%) of the participants were right extremity dominant, 7 (7.0%) were left extremity dominant. There was no difference in terms of OLST, and TST performed with the dominant and non-dominant leg (p>0.05). There was no difference in terms of FRT applied with the dominant and non-dominant arms (p>0.05). Conclusion: Our study revealed that leg dominance did not affect OLST and TST, and arm dominance did not affect FRT. The extremity for applying OLST, TST, and FRT can be left to participant preference or applied based on the dominant/non-dominant extremity as appropriate to the situation.

Numerical simulation of flow around the legs during walking in water with implications for hydrotherapeutic exercise

2025-06-23

Umang N. Patel , Frank C. Sup , Yahya Modarres‐Sadeghi | Journal of Fluids and Structures

Older persons’ experiences with wearable sensor-based fall risk screening in free-living conditions - a qualitative study

2025-06-21

Madelene Törnblom , Kari Rönkkö , Kerstin Ådahl +3 more | BMC Geriatrics

Abstract Background Falls are common among older persons and can have a major impact on their lives. Wearable sensors used in free-living conditions (moving naturally in one’s daily living environment) … Abstract Background Falls are common among older persons and can have a major impact on their lives. Wearable sensors used in free-living conditions (moving naturally in one’s daily living environment) can be used to predict falls and fall risks. To understand if using the wearable sensors is an acceptable way for older persons to be screened for fall risks, it is important to have knowledge of older persons’ experiences using wearable sensor-based technologies for fall risk assessment in free-living conditions Therefore, this study aimed to describe older persons’ experiences of using such technology. Methods A qualitative study using individual interviews was conducted with 21 community-dwelling older persons (aged 77–81) in Sweden between April and September 2024. The older persons wore a thigh-mounted wearable sensor for one week to screen for fall risks in free-living conditions. Interviews were conducted 9–89 days (median 15 days) after sensor use and were analysed using conventional qualitative content analysis. Results Older persons’ experiences with wearable sensor-based fall risk screening were described using the overarching theme ‘Being an older person in a fall screening process’ containing five categories: ‘Seeing a need for a fall risk sensor but imagining it as an unattainable ideal’, ‘Utilising a wearable sensor can be uncomplicated and fun’, ‘Having worries and experiencing problems’, ‘Thinking about what the wearable sensor has registered about me’, and ‘Reflecting on how I can benefit from the screening’. Conclusions The older persons had various experiences with the wearable sensor-based screening for fall risks in free-living conditions. The wearable sensor was easy to use, although problems could occur while wearing it, such as losing the sensor or developing skin problems. The older persons wanted to benefit from the screening and improve their health based on the results. Further research could focus on the accuracy of fall predictors used in free-living conditions for assessing fall risks in older persons, since the wearable sensor was perceived as acceptable to use.

End-of-life of running shoes: does cushioning matter?

2025-06-20

Cédric Morio , Aymeric Fontaine | Footwear Science

Postural demands modulate tactile perception in the lower limb in young and older adults

2025-06-20

Fabian Dominik Wachsmann , Katja Fiehler , Dimitris Voudouris | Scientific Reports

Abstract Balance control requires the continuous integration of feedback signals from several sensory organs with feedforward estimates about the state of the body. Such feedback signals are important for standing … Abstract Balance control requires the continuous integration of feedback signals from several sensory organs with feedforward estimates about the state of the body. Such feedback signals are important for standing upright, as shown in increased and more variable sway patterns when sensory feedback is compromised, for instance when standing with eyes closed or on unstable surfaces that make cutaneous signals from the foot less reliable. Poorer sensory processing is also considered to arise during healthy aging due to a decrease of the reliability and transmission rate of feedback signals. Here, we are interested in how processing of tactile signals from the lower leg is modulated when balance control is challenged and how this interacts with age-related sensorimotor changes. We examined tactile sensitivity on the lower leg during sitting, standing on stable ground, and standing on unstable ground (foam). We quantified the center of pressure during the two standing conditions by determining the area of a 95% confidence interval ellipse as well as the total displacement of the center of pressure. Tactile sensitivity was assessed by asking participants to detect brief vibrotactile probes of various intensities to the lower leg. As expected, postural sway increased when standing on foam than stable ground for both age groups. When postural demands were minimal (sitting), tactile sensitivity was overall poorer in older than younger adults. Tactile perception was also poorer when standing on foam than on the stable ground, for both age groups. We conclude that increased postural demands reduce reliance on tactile signals from the lower limb in both young and older adults.

Behaviour of foot regions at bipedal quiet stance

2025-06-20

Maryam Hassanpour , Naci Barış Yaradanakul , Veysel Alcan +2 more | Footwear Science

‘It's Common Sense’: Older Adults' Personal Strategies to Prevent Falls in the Hospital. A Qualitative Descriptive Study

2025-06-20

Hanne Dolan , Andrew Daniels , David W. Coon | Journal of Clinical Nursing

ABSTRACT Aims The purpose of this study was to describe the strategies older adults use to maintain their balance and prevent themselves from falling in the hospital. Design The Expanded … ABSTRACT Aims The purpose of this study was to describe the strategies older adults use to maintain their balance and prevent themselves from falling in the hospital. Design The Expanded Health Belief Model served as the theoretical framework for this qualitative descriptive study. Methods Audio‐recorded, semi‐structured interviews were conducted with 15 ( N = 15) older adults (female 53.3%), mean age of 77 (SD 9.9) admitted to a rural community hospital in the United States. Each transcript was analysed independently by two researchers using content analysis before reaching consensus. Sample size was guided by thematic saturation. Trustworthiness was ensured by using the criteria outlined by Lincoln and Guba. Results Four main themes emerged: My Balance Problem is My Personal Responsibility, Self‐efficacious Common‐Sense Balance Management Strategies, Hospital Staff as Contributors or Disruptors of My Balance Management, and My Needs for Balance Management Support. The older adults used extensive mental efforts in planning and executing personal strategies to maintain balance and viewed this as their personal responsibility. Their self‐efficacious balance management strategies included observing the environment, assessing furniture and equipment, staying focused, and moving slowly. Assistance from hospital staff members either supported or disrupted the older adults' balance management efforts. The older adults desired to learn more about fall prevention in the hospital. The older adults found physical guidance, demonstration and verbal guidance to be the preferred method of learning. Conclusion Rurally hospitalised older adults employ independent, self‐efficacious balance management strategies. Implications Older adults' personal balance management strategies must be recognised by healthcare workers. Impact Future inpatient fall prevention interventions and policies must focus on exploring hospitalised older adults' optimal and suboptimal balance management behaviours to develop patient‐centred fall prevention interventions to decrease inpatient falls among older adults. Reporting Method The Consolidated Criteria for Reporting Qualitative Research. Patient or Public Contribution No patient or public contribution.

The effect of minimal shoes in combination with textured and supportive insoles on static stability across the lifespan

2025-06-20

Salahuddin Haowlader , Charlotte Apps , Maria Bisele +1 more | Footwear Science

Age-related changes in gait coordination are focused on the step-to-step transition

2025-06-20

Elham Alijanpour , Daniel M. Russell | Journal of Biomechanics

Validity and Reliability of a Smartphone-Based Gait Assessment in Measuring Temporal Gait Parameters: Challenges and Recommendations

2025-06-20

Sam Guoshi Liang , Ho Yin Chung , Kai-Cheung Kenneth Chu +6 more | Biosensors

Smartphone-embedded inertia sensors are widely available nowadays. We have developed a smartphone application that could assess temporal gait characteristics using the built-in inertia measurement unit with the aim of enabling … Smartphone-embedded inertia sensors are widely available nowadays. We have developed a smartphone application that could assess temporal gait characteristics using the built-in inertia measurement unit with the aim of enabling mass screening for gait abnormality. This study aimed to examine the test–retest reliability and concurrent validity of the smartphone-based gait assessment in assessing temporal gait parameters in level-ground walking. Twenty-six healthy young adults (mean age: 20.8 ± 0.7) were recruited. Participants walked at their comfortable pace on a 10 m pathway repetitively in two walking sessions. Gait data were simultaneously collected by the smartphone application and a VICON system during the walk. Gait events of heel strike and toes off were detected from the sensors signal by a peak detection algorithm. Further gait parameters were calculated and compared between the two systems. Pearson Product–Moment Correlation was used to evaluate the concurrent validity of both systems. Test–retest reliability was examined by the intraclass correlation coefficients (ICCs) between measurements from two sessions scheduled one to four weeks apart. The validity of smartphone-based gait assessment was moderate to excellent for parameters involving only heel strike detection (r = 0.628–0.977), poor to moderate for parameters involving detection of both heel strike and toes off (r = 0.098–0.704), and poor for the proportion of gait phases within a gait cycle. Reliability was good to fair for heel strike-related parameters (ICC = 0.845–0.388), good to moderate for heel strike and toes-off-related parameters (ICC = 0.827–0.582), and moderate to fair for proportional parameters. Validity was adversely affected when toe off was involved in the calculation, when there was an insufficient number of effective steps taken, or when calculating sub-phases with short duration. The use of smartphone-based gait assessment is recommended in calculating step time and stride time, and we suggest collecting no less than 100 steps per leg during clinical application for better validity and reliability.

Safety shoes with ankle support decrease gait stability and may increase trip-related fall-risk

2025-06-20

Mathias Munk-Hansen , Lasse Jakobsen , Mark de Zee +2 more | Footwear Science

Effect of weightlifting shoes on stability during barbell squat in high intensity cross training athletes

2025-06-20

Giorgio Poletto , Eduardo Gonçalves , Daiani de Campos +3 more | Footwear Science

Fear of Falling in Older Adults Undergoing Comprehensive Geriatric Care: Results of a Prospective Observational Study

2025-06-19

Marco Meyer , Andreas Arnold , T. Peter Stein +2 more | Journal of Clinical Medicine

Objectives: This prospective observational study aimed to investigate the prevalence, progression, and clinical factors associated with fear of falling (FOF) in older adults hospitalized for comprehensive geriatric care (CGC). Methods: … Objectives: This prospective observational study aimed to investigate the prevalence, progression, and clinical factors associated with fear of falling (FOF) in older adults hospitalized for comprehensive geriatric care (CGC). Methods: FOF was assessed using two measures: a single-item question (SIQ) asking, "Are you currently afraid of falling?" with responses scored as (0) not at all; (1) a little; (2) quite a bit; (3) very much, and the Falls Efficacy Scale International (FES-I). FES-I scores were categorized into low (FES-I 16-19), moderate (FES-I 20-27), and high (FES-I 28-64) concerns about falling. FOF scores were analyzed in relation to patients' characteristics and functional performance. Results: A total of 103 patients were included in the final analysis (mean age: 81.9 years, 64.1% female). Upon hospital admission, 74.8% of patients reported FOF (SIQ ≥ 1), with no significant change at discharge (73.8%, p > 0.999). Patients' FES-I scores indicated high concerns about falling, with only slight improvements following CGC. The median FES-I score upon admission decreased from 31 (IQR: 23.5-40) to 30 (IQR: 23.5-38) at discharge (p < 0.001). Logistic regression analysis revealed that persistently high concerns about falling (FES-I 28-64) after undergoing CGC were associated with depressive symptoms (Geriatric Depression Scale score ≥ 6; OR: 3.61, 95% CI: 1.30-10.04) and a diagnosis of heart failure (OR: 3.63, 95% CI: 1.30-10.11). Patients' scores in the Barthel Index, Timed Up and Go Test, and Tinetti Test improved after treatment, but these changes (Δ) did not show a significant correlation with those in the FES-I or SIQ. Conclusions: Our findings demonstrate that FOF is highly prevalent among older adults hospitalized for CGC and persists with only minimal improvement following treatment. Persistently high concerns about falling even after completing CGC were associated with depressive symptoms and a diagnosis of heart failure. These results highlight the potential for more targeted interventions within CGC to more effectively address FOF in this vulnerable population.

Virtual Reality Intervention for Fall Prevention in Older Adults: A Meta‐Analysis

2025-06-18

Ita Daryanti Saragih , Yao‐Mei Chen , Ira Suarilah +2 more | Journal of Nursing Scholarship

ABSTRACT Purpose Falls among older adults are a major public health concern, often leading to serious outcomes such as fractures, head trauma, and increased mortality. Virtual reality (VR) interventions have … ABSTRACT Purpose Falls among older adults are a major public health concern, often leading to serious outcomes such as fractures, head trauma, and increased mortality. Virtual reality (VR) interventions have emerged as a promising strategy for fall prevention by improving balance, reducing fear of falling, and enhancing confidence. However, the impact of VR interventions on specific outcomes such as fear of falling, balance, and postural control in older adults remains insufficiently synthesized. Design Systematic review and meta‐analysis. Methods A comprehensive systematic search of six databases was conducted from inception to January 20, 2025. Randomized controlled trials (RCTs) evaluating VR interventions targeting fear of falling, balance, and postural control in older adults were included. Methodological quality was assessed using the Cochrane risk‐of‐bias tool (RoB‐2). Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random‐effects models for each outcome. Findings Seventeen RCTs involving 988 older adults, published between 2016 and 2025, met the inclusion criteria. VR interventions demonstrated significant effects in reducing fear of falling (SMD = −0.40; 95% CI: −0.72 to −0.08; I 2 = 45.10%; p = 0.02), improving balance (SMD = 0.45; 95% CI: 0.07–0.83; I 2 = 73.54%; p = 0.02), and enhancing postural control (SMD = 0.50; 95% CI: 0.13–0.86; I 2 = 46.89%; p = 0.01). Conclusion This meta‐analysis highlights the effectiveness of VR interventions in reducing fear of falling and improving balance and postural control among older adults. Clinical Relevance VR represents a valuable tool in fall prevention strategies, addressing key outcomes essential for maintaining independence and mobility in this population.

Relationship between executive function and dual-task walking in people with Parkinson's disease

2025-06-18

Junhong Zhou , Ray-Yau Wang , Yo-Tsen Liu +3 more | Frontiers in Aging Neuroscience

Background Cognitive impairment may present early in people with Parkinson's disease (PwPD), with deficits in executive function potentially impacting gait performance. Previous studies have investigated the association between dual-task walking … Background Cognitive impairment may present early in people with Parkinson's disease (PwPD), with deficits in executive function potentially impacting gait performance. Previous studies have investigated the association between dual-task walking and executive function in PwPD; however, the results were inconsistent, and the correlation between dual-task walking and subdomains of executive function has not been explored. This study aims to examine the correlation between dual-task walking and subdomains of executive function in PD and assess the predictive power of different subdomains of executive function on dual-task walking performance. Methods This cross-sectional study included 30 PwPD. Gait was assessed under single-task walking, cognitive dual-task walking, and motor dual-task walking conditions. Executive function was evaluated using the Trail Making Test (TMT), Stroop Color and Word Test (SCWT), and Digit Span Test (DST). Correlation analyses (Pearson or Spearman, as appropriate) and linear regression analyses were used to examine the contribution of executive function subdomains to gait variables that showed significant correlations. Results Walking speeds under both dual-task conditions were moderately correlated with performance on the TMT Part A and the SCWT. In contrast, stride length during dual-task walking showed broader associations, demonstrating significant correlations with multiple executive function measures. Stepwise linear regression analysis revealed that the SCWT was the only significant predictor of walking speed under both dual-task conditions. For stride length during cognitive dual-task walking, the SCWT remained a significant predictor, while in the motor dual-task condition, both the SCWT and the Forward DST contributed significantly. Specifically, two regression models were significant for stride length during motor dual-task walking: Model 1 included only the SCWT, while Model 2 incorporated both the SCWT and Forward DST. Among dual-task cost outcomes, only the cost of stride length during cognitive dual-task walking was significantly correlated with TMT Part A; however, this association did not remain significant in subsequent regression analyses. Conclusion This study indicates that, among various executive function assessments, the SCWT shows the strongest correlation with dual-task gait performance in PwPD. This suggests that inhibitory control plays a key role in regulating dual-task walking in individuals with PD.

Traditional Chinese martial art Wushu to improve the mental state and physical fitness of students: designing space for optimal practice and training

2025-06-18

Z.H. Tu , Lei Zhong , Jiahui Xie | Frontiers in Psychology

Introduction Traditional Chinese martial arts (Wushu) possess the potential to enhance both the psychological resilience and physical capacities of learners. Their effective implementation necessitates consideration of spatial and architectural features. … Introduction Traditional Chinese martial arts (Wushu) possess the potential to enhance both the psychological resilience and physical capacities of learners. Their effective implementation necessitates consideration of spatial and architectural features. This study investigates the impact of spatial-architectural determinants on the psychophysiological adaptation of Wushu practitioners within Chinese and European pedagogical systems. Methods A mixed-methods approach was employed, combining quantitative biomechanical assessments ( n = 184 trainees) with qualitative ethnographic observations (24 training settings over 4-week immersion periods) and semi-structured interviews ( n = 42 instructors). Architectural parameters—including ceiling height, floor elasticity, and acoustic properties—were systematically documented, alongside measurements of biomechanical performance indicators. Results and discussion Chinese training environments, characterized by high ceilings (&gt;4 m) and specialized wooden flooring, correlated with superior flexibility (hip flexion: 142° ± 3.6° vs. 130° ± 3.8°; p &lt; 0.01) and cardiovascular efficiency (shuttle run: 987 ± 42 m vs. 924 ± 38 m; p &lt; 0.01). European facilities, utilizing rigid synthetic materials, demonstrated advantages in explosive strength metrics (vertical jump: 54.3 ± 3.1 cm vs. 50.0 ± 2.9 cm; p &lt; 0.05). Ceiling height emerged as the dominant architectural predictor of flexibility parameters ( β = 0.73, p &lt; 0.001); acoustic characteristics significantly influenced exercise execution speed ( β = −0.68, p &lt; 0.001); and spatial volume affected cardiorespiratory adaptation (β = 0.65, p &lt; 0.001). Environments incorporating traditional design elements improved attentional resilience by 27% compared to modernized spaces. The application of data-driven spatial design principles—such as the inclusion of ritualized zones, hierarchical spatial organization, and tailored acoustic environments—represents an underexplored domain within martial arts pedagogy with promising implications for educational practice.

Beam walking increases gait velocity and reduces falls risk in older adults

2025-06-18

Ben Sidaway | Experimental Gerontology

A third of community-dwelling older adults will fall at least once per year, often during walking. In such individuals, the greatest postural instability during walking occurs in the mediolateral direction … A third of community-dwelling older adults will fall at least once per year, often during walking. In such individuals, the greatest postural instability during walking occurs in the mediolateral direction and thus lateral instability is a significant risk factor for falls. The current study uses one-month of beam walking to challenge the dynamic mediolateral stability of older adults in an attempt to improve balance and reduce falls risk. 25 community dwelling older adults over 70 years of age (Mean = 83.5 yrs.) completed a fear of falling questionnaire, the Activities-specific Balance Confidence (ABC) scale, the Dynamic Gait Index (DGI), and normal and fast walking trials. Participants then walked along a series of wooden beams of decreasing widths. Following pretest measurements participants practiced walking on the beams twice a week for 4 weeks. Assessments were conducted at the end of practice (posttest) and one week later (retention test). At the pretest 83 % of the participants reported they were somewhat afraid of falling while at the retention test 37 % were somewhat afraid of falling. ABC scores improved from the pretest (M = 61 %) to the retention test (M = 90 %). The DGI also improved significantly as a result of the beam-walking. Gait analysis revealed that stride length and gait velocity increased significantly following training while stride length and stride width variability decreased. Beam training appears to be a simple intervention that can improve dynamic mediolateral stability consequently reducing the falls risk of older adults.

Age-Related Compensatory Gait Strategies During Induced Perturbations in the Pre-Swing Gait Phase: A Kinematic and Kinetic Analysis

2025-06-18

Katarzyna Chodkowska , Michalina Błażkiewicz , Andrzej Mroczkowski +1 more | Applied Sciences

The response to perturbations in the gait of elderly and young individuals can differ due to various factors, such as age-related changes in sensorimotor function, muscle strength, and balance control. … The response to perturbations in the gait of elderly and young individuals can differ due to various factors, such as age-related changes in sensorimotor function, muscle strength, and balance control. This study aimed to identify and compare compensatory kinematic and kinetic gait strategies in response to sudden treadmill perturbations applied during the Pre-Swing phase in young and older adults. The analysis focused on determining age-related differences in joint behavior and force production under perturbation stress, with implications for fall prevention. Twenty-one young and an equal number of elderly healthy females walked on a treadmill in a virtual environment (GRAIL, Motek). Unexpected perturbations were applied five times. Principal Component Analysis (PCA) and k-means clustering identified three distinct compensatory strategies per limb. Young adults primarily employed Strategies I (42.2%) and II (40%), while older adults most often selected Strategy II (45.5%). Statistical analysis (SPM and Mann-Whitney U test, p = 0.05) showed significant between-group differences in joint angles and torques across the gait cycle. For instance, in Strategy I, young participants had significantly lower ankle plantarflexion angles (p < 0.01) and hip extension torques (p < 0.05) compared to the elderly. Strategy II in older adults showed significantly higher vGRF minimums (p < 0.01) and anterior-posterior GRF peaks (p < 0.001). The elderly adopted strategies compatible with their neuromuscular capacity rather than those minimizing joint load, as observed in the young group. These findings offer novel insights into age-related compensatory mechanisms and highlight the importance of tailored fall-prevention strategies based on biomechanical response patterns.

A Cross-Sectional Study on the Biomechanical Effects of Squat Depth and Movement Speed on Dynamic Postural Stability in Tai Chi

2025-06-18

Wenlong Li , Minjun Liang , Liangliang Xiang +2 more | Life

This study aimed to explore the independent and interactive effects of varying squat depths and movement speeds on dynamic postural stability during the Part the Wild Horse's Mane (PWHM) movement. … This study aimed to explore the independent and interactive effects of varying squat depths and movement speeds on dynamic postural stability during the Part the Wild Horse's Mane (PWHM) movement. Thirteen male participants (age: 25.86 ± 1.35 years; height: 174.26 ± 6.09 cm; body mass: 68.64 ± 8.15 kg) performed the PWHM movement at three different squat heights, high squat (HS), middle squat (MS), low squat (LS), and two different speeds, fast and slow. Dynamic postural stability (DPSI) was assessed through the center-of-mass (CoM) trajectory and the center-of-pressure (CoP) trajectory. The analyses used two-factor repeated-measures ANOVA and statistical nonparametric mapping, with key metrics including anteroposterior stability (APSI), mediolateral stability (MLSI), vertical stability (VSI), DPSI indices, and the path lengths of the CoP and CoM. LS exhibited significantly greater CoP and CoM path lengths compared with MS and HS (p < 0.01). Furthermore, fast movements demonstrated higher VSI and DPSI than slow movements (p < 0.05). Tai Chi with different squat depths and speeds can affect postural stability. To reduce the fall risk, older adults and individuals with balance impairments should prioritize slower Tai Chi movements, particularly when using high squat postures.

Personalized auditory cues improve gait in patients with early Parkinson's disease

2025-06-18

Xinjin Li , Shiya Wang , Kai Wang +5 more | Frontiers in Neurology

Introduction Parkinson's disease (PD) patients experience a wide variety of gait and posture problems that significantly impair their functional mobility and quality of life. Auditory cue-based training has been shown … Introduction Parkinson's disease (PD) patients experience a wide variety of gait and posture problems that significantly impair their functional mobility and quality of life. Auditory cue-based training has been shown to improve gait performance in PD patients. However, most of the current methods target gains in bilateral spatiotemporal variables, whereas in the early-stages of PD, symptoms are usually unilateral. Methods To address the effects of unilateral onset and heterogeneity of early-stage PD on patients' gait performance, we propose a personalized training method based on auditory cues to reduce gait asymmetry between patients' right and left feet. The method targets patients' gait performance through personalized music (auditory cues) and dynamically adjusts the music based on real-time gait data to ensure synchronization with the patient's walking rhythm. Specifically, gait data are acquired in real time via Inertial Measurement Units (IMUs) attached to the ankles of the patient's right and left feet, which are used to calculate the gait cycles of the patient's right and left feet. Personalized music is then generated based on the patient's gait cycle. During the training process, the music is dynamically updated by continuously assessing the synchronization between the patient's gait cycle and the music beats. Results Fifteen early-stage PD patients(H&amp;Y ≤ 2.5) were initially recruited to compare and analyze the effects of training with and without auditory cues. Gait symmetry improved in all patients who received auditory cues (t = 4.9166, p = 0.0002), with a maximum improvement of 17.685%, and gait variables also showed significant enhancement. Eleven early-stage patients were then recruited for a 7-day intervention, with a mean improvement in gait symmetry of 11.803% ( t = 4.391, p = 0.001). There were significant improvements in left-foot velocity ( t = 4.613, p = 0.001), right-foot velocity (t = 6.250, p = 0.0001), and right-foot stride length ( t = 4.004, p = 0.0025), and the average improvement rate of gait variables reached 37.947%. This indicates that the personalized training method proposed in this paper for the unilateral onset characteristics of early-stage PD is effective. It not only enhances the symmetry of walking in patients with early-stage PD, but also improves motor performance. Discussion The proposed method can serve as a complementary approach to pharmacological treatment in the rehabilitation of PD patients, demonstrating its effectiveness in clinical application.

An analysis of lateral stepping using proactive and reactive assessment methods in young adults

2025-06-18

Praveen Kumar Chennimalai Ravi , Alekhya Bandi , Sivakumar Ramachandran | Physiotherapy Quarterly

Introduction Stepping is a common reactive postural control strategy. Lateral stepping is a more challenging movement and has unique biomechanical characteristics. Stepping is commonly assessed using the Balance Evaluation System … Introduction Stepping is a common reactive postural control strategy. Lateral stepping is a more challenging movement and has unique biomechanical characteristics. Stepping is commonly assessed using the Balance Evaluation System Test (BESTest), waist pulls and surface translation. The speed and characteristics of stepping are critical to prevent a fall. It is important to consider the influence of the test construct on stepping behaviour. The aim of this study is to identify differences in stepping characteristics between two selected methods and determine which method elicits the most optimal stepping response as indicated by smaller spatio-temporal characteristics. Methods Sixty healthy young adults aged between 18 and 26 years were tested for lateral stepping using the BESTest and moving platform perturbations. Video recordings of the test procedures were analysed using “TRACKER” software to measure various spatio-temporal parameters of the lateral stepping reactions, such as first step time, balance recovery length, balance recovery time and number of steps. The Mann–Whitney U test was used to assess differences between the parameters from both methods of assessment. Results The mean values of spatio-temporal parameters of stepping triggered by the moving platform were smaller compared to the BESTest. Furthermore, the stepping characteristics differed between the two assessment methods. Conclusions The perturbations induced by the moving platform elicited stepping responses of shorter duration and shorter distances, indicating the participants’ best stepping behaviour. The method of assessment significantly influenced the stepping behaviour, highlighting the importance of carefully selecting an appropriate assessment for postural control testing.

The influence of the design of the assessment method on the attributes of reactive backwards stepping in young adults

2025-06-18

Radhika Chockalingam Muthukumar , Sivakumar Ramachandran , Jayashree Vaidhyanathan | Physiotherapy Quarterly

Objective Reactive backwards stepping occurs to prevent a backwards fall when a person’s centre of mass is shifted posteriorly by an unexpected external force. Methods such as the Balance Evaluation … Objective Reactive backwards stepping occurs to prevent a backwards fall when a person’s centre of mass is shifted posteriorly by an unexpected external force. Methods such as the Balance Evaluation Systems Test (BESTest) and platform translations are used to assess the ability to perform backwards stepping. However, the response may vary based on the perturbations administered during testing, which could reflect the individual’s optimal response capability. This study aims to analyse the characteristics of backwards reactive stepping in both the BESTest and moving platform methods. Methods In this observational study, 60 healthy young adults were tested for backwards stepping using the BESTest and a moving platform. Three trials were video-recorded and analysed. The first step length, first step time, balance recovery length and balance recovery time were measured and compared between the BESTest and moving platform methods. Mann–Whitney U was used to test the differences at a significance level of p < 0.05. Results The results showed that the values for first step length, balance recovery length and balance recovery time were smaller for the moving platform perturbation compared to the BESTest (p < 0.05). Conversely, no difference was observed in first step time between the two methods. Conclusions The design of the evaluation method influenced the characteristics of stepping. The moving platform elicited a more proficient backwards stepping reaction compared to the BESTest.

Seasonal association between spatiotemporal gait variables and falls among community-dwelling older adults living in snowy areas: a cross-sectional study

2025-06-18

Hideyuki Tashiro , Hikaru Ihira , Kazuki Yokoyama +7 more | Research Square (Research Square)

<title>Abstract</title> Purpose To examine whether kinematic gait variables are related to fall history during the winter and non-winter seasons in community-dwelling older adults living in snowy regions. Methods This cross-sectional … <title>Abstract</title> Purpose To examine whether kinematic gait variables are related to fall history during the winter and non-winter seasons in community-dwelling older adults living in snowy regions. Methods This cross-sectional study included 287 community-dwelling older adults (mean age, 77.6 ± 5.7 years; sex, 69.0% female) living in Hokkaido, Japan. The fall history in winter and non-winter seasons was assessed through face-to-face interviews. Spatiotemporal gait variables, including gait speed, cadence, stride length, stride length variability, double support time, and double support time variability, were measured using an electronic gait analysis system. Results The prevalence of falls was 19.5% (n = 56) during winter and 18.1% (n = 52) during non-winter months. Logistic regression analyses showed no significant associations between gait variables and a history of falls during winter. However, during non-winter months, a shorter stride length (odds ratio, 0.98; 95% confidence interval, 0.96–0.99; <italic>p</italic> = 0.027) was significantly associated with a history of falls, even after controlling for age, sex, body mass index, living alone, polypharmacy, fear of falling, cognitive function, and depressive symptoms. Conclusion Spatiotemporal gait variables played a lesser role in identifying risk factors for fall history during winter compared to non-winter months in community-dwelling older adults living in snowy regions.

Effectiveness of Yoga along with Occupational Therapy Intervention on Balance and Gait in Older Adults

2025-06-18

Priyanka Bhama , Gunjan Kumar , A Aneesh +2 more | International Journal of Health Sciences and Research

Background: Falls are a leading cause of morbidity among the elderly, with fear of falling (FoF) contributing to reduced physical activity, social participation, and quality of life. Evidence suggests that … Background: Falls are a leading cause of morbidity among the elderly, with fear of falling (FoF) contributing to reduced physical activity, social participation, and quality of life. Evidence suggests that structured physical activity, including occupational therapy and yoga, may enhance balance and gait performance. However, limited research exists on their combined impact. Methodology: A randomized controlled trial was conducted among 56 community-dwelling older adults aged 60–80 years with balance impairments or FoF. Participants were randomly assigned to either a control group receiving occupational therapy (OT) intervention or an experimental group receiving OT combined with yoga. Both groups underwent 12 weeks of bi-weekly sessions. Balance and gait were assessed using the Performance Oriented Mobility Assessment II (POMA II) at baseline and post-intervention. Statistical analysis was conducted using paired and independent t-tests with a significance level of p<0.005. Results: Both groups demonstrated significant improvements in POMA II scores post-intervention. The experimental group showed greater improvements across multiple components including chair balance (p=0.001), standing balance (p=0.000), and gait elements such as walk initiation and step characteristics (p<0.05). Though both interventions were beneficial, the addition of yoga in the experimental group yielded superior outcomes in several domains, suggesting a synergistic effect. Conclusion: Occupational therapy interventions, both alone and in combination with yoga, effectively improved balance and gait in older adults, contributing to a reduced risk of falls. The integration of yoga further enhanced these benefits, highlighting its potential as a valuable adjunct to traditional OT programs. Key words: occupational therapy, elderly, yoga, balance, fall prevention

Unique Impact of Strengthening of Ankle Eversion Muscles with Proprioceptive Indoctrination in Older Adults for Fall Prevention- A Case Report

2025-06-18

Pooja Chaurasia | International Journal of Health Sciences and Research

Falls are a major concern for older adults, with around one-third of individuals aged 65 and above experiencing them. Key contributors to these falls include muscle weakness-particularly in the ankle … Falls are a major concern for older adults, with around one-third of individuals aged 65 and above experiencing them. Key contributors to these falls include muscle weakness-particularly in the ankle eversion muscles-and compromised proprioception. These factors not only lead to significant injuries but also contribute to considerable healthcare costs and impacts on quality of life. This case study aims to enhance our understanding by examining the impact of strengthening ankle eversion muscles alongside proprioceptive training in older adults who have a history of recurrent falls. To measure outcomes, we utilized muscle strength grading for the ankle eversion muscles, the Timed Up and Go (TUG) test, and the Berg Balance Scale (BBS), and readings were noted on pre and post-treatment. Current study findings demonstrate that the unique impact of strengthening ankle eversion muscles with proprioceptive indoctrination in older adults for fall prevention can effectively improve balance and reduce the risk of falls in older adults. The notable enhancements in muscle strength, balance, and functional mobility seen in this patient underscore the necessity of integrating these exercises into fall prevention strategies. As our population continues to age, implementing evidence-based interventions like this becomes essential to ensure the health, safety, and independence of older adults. Key words: Fall prevention, Strengthening ankle eversion muscles, Proprioception training, older adults.

The contribution of vestibular and proprioceptive signals to trunk stabilization varies between postural tasks and between walking speeds.

2025-06-17

Y. Li , Sjoerd M. Bruijn , Koen K. Lemaire +2 more | bioRxiv (Cold Spring Harbor Laboratory)

Abstract Stabilizing the upright posture of the trunk relies on vestibular and proprioceptive afference. Previous studies found that the feedback responses to sensory afference vary between postures and tasks. We … Abstract Stabilizing the upright posture of the trunk relies on vestibular and proprioceptive afference. Previous studies found that the feedback responses to sensory afference vary between postures and tasks. We investigated whether and how vestibular and proprioceptive afference contribute to trunk stabilization during different postural tasks, and during walking at different speeds. Twelve healthy adults performed tasks in a random order: sitting, standing on the right foot or both feet, and treadmill walking at five speeds: 0.8, 2.0, 3.2, 4.3 and 5.5 km/h, while exposed to unilateral muscle vibration on the right paraspinal muscles at the level of the second lumbar vertebra, or to a step-like electrical vestibular stimulation (EVS) with the anode behind the left ear. The mediolateral displacements of markers at the sixth thoracic level and sacrum in the global coordinate system were used to evaluate the responses to sensory stimulation. No significant responses to EVS at T6 and sacrum level were found in sitting and standing. Responses to muscle vibration were significant and differed between unipedal standing compared to sitting and bipedal standing. The latter suggests a different interpretation of the sensation of muscle lengthening in these postures. The magnitude of the responses to both stimuli increased from very slow speeds to moderate speeds. This may indicate that a different control strategy is adopted in walking at slow speeds compared to walking at faster speeds. From moderate to high speeds, the responses decreased, suggesting a decreased demand for feedback control at higher speeds.

Challenges and opportunities for falls prevention: an online survey across European healthcare professionals

2025-06-17

Lotta J. Seppälä , James Frith , Dawn A. Skelton +7 more | European Geriatric Medicine

Prediction of future aging-related slow gait and its determinants with deep learning and logistic regression

2025-06-17

Alison Deatsch , Michael J. McKenna , Jonathan Palumbo +5 more | PLoS ONE

Background Identification of accelerated aging and its biomarkers can lead to more timely therapeutic interventions and decision-making. Therefore, we sought to predict aging-related slow gait, a known predictor of accelerated … Background Identification of accelerated aging and its biomarkers can lead to more timely therapeutic interventions and decision-making. Therefore, we sought to predict aging-related slow gait, a known predictor of accelerated aging, and its determinants. Methods We applied a deep learning neural network (NN) and compared it to conventional logistic regression (LR) analysis. We incorporated 1,363 participants from the Baltimore Longitudinal Study of Aging to predict current and future slow gait at 6-year and 10-year follow-up using two clinically-relevant cut-points. Results Our NN achieved a maximum sensitivity (specificity) of 81.2% (87.9%), for a 10-year prediction with 0.8 m/s cut-point. We demonstrated the necessity of class balancing and found the NN to perform comparably to or in some cases, better than, LR which achieved a maximum sensitivity and specificity of 84.5% and 86.3%, respectively. Sobol index analysis identified the strongest determinants to be age, BMI, sleep, and grip strength. Conclusions The novel use of a NN for this purpose, and successful benchmarking against conventional techniques, justifies further exploration and expansion of this model.

Proprioceptive Control of Muscle Activation in Aging: Implications for Balance and Fall Risk

2025-06-16

Łukasz Oleksy , Anna Mika , Martyna Sopa +7 more | Biology

(1) Background: This study aimed to assess whether older adults exhibit greater discrepancies between intended and actual motor unit recruitment, which could affect the quality of muscle activation and potentially … (1) Background: This study aimed to assess whether older adults exhibit greater discrepancies between intended and actual motor unit recruitment, which could affect the quality of muscle activation and potentially increase the risk of falls. (2) Methods: Forty-eight physically active older women were assessed (65 ± 6 years, 164 ± 6 cm, and 76 ± 7 kg). The bioelectrical activity (EMG) of the vastus lateralis oblique (VLO) and vastus medialis oblique (VMO) muscles were assessed during isometric testing with the knee joint bent to 75 degrees. The participants were instructed to press against a stable bar for 5 s at a specific percentage of their perceived force level (at 15%, 30%, and 60% of MVC) when the EMG activity was recorded. Balance was assessed using a stabilometric platform in a standing position. (3) Results: In all three thresholds, the bioelectrical activity of the VLO and VMO muscles significantly deviated from what was expected under the assumption of a nearly linear relationship between muscle force and bioelectrical activity. In each of the three thresholds, it did not exceed 10% MVC and significantly differed only between the 15% and 60% MVC thresholds. No significant differences were found between the dominant and non-dominant sides. A significant relationship was observed between the sway area (Area 95%) and the activity of the non-dominant limb VLO muscle. (4) Conclusions: Our results suggest that older adults experience deficits in muscle activation perception, leading to discrepancies between intended and actual muscle engagement, which may affect functional task performance and potentially increase fall risk.

A pilot study on the feasibility and initial outcomes of a telerehabilitation system for balance and cognitive training in older adults

2025-06-16

Milada Luisa Sedivcova , Karla Mothejlová , Karel Hána +2 more | Biomedical Papers

This randomized controlled multicentric pilot study aimed to evaluate the feasibility, safety, and preliminary clinical efficacy of a home-based telerehabilitation system for improving balance and cognitive function in older adults. … This randomized controlled multicentric pilot study aimed to evaluate the feasibility, safety, and preliminary clinical efficacy of a home-based telerehabilitation system for improving balance and cognitive function in older adults. The study was conducted in two four-week phases across multiple centres. In Phase A (n=18), participants were randomized into an experimental group (n=10) using a telerehabilitation balance training module (Stability Module) and a control group (n=8) receiving standard kinesiotherapy. In Phase B (n=11), a second cohort was randomized into an experimental group (n=5) receiving combined balance and cognitive training (Stability + ActiveCOG Modules) and a control group (n=6) receiving standard therapy. Outcomes were measured using the Berg Balance Scale (BBS) and Mini Mental State Examination (MMSE). Statistical analysis included paired t-tests, Fisher's exact test, Wilcoxon rank-sum test, and effect size estimation using Cohen's d. In Phase A, both the experimental and control groups showed significant within-group improvements in balance (BBS: P=0.004 and P=0.041, respectively), with no significant difference between groups. In Phase B, the intervention group demonstrated significant within-group improvements in both balance (BBS: P=0.009) and cognitive function (MMSE: P=0.034), while between-group differences did not reach statistical significance (P≥0.05). Effect sizes in Phase B suggested substantial clinical relevance (Cohen's d>1.0). The study confirmed the feasibility and safety of the telerehabilitation system and highlighted its usability in home environments. While preliminary clinical improvements were observed, particularly with combined motor-cognitive training, the small sample size limits definitive conclusions. These findings support the feasibility of larger, longer-term trials to further evaluate clinical efficacy and scalability.

The Role of Executive Function Domains on Cognitive and Gait Performance during Dual Task Walking in Healthy Young Adults: A Preliminary Study

2025-06-16

Young-Tae Lim , Shu-Wei Huang , Yan-Ci Liu | Gait & Posture

Concerns regarding falling after stroke: analysis of the psychometric properties of the Taiwan Chinese version of the Iconographical Falls Efficacy Scale in people with stroke

2025-06-15

Shu-Chun Lee , Chi-Tzu Feng , Chen‐Ju Lin +3 more | Disability and Rehabilitation

This study evaluated the validity and reliability of the 30- and 10-item Taiwan Chinese version of the Iconographical Falls Efficacy Scale (Icon-FES (TW)) for people with stroke. Sixty people with … This study evaluated the validity and reliability of the 30- and 10-item Taiwan Chinese version of the Iconographical Falls Efficacy Scale (Icon-FES (TW)) for people with stroke. Sixty people with chronic stroke completed the Taiwanese version of the Icon-FES, the International Falls Efficacy Scale, and the World Health Organization Quality of Life Questionnaire Brief version. They also completed the Berg Balance Scale (BBS) and the Short Physical Performance Battery (SPPB). After one week, they recompleted the Icon-FES. Discriminant validity, construct validity, internal consistency, and test-retest reliability were assessed. The 30- and 10-item Icon-FESs had high internal consistency (Cronbach's α = 0.971 and 0.912). Both versions significantly correlated with the International Falls Efficacy Scale (r = 0.87, 0.92) and showed associations with the SPPB, BBS, and the physical domain of the World Health Organization Quality of Life Questionnaire. They effectively differentiated people based on concern levels and BBS/SPPB scores. Test-retest reliability was high (ICC = 0.87, 0.86). The Icon-FES is a reliable and valid tool for assessing concerns regarding falling in people with stroke.

DETERMINANTS OF FALLS ON THE NOVEL STANDING-SLIP AND MOTOR LEARNING ON REPEATED STANDING-SLIPS AMONG PEOPLE WITH MULTIPLE SCLEROSIS

2025-06-14

Diané Brown , Feng Yang | Multiple Sclerosis and Related Disorders

Effectiveness of an Artificial Intelligence-Infused SinDance Exergame for Enhancing Physical Functions and Well-Being in Older Adults: A Pilot Randomized Controlled Trial

2025-06-13

Ying Jiang , Kei Oide , Yue En Chow +4 more | Journal of the American Medical Directors Association

Factors associated with fear of falling among Saudi community-dwelling older adults: A cross-sectional study

2025-06-13

Rehab Abdulrhman Al Harbi , Mohammed Taher Ahmed Omar , Samiha Mohamed Ibrahim Abd Elkader +2 more | Medicine

Fear of falling (FOF) is closely associated with increased disability among older adults, resulting in significant public health concerns. This study aimed to determine the risk factors and predictors of … Fear of falling (FOF) is closely associated with increased disability among older adults, resulting in significant public health concerns. This study aimed to determine the risk factors and predictors of falling (FOF) in older adults in Saudi Arabia. This cross-sectional study recruited 170 older adults (aged ≥ 60 years) from 3 tertiary hospitals and the Geriatric Society Center in Jeddah. FOF was assessed using the Falls Efficacy Scale-International (FES-I). Data were collected using the short Geriatric Depression Scale-15 (GDS-15) and physical functional assessments, including activities of daily living questionnaire, time up and go test, and hand grip strength. The prevalence of FOF among the older Saudi adults was 46.5%. Predictors of FOF included poor health perception (OR = 10.5, 95% CI = 1.26–87.73; P = .03), female gender (OR = 6.17, 95% CI = 1.57–24.14; P = .009), vision problems (OR = 3.81, 95% CI = 1.58–9.21; P = .003), a history of falls (OR = 3.29, 95% CI = 1.35–8.01; P = .009), and the timed up and go score (OR = 1.38, 95% CI = 1.09–1.17; P = .007), while no medication use is more likely to have less FOF (OR = 0.03, 95% CI = 0–0.40, P = .007). FOF is a prevalent issue and is associated with several factors, highlighting the importance of FOF assessments among older adults in Saudi Arabia.

Combined association of gait speed and processing speed on cardiometabolic disease mortality risk in the US older adults: a prospective cohort study from NHANES

2025-06-13

Hang Yang , Ye Zhou , Xiaoying Wang +1 more | Frontiers in Aging Neuroscience

Background Gait speed and processing speed, as measured by the Digit Symbol Substitution Test (DSST), are important indicators of health in older adults, with their potential impact on mortality risk. … Background Gait speed and processing speed, as measured by the Digit Symbol Substitution Test (DSST), are important indicators of health in older adults, with their potential impact on mortality risk. However, their combined effects on cardiometabolic disease (CMD) mortality remain unclear. Objective This study investigates how gait speed and cognitive function, individually and combined, influence CMD-specific and all-cause mortality in older adults. Methods Data were obtained from the National Health and Nutrition Examination Survey 1999–2002, with mortality follow-up linked to the National Death Index. Gait speed was measured by the timed 20-foot walk and processing speed was assessed using the DSST. Then the combined Gait-DSST groups were created and the Cox proportional hazards regression (HR) models were applied to examine their associations on CMD-specific and all-cause mortality, as well as the subgroup analyses stratified by age, sex and education. Results A total of 2,482 participants aged ≥60 years were included in the study with a median follow-up of 175 months, during which 587 CMD-specific deaths and 1,627 all-cause deaths were recorded. The slow gait was significantly associated with increased risk of CMD mortality, while low processing speed was only significantly associated with increased all-cause mortality risk. When analyzing the combined groups, individuals with slow gait and high processing speed exhibited a 86% increased risk of CMD mortality (HR = 1.86, 95% CI: 1.29, 2.68). However, the group with poor gait and processing speed had a twofold increased risk for all-cause mortality (HR = 2.01, 95% CI: 1.69, 2.39). The significant associations between slow gait with low processing speed and CMD mortality was more likely to be in age&lt;75 years, male, and less-educated populations. Conclusion Slow gait is a significant predictor of CMD-specific mortality in older adults, largely independent of processing speed. Routine screening of gait speed and DSST performance should be prioritized in clinical and public health settings. Future intervention studies should aim at elucidating the biological and behavioral mechanisms linking physical and cognitive function to CMD outcomes.

Gait Metrics in Elderly Fallers and Non-Fallers with Varying Levels of Glaucoma: A Longitudinal Prospective Cohort Study

2025-06-13

Louay Almidani , Jose Norberto S. Vargas , Zhuochen Yuan +6 more | Sensors

To understand the impact of falls on gait in those with poor sight, we examined how gait changed after falls in older adults with varying degrees of visual impairment from … To understand the impact of falls on gait in those with poor sight, we examined how gait changed after falls in older adults with varying degrees of visual impairment from glaucoma. Participants were classified as fallers or non-fallers based on prospective falls data from the first study year. Injurious fallers were those who suffered injuries from falls. The GAITRite Electronic Walkway characterized gait at baseline and three annual follow-ups. Parameters examined included stride length, variability in stride length (CV), stride velocity, stride velocity CV, base of support, base of support CV, and cadence. Longitudinal gait changes were assessed using generalized estimating equation models. Stride length significantly decreased in both fallers (β = −0.09 z-score unit/year) and non-fallers (β = −0.08 z-score unit/year), stride velocity slowed only among fallers (β = −0.08 z-score unit/year), and, in contrast, stride velocity CV decreased only among non-fallers (β = −0.07 z-score unit/year). No longitudinal differences were noted between groups. Additionally, no significant differences in gait metrics were observed between non-fallers, one-time fallers, and multiple fallers, nor between those with and without an injurious fall. Amongst older adults, and enriched for those with visual impairment, fallers and non-fallers adopted a more cautious gait over time, with similar gait changes across groups. Our results suggest that, in visual impairment, many falls may not lead to significant changes in gait.

Examining Different Motor Learning Paradigms for Improving Balance Recovery Abilities Among Older Adults Random versus Block training: A Randomized Controlled Pilot Trial

2025-06-13

Hadas Nachmani , Inbal Paran , Moti Salti +4 more | Gerontology

Introduction: Older adults can reduce the risk of falls after participation in a Perturbation-Based Balance Training (PBBT). We aimed to compare two perturbation motor learning paradigms: random vs block practice. … Introduction: Older adults can reduce the risk of falls after participation in a Perturbation-Based Balance Training (PBBT). We aimed to compare two perturbation motor learning paradigms: random vs block practice. Methods: Twenty community-dwelling older adults were recruited and randomly allocated to a random PBBT group (n=8), participants were exposed to unannounced perturbations in multiple directions during each training session, or a block PBBT group (n=12) participants experienced perturbations from a single during every training session during treadmill walking. Both groups received eight training sessions over a four-weeks period that included a concurrent cognitive task during training. Primary outcome measures were parameters of reactive stepping i.e., step-thresholds in walking and kinematics of reactive stepping during walking; and secondary outcome measures were proactive balance, i.e. voluntary step test and cognitive performance. All outcomes were measured before and after PBBT. Results: Both PBBT groups improved their ability to cope with higher perturbations post training and a reduction in Center of Mass path displacement during the recovery after the perturbation in walking. No improvement was found in voluntary stepping post training, both groups, however, showed improvement in cognitive performance post-training. Discussion: Results show some improvements in reactive stepping performance but not in proactive voluntary stepping in both random and block PBBT methods, with no superiority of one training method over the other. Some improvements in cognitive performance in both groups suggest a transfer effect post training, regardless of training method. Given the small sample size, results are preliminary and should be interpreted with caution.

Reasons for adhesion and adherence to a remote case management program for fall prevention delivered to older adults: a qualitative study

2025-06-13

Adão Porto Barros , Juliana Hotta Ansai , Maria Juana Beatriz Lima Candanedo +5 more | Revista Brasileira de Atividade Física & Saúde

Objective: To analyze the reasons for participation and retention of older adults who suffered at least two falls in the previous year in an online multidisciplinary case management program for … Objective: To analyze the reasons for participation and retention of older adults who suffered at least two falls in the previous year in an online multidisciplinary case management program for fall prevention, delivered remotely. Methods: Qualitative and observational study conducted in Brazil between 2021 and 2023, with 50 participants. Inclusion criteria were older adults with a history of at least two falls in the previous 12 months, the ability to walk, and access to resources for virtual communication. The 16-week intervention included case management on risk factors and supervised physical exercises. Sociodemographic data and answers to open ended questions about reasons for participation and retention were collected by video call and analyzed qualitatively using Bardin analysis. Results: Most participants were female (90%) and between 60 and 69 years of age (46%). The main reasons for participation were interest in the topic of falls (50.8%), the characteristics of the program being offered remotely and by a highly credible institution (16.9%), the provision of activities that promote quality of life and health (11.3%), and family encouragement (10.5%). Regarding retention, the characteristics of the program stood out in terms of the quality of the proposed model (41.2%), positive bond with researchers (33%), and contribution to research and the institution (8.2%). Conclusion: Reasons for participation and retention are related to the quality of the intrinsic characteristics of the program, which should be prioritized in order to increase the chances of greater implementation.

Association of intraindividual variability in simple reaction time with balance and falls in older cancer survivors: A secondary analysis

2025-06-13

Brendan McNeish , Claire Shores , Sarah Bell +7 more | Journal of Geriatric Oncology