Improved Prediction of Falls in Community-Dwelling Older Adults Through Phase-Dependent Entropy of Daily-Life Walking.
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ABSTRACT:
SUBMITTER: Ihlen EAF
PROVIDER: S-EPMC5844982 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundWalking speed is an important measure associated with health outcomes in older individuals, such as dependency and death. This study aimed to examine whether the walking speed of community-dwelling older adults varies between time periods within a day, as measured outdoors in daily life. We aimed to determine the types of walking speed variations and examine the factors associated with them.MethodsDaily life outdoor walking speed was measured in 92 participants (average age 71.9 years±5.64) using a GPS smartphone app for 1 month. Average walking speeds for five time periods were analyzed with a linear mixed model. Intra-day walking speed variation patterns were classified by latent class analysis. Factors associated with the class were identified by logistic regression analysis.ResultsA statistically significant difference in average walking speed was found between early morning (1.33 m/s), and afternoon (1.27 m/s) and evening (1.26 m/s) (p < 0.01). The intra-day variation in walking speed was attributed to variation in cadence. Two classes were identified: (1) fast walking speed with large variation and (2) slow walking speed with little variation; hypertension and frailty level were associated with the class.ConclusionThe results suggest that there is intra-day variation in walking speed in daily life, wherein the speed is the fastest early in the morning and slower in the afternoon and evening. A larger variation in the walking speed was related to the health status without hypertension or frailty. These results suggest that if a person shows less intra-day variation in walking speed, this could be a sign that they are susceptible to hypertension and an increased frailty level.
| S-EPMC8268528 | biostudies-literature
Project description:IntroductionFalls are a worldwide health problem among community-dwelling older adults. Emerging evidence suggests that foot problems increase the risk of falling, so the podiatrist may be crucial in detecting foot-related fall risk. However, there is no screening tool available which can be used in podiatry practice. The predictive value of existing tools is limited, and the implementation is poor. The development of risk models for specific clinical populations might increase the prediction accuracy and implementation. Therefore, the aim of this study was to develop and internally validate an easily applicable clinical prediction model (CPM) that can be used in podiatry practice to predict falls in community-dwelling older adults with foot (-related) problems.MethodsThis was a prospective study including community-dwelling older adults (≥65 years) visiting podiatry practices. General fall-risk variables, and foot-related and function-related variables were considered as predictors for the occurrence of falls during the 12-month follow-up. Logistic regression analysis was used for model building, and internal validation was done by bootstrap resampling.Results407 participants were analyzed; the event rate was 33.4%. The final model included fall history in the previous year, unsteady while standing and walking, plantarflexor strength of the lesser toes, and gait speed. The area under the receiver operating characteristic curve was 0.71 (95% CI: 0.66-0.76) in the sample and estimated as 0.65 after shrinkage.ConclusionA CPM based on fall history in the previous year, feeling unsteady while standing and walking, decreased plantarflexor strength of the lesser toes, and reduced gait speed has acceptable accuracy to predict falls in our sample of podiatry community-dwelling older adults and is easily applicable in this setting. The accuracy of the model in clinical practice should be demonstrated through external validation of the model in a next study.
| S-EPMC9677838 | biostudies-literature
Project description:Falls and fall-related fractures are a major public health problem among the older adults. Although objective measures of poor vision have been reported to be associated with falls, the association of self-reported visual function and vision-specific quality of life (QOL) with falls has been inconsistent across several studies. We investigated the association of self-reported visual function and vision specific QOL with falls in community-dwelling older adults.We conducted a cross-sectional analysis using the baseline data from participants of the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS), which is an ongoing population-based cohort study to evaluate the association of physical dysfunction with the clinical outcomes in community-dwelling people. In the present study, the participants aged over 65 years in 2010 were eligible. The exposure variable was the composite score of the VFQ-J11, which was newly developed using item response theory to evaluate vision specific QOL, and the self-reported outcomes were any fall and frequent falls (≥2) over a 1-month period. We estimated odds ratios using separate logistic regression models adjusted for relevant confounding factors.Among 1624 participants, the median (interquartile range) composite score of VFQ-J11 was 86.8 (76.0-95.9). Any fall and frequent falls were reported by 13.9% and 5.4% of participants, respectively. The composite score of the VFQ-J11 was significantly associated with both frequent falls (adjusted ORs per 10 points, 0.80; 95% CI, 0.68-0.93) and any fall (adjusted ORs per 10 points, 0.84; 95% CI, 0.76-0.94).We found that the composite score of the VFQ-J11 was associated with falls in community-dwelling older adults. Detecting individuals with visual impairments associated with falls using the VFQ-J11 and improvement in the score by interventions could prevent falls. We may consider adding self-reported visual function and vision-specific QOL to conventional risk factors for fall among older adults.
| S-EPMC5978984 | biostudies-literature
Project description:ObjectivesTo determine the relationship between neighborhood-level socioeconomic characteristics, life-space mobility, and incident falls in community-dwelling older adults.DesignProspective, observational cohort study with a baseline in-home assessment and 6-month telephone follow-up.SettingCentral Alabama.ParticipantsCommunity-dwelling adults aged 65 and older recruited from a random sample of Medicare beneficiaries (N = 1,000).MeasurementsNeighborhood disadvantage was measured using a composite index derived from baseline neighborhood-level residential census tract socioeconomic variables. Data on individual-level socioeconomic characteristics, clinical variables, and life-space collected at baseline were included as covariates in a multivariate model using generalized estimating equations to assess the association with incident falls in the 6 months after baseline.ResultsOf the 940 participants who completed baseline and follow-up assessments, 126 (13%) reported one or more new falls in the 6 months after baseline. There was an independent nonlinear association between neighborhood disadvantage (according to increasing quartiles of disadvantage) and incident falls after adjusting for confounders: The lowest quartile served as reference; 2nd quartile odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.2-4.6; 3rd quartile OR = 1.9, 95% CI = 1.0-3.7; 4th quartile OR = 3.2, 95% CI = 1.7-6.0. Each 10-point decrement in life-space (OR = 1.2, 95% CI = 1.0-1.3) was associated with a higher risk of falls.ConclusionGreater neighborhood disadvantage was associated with greater risk of falls. Life-space also contributes separately to fall risk. Community-dwelling older adults in disadvantaged neighborhoods, particularly those with limited mobility, may benefit from a more-rigorous assessment of their fall risk by healthcare providers. Neighborhood level socioeconomic characteristics should also be an important consideration when identifying vulnerable populations that may benefit the most from fall prevention programs.
| S-EPMC6986269 | biostudies-literature
Project description:Older adults who report environmental barriers in their neighborhood have a higher risk for walking difficulty. However, environmental facilitators that protect against walking difficulty are not well known. The objective of this study was to identify the effect of environmental facilitators for outdoor walking on development of walking difficulty in community-dwelling older people. This was a prospective study with a 3.5-year follow-up time on 261 community-dwelling people aged 75-81 years, who at baseline were able to walk 0.5 km without difficulty. Environmental facilitators for outdoor walking were self-reported with standardized questionnaires, including having features in one's home which make it easy to access the outdoors, having a park or other green area within a walking distance from home, having outdoor recreational facilities within a walking distance from home, having features in the nearby environment, which are attractive for outdoor activities, and perceiving the surrounding environment or facilities nearby as motivating factors for physical activity. Self-reported difficulty in walking 0.5 km was assessed every 6 months. Of the participants, 46 % developed walking difficulty during the follow-up. Having a park or other green area within a walking distance from home was the most frequently reported facilitator. Environmental facilitators decreased the risk for development of walking difficulty, hazard ratio per item 0.86, (95 % confidence interval 0.73-1.02). The results indicate that the mobility of older community-dwelling people may be promoted with outdoor recreational facilities that are easy to access and located within a walking distance from home.
| S-EPMC5549184 | biostudies-other
Project description:Little is known about the landing behavior of the trailing (recovery) foot and ensuing types of falls following a forward slip in walking. The purposes of this study were to (1) determine if community-dwelling older adults experienced bilateral slips at the same rate as had been previously observed for young adults during over-ground walking; (2) determine if fall rate in older adults was dependent on slip type (unilateral vs. bilateral); and (3) identify differences in spatiotemporal variables of the trailing leg step between unilateral and bilateral slips. One-hundred-seventy-four participants experienced an unannounced, unrehearsed slip while walking on a 7-m walkway. Each trial was monitored with a motion capture system and bilateral ground reaction force plates. Although the experimental design, developed with original data from a young adult population, favored bilateral slips, more older adults (35%) than anticipated (10% previously observed in young, p<0.001) displayed a unilateral slip. The probability of fall was equal in the two types of slips. Eighty-two people recovered from the slip, while the remaining 92 (53%) fell. These 92 were classified into two exclusive categories based on the heel distance at the time of fall arrest using cluster analysis: those which resembled a fall into a "splits" position (n=47) or a feet-forward fall (n=45). All (100%) unilateral slips led to splits falls, as expected. Yet, not all bilateral slips (only 83%) resulted in feet-forward falls. A longer forward recovery step with a prolonged step time led to both feet slipping, nearly together, hence a feet-forward fall.
| S-EPMC3390203 | biostudies-literature
Project description:BackgroundFall injuries are a leading cause of death in older adults. The potential impact of chronic pain characteristics on risk for injurious falls is not well understood. This prospective cohort study examined the relationship between chronic pain and risk for injurious falls in older adults.MethodThe MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older living in and around Boston, Massachusetts. Chronic pain characteristics, including pain severity, pain interference, and pain distribution, were measured at baseline using the Brief Pain Inventory subscales and a joint pain questionnaire. Occurrence of falls and fall-related injuries were recorded using monthly fall calendar postcards and fall follow-up interviews during the 4-year follow-up period.ResultsNegative binomial regression models showed that pain interference and pain distribution, but not pain severity, independently predicted injurious falls adjusting for potential confounders. Participants in the highest third of pain interference scores had a 61% greater risk of injurious falls compared to those reporting little or no pain interference. Compared to no pain, multisite pain was associated with a 57% greater risk of injurious falls. Stratified by gender, the association was only significant in women. In the short term, moderate-to-severe pain in a given month was associated with increased risk of injurious falls in the subsequent month.ConclusionsGlobal pain measures are associated with increased risk of injurious falls in older adults. Pain assessment should be incorporated into fall risk assessments. Interventions are needed to prevent fall injuries among elders with chronic pain.
| S-EPMC8499212 | biostudies-literature
Project description:To calculate the prevalence of all falls, non-accidental falls and syncope in an older population and characterize cardiovascular risk profiles.Prospective, longitudinal cohort study.The first two waves of data from the Irish Longitudinal Study on Ageing (TILDA).8172 community-dwelling adults aged 50 years and older resident in the Republic of Ireland.Self-reported history of all falls, non-accidental falls and syncope in the year preceding the first two waves of data collection. Demographic factors and self-reported cardiovascular conditions were used to characterize cardiovascular risk profiles.The prevalence of all falls in the past year was 19.2% or 192 per thousand persons and increased with age (50-64 years 17.5%; 65-74 years 19.4%; 75+ years 24.4%). Non-accidental falls had an estimated prevalence of 5.1% or 51 falls per thousand persons and accounted for 26.5% of all falls reported and also increased with age (50-64 years 4.0%; 65-74 years 5.5%; 75+ years 8.0%). The prevalence for syncope was estimated to be 4.4% or 44per thousand persons but did not show a similar age gradient. Participants with at least 5 cardiovascular conditions were more likely to report all falls (OR = 2.07, 95% CI 1.18-3.64, p<0.05) and NAF (OR = 2.89, 95%CI 1.28-6.52, p<0.05).The prevalence of all falls and non-accidental falls increases with age but the same pattern was not consistently observed for syncope. There is an increased odds of reporting all three outcomes with increasing number of self-reported cardiovascular conditions. Further work is needed to uncover the interplay between cardiovascular disease and subsequent falls.
| S-EPMC5521793 | biostudies-other
Project description:BackgroundFalls among older adults is a common precipitating factor for unintentional injuries and represent a major health problem associated with increased morbidity, mortality, and health care cost in low-and-middle-income countries. The burden of fall in this population is well established in high-income countries and scant attention is given to this precipitating factor in low-and-middle-income countries, including Ethiopia. Therefore, this study aimed to estimate the prevalence and factors associated with fall among community-dwelling older adults in Ethiopia.MethodsA community-based cross-sectional study was conducted among community-dwelling older adults of Gondar. Multi-stage random sampling technique was used across administrative areas. Six hundred and five households were selected proportionally using systematic random sampling technique. Physical measurement and face to face interview method were employed using a structured questionnaire for data collection. Data were analyzed descriptively and through uni- and multivariate logistic regression model.ResultsOne hundred and seventy (n = 170, 28.4%; 95% CI 24.7-32.1) community-dwelling older adults reported having experienced fall in the past 12 months. Sex (OR = 1.91, 95% CI: 1.24-2.95), low educational status (OR = 2.37, 95% CI: 1.19-4.74), uncomfortable home environment (OR = 2.02, 95% CI: 1.34, 3.04), having diagnosed medical condition (OR = 4.659, 95% CI: 1.20-18.02), and use of medication (OR = 5.57, 95% CI: 1.19-26.21) were significantly associated risk factors of self-reported fall in the past 12 months. Most outdoor falls are associated with females and participants aged below 66 years.ConclusionIn conclusion, more than 1/4th of the community-dwelling older adults experienced at least one episode of fall and about 60% of them reported recurrent falls. Identifying risk group and risk factors that could be modified so as to prevent falls in older adults deserves attention. Outdoor falls are usually attributable to modifiable environmental aspects and improvements in outdoor environment needed.
| S-EPMC6736232 | biostudies-literature
Project description:BackgroundFalls efficacy is a widely-studied latent construct in community-dwelling older adults. Various self-reported instruments have been used to measure falls efficacy. In order to be informed of the choice of the best measurement instrument for a specific purpose, empirical evidence of the development and measurement properties of falls efficacy related instruments is needed.MethodsThe Consensus-based Standards for the Selection of Health Measurement Intruments (COSMIN) checklist was used to summarise evidence on the development, content validity, and structural validity of instruments measuring falls efficacy in community-dwelling older adults. Databases including MEDLINE, Web of Science, PsychINFO, SCOPUS, CINAHL were searched (May 2019). Records on the development of instruments and studies assessing content validity or structural validity of falls efficacy related scales were included. COSMIN methodology was used to guide the review of eligible studies and in the assessment of their methodological quality. Evidence of content validity: relevance, comprehensiveness and comprehensibility and unidimensionality for structural validity were synthesised. A modified GRADE approach was applied to evidence synthesis.ResultsThirty-five studies, of which 18 instruments had been identified, were included in the review. High-quality evidence showed that the Modified Falls Efficacy Scale (FES)-13 items (MFES-13) has sufficient relevance, yet insufficient comprehensiveness for measuring falls efficacy. Moderate quality evidence supported that the FES-10 has sufficient relevance, and MFES-14 has sufficient comprehensibility. Activities-specific Balance Confidence (ABC) Scale-Simplified (ABC-15) has sufficient relevance in measuring balance confidence supported by moderate-quality evidence. Low to very low-quality evidence underpinned the content validity of other instruments. High-quality evidence supported sufficient unidimensionality for eight instruments (FES-10, MFES-14, ABC-6, ABC-15, ABC-16, Iconographical FES (Icon-FES), FES-International (FES-I) and Perceived Ability to Prevent and Manage Fall Risks (PAPMFR)).ConclusionContent validity of instruments to measure falls efficacy is understudied. Structural validity is sufficient for a number of widely-used instruments. Measuring balance confidence is a subset of falls efficacy. Further work is needed to investigate a broader construct for falls efficacy.
| S-EPMC7792090 | biostudies-literature