Aging in 10 Minutes: Do Age Simulation Suits Mimic Physical Decline in Old Age? Comparing Experimental Data with Established Reference Data.

INTRODUCTION: Age simulation suits are increasingly used in health care education. However, empirical evidence that quantifies the simulated performance losses in established geriatric tests and compares those declines with reference data of older adults is scarce. METHODS: In a standardized lab setting, we compared performance of N = 61 participants (46 middle-aged, 15 young adults) with and without age simulation suit, for example in the Timed Up and Go Test (+dual task), Short Physical Performance Battery, grip strength, and 30-Second-Chair- Standing Test. Additionally, we compared the results with suit to established reference values of older adults in different age groups. RESULTS: Reduced performance was observed in both groups when wearing the suit, yet to different degrees dependent on the assessment and user age. For one, larger declines were observed in more challenging and complex tasks across age groups. In addition, comparisons with reference values revealed age-differential "instant aging" effects. DISCUSSION: A simulated "fourth age," where frailty and impairments are accumulating, was not reached in the majority of assessments, especially not among younger participants. In conclusion, existing age simulation suits may have some educational and empathy potential, but so far, they fail in simulating the age period with most serious functional loss.

Towards Using the Instrumented Timed Up-and-Go Test for Screening of Sensory System Performance for Balance Control in Older Adults.

Background: Decreasing performance of the sensory systems' for balance control, including the visual, somatosensory and vestibular system, is associated with increased fall risk in older adults. A smartphone-based version of the Timed Up-and-Go (mTUG) may allow screening sensory balance impairments through mTUG subphases. The association between mTUG subphases and sensory system performance is examined. Methods: Functional mobility of forty-one community-dwelling older adults (>55 years) was measured using a validated mTUG. Duration of mTUG and its subphases 'sit-to-walk', 'walking', 'turning', 'turn-to-sit' and 'sit-down' were extracted. Sensory systems' performance was quantified by validated posturography during standing (30 s) under different conditions. Visual, somatosensory and vestibular control ratios (CR) were calculated from posturography and correlated with mTUG subphases. Results: Vestibular CR correlated with mTUG total time (r = 0.54; p < 0.01), subphases 'walking' (r = 0.56; p < 0.01), and 'turning' (r = 0.43; p = 0.01). Somatosensory CR correlated with mTUG total time (r = 0.52; p = 0.01), subphases 'walking' (r = 0.52; p < 0.01) and 'turning' (r = 0.44; p < 0.01). Conclusions: Supporting the proposed approach, results indicate an association between specific mTUG subphases and sensory system performance. mTUG subphases 'walking' and 'turning' may allow screening for sensory system deterioration. This is a first step towards an objective, detailed and expeditious balance control assessment, however needing validation in a larger study.

[Influence of dual-tasking on straight ahead and curved walking in older adults]. / Einfluss von Dual-Tasking auf das Geradeaus- und Kurvengehen älterer Menschen.

BACKGROUND: Walking is not an automatic movement task but requires continuous attention resources. While walking and undertaking an additional task (dual tasking), gait changes occur which are associated with falls in older adults. To date, the evaluation of gait characteristics under dual task conditions is typically performed during walking straight ahead (SW); however, everyday life also requires more complex walking maneuvers such as walking in a curve (CW). Complex walking maneuvers may require higher attentional resources and thus might have a greater impact on the gait under dual task conditions. OBJECTIVE: The aim was to compare the gait characteristics under dual task conditions during SW and CW. MATERIAL AND METHODS: In 30 community-dwelling older adults (mean age: 71.6 ± 6.6 years) gait parameters including single leg support phase, velocity, cadence, step length and width were measured by electronic gait analysis (GAITRite®, CIR Systems Inc., Franklin, New Jersey, USA) during SW and CW under single and dual task conditions. For each gait parameter the relative change from single to dual task condition was calculated as dual task costs (DTC) and compared using paired t­tests. RESULTS: For the single leg support phase, velocity, cadence and step width, descriptive results showed increased DTC during CW (2.08-23.74%) as compared to SW (1.39-12.90%). For cadence (DTC: SW 6.81 ± 12.58%, CW 10.54 ± 13.46%, p = 0.026) and step width (DTC: SW -12.90 ± 18.01%, CW -23.74 ± 56.37%, p = 0.004) the differences were statistically significant. CONCLUSION: The relative decline in gait performance under dual task conditions is greater during CW than during SW. The results suggest that CW requires greater attentional resources as compared to SW. In turn, the risk of falling might be increased during CW under dual task conditions. The present findings may contribute to the development of new, ecologically valid assessment and training strategies taking complex walking maneuvers into account.

German version of the Community Balance and Mobility Scale : Translation and evaluation of measurement properties.

BACKGROUND: Tools to detect subtle balance deficits in high-functioning community-dwelling older adults are lacking. The Community Balance and Mobility Scale (CBM) is a valuable tool to measure balance deficits in this group; however, it is not yet available in the German language. OBJECTIVE: The aim was 1) to translate and cross-culturally adapt the CBM into the German language and 2) to investigate the measurement properties of the German CBM (G-CBM). MATERIAL AND METHODS: The original CBM was translated into the German language according to established guidelines. A total of 51 older adults (mean age 69.9 ± 7.1 years) were recruited to measure construct validity by comparing the G­CBM against standardized balance and/or mobility assessments including the Fullerton Advanced Balance Scale (FAB), Berg Balance Scale (BBS), 3 m Tandem Walk (3MTW), 8 Level Balance Scale (8LBS), 30 s Chair Stand Test (30CST), Timed Up and Go (TUG) test, gait speed, and the Falls Efficacy Scale International (FES-I). Intrarater and interrater reliability and internal consistency reliability were estimated using intraclass correlations (ICC) and Cronbach's alpha, respectively. Ceiling effects were calculated as the percentage of the sample scoring the maximum score. RESULTS: The G­CBM correlated excellently with FAB and BBS (ρ = 0.78-0.85; P < 0.001), good with 3MTW, TUG, and FES-I (ρ = -0.55 to -0.61; P < 0.001), and moderately with 8LBS, 30CST, and habitual gait speed (ρ = 0.32-0.46; P < 0.001). Intrarater (ICC3,k = 0.998; P < 0.001) and interrater (ICC2,k = 0.996; P < 0.001) reliability, and internal consistency reliability (α = 0.998) were also high. The G­CBM did not show ceiling effects. CONCLUSION: The G­CBM is a valid and reliable tool for measuring subtle balance deficits in older high-functioning adults. The absence of ceiling effects emphasizes the use of this scale in this cohort. The G­CBM can now be utilized in clinical practice.

Effects of Wearable Sensor-Based Balance and Gait Training on Balance, Gait, and Functional Performance in Healthy and Patient Populations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Wearable sensors (WS) can accurately measure body motion and provide interactive feedback for supporting motor learning. OBJECTIVE: This review aims to summarize current evidence for the effectiveness of WS training for improving balance, gait and functional performance. METHODS: A systematic literature search was performed in PubMed, Cochrane, Web of Science, and CINAHL. Randomized controlled trials (RCTs) using a WS exercise program were included. Study quality was examined by the PEDro scale. Meta-analyses were conducted to estimate the effects of WS balance training on the most frequently reported outcome parameters. RESULTS: Eight RCTs were included (Parkinson n = 2, stroke n = 1, Parkinson/stroke n = 1, peripheral neuropathy n = 2, frail older adults n = 1, healthy older adults n = 1). The sample size ranged from n = 20 to 40. Three types of training paradigms were used: (1) static steady-state balance training, (2) dynamic steady-state balance training, which includes gait training, and (3) proactive balance training. RCTs either used one type of training paradigm (type 2: n = 1, type 3: n = 3) or combined different types of training paradigms within their intervention (type 1 and 2: n = 2; all types: n = 2). The meta-analyses revealed significant overall effects of WS training on static steady-state balance outcomes including mediolateral (eyes open: Hedges' g = 0.82, CI: 0.43-1.21; eyes closed: g = 0.57, CI: 0.14-0.99) and anterior-posterior sway (eyes open: g = 0.55, CI: 0.01-1.10; eyes closed: g = 0.44, CI: 0.02-0.86). No effects on habitual gait speed were found in the meta-analysis (g = -0.19, CI: -0.68 to 0.29). Two RCTs reported significant improvements for selected gait variables including single support time, and fast gait speed. One study identified effects on proactive balance (Alternate Step Test), but no effects were found for the Timed Up and Go test and the Berg Balance Scale. Two studies reported positive results on feasibility and usability. Only one study was performed in an unsupervised setting. CONCLUSION: This review provides evidence for a positive effect of WS training on static steady-state balance in studies with usual care controls and studies with conventional balance training controls. Specific gait parameters and proactive balance measures may also be improved by WS training, yet limited evidence is available. Heterogeneous training paradigms, small sample sizes, and short intervention durations limit the validity of our findings. Larger studies are required for estimating the true potential of WS technology.

"If this is what it means to be old ": a mixed methods study on the effects of age simulation on views on aging and perceptions of age-related impairments.

Age simulation suits are a promising tool to increase empathy and to promote positive attitudes toward older adults. However, studies have largely focused on (young) healthcare professionals, are probably biased by social desirability, and have not addressed participants' views of the aging process triggered by the simulation. The current work combines two studies addressing effects of aging suits on both general and personal views on aging among heterogeneous samples, and exploring spontaneous associations during the simulation. In study 1, N = 165 adults (M = 37.1 years, SD = 15.4, range 18-74 years) answered questionnaires containing general views regarding older adults ("old people are…") as well as personal perceptions ("aging means to me…") before and after wearing an aging suit. In study 2, young adults (N = 22; M = 24.8 years, SD = 4.3, range 20-38 years) and middle-aged adults (N = 41; M = 60.8 years, SD = 6.9, range 40-75 years) carried out established geriatric assessments with and without aging suit, and spontaneous impressions on the instant aging experience were recorded. Findings indicated negative shifts in both general and personal views on aging measures in both age groups (d = .30 to d = .44). Analyses of qualitative data resulted in seven main themes, e.g., "strain/coordination", "future me", "empathy/insight". Group comparisons revealed higher frequencies of future-self related thoughts among middle-aged adults, whereas younger adults mentioned predominantly physical effects of the suit. In conclusion, applying age simulation suits might evoke unintended negative views on aging. In comparison with young adults, middle-aged adults showed broader reflections including thoughts related to emotions, future-self, and potential struggles of older people.

"Aging Means to Me That I Feel Lonely More Often"? An Experimental Study on the Effects of Age Simulation Regarding Views on Aging.

Over the last decades, educational programs involving age simulation suits (ASS) emerged with the ambition to further the understanding of age-related loss experiences, enhance empathy and reduce negative attitudes toward older adults in healthcare settings and in younger age groups at large. However, the impact of such "instant aging" interventions on individuals' personal views on aging have not been studied yet. The aim of the current study is to address possible effects of ASS interventions on multiple outcomes related to views on aging, i.e., aging-related cognitions (i.e., expectations regarding social losses), awareness of age-related change (AARC) and age stereotypes. Moreover, we explore effects on broader constructs with relevance to aging, i.e., perceived obsolescence, risk perceptions, as well as desired support through technology. In a within-subjects design, N = 40 participants (M = 61.4 years, SD = 6.16) went through a series of established geriatric assessments (i.e., Timed up and Go) with and without an ASS. Views on aging constructs were assessed in standardized questionnaires before and after the ASS intervention. Changes in aging-related cognitions were observed, with more negative expectations regarding social integration and continuous development after wearing the ASS. AARC and age stereotypes did not change from pre- to post-assessment, but participants reported an increased susceptibility to age-associated impairments and stronger feelings of obsolescence. Those participants who exhibited higher difficulties in geriatric assessments while wearing the suit reported higher openness to be supported by intelligent assistive devices or robots afterwards. We conclude that ASS interventions should only be combined with education on losses and gains during the aging process to prevent negative effects on individual views on aging. On the other hand, potentials regarding technology acceptance and formation of intentions to engage in prevention and health behaviors among middle-aged to young-old adults are discussed.

Effects of age simulation suits on psychological and physical outcomes: a systematic review.

Age simulation suits (ASS) are widely used to simulate sensory and physical restrictions that typically occur as people age. This review has two objectives: first, we synthesize the current research on ASS in terms of the observed psychological and physical effects associated with ASS. Second, we analyze indicators able to estimate the validity of ASS in simulating "true" ageing processes. Following the PRISMA guidelines, eight electronic databases were searched (BASE, Cinhal, Cochrane, Google Scholar, ProQuest, PsychINFO, Pubmed, and Web of Science). Qualitative and quantitative studies addressing effects of ASS interventions regarding psychological outcomes (i.e., empathy, attitudes) or physical parameters (i.e., gait, balance) were included. The Mixed Methods Appraisal Tool was applied for quality assessment. Of 1890 identified citations, we included 94 for full-text screening and finally 26 studies were examined. Publication years ranged from 2001 to 2021. Study populations were predominantly based on students in health-related disciplines. Results suggest that ASS can initiate positive effects on attitudes toward (d weighted = 0.33) and empathy for older adults (d weighted = 0.54). Physical performance was significantly reduced; however, there is only little evidence of a realistic simulation of typical ageing processes. Although positive effects of ASS are supported to some extent, more diverse study populations and high-quality controlled designs are needed. Further, validation studies examining whether the simulation indeed reflects "real" ageing are needed and should build on reference data generated by standardized geriatric assessments or adequate comparison groups of older adults. Prospero registration: 232686. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00722-1.