Older Adults' Biobehavioral Fall Risks Were Affected by the COVID-19 Pandemic: Lessons Learned for Future Fall Prevention Research to Incorporate Multilevel Perspectives.

Background and Objectives: Examining the impact of coronavirus disease 2019 (COVID-19) pandemic on fall risks may provide insight into how multilevel factors as described in National Institute of Nursing Research's (NINR's) draft strategic plan can guide future fall prevention research. This article describes the affect of COVID-19 on fall risks from the perspective of older adults who live in assisted living facilities (ALFs), and explores the needs and approaches to implement fall prevention interventions at individual, social, community, and policy levels. Research Design and Methods: Exploratory survey study. Participants from a fall prevention study at 2 ALFs in Oregon were invited to the study. Survey questions asked about COVID experience, and changes in fall risks and day-to-day activities in Spring 2020. Quantitative responses were analyzed using descriptive statistics and Cohen's d effect sizes. Qualitative responses were analyzed using conventional content analysis. Results: Thirteen participants (age: M = 87.08, standard deviation = 6.52) responded. More participants reported feeling unsteady compared to pre-COVID data (38% vs. 62%), while the proportion of those worried about falling remained the same at 38%. Participants reported negligible decreases in importance of fall prevention and small decreases in confidence of fall prevention (Cohen's d = -0.13 and -0.21, respectively). The themes related to the affect of COVID on fall risks were: not to worry about fall risks but be cautious and physical activity is important, but it's hard during COVID. Impact of COVID on day-to-day activities were: varying degrees of concern for COVID, lack of social and community support, and finding unique ways to cope with COVID. Discussion and Implications: These individual-level perspectives suggest that older adults were at increased risk for falling. Results exemplify the influence of broader-level factors (e.g., social, community, and policy) on individual biobehavioral factors (e.g., fall risks and health behaviors), and illustrate the value of examining multilevel factors in future fall prevention research.

Remote administration of physical performance tests among persons with and without a cancer history: Establishing reliability and agreement with in-person assessment.

OBJECTIVES: To assess the reliability of using videoconference technology to remotely administer the Short Physical Performance Battery (SPPB), including the 5-time sit-to-stand (5XSTS) and usual 4-m walk (4mWT), and the Timed Up and Go (TUG) tests and agreement with in-person administration among adults with and without cancer. METHODS: Participants from two ongoing clinical exercise trials in cancer survivors, one that included partners without cancer, comprised the available sample (n = 176; mean age 62.5 ± 11.5 years.). Remote tests were administered on two separate days by either the same or a different assessor to determine intra-rater and inter-rater reliability, respectively. We also compared tests conducted remotely and in-person using the same assessor and the same participant. Intraclass correlation coefficients (ICC) and 95% confidence intervals (95% CI) were used for all comparisons, except for the SPPB score, which used Cohen's kappa and Krippendorf's alpha for intra- and inter-rater reliability, respectively. RESULTS: Remote assessment of the TUG test had excellent intra-rater reliability (0.98, 95% CI 0.93-0.99), inter-rater reliability (ICC = 0.96, 95% CI 0.90-0.99), and good agreement with in-person tests (ICC = 0.88, 95% CI 0.74-0.94). The 5XSTS and 4mWT showed excellent (ICC = 0.92, 95% CI 0.84-0.96) and good (ICC = 0.87, 95% CI 0.71-0.94) intra-rater reliability, respectively, but somewhat lower inter-rater reliability (5XSTS: ICC = 0.65, 95% CI 0.34-0.83 and 4mWT: ICC = 0.62, 95% CI 0.30-0.81). Remote 5XSTS had moderate agreement (ICC = 0.72, 95% CI 0.62-0.80) and 4mWT had poor agreement (ICC = 0.48, 95% CI -0.07-0.76) with in-person tests. CONCLUSIONS: Remote assessment of common physical function tests in older adults, including those who have cancer, is feasible and highly reliable when using the same assessor. TUG may be the most methodologically robust measure for remote assessment because it is also highly reliable when using different assessors and correlates strongly with in-person testing. Adapting administration of objective measures of physical function for the remote environment could significantly expand the reach of research and clinical practice to assess populations at risk of functional decline.