Failure on the Foam Eyes Closed Test of Standing Balance Associated With Reduced Semicircular Canal Function in Healthy Older Adults.

OBJECTIVES: Standing on foam with eyes closed (FOEC) has been characterized as a measure of vestibular function; however, the relative contribution of vestibular function and proprioceptive function to the FOEC test has not been well described. In this study, the authors investigate the relationship between peripheral sensory systems (vestibular and proprioception) and performance on the FOEC test in a cohort of healthy adults. DESIGN: A total of 563 community-dwelling healthy adults (mean age, 72.7 [SD, 12.6] years; range, 27 to 93 years) participating in the Baltimore Longitudinal Study of Aging were tested. Proprioceptive threshold (PROP) was evaluated with passive motion detection at the right ankle. Vestibulo-ocular reflex (VOR) gain was measured using video head impulses. Otolith function was measured with cervical and ocular vestibular-evoked myogenic potentials. Participants stood on FOEC for 40 sec while wearing BalanSens (BioSensics, LLC, Watertown, MA) to quantify center of mass sway area. A mixed-model multiple logistic regression was used to examine the odds of passing the FOEC test based on PROP, VOR, cervical vestibular-evoked myogenic potential, and ocular vestibular-evoked myogenic potential function in a multisensory model while controlling for age and gender. RESULTS: The odds of passing the FOEC test decreased by 15% (p < 0.001) for each year of increasing age and by 8% with every 0.1 reduction in VOR gain (p = 0.025). Neither PROP nor otolith function was significantly associated with passing the FOEC test. CONCLUSIONS: Failure to maintain balance during FOEC may serve as a proxy for rotational vestibular contributions to postural control. Semicircular canals are more sensitive to low-frequency motion than otoliths that may explain these relationships because standing sway is dominated by lower frequencies. Lower VOR gain and increased age independently decreased the odds of passing the test.

Fear of falling and its association with life-space mobility of older adults: a cross-sectional analysis using data from five international sites.

Background: fear of falling (FOF) is a major health concern among community-dwelling older adults that could restrict mobility. Objective: to examine the association of FOF with life-space mobility (i.e. the spatial area a person moves through in daily life) of community-dwelling older adults from five diverse sites. Methods: in total, 1,841 older adults (65-74 years) were recruited from Kingston, Canada; Saint-Hyacinthe, Canada; Tirana, Albania; Manizales, Colombia and Natal, Brazil. FOF was assessed using the Fall Efficacy Scale-International (FES-I total score), and the life space was quantified using the Life-Space Assessment (LSA), a scale that runs from 0 (minimum life space) to 120 (maximum life space). Results: the overall average LSA total score was 68.7 (SD: 21.2). Multiple-linear regression analysis demonstrated a significant relationship of FOF with life-space mobility, even after adjusting for functional, clinical and sociodemographic confounders (B = -0.15, 95% confidence interval (CI) -0.26 to -0.04). The FOF × site interaction term was significant with a stronger linear relationship found in the Canadian sites and Tirana compared with the South American sites. After adjusting for all confounders, the association between FOF with LSA remained significant at Kingston (B = -0.32, 95% CI -0.62 to -0.01), Saint-Hyacinthe (B = -0.81, 95% CI -1.31 to -0.32) and Tirana (B = -0.57, 95% CI -0.89 to -0.24). Conclusion: FOF is an important psychological factor that is associated with reduction in life space of older adults in different social and cultural contexts, and the strength of this association is site specific. Addressing FOF among older adults would help improve their mobility in local communities, which in turn would improve social participation and health-related quality of life.

Sex-specific age associations of ankle proprioception test performance in older adults: results from the Baltimore Longitudinal Study of Aging.

OBJECTIVES: this study was aimed to test the hypothesis that ankle proprioception assessed by custom-designed proprioception testing equipment changes with ageing in men and women. METHODS: ankle proprioception was assessed in 289 participants (131 women) of the Baltimore Longitudinal Study of Aging (BLSA); the participants aged 51-95 years and were blinded during testing. RESULTS: the average minimum perceived ankle rotation was 1.11° (SE = 0.07) in women and 1.00° (SE = 0.06) in men, and it increased with ageing in both sexes (P < 0.001, for both). Ankle tracking performance, which is the ability to closely follow with the left ankle, a rotational movement induced on the right ankle by a torque motor, declines with ageing in both men and women (P = 0.018 and P = 0.011, respectively). CONCLUSIONS: a simple, standardised method for assessing ankle proprioception was introduced in this study using a customized test instrument, software and test protocol. Age-associated reduction in ankle proprioception was confirmed from two subtests of threshold and tracking separately for women and men. Findings in this study prompt future studies to determine whether these age-associated differences in the threshold for passive motion detection and movement tracking are evident in longitudinal study and how these specific deficits in ankle proprioception are related to age-associated chronic conditions such as knee or hip osteoarthritis and type II diabetes and affect daily activities such as gait.

Sensorimotor and psychosocial determinants of 3-year incident mobility disability in middle-aged and older adults.

OBJECTIVE: to identify sensorimotor and psychosocial determinants of 3-year incident mobility disability. DESIGN: prospective. SETTING: population-based sample of community-dwelling older persons. PARTICIPANTS: community-living middle-aged and older persons (age: 50-85 years) without baseline mobility disability (n = 622). MEASUREMENTS: mobility disability, defined as self-reported inability to walk a quarter mile without resting or inability to walk up a flight of stairs unsupported, was ascertained at baseline and 3-year follow-up. Potential baseline determinant characteristics included demographics, education, social support, financial condition, knee extensor strength, visual contrast sensitivity, cognition, depression, presence of chronic conditions and history of falls. RESULTS: a total of 13.5% participant reported 3-year incident mobility disability. Age ≥75 years, female sex, knee extensor strength in the lowest quartile, visual contrast sensitivity <1.7 on the Pelli-Robson chart or significant depressive symptoms (CESD score >16) were independent determinants of 3-year incident mobility disability (ORs 1.84-16.51). CONCLUSIONS: low visual contrast sensitivity, poor knee extensor strength and significant depressive symptoms are independent determinants of future onset of mobility disability.

Spinal Anaesthesia Using Hypobaric Drugs: A Review of Current Evidence.

Spinal anesthesia is one of the most widely used techniques in modern anesthesia practice. It involves the injection of local anesthetic drugs into the cerebrospinal fluid (CSF) within the subarachnoid space. The choice of drug, its concentration, and baricity play a crucial role in determining the characteristics of the spinal block and has evolved over the years with continuous advancements in drug formulations and administration methods. Spinal anesthesia with hypobaric drugs represents a valuable technique in the armamentarium of anesthesiologists, offering distinct advantages in terms of targeted action, reduced systemic toxicity, and enhanced hemodynamic stability. This review aims to scan the characteristics of hypobaric drugs, factors influencing their spread within the spinal canal, challenges associated with their use, clinical applications in various surgical scenarios, and potential implications for patient outcomes and healthcare practice. PubMed and Google Scholar databases were searched for relevant articles and a total of 23 relevant articles were selected for the review based on inclusion and exclusion criteria. Hypobaric drugs have many advantages in high-risk morbidly ill patients for some select surgical procedures and daycare surgeries. The concentration and volume of hypobaric drugs need to be selected according to the extensiveness of the surgery and the desired block can be achieved by giving spinal injection in specific positions. The dynamic field of anesthesiology encompasses the integration of emerging technologies and evidence-based practices, which will contribute to further refining the safety and efficacy of spinal anesthesia with hypobaric drugs.

Predicting 3-year incident mobility disability in middle-aged and older adults using physical performance tests.

OBJECTIVE: To identify a standard physical performance test, which can predict 3-year incident mobility disability independent of demographics. DESIGN: Longitudinal cohort study. SETTING: Population-based middle-aged and older adult cohort assessment performed at a local geriatric clinical center. PARTICIPANTS: Community-living middle-aged and older persons (age, 50-85y) without baseline mobility disability (N=622). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mobility disability was ascertained at baseline and at 3-year follow-up using an established self-report method: self-reported inability to walk a quarter mile without resting or inability to walk up a flight of stairs unsupported. Physical performance tests included self-selected usual gait speed, time required to complete 5 times sit-to-stand (5TSTS), and 400-m brisk walking. Demographic variables age, sex, height, and weight were recorded. RESULTS: Overall, 13.5% participants reported 3-year incident mobility disability. Usual gait speed <1.2m/s, requiring >13.6 seconds to complete 5TSTS, and completing 400m at <1.19m/s walking speed were highly predictive of future mobility disability independent of demographics. CONCLUSIONS: Inability to complete 5TSTS in <13.7 seconds can be a clinically convenient guideline for monitoring and for further assessment of middle-aged and older persons, in order to prevent or delay future mobility disability.

Validity and reliability of the Brazilian activities-specific balance confidence scale and determinants of balance confidence in community-dwelling older adults.

Introduction: The Activities-specific Balance Confidence scale is the most used tool to quantify balance confidence, a psychological factor related to balance impairment among older adults. Objective: To investigate the validity and reliability of the original and short versions of the Brazilian Activities-specific Balance Confidence scales, to determine cutoff points for balance impairments and to identify the determinants of balance confidence of community-dwelling older adults.Methods: The validity of both versions of the scales was verified by correlating its results with postural balance, fear of falling and mobility (n = 105). Both scales were administered with a 30 min (interrater reliability, n = 158) and 1-week intervals (intrarater reliability, n = 105). Receiver operating characteristic curve was used to determine the cutoff points, and linear regression was applied to identify the determinants of balance confidence.Results: The Brazilian versions of the scale correlated to postural balance, fear of falling and mobility (p < .05). Excellent interrater (α = 0.946, 95% CI: 0.902-0.976; α = 0.932, 95% CI: 0.918-0.960) and intrarater reliability (α = 0.946, 95% CI: 0.905-0.960; α = 0.952, 95% CI: 0.921-0.965) were found for the original and short versions.  Values of ≤67% (sensitivity: 81%, specificity: 77.4%) and ≤44% (sensitivity: 87.5%, specificity: 82.1%) were observed to identify balance impairments for the original and short versions of the scale. Physical inactivity, fear of falling, imbalance sensation, and number of falls are the main determinants of balance confidence.Conclusion: Both scales are valid and reliable to assess balance confidence. Cutoff points to identify balance impairments were determined and some factors may act as possible predictors of balance confidence.

Sensorimotor and psychosocial correlates of adaptive locomotor performance in older adults.

OBJECTIVE: To identify sensorimotor and psychosocial factors independently associated with an inability to perform adaptive walking tasks in older adults. DESIGN: Cross-sectional cohort study. SETTING: Population-based older cohort. PARTICIPANTS: Community-living elderly (N=720; age ≥65y) who could walk 7m at self-selected normal speed. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Walking performance was assessed in 4 walking tests: fast walking, obstacle crossing, narrow-based walking, and walking while talking. Possible correlates of the inability to perform the walking test included knee extensor strength, lower limb coordination, Cumulative Somatosensory Impairment Index (CSII), visual acuity and contrast sensitivity, cognition, depression, personal mastery, social support, and years of education. RESULTS: The results of binary logistic regression analyses, adjusted for demographics and self-selected normal speed, demonstrated that poor knee extensor strength was associated with an inability to perform tasks demanding an increase in walking speed (fast walking and obstacle crossing). Both poor lower limb coordination and higher CSII were significantly associated with failure in tests that demanded precise control over foot placement (obstacle crossing and narrow-based walking). Higher CSII was associated with failure in all tests except in the walking while talking. In contrast, poor cognition was associated with an inability to perform walking while talking. Poor personal mastery was the only variable that was associated with failure in all walking tests. CONCLUSIONS: The results demonstrated a systematic and coherent pattern in these associations and indicated possible sensorimotor and psychological parameters that should be specifically investigated and should be intervened if a patient reports a difficulty/inability in walking in certain situations.

Validity of clinically derived cumulative somatosensory impairment index.

DESIGN: Prospective cohort study. SETTING: Population-based cohort. PARTICIPANTS: InCHIANTI ("Invecchiare in Chianti" or aging in the Chianti area) study participants (N=960; age, 21-91 y, 51.8% women). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Cumulative Somatosensory Impairment Index was derived from baseline performance on clinical tests of pressure sensitivity, vibration sensitivity, proprioception, and graphesthesia. Global postural control was assessed using Frailty and Injuries Cooperative Studies of Intervention Techniques (FICSIT) balance test, time to complete 5 repeated chair stands, and fast walking speed, at baseline and at 3-year follow-up. RESULTS: In participants without neurologic conditions (n=799), the Cumulative Somatosensory Impairment Index was significantly different in age groups classified by decades (P<.001). Compared with participants without prevalent conditions, the Cumulative Somatosensory Impairment Index was significantly higher in persons with diabetes (P=.017), peripheral arterial disease (P=.006), and a history of stroke (P<.001). In the overall population (N=960), in the fully adjusted multiple regression models, the Cumulative Somatosensory Impairment Index independently predicted deterioration in FICSIT scores (P=.002), time for 5 repeated chair stands (P<.001), and fast gait speed (P=.003) at 3-year follow-up. CONCLUSIONS: The Cumulative Somatosensory Impairment Index is a valid measure that detects relevant group differences in lower limb somatosensory impairment and is an independent predictor of decline in postural control over 3 years.

Vestibular and Cardiovascular Responses After Long-Duration Spaceflight.

BACKGROUND: The vestibulo-sympathetic reflex operates during orthostatically challenging movements to initiate cardiovascular responses in advance of a baroreceptor-mediated response. The objective of this study was to determine whether there was an association between changes in vestibular function and cardiovascular responses during a prone-to-stand movement in astronauts after return from long-duration spaceflight.METHODS: Thirteen crewmembers who participated in International Space Station missions were tested before spaceflight and 1 d after landing. Vestibular function was evaluated by computerized dynamic posturography while their head was erect and while they performed dynamic head tilts. Heart rate and mean arterial blood pressure were measured while the subjects were in prone and standing positions.RESULTS: The 21.4% increase in the astronauts' heart rate during the prone to stand maneuver after spaceflight correlated significantly with their spaceflight-induced 48.7% decrease in postural stability during dynamic head tilts. The larger mean arterial pressure in the prone position after spaceflight compared to preflight (+7%) also correlated with the postflight decrease in postural stability during dynamic head tilts.CONCLUSION: These results indicate that an appropriate vestibular function is important to evoke optimum vestibulo-sympathetic response during orthostatically challenging voluntary movements performed after spaceflight. They also suggest that there may be a greater need to generate an anticipatory cardiovascular response after spaceflight.Deshpande N, Laurie SS, Lee SMC, Miller CA, Mulavara AP, Peters BT,Reschke MF, Stenger MB, Taylor LC, Wood SJ, Clément GR, Bloomberg JJ. Vestibular and cardiovascular responses after long-duration spaceflight. Aerosp Med Hum Perform. 2020; 91(8):621-627.

Gait speed under varied challenges and cognitive decline in older persons: a prospective study.

OBJECTIVE: to examine whether usual gait speed, fast gait speed or speed while walking with a cognitive or neuromuscular challenge predicts evolving cognitive decline over 3 years. DESIGN: prospective study. SETTING: population-based sample of community-dwelling older persons. PARTICIPANTS: 660 older participants (age > or = 65 years). MEASUREMENTS: usual gait speed, fastest gait speed, gait speed during 'walking-while-talking', depression, comorbidities, education, smoking and demographics were assessed at baseline. Cognition was evaluated at baseline and follow-up. A decline in MMSE score by > or = 3 points was considered as significant cognitive decline (SCD). RESULTS: adjusting for confounders, only fast speed was associated with cognitive performance at 3-year follow-up. One hundred thirty-five participants had SCD over 3 years. Participants in the lowest quartile of usual speed or walking-while-talking speed were more likely to develop SCD. Conversely, participants in the third and fourth quartiles of fast speed were more likely to develop SCD. J-test showed that the model including fast speed quartiles as a regressor was significantly more predictive of SCD than the models with usual speed or walking-while-talking speed quartiles. CONCLUSION: measuring fast gait speed in older persons may assist in identifying those at high risk of cognitive decline.

Interpreting fear of falling in the elderly: what do we need to consider?

PURPOSE: Fear of falling (FF) is a serious problem in elderly. Available scales quantify FF by generating an aggregate total FF score disregarding the environment in which fear is expressed. This study examined the differences in psychosocial and physical characteristics and global functional capabilities between the elderly who experienced FF exclusively for activities usually performed in community environments and those who reported FF only for home-based activities. METHODS: Older participants (age > or = 65, n = 1155) enrolled in the InCHIANTI study completed the evaluation of FF, personal mastery, depression, cognition, social support, lower limb strength, grip strength, balance, timed repeated sit-to-stand performance, visual acuity, and contrast sensitivity. Functional capacity measures included walking speed, ADL and IADL disability, self-reported difficulty climbing steps without support and difficulty walking at least 400m. Only those who reported FF exclusively for activities usually performed in the community environment (n = 232) or in home environment (n = 110) were included in the analysis. RESULTS: Multivariate analysis of variance revealed that those who reported FF exclusively for home-based activities were significantly worse in psychosocial and physical characteristics measured (F(1,339) = 4.27; p < 0.01) and were also less able in all global functional capacity measures (p = 0.04 to < 0.01). CONCLUSIONS: There are significant characteristic and functional differences between the older persons who have FF performing community environment activities and those who express FF in home environment activities. The results strongly indicate the need to classify FF according to the environment or alternatively, to derive an aggregate score by appropriately weighting according to the environment, for valid interpretation of FF.

Visual-Vestibular Interaction for Postural Control During Sit-to-Stand: Effects of Aging.

During sit-to-stand (STS), the vestibular system is highly stimulated in response to linear acceleration of the head and may play an important role, in addition to vision, for postural control. We examined the effects of aging on visual-vestibular interaction for postural control during STS in 15 young (22.5 ± 1.1 years) and 15 older (73.9 ± 5.3 years) participants. Vestibular information was manipulated using galvanic vestibular stimulation. Vision conditions involved normal (eyes open), suboptimal (blurring goggles), and no (eyes closed) vision. Older participants had significantly greater mediolateral peak-to-peak trunk roll (p = .025) and center of mass displacements (p < .001) than young participants. However, despite having greater mediolateral instability, older participants utilized similar strategies as young participants to overcome sensory perturbations during STS. Overall visual inputs were more dominantly used for mediolateral trunk control during STS than vestibular inputs.

Head and Trunk Control While Walking in Older Adults with Diabetes: Effects of Balance Confidence.

Investigations of gait in older adults with diabetes mellitus (DM) have been primarily focused on lower limb biomechanical parameters. Yet, the upper body accounts for two thirds of the body's mass, and head and trunk control are critical for balance. The authors examined head and trunk control during self-selected comfortable, fast, and dual-task walking and the relationship between balance confidence and potential head-trunk stiffening strategies in older adults with DM without diagnosed diabetic peripheral neuropathy (DPN). Twelve older adults with DM without diagnosed DPN (DM group) and 12 without DM (no-DM group) were recruited. Walking speed, peak-to-peak head and trunk roll displacement, head and trunk roll velocity, and head-trunk correlation were measured while walking at a self-selected comfortable or fastest possible speed with or without a secondary cognitive task. The Activities-specific Balance Confidence scale measured balance confidence. Subtle group differences in axial segmental control (lower trunk roll velocity; higher head-trunk correlation) were apparent in older adults with DM even in the absence of DPN. Balance confidence was 19% lower in the DM group than in the no-DM group, and partially explained (34%) the group difference in head-trunk stiffening. These results emphasize the need for proactive monitoring of postural control and balance confidence before the onset of DPN.

Fear of Falling and Balance Confidence in Older Adults With Type 2 Diabetes Mellitus: A Scoping Review.

Type 2 diabetes mellitus is highly prevalent in older adults (≥65 years of age) and increases fall risk. Fear of falling and low balance confidence are reported in both fallers and nonfallers and can potentially be more debilitating than a fall itself. Therefore, the objective of this scoping review was to examine and map the current research evidence of balance confidence and fear of falling in older adults with type 2 diabetes. A search of CINAHL, EMBASE and PubMed was conducted. The search included MeSH terms and the key terms diabet* AND fear OR falls AND self-efficacy OR balance confidence. Inclusion criteria were 1) population: older adults (≥65 years of age) with type 2 diabetes; and 2) outcome measure: balance confidence or fear of falling. We included 21 studies: fear of falling (n=14); balance confidence (n=7). We categorized them into 4 themes: prevalence, severity, determinants and interventions. Determinants were further categorized into physical, psychosocial and health-related domains. Fear of falling and low balance confidence were highly prevalent and more severe in older adults with type 2 diabetes. Determinants of fear of falling and balance confidence occurred beyond the physical domain and the presence of diabetic peripheral neuropathy. Targeted group-based interventions (e.g. gait and balance training, tai chi, yoga) appear to be beneficial in reducing fear of falling and improving balance confidence. Future work is needed to generate best practices related to fear of falling and low balance confidence in older adults with type 2 diabetes.

Fear of Falling in Older Adults with Diabetes Mellitus: The IMIAS Study.

ABSTRACTSeveral determinants of developing fear of falling (FoF) overlap with the consequences of diabetes mellitus (DM). We compared the prevalence and severity of FoF in older adults with and without DM and identified which FoF determinants contribute to FoF severity in older adults with DM. We used Canadian baseline data from the International Mobility in Aging Study (IMIAS) which identified 141 older adults with DM (DM-group;age:68.88±2.80years) and 620 without DM (noDM-group;age:68.81±2.68years). FoF was quantified with Falls Efficacy Scale-International (FES-I). FoF determinants were evaluated in demographic/health-related, physical, psychological, and social domains. High concern of FoF was more prevalent and of higher severity in 10/16 FES-I activities in the DM-group compared to the noDM-group. Higher FoF severity in the DM-group was associated with poor physical performance, being female, fall history, and clinical depressive symptoms. Protocols developed for screening and interventions may reduce FoF severity in this population.

Factors Associated With Visual Impairment and Eye Care Utilization: The International Mobility in Aging Study.

OBJECTIVE: To examine factors associated with visual impairment (VI) and eye care in the International Mobility in Aging Study (IMIAS). METHOD: IMIAS data were analyzed ( N = 1,995 with ages 65-74). Outcomes were VI defined as presenting visual acuity worse than 6/18 in the better eye and eye care utilization assessed by annual visits to eye care professionals. The Hurt-Insult-Threaten-Scream (HITS) questionnaire requested information on domestic violence. RESULTS: Among men, VI varied from 24% in Manizales (Colombia) to 0.5% in Kingston (Canada); among women, VI ranged from 20% in Manizales to 1% in Kingston; lifetime exposure to domestic violence was associated with VI (odds ratio [OR] = 1.87; 95% confidence interval [CI] = [1.17, 3.00]). Eye care utilization varied from 72% in Kingston's men to 25% in Tirana's men; it was associated with domestic violence (prevalence ratio [PR] = 1.3; 95% CI = [1.1, 1.6]). DISCUSSION: VI is more frequent where eye care utilization is low. Domestic violence may be a risk factor for VI.

The Short Version of the Activities-Specific Balance Confidence Scale for Older Adults with Diabetes-Convergent, Discriminant and Concurrent Validity: A Pilot Study.

OBJECTIVES: The short version of the Activities-Specific Balance Confidence Scale (ABC-6) is advantageous in busy clinical or research settings because it can be administered in less time than the original 16-item Activities-Specific Balance Confidence Scale (ABC-16). This pilot study examined the convergent, discriminant and concurrent validity of the ABC-6 in older adults with diabetes mellitus with and without diagnosed diabetic peripheral neuropathy (DPN). METHODS: Thirty older adults (aged ≥65) were age- and sex-matched in 3 groups: 10 with diabetes (DM group), 10 with diagnosed DPN (DPN group) and 10 without diabetes (no-DM group). Balance confidence was quantified by the ABC-16, which includes the ABC-6. Potential correlates were evaluated in physical and psychological domains. RESULTS: The ABC-6 and ABC-16 balance confidence scores were strongly correlated (r=0.969; p<0.001; convergent validity). The ABC-6 revealed significant differences in balance confidence between the no-DM and the DM groups (p<0.001; discriminant validity), whereas the ABC-16 did not (p>0.05). The ABC-6 was moderately, but significantly, correlated with physical activity level (r=0.528; p=0.017), mobility (r=-0.520; p=0.027), balance (r=0.633; p=0.003), and depressive symptoms (r=-0.515; p=0.020) in the DM study groups (concurrent validity). CONCLUSIONS: The ABC-6 and ABC-16 had excellent convergent validity, and both ABC scales had similar concurrent validity. However, the ABC-6 was more sensitive in detecting subtle differences in balance confidence in older adults with diabetes without diagnosed DPN than the ABC-16. Overall, this pilot study provided evidence of the validity of the ABC-6 in older adults with diabetes. Further exploration involving a larger sample size is recommended to confirm these findings.

Sensory Functions, Balance, and Mobility in Older Adults With Type 2 Diabetes Without Overt Diabetic Peripheral Neuropathy: A Brief Report.

This study examined possible subtle degradation in sensory functions, balance, and mobility in older adults with type 2 diabetes (T2D) prior to overt development of diabetic peripheral neuropathy (DPN). Twenty-five healthy controls (HC group, age = 74.6 ± 5.4) and 35 T2D elderly without DPN (T2D group, age = 70.6 ± 4.7) were recruited. Sensory assessment included vibrotactile sensitivity, bilateral caloric weakness, and visual contrast sensitivity. Self-report measures comprised of Activity-Specific Balance Confidence (ABC), Human Activity Profile-adjusted activity scores (HAP-AAS), falls, and mobility disability. Performance measures included modified Timed-Up and Go (mTUG), Clinical Test of Sensory Integration for Balance (mCTSIB), and Frailty and Injuries (FICSIT-4) balance test. T2D group demonstrated significantly worse bilateral caloric weakness, marginally higher threshold of vibrotactile sensitivity and lower visual contrast sensitivity, and as well as signifcantly lower HAP-AAS. A significantly higher proportion of the T2D group failed mCTSIB Condition 4 than in the HC group. Subtle changes in multiple sensory systems of older adults with T2D may reduce redundancy available for balance control while performing challenging activities much before DPN development.

Effectiveness of Otolith Repositioning Maneuvers and Vestibular Rehabilitation exercises in elderly people with Benign Paroxysmal Positional Vertigo: a systematic review.

INTRODUCTION: Benign Paroxysmal Positional Vertigo is highly prevalent in elderly people. This condition is related to vertigo, hearing loss, tinnitus, poor balance, gait disturbance, and an increase in risk of falls, leading to postural changes and quality of life decreasing. OBJECTIVE: To evaluate the outcomes obtained by clinical trials on the effectiveness of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises in the treatment of Benign Paroxysmal Positional Vertigo in elderly. METHODS: The literature research was performed using PubMed, Scopus, Web of Science and PEDro databases, and included randomized controlled clinical trials in English, Spanish and Portuguese, published during January 2000 to August 2016. The methodological quality of the studies was assessed by PEDro score and the outcomes analysis was done by critical revision of content. RESULTS: Six studies were fully reviewed. The average age of participants ranged between 67.2 and 74.5 years. The articles were classified from 2 to 7/10 through the PEDro score. The main outcome measures analyzed were vertigo, positional nystagmus and postural balance. Additionally, the number of maneuvers necessary for remission of the symptoms, the quality of life, and the functionality were also assessed. The majority of the clinical trials used Otolith Repositioning Maneuver (n=5) and 3 articles performed Vestibular Rehabilitation exercises in addition to Otolith Repositioning Maneuver or pharmacotherapy. One study showed that the addition of movement restrictions after maneuver did not influence the outcomes. CONCLUSION: There was a trend of improvement in Benign Paroxysmal Positional Vertigo symptomatology in elderly patients who underwent Otolith Repositioning Maneuver. There is sparse evidence from methodologically robust clinical trials that examined the effects of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises for treating Benign Paroxysmal Positional Vertigo in the elderly. Randomized controlled clinical trials with comprehensive assessment of symptoms, quality of life, function and long-term follow up are warranted.