Characteristics of Unsuccessful Balance Reactive Responses to Lateral Loss of Balance in Older Adults.

INTRODUCTION: An effective reactive step response to an unexpected balance loss is an important factor that determines if a fall will happen. We investigated reactive step strategies and kinematics of unsuccessful balance recovery responses that ended with falls in older adults. METHODS: We compared the strategies and kinematics of reactive stepping after a lateral loss of balance, i.e., perturbations, between 49 older female adults who were able to successfully recover from perturbations (perturbation-related non-fallers, PNFs) and 10 female older adults who failed to recover (perturbation-related fallers, PFs). In addition, we compared the successful versus unsuccessful recovery responses of PFs matched to perturbation magnitude. RESULTS: The kinematics of the first reactive step response were significantly different between PFs and PNFs, i.e., longer initiation time, step time, swing time, and time to peak swing-leg velocity, larger first-step length, and center-of-mass displacement. Incomplete crossover stepping and leg collision were significant causes of falls among PFs. Similar findings were found when we compared the successful versus unsuccessful recovery responses of PFs. CONCLUSIONS: The crossover step, which requires a complex coordinated leg movement, resulted in difficulty in controlling and decelerating the moving center of mass following a lateral perturbation, affecting the kinematics of the stepping response, leading to a fall.

A survey of Israeli physical therapists regarding reactive balance training.

BACKGROUND: 'Reactive balance training' (RBT) was developed to improve balance reactions to unexpected losses of balance. Although this training method is effective, its practical usage in the field of physical-therapy in Israel and world-wide is still unclear. AIMS: This study aimed to evaluate the extent of RBT use in physical-therapy clinics in Israel, to identify the significant barriers to/facilitators for implementing RBT in clinical practice among physical therapists, and to determine which aspects of RBT most interest physical therapists in Israel. METHODS: Physical therapists in Israel completed a survey using a questionnaire regarding their knowledge and use of RBT in their clinical practices. We compared the specific use of RBT among users; non-users; and open-to-use physical therapists. The odds ratios of the facilitators and barriers were calculated using univariate and multivariate logistic regression models. RESULTS: Four-hundred and two physical therapists responded to a yes/no question regarding their use of RBT. Three-quarters (75.4%) of physical therapists reported using RBT in their practices. The most prevalent barrier cited was insufficient space for setting up equipment and most prevalent facilitator was having a colleague who uses RBT. Most of the respondents wanted to learn more about RBT, and most of the non-users wanted to expand their knowledge and mastery of RBT principles. CONCLUSIONS: There are misconceptions and insufficient knowledge about RBT among physical therapists in Israel, indicating that they may falsely believe that RBT requires large and expensive equipment, suggesting they categorize RBT as external perturbation training only. Reliable information may help to improve general knowledge regarding RBT, and to facilitate the more widespread implementation of RBT as an effective fall-prevention intervention method.

Development of an Elliptical Perturbation System that provides unexpected perturbations during elliptical walking (the EPES system).

BACKGROUND: 'Perturbation-based balance training' (PBBT) is a training method that was developed to improve balance reactive responses to unexpected balance loss. This training method is more effective in reducing fall rates than traditional balance training methods. Many PBBTs are performed during standing or treadmill walking which targeted specifically step reactive responses, we however, aimed to develop and build a mechatronic system that can provide unexpected perturbation during elliptical walking the Elliptical Perturbation System (the EPES system), with the aim of improving specifically the trunk and upper limbs balance reactive control. METHODS: This paper describes the development, and building of the EPES system, using a stationary Elliptical Exercise device, which allows training of trunk and upper limbs balance reactive responses in older adults. RESULTS: The EPES system provides 3-dimensional small, controlled, and unpredictable sudden perturbations during stationary elliptical walking. We developed software that can identify a trainee's trunk and arms reactive balance responses using a stereo camera. After identifying an effective trunk and arms reactive balance response, the software controls the EPES system motors to return the system to its horizontal baseline position after the perturbation. The system thus provides closed-loop feedback for a person's counterbalancing trunk and arm responses, helping to implement implicit motor learning for the trainee. The pilot results show that the EPES software can successfully identify balance reactive responses among participants who are exposed to a sudden unexpected perturbation during elliptical walking on the EPES system. CONCLUSIONS: EPES trigger reactive balance responses involving counter-rotation action of body segments and simultaneously evoke arms, and trunk reactive response, thus reactive training effects should be expected.

Daily Outdoor Cycling by Older Adults Preserves Reactive Balance Behavior: A Case-Control Study.

We examined whether older adults who cycle outdoors regularly have better reactive balance control than noncycling older adults. Sixteen cyclist older adults and 24 age-, sex-, and health-matched controls who did not cycle (noncyclists) were exposed to unannounced perturbations of increased magnitudes in standing. We evaluated the strategies and kinematics employed at each perturbation magnitude. We found that cyclists exhibited a significantly higher stepping threshold, lower probability of stepping at each perturbation magnitude, and lower number of trials in which the participant needed to make a step to retain their balance. Cyclists also tended to recover balance using unloaded leg strategies in the first recovery step rather than a loaded leg strategy; they showed faster swing phase duration in the first recovery step, better controlling the displacement of center of mass than noncyclists. Older adults who cycle regularly outdoors preserve their reactive balance functions, which may reduce fall risks.

The relevance of geriatric assessments on the association between chronic kidney disease stages and mortality among older people: a secondary analysis of a multicentre cohort study.

BACKGROUND: age-adapted definition of chronic kidney disease (CKD) does not take individual risk factors into account. We aimed at investigating whether functional impairments influence CKD stage at which mortality increases among older people. METHODS: our series consisted of 2,372 outpatients aged 75 years or more enrolled in a multicentre international prospective cohort study. The study outcome was 24-month mortality. Kidney function was assessed by estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Geriatric assessments included handgrip strength, short physical performance battery (SPPB), cognitive impairment, dependency in basic activities of daily living (BADL) and risk of malnutrition. Analysis was carried out by Cox regression, before and after stratification by individual functional impairments. Survival trees including kidney function and functional impairments were also investigated, and their predictivity assessed by C-index. RESULTS: overall, mortality was found to increase starting from eGFR = 30-44.9 ml/min/1.73 m2 (hazard ratio [HR] = 3.28, 95% confidence interval [CI] = 1.81-5.95) to ACR = 30-300 mg/g (HR = 1.96, 95%CI = 1.23-3.10). However, in survival trees, an increased risk of mortality was observed among patients with impaired handgrip and eGFR = 45-59.9 ml/min/1.73 m2, as well as patients with ACR < 30 mg/g and impaired handgrip and SPPB. Survival tree leaf node membership had greater predictive accuracy (C-index = 0.81, 95%CI = 0.78-0.84 for the eGFR survival tree and C-index = 0.77, 95%CI = 0.71-0.81 for the ACR survival tree) in comparison with that of individual measures of kidney function. CONCLUSIONS: physical performance helps to identify a proportion of patients at an increased risk of mortality despite a mild-moderate impairment in kidney function and improves predictive accuracy of individual measures of kidney function.

Characteristics of step responses following varying magnitudes of unexpected lateral perturbations during standing among older people - a cross-sectional laboratory-based study.

INTRODUCTION: The inability to recover from unexpected lateral loss of balance may be particularly relevant to the problem of falling. AIM: We aimed to explore whether different kinematic patterns and strategies occur in the first recovery step in single-step trials in which a single step was required to recover from a fall, and in multiple-step trials in which more than one step was required to recover from a fall. In addition, in the multiple-step trials, we examined kinematic patterns of balance recovery where extra steps were needed to recover balance. METHODS: Eighty-four older adults (79.3 ± 5.2 years) were exposed to unannounced right/left perturbations in standing that were gradually increased to trigger a recovery stepping response. We performed a kinematic analysis of the first recovery step of all single-step and multiple-step trials for each participant and of total balance recovery in the multiple-step trial. RESULTS: Kinematic patterns and strategies of the first recovery step in the single-step trials were significantly dependent on the perturbation magnitude. It took a small, yet significantly longer time to initiate a recovery step and a significantly longer time to complete the recovery step as the magnitude increased. However, the first recovery step in the multiple-step trials showed no significant differences between different perturbation magnitudes; while, in total balance recovery of these trials, we observed a small, yet significant difference as the magnitude increased. CONCLUSIONS: At relatively low perturbation magnitudes, i.e., single-step trials, older adults selected different first stepping strategies and kinematics as perturbation magnitudes increased, suggesting that this population activated pre-planned programs based on the perturbation magnitude. However, in the first recovery step of the multiple-step trials, i.e., high perturbation magnitudes, similar kinematic movement patterns were used at different magnitudes, suggesting a more rigid, automatic behavior, while the extra-steps were scaled to the perturbation magnitude. This suggest that older adults activate pre-planned programs based on the magnitude of the perturbation, even before the first step is completed..

Balance recovery stepping responses during walking were not affected by a concurrent cognitive task among older adults.

BACKGROUND: Most of older adults' falls are related to inefficient balance recovery after an unexpected loss of balance, i.e., postural perturbation. Effective balance recovery responses are crucial to prevent falls. Due to the considerable consequences of lateral falls and the high incidence of falls when walking, this study aimed to examine the effect of a concurrent cognitive task on older adults' balance recovery stepping abilities from unannounced lateral perturbations while walking. We also aimed to explore whether cognitive performance accuracy is affected by perturbed walking and between task trade-offs. METHODS: In a laboratory-based study, 20 older adults (> 70 years old) performed the following test conditions: (1) cognitive task while sitting; (2) perturbed walking; and (3) perturbed walking with a concurrent cognitive task. The cognitive task was serial numbers subtraction by seven. Single-step and multiple-step thresholds, highest perturbation achieved, 3D kinematic analysis of the first recovery step, and cognitive task performance accuracy were compared between single-task and dual-task conditions. Between task trade-offs were examined using dual-task cost (DTC). RESULTS: Single-step and multiple-step thresholds, number of recovery step trials, number of foot collision, multiple-step events and kinematic recovery step parameters were all similar in single-task and dual-task conditions. Cognitive performance was not significantly affected by dual-task conditions, however, different possible trade-offs between cognitive and postural performances were identified using DTC. CONCLUSIONS: In situations where postural threat is substantial, such as unexpected balance loss during walking, balance recovery reactions were unaffected by concurrent cognitive load in older adults (i.e., posture first strategy). The study was approved by the Helsinki Ethics Committee of Soroka University Medical Center in Beer-Sheva, Israel (ClinicalTrials.gov Registration number NCT04455607 , ID Numbers: Sor 396-16 CTIL; 02/07/2020).

Transient versus stable nature of fear of falling over 24 months in community-older persons with falls- data of the EU SCOPE project on Kidney function.

BACKGROUND: Fear of falling (FoF) is an important risk factor for falls among older people. The objectives of our investigations were: a.) to present characteristics of older community-dwelling (CD) fallers with persistent or transient FoF (P-FoF or T-FoF) over 12 months, and b.) to investigate clinical predictors of P-FoF and T-FoF and c.) to explore differences between P-FoF and T-FoF. METHODS: Our series consisted of 389 older people reporting a fall or injurious fall at baseline and during 24 months follow-up participating in a multicenter prospective study. T-FoF was defined as participants reported "not at all" at baseline and "somewhat/fairly/very concerned" at follow-up, or "not at all" at follow-up, and "somewhat/fairly/very concerned" at baseline, and P-FoF was defined as participants answered "somewhat/fairly/very concerned" in both assessments at baseline and at follow-up. The association between risk factors and T-FoF or P-FoF was investigated by logistic regression analysis. RESULTS: The mean age of fallers in our sample was 79.0 years (SD 6.0), and 54.2% were females. Out of 389 older adults with a fall history at baseline, 83 participants (21.3%) did not report any FoF over time, P-FoF and T-FoF were observed in 42.7% and 35.9% of participants, respectively. After adjusting for potential confounders (e.g. age, gender), osteoporosis (OR = 2.04, 95%CI = 1.03-4.05) and impaired physical performance (OR = 2.38, 95%CI = 1.12-5.03) were significant predictors of T-FoF vs No-FoF. Osteoporosis (OR = 2.68, 95%CI = 1.31-5.48), depressive symptoms (OR = 3.54, 95%CI = 1.23-10.1) and living alone (OR = 2.44, 95%CI = 1.17-5.06) were significantly associated with P-FoF vs No-FoF. When comparing T-FoF and P-FoF, female gender (OR = 1.95, 95%CI = 1.16-3.27), BMI (OR = 1.08, 95%CI = 1.02-1.14), overall comorbidity (OR = 1.07, 95%CI = 1.02-1.13) and depression (OR = 2.55, 95%CI = 1.33-4.88) were significant predictors of P-FoF. CONCLUSIONS: T-FoF and P-FoF may be predicted by different sets of risk factors among older fallers. Thus, fallers should be screened for FoF especially when carrying specific risk factors, including female gender, osteoporosis, depression, living alone, impaired physical performance, BMI, comorbidity. These findings may be helpful in designing tailored intervention to blunt the risks related to consequence of FoF among older people experiencing falls. TRIAL REGISTRATION: The SCOPE study was registered prospectively at clinicaltrials.gov (NCT02691546; 25/02/2016).

Temporal But Not Spatial Gait Parameters Associated With Lower Balance Capacity in Moderate-High Functioning Persons With Stroke.

BACKGROUND AND PURPOSE: Falls are a major health concern after stroke. Spatial and temporal gait asymmetry and variability can contribute to instability and increased fall risk in persons with stroke (PwS). We aimed to quantify gait spatiotemporal symmetry and variability parameters in PwS undergoing rehabilitation in the subacute stage of the disease, by comparison to healthy participants, and to examine the associations between these parameters and patients' reactive and proactive balance capacity. METHODS: Twenty-two PwS and 12 healthy adults walked over a computerized treadmill system at their self-selected walking speed. Symmetry and variability of gait parameters (step length, swing time, and stance time) as well as upper extremity and lower extremity angular range of motion in the sagittal plane were extracted. In addition, the Berg Balance Scale (BBS) and the fall threshold in response to sudden surface translations at increasing intensities were assessed. RESULTS: PwS demonstrated significantly higher asymmetry in all gait parameters in comparison to controls. Also, PwS demonstrated increased stance time variability in comparison to healthy controls and increased swing time variability in the paretic lower extremity. Significant negative associations were found between fall threshold and stance time asymmetry in PwS (r = -0.48, P = 0.022), between the BBS and swing time asymmetry (r = -0.50, P = 0.018), and between the BBS and stance time variability of the paretic lower extremity (r = -0.56, P = 0.006). DISCUSSION AND CONCLUSIONS: Findings highlight the importance of gait temporal symmetry and variability measures for dynamic balance control after stroke. These parameters should be considered when assessing gait recovery and safety in PwS.Video Abstract available for more insight from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A355).

Development and piloting of a perturbation stationary bicycle robotic system that provides unexpected lateral perturbations during bicycling (the PerStBiRo system).

BACKGROUND: Balance control, and specifically balance reactive responses that contribute to maintaining balance when balance is lost unexpectedly, is impaired in older people. This leads to an increased fall risk and injurious falls. Improving balance reactive responses is one of the goals in fall-prevention training programs. Perturbation training during standing or treadmill walking that specifically challenges the balance reactive responses has shown very promising results; however, only older people who are able to perform treadmill walking can participate in these training regimes. Thus, we aimed to develop, build, and pilot a mechatronic Perturbation Stationary Bicycle Robotic system (i.e., PerStBiRo) that can challenge balance while sitting on a stationary bicycle, with the aim of improving balance proactive and reactive control. METHODS: This paper describes the development, and building of the PerStBiRo using stationary bicycles. In addition, we conducted a pilot randomized control trial (RCT) with 13 older people who were allocated to PerStBiRo training (N = 7) versus a control group, riding stationary bicycles (N = 6). The Postural Sway Test, Berg Balance Test (BBS), and 6-min Walk Test were measured before and after 3 months i.e., 20 training sessions. RESULTS: The PerStBiRo System provides programmed controlled unannounced lateral balance perturbations during stationary bicycling. Its software is able to identify a trainee's proactive and reactive balance responses using the Microsoft Kinect™ system. After a perturbation, when identifying a trainee's trunk and arm reactive balance response, the software controls the motor of the PerStBiRo system to stop the perturbation. The pilot RCT shows that, older people who participated in the PerStBiRo training significantly improved the BBS (54 to 56, p = 0.026) and Postural Sway velocity (20.3 m/s to 18.3 m/s, p = 0.018), while control group subject did not (51.0 vs. 50.5, p = 0.581 and 15 m/s vs. 13.8 m/s, p = 0.893, respectively), 6MWT tended to improve in both groups. CONCLUSIONS: Our participants were able to perform correct balance proactive and reactive responses, indicating that older people are able to learn balance trunk and arm reactive responses during stationary bicycling. The pilot study shows that these improvements in balance proactive and reactive responses are generalized to performance-based measures of balance (BBS and Postural Sway measures).

Characteristics of First Recovery Step Response following Unexpected Loss of Balance during Walking: A Dynamic Approach.

INTRODUCTION: Many falls in older adults occur during walking and result in lateral falls. The ability to perform a recovery step after balance perturbation determines whether a fall will occur. AIM: To investigate age-related changes in first recovery step kinematics and kinematic adaptations over a wide range of lateral perturbation magnitudes while walking. METHODS: Thirty-five old (78.5 ± 5 years) and 19 young adults (26.0 ± 0.8 years) walked at their preferred walking speed on a treadmill. While walking, the subjects were exposed to announced right/left perturbations in different phases of the gait cycle that were gradually increased in order to trigger a recovery stepping response. The subjects were instructed to react naturally and try to avoid falling. Kinematic analysis was performed to analyze the first recovery step parameters (e.g., step initiation, swing duration, step length, and the estimated distance of the center of mass from the base of support [dBoS]). RESULTS: Compared with younger adults, older adults displayed a significantly lower step threshold and at lower perturbation magnitudes during the experiment. Also, they showed slower compensatory step initiation, shorter step length, and dBoS with similar step recovery times. As the perturbation magnitudes increased, older adults showed very small, yet significant, decreases in the timing of the step response, and increased their step length. Younger adults did not show changes in the timing of stepping, with a tendency toward a significant increase in step length. CONCLUSIONS: First compensatory step performance is impaired in older adults. In terms of the dynamic approach, older adults were more flexible, i.e., less automatic, while younger adults displayed more automatic behavior.

The kinematics and strategies of recovery steps during lateral losses of balance in standing at different perturbation magnitudes in older adults with varying history of falls.

BACKGROUND: Step-recovery responses are critical in preventing falls when balance is lost unexpectedly. We investigated the kinematics and strategies of balance recovery in older adults with a varying history of falls. METHODS: In a laboratory study, 51 non-fallers (NFs), 20 one-time fallers (OFs), and 12 recurrent-fallers (RFs) were exposed to random right/left unannounced underfoot perturbations in standing of increasing magnitude. The stepping strategies and kinematics across an increasing magnitude of perturbations and the single- and multiple-step threshold trials, i.e., the lowest perturbation magnitude to evoke single step and multiple steps, respectively, were analyzed. Fall efficacy (FES) and self-reported lower-extremity function were also assessed. RESULTS: OFs had significantly lower single- and multiple-step threshold levels than NFs; the recovery-step kinematics were similar. Surprisingly, RFs did not differ from NFs in either threshold. The kinematics in the single-step threshold trial in RFs, however, showed a significant delay in step initiation duration, longer step duration, and larger center of mass (CoM) displacement compared with NFs and OFs. In the multiple-step threshold trial, the RFs exhibited larger CoM displacements and longer time to fully recover from balance loss. Interestingly, in the single-stepping trials, 45% of the step-recovery strategies used by RFs were the loaded-leg strategy, about two times more than OFs and NFs (22.5 and 24.2%, respectively). During the multiple-stepping trials, 27.3% of the first-step recovery strategies used by RFs were the loaded-leg strategy about two times more than OFs and NFs (11.9 and 16.4%, respectively), the crossover stepping strategy was the dominated response in all 3 groups (about 50%). In addition, RFs reported a lower low-extremity function compared with NFs, and higher FES in the OFs. CONCLUSIONS: RFs had impaired kinematics during both single-step and multiple-step recovery responses which was associated with greater leg dysfunction. OFs and NFs had similar recovery-step kinematics, but OFs were more likely to step at lower perturbation magnitudes suggesting a more "responsive" over-reactive step response related from their higher fear of falling and not due to impaired balance abilities. These data provide insight into how a varying history of falls might affect balance recovery to a lateral postural perturbation. TRIAL REGISTRATION: This study was registered prospectively on November 9th, 2011 at clinicaltrials.gov ( NCT01439451 ).

Chronic kidney disease in the context of multimorbidity patterns: the role of physical performance : The screening for CKD among older people across Europe (SCOPE) study.

BACKGROUND: Chronic kidney disease (CKD) is known to be associated with several co-occurring conditions. We aimed at exploring multimorbidity patterns associated with CKD, as well as the impact of physical performance and CKD severity on them in a population of older outpatients. METHODS: Our series consisted of 2252 patients enrolled in the Screening of CKD among Older People across Europe multicenter observational study. Hypertension, stroke, transient ischemic attack, cancer, hip fracture, osteoporosis, Parkinson's disease, asthma, chronic obstructive pulmonary disease, congestive heart failure, angina, myocardial infarction, atrial fibrillation, anemia, CKD (defined as GFR < 60, < 45 or < 30 ml/min/1.73 m2), cognitive impairment, depression, hearing impairment and vision impairment were included in the analyses. Physical performance was assessed by the Short Physical Performance Battery (SPPB) and used as stratification variable. Pairs of co-occurring diseases were analyzed by logistic regression. Patterns of multimorbidity were investigated by hierarchical cluster analysis. RESULTS: CKD was among the most frequently observed conditions and it was rarely observed without any other co-occurring disease. CKD was significantly associated with hypertension, anemia, heart failure, atrial fibrillation, myocardial infarction and hip fracture. When stratifying by SPPB, CKD was also significantly associated with vision impairment in SPPB = 5-8 group, and hearing impairment in SPPB = 0-4 group. Cluster analysis individuated two main clusters, one including CKD, hypertension and sensory impairments, and the second including all other conditions. Stratifying by SPPB, CKD contribute to a cluster including diabetes, anemia, osteoporosis, hypertension and sensory impairments in the SPPB = 0-4 group. When defining CKD as eGFR< 45 or 30 ml/min/1.73 m2, the strength of the association of CKD with hypertension, sensory impairments, osteoporosis, anemia and CHF increased together with CKD severity in pairs analysis. Severe CKD (eGFR< 30 ml/min/1.73 m2) contributed to a wide cluster including cardiovascular, respiratory and neurologic diseases, as well as osteoporosis, hip fracture and cancer. CONCLUSIONS: CKD and its severity may contribute significantly to specific multimorbidity patterns, at least based on the cluster analysis. Physical performance as assessed by SPPB may be associated with not negligible changes in both co-occurring pairs and multimorbidity clusters. TRIAL REGISTRATION: The SCOPE study is registered at clinicaltrials.gov ( NCT02691546 ).

Impaired kidney function is associated with lower quality of life among community-dwelling older adults : The screening for CKD among older people across Europe (SCOPE) study.

BACKGROUND: Quality of life (QoL) refers to the physical, psychological, social and medical aspects of life that are influenced by health status and function. The purpose of this study was to measure the self-perceived health status among the elderly population across Europe in different stages of Chronic Kidney Disease (CKD). METHODS: Our series consisted of 2255 community-dwelling older adults enrolled in the Screening for Chronic Kidney Disease (CKD) among Older People across Europe (SCOPE) study. All patients underwent a comprehensive geriatric assessment (CGA), including included demographics, clinical and physical assessment, number of medications taken, family arrangement, Geriatric Depression Scale (GDS), Cumulative Illness Rating Scale, History of falls, Lower urinary tract symptoms, and Short Physical Performance Battery (SPPB). Estimated glomerular filtration rate (eGFR) was calculated by Berlin Initiative Study (BIS) equation. Quality of life was assessed by Euro Qol questionnaire (Euro-Qol 5D) and EQ-Visual Analogue Scale (EQ-VAS). The association between CKD (eGFR < 60, < 45 ml or < 30 ml/min/1.73m2) and low EQoL-VAS was investigated by multivariable logistic regression models. RESULTS: CKD was found to be significantly associated with low EQoL-VAS in crude analysis (OR = 1.47, 95%CI = 1.16-1.85 for eGFR< 60; OR = 1.38, 95%CI = 1.08-1.77 for eGFR< 45; OR = 1.57, 95%CI = 1.01-2.44). Such association was no longer significant only when adjusting for SPPB (OR = 1.20, 95%CI = 0.93-1.56 for eGFR< 60; OR = 0.87, 95%CI = 0.64-1.18 for eGFR< 45; OR = 0.84, 95%CI = 0.50-1.42), CIRS and polypharmacy (OR = 1.16, 95%CI = 0.90-1.50 for eGFR< 60; OR = 0.86, 95%CI = 0.64-1.16 for eGFR< 45; OR = 1.11, 95%CI = 0.69-1.80) or diabetes, hypertension and chronic obstructive pulmonary disease (OR = 1.28, 95%CI = 0.99-1.64 for eGFR< 60; OR = 1.16, 95%CI = 0.88-1.52 for eGFR< 45; OR = 1.47, 95%CI = 0.92-2.34). The association between CKD and low EQoL-VAS was confirmed in all remaining multivariable models. CONCLUSIONS: CKD may significantly affect QoL in community-dwelling older adults. Physical performance, polypharmacy, diabetes, hypertension and COPD may affect such association, which suggests that the impact of CKD on QoL is likely multifactorial and partly mediated by co-occurrent conditions/risk factors.

Kidney function and other factors and their association with falls : The screening for CKD among older people across Europe (SCOPE) study.

BACKGROUND: Reduced kidney function has become a major public health concern, especially among older people, as Chronic Kidney Disease (CKD) is associated with increased risk of end stage renal disease and mortality. Falls are a serious negative health outcome in older persons with one third of people aged 65 years experiencing a fall per year and increasing fall rates with increasing age. The impact of CKD on falls in older community-dwelling persons is not well investigated. Additionally, lower urinary tract symptoms (LUTS) may also increase the risk of falls. Therefore, our aim was to investigate the impact of CKD and LUTS on falls as well as on injurious falls. METHODS: The SCOPE study is an observational, multinational, multicenter, prospective cohort study involving community-dwelling older persons aged 75 years and more recruited from August 2016 to March 2018 in seven European countries. The main outcomes of the present study were any falls and any injurious falls during the 12 months before enrolment. The cross-sectional association of estimated glomerular filtration rate (eGFR) and LUTS with study outcomes was investigated by logistic regression analysis adjusted for baseline characteristics of enrolled subjects. RESULTS: Our series consisted of 2256 SCOPE participants (median age = 79.5 years, 55.7% female). Of them, 746 participants experienced a fall and 484 reported an injurious fall in the 12 months prior to baseline assessment. CKD was not significantly associated with falls (OR = 0.95, 95%CI = 0.79-1.14 for eGFR< 60; OR = 1.02, 95%CI = 0.81-1.28 for eGFR< 45; OR = 1.08, 95%CI = 0.74-1.57 for eGFR< 30) or injurious falls (OR = 0.91, 95%CI = 0.67-1.24 for eGFR< 60; OR = 0.93, 95%CI = 0.63-1.37 for eGFR< 45; OR = 1.19, 95%CI = 0.62-2.29 for eGFR< 30). LUTS were found significantly associated with both falls (OR = 1.56, 95%CI = 1.29-1.89) and injurious falls (OR = 1.58, 95%CI = 1.14-2.19), and such associations were confirmed in all multivariable models. CONCLUSIONS: Cross-sectional data suggest that CKD may not be associated with history of falls or injurious falls, whereas LUTS is significantly associated with the outcomes. TRIAL REGISTRATION: This study was registered on 25th February 2016 at clinicaltrials.gov ( NCT02691546 ).

Prevalence of sarcopenia in community-dwelling older adults using the updated EWGSOP2 definition according to kidney function and albuminuria : The Screening for CKD among Older People across Europe (SCOPE) study.

BACKGROUND: Loss of muscle mass and function may be more pronounced in older adults with chronic kidney disease (CKD) and with albuminuria. Thus, we investigated the prevalence of sarcopenia among community-dwelling older adults according to kidney function and grade of albuminuria. We also explored differences in the prevalence of sarcopenia according to three different equations for the estimation of glomerular filtration rate (eGFR). METHODS: A cross-sectional analysis of 1420 community-dwelling older adults (≥75 years old) included in the SCOPE study, a multicenter prospective cohort study, was conducted. Comprehensive geriatric assessment including short physical performance battery (SPPB), handgrip strength test and bioelectrical impedance analysis (BIA) was performed. Sarcopenia was defined using the updated criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). eGFR was calculated using Berlin Initiative Study (BIS), Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) and Full Age Spectrum (FAS) equations, and urinary albumin-to-creatinine ratio (ACR) was collected to categorize CKD according to Kidney Disease Improving Global Outcomes guidelines. RESULTS: Median age was 79.5 years (77.0-83.0), 804 (56.6%) were women. Using EWGSOP2 definition, 150 (10.6%) participants met diagnostic criteria for sarcopenia. Moreover, 85 (6%) participants had severe sarcopenia. Sarcopenia was more prevalent in participants with more advanced stages of CKD according to BIS eq. (9.6% in stages 1 and 2 and 13.9% in stages 3a, 3b and 4, p = 0.042), and also according to CKD-EPI (9.8% vs. 14.2%, p = 0.042) and FAS although not reaching statistical signification (9.8% vs. 12.7%, p = 0.119). Thus, differences in prevalence are observed among CKD categories as estimated by different equations. Prevalence of sarcopenia was also higher with increasing albuminuria categories: 9.3% in normoalbuminuric, 13.2% in microalbuminuric and 16.8% in macroalbuminuric participants, (p = 0.019). CONCLUSIONS: Sarcopenia is common among community-dwelling older adults, especially among those with more advanced CKD categories, with prevalence estimates differing slightly depending on the equation used for the estimation of eGFR; as well as among those with higher albuminuria categories.

Inter-observer Reliability and Concurrent Validity of Reactive Balance Strategies after Stroke.

BACKGROUND: Falls are a common complication in persons with stroke (PwS). Reliable assessment of balance responses to unexpected loss of balance has the potential to identify risk for falls. OBJECTIVES: To examine inter-observer reliability of balance responses to unannounced surface perturbations in PwS and to explore the concurrent validity of a balance recovery assessment protocol. METHODS: Two observers evaluated balance recovery strategies and fall threshold (a fall into a harness system) in 15 PwS and 15 healthy adults who were exposed to forward, backward, right, and left unannounced surface translations in six increasing intensities while standing. RESULTS: Observer agreement was 100% for the fall threshold. Kappa coefficients for step strategies were 0.960-0.988 in PwS and 0.886-0.938 in healthy adults, 0.905-0.988 for arm reactions in PwS and 0.754-0.926 in healthy adults. Significant correlations were found between fall threshold and Berg Balance Scale (r = 0.691), 6-minute walk test (r = 0.599), and fall efficacy scale-international (r= -0.581). CONCLUSIONS: A trained examiner can reliably classify reactive balance responses to surface perturbations. The high frequency of falls observed in PwS highlights the importance of assessing reactive balance responses to different directions and intensities of surface translations.

Validity and Inter-observer Reliability of the TURN 180 Test to Identify Older Adults Who Reported Falls.

BACKGROUND: Falls while turning are associated with increased risk of hip fracture in older adults. Reliable and clinically valid methods for turn ability assessments are needed. OBJECTIVES: To explore the inter-observer reliability and known group validity of the TURN 180 test. METHODS: We divided 78 independent older adults (mean age 76.6 ± 6.5 years) into three groups: non-fallers, infrequent fallers (1-2 falls per year), and recurrent fallers (> 2 falls per year). Participants underwent performance-based tests: Timed Up and Go (TUG), Performance Oriented Mobility Assessment (POMA), and Berg Balance Scale (BBS). TUG was videotaped for later analysis of the TURN 180 test by two blinded observers. RESULTS: A significant difference was found in the TURN 180 test parameters among the groups (P < 0.04). TURN 180 was highly correlated with TUG (r = 0.81-0.89, P < 0.001) and BBS (r = -0.704-0.754, P < 0.0001) and moderately with POMA (r = -0.641-0.698, P < 0.0001). The number of steps was found to be the strongest parameter to determine fallers among older adults (specificity 96.3%, sensitivity 40%). Inter-rater reliability (intraclass correlation coefficient 0.91-0.96, P < 0.0001) was found to be excellent for the number of steps, time taken to accomplish a turn, and total test score categories. CONCLUSIONS: The TURN 180 test is highly reliable and can identify the older adults who fall. Our results show that the TURN 180 test can serve as a good performance-based examination for research or clinical setting.

Daily Bicycling in Older Adults May be Effective to Reduce Fall Risks-A Case-Control Study.

Older adults gain many health benefits from riding bicycles regularly. We aimed to explore whether older persons who ride bicycles regularly have better balance than controls. Balance control and voluntary stepping were assessed in 20 older adults aged 65-85 years who live in an agricultural community village and who ride bicycles regularly, and 30 age- and gender-matched nonbicycle riders (NBR). Self-reported function and fear of fall were also assessed. Bicycle riders (BR) showed significantly better balance, faster voluntary stepping, and better self-reported advanced lower-extremity function compared with NBR. The results might suggest that bicycling regularly preserves balance control and speed of voluntary stepping in older adults because bicycling might maintain specific balance coordination patterns. The results should be treated with caution as bicycle riders were older adults who selected an active lifestyle (i.e., bicycling as well as living in an agricultural village) that may bias the results.

Gait Coordination Deteriorates in Independent Old-Old Adults.

Human gait is symmetric and bilaterally coordinated in young healthy persons. In this study, we aimed to explore the differences in bilateral coordination of gait as measured by the phase coordination index (PCI), gait asymmetry, and stride time variability of gait between four age groups. A total of 44 older adults were recruited: nine young-old (age 70-74 years), 26 old (age 75-84 years), nine old-old (>85 years and older), and 13 young adults (age 20-30 years). Subjects walked on a treadmill; walking speed was systematically increased from 0.5 to 0.9 m/s in steps of 0.1 m/s. There were marginal effects of age on PCI, significant main effects of walking speeds without interaction between walking speeds and age group. A difference in PCI could distinguish between young's and late aging group, and only during their preferred treadmills walking speed. This study explicitly shows that bilateral coordination of walking is modified by gait speed, and deteriorates only at a very old age.