User Perspectives of Geriatric German Patients on Smart Sensor Technology in Healthcare.

With consideration of the progressing aging of our societies, the introduction of smart sensor technology can contribute to the improvement of healthcare for older patients and to reductions of the costs of care. From the clinical and medico-ethical points of view, the advantages of smart sensor technology are copious. However, any ethical evaluation of an introduction of a new technology in medical practice requires an inclusion of patients' perspectives and their assessments. We have conducted qualitative, semi-structured, exploratory interviews with 11 older patients in order to gain their subjective opinions on the use of smart sensor devices for rehabilitation purposes. The interviews were analyzed using methods of qualitative content and thematic analyses. In our analysis, we have focused on ethical aspects of adoption of this technology in clinical practice. Most of the interviewees expressed their trust in this technology, foremost because of its accuracy. Several respondents stated apprehension that the use of smart sensors will lead to a change in the patient-healthcare professional relationship. Regarding costs of introduction of smart sensors into healthcare, interviewees were divided between health insurance bearing the costs and individual participation in corresponding costs. Most interviewees had no concerns about the protection of their privacy or personal information. Considering these results, improvement of users' technology literacy regarding possible threats connected with putting smart sensors into clinical practice is a precondition to any individual application of smart sensors. This should occur in the form of extended and well-designed patient information adapted to individual levels of understanding. Moreover, application of smart sensors needs to be accompanied with careful anamnesis of patient's needs, life goals, capabilities, and concerns.

Effect of a Passive Exosuit on Sit-to-Stand Performance in Geriatric Patients Measured by Body-Worn Sensors-A Pilot Study.

Standing up from a seated position is a prerequisite for any kind of physical mobility but many older persons have problems with the sit-to-stand (STS) transfer. There are several exosuits available for industrial work, which might be adapted to the needs of older persons to support STS transfers. However, objective measures to quantify and evaluate such systems are needed. The aim of this study was to quantify the possible support of an exosuit during the STS transfer of geriatric patients. Twenty-one geriatric patients with a median age of 82 years (1.-3.Q. 79-84 years) stood up at a normal pace (1) from a chair without using armrests, (2) with using armrests and (3) from a bed with pushing off, each condition with and without wearing an exosuit. Peak angular velocity of the thighs was measured by body-worn sensors. It was higher when standing up with exosuit support from a bed (92.6 (1.-3.Q. 84.3-116.2)°/s versus 79.7 (1.-3.Q. 74.6-98.2)°/s; p = 0.014) and from a chair with armrests (92.9 (1.-3.Q. 78.3-113.0)°/s versus 77.8 (1.-3.Q. 59.3-100.7)°/s; p = 0.089) compared to no support. There was no effect of the exosuit when standing up from a chair without using armrests. In general, it was possible to quantify the support of the exosuit using sensor-measured peak angular velocity. These results suggest that depending on the STS condition, an exosuit can support older persons during the STS transfer.

Reference equations for harmonizing gait speed results of different test protocols in community-dwelling older adults.

BACKGROUND AND AIMS: Different gait speed assessment protocols regarding start and stop of walking make comparison between studies impossible. The aim of this study was providing reference equations to estimate a person´s steady-state gait speed from gait speed measured with a test protocol including static start and/or stop. METHODS: Gait speed of 150 community-dwelling older adults (mean age 80.5 ± 4.5 years; 61% women) was measured over 4 m with different assessment protocols regarding start and stop of walking on an instrumented walkway. Reference equations to estimate steady-state gait speed from the results of other test protocols were calculated by regression analysis within a fivefold cross-validation. RESULTS: Mean absolute errors and the root mean squared errors of all reference equations ranged from 0.063 m/s to 0.074 m/s and 0.082 m/s to 0.096 m/s, respectively. CONCLUSIONS: The provided reference equations can help harmonizing results between studies in community-dwelling older adults.

Assessment of Thigh Angular Velocity by an Activity Monitor to Describe Sit-to-Stand Performance.

The assessment of sit-to-stand (STS) performance is highly relevant, especially in older persons, but testing STS performance in the laboratory does not necessarily reflect STS performance in daily life. Therefore, the aim was to validate a wearable sensor-based measure to be used under unsupervised daily life conditions. Since thigh orientation from horizontal to vertical is characteristic for STS movement, peak angular velocity (PAV) of the thigh was chosen as the outcome variable. A total of 20 younger and older healthy persons and geriatric patients (mean age: 55.5 ± 20.8 years; 55% women) with a wide range of STS performance were instructed to stand up from a chair at their usual pace. STS performance was measured by an activity monitor, force plates, and an opto-electronic system. The association between PAV measured by the thigh-worn activity monitor and PAV measured by the opto-electronic system (gold standard) was r = 0.74. The association between PAV measured by the thigh-worn activity monitor and peak power measured by force plate and opto-electronic system was r = 0.76. The Intra-Class Coefficient (ICC) of agreement between the 2 trials was ICC(A,1) = 0.76. In this sample of persons with a wide range of physical performance, PAV as measured by a thigh-worn acceleration sensor was a valid and reliable measure of STS performance.

Gender-Specific Differences of Renal Heat Tolerance in Older Adults during Heat Waves.

BACKGROUND: Heat waves are known to cause increased morbidity and mortality in susceptible populations like old and functionally impaired people. The objective of the study was to assess renal tubular stress, a predictor for development of acute kidney injury, during heat waves in Central Europe. As a marker of renal tubular stress tissue inhibitor of metalloproteinases-2 [TIMP-2]·insulin-like growth factor binding protein-7 [IGFBP7], a new FDA-cleared renal tubular stress biomarker, was used. MATERIALS AND METHODS: 68 residents from facilities of sheltered housing with urine samples collected at heat waves in 2015 and at control visits were included. Urinary [TIMP-2]·[IGFBP7] was compared between the heat waves and the control visits. Multivariate linear models were adjusted for age, frailty index, and functional comorbidity index. RESULTS: The median age was 82.0 years, 82.3% were women. The percentage of elevated levels of urinary [TIMP-2]·[IGFBP7] (>0.3 [ng/mL]2/1,000) in the total study population was higher at the heat waves than at the control visits (25.0% vs. 17.7%). The effect of the heat waves on urinary [TIMP-2]·[IGFBP7] was stronger in men than in women: The percentage of elevated levels was 75.0% in men and 14.3% in women. In the multivariate analysis, the mean urinary [TIMP-2]·[IGFBP7] was 0.48 (95% CI 0.25; 0.70) (ng/mL)2/1,000 higher in men than in women. Except gender, a number of additional variables did not show an association with urinary [TIMP-2]·[IGFBP7] at the heat waves or the control visits. CONCLUSIONS: At heat waves, urinary [TIMP-2]·[IGFBP7] was elevated and higher in men than in women. This suggests gender-specific differences in renal heat tolerance in older people.

Change of physical activity parameters of hip and pelvic fracture patients during inpatient rehabilitation and after discharge: analysis of global and in-depth parameters.

BACKGROUND: A growing number of older adults suffer hip and pelvic fractures leading to hospital admission. They often result in reduced physical activity (PA) and impaired mobility. PA can be objectively measured with body-worn sensors. Usually, global cumulative PA parameters are analysed, such as walking duration, upright-time and number of steps. These traditional parameters mix different domains of PA, such as physical capacity (PC), behaviour and living environment. We examined the change of global cumulative PA measures during rehabilitation and after discharge in patients with hip or pelvic fracture and whether more 'in-depth' PA parameters, such as walking interval length, variability of interval length and sit-to-stand transitions and their changes during rehabilitation and 3 months after discharge might better reflect the above mentioned three clinically relevant domains of PA. METHODS: This study is a secondary data analysis of a randomised controlled trial to improve PA and fall-related self-efficacy in hip or pelvic fracture patients (≥60 years) with concerns about falling. Changes of accelerometer-measured global cumulative and in-depth PA parameters (activPAL3) were analysed in an observational design before and after discharge combining both groups. For comparison, the same analyses were applied to the traditional PC measures gait speed and 5-chair-rise. RESULTS: Seventy-five percent of the 111 study participants were female (mean age: 82.5 (SD = 6.76) years. Daily walking duration, upright time and number of steps as aspects of global PA increased during inpatient rehabilitation as well as afterwards. The in-depth PA parameters showed differing patterns. While the total number of walking bouts increased similarly, the number of longer walking bouts decreased by 50% after discharge. This pattern was also seen for the average walking interval length, which increased by 2.34 s (95% confidence interval (CI): 0.68; 4.00) during inpatient rehabilitation and decreased afterwards below baseline level (- 4.19 s (95% CI: - 5.56; - 2.82)). The traditional PC measures showed similar patterns to the in-depth PA parameters with improvements during rehabilitation, but not at home. CONCLUSION: Our findings suggest that the in-depth PA parameters add further information to the global cumulative PA parameters. Whereas global cumulative PA parameters improved significantly during inpatient rehabilitation and after discharge, in-depth PA parameters as well as PC did not continuously improve at home. In contrast to global cumulative PA parameters the in-depth parameters seem to reflect contextual factors such as the build environment and aspects of PC, which are traditionally assessed by clinical PC measures. These in combination with digital mobility measures can help clinicians to assess the health status of fragility fracture patients, individually tailor therapy measures and monitor the rehabilitation process.

The course of gait speed during a 400m walk test of mobility limitations in community-dwelling older adults.

BACKGROUND: The 400­m walk test (400MWT) of usual gait speed is an assessment of mobility limitations in geriatric medicine and sarcopenic research. OBJECTIVE: The aim of this study was to describe the course of gait speed during a 400MWT in community-dwelling older adults in terms of physical, psychological and general health-related outcomes. Possible plateau phases during the 400MWT could enable integrated measurements of short distance walk tests. METHODS: In this study 148 community-dwelling older adults (mean age 80.4 ± 4.4 years, 61% women) performed a 400MWT at comfortable gait speed. Additionally, an 8m walk test was carried out and history of falling, sex, comorbidities, fear of falling, executive function and gait variability were determined as covariates. RESULTS: Gait speed was higher in the beginning and the end of the 400MWT compared to the middle part with respect to all analyzed covariates. Mean gait speed of the 8 m walk test was significantly faster than mean gait speed of the 400MWT (t (df = 147) = 0.07, p = 0.001). CONCLUSION: The course of gait speed during a 400MWT performed by community-dwelling older adults was not affected by sex, gait variability, comorbidity, history of falling, fear of falling or executive function. Gait speed measurements of the 400MWT do not fully represent assessment of supervised short distance gait speed in community-dwelling adults.

Short distance analysis of the 400-meter walk test of mobility in community-dwelling older adults.

BACKGROUND: The 400-meter walk test (400MWT) is used to assess cardiovascular and pulmonary fitness or to predict adverse outcomes such as mobility disability. Additionally, short tests of walking such as the 4- or 8-meter walk test are administered to predict mortality, falls and other events. It remains uncertain if and how an integrated measurement of a short distance during 400MWT can replace an additional short distance measurement which would be clinically useful. RESEARCH QUESTION: How do short distance (i.e. segment) measurements of gait speed and walk ratio during a 400MWT of mobility compare to those from an additional 8-meter walk test? METHODS: A 400MWT and a separate 8-meter walk test were performed by 148 community-dwelling older adults (mean age 80.4 ± 4.4 years) using an instrumented walkway. RESULTS: Gait speed and walk ratio (i.e. step length divided by step frequency) of single segments of the 400MWT were strongly associated with gait speed (r ≥ 0.91) and walk ratio (r ≥ 0.93) of an 8-meter walk test with best agreement in the middle part 20-meter walk during the 400MWT. Mean gait speed of all single walks on the instrumented walkway during the 400MWT was faster than the mean gait speed of the total 400MWT. SIGNIFICANCE: A single walk of the 6th to 10th 20-meter walk during the 400MWT can be used as a substitute to an additional short distance trial. Furthermore, the awareness of being measured is higher on an instrumented walkway and possibly increases the motivation to overperform.

Estimate of gait speed by using persons' walk ratio or step-frequency in older adults.

BACKGROUND AND AIMS: Gait speed estimation using wearable inertial sensors during daily activities suffers from high complexity and inaccuracies in distance estimation when integrating acceleration signals. The aim of the study was to investigate the agreement between the methods of gait speed estimation using the persons' walk ratio (step-length/step-frequency relation) or step-frequency (number of steps per minute) and a "gold standard". METHODS: For this cross-sectional validation study, 20 healthy community-dwelling older persons (mean age 72.1 years; 70% women) walked at slow, normal, and fast speed over an instrumented walkway (reference measure). Gait speed was calculated using the person's pre-assessed walk ratio. Furthermore, the duration of walking and number of steps were used for calculation. RESULTS: The agreement between gait speed calculation using the walk ratio or step-frequency (adjusted to body height) and reference was r = 0.98 and r = 0.93, respectively. Absolute and relative mean errors of calculated gait speed using pre-assessed walk ratio ranged between 0.03-0.07 m/s and 1.97-4.17%, respectively. DISCUSSION AND CONCLUSIONS: After confirmation in larger cohorts of healthy community-dwelling older adults, the mean gait speed of single walking bouts during activity monitoring can be estimated using the person's pre-assessed walk ratio. Furthermore, the mean gait speed can be calculated using the step-frequency and body height and can be an additional parameter in stand-alone activity monitoring.

Karate as a supporting therapy of secondary prevention in breast cancer: a pilot study.

BACKGROUND: Breast cancer is a major health burden for women and the most common female cancer. Regarding secondary prevention, it is important to evaluate new approaches of supportive care. Recently, exercise interventions derived from martial arts have been applied in breast cancer patients. The aim of this pilot study was to describe the feasibility of a health-related karate intervention in breast cancer patients. METHODS: In this pilot study, health-related karate was offered to 20-60 years old women after primary cancer treatment. Participants were recruited in an oncological outpatient center. Feasibility of the intervention was described by eligibility, uptake, adherence, class attendance, adverse events, and continuation after the study. RESULTS: The uptake rate was 46.5% out of 88% eligible patients. Class attendance of the 15 participating women (median age 52 years) was 84%. Adherence during intervention was 93% and 12 women (80%) continued the karate training after the study. No adverse events were reported. CONCLUSIONS: Health-related karate exercises are feasible in breast cancer patients after finished primary cancer treatment. High eligibility, uptake and adherence allow the initiation of exercise classes.

The effect of different test protocols and walking distances on gait speed in older persons.

BACKGROUND AND AIMS: Walking is the core physical activity of older persons. The assessment of walking capacity is increasingly important for clinical purposes and clinical research. Differences between assessment tools and protocols for short walks to obtain gait characteristics can be responsible for changes, e.g., in gait speed from 0.1 to 0.2 m/s. The purpose of this study was to generate further knowledge for the harmonization and/or standardization of short walk-test protocols for assessing gait characteristics under supervised conditions. METHODS: For this cross-sectional study, 150 community-dwelling older adults (mean age 80.5 ± 4.5 years) were recruited. Participants performed eight walks differing in the distance (8-versus 4-m), static versus dynamic trials and comparing different test speed instructions (usual versus maximal) on an electronic walkway. RESULTS: A meaningful significant difference in mean usual gait speed was documented comparing the 4-m dynamic and static test protocol (0.12 m/s; p = 0.001). For the same comparison over an 8-m distance (dynamic versus static) and for the comparison between usual gait speed over 4-and 8-m, the differences in gait speed were smaller, but still statistically significant (p = 0.001). CONCLUSIONS: Gait speed was faster, if the test protocol did not include a static start or stop. The differences were greater for a shorter walking distance. This aspect should be considered for the comparison of study results and is particularly relevant for systematic reviews and meta-analyses.

Perturbation in public transport as a basic concept for perturbation-based balance training for fall prevention.

INTRODUCTION: The aim of the study was to collect real-world sensor data on acceleration and deceleration while riding a bus or tram. With respect to the risk of suffering fall-related injuries while using public transportation, our interest was to understand the amplitude of real-world perturbations to translate them to innovative reactive balance training programs. METHODS: Acceleration and deceleration data were collected during 12 days in buses and trams in a German city. A sensor, which was fixed to a vertical bar in the vehicle, measured the acceleration signals. Additionally, extreme values of deceleration during full braking were collected in a driving school bus. RESULTS: For the incident type acceleration from standing extreme values of acceleration and jerking were higher in buses compared to trams with a maximum acceleration of 3.37 m/s2 and 1.80 m/s2, respectively, and extreme jerking of 13.30 m/s3 and -5.56 m/s3, respectively. Similarly, for the incident type deceleration approaching a stop extreme values of deceleration and jerking were higher in buses compared to trams with maximum deceleration of -3.12 m/s2 and -2.31 m/s2, respectively, and extreme jerking of -19.19 m/s3 and -10.83 m/s3, respectively. Extreme values for maximum deceleration and extreme jerking as simulated at the driving school were not reached during real-world measurements. The duration of incidents in acceleration from standing and deceleration approaching a stop was shorter for buses than for trams. CONCLUSION: Acceleration and jerking values were higher in buses compared to trams. Based on this study, laboratory simulation paradigms can be developed to study balance responses in older persons and to design fall prevention interventions which are ecologically valid.

German version of the outcome expectations for exercise scale-2 : Psychometric properties in geriatric patients after hip or pelvic fractures with fear of falling.

OBJECTIVE: Physical exercise is associated with many health benefits. Especially for older adults it is challenging to achieve an appropriate adherence to exercise programs. The outcome expectations for exercise scale 2 (OEE-2) is a 13-item self-report questionnaire to assess negative and positive exercise outcome expectations in older adults. The aim of this study was to translate the OEE­2 into German and to assess the psychometric properties of this version. METHODS: The OEE­2 was translated from English into German including a forward and backward translation process. Psychometric properties were assessed in 115 patients with hip/pelvic fractures (76% female, mean age 82.5 years) and fear of falling during geriatric inpatient rehabilitation. RESULTS: Principal component analyses could confirm a two-factor solution (positive/negative OEE) that explained 58% of the total variance, with an overall internal reliability of α = 0.89. Cronbach's α for the 9­item positive OEE subscale was 0.89, for the 4­item negative OEE subscale 0.79. The two subscales were correlated with rs = 0.49. Correlations of the OEE total score were highest with the perceived ability to manage falls, prefracture leisure time activities and prior training history (rs = 0.35-0.41). CONCLUSION: These results revealed good internal reliability and construct validity of the German version of the OEE­2. The instrument is valid for measuring physical exercise outcome expectations in older, German-speaking patients with hip or pelvic fractures and fear of falling.

Spatiotemporal gait analysis of older persons in clinical practice and research : Which parameters are relevant?

For older persons walking is a basic activity of daily life which characterizes the person's functional mobility. Therefore, the improvement of walking performance is a major clinical outcome during geriatric rehabilitation. Furthermore, walking performance is relevant for several geriatric research issues. Quantitative gait analysis can describe walking performance in detail. Besides gait speed, various qualitative parameters related to different aspects of walking performance, such as symmetry, regularity, coordination, dynamic balance and foot movement during the swing phase, can serve as outcome parameters in geriatric research and in clinical practice. Clinicians and researchers have to decide which parameters are appropriate to be used as relevant outcome parameters in the investigated person or group of persons.

Change of Objectively-Measured Physical Activity during Geriatric Rehabilitation.

This prospective study investigated feasibility and sensitivity of sensor-based physical activity (PA) measures to monitor changes in PA during geriatric rehabilitation and its relation to clinical parameters at admission. PA was routinely measured at day 2 and day 15 after admission in 647 patients (70.2% women, mean age = 82.0 (SD = 7.19) years) of a German geriatric hospital using a thigh-worn accelerometer. Clinical records were used to include age, Barthel Index, diagnosis, mobility, orientation and cognition. Mean values and 95% confidence intervals (95%-CI) of walking duration, walking bout duration and number of sit-to-stand transfers were calculated to quantify different domains of PA. All observed PA parameters improved during rehabilitation, regardless of age, diagnosis or physical and cognitive function at admission. Walking duration increased by 12.1 (95%-CI: 10.3; 13.8) min, walking bout duration by 2.39 (95%-CI: 1.77; 3.00) s, and number of sit-to-stand transfers by 7 (95%-CI: 5; 8). Floor and ceiling effects were not observed. Walking duration at day 2 as well as day 15 was continuously associated with Barthel Index and statistically significant improved for all levels of Barthel Index. In summary, this study showed that sensor-based PA monitoring is feasible to assess the individual progress in geriatric rehabilitation patients.

A simple method to categorize gait speed of older persons based on visual inspection of stepping.

The aim of this study was to develop a simple visualized approach to classify persons into meaningful gait speed categories. Footprints of 310 instrumented gait analyses of 190 geriatric persons (mean age 79.1 years, 74 women) were used in a retrospective analysis to classify persons´ footprints into a left/right step overlapping, an intermediate or a long stepping pattern. The association between gait speed and step length was r = 0.91. More than 75% of the measurements classified as overlapping stepping pattern had a gait speed of below 0.5 m/s. All participants of the long stepping pattern group had a gait speed of faster than 1 m/s. The positive predictive values for classifying gait speed correctly were 71-100%. The proposed screening tool can be used in outpatient settings or home visits and is likely to be applicable if instrumented gait speed assessment is not available.

[New approaches in preventing health risks and excess mortality of older persons during extreme heat]. / Neue Wege zur Prävention gesundheitlicher Risiken und der Übersterblichkeit von älteren Menschen bei extremer Hitze.

More and longer heatwaves can be expected in Germany as a consequence of climate change. Older persons are predominantly threatened with the associated health-related problems and premature death. So far, heat action plans have failed to prevent excess mortality. Therefore, new approaches of prevention must be found.General practitioner, ambulant care, hospital, and nursing home settings were investigated in a project funded by the German ministry of health. Workshops were conducted and the results are presented here.Sufficient knowledge and continuous care are available in hospitals and nursing homes. The basic challenge for general practitioners and ambulatory caregivers is to provide appropriate care for older persons living alone and in need of help. Proactive care during extremely hot days cannot be provided due to staff shortages. Experience from other countries indicates that a new course of action must be found. The main tasks of general practitioners should be the identification and consultation of persons at risk. Experience from previous years have demonstrated that formal structures of nursing and medical care alone failed to prevent the recurrence of a catastrophe caused by a heatwave and that human loss is substantial.A possible approach could be volunteer-based disaster protection, which is well-developed in Germany. After proclamation of a major (heat) disaster in the community, close cooperation with general practitioners would be essential. A registry of persons at health risk from heat waves would also be essential. The feasibility and effectiveness of the suggested approach should be tested and ultimately regulated at a political level.

Objective measures of rollator user stability and device loading during different walking scenarios.

Walking aids are widely used by older adults, however, alarmingly, their use has been linked to increased falls-risk, yet clinicians have no objective way of assessing user stability. This work aims to demonstrate the application of a novel methodology to investigate how the type of walking task, the amount of body weight supported by the device (i.e., device loading), and task performance strategy affect stability of rollator users. In this context, ten users performed six walking tasks with an instrumented rollator. The combined stability margin "SM" was calculated, which considers user and rollator as a combined system. A Friedman Test was used to investigate the effects of task on SM and a least-squares regression model was applied to investigate the relationship between device loading and SM. In addition, the effects of task performance strategy on SM were explored. As a result, it was found that: the minimum SM for straight line walking was higher than for more complex tasks (p<0.05); an increase in device loading was associated with an increase in SM (p<0.05); stepping up a kerb with at least 1 rollator wheel in ground contact at all times resulted in higher SM than lifting all four wheels simultaneously. Hence, we conclude that training should not be limited to straight line walking but should include various everyday tasks. Within person, SM informs on which tasks need practicing, and which strategy facilitates stability, thereby enabling person-specific guidance/training. The relevance of this work lies in an increase in walking aid users, and the costs arising from fall-related injuries.

Social participation and heat-related behavior in older adults during heat waves and on other days.

BACKGROUND: High indoor temperatures require behavioral adaptation, especially among vulnerable older adults. There are uncertainties as to the degree to which people adapt to these challenging conditions. OBJECTIVE: The aim of this study was to describe the degree of adaptation of social participation and other heat-related behavior with respect to higher indoor temperatures. METHODS: In this study 81 residents from 10 sheltered living facilities (84% women, mean age 80.9 years) were visited every 4 weeks from May to October 2015 and additionally during 2 heat waves in July and August 2015. The indoor temperature, drinking and clothing and social participation were documented. Baseline documentation of gait speed and residential area were used to create subgroups of people with high or low gait speed and with facility location in a garden city/suburb or city/city center. RESULTS: Social participation and clothing decreased with -4.53 in the World Health Organization participation score units (95% confidence interval CI -5.32; -3.74) and -0.41 for clothing units (95% CI -0.46; -0.37) and volume of drinking increased (0.65 l/day; 95% CI 0.52; 0.77) per increase of indoor temperature by 10 °C. The negative association between indoor temperature and social life participation was stronger if functional capacity was low or if the facility was located in the city/city center. Not all older adults displayed temperature-related adaptive behavior. CONCLUSION: For older adults the negative association between indoor temperature and social life participation was stronger in the city/city center or if their functional capacity was low. Frequent personal contact and motivation of those who are frail might be helpful to support their adaptive behavior of drinking and clothing during heat stress.

Hip and pelvic fracture patients with fear of falling: development and description of the "Step by Step" treatment protocol.

OBJECTIVE: Based on a theoretical framework and sound evidence, this article describes a rehabilitation programme for patients with fear of falling after hip and pelvic fracture. RATIONALE: Based on exercise science principles, current knowledge from fall prevention, emotion regulation, and the Health Action Process Approach we developed a theoretical framework, from which the components of the intervention were derived. Description of the intervention: The intervention consists of 6 components: (1) relaxation, (2) meaningful activities and mobility-based goals, (3) falls related cognitions and emotions, coping with high risk tasks and situations, (4) individual exercise programme, (5) planning and implementing exercises and activities, and (6) fall risks and hazards. The intervention comprises of 8 individual sessions during 3 to 5 weeks of inpatient rehabilitation and 4 telephone calls and 1 home visit over a 2-month post-discharge period. Each session or telephone call takes about 30-60 minutes. It is provided to geriatric hip and pelvic fracture patients with concerns about falling and no cognitive impairment. To ensure completeness of reporting, the Template for Intervention Description and Replication (TIDierR) is used. RESULTS: Fifty-seven patients were assigned to the intervention group. All 46 completers met all pre-defined criteria for an intervention per protocol. CONCLUSION: The programme is feasible to administer. We have completed a randomised controlled trial, which will be submitted in due time (for trial protocol: www.isrctn.org ; ISRCTN79191813).