Dynamic performance-exposure algorithm for falling risk assessment and prevention of falls in community-dwelling older adults.

This study aimed to design a dynamic performance-exposure algorithm for falling risk assessment and prevention of falls in community-dwelling older adults. It involved a cross-sectional and follow-up survey assessing retrospective and prospective falls and respective performance-related, exposure and performance-exposure risk factors. In total, 500 Portuguese community-dwelling adults participated. Data modelling showed significant (p<0.05) relationships between the above risk factors and selected nine key ordered outcomes explaining falls to include in the algorithm: previous falls; health conditions; balance; lower strength; perceiving action boundaries; fat mass; environmental hazards; rest periods; and physical activity. Respective high-, moderate- and low-risk cutoffs were established. The results demonstrated a dynamic relationship between older adults' performance capacity and the exposure to fall opportunity, counterbalanced by the action boundary perception, supporting the build algorithm's conceptual framework. Fall prevention measures should consider the factors contributing most to the individual risk of falling and their distance from low-risk safe values.

Can two multimodal psychomotor exercise programs improve attention, affordance perception, and balance in community dwellings at risk of falling? A randomized controlled trial.

BACKGROUND: Falls are associated with cognitive and physical function deterioration. Attention decline, inaccurate affordance perception, and balance impairment are considered to be risk factors for falls. Furthermore, few studies have reported psychomotor intervention as a fall prevention program. This study aimed to investigate the effects of two multimodal programs on attention, perceptual and stepping-forward boundaries, and balance in community-dwelling older adults at risk of falling. METHODS: Fifty-one community-dwelling older adults were recruited to participate in a 24-week randomized controlled trial. Participants (75.4 ± 5.6 years) were randomly assigned to one of three groups: the 1) multimodal psychomotor program [EG1], 2) combined program (multimodal psychomotor program + whole-body vibration program) [EG2], and 3) control group. Participants were assessed at baseline, at post-intervention, and after a 12-week no-intervention follow-up period. RESULTS: The within-group comparisons showed significant improvements in attention and balance in EG1 and EG2 after the intervention (p <  0.05). The magnitudes of the treatment effects were similar in both EGs, ranging from medium to large. Decreases in the fall rate were also observed in EG1 (- 44.2%) and EG2 (- 63.0%) (p <  0.05). During the follow-up period, these improvements in attention were maintained, while those in balance were reversed in both EGs. No significant differences between groups were found. CONCLUSIONS: These study results suggest that both multimodal exercise programs were effective for fall prevention and were well tolerated by the participants. Specifically, EG1 and EG2 showed identical improvements in attention, and EG2 presented a slightly larger enhancement in balance and a larger decrease in the fall rate. Our findings demonstrate the benefits of maintaining the psychomotor intervention program by itself or in combination with the whole-body vibration program to prevent cognitive and physical function deterioration. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03446352 . Date of registration: February 26, 2018.

Benefits of Two 24-Week Interactive Cognitive-Motor Programs on Body Composition, Lower-Body Strength, and Processing Speed in Community Dwellings at Risk of Falling: A Randomized Controlled Trial.

This 24-week randomized controlled trial study evaluated the effects of two interactive cognitive−motor programs on body composition, lower-body strength, and processing speed in community dwellings at risk of falling. Forty-eight participants (75.0 ± 5.4 years) were allocated into EG1 (psychomotor intervention program), EG2 (combined program (psychomotor intervention + whole-body vibration)), and a control group. EG programs induced significant improvements in bone mass, lower-body strength, and processing speed (p < 0.05), with similar treatment effects on lower-body strength and processing speed and higher bone mineral content and density within EG2. The fall rate decreased in EG1 (44.2%) and EG2 (63%) (p < 0.05). After the 12-week no-intervention follow-up, improvements in lower-body strength were reversed in both EGs, but those in processing speed were maintained, mainly in EG2 (p < 0.05). In conclusion, both programs were accepted and well tolerated. The combined program led to additional benefits in bone mass. Both programs positively impacted physical and cognitive risk factors for falls and injuries. They induced similar improvements in lower-body strength and processing speed, decreasing the fall rate. These findings suggest that both programs are successful for fall and injury prevention in the studied population.

Effects of two 24-week multimodal exercise programs on reaction time, mobility, and dual-task performance in community-dwelling older adults at risk of falling: a randomized controlled trial.

BACKGROUND: Falls in older adults are considered a major public health problem. Declines in cognitive and physical functions, as measured by parameters including reaction time, mobility, and dual-task performance, have been reported to be important risk factors for falls. The aim of this study was to investigate the effects of two multimodal programs on reaction time, mobility, and dual-task performance in community-dwelling older adults at risk of falling. METHODS: In this randomized controlled trial, fifty-one participants (75.4 ± 5.6 years) were allocated into two experimental groups (EGs) (with sessions 3 times per week for 24 weeks), and a control group: EG1 was enrolled in a psychomotor intervention program, EG2 was enrolled in a combined exercise program (psychomotor intervention program + whole-body vibration program), and the control group maintained their usual daily activities. The participants were assessed at baseline, after the intervention, and after a 12-week no-intervention follow-up period. RESULTS: The comparisons revealed significant improvements in mobility and dual-task performance after the intervention in EG1, while there were improvements in reaction time, mobility, and dual-task performance in EG2 (p ≤ 0.05). The size of the interventions' clinical effect was medium in EG1 and ranged from medium to large in EG2. The comparisons also showed a reduction in the fall rate in both EGs (EG1: -44.2%; EG2: - 63.0%, p ≤ 0.05) from baseline to post-intervention. The interventions' effects on reaction time, mobility, and dual-task performance were no longer evident after the 12-week no-intervention follow-up period. CONCLUSIONS: The results suggest that multimodal psychomotor programs were well tolerated by community-dwelling older adults and were effective for fall prevention, as well as for the prevention of cognitive and physical functional decline, particularly if the programs are combined with whole-body vibration exercise. The discontinuation of these programs could lead to the fast reversal of the positive outcomes achieved. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03446352. Date of registration: February 07, 2018.

Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach.

BACKGROUND: Fall risk assessment in older people is of major importance for providing adequate preventive measures. Current predictive models are mainly focused on intrinsic risk factors and do not adjust for contextual exposure. The validity and utility of continuous risk scores have already been demonstrated in clinical practice in several diseases. In this study, we aimed to develop and validate an intrinsic-exposure continuous fall risk score (cFRs) for community-dwelling older people through standardized residuals. METHODS: Self-reported falls in the last year were recorded from 504 older persons (391 women: age 73.1 ± 6.5 years; 113 men: age 74.0 ± 6.1 years). Participants were categorized as occasional fallers (falls ≤1) or recurrent fallers (≥ 2 falls). The cFRs was derived for each participant by summing the standardized residuals (Z-scores) of the intrinsic fall risk factors and exposure factors. Receiver operating characteristic (ROC) analysis was used to determine the accuracy of the cFRs for identifying recurrent fallers. RESULTS: The cFRs varied according to the number of reported falls; it was lowest in the group with no falls (- 1.66 ± 2.59), higher in the group with one fall (0.05 ± 3.13, p < 0.001), and highest in the group with recurrent fallers (2.82 ± 3.94, p < 0.001). The cFRs cutoff level yielding the maximal sensitivity and specificity for identifying recurrent fallers was 1.14, with an area under the ROC curve of 0.790 (95% confidence interval: 0.746-0.833; p < 0.001). CONCLUSIONS: The cFRs was shown to be a valid dynamic multifactorial fall risk assessment tool for epidemiological analyses and clinical practice. Moreover, the potential for the cFRs to become a widely used approach regarding fall prevention in community-dwelling older people was demonstrated, since it involves a holistic intrinsic-exposure approach to the phenomena. Further investigation is required to validate the cFRs with other samples since it is a sample-specific tool.

Proposal for a New Fixation Method for Pauwels Type III Femoral Neck Fracture-Metaphyseal Stem: A Finite-Element Analysis.

OBJECTIVE: To evaluate the biomechanical behavior of a metaphyseal stem specifically designed for the fixation of Pauwels type-III femoral neck fractures using finite-element analysis. METHODS: Three different constructions were studied: the dynamic hip screw with a superior anti-rotation screw (DHS + ARS), multiple cannulated screws in an inverted triangle configuration (ASNIS), and the Metaphyseal Nailing System (MNS), a new implant developed by the authors. Vertical and total displacement, localized and total maximum and minimum principal, and the Von Mises peak stresses were evaluated. RESULTS: Results are shown for the DHS + ARS, ASNIS, and MNS models, respectively. Vertical displacement (mm) was 1.49, 3.63, and 1.90; total displacement (mm) was: 5.33, 6.02, and 6.30; localized maximum principal (Mpa) was: 2.77, 4.5, and 1.7; Total maximum principal (Mpa) was: 126, 223, and 531; localized minimum principal (Mpa) was: -1.8, -3.15, and -0.39; total minimum (Mpa) was: -121, -449, and -245; and Von Mises peak stress (MPA) was: 315.5, 326.1, and 286.0. CONCLUSION: The present FEM study showed that the MNS device increases general stresses and reduces localized stresses, when compared to the DHS + ARS and ASNIS constructions used to fix Pauwels type-III femoral neck fracture in synthetic models. In this sense, the MNS showed a low fracture focus shift, conducive to the consolidation environment. The significant reduction in the maximum principal stress, allows to affirm that the main deforming force, the shear, in this fracture pattern, was considerably reduced and the low value of Von Mises obtained, consistent with an implant capable of making an effective load sharing.

Differences between two types of dual tasks according to the educational level in older adults.

INTRODUCTION: For dual-task paradigms, the timed up and go (TUG) test along with other cognitive or motor tasks has been used to evaluate and predict the risk of falling in older adults. However, the interference between motor-cognitive tasks can differ by the cognitive task. OBJECTIVE: To evaluate the performance of the TUG test under a single task condition and two dual-task conditions in older adults and to explore the effect of educational level on task performance. METHODS: A total of 418 older adults (328 females) voluntarily participated in this study. The TUG test was administered as a single task and a dual task with one secondary simultaneous task: counting aloud backward from 100 or naming animals. Comparisons were performed to determine the interference caused by each cognitive task on the motor task, and correlation analysis was performed to explore the role of educational level. RESULTS: The animal task led to a poorer TUG performance and a higher dual-task cost than did the counting task. Furthermore, the motor task led to a higher percentage of errors and cognitive stops in the animal task. Educational level plays a significant role in the interaction between tasks. CONCLUSIONS: Between-task interference differs by the type of cognitive task performed and the educational level of the participants. The results of the present study should be considered when dual-task assessments are planned for older adults.

Reliability and construct validity of the stepping-forward affordance perception test for fall risk assessment in community-dwelling older adults.

Thus far, few studies have examined the estimation and actual performance of locomotor ability in older adults. To our knowledge, there are no studies examining the relationship between stepping-forward estimation versus ability and fall occurrence. The aim of this study was to develop and assess the reliability and validity of a new test for fall risk assessment in community-dwelling older adults. In total, 347 participants (73.1 ± 6.2 years; 266 women) were assessed for their perception of maximum distance for the stepping-forward and action boundary. The test was developed following the existing literature and expert opinions. The task showed strong internal consistency. Intraclass correlation ranged from 0.99 to 1 for intrarater agreement and from 0.83 to 0.97 for interrater agreement. Multivariate binary regression analysis models revealed an area under the curve (AUC) of 0.665 (95% CI: 0.608-0.723) for fallers and 0.728 (95% CI: 0.655-0.797) for recurrent fallers. The stepping-forward affordance perception test (SF-APT) was demonstrated to be accurate, reliable and valid for fall risk assessment. The results showed that a large estimated stepping-forward associated with an underestimated absolute error works as a protective mechanism for fallers and recurrent fallers in community-dwelling older adults. SF-APT is safe, quick, easy to administer, well accepted and reproducible for application in community or clinical settings by either clinical or nonclinical care professionals.

Effects of a 10-week multimodal exercise program on physical and cognitive function of nursing home residents: a psychomotor intervention pilot study.

BACKGROUND: Nursing home institutionalization tends to exacerbate loss of functioning. AIMS: Examine the feasibility and the effect of a psychomotor intervention-a multimodal exercise program promoting simultaneous cognitive and motor stimulation-on the executive (planning ability and selective attention) and physical function of nursing home residents. METHODS: Seventeen participants engaged in a 10-week multimodal exercise program and 17 maintained usual activities. RESULTS: Exercise group improved planning ability (25-32%), selective attention (19-67%), and physical function [aerobic endurance, lower body strength, agility, balance, gait, and mobility (19-41%)], corresponding to an effect size ranging from 0.29 (small) to 1.11 (high), p < 0.05. DISCUSSION: The multimodal exercise program was feasible and well tolerated. The program improved executive and physical functions of the nursing home residents, reverting the usual loss of both cognitive and motor functioning in older adult institutionalized. CONCLUSIONS: Multimodal exercise programs may help to maintain or improve nursing home residents' functioning.