Recreating Fall Risk Appraisal matrix using R to support fall prevention programs.

Objective: This study aimed to optimize Fall Risk Appraisal (FRA) graphing for use in intervention programs tailored toward reducing the fall risk of older adults by using computing graphic functions in the R language. Materials and Methods: We utilized RStudio, a free development environment for the R language, as well as the functions within the "ggplot2" and "grid" packages, to develop a code that would recreate the FRA matrix for use in data visualization and analysis, as well as feedback for older adults. Results: The developed code successfully recreates the FRA matrix in R and allows researchers and clinicians to graph participant data onto the matrix itself. Discussion: The use of an R code allows for a streamlined approach to manipulating the FRA matrix for use in data visualization and feedback for older adults, which improves upon the traditional paper-pencil method that has been previously used. Conclusions: The code presented in this study recreates the FRA matrix instrument in the R language and gives researchers the ability to instantaneously add, remove, or change different aspects of the instrument to improve its readability for researchers and older adults.

Comparing Device-Generated and Calculated Bioimpedance Variables in Community-Dwelling Older Adults.

Despite BIA emerging as a clinical tool for assessing older adults, it remains unclear how to calculate whole-body impedance (Z), reactance (Xc), resistance (R), and phase angle (PhA) from segmental values using modern BIA devices that place electrodes on both sides of the body. This investigation aimed to compare both the whole-body and segmental device-generated phase angle (PhADG) with the phase angle calculated using summed Z, Xc, and R from the left, right, and combined sides of the body (PhACalc) and to compare bioelectric variables between sides of the body. A sample of 103 community-dwelling older adults was assessed using a 50 kHz direct segmental multifrequency BIA device. Whole-body PhACalc values were assessed for agreement with PhADG using 2.5th and 97.5th quantile nonparametric limits of agreement and Spearman's rho. Bioelectrical values between sides of the body were compared using Wilcoxon rank and Spearman's rho. A smaller mean difference was observed between PhADG and right PhACalc (-0.004°, p = 0.26) than between PhACalc on the left (0.107°, p = 0.01) and on the combined sides (0.107°, p < 0.001). The sum of Z, R, and PhACalc was significantly different (p < 0.01) between the left (559.66 ± 99.55 Ω, 556.80 ± 99.52 Ω, 5.51 ± 1.5°, respectively) and the right sides (554.60 ± 94.52 Ω, 552.02 ± 94.23 Ω, 5.41 ± 0.8°, respectively). Bilateral BIA values do not appear to be interchangeable when determining whole-body measurements. Present data suggest that using right-sided segmental values would be the most appropriate choice for calculating whole-body bioelectrical variables.

Comparing Sleep Quality, Duration, and Efficiency Among Low-Income Community-Dwelling Older Adults With and Without Physical Disabilities.

PURPOSE: Physical disabilities may exacerbate the natural decline in sleep quality that occurs with aging. In the current study, we assessed sleep quality and medicinal sleep aid use among 87 community-dwelling older adults with (n = 24) and without (n = 63) physical disabilities. METHOD: Sleep quality, duration, and efficiency were assessed subjectively with the Pittsburgh Sleep Quality Index. Sleep duration and efficiency were objectively measured with actigraphy. Participants self-reported medicinal sleep aid use. RESULTS: Significant group differences were observed in sleep duration measured objectively (p = 0.01) and subjectively (p = 0.04). No other group differences were observed for sleep factors (p > 0.05) or medicinal sleep aid use (p = 0.41). CONCLUSION: Findings show that physical disability may be a factor in sleep duration; however, physical disability was not found to be associated with worsened sleep perception or greater reliance on medicinal sleep aids. Future research should consider longer objective actigraphy assessment windows and explore potential subgroup differences in sex and race/ethnicity. [Journal of Gerontological Nursing, 50(7), 12-18.].

Comparing Sensitivity, Specificity, and Accuracy of Fall Risk Assessments in Community-Dwelling Older Adults.

Purpose: The US Centers for Disease Control and Prevention (CDC) has implemented the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. This initiative provides an algorithm for fall risk screening. However, the algorithm has the potential to overcategorize individuals as high risk for falling upon initial screening, which may burden clinicians with the task of recategorizing individuals after follow-up testing. Therefore, this study aimed to compare the accuracy, sensitivity, and specificity of fall risk appraisal between the STEADI, Short Fall-Efficacy Scale International (FES-I), and portable balance system (BTrackS) assessments in community-dwelling older adults. Patients and Methods: This cross-sectional analysis included 122 community-dwelling older adults, comprising 94 women and 28 men. Center-of-pressure postural sway was assessed using the BTrackS, fear of falling was assessed using the Short FES-I questionnaire, and all participants completed the STEADI checklist. Each assessment categorized participants as either high or low fall risk and fall risk appraisal was compared between groups using McNemar tests. Results: The STEADI checklist (high risk: n = 62; low risk: n = 60) significantly differed in fall risk appraisal compared to the BTrackS (high risk: n = 44; low risk: n = 78; p = 0.014) and the Short FES-I (high risk: n = 42; low risk: n = 80; p = 0.002). Compared to the BTrackS, the STEADI checklist had a specificity of 62.8%, sensitivity of 70.5%, and accuracy of 65.6%. Compared to the Short FES-I, the STEADI checklist had a specificity of 67.5%, sensitivity of 81.0%, and accuracy of 72.1%. Conclusion: The STEADI checklist appears to overcategorize individuals as high fall risk more frequently than direct assessments of postural sway and fear of falling. Further research is needed to examine potential improvements in accuracy when combining the STEADI checklist with direct assessments of postural sway and/or fear of falling.

Fall risk assessments are crucial for preventative care in older adults. However, the demands of clinical practice require an accurate and time-efficient method. The U.S Centers for Disease Control and Prevention (CDC) has implemented a fall risk checklist through the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. However, the STEADI checklist might cost clinicians more time than expected, as some patients initially classified as high risk for falling may not actually be at high risk. This leads to unnecessary follow-up assessments. In this study, we compared the STEADI checklist to direct measures of postural sway (balance) using the BTrackS system and fear of falling using the Short FES-I survey to determine how they differed in classifying community-dwelling older adults as high versus low fall risk. Our results show that the STEADI checklist classifies older adults as high risk more frequently than the BTrackS and Short FES-I. Considering that the follow-up assessments for a high-risk classification by the STEADI checklist include a balance test, we suggest that combining a balance test such as the BTrackS with a questionnaire or checklist may yield better screening outcomes and accurately identify high-risk individuals in a timely manner. Further research is needed to determine the effectiveness of this combination and to establish a true gold standard method for fall risk appraisal.

Phase Angle and Impedance Ratio as Indicators of Physical Function and Fear of Falling in Older Adult Women: Cross-Sectional Analysis.

Background: Older adults experience a significant decline in muscle integrity and function with aging. Early detection of decreased muscle quality can pave the way for interventions to mitigate the progression of age-related physical declines. Phase angle (PhA) and impedance ratio (IR) are measures of muscle integrity, which can be assessed quickly via bioelectrical impedance analysis (BIA) and may be indicative of physical function. Objective: This study aimed to characterize the relationships among handgrip strength (HGS), sit-to-stand (STS), BTrackS balance scores, fear of falling (evaluated using the Short Falls Efficacy Scale-International [Short FES-I]), and IR among community-dwelling older adult women classified as having a low or high PhA. Methods: A cross-sectional analysis was conducted with 85 older women (mean age 75.0, SD 7.2 years; mean weight 71.0, SD 15.0 kg; mean height 162.6, SD 6.1 cm). To examine the influence of PhA on performance measures, participants were divided into 2 PhA groups: high (>4.1°; n=56) and low (≤4.1°; n=29). Data were nonnormative; hence, the Mann-Whitney U test was used to evaluate between-group differences, and Kendall τ coefficients were used to determine the partial correlations. Results: The low PhA group had a significantly higher IR (mean 0.85, SD 0.03) than the high PhA group (mean 0.81, SD 0.03; r=.92; P<.001). The high PhA group had superior HGS (mean 21.4, SD 6.2 kg; P=.007; r=0.36), BTrackS balance scores (mean 26.6, SD 9.5 cm; P=.03; r=0.30), and STS scores (mean 16.0, SD 5.5; P<.001; r=0.49) than the low PhA group (mean HGS 17.6, SD 4.7 kg; mean BTrackS balance score 37.1, SD 21.1 cm; mean STS score 10.7, SD 6.2). Both PhA and IR were significantly correlated with HGS and BTrackS balance, STS, and Short FES-I scores (P<.05). However, on adjusting for the whole sample's age, only PhA was strongly correlated with HGS (τb=0.75; P=.003) and STS scores (τb=0.76; P=.002). Short FES-I scores were moderately correlated with IR (τb=0.46; P=.07) after controlling for age. No significant between-group differences were observed for height, weight, or BMI. Conclusions: PhA and IR are associated with physical function and the fear of falling in older women. However, only PhA was significantly associated with physical function (HGS and STS) independent of age. Conversely, only IR was significantly associated with the fear of falling. Diminished physical function and increased IR appear to be characteristics of older women with a PhA of ≤4.1°. These findings suggest that PhA and IR measured through BIA together may serve as a valuable tool for early identification of older women at the risk of functional decline and a heightened fear of falling.

Bodybuilding Coaching Strategies Meet Evidence-Based Recommendations: A Qualitative Approach.

Bodybuilding is a sport where coaches commonly recommend a variety of nutrition and exercise protocols, supplements, and, sometimes, performance-enhancing drugs (PEDs). The present study sought to gain an understanding of the common decisions and rationales employed by bodybuilding coaches. Focusing on coaches of the more muscular divisions in the National Physique Committee/IFBB Professional League federations (men's classic physique, men's bodybuilding, women's physique, women's bodybuilding) for both natural and enhanced athletes, coaches were recruited via word of mouth and social media, and 33 responded to an anonymous online survey. Survey responses indicated that participant coaches recommend three-to-seven meals per day and no less than 2 g/kg/day of protein regardless of sex, division, or PED usage. During contest preparation, participant coaches alter a natural competitor's protein intake by -25% to +10% and an enhanced competitor's protein intake by 0% to +25%. Regarding cardiovascular exercise protocols, approximately two-thirds of participant coaches recommend fasted cardiovascular exercise, with the common rationale of combining the exercise with thermogenic supplements while considering the athlete's preference. Low- and moderate-intensity steady state were the most commonly recommended types of cardiovascular exercise among participant coaches; high-intensity interval training was the least popular. Creatine was ranked in the top two supplements for all surveyed categories. Regarding PEDs, testosterone, growth hormone, and methenolone were consistently ranked in the top five recommended PEDs by participant coaches. The results of this study provide insight into common themes in the decisions made by bodybuilding coaches, and highlight areas in which more research is needed to empirically support those decisions.