Prospective monitoring and self-report of previous falls among older women at high risk of falls and fractures: a study of comparison and agreement

Background: The identification of the occurrence of falls is an important step for screening and for rehabilitation processes for the elderly. The methods of monitoring these events are susceptible to recording biases, and the choice of the most accurate method remains challenging. Objectives: (i) To investigate the agreement between retrospective self-reporting and prospective monitoring of methods of recording falls, and (ii) to compare the retrospective self-reporting of falls and the prospective monitoring of falls and recurrent falls over a 12-month period among older women at high risk of falls and fractures. Method: A total of 118 community-dwelling older women with low bone density were recruited. The incidence of falls was monitored prospectively in 116 older women (2 losses) via monthly phone calls over the course of a year. At the end of this monitoring period, the older women were asked about their recall of falls in the same 12-month period. The agreement between the two methods was analyzed, and the sensitivity and specificity of self-reported previous falls in relation to the prospective monitoring were calculated. Results: There was moderate agreement between the prospective monitoring and the retrospective self-reporting of falls in classifying fallers (Kappa=0.595) and recurrent fallers (Kappa=0.589). The limits of agreement were 0.35±1.66 falls. The self-reporting of prior falls had a 67.2% sensitivity and a 94.2% specificity in classifying fallers among older women and a 50% sensitivity and a 98.9% specificity in classifying recurrent fallers. Conclusion: Self-reporting of falls over a 12-month period underestimated 32.8% of falls and 50% of recurrent falls. The findings recommend caution if one is considering replacing monthly monitoring with annual retrospective questioning. .

Estudo da relação entre função muscular, mobilidade funcional e nível de atividade física em idosos comunitários / A study on the relationship between muscle function, functional mobility and level of physical activity in community-dwelling elderly

OBJETIVOS: Avaliar a relação da função muscular de membros inferiores (MMII), circunferência de panturrilha (CP), força de preensão palmar (FPP), mobilidade funcional e nível de atividade física (NAF) em idosos comunitários ativos com idades entre 65-69, 70-79 e 80 ou mais anos e identificar a melhor medida clínica para rastreamento de redução de função muscular de MMII em idosos. MÉTODOS: Oitenta e um idosos (42 mulheres e 39 homens) submeteram-se à avaliação da velocidade de marcha (Kit Multisprint), FPP (dinamômetro Jamar), força e potência muscular de MMII (dinamômetro isocinético Biodex), NAF (Perfil de Atividade Humana) e CP (fita métrica). Procedeu-se à análise estatística com ANOVA, correlação de Pearson e curva ROC. RESULTADOS: Os idosos de 80 ou mais anos apresentaram valores menores que os de 65-69 para CP dominante (34,9±3 vs 37,7±3,6), velocidade de marcha habitual (VMH) (1,1±0,2 vs 1,2±0,2) e velocidade de marcha máxima (VMM) (1,4±0,3 vs 1,7±0,3), FPP (23,8±7,5 vs 31,8±10,3), média de pico de torque (MPT) e potência média (PM) de quadril, joelho e tornozelo (p<0,05). O NAF não apresentou diferença significativa entre os grupos. A força e potência muscular apresentaram correlações moderadas com VMH, VMM e FPP e correlações baixas com a CP e com o NAF (p<0,05). A curva ROC sugeriu o ponto de corte de FPP de 14,51 Kgf para rastreamento de redução de função muscular nas mulheres idosas (p=0,03). CONCLUSÕES: Existe associação entre a função muscular de MMII, FPP e VMM: esses parâmetros diminuem com o envelhecimento, e a FPP pode prever redução de função muscular de MMII em idosas.

OBJECTIVES: to evaluate the relationship between lower extremity muscle function, calf circumference (CC), handgrip strength (HG), functional mobility and level of physical activity among age groups (65-69, 70-79, 80+) of older adults (men and women) and to identify the best parameter for screening muscle function loss in the elderly. METHODS: 81 community-dwelling elderly (42 women and 39 men) participated. Walking speed (Multisprint Kit), HG (Jamar dynamometer), hip, knee and ankle muscle function (Biodex isokinetic dynamometer), level of physical activity (Human Activity Profile) and CC (tape measure) were evaluated. ANOVA, Pearson correlation and ROC curves were used for statistical analysis. RESULTS: Dominant CC (34.9±3 vs 37.7±3.6), habitual (1.1±0.2 vs 1.2±0.2) and fast (1.4±0.3 vs 1.7±0.3) walking speed, HG (23.8±7.5 vs 31.8±10.3), average peak torque and average hip, knee and ankle power (p<0.05) were lower for the 80+ group than for the 65-69 year-olds. There were no differences in physical activity level among age groups. Moderate significant correlations were found between muscle function parameters, walking speed and HG; a fair degree of relationship was found between muscle function parameters, CC and level of physical activity (p<0.05). The ROC curve analysis suggested a cutoff point of 14.51 Kgf for screening muscle function loss in elderly women (p=0.03). CONCLUSIONS: This study demonstrated an association between muscle function, HG and fast walking speed, a decrease in these parameters with age and the possibility of using HG to screen for muscle function of the lower extremities.