Walking (and talking) the plank: dual-task performance costs in a virtual balance-threatening environment.

We evaluated the effects of engaging in extemporaneous speech in healthy young adults while they walked in a virtual environment meant to elicit low or high levels of mobility-related anxiety. We expected that mobility-related anxiety imposed by a simulated balance threat (i.e., virtual elevation) would impair walking behavior and lead to greater dual-task costs. Altogether, 15 adults (age = 25.6 ± 4.7 yrs, 7 women) walked at their self-selected speed within a VR environment that simulated a low (ground) and high elevation (15 m) setting while speaking extemporaneously (dual-task) or not speaking (single-task). Likert-scale ratings of cognitive and somatic anxiety, confidence, and mental effort were evaluated and gait speed, step length, and step width, as well as the variability of each, was calculated for every trial. Silent speech pauses (> 150 ms) were determined from audio recordings to infer the cognitive costs of extemporaneous speech planning at low and high virtual elevation. Results indicated that the presence of a balance threat and the inclusion of a concurrent speech task both perturbed gait kinematics, but the virtual height illusion led to increased anxiety and mental effort and a decrease in confidence. The extemporaneous speech pauses were longer on average when walking, but no effects of virtual elevation were reported. Trends toward interaction effects arose in self-reported responses, with participants reporting more comfort walking at virtual heights if they engaged in extemporaneous speech. Walking at virtual elevation and while talking may have independent and significant effects on gait; both effects were robust and did not support an interaction when combined (i.e., walking and talking at virtual heights). The nature of extemporaneous speech may have distracted participants from the detrimental effects of walking in anxiety-inducing settings.

Epidemiology and Functional Impact of Early Peripheral Neuropathy Signs in Older Adults from a General Population.

INTRODUCTION: Peripheral neuropathy (PN) becomes more common with increasing life expectancy, but general population prevalence estimates are lacking. We investigated an epidemiological distribution of signs of PN among 2,996 community-dwelling participants in Good Aging in Skåne Study, age 60-97, and their impact on physical and autonomic function. METHODS: Signs of PN were measured with Utah Early Neuropathy Scale (UENS). Associations between UENS and physical tests, pain, and dysautonomic phenomena were calculated for each sex, adjusted for age, with estimated marginal means (EMM) and odds ratios (ORs) in four UENS quantiles (Q1-Q4). RESULTS: Participants in Q4 had worse EMM for: time to complete Timed Up and Go test (Q4-Q1: male 10.8-9.6 s; female 11.7-10.2 s), 15 m Walk test (Q4-Q1: male 11.1-9.9 s; female 11.2-10.4 s), and fewer repetitions in Step test (Q4-Q1: male 15.2-17.0 steps; female 14.5-15.8 steps). Higher OR of failing one-leg balance 60 s test {male 2.5 (confidence interval [CI] 95%: 1.7-3.8); female 2.1 (1.1-3.2)}, Foam Pad Balance test (male 4.6 [CI 95%: 3.2-6.7]; female 1.8 [1.3-2.6]), and lower physical quality of life were seen in Q4 compared to Q1. Participants in Q4 had higher OR for walking aid usage, falls, fear of falling, pain, and urinary incontinence, while in males, higher OR for orthostatic intolerance, fecal incontinence, and constipation. CONCLUSIONS: In a general population, 20-25% of older adults who have highest UENS scores, a sensitive measure of early PN, express slower gait, worse balance, lower quality of life, pain, falls and fear of falling, and autonomic symptoms.

Moving the needle on implementing fall prevention programs in Saudi Arabia: assessing knowledge and perceptions of fall risk among community-dwelling older women.

BACKGROUND: Saudi Arabia, like many nations globally, is experiencing a demographic shift towards an aging population. With this demographic shift, falls and the fear of falling (FOF) emerge as serious public health concerns among community-dwelling older adults. Addressing misconceptions and enhancing awareness regarding fall risks among older adults holds significant importance, offering insights for informing targeted interventions and enhancing well-being. This study aimed to examine knowledge and perceptions of fall risk among community-dwelling older women in Saudi Arabia. METHODS: A cross-sectional study was conducted with 150 Saudi older women, with a mean age (SD) of 63.98 (4.90) years. Participants completed questionnaires assessing fall history, fall knowledge, fall perception, the Falls Efficacy Scale-International (FES-I), Timed Up and Go (TUG), and the Barthel Index. Fall knowledge and perception were assessed using previously constructed statements translated into Arabic and carried out in interviewer-administered forms. RESULTS: Nearly half of the participants reported experiencing at least one fall in the previous 12 months. Despite good knowledge of falls, some gaps were identified, particularly regarding the awareness of social isolation as a consequence of falls. Participants demonstrated positive perceptions towards fall prevention programs but also highlighted misconceptions regarding aging and falls. FOF was prevalent, with higher levels identified among participants without a history of falls. CONCLUSION: Multidimensional strategies are needed to address falls and FOF among community-dwelling older women in Saudi Arabia. Leveraging existing knowledge and perceptions towards fall prevention and implementing evidence-based interventions can reduce the burden of falls and enhance health outcomes in older adults. Future research should focus on diverse samples and evaluate the feasibility of implementing fall prevention interventions within Saudi Arabia's healthcare systems.

The global prevalence of and risk factors for fear of falling among older adults: a systematic review and meta-analysis.

BACKGROUND: As a common psychological problem among older adults, fear of falling was found to have a wide range prevalence in different studies. However, the global prevalence of it was unknown and a lack of the large sample confirmed its risk factors. OBJECTIVES: To report the global prevalence of fear of falling and to explore its risk factors among older adults for further developing precise interventions to systematically manage FOF. DESIGN: A systematic review and meta-analysis was conducted by PRISMA guidelines. METHODS: Searches were conducted in PubMed, Web of Science, EMBASE, the Cochrane Library and the manual search in August 20, 2022, updated to September 2, 2023. Observational studies published in English were included and two researchers independently screened and extracted the data. Fixed or random effects mode was used to estimate the pooled prevalence of and risk factors for fear of falling. Heterogeneity resources were analyzed by subgroup and sensitivity analysis. Publication bias was assessed through funnel plots, Egger's test and Begg's test. RESULTS: A total of the 153 studies with 200,033 participants from 38 countries worldwide were identified. The global prevalence of fear of falling was 49.60%, ranging from 6.96-90.34%. Subgroup analysis found the estimates pooled prevalence of it was higher in developing countries (53.40%) than in developed countries (46.7%), and higher in patients (52.20%) than in community residents (48.40%). In addition, twenty-eight risk factors were found a significant associations with fear of falling, mainly including demographic characteristics, physical function, chronic diseases and mental problems. CONCLUSION: The global prevalence of FOF was high, especially in developing countries and in patients. Demographic characteristics, Physical function, chronic diseases and mental problems were a significant association with FOF. Policy-makers, health care providers and government officials should comprehensively evaluate these risk factors and formulate precise intervention measures to reduce FOF. TRIAL REGISTRATION: The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD42022358031.

Digital music and movement intervention to improve health and wellbeing in older adults in care homes: a pilot mixed methods study.

BACKGROUND: Low physical activity among older adults is related to adverse health outcomes such as depression and loneliness, poor physical function and increased risk of falls. This study was designed to increase physical activity through a digital, group-based, physical activity and music intervention and to examine its effectiveness on social, mental and physical health outcomes. METHODS: Participants were 34 older adults (65 years +) recruited across four care homes in Scotland to a pilot study. Surveys were administered at baseline and post-intervention, comprising measures of fear of falling, depression and anxiety, loneliness, sleep satisfaction and quality of life. A battery of physical function tests and saliva sampling for cortisol and dehydroepiandrosterone hormone analysis were also conducted at each time point. Additionally, process evaluation measures (recruitment, intervention fidelity, attendance, retention rates and safety) were monitored. The intervention comprised 12 weeks of three prescribed digital sessions per week: movement and music (n = 2) and music-only (n = 1), delivered by an activity coordinator in the care home. Post-intervention interviews with staff and participants were conducted to gain qualitative data on the acceptability of the intervention. RESULTS: An average of 88% of prescribed sessions were delivered. Pre- to post-intervention intention-to-treat analysis across all participants revealed significant improvements in anxiety, salivary DHEA, fear of falling and loneliness. There were no significant improvements in health-related quality of life, perceived stress, sleep satisfaction or physical function tests, including handgrip strength. Qualitative analysis highlighted benefits of and barriers to the programme. CONCLUSIONS: The digital movement and music intervention was deemed acceptable and delivered with moderate fidelity, justifying progression to a full-scale trial. Although a proper control group would have yielded more confident causal relationships, preliminary psychosocial and biological effects were evident from this trial. To show significant improvements in physical function, it is likely that a bigger sample size providing sufficient power to detect significant changes, greater adherence, longer intervention and/or higher exercise volume may be necessary. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov, number NCT05601102 on 01/11/2022.

The impact of fear of falling on health-related quality of life in community-dwelling older adults: mediating effects of depression and moderated mediation effects of physical activity.

BACKGROUND: The fear of falling is a common issue among older adults that negatively affects physical and psychological aspects of health-related quality of life, regardless of actual fall events. Interventions aimed at reducing fear of falling, independent of falls, may improve older adults' quality of life. This study examined the moderated mediation effect of physical activity in how fear of falling affects health-related quality of life through depression in community-dwelling older adults. METHODS: This study used secondary data from the Korea Centers for Disease Control and Prevention's 2019 Community Health Survey. The study included 73,738 adults aged 65 years or older. The researchers used the fear of falling scale, International Physical Activity Questionnaire, Patient Health Questionnaire-9, and EuroQol 5 Dimension as research tools, and performed descriptive statistics, Pearson's correlation coefficient, and SPSS PROCESS macro analysis. The study used the bootstrapping method to assess the adjusted mediating effect by resampling 5,000 times, and determined statistical significance with a 95% confidence interval. RESULTS: In the model in which fear of falling affects health-related quality of life by mediating depression, the moderated mediation effect of physical activity was statistically significant, as the bootstrapping result did not include 0 in the 95% confidence interval (Index of moderated mediation [95% CI] = 0.006 [0.004-0.007], 0.008 [0.006-0.009]). Depression and health-related quality of life impairment decreased as the level of physical activity increased through inactivity, minimal activity, and health promotion activities, as the negative mediating effects decreased. CONCLUSION: Physical activity reduces depression and improves health-related quality of life by influencing older adults' fear of falling. Community-based programs are needed to encourage and support older adults in maintaining moderate physical activity to manage the depression caused by fear of falling, which is common among older adults, and to improve their health-related quality of life.

Normalized stability time analysis within the boundaries between adults with and without fear of falling.

BACKGROUND: The unilateral stance test, measured by the center of pressure (COP), has been widely used to identify balance deficits. However, there is a critical gap in understanding the specific COP thresholds on postural stability in adults with a fear of falling (FOF). AIMS: To investigate the normalized stability time, which was defined as the ratio of time spent within stability boundaries to the total test duration, under different visual conditions and specific thresholds between adults with and without FOF. METHODS: Twenty-one older adults with FOF and 22 control subjects completed the unilateral limb standing test in eyes-open and eyes-closed conditions. Normalized stability times were computed based on five pre-determined COP sway range thresholds: 10 mm, 15 mm, 20 mm, 25 mm, and 30 mm. RESULTS: Receiver operating characteristic analysis determined the diagnostic accuracy of FOF. There were significant differences in the effects of both visual conditions (F = 46.88, p = 0.001) and threshold settings (F = 119.38, p = 0.001) on stability time between groups. The FOF group significantly reduced normalized stability time at the 10 mm COP threshold under eyes-closed conditions (t = - 1.95, p = 0.03). DISCUSSION: The findings highlight the heightened sensitivity of the 10 mm COP threshold in identifying group variances in postural stability when eyes are closed. Moreover, the FOF group displayed a marked reduction in stability duration based on visual scenarios and normalized thresholds. CONCLUSION: The study highlights the need to account for both COP boundaries and visual conditions in adults with FOF. When assessing postural control during unilateral stances, clinicians must also give attention to non-visual cues.

Topography of Cholinergic Nerve Terminal Vulnerability and Balance Self-Efficacy in Parkinson's Disease.

BACKGROUND: Postural instability and gait disturbances (PIGD) represent a significant cause of disability in Parkinson's disease (PD). Cholinergic system dysfunction has been implicated in falls in PD. The occurrence of falls typically results in fear of falling (FoF) that in turn may lead to poorer balance self-efficacy. Balance self-efficacy refers to one's level of confidence in their ability to balance while completing activities of daily living like getting dressed, bathing, and walking. Lower self-efficacy, or greater FoF during these activities is a function of motor, cognitive, and emotional impairments and may impact quality of life in PD. Unlike known cholinergic reduction, especially in the right lateral geniculate and caudate nuclei, little is known about the role of cholinergic transporters in FoF or mobility self-efficacy in PD. METHODS: [18F]fluoroethoxybenzovesamicol ([18F]FEOBV) positron emission tomography (PET) studies were conducted to assess vesicular acetylcholine transporter (VAChT) expression in 126 patients with PD (male (m) = 95, female (f) = 31). Participants had a mean age of 67.3 years (standard deviation (SD) = 7.1) and median Hoehn Yahr stage of 2.5. Patients also completed the Short Falls Efficacy Scale (sFES-I) as a survey measure of concerns about falling. [18F]FEOBV data were processed in Statistical Parametric Mapping (SPM) using a voxel-wise regression model with sFES-I scores as the outcome measure. RESULTS: Reduced [18F]FEOBV binding in tectum, metathalamic (lateral more than medial geniculate nuclei), thalamus proper, bilateral mesiotemporal (hippocampal, parahippocampal, fusiform gyri and fimbriae), and right cerebellar lobule VI significantly associated with higher sFES-I scores (p < 0.05, family-wise error (FWE) correction after Threshold-Free Cluster Enhancement (TFCE)). CONCLUSIONS: Unlike the more limited involvement of the brainstem-thalamic complex and caudate nuclei cholinergic topography associated with falls in PD, cholinergic reductions in the extended connectivity between the thalamic complex and the temporal limbic system via the fimbriae associates with FoF. Additional cholinergic changes were seen in the cerebellum. The temporal limbic system plays a role not only in episodic memory but also in spatial navigation, scene and contextual (e.g., emotional) processing. Findings may augur novel therapeutic approaches to treat poor mobility self-efficacy in PD. CLINICAL TRIAL REGISTRATION: No: NCT02458430. Registered 18 March, 2015, https://www. CLINICALTRIALS: gov/study/NCT02458430; No: NCT05459753. Registered 01 July, 2022, https://www. CLINICALTRIALS: gov/study/NCT05459753.

Perceived balance and self-reported falls: A retrospective cross-sectional study using the National Health and Aging Trend Study.

AIMS: To examine how perceived balance problems are associated with self-reported falls in the past month after controlling for known correlates of falls among older adults. BACKGROUND: Approximately 30% of adults age 65 and older fall each year. Most accidental falls are preventable, and older adults' engagement in fall prevention is imperative. Limited research suggest that older adults do not use the term 'fall risk' to describe their risk for falls. Instead, they commonly use the term 'balance problems'. Yet, commonly used fall risk assessment tools in both primary and acute care do not assess older adults' perceived balance. DESIGN AND METHOD: The Health Belief Model and the concept of perceived susceptibility served as the theoretical framework. A retrospective, cross-sectional secondary analysis using data from the National Health and Aging Trends Study from year 2015 was conducted. The outcome variable was self-reported falls in the last month. RESULTS: A subsample of independently living participants (N = 7499) was selected, and 10.3% of the sample reported a fall. Multiple logistic regression analysis revealed that the odds of reporting a fall in the past month was 3.4 times (p < .001) greater for participants who self-reported having a balance problem compared to those who did not. In contrast, fear of falling and perceived memory problems were not uniquely associated with falls. Using a mobility device, reporting pain, poor self-rated health status, depression and anxiety scores were also associated with falling. CONCLUSION AND IMPLICATIONS: Older adults' perceived balance problem is strongly associated with their fall risk. Perceived balance may be important to discuss with older adults to increase identification of fall risk. Older adults' perceived balance should be included in nursing fall risk assessments and fall prevention interventions. A focus on balance may increase older adults' engagement in fall prevention.

Association between fear of falling and mortality in middle-aged and older adults: A systematic review and meta-analysis.

BACKGROUND: Fear of falling (FOF) has emerged as a significant public health issue, contributing to excess disability among middle-aged and older adults. The association between FOF and mortality remains unclear. METHODS: Prominent electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycINFO, Scopus, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang Database) were searched from inception until October 21, 2023 (data updated on June 9, 2024), for cohort or longitudinal studies investigating the association between FOF and mortality. The heterogeneity between studies was quantitatively assessed using I2. A fixed-effect model calculated the pooled effect size. RESULTS: A total of seven cohort studies, including 27,714 participants, were analyzed in this systematic review and meta-analysis. The meta-analysis results demonstrated a positive association between FOF and mortality, with a significant increase in the risk of mortality for those with FOF (hazard ratio [HR]:1.29, 95 % confidence interval [CI]: 1.19-1.41, p < 0.05). Subgroup analysis indicated that age, male sex, clinical diagnosis of depression, number of chronic diseases, activity restriction due to FOF, and FOF levels were associated with mortality. CONCLUSIONS: FOF and mortality have a positive association, which needs to be confirmed by further prospective studies with large samples and long-term follow-up to provide evidence for clinicians to intervene in FOF to reduce mortality in middle-aged and older adults.