Falls Prevention: Community Exercise Programme, Reducing Risk of Falls, Deconditioning and Loneliness in Frail Elderly Patients

Introduction Covid has had a devastating effect on the Elderly, resulting in deconditioning, increased falls and loneliness. Tailored exercises can reduce falls in people aged over 65 by 54% and participation in physical activity reduces the risk of hip fractures by 50%, currently costing the NHS 1.7 billion per year in England. This 8-week intervention delivered by trained volunteers in patient's homes, aims to reduce deconditioning, loneliness and the risk, incidence and fear of falling (FOF) amongst frail patients post-discharge from hospital. Method A gap in service was identified in Frail patients discharged from hospital, at risk of falling and awaiting community physiotherapy. A steering group was set up including acute and community therapists, volunteers and carers to design a collaborative intervention to bridge the gap. At risk patients were identified and referred by ward therapists supported by the hospital volunteering team. Volunteers were trained to deliver an 8 weeks programme of progressive exercises in patients' homes with additional signposting to appropriate statutory and voluntary services. Qualitative and quantitative outcome measures were taken at week 1 and week 8 of the intervention Results 91.5% total health outcomes improved or maintained by average: - FOF reduced by 22.5% - 180 degree turn improved by 43% - 60 sec Sit to Stand improved by 14.75% - Timed Up And Go improved by 15.5% - Confidence to cope at home improved by 15% - Pain / discomfort (self-reported) improved by 18.75% - Overall health (self-reported) improved by 8.5% Conclusion(s) Targeted exercise at home with skilled volunteers can improve functional fitness and health outcomes in a frail elderly population at risk of falls when discharged home from hospital. The programme increases patients' connectivity to local voluntary and community sector services. Volunteers' mental health improves by engaging in meaningful service.

Effects of a psychomotor program developed in the COVID pandemic on risk factors for falls in nursing home older adults

Objective: This study aimed to determine the effects of a psychomotor program performed during the COVID pandemic on risk factors for falls in nursing home older adults. Method(s): The study involved 10 nursing home older adults (aged 67-91 years old) who integrated two periods without intervention (control: pre-lockdown;and lockdown) and an experimental period (attending the program). Cognitive, emotional and physical functioning risk factors for falling were measured before and after each period. Result(s): Friedman's Test followed by Pairwise Comparison post-test showed that the program induced significant improvements with an effect size (EF) ranging from large to small in the follow risk factors: fear of falling (EF=3.22), depressive states (EF=1.49), static balance (EF=0.83), lower strength (EF=0.76), upper strength (EF=0.73), cognitive status (EF=0.58), upper flexibility (0.52), perception of affordances - real (EF=0.51) and estimated (EF=0.45), agility and balance (EF=0.37), balance and mobility (EF=0.36), lower flexibility (EF=0.24) and aerobic resistance (EF=0.21), (p<0.05). On the other hand, in the no-intervention periods, lower and upper strength, upper flexibility and perception of affordances - estimated significantly decreased (p<0.05). Conclusion(s): Results from the study showed that the psychomotor program was effective in falls prevention by improving cognitive, emotional and physical functioning risk factors for falling. These findings suggest that for older adults' good quality of life, psychomotor programs should be implemented in nursing homes.

Differences in Physical and Mental Health of Older Adults over the Covid-19 Pandemic from Face-to-Face versus Hybrid Methods

Background/Purpose: As a result of the COVID-19 pandemic, changes in data collection methods have been introduced in research to ensure continuity despite physical distancing and lockdown restrictions. Our objective was to compare differences in physical and mental health of older adults participating in falls research using data collection methods pre-covid-19 pandemic (face-to-face) and during the pandemic (hybrid). Method(s): Individuals aged 60 years and over with at least one fall in the past 12 months, and controls with no history of falls in the past 12 months were recruited. Pre-pandemic, individuals were interviewed face-to-face exclusively, those interviews after the start of the pandemic were conducted virtually with physical assessments conducted face-to-face to minimize physical contact. Cognitive status, physical performance, psychological status, quality of life, physical activity, and social participation were measured. Result(s): Of the 145 participants of similar socio-demographic backgrounds, 69 were interviewed face-to-face, while 76 were assessed using a hybrid method. Differences were observed in presence of fall characteristics, with fewer fallers seeing a doctor and more fallers attending the emergency department after the start of the pandemic. After adjustment for baseline differences, participants interviewed using hybrid status had lower depression scores (OR (95%CI)=0.29(0.14-0.61)) and stress scores (OR(95%CI)=0.33(0.15-0.72)), but greater fear of falling (OR(95%CI)=2.16(1.04-4.48)) and reduced social participation (OR(95%CI)=2.64(1.20-5.79)). Conclusion(s): Alterations in data collection methods to overcome pandemic restrictions should take into consideration potential differences in individuals who agree to participate as well as the influence of major life events on the psychological status of participants. Copyright © 2022, Full Universe Integrated Marketing Limited. All rights reserved.

Factor affecting the activities of daily living among aging people during the COVID-19 pandemic - a structural equation modelling.

Introduction: The activities of daily living (ADLs) are a set of basic skills necessary for self-care. The inability of elderly people to perform ADLs leads to dependence, insecure conditions, and poor quality of life. The COVID-19 pandemic has affected all aspects of the daily life of the elderly. This study aimed to determine the factors associated with ADLs among elderly people during the COVID-19 pandemic using structural equation modelling/path analysis. Material and methods: It was a descriptive-analytical study which had conducted on 487 elderly people who were selected randomly to participate in the study. Data collection tools included a demographic information questionnaire, an activities of daily living questionnaire, a knee pain and personal performance questionnaire Western Ontario and McMaster Universities Osteoarthritis (WOMAC), and the falls efficacy scale, which were completed by interview and self-report methods. SPSS-22 and AMOS software were used for data analysis. Results: Two structures of the fear of falling (FOF) and knee pain and personal performance questionnaire WOMAC had a significant role in explaining the ADL variance among the studied elderly people (p < 0.001, root mean square error of approximation = 0.063). These variables explained 64% of the ADL variance. Conclusions: The structures of this model (FOF and WOMAC) can be used as a reference framework to design effective interventions for improving ADLs among elderly people during the COVID-19 epidemic. It is also recommended that a multi-component program be provided, which includes exercise and psychological strategies for this population during the COVID-19 pandemic through online videos, distance health programs, etc.

Social vulnerability increased the non-motor worsening in people living with Parkinson's disease during the COVID-19 pandemic

Objective: To investigate the social vulnerability impact on motor and non-motor worsening in people living with PD during the COVID- 19 pandemic. Background: The COVID-19 pandemic has imposed a large variety of unparalleled challenges, many of which appear to be disproportionately impacting the mental and physical health of people living in different social vulnerability condition. People living with Parkinson's disease (PD) experimented a clinical worsening during the pandemic explained by multidimensional factors (Silva-Batista et al.,2021). Methods: One hundred people with a confirmed diagnosis of Idiopathic PD, 45 females, mean age of 67.3 years (SD = 9.2), in stage 1-3 of disease evolution according to Hoehn and Yahr classification, participated in the present study. After presenting the informed consent form, and expressing agreement to participate in the study, participants were asked to answer, through telephone interviews, a previously established questionnaire that investigates: (1) general information;(2) socioeconomic status;(3) information associated with PD;(4) quality of life worsening;(5) health conditions related to COVID-19;(6) mental health worsening;(7) fear of falling;(8) level of physical activity;(9) cognitive health conditions and (10) motor and non-motor aspects of daily life experience. The participants were divided into two groups, according to the social vulnerability condition: high social vulnerability group (HSV) and low social vulnerability group (LSG). The comparison in worsening severity of all factors between the two groups was analyzed by ANOVA one-way. Results: The groups were comparable in demographic and clinical aspects. The ANOVA showed a significant statistical difference between the groups only for pain (F(1,95) = 6.98, p = .009), urinary problems (F (1,96) = 4.47 p = .03), and apathy F(1,95) = 4.52, p = .03). The Tukey post-hoc confirmed a more severe worsening for HSV (p < .001). Conclusion: People with PD living in a high social vulnerability condition demonstrated increased non-motor worsening during the COVID-19 pandemic. These results emphasize the importance of developing support social and health assistance to alleviate the social vulnerability impact during the COVID-19 pandemic and other similar unexpected stress situations on people living with PD.

Gender differences in stress and mental health due to COVID-19 pandemic in people living with Parkinson's disease

Objective: To investigate the gender differences in the motor and non-motor worsening associated with COVID-19 pandemic in people living with PD. Background: The COVID-19 pandemic has imposed a large variety of unparalleled challenges, many of which appear to be disproportionately impacting the mental health and well-being of men and women. People living with Parkinson's disease (PD) experimented a clinical worsening during the pandemic explained by multidimensional factors, however, gender was not one of them. Investigate the gender influence on the response to adverse effects of stressful effects of unexpected conditions may help to guide preventive programs for people living with PD. Methods: 100 people with Idiopathic PD, 45 females, mean age of 67.3 years (SD = 9.2), in stage 1-3 of disease evolution according to H&Y classification, participated in the present study. After expressing agreement to participate in the study, participants were asked to answer, through telephone interviews, a previously established questionnaire that investigates: (1) general information;(2) socio-economic status;(3) information associated with PD;(4) quality of life worsening;(5) health conditions related to COVID-19;(6) mental health worsening;(7) fear of falling;(8) level of physical activity;(9) cognitive health conditions and (10) motor and non-motor aspects of DLA. The participants were divided into two groups, according to gender. The comparison in worsening severity of all factors between the two groups (male and female), was analyzed by ANOVA one-way. Results: The groups were comparable in demographic and clinical aspects. The ANOVA showed a significant statistical difference between the groups only for discouragement, sadness, hopelessness (F(1, 95) = 5.6, p = .01) and adaptation difficulty (F(1, 95) = 11.4, p = .001. The Tukey post-hoc confirmed a more severe worsening of mental health in females (p < .001). Conclusion: Females living with PD demonstrated higher levels of discouragement, sadness, hopelessness, and higher difficulty to adapt the social isolation during the COVID-19 pandemic. These results emphasize the importance of developing support assistance to mitigate the extensive negative impacts of the COVID-19 pandemic and other similar unexpected stress situations on people living with PD, as also of the development of specific interventions to the gendered impacts on mental health and well-being.

Changes in activity levels, physical functioning, and fall risk during the COVID-19 pandemic.

BACKGROUND: Physical function worsens with older age, particularly for sedentary and socially isolated individuals, and this often leads to injuries. Through reductions in physical activity, the COVID-19 pandemic may have worsened physical function and led to higher fall-related risks. METHODS: A nationally representative online survey of 2006 U.S. adults aged 50-80 was conducted in January 2021 to assess changes in health behaviors (worsened physical activity and less daily time spent on feet), social isolation (lack of companionship and perceived isolation), physical function (mobility and physical conditioning), and falls (falls and fear of falling) since March 2020. Multivariable logistic regression was used to assess relationships among physical activity, social isolation, physical function, falls, and fear of falling. RESULTS: Among respondents, 740 (36.9%) reported reduced physical activity levels, 704 (35.1%) reported reduced daily time spent on their feet since March 2020, 712 (37.1%) reported lack of companionship, and 914 (45.9%) social isolation. In multivariable models, decreased physical activity (adjusted risk ratio, ARR: 2.92, 95% CI: 2.38, 3.61), less time spent on one's feet (ARR: 1.95, 95% CI: 1.62, 2.34), and social isolation (ARR: 1.51, 95% CI: 1.30, 1.74) were associated with greater risks of worsened physical conditioning. Decreased physical activity, time spent daily on one's feet, and social isolation were similarly associated with worsened mobility. Worsened mobility was associated with both greater risk of falling (ARR: 1.70, 95% CI: 1.35, 2.15) and worsened fear of falling (ARR: 2.02, 95% CI: 1.30, 3.13). Worsened physical conditioning and social isolation were also associated with greater risk of worsened fear of falling. CONCLUSION: The COVID-19 pandemic was associated with worsened physical functioning and fall outcomes, with the greatest effect on individuals with reduced physical activity and social isolation. Public health actions to address reduced physical activity and social isolation among older adults are needed.

Effects of a Rehabilitation Program Using a Patient-Personalized Exergame on Fear of Falling and Risk of Falls in Vulnerable Older Adults: Protocol for a Randomized Controlled Group Study.

BACKGROUND: Older adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames. OBJECTIVE: This study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation. METHODS: This is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis. RESULTS: The protocol (2019-11-22) has been approved by the Comité de Protection des Personnes Nord-Ouest I-Université de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022. CONCLUSIONS: The effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT04134988; https://clinicaltrials.gov/ct2/show/NCT04134988. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24665.

Increased anxiety about falls and walking ability among community-dwelling Japanese older adults during the COVID-19 pandemic.

BACKGROUND: Understanding the physical and mental changes in community-dwelling elderly people is very important during the coronavirus disease 2019 (COVID-19) pandemic when considering preventive measures. The purpose of this study was to clarify the changes of physical function and anxiety for activities of daily living in community-dwelling older adults, focusing on locomotor function during the COVID-19 pandemic. METHODS: The study participants were 127 older people who participated in successive surveys, in the summers of 2019 and again in 2020, after the state of emergency. The Locomo 25 questionnaire, Geriatric Depression Scale-15 (GDS-15) questionnaire, medical history, and number of people living together were self-reported. The Locomo 25 covers six aspects of physical pain, movement-related difficulty, usual care, daily activity, social activities, and anxiety. RESULTS: The paired samples t-test revealed that Locomo 25 total scores in 2020 were significantly higher than those in 2019. The GDS-15 score showed no significant difference. The comparison of scores for each item of the Locomo 25 revealed significantly higher scores in 2020 on Q21 ('difficult to perform sports activity', P = 0.0021), Q22 ('restricted from meeting own friends', P < 0.001), Q23 ('restricted from joining social activities', P < 0.001), Q24 ('anxious about falling in own house', P = 0.0023), and Q25 ('anxious about being unable to walk in the future', P = 0.0016). CONCLUSIONS: About 2 months after declaration of the first state of emergency due to the COVID-19 pandemic in Japan, social activity was severely restricted. Older adults showed almost no changes in body pain and locomotive disabilities, but increases in their anxieties about walking ability and falling were remarkable.