Fall risk in Chinese community-dwelling older adults: A physiological profile assessment study.

AIM: The short-form Physiological Profile Assessment (PPA) is increasingly used in clinical practice for assessing fall risk in older people. However, a normative database is only available for Caucasian populations. The purpose of the present study was to develop a normative database for Hong Kong Chinese older people and examine the fall risk profile of this population. METHODS: A total of 622 participants aged 60-95 years were recruited. Participants underwent the PPA (containing tests of contrast sensitivity, proprioception, quadriceps strength, reaction time and sway), and composite fall risk scores were computed. Participants were then followed up for falls for 1 year. RESULTS: Quadriceps strength and lower limb proprioception scores were comparable with those reported for Caucasian populations. However, contrast sensitivity, simple reaction time and postural sway scores were relatively poor. The average composite fall risk score was 1.7 ± 1.5, showing a "moderate" fall risk when compared with the Caucasian norms. Despite the relatively poor physical performances and moderately high fall risk scores, the incidence of one plus falls in the 1-year follow-up period was just 16.4%, with just 2.6% reporting two plus falls. The area under the curve for composite fall risk scores in discriminating fallers from non-fallers was 0.53 (95% CI 0.45-0.60). CONCLUSIONS: Despite poorer performance in PPA tests, the incidence of prospective falls in a Hong Kong Chinese population was low. In consequence, the PPA could not discriminate well between fallers and non-fallers. The present study provided normality data for short-form PPA measures for older Chinese people as a reference for further studies.

Depressive symptoms in addition to visual impairment, reduced strength and poor balance predict falls in older Taiwanese people.

OBJECTIVE: to determine whether depression is an important and independent predictor of falls in community-dwelling older people living in Taiwan. DESIGN: longitudinal study. SETTING: five randomly selected villages from Tainan city, Taiwan. PARTICIPANTS AND METHODS: in total, 280 community-dwelling people not taking anti-depressant medication aged 65-91 years (mean age 74.9). Participants completed the Geriatric Depression Scale and underwent a range of sensorimotor, balance and mobility tasks and were then followed up for 2 years with monthly telephone calls to determine falls incidence. RESULTS: of the 260 participants with complete follow-up data, 174 (66.9%) experienced no falls, 51 (19.6%) fell once and 35 (13.5%) fell two or more times. Depressive symptoms were significantly more prevalent in recurrent fallers (40.0%) and once-only fallers (27.5%) compared with non-fallers (16.1%). Negative binomial regression analysis identified depression, poor depth perception, reduced lower limb strength and increased sway as independent and significant predictors of falls. CONCLUSION: depressive symptoms were found to be common in older Taiwanese people and associated with an increased fall risk. These findings suggest that in addition to implementing approaches to maximise vision, strength and balance, fall prevention strategies should also include interventions to assess and treat depression.

Sensorimotor function, balance abilities and pain influence Timed Up and Go performance in older community-living people.

BACKGROUND AND AIMS: The Timed up and Go Test (TUG) is recommended as a screening tool for fall risk in older people. It is assumed that this general mobility test is underpinned by physiological factors such as strength, coordination and balance. However, no studies have examined the range of physiological and psychological factors which influence performance on this test. The aim of this study was to examine the relative contributions of a range of sensorimotor, balance and psychological factors to TUG performance in a large sample of older people. METHODS: 280 community-dwelling people aged 65 plus years (mean age 74.9, SD=6.4) underwent the TUG test, as well as quantitative tests of vision, peripheral sensation, strength, reaction time, balance, fear of falling, pain and vitality. RESULTS: The time required to complete the TUG was significantly related to limitations in instrumental activities of daily living and fear of falling. Many physiological and psychological factors were significantly associated with TUG performance in univariate analyses. Stepwise multiple regression analyses identified knee strength, postural sway, reaction time, edge contrast sensitivity, MMSE score, SF12 body pain and general health scores, number of medical conditions and age as significant and independent predictors of TUG performance. Of these measures, the lower limb strength measure explained most variance in TUG times. However, other sensorimotor, balance, psychological and health measures provided important independent information. The combined set of variables explained 43.5% of the variance in TUG times (multiple r=0.65). CONCLUSIONS: Findings indicate that, in community-dwelling older people, TUG performance is influenced by lower limb strength, balance, reaction time, vision and pain, in addition to cognitive function and health status.

Minimal chair height standing ability is independently associated with falls in Taiwanese older people.

OBJECTIVE: To determine whether a test of minimal chair height standing (MCHS) ability is an important predictor of fall risk in community-dwelling older people living in Taiwan, and whether poor performance in this test is associated with impaired sensorimotor functioning, balance, and mobility in this group. DESIGN: Cross-sectional study. SETTING: Community based. PARTICIPANTS: Community-dwelling participants (N=280; mean age, 74.9y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The MCHS test, which measures the lowest height from which a participant can stand; the Physiological Profile Assessment (PPA); and a range of functional balance and mobility tests. RESULTS: In the 12 months before the study, 81 participants (28.9%) experienced 1 or more falls. The fallers had significantly higher MCHS scores compared with the nonfallers: 29.7±9.0 and 25.0± 9.2cm, respectively. Fallers also had significantly higher PPA fall risk scores than nonfallers and performed significantly worse in tests of reaction time, standing and leaning balance, and alternate stepping ability. Discriminant function analysis revealed that poor performance in the MCHS and high PPA scores were both independently and significantly associated with falls. These 2 variables correctly classified 64.5% of participants into faller and nonfaller groups. Participants who reported regular squatting performed significantly better in the MCHS test, and multiple regression analysis revealed that impaired knee extension strength, poor single-leg stance ability, and reduced leaning balance were independent predictors of poor MCHS. CONCLUSIONS: In this study, MCHS was an independent risk factor for falls. It is a functional test similar to deep squatting and underpinned by strength and balance. Because the MCHS is quick to administer, it may have scope for clinical application.

Falls incidence, risk factors, and consequences in Chinese older people: a systematic review.

Falls incidence in Chinese older people has been reported to be approximately half that of Caucasian populations. It is possible that the falls risk factor profile may differ significantly between Caucasian and Chinese populations, and a better understanding of this reported difference in incidence and associated risk factors may influence potential approaches to future intervention. A systematic literature review was conducted using the EMBase, Medline, Chinese Electronic Periodical Services, and WanFangdata databases to collate and evaluate the studies that have addressed the incidence and risk factors for falls in Chinese older people. Twenty-one studies conducted in China, Hong Kong, Macao, Singapore, and Taiwan met the inclusion criteria. Fall rates ranged between 14.7% and 34% per annum (median 18%). In the four prospective studies, injuries were reported by 60% to 75% of those reporting falls, with fractures constituting 6% to 8% of all injuries. One hundred thirty-two variables were identified as fall risk factors, with commonly reported factors being female sex, older age, use of multiple medications, gait instability, fear of falling, and decline in activities of daily living. The findings reveal a consistently lower incidence of self-reported falls in Chinese older people than in Caucasian older people, although the types and prevalence of risk factors were not dissimilar from those found in studies of Caucasian older people. A greater understanding of the health, behavioral, and lifestyle factors that influence fall rates in Chinese populations is required for elucidating fall prevention strategies in Chinese and non-Chinese older people.

Group exercise can improve participants' mobility in an outpatient rehabilitation setting: a randomized controlled trial.

OBJECTIVE: To establish the effects of group exercise on mobility and strength. DESIGN: Randomized controlled trial. SETTING: Two public hospital outpatient rehabilitation services. PARTICIPANTS: One hundred and seventy-three people (mean age 74.9 years, SD 10.8) with impaired mobility were randomized and 159 people (92%) completed the trial. INTERVENTIONS: Five-week, twice-weekly ;circuit-style' group exercise programme run by a physiotherapist (n = 85) and a no-intervention waiting list control group (n = 88). MAIN OUTCOME MEASURES: Three aspects of mobility: balance while standing and stepping (Step Test, semi-tandem and tandem stance times); sit-to-stand ability (rate and minimum height) and gait (6-metre and 6-minute walk tests). Lower limb muscle strength (knee flexion and extension). RESULTS: At retest, exercise participants had improved significantly more than their control counterparts on measures of balance while stepping, sit to stand and gait. Exercise participants averaged 1.6 more steps on the 15-second Step Test (95% confidence interval (CI) 0.5 to 2.8, P=0.005), walked an average of 0.12 m/s faster (95% CI 0.05 to 0.2, P=0.002) and took 2.5 fewer steps in 6 metres (95% CI -4.2 to -0.8, P=0.004). Exercise participants also averaged 0.04 more sit-to-stands/second, (95% CI 0.003 to 0.08, P=0.037) and walked an average of 30.9 metres further in 6 minutes (95% CI 9.4 to 52.4, P=0.005). There were no clinically important or statistically significant between-group differences at retest for the measures of strength (knee extension and flexion), balance while standing or minimal sit-to-stand height. CONCLUSION: This short-duration circuit class programme improved mobility, but not strength.

A novel weight-bearing strengthening program during rehabilitation of older people is feasible and improves standing up more than a non-weight-bearing strengthening program: a randomised trial.

QUESTION: What is the feasibility and effectiveness of a novel weight-bearing strengthening program compared with that of a traditional non-weight-bearing strengthening program for older inpatients undergoing rehabilitation? DESIGN: Randomised, controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Eighty-eight inpatients (11% loss to follow-up) aged on average 82 years old from three rehabilitation units with no contraindications to exercise. INTERVENTION: Both the weight-bearing and non-weight-bearing strengthening programs were supervised by physiotherapists and were of similar intensities (10 to 15 RM) for two weeks. OUTCOME MEASURES: The primary outcomes were standing up performance measured as minimum chair height, and strength measured as maximum isometric knee extensor force of both legs. The secondary outcomes were other mobility measures such as standing-up rate, walking, standing and overall mobility, and other strength measures such as maximum isometric hip extensor, hip abductor, and knee flexor force of both legs. RESULTS: After the two-week intervention, the weight-bearing strengthening group had decreased their minimum chair height by 5.3 cm (95% CI 0.7 to 9.8) and increased their hip extensor strength on the weaker leg by 9 N (95% CI 1 to 17) more than the non-weight-bearing strengthening group. There were no clinically-worthwhile or statistically-significant differences between the groups for any other measures. CONCLUSION: This novel weight-bearing strengthening program was feasible and safe in an inpatient rehabilitation setting and had some additional benefits over a traditional non-weight-bearing strengthening program.

Reliability of clinical tests of foot and ankle characteristics in older people.

Lower-extremity problems are common in older people; however, the reliability of clinical tools used to assess foot and ankle characteristics has not been rigorously evaluated. This study evaluated the test-retest reliability of a battery of simple clinical tests of foot and ankle characteristics (tactile sensitivity of the first metatarsophalangeal joint, navicular height, foot length and width, hallux valgus severity, an overall foot problem score, ankle flexibility, ankle dorsiflexion strength, and foot pain) in 31 individuals (13 men and 18 women) aged 76 to 87 years recruited from the community. Three examiners performed the tests on two occasions approximately 2 weeks apart. Intraclass correlation coefficients and coefficients of variation were calculated for continuously scored tests, and the kappa statistic (kappa) was used to determine the reliability of hallux valgus severity grading. All of the continuously scored tests had acceptable reliability (intraclass correlation coefficients of 0.64 to 0.98; coefficients of variation of 0.6% to 15.0%), as did hallux valgus severity grading (kappa = 0.77; absolute percentage agreement, 84%). These simple clinical tests can now be used with confidence in clinical and research settings to provide reliable and functionally important information regarding foot and ankle characteristics in older people.