Diabetes mellitus in older persons with neurocognitive disorder: overtreatment prevalence and associated structural brain MRI findings.

BACKGROUND: Tight diabetes control is often applied in older persons with neurocognitive disorder resulting in increased hypoglycemic episodes but little is known about the pattern of brain injury in these overtreated patients. This study aims to: (a) quantify the prevalence of diabetes overtreatment in cognitively impaired older adults in a clinical population followed in an academic memory clinic (b) identify risk factors contributing to overtreatment; and (c) explore the association between diabetes overtreatment and specific brain region volume changes. METHODS: Retrospective study of older patients with type 2 diabetes and cognitive impairment who were diagnosed in a memory clinic from 2013 to 2020. Patients were classified into vulnerable and dependent according to their health profile. Overtreatment was defined when glycated hemoglobin was under 7% for vulnerable and 7.6% for dependent patients. Characteristics associated to overtreatment were examined in multivariable analysis. Grey matter volume in defined brain regions was measured from MRI using voxel-based morphometry and compared in patients over- vs. adequately treated. RESULTS: Among 161 patients included (median age 76.8 years, range 60.8-93.3 years, 32.9% women), 29.8% were considered as adequately treated, 54.0% as overtreated, and 16.2% as undertreated. In multivariable analyses, no association was observed between diabetes overtreatment and age or the severity of cognitive impairment. Among patients with neuroimaging data (N = 71), associations between overtreatment and grey matter loss were observed in several brain regions. Specifically, significant reductions in grey matter were found in the caudate (adj ß coeff: -0.217, 95%CI: [-0.416 to -0.018], p = .033), the precentral gyri (adj ßcoeff:-0.277, 95%CI: [-0.482 to -0.073], p = .009), the superior frontal gyri (adj ßcoeff: -0.244, 95%CI: [-0.458 to -0.030], p = .026), the calcarine cortex (adj ßcoeff:-0.193, 95%CI: [-0.386 to -0.001], p = .049), the superior occipital gyri (adj ßcoeff: -0.291, 95%CI: [-0.521 to -0.061], p = .014) and the inferior occipital gyri (adj ßcoeff: -0.236, 95%CI: [-0.456 to - 0.015], p = .036). CONCLUSION: A significant proportion of older patients with diabetes and neurocognitive disorder were subjected to excessively intensive treatment. The association identified with volume loss in several specific brain regions highlights the need to further investigate the potential cerebral damages associated with overtreatment and related hypoglycemia in larger sample.

Unplanned transfer to acute care during inpatient geriatric rehabilitation: incidence, risk factors, and associated short-term outcomes.

BACKGROUND: Information is scarce on unplanned transfers from geriatric rehabilitation back to acute care despite their potential impact on patients' functional recovery. This study aimed 1) to determine the incidence rate and causes of unplanned transfers; 2) to compare the characteristics and outcomes of patients with and without unplanned transfer. METHODS: Consecutive stays (n = 2375) in a tertiary geriatric rehabilitation unit were included. Unplanned transfers to acute care and their causes were analyzed from discharge summaries. Data on patients' socio-demographics, health, functional, and mental status; length of stay; discharge destination; and death, were extracted from the hospital database. Bi- and multi-variable analyses investigated the association between patients' characteristics and unplanned transfers. RESULTS: One in six (16.7%) rehabilitation stays was interrupted by a transfer, most often secondary to infections (19.3%), cardiac (16.8%), abdominal (12.7%), trauma (12.2%), and neurological problems (9.4%). Older patients (AdjORage≥85: 0.70; 95%CI: 0. 53-0.94, P = .016), and those admitted for gait disorders (AdjOR: 0.73; 95%CI: 0.53-0.99, P = .046) had lower odds of transfer to acute care. In contrast, men (AdjOR: 1.71; 95%CI: 1.29-2.26, P < .001), patients with more severe disease (AdjORCIRS: 1.05; 95%CI: 1.02-1.07, P < .001), functional impairment before (AdjOR: 1.69; 95%CI: 1.05-2.70, P = .029) and at rehabilitation admission (AdjOR: 2.07; 95%CI: 1.56- 2.76, P < .001) had higher odds of transfer. Transferred patients were significantly more likely to die than those without transfer (AdjOR 13.78; 95%CI: 6.46-29.42, P < .001) during their stay, but those surviving had similar functional performance and rate of home discharge at the end of the stay. CONCLUSION: A significant minority of patients experienced an unplanned transfer that potentially interfered with their rehabilitation and was associated with poorer outcomes. Men, patients with more severe disease and functional impairment appear at increased risk. Further studies should investigate whether interventions targeting these patients may prevent unplanned transfers and modify associated adverse outcomes.

Impact of an early geriatric rehabilitation program in acutely hospitalised vulnerable patients: a real-life study in an ACE unit in Switzerland.

INTRODUCTION: Early geriatric rehabilitation programs are potential means to prevent acute hospitalisation-associated functional decline. METHODS: The objectives were to measure the impact of an interdisciplinary rehabilitation program on patients' administrative in hospital data and on functional trajectories. With a before-and-after design, we compared all patients admitted from January to August 2018 into the Acute Care for Elders (ACE) unit of an Academic hospital in Switzerland who received this type of program to those admitted during the same period in 2016 and 2017. We considered vulnerable patients aged 75 or older. Functional independency level was assessed at baseline, admission, and discharge according to Katz's basic activities daily living (BADL). RESULTS: In total, 378/1,073 patients (mean age 86.6 ± 6.4; 74.6% women; 84% admitted from the emergency department) were prospectively admitted into the ACE unit in 2018. With an adherence rate of 74.0% to functional therapies and compared to the prior years, the program reduced transfers to rehabilitation settings (28.5 vs. 24.3%, p=0.04) and increased direct discharges to home (46.8 vs. 42.4%, p=0.04). Rates of early-unplanned readmission were similar. Between admission to discharge, 89.9% of the patients engaged in the program remained functionally stable or enhanced. Whatever the BADL score at the admission, 46.5% improved their status for at least one BADL. Even though no clinical determinant was identified, patients who engaged ≥ 5 sessions of functional therapy per week were more likely to improve their functional level (OR = 3.05; 95% CI 1.76-5.27). CONCLUSION: This real-life study demonstrates arguments to implement early interdisciplinary rehabilitation program in ACE units in particular to prevent functional decline in vulnerable patients. These findings support consideration regarding the interest of switching from the traditional disease-centred approach in acute care for older patients to a modern one, that also put the emphasis on maintaining functional capacities.

Mortality in COVID-19 older patients hospitalized in a geriatric ward: Is obesity protective?

BACKGROUNDS: To investigate the relationship between obesity and 30-day mortality in a cohort of older hospitalized COVID-19 inpatients. METHODS: Included patients were aged 70 years or more; hospitalized in acute geriatric wards between March and December 2020; with a positive PCR for COVID-19; not candidate to intensive care unit admission. Clinical data were collected from patients electronic medical records. Data on 30-day mortality were retrieved from the hospital administrative database. RESULTS: Patients included (N = 294) were on average 83.4 ± 6.7 years old, 50.7% were women, and 21.7% were obese (BMI > 30 kg/m2). At 30-day, 85 (28.9%) patients were deceased. Compared to survivors in bivariable analysis, deceased patients were older (84.6 ± 7.6 vs 83.0 ± 6.3 years), more frequently with very complex health status (63.5% vs 39.7%, P < .001), but less frequently obese (13.4% vs 24.9%, P = .033) at admission. Over their stay, deceased patients more frequently (all P < .001) developed radiologic signs of COVID-19 (84.7% vs 58.9%), anorexia (84.7% vs 59.8%), hypernatremia (40.0% vs 10.5%), delirium (74.1% vs 30.1%), and need for oxygen (87.1% vs 46.4%) compared to survivors. In multivariable analysis that controlled for all markers of poor prognosis identified in bivariable analysis, obese patients remain with 64% (adjOR 0.36, 95%CI 0.14-0.95, P = .038) lower odds to be deceased at 30-day than non-obese patients. CONCLUSIONS: In this population of older COVID-19 inpatients, an inverse association between obesity and 30-day mortality was observed even after adjusting for all already-known markers of poor prognosis. This result challenges previous observations in younger cohorts and would need to be replicated.

Executive function and prospective falls: a 6-year longitudinal study in community-dwelling older adults.

BACKGROUND: Older people with impaired executive function (EF) might have an increased fall risk, but prospective studies with prolonged follow-up are scarce. This study aimed to investigate the association between a) EF at baseline; b) 6-year decline in EF performance; and fall status 6 years later. METHODS: Participants were 906 community-dwelling adults aged 65-69 years, enrolled in the Lausanne 65 + cohort. EF was measured at baseline and at 6 years using clock drawing test (CDT), verbal fluency (VF), Trail Making Test (TMT) A and B, and TMT ratio (TMT-B - TMT-A/TMT-A). EF decline was defined as clinically meaningful poorer performance at 6 years. Falls data were collected at 6 years using monthly calendars over 12 months. RESULTS: Over 12-month follow-up, 13.0% of participants reported a single benign fall, and 20.2% serious (i.e., multiple and/or injurious) falls. In multivariable analysis, participants with worse TMT-B performance (adjusted Relative Risk Ratio, adjRRRTMT-B worst quintile = 0.38, 95%CI:0.19-0.75, p = .006) and worse TMT ratio (adjRRRTMT ratio worst quintile = 0.31, 95%CI:0.15-0.64, p = .001) were less likely to report a benign fall, whereas no significant association was observed with serious falls. In a subgroup analysis among fallers, participants with worse TMT-B (OR:1.86, 95%CI = 0.98-3.53, p = .059) and worse TMT ratio (OR:1.84,95%CI = 0.98-3.43,p = .057) tended to have higher odds of serious falls. EF decline was not associated to higher odds of falls. CONCLUSIONS: Participants with worse EF were less likely to report a single benign fall at follow-up, while fallers with worse EF tended to report multiple and/or injurious falls more frequently. Future studies should investigate the role of slight EF impairment in provoking serious falls in active young-old adults.

Effectiveness of Information Sessions About COVID-19 Vaccines in Healthcare Professionals Working in Geriatrics.

Objectives: To determine change in (a) perceived knowledge about COVID-19 vaccines; (b) level of confidence in transmitting information about vaccines; and (c) intention to get vaccinated; among healthcare professionals (HCP) working in a Swiss academic geriatric department who attended a 30-minute information session about COVID-19 vaccines. Measurements: At the session's end, a self-administered questionnaire collected information about socio-demographics, personnel, and/or relatives' experience with COVID-19. In addition, participants were asked to rate their: (a) perceived knowledge about COVID-19 vaccines; (b) level of confidence in transmitting information about COVID-19 vaccines to patients and relatives; and (c) intention to get vaccinated; before and after the session. Results: Overall, 97 (42.2% of all HCPs) participated to 14 sessions and completed the questionnaire. Improvements were observed in knowledge, confidence in providing information, and intention to be vaccinated after the session (all p < .001). Similar improvements were observed in subgroup analyses by gender, age groups, profession (involved in direct care or not), and previous experience with COVID-19 (all p < .010). However, HCP aged 20 to 29 years were less likely to feel completely confident in providing information than those aged 30 to 49 and 50+ years (17.1% vs. 43.2% vs. 44.0%, respectively, p = .031) and to report being very likely to be vaccinated (31.4% vs. 56.8% vs. 56.0%, respectively, p = .060). Conclusions: These information sessions positively influenced HCP knowledge, confidence in providing information, and, to a lesser extent, intention to be vaccinated. Younger HCP reported similar improvements but remained less likely to consider vaccination. Additional efforts are needed to convince these undecided HCP and enhance COVID-19 vaccines uptake.

Instrumented 5-Time Sit-To-Stand Test: Parameters Predicting Serious Falls beyond the Duration of the Test.

BACKGROUND: Falls are a major cause of injuries in older adults. To evaluate the risk of falls in older adults, clinical assessments such as the 5-time sit-to-stand (5xSTS) test can be performed. The development of inertial measurement units (IMUs) has provided the possibility of a more in-depth analysis of the movements' biomechanical characteristics during this test. The goal of the present study was to investigate whether an instrumented 5xSTS test provides additional information to predict multiple or serious falls compared to the conventional stopwatch-based method. METHODS: Data from 458 community-dwelling older adults were analyzed. The participants were equipped with an IMU on the trunk to extract temporal, kinematic, kinetic, and smoothness movement parameters in addition to the total duration of the test by the stopwatch. RESULTS: The total duration of the test obtained by the IMU and the stopwatch was in excellent agreement (Pearson's correlation coefficient: 0.99), while the total duration obtained by the IMU was systematically 0.52 s longer than the stopwatch. In multivariable analyses that adjusted for potential confounders, fallers had slower vertical velocity, reduced vertical acceleration, lower vertical power, and lower vertical jerk than nonfallers. In contrast, the total duration of the test measured by either the IMU or the stopwatch did not differ between the 2 groups. CONCLUSIONS: An instrumented 5xSTS test provides additional information that better discriminates among older adults those at risk of multiple or serious falls than the conventional stopwatch-based assessment.

Delirium in older patients undergoing aortic valve replacement: incidence, predictors, and cognitive prognosis.

BACKGROUND: Transcatheter aortic valve replacement is increasingly performed in frail older patients who were previously ineligible for a standard surgical procedure. The objectives of this study are to determine delirium incidence, predictors, and relationship with cognitive performance at 3-month follow-up in older patients undergoing aortic valve replacement (AVR). METHODS: Patients (N = 93) aged 70 years and older, undergoing transcatheter (TAVR, N = 66) or surgical (SAVR, N = 27) aortic valve replacement in an academic medical center were enrolled in this prospective cohort study. Delirium was assessed using the Confusion Assessment Method (CAM) on postoperative days 1, 2, 3, and 7. Data on patients' socio-demographics, functional status (including instrumental activities of daily living (IADL), and surgical risk scores (including Society of Thoracic Surgeons (STS) risk score), were collected at baseline. Cognitive status was assessed with the Mini-Mental Status Exam (MMSE) and the Clock Drawing Test (CDT) at baseline and 3 months after AVR. RESULTS: Delirium occurred in 21 (23%) patients, within the first three postoperative days in 95% (20/21) of the cases. Delirium incidence was lower in TAVR (13/66 = 20%) than SAVR (8/27 = 30%) patients, but this difference was not statistically significant (p = .298). Patients with delirium had lower baseline cognitive performance (median MMSE score 27.0 ± 3.0 vs 28.0 ± 3.0, p = .029), lower performance in IADL (7.0 vs 8.0, p = .038), and higher STS risk scores (4.7 ± 2.7 vs 2.9 ± 2.3, p = .020). In multivariate analyses, patients with intermediate (score > 3 to ≤8) and high (score > 8) STS risk scores had 4.3 (95%CI 1.2-15.1, p = .025) and 16.5 (95%CI 2.0-138.2, p = .010), respectively, higher odds of incident delirium compared to patients with low (score ≤ 3) STS risk scores. At 3-month follow-up (N = 77), patients with delirium still had lower MMSE score (27.0 ± 8.0 vs 28.0 ± 2.0, p = .007) but this difference did not remain significant once adjusting for baseline MMSE (ß-coefficient 1.11, 95%CI [- 3.03-0.80], p = .248). CONCLUSIONS: Delirium occurred in about one in five older patients undergoing AVR, almost essentially within the first three postoperative days. Beside cognitive performance, STS risk score could enhance the identification of high-risk older patients to better target preventative interventions.

Falls Efficacy Is Associated With Better Gait and Functional Outcomes After Rehabilitation in Older Patients.

OBJECTIVE: To examine the relationship between falls efficacy and the change in gait speed and functional status in older patients undergoing postacute rehabilitation. DESIGN: Prospective cohort study. SETTING: Postacute rehabilitation facility. PARTICIPANTS: Patients (N=180) aged 65 years and older (mean age ± SD, 81.3±7.1y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Data on demographics; functional, cognitive, and affective status; and falls efficacy using a 10-item version of the Falls Efficacy Scale (FES; range, 0-100) were collected upon admission. Data about gait speed and functional status (Barthel Index and Basic Activities of Daily Living [BADL]) were measured at admission and discharge. In addition, BADL performance was self-reported 1 month after discharge. RESULTS: Compared with admission, all rehabilitation outcomes improved at discharge: gait speed (0.41±0.15 m/s vs 0.50±0.16 m/s; P<.001), Barthel Index score (68.4±16.3 vs 82.5±13.6; P<.001), and BADL (3.5±1.6 vs 4.7±1.3; P<.001). Adjusting for baseline status and other potential confounders, baseline FES independently predicted gait speed (adjusted coefficient: 0.002; 95% confidence interval [CI], 0.000-0.004; P=.025) and Barthel index (adjusted coefficient: 0.225; 95% CI, 0.014-0.435; P=.037) at discharge, with higher confidence at baseline predicting greater improvement. Baseline FES was also independently associated with self-reported BADL performance at the 1-month follow-up (adjusted coefficient: 0.020; 95% CI, 0.010-0.031; P<.001). CONCLUSIONS: In older patients, higher falls efficacy predicted better gait and functional rehabilitation outcomes, independently of baseline performance. These results suggest that interventions aiming at falls efficacy improvement during rehabilitation might also contribute to enhancing gait speed and functional status in patients admitted to this setting.

Factors associated with going outdoors frequently: a cross-sectional study among Swiss community-dwelling older adults.

OBJECTIVE: This study examines potential risk and protective factors associated with going outdoors frequently among older persons, and whether these factors vary according to physical limitations. DESIGN: Cross-sectional analysis. SETTING AND PARTICIPANTS: Community-dwelling participants of the Lausanne cohort Lc65+ in 2016, aged 68-82 years (n=3419). METHODS: Associations between going outdoors frequently and physical limitations, sociodemographic, health, psychological and social variables were examined using logistic regression models. Subgroup analyses were performed according to the severity of physical limitations. MAIN OUTCOME MEASURES: 'Going outdoors frequently' was defined as going out ≥5 days/week and not spending most of the time sitting or lying down. RESULTS: Three in four (73.9%) participants reported going outdoors frequently. Limitations in climbing stairs (adjusted OR (AdjOR) 0.61, 95% CI 0.47 to 0.80) and walking (AdjOR 0.24, 95% CI 0.18 to 0.31), as well as depressive symptoms (AdjOR 0.58, 95% CI 0.47 to 0.70), dyspnoea (AdjOR 0.60, 95% CI 0.48 to 0.75), age (AdjORolder age group 0.73, 95% CI 0.59 to 0.92) and fear of falling (AdjOR 0.75, 95% CI 0.62 to 0.91) reduced the odds of going outdoors frequently. In contrast, living alone (AdjOR 1.30, 95% CI 1.08 to 1.56), reporting a dense (AdjOR 1.57, 95% CI 1.26 to 1.96) and a high-quality (AdjOR 1.28, 95% CI 1.06 to 1.53) social network increased the odds of going outdoors frequently. Among participants with severe limitations, 44.6% still went outdoors frequently. Among this subgroup, a new emotional relationship (AdjOR 2.52, 95% CI 1.18 to 5.38) was associated with going outdoors, whereas cognitive complaints (AdjOR 0.66, 95% CI 0.47 to 0.93), urinary incontinence (AdjOR 0.67, 95% CI 0.46 to 0.97), dyspnea (AdjOR:0.67, 95%CI:0.48-0.93), and depressive symptoms (AdjOR 0.67, 95% CI 0.48 to 0.93) lowered the odds of going outdoors. CONCLUSION: Physical limitations are associated with decreased odds of going outdoors frequently. However, social characteristics appear to mitigate this association, even among older persons with severe limitations. Further studies are needed to determine causality and help guide interventions to promote going outdoors as an important component of active ageing.

Sleep characteristics and self-rated health in older persons.

PURPOSE: It remains unclear, how much older persons' sleep problems are due to age-related changes in sleep architecture and pattern, or whether they are a consequence of health problems. This work aimed to examine the association between sleep characteristics and self-rated health, taking into account potential confounders. METHODS: Data about sleep, including sleep efficiency (ratio of sleep duration to the amount of time spent in bed, considered as good if > 85%), as well as health-rated characteristics were self-reported by community-dwelling persons enrolled in the Lausanne cohort 65+ study (n = 2712, age 66-75 years). Participants' subjective health was categorized as good versus poor. The cross-sectional association between good self-rated health and sleep characteristics was examined in bivariate and multivariate analysis. RESULTS: The majority of participants (68.4%) rated their health as good. Compared to the participants with poor-rated health, they more often reported a good sleep efficiency (59.5% vs 45.0%, p < 0.001) and less often reported napping (41.6% vs 54.0%, p < 0.001) as well as using sleep medication (12.7% vs 31.8%, p < 0.001). After adjustment for comorbidity, depressive symptoms and cognitive difficulties, a positive association persisted between good sleep efficiency and good self-rated health (adjOR: 1.35, 95% CI 1.10-1.66). Regular napping remained negatively associated to feel healthy (adjOR: 0.65, 95% CI 0.53-0.79). CONCLUSION: Sleep efficiency is positively associated with subjective health, whereas napping and use of sleep medication are negatively associated to rating own health as good. These associations need to be further investigated in longitudinal analyses to better understand causality.

Unknown osteoporosis in older patients admitted to post-acute rehabilitation.

BACKGROUND: Osteoporotic fractures are associated with increased morbidity, mortality, and increased health care use. As the number of older adults increases, identifying those at increased risk for osteoporotic fractures has become of utmost importance to providing them with preventive and therapeutic interventions. AIMS: To determine the prevalence of unknown clinical and densitometric osteoporosis and to investigate the performance of different diagnostic strategies for osteoporosis in elderly patients admitted to rehabilitation. METHOD: This is an observational study. Eligible participants were older adults admitted to rehabilitation in an academic hospital in Switzerland over an 11-month period. Patients with previously unknown osteoporosis underwent dual-energy X-ray absorptiometry (DXA), vertebral fracture assessment (VFA), and history review for past fractures. RESULTS: Complete assessment was available for 252 patients. Previously undiagnosed osteoporosis was identified in 62.3% of these patients, a proportion that was higher among women (71.5%) than men (44.8%). DXA proved most sensitive, followed by VFA and history review. Results differed across gender: DXA remained the most sensitive single test among women, but VFA proved most sensitive in men. The best test to combine with history review was DXA in women (detection increasing from 47.5 to 93.2%) and VFA in men (detection increasing from 35.9 to 84.6%). CONCLUSIONS: Prevalence of previously unknown osteoporosis appears very high in elderly patients admitted to post-acute rehabilitation. The combination of history review of previous fractures with DXA in women and with VFA in men appears the best two-step strategy to improving detection of osteoporosis in this population.

Impact of staffing a surgical intermediate care unit with a critical care specialist.

AIM: To assess the impact of reorganising an 11-bed surgical intermediate care unit (IMCU) from an open to a semi-closed system in a Swiss University Hospital by adding a critical care specialist (CCS). METHODS: This was a cohort study including adult IMCU patients enrolled in an Enhanced Recovery After Surgery protocol in the Department of Visceral Surgery, Lausanne University Hospital, from 1 February 2014 to 31 January 2016. Medical supervision by a CCS was implemented on 1 February 2015. RESULTS: Introduction of a CCS in a surgical IMCU significantly reduced intensive care unit length of stay (p = 0.005) and potentially preventable operation (p = 0.04) for patients undergoing oesophageal surgery. A CCS in IMCU also proved to significantly reduce readmission in IMCU for hepatic surgery patients (p = 0.04). For other sub-specialties (colorectal, pancreatic and gastric bypass surgery) no significant difference could be found. CONCLUSIONS: Reorganisation of a surgical IMCU from an open to a semi-closed system by implementing supervision by a CCS decreased length of stay and complications for the most fragile surgical patients (oesophageal and hepatic patients) after 12 months of implementation.

Concern about Falling and Complexity of Free-Living Physical Activity Patterns in Well-Functioning Older Adults.

BACKGROUND: Fall-related psychological concerns are common among older adults, potentially contributing to functional decline as well as to restriction of activities and social participation. To effectively prevent such negative consequences, it is important to understand how even very low concern about falling could affect physical activity behavior in everyday life. We hypothesized that concern about falling is associated with a reduction in diversity, dynamics, and performance of daily activities, and that these features can be comprehensively quantified in terms of complexity of physical activity patterns. METHODS: A sample of 40 community-dwelling older adults were assessed for concern about falling using the Falls Efficacy Scale-International (FES-I). Free-living physical activity was assessed using a set of metrics derived from data recorded with a chest-worn tri-axial accelerometer. The devised metrics characterized physical activity behavior in terms of endurance (total locomotion time, longest locomotion period, usual walking cadence), performance (cadence of longest locomotion period, locomotion periods with at least 30 steps and 100 steps/min), and complexity of physical activity patterns. Complexity was quantified according to variations in type, intensity, and duration of activities, and was considered as an adaptive response to environmental exigencies over the course of the day. RESULTS: Based on FES-I score, participants were classified into two groups: not concerned at all/fully confident (n = 25) and concerned/less confident (n = 15). Demographic and health-related variables did not differ significantly between groups. Comparison of physical activity behavior indicated no significant differences for endurance-related metrics. In contrast, performance and complexity metrics were significantly lower in the less confident group compared to the fully confident group. Among all metrics, complexity of physical activity patterns appeared as the most discriminative feature between fully confident and less confident participants (p = 0.001, non-parametric Cliff's delta effect size = 0.63). CONCLUSIONS: These results extend our understanding of the interplay between low concern about falling and physical activity behavior of community-dwelling older persons in their everyday life context. This information could serve to better design and evaluate personalized intervention programs in future prospective studies.