Standing from the Floor in Community-Dwelling Older Adults.

While considerable research has targeted physical performance in older adults, less is known about the ability to rise from the floor among community-dwelling elders. The purposes of the study were to (1) examine physical performance correlates of timed supine to stand performance and (2) identify the predominant motor pattern used to complete floor rise. Fifty-three community-dwelling adults over the age of 60 (x = 78.5 ± 8.5; 36 [68%] females) performed a timed supine to stand test and physical performance assessments. Forty-eight subjects (90.6%) demonstrated an initial roll with asymmetrical squat sequence when rising to stand. Supine to stand performance time was significantly correlated with all physical performance tests, including gait speed (r = -.61; p < .001), grip strength (r = -.30; p < .05), and Timed Up and Go (TUG) performance (r = .71; p < .001). Forty-eight percent of the variance in rise time (p < .001) was attributed to TUG velocity. Findings serve to enhance both functional performance assessment and floor rise interventions.

Fear of falling and balance ability in older men: the priest study.

Studies examining fear of falling among older adult men remain limited. The objectives of this study were to compare balance confidence in 2 age cohorts of older clergy and identify predictive determinants of balance confidence in a liturgical research initiative. Participants included 131 community-dwelling Roman Catholic priests age 60-97 yr living in religious communities in 10 mid-Atlantic states. Subjects completed the Activities-specific Balance Confidence Scale (ABC), Berg Balance Scale (BBS), timed up-and-go (TUG) test, and 15-item Geriatric Depression Scale (GDS). Younger priests (60-74 yr) demonstrated a significantly higher ABC score than the older cohort (75 and above yr) of priests (89.1 ± 12.6 vs.78.4 ± 13.9, p = .001). Confidence was significantly correlated with BBS (rho = .69, p < .01), TUG (r = -.58, p < .01), and GDS (r = -.39, p < .01) scores. A stepwise-regression model demonstrated that balance ability, mood, assistive-device use, and physical activity predicted 52% of the variance in balance confidence.

The effects of aging on the attentional demands of walking toward and stepping up onto a curb.

Community ambulation requires the capacity to alter gait in response to obstacles within the path of travel that appear at a known location. Acquiring information from the environment to safely negotiate a curb may increase the cognitive demands of walking. The purpose of this study was to examine the attentional demands of walking toward and stepping up onto a curb in young, middle-age and older adults. Single and dual-task voice reaction time (VRT) was measured in community-dwelling young (n = 24), middle-age (n = 24), and older adults (n = 24) across 5 conditions: sitting in a chair, standing, level walking, and walking toward and while stepping up onto a curb. A 3 (group) by 5 (task condition) ANOVA was used to examine VRT. The interaction of group with task revealed statistically significant within group increases in VRT when comparing either sitting and/or standing to walking on a level surface and walking toward the curb and stepping up onto the curb. When compared to the other groups, older adults had significantly longer VRT for all walking tasks. Stepping onto the curb significantly increased the attentional requirements of walking for all of the groups when compared to level walking. The pattern of statistically significant between group and within group differences during the walking tasks indicate the effects of a curb located at a predictable place in the environment on attentional allocation.

Effect of guided relaxation and imagery on falls self-efficacy: a randomized controlled trial.

OBJECTIVES: To examine the effects of guided relaxation and imagery (GRI) on improvement in falls self-efficacy in older adults who report having a fear of falling. DESIGN: Randomized, controlled trial with allocation to GRI or guided relaxation with music of choice. SETTING: General community. PARTICIPANTS: Ninety-one men and women aged 60 to 92. INTERVENTION: Participants were randomized to listen to a GRI audio compact disk (intervention group) or a guided relaxation audio compact disk and music of choice (control group) twice a week for 6 weeks for 10 minutes per session. MEASUREMENTS: Primary outcome measure was the Short Falls Efficacy Scale-International (FES-I). Secondary outcome measures were the Leisure Time Exercise Questionnaire (LTEQ) and the Timed Up and Go (TUG) mobility test. RESULTS: GRI participants reported greater improvements on the Short FES-I (P = .002) and LTEQ (P = .001) scores and shorter time on the TUG (P = .002) than the guided relaxation and music-of-choice group. CONCLUSION: GRI was more effective at increasing falls self-efficacy and self-reported leisure time exercise and reducing times on a simple mobility test than was guided relaxation with music of choice. GRI is an effective, simple, low-cost tool for older adults to improve falls self-efficacy and leisure time exercise behaviors.

Usefulness of the Berg Balance Scale to predict falls in the elderly.

OBJECTIVE: The purpose of this systematic review was to complete a comprehensive search and review of the literature to determine the ability of the Berg Balance Scale (BBS) to predict falls in the elderly with and without pathology. Specifically, the cutoff score that is most predictive of falls in the older adults and the sensitivity and specificity of the BBS in predicting falls. METHODS: A search of English-language-based literature with relevant search terms using the OVID, CINAHL, PubMed, and MEDLINE search engines from 1985 to March 2009. RESULTS: Nine studies warranted inclusion in this systematic review after evaluation for article objectives, inclusion criteria, and scoring 5 or more out of 10 on the Physiotherapy Evidence Database scale. Five studies addressed the elderly population ( = 65 years) without pathology. The remaining 4 studies addressed elderly participants with neurological disorders. All 9 studies reported sensitivity and specificity of the BBS in predicting falls. Sensitivity and specificity results varied greatly depending on the cutoff score and the author's objectives. Eight of the 9 studies recommended specific cutoff scores. DISCUSSION AND CONCLUSION: The BBS alone is not useful for predicting falls in the older adults with and without pathological conditions. Given the varied recommended cutoff scores and psychometric values, clinicians should use the BBS in conjunction with other tests/measures considering unique patient factors to quantify the chances of falls in the older adults. This study recommends research to formulate a scoring algorithm that can further enhance the clinician's ability to predict falls in the older adults.

The effect of guided relaxation and exercise imagery on self-reported leisure-time exercise behaviors in older adults.

The purpose of this study was to examine the effects of a 6-wk intervention that used guided relaxation and exercise imagery (GREI) to increase self-reported leisure-time exercise behavior among older adults. A total of 93 community-dwelling healthy older adults (age 70.38 ± 8.15 yr, 66 female) were randomly placed in either a placebo control group or an intervention group. The intervention group received instructions to listen to an audio compact disk (CD) containing a GREI program, and the placebo control group received an audio CD that contained 2 relaxation tracks and instructions to listen to music of their choice for 6 wk. Results revealed that listening to a GREI CD for 6 wk significantly increased self-reported leisure-time exercise behaviors (p = .03). Further exploration of GREI and its effects on other psychological variables related to perceived exercise behaviors may substantiate its effectiveness.

Ability of Functional Independence Measure to accurately predict functional outcome of stroke-specific population: systematic review.

Stroke is a leading cause of functional impairments. The ability to quantify the functional ability of poststroke patients engaged in a rehabilitation program may assist in prediction of their functional outcome. The Functional Independence Measure (FIM) is widely used and accepted as a functional-level assessment tool that evaluates the functional status of patients throughout the rehabilitation process. From February to March 2009, we searched MEDLINE, Ovid, CINAHL, and EBSCO for full-text articles written in English. Article inclusion criteria consisted of civilian and veteran patients posthemorrhagic and ischemic stroke with an average age of 50 years or older who participated in an inpatient rehabilitation program. Articles rated 5 or higher on the PEDro (Physiotherapy Evidence Database) scale were analyzed, including one cluster randomized trial and five cohort studies. Descriptive and psychometric data were outlined for each study. Key findings, clinical usefulness of the FIM, potential biases, and suggestions for further research were summarized. Although limited, evidence exists that FIM scores can be used as an accurate predictor of outcomes in poststroke patients.

Examination of the six minute walk test to determine functional capacity in people with chronic heart failure: a systematic review.

PURPOSE: To evaluate the reliability and validity of the six-minute walk test (6MWT) with respect to its ability to predict functional capacity in patients with chronic heart failure. METHODS: A systematic review was performed via 8 databases to assess relevant English language full-text articles published from January 1, 1980 to October 31, 2009. Participant characteristics, interventions, reliability, validity, and predictive value for each article with respect to functional capacity as defined by peak VO(2) levels were extracted and compared. Quality Assessment of Diagnostic Accuracy Studies (QUADAS) scores were determined for each study. RESULTS: Fourteen studies met the selection criteria. Comparison of the studies investigating reliability shows that the 6MWT has good reproducibility. The 6MWT demonstrates moderate correlation with peak VO(2) levels, and ability to predict VO(2) (functional capacity) dependent on distance walked. Cut-off distances vary from 300 to 490 meters depending on the study; if total distance walked remains equal or less than these values, the 6MWT retains its strong predictive value. CONCLUSION: The 6MWT has good reliability, moderate validity, and a significant ability to predict functional capacity in patients with CHF who do not walk greater than 490 meters.

Gait variability detects women in early postmenopause with low bone mineral density.

BACKGROUND: Women in early postmenopause and with low bone mineral density (BMD) may exhibit early markers for physical frailty as a result of sarcopenia and osteopenia. OBJECTIVE: The purpose of this study was to determine whether women in early postmenopause and with low BMD exhibit decreased physical performance and differences in gait variability and fall and fracture rates. DESIGN: This study was an observational cohort design with participants assigned to groups on the basis of BMD status. METHODS: Fifty-four women, 31 with low BMD and 23 with normal BMD, participated. This study was conducted in a university research facility. Physical performance was measured by assessment of dynamic balance (timed backward tandem walk test), strength (handheld dynamometry of isometric quadriceps muscle force production), and free gait speed. Gait variability was assessed on the basis of the coefficient of variation for temporal-spatial gait characteristics. Falls and fractures were assessed for the year after initial testing. RESULTS: Significant between-group differences were found for step time and stance time variability. LIMITATIONS: The limitations of this study included group assignment on the basis of the results of the most recent bone density scan within the preceding 2 years. CONCLUSIONS: Women in early postmenopause and with low BMD exhibited increased gait variability in step time and stance time but did not exhibit differences in balance, strength, or gait speed. Gait variability may be more sensitive for detecting differences in women in early postmenopause and with or without low BMD than more typical measures of physical performance.

Tae Kwon Do: an effective exercise for improving balance and walking ability in older adults.

BACKGROUND: Age-related declines in balance and walking ability are major risk factors for falls. Older adults reduce the dynamic components of walking in an effort to achieve a more stable walking pattern. Tae Kwon Do is an exercise that trains dynamic components of balance and walking that diminish with age. METHODS: Twenty participants from a Tae Kwon Do exercise class (average age 72.7 years) and 20 nonexercising controls (average age 73.8 years) participated. Balance and walking ability for all participants were pretested and posttested using the following measures: single-leg stance (SLS), Multidirectional Reach Test (MDRT), Timed Up-and-Go (TUG), walking velocity, cadence, gait stability ratio (GSR), and sit-and-reach (S&R). Analysis of variance for a mixed design was used to assess differences at the 0.05 level of significance. RESULTS: For nonexercising controls, no differences were found between pretest and posttest measures. Tae Kwon Do participants showed significant improvements on the MDRT when reaching backward, right, and left. TUG, walking velocity, GSR, and S&R also showed significant improvement in this exercising group. CONCLUSIONS: Tae Kwon Do exercise was effective for improving balance and walking ability in community-dwelling older adults. These improvements were attributed to Tae Kwon Do movements that emphasize dynamic movement components typically deficient in the older adult walking pattern. Improving balance and walking ability through Tae Kwon Do exercise may serve to restore function that has declined with age and preserve mobility for older adults.

Performance-oriented mobility assessment (POMA) balance score indicates need for assistive device.

PURPOSE: To determine (1) if older adults using an assistive device (AD) score lower on the Performance-Oriented Mobility Assessment (POMA) balance subscale (B-subscale) than individuals not using an AD; and (2) if a cut-score of 12 would indicate the need to use an AD. METHODS: Elderly persons (n = 82, mean age = 82.1 years) were surveyed about AD use, health status, activity level and fall history. A one-time assessment of balance was conducted using the B-subscale. The 'arising task' was repeated to evaluate performance on the sit-to-stand task without using hands. RESULTS: A significant difference in B-subscale scores was observed between the two groups (AD; no AD), (P < 0.001). AD use was associated with lower activity level and health status. A cut-score of 12 points indicated device use (P = 0.000). The repeated 'arising task' demonstrated that 76.8% performed the task without using hands for support. CONCLUSION: Older adults using an AD will score lower on the B-subscale and report lower activity level and health status. A score of less than 12 on the B-subscale is indicative of AD need. Older adults who use an AD and self-report a falls history will score lower on the B-subscale than individuals using an AD and no reported history of falls.

Association of balance measures and perception of fall risk on gait speed: a multiple regression analysis.

Gait speed, commonly modified to adapt to the balance and stability challenges of aging, is related to measures of balance and mobility. This study investigated associations between age, Berg Balance Scale, Activities-Specific Balance Confidence (ABC) Scale, One Question Fear of Falling (1QFOF), and gait speed in adults using regression analysis. Results suggested an interaction between 1QFOF and ABC scores. An expanded five-variable model explained 49% of gait speed variance. Age, ABC, and 1QFOF-ABC interactions were significantly associated with gait speed. Regression analysis is useful in investigating associations between performance variables and function. Continued research needs to identify optimal variable combinations and improve prediction of function.

Relationship between balance and gait stability in healthy older adults.

Age-related adaptations during walking create a more stable walking pattern, which is less effective for forward progression and might be related to balance deficiencies. This study determined the relationship between walking stability and measures of balance in older adults. Seventeen older and 20 young adults performed the Berg Balance Test (BBT) and walked 10 m. Walking velocity (WV) and cadence were measured, and a gait-stability ratio (GSR) was calculated. Higher GSR indicated that a greater portion of the gait cycle was spent in double-limb support. Age-group comparisons established declines in BBT scores and WV and increases in GSR with age. Significant relationships were identified for BBT Item 12 (alternate stepping on a stool) with WV (r =.58, r(2) =.34) and GSR (r = -.74, r(2) =.54). The correlation of BBT Item 12 with GSR was stronger than with WV (p <.05). Results indicated a strong relationship between increased gait stability and decreased balance for a dynamic weight-shifting task. Therefore, GSR is a better indicator of balance deficits during walking than is WV alone.

Influence of vision on head stabilization strategies in older adults during walking.

BACKGROUND: Maintaining balance during dynamic activities is essential for preventing falls in older adults. Head stabilization contributes to dynamic balance, especially during the functional task of walking. Head stability and the role of vision in this process have not been studied during walking in older adults. METHODS: Seventeen older adults (76.2 +/- 6.9 years) and 20 young adults (26.0 +/- 3.4 years) walked with their eyes open (EO), with their eyes closed (EC), and with fixed gaze (FG). Participants performed three trials of each condition. Sagittal plane head and trunk angular velocities in space were obtained using an infrared camera system with passive reflective markers. Frequency analyses of head-on-trunk with respect to trunk gains and phases were examined for head-trunk movement strategies used for head stability. Average walking velocity, cadence, and peak head velocity were calculated for each condition. RESULTS: Differences between age groups demonstrated that older adults decreased walking velocity in EO (p =.022). FG (p = .021), and EC (p = .022). and decreased cadence during EC (p = .007). Peak head velocity also decreased across conditions (p < .0001) for older adults. Movement patterns demonstrated increased head stability during EO. diminished head stability with EC, and improved head stability with FG as older adult patterns resembled those of young adults. CONCLUSIONS: Increased stability of the lower extremity outcome measures for older adults was indicated by reductions in walking velocity and cadence. Concomitant increases in head stability were related to visual tasks. Increased stability may serve as a protective mechanism to prevent falls. Further, vision facilitates the head stabilization process for older adults to compensate for age-related decrements in other sensory systems subserving dynamic balance.