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      The role of attentional focus on walking efficiency among older fallers and non-fallers

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          Abstract

          Background

          This study evaluated the effect of attentional focus instructions on movement efficiency during a level-ground walking task in older adults with and without a history of falls.

          Methods

          One hundred and thirty-four community-dwelling older adults were categorised into older fallers (OF) ( n = 37) and older non-fallers (ONF) ( n = 97). Each participant was instructed to walk at a self-selected pace along a 6 m walkway under three attentional focus conditions (i.e. internal, goal-directed and control) for a total of nine trials. Average muscle activity indices of lower limb co-contractions were measured using surface electromyography.

          Results

          Both shank and thigh muscle co-contractions were higher in OF than in ONF in all three conditions. OF also demonstrated higher shank muscle co-contraction under the internal relative to the goal-directed condition, with no such change observed in ONF.

          Conclusion

          Despite no significant between-group differences in functional balance and balance confidence, relative walking inefficiencies were observed in OF compared with ONF. This finding demonstrates the debilitating consequences of falling that can occur with relative independence from various physiological or psychological factors that are commonly associated with falling and used to rationalise behavioural change. We also provide evidence that OF are more susceptible to conditions that provoke them to allocate attention internally. Therefore, in clinical contexts (e.g. gait rehabilitation), verbal instructions that refer to body movements (internal focus) might serve to compromise movement efficiency in older adults with a history of falls. Such changes will, theoretically, lessen the ability to react efficiently to changing environments experienced in daily life.

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          Most cited references22

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          Falls efficacy as a measure of fear of falling.

          We developed the Falls Efficacy Scale (FES), an instrument to measure fear of falling, based on the operational definition of this fear as "low perceived self-efficacy at avoiding falls during essential, nonhazardous activities of daily living." The reliability and validity of the FES were assessed in two samples of community-living elderly persons. The FES showed good test-retest reliability (Pearson's correlation 0.71). Subjects who reported avoiding activities because of fear of falling had higher FES scores, representing lower self-efficacy or confidence, than subjects not reporting fear of falling. The independent predictors of FES score were usual walking pace (a measure of physical ability), anxiety, and depression. The FES appears to be a reliable and valid method for measuring fear of falling. This instrument may be useful in assessing the independent contribution of fear of falling to functional decline among elderly people.
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            Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention.

            Previous cross-sectional studies have shown a correlation between falls and fear of falling, but it is unclear which comes first. Our objectives were to determine the temporal relationship between falls and fear of falling, and to see whether these two outcomes share predictors. A 20-month, population-based, prospective, observational study. Salisbury, Maryland. Each evaluation consisted of a home-administered questionnaire, followed by a 4- to 5-hour clinic evaluation. The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations. At baseline, subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher. Demographics, visual function, comorbidities, neuropsychiatric status, medication use, and physical performance-based measures were assessed. Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation, first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors. Falls at baseline were an independent predictor of developing fear of falling 20 months later (odds ratio (OR) = 1.75; P <.0005), and fear of falling at baseline was a predictor of falling at 20 months (OR = 1.79; P <.0005). Women with a history of stroke were at risk of falls and fear of falling at follow-up. In addition, Parkinson's disease, comorbidity, and white race predicted falls, whereas General Health Questionnaire score, age, and taking four or more medications predicted fear of falling. Individuals who develop one of these outcomes are at risk for developing the other, with a resulting spiraling risk of falls, fear of falling, and functional decline. Because falls and fear of falling share predictors, individuals who are at a high risk of developing these endpoints can be identified.
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              Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older.

              Although gait velocity (GV) measurement could predict poor outcomes, few studies regarding its usefulness as a single test in well functioning elderly persons have been pursued. The aim of this study was to asses whether GV could be sufficient to predict adverse events such as hospitalization for any cause, requirement for a caregiver, nursing home placement, falls, fractures, or death in healthy elderly persons. Ours was a cohort study comprising 102 well functioning participants aged 75 and older. Demographic features, health status, and functional capacity were assessed at baseline and followed for adverse outcomes. Measurements included evaluation of cognition, activities of daily living, and mobility. The time required to walk the middle 8 meters of 10 meters was defined as GV. Three GV groups were distinguished: high GV (>1.1 m/s), median GV (1-0.7 m/s), and low GV (<0.7 m/s). At baseline, the three groups were comparable in their health status with an average age of 79.6 +/- 4 years. At 24 months, the low GV group had a significantly higher incidence of adverse events than did the other groups. Low GV was a predictor of hospitalization (relative risk [RR] = 5.9, 95% confidence interval [CI], 1.9-8.5), requirement of a caregiver (RR = 9.5, 95% CI, 1.3-2.5), and new falls (RR = 5.4, 95% CI, 2.0-4.3). These associations remained significant after a multiple logistic regression analysis. GV measurement in the ambulatory setting may allow the detection of healthy elderly people at risk for adverse events. These data may suggest that simple assessment of GV is enough to predict adverse events in well functioning older persons.
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                Author and article information

                Journal
                Age Ageing
                Age Ageing
                ageing
                Age and Ageing
                Oxford University Press
                0002-0729
                1468-2834
                November 2019
                03 October 2019
                03 October 2019
                : 48
                : 6
                : 811-816
                Affiliations
                [1 ] School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR, China
                [2 ] Institute of Environment, Health and Societies, Brunel University London , UK
                [3 ] Department of Clinical Sciences, Brunel University London , UK
                [4 ] College of Life and Environmental Sciences, University of Exeter , UK
                [5 ] Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Co. Ltd , Beijing, China
                [6 ] Department of Kinesiology, Shenyang Sport University , Shenyang, China
                [7 ] Department of Health and Physical Education, The Education University of Hong Kong , Hong Kong SAR, China
                Author notes
                Address correspondence to: Thomson W.L. Wong. Tel: +852 2817 5258. E-mail: wongtwl@ 123456hku.hk
                Article
                afz113
                10.1093/ageing/afz113
                6814087
                31579906
                1a7f73c5-b9ed-4218-a91c-007d847ae209
                © The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Pages: 6
                Product
                Funding
                Funded by: Research Grants Council of the Hong Kong Special Administrative Region, China
                Award ID: 27608815
                Categories
                Research Paper

                Geriatric medicine
                falls,gait,muscle,efficiency,attention,older people
                Geriatric medicine
                falls, gait, muscle, efficiency, attention, older people

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