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      Motor Performance and Physical Activity as Predictors of Prospective Falls in Community-Dwelling Older Adults by Frailty Level: Application of Wearable Technology

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          Abstract

          Background: Few studies of the association between prospective falls and sensor-based measures of motor performance and physical activity (PA) have evaluated subgroups of frailty status separately. Objective: To evaluate wearable sensor-based measures of gait, balance, and PA that are predictive of future falls in community-dwelling older adults. Methods: The Arizona Frailty Cohort Study in Tucson, Arizona, followed community-dwelling adults aged 65 years and over (without baseline cognitive deficit, severe movement disorders, or recent stroke) for falls over 6 months. Baseline measures included Fried frailty criteria: in-home and sensor-based gait (normal and fast walk), balance (bipedal eyes open and eyes closed), and spontaneous daily PA over 48 h, measured using validated wearable technologies. Results: Of the 119 participants (36% non-frail, 48% pre-frail, and 16% frail), 48 reported one or more fall (47% of non-frail, 33% of pre-frail, and 47% of frail). Although balance deficit and PA were independent fall predictors in pre-frail and frail groups, they were not sensitive to predict prospective falls in the non-frail group. Even though gait performance deteriorated as frailty increased, gait was not a predictor of prospective falls when participants were stratified based on frailty status. In pre-frail and frail participants combined, center of mass sway [odds ratio (OR) = 5.9, 95% confidence interval (CI) 2.6-13.7], PA mean walking bout duration (OR = 1.1, 95% CI 1.0-1.2), PA mean standing bout duration (OR = 0.94, 95% CI 0.91-0.99), and a fall in previous 6 months (OR = 7.3, 95% CI 1.5-36.4) were independent predictors of prospective falls (area under the curve: 0.882). Conclusion: This study suggests that independent predictors of falls are dependent on frailty status. Among sensor-derived parameters, balance deficit, longer typical walking episodes, and shorter typical standing episodes were the most sensitive predictors of prospective falls in the combined pre-frail and frail sample. Gait deficit was not a sensitive fall predictor in the context of frailty status.

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          Most cited references25

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          Development and initial validation of the Falls Efficacy Scale-International (FES-I).

          There is a need for a measure of fear of falling that assesses both easy and difficult physical activities and social activities and is suitable for use in a range of languages and cultural contexts, permitting direct comparison between studies and populations in different countries and settings. To develop a modified version of the Falls Efficacy Scale to satisfy this need, and to establish its psychometric properties, reliability, and concurrent validity (i.e. that it demonstrates the expected relationship with age, falls history and falls risk factors). Cross-sectional survey. Community sample. 704 people aged between 60 and 95 years completed The Falls Efficacy Scale-International (FES-I) either in postal self-completion format or by structured interview. The FES-I had excellent internal and test-retest reliability (Cronbach's alpha=0.96, ICC=0.96). Factor analysis suggested a unitary underlying factor, with two dimensions assessing concern about less demanding physical activities mainly in the home, and concern about more demanding physical activities mainly outside the home. The FES-I had slightly better power than the original FES items to discriminate differences in concern about falling between groups differentiated by sex, age, occupation, falls in the past year, and falls risk factors (chronic illness, taking multiple or psychoactive medications, dizziness). The FES-I has close continuity with the best existing measure of fear of falling, excellent psychometric properties, and assesses concerns relating to basic and more demanding activities, both physical and social. Further research is required to confirm cross-cultural and predictive validity.
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            Guideline for the Prevention of Falls in Older Persons

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              Discriminative ability and predictive validity of the timed up and go test in identifying older people who fall: systematic review and meta-analysis.

              To investigate the discriminative ability and diagnostic accuracy of the Timed Up and Go Test (TUG) as a clinical screening instrument for identifying older people at risk of falling. Systematic literature review and meta-analysis. People aged 60 and older living independently or in institutional settings. Studies were identified with searches of the PubMed, EMBASE, CINAHL, and Cochrane CENTRAL data bases. Retrospective and prospective cohort studies comparing times to complete any version of the TUG of fallers and non-fallers were included. Fifty-three studies with 12,832 participants met the inclusion criteria. The pooled mean difference between fallers and non-fallers depended on the functional status of the cohort investigated: 0.63 seconds (95% confidence (CI) = 0.14-1.12 seconds) for high-functioning to 3.59 seconds (95% CI = 2.18-4.99 seconds) for those in institutional settings. The majority of studies did not retain TUG scores in multivariate analysis. Derived cut-points varied greatly between studies, and with the exception of a few small studies, diagnostic accuracy was poor to moderate. The findings suggest that the TUG is not useful for discriminating fallers from non-fallers in healthy, high-functioning older people but is of more value in less-healthy, lower-functioning older people. Overall, the predictive ability and diagnostic accuracy of the TUG are at best moderate. No cut-point can be recommended. Quick, multifactorial fall risk screens should be considered to provide additional information for identifying older people at risk of falls. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
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                Author and article information

                Journal
                GER
                Gerontology
                10.1159/issn.0304-324X
                Gerontology
                Gerontology
                S. Karger AG (Basel, Switzerland karger@ 123456karger.com http://www.karger.com )
                0304-324X
                1423-0003
                October 2016
                30 April 2016
                : 62
                : 6
                : 654-664
                Affiliations
                aArizona Center on Aging, College of Medicine, bSection of Geriatrics and Gerontology, Department of Medicine, College of Medicine, cInterdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, and dCollege of Nursing, University of Arizona, Tucson, Ariz., and eInterdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex., USA
                Article
                GER2016062006654 PMC5073011 Gerontology 2016;62:654-664
                10.1159/000445889
                PMC5073011
                27160666
                fbb54af8-ddfc-4cbb-b9b6-88dfaa690491
                © 2016 S. Karger AG, Basel

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                History
                : 11 November 2015
                : 04 April 2016
                Page count
                Tables: 5, References: 45, Pages: 11
                Categories
                Regenerative and Technological Section / Original Paper

                Medicine,General social science
                Physical activity,Balance,Frailty,Falls,Wearable sensors,Monitoring,Physical function,Gait

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