Effectiveness of Nurse Practitioners in nursing homes: a systematic review Executive functions are associated with gait and balance in community-living elderly people. Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Incidence and predictors of falls in the chinese elderly. Are exergames promoting mobility an attractive alternative to conventional self-regulated exercises for elderly people in a rehabilitation setting? Study protocol of a randomized controlled trial Properties of the ‘Timed Up and Go’ Test: More than Meets the Eye Fall prevention in the young old using an exoskeleton human body posturizer: a randomized controlled trial Specific effects of balance and gait exercises on physical function among the frail elderly Lower limb power rehabilitation (LLPR) using interactive video game for improvement of balance function in older people. The design of the Dutch EASYcare study: a randomised controlled trial on the effectiveness of a problem-based community intervention model for frail elderly people [NCT00105378] Physical training in institutionalized elderly people with multiple diagnoses--a controlled pilot study. Effects of Tango on Functional Mobility in Parkinson's Disease: A Preliminary Study Effectiveness of aquatic and non-aquatic lower limb muscle endurance training in the static and dynamic balance of elderly people. Fear of falling and restriction of mobility in elderly fallers. Falls in the healthy elderly: predisposing causes. Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities Weight transfer analysis in adults with hemiplegia using ankle foot orthosis A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial Rehabilitation of elderly fallers: pilot study of a low to moderate intensity exercise program. Use of Clinical Risk Factors in Elderly Women with Low Bone Mineral Density to Identify Women at Higher Risk of Hip Fracture: The EPIDOS Prospective Study
 Reliability of Six Physical Performance Tests in Older People With Dementia Combined effects of functionally-oriented exercise regimens and nutritional supplementation on both the institutionalised and free-living frail elderly (double-blind, randomised clinical trial) Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies
Background There are 1.5 million people living in nursing homes in the United States1 . The number of people admitted to nursing homes has increased since 1994 , and it is expected that the number of people aged 65 and older living in nursing homes will double by the year 20202 . Nursing home patients are sicker than they have been in the past 10 years , and the frail , sick patients are more likely to be hospitalized3 . Unnecessary hospitalization of nursing home patients is a costly and critical problem in our healthcare system3 . Hospitalization can cause irreversible decline in function for the elderly patient and can " expose residents to iatrogenic disease and delirium"4 . It has been cl aim ed that nurse practitioners ( NPs ) can play a valuable role in caring for the long term care patient , reducing unnecessary hospital admissions , and supporting the physician 's practice . A NP on site in the nursing home can provide quick assessment and treatment when a patient has a change of condition . The NP can intervene and treat the patient as needed , instead of transferring the patient to the hospital for assessment . Objectives The objective of this systematic review was to evaluate the effectiveness of having a NP in the nursing home and whether this lead to a decrease in the rate of patient hospitalizations . Inclusion Criteria Types of Participants This systematic review considered studies that include long term care nursing home residents . Types of Interventions The review considered studies that evaluate utilization of a NP ( in collaboration with a physician ) as a primary care provider for long term care nursing home patients . Types of Outcomes This review considered studies that include the following outcome measures : incidence of hospitalization , types of hospitalization and duration of hospitalization of nursing home patients . Types of Studies R and omized controlled trials ( RCTs ) were not identified in the search . Therefore , other research design s , such as non‐r and omized controlled trials and before and after studies , were included . Search Strategy Major data bases were search ed for English articles written from 1983 to December 2008 . Method ological Quality Seven papers were selected for retrieval , and were assessed by two independent review ers for method ological validity prior to inclusion in the review using st and ardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument ( JBI‐MAStARI ) ( Appendix I ) . Data Collection / Extraction Quantitative data was extracted from papers included in the review using the st and ardized data extraction tool from JBI‐MAStARI ( Appendix II ) . Data Synthesis Statistical pooling was not possible and the findings are presented in narrative form . Results The review consisted of 12,681 patients in 238 nursing homes . All of the seven included articles found a decrease in hospitalization rates when NPs were utilized as a part of the medical team . Five of the 7 studies found a decrease in ER transfers with the NP group . Garrard , Kane , et al17 did not measure ER transfers and Kane , Garrard et al24 found no difference in rate of ER use . Three studies also measured length of hospitalization , and all 3 found that the patients with NPs had shorter lengths of stay . Conclusions This review has demonstrated that nurse practitioners can reduce hospitalization and ER transfers of nursing home patients . Implication s for Research It is recommended that more studies be initiated using only Master 's prepared advanced practice nurses . Implication s for Practice It is recommended that NPs be utilized as primary care providers in nursing homes . Physicians should be encouraged to employ NPs to improve patient outcomes and to assist with patient loads BACKGROUND Cognition influences gait and balance in elderly people . Executive functions seem to play a key role in this mechanism . Previous studies used only a single test to probe executive functions , and outcome measures were restricted to gait variables . We extend this prior work by examining the association between two different executive functions and measures of both gait and balance , with and without two different cognitive dual tasks . METHODS This is a cross-sectional study with r and omly selected community-living elderly people . Executive functions were tested with the Trail Making Test Parts A and B and the Stroop Color Word Test ; memory with Cambridge Neuropsychological Test Automated Battery ( CANTAB ) subtests . Patients walked without and with two dual tasks ( subtracting serial sevens and animal naming ) . Main outcomes focused on gait ( velocity , stride length , and stride time variability ) , measured on an electronic walkway , and balance , measured as trunk movements during walking . Associations were assessed with multiple regression models . RESULTS One hundred elderly people , with a mean age 80.6 years ( range 75 - 93 years ) participated . Both dual tasks decreased gait velocity and increased variability and trunk sway . Executive functions were associated with only stride length variability and mediolateral trunk sway during performance of animal naming as the dual task . Memory was not associated with the gait and balance variables . CONCLUSIONS In community-living elderly people , executive functions are associated with gait and balance impairment during a challenging dual-task condition that also depends on executive integrity . Next steps will be to explore the value of executive functions in defining fall-risk profiles and in fall-prevention interventions for frail patients Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made INTRODUCTION This is the first prospect i ve longitudinal study carried out in a Chinese elderly population with the objective of identifying the incidence and predictors of falls . MATERIAL S AND METHODS This is a population -based cohort study in Hong Kong with 1517 ambulatory elderly Chinese recruited using a multi-stage sampling method . Baseline data on demographic , comorbid diseases , drugs , Activities of Daily Living ( ADL ) [ Barthel Index and Lawton 's Instrumental Activities of Daily Living ( IADL ) ] , Geriatric Depression Scale ( GDS-15 ) , cognitive assessment by the Abbreviated Mental Test ( AMT ) , fear of falling , self-perceived mobility problem , h and grip strength , lower limb power , balance and gait tests were performed . Every subject was followed up for 1 year . RESULTS Four hundred and one falls occurred in 294 fallers ( 19.3 % ) over 1 year of follow-up . The prevalence of falls and recurrent falls were 19.3 % and 4.75 % , respectively . The incidences of falls ( i.e. , the fall events ) were 220 , 324 and 270 per 1000 person-years for men , women and both gender , respectively . The independent predictors of falls were previous history of falls , advancing age , Parkinson 's disease , knee extension power and gait speed . The independent predictors of recurrent falls were previous history of falls , self-perceived mobility problem , the knee extension strength and the Total Mobility Score of the Tinetti Balance and Gait Evaluation . CONCLUSIONS The incidence of falls in the Chinese elderly was 270 per 1000 person-years . History of falls , old age , Parkinson 's disease , decreased lower limb power and impairment in balance and gait function were important independent predictors of falls or recurrent falls in the Chinese elderly . Effective fall prevention programmes targeted at improving these risk factors for falls should be developed for the Chinese elderly in Hong Kong and Asia Background Maintaining mobility in elderly persons has become a primary goal within healthcare services . In older adults , exercise programs significantly reduce the risk of falling and death . Long-lasting and high-intensive multi-component exercises are most effective . In a rehabilitation setting , self-regulated exercises are conventionally taught by physiotherapists , using h and outs . However , the adherence of elderly persons to executing these self-administered programs varies considerably . They are often considered tedious and boring , and thus prematurely stopped . The primary aim of this clinical trial is to determine whether elderly persons in a rehabilitation setting show higher adherence to self-regulated training when using exergames than when performing conventional exercises . The second objective is to explore which mode of exercise leads to greater improvement in balance performance . Methods / Design The study consists of a single blind , stratified , r and omized control trial with two parallel groups . Once included , study participants will be stratified according to their balance and computer skills and r and omly allocated to self-regulated training with conventional exercise programs or with exergames played with the Windows Kinect ® sensor and FitBit ® pedometer . In both groups , self-administered exercise programs will be taught by experienced physiotherapists and performed at the patient ’s own discretion during the ten days of intervention . The primary outcome is the performed daily training volume , collected by the participants in a logbook . Secondary outcomes are objective and subjective balance skills measured by an activity tracker and the Fall Efficacy Scale self-administered question naire . Both assessment s will be performed at pre- and post-intervention . Discussion According to the available literature , this study is the first to compare conventional self-regulated exercises with exergames among older patients in a rehabilitation setting . Results of this study will contribute to our underst and ing of its motivational potential on exercise adherence in elderly persons and provide more insight into the potential effectiveness of exergames promoting mobility . Trial registration The present clinical study has been registered on Clinical Trials.gov under the identifier number : NCT02077049 . The detailed trial protocol can be accessed online on : NCT02077049 Background : The  ‘ timed up and go ’ test ( TUG ) is a simple , quick and widely used clinical performance-based measure of lower extremity function , mobility and fall risk . We speculated that its properties may be different from other performance-based tests and assessed whether cognitive function may contribute to the differences among these tests in a cohort of healthy older adults . Objective : To evaluate psychometric properties of the TUG in healthy older adults in comparison to the Berg balance test ( BBT ) and the Dynamic Gait Index ( DGI ) . Methods : The  TUG , DGI and BBT  were assessed in 265 healthy older adults ( 76.4 ± 4.3 years ; 58.3 % women ) who participated in a 3-year prospect i ve study . The  Mini-Mental State Examination , digit span and verbal fluency measured cognitive function . The one- sample Kolmogorov-Smirnov test evaluated deviations from a normal distribution and Pearson ’s correlation coefficients quantified associations . Results : The mean scores of the BBT , DGI and TUG were : 54.0 ± 2.4 , 22.8 ± 1.5 , 9.5 ± 1.7 s , respectively . The BBT and the DGI were not normally distributed ( p < 0.001 ) , but the TUG was ( p = 0.713 ) . The TUG times were mildly associated ( p < 0.01 ) with digit span and verbal fluency and were related to future falls , while the BBT and the DGI were not . Conclusions : The TUG appears to be an appropriate tool for clinical assessment of functional mobility even in healthy older adults . It does not suffer from ceiling effect limitations , is normally distributed and is apparently related to executive function . The BBT and the DGI do not share these beneficial properties . Perhaps the transferring and turning components of the TUG help to convert this relatively simple motor task into a more complex measure that also depends on cognitive re sources Abstract Background Fall risk in elderly has been related with physical decline , low quality of life and reduced survival . Aim To evaluate the impact of exoskeleton human body posturizer ( HBP ) on the fall risk in the elderly . Methods 150 subjects ( mean age 64.85 ; 79 M/71 F ) with mild fall risk were r and omized into two groups : 75 for group treated with human body posturizer ( HBP group ) and 75 for physical training without HBP group ( exercise group ) . The effects of interventions were assessed by differences in tests related to balance and falls .  Medically eligible patients were screened with Tinetti balance and Gait evaluation scale , short physical performance battery and numeric pain rating scale to determine fall risk in elderly people . Results In the HBP group there was a significant improvement in short physical performance battery , Tinetti scale and Pain Numeric rating scale with a significant reduction in fall risk ( p < 0.05 ) . In the exercise group we observed only minimal variations in the test scores . Discussion The results at the sixth and twelfth months show a twofold positive effect in the HBP group reducing fall risk and improving quality of life by reducing pain . Conclusion The use of exoskeleton human body posturizer seems to be a new significant device for prevention of fall in elderly patients . Further research should be carried out to obtain more evidence on effects of robotic technology for fall prevention in the elderly Objective : To evaluate the specific effects of balance and gait exercises among frail elderly individuals . Design : A r and omized three-group parallel controlled study . Setting : Geriatric health services facility in Japan . Subjects : Thirty-four frail elderly subjects attending the care facility were r and omized into a control group , an exercise group with emphasis on balance or an exercise group with emphasis on gait re-education . Interventions : The two exercise groups received balance or gait exercise for 40 minutes , 2–3 times weekly , for 12 weeks . Main outcome measures : One Leg St and ing Test , Functional Reach Test , Manual Perturbation Test , Functional Balance Scale , Performance-Oriented Mobility Assessment , Timed ‘ Up and Go ’ Test and Stair Climbing/Descending Test . These assessment s were performed before and after 12-week intervention . Results : Comparison of the performance before and after intervention demonstrated significant improvement in One Leg St and ing Test , Functional Reach Test and Functional Balance Scale in the balance exercise group , and Functional Balance Scale , Timed ‘ Up and Go ’ Test and Stair Descending Test showed improvement in the gait exercise group . All test items showed no significant differences in the control groups . Among the three groups , the balance exercise group showed more significant improvement in Functional Balance Scale , and the gait exercise group showed more significant improvement in Performance-Oriented Mobility Assessment than the control group . The balance exercise group showed greater improvement in performance in Functional Reach Test than the gait exercise group . Conclusions : Balance exercises led to improvements in static balance function , and gait exercises result ed in improvements to dynamic balance and gait functions in the very frail elderly Declined balance functions have adverse effects on elderly population .  Lower limbs muscle power training is currently an emerging concept in rehabilitation on individuals with decreased balance and mobility . In this prospect i ve , controlled study , we used a human-computer interactive video-game-based rehabilitation device ( LLPR ) for training of lower limb muscle power in the elderly . Forty ( aged > 65 years ) individuals were recruited from the community . Twenty participants in the exercise group received 30-min training , twice a week , using the LLPR system . The LLPR system allows participants to perform fast speed sit-to-st and ( STS ) movements . Twenty age-matched participants in the control group performed slow speed STS movements , as well as strengthening and balance exercises , with the same frequency and duration . The results were compared after 12 sessions ( 6 weeks ) of training . The mechanical and time parameters during STS movement were measured using the LLPR system . Modified falls efficacy scale ( MFES ) , Tinetti Performance-Oriented Mobility Assessment ( POMA ) , function reach test , five times sit to st and ( FTSS ) and Timed Up and Go ( TUG ) were administered to participants as clinical assessment s. Results showed that in the exercise group , all the mechanical and time parameters showed significant improvement . In control group , only the maximal vertical ground reaction force ( MVGRF ) improved significantly . For clinical assessment s ( balance , mobility , and self-confidence ) , exercise group showed significantly better scores . The STS movements in video-game-based training mimic real life situations which may help to transfer the training effects into daily activities . The effectiveness of lower limb muscle training is worthy of further investigation Background Because of their complex clinical presentations and needs frail elderly people require another approach than people who age without many complications . Several inpatient geriatric health services have proven effectiveness in frail persons . However , the wish to live independently and policies that promote independent living as an answer to population aging call for community intervention models for frail elderly people . Maybe models such as preventive home visits , comprehensive geriatric assessment , and intermediate care qualify , but their efficacy is controversial , especially in frail elderly persons living in the community . With the Dutch EASYcare Study Geriatric Intervention Programme ( DGIP ) we developed a model to study effectiveness of problem based community intervention models in frail elderly people . Methods / Design DGIP is a community intervention model for frail elderly persons where the GP refers elderly patients with a problem in cognition , mood , behaviour , mobility , and nutrition . A geriatric specialist nurse applies a guideline -based intervention with a limited number of follow up visits . The intervention starts with the application of the EASYcare instrument for geriatric screening . The EASYcare  instrument  assesses ( instrumental ) activities of daily life , cognition , mood , and includes a goal setting item . During the intervention the nurse regularly consults the referring GP and a geriatrician . Effects on functional performance ( Groningen Activity Restriction Scale ) , health related quality of life ( MOS-20 ) , and carer burden ( Zarit Burden Interview ) are studied in an observer blinded r and omised controlled trial . 151 participants were r and omised over two treatment arms – DGIP and regular care – using pseudo cluster r and omisation . We are currently performing the follow up visits . These visits are planned three and six months after inclusion . Process measures and cost measures will be recorded . Intention to treat analyses will focus on post intervention differences between treatment groups . Discussion The design of a trial evaluating the effects of a community intervention model for frail elderly people was presented . The problem-based participant selection procedure satisfied ; few patients that the GP referred did not meet our eligibility criteria . The use of st and ard terminology makes detailed insight into the contents of our intervention possible using terminology others can underst and well Reduction in muscle mass and physical function depends on a variety of interacting factors : age , physical activity level , nutritional state and the type and impact of disease . The aim of this study was to investigate the effect of an individualized moderate intensity physical training program on muscle strength , balance , mobility , ambulation and activities of daily living ( ADL ) in institutionalized elderly people aged 65 and over with multiple diagnoses . Baseline assessment s consisted of strength , balance , mobility/ambulation , and ADL .  Twenty-one subjects were included in the intervention program . A control group ( 21 subjects ) was first matched in pairs according to gender , age , ADL and mobility , and then by balance , ambulation and strength . The intervention program was individualized and included strength , mobility , balance and endurance training . Follow-up measures were conducted directly after the intervention and 10 weeks later . After drop-out , 20 subjects in the intervention group and 15 subjects in the control group remained for analyses . Balance and mobility improved significantly in the intervention group while declining in the control group . This pilot study indicates that a physical training program may improve functional capacity for institutionalized elderly persons with multiple diagnoses Recent research has shown that dance , specifically tango , may be an appropriate and effective strategy for ameliorating functional mobility deficits in people who are frail and elderly . Individuals with Parkinson 's disease ( PD ) experience declines in functional mobility that may be even more pronounced than those experienced by frail elderly individuals without PD . The purpose of this study was to compare the effects of two movement programs : tango classes or exercise classes .  Nineteen subjects with PD were r and omly assigned to a  tango group or a  group exercise class  representative of the current classes offered in our geographical area for individuals with PD . Subjects completed a total of 20 tango or exercise classes and were evaluated the week before and the week following the intervention . Both groups showed significant improvements in overall Unified Parkinson 's Disease Rating Scale ( UPDRS ) score and nonsignificant improvements in self-reported Freezing of Gait . In addition , the tango group showed significant improvements on the Berg Balance Scale . The exercise group did not improve on this measure . Finally , the tango group showed a trend toward improvement on the Timed Up and Go test that was not observed in the exercise group . Future studies with a larger sample are needed to confirm and extend our observation that tango may be an effective intervention to target functional mobility deficits in individuals with PD BACKGROUND Aging compromises the ability of the central nervous system to maintain body balance and reduces the capacity for adaptive reactions . To prevent falls , the reception conditions for sensory information need to be improved . OBJECTIVES To evaluate the impact of a structured aquatic and a non-aquatic exercise program for lower-limb muscle endurance on the static and dynamic balance of elderly people . METHODS This was a prospect i ve r and omized clinical study in which the variables were assessed before and after the training program . Thirty-six elderly people were evaluated using four tests : the Berg Balance Scale , Dynamic Gait Index , gait speed and t and em gait . The participants were r and omized into three groups : aquatic exercise group , non-aquatic exercise group and control group . The exercise groups underwent a program for lower-limb muscle endurance that consisted of 40-minute sessions twice a week for six weeks . The participants were reevaluated after six weeks . The data were analyzed statistically using the univariate ANOVA test for comparisons between the groups before and after the intervention . RESULTS The program for lower-limb muscle endurance significantly increased balance ( p<0.05 ) in the evaluation tests after the training program . CONCLUSION The muscle endurance program provided a significant improvement in static and dynamic balance among community-dwelling elderly people . It was also possible to infer that this improvement occurred regardless of the environment , i.e. aquatic or non-aquatic . Article registered in the Australian New Zeal and Clinical Trials Registry ( ANZCTR ) under the number ACTRN 12609000780257 OBJECTIVES To identify the characteristics of elderly persons who develop a fear of falling after experiencing a fall and to investigate the association of this fear with changes in health status over time . DESIGN A prospect i ve study of falls over a 2-year period ( 1991 - 92 ) . Falls were ascertained using bimonthly postcards plus telephone interview with a st and ardized ( World Health Organisation ) question naire for circumstances , fear of falling and consequences of each reported fall . Each participant underwent a physical exam and subjective health assessment each year form 1990 to 1993 . SETTING New-Mexico Aging Process Study , USA . SUBJECTS 487 elderly subjects ( > 60 years ) living independently in the community . MAIN OUTCOME MEASURES Fear of falling after experiencing a fall . RESULTS 70 ( 32 % ) of 219 subjects who experienced a fall during the 2 year study period reported a fear of falling . Women were more likely than men to report fear of falling ( 74 % vs 26 % ) . Fallers who were afraid of falling again had significantly ore balance ( 31.9 % vs 12.8 % ) and gait disorders ( 31.9 % vs 7.4 % ) at entry in the study in 1990 . Among sex , age , mental status , balance and gait abnormalities , economic re source and physical health , logistic regression analysis show gait abnormalities and poor self-perception of physical health , cognitive status and economic re sources to be significantly associated with fear of falling . Subjects who reported a fear of falling experienced a greater increase in balance ( P = 0.08 ) , gait ( P < 0.01 ) and cognitive disorders ( P = 0.09 ) over time , result ing in a decrease in mobility level . CONCLUSION The study indicated that about one-third of elderly people develop a fear of falling after an incident fall and this issue should be specifically addressed in any rehabilitation programme One hundred healthy men and women aged 65 - 85 took part in a prospect i ve study . They were clinical ly examined and underwent laboratory tests of gait , balance and reaction time at the start of an observation year . All falls occurring in that year were analysed in detail . Three-quarters of them were trips or slips ; however , ten personal factors were identified which , if present , increased the likelihood of a fall occurring . These were : disturbance of gait following a rest period accompanied by a lighting change ( in persons aged 70 and over ) ; an absent or abnormal plantar reflex ; failure to wear prescribed spectacles ; the presence of anxiety/depression , of a foot problem , or of two or more self-perceived limitations on mobility ; a history of former wearing of high heels ; a sustained drop in pulse pressure 5 min after cessation of a rest period ; restricted neck movements ; and the presence of an inverse Romberg ratio . The number of circumstantial and personal factors contributing to the falls varied between thr Background and aims : Impaired mobility is one of the strongest predictors for falls in older people . We hypothesized that exercise as part of a fall prevention program would have positive effects , both short- and long-term , on gait , balance and strength in older people at high risk of falling and with varying levels of cognition , residing in residential care facilities . A secondary hypothesis was that these effects would be associated with a reduced risk of falling . Methods : 187 out of all residents living in 9 facilities , ≥65 years of age were at high risk of falling . The facilities were clusterr and omized to fall intervention or usual care . The intervention program comprised : education , environment , individually design ed exercise , drug review , post-fall assessment s , aids , and hip protectors . Data were adjusted for baseline performance and clustering . Results : At 11 weeks , positive intervention effects were found on independent ambulation ( FAC , p=0.026 ) , maximum gait speed ( p=0.002 ) , and step height ( ≥10 cm , p<0.001 ) , but not significantly on the Berg Balance Scale . At 9 months ( long-term outcome ) , 3 intervention and 15 control residents had lost the ability to walk ( p=0.001 ) . Independent ambulation and maximum gait speed were maintained in the intervention group but deteriorated in the control group ( p=0.001 ) . Residents with both higher and lower cognition benefited in most outcome measures . No association was found between improved mobility and reduced risk of falling . Conclusions : Exercise , as part of a fall prevention program , appears to preserve the ability to walk , maintain gait speed , ambulate independently , and improve step height . Benefits were found in residents with both lower and higher cognitive impairment , but were not found to be associated with a reduced risk of falling Background : Identifying and underst and ing the changes in transfer of momentum that are directly affected by orthotic intervention are significant factors related to the improvement of mobility in individuals with hemiplegia . Objectives : The purpose of this investigation was to use a novel analysis technique to objective ly measure weight transfer during double support ( DS ) in healthy individuals and individuals with hemiplegia secondary to stroke with and without an ankle foot orthosis .  Study design : Prospect i ve , Repeated measures , case-controlled trial . Methods : Participants included 25 adults with stroke-related hemiplegia > 6 months using a prescribed ankle foot orthosis and 12 age-matched healthy controls . Main outcome measures included the weight transfer point timing ( WTP , % DS ) , maximum total force timing ( MTF , % DS ) , timing difference between WTP and MTF ( MTF-WTP , % DS ) and the linearity of loading ( LOL , R2 ) during the DS phase of the gait cycle . Results : The WTP and LOL were significantly different between conditions with and without the ankle foot orthosis for the affected and unaffected limb in post-stroke individuals , p ≤ 0.01 . The MTF and difference in timing between MTF-WTP were significantly different during affected limb loading with and without the ankle foot orthosis in the stroke group , p ≤ 0.0001 and p = 0.03 , respectively . MTF , MTF-WTP and LOL were significantly different between individuals with stroke ( during affected limb loading ) and healthy controls ( during right limb loading ) . Conclusions : This research established a systematic method for analysing weight transfer during walking to evaluate the effect of an ankle foot orthosis on loading during double support in hemiplegic gait . This novel method can be used to eluci date biomechanical mechanisms behind orthosis-mediated changes in gait patterns and quantify functional mobility outcomes in rehabilitation . Clinical relevance This novel approach to orthotic assessment will provide the clinician with needed objective evidence to select the most effective orthotic intervention to maximize functional recovery for individuals with hemiplegia secondary to stroke Summary This study showed that combination of strength , balance , agility and jumping training prevented functional decline and bone fragility in home-dwelling elderly women . The finding supports the idea that it is possible to maintain good physical functioning by multi-component exercise program and thus postpone the age-related functional problems . Introduction This 1-year r and omized , controlled exercise intervention trial assessed the effects of two different training programs and their combination on physical functioning and bone in home-dwelling elderly women . Methods One hundred and forty-nine healthy women aged 70–78 years were r and omly assigned into : group 1—resistance training ( RES ) , group 2—balance-jumping training ( BAL ) , group 3—combination of resistance and balance-jumping training ( COMB ) , and group 4—controls ( CON ) . Self-rated physical functioning , leg extensor force , dynamic balance , and bone mass and structure were measured . Results Self-rated physical functioning improved in the COMB group , but was reduced in the CON group ; the mean inter-group difference was 10 % ( 95 % CI : 0–22 % ) . Mean increase in the leg extensor force was higher in the RES ( 14 % ; 4–25 % ) and COMB ( 13 % ; 3–25 % ) compared with the CON groups . Dynamic balance improved in the BAL ( 6 % ; 1–11 % ) and in the COMB ( 8 % ; 3–12 % ) groups . There were no inter-group differences in BMC at the proximal femur . In those COMB women who trained at least twice a week , the tibial shaft structure weakened 2 % ( 0–4 % ) less than those in the CON group . Conclusions Strength , balance , agility , and jumping training ( especially in combination ) prevented functional decline in home-dwelling elderly women . In addition , positive effects seen in the structure of the loaded tibia indicated that exercise may also play a role in preventing bone fragility OBJECTIVE The role of exercise in the prevention of falls and fall-related injuries among elderly persons is unclear . The objective of this study was to assess the response to an exercise-based rehabilitation program intended to improve balance and mobility and reduce or prevent falls . DESIGN Pretest-posttest experimental design with repeated measures at baseline , immediately postintervention , and 6 months postintervention . To assess the effect of repeated exposure to our main outcome measure ( the obstacle course ) , half of the participants ( r and omly selected ) were allowed to practice on the obstacle course . SETTING A veterans affairs medical center . PARTICIPANTS Elderly , ambulatory , community-dwelling volunteers recruited from among local out patients at our medical center . INTERVENTION Sixty-five volunteers completed a 6-week supervised low to moderate intensity program of stretching , postural control , endurance walking , and coordination exercises design ed to improve balance and mobility . Participants were divided into 2 groups : 34 participants who did not practice on the obstacle course during their exercise program and 31 participants who practice d on the obstacle course in addition to their otherwise identical exercise program . MAIN OUTCOME MEASURES Performance on a functionally oriented obstacle course and self-reported falls and fall-related injuries . RESULTS No significant performance differences were found between the two groups . After intervention , mean qualitative obstacle course scores improved modestly ( 5 % ) and mean obstacle course completion time decreased by 15 % from baseline . These postintervention pairwise performance differences were clinical ly important but not statistically significant . Relative to baseline levels , postintervention falls and injuries did not change significantly . CONCLUSIONS Our exercise intervention may have the potential to improve functional performance . However , some modifications are necessary to enhance efficacy . The obstacle course may be a useful tool in the evaluation of elderly persons with balance and mobility impairment in the rehabilitation setting Abstract : Elderly women with very low bone mineral density ( BMD ) ( T-score ≤−3.5 ) have a risk of hip fracture more than two times higher than the average risk of women of the same age . Using data from the EPIDOS prospect i ve study , we have shown that by measuring BMD on the 50 % of women who have the lowest weight , it is possible to identify the majority of these women at higher risk . In the present analysis , we assessed whether the use of clinical risk factors , in the subset of women selected for osteodensitometry and with moderately low BMD ( T-score between −3.5 and −2.5 ) , allows the identification of another subgroup of women with a risk 2 times higher than average and , thereby , increases the efficiency of selective BMD screening . We then assessed the discriminant value for hip fracture of the overall screening strategy ( i.e. , use of weight to select women for osteodensitometry , then use of clinical risk factors to enhance the predictive value of BMD ) , and compared it with the value of BMD used as a population screening tool . In total , 6933 EPIDOS participants , aged 75 years or above , were included in this analysis . Using Cox regression models , we first determined which baseline factors were most predictive of hip fracture among the 1588 women with weight below median ( selection criteria for osteodensitometry in the proposed strategy ) and T-score between −3.5 and −2.5 . Based on the relative risk ( RR ) estimates from the final risk function , we calculated an individual risk score for hip fracture . We assessed the incidence of hip fracture for each value of the score , and determined the cutoff to identify women with a risk about 2 times higher than the average risk in this elderly cohort . The overall screening strategy ( i.e. , selective BMD measurement based on weight , followed by clinical fracture risk assessment ) identifies two subgroups of higher risk women : a group with very low BMD ( T-score ≤–3.5 ) , and another group with moderately low BMD ( T-score between –3.5 and –2.5 ) but a high fracture risk score . We calculated the total number of women classified as being at high risk , and assessed the overall sensitivity and specificity of this strategy to identify elderly women who will suffer a hip fracture  . Among women with weight below median and T-score between −3.5 and −2.5 , the factors most predictive of the risk of hip fracture were age , history of fall , ability to do the t and em walk ( test of dynamic balance ) , gait speed and visual acuity . A simple additive score based on these factors ( except visual acuity ) allows a high-risk group ( risk about 2 times higher than average ) to be clearly distinguished from a low-risk group ( risk below average ) . Overall , the proposed strategy identifies approximately 15 % of the women in the cohort as being at high risk , i.e. , 543 women with T-score ≤−3.5 and 503 women with −3.5 < T-score ≤−2.5 and a high fracture risk score . The sensitivity for hip fracture is equal to 37 % and the specificity to 85 % , which is equivalent to the discriminant value of BMD as a population screening tool . In elderly women , the use of a simple clinical risk score , in women with previous BMD values , allows the number of high-risk women identified to be increased . Overall , the proposed screening strategy ( use of weight to select women for osteodensitometry , and then use of clinical risk factors to enhance the predictive value of BMD ) has the same discriminant value for hip fracture as BMD used as a population screening tool Background Physical performance tests are important for assessing the effect of physical activity interventions in older people with dementia , but their psychometric properties have not been systematic ally established within this specific population . Objective The purpose of this study was to determine the relative and absolute test-retest reliability of the  6-m walk test  , the  Figure-of-Eight Walk Test ( F8W ) , the  Timed “ Up & Go ” Test ( TUG )  , the  Frailty and Injuries : Cooperative Studies of Intervention Techniques–4  ( FICSIT–4 ) Balance Test , the  Chair Rise Test ( CRT )  , and the  Jamar dynamometer .  These tests are used to assess gait speed , dynamic balance , functional mobility , static balance , lower-limb strength , and grip strength , respectively . Design This investigation was a prospect i ve , nonexperimental study . Methods Older people with dementia ( n=58 , age range=70–92 years ) performed each test at baseline and again after 1 week . Intraclass correlation coefficients ( ICC ) , st and ard error of measurement ( SEM ) , minimal detectable change ( MDC ) , and log-transferred limits of agreement of Bl and -Altman plots were calculated . Results The relative reliability of the F8W , TUG , and Jamar dynamometer was excellent ( ICC=.90–.95 ) and good for the 6-m walk test , FICSIT–4 , and CRT ( ICC=.79–.86 ) . The SEMs and MDCs were large for all tests . The absolute reliability of the TUG and CRT was significantly influenced by the level of cognitive functioning ( as assessed with the Mini-Mental State Examination [ MMSE ] ) . Limitations The specific etiology of dementia was not obtained . Conclusions The physical performance tests evaluated are useful for detecting differences in performance between older people with mild to moderate dementia and , therefore , are suitable for cross-sectional or controlled intervention studies . They appear less suitable to monitor clinical ly relevant intra-individual performance changes . Future studies should focus on the development of more sensitive tests and the identification of criteria for clinical ly relevant changes in this rapidly growing population Background Consistently swelling proportion of the frail elderly within a modern society challenges the overstrained public health sector to provide both adequate medical care and comprehensive assistance in their multiple functional deficits of daily living . Easy-to-apply and task-specific ways of addressing this issue are being sought out , with a view to proposing systemic solutions for nationwide application . Methods The present r and omised , double-blind , placebo-controlled , 7-week clinical trial aim ed to determine whether specifically structured , intensive exercise regimens , combined with nutritional supplementation , might improve and help sustain individual muscle strength and mobility , and possibly enhance individual functional capabilities in an on-going quest for active prevention of care-dependency . Ninety-one frail elderly ( F 71 M 20 ; mean age 79 years ) were recruited from both nursing home residents and community dwellers and r and omly split into four groups : Group I – progressive resistance exercises ( PRE ) + functionally-oriented exercises ( FOE ) + nutritional supplementation ( NS ) , Group II – PRE + FOE + placebo , Group III – st and ard exercises ( SE ) + FOE + NS , Group IV – SE + FOE + placebo . Each group pursued a 45 min . exercise session 5 times weekly . The subjects ' strength with regard to four muscle groups , i.e. hip and knee extensors and flexons , was assessed at 80 % ( 1 RM ) weekly , whereas their balance and mobility at baseline and at the end of the study . Results The study was completed by 80 subjects . Despite its relatively short duration significant differences in muscle strength were noted both in Group I and Group II ( p = 0.01 ; p = 0.04 ; respectively ) , although this did not translate directly into perceptible improvement in individual mobility . Notable improvements in individual mobility were reported in Group III and Group IV ( p = 0.002 ) , although without positive impact on individual muscle strength . Conclusion Comprehensively structured , high-intensity regimen made up of diverse exercise types , i.e. functionally-oriented , progressive resistance and st and ard ones , preferably if combined with nutritional supplementation in adequate volume , demonstrates clear potential for appreciably improving overall functional status in the frail elderly in terms of individual walking capacity and muscle strength . Trial registration Central Register of Clinical Trials , Pol and – CEBK180/2000 Abstract Objectives : To identify clinical characteristics of elderly in patients that predict their chance of falling ( phase 1 ) and to use these characteristics to derive a risk assessment tool and to evaluate its power in predicting falls ( phases 2 and 3 ) . Design : Phase 1 : a prospect i ve case-control study . Phases 2 and 3 : prospect i ve evaluations of the derived risk assessment tool in predicting falls in two cohorts . Setting : Elderly care units of St Thomas 's Hospital ( phase 1 and 2 ) and Kent and Canterbury Hospital ( phase 3 ) . Subjects : Elderly hospital in patients ( aged 65 years ) : 116 cases and 116 controls in phase 1 , 217 patients in phase 2 , and 331 in phase 3 . Main outcome measures : 21 separate clinical characteristics were assessed in phase 1 , including the abbreviated mental test score , modified Barthel index , a transfer and mobility score obtained by combining the transfer and mobility sections of the Barthel index , and several nursing judgments . Results : In phase 1 five factors were independently associated with a higher risk of falls : fall as a presenting complaint ( odds ratio 4.64 ( 95 % confidence interval 2.59 to 8.33 ) ; a transfer and mobility score of 3 or 4 ( 2.10 ( 1.22 to 3.61 ) ) ; and primary nurses ' judgment that a patient was agitated ( 20.9 ( 9.62 to 45.62 ) ) , needed frequent toileting ( 2.48 ( 1.08 to 5.70 ) ) , and was visually impaired ( 3.56 ( 1.26 to 10.05 ) ) . A risk assessment score ( range 0 - 5 ) was derived by scoring one point for each of these five factors . In phases 2 and 3 a risk assessment score > 2 was used to define high risk : the sensitivity and specificity of the score to predict falls during the following week was 93 % and 88 % respectively in phase 2 and 92 % and 68 % respectively in phase 3 . Conclusion : This simple risk assessment tool predicted with clinical ly useful sensitivity and specificity a high percentage of falls among elderly hospital in patients
The analysis of our outcomes illustrates the similarities and differences between the identified tests
Assessment s of gait , balance , and transfer in elderly people play a valuable role in maintaining healthy aging and preventing a decline in mobility .
Several evaluation tools have been proposed ; however , clinicians should select the most accurate ones wisely , based on numerous criteria .
This systematic review aims to identify all applicable elderly mobility assessment tests and show their measurement properties with as much detail as possible .