bluuebunny/crossref_metadata_2025_split huggingface dataset:
68 Task Specificity in Fall Prevention
Authors: Lord Stephen 
Published: December 2019

Abstract
Falls pose a major threat to the well-being and quality of life of older people. Falls can result in fractures and other injuries, disability and fear and are can trigger a decline in physical function and loss of autonomy. This presentation with synthesises recent published findings on fall risk and mobility assessments and fall prevention interventions and considers how this field of research may evolve in future, Fall risk topics include the utility of remote monitoring using wearable sensors and recent work investigating brain activation and gait adaptability. New approaches for exercise for fall fall prevention including dual task training, cognitive-motor training with exergames and reactive step training are discussed. The presentation will discuss how these new initiatives and technologies have potential for effective fall prevention and improved quality of life. It concludes by emphasising the need for a continued focus on translation of evidence into practice including robust effectiveness evaluations of so that resources can be appropriately targeted into the future.
72 Test-Retest Reliability and Minimal Detectable Change for Postural Sway by using Sway Meter in Elderly Subjects
Authors: Rongsawad Kitima , Worawan Laddawon , Jirarojprapa Karnsiree , Kaewkham Sararat , Khattiwong Sarawut 
Published: December 2019

Abstract

Introduction
Static postural stability is the ability to maintain the posture with minimum sway. Increasing postural sway during standing in different sensory conditions is associated with aging due to decline in sensory and motor functions. Sway area measured by using sway meter is usually simple method for assessing postural stability in elderly subjects. Like many biological measurements, sway area has an intrinsic variability that affects their test-retest reliability and responsiveness of postural stability assessment. The minimal detectable change (MDC) is ability to detect smallest change beyond measurement error that reflects a reliable change. Therefore, the MDC value could provide information of clinical relevance on postural stability. The aims of this study were to determine test-retest reliability and MDC of sway area obtained from sway meter in elderly subjects.

Methods
Twelve healthy elderly subjects aged 60 years and above were participated in this study. The test and retest repeatability of postural sway measurements were performed twice with a 1-hour interval. For each subject was assess postural sway using Lord’s sway meter during standing on 4 sensory conditions for 30 seconds of each condition. The test-retest reliability of sway area was calculated using intraclass correlation coefficient. The MDC for each sway area was calculated to quantify clinical relevance.

Results
The test-retest reliability of sway area revealed good to excellent reliability ranged from 0.85 to 0.94. Standard error of measurement (SEM) and MDC ranged from 75 to 205 mm2 and 209 to 568 mm2, respectively.

Discussion and Conclusion
Our findings reveal that sway area in different sensory conditions could be used in assessment of postural stability in elderly subjects. SEM and MDC of sway area increased when subjects were asked to close their eyes and on foam surface. The sway meter is a reliable tool for assessing postural stability in clinical setting.
73 Exercise Habit is Associated with Lower Fall Risks among Elderly People Living in Urban Areas
Authors: Yokoyama Hisayo , Watanabe Hitoshi , Saito Kazumi , Shibata Ayane , Suzuki Yuta , Imai Daiki , Okazaki Kazunobu , Ogita Akira 
Published: December 2019

Abstract
In the present super aged society that has limited financial resources for efficient health care for the elderly population, fall prevention is an urgent issue. The present study examined the relationship between exercise habit and fall risks among elderly people living in an urban area. A total of 1,014 elderly people (age: 65–89 years) living in Osaka City were enrolled in this study and assigned to 5 different age groups. The motor abilities of the participants were evaluated by the Functional Reach Test (FRT) and the Timed Up and Go (TUG) test, with the cutoff value for fall risk set at 25 cm and 13.5 s, respectively. Exercise habit (≤1 h, 1–2 h, or ≥2 h per week), history of recent falls, and anxiety about falling were also assessed using a questionnaire modified from the checklist by the Ministry of Health, Labour and Welfare of Japan. The results of the FRT and TUG tests were increasingly poorer in higher age groups. History of recent falls and anxiety about falling were also more frequent in higher age groups (all p &lt; .05). The prevalence of exercise habits was similar among the age groups. In the age groups &gt;75 years, there was an association between exercise habit and a decrease in fall risks, based on the FRT results (all p &lt; .05). The mean FRT value of the participants with the greatest exercise habit was equivalent to that of the generation 10 years younger with the lowest exercise habit. There was an association between exercise habit and decreased anxiety about falling (p = .003), but not with a history of recent falls. Our results suggest that exercise should be promoted among elderly people living in urban areas to contribute to fall prevention.
79 A Life Course Approach to Standing Balance: Risk Factors Across Life
Authors: Blodgett Joanna , Cooper Rachel , Davis Daniel H J , Kuh Diana , Hardy Rebecca 
Published: December 2019

Abstract

Introduction
Poor balance ability in mid and later life is associated with increased risk of adverse health outcomes. Understanding what factors across life contribute to balance ability in the ageing population is important in order to prevent, delay or minimise balance decline. Our aim was to identify socioeconomic indicators, health behaviours, health status indicators and cognition that are associated with balance and identify how these associations varied by age and sex.

Methods
Data from the MRC National Survey of Health and Development, a British birth cohort study, were utilised (n=3111). Multilevel models examined associations between twelve different factors across life (maternal education, paternal occupational class, education, own occupational class, physical activity, smoking, diabetes, respiratory symptoms, cardiovascular events, knee pain, depression and verbal memory) and one-legged standing balance (assessed at ages 53, 60-64 and 69).

Results
Men had better balance than women at age 53 (b=18.8% (95%CI: 13.6, 23.9), although this difference decreased with age (11.8% at age 60-64 and 7.6% at age 69). Low socioeconomic position, poor health behaviours, poor health status and lower cognition were associated with poorer balance at all three ages. For example, those from the lowest paternal occupational class had 29.6% (95% CI: 22.2, 38.8%) worse balance than those from the highest class. There were no sex differences in patterns of associations. Associations of balance with socioeconomic indicators, cognition and physical activity got smaller with age, while the associations with knee pain and depression increased.

Discussion
Factors across life that contribute to balance are multifaceted and complex. A multifactorial intervention to minimise balance decline and falls could be more appropriate than a single factor approach. Due to different patterns of association with age (i.e. knee pain or depression), different factors should be targeted depending on age.
80 The Effects of Predisposing and Precipitating Factors on Gravity of Falls
Authors: Isacu Daniella , Slimani Mohand , Margine Daniela , Reben Isabelle , Gabteni Ghazoua , Marais Sarah 
Published: December 2019

Abstract
During 14 months, on the Geriatric Department of HC of Loches were hospitalised for falls 97 patients with an average age of 82,2 years.
We studied the effect of predisposing (neuro-sensitive deficiency; walking disabilities; cognitive disorders; depression; malnutrition; vitamin D deficiency; iatrogenic factors; abnormal feet) and precipitating (infections; stroke; confusion; ionic disturbances; toxic substances; anemia; rhythm and conduction heart disorders; orthostatic hypotension) factors on gravity of falls using ANOVA statistical analysis tests.
Following the interrogation we found that from the 62,88% women and 37,12% men, 79,38% have fallen at home, in nursing homes 12,37% and in our department 8,25%. The falls have had as consequences in 45 cases no trauma, in 34 cases mild trauma and 18 fractures.
The results showed that the most representatives predisposing factors were walking disabilities 76,28%; cognitive disorders 66% and iatrogenic 54,63%. Among the precipitating factors the most representatives were arhythmia and conduction heart disorders 62,88% and infections 56,7%.
There was a significant difference (p&lt;0,0001) between the predisposing factors and precipitating factors in no trauma and mild falls (p&lt;0,001), showing that precipitating factors have less influence on falls without sever consequences. There was no difference (p=0,4) between the factors when a fracture was the consequence. In this case the precipitating factors have the same impact on gravity of falls as the predisposing factors.
Iatrogenic factors (39,62% beta–blockers) and arrhythmias had significantly higher values in patients with falls and fractures than in those with falls without trauma (p&lt;0,05) or mild trauma (p&lt;0,001).
The addition of some two types of factors influences the severity of falls in elderly people.
81 Balance Ability and Falls in Mid-Life: Understanding Associations and Potential Diagnostic Screening
Authors: Blodgett Joanna , Cooper Rachel , Davis Daniel H J , Kuh Diana , Hardy Rebecca 
Published: December 2019

Abstract

Background
Falls in older adults are a growing public health concern. Evidence shows that balance ability is associated with falls and may be a useful screening tool to identify high-risk individuals. However, research has primarily focused on individuals aged 65+. This evidence has used regression modeling, without assessing the diagnostic accuracy of balance. We aimed to investigate both associations and screening accuracy of balance ability at ages 53 and 60-64 with falls at ages 60-64 and 68.

Methods
Data from the MRC National Survey of Health and Development, a British birth cohort study, were utilised (n=3563). At ages 53 and 60-64, one-legged balance time with eyes-closed was assessed. At ages 60-64 and 68, participants self-reported fall frequency (0, 1, 2+) and type (injurious, non-injurious) within the last year. Sex-adjusted multinomial logistic regressions assessed associations of balance with fall frequency and type. Areas under the curve (AUCs) of balance and sex prediction models were calculated.

Results
Better balance ability at age 53 was associated with lower risk of recurrent falls at ages 60-64 [RRR(95%CI) of 0.97(0.94,1.00)] and 68 [0.97(0.94,0.99)], and balance at age 60-64 was associated with risk of recurrent falls at age 68 [0.92(0.88,0.97)]. Higher balance at age 53 was associated with injurious falls at age 60-64 [0.95(0.92,0.99)], while higher balance at age 60-64 was associated with non-injurious falls in women [0.90(0.85,0.96)]. AUCs for all models remained low (&lt;0.650); the addition of balance to a sex-only model improved diagnostic accuracy for recurrent and injurious falls.

Conclusions
Balance and falls are associated, even at younger ages. The poor discriminatory ability of balance tests suggests that it may not be an appropriate tool to identify those at risk of falling. Despite an underlying aetiological association between balance and falls, further translational research is needed before balance screenings are implemented into primary care.
84 Identifying Potential Recurrent Fallers in the Community using Frailty Indicators
Authors: Lam Freddy M H , Leung Jason C S , Kwok Timothy C Y 
Published: December 2019

Abstract

Introduction
Frailty indicators were proposed to be significant predictors of falls. However, their comparative and additional value to other simple fall predictors has not been evaluated. This study aims to compare the clinical value of three frailty indicators to fall history in predicting recurrent falls in older adults.

Methods
Four thousand community-dwelling elderly (2000 female) aged 65 years or above were recruited in Hong Kong. The three candidate frailty indicators were the FRAIL scale, the Cardiovascular Health Study Criteria (CHS), and the Study for Osteoporosis and Fracture Criteria (SOF). The comparative predictor was fall history. The area under the receiver operating characteristic curve (AUC) was used to assess their ability to predict recurrent falls in the second year after baseline. Classification and Regression Tree (CART) analysis was used to evaluate the clinical potential of significant predictors on identifying older recurrent fallers in a simulated clinical pathway.

Results
Fall history is better than all frailty indicators in predicting recurrent falls in men and women (Fall History: AUC: men=0.681; women=0.645; Frailty indicators: AUC≤0.641). Upon adjusting for fall history, FRAIL and SOF remained as significant predictors for women but no frailty indicator remained significant for men. FRAIL could separate older women into two groups with different proportion of recurrent fallers in those with history of recurrent falls (16.0% vs 30.8%), single fall history (9.5% vs 37.5%), and no fall history (3.8% vs 7.5%). SOF provides limited value in people with a single fall history (history of recurrent falls: 16.5% vs 20.6%; single fall history: 10.2% vs 10.9%; no fall history: 3.9% vs 8.6%).

Conclusion
Adding FRAIL or SOF on top of fall history improves the prediction of recurrent falls in older women but not men. FRAIL could be a useful tool for identifying community-dwelling older women at high risk of recurrent falls.
85 Exploring the Feasibility of the Adapted Lifestyle - Integrated Functional Exercise (ALIFE) Programme to Prevent Falls among Older Adults in Thailand
Authors: Ounjaichon Sasiporn , Todd Chris , Stanmore Emma , Boulton Elisabeth 
Published: December 2019

Abstract

Background
Falls are the leading cause of injuries in older adults in Thailand. Exercise appears to be a strategy to reduce falls. There is a need to develop a fall prevention exercise programme to encourage participation and adherence. The adapted Lifestyle-integrated Functional Exercise (aLiFE) programme may be suitable by integrating exercise into daily routines as opposed to attending an exercise class. This study aimed to explore the acceptability and feasibility of the aLiFE programme in older Thai adults and identify if modifications are necessary for this population.

Method
To obtain older Thai adults' perspectives and stakeholders’ views, 40 community-dwelling older adults aged ≥ 60 years, in urban and rural locations in Thailand, and 14 stakeholders (e.g. healthcare professionals) working with older Thai adults were included. Qualitative methods were used to conduct focus groups and in-depth interviews with older adults, and semi-structured interviews with stakeholders. Thematic analyses using Framework Approach were conducted.

Results
Findings revealed positive views and identified four themes including: (a) individual factors, (b) perceptions of aLiFE, (c) recommendations for implementing aLiFE in Thailand, and (d) motivation. Older participants expressed interest in performing aLiFE in their daily activities, although some activities may need to be modified to fit the Thai cultural context. Stakeholders were concerned about how to motivate older Thai adults to adhere to aLiFE. Healthcare professionals and family members could play a major role to support older adults in uptake of aLiFE. Benefits (e.g. independence and fall prevention) may motivate older adults to engage in aLiFE. Clear and simple instructions were requested.

Conclusion
The aLiFE programme should be feasible and acceptable among older Thai adults. The aLiFE programme has been appropriately modified to be ‘Thai LiFE (TLiFE)’. A feasibility randomised controlled trial of the TLiFE programme has been conducted in older Thai adults.
89 Randomised Controlled Trial of the Effect of Tai Chi on Postural Balance of People with Dementia
Authors: Nyman Samuel , Ingram Wendy , Sanders Jeanette , Thomas Peter , Thomas Sarah , Vassallo Michael , Raftery James , Bibi Iram , Barrado-Martín Yolanda 
Published: December 2019

Abstract

Introduction
We investigated the effect of Tai Chi exercise on postural balance among people with dementia (PWD), and the feasibility of a definitive trial on falls prevention.

Method
We conducted a randomised controlled trial. Dyads, comprising community-dwelling PWD and their informal carer (N=85), were randomised to usual care (n=43) or usual care plus the intervention (n=42). For the intervention, over 20 weeks, Tai Chi classes were provided weekly and Tai Chi home practice was facilitated by the carer. The primary outcome was the timed up and go test. Secondary outcomes for PWD included functional balance, static balance, fear of falling, cognitive functioning, quality of life, and falls. Secondary outcomes for carers included dynamic balance, static balance, quality of life, and carer burden. Outcomes were assessed six months post-baseline, except for falls, which were collected prospectively over the six-month follow-up period.

Results
For PWD, there was no significant difference at follow-up on the timed up and go test (mean difference [MD] = 0.82, 95% confidence interval [CI] = -2.17, 3.81, standardised effect size [ES] = 0.14). Among the secondary outcomes, at follow-up, PWD in the Tai Chi group had significantly higher quality of life (MD = 0.051, 95% CI = 0.002, 0.100, ES = 0.51) and a significantly lower rate of falls (rate ratio = 0.35, 95% CI =0.15, 0.81), which was no longer significant when an outlier was removed. Carers in the Tai Chi group at follow-up were significantly worse on the timed up and go test (MD = 1.83, 95% CI = 0.12, 3.53, ES = 0.61). The remaining secondary outcomes were not significant. No serious adverse events were related to participation in Tai Chi.

Conclusion
With refinement, this Tai Chi intervention has potential to reduce the incidence of falls and improve quality of life among community-dwelling PWD.
91 Individuals Aged 65-69 Years Have Poorer Postural Control Related to Fear of Falling than Individuals Aged 70-74 Years
Authors: Mat Sumaiyah , Ng Chin Teck , Tan Maw Pin 
Published: December 2019

Abstract

Background
Fear of falling (FoF) is common in older people with a history of falls and increases the risk of future falls. It is postulated that individuals with FoF may lose the balance control in response to threatening situations due to psycho-emotional responses to a previous event. Little is known of how FoF influences postural control in older people.

Aim
To compare the influence of age in the association between FoF and postural control among older persons

Methods
A case-control study involving individuals aged ≥65 years with ≥2 falls or one injurious fall over 12 months with volunteers aged ≥65 years with no falls in the past year. Postural sway was quantified by using a long force-plate balance platform (Balancemaster, NeuroCom, USA). Fear of falling was assessed using the short Falls Efficacy Scale-International questionnaire.

Result
Of 102 participants recruited in this study, 33 (32.4%) were aged 65-69y, 36 (35.3%) aged 70-74y, and 33 (32.4%) age≥ 75y. There was no significant difference in FoF across the groups. The oldest age group had poorer postural control. Fear of falling in the youngest old group was associated with poorer standing balance in ‘eyes closed, firm surface’ conditions (p-value=0.012), forward maximal excursion (p-value=0.007), forward end point (p-value=0.001), forward movement velocity (p-value=0.008) and forward directional control (p-value &lt;0.001). The associations remained significant even after adjustment of history of falls, body mass index and comorbidities.

Conclusion
The influence of FoF on postural control is age dependent with posturography measurements only significantly associated with FoF within the 65-69y age group, but not the 70-74y or ≥ 75y age groups. Psychological interventions for fall prevention may therefore be more appropriately targeted according to age groups, rather than treating all over 65s as a homogenous group. This approach should be evaluated in future studies.
92 Development and Validity of a Fall-Risk Score for Older People who Receive Nursing-Care-Service
Authors: Oshima Kensuke , Asai Tsuyoshi , Naruse Fumihiro , Yamamoto Junshiro , Minami Chie 
Published: December 2019

Abstract

Introduction
Older people who receive nursing-care-service have multiple fall-risk than well-functioning older people. To our knowledge, there is no appropriate fall-risk assessment for them. Most of the fall-risk assessments in previous researches were subjective. Thus, we aimed to develop a new fall-risk score included major fall-related factors such as objective motor-functions for older who receive nursing-care-service, and to verify the validity of the score.

Method
We recruited 264 older people who receive nursing-care-service. They were randomly allocated to the fall-risk score development group (Development group) and the score validity group (Validity group). All assessment items were major fall-risk related factors. As motor-function tests, Short-Physical-Performance-Battery (SPPB) including single-task-walking (STW), and dual-task-walking (DTW) were performed. Dual-task-cost (DTC) was computed. The DTC score was made with 0 = lower than 20%, 1 = more than 20%, 2 = incomplete DTW. As a cognitive-function test, Mini-Mental-State-Examinations was examined. Basic-health-related-information and past one-year fall-history were obtained via patient care records. Information of fear of falling was obtained via interview. In the Development group, the association between fall-history and the major fall-related factors were analyzed using multiple-logistic-regression analysis. Based on these results, we developed the 4-point fall-risk score consisted of DTC score and SPPB score (0=more than 10-point, 1=7 to 9 point, 2=less than 6-point). Finally, in the Validity group, the association between fall-history and the fall-risk score was investigated using logistic-regression analysis, and we computed area-under-the-curve (AUC).

Results
In the Development group, the fall-history was associated with SPPB (Odds ratio[95%CI] = 0.73[0.61-0.87]), and DTC score (Odds ratio[95%CI] = 2.50[1.14-5.79]). In the Validity group, our fall-risk score was significantly associated with fall-history [ AUC=73%, sensitivity=67%, specificity=71% ].

Conclusion
In the fall-risk assessment for older people who receive nursing-care-service, our fall-risk score included SPPB and DTC are useful. The validity of our fall-risk score was confirmed.