scholarly journals Mobility Performance in Community-Dwelling Older Adults: Potential Digital Biomarkers of Concern about Falling

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Changhong Wang ◽  
Michelle Patriquin ◽  
Ashkan Vaziri ◽  
Bijan Najafi
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Stride Length ◽  
Performance Metrics ◽  
Community Dwelling ◽  
Gait Symmetry ◽  
Mobility Performance ◽  
High Concern ◽  
Community Dwelling Older Adults ◽  
Digital Biomarkers

<b><i>Introduction:</i></b> Concern about falling is a prevalent worry among community-dwelling older adults and may contribute to a decline in physical and mental health. This study aimed to examine the association between mobility performance and concern about falling. <b><i>Methods:</i></b> Older adults aged 65 years and older, with Mini-Mental State Examination score ≥24, and ambulatory (with or without the assistive device) were included. Concern about falling was evaluated with Falls Efficacy Scale-International (FES-I) scores. Participants with high concern about falling were identified using the cutoff of FES-I ≥23. Participants’ motor capacity was assessed in standardized walking tests under single- and dual-task conditions. Participants’ mobility performance was measured based on a 48-h trunk accelerometry signal from a wearable pendant sensor. <b><i>Results:</i></b> No significant differences were observed at participant characteristics across groups with different levels of concern about falling (low: <i>N</i> = 64, age = 76.3 ± 7.2 years, female = 46%; high: <i>N</i> = 59, age = 79.3 ± 9.1 years, female = 47%), after propensity matching with BMI, age, depression, and cognition. With adjustment of motor capacity (stride velocity and stride length under single- and dual-task walking conditions), participants with high concern about falling had significantly poorer mobility performance than those with low concern about falling, including lower walking quantity (walking bouts, steps and time per day, and walking bout average, walking bout variability, and longest walking bout, <i>p</i> ≤ 0.013), and poorer daily-life gait (stride velocity and gait variability, <i>p</i> ≤ 0.023), and poorer walking quality (frontal gait symmetry, and trunk acceleration and velocity intensity, <i>p</i> ≤ 0.041). The selected mobility performance metrics (daily steps and frontal gait symmetry) could significantly contribute to identifying older adults with high concern about falling (<i>p</i> ≤ 0.042), having better model performance (<i>p</i> = 0.036) than only walking quantity (daily steps) with adjustment of confounding effects from the motor capacity (stride length under dual-task walking condition). <b><i>Conclusion:</i></b> There is an association between mobility performance and concern about falling in older adults. Mobility performance metrics can serve as predictors to identify older adults with high concern about falling, potentially providing digital biomarkers for clinicians to remotely track older adults’ change of concern about falling via applications of remote patient monitoring.

Transfer Effects of Fall Training on Balance Performance and Spatiotemporal Gait Parameters in Healthy Community-Dwelling Older Adults: A Pilot Study

2014 ◽  
Vol 22 (3) ◽  
pp. 324-333 ◽  
Author(s):  
Lars Donath ◽  
Oliver Faude ◽  
Stephanie A. Bridenbaugh ◽  
Ralf Roth ◽  
Martin Soltermann ◽  
...  
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Stride Length ◽  
Fear Of Falling ◽  
Community Dwelling ◽  
Stride Time ◽  
Balance Performance ◽  
Transfer Effects ◽  
Gait Parameters ◽  
Community Dwelling Older Adults

This study examined transfer effects of fall training on fear of falling (Falls Efficacy Scale—International [FES–I]), balance performance, and spatiotemporal gait characteristics in older adults. Eighteen community-dwelling older adults (ages 65–85) were randomly assigned to an intervention or control group. The intervention group completed 12 training sessions (60 min, 6 weeks). During pre- and posttesting, we measured FES–I, balance performance (double limb, closed eyes; single limb, open eyes; double limb, open eyes with motor-interfered task), and gait parameters (e.g., velocity; cadence; stride time, stride width, and stride length; variability of stride time and stride length) under single- and motor-interfered tasks. Dual tasks were applied to appraise improvements of cognitive processing during balance and gait. FES–I (p = .33) and postural sway did not significantly change (0.36 < p < .79). Trends toward significant interaction effects were found for step width during normal walking and stride length variability during the motor dual task (p = .05, ηp2 = .22). Fall training did not sufficiently improve fear of falling, balance, or gait performance under single- or dual-task conditions in healthy older adults.

Digital Biomarkers of Cognitive Frailty: The Value of Detailed Gait Assessment Beyond Gait Speed

Gerontology ◽  
2021 ◽  
pp. 1-10
Author(s):  
He Zhou ◽  
Catherine Park ◽  
Mohammad Shahbazi ◽  
Michele K. York ◽  
Mark E. Kunik ◽  
...  
Keyword(s):  
Older Adults ◽  
Steady State ◽  
Dual Task ◽  
Gait Speed ◽  
Stride Length ◽  
Cognitive Frailty ◽  
Single Task ◽  
Double Support ◽  
Gait Parameters ◽  
Digital Biomarkers

<b><i>Background:</i></b> Cognitive frailty (CF), defined as the simultaneous presence of cognitive impairment and physical frailty, is a clinical symptom in early-stage dementia with promise in assessing the risk of dementia. The purpose of this study was to use wearables to determine the most sensitive digital gait biomarkers to identify CF. <b><i>Methods:</i></b> Of 121 older adults (age = 78.9 ± 8.2 years, body mass index = 26.6 ± 5.5 kg/m<sup>2</sup>) who were evaluated with a comprehensive neurological exam and the Fried frailty criteria, 41 participants (34%) were identified with CF and 80 participants (66%) were identified without CF. Gait performance of participants was assessed under single task (walking without cognitive distraction) and dual task (walking while counting backward from a random number) using a validated wearable platform. Participants walked at habitual speed over a distance of 10 m. A validated algorithm was used to determine steady-state walking. Gait parameters of interest include steady-state gait speed, stride length, gait cycle time, double support, and gait unsteadiness. In addition, speed and stride length were normalized by height. <b><i>Results:</i></b> Our results suggest that compared to the group without CF, the CF group had deteriorated gait performances in both single-task and dual-task walking (Cohen’s effect size <i>d</i> = 0.42–0.97, <i>p</i> &#x3c; 0.050). The largest effect size was observed in normalized dual-task gait speed (<i>d</i> = 0.97, <i>p</i> &#x3c; 0.001). The use of dual-task gait speed improved the area under the curve (AUC) to distinguish CF cases to 0.76 from 0.73 observed for the single-task gait speed. Adding both single-task and dual-task gait speeds did not noticeably change AUC. However, when additional gait parameters such as gait unsteadiness, stride length, and double support were included in the model, AUC was improved to 0.87. <b><i>Conclusions:</i></b> This study suggests that gait performances measured by wearable sensors are potential digital biomarkers of CF among older adults. Dual-task gait and other detailed gait metrics provide value for identifying CF above gait speed alone. Future studies need to examine the potential benefits of gait performances for early diagnosis of CF and/or tracking its severity over time.

scholarly journals 94 Association between Dual-Task Timed “UP and GO” Test and Occurrence of Falls According to Age Group (Young-Older or Old-Older Adults): A Longitudinal Observation Study

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv18-iv27
Author(s):  
Tsuyoshi Asai ◽  
Kensuke Oshima ◽  
Yoshihiro Fukumoto ◽  
Shogo Misu
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Dual Task ◽  
Community Dwelling ◽  
Age Group ◽  
Adult Group ◽  
Observation Study ◽  
Timed Up And Go ◽  
Community Dwelling Older Adults

Abstract Aim To elucidate the association between the occurrence of falls and timed “up and go” (TUG) test score in a dual-task condition among community-dwelling older adults by age group. Methods This longitudinal observation study included 987 community-dwelling older adults at baseline. A TUG test (single-TUG) and a TUG test while counting aloud backward from 100 (dual-TUG) were conducted at baseline. The dual-task cost (DTC) value was computed from these results. Data on fall history were obtained using a self-administered questionnaire at the 1-year follow-up. At follow-up, 322 participants had dropped out and six participants had missing data for falls. The final analysis included 658 individuals (follow-up rate: 658/987, 67%) divided into a young-older adult group (aged 60–74 years) and an old-older adult group (aged 75 years or older). Associations between the occurrence of falls and TUG-related values were analyzed by age group using multivariate logistic regression models. Results For old-older adults, there were significant associations between the occurrence of falls and DTC value (odds ratio [OR] 0.981, 95% confidence interval [CI]: 0.963–0.999, p = 0.040) and single-TUG score (OR 1.129, 95% CI: 1.006–1.268, p = 0.039). However, no significant associations were observed for young-older adults. Conclusions Slower single-TUG test score and lower DTC value are associated with the occurrence of falls among old-older adults but not among young-older adults. Dual task assessment is useful for predicting falls in TUG fall assessment for old-older adults.

scholarly journals Longitudinal Associations Between Gait, Falls, and Disability in Community-Dwelling Older Adults With Type II Diabetes Mellitus: Findings From The Irish Longitudinal Study on Ageing (TILDA)

2020 ◽  
Author(s):  
Orna A Donoghue ◽  
Siobhan Leahy ◽  
Rose Anne Kenny
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Type Ii Diabetes ◽  
Step Length ◽  
Community Dwelling ◽  
Type Ii ◽  
Diabetes Status ◽  
Increased Risk ◽  
Community Dwelling Older Adults ◽  
Task Step

Abstract Background Diabetes is associated with gait deficits, future falls, and disability; however, it is unclear if associations remain after controlling for relevant confounders. This study investigated (i) the effects of type II diabetes on spatiotemporal gait parameters in community-dwelling older adults and (ii) if diabetes status was independently associated with future falls and disability, after controlling for gait and other confounders. Method Baseline data were obtained from 2608 community-dwelling adults (≥60 years) participating in The Irish Longitudinal Study on Ageing (TILDA). Diabetes was identified from self-reported doctors’ diagnosis, medications, and glycated hemoglobin levels. Gait characteristics were obtained during single- and dual-task walking using a GAITRite mat (n = 2560). Incident falls and disability were collected over 4 years follow-up (n = 2473). Associations between diabetes status and gait (cross-sectional) and falls and disability (longitudinal) were investigated using regression analysis, adjusting for medications, cardiovascular health, neuropsychological function, and fall-related factors. Results Diabetes (prevalence = 9.1%) was cross-sectionally associated with shorter dual-task step length after adjusting for covariates (β = −1.59, 95% CI: −3.10, −0.08, p &lt; .05). Diabetes was independently associated with increased risk of future instrumental activity of daily living (IADL) difficulty in those with no prior difficulty (incidence rate ratio [IRR] = 1.51, 95% CI: 1.08, 2.11, p &lt; .05) although dual-task step length was an important confounder in all disability models. No independent associations between diabetes and falls were observed. Conclusions Diabetes was independently associated with shorter dual-task step length and increased risk of future IADL difficulty. Multidimensional interventions addressing poor health and function in those with diabetes may help reduce the risk of gait deficits and future disability.

scholarly journals The Effect of Different Types of Walking on Dual-Task Performance and Task Prioritization among Community-Dwelling Older Adults

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Maayan Agmon ◽  
Einat Kodesh ◽  
Rachel Kizony
Keyword(s):  
Older Adults ◽  
Task Performance ◽  
Dual Task ◽  
Cognitive Task ◽  
Community Dwelling ◽  
Cognitive Tasks ◽  
Dual Task Performance ◽  
Different Types ◽  
Task Prioritization ◽  
Community Dwelling Older Adults

Background. The ability to safely conduct different types of walking concurrently with a cognitive task (i.e., dual task) is crucial for daily life. The contribution of different walking types to dual-task performance has not yet been determined, nor is there agreement on the strategies that older adults use to divide their attention between two tasks (task prioritization).Objectives. To compare the effect of walking in three different directions (forward, backward, and sideways) on dual-task performance and to explore the strategies of older adults to allocate their attention in response to different motor task demands.Design. A cross-sectional study.Subjects. Thirty-two (22 female) community-dwelling older adults (aged72.7±5.7years).Methods. Subjects randomly conducted single and dual task: walking to three directions separately, cognitive tasks separately, and combination of the two.Results. Walking forward was the least demanding task, during single (FW < BW, SW) (P<.001) and dual tasks (FW < BW < SW) (P<.001). The calculation of DTC revealed the same pattern (P<.001). DTC of the cognitive tasks was not significantly different among the three walking types.Conclusions. The decline mainly in the motor performance during dual task indicates that participants prioritized the cognitive task. These findings challenge the “posture first” paradigm for task prioritization.

scholarly journals The Effect of Co-dependent (Thinking in Motion [tim]) Versus Single-modality (Cognifit) Interventions on Cognition and Gait Among Community Dwelling Older Adults With Cognitive Decline: a Randomized Controlled Study

2022 ◽  
Author(s):  
Shiri Embon-Magal ◽  
Tal Krasovsky ◽  
Israel Doron ◽  
Kfir Asraf ◽  
Iris Haimov ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Dual Task ◽  
Group Intervention ◽  
Community Dwelling ◽  
Secondary Outcome ◽  
Controlled Study ◽  
Post Intervention ◽  
Community Dwelling Older Adults ◽  
Single Modality

Abstract Background. Cognition and motor skills are interrelated throughout the aging process and often show simultaneous deterioration among older adults with cognitive decline. Co-dependent training has the potential to ameliorate both domains; however, its effect on the gait and cognition of older adults with cognitive decline has yet to be explored. The aim of this study is to compare the effects of the well-established single-modality cognitive computerized training program, CogniFit, with “Thinking in motion (TIM),” a co-dependent group intervention, among community-dwelling older adults with cognitive decline. Methods. Employing a single-blind randomized control trial design, 47 community-dwelling older adults with cognitive decline were randomly assigned to eight-week thrice weekly trainings of TIM or CogniFit. Pre- and post-intervention assessments included cognitive performance, evaluated by a CogniFit battery, as a primary outcome, and gait, under single- and dual-task conditions, as a secondary outcome. Results. CogniFit total Z scores significantly improved from baseline to post-intervention for both groups. There was a significant main effect for time [F (1, 44) = 17.43, p<.001, ηp2=.283] but not for group [F (1, 44) = 0.001, p=.970]. No time X group interaction [F (1, 44) = 1.29, p=.261] was found. No changes in gait performance under single and dual-task performance were observed in both groups. Conclusions. The findings show that single-modality (CogniFit) and co-dependent (TIM) trainings improve cognition but not gait in older adults with cognitive decline. Such investigations should be extended to include various populations and a broader set of outcome measurements. Trial registration: anzctr Id: 371522. Date: 08/11/2016

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