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Roman De Mettelinge T.,Ghent University | Delbaere K.,Falls and Balance Research Group | Calders P.,Ghent University | Gysel T.,Ghent University | And 2 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2013

Objective: To investigate the effect of peripheral neuropathy and cognition on gait performance in older adults with type 2 diabetes mellitus. Design: Cross-sectional study. Setting: Community and residential aged care setting. Participants: Older adults (N=101; 56 patients with diabetes, 28 with peripheral neuropathy and 28 without peripheral neuropathy; and 45 matched controls). Interventions: Not applicable. Main Outcome Measures: Spatiotemporal gait parameters were recorded under 3 conditions: simple, counting backward by 3 from 40, and reciting animal names. The Mini-Mental State Examination and the clock drawing test were used to estimate cognitive impairment levels. Results: Compared with controls, older adults with diabetes walked slower, took shorter strides during all walking conditions, and showed more gait variability especially during dual-task conditions. Gait patterns did not differ between participants suffering from diabetes mellitus with and without neuropathy. Compared with normal walking, dual-task conditions affected all gait parameters similarly in all groups. Backward counting affected gait more than animal naming in participants with diabetes but not in healthy controls. Additional analyses in older adults with diabetes showed that participants with impaired cognitive function walked slower, took shorter strides, had shorter double support time, and increased gait variability compared with participants with intact cognitive function. Conclusions: This study showed that gait parameters are affected in older adults with type 2 diabetes. Gait was further affected by reduced cognitive function, irrespective of the presence of neuropathy. © 2013 by the American Congress of Rehabilitation Medicine.

Menant J.C.,Falls and Balance Research Group | Menant J.C.,University of New South Wales | Latt M.D.,Royal Prince Alfred Hospital | Menz H.B.,La Trobe University | And 2 more authors.
Movement Disorders | Year: 2011

Background: Although Parkinson's disease (PD) is a well recognised risk factor for falls, how this disease and its therapy affect postural stability and leaning balance remains unclear. The aim of this study was to examine the effects of PD and levodopa on postural sway and leaning balance. Methods: Performances of 28 PD participants {median [inter-quartile range (IQR)] duration of PD: 10 (6-13) years, median (IQR) UPDRS motor score "off": 22 (14-31) "on" and "off" levodopa were compared with 28 age- and gender-matched healthy controls on two measures of controlled leaning balance [ratio of anterior-posterior (AP) sway to maximal balance range (MBR) and coordinated stability]. Results: PD participants had greater ratio of AP sway to MBR than controls (P < 0.001), indicating that they swayed more as a proportion of their limits of stability, both "off" and "on" levodopa (P < 0.001). They also performed poorer in the coordinated stability test both "off" and "on" levodopa compared to controls (P < 0.001, for both), suggesting greater difficulty in controlling the center of mass at or near the limits of stability. Levodopa improved PD "participants" leaning balance (P < 0.001) and reduced the AP sway to MBR ratio (P < 0.001), although not to the level of controls. Conclusions: PD participants perform poorer than controls in leaning balance tests but significantly improve when "on" levodopa. Regardless of medication state, PD participants sway markedly more as a percentage of their limits of stability than controls suggesting a higher risk of falling. © 2011 Movement Disorder Society.

Roman de Mettelinge T.,Ghent University | Cambier D.,Ghent University | Calders P.,Ghent University | Van Den Noortgate N.,Ghent University | Delbaere K.,Falls and Balance Research Group
PLoS ONE | Year: 2013

Background:Older adults with type 2 Diabetes Mellitus are at increased risk of falling. The current study aims to identify risk factors that mediate the relationship between diabetes and falls.Methods:199 older adults (104 with diabetes and 95 healthy controls) underwent a medical screening. Gait (GAITRite®), balance (AccuGait® force plate), grip strength (Jamar®), and cognitive status (Mini-Mental State Examination and Clock Drawing Test) were assessed. Falls were prospectively recorded during a 12-month follow-up period using monthly calendars.Results:Compared to controls, diabetes participants scored worse on all physical and cognitive measures. Sixty-four participants (42 diabetes vs. 22 controls) reported at least one injurious fall or two non-injurious falls ("fallers"). Univariate logistic regression identified diabetes as a risk factor for future falls (Odds Ratio 2.25, 95%CI 1.21-4.15, p = 0.010). Stepwise multiple regressions defined diabetes and poor balance as independent risk factors for falling. Taking more medications, slower walking speed, shorter stride length and poor cognitive performance were mediators that reduced the Odds Ratio of the relationship between diabetes and faller status relationship the most followed by reduced grip strength and increased stride length variability.Conclusions:Diabetes is a major risk factor for falling, even after controlling for poor balance. Taking more medications, poorer walking performance and reduced cognitive functioning were mediators of the relationship between diabetes and falls. Tailored preventive programs including systematic medication reviews, specific balance exercises and cognitive training might be beneficial in reducing fall risk in older adults suffering from diabetes. © 2013 Roman de Mettelinge et al.

Kwan M.M.S.,Falls and Balance Research Group | Kwan M.M.S.,University of New South Wales | Tsang W.W.N.,Hong Kong Polytechnic University | Lin S.-I.,National Cheng Kung University | And 5 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2013

Background. Chinese older people have approximately half the risk of falling as their white counterparts, but no studies to date have explained why such a disparity exists.Methods. A total of 692 Chinese and 764 white community-dwelling older people participated in a multicohort study conducted in Taiwan, Hong Kong, and Australia. Baseline measurements included sociodemographic, psychological, and physical measures; concern about falling (Falls Efficacy Scale-International scores); and physical activity levels. Falls were monitored prospectively for 12-24 months.Results. The standardized annual fall rates for the 3 Chinese cohorts were 0.26±0.47 in Taiwan, 0.21±0.57 in Hong Kong, and 0.36±0.80 in Australia, which were significantly lower than that of the white cohort at 0.70±1.15. The fall rates for the Taiwan and Hong Kong cohorts were also significantly lower than that of the Australian Chinese cohort. The difference in fall rates was not due to better physical ability in the Chinese cohorts. However, the Chinese cohorts did more planned activity and expressed more concern about falling. Negative binomial regression analysis revealed a significant Cohort × Falls Efficacy Scale-International score interaction. After adjusting for this interaction, Falls Efficacy Scale-International scores, other predictors, and confounders, the incidence rate ratios comparing the cohorts were no longer statistically significant.Conclusions. Low fall rates in Chinese cohorts appear to be due to increased concern about falling as manifest in high Falls Efficacy Scale-International scores. These findings suggest that the Chinese cohorts are more likely to adapt their behaviors to lessen fall risk and that such adaptations are partially lost in Chinese people who have migrated to a "Westernized" country. © The Author 2013.

Taylor M.E.,Falls and Balance Research Group | Delbaere K.,Falls and Balance Research Group | Lord S.R.,Falls and Balance Research Group | Mikolaizak A.S.,Falls and Balance Research Group | And 4 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2014

Background. Older people with cognitive impairment have an elevated fall risk, with 60% falling annually. There is a lack of evidence for fall prevention in this population, in part due to limited understanding of risk factors. This study examined fall risk in older people with cognitive impairment with an emphasis on identifying explanatory and modifiable risk factors. Methods. One hundred and seventy-seven community-dwelling older people with mild-moderate cognitive impairment (Mini-Mental State Examination 11-23/Addenbrooke's Cognitive Examination-Revised <83) underwent neuropsychological, physical, and functional assessments. Falls were recorded prospectively for 12 months with the assistance of carers. Results. Of the 174 participants available to follow-up, 111 (64%) fell at least once and 71 (41%) at least twice. Higher fall rates were associated with slower reaction time, impaired balance (sway on floor and foam, semitandem, near-tandem, tandem stance), and reduced functional mobility (co-ordinated stability, timed up-and-go, steps needed to turn 180°, sit-to-stand, gait velocity). Higher fall rates were also associated with increased medication use (central nervous system, total number) and poorer performances in cognitive (Addenbrooke's Cognitive Examination-Revised: visuospatial domain, cube drawing; Trail-Making Test) and psychological (Geriatric Depression Scale, Goldberg Anxiety Scale, Falls Efficacy Scale-International) tests. Multivariate analysis identified increased sway on foam, co-ordinated stability score, and depressive symptoms to be significantly and independently associated with falls while controlling for age, years of education, and Addenbrooke's Cognitive Examination-Revised score. Conclusions. This study identified several risk factors of falls in older people with cognitive impairment, a number of which are potentially modifiable. Future research involving targeted interventions addressing medication use, balance, mood, and functional performance may prove useful for fall prevention in this population. © 2013 The Author.

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