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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.


Delbaere K.,Falls and Balance Research Group | Delbaere K.,Ghent University | Close J.C.T.,Falls and Balance Research Group | Close J.C.T.,University of New South Wales | And 8 more authors.
Journal of the American Geriatrics Society | Year: 2010

OBJECTIVE: To identify the interrelationships and discriminatory value of a broad range of objectively measured explanatory risk factors for falls. DESIGN: Prospective cohort study with 12-month follow-up period. SETTING: Community sample. PARTICIPANTS: Five hundred community-dwelling people aged 70 to 90. MEASUREMENTS: All participants underwent assessments on medical, disability, physical, cognitive, and psychological measures. Fallers were defined as people who had at least one injurious fall or at least two noninjurious falls during a 12-month follow-up period. RESULTS: Univariate regression analyses identified the following fall risk factors: disability, poor performance on physical tests, depressive symptoms, poor executive function, concern about falling, and previous falls. Classification and regression tree analysis revealed that balance-related impairments were critical predictors of falls. In those with good balance, disability and exercise levels influenced future fall risk - people in the lowest and the highest exercise tertiles were at greater risk. In those with impaired balance, different risk factors predicted greater fall risk - poor executive function, poor dynamic balance, and low exercise levels. Absolute risks for falls ranged from 11% in those with no risk factors to 54% in the highest-risk group. CONCLUSIONS: A classification and regression tree approach highlighted interrelationships and discriminatory value of important explanatory fall risk factors. The information may prove useful in clinical settings to assist in tailoring interventions to maximize the potential benefit of falls prevention strategies. © 2010, The American Geriatrics Society.


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.


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.


Kwan M.M.-S.,Falls and Balance Research Group | Kwan M.M.-S.,University of New South Wales | LinS.I.,National Cheng Kung University | Close J.C.T.,Falls and Balance Research Group | And 3 more authors.
Age and Ageing | Year: 2012

Objective: to determine whether depression is an important and independent predictor of falls in community-dwelling older people living in Taiwan.Design: longitudinal study.Setting: five randomly selected villages from Tainan city, Taiwan. Participants and methods: in total, 280 community-dwelling people not taking anti-depressant medication aged 65-91 years (mean age 74.9). Participants completed the Geriatric Depression Scale and underwent a range of sensorimotor, balance and mobility tasks and were then followed up for 2 years with monthly telephone calls to determine falls incidence.Results: of the 260 participants with complete follow-up data, 174 (66.9%) experienced no falls, 51 (19.6%) fell once and 35 (13.5%) fell two or more times. Depressive symptoms were significantly more prevalent in recurrent fallers (40.0%) and once-only fallers (27.5%) compared with non-fallers (16.1%). Negative binomial regression analysis identified depression, poor depth perception, reduced lower limb strength and increased sway as independent and significant predictors of falls.Conclusion: depressive symptoms were found to be common in older Taiwanese people and associated with an increased fall risk. These findings suggest that in addition to implementing approaches to maximise vision, strength and balance, fall prevention strategies should also include interventions to assess and treat depression. © The Author 2012. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.


Schoene D.,Falls and Balance Research Group | Schoene D.,University of New South Wales | Wu S.M.-S.,University of New South Wales | Mikolaizak A.S.,Falls and Balance Research Group | And 9 more authors.
Journal of the American Geriatrics Society | Year: 2013

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


Menant J.C.,Falls and Balance Research Group | Menant J.C.,University of New South Wales | Schoene D.,Falls and Balance Research Group | Schoene D.,University of New South Wales | And 3 more authors.
Ageing Research Reviews | Year: 2014

Although simple assessments of gait speed have been shown to predict falls as well as hospitalisation, functional decline and mortality in older people, dual task gait speed paradigms have been increasingly evaluated with respect to fall prediction. Some studies have found that dual task walking paradigms can predict falls in older people. A systematic review and meta-analysis was conducted to determine whether dual task walking paradigms involving a secondary cognitive task have greater ability to predict falls than single walking tasks. The meta-analytic findings indicate single and dual task tests of gait speed are equivalent in the prediction of falls in older people and sub-group analyses revealed similar findings for studies that included only cognitively impaired participants, slow walkers or used secondary mental-tracking or verbal fluency tasks. © 2014 Elsevier B.V.


Schoene D.,Falls and Balance Research Group | Schoene D.,University of New South Wales | Lord S.R.,Falls and Balance Research Group | Lord S.R.,University of New South Wales | And 5 more authors.
PLoS ONE | Year: 2013

Background: Stepping impairments are associated with physical and cognitive decline in older adults and increased fall risk. Exercise interventions can reduce fall risk, but adherence is often low. A new exergame involving step training may provide an enjoyable exercise alternative for preventing falls in older people. Purpose: To assess the feasibility and safety of unsupervised, home-based step pad training and determine the effectiveness of this intervention on stepping performance and associated fall risk in older people. Design: Single-blinded two-arm randomized controlled trial comparing step pad training with control (no-intervention). Setting/Participants: Thirty-seven older adults residing in independent-living units of a retirement village in Sydney, Australia. Intervention: Intervention group (IG) participants were provided with a computerized step pad system connected to their TVs and played a step game as often as they liked (with a recommended dose of 2-3 sessions per week for 15-20 minutes each) for eight weeks. In addition, IG participants were asked to complete a choice stepping reaction time (CSRT) task once each week. Main Outcome Measures: CSRT, the Physiological Profile Assessment (PPA), neuropsychological and functional mobility measures were assessed at baseline and eight week follow-up. Results: Thirty-two participants completed the study (86.5%). IG participants played a median 2.75 sessions/week and no adverse events were reported. Compared to the control group, the IG significantly improved their CSRT (F31,1 = 18.203, p<.001), PPA composite scores (F31,1 = 12.706, p = 0.001), as well as the postural sway (F31,1 = 4.226, p = 0.049) and contrast sensitivity (F31,1 = 4.415, p = 0.044) PPA sub-component scores. In addition, the IG improved significantly in their dual-task ability as assessed by a timed up and go test/verbal fluency task (F31,1 = 4.226, p = 0.049). Conclusions: Step pad training can be safely undertaken at home to improve physical and cognitive parameters of fall risk in older people without major cognitive and physical impairments. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12611001081909. © 2013 Schoene et al.


Taylor M.E.,Falls and Balance Research Group | Taylor M.E.,University of New South Wales | Delbaere K.,Falls and Balance Research Group | Delbaere K.,University of New South Wales | And 5 more authors.
Gait and Posture | Year: 2013

Impaired gait may contribute to the increased rate of falls in cognitively impaired older people. We investigated whether gait under simple and dual task conditions could predict falls in this group. The study sample consisted of 64 community dwelling older people with mild to moderate cognitive impairment. Participants walked at their preferred speed under three conditions: (a) simple walking, (b) walking while carrying a glass of water and (c) walking while counting backwards from 30. Spatiotemporal gait parameters were measured using the GAITRite® mat. Falls were recorded prospectively for 12months with the assistance of carers. Twenty-two (35%) people fell two or more times in the 12month follow-up period. There was a significant main effect of gait condition and a significant main effect of faller status for mean value measures (velocity, stride length, double support time and stride width) and for variability measures (swing time variability and stride length variability). Examination of individual gait parameters indicated that the multiple fallers walked more slowly, had shorter stride length, spent longer time in double support, had a wider support width and showed more variability in stride length and swing time (p<0.05). There was no significant interaction between gait condition and faller status for any of the gait variables. In conclusion, dual task activities adversely affect gait in cognitively impaired older people. Multiple fallers performed worse in each gait condition but the addition of a functional or cognitive secondary task provided no added benefit in discriminating fallers from non-fallers with cognitive impairment. © 2012 Elsevier B.V.

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