Showing papers by "Kim Delbaere published in 2015"

Characteristics and effectiveness of fall prevention programs in nursing homes: a systematic review and meta-analysis of randomized controlled trials

Abstract: OBJECTIVES: To determine characteristics and effectiveness of prevention programs on fall-related outcomes in a defined setting. DESIGN: Systematic review and meta-analysis. SETTING: A clearly described subgroup of nursing homes defined as residential facilities that provide 24-hour-a-day surveillance, personal care, and limited clinical care for persons who are typically elderly and infirm. PARTICIPANTS: Nursing home residents (N = 22,915). MEASUREMENTS: The primary outcomes were number of falls, fallers, and recurrent fallers. RESULTS: Thirteen studies met the inclusion criteria. Six fall prevention programs were single (one intervention component provided to the residents), one was multiple (two or more intervention components not customized to individual fall risk), and six were multifactorial (two or more intervention components customized to each resident's fall risk). Meta-analysis found significantly fewer recurrent fallers in the intervention groups (4 studies, relative risk (RR) = 0.79, 95% confidence interval (CI) = 0.65-0.97) but no significant effect of the intervention on fallers (6 studies, RR = 0.97, 95% CI = 0.84-1.11) or falls (10 studies, RR = 0.93, 95% CI = 0.76-1.13). Multifactorial interventions significantly reduced falls (4 studies, RR = 0.67, 95% CI = 0.55-0.82) and the number of recurrent fallers (4 studies, RR = 0.79, CI = 0.65-0.97), whereas single or multiple interventions did not. Training and education showed a significant harmful effect in the intervention groups on the number of falls (2 studies, RR = 1.29, 95% CI = 1.23-1.36). CONCLUSION: This meta-analysis failed to reveal a significant effect of fall prevention interventions on falls or fallers but, for the first time, showed that fall prevention interventions significantly reduced the number of recurrent fallers by 21%. Language: en

Interactive cognitive-motor step training improves cognitive risk factors of falling in older adults - a randomized controlled trial

Abstract: PURPOSE: Interactive cognitive-motor training (ICMT) requires individuals to perform both gross motor movements and complex information processing. This study investigated the effectiveness of ICMT on cognitive functions associated with falls in older adults. METHODS: A single-blinded randomized controlled trial was conducted in community-dwelling older adults (N = 90, mean age 81.5±7) without major cognitive impairment. Participants in the intervention group (IG) played four stepping games that required them to divide attention, inhibit irrelevant stimuli, switch between tasks, rotate objects and make rapid decisions. The recommended minimum dose was three 20-minute sessions per week over a period of 16 weeks unsupervised at home. Participants in the control group (CG) received an evidence-based brochure on fall prevention. Measures of processing speed, attention/executive function (EF), visuo-spatial ability, concerns about falling and depression were assessed before and after the intervention. RESULTS: Eighty-one participants (90%) attended re-assessment. There were no improvements with respect to the Stroop Stepping Test (primary outcome) in the intervention group. Compared to the CG, the IG improved significantly in measures of processing speed, visuo-spatial ability and concern about falling. Significant interactions were observed for measures of EF and divided attention, indicating group differences varied for different levels of the covariate with larger improvements in IG participants with poorer baseline performance. The interaction for depression showed no change for the IG but an increase in the CG for those with low depressive symptoms at baseline. Additionally, low and high-adherer groups differed in their baseline performance and responded differently to the intervention. Compared to high adherers, low adherers improved more in processing speed and visual scanning while high-adherers improved more in tasks related to EF. CONCLUSIONS: This study shows that unsupervised stepping ICMT led to improvements in specific cognitive functions associated with falls in older people. Low adherers improved in less complex functions while high-adherers improved in EF. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613000671763. Language: en

ICT-based system to predict and prevent falls (iStoppFalls): results from an international multicenter randomized controlled trial

Abstract: Falls and fall-related injuries are a serious public health issue. Exercise programs can effectively reduce fall risk in older people. The iStoppFalls project developed an Information and Communication Technology-based system to deliver an unsupervised exercise program in older people’s homes. The primary aims of the iStoppFalls randomized controlled trial were to assess the feasibility (exercise adherence, acceptability and safety) of the intervention program and its effectiveness on common fall risk factors. A total of 153 community-dwelling people aged 65+ years took part in this international, multicentre, randomized controlled trial. Intervention group participants conducted the exercise program for 16 weeks, with a recommended duration of 120 min/week for balance exergames and 60 min/week for strength exercises. All intervention and control participants received educational material including advice on a healthy lifestyle and fall prevention. Assessments included physical and cognitive tests, and questionnaires for health, fear of falling, number of falls, quality of life and psychosocial outcomes. The median total exercise duration was 11.7 h (IQR = 22.0) over the 16-week intervention period. There were no adverse events. Physiological fall risk (Physiological Profile Assessment, PPA) reduced significantly more in the intervention group compared to the control group (F1,127 = 4.54, p = 0.035). There was a significant three-way interaction for fall risk assessed by the PPA between the high-adherence (>90 min/week; n = 18, 25.4 %), low-adherence (<90 min/week; n = 53, 74.6 %) and control group (F2,125 = 3.12, n = 75, p = 0.044). Post hoc analysis revealed a significantly larger effect in favour of the high-adherence group compared to the control group for fall risk (p = 0.031), postural sway (p = 0.046), stepping reaction time (p = 0.041), executive functioning (p = 0.044), and quality of life (p for trend = 0.052). The iStoppFalls exercise program reduced physiological fall risk in the study sample. Additional subgroup analyses revealed that intervention participants with better adherence also improved in postural sway, stepping reaction, and executive function. Australian New Zealand Clinical Trials Registry Trial ID: ACTRN12614000096651 International Standard Randomised Controlled Trial Number: ISRCTN15932647

Eight-Week Remote Monitoring Using a Freely Worn Device Reveals Unstable Gait Patterns in Older Fallers

Abstract: Objectives: Develop algorithms to detect gait impairments remotely using data from freely worn devices during long-term monitoring. Identify statistical models that describe how gait performances are distributed over several weeks. Determine the data window required to reliably assess an increased propensity for falling. Methods: 1085 days of walking data were collected from eighteen independent-living older people (mean age 83 years) using a freely worn pendant sensor (housing a triaxial accelerometer and pressure sensor). Statistical distributions from several accelerometer-derived gait features (encompassing quantity, exposure, intensity, and quality) were compared for those with and without a history of falling. Results: Participants completed more short walks relative to long walks, as approximated by a power law. Walks less than 13.1 s comprised 50% of exposure to walking-related falls. Daily-life cadence was bimodal and step-time variability followed a log-normal distribution. Fallers took significantly fewer steps per walk and had relatively more exposure from short walks and greater mode of step-time variability. Conclusions: Using a freely worn device and wavelet-based analysis tools allowed long-term monitoring of walks greater than or equal to three steps. In older people, short walks constitute a large proportion of exposure to falls. To identify fallers, mode of variability may be a better measure of central tendency than mean of variability. A week's monitoring is sufficient to reliably assess the long-term propensity for falling. Significance: Statistical distributions of gait performances provide a reference for future wearable device development and research into the complex relationships between daily-life walking patterns, morbidity, and falls.

Kinect-Based Five-Times-Sit-to-Stand Test for Clinical and In-Home Assessment of Fall Risk in Older People.

Abstract: Background Accidental falls remain an important problem in older people. The five-times-sit-to-stand (5STS) test is commonly used as a functional test to assess fall risk. Recent advances in sensor technologies hold great promise for more objective and accurate assessments. Objective The aims of this study were: (1) to examine the feasibility of a low-cost and portable Kinect-based 5STS test to discriminate between fallers and nonfallers and (2) to investigate whether this test can be used for supervised clinical, supervised and unsupervised in-home fall risk assessments. Methods A total of 94 community-dwelling older adults were assessed by the Kinect-based 5STS test in the laboratory and 20 participants were tested in their own homes. An algorithm was developed to automatically calculate timing- and speed-related measurements from the Kinect-based sensor data to discriminate between fallers and nonfallers. The associations of these measurements with standard clinical fall risk tests and the results of supervised and unsupervised in-home assessments were examined. Results Fallers were significantly slower than nonfallers on Kinect-based measures. The mean velocity of the sit-to-stand transitions discriminated well between the fallers and nonfallers based on 12-month retrospective fall data. The Kinect-based measures collected in the laboratory correlated strongly with those collected in the supervised (r = 0.704-0.832) and unsupervised (r = 0.775-0.931) in-home assessments. Conclusion In summary, we found that the Kinect-based 5STS test discriminated well between the fallers and nonfallers and was feasible to administer in clinical and supervised in-home settings. This test may be useful in clinical settings for identifying high-risk fallers for further intervention or for regular in-home assessments in the future.

Prevalence of dementia in urban and regional Aboriginal Australians

Abstract: Background This study aimed to determine the prevalence of dementia in collaboration with urban/regional Aboriginal communities. Methods A census of Aboriginal and Torres Strait Islander men and women aged 60 years and above in the target communities identified 546 potential participants, with 336 (61.5%) participating in this cross-sectional study. Participants completed a structured interview and cognitive screening tests. One hundred fifty-three participants also completed a detailed medical assessment. Assessment data were reviewed by a panel of clinicians who determined a diagnosis of dementia or mild cognitive impairment (MCI) according to standard criteria. Results Crude prevalence of dementia was 13.4%, and age-standardized prevalence was 21.0%. The most common types of dementia were Alzheimer's dementia (44%) and mixed dementia diagnoses (29%). Estimated prevalence of MCI was 17.7%. Conclusion Consistent with previous findings in a remote population, urban and regional Aboriginal Australians face high rates of dementia at younger ages, most commonly Alzheimer's dementia.

The effect of sensor-based exercise at home on functional performance associated with fall risk in older people - a comparison of two exergame interventions

Abstract: There is good evidence that balance challenging exercises can reduce falls in older people. However, older people often find it difficult to incorporate such programs in their daily life. Videogame technology has been proposed to promote enjoyable, balance-challenging exercise. As part of a larger analysis, we compared feasibility and efficacy of two exergame interventions: step-mat-training (SMT) and Microsoft-Kinect® (KIN) exergames. 148 community-dwelling people, aged 65+ years participated in two exergame studies in Sydney, Australia (KIN: n = 57, SMT: n = 91). Both interventions were delivered as unsupervised exercise programs in participants’ homes for 16 weeks. Assessment measures included overall physiological fall risk, muscle strength, finger-press reaction time, proprioception, vision, balance and executive functioning. For participants allocated to the intervention arms, the median time played each week was 17 min (IQR 32) for KIN and 48 min (IQR 94) for SMT. Compared to the control group, SMT participants improved their fall risk score (p = 0.036), proprioception (p = 0.015), reaction time (p = 0.003), sit-to-stand performance (p = 0.011) and executive functioning (p = 0.001), while KIN participants improved their muscle strength (p = 0.032) and vision (p = 0.010), and showed a trend towards improved fall risk scores (p = 0.057). The findings suggest that it is feasible for older people to conduct an unsupervised exercise program at home using exergames. Both interventions reduced fall risk and SMT additionally improved specific cognitive functions. However, further refinement of the systems is required to improve adherence and maximise the benefits of exergames to deliver fall prevention programs in older people’s homes. ACTRN12613000671763 (Step Mat Training RCT) ACTRN12614000096651 (MS Kinect RCT)

Evaluating the effectiveness of a home-based exercise programme delivered through a tablet computer for preventing falls in older community-dwelling people over 2 years: study protocol for the Standing Tall randomised controlled trial

Abstract: Introduction In order to prevent falls, older people should exercise for at least 2 h per week for 6 months, with a strong focus on balance exercises. This article describes the design of a randomised controlled trial to evaluate the effectiveness of a home-based exercise programme delivered through a tablet computer to prevent falls in older people. Methods and analysis Participants aged 70 years or older, living in the community in Sydney will be recruited and randomly allocated to an intervention or control group. The intervention consists of a tailored, home-based balance training delivered through a tablet computer. Intervention participants will be asked to complete 2 h of exercises per week for 2 years. Both groups will receive an education programme focused on health-related information relevant to older adults, delivered through the tablet computer via weekly fact sheets. Primary outcome measures include number of fallers and falls rate recorded in weekly fall diaries at 12 months. A sample size of 500 will be necessary to see an effect on falls rate. Secondary outcome measures include concern about falling, depressive symptoms, health-related quality of life and physical activity levels (in all 500 participants); and physiological fall risk, balance, functional mobility, gait, stepping and cognitive performance (in a subsample of 200 participants). Adherence, acceptability, usability and enjoyment will be recorded in intervention group participants over 2 years. Data will be analysed using the intention-to-treat principle. Secondary analyses are planned in people with greater adherence. Economic analyses will be assessed from a health and community care provider perspective. Ethics and dissemination Ethical approval was obtained from UNSW Ethics Committee in December 2014 (ref number HC#14/266). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conferences. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN)12615000138583.

Predicting Cognitive, Functional, and Diagnostic Change over 4 Years Using Baseline Subjective Cognitive Complaints in the Sydney Memory and Ageing Study.

Abstract: Objective There is limited understanding of the usefulness of subjective cognitive complaint(s) (SCC) in predicting longitudinal outcome because most studies focus solely on memory (as opposed to nonmemory cognitive ) complaints, do not collect data from both participants and informants, do not control for relevant covariates, and have limited outcome measures. Therefore the authors investigate the usefulness of participant and informant SCCs in predicting change in cognition, functional abilities, and diagnostic classification of mild cognitive impairment or dementia in a community-dwelling sample over 4 years. Methods Nondemented participants (N = 620) in the Sydney Memory and Ageing Study aged between 70 and 90 years completed 15 memory and 9 nonmemory SCC questions. An informant completed a baseline questionnaire that included 15 memory and 4 nonmemory SCC questions relating to the participant. Neuropsychological, functional, and diagnostic assessments were carried out at baseline and again at 4-year follow-up. Cross-sectional and longitudinal analyses were carried out to determine the association between SCC indices and neuropsychological, functional, and diagnostic data while controlling for psychological measures. Results Once participant characteristics were controlled for, participant complaints were generally not predictive of cognitive or functional decline, although participant memory-specific complaints were predictive of diagnostic conversion. Informant-related memory questions were associated with global cognitive and functional decline and with diagnostic conversion over 4 years. Conclusion Informant memory complaint questions were better than participant complaints in predicting cognitive and functional decline as well as diagnoses over 4 years.

Comparison of Three Cognitive Screening Tools in Older Urban and Regional Aboriginal Australians

Abstract: Background: Validated cognitive screening tools for use in urban and regional Aboriginal populations in Australia are lacking. Methods:

Good Lateral Harmonic Stability Combined with Adequate Gait Speed Is Required for Low Fall Risk in Older People

Abstract: Background: Good lateral harmonic stability in gait may be important for minimising fall risk in older people because many falls occur during walking when the base of support is narrowest in the mediolateral (ML) direction. However, the traditional ML harmonic ratio (MLHR) may be a sub-optimal measure of gait quality because of insufficient frequency resolution. Objective: The primary objective was to investigate if a new measure of lateral harmonic stability, the 8-step MLHR, could discriminate older fallers from non-fallers while taking different walking speeds into account. Methods: Repeat walks over 20 m were completed by 96 older people (mean age 80, SD 4 years); 35 participants had a history of one or more falls in the past year. The traditional MLHR and the 8-step MLHR were obtained from an accelerometer attached to the sacrum. Results: Compared to the traditional MLHR, the 8-step MLHR demonstrated similar univariate ability to identify significant differences in fall risk based on age, walking speed and physiology (p ≤ 0.05). When differences in walking speed were taken into account, we observed that participants who walked both faster than average and had above-average lateral harmonic stability (by the 8-step MLHR) were 5.3 times less likely to be fallers than all other participants (relative risk: 0.19, 95% confidence interval: 0.06-0.57). For the traditional MLHR, however, no significant differences between the fallers and non-fallers were evident. Conclusions: The findings indicate that good lateral harmonic stability interacts with adequate gait speed and, when coincident, are associated with reduced fall risk in older people. Future research could examine whether interventions focusing on enhancing both gait speed and lateral stability can reduce fall risk and whether these combined gait measures can remotely predict deteriorating health using wearable technology.

The design of a purpose-built exergame for fall prediction and prevention for older people

Abstract: Falls in older people represent a major age-related health challenge facing our society. Novel methods for delivery of falls prevention programs are required to increase effectiveness and adherence to these programs while containing costs. The primary aim of the Information and Communications Technology-based System to Predict and Prevent Falls (iStoppFalls) project was to develop innovative home-based technologies for continuous monitoring and exercise-based prevention of falls in community-dwelling older people. The aim of this paper is to describe the components of the iStoppFalls system. The system comprised of 1) a TV, 2) a PC, 3) the Microsoft Kinect, 4) a wearable sensor and 5) an assessment and training software as the main components. The iStoppFalls system implements existing technologies to deliver a tailored home-based exercise and education program aimed at reducing fall risk in older people. A risk assessment tool was designed to identify fall risk factors. The content and progression rules of the iStoppFalls exergames were developed from evidence-based fall prevention interventions targeting muscle strength and balance in older people. The iStoppFalls fall prevention program, used in conjunction with the multifactorial fall risk assessment tool, aims to provide a comprehensive and individualised, yet novel fall risk assessment and prevention program that is feasible for widespread use to prevent falls and fall-related injuries. This work provides a new approach to engage older people in home-based exercise programs to complement or provide a potentially motivational alternative to traditional exercise to reduce the risk of falling.

Fear of falling in vision impairment.

Abstract: Falls are the leading cause of injury-related morbidity and mortality among older adults. In addition to the resulting physical injury and potential disability after a fall, there are also important psychological consequences, including depression, anxiety, activity restriction, and fear of falling. Fear of falling affects 20 to 43% of community-dwelling older adults and is not limited to those who have previously experienced a fall. About half of older adults who experience fear of falling subsequently restrict their physical and everyday activities, which can lead to functional decline, depression, increased falls risk, and reduced quality of life. Although there is clear evidence that older adults with visual impairment have higher falls risk, only a limited number of studies have investigated fear of falling in older adults with visual impairment and the findings have been mixed. Recent studies suggest increased levels of fear of falling among older adults with various eye conditions, including glaucoma and age-related macular degeneration, whereas other studies have failed to find differences. Interventions, which are still in their infancy in the general population, are also largely unexplored in those with visual impairment. The major aims of this review were to provide an overview of the literature on fear of falling, its measurement, and risk factors among older populations, with specific focus on older adults with visual impairment, and to identify directions for future research in this area.

New Methods to Monitor Stair Ascents Using a Wearable Pendant Device Reveal How Behavior, Fear, and Frailty Influence Falls in Octogenarians

Abstract: Goals: To investigate if the stair negotiation by older people during activities of daily life (ADL) can be accurately identified using a freely worn pendant device. To investigate how usual stair-ascent performances during ADL relate to clinical assessments and prospective falls . Methods: ADL were recorded for 30 min by 52 community-dwelling older people (83 ± 4 years) using a small pendant device. Classification accuracy was assessed using annotated video and four-fold cross validation. Correlations between sensor-derived stair-ascent features (comprising intensity, variability, and stability) and a battery of clinical tests (comprising physiological, psychological, health, and follow-up falls) were investigated. Results: Accurate identification of stair events (99.8%, Kappa 0.92) was possible in both “frail” and “athletic” participants by scaling the barometer threshold to stair cadences. Cautious double-stepping strategy could be identified remotely. Stair-ascent performance was correlated with ascent strategy ( $r = -0.67$ ), age ( $r = -0.44$ ), concern about falling ( $r = -0.43$ ), fall-risk scores ( $r = -0.41$ ), processing speed ( $r = -0.38$ ), and contrast sensitivity ( $r = 0.32$ ). Follow-up falls were correlated with ascent stability ( $r = -0.35$ ). Conclusion: Remote analysis of stair ascents is feasible. In our healthy older people, outcomes appeared more related to mental rather than physiological factors. The ascent strategies we observed in some older people may have reflected an appropriate behavioral response to increased concerns about falling. Significance: Given acceptance of wearable devices is increasing; reduced functional performance and altered strategies for undertaking ADL could soon be routinely tracked to augment health care.

Neuroticism scores increase with late‐life cognitive decline

Abstract: Objective Neuroticism has been reported as both a risk factor for cognitive decline and a characteristic that increases in parallel with the development of mild cognitive impairment (MCI) and dementia. However, the evidence for these associations is inconclusive, and whether effects are stronger for particular cognitive domains is unknown. We investigated these issues and determined if associations differ among different components of neuroticism. Methods A neuroticism scale (NEO-FFI) and neuropsychological test battery were administered to 603 older adults without dementia, with 493 of these reassessed two years later. Diagnoses of MCI and dementia (at follow-up) were made, and global cognition and performance in six cognitive domains quantified. The neuroticism components were negative affect, self-reproach, and proneness to psychological distress. Results For the whole sample, neuroticism scores remained stable between baseline (15.3 ± 7.0) and follow-up (15.5 ± 7.0), as did all neuroticism component scores. However, there were declines in global cognition (p < 0.05) and particular cognitive domains (p < 0.001). Higher neuroticism was associated with poorer cognition cross-sectionally (p < 0.01), but did not predict cognitive decline. For 43 participants who developed incident MCI or dementia, there were increases in neuroticism (15.3 ± 6.4 to 17.1 ± 8.3, p < 0.05) and negative affect (p < 0.05). Declines in all cognitive measures except executive function were associated with increases in neuroticism and component scores (p < 0.05). Conclusions Late-life cognitive decline is associated with an increase in neuroticism scores. However, associations vary between different cognitive domains and components of neuroticism. An increase in neuroticism or negative affect scores may be a sign of MCI or dementia. Copyright © 2015 John Wiley & Sons, Ltd.

Multiple sclerosis severity and concern about falling: Physical, cognitive and psychological mediating factors.

Abstract: BACKGROUND: Concern about falling can have devastating physical and psychological consequences in people with multiple sclerosis (MS). However, little is known about physical and cognitive determinants for increased concern about falling in this group. OBJECTIVE: To investigate direct and indirect relationships between MS severity and concern about falling using structural equation modelling (SEM). METHODS: Two hundred and ten community-dwelling people (21–73 years) with MS Disease Steps 0–5 completed several physical, cognitive and psychological assessments. Concern about falling was assessed using the Falls Efficacy Scale-International. RESULTS: Concern about falling was significantly associated with MS Disease Step and also balance, muscle strength, disability, previous falls, and executive functioning. SEM revealed a strong direct path between MS Disease Step and concern about falling (r = 0.31, p < 0.01), as well as indirect paths explained by impaired physical ability (r = 0.25, p < 0.01) and reduced cognitive function (r = 0.13, p < 0.01). The final model explained 51% of the variance of concern about falling in people with MS and had an excellent goodness-of-fit. CONCLUSIONS: The relationship between MS severity and increased concern about falling was primarily mediated by reduced physical ability (especially if this resulted in disability and falls) and less so by executive functioning. This suggests people with MS have a realistic appraisal of their concern about falling.

Systems and methods to monitor the step performance of a user

Abstract: Described herein are systems and methods to monitor the step performance of a user and to provide an adaptive training routine to the user to reduce the risk of falls. On embodiments provides a system (1) including a computer (3) configured to execute a step training routine to control a visual stimulus on an associated display device (5). The stimulus includes at least one prompt for a user to make a predefined step action at a predefined time. Computer (3) is further configured to receive a user step response signal (7) from one or more sensors of a step sensor pad (9). The response signal (7) is indicative of the timing and/or direction of the user's step action in response to the stimulus. The computer (3) is also configured to communicate with a remote server (11), which is in turn configured to receive user response data derived from the user response signal (7), characterise a step performance of the user's step action in response to the stimulus and selectively adapt the training routine provided to the user based on the characterisation.