Assessment of fall risk, cognitive impairment, fear of falling in relation to functional mobility, and balance impairments in older adults 10.55131/jphd/2024/220304
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Abstract
Among older adults, falls are the most common injury and may increase the risk of mortality. This study aimed to investigate factors associated with functional mobility and balance impairments among community-dwelling older adults. A cross-sectional study was conducted among a total of 515 older adults. The questionnaires recorded demographic characteristics and health data, including the mental state examination T10 version (MSET10) and fear of falling (FOF). Functional mobility and balance impairments were assessed using the timed up and go (TUG) test. Leg strength and endurance were assessed using the sit to stand (STS) test. Demographic factors that were associated with significant differences for TUG and TUG-cognitive included age, education, occupation, history of falls in the previous year, and comorbidities. The TUG-cognitive, STS, and TUG tests at higher risk of falling were 42.5%, 18.6%, and 14.2%, respectively. The Pearson correlation coefficient analysis showed that STS and FOF were positively associated with TUG and TUG-cognitive, while the MSET10 was negatively associated with TUG and TUG-cognitive. Multiple linear regression analysis showed that increasing FOF was associated with increasing TUG and TUG-cognitive after adjusting for confounding variables (p < 0.001 and p = 0.015, respectively). Several risk factors need to be considered to determine the effectiveness of preventive measures and interventions to reduce the risk of falling. In particular, interventions for older adults should focus on functional mobility and balance impairments.
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References
World Health Organization (WHO). Ageing and health [Internet]. 2022. [cited 2024 Apr 5]. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
World Health Organization (WHO). Mental health of older adults [Internet]. 2017. [cited 2024 Apr 5]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/mental-health-of-older-adults
Sadjapong U, Silangirn P, Chaichana K, Thongtip S. Malnutrition, fear of falling, and quality of life are associated with frailty in older adults. J Health Res. 2024;38(3):283-290. doi: https:// doi.org/10.56808/2586-940X.1085
Goh JW, Singh DKA, Mesbah N, Hanafi AAM, Azwan AF. Fall awareness behaviour and its associated factors among community dwelling older adults. BMC Geriatr. 2021;21:1-11. doi: https://doi.org/10.1186/ s12877-021-02122-z
Ploeg J, Matthew-Maich N, Fraser K, Dufour S, McAiney C, Kaasalainen S, et al. Managing multiple chronic conditions in the community: a Canadian qualitative study of the experiences of older adults, family caregivers and healthcare providers. BMC Geriatr. 2017;17(1):40. doi: https://doi.org/10.1186/s12877-017-0431-6
Ohrnberger J, Fichera E, Sutton M. The dynamics of physical and mental health in the older population. J Econ Ageing. 2017;9:52-62. doi: https://doi.org/ 10.1016/j.jeoa.2016.07.002
Chittrakul J, Siviroj P, Sungkarat S, Sapbamrer R. Multi-system physical exercise intervention for fall prevention and quality of life in pre-frail older adults: A randomized controlled trial. Int J Environ Res Public Health. 2020;17(9):3102. doi: https://doi.org/ 10.3390/ijerph17093102
World Health Organization (WHO). Falls [Internet]. 2021. [cited 2024 Apr 5]. Available from: https://www.who. int/news-room/fact-sheets/detail/falls
Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013;75(1):51-61. doi: https://doi.org/10.1016/j.maturitas.2013.02.009
Wang C, Chong Y, Wang L, Wang Y. The correlation between falls and cognitive frailty in elderly individuals with hypertension in a Chinese community. Front. Aging Neurosci. 2022:466. doi: https://doi.org/10.3389/ fnagi.2022.783461
Al-Aama T. Falls in the elderly: spectrum and prevention. Can Fam Physician. 2011;57(7):771-6.
Yang NP, Hsu NW, Lin CH, Chen HC, Tsao HM, Lo SS, et al. Relationship between muscle strength and fall episodes among the elderly: the Yilan study, Taiwan. BMC Geriatr. 2018;18(1):90. doi: 10.1186/s12877-018-0779-2.
Centers for Disease Control and Prevention (CDC). Older adult fall prevention [Internet]. 2021. [cited 2024 Apr 5]. Available from: https://www. cdc.gov/falls/index.html
Moreland B, Kakara R, Henry A. Trends in nonfatal falls and fall-related injuries among adults aged≥ 65 years—United States, 2012–2018. M
MWR Morb Mortal Wkly Rep. 2020;69(27):875-81. doi: https://doi. org/10.15585/mmwr.mm6927a5
World Health Organization (WHO) (2007). WHO global report on falls prevention in older age [Internet]. 2007. [cited 2024 Apr 5]. Available from: https://extranet.who.int/agefriendlyworld/wp-content/uploads/2014/06/WHo-Global-report-on-falls-prevention-in-older-age.pdf
Li Y, Hou L, Zhao H, Xie R, Yi Y, Ding X. Risk factors for falls among community-dwelling older adults: A systematic review and meta-analysis. Front Med. 2023;9:1019094. doi: https://doi.org/10.3389/fmed.2022.1019094. 2023;9.
Jehu DA, Davis JC, Falck RS, Bennett KJ, Tai D, Souza MF, et al. Risk factors for recurrent falls in older adults: A systematic review with meta-analysis. Maturitas. 2021;144:23-8. doi: https:// doi.org/10.1016/j.maturitas.2020.10.021
Khongboon P, Kespichayawatt J. Accidental falls and associated factors among the elderly in Thailand: a national cross-sectional study in 2007, 2011, 2014 and 2017 J Health Res. 2021;36(4):767-80. doi: https://doi.org/ 10.1108/JHR-07-2020-0308
Sitdhiraksa N, Piyamongkol P, Chaiyawat P, Chantanachai T, Ratta-Apha W, Sirikunchoat J, et al. Prevalence and factors associated with fear of falling in community-dwelling Thai elderly. Gerontology. 2021;67(3): 276-80. doi: https://doi.org/10.1159/ 000512858
Daniel WW. Biostatistics: A foundation for analysis in the health sciences (6th ed.). 1995;37(6):744. doi: https://doi. org/ 10.1002/bimj.4710370610
Ngamjarus C. n4Studies: Sample Size Calculation for an Epidemiological Study on a Smart Device. Siriraj Medical Journal. 2016;68(3):160-70.
Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr. 2014;14(1):1-14. doi: https://doi.org/10.1186/1471-2318-14-14
Buatois S, Miljkovic D, Manckoundia P, Gueguen R, Miget P, Vançon G, et al. Five times sit to stand test is a predictor of recurrent falls in healthy community-living subjects aged 65 and older. J Am Geriatr Soc. 2008;56(8): 1575-7. doi: https://doi.org/10.1111/ j.1532-5415.2008.01777.x
Makizako H, Shimada H, Doi T, Tsutsumimoto K, Nakakubo S, Hotta R, et al. Predictive cut off values of the five-times sit-to-stand test and the timed "up & go" test for disability incidence in older people dwelling in the community. Phys Ther. 2017;97(4): 417-24. doi: https://doi.org/10.2522/ptj. 20150665
Tanglakmankhong K, Hampstead BM, Ploutz-Snyder RJ, Potempa K. Does the Abbreviated Mental Test Accurately Predict Cognitive Impairment in Thai Older Adults? A Retrospective Study. Pac Rim Int J Nurs Res Thail. 2021; 25(1):23-33.
Healthy Ageing Research Group, The University of Manchester. The falls efficacy scale international (FES-I) [Internet]. 2022. [cited 2024 Apr 5]. Available from: https://sites. manchester.ac.uk/fes-i/
Ascencio EJ, Cieza-Gómez GD, Carrillo-Larco RM, Ortiz PJ. Timed up and go test predicts mortality in older adults in Peru: a population-based cohort study. BMC Geriatr. 2022;22(1): 1-13. doi: https://doi.org/10.1186/ s12877-022-02749-6
Beauchet O, Fantino B, Allali G, Muir SW, Montero-Odasso M, Annweiler C. Timed Up and Go test and risk of falls in older adults: a systematic review. J Nutr Health Aging. 2011;15(10):933-8. doi: https://doi.org/10.1007/s12603-011-0062-0
Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000;80(9): 896-903. doi: https://doi.org/10.1093/ ptj/80.9.896
Chittrakul J, Siviroj P, Sungkarat S, Sapbamrer R. Physical frailty and fall risk in community-dwelling older adults: A cross-sectional study. J Aging Res. 2020:3964973. doi: https://doi. org/ 10.1155/2020/3964973.
Appeadu MK, Bordoni B. Falls and fall prevention in older adults [Internet]. [Cited 2024 May 17]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560761/
Immonen M, Haapea M, Similä H, Enwald H, Keränen N, Kangas M, et al. Association between chronic diseases and falls among a sample of older people in Finland. BMC Geriatr. 2020;20(1):225. doi: https://doi.org/ 10.1186/s12877-020-01621-9.
Asai T, Oshima K, Fukumoto Y, Yonezawa Y, Matsuo A, Misu S. The association between fear of falling and occurrence of falls: a one-year cohort study. BMC Geriatr. 2022;22(1):1-7. doi: https://doi.org/10.1186/s12877-022-03018-2
Gale CR, Westbury LD, Cooper C, Dennison EM. Risk factors for incident falls in older men and women: the English longitudinal study of ageing. BMC Geriatr. 2018;18:1-9. doi: https://doi.org/10.1186/s12877-018-0806-3
Çekok K, Kahraman T, Duran G, Dönmez Çolakoğlu B, Yener G, Yerlikaya D, et al. Timed up and go test with a cognitive task: correlations with neuropsychological measures in people with Parkinson's disease. Cureus. 2020; 12(9). doi: https://doi.org/10.7759/ cureus.10604
Kear BM, Guck TP, McGaha AL. Timed up and go (TUG) test: normative reference values for ages 20 to 59 years and relationships with physical and mental health risk factors. J Prim Care Community Health. 2017;8(1):9-13. doi: https://doi.org/10.1177/21501319 16659282
Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148-57. doi: https://doi.org/10.1111/j.1532-5415.2010.03234.x
Zasadzka E, Borowicz AM, Roszak M, Pawlaczyk M. Assessment of the risk of falling with the use of timed up and go test in the elderly with lower extremity osteoarthritis. Clin Interv Aging. 2015;7(10):1289-98. doi: https:// doi.org/10.2147/CIA.S86001
Griffiths J, Thaikruea L, Wongpakaran N, Munkhetvit P. Prevalence of mild cognitive impairment in rural Thai older people, associated risk factors and their cognitive characteristics. Dement Geriatr Cogn Dis Extra. 2020;10(1):38-45. doi: https://doi.org/10.1159/ 000506279
Xu Z, Zhang D, Sit RWS, Wong C, Tiu JYS, Chan DCC, et al. Incidence of and risk factors for mild cognitive impairment in Chinese older adults with multimorbidity in Hong Kong. Sci Rep. 2020;10(1):4137. doi: https://doi.org/ 10.1038/s41598-020-60901-x
De Roza JG, Ng DWL, Mathew BK, Jose T, Goh LJ, Wang C, et al. Factors influencing fear of falling in community-dwelling older adults in Singapore: a cross-sectional study. BMC Geriatr. 2022;22(1):1-10. doi: https://doi.org/10.1186/s12877-022-02883-1
Lee S, Oh E, Hong GS. Comparison of factors associated with fear of falling between older adults with and without a fall history. Int J Environ Res Public Health. 2018;15(5):982. doi: https://doi.org/10.3390/ijerph15050982
Su Q, Gao Y, Zhang J, Tang J, Song M, Song J, et al. Prevalence of fear of falling and its association with physical function and fall history among senior citizens living in rural areas of China. Front Public Health. 2021;9:766959. doi:https://doi.org/10.3389/fpubh. 2021.766959
Liwsrisakun C, Pothirat C, Chaiwong W, Techatawepisarn T, Limsukon A, Bumroongkit C, et al. Diagnostic ability of the Timed Up & Go test for balance impairment prediction in chronic obstructive pulmonary disease. J Thorac Dis. 2020;12(5):2406. doi: https://doi.org/10.21037/jtd.2020.03.47
Svinøy OE, Hilde G, Bergland A, Strand BH. Timed up and go: Reference values for community-dwelling older adults with and without arthritis and non-communicable diseases: The Tromsø Study. Clin Interv Aging. 2021;16:335-43. doi: https://doi.org/ 10.2147/CIA.S294512
Becker H, Garcia-Agundez A, Müller PN, Tregel T, Miede A, Göbel S. Predicting functional performance via classification of lower extremity strength in older adults with exergame-collected data. J Neuroeng Rehabil. 2020;17(1):1-8. doi: https://doi.org/ 10.1186/s12984-020-00778-z
Bohannon RW, Bubela DJ, Magasi SR, Wang YC, Gershon RC. Sit-to-stand test: performance and determinants across the age-span. Isokinet Exerc Sci. 2010;18(4):235-40. doi: https://doi.org/ 10.3233/IES-2010-0389
Alcazar J, Kamper RS, Aagaard P, Haddock B, Prescott E, Ara I, et al. Relation between leg extension power and 30-s sit-to-stand muscle power in older adults: validation and translation to functional performance. Sci Rep. 2020;10(1):16337. doi: https://doi.org/ 10.1038/s41598-020-73395-4
Cedervall Y, Kilander L, Aberg AC. Declining physical capacity but maintained aerobic activity in early Alzheimer's disease. Am J Alzheimers Dis Other Demen. 2012;27(3):180-7. doi: https://doi.org/10.1177/15333175 12442996
Nishiguchi S, Yorozu A, Adachi D, Takahashi M, Aoyama T. Association between mild cognitive impairment and trajectory-based spatial parameters during timed up and go test using a laser range sensor. J NeuroEngineering Rehabil. 2017;14:1-9. doi: https://doi. org/ 10.1186/s12984-017-0289-z
Cedervall Y, Stenberg AM, Åhman HB, Giedraitis V, Tinmark F, Berglund L, et al. Timed up-and-go dual-task testing in the assessment of cognitive function: a mixed methods observational study for development of the UDDGait protocol. Int J Environ Res Public Health. 2020;17(5):1715. doi: https://doi.org/ 10.3390/ijerph17051715
Arevalo-Rodriguez I, Smailagic N, Roqué-Figuls M, Ciapponi A, Sanchez-Perez E, Giannakou A, Pedraza OL, et al. Mini‐mental state examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev. 2021;7:CD010783. doi: https://doi.org/10.1002/14651858.CD010783.pub3
Williams JM, Nyman SR. Association between the instrumented timed up and go test and cognitive function, fear of falling and quality of life in community dwelling people with dementia. J Frailty Sarcopenia Falls. 2018;3(4): 185. doi: https://doi.org/10.22540/ JFSF-03-185
Hershkovitz L, Malcay O, Grinberg Y, Berkowitz S, Kalron A. The contribution of the instrumented Timed-Up-and-Go test to detect falls and fear of falling in people with multiple sclerosis. Mult Scler Relat Disord. 2019;27:226-31. doi: https:// doi.org/10.1016/j.msard.2018.10.111
Block VJ, Pitsch EA, Gopal A, Zhao C, Pletcher MJ, Marcus GM, et al. Identifying falls remotely in people with multiple sclerosis. J Neurol. 2022;269(4):1889-98. doi: https://doi. org/10.1007/s00415-021-10743-y