The article describes the process of identifying 100 community-dwelling elderly adults at risk for physical disability, yet not functionally disabled, for participation in a research project to develop appropriate exercise programs for at-risk elderly. Over a period of 14 months, initial contact was made with 941 older adults, 11% of whom (101 people) were eligible for and willing to complete all stages of the study protocol. The most successful recruitment strategies were a mass mailing followed by a telephone call and advertising in a newspaper with a large circulation (rather than a local paper). Aspects of the recruitment and retention of study participants are discussed.
Marcia S. Marx, Jiska Cohen-Mansfield and Jack M. Guralnik
Katherine B. Gunter, Jennifer De Costa, Karen N. White, Karen Hooker, Wilson C. Hayes and Christine M. Snow
This study assessed changes in balance self-efficacy (BSE) over 1 year in community-dwelling elderly, compared changes in BSE between fallers and nonfallers, and assessed the relationship between specific balance and mobility risk factors for side falls and BSE scores. Elderly fallers (n = 67; 80.2 ± 5.9 years) and nonfallers (n = 75; 79.4 ± 4.9), categorized based on self-reported falls over 1 year, were tested at baseline on postural sway, hip-abduction strength, lateral-stepping velocity, tandem walk, and get-up-and-go and given a BSE questionnaire. Fallers had lower BSE scores than nonfallers did (141.6 ± 33.5 and 154.9 ± 25.4; p = .008). BSE did not change over 1 year. In stepwise regression, BSE scores were predictive of time on the get-up-and-go, mediolateral sway, and tandem walk independent of age, height, and strength (p < .001). The BSE scale might be useful for screening individuals at risk for injurious falls because it is inexpensive and noninvasive.
Mary A. Murphy, Sharon L. Olson, Elizabeth J. Protas and Averell R. Overby
Fifty community-dwelling elders were screened and followed for 14 months. Sixteen experienced falls and 34 did not. The screening variables consisted of age, the Clinical Test of Sensory Interaction in Balance, the Performance-Oriented Mobility Assessment for Balance, functional reach, the Physical Performance Test, and the following timed tests: floor transfer; 5-step test; 5 chair stands; tandem, semitandem, and side-by-side stance; penny pick-up; 360° turn; 50-ft walk; and 5-min walk. Data analysis and chi-squared or t tests were performed for each variable to determine significant differences between groups. Correlations, sensitivity, and specificity were calculated, and a stepwise discriminant analysis was conducted to determine which significant variables best predicted falls. Discriminant analysis determined that the floor transfer and then the 50-ft walk predicted falls in community-dwelling elders, correctly classifying 95.5% of participants. Prediction for falls was 81.8%, and for no falls, 100%. The timed floor transfer and 50-ft walk were the most discriminating measures to identify potential fallers.
Laura S. Ho, Harriet G. Williams and Emily A.W. Hardwick
The study’s objective was to examine the health status, physical activity behaviors, and performance-based functional abilities of individuals classified as being at high or low risk for frailty and to determine which of these characteristics discriminates between the 2 groups. Participants were 78 community-dwelling individuals with an average age of 74 years; 37 were categorized as being at high risk and 42 at low risk for frailty. Logistic-regression analysis indicated that individuals classified as being at high risk for frailty were more likely to have visited the doctor more than 3 times in the past year, experienced a cardiac event, taken more than 4 medications a day, and participated in little or no physical activity. High-risk individuals were more likely to have poor balance, difficulty with mobility, decreased range of motion, poor unimanual dexterity, and difficulty performing activities of daily living than were those classified as being at low risk for frailty.
Alessandra de Carvalho Bastone, Eduardo Ferriolli, Claudine Patricia Teixeira, João Marcos Domingues Dias and Rosângela Corrêa Dias
Self-reported measures of decreased aerobic fitness and low physical activity are criteria of frailty. However, research assessing aerobic fitness and physical activity levels associated with frailty is limited. Therefore, the aims of this study were to objectively assess the aerobic fitness and the physical activity level of frail and nonfrail elderly, and to examine the association between frailty, aerobic fitness and habitual physical activity.
This study included 26 elderly (66 to 86 years), randomly selected. The groups (frail/nonfrail) were age and sex paired. Peak oxygen consumption, maximal walking distance and speed were assessed during the incremental shuttle walk test (ISWT). Average daily time spent in sedentary, light, moderate and hard activity, counts, number of steps and energy expenditure were measured by accelerometry.
All variables measured by the ISWT and accelerometer differed significantly between the groups (P < .02). All aerobic fitness and physical activity variables were significantly associated with frailty, independent of the number of chronic health conditions (P < .05).
Frailty is associated with low peak oxygen consumption and low physical activity level. These findings could guide future clinical trials designed to evaluate the efficacy of aerobic exercises in the prevention and treatment of frailty.
Ecosse L. Lamoureux, Aron Murphy, Anthony Sparrow and Robert U. Newton
This study examined the effects of improved strength on an obstacle course (OC) simulating gait tasks commonly encountered by community-living older adults. Forty-five adults (mean age 68.2 ± 1.5 years) were randomly assigned to a control (10 women, 5 men) or an experimental group (EXP; 19 women, 10 men) and trained 3 days/week for 12 weeks. Using a 1-repetition-maximum (1-RM) method, 6 leg-strength measures were evaluated pre- and posttest. The times to walk an OC of 4 gait tasks (stepping over and across an obstacle, negotiating a raised surface, and foot targeting) set at 3 progressively challenging levels were also assessed. Significant Group × Time interactions were found on all 1-RM tests, with only EXP recording significant improvements (124–147%; p < .001). Strength gains in EXP were accompanied by significant improvements in the times to negotiate all gait stations and walk the entire OC (6-15%; p = .001–.014). This study showed that improving strength is an effective strategy to improve community locomotion, which might decrease the risks of falls in community-living older adults.
Sharon L. Olson, Shu-Shi Chen and Ching-Yi Wang
To determine exercise efficacy in improving dynamic balance in community-dwelling elderly with a fall history.
Thirty-five participants were randomly assigned to a treatment (TG; n = 19, 77 ± 7 yr) or control group (CG; n = 16, 75 ± 8 yr). The TG received an individualized home exercise program, and the CG received phone calls twice per week for 12 weeks. Participants’ dynamic-balance abilities— directional control (DC), endpoint excursion (EE), maximum excursion (ME), reaction time (RT), and movement velocity (MV)—were measured using the Balance Master at 75% limits of stability. Functional reach (FR) was also measured.
At 12 weeks the TG demonstrated significant improvements in DC (p < .0025), EE (p < .0005), and ME (p < .0005), but the CG did not. No significant group differences were found for MV, RT, or FR.
Excursion distances and directional control improved but not reaction time, suggesting that exercises requiring quick responses may be needed.
Masamitsu Kamada, Jun Kitayuguchi, Kuninori Shiwaku, Shigeru Inoue, Shimpei Okada and Yoshiteru Mutoh
Physical activity contributes to maintaining functional ability later in life. Specific relationships between walking for particular purposes (eg, recreation or transport) and functional ability are not clear. It is useful for planning health promotion strategies to clarify whether walking time for recreation, or walking time for transport has the stronger relationship with maximum walking speed (MWS), a determinant of functional ability later in life in the elderly.
A cross-sectional survey was conducted in 2007 using a sample of 372 community-dwelling elderly people aged 60 to 87 years in Mitoya Town, Unnan City, rural Japan. Associations with MWS were examined for self-reported weekly times of walking for recreation and for transport using multiple linear regression analyses.
Both in men and women, walking time for recreation was significantly associated with MWS after controlling for age, height, weight, hip and knee pain, and a number of chronic diseases (men: β = 0.18, P = .024; women: β = 0.17, P < .01). However, walking time for transport was not significantly associated with MWS (men: β = −0.094, P = .24; women: β = −0.040, P = .50).
Walking for recreation may contribute to maintaining functional abilities such as MWS in the elderly.
Ching-Yi Wang, Sharon L. Olson and Elizabeth J. Protas
The purposes of this study were to evaluate community-dwelling elderly adults with different levels of perceived mobility with 5 physical-performance tests, determine the cutoff values of the 5 tests, and identify the best tests for classifying mobility status. The community-mobility statuses of 203 community-dwelling elders were classified as able, decreased, or disabled based on their self-reported ability to walk several blocks and climb stairs. They also performed the functional reach, timed 50-ft walk, timed 5-step, timed floor transfer, and 5-min-walk endurance tests. We found in all tests that the “able” outperformed the “decreased” and that the “decreased” outperformed the “disabled,” except on the floor-transfer task. The optimum cutoff values of the 5 performance tests were also reported. The 5-min walk and timed 5-step test could best separate the “able” from the “decreased,” whereas the 50-ft-walk-test could best differentiate the “decreased” from the “disabled.” The results suggest that community-mobility function of older adults can be captured by performance tests and that the cutoff values of the 5-min-walk, 5-step, and 50-ft-walk tests can be used in guiding intervention or prevention programs.
Okada * Jun-ichiro Hayano * Nobuo Takeshima * 1 2003 11 1 18 26 10.1123/japa.11.1.18 Balance Self-Efficacy Predicts Risk Factors for Side Falls and Frequent Falls in Community-Dwelling Elderly Katherine B. Gunter * Jennifer De Costa * Karen N. White * Karen Hooker * Wilson C. Hayes