FES
Tyrosine-protein kinase Fes/Fps (EC 2.7.10.2) (Feline sarcoma/Fujinami avian sarcoma oncogene homolog) (Proto-oncogene c-Fes) (Proto-oncogene c-Fps) (p93c-fes) [FPS]
Publications[править]
To evaluate the effectiveness of an evidence-based 12-week Tai Chi course designed to improve balance and physical function in a population of older veterans. Community dwelling veterans of all ages with gait and balance problems were invited to participate in the Tai Chi program. Participants completed the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, and the Falls Efficacy Scale-International (FES-I) at baseline and again at the end of the program. Descriptive statistics were used to summarize study participants' characteristics. The change from baseline to the end of the 12-week program was calculated for each of the three primary outcome variables (BBS, TUG, FES-I). Twenty-two veterans, aged 58 years and above, with perceived gait and/or balance issues were enrolled in the program with completion by 11 veterans. Veterans who completed their final assessments showed the BBS, improved significantly (p = 0.004) from baseline to the 12-week assessment. The TUG scores improved by a median of 1.3 s (p = 0.022). There was not a significant change in the FES-I. Preliminary findings provide evidence of the effectiveness of a 12-week Tai Chi program to improve functional outcomes for older veterans with mild to moderate gait and balance problems.
Keywords
- Tai Chi
- balance
- exercise
- gait
- geriatrics
To study gait function among individuals with spina bifida (SB) aged 50 years or older. A cross-sectional study conducted in 2017. Home-dwelling participants from all regions in Norway. Individuals between the ages of 51 and 76 years (N=26; 16 women) categorized as independent walkers (n=9), walkers with aids (n=10) and nonwalkers (n=7). Not applicable. Questionnaire, pain assessment, anthropometry, Falls Efficacy Scale International (FES-I), objective gait analysis, 6-minute walk test (6MWT), and timed Up and Go (TUG). Walking speed correlated with SB severity (ρ=-.59; P=.008). Individuals who walked slower than 0.81 m/s had a higher body mass index (BMI) than those who walked faster (P=.008). Independent walkers walked slower than healthy age-matched walkers (P=.046); spatiotemporal variables showed that this was owing to shorter steps rather than cadence. The mean TUG was 10.6±2.6 seconds in independent walkers and 20.2±6.5 in walkers with aids (P<.01). The mean 6MWT was 504±126 meters in independent walkers and 316±88 in walkers with aids (P<.01). The mean pain intensity (numeric rating scale) was 4.9±2.2 in independent walkers and 4.2±1.6 in walkers with aids, but the difference was not statistically significant. FES-I was significantly lower among independent walkers (mean, 23.6±3.9) than walkers with aids (mean, 31.4±10.0) (P=.042). Participants commonly experienced an early onset deterioration in gait function, and walking speed was influenced by SB severity and BMI. This highlights the importance of early monitoring and weight management during follow-up for SB.
Keywords
- Adult
- Aging
- Gait analysis
- Myelomeningocele
- Rehabilitation
Screening programs for fall prevention in older adults may include several assessment methods. This study investigated the validity of aggregating fall risk assessment methods for stratifying the risk of falling in older adults. This secondary data analysis included 52 community-dwelling residents aged [median (interquartile range)] 74 (69-80) years. Fall occurrences were registered prospectively for six months, with 9 (17%) participants reporting at least one fall during follow-up. The fall risk assessment included the Berg Balance Scale (BBS); polypharmacy (POLY); Falls Risk Assessment Score (FRAS); Fall Risk Assessment Tool (FRAT-up); Falls Efficacy Scale (FES); and posturography with the Wii Balance Board (WBB). Aggregation of methods' results was performed according to the risk classification ('high risk' or 'low risk') assigned by their respective cut-off values under the 'believe the positive' (BP) strategy. Aggregating 1 (POLY), 2 ( BBS), 3 ( FES), 4 ( FRAT-up), 5 ( FRAS), and 6 ( BBS) methods resulted in a monotonic decrease of several validity indices including (index [95% confidence interval]) diagnostic odds ratio (10.82 [2.38-54.28] to 0.59 [0.12-2.09]) and accuracy (0.67 [0.54-0.78] to 0.20 [0.11-0.31]). Aggregating fall risk assessment methods-BBS, POLY, FRAS, FRAT-up, FES, WBB-under the BP strategy does not increase the validity of stratification of the risk of falling in older adults.
Keywords
- aging
- creening programs
- elderly health
- rehabilitation
- risks
Fear of falling (FOF) is common in older persons and related to negative outcomes. This study aimed to investigate the relationship between 2 FOF measures: the Falls Efficacy Scale-International (FES-I) and the single question on FOF and activity restriction (SQ-FAR). Factors associated with disagreement between the 2 measures were further examined. Cross-sectional study. Participants (N = 1359) were community-dwelling persons aged 65 to 70 years who were enrolled in the Lausanne cohort 65 . Data included demographic, functional, cognitive, affective, and health status. FOF was measured with FES-I and the 3-level SQ-FAR (no FOF, FOF without activity restriction (AR, FOF with AR). FES-I concern about falling was categorized as low (score 16-19), moderate (score 20-27), and high (score 28-64). Weighted agreement between the FES-I and the SQ-FAR was 87.8% (Kappa = 0.57). Using the FES-I as gold standard, the performance of SQ-FAR was good (specificity 86%; sensitivity 74%, negative predicting value 89%, positive predicting value 69%). Among participants with moderate/high FOF according to FES-I, male sex (P = .011) and the absence of previous falls (P < .001) were associated with disagreement between the 2 tools. Among participants with low FOF, female sex (P = .005), falls history (P < .001), and pre-frailty/frailty status (P = .050) were associated with disagreement. The SQ-FAR has a moderate agreement with FES-I and might be used as a screening tool. The results also may help design a step-by-step strategy to evaluate and address FOF in the clinical setting.
Keywords
- FES-I
- elderly
- fear of falling
- healthy aging
- older adults
Fall-related efficacy has been found to be associated with both falls and fall risk factors such as physical performance. The aim of the present study was to clarify whether fall-related efficacy is, independent of physical performance and other potential risk factors, associated with future falls in community-dwelling older people. The study participants were 237 Japanese older people aged 65 years and over who were living independently in their community. Fall-related efficacy and physical performance were assessed at baseline using the short version of the Falls Efficacy Scale-International (short FES-I) and 5-m walking time, the Timed Up and Go Test, the 5 Times Sit to Stand Test, and grip strength. Physical performance was then again assessed at 1-year follow-up. The number of falls was obtained every 6 months for 1 year after the baseline survey. Instrumental activities of daily living (IADL), depression, fall history, current medications, medical history, and pain were also investigated as potential confounding factors that have possible associations with falls. The associations between the short FES-I, physical performance, and number of falls were analyzed using Poisson regression analysis adjusted for physical performance and potential confounding factors. The mean age of the participants (75.9% women) was 71.1 ± 4.6 years, and 92.8% could perform IADL independently. The total numbers of falls and fallers during the 1-year follow-up period were 70 and 42, respectively. On Poisson regression analysis adjusted for walking time and potential confounding factors, independent of physical performance, the short FES-I was found to be significantly associated with number of falls (relative risk = 1.09, p < 0.05). On the other hand, physical performance was not significantly associated with the number of falls. The findings of the present study suggest that the short FES-I, independent of physical performance and other potential risk factors, is a useful index to detect fall risk in community-dwelling older people, and that fall-related efficacy is an important factor in terms of fall prevention.
MeSH Terms
- Accidental Falls
- Activities of Daily Living
- Aged
- Aging
- Female
- Geriatric Assessment
- Humans
- Independent Living
- Japan
- Longitudinal Studies
- Male
- Physical Functional Performance
- Postural Balance
- Risk Factors
- Walking Speed
Keywords
- Accidental falls
- Aged
- Fall-related efficacy
- Japanese
- Physical performance
- Adjustments of posture in response to balance challenges may lead to subsequent increases in conscious posture processing. If cognitive resources are stretched by conscious processing of postural responses fewer resources will be available to attend to environmental trip or fall hazards. The objective of the study was to explore brain activity related to conscious processing of posture as a function of movement specific reinvestment and fear of falling. : Forty-three older adults ([i]M[/i] = 71.4, [i]SD[/i] = 4.1) stood with a wide or narrow stance on a force-plate while neural coherence between verbal-analytical (T3) and motor planning (Fz) regions of the brain was assessed using electroencephalography. The propensity for movement specific reinvestment was assessed using the Chinese version Movement Specific Reinvestment Scale (MSRS-C) and fear of falling was assessed using the Chinese version Fall Efficacy Scale International (FES-I[CH]). : Scores from the MSRS-C were negatively correlated with changes in T3-Fz coherence that occurred when participants shifted from wide to narrow stance. Together, MSRS-C and FES-I(CH) uniquely predicted the percentage change in T3-Fz coherence between the two stance conditions. : Presented with two postural tasks of different complexities, participants with a lower propensity for conscious control of their movements (movement specific reinvestment) exhibited larger changes in real-time brain activity (neural coherence) associated with conscious postural processing.
MeSH Terms
- Accidental Falls
- Aged
- Aging
- Brain
- Electroencephalography
- Fear
- Female
- Humans
- Male
- Movement
- Postural Balance
- Posture
Foot problems are prevalent in older adults, which may increase the risk and concern for falls. Ankle-foot orthoses (AFO) have been shown to be effective in the stabilization of lower extremities, but their long-term effectiveness in improving balance and their potential to encourage older adults to become more physically active are still debated. This randomized controlled trial investigated the effectiveness of daily use of a custom-made AFO on balance, fear of falling, and physical activity in older adults. Forty-four older adults with concern about or at risk for falling were randomly allocated to either the control group (CG; 77.3% female, age 75.6 ± 6.5 years, BMI 29.3 ± 6.4) or the intervention group (IG; 63.6% female, age 73.7 ± 6.3 years, BMI = 27.8 ± 4.8). The IG received walking shoes and bilateral custom-made AFO. The CG received only walking shoes. At the baseline and 6-month follow-ups, balance and physical activity were assessed using validated wearable instrumentation and fear of falling was assessed using the Fall Efficacy Scale-International (FES-I). Adherence and acceptability toward wearing the AFO were assessed using self-reported questionnaires at the 6-month follow-up. No significant between-group difference was observed at baseline (p = 0.144-0.882). Compared to baseline and the CG, hip, ankle, and center-of-mass (COM) sways were significantly reduced at the 6-month follow-up in the IG while standing with the feet together during the eyes-open condition (p = 0.005-0.040). Within the IG, the FES-I was reduced significantly (p = 0.036) and there was an increasing trend in the number of walking bouts with a medium effect size (d = 0.52, p = 0.440) compared to baseline. However, there were no significant changes in FES-I and physical activity measures in the CG (p = 0.122-0.894). The reduction in COM sway in the IG was moderately correlated with adherence (r = -0.484, p = 0.047) and strongly correlated with baseline COM sway (r = -0.903, p < 0.001). Results suggest that bilateral custom-made AFO plus walking shoes is effective in improving balance compared to walking shoes alone, and it significantly reduces the fear of falling, with a nonsignificant but noticeable positive trend in physical activity, compared to baseline. The results also suggest that older adults with poor balance at baseline and higher daily adherence to using the AFO will gain more benefit from the AFO intervention.
MeSH Terms
- Accidental Falls
- Aged
- Aged, 80 and over
- Ankle Joint
- Exercise
- Fear
- Female
- Foot
- Foot Orthoses
- Geriatrics
- Humans
- Male
- Patient Compliance
- Patient Satisfaction
- Postural Balance
- Shoes
- Treatment Outcome
- Walking
Keywords
- Ankle-foot orthoses
- Balance
- Fear of falling
- Older adults
- Physical activity
Physical performance including balance tasks is one of the main factors explaining the variance in falls self-efficacy in older adults. Balance performance is often measured by use of gross assessment scales, which assess the result of integration of all systems involved in postural control. We aimed to investigate which measurements of postural control correlate to falls self-efficacy scores as measured by the FES-I instrument, and which sensory and motor systems best explain them. A cross sectional study was designed, in which 45 older adults performed quiet stance and limits of stability trials during which their center of pressure (CoP) excursion was recorded. Falls self-efficacy was measured using the Falls Efficacy Scale - International. Eyesight, vestibular function, proprioception, reaction time and strength were also measured. Hierarchical orthogonal projection of latent structures was used to model FES-I with the CoP trials and then with the sensory and muscle function data. Fes-I could be explained to 39%, with the eyes open trials and the limits of stability trials loading the heaviest. The base model could be explained to 40% using the sensory and muscle function data, with lower limb strength, leg proprioception, neck proprioception, reaction time and eyesight loading the heaviest.
MeSH Terms
- Accidental Falls
- Aged
- Aged, 80 and over
- Aging
- Female
- Humans
- Male
- Muscle, Skeletal
- Postural Balance
- Proprioception
- Self Efficacy
Keywords
- Aging
- Fear
- Postural balance
- Posture
- Self efficacy
ABSTRACTSeveral determinants of developing fear of falling (FoF) overlap with the consequences of diabetes mellitus (DM). We compared the prevalence and severity of FoF in older adults with and without DM and identified which FoF determinants contribute to FoF severity in older adults with DM. We used Canadian baseline data from the International Mobility in Aging Study (IMIAS) which identified 141 older adults with DM (DM-group;age:68.88±2.80years) and 620 without DM (noDM-group;age:68.81±2.68years). FoF was quantified with Falls Efficacy Scale-International (FES-I). FoF determinants were evaluated in demographic/health-related, physical, psychological, and social domains. High concern of FoF was more prevalent and of higher severity in 10/16 FES-I activities in the DM-group compared to the noDM-group. Higher FoF severity in the DM-group was associated with poor physical performance, being female, fall history, and clinical depressive symptoms. Protocols developed for screening and interventions may reduce FoF severity in this population.
MeSH Terms
- Accidental Falls
- Aged
- Case-Control Studies
- Cross-Sectional Studies
- Depression
- Diabetes Mellitus
- Fear
- Female
- Geriatric Assessment
- Humans
- Independent Living
- Longitudinal Studies
- Male
- Mobility Limitation
- Quality of Life
- Severity of Illness Index
- Social Support
Keywords
- aging
- chutes
- diabetes mellitus
- diabète de type 2
- falls
- fear of falling
- peur de chuter
- vieillissement
The Iconographical Falls Efficacy Scale (Icon-FES) is an innovative tool to assess concern of falling that uses pictures as visual cues to provide more complete environmental contexts. Advantages of Icon-FES over previous scales include the addition of more demanding balance-related activities, ability to assess concern about falling in highly functioning older people, and its normal distribution. To perform a cross-cultural adaptation and to assess the measurement properties of the 30-item and 10-item Icon-FES in a community-dwelling Brazilian older population. The cross-cultural adaptation followed the recommendations of international guidelines. We evaluated the measurement properties (i.e. internal consistency, test-retest reproducibility, standard error of the measurement, minimal detectable change, construct validity, ceiling/floor effect, data distribution and discriminative validity), in 100 community-dwelling people aged ≥60 years. The 30-item and 10-item Icon-FES-Brazil showed good internal consistency (alpha and omega >0.70) and excellent intra-rater reproducibility (ICC =0.96 and 0.93, respectively). According to the standard error of the measurement and minimal detectable change, the magnitude of change needed to exceed the measurement error and variability were 7.2 and 3.4 points for the 30-item and 10-item Icon-FES, respectively. We observed an excellent correlation between both versions of the Icon-FES and Falls Efficacy Scale - International (rho=0.83, p<0.001 [30-item version]; 0.76, p<0.001 [10-item version]). Icon-FES versions showed normal distribution, no floor/ceiling effects and were able to discriminate between groups relating to fall risk factors. Icon-FES-Brazil is a semantically and linguistically appropriate tool with acceptable measurement properties to evaluate concern about falling among the community-dwelling older population.
MeSH Terms
- Accidental Falls
- Brazil
- Cross-Cultural Comparison
- Humans
- Independent Living
- Reproducibility of Results
- Risk Factors
Keywords
- Accidental falls
- Aging
- Fear of falling
- Measurement properties
- Older people
Understanding which aspects of vision are related to falls is important. We examine the associations between tests of balance, mobility, fear of falling (FES-1) and aspects of vision in 72 adults aged 70 . Balance and mobility were examined using the One Legged Stance test (OLST), the Sit to Stand test (STST) and the 5 Meter Walking test (5MWT). Visual measures included visual acuity (VA), contrast sensitivity, stereoacuity, binocular vision (BV) measurements, Useful field of View (UFV) and Attended Field of View (AFOV). Reduced performance on the OLST and the STST was significantly correlated with abnormal BV and poorer intermediate VA. Poorer function on the 5MWT and the FES-I was also predicted by poor intermediate VA and poorer performance on the OLST, STST and the 5MWT was associated with UFV errors. The results are of high importance as many BV disorders are treatable and visual attention is trainable.
MeSH Terms
- Accidental Falls
- Aged
- Aged, 80 and over
- Contrast Sensitivity
- Female
- Humans
- Male
- Postural Balance
- Vision Disorders
- Vision, Binocular
- Visual Acuity
Keywords
- aging
- falls
- geriatric
- vision
Differences in DNA methylation are known to contribute to the development of immune-related disorders in humans but relatively little is known about how methylation regulates immune function in cattle. Utilizing whole-transcriptome analyses of bovine dermal fibroblasts, we have previously identified an age and breed-dependent up-regulation of genes within the toll-like receptor 4 (TLR4) pathway that correlates with enhanced fibroblast production of IL-8 in response to lipopolysaccharide (LPS). Age-dependent differences in IL-8 production are abolished by treatment with 5-aza-2-deoxycytidine and Trichostatin A (AZA-TSA), suggesting epigenetic regulation of the innate response to LPS. In the current study, we performed reduced representation bisulfite sequencing (RRBS) on fibroblast cultures isolated from the same animals at 5- and 16-months of age to identify genes that exhibit variable methylation with age. To validate the role of methylation in gene expression, six innate response genes that were hyper-methylated in young animals were assessed by RT-qPCR in fibroblasts from animals at different ages and from different breeds. We identified 14,094 differentially methylated CpGs (DMCs) that differed between fibroblast cultures at 5- versus 16-months of age. Of the 5065 DMCs that fell within gene regions, 1117 were located within promoters, 1057 were within gene exons and 2891 were within gene introns and 67% were more methylated in young cultures. Transcription factor enrichment of the promoter regions hyper-methylated in young cultures revealed significant regulation by the key pro-inflammatory regulator, NF-κB. Additionally, five out of six chosen genes (PIK3R1, FES, NFATC1, TNFSF13 and RORA) that were more methylated in young cultures showed a significant reduction in expression post-LPS treatment in comparison with older cultures. Two of these genes, FES and NFATC1, were similarly down-regulated in Angus cultures that also exhibit a low LPS response phenotype. Our study has identified immune-related loci regulated by DNA methylation in cattle that may contribute to differential cellular response to LPS, two of which exhibit an identical expression profile in both low-responding age and breed phenotypes. Methylation biomarkers of differential immunity may prove useful in developing selection strategies for replacement cows that are less susceptible to severe infections, such as coliform mastitis.
MeSH Terms
- Aging
- Animals
- Cattle
- DNA Methylation
- Epigenesis, Genetic
- Fibroblasts
- Genetic Loci
- Genomics
- Interleukin-6
- Interleukin-8
- Lipopolysaccharides
- Transcriptome
Keywords
- DNA Methylation
- Inflammation
- Innate Immunity
- LPS
- RRBS
Capacity of adult neural and muscle tissues to respond to external Electrical Stimulation (ES) is the biological basis for the development and implementation of mobility impairment physiotherapy protocols and of related assistive technologies, e.g, Functional Electrical Stimulation (FES). All body tissues, however, respond to electrical stimulation and, indeed, the most successful application of FES is electrical stimulation of the heart to revert or limit effects of arrhythmias (Pace-makers and Defibrillators). Here, we list and discuss results of FES current research activities, in particular those presented at 2016 Meetings: the PaduaMuscleDays, the Italian Institute of Myology Meeting, the 20 International Functional Electrical Stimulation Society (IFESS) conference held in Montpellier and the Vienna Workshop on FES. Several papers were recently e-published in the European Journal of Translational Myology as reports of meeting presentations. All the events and publications clearly show that FES research in Europe and beyond is alive and promisses translation of results into clinical management of a very large population of persons with deficiencies.
Keywords
- FES
- aging
- biomedical technology
- denervated muscle
- mobility impairment
- prevention and assistive technology
- rehabilitation
Histochemistry, immuno-histochemistry, gel electrophoresis of single muscle fibers and electromyography of aging muscles and nerves suggest that: i) denervation contributes to muscle atrophy, ii) impaired mobility accelerates the process, and iii) lifelong running protects against loss of motor units. Recent corroborating results on the muscle effects of Functional Electrical Stimulation (FES) of aged muscles will be also mentioned, but we will in particular discuss how and why a lifelong increased physical activity sustains reinnervation of muscle fibers. By analyzing distribution and density of muscle fibers co-expressing fast and slow Myosin Heavy Chains (MHC) we are able to distinguish the transforming muscle fibers due to activity related plasticity, to those that adapt muscle fiber properties to denervation and reinnervation. In muscle biopsies from septuagenarians with a history of lifelong high-level recreational activity we recently observed in comparison to sedentary seniors: 1. decreased proportion of small-size angular myofibers (denervated muscle fibers); 2. considerable increase of fiber-type groupings of the slow type (reinnervated muscle fibers); 3. sparse presence of muscle fibers co-expressing fast and slow MHC. Immuno-histochemical characteristics fluctuate from those with scarce fiber-type modulation and groupings to almost complete transformed muscles, going through a process in which isolated fibers co-expressing fast and slow MHC fill the gaps among fiber groupings. Data suggest that lifelong high-level exercise allows the body to adapt to the consequences of the age-related denervation and that it preserves muscle structure and function by saving otherwise lost muscle fibers through recruitment to different slow motor units. This is an opposite behavior of that described in long term denervated or resting muscles. These effects of lifelong high level activity seems to act primarily on motor neurons, in particular on those always more active, i.e., on the slow motoneurons. The preferential reinnervation that follows along decades of increased activity maintains neuron and myofibers. All together the results open interesting perspectives for applications of FES and electroceuticals for rejuvenation of aged muscles to delay functional decline and loss of independence that are unavoidable burdens of advanced aging. ClinicalTrials.gov: NCT01679977.
Keywords
- aging
- co-expression of fast and slow myosin heavy chains
- fiber type grouping
- human skeletal muscle
- lifelong physical exercise denervation and reinnervation
Many factors contribute to the decline of skeletal muscle that occurs as we age. This is a reality that we may combat, but not prevent because it is written into our genome. The series of records from World Master Athletes reveals that skeletal muscle power begins to decline at the age of 30 years and continues, almost linearly, to zero at the age of 110 years. Here we discuss evidence that denervation contributes to the atrophy and slowness of aged muscle. We compared muscle from lifelong active seniors to that of sedentary elderly people and found that the sportsmen have more muscle bulk and slow fiber type groupings, providing evidence that physical activity maintains slow motoneurons which reinnervate muscle fibers. Further, accelerated muscle atrophy/degeneration occurs with irreversible Conus and Cauda Equina syndrome, a spinal cord injury in which the human leg muscles may be permanently disconnected from the nervous system with complete loss of muscle fibers within 5-8 years. We used histological morphometry and Muscle Color Computed Tomography to evaluate muscle from these peculiar persons and reveal that contraction produced by home-based Functional Electrical Stimulation (h-bFES) recovers muscle size and function which is reversed if h-bFES is discontinued. FES also reverses muscle atrophy in sedentary seniors and modulates mitochondria in horse muscles. All together these observations indicate that FES modifies muscle fibers by increasing contractions per day. Thus, FES should be considered in critical care units, rehabilitation centers and nursing facilities when patients are unable or reluctant to exercise.
MeSH Terms
- Age Factors
- Aged
- Aging
- Animals
- Cauda Equina
- Electric Stimulation
- Electric Stimulation Therapy
- Exercise
- Horses
- Humans
- Muscle Fibers, Skeletal
- Muscle Weakness
- Muscle, Skeletal
- Muscular Atrophy
- Spinal Cord Injuries
Keywords
- Aging
- Denervation and type grouping
- FES recovery
- Master Athletes
- Muscle
- Muscle Color Computed Tomography
There is something in our genome that dictates life expectancy and there is nothing that can be done to avoid this; indeed, there is not yet any record of a person who has cheated death. Our physical prowess can vacillate substantially in our lifetime according to our activity levels and nutritional status and we may fight aging, but we will inevitably lose. We have presented strong evidence that the atrophy which accompanies aging is to some extent caused by loss of innervation. We compared muscle biopsies of sedentary seniors to those of life long active seniors, and show that these groups indeed have a different distribution of muscle fiber diameter and fiber type. The senior sportsmen have many more slow fiber-type groupings than the sedentary people which provides strong evidence of denervation-reinnervation events in muscle fibers. It appears that activity maintains the motoneurons and the muscle fibers. Premature or accelerated aging of muscle may occur as the result of many chronic diseases. One extreme case is provided by irreversible damage of the Conus and Cauda Equina, a spinal cord injury (SCI) sequela in which the human leg muscles may be completely and permanently disconnected from the nervous system with the almost complete disappearance of muscle fibers within 3-5 years from SCI. In cases of this extreme example of muscle degeneration, we have used 2D Muscle Color CT to gather data supporting the idea that electrical stimulation of denervated muscles can retain and even regain muscle. We show here that, if people are compliant, atrophy can be reversed. A further example of activity-related muscle adaptation is provided by the fact that mitochondrial distribution and density are significantly changed by functional electrical stimulation in horse muscle biopsies relative to those not receiving treatment. All together, the data indicate that FES is a good way to modify behaviors of muscle fibers by increasing the contraction load per day. Indeed, it should be possible to defer the muscle decline that occurs in aging people and in those who have become unable to participate in physical activities. Thus, FES should be considered for use in rehabilitation centers, nursing facilities and in critical care units when patients are completely inactive even for short periods of time.
Keywords
- Muscle power
- aging decay
- equine muscle spasm
- h-b FES-induced muscle recovery
- long-term denervated muscles
- master athletes
- muscle denervation/reinnervation
- subsarcolemmal mitochondria
- type groupings
To analyze the equilibriometric differences between 2 populations of elderly patients (young elderly and very elderly) with instability induced solely by age. Cross-sectional study, with 2 study groups classified according to patient age (cut-points in twenty-fifth and seventy-fifth percentiles of the age of the sample). 64 patients aged 65 years or more. Two groups of 32 subjects were established: group A (people 65 years of age or older but less than 72.6, twenty-fifth percentile) and group B (patients 82.5 years, seventh-fifth percentile, or older). Main analyzed variables: timed up-and-go test, sensory organization test of the computerized dynamic posturography, Dizziness Handicap Inventory (DHI), and Short Falls Efficacy Scale-International (FES-I) questionnaires. Student's t test or the Mann-Whitney test were used. The older patients obtain poorer scores in the equilibriometric tests but not in all of them. In the sensory organization test, the older patients make poorer use of visual and vestibular information; they also require more time and steps for the timed up-and-go. With regards to the questionnaires, fear of falling is greater (higher Short FES-I scores) but not subjective perception of disability (DHI scores without differences). There is a need to establish aged subgroups of elderly patients with instability, adapting therapeutic strategies.
MeSH Terms
- Accidental Falls
- Age Factors
- Aged
- Aged, 80 and over
- Aging
- Cross-Sectional Studies
- Dizziness
- Female
- Humans
- Male
- Postural Balance
- Sensation Disorders
- Surveys and Questionnaires
- Vestibular Diseases
Keywords
- DHI
- computerized dynamic posturography
- elderly
- fall
- instability
This paper investigates the utility of forced expiratory spirometry (FES) test with efficient machine learning algorithms for the purpose of gender detection and age group classification. The proposed method has three main stages: feature extraction, training of the models and detection. In the first stage, some features are extracted from volume-time curve and expiratory flow-volume loop obtained from FES test. In the second stage, the probabilistic models for each gender and age group are constructed by training Gaussian mixture models (GMMs) and Support vector machine (SVM) algorithm. In the final stage, the gender (or age group) of test subject is estimated by using the trained GMM (or SVM) model. Experiments have been evaluated on a large database from 4571 subjects. The experimental results show that average correct classification rate performance of both GMM and SVM methods based on the FES test is more than 99.3 % and 96.8 % for gender and age group classification, respectively.
MeSH Terms
- Aging
- Algorithms
- Exhalation
- Humans
- Models, Statistical
- Normal Distribution
- Sex Characteristics
- Spirometry
- Support Vector Machine
Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to evaluate whether there is a correlation between FOF, estimated via the short FES-I test, and objective evaluation of balance in a group of elderly patients with age-related instability. The balance of 139 subjects of more than 65 years of age is evaluated by the timed up and go test and the computerised dynamic posturography (CDP). Different groups of elderly patients were established according to the number of falls in the previous 12 months, and the correlation with short FES-I test scores was evaluated. Based on the results, ROC curves were calculated. The short FES-I test presents a good capacity to distinguish between subjects with ≤ 3 falls/year and subjects with ≥ 4 falls/year (AUC 0.719, 95%CI 0.627-0.810). A test score of 14.5 is the best cut-off point (74% sensitivity, 51% specificity). Using this cut-off point, the study sample comprises two groups: subjects with test scores of 7-14 vs 15-28, with the first group obtaining best results with statistical significance (Student's t-test and the Mann-Whitney test) in most of the balance tests. The short FES-I is an excellent instrument that measures FOF in the elderly, and it is correlated with their number of falls both in real life and on the CDP. It is simple and fast, and so can be considered an extraordinary screening test relative to real risk of falls in the elderly.
MeSH Terms
- Accidental Falls
- Aged
- Aged, 80 and over
- Aging
- Fear
- Female
- Geriatric Assessment
- Humans
- Male
- Postural Balance
- Psychometrics
- Reproducibility of Results
- Sensitivity and Specificity
Keywords
- Computerised dynamic posturography
- Fear of falling
- Instability
- Older people
- Short FES-I
This 3-year longitudinal study among older adults showed that declining muscle mass, strength, power, and physical performance are independent contributing factors to increased fear of falling, while declines of muscle mass and physical performance contribute to deterioration of quality of life. Our findings reinforce the importance of preserving muscle health with advancing age. The age-associated loss of skeletal muscle quantity and function are critical determinants of independent physical functioning in later life. Longitudinal studies investigating how decrements in muscle components of sarcopenia impact fear of falling (FoF) and quality of life (QoL) in older adults are lacking. Twenty-six healthy older subjects (age, 74.1 ± 3.7; Short Physical Performance Battery (SPPB) score ≥10) and 22 mobility-limited older subjects (age, 77.2 ± 4.4; SPPB score ≤9) underwent evaluations of lower extremity muscle size and composition by computed tomography, strength and power, and physical performance at baseline and after 3-year follow-up. The Falls Efficacy Scale (FES) and Short Form-36 questionnaire (SF-36) were also administered at both timepoints to assess FoF and QoL, respectively. At 3-year follow-up, muscle cross-sectional area (CSA) (p < 0.013) and power decreased (p < 0.001), while intermuscular fat infiltration increased (p < 0.001). These decrements were accompanied with a longer time to complete 400 m by 22 ± 46 s (p < 0.002). Using linear mixed-effects regression models, declines of muscle CSA, strength and power, and SPPB score were associated with increased FES score (p < 0.05 for each model). Reduced physical component summary score of SF-36 over follow-up was independently associated with decreased SPPB score (p < 0.020), muscle CSA (p < 0.046), and increased 400 m walk time (p < 0.003). In older adults with and without mobility limitations, declining muscle mass, strength, power, and physical performance contribute independently to increase FoF, while declines of muscle mass and physical performance contribute to deterioration of QoL. These findings provide further rationale for developing interventions to improve aging muscle health.
MeSH Terms
- Accidental Falls
- Aged
- Aged, 80 and over
- Aging
- Case-Control Studies
- Exercise Test
- Fear
- Female
- Follow-Up Studies
- Geriatric Assessment
- Humans
- Male
- Mobility Limitation
- Motor Activity
- Muscle Strength
- Muscle, Skeletal
- Prospective Studies
- Psychometrics
- Quality of Life
Keywords
- Aging
- Fear of falling
- Muscle
- Physical functioning
- Quality of life
- Sarcopenia
The purpose of this study was to compare three different intervals for a between sets rest period during a common isokinetic knee extension strength-testing protocol of twenty older Brazilian men (66.30 ± 3.92 yrs). The volunteers underwent unilateral knee extension (Biodex System 3) testing to determine their individual isokinetic peak torque at 60, 90, and 120° ·s-1. The contraction speeds and the rest periods between sets (30, 60 and 90 s) were randomly performed in three different days with a minimum rest period of 48 hours. Significant differences between and within sets were analyzed using a One Way Analysis of Variance (ANOVA) with repeated measures. Although, at angular velocity of 60°·s-1 produced a higher peak torque, there were no significant differences in peak torque among any of the rest periods. Likewise, there were no significant differences between mean peak torque among all resting periods (30, 60 and 90s) at angular velocities of 90 and 120°·s-1. The results showed that during a common isokinetic strength testing protocol a between set rest period of at least 30 s is sufficient for recovery before the next test set in older men. Key PointsMuscle fiber cross sectional area (CSAf ) decreased 38% following spinal cord injury (SCI).Early intervention with functional electric stimulation cycle ergometry (FES-CE) prevented further loss of CSAf in SCI patients and increased power output.Muscle myosin heavy chain (MHC) and myonuclear density were unaffected by SCI or FES-CE.
Keywords
- Aging
- isokinetic test
- muscle fatigue
- muscle strength
Fear of falling has been linked to activity restriction, functional decline, decreased quality of life and increased risk of falling. Factors that distinguish persons with a high concern about falling from those with low concern have not been systematically studied. This study aimed to expose potential health-related, functional and psychosocial factors that correlate with fear of falling among independently living older women who had fallen in the past year. Baseline data of 409 women aged 70-80 years recruited to a randomised falls prevention trial (DEX) (NCT00986466) were used. Participants were classified according to their level of concern about falling using the Falls Efficacy Scale International (FES-I). Multinomial logistic regression analyses were performed to explore associations between health-related variables, functional performance tests, amount of physical activity, quality of life and FES-I scores. 68% of the participants reported a moderate to high concern (FES-I ≥ 20) about falls. Multinomial logistic regression showed that highly concerned women were significantly more likely to have poorer health and quality of life and lower functional ability. Reported difficulties in instrumental activities of daily living, balance, outdoor mobility and poorer quality of life contributed independently to a greater concern about falling. Concern about falling was highly prevalent in our sample of community-living older women. In particular, poor perceived general health and mobility constraints contributed independently to the difference between high and low concern of falling. Knowledge of these associations may help in developing interventions to reduce fear of falling and activity avoidance in old age.
MeSH Terms
- Accidental Falls
- Activities of Daily Living
- Aged
- Aged, 80 and over
- Aging
- Fear
- Female
- Finland
- Health Status
- Humans
- Independent Living
- Logistic Models
- Motor Activity
- Quality of Life
- Risk Factors
- Surveys and Questionnaires
fear of falling (FOF) is common in older people and associated with serious physical and psychosocial consequences. Identifying those at risk of FOF can help target interventions to both prevent falls and reduce FOF. to identify factors associated with FOF. cross-sectional study in 1,088 community-dwelling older people aged ≥65 years. data were collected on socio-demographic characteristics, self-perceived health, exercise, risk factors for falls, FOF (Short FES-I), and functional measures. Logistic regression models of increasing complexity identified factors associated with FOF. high FOF (Short FES-I ≥11) was reported by 19%. A simpler model (socio-demographic falls risk factors) correctly classified as many observations (82%) as a more complex model (socio-demographic falls risk factors functional measures) with similar sensitivity and specificity values in both models. There were significantly raised odds of FOF in the simpler model with the following factors: unable to rise from a chair of knee height (OR: 7.39), lower household income (OR: 4.58), using a walking aid (OR: 4.32), difficulty in using public transport (OR: 4.02), poorer physical health (OR: 2.85), black/minority ethnic group (OR: 2.42), self-reported balance problems (OR: 2.17), lower educational level (OR: 2.01) and a higher BMI (OR: 1.06). a range of factors identify those with FOF. A simpler model performs as well as a more complex model containing functional assessments and could be used in primary care to identify those at risk of FOF, who could benefit from falls prevention interventions.
MeSH Terms
- Accidental Falls
- Age Factors
- Aged
- Aged, 80 and over
- Aging
- Cross-Sectional Studies
- England
- Fear
- Female
- Geriatric Assessment
- Humans
- Independent Living
- Logistic Models
- Male
- Multivariate Analysis
- Odds Ratio
- Risk Factors
Keywords
- elderly
- falling
- fear of falling
- older people
- older persons
- risk factors
Age related bone loss predisposes adults to osteoporosis. This is especially true for individuals with spinal cord injury (SCI). The effects of decreased bone loading with older age and paralysis significantly contribute to decreased bone mass and increased risk for fragility fractures. Loading bone via volitional muscle contractions or by using electrical stimulation are common methods for helping to prevent and/or decrease bone loss. However the effectiveness and safety of electrical stimulation activities remain unclear. The purpose of this review is to investigate the factors associated with aging and osteoporosis after SCI, the accuracy of bone measurement, the effects of various forms of bone loading activities with a focus on electrical stimulation activities and the safety of physical exercise with a focus on electrical stimulation cycling. Osteoporosis remains a disabling and costly condition for older adults and for those with paralysis. Both dual energy x-ray absorptiometry and peripheral quantitative computed tomography are valuable techniques for measuring bone mineral density (BMD) with the latter having the ability to differentiate trabecular and cortical bone. Physical activities have shown to be beneficial for increasing BMD however, the extent of the benefits related to aging and paralysis remain undetermined. Electrical stimulation activities administered appropriately are assumed safe due to thousands of documented safe FES cycling sessions. However, specific documentation is needed to verify safety and to development formal guidelines for optimal use.
Keywords
- aging
- bone mineral density
- electrical stimulation exercise
- osteoporosis
- spinal cord injury
This study evaluated psychometric properties of the Iconographical Falls Efficacy Scale (Icon-FES) to measure fear of falling in cognitively impaired older people. Icon-FES uses pictures as visual cues to prompt responses. A total of 50 community-dwelling older people with moderate cognitive impairment were assessed on Icon-FES, Falls Efficacy Scale-International, and various physical and cognitive measures. Overall structure and measurement properties of Icon-FES, as evaluated with item response theory, were good. Internal consistency was high (Cronbach's alpha = 0.97). Distribution was near normal, indicating absence of floor and ceiling effects. Icon-FES construct validity was supported by its relation with Falls Efficacy Scale-International (r = .68, p < .001) and its ability to discriminate between groups relating to fall risk factors (gender, balance, falls). Scores were not affected by different levels of cognitive functioning, as assessed with the Mini-Mental State Examination and Trail Making Test. Icon-FES is the first measure of fear of falling that compensates for reduced abstract abilities by using pictures to match the verbal descriptions. This study supports its feasibility, reliability, and validity to assess fear of falling in people with moderate cognitive impairment or dementia living in the community. Compared with Falls Efficacy Scale-International, Icon-FES was better at identifying participants with higher fall risk and did not show a floor effect likely due to a greater range of physically challenging activities.
MeSH Terms
- Accidental Falls
- Aged
- Aged, 80 and over
- Aging
- Cognitive Dysfunction
- Cohort Studies
- Fear
- Female
- Humans
- Male
- Psychometrics
- Reproducibility of Results
- Risk Factors
Keywords
- Alzheimer’s disease
- Dementia
- Falls
- Fear of falling
- Geriatric assessment
Pilot-testing a new instrument: the Falls Efficacy Scale-International/Hips (FES-I/Hips). This instrument is intended to measure 'Fear of Falling' (FoF). To the current instrument, the Falls Efficacy Scale-International, are four questions added for patients who are rehabilitating in a nursing home. It is pretested and used in the HIPS-study. Qualitative exploratory study with interviews in a Three Step Test Interview (TSTI) protocol. Respondents (N = 12) were asked to think aloud while completing the questionnaire. The instruction how to complete the questionnaire is well understood by patients but was not properly used by them. The questionnaire contains questions with difficult words and questions which are no longer relevant. There are six "two-in-one questions" that cause confusion. Use of the standard instruction when completing the FES-I/Hips can lead to underreporting of FoF. Adaptation of certain items may improve content validity. Further psychometric studies are recommended to determine whether the proposed adjustments are appropriate.
MeSH Terms
- Accidental Falls
- Aged
- Aged, 80 and over
- Aging
- Fear
- Female
- Hip Fractures
- Humans
- Male
- Nursing Homes
- Pilot Projects
- Psychometrics
- Surveys and Questionnaires
As Baby Boomers enter late life, relationships with family members gain importance. This review article highlights two aspects of their intergenerational relationships: (a) caregiving for aging parents and (b) interactions with adult children in the context of changing marital dynamics. The researchers describe three studies: (a) the Within Family Differences Study (WFDS) of mothers aged 65-75 and their multiple grown children (primarily Baby Boomers) ongoing since 2001; (b) the Family Exchanges Study (FES) of Baby Boomers aged 42-60, their spouses, parents, and multiple grown children ongoing since 2008; and (c) the Longitudinal Study of Generations (LSoG) of 351 three-generation families started when the Baby Boomers were teenagers in 1971, with interviews every 3-5 years from 1985 to 2005. These studies show that the Baby Boomers in midlife navigate complex intergenerational patterns. The WFDS finds aging parents differentiate among Baby Boomer children in midlife, favoring some more than others. The FES shows that the Baby Boomers are typically more involved with their children than with their aging parents; Boomers' personal values, family members' needs, and personal rewards shape decisions about support. The LSoG documents how divorce and remarriage dampen intergenerational obligations in some families. Moreover, loosening cultural norms have weakened family bonds in general. Reviews of these studies provide insights into how the Baby Boomers may negotiate caregiving for aging parents as well as the likelihood of family care they will receive when their own health declines in the future.
MeSH Terms
- Adult Children
- Aging
- Caregivers
- Female
- Humans
- Intergenerational Relations
- Male
- Parent-Child Relations
- Parenting
- Parents
- Population Growth
- Social Support
Increased fear of falling is associated with greater muscular coactivation during standing postural control. Excessive muscular coactivation reduces the performance of agonist muscles. Although several recent studies have observed increased muscular coactivation during walking in older adults, little is known about the relationship between fear of falling and muscular coactivation during walking. The purpose of this study was to compare muscular coactivation during walking between older adults with fear of falling and older adults without fear of falling. Thirty-eight healthy older adults (82.3 ± 6.8 years) participated in this study. Walking speed and step length were measured. Electromyography (EMG) data were collected from the tibialis anterior and soleus during walking to calculate the co-contraction index (CI). Subjects were divided into those with fear of falling and those without fear of falling, on the basis of a modified Falls Efficacy Scale (FES). Stepwise multiple regression analysis was used, with CI as the dependent variable, and fear of falling, experience of falling (during the past year), walking speed, step length, and age as independent variables. Mean values of CI during walking, walking speed, and step length were 51.9 ± 11.7%, 0.90 ± 0.40 m/s, and 0.43±0.11 m, respectively. Eight subjects (21.1%) had fallen within the past year, and 19 subjects (50.0%) had fear of falling. All subjects without fear of falling had FES scores of 10 (maximum score). Subjects with fear of falling had a median FES score of 17 (interquartile range, 13 to 25). Stepwise multiple regression analysis revealed that fear of falling remained significantly associated with CI (p<0.01): CIs for subjects with fear and those without fear were 59.5 ± 12.2% and 46.7 ± 8.5%, respectively. Individuals with a fear of falling have increased muscular co-activation at the ankle joint during walking, at least in a certain subgroup of older adults. Further research is needed to clarify negative and positive effects of muscular coactivation during walking in fearful subjects.
MeSH Terms
- Accidental Falls
- Age Factors
- Aged, 80 and over
- Aging
- Electromyography
- Fear
- Female
- Humans
- Male
- Muscle, Skeletal
- Postural Balance
- Posture
- Walking
Falls efficacy has been shown to predict functional decline, but whether it is independently associated with frailty is still unclear. This study investigated the cross-sectional association between falls efficacy and the frailty phenotype in high-functioning older persons. Subjects (n=861) were a sub-sample of community-dwelling persons aged 65 to 70 years enrolled in the "Lc65 " cohort, who had gait assessment. Data included demographics, functional, cognitive, affective and health status, as well as measures of physical performance. Falls efficacy was measured with the Falls Efficacy Scale-International (FES-I) and frailty with Fried's criteria. Participants were categorized into robust (no frailty criterion) and vulnerable (1 or more criteria). Low falls efficacy was defined as a FES-I score in the lowest quartile. Overall, 23.9% of participants were vulnerable. Compared with robust participants, they were more likely to report low falls efficacy (43.3% vs 19.1%, p<0.001) and had poorer health and functional and mental status. They had slower gait speed (1.07 /-0.18 vs 1.15 /-0.15 m/s, p<0.001) and increased gait speed variability (coefficient of variation 4.10 /-4.03 vs 3.33 /-1.45%, p<0.001), although only 6 participants (0.7%) fulfilled Fried's slow walking criterion. In multivariate analysis, low falls efficacy remained associated with being vulnerable (adjusted OR 1.80, 95% CI 1.19-2.74, p=0.006), independent of comorbidity, functional status, falls history and gait performance. In high-functioning older persons, low falls efficacy was associated with vulnerability, even after controlling for gait performance and falls history. Whether low falls efficacy is a potential target on the pathway leading to frailty should be further examined prospectively.
MeSH Terms
- Accidental Falls
- Activities of Daily Living
- Aged
- Aging
- Cross-Sectional Studies
- Disability Evaluation
- Exercise
- Fear
- Female
- Frail Elderly
- Gait
- Humans
- Male
- Physical Fitness
- Self Efficacy
- Surveys and Questionnaires
Frail, old patients with and without cognitive impairment are at high risk of falls and associated medical and psychosocial issues. The lack of adequate, validated instruments has partly hindered research in this field. So far no questionnaire documenting fall-related self-efficacy/fear of falling has been validated for older persons with cognitive impairment or for different administration methods such as self-report or interview. To validate the self-report and interview version of the Falls Efficacy Scale (FES) and the Falls Efficacy Scale International Version (FES-I) in frail geriatric patients with and without cognitive impairment. 156 geriatric patients in geriatric rehabilitations wards with (n = 75) and without cognitive impairment (n = 81) were included in this study. Reports of fall-related self-efficacy were based on self-reported and interview-based questionnaires. Descriptive statistics, reliability estimates and validation results were computed for the total group and sub-samples with respect to cognitive status, for the 2 different questionnaires (FES/FES-I) and for the 2 administration methods. Test-retest reliability was tested in a subsample of 62 patients. Internal reliability and test-retest reliability were good to excellent in both the FES and FES-I, with the FES-I showing better internal reliability and the FES better test-retest reliability with respect to cognitively impaired persons. The group of cognitively impaired persons tended to show lower test-retest reliability and mean fall-related self-efficacy and had significantly lower completion rates in self-administered questionnaires. As indicated by significant differences in parameters closely related to falls, such as vertigo, functional performances, fear of falling and history of falls, both the FES and the FES-I showed good construct validity. Effect sizes computed for the above-mentioned groups for fall-related parameters confirmed the results of construct validation. Both the FES as well as the FES-I showed good to excellent measurement properties in persons with and without moderate cognitive impairment. In frail older persons, especially in persons with cognitive impairment, an interview-based administration method is recommended.
MeSH Terms
- Accidental Falls
- Aged
- Aged, 80 and over
- Aging
- Dementia
- Fear
- Female
- Frail Elderly
- Humans
- Male
- Middle Aged
- Surveys and Questionnaires
The purpose of this study was to determine if the Activities-specific Balance Confidence (ABC) Scale, Falls Efficacy Scale (FES), and Survey of Activities and Fear of Falling in the Elderly (SAFE) assessments measured fear of falling in the same manner (convergent validity) and to determine if they predicted those individuals who, based upon a previous history of falls, limitation of activity, and not leaving home, had an increased potential for falling (predictive validity). One hundred and eighteen individuals, 60 years of age and older, completed each of the assessments. They self-reported activity restriction, fall history, and the number of times they left the home each week. The convergent validity of each assessment was established by correlating each assessment tool with each of the others. Findings indicated the ABC and FES were highly correlated with each other, indicating they measured similar constructs, and both were moderately correlated with the SAFE, suggesting these assessments measured different constructs. The predictive validity of each instrument in relation to the frequency of falls, limitation of activity, and frequency of leaving the home revealed no individual tool could accurately predict any of these characteristics of the sample. As a result, no one test by itself was able to identify individuals who may be at risk and a candidate for an intervention program.
MeSH Terms
- Accidental Falls
- Aged
- Aged, 80 and over
- Fear
- Geriatrics
- Humans
- Middle Aged
- Reproducibility of Results
- Surveys and Questionnaires
The aim of this study was to assess the impact of fear of falling on the health of older people. A total of 528 subjects (mean age 77 years) were recruited from two hospitals in Sydney, Australia, and followed for approximately 12 months. Eighty-five subjects died during follow-up, and 31 were admitted to an aged care institution. Tinetti's Falls Efficacy Scale (FES) was successfully administered to 418 subjects as part of the baseline assessment. Among those with baseline FES scores, ability to perform 10 activities of daily living (ADLs) was assessed at baseline and follow-up in 307 subjects, and SF-36 scores were assessed at baseline and follow-up in 90 subjects recruited during the latter part of the study. Falls during follow-up were identified using a monthly falls calendar. Compared with those with a high fall-related self-efficacy (FES score = 100), those with a low fall-related self-efficacy (FES score < or = 75) had an increased risk of falling (adjusted relative risk 2.09, 95% confidence interval [CI] 1.31-3.33). Those with poorer fall-related self-efficacy had greater declines in ability to perform ADLs (p < .001): the total ADL score decreased by 0.69 activities among persons with low FES scores (< or =75) but decreased by only 0.04 activities among persons with FES scores of 100. Decline in ADLs was not explained by the higher frequency of falls among persons with low FES scores. SF-36 scores (particularly scores on the Physical Function and Bodily Pain subscales) tended to decline more among persons with poor fall-related self-efficacy. Nonfallers who said they were afraid of falling had an increased risk of admission to an aged care institution. Fear of falling has serious consequences for older people. Interventions that successfully reduce fear of falling and improve fall-related self-efficacy are likely to have major health benefits.
MeSH Terms
- Accidental Falls
- Activities of Daily Living
- Aged
- Aging
- Australia
- Disability Evaluation
- Fear
- Female
- Homes for the Aged
- Humans
- Linear Models
- Male
- Nursing Homes
- Patient Admission
- Proportional Hazards Models
- Prospective Studies
- Self Efficacy
- Surveys and Questionnaires