Journal of Geriatric Physical Therapy最新文献

Background and purpose: Sarcopenia is a common muscle disease among the older population, posing an increased risk for functional decline and intervention for loss of independence in daily living. Early detection of sarcopenia among older people before functional decline would be beneficial in enhancing their quality of life. The Asian Working Group for Sarcopenia (AWGS) 2019 recommends the use of 3 screening methods for community-based sarcopenia detection: calf circumference (CC), or the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire, or the SARC-F in combination with CC (SARC-CalF) questionnaire. This study aims to compare the relative performance of these 3 methods as screening tools for sarcopenia within a community-dwelling older population.

Methods: A total number of 700 community-dwelling older adults participated in the current study. Muscle mass, muscle strength, and physical performance were measured with bioelectrical impedance analysis, handgrip strength, and gait speed, respectively. The AWGS 2019 criteria were considered the criterion standard The sensitivity/specificity, receiver operating characteristic (ROC) curve, and area under the receiver operating characteristic curve (AUROC) analyses were determined for CC, SARC-F, and SARC-CalF to determine their relative diagnostic performance.

Results: Sarcopenia was identified in 21.4% of participants according to the AWGS2019 criteria. The overall prevalence of sarcopenia was 56.6%, 14.7%, and 22.9% according to CC, SARC-F, and SARC-CalF, respectively. Calf circumference showed the highest sensitivity but lowest specificity based on AWGS 2019 as the criterion standard regardless of age, gender, and body mass index. The SARC-CalF showed better sensitivity but similar specificity than the SARC-F. The AUROC of CC was significantly better than that of SARC-F and SARC-CalF. The AUROCs of CC, SARC-F, and SARC-CalF were statistically significant in all populations, as well as in the categories of age, gender, and body mass index ( P < .05).

Conclusions: Calf circumference is useful in ruling out the presence of sarcopenia while the SARC-F is more effective in ruling in sarcopenia, especially in the context of population-based screening. Future studies should be carried out to investigate the value of population-based sarcopenia detection using these screening tools.

Background and purpose: The literature has associated bone mineral density (BMD) and Alzheimer's disease (AD). The aim of the present systematic review was to investigate BMD in older adults with AD compared with older adults with no dementia.

Methods: Searches were performed in the MEDLINE, EMBASE, CINAHL, and Web of Science databases from inception to May 2022. Observational studies that compared BMD in the populations of interest were included. Methodical quality (risk of bias) was appraised using the Newcastle-Ottawa Scale. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Standardized mean differences (SMD) were calculated for meta-analyses.

Results and discussion: Five studies were included, involving a total of 1772 older adults (373 with AD and 1399 with no dementia). A first meta-analysis compared 207 older adults with AD and 1243 with no dementia for BMD in the femoral neck. The results showed lower BMD in the AD groups (SMD =-1.52; 95% CI, -2.61 to -0.42; P = .007, low quality of evidence). A second meta-analysis considering different sites of the body (whole body, trunk, femur, and lumbar spine) also showed lower BMD in older adults with AD compared with the group with no dementia (SMD =-0.98; 95% CI, -1.91 to -0.05; P = .04, low quality of evidence). Newcastle-Ottawa Scale scores ranged from 7 to 9, indicating low risk of bias.

Conclusions: Bone mineral density is lower in older adults with AD than in older adults with no dementia, especially in the femoral neck. These results suggest that older adults with AD may be at greater risk of developing osteopenia and osteoporosis. Current clinical practice guidelines should be amended for screening frequency and methodology for this particular cohort. Further studies are needed to confirm whether older people with AD have lower BMD in other sites of the body.

Background and purpose: Balance confidence assessment in older adults has implications for falls prevention and quality of life. It remains unclear whether the original Activities-specific Balance Confidence Scale (ABC-16) or the shortened 6-item scale (ABC-6) is recommended clinically. This study examined ABC-16 and ABC-6 association and agreement, internal consistencies, and relationships with self-rated health (SRH) in community-dwelling older adults.

Methods: Secondary analysis of an existing dataset (N = 77) was performed. Scale association and agreement were assessed with a Spearman ρ correlation (rs), intraclass correlation coefficient, 95% limits of agreement (LoA), and Bland-Altman plot. Cronbach α values were calculated to determine internal consistencies. Separate multiple linear regression models with SRH as the outcome and ABC-6 and ABC-16 scores as primary predictors were estimated and subsequently used to conduct Hotelling t test.

Results and discussion: Participants were primarily female (80.5%) with a median age of 68 years living in the metro Detroit area. The ABC-6 and ABC-16 were closely associated [rs = 0.97, P < .001; intraclass correlation coefficient (2,1) = 0.80] but demonstrated discrepancy (95% LoA range of -3.9 to +18.2; mean difference = 7.2 points in the direction of the ABC-16). Cronbach α values were 0.95 (ABC-16) and 0.89 (ABC-6). Regression model 1 (ABC-6 = primary predictor) explained more of the variance (R2 = 0.36) in SRH compared with model 2 (ABC-16 = primary predictor; R2 = 0.29). Hotelling t test [t(74) = 2.4, P = .008] found that the predicted values from the ABC-6 model were significantly more highly correlated with SRH than those from the ABC-16 model.

Conclusions: Despite a high correlation between the ABC-16 and ABC-6, the 2 scales showed limited agreement and should not be considered interchangeable. Given that the ABC-16 takes longer to administer, does not relate to SRH as strongly, and could have redundant items, the ABC-6 may be preferable to the ABC-16 for balance confidence assessment in older adults living in cold weather, urban, or well-resourced areas.

Background and purpose: Fear of falling is common in older adults and greatly increases their risk for falls. Interventions aimed at reducing fall risk in older adults with a fear of falling typically aim to improve balance. However, this approach has limited success, and the idea that balance performance impacts fall risk in this population is largely based on research in the general older adult population. The aim of this study was to assess whether presence of fear of falling modifies the relationship between balance performance and future falls in a sample of nationally representative older adults.

Methods: We analyzed data from 5151 community-dwelling Medicare beneficiaries (65 years or older) from waves 1 and 2 of the National Health and Aging Trends Study. In this prospective cohort study, balance performance and fear of falling were recorded during wave 1, while a report of a fall was recorded during wave 2 (1-year follow-up). The interplay between fear of falling, balance performance, and fall risk was analyzed using logistic regression with fear of falling as a moderating variable while controlling for common confounding variables.

Results: Twenty-seven percent of participants reported a fear of falling at wave 1 while 32.7% reported a fall at wave 2. Reduced balance performance was significantly associated with increased future fall likelihood in individuals with and without a fear of falling ( P = .008). Further, the presence of fear of falling did not modify the association between balance and future falls ( P = .749). Fear of falling was associated with increased future fall likelihood independent of balance performance ( P < .001).

Conclusion: These findings demonstrate that fear of falling did not modify the relationship between balance performance and future fall risk, thus suggesting that balance training is appropriate to reduce falls in older adults with a fear of falling. However, balance training alone may be insufficient to optimally reduce falls in older adults with a fear of falling, as the presence of this fear increased future fall risk independent of balance performance.

Background: Although the pharmacological approach may help with motor symptoms in Parkinson's disease (PD), they are clearly not the complete solution. Thus, for the treatment of PD motor symptoms, physical activity has been proposed as an effective intervention.

Methods: A systematic search in MEDLINE, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials databases was conducted to identify randomized controlled trials testing the effectiveness of exercise interventions on motor symptoms of PD. Physical exercise interventions were divided into 9 categories: endurance, resistance, combined, balance, dance, alternative exercises, body weight supported, sensorimotor interventions including endurance exercise, and sensorimotor interventions not including endurance exercise. A pairwise meta-analysis for direct and indirect comparisons between intervention and control/nonintervention groups was carried out.

Results: Fifty-six studies met the inclusion criteria, including 2740 participants, aged between 57.6 and 77.7 years. Results showed that sensorimotor training including endurance (effect size [ES]-1.09; 95% confidence interval [CI], -1.68 to -0.50), resistance (ES-0.82; 95% CI, -1.23 to -0.41), and dance (ES-0.64; 95% CI, -1.24 to -0.05) were the most effective physical activity interventions for mitigating PD motor symptoms.

Conclusion: Physical activity interventions are an effective strategy for the management of motor symptoms in patients with PD. Among the different exercise intervention programs, those including more complex and demanding activities (sensorimotor training including endurance, resistance, and dance) seem to be the most effective physical activity interventions.

Background and purpose: Fear of falling is associated with poor physical health and influences postural stability during whole-body movement. The ability to recover from lateral balance loss is required to prevent falls; however, the relationship between lateral balance recovery and fear of falling has not been established. This study aimed to investigate whether fear of falling is associated with the stepping threshold for lateral balance recovery.

Methods: This study included 56 ambulatory, community-dwelling women aged 65 years or older. We determined the single-step threshold as the maximum lean magnitude normalized with body weight from which participants could be suddenly released and still recover balance using a single side step. The short-form Falls Efficacy Scale International was used as a measure of fear of falling.

Results and discussion: The single-step threshold significantly correlated with age ( rs =-0.603) and the short-form Falls Efficacy Scale International score ( rs =-0.439). Ordinal regression analysis revealed that age (odds ratio, 0.826; 95% confidence interval, 0.742-0.920) and the short-form Falls Efficacy Scale International score (odds ratio, 0.811; 95% confidence interval, 0.680-0.966) were significantly associated with the single-step threshold, such that older age and greater fear of falling each independently predicted that failure to recover balance with a single step would occur at a lower percentage of body weight.

Conclusions: Greater fear of falling was associated with reduced ability to recover from lateral balance loss in addition to aging. Future studies should explore whether evidence-based interventions to reduce fear of falling combined with perturbation training might lead to improved ability to recover from balance loss.