BMC Geriatrics最新文献

Background: Falls are important public health issues among older people. Previous studies reported the fall-related alterations in electromyographic (EMG) activation of specific trunk muscles following a single direction of perturbation, while the activation patterns following multiple directions of balance perturbations remained unclear. Additionally, although the static structural/morphological characteristics of trunk muscles have been associated with balance performance, the fall-related trunk muscle contraction patterns for maintaining reactive balance remained unknown. This pilot observational study therefore aimed to comprehensively explore how trunk muscles' activation and contraction patterns during reactive balance control differed between older recurrent fallers and older non-fallers.

Methods: Six community-dwelling older recurrent fallers (70.0 ± 5.1 years; 4 females; ≥2 falls in past one year), and six older non-fallers (70.8 ± 3.9 years; 5 females) were recruited. Eligibility criteria were aged 65 years or older, with independent mobility, without cognitive impairment or balance-affecting conditions, without recent injuries/surgery, and without recent structured exercise. Participants received unpredictable translational moving-platform balance perturbations during natural standing. The dominant-side trunk muscle thickness changes (measured by wearable ultrasound imaging) and electrical activities (measured by EMG) for maintaining reactive balance were focused, supplemented by analyzing pelvic motions and postural sways.

Results: Compared to older non-fallers, older recurrent fallers had significantly: (1) 51% smaller rate (following anterior perturbations; d = 1.47; p = 0.029) and 50% smaller peak (following medial perturbations; d = 1.32; p = 0.045) of the internal oblique (IO) muscle thickness change; and (2) smaller peak of IO muscle EMG signal following medial perturbations, and slower/smaller EMG responses of the rectus abdominis (RA) muscle following posterior/medial/lateral perturbations (p < 0.05).

Conclusions: This study demonstrated the feasibility of using wearable dynamic ultrasound imaging to characterize fall-related morphological changes during reactive balance control in older adults. The participated recurrent fallers exhibited the perturbation-direction-specific slower/smaller activation and contraction of IO muscle and slower/smaller activation of RA muscle, as compared to non-fallers. Given the pilot study, future longitudinal research with adequately powered samples is warranted to confirm this preliminary finding, which may help complement the current fall-risk assessments and imply the targeted fall-prevention exercises in older adults.

Background: Falls are the leading cause of disability, premature institutionalization, and mortality in the aging population. Older adults with cognitive impairment are more susceptible to falls and have a significantly higher risk of falls compared to those with normal cognition. Physical activity (PA) is a key fall prevention strategy; however, evidence on the dose-response relationship between PA and falls among older adults with impaired cognition is limited. We investigated associations of physical activity and health symptoms with falls in cognitively diverse older adults to identify differential effects.

Methods: We conducted a cross-sectional secondary analysis of 6,781 adults aged ≥ 65 who participated in both 2020 and 2022 Health and Retirement Study (HRS) interview years. Weighted survey logistic regression models estimated associations between PA levels and self-reported falls, defined as reporting at least one fall in the previous two years. Cognitive status was assessed using the 27-point HRS cognition scale. Models sequentially adjusted for demographics and health symptoms, including pain, dyspnea, obesity, and depressive symptoms.

Results: In fully adjusted models, high-intensity PA was significantly associated with lower odds of falling (OR = 0.76, 95% CI: 0.60-0.98). Associations observed for moderate PA in partially adjusted models were attenuated and no longer statistically significant after full adjustment (OR = 0.83, 95% CI: 0.66-1.05). Mild PA was not significantly associated with falls across models. Stratified analyses showed a consistent pattern of lower odds of falls with increasing PA intensity in both cognition groups; however, significant associations for moderate and high PA were lost after adjusting for health symptoms in the normal cognition group. Among those with impaired cognition, only high-level PA demonstrated a similar attenuated trend, while mild and moderate PA remained non-significant across models. Chronic pain, dyspnea, and depressive symptoms were significantly associated with increased fall risk in both subgroups, while obesity was only significantly associated with falls in the normal cognition group.

Conclusions: Moderate and high-intensity PA were associated with lower odds of falls, with important effect modification by cognitive status and health symptoms. These findings suggest that fall prevention strategies should account for cognitive function and symptom burden when promoting physical activity in older adults.

Background: This study evaluates the impact of the SOCAV program on promoting self-direction of individuals with dementia in nursing homes and examines the behavioral changes in care staff when trained and coached to implement the program. SOCAV is a longitudinal training and coaching intervention designed to enhance person-centered care and support self-direction in individuals with dementia.

Methods: This mixed-methods longitudinal pilot study was conducted in two long-term care units and one day activity center of a nursing home. Participants included 61 individuals with dementia, 48 caregivers, and 85 care staff members. Qualitative data were collected from reflective coaching diaries, while quantitative data were gathered using the Canadian Occupational Performance Measure (COPM) from the perspectives of individuals with dementia, their caregivers, and care staff.

Results: Thematic analysis revealed four positive changes in care staff: acceptance of reflective coaching, focus on self-direction, improvement in communication and interaction, and enhanced team collaboration. Statistically significant improvements in COPM performance and satisfaction were observed in individuals with dementia, as reported by all stakeholders, providing quantitative validation of the observed behavioral changes adopted by the care staff. Initial resistance from staff, linked to fears of criticism and discomfort with change, diminished through supportive peer coaching and emphasis on positive experiences.

Conclusions: The SOCAV program was associated with meaningful improvements in care staff attitudes and behaviors that support self-direction among individuals with dementia. Key facilitators, including peer coaching, team cohesion, and the realization of staff impact on residents' self-direction, were instrumental in establishing these changes. Future research is needed to assess potential benefits of the SOCAV program in other settings and populations.