Turning difficulty characteristics of adults aged 65 years or older.

BACKGROUND AND PURPOSE Falls that occur while walking have been associated with an increased risk of hip fracture in elderly people. This study's purpose was to describe movement characteristics in older adults that serve as indicators of difficulty in turning while walking. SUBJECTS Three groups were assessed: young adults who had no difficulty in turning (age range=20-30 years, n=20) (YNDT group), elderly adults who had no difficulty in turning (age range=65-87 years, n=15) (ENDT group), and elderly adults who had difficulty in turning (age range=69-92 years, n=15) (EDT group). METHODS All subjects were videotaped performing a self-paced 180-degree turn during the Timed "Up & Go" Test. Movement characteristics of each group were identified. Four characteristics were used to identify difficulty in turning: (1) the type of turn, (2) the number of steps taken during the turn, (3) the time taken to accomplish the turn, (4) and staggering during the turn. RESULTS In general, the EDT group took more steps during the turn and more time to accomplish the turn than the YNDT and ENDT groups. Although the only turning strategy used by the YNDT group was a pivot type of turn, there was an almost total absence of a pivot type of turn in the EDT group. No differences were found among the groups on the staggering item, yet the EDT group was the only group in which staggering was present. We believe these changes observed in the 4 characteristics only in the EDT group are indicators of difficulty in turning while walking. CONCLUSION AND DISCUSSION These indicators of difficulty may be useful for the early identification of individuals aged 65 years or older who are having difficulty in turning and may well serve as the basis for the development of a scale for difficulty in turning in older adults. Preliminary findings indicate the need for further study into the reliability, validity, and sensitivity of measurements obtained with such a scale.

[1]  M. Tinetti,et al.  Fall risk index for elderly patients based on number of chronic disabilities. , 1986, The American journal of medicine.

[2]  D. Winter Biomechanics of Human Movement , 1980 .

[3]  S. Cummings,et al.  Type of Fall and Risk of Hip and Wrist Fractures: The Study of Osteoporotic Fractures , 1993, Journal of the American Geriatrics Society.

[4]  S. Cummings,et al.  TYPE OF FALL AND RISK OF HIP AND WRIST FRACTURES: THE STUDY OF OSTEOPOROTIC FRACTURES , 1993, Journal of the American Geriatrics Society.

[5]  J W Rowe,et al.  Predicting changes in physical performance in a high-functioning elderly cohort: MacArthur studies of successful aging. , 1994, Journal of gerontology.

[6]  L G Branch,et al.  Physical performance measures in aging research. , 1989, Journal of gerontology.

[7]  A. Gentile,et al.  Skill acquisition : Action, movement, and neuromotor processes , 1987 .

[8]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[9]  R. Cumming,et al.  Fall Frequency and Characteristics and the Risk of Hip Fractures , 1994, Journal of the American Geriatrics Society.

[10]  U S Nayak,et al.  Balance in elderly patients: the "get-up and go" test. , 1986, Archives of physical medicine and rehabilitation.

[11]  A. Schultz,et al.  Mobility impairment in the elderly: challenges for biomechanics research. , 1992, Journal of biomechanics.

[12]  Waneen Wyrick Spirduso,et al.  Physical dimensions of aging , 1995 .

[13]  A. Vansant,et al.  Rising from a supine position to erect stance. Description of adult movement and a developmental hypothesis. , 1988, Physical therapy.

[14]  K. Berg Measuring balance in the elderly: preliminary development of an instrument , 1989 .

[15]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[16]  H. Yack Techniques for clinical assessment of human movement. , 1984, Physical therapy.

[17]  N. Alexander,et al.  Quantitative Assessment of Bed Rise Difficulty in Young and Elderly Women , 1992, Journal of the American Geriatrics Society.

[18]  P. Thompson,et al.  ACSM's Guidelines for Exercise Testing and Prescription , 1995 .

[19]  B. Maki,et al.  Are Activity‐Based Assessments of Balance and Gait in the Elderly Predictive of Risk of Falling and/or Type of Fall? , 1993, Journal of the American Geriatrics Society.

[20]  M. Tinetti,et al.  Prevention of falls among the elderly. , 1989, The New England journal of medicine.

[21]  D. Prudham,et al.  A prospective study of fractured proximal femur: incidence and outcome. , 1979, Public health.