Continuous Monitoring of Turning Mobility and Its Association to Falls and Cognitive Function: A Pilot Study.

BACKGROUND Difficulty turning is a major contributor to mobility disability, falls, and reduced quality of life in older people because it requires dynamic balance control that worsens with age. However, no study has quantified the quality and quantity of turning during normal daily activities in older people. The objective of this pilot study was to determine if quality of turning during daily activities is associated with falls and/or cognitive function. METHODS Thirty-five elderly participants (85 ± 8 years) wore three Opal inertial sensors. Turning and activity rate were measured. Based on retrospective falls, participants were grouped into nonfallers (N = 16), single fallers (N = 12), and recurrent fallers (N = 7). We also determined which turning characteristic predicted falls in the 6 months following the week of monitoring. RESULTS Quality of turning was significantly compromised in recurrent fallers compared with nonfallers (p < .05). In contrast, activity rate and mean number of turns per hour were similar across the three groups. Also, quality of turning during a prescribed test was similar across the three groups. Visuospatial and memory functions and the Tinetti Balance Scores were associated with quality of turning. Future falls were related to an increased variability of number of steps to turn. CONCLUSIONS Continuous monitoring of turning characteristics, while walking during daily activities, is feasible in older people. Turning characteristics during daily life appear to be more sensitive to fall risk than prescribed turning tasks. These findings suggest a slower, less variable, cautious turning strategy in elderly volunteers with a history of falls.

[1]  A. Patla,et al.  Visual control of locomotion: strategies for changing direction and for going over obstacles. , 1991, Journal of experimental psychology. Human perception and performance.

[2]  J. Morris.  The Clinical Dementia Rating (CDR) , 1993, Neurology.

[3]  L. Bouter,et al.  Falls in the elderly: a prospective study of risk factors and risk profiles. , 1996, American journal of epidemiology.

[4]  A. Shumway-cook,et al.  Predicting the probability for falls in community-dwelling older adults. , 1997, Physical therapy.

[5]  R. Stein,et al.  Turning strategies during human walking. , 1999, Journal of neurophysiology.

[6]  A. E. Patla,et al.  Online steering: coordination and control of body center of mass, head and body reorientation , 1999, Experimental Brain Research.

[7]  S. Flynn,et al.  Turning difficulty characteristics of adults aged 65 years or older. , 2000, Physical therapy.

[8]  M. Woollacott,et al.  Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. , 2000, Physical therapy.

[9]  Wayne Dite,et al.  Development of a clinical measure of turning for older adults. , 2002, American journal of physical medicine & rehabilitation.

[10]  Wayne Dite,et al.  A clinical test of stepping and change of direction to identify multiple falling older adults. , 2002, Archives of physical medicine and rehabilitation.

[11]  G. Pera,et al.  Incidencia y consecuencias de las caídas en las personas mayores que viven en la comunidad , 2004 .

[12]  G. Pera,et al.  Incidence and consequences of falls among elderly people living in the community. , 2004, Medicina clinica.

[13]  S. Studenski,et al.  Too much or too little step width variability is associated with a fall history in older persons who walk at or near normal gait speed , 2005, Journal of NeuroEngineering and Rehabilitation.

[14]  S. Cummings,et al.  Non-skeletal determinants of fractures: the potential importance of the mechanics of falls , 2005, Osteoporosis International.

[15]  G. Blake,et al.  Distribution of bone mineral density in the lumbar spine in health and osteoporosis , 1994, Osteoporosis International.

[16]  C. Becker,et al.  Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus , 2005, Journal of the American Geriatrics Society.

[17]  O. Piguet,et al.  Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney Older Persons Study , 2005, Journal of the Neurological Sciences.

[18]  Subashan Perera,et al.  Gait variability and the risk of incident mobility disability in community-dwelling older adults. , 2007, The journals of gerontology. Series A, Biological sciences and medical sciences.

[19]  Greta C Bernatz,et al.  Video task analysis of turning during activities of daily living. , 2007, Gait & posture.

[20]  Fabio Feldman,et al.  Reducing hip fracture risk during sideways falls: evidence in young adults of the protective effects of impact to the hands and stepping. , 2007, Journal of biomechanics.

[21]  Lori Ann Vallis,et al.  Strategies used by older adults to change travel direction. , 2007, Gait & posture.

[22]  Lori Ann Vallis,et al.  Age-related modifications in steering behaviour: effects of base-of-support constraints at the turn point , 2008, Experimental Brain Research.

[23]  Peter Graf,et al.  Increased Risk of Falling in Older Community-Dwelling Women With Mild Cognitive Impairment , 2008, Physical Therapy.

[24]  R. Lipton,et al.  Quantitative gait markers and incident fall risk in older adults. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[25]  F. Horak,et al.  Reduced performance in balance, walking and turning tasks is associated with increased neck tone in Parkinson's disease , 2009, Experimental Neurology.

[26]  Mark Speechley,et al.  Quantifying the magnitude of risk for balance impairment on falls in community-dwelling older adults: a systematic review and meta-analysis. , 2010, Journal of clinical epidemiology.

[27]  Jeffrey Kaye,et al.  The trajectory of gait speed preceding mild cognitive impairment. , 2010, Archives of neurology.

[28]  Mark Speechley,et al.  Balance Impairment as a Risk Factor for Falls in Community-Dwelling Older Adults Who Are High Functioning: A Prospective Study , 2010, Physical Therapy.

[29]  Jeffrey M. Hausdorff,et al.  Properties of the ‘Timed Up and Go’ Test: More than Meets the Eye , 2010, Gerontology.

[30]  M. Barr,et al.  Prevalence, circumstances and consequences of falls among community-dwelling older people: results of the 2009 NSW Falls Prevention Baseline Survey. , 2011, New South Wales public health bulletin.

[31]  Jasmine C Menant,et al.  Step Time Variability and Pelvis Acceleration Patterns of Younger and Older Adults: Effects of Footwear and Surface Conditions , 2010, Research in sports medicine.

[32]  Misha Pavel,et al.  Executive function predicts risk of falls in older adults without balance impairment , 2011, BMC geriatrics.

[33]  Beatrix Vereijken,et al.  Physical activity monitoring by use of accelerometer-based body-worn sensors in older adults: a systematic literature review of current knowledge and applications. , 2012, Maturitas.

[34]  Laurie A. King,et al.  Do Clinical Scales of Balance Reflect Turning Abnormalities in People With Parkinson's Disease? , 2012, Journal of neurologic physical therapy : JNPT.

[35]  S. Studenski,et al.  Use of Stance Time Variability for Predicting Mobility Disability in Community-Dwelling Older Persons: A Prospective Study , 2012, Journal of geriatric physical therapy.

[36]  T. Hayes,et al.  One walk a year to 1000 within a year: continuous in-home unobtrusive gait assessment of older adults. , 2012, Gait & posture.

[37]  Jeffrey M. Hausdorff,et al.  Does the Evaluation of Gait Quality During Daily Life Provide Insight Into Fall Risk? A Novel Approach Using 3-Day Accelerometer Recordings , 2013, Neurorehabilitation and neural repair.

[38]  S. Robinovitch,et al.  Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study , 2013, The Lancet.

[39]  T. Hamid,et al.  Home based exercise to improve turning and mobility performance among community dwelling older adults: protocol for a randomized controlled trial , 2014, BMC Geriatrics.

[40]  N. A. Abu Osman,et al.  Are the spatio-temporal parameters of gait capable of distinguishing a faller from a non-faller elderly? , 2014, European journal of physical and rehabilitation medicine.

[41]  B. Najafi,et al.  Sensor-Derived Physical Activity Parameters Can Predict Future Falls in People with Dementia , 2014, Gerontology.

[42]  Nir Giladi,et al.  Association Between Performance on Timed Up and Go Subtasks and Mild Cognitive Impairment: Further Insights into the Links Between Cognitive and Motor Function , 2014, Journal of the American Geriatrics Society.

[43]  Eric Barrey,et al.  Gait disturbances as specific predictive markers of the first fall onset in elderly people: a two-year prospective observational study , 2013, Front. Aging Neurosci..

[44]  Sean Pearson,et al.  Continuous Monitoring of Turning in Patients with Movement Disability , 2013, Sensors.

[45]  Jaap H van Dieën,et al.  Ambulatory fall-risk assessment: amount and quality of daily-life gait predict falls in older adults. , 2015, The journals of gerontology. Series A, Biological sciences and medical sciences.