Mobility Assessment To Predict Falls And Its Intervention In Community-dwelling Elderly

Objective:This study consisted of 2 experiments.Experiment 1 identified which functional mobility tests were more sensitive to predicting falls in older adults through a 12-month prospective study.Based on the results of Experiment 1,in Experiment 2,the most sensitive functional mobility test was selected as the main observation indicators,and the 5-week exercise intervention was carried out.To explore the effects of Progressive Cup-Tab Balance Training and Strength Training on motor function of the elderly,and to provide theoretical and empirical basis for the prevention of falls in the community-dwelling people.Methods:Experiment 1:Seventy-nine physically active older adults in community aged over65?32 Male,47 Female,mean age 73.07 years,mean BMI 23.94kg/m²?were assessed and followed up for 12 months.Functional mobility assessments included the 30seconds sit-to-stand test?30s-STS?,five times sit-to-stand test?5-STS?,single-task timed-up-and-go test?Single-TUG?,motor dual-task TUG?Mot-TUG?test,and cognitive dual-task TUG test?Cog-TUG?.Independent samples t-test,Spearman correlation,and receiver operating characteristic?ROC?analysis were performed to determine the value of these mobility assessments for predicting falls.Comparing the differences between functional mobility tests for faller and non-faller groups during the12-month follow-up,to identify the relationships between variables related to falls,explore the value of functional mobility assessment in predicting falls,and determine which functional mobility assessment are more sensitive to predicting falls in the elderly.Experiment 2:Based on the results of Experiment 1,Seventy-seven elderly people?27 Males,50 Females,mean age 71.16 years,mean BMI 23.49kg/m²?in shanghai community were given exercise intervention for five weeks.To observe whether there are differences in the improvement of functional mobility of the elderly with different exercise interventions.Through the health questionnaire survey and body measurement,obtain the basic information such as gender,age,height,weight and health status.According to the principle of randomization,the subjects were randomly divided into Progressive Cup-Tab Balance Training Group?TBG,n=24?,Strength Training Group?STG,n=27?and Control Group?CG,n=26?.Subjects in the TBG and the STG respectively underwent exercise intervention for 5 weeks with the same frequency,2interventions per week,each intervention lasted 1 hour?including 10 minutes of warm-up,40 minutes of TBG or STG,and 10 minutes of rest adjustment?.The CG conducts health education without exercise intervention.Based on the results of experiment 1 the main observation indicator was chosen as Cog-TUG.The paired sample t-test was used to compare the intra-group differences before and after the intervention,One-way analysis of variance was used to compare the differences between the groups before and after the intervention.Results:Experiment 1:Over a 12-month period,eight?10.1%?of the physically active older had at least one fall in the Seventy-nine elderly age over 65 years.The Single-TUG,Mot-TUG and Cog-TUG performances of fallers were significantly worse than for the non-fallers.Mot-TUG?p<0.01,?95%CI-4.268 to-1.230??and Cog-TUG?p<0.01,?95%CI-6.457 to-2.078??performances were moderately correlated with falls?r=0.359,p<0.01 and r=0.372,p<0.01 respectively?and Age was weakly correlated with falls?r=0.245,P<0.05?.None of Single-TUG,5-STS,or 30s-STS performance was significantly correlated with falls.According to the correlation analysis results,when Mot-TUG,Cog-TUG or Age were included as fall predictors,the area under the ROC curve?AUC?discrimination scores were AUC_?Mot-TUG?=0.843?p<0.01?,AUC_?Cog-TUG?=0.856?p<0.01?,and AUC_?Age?=0.734?P<0.05?.The cut-off point for Cog-TUG was10.98 seconds,with test sensitivity of 1.00 and specificity of 0.66.Experiment 2:This study was self-rated based on the Physiotherapy Evidence Database score;the total score is 6.which means that the quality of this randomized controlled trials is high.After 5 weeks of exercise intervention,the t-test results of the matched samples in the intra-group shown that,the Cog-TUG scores of the TBG were significantly improved,with statistically significant?P<0.05,?95%CI 0.627 to 2.062??.There was no significant difference between the STG and the CG.One-way ANOVA results between groups showed that,there were significant differences in Cog-TUG between different groups?P<0.05?.The Least Significant Difference?LSD?post hoc test showed that there was a significant difference between the TBG and the CG?P<0.05,?95%CI-2.308 to-0.342??,the motor performance of Cog-TUG in the elderly with TBG was significantly improved.Conclusion:Experiment 1,a 12-month prospective study of elderly people in Shanghai community showed that the Cog-TUG was the best functional mobility test to predict falls among older adults in communities with normal physical activity.When the cut-off value was 10.98 seconds,the prediction sensitivity was 1.00 and the specificity was0.66.Therefore,the Cog-TUG should be a key indicator for the evaluation of sports rehabilitation for elderly people in the community.According to the results of Experiment 1,randomized controlled trials for 5 weeks in the Experiment 2 were divided into Progressive Cup-Tab Balance Training and Strength Training for community elderly in the Experiment 2.The results showed that the motor performance of Cog-TUG in the TBG was significantly improved,while Strength Training alone could not effectively improve the performance of Cog-TUG.Therefore,Progressive Cup-Tab Balance Training involving cognitive tasks should be adopted in community rehabilitation to improve the performance of Cog-TUG for elderly in the community,instead of simple strength training,so as to reduce the risk of falling.