Longitudinal associations between gait, falls and disability in community-dwelling older adults with type II diabetes mellitus: findings from The Irish Longitudinal Study on Ageing (TILDA)

Background Diabetes is associated with gait deficits, future falls and disability, however it is unclear if associations remain after controlling for relevant confounders. This study investigated (i) the effects of type II diabetes on spatiotemporal gait parameters in community-dwelling older adults and (ii) if diabetes status was independently associated with future falls and disability, after controlling for gait and other confounders. Methods Baseline data were obtained from 2,608 community-dwelling adults (≥60 years) participating in The Irish Longitudinal Study on Ageing (TILDA). Diabetes was identified from self-reported doctors’ diagnosis, medications and glycated haemoglobin levels. Gait characteristics were obtained during single and dual task walking using a GAITRite® mat (n=2560). Incident falls and disability were collected over four years follow-up (n=2473). Associations between diabetes status and gait (cross-sectional) and falls and disability (longitudinal) were investigated using regression analysis, adjusting for medications, cardiovascular health, neuropsychological function and fall-related factors. Results Diabetes (prevalence = 9.1%) was cross-sectionally associated with shorter dual task step length after adjusting for covariates (β=-1.59, 95% CI: -3.10, -0.08, p<0.05). Diabetes was independently associated with increased risk of future IADL difficulty in those with no prior difficulty (IRR=1.51, 95% CI: 1.08 2.11, p<0.05) although dual task step length was an important confounder in all disability models. No independent associations between diabetes and falls were observed. Conclusions Diabetes was independently associated with shorter dual task step length and increased risk of future IADL difficulty. Multidimensional interventions addressing poor health and function in those with diabetes may help reduce the risk of gait deficits and future disability

Association of antidepressants with recurrent, injurious and unexplained falls is not explained by reduced gait speed.

Objective: To examine if antidepressants at baseline are associated with falls and syncope over 4 years follow-up and if any observed associations are explained by baseline gait speed.Design: Longitudinal study (three waves).Setting: The Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort study.Participants: Two thousand ninety-three community-dwelling adults aged ≥60 years.Measurements: Antidepressants (ATC code "N06A") were identified. Recurrent falls (≥2 falls), injurious falls (requiring medical attention), unexplained falls, and syncope were reported at either Wave 2 or 3. Usual gait speed was the mean of two walks on a 4.88 m GAITRite walkway. Poisson regression analysis was used to examine associations between baseline antidepressant use and future falls adjusting for sociodemographics, physical, cognitive and mental health, and finally, gait speed.Results: Compared to non-antidepressant users, those on antidepressants at baseline were more likely to report all types of falls (24.8-40.7% versus 9.8-18%) at follow-up. Antidepressants at baseline were independently associated with injurious falls (incidence risk ratio: 1.58, 95% confidence interval: 1.21, 2.06, z = 3.38, p = 0.001, df = 32) and unexplained falls (incidence risk ratio: 1.49, 95% confidence interval: 1.04, 2.15, z = 2.17, p = 0.030, df = 32) independent of all covariates including gait speed.Conclusion: There was little evidence to support the hypothesis that gait would (partly) explain any observed associations between baseline use of antidepressants and future falls. The underlying mechanisms of the observed relationships may be related to depression, vascular pathology, or direct effects of antidepressants. Clinicians should identify the best treatment option for an individual based on existing risk factors for outcomes such as falls.</p

Falls, non-accidental falls and syncope in community-dwelling adults aged 50 years and older: Implications for cardiovascular assessment.

To calculate the prevalence of all falls, non-accidental falls and syncope in an older population and characterize cardiovascular risk profiles.Prospective, longitudinal cohort study.The first two waves of data from the Irish Longitudinal Study on Ageing (TILDA).8172 community-dwelling adults aged 50 years and older resident in the Republic of Ireland.Self-reported history of all falls, non-accidental falls and syncope in the year preceding the first two waves of data collection. Demographic factors and self-reported cardiovascular conditions were used to characterize cardiovascular risk profiles.The prevalence of all falls in the past year was 19.2% or 192 per thousand persons and increased with age (50-64 years 17.5%; 65-74 years 19.4%; 75+ years 24.4%). Non-accidental falls had an estimated prevalence of 5.1% or 51 falls per thousand persons and accounted for 26.5% of all falls reported and also increased with age (50-64 years 4.0%; 65-74 years 5.5%; 75+ years 8.0%). The prevalence for syncope was estimated to be 4.4% or 44per thousand persons but did not show a similar age gradient. Participants with at least 5 cardiovascular conditions were more likely to report all falls (OR = 2.07, 95% CI 1.18-3.64, p<0.05) and NAF (OR = 2.89, 95%CI 1.28-6.52, p<0.05).The prevalence of all falls and non-accidental falls increases with age but the same pattern was not consistently observed for syncope. There is an increased odds of reporting all three outcomes with increasing number of self-reported cardiovascular conditions. Further work is needed to uncover the interplay between cardiovascular disease and subsequent falls

Using timed up-and-go to identify frail members of the older population

Fried's definition of frailty is widely used but its measurement is problematic. Timed up-and-go (TUG) is a simple measure of mobility that may be a useful proxy for frailty. Here, we describe the distribution of frailty and TUG in the older population of Ireland and discuss the extent to which TUG identifies the frail and prefrail populations

The temporal precision of audiovisual integration is associated with longitudinal fall incidents but not sensorimotor fall risk in older adults

Abstract Sustained multisensory integration over long inter-stimulus time delays is typically found in older adults, particularly those with a history of falls. However, the extent to which the temporal precision of audio-visual integration is associated with longitudinal fall or fall risk trajectories is unknown. A large sample of older adults (N = 2319) were grouped into longitudinal trajectories of self-reported fall incidents (i.e., decrease, stable, or increase in number) and, separately, their performance on a standard, objective measure of fall risk, Timed Up and Go (TUG; stable, moderate decline, severe decline). Multisensory integration was measured once as susceptibility to the Sound-Induced Flash Illusion (SIFI) across three stimulus onset asynchronies (SOAs): 70 ms, 150 ms and 230 ms. Older adults with an increasing fall number showed a significantly different pattern of performance on the SIFI than non-fallers, depending on age: For adults with increasing incidents of falls, those aged 53–59 years showed a much smaller difference in illusion susceptibility at 70 ms versus 150 ms than those aged 70 + years. In contrast, non-fallers showed a more comparable difference between these SOA conditions across age groups. There was no association between TUG performance trajectories and SIFI susceptibility. These findings suggests that a fall event is associated with distinct temporal patterns of multisensory integration in ageing and have implications for our understanding of the mechanisms underpinning brain health in older age

Variance between walking speed and neuropsychological test scores during three gait tasks across the irish longitudinal study on aging (TILDA) dataset

This study investigated the relationship between neuropsychological test scores and gait speed in three gait tasks using baseline cross-sectional data from 4694 healthy adults (54% women, age (mean±sd) 62.4±8.2) from The Irish Longitudinal study on Aging (TiLDA). Global cognition, short term memory, speed of processing, executive function and sustained attention were measured by a detailed battery of neuropsychological tests. Gait speed was recorded from a GaitRite™ pressure sensing mat during a single walk and two dual walking tasks; dual cognitive walk (alternate letters) and dual motor walk (carrying a glass of water). Correlations between neuropsychological test scores and the three gait speed outcomes were investigated using univariate and multiple linear regressions models; firstly adjusting for age, gender, height, education and depression only and then including all neuropsychological test scores in the same regression model and adjusting as previously. It was found that short term memory, speed of processing and attention were significantly correlated with gait speed in all three gait conditions, with global cognition and executive function also significantly correlated with gait speed in the dual cognitive walk. The nature and complexity of the task performed affected gait speed with the addition of the cognitive task while walking causing a larger reduction in gait speed than the addition of the motor task. This indicates that for this healthy nationally representative population sample there is a link between neural processes involved in movement and cognition and this association differs depending on the gait task performed

Atrial fibrillation is associated with impaired mobility in community-dwelling older adults

To examine the independent associations between atrial fibrillation (AF) and objectively measured mobility in a nationally representative cohort. Wave 1 of The Irish Longitudinal Study on Ageing (TILDA), a population-based study assessing health, economic, and social aspects of ageing. Community-dwelling adults completed a home-based interview and a center-based health assessment. Participants aged 50 years or older, with Mini-Mental State Examination score of 24 or higher, and who completed at least 1 mobility test (n = 4525). Mobility was assessed with the Timed Up-and-Go (TUG) test and usual and dual task gait speed obtained using a 4.88-m GAITRite® mat. AF was diagnosed using a 10-minute surface electrocardiogram recording. Linear regression analyses were performed to compare mobility in participants with and without AF, adjusting for confounders. In this sample (mean age 62.3 years; range 51-89), overall prevalence of AF was 3.1%, increasing to 6.7% in the over 70s (11.8% men; 2.8% women). In multivariate analysis, AF was independently associated with slower TUG (β 0.37; 95% confidence interval [CI] 0.07-0.71; P = .043) and slower usual gait speed (β -3.59; 95% CI -7.05 to -0.12; P = .030). There was a significant age*AF interaction effect for usual gait speed (β -0.480, 95% CI -0.907 to -0.053, P = .028). Adults with AF walked 3.77 cm/s more slowly than adults without AF at age 70, declining by 4.8 cm/s for each additional decade. AF is independently associated with lower usual gait speed in community-dwelling adults and this effect is magnified in those aged 70 and older. This may place them at increased risk of falls, hospitalization, cognitive decline, and mortality, as well as stroke and heart failure. Early recognition and treatment of AF is vital to improve physical function and reduce this ris

Impaired Stabilisation of Orthostatic Cerebral Oxygenation is Associated with Slower Gait Speed: Evidence from The Irish Longitudinal Study on Ageing

BACKGROUND: Cerebral autoregulation (CAR) systems maintain blood flow to the brain across a wide range of blood pressures. Deficits in CAR have been linked to gait speed (GS) but previous studies had small sample sizes and used specialized equipment which impede clinical translation. The purpose of this work was to assess the association between GS and orthostatic cerebral oxygenation in a large, community-dwelling sample of older adults. METHOD: Data for this study came from the Irish Longitudinal Study on Ageing. A near-infrared spectroscopy (NIRS) device attached to the forehead of each participant (n = 2 708) was used to track tissue saturation index (TSI; the ratio of oxygenated to total hemoglobin) during standing. GS was assessed using a portable walkway. RESULTS: Recovery was impaired in slower GS participants with a TSI value at 20 seconds (after standing) of −0.55% (95% CI: −0.67, −0.42) below baseline in the slowest GS quartile versus −0.14% (95% CI: −0.25, −0.04) in the fastest quartile. Slower GS predicted a lower TSI throughout the 3-minute monitoring period. Results were not substantially altered by adjusting for orthostatic hypotension. Adjustment for clinical and demographic covariates attenuated the association between but differences remained between GS quartiles from 20 seconds to 3 minutes after standing. CONCLUSION: This study reported evidence for impaired recovery of orthostatic cerebral oxygenation depending on GS in community-dwelling older adults. Future work assessing NIRS as a clinical tool for monitoring the relationship between GS and cerebral regulation is warranted

Prevalence and incidence of all falls, non-accidental falls (NAF) and syncope.

<p>Prevalence (wave one) and incidence (wave two) based on self-reported data from TILDA participants (n = 8172).</p