The falls efficacy scale international (FES-I): a comprehensive longitudinal validation study

Method: five hundred community-dwelling older people (70-90 years) were assessed on the FES-I in conjunction with demographic, physiological and neuropsychological measures at baseline and at 12 months. Falls were monitored monthly and fear of falling every 3 months. Results: the overall structure and measurement properties of both FES-I scales, as evaluated with item response theory, were good. Discriminative ability on physiological and neuropsychological measures indicated excellent validity, both at baseline (n = 500, convergent validity) and at 1-year follow-up (n = 463, predictive validity). The longitudinal follow-up suggested that FES-I scores increased over time regardless of any fall event, with a trend for a stronger increase in FES-I scores when a person suffered multiple falls in a 3-month period. Additionally, using receiver-operating characteristic (ROC) curves, cut-points were defined to differentiate between lower and higher levels of concern. Conclusions: the current study builds on the previously established psychometric properties of the FES-I. Both scales have acceptable structures, good validity and reliability and can be recommended for research and clinical purposes. Future studies should explore the FES-I's responsiveness to change during intervention studies and confirm suggested cut-points in other settings, larger samples and across different cultures

A multifactorial approach for understanding fall risk in older people

OBJECTIVE: To identify the interrelationships and discriminatory value of a broad range of objectively measured explanatory risk factors for falls. DESIGN: Prospective cohort study with 12-month follow-up period. SETTING: Community sample. PARTICIPANTS: Five hundred community-dwelling people aged 70 to 90. MEASUREMENTS: All participants underwent assessments on medical, disability, physical, cognitive, and psychological measures. Fallers were defined as people who had at least one injurious fall or at least two noninjurious falls during a 12-month follow-up period. RESULTS: Univariate regression analyses identified the following fall risk factors: disability, poor performance on physical tests, depressive symptoms, poor executive function, concern about falling, and previous falls. Classification and regression tree analysis revealed that balance-related impairments were critical predictors of falls. In those with good balance, disability and exercise levels influenced future fall risk-people in the lowest and the highest exercise tertiles were at greater risk. In those with impaired balance, different risk factors predicted greater fall risk-poor executive function, poor dynamic balance, and low exercise levels. Absolute risks for falls ranged from 11% in those with no risk factors to 54% in the highest-risk group. CONCLUSIONS: A classification and regression tree approach highlighted interrelationships and discriminatory value of important explanatory fall risk factors. The information may prove useful in clinical settings to assist in tailoring interventions to maximize the potential benefit of falls prevention strategies

Psychometric properties of the Dutch version of the London Measure of Unplanned Pregnancy in women with pregnancies ending in birth

OBJECTIVE: To evaluate the psychometric properties of the Dutch version of the London Measure of Unplanned Pregnancy in women with pregnancies ending in birth. METHODS: A two-phase psychometric evaluation design was set-up. Phase I comprised the translation from English into Dutch and pretesting with 6 women using cognitive interviews. In phase II, the reliability and validity of the Dutch version of the LMUP was assessed in 517 women giving birth recently. Reliability (internal consistency) was assessed using Cronbach's alpha, inter-item correlations, and corrected item-total correlations. Construct validity was assessed using principal components analysis and hypothesis testing. Exploratory Mokken scale analysis was carried out. RESULTS: 517 women aged 15-45 completed the Dutch version of the LMUP. Reliability testing showed acceptable internal consistency (alpha = 0.74, positive inter-item correlations between all items, all corrected item-total correlations >0.20). Validity testing confirmed the unidimensional structure of the scale and all hypotheses were confirmed. The overall Loevinger's H coefficient was 0.57, representing a 'strong' scale. CONCLUSION: The Dutch version of the LMUP is a reliable and valid measure that can be used in the Dutch-speaking population in Belgium to assess pregnancy planning. Future research is necessary to assess the stability of the Dutch version of the LMUP, and to evaluate its psychometric properties in women with abortions

Impact of white matter lesions on physical functioning and fall risk in older people a systematic review

Background and Purpose-White matter lesions (WMLs) are common findings on neuroimaging in older people. This review systematically evaluates the published literature on the associations between WMLs and balance, gait, mobility, and falls in older people. Methods-Studies were identified with searches of the MEDLINE databases. Articles reporting associations between WMLs and balance, gait, mobility, and falls in older people in cross-sectional and longitudinal studies were included. Results-Thirty-one articles reporting data from 19 studies met the inclusion criteria. There were consistent findings from both cross-sectional and longitudinal studies indicating greater WML volumes are associated with impaired balance, slower gait, and reduced mobility. Most studies addressing regional WML distributions have reported that WMHs in the frontal lobe and periventricular regions show the strongest relationships with balance, gait, and mobility impairments. In relation to falls, a threshold effect was apparent in that only those with severe WML volumes were found to be at increased risk of falling. Conclusions-The findings of this systematic review indicate that WMLs are common and are significantly associated with impaired balance, gait, mobility, and falls in older people. In many studies, however, impaired mobility and increased fall risk are only evident in people who have the most severe degree of WMLs. (Stroke. 2011; 42: 2086-2090.

Catch the ruler: concurrent validity and test–retest reliability of the ReacStick measures of reaction time and inhibitory executive function in older people

Background: Reduced cognitive function, particularly executive function (EF), is associated with an increased risk of falling in older people. We evaluated the utility of the ReacStick test, a clinical test of reaction time, and inhibitory EF developed, for young athletes, for fall-risk assessment in older people. Aims: To evaluate the psychometric properties of ReacStick measures of reaction time and executive functioning in healthy community-dwelling older people. Methods: 140 participants (aged 77 ± 5 years) underwent testing. Two test conditions—simple and inhibitory go/no-go—provided measures of reaction time, recognition load (difference in reaction time between conditions), and go/no-go accuracy. Concurrent validity was evaluated against the conventional tests of reaction time and EF (simple hand reaction time, trail-making test, and Stroop colour test). Discriminant ability was determined for fall-risk factors (age, gender, physiological profile assessment, and fall history). Test–retest reliability after 1 week was evaluated in 30 participants. Results: ReacStick reaction time correlated with tests of reaction time and EF, recognition load correlated with inhibitory EF, and go accuracy correlated with reaction time and inhibitory EF. No-go accuracy was not significantly correlated with any of the reaction time and EF tests. Test–retest reliability was good-to-excellent (ICC > 0.6) for all the outcomes. ReacStick reaction time discriminated between groups based on age, recognition load between genders, and no-go accuracy between retrospective fallers and non-fallers. Discussion: An unavoidable time pressure may result in complementary information to the traditional measures. Conclusions: The ReacStick is a reliable test of reaction time and inhibitory EF in older people and could have value for fall-risk assessment

Intraindividual Stepping Reaction Time Variability Predicts Falls in Older Adults With Mild Cognitive Impairment

Background: Reaction time measures have considerable potential to aid neuropsychological assessment in a variety of health care settings. One such measure, the intraindividual reaction time variability (IIV), is of particular interest as it is thought to reflect neurobiological disturbance. IIV is associated with a variety of age-related neurological disorders, as well as gait impairment and future falls in older adults. However, although persons diagnosed with Mild Cognitive Impairment (MCI) are at high risk of falling, the association between IIV and prospective falls is unknown. Methods: We conducted a longitudinal cohort study in cognitively intact (n = 271) and MCI (n = 154) community-dwelling adults aged 70–90 years. IIV was assessed through a variety of measures including simple and choice hand reaction time and choice stepping reaction time tasks (CSRT), the latter administered as a single task and also with a secondary working memory task. Results: Logistic regression did not show an association between IIV on the hand-held tasks and falls. Greater IIV in both CSRT tasks, however, did significantly increase the risk of future falls. This effect was specific to the MCI group, with a stronger effect in persons exhibiting gait, posture, or physiological impairment. Conclusions: The findings suggest that increased stepping IIV may indicate compromised neural circuitry involved in executive function, gait, and posture in persons with MCI increasing their risk of falling. IIV measures have potential to assess neurobiological disturbance underlying physical and cognitive dysfunction in old age, and aid fall risk assessment and routine care in community and health care settings

Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial

Background: Concerns about falls are common among older people. These concerns, also referred to as fear of falling, can have serious physical and psychosocial consequences, such as functional decline, increased risk of falls, activity restriction, and lower social participation. Although cognitive behavioral group programs to reduce concerns about falls are available, no home-based approaches for older people with health problems, who may not be able to attend such group programs are available yet. The aim of this study was to assess the effectiveness of a home-based cognitive behavioral program on concerns about falls, in frail, older people living in the community. Methods: In a randomized controlled trial in the Netherlands, 389 people aged 70 years and older, in fair or poor perceived health, who reported at least some concerns about falls and related activity avoidance were allocated to a control (n = 195) or intervention group (n = 194). The intervention was a home-based, cognitive behavioral program consisting of seven sessions including three home visits and four telephone contacts. The program aims to instill adaptive and realistic views about fall risks via cognitive restructuring and to increase activity and safe behavior using goal setting and action planning and was facilitated by community nurses. Control group participants received usual care. Outcomes at 5 and 12 months follow-up were concerns about falls, activity avoidance due to concerns about falls, disability and falls. Results: At 12 months, the intervention group showed significant lower levels of concerns about falls compared to the control group. Furthermore, significant reductions in activity avoidance, disability and indoor falls were identified in the intervention group compared with the control group. Effect sizes were small to medium. No significant difference in total number of falls was noted between the groups. Conclusions: The home-based, cognitive behavioral program significantly reduces concerns about falls, related activity avoidance, disability and indoor falls in community-living, frail older people. The program may prolong independent living and provides an alternative for those people who are not able or willing to attend group programs

Multifaceted needs of individuals living with peripheral arterial disease: a qualitative study

Objectives To ascertain a comprehensive perspective of the impact of peripheral arterial disease (PAD) on people including needs for access to disease specific information, education, services, and support. Methods Participants were recruited from outpatient clinics at a tertiary hospital in metropolitan Australia. Telephone and face-to-face semi-structured interviews were conducted with nine individuals living with PAD and analysed using qualitative content thematic analysis. Results The nine participants were on average 74.2 (SD 10.9) years and predominantly women (67%). Lack of understanding of PAD and inconsistent information resulted in confusion regarding self-management strategies. Effects of pain and mobility problems were amplified for participants who lived alone and did not have an informal carer. Discussion Poor quality of life in PAD reflects pain, social isolation and fear of falls. Multidisciplinary teams with case managers should consider older people’s living situations and needs for additional support services and education to facilitate integrated care

Dithienylethene-Based Gated Ambichromic Dyads

A set of dithienylethene (DTE)-based ambichromic dyads containing an acido-, photo-, and electrosensitive indolino[2,1-b]oxazolidine (BOX) unit displays gated photochromism. Ring opening of BOX prevents photoinduced electrocylization between open and closed forms of DTE. The photochromic performances are regenerated by two different pathways. NMR and electrochemical studies evidence interactions between indolenium and phenyl–thienyl sidearms

BT-2-BOX: an assembly toward multi-modal and multi-level molecular system simple as a breeze

TThe design of multistate/multifunctional molecular systems continues to arouse a lot of interest. Such compounds are able to commutate reversibly between two metastable states by application of an external stimulation such as light, heat, proton or electron. In this context, we are interested in molecular switches based on indolino-oxazolidine (BOX) which is a relatively confidential sub-class of multi-modal addressable units. Their particularity consists on the possi-bility to induce the opening/closing of the oxazolidine ring by using indifferently light, electrochemical or acido-basic stimulation. Up to now, most of the reported systems based on BOX have allowed to modulate a molecular property but only between two discrete levels which can be only extend-ed by their association with other classical switchable unit such as example a dithienylethene unit. For this reason, we report here our effort to enhance the number of metastable states by simply connecting two identical BOX units by a bithiophene (BT) linker. The resulting system ability to switch between the three possible metastable states was investigated. Whatever the nature of the stimulation, the full commutation of the system can be reached but our works reveal mainly that the opening of both oxazolidine rings occurs in a stepwise manner. If this unreported selectivity upon a unique stimulus with two identical switchable units is observed whatever the stimulation, it must be pointed out that its efficiency depends on the nature of the latter. The direct stimulation with acid or light leads to the coexistence of the three different states of the system over a broad stim-ulation period. At the opposite, the indirect stimulation of the BOX via an electromediated process thanks to the elec-troactivity of the bithiophene, conducts to enhance strongly the selective addressability between both identical BOX units