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(1) Background: The goal of this study was to analyze the reliability and validity of the Portuguese version of the SARC-F in older adults. (2) Methods: A total of 100 participants (77.1 ± 7.36 years, 73% women) were included in the study. In a first phase, the Portuguese SARC-F was adapted following the standardized forward–backward translation procedure, and internal consistency as well as inter-rater and test–retest reliability of the Portuguese SARC-F were analyzed. Secondly, clinical validation was evaluated by comparing the SARC-F total score with five operational definitions of sarcopenia and with other sarcopenia-related measurements. Discriminant validity, with respect to low muscle mass and strength and physical function were analyzed. (3) Results: The Portuguese SAR-F showed acceptable internal consistency (Cronbach α = 0.82), excellent inter-rater reliability (total score), and substantial to excellent test–retest reliability (ICC = 0.891 for the total score). Specificity ranged from 72.5% (FNIH) to 73.4 (IGWS), and negative predictive values went from 91.8% (EWGSOP1) to 97.3% (FNIH), but low sensitivity and positive predictive value were observed. The Portuguese SARC-F showed a moderate ability to discriminate people with low muscle strength (AUC = 0.78) and gait speed (AUC = 0.89). (4) Conclusions: The Portuguese SARC-F is a valid and reliable tool for ruling out sarcopenia in community-dwelling older adults and can discriminate between people with low handgrip strength and gait speed. [ABSTRACT FROM AUTHOR]

The four-meter gait speed (4MGS) is a recommended physical performance test in older adults but is challenging to implement clinically. We developed a smartphone application (App) with a four-meter ribbon for remote 4MGS testing at home. This study aimed to assess the validity and reliability of this smartphone App-based assessment of the home 4MGS. We assessed the validity of the smartphone App by comparing it against a gold standard video assessment of the 4MGS conducted by study staff visiting community-dwelling older adults and against the stopwatch-based measurement. Moreover, we assessed the test–retest reliability in two supervised sessions and three additional sessions performed by the participants independently, without staff supervision. The 4MGS measured by the smartphone App was highly correlated with video-based 4MGS (r = 0.94), with minimal differences (mean = 0.07 m/s, ± 1.96 SD = 0.12) across a range of gait speeds. The test–retest reliability for the smartphone App 4MGS was high (ICC values: 0.75 to 0.93). The home 4MGS in older adults can be measured accurately and reliably using a smartphone in the pants pocket and a four-meter strip of ribbon. Leveraging existing technology carried by a significant portion of the older adult population could overcome barriers in busy clinical settings for this well-established objective mobility test. [ABSTRACT FROM AUTHOR]

With an aging population, numerous assistive and monitoring technologies are under development to enable older adults to age in place. To facilitate aging in place, predicting risk factors such as falls and hospitalization and providing early interventions are important. Much of the work on ambient monitoring for risk prediction has centered on gait speed analysis, utilizing privacy-preserving sensors like radar. Despite compelling evidence that monitoring step length in addition to gait speed is crucial for predicting risk, radar-based methods have not explored step length measurement in the home. Furthermore, laboratory experiments on step length measurement using radars are limited to proof-of-concept studies with few healthy subjects. To address this gap, a radar-based step length measurement system for the home is proposed based on detection and tracking using a radar point cloud followed by Doppler speed profiling of the torso to obtain step lengths in the home. The proposed method was evaluated in a clinical environment involving 35 frail older adults to establish its validity. Additionally, the method was assessed in people's homes, with 21 frail older adults who had participated in the clinical assessment. The proposed radar-based step length measurement method was compared to the gold-standard Zeno Walkway Gait Analysis System, revealing a 4.5 cm/8.3% error in a clinical setting. Furthermore, it exhibited excellent reliability (ICC(2,k) = 0.91, 95% CI 0.82 to 0.96) in uncontrolled home settings. The method also proved accurate in uncontrolled home settings, as indicated by a strong consistency (ICC(3,k) = 0.81 (95% CI 0.53 to 0.92)) between home measurements and in-clinic assessments. [ABSTRACT FROM AUTHOR]

Peripheral inflammation and gait speed alterations are common in several neurological disorders and in the aging process, but the association between the two is not well established. The aim of this systematic literary review is to determine whether proinflammatory markers are a positive predictor for gait impairments and their complications, such as falls in older adults, and may represent a risk factor for slow gait speed and its complications. The systematic review was performed in line with the Preferred Report Items for Systematic Review and Meta-Analyses (PRISMA). A protocol for literature searches was structured a priori and designed according to the International Perspective Register of Systemic Review (PROSPERO: CRD42023451108). Peer-reviewed original articles were identified by searching seven electronic databases: Excerpta Medica Database (EMBASE), SciVerse (ScienceDirect), Scopus, PubMed, Medline, Web of Science, and the Cochrane Library. The search strategy was formulated based on a combination of controlled descriptors and/or keywords related to the topic and a manual search was conducted of the reference lists from the initially selected studies to identify other eligible studies. The studies were thoroughly screened using the following inclusion criteria: older adults, spatiotemporal gait characteristics, and proinflammatory markers. A meta-analysis was not performed due to the heterogeneity of the studies, and the results were narratively synthesized. Due to the clinical and methodological heterogeneity, the studies were combined in a narrative synthesis, grouped by the type of biomarkers evaluated. A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, spatiotemporal gait parameters such as gait velocity, and proinflammatory markers such as TNF-α, high sensitivity C-reactive (CRP) proteins, and IL-6. We included 21 out of 51 studies in our review, which examined the association between inflammatory biomarkers and gait impairment. This review highlights the role of TNF-α, CRP, and IL-6 in gait impairment. Biomarkers play an important role in the decision-making process, and IL-6 can be an effective biomarker in establishing the diagnosis of slow gait speed. Further longitudinal research is needed to establish the use of molecular biomarkers in monitoring gait impairment. [ABSTRACT FROM AUTHOR]

Background: The risk for an unexpected fall can be due to increasing age, health conditions, and loss of cognitive, sensory, or musculoskeletal functions. Falls have personal and economic consequences in many countries. Different disturbances can occur during gait, such as tripping, slipping, or other unexpected circumstances that can generate a loss of balance. The strategies used to recover balance depend on many factors, but selecting a correct response strategy influences the success of balance recovery. Objectives: (1) To collect and clarify the definitions of compensatory protective step strategies to recover balance in older adults; (2) to identify the most used methods to induce loss of balance; and (3) to identify the most used spatiotemporal variables in analyzing these actions. Methods: The present review has followed the PRISMA guideline extension for Scoping Review (PRISMA-ScR) and the phases proposed by Askery and O'Malley. The search was conducted in three databases: PubMed, Web of Science, and Scopus. Results: A total of 525 articles were identified, and 53 studies were included. Forty-five articles were quasi-experimental studies, six articles were randomized controlled trials, and two studies had an observational design. In total, 12 compensatory protective step strategies have been identified. Conclusions: There are 12 compensatory protective step strategies: lowering and elevating strategy, short- and long-step strategy, backward and forward stepping for slip, single step, multiple steps, lateral sidesteps or loaded leg sidestep unloaded leg sidestep, crossover step (behind and front), and medial sidestep. To standardize the terminology applied in future studies, we recommend collecting these strategies under the term of compensatory protective step strategies. The most used methods to induce loss of balance are the tether-release, trip, waist-pull, and slip methods. The variables analyzed by articles are the number of steps, the acceleration phase and deceleration phase, COM displacement, the step initiation or step duration, stance phase time, swing phase time and double-stance duration, stride length, step length, speed step, speed gait and the type of step. [ABSTRACT FROM AUTHOR]

Dual-tasking can cause cognitive–motor interference (CMI) and affect task performance. This study investigated the effects of age, gait speed, and type of cognitive task on CMI during gait. Ten younger and 10 older adults walked on a pressure-sensitive GAITRite walkway which recorded gait speed and step length. Participants walked at a slow, preferred, or fast speed while simultaneously completing four cognitive tasks: visuomotor reaction time (VMRT), serial subtraction (SS), word list generation (WLG), and visual Stroop (VS). Each combination of task and speed was repeated for two trials. Tasks were also performed while standing. Motor and cognitive costs were calculated with the formula: ((single-dual)/single × 100). Higher costs indicate a larger reduction in performance from single to dual-task. Motor costs were higher for WLG and SS than VMRT and VS and higher in older adults (p < 0.05). Cognitive costs were higher for SS than WLG (p = 0.001). At faster speeds, dual-task costs increased for WLG and SS, although decreased for VMRT. CMI was highest for working memory, language, and problem-solving tasks, which was reduced by slow walking. Aging increased CMI, although both ages were affected similarly by task and speed. Dual-task assessments could include challenging CMI conditions to improve the prediction of motor and cognitive status. [ABSTRACT FROM AUTHOR]

The timed up and go test (TUG) is a common clinical functional balance test often used to complement findings on sensorimotor changes due to aging or sensory/motor dysfunction. The instrumented TUG can be used to obtain objective postural and gait measures that are more sensitive to mobility changes. We investigated whether gait and body coordination during TUG is representative of walking. We examined the walking phase of the TUG and compared gait metrics (stride duration and length, walking speed, and step frequency) and head/trunk accelerations to normal walking. The latter is a key aspect of postural control and can also reveal changes in sensory and motor function. Forty participants were recruited into three groups: young adults, older adults, and older adults with visual impairment. All performed the TUG and a short walking task wearing ultra-lightweight wireless IMUs on the head, chest, and right ankle. Gait and head/trunk acceleration metrics were comparable across tasks. Further, stride length and walking speed were correlated with the participants' age. Those with visual impairment walked significantly slower than sighted older adults. We suggest that the TUG can be a valuable tool for examining gait and stability during walking without the added time or space constraints. [ABSTRACT FROM AUTHOR]

Gait speed declines with age and slower walking speeds are associated with poor health outcomes. Understanding why we do not walk faster as we age, despite being able to, has implications for rehabilitation. Changes in regional oxygenated haemoglobin (HbO2) across the frontal lobe were monitored using functional near infrared spectroscopy in 17 young and 18 older adults while they walked on a treadmill for 5 min, alternating between 30 s of walking at a preferred and fast (120% preferred) speed. Gait was quantified using a triaxial accelerometer (lower back). Differences between task (preferred/fast) and group (young/old) and associations between regional HbO2 and gait were evaluated. Paired tests indicated increased HbO2 in the supplementary motor area (right) and primary motor cortex (left and right) in older adults when walking fast (p < 0.006). HbO2 did not significantly change in the young when walking fast, despite both groups modulating gait. When evaluating the effect of age (linear mixed effects model), greater increases in HbO2 were observed for older adults when walking fast (prefrontal cortex, premotor cortex, supplementary motor area and primary motor cortex) compared to young adults. In older adults, increased step length and reduced step length variability were associated with larger increases in HbO2 across multiple regions when walking fast. Walking fast required increased activation of motor regions in older adults, which may serve as a therapeutic target for rehabilitation. Widespread increases in HbO2 across the frontal cortex highlight that walking fast represents a resource-intensive task as we age. [ABSTRACT FROM AUTHOR]

The rising tide of smoking-related diseases has irreparably damaged the health of both young and old people, according to the World Health Organization. This study explores the dynamics of the age-structure smoking model under fractal-fractional (F-F) derivatives with government intervention coverage. We present a new fractal-fractional model for two-age structure smokers in the Caputo–Fabrizio framework to emphasize the potential of this operator. For the existence-uniqueness criterion of the given model, successive iterative sequences are defined with limit points that are the solutions of our proposed age-structure smoking model. We also use the functional technique to demonstrate the proposed model stability under the Ulam–Hyers condition. The two age-structure smoking models are numerically characterized using the Newton polynomial. We observe that in Groups 1 and 2, a change in the fractal-fractional orders has a direct effect on the dynamics of the smoking epidemic. Moreover, testing the inherent effectiveness of government interventions shows a considerable impact on potential, occasional, and temporary smokers when the fractal-fractional order is 0.95. It is the view that this study will contribute to the applicability of the schemes, the rich dynamics of the fractal, and the fractional perspective of future predictions. [ABSTRACT FROM AUTHOR]

Cortical activity and walking speed are known to decline with age and can lead to an increased risk of falls in the elderly. Despite age being a known contributor to this decline, individuals age at different rates. This study aimed to analyse left and right cortical activity changes in elderly adults regarding their walking speed. Cortical activation and gait data were obtained from 50 healthy older individuals. Participants were then grouped into a cluster based on their preferred walking speed (slow or fast). Analyses on the differences of cortical activation and gait parameters between groups were carried out. Within-subject analyses on left and right–hemispheric activation were also performed. Results showed that individuals with a slower preferred walking speed required a higher increase in cortical activity. Individuals in the fast cluster presented greater changes in cortical activation in the right hemisphere. This work demonstrates that categorizing older adults by age is not necessarily the most relevant method, and that cortical activity can be a good indicator of performance with respect to walking speed (linked to fall risk and frailty in the elderly). Future work may wish to explore how physical activity training influences cortical activation over time in the elderly. [ABSTRACT FROM AUTHOR]

This study aimed to clarify the relationship between visual acuity and motor function in younger and elderly participants and to compare differences between non-elderly and elderly participants. In total, 295 participants who underwent visual and motor functional examinations were included; participants with visual acuity ≥0.7 were assigned to the normal group (N group) and those with visual acuity ≤0.7 were assigned to the low-visual-acuity group (L group). Motor function was compared between the N and L groups; the analysis was performed by grouping participants into those aged >65 years (elderly) and those aged <65 years (non-elderly). The non-elderly group (average age, 55.6 ± 6.7 years) had 105 and 35 participants in the N and L groups, respectively. Back muscle strength was significantly lower in the L group than in the N group. The elderly group (average age, 71.1 ± 5.1 years) had 102 and 53 participants in the N and L groups, respectively. Gait speed was significantly lower in the L group than in the N group. These results reveal differences in the relationship between vision and motor function in non-elderly and elderly adults and indicate that poor vision is associated with lower back-muscle strength and walking speed in younger and elderly participants, respectively. [ABSTRACT FROM AUTHOR]

This study examined the potential for effect of a six-week gait aid training program for people with dementia on spatiotemporal gait outcomes, perception of use, and falls with gait aid use. The program utilised four 30-min physiotherapy home visits, scheduled at weeks 1/2/3/6, and was enhanced by carer-supervised practice. Falls and the physiotherapist's clinical judgement of participants achieving safe gait aid use during and after the program were described. Perception ratings at each visit were measured using Likert scales which, along with the spatiotemporal outcomes using the gait aid (Time-Up-and-Go-Test, 4-m-walk-test, Figure-of-8-Walk-Test with/without a cognitive task) at weeks 1 and 6, and at weeks 6 and 12 (6-week post-program), were examined with ordinal logistic regression analyses. Twenty-four community-dwelling older people with dementia and their carers participated. Twenty-one (87.5%) older people achieved safe gait aid use. Twenty falls occurred, and only one faller was using their gait aid when they fell. Walking speed, step length, and cadence significantly improved when walking with the gait aid at week 6 compared with week 1. No significant improvements in spatiotemporal outcomes were retained at week 12. Physiotherapists were more likely to agree that gait aid use had improved walking safety among older people with dementia with subsequent training visits. Larger studies of the gait aid training program are needed for this clinical group. [ABSTRACT FROM AUTHOR]

This study, conducted on a large sample of older adults at elevated fall risk (1), aimed to verify statistical differences in gait stability ratio (GSR) and body balance (BB) according to sex, (2) to examine and compare GSR and BB performance between older adult fallers and non-fallers, (3) to determine an association between GSR and BB according to the history of falls, and (4) to explore whether GSR and BB mediate the association between sex and falls. We included 619 individuals (69.8 ± 5.6 years) living in the Autonomous Region of Madeira, Portugal. The frequency of falls was obtained by self-report. BB was determined by the Fullerton Advanced Balance scale, while GSR was established by dividing cadence by gait speed and data collected during the 50-foot walk test. Males indicated a lower prevalence of falls in the last 12 months (23.6%), while females had a higher score (48.7%), as well as a lower balance performance (p < 0.001) and higher GSR scores (p < 0.001). Lower BB control (p < 0.001), as well as higher GSR, were more expressive for fallers (p < 0.001). We found a large, negative and significant correlation between GSR and BB for historical falls (r = −0.560; p < 0.001), and between male and female cohorts (r = −0.507; p < 0.001). The total effect of sex on falls mediated by GSR and BB was 16.4%. Consequently, GSR and BB mediated this association by approximately 74.0% and 22.5%, respectively. [ABSTRACT FROM AUTHOR]

Older adults (aged 55 years and above) have greater difficulty carrying out activities of daily living than younger adults (aged 25–55 years). Although age-related changes in human gait kinetics are well documented in qualitative terms in the scientific literature, these differences may be quantified and analyzed using the analysis of motor control strategies through kinetic synergies. The gaits of two groups of people (older and younger adults), each with ten members, were analyzed on a treadmill at a constant controlled speed and their gait kinetics were recorded. The decomposition of the kinetics into synergies was applied to the joint torques at the hip, knee, and ankle joints. Principal components determined the similarity of the kinetic torques in the three joints analyzed and the effect of the walking speed on the coordination pattern. A total of three principal components were required to describe enough information with minimal loss. The results suggest that the older group showed a change in coordination strategy compared to that of the younger group. The main changes were related to the ankle and hip torques, both showing significant differences (p-value < 0.05 ) between the two groups. The findings suggest that the differences between the gait patterns of the two groups were closely related to a reduction in ankle torque and an increase in hip torque. This change in gait pattern may affect the rehabilitation strategy used when designing general-purpose rehabilitation devices or rehabilitation/training programs for the elderly. [ABSTRACT FROM AUTHOR]

Gait quality characteristics obtained from daily-life accelerometry are clinically relevant for fall risk in older adults but it is unknown whether these characteristics are responsive to changes in gait quality. We aimed to test whether accelerometry-based daily-life gait quality characteristics are reliable and responsive to changes over one year in older adults who experienced a fall or an exercise intervention. One-week trunk acceleration data were collected from 522 participants (65–97 years), at baseline and after one year. We calculated median values of walking speed, regularity (sample entropy), stability (logarithmic rate of divergence per stride), and a gait quality composite score, across all 10-s gait epochs derived from one-week gait episodes. Intraclass correlation coefficients (ICC) and limits of agreement (LOA) were determined for 198 participants who did not fall nor participated in an exercise intervention during follow-up. For responsiveness to change, we determined the number of participants who fell (n = 209) or participated in an exercise intervention (n = 115) that showed a change beyond the LOA. ICCs for agreement between baseline and follow-up exceeded 0.70 for all gait quality characteristics except for vertical gait stability (ICC = 0.69, 95% CI [0.62, 0.75]) and walking speed (ICC = 0.68, 95% CI [0.62, 0.74]). Only walking speed, vertical and mediolateral gait stability changed significantly in the exercisers over one year but effect sizes were below 0.2. The characteristic associated with most fallers beyond the LOA was mediolateral sample entropy (4.8% of fallers). For the exercisers, this was gait stability in three directions and the gait quality composite score (2.6% of exercisers). The gait quality characteristics obtained by median values over one week of trunk accelerometry were not responsive to presumed changes in gait quality after a fall or an exercise intervention in older people. This is likely due to large (within subjects) differences in gait behaviour that participants show in daily life. [ABSTRACT FROM AUTHOR]

Background: Fear of falling and environmental barriers in the home are two major factors that cause the incidence of falling. Poor visibility at night is one of the key environmental barriers that contribute to falls among older adult residents. Ensuring their visual perception of the surroundings, therefore, becomes vital to prevent falling injuries. However, there are limited works in the literature investigating the impact of the visibility of the target on older adults' walking destinations and how that impact differs across them with different levels of fear of falling. Objective: The purpose of the study was to examine the effects of target salience on older adults' walking performance and investigate whether older adults with varying levels of fear of falling behave differently. Methods: The salient target was constructed with LED strips around the destination of walking. Fifteen older adults (aged 75 years old and above), seven with low fear of falling and eight with high fear of falling, volunteered for the study. Participants walked from the designated origin (i.e., near their beds) to the destination (i.e., near the bathroom entrance), with the target turned on or off around the destination of the walking trials. Spatiotemporal gait variables and lower-body kinematics were recorded by inertial sensors and compared by using analysis of variance methods. Results: Data from inertial sensors showed that a more salient target at the destination increased older adults' gait speed and improved their walking stability. These changes were accompanied by less hip flexion at heel strikes and toe offs during walking. In addition, older adults with low fear of falling showed more substantial lower-body posture adjustments with the salient target presented in the environment. Conclusions: Older adults with a low fear of falling can potentially benefit from a more salient target at their walking destination, whereas those with a high fear of falling were advised to implement a more straightforward falling intervention in their living areas. [ABSTRACT FROM AUTHOR]

Humans' balance recovery responses to gait perturbations are negatively impacted with ageing. Slip and trip events, the main causes preceding falls during walking, are likely to produce severe injuries in older adults. While traditional exercise-based interventions produce inconsistent results in reducing patients' fall rates, perturbation-based balance training (PBT) emerges as a promising task-specific solution towards fall prevention. PBT improves patients' reactive stability and fall-resisting skills through the delivery of unexpected balance perturbations. The adopted perturbation conditions play an important role towards PBT's effectiveness and the acquisition of meaningful sensor data for studying human biomechanical reactions to loss of balance (LOB) events. Hence, this narrative review aims to survey the different methods employed in the scientific literature to provoke artificial slips and trips in healthy adults during treadmill and overground walking. For each type of perturbation, a comprehensive analysis was conducted to identify trends regarding the most adopted perturbation methods, gait phase perturbed, gait speed, perturbed leg, and sensor systems used for data collection. The reliable application of artificial perturbations to mimic real-life LOB events may reduce the gap between laboratory and real-life falls and potentially lead to fall-rate reduction among the elderly community. [ABSTRACT FROM AUTHOR]

Failure to obtain the recommended 7–9 h of sleep has been associated with injuries in youth and adults. However, most research on the influence of prior night's sleep and gait has been conducted on older adults and clinical populations. Therefore, the objective of this study was to identify individuals who experience partial sleep deprivation and/or sleep extension the prior night using single task gait. Participants (n = 123, age 24.3 ± 4.0 years; 65% female) agreed to participate in this study. Self-reported sleep duration of the night prior to testing was collected. Gait data was collected with inertial sensors during a 2 min walk test. Group differences (<7 h and >9 h, poor sleepers; 7–9 h, good sleepers) in gait characteristics were assessed using machine learning and a post-hoc ANCOVA. Results indicated a correlation (r = 0.79) between gait parameters and prior night's sleep. The most accurate machine learning model was a Random Forest Classifier using the top 9 features, which had a mean accuracy of 65.03%. Our findings suggest that good sleepers had more asymmetrical gait patterns and were better at maintaining gait speed than poor sleepers. Further research with larger subject sizes is needed to develop more accurate machine learning models to identify prior night's sleep using single-task gait. [ABSTRACT FROM AUTHOR]

Studies on gait symmetry in healthy population have mainly been focused on small range of age categories, neglecting Teenagers (13–18 years old) and Middle-Aged persons (51–60 years old). Moreover, age-related effects on gait symmetry were found only when the symmetry evaluation was based on whole-body acceleration than on spatiotemporal parameters of the gait cycle. Here, we provide a more comprehensive analysis of this issue, using a Symmetry Index (SI) based on whole-body acceleration recorded on individuals aged 6 to 84 years old. Participants wore a single inertial sensor placed on the lower back and walked for 10 m at comfortable, slow and fast speeds. The SI was computed using the coefficient of correlation of whole-body acceleration measured at right and left gait cycles. Young Adults (19–35 years old) and Adults (36–50 years old) showed stable SI over the three speed conditions, while Children (6–12 years old), Teenagers (13–18 years old), Middle-Aged persons and Elderly (61–70 and 71–84 years old) exhibited lower SI values when walking at fast speed. Overall, this study confirms that whole-body gait symmetry is lower in Children and in Elderly persons over 60 years of age, showing, for the first time, that asymmetries appear also during teenage period and in Middle-Aged persons (51–60 years old). [ABSTRACT FROM AUTHOR]

Background: As a result of the increase in older people covered by long-term care insurance (LTCI), prevention of sarcopenia and maintenance and improvement of health-related quality of life (HRQOL) have become important themes. This study aimed to clarify both the differences in HRQOL in older people with and without sarcopenia covered by LTCI and the correlation between HRQOL and physical function. Methods: Participants were 101 older people with LTCI at a daycare center in Japan. We investigated clinical factors using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L). Analysis was by unpaired t-test, Mann–Whitney U test, chi-square test, analysis of covariance, Pearson's correlation coefficient, and Spearman's rank correlation coefficient. Results: Compared to the no sarcopenia group (n = 40), the sarcopenia group (n = 24) had significantly lower body mass index, skeletal muscle mass index, gait speed, EQ-5D-3L, and adjusted EQ-5D-3L (p < 0.05). The EQ-5D-3L showed a significant correlation with handgrip strength in the sarcopenia group (p = 0.02) and significant correlations with gait speed and one-leg standing time (both, p = 0.01) in the no sarcopenia group. Conclusion: We clarified differences in HRQOL in older people with and without sarcopenia covered by LTCI. This information on the interrelationship between HRQOL and physical function may help maintain and improve HRQOL in these people. [ABSTRACT FROM AUTHOR]

In the assessment of skeletal muscle strength, rate of force development (RFD) is clinically identified as a functional index that reflects the effects of aging, but there are few reports on RFD of the tongue. The purpose of this study was to examine the relationship between RFD of tongue pressure (RFD-TP) and oral and whole-body physical performance in older adults, and to clarify its characteristics. We enrolled adults aged ≥65 years with pathological occlusal contact in premolar and molar regions of teeth in the Tamba-Sasayama area, Japan, from 2017 to 2018. Maximum tongue pressure (MTP) and the speed to reach the maximum tongue pressure (RFD-TP) were evaluated as measures of tongue function. Oral functions related to objective measures of tongue function, such as repetitive saliva swallowing test, oral diadochokinesis, and physical status or performance, such as mini mental state examination, body mass index, skeletal mass index, knee extension force, one-leg standing time, grip strength, walking speed, timed up-and-go test, and five-time chair stand speed was evaluated. No significant correlation was found between MTP and age, but RFD-TP had a significant negative correlation with age. Neither RFD-TP nor MTP showed a significant correlation with oral function. RFD-TP was associated with physical performance, such as knee extension force and one-leg standing time. RFD-TP is more sensitive to aging than MTP. In addition, RFD-TP is related to physical performance and may be useful for the early detection of frailty. [ABSTRACT FROM AUTHOR]

Contemporary cities require excellent walking conditions to support human physical activity, increase humans' well-being, reduce traffic, and create a healthy urban environment. Various indicators and metrics exist to evaluate walking conditions. To evaluate the spatial pattern of objective-based indicators, two popular indices were selected—the Walkability Index (WAI), representing environmental-based indicators, and Walk Score (WS), which applies an accessibility-based approach. Both indicators were evaluated using adequate spatial units (circle buffers with radii from 400 m to 2414 m) in two Czech cities. A new software tool was developed for the calculation of WS using OSM data and freely available network services. The new variant of WS was specifically designed for the elderly. Differing gait speeds, and variable settings of targets and their weights enabled the adaptation of WS to local conditions and personal needs. WAI and WS demonstrated different spatial pattern where WAI is better used for smaller radii (up to approx. 800 m) and WS for larger radii (starting from 800 m). The assessment of WS for both cities indicates that approx. 40% of inhabitants live in unsatisfactory walking conditions. A sensitivity analysis discovered the major influences of gait speed and the β coefficient on the walkability assessment. [ABSTRACT FROM AUTHOR]

Falling is a frequent and major clinical problem among older adults, as well as in patients with chronic cerebrovascular diseases (CVD). At present, sequential (mixed) and simultaneously (dual-task) motor-cognitive trainings are the best approaches to affording patients more autonomy in their everyday motor independence while reducing fall risks and consequences. The objective of this study was to evaluate the efficacy of an advanced and innovative dual-task motor-cognitive rehabilitation program on fall risks in vulnerable older persons with chronic CVD. To this purpose, 26 consecutive older fallers with chronic CVD were recruited, and completed a mixed motor-cognitive or a dual-task motor-cognitive training program. Each patient also underwent two test evaluations to assess balance, gait, fear of falling, and walking performance at pre-and post-intervention. We found that our experimental motor-cognitive dual-task rehabilitation program could be an effective method to improve walking balance, gait, walking speed, and fear of falling, while reducing the risk of falls in older people with chronic CVD. Furthermore, results show that the simultaneous motor-cognitive training is more effective than the sequential motor-cognitive training. Therefore, our study brings innovative data, which can contribute positively to the management of this population. [ABSTRACT FROM AUTHOR]

Motor fitness and flexibility have been linked to several health issues. We aimed to investigate the predictive validity of motor fitness and flexibility tests in relation to health outcomes in adults and older adults. Web of Science and PubMed databases were screened for studies published from inception to November 2020. Two authors systematically searched, evaluated, and extracted data from identified original studies and systematic reviews/meta-analysis. Three levels of evidence were constructed: strong, moderate, and limited/inconclusive evidence. In total, 1182 studies were identified, and 70 studies and 6 systematic reviews/meta-analysis were summarized. Strong evidence indicated that (i) slower gait speed predicts falls and institutionalization/hospitalization in adults over 60 years old, cognitive decline/impairment over 55 years old, mobility disability over 50 years old, disability in instrumental activities of daily living (IADL) over 54 years old, cardiovascular disease risk over 45 years old, and all-cause mortality over 35 years old; (ii) impaired balance predicts falls and disability in IADL/mobility disability in adults over 40 years old and all-cause mortality over 53 years old; (iii) worse timed up&go test (TUG) predicts falls and fear of falling over 40 years old. Evidence supports that slower gait speed, impaired balance, and worse TUG performance are significantly associated with an increased risk of adverse health outcomes in adults. [ABSTRACT FROM AUTHOR]

In the elderly, walking while simultaneously engaging in other activities becomes more difficult. This study aimed to examine the changes in cortical activity during walking with aging. We try to reveal the effects of an additional task and increased walking speed on cortical activation in the young-old and the old-old elderly. Twenty-seven young-old (70.2 ± 3.0 years) and 23 old-old (78.0 ± 2.3 years) participated in this study. Each subject completed four walking tasks on the treadmill, a 2 × 2 design; two single-task (ST) walking conditions with self-selected walking speed (SSWS) and fast walking speed (FWS), and two dual-task (DT) walking conditions with SSWS and FWS. Functional near-infrared spectroscopy was applied for measurement of cerebral oxyhemoglobin (oxyHb) concentration during walking. Cortical activities were increased during DT conditions compared with ST conditions but decreased during the FWS compared with the SSWS on the primary leg motor cortex, supplementary motor area, and dorsolateral prefrontal cortex in both the young-old and the old-old. These oxyHb concentration changes were significantly less prominent in the old-old than in the young-old. This study demonstrated that changes in cortical activity during dual-task walking are lower in the old-old than in the young-old, reflecting the reduced adaptive plasticity with severe aging. [ABSTRACT FROM AUTHOR]

The present study developed a simplified decision-tree algorithm for fall prediction with easily measurable predictors using data from a longitudinal cohort study: 2520 community-dwelling older adults aged 65 years or older participated. Fall history, age, sex, fear of falling, prescribed medication, knee osteoarthritis, lower limb pain, gait speed, and timed up and go test were assessed in the baseline survey as fall predictors. Moreover, recent falls were assessed in the follow-up survey. We created a fall-prediction algorithm using decision-tree analysis (C5.0) that included 14 nodes with six predictors, and the model could stratify the probabilities of fall incidence ranging from 30.4% to 71.9%. Additionally, the decision-tree model outperformed a logistic regression model with respect to the area under the curve (0.70 vs. 0.64), accuracy (0.65 vs. 0.62), sensitivity (0.62 vs. 0.50), positive predictive value (0.66 vs. 0.65), and negative predictive value (0.64 vs. 0.59). Our decision-tree model consists of common and easily measurable fall predictors, and its white-box algorithm can explain the reasons for risk stratification; therefore, it can be implemented in clinical practices. Our findings provide useful information for the early screening of fall risk and the promotion of timely strategies for fall prevention in community and clinical settings. [ABSTRACT FROM AUTHOR]

In the elderly, geriatric problems such as the risk of fall or frailty are a challenge for society. Patients with frailty present difficulties in walking and higher fall risk. The use of sensors for gait analysis allows the detection of objective parameters related to these pathologies and to make an early diagnosis. Inertial Measurement Units (IMUs) are wearables that, due to their accuracy, portability, and low price, are an excellent option to analyze human gait parameters in health-monitoring applications. Many relevant gait parameters (e.g., step time, walking speed) are used to assess motor, or even cognitive, health problems in the elderly, but we perceived that there is not a full consensus on which parameters are the most significant to estimate the risk of fall and the frailty state. In this work, we analyzed the different IMU-based gait parameters proposed in the literature to assess frailty state (robust, prefrail, or frail) or fall risk. The aim was to collect the most significant gait parameters, measured from inertial sensors, able to discriminate between patient groups and to highlight those parameters that are not relevant or for which there is controversy among the examined works. For this purpose, a literature review of the studies published in recent years was carried out; apart from 10 previous relevant reviews using inertial and other sensing technologies, a total of 22 specific studies giving statistical significance values were analyzed. The results showed that the most significant parameters are double-support time, gait speed, stride time, step time, and the number of steps/day or walking percentage/day, for frailty diagnosis. In the case of fall risk detection, parameters related to trunk stability or movements are the most relevant. Although these results are important, the total number of works found was limited and most of them performed the significance statistics on subsets of all possible gait parameters; this fact highlights the need for new frailty studies using a more complete set of gait parameters. [ABSTRACT FROM AUTHOR]

Pathophysiological changes after acute hospitalizations may influence physical functioning in older adults, which can lead to disability and loss of independence. This study evaluated the association between pneumonia, fracture, heart attack, stroke, and other hospitalizations with major mobility disability (MMD) and gait speed. This was a secondary analysis of the Lifestyle Interventions and Independence for Elders (LIFE) Study, which was conducted across eight sites during 2010–2013 with longitudinal follow-up for 1635 individuals over an average of 2.6 years. Participants included adults ≥70 years old with pre-existing mobility limitations randomized to a physical activity intervention or a health education control arm. Hospitalizations were recorded via self-report and adjudicated by medical reviewers. MMD was measured by the inability to complete a 400 m walk test, or other proxies, as a binary outcome. Gait speed was recorded during the walk test in meters per second (m/s) and measured on a linear scale. Mixed-effects repeated measures regression adjusted for baseline demographics, comorbid conditions, and frailty. Among the 1635 participants, there were 1458 hospitalizations, which included 80 (5.5% of all hospitalizations) cases of pneumonia, 92 (6.3%) hospitalized fractures, 87 (6.0%) heart attacks, and 61 (4.2%) strokes. In the short-term measurement period immediately following hospitalization (1 day to 6 months), stroke (OR = 3.98 (3.41–4.54)) had the strongest association with MMD followed by fracture (OR = 3.03 (2.54–3.52)), pneumonia (OR = 2.76 (2.23–3.30)), and heart attack (OR = 2.03 (1.52–2.53)). Associations with long-term (6–12 months after) MMD were decreased or not significant for all causes. Pneumonia, fracture, stroke, and other hospitalizations were associated with short-term relative gait speed changes between −4.8% up to −19.5%, and only fracture was associated with long-term changes. Hospitalizations for pneumonia, heart attack, stroke, and fractures were associated with short-term decreases in mobility in older adults. Older adults may be at risk for decreased mobility and disability following acute hospitalizations, with the magnitude determined by the cause of the precipitating event. [ABSTRACT FROM AUTHOR]

The study aimed to investigate cross-sectionally the associations of cognitive reserve (CR) and premorbid IQ with cognitive and functional status in a cohort of older outpatients. Additionally, we evaluated the association of CR and premorbid IQ with the worsening of patients' cognitive status at one-year follow-up. We originally included 141 outpatients (mean age 80.31 years); a telephone-based cognitive follow-up was carried out after one year, including 104 subjects (mean age 80.26 years). CR (β = 0.418), premorbid IQ (β = 0.271) and handgrip strength (β = 0.287) were significantly associated with the MMSE score. The cognitive worsening at follow-up was associated with lower CR, lower MMSE score, reduced gait speed and frailty exhibited at baseline. Univariate linear regressions showed that CR was associated with handgrip strength (β = 0.346), gait speed (β = 0.185), autonomy in basic (β = 0.221) and instrumental (β = 0.272) daily activities, and frailty (β = −0.290); premorbid IQ was significantly associated with autonomy in instrumental daily activities (β = 0.211). These findings highlight the need for integrating CR and premorbid IQ with physical and motor measures when appraising predictors of cognitive decline in the elderly population. The study also newly extends the link of CR and premorbid IQ to the functional status in older adults. [ABSTRACT FROM AUTHOR]

The high prevalence of falls and the enormous impact they have on the elderly population is a cause for concern. We aimed to develop a walking-monitor gait pattern (G-STRIDE) for older adults based on a 6-axis inertial measurement (IMU) with the application of pedestrian dead reckoning algorithms and tested its structural and clinical validity. A cross-sectional case–control study was conducted with 21 participants (11 fallers and 10 non-fallers). We measured gait using an IMU attached to the foot while participants walked around different grounds (indoor flooring, outdoor floor, asphalt, etc.). The G-STRIDE consisted of a portable inertial device that monitored the gait pattern and a mobile app for telematic clinical analysis. G-STRIDE made it possible to measure gait parameters under normal living conditions when walking without assessing the patient in the outpatient clinic. Moreover, we verified concurrent validity with convectional outcome measures using intraclass correlation coefficients (ICCs) and analyzed the differences between participants. G-STRIDE showed high estimation accuracy for the walking speed of the elderly and good concurrent validity compared to conventional measures (ICC = 0.69; p < 0.000). In conclusion, the developed inertial-based G-STRIDE can accurately classify older people with risk to fall with a significance as high as using traditional but more subjective clinical methods (gait speed, Timed Up and Go Test). [ABSTRACT FROM AUTHOR]

Difficulty in turning is prevalent in older adults and results in postural instability and risk of falling. Despite this, the mechanisms of turning problems have yet to be fully determined, and it is unclear if different speeds directly result in altered posture and turning characteristics. The aim of this study was to identify the effects of turning speeds on whole-body coordination and to explore if these can be used to help inform fall prevention programs in older adults. Forty-two participants (21 healthy older adults and 21 younger adults) completed standing turns on level ground. Inertial Measurement Units (XSENS) were used to measure turning kinematics and stepping characteristics. Participants were randomly tasked to turn 180° at one of three speeds; fast, moderate, or slow to the left and right. Two factors mixed model analysis of variance (MM ANOVA) with post hoc pairwise comparisons were performed to assess the two groups and three turning speeds. Significant interaction effects (p < 0.05) were seen in; reorientation onset latency of head, pelvis, and feet, peak segmental angular separation, and stepping characteristics (step frequency and step size), which all changed with increasing turn speed. Repeated measures ANOVA revealed the main effects of speeds within the older adults group on those variables as well as the younger adults group. Our results suggest that turning speeds result in altered whole-body coordination and stepping behavior in older adults, which use the same temporospatial sequence as younger adults. However, some characteristics differ significantly, e.g., onset latency of segments, peak head velocity, step frequency, and step size. Therefore, the assessment of turning speeds elucidates the exact temporospatial differences between older and younger healthy adults and may help to determine some of the issues that the older population face during turning, and ultimately the altered whole-body coordination, which lead to falls. [ABSTRACT FROM AUTHOR]

The number of elderly people has increased as life expectancy increases. As muscle strength decreases with aging, it is easy to feel tired while walking, which is an activity of daily living (ADL), or suffer a fall accident. To compensate the walking problems, the terrain environment must be considered, and in this study, we developed the locomotion mode recognition (LMR) algorithm based on the gaussian mixture model (GMM) using inertial measurement unit (IMU) sensors to classify the five terrains (level walking, stair ascent/descent, ramp ascent/descent). In order to meet the walking conditions of the elderly people, the walking speed index from 20 to 89 years old was used, and the beats per minute (BPM) method was adopted considering the speed range for each age groups. The experiment was conducted with the assumption that the healthy people walked according to the BPM rhythm, and to apply the algorithm to the exoskeleton robot later, a full/individual dependent model was used by selecting a data collection method. Regarding the full dependent model as the representative model, the accuracy of classifying the stair terrains and level walking/ramp terrains is BPM 90: 98.74%, 95.78%, BPM 110: 99.33%, 95.75%, and BPM 130: 98.39%, 87.54%, respectively. The consumption times were 14.5, 21.1, and 14 ms according to BPM 90/110/130, respectively. LMR algorithm that satisfies the high classification accuracy according to walking speed has been developed. In the future, the LMR algorithm will be applied to the actual hip exoskeleton robot, and the gait phase estimation algorithm that estimates the user's gait intention is to be combined. Additionally, when a user wearing a hip exoskeleton robot walks, we will check whether the combined algorithm properly supports the muscle strength. [ABSTRACT FROM AUTHOR]

Pathophysiological changes caused by pneumonia may influence physical functioning in older adults. This study was a secondary analysis of the Lifestyle Interventions and Independence for Elders (LIFE) Study. The LIFE Study included 1635 individuals over an average follow-up of 2.6 years at eight clinical sites during 2010–2013. Adults ≥70 years-old with mobility limitations (Short Physical Performance Battery score ≤9) were randomized to a physical activity (exercise) intervention or health education control arm. This analysis evaluated the association between pneumonia events and major mobility disability (MMD), gait speed, and physical activity levels. Pneumonia events, classified as inpatient or outpatient, were assessed by self-report during longitudinal follow-up. MMD was measured by the inability to complete a 400-m walk test, or other proxies, as a binary outcome and separately analyzed as "short-term" and "long-term" MMD. Short-term MMD was defined as MMD occurring in the assessment period immediately following (between 1-day to 6-months after) a pneumonia event and long-term was in the following assessment period (6 to 12 months after the event). Short- and long-term gait speed was similarly recorded during the walk test in meters per second (m/s) and measured on a linear scale. Physical activity levels were captured via accelerometry and shown visually. Mixed-effects repeated measures regression adjusted for intervention assignment, baseline demographics, comorbid conditions, and frailty. Among the 1635 participants, n = 174 (10.7%) had a pneumonia event of which 80 (46% of events) were hospitalized. Those with pneumonia during follow-up had higher baseline medication use, prior hospitalizations, and higher prevalence of lung disorders but similar baseline functioning. Pneumonia hospitalization was associated with a 4-fold increase [OR = 4.1 (3.2–5.0)] and outpatient events were associated with a 2-fold increase [OR = 2.6 (2.1–3.1)] in the odds of short-term MMD. Pneumonia hospitalizations, but not outpatient events, were associated with a nearly 10% decrement in short-term gait speed. Pneumonia events were not associated with either long-term MMD or gait speed outcomes. Physical activity levels decreased from baseline immediately following the pneumonia episode (10–30% reductions) and returned to baseline after 6 months. These results emphasize the importance of managing pneumonia risk factors to prevent disease in order to maintain physical independence and activity in older adults. [ABSTRACT FROM AUTHOR]

Cannabis is one of the most common drugs in the United States and is the third most prevalent substance consumed by adults aged 50 years and older. Normal aging is associated with physiological changes that make older adults vulnerable to impaired function and geriatric conditions (e.g., falls, cognitive impairment). However, the impact of medical cannabis use on fall risk in older adults remains unexplored. The purpose of this study was to investigate if cannabis use in older adults influences fall risk, cognitive function, and motor function. It was hypothesized that older chronic cannabis users would perform worse than non-users on gait, balance, and cognitive tests. Sixteen older adults, split into cannabis Users and age- and sex-matched Non-Users groups (n = 8/group), participated in the study. The results indicate a higher fall risk, worse one leg standing balance performance, and slower gait speed in Users vs. Non-Users. No significant differences in cognitive function were found. Thus, chronic cannabis use was purported to exacerbate the poorer balance control and slower gait velocity associated with normal aging. Future mechanistic (e.g., neuroimaging) investigations of the short- and long-term effects of using a variety of cannabis products (e.g., THC/CBD ratios, routes of administration) on cognitive function, motor function, and fall incidence in older adults are suggested. [ABSTRACT FROM AUTHOR]

Executive function and motor control deficits adversely affect gait performance with age, but the neural correlates underlying this interaction during stair climbing remains unclear. Twenty older adults (72.7 ± 6.9 years) completed single tasks: standing and responding to a response time task (SC), ascending or descending stairs (SMup, SMdown); and a dual-task: responding while ascending or descending stairs (DTup, DTdown). Prefrontal hemodynamic response changes (∆HbO2, ∆HbR) were examined using functional near-infrared spectroscopy (fNIRS), gait speed was measured using in-shoe smart insoles, and vocal response time and accuracy were recorded. Findings revealed increased ∆HbO2 (p = 0.020) and slower response times (p < 0.001) during dual- versus single tasks. ∆HbR (p = 0.549), accuracy (p = 0.135) and gait speed (p = 0.475) were not significantly different between tasks or stair climbing conditions. ∆HbO2 and response time findings suggest that executive processes are less efficient during dual-tasks. These findings, in addition to gait speed and accuracy maintenance, may provide insights into the neural changes that precede performance declines. To capture the subtle differences between stair ascent and descent and extend our understanding of the neural correlates of stair climbing in older adults, future studies should examine more difficult cognitive tasks. [ABSTRACT FROM AUTHOR]

This study aimed to examine the concurrent validity of a novel motor-cognitive dual-task test, the Stepping Trail Making Test (S-TMT), as an indicator of cognitive impairment (CI), and compare its screening performance to that of motor or cognitive tests alone. This was a population-based cross-sectional study including 965 Japanese adults aged ≥ 70 years. To measure the time taken to perform the S-TMT, the participants were instructed to step on 16 numbers in sequence as quickly and accurately as possible. Motor and cognitive functions were assessed by gait speed and TMT part A (TMT-A), respectively. Participants were classified into CI (< 24 points), mild CI (MCI, 24–27 points), and intact cognition (> 27 points) categories based on their Mini-Mental State Examination score. Binary logistic regression models showed that the addition of the S-TMT to the covariates model gave the highest discrimination index (c-statistics), and significantly improved reclassification indices (net reclassification improvement and integrated discrimination improvement) for screening both CI and MCI compared to those of gait speed or TMT-A alone. These results show that S-TMT has a concurrent validity as a dual-task test for screening CI and MCI and better discrimination and reclassification performance than motor or cognitive tests alone in older adults. [ABSTRACT FROM AUTHOR]

The main purpose of the present study was to compare the smoothness of gait in older adults with and without cognitive impairments, using the harmonic ratio (HR), a metric derived from trunk accelerations. Ninety older adults aged over 65 (age: 78.9 ± 4.8 years; 62% female) underwent instrumental gait analysis, performed using a wearable inertial sensor and cognitive assessment with the Mini Mental State Examination (MMSE) and Addenbrooke's Cognitive Examination Revised (ACE-R). They were stratified into three groups based on their MMSE performance: healthy controls (HC), early and advanced cognitive decline (ECD, ACD). The spatio-temporal and smoothness of gait parameters, the latter expressed through HR in anteroposterior (AP), vertical (V) and mediolateral (ML) directions, were derived from trunk acceleration data. The existence of a relationship between gait parameters and degree of cognitive impairment was also explored. The results show that individuals with ECD and ACD exhibited significantly slower speed and shorter stride length, as well as reduced values of HR in the AP and V directions compared to HC, while no significant differences were found between ECD and ACD in any of the investigated parameters. Gait speed, stride length and HR in all directions were found to be moderately correlated with both MMSE and ACE-R scores. Such findings suggest that, in addition to the known changes in gait speed and stride length, important reductions in smoothness of gait are likely to occur in older adults, owing to early/prodromal stages of cognitive impairment. Given the peculiar nature of these metrics, which refers to overall body stability during gait, the calculation of HR may result in being useful in improving the characterization of gait patterns in older adults with cognitive impairments. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the association between a virtual reality (VR) intervention program and cognitive, brain and physical functions in high-risk older adults. In a randomized controlled trial, we enrolled 68 individuals with mild cognitive impairment (MCI). The MCI diagnosis was based on medical evaluations through a clinical interview conducted by a dementia specialist. Cognitive assessments were performed by neuropsychologists according to standardized methods, including the Mini-Mental State Examination (MMSE) and frontal cognitive function: trail making test (TMT) A & B, and symbol digit substitute test (SDST). Resting state electroencephalogram (EEG) was measured in eyes open and eyes closed conditions for 5 minutes each, with a 19-channel wireless EEG device. The VR intervention program (3 times/week, 100 min each session) comprised four types of VR game-based content to improve the attention, memory and processing speed. Analysis of the subjects for group–time interactions revealed that the intervention group exhibited a significantly improved executive function and brain function at the resting state. Additionally, gait speed and mobility were also significantly improved between and after the follow-up. The VR-based training program improved cognitive and physical function in patients with MCI relative to controls. Encouraging patients to perform VR and game-based training may be beneficial to prevent cognitive decline. [ABSTRACT FROM AUTHOR]

Depressive symptoms and memory problems are risk factors for dementia. Exercise can reduce these in older people, and horticultural activity can benefit people with dementia. This study assessed the efficacy of exercise and horticultural interventions for community-dwelling older adults with depressive symptoms and mild memory decline. In this randomized controlled trial, older adults (n = 89) were assigned to exercise, horticultural, or control groups. Exercise and horticultural programs included 20 weekly 90-min sessions. The control group attended two 90-min classes. Outcomes were assessed at baseline, and then 6- and 12-months post-intervention. Primary outcome measures were the Geriatric Depression Scale-15 (GDS-15) and Wechsler Memory Scale-Revised. Walking speed, two-minute walking test scores, social network, life space, and subjective daily physical activity were secondary outcome measures. Compared with the control group, the exercise group obtained higher immediate and delayed recall logical memory scores, and the increase in immediate recall scores remained 12-months post-intervention. Two-minute walking performance improved in the exercise group, but not after 12 months. GDS-15 scores showed no significant improvements. The horticultural and control groups showed no differences. Exercise may improve memory, while horticultural activity may not. The effects of exercise and horticultural interventions on depressive symptoms remain unclear. [ABSTRACT FROM AUTHOR]

A gradually increasing prevalence of mild cognitive impairment (MCI) is recognized in the super-aging society that Japan faces, and early detection and intervention in community-dwellers with MCI are critical issues to prevent dementia. Although many previous studies have revealed MCI/non-MCI differences in older individuals, information on the prevalence and characteristics of MCI in rural older adults is limited. The aim of this study was to investigate differential characteristics between older adults with and without MCI. The investigation was conducted over one year from 2018 to 2019. Participants were recruited from Akita in northern Japan. Neuropsychological assessments were applied to classify MCI, including the National Center for Geriatrics and Gerontology Functional Assessment Tool (NCGG-FAT) and the Touch panel-type Dementia Assessment Scale (TDAS) based on the Alzheimer's disease assessment scale. Our samples consisted of 103 older adults divided into 54 non-MCI and 49 MCI. The MCI group had lower scores of all cognitive items. Our results showed that individuals with MCI had significantly slower walking speed (WS) and worse geriatric depression scale (GDS) compared to non-MCI. In addition, WS was significantly associated with some cognitive items in non-MCI, but not in MCI. Finally, we showed that predictive variables of MCI were WS and GDS. Our study provides important information about MCI in rural community-dwellers. We suggest that older adults living in a super-aging society should receive lower limb training, and avoiding depression in older adults through interaction of community-dwellers may contribute to preventing the onset of MCI. [ABSTRACT FROM AUTHOR]

There has been less research conducted on the psychological aspects of frailty than on the physical and cognitive characteristics of frailty. Thus, we aimed to define psychological frailty, clarify its prevalence, and investigate the relationship between psychological frailty and lifestyle activity or disability incidence in older adults in Japan. The participants in our study were 4126 older adults (average age 71.7 years) enrolled in the National Center for Geriatrics and Gerontology-i87uStudy of Geriatric Syndromes (NCGG-SGS). We characterized physical frailty of the following as ≥ 3: slow walking speed, muscle weakness, exhaustion, low physical activity, and weight loss. We used the Geriatric Depression Scale 15 items version (GDS-15) to screen for depressive mood, indicated by 5 points or more on the scale. The co-presence of physical frailty and depressive mood was defined as psychological frailty. The incidence of disability was determined using data from the Japanese long-term care insurance system over 49 months. We found that the prevalence of physical frailty, depressive mood, and psychological frailty were 6.9%, 20.3%, and 3.5%, respectively. Logistic regression indicated that the odds ratios for loss of lifestyle activities were significantly higher in participants with psychological frailty for going outdoors using the bus or train, driving a car, using maps to go to unfamiliar places, reading books or newspapers, cognitive stimulation, culture lessons, giving advice, attending community meetings, engaging in hobbies or sports, house cleaning, fieldwork or gardening, and taking care of grandchildren or pets. During the follow-up period, 385 participants (9.3%) developed a disability. The incidence of disability was associated with both physical and psychological frailty in the fully adjusted model. However, no significant association between disability and depressive mood was found. We conclude that individuals with psychological frailty had the highest risk of disability. Future policies should implement disability prevention strategies among older adults with psychological frailty. [ABSTRACT FROM AUTHOR]