Anne Viljanen

Hearing as a Predictor of Falls and Postural Balance in Older Female Twins

BACKGROUND The purpose of the present study was to examine, first, whether hearing acuity predicts falls and whether the potential association is explained by postural balance and, second, to examine whether shared genetic or environmental effects underlie these associations. METHODS Hearing was measured using a clinical audiometer as a part of the Finnish Twin Study on Aging in 103 monozygotic and 114 dizygotic female twin pairs aged 63-76 years. Postural balance was indicated as a center of pressure (COP) movement in semi-tandem stance, and participants filled in a fall-calendar daily for an average of 345 days after the baseline. RESULTS Mean hearing acuity (better ear hearing threshold level at 0.5-4 kHz) was 21 dB (standard deviation [SD] 12). Means of the COP velocity moment for the best to the poorest hearing quartiles increased linearly from 40.7 mm(2)/s (SD 24.4) to 52.8 mm(2)/s (SD 32.0) (p value for the trend = .003). Altogether 199 participants reported 437 falls. Age-adjusted incidence rate ratios (IRRs) for falls, with the best hearing quartile as a reference, were 1.2 (95% confidence interval [CI] = 0.4-3.8) in the second, 4.1 (95% CI = 1.1-15.6) in the third, and 3.4 (95% CI = 1.0-11.4) in the poorest hearing quartiles. Adjustment for COP velocity moment decreased IRRs markedly. Twin analyses showed that the association between hearing acuity and postural balance was not explained by genetic factors in common for these traits. CONCLUSION People with poor hearing acuity have a higher risk for falls, which is partially explained by their poorer postural control. Auditory information about environment may be important for safe mobility.

Poor vision accompanied with other sensory impairments as a predictor of falls in older women

OBJECTIVES we studied visual acuity (VA) and co-existing hearing impairment and poor standing balance as predictors of falls. DESIGN prospective study with 1-year follow-up. SETTING research laboratory and residential environment. PARTICIPANTS 428 women aged 63-76 years from the Finnish Twin Study on Aging. MEASUREMENTS participants were followed up for incidence of falls over 1 year. VA, hearing ability and standing balance were assessed at the baseline. The incidence rate ratios (IRR) for falls were computed using the negative binomial regression model. RESULTS during the follow-up, 47% of participants experienced a fall. After adjusting for age and interdependence of twin sisters, participants with vision impairment (VA of <1.0) but no other sensory impairments had a higher, but non-significant, risk for falls compared to persons with normal vision (IRR 1.5, 95% CI 0.6-4.2). Co-existing vision impairment and impaired balance increased the risk (IRR 2.7, 95% CI 0.9-8.0), as also did co-existing vision and hearing impairment (IRR 4.2, 95% CI 1.5-11.3), compared to those with normal vision. Among persons with all three impairments, the IRR for falls increased to 29.4 (95% CI 5.8-148.3) compared to participants with good vision. CONCLUSION the impact of vision impairment on fall risk was higher when accompanied with other sensory and balance impairments, probably because the presence of other impairments prevented the reception of compensatory information about body posture and environment being received from other sensory sources. When aiming to prevent falls and their consequences in older people, it is important to check whether poor vision is accompanied with other impairments.

Individual and environmental factors underlying life space of older people – study protocol and design of a cohort study on life-space mobility in old age (LISPE)

BackgroundA crucial issue for the sustainability of societies is how to maintain health and functioning in older people. With increasing age, losses in vision, hearing, balance, mobility and cognitive capacity render older people particularly exposed to environmental barriers. A central building block of human functioning is walking. Walking difficulties may start to develop in midlife and become increasingly prevalent with age. Life-space mobility reflects actual mobility performance by taking into account the balance between older adults internal physiologic capacity and the external challenges they encounter in daily life. The aim of the Life-Space Mobility in Old Age (LISPE) project is to examine how home and neighborhood characteristics influence people’s health, functioning, disability, quality of life and life-space mobility in the context of aging. In addition, examine whether a person’s health and function influence life-space mobility.DesignThis paper describes the study protocol of the LISPE project, which is a 2-year prospective cohort study of community-dwelling older people aged 75 to 90 (n = 848). The data consists of a baseline survey including face-to-face interviews, objective observation of the home environment and a physical performance test in the participant’s home. All the baseline participants will be interviewed over the phone one and two years after baseline to collect data on life-space mobility, disability and participation restriction. Additional home interviews and environmental evaluations will be conducted for those who relocate during the study period. Data on mortality and health service use will be collected from national registers. In a substudy on walking activity and life space, 358 participants kept a 7-day diary and, in addition, 176 participants also wore an accelerometer.DiscussionOur study, which includes extensive data collection with a large sample, provides a unique opportunity to study topics of importance for aging societies. A novel approach is employed which enables us to study the interactions of environmental features and individual characteristics underlying the life-space of older people. Potentially, the results of this study will contribute to improvements in strategies to postpone or prevent progression to disability and loss of independence.

Hearing Acuity as a Predictor of Walking Difficulties in Older Women

OBJECTIVES: To examine whether hearing acuity correlates with walking ability and whether impaired hearing at baseline predicts new self‐reported walking difficulties after 3 years.

Fear of Falling and Coexisting Sensory Difficulties As Predictors of Mobility Decline in Older Women

BACKGROUND Mobility decline, the coexistence of several sensory difficulties and fear of falling (FOF) are all common concerns in older people; however, knowledge about the combined effect of FOF and coexisting sensory difficulties on mobility is lacking. METHODS Data on self-reported FOF, difficulties in hearing, vision, balance, and walking 2 km were gathered with a structured questionnaire among 434 women aged 63-76 years at baseline and after a 3-year follow-up. Logistic regression models were used for analyses. RESULTS Every third participant reported difficulties in walking 2 km at baseline. In cross-sectional analysis, the odds ratio for difficulties in walking 2 km was higher among persons who reported FOF compared with persons without FOF and the odds increased with the increasing number of sensory difficulties. Persons who reported FOF and who had three sensory difficulties had almost fivefold odds (odds ratio = 4.7, 95% confidence interval = 1.9-11.7) for walking difficulties compared with those who reported no FOF and no sensory difficulties. Among the 290 women without walking difficulties at baseline, 54 participants developed difficulty in walking 2 km during the 3-year follow-up. Odds ratio for incident walking difficulty was 3.5 (95% confidence interval = 1.6-7.8) in participants with FOF and with 2-3 sensory difficulties compared with persons without FOF and with at most one sensory difficulty at baseline. CONCLUSIONS Older women who have several coexisting sensory difficulties combined with FOF are particularly vulnerable to mobility decline. Avoidance of walking as a result of FOF is likely to be reinforced when multiple sensory difficulties hinder reception of accurate information about the environment, resulting in accelerated decline in walking ability.

association Between Physical Performance and Sense of Autonomy in Outdoor Activities and Life-space Mobility in Community-dwelling Older People

To study the relationship between physical performance and sense of autonomy in outdoor activities with life‐space mobility—the spatial area a person purposefully moves through in daily life—in community‐dwelling older people.

Life-space mobility assessment in older people in Finland; measurement properties in winter and spring

BackgroundLife-space mobility refers to the spatial area an individual moves through, the frequency and need for assistance. Based on the assumption that measurement scale properties are context-specific, we tested the scale distribution, responsiveness, and reproducibility of the 15-item University of Alabama at Birmingham Study of Aging Life-Space Assessment in older people in Finland, specifically accounting for season.MethodsCommunity-dwelling older men and women in central Finland aged 75-90 years were interviewed to determine life-space mobility (score range 0-120). Baseline (January-June 2012) and one-year follow-up data (January-June 2013; n = 806) from the cohort study “Life-space mobility in old age” were used to investigate the scale distribution and responsiveness over a period of one year. In addition, with a sub-sample in conjunction with the one-year follow-up, we collected data to study the two-week test-retest reproducibility (n = 18 winter and n = 21 spring 2013).ResultsThe median life-space mobility score at baseline was 64. The median change in score over the one-year follow-up was zero. However, participants reporting a decline in health (repeated measures ANOVA p = .016) or mobility (p = .002) status demonstrated a significantly larger decrease in life-space mobility score than those reporting no or positive changes over the year. The two-week intra-class correlation (ICC) coefficient was .72. Lower ICC was found in the winter than in the spring sample and for items that represent higher life-space levels.ConclusionsThe test-retest reproducibility of the Life-Space Assessment was fair but somewhat compromised in the winter. Mobility of older people at the life-space levels of “town” and “beyond town” may be more variable. Life-space mobility was responsive to change, regardless of season. Further study is warranted to obtain insight in the factors contributing to seasonal effects.

The progression of myopia from its onset at age 8-12 to adulthood and the influence of heredity and external factors on myopic progression. A 23-year follow-up study

To examine myopic progression and factors connected with myopic progression.

Associations Between Environmental Characteristics and Life-Space Mobility in Community-Dwelling Older People

Objective: To examine the association between perceived environmental barriers to and facilitators for outdoor mobility with life-space among older people. Methods: Community-dwelling, 75- to 90-year-old people (n = 848) were interviewed face-to-face using standard questionnaires. The Life-Space Assessment (LSA), indicating distance and frequency of moving and assistance needed in moving (range 0-120), was used. Environmental barriers and facilitators outdoors were self-reported. Results: Altogether, 41% (n = 348) of the participants had restricted life-space (LSA score < 60). Those reporting one or more environmental barriers had more than double the odds for restricted life-space compared with those reporting no barriers after adjustments for ill health, functioning, and socioeconomic status (SES) differences. Similarly, those reporting four to seven facilitators had lower odds for restricted life-space compared with those reporting three or fewer facilitators. Discussion: Perceptions of one’s environment may either constrain or extend older people’s life-space. Longitudinal studies are needed to study the causality of the findings.

The association between objectively measured physical activity and life‐space mobility among older people

The purpose of this cross‐sectional study was to investigate the association between objectively measured physical activity and life‐space mobility in community‐dwelling older people. Life‐space refers to the spatial area a person purposefully moves through in daily life (bedroom, home, yard, neighborhood, town, and beyond) and life‐space mobility to the frequency of travel and the help needed when moving through different life‐space areas. The study population comprised community‐living 75‐ to 90‐year‐old people {n = 174; median age 79.7 [interquartile range (IQR) 7.1]}, participating in the accelerometer substudy of Life‐Space Mobility in Old Age (LISPE) project. Step counts and activity time were measured by an accelerometer (Hookie “AM20 Activity Meter”) for 7 days. Life‐space mobility was assessed with Life‐Space Assessment (LSA) questionnaire. Altogether, 16% had a life‐space area restricted to the neighborhood when moving independently. Participants with a restricted life space were less physically active and about 70% of them had exceptionally low values in daily step counts (≤ 615 steps) and moderate activity time (≤ 6.8 min). Higher step counts and activity time correlated positively with life‐space mobility. Prospective studies are needed to clarify the temporal order of low physical activity level and restriction in life‐space mobility.