Ellen Freiberger

Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: Results from Germany, the Netherlands and the UK were satisfactory

Purpose. To carry out a cross-cultural validation of the Falls Efficacy Scale International (FES-I), a 16-item modified version of the Falls Efficacy Scale that was developed to assess both easy and more complex physical and social activities, in a range of languages and different cultural contexts. Method. Data were collected in Germany (n = 94), The Netherlands (n = 193), and the UK (n = 178) in samples of older people living in the community. Four-week FES-I re-test data were collected in Germany and The Netherlands. Descriptive statistics and reliability estimates were computed as well as FES-I sum scores according to age, sex, falls history and fear of falling. Results. Mean inter-item correlations were all above 0.38 and internal reliability estimates were all 0.90 or above. The intra-class correlation coefficients in the German and the Dutch sample were 0.79 and 0.82, respectively. As expected, FES-I scores were associated with age, sex, falls history and fear of falling. In addition, the FES-I discriminated between sub-groups somewhat better than the original ten-item FES scale. Conclusions. The FES-I has been shown to have acceptable reliability and construct validity in different samples in different countries and may be used in cross-cultural rehabilitation research and clinical trials.

Long-Term Effects of Three Multicomponent Exercise Interventions on Physical Performance and Fall-Related Psychological Outcomes in Community-Dwelling Older Adults: A Randomized Controlled Trial

To determine the long‐term effects of three strength and balance exercise interventions on physical performance, fall‐related psychological outcomes, and falls in older people.

Performance-based physical function in older community-dwelling persons: a systematic review of instruments

BACKGROUND Identification of older persons at risk for the loss of independence, onset of (co)-morbidity or functional limitations through screening/assessment is of interest for the public health-care system. To date several different measurement instruments for overall physical function are frequently used in practice, but little information about their psychometric properties is available. Objectives and METHODS Our aim was to assess instruments with an overall score related to functional status and/or physical performance on content and psychometric properties. Electronic databases (Medline, EMBASE, AMED, Cochrane Library and CINAHL) were searched, using MeSH terms and relevant keywords. Studies, published in English, were included if their primary or secondary purpose was to evaluate the measurement properties of measurement instruments for overall physical function in community-dwelling older persons aged 60 years and older. Reliability, validity, responsiveness and practicability were evaluated, adhering to a specified protocol. RESULTS In total 78 articles describing 12 different functional assessment instruments were included and data extracted. Seven instruments, including their modified versions, were evaluated for reliability. Nine instruments, including their modified versions, were evaluated with regard to validity. CONCLUSION In conclusion, the Short Physical Performance Battery can be recommended most highly in terms of validity, reliability and responsiveness, followed by the Physical Performance Test and Continuous Scale Physical Functional Performance.

Preventing Falls in Physically Active Community-Dwelling Older People: A Comparison of Two Intervention Techniques

Background: Falls are common in physically active older people; however, most intervention studies have been targeted at frail older people. Objective: To evaluate the effectiveness of two intervention techniques for preventing falls in physically active community-dwelling older people. Methods: Two hundred and seventeen people (120 men and 97 women) aged between 70 and 90 years recruited from a health insurance company membership database were randomly allocated to receive either a psychomotor intervention focusing on body awareness, body experience and coordination, a fitness intervention focusing on functional skills, strength, endurance and flexibility, or no intervention (control group).The outcome measures wereprospective falls (number of fallers, number of multiple fallers, number of falls and falls rate) and measures of physical performance (Timed Up and Go Test, maximal step length, sit-to-stand time, normal and fast walking speed). Results: At the 4-month follow-up, significant improvements in the Timed Up and Go Test and sit-to-stand times were observed for both the psychomotor and fitness intervention groups. During the 12-month follow-up period, 39% of the participants fell at least once, and 19% fell on multiple occasions. The proportion of fallers in the fitness intervention group was 23% less than in the control group (RR = 0.77, 95% CI 0.60–0.97), but no significant reduction in falls was observed in the psychomotor intervention group. Conclusion: A fitness training program improves some aspects of physical performance and reduces falls by 23% in physically active older people.

Predictors for occasional and recurrent falls in community-dwelling older people

BACKGROUND Little is known about the prevalence of falls and the related risk factors in the general population of community-living older people in Germany. OBJECTIVES To assess the prevalence and related predictors of different types of falls in a sample of community-dwelling 65 years and older people in Germany living in a metropolitan area. Study design and setting prospective cohort study in 622 community dwelling people aged > or =65 years. RESULTS A total of 107 persons (17.2%) reported falling at least once (occasional fallers), while 36 (5.7%) experienced two or more falls (recurrent fallers) in the last 6 months. Main predictors for all fallers were age (OR 1.8; 95% CI 1.1-3.0), being female (OR 1.7; 95% CI 1.1-2.2), living alone (OR 1.9; 95% CI 1.2-2.9), poor health status (OR 3.3; 95% CI 2.1-5.3), varifocals (OR 1.7; 95% CI 1.0-3.1), disturbance of memory (OR 1.7; 95% CI 1.0-3.0), depression (OR 4.8; 95% CI 2.5-9.2), sleep disturbances (OR 2.7; 95% CI 1.7-4.3), incontinence (OR 2.1; 95% CI 1.3-4.9), dizziness (OR 3.0; 95% CI 1.9-5.0), 3 medical conditions or more (OR 3.3; 95% CI 2.1-5.1), lower physical functioning and mobility. Two of the strongest predictors were reported falls (OR 4.9; 95% CI 3.1-7.7) and recurrent falls (OR 10.0; 95% CI 5.0-20.0) in the last 6 months. CONCLUSION Older adults living at home should be screened for falls in history and problems in gait and mobility in any anamnesis to identify those who are at risk for falls.

Die Deutsche Version der Falls Efficacy Scale-International Version (FES-I)

ZusammenfassungVorgestellt wird die deutsche Version der Falls Efficacy Scale-International Version (FES-I). Dieser Fragebogen zur Erfassung sturzassoziierter Selbstwirksamkeit bei älteren Menschen wurde im Rahmen eines Experten- Netzwerks zur Sturzprävention (Prevention of Falls Network Europe ProFaNE) entwickelt. Die FES-I stellt eine Erweiterung der Falls Efficacy Scale (FES) dar, in der zum einen komplexere funktionelle Aktivitäten und zum anderen soziale Aspekte der Selbstwirksamkeit zusätzlich aufgenommen wurden. Die FES-I zeigt sowohl eine hohe interne Konsistenz (Cronbachs α = 0,96) als auch eine hohe Retest-Reliabilität (r = 0,96). Die Item-Interkorrelation betrug im Mittel r = 0,55 (Range r = 0,29– 0,79). Ergebnisse von Validierungsstudien bei zu Hause lebenden Älteren aus unterschiedlichen europäischen Ländern und von geriatrischen Patienten mit kognitiver Schädigung werden in Kürze publiziert.SummaryThe German version of the Falls Efficacy Scale-International Version (FES-I), which is presented, was developed for the documentation of fall-related selfefficacy in older persons by a EU-funded expert network (Prevention of Falls Network Europe ProFaNE). The FES-I represents a modification of the original Falls Efficacy Scale (FES), including additional items on complex functional performances and social aspects of falls. The FES-I shows high internal reliability (Cronbach’s α = 0.96) as well as high test-retest reliability (r=0.96). The mean inter-item correlation was: r = 0.55 (Range r = 0.29–0.79). Results of validation studies for the FES-I in community dwelling older persons for different European countries and geriatric patients with cognitive impairment will be published in the near future.

[The German version of the Falls Efficacy Scale-International Version (FES-I)].

ZusammenfassungVorgestellt wird die deutsche Version der Falls Efficacy Scale-International Version (FES-I). Dieser Fragebogen zur Erfassung sturzassoziierter Selbstwirksamkeit bei älteren Menschen wurde im Rahmen eines Experten- Netzwerks zur Sturzprävention (Prevention of Falls Network Europe ProFaNE) entwickelt. Die FES-I stellt eine Erweiterung der Falls Efficacy Scale (FES) dar, in der zum einen komplexere funktionelle Aktivitäten und zum anderen soziale Aspekte der Selbstwirksamkeit zusätzlich aufgenommen wurden. Die FES-I zeigt sowohl eine hohe interne Konsistenz (Cronbachs α = 0,96) als auch eine hohe Retest-Reliabilität (r = 0,96). Die Item-Interkorrelation betrug im Mittel r = 0,55 (Range r = 0,29– 0,79). Ergebnisse von Validierungsstudien bei zu Hause lebenden Älteren aus unterschiedlichen europäischen Ländern und von geriatrischen Patienten mit kognitiver Schädigung werden in Kürze publiziert.SummaryThe German version of the Falls Efficacy Scale-International Version (FES-I), which is presented, was developed for the documentation of fall-related selfefficacy in older persons by a EU-funded expert network (Prevention of Falls Network Europe ProFaNE). The FES-I represents a modification of the original Falls Efficacy Scale (FES), including additional items on complex functional performances and social aspects of falls. The FES-I shows high internal reliability (Cronbach’s α = 0.96) as well as high test-retest reliability (r=0.96). The mean inter-item correlation was: r = 0.55 (Range r = 0.29–0.79). Results of validation studies for the FES-I in community dwelling older persons for different European countries and geriatric patients with cognitive impairment will be published in the near future.

Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons--a narrative review.

One of the many threats to independent life is the age-related loss of muscle mass and muscle function commonly referred to as sarcopenia. Another important health risk in old age leading to functional decline is obesity. Obesity prevalence in older persons is increasing, and like sarcopenia, severe obesity has been consistently associated with several negative health outcomes, disabilities, falls, and mobility limitations. Both sarcopenia and obesity pose a health risk for older persons per se, but in combination, they synergistically increase the risk for negative health outcomes and an earlier onset of disability. This combination of sarcopenia and obesity is commonly referred to as sarcopenic obesity. The present narrative review reports the current knowledge on the effects of complex interventions containing nutrition and exercise interventions in community-dwelling older persons with sarcopenic obesity. To date, several complex interventions with different outcomes have been conducted and have shown promise in counteracting either sarcopenia or obesity, but only a few studies have addressed the complex syndrome of sarcopenic obesity. Strong evidence exists on exercise interventions in sarcopenia, especially on strength training, and for obese older persons, strength exercise in combination with a dietary weight loss intervention demonstrated positive effects on muscle function and body fat. The differences in study protocols and target populations make it impossible at the moment to extract data for a meta-analysis or give state-of-the-art recommendations based on reliable evidence. A conclusion that can be drawn from this narrative review is that more exercise programs containing strength and aerobic exercise in combination with dietary interventions including a supervised weight loss program and/or protein supplements should be conducted in order to investigate possible positive effects on sarcopenic obesity.

Physical activity, exercise, and sarcopenia – future challenges

ZusammenfassungGRUNDLAGEN: Viele Studien haben nachgewiesen, dass die Ethologie von Sarkopenie multikausal und sehr komplex ist. Die Verminderung der Muskelmasse führt zu einem Verlust von Muskelkraft, später zu einem abnehmenden funktionellem Status mit eingeschränkter Mobilität, damit wiederum zu einem höheren Sturzrisiko und zum Schluss zu einem höheren Mortalitätsrisiko. Aktuelle Empfehlungen und Leitlinien geben an, dass körperliche Inaktivität oder ein abnehmendes Niveau der körperlichen Aktivität Teil des Entstehungszyklus von Sarkopenie sind und deshalb körperliche Aktivität als wichtige Säule bei der Entwicklung und Behandlung von Sarkopenie berücksichtigt werden muss. THEMA: Ergebnisse zum Zusammenhang von körperlicher Aktivität und dem Alternsprozess haben nicht immer eindeutige Resultate gezeigt. Diese Inkonsistenz der wissenschaftlichen Ergebnisse ist zum Einen darauf zurückzuführen, dass Begriffe und das zugrunde liegende Konstrukt nicht einheitlich benutzt werden. Zum Anderen beruhen die unterschiedlichen Ergebnisse in der Heterogenität der Zielpopulation, Art der Interventionen oder auch den eingesetzten Messinstrumentarien. Diese Aspekte werden in dem Artikel thematisiert. Mit Bezug auf die zukünftigen Herausforderungen für die Rolle und den Einsatz von körperlicher Aktivität werden zusätzlich in diesem Artikel mögliche Barrieren und Anregungen zur Prävention und Behandlung von Sarkopenie diskutiert. Eine Vielzahl von Studien zeigt, dass strukturierte und gut geplante Trainingsprogramme, bestehend aus progressivem Krafttraining oder einem Schnellkrafttraining, positive Effekte auf die Sarkopenie oder Sarkopenie bezogene Komponente haben. Weniger eindeutig ist allerdings der Erkenntnisstand zum Transfer dieser Ergebnisse auf funktionelle Parameter. SCHLUSSFOLGERUNGEN: Beides, körperliche Aktivität und Training, haben gezeigt, dass sie das Sarkopenierisiko und den Beginn von funktionellen Einschränkungen bei älteren Menschen reduzieren können. Unglücklicherweise weist die Kohorte älterer Menschen gerade die höchsten Anteile von inaktiven oder gering aktiven Menschen auf. Deshalb scheint es zwingend notwendig, ältere Menschen zu motivieren, ihr körperliches Aktivitätsniveau zu erhöhen und sicheren Zugang sowie entsprechenden Trainingsprogramme bereit zu stellen.SummaryBACKGROUND: Numerous studies have demonstrated that the etiology of sarcopenia is multi-causal and very complex process. The degradation of muscle mass leads to a loss of strength, later on to a decreased functional status, impaired mobility, a higher risk of falls, and eventually an increased risk of mortality. Present guidelines state that physical inactivity or a decreased physical activity level is a part of the underlying mechanisms of sarcopenia and therefore physical activity can be seen as an important factor to reverse or modify the development of sarcopenia. TOPIC: Results in the area of physical activity and aging have not always been homogeneous. The inconsistent findings in this research area are related to the different understanding of terms and underlying constructs along with different population, type of intervention, or measurement methods. These aspects will be discussed in the paper. With regard to the formulated future role of physical activity this article will discuss in addition different barriers and challenges in the prevention and treatment of sarcopenia. A multitude of studies shows that structured exercise programs including progressive resistance or power training have positive effects on sarcopenia and sarcopenia-related outcomes but less or inconclusive information is available for the transfer to functional outcomes. CONCLUSIONS: Both physical activities and exercise have shown to decrease risk of sarcopenia and onset of functional limitations in older persons. Unfortunately the cohort of older persons is the one with the highest percentage of individuals classified as inactive or sedentary. Therefore motivating older persons to increase their physical activity level as well as providing safe access to exercise programs seems to be a mandatory task.

Residual effects of muscle strength and muscle power training and detraining on physical function in community-dwelling prefrail older adults: a randomized controlled trial

BackgroundAlthough resistance exercise interventions have been shown to be beneficial in prefrail or frail older adults it remains unclear whether there are residual effects when the training is followed by a period of detraining. The aim of this study was to establish the sustainability of a muscle power or muscle strength training effect in prefrail older adults following training and detraining.Methods69 prefrail community-dwelling older adults, aged 65–94 years were randomly assigned into three groups: muscle strength training (ST), muscle power training (PT) or controls. The exercise interventions were performed for 60 minutes, twice a week over 12 weeks. Physical function (Short Physical Performance Battery=SPPB), muscle power (sit-to-stand transfer=STS), self-reported function (SF-LLFDI) and appendicular lean mass (aLM) were measured at baseline and at 12, 24 and 36 weeks after the start of the intervention.ResultsFor the SPPB, significant intervention effects were found at 12 weeks in both exercise groups (ST: p = 0.0047; PT: p = 0.0043). There were no statistically significant effects at 24 and 36 weeks. In the ST group, the SPPB declined continuously after stop of exercising whereas the PT group and controls remained unchanged. No effects were found for muscle power, SF-LLFDI and aLM.ConclusionsThe results showed that both intervention types are equally effective at 12 weeks but did not result in statistically significant residual effects when the training is followed by a period of detraining. The unchanged SPPB score at 24 and 36 weeks in the PT group indicates that muscle power training might be more beneficial than muscle strength training. However, more research is needed on the residual effects of both interventions. Taken the drop-out rates (PT: 33%, ST: 21%) into account, muscle power training should also be used more carefully in prefrail older adults.Trial registrationThis trial has been registered with clinicaltrials.gov (NCT00783159)