Roland Rupprecht

Intrasession reliability of force platform parameters in community-dwelling older adults.

OBJECTIVE To investigate the intrasession reliability of center of pressure (COP) parameters calculated from force platform measurements. DESIGN A cross-sectional study. SETTING Gait and balance laboratory. PARTICIPANTS Community-dwelling healthy older adults (N=63) above the age of 62 years (mean age, 78.74 y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES COP was estimated from a force platform, and the following parameters were calculated: (1) the total length of the COP displacement, (2) area of sway, (3) length of the COP displacement in the sagittal plane, and (4) length of the COP displacement in the frontal plane. Intraclass correlation coefficients (ICCs) were calculated by using 3 successive trials with 4 different test conditions. The test conditions were (1) normative standing with eyes open, (2) normative standing with eyes closed, (3) narrow stance with eyes open, and (4) narrow stance with eyes closed. RESULTS The ICCs for the tests with eyes closed (.710-.946) were higher than those for tests with eyes open (.841-.945). The highest value was obtained for the vector sum of the COP during anteroposterior movement in narrow stance with eyes closed (.946). The value .710 was the lowest of all parameters and was an outlier for the narrow stance with eyes closed test, which was otherwise very reliable. CONCLUSIONS Eight of 16 calculated ICCs showed excellent reliability (>.90). They can be recommended for further use in clinical trials. Tests with closed eyes were more reliable than tests with eyes open. We recommend using eyes closed test conditions when assessing static balance control. For these tests, all the calculated ICCs were over .90, except for measurements of sway area.

The SIMA-project: effects of 1 year cognitive and psychomotor training on cognitive abilities of the elderly

In an interdisciplinary project on maintaining and supporting independent living in old age, (a) competence training, (b) memory training and (c) psychomotor training as well as (d) combined competence and psychomotor training and (e) combined memory and psychomotor training was performed with n = 309 elderly of 75 to 89 years of age for 9 months. Regardless of treatment conditions, an age-related decline of health and subjective well-being was found 1 year after the end of the training. The specific training measures each led to highly significant specific improvements of the trained functions. A favorable influence of competence training on everyday coping and hence on active strategies for staying independent as well as of memory training on all cognitive functions and especially on memory performance was found. While global psychomotor performance was not significantly improved, effects of psychomotor training on specific functions were detected. In addition, the combined psychomotor and memory training led to an improvement of psychomotor performance and to a reduction of symptoms of dementia, even though neither psychomotor training alone nor memory training alone resulted in such effects. Neurophysiological changes leading to a provision of reserve-capacity of CNS-performance are among other effects assumed as an explanation.

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.

Bedingungen der Erhaltung und Förderung von Selbstständigkeit im höheren Lebensalter (SimA)

Zusammenfassung: Das Erzbistum Bamberg, das Bistum Eichstatt und das katholische Bildungswerk der Diozese Linz in Oberosterreich bilden seit 1996, auf der Grundlage der SimA-Trainingsmaterialien, Kursleiter aus, die zahlreiche Trainingsgruppen mit inzwischen mehreren Tausend Senioren durchgefuhrt haben. In Zusammenarbeit mit den kirchlichen Tragern fuhrte das Institut fur Psychogerontologie zwei Evaluierungsstudien durch. In Bayern konnten dabei 392 Personen (Alter: 44-88 Jahre) aus 29 Gruppen im Bereich der Erzdiozese Linz 668 Personen (Alter: 47-93 Jahre) aus 46 Gruppen in die Untersuchung einbezogen werden, Die Auswertung zeigt, dass sich sowohl das allgemeine Befinden als auch die subjektive korperliche Fitness der Teilnehmer durch das Training signifikant verbessert haben. Daneben berichteten die Teilnehmer, dass sich ihre vor dem Training beklagten Gedachtnisstorungen deutlich verringert hatten. Dieses Ergebnis lasst sich durch die objektiven Befunde zum Kurzzeit- und Langzeitgedachtnis bestatigen. ...

Nichtmedikamentöse Therapie und Prävention der Alzheimer Krankheit

Zusammenfassung Nach einer Übersicht zur Prävalenz und den empirisch dokumentierten Risikofaktoren einer dementiellen Erkrankung folgt eine kurze Darstellung therapeutischer Ansätze. Im Anschluss hieran werden Ergebnisse zur Prävalenz sowie den multivariaten Analysen der Frühindikatoren und Risikofaktoren einer Demenz in der SIMA-Studie vorgestellt. Abschließend werden Befunde zu risikomindernden Auswirkungen des im Rahmen der SIMA-Studie entwickelten kombinierten Gedächtnis- und Psychomotoriktrainings erörtert.Summary An overview of prevalence data and empirically documented risk factors of a dementia is followed by a short description of intervention strategies. After this, prevalence data from the SIMA Study are presented and results of the multivariate analyses of early indicators and risk factors are discussed. The last section is dedicated to the risk decreasing effects of a combined memory and psychomotor training program which was developed within the study’s scope.

Reliability analysis of time series force plate data of community dwelling older adults

Frequency-based analysis of body sway has been used to distinguish between healthy young, healthy elderly adults and elderly adults with Huntingtons disease. Our aim was to assess the reliability of spectral-based outcomes of the centre of pressure (CoP) kinematics in order to determine if these outcomes could be tested for their capability to distinguish between elderly fallers and non-fallers in a future study. We have studied balance for 30 community dwelling healthy older adults 60 years or older. Four test conditions were used. Three successive trials were performed for each condition. CoP kinematics were estimated with a force platform with three strain gauges set in a triangular position. The frequency content of these signals was estimated. Intrasession correlation coefficients (ICCs) were then calculated for all test conditions. The reliability of the selected parameters varied between low and high (ICC 0.652-0.939). The ICCs for the narrow stance tests were higher compared to tests with normal standing conditions (0.771-0.94) to (0.652-0.865). The highest value was obtained in the high frequency band (0.939). These measures should be viewed with caution when screening geriatric patients because their reliability cannot always be assumed.

Instrumented gait analysis: a measure of gait improvement by a wheeled walker in hospitalized geriatric patients

BackgroundIn an increasing aging society, reduced mobility is one of the most important factors limiting activities of daily living and overall quality of life. The ability to walk independently contributes to the mobility, but is increasingly restricted by numerous diseases that impair gait and balance. The aim of this cross-sectional observation study was to examine whether spatio-temporal gait parameters derived from mobile instrumented gait analysis can be used to measure the gait stabilizing effects of a wheeled walker (WW) and whether these gait parameters may serve as surrogate marker in hospitalized patients with multifactorial gait and balance impairment.MethodsOne hundred six patients (ages 68–95) wearing inertial sensor equipped shoes passed an instrumented walkway with and without gait support from a WW. The walkway assessed the risk of falling associated gait parameters velocity, swing time, stride length, stride time- and double support time variability. Inertial sensor-equipped shoes measured heel strike and toe off angles, and foot clearance.ResultsThe use of a WW improved the risk of spatio-temporal parameters velocity, swing time, stride length and the sagittal plane associated parameters heel strike and toe off angles in all patients. First-time users (FTUs) showed similar gait parameter improvement patterns as frequent WW users (FUs). However, FUs with higher levels of gait impairment improved more in velocity, stride length and toe off angle compared to the FTUs.ConclusionThe impact of a WW can be quantified objectively by instrumented gait assessment. Thus, objective gait parameters may serve as surrogate markers for the use of walking aids in patients with gait and balance impairments.

Prediction of future falls in a community dwelling older adult population using instrumented balance and gait analysis

BackgroundThe role of instrumented balance and gait assessment when screening for prospective fallers is currently a topic of controversial discussion.ObjectivesThis study analyzed the association between variables derived from static posturography, instrumented gait analysis and clinical assessments with the occurrence of prospective falls in a sample of community dwelling older people.MethodsIn this study 84 older people were analyzed. Based on a prospective occurrence of falls, participants were categorized into fallers and non-fallers. Variables derived from clinical assessments, static posturography and instrumented gait analysis were evaluated with respect to the association with the occurrence of prospective falls using a forward stepwise, binary, logistic regression procedure.ResultsFallers displayed a significantly shorter single support time during walking while counting backwards, increased mediolateral to anteroposterior sway amplitude ratio, increased fast mediolateral oscillations and a larger coefficient (Coeff) of sway direction during various static posturography tests. Previous falls were insignificantly associated with the occurrence of prospective falls.ConclusionVariables derived from posturography and instrumented gait analysis showed significant associations with the occurrence of prospective falls in a sample of community dwelling older adults.ZusammenfassungHintergrundDer Nutzen instrumenteller Gang- und Gleichgewichtsanalyse, zur Früherkennung von Stürzereignissen, wird aktuell kontrovers diskutiert.FragestellungUntersucht wurde der Zusammenhang zwischen Variablen der statischen Posturographie, der instrumentellen Ganganalyse und klinischer Assessments mit dem Auftreten von Stürzereignissen, bei selbstständig lebenden älteren Personen.MethodenBasierend auf einem prospektiv aufgetretenen Sturz wurden 84 ältere Personen in „Stürzer“ und „Nichtstürzer“ klassifiziert. Variablen aus klinischen Assessments, der statischen Posturographie und der instrumentellen Ganganalyse wurden in Hinblick auf eine Assoziation mit prospektiven Stürzen evaluiert, dazu diente ein vorwärts schrittweises, binärer, logistisches Regressionsverfahren.ErgebnisseStürzer zeigten eine signifikant kürzere monopedale Standphase bein Gehen und Rückwärtszählen, im Vergleich mit anterior-posterioren Schwankungen höheremedio-laterale Schwankungen, verstärkte schnelle mediolaterale Oszillationen und einen vergrößerten Koeffizient der Schwankungsrichtung während verschiedener statische posturographischer Tests. Frühere Stürzereignisse waren nicht signifikant assoziiert mit prospektiv erfassten Stürzen.DiskussionVariablen der statischen Posturographie und instrumenteller Ganganalyse zeigten bei selbstständig lebenden älteren Personen signifikante Assoziationen mit prospektiv erfassten Stürzen.

Psychologische Theorien zum Alternsprozess

Das folgende Kapitel zeigt, dass sich Erleben und Verhalten alterer Menschen nicht durch eine einzige allgemeine Alternstheorie erklaren lassen, sondern dass dazu im Verlauf der gerontologischen Wissenschaftshistorie eine grosere Anzahl von theoretischen Uberlegungen entwickelt wurde. Dabei mussten mehrfach „alte“, scheinbar bewahrte Theorien revidiert, neue Theorien aufgestellt und wiederum modifiziert werden. Neben einem kurzen Exkurs zu wissenschaftstheoretischen Grundlagen der Theoriebildung werden, orientiert an der historischen Abfolge, eine Auswahl an Theorien beschrieben, die im Allgemeinen fur die Entwicklung der Gerontologie als Wissenschaft ebenso wie fur das praktische Handeln im Bereich der Intervention mit alteren Menschen als wichtig gelten. Vorgestellt werden dabei das „Defizitmodell des Alterns“, „qualitative Verlaufsmodelle (Stufenmodelle oder Entwicklungsaufgaben)“, „Trait-Theorien“, „Theorien des erfolgreichen Alters“, die „Kompetenztheorie“ und die „kognitive Theorie des Alterns“.

Subjektive Restlebenszeit und vorsorgende Umzugsplanung in der zweiten Lebenshälfte

BACKGROUND Many people wish to remain in current residence for as long as possible. Nonetheless, they do think about their residential future. For older people the question of where to live must be considered with respect to age-related changes and continuity. So far only little research has been focused on the influence of the subjective perception of remaining lifetime until death on plans for the future, for example regarding relocation. OBJECTIVE This study investigated the influence of the subjective perception of time left to live on relocation planning and its timing in the further course of life. MATERIAL AND METHODS The data were obtained from a paper-pencil questionnaire including 2156 persons aged 50 years and older (average age  65.5 years, SD = 9.7 years, range 50-94 years, 51.1 % female) who were asked about their wishes and plans for the future, particularly about their relocation considerations and the subjective perception of remaining time until death. RESULTS Approximately 39 % of the subjects considered relocation in the further course of life. Besides social demographics, current housing and the state of health, the subjective time left in life had a significant influence on the consideration of relocation and its timing in the further course of life. Persons who perceived their time horizon as limited considered relocation later in life (temporizing relocation planning) than persons who perceived themselves to have more time left in life. Their temporal occurrence of precautionary relocation planning is embedded earlier in the course of life. CONCLUSION Thoughts about the residential future of older people should be considered not only in connection with the content of these wishes but also related to the future time perspective and the timing in the further course of life. This can be of assistance in consultation and decision-making situations.