title: Executive Function and Falls in Older Adults: New Findings from a Five-Year Prospective Study Link Fall Risk to Cognition Single Stance Stability and Proprioceptive Control in Older Adults Living at Home: Gender and Age Differences Effect of music-based multitask training on gait, balance, and fall risk in elderly people: a randomized controlled trial. Prognostic value of usual gait speed in well-functioning older people--results from the Health, Aging and Body Composition Study. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Age-associated gait changes in the elderly: pathological or physiological? Effects of new, individually adjusted, progressive balance group training for elderly people with fear of falling and tend to fall: a randomized controlled trial Gait changes in older adults: predictors of falls or indicators of fear. Gait, gait variability and the risk of multiple incident falls in older people: a population-based study. Sensori-motor function, gait patterns and falls in community-dwelling women. The Effects of EnhanceFitness (EF) Training on Dual-Task Walking in Older Adults
abstract: Background Recent findings suggest that executive function ( EF ) plays a critical role in the regulation of gait in older adults , especially under complex and challenging conditions , and that EF deficits may , therefore , contribute to fall risk . The objective of this study was to evaluate if reduced EF is a risk factor for future falls over the course of 5 years of follow-up . Secondary objectives were to assess whether single and dual task walking abilities , an alternative window into EF , were associated with fall risk . Methodology /Main Results We longitudinally followed 256 community-living older adults ( age : 76.4±4.5 yrs ; 61 % women ) who were dementia free and had good mobility upon entrance into the study . At baseline , a computerized cognitive battery generated an index of EF , attention , a closely related construct , and other cognitive domains . Gait was assessed during single and dual task conditions . Falls data were collected prospect ively using monthly calendars . Negative binomial regression quantified risk ratios ( RR ) . After adjusting for age , gender and the number of falls in the year prior to the study , only the EF index ( RR : .85 ; CI : .74–.98 , p = .021 ) , the attention index ( RR : .84 ; CI : .75–.94 , p = .002 ) and dual tasking gait variability ( RR : 1.11 ; CI : 1.01–1.23 ; p = .027 ) were associated with future fall risk . Other cognitive function measures were not related to falls . Survival analyses indicated that subjects with the lowest EF scores were more likely to fall sooner and more likely to experience multiple falls during the 66 months of follow-up ( p<0.02 ) . Conclusions / Significance These findings demonstrate that among community-living older adults , the risk of future falls was predicted by performance on EF and attention tests conducted 5 years earlier . The present results link falls among older adults to cognition , indicating that screening EF will likely enhance fall risk assessment , and that treatment of EF may reduce fall risk In developed countries ,  falls  in  older people  represent a rising problem . As effective prevention should start before the risk becomes evident , an early predictor is needed . Single stance instability would appear as a major risk factor . Aims of the study were to describe single stance stability , its sensory components , and their correlation with age and gender . A r and om sample of 597 older adults ( 319 men , 278 women ) living at home , aged 65–84 , was studied . Stability tests were performed with an electronic postural station . The single stance test showed the impairment of single stance stability in older individuals ( 75–84 yrs ) . The significant decline of stability in the older subjects may be explained by the impairment of proprioceptive control together with the decrease in compensatory visual stabilization and emergency responses .  Younger subjects ( 65–74 yrs ) exhibited better , but still inadequate , proprioceptive control with compensatory visual stabilization . Gender differences appeared in older subjects : women were significantly less stable than men . The measurement of the sensory components of single stance stability could aid in the early detection of a decay in antigravity movements many years before the risk of falling becomes evident . Adequate proprioceptive control could mitigate the effects of all other risks of falling BACKGROUND Falls occur mainly while walking or performing concurrent tasks . We determined whether a music-based multitask exercise program improves gait and balance and reduces fall risk  in elderly individuals . METHODS We conducted a 12-month r and omized controlled trial involving 134 community-dwelling individuals older than 65 years , who are at increased risk of falling . They were r and omly assigned to an intervention group ( n = 66 ) or a delayed intervention control group scheduled to start the program 6 months later ( n = 68 ) . The intervention was a 6-month multitask exercise program performed to the rhythm of piano music .  Change in gait variability under dual-task condition from baseline to 6 months was the primary end point . Secondary outcomes included changes in balance , functional performances , and fall risk . RESULTS At 6 months , there was a reduction in stride length variability ( adjusted mean difference , -1.4 % ; P < .002 ) under dual-task condition in the intervention group , compared with the delayed intervention control group . Balance and functional tests improved compared with the control group . There were fewer falls in the intervention group ( incidence rate ratio , 0.46 ; 95 % confidence interval , 0.27 - 0.79 ) and a lower risk of falling ( relative risk , 0.61 ; 95 % confidence interval , 0.39 - 0.96 ) . Similar changes occurred in the delayed intervention control group during the second 6-month period with intervention . The benefit of the intervention on gait variability persisted 6 months later . CONCLUSION In community-dwelling older people at increased risk of falling , a 6-month music-based multitask exercise program improved gait under dual-task condition , improved balance , and reduced both the rate of falls and the risk of falling . Trial Registration clinical trials.gov Identifier : NCT01107288 OBJECTIVES To define clinical ly relevant cutpoints for usual gait speed and to investigate their predictive value for health-related events in older persons . DESIGN Prospect i ve cohort study . SETTING Health , Aging and Body Composition Study . PARTICIPANTS Three thous and forty-seven well-functioning older persons ( mean age 74.2 ) . MEASUREMENTS Usual gait speed on a 6-m course was assessed at baseline . Participants were r and omly divided into two groups to identify ( Sample A ; n=2,031 ) and then vali date ( Sample B ; n=1,016 ) usual gait-speed cutpoints . Rates of persistent lower extremity limitation events ( mean follow-up 4.9 years ) were calculated according to gait speed in Sample A. A cutpoint ( defining high- ( < 1 m/s ) and low risk ( > or = 1 m/s ) groups ) was identified based on persistent lower extremity limitation events . The predictive value of the identified cutpoints for major health-related events ( persistent severe lower extremity limitation , death , and hospitalization ) was evaluated in Sample B using Cox regression analyses . RESULTS A grade d response was seen between risk groups and health-related outcomes . Participants in the high-risk group had a higher risk of persistent lower extremity limitation ( rate ratio (RR)=2.20 , 95 % confidence interval (CI)=1.76 - 2.74 ) , persistent severe lower extremity limitation ( RR=2.29 , 95 % CI=1.63 - 3.20 ) , death ( RR=1.64 , 95 % CI=1.14 - 2.37 ) , and hospitalization ( RR=1.48 , 95 % CI=1.02 - 2.13 ) than those in the low-risk group . CONCLUSION Usual gait speed of less than 1 m/s identifies persons at high risk of health-related outcomes in well-functioning older people . Provision of a clinical ly meaningful cutpoint for usual gait speed may facilitate its use in clinical and research setting OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity AIM To examine the role of disease-related factors and age-related physiological changes in affecting gait speed and stride length in the elderly . SUBJECTS 925 men and 890 women aged 70 years and above who were ambulant , recruited by r and om sampling stratified according to age and sex , from all recipients of Old Age and Disability Allowance in Hong Kong . DESIGN Gait was assessed by measuring the time taken and the number of steps required to complete a 16-foot walk . Information on health and functional status , cognitive function , and depressive symptoms was collected , and anthropometric indices obtained . Factors affecting walking speed and stride were examined in the overall population and also after excluding those with physical disability or diseases . RESULTS Results were analyzed separately for men and women since mean walking speed was slower in women , who also took a larger number of steps . Age , coexisting disease , leg or back pain , poor vision , low level of physical activity , functional and cognitive impairment , high depressive symptom score , and anthropometric indices were all negatively associated with walking speed . Fallers also had slower speed . After excluding those with diseases or physical impairment , multivariate analysis showed that the only factors affecting speed were age in men , and age , height , and level of physical activity in women . Age and height were factors associated with stride length in men , and height only for women . CONCLUSION Both disease-related factors as well as age-related physiological changes contribute to the decline in walking speed and stride length Objective : To evaluate the effects of a new , individually adjusted , progressive and specific balance group training programme on fear of falling , step execution , and gait in healthy elderly people with fear of falling and tend to fall . Design : R and omized controlled trial . Setting : The study was conducted in Stockholm County , Sweden . Subjects : Fifty-nine community dwelling elderly people were recruited by advertisement , and allocated at r and om to an intervention group ( n = 38 ) or a control group ( n = 21 ) . Intervention : Individually adjusted , progressive and specific balance group training was given three times a week for three months . The training incorporated elements included in , and required for , independent activities of daily living , and for reactions to loss of balance during dual or multiple tasks . Main measures : Fear of falling was assessed with Falls Efficacy Scale International ( FES-I ) . The reaction time of step execution was measured with the step-execution test , and gait was measured with GAITRite ® . Results : After three months the intervention group showed significant positive changes in the FES-I ( P = 0.008 ) , in the step-execution phase of dual-task performance ( P = 0.012 ) , and in gait at preferred speed during single-task performance ; in cadence ( P = 0.030 ) and , at fast speed , in velocity ( P = 0.004 ) and cadence ( P = 0.001 ) . Significant decreases were also found for the likelihood of depression after participating in the training programme . Conclusion : This new balance training programme is feasible and leads to decreased fear of falling , decreased time for step execution during dual-task performance and increased velocity during fast walking OBJECTIVE To determine , in a cohort of ambulatory older adults , whether spatial-temporal measures of foot placement during gait can predict the likelihood of future falls or whether these measures are more likely to be indicative of adaptations associated with pre-existing fear of falling . DESIGN Prospect i ve cohort study . SETTING Baseline gait measurements were performed in a gait and balance laboratory ; subsequent history of falling was monitored prospect ively for 1 year in two self-care facilities . PARTICIPANTS Fourteen male and 61 female consecutive volunteers ( mean age = 82 , SD = 6 ) who were independent in activities of daily living and able to walk 10 m unaided . MEASUREMENTS Spatial gait parameters  were derived from digitized " footprints " ; temporal parameters were derived using footswitches . A clinical activity-based gait assessment was also performed . The dependent variables were pre-existing fear of falling ( reported at baseline ) and future falling ( experiencing one or more falls during the 1-year follow-up ) . MAIN RESULTS Reduced stride length , reduced speed , increased double-support time , and poorer clinical gait scores were associated with fear but showed little evidence of an independent association with falling . Conversely , increased stride-to-stride variability in stride length , speed , and double-support was associated independently with falling but showed little evidence of relationship to fear . Increased stride width showed some evidence of association with both falling and fear . Stride-to-stride variability in speed was the single best independent predictor of falling . CONCLUSIONS Changes in gait cited previously as risk factors for falling , i.e. , decreased stride length and speed and prolonged double support , may in fact be stabilizing adaptations related to fear of falling . Stride-to-stride variability in the control of gait is an independent predictor of falling and may be a useful measure for identifying high-risk individuals and evaluating preventive interventions . Stride width may also be a useful outcome measure . Contrary to common expectation , a wider stride does not necessarily increase stability but instead seems to predict an increased likelihood of experiencing falls BACKGROUND it is uncertain as to which measures of gait best predict those who are likely to fall . Our aim was to investigate the associations of gait and gait variability measures with incident falls risk . METHODS individuals aged 60 - 86 years ( n = 412 ) were r and omly selected from the Tasmanian electoral roll .  Average gait and gait variability measures were collected on a computerised walkway . Falls were recorded prospect ively over 12 months . Log multinomial regression was used to estimate the relative risk of single and multiple falls associated with gait measures . Covariates included age , sex , sensorimotor and cognitive measures , mood and medications . RESULTS in this population -based study greater intra-individual variability in step length and double-support phase were linearly associated with increased risk of multiple falls ( P = 0.04 ) . Non-linear associations with multiple falls were found for gait speed P = 0.002 , cadence P = 0.004 and step time variability P = 0.03 . None of the gait measures predicted risk of single falls . CONCLUSION there is an increased risk of multiple falls , but not single falls , in older people with poorer gait . Specific measures of gait and gait variability seem to confer this risk and may be amenable to interventions design ed to reduce the risk of multiple falls in older people Tests of vision , vestibular function , peripheral sensation , strength , reaction time , balance and gait were administered to 183 community-dwelling women aged 22 - 99 years .  Walking speed , stride length and cadence declined with age with corresponding increases in stance duration and percentage of the stride in the stance phase . Visual acuity and contrast sensitivity , tactile and vibration sense in the lower limb , vestibular function ( as assessed by the vestibular X Writing Test ) , quadriceps and ankle dorsiflexion strength and reaction time were significantly associated with all five gait parameters . Postural sway measures were associated with walking speed , stride length and percentage of the stride in the stance phase . Multiple regression analyses revealed seven sensori-motor measures as significant predictors for one or more of the gait parameters : low contrast visual acuity , tactile sensitivity , vibration sense , vestibular X-test writing performance , quadriceps strength , reaction time and sway . Quadriceps strength was included as a predictor variable for every gait parameter and in each case had the strongest beta weight . Women who fell on two or more occasions in a one-year prospect i ve period had significantly reduced and more variable cadence and significantly increased stance duration ( measured in absolute terms and as a percentage of stride ) than those who did not fall or fell on one occasion only . The study findings eluci date the relative importance of specific physiological systems in the maintenance of normal gait and identify temporal gait measures that are associated with falling in older people Decline in dual-task walking performance is associated with increased risk of falls among older adults . The objective of this study is to determine whether 18 hr of participation in EnhanceFitness ( EF ) , an evidence -based group exercise program , improves dual-task walking performance among community-dwelling older adults . Twenty-eight healthy , community-dwelling older adults were evaluated before participating in EF and after 18 hr of participation . Gait speed was evaluated under single task and dual tasks using the TUG ( Timed Up and Go ) and 1-min walk tests . Dual-task costs ( DTC ) , the relative cost of dual-task performance compared to single-task performance , were calculated for both cognitive and motor tasks . Postural control and executive functions were evaluated as well . After 18 hr of EF , dual-task walking performance improved . Single-task performance improved as well as postural control and executive function . There was no significant change in DTC across all measurements , except for the cognitive task of the TUG
target: Gait speed significantly reduced with the addition of a dual task , with increasing complexity showing greater decrements .
  Cadence , stride time , and measures of gait variability were all negatively affected under the dual-task condition .
  In older adults , the addition of a dual task significantly reduces gait speed and cadence , with possible implication s for the assessment of older people , as the addition of a dual task may expose deficits not observed under single-task assessment
background: This review examines the effect of a dual task on the gait parameters of older adults with a mean gait speed of 1.0 m/s or greater , and the effect of type and complexity of task .