Volume 5, Issue 2, June 2020

Objectives

Previous research has shown that balance and gait difficulties are predictors of falls. The aim of this study was to evaluate the predictive validity of two tools reporting on balance and gait among older community living adults independent in personal activities of daily living (p-ADL).

Methods

Prospective study design. Baseline assessment included the Timed Up and Go test (TUG) and the Short Physical Performance Battery (SPPB). Following baseline, falls were recorded monthly for one year by 202 participants (70.1% women) who were independent in p-ADL, and at least 75 years old (79.2±3.5). ROC-curves were made and AUC were calculated.

Results

Fortyseven percent of the participants reported falls. AUCs calculated for TUG were 0.5 (95% CI: 0.5-0.6) for those with at least one fall, and 0.5 (95% CI: 0.5-0.6) for recurrent fallers. Corresponding figures for SPPB were 0.5 (95% CI: 0.5-0.6) and 0.5 (95% CI: 0.5-0.6).

Conclusion

This study does not support a recommendation to use the Timed Up and Go test or the Short Physical Performance Battery as tools for the identification of fall-prone persons among older adults living in the community. These results reinforce the need for further research into appropriate tools for identifying independent but fall-prone older adults.

Considerable attention has recently focused on the role of dual-task exercises (DT) in the older adult. The aim was to conduct a review to describe the dual-task exercises that have been shown to be effective in improving balance and other physical characteristics such as decreased falling and walking speed in older adults. Review of intervention studies, in the Pubmed, PEDro, CINAHL and Web of Science databases. The search produced 498 references, 11 of which were identified with the description of the dual-task exercises, finding a wide variety of exercises, as well as great variability of outcome measures, discovering that the dual task is predominantly used for balance and walking speed training. All studies presented at least one group performing a double cognitive-motor task, some studies used the fixed priority modality in one group and variable in another, finding greater improvements in variable prioritisation. It can be said that dual-task training in older adults can improve balance and walking speed, which in turn reduces the risk of falling only if the planned dual-task training meets certain characteristics, such as training in specific concepts crucial in motor learning and dual-task training modalities.

Sarcopenia is a disease characterized by quantitative and qualitative degeneration of the skeletal muscles and it primarily presents with a decline in the muscle strength. It frequently occurs in patients after a cerebrovascular accident due to a combination of various factors, such as the brain injury, structural adaptations, limited physical activity as long as malnutrition. Most of the articles and reviews concerning stroke-related sarcopenia are limited and usually are discussing about the factors and causes that may lead to the muscle wasting and the particular characteristics that distinguish it from age-related sarcopenia. As a result, even though sarcopenia is described as a medical entity, it appears to lack the attention that requires, limiting the maximum therapeutic effect a patient can obtain. Suggestions have been made concerning general treatment and management of sarcopenia, associated with exercise, diet and the use of medical preparations, lacking though disease-specific guidelines for management, treatment and possibly prevention of stroke-related sarcopenia. Nowadays, it is considered of major importance that the medical community should be properly informed and to raise awareness on this particular issue aiming to a better and holistic management of the patients after a cerebrovascular accident, in order to reduce morbidity and disability that both are sequelae that reduce quality of life.

MOVE.TE is a non-profit participatory physiotherapy platform that aims at translating knowledge in the field of physiotherapy and developing freely available evidence-based physiotherapy programmes targeting the primary care services of the Portuguese National Health service. A group of volunteer academics and clinicians collaborated at different stages and time points to create the first ever falls prevention and management programme and guidance for Physiotherapy in primary care, in Portugal. This report describes this seven-step process. In spite of many challenges, this project constitutes an example of advocacy in physiotherapy for the promotion of better healthcare for older adults.