Advertisement

Engineering Improved Balance Confidence in Older Adults With Complex Health Care Needs: Learning From the Muscling Up Against Disability Study

Published:April 05, 2018DOI:https://doi.org/10.1016/j.apmr.2018.03.004

      Abstract

      Objective

      To investigate the associations of balance confidence with physical and cognitive markers of well-being in older adults receiving government-funded aged care services and whether progressive resistance plus balance training could positively influence change.

      Design

      Intervention study.

      Setting

      Community-based older adult–specific exercise clinic.

      Participants

      Older adults (N=245) with complex care needs who were receiving government-funded aged care support.

      Interventions

      Twenty-four weeks of twice weekly progressive resistance plus balance training carried out under the supervision of accredited exercise physiologists.

      Main Outcome Measures

      The primary measure was the Activity-specific Balance Confidence Scale. Secondary measures included the Short Physical Performance Battery; fall history gathered as part of the health history questionnaire; hierarchical timed balance tests; Geriatric Anxiety Index; Geriatric Depression Scale; Fatigue, Resistance, Ambulation, Illness, Loss of Weight scale; and EuroQoL-5 dimension 3 level.

      Results

      At baseline, better physical performance (r=.54; P<.01) and quality of life (r=.52; P<.01) predicted better balance confidence. In contrast, at baseline, higher levels of frailty predicted worse balance confidence (r=−.55; P<.01). Change in balance confidence after the exercise intervention was accompanied by improved physical performance (+12%) and reduced frailty (−11%). Baseline balance confidence was identified as the most consistent negative predictor of change scores across the intervention.

      Conclusions

      This study shows that reduced physical performance and quality of life and increased frailty are predictive of worse balance confidence in older adults with aged care needs. However, when a targeted intervention of resistance and balance exercise is implemented that reduces frailty and improves physical performance, balance confidence will also improve. Given the influence of balance confidence on a raft of well-being determinants, including the capacity for positive physical and cognitive change, this study offers important insight to those looking to reduce falls in older adults.

      Keywords

      List of abbreviations:

      ABC (Activity-specific Balance Confidence Scale), DNF (did not finish), DNS (did not start), FIN (finished), FRAIL (Fatigue, Resistance, Ambulation, Illness, Loss of Weight), PRBT (progressive resistance plus balance training), SPPB (Short Physical Performance Battery)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Howland J.
        • Peterson E.W.
        • Levin W.C.
        • Fried L.
        • Pordon D.
        • Bak S.
        Fear of falling among the community-dwelling elderly.
        J Aging Health. 1993; 5: 229-243
        • Australian Institute of Health and Welfare
        Hospitalised fall injury in older people.
        National Injury Surveillance Unit, Canberra2013
        • Hill K.D.
        Call to action on falls prevention 2014.
        (Available at:) (Accessed June 20, 2017)
        • Fairhall N.
        • Sherrington C.
        • Lord S.R.
        • et al.
        Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomised controlled trial.
        Age Ageing. 2013; 43: 616-622
        • Australian Institute of Health and Welfare, Australian Government
        Falls most common cause of injury—with numbers rising.
        Australian Government, Canberra2015
        • Ibrahim J.E.
        • Bugeja L.
        • Willoughby M.
        • et al.
        Premature deaths of nursing home residents: an epidemiological analysis.
        Med J Aust. 2017; 206: 442
        • Cantwell K.
        • Burgess S.
        • Morgans A.
        • Smith K.
        • Livingston M.
        • Dietze P.
        Temporal trends in falls cases seen by EMS in Melbourne: the effect of residence on time of day and day of week patterns.
        Injury. 2016; 47: 266-271
        • Askew C.
        • Field A.
        The vicarious learning pathway to fear 40 years on.
        Clin Psychol Rev. 2008; 28: 1249-1265
        • Powell L.E.
        • Myers A.M.
        The Activities-specific Balance Confidence (ABC) Scale.
        J Gerontol A Biol Sci Med Sci. 1995; 50: M28-M34
        • Lachman M.E.
        • Howland J.
        • Tennstedt S.
        • Jette A.
        • Assmann S.
        • Peterson E.W.
        Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE).
        J Gerontol B Psychol Sci Soc Sci. 1998; 53: P43-P50
        • Trombetti A.
        • Reid K.
        • Hars M.
        • et al.
        Age-associated declines in muscle mass, strength, power, and physical performance: impact on fear of falling and quality of life.
        Osteoporos Int. 2016; 27: 463-471
        • Deshpande N.
        • Metter E.J.
        • Lauretani F.
        • Bandinelli S.
        • Guralnik J.
        • Ferrucci L.
        Activity restriction induced by fear of falling and objective and subjective measures of physical function: a prospective cohort study.
        J Am Geriatr Soc. 2008; 56: 615-620
        • Denkinger M.D.
        • Lukas A.
        • Nikolaus T.
        • Hauer K.
        Factors associated with fear of falling and associated activity restriction in community-dwelling older adults: a systematic review.
        Am J Geriatr Psychiatry. 2015; 23: 72-86
        • Plummer M.
        • Bradley C.
        Tai Chi as a falls prevention strategy in older adults compared to conventional physiotherapy exercise: a review.
        Int J Ther Rehabil. 2017; 24: 239-247
        • Shubert T.E.
        • Smith M.L.
        • Goto L.
        • Jiang L.
        • Ory M.G.
        Otago Exercise Program in the United States: comparison of 2 implementation models.
        Phys Ther. 2017; 97: 187-197
        • Henwood T.
        • Taaffe D.
        Detraining and retraining in older adults following long-term muscle power or muscle strength specific training.
        J Gerontol A Biol Sci Med Sci. 2008; 63: 751-758
        • Henwood T.R.
        • Riek S.
        • Taaffe D.R.
        Strength versus muscle power-specific resistance training in community-dwelling older adults.
        J Gerontol A Biol Sci Med Sci. 2008; 63: 83-91
        • Hewitt J.
        • Refshauge K.M.
        • Goodall S.
        • Henwood T.
        • Clemson L.
        Does progressive resistance and balance exercise reduce falls in residential aged care? Randomized controlled trial protocol for the SUNBEAM program.
        Clin Interv Aging. 2014; 9: 369-376
        • Sherrington C.
        • Whitney J.C.
        • Lord S.R.
        • Herbert R.D.
        • Cumming R.G.
        • Close J.C.
        Effective exercise for the prevention of falls: a systematic review and meta-analysis.
        J Am Geriatr Soc. 2008; 56: 2234-2243
        • Keogh J.W.
        • Henwood T.
        • Gardiner P.
        • Tuckett A.
        • Hodgkinson B.
        • Rouse K.
        Examining evidence based resistance plus balance training in community-dwelling older adults with complex health care needs: trial protocol for the Muscling Up Against Disability project.
        Arch Gerontol Geriatr. 2017; 68: 97-105
        • Mak M.K.
        • Pang M.Y.
        • Mok V.
        Gait difficulty, postural instability, and muscle weakness are associated with fear of falling in people with Parkinson’s disease.
        Parkinsons Dis. 2012; 2012: 901721
        • Moore D.S.
        • Ellis R.
        • Kosma M.
        • Fabre J.M.
        • McCarter K.S.
        • Wood R.H.
        Comparison of the validity of four fall-related psychological measures in a community-based falls risk screening.
        Res Q Exerc Sport. 2011; 82: 545-554
        • Guralnik J.M.
        • Simonsick E.M.
        • Ferrucci L.
        • et al.
        A Short Physical Performance Battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
        J Gerontol. 1994; 49: M85-M94
        • Studenski S.
        • Perera S.
        • Patel K.
        • et al.
        Gait speed and survival in older adults.
        JAMA. 2011; 305: 50-58
        • Kurlowicz L.
        The Geriatric Depression Scale (GDS).
        J Gerontol Nurs. 1999; 25: 8-9
        • Pachana N.A.
        • Byrne G.J.
        • Siddle H.
        • Koloski N.
        • Harley E.
        • Arnold E.
        Development and validation of the Geriatric Anxiety Inventory.
        Int Psychogeriatr. 2007; 19: 103-114
        • Morley J.E.
        • Malmstrom T.
        • Miller D.
        A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans.
        J Nutr Health Aging. 2012; 16: 601-608
        • Herdman M.
        • Gudex C.
        • Lloyd A.
        • et al.
        Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L).
        Qual Life Res. 2011; 20: 1727-1736
        • Green S.
        • Salkind N.
        Using SPSS for Windows and Macintosh: analyzing and understand data.
        Prentice Hall, Upper Saddle River2003
        • Gelman A.
        Scaling regression inputs by dividing by two standard deviations.
        Stat Med. 2008; 27: 2865-2873
        • Friedman J.
        • Hastie T.
        • Tibshirani R.
        Regularization paths for generalized linear models via coordinate descent.
        J Stat Softw. 2010; 33: 1-22
        • da Câmara S.M.
        • Alvarado B.E.
        • Guralnik J.M.
        • Guerra R.O.
        • Maciel A.C.
        Using the Short Physical Performance Battery to screen for frailty in young-old adults with distinct socioeconomic conditions.
        Geriatr Gerontol Int. 2013; 13: 421-428
        • Freire A.N.
        • Guerra R.O.
        • Alvarado B.
        • Guralnik J.M.
        • Zunzunegui M.V.
        Validity and reliability of the Short Physical Performance Battery in two diverse older adult populations in Quebec and Brazil.
        J Aging Health. 2012; 24: 863-878
        • Huang T.T.
        • Wang W.S.
        Comparison of three established measures of fear of falling in community-dwelling older adults: psychometric testing.
        Int J Nurs Stud. 2009; 46: 1313-1319
        • Marchetti G.F.
        • Whitney S.L.
        • Redfern M.S.
        • Furman J.M.
        Factors associated with balance confidence in older adults with health conditions affecting the balance and vestibular system.
        Arch Phys Med Rehabil. 2011; 92: 1884-1891
        • Jacobs J.
        • Horak F.
        • Tran V.
        • Nutt J.
        Multiple balance tests improve the assessment of postural stability in subjects with Parkinson’s disease.
        J Neurol Neurosurg Psychiatry. 2006; 77: 322-326
        • Klima D.W.
        • Newton R.A.
        • Keshner E.A.
        • Davey A.
        Fear of falling and balance ability in older men: the priest study.
        J Aging Phys Act. 2013; 21: 375-386
        • Sherrington C.
        • Tiedemann A.
        • Fairhall N.
        • Close J.C.
        • Lord S.R.
        Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations.
        N S W Public Health Bull. 2011; 22: 78-83
        • Lord S.R.
        • Sherrington C.
        • Menz H.B.
        • Close J.C.
        Falls in older people: risk factors and strategies for prevention.
        Cambridge Univ Pr, Cambridge (UK)2007
        • World Health Organization
        Ageing Life Course: WHO global report on falls prevention in older age.
        World Health Organization, France2008
        • Kostanjsek N.
        Use of the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework and common language for disability statistics and health information systems.
        BMC Public Health. 2011; 11: S3
        • World Health Organization
        How to use the ICF: a practical manual for using the International Classification of Functioning, Disability and Health (ICF): exposure draft for comment.
        World Health Organization, Geneva2013
        • Dishman R.K.
        Compliance/adherence in health-related exercise.
        Health Psychol. 1982; 1: 237-267
        • Dishman R.K.
        Advances in exercise adherence.
        Human Kinetics, Champaign, IL1994
        • Rhodes R.E.
        • Martin A.D.
        • Taunton J.E.
        • Rhodes E.C.
        • Donnelly M.
        • Elliot J.
        Factors associated with exercise adherence among older adults.
        Sports Med. 1999; 28: 397-411
        • de Morton N.A.
        The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study.
        Aust J Physiother. 2009; 55: 129-133
        • Downey G.
        Scaffolding imitation in Capoeira: physical education and enculturation in an Afro-Brazilian art.
        Am Anthropol. 2008; 110: 204-213