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The study provides evidence that a simple, safe measure of step execution under dual-task conditions can identify elderly individuals at risk for falls.

Abstract-This study evaluated the reliability and validity of the Hebrew version of the Late-Life Function and Disability Instrument (LLFDI). Fifty-five older adults (mean age 79.7 +/-5.2) participated. We calculated test-retest reliability with intraclass correlation coefficients (ICCs). Partial correlations determined the construct validity with a balance measure (Berg Balance Scale [BBS]) and a mobility measure (Timed Up and Go [TUG] test). We examined known-group validity by comparing the scores of cane and noncane users. Test-retest ICCs ranged from good to excellent (0.77-0.90) for the function component and fair to good for the disability component (0.63-0.83), except for the disability management role subscale (0.46). BBS and TUG were associated with LLFDI overall function (r = 0.48, p < 0.001 and r = -0.52, p < 0.001, respectively). TUG and BBS were weakly associated with disability limitations (r = -0.26 and 0.32, respectively) and disability frequency (r = -0.16 and 0.24, respectively). Cane users showed significantly lower function scores than noncane users. We demonstrated that the Hebrew version of the LLFDI reliably and validly assesses older adults' function and disability. The LLFDI is recommended as an outcome instrument in studies in which older adults' function and disability are outcomes of interest.

BackgroundFalls are common among elderly, most of them occur while slipping or tripping during walking. We aimed to explore whether a training program that incorporates unexpected loss of balance during walking able to improve risk factors for falls.MethodsIn a double-blind randomized controlled trial 53 community dwelling older adults (age 80.1±5.6 years), were recruited and randomly allocated to an intervention group (n = 27) or a control group (n = 26). The intervention group received 24 training sessions over 3 months that included unexpected perturbation of balance exercises during treadmill walking. The control group performed treadmill walking with no perturbations. The primary outcome measures were the voluntary step execution times, traditional postural sway parameters and Stabilogram-Diffusion Analysis. The secondary outcome measures were the fall efficacy Scale (FES), self-reported late life function (LLFDI), and Performance-Oriented Mobility Assessment (POMA).ResultsCompared to control, participation in intervention program that includes unexpected loss of balance during walking led to faster Voluntary Step Execution Times under single (p = 0.002; effect size [ES] =0.75) and dual task (p = 0.003; [ES] = 0.89) conditions; intervention group subjects showed improvement in Short-term Effective diffusion coefficients in the mediolateral direction of the Stabilogram-Diffusion Analysis under eyes closed conditions (p = 0.012, [ES] = 0.92). Compared to control there were no significant changes in FES, LLFDI, and POMA.ConclusionsAn intervention program that includes unexpected loss of balance during walking can improve voluntary stepping times and balance control, both previously reported as risk factors for falls. This however, did not transferred to a change self-reported function and FES.Trial registrationClinicalTrials.gov Registration number: NCT01439451.

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Voluntary Step Execution Test in both single- and dual-task conditions is a simple and safe examination which can potentially and effectively predict future falls, with no added value to dual- over single-task condition.

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Background: Stepping response may be considered the most important postural reaction to prevent a fall because it is the inability to respond effectively to a loss of balance that ultimately determines whether a fall occurs. However, very little has been studied on the effect of exercising on step execution behavior in the elderly. Objectives: To explore whether older persons who exercise regularly have faster voluntary stepping times than sedentary elderly persons. Additionally, we investigated the association between step execution behavior, self-reported physical function, and balance performance. Methods: Case-control study of 48 elderly adults aged 65–91 years who live independently in retirement homes. Participants were classified as 24 exercisers (reporting >2 exercise training activities/week) and 24 age- and gender-matched inactive elderly individuals (who do not exercise regularly). The Voluntary Step Execution Test was performed as a reaction time task while standing on a force platform under single-task and dual-task conditions. Step initiation phase, foot off time, foot contact time, preparatory, and swing phases were extracted from center of pressure and ground reaction force data. Self-reported function was examined using Late-Life Function and Disability Instrument; Berg Balance Test was also performed. Results: Exercisers had significantly faster voluntary step times in single-task condition (959 vs. 1,158 ms) but not during dual-task condition (1,170 vs. 1,303 ms). Exercisers had a significantly higher Berg Balance Test (53.7 ±3.6 vs. 49.8 ±5.3), consumed less medication (3.3 ±2.3 vs. 5.6 ±2.9), and their lower extremity function scores were higher (88.61 ±2.3 vs. 73.1 ±2.7) than those of inactive subjects. Conclusion: Exercising regularly protects from physical functioning loss in older persons and against a decrease in voluntary step execution times during single-task but not during dual-task conditions. Lack of specificity (dual-task exercises) during the training may be the cause of insignificant differences in dual-task stepping performance. Thus, adding dual-task training may improve dual-task performance in the elderly.