Patterns of participation restriction among older adults at risk of falls and relationship with intrinsic capacity: A latent cluster analysis

Abstract

IntroductionThe concept of participation restriction was first described by the World Health Organization in 2001 as a component of The International Classification of Functioning, Disability and Health Framework. Both falls and fear of falling (FOF) are associated with social isolation, depression, anxiety, poor quality of life and cognitive impairment resulting in participation restriction. Life-space mobility (LSM) is an important indicator for participation restriction which depends on multiple inter-related factors. We aimed to determine participation patterns using latent cluster analysis (LCA) in older adults at risk of falls, its relationship with intrinsic capacity (IC) and its risk prediction.MethodsCross-sectional study of 154 community dwelling older adults ≥ 60 years with falls or risk of falls was conducted. Questionnaires were administered on demographics, hearing, LSM, frailty (FRAIL scale), anorexia of aging (SNAQ), cognition (Montreal Cognitive Assessment, MoCA), FOF (Falls Efficacy Scale-International), physical function, and assessment for handgrip strength (HGS), gait speed, 5-times sit to stand (STS), vision and times-up-and-go (TUG) were performed. Six IC domains (vision and hearing, cognition, nutrition, mobility and depression) were measured.ResultsThree pattern of participation cluster were identified, high (n = 63, 40.9%), moderate (n = 83, 53.9%) and low (n = 8, 33 5.2%). Individuals in the high participation cluster were significantly younger, had higher LSM scores and lower FES-I scores, more robust, fewer ADL and IADL limitations, lower prevalence of low HGS, higher gait speed and shorter TUG. In the fully adjusted model compared to the high participation cluster, moderate participation was significantly associated with low MoCA scores (OR 4.2, 95% CI 1.7–10.4, p = 0.02), poor STS (OR 7.1, 95% CI 3.0–17.0, p < 0.001) whereas low participation was associated with anorexia of aging (OR 9.9, 95% CI 1.6–60.9, p = 0.014), poor STS (OR 19.1, 95% CI 2.0–187.5, p = 0.011) and hearing impairment (OR 9.8, 95% CI 1.4–70.8, p = 0.024). Participants with 3 out of 6 IC decline had a probability of greater than 80% to belong to the low/moderate participation class.DiscussionPhysical function, cognition, hearing and nutrition were significantly associated with low and/or moderate participation class. Future studies are needed to evaluate improvement in participation of those with falls or at risk for falls through restoration of IC.

Associations of intrinsic capacity, fall risk and frailty in old inpatients

“…Liu et al demonstrated that impaired vitality, locomotion, and psychology domains predicted the incidence of future falls within two years and that cognitive decline was associated with activities of daily living dependence in the future ( 21 ). Another study suggested that older adults with falls or those at risk of falls had at least three domains of IC decline ( 47 ). Thus, older inpatients with low IC composite scores and their domains constitute a high-risk group for falls in hospital settings.…”

The assessment and detection rate of intrinsic capacity deficits among older adults: a systematic review and meta-analysis

“…Sample size varied from 100 to 37,993, with 67.9% comprising studies with fewer than 1,000 participants. About eight studies only recruited individuals with health conditions, such as hypertension, acute coronary syndrome, a history of falls within the past 12 months, or limitations in activities [27][28][29][30][31][32][33][34] (Detailed characteristics were summarized in Table 2).…”

Construction of a predictive model for fear of fall in rehabilitating elderly stroke patients using a multi- layer perceptron neural network

“…Depression and FOF are the reaction of elderly psychological problems,The prevalence of FOF in elderly stroke patients with depressed mood was 3.014 times higher compared with other patients, the results are consistent with a study in South Korea, 20 depression may cause cognitive impairment, suicide, quality of life and other adverse consequences, these negative performance in turn can induce even aggravate FOF. 21 A healthy mental state is an important guarantee for the body to maintain normal emotions and maintain cognitive and physical activities. Therefore, it is necessary to implement targeted intervention for stroke patients with FOF in various aspects such as physiological, psychological and social and external environment, so as to reduce the health damage of FOF to the elderly.…”