Physical Function and Fatigue in Community-Dwelling Older Adults with High Fall Risk
American Journal of Physical Medicine and Rehabilitation
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Disclosures: Armando S. Miciano, Jr., MD: No financial relationships or conflicts of interest. Objective : 1) Quantify the physical function (PF) and fatigue level (FL) in community-dwelling older adults (CDA) with high fall risk (HFR); and, 2) Investigate correlations of PF with FL and other WHO-ICF body function components (BF): anxiety, depression, and sleep disturbance (SD) and with clinician-derived performance-based assessments (PBA). Design: Retrospective cross-sectional study. Setting : PMR clinic. Participants : 25 CDA [13 males; mean age (SD) male/female 78(7) / 74(7) years] were identified as HFR, defined as CDC-STEADI score >/=4. Interventions: n/a. Main Outcome Measures: PROMIS-29v2.0-Physical-Function (PrPF) sub-scale quantified PF, and PROMIS-29v2.0-Fatigue (PrF) measured FL. Other studied BF included PROMIS-57v2.0-sleep-disturbance (SL), anxiety, and depression sub-scales. PBA included: 6-Minute Walk Test (6MWT) as a measure for gait speed, Berg-Balance-Scale (BBS) for balance/coordination, Dynamic-Gait-Index (DGI) for endurance/power, dynamometer for strength, and skeletal muscle index (by bioelectric impedance analysis) for muscle composition. Results: Data met normality assumptions; hence parametric procedures were used. Mean (SD) scores were (male/female): STEADI 8.3 (4)/7.7 (3), PrPF T-score 34(9)/32(6), PrF T-score 58(11)/57(7), 6MWT (mph) 1.8(0.39)/1.6(0.55), and DGI (maximum score 24) 17(4)/19(3). PF positively correlated with age (r=0.39;p=0.055) and DGI (r=0.579;p=0.024), while fatigue positively correlated with anxiety (r=0.605;p=0.005), depression (r=0.581;p=0.007) and SL (r=0.61;p=0.002). STEADI negatively correlated with age (r=-0.57;p=0.003), PF (r=-0.393;p=0.052), and DGI (r=-0.569;p=0.027). Conclusions: CDA with HFR tend to have severely low physical function, have mild fatigue, and be clinically slow. Their PF is significantly associated with age and power/endurance, while their fatigue is associated with other BF(s) – mood and sleep disturbance. The study supports the importance of studying inter-relationships of fall risk with the WHO-ICF components: body functions (specifically anxiety/depression, fatigue, sleep) and activity limitations when assessing falls in older adults. Future research is needed to determine inter-relationships between BF and PF in other geriatric syndromes such as osteoporosis. Level of Evidence: Level II
Physical function; Fatigue level; Community-dwelling older adults; High fall risk; Correlations; Body function components; Performance-based assessments
Medicine and Health Sciences | Rehabilitation and Therapy
Miciano, A. S.,
Cross, C. L.
Physical Function and Fatigue in Community-Dwelling Older Adults with High Fall Risk.
American Journal of Physical Medicine and Rehabilitation, 12