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The primary aim of this study was to systematically review and meta-analyze the impact of sensorimotor and proprioceptive exercises on balance in older adults. We also sought to define how researchers describe proprioceptive and sensory-motor training and their respective protocols. The review was conducted following the PRISMA guidelines, with searches performed in March 2023. Both authors carried out independent searches using the PubMed and PEDro databases. From a total of 320 identified records, 12 studies were deemed eligible for meta-analysis after screening and removal of duplicates. The average PEDro score was 5.11 ± 1.11 indicating overall fair quality of studies. Common outcome measures included the Berg balance scale, Timed up and go test, Tinetti balance scale, Functional reach test and various single-leg stance tests. All outcomes were significantly improved by the interventions (standard mean difference = 0.65 – 1.29), with little difference between proprioceptive and sensorimotor training. However, the quality of evidence ranged from “very low” to “low” based on GRADE guidelines, suggesting further high-quality studies are needed. This review underscores the potential benefits of sensorimotor and proprioceptive exercises for enhancing balance in older adults, while also highlighting the ambiguity and inconsistency regarding the usage of the terms proprioceptive and sensorimotor training.

Abstract Background Fear of falling (FoF) is an important risk factor for falls among older people. The objectives of our investigations were: a.) to present characteristics of older community-dwelling (CD) fallers with persistent or transient FoF (P-FoF or T-FoF) over 12 months, and b.) to investigate clinical predictors of P-FoF and T-FoF and c.) to explore differences between P-FoF and T-FoF. Methods Our series consisted of 389 older people reporting a fall or injurious fall at baseline and during 24 months follow-up participating in a multicenter prospective study. T-FoF was defined as participants reported “not at all” at baseline and “somewhat/fairly/very concerned” at follow-up, or “not at all” at follow-up, and “somewhat/fairly/very concerned” at baseline, and P-FoF was defined as participants answered “somewhat/fairly/very concerned” in both assessments at baseline and at follow-up. The association between risk factors and T-FoF or P-FoF was investigated by logistic regression analysis. Results The mean age of fallers in our sample was 79.0 years (SD 6.0), and 54.2% were females. Out of 389 older adults with a fall history at baseline, 83 participants (21.3%) did not report any FoF over time, P-FoF and T-FoF were observed in 42.7% and 35.9% of participants, respectively. After adjusting for potential confounders (e.g. age, gender), osteoporosis (OR = 2.04, 95%CI = 1.03–4.05) and impaired physical performance (OR = 2.38, 95%CI = 1.12–5.03) were significant predictors of T-FoF vs No-FoF. Osteoporosis (OR = 2.68, 95%CI = 1.31–5.48), depressive symptoms (OR = 3.54, 95%CI = 1.23–10.1) and living alone (OR = 2.44, 95%CI = 1.17–5.06) were significantly associated with P-FoF vs No-FoF. When comparing T-FoF and P-FoF, female gender (OR = 1.95, 95%CI = 1.16–3.27), BMI (OR = 1.08, 95%CI = 1.02–1.14), overall comorbidity (OR = 1.07, 95%CI = 1.02–1.13) and depression (OR = 2.55, 95%CI = 1.33–4.88) were significant predictors of P-FoF. Conclusions T-FoF and P-FoF may be predicted by different sets of risk factors among older fallers. Thus, fallers should be screened for FoF especially when carrying specific risk factors, including female gender, osteoporosis, depression, living alone, impaired physical performance, BMI, comorbidity. These findings may be helpful in designing tailored intervention to blunt the risks related to consequence of FoF among older people experiencing falls. Trial registration The SCOPE study was registered prospectively at clinicaltrials.gov (NCT02691546; 25/02/2016).

Identifying the characteristics of fallers is important for preventing falls because such events may reduce quality of life. It has been reported that several variables related to foot positions and angles during gait (e.g., sagittal foot angle and minimum toe clearance) differ between fallers and non-fallers. However, examining such representative discrete variables may not be sufficient to detect crucial information, which may be contained in the large portions of unanalyzed data. Therefore, we aimed to identify the comprehensive characteristics of foot position and angle during the swing phase of gait in non-fallers and fallers using principal component analysis (PCA). Thirty non-fallers and 30 fallers were recruited for this study. We performed PCA to reduce the dimensions of foot positions and angles during the swing phase and obtained principal component scores (PCSs) for each principal component vector (PCV), which were then compared between groups. The results revealed that the PCS of PCV3 in fallers was significantly larger than that in non-fallers (p = 0.003, Cohen’s d = 0.80). We reconstructed waveforms of foot positions and angles during the swing phase using PCV3 and our main findings can be summarized as follows. Compared to non-fallers, fallers have a 1) low average foot position in the z-axis (i.e., height) during the initial swing phase 2) small average foot angle in the x-axis (i.e., rotation in the sagittal plane), during the initial swing phase, and 3) large variability in foot position in the y-axis (i.e., anterior/posterior position) during the initial swing phase. We can conclude that these are characteristics of gait related to fallers. Therefore, our findings may be beneficial for evaluating fall risk during gait using a device such as a shoe- or insole-embedded inertial measurement unit.

This study aimed to determine the relationship between postural asymmetry and falls in Parkinson's disease (PD). In total, 28 patients with PD were included. Postural control was analyzed in bipedal, tandem, and unipedal standing. Center of pressure (CoP) parameters were calculated for both limbs, and asymmetry was assessed using the asymmetry index. Logistic regression was used to predict/classify fallers through postural asymmetry. The Spearman correlation was performed to relate asymmetry and falls number. Poisson regression models were created to predict the number of falls in each condition. The results demonstrated that asymmetry can classify 75% of fallers and nonfallers. Asymmetry in anteroposterior-mean velocity of CoP in unipedal standing was related to the number of falls. Poisson regression showed that anteroposterior-mean velocity of CoP predicts falls in PD, indicating that increased asymmetry results in a greater number of falls. Anteroposterior-mean velocity of CoP seems to be a sensitive parameter to detect falls in PD, mainly during a postural challenging task. [ABSTRACT FROM AUTHOR]

Background: Fear of falling (FoF) is an important risk factor for falls among older people. The objectives of our investigations were: a.) to present characteristics of older community-dwelling (CD) fallers with persistent or transient FoF (P-FoF or T-FoF) over 12 months, and b.) to investigate clinical predictors of P-FoF and T-FoF and c.) to explore differences between P-FoF and T-FoF.Methods: Our series consisted of 389 older people reporting a fall or injurious fall at baseline and during 24 months follow-up participating in a multicenter prospective study. T-FoF was defined as participants reported "not at all" at baseline and "somewhat/fairly/very concerned" at follow-up, or "not at all" at follow-up, and "somewhat/fairly/very concerned" at baseline, and P-FoF was defined as participants answered "somewhat/fairly/very concerned" in both assessments at baseline and at follow-up. The association between risk factors and T-FoF or P-FoF was investigated by logistic regression analysis.Results: The mean age of fallers in our sample was 79.0 years (SD 6.0), and 54.2% were females. Out of 389 older adults with a fall history at baseline, 83 participants (21.3%) did not report any FoF over time, P-FoF and T-FoF were observed in 42.7% and 35.9% of participants, respectively. After adjusting for potential confounders (e.g. age, gender), osteoporosis (OR = 2.04, 95%CI = 1.03-4.05) and impaired physical performance (OR = 2.38, 95%CI = 1.12-5.03) were significant predictors of T-FoF vs No-FoF. Osteoporosis (OR = 2.68, 95%CI = 1.31-5.48), depressive symptoms (OR = 3.54, 95%CI = 1.23-10.1) and living alone (OR = 2.44, 95%CI = 1.17-5.06) were significantly associated with P-FoF vs No-FoF. When comparing T-FoF and P-FoF, female gender (OR = 1.95, 95%CI = 1.16-3.27), BMI (OR = 1.08, 95%CI = 1.02-1.14), overall comorbidity (OR = 1.07, 95%CI = 1.02-1.13) and depression (OR = 2.55, 95%CI = 1.33-4.88) were significant predictors of P-FoF.Conclusions: T-FoF and P-FoF may be predicted by different sets of risk factors among older fallers. Thus, fallers should be screened for FoF especially when carrying specific risk factors, including female gender, osteoporosis, depression, living alone, impaired physical performance, BMI, comorbidity. These findings may be helpful in designing tailored intervention to blunt the risks related to consequence of FoF among older people experiencing falls.Trial Registration: The SCOPE study was registered prospectively at clinicaltrials.gov (NCT02691546; 25/02/2016). [ABSTRACT FROM AUTHOR]

Abstract Background Falling is the most common accident of daily living and the second most prevalent cause of accidental death in the world. The complex nature of risk factors associated with falling makes those at risk amongst the elderly population difficult to identify. Commonly used clinical tests have limitations when it comes to reliably detecting the risk of falling, but existing laboratory tests, such as force platform measurements, represent one method of overcoming this lack of a test. Despite their widespread use, however, Center of Pressure (COP) signal analysis techniques vary and there is currently no consensus on which features should be used diagnostically. Our objective is to identify, through a systematic review and meta-analysis, the COP characteristics of older adults (≥ 60 years old) during quiet bipedal stance which will allow fallers to be distinguished from non-fallers. Methods The systematic review will include both prospective and retrospective articles. Five databases will be searched: PubMed, Cochrane CENTRAL, EMBASE, and ScienceDirect. In addition, a search of gray literature will be performed using Google Scholar and ClinicalTrials.gov. Searches will be circumscribed to include only older adults (aged over 60 years) who underwent a bipedal quiet standing measure of their balance and for whom the number of falls was reported. Two authors will independently assess the risk of bias for each included article using a 26-item checklist. Funnel plots will be drawn to attest of possible publication biases for each COP parameters. The results will be synthesized descriptively and a meta-analysis will be undertaken. When trial methodological heterogeneity is too great for pooling of the data into a meta-analysis, evidence strength will be evaluated using best evidence analysis. Discussion Despite the numerous advantages of posturography, the diversity of studies exploring balance in older fallers has led to uncertainty regarding the method’s ability to reliably identify fall-prone older adults. It is expected that the findings from this systematic review will help clinicians use bipedal quiet standing measures as a diagnostic test and allow researchers to explore COP characteristics to create better models for fall prevention care. Systematic review registration PROSPERO CRD42018098671

Background: Self-inflicted injuries represent a consistent cause of trauma and falls from heights (FFH) represent a common dynamic used for suicidal attempts. The aim of the current report is to compare, among FFH patients, unintentional fallers and intentional jumpers in terms of demographical characteristics, clinical-pathological parameters and mortality, describing the population at risk for suicide by jumping and the particular patterns of injury of FFH patients. Materials and methods: The present study is a retrospective analysis of prospectively collected data regarding FFH patients, extracted from the Trauma Registry of the Papa Giovanni XXIII Hospital in Bergamo, Italy. Demographic characteristics, clinical-pathological parameters, patterns of injury, outcomes including mortality rates of jumpers and fallers were analyzed and compared. Results: The FFH trauma group included 299 patients between April 2014 and July 2016: 259 of them (86.6%) were fallers and 40 (13.4%) were jumpers. At multivariate analysis both young age (p = 0.01) and female sex (p < 0.001) were statistical significant risk factors for suicidal attempt with FFH. Systolic blood pressure (SBP) at the arrival was lower and ISS was higher in the self-inflicted injury group (SBP 133.35 ± 23.46 in fallers vs 109.89 ± 29.93 in jumpers, p < 0.001; ISS in fallers 12.61 ± 10.65 vs 18.88 ± 11.80 in jumpers, p = 0.001). Jumpers reported higher AIS score than fallers for injuries to: face (p = 0.023), abdomen (p < 0.001) and extremities (p = 0.004). The global percentage of patients who required advanced or definitive airway control was significantly higher in the jumper group (35.0% vs 16.2%, p = 0.005). In total, 75% of jumpers and the 34% of fallers received surgical intervention (p < 0.001). A higher number of jumpers needed ICU admission, as compared to fallers (57.5% vs 23.6%, p < 0.001); jumpers showed longer total length of stay (26.00 ± 24.34 vs 14.89 ± 13.04, p = 0.007) and higher early mortality than fallers (7.5% vs 1.2%, p = 0.008). Conclusions: In Northern Italy, the population at highest risk of suicide by jumping and requiring Trauma Team activation is greatly composed by middle-aged women. Furthermore, FFH is the most common suicidal method. Jumpers show tendency to "feet-first landing" and seem to have more severe injuries, worse outcome and a higher early mortality rate, as compared to fallers. The Trauma Registry can be a useful tool to describe clusters of patients at high risk for suicidal attempts and to plan preventive and clinical actions, with the aim of optimizing hospital care for FFH trauma patients. [ABSTRACT FROM AUTHOR]

Background: Pregnant women experience numerous physiological and biomechanical alterations which may be associated with their increased risk of experiencing a fall. Gait alterations in other populations who fall include increased step width and mediolateral trunk motion. It is not known if pregnant women who have fallen exhibit these alterations.Research Question: Our purpose was to examine torso kinematics and step width during gait in pregnant fallers, pregnant non-fallers and non-pregnant controls. We also examined trunk anthropometry in the pregnant groups to determine if pregnant fallers have different trunk physiques than pregnant non-fallers.Methods: 3D kinematic data were collected on 14 pregnant fallers, 15 pregnant non-fallers and 40 non-pregnant controls. Pregnant women were in their second or third trimester of pregnancy. Frontal plane translations of C7 and L4, step width, stride length, walking velocity, and 3D thoracic and pelvic kinematics were determined. Anthropometric torso measurements were obtained on the pregnant women. A series of MANCOVAs was performed (covariate: walking velocity, α = 0.05) to compare the dependent variables between pregnant fallers, pregnant non-fallers, and controls. Tukey post-hoc analyses were performed when appropriate (α = 0.05). A MANOVA compared anthropometric variables between pregnant fallers and non-fallers (α = 0.05).Results: Pregnant non-fallers exhibited greater step width and frontal and transverse plane angles at heel contact and range of motion over the gait cycle when compared to the fallers. Trunk anthropometry did not differ between pregnant fallers and non-fallers.Significance: Pregnancy-associated gait alterations differed between fallers and non-fallers. Greater step width of the pregnant non-fallers increased the base of support, thus increasing stability. Exercise participation may allow pregnant women to better adapt to their altered physiques and be more able to prevent a fall should a trip or slip occur. [ABSTRACT FROM AUTHOR]

Older adults who fall recurrently have sub-optimal physical performance especially muscle strength, mobility and balance. Recurrent falls lead to a heightened fear of falls. However, there is limited information regarding other domains of physical performance, namely flexibility and endurance. In addition, there is still limited knowledge pertaining fear of falls and physical activity levels among Malaysian community-dwelling older adults who are recurrent fallers. The aim of our study was to compare fear of falls, physical performance and physical activity levels among older adults with falls and recurrent falls. This cross-sectional study was carried out in two Malaysian urban districts. Physical performance was examined using Functional Fitness MOT (FFMOT). Modified Baecke Questionnaire and Activities-Specific Balance Confidence (ABC-6) Scale were administered to evaluate the level of daily physical activity and fear of falls respectively. A total of 35 older adults participated in this study, 20 fallers (mean age: 71.95±8.22) and 15 recurrent fallers (mean age: 76.73±8.82) respectively. Our study results showed that older adults with recurrent falls had significantly reduced lower extremity strength, dynamic balance, endurance, balance confidence in activities of daily living and physical activity levels compared to faller group (p < 0.05). Although flexibility and upper limb strength were not significantly different among fallers and recurrent fallers, overall improvement in physical performance should be targetted in falls prevention and management. This is vital to prevent further deterioration in physical performance among older adults with recurrent falls. [ABSTRACT FROM AUTHOR]

Elissa Burton,1,2 Vinicius Cavalheri,1 Richard Adams,3 Colleen Oakley Browne,4 Petra Bovery-Spencer,4 Audra M Fenton,3 Bruce W Campbell,5 Keith D Hill1,6 1School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia; 2Research Department, Silver Chain, Perth, WA, Australia; 3Community Services, West Gippsland Healthcare Group, Warragul, VIC, Australia; 4Falls Prevention for People Living with Dementia Project, Central West Gippsland Primary Care Partnership, Moe, VIC, Australia; 5Allied Health, Latrobe Regional Hospital, Traralgon, VIC, Australia; 6Preventive and Public Health Division, National Ageing Research Institute, Melbourne, VIC, Australia Objective: The objective of this systematic review and meta-analysis is to evaluate the effectiveness of exercise programs to reduce falls in older people with dementia who are living in the community.Method: Peer-reviewed articles (randomized controlled trials [RCTs] and quasi-experimental trials) published in English between January 2000 and February 2014, retrieved from six electronic databases – Medline (ProQuest), CINAHL, PubMed, PsycInfo, EMBASE and Scopus – according to predefined inclusion criteria were included. Where possible, results were pooled and meta-analysis was conducted.Results: Four articles (three RCT and one single-group pre- and post-test pilot study) were included. The study quality of the three RCTs was high; however, measurement outcomes, interventions, and follow-up time periods differed across studies. On completion of the intervention period, the mean number of falls was lower in the exercise group compared to the control group (mean difference [MD] [95% confidence interval {CI}] =-1.06 [-1.67 to -0.46] falls). Importantly, the exercise intervention reduced the risk of being a faller by 32% (risk ratio [95% CI] =0.68 [0.55–0.85]). Only two other outcomes were reported in two or more of the studies (step test and physiological profile assessment). No between-group differences were observed in the results of the step test (number of steps) (MD [95% CI] =0.51 [-1.77 to 2.78]) or the physiological profile assessment (MD [95% CI] =-0.10 [-0.62 to 0.42]).Conclusion: Findings from this review suggest that an exercise program may potentially assist in preventing falls of older people with dementia living in the community. However, further research is needed with studies using larger sample sizes, standardized measurement outcomes, and longer follow-up periods, to inform evidence-based recommendations. Keywords: cognitive impairment, older people, physical activity, fallers, community dwelling

Falls from height are a common cause of marbidity and mortality. The aim of this study is to examine the characteristics of the victims, the circumstances of the fall and distribution of the injuries of accidental and suicidal falls from height. It was a retrospective cross-sectional study, based on autopsies performed over 16 years (January 2005 to December 2020). The recorded variables included demographic data of the victim, height of fall, death scene findings, length of hospital stay, autopsy findings, and toxicological results. Of the 753 victims of fall from height, 607 were fallers and 146 were jumpers. We found that male victims were predominant in the accidental group (86.8% vs. 69.2%). The mean age at death was 43.6 ± 17.9 years. Suicidal falls occurred in a private house in the majority of cases (70.5%), while accidental falls occurred most frequently at workplace (43.8%). Suicidal falls were higher than accidental falls (10.4 ± 7.3 m vs. 7.1 ± 5.7 m). Injuries in the thorax, abdomen, pelvis, upper and lower extremities were more frequentl in the suicidal falls group. Pelvic fractures were 2.1 times more likely to occur in the suicidal falls. Head injuries were more frequent in the accidental falls group. The survival delay was shorter in the suicidal falls group. our study highlights the differences in the profile of the victims and in the pattern of injuries caused by falls from height, depending on the victim's intention to fall. [ABSTRACT FROM AUTHOR]

This study compared visual search under everyday conditions among participants across the life span (healthy participants in 4 groups, with average age of 6 years, 8 years, 22 years, and 75 years, and 1 group averaging 73 years with a history of falling). The task involved opening a door and stepping into a room find 1 of 4 everyday objects (apple, golf ball, coffee can, toy penguin) visible on shelves. The background for this study included 2 well-cited laboratory studies that pointed to different cognitive mechanisms underlying each end of the U-shaped pattern of visual search over the life span (Hommel et al., 2004; Trick & Enns, 1998). The results recapitulated some of the main findings of the laboratory study (e.g., a U-shaped function, dissociable factors for maturation and aging), but there were several unique findings. These included large differences in the baseline salience of common objects at different ages, visual eccentricity effects that were unique to aging, and visual field effects that interacted strongly with age. These findings highlight the importance of studying cognitive processes in more natural settings, where factors such as personal relevance, life history, and bodily contributions to cognition (e.g., limb, head, and body movements) are more readily revealed. [ABSTRACT FROM AUTHOR]

Minimum toe clearance (MTC) is thought to quantify the risk of the toe contacting the ground during the swing phase of gait and initiating a trip, but there are methodological issues with this measure and the risk of trip-related falls has been shown to also be associated with gait speed and dynamic stability. This paper proposes and evaluates a new measure, trip risk integral (TRI), that circumvents many issues with MTC as typically calculated at a single point by considering minimum foot clearance across the entire swing phase and taking into account dynamic stability to estimate risk of falling due to a trip rather than risk of the foot contacting the floor. Shoes and floor surfaces were digitized and MTC and TRI calculated for unimpaired younger ( N = 14, age = 26 ± 5), unimpaired older ( N = 14, age = 73 ± 7), and older adults who had recently fallen ( N = 11, age = 72 ± 5) walking on surfaces with no obstacles, visible obstacles, and hidden obstacles at slow, preferred, and fast gait speeds. MTC and TRI had significant ( F ≥ 5, p ≤ 0.005) but differing effects of gait speed and floor surface. As gait speed increased (which increases risk of trip-related falls) MTC indicated less and TRI greater risk, indicating that TRI better quantifies risk of falling due to a trip. While MTC and TRI did not differ by subject group, strong speed-related effects of TRI ( F ≥ 8, p ≤ 0.0007) resulted in improved TRI for fallers due to their slower self-selected preferred gait. This demonstrates that slower gait is both an important covariate and potential intervention for trip-related falls. [ABSTRACT FROM AUTHOR]

Falls are a major health-care concern, and while dual-task performance is widely recognized as being impaired in those at-risk for falls, the underlying neurocognitive mechanisms remain unknown. A better understanding of the underlying mechanisms could lead to the refinement and development of behavioural, cognitive, or neuropharmacological interventions for falls prevention. Therefore, we conducted a cross-sectional study with community-dwelling older adults aged 70-80 years with a history of falls (i.e., two or more falls in the past 12 months) or no history of falls (i.e., zero falls in the past 12 months); n = 28 per group. We compared functional activation during cognitive-based dual-task performance between fallers and non-fallers using functional magnetic resonance imaging (fMRI). Executive cognitive functioning was assessed via Stroop, Trail Making, and Digit Span. Mobility was assessed via the Timed Up and Go test. We found that non-fallers exhibited significantly greater functional activation compared with fallers during dual-task performance in key regions responsible for resolving dual-task interference, including precentral, postcentral, and lingual gyri. Further, we report slower reaction times during dual-task performance in fallers and significant correlations between level of functional activation and independent measures of executive cognitive functioning and mobility. Our study is the first neuroimaging study to examine dual-task performance in fallers, and supports the notion that fallers have reduced functional brain activation compared with non-fallers. Given that dual-task performance – and the underlying neural concomitants – appears to be malleable with relevant training, our study serves as a launching point for promising strategies to reduce falls in the future.

Moving visual fields can have strong destabilising effects on balance, particularly when visually perceived motion does not correspond to postural movements. This study investigated relationships between visual field dependence (VFD), as assessed using the roll vection test, and reported dizziness, falls and sway under eyes open, eyes closed and optokinetic conditions. Ninety five falls clinic attendees undertook the roll vection test (i.e. attempted to align a rod to the vertical while exposed to a rotating visual field). Sway was assessed under different visual conditions by centre of pressure movement. Participants also completed questionnaires on space and motion discomfort, fear of falling, depression and anxiety. Thirty four (35.8%) participants exhibited VFD, i.e. had an error >6.5º in the roll vection test. Compared to participants without VFD, participants with VFD demonstrated less movement of the centre of pressure across all visual conditions, were more likely to report space and motion discomfort and to have suffered more multiple falls in the past year. VFD was independent of fear of falling, anxiety and depression. VFD in a falls clinic population is associated with reduced sway possibly due to a stiffening strategy to maintain stance, dizziness symptoms and an increased risk of falls. [ABSTRACT FROM AUTHOR]

The health and financial cost of falls has spurred research to differentiate the characteristics of fallers and non-fallers. Postural stability has received much of the attention with recent studies exploring various measures of entropy. This study compared the discriminatory ability of several entropy methods at differentiating two paradigms in the center-of-pressure of elderly individuals: (1) eyes open (EO) vs. eyes closed (EC) and (2) fallers (F) vs. non-fallers (NF). Methods were compared using the area under the curve (AUC) of the receiver-operating characteristic curves developed from logistic regression models. Overall, multiscale entropy (MSE) and composite multiscale entropy (CompMSE) performed the best with AUCs of 0.71 for EO/EC and 0.77 for F/NF. When methods were combined together to maximize the AUC, the entropy classifier had an AUC of for 0.91 the F/NF comparison. These results suggest researchers and clinicians attempting to create clinical tests to identify fallers should consider a combination of every entropy method when creating a classifying test. Additionally, MSE and CompMSE classifiers using polar coordinate data outperformed rectangular coordinate data, encouraging more research into the most appropriate time series for postural stability entropy analysis. [ABSTRACT FROM AUTHOR]

Falls are a major health-care concern, and while dual-task performance is widely recognized as being impaired in those at-risk for falls, the underlying neurocognitive mechanisms remain unknown. A better understanding of the underlying mechanisms could lead to the refinement and development of behavioral, cognitive, or neuropharmacological interventions for falls prevention. Therefore, we conducted a cross-sectional study with community-dwelling older adults aged 70–80 years with a history of falls (i.e., two or more falls in the past 12 months) or no history of falls (i.e.,zero falls in the past 12 months); n = 28 per group. We compared functional activation during cognitive-based dual-task performance between fallers and non-fallers using functional magnetic resonance imaging (fMRI). Executive cognitive functioning was assessed via Stroop, Trail Making, and Digit Span. Mobility was assessed via the Timed Up and Go test (TUG). We found that non-fallers exhibited significantly greater functional activation compared with fallers during dual-task performance in key regions responsible for resolving dual-task interference, including precentral, postcentral, and lingual gyri. Further, we report slower reaction times during dual-task performance in fallers and significant correlations between level of functional activation and independent measures of executive cognitive functioning and mobility. Our study is the first neuroimaging study to examine dual-task performance in fallers, and supports the notion that fallers have reduced functional brain activation compared with non-fallers. Given that dual-task performance—and the underlying neural concomitants—appears to be malleable with relevant training, our study serves as a launching point for promising strategies to reduce falls in the future. [ABSTRACT FROM AUTHOR]

Identifying the characteristics of fallers is important for preventing falls because such events may reduce quality of life. It has been reported that several variables related to foot positions and angles during gait (e.g., sagittal foot angle and minimum toe clearance) differ between fallers and non-fallers. However, examining such representative discrete variables may not be sufficient to detect crucial information, which may be contained in the large portions of unanalyzed data. Therefore, we aimed to identify the comprehensive characteristics of foot position and angle during the swing phase of gait in non-fallers and fallers using principal component analysis (PCA). Thirty non-fallers and 30 fallers were recruited for this study. We performed PCA to reduce the dimensions of foot positions and angles during the swing phase and obtained principal component scores (PCSs) for each principal component vector (PCV), which were then compared between groups. The results revealed that the PCS of PCV3 in fallers was significantly larger than that in non-fallers ( p = 0.003, Cohen's d = 0.80). We reconstructed waveforms of foot positions and angles during the swing phase using PCV3 and our main findings can be summarized as follows. Compared to non-fallers, fallers have a 1) low average foot position in the z -axis (i.e., height) during the initial swing phase 2) small average foot angle in the x -axis (i.e., rotation in the sagittal plane), during the initial swing phase, and 3) large variability in foot position in the y -axis (i.e., anterior/posterior position) during the initial swing phase. We can conclude that these are characteristics of gait related to fallers. Therefore, our findings may be beneficial for evaluating fall risk during gait using a device such as a shoe- or insole-embedded inertial measurement unit., Competing Interests: Authors CH, FN, KeN, and KF are employed by the company NEC Corporation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Inai, Kobayashi, Huang, Fujita, Fujimoto, Nihey, Yamamoto, Nakajima, Nakahara, Kutsuzawa, Fukushi and Kudo.)

Background: Fall-related fractures are an increasing problem for society. Dizziness is identified as a risk factor for falls and vestibular asymmetry is often found among patients with fall-related fractures. An option to prevent fall-related fractures may be to identify patients with vestibular asymmetry and to improve their balance and asymmetry by exercise. Objective: To examine whether vestibular rehabilitation improves vestibular function, balance and self-rated health among patients with fall-related wrist fractures. Methods: Sixty-eight persons (65 women) with fall-related wrist fractures, mean age 72 years (54-89) participated in this randomized controlled trial. The following tests and measurements were performed: head shake test to evaluate vestibular asymmetry as primary outcome measure, five clinical balance measures, a force plate to measure postural sway, a tuning fork to measure vibration and the EQ5D questionnaire to measure self-rated health. The intervention comprised group-based vestibular rehabilitation sessions conducted twice a week for 9 weeks. Results: Nystagmus occurred in the head shake test in 65% (44 of 68) of the patients, indicating vestibular asymmetry. More patients in the intervention group (6 of 21) than in the control group (0 of 23) changed from having nystagmus in the head shake test at baseline (indicating vestibular asymmetry) to not having nystagmus at follow-up, and more patients in the control group (3 of 9) than in the intervention group (0 of 3) changed from not having nystagmus at baseline to have nystagmus at follow-up (p < 0.00). No other changes occurred between the two groups between baseline and follow-up. At baseline, patients with vestibular asymmetry had more balance deficits and increased postural sway compared to patients without (p = 0.00-0.05). Conclusion: Group sessions with vestibular rehabilitation twice a week for 9 weeks affected the occurrence of vestibular asymmetry positively among patients having vestibular asymmetry. Patients with vestibular asymmetry had more balance deficits and increased postural sway than patients without vestibular asymmetry. Vestibular assessment is important, and, in patients with diagnosed vestibular asymmetry, vestibular rehabilitation may prove beneficial on balance and possibly reduce the risk of future falls. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Maximum step length is a brief clinical test involving stepping out and back as far as possible with the arms folded across the chest. This test has been shown to predict fall risk, but the biomechanics of this test are not fully understood. Knee and hip kinetics (moments and powers) are greater for longer steps and for younger subjects, but younger subjects also step farther. Methods: To separate the effects of step length, age, and fall history on joint kinetics; healthy younger (age=27(5), N=14), older non-fallers (age=72(5), N=14), and older fallers (age=75(6), N=11) all stepped to the same relative target distances of 20–80% of their height. Knee and hip kinetics and knee co-contraction were calculated. Findings: Hip and knee kinetics and knee co-contraction all increased with step length, but older non-fallers and fallers utilized greater stepping hip and less stepping knee extensor kinetics. Fallers had greater stepping knee co-contraction than non-fallers. Stance knee co-contraction of non-fallers was similar to young for shorter steps and similar to fallers for longer steps. Interpretation: Age had minimal effects and fall history had no effects on joint kinetics of steps to similar distances. Effects of age and fall history on knee co-contraction may contribute to age-related kinetic differences and shorter maximal step lengths of older non-fallers and fallers, but step length correlated with every variable tested. Thus, declines in maximum step length could indicate declines in hip and knee extensor kinetics and impaired performance on similar tasks like recovering from a trip. [Copyright &y& Elsevier]

Abstract: Many elderly people experience difficulty with independent living after injuries associated with falls. This study aimed to examine the influence of fall characteristics and physical function level on the severity of fall related injuries. The surveys were conducted in 1955 community dwelling elderly. The questions regarded the following: fall experience within the past year, fall direction, fall cause, injured parts and degree of injury, and an activity of daily living (ADL) questionnaire from the Ministry of Education, Culture, Sports, Science and Technology Japan. Data of 1850 subjects with available and complete responses were used for analysis. Three hundred and eighty-six (20.9%) elderly people experienced a fall within the past year and 257 (66.7%) were injured. ADL score was significantly higher in the elderly without fall experience than the elderly with fall experience. No significant difference was found in frequency of fall cause and fall direction between the elderly with and without injuries caused by falling. Significant correlations were found between fall direction and fall cause and injured parts (φ =0.49 and 0.32). ADL score of the elderly who fell by leg backlash was significantly lower than that of the elderly who fell by tripping, slipping and staggering. A decrease of ADL affects the rate of falls in the elderly, but not the degree of injury. Fall characteristics may not be related to the extent of fall injury. [Copyright &y& Elsevier]

The authors examined differences between young adults (n = 25) and healthy older adults (n = 48) in reaction time and the relations between center of pressure (COP) and center of mass (COM) motions during rapid initiation and termination of voluntary postural sway. Older adults were divided into low and high falls-risk groups based on Physiological Profile Assessment scores of sensorimotor function. Low falls-risk older adults had slower reaction times during anteroposterior sway initiation and decreased COP–COM separation during anteroposterior and medialateral sway initiation and anteroposterior continuous voluntary sway compared with young adults. High falls-risk older adults had slower initiation and termination reaction times in all response directions and decreased COP–COM separation during sway initiation and continuous voluntary sway in the anteroposterior and medialateral directions compared with young adults. Compared with low falls-risk older adults, high falls-risk older adults had slower initiation and termination reaction times in all response directions and decreased COP–COM separation during medialateral continuous voluntary sway. Reaction time and COP–COM measures significantly predicted group status in discriminant models with sensitivities and specificities of 72–100%. Overall, these findings highlight important associations of age-related declines in sensorimotor function related to an increased risk of falling with slower postural reaction time and reduced postural stability. [ABSTRACT FROM AUTHOR]

Background: Falls are one of the greatest concerns among the elderly. A number of studies have described peak torque as one of the best fall-related predictor. No studies have comprehensively focused on the rate of torque development of the lower limb muscles among elderly fallers. Then, the aim of this study was to determine the relationship between muscle peak torque and rate of torque development of the lower limb joints in elderly with and without fall history. It was also aimed to determine whether these parameters of muscle performance (i.e., peak torque and rate of torque development) are related to the number of falls. Methods: Thirty-one women volunteered to participate in the study and were assigned in one of the groups according to the number of falls over the 12months that preceded the present. Then, participants with no fall history (GI; n =13; 67.6[7.5] years-old), one fall (GII; n =8; 66.0[4.9] years-old) and two or more falls (GIII; n =10; 67.8[8.8] years-old) performed a number of lower limb maximal isometric voluntary contractions from which peak torque and rate of torque development were quantified. Findings: Primary outcomes indicated no peak torque differences between experimental groups in any lower limb joint. The rate of torque development of the knee flexor muscles observed in the non-fallers (GI) was greater than that observed in the fallers (P <0.05) and had a significant relationship with the number of falls (P <0.05). Interpretation: The greater knee flexor muscles’ rate of torque development found in the non-fallers in comparison to the fallers indicated that the ability of the elderly to rapidly reorganise the arrangement of the lower limb may play a significant role in allowing the elderly to recover balance after a trip. Thus, training stimulus aimed to improve the rate of torque development may be more beneficial to prevent falls among the elderly than other training stimulus, which are not specifically designed to improve the ability to rapidly produce large amounts of torque. [Copyright &y& Elsevier]

Background: Parkinson's disease (PD) predisposes one to falls, which in turn may lead to serious injury and decreased quality of life. Therefore, it is critical to accurately identify those at risk of falling so that preventive measures may be properly applied. Methods: Forty-nine participants (25 retrospectively identified fallers and 24 nonfallers) with a diagnosis of idiopathic PD were included in this study. Each was assessed using three categories of measurement tools: PD-specific scales (modified Hoehn and Yahr [HY] and Unified Parkinson's Disease Rating Scale [UPDRS]), balance-specific scales (Berg Balance Scale [BBS], Sensory Organization Test [SOT], and Activities-Specific Balance Confidence Scale [ABC]), and functional gait scales (Self-Selected Gait Velocity [SSGV], Dynamic Gait Index [DGI]), and a standardized obstacle course. Results: Using discriminant function analysis, the BBS, HY, and UPDRS-Activities of Daily Living subscale (UPDRS-ADL) were found to be the best discriminators of faller or nonfaller group membership. Receiver operating characteristic (ROC) curves were employed to suggest cutoff scores and to determine overall predictability. The area under the ROC curves, and the corresponding cutoff scores were as follows for the highest three clinical tests: UPDRS-ADL (0.888/12.5), UPDRS-Overall (0.879/36.5), and the BBS (0.851/43.5). The odds ratios for the UPDRS-ADL, UPDRS-Overall, and the BBS were 32.8, 26.7, and 48.9, respectively. Using positive likelihood ratios and a pretest probability of 51.0%, the changes in posttest probability were UPDRS-ADL (85.9%), UPDRS-Overall (89.9%), and BBS (94.4%). Conclusion: Results from this study suggest that the UPDRS-ADL, UPDRS-Overall, and the BBS are the best clinical tests for discriminating falls in persons with PD. [ABSTRACT FROM AUTHOR]

Abstract: Background : Many clinical trials involving elderly people living at home suffer from low recruitment. We report our experience of recruiting people with Parkinson''s disease (PD) from specialist clinical databases, to a randomised controlled trial of personalised exercise. Methods : We aimed to recruit 200 repeat fallers with PD. Subjects were recruited through the clinical registers of specialists in PD in two NHS trusts. They had to have a confirmed diagnosis of PD, be independently mobile, live in the community, be a repeat faller, and were screened for cognitive impairment. Results : Out of 1107 patients on the registers, 457 did not meet the eligibility criteria for the trial. A further 151 were excluded for other reasons. Four hundred and ninety-nine were approached to have a home screening visit: 405 replied and 305 agreed to be screened for the trial. Of those screened, 126 were non-repeat fallers and 22 failed other eligibility criteria. Out of the remaining 157 patients, 18 (11%) decided not to participate in the trial which left 139 recruited to the trial. Seven more were recruited from a second screen of previous non-repeat fallers. In total 146 patients were recruited: 142 to the main trial and four to the initial pilot phase. Conclusion : The percentage of patients who participated in the main trial was only 13% (95% confidence interval 11% to 15%) of those on specialists’ registers, considerably less than estimated, although the proportion of fallers and repeat fallers was similar to that previously reported. [Copyright &y& Elsevier]

A common way of predicting falling risks in elderly people can be to study center of pressure (CP) trajectories during undisturbed upright stance maintenance. By estimating the difference between CP and center of gravity (CG) motions (CP - CGv, one can estimate the neuromuscular activity. The results of this study, which included 34 sedentary elderly persons aged over 75 years (21 fallers and 13 nonfallers), demonstrated significantly increased CGh and CP - CGh motions in both axes for the fallers. In addition, the fallers presented larger CGv motions in the mediolateral axis, suggesting an enlarged loading-unloading mechanism, which could have reflected the adoption of a step-initiating strategy. As highlighted by fractional Brownian motion modeling, the distance covered by the CP - CGv, motions before the successive control mechanisms switched was enhanced for the fallers in both axes, therefore increasing the risk that the CG would be outside of the base of support. [ABSTRACT FROM AUTHOR]

Objectives: Because impaired renal function is detrimental for the conversion of calcidiol to calcitriol (D-hormone) and since D-hormone analogues have been shown to decrease the risk of falls, we investigated whether creatinine clearance (CrCl) is associated with the number of fallers and falls in elderly men and women. Methods: Within a randomized controlled study, we observed for 36 weeks 186 placebo-treated community-dwelling elderly men and women over 70, in an attempt to determine the influence of baseline CrCl on calcitropic hormone serum levels, as well as the influence of baseline CrCl on the number of fallers and falls over time. With the help of questionnaires, we regularly assessed fall incidence and frequency. The risk of falls and the risk of becoming a faller were assessed in multivariate-controlled logistic regression models according to a cutoff value of the CrCl set at 65 ml/min. Results: At baseline, serum levels of 1.25(OH)2D3 and iPTH were, in multivariate-controlled analyses, significantly associated with CrCl (p<0.0001,p=0.001, respectively), whereas serum levels of 25(OH)D3 were not associated with CrCl. Below a CrCl of 65 ml/min, 1.25(OH)2D3 serum levels steadily declined. We therefore chose a CrCl of 65 ml/min as cutoff for further analyses. During the 36 weeks of observation, elderly people with a CrCl of<65 ml/min had, in multivariate controlled analyses, compared with elderly with a CrCl of =65 ml/min, a significantly higher incidence of number of fallers (25/70 vs 21/116; OR=4.01; 95% CI, 1.48-10.98;p=0.006), and a significantly higher incidence of falls (28/70 vs 23/116; OR=3.68; 95% CI, 1.38-9.82;p=0.009). Conclusions: For the first time we showed that in a community-dwelling population of elderly men and women, a CrCl of less than 65 ml/min is a significant and independent risk factor for fallers and falls. [ABSTRACT FROM AUTHOR]

We previously observed that a creatinine clearance (CrCl) of<65 ml/min is a significant and independent risk factor for the number of fallers and falls in a community-dwelling elderly population and postulated that this increased risk is due to the associated significant lower D-hormone serum levels. To test our hypothesis, we investigated in a post hoc analysis of a double-blind randomized study whether treatment with alfacalcidol, a synthetic prodrug of the D-hormone, can reduce the high incidence of fallers and the high risk of falls associated with low CrCl. Of 378 Swiss community-dwelling women (n=191) and men (n=187), aged 70 years and older, 191 received randomly 1 µg capsules of alfacalcidol (AlphaD3: Teva), and 187 received one capsule of placebo daily. With the help of questionnaires we regularly assessed the incidence and frequency of falls. The risk of becoming a faller and the risk of falling were assessed in multivariate-controlled logistic regression models according to treatment groups and according to a CrCl cut-off of 65 ml/min. The presented results are from ITT analyses. In participants with a CrCl of<65 ml/min, the 36 weeks of treatment with alfacalcidol was, compared with placebo, associated with a significant reduction in the number of fallers (14/72 versus 25/70; OR 0.26, 95% CI 0.08-0.80,P=0.019), and a significant reduction of the number of falls (16/72 versus 28/70; OR 0.29, 95% CI 0.09-0.88,P=0.028). No such association was observed in participants with a CrCl of =65 ml/min (for fallers 26/120 versus 21/116; OR 0.92 95% CI 0.34-2.52,P=0.875; for falls 32/120 versus 23/116; OR 0.93 95% CI 0.34-2.54,P=0.885). In the placebo group frequency of falls was dependent on CrCl (P=0.006), whereas in the alfacalcidol treatment group frequency of falls was independent of CrCl (P=0.494). No cases of clinically relevant hypercalcemia were observed. In a community-dwelling population of elderly men and women with a CrCl of<65 ml/min, treatment with alfacalcidol can significantly and safely reduce the low CrCl associated increased number of fallers and the high risk of falls. [ABSTRACT FROM AUTHOR]

To study the effect of alfacalcidol (1α(OH)D3) on fall risk in community-dwelling elderly men and women. Randomized, double-blind, placebo-controlled intervention trial. Basel, Switzerland. Three hundred seventy-eight community-dwelling elderly (191 women/187 men). Participants were randomly assigned to receive 1 μg of alfacalcidol or matched placebo daily for 36 weeks. Serum 25-hydoxyvitamin D3 (25(OH) D,1,25-dihydroxyvitamin D3 (D-hormone), and intact parathormone (iPTH) levels were measured using radioimmunoassay at baseline and every 12 weeks. Numbers of fallers and falls were assessed using a questionnaire during each study site visit. Dietary calcium intake was assessed at baseline using a food frequency questionnaire. At baseline, participants had, on average, normal vitamin D and D-hormone serum levels. Over 36 weeks, alfacalcidol treatment was associated with fewer fallers (odds ratio (OR)=0.69, 95% confidence interval (CI)=0.41–1.16) than placebo. In a post hoc subgroups analysis by medians of total calcium intake, this reduction reached significance in alfacalcidol-treated subjects with a total calcium intake of more than 512 mg/d (OR=0.45, 95% CI=0.21–0.97, P=.042) but not in those who consumed less than 512 mg/d (OR=1.00, 95% CI= 0.47–2.11, P=.998). Alfacalcidol treatment was also, independent of total calcium intake, associated with a significant 37.9% reduction in iPTH serum levels ( P<.0001). No cases of clinically relevant hypercalcemia were observed. Provided a minimal calcium intake of more than 512 mg/d, alfacalcidol treatment significantly and safely reduces number of fallers in an elderly community dwelling population. [ABSTRACT FROM AUTHOR]

Older adults demonstrate increased amounts of postural sway, which may ultimately lead to falls. The mechanisms contributing to age-related increases in postural sway and falls in the elderly remain unclear. In an effort to understand age-related changes in posture control, we assessed foot center-of-pressure (COP) displacements and electromyographic data from the tibialis anterior, soleus, vastus lateralis, and biceps femoris collected simultaneously during quiet-standing trials from elderly fallers, elderly non-fallers, and healthy young subjects. Both traditional measures of COP displacements and stabilogram-diffusion analysis were used to characterize the postural sway of each group. Regression analyses were used to assess the relationship between the COP measures and muscle activity. Elderly fallers demonstrated significantly greater amounts of sway in the anteroposterior (AP) direction and greater muscle activity during quiet standing compared with the young subjects, while elderly non-fallers demonstrated significantly greater muscle activation and co-activation compared with the young subjects. No significant differences were found between elderly fallers and elderly non-fallers in measures of postural sway or muscle activity. However, greater postural sway in both the AP and mediolateral (ML) directions and trends of greater muscle activity were found in those older adults who demonstrated lower scores on clinical measures of balance. In addition, short-term postural sway was found to be significantly correlated with muscle activity in each of these groups. This work suggests that high levels of muscle activity are a characteristic of age-related declines in postural stability and that such activity is correlated with short-term postural sway. It is unclear whether increases in muscle activity preclude greater postural instability or if increased muscle activity is a compensatory response to increases in postural sway. [Copyright &y& Elsevier]

Background: The risk of people with Parkinson's disease (PD) falling is greater than that of the general population but to date, disease-specific predictors of falling have not been identified.Objectives: To identify one or more features, which would predict individuals at risk of falling during a 3-month prospective follow-up study.Method: A battery of standardised tests administered in the home and the laboratory with a 3-month follow-up telephone interview.Results: Sixty-three people with PD were recruited from GP practices. Eleven interview variables and six gait laboratory variables were used with subsamples (55 and 44 subjects, respectively) to fit predictive models for identifying future fallers. The number of falls in the previous year was the most important variable, without exception, to be selected as a predictor in various logistic regression models. A history of two or more falls had a sensitivity of 86.4% (95% CI 67.3-96.2%) and a specificity of 85.7% (95% CI 71.2-94.2%) in predicting falling in the next 3 months.Conclusion: Healthcare workers should be asking their patients with PD regularly and carefully about falling, and should consider instigating programmes of fall management for patients with PD who have fallen two or more times in the previous 12 months. [ABSTRACT FROM AUTHOR]

Introduction: Measurement of reactive balance is critical for fall prevention but is severely underrepresented in the clinical setting due to the lack of valid assessments. The Stepping Threshold Test (STT) is a newly developed instrumented test for reactive balance on a movable platform, however, it has not yet been validated for fall-prone older adults. Furthermore, different schemes of observer-based evaluation seem possible. The aim of this study was to investigate validity with respect to fall risk, interpretability, and feasibility of the STT using two different evaluation strategies. Methods: This study involved 71 fall-prone older adults (aged ≥ 65) who underwent progressively increasing perturbations in four directions for the STT. Single and multiple-step thresholds for each perturbation direction were determined via two observer-based evaluation schemes, which are the 1) consideration of all steps (all-step-count evaluation, ACE) and 2) consideration of those steps that extend the base of support in the direction of perturbation (direction-sensitive evaluation, DSE). Established balance measures including global (Brief Balance Evaluations Systems Test, BriefBEST), proactive (Timed Up and Go, TUG), and static balance (8-level balance scale, 8LBS), as well as fear of falling (Short Falls Efficacy Scale-International, FES-I) and fall occurrence in the past year, served as reference measurements. Results: The sum scores of STT correlated moderately with the BriefBEST (ACE: r = 0.413; DSE: r = 0.388) and TUG (ACE: r = -0.379; DSE: r = -0.435) and low with the 8LBS (ACE: r = 0.173; DSE: r = 0.246) and Short FES-I (ACE: r = -0.108; DSE: r = -0.104). The sum scores did not distinguish between fallers and non-fallers. No floor/ceiling effects occurred for the STT sum score, but these effects occurred for specific STT thresholds for both ACE (mean floor effect = 13.04%, SD = 19.35%; mean ceiling effect = 4.29%, SD = 7.75%) and DSE (mean floor effect = 7.86%, SD = 15.23%; mean ceiling effect = 21.07%, SD = 26.08). No severe adverse events occurred. Discussion: Correlations between the STT and other balance tests were in the expected magnitude, indicating convergent validity. However, the STT could not distinguish between fallers and non-fallers, referring to a need for further studies and prospective surveys of falls to validate the STT. Current results did not allow a definitive judgment on the advantage of using ACE or DSE. Study results represented a step toward a reactive balance assessment application in a clinical setting., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Adams, Brüll, Lohkamp and Schwenk.)

Nutritional status is relevant to functional recovery in patients after an acute process requiring rehabilitation. Nevertheless, little is known about the impact of malnutrition on geriatric rehabilitation. This study aimed to determine the association between nutritional status at admission and the evolution of functional and physical outcomes, as well as the capability of nutritional status to identify fallers among patients admitted to geriatric rehabilitation for different reasons. This was a retrospective cohort study of 375 patients. Data collected included age, gender, diagnosis at admission, comorbidities, cognitive and nutritional status, functional and physical measurements, length of stay, mortality and falls. Orthogeriatric patients with worse nutritional status according to the Mini Nutritional Assessment-Short Form (MNA-SF) had a significantly lower Barthel Index at admission and discharge with worse functional gain and poorer outcomes in the Short Physical Performance Battery (SPPB). However, in hospital-deconditioned patients, the MNA-SF score was not significantly associated with functional and physical recovery. Poor nutritional status at admission increased the risk of experiencing at least one fall during rehabilitation in orthogeriatric patients. However, hospital-deconditioned patients who fell had better SPPB scores than those who did not fall. Our results demonstrate the importance of nutritional status in the clinical evolution of orthogeriatric patients throughout the rehabilitation process. [ABSTRACT FROM AUTHOR]