TIMED UP AND GO PERFORMANCE IN OLDER PEOPLE WITH DIABETES MELLITUS: ASSOCIATIONS WITH SENSORIMOTOR FUNCTION, BALANCE, COGNITION, AND FALLS
DOI:
https://doi.org/10.15621/ijphy/2020/v7i2/655Keywords:
Timed Up and Go test, lower limb strength, reaction time, balance, vision, accidental falls, Diabetes.Abstract
Background: The Timed up and Go Test (TUG) is often used as a mobility measure in older people. However, it is
unclear whether the TUG is useful for identifying fall risk in people with diabetes mellitus (DM) and which physical and cognitive/psychological factors influence the performance of this test.
Objectives: To investigate whether slow TUG times (standard test and when performed with a secondary cognitive task (c-TUG)) are a risk factor for falls in older people with DM and to determine the relative contributions of a range of sensorimotor, balance and cognitive/psychological factors to TUG performance in this population.
Methods: Community-dwelling people (n=103, mean age 61.57, SD=6.3) underwent the TUG and c-TUG tests as
well as quantitative tests of vision, peripheral sensation, strength, reaction time, balance, cognition, and fear of falling. Participants were then followed up for falls for six months.
Results: Negative binomial regression analyses revealed that each 1s increase in TUG and c-TUG times increased the risk of falling by 29% and 13%, respectively. Multiple regression analyses identified vibration sense (p<0.001), knee extension strength (p=0.001, r²=0.430), edge contrast sensitivity (p=0.002), neuropathy examination score (p=0.001, r²=0.498) and controlled leaning balance (p=0.033) as significant and independent explanatory predictors of TUG performance. The regression model for c-TUG was similar, vibration sense (p=0.042), knee extension strength (p=0.009, r²=0.256), neuropathy examination score (p=0.156, r²=0.272) and sway path-floor (p=0.042) except that the MOCA cognitive assessment (p=0.015) was included instead of edge contrast sensitivity. The combined explanatory variable models explained 43% and 26% of the variance in TUG and c-TUG times, respectively.
Conclusions: Slow TUG and c-TUG times significantly increased the risk of falls in community-dwelling older people with DM. Poor TUG and c-TUG performances were related independently to decreased vibration sense, lower limb weakness, and poor balance, with the c-TUG additionally influenced by cognitive function.
References
Diabetes fact sheet. World Health Organization. 2019. https://www.who.int/news-room/fact-sheets/detail/diabetes.
Martínez MS, Blanco A, Castell MV, Misis AG, Montalvo JIG, Zunzunegui MV, et al. Diabetes in older people: Prevalence, incidence and its association with medium- and long-term mortality from all causes. Aten Primaria. 2014; 46(7): 376-84.
Katulanda P, Sheriff MH, Matthews DR. The diabetes epidemic in Sri Lanka - a growing problem. Ceylon Med J. 2006; 51(1): 26-8.
International Diabetes Federation Diabetes Atlas, South-east Asia. Sri Lanka. 2019. https://idf.org/our-network/regions-members/south-east-asia/members/98-sri-lanka.html
Tilling LM, Darawil K, Britton M. Falls as a complication of Diabetes mellitus in older people. J Diabetes Complications. 2006; 20(3): 158-62.
Schwenk M, Lauenroth A, Stock C, Moreno RR, Oster P, McHugh G, et al. Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: a systematic review. BMC Med Res Methodol. 2012; 12: 50.
Sekaran NK, Choi H, Hayward RA, Langa KM. Fall-associated difficulty with activities of daily living in functionally independent individuals aged 65 to 69 in the United States: a cohort study. J Am Geriatr Soc. 2013; 61(1): 96-100.
Hajek A, König HH. The association of falls with loneliness and social exclusion: Evidence from the DEAS German Ageing Survey. BMC Geriatrics. 2017; 17: 204.
Friedman SM., Munoz B, West SK, Rubin GS, Fried LP. Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc. 2002; 50(8): 1329-35.
Downton JH, Andrews K. Prevalence, characteristics and factors associated with falls among the elderly living at home. Aging (Milano). 1991; 3(3): 219-28.
Hawkins K , Musich S, Ozminkowski RJ, Bai M, Migliori RJ, Yeh CS. The burden of falling on the quality of life of adults with Medicare supplement insurance. J Gerontol Nurs. 2011; 37(8): 36-47.
Bennie S, Bruner K, Dizon A, Fritz H, Goodman B, Peterson S. Measurements of Balance: Comparison of the Timed "Up and Go" Test and Functional Reach Test with the Berg Balance Scale. J Phys Ther Sci. 2003; 15: 93-97.
Lin MR, Hwang HF, Hu MH, Wu HD, Wang YW, Huang FC. Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people. J Am Geriatr Soc. 2004; 52(8): 1343-8.
Shumway-Cook A, Brauer S, Woollacott M. Predicting the Probability for Falls in Community-Dwelling Older Adults Using the Timed Up & Go Test. Physical Therapy. 2000; 80(9): 896-903.
Thompson M, Medley A. Performance of Community Dwelling Elderly on the Timed Up and Go Test. Physical & Occupational Therapy In Geriatrics. 1995; 13(3): 17-30.
Oliveira PP, Fachin SM, Tozatti J, Ferreira MC, Marinheiro LP. Comparative analysis of risk for falls in patients with and without type 2 diabetes mellitus. Rev Assoc Med Bras. 2012; 58(2): 234-9.
Bruce D, Hunter M, Peters K, Davis T, Davis W. Fear of falling is common in patients with type 2 diabetes and is associated with increased risk of falls. Age and Ageing. 2015; 44(4): 687-690.
Moreira Bde S, Dos Anjos DM, Pereira DS, Sampaio RF, Pereira LS, Dias RC, et al. The geriatric depression scale and the timed up and go test predict fear of falling in community-dwelling elderly women with type 2 diabetes mellitus: a cross-sectional study. BMC Geriatr. 2016; 16: 56.
Rucker JL, Jernigan SD, McDowd JM, Kluding PM. Adults with diabetic peripheral neuropathy exhibit impairments in multitasking and other executive functions. Journal of neurologic physical therapy. 2014; 38(2): 104-110.
Mythili A, Kumar KD, Subrahmanyam KA, Venkateswarlu K, Butchi RG. A Comparative study of examination scores and quantitative sensory testing in diagnosis of diabetic polyneuropathy. International journal of Diabetes in developing countries. 2010; 30(1): 43-48.
Henderson E, Lord S, Bordie MA, Gaunt DM, Lawrence AD, Close JCT, et al. Rivastigmine for gait stability in patients with Parkinson's disease (ReSPonD): a randomised, double-blind, placebo-controlled, phase 2 trial. The Lancet Neurology. 2016; 15(3): 249-258.
Liu-Ambrose TY, Ashe MC, Graf P, Beattie BL, Khan KM. Increased risk of falling in older community-dwelling women with mild cognitive impairment. Phys Ther. 2008; 88(12): 1482-91.
Vazzana R, Bandinelli S, Lauretani F, Volpato S, Lauretani F, Di Iorio A, et al. Trail Making Test predicts physical impairment and mortality in older persons. J Am Geriatr Soc. 2010; 58(4): 719-23.
Lord SR., Menz HB, Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Phys Ther. 2003; 83(3): 237-52.
Hazel CA, Elliott DB. The dependency of logMAR visual acuity measurements on chart design and scoring rule. Optom Vis Sci. 2002; 79(12): 88-92.
Tsai YJ, Yang YC, Lu FH, Lee PY, Lee IT, Lin SI. Functional Balance and Its Determinants in Older People with Diabetes. PloS one. 2016; 11(7): e0159339-e0159339.
Lord SR, Rogers MW, Howland A, Fitzpatrick R. Lateral stability, sensorimotor function and falls in older people. J Am Geriatr Soc. 1999; 47(9): 1077-81.
Menant JC, Latt MD, Menz HB, Fung VS, Lord SR. Postural sway approaches center of mass stability limits in Parkinson's disease. Mov Disord. 2011; 26(4): 637-43.
Lamb SE, Jørstad-Stein EC, Hauer K, Becker C. Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc. 2005; 53(9): 1618-22.
Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr. 2014; 14: 14.
Menant JC, Schoene D, Sarofim M, Lord SR. Single and dual task tests of gait speed are equivalent in the prediction of falls in older people: a systematic review and meta-analysis. Ageing Res Rev. 2014; 16: 83-104.
Schoene D, Wu SM, Mikolaizak AS, Menant JC, Smith ST, Delbaere K, et al. Discriminative ability and predictive validity of the timed up and go test in identifying older people who fall: systematic review and meta-analysis. J Am Geriatr Soc. 2013; 61(2): 202-8.
Daubney M, Culham E. Lower-extremity muscle force and balance performance in adults aged 65 years and older. Phys Ther. 1999; 79: 1177-1185.
Kwan MM, Lin SI, Chen CH, Close JC, Lord SR. Sensorimotor function, balance abilities and pain influence Timed Up and Go performance in older community-living people. Aging Clin Exp Res. 2011; 23(3): 196-201.
Lord S, Dayhew J. Visual risk factors for falls in older people. J Am Geriatr Soc. 2001; 49: 508-515.
Lord S, Menz H. Visual contributions to postural stability in older adults. Gerontology. 2000; 46: 306-310.
Lord S, Fitzpatrick R. Choice stepping reaction time: a composite measure of falls risk in older people. J Gerontol A Biol Sci Med Sci. 2001; 56: M627-632.
Yiou E, Caderby T, Delafontaine A, Fourcade P, Honeine JL. Balance control during gait initiation: State-of-the-art and research perspectives. World journal of orthopedics. 2017; 8(11): 815-828.
Conradsson D, Paquette C, Franzén E. Medio-lateral stability during walking turns in older adults. PLOS ONE. 2018; 13(6): e0198455.
Day BL, Lord SR. Handbook of Clinical Neurology, Balance, Gait and Falls. Vol. 159; 2018.
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