Does falls efficacy predict gait performance in high-functioning older people?

Introduction: Falls efficacy, defined as confidence in performing activities without falling, is a measure of fear of falling associated with gait impairment, falls and functional decline in frail older people. This relationship has not been well studied in high-functioning older people. Objective: To evaluate the relationship between falls efficacy and gait performance in a cohort of high-functioning older people. Methods: Subjects (N = 864) were a subsample of communitydwelling older people aged 65 to 70 years, enrolled in the "Lc65+" cohort, who completed gait assessment at baseline. Data were collected on demographics, functional, cognitive, affective, and health status. Falls efficacy was assessed using the Falls Efficacy Scale- International (FES-I) that measures confidence in performing 16 activities of daily life (ADL) without falling (score from 16 to 64, higher score indicates lower confidence). Gait parameters were measured over a 20 m walk at preferred gait speed using Physilog, an ambulatory gait monitoring system. Results: Participants (mean age 68.0 ± 1.4 years, 55.0% women) had excellent physical (92.2% independent in basic ADL, mean gait speed 1.13 ± 0.16 m/sec) and cognitive (98.0% with MMSE 024) performance. Nevertheless, 22.1% reported depressive symptoms and 16.1% one or more fall in the previous year. Mean FES-I score was 18.8 ± 4.1. Falls efficacy was associated with gait speed (Spearman rho -0.23, P <.001) and gait variability (Spearman rho 0.10, P = .006), measured by the coefficient of variation of stride velocity. These associations remained in multivariate analysis for both gait speed (adj [beta] coeff: -0.008, 95%CI -0.005 to -0.010, P <.001) and gait variability (adj [beta] coeff 0.024, 95%CI 0.003 to 0.045, P = .023) independent of gender, falls, functional, affective, cognitive, and frailty (Fried's criteria) status. On average, compared to subjects with poor confidence in performing one ADL without falling, those with full confidence had a 0.02 m/sec (2%) faster gait speed and a 2% decrease in gait variability. Conclusion: Even in high-functioning older people, poor falls efficacy is associated with reduced gait speed and stability, independent of health, functional, and frailty status. The direction of this relationship needs to be investigated prospectively to determine causality and design interventions to improve gait performance, reduce fall risk, and prevent functional decline.

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In November of 2001 the Government launched its new National Health Strategy â?" â?oQuality and Fairness, A Health System for youâ?Âù (hereafter referred to as Quality and Fairness). Quality and Fairness was developed following one of the largest consultation processes ever undertaken in the public service. It sets out the vision for the health service, the four principles upon which this vision will be built, it also establishes four National goals and finally sets out six â?~frameworks for changeâ?T, which will be used to achieve the vision, principles and goals. One of the six frameworks for change is Developing Human Resources. The health service is one of the largest employers in the public sector, with the employment level at the end of 2001 approaching 93,000 full time employees. These employees are spread across a large number of organisations, in multiple locations and settings across the country. Each employee plays a key role in the delivery of health service, in all settings, to the public. Download document here

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The Conference took place on May 30th, 2002 in the Royal Marine Hotel, Dun Laoigaire. It attracted over 250 delegates from across the statutory, voluntary and private sectors and the interest that was expressed in the Conference was indicative of the growing recognition of the importance of establishing a more co-ordinated way of conducting health and social care assessments for older people. The Conference provided the opportunity to both discuss the necessity for a standardised approach to conducting assessments and to explore the merits of establishing a national framework for the multi-disciplinary assessment of older people’s health and social care needs and preferences.   Download document here

Meeting the Health, Social Care and Welfare Services Information Needs of Older People

As Chairperson of the National Council on Ageing and Older People, it gives me great pleasure to introduce this report, Meeting the Health, Social Care and Welfare Services Information Needs of Older People in Ireland. The Council has asserted, in previous reports in the past, the need to improve information provision for older people in order to enable them to make informed decisions in relation to their health, social care and welfare services needs and preferences so that they can become partners in their own care. This is consistent with current policy initiatives intended to re-orientate services more towards the older person and to place him/her at the heart of service planning, delivery and evaluation. Download document here

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