Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Japan.
Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.
J Gerontol A Biol Sci Med Sci. 2021 Aug 13;76(9):e228-e234. doi: 10.1093/gerona/glab073.
Older adults at risk of falling or who have fear of falling (FoF) present a discrepancy between "imagined" and "performed" actions. Using the gait-related motor imagery paradigm, we investigated whether prediction accuracy in motor execution is associated with the onset of FoF and with prospective falls among older adults with FoF.
A cohort of 184 community-dwelling older adults was tested for imaginary and executed Timed Up and Go (TUG) tests at a fast pace at baseline. They were first asked to imagine performing TUG and estimate the time taken to complete it (iTUG) and then to perform the actual trial (aTUG); the difference between the 2 times was calculated. Prospective falls were monitored between baseline and 2-year follow-up of FoF assessment.
At follow-up, 27 of 85 participants without FoF at baseline (31.8%) had developed FoF. Twenty-seven of 99 participants (27.2%) with FoF at baseline experienced falls. A significantly shorter iTUG duration, when compared with aTUG, was observed in those who developed FoF or experienced multiple prospective falls, indicating overestimation of their TUG performance. The adjusted logistic regression model showed that a greater ΔTUG (ie, tendency to overestimate) at baseline was associated with an increased risk of new-onset FoF among those without FoF at baseline and multiple prospective falls among those with FoF at baseline.
Deficits in motor imagery (ie, overestimation of physical capabilities), reflecting impairment in motor planning, could provide an additional explanation of the high risk of FoF and recurrent falls among people with FoF.
有跌倒风险或有跌倒恐惧的老年人在“想象”和“执行”动作之间存在差异。使用与步态相关的运动意象范式，我们研究了在有跌倒恐惧的老年人中，运动执行的预测准确性是否与跌倒恐惧的发生和前瞻性跌倒有关。
一个由 184 名居住在社区的老年人组成的队列在基线时接受了快速的想象和执行计时起立行走（TUG）测试。他们首先被要求想象执行 TUG 并估计完成它所需的时间（iTUG），然后执行实际试验（aTUG）；计算这两个时间的差异。在基线和 FoF 评估的 2 年随访期间监测前瞻性跌倒。
在随访中，85 名基线时无 FoF 的参与者中有 27 名（31.8%）出现了 FoF。99 名基线时患有 FoF 的参与者中有 27 名（27.2%）发生了跌倒。与 aTUG 相比，出现 FoF 或经历多次前瞻性跌倒的患者 iTUG 持续时间明显缩短，表明他们对 TUG 表现的高估。调整后的逻辑回归模型显示，基线时更大的 ΔTUG（即高估倾向）与基线时无 FoF 的参与者新发生 FoF 的风险增加以及基线时患有 FoF 的参与者多次发生前瞻性跌倒的风险增加相关。
运动意象缺陷（即对身体能力的高估）反映了运动规划的损伤，可能为有 FoF 的人跌倒恐惧和反复跌倒的高风险提供了额外的解释。
