Multimodal Factors Affect Longitudinal Changes in Dynamic Balance in Community-Dwelling Older Adults

Abstract

Chitra Banarjee,1 Jethro Raphael M Suarez,2,3 Kworweinski Lafontant,2,4 Hwan Choi,3 Chen Chen,5 Rui Xie,6,7 Ladda Thiamwong2,7 1College of Medicine, University of Central Florida, Orlando, FL, USA; 2College of Nursing, University of Central Florida, Orlando, FL, USA; 3Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, USA; 4Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA; 5Center for Research in Computer Vision, University of Central Florida, Orlando, FL, USA; 6Department of Statistics and Data Science, University of Central Florida, Orlando, FL, USA; 7Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USACorrespondence: Chitra Banarjee, College of Medicine, University of Central Florida, Orlando, FL, USA, Email [email protected]: Dynamic balance, an important contributor to fall risk in older adults, involves maintaining the center of pressure while in locomotive states and is. Fall risk appraisal (FRA) is defined as assessing an older adult’s awareness of their physiological and perceived fall risk. This longitudinal study aimed to evaluate how multimodal factors predict fluctuations in dynamic balance in community-dwelling low-income older adults, utilizing fear of falling (FoF), static balance, fall history, and moderate-to-vigorous physical activity (MVPA).Patients and Methods: The longitudinal study included 140 community-dwelling, low-income older adults, with 124 women and 16 men. FoF was assessed using the Short Falls Efficacy Scale International (Short FES-I) and static balance using BTracks Balance Test (BBT). Both were utilized to define FRA Distance, an integrated quantification of physiological and perceived balance deficits. MVPA was assessed using accelerometers, fall history using self-report, and dynamic balance using the Timed Up and Go (TUG) test. The study was conducted at 4 timepoints at T1 (baseline), T2 (2 months), T3 (4 months), and T4 (6 months).Results: Using mixed effects multilevel models, TUG scores were predicted by time, %MVPA, and FRA distance ratio. The effect of FRA distance ratio was primarily driven by FoF, and the effect of %MVPA varied by age. Additionally, while fall history did not show a predictive relationship with TUG scores, it did predict FRA distance.Conclusion: Dynamic balance fluctuated over time and was influenced by multimodal factors, namely MVPA and FRA, which captured the interplay between static balance and FoF. Fall history did not directly predict dynamic balance but played a role in FRA, implicating the subjective effects of fall history. These findings demonstrate how physical activity, FRA, and their interactions can predict changes in dynamic balance. Future work can utilize the results to evaluate low-cost interventions for community-dwelling older adults.Plain Language Summary: Evaluating changes in dynamic balance is critical for evaluating fall risk in older adults. This study aimed to determine what drives these fluctuations, including fear of falling, static balance, physical activity, and fall history using assessments at four timepoints across 6 months. The authors found that each of these variables except fall history directly influenced dynamic balance, with fall history influencing how older adults perceive their fall risk compared to their actual fall risk. These results confirm that changes in dynamic balance are influenced by modifiable factors, an important point for designing future interventions. Keywords: balance, older adults, physical activity, fear of falling

Keywords

• balance
• older adults
• physical activity
• fear of falling