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P OSTER
A BSTRACTS
a different strategy than young adults to deal with a walking challenge
may potentially inform interventions to improve motor skill in
walking.
B162
Dual-Stiffness Flooring: Does it Reduce Fracture Rates Among
Older Fallers ?
F. Knoefel, 1 L. Patrick, 1 J. Taylor, 1 R. Goubran. 2,1 1. EBRI Research
Institute, Ottawa, ON, Canada; 2. Engineering and Design, Carleton
University, Ottawa, ON, Canada.
Supported By: Satech Inc., Chehalis, WA, USA
BACKGROUND: Fractures in older adults are associated with
significant morbidity and mortality. Falls in this population lead to
fractures approximately once every 20 falls. A number of bio-mechanical
studies suggest that dual-stiffness flooring (DSF) diminishes
the impact of contact with a floor, potentially reducing injuries associated
with falls. To our knowledge however, there has never been a
controlled study comparing fracture rates on regular flooring to that
on DSF. METHODS: Mountain View Manor is a Skilled Nursing Facility
in Prescott, Arizona where two resident bedrooms have DSF
flooring (SmartCells flooring). Falls and related injuries were tracked
during the period of July 1, 2008 to December 31, 2010. Injury rate
comparisons, based on Chi-Square analyses, and prediction of room
type allocation based on the number of injuries sustained, using Logistic
Regression, were conducted. RESULTS: A total of 167 falls
were reviewed. Fifty-five percent (55%) of falls resulted in an injury
and 26% in a significant injury, defined as abrasion, cut, fracture or
two or more injuries. There were 82 falls on the DSF and 85 falls on
the regular floor. Patients in the dual-stiffness flooring rooms were
significantly younger and took significantly fewer medications; these
factors were thus treated as covariates in the analyses. There was a
marked tendency for residents falling on DSF to have less bruising
and abrasions, while having more redness and cuts. There were two
fractures on regular flooring (2.4% fracture rate) and none on the
DSF flooring (0% fracture rate). DISCUSSION: A 2.4% fracture
rate (as noted on the regular floor) is consistent with numerous incidence
reports in the literature; whereas a 0% rate (as noted on Smart-
Cells DSF floor) is a clinically significant improvement over prior reported
results. Both clinical findings and preliminary statistical trends
analysis suggest a positive effect of dual-stiffness flooring. This suggests
that DSF may be a practical approach for institutions and consumers
to reduce fall-related injuries. In contrast to other solutions,
like hip protectors, DSF requires no active client participation. A
large scale study to achieve sufficient statistical power to statistically
confirm these preliminary findings is warranted.
B163
Subcortical Hyperintensities and Outcomes of Targeted Gait
Interventions for Mobility Impairment.
N. K. Nadkarni, S. Perera, J. Brach, H. Aizenstein, C. Rosano,
S. A. Studenski, J. M. Van Swearingen. University of Pittsburgh,
Pittsburgh, PA.
Supported By: Source of funding: Pittsburgh Claude D. Pepper
Older American’s Independence Center grant (P30 AG024827)
Background: Gait interventions that incorporate motor-skill acquisition
are superior to standard therapy in improving mobility impairment
in elderly. Subcortical hyperintensities (SH), commonly
seen on brain MRI of older adults, are associated with impairments in
gait and executive function.
Objective: We examined whether regional SH volumes influence
gait outcomes from two types of gait interventions.
Methods: We analyzed data from a 12 week randomized trial of
community-dwelling older adults with mobility impairment receiving
two interventions: progressive strength, balance and endurance training
(I) vs goal-directed motor learning, adaptive stepping, pattern
walking and dual-tasking (M). A linear model was used to study the
relationship between pre- to post-intervention change in outcomes
(gait speed, double-support time, step-time, stance time variability)
with baseline SH in regions associated with executive function (anterior
prefrontal cortex (APC), dorsolateral prefrontal cortex
(DLPFC), ventrolateral prefrontal cortex (VLPFC), anterior cingulate
(AC), basal ganglia and posterior parietal cortex).
Results: Significant interactions emerged between right APC
SH and intervention on changes in gait speed (p=0.04), step-time
(p=0.001) and double-support time (p=0.01). With respect to steptime
change, significant interactions emerged for SH in left APC
(p=0.02), right and left DLPFC (p=0.03 and 0.02), right VLPFC
(p=0.04) and right AC (p=0.02) with intervention. In the I-group,
greater right APC and right AC SH were associated with poorer
changes in gait speed (p=0.005 and 0.02), double support time
(p=0.002 and 0.001), step-time (p=0.002 and 0.001) and variability in
stance-time (p=0.004 and 0.01). In the M-group, there were no significant
associations between changes in outcomes and SH in any of the
above brain regions.
Conclusion: Gait interventions that incorporate motor-skill acquisition
and dual-tasking may benefit older adults irrespective of SH
severity in brain regions linked to executive function while benefits
from impairment-based interventions may depend on SH burden in
these regions.
B164
Mood and Neurocognitive Measures to Predict Intake and Function
in Elderly in a Recuperative Care Unit.
P. R. Padala, 1,3 P. Dubbert, 1,3 K. P. Padala, 1,2 K. Garner, 1,2
R. A. Dennis, 1,2 M. Bopp, 1,2 D. H. Sullivan. 1,2 1. Geriatric Research
Education and Clinical Center, VISN16/CAVHS, North Little Rock,
AR; 2. Geriatrics, University of Arkansas for Medical Sciences, Little
Rock, AR; 3. Psychiatry, University of Arkansas for Medical Sciences,
Little Rock, AR.
Supported By: VA Health Services and Clinical Science Research
and Development programs (HSR&D IIR-04-298 and CSR&D)
and a University of Arkansas for Medical Sciences Tobacco
Settlement award
Background: Among older patients hospitalized for recuperative
care and rehabilitation, persistent anorexia and poor functional
rehabilitation are associated with high levels of inflammatory markers
and other indicators of illness severity at admission. It is not
known whether cognitive dysfunction or depression also contribute
to the persistent anorexia and poor functional outcomes.
Methods: This prospective study included patients over 64 years
admitted to a recuperative care and rehabilitation unit in a VA hospital
Community Living Center. Each subject’s daily total nutrient intake
from all sources was measured using a standardized protocol.
Depression was measured by the Geriatric Depression Scale-15 items
(GDS), apathy was derived from 3 items on the GDS related to motivation
(GDS-apathy), and executive function was measured by verbal
fluency, digit span and Florida praxis battery. Correlation analyses
were performed between the dependent variables of energy and protein
intake with independent variables of mood and neurocognitive
measures followed by regression analyses. T-tests were performed on
the neurocognitive measures based on if the subjects were apathetic
or not.
Results: 416 veterans were enrolled. Mean scores at baseline
were 3.7 (± 2.7) for GDS, 1.5 (±0.9) for GDS-apathy, 5.9 (±3.7) for
Verbal Fluency-F, 7.4 (±2.5) for Digit Span Forward, 4.6 (±2.2) for
Digit Span Backwards, 14.6 (±1.4) for Florida Praxis Battery, 83.8
(±35.7) and 59.7 (±23.6)for Average Energy and Protein Intake respectively.
Baseline measures of apathy, depression, executive function
did not predict either energy or protein intake. However baseline
AGS 2012 ANNUAL MEETING
S129