1
Q
Optimal muscle functioning is dependent on: [2 items]
A
- Physical Activity Level
- Nutritional Status
2
Q
Consequences of Sarcopenia- age related loss of skeletal muscle mass:
A
- Decreased Strength
- Decreased Aerobic capacity
- Decreased Functional capacity
- Decreased Bone density
3
Q
Muscle impairments + Increased fat mass =
A
- ↑Risk of falling
- Frailty
- Comorbid conditions (IDDM)
- ↓ Protein reserves/protein synthesis
4
Q
Percentage of decrease of lean muscle mass and total number of muscle fibers with aging
A
- ↓ 25%
5
Q
Weight training + multi-nutritional supplementation can impact/lead to:
A
- Increased strength Type II fibers > Type I fibers
- Musculoskeletal remodeling and increases in muscle area
- Decrease / Prevent Sarcopenia
6
Q
With reference to metabolic function in aging:
A
- After the 2nd decade, whole body resting metabolic rate declines at 1-2% per decade
- Increase in amount of fat in muscle tissue
7
Q
5 changes with reference to endocrine function in aging:
A
- Increased insulin resistance
- Decreased growth hormone
- Decreased estrogen and progesterone
- Vitamin D deficiency
- Increased parathyroid hormone (PTH)
8
Q
Effects of nutritional intake:
A
- May help to minimize loss of lean muscle tissue and muscle strength in older adults
- Stimulation of muscle hypertrophy through resistance exercise requires positive energy balance and positive protein intake (MPS-muscle protein synthesis)
- Moderate protein intake: 4oz of lean meat at any one meal
- Protein supplementation immediately before or immediately after resistance training session more beneficial
9
Q
Nutritional intake recommendations and effects for Calcium:
…and impacts improves 4 things…
A
- Calcium: 1200mg/dl
- Impacts/improves:
- Blood clotting
- Bone and tooth formation
- muscle contraction
- nerve transmission
- Impacts/improves:
10
Q
Nutritional intake recommendations and effects for Vitamin B12:
A
- 2.4μg/d
- Impacts/improves
- Nucleic acid metabolism
- Megaloblastic anemia prevention
- Impacts/improves
11
Q
Nutritional intake recommendations and effects for Vitamin D:
A
- 200-70 400IU/d; >70 600IU/d
- Impacts/Improves
- Serum calcium and phosphorous concentrations
- Calcium absorption
- Impacts/Improves
12
Q
Changes to connective tissue with aging:
A
- Increased stiffness
- Decreased Water Content
- Decreased strength
- Decreased cross sectional area and volume
13
Q
Clinical implications of changes to connective tissue changes in aging:
A
- Increased risk of injury
- Pain
- Decreased function
- Disability
14
Q
Joint range of motion changes in aging
A
- Joint range of motion (ROM) decreases with increasing age, although nonuniformly among joints, and is often direction-specific within a given joint.
- Generally, active and passive motion both decrease, with active ROM tending to decline more than passive.
15
Q
Characteristics of the aging joint:
A
- Decreased joint space
- Increased laxity
- Altered dispersion of loads
- Altered joint movements of force
- DECREASED RANGE OF MOTION
16
Q
Changes to the C-Spine with aging:
A
- gradual decline in ROM is seen beyond the age of 30
- extension and lateral flexion demonstrating the greatest decline.
17
Q
Changes to the aging thoracic and lumbar spine:
A
- Examinations of thoracic and lumbar motion reveal:
- extension to be most limited in older adults
- minimal or no age-dependent decline in rotation.
18
Q
Aging in the lower extremity:
A
- Declines in joint motion occur at the hip and foot/ankle joint complexes
- knee motion, in the absence of pathology, remains relatively consistent across the life span.
- Hip/ foot / ankle limitations most common in sagittal plane
19
Q
Aging in the hip:
A
- Hip flexion is typically well maintained as people age.
- However, extension ROM has been shown to decrease by more than 20%.
- reduced hip extension seen with aging may directly relate to decreased walking speed in older adults
20
Q
The aging ankle:
A
- Decreased ankle sagittal plane motion is seen with aging, particularly in the direction of dorsiflexion
21
Q
The aging shoulder:
A
- The shoulder complex is most influenced UE joint, with flexion and external rotation being the primary motions affected.
- Compared to the lower extremity and trunk, there is relatively less influence of age on upper extremity joint ROM.
22
Q
Impacts of aging on chondroid structures:
A
- Excessive loading/torsion= OA
- Limited Capacity for healing
- ↑ Calcification of articular cartilage
- has been shown to occur independent of osteoarthritic changes, indicating that it is a typical response to aging.
- Leads to ↓ tissue hydration
- Calcification, along with cellular and molecular changes associated with traumatic articular cartilage healing (lesion repair to the original hyaline cartilage with production of matrix molecules or fibrocartilage), leads to decreased osmotic pressure in articular cartilage.
- Decreased hydration compromises the viscoelastic properties and load-absorbing capacity of the cartilage
23
Q
Impact of aging on IV discs (chondroid structure):
A
- The nucleus becomes more fibrous and less gel-like
- The annulus becomes less organized
- As a result, delineation of annulus and nucleus is diminished in older adults.
- Decreased water content is also noted in the intervertebral discs and is associated with shorter disc heights.
- The loss of disc height can lead to the chronic pathological condition referred to as spinal stenosis
- Change of the intervertebral disc also alters surrounding structures.
- The diarthrodial facet joints may experience greater loads
- elasticity of the ligamentum flavum may decrease because of decreasing tensile forces over time.
24
Q
Changes to fibrous joint structures in aging:
A
- Increased stiffness
- Reduced elasticity.
- Decreased cross-sectional area and tensile strength.
- evidence from animal models
25
Changes to bony joint structures in aging:
* Directly
* changes in bone can influence the joint surfaces to alter joint mechanics
* Indirectly
* fractures and other bony structural change can alter joint alignment and function with possible secondary influences on joint mobility.
* Thickness and density of subchondral bone tends to decrease with advancing age
* this is not uniform at all joint surfaces
26
After the third decade formation vs. resorption in bone:
Favors resorption
27
Rate of bone loss in aging is affected by [4 factors]:
* Hormones
* Nutrition
* Calcium, Vitamin D
* Diseases:
* Crohn’s disease, Celiac disease, Anorexia; Rheumatoid Arthritis
* Lifestyle factors:
* Smoking, Alcohol excess, Inactivity
28
Hormones that affect rate of bone loss:
* Parathyroid
* Estrogen
* Testosterone,
* Progesterone
* Growth hormone
* Glucocorticoids
29
Bone loss in menopausal women:
* 20%-30% Cancellous bone
* 5-10% Cortical bone
* Continues for 4-8 years
30
• Bone loss in Post Menopausal Women and Men
* 20-25% overall
31
Clinical indicators of frailty [5 possible] criteria:
* must have 3 or more indicators for diagnosis
* Weakness in grip strength
* Slow walking speed
* Low physical activity
* Unintentional weight loss (\>10lbs/yr)
* Self reported exhaustion
32
Frailty predicts:
* (Frailty increases with age)
* (Greater in women than in men)
* Worsening Mobility/ADL’s
* Disability
* Incident Falls
* Hospitalization
* Death
33
Second most common musculoskeletal disease
among adults:
* Arthritis
* Most common cause of disability associated with
* Activity limitation
* Reduced QOL
* High Health Care costs
* Impacts Women\>Men
34
Non-Modifiable Risk Factors for arthritis:
* Increasing age
* Gender
* Genetics
* Rheumatoid arthritis
* Systemic lupus erythematosus
* Ankylosing spondylitis
35
Modifiable Risk Factors for arthritis:
* Overweight/ Obese
* Joint injuries
* Certain infections
* Occupations
* Reduced Proprioception
* Poor joint biomechanics
* Muscle weakness
* Inactivity
36
Characteristics of Osteoarthritis
* Degenerative joint disease
* Most common form of arthritis
* Characterized by
* Focal and progressive loss of the hyaline cartilage of joints
* Bony changes
* Decreased ROM/Function
* Pain/Swelling
37
Osteoarthritis interventions include:
* Exercise-strengthening, aerobic, water-based
* NSAIDS and pharmacological interventions
* Lifestyle education
* Increased activity
* Activity pacing
* Weight reduction
* Bracing-Valgus/Varus
* Footwear assessment
38
Rheumatoid Arthritis is/causes:
* Chronic, Inflammation of synovium of joints
* Joint Damage
* Pain
* Loss of function
* disability
39
Three Phases of RA:
* _Phase one_:
* Swelling of synovium-pain, warmth, stiffness, erythema, joint effusion
* _Phase two_:
* Thickening of the Synovium
* _Phase three_:
* Release of enzymes from inflamed cells
* Bone and Cartilage destruction
* Joint malalignment, pain, ↓ ROM
40
Interventions for RA:
* High-Intensity strength training and aerobic activity
* Less joint damage
* Less progression of joint damage
* Improved muscle strength
* Must adjust intensity according to current symptoms and functional abilities
41
Osteoporotic fractures lead to:
* Loss of height
* Increased Thoracic kyphosis that worsens over time
* Breathing difficulties, abdominal pain, digestive issues
* Decreased QOL, Mobility, Energy
* Pain and deterioration of physical function
42
Complications of Hyperkyphosis as a result of osteoporotic fractures:
* Reduced muscle strength
* Increased mediolateral body sway
* Decreased balance with gait
* Increased risk of falls
43
According to Mentz et. al., programs to improve mobility and decrease the risk of falls:
* focused on improving strength and flexibility of the foot and ankle
* attempt to enhance plantar sensation
44
According to Mentz et. al....independent predictors of balance and function:
* Ankle flexibility
* Plantar tactile sensitivity
* Toe plantar strength
45
Some of the most salient age-related changes in the neuromusculoskeletal system include the following:
Decreased muscle strength and power
* Marked loss of skeletal muscle mass
* Decreased number of functional motor units
* Decreased percentage of Type II (fast twitch) fibers
* Changes in postural alignment
* Bone and cartilage changes
* Changes in balance and gait
* Decreased maximal speed of movement and initiation of responses
* Increased threshold for vibration sensation and decreased proprioception
46
Maximal muscle strength, the amount of force produced in a single maximum contraction of a muscle or muscle group, is achieved in what decade?
* in the second or third decade and then declines.
47
Change in isometric strength:
* change insignificantly until about the sixth decade
* then decreases by about 1 to 1.5 percent per year from 50 to 70 years of age
* about 3 percent thereafter
48
Age-related declines in muscle power are:
* greater than declines in muscle strength
* age-related absolute power and relative power (scaled to body mass) decrease at a similar rate
* about 6 to 11 percent (absolute power) per decade
* 6 to 8 percent (relative power) per decade,
49
Age related declines in muscle morphology:
* Decline of total muscle fiber number
* Atrophy of some fibers, hypertrophy of other fibers
* Loss of muscle mass
* Increased lipofusion
* Increased fatty and connective tissue
* Ringbinden (aberrant myofibril wrapped around muscle fibers) found
* Cytoplasmic bodies found
* Myofibrillar degeneration
* Streaming of Z lines
* Denervation of muscle fibers
50
Rate of motor neuron loss associated with aging:
* Approximately 1 percent of the total number of motor neurons is lost per year beginning in the third decade
* this rate increases after age 60
51
changes that commonly occur in the nervous system of older adults:
* Cerebral atrophy
* Increased cerebrospinal fluid space
* Specific neuronal loss
* Reduced dendritic branching
* Increased lipofuscin granules
* Decreased effectiveness of neurotransmitter systems; selectively reduced activities in dopaminergic, cholinergic, and noradrenergic systems
* Reduced cerebral blood flow
* Diminished glucose utilization
* Alterations in electroencephalogram
* Loss of motor nerve fibers
* Decreased number and size of motor units
* Slowing of nerve conduction velocities
* Increased plaques and neurofibrillary tangles in selective brain regions
52
causes of changes that commonly occur in the nervous system of older adults:
* Biochemical and morphological changes in the neurons and receptors
* Loss of neurons
* Defects in neuronal transport mechanisms
* Decreases in myelin reducing the conduction velocity of nerves
* Defects in protein synthesis
* Cumulative trauma
* Oxidative stress and vascular changes
53
Lower and upper extremity flexibility can be measured by:
* "sit-and-reach test" [LE] (Nieman, 2003)
* "back-scratch test" [UE] (Rikli & Jones, 2001), respectively.
* Flexibility is a measure of the extent to which joint ROM is limited by the extensibility of joint soft tissues as well as tendons and muscles
54
Caution should be used, especially when testing older adults with osteoporosis or when testing the upper extremity of older, frail individuals because:
* testing the isokinetic strength of these muscles may cause an exaggerated blood pressure response.
55
One of the strongest motivators affecting exercise adherence in older adults is:
* _self-efficacy_
* the concept that a person is capable of controlling his or her own behavior
* *Outcome expectation, the belief that specific consequences will result from specific personal actions, is another strong motivator*
56
Barriers to exercise for older adults include:
* fear of falling or injury
* lack of time
* social support
* a physical space to exercise
* transportation to the exercise site;
* insufficient resources either to buy exercise equipment or to join an exercise facility
* stress and depression
* increased age
* decreased health status
* lack of enjoyment while exercising are associated with poor exercise adherence
57
90% of hip fractures are caused by:
* Falls (sideways)
58
Interventions for osteoporotic fractures(?)
* • Weight-Bearing exercises
* Resistance training
* Posture and body mechanics training
* Fall Prevention training
* Extension Exercises
59
Osteoporosis hip fx: (women's statistics)
* Women \>50:
* 20% die within 12 months post fx
* 20% require LTC
* 15% will resume ambulation unaided at 6mos Post fx
* 4x more likely to have a 2nd hip fx
60
Osteoporosis hip fx: (men's statistics)
* Men \> 50
* 40% die with 12 months post fx
61
Factors associated with decreased spinal stability in the aging spine:
* Ligamentum Flavum elasticity
* Dorsal Column and abdominal muscle weakness
* Altered Vertebral Body Shape:
* Micro fractures
* Sclerosis
* Bone formation of the end plates
* Osteophyte formation
62
Factors associated with radicular pain:
* Disc degeneration
* Bony overgrowth-lateral/central stenosis
* Spondylolistheses
* Scoliosis
63
Increased severity of neck pain associated with:
* More joint pain at other body sites
* Poor functional capacity
* Decreased upper extremity physical performance
* Caucasian, Women\>Men
* Hx: arthritis, angina, and heart attack
* Lower educational status
* Depressive symptomology
* Poorer self-rated health
64
Benefits for exercise for chronic LBP (Rainville et al.)
* To improve flexibility strength in low back
* Reduce the intensity of pain
* Reduce disability from back pain through:
* desensitization of concerns and fears
* alteration of attitudes and beliefs about pain
65
Typical presentation of RTC tears in the elderly:
* No report of trauma
* Sudden inability to perform overhead arm raise during functional activity
* May/may not report pain
* Patient cannot hold arm in 90 degree abducted position (failure of drop arm test)
* (*Surgical repair produces less satisfactory outcomes in persons older than 65)*
66
The most commmon musculoskeletal dosirder that affects the knee:
* Osteoarthritis
67
Physical activity consideration in the frailest older adults:
* In the frailest older adults, muscle strengthening, balance activities, or both may need to precede aerobic training.
68
Exercise recommendations for older adults:
* Aerobic intensity
* Target range of 50-85% of oxygen uptake reserve (VO2R)
* Equivalent of RPE 5/6 on 10-point scale
* Resistance intensity
* 10-15 reps per set vs 8-12
* 2-second; 1-second; 4 second pattern
69
decreases in peripheral and upper field result from
* _decreased pupil size_ lets in less light (early change)
* _decreased retinal metabolism_ (late change)
70
Accommodations for the loss of visual acuity
* Visual aids (glasses, contact lenses)
* magnifiers
* large-print books and devices
* large-print computer software
71
Factors responsible for decreased visual acuity include:
* _increased thickness of the lens_, which affects the amount of light allowed to reach the retina and the _loss of elasticity_ of the lens.
* decreased ability to see clearly and particularly affect near objects
* _changes in the iris and pupil_
* the iris loses its ability to change width, and pupil size remains small in both dim and bright light.
* leads to decreased night vision
72
(True or False)
Neural changes have the greatest effects on vision under low illumination
* True
73
Older Adults require as much as _________ as much light as younger adults
* 2 to 4 times
74
Corrections for adequate illumination:
* Wall mounted light fixtures and floor lamps
* Lighting that focuses directly on tasks
* Using 200-or 300-watt bulbs
* UV-absorbing lenses
* gooseneck lamps
75
Glare results from:
* diffuse light scattering on the retina as it passes through mildly opaque refractive media, inhibiting clear vision
76
A primary cause of glare sensitivity is:
* the increasing opacity of the lens (cloudiness of the lens) which diffuses the incoming light.
77
DIrect glare:
* occurs when light reaches the eye directly from its source
* example:
* uncontrolled natural light that enters a darkened room through a window.
* excessive light from exposed light bulbs.
78
Indirect glare
* Indrect glare
* result of light reflecting off another surface.
* Examples:
* light reflecting off highly polished surfaces including waxed floors; plastic-covered furniture; polished silverware; or stainless steel assistive devices, including grab bars and walkers
79
Changes that typically occur with aging and are detrimental to the older individual’s ability to function independently in the environment include:
* high-tone hearing loss
* decreased speech discrimination
* difficulty in detecting and appropriately filtering background noise
80
Age-related hearing loss can lead to:
* decreased awareness of environmental cues
* poor communication skills
* social isolation
81
Sensory presbycusis:
* Epithelial atrophy and degeneration of hair cells at the basal end of the organ or Corti
* results in loss of high-frequency hearing
82
Neural presbycusis:
* degenerative changes to nerve fibers of the cochlea and neuron loss along the auditory pathway.
* Results in loss in speech discrimination
* (ie can hear tone, but cannot understand what is being heard)
83
Age-related sensorineural hearing loss is referred to as:
* Presbycusis
* Dysfunction in conversion of soundwaves to electrical signals by inner ear
* Epithelial atrophy and degeneration of hair cells at the basal end of the organ or Corti and results in loss of high-frequency hearing
84
Cochlear conductive presbycusis is caused by:
* A disorder in the motion mechanics of the cochlear duct.
* The result is increasing hearing loss from low to high frequencies.
* The ability to understand speech is affected.
* High-pitched consonants such as s, t, f, and g are increasingly difficult to understand, especially in the presence of background noise
85
Which declines more with age, smell or taste?
Smell
86
Describe degenerative changes to tactile sensation in aging:
* Degenerative changes in _Meissner corpuscles_ may result in decreased sensitivity of the skin on the _palm of the hand and sole of the foot_ but not of hairy skin.
* Decrease in touch acuity can affect the ability of older individuals to localize stimuli.
* older individuals may have problems differentiating or manipulating small objects, including buttons and coins.
* The decrease in speed of reaction to tactile stimulation can cause harm to older persons, as they take longer to become aware of harmful or noxious stimuli, such as temperature extremes, chemical irritants, or simple pressure from a stone in a shoe.
87
Describe changes to thermal sensitivity in aging:
* _Changes in vascular circulation and loss of subcutaneous tissue_ in older individuals may result in changes in thermal sensitivity and impaired ability to cope with extreme environmental temperatures.
* One consequence is that older persons may feel cold and uncomfortable, even on a day that seems warm to a younger person.
* extremes in hot temperatures, for exam- ple, from hot bathwater or a heating pad, may not be readily detected by older individuals.
* As a consequence, individuals may suffer a burn from the inability to react quickly to the temperature extreme.
88
Discuss special considerations for patients with alzheimer's and/or dementia:
* Perception and interpretation of the environment significantly altered
* Persons affected by the amount, type and variety of stimuli found in the environment
* Under and Over stimulation can lead to confusion, illusions , frustration and agitation
* Changes in visual ability typical
* Dementia-associated fall risk may be reduced by choosing floor coverings/carpeting that avoid patterns or borders that increase visual-spatial difficulties
* strong color contrast can enhance functional ability by highlighting environmental features between floors and walls, chairs and flooring, and even utensils and tabletops, thereby facilitating more meaningful interpretation of the environment.
89
Age-related changes in the axial skeleton are common and include the following (4 items):
* Forward head position and rounded shoulders
* Increased thoracic kyphotic curvature (hyperkyphosis)
* Increased knee flexion angle
* A more posterior hip position (Balzini, et al., 2003)
90
In the extremities, the most common postural variations in aged adults are:
* rounded shoulders with protracted scapula and slightly flexed elbows, hips, and knees.
* changes in the articular surfaces and joint capsules often cause varus or valgus deformities at the hips, knees, or ankles.
* The normally obtuse angle between the neck and shaft of the femur may become more acute, which emphasizes the flexed posture.
91
Coordination is:
* The ability to execute smooth, accurate, controlled movements, which is dependent on an intact neuromusculoskeletal system; inputs from visual, somatosensory, and vestibular systems; and sensorimotor processing.
92
Normal coordination related impairments in aging:
* slower eye-hand coordination
* decreases in:
* interlimb coordination
* homolateral (same side) hand and foot movements
* motor coordination
* manual dexterity.
93
Postural stability in normal healthy adults is affected by the availability and validity of:
* visual, vestibular, haptic, and proprioceptive information that can provide a referential context for updating the body's location in space.
94
Age-related changes which may contribute to postural control and stability problems:
* Impairment/loss in:
* visual and vestibular information
* muscular atrophy
* loss of proprioception and vibration sense
* extrapyramidal dysfunction
* slowed reaction times
* decreases in muscle strength and power
* hyperkyphosis
95
Aging process in the extrapyramidal systems may produce:
* slowing of skilled motor movements
* alterations of gross movements
* The basal ganglia and cerebellum play a major role in control of movement.
* Tics or tremors may become evident, and movement may be slowed (bradykinesia), altered or absent, leading to postural instability in the older adult
96
What is likely the primary factor leading increased reaction time in older adults?
* Slowed central processing
* rather than other factors such as decreases in motor or sensory nerve conduction velocities or rate of muscle contraction.
97
True or false:
Regular physical activity has no effects on age-related decreases in proprioception
False:
Regular physical activity may attenuate age-related decreases in proprioception
98
The most typical gait changes with aging are the following:
* Decreased step length
* Decreased stride length
* Slower walking velocity
* Decreased cadence
* Decreased ankle range and push-off
* Increased double-stance time
* Decreased vertical displacement of center of mass
99
for Static Posture Assessment use:
plumb line
100
Postural sway, small oscillating movements of the body over the feet during bipedal standing, can be assessed by:
* observation
* computer-assisted postural sway analyzers
* force platforms
101
The most common clinical approach to evaluating coordination in the older adult is to:
Observe the performance of functional movements and activities and the resultant movement characteristics.
102
When assessing coordination the following should be considered:
* the accurate ability to perform the task and the speed required to complete the task
* Movement should be in the correct direction, and the movement trajectory should be smooth and fluid and well timed throughout.
* problems with muscle tension and movement control achieved by groups of muscles working together (synergies) and dfficulty initiating or stopping the movement should be noted.
* Body or extremity posture should be maintained during the movement
* movements should be easily reversed, even with changes in speed and direction of movement
103
Inability to maintain an upright posture without visual input is referred to as:
* a positive Romberg sign.
104
[Four] Standardized assessments of arm-hand function and motor coordination, and eye-hand coordination for use in older adults include the:
* Purdue Pegboard Test
* Jebsen Hand Function Test
* Timed Manual Performance
* Upper Extremity Performance Test for the Elderly (TEMPA)
105
Balance in the older adult is assessed clinically using a variety of balance measures that evaluate the following areas:
1. Static balance—standing quietly
2. Limits of stability
3. Anticipatory postural control
4. Reactive postural control
5. Sensory strategies and integration
6. Functional balance skills
7. Effects of cognitive demand on balance
8. Self-report measures of balance activities
106
To test limits of stability:
* Functional Reach Test
* FRT has been found to be predictive of falls among older adults
* Also: Multi-Directional Reach Test (MDRT), an expansion of the FRT, examines the older adult's limits of stability backward and laterally to the right and left, in addition to the forward direction
107
Testing Anticipatory Postural Control
* Portions of the dynamic gait index
* telling the older adult a nudge is going to be applied in advance of the action and he or she needs to resist it
* asking the individual to negotiate an obstacle course.
108
Testing reactive postural control
* Nudge test, by Tinetti
* Postural Stress Test
109
Testing Functiional Ballance Skills and Balance Measures
* Timed and Get up and-Go tests are used to measure an individual's functional dynamic balance
* Get-Up-and-Go test
* Berg Balance Scale (BBS)
* balance portion of the Tinetti Performance-Oriented Mobility Assessment (POMA)
* Fullerton Advanced Balance (FAB) scale
* intended for use in higher-functioning older adults because the majority of items are considerably more challenging than the POMA or BBS
* Balance Evaluation Systems Test (BESTest)
*
110
Should single tests of mobility be used to identify fall risks in older adults?
* No
* clinicians who assess older adults for risk of falling should ideally do so in a comprehensive manner rather than relying on a single test of mobility and that the multifactorial nature of falls should be taken into account
111
Testing cognitive demand in balance:
* dual-task TUG
* TUGDT\_cognitive asks the older adult to complete the TUG while counting backward by threes,
* TUGDT\_manual asks the older adult to complete the TUG while carrying a cup of water
112
\_\_\_\_\_ ________ has been demonstrated to be a sensitive test for detecting mobility impairments and a strong predictor of adverse events, even for highly functional older adults
* Gait velocity
Gerontology
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