Ayse Kuspinar

Objectives: This study assessed the construct validity, predictive validity, and responsiveness of the 4-metre walk test (4MWT) in community-dwelling older Canadians. Methods: Baseline and 3-year follow-up data from the Canadian Longitudinal Study on Aging were examined, including participants ≥ 65 years with 4MWT assessments. Secondary outcomes included physical and self-report measures and healthcare utilization (e.g., hospitalization and emergency department visits). Results: Baseline data on 12,433 and follow-up data on 10,107 participants were analysed. For construct validity, low-to-high correlations with the comparator measures (rho = 0.25 [with the Life Space Assessment] to 0.72 [with the Timed-Up and Go]) and known-groups differences of 0.15 m/s (assistive device use) and 0.04 m/s (falls) were found. For predictive validity, areas under the curve ranged from 0.51 to 0.59 for healthcare utilization, indicating poor prediction. For responsiveness, low-to-moderate correlations between change scores were found (rho = 0.01–0.44). Conclusions: Findings demonstrated partial support for construct validity and responsiveness and no support for predictive validity.

Background: Falls are the leading cause of unintentional injury in older adults. While guidelines recommend balance and mobility tests to identify individuals at risk, their ability to predict future falls and improve the World Falls Guidelines (WFG) risk stratification remains uncertain. Methods: A 12-month prospective cohort study of community-dwelling older adults in Canada (≥65 years) who could walk 10 m without physical assistance. Balance and mobility assessments included the timed up and go (TUG) at usual and fast pace and with a cognitive dual task (cog), the Brief BESTest, five times sit-to-stand, single-leg stance (SLS) and gait speed. Falls were recorded prospectively using monthly fall calendars and quarterly telephone interviews. Results: Of 514 participants who completed baseline assessments, 486 (95%) completed the 12-month follow-up. Mean age was 76.4 years, 64% were female, and 266 (52%) experienced ≥1 fall during follow-up. For predicting ≥1 fall, area under the curve (AUC) values ranged from 0.561 [95% confidence interval (CI) = 0.51–0.61] for SLS to 0.593 (95% CI = 0.50–0.69) for gait speed. For ≥2 falls, AUCs ranged from 0.581 (95% CI = 0.52–0.64) for TUGcog to 0.639 (95% CI = 0.54–0.74) for gait speed and for injurious falls from 0.620 (95% CI = 0.54–0.70) for TUGcog to 0.70 (95% CI = 0.54–0.86) for gait speed. Using the WFG algorithm without mobility tests deemed 282 participants as low risk, 41% of whom fell; adding mobility tests to the algorithm increased this proportion to 56%. Conclusion and relevance: Common balance and mobility tests showed limited predictive validity for future falls. Incorporating these tests into the WFG algorithm did not improve fall risk stratification in community-dwelling older adults.

Background: Life‐space mobility refers to the way individuals maneuver themselves in their home and community and is commonly assessed using the Life‐SpaceAssessment (LSA). Before using the LSA, it is important to ensure that it demonstrates validity in the population being used, as culture, built environment, and modes of transportation in different geographical regions can influence mobility. Therefore, the purpose of this study was to assess the convergent, divergent, and known‐groups validity of the LSA in community‐dwelling Canadian middle‐aged and older adults using data from the Canadian Longitudinal Study on Aging (CLSA). Methods: Spearman’s correlation coefficients were calculated for all measures of convergent (hypothesis: r > 0.5) and divergent (hypothesis: r < 0.3) validity. Known‐groups validity was assessed by determining if the LSA can differentiate between people with chronic diseases and a history of falls using measures of clinical significance (i.e., LSA score change of 5 or more points). Results: The sample ( n = 24,577) had a median LSA score of 86.0. Correlations between the LSA and comparator measures of convergent validity ( r = 0.10–0.29) did not meet the hypothesis; however, measures of divergent validity ( r = 0.15–0.17) met the hypothesis. For known‐groups validity, the LSA can be used to differentiate between those with (median score = 84; interquartile range [IQR] = 72–100) and without (median score = 90; IQR = 74–100) a history of falls among the whole sample. Further, it can be used to differentiate between those with and without chronic conditions, among males and females aged 75+ years. Conclusion: The LSA can be used to differentiate between known groups. However, there is limited evidence of its convergent validity as its relationship with other measures of actual mobility, perceived mobility, and locomotor capacity for mobility was weak. Future studies need to assess the convergent validity of the LSA against different comparator measures before its use among community‐dwelling Canadians.

Background: Walking difficulties are a common and costly problem. However, disability associated with the decline in walking ability is not an inevitable consequence. With an aging population, it is increasingly important to establish strategies to help older adults preserve the capacity to live independently and function well in late life. Preclinical mobility limitation (PCML), which is characterized by subtle changes or limitations in mobility that precede disability, manifests as changes in how daily tasks such as walking are performed. Persons with PCML are at increased risk for the onset of disability and chronic disease. For that reason, PCML is a critical stage in the natural history of functional change when there is the opportunity for primary prevention interventions. Objective: To evaluate the effect of a 12-week online mobility self-management program (Stepping Up) on mobility outcomes, including walking speed, aerobic exercise capacity, dual-task cost, physical functioning (balance and strength), balance confidence, extent of community mobility, self-management of mobility, and quality of life in older adults with PCML. Methods: This randomized controlled trial (RCT) will recruit 249 older adults (aged 55-75 years) screened for PCML. Participants will be assigned to the Stepping Up program, a telephone-based coaching walking program or an online chair-based yoga program. Programs will be delivered over 12 weeks and participants will undergo virtual assessments with a blinded physiotherapist at baseline, 12, 24, and 36 weeks. An economic evaluation will be conducted alongside this RCT. Results: A total of 253 participants were enrolled in the trial. Data collection commenced in August 2021 and will be completed in October 2025. Data analysis will begin in November 2025 and results will be published in the Summer of 2026. Conclusions: To our knowledge, PCML has not been addressed by primary prevention interventions that incorporate both task-oriented motor learning exercise and mobility self-management sessions. Results will establish if the Stepping-Up program has the potential to serve as a model for sustainable, accessible, and cost-effective programming for individuals with early mobility limitations. Trial Registration: ClinicalTrials.gov NCT04368949; https://clinicaltrials.gov/study/NCT04368949 International Registered Report Identifier (IRRID): DERR1-10.2196/72585

Purpose: The McMaster Monitoring My Mobility (MacM3) study aims to understand trajectories of mobility decline in later life using multi-sensor wearable technology. To our knowledge, MacM3 is the first major cohort to combine accelerometry and GPS to track real-world mobility in community-dwelling older adults. Participants: Between May 2022 and May 2024, MacM3 recruited 1,555 community-dwelling older adults (mean age 73.9 years, SD = 5.5) from Hamilton and Toronto, Ontario. Of the cohort, 68.4% were female, 62.4% married/partnered, 75.3% had post-secondary education, and 63.0% had ≥3 comorbidities. Most were Canadian born (69.4%) and White/Caucasian (88.0%), with greater ethnocultural diversity observed at the Toronto site. Findings to date: At baseline, 56.7% of participants reported no mobility limitations, 15.9% had preclinical limitations, and 27.4% had minor mobility limitations. Mean gait speed for the total sample was 1.23 m/s, with a mean Timed Up and Go time of 9.4 seconds and a 5x sit-to-stand time of 13.0 seconds. A total of 1,301 participants had valid wrist-worn device data, and 1,008 participants who agreed to wear the thigh-worn device had valid data (≥7 days with ≥10 hours of wear per day). Step count data (n = 1008) revealed a mean of 8,437 steps per day (SD = 2,943), with 5,073 steps in the lowest quartile and 12,303 steps in the highest. Future plans: Ongoing work aims to develop predictive models of mobility decline by integrating wearable, clinical, and environmental data. Pipeline enhancements will enable GPS/inertial measurement unit fusion to explore mobility-environment interactions and support aging-in-place tools.

Background: Falls are a key public health concern, resulting in disability and increased mortality risk. An extensive body of literature has examined risk factors for falls, however results vary across different studies and populations. We aimed to synthesize systematic reviews on fall risk factors in community-dwelling older adults. Methods: A systematic review of systematic reviews. Searches were executed in six databases (Medline, Embase, CINAHL, Cochrane Library, PsychINFO, Ageline) from inception until June 13, 2023. Eligible studies included systematic reviews of prospective cohort studies that included a population of community dwelling older adults (≥60 years) and reported fall risk factors. Three reviewers (SS, CD, QH) screened 8173 records. Summary data were extracted and the units of analyses were the relationships between risk factors and falls. Descriptive results are reported in counts and frequencies. The study was registered in Prospero (CRD42022335392). Findings: Fifty-seven reviews were included. Mobility-related measures (balance, gait, physical function, physical activity, dual task ability, strength, range of motion) accounted for 40% of all relationships. Of these, clinical tests of balance and physical function were consistently predictive of falls. Other consistent predictors were cognition, specifically executive function (76% significant) and processing speed (100%), medications (58%), frailty (100%), and chronic conditions (83%). There was a paucity of evidence for psychosocial, environmental, and sociodemographic factors. The majority of reviews (54%) were rated as low risk of bias. Conclusions: Mobility-related risk factors for falls are well established and can be addressed through interventions. Findings highlight the limited examination of psychosocial, sociodemographic, and environmental risk factors for falls, indicating areas for future research. Highlights: This study synthesized all systematic and scoping reviews from six databases that examined 29 fall risk factors in community-dwelling older adults (≥60 years) from over 300 prospective studies The results highlight the extensive evaluation of mobility-related measures and identifies promising factors for fall risk assessment (i.e., clinical tests of balance and physical function, executive function, processing speed, frailty, chronic conditions) The study synthesizes the magnitude of relationships between risk factors with meta-analysis results The evidence from this study will help researchers refine those risk factors most important for identifying fall risk. Psychosocial, sociodemographic, and environmental factors could be valuable targets for future research on fall prevention.