Capturing Change in Balance Confidence over 30 Days: Insights Gained from a Micro-Longitudinal Study

Abstract Balance confidence reflects one’s estimate of their ability to maintain balance and avoid falls. Extensive literature has shown the relationships between balance confidence, functional limitations, and falls in later life. However, change in balance confidence, especially within short timescale, remains largely unknown and deserves further research. In this study, we aimed to investigate how older adults’ balance confidence would change over 30 days and explore whether baseline characteristics would explain the individual differences in change. We used data from the Daily Balance Project that employed intensive-repeated measurements to examine the dynamics of subjective and objective fall risk across a month. Twenty-one participants (age=78.6±5.8, 48%female) were enrolled, and individual characteristics were measured upon recruitment. Throughout the study, participants self-reported their daily balance confidence using the Activity-Specific Balance Confidence (ABC) Scale. We performed growth modeling techniques to examine change within a multilevel framework. Our results showed that overall, ABC scores were high (79.9±17.4) at first, but the linear change was non-significant (b=0.03, SE=0.21, p=.89) on average. However, we found that balance confidence increased in individuals with higher educational attainment (b=0.37, SE=0.13, p<.01) and decreased among those with greater physical fall risk (b=-0.18, SE=0.07, p<.01) and accurate understanding of fall risk at baseline (b=-0.24, SE= 0.12, p=.04). Although ABC scores were stable within the period of one month, our study highlights the distinction of individual characteristics in the process of balance confidence appraisal. We suggest that these nuances should be taken into account when developing more fine-grained fall risk assessments and interventions.

Vancouver, British Columbia, Canada, 2. University of British Kelowna,British Columbia,Canada,3. the University of British Columbia,Vancouver,British Columbia,Canada Combating dementia is a public health priority, and exercise training is one promising strategy for dementia prevention.However, its efficacy in promoting cognitive outcomes in different types of dementia remains unknown.We conducted a systematic review (N = 27) and meta-analysis (N = 24) of randomized controlled trials with cognitive function as a primary or secondary outcome.We aimed to assess the effect of exercise interventions on the cognitive function of older adults (>60 years) diagnosed with different types of dementia.We synthesized data from 2,441 older adults with dementia.Eleven trials included older adults with multiple types of dementia, eight with Alzheimer's disease, six with unspecified types of dementia, and two with vascular cognitive impairment.We performed random-effects models using robust variance estimation (RVE) and tested potential moderators using the approximate Hotelling-Zhang test (HTZ).Results suggest a small effect of exercise on cognitive function for all-cause dementia (g = 0.18; 95% CI: 0.04, 0.33; p = 0.016); however, the effects did not differ by type of dementia.Moderation analyses showed that trials that did not specify participants' severity of dementia, applied individuallevel randomization, and had higher intervention adherence demonstrated larger exercise effects on cognitive function for all-cause dementia.We conclude that exercise promotes small improvements in the cognitive function of older adults with all-cause dementia.More research including different types of dementia is needed if we hope to determine the precise effects of exercise for each type of dementia.

THE INVENTORY OF PHYSICAL ACTIVITY BARRIERS FOR ADULTS 50 YEARS AND OLDER: REFINEMENT AND VALIDATION
Mariana Wingood, 1 Salene Jones, 2 Nancy Gell, 3 Denise Peters, 3 and Jennifer Brach, 4 , 1. University of Vermont, University of Vermont, Vermont, United States,2. Fred Hutchinson Cancer Research Center,Seattle,Washington,United States,3. University of Vermont,Burlington,Vermont,United States,4

. University of pittsburgh, Pittsburgh, Pennsylvania, United States
Addressing physical activity (PA) barriers is an essential component of increasing PA among the 56-73% of community-dwelling adults 50 years and older who are not performing the recommended 150 minutes of moderateto-vigorous PA.As there is no feasible, multi-factorial tool to assess PA barriers among this population, we developed and validated a PA barrier assessment tool called the Inventory of Physical Activity Barriers (IPAB).We collected cross-sectional data on 503 adults (mean age 70.1), with 79 participants completing the scale twice for test-retest reliability and 64 completing a cross-over design examining the ability to use two administration formats interchangeably.Our analyses consisted of exploratory and confirmatory factor analysis, Cronbach alpha, intraclass correlation coefficient, Bland-Altman Plot, and t-tests.Using factor analysis, we identified and confirmed an eight-factor solution consisting of 27 items.The 27-item IPAB is internally consistent (alpha= 0.91), has a high test-retest reliability (intraclass correlation coefficient=0.99), and can differentiate between individuals who meet the recommended levels of PA and those who do not (p < 0.001).The IPAB scores ranged between 1.00-3.11for the paper format (mean=1.78)and 1.07-3.48for the electronic format (mean=1.78),with no statistical difference between the paper and electronic administration formats (p=0.94),resulting in the conclusion that the two administration formats can be used interchangeably.Participant feedback illustrates that the IPAB is easy to use, has clear instruction, and is an appropriate length.The newly validated IPAB scale can be used to develop individualized PA interventions that address PA barriers among patients 50 years and older.

FALLS: SCREENING, RISKS, AND PREVALENCE CAPTURING CHANGE IN BALANCE CONFIDENCE OVER 30 DAYS: INSIGHTS GAINED FROM A MICRO-LONGITUDINAL STUDY
Tai-Te Su, 1 Aileen Griffin, 2 Faith-Christina Washington, 1 Jacob Sosnoff, 3  Balance confidence reflects one's estimate of their ability to maintain balance and avoid falls.Extensive literature has shown the relationships between balance confidence, functional limitations, and falls in later life.However, change in balance confidence, especially within short timescale, remains largely unknown and deserves further research.In this study, we aimed to investigate how older adults' balance confidence would change over 30 days and explore whether baseline characteristics would explain the individual differences in change.We used data from the Daily Balance Project that employed intensive-repeated measurements to examine the dynamics of subjective and objective fall risk across a month.Twenty-one participants (age=78.6±5.8,48%female) were enrolled, and individual characteristics were measured upon recruitment.Throughout the study, participants self-reported their daily balance confidence using the Activity-Specific Balance Confidence (ABC) Scale.We performed growth modeling techniques to examine change within a multilevel framework.Our results showed that overall, ABC scores were high (79.9±17.4) at first, but the linear change was nonsignificant (b=0.03,SE=0.21, p=.89) on average.However, we found that balance confidence increased in individuals with higher educational attainment (b=0.37,SE=0.13, p<.01) and decreased among those with greater physical fall risk (b=-0.18,SE=0.07, p<.01) and accurate understanding of fall risk at baseline (b=-0.24,SE= 0.12, p=.04).Although ABC scores were stable within the period of one month, our study highlights the distinction of individual characteristics in the process of balance confidence appraisal.We suggest that these nuances should be taken into account when developing more fine-grained fall risk assessments and interventions.
and Shannon Meija, 4 , 1. University of Illinois at Urbana-Champaign, Champaign, Illinois, United States, 2. University of Illinois at Urbana-Champaign, Aurora, Illinois, United States, 3. School of Health Professions, University of Kansas Medical Center, Kansas City, Kansas, United States, 4. University of Illinois, Champaign, Illinois, United States