The role of movement specific reinvestment, fall efficacy and perception in walking and falling in community-dwelling older adultsin Hong Kong

Abstract

In six experiments, the relationships between history of falls, reinvestment, fear of falling, perception, balance ability and walking ability of community-dwelling older adults was investigated. In addition, the Movement Specific Reinvestment Scale (MSRS) (Masters, Polman, & Hammond, 1993; Masters, Eves, & Maxwell, 2005) was further validated, using a Chinese version (MSRS-C). In the first experiment (Chapter 2), it was shown that elder fallers scored significantly higher than non-fallers on both the movement self-consciousness and the conscious motor processing components of the MSRS-C. The conscious motor processing component of the MSRS-C was found to discriminate previous faller from non-faller status. In the second experiment (Chapter 3), findings demonstrated that internal focus of attention was greater in elder repeat fallers and increased as task demands increased.

However, external focus of attention increased in both elder repeat fallers and elder non-fallers as task demands increased. Elder repeat fallers scored significantly higher than elder non-fallers on the MSRS-C. In the third and fourth experiments (Chapter 4), it was revealed that elder fallers demonstrated greater fear of falling and a higher propensity for movement specific reinvestment than non-fallers. Elderly people perceived stairs as steeper than they were and judged stairs as steeper when making visual-matching and verbal-report estimates that required conscious involvement compared to haptic estimates that are thought to require little conscious involvement. Overestimations when making explicit, conscious judgments were reduced by carrying out a concurrent secondary task during estimation, but there was little effect of the secondary task on implicit, non-conscious judgments of steepness. In Chapter 5, focus group work was conducted to investigate whether (1) elderly people respond differently when asked to complete the MSRS-C in respect of contexts that are not directly related to balance or locomotion and (2) elderly people are better able to differentiate a 4-point Likert response format when completing the MSRS-C than the original 6-point format. Experiment five (Chapter 6) further validated the MSRS-C based on the findings from Chapter 5. Results revealed that both the MSRS-C (general) and MSRS-C (walking) can be used with a six-point or a four-point response format to differentiate elderly Chinese fallers from non-fallers. The overall findings were discussed in the context of theories of motor learning and reinvestment. Implications for rehabilitation training were elucidated.