Klaus Hauer

AGAPLESION BETHANIEN KRANKENHAUS HEIDELBERG · research department

Background: Fear of falling (FoF) is a lasting concern about falling that leads to an individual avoiding activities that he/she remains capable of performing. It is a common condition amongst older adults and may occur independently of previous falls. Cognitive behavioural therapy (CBT), a talking therapy that helps change dysfunctional thoughts...

Purpose To examine distinct mobility outcomes (locomotor capacity, physical activity, life-space mobility) of acute geriatric care (AGC) in acutely hospitalized older adults and identify predictors associated with these outcomes. Methods The PAGER study was designed as a prospective observational study. Mobility outcomes of 107 hospitalized older...

Background and objectives: The Life-Space Assessment (LSA) is the most commonly used questionnaire to assess life-space mobility (LSM) in older adults, with well-established psychometric properties for face-to-face (FF) administration. However, these properties have not yet been explicitly studied when the LSA is administered by telephone. The stu...

Concerns (or 'fears') about falling (CaF) are common in older adults. As part of the 'World Falls Guidelines Working Group on Concerns about Falling', we recommended that clinicians working in falls prevention services should regularly assess CaF. Here, we expand upon these recommendations and argue that CaF can be both 'adaptive' and 'maladaptive'...

Background: Depression is the most common mental disorder in older adults and is influenced by age-related processes. Frailty is a well-established clinical expression of ageing that implies a state of increased vulnerability to stressor events as well as increased risks of disability, hospitalization and death. Neurobiological findings will disen...

Background: Life-space mobility (LSM), as the extent of mobility within one's environment, is a key for successful aging and has become a relevant concept in gerontology and geriatric research. Adequate assessment instruments are needed to identify older persons with LSM restrictions, and to initiate, adapt or evaluate intervention strategies. Ob...

Sarcopenia - the age-associated loss of muscle function and muscle mass - is of utmost importance for older patients with degenerative and traumatic diseases of the musculoskeletal system, as it closely linked to the loss of independence and quality of life in higher age. Impairments of mobility that are highly present in this patient group acceler...

Background Older people with cognitive impairment (CI) are at high risk for mobility limitations and adverse outcomes after discharge from geriatric rehabilitation settings. The aim was to estimate the effects of a specifically designed home-based physical training and activity promotion program on physical capacity, different aspects of physical a...

Background: The strength, assistance walking, rise from a chair, climb stairs, and falls (SARC-F) questionnaire is a well-established instrument for screening of sarcopenia and sarcopenia-related functional impairments. As it is based on self-reporting, its use precludes patients who are unable to answer the questionnaire as a consequence of sever...

Guideline/rationale for geriatric rehabilitation in a ortho-geriatric setting as supported by the "Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) and the "Deutsche Gesellschaft für Geriatrie (DGG)

Background: Cognitive impairment (CI) has been reported to negatively impact rehabilitation outcomes. Knowledge about differences in rehabilitation received in dependence of CI as a potential mediating factor is limited. Objective: To analyze whether CI affects amount and frequency of rehabilitation received and if associations between CI and re...

Dear Editor, We have read with great interest the article by Suri et al. (1) who reported an association between gait quality measures recorded in the laboratory and life-space mobility (LSM) in community-dwelling older adults. Given the negative consequences of limited mobility for daily functioning, social participation, and quality of life, it...

Objective: The aim of the study is to assess the feasibility, sustainability, and effectiveness of task-specific memory exergame training on motor–cognitive performance in older adults. Materials and Methods: Fifty older adults (age: 78.8 ± 7.0 years) participated in a randomized controlled trial with a 10-week intervention and 3-month follow-up pe...

(1) Background: Life-space mobility assessments for institutionalized settings are scarce and there is a lack of comprehensive validation and focus on persons with cognitive impairment (CI). This study aims to evaluate the psychometric properties of the Life-Space Assessment for Institutionalized Settings by proxy informants (LSA-IS-proxy) for inst...

Background Identifying patients with maladaptive fear of falling (FOF) is important in the rehabilitation phase after serious fall. The 6-item Fear of Falling Questionnaire-revised (FFQ-R) was seen as promising measurement instrument as it evaluates FOF in a broader way than the one-item-question and independent of physical activities.AimThe purpos...

Introduction: There is a substantial lack of home-based exercise programs in the highly vulnerable group of geriatric patients with cognitive impairment (CI) after discharge from ward rehabilitation. Beyond clinical effectiveness, the cost-effectiveness of intervention programs to enhance physical performance is not well investigated in this targe...

PurposeThe “Life-Space Assessment in Persons with Cognitive Impairment” (LSA-CI) to assess mobility within the environment including frequency and independence in 1 week has been developed for and successfully validated in older persons with mild to moderate cognitive impairment. However, its psychometric properties in persons without cognitive imp...

This study aimed to identify determinants of quantitative dimensions of physical activity (PA; duration, frequency, and intensity) in community-dwelling, multi-morbid, older persons with cognitive impairment (CI). In addition, qualitative and quantitative aspects of habitual PA have been described. Quantitative PA and qualitative gait characteristi...

Background Self-reported life-space assessment methods so far focus on community-dwelling persons, with a lack of validated assessment methods for institutionalized settings. This study evaluated construct validity, test-retest reliability, sensitivity to change, and feasibility of a new Life-Space Assessment for Institutionalized Settings (LSA-IS)...

Objective: To investigate short-term changes in clinical characteristics in the transition period between geriatric inpatient rehabilitation and independent living at home in older patients with hip/pelvic fracture and cognitive impairment. Design: Longitudinal observational study. Subjects: A total of 127 multi-morbid, older patients with hip/pelv...

Background: Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk for losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The study aim was to evaluate the effects of a CI-specific, home-based physical training and activity pro...

Background: Training effects reported for stepping exergames on stepping performances in older adults often based on not comprehensively validated outcomes measures, and follow-up data on their sustainability are lacking. The aim of this study is to evaluate the effectiveness and sustainability of a motor-cognitive stepping exergame training on the...

Background: Match or mismatch of objective physiological and subjectively perceived fall risk may have serious consequences in patients with dementia (PwD) while research is lacking. Objectives: To analyze mismatch of objective and subjective fall risk and associated factors in PwD. Method: Cohort study in a geriatric rehabilitation center. Objecti...

The aim of this study was to identify in-hospital fall risk factors specific for multimorbid hospitalized geriatric patients with dementia (PwD) during hospitalization. Geriatric inpatients during ward-based rehabilitation (n = 102; 79.4% females; 82.82 (6.19) years of age; 20.26 (5.53) days of stay) were included in a comprehensive fall risk asses...

The aim of the present study was to examine adherence and acceptance of a home-based program to promote physical activity (PA) in older persons with cognitive impairment (CI) following inpatient rehabilitation. Sixty-three older persons (≥ 65 years) with mild to moderate CI (Mini-Mental State Examination score 17–26), allocated to the intervention...

Body-fixed sensor (BFS) technology offers portable, low-cost and easy-to-use alternatives to laboratory-bound equipment for analyzing an individual’s gait. Psychometric properties of single BFS systems for gait analysis in older adults who require a rollator for walking are, however, unknown. The study’s aim was to evaluate the concurrent validity,...

Bathing robots have the potential to foster independence of older adults who require assistance with bathing. Making human-robot interaction (HRI) for older persons as easy, effective and user-satisfying as possible is, however, a major challenge in the development of such robots. The study aimed to evaluate the effectiveness (coverage, step effect...

In this paper we present a prototype integrated robotic system, the I-Support bathing robot, that aims at supporting new aspects of assisted daily-living activities on a real-life scenario. The paper focuses on describing and evaluating key novel technological features of the system, with the emphasis on cognitive human–robot interaction modules an...

Aim: To evaluate the effectiveness and user satisfaction with the sit-to-stand (STS) assistance system of a smart walker (SW), and to identify factors associated with them in potential users. Methods: A total of 33 older adults (29 women, aged ≥65 years) with motor impairments (habitual rollator use) and no severe cognitive impairment (Mini-Ment...

Dual-task (DT) training, which impacts both motor and cognitive function, has so far rarely been included in fall prevention research even so cognitive impairment, including attentional deficits, represents a potential high-impact pathway for risk of falling in older persons. This chapter systematically reviews the literature and appraises previous...

This study investigated the effectivity and sustainability of a physical activity (PA) promotion- and motor training program and analyzed predictors for PA changes in persons with dementia (PwD). A total of 122 participants with mild-to-moderate dementia were randomized to the intervention program designed for PwD (intervention group [IG]) or a mot...

Background: Gesture-based human-robot interaction (HRI) depends on the technical performance of the robot-integrated gesture recognition system (GRS) and on the gestural performance of the robot user, which has been shown to be rather low in older adults. Training of gestural commands (GCs) might improve the quality of older users' input for gestu...

Objective To gain a better understanding about the nature of fear of falling, this study analyzed associations between psychological and physical aspects related to fear of falling and falls efficacy in hip/pelvic fracture patients. Design Baseline data of a randomized controlled trial. Setting Geriatric inpatient rehabilitation hospital. Subjec...

Selecting appropriate outcome measures for multimorbid, acutely hospitalized geriatric patients poses specific challenges, which may have caused inconsistent findings of previous intervention trials on early inpatient rehabilitation. The objective of this review was to describe primary outcome measures used in randomized controlled trials (RCTs) on...

Abstract Background: Setting meaningful, individualized rehabilitation goals is an essential part of the rehabilitation process. Even though patients with dementia are a drastically increasing patient group, empirical data about meaningful rehabilitation goals and collaborative goal-setting in this target group is missing. Cognitive impairment and...

Objective: To comprehensively validate an assessment tailored to an exergaming training program with motor-cognitive challenges. Materials and Methods: Fifty-eight cognitively intact, multimorbid, independently living older adults (mean age [SD]: 78.3 [6.5] years) with moderate functional limitations participated in the study. For construct validit...

Objective: The aim of the study was to investigate the psychometrical quality of a newly developed activity monitor (uSense) to document established physical activity parameters as well as innovative qualitative and quantitative gait characteristics in geriatric patients. Approach: Construct and concurrent validity, test-retest reliability, and fe...

Hintergrund/Ziel der Studie: Multimorbide, ältere Personen mit Hüft-/Beckenfraktur (HBF) und kognitiver Einschränkung (KE) sind nach einer stationären Rehabilitation von einem erneuten Rückgang ihrer motorischen Leistungsfähigkeit und damit vom Verlust ihrer Autonomie bedroht. Ziel der Studie war es, die Effekte eines von freiwilligen Laienhelfer_i...

Objective: To investigate the day-to-day variability of various sensor-based physical activity (PA) parameters and to analyze effects of weekdays vs. weekend days as well as the influence of concomitant factors (gender, living conditions, cognitive status, physical performance, and level of PA) in multi-morbid, older persons with mild-to-moderate...

Background: Selecting appropriate outcome measures for vulnerable, multimorbid, older patients with acute and chronic impairments poses specific challenges, which may have caused inconsistent findings of previous intervention trials on early inpatient rehabilitation in acutely hospitalized older patients. The aim of this review was to describe pri...

Objective: To assess the concurrent validity of a smart walker-integrated gait analysis system with the GAITRite® system for measuring spatiotemporal gait parameters in potential users of the smart walker. Design: Criterion standard validation study. Setting: Research laboratory in a geriatric hospital. Participants: Twenty-five older adults...

Background A hip or pelvic fracture is a major fall-related injury which often causes a decline in mobility performance and physical activity. Over 40% of patients with hip fracture have cognitive impairment or dementia and poorer rehabilitation outcomes than those without cognitive impairment. In this subgroup, there is a lack of evidence on the b...

We present the design of a system combining augmented reality (AR) and gamification to support elderly persons’ rehabilitation activities. The system is attached to the waist; it collects detailed movement data and at the same time augments the user’s path by projections. The projected AR-elements can provide location-based information or incite mo...

Depressive symptoms are highly prevalent in nursing home (NH) residents. We assume that enjoyability, besides frequency of activities, is an important facet of expanded everyday activities (EEAs; Baltes et al., in: Baltes and Mayer (eds) The Berlin aging study, University of California Press, Berkeley, 2001) and affects residents’ depressive sympto...

Objectives: To describe life-space mobility and identify its determinants in older persons with cognitive impairment after discharge from geriatric rehabilitation. Methods: A cross-sectional study in older community-dwelling persons with mild to moderate cognitive impairment (Mini-Mental State Examination, MMSE: 17-26) following geriatric rehabi...

Die Entwicklung von Robotern im Gesundheitsbereich oder AAL-System folgt ethischen wie auch technischen Grundsätzen. Ein Schwerpunkt in der ethischen Bewertung wie auch der zielführenden technischen Entwicklung von Unterstützungssystemen ist die Passung (Match) von technischen Funktionen mit den Ressourcen, Wünschen und Bedürfnissen der Zielgruppe...

Background: Some studies have already suggested that exergame interventions can be effective to improve physical, cognitive, motor-cognitive, and psychological outcomes in patients with dementia (PwD). However, little is known about the training volume required to induce such positive effects and the inter-individual differences in training respons...

Background: A version of the Life-Space Assessment in persons with cognitive impairment (LSA-CI) has recently been developed. Aims: To establish a cut-off value for the newly developed Life-Space Assessment in persons with cognitive impairment (LSA-CI). Methods: In a cross-sectional study including 118 multimorbid, older persons with cognitive im...

The aim of the study was to investigate the biometrical quality of a newly developed activity monitor (uSense) to document established physical activity (PA) parameters as well as innovative qualitative and quantitative gait characteristics for habitual activity behavior in multi-morbid, older adults. Validity, test-retest reliability, and feasibil...

The study objective was to determine effectiveness of a specific, standardized home-based training to improve life-space mobility (LSM) in community-dwelling, multi-morbid, older persons with motor and cognitive impairment (CI) after discharge from ward-based rehabilitation. A double-blinded, randomized, controlled trial including 118 older persons...

The objective of this study was to evaluate immediate and long-term transfer from trained to non-trained Dual Task (DT) performances in patients with dementia (PwD). Multi-morbid, older PwD (n=105) were included in a 10-week randomized, controlled trial with the intervention group (IG) performing a DT-based training (‘Walking and Counting’) while t...

Exergaming can be effective to improve physical and cognitive functions, motor-cognitive per-formances, and psychological outcomes in older persons with or without cognitive impairment. However, little is known about the training volume required to achieve positive effects. The aim of this study was to evaluate the time course of improvements in mo...

Studies on life-space mobility (LSM) and its determinants have previously been conducted in older community-dwelling persons, but are lacking in multi-morbid, older persons with persistent and acute motor and cognitive impairment following discharge from geriatric rehabilitation. The study objective was to describe LSM and identify sample-specific...

Background: Geriatric patients after hip/pelvic fracture (HPF) have reduced motor performance and are at risk of losing their autonomy during the transition from inpatient rehabilitation to their home environment. This risk increases with cognitive impairment (CI). Aim of this study: The investigation of the change of motor performance in geriatric...

Hintergrund: Geriatrische Patienten mit Hüft - oder Beckenfraktur (HBF) weisen eine reduzierte motorische Leistungsfähigkeit auf und sind in der vulnerablen Phase des Übergangs von der stationären Rehabilitation ins häusliche Umfeld stark vom Verlust ihrer Autonomie bedroht. Dieses Risiko nimmt bei gleichzeitig vorliegender kognitiver Einschränkung...

Background: Specific dual-task (DT) training is effective to improve DT performance in trained tasks in patients with dementia (PwD). However, it remains an open research question if successfully trained DTs show a transfer effect to untrained DT performances. Objective: To examine transfer effects and the sustainability of a specific DT training...

Short description of relevance and outlook of geriatric rehabilitation in patients with femoral fracture.

Background and objectives: To investigate the validity, reliability, sensitivity to change, and feasibility of a modified University of Alabama at Birmingham Study of Aging Life-Space Assessment (UAB-LSA) in older persons with cognitive impairment (CI). Research design and methods: The UAB-LSA was modified for use in persons with CI Life-Space A...

Background: Navigational skills decline with age, and this decline is even more pronounced in cognitively impaired (CI) older adults. Navigation assistance is an emerging functionality of robotic rollators (RRs). The evidence on the effectiveness of RR-integrated navigation systems in potential end-users is, however, scarce. Objective: To determ...

Background: Dementia is a frequent diagnosis in geriatric rehabilitation. Studies in patients with dementia on the development of their cognitive status during rehabilitation and its relation to functional outcomes have been scarce. Objectives: To describe the changes in cognitive status in patients with dementia during inpatient rehabilitation...

Hintergrund: Körperliche Aktivität (KA) wird in sensorbasierten Assessments durch multiple Einzelparameter und zusammengesetzte Parameter dokumentiert. Wie hoch die Tag-zu-Tag-Variabilität dieser technisch definierten Parameter ist und wie viele Messtage notwendig sind, um habituelle Aktivität zu erfassen, wurde bei multimorbiden, gebrechlichen, ho...

Background: Restricted life-space mobility in older persons is associated with higher mortality and dependency, higher institutionalization and negatively affects quality of life and social participation. Cognitive impairment increases the risk for mobility limitations. The UAB Life-Space-Assessment (LSA) represents the most frequently used life sp...

Background and Objectives: To determine whether a multicomponent, individually tailored intervention to promote physical activity (PA) enhances life-space (LS) utilization in nursing home (NH) residents and whether intervention effects can be sustained at follow-up after continuation of the program as part of institutional daily routines. Research...

Background Geriatric patients with cognitive impairment (CI) show an increased risk for a negative rehabilitation outcome and reduced functional recovery following inpatient rehabilitation. Despite this obvious demand, evidence-based training programs at the transition from rehabilitation to the home environments are lacking. The aim of this study...

Background: A complex motor skill highly relevant to mobility in everyday life (e.g., sit-to-stand [STS] transfer) has not yet been addressed in studies on motor learning in people with dementia (PwD). Objective: To determine whether a dementia-specific motor learning exercise program enables PwD to learn compensatory STS maneuvers commonly taught...

Background: Post-ward geriatric rehabilitation programs have hardly been developed and validated, which leaves a substantial gap in rehabilitative care in older adults and hinders full exploitation of maintained, but often unrecognized rehabilitation potentials. Geriatric rehabilitation patients with cognitive impairment represent a highly vulnera...

Objectives: To examine the effects of a computerized, game-based training on motor-cognitive performances, the transfer of training effects on untrained tasks, and the sustainability of training gains in people with dementia. Method: Ninety-nine individuals with a mean age of 82.9 (5.8) and dementia participated in a 10-week randomized controlled t...

Fall related hip and pelvic fractures are among the injuries with the most serious consequences for the elderly population. The prognosis for functional recovery markedly worsens in the large subgroup of patients with cognitive impairment. So far, only a small number of clinical trials could show that cognitive impaired hip fracture patients can be...

Attention-based cognitive functions have become a focus of interventional or diagnostic research as they represent early markers of cognitive decline, relevant for ADL autonomy. However, assessment methods have not been comprehensively validated including sensitivity data and feasibility for different assessment approaches, especially in the target...

Exergames are increasingly established for training purpose; however, newly assessment strategies based on the internal data flow are hardly developed and validated. Such assessment strategies provide high-class data with strict focus on applied training goals and programs. In this study we analyzed construct validity, test-retest reliability, sens...

Decrease in memory performance and executive functions represent early markers of age- associated cognitive decline or neurodegenerative disorders while procedural memory is sustained. The purpose of this randomised controlled trail (RCT) was to examine the effect of a newly developed computer-based memory training program (Physiomat®) using proced...

Study objective was to examine the effect of an intervention program on fear of falling, physical performance and life space in nursing home residents. Frail, multi-morbid nursing homes residents (n=83, mean age: 82.6 ± 10.1, MMSE 19.5 ± 7.4) took part in a controlled intervention trial to promote physical activity. The intervention group (IG: n=56...

Fear of falling is common in different older populations, both in fallers and non-fallers. Previous studies have shown that fear of falling may lead to activity avoidance, and has a negative impact on balance, gait, mobility, social activity, mental health and independence. Internationally the research on fear of falling has taken a flight but rese...

Background: Physical activity is beneficial in people with dementia. As physical activity increases risk exposure for falls, safety concerns arise. Prior exercise trials in people with dementia have not measured physical activity. Falls in relation to exposure time rather than person-years as outcome measure has been promoted but not investigated...

Objectives: Physical activity (PA) may counteract depressive symptoms in nursing home (NH) residents considering biological, psychological, and person-environment transactional pathways. Empirical results, however, have remained inconsistent. Addressing potential shortcomings of previous research, we examined the effect of a whole-ecology PA inter...

Sit-to-stand (STS) transfers are a common human task which involves complex sensorimotor processes to control the highly nonlinear musculoskeletal system. In this paper, typical unassisted and assisted human STS transfers are formulated as optimal feedback control problem that finds a compromise between task end-point accuracy, human balance, energ...

Objective: To investigate validity, test-retest reliability, sensitivity to change, and feasibility of dual task (DT) assessments in patients with dementia. Design: Validation study. Setting: Post ward-rehabilitation. Participants: Geriatric patients (n=105) with dementia (age 82.7±5.9, MMSE score 21.9). Main outcome measures: Psychometric...

Background: Studies on life-space (LS) and its determinants have previously been limited to community-dwelling subjects but are lacking in institutionalized older persons. The purpose of this study was to provide an advanced descriptive analysis of LS in nursing home residents and to identify associated factors based on an established theoretical...