Fall risk assessment and knee extensor muscle activity in elderly people

PURPOSE: The purpose of this study was to analyze relationships between the history of falls, tripping, sway, and knee extensor muscle strengths as a tool for fall risk assessment in elderly people. We examined effective fall prevention measures. METHODS: We investigated 102 elderly volunteers in the community. The subjects were classified according to history of falls, tripping, sway and 5 performance tests conducted to assess fall risk including Timed up-and-go test (TUG), Functional Reach test (FR), Hand grip and Reaction time (RT). In addition, the time serial data of the knee extensor muscle strength were acquired using a hand-held dynamometer. RESULTS: In comparison to the non-faller group, the faller group showed a significantly higher incident rate of tripping and sway. A frequency analysis using the Maximum Entropy Method revealed that the fallers group showed lower peak frequency (p=0.025). Also, the slope of the logarithmical spectrum was less steep in the fallers group (p=0.035). Also results from analysis of the peak force latency from the beginning of measurement to 50%, 80%, and 100% muscle strength, also showed that the faller group took more time for maximal voluntary contraction. CONCLUSIONS: The frequency analysis of the time series date of peak force latency of knee extensor muscle strength revealed that the muscle activity differs in faller compared to non-fallers. This study suggested that knee extensor muscle isometric performance could possibly be used as a new tool for fall risk assessment. We concluded that exercises to raise maximal muscle strength and muscle response speed are useful for the prevention of falls.     

Fall injuries in the elderly

Injuries are the sixth leading cause of death in the 75-and-over population, with falls the leading cause of injury-related deaths. Hospitals and residential centers for the elderly have high rates of falls and injuries. With increasing age, patients in nursing homes have a corresponding increase in the proportion of fatal falls. The patterns of reduction of injury and mortality in the past two decades are likely to have been the result of our medical and trauma care system's impact on the outcome of less severe injuries. Major improvements in the future will come through prevention.     

Fall prevalence,time trend and its related risk factors among elderly people in China

ObjectivesTo study the fall prevalence, time trends and related risk factors among elderly people in the Chinese mainland from 2011 to 2013.MethodsOur data were from China Health and Retirement Longitudinal Study in 2011 and 2013. The population sample included people aged 60 years and over. Whether the person had experienced fall accident in the last two years was used to measure fall incidence. The time trend and age groups were investigated through the chi-square test. The related risk factors were examined based on the binary logistic regression model.ResultsIn 2011, 19.64% (95% CI, 18.66%, 20.67%) of elderly people experienced fall incidents and in 2013, 19.28% (95% CI, 18.46%, 20.13%) of elderly people experienced fall incidents. However, no significant difference was seen in the fall prevalence between 2011 and 2013. The fall prevalence among elderly people aged 66–70 declined significantly while that among people aged over 80 showed an increasing time trend. The fall prevalence was affected significantly by factors including age (66–70), gender, marital status, self-rated health, quantity of chronic diseases, quantity of disability items, activities of daily living and physical functioning.ConclusionsIt is revealed the fall prevalence showed no increment from 2011 to 2013 but at a high level. More efforts should be made to reduce the fall prevalence, and special attention should be paid to the elderly people aged over 80 and older.     

70岁以上老年人股骨粗隆间骨折术式的选择

目的 探讨70以上老年人股骨粗隆间骨折术的选择与风险程度。方法 对176例患者采用高位多枚圆针、低位多枚圆针、加压滑动鹅头钉、Gamma钉、单臂外固定架5种方法治疗,观察其预后,并比较各组间治疗风险。结果 高位多枚圆针、低位多枚圆针组髋内翻率分别为69．7％、40．0％,主要发生在Ⅲ、Ⅳ型骨折,加压滑动鹅头钉、Gamma钉、单臂外固定架组髋内翻率分别为5．7％、10．0％、13．0％。无术中、术后3个月内死亡。高、低位多枚圆针组因针尾刺痛而不肯活动者发生的并发症比较多,单臂外固定架组膝关节功能恢复较差。结论 加压滑动鹅头钉、Gamma钉方法有固定牢固、防止髋内翻的优点,患者下床早,并发症少,基手术风险与另3种方法相比增加不明显,可作为首选治疗方法。单臂外固定架方法可应用于不能使用加压滑动鹅头钉、Gamma钉方法的患者,但应慎用。对70岁以上老年骨折患者需作为一个特殊的、手术高风险人群给以足够的重视。     

Fall and fracture prevention exercise and self-efficacy

This article is to comment on the scale for fall-related self-efficacy and the fall prevention program that is focused on Bandura's self-efficacy theory. Fall-related self-efficacy is the confidence to carry on the activities of daily living without falling. There are four sources of information that influence a fall-related self-efficacy. These are " inactive mastery experience", " vicarious experience", " verbal persuasion" and " physiological and affective states".     

Knowledge of medicine required for the exercise cure for prevention of fall and fracture in elderly people

The typical medicine constituting elderly people cause of a fall is the anxiolytic and hypnotic drugs of Benzodiazepines. The danger of the fall by the prolonged action type or the medicine with a strong line relaxation action is suggested especially. Moreover, anti-depressant drugs and anti-hypertensive drugs with alpha-adrenaline interception action also causes orthostatic hypotention, and induces a fall. In elderly, there are many complications and there is a tendency for combined use medicine to increase in number. Since the danger of fall increases in proportion to the number of medicines, much more cautions are required of the elderly people who have taken two or more medicines.     

Fall injuries among the elderly. Community-based surveillance

Falls are a leading cause of fatal and nonfatal injuries among the elderly in the United States. Despite the importance of fall injuries, epidemiological studies of falls among the elderly have identified neither their causes nor the methods to prevent them. Therefore, we established a community-based surveillance system in Miami Beach, Florida, as part of a study to assess falls among the elderly. A total of 1,827 fall injury events occurred in this community between July 1985 and June 1986. More than 85% (1,567) of the persons who fell and received care were seen in an emergency room. The remaining cases were identified from one of the three other sources used: fire rescue reports, inpatient medical records, or medical examiner reports. Most falls (97%) were coded as accidental (E880-E888). More than 100 people sought medical assistance for a fall each month. The time of the injury was known for 68% (1,244) of the people who fell. Seventy-four percent of these falls (921) occurred during daylight hours. Fifty-four percent of the falls (986) occurred in and around the home, and 38% of these had a particular area of the home recorded: 42% occurred in the bedroom, 34% in the bathroom, 9% in the kitchen, 5% on the stairs, 4% in the living room, and the remaining 6% in other areas. This surveillance system will help us use the study to clarify the causes of falls in the elderly and identify and evaluate appropriate prevention efforts. It will also help others in designing and implementing other injury surveillance systems.     

The basic idea and exercise program of "fall and fracture prevention school" for elderly people

With the arrival of an aging society in Japan, accidents among elderly people involving falls and bone fractures are on the increase. Efforts to prevent such accidents are strongly required, so the concept of a "fall and fracture prevention school" is spreading. The aims of these classes are to make elderly people aware of the condition of their bodies and to improve deteriorating physical ability through exercise programs, since the latter is the cause of such falls. In conducting an exercise program for the elderly, it is important to make it enjoyable as well as safe.     

Acromegaly in elderly people

Acromegaly is associated with increased morbidity and mortality. Cardiovascular complications are the major predictors of mortality. Age and duration of symptoms are the major determinants of acromegalic cardiopathy. Successful control of acromegaly reverse cardiovascular abnormalities. Herein, we review clinical, biological and histopathological findings in elderly people. Treatments and side effects in relation with aging are questioned.     

Epilepsy in elderly people

The prevalence and incidence of epilepsy are highest in later life with around 25% of new cases occurring in elderly people, many of whom will have concomitant neurodegenerative, cerebrovascular, or neoplastic disease. Difficulties accepting the diagnosis are frequently compounded by its unpredictable nature. Those affected commonly lose confidence and independence. Seizures in older people can result in physical injury, adding to low morale. Complete control is achievable in around 70% of patients with antiepileptic drug treatment. Optimum management requires rapid investigation, accurate diagnosis, effective treatment, sympathetic education, and assured support. The emergence of seizure disorders in old age places an increasing burden on health-care facilities and costs. A coordinated programme among health-care workers is advised to maintain the independence and improve the quality of life of this vulnerable patient population.