Suppression of the Vertical Vestibulo-ocular Reflex in Older Persons at Risk of Falling

A case-control design was used to assess eye-head-trunk coordination for community-dwelling elders performing a stand-walk task. Eighteen elders with a high risk of falling were matched to 18 subjects with low risk on the basis of age, living status (living alone or with someone) and category of residence (independent living or assisted living facility). Standard electro-oculography was used in conjunction with an electromagnetic tracking device to measure eye and head-trunk motion, respectively. For the low-risk group, the mean slope of gaze-head and gaze-trunk relationships was significantly greater than zero (0.91 and 0.64, respectively), whereas high-risk elders did not demonstrate slope magnitudes significantly different from zero (0.52 and 0.16, respectively) due to large inter-subject variations. While the majority of subjects showed some counter-rotation of the eyes with head pitch, a greater percentage of subjects in the high-risk group did not suppress this response and consequently gaze and gaze velocity overcompensated for head pitch. These findings suggest that the vertical vestibulo-ocular reflex is not adequately suppressed during the stand-walk task in elders who are at a high risk of falling. Possible mechanisms contributing to these findings are discussed.     

Cross-cultural validation of the Falls Efficacy Scale International (FES-I) using self-report and interview-based questionnaires among Persian-speaking elderly adults

FES-I has been designed to assess fear of falling (FoF). The purpose of this study was to establish the Persian-language version of the FES-I and to assess its psychometric properties under different modes of administration: self-report and interview-based. Participants included 191 elderly people aged over 60 who were mostly community dwelling. With an interval of 14 days, 97 volunteers completed the questionnaire in the retest session. To evaluate the construct validity, we assessed the ability of the FES-I to discriminate people based on gender, level of education, number of falls and FoF. The correlation with the Short Form of Health Survey (SF-36), Timed Up and Go (TUG) and Functional Reach Test (FRT) was also determined to test validity. Internal consistency was excellent in both self-report (0.93) and interview (0.92) versions. All intra-class correlations (ICCs) were above 0.70 with the highest reliability obtained for the condition where the interview based FES-I was used in both test and retest sessions. The strength of correlation between the FES-I and TUG varied based on mode of administration: moderate for interview and high for self-report mode. The FES-I had a higher correlation with the SF-36 subscales of physical health than subscales of mental health. The FES-I had the ability to discriminate the participants based on gender, educational level, and number of falls and FoF. In conclusion, both interview and self-report versions of the FES-I demonstrated acceptable measurement properties to assess FoF in Iranian elderly persons.     

基于MEMS传感器的可穿戴式老年人跌倒监测系统的设计

为了缩短老年人跌倒后的救助时间和提高安全保障,我们设计了一种基于加速度和角速度传感器的跌倒监测装置。该装置结合机械微电子系统(microelectro mechanical system,MEMS)传感器、数字信号处理及无线传输技术应用于智能手机上。为区分人体跌倒事件和日常行为,结合人体三轴加速度和角速度联合对跌倒事件进行判断,通过大量实验选取合适阈值。针对老年人的生活特点,数据通过蓝牙装置发送至手机上进行处理,通过手机语音报警、手机GPS定位系统和短信通知医院和用户监护人,使得老年人跌倒后能够在第一时间获得救治,减小伤害。经过大量的实验测试结果统计,相比较于传统的三轴加速度判断跌倒事件,结合三轴加速度和加速度联合判断使该系统的准确率从84.29%提高至100%。结果表明:基于MEMS传感器的可穿戴式跌倒监测系统具有便捷、准确、功耗低的特点,能够准确监测出跌倒事件并进行报警。     

120例慢性咽炎患者临床症状与病理学改变分析

目的了解慢性咽炎口咽部炎症改变与临床症状之间的关系。方法对门诊120例主诉咽部不适的患者按照病程长短以及炎性症状进行分组，分别在患者口咽部采取标本，进行染色、固定、观察、分析。结果通过对症状轻型组与重型组、口咽部检查炎症轻型绀与重型组的脱落细胞学资料的统计分析，发现以上各组相互间在粒细胞、淋巴细胞、炎症细胞、组织细胞等方面均无明显差异（P〉0．05）。结论口咽部炎症改变与临床症状之间无明显关系。口咽部炎性症状的致病因素较多，对经常出现临床症状的人要进行仔细检查、认真分析，查找原发病及致病因素，以明确诊断，不要草率下“慢性咽炎”的结论，以免引起患者恐慌，造成不必要的精神负担。     

预防长期住院高龄患者跌倒的护理干预

目的探讨长期住院高龄患者跌倒的危险因素及预防对策。方法对我院老年病区258例患者采取预防跌倒知识的宣教等干预,并对其效果进行分析总结。结果98．5％的患者或家属不同程度掌握了跌倒相关危险因素及预防措施的知识,老年患者在住院期间无跌倒发生。结论护理干预能有效地预防老年人跌倒,对提高老年人生活质量有重要意义。     

Balance confidence and functional mobility are independently associated with falls in people with Parkinson’s disease

The present study aimed to examine the association of falls with self-perceived balance confidence level, and balance and mobility performance in patients with Parkinson’s disease (PD). Forty-nine healthy subjects and 71 subjects with PD completed the study. Among the PD patients, 33 (46%) were fallers and 38 were non-fallers. All subjects were tested with the activities-specific balance confidence scale (ABC), one-leg-stance test (OLS), and timed-up-and-go test (TUG). Results indicated that PD fallers had significantly lower ABC scores, shorter OLS times and longer times to complete TUG than PD non-fallers (P < 0.05). Having a high ABC score (>80) was significantly associated with a lower fall risk, after adjusting for age, gender, and duration of PD, and for depression [odds ratio (OR) = 0.06, P = 0.020]. For performance-based measures of balance and mobility, a longer TUG time (≥16 s) was independently associated with increased risk of falling after controlling for relevant factors (OR = 3.86, P = 0.043); OLS time, however, was not significantly associated with falls. A lower self-perceived balance confidence level and a prolonged time to complete TUG were associated with increased risk of falling in patients with PD. Interventions to improve these modifiable risk factors could be useful in reducing future falls in the PD population and will require further study.     

骨科住院患者意外跌倒风险因素评估及护理对策

目的：探讨骨科住院病人意外跌倒的风险因素,分析并制定有效的护理对策,以防止住院病人意外跌倒的发生。方法：采用统计学分析方法,调查2007年7月至2008年12月骨科住院病人发生意外跌倒例数和相关风险因素构成比。2009年1月至2010年7月对评估有意外跌倒风险的骨科病人实施安全护理,预防意外跌倒发生。结果：实施护理对策后目标人群防跌倒意识加强,意外跌倒病人发生率显著下降,P〈0.05。结论：对骨科病人意外风险因素进行评估,并对目标人群实施安全护理对策,可有效预防骨科住院病人意外跌倒的发生。     

Relationships between physical activity,ADL capability and fall risk in community-dwelling Japanese elderly population

Objective The purpose of this study was to clarify the relationships among fall risk, physical activity habits, and ADL capability in a community-dwelling Japanese elderly population. Methods The subjects were 1,407 Japanese aged 65 or older (604 males, 803 females). Fall risk was evaluated using the Falling Assessment Chart of Suzuki et al. (2003). Physical activity habits such as the frequency of leaving the house, the use of transportation, the frequency of physical exercise, and interests were evaluated. ADL capability was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Results Approximately 25% of the subjects had a high fall risk (score of 5 or more). Fall risk increased with age and ADL capability decreased with age. The group with a low fall risk (score<5) had a significantly higher ADL capability than the group with a high fall risk (score≥5). From results of two-way ANCOVA (gender×physical activity habits) with age as the covariate, the fall risk of people who regularly go on leaving the house, exercise, and have interests tended to be low. Further more, the relationships between the scores and physical activity habits were examined by two-way ANCOVA with age and ADL capability as the covariates. There were significant differences in the frequency of leaving the house, and elderly persons who leaved regularly the house, had a low fall risk. Conclusions This study showed that fall risk is closely related to ADL capability, and that the frequency of leaving the house is very important for reducing fall risk.     

Influence of transfemoral amputation length on resulting loads at the osseointegrated prosthesis fixation during walking and falling

Background

Transfemoral amputation is a surgical measure in which the surgeon typically conserves as much tissue and bone as possible. Osseointegrated fixation of prostheses is a promising alternative to conventional socket-based fixation. However, osseointegrated prostheses pose some risk of possible bone fracture under unexpected high-impact loading scenarios, such as a fall, and this should be protected against by a safety element. The aim of the present study was to determine the effect of amputation height on the forces and moments at the bone–prosthesis interface during normal gait and three falling scenarios.

Methods

Forces and moments at four amputation heights were determined from a multi-body simulation driven by data captured from an able-bodied participant.

Findings

In all three falling scenarios, forces were relatively independent of amputation height, while moments generally displayed considerable increases with shorter residual limb length. Peak moments ranged from 105 Nm (SD 75) (most distal amputation height) to 229 Nm (SD 99) (most proximal amputation height) for a “falling during gait” scenario.

Interpretation

Our findings reveal the dependence of interface loads on amputation height in normal gait and falling. This information may lead to improved prosthesis safety elements against bending moments.     

Prevalence and correlates of fear of falling in Korean community-dwelling elderly subjects

Purpose

This study was conducted to investigate the factors related to fear of falling in elderly subjects, with a view to developing interventions to prevent falls.

Methods

Data from 9033 elderly subjects aged ≥ 65 years were analyzed from the 2008 National Elderly Survey of the Korea Ministry of Health & Welfare.

Results

In total, 76.6% of elderly Korean subjects had fear of falling. Factors associated with an increased risk of fear of falling in elderly subjects were, in order from highest to lowest, previous experience of falling (odds ratio [OR] = 6.41, p < 0.001), experience of body pain (OR = 2.45, p < 0.001), lower perceived health status (OR = 1.89, p < 0.001), presence of depression (OR = 1.82, p < 0.001), receipt of more doses of drugs per day for those receiving 1–2 (OR = 1.72, p < 0.001) or ≥ 3 doses of drugs per day (OR = 1.67, p = 0.001), older age (OR = 1.68, p < 0.001), female gender (OR = 1.64, p < 0.001), dependence for instrumental activities of daily living (OR = 1.55, p < 0.001), dependence for activities of daily living (OR = 1.44, p = 0.017), and lower education level (OR = 1.18, p = 0.016).

Conclusion

The fear of falling can be attenuated by providing interventions to reduce the impact of modifiable risk factors that were identified in this study.