Summary of factors contributing to falls in older adults and nursing implications

Detraining effects of regular Tai Chi exercise on postural control ability in older women: A randomized controlled trial

BACKGROUND/OBJECTIVE

This study aimed to investigate the training and detraining effects of Tai Chi (TC) on postural control ability in single leg stance (SLS) by conducting a single-blind randomized controlled trial.

METHOD

Forty-eight older women were randomly divided into the TC, brisk walking (BW), and control(C) groups by using computer-generated program. The participants completed a 16-week intervention training and 8-week detraining program. Postural control ability in SLS was tested at the baseline, 16 t h, 20 t h, and 24 t h weeks. The primary outcomes included single-leg stance time (Time) and secondary outcomes included maximal displacement of the center of pressure (COP) in the anterior-posterior (AP) direction (D-ap), maximal displacement of the COP in the medial-lateral (ML) direction (D-ml), total length of the COP trajectories (Lng), and 95% confidence ellipse area of the COP movements (area), mean AP total excursion velocities (V-ap), and mean ML total excursion velocities (V-ml).

RESULTS

Significant within-group difference compared with the baseline and between-groups difference compared with control group were found at 16 t h, 20 t h, and 24 t h weeks in the TC group and at the 16 t h and 20 t h weeks in the BW group in all the primary and secondary outcomes. Most of secondary outcomes including Lng, D-ml, V-ml, Area increased significantly at the 24 t h week compared with that at the 16 t h week in BW group.

CONCLUSIONS

TC was effective in improving postural control ability and maintaining intervention gains, and was recommended as an appropriate exercise to prevent falls in the older adults.

Identifying Factors Associated With Mobility Decline Among Hospitalized Older Adults

Hospitalization can negatively affect mobility among older adults. Early detection of older patients most at risk for mobility decline can lead to early intervention and prevention of mobility loss. This study's purpose was to identify factors from the International Classification of Functioning, Disability, and Health associated with mobility decline among hospitalized elders. We conducted a secondary analysis of data from 959 hospitalized adults age 65 and older. We estimated the effects of health conditions and environmental and personal factors on mobility decline using logistic regression. Almost half of the sample declined in mobility function during hospitalization. Younger age, longer length of hospital stay, having a hearing impairment, and non-emergency admit type were associated with mobility decline, after adjusting for covariates. Findings may be used to develop an evidence-based, risk-determination tool for hospitalized elders. Future research should focus on individual, environmental, and policy-based interventions promoting physical activity in the hospital.

Is there an increased risk of falls and fractures in people with early diagnosed hip and knee osteoarthritis? Data from the Osteoarthritis Initiative

AIMS

To assess the probability of individuals with early-diagnosed hip or knee osteoarthritis experiencing a fall and/or fracture compared to a cohort without osteoarthritis.

METHODS

Data were analyzed from the Osteoarthritis Initiative dataset. We identified all people who were diagnosed with hip or knee osteoarthritis within a 12 month period, compared to those without osteoarthritis. We determined whether there was a difference in the occurrence of falls, with or without consequential fractures, between people newly diagnosed with hip or knee osteoarthritis compared to those who had not, using odd ratios (OR) and 95% confidence intervals (95% CI).

RESULTS

Five hundred and fifty-two individuals with hip osteoarthritis were compared to 4244 individuals without hip osteoarthritis; 1350 individuals with knee osteoarthritis were compared to 3445 individuals without knee osteoarthritis. People with knee osteoarthritis had a 54% greater chance of experiencing a fall compared to those without (OR: 1.54; 95% CI: 1.35-1.77). People with hip osteoarthritis had a 52% greater chance of experiencing a fall compared to those without hip osteoarthritis (OR: 1.52; 95% CI: 1.26-1.84). People with knee and hip osteoarthritis demonstrated over an 80% greater chance of experiencing a fracture in the first 12 months of their diagnosis compared to those without hip or knee osteoarthritis (total knee arthroplasty: OR 1.81; total hip arthroplasty: OR 1.84).

CONCLUSIONS

There is an increased risk of falls and fractures in early-diagnosed knee and hip osteoarthritis compared to those without osteoarthritis. International guidelines on the management of hip and knee osteoarthritis should consider the management of falls risk.

Effect of foot position on balance ability in single-leg stance with and without visual feedback

The purpose of this study was to determine the natural foot position and to quantify the effect of foot position on balance performance during single-leg stance. Forty healthy subjects participated in this study (age, 18 to 32 years; 24 female). Subjects were asked to perform single-leg balance trials on a balance force plate in their self-selected and four predetermined foot positions with their eyes open and closed. Sway distance, area and velocity were computed for each trial. There was significant interactions between visual conditions and foot position for all sway parameters (P<.001). With the eyes closed, sway parameters were greatest for the self-selected foot position compared to the other foot positions (P<.005). No differences in sway parameters between foot positions were detected for the eyes-open condition. Sway distance, area and velocity were 94%, 400% and 89% greater, respectively, for the eyes-closed than the eyes-open condition. Self-selected foot placement did not produce the most stable single-leg stance. The results of this study indicate that foot position is not important for protocols for assessing balance or for rehabilitation exercises using eyes-open conditions and that assessment protocols and rehabilitation exercises should clearly specify the foot position when using eyes-closed protocols.