Factors contributing to falls in elderly men living in the community

Screening Gait Performance, Falls, and Physical Activity among Benedictine and Trappist Monks

Background and Objective:

Physical performance in older men has been reported in analyses with veterans and in disease-based cohort research. Studies examining gait performance among older monks, however, are narrow. The purpose of this study was to analyze the impact of a recent fall on gait ability in a cohort of Benedictine and Trappist monks in 4 US monastic communities. The second aim was to analyze physical activity and a recent fall as predictive markers of 2 constructs of gait performance.

Methods:

In this cross-sectional study, 53 Benedictine and Trappist monks over 60 (x = 74.7 ± 7.6; range: 61-94 years) completed a basic sociodemographic and fall history profile, the Timed Up and Go (TUG) Test, Dynamic Gait Index (DGI) and the Physical Activity Scale for the Elderly (PASE).

Results:

Demographic profiles revealed that 10% of participants had fallen over the past 3 months; in addition, those who had fallen were more likely to limit activities because of fear of falling (P = .005). Monks who had fallen over the past 3 months demonstrated significantly poorer TUG (12.6 ± 2.1 vs 10.5 ± 1.8; P = .01) and DGI (17.2 ± 5.3 vs 22.3 ± 2.3; P < .001) scores. There was a significant association between physical activity and both the TUG (–0.55; P < .001) and DGI (64; P < .001). Multiple regression models demonstrated that physical activity and a fall in the past 3 months predicted 24% of the variance in the TUG (P < .001) and 46% of the variance in the DGI (P < .001).

Conclusions:

Gait performance is linked to a recent fall episode among older monks. Predictive determinants of functional mobility (TUG) and superimposing tasks on the gait cycle (DGI) include recent fall history and physical activity. Appropriate health promotion activities can be aligned with these lifestyle attributes in monastic communities.

Single Inertial Sensor-Based Neural Networks to Estimate COM-COP Inclination Angle During Walking

A biomechanical understanding of gait stability is needed to reduce falling risk. As a typical parameter, the COM-COP (center of mass-center of pressure) inclination angle (IA) could provide valuable insight into postural control and balance recovery ability. In this study, an artificial neural network (ANN) model was developed to estimate COM-COP IA based on signals using an inertial sensor. Also, we evaluated how different types of ANN and the cutoff frequency of the low-pass filter applied to input signals could affect the accuracy of the model. An inertial measurement unit (IMU) including an accelerometer, gyroscope, and magnetometer sensors was fabricated as a prototype. The COM-COP IA was calculated using a 3D motion analysis system including force plates. In order to predict the COM-COP IA, a feed-forward ANN and long-short term memory (LSTM) network was developed. As a result, the feed-forward ANN showed a relative root-mean-square error (rRMSE) of 15% while the LSTM showed an improved accuracy of 9% rRMSE. Additionally, the LSTM displayed a stable accuracy regardless of the cutoff frequency of the filter applied to the input signals. This study showed that estimating the COM-COP IA was possible with a cheap inertial sensor system. Furthermore, the neural network models in this study can be implemented in systems to monitor the balancing ability of the elderly or patients with impaired balancing ability.

Risk factors for falls in Iranian older adults: a case-control study

Falls are an important cause of morbidity and mortality in older adults. Identifying potential risk factors would provide a considerable public health benefit. The objective of this retrospective study was to determine the risk factors for falling among Iranian older adults. Two hundred eighty community-dwelling elders, with and without a history of falls, participated in the study. Elders aged 60 or over referred to retirement centres completed a multi-section questionnaire on demographic information, behavioural, environmental, and medical factors of fall from May to September 2018. Data analysis was performed with descriptive statistics and logistic regression using the Stata version 14 software. Sedentary activity level (OR: 2.14; 95% CI: 1.85, 3.23), hearing loss (OR: 2.17; 95% CI: 1.23, 3.83), vertigo or dizziness (OR: 2.24; 95% CI: 1.02, 4.91) and visual impairment (OR: 1.63; 95% CI: 1.01, 2.67) were important predictors of falls. No significant associations were observed between falls with demographic factors and medication. This study indicates several modifiable risk factors may be associated with falls that affect the health of older adults. Appropriate interventions are necessary to reduce modifiable risk factors of falls of high-risk elders.

The relative contributions of sagittal, frontal, and transverse joint works to self-paced incline and decline slope walking

Positive and negative work are generated at the lower limb joints in order to locomote over various terrains. Joint work quantifies the changes in energy that are necessary to adapt gait to environmental demands. The aim of this study was to quantify 3D joint work at the hip, knee, and ankle during slope walking. Work was calculated for ten males (23.9 ± 1.1 years) walking at a self-selected speed on inclines and declines (-20, -12, -6, 0, 6, 12, 20 degrees). Sagittal positive work significantly increased at the hip, knee, and ankle for incline walking (for example, hip positive work increased 153%, 280%, and 453% for 6, 12, and 20 degrees, respectively; knee and ankle positive work also increased) (p ≤ 0.05), in order to raise and propel the body forward. Sagittal negative work increased significantly at the hip, knee and ankle for decline walking (for example, knee negative work increased 193%, 355%, and 496% for -6, -12, and -20 degrees, respectively; hip and ankle negative work also increased) (p ≤ 0.05), in order to control body descent. These substantial changes in work will be especially challenging for people with compromised strength due to age and disease. Furthermore, changes in work were not limited to the sagittal plane: 46% of the total hip joint work occurred in the frontal and transverse planes for six degree decline walking. Thus, decline walking placed greater demands on the hip ab/adductors and rotators, and this may be related to the greater risk of falls observed for descent versus ascent.

Exploring Older Adult ED Fall Patients' Understanding of Their Fall: A Qualitative Study

Objective:

We sought to understand older patients’ perspectives about their fall, fall risk factors, and attitude toward emergency department (ED) fall-prevention interventions.

Methods:

We conducted semistructured interviews between July 2015 and January 2016 of community-dwelling, nondemented patients in the ED, who presented with a fall to an urban, teaching hospital. Interviews were halted once we achieve thematic saturation with the data coded and categorized into themes.

Results:

Of the 63 patients interviewed, patients blamed falls on the environment, accidents, a medical condition, or themselves. Three major themes were generated: (1) patients blamed falls on a multitude of things but never acknowledged a possible multifactorial rationale, (2) patients have variable level of concerns regarding their current fall and future fall risk, and (3) patients demonstrated a range of receptiveness to ED interventions aimed at preventing falls but provided little input as to what those interventions should be.

Conclusions:

Many older patients who fall do not understand their fall risk. However, based on the responses provided, older adults tend to be more receptive to intervention and more concerned about their future fall risk, making the ED an appropriate setting for intervention.

Effects of treadmill incline and speed on peroneus longus muscle activity in persons with chronic stroke and healthy subjects

OBJECTIVE

To examine the effects of walking at different inclines and speeds on Peroneus Longus (PL) muscle activation and medial gastrocnemius (MG) coactivation with PL in healthy controls and subjects with stroke.

DESIGN

Nineteen persons post-stroke (13M/6F) and fifteen healthy controls (10M/5F) walked on a treadmill at different inclines (0°, 3°, and 6°) and speeds (self-selected, self-selected+20%, self-selected+40%). The electromyographic activity of the PL and MG muscles in the stance phase of gait cycle was measured.

RESULTS

The paretic PL muscle activity did not change with incline, but increased at +40% speed only (p<0.05). The nonparetic PL increased at 6° incline and at faster speeds (p<0.05). In the healthy group, PL muscle activity increased only on the right side at 6° incline, but increased bilaterally at +40% faster speed (p<0.05). The timing of PL muscle activity did not change with incline (p>0.05), but was significantly delayed at +40% faster speed on the paretic side only (p<0.05). In healthy controls, PL muscle activation timing was unchanged with incline (p>0.05), but was significantly delayed at +40% speed only on the left side (p<0.05). The MG/PL amplitude and timing ratios were not significantly different between various walking conditions (p>0.05).

CONCLUSION

An increase in PL activity occurs to provide ankle stability at walking speeds up to 40% faster than the self-selected speed. Important interlimb differences which may be related to leg dominance and motor control were observed in both stroke and healthy control groups in both PL muscle timing and their clinical impact should be investigated in future studies.

More than osteoporosis: age-specific issues in bone health

PURPOSE OF REVIEW

The interaction between fall and fracture risk factors is an area of increasing clinical relevance, but little information is known about the age-specific issues in bone health unique to HIV-infected adults. The present review will focus on what is known about falls and fall risk factors among HIV-infected adults, and then review the association between decreased muscle, increased adiposity, and frailty with both low bone mineral density (BMD) and falls.

RECENT FINDINGS

The rate of falls among middle-aged HIV-infected adults is similar to that of HIV-uninfected adults 65 years and older. Many of the clinical factors that contribute to low BMD overlap with risk factors for falls, resulting in a high risk of a serious fall among older adults with the greatest risk for a fracture. Low muscle mass, increased adiposity and metabolic syndrome, physical function impairment and frailty, common among older HIV-infected adults, contribute to an increased risk for low BMD and falls, and subsequently, may increase the risk of fracture among HIV-infected older adults.

SUMMARY

Interventions with dual benefit on reducing fall risk and improving BMD are likely to have the greatest impact on fracture prevention in the older, HIV-infected adult.

[Assessing the risk of falls for the elderly in Basic Health Units]

The world population is aging rapidly, which poses a greater challenge for the institutions involved which, in turn, require new public health policies that include the prevention of falls. The objective of this study was to assess the risk of falls in the elderly. This epidemiological, cross-sectional study was performed at a family health unit, using a quantitative approach. The sample consisted of 150 elderly individuals evaluated from January to April 2009. Data were collected using the Fall Risk Score, which was analyzed using SPSS 17.0. Of all seniors evaluated, 58.8% did not suffer falls. However, 63 seniors did suffer falls, 71.4% of this total experienced 1 to 2 falls, and the main intrinsic cause they reported was dizziness/vertigo, whereas the extrinsic cause was wet or slippery floors. Therefore, it is concluded that it is important to assess the risk of falls among the elderly so that preventive measures can be taken, with a view to maximizing their quality of life.

A multimodal assessment of balance in elderly and young adults

Falling is a significant health issue among elderly adults. Given the multifactorial nature of falls, effective balance and fall risk assessment must take into account factors from multiple sources. Here we investigate the relationship between fall risk and a diverse set of biochemical and biomechanical variables including: skeletal muscle-specific troponin T (sTnT), maximal strength measures derived from isometric grip and leg extension tasks, and postural sway captured from a force platform during a quiet stance task. These measures were performed in eight young and eleven elderly adults, along with estimates of fall risk derived from the Tinetti Balance Assessment. We observed age-related effects in all measurements, including a trend toward increased sTnT levels, increased postural sway, reduced upper and lower extremity strength, and reduced balance scores. We observed a negative correlation between balance scores and sTnT levels, suggesting its use as a biomarker for fall risk. We observed a significant positive correlation between balance scores and strength measures, adding support to the notion that muscle strength plays a significant role in postural control. We observed a significant negative correlation between balance scores and postural sway, suggesting that fall risk is associated with more loosely controlled center of mass regulation.

Association Between Obesity and Falls Among Korean Adults: A Population-Based Cross-Sectional Study

The objective of this study was to evaluate the association between falls and obesity using Asian body mass index (BMI) classifications. Using the data from the Korean community health survey in 2011, a total of 229,226 participants ranging from 19 to 106 years old were included in this study. The BMI groups were classified as underweight (<18.5), healthy (18.5 ≤ BMI < 23), overweight (23 ≤ BMI <25), and obese (≥25) using Asian BMI classifications. The associations between BMI groups and falls (≥1 time or ≥2 times per year) were analyzed using multiple logistic regression analyses with complex sampling. A subgroup analysis was conducted according to age (19-40, 41-60, and ≥61 years) and the location of the fall (indoor and outdoor). Physical activity, household income, education level, alcohol consumption, smoking, stress level, and medical comorbidities were adjusted as confounders. In total, 16.8% and 6.1% of the participants experienced falls ≥1 time and ≥2 times per year, respectively. Compared to the healthy weight group, the other BMI groups showed a significant U-shaped relationship with falls ≥1 time (AOR underweight = 1.12, 95% CI [confidence interval] = 1.05-1.19; AOR obese = 1.06, 95% CI = 1.02-1.10, P < 0.001) and ≥2 times (AOR underweight = 1.14, 95% CI = 1.04-1.26; AOR obese = 1.04, 95% CI = 0.99-1.10, P < 0.001). Obese status was significantly associated with falls (≥1 fall per year) in all age groups, whereas being underweight was significantly associated with falls in the 19 to 40 year age group only. In conclusion, both underweight and obese statuses were significantly associated with falls in this adult Korean population. However, the relationship between BMI group and falls varied according to age and the location of the falls.

Long-term impact of HIV wasting on physical function

BACKGROUND

The long-term consequences of wasting among HIV-infected persons are not known.

DESIGN

HIV-infected men surviving ≥2 years based on Kaplan-Meier analysis after a clinical diagnosis or weight trajectory consistent with wasting and with available physical function assessment data [grip strength, gait speed, and quality of life (QoL)] were matched to HIV-infected and uninfected men without wasting.

METHODS

Matching criteria at the functional assessment included age, calendar year, and CD4 T-cell count and plasma HIV-1 RNA (HIV-infected only). Multivariable linear regression analyses adjusted for age, cohort, race, hepatitis C status, and number of comorbid illnesses were used to assess the impact of wasting on subsequent physical function.

RESULTS

Among 85 HIV-infected men surviving ≥2 years after wasting, we evaluated physical function outcomes compared with 249 HIV-infected and 338 HIV-uninfected men with no historical wasting. In multivariable regression models, HIV-infected men with prior wasting had lower grip strength and poorer physical QoL than HIV-infected men with no wasting (P ≤ 0.03), and poorer physical QoL, but higher mental QoL than HIV-uninfected men (P ≤ 0.05). When controlling for measures of immune suppression (nadir CD4 T-cell count/AIDS, the association between wasting and physical QoL was markedly attenuated, whereas there was minimal impact on the association between wasting and grip strength.

CONCLUSIONS

HIV-infected wasting survivors had weaker grip strength compared with HIV-infected persons without wasting; immune suppression was associated only with physical QoL. HIV-infected survivors of wasting may represent a population of adults at increased risk for physical function decline.

Instructions influence response to the Chinese version of the Movement-Specific Reinvestment Scale in community-dwelling older adults

AIM

To examine whether differences emerged when the Chinese version of the Movement-Specific Reinvestment Scale (MSRS-C) was administered to community-dwelling older adults with instructions to respond in the context of "general" movements, walking, using chopsticks or dressing. Furthermore, the difference between the six-point Likert scale and four-point Likert scale response formats of the MSRS-C was investigated.

METHODS

The study was implemented in the community of Hong Kong with 52 older adults (mean age 77.4 years). Telephone interviews were carried out on two occasions for each participant. Participants provided a verbal response to each of 10 questions from the MSRS-C with different response formats (i.e., six-point or four-point Likert Scales) and different instructions in the response context (i.e. general, walking, using chopsticks, dressing). The sequence of response format and context was randomized for each participant.

RESULTS

Older fallers scored significantly higher on the MSRS-C (general) with six-point or four-point response formats than non-fallers. The MSRS-C (general) and MSRS-C (walking) were not statistically different, and showed good discriminative power for previous older fall status (older fallers or older non-fallers). However, MSRS-C (chopsticks) and MSRS-C (dressing) failed to differentiate older fallers from older non-fallers.

CONCLUSION

Both the MSRS-C (general) and MSRS-C (walking) with a six-point or a four-point response format showed good discrimination of older fallers from non-fallers. Older adults might respond to the MSRS-C with respect to the most challenging movements (e.g. fall-related movements) in their daily living. Geriatr Gerontol Int 2016; 16: 1305-1311.

Control of body's center of mass motion relative to center of pressure during uphill walking in the elderly

Uphill walking places more challenges on the locomotor system than level walking does when the two limbs work together to ensure the stability and continuous progression of the body over the base of support. With age-related degeneration older people may have more difficulty in maintaining balance during uphill walking, and may thus experience an increased risk of falling. The current study aimed to investigate using gait analysis techniques to determine the effects of age and slope angles on the control of the COM relative to the COP in terms of their inclination angles (IA) and the rate of change of IA (RCIA) during uphill walking. The elderly were found to show IAs similar to those of the young, but with reduced self-selected walking speed and RCIAs (P<0.05). After adjusting for walking speed differences, the elderly showed significantly greater excursions of IA in the sagittal plane (P<0.05) and increased RCIA at heel-strike and during single limb support (SLS) and double limb support (DLS) in the sagittal plane (P<0.05), and increased RCIA at heel-strike in the frontal plane (P<0.05). The RCIAs were significantly reduced with increasing slope angles (P<0.05). The current results show that the elderly adopted a control strategy different from the young during uphill walking, and that the IA and RCIA during walking provide a sensitive measure to differentiate individuals with different balance control abilities. The current results and findings may serve as baseline data for future clinical and ergonomic applications.

Does functional fitness decline in accordance with our expectation? - a pilot study in healthy female

BACKGROUND

Aging may cause various functional abilities gradually deteriorate. With changes in social forms, the trend of functional fitness decline will change accordingly. Therefore, this study endeavored to identify the trends in functional fitness decline by comparing the differences in the functional fitness of females in various age groups.

METHODS

Thirty six healthy females were divided into 3 age groups: young healthy females (20 to 30 y); middle-age (45 to 55 y); and older (65 to 75 y). Functional fitness test battery included flexibility, muscle strength/endurance, aerobic endurance, balance and agility.

RESULTS

The performance in the elderly group was significantly worse (P < .05) in all the tests, whereas the muscle strength and endurance, as well as aerobic endurance for the middle-age group showed significantly lower than young groups (P < .05).

CONCLUSIONS

The reduction in lower extremity muscle strength occurs in the middle-age group. We recommend that middle-age women be conscious of the reduction in their lower extremity muscle strength and conduct advanced preparations for future aging.

Resistance training exercise program for intervention to enhance gait function in elderly chronically ill patients: multivariate multiscale entropy for center of pressure signal analysis

Falls are unpredictable accidents, and the resulting injuries can be serious in the elderly, particularly those with chronic diseases. Regular exercise is recommended to prevent and treat hypertension and other chronic diseases by reducing clinical blood pressure. The "complexity index" (CI), based on multiscale entropy (MSE) algorithm, has been applied in recent studies to show a person's adaptability to intrinsic and external perturbations and widely used measure of postural sway or stability. The multivariate multiscale entropy (MMSE) was advanced algorithm used to calculate the complexity index (CI) values of the center of pressure (COP) data. In this study, we applied the MSE & MMSE to analyze gait function of 24 elderly, chronically ill patients (44% female; 56% male; mean age, 67.56 ± 10.70 years) with either cardiovascular disease, diabetes mellitus, or osteoporosis. After a 12-week training program, postural stability measurements showed significant improvements. Our results showed beneficial effects of resistance training, which can be used to improve postural stability in the elderly and indicated that MMSE algorithms to calculate CI of the COP data were superior to the multiscale entropy (MSE) algorithm to identify the sense of balance in the elderly.

Factors Associated with Falls Among Community-Dwelling Older People in Taiwan

Introduction: Falls are common among older people. Previous studies have shown that falls were multifactorial. However, data regarding community-dwelling Chinese population are minimal. We aimed to study factors associated with falls among community-dwelling older Chinese people. Materials and Methods: We conducted a cross-sectional study in a community hospital in Taiwan in 2010. Our sample included 671 elders from the 3680 examinees of the free annual Senior Citizens Health Examination. Participants were interviewed with a detailed questionnaire, and 317 elders were further invited for serum vitamin D tests. The main outcome was falls in the previous 12 months. Predictor variables included sociodemographic characteristics, lifestyle risk factors, body stature, frailty, serum 25 (OH) D levels, and medications. Results: The mean age of the 671 participants was 75.7 ± 6.4 years old, and 48.7% of which were female. Fallers comprised 21.0% of the study population. In multivariate models, female gender (adjusted odds ratio (aOR): 2.32), loss of height in adulthood (aOR: 1.52), low body weight (aOR: 2.69), central obesity (aOR: 1.67), frailty (aOR: 1.56), polypharmacy (aOR: 2.18) and hyperglycaemia (aOR: 1.56) were factors associated with falls. Vitamin D insufficiency (serum 25 (OH) D levels <30 ng/mL) was not associated with falls (OR: 0.78; 95% CI, 0.38 to 1.60) (n = 317) in this study. Conclusion: Among community-dwelling older people in Taiwan, falls were mainly associated with female gender, polypharmacy, frailty, reduced body height, low body weight or central obesity, and hyperglycaemia. In addition to other risk factors, body stature should be considered as a novel risk factor when screening elders at risk for falls. Key words: Accidental falls, Aged, Risk factors

Home environmental and health-related factors among home fallers and recurrent fallers in community dwelling older Korean women

The purpose of the study was to determine home environmental and health-related factors among home fallers and recurrent fallers in community dwelling older Korean women. The study population included 438 older women aged 65 years and over. Measures included a checklist of home environments and health-related items. Risk indicators for accidental falls and recurrent falling were analysed using logistic regression. Logistic regression analysis revealed that chronic disease (odds ratio (OR) = 2.02, P = 0.007), poor night light (OR = 1.97, P = 0.032) and obstacle of door sill (OR = 1.76, P = 0.021) were predictors of accidental falls, and physical inactivity (OR = 2.34, P = 0.018) and slippery floor in the bathroom (OR = 0.41, P = 0.034) were predictors of recurrent falling. The findings have implications for strategies and suggest the need to modify home environmental context in systematic and consistent ways and the need to maintain physical activities to prevent falls and recurrent falling.

Análise da marcha no plano inclinado e declinado de adultas e idosas com diferentes volumes de atividades semanais

A marcha é um dos mais naturais movimentos humanos, porém com o envelhecimento, sua eficiência vai se reduzindo, principalmente durante a transposição de superfícies inclinadas, onde o risco de acidentes aumenta. OBJETIVO: Avaliar as diferenças do padrão da marcha de indivíduos idosos ativos (ATI) e sedentários (SED) em relação aos indivíduos adultos (ADU) durante a locomoção em um terreno inclinado (rampa). MÉTODOS: Quarenta e cinco indivíduos (15 ADU, 15 ATI e 15 SED) caminharam, subindo e descendo uma rampa com 10% de inclinação. A análise cinemática (Vicon MX-13) e cinética (Plataforma de Força AMTI) de variáveis relacionadas com a marcha foi realizada. RESULTADOS: Foram identificadas reduções na amplitude e potência do impulso ao redor do tornozelo dos indivíduos SED e ATI em comparação aos ADU durante a subida da rampa. Na descida, as principais diferenças entre o grupo ADU e os grupos SED e ATI foram com relação à velocidade de deslocamento, provavelmente por limitações musculares de ordem elástica, principalmente ao redor do quadril. CONCLUSÃO: Aparentemente, o nível de atividades físicas não influenciou a marcha dos SED e ATI; entretanto, uma limitação do IPAQ de conseguir classificar adequadamente diferentes níveis de atividades físicas pode ter influenciado o resultado. Futuros estudos longitudinais nos quais os indivíduos são submetidos a diferentes volumes de atividades físicas diárias são necessários para que os resultados aqui encontrados possam ser confirmados.

An obese body mass increases the adverse effects of HIV/AIDS on balance and gait

BACKGROUND

Balance and gait problems have been detected among patients with HIV/AIDS. The extent to which these problems are exacerbated by either frailty or obesity has not been examined. Objective The purpose of this study was to compare participants who differed in body mass and the presence or absence of HIV/AIDS.

DESIGN

This was a cross-sectional study.

METHODS

Quantitative measurements were obtained from 86 participants who were HIV-type 1 (HIV-1) seronegative and 121 participants who were seropositive divided into subgroups based on their body mass index (BMI <21, 21-29, or >29 kg/m(2)).

RESULTS

Participants who were seropositive were impaired relative to seronegative controls on several indices, including the limit of stability, sway amplitude and sway strategy, gait initiation time, and gait speed during a fast pace condition. Participants who were obese also exhibited impairments, which were evident during assessments of the limit of stability, nonpreferred leg stance time, sway strategy, normal and fast gait speed, fast gait initiation time, and 360-degree turn time. Importantly, the analysis revealed that participants with both attributes were more impaired than those with either or neither attribute: patients who were obese and seropositive were more impaired in fast gait initiation time and cadence, nonpreferred leg stance time, 360-degree turn time, and sway strategy scores. Limitations The validity of BMI as a measure of body mass can be challenged. In addition, the validity of chair rise time and 360-degree turn time as estimates of lower-extremity strength (force-generating capacity) can be argued.

CONCLUSIONS

The present findings have an obvious and unfortunate implication: as more patients who are HIV-1 seropositive join the seronegative community in becoming obese, the effects of obesity and their disease may summate and their risk for balance and gait problems may increase.

Efeito transiente de exercícios de flexibilidade na articulação do quadril sobre a marcha de idosas

A marcha é a atividade mais comum que o ser humano realiza, sendo uma habilidade motora fundamental para a locomoção. Contudo, o processo do envelhecimento é caracterizado pela redução gradativa da eficiência do aparelho locomotor, que ocorre pela diminuição da força e da massa muscular, assim como diminuição na flexibilidade. O estudo objetivou verificar o efeito transiente de uma sessão de exercícios de flexibilidade dos músculos extensores e flexores do quadril sobre a marcha de indivíduos idosos. Cinco idosas (67,0 ± 3,8 anos; 1,59 ± 0,07 m; 64,3 ± 15,3 Kg) voluntariaram participar do estudo. A marcha dos sujeitos foi analisada antes e depois dos exercícios de flexibilidade. O protocolo consistiu em uma sessão de três séries de exercícios de flexibilidade de 30s do método estático, feitos para os músculos flexores e extensores da articulação do quadril. Após a sessão de flexibilidade, a marcha das participantes apresentou menor pico de inclinação anterior da pelve, maior pico de extensão e amplitude total de movimento da articulação do quadril, maior amplitude de movimento do joelho com maior ângulo de flexão durante a fase de balanço médio e maior altura de separação do pé ao solo (aumento esse de 28,6%). Os resultados mostram que imediatamente após a sessão dos exercícios de flexibilidade as mulheres idosas apresentaram mudanças no padrão da marcha nos quais algumas variáveis sugerem uma redução no risco de quedas. Os efeitos da idade sobre determinadas variáveis foram parcialmente revertidos e as participantes apresentaram um padrão da marcha mais similar aos adultos jovens que antes dos alongamentos.

An examination of the impact of gender and veteran status on falls among community-dwelling seniors: implications for targeting falls prevention activities

The objective of this study was to broaden our understanding of the specific characteristics of community-dwelling seniors who are at increased risk of falling and becoming injured, by paying particular attention to gender and veteran status. The 137 respondents included 69 senior male veterans and 68 seniors in the general population. Results indicated that the veterans were at higher risk of falling than the general senior population, and were at higher risk of becoming injured after falling. Senior women were at less risk of falling and becoming injured than the veterans, but were at higher risk than the senior nonveteran men. It is imperative to target screening and falls prevention activities at these and other specific subgroups in the senior population that are at high risk of falling and becoming injured.

Contribution of falling and being homebound status to subsequent functional changes among the Japanese elderly living in a community

Using the data from the community-based longitudinal study of the elderly persons aged 65 or older, this study examined relationships between the occurrence of falls varied by their activity level and subsequent functional decline over time. Of the 705 respondents at baseline, 662 and 632 subjects were assessed at first and second follow-ups. Falling and homebound status at baseline and health function (self-rated general health, activities of daily living (ADLs), instrumental activities of daily living (IADLs), intellectual activity, and social role) at baseline and follow-ups were assessed, and changes in each health function were compared among four groups defined by baseline falling/homebound status. Baseline falling/homebound status was significantly associated with subsequent decline in ADLs over 1 year, and in ADLs, IADLs, intellectual activity, and social role over 2 years. Being homebound might act as a stronger risk factor for ADLs disabilities rather than the occurrence of falls. Moreover, the homebound elderly with no experience of falls was at the greatest risk of the decline of social role. We consider that prevention program and home-based care for homebound elderly should be provided in the community.

Nonlinear Association of Higher-Level Functional Capacity with the Incidence of Falls in Japan

OBJECTIVE

To examine the nonlinear association of higher-level functional capacity with the incidence of falls.

DESIGN

We analyzed the cross-sectional data of Minamifurano-town Aging Study. Seven hundred forty-three noninstitutionalized older persons aged 65 yrs or older were mailed a self-administered questionnaire in June 2002 in which they were asked the incidence of falls in the past year and their higher-level functional capacity according to the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence. The association of higher-level functional capacity with the incidence of falls was examined using linear, polynomial, and nonparametric logistic regression models.

RESULTS

Under the assumption of a nonlinear function, the quadratic function and the smoothing function provided a significant improvement of the fit compared with the linear model in women but not men.

CONCLUSION

We have proposed the use of nonlinear model in estimating the incidence of falls with respect to the total score of the TMIG index of competence. The association of varying total score with the incidence of falls in women diverged from the linearity assumption. The gender-based difference in the association of higher-level functional capacity with the incidence of falls might be related to societal role or activity-related aspects.