Backgorund Decreased affective efficiency, preceded by emotional problems, is a common advanced-age disorder which can lead to depression. Aim The aim of this study was to assess the relationship between depressive symptoms experienced by elderly people and their sociodemographic data, self-reported health status, physical fitness, functional capacity, and history of falls. Material and methods The study involved 304 individuals aged 65-100 years. The research instruments were the Geriatric Depression Scale-Short Form, the Barthel Scale, and the Background Survey Geriatric Questionnaire. Results Depression was more common among the elders who had a lower education level, lived alone, were in a worse financial position, and among those whose families were unprepared to provide them with informal care (p < 0.05). Conclusions Depressive symptoms observed in the respondents were significantly related to their sociodemographic data, reduced ability to perform daily activities, low self-reported health status and physical fitness, and recurrent falls.
Introduction Ageing processes are accompanied by degenerative changes within all functional and anatomical systems. These changes affect postural stability. This study sought to compare balance and fall risk indexes taking into account the age of the participants. Material and methods The study included female members (n=59) of the University of the Third Age (U3A) set up at the University of Physical Education in Warsaw. The participants were divided into five age groups: 1 (60-64 years), 2 (65-69), 3 (70-74), 4 (75-79) and 5 (>80). Biodex Balance System was applied in the study. The overall stability index (OSI), the anteroposterior stability index (APSI), the mediolateral stability index (MLSI) and the fall risk test were used in the analysis. The participants performed tests that involved standing on both feet with eyes open and closed on a stable surface as well as standing with eyes open on an unstable surface. ANOVA was used to assess balance with regard to age. U Mann-Whitney test was employed to compare groups in terms of balance and the fall risk (p<0.05). Results The oldest group demonstrated the worst balance performance with eyes open: OSI – 0.70±0.47; APSI – 0.49±0.30; MLSI – 0.37±0.43. The best values of balance performance were manifested by the subjects aged 65-69: OSI – 0.36±0.13; APSI – 0.25±0.08; MLSI – 0.18±0.11. Compared to eyes-open conditions, the tests performed with eyes closed revealed the smallest differences between the groups in OSI. The lowest fall risk was noted in groups 1 and 2. The highest fall risk index was found in group 4. Conclusions The findings of the study show that older adults depend on their vision when keeping balance. Physical activity exerts a positive influence on their balance and reduces the risk of falling. However, balance performance deteriorates and the fall risk increases with ageing.
The aim of the study was to find factors which differentiate generally healthy elderly men who had fallen versus those whom had not fallen throughout the year prior to the study. The participants (66 generally healthy men aged over 70 years) were divided into two groups - those who had fallen (F) and those who had not fallen (NF) in the period of one year before the study. Their body mass index and fat mass were measured. On the basis of the value of maximum sways on a stable posturographic platform, the sway area was calculated. To study psychomotor fitness reaction time, an analysis was measured by the "Vienna System Test". Functional fitness was measured on the basis of selected tests from "The Senior Fitness Test". The complexity of the multiple mechanisms underlying postural control does not allow for clear indication of the risks of stability loss. The experimental group of men over 70 yrs who had fallen (F) was characterised by lower body strength (p<0.05) and endurance (p<0.05), compared to NF group. Exercise programs designed to prevent accidental falls should incorporate strength and aerobic exercises.
The aim of the study was to determine the level of functional independence in adult patients with previously undiagnosed or untreated phenylketonuria (PKU). The study was conducted among 400 intellectually impaired adult residents of Social Welfare Homes in South-Eastern Poland born prior to the introduction of neonatal PKU screening programs. PKU was screened by filter paper test using tandem mass spectrometry methods, and confirmed by gas chromatography-mass spectrometric analysis of PKU organic acids in urine. Degree of functional independence included the assessment of activities of daily living (Barthel Index) and measures of balance and gait (Tinetti scale). Eleven individuals with previously untreated PKU were identified whereby eight presented with moderate disability and three with mild disability. Six had a high risk of falls and five had a moderate risk of falls. This study indicates that there is considerable number of undiagnosed PKU patients within the Polish population who require assessment and management in order to reduce the impact of the neurological and neuropsychiatric problems associated with the condition. Appropriate therapy for those with undiagnosed PKU should, in particular, address the risk of falls.
Elderly people are not only more susceptible to disease, but they are also at a higher risk of sustaining accidents such as falls, which definitely affects the quality of human life. Aging, in other words, carries with it an increased danger of illness and injuries, including those caused by falling. Research referred to in this article consisted in collecting and analyzing anonymized data of 411 geriatric patients admitted to a hospital in Berlin, Germany, over a period of six months, between January and June 2020, and attempted to look at how fall prophylaxis can reduce the overall healthcare costs generated by senior citizens. Of the 411 geriatric patients, 105, aged between 49 and 97 (69 females and 36 males), sustained injuries due to falling and made up 34.3% of all geriatric patients. Conclusions that the author arrived at can prove useful to determine the importance of the prevention of falls of older people in reducing the complications resulting from falls. The overall costs of senior citizens' health care were also taken into consideration. Therefore, solutions should be sought to reduce the number of falls of older people. Falls are an important public health problem causing suffering for elderly patients, worsening the comfort of further life and additionally generating relatively high costs for the economy.
Co najmniej połowa pacjentów z chorobą Parkinsona ma doświadczenie związane z upadkiem, zaś w późniejszych stadiach choroby dotyka to dwóch spośród trzech chorych. Rehabilitacja chorych z chorobą Parkinsona, zwłaszcza w rozwiniętej postaci choroby, jest trudna i skomplikowana. Ważnym jej elementem są ćwiczenia koordynacyjno-równoważne i zapobieganie upadkom. W pracy poglądowej przedstawiono zasady kompleksowej rehabilitacji osób z chorobą Parkinsona, omówiono zasady profilaktyki upadków, zaprezentowano wykorzystanie stabilometrii, posturometrii i analizy chodu dla wczesnej diagnostyki, rehabilitacji i profilaktyki upadków.
EN
Some people suffering from Parkinson Disease experience problems with gait and keeping stable posture. Sometimes they fall down, which can be dangerous. Statistics show that more than 50% of PD patients happen to fall. The rehabilitation of those patients is difficult and complicated and its most important elements are coordination and balance exercises. The factors predicting falls are the following: age, cognitive disturbances, troubles with eyesight, bowel and bladder incontinence, intake of drugs. According to Hoehn and Yahr, in stages III, IV and V a loss of balance or/and a loss of body stability control can be observed. In this review the common rules of comprehensive rehabilitation of the patients suffering from Parkinson Disease and the prevention of falls have been described. The paper also presents the use of stabilometry, posturometry and gait analysis for early diagnosis, rehabilitation and prevention of falls.
INTRODUCTION Falls as a major cause of injuries and disability have been a subject of numerous studies in community-dwelling elderly people. However, few studies have analysed falls among inpatients. The aim of the study was to evaluate the risk factors of falls in patients of a geriatric ward and the effectiveness of a falls prevention program. MATERIALS AND METHODS The study included 100 consecutive patients admitted to the Geriatric Ward aged 80.2 ± 7.65 (mean ± SD) (69 women and 31 men). Barthel and IADL scales were used to assess independence and mobility, VAS – to assess the pain level, and MMSE – for mental status examination. Balance was assessed using a stabilometric platform, and the risk of falling using the Tinetti scale. The body structure was analysed using the bioimpedance method. All the patients were qualified to an appropriate category of the falls prevention program. RESULTS The most common risk factors for falling were: asthenia – 78%, age ≥ 80 years – 61%, leg pain – 53%, back pain – 50%, dizziness – 49%, visual impairment – 47%, a history of falls – 45%, and osteoarthritis – 44%. Among the respondents, 9% had 1–3 fall risk factors, 27% – 4–6, 44% – 7–9, 20% – ≥ 10 factors. Four patients had experienced a fall. All the cases were connected with noncompliance of patients with falls prevention. Among those who had fallen , three subjects had normal cognitive function, another one – delirium. One fall was complicated with a slight facial injury. CONCLUSIONS Geriatric ward patients constitute a group with a high risk of falls. The main risk
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W S T Ę P Upadki stanowiące główną przyczynę urazów osób starszych były przedmiotem licznych badań w środowisku mieszkalnym i komunalnym. Nieliczne analizy poświęcono upadkom u chorych hospitalizowanych. Celem pracy była ocena czynników ryzyka upadków u chorych na oddziale geriatrycznym oraz analiza skuteczności programu profilaktyki upadków. M A T E R I A Ł I M E T O D Y Badaniem objęto 100 kolejnych chorych przyjętych do Oddziału Geriatrii, o średniej wieku 80,2 ± 7,65 roku ( x ± SD), w tym 69 kobiet i 31 mężczyzn. Zastosowano skale Barthel oraz IADL (ocena samodzielności i zdolności poruszania się), VAS (ocena natężenia bólu), MMSE (ocena stanu umysłowego). Zachowanie równowagi oceniono za pomocą platformy stabilometrycznej, ryzyko upadku za pomocą skali Tinetti. Metodą bioimpedancji analizowano strukturę ciała. Wszyscy chorzy kwalifikowani byli do jednej z trzech kategorii programu profilaktyki upadków. WYNIKI Do najczęstszych czynników ryzyka upadku należały: osłabienie – 78%, wiek ≥ 80 lat – 61%, ból kończyn dolnych – 53%, ból kręgosłupa – 50%, zawroty głowy – 49%, upośledzenie wzroku – 47%, upadki w przeszłości – 45%, choroba zwyrodnieniowa stawów – 44%. U 9% badanych stwierdzono 1–3 czynniki ryzyka upadku, u 27% – 4–6, u 44% – 7–9, zaś u 20% ≥ 10 czynników ryzyka upadku. Upadku doznało 4 chorych z zaburzeniami równowagi, którzy nie zastosowali się do zaleceń profilaktyki upadków; w 3 przypadkach byli to pacjenci bez istotnych zaburzeń poznawczych, w 1 – z zespołem majaczeniowym. Jeden upadek był powikłany lekkim urazem twarzy, pozostałe były niepowikłane. WNIOSKI Pacjenci oddziału geriatrycznego stanowią grupę obarczoną dużym ryzykiem upadków. Do najważniejszych czynników ryzyka upadku na oddziale geriatrycznym należą majaczenie i nieprzestrzeganie przez chorych zaleceń personelu.
Wstęp. Istotnymi problemami starości są rozmaite zaburzenia występujące podczas wykonywania czynności życia codziennego oraz upadki. Cel. Ocena wpływu dwóch programów rehabilitacji na wykonanie prostych czynności ruchowych i ryzyko upadków u osób po 85 roku życia z zaburzeniami czynności życia codziennego. Materiał i metody. Badaniami objęto 50 osób (32 K, 18 M., śr. wieku 87 lat), podzielonych losowo na dwie grupy. Grupa I realizowała program rehabilitacji, obejmujący ćwiczenia czynne wolne, ćwiczenia sensomotoryczne, ćwiczenia zmiany pozycji i marsz na krótkim dystansie oraz naukę podnoszenia się po upadku. Grupa II wykonywała ćwiczenia czynne wolne, ćwiczenia sensomotoryczne. Oba programy rehabilitacji trwały 3 miesiące i były realizowane 2 razy w tygodniu. W grupie I ukończyło program 25 badanych, a w grupie II – 18. Na początku i końcu badań wykonywano test Timed UP & GO oraz test Tinetti (POMA). Przed rozpoczęciem badań nie odnotowano istotnych statystycznie różnic pomiędzy badanymi grupami. Do opisu materiału badawczego wykorzystano podstawowe parametry statystyczne, a w celu porównania uzyskanych wyników zastosowano test t-Studenta oraz nieparametryczny test Wilcoxona. Wyniki. Rezultaty wykonywania testów poprawiły się w sposób istotny statystycznie (p<0,05) tylko w grupie I. Średni czas wykonania testu UP & GO przed programem wynosił 26,1 s, a po jego zakończeniu 20,9 s. Wyniki testu Tinetti, zarówno wynik sumaryczny, jak i ocena równowagi (przed programem 11,2 ±1,8 po 13,1 ±1,8) oraz chodu (przed programem 8,9 ±1,5 po 10,4 ±1,7) były lepsze. W grupie II różnice przed i po programie rehabilitacji nie były istotne statystycznie. Wnioski. Ćwiczenia sensomotoryczne połączone z nauką podnoszenia się po upadku i nauką zmiany pozycji oraz marszem na krótkim odcinku, stosowane u osób starszych z zaburzeniami czynności życia codziennego, wpływają na poprawę wykonywania tych czynności i zmniejszenie ryzyka upadków
EN
Background. Disturbances in functioning associated with performing simple tasks of daily living, especially in conjunction with a constant hazard of incidental falls, constitute major challenges any elderly population has to face.Aim. To assess the effects of two specifically structured physical rehabilitation regimens on enhancing individual functional capabilities and minimising the risk of incidental falls among the frail octogenarians (over 85).Material and methods. Duration of the study was 3 months (comprising two exercise sessions a week). Fifty subjects (mean age: 87 years) randomised into two groups: Group I – 25, Group II (controls) – 18. Group I was assigned an intensive rehabilitation regimen combining active exercises, multi-sensory training, instruction on performing safe postural shifts and rising effectively from falls, walking short distances; Group II – active exercises and multi-sensory training. Twenty five subjects in Group I and 18 subjects in Group II completed the study,. The Timed UP & GO and Tinetti (POMA) tests were applied respectively to assess individual mobility before and upon completion of the study. The results were subsequently processed, inter alia, with a non-parametric Wilcoxon test.Results. Statistically significant improvement was observed in Group I (p<0.05) in the Timed UP & GO test score (mean time 26.1 sec. vs. 20.9 sec.), as well as in the Tinetti (POMA) test (balance assessed before: 11.2 ±1.8 after 13.1 ±1.8, gait assessed before: 8.9 ±1.5; after 10.4 ±1.7), whereas the changes observed in Group II were not statistically significant.Conclusions. Structured rehabilitation regimen combining diverse active exercises, walking training, multi-sensory training, instruction on safe postural shifts and rising effectively from incidental falls is believed to significantly enhance individual functional capabilities in the frail octogenarians.
Zaburzenia równowagi i chodu należą do najbardziej niepokojących objawów starzenia. Ich następstwem są upadki, które stanowią główną przyczynę złamań kośćca u starszych osób. Celem pracy była ocena stanu równowagi i zdolności lokomocyjnych starszych osób zamieszkujących w domu opieki społecznej. Badaniami objęto 58 osób (30 kobiet i 28 mężczyzn) w wieku od 65 do 93 lat (średnio 77,1 ± 7,7), zamieszkujących w Domu Pomocy Społecznej "Pogodna Jesień" w Cieplicach. Ocenę równowagi i chodu przeprowadzono za pomocą testu Tinetti, który pozwala oszacować zagrożenie upadkami. Uzyskane wyniki wskazują na znaczne deficyty w utrzymywaniu równowagi i chodzie badanych osób. Tylko u 13% uczestników wynik wskaźnika Tinetti wskazał na niewielkie ryzyko upadku. Umiarkowane zagrożenie upadkiem stwierdzono u 50% osób, a u 37% prawdopodobieństwo, że do upadku dojdzie, było pięciokrotnie większe niż u pozostałych. Wykazano istotny związek między wiekiem a stopniem zagrożenia upadkami. W badanej grupie deficyty w równowadze ciała i związane z tym podwyższone ryzyko upadków dotyczyły 87% starszych osób. W zapobieganiu upadkom szczególna rola przypada rehabilitacji ruchowej.
EN
Disorders of balance and gait are one of the most disturbing symptoms of ageing. They lead to repeated falls, that are the main reason for injuries in the elderly. They result in suffering, disability, loss of self-dependence and social isolation of the affected individuals. The aim of the study was to evaluate the balance and locomotor abilities in the elderly people living in a nursing home. The study was performed on 58 individuals (30 women and 28 men) aged 65-93 (mean age 77.1 ± 7.7) living in a nursing home in Jelenia Góra. Balance and gait were evaluated by means of the Tinetti test. The result of the test, called Tinetti mobility index, can help evaluate the risk of falls. The results suggest significant deficits in maintaining balance and quality of gait in the examined. The results in women were worse than in men, yet he differences were not statistically significant. Only in four people (13%) the Tinetti index showed the risk of falling. The risk of falling was observed in 15 patients (50%) and in eleven of them the probability of falls was 5 times higher than in the rest. Age significantly influenced body balance and the risk of falls. In the examined group the deficits of body balance and the increased risk of falling related to them were observed in 87% of the elderly. Physiotherapy plays an important role in prophylaxis of falls and it should be introduced in nursing homes for the elderly.
Lęk przed upadkami dotyka znacznej części osób starszych. Jest złożonym problemem mającym istotne znaczenie dla utraty samodzielności i pogorszenia jakości życia. Początkowo opisywany jako jedna z psychologicznych konsekwencji upadku, z czasem został uznany za niezależne zjawisko o złożonej genezie. Lęk przed upadkiem to nie tylko obawa przed urazem fizycznym, długoterminowym uszczerbkiem na zdrowiu i niepełnosprawnością. Dotyczy także społecznych konsekwencji upadku, takich jak wstyd, utrata pewności siebie, czy poczucie zależności od innych. Badania donoszą, iż lęk przed upadkami dotyczy różnych grup w populacji osób po 65 r.ż. Wśród osób starszych żyjących samodzielnie występowanie lęku przed upadkami szacuje się na 12-65% u osób nieupadających i 29- 92% u tych, które w niedalekiej przeszłości doświadczyły upadku. Występowanie upadków w grupie osób po 65 r.ż. objętych opieką instytucjonalną szacuje się na około 30%. Do konsekwencji lęku przed upadkami należą: ograniczenie aktywności, niepełnosprawność w zakresie wykonywania czynności życia codziennego, zaburzenia chodu i równowagi, zwiększenie ryzyka upadków i objęcia opieką instytucjonalną oraz pogorszenie jakości życia. Możliwie precyzyjny i ujednolicony pomiar subiektywnych odczuć lęku przed upadkami jest warunkiem prowadzenia badań naukowych nad tym zjawiskiem oraz identyfikowania osób zagrożonych konsekwencjami tego lęku w warunkach klinicznych. Przegląd literatury dotyczącej problematyki badania lęku przed upadkami wykazał, iż Falls Efficacy Scale – International jest narzędziem, które doskonale nadaje się do tego celu. Jego zastosowanie w Polsce przyczyni się do pogłębienia wiedzy na temat występowania tego zjawiska w procesie starzenia oraz pozwoli na porównanie rodzimych badań z pracami zagranicznymi.
EN
The fear of falling affects a large percentage of the elderly population. This complex fear can significantly curtail an individual’s independence and diminish their overall quality of life. Initially described as merely the psychological consequence of a fall, this fear has gradually been acknowledged as a complex phenomenon within its own right. The fear of falling is not just a fear of physical injury, long-term health damage or physical disability. It also engages a series of social consequences, e.g., shame, the sense of being a burden to others, and an appreciable loss of self-confidence. Studies reveal that a fear of falling actually affects a larger proportion of the population than the actual incidence of falling itself. Fear of falling in an elderly community is estimated to affect between 12% – 65% of the population of non-fallers, and 29% – 92% of those who have sustained a recent fall. The overall incidence of falls is estimated to be approximately 30%. Fear of falling not only imposes limitations on individual activity, resulting in a reduced ability to pursue the activities involved in daily living, but also results in impaired gait and balance, which itself further increases the risk of falls, institutionalization, and an overall decline in quality of life. A precise and standardized measurement of the fear of falling, from a subjective perspective, is necessary for an effective evaluation of this phenomenon with a view to effectively identifying the individuals most at risk of exposure to its consequences within a clinical environment. A review of the literature on this subject acknowledges the appropriateness of the Falls Efficacy Scale – International as an effective instrument for this assessment. Its prospective application across Poland should significantly contribute to an improved appreciation of this phenomenon within the aging process, and facilitate a viable comparison of Polish research data with results obtained in foreign studies.
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