[Evaluation of postural control systems in elderly patients with repeated falls]

An Assessment of Balance through Posturography in Healthy about Women: An Observational Study

The incidence of falls in adults constitutes a public health problem, and the alteration in balance is the most important factor. It is necessary to evaluate this through objective tools in order to quantify alterations and prevent falls. This study aims to determine the existence of alteration of balance and the influence of age in a population of healthy women. Static posturography was performed on 49 healthy adult women with no history of falls in four different situations using the Romberg test with the NedSVE/IBV^® platform. The variables studied were the body sway area and the anteroposterior and mediolateral displacements. The situation of maximum instability occurred in RGC (p = 0.001), with a significant increase in anteroposterior oscillations regarding the ML (p < 0.001), with no correlation to age. Age alone does not influence the balance in the sample studied, other factors must come together to alter it. The joint cancellation of visual and somatosensory afferents could facilitate the appearance of falls, given that it is a situation of maximum instability. Proprioceptive training is interesting as a preventive strategy for falls.

[Experience of a falls prevention unit in an intermediate care hospital]

INTRODUCTION

The aim of this study is to determine clinical features and interventions in patients attended in our hospital falls prevention unit.

MATERIAL AND METHODS

Medical records and evaluation protocols from October 2010 to June 2012 were reviewed. Results are expressed in means and standard deviation.

RESULTS

We studied 68 patients: 53 came due to falls (77.9%), and 15 (22%) due to gait disorders. The mean age was 77.6±7.9. Number of women: 63 (92.6%). Previous Barthel Index was 94/100, cognitive impairment 23 (33.8%), polypharmacy 69.1%, orthostatic hypotension 18 (26.4%). Walking speed 0.66± 0.19m/s and Time up and go to (TUG) 16.6±4.5 s. Post-urography detected vestibular dysfunction in 34 patients (77%). Clinical cause of fall and/or gait disorder was multifactorial in 33 (48.5%), Parkinsonism 19 (27.9%), chronic pain/arthropathy 8 (11.4%), and vestibular syndrome 8 (11.4%). Two-thirds (45; 66.1%) of the patients began Physical therapy, and vitamin D was given to 47 (69.1%). Phone calls were made to patients and/or their relatives and noted that after 3 months of the treatment: 48 (70.5%) had no fall; 59 (86.7%) patients followed the recommendations, and 57 (83.8%) were satisfied.

CONCLUSIONS

In this sample of older patients, mostly female with a good functional and cognitive condition, the causes of the falls were multifactorial in the half of the cases, and the post-urography detected vestibular changes in the half of the patients.

[Fear of falling]

Fear of falling (FF) can be considered as a protective response to a real threat, preventing the elderly from performing activities with high risk of falling, but can also lead to a restriction of the activities that will result in a long-term adverse effect on social, physical or cognitive functions. There is a prevalence of FF in 30% in the elderly who have no history of falls, and double that in those with a history of falling. Its prevalence is increased in women and with advanced age. Several scales have been developed to measure the psychological effects of FF, among which are noted are, the Fall Efficacy Scale (FES), the Activities-specific Balance and Confidence Scale (ABC), and the survey of activities and fear of falling in the elderly (SAFE). It has negative consequences in the functionality, the subjective feeling of well-being, and in the consequent loss of independence. The functional and physical deterioration, or the quality of life is clearly related to the FF, although it has not been established if these factors are cause or effect. Multiple interventions have been recommended, bringing about changes that reinforce their confidence to carry out activities. Interventions and research should promote a realistic and appropriate approach to the risk of falls and teach the elderly to perform activities safely. The reduction in FF is an important goal in itself to improve the subjective feeling of well-being, and the benefits could be increased if this reduction was also accompanied by an increase in safe behaviour, social participation, and activities of the daily life.