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1: Bergland A., Jarnlo G.B., Laake K.
Predictors of falls in the elderly by location.
Aging Clin Exp Res 2003 Feb;15(1):43-50.
BACKGROUND AND AIMS: In the elderly, balance and walking impairments are
assumed to play an important role in causing falls. We have assessed
prospectively the predictive ability of health, function and balance variables
regarding falls and their location. METHODS: Falls which occurred during one
year in a random sample of 307 women aged 75 years and over (mean 80.8 years,
response rate 74.5%) living in the community were recorded and related to
baseline registrations of health, medication and tests of walking andbalance.
RESULTS: In all, 155 women (50.5%) reported 308 falls. Outdoor falls were
significantly more frequent than indoor falls (57.5 vs 42.5%). Thevariables
having had a fall before the start of the study, osteoporosis, hypertension,
feeling depressed, unable to climb 40 cm high steps and walking slowly, all
independently predicted a higher number of falls overall. Regarding fall
location, having experienced a fall before study start was associated with more
falls indoors as well as outdoors. Vision impairment, symptoms of depression, a
faster comfortable walking speed, and being able to cope with higher steps were
all independent predictors of more outdoor fallsalso after adjustment for
outdoor exposure. A slower comfortable walking speed, a higher amplitude of the
center of pressure movements in the frontalplane, a poorer score on the Timed
Up & Go test, multimorbidity, poor cognition and hypertension were independent
risk factors for indoor falls. Neither number of drugs used nor any specific
medication appeared as independent risk factors for falls in this study.
CONCLUSIONS: The findings of this study suggest that risk factors for indoor
and outdoor falls are different. Location of fall may be an important
confounder in studies of predictors offalls in the elderly which should
encompass this type of information
Rasool I., Gupta I., Bennett G.
Paroxysmal 'funny turns' in an elderly woman - a 95-year-old with an
insulinoma.
Age Ageing 2003 Jul;32(4):453-455.
A 95-year-old woman was admitted to hospital with a fractured neck offemur
following a fall. There was no past history of note other than numerous
episodes of 'funny turns' preceding falls some of which resulted in fractures.
During her admission she had a 'funny turn'. Immediate investigations revealed
hypoglycaemia and subsequent biochemical abnormalities, most likely due to a
benign endocrine tumour - an insulinoma.
Shabat S., Gepstein R., Mann G., Stern A., Nyska M.
Simultaneous distal radius and hip fractures in elderly patients--implications
to rehabilitation.
Disabil Rehabil 2003 Aug;25(15):823-6.
Purpose: The reasons for fractures in the elderly patients are multifactorial.
Osteoporosis is considered to be the main pathology. Other reasons are the
increase in fall frequency and the protective response to trauma. The most
common sites at which these fractures occur are the hip, vertebra and distal
radius. A combination of these is uncommon. Methods: All patients who were
treated between January 1990 and December 2000 with a combination of distal
radius and hip fractures and were older than 65-years were retrospectively
evaluated. The following parameters were evaluated: age;sex; pre fall function;
use of drugs; chronic and acute comorbidity; circumstance of the fall;
hospitalization length of stay; treatment procedure; complications; and
post-hospitalization rehabilitation. Results: Forty-six patients met the
study's criteria. Group I consisted of 16 patients between 65-80 years, and
group II consisted of the remaining 30 patients older than80 years. All
patients suffered low energy trauma. Ten out of the 16 patients in group I, and
eight out of the 30 patients in group II were totally independent, while the
remaining patients needed some help with activity of daily living (ADL). In all
patients the simultaneous fractures were ipsilaterally. For 45 patients
hospital stay ranged from 5-23 days. Twenty-eight patients were transferred to
a geriatric rehabilitation centre. Twenty-six of them returned to their
previous ADL after a period of 60 days on average.Among the 18 remaining
patients, 11 gained full recovery (6 from group I and 5 from group II) and
seven patients (5 from group II) had a slight reduction in ADL. Conclusions: A
combination of these fractures is probably moretraumatic and occurs in the
higher-age group. It is always located in the ipsilateral side. The double
trauma represents a better pre-morbid condition relative to patients in the
same age group, and thus it may serve as a prognostic indicator for success in
rehabilitation.
Barnett A., Smith B., Lord S.R., Williams M., Baumand A.
Community-based group exercise improves balance and reduces falls in at-risk
older people: a randomised controlled trial.
Age Ageing 2003 Jul;32(4):407-414.
BACKGROUND:recent studies have found that moderate intensity exercise is an
effective intervention strategy for preventing falls in older people. However,
research is required to determine whether supervisedgroup exercise programmes,
conducted in community settings with at-risk older people referred by their
health care practitioner are also effective inimproving physical functioning
and preventing falls in this group. OBJECTIVES:to determine whether
participation in a weekly group exercise programmewith ancillary home exercises
over one year improves balance, muscle strength, reaction time, physical
functioning, health status and prevents falls in at-risk community-dwelling
older people. METHODS:the sample comprised 163 people aged over 65 years
identified as at risk of falling using a standardised assessment screen by
their general practitioner or hospital-based physiotherapist, residing in South
Western Sydney, Australia. Subjects were randomised into either an exercise
intervention group or a control group. Physical performance and general health
measures were assessed at baseline and repeated 6-months into the trial. Falls
were measured over a 12-month follow-up period using monthly postal surveys.
RESULTS:at baseline both groupswere well matched in their physical performance,
health and activity levels. The intervention subjects attended a median of 23
exercise classes over the year, and most undertook the home exercise sessions
at least weekly. Atretest, the exercise group performed significantly better
than the controls in three of six balance measures; postural sway on the floor
with eyes open and eyes closed and coordinated stability. The groups did not
differ at retest in measures of strength, reaction time and walking speed or on
Short-Form 36, Physical Activity Scale for the Elderly or fear of falling
scales. Within the 12-month trial period, the rate of falls in the intervention
group was 40% lower than that of the control group (IRR=0.60, 95% CI
0.36-0.99). CONCLUSIONS:these findings indicate that participation in a weekly
group exercise programme with ancillary home exercises can improve balance and
reduce the rate of falling in at-risk community dwelling older people
Shabat S., Mann G., Kish B., Stern A., Sagiv P., Nyska M.
Functional results after patellar fractures in elderly patients.
Arch Gerontol Geriatr 2003 Jul;37(1):93-8.
Elderly patients tend to fracture the patella because of a simple fall. In this
group of patients restoration of primary functional level is crucial.
Sixty-eight patients more than 65 years of age withpatellar fractures, who were
treated in our institution between January 1990 and December 1999 were
evaluated. There were 43 females and 25 males. The ages ranged from 65 to 88
years (17 patients >80). We focus on the mechanism, which led to the fracture,
the pre-morbid and post-morbid state of thepatients and the various aspects of
treatment in this group of patients. The majority (82%) had a simple fall. Half
of the patients had background diseases. Forty-five patients (66%) had
comminuted patellar fracture. In 58 patients (85%) the extensor mechanism was
disrupted, which therefore, necessitated an operation (group I). The rest, ten
patients, were treated conservatively (group II). Follow-up time ranged between
0.5 and 10.5 years (mean 4.5 years). Minor complications were noted in five
patients. Sixty patients(88%) had intact extensor mechanism, while five
patients in group I (9%) and three in group II (30%) had extension-lag of 10-30
degrees (P<0.05). None of the patients had non-union, cosmetic disturbances or
developed osteoarthritis. Fifty-six patients (82%) (41 patients in group I and
five in groupII, P<0.05) achieved the same independence mobility status
post-fracture. In elderly patients the cause of the fracture is a direct blow
by simple fall to the patella causing comminuted fractures; however, with these
patients excellent or good results were eventually achieved. Surgical treatment
yielded better results than non-surgical.
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