© Borgis - New Medicine 4/2003, s. 130-132
Marek Zak1, Magdalena Namysl2
Assessment of potential risk factors for falls in the frail elderly versus individual mobility considerations
1 Faculty of Clinical Rehabilitation Academy of Physical Education, Cracow, Poland
Head: prof. Krzysztof Spodaryk, MD, PhD
2 Nursing home, Sportowe 9, Cracow, Poland
Background: The frequency of falls in the elderly breaks down as 33% amongst outpatients, 20% in hospitalised patients, and 45% in nursing home residents. Both the frail elderly and their relatively fit peers are equally exposed to a potential risk of fall.
Materials and methods: The study group comprised 78 nursing home residents (aged 65-94). A timed „Up-and-Go” test was applied in order to assess individual mobility. All assessments were pursued in compliance with the Pilet and Swine method. Group I comprised subjects who scored 12 seconds or more (50 subjects – 41 women, 9 men; mean age 81 years), whereas Group II comprised those who scored 8 seconds or less (28 subjects – 17 women, 11 men; mean age 77 years).
Results: There were no statistically significant differences in the risk of fall assessment. In Group I (where the subjects scored worse in the timed „Up-and-Go” test), a high risk of fall was reported in 84% of subjects, whereas in Group II (better test scores) it was about 71%. The subjects proved most at risk when attempting to change posture, or when assessed for their individual sense of balance.
Conclusions: We cannot conclude that better locomotive capabilities in the elderly reduce the individual risk of an accidental fall. Paradoxically, the highest risk correlated with executing the apparently simple tasks of daily life.
The frequency of falls in the elderly breaks down as 33% amongst outpatients, 20% in hospitalised patients, and 45% in nursing home residents (1, 2, 3). Data regarding the actual frequency of falls often misrepresent the facts, as most falls do not usually result in severe complications. However enough facilitate development of a post-fall syndrome and – in due course – a perceptible deterioration of patient´s overall mobility, effectively making them even more prone to the falls (3, 4, 5).
Around 10-15% of falls result in serious life-threatening trauma. Immobilisation of a patient in the wake of a serious fall brings about a threat of venous thrombosis, pulmonary embolism, dehydration, muscular contracture, and bed sores (4, 5). Consequently, more frequent and prolonged hospitalisation is required, a patient becoming steadily more care-dependent. By far the most frequent consequences of falls are bone fractures (50%). Those within the upper femoral bone area being the most serious (6). Mortality from post-fall complications tends to increase significantly with every decade of age.
As may be seen from observations, the vast majority of falls are sustained during simple activities of daily living, such as getting out of bed, change of posture (e.g. bending down to pick something up), or just walking, whereas only 5% are reported to occur when potentially dangerous tasks are being attempted, e.g. climbing a ladder. Minimising the risk of accidental falls and any attendant complications invariably depends upon gaining a good insight into the accompanying circumstances, with a view to establishing the nature of potential risks to which patients are exposed, and ultimately developing a series of effective preventive measures.
The authors therefore aimed to gain a detailed insight into the circumstances of such events, to identify and categorise the principal risk factors. Given the fact that both the frail elderly, usually suffering from multiple ailments, and their relatively fit peers are equally exposed to a potential risk of fall, the authors set out to assess the risk factors, considerating individual mobility with the following questions in the study:
Can it be unequivocally established that nursing home residents with relatively unimpaired mobility are exposed to a lesser risk of sustaining an accidental fall?
During which activities of daily living do the nursing home residents run the highest risk of an accidental fall?
MATERIALS AND METHODS
The study group comprised 78 nursing home residents (aged 65-94) from two nursing homes in Krakow. Each of them was reported to have sustained at least one fall prior to the commencement of the study.
The largest part of the study group (41%) was subjects whose principal ailments were related to circulatory disorders, impaired mobility in 31%, whereas disorders of the nervous system accounted for 28% of the entire group.
The following inclusion criteria were applied in admitting the patients into the study:
1. Patient´s informed written consent for participation in the study
2. At least one fall sustained within a 6-month period immediately preceding the commencement of the study
3. Overall fitness allowing for the execution of test procedures
4. Mental condition allowing written consent to participation in the study
The inclusion criteria required that each patient should have sustained at least one accidental fall in the period preceding the actual study (pursued in 2000-2001). Out of 160 residents, 78 were eventually enrolled as fully compliant.
At first, a timed „Up-and-Go” test was applied in order to assess individual mobility amongst the subjects (7). Subsequently, the subjects were split into two groups depending on results. Group I was subjects who scored 12 seconds or more (50 subjects – 41 women, 9 men; mean age 81 years), whereas Group II was those who scored 8 seconds or less (28 subjects – 17 women, 11 men; mean age 77 years). The „Up-and-Go” test was carried out on each subject three times and the best score was considered for allocation to a group.
The study focused principally upon assessing the risk of accidental falls and individual functional abilities, pursued in full compliance with the method put forward by Pilet and Swine (8).
The study consisted of two parts. The first focused on assessing the risk of fall during routine daily activities, and the second concerned ability to cope effectively after sustaining a fall.
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