جستجوی مقالات مرتبط با کلیدواژه « افتادن » در نشریات گروه « پزشکی »

 Old age comes with many changes to the physiological and psychological organs and functions of the body. Fall down is one of the serious issues of old age that occurs due to many factors. Among the problems recorded in old age are eating disorders, dissatisfaction with body image and low self-esteem. The aim of the present study was to compare eating disorders, body image and self-esteem in the elderly with and without a history of fall down.

 The current research was causal-comparative research and applied in terms of its purpose. For this purpose, 60 elderly women aged between 60 and 70 from Tabriz voluntarily participated in the research. The subjects were divided into two groups with and without a history of fall down. The fall down history questionnaire measured the fall down history of the volunteers. Also, eating disorders, body image and self-esteem were measured by Garner, multidimensional body-self relationships (MBSRQ) and Rosenberg questionnaires, respectively. Independent t-test was used to compare the mean variables in two groups and SPSS statistical software was used for data analysis.

 The results showed that there was a significant difference between eating disorders and self-esteem index in the elderly with and without a history of fall down (P<0.05). However, there was no significant difference between the body image index in the elderly with and without a history of fall down (P>0.05).

 According to the results of this research, people without a history of falling had a better condition than people with a history of falling in the indicators of eating disorders and self-esteem. Therefore, it is necessary to pay special attention to improving the nutritional conditions and self-esteem of the elderly with a history of falling.

Background &

Osteosarcopenia, the presence of osteopenia/osteoporosis and sarcopenia, is an emerging geriatric giant, which poses a serious global health burden.

The latest studies conducted in recent years in the field of pathophysiology, epidemiology, diagnosis and treatment of osteosarcopenia were reviewed.

Getting old and being healthy is contingent on maintaining the integrity of several physiological systems such as the musculoskeletal system which is important for both human movement and storing calcium and glucose. As individuals get to their sixtieth, their muscle mass and bone minerals will decrease and the elderly will become susceptible to sarcopenia and osteoporosis. According to the World Health Organization, the definition of osteopenia and osteoporosis is a T score of less than -1 and -2.5 standard deviations, respectively. Sarcopenia is defined by cut-off amounts for low muscle mass, strength, and/or functional capability and is related to different metabolic conditions. Both diseases have common risk factors and are associated with falls, frailty, fractures, hospitalizations, and mortality as well as causing an increase in healthcare expenses. These disorders put a heavy burden on societies, especially the geriatric population to the extent that in 2010 there were 27.5 million people diagnosed with osteoporosis in the European Union. Osteosarcopenia is defined as low bone density and low muscle mass. As in individual ages, the prevalence of osteosarcopenia increases as well with 59.4 percent and 48.3 percent in men and women above 75 years old. It has been shown in a study of 590 post-menopausal women that the risk for osteoporosis will be 12.9 times higher in the presence of sarcopenia.  A recent study of 3334 older individuals reported that individuals with sarcopenia (compared with no sarcopenia) had lower BMD when employing the 2019 European definition of sarcopenia. So there is a bidirectional relationship between osteoporosis and sarcopenia, which results in  the development of osteosarcopenia. Major risk factors for this disorder are age and sex, however body mass index and physical activity are reversely related to osteosarcopenia and high fat mass will increase its risk. Glycine-N-acyltransferase (GLYAT) genes polymorphisms, peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), and myocyte enhancer factor-2 (MEF2C) are related to muscle atrophy and bone loss. Furthermore, genetic traits determine peak muscle and bone volume in early life which may be a mechanism for delaying sarcopenia and osteoporosis in old ages.
In comparison with non-osteosarcopenic subjects, the risk of falls (ORs: 2.83–3.63; P < 0.05) and fractures (ORs: 3.86– 4.38; P < 0.05) is significantly higher in osteosarcopenic older individuals attending a falls and fractures clinic. The risk of o a minccurance of a minimal-trauma or no trauma fracture when the patient is sarcopenic was also reported to be much greater than in non sarcopenic older persons (relative risk 1.37, 95% CI 1.18–1.58).
It has been suggested that clinicians should be alert to the fact that, recognition of one of these conditions makes the investigation for the other one necessary because of their co-occurance.  A physical examination must be typical in the comprehensive geriatric investigation. But additional physical assessments are needed to diagnose sarcopenia. Physical assessments are considered to assess muscle strength (grip strength, sit to stand test) or functional capacity (gait speed, short physical performance battery, timed up and go test). The two most used and accurate assessments are gait speed grip power Osteosarcopenia cannot be screened and there is no efficient tool for predicting this condition, but there are tools for osteoporosis and sarcopenia such as SARC-F questionare which is highly specific and most accurate. Bone Marrow Densitometry through DXA is used for osteoporosis in individuals with age more than 50, post-menopausal women, adults with Rheumatoid Arthritis and adults who are on corticosteroid medications. FRAX© is the best tool for risk stratification of osteoporosis.
Increased risk for falls and following fractures are identifiable by testing for 25 OH vitamin D, serum calcium, parathyroid hormone and serum testosterone. BMD and muscle mass assessment are the essentials of osteosarcopenia workup. DXA is the greatest tool to assess BMD accurately, and has the benefits of estimating the lean body mass and appendicular lean mass in an accurate manner. Bioelectrical impedance analysis which assesses the fat-free mass, peripheral quantitative computerized tomography, muscle cross-sectional area and intramuscular adipose tissues and magnetic resonance imaging. A new technique named as the D3-creatine dilution method has been found to have strong associations with falls, fractures and risk of mortality in old men. This technique needs further assessment to be considered a typical clinical tool.
Resistance training exercises which stimulate muscle protein synthesis and the activity of osteoblasts will improve the activity of older individuals with osteosarcopenia. In addition, this kind of exercise will also improve the cardiometabolic and cognitive health in different populations. This kind of exercise is recommended for preventing osteosarcopenia. As the ability of muscles to absorb dietary amino acids will decline with age, supplementation with dietary proteins in addition to resistance exercises is proposed as an ideal therapy for maintaining the optimal musculoskeletal function in older adults. Whey protein which is rich in Leucine and stimulates mTORC1 in skeletal muscles is the best way to increase muscle protein synthesis on condition that the individual has optimal vitamin D levels. The most prevalent micronutrient in bone structure is calcium and its kinetic is remarkable in muscle contractility force. It has been offered that 1000–1300 mg/day of calcium should be administered in populations with insufficient diets. Creatine is also believed to boost the exercise induced increase in muscle mass and also it causes an increase in bone density.
Peripheral DXA, quantitative computerized tomography and radiographic absorptiometry are alternative techniques to DXA that estimate BMD include. Most older adults who experience a low-trauma fracture have BMD in the normal or osteopenic range. BMD assessment techniques are highly sensitive but  not so specific for prediction of fracture.
Although there is no FDA approved drug for sarcopenia, there are numerous drugs for osteoporosis including antiresorptive (denosumab, bisphosphonates), anabolic (teriparatide, abaloparatide), antisclerostin (romosozumab), and hormonal (hormone replacement therapy, selective oestrogen receptor modulators) agents. Adults with T score of -2.5 or less on DXA, or a FRAX© 10-year fracture risk of ≥3% at the hip or ≥20% for any other osteoporotic fracture will mostly benefit from antiresorptive or anabolic treatment. Denosumab which is a RANK ligand inhibitor has promising effects on bone and muscle and those who consume this drug experience significant increase in lean body mass and handgrip strength; however bisphosphonates have no such effects. Osteosarcopenia requires ongoing monitoring and assessment of falls and fracture risk, quality of life impact, and response to treatment.

Osteosarcopenia is a hot topic in geriatric research. Lifestyle, genetic, mechanical factors and endocrine factors are altogether effective in occurrence of osteosarcopenia. Resistance training exercise and nutritional supplementation is a way to hinder osteosarcopenia. There is a definite need for further clinical trials for investigating pharmacologic interventions for this condition and providing new diagnostic methods, screening tools and therapies.

Falling and fear of falling, especially in the elderly with diabetes, is a common problem. It is highly important to identify people at risk. This study aimed to determine the relationship between the fear of falling and static and dynamic balance in the elderly with type II diabetes.

In this analytical cross-sectional study, 134 elderly people with type II diabetes were selected. The fear of falling was examined using the Falls Efficiency Scale International, and based on that, patients were divided into two groups, namely with and without fear of falling. Single leg standing and Narrow Path Walking tests were performed for each of the samples in both groups. Data were analyzed using SPSS software (version 22).

Out of 134 elderly people with diabetes, 26.1% had a history of falling, 70.9% suffered from neuropathy, and 51.5% had experienced fear of falling. Static and dynamic balance tests showed a significant difference in the groups with and without fear of falling (P<0.001). It means that the results of balance tests were poorer in the group with the fear of falling than in the group without the fear of falling.

The results showed that static and dynamic balance was significantly weaker in the elderly who had the fear of falling. It is suggested that in addition to psychological counseling for the elderly with diabetes who have the fear of falling, physical and balance exercises be planned and implemented for them.

With age, some physiological changes cause a negative effect on gait patterns. The aim of this study was to evaluate the effectiveness of a 6-week rotary exercises program on spatial and temporal gait parameters in elderly men.

This was a quasi-experimental study. A total of 38 employees and retirees over 60 years of age from Isfahan University of Technology in 2019, were selected by the convenience and purposeful sampling and were randomly divided into experimental and control groups (19 people). The gait parameters were assessed through marking the subjects’ trunk and lower extremities, along with simultaneously filming from three directions (anterior, posterior, and lateral) with a Canon 700D camera, and loading the videos into KINOVEA software. The exercise program were performed in three 60-minute sessions per week for six weeks. To analyze the data, descriptive statistics and the analysis of variance with repeated measures were used.

The results showed a significant difference in the number of steps per minute (Cadence) (P<0.001), step speed (P=0.019), stride time (P<0.001), step time (P<0.001), time of stretching or deployment (P=0.002), oscillation time (P<0.001) and dual protection time (P=0.014), but other parameters such as stride length (P=0.102), step length (P=0.137) and step width (P=0.089) were not significantly different.

Implementation of the 6-week combined rotary exercises program in the elderly can improve the gait parameters, reduce the risk of falls and thus reduce the number of referrals to treatment centers in this age group.

 Older people are at risk of falling and its complications more than other age groups. Evaluation of environmental hazards requires time and money. So it seems necessary to design a self-report questionnaire for initial screening. This study aims to develop a self-report tool for falling risk assessment in Iranian older people.

 After approval of the Ethics Committee of Iran University of Medical Sciences, an expert group prepared and wrote the study items using simple words and fluent structure. The reliability of the questionnaire was evaluated through test-retest method and its validity through content validity method. The elders were residents in their homes and had the appropriate level of consciousness to understand and respond to Persian sentences correctly. Information was collected through questionnaires and observations. Statistical evaluation was performed by SPSS version 16, and the retest test reliability of the questionnaire was determined by intra-class correlation coefficient.

In terms of content validity, Content Validity Ratio (CVR) formula was used, and the agreement between the experts was significant, so the questionnaire has good content validity. Test-retest reliability was calculated by Standard Error of Mean (SEM), and relative and absolute repeatability coefficients showed excellent reliability of this questionnaire. The validity of the questionnaire was calculated based on the Spearman correlation coefficient of 0.95 and P value less than 0.001. The questionnaire contained 15 main questions and 75 sub-questions about the dangers of the home environment.

The results of this study showed high validity and reliability of this questionnaire, so it can be used as a practical tool for identifying the risks of falling at home.

Considering the upward trend of elderly populations, the prevalence of disabilities will be a major public health problem that affects different aspects of their lives including the individual, social and economic consequences and even the community. The aim of the study was to evaluate the disability and related factors in the elderly aged 60 years and older in Qom.

This cross-sectional study included 166 elderly at the age above 60 years old randomly selected from Qom, Iran through a three-stage sampling. An in-depth interview and the DAS-WHO 2 questionnaire was used to assess disability in the elderly. Multiple linear regression model was used in order to examine associations between disability and independent factors.

It is estimated that 66.9% of the elderly with the disability. The prevalence of severe disability and moderate disability was 4.2% and 16.9%, respectively. The prevalence of falling was estimated 23% during the last month. There were association among disability score with gender (P=0.001, effect size=0.288), age (P=0.001, effect size=0.206), history of pain (P=0.001, effect size=0.376), history of falling (P=0.001, effect size=0.201), education (P=0.035, effect size=-0.129) and job (P=0.001, effect size=-0.366).     

Aging is avoidable, so regarding the upward trend as well as high disability prevalence related to aging, management, and controlling activities are necessary to prevent or reduce it. Increasing financial security, paying attention to women, especially those with low education, will be essential to reducing the age-old injuries.

The world''s elderly population is increasing and fall is an outcome of ageing. Visual disturbance is one of the internal risk factors of falling. The aim of this study was to compare of the visual perception as a subgroup of visual disturbance in the City of Sabzevar، Iran.

In the present case-control study، based on convenience sampling method، 89 older adults (46 faller and 43 non-faller) were enrolled. All participants were assessed as follow: dementia (Hachinski ischemia score)، fall (fear of fall questionnaire) and visual perception (Developmental test of visual perception adolescence and Adult). Data were analyzed in SPSS software version 17. 0 using Mann-Whitney U test.

A significant difference was observed between general visual perception (p<0. 001)، Motor-Reduced visual perception (p<0. 001) and Visual-Motor integration (p<0. 001) skills of faller and non-faller older adults.

Because the faller older adults had less visual perception ability than non-faller counterparts، it might be assumed that visual perception disorder is one of the causes of fall.