Mittwoch, 17. Oktober 2012
Vibrationstraining / Fitvibe: Sarcopenia and whole body vibration training: an o...
Vibrationstraining / Fitvibe: Sarcopenia and whole body vibration training: an o...: Abstract The loss of muscle mass, muscle strength and muscle endurance-capability in the elderly is summarized under the term 'sarcopen...
Samstag, 6. Oktober 2012
Fall-Risk Evaluation and Management
Fall-Risk Evaluation and Management: Challenges in Adopting Geriatric Care Practices
Autoren:Abstract
One third of older adults fall each year,
placing them at risk for serious injury, functional decline, and health
care utilization.
Despite the availability of effective preventive
approaches, policy and clinical efforts at preventing falls among older
adults
have been limited. In this article we present the
burden of falls, review evidence concerning the effectiveness of
fall-prevention
services, describe barriers for clinicians and for
payers in promoting these services, and suggest strategies to encourage
greater use of these services.
The challenges are
substantial, but strategies for incremental change are available while
more
broad-based changes in health care financing and
clinical practice evolve to better manage the multiple chronic health
conditions,
including falls, experienced by older Americans.
Key words
Quelle: http://gerontologist.oxfordjournals.org/content/46/6/717.short
pdf / online im internet / Zugriff vom 06.10.2012 -
Fall-Risk Evaluation and Management: Challenges in Adopting Geriatric Care Practices
http://www.mnfallsprevention.net/downloads/the_forum.pdf
Preventing Falls in Elderly Persons
N Engl J Med 2003; 348:42-49January 2, 2003A 79-year-old woman with a history of congestive heart failure, arthritis, depression and difficulty sleeping presents for a follow-up visit. She takes several prescription medications, including an antidepressant, a diuretic, an angiotensin-converting–enzyme inhibitor, and a beta-blocker, as well as over-the-counter sleep and allergy medications. Her chronic conditions appear to be stable. Her daughter reports that the patient has fallen twice during the past six months. What can be done to prevent future falls?
Quelle: http://www.nejm.org/doi/full/10.1056/NEJMcp020719
pdf / online im internet / Zugriff vom 06.10.2012 -
http://www.chcr.brown.edu/PDFS/TINETTI_FALL_PREVENTION_NEJM_2003.PDF
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A randomized controlled trial of fall prevention
by a high-intensity functional exercise program for older people living in residential care facilities
- Autoren: Rosendahl, E.; Gustafson, Y.; Nordin, E.; Lundin-Olsson, L.; Nyberg, L.
- Journal: Aging, Clinical and Experimental Research 2008 Vol. 20 No. 1 pp. 67-75
Abstract
BACKGROUND AND AIMS:Falls are particularly common among older people living in residential care facilities. The aim of this randomized controlled trial was to evaluate the effectiveness of a high-intensity functional exercise program in reducing falls in residential care facilities.
METHODS:
Participants consisted of 191 older people, 139 women and 52 men, who were dependent in activities of daily living. Their mean±SD score on the Mini-Mental State Examination was 17.8±5.1 (range, 10-30). Participants were randomized to a high-intensity functional exercise program or a control activity, consisting of 29 sessions over 3 months. The fall rate and proportion of participants sustaining a fall were the outcome measures, subsequently analysed using negative binominal analysis and logistic regression analysis, respectively.
RESULTS:
During the 6-month follow-up period when all participants were compared, no statistically significant difference between groups was found for fall rate (exercise group, 3.6 falls per person years, PY; control group, 4.6 falls per PY; incidence rate ratio, 0.82; 95% CI, 0.49-1.39; P=0.46) or the proportion of participants sustaining a fall (exercise, 53%; control, 51%; odds ratio, 0.95; 95% CI, 0.52-1.74; P=0.86).
A subgroup interaction analysis revealed that, among participants who improved their balance during the intervention period, the exercise group had a lower fall rate than the control group (exercise, 2.7 falls per PY; control, 5.9 falls per PY; incidence rate ratio, 0.44; 95% CI, 0.21-0.91; P=0.03).
CONCLUSIONS:
In older people living in residential care facilities, a high-intensity functional exercise program may prevent falls among those who improve their balance.
Quelle: http://www.cabdirect.org/abstracts/20083130691.html;jsessionid=8337FB0DAB8B5708819DF486DB59EF51
A randomized controlled trial of fall prevention by a high-intensity functional exercise program for older people living in residential care facilities. / Full Text / pdf / online im internet / Zugriff vom 06.10.2012:
http://pure.ltu.se/portal/files/2228781/Article.pdf
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Progressive resistance strength training for improving physical function in older adults
Review von LIU und LATHAM. / Quelle: s.u.
Muscle
weakness in old age is associated with physical function decline.
Progressive resistance strength training (PRT) exercises are designed to
increase strength.
To assess the effects of PRT on older people and identify adverse events.
We
searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized
Register (to March 2007), the Cochrane Central Register of Controlled
Trials (The Cochrane Library 2007, Issue 2),
MEDLINE (1966 to May 01, 2008), EMBASE (1980 to February 06 2007),
CINAHL (1982 to July 01 2007) and two other electronic databases. We
also searched reference lists of articles, reviewed conference abstracts
and contacted authors.
Randomised controlled trials reporting physical outcomes of PRT for older people were included.
Two review authors independently selected trials, assessed trial quality and extracted data. Data were pooled where appropriate.
One
hundred and twenty one trials with 6700 participants were included. In
most trials, PRT was performed two to three times per week and at a high
intensity. PRT resulted in a small but significant improvement in
physical ability (33 trials, 2172 participants; SMD 0.14, 95% CI 0.05 to
0.22). Functional limitation measures also showed improvements: e.g.
there was a modest improvement in gait speed (24 trials, 1179
participants, MD 0.08 m/s, 95% CI 0.04 to 0.12); and a moderate to large
effect for getting out of a chair (11 trials, 384 participants, SMD
-0.94, 95% CI -1.49 to -0.38). PRT had a large positive effect on muscle
strength (73 trials, 3059 participants, SMD 0.84, 95% CI 0.67 to 1.00).
Participants with osteoarthritis reported a reduction in pain following PRT(6 trials, 503 participants, SMD -0.30, 95% CI -0.48 to -0.13). There was no evidence from 10 other trials (587 participants) that PRT had an effect on bodily pain.
Adverse events were poorly recorded but adverse events related to musculoskeletal complaints, such as joint pain and muscle soreness, were reported in many of the studies that prospectively defined and monitored these events. Serious adverse events were rare, and no serious events were reported to be directly related to the exercise programme.
This
review provides evidence that PRT is an effective intervention for
improving physical functioning in older people, including improving
strength and the performance of some simple and complex activities.
However, some caution is needed with transferring these exercises for
use with clinical populations because adverse events are not adequately
reported.
Older
people generally lose muscle strength as they age. This reduction in
muscle strength and associated weakness means that older people are more
likely to have problems carrying out their daily activities and to
fall.
Progressive resistance training (PRT) is a type of exercise where participants exercise their muscles against some type of resistance that is progressively increased as their strength improves. The exercise is usually conducted two to three times a week at moderate to high intensity by using exercise machines, free weights, or elastic bands.This review sets out to examine if PRT can help to improve physical function and muscle strength in older people.
Evidence from 121 randomised controlled trials (6,700 participants) shows that older people who exercise their muscles against a force or resistance become stronger. They also improve their performance of simple activities such as walking, climbing steps, or standing up from a chair more quickly. The improvement in activities such as getting out of a chair or stair climbing is generally greater than walking speed.
Moreover, these strength training exercises also improved older people's physical abilities, including more complex daily activities such as bathing or preparing a meal. PRT also reduced pain in people with osteoarthritis. There was insufficient evidence to comment on the risks of PRT or long term effects.
Quelle: The Cochrane Library / http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002759.pub2/abstract
Reprint / pdf / online im internet - Zugriff vom 06.10.2012:
http://www.cfah.org/hbns/archives/viewSupportDoc.cfm?supportingDocID=806
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Abstract
Background
Objectives
Search methods
Selection criteria
Data collection and analysis
Main results
Participants with osteoarthritis reported a reduction in pain following PRT(6 trials, 503 participants, SMD -0.30, 95% CI -0.48 to -0.13). There was no evidence from 10 other trials (587 participants) that PRT had an effect on bodily pain.
Adverse events were poorly recorded but adverse events related to musculoskeletal complaints, such as joint pain and muscle soreness, were reported in many of the studies that prospectively defined and monitored these events. Serious adverse events were rare, and no serious events were reported to be directly related to the exercise programme.
Authors' conclusions
Plain language summary
Progressive resistance strength training for improving physical function in older adults
Progressive resistance training (PRT) is a type of exercise where participants exercise their muscles against some type of resistance that is progressively increased as their strength improves. The exercise is usually conducted two to three times a week at moderate to high intensity by using exercise machines, free weights, or elastic bands.This review sets out to examine if PRT can help to improve physical function and muscle strength in older people.
Evidence from 121 randomised controlled trials (6,700 participants) shows that older people who exercise their muscles against a force or resistance become stronger. They also improve their performance of simple activities such as walking, climbing steps, or standing up from a chair more quickly. The improvement in activities such as getting out of a chair or stair climbing is generally greater than walking speed.
Moreover, these strength training exercises also improved older people's physical abilities, including more complex daily activities such as bathing or preparing a meal. PRT also reduced pain in people with osteoarthritis. There was insufficient evidence to comment on the risks of PRT or long term effects.
Quelle: The Cochrane Library / http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002759.pub2/abstract
Reprint / pdf / online im internet - Zugriff vom 06.10.2012:
http://www.cfah.org/hbns/archives/viewSupportDoc.cfm?supportingDocID=806
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Falls among older adults--Risk factors and prevention strategies.
Stevens, Judy A. /
Journal of Safety Research, Vol 36(4), 2005, 409-411.ABSTRACT
Among people age 65 and older, falls are the leading cause of injury deaths. Fall risk factors are often categorized as personal or environmental.
Personal factors include characteristics of the individual (such as age, functional abilities, and chronic conditions) while environmental risk factors usually refer to fall hazards in and around the home (such as tripping hazards, unstable furniture, and poor lighting). After clinical assessment with risk factor reduction, the most effective single intervention was exercise.
Many seniors use psychoactive medications, specifically benzodiazepines, antidepressants, and sedatives/hypnotics, which increase the risk of falling.
Decreasing the use of multiple medications and specific types such as tranquilizers, sleeping pills, and anti-anxiety drugs, reduces the likelihood of falling. Home assessment and modification may be effective in reducing falls when done by trained professionals such as occupation therapists and when focused on high risk seniors.
Multi-component interventions may include risk factor screening; tailored exercise or physical therapy to improve gait, balance and strength; medication management; and other elements such as education about fall risk factors, referrals to health care providers for treatment of chronic conditions that may contribute to fall risk, and having vision assessed and corrected. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
QUELLE: http://psycnet.apa.org/psycinfo/2005-14635-012
Full Text / pdf / online im internet / Zugriff vom 06.10.2012:
http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Review-Paper_Final.pdf#page=9
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Community-based exercise program
CMAJ. 2002 October 29; 167(9): 997–1004.
Quelle und Full Text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC134175/
Full Text / pdf: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC134175/pdf/20021029s00016p997.pdf
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PMCID: PMC134175
Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial - Carter et al
Abstract
Background
Exercise
programs improve balance, strength and agility in elderly people and
thus may prevent falls. However, specific exercise programs that might
be widely used in the community and that might be “prescribed” by
physicians, especially for patients with osteoporosis, have not been
evaluated. We conducted a randomized controlled trial of such a program
designed specifically for women with osteoporosis.
Methods
We
identified women 65 to 75 years of age in whom osteoporosis had been
diagnosed by dual-energy X-ray absorptiometry in our hospital between
1996 and 2000 and who were not engaged in regular weekly programs of
moderate or hard exercise. Women who agreed to participate were randomly
assigned to participate in a twice-weekly exercise class or to not
participate in the class. We measured baseline data and, 20 weeks later,
changes in static balance (by dynamic posturography), dynamic balance
(by a timed figure-eight run) and knee extension strength (by
dynamometry).
Results
Of
93 women who began the trial, 80 completed it. Before adjustment for
covariates, the intervention group tended to have greater, although
nonsignificant, improvements in static balance (mean difference 4.8%,
95% confidence interval [CI] –1.3% to 11.0%), dynamic balance (mean
difference 3.3%, 95% CI –1.7% to 8.4%) and knee extension strength (mean
difference 7.8%, 95% CI –5.4% to 21.0%). Mean crude changes in the
static balance score were –0.85 (95% CI –2.91 to 1.21) for the control
group and 1.40 (95% CI –0.66 to 3.46) for the intervention group. Mean
crude changes in figure-eight velocity (dynamic balance) were 0.08 (95%
CI 0.02 to 0.14) m/s for the control group and 0.14 (95% CI 0.08 to
0.20) m/s for the intervention group. For knee extension strength, mean
changes were –0.58 (95% CI –3.02 to 1.81) kg/m for the control group and
1.03 (95% CI –1.31 to 3.34) kg/m for the intervention group. After
adjustment for age, physical activity and years of estrogen use, the
improvement in dynamic balance was 4.9% greater for the intervention
group than for the control group (p = 0.044). After adjustment
for physical activity, cognitive status and number of fractures ever,
the improvement in knee extension strength was 12.8% greater for the
intervention group than for the control group (p = 0.047). The
intervention group also had a 6.3% greater improvement in static balance
after adjustment for rheumatoid arthritis and osteoarthritis, but this
difference was not significant (p = 0.06).
Interpretation
Relative
to controls, participants in the exercise program experienced
improvements in dynamic balance and strength, both important
determinants of risk for falls, particularly in older women with
osteoporosis.
In
people with osteoporosis, exercise may reduce the risk of fracture by
its effect on maintenance of bone mass and, probably more important, by
improving postural stability and thus decreasing rates of falling.1
Numerous studies have examined the effect of exercise on bone mineral
density in women with normal bone mass. Meta-analyses have revealed that
either aerobic or resistance training can confer a 1% to 2% advantage
relative to control participants, largely by slowing the loss of bone
mineral.2,3,4,5,6 Few exercise interventions have been undertaken in women with osteoporosis,7
but even the limited data available make it clear that antiresorptive
therapy augments bone mineral more effectively than does exercise alone.8,9
There
is, however, increasing evidence that specific exercise interventions
can reduce risk factors for falls and actual falls in older people.10,11,12
Further investigation in women with osteoporosis is therefore
warranted, as these subjects are at particular risk of fracture if they
fall. The response to exercise programs could very well be similar for
women with osteoporosis and those with normal bone health, but this
assumption needs to be tested. There may be disease-related,
physiological, or biomechanical and posture-related differences between
women with osteoporosis and the women in whom exercise and risk factors
for falls have been studied previously.
In a randomized
controlled trial of 10 weeks of physiotherapy in 53 women with vertebral
osteoporosis and back pain, Malmros and colleagues13
showed that static balance (measured by computerized posturography)
improved significantly in the treatment group. In another randomized
clinical trial, physiotherapy-directed exercise in 30 patients with
osteoporosis (not defined) significantly improved static balance
measured by functional reach and quadriceps strength determined with an
isokinetic dynamometer.14
Although both studies showed that exercise programs could improve known
risk factor profiles for falls, they were limited by the small number
of subjects and their short duration (maximum 12 weeks). Neither study
measured both static and dynamic balance, both of which are predictors
of falls.10,11,12,13,15
Lastly, both studies employed hospital-based physiotherapists as
instructors and thus could not be widely used for patients living in the
community.
A large number of tools are available to measure risk factors for falls, such as static and dynamic balance and strength.10
A sophisticated tool for measuring static balance, the Equitest
computerized posturography platform (Neurocom International, Clackamas,
Ore.), is considered by many the gold standard for measuring sway.16
It is reliable and is designed to distinguish the contributions of the
visual, proprioceptive and vestibular systems in maintaining balance,17
but the device measures sway only in the anteroposterior plane, even
though most falls occur to the side. In contrast, a measure of dynamic
balance, the figure-eight run,18 which has previously been used in older people19,20
is simple to perform and does not require special equipment or
training. Quadriceps strength is another independent predictor of both
falls21 and fracture risk,10,22 and it can be measured reliably, simply and cheaply with a strain gauge dynamometer.21
The
Osteoporosis Program at the BC Women's Hospital and Health Centre
developed Osteofit, a community-centre-based exercise program suitable
for people with osteoporosis.23
The program aims to improve participants' static and dynamic balance,
strengthen key muscle groups and ameliorate quality of life. Since its
inception in 1998, over 500 women have participated in the program in
over 50 community centres. Similar programs exist in the United States,
Australia and Europe, but to our knowledge there have been no reports of
the efficacy of any readily accessible community-based exercise
programs on risk factors for falls in women with osteoporosis.
We
tested the primary hypothesis that a 20-week Osteofit exercise program,
provided in a community centre setting with classes of 12 participants
per certified instructor, would improve measures of balance and knee
extension strength in community-dwelling women aged 65 to 75 years in
whom osteoporosis had been diagnosed by dual-energy X-ray
absorptiometry. Our secondary hypothesis was that the intervention would
also improve quality of life24,25 as measured by an osteoporosis-specific quality-of-life index.26 A planned interim report of the trends observed after 10 weeks of intervention has been published elsewhere.27
Quelle und Full Text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC134175/
Full Text / pdf: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC134175/pdf/20021029s00016p997.pdf
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Sturzprävention
Cochrane Review von Gillespie et al / Sept. 2012:
.........Doch nicht alle Bemühungen um ein verringertes Sturzrisiko hatten tatsächlich auch den erwünschten Erfolg.
Manchmal wurde durch die Maßnahmen sogar das Gegenteil erreicht, etwa wenn eine Brille für mehr Klarsicht sorgen sollte, sich der alte Mensch aber erst einmal an die neuen Perspektiven gewöhnen musste.
Auch eine Medikamenten-Neueinstellung oder -Umstellung konnte die Sturzrate infolge einer Schwindelsymptomatik vorübergehend erhöhen.
Nicht bestätigen ließ sich die Hoffnung auf eine geringere Sturzrate durch Vitamin-D-Supplementation, zumindest bei ausreichend versorgten Personen.
Auch die alleinige Aufklärung über Maßnahmen zur Sturzprävention oder eine kognitive Verhaltenstherapie hatten keinen Effekt.
Obwohl die derzeitige Studienlage den positiven Effekt einer ganzen Reihe von Maßnahmen zur Prävention von Stürzen bei älteren Menschen bestätigt und sich sogar langfristig ein Kosten/Nutzen-Vorteil für entsprechende Interventionen abzuzeichnen scheint, bleibt offen, ob dies auch bei Demenzerkrankungen gilt.
Diese Frage konnte nicht geklärt werden, da Patienten mit Demenz aus den meisten Studien ausgeschlossen worden waren.
Grundlage des Cochrane-Review waren 159 randomisierte Studien mit 79.193 Teilnehmern. In den Studien waren meist Probanden aus Sturzpräventionsprogrammen mit solchen verglichen worden, denen keine derartigen Maßnahmen zuteil wurden.
Quelle und vollstdändiger Text: http://www.aerztezeitung.de/medizin/krankheiten/skelett_und_weichteilkrankheiten/article/822523/senioren-lassen-stuerze-vermeiden.html?sh=1&h=-1550180877
Cochrane-Review / Direktlink: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007146.pub3/abstract
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.........Doch nicht alle Bemühungen um ein verringertes Sturzrisiko hatten tatsächlich auch den erwünschten Erfolg.
Manchmal wurde durch die Maßnahmen sogar das Gegenteil erreicht, etwa wenn eine Brille für mehr Klarsicht sorgen sollte, sich der alte Mensch aber erst einmal an die neuen Perspektiven gewöhnen musste.
Auch eine Medikamenten-Neueinstellung oder -Umstellung konnte die Sturzrate infolge einer Schwindelsymptomatik vorübergehend erhöhen.
Nicht bestätigen ließ sich die Hoffnung auf eine geringere Sturzrate durch Vitamin-D-Supplementation, zumindest bei ausreichend versorgten Personen.
Auch die alleinige Aufklärung über Maßnahmen zur Sturzprävention oder eine kognitive Verhaltenstherapie hatten keinen Effekt.
Obwohl die derzeitige Studienlage den positiven Effekt einer ganzen Reihe von Maßnahmen zur Prävention von Stürzen bei älteren Menschen bestätigt und sich sogar langfristig ein Kosten/Nutzen-Vorteil für entsprechende Interventionen abzuzeichnen scheint, bleibt offen, ob dies auch bei Demenzerkrankungen gilt.
Diese Frage konnte nicht geklärt werden, da Patienten mit Demenz aus den meisten Studien ausgeschlossen worden waren.
Grundlage des Cochrane-Review waren 159 randomisierte Studien mit 79.193 Teilnehmern. In den Studien waren meist Probanden aus Sturzpräventionsprogrammen mit solchen verglichen worden, denen keine derartigen Maßnahmen zuteil wurden.
Quelle und vollstdändiger Text: http://www.aerztezeitung.de/medizin/krankheiten/skelett_und_weichteilkrankheiten/article/822523/senioren-lassen-stuerze-vermeiden.html?sh=1&h=-1550180877
Cochrane-Review / Direktlink: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007146.pub3/abstract
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