-
[show abstract]
[hide abstract]
ABSTRACT: Sufficient capacity and quality of performance of complex movement patterns during daily activity, such as standing up from a bed, is a prerequisite for independent living and also may be an indicator of fall risk. Up to now, the transfer from lying-to-sit-to-stand-to-walk (LSSW) was investigated by functional testing, subjective rating or for activity classification of sub-tasks. The aim of this study was to use a single body-fixed inertial sensor to describe the complex movement of the LSSW transfer. Fifteen older patients of a geriatric rehabilitation clinic (median age 81 years) and 10 young healthy persons (median age 37 years) were instructed to stand up from bed in a continuous movement and to start walking. Data acquisition was performed using an inertial measurement unit worn on the lower back. Parameters extracted from the sensor outputs were able to correctly classify the subjects into a correct group with sensitivity and specificity between 90% and 100%. ICCs3,1 of the descriptive parameters ranged between 0.85 and 0.95 in the cohort of older patients. The different strategies adopted to transfer from lying to standing up were estimated through an Extended Kalman Filter. The results obtained in this study suggest the usability of the instrumented LSSW test in clinical settings.
IEEE transactions on neural systems and rehabilitation engineering: a publication of the IEEE Engineering in Medicine and Biology Society 12/2012; · 2.42 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Falls are not an inevitable consequence of aging. The risk and rate of falls can be reduced. Recent improvements in smartphone technology enable implementation of a wide variety of services and applications, thus making the smartphone more of a digital companion than simply a communication tool. This paper presents the results obtained by the FARSEEING project where smartphones are one example of intervention in a population-based scenario. The applications developed take advantage of the smartphone-embedded inertial sensors and require that subjects wear the smartphone by means of a waist belt. The uFall Android application has been developed for monitoring the user's motor activities at home. The application does not require any direct interaction with the user and it is also capable of running a real-time fall-detection algorithm. uTUG is a stand-alone application for instrumenting the Timed Up and Go test, which is a test often included in fall risk assessment protocols. The application acts like a pocket-sized motion laboratory, since it is capable not only of recording the trial but also of processing the data and immediately displaying the results. uTUG is designed to be self-administrable at home.
Zeitschrift für Gerontologie + Geriatrie 12/2012; 45(8):722-727. · 0.61 Impact Factor
-
C Becker,
L Schwickert,
S Mellone,
F Bagalà,
L Chiari,
J L Helbostad,
W Zijlstra,
K Aminian,
A Bourke,
C Todd,
S Bandinelli,
N Kerse,
J Klenk
[show abstract]
[hide abstract]
ABSTRACT: Falls are by far the leading cause of fractures and accidents in the home environment. The current Cochrane reviews and other systematic reviews report on more than 200 intervention studies about fall prevention. A recent meta-analysis has summarized the most important risk factors of accidental falls. However, falls and fall-related injuries remain a major challenge. One novel approach to recognize, analyze, and work better toward preventing falls could be the differentiation of the fall event into separate phases. This might aid in reconsidering ways to design preventive efforts and diagnostic approaches. From a conceptual point of view, falls can be separated into a pre-fall phase, a falling phase, an impact phase, a resting phase, and a recovery phase. Patient and external observers are often unable to give detailed comments concerning these phases. With new technological developments, it is now at least partly possible to examine the phases of falls separately and to generate new hypotheses.The article describes the practicality and the limitations of this approach using body-fixed sensor technology. The features of the different phases are outlined with selected real-world fall signals.
Zeitschrift für Gerontologie + Geriatrie 12/2012; 45(8):707-715. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although mostly negative aspects are reported to be associated with gait variability, irregular walking is needed when walking performance has to be adapted to specific environmental conditions. The aim of this study was to evaluate the test-retest reliability and discriminative ability of a measure to assess adaptive walking performance and to identify parameters associated with test performance in young and elderly subjects. Eighteen older (mean age 78.1 years) and 19 young women (mean age 30.8 years) were instructed to walk as precisely as possible over a defined course targeting 26 arbitrarily positioned rectangle boxes fixed on an instrumented walk way with embedded pressure sensors. ICC(1,1) of 0.79 demonstrated sufficient reliability in the cohort of older women. Targeting was significantly worse (or deviation was larger) in older women than in young women (mean 3.20cm versus 2.27cm, p=0.005). Mean gait speed of the older women was higher during the test (0.50m/s versus 0.40m/s, p=0.020), but not during unconstrained walking (1.15m/s versus 1.50m/s, p<0.001). The deviation measure classified 78% of the subjects into correct age group (sensitivity 67%, specificity 90%, p=0.003). Adaptive walking performance was associated with parameters describing physical performance as well as with cognitive executive function. This study shows that this test of adaptive walking performance is a reliable measure of irregular walking with ability to discriminate between young and older subjects. Our results suggest that older persons might try to camouflage their lack of accuracy during adaptive walking by higher gait speed.
Medical Engineering & Physics 11/2012; · 1.62 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In older adults, physical activity (PA) is promoted for public health preventive effort. It is also a major target in the rehabilitation process. Existing assessment tools in the clinical routine do not include any aspects of PA or participation and are often prone to floor or ceiling effects. The aim of this study was to document the process of rehabilitation by activity monitoring without floor or ceiling effects. Ninety-two stroke patients of a geriatric rehabilitation unit (mean age 82 years, ±6.21 years, 61% women) were included in an observational study to assess physical capacity (balance, chair rise, gait speed) and PA at admission and two weeks thereafter. PA was measured through an ambulatory activity monitor based on accelerometers and gyroscopes and showed no floor or ceiling effects. Floor effects were however documented for measures of physical capacity (admission 5-11%; follow-up 2-9%) and ceiling effects were registered for the balance test (admission 17.4%; follow-up 22.8%). Improvements were documented for measures of physical capacity as well as for PA (all p < 0.001). We conclude that the assessment of PA by activity monitoring is a valuable measure to document objectively the process of rehabilitation without floor or ceiling effects.
Physiological Measurement 10/2012; 33(11):1923-1930. · 1.68 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to analyze the cost-effectiveness of a multifactorial fall prevention program in nursing home residents. Given a willingness-to-pay (WTP) of 50,000 EUR per year free of femoral fracture, the probability that the intervention is cost-effective is 83 %. INTRODUCTION: Despite their increased risk of falls and fractures, nursing home residents have been neglected in economic evaluations of fall prevention programs so far. The purpose of this study was to analyze, for the first time, the cost-effectiveness of a multifactorial fall prevention program in nursing home residents. METHODS: This study is part of a prospective, unblinded, cluster, nonrandomized, controlled study focusing on the transfer of an efficacious fall prevention program into a real-world setting. The analyzed subsample was derived from claims data and consisted of data on intervention (n = 256, residents n = 10,178) and control homes (n = 893, residents n = 22,974), representing all insurants of a sickness fund (AOK Bavaria, Germany) who were 65 years or older, residing in a nursing home on the 31st of March 2007 and had a level of care of ≥1 according to the classification of the statutory long-term care insurance. Time free of femoral fracture (ICD-10, S72) was used as measure of health effects. Femoral fracture-related costs and intervention costs were measured from a payer perspective. Multivariate regression models were applied. Sensitivity analyses were performed and cost-effectiveness acceptability curves computed. RESULTS: Within the first year of the intervention, femoral fracture rate was significantly reduced, resulting in a nonsignificant incremental mean time of 1.41 days free of femoral fracture. Incremental mean total direct costs were 29 EUR per resident, which was not significant. The incremental cost-effectiveness ratio (ICER) was 7,481 EUR per year free of femoral fracture. The probability of an ICER < 50,000 EUR per year free of femoral fracture was 83 %. CONCLUSION: Depending on the amount the decision-maker is willing to pay for the incremental effect, the fall prevention program might be cost-effective within the first year. Future studies should expand the range of costs and effects measured.
Osteoporosis International 07/2012; · 4.58 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Stürze gehören zu den häufigsten unerwünschten Ereignissen älterer Menschen. In der Notaufnahme, in der ambulanten internistischen
Praxis und auf der internistischen Station sollte ein diagnostisches Konzept vorliegen und ein evidenzbasiertes Risikomanagement
zur Sturzprävention implementiert werden. Die kürzlich veröffentlichten Cochrane-Reviews und die überarbeiteten Leitlinien
der britischen und US-amerikanischen Fachgesellschaften bieten hierfür eine gute Basis. Diese Vorgaben müssen jedoch an das
eigene Umfeld angepasst werden. Gegenwärtig ist davon auszugehen, dass mindestens 30% der Stürze zu verhindern sind. Anderseits
gehört eine systematische Sturzanamnese und ein strukturiertes Assessment nicht zur Routine in den Praxen und Kliniken. Die
geplante Überarbeitung der deutschen Pflegeleitlinien bis zum Jahr 2012 und die gegenwärtigen Aktivitäten des Aktionsbündnisses
Patientensicherheit werden dazu führen, dass Einrichtungen ohne strukturiertes Risikomanagement nicht zuletzt in juristische
Rechtfertigungsprobleme kommen.
Falls are among the most frequent adverse events in the life of an older person. Accident and emergency units, outpatient
services and internal medicine wards should have a diagnostic concept for falls and fall-related injuries and implement an
evidence-based risk management for fall prevention. The recently published Reviews of the Cochrane Collaboration and the revised
guidelines of the Anglo-American medical societies are a proper basis to plan these steps. This, of course, has to be adapted
for the needs of each institution. Currently, it is probable that at least 30% of all falls are preventable. A structured
fall history and multifactorial assessment is not part of the routine of outpatient and inpatient services in Germany. The
planned revision of the German nursing guideline on fall prevention and the current activities of the Aktionsbündnis Patientensicherheit will also lead to a legal dilemma for those institutions that have not implemented an adequate workup.
SchlüsselwörterSturz–Ältere Menschen–Risikomanagement–Unerwünschte Ereignisse–Assessment
KeywordsAccidental falls–Older persons–Risk management–Adverse events–Assessment
Der Internist 04/2012; 52(8):939-945. · 0.30 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Progressive supranuclear palsy (PSP) is a neurodegenerative disease with no sufficient treatment options to date. The most
devastating symptom is the loss of balance with consecutive falls. Based on the observation that postural control improved
in patients with vestibular dysfunction after audio-biofeedback training, we tested the effects of this training in PSP patients.
Eight PSP patients were included into an uncontrolled 6-week intervention trial. The focus of the training was the improvement
of posture and dynamic balance by using audio-biofeedback. The device was well accepted. No adverse events occurred. A significant
improvement in the Berg Balance Scale was observed (T2 vs. T1, p=0.016), which remained significant at the 4-week follow-up
(T3 vs. T1, p=0.008). Significant improvement of the Parkinson’s disease questionnaire was demonstrated. No significant changes
were found in the Timed Up-and-Go Test, the Five Chair Rise Test, and in specific clinical scales. To our knowledge, the present
study is the first to demonstrate that audio-biofeedback training with PSP patients is associated with improvements of balance
and psychosocial aspects.
Progressive supranukleäre Blickparese (PSP) ist eine neurodegenerative Erkrankung, für die es zurzeit noch keine geeigneten
Behandlungsmethoden gibt. Der Verlust der Gleichgewichtsfähigkeit und die daraus resultierenden Stürze sind die Hauptsymptome.
Ausgehend von einer Studie, die eine Verbesserung der Gleichgewichtsfähigkeit nach einem Audiobiofeedback- (ABF-)Training
bei Patienten mit beidseitigem Vestibularisausfall zeigte, überprüften wir, ob dieser Effekt auch bei PSP-Patienten nachweisbar
ist. Acht PSP-Patienten wurden in eine nichtkontrollierte 6-wöchige Interventionsstudie eingeschlossen. Ziel des Trainings
war die Verbesserung der Haltung und des dynamischen Gleichgewichts mithilfe von ABF. Das Gerät wurde gut akzeptiert. Die
Berg-Balance-Skala zeigte eine Verbesserung (T2 vs. T1, p=0,016), die auch beim Follow-up nachweisbar war (T3 vs. T1, p=0,008).
Auch im Parkinson’s Disease Questionnaire ließen sich Verbesserungen finden. Der Timed Up-and-Go Test, der Five Chair Rise
Test und spezifische klinische Einschätzungen ergaben keine signifikanten Veränderungen. Unseres Wissens ist dies die erste
Studie mit PSP-Patienten, die durch ein ABF-Training Verbesserungen des Gleichgewichts und psychosozialer Aspekte zeigt.
KeywordsIntervention-Mobility-Neurodegenerative disease-Posture control-Postural stability
SchlüsselwörterIntervention-Mobilität-Neurodegenerative Erkrankung-Haltungskontrolle-Haltungsstabilität
Zeitschrift für Gerontologie + Geriatrie 04/2012; 43(4):224-228. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A National Expert Standard for Fall and Fracture Prevention ("Expertenstandard Sturzprophylaxe") was established a few years ago in Germany. The purpose of this study was to determine for the first time the implementation and costs of fall and fracture prevention measures based on this National Expert Standard in German nursing homes in a real world setting.
This before/after study is based on an un-blinded, controlled translational study focussing on the primary prevention of fall-related hip fractures in nursing homes in Bavaria. 274 nursing homes were included in this study in 2008. The intervention aimed at implementing fall and fracture prevention measures based on the National Expert Standard. A random sample of 79 nursing homes was assessed via telephone at baseline and two follow ups. Costs were determined from a societal perspective, based on a questionnaire covering use and costs of fall and fracture prevention measures. Costs were analysed using paired t-tests and non-parametric bootstrapping techniques.
The implementation of this program led to an increase in fall and fracture prevention activities and to additional mean costs of 6,248 EUR (± SD 7,340 EUR; pricing year 2008) per nursing home over 18 months. Costs varied widely between nursing homes. The majority of additional costs occurred for the implementation of strength and balance training. Depending on type and costs of staff conducting the training, total costs varied between 4,347 EUR (± SD 7,167 EUR) and 7,024 EUR (± SD 7,439 EUR).
The implementation of fall and fracture prevention measures based on the National Expert Standard led to additional costs. Cost figures can be used by decision-makers with respect to decisions on resource allocation for different prevention programs (e.g., different National Expert Standards), to determine the main cost components, and finally for model-based cost-effectiveness analyses of fall-prevention programs in nursing homes.
Zeitschrift für Gerontologie + Geriatrie 02/2012; 45(2):128-37. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Gait disorders are more common in dementia than in the context of the physiological aging process. Prevalence of dementia-associated gait disturbances depends on the type of dementia and the severity of cognitive impairment. While in vascular dementia gait abnormalities are often clinically apparent at early disease stages, Alzheimer's disease patients usually have stable gait until late disease stages. With up-to-date ''brain-imaging" methods, it has been demonstrated that people suffering from dementia are more dependent on cortical activity in order to maintain gait stability in complex situations. When dysfunction of the frontal or temporal lobes occurs, allocation of these resources may no longer be sufficient. Dual-task paradigms are useful to test such resources. It has been shown in early Alzheimer's disease patients that, if the demand of attention exceeds available capacities, quantitative gait changes occur. Relevant parameters seem to be, e.g., walking speed and stride-time variability. Quantitative assessment of gait dysfunction in dementia may, thus, have the potential to serve as a trait marker.
Zeitschrift für Gerontologie + Geriatrie 01/2012; 45(1):40-4. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: With the growing incidence of upper arm fractures among older people, innovative treatment strategies will be needed in geriatric rehabilitation. A pilot study was designed to test the feasibility of robotic-assisted rehabilitation after proximal humeral fractures.
Within a sample of 8 older patients (79.5 ± 6.12 years), functional ability, quality and range of movement, self-rated impairment, quality of life, and user satisfaction were measured in an observational pre-/postdesign. During rehabilitation robotic-assisted training was applied.
Training motivation and acceptance were high in this sample, showing improvements in functional ability (p = 0.03), quality of movement (p = 0.02), range of motion, self-evaluation (p = 0.01), and quality of life.
This pilot study highlights the possible implementation of robotic-assisted rehabilitation after proximal humeral fractures in geriatric rehabilitation. The measurement and training protocol was suitable to document progress in rehabilitation.
Zeitschrift für Gerontologie + Geriatrie 12/2011; 44(6):387-92. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Because of the growing demand of geriatric rehabilitation, objective and clear indication decisions are needed with respect to limited financial resources. The aim of an interdisciplinary consensus group was to critically evaluate the most commonly used tests of functional performance of the lower limbs and to recommend useful tests to document progress of inpatient rehabilitation. Assessment of standing, walking, walking with a dual-task, sit-to-stand transfer, lying-to-sit-to-stand transfer, and stair climbing were recommended to document functional performance of the lower limbs and to describe rehabilitation targets. Future research is needed, because reasonably validated assessment tools do not exist for all of these domains. In addition to a standardized assessment of physical capacity, physical activity and participation with regard to the International Classification of Functioning, Disability, and Health (ICF) context have to be assessed. Body fixed sensors seem to be a promising assessment tool to objectively document progress in rehabilitation.
Zeitschrift für Gerontologie + Geriatrie 12/2011; 44(6):429-36. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Distal radial fracture is the most common bony injury in man. Still there are unsatisfying treatment results, such as limited joint movement, muscle atrophy and pain, resulting from immobilisation while the fracture is healing. During this period, also joint movement seems to be "forgotten". This study experimentally examined if the method of mental practice, meaning the systematic repetition of a consciously imagined movement or action without simultaneous practical execution, can positively influence these findings.
21 right-handed males had application of a circular forearm plaster for immobilisation of their left radiocarpal joint, simulating a distal radial fracture for three weeks. Following randomisation, half of the study participants learned mental practice for "virtual movement" of their radiocarpal joint and had to perform it, the others were not treated at all. At beginning and end of the experiment, joint movement was measured, and an MRI examination of the forearm muscles was performed. The brain (cortex) areas, responsible for radiocarpal joint movement, were examined concerning their activity with functional MRI at the beginning and also at the end of the three weeks. The experiment was also performed on three "real" patients suffering from a distal radial fracture demanding plaster immobilisation, all of them were mentally treated.
Mental practice significantly ameliorated dorsal extension and ulnar abduction after plaster removal in comparison to those not having been mentally trained. Muscle atrophy of forearm muscles, measured via MRI, was significantly less in those having mental training. The cortex areas responsible for radiocarpal joint movements (supplementary motor area, precentral gyrus, putamen, nucleus caudatus, prefrontal cortex, thalamus and cerebellum) showed significant signal changes at the end of the three weeks in those having been mentally trained. There were significant correlations between MRI and functional MRI findings. The findings in the three "real" patients were similiar.
The results of this experimental study show that mental practice can have a positive influence on the outcome of distal radial fractures demanding immobilisation. A study with a larger number of "real patients" should follow.
Zeitschrift fur Orthopadie und Unfallchirurgie 06/2011; 149(3):288-95. · 0.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Potential predictors of availability and use of hip protectors were studied in residents of 48 nursing homes. The likelihood of being offered a hip protector was reduced in men, in residents with very low or very high care needs, in residents with migration background, and in recipients of welfare aid.
The purpose of this study is to analyze potential predictors of availability and use of hip protectors in residents of nursing homes.
In 48 German nursing homes, individual information on availability and use of hip protectors was collected from all institutionalized residents (3,924 residents; 78.2% women). Information on nursing home characteristics was obtained by telephone interview. The effect of individual variables and of nursing home characteristics on hip protector availability and use was estimated using multilevel logistic regression analyses.
The prevalence of hip protectors being made available was 10.0% in women and 6.2% in men. Sixty-four percent of those with a hip protector used it during the 4 weeks prior to the examination. The likelihood of being offered a hip protector was reduced in men (odds ratio (OR), 0.59; 95% confidence interval (CI), 0.43; 0.83), in residents with very low or very high care needs (OR, 0.32; 95% CI, 0.18; 0.56 and OR, 0.55; 95% CI, 0.38; 0.79, respectively), in residents with a migration background (OR, 0.30; 95% CI, 0.09; 0.99), and in recipients of welfare aid (OR, 0.60; 95% CI, 0.44; 0.81). Nursing home characteristics such as the size of the nursing home or staff participation rate in training measures had no effect on hip protector availability and use.
Predictors of hip protector availability were sex, the degree of care need, migration status, and welfare aid. The lower availability of hip protectors in residents with welfare aid and migration status may be an indicator for health inequality in the German health system.
Osteoporosis International 05/2011; 22(5):1593-8. · 4.58 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Early discharge from a rehabilitation center is only possible, if patients are able to do basic transfers independently (e.g., get up from bed and walk to the toilet). Against this background, the Lie-to-Sit-to-Stand-to-Walk Transfer (LSSWT) test was developed in order to quantify complex transfer abilities in older adults. This study was to evaluate the reliability and validity of this instrument.
A total of 24 older patients (80.25±8.10 years) of a geriatric rehabilitation unit performed the LSSWT test. Expert ratings were used to measure criterion validity. The Timed Up & Go test (TUG) was administered to assess construct validity. Furthermore, the time score of the LSSWT test was correlated with the Trunk Control Test (TCT), balance performance, the Chair Stand Test (CST) and gait speed. Intra- and interrater reliability were measured, conducting the LSSWT test on consecutive days.
The coefficients of correlation between the LSSWT test and the expert ratings as well as the TUG test were r=-0.82 and r=0.83, respectively. Furthermore, the association with the TCT, balance, CST, and gait speed were r=-0.51, r=-0.45, r=0.47, and r=-0.72, respectively. The results of intrarater reliability and interrater reliability were ICC=0.96 and ICC=0.77, respectively.
The study shows that the LSSWT test is a valid measure for quantifying difficulties in transfer abilities of patients during geriatric rehabilitation. The good correlation between LSSWT test and TUG test indicates good construct validity, but also that the LSSWT test provides additional information. Interrater reliability was moderate; therefore, the training of the supervisors should be re-evaluated. Further research is needed to establish cut-off values for discharge decision and to analyze the use of the LSSWT test in different subgroups.
Zeitschrift für Gerontologie + Geriatrie 04/2011; 44(4):262-7. · 0.61 Impact Factor
-
Journal of Aging and Physical Activity 12/2010; 18:75-86.
-
J Klenk, C Becker,
F Lieken,
S Nicolai,
W Maetzler,
W Alt,
W Zijlstra,
J M Hausdorff,
R C van Lummel,
L Chiari,
U Lindemann
[show abstract]
[hide abstract]
ABSTRACT: Most of the knowledge on falls of older persons has been obtained from oral reports that might be biased in many ways. Fall simulations are widely used to gain insight into circumstances of falls, but the results, at least concerning fall detection, are not convincing. Variation of acceleration and maximum jerk of 5 real-world backward falls of 4 older persons (mean age 68.8 years) were compared to the corresponding signals of simulated backward falls by 18 healthy students. Students were instructed to "fall to the back as if you were a frail old person" during experiment 1. In experiment 2, students were instructed not to fall, if possible, when released from a backward lean. Data acquisition was performed using a tri-axial acceleration sensor. In experiment 1, there was significantly more variation within the acceleration signals and maximum jerk was higher in the real-world falls, compared to the fall simulation. Conversely, all values of acceleration and jerk were higher for the fall simulations, compared to real-world falls in experiment 2. The present findings demonstrate differences between real-world falls and fall simulations. If fall simulations are used, their limitations should be noted and the protocol should be adapted to better match real-world falls.
Medical Engineering & Physics 11/2010; 33(3):368-73. · 1.62 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Mortality after pelvic fracture was calculated in residents of nursing homes. Compared with a matched comparison nonfracture group, excess mortality was found during the first 2 months after pelvic fracture.
Low energy pelvic fractures are mainly observed in people of advanced older age. The incidence of these fractures has increased considerably during the last decades. Information about excess mortality after pelvic fractures in older people is not available.
To calculate excess mortality, a retrospective cohort study was conducted. Data from residents institutionalized in Bavarian nursing homes between 2001 and 2006 were used. For each patient with a pelvic fracture (n=1,154), five residents without pelvic fracture (n=5,770) were matched by sex, age, date of admission to the nursing home, and level of care (measure for the need of care). Hazard regression models were applied.
An excess mortality was found during the first months after pelvic fracture. In women, the increased mortality risk was limited to the first (hazard rate ratio (HR) 1.83, 95% confidence interval (CI) 1.42-2.37) and second (HR 1.52, 95% CI 1.13-2.04) months after the injury. In men, excess mortality was more pronounced (HR 2.95, 95% CI 1.57-5.54 for the first month) and appeared to last longer than in women. The majority of deaths due to pelvic fractures in the first 2 months after injury occurred following discharge from the hospital to the nursing home.
Pelvic fractures are associated with an increased mortality. These results should encourage the development of preventive measures to reduce this excess mortality.
Osteoporosis International 11/2010; 21(11):1835-9. · 4.58 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The number of older patients with decreased capacity to independently perform a sit-to-stand transfer will increase during the next decade. It was hypothesized that an ergonomically modified bed prototype would either allow patients to stand up from the prototype independently or with reduced impact on the lower extremities. Standing up from the prototype was examined by force plate measurements in 30 patients of a geriatric rehabilitation hospital (median age 83.5 years). Nine of the patients were not able to stand up from the bed without arm rests, but were able to stand up with the help of arm rests. In those 21 patients, able to stand up even without arm rests, the use of arm rests caused a lower maximum vertical ground reaction force (p=0.03). No differences in quality concerning using or not using the armrests were documented neither for the time to stand up nor for symmetry of ground reaction force. In summary, the study shows that an ergonomically modified bed adds increased independency during the sit-to-stand transfer in selected patients. The reduction of peak vertical ground reaction force by using arm rests could be beneficial for certain patient groups.
Zeitschrift für Gerontologie + Geriatrie 08/2010; 43(4):235-8. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Progressive supranuclear palsy (PSP) is a neurodegenerative disease with no sufficient treatment options to date. The most devastating symptom is the loss of balance with consecutive falls. Based on the observation that postural control improved in patients with vestibular dysfunction after audio-biofeedback training, we tested the effects of this training in PSP patients. Eight PSP patients were included into an uncontrolled 6-week intervention trial. The focus of the training was the improvement of posture and dynamic balance by using audio-biofeedback. The device was well accepted. No adverse events occurred. A significant improvement in the Berg Balance Scale was observed (T2 vs. T1, p=0.016), which remained significant at the 4-week follow-up (T3 vs. T1, p=0.008). Significant improvement of the Parkinson's disease questionnaire was demonstrated. No significant changes were found in the Timed Up-and-Go Test, the Five Chair Rise Test, and in specific clinical scales. To our knowledge, the present study is the first to demonstrate that audio-biofeedback training with PSP patients is associated with improvements of balance and psychosocial aspects.
Zeitschrift für Gerontologie + Geriatrie 08/2010; 43(4):224-8. · 0.61 Impact Factor
