study of intrinsic and extrinsic risk factors in falls among the elderly

The aim of this study is to identify the intrinsic and extrinsic risk factors involved in falls in elderly focusing on the kinematic, temporal and phasic characteristics of gait using the 2-dimentional motion analysis system. One hundred elderly fallers, 100 elderly non fallers matched for age and sex and 50 apparently healthy young individuals were subjected to the following to achieve the purpose of the study: a questionnaire which was developed to identify intrinsic and extrinsic factors associated with falls, clinical evaluation of neuromuscular system, functional performance tests, visual examinations, routine laboratory investigations, radiological investigations and two dimensional gait analysis. There was a significant difference as regard the time of fall in favor of daytime [P<0.001]. Higher frequency of falls in elderly with neurological insult, impaired cognitive functions, multiorgan affection and those receiving higher number of medications [P<0.001]. All members of both elderly groups complaining from osteoarthritis [OA] knees, there was a significantly higher number of fallers in higher grades of radiological severity [P<0.001]. Also, higher incidence of knee and ankle joint synovitis in fallers [P<0.001] As regard the antigravity muscle power, there was a highly significant [P<0.001] weakness in four groups tested in fallers. There were highly significant differences [P<0.001] as regard heel rise, toe rise and timed up and go tests of functional performance, denoting the possibility of using these tests as screening for predilection of falls. As regard the visual parameters, there was a significantly higher incidence [P<0.001] of poor vision, cataractus lenses and constricted field of vision in fallers group. Examination of averaged hip, knee and ankle joints kinematics showed significant differences [P<0.001], [P<0.05] between groups, except for knee joint extension at terminal stance [P>0.05]. There was insignificant difference [P>0.05] between non fallers and fallers elderly groups except for hip joint extension at terminal stance, knee joint flexion at initial swing and ankle joint planter flexion at preswing [P<0.05]. As regard the results of general phasic and temporal gait parameters among the three groups, showed highly significant difference of all parameters [P<0.001]. From these results we can concluded that, most of the falls occur at the daytime while the elderly is moving and for those receiving higher numbers of medications. Elderly complaining from neurological, visual, musculoskeletal and multiorgan disorders are more prone to fall. Timed up and go [TUG], heel rise and toe rise tests are advisable as screening tools to predict falls in elderly. Limited hip extension at terminal stance, limited knee flexion at initial swing, limited ankle planter flexion at preswing, increased temporal parameters and decreased stride length, step length, cadence and velocity have a significant role in fall in elderly

Assessment of fatigue in rheumatoid arthritis

This study was carried out to assess the level of fatigue in patients with rheumatoid arthritis [RA] and to determine its Correlation to demographics, psychosocial and disease-related variables. Forty RA patients and 20 matched healthy controls were subjected to thorough clinical assessment, routine laboratory investigations and measurement of serum cortisol level Questionnaires included the Multidimensional Assessment of Fatigue Scale, Sleep Survey, Health Assessment Questionnaire, Social Support List-Interactions, Social Index, State Trait Anxiety Inventory, and Beck Depression Inventory. Our results showed that fatigue scores were significantly higher [P>0.001] in patients with RA than in controls. Fatigue most affected exercise and work. No significant correlations [p<0.05] were found between fatigue and demographic variables but highly significant correlations [p>0.001] were found between fatigue and both psychosocial and disease-related variables. With multiple regression analyses, the best predictors of increased fatigue were higher levels of cortisol, prolongation of morning stiffness, more depressive symptoms, and higher functional disability. Form this study, we concluded that, fatigue was a prevalent and persistent symptom in our RA patients. Effective management is needed to control clinical manifestations that were found to be strongly associated with fatigue such as disease activity, functional disability, depression, and poor sleep