ABSTRACT
Objective To investigate the risk of falling and nutritional status in elderly surgical patients,and to assess the correlation between them.Methods Patients aged ≥65 in Department of General Surgery of Beijing Hospital between January and June 2015 were enrolled in this study.The Morse Fall Scale was used to evaluate the risk of falling.Anthropometrics,body composition,and Nutritional Risk Screening 2002 (NRS 2002) scores were collected to evaluate the nutritional status of the patients.The correlation between risk of falling and nutritional status was analyzed.Results A total of 383 patients were included,including 314 cases under 80 (65-79 years) and 69 cases ≥ 80.Patients ≥ 80 years showed significantly lower grip [(24.53 ± 8.09)kgvs.(30.57 ±8.48)kg,P＜0.05] and4-meter gait speed [(0.66 ±0.19)m/s vs.(0.84 ± 0.20) m/s,P ＜ 0.05],but significantly increased undemutrition [15.9％ (11/69) vs.7.0％ (22/314),P ＜ 0.05] and nutritional risk [56.5％ (39/69) vs.38.2％ (120/314),P ＜0.05].Altogether 33.9％ of the patients (130/383) were at high risk of falling,and the prevalence was significantly higher in patients ≥80 than in patients ＜ 80 [44.9％ (31/69) vs.31.5％ (99/314),P =0.036].Compared with patients not at high risk of falling,high-risk patients had lower body mass index [(22.33 ± 1.82) kg/m2 vs.(23.76 ± 3.26) kg/m2] and grip [(24.95 ± 8.56) kg vs.(30.72 ± 8.39) kg],but higher prevalence of nutritional risk [46.9％ (61/130) vs.38.7％ (98/253)] (all P＜0.05).Conclusions Eldedy surgical patients have a high risk of falling,which may be related with their nutritional status.Nursing and nutrition intervention should be emphasized in there patients to prevent falling and improve clinical outcome.
ABSTRACT
Objective To investigate the effect of once yearly zoledronic acid of 5 mg on postmenopausal women with osteoporosis of different causes. MethodsFrom October 2009 to December 2009,a total of 89 postmenopausal women with osteoporosis were enrolled and assigned into 2 groups.There were 45 cases of primary postmenopausal osteoporosis,including 27 cases of fresh fracture,in group A.They were aged from 47 to 83 years,with an average of 63.7 years.There were 44 cases of secondary postmenopausal osteoporosis,including 28 cases of fresh fracture,in group B.All patients were given a.single 30-minute intravenous injection of zoledronic acid (5 mg),supplemented by 1,25-dihydroxyvitamin D of 0.25 μg and calcium of 600 mg with VitD125 IU daily.At pre-intervention and 12 months after intervention respectively,bone mineral density (BMD) was measured by dual-X-ray absorptiometry (DXA) at the lumbar spine and hip,and a balance test(Sunlight Tetrax- Ⅱ) was performed to evaluate the risk of falling.Intervention compliance of the patients and adverse events related to zoledronic acid infusion were observed. Results All cases of fresh fracture healed well at 3-month follow-up.At 12 months,43 subjects in group A and 42 subjects in group B completed the follow-up.In group A,BMD increased by 5.8％ at the lumbar spine,by 2.9％ at the femoral neck,by 5.2％ at the Words area,by 5.3％ at the greater trochanter and by 3.9％ at the total hip while the risk of falling decreased by 26.1％; in group B,BMD increased by by 3.4％ at the lumbar spine,by 2.1％ at the femoral neck,by 3.2％ at the Words area,by 3.0％ at the greater trochanter and by 2.5％ at the total hip while the risk of falling decreased by 21.8％.The differences between pre-intervention and post-intervention were significant in both groups ( P ＜ 0.05).No intolerable adverse events occurred in both groups except that one new fracture happened in each group but responded to conservative treatment.ConclusionA once-yearly infusion of zoledronic acid of 5 mg is a convenient and effective therapy for treatment of osteoporosis in postmenopausal women.
ABSTRACT
The authors advocate a modernization of the neurologic exam with regard to the evaluation of static equilibrium through the application of some easily performed and interpreted bedside maneuvers like the Clinical Test of Sensory Integration and Balance - modified and the Functional Reach Test. The authors also believe that these and other assessments, such as that of the risk of falling for elderly patients, should be incorporated into the routine neurological examination.
Os autores advogam a modernização do exame neurológico no que diz respeito à pesquisa do equilíbrio estático, por meio da aplicação de algumas manobras de beira-de-leito fáceis de serem executadas e interpretadas, tais como o Teste Clínico de Integração Sensorial e Equilíbrio-modificado e o Teste do Alcance Funcional. Os autores também acreditam que estes e outros testes visando avaliação de risco de queda em pacientes idosos devem fazer parte do exame neurológico de rotina.
Subject(s)
Aged , Humans , Accidental Falls/prevention & control , Dizziness/diagnosis , Neurologic Examination/methods , Postural Balance/physiology , Dizziness/physiopathology , Geriatric Assessment , Neurologic Examination/standards , Risk FactorsABSTRACT
The authors propose that the neurological exam needs reevaluation with respect to the dynamic balance test (walking). Validated tests such as: preferred and maximum gait speed, dynamic gait index, five-times-sit-to-stand test, timed up & go cognitive and manual, should be part of the neurological examination routine. In the neurological exam of older patients, these same bedside tests bring the plus of evaluation the risk of occasional falling.
Os autores propõem que o exame neurológico tradicional seja reavaliado no que diz respeito ao exame do equilíbrio dinâmico (marcha). Testes validados tais como: velocidade da marcha - preferencial e máxima; índice dinâmico da marcha, teste senta-levanta cinco vezes e o tempo levanta-e-anda cognitivo e manual, deveriam fazer parte do exame neurológico de rotina. Na avaliação neurológica dos pacientes idosos, esses mesmos testes à beira do leito trazem benefício adicional ao aferir o risco de queda ocasional.
Subject(s)
Adult , Aged , Humans , Middle Aged , Young Adult , Accidental Falls/prevention & control , Dizziness/diagnosis , Gait/physiology , Neurologic Examination/methods , Postural Balance/physiology , Dizziness/physiopathology , Geriatric Assessment , Neurologic Examination/standards , Reference Values , Risk FactorsABSTRACT
<b>BACKGROUND:</b> The purpose of this study was to examine the association between habitual walking and multiple or injurious falls among community-dwelling older adults. <b>METHODS:</b> Cross-sectional analysis was conducted on the data from 708 community-dwelling older adults, aged 60-91 years (72.3 +/- 6.6 yr, 233 men and 475 women). Prevalence of falls between walkers and non-walkers was compared separately by the number of risk factors (Groups R0, R1, R2, R3 and R4+). Logistic regression analysis was used to assess the association between habitual walking and falls separately by lower (R<3) and higher (R3+) risk groups. An interaction between habitual walking and risk of falling was examined in logistic regression analysis among all participants. <b>RESULTS:</b> In Groups R0, R1 and R2, prevalence of falls was lower in walkers than non-walkers; however, in Groups R3 and R4+, prevalence of falls was higher in walkers. Logistic regression analysis showed that habitual walking was significantly associated with fewer falls (Odds ratio (OR): 0.44, 95% confidence interval (CI): 0.20-0.97) among the lower risk group, but significantly associated with greater falls (OR: 4.61, 95% CI: 1.32-16.09) among the higher risk group. The interaction between habitual walking and higher risk of falling was significant (<i>P</i> < 0.05). <b>CONCLUSION:</b> Habitual walking seems to positively affect the prevention of multiple or injurious falls but only in community-dwelling older adults who have less than three risk factors.