ABSTRACT
Introduction: Falls are a major health problem in older adults, leading to serious injuries and burdening their quality of life and functionality. Social isolation is predictive of falls, so a need for effective distance interventions is of great importance in this vulnerable population. Methods: An interdisciplinary programme for falls prevention was designed in community-dwelling older adults at falls risk, including physical exercise, nutritional education and falls prevention training. Screening measurements took place before and after the intervention for a complete assessment of the participants' physical, mental and social state. The implementation of the programme coincided with the lockdown due to the COVID-19 pandemic and this led us to a forceful transformation to a pilot digital programme. Thus, the new version of the programme had driven us to minimize face-to face contact and at the same time ensure that the participants' healthcare and social support needs were addressed. Moreover, new engagement techniques had to be used. Therefore, a digital platform was created and hosted by the FFN Greece website and 6 zoom teleconferences were organized with health professionals (orthopaedic, social worker, geriatrician, nutritionist). In addition, the participants could communicate with a psychologist and had zoom dancing lessons once a week. The digital educational material was adapted in order to provide the participants with health information regarding copying with falls incidents during the pandemic home restriction. Results: 20 people participated in the programme (95% women, mean age: 69 years). Among the most important results of the intervention were: The reduction of Fear of Falls (FES-I mean score before and after the intervention 28.1 vs 26.3, respectively);The improvement of important aspects of quality of life (SF-36 Physical Functioning mean score and SF-36 Emotional Well-being mean score before and after the intervention 81.8 vs 88.2 and 75.0 vs 90.2, respectively);The improvement of nutritional habits (Mediterranean Diet Scale mean score before and after the intervention 32.2 vs 34.2, respectively). Conclusion: This pilot programme indicates that health professionals need to be vigilant in adapting falls prevention programmes effectively, even in unpredicted situations like the recent COVID-19 pandemic. The results were encouraging, since there were no falls incidents, the physical, the emotional well-being of the participants and their falls related knowledge and skills were improved.
ABSTRACT
The COVID-19 pandemic invaded suddenly in our lives and came to change our daily way of living in such a short time. One of the measures adopted for social health protection was that of quarantine. However, pandemic and quarantine brought about various negative emotions, such as fear, anxiety, insecurity, changes in daily life and environment of the elderly, while many of them were led to social and physical isolation. All these have had a negative impact on the psychological state of these individuals and as a result many of them developed depressive symptoms or depression. Depression and relationship with Falls, Fragility Fractures and Osteoporosis Depression can be a risk factor for falls and fragility fractures. This is confirmed in various studies and meta-analyses1,2. There is a bidirectional relationship between these three concepts, depression, falls and fractures, that create a vicious circle that is self-perpetuating. Antidepressants in combination with depressionrelated factors such as fear of falls, gait and eating disorders etc., predispose to falls and these in turn, as fear increases, cause depression, triggering avoidance behaviours and social isolation but also injuries or disability from possible fractures3. Finally, depression directly affects bone metabolism through various mechanisms with a negative impact on bone density causing the onset of osteoporosis4. Investigating depression during the quarantine due to the pandemic in a sample of elderly people in Patras The survey was conducted by telephone on a sample of 55 elderly people in April 2020 in order to investigate the effect of quarantine, as a public protective health measure of the population from the SARS-Cov2 coronavirus, in relation to the existence of depression. The tools that were used during the telephone interview were: a) The GERIATRIC DEPRESSION SCALE (GDS-15 items), a decimal scale in which 1 is the lowest possible value and 10 the highest, and is used to determine health self-perception, mood self-perception and lifestyle changes due to the pandemic and b) A Likert scale to assess the compliance with state measures stay at home (1=absolute compliance and 5=no compliance). The mean GDS value in our sample was found to be 4.61 (S=±3.24) [3.72 (SD=±2.90) for men and 4.84 (SD=±3.31) for women]. This was significantly better in comparison with the corresponding study5, which was conducted in a sample of 78 elderly people, who attended the program at an Open Care Centre for the Elderly in Crete in a rural area, before the beginning of the pandemic. The corresponding value of this study was found to be 5.9 (SD=±4.1). However, the mean value of the GDS in our study was higher than the reference value of the Greek population of healthy elderly, with an average age of 79.98 years, which was 2.96 (SD=±1,66)6. Diagram 1 shows that older people with greater number of depressive symptoms are more likely to have low self-perception about their physical health, emotional well-being and vice versa. These findings are related to the pandemic. These show that seniors who believed that the onset of the pandemic has led to changes in their lifestyle are more likely to have higher GDS-15 values and vice versa. In contrast, a significant negative correlation (p<,01) was found between GDS-15 values and the stay of the elderly at home. Diagram 1. Corelations of GDS-15 with the Self perception of health and other parameters. An interesting result is the positive statistical correlation (p<0.05) between GDS-15 values and the number of people who live with the elderly of our sample. This finding seems contradictory, as the elderly who are living alone face the problem of loneliness. However, there are elderly people who live with their children because of their children's health or financial problems. Therefore, cohabitation with other people beyond the couple is not a choice, but a necessity. Conclusions: The study showed that about 1/3 of the sample (34.6%) were depressed and although the mean GDS-15 (4.61) is marginally below the moderate depres ion, it is above the average value (2.96), which was found in the healthy Greek population. Older people staying home during quarantine are more vulnerable in developing depression. This should be under concern to the health policy makers, as depression is a risk factor for other diseases, especially falls and fractures.