[Factors predicting falls by patients with vascular hemiplegia at a physical medicine center]. / Facteurs prédictifs de la chute chez l'hémiplégique vasculaire en centre de médecine physique.

OBJECTIVES: To determine factors predicting falls by patients with vascular hemiplegia to establish a program aimed at preventing falls in this population. METHODS: A comparative prospective study performed over 19 months with 44 patients older than 16 years who had had a cerebral vascular accident (CVA, stroke) and were consequently admitted to the Centre Richelie. The exclusion criteria were represented by CVA history, evidence of another form of encephalic lesion, and subsequent admission to hospital after hemiplegia or for follow-up. Assessment consisted of taking note of the mechanism of the fall, possible lesions, and number of falls and analyzing follow-up after the return home. Also included for all patients was information on 20 variables that could be risk factors for fall. RESULTS: The patients' average age was 60.43+/-13.43 years and 20 had had at least one fall (mean 2.2), which allowed us to determine a "falling" group and a control group. Statistical analysis revealed the following factors considered to predict falls: large amount of time prior to hospitalization and lengthy hospitalization, low functional independence measure for entering and leaving, the existence of sensitivity disorders, spatial neglect, failed seated and standing equilibrium, and sedative treatment. In most cases, whatever their nature, falls occurred during transfers (68% of cases). Most often, the post-fall lesions were minor. However, in one case, a femur neck fracture necessitated osteosynthesis. One-third of the patients had a fall at home (as opposed to 5% of the control group). CONCLUSION: Our results confirm those in the literature. The predictive factors for falls in patients with hemiplegia are therefore well established and essentially correlate with the CVA. This consideration must lead to implementation of a prevention program including material-based as well as human measures.

[Home postural evaluation in the elderly: comparison between fallers and non fallers]. / Evaluation posturale à domicile chez la personne âgée: comparaison chuteurs-non chuteurs.

OBJECTIVES: To determine the main clinical and posturographic factors correlated with falls in elderly individuals and to specify the role of static posturography in this appraisal. MATERIALS AND METHODS: The study involved 38 people living in an residential center who were autonomously ambulatory and had a Mini Mental Test score> or =24. Fallers (N = 15) had fallen within 1 month, and nonfallers (N = 23) had not fallen for at least a year. Assessment consisted of a series of questions, a complete clinical appraisal, specific independently validated tests, and static posturographic analysis different parameters of the stabilogram with the eyes first open and then closed, all carried out in the center. RESULTS: From the clinical standpoint, spinal pathologic features and the scores on the Functional Reach Test were significantly different between the fallers and nonfallers. In static posturography, fallers' equilibrium was more precarious than that of nonfallers with eyes are closed: significant differences were observed in surface, X length and overall fast Fourier transform score. The comparison between results with open and closed eyes showed that the fallers had a pronounced tendency to retropulsion in the absence of visual participation: a significant difference as regards overall length, Y length, minimum Y and FFT Y (0.5-2 Hz). CONCLUSIONS: To complement a satisfactorily conducted clinical examination, static posturography allows for rapid assessment of equilibrium and posture in elderly patients who fall? Performed at the place where an individual resides, this appraisal constitutes an original and pragmatic element. As an evaluation strategy, it can reveal nonnegligible information within the framework of an appraisal of such, and thereby allows for adjustment of the rehabilitation or compensatory strategy.

[Diagnosis of malnutrition in the elderly by dual energy absorptiometry]. / Diagnostic de la dénutrition chez les personnes âgées par l'absorptiométrie biénergétique.

OBJECTIVES: Denutrition is a frequent condition in elderly persons and may have major consequences. A noninvasive investigation, whole body dual energy X-ray absorptiometry, should allow, by direct measurement of body composition, early and reliable diagnosis of denutrition. This study was conducted to elaborate a diagnostic tool using this exam and to test its validity. PATIENTS AND METHODS: A global index of denutrition was proposed combining anthropometric, biological criteria, and the Mini Nutritional Assessment scale. Two agreement analyses were made between classical diagnostic criteria of nutritional status and body fat and fat free mass assessed by anthropometry and absorptiometry. An association between nutritional status and body absorptiometric composition were studied with univariate analysis followed by a multivariate logistic regression model. This model allowed an elaboration of a nutritional absorptiometric index (NAI). RESULTS: One hundred one elderly subjects were included. Twenty-three were considered to be in a state of denutrition. Agreement was poor between anthropometric and biological diagnostic criteria of denutrition. It was good between the different masses assess by anthropometry and absorptiometry. Subjects in a state of denutrition had significantly lower body fat and lower fat free mass. The fat free mass index (fat free mass divided by the square height) and body fat were entered into a logistic model and composed the NAI, which showed good diagnostic validity in terms of specificity and sensitivity. DISCUSSION: Absorptiometry appears to be a simple reliable diagnostic tool for assessing denutrition in elderly persons in routine practice. Further studies are required and should lead to a confirmation of the interest of these absorptiometric indexes.