Comparison of static balance and mobility between nursing home residents and community-dwelling elderly.
Livia Marcondes Faber, Lara Alves Moreira, Marcos Eduardo Scheicher
Abstract
Background: Postural control is considered to be a complex motor skill derived from the interaction of multiple sensorimotor processes. Objectives: To compare the static balance and mobility of nursing home residents with community-dwelling elderly and verify which confounders imply in a worse postural balance on nursing home residents. Methods: Were included elderly aged 60 and more, both sexes, living at nursing homes (NHs) and at the community. The static balance was evaluated by a force platform and the mobility by the Timed Up and Go test (TUG). The confounders available were length of institutionalization, age, gender, body mass index, number of falls and number of medication. Comparisons were made by unpaired t-tests and by the Mann-Whitney test. The risk of falls was evaluated by Fisher’s Exact Test. Pearson or Spearman correlation analysis was performed to identify the independent variables with a significant relationship with the dependent variables. The simple linear regression analysis and R2 was analyzed to ascertain the coefficient of determination of the percentage variation. A value of p≤0.05 was considered significant. Results: 21 nursing home residents and 21 community-dwelling elderly were included. The NHs residents presented significantly higher values of COP oscillation than the community group (total displacement: p=0.0002; mean velocity: p=0.001, 95% ellipse area: p=0,04, and standard deviation in the frontal plane: p=0.01). The NHs group presented longer time to perform the TUG test than the community group (17.28±4.5 s and 13.21±3.9 s, p=0.002). Was observed that the number of medications showed a significant correlation with the TUG (r=0.52; p=0.01), and none variable showed correlation with the static balance. Conclusion: The results showed that the nursing home residents with a normal cognitive condition had greater center of gravity oscillation, worse mobility, and higher risk of falls than community elders. In addition, it was found that in nursing home residents, the ingestion of five or more drugs had relation with mobility.
Keywords
References
1. Horak FB. Postural orientation and equilibrium: What do we need to know about neural control of balance to prevent falls? Age Ageing. 2006;35:7–11.
2. Holtrop JL, Loucks TM, Sosnoff JJ, Sutton BP. Investigating Age-related changes in fine motor control across different effectors and the impact of white matter integrity. Neuroimage. 2014;96:81–7.
3. Linortner P, Jehna M, Johansen-berg H, Matthews P, Schmidt R, Fazekas F, et al. Aging associated changes in the motor control of ankle movements in the brain. Neurobiol Aging. 2014;35(10):2222–9.
4. Antes DL, Schneider IJC, d’Orsi E. Mortality caused by accidental falls among the elderly: a time series analysis. Rev Bras Geriatr e Gerontol. 2015;18(4):769–78.
5. de Souto Barreto P, Lapeyre-Mestre M, Mathieu C, Piau C, Bouget C, Cayla F, et al. A multicentric individually-tailored controlled trial of education and professional support to nursing home staff: research protocol and baseline data of the IQUARE study. J Nutr Health Aging. 2013 Feb 15;17(2):173–8.
6. Oliveira RG De, Tolocka RE. Inclusão social e pessoas que participam de bailes em uma instituição de longa permanência para idosos. Rev da Educ Física/UEM. 2009;20(1):85–96.
7. Ikezoe T, Asakawa Y, Shima H, Kishibuchi K, Ichihashi N. Daytime physical activity patterns and physical fitness in institutionalized elderly women: An exploratory study. Arch Gerontol Geriatr. 2013;57(2):221–5.
8. Vu MQ, Weintraub N, Rubenstein LZ. Falls in the nursing home: Are they preventable? J Am Med Dir Assoc. 2004;5(6):401–6.
9. Rubenstein LZ, Josephson KR, Robbins AS. Falls in the Nursing Home. Ann Intern Med. 1994;121(6):442–51.
10. Greenberg SA, Sullivan-Marx E, Chittams J, Cacchione PZ. Measuring fear of falling among high-risk, urban, community-dwelling older adults. Geriatr Nurs (Minneap). 2016;37(6):489–95.
11. Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults — United States. J Safety Res [Internet]. 2016;58:99– 103. Available from: http://dx.doi.org/10.1016/j.jsr.2016.05.001
12. Yamagata M, Ikezoe T, Kamiya M, Masaki M, Ichihashi N. Correlation between movement complexity during static standing and balance function in institutionalized older adults. Clin Interv Aging. 2017;12:499–503.
13. Visser JE, Carpenter MG, van der Kooij H, Bloem BR. The clinical utility of posturography. Clin Neurophysiol. 2008;119(11):2424–36.
14. Drozdova-Statkevičienė M, Česnaitienė VJ, Pukėnas K, Levin O, Masiulis N. Sway regularity and sway activity in older adults’ upright stance are differentially affected by dual task. Neurosci Lett. 2018;666(November 2017):153–7.
15. King GW, Abreu EL, Cheng A-L, Chertoff KK, Brotto L, Kelly PJ, et al. A multimodal assessment of balance in elderly and young adults. Oncotarget. 2016;7(12).
16. Howcroft J, Lemaire E, Kofman J, McIlroy W. Elderly fall risk prediction using static posturography. PLoS One. 2017;12(2):1–13.
17. Scheicher ME, Fonseca LCS, Bortolloto TB, de Carvalho IF. A patellar bandage improves mobility but not static balance in elderly female fallers. J Bodyw Mov Ther. 2017;1–5.
18. Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr. 2003 Sep;61(3B):777–81.
19. Duarte M, Freitas SMSF. Revision of posturography based on force plate for balance evaluation. Rev Bras Fisioter. 2010;14(3):183–92.
20. Schoene D, Wu SMS, Mikolaizak AS, Menant JC, Smith ST, Delbaere K, et al. Discriminative ability and predictive validity of the timed up and go test in identifying older people who fall: Systematic review and meta-analysis. J Am Geriatr Soc. 2013;61(2):202–8.
21. Trueblood P, Hodson-Chennault N, McCubbin A, Youngclarke D. Performance_and_Impairment_Based_Assessments_Among.1.pdf. J Geriatr Phys Ther. 2001;24(1):1–6.
22. Alexandre TS, Meira DM, Rico NC, Mizuta SK. Accuracy of Timed Up and Go Test for screening risk of falls among community-dwelling elderly. Brazilian J Phys Ther. 2012 Oct;16(5):381–8.
23. Błaszczyk JW. The use of force-plate posturography in the assessment of postural instability. Gait Posture. 2016;44:1–6.
24. Peterka RJ. Sensorimotor Integration in Human Postural Control. J Neurophysiol. 2002;88:1097–118.
25. Kubicki A. Functional assessment in older adults: Should we use timed up and go or gait speed test? Neurosci Lett. 2014 Aug;577:89–94.
26. Yümin ET, Şimşek TT, Sertel M, Öztürk A, Yümin M. The effect of functional mobility and balance on health-related quality of life (HRQoL) among elderly people living at home and those living in nursing home. Arch Gerontol Geriatr. 2011;52(3):e180–4.
27. Batista WO, Alves Junior E de D, Porto F, Pereira FD, Santana RF, Gurgel JL. Influence of the length of institutionalization on older adults’ postural balance and risk of falls: a transversal study. Rev Lat Am Enfermagem. 2014;22(4):645–53.
28. Zia A, Kamaruzzaman SB, Tan MP. Polypharmacy and falls in older people: Balancing evidence-based medicine against falls risk. Postgrad Med. 2015 May 4;127(3):330–7.
29. Nakagawa HB, Ferraresi JR, Prata MG, Scheicher ME. Postural balance and functional independence of elderly people according to gender and age: Cross-sectional study. Sao Paulo Med J. 2017;135(3):260–5.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email