Jurnal Geriatri

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    Effectiveness of simple balancing

    training program in elderly

    patients with history offrequent falls

    Kuptniratsaikul V, Praditsuwan R, Assantachai P,

    Ploypetch T, Udompunturak S, Pooliam J.

    Clinical Interventions in Aging 2011:6 111117

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    Falling is one of the most common problems in the elderly

    that can cause morbidity and mortality. It may have

    negative effects on physical, psychological, and

    socioeconomic status. The incidence of falls will increase with advancing age.

    Elderly with a history of falls are at greater risk of falling

    again

    Fall prevention is an important strategy for reducingosteoporotic fractures.

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    There is evidence that exercise can prevent falls.

    A meta-analysis of the seven Frailty and Injuries:

    Cooperative Studies of Intervention Techniques (1995)

    exercise trials suggests that balance exercise may bemore effective in lowering falls risk than the other exercise

    components

    Older adults who are at risk usually refuse to participate in

    hospital-based exercise programs. Home-based exercisesmay be appropriate for such a long term condition.

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    The Aimed of Study

    To study the effectiveness of simply performed

    balancing training exercise, done at home, in

    reducing falls and improving balancing abilities in

    elderly patients who had already suffered fromfalls, and to follow up these effects for 1 year.

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    The inclusion criteria

    aged > 50 years

    outpatients who fell or a history of

    osteoporotic fracture in theprevious 12 months

    The exclusion criteria

    could not follow commands orhad a severe medicalcondition that prevented themfrom performing exercise

    This study was conducted at SirirajHospital, Thailand, from January

    2009 to May 2010.

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    After participants signed the

    informed consent, demographicdata were recorded, including

    age and sex

    underlying diseases

    fall history

    walking ability, turning,ability to go outside by

    oneself

    fear of fall history

    Participants were

    evaluated for balancingabilities using :

    Timed Up and Gotest (TUGT)

    Chair stand

    Functional reach

    Berg balancescale-short form

    (BBS-SF)

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    All of the tests were conducted sequentially at

    baseline, and after 3 months, 6 months, 9 months,

    and 12 months in the exercise program.

    A SF-36 and a fall efficacy scale (FES) wereassessed at baseline and after a 12-month period.

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    The exercises were :

    strengthening exercise closed kinetic chain quadriceps exercise

    Marching

    stepping over a bench

    standing up from a chair with arms folded tandem walk.

    1020

    repetitions/each,

    1520

    minutes/day,

    record the

    frequency of

    exercise orcompliance in their

    diaries

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    Participants who exercised < 3 days/week were

    classified as having poor compliance, while good

    compliance was defined as performing exercise at

    least 3 days/week. New falls during the study period were recorded

    prospectively in their diaries. The factors related to

    falls were also analyzed.

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    Discussion

    This study showed that simply-designed balancing

    exercises used by the elderly who have a history of

    frequent falls can decrease fall rate, and significantly

    increase balancing abilities including TUGT, chair

    stand, and Berg balance scores.

    The improved outcomes may be due to the

    encouragement of the elderly to be aware of falls and

    to perform regular exercise at home. The number of falls was significantly reduced after

    intervention

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    Discussion

    The type of exercise that the elderly could accept

    and comply well with was still questionable. They

    designed a simple balancing exercise that was

    easily done at home, with less adverse events, andwhich was appropriate for the elderly.

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    Discussion

    There are many factors relating to falls including age,

    muscle power, impaired balance, use of psychoactive

    drugs, poor vision and degenerative joint disease.

    Strategies to prevent falls, including reviewing

    medications, correction of environment, improvement of

    strength, and regular balance training

    This study revealed that one of the factors

    affecting fall rate was a history of previous falls.

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    Discussion

    Compliance is another factor affecting fall rate. This study couldnot demonstrate that compliance had any effect on balancing

    abilities may be because:

    the number of subjects in each group was insufficient to

    demonstrate significant changes in each groups balancingabilities

    most of participants were young-old (60.3% were < 70 years),their balance would be better

    difficulty experienced by elderly patients in recording thefrequency of exercise

    these balancing abilities may not be sensitive enough torepresent true balance

    the final classification group of compliance with exercise may belimitation because to be classified in the good compliance group,subjects had to perform well at every visit

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    Discussion

    This simply-designed exercise also affects QoL in both

    physical and mental health dimensions.

    Encouraging the elderly to exercise regularly is an

    effective way to prevent falls, and should beemphasized in medical practices

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    Limitation

    No control group, compared pre- and post-intervention inthe frequent faller group. Didnt recruit non-fallers becausetheir objective was to study the efficacy of simple balance

    exercise in frequent fallers.

    The number of participants who could be completelyfollowed up was only 104 from 146 (71.2%). The 28

    subjects who were lost to follow up were older. This may bedue to the need to make multiple visits to the clinic during

    the study period.

    The record of compliance of exercise in elderly patients israther difficult to validate

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    Conclusion

    A simply-designed balancing exercise program,

    performed at least 3 days per week, can increase

    balancing abilities, and decrease fall rates in the

    elderly with previous falls.

    Strategies to encourage elderly compliance may

    prevent falling.

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