Post-fall Syndrome Research Articles

Gait Disorder among Elderly People, Psychomotor Disadaptation Syndrome: Post-Fall Syndrome, Risk Factors and Follow-Up – A Cohort Study of 70 Patients

Introduction: Falls among older people are a major health issue and the first cause of accidental death after 75 years of age. Post-fall syndrome (PFS) is commonly known and yet poorly studied. Objective: Identify risk factors for PFS and do a follow-up 1 year later. Methods: We included all patients over 70 years of age hospitalized after suffering a fall in a case-control study, and then followed them in a cohort study. PFS was retained in case of functional mobility decline (transferring, walking) occurring following a fall in the absence of an acute neurological, orthopedic or rheumatic pathology directly responsible for the decline. The data initially collected were: clinical (anamnestic, emergency and departmental/ward evolution, medical history, lifestyle, treatments, clinical examination items); and imaging if the patient had been subjected to brain imaging in the last 3 years prior to inclusion. Regarding the follow-up at 1 year, we collected from the general physician the occurrence and the characteristics of new falls, functional mobility assessment, hospitalization and death. Results: Inclusion took place from March 29, 2016 to June 7, 2016 and follow-up until June 30, 2017. We included 70 patients. A total of 29 patients exhibited a PFS (41.4 %). Risk factors for PFS included age, walking disorder prior to the fall, the use of a walking aid prior to the fall, no unaccompanied outdoor walk in the week before the fall, visual impairment making close reading impossible, stiffness in ankle dorsiflexion, grip strength and the fear of falling. Among patients with PFS, 52.9% could still perform a transfer at 1 year and 64.7% could still walk against 80.7% and 85.2%, respectively, for patients without PFS. Conclusion: The study showed the existence of body functions/structure impairments and activity limitations prior to the fall among patients exhibiting a PFS. This suggests the existence of a pre-fall syndrome, i.e., a psychomotor disadaptation syndrome existing prior to the fall. Among the 8 risk factors, fear of falling, vision impairment and muscle strength could be targeted for improvement. The diagnosis of PFS could be a marker of loss of functional mobility at 1 year.

Frequency of fear of fall among diabetic patients in Hayatabad Medical Complex Peshawar

Introduction: A fall may be defined as a loss of balance, resulting in coming to rest on the ground or on another object below knee level. Fear of all or Basophobia is a condition of concern towards falls and natural fear of unable to stand or walk. Since the identification of the post-fall syndrome, fear of fall is considered the major health issue among elderly population. Therefore, this study was conducted to measure the level of fear of fall and factors which might contribute to it. Material & Methods: It was a cross sectional study conducted to measure the level of fear of fall among the diabetic patients of Hayatabad Medical Complex Peshawar. According to the inclusion criteria, participants who had age more than 40 years and diabetic history of more than 2 years were included in the study. We measured the fear of fall with age, gender and duration of diabetes mellitus. Convenient sampling technique was used for the recruitment of the participants. Data was collected by self-repored questionnaires and was analyzed by SPSS 20.0 version. Results: A total of 306 participants, 164 (53.59%) males and 142 (46.40%) female with a mean age 56.02 ± 9.68 years (mean ± sd) were recruited. The level of fear of all was high in diabetic patients in which 222 (72.5%) participants showed high, 48 (15.7%) moderate and 36 (11.8%) low concerns. Conclusion: Fear of fall is a common problem in both male and female population having diabetes mellitus. It is one of the major concerns among patients with diabetes. It has a positive relation with age, duration of DM, and insulin intake.

Management and orientation of geriatric patients admitted to emergencies for a fall: results of the French prospective OREGoN cohort study

We included all patients aged 75 and over admitted to the emergency department of the University hospital of Angers, France, for a fall between 1st October and 1st November 2015. The consensual criteria proposed by the French national authority for health (2009) were used to define serious falls. Of the 214 older fallers admitted to the emergency department, 213 (99.5%) had at least one severity criterion for the fall. Only 40 older patients (18.7%) were referred to a geriatrician during the following 12 months. They exhibited more frequently a post-fall syndrome (p=0.007), more than 3 fall risk factors (p <0.001), and took more often an anticoagulant (p=0.032) than those who had not been referred to a geriatrician. Although almost all older fallers admitted to the emergency room had experienced a serious fall, only a minority of them received a geriatric assessment in the following year.

180-Day functional decline among older patients attending an emergency department after a fall

ObjectivesTo determine functional changes and factors affecting 180-day functional prognosis among older patients attending a hospital emergency department (ED) after a fall. Study designRetrospective analysis from a prospective cohort study (FALL-ER Registry) spanning one year that included individuals aged ≥65 years attending four Spanish EDs after a fall. We collected 9 baseline and 6 fall-related factors. Main outcome measuresBarthel Index (BI) was measured at baseline, discharge and 30, 90 and 180 days after the index fall. Absolute and relative BI changes were calculated. Absolute difference of ≥10 points between BI at baseline and at 180 days was considered a clinically significant functional decline. Results452 patients (mean age 80 ± 8 years; 70.8% women) were included. Baseline BI was 79.3 ± 23.1 points. Compared with baseline, functional status was significantly lower at the 4 follow-up time points (-8.7% at discharge; and −6.9%, −7.9% and −9.5% at 30, 90 and 180 days; p < 0.001 for all comparisons in relation to baseline; p = 0.001 for change over time). One hundred and thirty-three (29.6%) patients had a clinically significant functional decline at 180 days. Age ≥85 years (OR = 2.24, 95%CI 1.23–4.08; p = 0.008), fall-related fracture (OR = 2.45, 95%CI 1.43–4.28; p = 0.001), hospitalization (OR = 1.91; 95%CI 1.11–3.29; p = 0.019) and post-fall syndrome (OR = 1.77, 95%CI 1.13-2.77; p = 0.013) were independently associated with 180-day clinically significant functional decline. ConclusionPatients ≥65 years attending EDs after a fall experience a consistent and persistent negative impact on their functional status. Several factors may help identify patients at increased risk of functional impairment.

Traumatic and psychosocial complications of falls in the elderly in Tunisia

IntroductionLes chutes chez le sujet âgé constituent un problème de santé majeur de par les complications traumatiques et psychosociales qui peuvent entrainer une perte de l'autonomie et un état de dépendance. L'objectif de notre travail est d'étudier les circonstances et les conséquences traumatiques et psychosociales des chutes chez les sujets âgés.MéthodesNous avons mené une étude rétrospective réalisée entre septembre 2014 et janvier 2016 incluant 40 patients âgés de 65 ans et plus ayant fait au moins une chute l'année précédente recrutés parmi les patients hospitalisés ou suivis à la consultation externe du service de Médecine Interne B de l'hôpital Charles Nicolle. Les circonstances et les conséquences des chutes ont été recueillies par l'interrogatoire rétrospectif des patients et de leur entourage à distance de la chute.RésultatsL'âge moyen des patients chuteurs était de 75,7 ans avec une prédominance féminine nette (30F/10H). Des facteurs précipitants étaient retrouvés chez 38 patients. Ils étaient de type extrinsèque dans 78,9% des cas et intrinsèques dans 50% des cas. Un séjour prolongé au sol était noté dans 10% des cas. Les fractures étaient plus fréquentes chez les femmes (12F/1H) intéressant surtout les membres supérieurs (61,5%). Les conséquences psychosociales ont été plus fréquentes chez les femmes. Un syndrome post chutes a été noté chez 5 patients.ConclusionLa correction des facteurs précipitants intrinsèques et extrinsèques des chutes et l'apprentissage du relever du sol en post chutes permettra de prévenir le risque de chute ainsi que ses conséquences graves.

Beneficial falls in stroke patients: evaluation using a mixed method design

PurposeTo use a mixed method design to evaluate how clinicians judge falls in stroke patients as a beneficial event, and to identify patient-specific characteristics associated with beneficial falls.MethodsThe definition of beneficial falls was based on interviews with six experienced clinicians in stroke rehabilitation. Interview data were analyzed using the grounded theory approach, with outcomes used to develop a checklist to judge falls as beneficial. We subsequently used the checklist to identify falls sustained by patients in our rehabilitation unit as beneficial events. The characteristics of beneficial fallers were investigated in this retrospective study.ResultsAccording to experienced clinicians, beneficial falls result from patient-specific factors and level of independence. Beneficial falls are not associated with after-effects or a diagnosis of cognitive impairment, do not result in physical injury and post-fall syndrome, and do not alter the course of rehabilitation. These falls are considered to enhance patients’ self-awareness of their physical status and abilities. Among the 123 stroke patients who experienced a fall in our study group, 23 patients (18.7%) were identified as beneficial fallers according to our checklist. The majority had a left hemiplegia and perceptual impairments, and were at low risk of recurrent falls and made functional gains during rehabilitation.ConclusionsBased on our results, we created a 10-item checklist to differentiate beneficial from adverse falls. This differentiation is important to target fall prevention programs to adverse fallers in rehabilitation units.

Post-fall syndrome: Profile and outcomes

Post-fall syndrome (PFS) is a severe complication of falls in older adults. PFS is considered to be a medical emergency in geriatric patients, given the risk of a decompensatory “domino effect” and mortality. Unfortunately, there is currently no consensus on how to detect patients at risk of PFS. The primary objective of the present study was to profile patients suffering from PFS. The secondary objective was to study the prognosis of patients with PFS after their discharge from an aftercare and rehabilitation department (ARD). We prospectively surveyed patients hospitalized in the geriatric ARD at Lille University Hospital (Lille, France) after a fall. Cases (i.e. patients meeting the criteria for PFS: the simultaneous presence of a postural disorder, a gait disorder and a psychobehavioural disorder) were compared with controls (i.e. patients free of PFS). Seventy-two patients were included (females: 74%). The median [interquartile range] age was 85.5 [81; 90]. Thirty-four patients (47%) had PFS. The symptoms most frequent significantly associated with PFS were retropulsion in stance, and anxiety about movement. Cases and controls did not differ significantly with regard to other signs (little step walking, axial akinesia, oppositional hypertonia, etc.). Patients with PFS were more likely to present with vascular dementia ( P = 0.0166) and osteoporosis ( P = 0.0458), and were less likely to be taking drugs associated with falls ( P = 0.0003). Initial functional assessments (according to both the Mini Motor Test and the Timed Up-and-Go test) showed that functional abilities were more severely impaired in the patients suffering from PFS. Nevertheless, the same functional assessment on discharge did not reveal a significant difference between the two groups. Likewise, there were no intergroup differences in mortality or institutionalization on discharge from the ARD. The imperative development of a precise, consensual definition of PFS is now justified by the gravity of this syndrome and the potential for functional recovery. Continuation of this ongoing study may highlight prognostic factors associated with the status of patients with PFS 6 months after discharge from the ARD.

Effects of Mild Cognitive Impairment on the Development of Fear of Falling in Older Adults: A Prospective Cohort Study

ObjectivesThe aim of this study was to determine whether mild cognitive impairment (MCI) affects the development of fear of falling (FoF) in older adults. DesignProspective cohort study. SettingThe Obu Study for Health Promotion in the Elderly, Japan. ParticipantsA total of 1700 community-dwelling people aged 65 years or older without FoF at baseline participated. MeasurementsFoF and related variables, such as physical function, self-rated health, depression, and total number of medication doses, were investigated at baseline. Participants also underwent cognitive tests and were divided into cognitive healthy and MCI. Fifteen months after the baseline measurements, we collected information about the status of FoF and fall incidence during the 15-month follow-up. ResultsAt the 15-month follow-up survey, 452 participants (26.5%) reported the development of FoF. Logistic regression analysis showed that MCI (odds ratio [95% CI] = 1.41 [1.07–1.87]) and a fall incident (3.00 [2.23–4.07]) during follow-up independently predicted the development of FoF, after controlling for demographic factors, physical function, self-rated health, and depression. The odds ratio for the development of FoF in participants with both MCI and a fall incident compared with those without them was 7.34 (4.06–13.3), after controlling for confounding factors. ConclusionMCI predicts the new onset of FoF in older adults, especially when they have experience with falling. Aside from the risk of falling, it is suggested that individuals with MCI are an at-risk population for FoF and related negative consequences in terms of postfall syndrome.

Virtual reality exposure therapy in post-traumatic stress disorder: Developing new opportunities of rehabilitation of post-fall syndrome in elderly subjects

Virtual reality exposure therapy in post-traumatic stress disorder: Developing new opportunities of rehabilitation of post-fall syndrome in elderly subjects

Virtual Reality Exposure Therapy in posttraumatic stress disorder: A brief review to open new opportunities for post-fall syndrome in elderly subjects

BackgroundA fall can lead to psychological consequences that contribute to the emergence of a post-fall syndrome or even a Post Traumatic Stress Disorder (PTSD). This syndrome makes rehabilitation more difficult because of the need to take both the motor and psychological consequences into account. Virtual Reality Exposure Therapy (VRET) has already been presented as a useful therapeutic tool to improve motor rehabilitation or anxiety disorders. More recently, VR has also been tested with success in treating combat-related PTSD. MethodsWe conducted a rapid review of studies that have used this technique in the treatment of PTSD with a computer search strategy on MEDLINE using the Medical Subject Headings: “PTSD” AND “virtual reality”. ResultsThe results of this review suggest the potential efficacy of VRET in the treatment of PTSD for different types of trauma and it could therefore, be specifically related to falls in elderly patients. Indeed, the psychological symptoms of post-fall syndrome presented by some elderly subjects after a fall can be related to PTSD. ConclusionIt would appear worthwhile to carry out studies in virtual environments in order to evaluate the usefulness of VRET for the development of novel treatments for this syndrome in elderly subjects.

Le vieillissement traumatique

With the increase in life expectancy and dementia, the clinical question of post-traumatic stress disorder (PTSD) in the elderly is a major public health issue. PTSD is structured or restructured in old age according to several psychodynamic variants, which can be a reaction to a psychic trauma that is presented de novo; PTSD can also develop at a young age to later become chronic in old age. PTSD can thus be diagnosed very remotely, in time, from the event that was once the cause. The clinical presentation of PTSD is not constant but fluctuates over time: Following the apogee during the acute phase, the psychotraumatic symptoms decrease for a few years or even decades before increasing again at the start of old age. If traumatic or stressful life events that occur during old age can be isolated from a previously structured PTSD, the themes of the suffering experienced within the life history overlap. The symptoms of PTSD can evolve through absence, fluctuating over time to be updated in the elderly person through an organic pathology, sensory deficiency disorders, a cognitive decline or an institutionalization. Over time, the specific symptoms (reexperiencing, avoidance and hypervigilance) decrease in favor of nonspecific symptoms (asthenia, depression, use of psychoactive substances). The somatic presentation of PTSD is a fundamental aspect of the request for treatment in elderly patients: A somatic illness can lead to a PTSD de novo or cause old psychological psychotraumatic pain to reappear. With age the revivifications wane in favor of hypervigilance and avoidance strategies. The latter are at the forefront of “post-fall syndrome”, a syndrome considered as a psychotraumatic picture specific to the elderly person that develops into a normal aging process or dementia. In the face of a potentially traumatogenic situation, the integrity of the cognitive abilities is primordial to ensure a non-pathological psychological resolution. The difficulty in inhibiting traumatic memories will lead to their update. Likewise, PTSD is the locus of a decline in cognitive functions: recent or prolonged stress precedes the development of dementia in 80% of cases, playing the role of a triggering factor or facilitator. As revivifications are expressed more clinically due to neurocognitive disorders, it can be feared that the appearance or the exacerbation of a latent PTSD is the sign of the onset of dementia. Hypocampal atrophy with relative conservation of the amygdala is a biological support for dementia such as PTSD: pathological compensatory mnemic mechanisms could be at work here favoring productions that do not reflect real memories but thoughts guided by semantic knowledge. The absence of possibility of symbolizing death beyond life can fix thoughts on an ancient, unresolved confrontation where this death has already imposed itself. Far from a trivialization or a fatalistic vision of psychotraumatic disorders in elderly people, we wished to highlight research prospects, which open up the way to multidisciplinary questions notably including anthropological determinants. A dementia process can associate, at clinical level, hypo- and hypermnesic affections. It is thus fitting to assert the interest of considering dementia not only from a deficiency point of view but also according to its productive aspects. At an advanced stage of dementia it is difficult to establish a diagnosis of PTSD, all the more so as the emotional memory is affected.

National Fall Prevention Workshop: stepping up pan-Canadian coordination

About one in three Canadian seniors will experience a fall at least once each year. Such falls are the leading cause of injury-related hospitalizations among older people. Apart from causing injury, falls can result in chronic pain, reduced quality of life and, in severe cases, death. Psychological effects of a fall may cause a post-fall syndrome that includes dependence on others for daily activities, loss of autonomy, confusion, immobilization and depression. Falls and the resulting injuries often occur due to a combination of factors, including health conditions associated with aging such as vision problems, osteoporosis, dementia and symptoms of a chronic disease. They can be due to the side effects of medications, environmental hazards and risk-taking behaviours. Fall prevention initiatives and strategies are taking place in all provinces and territories and at the national level. To enhance the collaborative understanding of these initiatives, a National Fall Prevention Workshop was held at the Canadian Injury Prevention and Safety Promotion Conference in Vancouver, British Columbia, on 17 November 2011. The Workshop was co-hosted by the British Columbia Injury Research and Prevention Unit (BCIRPU) and the Public Health Agency of Canada (PHAC). Fall prevention leads from each province and territory were invited to present their most recent activities and their plans.

Evaluación de los pacientes con miedo a caídas. ¿El método empleado modifica los resultados? Una revisión sistemática

Objective To analyse if the use of different methods to assess fear of falling (FF), changes the risk factors for developing it, and the consequences arising from this. Design Systematic review. Data sources Electronic data bases, MEDLINE, EMBZ, EMBASE, CINAHL and PBMA. Key words «fear, fall and aged+65 years», «fear of falling», «post-fall syndrome», «self-efficacy, fall and aged+65 years». Period: 1966-March 2008. Selecting the studies Inclusion/exclusion criteria: original observational studies, clearly identifying the method employed to measure FF and which mention risk factors and/or the consequences arising from this fear. A total of 327 summaries were initially identified, from which 24 articles were selected. Data collection The abstracts and articles were selected by the first author. If there were doubts, the opinion of the second signatory was considered. The method for detecting FF, the risk factors and/or the consequences were collected and analysed. Results There is a large variety of FF assessment methods, which can be grouped into three types: a) they question directly if it exists; b) they question on the limitation of activity due to this fear, and c) they use scales that detect and quantify the fear. The main risk factors: changes in gait, previous falls, failing sight, health problems, female sex and lack of social support. Main consequences: balance problems, depression, increased risk of falls and less social activity. Conclusions The risk factors and consequences of FF are similar in the different studies, particularly those that employ direct questions. The study population, the objective and the time available have an effect on the choice of method for assessing FF.

Muscle and bone health as a risk factor of fall among the elderly. Kaigoyobou and prevention of falling

Kaigoyobou, prevention of long-term care use, is a comprehensive approach, including physical, nutritional, and social, to maintain independent living in the elderly. Prevention of falling is one useful method of Kaigoyobou. From literature review, post-fall syndrome should be primarily eliminated in the elderly since falling rate of the elderly with the falling history reported significantly greater falling rate than the other community dwelling elderly. The ability to avoid falling when they trip or slip during walking may be the most important physical function needed to be intervened. In order to train elderly person successfully, nutritional intervention need to be considered into fall prevention program.

Post-fall syndrome: a matter to study in patients with hip fractures admitted to orthopaedic wards

Post-fall syndrome: a matter to study in patients with hip fractures admitted to orthopaedic wards

Représentation de soi chez des sujets âgés chuteurs et non chuteurs

The fall in elderly is frequent and implies great outcomes. Inhibition and turning on oneself mark the post-fall syndrome which illustrates perturbations from fall. This study compares the self concept of old persons with fall and without fall, self concept definited like the perceptions of a subject about himself. Words production is significatively less important for fall subjects and indicates the preponderance of the structure personal Self (SP). The auto description is negative with auto depreciatory, loss of confidence, decreasing of activities, feeling of helpessness in daily life and in future.

Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women

Falls are common in elderly people. Possible consequences include serious injuries and the post-fall syndrome, with functional decline and limitation of physical activity. The present randomized controlled study sought to clarify the benefits of a combined long-term and home-based fall prevention program for elderly Japanese women. The subjects were individuals aged over 73 years, living at home in a western suburb of Tokyo, who had attended a comprehensive geriatric health check. Persons with a marked decline in the basic activities of daily living (ADL), hemiplegia, or those missing baseline data were excluded. Fifty-two subjects who expressed a wish to participate in the trial were randomized, 28 to an exercise-intervention group and 24 to a control group. Baseline data for age, handgrip force, walking speed, total serum cholesterol, serum albumin, basic ADL, visual and auditory impairments, self-rated health, and experience of falls did not differ significantly between the two groups. Beginning from June 2000, the intervention group attended a 6-month program of fall-prevention exercise classes aimed at improving leg strength, balance, and walking ability; this was supplemented by a home-based exercise program that focused on leg strength. The control group received only a pamphlet and advice on fall prevention. The average rate of attendance at exercise class was 75.3% (range, 64% to 86%). Participants showed significant improvements in tandem walk and functional reach after the intervention program, with enhanced self confidence. At the 8-month follow-up, the proportion of women with falls was 13.6% (3/22) in the intervention group and 40.9% (9/22) in the control group. At 20 months, the proportion remained unchanged, at 13.6% in the intervention group, but had increased to 54.5% (12/22) in the control group, which showed a statistically significant difference between the two groups (Fisher's exact test; P = 0.0097). The total number of falls during the 20-month follow-up period was 6 in the intervention group and 17 in the control group. We conclude that a moderate exercise intervention program plus a home-based program significantly decreases the incidence of falls in both the short and the long term, contributing to improved health and quality of life in the elderly.

Utilisations de l'Épreuve d'Anticipation en clinique du sujet âgé chuteur

The fall in elderly is a frequent event which has serious consequences. The fall can end up to post fall syndrome of which the central component is the fear of fall implicating walking inhibition. The person is depressive, without plans. The future perspective is an essential variable of post fall syndrome like if future was absolutely negative. Future builds behaviours of faller or in another direction, actions are inhibited by future. The anticipation defined like ability of person to project himself in future is studied with a projection test: anticipation test (AT). In this test the person formulates with images that she does not want become and that she wants become in another life, everything except a person. Then in a procedure of twelve stages, she specifies her desire and her refusal in two opposite existential plans: positive plan, negative plan. From a diagnostic point of view, pathology is incapacity for the person to establish psychic relations between this two plans (positive and negative). In fall syndrome, the death problematic is really present. The case study is about an old woman (88 years) hospitalised after a fall. She has a grave post fall syndrome with a great anxiety about her moving. In the first test the death is recalled with images like bones, worms, tomb in the negative existential plan. Refuse, this plan is very active in psychism. During two discussions this negative plan is elaborated. Using images from protocol, it is showing that the end of a life is not the end of life and the husband continues to live in children and grandchild like a tree which seems dying in autumn with the fall of leaves… The second test shows a relation between two opposite plans. The person has a mediating object which can hold antagonists notions in a same symbol. These results are confirmed by a decreasing of post fall syndrome.

エビデンスからみた転倒予防プログラムの効果―２．転倒にまつわる諸問題と転倒研究における今後の課題―

The second part of the review discusses some important issues associated with fall prevention and future perspectives on fall related research. Currently, many kinds of interventions are available for the treatment of patients suffering from osteoporosis, i. e. nutritional supports, medications acting on bone metabolism and exercise. However, a series of meta-analyses showed that only alendronate and risedronate have been proven to prevent non-vertebral fractures in persons with osteoporosis. Anaerobic and weight bearing exercises are known to have a positive effect on the bone mineral density of the spine. There is, however, no reliable data for fracture prevention with exercise alone. Also, the synergistic effect of a combination of these interventions has not been clearly proven. Although there is evidence that the use of hip protectors in institutional settings reduces the rate of hip fractures, this approach faces the problem of patient acceptance and compliance. Psychosocial problems related to falls such as fear of falling, post-fall syndrome and cost-effectiveness of the prevention programs are becoming increasingly important in elderly health care, but little evidence of such has been reported in the literature. In future perspectives on fall relared research, a theory-based approach for fall prevention needs to be included to explore more effective interventions. We must also consider the double-edged effects of interventions that may increase certain fall risk factors while reducing another. Especially, the relation between activities and incidence of falls is important to consider, because increased activity itself may increase the chance of falls. When applying exercise or rehabilitative approaches, the interaction between falls, activity levels, frailty, and injury must be studied much more carefully. In addition, one has to always think about what is the true aim of a program, because the aim of fall prevention goes beyond preventing falls. Although some research has so far been conducted in Europe and the U. S. A. by researchers and practitioners in various fields, the quantity and quality of fall prevention research are still lacking and the available data is therefore insufficient to suggest appropriate decision-making in clinical practice. Especially in Japan, there have been only a few RCTs to determine the effectiveness of fall prevention programs. Because there are many differences in the characteristics of our native population and health care systems vs those of Europe and the U. S. A., it is a critical issue for us to establish fall prevention programs suited to Japanese population and health care system.

Rehabilitation of serious postural insufficiency after falling in very elderly subjects

Postural insufficiency, gait disorders and fear of falling have been observed after falling in frail older patients. The aim of this study was to assess the benefit of a specific rehabilitation program in patients demonstrating ‘post fall syndrome’. The studied population consisted in 13 females aged 70 years and over who were admitted to hospital after falling. They suffered from post-fall syndrome. ‘Get-Up and Go’ and ‘Timed Get-Up and Go’ tests, and assessment of functional activities and postural abilities (AFAPA) were performed at hospital admission (T1), then at hospital discharge (T2) again. A specific rehabilitation program was performed during the hospital stay. The main goal of this rehabilitation program was to correct postural insufficiency and to improve motor patterns, which underlie independence in ADL. The results showed a significant improvement in score and time of ‘Get up and Go’ test between T1 and T2. In the same way, a great number of subjects showed better performances in several items of AFAPA between T1 and T2, and rising from the floor with support was performed by 6 out of the 13 subjects at T2 compared to 0 subject at T1. This study highlights the efficiency of specific rehabilitation programs in frail elderly people demonstrating ‘post fall syndrome’.