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      Análise de fatores extrínsecos e intrínsecos que predispõem a quedas em idosos Translated title: Analysis of extrinsic and intrinsic factors that predispose elderly individuals to fall

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          Abstract

          OBJETIVO: Analisar, em uma amostra de idosos de Porto Alegre, RS, os fatores intrínsecos e extrínsecos que predispõem ao risco de queda e fraturas. MÉTODOS: O estudo contou com uma amostra aleatória de 267 idosos, aos quais foram aplicados dois testes de equilíbrio: o Teste do Alcance Funcional (TAF) e o Timed Up and Go Test (TUG). Os idosos também responderam a um questionário (13 questões divididas em quatro categorias) sobre fatores sociodemográficos e sobre a saúde. RESULTADOS: Participaram idosos de ambos os sexos (76,8% mulheres) com idades entre 60 e 90 anos (média = 70,22 anos; DP = ± 7,30 anos). Foram encontradas relações estatisticamente significativas (p < 0,05) entre faixa etária, autopercepção de visão, tipo de moradia, última renda mensal e o TAF e entre faixa etária, autopercepção de saúde (p < 0,001) e o TUG. CONCLUSÃO: Foi identificado que, na amostra de idosos residentes em Porto Alegre/RS, os fatores intrínsecos que predispõem ao risco de quedas e fraturas são: faixa etária mais elevada; autopercepção ruim da visão e autopercepção ruim da saúde; já os fatores extrínsecos são o tipo de moradia (residir em casa) e a renda mensal igual ou inferior a um salário-mínimo.

          Translated abstract

          OBJECTIVE: In a sample of elderly individuals from Porto Alegre - RS, Brazil, to analyze the intrinsic and extrinsic factors that predispose them to the risk of falls and fractures. METHODS: The study included a random sample of 267 elderly individuals, to whom two balance tests were applied: the Functional Reach Test (FRT) and the Timed Up and Go Test (TUG). The elderly also answered a questionnaire (13 questions divided into four categories) on sociodemographic and health factors. RESULTS: Elderly individuals from both genders (76.8% women), aged between 60 and 90 years (mean = 70.22 years, SD = ± 7.30 years) participated in the study. A statistically significant association (p < 0.05) was found between age, self-perception of eyesight, type of dwelling, last monthly income, and the FRT; the same was found between age range, self-rated health (p < 0.001) and the TUG. CONCLUSION: It was identified that, in the sample of elderly individuals living in Porto Alegre - RS, Brazil, the intrinsic factors that predispose to the risk of falls and fractures are older age, poor self-perception of eyesight, and poor selfrated health; the extrinsic factors are type of dwelling (living in a house) and a monthly income < one minimum wage.

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          Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?

          Postural control is no longer considered simply a summation of static reflexes but, rather, a complex skill based on the interaction of dynamic sensorimotor processes. The two main functional goals of postural behaviour are postural orientation and postural equilibrium. Postural orientation involves the active alignment of the trunk and head with respect to gravity, support surfaces, the visual surround and internal references. Sensory information from somatosensory, vestibular and visual systems is integrated, and the relative weights placed on each of these inputs are dependent on the goals of the movement task and the environmental context. Postural equilibrium involves the coordination of movement strategies to stabilise the centre of body mass during both self-initiated and externally triggered disturbances of stability. The specific response strategy selected depends not only on the characteristics of the external postural displacement but also on the individual's expectations, goals and prior experience. Anticipatory postural adjustments, prior to voluntary limb movement, serve to maintain postural stability by compensating for destabilising forces associated with moving a limb. The amount of cognitive processing required for postural control depends both on the complexity of the postural task and on the capability of the subject's postural control system. The control of posture involves many different underlying physiological systems that can be affected by pathology or sub-clinical constraints. Damage to any of the underlying systems will result in different, context-specific instabilities. The effective rehabilitation of balance to improve mobility and to prevent falls requires a better understanding of the multiple mechanisms underlying postural control.
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            Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials.

            To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group. Systematic review and meta-analyses. Medline, HealthSTAR, Embase, the Cochrane Library, other health related databases, and the reference lists from review articles and systematic reviews. Components of falls intervention: multifactorial falls risk assessment with management programme, exercise, environmental modifications, or education. 40 trials were identified. A random effects analysis combining trials with risk ratio data showed a reduction in the risk of falling (risk ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining trials with incidence rate data showed a reduction in the monthly rate of falling (incidence rate ratio 0.80, 0.72 to 0.88). The effect of individual components was assessed by meta-regression. A multifactorial falls risk assessment and management programme was the most effective component on risk of falling (0.82, 0.72 to 0.94, number needed to treat 11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in treatment group per 100 patients per month). Exercise interventions also had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99, number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01; 2.7). Interventions to prevent falls in older adults are effective in reducing both the risk of falling and the monthly rate of falling. The most effective intervention was a multifactorial falls risk assessment and management programme. Exercise programmes were also effective in reducing the risk of falling.
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              Functional reach: a new clinical measure of balance.

              A new clinically accessible measure of balance, functional reach (FR), is the difference between arm's length and maximal forward reach, using a fixed base of support. The purposes of this study were to (a) establish FR as a measure of the margin of stability versus the laboratory measure, center of pressure excursion (COPE); (b) test reliability and precision, and (c) determine factors that influence FR, including age and anthropometrics. We evaluated FR in 128 volunteers (age 21-87 years). FR was determined with a precise electronic device and a simple clinical apparatus (yardstick). FR correlates with COPE (Pearson r = .71) and is precise (coefficient of variation = 2.5%) and stable (intraclass correlation coefficient across days = .81). Age and height influence FR. FR is portable, inexpensive, reliable, precise, and a reasonable clinical approximator of the margin of stability. FR may be useful for detecting balance impairment, change in balance performance over time, and in the design of modified environments for impaired older persons.
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                Author and article information

                Journal
                ramb
                Revista da Associação Médica Brasileira
                Rev. Assoc. Med. Bras.
                Associação Médica Brasileira (São Paulo, SP, Brazil )
                0104-4230
                1806-9282
                August 2012
                : 58
                : 4
                : 427-433
                Affiliations
                [05] Porto Alegre RS orgnamePUCRS orgdiv1Faculdade de Enfermagem, Nutrição e Fisioterapia Brasil
                [01] Porto Alegre RS orgnamePOA orgdiv1Secretaria Municipal de Educação Brasil
                [04] Porto Alegre RS orgnamePUCRS orgdiv1Programa de Pós-graduação em Gerontologia Biomédica Brasil
                [02] Porto Alegre RS orgnameUniversidade Federal de Ciências da Saúde de Porto Alegre orgdiv1Curso de Fonoaudiologia Brasil
                [03] Porto Alegre RS orgnamePontifícia Universidade Católica do Rio Grande do Sul Brasil
                Article
                S0104-42302012000400012 S0104-4230(12)05800400012
                10.1590/S0104-42302012000400012
                22930020
                dec693df-9c85-4636-91e2-c73531ae5474

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 17 April 2012
                : 15 August 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 52, Pages: 7
                Categories
                Artigos Originais

                fall accidents,fatores de risco,Elderly,equilíbrio postural,risk factors,postural balance,acidentes por quedas,Idoso

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