Sensory reweighting in frail aged adults: Are the balance deficiencies mainly compensated by visual or podal dependences?

BACKGROUND: Postural control is based on the integration of different sensory inputs. The process of scaling the relative importance of these sensory cues (visual, vestibular and proprioceptive) depends on individuals and creates sensory preferences, leading to sensory dependences when one particular source is preponderant. In this context, the literature showed a frequent visual dependence (visual inputs weighting) in aged adults. However, the somaesthetic inputs can also be prioritised in a podal-dependent profile. In the frail aged adults, none study has shown the distribution of these two dependences. RESEARCH QUESTION: Which sensory orientation profile is preferentially adopted by frail aged males and females? METHODS: In this cross-sectional study, we compared 33 frail aged adults to 16 non frail aged adults during a static postural control task in three conditions on a force platform: i) a standard condition, ii) a no-vision condition and iii) a foam condition. An analysis with the factor sex was also performed in each group of participants. RESULTS: The analysis of stabilometric parameters (mean velocity and mean velocity variance) highlighted a significant difference in no-vision or foam conditions when compared to the standard condition in frail aged males and only in the foam condition when compared to the standard condition for females in the frail group. No significant difference was observed between conditions in the control group. SIGNIFICANCE: Our study showed the predominance of both visual and podal information in frail aged adults when controlling their posture. Considering the sex factor, frail males were more dependents to their visual cues than frail females. This result should be used when designing the rehabilitation programs in this population.

[Preventing falls among frail elderly patients in acute care: The use of non-slip socks. A systematic literature review]. / Prévention des chutes chez les personnes âgées fragiles hospitalisées en court séjour : utilisation des chaussettes antidérapantes. Une revue systématique de littérature.

INTRODUCTION: Falls among hospitalized frail elderly patients are a worrying, major daily phenomenon. CONTEXT: Inadequate footwear, frequently observed in this population, is one of the main risk factors behind falls. Several hospitals use non-slip socks as a preventive measure. However, in the context of evidence-based medicine, it is important to verify the existence of strong evidence for their effectiveness. OBJECTIVE: The aim of this study is to determine the preventive effectiveness of non-slip socks. METHOD: Five databases were investigated (PubMed, PEDro, Cochrane, ScienceDirect, and Google Scholar). Eligibility criteria were established (using the PICO method), for studies including elderly hospitalized patients. RESULTS: Seven studies were included. Non-slip socks showed a preventive effect in reducing the recurrence of falls (p=0.009) and the prevalence of falls related to urinary incontinence. DISCUSSION: Several studies conclude on the added value of non-slip socks compared to traditional socks or slippers. The limitations inherent in the selected studies are taken into account when drawing conclusions. CONCLUSION: Footwear that is considered safe by therapists and secure by the patient is currently the most recommended option. However, more clinical studies are needed to support our findings.

Prévention des chutes chez les personnes âgées fragiles hospitalisées en court séjour : utilisation des chaussettes antidérapantes. Une revue systématique de littérature.

INTRODUCTION: Falls among hospitalized frail elderly patients are a worrying, major daily phenomenon. CONTEXT: Inadequate footwear, frequently observed in this population, is one of the main risk factors behind falls. Several hospitals use non-slip socks as a preventive measure. However, in the context of evidence-based medicine, it is important to verify the existence of strong evidence for their effectiveness. OBJECTIVE: The aim of this study is to determine the preventive effectiveness of non-slip socks. METHOD: Five databases were investigated (PubMed, PEDro, Cochrane, ScienceDirect, and Google Scholar). Eligibility criteria were established (using the PICO method), for studies including elderly hospitalized patients. RESULTS: Seven studies were included. Non-slip socks showed a preventive effect in reducing the recurrence of falls (p=0.009) and the prevalence of falls related to urinary incontinence. DISCUSSION: Several studies conclude on the added value of non-slip socks compared to traditional socks or slippers. The limitations inherent in the selected studies are taken into account when drawing conclusions. CONCLUSION: Footwear that is considered safe by therapists and secure by the patient is currently the most recommended option. However, more clinical studies are needed to support our findings.

Geriatric Rehabilitation and COVID-19: a Case Report.

The COVID-19 infection has particularly affected older adults. Clinical observations in this population highlight major respiratory impairment associated with the development or aggravation of the patient's frailty state. Mr. P is a 93-year-old frail patient, hospitalized after a COVID-19 infection. The assessment process of this patient has been supported by an innovative multi-systemic tool developed in view of the COVID-19 clinical consequences and a systemic evaluation of motor functions by the Frail'BESTest. This process allowed a mixed clinical picture associated with significant respiratory distress (linked with acute respiratory distress syndrome) and an evident motor frailty. The care plan was developed accordingly, and four assessments were done in the same manner until Mr. P returned home. This case report allows us to see a holistic COVID-19 clinical picture, showing the different axes of clinical reasoning to enhance the rehabilitation process. Furthermore, this case report illustrates the importance of rehabilitation in the COVID-19 context.