[Muscle and bone health as a risk factor of fall among the elderly. An approach to identify high-risk fallers by risk assessment].

Fall-induced hip fracture is one of the major causes rendering the elderly to be in a low ADL or bed-ridden status. Fall is not only the cause for fractures, but it lowers elderly peoples'ADL. History of fall, age, decline of motor function, orthostatic hypotension, balance deficit, dementia, drug and environmental factors were raised as possible risk factor for falls. We created a fall predicting score which consist of 21 risk factors and a history of falls. We found that the score is useful to identify high-risk fallers. It would be necessary to identify high-risk fallers early and give an appropriate individual approach.

[Fall risk assessment in regular exercising elderly women].

AIM: Fall prevention is important for elderly people to maintain their functional independence. We made a longitudinal fall-risk assessment using our "Fall-predicting score" of women who are 60 years or older and who exercised regularly. METHODS: We sent "fall-predicting questionnaires" to 632 elderly women aged 60 years or older (mean 65.0+/-4.3), members of "Miishima gymnastics program", and asked about their fall history of falling in the past year in 2004 and 2005. We performed a logistic regression analysis to determine the future risk factor of falling in 2005. RESULTS: The number of people who fell was 134 (21.2%) in 2004 and 121 (19.1%) in 2005. The number of people who fell decreased in the seventh decade, but increased in the eighth decade, and members for 6-10 years showed most decreased fall rates. Logistic regression analysis revealed that age, falls in 2004, "tripping", "cannot squeeze a towel", and "walk steep slope around the house" were significant independent risk factors of "falls in 2005". Logistic regression analysis of non-fallers in 2004 showed that age and "tripping" were the significant independent risk factors of "falls in 2005", and the analysis of people who fell in 2004 showed that age, "tripping", "cannot squeeze a towel", "walk steep slope around the house", and "taking more than 5 medicines" were significant independent risk factors for falls in 2005. CONCLUSIONS: In regular exercising elderly women, exercise appears to prevent falls in people in the seventh decade and in the members of 6-10 years. Age, past history of falls, and fall-predicting questionnaire were important risk predictors of future falls.

["Activity scale for the elderly" as a measurement for the QOL of local elderly individuals and the assessment of the influence of age and exercise].

AIM: To study the influence of exercise on the QOL of local elderly individuals, we created an activity scale for the elderly (ASE) and investigated its reliability and validity. METHODS: We created 36-item ASE and performed factor analysis. The reliability of the ASE was tested by determining Cronbach's coefficient alpha and confirmatory factor analysis in a cohort of 5,280 people, living in the community. The validity of the ASE was assessed by analyzing the interrelationship between the subdomains, age, and exercise. RESULTS: By factor analysis, four subdomains and 20 items remained significant for measuring ASE. The average ASE in the 5,280 people was 27.18+/-5.28 points, with no sex difference. Confirmatory factor analysis showed the stability of the four subdomains. Cronbach's alpha demonstrated the internal consistency of the scale. Regarding the relationship between the four subdomains, age, and exercise, a significant difference was found between those who exercised and those who did not exercise, and between the 4 different age groups. By means of two-way ANOVA, significant interaction was found between exercise and age; ASE decreased from 26.3 points in the sixth decade of life to 23.9 in the seventh decade of life in those who did not exercise, while no decrease was found in those who exercised. Furthermore, ASE was significantly higher in those who exercised than those who did not non-exercise in each age decade group. These results suggest that exercise prevents age-associated decline in ASE. CONCLUSION: ASE provides a reliable and valid measure for the QOL of elderly individuals living in the community, and exercise appears beneficial for preventing age-associated decline in ASE.

[Creatinine clearance estimation in the extremely elderly subjects].

BACKGROUND: It has been reported that elderly outpatients take at least 6 different kinds of medication. PURPOSE: To know which formula will best predict creatinine clearance, because 24-hour urine collection is difficult for elderly outpatients. PATIENTS AND METHODS: We compared four types of formulae (Cockcroft and Gault, Yasuda, Orita, Walser) to estimate creatinine clearance using serum creatinine of 143 elderly inpatients (73 men, 70 women, mean age 82.9 +/- 8.6 years old) including 67 extremely elderly people with various underlying diseases. RESULT: The formula of Cockcroft and Gault showed the best correlation with creatinine clearance in the extremely elderly subjects (r = 0.74) as well as in people under 85 years (r = 0.76). However, the estimated values of the extremely elderly women were lower than actual creatinine clearance. CONCLUSION: The formula of Cockcroft and Gault is the best predictive equation of creatinine clearance, except in the extremely elderly women.

Evaluation of risk of falls in patients at a memory impairment outpatient clinic.

AIM: We investigated the usefulness of the fall-predicting score, a simple screening test to identify patients at high risk of falls in outpatients with cognitive impairment. METHODS: This was a 1-year prospective study. Seventy-nine patients (28 men and 51 women, 78.1 +/- 5.9 years old) in the Memory Impairment Outpatient Clinic of Kyorin University Hospital. History of falls in the past year, record of falls in the follow-up period (1 year), fall-predicting score, time of standing on one foot, timed Up & Go test, tandem gait, functional reach, grip strength, maximum circumference of the legs and blood laboratory tests were measured. RESULTS: Of the 79 subjects, 38 (48.1%) had experienced falls in the past year, and 29 (36.7%) experienced falls during the follow-up period. Comparing the two groups with and without a history of falls during the follow-up period, a significant difference was observed in fall-predicting score, timed Up & Go test, tandem gait and functional reach. Logistic regression analysis revealed that fall-predicting score was the only significant determinant for predicting future falls. Furthermore, fall-predicting score correlated with timed Up & Go, duration of standing on one foot, functional reach, grip strength and tandem gait. When the chi(2)-test was performed to investigate the correlation between individual items of the fall-predicting questions and falls during the follow-up period, "Do you use a stick when you walk?" and "Are there any obstacles in your house?" showed a significant difference (P < 0.05). CONCLUSION: Fall-predicting score is useful as a screening test to predict future falls in patients with cognitive decline.