202360 EHR525 Week 05a Ageing and Falls (1 Slide).pdf

WARNING This material has been reproduced and communicated to you by or on behalf of Charles Sturt University in accordance with section 113P of the Copyright Act 1968 (Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of th...

WARNING This material has been reproduced and communicated to you by or on behalf of Charles Sturt University in accordance with section 113P of the Copyright Act 1968 (Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice School of Allied Health, Exercise and Sports Sciences 1 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 1 EHR525 EXERCISE FOR NEUROLOGICAL & MENTAL HEALTH CONDITIONS Ageing and Falls In Older People Presenter: Jack Cannon School of Allied Health, Exercise and Sports Sciences 2 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 2 What We Will Cover ■ Define the term ‘fall’ and characterise the key features of a falling event. ■ Review falls statistics in older people as they relate to incidence, frequency, injury, and economic outcomes. ■ Risk factors for falls in older people. ■ Age-related changes in the sensory-motor system and functional changes contributing to an increased falls risk in older people. School of Allied Health, Exercise and Sports Sciences 3 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 3 WHAT IS A “FALL”? ■ “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level” (World Health Organisation, 2007) ■ “an event in which the participant comes to rest on the group, floor or lower level” (Prevention of Falls Network Europe, 2007) ■ “an unintentional change in position where the elder ends up on the floor or ground” (Canadian Institute for Health Information, 2002) School of Allied Health, Exercise and Sports Sciences 4 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 4 INCIDENCE OF FALLS (NSW DATA) ■ 25.6 % of community dwelling people >65yrs (775,000) fell at least once in the preceding 12 months (55% female vs 45% male). ■ Most (65%) occur in or around the home. ■ Greater incidence in people in residential care facilities (50%). Centre for Health Advancement and Centre for Epidemiology and Research. New South Wales Falls Prevention Baseline Survey: 2009 Report. Sydney: NSW Department of Health, 2010. School of Allied Health, Exercise and Sports Sciences 5 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 5 FALLS FREQUENCY INCREASES WITH AGE Lord, S. R. (1993). Australian Journal of Public Health, 17: 240–245. School of Allied Health, Exercise and Sports Sciences 6 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 6 ACTIVITY WHEN FALL OCCURRED School of Allied Health, Exercise and Sports Sciences 7 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 7 BODY REGIONS INJURED BY FALLS AIHW: Bradley C 2013. Hospitalisations due to falls by older people, Australia 2009–10. Injury research and statistics series no. 70. Cat. no. INJCAT 146. Canberra: AIHW. School of Allied Health, Exercise and Sports Sciences 8 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 8 PERSONAL COSTS ■ 2/3 falls result in injury (10-15% cause fractures). ■ 1/5 require hospitalisation: many discharged to nursing home care. ■ 10% require on-going assistance from community care services. ■ Activity restriction and loss of confidence. School of Allied Health, Exercise and Sports Sciences 9 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 9 ECONOMIC COSTS ■ Total cost of health care associated with fall injuries in NSW was $558.5 million. ■ $3,906 per fall injury treated (females $4,211 vs males $3,366). Watson W, Clapperton A, Mitchell R. The incidence and cost of falls injury among older people in New South Wales 2006/07. Sydney: NSW Department of Health, 2010. School of Allied Health, Exercise and Sports Sciences 10 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 10 Cost ($ Millions) PROJECTED TOTAL HEALTH CARE COSTS Year Moller, J. 2003. New Directions in health and Safety. Report to the Commonwealth Department of Health and Ageing under the National Falls Prevention for Older People Initiative. School of Allied Health, Exercise and Sports Sciences 11 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 11 DEMOGRAPHIC/PSYCHOSOCIAL RISK FACTORS ■ ■ ■ ■ ■ ■ ■ ■ Advanced age History of falls ADL limitations Female gender Living alone Inactivity Fear of falling Alcohol School of Allied Health, Exercise and Sports Sciences *** *** *** ** ** ** ** - Strength of evidence: *** Good evidence ** Moderate evidence * Inconsistent evidence - No evidence 12 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 12 MEDICAL RISK FACTORS ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Impaired cognition Stroke Parkinson’s Depression Acute illness Arthritis Foot problems Vertigo Orthostatic HTN * Vestibular disorders School of Allied Health, Exercise and Sports Sciences *** *** *** ** ** ** ** * Strength of evidence: *** Good evidence ** Moderate evidence * Inconsistent evidence - No evidence - 13 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 13 PHARMACOLOGICAL RISK FACTORS ■ Psychoactive meds *** □ Benzodiazapines □ Antidepressants □ Antipsychotics *** *** *** ■ ■ ■ ■ Multiple meds (=>4) Cardiovascular meds Analgesics Anti-inflammatories School of Allied Health, Exercise and Sports Sciences Strength of evidence: *** Good evidence ** Moderate evidence * Inconsistent evidence - No evidence *** * - 14 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 14 SENSORY & NEUROMUSCULAR RISK FACTORS ■ ■ ■ ■ ■ ■ Muscle weakness Reduced peripheral sensation Poor reaction time Visual contrast sensitivity Depth perception Reduced vestibular function School of Allied Health, Exercise and Sports Sciences *** *** *** *** ** * Strength of evidence: *** Good evidence ** Moderate evidence * Inconsistent evidence - No evidence 15 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 15 BALANCE & MOBILITY RISK FACTORS ■ ■ ■ ■ Impaired gait & mobility Impaired ability to stand up Impaired ability with transfers Impaired standing stability when standing ■ Impaired stability when leaning and reaching School of Allied Health, Exercise and Sports Sciences *** *** *** Strength of evidence: *** Good evidence ** Moderate evidence * Inconsistent evidence - No evidence ** ** 16 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 16 POSTURAL STABILITY/BALANCE ■ Ability to maintain the position of the body (COM) within the base of support (stability limits). ■ Poor postural stability/balance is a significant contributor to falls. School of Allied Health, Exercise and Sports Sciences 17 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 17 POSTURAL SWAY ■ Constant fluctuations in the CoM from vertical. ■ Magnitude and velocity increase with age. ■ More discriminating with sensory deprivation. Sullivan et al. (2009). Neurobiology of Aging, 30, 793–807. School of Allied Health, Exercise and Sports Sciences 18 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 18 CATEGORIES OF POSTURAL CONTROL/BALANCE TASKS ■ Maintain stability during standing or sitting. □ Postural sway. ■ Anticipatory adjustments to voluntary movement. □ Reaching, gait, initiation, voluntary stepping. ■ Reactions to expected external perturbations □ Catching a ball. ■ Reactions to unexpected external perturbations. □ Bump in a crowd, trip/slip. School of Allied Health, Exercise and Sports Sciences 19 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 19 SENSORIMOTOR CONTROL OF BALANCE AND GAIT ■ Requires a complex integration of sensory information regarding body positioning relative to the environment and the ability to generate appropriate motor responses to control movement. ■ Involves all levels of the nervous system. School of Allied Health, Exercise and Sports Sciences 20 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 20 SENSORIMOTOR CONTRIBUTIONS TO BALANCE AND GAIT Sensory Input  Central Processing  Motor Response School of Allied Health, Exercise and Sports Sciences 21 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 21 AGE-ASSOCIATED CHANGES IN VESTIBULAR SENSATION ■ Inner ear structure that detects position and motion of the head. ■ Important for posture and coordination of the head, eyes, and body movements. ■ Losses in stereocilia with age. School of Allied Health, Exercise and Sports Sciences 22 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 22 AGE-ASSOCIATED CHANGES IN PERIPHERAL SENSATION ■ Both balance and gait rely upon peripheral sensory cues. ■ Tactile information from hands and feet provide information on how we are interacting with the environment. ■ Proprioception from muscles and joints provides information on limb and body position. School of Allied Health, Exercise and Sports Sciences 23 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 23 AGE-ASSOCIATED CHANGES IN VISION ■ An important source of information related to balance and gait. □ Information about the external environment. □ Feedback about body position and movements. ■ Ageing effects: □ □ □ □ □ Visual acuity. Contrast sensitivity. Depth perception. Visual field (peripheral vision). Glasses. School of Allied Health, Exercise and Sports Sciences 24 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 24 AGE-ASSOCIATED CHANGES IN NEUROANATOMY ■ Brain loses 10% of it’s weight by 90 years of age (reflects a loss of neurons). ■ Deficits in the basal ganglia can affect initiation, speed, and control of movement. ■ Deficits in the cerebellum can affect equilibrium and interlimb coordination. ■ Loss of myelin slows/impairs conduction velocity. School of Allied Health, Exercise and Sports Sciences 25 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 25 AGE-ASSOCIATED CHANGES IN MUSCULAR SYSTEM ■ Progressive loss of muscle quality (35-40% by 80yrs). ■ Preferential loss and atrophy of Type II fibres. ■ Decline in muscle quality >80 years. ■ Reductions in strength, power, and endurance. School of Allied Health, Exercise and Sports Sciences 26 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 26 AGE-ASSOCIATED CHANGES IN REACTION TIME ■ Ability to detect and initiate an appropriate movement response to stimuli. ■ Simple reaction time slowly increases from 20-60 yrs then accelerates. ■ Choice reaction time or more complex tasks demonstrate larger effects of age. ■ May be related to sensory sensitivity, central processing, nerve conduction, motor response generation. School of Allied Health, Exercise and Sports Sciences 27 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 27 MUSCULAR CONTROL OF GAIT • Absorb mechanical energy: dorsiflexors, plantar flexors, hip extensors. • General mechanical energy: plantar flexors, hip extensors. • Control of swing: hip flexors, dorsiflexors, knee flexors. School of Allied Health, Exercise and Sports Sciences 28 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 28 AGE-ASSOCIATED CHANGES IN GAIT ■ ■ ■ ■ ■ ■ ■ ■ Decreased walking speed. Decreased stride length. Increased stance time. Increased stance width. Reduced stride rate. Reduced joint ROM. Reduced push-off power. Increased gait variability. School of Allied Health, Exercise and Sports Sciences 29 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 29 SUMMARY ■ Incidence of falls in older adults is high and is projected to increase. ■ Need for prevention and intervention programs to reduce the burden of falls. ■ Balance and gait rely on contributions from vision, vestibular input, peripheral sensation, musculoskeletal proficiencies, reaction time, and neuromuscular control. ■ All physiological factors contributing to balance and gait progressively decline with age and are compounded by other risk factors. ■ Exercise has a major role to play in modifying key risk factors and exercise Physiologists are well placed to deliver these services. ■ Main muscles driving forward gait are PF, DF, HF, HE. School of Allied Health, Exercise and Sports Sciences 30 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 30