Falls in older people

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    Abstract

    Falls are common incidents, which can have major con-sequences. For example, falls and the interrelated category of accidents being struck by or against objects account for more than 40% of injuries and 30% of injury costs in the USA (Corso et al., 2006). Especially among older adults, falls occur frequently (for overview, see Lord and Dayhew, 2001; Masud and Morris, 2001), even in the large group of relatively fit and healthy elderly (Stel et al., 2003). Conse-quences of falls are known to contribute substantially to the prevalence of health problems (Lord et al., 2001), health care costs (Stevens et al., 2006), and to lost quality of life (Cumming et al., 2000). In the elderly, falls were found to be the second largest source of unintentional fatal injuries and the leading cause of nonfatal injuries (Dellin-ger and Stevens, 2006). The fact that the population of el-derly is rapidly growing in the industrialized world suggests that the scope of this problem can be expected to increase in future decades (Woolf and Pfleger, 2003). The statistics sketched above show that it is of great importance to prevent falls among the elderly. To develop effective and efficient approaches towards fall prevention in the elderly, causal factors for falls in this group need to be determined. Many epidemiological studies have been published on predictors of falls in the elderly (for over-view, see Dieën et al., 2005; Lord et al., 2001; Tideiksaar, 1997). However, given the limitations of such observa-tional designs, these studies often only provide general directions for prevention. Experimental studies can com-plement data from observational studies with more de-tailed insight, which can be used to determine who are at risk for falls and which are the modifiable factors determining fall risk. Fall incidents and the ensuing injury process are multi-factorial. Environmental hazards, such as loose carpets and badly visible steps can play a role, but do so usually in combination with intrinsic factors (Tideiksaar, 1997). Stable locomotion and even stable stance depend on ade-quate cardiovascular function, in particular cerebral blood flow (Carey and Potter, 2001) and adequate proprioception (Bloem et al., 2003). When moving through a variable and unpredictable environment, visual contrast sensitivity and depth perception are crucial for detection of environmental hazards (Lord, 2006). Moreover, responses need to be se-lected to deal with these hazards, which requires adequate processing of the information and it has been shown that the level of cognitive functioning affects this (van Schoor et al., 2002). Subsequently, selected responses need to be carried out adequately, which can be limited by neural and muscular factors. When perturbations of balance oc-cur, as they inevitably do, impairments of the sensory sys-tem may limit detection. Again adequate response selection and execution may serve to regain balance and prevent a fall. Finally, even when a fall is inevitable, the conse-quences can be limited by changing the mechanics of the fall and ground contact. Research aspiring to contribute to fall prevention, therefore, needs to be multidisciplinary. The role of epidemiology was already mentioned, but given the above contributions from sensory physiology, muscle physiology, neurophysiology, neuropsychology, and bio-mechanics are necessary. This special issue aims to provide an overview of exper-imental work that attempts to provide a basis for the pre-vention of falls and fall-related injuries in the elderly. It is based on the presentations of a group of invited partici-pants to a symposium organized as part of the 5th World Congress of Biomechanics held in Munich, Germany in August 2006. Consequently, the focus is on biomechanics, but the importance of neurophysiological and muscle physiological issues and research approaches will be evi-dent in many of the papers presented. Obviously, the for-mat of conference presentations of 10 min is less than ideal for providing a broad overview of the field of study. Where appropriate, the authors were, therefore, invited not to confine themselves to presenting a single study, but rather to provide an overview of their own work in this field. We believe that in this way the issue will provide a valuable introduction for those new to this field and those interested in the broad aspects of experimental research on this topic. The first paper by Granata and Lockhart focuses on sta-bility of gait. The authors use a numerical method derived from the theory of dynamical systems to quantify stability
    Original languageEnglish
    Pages (from-to)169-171
    Number of pages3
    JournalJournal of Electromyography and Kinesiology
    Volume18
    Issue number2
    Early online date26 Jul 2007
    DOIs
    Publication statusPublished - Apr 2008

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