PubMed · 8441925
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J W Freeman. 1993. Thoughtful restraint.. https://pubmed.ncbi.nlm.nih.gov/8441925/
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The incidence of hip fractures among the elderly is high. Previous studies have revealed considerable geographical differences in Norway with the highest incidence of hip fractures in Oslo. Using hospital registers, we found there was an annual incidence of first-time hip fractures of 583 per 100,000 inhabitants 50 years and older in the county of Nord-Trøndelag. This incidence is about the same as in Troms county in Northern Norway. The number of fractures almost doubled in the winter months of December and January compared to June and July. This study was not designed to explain these seasonal differences, but some of the reasons may be explained as follows: during the light, summer months elderly people are at less risk when moving about, both indoors and out, whereas they are at greater risk in the winter when roads and pavements are slippery. Preventive measures in the community may reduce the incidence of hip fractures.
By collecting data on hip fractures among people over 66 years of age in the Stovner district of Oslo, we were able to evaluate a programme to prevent fall accidents in the elderly population. The programme has several approaches. It includes information for both the elderly and the personnel working with them on accident risk factors and identification and removal of risk factors at home. The incidence of hip fractures among those over 66 years of age in the Stovner district was reduced from 30/1,000 in 1990 to 16/1,000 in 1996. There was a significant downward trend during the whole period (p < 0.001). A similar reduction was not seen for the rest of Oslo. We believe that the programme has contributed to reducing the number of hip fractures. However, as several approaches were tried simultaneously, it is difficult to decide whether one particular approach was more efficient than the others.
BACKGROUND: Falling is a major cause of disability and morbidity among older adults. Because poor balance is a major reason for frequent falls, assessment of balance and its risk factors are important. In this study, we postulated that cerebral changes identified on magnetic resonance (MR) imaging are related to balance, and that older adults with balance problems would have significantly greater prevalence of such brain abnormalities than older adults without balance problems. DESIGN AND MEASUREMENTS: Several measures of balance were examined in more than 700 community-dwelling older men and women, blacks and whites. Balance measures included dynamic posturography, functional reach, Romberg and 1-foot stand tests, tandem stand, and 1-foot stand. Cerebral MR imaging assessments included ventricular size, sulcal widening, white matter disease, and ischemic infarctions. Cardiovascular disease and hypertension were determined and controlled for in the analyses. RESULTS: A summary of the balance measures was significantly related to each of the 4 MR imaging measures, with those with poorer balance having more disease. The strongest associations with balance were seen for white matter disease and ventricular size. All but the ischemic infarction variable remained significantly associated with balance after adjustments for sex, race, age, cardiovascular disease, and hypertension. CONCLUSION: Cerebral changes identified by MR imaging are associated with poorer balance among older adults.