Age Scale for Assessing Activities of Daily Living

The purpose of this study was to develop an age scale for assessing activities of daily living (ADL) among community-dwelling adults aged 75 years or older. Participants were 1006 older Japanese: 312 men (79.6 ± 4.3 years) and 694 women, (79.9 ± 5.5 years). Participants completed a battery of 8 performance tests related to ADL and the Barthel index (BI) questionnaire. Spearman rank-order correlation analysis was applied to obtain the correlation of the 8 ADL performance tests with the total BI score. Three variables were high rank-order correlated with BI, secondly those items were subjected to the principal component analysis. The weighted combination of the principal component scores was summed. Resulting in an ADL score (ADLS), women = 0.075 X1 - 0.082 X2 - 0.063 X3 + 0.124, men = 0.051 X1 - 0.105 X2 - 0.099 X3 + 0.249, where X1 = hand-grip strength, X2 = timed up and go, X3 = five-chair sit to stand. Individual ADLS was transformed to an ADL age scale (ADLA). The estimation was - 5.493 ADLS + 79.90 for women, and - 4.272 ADLS + 79.57 for men. Due to the distortion at the regression edges, the equation was corrected as suggested by Dubina et al. ADLA women after correction was = 0.447 (chronological age: CA) - 5.49ADLS + 44.17, men = 0.519CA - 4.27ADLS + 38.26. ADLA can be used to identify or monitor the characteristics of the ADL levels of physical abilities in older Japanese aged 75 years or older

シンリョウノート 5 テントウ コッセツ ノ エッセンス

わが国では、老年人口（65歳以上）が25％を超えて、超高齢社会を迎えている。転倒に起因する大腿骨近位部骨折によって寝たきり・要介護に陥る高齢者は少なくなく、病院・診療所での患者の転倒や介護施設・福祉施設内での入所者・利用者の転倒など様々な場面での転倒が問題となっている。超高齢社会における重要な課題の一つが転倒予防である。そして転倒予防に関わる様々な分野の人が参加し、情報およびネットワークを共有し、転倒予防に関する取り組みを発展させることを目指して、2014年４月に「日本転倒予防学会」が発足した。　地域在住高齢者の１年間の転倒発生率は10～30%であるといわれている。転倒の原因は、内的要因と外的要因に大別され、内的要因として、身体的因子（筋力低下・バランス不良・加齢に伴う歩行動作の変化、起立性低血圧、糖尿病、脳梗塞、パーキンソン病、運動器障害、認知障害・認知症、感覚器障害など）や、睡眠薬や精神安定薬などの薬物使用などがあり、外的要因として、環境因子（段差、家の中が片付いていない、滑りやすい床、階段、照明不良など）がある。Fall Risk Index（FRI）などを用いて、転倒ハイリスク者を早期に発見し、総合的に転倒予防対策を立てることが求められる。　転倒・骨折の予防には、筋力やバランス能力を向上させる運動療法が第一に推奨される。また最近の研究では、カルシウム代謝調節ホルモンであるビタミンDは、骨代謝を改善するだけでなく、筋力の増強などにより、転倒・骨折を減少させることが示唆されている。Among older adults, falls are the number one cause of fractures. Many falls are related to physical conditions or medical problems. Muscle weakness, poor balance or difficulty in walking are important risk factors of falls. Postural hypotension resulting from dehydration, diabetes, Parkinson’s disease or certain medications can cause falls. Chronic diseases such as diabetes, stroke or Parkinson’s disease, and also cognitive impairment, dementia, vision problems or some medications can increase a risk of falling. The more medications you take the more likely you are to fall. Other causes could be safety hazards in the person’s home or community environment.　Hip fractures such as femoral neck fractures are one of the most serious types of fall injury. They are a leading cause of hospitalization, loss of independent living and physical or mental disabilities among older adults. Many of them will need long-term care.　Exercise to improve your balance and strengthen your muscles helps to prevent falls. Vitamin D is a steriod hormone essential for calcium absorption and bone mineralization. Prolonged and severe vitamin D deficiency leads to rickets in children and osteomalacia in adults. Recent studies have suggested the role of vitamin D in preventing falls and fractures. Some studies have demonstrated that vitamin D supplementation can improve muscle strength which in turn contributes to a decrease in incidence of falls