An approach to balance problems and falls in elderly persons

Gait instability and falls are common in elderly persons and have devastating consequences, with substantial morbidity and mortality.Furthermore, they are a precipitant for functional decline, increasing frailty and institutionalisation. The rate of falls and severity ofcomplications increase with age and frailty. A consequence of falls with or without injury is that at least a third of persons develop a fear offalling, which leads to functional decline and a progressive decline in gait. The causes of falls in elderly persons are multifactorial and includephysiological changes of ageing, frailty, pathologies, and environmental and situational factors. Maintaining postural control requires acomplex integration of sensory input, central processing, motor co-ordination and musculoskeletal function, which decrease with ageing.This change, combined with sarcopenia, leads to slowed and weakened postural control and muscle responses, resulting in gait instabilityand falls.The assessment and management of a patient who is at risk of falls or who has fallen require a multidisciplinary approach to identifyand address factors contributing to the fall. The assessment, which includes history, physical examination, and evaluation of gait, posturalcontrol and mental function, is aimed at identifying situational and associated factors surrounding a fall, intrinsic impairments in gait orpathologies that increase the risk of falls. The components of the assessment comprise a full medical evaluation for pathologies, includingvision, medication review (including over-the-counter medication) with regard to polypharmacy and high-risk medications, psychogeriatricreview, functional status (instrumental activities of daily living (IADLs) and activities of daily living (ADLs)), functional assessment of gaitand balance, and assessment of environmental hazards in the home. Laboratory investigations are guided by clinical suspicions or diagnosesarising from the medical assessment and screening for common conditions that may increase the risk of falls.Management and prevention of falls focus on maintaining mobility and balance, and identifying those at risk of a fall for multidisciplinaryassessment and intervention. Intervention to reduce the risk of subsequent falls is targeted at modification of the contributory factors.Intervention includes management of underlying pathologies, strength and balance training by a physiotherapist, assessment andmodification of environmental hazards in the home by an occupational therapist, medication review and rationalisation of high-riskmedications and polypharmacy, and supplementation of vitamin D where indicated

Does social support effect knowledge and diabetes self-management practices in older persons with Type 2 diabetes attending primary care clinics in Cape Town, South Africa?

BACKGROUND:In South Africa with one of the most rapidly ageing populations in Africa despite the demographic impact of the HIV/AIDS epidemic, diabetes is a major cause of morbidity and mortality. Self-management is challenging for all those with the condition but is likely to create a higher demand for those who may have existing co-morbidities associated with age, and long-standing chronic diseases. OBJECTIVE:To determine the relationship of social support, especially that of family and friends with their self-management. METHODS:This cross-sectional study was undertaken in the Cape Town metropole primary care clinics. The sample comprised 406 people drawn from four community health centres (CHC) that are served by Groote Schuur Hospital at the tertiary level. RESULTS:Of the 406 participants, 68.5% were females, 60.5% were living with a family member, and almost half were married. The mean duration of diabetes from diagnosis was eight years. More than half (57.4%) had no or only primary education. Half the participants (50.2%) had poor knowledge level in relation to symptoms and complications of diabetes. Multivariable linear regression showed older age was associated with poor knowledge (®: -1.893, 95% CI-3.754; -0.031) and higher income was associated with self-management practice (®: 3.434, 95% CI 0.797; 6.070). Most participants received family support to follow aspects of diabetes self-management. The ordinal logistic regression indicated that family support was positively associated with the self-management practice score for following a diabetic meal plan, taking care of feet, physical activity, testing blood sugar and handling participants' feelings about being diabetic, but not for taking medication. CONCLUSIONS:Consideration needs to be given to developing and testing education programmes that focus on needs of older people with diabetes and emphases the role of family and friends