Co-relation between risk factors of falls down and the Berg balance scale in elderly people ( third age )

This study encompassed 77 randomly assigned participants of both sexes and older than 65 of age. Every participant was questioned in his/her own house and completely familiarized with the methodology and the aims of the questionnaire. Out of 27 men, data on falls down were provided by 4 participants (14.81%): one of them lived alone while three of them lived in their families. Out of 50 women, data on falls down were provided by 17 (34%) participants: 9 of them lived in their families and 8 lived alone. Out of all living alone women 44% fell down twice or more during this study in comparison to 20% of living alone men. Regarding the values of the score of risk factors obtained throughout the questionnaire and the Berg balance scale, there are statistically significant differences between men and women (p < 0.005, i.e. p < 0.01), as well as participants that have never fallen down (p < 0.001, i.e. p < 0.01), while regarding the life style (living alone or in the family) there are no statistically significant differences (P > 0.05). Nowadays, the Berg balance scale is the most frequently used questionnaire that is, in total, significantly superior to other ever utilized tests. Average values of results obtained throughout the Berg balance scale in this study are statistically significantly higher in men and those participants who did not provide data on falls down, while regarding the life style there are no statistically significant differences.


Introduction
Rapid industrialization and urbanization, as well as rapid progress in technique put third aged people on the margin of interest of health institutions.On the other hand, the progress of civilization (improvement of general, economic, social and health condition, as well as better working conditions, progress in technique) causes prolonged average lifetime.It is assumed that an average lifetime of people in developed countries was approximately 85 years of age (year 2000) (1).Body balance and moving require a very complex relation between perceptive, neuromuscular and cardiovascular functions, as well as an ability of fast adaptation to the requirements of the environment.In biomechanical sense, human walk is actually a loss and a regaining of the body balance in the manner that it is re-established before it would become disordered during the fall down.With age, body balance is weakening while staggering process advances.The result of this is vulnerability that makes elderly person inclined to fall down when facing additional burden to any of the formerly mentioned functions.Thus, a simple fall down may result in serious problems such as pneumonia or myocardial attack.Hypothetically, age weakening of the sensory systems induces a rise in order to strengthen the signals that come from these systems and everything in order to ensure necessary information for the control of the body posture (2).

Aim of the work
Aim of this work was to conduct a questionnaire about fall down risk factors and the Berg balance scale in order to find out the co-relation between results of falls down risk factors and the Berg balance scale.

Participants and the methods of research
The study was clinical and consisted of manipulative, prospective and control exams.The research itself encompassed 77 randomly assigned participants of both sexes, all older than 65 years.Each participant was questioned in his/her own house and absolutely familiarized with methodology and aims of the research.Six month later, a control review was done and all participants were divided into two groups: a group without falls down and a group with falls down.In this manner, the group without falls down presented a control group while the group with falls down presented a tested group.Research inclusion criteria were: age over 65 years and ability to move with or without a device (stick).Research exclusion criteria were: death of the participant during the study or appearance of an illness that might affect participant functional ability during the research period.All patients were examined by a physiatrist.There was a separate questionnaire for the each participant about risk factors (Annex 1).The questionnaire consisted of 22 questions, which were rated in dichotomised manner ("yes" or "no").The summary of positive answers presents the relative index of fall down risk.This evaluation is based on the observation of the researcher, patients' answers and data from available medical documentation.The Berg

Co-relation between risk factors of falls down and the Berg balance scale in elderly people (third age)
Avdiae Dijana 1 , Škrbo Armin 2  1 -Orthopaedic and Trauma Clinic "KCU Sarajevo" 2 -Faculty of Pharmacy, Sarajevo balance scale was conducted in each patient (3,4,5,6) (Annex 2).Otherwise, the Berg balance scale consists of 14 tasks being scored based on the previously set criteria.Primarily, the performance of each task was demonstrated to each patient.The necessary equipment included a stopwatch, centimetre tape, chair and armchair, as well as a small chair which height co-related to the average height of foot-lift while walking.Maximum Berg balance scale score is 56 and indicates an excellent body balance.Results were statistically analysed according to SPSS program version 9.0, and presented in tables and graphs.Following parameters were determined for each clinical test: frequencies and measures of central tendency, specificity, sensitivity, positive and negative predictive value, percentage of false positive and false negative results.T test values indicate that all examined variables statistically significantly differ.In order to uncover the individual variables predictive for fall down, a logistic regressive analysis was performed while the depending variable was represented by datum on fall down 0 (0 -no fall, 1 -with a fall).

Results
77 participants were included in the study: 27 men (35.06%) and 50 women (64.94%).Distribution of questioned participants according to the sex is shown in Graph 1.

Graph 1 Distribution of questioned participants according to the sex
Average age was 71.23 ± 5.63 (ranging from 65 to 90 years): for women 71.22 ± 5.80 (ranging from 65 to 90 years), and for men 72.67 ± 5.26 years (ranging from 65 to 82 years).During the study period, 21 participants (27.27%) fell down twice or more times, while the same number of participants provided data on only one fall down.Out of 27 men, data on falls down were provided by 4 participants (14.81%) -one living alone and three living in their families.Out of 50 women, the data on falls down were provided by 17 participants (34%) -9 of them living in their families and 8 living alone.Data on falls down, related to the sex and life style (living alone or within a family), are shown in Table 1.Average value of the risk factor score gained throughout the questionnaire and the results of the Berg balance scale are shown in Tables 2-4.

27
Women Men

Graph 2 Average value of the Berg balance scale
Regarding risk factor score gained throughout the questionnaire and the Berg balance scale there are statistically significant differences between men and women, as well as between participants who fell down and those who did not, while there are no statistically significant differences regarding their life style (living alone or in a family) (Tables 5-7).

Discussion
The study encompassed 77 participants of both sexes with average life age of 71.73 ± 5.63 years (ranging from 65 to 90 years), who were randomly assigned.Every patient was questioned in his/her house and was familiarized with the methodology and aims of the study.The percentage of women was 64.94% (50 female participants) while the percentage of men was 35.06% (27 male participants), which is in accordance with this population group demographic data in our conditions.1 In other studies, sex structure differs, so Harada and colleagues (7)     Average values of the results gained throughout the Berg balance scale in this study are statistically significantly higher in men and participants who provided no data about falls down, while statistically significant differences regarding the life style were not observed.These results are co-relating to literature data (4,8,12,13,15).Many participants categorically stated that they could not perform some of the tasks (keeping body balance while turning for 360 degrees), and for their performance, apart from the proper explanation, longer verbal support was needed.This result is in accordance with the result of Studenski and colleagues (16), who published that elderly people with recent fall down experience were more unstable than people from the similarly aged control group (performance of the postural test of one-leg standing and turning around).The Berg balance scale did not reveal significant problems in performing Romberg test, though the literature proves two opposite opinions.Briggs and colleagues (17), differently from Heitmann and colleagues (18), have found no difference between the leaning time of the third aged persons during the Romberg test performance and one-leg standing in comparison to the data on falls down.

Conclusions
1. Regarding the risk factor score gained throughout the questionnaire and the Berg balance scale results, there are statistically significant differences between men and women (p < 0.005, i.e. p < 0.01), as well as participants who did not fall down (p < 0.001, i.e. p < 0.01), while there are no statistically significant differences regarding the life style (alone or in family) (p > 0.05).

Table 1
Distribution of participants according to the data on falls down and related to the life style and sex

Table 2
Average values of the risk factor score and the Berg balance scale according to the sex

Table 3
Average values of the risk factor score and the Berg balance scale according to the life style

Table 4
Average values of the risk factor score and the Berg balance scale according to data on falls down

Table 5
Testing of the significance of the each test differences between men and women

Table 6
Testing of the significance of the each test differences between participants who lived alone and those who lived in the family

Table 7
Testing of the significance of the each test differences between participants who fell down and those who did not fall down 2. Clinical methods of evaluation that are in use nowadays are especially suitable for the screening process since they can uncover specific damages and they can be carried out by both medical and previously trained non-medical staff.3.After such screenings, further expert evaluation is to be performed.4.The Berg balance scale is nowadays mostly used in the practice and in overall superior in comparison to the other tests that are being used. 5. Average values of the results gained throughout the Berg balance scale in this study are statistically significantly higher in men and in participants who provided no data about falls down, while statistically significant differences regarding the life style were not observed.Does he/she have some of the following illnesses that might result in a fall?YES NO • Neurological (e.g.cancer, peripheral neuropathy, multiple sclerosis, lupus…) • Cardiovascular (e.g.postural hypo tension) • Muscle-skeleton (e.g. total joint prosthetics implant) • Sensory (e.g.damages to sight) • Other (amputation, Parkinson disease, Alzheimer disease) 22.Does he/she take medications potentially dangerous from aspects of falling?