施設入居高齢者の転倒回避能力の経時的変化

We previously reported the importance of exercise in elderly people living in a barrier-free nursing home, to prevent the decline in physical activity. In this study, we attempted to obtain basic data for the purpose of training elderly people to perform age-appropriate exercises in daily life, by studying the age-dependent decline in physical activity.<br>The subjects were 11 elderly people (5 males, 6 females; mean age: 77.7 yr, range 64-84 yr) who lived in a barrier-free nursing home. (The subjects were generally healthy, and could live independently in the nursing home setting) We evaluated the physical activity and the ability to avoid falling in each subject in November 1998 and in November 1999. The 11 subjects did not undergo any interventions during that period. The main outcomes measured were the Good Walker's Index, which was calculated based on the 10m walking time, maximum width of steps, and ability to climb up and down a 40cm-staircase physical measurements; and shaking of the center of balance on stabilometry. The paired t-test or the McNemar test was used to analyze the differences between the parameters in November 1998 and November 1999.<br>The Good Walker's Index in the 11 subjects tended to decrease over the one-year period. The time and the number of steps taken in the 10-m free gait with their full ability in November 1999 were higher than the respective value in November 1998. However, the differences were not significant. The actual length of the maximum width of a step and the ratio of the maximum length of a step to the length of the lower limbs, in November 1998 and in November 1999 did not significantly differ. On the test to climb up and down a 40cm-staircase, in November 1998, 3 cases had difficulty and the remaining 8 cases could not climb up and down the stairs by themselves; whereas in November 1999, one case had difficulty and the remaining 10 cases could not climb up and down the stairs by themselves. On stabilometry, the Romberg ratio of the total length (cm) of deviation from the center of gravity (the relation between eyes closed and eyes open), the ratio of length/area (of total length (cm) by record times (second)) (1/cm), the Y-axis maximum deviation and the ratio of X/Y maximum deviation ratio in November 1999 were all significantly poorer in comparison with those in November 1998.<br>These results suggest that in elderly people living in a barrier-free nursing home, there is more prominent reduction in neurological function such as the shaking of the center of balance, than muscle strength such as the degree of good walking with aging. Therefore, it is necessary to guide the physical exercises of elderly people to maintain the balance function, such as by training them to wear shoes and giving them appropriate training in walking in consideration of their lower function.