I. はじめに 1,2) 3) 2 4) 5) 6) 7) 8) 6) Horikawa 9) ) Holtzer 11) ) 6,9,11) 7,8,12) 13) Modified Stroop Test Moreland 14)

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1 原著 The Influence of Physical and Cognitive Functions on Falls by Elderly Persons Attending Community Day-care Centers 1,2) 3) 3) TATSUYA JINNOUCHI 1,2), TATSUYA HIRASE 3), SHIGERU INOKUCHI 3) 1) Geriatric Health Services Facility Gaianosato: Otsu, Aino-machi, Unzen-shi, Nagasaki , Japan TEL ) Department of Locomotive Rehabilitation Science, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biochemical Sciences 3) Department of Physical Therapy Science, Unit of Physical and Occupational Therapy Sciences, Nagasaki University Graduate School of Biochemical Sciences Rigakuryoho Kagaku 31(1): 31 35, Submitted Jul. 27, Accepted Aug. 31, ABSTRACT: [Purpose] The purpose of this study was to examine the influence of physical and cognitive functions on falls by elderly persons attending community day-care centers. [Subjects] The subjects were 60 elderly persons attending community day-care centers. [Methods] Physical function was assessed using the timed up-and-go test (TUG), chair-stand test, and 5m walking speed. Cognitive function was assessed using the Mini Mental State Examination, digit span, and Trail-Making Test part A (TMT-A). The fall risk score was also evaluated. [Results] Participants who had a history of falls had higher TUG and TMT-A scores, and a higher fall risk score. TMT-A was strongly associated with a history of falls. [Conclusion] The results suggest that TMT-A, known as a marker of execution and attention, is associated with a history of falls, and interventions for the execution and attention functions may be important for fall prevention for elderly adults who attend community day-care centers. Key words: falls, cognitive function, community day-care center 要旨 : 60 Timed up and Go TUG5 m 5 Mini Mental State ExaminationTrail Making Test parta TMT-A 1 TMT-A TUG TMT-A TMT-A キーワード : 1) : TEL ) 3)

2 I. はじめに 1,2) 3) 2 4) 5) 6) 7) 8) 6) Horikawa 9) ) Holtzer 11) ) 6,9,11) 7,8,12) 13) Modified Stroop Test Moreland 14) II. 対象と方法 A M : 18 2: 15 1: 17 2: 6 3: Timed up and Go test TUG 15) 5 m 5 m 16) 5 Chair standing test-5cst-5 17) 2 Mini Mental State Examination MMSE 18) 19) Trail Making Test part A TMT-A 20) 1 1 TMT-A A Geriatric Depression Scale-15 item short formgds-15 21) 22) 15 15

3 33 表 1 n=60 n=35 n= TUG * m CST MMSE TMT-A ** GDS * * p<0.05 ** p< ) Mann-Whitney U IBM SPSS Statistics III. 結果 n=35 n=25 TUG p=0.03 TMT-A p<0.01 p= TUG TMT-A Pearson 0.8 表 2 TMT-A p= IV. 考 TUG TMT-A TMT-A 察 95 CI TUG TMT-A ** ** p<0.01.

4 ) Shumway-Cook 25) TUG Morris 26) 5 m TUG 1 TMT-A 11,27) Demura 28) ) ) TMT-A Cochrane 31) 12) 6 1 引用文献 1) Hausdorff JM, Rios DA, Edelberg HK: Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Reha, 2001, 82(8): ) Thiem U, Mielke RK, Trampisch U, et al.: Falls and EQ- 5D rated quality of life in community-dwelling seniors with concurrent chronic diseases: a cross-sectional study. Health Qual Life Outcomes, 2014, 12: 2. 3) Shymway-Cook A, Ciol MA, Hoffman J, et al.: Falls in the medicare population: incidence, associated factors, and impact on health care. Phys Ther, 2009, 89(2): ) 2009, 46(4): ) Rubenstein LZ, Josephson KR, Robbins AS: Falls in the nursing home. Ann Intern Med, 1994, 121(6): ) American Geriatrics Society, Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention: Guideline for the prevention of falls in older persons. J Am Geriatr Soc, 2001, 49(5): ) , 26(1): ) Inokuchi S, Matsusaka N, Hayashi T, et al.: Feasibility and effectiveness of a nurse-led community exercise programme for prevention of falls among frail elderly people: a multicentre controlled trial. J Rehabil Med, 2007, 39(6): ) Horikawa E, Matsui T, Arai H, et al.: Risk of falls in Alzheimer s disease: a prospective study. Intern Med, 2005, 44(7): ) 2005, 20(4): ) Holtzer R, Friedman R, Lipton RB, et al.: The relationship between specific cognitive functions and falls in aging. Neuropsychology, 2007, 21(5): ) 2009, 24(1): ) 2011, 26(2): ) Moreland J, Richardson J, Chan DH, et al.: Evidence-based guidelines for secondary prevention of falls in older adults.

5 35 Gerontology, 2003, 49(2): ) Podsiadlo D, Richardson S: The Timed Up and Go: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc, 1991, 39(2): ) 5 m 2000, 2(Suppl.): ) Csuka M, McCarty DJ: Simple method for measurement of lower extremity muscle strength. Am J Med, 1985, 78(1): ) Folstein MF, Folstein SE, McHugh PR: Mini Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 1975, 12(3), ) 2003, p ) Hirota C, Watanabe M, Sun W, et al.: Association between the Trail Making Test and physical performance in elderly Japanese. Geriatr Gerontol lnt, 2010, 10(1): ) Cruice M, Worrall L, Hickson L: Reporting on psychological well-being of older adults with chronic aphasia in the context of unaffected peers. Disabil Rehabil, 2011, 33(3): ) 2006, pp ) 2006, 43(2): ) Deandrea S, Lucenteforte E, Bravi F, et al.: Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology, 2010, 21(5): ) Shumway-Cook A, Brauer S, Woollacott M: Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther, 2000, 80(9): ) Morris R, Harwood RH, Baker R, et al.: A comparison of different balance tests in the prediction of falls in older women with vertebral fractures: a cohort study. Age Ageing, 2007, 36(1): ) Hausdorff JM, Doniger GM, Springer S, et al.: A common cognitive profile in elderly fallers and in patients with parkinson s disease: the prominence of impaired executive function and attention. Exp Aging Res, 2006, 32(4): ) Demura S, Sato S, Shin S, et al.: Setting the criterion for fall risk screening for healthy community-dwelling elderly. Arch Gerontol Geriatr, 2011, 53(2): ) 2010, 25(2): ) 2005, 32(2): ) Gillespie LD, Robertson MC, Gillespie WJ, et al.: Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev, 2012, 9: CD007146

Epidemiology and implications of falling among the elderly

Epidemiology and implications of falling among the elderly 3) Blake AJ, Morgan K, Bendall MJ : Falls by elderly people at home : prevalence and associated factors. Age Ageing 1988 ; 17 : 365-372.