Zusammenfassung
Stürze im Alter und ihre Folgen stellen weltweit ein großes gesundheitspolitisches Problem dar. Die Sturzfolgen können so schwerwiegend sein, dass Betroffene versterben oder eine schwere Behinderung mit Pflegebedürftigkeit davontragen. Unter den zahlreichen Risikofaktoren für Stürze im Alter scheinen sensomotorische Störungen mit verminderten Muskelfunktionen, beeinträchtigter posturaler Balance und Veränderungen der Gehfunktionen im Alter besonders bedeutend zu sein. Sarkopenie beschreibt die altersassoziierten morphologischen und funktionellen Änderungen im Muskel. Mit zunehmendem Alter nehmen die posturalen Balancefunktionen ab, und die automatischen posturalen Reaktionsmuster infolge einer Störung des Haltungsgleichgewichts werden komplexer. Das Gangbild beim alten Menschen verliert an Dynamik; Schrittzeit und Schrittweite variieren stärker als bei jungen Leuten. Die Objektivierung der Muskelfunktionen, Gleichgewichtsfunktionen und Gehfunktionen ist im Rahmen der Abklärung des Sturzrisikos beim alten Menschen sinnvoll, da diagnostizierte Störungen mit physikalischen Therapien im Rahmen der Rehabilitation und Prävention erfolgreich behandelt werden können.
Abstract
Fall related injuries in elderly persons represent an enormous challenge to health care policies all over the world. Sequels of falls in elderly may be so momentous that a person concerned may die or suffer from severe disability depending on long-term nursing care. Among the numerous risk factors identified for falls in elderly, impaired sensorimotor functions like impaired muscle functions, postural balance functions and gait functions seem of particular relevance. Sarcopenia refers to a loss of skeletal muscle mass and function that occurs with advancing age. Postural balance functions decrease in the elderly and postural automatic responses following postural perturbations become more complex. Gait performance in elderly becomes less dynamic; stride time and step width vary considerably more than in young people. We recommend to objectively test age related muscle, gait and balance functions in elderly people as these functions, if impaired, may be improved with physical therapies that are administered within rehabilitation or prevention programs.
Schlüsselwörter
Alter - Stürze - Sarkopenie - Gehfunktion - Muskelfunktion - Haltungsgleichgewichtsfunktion
Key words
elderly - falls - sarcopenia - gait functions - muscle functions - postural balance functions
Literatur
-
1
Campbell A J, Borrie M J, Spears G F. et al .
Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study.
Age Ageing.
1990;
19
136-141
-
2
Rubenstein L Z, Josephson K R.
The epidemiology of falls and syncope.
Clin Geriatr Med.
2002;
18 (2)
141-158. Review
-
3
Tinetti M E.
Clinical practice. Preventing falls in elderly persons.
N Engl J Med.
2003;
348 (1)
42-49. Review
-
4
Reinisch S, MacRae P, Lachenbruch P A. et al .
Attempts to prevent falls and injury: a prospective community study.
Gerontologist.
1992;
32 (4)
450-456
-
5
Tinetti M E, Baker D I, McAvay G. et al .
A multifactorial intervention to reduce the risk of falling among elderly people living in the community.
NEJM.
1994;
331
821-827
-
6
Tinetti M E, Williams T F, Mayewski R.
Fall risk index for elderly patients based on number of chronic disabilities.
NEJM.
1988;
319
1701-1707
-
7
Berg W P, Alessio H M, Mills E M. et al .
Circumstances and consequences of falls in independent community-dwelling older adults.
Age Ageing.
1997;
26 (4)
261-268
-
8
Ganz D A, Bao Y, Shekelle P G. et al .
Will my patient fall?.
JAMA.
2007;
297 (1)
77-86. Review
-
9
Horak F B.
Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?.
Age Ageing.
2006;
35 (Suppl. 2)
ii7-ii11. Review
-
10
Morley J E, Baumgartner R N, Roubenoff R. et al .
Sarcopenia.
J Lab Clin Med.
2001;
137 (4)
231-243
-
11
Roubenoff R, Hughes V A.
Sarcopenia: current concepts.
J Gerontol A Biol Sci Med Sci.
2000;
55 (12)
M716-724. Review
-
12
Vandervoort A A.
Aging of the human neuromuscular system.
Muscle Nerve.
2002;
25 (1)
17-25. Review
-
13
Doherty T J.
Invited review: Aging and sarcopenia.
J Appl Physiol.
2003;
95 (4)
1717-1727. Review
-
14
Phillips S K, Bruce S A, Newton D. et al .
The weakness of old age is not due to failure of muscle activation.
J Gerontol.
1992;
47 (2)
M45-49
-
15
Dirks A J, Leeuwenburgh C.
The role of apoptosis in age-related skeletal muscle atrophy.
Sports Med.
2005;
35 (6)
473-483. Review
-
16
Solomon A M, Bouloux P MG.
Modifying muscle mass – the endocrine perspective.
J Endocrinol.
2006;
191 (2)
349-360. Review
-
17
Heath K M, Elovic E P.
Vitamin D deficiency: implications in the rehabilitation setting.
Am J Phys Med Rehabil.
2006;
85 (11)
916-923. Review
-
18
Lips P.
Vitamin D physiology.
Prog Biophys Mol Biol.
2006;
92 (1)
4-8. Epub 2006 Feb 28. Review
-
19
Capiati D, Benassati S, Boland R L.
1,25(OH)2-vitamin D3 induces translocation of the vitamin D receptor (VDR) to the plasma membrane in skeletal muscle cells.
J Cell Biochem.
2002;
86
128-135
-
20
Roth S M, Zmuda J M, Cauley J A. et al .
Vitamin D receptor genotype is associated with fat-free mass and sarcopenia in elderly men.
J Gerontol A Biol Sci Med Sci.
2004;
59 (1)
10-15
-
21
Carmeli E, Coleman R, Reznick A Z.
The biochemistry of aging muscle.
Exp Gerontol.
2002;
37 (4)
477-489. Review
-
22
Kirkendall D T, Garrett W E.
The effects of aging and training on skeletal muscle.
Am J Sports Med.
1998;
26 (4)
598-602. Review
-
23
Roos M R, Rice C L, Vandervoort A A.
Age-related changes in motor unit function.
Muscle Nerve.
1997;
20 (6)
679-690
-
24
Campbell M J, McComas A J, Petito F.
Physiological changes in ageing muscles.
J Neurol Neurosurg Psychiatry.
1973;
36 (2)
174-182
-
25
Doherty T J, Brown W F.
The estimated numbers and relative sizes of thenar motor units as selected by multiple point stimulation in young and older adults.
Muscle Nerve.
1993;
16 (4)
355-366
-
26
Baudry S, Klass M, Duchateau J.
Postactivation potentiation influences differently the nonlinear summation of contractions in young and elderly adults.
J Appl Physiol.
2005;
98 (4)
1243-1250
-
27
D'Antona G, Pellegrino M A, Adami R. et al .
The effect of ageing and immobilization on structure and function of human skeletal muscle fibres.
J Physiol.
2003;
552 (Pt 2)
499-511
-
28
Frontera W R, Suh D, Krivickas L. et al .
Skeletal muscle fiber quality in older men and women.
Am J Physiol Cell Physiol.
2000;
279 (3)
C611-618
-
29
Erim Z, Beg M F, Burke D T. et al .
Effects of aging on motor-unit control properties.
J Neurophysiol.
1999;
82 (5)
2081-2091
-
30
DeLuca C J, Erim Z.
Common drive of motor units in regulation of muscle force.
Trends Neurosci.
1994;
17 (7)
299-305. Review
-
31
DeLuca C J, Erim Z.
Common drive in motor units of a synergistic muscle pair.
J Neurophysiol.
2002;
87 (4)
2200-2204
-
32
Enoka R M.
Neural strategies in the control of muscle force.
Muscle Nerve Suppl.
1997;
5
S66-69. Review
-
33
Duchateau J, Hainaut K.
Effects of immobilization on contractile properties, recruitment and firing rates of human motor units.
J Physiol.
1990;
422
55-65
-
34
Seki K, Taniguchi Y, Narusawa M.
Effect of joint immobilization on firing rate modulation of human motor units.
J Physiol (Lond).
2001;
530
507-519
-
35
Klass M, Baudry S, Duchateau J.
Voluntary activation during maximal contraction with advancing age: a brief review.
Eur J Appl Physiol.
2007;
100 (5)
543-551
-
36
Narici M V, Maganaris C N.
Adaptability of elderly human muscles and tendons to increased loading.
J Anat.
2006;
208 (4)
433-443. Review
-
37
Lieber R L, Friden J.
Functional and clinical significance of skeletal muscle architecture.
Muscle Nerve.
2000;
23
1647-1666
-
38
Wilkie D R.
The relation between force and velocity in human muscle.
J Physiol.
1949;
110
249-280
-
39
Maki B E, Holliday B J, Topper A K.
A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population.
J Gerontol.
1994;
49 (2)
M72-84
-
40
Meltzer I, Benjuya N, Kaplanski J.
Postural stability in the elderly: a comparison between fallers and non-fallers.
Age Ageing.
2004;
33 (6)
602-607
-
41
Cordo P, Inglis J T, Verschueren S. et al .
Noise in human muscle spindles.
Nature.
1996;
383 (6603)
769-770
-
42
Scheibel A B.
Falls, motor dysfunction, and correlative neurohistologic changes in the elderly.
Clin Geriatr Med.
1985;
1 (3)
671-677
-
43
Turano K, Rubin G S, Herdman S J. et al .
Visual stabilization of posture in the elderly: fallers vs. nonfallers.
Optom Vis Sci.
1994;
71 (12)
761-769
-
44
Lord S R, Webster I W.
Visual field dependence in elderly fallers and non-fallers.
Int J Aging Hum Dev.
1990;
31 (4)
267-277
-
45
Laughton C A, Salvin M, Katdare K. et al .
Aging, muscle activity, and balance control: physiologic changes associated with balance impairment.
Gait Posture.
2003;
18 (2)
101-108
-
46
Accornero N, Cappozza M, Rinalduzzi S. et al .
Clinical multisegmental posturography: age-related changes in stance control.
Electroencephalogr Clin Neurophysiol.
1997;
105 (3)
213-219
-
47
Allum J H, Carpenter M G, Honegger F. et al .
Age-dependent variations in the directional sensitivity of balance corrections and compensatory arm movements in man.
J Physiol.
2002;
542 (Pt 2)
643-663
-
48
Kerrigan D C, Lee L W, Nieto T J. et al .
Kinetic alterations independent of walking speed in elderly fallers.
Arch Phys Med Rehabil.
2000;
81 (6)
730-735
-
49
Kerrigan D C, Lee L W, Collins J J. et al .
Reduced hip extension during walking: Healthy elderly and fallers versus young adults.
Arch Phys Med Rehabil.
2001;
82
26-30
-
50
Kerrigan D C, Xenopoulos-Oddsson A, Sullivan M J. et al .
Effect of a hip flexor-stretching program on gait in the elderly.
Arch Phys Med Rehabil.
2003;
84
1-6
-
51
Hausdorff J M, Levy B R, Wei J Y.
The power of ageism on physical function of older persons: reversibility of age-related gait changes.
J Am Geriatr Soc.
1999;
47 (11)
1346-1349
-
52
Hausdorff J M, Rios D A, Edelberg H K.
Gait variability and fall risk in community-living older adults: a 1-year prospective study.
Arch Phys Med Rehabil.
2001;
82 (8)
1050-1056
-
53
Thies S B, Richardson J K, Ashton-Miller J A.
Effects of surface irregularity and lighting on step variability during gait: a study in healthy young and older women.
Gait Posture.
2005;
22 (1)
26
Univ.-Prof. Dr. Gerold R. Ebenbichler
Universitätsklinik für Physikalische Medizin und Rehabilitation, MUW, AKH Wien
Währinger Gürtel 18–20
A-1090 Wien
Email: Gerold.Ebenbichler@meduniwien.ac.at
