Validierung einer Testbatterie (Sturzrisiko-Index) zur Unterscheidung zwischen gestürzten und nicht gestürzten Personen und zur Identifizierung von durch Training modifizierbaren Parametern bei selbstständig lebenden und betreut/betreubar lebenden Senioren

Zusammenfassung

Hintergrund: Um potenziell sturzgefährdete Personen zu identifizieren und entsprechende Maßnahmen einzuleiten, muss möglichst zeitsparend das Sturzrisiko von Senioren bestimmt werden. Für die Planung von Interventionen ist es zusätzlich notwendig, die Schwächen und Stärken der Teilnehmer zu erheben.

Ziel: Die Studie zielte darauf ab, aus bereits vorhandenen Einzeltests eine Testbatterie zu entwickeln, die das Sturzrisiko möglichst präzise bestimmt. Angestrebt wurde eine zeitsparende Testbatterie, die die Teilbereiche des Gleichgewichts (kontinuierlich und proaktiv) und die Erhebung der Beinkraft abdeckt.

Methode: Die Studie umfasste 271 Senioren mit einem Durchschnittsalter von 80 Jahren, die zum Testzeitpunkt ein selbstständiges bzw. mit Alltagsunterstützung betreutes Leben führten. Die Unterteilung in gestürzte und nicht gestürzte Personen erfolgte anhand mündlicher Befragung (Einzelinterviews) über Sturzereignisse in den letzten 12 Monaten. Die Personen wurden in der Durchführung der einzelnen Tests instruiert. Die Messungen erfolgten mithilfe des T.F.T.-Systems und einem Beschleunigungsmesser (Accelerometer).

Ergebnisse: Zur Bildung des Sturzrisiko-Index wurde beim 5 Chair Rise Test die Aufstehgeschwindigkeit und die Zeit ausgeschlossen, da diese die Reliabilität nicht erhöhten. Beim Static Balance Test wurde die geschaffte Zeit und beim Alternate Step Test die benötigte Zeit gewertet. Beim Functional Reach Test wurde die erreichte Distanz und beim Maximum Step Test die überstiegene Distanz gemessen. Der Sturzrisiko-Index zeigte (angesichts der inhomogenen Untersuchungsgruppe) die beste, wenngleich mäßige, Unterscheidbarkeit von Nicht-Stürzern und Stürzern bei 2,5/5 erreichten Normwerten. Zusätzlich war eine gute Differenzierung zwischen betreut/betreubar und selbstständig lebenden Personen bei einem Cut-off von 2,5/5 Punkten möglich.

Schlussfolgerung: Die Unterscheidung zwischen gestürzten und nicht gestürzten Personen ist mit dem Sturzrisiko-Index mit mäßiger Genauigkeit möglich. Mit guter Differenzierungsmöglichkeit kann er in betreut/betreubar und selbständig lebende Personen unterscheiden. Bei einer heterogenen Personengruppe eignet sich der Sturzrisiko-Index dazu, das Sturzrisiko zu bestimmen und Interventionen auf Stärken und Schwächen hinsichtlich modifizierbarer Risikofaktoren und der Lebensumstände der teilnehmenden Personen auszurichten.

Abstract

Background: In order to identify subjects with potential risk of falling and to initiate concordant measures, the fall risk in the elderly must be assessed as time-saving as possible. For the management planning it is necessary to determine the participants’ strengths and weaknesses.

Objective: The aim of this study was the development of a test battery of already existing single tests that evaluates the fall risk as precisely as possible. The intention was a time-saving test battery covering the balance subareas (continued and proactive) as well as leg strength assessment.

Method: The study involved 271 community-dwelling and assisted living elderly with a mean age of 80 years. They were allocated into fallers and non-fallers using oral inquiries (single interviews) on their falling history during the last 12 months. The subjects were instructed concerning the test performance. The T.F.T. System and an accelerometer were used for the assessment.

Results: For the fall risk index the speed for standing up and time in the 5 chair rise test were excluded since they could not improve its reliability. In the static balance test the scored time and in the alternate step test the required time were counted. In the functional reach test the scored distance and in the maximum step test the exceeded distance were measured. The fall risk index showed (in view of the inhomogenous investigation group) an optimal – however moderate – cut-off at 2.5/5 of standard values reached to differentiate between fallers and non-fallers. In addition, it was possible to differentiate between assisted-living and community-dwelling elderly people at a cut-off at 2.5/5 points.

Conclusions: The fall risk index shows moderate accuracy in view of differentiation between fallers and non-fallers. It may be used to differentiate between assisted-living and community-dwelling persons. In heterogenous groups the fall risk index is suitable to assess the fall risk and to direct interventions towards the participants’ strengths and weaknesses related to risk factors and life circumstances.

Schlüsselwörter

Sturz im Alter - Sturzrisiko - Assessment - Accelerometer - selbstständige Senioren - kontinuierliches Gleichgewicht - proaktives Gleichgewicht - Beinkraft

Key words

falls in older people - fall risk - assessment - accelerometer - community-dwelling older people - continued balance - proactive balance - leg strength

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