Yaşlılarda Düşmenin Değerlendirilmesi: Huzursuz Bacak Sendromu ile Düşmeler Arasında İlişki Var mı?

Year 2016, Volume: 16 Issue: 1, 0 - 0, 04.03.2016

Kamile Sılay , Hilal Özkaya Sema Akıncı Arife Ulaş Bülent Yalçın Ahmet Yalçın Esin Öztürk Merve Canbaz

https://doi.org/10.17098/amj.47556

Abstract

Amaç: Düşme riski yaşlı hastalarda ileri yaşa eşlik eden komorbid hastalıklar nedeni ile yüksektir. Sensörimotor bir bozukluk olan huzursuz bacak sendromu (HBS) parestezi ve motor semptomlar ile karakterize olup uyku bozukluklarına yol açar. Bu çalışmanın amacı geriatrik hastalarda huzursuz bacak sendromunun düşmeler üzerine etkisini ve düşmelerle ilişkili diğer risk faktörlerini araştırmaktır.

Materyal ve Metot: Çalışmamız kesitsel olup, 65 yaş ve üzeri hastaları kapsamaktadır. HBS tanısı Uluslararası Huzursuz Bacak Sendromu Çalışma Grubu, 2012 kriterlerine göre konulmuştur. Hastalar kapsamlı geriatrik muayene ile değerlendirilmiştir. HBS, geriatrik problemler ve düşmeler arasındaki ilişki binominal lojistik regresyon ile analiz edilmiştir.

Bulgular: Çalışmaya toplam 70 hasta alınmıştır. Hastaların otuz yedisi kadın olup, %44.3’ü yaşlı bakım evinde kalmaktadır. Huzursuz bacak sendromu oranı %15.7’dir. Bir önceki yılda düşme oranı %24.3’tür. Komorbidite ve polifarmasi oranları sırasıyla %37.1 ve % 65.7’dir. Çalışmaya katılanların %21.4’ü günlük yaşam aktivelerinde (GYA) bağımlı bulunmuşken; %40’ında kalk ve yürü testi pozitiftir. Depresyon ve kognitif bozukluk tarama testleri sırasıyla %47.1 ve %38.6’sında pozitiftir. Huzursuz bacak sendromu, kalk ve yürü testi ile düşmeler arasındaki ilişki istatiksel olarak anlamlı bulunmuştur (p=0.041, OR=6.59 ve p=0.046, OR=6.31).

Sonuç: Çalışmamız huzursuz bacak sendromunun yaşlı hastalarda düşmeler için bir risk faktörü olduğunu göstermiştir. Bu çalışma klinisyenlerin huzursuz bacak sendromunun bir düşme riski olabileceği konusundaki duyarlılığını arttıracaktır. Yaşlı hastalarda düşmelere sebep olan risk faktörleri araştırılıp, modifiye edilirken huzursuz bacak sendromu da göz önünde bulundurulmalıdır. Ayrıca düşme ve pozitif kalk ve yürü testi ilişkisi de anlamlı bulunmuştur. Bu bağlamda kalk ve yürü testi düşme değerlendirmesinin önemli bir parçası olarak ele alınmalıdır.

Keywords

Huzursuz Bacak Sendromu, Düşme, Geriyatrik Değerlendirme, Komorbidite

Assessment of Falls in Older People: Is There any Association Between Restless Leg Syndrome and Falls?

Abstract

Objectives: The fall risk increases in the elderly due to comorbidities and age. Restless legs syndrome (RLS) might be a potential risk factor since it is a sensorimotor disorder. It is associated with paresthesias and motor restlessness which may cause sleep problems. The aim of this study is to evaluate the effect of restless legs syndrome on falls among geriatric patients and identify the other risk factors for falls.

Materials and Methods: This is a cross sectional study including patients 65 years and older. The diagnosis of RLS was established with 2012 International Restless Legs Syndrome Study Group criteria. Patients were evaluated with comprehensive geriatric assessment. The association between falls and RLS and geriatric conditions was evaluated with binominal logistic regression analysis.

Results: There were total 70 patients in the study. 44.3% of patients were living in the assisted living facility. There were 37 females. The rate of restless legs syndrome was shown 15.7%. The number of falls in the last one year was 24.3%. The rate of comorbidity and polypharmacy was 37.1% and 65.7% respectively. 21.4% patients were dependent on activities of daily living (ADL) and 40% had positive timed up and go (TUG) test. Possible depression and cognitive impairment rate was found 47.1% and 38.6 respectively. The association between falls and RLS and positive TUG test was found statistically significant (p=0.041, OR=6.59 and p=0.046, OR=6.31).

Conclusion: Our study revealed that RLS is a risk factor for falls in elderly. It is essential to address and modify the underlying risk factors including RLS in older patients. This finding would increase the awareness of physicians about RLS as a risk factor for falls. Also the association between falls and positive TUG test has been found statistically significant. Our study suggests that performing TUG test should be an essential part of fall evaluation.

Keywords

Restless Leg Syndrome, Falls, Geriatric Assessment, Comorbidity

References

• Ohayon MM, O'Hara R, Vitiello MV. Epidemiology of restless legs syndrome: a synthesis of the literature. Sleep Med Rev 2012; 16(4): 283-95.
• Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 2003; 4(2): 101-19.
• International Restless Legs Syndrome Study Group, 2011 revised diagnostic criteria.
• Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, et al. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance. Sleep Med 2014; 15(8): 860-73.
• Pasquetti P, Apicella L, Mangone G. Pathogenesis and treatment of falls in elderly.Clin Cases Miner Bone Metab. 2014; 11(3): 222-5.
• Carlson C, Merel SE, Yukawa M. Geriatric syndromes and geriatric assessment for the generalist. Med Clin North Am. 2015; 99(2): 263-79.
• Tchalla AE, Dufour AB, Travison TG, Habtemariam D, Iloputaife I, Manor B et al. Patterns, predictors, and outcomes of falls trajectories in older adults: the MOBILIZE Boston Study with 5 years of follow-up. PLoS One. 2014 ; 9(9): e106363.
• Luk JK, Chan TY, Chan DK. Falls prevention in the elderly: translating evidence into practice. Hong Kong Med J. 2015 ; 21(2):165-71.
• Trombetti A, Reid KF, Hars M, Herrmann FR, Pasha E, Phillips EM et al. Age-associated declines in muscle mass, strength, power, and physical performance: impact on fear of falling and quality of life. Osteoporos Int. 2016; 27(2): 463-71.
• Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med 2003; 348(1): 42-9.
• Jodaitis L, Vaillant F, Snacken M, Boland B, Spinewine A, Dalleur O et al. Orthostatic hypotension and associated conditions in geriatric inpatients.Acta Clin Belg. 2015 Aug;70(4):251-8.
• Cattagni T, Scaglioni G, Cornu C, Berrut G, Martin A. What are the effects of the aging of the neuromuscular system on postural stability? Geriatr Psychol Neuropsychiatr Vieil. 2015 ;13(4): 363-80.
• Chang JT, Morton SC, Rubenstein LZ, Mojica WA, Maglione M, Suttorp MJ, et al. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomized clinical trials. BMJ 2004; 328(7441): 680.
• Tinetti ME, Williams CS. The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci 1998; 53(2): M112-9.
• Gupta S, Gupta SK, Devkota S, Ranjit A, Swaroop M, Kushner AL et al. Fall Injuries in Nepal: A Countrywide Population-based Survey. Ann Glob Health. 2015; 81(4):487-94.
• Kim SB, Zingmond DS, Keeler EB, Jennings LA, Wenger NS, Reuben DB et al. Development of an algorithm to identify fall-related injuries and costs in Medicare data. Inj Epidemiol. 2016; 3:1. Epub 2016 Jan 5.
• American Geriatrics Society, British Geriatrics Society. 2010 AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons. New York: American Geriatrics Society; 2010.
• Katsi V, Katsimichas T, Kallistratos MS, Tsekoura D, Makris T, Manolis DAJ, et al. The association of Restless Legs Syndrome with hypertension and cardiovascular disease. Med Sci Monit. 2014; 20: 654–9.
• Emma Barry, Rose Galvin, Claire Keogh, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis. BMC Geriatr. 2014; 14: 14.
• de Souza Moreira B, Mourão Barroso C, Cavalcanti Furtado SR, Sampaio RF, Drumond das Chagas e Vallone ML, Kirkwood RN. Clinical functional tests help identify elderly women highly concerned about falls. Exp Aging Res. 2015; 41(1):89-103.
• Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ. Will my patient fall? JAMA. 2007; 297(1): 77-86.
• Aizenberg D, Weizman A, Weiss A, Akopian M, Amitai M, Beloosesky Y. The Association in Elderly Hospitalized Patients, Between Psychotropic Drugs and Hip Fractures Resulting from Falls. Exp Aging Res. 2015; 41(5):546-55.