GERİATRİK TİP 2 DİYABETES MELLİTUS OLAN HASTALARDA DENGE PARAMETRELERİ VE DÜŞME KORKUSUNUN İLİŞKİSİ

Abstract

Purpose: The purpose of this study is to investigate the effects of FOF on balance in elderly with Type 2 DM.

Methods: The study included 31 Type-2 DM patients who were diagnosed by a specialist doctor and 29 healthy control groups over aged of 55 years. Fear of falling was assessed by International Fall Efficacy Scale. The balance parameters about center of the pressure which are COP length and COP velocity were measured and recorded by the Zebris FDM-2 instrument in standing position. Mobility of the individuals was assessed by timed up and go test. 

Results:There was significant difference between diabetic and control groups regarding COP parameters (p<0.05). In the diabetic patients, there was a statistically significant relationship between fear of falling, COP length and COP velocity (p<0.05). There was significant correlation between COP velocity, COP length and TUG (p<0.05).

Conclusion: In elderly with Type 2 DM, more balance disturbances occurs compared to age matched individuals without DM and fear of falling can affect balance negatively in geriatric type 2 diabetes patients.

RELATIONSHIP BETWEEN BALANCE AND FEAR OF FALLING IN GERIATRIC TYPE 2 DIABETES MELLITUS PATIENTS

Öz

Purpose: The purpose of this study was to compare balance parameters and fear of falling in geriatric individuals with and without type 2 diabetes (DM), and to investigate the relationship between balance and fear of falling in these groups.

Methods: The study included 31 type 2 DM patients who were diagnosed by a specialist doctor and 29 age matched controls. Fear of falling was assessed using the International Fall Efficacy Scale. The balance parameters including center of the pressure (COP) which are the COP length and the COP velocity were measured and recorded using the gait analysis system, Zebris FDM-2 instrument, in standing position. Balance was also assessed using timed up and go test (TUG).

Results: There was a significant difference between diabetic and control groups regarding COP length (p=0.021) and COP velocity (p=0.028). In the diabetic patients, there was a statistically significant relationship between fear of falling and COP length (p=0.001) and COP velocity (p= 0.001). There was a significant correlation between TUG and COP velocity (p<0.001) and COP length (p< 0.001) in type 2 DM patients.

Conclusion: In elderly with type 2 DM, increased balance disturbances occurred compared to age matched individuals without DM, and fear of falling was associated with balance in geriatric type 2 DM patients. It is therefore important to understand the changes occurring in balance so that future complications may be prevented, early diagnosis and intervention may be achieved in the event of a problem, and a decision about appropriate approaches for treatment can be made.

Anahtar Kelimeler

• Balance,Diabetes Mellitus,Fear of Falling

References

1. 10. Ulus Y, Durmus D, Akyol Y, Terzi Y, Bilgici A, Kuru O. Reliability and validity of the Turkish version of the Falls Efficacy Scale International (FES-I) in community-dwelling older persons. Archives of gerontology and geriatrics. 2012;54(3):429-33.
2. 11. Kim S, So WY. Prevalence and correlates of fear of falling in Korean community-dwelling elderly subjects. Experimental gerontology. 2013;48(11):1323-8.
3. 12. Anjos DMC, Gomes LPO, Sampaio LMM, Correa JCF, Oliveira CS. Assessment of plantar pressure and balance in patients with diabetes. Archives of Medical Science : AMS. 2010;6(1):43-8.
4. 13. Lin D, Seol H, Nussbaum MA, Madigan ML. Reliability of COP-based postural sway measures and age-related differences. Gait & posture. 2008;28(2):337-42.
5. 14. Winter DA, Patla AE, Frank JS. Assessment of balance control in humans. Med prog technol. 1990;16(1-2):31-51.
6. 15. Lafond D, Corriveau H, Hébert R, Prince F. Intrasession reliability of center of pressure measures of postural steadiness in healthy elderly people. Archives of physical medicine and rehabilitation. 2004;85(6):896-901.
7. 16. Baloh RW, Jacobson KM, Enrietto JA, Corona S, Honrubia V. Balance disorders in older persons: quantification with posturography. Otolaryngology—Head and Neck Surgery. 1998;119(1):89-92.
8. 17. Baloh RW, Jacobson KM, Beykirch K, Honrubia V. Static and dynamic posturography in patients with vestibular and cerebellar lesions. Archives of neurology. 1998;55(5):649-54.

9. 18. Ekdahl C, Jarnlo GB, Andersson SI. Standing balance in healthy subjects. Evaluation of a quantitative test battery on a force platform. Scandinavian journal of rehabilitation medicine. 1989;21(4):187-95.
10. 19. Le Clair K, Riach C. Postural stability measures: what to measure and for how long. Clinical Biomechanics. 1996;11(3):176-8.
11. 1. DeFronzo RA, Ferrannini E, Zimmet P, Alberti G. International Textbook of Diabetes Mellitus, 2 Volume Set: John Wiley & Sons; 2015.
12. 20. Jakobsen MD, Sundstrup E, Krustrup P, Aagaard P. The effect of recreational soccer training and running on postural balance in untrained men. European journal of applied physiology. 2011;111(3):521-30.
13. 21. Reelick MF, van Iersel MB, Kessels RP, Rikkert MGO. The influence of fear of falling on gait and balance in older people. Age and ageing. 2009;38(4):435-40.
14. 22. Moreira Bde S, Dos Anjos DM, Pereira DS, Sampaio RF, Pereira LS, Dias RC, et al. The geriatric depression scale and the timed up and go test predict fear of falling in community-dwelling elderly women with type 2 diabetes mellitus: a cross-sectional study. BMC geriatrics. 2016;16:56.
15. 23. Haas BM, Burden AM. Validity of weight distribution and sway measurements of the Balance Performance Monitor. Physiotherapy Research International. 2000;5(1):19-32.
16. 24. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical therapy. 2000;80(9):896-903.
17. 25. Chiba Y, Kimbara Y, Kodera R, Tsuboi Y, Sato K, Tamura Y, et al. Risk factors associated with falls in elderly patients with type 2 diabetes. Journal of diabetes and its complications. 2015;29(7):898-902.
18. 26. Kukidome D, Nishikawa T, Sato M, Nishi Y, Shimamura R, Kawashima J, et al. Impaired balance is related to the progression of diabetic complications in both young and older adults. Journal of diabetes and its complications. 2017.
19. 2. Shah AD, Langenberg C, Rapsomaniki E, Denaxas S, Pujades-Rodriguez M, Gale CP, et al. Type 2 diabetes and incidence of a wide range of cardiovascular diseases: a cohort study in 1· 9 million people. The Lancet. 2015;385:S86.
20. 3. Atlas D. International Diabetes Federation. IDF Diabetes Atlas, 8th edn. Brussels, Belgium: International Diabetes Federation, 2017.
21. 4. Tilling LM, Darawil K, Britton M. Falls as a complication of diabetes mellitus in older people. Journal of diabetes and its complications. 2006;20(3):158-62.
22. 5. Morrison S, Colberg SR, Mariano M, Parson HK, Vinik AI. Balance training reduces falls risk in older individuals with type 2 diabetes. Diabetes care. 2010;33(4):748-50.
23. 6. Tander B, Atmaca A, Ulus Y, Tura Ç, Akyol Y, Kuru Ö. Balance performance and fear of falling in older patients with diabetics: a comparative study with non-diabetic elderly. Turkish Journal of Physical Medicine & Rehabilitation/Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi. 2016;62(4).
24. 7. Tinetti ME, Powell L. Fear of falling and low self-efficacy: a cause of dependence in elderly persons. Journal of gerontology. 1993.
25. 8. Maki BE, Holliday PJ, Topper AK. Fear of falling and postural performance in the elderly. Journal of gerontology. 1991;46(4):M123-M31.
26. 9. Huurnink A, Fransz DP, Kingma I, van Dieën JH. Comparison of a laboratory grade force platform with a Nintendo Wii Balance Board on measurement of postural control in single-leg stance balance tasks. Journal of biomechanics. 2013;46(7):1392-5.