Postural balance and associated factors with the fall risk assessed in older adults with type 2 diabetes mellitus

Carlos, Adriana Guedes; Dias, Vanessa da Nóbrega; Perracini, Monica Rodrigues; Doná, Flávia; Sousa, André Gustavo Pires; Gazzola, Juliana Maria

doi:10.1590/1981-22562023026.230161.pt

Tabla de contenido Anterior Actual Siguiente

Original Articles • Rev. bras. geriatr. gerontol. 27 • 2024 • https://doi.org/10.1590/1981-22562023026.230161.en linkcopy

Postural balance and associated factors with the fall risk assessed in older adults with type 2 diabetes mellitus

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective Identify clinical-functional factors associated to the risk of falls, assessed by Mini-BESTest in older adults with type 2 diabetes mellitus (T2DM).

Method This cross-sectional study. A total of 145 older adults aged ≥60 years were evaluated through sociodemographic variables (sex, age group, married, education level, general health status hearing and vision), Mini-BESTest, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and dual-task Timed Up and Go Test (TUG) Multiple logistic regression model was used.

Results The sensory orientation domain presented the highest average score, followed by the gait stability, anticipatory postural adjustments and postural responses domains. Factors associated to the risk of falls in older adults are: poor/very poor visual perception OR 3.40 (1.50-7.72); have respiratory diseases OR 8.00 (1.32-48.46); feeling dizzy OR 2.53 (1.10-5.80); and TUGT (dual task) time equal to or greater than 13.5 seconds OR 3.31 (1.03-10.64).

Conclusion Older adults in this study presented impaired postural balance, mainly in the postural responses domain. The knowledge of the factors associated with the risk of falls in older adults with T2DM allows for better guidance in prevention, assessment and intervention, in order to minimize the occurrence of falls and maintain or optimize postural balance. Several factors influenced this outcome, such as overweight, low physical activity and education, several comorbidities, polypharmacy, T2DM diagnosis for more than ten years, negative perception of general health and vision, and depressive symptoms.

Keywords
Older Adults; Accidental Falls; Postural Balance; Diabetes Mellitus; Health Evaluation

Categories	Occurrence	Percent (%)
Number of diseases
1 – 4	88	60.7
5 or more	57	39.3
Category of diseases
Infectious and parasitic	0	0.0
Neoplastic (tumors)	10	6.9
Blood, organs, hemopoietic and/or immune disorders	42	29.0
Mental and/or behavioral disorders	7	4.8
Eye and annex	29	18.6
Nervous system	9	6.2
Cardiovascular system	114	78.6
Respiratory system	13	9.0
Digestive system	18	12.4
Skin and/or subcutaneous tissue	3	2.1
Musculoskeletal system and/or tissue	57	39.3
Genitourinary	27	18.6
Number of medications
0 – 4	2	2.4
5 or more	91	62.8
Vision
Poor / Very Poor	65	44.8
Hearing
Poor / Very Poor	40	27.6
Time of T2DM diagnosis
0 – 5	42	29.0
6 or more	103	71.0
T2DM Medication
Does not use	6	4.1
Oral	94	64.8
Oral insulin +	32	22.1
Insulin	13	9.0
Handgrip strength
Low strength (the lowest quintile)	63	43.4
Falls in the last year
None	90	62.1
One fall	27	18.6
Two or more falls	28	19.3
Falls risk (Mini-BESTest)
No	69	47.6
Yes	76	52.4
Regular physical activity
Yes	38	26.2
Body Mass Index
Malnourished or normal weight	92	63.4
Overweight	53	36.6
Glycated hemoglobin (n=108)
Up to 8% (normal)	57	39.3
Above 8,1% (altered)	51	35.2
Fasting blood glucose (n=133)
Up to 130mg/dl (normal)	73	50.3
131mg/dl or more (altered)	60	41.4
Pain in lower limbs
Yes	75	57.1
Dizziness complaint
Yes	64	44.1
Global cognition
Positive screening	61	42.1
Depressive symptoms (GDS-15)
6 or more	68	47.2
Falls risk (dual-task TUGT) (n=136)
13.5 seconds or more (high)	112	77.2
High (low)	24	16.6

Mini-BESTest Domains	Mean (±SD) in %	95% CI
Anticipatory postural adjustment (%) tasks
Total	78.2 (17.1)	75.3 to 81.1
Seated to standing	97.1 (14.4)	94.7 to 99.5
Stand on tiptoe	87.1 (25.7)	82.9 to 91.4
Standing on one leg	53.2 (27.6)	48.6 to 57.8
Postural responses (%) tasks
Total	64.1 (31.9)	58.7 to 69.4
Forward	71.5 (37.9)	65.2 to 77.9
Backward	65.0 (36.8)	58.9 to 71.1
Side	55.0 (39.0)	48.5 to 61.5
Sensory orientation (%) taks
Total	93.6 (13.5)	91.3 to 95.8
Solid surface	98.2 (9.3)	96.6 to 99.7
Foam Surface	86.7 (28.5)	82.0 to 91.5
Tilt	95.7 (14.0)	93.4 to 98.1
Stability in gait (%) taks
Total	84.7 (17.70	81.7 to 87.6
Speed	91.8 (19.5)	88.5 to 95.0
Head turn	80.3 (26.6)	75.9 to 84.8
Axis turn	91.8 (20.4)	88.4 to 95.2
Overcome obstacle	80.3 (29.8)	75.4 to 85.3
Timed Up and Go Test	77.5 (29.6)	72.5 to 82.4

Variables and Categories	No	Yes	p-value
Sex
Male	34 (23.4%)	17 (11.7%)	0.001 *
Female	35 (24.1%)	59 (40.7%)
Vision
Excellent / very good / good	50 (34.5%)	30 (20.7%)	<0.001 *
Poor / Very Poor	19 (13.1%)	46 (31.7%)
Hearing
Excellent / very good / good	57 (39.3%)	48 (33.1%)	0.010 *
Poor / Very Poor	12 (8.3%)	28 (19.3%)
Regular physical activity
Yes	25 (17.2%)	13 (9.0%)	0.013*
No	44 (30.3%)	63 (43.4%)
Number of diseases
1 – 4	50 (34.5%)	38 (26.2%)	0.007 *
5 or more	19 (13.1%)	38 (26.2%)
Respiratory system
Yes	2 (1.4%)	11 (7.6%)	0.019 *
No	67 (46.2%)	65 (44.8%)
Falls in the last year
None	50 (34.5%)	40 (27.6%)	0.046 *
One fall	10 (6.9%)	17 11.7%)
Two or more falls	9 (6.2%)	19 (13.1%)
Dizziness complaint
Yes	20 (13.8%)	44 (30.3%)	0.001 *
No	49 (33.8%)	32 (22.1%)
Depressive symptoms (GDS-15)
6 or more	23 (16.0%)	45 (31.2%)	0.002 *
Up to 5	46 (31.9%)	30 (20.8%)
Falls risk (dual-task TUGT)
13.5 seconds or +	5 (3.7%)	19 (14.0%)	0.006 *
< 13.5 seconds	59 (43.4%)	53 (39.0%)

Predictor category	OR (95% CI)	p-value
Vision
Poor/very poor	3.40 (1.50 - 7.72)	0.003
Respiratory diseases
Yes	8.00 (1.32 - 48.46)	0.024
Dizziness complaint
Yes	2.53 (1.10 - 5.80)	0.028
Dual-task TUGT
13.5 seconds or more	3.31 (1.03 - 10.64)	0.045

location_on

Universidade do Estado do Rio Janeiro Rua São Francisco Xavier, 524 - Bloco F, 20559-900 Rio de Janeiro - RJ Brasil, Tel.: (55 21) 2334-0168 - Rio de Janeiro - RJ - Brazil
E-mail: revistabgg@gmail.com

rss_feed Acompañe los números de esta revista en su lector de RSS

[tfne1] T2DM: Type 2 Diabetes Mellitus; GDS: Geriatric Depression Scale; TUGT: Timed Up and Go Test; Mini-BESTest: Mini-Balance Evaluation Systems Test.