Participação dos sistemas de manutenção do equilíbrio corporal, do risco de quedas e do medo de cair em idosos e longevos

Abstract

Introduction: Loss of balance limits the life of the elderly as it is related to falls. The balance is maintained by the action of four Balance-Maintenance-Systems (BMS): vestibular, visual, somatosensory, and visual preference whose information is organized by the central nervous system (CNS). The CNS receives and organizes sensory information and plans the actions of effector organs responsible for maintaining body balance. The oldest-old (80 years or older) is the age group with the highest prevalence of falls and least studied. Objective: To study the involvement of mechanisms to maintain body balance, the risk of falls and fear of falling in elderly and oldest old. Methods: The participation of BMS was conducted in two groups: 32 elderly (60-69 years) and 30 oldest-old (80 years or more) performing cognitive screening (Mini Mental State Examination - MMSE), assessment of risk of falls (Timed Up and Go - TUG), fear of falling (Falls Efficacy Scale - FES) and Sensory Organization Test (SOT) by foam-laser dynamic posturography. This research project was approved by the Scientific Committee of the Institute of Geriatrics and Gerontology - PUCRS and by the Ethics Committee in Research of PUCRS. Results: The oldest-old performed worse in all SOT, significantly in those with somatosensory conflict. Significant differences were observed between elderly and oldest-old in the systems: visual (91.1±6.1 and 54.8±43.7), vestibular (76.5±9.8 and 38.3±33.3) and visual preference (78.9±17.8 and 64.2±23.3), with similar performance in somatosensory (86.8±7.9 and 83.8±17.3). TUG and FES differ significantly between the groups and associated with scores of SME. The association between TUG and the visual system was affected by the MMSE and FES. Physical activity and education were associated with scores of SME. Conclusions: We conclude that SME most affected were the vestibular and visual. Differences between elderly and oldest-old were higher than expected for the visual and vestibular systems, but smaller in the somatosensory system. Dynamic posturography may be efficient to guide rehabilitation programs encouraging the use of more appropriate strategies for each elderly or oldest-old.