walking speed was the best physical performance measure for predicting the onset of functional dependence in a Japanese rural older population.

Having a high level hand-grip strength, good intellectual activities, and good social roles are strongly associated with remaining independence in IADL for the nondisabled Japanese persons aged > or = 65.

Spinalenheter og andre enheter2036 I Tidsskriftet nr. 14/2012 om temaserien om ryggmargsskader problematiserer Ragnar Stien to felter (1): begrepet «spi-nalenhet» på den ene siden og viktigheten av tette bånd mellom akuttbehandling og rehabilitering og oppfølging av rygg-margsskader på den andre. Det er viktig at akuttbehandlere har kunnskap om langtidsutfall som grunnlag for evaluering av sin virksomhet i tillegg til at det bør vaere tett kontakt og felles vurderinger når det gjelder eventuell kirurgisk behandling av komplikasjoner. Stien har nok et poeng i at samarbeid mellom akutt-og rehabiliteringsmiljøene kan forbedres, selv om mitt inntrykk er at dette står i sentrum hos de ryggmargs-skadebehandlende og-rehabiliterende miljøene i Norge. Et tettere samarbeid er nok ikke minst også mulig mellom miljøene som gjennomfører kirurgisk behandling av ryggmargsskadede. Når det gjelder begrepsbruken, synes Stien å forutsette at begrepet «enhet» kun kan brukes hvis behandlingen på en enhet omfatter alt fra akuttbehandling til langtidsoppfølging. Jeg tror få avdelinger i norsk helsevesen er organisert slik. Et eksempel er slagenhetene som står for akuttbehandling og tidlig rehabilitering av slagpasienter de første par ukene etter slaget, men som regel ikke videre oppfølging, unntatt eventuelt en poliklinisk kontroll 3-6 måneder etter slaget (som heller ikke alltid er tett knyttet opp mot slagenheten). Mye av den videre behandlingen og oppfølgingen innenfor spesialisthelsetjenesten, spesielt den delen som er rettet mot funksjonsnedsettelsene på grunn av hjerneslaget, skjer i reha-biliteringsavdelinger. Selv om dagens slagenheter dermed ikke er «comprehensive» i den forstand Stien nevner, synes «slagenhet» å vaere et nyttig begrep.

Falls are common in elderly people. Possible consequences include serious injuries and the post-fall syndrome, with functional decline and limitation of physical activity. The present randomized controlled study sought to clarify the benefits of a combined long-term and home-based fall prevention program for elderly Japanese women. The subjects were individuals aged over 73 years, living at home in a western suburb of Tokyo, who had attended a comprehensive geriatric health check. Persons with a marked decline in the basic activities of daily living (ADL), hemiplegia, or those missing baseline data were excluded. Fifty-two subjects who expressed a wish to participate in the trial were randomized, 28 to an exercise-intervention group and 24 to a control group. Baseline data for age, handgrip force, walking speed, total serum cholesterol, serum albumin, basic ADL, visual and auditory impairments, self-rated health, and experience of falls did not differ significantly between the two groups. Beginning from June 2000, the intervention group attended a 6-month program of fall-prevention exercise classes aimed at improving leg strength, balance, and walking ability; this was supplemented by a home-based exercise program that focused on leg strength. The control group received only a pamphlet and advice on fall prevention. The average rate of attendance at exercise class was 75.3% (range, 64% to 86%). Participants showed significant improvements in tandem walk and functional reach after the intervention program, with enhanced self confidence. At the 8-month follow-up, the proportion of women with falls was 13.6% (3/22) in the intervention group and 40.9% (9/22) in the control group. At 20 months, the proportion remained unchanged, at 13.6% in the intervention group, but had increased to 54.5% (12/22) in the control group, which showed a statistically significant difference between the two groups (Fisher's exact test; P = 0.0097). The total number of falls during the 20-month follow-up period was 6 in the intervention group and 17 in the control group. We conclude that a moderate exercise intervention program plus a home-based program significantly decreases the incidence of falls in both the short and the long term, contributing to improved health and quality of life in the elderly.

ObjectivesTo determine age- and sex-specific reference values for six physical performance measures, i.e. hand-grip strength, one-legged stance, and gait speed and step length at both usual and maximum paces, and to investigate age and sex differences in these measures among community-dwelling older Japanese adults.MethodsWe conducted a pooled analysis of data from six cohort studies collected between 2002 and 2011 as part of the Tokyo Metropolitan Institute of Gerontology-Longitudinal Interdisciplinary Study on Aging. The pooled analysis included cross-sectional data from 4683 nondisabled, community-dwelling adults aged 65 years or older (2168 men, 2515 women; mean age: 74.0 years in men and 73.9 years in women).ResultsUnweighted simple mean (standard deviation) hand-grip strength, one-legged stance, usual gait speed, usual gait step length, maximum gait speed, and maximum gait step length were 31.7 (6.7) kg, 39.3 (23.0) s, 1.29 (0.25) m/s, 67.7 (10.0) cm, 1.94 (0.38) m/s, and 82.3 (11.6) cm, respectively, in men and 20.4 (5.0) kg, 36.8 (23.4) s, 1.25 (0.27) m/s, 60.8 (10.0) cm, 1.73 (0.36) m/s, and 69.7 (10.8) cm, respectively, in women. All physical performance measures showed significant decreasing trends with advancing age in both sexes (all P<0.001 for trend). We also constructed age- and sex-specific appraisal standards according to quintiles. With increasing age, the sex difference in hand-grip strength decreased significantly (P<0.001 for age and sex interaction). In contrast, sex differences significantly increased in all other measures (all P<0.05 for interactions) except step length at maximum pace.ConclusionOur pooled analysis yielded inclusive age- and sex-specific reference values and appraisal standards for major physical performance measures in nondisabled, community-dwelling, older Japanese adults. The characteristics of age-related decline in physical performance measures differed between sexes.