Objectives: Falls by elderly people area frequent cause of morbidity and mortality, especially in institutionalized elders. to describe the features of falls among institutionalized elderly people.

Methods & Materials: characteristics of falls in the preceding six months (March 2006 - September 2006) that occurred among elder lies (aged over 60years) with normal physical function and cognitive status, who lived at Kahrizak Institute, along term nursing home in Tehran, were surveyed and analyzed.

Results: The mean age of the patients with falls was 76.9 yrs. These numbers of falls had occurred among 29 elders that 48.3% were women and 51.7% were men. 57.6% off alls were simple and elders could standup immediately independently. 42.4% of falls needed to help for standup, 2 elder person (2.6%) had sever consequence of fall and had fractures. (Skull fracture, head trauma & hip fracture) 30.3% of falls occurred in yard, 28.9% at room, 18.4%inhallway, 14.5% at WC, .3.9%at bathroom, and 3.9% at lunch saloon. Analysis of the time of falls showed: 45.3% of falls occurred at 7bl2 am, 13.2% at the lunch time (12bI4), 17% at 14b19, 11.3%at night (19b4 am), and 13.2% at 4b7 am.

Conclusion: falls among elder lies occur mainly outside of room. And occur at the time of maximum activities, for example at morning; also falls have been happened more in subjects older, and occasionally result in sever injury such as head trauma, skull fracture, femur and pelvis fracture and cause more mortality and morbidity. Control of environmental risk factors could be protective factors against falls.

Objectives: To investigate the effect of Romberg exercise on balance improvement in elderly persons, 70 elderly persons with the history of two or more falling during recent 3 months were selected from Kahrizak nursing home in Tehran (38 as cases and 32 as controls).

Methods & Materials : Romberg exercise was done in case group every day (45 minute per day and one time each day) for 3 months. Among all persons, 28 persons in case group and 21 persons in control group were followed for 6 months and incidence and frequency of falling were assessed during this time.

Results: The Incidence of one or more falling in case and control groups was 31.3% and 47.6% in men and 57.9% and 27.3% in women, respectively. We found no significant relation between gender and the incidence of falling (P=0.460). Also, no significant relation was found between age and incidence (P=0.554) and frequency of falling (P=0.144) in elderly persons.

Conclusion: Although the effect of Romberg exercise on improvement of balance disturbance and falling was not demonstrated, it needs additional studies with larger sample size and longer follow-up.

Objectives: Poor balance is one of risk factors of falling, a cause of injury and even death in elderly. The aim of this study was to evaluate the effect of a water exercise program on static and dynamic balance in elder women.

Methods & Materials: Thirty participants aged 55-70 years completed an exercise program (60 min, 3 days and 6 weeks), in 2 groups, exercise and control, voluntarily. Static and dynamic balances were measured before and after exercise program in both groups. Postural sway parameters, including mean displacement of center of pressure and velocity of center of pressure in Medio-Lateral (ML) and Anterio-Posterior (AP) directions, in single stance position, as a measure of static balance and functional reach test, functional reach right test and functional reach left test, as dynamic measure of balance was considered. T test for deepened groups was used for evaluation of changes within groups, and T test for independent groups was used for between groups' changes at threshold of 0.05 After 6 weeks.

Results: Significant changes were observed in results of Functional Reach Test (FRT), Functional Reach Left Test (FRLT) after exercise program, also in average displacement of cop and velocity of cop in ML direction. Between groups significant differences were observed in results of average cop displacement and velocity of displacement, FRT and FRLT.

Conclusion: These results suggest that challenging the physiological systems involved in balance control, in water, while on the non stable support surface, improved both static and dynamic balance and probably might decrease the risk of falling.

Objectives: Verbal instructions related to directing the focus of attention to the movement itself or to its effects on or outcomes in the environment affects learning and performing movement skills. The pattern of these effects differs with increase in task difficulty. The goal of this study was to explore the effects of support surface and attention focus on the balance in elderly.

Methods & Materials: Twenty-eight elderly (65 & older) with a history of one or more falls in the last year were participated in the study. The design of the study was two factors within group with repeated measures. Participants were tested in two conditions of moving and stable support surface and three conditions of baseline, internal, and external focus of attention.

Results: Difference in support surface from stable to moving (i.e. increasing task difficulty) generally decreased the level of performance. There was a strong interaction between conditions off support surface and conditions of attention focus (P<0.001). The maximum decrease in performance happened in internal focus of attention/moving support surface and the minimum decrease occurred in external focus of attention/moving support surface.

Conclusion: The effectiveness of the external focus of attention was most significant and more beneficial to the balance performance in the moving unstable support surface (increased task difficulty) than other conditions of attention focus. The interesting finding was that not instructing at all is more effective on balance performance than internal focus of attention instruction in elderly people with a history of falling.

Objectives: This study aimed to identify elderly fallers and non-fallers by balance test under dual tasks conditions.

Methods & Materials: This study was an analyze-comparative study. Subjects were from three park of Tehran. Subjects were 20 older adults with outhistory of falls (aged 75.95±6.28 years) and 21 older adults with a history of 2 or more falls in the previous one year (aged 72.50±7.31 Years) . All subjects performed Timed Up & Go test under 3 conditions (TimedUp & Go, Timed Up & Go with numbers counter randomly [TUG cognitive], and Timed Up & Go while carrying a full cup of water [TUG manual]). A multivariate analysis of variance and logistic regression analyses were performed.

Results: The results showed significant difference between elderly fallers and non fallers in fall risk composed dependent variable (P=0.0005), as the non fallers had greater score than the elderly fallers. Also, results showed that TUG cognitive has prediction capacity of elderly fall (P=0.013).

Conclusion: Consequently, balance under cognitive dual task conditions could be useful method in identification of risk of falling and planning dual task exercise program and physiotherapy to preventfalls.

Objectives: This study aimed to compare elderly fallers and non fallers by balance test under dual tasks conditions.

Methods & Materials: This study was a analyse-comparative study. Subjects were chosen from three parks of Tehran. Subjects were 20 older adults with no history of falls (aged 72.60±5 years) and 21 older adults with a history of 2 or more falls in the last one year (aged 74.50±6 Years). All subjects performed speed gait test under 3 conditions (speed gait, speed gait with numbers counter randomly [speed gait cognitive], and speed gait while carrying a full cup of water [speed gait manual]). Data was analysed from multivariate analysis with SPSS 17.

Results: The results showed significant difference between elderly fallers and non fallers in fall risk composed dependent variable (P=0.0005), as the non fallers had greater score than elderly fallers.

Conclusion: Consequently, we can apply the Gait Speed test under both dual task conditions (Cognitive and Motor) for identification of risk of falling in elderly adults with and without of falling history.

Objectives: The purpose of this study was to examine the effect of core stabilization Abstract training program on falling in elderly population.

Methods & Materials: For this clinical trial study, forty elderly female subject (age: 70.58±5.98 years, weight: 55.76±5.78 kg, height: 157.76±7.8 cm) voluntarily participated. A week prior to starting training program the balance measured with the Berg Balance Test (BBT) and subjects divided into two groups, based on obtained score in BBT low risk falling (group 1), high risk falling (group 2) groups. Then subjects divided to two control & Experimental groups. The Experimental groups performed a core stabilization program included three levels for 6- week and three times per week on the alternate day and 30 min in section. The post-test of BBT were done for two groups afterwards. Independent and dependent t-test used to analyze the data. Significant level Considered to be %0.05.

Results: In group 1&2 no Significant differences shown for pretest of balance between control & experimental groups (P=0.486, P=0.193). The balance of experimental groups compared to control groups improved after training program (P=0.007, P=0.000). Rate of improvement in experimental groups 1 and 2 were 3.38% and 15/06% and fore control groups were 0.95% and 3.7% respectively.

Conclusion: Core stabilization training program may improve balance and decrease falling in elderly.

Objectives: The purpose of this study was to investigate relationship between body composition indices with static and dynamic balance and rate of falling in active elderly people.

Methods & Materials: This research was a correlation study. Active elderly women volunteered for participation in this research (n=45). Body composition indices (body fat mass, fat free mass, body mass index, waist to hip ratio) measured with the body composition analyzer. Static and dynamic balance measured by Biodex, with postural stability and fall risk tests, respectively. Also, the rate of falling in the previous 1- year asked for subjects. Statically analyses performed with the Pearson correlation test, significant level was set at P≤0.05. SPSS software was used.

Results: The results of this study showed all of body composition indices have significant correlation with static and dynamic balance and rate of falling (P≤0.05).

Conclusion: The finding of this research showed that all of body composition indices have significant correlation with static and dynamic balance and rate of falling in active elderly people. Therefore, it seems physical activity through improvement of body composition indices in active elderly people, causes improvement of static and dynamic balance and lowering the rate of falling.

Objectives: Falling is a main problem in all health systems and approximately 30% of elderly experience one or more falling every year. Cognitive function is known to be a main risk factor for elderly falling. In this study we aim to compare general health and general cognitive status in elderly with and without history of falling.

Methods & Materials: In this study 22 elderly without history of falling (15 M, 7 FM) were evaluated and compared with 31 elderly with history of falling (21 M, 10 FM) using general health questionnaire (GHQ) and MMSE. Independent t-test is used for data analysis.

Results: Findings showed that differences of general health (P=0.009), and subtest of anxiety and sleep disorder (P=0.004) between two groups are significant. Means comparison showed worst status in elderly with history of falling than those without in general health, sleep disorder, and anxiety. Significant difference between cognitive health score of faller and non-faller elders was seen (P=0.022). Comparing means showed more cognitive impairment in elderly with history of falling than those without history of falling.

Conclusion: This study confirms relationship between anxiety, sleep disorder and falling. Sleep disorder may cause falling due to dizziness. Anxiety and fear of falling may cause limited physical activity, balance, and increased risk of falling. Therapeutic methods in reducing anxiety would avoid falling. In addition, cognitive therapy for elderly can reduce the risk of falling.

Objectives: Falling down is one of the most common problems that involve old people. It may affect the physical, emotional and social aspects of individual’s health and may cause economical and social problems for individuals and society.

Methods & Materials: In a cross sectional study, 750 old people with ages of 55 or more, living in the city of Shiraz (409 female, 341 male, mean ages 67.32 year) with a convenience sampling method took part in this study. A questionnaire was designed to gather the information about the history of falling down on past year, its complications and the possible associated factors. Chi square and Mann_ Witeny test and logistic regression method was used to analyze the study data.

Results: the prevalence of falling down was 33.6%. 20.4% of people had single falling down and 13.2% of them had recurrent falling down. There were significant correlations between falling down and age (P=0.016), sex (P<0.001), diabetes (P=0.008), vertigo (P<0.0001). However no significant correlation was found between falling down with arthritis, heart disease, nervous system disease, rheumatologic disease, hypertension and use of cane and glass. There were significant correlation between recurrent falling down and sex (P=0.021), vertigo (P<0.0001) and osteoporosis (P=0.024). Also, use of cane (P=0.023) and arthritis (P=0.048) were associated with falling down with injury.

Conclusion: According to results of this study, one third of old people over 55 year living in the community experienced falling down within one year. Diabetes and vertigo increased the risk of falling down in elderly population. Planning for controlling these risk factors can reduce the rate of falling down and its associated problems and complications.

Objectives: Fall is one of the most common serious injuries among those elderly which were residence in care centers. Current study was carried out to determine fall epidemiology in men and women elderly in Tehran care centers in 2011.

Methods & Materials: A cross sectional study was developed. 400 elderly 60 years and more than 60 s years were residence in care centers were selected ramdomly.Data was collected using observation, interview, patients records techniques and standard questionnaires: Activity daily living (Barthel Index), balance and walking (Berg Balance scale), fear from fall (falls efficacy scale) nutrition status (Mini nutrition assessment) was filled by trained experts after taking consent form. Environmental factors were collected by observation and check list.

Results: Subjects were 400 elderly (35% female and 65% male) with Mean age: 22.0±70. Fall accident background during one year ago was observed among 73% of subjects (more than 60% experienced fall more than once and 41% of them were 89-80 years old (71% female, 29% male). There was significant difference between sex and number of fall (P<0.025). Significant difference was observed between osteoporoses and sex (P<0.001). Osteoporoses disease odds ratio was 3.106  (5.804-1.663) among female. Males were significantly exposed to mal nutrition while this difference was contrary in mal nutrition cases (P<0.001). Kind of elder clothing was inappropriate and their physical environment was dangerous.

Conclusion: Based on prevalence of fall among female elderly who had osteoporosis diseases and malnutrition, appropriate planning to prevention and control of diseases especially osteoporoses diseases and malnutrition among females must be implemented.

Objectives: The purpose of this study was validation and reliability determination of Persian translated version of Fall Efficacy Scale-International (FES-I).

Methods & Materials: Statistical population was Arak,s men and women older adults in 2012-13 and sample was two groups of older adults (over 60 yrs, mean age=68.79±6.41) dwelling in Arak (203 and 120 subjects for exploring and confirmatory factor analysis respectively) that availably selected. Sampling criterion was 5-subject for each item. Data were collected with Persian translated of Fall Efficacy Scale-International that measure concern about falling when performing 16-activities of daily living. Internal reliability with Cronbach,s alpha 0.98 and test-retest reliability with Pearson correlation coefficient 0.70 confirmed.

Results: K-M-O measure was 0.965 and meaningful, indicating sampling adequacy. Factor analysis with Principal component and Varimax rotation resulted in one factor extraction with Eigenvalue over 1 (12.474) that predicted 77.96% of variance. Factor loading for 16-item ranged 0.637 to 0.859. Internal reliability was excellent (Cronbach,s Alpha 0.98) and 1 to 2-week test-retest reliability (n=36, 50% female) was good (Pearson correlation coefficient 0.70). Statistical operation performs with SPSS-16.

Conclusion: According the results, Persian translated version of «Fall Efficacy Scale-International» has acceptable validity and reliability for Iranian older adults' population and can be used in research and clinical purposes.

Objectives: the main aim of this study was the comparisons between the risky agents correspond to fall in elderly people of urban and rural regions of Zabol.

Methods & Materials: The current study was a Cross sectional survey during 2010-2011 on a sample that contains 173 elderly without Cognitive impairment that are residents of Zabol and aged more than 60 years. The materials for data gathering were Questionnaires. The data was analyzed by employing version 16 of SPSS software, Central and dispersion indices, t-test, ANOVA, and Sig. (2-tailed) test at the significance level of.

Results: Among the internal agents, diabetes, lung problems, hearing problems, heart problems, surgery history, and high blood pleasure were significantly more in elderly adults of urban regions relative to rural ones (P<0.05). Among the external agents, the amount of physical exercises for the elderly adults of urban regions was significantly more relative to rural ones (P=0.020). The urban and rural elderly adults were in same situation after fall.

Conclusion: The results show that Diabetes, lung problems, Hearing problems, and Surgery history, were the main reasons of fall for the elderly adults of urban regions. The physical activity of urban elderly adults is more than that in rural ones The main places in which the fall occurred were the yard, and then the room. The main time of fall was also the morning. Therefor these confirm that the physical activity is not enough to improve the health degree and it require more care. Control of comorbidities and Attention to environment risk factors are necessary.

Objectives: Many countries are faced with the growing population of the elderly each year and so designing an appropriate system for monitoring of various elderly states is necessity. Every year thousands of the elderly suffer serious damages such as articular fractures, broken bones and even death due to their fall

Methods & Materials: In this paper, based on the analysis of images taken from the elderly’s movement, an efficient system has been proposed that, in the first phase, simulates the movement of the elderly by detecting their abnormal walking. The, by combining several important features, including an estimate of body angle, representation of the motion and estimate of the magnitude and direction of movement, the speed of the falling is calculated. This system has been implemented on a set of 57425 video frames received from the elderly residing in Farzanegan Health Care Center in Mashhad and the video sequences containing the actual occurrence the of falling. All the sequences were randomly converted into four Movie categories with these details: AVI format, 120×160 pixels resolution and 15 fps.

Results: Simulation of algorithm distinguishes the proposed system from similar ones, particularly due to its intelligent monitoring and its real time detection of the elderly’s fall. The average accuracy (AAC), detection rate (DR) and insignificant false alarm rate (FAR) are 94%, 92.91% and 5.52% respectively in acceptable level. The 92% sensitivity and 94.47% specificity indicate the ability of the system in identifying the incidents similar to the fall.

Conclusion: Many advantages such as high speed in data processing, unique accuracy and sensitivity and time parsimony make a system has particular performance and implementation of it due to intelligent monitoring and Real-Time tracking of seniors in Health Care Center and houses.

Objectives: Fall is one of the common reasons of older people referring to emergency rooms. Besides suffering, it exposes huge financial burden on the patient and the community health system, as well. It is important to know about risk factors, predictors, consequences and trauma scoring in elderly following the fall. This study aimed to evaluate the efficacy of TRISS (Trauma-Injury Severity) for predicting prognosis of fall among elderly people.

Methods & Materials: This cross sectional study conducted among 118 elderly patients attended to Imam-Hossein Hospital in Tehran because of the fall. A check list was used to collect the data.Then, trauma scores were assessed by TRISS, ISS (Injury Severity Score) and RTS (Revised Trauma Score). The clinical value of the TRISS was also evaluated.

Results: The findings showed that sliding (67%) and syncope (33%) were the reasons of fall. Mortality rate was 22%, more than half of participants had morbidity (bone fracture) followed by 41% impaired functional ability. Means for ISS, RTS and TRISS were 12.06±8.9, 6.54±4.52 and 0.45±0.33 respectively. There was a significant relationship between the mean scores and mortality and morbidity rates, which means all scores were higher among those with higher mortality and morbidity rate (P<0.05).

Objectives: Falls and fall-related physiological and psychological events are major problems for elderly people. The objective of this research was to examine the effect of an interventional training program on fall-related psychological factors among the elderly men in Arak.

Methods & Materials: In this quasi experiment research on male older adults in Arak, 27 participants randomly assigned to Control group (mean age=70.21±6.65) and Experimental group (mean age=66.07±4.38). Experimental group members participated in a 12 week interventional training program.

Objectives The purpose of this study was to investigate the validity and reliability of Timed Up and Go (TUG) and Functional Reach (FR) tests in evaluating fall risk in the elderly. 
Methods & Materials 200 elderly were equally divided into falling or no falling history groups. The participants were community-dwelling adults aged 60 years and over in Tehran, Iran. All subjects performed TUG and FR tests. Data were analyzed using Pearson's correlation, ANOVA, Cronbach’s alpha and t tests. 
Results TUG test had acceptable construct validity (Group difference, growth and clinical validity), Cronbach’s alpha was 0.81 and time stability was 0.98. Also, FR test had acceptable construct validity (Group difference, growth and clinical validity) and time stability (0.97). Results showed that TUG and FR tests have significant correlations with fall risk. 
Conclusion TUG and FR tests have acceptable validity and reliability for the elderly. Therefore, these two tests can be used to identify possible fall risk in elderly.

Objectives: The purpose of current study was to study and compare the musculoskeletal profile of the elderly with and without the history of falling living at nursing homes in Rasht, Iran.

Methods & Materials: A total of 54 elderly men and women, aged 60 years and older participated in this study. Of them, 16 (fall group) experienced a fall in the previous year [Mean(SD) of age: 79(9.90) years; height: 1.51(0.103) m; and weight: 60.03(11.12) kg] and 38 (no fall group) had no history of falling [Mean(SD) of age: 70.16(8.16) years; height: 1.56(0.11) m; and weight 65.6(14.93) kg]. The foot arch, distance between femoral condyles, kyphosis, lordosis, flexibility and the ability to walk were measured by ruler, caliper, flexible ruler, sit and reach test, and functional gait assessment questionnaires, respectively. Data analysis was done through independent t-test using SPSS. Study significance level was set at 0.05.

Results: In the fall group the mean(SD) of measured variables were as follows: body mass index (BMI): 25.95(3.35) kg/m²; foot arch: 9.94(4.34) mm; flexibility: 8.25(6.38) cm, lordosis: 20.86(9.48) degree; kyphosis: 35.07(14.98) degree. And in no fall group, the same variables were as follows: BMI: 26.87(5.12) kg/m²; foot arch: 10.95(5.60) mm; flexibility: 8.16(5.24) cm; lordosis 26.66(14.78) degree; and kyphosis: 41.11(9.84) degree. These variables were not significantly different between the groups; however, the functional gait assessment and distance between femoral condyles test showed significant differences. In the group with a history of fall, the functional gait assessment and distance between femoral condyles were 12.50(7.07) and 2.74(2.38) cm and in the group without a history of fall functional gait assessment and distance between femoral condyles were 23.63(5.49) and 1.20(1.4) cm, respectively. According to the results, in the fall group, the distance between femoral condyles was more and the performance level was less (P≤0.05).

Conclusion: Results showed that none of the variables of foot arch, flexibility, lordosis, and kyphosis were significantly different between 2 groups and were not risk factors for falling among older people. While the distance between femoral condyles and functional gait assessment in 2 groups were significantly different. It seems that functional gait assessment test and the distance between two condyles were the best indexes for the distinction between 2 groups. Perhaps, this method can be used as an appropriate way for predicting and consequently preventing the elderly from falling.

Objectives: This study aimed to examine the effect of exercise in and out of the water on the balance level and falling risk of healthy male older people.
Methods & Materials: A total of 45 old men, ≥65 years, were randomly selected and divided into 3 groups of exercising in the water, exercising out of the water, and control. Each group included 15 people. Two groups of exercising in and out of the water participated in the similar exercises for 12 weeks, 3 sessions per week, each session lasting 60 minutes.
Results: The findings of the study showed that exercise programs in and out of the water have significant effect on the static and dynamic balance and the falling risk of older people (P≤0.05). The results indicated significant differences between the subjects of exercise and control groups (P≤0.05) after the exercise program. However, the results did not show any significant differences between 2 groups exercising in and out of the water (P≥0.05).
Conclusion: According to this study, doing the exercises in or out of the water is effective on improving the static and dynamic balance of old people and reducing their risk of falling.