title: Peripheral arterial disease, diabetes and postural balance among elderly Finns: a population-based study.
abstract: OBJECTIVE
  Little is known about the role of peripheral arterial disease (PAD) in the development of balance impairment. The aim of this study was to assess postural balance among people having PAD or PAD combined with diabetes.
  
  
  METHODS
  As part of the comprehensive health examination of the Health 2000 survey (two-stage stratified cluster sampling), 1323 people aged 65 years or older took part in balance assessments using a force platform system. The presence of PAD was confirmed with data from the National Hospital Discharge Registry. Individuals with hospitalization due to PAD were regarded as having severe disease, whereas those with solely self-reported diagnosis were considered possible cases. Diabetes was ascertained on the basis of self-reported physicians' diagnoses subsequently confirmed in a clinical examination.
  
  
  RESULTS
  Forty-five (3.4%) individuals had previously been hospitalized due to PAD, and 32 (2.4%) reported that they had been diagnosed with the disease. 413 (31%) participants had diabetes. Compared with people without PAD, those with confirmed diagnoses exhibited significantly increased movement of the center of pressure while standing, indicating deteriorated balance. Those with possible PAD formed an intermediate group. Diabetes exacerbated the deterioration in balance, but the interaction term between PAD and diabetes did not reach statistical significance. The risk of failing tandem stance tests was over three-fold (OR 3.20, 95% CI 1.09-9.37) among those with confirmed PAD and almost one and a half-fold (OR 1.44, 95% CI 1.07-1.93) among those with diabetes, in comparison to those without these diseases.
  
  
  CONCLUSIONS
  Individuals over 65 years of age with severe PAD showed increased balance impairment, a known risk factor for falls and disability in aged people. Diabetes affected balance somewhat less than PAD, but there was no formal evidence of the synergetic effect of the two diseases. Additional studies are indicated to reveal the possible effect of proper treatment of PAD and diabetes, combined with suitable training interventions on slowing down the progression of balance impairment.
authors.affiliation: Jyväskylä Central Hospital, Department of Surgery, Jyväskylä, Finland. velipekka.suominen@pshp.fi
authors.forename: Velipekka
authors.initials: V
authors.lastname: Suominen
authors.forename: Juha
authors.initials: J
authors.lastname: Salenius
authors.forename: Päivi
authors.initials: P
authors.lastname: Sainio
authors.forename: Antti
authors.initials: A
authors.lastname: Reunanen
authors.forename: Taina
authors.initials: T
authors.lastname: Rantanen
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D016491:Peripheral Vascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D004856:Postural Balance; D012307:Risk Factors