Effectiveness of a Multifaceted Intervention on Falls

Abstract:  Effectiveness of a Multifaceted Intervention on Falls in Nursing Home Residents  - Clemens Becker et al ^-

Article first published online: 20 FEB 2003

DOI: 10.1046/j.1532-5415.2003.51103.x

ABSTRACT 

Keywords:

• accidental falls;
• older people;
• prevention;
• hip protector;
• exercise

OBJECTIVES:   To evaluate the effectiveness of a multifaceted, nonpharmaceutical intervention on incidence of falls and fallers.

DESIGN:   Prospective, cluster-randomized, controlled 12-month trial.

SETTING:   Six community nursing homes in Germany.

PARTICIPANTS:   Long-stay residents (n = 981) aged 60 and older; mean age 85; 79% female.

INTERVENTIONS:   Staff and resident education on fall prevention, advice on environmental adaptations, progressive balance and resistance training, and hip protectors.

MEASUREMENTS:   Falls, fallers, and fractures.

RESULTS:   The incidence density rate of falls per 1,000 resident years (RY) was 2,558 for the control group (CG) and 1,399 for the intervention group (IG) (relative risk (RR) = 0.55, 95% confidence interval (CI) = 0.41–0.73). Two hundred forty-seven (52.3%) fallers were detected in the CG and 188 (36.9%) in the IG (RR = 0.75, 95% CI = 0.57–0.98). The incidence density rate of frequent fallers (>2/year) was 115 (24.4%) for the CG and 66 (13.0%) for the IG (RR = 0.56, 95% CI = 0.35–0.89). The incidence density rate of hip fractures per 1,000 RY was 39 for the CG and 43 for the IG (RR = 1.11, 95% CI = 0.49–2.51). Other fractures were diagnosed with an incidence density rate of 52 per 1,000 RY for CG and 41 per 1,000 RY for IG (RR = 0.78, 95% CI = 0.57–1.07).

CONCLUSION:   The incidence density rate of falls and fallers differed considerably between the control and intervention groups. The study was underpowered to demonstrate a significant difference of hip or nonhip fractures. Because of a low fracture rate in both groups, the investigation of fracture rates would have required a larger sample size to detect an effect of the intervention.

Quelle: http://onlinelibrary.wiley.com/doi/10.1046/j.1532-5415.2003.51103.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=true

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The Effect of Multidimensional Exercises .....

....... on Balance, Mobility, and Fall Risk in Community-Dwelling Older Adults

1. Anne Shumway-Cook,
2. William Gruber,
3. Margaret Baldwin and
4. Shiquan Liao

Abstract

Background and Purpose. 

This prospective clinical investigation examined the effects of a multidimensional exercise program on balance, mobility, and risk for falls in community-dwelling older adults with a history of falling. Factors used to predict adherence and a successful response to exercise were identified. 

Subjects. A total of 105 community-dwelling older adults (≥65 years of age) with a history of two or more falls in the previous 6 months (no neurologic diagnosis) participated. They were classified into (1) a control group of fallers (n=21), (2) a fully adherent exercise group (n=52), and (3) a partially adherent exercise group (n=32). 

Methods. Following evaluation, each patient received an individualized exercise program addressing the impairments and functional disabilities identified during the assessment. The control group received no intervention. Changes in performance on five clinical tests of balance and mobility and fall risk were compared among groups.  

Results. Both exercise groups scored better than the control group on all measures of balance and mobility. Although both exercise groups showed a reduction in fall risk compared with the control group, the greatest reduction was found in the fully adherent exercise group. Factors associated with successful response to exercise included degree of adherence to exercise program and pretest score on the Tinetti Mobility Assessment.  

Conclusion and Discussion. Exercise can improve balance and mobility function and reduce the likelihood for falls among community-dwelling older adults with a history of falling. The amount of exercise needed to achieve these results, however, could not be determined from this study.

Quelle:  http://www.physicaltherapyjournal.com/content/77/1/46.short


Full Text / pdf - online im internet - Zugriff 01.10.2012 -  The Effect of Multidimensional Exercises on Balance, Mobility, and Fall Risk in Community-Dwelling Older Adults

http://www.physicaltherapyjournal.com/content/77/1/46.full.pdf+html

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Prevention of falls and consequent injuries in elderly people

Review / von:

• Prof Pekka Kannus, MD^{a, b, ,} ,
• Harri Sievänen, ScD^a,
• Mika Palvanen, MD^a,
• Teppo Järvinen, MD^b,
• Jari Parkkari, MD^c

• ^a Accident & Trauma Research Centre, UKK Institute for Health Promotion Research, Tampere, Finland
• ^b Department of Surgery, Tampere University Medical School and University Hospital, Tampere, Finland
• ^c Tampere Research Centre of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland

Abstract / Summary

Injuries resulting from falls in elderly people are a major public-health concern, representing one of the main causes of longstanding pain, functional impairment, disability, and death in this population.

The problem is going to worsen, since the rates of such injuries seem to be rising in many areas, as is the number of elderly people in both the developed and developing world.

Many methods and programmes to prevent such injuries already exist, including regular exercise, vitamin D and calcium supplementation, withdrawal of psychotropic medication, cataract surgery, professional environment hazard assessment and modification, hip protectors, and multifactorial preventive programmes for simultaneous assessment and reduction of many of the predisposing and situational risk factors.

To receive broader-scale effectiveness, these programmes will need systematic implementation. Care must be taken, however, to rigorously select the right actions for those people most likely to benefit, such as vitamin D and calcium supplementation and hip protectors for elderly people living in institutions.

Quelle:   http://www.sciencedirect.com/science/article/pii/S0140673605676040


Prevention of falls and consequent injuries in elderly people - Full Text / pdf:

http://www.grg-bs.it/usr_files/eventi/journal_club/programma/falls_lancet.pdf

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