Fall Prevention in Residential Care

A Cluster, Randomized, Controlled Trial

1. Ngaire Kerse MBChB, PhD,
2. Meg Butler MPH,
3. Elizabeth Robinson MSc,
4. Maree Todd FRACP, MBChB

Article first published online: 30 MAR 2004

DOI: 10.1111/j.1532-5415.2004.52157.x

ABSTRACT:

Keywords:

• fall prevention;
• residential care;
• cluster randomized controlled trial

Objectives: To establish the effectiveness of a fall-prevention program in reducing falls and injurious falls in older residential care residents.

Design: Cluster, randomized, controlled trial.

Setting: Fourteen randomly selected residential care homes in Auckland, New Zealand.

Participants: All older residents (n=628, 95% participation rate).

Intervention: Residential care staff, using existing resources, implemented systematic individualized fall-risk management for all residents using a fall-risk assessment tool, high-risk logo, and strategies to address identified risks.

Measurements: Number of residents sustaining a fall, falls, and injurious-falls incidence rates.

Results: During 12 months of follow-up, 103 (43%) residents in the control group and 173 (56%) residents in the intervention group fell (P<.018). There was a significantly higher incidence rate of falls in intervention homes than in control homes (incident rate ratio=1.34, 95% confidence interval=1.06–1.72) during the intervention period after adjusting for dependency level (type of home), baseline fall rate, and clustering. There was no difference in the injurious fall incidence rate or incidence of serious injuries.

Conclusion: This fall-prevention intervention did not reduce falls or injury from falls. Low-intensity intervention may be worse than usual care.

Quelle:  http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2004.52157.x/abstract

Full Text / pdf:

Kerse, N., Butler, M., Robinson, E. and Todd, M. (2004), Fall Prevention in Residential Care: A Cluster, Randomized, Controlled Trial. Journal of the American Geriatrics Society, 52: 524–531. doi: 10.1111/j.1532-5415.2004.52157.x

 http://ot.creighton.edu/community/EBLP/Question3/Kerse%202004%20Fall%20Prevention%20in%20Residential%20Care.pdf

Online im internet - Zugriff vom 04.10.2012


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Therapeutic benefits of Tai Chi exercise

Research review

Kuramoto AM.

Source

University of Wisconsin-Milwaukee College of Nursing, WI, USA. alicek@uwm.edu

Abstract

The majority of studies on Tai Chi conducted between 1996 and 2004 had focused on health and well being of Tai Chi exercise for senior adults. The results show that Tai Chi may lead to improved balance, reduced fear of falling, increased strength, increased functional mobility, greater flexibility, and increased psychological well-being, sleep enhancement for sleep disturbed elderly individuals, and increased cardio functioning. Wang, Collet, and Lau did a systematic review on Tai Chi research and found some limitations or biases existing in some of the studies, and it was difficult to draw firm conclusions about the benefits reported.

Therefore, more well-designed studies are needed in the future. There need to be studies on the effects on younger and middle-aged people. More longitudinal studies are needed, since time is an important factor of physical and psychological interventions. Studies on the effects of Tai Chi on the immune system and bone loss reduction are still very exploratory and will be especially useful for arthritis patients and others with immune disorders.

Future studies should investigate outcomes associated with Tai Chi training as a function of different instructional techniques, different Tai Chi styles, different diagnostic groups, and different age groups. It is not yet clear which of the components in Tai Chi makes the exercise form especially effective for seniors.

Tai Chi exercise is a relatively "low tech" approach to preventing disability and maintaining physical performance in older adults. The positive effects of Tai Chi may be due solely to its relaxing, meditative aspects.

The current data suggest that Tai Chi can influence older individuals' functioning and well being and provide some appreciation for why this exercise form has been practiced by older Chinese for more than 3 centuries.

Quelle:  http://www.ncbi.nlm.nih.gov/pubmed/17163086





Full Text / pdf / Link - online im internet - Zugriff vom 04.10.12:

http://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/issues/wmj_v105n7/kuramoto.pdf



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The efficacy of a specific balance-strategy training programme

The efficacy of a specific balance-strategy training programme for preventing falls among older people: A pilot randomised controlled trial

Nitz, Jennifer C. and Low Choy, Nancy (2004) The efficacy of a specific balance-strategy training programme for preventing falls among older people: A pilot randomised controlled trial. Age and Ageing, 33 1: 52-58.

ABSTRACT:

 Background: older people participate in exercise programmes to reduce the risk of falls but no study has investigated a specific balance strategy training intervention presented in a workstation format for small groups.

Objective: to determine whether a specific balance strategy training programmeme delivered in a workstation format was superior to a community based exercise class programme for reducing falls.


Design: a randomised controlled trial model.


Setting: Neurological Disorders, Ageing and Balance Clinic, Department of Physiotherapy, The University of Queensland.


Subjects: 73 males and females over 60 years, living independently in the community and who had fallen in the previous year were recruited.


Methods: all subjects received a falls risk education booklet and completed an incident calendar for the duration of the study. Treatment sessions were once a week for 10 weeks. Subject assessment before and after intervention and at 3 months follow-up included number of falls, co-morbidities, medications, community services and activity level, functional motor ability, clinical and laboratory balance measures and fear of falling.


Results: all participants significantly reduced the number of falls (P < 0.000). The specific balance strategy intervention group showed significantly more improvement in functional measures than the control group (P = 0.034). Separate group analyses indicated significantly improved performance in functional motor ability and most clinical balance measures for the balance group (P < 0.04). The control group only improved in TUG and TUGcog.


Conclusions: the results provide evidence that all participants achieved a significant reduction in falls. Specific balance strategy training using workstations is superior to traditional exercise classes for improving function and balance.
 

Quelle:  http://espace.uq.edu.au/view/UQ:68941



Full Text / Link / pdf - online im internet - Zugriff vom 04.10.2012:

The efficacy of a specific balance-strategy training programme for preventing falls among older people: A pilot randomised controlled trial

Nitz, Jennifer C. and Low Choy, Nancy (2004) The efficacy of a specific balance-strategy training programme for preventing falls among older people: A pilot randomised controlled trial. Age and Ageing, 33 1: 52-58.


http://www.udel.edu/PT/PT%20Clinical%20Services/journalclub/noajc/03_04/jul04/NitzBalanceTraining.pdf


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Evidence for a Non-linear Relationship between Leg Strength and Gait Speed

1. DAVID M. BUCHNER,
2. ERIC B. LARSON,
3. EDWARD H. WAGNER,
4. THOMAS D. KOEPSELL and
5. BARBARA J. DE LATEUR

Abstract

Although the relationship between strength and physical performance in older adults is probably non-linear, few empirical studies have demonstrated that this is so. 

In a population-based sample of adults aged 60–96 years (n = 409), leg strength was measured in four muscle groups (knee extensor, knee flexor, ankle plantar flexor, ankle dorsiflexor) of both legs using an isokinetic dynamometer. A leg strength score was calculated as the sum of the four strength measurements in the right leg. Usual gait speed was measured over a 15.2 metre course. 

With a linear model, leg strength explained 17% of the variance in gait speed. Non–linear models (quadratic and inverse) explained significantly more variance (22%). 

The nature of the non-linear relationship was that, in stronger subjects, there was no association between strength and gait speed, while in weaker subjects, there was an association. Body weight and age also explained significant amounts of variance in gait speed, while sex and height did not.

The results supported the hypothesis of a non-linear relationship between leg strength and gait speed that is similar for older men and women. 

This finding represents a mechanism for how small changes in physiological capacity may have substantial effects on performance in frail adults, while large changes in capacity have little or no effect in healthy adults.

• © Oxford University Press

Quelle:  http://ageing.oxfordjournals.org/content/25/5/386.short



Full Text / pdf von:  Evidence for a Non-linear Relationship between Leg Strength and Gait Speed - online im internet - Zugriff vom 02.10.2012:

http://ageing.oxfordjournals.org/content/25/5/386.full.pdf

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Identification of elderly fallers by muscle strength measures

Abstract The original publication is available at http://link.springer.de/link/service/journals/00421/index.htm. For efficient prevention of falls among older adults, individuals at a high risk of falling need to be identified. In this study, we searched for muscle strength measures that best identified those individuals who would fall after a gait perturbation and those who recovered their balance. Seventeen healthy older adults performed a range of muscle strength tests. We measured maximum and rate of development of ankle plantar flexion moment, knee extension moment and whole leg push-off force, as well as maximum jump height and hand grip strength. Subsequently, their capacity to regain balance after tripping over an obstacle was determined experimentally. Seven of the participants were classified as fallers based on the tripping outcome. Maximum isometric push-off force in a leg press apparatus was the best measure to identify the fallers, as cross-validation of a discriminant model with this variable resulted in the best classification (86% sensitivity and 90% specificity). Jump height and hand grip strength were strongly correlated to leg press force (r = 0.82 and 0.59, respectively) and can also be used to identify fallers, although with slightly lower specificity. These results indicate that whole leg extension strength is associated with the ability to prevent a fall after a gait perturbation and might be used to identify the elderly at risk of falling.
Quelle:  http://en.scientificcommons.org/34613507

Full Text / pdf von:  Identification of elderly fallers by muscle strength measures - online im internet - Zugriff vom 02.102012: 

http://www.biomedsearch.com/attachments/00/18/07/17/18071745/421_2007_Article_613.pdf

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Tai Chi and Fall Reductions in Older Adults

A Randomized Controlled Trial

Abstract

Background. The authors' objective was to evaluate the efficacy of a 6-month Tai Chi intervention for decreasing the number of falls and the risk for falling in older persons. 

Methods. This randomized controlled trial involved a sample of 256 physically inactive, community-dwelling adults aged 70 to 92 (mean age, 77.48 years; standard deviation, 4.95 years) who were recruited through a patient database in Portland, Oregon. Participants were randomized to participate in a three-times-per-week Tai Chi group or to a stretching control group for 6 months. The primary outcome measure was the number of falls; the secondary outcome measures included functional balance (Berg Balance Scale, Dynamic Gait Index, Functional Reach, and single-leg standing), physical performance (50-foot speed walk, Up&Go), and fear of falling, assessed at baseline, 3 months, 6 months (intervention termination), and at a 6-month postintervention follow-up. 

Results. At the end of the 6-month intervention, significantly fewer falls (n = 38 vs 73; p =.007), lower proportions of fallers (28% vs 46%; p =.01), and fewer injurious falls (7% vs 18%; p =.03) were observed in the Tai Chi group compared with the stretching control group. After adjusting for baseline covariates, the risk for multiple falls in the Tai Chi group was 55% lower than that of the stretching control group (risk ratio,.45; 95% confidence interval, 0.30 to 0.70). Compared with the stretching control participants, the Tai Chi participants showed significant improvements (p <.001) in all measures of functional balance, physical performance, and reduced fear of falling. Intervention gains in these measures were maintained at a 6-month postintervention follow-up in the Tai Chi group. 

Conclusions. A three-times-per-week, 6-month Tai Chi program is effective in decreasing the number of falls, the risk for falling, and the fear of falling, and it improves functional balance and physical performance in physically inactive persons aged 70 years or older.

• Copyright 2005 by The Gerontological Society of America

Quelle:  http://biomedgerontology.oxfordjournals.org/content/60/2/187.short

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Exercise and injury prevention in older people

1. D. A. Skelton,
2. N. Beyer

Article first published online: 14 JAN 2003

^ABSTRACT

 Keywords:

• exercise;
• balance;
• falls;
• risk of falling;
• fall prevention;
• injury prevention;
• aged.

This review aims to provide the reader with up to date evidence in relation to the role of exercise in the reduction of risk factors and the prevention of falls and injuries. 

Falls and injury may lead to a spiral of inactivity and decline that take older people close to or below the critical “thresholds” of performance necessary for everyday activities. 

Yet, low strength and power, poor balance, poor gait and functional ability, and fear of falling are all risk factors for falls modifiable with tailored exercise. 

Although the evidence on types, amounts and specificity of exercise to prevent falls is not complete, recommendations have been published that have been effective, either as an exercise stand-alone intervention or with exercise as part of a multifactorial intervention. 

It is clear that the target population must be at risk or already fallers, they must be “not too fit” and “not too frail”. 

Supervised home-based exercise programs may be effective in those aged over 80 because they fall more frequently, injure more easily, and recover more slowly. 

In younger, community-dwelling, fallers multifactorial group interventions including targeting of balance, strength, power, gait, endurance, flexibility, co-ordination and reaction may be more effective. 

There are, however, research questions that still need answering – whether there are certain types of exercise harmful in certain subgroups of older people, what is the ideal intensity, frequency and duration of exercise for different subgroups of older people (primary and secondary prevention) and the relative value of the different components of fitness to prevention of falls and injuries. 

This review highlights the necessity of tailored, specific balance and strength exercise in the multidisciplinary prevention of falls and injuries.

 

^{Quelle:  http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0838.2003.00300.x/abstract}

Exercise and injury prevention in older people -D. A. Skelton,N. Beyer

^{Full Text / pdf:  http://www.laterlifetraining.co.uk/wp-content/uploads/2011/12/ExInjPrevScandJMedSciSports2003.pdf}

 

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Falls prevention over 2 years

Falls prevention over 2 years: a randomized controlled trial in women 80 years and older.

1. A J Campbell,
2. M C Robertson,
3. M M Gardner,
4. R N Norton and
5. D M Buchner

Abstract

BACKGROUND: 

after 1 year, a home-based programme of strength and balance retraining exercises was effective in reducing falls and injuries in women aged 80 years and older. The exercise programme had been individually prescribed by a physiotherapist during the first 2 months of a randomized controlled trial. 

OBJECTIVE: 

we aimed to assess the effectiveness of the programme over 2 years. 

SUBJECTS:

 women from both the control group and the exercise group completing a 1-year trial (213 out of the original 233) were invited to continue for a further year. METHODS: falls and compliance to the exercise programme were monitored for 2 years. 

RESULTS: 81 (74%) in the control group and 71 (69%) in the exercise group agreed to continue in the study. After 2 years, the rate of falls remained significantly lower in the exercise group than in the control group. The relative hazard for all falls for the exercise group was 0.69 (95% confidence interval 0.49-0.97). The relative hazard for a fall resulting in a moderate or severe injury was 0.63 (95% confidence interval 0.42-0.95). Those complying with the exercise programme at 2 years had a higher level of physical activity at baseline, were more likely to have reported falling in the year before the study and had remained more confident in the first year about not falling compared with the rest of the exercise group. 

CONCLUSIONS: 

falls and injuries can be reduced by an individually tailored exercise programme in the home. For those who keep exercising, the benefit continues over a 2-year period. 

Quelle:    http://ageing.oxfordjournals.org/content/28/6/513.short

 Full Text / pdf - Falls prevention over 2 years: a randomized controlled trial in women 80 years and older.  Autoren:

1. A J Campbell,
2. M C Robertson,
3. M M Gardner,
4. R N Norton and
5. D M Buchner

 online im internet - Zugriff vom 02.10.2012 - http://ageing.oxfordjournals.org/content/28/6/513.full.pdf

 

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Physical Activity and Public Health in Older Adults

Recommendation from the American College of Sports Medicine and the American Heart Association

• Autores: Miriam E. Nelson, W. Jack Rejeski, Steven N. Blair
• Localización: Medicine & Science in Sports & exercise: Official Journal of the American College of Sports Medicine, ISSN 0195-9131, Vol. 39, Nº. 8, 2007, págs. 1435-1445
• Resumen
•  
  • Objective: To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults.
    
    Participants: A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology.
    
    Evidence: The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature.
    Process: After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults.
    
    Summary: The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.
    

Quelle:  http://dialnet.unirioja.es/servlet/articulo?codigo=2888508



Full Text / pdf - online im internet - Zugriff vom 02.10.2012 - http://www.lorenzinifoundation.org/ActiveDoctors2011/Letteratura%5CPA%20guidelines%20for%20older%20adults_2007.pdf

Physical Activity and Public Health in Older Adults: Recommendation from the American College of Sports Medicine and the American Heart Association

 http://www.lorenzinifoundation.org/ActiveDoctors2011/Letteratura%5CPA%20guidelines%20for%20older%20adults_2007.pdf

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