Rethinking individual and community fall prevention strategies

Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions

1. A. John Campbell and
2. M. Clare Robertson

1. Department of Medical and Surgical Sciences, University of Otago Medical School, Dunedin, New Zealand

1. Address correspondence to: A. john Campbell. Email: john.campbell@stonebow.otago.ac.nz

 Abstract

Background guidelines recommend that fall prevention programmes for older people include multifactorial interventions. 

Objective we aimed to determine if randomised controlled trial evidence supports interventions with multiple components over single strategies in community based fall prevention. 

Methods we searched the literature for trials of interventions aimed at preventing falls. We included trials if they met the following criteria: (i) participants were randomly allocated to intervention and control groups, (ii) all participants were aged 65 years or older, (iii) the majority lived independently in the community, (iv) fall events were recorded prospectively using a diary or calendar during the entire trial and monitored at least monthly, (v) follow up was for 12 months or longer, (vi) at least 70% of participants completed the trial, (vii) all falls during the trial for at least 50 participants were included in the analysis, and (viii) a relative rate ratio with 95% CI comparing the number of falls in the intervention and control groups was reported. We calculated a pooled rate ratio separately for trials testing multifactorial and single interventions and compared their overall efficacy using meta-regression. 

Results meta-regression showed that single interventions were as effective in reducing falls as interventions with multiple components (pooled rate ratios 0.77, 95% CI 0.67–0.89 and 0.78, 0.68–0.89 respectively). 

Conclusion multifactorial fall prevention interventions are effective for individual patients. However, for community programmes for populations at risk, targeted single interventions are as effective as multifactorial interventions, may be more acceptable and cost effective.

Quelle:   http://ageing.oxfordjournals.org/content/36/6/656.full




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Effects of a fall prevention program including exercise on mobility and falls

Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities.

Jensen J, Nyberg L, Rosendahl E, Gustafson Y, Lundin-Olsson L.

Source:  Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå University, Sweden. jane.jensen@physiother.umu.se

Abstract

BACKGROUND AND AIMS:

Impaired mobility is one of the strongest predictors for falls in older people. We hypothesized that exercise as part of a fall prevention program would have positive effects, both short- and long-term, on gait, balance and strength in older people at high risk of falling and with varying levels of cognition, residing in residential care facilities. A secondary hypothesis was that these effects would be associated with a reduced risk of falling.

METHODS:

187 out of all residents living in 9 facilities, > or =65 years of age were at high risk of falling. The facilities were cluster-randomized to fall intervention or usual care. The intervention program comprised: education, environment, individually designed exercise, drug review, post-fall assessments, aids, and hip protectors. Data were adjusted for baseline performance and clustering.

RESULTS:

At 11 weeks, positive intervention effects were found on independent ambulation (FAC, p=0.026), maximum gait speed (p=0.002), and step height (> or =10 cm, p<0.001), but not significantly on the Berg Balance Scale. At 9 months (long-term outcome), 3 intervention and 15 control residents had lost the ability to walk (p=0.001). Independent ambulation and maximum gait speed were maintained in the intervention group but deteriorated in the control group (p=0.001). Residents with both higher and lower cognition benefited in most outcome measures. No association was found between improved mobility and reduced risk of falling.

CONCLUSIONS:

Exercise, as part of a fall prevention program, appears to preserve the ability to walk, maintain gait speed, ambulate independently, and improve step height. Benefits were found in residents with both lower and higher cognitive impairment, but were not found to be associated with a reduced risk of falling.

Quelle:  http://www.ncbi.nlm.nih.gov/pubmed/15575122





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Mauerbergstraße 110

76534 Baden-Baden

Tel.: 07223 / 8004699

Mobil: 0177 / 4977232

Mail: info@aktiv-training.de

Fax: 07223 / 8005271 

web: www.aktiv-training.de

Wordpress: www.aktivtraining.wordpress.com

Personal Training: www.personaltrainingbadenbaden.wordpress.com

Sturzprävention: www.sturztraining.de