Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities
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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, ≥65 years of age were at high risk of falling. The facilities were clusterrandomized 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 (≥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.
- Bergland A, Jarnlo GB, Laake K. Predictors of falls in the elderly by location. Aging Clin Exp Res 2003; 15: 43–50.
- Rosendahl E, Lundin-Olsson L, Kallin K, Jensen J, Gustafson Y, Nyberg L. Prediction of falls among older people in residential care facilities by the Downton index. Aging Clin Exp Res 2003; 15: 142–7.
- Graafmans WC, Ooms ME, Hofstee HM, Bezemer PD, Bouter LM. Lips P. Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol 1996; 143: 1129–36.
- Buchner DM. Larson EB. Falls and fractures in patients with Alzheimer-type dementia. JAMA 1987; 257: 1492–5.
- American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001; 49: 664–72. CrossRef
- American College of Sports Medicine Position Stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 1998; 30: 992–1008. CrossRef
- Singh MA. Exercise comes of age: rationale and recommendations for a geriatric exercise prescription. J Gerontol 2002; 57: M262–82. CrossRef
- Fiatarone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994; 330: 1769–75. CrossRef
- Chandler JM, Hadley EC. Exercise to improve physiologic and functional performance in old age. Clin Geriatr Med 1996; 12: 761–84.
- Lazowski DA, Ecclestone NA, Myers AM, et al. A randomized outcome evaluation of group exercise programs in long-term care institutions. J Gerontol 1999; 54: M621–8. CrossRef
- MacRae PG, Asplund LA, Schnelle JF, Ouslander JG, Abrahamse A, Morris C. A walking program for nursing home residents: effects on walk endurance, physical activity, mobility, and quality of life. J Am Geriatr Soc 1996; 44: 175–80.
- Schnelle JF, Alessi CA, Simmons SF, Al-Samarrai NR, Beck JC, Ouslander JG. Translating clinical research into practice: a randomized controlled trial of exercise and incontinence care with nursing home residents. J Am Geriatr Soc 2002; 50: 1476–83. CrossRef
- Meuleman JR, Brechue WF, Kubilis PS, Lowenthal DT. Exercise training in the debilitated aged: strength and functional outcomes. Arch Phys Med Rehabil 2000; 81: 312–8.
- Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people (Cochrane Review). Cochrane Database Syst Rev 2002; 3.
- Day L, Fildes B, Gordon I, Fitzharris M, Ramer H, Lord S. Randomised factorial trial of falls prevention among older people living in their own homes. BMJ 2002; 325: 128. CrossRef
- Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med 2003; 348: 42–9. CrossRef
- Nowalk MP, Prendergast JM, Bayles CM, D’Amico FJ, Colvin GC. A randomized trial of exercise programs among older individuals living in two long-term care facilities: the FallsFREE program. J Am Geriatr Soc 2001; 49: 859–65. CrossRef
- Mulrow CD, Gerety MB, Kanten D, et al. A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA 1994; 271: 519–24. CrossRef
- Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y. Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial. Ann Intern Med 2002; 136: 733–41. CrossRef
- Jensen J, Nyberg L, Gustafson Y, Lundin-Olsson L. Fall and injury prevention in residential care — effects in residents with higher and lower levels of cognition. J Am Geriatr Soc 2003; 51: 627–35. CrossRef
- Lord SR, Ward JA, Williams P, Strudwick M. The effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial. J Am Geriatr Soc 1995; 43: 1198–206.
- Buchner DM, Cress ME, de Lateur BJ, et al. The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. J Gerontol 1997; 52: M218–24.
- Lundin-Olsson L. Nyberg L. Gustafson Y. The Mobility Interaction Fall chart. Physiother Res Int 2000; 5: 190–201. CrossRef
- Wade DT, Collin C. The Barthel ADL Index: a standard measure of physical disability? Int Disabil Stud 1988; 10: 64–7. CrossRef
- Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.
- Malloy PF, Cummings JL, Coffey CE, et al. Cognitive screening instruments in neuropsychiatry: a report of the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci 1997; 9: 189–97.
- Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther 1984; 64: 35–40.
- Berg K, Wood-Dauphinée S, Williams J, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiother Canada 1989; 41: 304–11. CrossRef
- Rantanen T, Era P, Heikkinen E. Maximal isometric knee extension strength and stair-mounting ability in 75- and 80-year-old men and women. Scand J Rehabil Med 1996; 28: 89–93.
- Delorme CT. Restoration of muscle power by heavy-resistance exercises. J Bone Joint Surg 1945; 27: 645–67.
- Rantanen T, Guralnik JM, Izmirlian G, et al. Association of muscle strength with maximum walking speed in disabled older women. Am J Phys Med Rehabil 1998; 77: 299–305. CrossRef
- Yates JS, Lai SM, Duncan PW, Studenski S. Falls in community-dwelling stroke survivors: an accumulated impairments model. J Rehabil Res Dev 2002; 39: 385–94.
- Rubenstein LZ, Josephson KR, Trueblood PR, et al. Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. J Gerontol 2000; 55: M317–21. CrossRef
- Vitti KA, Bayles CM, Carender WJ, Prendergast JM, D’Amico FJ. A low-level strength training exercise program for frail elderly adults living in an extended attention facility. Aging Clin Exp Res 1993; 5: 363–9. CrossRef
- Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities
Aging Clinical and Experimental Research
Volume 16, Issue 4 , pp 283-292
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- Accidental falls
- frail elderly
- residential facilities