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PURPOSE: This study was conducted to develop and to determine the effect of an tailored falls prevention exercise for older adults.
METHOD: Subjects consisted of 59 older adults (experimental group : 29, control group : 30) living at nursing homes. Experimental group participated in tailored falls prevention exercise for 16 weeks (3 times a week, 50 min every session). Data were collected before the exercise, 16 weeks & 24 weeks after the beginning of exercise.
RESULTS: 1) the experimental group significantly improved the muscle strength of hip extensor & flexor, knee extensor & flexor, ankle dorsiflexor, & plantar flexor compared to the control group. 2) the experimental group significantly decreased the mean time for 10 times chair stand. 3) the experimental group significantly increased the standing time on one leg and the number of heel raise for 30 seconds compared to the control group. In addition more older adults in the experimental group completed the tandem stance and semi-tandem stance for 10 seconds than the control group. 4) The experimental group significantly decreased the mean time of 6m walk and the fall frequency compared to the control group.
CONCLUSIONS: This results suggest that tailored falls prevention exercise for older adults can improve muscle strength, static & dynamic balance and decrease the fall frequency of older adults.
Here's the most recent systematic review of exercise interventions for falls (more recent than the last Cochrane update in 2003). The important thing to highlight here is that all the included studies used falls over 12 months as the primary outcome measure, rather than physical performance measures:
Physical activity interventions to prevent falls among older people: update of the evidence
Sherrington C, Lord SR, Finch CF.
Prince of Wales Medical Research Institute, The University of New South Wales, Australia.
Injuries resulting from falls are a significant public health issue, particularly for older people. This review provides an update of the evidence on the effects of various physical activity (PA) or exercise intervention strategies for the prevention of unintentional falls among older people. Six systematic reviews, and three randomised controlled trials not incorporated in previous reviews, were located with a literature search. There is clear evidence that a targeted supervised home exercise program of strength and balance exercise and walking practice, prescribed by a trained health professional, can prevent falls among older community dwellers. There is also an indication that untargeted group exercise (ie, not individually prescribed) can prevent falls among community dwellers, particularly if it involves Tai Chi or other exercises which challenge balance. There is some indication that individual prescription of PA is more important in frailer groups. Further investigation is required to establish the effects of PA in residential aged care, and the relative effects of different types of PA in different populations. In addition, multidisciplinary, multifactorial. health/environmental risk factor screening/intervention programs have been found to be effective in preventing falls. For many individuals with physical risk factors for falls (eg, impaired strength, balance or functional ability), PA alone is likely to reduce the risk of falls. For those with additional risk factors (eg, visual impairments, psychoactive medication use), other interventions may also be required.
Falls are a major source of injury in older adults. Many falls occur after slipping. This study determined performance-related factors that both contribute to slip-related falls and that may be effectively and efficiently modified through targeted intervention. Thirty-five young adults and 21 healthy older adults (age: 70.9+/-5.1 years) were slipped in a laboratory using a slippery surface. The biomechanics of the 18 older adults who fell and the 30 younger adults who recovered following slips were analyzed. A set of potentially modifiable variables, initially based on significant between-groups differences, was further analyzed using stepwise discriminant analysis and logistic regression. The discriminant analysis correctly categorized 93.8% of the falls and recoveries based on two variables; the velocity of the slipping foot relative to the velocity of the whole body center of mass (COM), and the lateral placement of the recovery foot relative to the COM. The logistic regression determined the expected change in the odds of a recovery following a slip given a hypothesized intervention-induced improvement of these variables. Decreased velocity of the slipping foot relative to the COM, or decreased lateral placement of the recovery foot relative to the COM to zero, increased the odds of recovery by 17% and 27%, respectively. This suggests that intervention targeted at improving these specific lower extremity control variables following the onset of a slip has the potential to significantly decrease slip-related fall risk.
You have to laugh, l recently purchased a copy of "Falls in Older people: Risk Factors and Strategies for Prevention ", my father sat in the factory lunch room and read a page or two while the kettle boiled.
Page 5 gives a "Definition of the older person"
"The term is used for age-groups starting from as low as 50 years. However, the most frequently used is people aged 65 years and over. Within this age- band, commonly accepted subgroups are those aged 65 -74 years, 75 - 84 and 85 years and older"
My father put down the book and said..... "It's all about perspective isn't it, the 35 year old researcher thought 55 years was old and the 55 year old researcher thought 75 years was old, let these researchers know l am just shy of middle age at 74 years of age.
You have to laugh, l recently purchased a copy of "Falls in Older people: Risk Factors and Strategies for Prevention ", my father sat in the factory lunch room and read a page or two while the kettle boiled.
Page 5 gives a "Definition of the older person"
"The term is used for age-groups starting from as low as 50 years. However, the most frequently used is people aged 65 years and over. Within this age- band, commonly accepted subgroups are those aged 65 -74 years, 75 - 84 and 85 years and older"
My father put down the book and said..... "It's all about perspective isn't it, the 35 year old researcher thought 55 years was old and the 55 year old researcher thought 75 years was old, let these researchers know l am just shy of middle age at 74 years of age.
Dave:
After considerable research, I have discovered a new, fundamental law of nature, Age Relativity. I have determined that, every year, my definitions for "old" and "young" increase by exactly one year of age.
For example, when I was 10 years old, I thought that 15 was old, but when I became 20, I thought 15 was young. When I was 30, I though that 35 was old but when I became 40, I thought that 35 was young. Therefore, every year, my definitions for "old' and "young" have increased by exactly one year. So that now that I'm 51, even 46 year olds are young, while 56 year olds are still old.
This new fundamental law of nature has been established and confirmed utilizing multiple interviews of my patients and other individuals who will tolerate my questions. My paper on Age Relativity will soon be published in the Journal of Ageless Theories.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Preventing falls in older adults: new interventions to promote more effective change-in-support balance reactions.
Maki BE, Cheng KC, Mansfield A, Scovil CY, Perry SD, Peters AL, McKay S, Lee T, Marquis A, Corbeil P, Fernie GR, Liu B, McIlroy WE J Electromyogr Kinesiol. 2008 Apr;18(2):243-54
Quote:
"Change-in-support" (CIS) balance-recovery reactions that involve rapid stepping or reaching movements play a critical role in preventing falls; however, age-related deficits in the neuro-musculoskeletal systems may impede ability to execute these reactions effectively. This review describes four new interventions aimed at reducing fall risk in older adults by promoting more effective CIS reactions: (1) balance training, (2) balance-enhancing footwear, (3) safer mobility aids, and (4) handrail cueing systems. The training program uses unpredictable support-surface perturbations to counter specific CIS control problems associated with aging and fall risk. Pilot testing has demonstrated that the program is well-tolerated by balance-impaired older adults, and a randomized controlled trial is now in progress. The balance-enhancing footwear insole improves control of stepping reactions by compensating for age-related loss of plantar cutaneous sensation. In a clinical trial, subjects wore the insole for 12 weeks with no serious problems and no habituation of the balance-enhancing benefits. The mobility-aid intervention involves changes to the design of pickup walkers so as to reduce impediments to lateral stepping. Finally, work is underway to investigate the effectiveness of handrail cueing in attracting attention to the rail and ensuring that the brain registers its location, thereby facilitating more rapid and accurate grasping.
Exercise training can improve spatial characteristics of time-critical obstacle avoidance in elderly people.
Weerdesteyn V, Nienhuis B, Duysens J Hum Mov Sci. 2008 Jun 2;
Quote:
Fall prevention programs have rarely been evaluated by quantitative movement analysis methods. Quantitative movement analyses could provide insight into the mechanisms underlying the effects of training. A treadmill obstacle avoidance task under time pressure has recently been used to evaluate a fall prevention exercise program for community-dwelling elderly people and it showed that participants improved their obstacle avoidance success rates. The mechanism, by which the increased success rates were achieved, however, remained to be determined. Participants were elderly who had fallen at least once in the year prior to participation. They were assigned to either the exercise or the control group. The control group did not receive any specific treatment. The exercise group was administered a five week exercise program, which consisted of exercises on a functionally oriented obstacle course, walking exercises, and practice of fall techniques. Pre- and post-intervention laboratory obstacle avoidance tests were conducted. Three possible determinants of success were investigated, namely avoidance reaction times, the distribution of avoidance strategies, and three spatial parameters (toe distance, foot clearance and heel distance). Analysis yielded significant TimexGroup interactions in heel distances. The exercise group increased heel distance, while the control group did not. Increased heel distance may result in reduced risk of heel contact with the obstacle and, consequently, larger success rates. The remaining parameters showed no effect of training. In conclusion, the training program was effective in improving time-critical obstacle avoidance skills. In every day life, these effects of training may contribute to less obstacle-related fall incidents in elderly. In addition, these findings could indicate that the execution of other time-critical events, like an actual fall, could also be improved by training.
Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial
Ngaire Kerse, Kathy Peri, Elizabeth Robinson, Tim Wilkinson, Martin von Randow, Liz Kiata, John Parsons, Nancy Latham, Matthew Parsons, Jane Willingale, Paul Brown, and Bruce Arroll BMJ 2008;337:a1445, doi: 10.1136/bmj.a1445 (Published 9 October 2008)
Quote:
Objective To assess the effectiveness of an activity programme in improving function, quality of life, and falls in older people in residential care.
Design Cluster randomised controlled trial with one year follow-up.
Setting 41 low level dependency residential care homes in New Zealand.
Participants 682 people aged 65 years or over.
Interventions 330 residents were offered a goal setting and individualised activities of daily living activity programme by a gerontology nurse, reinforced by usual healthcare assistants; 352 residents received social visits.
Main outcome measures Function (late life function and disability instruments, elderly mobility scale, FICSIT-4 balance test, timed up and go test), quality of life (life satisfaction index, EuroQol), and falls (time to fall over 12 months). Secondary outcomes were depressive symptoms and hospital admissions.
Results 473 (70%) participants completed the trial. The programme had no impact overall. However, in contrast to residents with impaired cognition (no differences between intervention and control group), those with normal cognition in the intervention group may have maintained overall function (late life function and disability instrument total function, P=0.024) and lower limb function (late life function and disability instrument basic lower extremity, P=0.015). In residents with cognitive impairment, the likelihood of depression increased in the intervention group. No other outcomes differed between groups.
Conclusion A programme of functional rehabilitation had minimal impact for elderly people in residential care with normal cognition but was not beneficial for those with poor cognition.
Falls prevention
Linear Mode
