Development of a fall prevention program for elderly Japanese people

The purpose of this study was to develop a fall prevention program adapted to the individual risks of elderly patients in a long‐term care facility by increasing the caregiving skills and motivation of the staff members. The fall prevention program was created by synthesizing information based on evidence‐based practice and action research methodology was chosen to complete the development of the program. There were 31 participating patients in the intervention ward and 20 patients in the control ward. The Generalized Self‐efficacy Scale and the Social Support Scale were used to evaluate fall prevention skills the motivation of the staff members. The fall prevention program helped to reduce injuries from 41.9% to 9.7% among the elderly participants and to increase emotional support and self‐efficacy among the staff members. Empowerment was considered to be a driving force. The fall prevention program was shown to be acceptable for use among elderly individuals in a long‐term care facility.     

New intervention program for preventing falls among frail elderly people: the effects of perturbed walking exercise using a bilateral separated treadmill

OBJECTIVE: To determine the effects of a perturbed walking exercise using a bilateral separated treadmill in physically disabled elderly. DESIGN: Participants of the study were 32 long-term care facility residents and outpatients aged 66-98 yrs. Participants were randomly assigned to a usual exercise group or to a treadmill exercise group. Perturbed gait exercise on a treadmill continued for 6 mos. Number of falls and time to first fall during a 6-mo period, balance and gait functions, and reaction time were evaluated before and after intervention. RESULTS: The treadmill exercise group showed significant improvement in balance and reaction time when compared with the usual exercise group. Number of falls in the treadmill exercise group was 21% lower than that in the usual exercise group. However, this difference was not significant. No significant differences were seen in time to first fall. CONCLUSIONS: Gait training with unexpected perturbation seems to have a beneficial impact on physical function in disabled elderly individuals. The results suggest that this program may be used as an exercise intervention to reduce falls in institutional settings.     

Effects of a multifactorial falls prevention program for people with stroke returning home after rehabilitation: a randomized controlled trial

Batchelor FA, Hill KD, Mackintosh SF, Said CM, Whitehead CH. Effects of a multifactorial falls prevention program for people with stroke returning home after rehabilitation: a randomized controlled trial.ObjectivesTo determine whether a multifactorial falls prevention program reduces falls in people with stroke at risk of recurrent falls and whether this program leads to improvements in gait, balance, strength, and fall-related efficacy.DesignA single blind, multicenter, randomized controlled trial with 12-month follow-up.SettingParticipants were recruited after discharge from rehabilitation and followed up in the community.ParticipantsParticipants (N=156) were people with stroke at risk of recurrent falls being discharged home from rehabilitation.InterventionsTailored multifactorial falls prevention program and usual care (n=71) or control (usual care, n=85).Main Outcome MeasuresPrimary outcomes were rate of falls and proportion of fallers. Secondary outcomes included injurious falls, falls risk, participation, activity, leg strength, gait speed, balance, and falls efficacy.ResultsThere was no significant difference in fall rate (intervention: 1.89 falls/person-year, control: 1.76 falls/person-year, incidence rate ratio=1.10, P=.74) or the proportion of fallers between the groups (risk ratio=.83, 95% confidence interval=.60–1.14). There was no significant difference in injurious fall rate (intervention: .74 injurious falls/person-year, control: .49 injurious falls/person-year, incidence rate ratio=1.57, P=.25), and there were no significant differences between groups on any other secondary outcome.ConclusionsThis multifactorial falls prevention program was not effective in reducing falls in people with stroke who are at risk of falls nor was it more effective than usual care in improving gait, balance, and strength in people with stroke. Further research is required to identify effective interventions for this high-risk group.     

老年人跌倒危险因素的调查

目的:分析老年人跌倒的危险因素,为制定预防老年人跌倒的干预措施提供依据.方法:经方便取样,通过问卷访谈法调查200例60岁以上老人的跌倒状况及相关的危险因素.结果:老年人跌倒年发生率为34%,且随着年龄的增高而上升;64.4%跌倒发生在室内,主要是由腿脚无力和障碍物绊倒所致,跌倒造成的损伤主要有软组织损伤(75%)、骨折(25%),老年人跌倒是生理和心理状况、疾病、药物和生活环境等诸多因素交互作用的结果.结论:预防老年人跌倒建议采取包括安全教育、疾病治疗、用药指导、环境改造、体育锻炼等多元化的综合干预措施.     

Muscular Strength Assessments for Older Adults in the Community

Falls among the elderly are a major health problem associated with a significant risk of long term disability or mortality. This study investigated whether older adults who subsequently fall demonstrate weaker leg strength or impaired ankle flexion when compared with non-fallers. This study is the fist attempt to obtain values on leg strength for independently functioning older adults who subsequently suffered a fall and to compare a simple clinical procedure, the 10-stands, with a computerized dynamometric assessment. The results on both the clinical and computerized measurements did not indicate a significant difference in strength of selected muscle groups between the fallers and non-fallers. There was also no difference in' ankle dorsiflexion and ankle plantar flexion for people who subsequently fell. Thus, falls in this study do not seem to be the result of impaired leg strength in active older adults but may be due to environmental factors. The clinical measurement of 10-stands appears to be a useful procedure for settings that do not provide high-technology equipment.     

The effects of complex exercise on walking ability during direction change and falls efficacy in the elderly

[Purpose] This study was to assessed the efficacy of a complex exercise program for the elderly, with respect to the effects on walking ability during direction change and on falls efficacy. [Subjects] In total, 40 subjects were selected for this study and assigned randomly to either a complex exercise (n = 20) or a general exercise (n = 20) group. [Methods] The complex exercise consisted of resistance and aerobic exercises. The exercise program was conducted three times a week for eight weeks. We assessed outcome measures of the four square step test, the figure-of-8 walk test, and the falls efficacy scale. [Results] After the intervention, the four step square test, figure-of-8 walk test, and falls efficacy scale values increased significantly in both the complex exercise program and general exercise groups. The complex exercise group showed a more significant improvement than the general exercise group in the figure-of-8 walk test step and falls efficacy scale scores. [Conclusion] Complex exercise improved walking ability during direction change and falls efficacy in elderly individuals.Key words: Complex exercise, Falls efficacy, Gait     

Enhancing functional balance and mobility among older people living in long-term care facilities

This study of long-term care residents investigated whether a balance strategy training program (BSTP) developed for older people living in the community is effective in improving functional mobility and reducing falls when adapted to resident functional abilities. The BSTP was delivered twice weekly over 12 weeks. Outcome measures compared pre- and postintervention measured Timed Up and Go, Functional Reach, timed 5 sit-to-stand movements, and number of?falls in 12 weeks before intervention with 12-week follow-up period. Forty-seven residents participated, 26 of whom were cognitively impaired. There was a significant improvement in all functional balance and mobility measures, but this was clinically significant only in 5 sit-to-stand time. There was no reduction in falls, although this outcome was confounded by all fallers being acutely ill at the time of falling. These results suggest participation in a BSTP by residents of long-term care improves resident functional mobility and balance.     

Predicting which patient will fall again… and again

In order to compare the characteristics, preventive interventions and outcomes of single and multiple fallers, a retrospective cross-sectional study was conducted in a 680-bed acute-care hospital in Western Australia Fifty patients falling more than once (multiple fallers) were randomly selected from all patients reported to have fallen between 1 July 1989 and 31 December 1989, and age–sex matched with 50 patients falling once in the trial period (single fallers) In total, 382 in-patients were reported to have sustained 578 falls in the 6-month trial period Fifty-two per cent of these falls involved multiple fallers An analysis of the 100 single and multiple fallers showed that single fallers were more likely to have fallen from their bed, be discharged home from hospital, and be clinically deteriorating at the time of the fall Multiple fallers were more likely to be transferred to a long-term nursing facility after discharge from hospital, suffer blindness/poor vision, be sedated post fall, be ordered to be restrained following a fall, and be hospitalized for longer periods There was also a tendency for multiple fallers to repeat the type and location of the fall on successive falls Stepwise logistic regression showed that falling from the bed on the first fall predicted remaining a single faller Being ordered to be restrained following the first fall and hospitalized for longer periods predicted the patient would fall repeatedly Further analytical research incorporating an expanded number of independent variables is needed to allow confident assertions of causality To test the effectiveness of preventive measures, a prospective longitudinal study is required.     

Health care utilization and functional status in the aged following a fall

Falls in the aged may lead to increases in health care utilization and declines in functional status. The Longitudinal Study of Aging was analyzed to test the hypotheses that use of the health care system is greater in elderly persons subsequent to a fall in the preceding year than in those who have not fallen and that fallers are more likely to decline in function than are nonfallers. One-time fallers and, especially repeated fallers, (2 or more falls in the preceding year) were at greater risk of subsequent hospitalization, nursing home admission, and frequent physician contact than were nonfallers, after controlling for age, sex, self-perceived health status, and difficulties with activities of daily living. Similarly, one-time fallers, and especially repeated fallers, were at greater risk of reporting subsequent difficulties with activities of daily living, instrumental activities of daily living, and more physically demanding activities. These findings highlight the significant impact that falls have on the health care system and on the individual.     

Fall prevention in a Swiss acute care hospital setting Reducing multiple falls

Preventing in-hospital falls is an important goal in avoiding poor patient outcomes. In this quasi-experimental study, the authors evaluated the effectiveness of a nurse-led fall prevention program in a 300-bed Swiss hospital. Four hundred and nine patients (internal medicine) were included: intervention group (n = 198), usual-care group (n = 211). The program consisted of training nurses in the use of the Morse Fall Scale, and the implementation of 15 selected preventive interventions. In the intervention group, the proportion of patients at risk for falls was higher (p = .048), and fewer patients with multiple falls were observed (p = .009). The intervention program showed an effect in preventing multiple falls, but not first falls. The prolonged mean time to a first fall in a subgroup of fallers in the intervention group may indicate an increased awareness of the nurses and the appropriateness of the interventions used.     

Outcomes from the implementation of a facility-specific evidence-based falls prevention intervention program in residential aged care

For residents in long-term care facilities, falling is a major concern requiring preventive intervention. A prospective cohort study measured the impact of falls reduction following the implementation of evidence-based fall prevention interventions in 9 Australian residential care facilities. An external project team provided a comprehensive audit of current practice. Facilitated by an action research approach, interventions were individualized to be facility- and patient-specific and included the following: environmental modifications such as low beds and height-adjustable chairs, movement alarms, hazard removal, and hip protectors. Participants included 670 residents and 650 staff from 9 facilities across 3 states. A significant reduction of falls were observed per site in the proportion of fallers (P = .044) and single fallers (P = .04). However, overall the number of falls was confounded by multiple falls in residents. Reduction in fallers was sustained in the 6-month follow-up phase. Positive outcomes from interventions varied between facilities. Further research is necessary to target frequent fallers.     

Impact of falls on mental health outcomes for older adult mental health patients: An Australian study

Sustaining a fall during hospitalization reduces a patient's ability to return home following discharge. It is well accepted that factors, such as alteration in balance, functional mobility, muscle strength, and fear of falling, are all factors that impact on the quality of life of elderly people following a fall. However, the impact that falls have on mental health outcomes in older adult mental health patients remains unexplored. The present study reports Health of the Nation Outcome Scale scores for people over the age of 65 (HoNOS65+), which were examined in a cohort of 65 patients who sustained a fall and 73 non‐fallers admitted to an older adult mental health service (OAMHS). Results were compared with state and national HoNOS65+ data recorded in Australian National Outcome Casemix Collection data to explore the effect that sustaining a fall while hospitalized has on mental health outcomes. Australian state and national HoNOS65+ data indicate that older adults generally experience improved HoNOS65+ scores from admission to discharge. Mental health outcomes for patients who sustained a fall while admitted to an OAMHS did not follow this trend. Sustaining a fall while admitted to an OAMHS negatively affects discharge mental health outcomes.     

奥塔戈运动在预防出院后老年脑卒中患者跌倒中的应用效果

目的 研究奥塔戈运动对出院后老年脑卒中患者跌倒效能、平衡能力、生活自理能力和跌倒发生情况的影响。方法 选取我院神经内科2018.7.1～2020.6.30符合研究标准的出院患者80例随机分为观察组和对照组,每组40例,在院期间对2组患者均进行常规防跌倒措施,出院后均进行常规电话、微信及门诊随访,观察组在对照组基础上接受6个月的奥塔戈运动（OEP）干预。比较两组患者在干预前后跌倒效能、平衡能力、生活自理能力和跌到发生的情况,评价奥塔戈运动在预防出院后老年脑卒中患者跌倒中的效果。结果 干预前两组患者跌倒效能、平衡能力、Barthel生活自理能力评分及跌倒发生率比较,均无差异(P>0.05),干预6个月后,观察组与对照组,跌倒效能、平衡能力、Barthel生活自理能力评分与干预前比较,均有改善(P<0.05),且观察组的改善更为明显(P<0.05),而跌倒发生率无明显差异（P>0.05）。结论 6个月的奥塔戈运动干预,能够提高出院后老年脑卒中患者的跌倒效能、平衡能力和生活自理能力,但能否降低跌倒发生率,有待进一步研究。     

A randomized controlled trial of a group care program for community-dwelling elderly people with dementia

Aim: To examine the effectiveness of a group care program consisting of reminiscence and reality orientation care methods to prevent the decline of cognitive and daily activity function in community‐dwelling elderly persons with dementia in a randomized controlled trial with a 6‐month follow‐up period. Methods: Sixty community‐dwelling elderly persons with dementia were randomly assigned to either an intervention or a control group. The intervention group followed the group care program consisting of reminiscence and reality orientation care methods in addition to a routine day‐care service once a week for 10 consecutive weeks; the control group followed only a routine day‐care service in the same institution as the intervention group for the same study period. Results: On cognitive function, the intervention group exhibited a significant effect compared with the control group immediately after the intervention (P < 0.05), but no significant effect was observed after 6 months. On daily activity function, the intervention group exhibited significant effects compared with the control group in disorientation and withdrawal immediately after the intervention (P < 0.05) and after 6 months (P < 0.05). Conclusions: The group care program consisting of reminiscence and reality orientation care methods can be effective for the improvement of cognitive function in the short‐term and on the improvement of disorientation and withdrawal in the long‐term. It is suggested, however, that sustained intervention may be necessary to maintain the effect over time.     

Reduced hip extension during walking: healthy elderly and fallers versus young adults

OBJECTIVES: To test the hypothesis that reduced hip extension range during walking, representing a limiting impairment of hip tightness, is a consistent dynamic finding that (1) occurs with increased age and (2) is exaggerated in elderly people who fall. DESIGN: Using a 3-dimensional optoelectronic motion analysis system, we compared full sagittal plane kinematic (lower extremity joint motion, pelvic motion) data during walking between elderly and young adults and between elderly fallers and nonfallers. Comparisons were also performed between comfortable and fast walking speeds within each elderly group. SETTING: A gait laboratory. PARTICIPANTS: Twenty-three healthy elderly subjects, 16 elderly fallers (otherwise healthy elderly subjects with a history of recurrent falls), and 30 healthy young adult subjects. MAIN OUTCOME MEASURES: All major peak joint angle and pelvic position values. RESULTS: Peak hip extension was the only leg joint parameter measured during walking that was both significantly lower in elderly nonfallers and fallers than in young adult subjects and was even lower in elderly fallers compared with nonfallers (all p <.05). Peak hip extension +/- standard deviation during comfortable walking speed averaged 20.4 degrees +/- 4.0 degrees for young adults, 14.3 degrees +/- 4.4 degrees for elderly nonfallers, and 11.1 degrees +/- 4.8 degrees for elderly fallers. Peak hip extension did not significantly improve when elderly subjects walked fast. CONCLUSION: An isolated and consistent reduction in hip extension during walking in the elderly, which is exaggerated in fallers, implies the presence of functionally significant hip tightness, which may limit walking performance. Overcoming hip tightness with specific stretching exercises is worthy of investigation as a simple intervention to improve walking performance and to prevent falls in the elderly.