Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities.
OBJECTIVE
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.
Jensen
Jane
J
Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå University, Sweden. jane.jensen@physiother.umu.se
Nyberg
Lars
L
Rosendahl
Erik
E
Gustafson
Yngve
Y
Lundin-Olsson
Lillemor
L
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000503:physiopathology / Q000523:psychology; D015444:Exercise; D005260:Female; D016330:Frail Elderly; D005684:Gait; D006801:Humans; D008297:Male; D004856:Postural Balance; D011315:Preventive Medicine / Q000379:methods; D012112:Residential Facilities; D016138:Walking