Falls exercise interventions and reduced falls rate: always in the patient's interest?
Falls are a leading cause of mortality and morbidity in older adults. Physical, psychological and social consequences include injury, fall-related fear and loss of self-efficacy. In turn, these may result in decreased physical activity, reduced functional capacity, and increased risk of institutionalisation. Falls prevention exercise programmes (FPEP) are now widespread within the National Health Service, often part of multifactorial interventions, and are designed to minimise impairments that impact physical function, such as strength and balance. Assessment of the clinical efficacy of FPEPs has therefore focused on the measurement of physical function and rate of falls. Whilst important, this approach may be too narrow to capture the highly variable and multidimensional responses that individuals make to a fall and to a FPEP. We argue that the current focus may miss a paradoxical lack of or even deleterious impact on quality of life, despite a reduction in physical performance-related falls risk. We draw upon the Selective Optimisation and Compensation (SOC) model, developed by Paul and Margret Baltes, to explore how this paradox may be a result of the coping strategies adopted by individuals in response to a fall.
Laybourne
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AH
King's College London, Institute of Gerontology, Melbourne House, 46 Aldwych London WC2B 4LL, UK. anne.laybourne@kcl.ac.uk
Biggs
S
S
Martin
F C
FC
D000058:Accidental Falls / Q000517:prevention & control*; D000203:Activities of Daily Living / Q000523:psychology*; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D002183:Canes; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D015444:Exercise / Q000523:psychology; D016330:Frail Elderly / Q000523:psychology; D006699:Home Care Services; D006801:Humans; D008019:Life Style; D051346:Mobility Limitation; D008960:Models, Psychological; D053580:Muscle Strength; D010342:Patient Acceptance of Health Care; D010555:Personality Inventory; D004856:Postural Balance; D011788:Quality of Life / Q000523:psychology; D012803:Sick Role; D012917:Social Adjustment