An interdisciplinary intervention to prevent falls in community-dwelling elderly persons: protocol of a cluster-randomized trial [PreFalls]

Abstract

BackgroundPrevention of falls in the elderly is a public health target in many countries around the world. While a large number of trials have investigated the effectiveness of fall prevention programs, few focussed on interventions embedded in the general practice setting and its related network. In the Prevent Falls (PreFalls) trial we aim to investigate the effectiveness of a pre-tested multi-modal intervention compared to usual care in this setting.Methods/DesignPreFalls is a controlled multicenter prospective study with cluster-randomized allocation of about 40 general practices to an experimental or a control group. We aim to include 382 community dwelling persons aged 65 and older with an increased risk of falling. All participating general practitioners are trained to systematically assess the risk of falls using a set of validated tests. Patients from intervention practices are invited to participate in a 16-weeks exercise program with focus on fall prevention delivered by specifically trained local physiotherapists. Patients from practices allocated to the control group receive usual care. Main outcome measure is the number of falls per individual in the first 12 months (analysis by negative binomial regression). Secondary outcomes include falls in the second year, the proportion of participants falling in the first and the second year, falls associated with injury, risk of falls, fear of falling, physical activity and quality of life.DiscussionReducing falls in the elderly remains a major challenge. We believe that with its strong focus on a both systematic and realistic fall prevention strategy adapted to primary care setting PreFalls will be a valuable addition to the scientific literature in the field.Trial registrationNCT01032252

Functional Challenges in the Elderly

“…As a consequence of performance decline, elderly frequently experience falls (Blank, 2011 fear of falling, restricted mobility, loss of autonomy and bone fractures (Gill, 2004;Blank, 2011). Elderly people who have experienced bone fractures after falls have 45 to 60% of decline in their independency and around 8 0 % o f t h e m b e c o m e i n a c t i v e d u e t o psychosomatic aspects.…”

“…Strength training and weight-bearing exercises, functional power training, balance training, daily activity performance with motor coordination and proprioception, gait training with change of pace and direction while walking all contribute to functional activity improvement (Blank, 2011).…”

“…However, 65-year old people who have balance loss can be selected to a rehabilitation program (Vreede, 2004;Blank, 2011) To evaluate the risk of falling older people need to have at least one of the following criteria: fall within the last 12 months; fear for falling; sitting to standing >10 sec; Timed-up-and-goTest >10 sec (Blank, 2011) However, the elderly in general would improve muscle strength and balance from exercise programs because it's known that they have progressive and declining loss of all organ functions over time. (Priebe, 2000;Papaléo, 2002).…”

“…Strength training, weight-bearing exercise and functional power training, plus balance training, daily activity performance with motor coordination and sensory awareness, gait trainingare all part of different elderly rehabilitation (Judge, 1994;Tavares, 2008;Ciolac and Brech, 2010;Blank, 2011).…”

Examining Contextual Influences on Fall-Related Injuries Among Older Adults for Population Health Management

“…94 Older adults sometimes do not realize that FRIs can lead to rapid decline in health and functional independence, or even death. [95][96][97][98][99][100] If older individuals in communities with fewer economic resources are less disposed to seek treatment for FRIs, there is also less opportunity for providers to offer fall risk assessments and prevention assistance. It then becomes incrementally more difficult to prevent future FRIs and FRIrelated morbidity and mortality when initial FRIs are not treated or observed by providers.…”