Effectiveness of a Multifaceted Intervention on Falls in Nursing Home Residents

Becker, Clemens; Kron, Martina; Lindemann, Ulrich; Sturm, E.; Eichner, Barbara; Walter-Jung, B.; Nikolaus, Thorsten

doi:10.1046/j.1532-5415.2003.51103.x

Cited by 256 publications

(259 citation statements)

References 34 publications

(57 reference statements)

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“…19,[52][53][54][55][56] Furthermore, based on our results, exercise programs should last at least 3 months before a beneficial effect on falling can be expected. This compares favorably with the studies of Becker et al, 57 who found that intervention effect on falling became apparent only after 6 months of training, and of Wolf et al, 19 who reported effects after 4 months of training. It is observed that in these studies conclusions on time dependency were based on visual inspection and/or multiple comparisons, instead of demonstrating the time dependency by group by period interaction analyses.…”

Section: Discussionsupporting

confidence: 83%

Effects of Exercise Programs on Falls and Mobility in Frail and Pre-Frail Older Adults: A Multicenter Randomized Controlled Trial

Faber

Bosscher

Paw

et al. 2006

Archives of Physical Medicine and Rehabilitation

430

363

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ABSTRACT. Faber MJ, Bosscher RJ, Chin A Paw MJ, van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial. Arch Phys Med Rehabil 2006;87:885-96. Objectives:To determine the effects of moderate intensity group-exercise programs on falls, functional performance, and disability in older adults; and to investigate the influence of frailty on these effects.Design: A 20-week, multicenter randomized controlled trial, with 52-week follow-up.Setting: Fifteen homes for the elderly. Participants: Two hundred seventy-eight men and women (mean age Ϯ standard deviation, 85Ϯ6y).Interventions: Two exercise programs were randomly distributed across 15 homes. The first program, functional walking (FW), consisted of exercises related to daily mobility activities. In the second program, in balance (IB), exercises were inspired by the principles of Tai Chi. Within each home participants were randomly assigned to an intervention or a control group. Participants in the control groups were asked not to change their usual pattern of activities. The intervention groups followed a 20-week exercise program with 1 meeting a week during the first 4 weeks and 2 meetings a week during the remaining weeks.Main Outcome Measures: Falls, Performance Oriented Mobility Assessment (POMA), physical performance score, and the Groningen Activity Restriction Scale (GARS) (measuring self-reported disability).Results: Fall incidence rate was higher in the FW group (3.3 falls/y) compared with the IB (2.4 falls/y) and control (2.5 falls/y) groups, but this difference was not statistically significant. The risk of becoming a faller in the exercise groups increased significantly in the subgroup of participants who were classified as being frail (hazard ratio [HR]ϭ2.95; 95% confidence interval [CI], 1.64Ϫ5.32). For participants who were classified as being pre-frail, the risk of becoming a faller decreased; this effect became significant after 11 weeks of training (HRϭ.39; 95% CI, .18Ϫ.88). Participants in both exercise groups showed a small, but significant improvement in their POMA and physical performance scores. In the FW group, this held true for the GARS score as well. Post hoc analyses revealed that only the pre-frail participants improved their POMA and physical performance scores.Conclusions: Fall-preventive moderate intensity groupexercise programs have positive effects on falling and physical performance in pre-frail, but not in frail elderly.

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Section: Discussionsupporting

confidence: 83%

Effects of Exercise Programs on Falls and Mobility in Frail and Pre-Frail Older Adults: A Multicenter Randomized Controlled Trial

Faber

Bosscher

Paw

et al. 2006

Archives of Physical Medicine and Rehabilitation

430

363

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“…Interventions combining education, environmental adaptations, balance/ resistance training, and hip protectors successfully reduced falls in 1 study 25 ; in another, a combination of exercise, visual, and counseling interventions showed some success in reducing falls 26 . Gillespie, Gillespie, and Robertson 27 reviewed 10 years of randomized trials of interventions designed to reduce falls in elderly patients.…”

Section: Discussionmentioning

confidence: 97%

An Electronic Medical Record (EMR)-Based Intervention to Reduce Polypharmacy and Falls in an Ambulatory Rural Elderly Population

2008

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BACKGROUND: Falls are the leading cause of injuryrelated deaths in the aging population. Electronic medical record (EMR) systems can identify at-risk patients and enable interventions to decrease risk factors for falls. OBJECTIVE:The objectives of this study were to evaluate an EMR-based intervention to reduce overall medication use, psychoactive medication use, and occurrence of falls in an ambulatory elderly population at risk for falls. DESIGN:Prospective, randomized by clinic site. PATIENTS/PARTICIPANTS:Six-hundred twenty community-dwelling patients over 70 at risk for falls based on age and medication use. INTERVENTIONS:A standardized medication review was conducted and recommendations made to the primary physician via the EMR. MEASUREMENTS AND MAIN RESULTS:Patients were contacted to obtain self reports of falls at 3-month intervals over the 15-month period of study. Fall-related diagnoses and medication data were collected through the EMR. A combination of descriptive analyses and multivariate regression models were used to evaluate differences between the 2 groups, adjusting for baseline medication patterns and comorbidities. Although the intervention did not reduce the total number of medications, there was a significant negative relationship between the intervention and the total number of medications started during the intervention period (p <.01, regression estimate −0.199) and the total number of psychoactive medications (p<.05, regression estimate −0.204.) The impact on falls was mixed; with the intervention group 0.38 times as likely to have had 1 or more fall-related diagnosis (p<.01); when data on self-reported falls was included, a nonsignificant reduction in fall risk was seen. CONCLUSIONS:The current study suggests that using an EMR to assess medication use in the elderly may reduce the use of psychoactive medications and falls in a community-dwelling elderly population.

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“…Most of the studies evaluating multifactorial interventions have been conducted in community settings and, in a number of cases, similar approaches in residential care settings have not been as successful. Multifactorial fall prevention measures do not appear to work in those attending hospital after a fall with cognitive impairment (101), but similar interventions in residential care facilities are effective (98,(107)(108)(109). It appears that interventions should not only be tailored to the individual but also to the particular setting.…”

Section: Cognitively Impaired Older People and Those In Residential Cmentioning

confidence: 99%

“…Residential care dwellers (58,59,82,98,99,(106)(107)(108)(109)110) In long-term care and residential care settings assessment for risk and appropriate multifactorial interventions for all residents (including those with dementia and cognitive impairment) there is some evidence to support: Exercise (83,87,89-98, 102,107 ) Specific exercise programmes work best within a multifactorial fall-prevention programme but there is evidence that they work alone as well.…”

mentioning

confidence: 99%

Analysis of Fall Injuries by Body Mass Index

Ren¹,

Waclawczyk²,

Hartfield³

et al. 2014

Southern Medical Journal

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This report is HEN's response to a question from a decision-maker. It provides a synthesis of the best available evidence, including a summary of the main findings and policy options related to the issue. Fall prevention programmes can be effective in reducing the number of people who fall and the rate of falls. Targeted strategies aimed at behavioural change and risk modification for those living in the community appear to be most promising. Multifactorial intervention programmes that include risk factor assessment and screening have been shown to be effective. However, no screening tools have been rigorously validated across countries and further work is needed in this area.HEN, initiated and coordinated by the WHO Regional Office for Europe, is an information service for public health and health care decision-makers in the WHO European Region. Other interested parties might also benefit from HEN.

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Effectiveness of a Multifaceted Intervention on Falls in Nursing Home Residents

Cited by 256 publications

References 34 publications

Effects of Exercise Programs on Falls and Mobility in Frail and Pre-Frail Older Adults: A Multicenter Randomized Controlled Trial

Effects of Exercise Programs on Falls and Mobility in Frail and Pre-Frail Older Adults: A Multicenter Randomized Controlled Trial

An Electronic Medical Record (EMR)-Based Intervention to Reduce Polypharmacy and Falls in an Ambulatory Rural Elderly Population

Analysis of Fall Injuries by Body Mass Index

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