Muscle Weakness and Falls in Older Adults: A Systematic Review and Meta‐Analysis

Moreland, Julie; Richardson, Julie; Goldsmith, Charlie H.; Clase, Catherine M.

doi:10.1111/j.1532-5415.2004.52310.x

Cited by 757 publications

(501 citation statements)

References 57 publications

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“…Nevertheless, the intervention program resulted in a significant reduction in the frequency of falls, with multiple fallers deriving particular benefits. These findings substantiate the results of other studies showing that physical activation can decrease the risk of falls even in elderly adults who already show impairment [22,35].…”

Section: Discussionsupporting

confidence: 82%

“…Given that falls are known to be one of the major risk factors for becoming (more) dependent on care [4,49], physical activation has a major role to play in rehabilitative care. Training programs that combine strength and balance training to improve mobility can significantly reduce the frequency of falls [5,8,22,33,35]. Programs of this kind have proved to have positive effects on the functional performance and psychological state of nursing home residents [9,44].…”

Section: Improving Physical Performancementioning

confidence: 99%

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Effects of a multimodal activation program (SimA-P) in residents of nursing homes

Oswald

Gunzelmann

Ackermann

2007

Eur Rev Aging Phys Act

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Is it possible to maintain or even enhance functional and cognitive independence in residents of nursing homes? Little is known about the potentials and limits of therapeutic methods designed to maintain independence in elderly people already in need of residential nursing care. The aim of the "Rehabilitation in Nursing Homes" research project was to determine the practicability and effectiveness of a rehabilitative approach targeting residents of nursing homes. The main objectives of the activation program were to maintain and enhance residents' cognitive and functional autonomy. Data on psychological, functional, and medical variables were obtained from a sample of 294 nursing home residents (age range=70-99 years) at three points of measurement over a 12-month period. The intervention approach draws on the theoretical and practical findings of the SimA Study ("Bedingungen der Erhaltung und Förderung von Selbstständigkeit im höheren Lebensalter," "conditions on maintaining and supporting independent living in old age"; Oswald et al., Z. Gerontopsychol. Psychiatr., 15:61-84, 2002, Z. Gerontopsychol. Psychiatr., 15:13-31, 2002) and incorporates the results of recent therapeutic and rehabilitative studies in the fields of geriatrics and gerontopsychiatry. The intervention involves a combined program of cognitive and physical activation. An alternative program based on biographical information was designed specifically for residents with dementia. Results show that the intervention had significant effects on cognitive and functional parameters. Moreover, transfer effects were observed with respect to activities of daily living and frequency of falls.Keywords Nursing homes . Rehabilitation . Cognitive activation . Fall prevention . Activities of daily living Rehabilitation in nursing homesMost residents of nursing homes are elderly people in need of regular or around-the-clock nursing care [43]. Some 80% of the residents of nursing homes for the elderly have impaired mobility, 80% show cognitive impairment, and 70% experience symptoms of depression. Against this background, rehabilitative approaches to care [12] seek to maintain, enhance, or restore functional ability, or at least to prevent or delay the deterioration or loss of functioning and to help individuals adapt to irreversible losses in functional capacity.Epidemiological studies show that need for care is not determined by physical impairment or illness alone. In fact, it is characterized by multiple factors such as multimorbidity, mobility problems, cognitive impairment, psychological symptoms (primarily depression), and social isolation [25,40, 52]. Accordingly, multimodal intervention programs that target physical exercise and cognitive performance while, at the same time, promoting psychological well-being and social interaction should be most likely to have rehabilitative effects [1].

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Section: Discussionsupporting

confidence: 82%

Section: Improving Physical Performancementioning

confidence: 99%

Effects of a multimodal activation program (SimA-P) in residents of nursing homes

Oswald

Gunzelmann

Ackermann

2007

Eur Rev Aging Phys Act

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“…These parameters relate to declining physical function in the elderly, with a resulting increased risk of falling and a decreased capacity to protect bone from impact. (55) Combining these variables with BMD and geometric assessment of the proximal femur has been shown to improve hip fracture prediction compared with bone measures alone. (56) One of the strengths of our study is MIAF-Femur because there is a paucity of analysis tools available for QCT.…”

Section: Discussionmentioning

confidence: 99%

In vivo discrimination of hip fracture with quantitative computed tomography: Results from the prospective European Femur Fracture Study (EFFECT)

Bousson

Adams

Engelke³

et al. 2010

Journal of Bone and Mineral Research

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In assessing osteoporotic fractures of the proximal femur, the main objective of this in vivo case-control study was to evaluate the performance of quantitative computed tomography (QCT) and a dedicated 3D image analysis tool [Medical Image Analysis Framework-Femur option (MIAF-Femur)] in differentiating hip fracture and non-hip fracture subjects. One-hundred and seven women were recruited in the study, 47 women (mean age 81.6 years) with low-energy hip fractures and 60 female non-hip fracture control subjects (mean age 73.4 years). Bone mineral density (BMD) and geometric variables of cortical and trabecular bone in the femoral head and neck, trochanteric, and intertrochanteric regions and proximal shaft were assessed using QCT and MIAF-Femur. Areal BMD (aBMD) was assessed using dual-energy X-ray absorptiometry (DXA) in 96 (37 hip fracture and 59 non-hip fracture subjects) of the 107 patients. Logistic regressions were computed to extract the best discriminates of hip fracture, and area under the receiver characteristic operating curve (AUC) was calculated. Three logistic models that discriminated the occurrence of hip fracture with QCT variables were obtained (AUC ¼ 0.84). All three models combined one densitometric variable-a trabecular BMD (measured in the femoral head or in the trochanteric region)-and one geometric variable-a cortical thickness value (measured in the femoral neck or proximal shaft). The best discriminant using DXA variables was obtained with total femur aBMD (AUC ¼ 0.80, p ¼ .003). Results highlight a synergistic contribution of trabecular and cortical components in hip fracture risk and the utility of assessing QCT BMD of the femoral head for improved understanding and possible insights into prevention of hip fractures. ß

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“…Our meta-analysis of prospective cohort studies identified physical function and muscle weakness in the upper and lower limbs as a significant predictor of falls [25]. As the activity items in our daily performance score sheet are affected by muscle strength, a lower score may reflect muscle weakness and thus predict falls and stumbles.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of performance status of daily living activities and of the future risk of falls in the non-handicapped, community-dwelling elderly

Okamura

Tanabe

Shinoda

et al. 2009

Environ Health Prev Med

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Objectives There is a growing need to evaluate the performance status of the activities of daily living (ADL) of the elderly in the rapidly aging Japanese society. The purpose of this study was to verify the usefulness of our new scoring sheet for assessing present ADL status and to clarify whether or not the assessed ADL status can predict the future risk of adverse conditions related to falls. Methods The validation study was performed using 116 non-handicapped community-dwelling Japanese elderly at least 60 years of age. Of those subjects, 44 were also analyzed for the relationship between baseline ADL status and subsequent risk of adverse conditions related to falls. Results The daily living performance score sheet had good internal consistency, with a Cronbach's alpha of 0.82 and a sequential hierarchical structure that reflected the difficulty of the activities. The total score was significantly and positively associated with six of eight subscale scores on the Short-Form 36-Item Health Survey (P \ 0.01). In the follow-up study, every one-point decrease in total score was significantly associated with a 39% elevated risk of a stumble or fall (P = 0.022) and also borderline significantly associated with higher risks of a fall, anxiety while walking indoors, and anxiety while walking outdoors (P \ 0.10). Conclusion Our new scoring sheet can reliably and comprehensively assess present ADL status. The assessed ADL could predict the future risk of adverse conditions related to falls.

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Muscle Weakness and Falls in Older Adults: A Systematic Review and Meta‐Analysis

Abstract: Muscle strength (especially lower extremity) should be one of the factors that is assessed and treated in older adults at risk for falls. More clinical trials are needed to isolate whether muscle-strengthening exercises are effective in preventing falls.

Cited by 757 publications

References 57 publications

Effects of a multimodal activation program (SimA-P) in residents of nursing homes

Effects of a multimodal activation program (SimA-P) in residents of nursing homes

In vivo discrimination of hip fracture with quantitative computed tomography: Results from the prospective European Femur Fracture Study (EFFECT)

Evaluation of performance status of daily living activities and of the future risk of falls in the non-handicapped, community-dwelling elderly

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