Preventing falls among older fallers: study protocol for a two-phase pilot study of the multicomponent LIVE LiFE program

Abstract

BackgroundFalls reflect sentinel events in older adults, with significant negative consequences. Although fall risk factors have been identified as intrinsic (e.g., muscle weakness, balance problems) and extrinsic (e.g., home hazards), most prevention programs target only intrinsic factors. We present the rationale and design of a home-based multicomponent fall prevention program—the LIVE LiFE program—for community-living older adults. The program adapts and expands the successful Lifestyle Intervention Functional Exercise (LiFE) program by adding home safety, vision contrast screening, and medication review. The specific aims of the study are to (1) adapt the LiFE program to a US context and expand it into a multicomponent program (LIVE LiFE) addressing intrinsic and extrinsic fall risks, (2) examine feasibility and acceptability, and (3) estimate program impact on multiple outcome measures to prepare for an efficacy trial.MethodsThe study involves two phases: an open-label pilot, followed by a two-group, single-blinded randomized pilot trial. Eligible participants are community-living adults 70+ years reporting at least one injurious fall or two non-injurious falls in the previous year. Participants are randomized in a 2:1 ratio to the program group (LIVE LiFE, n = 25) or the control group (written fall risk assessment, n = 12). The open-label pilot participants (n = 3) receive the program without randomization and are assessed based on their experience, resulting in a stronger emphasis on the participant’s personal goals being integrated into LIVE LiFE. Fall risk and balance outcomes are assessed by the Timed Up and Go and the 4-Stage Balance Test at 16 weeks. Additional outcomes are incidence of falls and near falls, falls efficacy, fear of falling, number of home hazards, and medications assessed at 16 weeks. Incidence of falls and near falls, program adherence, and satisfaction are assessed again at 32 weeks.DiscussionBy expanding and adapting the evidence-based LiFE program, our study will help us understand the feasibility of conducting a multicomponent program and estimate its impact on multiple outcome measures. This will support moving forward with an efficacy trial of the LIVE LiFE program for older adults who are at risk of falling.Trial registrationClinicalTrials.gov, NCT03351413. Registered on 22 November 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-3114-5) contains supplementary material, which is available to authorized users.

Effects of a Multicomponent Program on Fall Incidence, Fear of Falling, and Quality of Life among Older Adult Nursing Home Residents

“…Another study in Iran reported that a multicomponent program including environmental modifications and exercise programs resulted in a significant decrease in falls prevalence among older adults living in nursing homes. 21 ) In a systematic review, Granbom et al 29 ) showed that multicomponent programs are more effective than single-component programs for fall prevention. They also suggested that interventions should integrate the exercise program into daily life and make the home environment safer as the place of residence for older adults to allow older adults to be more likely to continue the exercise program and stay active.…”

“…Most of the interventions in fall prevention programs in older people include exercise, use of medication, life environment interventions, use of support technologies such as alarms next to the bed, social environment interventions like training caregivers of older adults, and changes in the organizational system. 19 - 21 , 29 ) However, the effects of fall prevention programs on fall risk in older people differ in the literature. For example, a meta-analysis by Vlaeyen et al 30 ) showed that single-component interventions to prevent falls did not affect the number and risk of falls in more than half of the studies.…”

Health-promoting and preventive interventions for community-dwelling older people published from inception to 2019: a scoping review to guide decision making in a Swedish municipality context

“…This approach has also been integrated into some current Swedish guidance, on physical training, balance and more, issued from the National Board on Health and Welfare in the form of training for professionals working with older people and fall prevention [ 116 ]. However, effectiveness of exercise-based interventions is dependent on the uptake and long-term adherence [ 117 ]. Groups sessions led by professionals over a longer period (1 year or more) seems to affect this aspect positively but can be costly, foremost in terms of human resources needed if provided to a large population of older people.…”

The Lifestyle-integrated Functional Exercise (LiFE) program and its modifications: a narrative review

“…Feasibility of a multicomponent LiFE format was demonstrated by Granbom et al (2019). The multicomponent LIVE LiFE format improved all performance measures with small to large effect sizes, showing significant differences between the intervention and control group (Granbom et al, 2019).…”