Guidelines for the prevention of falls in people over 65

BMJ 2000; 321 doi: 10.1136/bmj.321.7267.1007 (Published 21 October 2000)

Cite this as: BMJ 2000;321:1007

ABSTRACT

Older people frequently fall. This is a serious public health problem, with a substantial impact on health and healthcare costs.1 These guidelines translate trial evidence about prevention of falls into recommendations that can be implemented in different settings, with the aim of reducing the rate of falls and injurious falls in people over 65 (see boxes 2 3).

Summary points

Multifaceted interventions reduce falls in older people (those over 65)

Home assessment of older people at risk of falls without referral or direct intervention is not recommended

Assessment of high risk residents in nursing homes with relevant referral is effective

Evidence from well designed single trials shows that assessment and modification of risk factors of older people who have presented to an accident and emergency department after a fall and the provision of hip protectors in residents of nursing homes are effective

Quelle:  http://www.bmj.com/content/321/7267/1007

Full text / HTML: online im internet - Zugriff vom 04.10.2012

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118778/


Full Text / pdf:  online im internet - Zugriff vom 04.10.2012

http://mcintranet.musc.edu/agingq3/documents/images/Copy%20of%20Feder_guidelines.pdf





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Falls among older adults--Risk factors and prevention strategies.

 Stevens, Judy A. /Journal of Safety Research, Vol 36(4), 2005, 409-411

ABSTRACT

Among people age 65 and older, falls are the leading cause of injury deaths. Fall risk factors are often categorized as personal or environmental. Personal factors include characteristics of the individual (such as age, functional abilities, and chronic conditions) while environmental risk factors usually refer to fall hazards in and around the home (such as tripping hazards, unstable furniture, and poor lighting). After clinical assessment with risk factor reduction, the most effective single intervention was exercise. Many seniors use psychoactive medications, specifically benzodiazepines, antidepressants, and sedatives/hypnotics, which increase the risk of falling. Decreasing the use of multiple medications and specific types such as tranquilizers, sleeping pills, and anti-anxiety drugs, reduces the likelihood of falling. Home assessment and modification may be effective in reducing falls when done by trained professionals such as occupation therapists and when focused on high risk seniors. Multi-component interventions may include risk factor screening; tailored exercise or physical therapy to improve gait, balance and strength; medication management; and other elements such as education about fall risk factors, referrals to health care providers for treatment of chronic conditions that may contribute to fall risk, and having vision assessed and corrected. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Quelle:  http://psycnet.apa.org/psycinfo/2005-14635-012




Full Text / pdf / online im internet - Zugriff vom 04.10.2012

http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Review-Paper_Final.pdf#page=9

 




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Effect of physical training on postural control of elderly

Melzer I, Benjuya N, Kaplanski J.

Source

Ben-Gurion University of the Negev and Kaye Institute of Education. Beer Sheva, Israel. itzikm@bgumail.bgu.ac.il

Abstract

BACKGROUND:

Preservation of balance in the elderly is fundamental to maintaining functional independence. Balance impairments have a tremendous impact on health care costs and quality of life. Fall prevention programs are an important health strategy, consequently there is a general need to develop effective and practical exercise programs that improve balance in the elderly.

OBJECTIVE:

To explore whether stability can be improved through exercise in inactive old subjects and to determine whether specific balance training proves to be more beneficial to retaining balance than strength training.

METHODS:

A randomized controlled study was conducted with 42 healthy elderly individuals. They were randomly allocated to three groups: Balance training (BT), Isometric training (IT) and Control (CG) received no intervention; each group consisted of 14 members. "Static" and "dynamic" postural stability were evaluated for seven postural conditions in upright standing before and immediately after 3 months of intervention using a force platform, and an isokinetic dynamometer used to determine whether the training improved muscle strength.

RESULTS:

The BT group significantly improved their forward-backward stability limits (maximal body lean) post intervention compared with other groups. Plantar and dorsiflexion isometric strength remained the same in all groups. No significant improvement was found in COP based measures in upright standing in all study groups, apart from the BT group that significantly improved parameters in performance with eyes open and during standing on a foam. BT subjects improved their self-confidence post intervention in 64.2%, while IT subjects improved in only 35.7%.

CONCLUSIONS:

Balance exercises appear to improve balance in the elderly, especially extending the boundaries of their stability a more dynamic component of balance. However it remains to be determined whether the lack of difference between groups in COP measures in upright standing ("static balance") was due to the short period of intervention, small sample size, unchallenged exercise regime or due to the inability of elderly individuals to improve their sway in upright standing.

Quelle:   http://www.ncbi.nlm.nih.gov/pubmed/16400783





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Community-based exercise program

Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial

Carter et al

Abstract

Background

Exercise programs improve balance, strength and agility in elderly people and thus may prevent falls. However, specific exercise programs that might be widely used in the community and that might be “prescribed” by physicians, especially for patients with osteoporosis, have not been evaluated. We conducted a randomized controlled trial of such a program designed specifically for women with osteoporosis.

Methods

We identified women 65 to 75 years of age in whom osteoporosis had been diagnosed by dual-energy X-ray absorptiometry in our hospital between 1996 and 2000 and who were not engaged in regular weekly programs of moderate or hard exercise. Women who agreed to participate were randomly assigned to participate in a twice-weekly exercise class or to not participate in the class. We measured baseline data and, 20 weeks later, changes in static balance (by dynamic posturography), dynamic balance (by a timed figure-eight run) and knee extension strength (by dynamometry).

Results

Of 93 women who began the trial, 80 completed it. Before adjustment for covariates, the intervention group tended to have greater, although nonsignificant, improvements in static balance (mean difference 4.8%, 95% confidence interval [CI] –1.3% to 11.0%), dynamic balance (mean difference 3.3%, 95% CI –1.7% to 8.4%) and knee extension strength (mean difference 7.8%, 95% CI –5.4% to 21.0%). Mean crude changes in the static balance score were –0.85 (95% CI –2.91 to 1.21) for the control group and 1.40 (95% CI –0.66 to 3.46) for the intervention group. Mean crude changes in figure-eight velocity (dynamic balance) were 0.08 (95% CI 0.02 to 0.14) m/s for the control group and 0.14 (95% CI 0.08 to 0.20) m/s for the intervention group. For knee extension strength, mean changes were –0.58 (95% CI –3.02 to 1.81) kg/m for the control group and 1.03 (95% CI –1.31 to 3.34) kg/m for the intervention group. After adjustment for age, physical activity and years of estrogen use, the improvement in dynamic balance was 4.9% greater for the intervention group than for the control group (p = 0.044). After adjustment for physical activity, cognitive status and number of fractures ever, the improvement in knee extension strength was 12.8% greater for the intervention group than for the control group (p = 0.047). The intervention group also had a 6.3% greater improvement in static balance after adjustment for rheumatoid arthritis and osteoarthritis, but this difference was not significant (p = 0.06).

Interpretation

Relative to controls, participants in the exercise program experienced improvements in dynamic balance and strength, both important determinants of risk for falls, particularly in older women with osteoporosis.

In people with osteoporosis, exercise may reduce the risk of fracture by its effect on maintenance of bone mass and, probably more important, by improving postural stability and thus decreasing rates of falling.¹ Numerous studies have examined the effect of exercise on bone mineral density in women with normal bone mass. Meta-analyses have revealed that either aerobic or resistance training can confer a 1% to 2% advantage relative to control participants, largely by slowing the loss of bone mineral.^2,3,4,5,6 Few exercise interventions have been undertaken in women with osteoporosis,⁷ but even the limited data available make it clear that antiresorptive therapy augments bone mineral more effectively than does exercise alone.^8,9

There is, however, increasing evidence that specific exercise interventions can reduce risk factors for falls and actual falls in older people.^10,11,12 Further investigation in women with osteoporosis is therefore warranted, as these subjects are at particular risk of fracture if they fall. The response to exercise programs could very well be similar for women with osteoporosis and those with normal bone health, but this assumption needs to be tested. There may be disease-related, physiological, or biomechanical and posture-related differences between women with osteoporosis and the women in whom exercise and risk factors for falls have been studied previously.

In a randomized controlled trial of 10 weeks of physiotherapy in 53 women with vertebral osteoporosis and back pain, Malmros and colleagues¹³ showed that static balance (measured by computerized posturography) improved significantly in the treatment group. In another randomized clinical trial, physiotherapy-directed exercise in 30 patients with osteoporosis (not defined) significantly improved static balance measured by functional reach and quadriceps strength determined with an isokinetic dynamometer.¹⁴ 

Although both studies showed that exercise programs could improve known risk factor profiles for falls, they were limited by the small number of subjects and their short duration (maximum 12 weeks). Neither study measured both static and dynamic balance, both of which are predictors of falls.^{10,11,12,13,15} Lastly, both studies employed hospital-based physiotherapists as instructors and thus could not be widely used for patients living in the community.

A large number of tools are available to measure risk factors for falls, such as static and dynamic balance and strength.¹⁰ A sophisticated tool for measuring static balance, the Equitest computerized posturography platform (Neurocom International, Clackamas, Ore.), is considered by many the gold standard for measuring sway.¹⁶ It is reliable and is designed to distinguish the contributions of the visual, proprioceptive and vestibular systems in maintaining balance,¹⁷ but the device measures sway only in the anteroposterior plane, even though most falls occur to the side. In contrast, a measure of dynamic balance, the figure-eight run,¹⁸ which has previously been used in older people^19,20 is simple to perform and does not require special equipment or training. Quadriceps strength is another independent predictor of both falls²¹ and fracture risk,^10,22 and it can be measured reliably, simply and cheaply with a strain gauge dynamometer.²¹

The Osteoporosis Program at the BC Women's Hospital and Health Centre developed Osteofit, a community-centre-based exercise program suitable for people with osteoporosis.²³ The program aims to improve participants' static and dynamic balance, strengthen key muscle groups and ameliorate quality of life. Since its inception in 1998, over 500 women have participated in the program in over 50 community centres. Similar programs exist in the United States, Australia and Europe, but to our knowledge there have been no reports of the efficacy of any readily accessible community-based exercise programs on risk factors for falls in women with osteoporosis.

We tested the primary hypothesis that a 20-week Osteofit exercise program, provided in a community centre setting with classes of 12 participants per certified instructor, would improve measures of balance and knee extension strength in community-dwelling women aged 65 to 75 years in whom osteoporosis had been diagnosed by dual-energy X-ray absorptiometry. Our secondary hypothesis was that the intervention would also improve quality of life^24,25 as measured by an osteoporosis-specific quality-of-life index.²⁶ A planned interim report of the trends observed after 10 weeks of intervention has been published elsewhere.²⁷

Quelle / full text / online im internet / Zugriff vom 04.10.2012: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC134175/

Full Text / pdf : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC134175/pdf/20021029s00016p997.pdf



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