Many recent research articles show that comprehensive assessment and prevention programs are useful ways to reduce falls and related injuries for older adults, in community, senior living, and care facility environments. The field of gait analysis has contributed to the appreciation of the motor and cognitive tasks involved in walking, a good way to analyze falls risk. Researchers at a Swiss gait analysis center have been applying a gait analysis system to study the relationship between gait and cognition, designed (by adding an additional cognitive task for research participants) to replicate a more real-life situation than studies that just involve gait analysis. The researchers found that their system was able to identify changes in gait that are too subtle to be identified by subjective observation, which suggests that some electronic measurement of gait change in everyday settings may be able to detect increased fall risk early.
The authors also presented a review of physical activities that are shown to reduce falls risk by improving the regularity and automaticity of walking for older adults. Another recent article presents a meta-analysis of assessment tools, these with more portable survey-type scales. Results were fairly mixed, leading the authors to point out the need for improved access to unpublished data relating to falls and falls reduction. The authors also argued for a model of evidence basis for falls reduction that distinguishes between types of falls.
Other studies have focused on reducing falls in particular subpopulations: older women enrolled in a community falls prevention program, adults in an acute care setting, and older adults with osteoporosis. The study of older women was a statewide, regionally and ethnically diverse sample in Texas. This particular falls prevention program focused on physical activity and improved balance confidence, delivered via a cognitive-behavioral model administered in a class by a trained layperson. The data showed stronger improvements among older women and minorities. The authors pointed to possible routes of selection bias that could have lead to this difference, but also pointed out that the study does serve to counter the assumption that the “older old” can’t benefit from such programs.
The article on interventions for individuals with osteoporosis is still only available in preview form (as of November 16, 2010). According to the information available, researchers performed a randomized control trial in a hospital setting in the Netherlands, measuring fall rate, balance efficacy, and other outcomes. The experimental group took part in an exercise-based falls reduction program, which led to a statistically significant lower falls rate and significantly higher balance efficacy.
The acute care study was done at four urban hospitals in cities in the U.S. After three pre-trial development phases, the researchers developed an interface to deliver an individualized falls risk intervention to their treatment sample. In the total population, the treatment group had a significantly lower decrease in total patients with falls and falls rate. Interestingly, there was no such difference across patients younger than age 65, while those 65 and better saw large statistically and clinically significant decreases in falls rates. The authors suggested that further study should indicate whether there are differences of treatment compliance by age and pointed out that their sample didn’t have enough statistical power to identify differences in repeat falls or falls with injury.
What can be learned here? First, this seems to confirm that programs that include an activity or exercise component seem particularly helpful. This may sound obvious at first until one considers how many older adults decrease their activity after a fall or upon feeling less confident in their ability to maintain balance. Evidence suggests that programs to improve motor skills and confidence should incorporate physical activity.
Second, these studies show the importance of context and population in designing interventions. Exploratory research on, for example, how groups differ in awareness of or receptivity to the benefits of falls reduction would help explain previous research and contribute to more effective interventions.
For information on our SAFE-TI falls intervention program, go to http://www.matherlifeways.com/safeti/, or email Louise Lyons at LLyons@matherlifeways.com.
Articles cited (click article for link):
Smulders E, Weerdesteyn V, Groen BE, Duysens J, Eijsbouts A, Laan R, van Lankveld W. (2010). Efficacy of a short multidisciplinary falls prevention program for elderly persons with osteoporosis and a fall history: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation. 91(11):1705-11.