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      Falls Reduction and Exercise Training in an Assisted Living Population

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          Abstract

          Multicomponent exercise programs are currently an efficacious fall prevention strategy among community dwelling older adults although research documents differential falls susceptibility among frail older adults. This study aimed to examine the association between the Boston FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) exercise program (the original exercise program to demonstrate that nursing home residents can increase strength) and falls incidents in an assisted living community. A descriptive cross-sectional study matched exercise charts for frequency and duration of training with number of reported fall incidents. Among 39 participants, 33% ( n = 13) reported a fall incident. Adults without a fall history reported more time in aerobic (26.30 versus 20.00, P value = 0.71) and strength (1.50 versus 0.50, P value = 0.01) training sessions compared to those with a fall history. Multivariate models adjusting for covariates illustrated a significant protective association between strength training and fall incidents (OR = 0.25; 95% CI = 0.07, 0.85). In this cross-sectional study, this progressive resistance exercise training program into an assisted living population was associated with a decrease in the number of fall incidents.

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          Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial.

          A. Barnett, Stephen Lord (2003)
          recent studies have found that moderate intensity exercise is an effective intervention strategy for preventing falls in older people. However, research is required to determine whether supervised group exercise programmes, conducted in community settings with at-risk older people referred by their health care practitioner are also effective in improving physical functioning and preventing falls in this group. to determine whether participation in a weekly group exercise programme with ancillary home exercises over one year improves balance, muscle strength, reaction time, physical functioning, health status and prevents falls in at-risk community-dwelling older people. the sample comprised 163 people aged over 65 years identified as at risk of falling using a standardised assessment screen by their general practitioner or hospital-based physiotherapist, residing in South Western Sydney, Australia. Subjects were randomised into either an exercise intervention group or a control group. Physical performance and general health measures were assessed at baseline and repeated 6-months into the trial. Falls were measured over a 12-month follow-up period using monthly postal surveys. at baseline both groups were well matched in their physical performance, health and activity levels. The intervention subjects attended a median of 23 exercise classes over the year, and most undertook the home exercise sessions at least weekly. At retest, the exercise group performed significantly better than the controls in three of six balance measures; postural sway on the floor with eyes open and eyes closed and coordinated stability. The groups did not differ at retest in measures of strength, reaction time and walking speed or on Short-Form 36, Physical Activity Scale for the Elderly or fear of falling scales. Within the 12-month trial period, the rate of falls in the intervention group was 40% lower than that of the control group (IRR=0.60, 95% CI 0.36-0.99). these findings indicate that participation in a weekly group exercise programme with ancillary home exercises can improve balance and reduce the rate of falling in at-risk community dwelling older people.
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            The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial.

            Chris Williams, S. Castell, Joanne Corcoran … (2003)
            To determine whether a 12-month program of group exercise can improve physical functioning and reduce the rate of falling in frail older people. Cluster randomized, controlled trial of 12 months duration. Retirement villages in Sydney and Wollongong, Australia. Five hundred fifty-one people aged 62 to 95 (mean+/-standard deviation=79.5+/-6.4) who were living in self- and intermediate-care retirement villages. Accidental falls, choice stepping reaction time, 6-minute walk distance postural sway, leaning balance, simple reaction time, and lower-limb muscle strength. Two hundred eighty subjects were randomized to the weight-bearing group exercise (GE) intervention that was designed to improve the ability of subjects to undertake activities for daily living. Subjects randomized to the control arm (n=271) attended flexibility and relaxation (FR) classes (n=90) or did not participate in a group activity (n=181). In spite of the reduced precision of cluster randomization, there were few differences in the baseline characteristics of the GE and combined control (CC) subjects, although the mean age of the GE group was higher than that of the CC group, and there were fewer men in the GE group. The mean number of classes attended was 39.4+/-28.7 for the GE subjects and 31.5+/-25.2 for the FR subjects. After adjusting for age and sex, there were 22% fewer falls during the trial in the GE group than in the CC group (incident rate ratio=0.78, 95% confidence interval (CI)=0.62-0.99), and 31% fewer falls in the 173 subjects who had fallen in the past year (incident rate ratio=0.69, 95% CI=0.48-0.99). At 6-month retest, the GE group performed significantly better than the CC group in tests of choice stepping reaction time, 6-minute walking distance, and simple reaction time requiring a hand press. The groups did not differ at retest in tests of strength, sway, or leaning balance. These findings show that group exercise can prevent falls and maintain physical functioning in frail older people.
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              Prevention of falls in community-dwelling older adults: U.S. Preventive Services Task Force recommendation statement.

              Virginia A Moyer (2012)
              Update of the 1996 U.S. Preventive Services Task Force (USPSTF) recommendation statement on counseling to prevent household and recreational injuries, including falls. The USPSTF reviewed new evidence on the effectiveness and harms of primary care-relevant interventions to prevent falls in community-dwelling older adults. The interventions were grouped into 5 main categories: multifactorial clinical assessment (with or without direct intervention), clinical management (with or without screening), clinical education or behavioral counseling, home hazard modification, and exercise or physical therapy. The USPSTF recommends exercise or physical therapy and vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk for falls. (Grade B recommendation)The USPSTF does not recommend automatically performing an in-depth multifactorial risk assessment in conjunction with comprehensive management of identified risks to prevent falls in community-dwelling adults aged 65 years or older because the likelihood of benefit is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of the circumstances of prior falls, comorbid medical conditions, and patient values. (Grade C recommendation).
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Aging Res
                Journal ID (iso-abbrev): J Aging Res
                Journal ID (publisher-id): JAR
                Title: Journal of Aging Research
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-2204
                ISSN (Electronic): 2090-2212
                Publication date (Print): 2015
                Publication date (Electronic): 5 August 2015
                Volume: 2015
                Electronic Location Identifier: 957598
                Affiliations
                1Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
                2College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
                3Atria Senior Living, Louisville, KY 40202, USA
                Author notes
                *Thelma J. Mielenz: tjm2141@ 123456columbia.edu

                Academic Editor: Miriam Vollenbroek-Hutten

                Article
                DOI: 10.1155/2015/957598
                PMC ID: 4541005
                SO-VID: 65bfc3ce-4a74-4fbf-94d9-602e700866a9
                Copyright © Copyright © 2015 Kimberly J. Alvarez et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 6 August 2014
                Date revision received : 11 December 2014
                Date accepted : 29 December 2014
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Molecular medicine
                Data availability:
                ScienceOpen disciplines: Molecular medicine

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