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Intervention to Prevent Falls in Elderly Adults Living in a Residential Home

2013; Wiley; Volume: 61; Issue: 8 Linguagem: Inglês

10.1111/jgs.12395

1532-5415

Eeva Tuunainen, Pirkko Jäntti, Ilmari Pyykkö, Jyrki Rasku, Päivi Moisio‐Vilenius, Erja Mäkinen, Esko Toppila,

Stroke Rehabilitation and Recovery

In people aged 85 and older, one in five fatal falls occurs in a nursing home.1 Approximately 60% of falls that older people experience result from multiple etiological factors.2-4 The most common precipitating factors for falls in homes for elderly adults are gait and balance disorders, weakness, dizziness, environmental hazards, confusion, visual impairment, and postural hypotension.5 Drugs; ambient conditions, especially poor lighting; and diseases also affect the risk of falls,6 although the relationship between vertigo, dizziness, poor balance, and falls is not a straightforward phenomenon but a complex association.7 Preventing falls in individuals requires the identification and treatment of these interacting factors. The study was performed in the residential facility of Koukkuniemi, Tampere, Finland. Fifty-nine elderly adults were included (15 men, 44 women, mean age 85) in the study. The residents were randomly divided into three groups: one undergoing strength training, one undergoing balance and strength training, and one undergoing self-administered training with instructions on the ward under the supervision of a geriatric nurse. Four of the participants died before baseline testing and the start of training, so the groups consisted of 17 elderly adults undergoing strength training, 18 undergoing balance and strength training, and 20 undergoing self-administered training. Training took place twice a week for 1 hour at a time over 13 weeks in five-person groups under the supervision of physiotherapists. Trainees were followed for 3 years after the training period. A standardized questionnaire was administered that consisted of 98 questions about the residents' symptoms, medical history, and medication.8 The Mini-Mental State Examination (MMSE) was administered, and falls during the follow-up period were recoded. Thirteen (24%) of the residents had a history of vertigo, dizziness, or both. The vertigo occurred in attacks and was present daily and lasted from a few minutes up to 20 minutes. The intensity varied from mild to moderate, so that the individuals were often forced to interrupt their ongoing activities and take a rest. Positional change and physical activity often triggered the vertigo. Twelve (22%) residents complained of a floating sensation related to balance control, 23 (42%) reported fear of falling, 12 (22%) reported postural instability, seven reported nausea linked to vertigo dizziness (13%), and three reported seizures. These complaints did not differ significantly between the training groups. One hundred forty falls were recorded in the 3-year period, indicating on average of 2.7 falls (range 0–30 falls) per subject, giving an annual incidence of 0.9 falls per subject. The most-common reason for first falls was vertigo and dizziness (35%), a trip or missed step (28%), unknown (28%), and a seizure (5%). For habitual fallers, poor balance was the most common reason and was linked to rising from a chair and not using an assistive device. The residents who underwent strength training and those who underwent balance and strength training tended to have fewer falls than those who underwent self-administered training, but the difference was not statistically significant (Kruskal–Wallis test, P = .14), although when the guided training groups were combined, the residents with guided exercise had fewer falls than those with self-administered training (Mann–Whitney U-test, P < .05). This study compared the effectiveness of guided balance and strength training with that of self-administered training in institutionalized elderly adults. Residents with moderate to severe dementia could perform exercises in a five-person group under the supervision of one physiotherapist. As an outcome variable, falls occurring within the 3 years were evaluated. The results showed that, in institutionalized elderly adults, guided balance training can prevent falls. There was no difference between strength training and combined balance and strength training, which leads to the conclusion that rehabilitation with balance or strength training or both is useful but that other preventive measures should be included for institutionalized elderly adults to improve quality of life or prevent early death. In the present study, the residents were assessed for vertigo symptoms, gait problems, memory, and fear of falling. Whether any of these variables would be a significant risk factor for a fall in institutionalized elderly adults was also analyzed. Thus, influencing a single factor such as gait problems, postural instability, vertigo, or dizziness may not be enough to prevent accidental falls in institutionalized elderly people with several simultaneous health problems and taking medications. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Prevention of Falls Network Europe (PROFANE) and Pirkanmaa Cultural and Science Foundation provided economical support for this study. Author Contributions: Tuunainen, Jäntti, Pyykkö: study concept and design, acquisition of subjects and data, analysis and interpretation of data, preparation of manuscript. Rasku: study concept and design, analysis and interpretation of data, preparation of manuscript. Moisio-Vilenius, Mäkinen: acquisition of subjects and data, intervention group training. Toppila: study concept and design, analysis and interpretation of data. Sponsor's Role: Pirkanmaa Cultural and Science Foundation did not have a role in study design, methods, subject recruitment, data collections, analysis, or preparation of paper. Study design was presented and discussed with PROFANE in annual meetings. PROFANE did not have a role in methods, subject recruitment, data collections, analysis, or preparation of paper.