Interventions for preventing falls in older people in nursing care facilities and hospitals

Cochrane Review: Authors – Ian D Cameron,´Geoff R Murray,Lesley D Gillespie, M Clare Robertson, Keith D Hill, Robert G Cumming, Ngaire Kerse

 

Abstract

Background

Falls in nursing care facilities and hospitals are common events that cause considerable morbidity and mortality for older people.

Objectives

To assess the effectiveness of interventions designed to reduce falls by older people in nursing care facilities and hospitals.

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2009); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 2); MEDLINE, EMBASE, and CINAHL (all to November 2008); trial registers and reference lists of articles.

Selection criteria

Randomised controlled trials of interventions to reduce falls in older people in nursing care facilities or hospitals. Primary outcomes were rate of falls and risk of falling.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data. Data were pooled where appropriate.

Main results

We included 41 trials (25,422 participants).

In nursing care facilities, the results from seven trials testing supervised exercise interventions were inconsistent. This was the case too for multifactorial interventions, which overall did not significantly reduce the rate of falls (rate ratio (RaR) 0.82, 95% CI 0.62 to 1.08; 7 trials, 2997 participants) or risk of falling (risk ratio (RR) 0.93, 95% CI 0.86 to 1.01; 8 trials, 3271 participants). A post hoc subgroup analysis, however, indicated that where provided by a multidisciplinary team, multifactorial interventions reduced the rate of falls (RaR 0.60, 95% CI 0.51 to 0.72; 4 trials, 1651 participants) and risk of falling (RR 0.85, 95% CI 0.77 to 0.95; 5 trials, 1925 participants). Vitamin D supplementation reduced the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; 4 trials, 4512 participants), but not risk of falling (RR 0.98, 95% CI 0.89 to 1.09; 5 trials, 5095 participants).

In hospitals, multifactorial interventions reduced the rate of falls (RaR 0.69, 95% CI 0.49 to 0.96; 4 trials, 6478 participants) and risk of falling (RR 0.73, 95% CI 0.56 to 0.96; 3 trials, 4824 participants). Supervised exercise interventions showed a significant reduction in risk of falling (RR 0.44, 95% CI 0.20 to 0.97; 3 trials, 131 participants).

Authors‘ conclusions

There is evidence that multifactorial interventions reduce falls and risk of falling in hospitals and may do so in nursing care facilities. Vitamin D supplementation is effective in reducing the rate of falls in nursing care facilities. Exercise in subacute hospital settings appears effective but its effectiveness in nursing care facilities remains uncertain.

Plain language summary

Interventions for preventing falls in older people in nursing care facilities and hospitals

Falls by older people in nursing care facilities and hospitals are common events that may cause loss of independence, injuries, and sometimes death as a result of injury. Effective interventions are important as they will have significant health benefits.

This review includes 41 trials involving 25,422 participants, with about three quarters being women and having an average age of 83 years. Many of the participants had cognitive problems.

In nursing care facilities, interventions targeting multiple risk factors were not clearly effective in preventing falls but may be so when these interventions are provided by a co-ordinated team of health workers. The prescription of vitamin D reduces falls, as may a review of medication by a pharmacist. There is no evidence that other interventions targeting single risk factors reduce falls and this includes exercise interventions.

For patients who are in hospital for more than a few weeks, interventions targeting multiple risk factors, and supervised exercise, are effective.

Limitations of the review included the small number of hospital studies, difficulty isolating effects of individual components of treatments that involved multiple components, and the variability of interventions.

Quelle / Abstract:    http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005465.pub2/abstract

 

Full Text / pdf / Reprint – online im internet – Zugriff vom 30.09.12 – Interventions for preventing falls in older people in nursing care facilities and hospitals  :

http://www.globalaging.org/health/us/2010/FallIntervention.pdf

 

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Relationship between Falls and Knee Extension Strength in the Elderly

Yasuyoshi Asakawa1), Tome Ikezoe1), Kan Hazaki1), Ichiro Kawano2), Seigo Irie2), Hideto Kanzaki2), Nobuo Aoki3)

1) Division of Physical Therapy, College of Medical Technology, Kyoto University, 53 Shougoin Kawahara-cho, Sakyo-ku, Kyoto-city 606-01, Japan. 2) Department of Physical Therapy, Kyoto University Hospital 3) Kenkoen Geriatric Clinic

Released 2001/12/27

Keywords: Fall, Knee extension strength, Elderly

ABSTRACT

This study examined the relationship between falls and knee extension strength in the eldely. Twenty-seven elderly persons who resided at the same home for aged were asked about their individual histories of falling during the previous year, including the location where the fall had occured, such as near the bed, in the toilet, or in the corridor.

The isometric maximal knee extension strength of the subjects was determined, measured by a hand-held dynamometer in the knee flexed at 90 degrees, as a percentage of their weight. Calculations were obtained on the dominant side and non-dominant side, and the sum of both sides was also noted.

The subjects were then divided into two groups: no-fall group (n=18), and fall group (n=9). The fall group was further divided into the fall outside the home group (n=2) and the fall in the home group (n=7). The knee extension strength was compared by two-sample t-test between the no-fall and the fall outside the home group, and between the no-fall and the fall in the home group.

In addition, the range of knee extension strength in the fall in the home group was examined by scattergraph, in which the knee extension strength of all subjects were plotted. The two-sample t-test revealed significant differences in knee extension strength between the no-fall group and the fall in the home group (p<0.05). The scattergraph indicated that the knee extension strength of the subjects who had a fall in the home was at a range less than approximately 35% of their weight.

These results suggested that poor knee extension strength was closely related to falls in the home, and it is thus desirable that elderly maintain their knee extension strength above approximately 35% of their weight in each side to prevent falls in the home.

Quelle:  https://www.jstage.jst.go.jp/article/jpts/8/2/8_2_45/_article

 

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Radfahren mit dem Theraband

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Wenn der koordinative Anspruch erhöht werden soll, wird die Übung wie im Video, sitzend auf einem Physioball durchgeführt.

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Functional Strength Training for Running: 10 Foundation Building Exercises

incl. einer Lunge-Matrix  (Ausfallschritte) und Cable Rows / Single Leg. – Die Cable Rows (Rudern am Kabelzug) werden einfach zu Hause oder auf demWaldsportpfad ersetzt durch ein Rudern mit einem Gummiband / Gray-Cook-Band. Darüberhinaus sind in diesem Video Übungsausführungen dabei, die gehören eindeutig in den Fortgeschrittenenbereich.

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