New research has indicated that more should be done to involve older people with interventions to prevent falls in care home and hospital settings.
In their study entitled 'Older People's Recruitment, Sustained Participation, and Adherence to Falls Prevention Interventions in Institutional Settings' - published today in Age and Ageing - http://ageing.oxfordjournals.org/content/early/recent - the official journal of the British Geriatrics Society - Dr Samuel Nyman from Bournemouth University and Professor Christina Victor of Brunel University suggest that particular attention should be paid to optimising older people's participation in interventions for the prevention of falls.
Randomised controlled trials to prevent falls have been systematically reviewed by the Cochrane Collaboration and recently separated into reviews of trials in the community and those in institutions. The results of trials in institutional settings were largely negative, though multifactorial and supervised exercise interventions were effective in hospital settings and vitamin D supplementation was effective in residential settings.
Dr Nyman and Professor Victor supplemented the Cochrane review with an analysis of older people's participation and engagement with falls prevention interventions in institutional settings, with a particular focus on recruitment, dropout and adherence to exercise interventions. They undertook this work as it was missing from the original Cochrane reviews and is important for the development of trials and the subsequent implementation of interventions in policy and practice.
What they discovered was on average half (48.5%) of older people approached in institutions are likely to participate in falls prevention interventions. Of these, by 12 months 16% will drop out of the trial (or 10% excluding mortality).
Adherence was high for exercise that was individually-targeted (e.g. 89% for physical therapy) and group-based (between 72-88%) and similarly high for medication interventions (68-88%). For multifactorial interventions, adherence ranged from 11% for attending exercise classes to 93% for use/repairs of aids. Adherence as a moderator of treatment effectiveness was only tested in six studies conducted in nursing care facilities. Of these, three studies - involving medication or personalised treatment in response to a multifactorial risk assessment - found that the more that older people were adhering to the intervention the greater they had reduced their risk of falls.
"Falls in later life are highly prevalent and associated with an increased risk of mortality and morbidity," said Dr Nyman, Lecturer in Psychology and a member of the Psychology Research Centre at Bournemouth University. "Approximately half of residents of long-term care will fall annually with incidence rates of between 0.6 - 3.6 falls per bed in care homes rising to 2.2 - 17.1 per 1,000 patient days for hospital inpatients."
"Falls are costly for the economy, particularly those that result in hip fracture," Dr Nyman continued, "with the prevalence of hip fractures in care homes estimated at 50.8/1000 person-years in women and 32.7/1000 in men. Their occurrence is associated with an increased mortality risk for at least six months."
"Older people need to take up interventions and keep participating in them (e.g. attending exercise classes) in the long-term to see the benefits in reducing their risk of having a fall. This new evidence published by Dr Nyman and Professor Victor suggests that health professionals need to attend not just to what are the best interventions for preventing falls, but also how best to invite older people to participate in these interventions and how best to help them make such interventions part of their daily life in the long-term."
Nyman, S.R. and Victor, C.R., 2011. Older people's recruitment, sustained participation, and adherence to falls prevention interventions in institutional settings: A supplement to the Cochrane systematic review. Age and Ageing.
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