Effects of an Exercise Program to Reduce Falls in Older People Living in Long-Term Care: A Randomized Controlled Trial

Taylor, LM
Parsons, J
Moyes, SA
Binns, E
Cavadino, A
Taylor, D
Lord, S
Del Din, S
Klenk, J
Rochester, L
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Journal Article
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Elsevier BV

Objectives: To investigate the effect of an exercise program on falls in intermediate and high-level long-term care (LTC) residents and to determine whether adherence, physical capacity, and cognition modified outcomes.

Design: Randomized controlled trial. Setting and Participants: Residents (n = 520, aged 84 ± 8 years) from 25 LTC facilities in New Zealand. Methods: Individually randomized to Staying UpRight, a physical therapist–led, balance and strength group exercise program delivered for 1 hour, twice weekly over 12 months. The control arm was dose-matched and used seated activities with no resistance. Falls were collected using routinely collected incident reports.

Results: Baseline fall rates were 4.1 and 3.3 falls per person-year (ppy) for intervention and control groups. Fall rates over the trial period were 4.1 and 4.3 falls ppy respectively [P = .89, incidence rate ratio (IRR) 0.98, 95% CI 0.76, 1.27]. Over the 12-month trial period, 74% fell, with 63% of intervention and 61% of the control group falling more than once. Risk of falls (P = .56, hazard ratio 1.08, 95% CI 0.85, 1.36) and repeat falling or fallers sustaining an injury at trial completion were similar between groups. Fall rates per 100 hours walked did not differ between groups (P = .42, IRR 1.15, 95% CI 0.81, 1.63). Program delivery was suspended several times because of COVID-19, reducing average attendance to 26 hours over 12 months. Subgroup analyses of falls outcomes for those with the highest attendance (≥50% of classes), better physical capacity (Short Physical Performance Battery scores ≥8/12), or cognition (Montreal Cognitive Assessment scores ≥ 18/30) showed no significant impact of the program.

Conclusions/Implications: In intermediate and high-level care residents, the Staying UpRight program did not reduce fall rates or risk compared with a control activity, independent of age, sex, or care level. Inadequate exercise dose because of COVID-19–related interruptions to intervention delivery likely contributed to the null result.

Falls , cognitive impairment , exercise , frailty , nursing homes , older adults , 4203 Health Services and Systems , 4206 Public Health , 42 Health Sciences , Rehabilitation , Behavioral and Social Science , Prevention , Clinical Trials and Supportive Activities , Clinical Research , 3.1 Primary prevention interventions to modify behaviours or promote wellbeing , 3 Prevention of disease and conditions, and promotion of well-being , Injuries and accidents , 1103 Clinical Sciences , 1110 Nursing , 1117 Public Health and Health Services , Geriatrics , 4203 Health services and systems , 4205 Nursing , 4206 Public health
Journal of the American Medical Directors Association, ISSN: 1525-8610 (Print); 1538-9375 (Online), Elsevier BV, 25(2), 201-208.e6. doi: 10.1016/j.jamda.2023.10.022
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2023 The Authors. Published by Elsevier Inc. on behalf of AMDA e The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).