Effects of an Exercise Program to Reduce Falls in Older People Living in Long-Term Care: A Randomized Controlled Trial
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Elsevier BV
Abstract
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.Description
Keywords
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
Source
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/).