Prévenir le risque de chutes des seniors falls prevention

0

A study tested the efficacy of a multidisciplinary program in reducing falls in people over 70 and living at home.

This Spanish randomized controlled trial, published in 2012 by Perula and colleagues in the Archives of Physical Medicine and Rehabilitation in 2012, tested the efficacy of a multifactorial intervention program aimed at reducing the risk of falls among older adults over 70 years of age and living at home. The results show a reduction in the risk of falls after 12 months of follow-up, but no statistically significant difference was found between the intervention group and the control group (who had received information on fall prevention). The only statistical difference reported for the intervention group concerned the fear of falling.

The Study Rationale

This study addressed the prevention of falls, a major concern for people over 65. Falls lead to painful and debilitating consequences. In 25% of cases, falls cause physical injury and social isolation. In 5% of cases, they cause bone fractures, which heal slowly or partially. According to the authors of this article, one way to prevent falls would be to offer a program of physical activity combined with specific preventive actions carried out by health professionals.

The Question

Can a health education program reduce the number of falls in people over 70 and living at home?

The Protocol

This randomized controlled trial tested the benefits of a multifactorial interventions program aimed at reducing the risk of falling among seniors over 70 years of age and living at home. The participants did not suffer from any debilitating disease. The non-pharmacological intervention (NPI) included five 90-minute group sessions of physical activity over a 3-week period supervised by a physiotherapist. It consisted of mixed physical exercises performed in workshops. The exercises were designed to improve flexibility, muscle strength, balance and walking. Participants also received a best practices information manual to prevent falls in the home and instructions to perform a regular exercise program (walking at least 30 minutes daily, do the recommended exercises at least 4 times weekly). Additionally, participants met with a nurse to learn about fall hazards and their consequences, the conditions in which they occur and environment management strategies to identify and avoid them. The program also included an individual consultation with the family doctor to foster participation in the program and to identify early potentials of fall situations. Additionally, the program included two home visits by a nurse to detect environmental fall hazards and to ensure that the recommendations were properly followed. The control group participants only received brief individual counseling and an information brochure on the prevention of fall hazards. The study included 404 people. An evaluation was conducted 12 months after the program.

Main Results

The results show a reduction in the risk of falls but no statistically significant difference between the intervention group and the control group (who received information on fall prevention). A year after the program, the number of falls in the intervention group was 27.5% vs. 49.3% for the control group. Nonetheless, these results are not statistically significant. The number of fractures was similar for both groups. The only difference reported for the intervention group concerned the fear of falling.

The Bottom Line

Issuing fall prevention information to people over 70 and living at home is known to be effective. This study does not provide evidence that a 3-week intervention program generates additional results.

What it means for Healthcare Professionals

At the very least, to reduce the risk of falls, people over 70 and living at home should be instructed to make adequate home environment arrangements and engage in regular physical activity. Additional research is needed to determine what type of multidisciplinary program may prove more beneficial than this mere advice.

What it means for Researchers

The results of this randomized controlled trial reveal a trend with no statistically significant difference between the treatment and control groups. Further consideration must given to the content provided to the control group, the number of subjects required for the study and its efficacy criteria. Regarding the latter, the study shows that the only difference between the two groups is observed on a self-reported item (fear of falling) – not on an objective criterion (the number of falls or bone fractures).

What it means for Policymakers

Health professionals should routinely provide fall prevention information to people over 70 and living at home. If specific programs should also be offered, prior research should be conducted to clarify their content.

 The reference

Pérula LA, Varas-Fabra F, Rodriguez V (2012). Effectiveness of a Multifactorial Intervention Program to Reduce Falls Incidence Among Community-Living Older Adults: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 93, 1677-1684.

To reference this Blog en Sante © article.

Ninot G (2014). Preventing Falls Among Older Adults. Blog en Sante, A23.

© Copyright 2014 Grégory Ninot. All rights reserved.

Thanks to Syl Billere for the English Revision.