Early Intervention to Reduce Falls in Community-Active Seniors: A Pilot Study
Authors: Edwin Irwin, Richard Ackermann, David Taylor, Edward Obrien
Abstract: Falling remains one of the chief causes of injury and reduced lifespan among people over 65 years of age. Clinical practice guidelines for primary care physicians instituted in 2004 have improved surveillance of seniors at significant risk of falling, resulting in a reduction in the annual prevalence of falls in people over 65, but still leaving more than one in 4 seniors subject to falling every year. Our research used a modified version of the multi-factorial risk screening (MFRS) and biomechanical measures of gait function, together with monthly follow-up over a 12-month period, to investigate the extent to which therapeutic intervention before patients enter the clinical fall-risk algorithm will reduce the risk of falls. A sample of 30 subjects were recruited in 3 age groups (65-74, 75-84, and 85+), and were randomly assigned to 3 treatment groups: control (initial data and MFRS with follow-up); managed (MFRS and biomechanical risk reported to subject, with follow-up); and mitigated (MFRS and biomechanical risks reported to geriatrician, with physical therapy and follow-up). Follow-up involved asking about falls, exercise type, and weekly exercise duration each month. MFRS and biomechanical measures were repeated after 12 months for the mitigated and managed groups.Physical therapy reduced the odds of falling by 8% among the youngest cohort, by 10% in the middle cohort, and by 3% in the oldest cohort, as measured by the logistic regression of MFRS scores. The mitigated group as a whole showed 16% lower prevalence of falling than the managed group. The mitigated group also maintained improved post-therapy gait mechanics by the end of the follow up period.In comparison, the managed group showed decreased gait function by the end of the follow up period. Managed subjects, who were given detailed reports about their risk of falling and how to reduce it, showed only modest changes in their overall risk of falling over the course of the year. Stratification of subjects into groups that exercised <90 minutes per week and >=90 minutes per week equally divided each of the three treatment groups. Reported exercise had no impact on fall risk. Problems with statistical power and exercise classification limited our ability to draw valid conclusions about the impact of exercise on the risk of falling in each sub-group.Our results indicate that use of a simple, clinically validated, multi-factorial risk assessment can identify people 65 and older who are at risk of falling before their physicians would otherwise recognize this. Targeted physical therapy can significantly reduce the risk of falling among this group. A more proactive clinical approach can prove more effective long-term than simply offering options for exercise, even when patients understand their risk of falling. Future work needs to investigate the dose-response and resilience of the response of specific types of exercise on gait biomechanics in different age groups.
Keywords: biomechanics, gait, falling, prevention
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