Fall Prevention among Older Adults

This presentation discusses the risk factors contributing to accidental falls among older adults and analyzes the best practice recommendations for fall prevention. The presentation highlights the importance of specialized physical exercise training, guidance from occupational therapists, and vitamin D supplementation. The evidence suggests that a combination of physical exercise, balance training, and cognitive improvement is more effective than conventional physical exercise in preventing falls among older adults. The presentation also includes a literature matrix and details of the search strategy.

Fall Prevention among older Adults
Presented by:

Accidental fall among the older adults
Background
Accidental falls are the main causes underlying the increased in mortality
and morbidity among the older adults. Some of the important risk factors
contributing towards accidental fall include gait, impaired balance,
polypharmacy and previous history of fall. Other risk factor includes age,
gender, visual impairments, cognitive impairment and associated
environmental factors. However there are no proper recommendations
regarding distinct fall prevention strategies. (Ambrose, Paul & Hausdorff,
2013; pp. 51-61). So the following poster aims to analyse best practice
recommendations for the prevention of fall among older adults.
Clinical Question
Specialised physical exercise training is effective in reducing the chances of
accidental fall among the older adults in comparison to conventional
physical exercise?
PICO Question
P Population Older adults
I Intervention Specialised physical exercise training
C Comparison Conventional physical exercise
O Outcomes Decrease in fall prevention
Details of the Search Strategy
•Type of evidence: Digital evidence: search of the literary articles via
electronic database search
•Databases used for the search of the articles: PubMed, Medline and
CINHAL
•Keywords used: “Fall prevention” OR “Accidental fall prevention” AND
“Older adults” OR “Aged care” AND “exercise”
•The search will mainly aim to highlight the papers which are structured on
the basis of the evidence based practice and the systematic review
Inclusion criteria Exclusion criteria
Articles published during 2013 to 2018
(last five years) Articles published before 2013
Articles published in English Articles published in English
Peered reviewed: Primary and Secondary
Pall prevention over children
Determination of level of evidence
Initial searches of the literary articles through electronic database highlighted 50 relevant RCTs,
qualitative studies and systematic reviews. Of these 4 randomised control trails and one systematic
review were selected for the literature matrix. The randomised control trials are mostly selected for
the literature matrix as they score for level of evidence 1.
Determination of quality of the paper: Use of CASP tool
Recommendations
1. In order to implement special physical exercise training program to reduction of fall among the older
adults. It is important to conduct proper leadership support, proper engagement of the front-line staff
in the program design, proper guidance for the fall prevention program by a multidisciplinary team,
proper pilot testing and use of proper technology in order to conduct proper exercise program (Miake-
Lye et al., 2013, pp: 390-396).
2. Proper guidance and support from the occupational therapist is mandate in order to conduct special
physical exercise training program for the prevention of fall among older adults (Carande-Kulis et al., 2015,
pp: 65-70)
3. Use of vitamin D supplementation is important in order to increase the bone strength and this will help
to prevent the chances of fatal injuries during accidental fall (Uusi-Rasi et al., 2015, pp: 1435)
Barriers Strategies
Fragile bone Vitamin D supplementation
Fear for performing exercise Proper mental strength and motivation by
nurse
Fear from getting injured while performing
combination physical exercise Proper supervision of occupational therapist
Evidence ‘Bottom Line’ Statement
Conventional physical exercise is insufficient alone in effectively reducing the chances of accidental
fall among the older adults. The effective fall prevention strategy must use combination of different
physical exercise along with special strength, endurance and balance and gait training to improve the
overall physical performance and chances of encountering accidental fall. But such specialized
physical training exercise must be done under the detailed supervision of professional occupational
therapists.
Source: Australian Government National Health and Medical Research Council. (2009)
References
•Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013). Risk factors for falls among older adults: a review of the
literature. Maturitas, 75(1), 51-61. https://doi.org/10.1016/j.maturitas.2013.02.009
•Australian Government National Health and Medical Research Council. (2009). NHMRC additional levels of evidence and grades for
recommendations for developers of guidelines. Access date: 14th September 2018. Retrieved from:
https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf
•Cadore, E. L., Rodríguez-Mañas, L., Sinclair, A., & Izquierdo, M. (2013). Effects of different exercise interventions on risk of falls, gait
ability, and balance in physically frail older adults: a systematic review. Rejuvenation research, 16(2), 105-114.
https://doi.org/10.1089/rej.2012.1397
•Carande-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., & Arias, I. (2015). A cost–benefit analysis of three older adult fall
prevention interventions. Journal of safety research, 52, 65-70. https://doi.org/10.1016/j.jsr.2014.12.007
•Gschwind, Y. J., Kressig, R. W., Lacroix, A., Muehlbauer, T., Pfenninger, B., & Granacher, U. (2013). A best practice fall prevention
exercise program to improve balance, strength/power, and psychosocial health in older adults: study protocol for a randomized
controlled trial. BMC geriatrics, 13(1), 105. https://doi.org/10.1186/1471-2318-13-105
•Lee, H. C., Chang, K. C., Tsauo, J. Y., Hung, J. W., Huang, Y. C., & Lin, S. I. (2013). Effects of a multifactorial fall prevention program on
fall incidence and physical function in community-dwelling older adults with risk of falls. Archives of physical medicine and
rehabilitation, 94(4), 606-615. https://doi.org/10.1016/j.apmr.2012.11.037
•Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient fall prevention programs as a patient safety strategy: a
systematic review. Annals of internal medicine, 158(5_Part_2), 390-396. Retrieved from: www.annals.org
•Tousignant, M., Corriveau, H., Roy, P. M., Desrosiers, J., Dubuc, N., & Hébert, R. (2013). Efficacy of supervised Tai Chi exercises versus
conventional physical therapy exercises in fall prevention for frail older adults: a randomized controlled trial. Disability and
rehabilitation, 35(17), 1429-1435. https://doi.org/10.3109/09638288.2012.737084
•Uusi-Rasi, K., Patil, R., Karinkanta, S., Kannus, P., Tokola, K., Lamberg-Allardt, C., & Sievänen, H. (2015). Exercise and vitamin D in fall
prevention among older women: a randomized clinical trial. JAMA internal medicine, 175(5), 703-711.
doi:10.1001/jamainternmed.2015.0225

Literature Matrix
Author/
Date Research Question/
Aim Population Study Design Findings Conclusions and Implications for
Practice Level of
Evidence
12
Limitations
Tousignant, M., Corriveau, H.,
Roy, P. M., Desrosiers, J., Dubuc,
N., & Hébert, R. (2013)
To study the efficacy of
supervised Tai Chi exercises
with conventional physical
exercises under personalized
rehabilitation settings to reduce
severity of falls among older
adults.
Frail older adults day care
hospital in Sherbrooke, Quebec,
Canada
Randomized control trial Tai Chi exercise showed greater
protective effect in decreasing the
chances of accidental fall among
older adults in comparison to
conventional physical ecercise
Tai Chi exercises done under active supervision as part of
a rehabilitation program is effective alternative to the
conventional physical therapy exercises for fall
prevention among older adults.
1 The fall in incidence was accessed via phone interview or via
calendar technique and this might induce biased results
Gschwind, Y. J., Kressig, R. W.,
Lacroix, A., Muehlbauer, T.,
Pfenninger, B., & Granacher, U.
(2013)
Assess the effects of a fall
prevention program developed
by an interdisciplinary expert
panel in healthy older adults.
Healthy old people (n = 54) who
are aged in between 65 to 80
years
Randomized control trial Supervised combination of balance
and strength / power training helped
to improve performance in variables
of balance, cognitive function,
psychosocial well-being, and falls
prevention among older adults.
A combination of physical exercise along with the
improvement of the balance of body and cognitive
improvement helped in improved fall prevention among
the older adults in comparison to normal conventional
exercise.
1 Only healthy older adults were selected for the case study
Cadore, E. L., Rodríguez-Mañas,
L., Sinclair, A., & Izquierdo, M.
(2013)
The aim of the review is to
recommend training strategies
in order to improve the
functional capacity among
physically frail older adults in
order reduce the chances of
accidental fall
Papers which were published
between 1990 to 2012 and are
conducted over older adults for
fall prevention were selected for
this systematic review: Total to 13
trails were investigated
Systematic review A multi-component exercise
intervention program based on
strength, endurance and balance
training is more effective than
conventional physical exercise to
promote fall prevention among
physically frail older adults.
Normal physical exercise mainly support muscle strength
but a combination of different exercise help to improve
the body balance, endurance, muscle strength and
mental health and well-being which helps to prevent
accidental fall prevention
4 The systematic review was conducted via using 13 trials. This
is a small sample size and thus the review might include
biased results
Uusi-Rasi, K., Patil, R.,
Karinkanta, S., Kannus, P., Tokola,
K., Lamberg-Allardt, C., &
Sievänen, H. (2015).
The aim of the study is to
analyze the effectiveness of
targeted exercise training and
use of vitamin D supplements in
reducing falls among older
women
409 home-dwelling women 70 to
80 years old
2 years randomized control
double blind trail
Vitamin D helped to maintain femoral
neck bone mineral density and
helped in slight increase in the tibial
trabecular density. Exercise helped to
improved muscle strength and body
balance. However, Vitamin D did not
enhance the effect of exercise on
physical functioning.
The effectiveness of vitamin D when used along with
physical exercise in reducing the muscle strength is still
not validated yet and more studies are required to be
undertaken in future for further analysis
1 The follow up study leads to decrease in the overall sample
size during the course of 2 years and the study only included
women
Lee, H. C., Chang, K. C., Tsauo, J.
Y., Hung, J. W., Huang, Y. C., &
Lin, S. I. (2013)
To access the effects of
multifactorial fall prevention
program in community-dwelling
older adults.
616 community dwelling older
adults (age: 76 +/- 7 years)
Multicenter randomized
control trial
Multifactorial fall prevention program
and physical exercise helped to
reduce the cumulative fall incidence.
The multifactorial fall prevention program with physical
exercise helped to improved functional performance and
fall reduction of older adults during 3 months of follow-
up but failed to reduce falls at 1-year follow-up.
1 The follow up study decreased the sample size during the
course of the year leading the generation of biased results.
The community dwelling patients are not raised under
equilibrium environmental climate
• Australian Government National Health and Medical Research Council. (2009). NHMRC additional levels of evidence and grades for
recommendations for developers of guidelines. Access date: 14th September 2018. Retrieved from: https://www.nhmrc.gov.au/_
files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf
• National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of
guidelines. https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf