Weekly Research Highlight in Fall Prevention

This weekly blog post aims to highlight articles published during the week regarding fall prevention. This week we take a look a multicomponent intervention for fall reduction at a rural mixed rehabilitation ward.

Abstracts for these studies can be found here

Reducing falls through the implementation of a multicomponent intervention on a rural mixed rehabilitation ward
Ma CLK, Morrissey RA. Aust. J. Rural Health 2020; ePub(ePub): ePub.
DOI 10.1111/ajr.12646 PMID 32794315

There have been many strategies developed in order to reduce inpatient falls across hospitals in Australia. There has been limited research into preventing falls on a mixed acute/subacute rehabilitation unit, especially in rural areas. This research was implemented when a rural rehabilitation unit was found to have the highest rate of falls when compared to other inpatient wards. In response a multicomponent intervention was developed using an audit to identify gaps in their existing falls reduction plan with proposed interventions. Key interventions included the implementation of a traffic light mobility system to provide visual aids for mobility, increased compliance with existing fall risk tools and improved documentation of fall incidents. Through this process they were able to reduce the number of patients falling from 10.4% to 5.4% of all admissions.

Weekly Research Highlight in Fall Prevention

This weekly blog post aims to highlight articles published during the week regarding fall prevention. This week we take a look at fall related anxiety and locomotion in older adults and a multifactorial fall prevention program for older people after stroke.

Abstracts for these studies can be found here

Conscious Movement Processing, Fall-Related Anxiety, and the Visuomotor Control of Locomotion in Older Adults
Ellmers TJ, Cocks AJ, Kal EC, Young WR. J. Gerontol. B Psychol. Sci. Soc. Sci. 2020; ePub(ePub): ePub.
DOI 10.1093/geronb/gbaa081 PMID 32761087
Older adults may consciously process walking movements in an attempt to avoid falling, however, in some circumstances this may increase stepping variability and errors and disrupt postural stability. It may also direct attention away from environment while walking. A common trigger for consious movement processing in older adults is fall-related anxiety. This study aimed to (a) confirm that previously observed anxiety-related changes in visual search behavior occur in conjunction with increased self-reported conscious movement processing and (b) manipulate conscious movement processing (independent from fall-related anxiety) to test for a causal link between this movement strategy and altered visual search. (Ellmers et al. 2020)
Evaluating a Novel Multifactorial Falls Prevention Activity Programme for Community-Dwelling Older People After Stroke: A Mixed-Method Feasibility Study
Koh JSG, Hill AM, Hill KD, Etherton-Beer C, Francis-Coad J, Bell E, Bainbridge L, de Jong LD. Clin. Interv. Aging 2020; 15: 1099-1112.
DOI 10.2147/CIA.S251516 PMID 32764897
Multifactorial approaches to fall prevention can reduce the rate of falls in the general older population, however, this is an underexplored area in patients after stroke. While exercise is important for improving balance capacity in people after stroke other areas such as fall prevention education, home hazard modifications and safe landing techniques may also help reduce fear of falling and injurious falls. Koh et al. developed a program that aimed to increase the participants’ falls prevention knowledge, improve their balance and strength, evaluate their home falls hazards, and gain skills in how to land safely in case of a fall, move on the floor and get up again. This feasibility trial of community-dwelling older people after stroke was implemented to determine the participants’ and physiotherapists’ experiences regarding the acceptability, implementation, and practicality of the programme and to test limited efficacy by exploring how participating impacted on the participants’ health-related quality of life in terms of their daily lived experience regarding physical, mental, emotional and social well-being.

Weekly Research Highlight in Fall Prevention

This weekly blog post aims to highlight articles published during the week regarding fall prevention. This week we take a look at exercise and the need for continued physical activity to reduce the effects of quarantine on chronic disease, frailty and falls.

Abstracts for these studies can be found here

Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: Special focus in older people
David Jiménez-Pavón, Ana Carbonell-Baeza, Carl J. Lavie, Progress in Cardiovascular Diseases,
Volume 63, Issue 3, 2020, Pages 386-388,
DOI 10.1016/j.pcad.2020.03.009.
This commentary on the effects that quarantine due to COVID-19 can have on diseases such as diabetes, hypertension, CVD, respiratory diseases as well as the increasing risk of the risk of frailty and sarcopenia due to inactivity. Exercise has been shown to be an effective therapy for most of the chronic diseases with direct effects on both mental and physical health. Exercise in older people can reduce or prevent frailty and sarcopenia, reduce the risk of falls, improve self-esteem and positively impact cognitive impairment or decline.We should aim to not totally interrupt or change the lifestyle of people during quarantine and to maintain an active lifestyle at home is very important for the health of the overall population but, especially, for those with additional risk factors and older people
Balance training monitoring and individual response during unstable vs stable balance Exergaming in elderly adults: Findings from a randomized controlled trial
Bakker J, Donath L, Rein R. Exp. Gerontol. 2020; ePub(ePub): ePub.
DOI 10.1016/j.exger.2020.111037 PMID 32730797
Physical activity contributes to physical, mental, and social well-being. Beside stress management and proper nutrition, strength, endurance, balance and flexibility have been mainly proposed to successfully maintain a healthy, fit and independent lifestyle. Exercise needs to be done at the right dose and be sufficiently challenging to successfully meet these outcomes. In this randomised controlled trial Bakker et al. aimed to elucidate whether differences of external load (game scores) and internal load (perceived efforts) criteria occur over the time course of a volitional step-training program using exergames. The obtained information may help to improve training programming and adjustment in order to provide intended, specific and challenging training stimuli.

Sit Up, Get Dressed and Keep Moving! University Hospital of North Midlands (UHNM) and the British Geriatrics Society

University Hospital of North Midlands (UHNM) and the British Geriatrics Society have relaunched the ‘Sit Up, Get Dressed and Keep Moving’ campaign which aims to help healthcare professionals recognise the long term effects of deconditioning, implement simple measures to prevent it, and educate patients and carers about the importance of remaining active during hospital admission and following discharge.

As part of this campaign new posters, banners and brochures have been developed for display in hospitals explaining the benefits of staying active, and illustrated guides outlining chair and bed-based exercises aimed at maintaining and gaining muscle strength, improving blood circulation, helping mobility progression and supporting overall recovery.

These resources are available here

Further Sit Up, Get Dressed and Keep Moving resources developed courtesy of the Leeds Teaching Hospitals NHS Trust.
Staying Active in Hospital A4
Pyjama Paralysis
EndPJparalysis challenge
Walking
Own Clothes
FAQStaying Active in Hospital
end PJ paralysis

Weekly Research Highlight in Fall Prevention

This weekly blog post aims to highlight articles published during the week regarding fall prevention. This week we take a look at backward walking to detect fallers in people with multiple sclerosis and a feasibility trial combining cognitive stimulation therapy and fall prevention exercise in older adults with dementia.

Abstracts for these studies can be found here

Backward walking sensitively detects fallers in persons with multiple sclerosis
Binns E, Kerse N, Peri K, Cheung G, Taylor D. Pilot Feasibility Stud. 2020; 6: e108.
DOI 10.1186/s40814-020-00646-6 PMID 32724661
Falls are common among people with multiple sclerosis (MS) with around 60% of people with MS experiencing at least one fall each 6 months and 30% experiencing multiple falls. There is a need to develop measures that accurately discriminate between fallers and non-fallers for people with MS. Edwards et al. investigated the use of backward walking as a predictor of retrospective and prospective falls in people with MS. Using backward walking velocity and symptom duration they were able to accurately classify 76.3% of cases and backward walking velocity alone accurately classified 71.1% of cases. Unfortunately due to poor rates of prospective fall data collection only retrospective data was sufficiently powered.
Combining cognitive stimulation therapy and fall prevention exercise (CogEx) in older adults with mild to moderate dementia: a feasibility randomised controlled trial
Edwards EM, Daugherty AM, Nitta M, Atalla M, Fritz NE. Mult. Scler. Relat. Disord. 2020; 45: e102390.
DOI 10.1016/j.msard.2020.102390 PMID 32707529
Living with dementia is an independent risk factor for falls with an annual incidence rate of around 60-80%. Appropriate strength and balance exercise programs are able to reduce the risk of falling in older adults, however, these programs are not always effective in people living with dementia. The CogEx trial combined 10 minutes of fall prevention exercises with cognitive stimulation therapy classes offered to the community and in residential aged care facilities in New Zealand over a 7 week period. They found that while fall prevention exercises could be incorporated into the existing cognitive stimulation therapy classes, fidelity was poor. The effectiveness of the balance training was limited both due to time restrictions and because participants predominately completed the exercises while seated. (Binns et al. 2020)