Abstract
Falls and fall-related injuries are common in community-dwelling older persons. Longitudinal data on effective fall prevention programs are rare. Therefore, we evaluated a 4-months multi-component exercise fall prevention program in a primary care setting on long-term effects over 24months on falls and concomitant injuries in older community-dwelling persons with high risk of falling. In the Prevention of Falls (PreFalls) study, forty general practitioners in Germany were cluster-randomized (1:1) into an intervention group (IG) or control group (CG). Three hundred seventy-eight independently living people with high risk of falling (78.1 ± 5.9years, 75% women) were assigned to IG (n = 222) or CG (n = 156). Patients in IG took part in a 4-months multi-component exercise program comprising strength and balance exercises (28 sessions); patients in CG received no intervention. Primary outcome measure was number of falls over 24months, analyzed by a patient-level, linear mixed Poisson model. Secondary endpoints were number of fall-related injuries, changes in physical function, fear of falling, and mortality. After 24months, the IG demonstrated significantly fewer falls (IRR = 0.63, p = 0.021), injurious falls (IRR = 0.69, p = 0.034), and less fear of falling (p = 0.005). The mortality rate was 5.0% in IG and 10.3% in CG (HR = 0.51, 95% CI: 0.24 to 1.12; p = 0.094). In older community-dwelling persons with high risk of falling, a short-term multi-component exercise intervention reduced falls and injurious falls, as well as fear of falling over 24months.
Highlights
Falls and fall-related injuries are common in communitydwelling older persons.[1,2] Injurious falls pose an immense burden on the public health care system,[3,4] as they are related to disability, admission to nursing homes, and even higher mortality.[2,3,5]Risk factors for falls can be grouped into intrinsic, extrinsic, and behavioral domains.[6,7] Fall-related psychological concerns (FrPCs) are reported up to 83% of community-dwelling older persons.[8]
19.1 falls calendar over the 24-months period were obtained in intervention group (IG) and 18.9 in control group (CG)
Intervention subjects averaged 1.89 falls per year, compared to 3.11 falls per year in the control group (IRR: 0.63; 95% confidence interval (CI): 0.44 to 0.94; p = 0.021) (Table 2)
Summary
Risk factors for falls can be grouped into intrinsic (related to the individual, e.g., skills in balance or strength), extrinsic (related to the environment), and behavioral domains (individual beliefs, cognition decision-making).[6,7] Fall-related psychological concerns (FrPCs) are reported up to 83% of community-dwelling older persons.[8] Fear of falling (FoF) has been linked to cautious gait,[9] reduced physical activity level due to activity avoidance, and social withdrawal.[10,11]. OBJECTIVE: we evaluated a 4-months multicomponent exercise fall prevention program in a primary care setting on long-term effects over 24 months on falls and concomitant injuries in older community-dwelling persons with high risk of falling. CONCLUSIONS: In older community-dwelling persons with high risk of falling, a short-term multi-component exercise intervention reduced falls and injurious falls, as well as fear of falling over 24 months
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