Postadychute-AG, Detection, and Prevention of the Risk of Falling Among Elderly People in Nursing Homes: Protocol of a Multicentre and Prospective Intervention Study.

Flavien Quijoux,Pierre-Paul Vidal,Damien Ricard,Marie Lefèvre,Philippe Zawieja,François Bertin-Hugault

doi:10.3389/fdgth.2020.604552

Abstract

Introduction: While falls among the elderly is a public health issue, because of the social, medical, and economic burden they represent, the tools to predict falls are limited. Posturography has been developed to distinguish fallers from non-fallers, however, there is too little data to show how predictions change as older adults' physical abilities improve. The Postadychute-AG clinical trial aims to evaluate the evolution of posturographic parameters in relation to the improvement of balance through adapted physical activity (APA) programs.Methods: In this prospective, multicentre clinical trial, institutionalized seniors over 65 years of age will be followed for a period of 6 months through computer-assisted posturography and automatic gait analysis. During the entire duration of the follow-up, they will benefit from a monthly measurement of their postural and locomotion capacities through a recording of their static balance and gait thanks to a software developed for this purpose. The data gathered will be correlated with the daily record of falls in the institution. Static and dynamic balance measurements aim to extract biomechanical markers and compare them with functional assessments of motor skills (Berg Balance Scale and Mini Motor Test), expecting their superiority in predicting the number of falls. Participants will be followed for 3 months without APA and 3 months with APA in homogeneous group exercises. An analysis of variance will evaluate the variability of monthly measures of balance in order to record the minimum clinically detectable change (MDC) as participants improve their physical condition through APA.Discussion: Previous studies have stated the MDC through repeated measurements of balance but, to our knowledge, none appear to have implemented monthly measurements of balance and gait. Combined with a reliable measure of the number of falls per person, motor capacities and other precipitating factors, this study aims to provide biomechanical markers predictive of fall risk with their sensitivity to improvement in clinical status over the medium term. This trial could provide the basis for posturographic and gait variable values for these elderly people and provide a solution to distinguish those most at risk to be implemented in current practice in nursing homes.Trial Registration: ID-RCB 2017-A02545-48.Protocol Version: Version 4.2 dated January 8, 2020.

Highlights

While falls among the elderly is a public health issue, because of the social, medical, and economic burden they represent, the tools to predict falls are limited
An analysis of variance will evaluate the variability of monthly measures of balance in order to record the minimum clinically detectable change (MDC) as participants improve their physical condition through adapted physical activity (APA)
Combined with a reliable measure of the number of falls per person, motor capacities and other precipitating factors, this study aims to provide biomechanical markers predictive of fall risk with their sensitivity to improvement in clinical status over the medium term

Summary

Introduction

While falls among the elderly is a public health issue, because of the social, medical, and economic burden they represent, the tools to predict falls are limited. With the risk of falling increasing with age, 24% of people over 80 years old fall recurrently (i.e., at least twice a year) [3] It was estimated in 2004 in France that 450,000 accidents requiring a visit to hospital emergency departments were linked to falls, making it the most common accident in everyday life. The frailty of elderly people should be measured through the following indicators: weight loss, self-reported exhaustion, physical weakness, slow walking speed, and low physical activity Screening for these risk factors is common in geriatric care, the analysis of these factors alone does not provide sufficient sensitivity and specificity to identify individuals at high risk of falling [9]. Exhaustive analysis of the fall risk factors has only a limited value, and in practice, a questionnaire on the history of falls and the expertise of the professional are more often preferred to identify people who will eventually fall in the coming months [10]

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