Abstract
Evidence-based fall prevention (EBFP) programs significantly decrease fall risk, falls, and fall-related injuries in community-dwelling older adults. To date, EBFP programs are only validated for use among people with normal cognition and, therefore, are not evidence-based for adults with intellectual and/or developmental disorders (IDD) such as Alzheimer's disease and related dementias, cerebral vascular accident, or traumatic brain injury. Adults with IDD experience not only a higher rate of falls than their community-dwelling, cognitively intact peers but also higher rates and earlier onset of chronic diseases, also known to increase fall risk. Adults with IDD experience many barriers to health care and health promotion programs. As the lifespan for people with IDD continues to increase, issues of aging (including falls with associated injury) are on the rise and require effective and efficient prevention. A modified group-based version of the Otago Exercise Program (OEP) was developed and implemented at a worksite employing adults with IDD in Montana. Participants were tested pre- and post-intervention using the Center for Disease Control and Prevention's (CDC) Stopping Elderly Accidents Deaths and Injuries (STEADI) tool kit. Participants participated in progressive once weekly, 1-h group exercise classes and home programs over a 7-week period. Discharge planning with consumers and caregivers included home exercise, walking, and an optional home assessment. Despite the limited number of participants (n = 15) and short length of participation, improvements were observed in the 30-s Chair Stand Test, 4-Stage Balance Test, and 2-Minute Walk Test. Additionally, three individuals experienced an improvement in ambulation independence. Participants reported no falls during the study period. Promising results of this preliminary project underline the need for further study of this modified OEP among adults with IDD. Future multicenter study should include more participants in diverse geographic regions with longer lengths of participation and follow-up.
Highlights
Each year, approximately one in three older adults experiences a fall [1]
Evidence-based fall prevention (EBFP) programs have been shown to significantly decrease fall risk, falls [2], and fallrelated injuries [3] among community-dwelling older adults with great return on investment [4]. These EBFP programs have been validated for use among people without cognitive impairment and, are not evidence-based for adults with intellectual and/or developmental disorders (IDDs) such as Alzheimer’s disease and related dementias (ADRD), cerebral vascular accident (CVA), or traumatic brain injury (TBI)
Despite general gains for the 4-Stage Balance Test, rates of improvement were more dramatic for female participants (f = 3.00, P = 0.107). This pilot project demonstrated that the utilization of the Otago Exercise Program (OEP) in adults with IDD produced test results that were similar to results to older adults with no cognitive impairments [57,58,59,60]
Summary
Approximately one in three older adults experiences a fall [1]. Of those that fall, about 20% sustain fall injuries including (but not limited to) hip fracture and traumatic brain injury (TBI) [1]. Evidence-based fall prevention (EBFP) programs have been shown to significantly decrease fall risk, falls [2], and fallrelated injuries [3] among community-dwelling older adults with great return on investment [4] To date, these EBFP programs have been validated for use among people without cognitive impairment and, are not evidence-based for adults with intellectual and/or developmental disorders (IDDs) such as Alzheimer’s disease and related dementias (ADRD), cerebral vascular accident (CVA), or TBI. Medical definitions do not always coincide with state law definitions used to determine eligibility for services For this community case study, great variations within the IDD population in terms of intellectual and physical functioning required selection of an EBFP that could be highly individualized and could still be offered in a group setting
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