Decrease Fall Risk Research Articles

Effect of High-Intensity Strength-Training on Functional Measures of Balance Ability in Balance-Impaired Older Adults

Objective The aim of this study was to evaluate the effect of a 10-week, high-intensity strength-training program targeting key lower extremity muscles for the purpose of improving postural control in balance-impaired older adults. Methods A quasi-experimental, delayed entry controlled design was used to evaluate balance ability in balance-impaired older adults after participation in 10 weeks of high-intensity strength training focused on the quadriceps, hamstrings, tibialis anterior, and gastrocnemius muscles. Participants were evaluated using validated clinical measures of functional balance ability: the Berg Balance Scale, the Timed Up and Go, and the Activities-Specific Balance Confidence Scale. Results After strength training, the exercisers were significantly stronger than the control subjects. They improved significantly on the Berg Balance Scale ( P = .030) from a mean score of 48.8 ± 2.4 of 56 before training to 51.2 ± 4.3 of 56 after training. The Timed Up and Go ( P = .045) and the Activities-Specific Balance Confidence Scale ( P = .038) also improved significantly in the experimental group. These changes are associated with a decrease in fall risk. Conclusions High-intensity strength training can safely and effectively strengthen lower extremity muscles in balance-impaired older adults, resulting in significant improvements in functional balance ability and decreased fall risk.

The Relationship of Intrinsic Fall Risk Factors to a Recent History of Falling in Older Women With Osteoporosis

Cross-sectional descriptive analysis investigating intrinsic fall risk factors in postmenopausal women with osteoporosis. To examine the relationships between history of recent falls and balance, pain, quality of life, function, posture, strength, and mobility. Women with osteoporosis who fall are at a high risk of fracture due to decreased bone strength. Identifying fall risk factors for older women with osteoporosis is a crucial step in decreasing the incidence of falls and fracture. METHOD AND MEASURES: Seventy-three women over 60 years of age with established osteoporosis participated in comprehensive testing of fall history, physical function, and quality of life. Significant correlations were found between a recent history of falls and degree of kyphosis (r = 0.29), fear of falls/emotional status (r = -0.27), and balance (r = -0.27). Degree of kyphosis and fear of falls/emotional status explained 20% of the variance of recent fall history using binary logistic regression. Women with an increased kyphosis were more likely to have had a recent fall (odds ratio [OR], 1.17; 95% CI, 1.03-1.34) and those with better emotional status and less fear of falling were less likely to have had a recent fall (OR, 0.61; 95% CI, 0.38-0.97). Increased thoracic kyphosis and fear of falling are 2 intrinsic factors associated with recent falls in women with osteoporosis. To design more effective interventions to decrease fall risk in this population, future prospective, longitudinal studies should monitor kyphosis, fear of falling, balance reactions, and other potential risk factors not identified in this study.

Psychotropic Medications and Risk for Falls Among Community-Dwelling Frail Older People: An Observational Study

Injuries due to falls are one of the most important public health concerns for all ages, but especially for frail elderly people. Although a small number of falls have a single cause, the majority have many different causes resulting from the interactions between intrinsic or extrinsic risk factors. We conducted an observational study on data from a large population of community-dwelling elderly people to tests the hypothesis that the current use of different classes of psychotropic medications, including antipsychotic agents, benzodiazepines, nonbenzodiazepine sedative-hypnotics, and antidepressants, increases the risk for falls. We analyzed data from a large collaborative observational study group, the Italian Silver Network Home Care project, that collected data on patients admitted to home care programs (n = 2854). After adjusting for all potential confounders, users of any psychotropic drugs had an increased risk of fall of nearly 47% (adjusted odds ratio [OR], 1.47; 95% confidence interval [CI], 1.24-1.74). Similarly, compared with nonusers, users of atypical antipsychotic drugs also had an increased risk of falling at least once (OR, 1.45; 95% CI, 1.00-2.11). Among benzodiazepine users, patients taking agents with long elimination half-life (OR, 1.45; 95% CI, 1.00-2.19) and patients taking benzodiazepines with short elimination half-life (OR, 1.32; 95% CI, 1.02-1.72) had an increased risk of falls. Patients taking antidepressants did not show a higher risk of falling compared to nonusers (OR, 0.92; 95% CI, 0.83-1.41). Our data suggest that, among psychotropic medications, antipsychotic agents and benzodiazepines are associated with an increased risk of falls. Our findings do not support the hypothesis that preferential prescribing of short-acting benzodiazepines instead of long-acting agents or atypical antipsychotic medications instead of typical agents will substantially decrease fall risk associated with the use of these classes of drugs.

Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents

Bruyere O, Wuidart M-A, Di Palma E, Goulay M, Ethgen O, Richy F, Reginster J-Y. Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents. Objective To investigate the effects of whole body vibration in the elderly. Design Randomized controlled trial. Setting Nursing home. Participants Forty-two elderly volunteers. Interventions Six-week vibration intervention plus physical therapy (PT) (n=22) or PT alone (n=20). Main outcome measures We assessed gait and body balance using the Tinetti test (maximum scores of 12 for gait, 16 for body balance, 28 for global score), motor capacity using the Timed Up & Go (TUG) test, and health-related quality of life (HRQOL) using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results After 6 weeks, the vibration intervention group improved by a mean ± standard deviation of 2.4±2.3 points on the gait score compared with no score change in the control group ( P<.001). The intervention group improved by 3.5±2.1 points on the body balance score compared with a decrease of 0.3±1.2 points in the control group ( P<.001). TUG test time decreased by 11.0±8.6 seconds in the treated group compared with an increase of 2.6±8.8 seconds in the control group ( P<.001). The intervention group had significantly greater improvements from baseline on 8 of 9 items on the SF-36 compared with the control group. Conclusions Controlled whole body vibration can improve elements of fall risk and HRQOL in elderly patients.

The positive effects of negative work: increased muscle strength and decreased fall risk in a frail elderly population.

The objective of this study was to determine if a chronic eccentric training intervention, i.e., negative work, could limit or even reverse sarcopenia and its related impairments and functional limitations. Is high-force eccentric training tolerable by elderly people and will it result in improved muscle size, strength, balance, and fall risk? 21 frail elderly subjects (mean age, 80 years) experienced 11 weeks of lower extremity resistance training. The experimental eccentric (ECC) group (n=11) performed negative work while exercising on a high-force eccentric ergometer. The active "controls" performed traditional (TRAD) (n=10) lower extremity resistance exercises (weight training). Muscle fiber cross-sectional area and strength, balance, stair descending abilities, and fall risk were assessed prior to and following this intervention. All ECC subjects who started the negative work intervention completed the study and reported the training to be relatively effortless; they experienced minimal and transient muscle soreness. Both groups experienced a significant increase in muscle fiber cross-sectional area (ECC=60%, TRAD=41%). Only the ECC group experienced significant improvements in strength (60%), balance (7%), and stair descent (21%) abilities. The timed up and go task improved in both groups, but only the ECC group went from a high to a low fall risk. These data demonstrate that lower extremity resistance exercise can improve muscle structure and function in those with limited exercise tolerance. The greater strength increase following negative work training resulted in improved balance, stair descent, and fall risk only in the ECC group. Because low energy cost is coupled to high force production with eccentric exercise, this intervention may be useful for a number of patients that are otherwise unable to achieve high muscle forces with traditional resistance exercise.

Recurrent falls are associated with increased length of stay in elderly psychiatric inpatients.

To identify factors which may contribute to prolonged length of stay in an elderly psychiatric inpatient setting. Retrospective case note study. A list of all patients over the age of 65 discharged from a private psychiatric hospital over a three-year period excluding those with a length of stay of over 365 days was obtained (n = 1147). A random sample of 150 patients was selected from the study population. A case note study was then performed looking at a number of variables which have been postulated to affect length of stay. The resulting data was analysed using multivariate statistics. There was no statistically significant association found between baseline factors (including age, gender, cognitive impairment, marital status, order of admission and preadmission living arrangement) and length of stay. Having recurrent falls whilst an inpatient was associated with prolonged hospital stay (p = 0.0006). Experiencing recurrent falls whilst an inpatient is associated with prolonged length of stay. Recurrent falls in the elderly may be associated with both physical illness and the use of psychotropic medications. A prospective study examining factors contributing to falls would be important in decreasing fall risk and reducing length of stay.

THE EFEECTS OF A WEIGHTED VEST ON KNEE STRENGTH AND LOWER LIMB MOMENTS IN OLDER ADULTS

2092 Aging is characterized by a pronounced decrease in musculoskeletal strength, which ultimately affects the biomechanics of physical-task performance. The purpose of this study was to determine the effects of a weighted vest on knee extensor strength, peak total support moment, and peak hip, knee, and ankle moments during normal walking in older adults. In this study we collected pre and post measurements for seven adults between the ages of 63 and 76 (5 female, 2 male). At each visit, measures of knee strength were obtained using a Kin-Com isokinetic dynomometer. Kinematic data were obtained using a cine camera, and kinetic data were recorded by a Kistler force plate. The exercise intervention consisted of each subject wearing a vest weighing 4-5% of his or her own body weight for eight weeks. Subjects wore their vests for 2-3 hours per day, four days per week. Modest increases in knee extensor strength (+9.34%, left; +12.18%, right) and peak support moment (+1.92%, left; +8.96%, right) were not statistically significant, but may be of clinical importance. The intervention did result in an overall increase in total weekly exercise time (p=0.01), as reported by each subject. The weighted vest provides older individuals with an easy-to-use method of participating in a weight bearing exercise program to improve strength and functional performance. The potential of the vest intervention to change limb dynamics may allow increased gait velocity, improved balance, and consequently, a decreased fall risk. Modifications of the current protocol are necessary to increase the effectiveness of the intervention. Supported by the NIA OAIC: AG10415-04