Number Of Fallers Research Articles

Does progressive resistance and balance exercise reduce falls in residential aged care? Randomized controlled trial protocol for the SUNBEAM program

IntroductionFalls are common among older adults. It is reported that approximately 60% of residents of aged care facilities fall each year. This is a major cause of morbidity and mortality, and a significant burden for health care providers and the health system. Among community dwelling older adults, exercise appears to be an effective countermeasure, but data are limited and inconsistent among studies in residents of aged care communities. This trial has been designed to evaluate whether the SUNBEAM program (Strength and Balance Exercise in Aged Care) reduces falls in residents of aged care facilities.Research questionIs the program more effective and cost-effective than usual care for the prevention of falls?DesignSingle-blinded, two group, cluster randomized trial.Participants and setting300 residents, living in 20 aged care facilities.InterventionProgressive resistance and balance training under the guidance of a physiotherapist for 6 months, then facility-guided maintenance training for 6 months.ControlUsual care.MeasurementsNumber of falls, number of fallers, quality of life, mobility, balance, fear of falling, cognitive well-being, resource use, and cost-effectiveness. Measurements will be taken at baseline, 6 months, and 12 months.AnalysisThe number of falls will be analyzed using a Poisson mixed model. A logistic mixed model will be used to analyze the number of residents who fall during the study period. Intention-to-treat analysis will be used.DiscussionThis study addresses a significant shortcoming in aged care research, and has potential to impact upon a substantial health care problem. Outcomes will be used to inform care providers, and guide health care policies.

Efficacy of falls prevention interventions: protocol for a systematic review and network meta-analysis

BackgroundFalls are a leading cause of morbidity and mortality in older adults. Although numerous trials of falls prevention interventions have been completed, there is extensive variation in their intervention components and clinical context, such that the key elements of an effective falls prevention program remain unclear to patients, clinicians, and policy-makers. Our objective is to identify the most effective interventions and combinations of interventions that prevent falls though a systematic review and meta-analysis, including a network meta-analysis.Methods/DesignWe will search for published (e.g., MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Ageline) and unpublished (e.g., trial registries, dissertations) randomised clinical trials (RCTs) in all languages examining interventions to prevent falls compared to usual care or other falls prevention interventions among adults aged ≥65 years from all settings (e.g., community, acute care, long-term care, and rehabilitation). The primary outcomes are number of injurious falls and number of hospitalizations due to falls. Secondary outcomes include falls rate, number of fallers, number of emergency room visits due to falls, number of physician visits due to falls, number of fractures, costs, and number of intervention-related harms (e.g., muscle soreness related to exercise).We will calibrate our eligibility criteria amongst the team and two independent team members will screen the literature search results in duplicate. Conflicts will be resolved through team discussion. A similar process will be used for data abstraction and quality appraisal with the Cochrane risk of bias tool.Our results will be synthesized descriptively and a random effects meta-analysis will be conducted if the studies are deemed methodologically, clinically, and statistically (e.g., I2<60%) similar. If appropriate, a network meta-analysis will be conducted, which will allow the comparison of interventions that have not been compared in head-to-head RCTs, as well as the effectiveness of interventions.DiscussionWe will identify the most effective interventions and combinations of interventions that prevent falls in older people. Our results will be used to optimize falls prevention strategies, and our goal is to ultimately improve the health of seniors internationally.Trial registrationPROSPERO registry number: CRD42013004151

Interventions for preventing falls in people after stroke

Falls are one of the most common medical complications after stroke with a reported incidence of 7% in the first week after stroke onset. Studies investigating falls in the later phase after stroke report an incidence of up to 73% in the first year post-stroke. To evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. We searched the trials registers of the Cochrane Stroke Group (November 2012) and the Cochrane Bone, Joint and Muscle Trauma Group (May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2012, Issue 5, MEDLINE (1950 to May 2012), EMBASE (1980 to May 2012), CINAHL (1982 to May 2012), PsycINFO (1806 to May 2012), AMED (1985 to May 2012) and PEDro (May 2012). We also searched trials registers, checked reference lists and contacted authors. Randomised controlled trials of interventions where the primary or secondary aim was to prevent falls in people after stroke. Review authors independently selected studies for inclusion, assessed trial quality, and extracted data. We used a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling we used a risk ratio and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate. We included 10 studies with a total of 1004 participants. One study evaluated the effect of exercises in the acute and subacute phase after stroke but found no significant difference in rate of falls (rate ratio 0.92, 95% CI 0.45 to 1.90, 95 participants). The pooled result of four studies investigating the effect of exercises on preventing falls in the chronic phase also found no significant difference for rate of falls (rate ratio 0.75, 95% CI 0.41 to 1.38, 412 participants).For number of fallers, one study examined the effect of exercises in the acute and subacute phase after stroke but found no significant difference between the intervention and control group (risk ratio 1.19, 95% CI 0.83 to 1.71, 95 participants). The pooled result of six studies examining the effect of exercises in the chronic phase also found no significant difference in number of fallers between the intervention and control groups (risk ratio 1.02, 95% CI 0.83 to 1.24, 616 participants).The rate of falls and the number of fallers was significantly reduced in two studies evaluating the effect of medication on preventing falls; one study (85 participants) compared vitamin D versus placebo in institutionalised women after stroke with low vitamin D levels, and the other study (79 participants) evaluated alendronate versus alphacalcidol in hospitalised people after stroke.One study provided single lens distance glasses to regular wearers of multifocal glasses. In a subgroup of 46 participants post-stroke there was no significant difference in the rate of falls (rate ratio 1.08, 95% CI 0.52 to 2.25) or the number of fallers between both groups (risk ratio 0.74, 95% CI 0.47 to 1.18). There is currently insufficient evidence that exercises or prescription of single lens glasses to multifocal users prevent falls or decrease the number of people falling after being discharged from rehabilitation following their stroke. Two studies testing vitamin D versus placebo and alendronate versus alphacalcidol found a significant reduction in falls and the number of people falling. However, these findings should be replicated before the results are implemented in clinical practice.

Prevention of falls in the elderly: A review

Falls often result in soft tissue injuries, dislocations, fractures, longstanding pain and reduced quality of life. Therefore, fall preventive programmes have been developed. In this review, we evaluate programmes that in randomized controlled trials (RCT) have been shown with fall reducing effect. Physical exercise that includes several training modalities, especially balance and strength training, is the only intervention programme that reduces both the number of fallers and the number of falls in community dwellers. Home hazards modification reduces the fall risk in community-living elderly but has the best effects in high risk groups when the programme is led by occupational therapists. Vitamin D supplement in those with low levels of vitamin D, adjustment of psychotropic medication and modification of multi-pharmacy are drug-related programmes that reduce the fall risk. Anti-slip shoe devices in elderly who walk outdoors during icy conditions and multifaceted podiatry to patients with specific foot disability are interventions targeted at the lower extremities with a fall-reducing effect. First eye cataract surgery and pacemakers in patients with cardio-inhibitory carotid sinus hypersensitivity are surgical procedures with fall-reducing effect. Multifactorial standardized preventive programmes that include an exercise component and individually-designed subject-specific programmes also reduce the number of falls. Fall preventive interventions should be provided to elderly by a structured approach, especially to high risk groups, as to reduce the number of falls and fallers.

Promotion of physical activity and fitness in sedentary patients with Parkinson’s disease: randomised controlled trial

Objective To evaluate whether a multifaceted behavioural change programme increases physical activities in patients with Parkinson’s disease.Design Multicentre randomised controlled trial.Setting 32 community hospitals in the Netherlands, collaborating in a...

Prevention of falls in the elderly—a review

The proportion of elderly in the society increases and fall frequency increases with advancing age. Many falls result in fractures and also soft tissue injuries, longstanding pain, functional impairment, reduced quality of life, increased mortality, and excess in healthcare costs. Due to the magnitude of these negative effects, a variety of single- and multicomponent fall-preventive intervention programs has been initiated.This review identifies programs that, in randomized controlled trials (RCTs), have been shown with fall-reductive effects.The most effective strategies in community-dwelling elderly include regular physical training with program that includes several different training modalities. Modification of the overall or patient-specific risk factor profile in home hazard modification program has been proven to decrease fall risk in community-living elderly. The elderly in the community benefit also from wearing antislip shoe devices when walking in icy conditions, from adjustment of psychotropic medication, and from structured modification of multipharmacy. If vitamin D levels in blood are low, supplementation is beneficial as is the first eye cataract surgery and pacemaker implantation in patients with cardioinhibitory carotid sinus hypersensitivity. In addition to modification of specific risk factors, generalized and individualized multifactorial preventive programs, all including some sort of physical training, have been found to decrease the fall risk. In summary, there is now strong evidence in the literature that structured fall-preventive programs in the elderly, especially in high-risk groups, are beneficial in reducing both the number of fallers and the number of falls in community.

Falls in People With Multiple Sclerosis Who Use a Walking Aid: Prevalence, Factors, and Effect of Strength and Balance Interventions

ObjectivesTo investigate falls prevalence, factors associated with falling, and the effects of balance and strengthening interventions on falls in persons with multiple sclerosis (MS). DesignBaseline and posttreatment data from a randomized controlled trial. SettingCommunity. ParticipantsPeople with MS (N=111) who use bilateral support for gait. InterventionsGroup and one-on-one physiotherapy. Main Outcome MeasuresFalls prevalence was assessed using retrospective recall. Demographic information was collected, impairments of body function were assessed, and results from the Berg Balance Scale, 6-minute walk test (6MWT), Multiple Sclerosis Impact Scale-29 version 2 physical and psychological scores, and the Modified Fatigue Impact Scale (MFIS) were obtained. ResultsThe prevalence of falls in a 3-month period was 50.5% among participants with MS, of whom 28% had more than 1 fall. Fallers had a greater physical (mean difference, −3.9; P=.048) and psychological (median difference, −4.5; P=.001) impact of MS and a greater impact of fatigue (mean difference, −9.4; P=.002). A logistic regression analysis found that the MFIS score made a unique, significant contribution to the model (odds ratio=1.04; 95% confidence interval, 1.018–1.079), correctly identifying 68% of fallers. A 10-week group physiotherapy intervention significantly reduced both the number of fallers (58.3% before to 22.9% after intervention, P=.005) and the number of falls (63 before to 25 after intervention, P=.001). ConclusionsThe prevalence of falls is high in this population of persons with MS, and the impact of MS and of fatigue is greater in fallers. Development and evaluation of interventions to reduce falls risk and the transition to faller or multiple faller status are required.

Falls and Fractures in the Elderly with Sinus Node Disease: The Impact of Pacemaker Implantation

Background. Falls and fractures in the elderly are among the leading causes of disability. We investigated whether pacemaker implantation prevents falls in patients with SND in a large cohort of patients. Methods. Patient demographics and medical history were collected prospectively. Fall history was retrospectively reconstituted from available medical records. The 10-year probability for major osteoporotic fractures was calculated retrospectively from available medical records using the Swiss fracture risk assessment tool FRAX-Switzerland. Results. During a mean observation period of 2.3 years after implantation, the rates of fallers and injured fallers with fracture were reduced to 15% and 6%, respectively. This corresponds to a relative reduction in the number of fallers of 75% (P < 0.001) and of injured fallers of 63% (P = 0.014) after pacemaker implantation. Similarly, the number of falls was reduced from 60 (48%) before pacemaker implantation to 22 (18%) thereafter (relative reduction 63%, P = 0.035) and the number of falls with injury from 22 (18%) to 7 (6%), which corresponds to a relative reduction of 67%, P = 0.013. Conclusion. In patients with SND, pacemaker implantation significantly reduces the number of patients experiencing falls, the total number of falls, and the risk for osteoporotic fractures.

Association Between Vitamin D Dosing Regimen and Fall Prevention in Long-term Care Seniors.

IntroductionThe effectiveness of vitamin D in reducing falls among long-term care (LTC) seniors remains nonconclusive. We reviewed how vitamin D dosing regimen could affect rate of fall and number of fallers among LTC seniors.MethodsWe conducted a systematic literature review. Studies were selected by two independent reviewers based on study characteristics (age 75 or older), quality assessment (primary analysis randomized controlled trials), and outcome (rate of fall and number of fallers). Analyses of all trials following trials using daily standard dosage (800–1000 IU) only were performed to compare daily standard dosage with intermittent supratherapeutic dosage in fall prevention.ResultsSeventy-nine studies were identified, with 28 selected by reviewers (kappa 0.98), and four RCT were conducted in LTC. Daily standard dosage provides greater reduction in rate of fall by 16%, which was statistically significant. However, reduction in number of fallers remained statistically insignificant even taking dosing regimen into account.ConclusionsDaily standard dosage of vitamin D has greater benefits in reducing fall rate than that of intermittent supratherapeutic doses, but not in number of fallers. This could imply that vitamin D is useful in preventing fall recurrence rather than first fall. Prospective studies randomizing LTC seniors to different dosing regimens are warranted.

Effect of a six-month therapy with alfacalcidol on muscle power and balance and the number of fallers and falls

In an open observational prospective multicentered study on a cohort of patients with a creatinine clearance of < or = 65 ml/min and diagnosed with the "Esslinger Fall Risk Assessment" to be at an increased risk for falls the effect of daily treatment with 1 microg alfacalcidol (CAS 41294-56-8; Alpha-D3) on muscle power, balance and number of fallers and falls was investigated. In this open prospective study on 237 participants recruited in Germany, 16.9% men and 83.1% women with a mean age of 75.9 years and a mean body mass index (BMI) of 26.3 kg/m2 underwent at the beginning and after 3 and 6 months different muscle strength and balance tests such as the Timed-up and Go Test (TUG), the Tandem Stand Test (TST) and the Chair Rising Test (CRT). A successful performance in these tests has been associated with a significantly lower risk for falls and non-vertebral fractures in elderly patients (successful test performance: TUG < 12 s, TST > 10 s, CRT < 10 s). Controlled for age, gender and BMI, treatment with alfacalcidol was associated with a significantly increased performance in all three muscle and balance tests already after 3 months. This effect increased after six months of therapy and a significant increase in the number of participants who were able to successfully perform the different tests was observed: plus 74.9% for the TUG (p < .0001), plus 112% for the TST (p < .0001) and plus 108% for the CRT (p < .0001). After six months the mean time used for the TUG was decreased by 2.01 s, by 2.29 s for the CRT, and increased by 2.02 s for the TST. Controlled for age, gender, BMI and CrCI, treatment with alfacalcidol for six moths resulted in a significant 48.1% (p _< or = .0001) decrease in the absolute number of fallers and a significant 51.3% (p .0001) decrease in the absolute number of falls, compared to the 6 months prior to alfacalcidol therapy. Treatment with alfacalcidol increases muscle power and balance as measured with three different muscle power and balance tests and leads to a highly significant decrease in the number of fallers and falls.

The effects of manual therapy on balance and falls: A systematic review

Abstract Objective The purpose of this study was to review the scientific literature on the effects of manual therapy interventions on falls and balance. Methods This systematic review included randomized and quasi-randomized controlled trials that investigated the effects of manual therapy interventions on falls or balance. Outcomes of interest were rate of falls, number of fallers reported, and measures of postural stability. Data sources included searches through June 2011 of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, Allied and Complimentary Medicine, Current Controlled Trials, Manual Alternative and Natural Therapy Index System, Index to the Chiropractic Literature, National Institutes of Health (USA), and Google Scholar. Results Eleven trials were identified that met the inclusion criteria. Most trials had poor to fair methodological quality. All included trials reported outcomes of functional balance tests or tests that used a computerized balance platform. Nine of the 11 trials reported some statistically significant improvements relating to balance after an intervention that included a manual therapy component. The ability to draw conclusions from a number of the studies was limited by poor methodological quality or very low participant numbers. A meta-analysis was not performed due to heterogeneity of interventions and outcomes. Only 2 small trials included falls as an outcome measure, but as a feasibility study and a pilot study, no meaningful conclusions could be drawn about the effects of the intervention on falls. Conclusion A limited amount of research has been published that supports a role for manual therapy in improving postural stability and balance. More well-designed controlled trials with sufficient participant numbers are required to draw meaningful clinical conclusions about the role that manual therapies may play in preventing falls or improving postural stability and balance.

Association Between Vitamin D Dosing Regimen and Fall Prevention in Long-term Care Seniors

IntroductionThe effectiveness of vitamin D in reducing falls among longterm care (LTC) seniors remains nonconclusive. We reviewed how vitamin D dosing regimen could affect rate of fall and number of fallers among LTC seniors.MethodsWe conducted a systematic literature review. Studies were selected by two independent reviewers based on study characteristics (age 75 or older), quality assessment (primary analysis randomized controlled trials), and outcome (rate of fall and number of fallers). Analyses of all trials following trials using daily standard dosage (800–1000 IU) only were performed to compare daily standard dosage with intermittent supratherapeutic dosage in fall prevention.ResultsSeventy-nine studies were identified, with 28 selected by reviewers (kappa 0.98), and four RCT were conducted in LTC. Daily standard dosage provides greater reduction in rate of fall by 16%, which was statistically significant. However, reduction in number of fallers remained statistically insignificant even taking dosing regimen into account.ConclusionsDaily standard dosage of vitamin D has greater benefits in reducing fall rate than that of intermittent supratherapeutic doses, but not in number of fallers. This could imply that vitamin D is useful in preventing fall recurrence rather than first fall. Prospective studies randomizing LTC seniors to different dosing regimens are warranted.

Falls and mobility in Parkinson's disease: protocol for a randomised controlled clinical trial

BackgroundAlthough physical therapy and falls prevention education are argued to reduce falls and disability in people with idiopathic Parkinson's disease, this has not yet been confirmed with a large scale randomised controlled clinical trial. The study will investigate the effects on falls, mobility and quality of life of (i) movement strategy training combined with falls prevention education, (ii) progressive resistance strength training combined with falls prevention education, (iii) a generic life-skills social program (control group).Methods/DesignPeople with idiopathic Parkinson's disease who live at home will be recruited and randomly allocated to one of three groups. Each person shall receive therapy in an out-patient setting in groups of 3-4. Each group shall be scheduled to meet once per week for 2 hours for 8 consecutive weeks. All participants will also have a structured 2 hour home practice program for each week during the 8 week intervention phase. Assessments will occur before therapy, after the 8 week therapy program, and at 3 and 12 months after the intervention. A falls calendar will be kept by each participant for 12 months after outpatient therapy.Consistent with the recommendations of the Prevention of Falls Network Europe group, three falls variables will be used as the primary outcome measures: the number of fallers, the number of multiple fallers and the falls rate. In addition to quantifying falls, we shall measure mobility, activity limitations and quality of life as secondary outcomes.DiscussionThis study has the potential to determine whether outpatient movement strategy training combined with falls prevention education or progressive resistance strength training combined with falls prevention education are effective for reducing falls and improving mobility and life quality in people with Parkinson's disease who live at home.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12606000344594

A Randomized Controlled Trial of a Multifactorial Falls Prevention Intervention for Older Fallers Presenting to Emergency Departments

To investigate the effect of a referral-based targeted multifactorial falls prevention intervention on the occurrence of recurrent falls and injuries in older people presenting to an emergency department (ED) after a fall and discharged directly home from the ED. Randomized controlled trial. Assessors of outcomes were unaware of group allocation. Seven EDs in metropolitan Melbourne, Australia. Inclusion criteria were community dwelling, aged 60 and older, presenting to an ED after a fall, and discharged directly home. Exclusion criteria were unable to follow simple instructions or walk independently. Targeted referrals to existing community services and health promotion recommendations, based on the falls risk factors found in a baseline assessment. Primary outcome measures were falls and resultant injuries occurring over the 12-month follow-up period. Falls and injury data were collected using falls calendars supported by medical record reviews. Three hundred sixty-one participants were randomized to the standard care group and 351 to the intervention group. No significant difference was found between the two groups over the 12-month follow-up period in number of fallers (relative risk (RR)=1.11, 95% confidence interval (CI)=0.95-1.31] or number of participants sustaining an injury from a fall (RR=1.06, 95% CI=0.86-1.29). This study does not support the use of a referral-based targeted multifactorial intervention program to reduce subsequent falls or fall injuries in older people who present to an ED after a fall.

Adverse Events Associated With the Res-Care Intervention

The purpose of this secondary data analysis was to evaluate the adverse events associated with a restorative care intervention (Res-Care) in nursing home (NH) residents. A randomized controlled repeated-measure design and generalized estimating equations were used to evaluate status at baseline and 4 and 12 months after initiation of the Res-Care Intervention. Twelve NHs in Maryland. A total of 487 residents; 256 in treatment sites and 231 in control sites, all long-stay NH residents ages 65 and older, with an MMSE of 11 or greater. The Res-Care Intervention was a 2-tiered self-efficacy-based intervention focused on motivating nursing assistants to actively engage residents in functional and physical activities. Baseline (2-month pre-intervention), 4-month, and 12-month records of adverse events, including falls, fall-related injuries, fractures, emergency room (ER) visits, hospital admissions, and death abstracted from NH records. There were significant baseline differences between treatment groups in resident race (more African Americans in control sites) and ER visits (more visits in treatment sites 2 months before intervention). Longitudinal models revealed significant differences in ER visits at 4 months and number of fallers at 12 months that were in the direction of a protective effect of treatment over time. The Res-Care Intervention, which maximizes physical functioning, is safe to conduct in NH residents and does not result in increased risks of falling, injury, or other adverse events.

The FARE: a new way to express falls risk among older persons including physical activity as a measure of exposure

ObjectivesCommon expressions of falls risk do not include exposure to hazards. We compared two expressions: the commonly used population incidence (fallers per 1000 person-years) and the FARE (FAlls Risk by...

Falls Clinics: an opportunity to address frailty and improve health outcomes (preliminary evidence)

Currently the operational model of a Falls Clinic is not clearly defined making it difficult to assess outcomes. Predominantly referrals are for older, frail adults and while there is merit in current interventions prescribed the effect on falls and other outcomes over time are unclear. The aim of this pilot study is to describe 12 month health outcomes of community-dwelling older adults who have attended a multi-disciplinary Falls Clinic. A sequential sample of 90 community-dwelling older adults (> or =65 years) attending a Falls and Injury Risk Assessment Clinic between April and October 2001 was followed-up at 12 months. Outcomes included grip strength, Timed- Up and Go, body weight, number of fallers, and change in accommodation. Data are summarised as mean (SD) and n (%) with change over time tested using paired sample t-tests (continuous data) and chi-square (categorical data). Sixty-five participants were available at 12 months. Mean (SD) age of participants was 80 (6) years and 30 of 65 (46%) were males. At 12 months, 62 (96%) remained in the same accommodation, 37 out of 65 (57%) reported >1 fall in the previous year, compared to 72% (n=47) on average at baseline (p=0.21). Grip strength (p=0.006), TUG (p=0.001) and body weight (p=0.033) all declined between baseline and 12 months. This pilot study found a trend for reduction in falls, but this was accompanied with a significant decline in measures of frailty, including outcomes of nutritional status, strength and mobility. Evaluation of more targeted multi-disciplinary frailty interventions in this at risk group are required.

The FARE: A new way to express FAlls Risk among older persons including physical activity as a measure of Exposure

Background Common expressions of falls risk do not include exposure to hazards. We compared two expressions: the commonly used population incidence (fallers per 1000 person-years) and the FARE (FAlls Risk by Exposure): the number of fallers per 1000 physically active person-days. Methods Prospective follow-up study among community dwelling older persons (N = 771) aged between 71 and 96 years in The Netherlands, 2005. Baseline data on age, gender, disabilities (vision, mobility), and number of days per week with minimally 30 min of physical activity were collected. Falls were registered monthly. Falls risk was expressed as the number of falls per 1000 person-years and as the FARE. A balance control difficulty score was based on the sumscore of 11 disability items. Results Increased difficulty controlling balance was linearly associated with reduced exposure to risky situations (Spearman correlation coefficient = −.56) and to an increased falls risk per 1000 person-years. In contrast, the FARE score increased exponentially, which is more indicative of the real risk people face, taking into account their activity restriction. Conclusions The FARE is recommended for use in public health policy and research on falls prevention because it takes into account reduced physical activity of older persons who experience increased difficulty controlling their balance.

The effects of lifestyle and behavioural interventions for urinary incontinence on mobility, physical activity and falls in older people: A comprehensive systematic review.

Review question and objectives This review will systematically examine the evidence to answer the question: • What are the effects of lifestyle and behavioural interventions used to treat urinary incontinence on mobility, physical activity and falls in older people? The key objectives to be addressed are: 1. To investigate the effectiveness of lifestyle interventions for urinary incontinence on physical activity, mobility and falls in older people 2. To investigate the effectiveness of behavioural interventions to treat urinary incontinence on physical activity, mobility and falls in older people 3. To identify the experiences of older people regarding lifestyle and behavioural interventions for urinary incontinence on mobility, physical activity and falls. Types of participants Older people aged 60 years and over, males and females, with any type of urinary incontinence, diagnosed by symptom classification or urodynamic study. They may be community‐living, hospitalised or a care home resident. Types of interventions Lifestyle and behavioural interventions for urinary incontinence including but not limited to pelvic floor muscle training, bladder training, prompted voiding, habit retraining, timed voiding, fluid management, caffeine reduction, treatment of constipation, weight loss, tobacco reduction, alcohol reduction Types of outcome measures The primary outcomes for this review are a demonstrable improvement in mobility and/or physical activity and a reduction in the number of falls as the result of introducing lifestyle and behavioural interventions for urinary incontinence in the over 60s. Mobility outcome measures will include both subjective (including but not limited to self‐report of mobility, gait, Activities of Daily Living) and objective (including but not limited to Timed Up and Go, Gait or walking speed). Physical Activity outcome measures will include both subjective (e.g. self‐report questionnaires) and objective (e.g. body fixed sensor activity monitoring). Falls outcomes (rate or number of falls, or number of fallers) will ideally be measured using prospective daily calendars returned monthly for at least one year 22 however, falls outcome measurements in the included studies will vary and we will also include trials where falls were recorded retrospectively or not monitored continuously throughout the trial. TRUNCATED AT 350 WORDS

Efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people: study protocol for a randomised trial.

BackgroundFalls in older people are a major public health problem, with at least one in three people aged over 65 years falling each year. There is increasing evidence that foot problems and inappropriate footwear increase the risk of falls, however no studies have been undertaken to determine whether modifying these risk factors decreases the risk of falling. This article describes the design of a randomised trial to evaluate the efficacy of a multifaceted podiatry intervention to reduce foot pain, improve balance, and reduce falls in older people.MethodsThree hundred community-dwelling men and women aged 65 years and over with current foot pain and an increased risk of falling will be randomly allocated to a control or intervention group. The "usual cae" control group will receive routine podiatry (i.e. nail care and callus debridement). The intervention group will receive usual care plus a multifaceted podiatry intervention consisting of: (i) prefabricated insoles customised to accommodate plantar lesions; (ii) footwear advice and assistance with the purchase of new footwear if current footwear is inappropriate; (iii) a home-based exercise program to strengthen foot and ankle muscles; and (iv) a falls prevention education booklet. Primary outcome measures will be the number of fallers, number of multiple fallers and the falls rate recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the Medical Outcomes Study Short Form 12 (SF-12), the Manchester Foot Pain and Disability Index, the Falls Efficacy Scale International, and a series of balance and functional tests. Data will be analysed using the intention to treat principle.DiscussionThis study is the first randomised trial to evaluate the efficacy of podiatry in improving balance and preventing falls. The trial has been pragmatically designed to ensure that the findings can be generalised to clinical practice. If found to be effective, the multifaceted podiatry intervention will be a unique addition to common falls prevention strategies already in use.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12608000065392