Interventions aiming at balance confidence improvement in older adults: an updated review

Older people's preferences regarding programme formats for managing concerns about falls

OBJECTIVE

to explore the preferences of community-dwelling older persons regarding different programme formats for managing concerns about falls.

SUBJECTS AND DESIGN

cross-sectional study of 5,755 community-dwelling people aged ≥ 70 years in the Netherlands.

METHODS

a questionnaire assessed people's willingness to participate per programme format (n=6), i.e. a programme at home, via telephone, via home visits and telephone consultations, via television or via Internet.

RESULTS

of the 2,498 responders, 62.7% indicated no interest in any of the formats. The willingness to participate per programme format varied between 21.5 (at home) and 9.4% (via Internet). Among people interested in at least one of the formats (n=931), higher levels of fall-related concerns were associated with increased preference for a programme with home visits. Poor perceived health and age ≥ 80 years were associated with less preference for a group programme. Higher educated people were more in favour of a programme via Internet compared with their lower educated counterparts.

CONCLUSION

the majority of community-dwelling older people are not likely to participate in any of the six proposed programme formats for managing concerns about falls. However, when diverse formats of effective programmes will be made available, uptake and adherence may be increased since programme preferences are associated to specific population characteristics.

Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial

OBJECTIVES

To determine the long-term effects of three strength and balance exercise interventions on physical performance, fall-related psychological outcomes, and falls in older people.

DESIGN

A single-blinded, four-group, randomized controlled trial.

SETTING

Community, Germany.

PARTICIPANTS

Community-dwelling adults aged 70 to 90 who had fallen in the past 6 months or reported fear of falling.

INTERVENTION

After baseline assessment, 280 participants were randomly assigned to the control group (CG; no intervention; n = 80) or one of three strength and balance exercise interventions (the strength and balance group (SBG; strength and balance only; n = 63), the fitness group (FG; strength and balance plus endurance training; n = 64), or the multifaceted group (MG; strength and balance plus fall risk education; n = 73). The interventions consisted of 32 one-hour group sessions in 16 weeks.

MEASUREMENTS

Data on physical performance, fall-related psychological outcomes, and falls were collected for 24 months.

RESULTS

Mixed-effects regression analyses showed improved short- and long-term (12 and 24 months, respectively) physical performance for the SBG and FG, particularly regarding mobility, balance, and walking speed (P < .05). The improvements in physical performance outcomes were most prominent in the FG. Fall-related psychological outcomes, number of falls, and injurious falls were not significantly different from in the control group.

CONCLUSION

Training focusing on strength, balance, and endurance can enhance physical performance for up to 24 months in community-dwelling older adults. These findings did not translate to improved fall-related psychological outcomes or reduced incidence of falls. This demonstrates the need for a different approach (e.g., regarding intervention dose and components) to gain intervention benefits in the multiple domains that contribute to independence and well-being in older adults.

Gait difficulty, postural instability, and muscle weakness are associated with fear of falling in people with Parkinson's disease

The present study aimed to examine the contribution of gait impairment, postural stability and muscle weakness to the level of fear of falling in people with Parkinson's disease (PD). Fifty-seven community-dwelling individuals with PD completed the study. Fear of falling was assessed by the Activities-specific Balance Confidence (ABC) scale. Postural stability and gait difficulty were determined by the posture and gait subscores of the Unified Parkinson's Disease Rating Scale (UPDRS-PG). A Cybex dynamometer was used to measure isokinetic knee muscle strength. Individuals with PD achieved a mean ABC score of 73.6 ± 19.3. In the multiple regression analysis, after accounting for basic demographics, fall history and disease severity, the UPDRS-PG score remained independently associated with the ABC score, accounting for 13.4% of the variance (P < 0.001). The addition of knee muscle strength significantly improved the prediction model and accounted for an additional 7.3% of the variance in the ABC score (P < 0.05). This is the first study to demonstrate that the UPDRS-PG score and knee muscle strength are important and independent determinants of the level of fear of falling in individuals with PD. Improving balance, gait stability and knee muscle strength could be crucial in promoting balance confidence in the appropriately targeted PD population.

Evaluating an in-home multicomponent cognitive behavioural programme to manage concerns about falls and associated activity avoidance in frail community-dwelling older people: Design of a randomised control trial [NCT01358032]

BACKGROUND

Concerns about falls are frequently reported by older people. These concerns can have serious consequences such as an increased risk of falls and the subsequent avoidance of activities. Previous studies have shown the effectiveness of a multicomponent group programme to reduce concerns about falls. However, owing to health problems older people may not be able to attend a group programme. Therefore, we adapted the group approach to an individual in-home programme.

METHODS/DESIGN

A two-group randomised controlled trial has been developed to evaluate the in-home multicomponent cognitive behavioural programme to manage concerns about falls and associated activity avoidance in frail older people living in the community. Persons were eligible for study if they were 70 years of age or over, perceived their general health as fair or poor, had at least some concerns about falls and associated avoidance of activity. After screening for eligibility in a random sample of older people, eligible persons received a baseline assessment and were subsequently allocated to the intervention or control group. Persons assigned to the intervention group were invited to participate in the programme, while those assigned to the control group received care as usual. The programme consists of seven sessions, comprising three home visits and four telephone contacts. The sessions are aimed at instilling adaptive and realistic views about falls, as well as increasing activity and safe behaviour. An effect evaluation, a process evaluation and an economic evaluation are conducted. Follow-up measurements for the effect evaluation are carried out 5 and 12 months after the baseline measurement. The primary outcomes of the effect evaluation are concerns about falls and avoidance of activity as a result of these concerns. Other outcomes are disability and falls. The process evaluation measures: the population characteristics reached; protocol adherence by facilitators; protocol adherence by participants (engagement in exposure and homework); opinions about the programme of participants and facilitators; perceived benefits and achievements; and experienced barriers. The economic evaluation examines the impact on health-care utilisation, as well as related costs.

DISCUSSION

A total number of 389 participants is included in the study. Final results are expected in 2012.

TRIAL REGISTRATION

NCT01358032.

Effects of new, individually adjusted, progressive balance group training for elderly people with fear of falling and tend to fall: a randomized controlled trial

Objective: To evaluate the effects of a new, individually adjusted, progressive and specific balance group training programme on fear of falling, step execution, and gait in healthy elderly people with fear of falling and tend to fall.

Design: Randomized controlled trial.

Setting: The study was conducted in Stockholm County, Sweden.

Subjects: Fifty-nine community dwelling elderly people were recruited by advertisement, and allocated at random to an intervention group ( n = 38) or a control group ( n = 21).

Intervention: Individually adjusted, progressive and specific balance group training was given three times a week for three months. The training incorporated elements included in, and required for, independent activities of daily living, and for reactions to loss of balance during dual or multiple tasks.

Main measures: Fear of falling was assessed with Falls Efficacy Scale International (FES-I). The reaction time of step execution was measured with the step-execution test, and gait was measured with GAITRite®.

Results: After three months the intervention group showed significant positive changes in the FES-I ( P = 0.008), in the step-execution phase of dual-task performance ( P = 0.012), and in gait at preferred speed during single-task performance; in cadence ( P = 0.030) and, at fast speed, in velocity ( P = 0.004) and cadence ( P = 0.001). Significant decreases were also found for the likelihood of depression after participating in the training programme.

Conclusion: This new balance training programme is feasible and leads to decreased fear of falling, decreased time for step execution during dual-task performance and increased velocity during fast walking.