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Lalor A, Callaway L, Koritsas S, Curran-Bennett A, Wong R, Zannier R, Hill K. Interventions to reduce falls in community-dwelling adults with intellectual disability: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1073-1095. [PMID: 37435852 DOI: 10.1111/jir.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/10/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND People with intellectual disability have a high risk of falls and falls-related injuries. Although people with intellectual disability are at increased risk of falls, there is a need to better understand the efficacy of interventions that can help reduce falls and address risk factors in this population. This systematic review aimed to evaluate the type, nature and effectiveness of interventions undertaken to reduce falls with community-dwelling adults with intellectual disability and the quality of this evidence. METHOD Four electronic databases were searched: Ovid MEDLINE, PsycINFO, CINAHL Plus and the Cochrane Library. Studies were included if they involved people aged 18 years or over, at least 50% of study participants had intellectual disability, participants were community-dwelling, and the study evaluated any interventions aiming to reduce falls. Study quality was assessed using the National Institutes of Health study quality assessment tools. Reporting of the review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Seven studies were eligible for review, with a total of 286 participants and mean age of 50.4 years. As only one randomised trial was identified, a narrative synthesis of results was undertaken. Five studies evaluated exercise interventions, one evaluated a falls clinic programme, and one evaluated stretch fabric splinting garments. Methodological quality varied (two studies rated as good, four as fair, and one as poor). Exercise interventions varied in terms of exercise type and dosage, frequency and intensity, and most did not align with recommendations for successful falls prevention exercise interventions reported for older people. While the majority of studies reported reduced falls, they differed in methods of reporting falls, and most did not utilise statistical analyses to evaluate outcomes. CONCLUSION This review identified a small number of falls prevention intervention studies for people with intellectual disability. Although several studies reported improvements in fall outcomes, ability to draw conclusions about intervention effectiveness is limited by small sample sizes and few studies. Further large-scale research is required to implement and evaluate falls prevention interventions specifically for adults with intellectual disability.
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Affiliation(s)
- A Lalor
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia
| | - L Callaway
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia
| | - S Koritsas
- Department of Strategy and Transformation, Scope, Melbourne, Australia, Australia
| | - A Curran-Bennett
- Department of Strategy and Transformation, Scope, Melbourne, Australia, Australia
| | - R Wong
- Department of Strategy and Transformation, Scope, Melbourne, Australia, Australia
- IDEAS Therapy Services, Victoria, Australia
| | - R Zannier
- Department of Strategy and Transformation, Scope, Melbourne, Australia, Australia
| | - K Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
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Ho P, Bulsara C, Patman S, Downs J, Hill AM. Exploring enablers and barriers to accessing health services after a fall among people with intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:604-617. [PMID: 32039539 DOI: 10.1111/jar.12704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/09/2019] [Accepted: 01/15/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adults with intellectual disability experience high rates of falls making falls prevention an important health need. The purpose of the study was to seek perspectives of older adults with intellectual disability and their caregivers to (a) explore the experiences of older adults with intellectual disability when seeking healthcare services after a fall and (b) identify enablers and barriers when taking up evidence-based falls recommendations. METHOD A qualitative exploratory study was undertaken as part of a prospective observational cohort study. Semi-structured interviews were conducted with a purposeful sample. Data were analysed thematically using Colaizzi's method. RESULTS Seventeen interviews were conducted (n = 21). Emergent themes demonstrated that participants had limited knowledge about falls prevention. Enablers included individualizing falls prevention strategies. Barriers included not being offered access to established falls prevention pathways. CONCLUSION There is an urgent need to develop high-quality falls prevention services for older adults with intellectual disability.
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Affiliation(s)
- Portia Ho
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Caroline Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Shane Patman
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Jenny Downs
- Telethon Kids Institute, Perth Children's Hospital, West Perth, WA, Australia.,Curtin University, Perth, WA, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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Hale L, Vollenhoven E, Caiman L, Dryselius A, Buttery Y. Feasibility and acceptability of Otago Exercise Programme and Prevention of Falls for Adults with Intellectual Disability: a multiple case study design. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2018.0054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background/AimsMany people with intellectual disability fall frequently. Understanding fall prevention intervention characteristics will assist efficacy trials to target appropriate people. An exploration of two exercise-based fall prevention interventions is reported, focusing on viability and acceptability.MethodsA multiple case study of adults with intellectual disability completing either the group Otago Exercise Programme or the Prevention of Falls for Adults with Intellectual Disability intervention was performed. Integrated data sources were used: semi-structured interviews with participants and support workers, observations, attendance/adherence, falls, adverse events and balance measures.ResultsIn total, seven adults with varying intellectual disability levels participated. Overall, three themes enabled understanding of suitability of people to each intervention: suitability of the exercises; role of the environment; and benefits to participants.ConclusionsEducating adults with intellectual disability and their support workers of the importance of regular exercise is key to participation. Both programmes required high levels of support and prioritisation to ensure exercises occurred and were carried out safely.
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Affiliation(s)
- Leigh Hale
- Professor, Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Emile Vollenhoven
- Student, Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | | | | | - Yvette Buttery
- Assistant Research Fellow, Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Cortés-Amador S, Carrasco JJ, Sempere-Rubio N, Igual-Camacho C, Villaplana-Torres LA, Pérez-Alenda S. Effects of a vestibular physiotherapy protocol on adults with intellectual disability in the prevention of falls: A multi-centre clinical trial. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:359-367. [DOI: 10.1111/jar.12531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/04/2018] [Accepted: 08/28/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | - Juan J. Carrasco
- Department of Physiotherapy; University of Valencia; Valencia Spain
- Intelligent Data Analysis Laboratory; University of Valencia; Valencia Spain
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Axmon A, Sandberg M, Ahlström G, Midlöv P. Fall-risk-increasing drugs and falls requiring health care among older people with intellectual disability in comparison with the general population: A register study. PLoS One 2018; 13:e0199218. [PMID: 29920564 PMCID: PMC6007903 DOI: 10.1371/journal.pone.0199218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/04/2018] [Indexed: 01/27/2023] Open
Abstract
Background Falls are the most common cause of injury for older people in the general population as well as among those with intellectual disability. There are many risk factors for falls, including a range of drugs which are considered to be fall-risk-increasing (FRIDs). The aim of the present study was to describe prescription patterns of FRIDs in itself as well as in relation to falls requiring health care among older people with intellectual disability and their age-peers in the general population. Moreover, to investigate possible differences between the two groups. Methods A cohort of people with intellectual disability and a referent cohort, one-to-one-matched by sex and year of birth, were established. Each cohort comprised 7936 people aged 55+ years at the end of 2012. Register data were collected for 2006–2012 on prescription of antidepressants, anxiolytics, hypnotics and sedatives, opioids, and antipsychotics, as well as for fall-related health care contacts. Analyses were performed on yearly data, using repeated measures models. Results People with intellectual disability were more likely to be prescribed at least one FRID (Relative Risk [RR] 2.31). The increase was highest for antipsychotics (RR 25.0), followed by anxiolytics (RR 4.18), antidepressants (RR 2.72), and hypnotics and sedatives (RR 1.42). For opioids, however, a lower prevalence (RR 0.74) was found. In both cohorts, those with prescription of at least one FRID were more likely to have a fall-related injury that required health care. The increased risk was higher in the referent cohort (RR 3.98) than among people with intellectual disability (RR 2.27), although people with intellectual disability and prescription still had a higher risk of falls than those with prescription in the referent cohort (RR 1.27). A similar pattern was found for all drug groups, except for opioids, where prescription carried the same risk of having a fall-related injury that required health care in both cohorts. Conclusions With or without prescription of FRIDs, older people with ID have a higher risk of falls requiring health care than their age-peers in the general population. It is important to be aware of this when prescribing drugs that further increase the risk of falls.
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Affiliation(s)
- Anna Axmon
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
- * E-mail:
| | - Magnus Sandberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
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Finlayson J, Crockett J, Shanmugam S, Stansfield B. Lycra splinting garments for adults with intellectual disabilities who fall due to gait or balance issues: a feasibility study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:391-406. [PMID: 29441642 DOI: 10.1111/jir.12477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 12/15/2017] [Accepted: 01/08/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (IDs) experience high rates of falls and have high rates of gait or balance issues which contribute to falls. Lycra splinting garments (LSGs) have potential to improve gait or balance, but they have never before been tested with adults with IDs who fall due to gait or balance issues. The aim of this study was to test in adults with IDs, the feasibility of using LSGs to improve movement and function and reduce falls, whilst also exploring usability and likely compliance. METHOD A convenience sample of nine adults with IDs wore tailored LSGs over a 6-week assessment period. Laboratory-based foot clearance, balance, and gait measures were collected pre- and post-LSG-wear. Falls charts and questionnaires on usability and likely compliance were also completed. RESULTS Seven participants experienced a reduction in falls during their six weeks of LSG wear; most notably in the group of five participants who wore lycra splinting socks, compared with only two in the group of four who wore lycra splinting shorts or leggings only. CONCLUSION Lycra splinting socks are likely to bring about positive outcomes for adults with IDs who fall due to gait/balance issues on an individual case by case basis over time, but further research is required to test this hypothesis under randomised controlled trial conditions. Potential benefits of more intrusive LSGs are outweighed by reported problems with usability and compliance.
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Affiliation(s)
- J Finlayson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - J Crockett
- Head of Service for Physiotherapy, Glasgow Learning Disability Services, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - S Shanmugam
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - B Stansfield
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Petropoulou E, Finlayson J, Hay M, Spencer W, Park R, Tannock H, Galbraith E, Godwin J, Skelton DA. Injuries Reported and Recorded for Adults with Intellectual Disabilities Who Live with Paid Support in Scotland: a Comparison with Scottish Adults in the General Population. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:408-415. [PMID: 26864714 DOI: 10.1111/jar.12244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Providers of supported living services to adults with intellectual disabilities (IDs) in the United Kingdom have procedures in place to monitor injuries; this provides opportunity to learn about the injuries being reported and recorded. The aim was to determine the incidence, causes and types of injuries experienced by 593 adults with intellectual disabilities who live with paid support in a 12-month period. METHOD Injury data, collected via a standard electronic injury monitoring system, were compared with data collected for a matched sample of the general population in the same year. RESULTS The adults with intellectual disabilities experienced a higher rate of injury. Falls were the commonest cause of injury for both samples, but significantly more so for the adults with intellectual disabilities. CONCLUSIONS The higher rate of injuries, particularly minor injuries, being reported suggests a culture of injury reporting and recording within these supported living services. Electronic injury monitoring is recommended for organizations providing supported living services for adults with intellectual disabilities.
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Affiliation(s)
| | - Janet Finlayson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Margaret Hay
- Learning Disability Services, Community Integrated Care, Widnes, UK
| | - Wendy Spencer
- Learning Disability Services, Turning Point Scotland, Glasgow, UK
| | - Richard Park
- Health and Safety Management, Crossreach, Edinburgh, UK
| | - Hugh Tannock
- Health and Safety Management, Turning Point Scotland, Glasgow, UK
| | - Erin Galbraith
- Learning Disability Services, Turning Point Scotland, Glasgow, UK
| | - Jon Godwin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Dawn A Skelton
- Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
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