Download pdf - Jurnal Geriatri

7/31/2019 Jurnal Geriatri

1/24

Effectiveness of simple balancing

training program in elderly

patients with history offrequent falls

Kuptniratsaikul V, Praditsuwan R, Assantachai P,

Ploypetch T, Udompunturak S, Pooliam J.

Clinical Interventions in Aging 2011:6 111117


2/24

Falling is one of the most common problems in the elderly

that can cause morbidity and mortality. It may have

negative effects on physical, psychological, and

socioeconomic status. The incidence of falls will increase with advancing age.

Elderly with a history of falls are at greater risk of falling

again

Fall prevention is an important strategy for reducingosteoporotic fractures.


3/24

There is evidence that exercise can prevent falls.

A meta-analysis of the seven Frailty and Injuries:

Cooperative Studies of Intervention Techniques (1995)

exercise trials suggests that balance exercise may bemore effective in lowering falls risk than the other exercise

components

Older adults who are at risk usually refuse to participate in

hospital-based exercise programs. Home-based exercisesmay be appropriate for such a long term condition.


4/24

The Aimed of Study

To study the effectiveness of simply performed

balancing training exercise, done at home, in

reducing falls and improving balancing abilities in

elderly patients who had already suffered fromfalls, and to follow up these effects for 1 year.


5/24

The inclusion criteria

aged > 50 years

outpatients who fell or a history of

osteoporotic fracture in theprevious 12 months

The exclusion criteria

could not follow commands orhad a severe medicalcondition that prevented themfrom performing exercise

This study was conducted at SirirajHospital, Thailand, from January

2009 to May 2010.


6/24

After participants signed the

informed consent, demographicdata were recorded, including

age and sex

underlying diseases

fall history

walking ability, turning,ability to go outside by

oneself

fear of fall history

Participants were

evaluated for balancingabilities using :

Timed Up and Gotest (TUGT)

Chair stand

Functional reach

Berg balancescale-short form

(BBS-SF)


7/24

All of the tests were conducted sequentially at

baseline, and after 3 months, 6 months, 9 months,

and 12 months in the exercise program.

A SF-36 and a fall efficacy scale (FES) wereassessed at baseline and after a 12-month period.


8/24

The exercises were :

strengthening exercise closed kinetic chain quadriceps exercise

Marching

stepping over a bench

standing up from a chair with arms folded tandem walk.

1020

repetitions/each,

1520

minutes/day,

record the

frequency of

exercise orcompliance in their

diaries


9/24

Participants who exercised < 3 days/week were

classified as having poor compliance, while good

compliance was defined as performing exercise at

least 3 days/week. New falls during the study period were recorded

prospectively in their diaries. The factors related to

falls were also analyzed.


10/24


11/24


12/24


13/24


14/24


15/24


16/24


17/24

Discussion

This study showed that simply-designed balancing

exercises used by the elderly who have a history of

frequent falls can decrease fall rate, and significantly

increase balancing abilities including TUGT, chair

stand, and Berg balance scores.

The improved outcomes may be due to the

encouragement of the elderly to be aware of falls and

to perform regular exercise at home. The number of falls was significantly reduced after

intervention


18/24

Discussion

The type of exercise that the elderly could accept

and comply well with was still questionable. They

designed a simple balancing exercise that was

easily done at home, with less adverse events, andwhich was appropriate for the elderly.


19/24

Discussion

There are many factors relating to falls including age,

muscle power, impaired balance, use of psychoactive

drugs, poor vision and degenerative joint disease.

Strategies to prevent falls, including reviewing

medications, correction of environment, improvement of

strength, and regular balance training

This study revealed that one of the factors

affecting fall rate was a history of previous falls.


20/24

Discussion

Compliance is another factor affecting fall rate. This study couldnot demonstrate that compliance had any effect on balancing

abilities may be because:

the number of subjects in each group was insufficient to

demonstrate significant changes in each groups balancingabilities

most of participants were young-old (60.3% were < 70 years),their balance would be better

difficulty experienced by elderly patients in recording thefrequency of exercise

these balancing abilities may not be sensitive enough torepresent true balance

the final classification group of compliance with exercise may belimitation because to be classified in the good compliance group,subjects had to perform well at every visit


21/24

Discussion

This simply-designed exercise also affects QoL in both

physical and mental health dimensions.

Encouraging the elderly to exercise regularly is an

effective way to prevent falls, and should beemphasized in medical practices


22/24

Limitation

No control group, compared pre- and post-intervention inthe frequent faller group. Didnt recruit non-fallers becausetheir objective was to study the efficacy of simple balance

exercise in frequent fallers.

The number of participants who could be completelyfollowed up was only 104 from 146 (71.2%). The 28

subjects who were lost to follow up were older. This may bedue to the need to make multiple visits to the clinic during

the study period.

The record of compliance of exercise in elderly patients israther difficult to validate


23/24

Conclusion

A simply-designed balancing exercise program,

performed at least 3 days per week, can increase

balancing abilities, and decrease fall rates in the

elderly with previous falls.

Strategies to encourage elderly compliance may

prevent falling.


24/24