Niedermann K1, Zindel B2, Meichtry A1, Krafft V2, Nast I1, Ernst M1, Wirz M1
1Zurich University of Applied Sciences, Institute of Physiotherapy, School of Health Professions, Winterthur, Switzerland, 2Swiss League Against Rheumatism, Zurich, Switzerland
Background: Falls in the elderly are an important public health issue, given the often severe medical consequences and persistent mobility impairments, together with the demographic development. Falls are often due to a combination of internal and external, e.g. environmental, risk factors. The Swiss League Against Rheumatism (SLAR) developed a multidimensional home-based fall prevention programme (FPP), where a trained physiotherapist (PT) or occupational therapist (OT) provides a 60 to 90-minutes visit to the senior at her/his home. The therapist performs a detailed assessment of the senior's individual risk of falling and subsequently recommends eliminating the identified environmental risk factors and provides tailored exercises. Four weeks later, the PT/OT calls the senior to check if a follow-up visit is required.
Purpose: The purpose of this study was to evaluate the effects of the FPP over one year. Primary outcome was the rate of falls; secondary outcomes were fear of falling, as well as PTs' recommendations and seniors' satisfaction and adherence.
Methods: A prospective observational study was carried out. Participants' demographic characteristics and fall risk were assessed at baseline, using the 'Timed Up&Go' (TUG) with additional motor (TUGmot) and cognitive tasks (TUGcog). Data on falls were assessed at baseline and during one year by fall diaries and bi-monthly telephone calls. The post-intervention fall-rate was compared with the pre-intervention fall-rate; fear of falling was assessed at the same time points using the Fall Efficacy Scale (FESI, 7 items on a 1-4 point scale). A Poisson-GEE model for fall counts and a Linear Mixed model for Fall Efficacy Scale were fitted to the data. Additionally the main PTs' recommendations and seniors' satisfaction with the intervention and adherence to the exercises after one year were assessed.
Results: The analysis was carried out over 335 person-years. The participants were mainly female (58%), with a mean age of 82.04 years (SD=5.2, range 57-97 years); 81% and 83% of the participants were able to perform the TUG and the TUGmot respectively, compared to 57% able to perform the TUGcog. The fall rate decreased from 1.34 falls (corresponding to 724 falls) before the intervention to 1.06 falls (corresponding to 577.8 falls) after the intervention, i.e. a relative rate reduction (RRR) of -0.21 (95% CI: -0.37, 0.00). Fear of falling decreased after one year by FESI -1.39 points (95% CI: -1, -1.79).
Main recommendations made by PTs/OTs were ´fixing down carpets´ (69%) and 'instruction of up to 5 exercises' (strength, balance, multi-task capability) (83.9%). Almost all seniors (98.2%) were satisfied with the programme, a follow-up visit was provided to 1% of the seniors. After one year, 64% of the participants reported to exercise 'always', 'most of time' or 'sometimes'.
Conclusion(s): This low-threshold, multidimensional home-based FPP achieved a 21% fall rate reduction, indicating a potential causal effect of the FPP. The FPP was feasible, and a substantial number of participants was adherent after one year.
Implications: Provided that the planned cost-effectiveness analysis is positive, the FPP developed by the SLAR and provided by PTs and OTs should be established in the national health system and reimbursed to participants.
Keywords: Fall prevention, Elderly, Geriatrics
Funding acknowledgements: This work is funded by the Age Foundation, Zurich, Switzerland and the Foundation for Health Promotion, Lausanne, Switzerland.
Purpose: The purpose of this study was to evaluate the effects of the FPP over one year. Primary outcome was the rate of falls; secondary outcomes were fear of falling, as well as PTs' recommendations and seniors' satisfaction and adherence.
Methods: A prospective observational study was carried out. Participants' demographic characteristics and fall risk were assessed at baseline, using the 'Timed Up&Go' (TUG) with additional motor (TUGmot) and cognitive tasks (TUGcog). Data on falls were assessed at baseline and during one year by fall diaries and bi-monthly telephone calls. The post-intervention fall-rate was compared with the pre-intervention fall-rate; fear of falling was assessed at the same time points using the Fall Efficacy Scale (FESI, 7 items on a 1-4 point scale). A Poisson-GEE model for fall counts and a Linear Mixed model for Fall Efficacy Scale were fitted to the data. Additionally the main PTs' recommendations and seniors' satisfaction with the intervention and adherence to the exercises after one year were assessed.
Results: The analysis was carried out over 335 person-years. The participants were mainly female (58%), with a mean age of 82.04 years (SD=5.2, range 57-97 years); 81% and 83% of the participants were able to perform the TUG and the TUGmot respectively, compared to 57% able to perform the TUGcog. The fall rate decreased from 1.34 falls (corresponding to 724 falls) before the intervention to 1.06 falls (corresponding to 577.8 falls) after the intervention, i.e. a relative rate reduction (RRR) of -0.21 (95% CI: -0.37, 0.00). Fear of falling decreased after one year by FESI -1.39 points (95% CI: -1, -1.79).
Main recommendations made by PTs/OTs were ´fixing down carpets´ (69%) and 'instruction of up to 5 exercises' (strength, balance, multi-task capability) (83.9%). Almost all seniors (98.2%) were satisfied with the programme, a follow-up visit was provided to 1% of the seniors. After one year, 64% of the participants reported to exercise 'always', 'most of time' or 'sometimes'.
Conclusion(s): This low-threshold, multidimensional home-based FPP achieved a 21% fall rate reduction, indicating a potential causal effect of the FPP. The FPP was feasible, and a substantial number of participants was adherent after one year.
Implications: Provided that the planned cost-effectiveness analysis is positive, the FPP developed by the SLAR and provided by PTs and OTs should be established in the national health system and reimbursed to participants.
Keywords: Fall prevention, Elderly, Geriatrics
Funding acknowledgements: This work is funded by the Age Foundation, Zurich, Switzerland and the Foundation for Health Promotion, Lausanne, Switzerland.
Topic: Older people; Health promotion & wellbeing/healthy ageing; Rheumatology
Ethics approval required: Yes
Institution: Canton of Zurich, Switzerland
Ethics committee: Cantonal Ethics Committee Zurich
Ethics number: BASEC 2016-00516
All authors, affiliations and abstracts have been published as submitted.
