Annals of Long Term Care

Fall Prevention in Residential Care: A Cluster, Randomized, Controlled Trial
Ngaire Kerse, MBChB, PhD, Meg Butler, MPH, Elizabeth Robinson, MSc, and Maree Todd, FRACP, MBChB

Objectives: To establish the effectiveness of a fall-prevention program in reducing falls and injurious falls in older residential care residents.

Design: Cluster, randomized, controlled trial.

Setting: Fourteen randomly selected residential care homes in Auckland, New Zealand.

Participants: All older residents (n=628, 95% participation rate).

Intervention: Residential care staff, using existing resources, implemented systematic individualized fall-risk management for all residents using a fall-risk assessment tool, high-risk logo, and strategies to address identified risks.

Measurements: Number of residents sustaining a fall, falls, and injurious-falls incidence rates.

Results: During 12 months of follow-up, 103 (43%) residents in the control group and 173 (56%) residents in the intervention group fell (P<.018). There was a significantly higher incidence rate of falls in intervention homes than in control homes (incident rate ratio=1.34, 95% confidence interval= 1.06–1.72) during the intervention period after adjusting for dependency level (type of home), baseline fall rate, and clustering. There was no difference in the injurious fall incidence rate or incidence of serious injuries.

Conclusion: This fall-prevention intervention did not reduce falls or injury from falls. Low-intensity intervention may be worse than usual care. J Am Geriatr Soc 2004;52(4):524-531.

CLINICAL INVESTIGATIONS
Resistance and Agility Training Reduce Fall Risk in Women Aged 75 to 85 with Low Bone Mass: A 6-Month Randomized, Controlled Trial
Teresa Liu-Ambrose, PhD, PT, Karim M. Khan, MD, PhD, Janice J. Eng, PhD, PR/OT, Patti A. Janssen, PhD, Stephen R. Lord, PhD, and Heather A. McKay, PhD

Objectives: To compare the effectiveness of group resistance and agility-training programs in reducing fall risk in community-dwelling older women with low bone mass.

Design: A randomized, controlled, single-blind 25-week prospective study with assessments at baseline, midpoint, and trial completion.

Setting: Community center.

Participants: Community-dwelling women aged 75 to 85 with low bone mass.

Intervention: Participants were randomly assigned to one of three groups: resistance training (n=32), agility training (n=34), and stretching (sham) exercises (n=32). The exercise classes for each study arm were held twice weekly.

Measurements: The primary outcome measure was fall risk (derived from weighted scores from tests of postural sway, reaction time, strength, proprioception, and vision), as measured using a Physiological Profile Assessment (PPA). Secondary outcome measures were ankle dorsiflexion strength, foot reaction time, and Community Balance and Mobility Scale score.

Results: Attendance at the exercise sessions for all three groups was excellent: resistance training (85.4%), agility training (87.3%), and stretching program (78.8%). At the end of the trial, PPA fall-risk scores were reduced by 57.3% and 47.5% in the resistance and agility-training groups, respectively, but by only 20.2% in the stretching group. In the resistance and agility groups, the reduction in fall risk was mediated primarily by improved postural stability, where sway was reduced by 30.6% and 29.2%, respectively. There were no significant differences between the groups for the secondary outcomes measures. Within the resistance-training group, reductions in sway were significantly associated with improved strength, as assessed using increased squat load used in the exercise sessions.

Conclusion: These findings support the implementation of community-based resistance and agility-training programs to reduce fall risk in older women with low bone mass.