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Prediction of falls among older people in residential care facilities by the Downton index
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
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2002 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, Vol. 15, no 2, 142-147 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: Falls are frequent among older people living in residential care facilities. The aim of this study was to investigate the prediction accuracy of the Downton fall risk index among older people living in residential care facilities at 3, 6 and 12 months, and with two different definitions of falls. METHODS: Seventy-eight residents in one residential care facility, 56 women and 22 men, mean +/- SD age 81 +/- 6 years, participated in this study. Forty-seven percent of participants had dementia, 45% depression, and 32% previous stroke. Forty-one percent of participants used a walking device indoors, and the median score of the Barthel ADL Index was 16. At baseline, the Downton fall risk index was scored for each individual. A score of 3 or more was taken to indicate high risk of falls. Participants were followed up prospectively for 12 months, with regard to falls indoors. RESULTS: At 3, 6 and 12 months, and using a fall definition including all indoor falls, sensitivity ranged from 81 to 95% with the highest value at 3 months, and specificity ranged from 35 to 40%. The prognostic separation values ranged from 0.26 to 0.37. Within 3 months, the risk of falling was 36% in the high-risk group (index score > or = 3) and 5% in the low-risk group. The accuracy of predictions did not improve when applying a fall definition in which falls precipitated by acute illness, acute disease, or drug side-effects were excluded. CONCLUSIONS: Already after 3 months, the Downton fall risk index appears to be a useful tool for predicting falls, irrespective of their cause, among older people in residential care facilities.

Place, publisher, year, edition, pages
2002. Vol. 15, no 2, 142-147 p.
Identifiers
URN: urn:nbn:se:umu:diva-5072PubMedID: 12889846OAI: oai:DiVA.org:umu-5072DiVA: diva2:144436
Available from: 2006-04-18 Created: 2006-04-18 Last updated: 2010-08-31Bibliographically approved
In thesis
1. Fall prediction and a high-intensity functional exercise programme to improve physical functions and to prevent falls among older people living in residential care facilities
Open this publication in new window or tab >>Fall prediction and a high-intensity functional exercise programme to improve physical functions and to prevent falls among older people living in residential care facilities
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Impairments in balance, mobility, and lower-limb strength are common in the growing population of older people and can lead to dramatic consequences for the individual, such as dependency in activities of daily living, admission to nursing home, falls, and fractures. The main purposes of this thesis were, among older people in residential care facilities, to validate a fall-risk assessment tool and to evaluate a high-intensity functional weight-bearing exercise pro-gramme regarding its applicability as well as its effect on physical functions and falls.

The prediction accuracy of the Downton fall risk index within 3, 6 and 12 months was evaluated among 78 residents, aged 65 years or more, at one residential care facility. The participants were assessed as having either a low or high fall risk according to the index and were followed-up for falls using two different fall definitions related to the cause of the fall. With all falls included, a significant prognostic separation was found between the low- and the high-risk group at 3, 6 and 12 months. A definition in which falls precipitated by acute illness, acute disease, or drug side-effects were excluded did not improve the accuracy of the fall prediction.

The effect on physical functions of a high-intensity functional exercise programme was evaluated in a randomised controlled trial among 191 older people, dependent in activities of daily living, with a Mini-Mental State Examination score of ten or more, and living in nine residential care facilities. Participants were randomised to an exercise programme or a control activity, including 29 supervised sessions over 3 months, as well as to an intake of a milk-based 200 ml protein-enriched energy supplement (7.4 g protein per 100 g) or a placebo drink immediately after each session. The Berg Balance Scale, usual and maximum gait speed, and one-repetition maximum in lower-limb strength in a leg press machine were followed up at 3 and 6 months by blinded assessors and analysed using the intention-to-treat principle. Significant long-term effects of the high-intensity functional exercise programme were seen in balance, gait ability and lower-limb strength in comparison with the control activity. The intake of the protein-enriched energy supplement did not increase the effect of the training.

The evaluation of the applicability of the exercise programme showed that there was a high rate of attendance, a relatively high achieved intensity in the exercises, and only two serious adverse events, neither of which led to manifest injury or disease, despite that most of the participants had severe cognitive or physical impairments. The applicability of the programme was not associated with the participants’ cognitive function.

The evaluation of the fall-prevention effect of the exercise programme, during the 6 months following the intervention, showed that neither fall rate nor proportion of participants who sustained a fall differed between the exercise programme and the control activity, when all participants were compared. However, among participants who improved their balance during the intervention period, a significant reduction in fall rate was seen in favour of the exercise group.

In conclusion, among older people living in residential care facilities, the Downton fall risk index appears to be a useful tool for predicting residents sustaining a fall, irrespective of the cause of the fall, even with a perspective of only a few months. A high-intensity functional exercise programme is applicable for use, regardless of cognitive function, and has positive long-term effects on balance, gait ability, and lower-limb strength. An intake of a protein-enriched energy supplement immediately after the exercise does not appear to increase the effect of the training. Participants who improve their balance function due to the exercise programme may reduce their risk of falling.

Place, publisher, year, edition, pages
Umeå: Samhällsmedicin och rehabilitering, 2006. 79 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1024
Keyword
aged, frail elderly, cognition disorders, residential facilities, randomized controlled trials, exercise, exercise therapy, nutrition, predictive value of tests, accidental falls: prevention & control
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-756 (URN)91-7264-072-3 (ISBN)
Public defence
2006-05-05, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2006-04-18 Created: 2006-04-18 Last updated: 2010-01-18Bibliographically approved

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Lundin-Olsson, LillemorJensen, Jane

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