Does the ‘Otago exercise programme’ reduce mortality and falls in older adults?: a systematic review and meta-analysis. Age Ageing
Rehabilitation and Aged Care, Flinders University, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, South Australia 5041, Australia. Age and Ageing
(Impact Factor: 3.64).
11/2010; 39(6):681-7. DOI: 10.1093/ageing/afq102
the 'Otago exercise programme' (OEP) is a strength and balance retraining programme designed to prevent falls in older people living in the community. The aim of this review was to evaluate the effect of the OEP on the risk of death and fall rates and to explore levels of compliance with the OEP in older adults.
a systematic review with meta-analysis. Clinical trials where the OEP was the primary intervention and participants were community-dwelling older adults (65+) were included. Outcomes of interest included risk of death, number of falls, number of injurious falls and compliance to the exercise programme.
seven trials, involving 1503 participants were included. The mean age of participants was 81.6 (±3.9) years. The OEP significantly reduced the risk of death over 12 months [risk ratio = 0.45, 95% confidence interval (CI) = 0.25-0.80], and significantly reduced fall rates (incidence rate ratio = 0.68, 95% CI = 0.56-0.79). There was no significant difference in the risk of a serious or moderate injury occurring as the result of a fall (risk ratio = 1.05, 95% CI = 0.91-1.22). Of the 747 participants who remained in the studies at 12 months, 274 (36.7%) were still exercising three or more times per week.
the OEP significantly reduces the risk of death and falling in older community-dwelling adults.
Available from: Carmen A Pfortmueller
- "Throughout the world, falls are a major public health problem and a socioeconomic burden [1–6]. Approximately one-third of the population over the age of 65 falls each year, rising to over 50% by the age of 80 [5, 7–10]. Falls and fall-related injuries are a major cause of disability and personal and professional impairment [3, 6–8]. "
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Throughout the world, falls are a major public health problem and a socioeconomic burden. Nevertheless there is little knowledge about how the injury types may be related to the aetiology and setting of the fall, especially in the elderly. We have therefore analysed all patients presenting with a fall to our Emergency Department (ED) over the past five years.
Our retrospective data analysis comprised adult patients admitted to our Emergency Department between January 1, 2006, and December 31, 2010, in relation to a fall.
Of a total of 6357 patients 78% (n = 4957) patients were younger than 75 years. The main setting for falls was patients home (n = 2239, 35.3%). In contrast to the younger patients, the older population was predominantly female (56.3% versus 38.6%; P < 0.0001). Older patients were more likely to fall at home and suffer from medical conditions (all P < 0.0001). Injuries to the head (P < 0.0001) and to the lower extremity (P < 0.019) occurred predominantly in the older population. Age was the sole predictor for recurrent falls (OR 1.2, P < 0.0001).
Falls at home are the main class of falls for all age groups, particularly in the elderly. Fall prevention strategies must therefore target activities of daily living. Even though falls related to sports mostly take place in the younger cohort, a significant percentage of elderly patients present with falls related to sporting activity. Falls due to medical conditions were most likely to result in mild traumatic brain injury.
- "Fortunately , a number of interventions have been shown to reduce the incidence of falls in this population  , particularly exercise to improve balance, mobility and strength deficits  . Evidence suggests that interventions targeting high-risk groups can prevent more falls and be more cost-effective than those aimed at the general population  . Therefore, it is imperative that clinicians can identify those at risk of falling to provide appropriate targeted interventions. "
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ABSTRACT: Introduction: Falls among community-dwelling older adults are a common yet often preventable occurrence. Clinicians frequently use task-based assessment tools to evaluate clients' balance and mobility with the aim of predicting falls and providing targeted fall prevention interventions, but no consensus exists on the optimum tool(s) to use for this purpose. This review aims to identify the task-based assessment tools that can best predict falls among community-dwelling older adults. Methods: Online databases Academic Search Complete, AMED, Biomedical Reference Collection: Expanded, CINAHL Plus, MEDLINE, General Science, and SPORTDiscus were searched from 1983 to 2013 to identify prospective studies assessing the performance of specific tasks in order to predict falls. Following screening, the methodological quality of studies included for review was appraised using a checklist based on the Critical Appraisal Skills Programme tool for cohort studies . Results: Thirty-seven studies, dating from 1996 to 2013 and largely of high methodological quality, were included in this review. A range of task performance-based assessment tools suitable for use in both clinical and laboratory settings were identified. CONCLUSIONS Strong evidence in favour of using the Timed Up-and-Go test, Five Times Sit-to-Stand test and assessments of gait speed to predict falls among this population in clinical settings was found, along with weaker evidence for tests of standing balance and reaching task performance. Laboratory-based assessments of postural sway and gait variability were also found to predict falls. Incorporating the recommended assessment tools into comprehensive assessments of community-dwelling older clients can lead to improved falls prediction by clinicians.
Available from: med.unc.edu
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ABSTRACT: Falls are the leading cause of emergency department visits, hospital admissions, and unintentional death for older adults. Balance and strength impairments are common falls risk factors for community-dwelling older adults. Though physical therapists commonly treat balance and strength, standardized falls screening has not been fully incorporated into physical therapy practice and there is much variation in the frequency, intensity, and duration of therapy prescribed to achieve optimal results. For community-dwelling older adults, a progressive exercise program that focuses on moderate to high-intensity balance exercises appears to be one of the most effective interventions to prevent falls. For more frail older adults in institutional settings, exercise programs in addition to multifactorial interventions appear to show promise as effective falls prevention interventions. The minimum dose of exercise to protect an older adult against falls is 50 hours. This article describes the current best practices for physical therapists to effectively improve balance and manage falls risk in patients. The unique challenges and opportunities for physical therapists to incorporate evidence-based fall-prevention strategies are discussed. Innovative practice models incorporating evidence-based fall-prevention programs and partnerships with public health and aging service providers to create a continuum of care and achieve the optimal dose of balance training are presented.
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