Broader assessment required to analyze effectiveness of elderly fall-prevention programs
Falls remain the most common source of injury in the elderly community, with 30 to 50 percent of community-dwelling elders falling at least once per year. The ongoing effort to create the most effective fall-prevention program has led physicians to factor in quality of life (QOL) as a useful tool to determine exactly what does and does not work.
A study was performed to establish the effectiveness of the QOL rating using 150 Taiwanese residents ages 65 and older who had fallen within a four-week interval prior to the study. Participants were randomly assigned to either of three interventions which were conducted once every two weeks for a four month period: an education group, an exercise/training group, and a home modification/assessment group. Primary outcomes were rated on a 26-item version of the World Health Organization Quality of Life instrument (WHOQOL-BREF), while secondary outcomes included functional measures such as activities of daily living (ADL), balance, gait and depression level.
The most notable of the results of the study came from the exercise group, which received 40 to 60 minutes of stretching, muscle strengthening and balance training during their biweekly sessions. Among findings in the primary analysis, the exercise group's scores increased by significant margins in all but the physical domain of the WHOQOL-BREF, which were the psychological, social and environmental domains. For the secondary outcome, the exercise group emerged from the trial with increased scores in functional reach, balance and gait, and a decreased fear of falling. The education group proved successful in only the physical domain of the primary measure and in reducing depression in the secondary, but increased their scores only minimally in other categories. The home modification and assessment was comparable to the education group, but did not improve to any relevant degree.
In analyzing the results of the study, it can be garnered that the exercise group was the most beneficial of the three in lowering factors that contribute to falls; however, if the study took into consideration only the occurrence of falls after preventative methods were taken, the effectiveness of the prevention method would not be given as clear a picture. Studies such as this that use additional factors like QOL to pinpoint precise advantages of certain methods will better help physicians refine preventative programs in order to make them as efficient as possible.
-As reported in a December '07 edition of American Family Physician
-By Greg Gargiulo
