A one-year proprioceptive exercise programme reduces the incidence of falls in community-dwelling elderly people: A before–after non-randomised intervention study
Introduction
The risk of falls increases with age. One-third of all people over 65 years of age suffer an accidental fall in the course of a year, and the incidence doubles after 75 years of age [1]. Falls are the cause of up to 87% of all fractures in elderly people, and have psychological consequences such as fear of falls, reduce quality of life, and result in a loss of independence [2]. This explains the importance of addressing falls prevention when anti-osteoporotic therapy is prescribed for the prevention of fractures [3]. Moreover, one-third of all elderly people who suffer falls die as a result of such accidents [4].
The risk of falls increases from 8% in people with no risk factors to 78% among elderly people with four or more risk factors (like history of previous falls and fractures, concomitant drug use, low muscle strength, alterations in balance, or walking disorders) [5], [6]. Polypharmacy is considered to be an independent risk factor for falls [7].
Falls depend on many factors, and in almost one in four cases falls are associated with alterations in balance [8]; balance exercise programmes have been shown to reduce the incidence of falls [8]. These exercises, performed at home for at least 12 weeks, are effective in improving balance, and compliance is high, since people do not need to go to the gym [9]. Falls may be regarded as constituting a geriatric syndrome, a serious and dangerous clinical problem, which is often underestimated by both health professionals and patients [10] and compliance with programmes aimed at preventing falls is very low [11]. The hypothesis of this research is that home exercise programmes to improve proprioception can be effective in reducing the incidence of falls among elderly people in the community.
The aim of this study was to assess whether a one-year proprioceptive exercise programme could reduce the incidence of falls. A secondary aim was to assess the association between drugs and falls.
Section snippets
Study design and participants
This was a before–after non-randomised intervention study (Fig. 1). The inclusion criteria were: 69 years or older; independent walking (technical aids could be used, but the participant could not be assisted by another person); and place of residence in the region of La Ribera (Valencia, Spain). The exclusion criteria were: the existence of associated disease conditions resulting in a life expectancy of under 6 months; blindness and deafness; serious psychiatric problems or moderate to severe
Effect of the exercise training intervention
A total of 572 subjects (63.3% women) were included, with a mean age of 76.1 ± 3.9 years (Fig. 2). Baseline characteristics of the sample are presented in Table 1. The proportion of elderly people with one or more falls during the 12 months before the start of the study was 35.7%, with a mean of 2.0 ± 1.5 falls. Of the 204 subjects with a history of falls before the intervention, 111 (54.4%) had had one fall, while 93 (45.6%) had had two or more falls.
Individuals who had had falls were older, mainly
Proprioceptive exercise and falls
The aim of this study was to assess whether a physical exercise programme aimed at stimulating proprioception can reduce the incidence of falls. After 12 months with this intervention a 10% reduction in the incidence of falls was reported, similar to previous reports [17]. During the study period none of the participants who fell suffered any fractures. A systematic review showed how exercise programmes aimed at reducing falls are effective in reducing the consequences of falls, such as
Conclusions
Training proprioception for 12 months is associated with a reduction in the incidence of falls.
Polypharmacy is an independent risk factor for falls in the elderly, and a number of drug groups have been related to the risk of falls. Beta-blocker use increased falls while antiplatelet/anticoagulation drugs were associated with a lesser risk of falls in a community-dwelling elderly people.
Contributors
Each of the authors significantly contributed to the design, data collection, analysis and discussion of the results and writing of the manuscript.
Conflict of interest
The authors declare they had no conflict of interest in connection with the study.
Funding
None of the authors received specific funding for this study.
Ethical approval
This study was approved by the Comisión de Investigación, Hospital Universitario de la Ribera. All participants gave written informed consent.
Provenance and peer review
This article has undergone peer review.
Acknowledgments
The authors wish to thank all the members of the Departamento de Salud de la Ribera for helping to make this study possible.
References (36)
- et al.
Factors associated with short-term functional recovery in elderly people with a hip fracture. Influence of cognitive impairment
J. Am. Med. Dir. Assoc.
(2015) - et al.
Falls and fractures: a systematic approach to screening and prevention
Maturitas
(2015) - et al.
Fear of falling revisited
Arch. Phys. Med. Rehabil.
(1996) - et al.
Interventions based on exercise and physical environment for preventing falls in cognitively impaired older people living in long-term care facilities: a systematic review and meta-analysis
Rev. Esp. Geriatr. Gerontol.
(2016) - et al.
Falls in the spanish elderly population: Incidence, consequences and risk factors
Rev. Esp. Geriatr. Gerontol.
(2015) - et al.
Quality of life in the elderly on polymedication and with multiple morbidities
Rev. Esp. Geriatr. Gerontol.
(2014) - et al.
A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity
Am. J. Geriatr. Pharmacother.
(2011) - et al.
Rationale for strengthening muscle to prevent falls and fractures: a review of the evidence
Calcif. Tissue Int.
(2016) - et al.
Shifting the focus in fracture prevention from osteoporosis to falls
BMJ
(2008) - et al.
Association of polypharmacy with fall risk among geriatric outpatients
Geriatr. Gerontol. Int.
(2011)
Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis
Epidemiology
Polypharmacy and falls in the elderly: a literature review
Nurs. Midwifery Stud.
The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults
Phys. Ther.
Effect of a home exercise program on dynamic balance in elderly with a history of falls
J. Aging Phys. Act.
Fall-risk assessment and management in clinical practice: views from healthcare providers
J. Am. Geriatr. Soc.
A systematic review of older people’s perceptions of facilitators and barriers to participation in falls-prevention interventions
Ageing Soc.
Risk-factors for falls among elderly persons living in the community
N. Engl. J. Med.
Euroqol – a new facility for the measurement of health-related quality-of-life
Health Policy
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