Elsevier

Maturitas

Volume 94, December 2016, Pages 155-160
Maturitas

A one-year proprioceptive exercise programme reduces the incidence of falls in community-dwelling elderly people: A before–after non-randomised intervention study

https://doi.org/10.1016/j.maturitas.2016.09.007Get rights and content

Highlights

  • Polypharmacy is an independent risk factor for falls in the elderly.

  • Use of beta-blockers was seen to be related to an increase in falls.

  • In this observational study, proprioception exercises reduced the incidence of falls.

Abstract

Background

The risk of falls increases with age. Balance alteration and polypharmacy are independent contributors to an increased risk of falls.

Objective

The primary aim was to assess whether a proprioceptive exercise programme reduces the incidence of falls. A secondary aim was to assess the association between drugs and falls.

Design

This was a before–after non-randomised intervention study.

Participants

The study recruited independent and cognitively intact community-dwelling people aged over 69 years, from December 2012 to May 2014.

Methods

The intervention was done by a nurse and consisted of a monthly supervised group session of proprioceptive training for 1 year, supplemented by a home diary exercise. Daily medication was reviewed.

Results

We included 572 subjects (63.3% women), mean age 76.1 ± 3.9 years.

The mean number of drugs prescribed at the start of the study was 4.7 ± 3.0and 353 of the participants (61.7%) were taking four or more drugs a day. The elderly who fell were more dependent in their activities of daily living (Barthel index), and their balance was worse (determined using the Tinetti scale), as were their results on a cognitive scale (the MEC). After the intervention, an increase in self-perceived quality of life (EQ5D) was reported. The incidence of falls was reduced from 37.5% in the 12 months prior to the intervention to 25.7% in the 12 months after the intervention.

During the follow-up, beta-blocker use was associated with an increased incidence of falls (OR = 2.05; 95%IC: 1.24–3.39; p = 0.005). In contrast, antiplatelet/anticoagulation drugs were associated with a lower risk of falls (OR = 0.7; 95%IC: 0.55–0.88; p = 0.003).

Conclusions

The proprioceptive exercise programme reduced the incidence of falls in community-dwelling older people. Multiple drug use was an independent predictor of an increased risk of falls, and specific drug groups were associated with falls.

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.

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