Community-Based Fall Prevention and Exercise Programs for Older Adults
Tóm tắt
Community-based exercise and fall prevention programs afford older adults the opportunity to engage in group-based activities that promote health and wellness, physical activity, and social interaction. This review will analyze eight programs, commonly offered to older adults, that utilize various instructional modes to target health promotion through exercise, falls efficacy, and education. All of the programs are supported by randomized control or quasi- experimental designs and have been found to reduce falls, reinforce falls efficacy, or improve some aspect of functional mobility. Program designs vary and include seminar-style instruction, exercise class activities, or a hybrid approach with interprofessional outreach. Physical performance benefits are based on a variety of outcomes. The Timed Up and Go (TUG) assessment was the most frequently administered outcome among programs, though the magnitude of improvement varied. Programs have become more accessible as outreach has extended to rural underserved areas and nontraditional settings such as faith-based organizations. Community-based programs offer older adults health promotion opportunities through exercise and education initiatives. Program designs vary and target different constructs of exercise and wellness to meet the needs of a wide variety of aging seniors. As a result of large-scale dissemination endeavors, programs are now extending to rural areas while maintaining operational fidelity.
Tài liệu tham khảo
Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged > 65 Years – United States. Morbidity Mortal Weekly Report. 65(37):993–8.
World Health Organization. Falls.https://www.who.int/news-room/fact-sheets/detail/falls Retrieved October 25, 2020.
Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. 2018;66(4):693–8. https://doi.org/10.1111/jgs.15304.
Tinetti ME, Kumar C. The patient who falls: It's always a trade-off. JAMA. 2010;303(3):258–66. https://doi.org/10.1001/jama.2009.2024.
Bloch F, Jegou D, Dhainaut JF, Rigaud AS, Coste J, Lundy JE, et al. Can metabolic abnormalities after a fall predict short term mortality in elderly patients? Eur J Epidemiol. 2009;24(7):357–62. https://doi.org/10.1007/s10654-009-9342-y.
Urban and Rural. United States Census Bureau. https://www.census.gov/programs-surveys/geography/guidance/geo-areas/urban-rural.html Retrieved October 20, 2020.
Olaisen RH, Rossen LM, Warner M, Anderson RN. Unintentional Injury Death Rates in Rural and Urban Areas.1999–2017. NCHS Data Brief; 2019; 343.
Lam O, Broderick B, Toor S. How Far Americans Live from the Nearest Hospital Differs by Community Type. Pew Research Center. https://www.pewresearch.org/fact-tank/2018/12/12/how-far-americans-live-from-the-closest-hospital-differs-by-community-type/ Retrieved October 20, 2020.
Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. 2008;37:19–24.
Denkinger MD, Lukas A, Nikolaus T, Hauer K. Factors associated with fear of falling and associated activity restriction in community-dwelling older adults: a systematic review. Am J Geriatr Psychiatry. 2015;23(1):72–86. https://doi.org/10.1016/j.jagp.2014.03.002.
Haynes M, League P, Neault G. A matter of balance: older adults taking control of falls by building confidence. Front Public Health. 2015;2:274. https://doi.org/10.3389/fpubh.2014.00274.
Peterson EW. Using cognitive behavioral strategies to reduce fear of falling: a matter of balance. Generations. 2002;26:53–9.
Yoshikawa A, Ramirez G, Smith ML, Lee S, Ory MG. Systematic review and meta-analysis of fear of falling and fall-related efficacy in a widely disseminated community-based fall prevention program. Arch Gerontol Geriatr. 2020;91:104235. https://doi.org/10.1016/j.archger.2020.104235.
Sartor-Glittenberg C, Bordenave E, Bay C, Bordenave L, Alexander JL. Effect of a matter of balance programme on avoidance behaviour due to fear of falling in older adults. Psychogeriatrics. 2018;18(3):224–30. https://doi.org/10.1111/psyg.12310.
Chen TY, Edwards JD, Janke MC. The effects of the a matter of balance program on falls and physical risk of falls, Tampa, Florida, 2013. Prev Chronic Dis. 2015;12:E157. https://doi.org/10.5888/pcd12.150096.
Ullmann G, Williams HG, Plass CF. Dissemination of an evidence-based program to reduce fear of falling, South Carolina, 2006-2009. Prev Chronic Dis. 2012;9:E103. https://doi.org/10.5888/pcd9.110093.
Paul SS, Li Q, Harvey L, Carroll T, Priddis A, Tiedemann A, et al. Scale-up of the stepping on fall prevention program amongst older adults in NSW: program reach and fall-related health service use. Health Promot J Austr. 2020. https://doi.org/10.1002/hpja.413.
Mahoney JE, Clemson L, Schlotthauer A, Mack KA, Shea T, Gobel V, et al. Modified Delphi Consensus to Suggest Key Elements of Stepping On Falls Prevention Program. Front Public Health. 2017;20(5):21. https://doi.org/10.3389/fpubh.2017.00021.
Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor K. The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial. J Am Geriatr Soc. 2004;52(9):1487–94. https://doi.org/10.1111/j.1532-5415.2004.52411.x.
Ory MG, Smith ML, Jiang L, Lee R, Chen S, Wilson AD, et al. Fall prevention in community settings: results from implementing stepping on in three states. Front Public Health. 2015;2:232. https://doi.org/10.3389/fpubh.2014.00232.
• Ford JH 2nd, Abramson B, Wise M, Dattalo M, Mahoney JE. Bringing Healthy Aging to Scale: A Randomized Trial of a Quality Improvement Intervention to Increase Adoption of Evidence-Based Health Promotion Programs by Community Partners. J Public Health Manag Pract. 2017;23(5):e17–24. https://doi.org/10.1097/PHH.0000000000000503Ford et al. compared the effectiveness of two community-based programs promoted by the Centers for Disease Control and Prevention: Stepping On and Chronic Disease Self-Management Program (CDSMP). A cluster-randomized control group design was implemented in sixteen rural Wisconsin counties. Rural counties were able to increase frequency of workshops and the number of older adults attending this dissemination study.
Mahoney JE, Gobel VL, Shea T, Janczewski J, Cech S, Clemson L. Improving Fidelity of Translation of the Stepping On Falls Prevention Program through Root Cause Analysis. Front Public Health. 2016;14(4):251. https://doi.org/10.3389/fpubh.2016.00251.
Stay Active and Independent for Life. Washington State Department of Health website. https://www.doh.wa.gov/YouandYourFamily/InjuryandViolencePrevention/OlderAdultFalls/StayActiveandIndependentforLifeSAIL Accessed November 1, 2020.
Shumway-Cook A, Silver IF, LeMier M, York S, Cummings P, Koepsell TD. Effectiveness of a community-based multifactorial intervention on falls and fall risk factors in community-living older adults: a randomized, controlled trial. J Gerontol A Biol Sci Med Sci. 2007;62(12):1420–7. https://doi.org/10.1093/gerona/62.12.1420.
Bohannon RW. Reference values for the timed up and go test: a descriptive meta-analysis. J Geriatr Phys Ther. 2006;29(2):64–8. https://doi.org/10.1519/00139143-200608000-0000.
Vincenzo JL, Patton SK. Older Adults' experience with fall prevention recommendations derived from the STEADI [published online ahead of print, 2019 Jul 27]. Health Promot Pract. 2019;22:236–47. https://doi.org/10.1177/1524839919861967.
Pope J, Helwig K, Morrison S, Estep A, Caswell S, Ambegaonkar J, et al. Multifactorial exercise and dance-based interventions are effective in reducing falls risk in community-dwelling older adults: a comparison study. Gait Posture. 2019;70:370–5. https://doi.org/10.1016/j.gaitpost.2019.03.030.
York SC, Shumway-Cook A, Silver IF, Morrison AC. A translational research evaluation of the stay active and independent for life (SAIL) community-based fall prevention exercise and education program. Health Promot Pract. 2011;12(6):832–9. https://doi.org/10.1177/1524839910375026.
Muniak J, Swan L, Verrier PC. Enhanced SAIL program: evaluation of an evidence-based fall prevention program for community elders. Phys Occup Ther Geriatr. 2019;37(1):1–9.
Program Information. Tai Ji Quan: Moving for Better Balance. https://tjqmbb.org/index.php/program-information/ Accessed November 1, 2020.
Li F.. Class Teaching Guide; Tai Ji Quan: Moving for Better Balance. Oregon Research Institute, Version 3.1;2016.
• Li F, Harmer P, Fitzgerald K, Eckstrom E, Akers L, Chou LS, et al. Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling: A Randomized Clinical Trial. JAMA Intern Med. 2018;178(10):1301–10. https://doi.org/10.1001/jamainternmed.2018.3915Li et al. conducted a randomized control trial to examine the effectiveness of implementing tai Ji Quan: moving for better balance (TJQMBB) in comparison to a multimodal exercise and stretching program. The incidence of falls in the TJQMBB group was significantly less than both the stretching and multimodal exercise groups. The TJQMBB and multimodal arms demonstrated greater physical performance outcomes than the stretching group.
Li F, Harmer P, Eckstrom E, Fitzgerald K, Chou LS, Liu Y. Effectiveness of tai Ji Quan vs multimodal and stretching exercise interventions for reducing injurious falls in older adults at high risk of falling: follow-up analysis of a randomized clinical trial. JAMA Netw Open. 2019;2(2):e188280. https://doi.org/10.1001/jamanetworkopen.2018.8280.
Jones DL, Starcher RW, Eicher JL, Wilcox S. Adoption of a tai chi intervention, tai Ji Quan: moving for better balance, for fall prevention by rural faith-based organizations, 2013-2014. Prev Chronic Dis. 2016;13:E92. https://doi.org/10.5888/pcd13.160083.
What is EnhanceFitness? EnhanceFitness. https://projectenhance.org/enhancefitness/ Retrieved November 1, 2020.
Petrescu-Prahova MG, Eagen TJ, Fishleder SL, Belza B. Enhance®fitness dissemination and implementation,: 2010-2015: a scoping review. Am J Prev Med. 2017;52(3 Suppl 3):S295–9. https://doi.org/10.1016/j.amepre.2016.08.015.
Belza B, Shumway-Cook A, Phelan EA, Williams B, Snyder SJ, LoGerfo JP. The effects of a community-based exercise program on function and health in older adults: the EnhanceFitness program. J Appl Gerontol. 2006;25(4):291–306. https://doi.org/10.1177/0733464806290934.
Fishleder S, Petrescu-Prahova M, Harris JR, Leroux B, Bennett K, Helfrich CD, et al. Predictors of improvement in physical function in older adults in an evidence-based physical activity program (EnhanceFitness). J Geriatr Phys Ther. 2019;42(4):230–42. https://doi.org/10.1519/JPT.0000000000000202.
Batra A, Palmer RC, Bastida E, McCoy HV, Khan HMR. Determining the long-term effectiveness of a group-based physical activity program. Health Promot Pract. 2019;20(3):401–8. https://doi.org/10.1177/1524839918769590.
Agmon M, Kelly VE, Logsdon RG, Nguyen H, Belza B. The effects of EnhanceFitness (EF) training on dual-task walking in older adults. J Appl Gerontol. 2015;34(3):NP128–42. https://doi.org/10.1177/0733464812465921.
Smith ML, Lorino AJ, Wilson AD, Pollet C, Ory MG. Reaching at-risk populations to improve clinical measures of physical activity: delivery of EnhanceFitness to low-income African American adults in Houston, Texas. Texas Public Health J. 2011;63(1):50–3.
Robertson AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ. 1997;315:1065–9.
Robertson MC, Campbell AJ, Gardner MM, Devlin N. Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. JAGS. 2002;50:905–11.
Shubert TE, Smith ML, Goto L, Jiang L, Ory MG. Otago exercise program in the United States: comparison of 2 implementation models. Phys Ther. 2017;97(2):187–97. https://doi.org/10.2522/ptj.20160236.
Shubert TE, Smith ML, Jiang L, Ory MG. Disseminating the Otago exercise program in the United States: perceived and actual physical performance improvements from participants. J Appl Gerontol. 2018;37(1):79–98. https://doi.org/10.1177/0733464816675422.
Kyrdalen IL, Moen K, Røysland AS, Helbostad JL. The Otago exercise program performed as group training versus home training in fall-prone older people: a randomized controlled trial. Physiother Res Int. 2014;19(2):108–16. https://doi.org/10.1002/pri.1571.
Healthy Steps for Older Adults. Pennsylvania Department of Aging. https://www.aging.pa.gov/aging-services/health-wellness/Healthy%20StepsFallPrevention/Pages/default.aspx Retrieved November 1, 2020.
Albert SM, Edelstein O, King J, Flatt J, Lin CJ, Boudreau R, et al. Assessing the quality of a non-randomized pragmatic trial for primary prevention of falls among older adults. Prev Sci. 2015;16(1):31–40. https://doi.org/10.1007/s11121-014-0466-2.
Albert SM, King J, Boudreau R, Prasad T, Lin CJ, Newman AB. Primary prevention of falls: effectiveness of a statewide program. Am J Public Health. 2014;104(5):e77–84. https://doi.org/10.2105/AJPH.2013.301829.
Albert SM, Raviotta J, Lin CJ, Edelstein O, Smith KJ. Cost-effectiveness of a statewide falls prevention program in Pennsylvania: healthy steps for older adults. Am J Manag Care. 2016;22(10):638–44.
Ascherio A, Schwarzschild MA. The epidemiology of Parkinson's disease: risk factors and prevention. Lancet Neurol. 2016;15(12):1257–72. https://doi.org/10.1016/S1474-4422(16)30230-7.
Tomlinson CL, Herd CP, Clarke CE, Meek C, Patel S, Stowe R, et al. Physiotherapy for Parkinson's disease: a comparison of techniques. Cochrane Database Syst Rev. 2014;6:CD002815. https://doi.org/10.1002/14651858.CD002815.pub2.
Alves Da Rocha P, McClelland J, Morris ME. Complementary physical therapies for movement disorders in Parkinson's disease: a systematic review. Eur J Phys Rehabil Med. 2015;51(6):693–704 Epub 2015 Jul 3.
MacCosham B, Webb E, Oey J, Gravelle F. A qualitative phenomenological exploration of the experiences of individuals with Parkinson’s disease engaged in a boxing program. Qual Rep. 2019;24(6):1460–77.
Rock Steady Boxing. https://www.rocksteadyboxing.org/about/ Retrieved November 1, 2020.
Combs SA, Diehl MD, Staples WH, Conn L, Davis K, Lewis N, et al. Boxing training for patients with Parkinson disease: a case series. Phys Ther. 2011;91(1):132–42. https://doi.org/10.2522/ptj.20100142.
Combs SA, Diehl MD, Chrzastowski C, Didrick N, McCoin B, Mox N, et al. Community-based group exercise for persons with Parkinson disease: a randomized control trial. NeuroRehabil. 2013;32:117–25. https://doi.org/10.3233/NRE-130828.
• Morris ME, Ellis TD, Jazayeri D, et al. Boxing for Parkinson’s disease: Has implementation accelerated beyond current evidence? Front Neurol. 2019;10:1–10. https://doi.org/10.3389/fneur.2019.01222Morris et al. performed a systematic review to examine the evidence on the effectiveness of boxing interventions in patients with Parkinson’s Disease (PD). Eight different databases were searched, and 1390 articles were initially screened. After the exclusion process, two articles were included: one case study and one randomized control trial. There was a total of 37 participants that attended 24–36 boxing sessions over a 12-week period. The authors concluded there was a moderately large effect for gait endurance and relatively large effect for balance confidence, however multiple methodologic limitations precluded summative conclusions.
Gafner SC, Bastiaenen CH, Ferrari S, Gold G, Terrier P, Hilfiker R, et al. Hip muscle and hand-grip strength to differentiate between older fallers and non-fallers: a cross-sectional validity study. Clin Interv Aging. 2017;21(13):1–8. https://doi.org/10.2147/CIA.S146834.
Donoghue OA, Savva GM, Börsch-Supan A, Kenny RA. Reliability, measurement error and minimum detectable change in mobility measures: a cohort study of community-dwelling adults aged 50 years and over in Ireland. BMJ Open. 2019;9(11):e030475. https://doi.org/10.1136/bmjopen-2019-030475.
A Matter of Balance https://www.ncoa.org/healthy-aging/falls-prevention/falls-prevention-programs-for-older-adults-2/
Stepping On https://www.steppingon.com/
Stay Active and Independent for Life (SAIL) https://www.doh.wa.gov/YouandYourFamily/InjuryandViolencePrevention/OlderAdultFalls/StayActiveandIndependentforLifeSAIL
EnhanceFitness https://projectenhance.org/enhancefitness/
Otago Exercise Program https://healthyagingnc.com/healthy-aging-programs/the-otago-exercise-program/
Tai Ji Quan for Better Balance https://tjqmbb.org/
Healthy Steps for Older Adults https://www.aging.pa.gov/aging-services/health-wellness/Healthy%20StepsFallPrevention/Pages/default.aspx
Rock Steady Boxing https://www.rocksteadyboxing.org/