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THE STEPS TO AVOID FALLS IN THE ELDERLY (SAFE) STUDY

ABSTRACT: Abstract A multi-center, two arm, parallel group, randomized controlled trial: study participants were screened, assessed for risk factors and randomized (control or intervention) based on the SPPB score at baseline. High-risk participants (SPPB less or equal 6) were given a home-based exercise program up to 12 sessions (3 times per week) that specifically targets and modifies impairments that interfere with engaging in exercise in a group setting. When the high-risk participants attained SPPB > 6, they transitioned to a community-based group exercise program and continued until the end of active intervention phase. Low-to-moderate risk patients (SPPB > 6) were directly enrolled into an evidence-based one-hour group exercise program, which was offered up to 24 sessions with free transportation (2 times a week). The primary outcome measure was the number of fallers at the end of the nine-month study period. All analyses performed were on an intention-to-treat basis. Between December 2012 and July 2014, 354 patients who were at least 65 years old and visited the Emergency Department for falls or fall-related injuries were recruited (177 participants in each group). At the end of the nine-month follow-up period, 37.9% of the control group and 30.5% of the intervention group fell at least once. The intervention program significantly reduced the number of fallers adjusting for critical comorbidities (odds ratio 0.33 [0.15 – 0.74], p=0.004). We also observed that the intervention group had a lower proportion of individuals with injurious falls and significantly less reduction in physical performance by SPPB. No adverse events were reported during the study period. The SAFE study showed that screening, risk modification and intensive, consistent and progressive physical therapy can effectively reduce the number of fallers and injurious falls. This study is registered with the U.S. Clinical Trials Registry, number NCT01713543 and was funded by Ministry of Health Singapore under its Health Services Research Competitive Research Grant (Grant Number: HSRG10MAY002).

SUBMITTER: Matchar D

PROVIDER: S-EPMC6243733 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND: Explicit criteria for determining potentially inappropriate medication consumption in elderly were elaborated by Beers et al. These lists have been used worldwide to evaluate medical prescriptions but there is little epidemiologic evidence demonstrating negative consequences of inappropriate medication use. It has been reported that some drugs could increase the risk of falls, which are a frequent and serious problem in elderly population. We aimed to evaluate the association between the use of potentially inappropriate medications and the risk of falls. METHODS: The 3C Study is a multicentre prospective cohort study conducted in France with 4 years of follow-up. Non-institutionalized men and women aged 65 years or over (N = 6343) were randomly selected from electoral rolls. Data on socio-demographic, medical characteristics and medication use (based on self-reports and data from the national healthcare insurance) were collected. Use of inappropriate medication for elderly was defined from established criteria. Data about falls were collected at the two follow-up examinations (2 years and 4 years after baseline). The association between the exposure to inappropriate medications and the risk of falls was evaluated using multivariate models (Cox model and logistic regression). RESULTS: 32% of subjects reported inappropriate medication use at baseline and 29% at least two of the three examinations; 22% had fallen 2 times or more during follow-up. Overall, inappropriate medication users had an increased risk of falling. This increase was mainly due to the use of long-acting benzodiazepines (adjusted odds ratio (OR) = 1.4, 95% confidence interval: [1.1-1.8], in both occasional and regular users), other inappropriate psychotropics (adjusted OR = 1.7 [1.7-2.7] in regular users), or medication with anticholinergic properties (adjusted OR = 1.6 [1.2-2.1] in regular users). Neither occasional, nor regular use of short- or intermediate-acting benzodiazepines was associated with an increased risk of falling. Further analysis in long-acting benzodiazepines users did not show any dose-effect relation between the number of prescriptions filled over a 3-year period and the risk of falling. CONCLUSION: Our study showed that use of inappropriate medications was associated with an increased risk of falling in elderly persons. This increase was mainly due to long-acting benzodiazepines and other inappropriate psychotropics, and to medications with anticholinergic properties.

Project description:BackgroundFalls may cause serious health conditions among older population. Fall-related physical factors are thought to be associated with occlusal conditions. However, few studies examined the relationship between occlusal force and falls. To identify the association between occlusal force and falls among community-dwelling elderly individuals in Japan, public health nurses conducted a cross-sectional descriptive study.MethodsWe performed extensive physical assessments of five items: maximum occlusal force, handgrip strength, maximal knee extensor strength, one-leg standing time with eyes open and body sway. We also conducted a questionnaire survey concerning the participants' demographic characteristics, health status and fall experience during the past year. Mean scores and standard deviations were calculated for age and the total points of the index of activities of daily living. Associations were examined using Mann-Whitney tests and logistic regression.ResultsWe examined 159 community-dwelling people aged ≥65 years, who were independent and active, including 38 participants (24.5%) with experience of falls in the past year. Maximum occlusal force had significant correlation with handgrip strength, maximal knee extensor strength, and one-leg standing time and body sway (P < .05, respectively). We found weak associations between participants with and without a history of falls in terms of the five physical measurements. Logistic regression analysis showed that fall experience was significantly associated with maximum occlusal force (P = 0.004).ConclusionsThis is the first study, led by public health nursing researchers, to examine the associations between maximum occlusal force and falls among community-dwelling elderly in Japan. The results showed that maximum occlusal force was significantly related to the other four extensive physical assessments, and might also suggest that maximum occlusal force assessment by public health nurses could contribute to more sophisticated and precise prediction of fall risks among the community-dwelling elderly. The latest occlusal force measurement device is non-invasive and easy to use. Public health nurses can introduce it at periodical community health checkup assembly events, which might contribute to raising awareness among community-dwelling elderly individuals and public health nurses about fall prevention and prediction.

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THE STEPS TO AVOID FALLS IN THE ELDERLY (SAFE) STUDY

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