Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 8 , Pages 1317-1324 , August 2009

Reducing Risk of Falling in Older People Discharged From Hospital: A Randomized Controlled Trial Comparing Seated Exercises, Weight-Bearing Exercises, and Social Visits

Presented to the Australia New Zealand Society for Geriatric Medicine, September 9, 2008, Melbourne, Australia.

  • Constance M. Vogler, MBBS, FRACP, PhD

      Affiliations

    • Department of Aged Care and Rehabilitation, Royal North Shore Hospital, University of Sydney, Sydney, Australia
    • Prince of Wales Medical Research Institute, University of New South Wales, Sydney, Australia
    • Corresponding Author InformationReprint requests to Constance Vogler, MBBS, FRACP, PhD, Dept of Aged Care and Rehabilitation, Royal North Shore Hospital, Sydney, Australia
  • ,
  • Catherine Sherrington, PhD

      Affiliations

    • George Institute for International Health, University of Sydney, Sydney, Australia
    • Prince of Wales Medical Research Institute, University of New South Wales, Sydney, Australia
  • ,
  • Susan J. Ogle, MBBS, FRACP

      Affiliations

    • Department of Aged Care and Rehabilitation, Royal North Shore Hospital, University of Sydney, Sydney, Australia
  • ,
  • Stephen R. Lord, PhD, DSc

      Affiliations

    • Prince of Wales Medical Research Institute, University of New South Wales, Sydney, Australia

References 

  1. Mahoney J, Sager M, Dunham NC, Johnson J. Risk of falls after hospital discharge. J Am Geriatr Soc. 1994;42:269–274
  2. Mahoney JE, Palta M, Johnson J, et al. Temporal association between hospitalization and rate of falls after discharge. Arch Intern Med. 2000;160:2788–2795
  3. Latham NK, Anderson CS, Lee A, et al. A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). J Am Geriatr Soc. 2003;51:291–299
  4. Campbell 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;315:1065–1069
  5. Barnett A, Smith B, Lord SR, Williams M, Baumand A. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Age Ageing. 2003;32:407–414
  6. Rooks DS, Kiel DP, Parsons C, Hayes WC. Self-paced resistance training and walking exercise in community-dwelling older adults: effects on neuromotor performance. J Gerontol A Biol Sci Med Sci. 1997;52:M161–M168
  7. Lindelof N, Littbrand H, Lindstrom B, Nyberg L. Weighted belt exercise for frail older women following hip fracture—a single subject design. Adv Physiother. 2002;4:54–64
  8. Alexander NB, Galecki AT, Grenier ML, et al. Task-specific resistance training to improve the ability of activities of daily living–impaired older adults to rise from a bed and from a chair. J Am Geriatr Soc. 2001;49:1418–1427
  9. Jessup JV, Horne C, Vishen RK, Wheeler D. Effects of exercise on bone density, balance, and self-efficacy in older women. Biol Res Nurs. 2003;4:171–180
  10. Bean JF, Herman S, Kiely DK, et al. Increased Velocity Exercise Specific to Task (InVEST) training: a pilot study exploring effects on leg power, balance, and mobility in community-dwelling older women. J Am Geriatr Soc. 2004;52:799–804
  11. Olivetti L, Schurr K, Sherrington C, et al. A novel weight-bearing strengthening program during rehabilitation of older people is feasible and improves standing up more than a non-weight-bearing strengthening program: a randomised trial. Aust J Physiother. 2007;53:147–153
  12. Christmas C, Andersen RA. Exercise and older patients: guidelines for the clinician. J Am Geriatr Soc. 2000;48:318–324
  13. Pollock ML, Franklin BA, Balady GJ, et al. AHA Science Advisory (Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: an advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association; Position paper endorsed by the American College of Sports Medicine). Circulation. 2000;101:828–833
  14. Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198
  15. Reece AC, Simpson JM. Preparing older people to cope after a fall. Physiotherapy. 1996;82:227–235
  16. Lord SR, Menz HB, Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Phys Ther. 2003;83:237–252
  17. Lord SR, Ward JA, Williams P. Exercise effect on dynamic stability in older women: a randomized controlled trial. Arch Phys Med Rehabil. 1996;77:232–236
  18. Lord SR, Ward JA, Williams P, Anstey KJ. Physiological factors associated with falls in older community-dwelling women. J Am Geriatr Soc. 1994;42:1110–1117
  19. Tiedemann A, Shimada H, Sherrington C, Murray S, Lord S. The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Age Ageing. 2008;37:430–435
  20. Lord SR, Clark RD, Webster IW. Visual acuity and contrast sensitivity in relation to falls in an elderly population. Age Ageing. 1991;20:175–181
  21. Haymes SA, Chen J. Reliability and validity of the Melbourne Edge Test and High/Low Contrast Visual Acuity chart. Optom Vis Sci. 2004;81:308–316
  22. Lord SR, Fitzpatrick RC. Choice stepping reaction time: a composite measure of falls risk in older people. J Gerontol A Biol Sci Med Sci. 2001;56:M627–M632
  23. Sturnieks DL, Tiedemann A, Chapman K, Munro B, Murray SM, Lord SR. Physiological risk factors for falls in older people with lower limb arthritis. J Rheumatol. 2004;31:2272–2279
  24. Menz HB, Lord SR. The contribution of foot problems to mobility impairment and falls in community-dwelling older people. J Am Geriatr Soc. 2001;49:1651–1656
  25. Hill KD, Bernhardt J, McGann AM, Maltese D, Berkovits D. A new test of dynamic standing balance for stroke patients: reliability, validity and comparison with healthy elderly. Physiother Can. 1996;48:257–262
  26. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–186
  27. Kurlowicz L. The Geriatric Depression Scale. J Gerontol Nurs. 1999;25:8–9
  28. Brooks R. EuroQol: the current state of play. Health Policy. 1996;37:53–72
  29. Hill KD, Schwarz JA, Kalogeropoulos AJ, Gibson SJ. Fear of falling revisited. Arch Phys Med Rehabil. 1996;77:1025–1029
  30. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–495
  31. Vickers AJ. Parametric versus non-parametric statistics in the analysis of randomized trials with non-normally distributed data. BMC Med Res Methodol. 2005;5:35
  32. Liu-Ambrose T, Khan KM, Eng JJ, Janssen PA, Lord SR, McKay HA. Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6-month randomized, controlled trial. J Am Geriatr Soc. 2004;52:657–665
  33. Lord SR, Ward JA, Williams P, Strudwick M. The effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial. J Am Geriatr Soc. 1995;43:1198–1206
  34. Shimada H, Obuchi S, Furuna T, Suzuki T. New intervention program for preventing falls among frail elderly people: the effects of perturbed walking exercise using a bilateral separated treadmill. Am J Phys Med Rehabil. 2004;83:493–499
  35. Wolfson L, Whipple R, Derby C, et al. Balance and strength training in older adults: intervention gains and tai chi maintenance. J Am Geriatr Soc. 1996;44:498–506
  36. Chandler JM, Duncan PW, Kochersberger G, Studenski S. Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders?. Arch Phys Med Rehabil. 1998;79:24–30
  37. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age Ageing. 1999;28:513–518
  38. Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994;331:821–827
  39. Anonymous. American College of Sports Medicine Position Stand (Exercise and physical activity for older adults). Med Sci Sports Exerc. 1998;30:992–1008
  40. Singh NA, Clements KM, Fiatarone MA. A randomized controlled trial of the effect of exercise on sleep. Sleep. 1997;20:95–101
  41. Singh NA, Clements KM, Fiatarone MA. A randomized controlled trial of progressive resistance training in depressed elders. J Gerontrol A Sci Med Sci. 1997;52:M27–M35
  42. Tinetti ME, Liu WL, Claus EB. Predictors and prognosis of inability to get up after falls among elderly persons. JAMA. 1993;269:65–70

 Supported by the National Health and Medical Research Council Prevention of Older People's Injuries Partnership in Injury; Good Age Trust; and the Geoff and Elaine Penney Research Trust at Royal North Shore Hospital.

 Sponsors had no role in the study design, recruitment, data collection, analysis, or preparation of this article.

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

 Australian New Zealand Clinical Trials Registry Number: ACTRN12605000335695.

PII: S0003-9993(09)00277-9

doi: 10.1016/j.apmr.2009.01.030

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 8 , Pages 1317-1324 , August 2009