Advertisement

The Efficacy of a Multidisciplinary Falls Prevention Clinic With an Extended Step-Down Community Program

      Abstract

      Sze P-C, Cheung W-H, Lam P-S, Lo HS-D, Leung K-S, Chan T. The efficacy of a multidisciplinary falls prevention clinic with an extended step-down community program.

      Objective

      To investigate the efficacy of a falls prevention clinic and a community step-down program in reducing the number of falls among community-dwelling elderly at high risk of fall.

      Design

      Prospective cohort.

      Setting

      Community.

      Participants

      Community-dwelling elderly (N=200) were screened for risk of fall; 60 were identified as being at high risk and were referred to the intervention program.

      Intervention

      Twelve sessions of a once-a-week falls prevention clinic, including fall evaluation, balance training, home hazard management program, and medical referrals, were provided in the first 3 months. The community step-down program, including falls prevention education, a weekly exercise class, and 2 home visitations, was provided in the following 9 months.

      Main Outcome Measures

      Fall rate, injurious fall, and its associated medical consultation were recorded during the intervention period and the year before intervention. Balance tests included the Berg Balance Scale (BBS), Sensory Organization Test, and limits of stability test; fear of falling, as evaluated using the Activities-specific Balance Confidence (ABC) scale, was measured at baseline and after the training in the falls prevention clinic.

      Results

      Significant reductions in fall rate (74%), injurious falls (43%), and fall-associated medical consultation (47%) were noted. Significant improvement in balance scores (BBS, P<.001; endpoint excursion in limits of stability test, P=.004) and fear of falling (ABC scale, P=.001) was shown.

      Conclusions

      The programs in the falls prevention clinic were effective in reducing the number of falls and injurious falls. The community step-down programs were crucial in maintaining the intervention effects of the falls prevention clinic.

      Key Words

      List of Abbreviations:

      ABC (Activities-specific Balance Confidence), BBS (Berg Balance Scale), PPA (Physiological Profile Assessment), SOT (Sensory Organization Test)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chu L.W.
        • Chi I.
        • Chiu A.Y.
        Incidence and predictors of falls in the Chinese elderly.
        Ann Acad Med Singapore. 2005; 34: 60-72
        • Murray C.L.
        • Lopez A.D.
        Murray C.J. Lopez A.D. Global and regional descriptive epidemiology of disability: incidence, prevalence, health expectation and years lived with disability The global burden of disease. Harvard Univ Pr, Boston1996: 201-246
        • Lam P.S.
        • Lam T.P.
        • Lui P.P.
        • Leung K.S.
        Fall-related injuries in the elderly population: a study of 3105 cases seen at a regional hospital.
        HK J Orthop Surg. 2005; 9 ([abstract]): 67
        • Qin L.
        • Choy W.
        • Leung K.
        • et al.
        Beneficial effects of regular Tai Chi exercise on musculoskeletal system.
        J Bone Miner Metab. 2005; 23: 186-190
        • Gillespie L.D.
        • Gillespie W.J.
        • Robertson M.C.
        • Lamb S.E.
        • Cumming R.G.
        • Rowe B.H.
        Interventions for preventing falls in elderly people.
        Cochrane Database Syst Rev. 2003; (CD000340)
        • American Geriatrics Society
        • British Geriatrics Society
        • American Academy of Orthopaedic Surgeons Panel on Falls Prevention
        Guideline for the prevention of falls in older persons.
        J Am Geriatr Soc. 2001; 49: 664-672
        • Perell K.L.
        • Manzano M.L.
        • Weaver R.
        • et al.
        Outcomes of a consult fall prevention screening clinic.
        Am J Phys Med Rehabil. 2006; 85: 882-888
        • Puisieux F.
        • Pollez B.
        • Deplanque D.
        • et al.
        Successes and setbacks of the falls consultation: report on the first 150 patients.
        Am J Phys Med Rehabil. 2001; 80: 909-915
        • Houghton S.
        • Birks V.
        • Whitehead C.H.
        • Crotty M.
        Experience of a falls and injuries risk assessment clinic.
        Aust Health Rev. 2004; 28: 374-381
        • Sze P.C.
        • Lam P.S.
        • Chan J.
        • Leung K.S.
        A primary prevention programme for older people in Hong Kong.
        Br J Comm Nurs. 2005; 10: 166-171
        • Lord S.R.
        • Menz H.B.
        • Tiedemann A.
        A physiological profile approach to falls risk assessment and prevention.
        Phys Ther. 2003; 83: 237-252
        • Buchner D.M.
        • Hornbrook M.C.
        • Kutner N.G.
        • et al.
        Development of the common data base for the FICSIT trials.
        J Am Geriatr Soc. 1993; 41: 297-308
        • Berg K.O.
        • Wood-Dauphinee S.L.
        • Williams J.I.
        • Maki B.
        Measuring balance in the elderly: preliminary development of an instrument.
        Physiother Can. 1989; 41: 304-311
        • Chiu A.Y.
        • Au-Yeung S.S.
        • Lo S.K.
        A comparison of four functional tests in discriminating fallers from non-fallers in older people.
        Disabil Rehabil. 2003; 25: 145-150
        • Wallmann H.W.
        Comparison of elderly nonfallers and fallers on performance measures of functional reach, sensory organization, and limits of stability.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M580-M583
        • Cheung W.H.
        • Mok H.W.
        • Qin L.
        • Sze P.C.
        • Lee K.M.
        • Leung K.S.
        High-frequency whole-body vibration improves balancing ability in elderly women.
        Arch Phys Med Rehabil. 2007; 88: 852-857
        • Cohen H.
        • Heaton L.G.
        • Congdon S.L.
        • Jenkins H.A.
        Changes in sensory organization test scores with age.
        Age Ageing. 1996; 25: 39-44
        • Powell L.E.
        • Myers A.M.
        The Activities-specific Balance Confidence (ABC) Scale.
        J Gerontol A Biol Sci Med Sci. 1995; 50: M28-M34
        • Tinetti M.E.
        • Baker D.I.
        • 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
        • Schoenfelder D.P.
        • Why K.V.
        A fall prevention educational program for community dwelling seniors.
        Public Health Nurs. 1997; 14: 383-390
        • Cumming R.G.
        • Thomas M.
        • Szonyi G.
        • et al.
        Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention.
        J Am Geriatr Soc. 1999; 47: 1397-1402
        • Fortinsky R.H.
        • Iannuzzi-Sucich M.
        • Baker D.I.
        • et al.
        Fall-risk assessment and management in clinical practice: view from healthcare providers.
        J Am Geriatr Soc. 2004; 52: 1522-1526
        • Campbell A.J.
        • Robertson M.C.
        • Gardner M.M.
        • Norton R.N.
        • Buchner D.M.
        Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized controlled trial.
        J Am Geriatr Soc. 1999; 47: 850-853
        • van Haastregt J.C.
        • Diederiks J.P.
        • van Rossum E.
        • de Witte L.P.
        • Voorhoeve P.M.
        • Crebolder H.F.
        Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial.
        BMJ. 2000; 321: 994-998
        • Lord S.R.
        • Clark R.D.
        • Webster I.W.
        Physiological factors associated with falls in an elderly population.
        J Am Geriatr Soc. 1991; 39: 1194-1200