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Falls prevention interventions for community-dwelling older persons with cognitive impairment: a systematic review

Published online by Cambridge University Press:  09 October 2012

Heidi Winter ,
Kerrianne Watt  and
Nancye May Peel
Heidi Winter
Affiliation:
School of Population Health, The University of Queensland, Herston, Queensland 4006, Australia
Kerrianne Watt
Affiliation:
School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland 4811, Australia
Nancye May Peel*
Affiliation:
Centre for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Woolloongabba, Queensland 4102, Australia
*
Correspondence should be addressed to: Dr. Nancye May Peel, Research Fellow, Centre for Research in Geriatric Medicine, The University of Queensland School of Medicine, Level 2, Building 33, Princess Alexandra Hospital, Woolloongabba QLD 4102, Australia. Phone: +61-7-3176-7402; Fax: +61-7-3176-6945. Email: n.peel@uq.edu.au.
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Abstract

Background: Globally, falls in older people are a leading cause of injury-related mortality and morbidity. Cognitive impairment is a well-known risk factor for falls in this population group. While there is now a large body of evidence to support effective interventions for falls reduction across care settings, very little is known about interventions in the vulnerable, but increasing population of cognitively impaired community-dwelling older people. Therefore, the purpose of this systematic review is to investigate interventions designed to reduce falls in community-dwelling, cognitively impaired older adults.

Methods: A literature search of databases was conducted to identify original research published in English, which met predefined inclusion and exclusion criteria for effective (non-pharmacological) falls prevention interventions in cognitively impaired community-dwelling people over 65 years of age. Data from the selected papers were extracted into data extraction tables and analyzed according to study characteristics, measures, results, and quality.

Results: The review identified 11 studies providing data from 1,928 participants. Interventions included exercise, health assessment and management of risk, multi-component and cognitive behavioral programs, and hip protectors as falls risk reduction strategies. Seven of the selected studies showed an intervention effect in decreasing falls risk; however, only two of these showed a significant improvement in physical performance measures specifically in a cognitively impaired group.

Conclusions: The diversity of interventions, study designs, populations, and quality of the studies, which met inclusion criteria, resulted in conflicting evidence and inconclusive results for falls prevention interventions in this highly complex population.

Keywords

accidental fallsprevention and controlcognition disorderscommunity setting

Information

Type
Review Article
Information
International Psychogeriatrics , Volume 25 , Issue 2 , February 2013 , pp. 215 - 227
Copyright
Copyright © International Psychogeriatric Association 2012

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References

Anstey, K. J., von Sanden, C. and Luszcz, M. A. (2006). 8-year prospective study of the relationship between cognitive performance and falling in very old adults. Journal of the American Geriatrics Society, 54, 1169–1176. doi:10.1111/j.1532-5415.2006.00813.x.CrossRefGoogle ScholarPubMed
Australian Institute of Health and Welfare (2007). Older Australia at a Glance. Canberra, Australia: AIHW.Google Scholar
Braun, M., Scholz, U., Bailey, B., Perren, S., Hornung, R. and Martin, M. (2009). Dementia caregiving in spousal relationships: a dyadic perspective. Aging and Mental Health, 13, 426–436. doi:10.1080/13607860902879441.CrossRefGoogle ScholarPubMed
Cameron, I. D.et al. (2010). Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database of Systematic Reviews, CD005465. doi:10.1002/14651858.CD005465.pub2.Google ScholarPubMed
Ferri, C. P.et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117. doi:10.1016/S0140-6736(05)67889-0.CrossRefGoogle ScholarPubMed
Folstein, M., Folstein, S. and McHugh, P. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Gillespie, L. D.et al. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, CD007146. doi:10.1002/14651858.CD007146.pub2.Google ScholarPubMed
Gleason, C. E., Gangnon, R. E., Fischer, B. L. and Mahoney, J. E. (2009). Increased risk for falling associated with subtle cognitive impairment: secondary analysis of a randomized clinical trial. Dementia and Geriatric Cognitive Disorders, 27, 557–563. doi:10.1159/000228257.CrossRefGoogle ScholarPubMed
Grimes, D. A. and Schulz, K. F. (2002). Bias and causal associations in observational research. Lancet, 359, 248–252. doi:10.1016/S0140-6736(02)07451-2.CrossRefGoogle ScholarPubMed
Hageman, P. A. and Thomas, V. S. (2002). Gait performance in dementia: the effects of a 6-week resistance training program in an adult day-care setting. International Journal of Geriatric Psychiatry, 17, 329–334. doi:10.1002/gps.597.CrossRefGoogle Scholar
Hauer, K., Becker, C., Lindemann, U. and Beyer, N. (2006). Effectiveness of physical training on motor performance and fall prevention in cognitively impaired older persons: a systematic review. American Journal of Physical Medicine and Rehabilitation, 85, 847–857. doi:10.1097/01.phm.0000228539.99682.32.CrossRefGoogle ScholarPubMed
Hernandez, S. S., Coelho, F. G., Gobbi, S. and Stella, F. (2010). Effects of physical activity on cognitive functions, balance and risk of falls in elderly patients with Alzheimer's dementia. Revista Brasileira de Fisioterapia, 14, 68–74. doi:S1413–35552010000100011 [pii].CrossRefGoogle ScholarPubMed
Huang, H. C., Lee, C. H. and Wu, S. L. (2006). Hip protectors: a pilot study of older people in Taiwan. Journal of Clinical Nursing, 15, 436–443. doi:10.1111/j.1365-2702.2006.01346.x.CrossRefGoogle ScholarPubMed
Huger, D., Zieschang, T., Schwenk, M., Oster, P., Becker, C. and Hauer, K. (2009). Designing studies on the effectiveness of physical training in patients with cognitive impairment. Zeitschrift fur Gerontologie und Geriatrie, 42, 11–19. doi:10.1007/s00391-008-0529-8.Google ScholarPubMed
Leung, A. Y., Lou, V. W., Kin Sun, C., Yung, A. and Chi, I. (2010). Care management service and falls prevention: a case-control study in a Chinese population. Journal of Aging and Health, 22, 348–361. doi:10.1177/0898264309358764.CrossRefGoogle ScholarPubMed
Lightbody, E., Watkins, C., Leathley, M., Sharma, A. and Lye, M. (2002). Evaluation of a nurse-led falls prevention programme versus usual care: a randomized controlled trial. Age and Ageing, 31, 203–210.CrossRefGoogle ScholarPubMed
Lin, M. R., Wolf, S. L., Hwang, H. F., Gong, S. Y. and Chen, C. Y. (2007). A randomized, controlled trial of fall prevention programs and quality of life in older fallers. Journal of the American Geriatrics Society, 55, 499–506. doi:10.1111/j.1532-5415.2007.01146.x.CrossRefGoogle ScholarPubMed
Mackintosh, S. F. and Sheppard, L. A. (2005). A pilot falls-prevention programme for older people with dementia from a predominantly Italian background. Hong Kong Physiotherapy Journal, 23, 20–26. doi:10.1016/s1013-7025(09)70055-7.CrossRefGoogle Scholar
Newbury, J. W., Marley, J. E. and Beilby, J. J. (2001). A randomised controlled trial of the outcome of health assessment of people aged 75 years and over. Medical Journal of Australia, 175, 104–107.CrossRefGoogle ScholarPubMed
Oliver, D.et al. (2007). Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. British Medical Journal, 334, 82. doi:10.1136/bmj.39049.706493.55.CrossRefGoogle ScholarPubMed
Peel, N. M. (2000). Validating recall of falls by older people. Accident Analysis and Prevention, 32, 371–372.CrossRefGoogle ScholarPubMed
Peel, N. M. (2011). Epidemiology of falls in older age. Canadian Journal on Aging, 30, 7–19. doi:10.1017/S071498081000070X.CrossRefGoogle ScholarPubMed
Peel, N. M. and Wilson, C. (2008). Frail older people as participants in research. Educational Gerontology, 34, 407–417. doi:10.1080/03601270701835973.CrossRefGoogle Scholar
Plassman, B. L.et al. (2008). Prevalence of cognitive impairment without dementia in the United States. Annals of Internal Medicine, 148, 427–434.CrossRefGoogle ScholarPubMed
Rait, G.et al. (2005). Prevalence of cognitive impairment: results from the MRC trial of assessment and management of older people in the community. Age and Ageing, 34, 242–248. doi:10.1093/ageing/afi039.CrossRefGoogle ScholarPubMed
Segev-Jacubovski, O., Herman, T., Yogev-Seligmann, G., Mirelman, A., Giladi, N. and Hausdorff, J. M. (2011). The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk? Expert Review of Neurotherapeutics, 11, 1057–1075. doi:10.1586/ern.11.69.CrossRefGoogle ScholarPubMed
Shaw, F. E. (2002). Falls in cognitive impairment and dementia. Clinics in Geriatric Medicine, 18, 159–173.CrossRefGoogle ScholarPubMed
Shaw, F. E. (2007). Prevention of falls in older people with dementia. Journal of Neural Transmission, 114, 1259–1264. doi:10.1007/s00702-007-0741-5.CrossRefGoogle ScholarPubMed
Shaw, F. E.et al. (2003). Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. British Medical Journal, 326, 73–75. doi:10.1136/bmj.326.7380.73.CrossRefGoogle Scholar
Sherrington, C., Tiedemann, A., Fairhall, N., Close, J. C. and Lord, S. R. (2011). Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. New South Wales Public Health Bulletin, 22, 78–83. doi:10.1071/NB10056.CrossRefGoogle ScholarPubMed
World Health Organization (2007). WHO Global Report on Falls Prevention in Older Age. Geneva, Switzerland: WHO.Google Scholar
Yao, L., Giordani, B. and Alexander, N. B. (2008). Developing a positive emotion-motivated Tai Chi (PEM-TC) exercise program for older adults with dementia. Research and Theory for Nursing Practice, 22, 241–255.CrossRefGoogle ScholarPubMed
Zaza, S.et al. (2000). Data collection instrument and procedure for systematic reviews in the guide to community preventive services. Task Force on Community Preventive Services. American Journal of Preventive Medicine, 18, 44–74.CrossRefGoogle Scholar
Zijlstra, G. A.et al. (2009). Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: results of a randomized controlled trial. Journal of the American Geriatrics Society, 57, 2020–2028. doi:10.1111/j.1532-5415.2009.02489.x.CrossRefGoogle ScholarPubMed