Original article
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.
https://doi.org/10.1016/j.apmr.2009.01.030Get rights and content

Abstract

Vogler CM, Sherrington C, Ogle SJ, Lord SR. Reducing risk of falling in older people discharged from hospital: a randomized controlled trial comparing seated exercises, weight-bearing exercises, and social visits.

Objective

To compare the efficacy of seated exercises and weight-bearing (WB) exercises with social visits on fall risk factors in older people recently discharged from hospital.

Design

Twelve-week randomized, controlled trial.

Setting

Home-based exercises.

Participants

Subjects (N=180) aged 65 and older, recently discharged from hospital.

Interventions

Seated exercises (n=60), WB exercises (n=60), and social visits (n=60).

Main Outcome Measures

Primary outcome factors were Physiological Profile Assessment (PPA) fall risk score, and balance while standing (Coordinated Stability and Maximal Balance Range tests). Secondary outcomes included the component parts of the PPA and other physical and psychosocial measures.

Results

Subjects were tested at baseline and at completion of the intervention period. After 12 weeks of interventions, subjects in the WB exercise group had significantly better performance than the social visit group on the following: PPA score (P=.048), Coordinated Stability (P<.001), Maximal Balance Range (P=.019); body sway on floor with eyes closed (P=.017); and finger-press reaction time (P=.007) tests. The seated exercise group performed better than the social visit group in PPA score (P=.019) but for no other outcome factor. The seated exercise group had the highest rate of musculoskeletal soreness.

Conclusions

In older people recently discharged from the hospital, both exercise programs reduced fall risk score in older people. The WB exercises led to additional beneficial impacts for controlled leaning, reaction time, and caused less musculoskeletal soreness than the seated exercises.

Section snippets

Subjects and Recruitment

Inpatients from Aged Care and Rehabilitation, General Medicine and Orthopaedics Services, Royal North Shore and Hornsby Ku-ring-gai Hospitals, northern Sydney, Australia, were screened for eligibility by a geriatrician (C.M.V.) and approached regarding participation after leaving hospital. Eligible subjects were 65 years or older. Subjects were excluded if they had medical contraindications to exercise,12, 13 if they were cognitively impaired (Mini-Mental State Examination score <24 out of 3014

Baseline Data, Completion Rates Compliance, and Intervention Intensity

The mean age of the 180 study participants was 80±7 years (range, 65–95y), and 143 subjects (79%) were women. Table 1 provides a summary of the baseline demographics of the study population. Table 2 describes the range of diagnoses at hospital admission and corresponding lengths of stay.

When comparing the baseline results of the current study with those from the Randwick Falls and Fractures Study17, 18, 33 (a study of community-dwelling older women randomly recruited via electoral rolls in

Discussion

In this population of older people recently discharged from hospital, both SR and WB exercises greatly lowered the risk of falling, as indicated by reductions in PPA composite scores. The WB exercise intervention, however, showed additional benefits over SR in that it produced fewer musculoskeletal adverse advents and provided improvements in leaning balance measures that may afford additional protection against falling in this at-risk group.

PPA fall risk is designated mild if the score is

Conclusions

Our findings indicate that on the basis of PPA scores, in older people recently discharged from hospital, both seated and WB exercises can reduce the risk of falling. WB exercise, however, appears to provide additional improvements in leaning balance and results in fewer musculoskeletal adverse events.

Acknowledgments

We thank Lydia Au, MBBS, and Nihal Nanda, MBBS, who assisted with recruitment at Hornsby Ku-ring-gai Hospital. We also thank the research physical therapists: Susan Murray M. Gerontology, Dip.Remed.Gymnast.Recreat.Ther, Patricia Pamphlett, Dip.Phys, BA, Yoke-feng Woodley, B.Appl.Sci(Physio), Suzanne Herring, B.Appl.Sci(Physio), and Monica Adams, Dip.Phys, BA(Hons), and our research assistants, Marcella Kwan, BSc, MPH, and Anne Tiedemann, PhD.

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    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.

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