Academic journal article Generations

Results of Intervention Research: Implications for Practice

Academic journal article Generations

Results of Intervention Research: Implications for Practice

Article excerpt

Over the course of the past twenty years, researchers have investigated the efficacy of a number of different intervention strategies designed to reduce the risk factors that contribute to falls, and the actual incidence of falls and fall-related injuries in the older adult population. These different types of strategies have been implemented with different target populations (e.g., healthy and frail community-residing older adults, frail nursing-home residents) and in a variety of settings (e.g., long-term-care facilities, community centers, hospitals, homes). Although the efficacy of a number of different intervention strategies has been investigated, this article will focus on three intervention strategies that have been proven to be the most effective in reducing fall incidence rates and fall-related injuries among the older adult population. These strategies are (1) exercise-based interventions (targeted and nontargeted), (2) environmental modifications, and (3) multifactorial risk-factor assessment and abatement strategies (e.g., Gillespie et al., 2002).

Other intervention strategies that have been investigated but will not be discussed here include injury minimalization aids such as hip protectors and assistive devices, health promotion and education, cognitive and behavioral interventions, medication withdrawal or adjustment, nutritional and vitamin supplementation, and hormonal and other pharmacological therapies.

EXERCISE INTERVENTIONS

The role of exercise as a method of reducing fall risk and fall incidence rates in the older adult population has been well studied. Many different types of exercise interventions have been used, ranging from single exercise (e.g., resistance exercises, walking, t'ai chi) to multicomponent exercise programs (e.g., aerobic endurance, flexibility, strength, and balance training). While some exercise studies have adopted a more general or nontargeted approach, others have included exercises that specifically target balance and gait impairments and other physical factors known to be associated with heightened fall risk, such as muscle weakness or reduced flexibility (e.g., Buchner et al., 1997). In addition to the different exercise components investigated, the method of delivery has also differed across studies (i.e., group-based versus one-to-one). Finally, the type of provider (e.g., physical or occupational therapists, nurses, physical activity instructors) used to implement these interventions has also differed across studies.

The multicentered FICSIT (Frailty and Injuries: Cooperative Studies on Intervention Techniques) randomized, controlled trials represented the first systematic and large-scale attempt to investigate the efficacy of exercise (both targeted and nontargeted) on selected indexes of frailty and fall incidence rates among older adults. Five of the seven intervention sites involved community-residing older adults, while the two remaining sites involved frail nursing-home residents. Although the interventions varied with respect to the type of exercise used and the intensity, frequency, and duration of the intervention, the results of a preplanned meta-analysis that combined the multisite out-comes demonstrated a significant reduction in the risk of falling for the seven interventions that included exercise as a component of the intervention. Fall risk was further reduced, however, if the exercise intervention was more targeted by including specific balance activities (Province et al., 1995).

In recent years, individualized exercise programs that have targeted specific physical impairments identified during an initial assessment have also been shown to significantly lower fall incidence rates. These programs are generally designed and supervised by physical or occupational therapists in the home setting (Campbell et al., 1997; 1999).

In contrast to the significant findings emerging from a number of studies conducted on fall incidence rates among community-residing older adults, the results of a smaller number of randomized controlled trials conducted in longterm-care settings have been largely unimpressive (e. …

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