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Falls and Frailty – Improves the ability to perform activities of daily living

Evidence summary (Updated 2022)
The evidence that multifactorial (home modification, medication management, education, exercise) approaches reduce difficulties with ADLs and instrumental ADLs (IADLs) in older adults is strong in a systematic review consisting of 94% Level I RCTs and 100% either Level II or Level I [1].

The pooled estimate of the effect of exercise on social participation is statistically significant in favour of an exercise intervention (Hedges’ g = 0.16, 95% confidence interval (CI) 0.04–0.27, P = 0.006). The point estimate of the effect of multi-faceted intervention with an exercise component on participation (Hedges’ g = 0.25, 95% CI = −04 to 0.53, P = 0.09) is larger than the effect from exercise as a single intervention (Hedges’ g = 0.09, 95% CI = −0.01 to 0.19, P = 0.07), although this difference is not significant [2].
On recent review there are mixed results from SRs looking at effect on ADLs:
One study (2467 >65) showed inconsistent effect of exercise on QoL or ADLs – likely reflects heterogeneity in study design and interventions. QoL and ADLs only improved in studies that also reported improved physical outcomes, suggesting QoL and ADLs are linked to physical function [3]

A MA showed that Balance Training (BT) after Hip Fracture Surgery improved overall physical functioning SMD = 0.39, CI = 0.114-0.667, P = 0.006). Positive effects on balance, gait, lower limb strength, performance task, ADLs, and HRQoL were evident. Therefore, BT should be included in postoperative rehabilitation programs and balance must be thoroughly checked in elderly patients with hip fractures. [4]

Quality of evidence
B Moderate quality but paucity of direct results

Strength of recommendation
1 Strong

A client-centred intervention plan that includes a mix of exercise, education, home modifications and assistive technology is supported by strong evidence for preserving independence in community-dwelling older adults. When physical activity and home modifications are provided individually, the evidence that these interventions promote ADL and IADL performance is moderate.
Exercise interventions targeting falls may improve social participation in older people; however due to the considerable heterogeneity and small effect size, the results must be interpreted with caution and ongoing evaluation and research is required.
Physical activity combined with other falls-prevention strategies can be recommended for the promotion of functional status in most community dwelling patients in most circumstances. Evidence for improvements in social participation is promising but less strong due to individual study design.
Balance training has been shown to improve ADL post hip surgery

[1] Chase CA, Mann K, Wasek S, Arbesman M. Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. American Journal of Occupational Therapy. 2012 May 1;66(3):284-91.
[2] Fairhall N, Sherrington C, Clemson L, Cameron ID. Do exercise interventions designed to prevent falls affect participation in life roles? A systematic review and meta-analysis. Age and ageing. 2011 Jul 14;40(6):666-74.
[3] Campbell E, Petermann-Rocha F, Welsh P, Celis-Morales C, Pell JP, Ho FK, Gray SR. The effect of exercise on quality of life and activities of daily life in frail older adults: A systematic review of randomised control trials. Exp Gerontol. 2021 May;147:111287. doi: 10.1016/j.exger.2021.111287. Epub 2021 Feb 18. PMID: 33609689.

[4] Lee SY, Jung SH, Lee SU, Ha YC, Lim JY. Effect of Balance Training After Hip Fracture surgery: A Systematic Review and Meta-analysis of Randomized Controlled Studies. J Gerontol A Biol Sci Med Sci. 2019 Sep 15;74(10):1679-1685. doi: 10.1093/gerona/gly271. PMID: 30517613.