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

Improves the ability to perform activities of daily living

Evidence summary

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 (4).

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 (5).

Quality of evidence

Moderate quality

Strength of recommendation

Strong

Conclusion

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.

References

  1. Gillespie, Lesley D., et “Interventions for preventing falls in older people living in the      community.” Cochrane Database Syst Rev 9.11 (2012).
  2. Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, Cumming RG, Herbert RD, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med. 2016 Oct 4:bjsports-2016.
  3. Lee SH, Kim HS. Exercise Interventions for Preventing Falls Among Older People in Care Facilities: A Meta‐Analysis. Worldviews on Evidence‐Based Nursing. 2017 Feb 1;14(1):74-80.
  4. 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.
  5. 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.
  6. El-Khoury F, Cassou B, Charles MA, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMj. 2013 Oct 29;347:f6234.
  7. Theou O, Stathokostas L, Roland KP, Jakobi JM, Patterson C, Vandervoort AA, Jones GR. The effectiveness of exercise interventions for the management of frailty: a systematic review. Journal of aging research. 2011.
  8. Singh NA, Quine S, Clemson LM, Williams EJ, Williamson DA, Stavrinos TM, Grady JN, Perry TJ, Lloyd BD, Smith EU, Singh MA. Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial. Journal of the American Medical Directors Association. 2012 Jan 1;13(1):24-30.
  9. Frost R, Belk C, Jovicic A, Ricciardi F, Kharicha K, Gardner B, Iliffe S, Goodman C, Manthorpe J, Drennan VM, Walters K. Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis. BMC geriatrics. 2017 Dec;17(1):157.
  10. Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, Vollenbroek-Hutten M, Germini F, D’avanzo B, Gwyther H, Holland C. Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. JBI database of systematic reviews and implementation reports. 2018 Jan 1;16(1):140-232.
  11. Yamada M, Arai H, Sonoda T, Aoyama T. Community-based exercise program is cost-effective by preventing care and disability in Japanese frail older adults. Journal of the American Medical Directors Association. 2012 Jul 1;13(6):507-11.
  12. Rogers NT, Marshall A, Roberts CH, Demakakos P, Steptoe A, Scholes S. Physical activity and trajectories of frailty among older adults: Evidence from the English Longitudinal Study of Ageing. PloS one. 2017 Feb 2;12(2):e0170878.
  13. Cadore EL, Rodríguez-Mañas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation research. 2013 Apr 1;16(2):105-14.