Falls exercise interventions and reduced falls rate: Always in the patient's interest?

Abstract

Falls are a leading cause of mortality and morbidity in older adults. Physical, psychological and social consequences include injury, fall-related fear and loss of self-efficacy. In turn, these may result in decreased physical activity, reduced functional capacity, and increased risk of institutionalisation. Falls prevention exercise programmes (FPEP) are now widespread within the National Health Service, often part of multifactorial interventions, and are designed to minimise impairments that impact physical function, such as strength and balance. Assessment of the clinical efficacy of FPEPs has therefore focused on the measurement of physical function and rate of falls. Whilst important, this approach may be too narrow to capture the highly variable and multidimensional responses that individuals make to a fall and to a FPEP. We argue that the current focus may miss a paradoxical lack of or even deleterious impact on quality of life, despite a reduction in physical performance-related falls risk. We draw upon the Selective Optimisation and Compensation (SOC) model, developed by Paul and Margret Baltes, to explore how this paradox may be a result of the coping strategies adopted by individuals in response to a fall.

Effect of equine-assisted therapy on the postural balance of the elderly

“…Of these events, 62.3% occur in the bedroom 1 . About 50% of those who fall and suffer a hip fracture will never again be functional walkers [2][3][4] . Falls are due to the inability to correct for body displacement during movement in space by a lack of coordinated response to control the center of mass 5,6 .…”

The ‘Ossébo’ intervention for the prevention of injurious falls in elderly women: background and design

“…The effect of successful interventions on these potential 'intermediate' variables has rarely been reported. Furthermore, the impact of a fall exercise intervention in terms of quality of life has been questioned (29).…”

The FARE: A new way to express FAlls Risk among older persons including physical activity as a measure of Exposure

“…Thus reducing exposure to hazards could be seen as a behavioral response to perceived difficulties controlling balance in order to maintain balance control (Laybourne et al, 2008;Wijlhuizen et al, 2008a,b). In fact, the person seems to be preventing falls (Wijlhuizen et al, 2007) and also perceives this as a way of preventing falls (Yardley et al, 2006;Simpson et al, 2003).…”