Feasibility of a Small Group Otago Exercise Program for Older Adults Living with Dementia

Abstract

Older adults with dementia experience more frequent and injurious falls than their cognitively-intact peers; however, there are no evidence-based fall-prevention programs (EBFPP) for this population. The Otago Exercise Program (OEP) is an EBFPP for older adults that has not been well-studied in people with dementia. We sought to explore the feasibility of group delivery of OEP in an adult day health center (ADHC) for people with dementia. We collected demographic data, Functional Assessment Staging Tool (FAST), and Mini Mental State Exam (MMSE) scores for seven participants with dementia. Pre- and post-test data included: Timed-Up-and-Go (TUG), 30-Second Chair-Stand (30s-CST), Four-Stage-Balance-Test (4-SBT), and Berg Balance Scale (BBS). We implemented a supervised group OEP, 3x/week × 8 weeks. Most participants required 1:1 supervision for optimal challenge and participation. Five participants completed the program. All had moderately severe to severe dementia based upon FAST; MMSE scores ranged from mild to severe cognitive impairment. Four of five participants crossed the threshold from higher to lower fall risk in at least one outcome (TUG, 30s-CST, 4-SBT, or BBS), and four of five participants improved by >Minimal Detectible Change (MDC90) score in at least one outcome. The group delivery format of OEP required significant staff oversight for optimal participation, making the program unsustainable.

New Trends in Cognitive Aging and Mild Cognitive Impairment

“…Difficulties in mobility in pathological aging can be caused neurodegenerative disease itself or vice versa, where a loss of mobility caused by a fall or lack of family care will eventually lead to cognitive impairment that, in many cases, becomes irreversible. This proposal is addressed in the article by Ries and Carroll 2021 [ 13 ], which deals with the problem of avoiding the most frequent falls through a prevention program in patients with moderate and severe dementia. They conclude that the type of format of this program determines that participation is optimal, thereby reducing the risk of deterioration caused by a fall or injury.…”

“…and polypharmacy, with a lot of medication that can alter their own quality of life. Regarding mobility, it is a matter of addressing this problem of falls in a preventive way, either through prevention programs, as proposed by Ries and Carroll [ 13 ], or by anticipating it through metabolic measures in Parkinson’s patients, as proposed by Lauretani et al [ 14 ]. Regarding polypharmacy, it is necessary to understand the complexity of therapeutic approaches and, as highlighted by Caamaño et al [ 7 ], the complexity of the management of these situations in different care systems.…”

The effectiveness of mental imagery on motor, cognitive and emotional status of older people with early-stage dementia: A study protocol

“…The physiotherapy exercise program will include exercises selected from the Otago Exercise Program (OEP) which was developed and tested by the New Zealand Falls Prevention Research Group in New Zealand to reduce falls in older persons. Yet little research has investigated the use of OEP in people with dementia[ 17 , 18 ]. In particular, OEP consists of a warm-up stage promoting circulation and preparing the body for the rest of the program.…”

Effects of Otago Exercise Program on postural control ability in elders living in the nursing home: A systematic review and meta-analysis

“…The Otago Exercise Program (OEP) is a multimodal exercise training program initially designed as an individually tailored home exercise program for community-dwelling elders and has been proven to be an effective evidence-based exercise program to enhance postural control and minimize risk of falls through improved muscle strength, balance, and endurance. [10,11] Some scholars consider the OEP likely to be accepted by elders in NHs and that the program is readily conducive to popularization. [12] However, only the effect of the OEP was analyzed for community-dwelling elders from an evidence-based level; whether the movement characteristics and exercise intensity meet the needs of NH elders still needs to be clarified and investigated through a thorough review and meta-analysis.…”