‘Start Active and Stay Active’: Fall Prevention Program in Primary Care

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Authors (including presenting author) :
Luk MLM, Ng DMT, Chow IHW, Chan ACM
Affiliation :
Physiotherapy Department, Queen Elizabeth Hospital
Introduction :
Fall and fall-related injuries are a threat to health and independence of elderly. Due to the aging population, the prevalence of falls is expected to grow unceasingly. The demand on public health system is undoubtedly increasing. Multi-dimensional exercise program was proven to reduce rate of falls and risk of falling. The benefits of this intervention on patients treated in primary care have to be investigated.
Objectives :
To investigate whether the multi-dimensional ‘Start Active and Stay Active’ Fall Prevention Program can (1) promote physical functions, (2) reduce fall rate and (3) reduce fear of falling on elderly treated in primary care.
Methodology :
A prospective study evaluated subjects aged 65 or above and had history or tendency of fall in past one year. Falls Risk Assessment for the Elderly was used to triage subjects into mild, moderate and high risk of fall. All subjects received educational class and home-based exercise program at Physiotherapy Department in Yau Ma Tei Jockey Club General Out-patient Clinic. Subjects classified as moderate and high risk groups attended additional supervised exercise intervention once per week for six weeks. Information on 1) physical condition - handgrip strength and quadriceps muscle strength, 2) balance and mobility performance - Berg Balance Scale and Time Up and Go Test and 3) fear of falling – Chinese version of Fall Efficacy Score-International were recorded at baseline and six months after completion of program. Number of episodes of fall was revealed by telephone follow up and information from electronic patient resource one year after the program.
Result & Outcome :
Seventy subjects (41 females) aged 71.4 ± 5.7 years old were studied. At 6-month follow ups, there was a significant improvement in Time Up and Go Test by 13.7% (p=0.021) and a significant increase in quadriceps muscle strength of the stronger leg by 21.5% (p=0.019). In addition, Berg Balance Scale score and Falls Efficacy Scale score were significantly improved by 23.5% (p=0.001) and 15.2% (p=0.002) respectively. However, no significant difference was found in handgrip strength for both dominant (p=0.063) and non-dominant hand (p=0.079). None of the subjects reported history of fall at six months after program completed. Three subjects reported history of fall at one year telephone follow up. Multi-dimensional fall prevention program in primary care showed improvement in muscle strength, balance performance as well as reduction of fear of fall and risk of fall in elderly. This exercise program helped to build up elderlies’ confidence in daily living and hence improved their quality of life.

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