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Falls and exercise in older people (Prevention of falls (Exercise…
Falls and exercise in older people
Epidemiology of falls
impact of falls
Personal
injuries
decrease
confidence
Activity levles
independence
Community participation
Aged care admission
occurance
individual
physiology can't cope with the task being undertaken
environment in which the task is being undertaken
Physical Factors
Balance, strength, vision, sensation, reaction time, CVS
Disease, medication, ageing, inactivity
Behavior
Choice and care of activity
cognition, Insight, Attitude , Distraction
Environmental hazards
triggers of trips and slips
Falls risk assessment
consideration
Realiability
Consostent each time
validity
measures what it is supposed to measure
Feasibility
appropriate for population and setting
functional tests
STS-5
Alt Step test
Ability
used in different populatio groups
assist in understanding fal cause
perdict future falls
Proscribe evidence base interventions
Physiological profile assessment - fallscreen
Physiological rather than disease orientated
Direct assessment of sensorimotor abilities
Vision, Melbourne edge test
Sensation (knee position sense)
speed (reaction time )
Strength (Knee extension)
Balance (Sway on foam )
Assumption
disease processes
manifest in impaired performances in one or more tests
cataracts - poor vision
Neuropathy - Poor sensation
Prior polio - weakness
Stroke - Weakness, in-coordination, instability
Evidence based practice
Database
Pedro
Australian and NZ falls prevention society
the cochrane library
Fall prevention interventions
Taichi / exercise
reduces fall rates
Target
high risk population
General older population
Taichi has greater impact on falls in general community
reduces number of #
Cognitive impairments
45%reduction in falls
Parkinsons disease
53% reduction in falls
Stroke
reduction in falls for people
Prevention of falls
Exercise
Mod to high challenge to ballance
allowed to add walking in addition
strength training in addition
at least 3 hrs per week
exercises
movement in the centre of mass
narrowing of the base of support
minimising upper limb support
sufficient dose to have effect
ongoing is necessary
gain benefit and maintain interest
targeted at general community and high risk for falls
walking should not be presciubed to high risk
undertaken in group or home based setting
Providers should refer to other risk factors to be addressed
Implementation ideas
everyday tasks
Practice is a key aspect of motor learning
task specificity
greater improvements in tasks which have been practiced
Benefits of Physical activity
Management and control
cVS
OA
Deoression and anxiety
Prevention
CVD
certain types of cancer
non insulin depended diabetes
Guidemines for older adults
Some form of PA no matter age, weight, health problems or abilities
should be active everyday
30 mins of mod intensity PA preferably everyday
should start at a level that is managable
gradually buildup amount , type and frequency
PA should be carried on in older ages in a manner suited to capability in older lives
Sendentary guidelines
minimise amount of time spent sitting
Break up periods of sitting as often as possible
Adherence
People
have exercised in the past
healthy and mobile
feel confident in ability to exercise
programs
effective
accisble , convienent , low cost, frequent
motivatd and enthusiastic leaders
address individual participant needs
sociable and fun
selling the program
Promote
– -maintaining an independent lifestyle;
– -staying healthy and physically active; and
– -promotion of activities that enhance fitness, balance/mobility
Behavior change
capability
Motivation
Opportunity
Health coaching
cliet centered approach
facilitate and empower client
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mobilise internal strength
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Reasons to change
How will you feel if you change?
What will this allow you to do in the future?
Strengths
Barriers/obstacles
Strategies to overcome obstacles
Goal setting
motivational interviewing
Goaloriented
client centered
faciitating and engaging intrinsic change
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individual
interaction
any middle / old age
opportunity o prescribe / encourage appropriate exercise
awareness of fall problem
benefits of exercise
advocate
suitable programs to be run by range of organisations
greater funding for evidence based interventions
Functional task training
replicate ADLs
encourage
incidental exercise at home
LiFE program
Assess ADL and routines
Teach principles and strategies
Plan activities with client
Encourage meaningful goals
Work towards habitual change
Feedback/monitoring, enhancing self efficacy
Form, upgrading and safety
Mastery and upgrading
stepping on fall prevention program
8 FTF sesh involving discussions and ex program
Yoga
Promises as falls prevention intervention
recently backed by systemic review
CHAnGE trial
outcomes
Objective physical activity
falls(Monthly postal calandars for 12 months
methods
Physical activity promotion/ falls prevention intervention
• Physical activity/ fall prevention booklet
• QuickScreen fall risk assessment
• Set two physical activity goals
• Wear Fitbit pedometer
• 6 months of fortnightly phone-based health coaching, then
monthly health coaching for a further 6 months
nutrition intervention
Healthy eating booklet
telephone based health coaching through NSW health funded service
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Falls in residential care
intervntion
effectiveness
conflicted findings
MD team
can prevent falls
difficult t implement cheaply
some exercise based intervention strategies promising
Chochrane review
Multifactorial interventions
reduce in fall and risk of falling
vitamin D
effective in reducing fall rates
Exercise in subacue hospital settings
appears effective
uncertain in nursing care