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Falls and Fitness

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Translating Evidence into Clinical Practice: A Falls Prevention Program for Community-Dwelling Seniors

Susan Maddock, RPT, Specialized Geriatric Services, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, ON.

Susan Gal, BScPE, BHScPT, Specialized Geriatric Services, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, ON.

MaryJane McIntyre, BScPT, Specialized Geriatric Services, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, ON.

Rory H. Fisher, MB, FRCP(Ed)(C), Division of Geriatric Medicine, Department of Medicine, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, ON.

Barbara A. Liu, MD, FRCPC, Division of Geriatric Medicine, Department of Medicine, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto; Program Director, Regional Geriatric Program of Toronto, Toronto, ON.

The Falls Prevention Program at Sunnybrook & Women’s College Health Sciences Centre was developed to provide patients with an evidence-based, multidisciplinary intervention to prevent falls. The goals of the program are to decrease the incidence of falls and improve patient confidence. Participants in the program are 65 or older with a history of falls or near-falls and are living in the community. Participants complete a 45-minute exercise circuit, twice a week for six weeks. In addition, patients undergo geriatric medical assessment and are seen by an occupational therapist for home safety education. Patients report fewer falls during the intervention and at follow-up, and subjectively report that they benefit from the program. The positive effects of this program support existing evidence that multidisciplinary intervention plays an important role in fall prevention.

Key words: falls prevention, older adults, exercise, balance, multidisciplinary, physiotherapy.

Related Terms: Falls and Fitness, balance, exercise, falls prevention, multidisciplinary, older adults, physiotherapy

Obesity in Older Adults

Isabelle J. Dionne, PhD, Faculty of Physical Activity and Sports, University of Sherbrooke; Research Centre on Aging, Geriatric Institute of Sherbrooke University, Sherbrooke, QC.
Martin Brochu, PhD, Faculty of Physical Activity and Sports, University of Sherbrooke; Research Centre on Aging, Geriatric Institute of Sherbrooke University, Sherbrooke, QC.

There is a high prevalence of obesity in older adults up to the age of 80. While women generally gain body weight during the menopausal transition, men tend to accumulate an excess of fat mass earlier in life for as yet unknown reasons. Consequently, an increasing proportion of older adults are now obese. Obesity’s association with metabolic diseases such as metabolic syndrome, type II diabetes, and cardiovascular disease is widely recognized. However, recent evidence shows that, in older adults, obesity is also related to functional impairment and decreased quality of life. This review addresses the actual prevalence and definition of obesity in older adults, the energy-balance equation, and the known consequences of obesity. Finally, the heterogeneity of obesity in older adults regarding its association with metabolic diseases and functional capacity will be discussed, as well as how obesity treatment should be conducted in this population.

Key words: obesity, metabolic syndrome, diabetes, weight loss, impaired functional capacity.

Related Terms: Falls and Fitness, Nutrition, diabetes, impaired functional capacity, metabolic syndrome, obesity, weight loss

The Canadian Centre for Activity and Aging's Home Support Exercise Program

Gareth R. Jones, PhD, Director, Canadian Centre for Activity and Aging, London, ON.
Jessalynn A.B. Frederick, BHK Honors Co-op, University of Windsor, Windsor, ON.
Canadian Centre for Activity and Aging is affiliated with St. Joseph's Health Care, London and the University of Western Ontario, London, ON.

"Homeboundness" is defined as never or almost never leaving one's home except for emergencies, not going beyond one's door without assistance, or going out of one's home less than once a month, and it is estimated to affect as much as 50% of the population who are 85+ years old.1 The older homebound adult is more likely to live alone, have mobility limitations, experience incontinence problems, and be considered at high risk for falling and fear of falling, as well as more likely to receive home support services.2 Frail seniors living at home are particularly difficult to reach and are at high risk for loss of functional independence and for institutionalization.3

Home exercise is an effective means to prevent falls, to maintain functional independence and to promote rehabilitation following injury or illness.4 However, for an older adult faced with mobility challenges and/or other medical problems, attending a traditional community-based exercise program may not be a suitable option.

Related Terms: Falls and Fitness, exercise, home support

Relationship Between Antidepressants and the Risk of Falls

Barbara Liu, MD, FRCPC, Sunnybrook &Women's College Health Sciences Centre and the Kunin-Lunenfeld Applied Research Unit, Baycrest Centre, Toronto, ON.

Falls are a common problem among older patients. Medications in general, and psychotropic drugs in particular, have been shown to increase the risk of falls. The possible mechanisms whereby psychotropic drugs increase this risk include sedation, orthostatic hypotension, arrhythmias, confusion due to anticholinergic effects, and dopaminergic effects on balance and motor control. Several epidemiological studies have identified antidepressant use--both tricyclic and selective serotonin re-uptake inhibitors--as a risk factor for falls. When treating a patient with an antidepressant, efforts should be made to reduce other modifiable risk factors for falls by optimizing intrinsic and extrinsic risk factors for falls.
Key words: falls, antidepressant, hip fracture, tricyclic antidepressant, selective serotonin re-uptake inhibitor.

Related Terms: Drug Safety, Falls and Fitness, antidepressants, falls, hip fracture, selective serotonin re-uptake inhibitor, tricyclic antidepressant

The Importance of Maximizing Vitamin D in the Elderly Diet with Respect to Function and Falls

Heike A. Bischoff, MD, MPH, Robert B. Brigham, Arthritis and Musculoskeletal Diseases Clinical Research Center, Brigham and Women's Hospital and Division on Aging, Harvard Medical School; Boston, MA, USA.

There is increasing evidence that vitamin D supplementation may improve musculoskeletal function and prevent falls in older persons at risk for vitamin D deficiency. One basic concept appears to be the direct effect of vitamin D on muscle strength. Highly specific receptors for 1,25-dihydroxyvitamin D are expressed in human muscle tissue and it has been suggested that these nuclear receptors promote protein synthesis in the presence of 1,25-dihydroxyvitamin D, eventually leading to improved strength.
Key words: vitamin D, muscle strength, function, elderly, falls.

Related Terms: Falls and Fitness, Nutrition, elderly, falls, function, muscle strength, vitamin D

Falls in Older People with Dementia

Fiona E. Shaw, MRCP, PhD, Consultant Physician and Geriatrician, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, UK.

Older people with dementia are at increased risk of falls and their adverse consequences. Postural instability (impaired gait and balance), medication, environmental hazards and neurocardiovascular instability, in particular orthostatic hypotension, are commonly identified as risk factors for falls in this patient group. It is possible to modify risk factors for falls in older people with dementia. However, to date it has not been possible to demonstrate conclusively that intervention can prevent falls in patients with dementia.
Key words: accidental falls, dementia, cognitive impairment, postural instability, neurocardiovascular instability (syncope).

Related Terms: Dementia, Falls and Fitness, accidental falls, cognitive impairment, dementia, neurocardiovascular instability (syncope), postural instability

Treatment of Orthostatic Hypotension: Preserving Function and Quality of Life

Margaret Grant, MD, FRCPC, Geriatrician and Medical Director, Geriatric Assessment Unit, Credit Valley Hospital, Mississauga, ON.

This article focuses on the treatment of orthostatic hypotension (OH) in the elderly. OH is a common problem that can affect an elderly person's function and quality of life. A careful history and physical examination must be done to make an accurate diagnosis and to determine the causes of OH. Treatment should focus on the causes of OH. Both nonpharmacological and pharmacological interventions are reviewed.
Key words: orthostatic hypotension, fludrocortisone, midodrine, octreotide, erythropoietin.

Related Terms: Falls and Fitness, erythropoietin, fludrocortisone, midodrine, octreotide, orthostatic hypotension

Delivery of Optimal Falls Prevention in Community-Dwelling Seniors

Meghan G. Donaldson, MSc, CIHR Doctoral Scholar, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC.
Karim M. Khan, MD, PhD, Assistant Professor, Department of Family Practice, Faculty of Medicine, University of British Columbia; consultant in the Osteoporosis Programme at B.C. Women's Hospital and Health Centre; CIHR New Investigator, Vancouver, BC.
Stephen R. Lord, PhD, NHMRC, Principal Research Fellow, The University of New South Wales, Sydney, Australia; Author of "Falls in Older People".

Falls are a major health problem in all Western societies. About 30% of community-dwelling seniors fall annually, and of these, half have recurrent falls. This article focuses on fall prevention in community-dwelling older people. It reviews risk factors for falls, addresses the role of exercise to prevent falls, and outlines management tips for physicians who see patients who fall. There is good evidence that strength and balance training should be prescribed to prevent falls. Also, there are many simple things a physician can do to reduce fall risk, such as medication rationalization and treating fall risk factors in a coordinated manner.
Key words: falls, exercise, balance, resistance training, risk factor modification.

Related Terms: Falls and Fitness, balance, exercise, falls, resistance training, risk factor modification

Promotion of Exercise Prescriptions in General Practice for Older Populations

Boyd Swinburn, MB, ChB, FRACP, MD, Professor, Centre for Physical Activity and Nutrition, Deakin University, Melbourne, Victoria, Australia.
Richard Sager, BHlthSc (N&D), APD, Public Health Research Fellow, Greater Green Triangle University, Department of Rural Health, Deakin University, Warrnambool, Victoria, Australia.

Regular physical activity in older populations reduces the risks of cardiovascular diseases, diabetes, osteoporosis and falls and also improves mental health. Some programs of written exercise prescriptions by general practitioners have been shown to significantly increase physical activity levels over the medium-term (six to 12 months). Increasing the confidence and skills of general practitioners to prescribe and monitor exercise programs is important. However, the more challenging barriers to the widespread uptake of exercise prescription programs are the structural and economic constraints within general practice, as well as the competing promotion of prescribing pharmaceutical products. Implementation research on overcoming these barriers is urgently needed.
Key words: exercise prescriptions, general practitioner, health gains, training, barriers, health promotion.

Related Terms: Falls and Fitness, Sports Medicine, barriers, exercise prescriptions, general practitioner, health gains, health promotion, training

Fear of Falling in the Elderly

Nadine Gagnon, MD, FRCP(C), Research Fellow, Department of Psychiatry, University of Toronto and University Health Network, and Toronto Rehabilitation Institute, Toronto, ON.
Alastair J. Flint, MB, ChB, FRCP(C), FRANZCP, Professor of Psychiatry, University of Toronto, and Head, Geriatric Psychiatry Program, University Health Network, Toronto, ON.

To date, researchers have addressed many aspects of falling. During the past two decades, there has been increasing interest in the phenomenon of fear of falling. This paper summarizes data pertaining to the epidemiology, assessment and management of fear of falling, as well as the relationship of fear of falling to other factors.
Key words: fear of falling, elderly, epidemiology, self-efficacy, activities of daily living.

Related Terms: Falls and Fitness, activities of daily living, elderly, epidemiology, fear of falling, self-efficacy
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