Accidental Falls | Community-based Falls Prevention Program for the Elderly
Accidental Falls research study
What is the primary objective of this study?
Background: Falls are the leading cause of injury among older adults in Singapore, but falls among the elderly can be preventable and the risks are predictable. Translating this understanding of falls etiology into an integrated clinical and public health program that is accessible to the elderly is a critical health services delivery challenge. Hypothesis: An evidence-based program of screening, risk modification and physical therapy delivered in a community setting will reduce recurrent falls incidence among a high-risk group of elderly recently discharged to the community. Methodology: This randomized controlled trial targets patients seen at Emergency Department (ED) for a fall or fall-related injuries who are at least 65 years old and will be discharged to home. Upon signing the informed consent form, the participants will be followed up for nine months from the baseline assessment during which the participants are randomized into either a control or the intervention group. The participants in the intervention group will be provided with a multifactorial program of screening, risk modification and physical therapy focused on progressive strength, balance, and gait training either as an individualized program or a group setting in the community for the first three months from the date of randomization. The number of recurrent falls will be monitored via a falls prevention diary maintained by (or for) each participant.
Who is eligible to participate?
Inclusion Criteria: - Age ≥ 65 years - Seen in the Emergency Department for a fall or injury related to a fall - Able to follow 3 step commands - Singapore citizen or Permanent Resident - Living at home upon discharge - Provision of informed consent - If admitted to the hospital, the illness or disability is one from which they are expected to recover basic ADLs or weight bearing of the lower extremity within the next month Exclusion Criteria: - Those patients with severe physical and/or mental impairments which preclude participation in a program of physical therapy (as determined by a primary physician) will NOT be eligible for participation. - Unable to participate in the exercise program due to conflicting schedules (e.g. full-time employment, on dialysis) - Serious life limiting illness - Patients seen at ED due to road traffic accidents - Unable to walk even with assistance - Not community dwelling prior to ED visit - Total blindness - Needs emergency inpatient surgery and, if admitted to the hospital, the illness or disability is one from which they are not expected to recover basic ADLs or weight bearing in the lower extremity within the next one month.
Which medical condition, disease, disorder, syndrome, illness, or injury is researched?
Interventions can include giving participants drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available or noninvasive approaches such as surveys, education, and interviews.
Other:physical therapyTailored physical therapy sessions to modify impairments in balance and/or gait and to transition high-risk participants to an evidence-based group exercise program.
Research studies and clinical trials typically have two or more research arms. An arm is a group of people who receive the same treatment in the study.
Intervention GroupThe intervention consists of a tailored physical therapy focused on progressive strength, balance and gait training for a period of 3 months.
Control GroupUsual care by physician.
Start Date: December 2012
Primary Outcome: The number of fallers who have fallen at least once during the 9-month study period
Secondary Outcome: The number of injurious falls and healthcare utilization
Study sponsors, principal investigator, and references
Principal Investigator: David B Matchar, MD
Lead Sponsor: National University, Singapore
Collaborator: Ministry of Health, Singapore
Duncan PW, Sullivan KJ, Behrman AL, Azen SP, Wu SS, Nadeau SE, Dobkin BH, Rose DK, Tilson JK; LEAPS Investigative Team. Protocol for the Locomotor Experience Applied Post-stroke (LEAPS) trial: a randomized controlled trial. BMC Neurol. 2007 Nov 8;7:39.