Tailored Exercise and Home Hazard Reduction Program for Fall Prevention in Older People With Cognitive Impairment: The i-FOCIS Randomized Controlled Trial

Morag E Taylor; Jacqueline Wesson; Catherine Sherrington; Keith D Hill; Susan Kurrle; Stephen R Lord; Henry Brodaty; Kirsten Howard; Sandra D O'Rourke; Lindy Clemson; Narelle Payne; Barbara Toson; Lyndell Webster; Roslyn Savage; Genevieve Zelma; Cecelia Koch; Beatrice John; Keri Lockwood; Jacqueline C T Close

doi:10.1093/gerona/glaa241

Tailored Exercise and Home Hazard Reduction Program for Fall Prevention in Older People With Cognitive Impairment: The i-FOCIS Randomized Controlled Trial

J Gerontol A Biol Sci Med Sci. 2021 Mar 31;76(4):655-665. doi: 10.1093/gerona/glaa241.

Authors

Morag E Taylor^{1

2}, Jacqueline Wesson^{1

3}, Catherine Sherrington^{4

5}, Keith D Hill⁶, Susan Kurrle⁷, Stephen R Lord¹, Henry Brodaty⁸, Kirsten Howard⁵, Sandra D O'Rourke¹, Lindy Clemson^{3

9}, Narelle Payne¹, Barbara Toson^{1

10}, Lyndell Webster¹, Roslyn Savage¹, Genevieve Zelma¹, Cecelia Koch¹, Beatrice John⁷, Keri Lockwood⁷, Jacqueline C T Close^{1

2}

Affiliations

¹ Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia.
² Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia.
³ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁴ Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.
⁵ Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁶ Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia.
⁷ Department of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
⁸ Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia.
⁹ Centre of Excellence for Population Ageing Research, The University of Sydney, Sydney, New South Wales, Australia.
¹⁰ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.

PMID: 32949456
DOI: 10.1093/gerona/glaa241

Abstract

Background: The evidence to support effective fall prevention strategies in older people with cognitive impairment (CI) is limited. The aim of this randomized controlled trial (RCT) was to determine the efficacy of a fall prevention intervention in older people with CI.

Method: RCT involving 309 community-dwelling older people with CI. The intervention group (n = 153) received an individually prescribed home hazard reduction and home-based exercise program during the 12-month study period. The control group (n = 156) received usual care. The primary outcome was rate of falls. Secondary outcomes included faller/multiple faller status, physical function, and quality of life.

Results: Participants' average age was 82 years (95% CI 82-83) and 49% were female. There was no significant difference in the rate of falls (incidence rate ratio [IRR] 1.05; 95% confidence interval [95% CI] 0.73-1.51). A sensitivity analysis, controlling for baseline differences and capping the number of falls at 12 (4 participants), revealed a nonsignificant reduction in fall rate in the intervention group (IRR 0.78; 95% CI 0.57-1.07). Analyses of secondary outcomes indicated the intervention significantly reduced the number of multiple fallers by 26% (RR 0.74; 95% CI 0.54-0.99) when adjusting for baseline differences. There was a differential impact on falls in relation to physical function (interaction term p-value = .023) with a significant reduction in fall rate in intervention group participants with better baseline physical function (IRR 0.60; 95% CI 0.37-0.98). There were no significant between-group differences for other secondary outcomes.

Conclusions: This intervention did not significantly reduce the fall rate in community-dwelling older people with CI. The intervention did reduce the fall rate in participants with better baseline physical function.

Clinical trials registration number: Australian and New Zealand Trials Registry ACTRN12614000603617.

Keywords: Accidental falls; Aged; Dementia; Neurocognitive disorder; Postural control.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Accidental Falls / prevention & control*
Accidents, Home* / prevention & control
Accidents, Home* / psychology
Aged, 80 and over
Australia / epidemiology
Cognitive Dysfunction* / complications
Cognitive Dysfunction* / physiopathology
Cognitive Dysfunction* / psychology
Efficiency, Organizational
Exercise Movement Techniques
Exercise Therapy / methods*
Female
Humans
Incidence
Independent Living* / psychology
Independent Living* / standards
Independent Living* / statistics & numerical data
Male
New Zealand / epidemiology
Outcome Assessment, Health Care / methods
Outcome Assessment, Health Care / statistics & numerical data
Physical Functional Performance
Quality of Life
Risk Reduction Behavior*

Associated data

ANZCTR/ACTRN12614000603617