Effects of an Exercise Program to Reduce Falls in Older People Living in Long-Term Care: A Randomized Controlled Trial

Lynne M Taylor; John Parsons; Simon A Moyes; Elizabeth Binns; Alana Cavadino; Denise Taylor; Sue Lord; Silvia Del Din; Jochen Klenk; Lynn Rochester; Ngaire Kerse

doi:10.1016/j.jamda.2023.10.022

Effects of an Exercise Program to Reduce Falls in Older People Living in Long-Term Care: A Randomized Controlled Trial

J Am Med Dir Assoc. 2024 Feb;25(2):201-208.e6. doi: 10.1016/j.jamda.2023.10.022. Epub 2023 Nov 29.

Authors

Affiliations

¹ The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand. Electronic address: Lm.taylor@auckland.ac.nz.
² The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand.
³ Auckland University of Technology, Health and Rehabilitation Research Institute, Auckland, New Zealand.
⁴ Translational and Clinical Research Institute Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom; National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom; The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
⁵ Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; IB University of Health and Social Sciences, Study Center Stuttgart, Stuttgart, Germany.

PMID: 38042173
DOI: 10.1016/j.jamda.2023.10.022

Abstract

Objectives: To investigate the effect of an exercise program on falls in intermediate and high-level long-term care (LTC) residents and to determine whether adherence, physical capacity, and cognition modified outcomes.

Design: Randomized controlled trial.

Setting and participants: Residents (n = 520, aged 84 ± 8 years) from 25 LTC facilities in New Zealand.

Methods: Individually randomized to Staying UpRight, a physical therapist-led, balance and strength group exercise program delivered for 1 hour, twice weekly over 12 months. The control arm was dose-matched and used seated activities with no resistance. Falls were collected using routinely collected incident reports.

Results: Baseline fall rates were 4.1 and 3.3 falls per person-year (ppy) for intervention and control groups. Fall rates over the trial period were 4.1 and 4.3 falls ppy respectively [P = .89, incidence rate ratio (IRR) 0.98, 95% CI 0.76, 1.27]. Over the 12-month trial period, 74% fell, with 63% of intervention and 61% of the control group falling more than once. Risk of falls (P = .56, hazard ratio 1.08, 95% CI 0.85, 1.36) and repeat falling or fallers sustaining an injury at trial completion were similar between groups. Fall rates per 100 hours walked did not differ between groups (P = .42, IRR 1.15, 95% CI 0.81, 1.63). Program delivery was suspended several times because of COVID-19, reducing average attendance to 26 hours over 12 months. Subgroup analyses of falls outcomes for those with the highest attendance (≥50% of classes), better physical capacity (Short Physical Performance Battery scores ≥8/12), or cognition (Montreal Cognitive Assessment scores ≥ 18/30) showed no significant impact of the program.

Conclusions/implications: In intermediate and high-level care residents, the Staying UpRight program did not reduce fall rates or risk compared with a control activity, independent of age, sex, or care level. Inadequate exercise dose because of COVID-19-related interruptions to intervention delivery likely contributed to the null result.

Keywords: Falls; cognitive impairment; exercise; frailty; nursing homes; older adults.

Publication types

Randomized Controlled Trial

MeSH terms

Accidental Falls* / prevention & control
Aged
Aged, 80 and over
COVID-19*
Exercise
Exercise Therapy
Humans
Long-Term Care