Vol. 2 No. 2 (2019): International Journal of Aging Research
Research Articles

An evaluation of a walking and socialization program in long-term care: Impact on injurious falls

Lilian U Thorpe MD, PhD1, Susan J. Whiting PhD2*, Vanina PM Dal Bello-Haas PhD3, Thomas Hadjistavropoulos PhD4.
1Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Canada; Rm 3247, E-Wing Health Sciences, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada; 2College of Pharmacy and Nutrition, University of Saskatchewan, Rm 3124 E-Wing Health Sciences, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada; 3School of Rehabilitation Science, McMaster University, 1400 Main Street West, 403/E, Hamilton, Ontario, L8S 1C7, Canada; 4Department of Psychology and Centre on Aging and Health, University of Regina, Regina, Saskatchewan, S4S 0A2, Canada.
Keywords
  • Walking; Falls; Long-term care; Longitudinal studies
How to Cite
Lilian U Thorpe MD, PhD1, Susan J. Whiting PhD2*, Vanina PM Dal Bello-Haas PhD3, Thomas Hadjistavropoulos PhD4. (2019). An evaluation of a walking and socialization program in long-term care: Impact on injurious falls. International Journal of Aging Research, 2(2), 31. https://doi.org/10.28933/ijoar-2019-03-0405

Abstract

The effects of a walking program in long-term care (LTC) are affected by multiple comorbidities and the LTC milieu. We randomly assigned residents 60 years and older into three groups (walking, socializing and control). Interventions were delivered five days weekly up to 30 minutes daily. Measurements were performed at baseline, 8, 16, 24 and 32 weeks, and included falls, grip strength, Berg Balance Scale, Senior Fitness Test, and Geriatric Depression Scale Short Form. Survival analysis with 168 participants for time to first injurious fall showed a significant (p=0.001) interaction between age and sex, with fall risk increasing with age in females, but lowest in the oldest age group in males. The hazard ratio for first injurious fall was more than doubled by the use of an antidepressant (HR=2.198, p=0.005), decreased by the score on the Berg Balance high fall risk rating (HR=0.471, p=0.010), but not affected by the activity-socialization intervention. The increased hazard of injurious falls related to antidepressants, but not depressive symptoms, suggests that the high prevalence of antidepressants in LTC needs re-evaluation. Further research efforts will need to control for alternate physical activities.

This work was supported by the Saskatchewan Health Research Foundation Health Research (SHRF) Team Grant. Trial registration: ClinicalTrials.gov NCT01277809

References

1. Terroso, M., Rosa, N., Torres Marques, A. et al. Physical consequences of falls in the elderly: a literature review from 1995 to 2010. European Review of Aging and Physical Activity, 2014;11(1):51–59.
2. Ambrose, A.F., Paul, G., Hausdorff, J.M. Risk factors for falls among older adults: a review of the literature. Maturitas, 2013; 75(1):51-61. ttps://doi.org/10.1016/j.maturitas.2013.02.009
3. Hill, K.D., Wee, R. Psychotropic drug-induced falls in older people: a review of interventions aimed at reducing the problem. Drugs and Aging, 2012;29(1):15-30. doi: 10.2165/11598420-000000000-00000.
4. Annweiler, C., Montero-Odasso, M., Schott, A.M., Berrut, G., Fantino, B., Beauchet, O. Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects. Journal of Neuroengineeering Rehabilitation 2010;11:7-50. doi: 10.1186/1743-0003-7-50.
5. El-Khoury, F., Cassou, B., Charles, M.A., Dargent-Molina. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. British Medical Journal, 2013;347:f6234. doi: 10.1136/bmj.f6234.
6. Papaioannou, A., Santesso, N., Morin, S.N. Feldman, S., Adachi, J.D., Crilly, R., Giangregorio, L.M., Jaglal, S., Josse, R.G., Kaasalainen, S., Katz, P., Moser, A., Pickard, L., Weiler, H., Whiting, S., Skidmore, C.J., Cheung, A.M. Scientific Advisory Council of Osteoporosis Canada. Recommendations for preventing fracture in long-term care. Canadian Medical Association Journal, 2015;187(15):1135-1144. doi: 10.1503/cmaj.141331
7. Bischoff-Ferrari, H.A., Willett, W.C, Orav, E.J., E.J., Lips, P., Meunier, P.J., Lyons, R.A., Flicker L, Wark J, Jackson RD, Cauley JA, Meyer HE, Pfeifer M., Sanders K.M., Stähelin HB, Theiler R, Dawson-Hughes B. A pooled analysis of vitamin D dose requirements for fracture prevention. New England Journal Medicine, 2012;367:40-49. doi: 10.1056/NEJMoa1109617.
8. Stalenhoef, P.A., Diederiks, J.P.M., Knottnerus, J.A., et al. A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. Journal of Clinical Epidemiology, 2002;55:1088–1094.
9. Iaboni, A., Flint, A.J. The complex interplay of depression and falls in older adults: a clinical review. American Journal of Geriatric Psychiatry, 2013 May;21(5):484-492. doi: 10.1016/j.jagp.2013.01.008
10. Cooney, G.M., Dwan, K., Greig, C.A., Lawlor, D.A., Rimer, J., Waugh, F.R, McMurdo, M., Mead, G.E. Exercise for depression. Cochrane Database of Systematic Reviews, 2013;9. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub6
11. Sheridan, A.J., Drennan, J., Coughlan, B. et al. Improving social functioning and reducing social isolation and loneliness among people with enduring mental illness: Report of a randomised controlled trial of supported socialisation. International Journal of Social Psychiatry, 2015;61(3):241-250. doi: 10.1177/0020764014540150.
12. Dal Bello-Haas, V., Thorpe, L, Lix, L.M. Scudds, R., Hadjistavropoulos, T. The effects of a long-term care walking program on balance, falls and well-being. BMC Geriatrics, 2012;12(1):76. doi: 10.1186/1471-2318-12-76.
13. Fraser, L.A., Liu, K., Naylor, K.L. Hwang, Y.J., Dixon, S.N., Shariff, S.Z., Garg, A.X. Falls and fractures with atypical antipsychotic medication use: a population-based cohort study. JAMA Internal Medicine, 2015;175(3):450-452. doi: 10.1001/jamainternmed.2014.6930.
14. Eom, C.S., Lee, H.K., Ye, S. Park, S.M., Cho, K.H. Use of selective serotonin reuptake inhibitors and risk of fracture: a systematic review and meta-analysis. Journal of Bone and Mineral Research, 2012;27(5):1186-1195. doi: 10.1002/jbmr.1554.
15. Wu, Q., Bencaz, A.F., Hentz, J.G., Crowell, M.D. Selective serotonin reuptake inhibitor treatment and risk of fractures: a meta-analysis of cohort and case-control studies. Osteoporosis International, 2012;23(1):365-375. doi: 10.1007/s00198-011-1778-8
16. Park, H., Satoh, H., Miki, A. Urushihara H, Sawada Y. Medications associated with falls in older people: systematic review of publications from a recent 5-year period. European Journal of Clinical Pharmacology, 2015;71(12):1429-1440. doi: 10.1007/s00228-015-1955-3.
17. Berg, K.O., Wood-Dauphinee, S.L., Williams, J.I. et al. Measuring balance in the elderly: validation of an instrument. Canadian Journal of Public Health, 1992;83 Suppl 2:S7-11.
18. Rikli, R.E., Jones, C.J. Development and validation of a functional fitness test for community-residing older adults. Journal of Aging and Physical Activity, 1999;6:127-159. doi: 10.1093/geront/gns071.
19. Fillenbaum, G.G. Multidimensional functional assessment of older adults: The Duke Older Americans Resources and Services procedures. Hillsdale, NJ, England: Lawrence Erlbaum Associates, Inc; 1988.
20. Sheikh, J.I, Yesavage, J.A. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontology, 1986;5(1/2):165-173.
21. Alexopoulos, G.A., Abrams, R.C., Young, R.C., et al. Cornell scale for depression in dementia. Biological Psychology, 1988; 23:271-284.
22. Teri, L., Truax, P., Logsdon, R. et al. Assessment of Behavioral Problems in Dementia: The Revised Memory and Behavior Problems Checklist (RMBPC). Psychology of Aging 1992;7:622-631.
23. Pfeiffer, E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatric Society, 1975;23(10):433-41.
24. McGrath, P.A., Seifert, C.E., Speechley, K.N. et al. Color analog scale. Pain. 1996;64:435–443.
25. RAI-MDS 2.0 © interRAI Corporation, Washington, D.C., 1997, 1999
26. Hirdes, J.P., Ljunggren, G., Morris, J.N. Frijters, D.H., Finne Soveri, H., Gray, L., Björkgren M, Gilgen R. Reliability of the interRAI suite of assessment instruments: A 12-country study of an integrated health information system. BMC Health Services Research 2008;8:227. doi: 10.1186/1472-6963-8-277.
27. IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.
28. Shumway-Cook, A., Baldwin, M., Polissar, N.L., Gruber, W. Predicting the probability for falls in community-dwelling older adults. Physical Therapy, 1997;77(8):812-819.
29. Canadian Institute for Health Information. Drug use among seniors on public drug programs in Canada, 2012: Revised October 2014. Ottawa, ON: CIHI; 2014.
30. Wei, Y.J., Simoni-Wastila, L., Lucas, J.A., brandt, N. Fall and fracture risk in nursing home residents with moderate-to-severe behavioral symptoms of Alzheimer’s disease and related dementias initiating antidepressants or antipsychotics. Journal of Gerontology A Biological Sciences and Medical Sciences, 2016; 72(5):695-702. doi: 10.1093/gerona/glw095
31. Fernandes, B.S., Hodge, J.M., Pasco, J.A., berk, M., Williams, L.J. Effects of depression and serotonergic antidepressants on bone: mechanisms and implications for the treatment of depression. Drugs and Aging 2016;33(1):21-25. doi: 10.1007/s40266-015-0323-4
32. Carrière, I., Farré, A., Norton, J., Wyart, M., Tzourio, C., Noize, P., Pérès, K., Fourrier-Réglat, A., Ancelin, M.L. Patterns of selective serotonin reuptake inhibitor use and risk of falls and fractures in community-dwelling elderly people: the Three-City cohort. Osteoporosis International, 2016;27:3187-3195. doi: 10.1007/s00198-016-3667-7.
33. Iaboni, A., Bronskill, S.E., Reynolds, K.B., Wang, X., Rochon, P.A., Herrmann, N.J., Flint, A. Changing pattern of sedative use in older adults: a population-based cohort study. Drugs and Aging 2016;33(7):523-533. doi: 10.1007/s40266-016-0380-3
34. Phillips, E.M., Schneider, J.C., Mercer, G.R. Motivating elders to initiate and maintain exercise. Archives of Physical and Medical Rehabilitation, 2004;85:52-57
35. Public Health Agency of Canada. Seniors’ falls in Canada: second report. Ottawa (ON): Public Health Agency of Canada; 2014. Retrieved 2017 Feb 22 from: https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/publications/publications-general-public/seniors-falls-canada-second-report.html