Preventing
Falls and Disability
in Inner-City Elderly
Neville
E. Strumpf, PhD, RN, C, FAAN
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Neville
Strumpf, PhD, RN, C, FAAN, Edith
Clemmer Steinbright Professor in Gerontology,
and Director of the Center for Gerontologic
Nursing Science and her colleagues at the University
of Pennsylvania were exploring ways to prevent
falls and disability in Inner-City Elderly in
one of their latest research projects.
The
National Institute on Aging -funded project,
Preventing falls and disability
in inner-city elderly (NIA, 1
R01 AG16333, 1999-2002, $, 949, 214, PI N. Strumpf)
was designed to develop a falls intervention
program and evaluate its feasibility in urban
community-dwelling elders, all of whom had visited
an ER consequent to a fall.
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Dr.
Neville E. Strumpf |
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The research included 204 elders (102 experimental,
102 control), 65 years of age or greater, who visited
1 of 3 West Philadelphia hospital emergency rooms as
the result of a fall. Mean age 76.05+/- 7.38 years,
range 65-98. Subjects were 74.5% female and 88.7% African
American.
Primary
measures were the Timed Up and Go Test, the Berg Balance
Test, a Knee Extension Test, and number of dependencies
in IADLs. Secondary measures were grip strength, the
Multi-directional reach test, Gait Stability Ratio (steps/meter),
physical activity as measured by the PASE scale, the
Activities Balance Confidence (ABC) scale, Mobility,
Time on One Foot, and Total Number of Medications.
In addition, frailty scores and level of adherence to
at-home exercise were calculated. Data were collected
at baseline, and 3 and 6 months following the intervention.
The
experimental group received a progressive program of
balance and strengthening exercises with slow walking
and lateral movements that were constructed using principles
of Tai Chi. During Month 1, the experimental group came
one day per week to the research site for exercise classes
with an exercise instructor. During Months 1-6, home
exercises were to be carried out 3 times per week, with
weekly follow-up phone calls and monthly home visits
by a community interventionist. The control group was
given a one-page flyer on the benefits of walking three
times per week.
There
were no statistically significant differences for the
primary outcomes at 3 and 6 months. There were also
no significant interactions of frailty with the intervention.
Lastly, the interaction of the intervention and adherence
was significant for the 6-Minute Walk Test and the number
of IADL dependencies. Those who adhered to the intervention
improved compared to people imputed as likely to have
had the same level of adherence to the protocol had
they not been assigned to the control group.
Thus,
we concluded that high adherence to the intervention
protocol had a beneficial effect on selected outcomes.
Future studies need to address factors that affect
motivation for exercise among elders, the intensity
of the intervention and its precise tailoring for
the population, and the appropriateness of alternative
outcome measures. Of special interest is that many
individuals in this urban group of predominantly
African American fallers had never been exposed
to an exercise protocol of this type.
Coimbra,
A, Newton, R. (2002), Physical performance measures
in known fallers with and without a history of arthritis,
Neurology Report, 26(4), 194. Presented at the Combined
Sections Meeting, American Physical Therapy Association,
Tampa, FL, February 2003.
Cromwell,
R, Newton, R, Grisso, J, Edwards, W, (2001), Relationship
between select balance measures and a gait stability
ratio in individuals who are known fallers. In J. Duysens,
B. Smits-Engelsman, & H. Kingma (Eds.), Control
of Posture and Gait, International Society for Postural
and Gait Research, Netherlands, 81-84. Presented as
a Symposium of the International Society for Postural
and Gait Research, Maastricht, The Netherlands, June
2001.
Marenberg,
M, Newton, R, Coimbra, A. Edwards, W, Weber, A, Strumpf,
N, & Stineman, M, (2002), Patterns of disability
in patients presenting in emergency rooms after falls:
A population in need of rehabilitation referral, Archives
of Physical Medicine and Rehabilitation, 8(10), 1490.
Presented at the Annual Meeting of the American Society
of Neurorehabilitation, Philadelphia, October, 2002.
Marenberg,
M. Edwards, W, Newton, R, Stineman, M, Marcus, S. Weber,
A, Comibra, A, Bradway, C, & Strumpf, N, (2002),
IADL Dependence among urban fallers presenting to the
ER, The Gerontologist, 42, 174-175. Presented at the
Annual Meeting of the Gerontological Society of America,
Boston, November 2002.
Marenberg,
M, Strumpf, N, Weber, A, Stineman, M, Edwards, W, Newton,
R, & Grisso, J, (2003), The effect of adherence
to exercise on reduction of falls resk factors in elderly
African American fallers. Presented at the Annual Meeting
of the American Geriatrics Society, Baltimore, May 2003.
Newton,
R, Coimbra, A, Berhameen, A, Edwards, W, Marenberg,
M, Stineman, M, Weber, A, & Grisso, J, (2002), Performance
measures in known fallers, The Gerontologist, 42 (10),
S170. Presented at the Annual Meeting of the Gerontological
Society of American, Boston, November 2002.
