Kevin M. Means

Rehabilitation of elderly fallers: Pilot study of a low to moderate intensity exercise program

OBJECTIVE The role of exercise in the prevention of falls and fall-related injuries among elderly persons is unclear. The objective of this study was to assess the response to an exercise-based rehabilitation program intended to improve balance and mobility and reduce or prevent falls. DESIGN Pretest-posttest experimental design with repeated measures at baseline, immediately postintervention, and 6 months postintervention. To assess the effect of repeated exposure to our main outcome measure (the obstacle course), half of the participants (randomly selected) were allowed to practice on the obstacle course. SETTING A veterans affairs medical center. PARTICIPANTS Elderly, ambulatory, community-dwelling volunteers recruited from among local outpatients at our medical center. INTERVENTION Sixty-five volunteers completed a 6-week supervised low to moderate intensity program of stretching, postural control, endurance walking, and coordination exercises designed to improve balance and mobility. Participants were divided into 2 groups: 34 participants who did not practice on the obstacle course during their exercise program and 31 participants who practiced on the obstacle course in addition to their otherwise identical exercise program. MAIN OUTCOME MEASURES Performance on a functionally oriented obstacle course and self-reported falls and fall-related injuries. RESULTS No significant performance differences were found between the two groups. After intervention, mean qualitative obstacle course scores improved modestly (5%) and mean obstacle course completion time decreased by 15% from baseline. These postintervention pairwise performance differences were clinically important but not statistically significant. Relative to baseline levels, postintervention falls and injuries did not change significantly. CONCLUSIONS Our exercise intervention may have the potential to improve functional performance. However, some modifications are necessary to enhance efficacy. The obstacle course may be a useful tool in the evaluation of elderly persons with balance and mobility impairment in the rehabilitation setting.

Use of an obstacle course to assess balance and mobility in the elderly. A validation study

An obstacle course, consisting of a series of 12 simulated functional tasks, has been developed to aid in the evaluation of rehabilitation interventions for elderly individuals with balance and mobility dysfunction. The validity of the obstacle course as a measure of balance and functional mobility was tested by comparing obstacle course performance scores of a sample of 237 community-dwelling veterans, aged 67 to 93 yr, with clinical indicators of balance and mobility including age, history of falls, symptoms of balance dysfunction, medication use, orthostatic blood pressure changes, neurologic examination abnormalities, muscle strength, joint range of motion, self-reported activity level, and functional status. Significant correlations were found between obstacle course scores and all clinical indicators except blood pressure changes and age. Multiple regression analysis of selected variables showed that activity level and neurologic abnormalities best determined both qualitative and quantitative obstacle course performance. Non-fallers performed significantly better on the obstacle course than fallers. These results suggest that the obstacle course is valid and has potential as a useful tool in the evaluation of older persons with balance and mobility impairment.

Obstacle Course Performance and Risk of Falling in Community-Dwelling Elderly Persons

OBJECTIVE To determine the efficacy of obstacle course performance scores in predicting persons at risk for falls, after adjusting for age, sociodemographic, health-status, and physiologic variables. DESIGN Correlational descriptive study design utilizing a logistic regression model. SETTING Community setting. PATIENTS OR PARTICIPANTS A convenience sample of 352 community-dwelling elderly individuals at sites in a metropolitan area. MAIN CRITERION MEASURE: Number of falls reported prospectively during a 2-year follow-up period. RESULTS Obstacle course performance, fall history, symptoms of balance dysfunction, and activity level distinguished those who fell and those who did not 12 and 18 months later. At 24 months, range of motion and number of medications also were significant. In multivariate logistic regression, only history of a fall was a significant predictor of future falling at 12 and 18 months; at 24 months, the presence of balance dysfunction symptoms was the significant predictor of those who fell. CONCLUSIONS The obstacle course, as a predictor of future falls, is not superior to the question of whether or not an individual has fallen in the previous year, and is not recommended to predict future falls. The obstacle course may be better as a short-term indicator of response to a rehabilitation program for balance and mobility.

Osteoarthritic KNEE OR HIP PAIN: Possible Indicators in Elderly Adults with Cognitive Impairment

Many elderly individuals with cognitive impairment (CI) suffer from chronic pain resulting from osteoarthritis (OA). They have diminished ability to communicate their pain to health care providers, and when pain is undetected, it may be untreated. A method of detecting chronic OA pain in elderly individuals with Cl and measuring treatment outcomes is thus urgently needed. This article examines indicators of chronic OA pain in cognitively intact elderly individuals that could be used to identify pain in elderly individuals with Cl. The review suggests that patients with severe knee or hip OA pain tend to show specific motor patterns, disturbances of gait patterns, and reduction of activity level. Therefore, these behaviors could serve as alternatives to verbal report of chronic pain in elderly individuals with Cl and knee or hip OA.