Nina Beyer

Recommendations for promoting the engagement of older people in activities to prevent falls

Objective: To develop recommendations for promoting uptake of and adherence to falls-prevention interventions among older people. Design: The recommendations were initially developed from literature review, clinical experience of the core group members, and substantial qualitative and quantitative studies of older people’s views. They were refined through a consultation process with members of the falls-prevention community, drawing on Delphi survey and nominal group techniques. Transparency was enhanced by recording and reporting aspects of the iterative consultation process such as the degree of consensus and critical comments on drafts of the recommendations. Setting: The recommendations were developed and refined at three meetings of the core group, and through internet-based consultation and two meetings involving members of the wider falls-prevention community. Participants: The authors developed the recommendations incorporating the feedback from the researchers and practitioners responding to a broad-based internet consultation and consulted in the meetings. Results: A high degree of consensus was achieved. Recommendations addressed the need for public education, ensuring that interventions were compatible with a positive identity, tailoring interventions to the specific situation and values of the individual, and using validated methods to maintain longer-term adherence. Conclusion: These recommendations represent a consensus based on current knowledge and evidence, but the evidence base from which these recommendations were developed was limited, and not always specific to prevention of falls. To increase the effectiveness of falls-prevention interventions, further research is needed to identify the features of falls-prevention programmes that will encourage older people’s engagement in them.

Effectiveness of physical training on motor performance and fall prevention in cognitively impaired older persons: a systematic review.

Hauer K, Becker C, Lindemann U, Beyer N: Effectiveness of physical training on motor performance and fall prevention in cognitively impaired older persons: A systematic review. Am J Phys Med Rehabil 2006;85:847–857. Objective:To determine whether older cognitively impaired people benefit from physical training with regard to motor performance or fall risk reduction and to critically evaluate the methodologic approach in identified randomized controlled intervention trials. Design:Published randomized controlled intervention trials from 1966 through 2004 were identified in PubMed, CINAHL, Gerolit, and the Cochrane Central Register of Controlled Trials according to predefined inclusion criteria and evaluated by two independent reviewers using a modified rating system for randomized controlled intervention trials developed by the Cochrane Library. Results:There were 11 randomized controlled intervention trials that met the predefined inclusion criteria. There was a large heterogeneity regarding methodology, sample size, type of intervention, study outcomes, and analyses. We found conflicting evidence regarding the effect of physical training on motor performance and falls in older people with cognitive impairment. However, a considerable number of the studies had methodologic limitations, which hampered the evaluation of the effectiveness of training. Conclusions:The randomized controlled intervention trials showed only limited effectiveness of physical training in patients with cognitive impairment. More studies with adequate sample size, sensitive and validated measurements, and higher specificity for the types of intervention targeting subgroups of patients with different degrees of cognitive impairment are required to give evidence-based recommendations.

Validation of the Falls Efficacy Scale and Falls Efficacy Scale International in geriatric patients with and without cognitive impairment: results of self-report and interview-based questionnaires.

Background: Frail, old patients with and without cognitive impairment are at high risk of falls and associated medical and psychosocial issues. The lack of adequate, validated instruments has partly hindered research in this field. So far no questionnaire documenting fall-related self-efficacy/fear of falling has been validated for older persons with cognitive impairment or for different administration methods such as self-report or interview. Objective: To validate the self-report and interview version of the Falls Efficacy Scale (FES) and the Falls Efficacy Scale International Version (FES-I) in frail geriatric patients with and without cognitive impairment. Methods: 156 geriatric patients in geriatric rehabilitations wards with (n = 75) and without cognitive impairment (n = 81) were included in this study. Reports of fall-related self-efficacy were based on self-reported and interview-based questionnaires. Descriptive statistics, reliability estimates and validation results were computed for the total group and sub-samples with respect to cognitive status, for the 2 different questionnaires (FES/FES-I) and for the 2 administration methods. Test-retest reliability was tested in a subsample of 62 patients. Results: Internal reliability and test-retest reliability were good to excellent in both the FES and FES-I, with the FES-I showing better internal reliability and the FES better test-retest reliability with respect to cognitively impaired persons. The group of cognitively impaired persons tended to show lower test-retest reliability and mean fall-related self-efficacy and had significantly lower completion rates in self-administered questionnaires. As indicated by significant differences in parameters closely related to falls, such as vertigo, functional performances, fear of falling and history of falls, both the FES and the FES-I showed good construct validity. Effect sizes computed for the above-mentioned groups for fall-related parameters confirmed the results of construct validation. Conclusion: Both the FES as well as the FES-I showed good to excellent measurement properties in persons with and without moderate cognitive impairment. In frail older persons, especially in persons with cognitive impairment, an interview-based administration method is recommended.

Nonsteroidal anti-inflammatory drug or glucosamine reduced pain and improved muscle strength with resistance training in a randomized controlled trial of knee osteoarthritis patients.

OBJECTIVES To investigate the effect of 12 weeks of strength training in combination with a nonsteroidal anti-inflammatory drug (NSAID), glucosamine, or placebo on muscle cross-sectional area (CSA), strength (primary outcome parameters), and function, power, pain, and satellite cell number (secondary outcome parameters) in patients with knee osteoarthritis (OA). DESIGN Double-blinded, randomized controlled trial. SETTING Hospital. PARTICIPANTS Patients (N=36; 20 women, 16 men; age range, 50-70y) with bilateral tibiofemoral knee OA. A total of 181 patients were approached, and 145 were excluded. INTERVENTIONS Patients were randomly assigned to treatment with the NSAID ibuprofen (n=12), glucosamine (n=12), or placebo (n=12) during 12 weeks of quadriceps muscle strength training. MAIN OUTCOME MEASURES Muscle CSA and strength. RESULTS No differences between groups were observed in gains in muscle CSA. Training combined with ibuprofen increased maximal isometric strength by an additional .22Nm/kg (95% confidence interval [CI], .01-.42; P=.04), maximal eccentric muscle strength by .38Nm/kg (95% CI, .05-.70; P=.02), and eccentric muscle work by .27J/kg (95% CI, .01-.53; P=.04) in comparison with placebo. Training combined with glucosamine increased maximal concentric muscle work by an additional .24J/kg versus placebo (95% CI, .06-.42; P=.01). CONCLUSIONS In patients with knee OA, NSAID or glucosamine administration during a 12-week strength-training program did not improve muscle mass gain, but improved maximal muscle strength gain in comparison with treatment with placebo. However, we do not find that the benefits are large enough to justify taking NSAIDs or glucosamine.

Die Deutsche Version der Falls Efficacy Scale-International Version (FES-I)

ZusammenfassungVorgestellt wird die deutsche Version der Falls Efficacy Scale-International Version (FES-I). Dieser Fragebogen zur Erfassung sturzassoziierter Selbstwirksamkeit bei älteren Menschen wurde im Rahmen eines Experten- Netzwerks zur Sturzprävention (Prevention of Falls Network Europe ProFaNE) entwickelt. Die FES-I stellt eine Erweiterung der Falls Efficacy Scale (FES) dar, in der zum einen komplexere funktionelle Aktivitäten und zum anderen soziale Aspekte der Selbstwirksamkeit zusätzlich aufgenommen wurden. Die FES-I zeigt sowohl eine hohe interne Konsistenz (Cronbachs α = 0,96) als auch eine hohe Retest-Reliabilität (r = 0,96). Die Item-Interkorrelation betrug im Mittel r = 0,55 (Range r = 0,29– 0,79). Ergebnisse von Validierungsstudien bei zu Hause lebenden Älteren aus unterschiedlichen europäischen Ländern und von geriatrischen Patienten mit kognitiver Schädigung werden in Kürze publiziert.SummaryThe German version of the Falls Efficacy Scale-International Version (FES-I), which is presented, was developed for the documentation of fall-related selfefficacy in older persons by a EU-funded expert network (Prevention of Falls Network Europe ProFaNE). The FES-I represents a modification of the original Falls Efficacy Scale (FES), including additional items on complex functional performances and social aspects of falls. The FES-I shows high internal reliability (Cronbach’s α = 0.96) as well as high test-retest reliability (r=0.96). The mean inter-item correlation was: r = 0.55 (Range r = 0.29–0.79). Results of validation studies for the FES-I in community dwelling older persons for different European countries and geriatric patients with cognitive impairment will be published in the near future.

[The German version of the Falls Efficacy Scale-International Version (FES-I)].

ZusammenfassungVorgestellt wird die deutsche Version der Falls Efficacy Scale-International Version (FES-I). Dieser Fragebogen zur Erfassung sturzassoziierter Selbstwirksamkeit bei älteren Menschen wurde im Rahmen eines Experten- Netzwerks zur Sturzprävention (Prevention of Falls Network Europe ProFaNE) entwickelt. Die FES-I stellt eine Erweiterung der Falls Efficacy Scale (FES) dar, in der zum einen komplexere funktionelle Aktivitäten und zum anderen soziale Aspekte der Selbstwirksamkeit zusätzlich aufgenommen wurden. Die FES-I zeigt sowohl eine hohe interne Konsistenz (Cronbachs α = 0,96) als auch eine hohe Retest-Reliabilität (r = 0,96). Die Item-Interkorrelation betrug im Mittel r = 0,55 (Range r = 0,29– 0,79). Ergebnisse von Validierungsstudien bei zu Hause lebenden Älteren aus unterschiedlichen europäischen Ländern und von geriatrischen Patienten mit kognitiver Schädigung werden in Kürze publiziert.SummaryThe German version of the Falls Efficacy Scale-International Version (FES-I), which is presented, was developed for the documentation of fall-related selfefficacy in older persons by a EU-funded expert network (Prevention of Falls Network Europe ProFaNE). The FES-I represents a modification of the original Falls Efficacy Scale (FES), including additional items on complex functional performances and social aspects of falls. The FES-I shows high internal reliability (Cronbach’s α = 0.96) as well as high test-retest reliability (r=0.96). The mean inter-item correlation was: r = 0.55 (Range r = 0.29–0.79). Results of validation studies for the FES-I in community dwelling older persons for different European countries and geriatric patients with cognitive impairment will be published in the near future.

Effect of strength training on muscle function in elderly hospitalized patients.

Immobilization due to hospitalization and major surgery leads to an increased risk of morbidity, disability and a decline in muscle function especially in frail elderly individuals. In fact, many elderly patients fail to regain their level of function and self‐care before admission to hospital. Given that reduced lower limb muscle strength and loss of skeletal muscle mass (i.e. sarcopenia) have been associated with functional impairments and disability with aging, attempts to counteract this process seem highly relevant. In recent years, strength training has emerged as an effective method to induce muscle hypertrophy and increase muscle strength and functional performance in frail elderly individuals. Furthermore, there is increasing evidence that strength training is an effective method to restore muscle function in post‐operative patients and in patients with chronic diseases. Despite this, strength training is rarely used in the rehabilitation of hospitalized elderly patients. The current knowledge on this topic will be the focus of this review.

Moderate-to-High Intensity Physical Exercise in Patients with Alzheimer's Disease: A Randomized Controlled Trial

BACKGROUND Studies of physical exercise in patients with Alzheimers disease (AD) are few and results have been inconsistent. OBJECTIVE To assess the effects of a moderate-to-high intensity aerobic exercise program in patients with mild AD. METHODS In a randomized controlled trial, we recruited 200 patients with mild AD to a supervised exercise group (60-min sessions three times a week for 16 weeks) or to a control group. Primary outcome was changed from baseline in cognitive performance estimated by Symbol Digit Modalities Test (SDMT) in the intention-to-treat (ITT) group. Secondary outcomes included changes in quality of life, ability to perform activities of daily living, and in neuropsychiatric and depressive symptoms. RESULTS The ITT analysis showed no significant differences between intervention and control groups in change from baseline of SDMT, other cognitive tests, quality of life, or activities of daily living. The change from baseline in Neuropsychiatric Inventory differed significantly in favor of the intervention group (mean: -3.5, 95% confidence interval (CI) -5.8 to -1.3, p = 0.002). In subjects who adhered to the protocol, we found a significant effect on change from baseline in SDMT as compared with the control group (mean: 4.2, 95% CI 0.5 to 7.9, p = 0.028), suggesting a dose-response relationship between exercise and cognition. CONCLUSIONS This is the first randomized controlled trial with supervised moderate-to-high intensity exercise in patients with mild AD. Exercise reduced neuropsychiatric symptoms in patients with mild AD, with possible additional benefits of preserved cognition in a subgroup of patients exercising with high attendance and intensity.

Acute hospitalization of the older patient: changes in muscle strength and functional performance during hospitalization and 30 days after discharge.

ObjectiveAcute hospitalization of older patients may be associated with loss of muscle strength and functional performance. The aim of this study was to investigate the effect of acute hospitalization as a result of medical disease on muscle strength and functional performance in older medical patients. DesignIsometric knee-extension strength; handgrip strength; and functional performance, that is, the Timed Up and Go test, were assessed at admission, at discharge, and 30 days after discharge. Twenty-four–hour mobility was measured during hospitalization. ResultsThe mean (SD) age was 82.7 (8.2) years, and the median length of stay was 7.5 days (interquartile range, 4.25–11). Knee-extension strength did not change over time (1.0 [N·m]/kg, 1.1 [N·m]/kg, and 1.1 [N·m]/kg, P = 0.138), as did handgrip strength (24.2 kg, 23.3 kg, and 23.5 kg, P = 0.265). The Timed Up and Go test improved during hospitalization, from 17.3 secs at admission to 13.3 secs at discharge (P = 0.003), but with no improvement at the 30-day follow-up (12.4 secs, P = 0.064). The median times spent in lying, sitting, and standing/walking were 17.4 hrs per day, 4.8 hrs per day, and 0.8 hrs per day, respectively. ConclusionsMuscle strength did not change during hospitalization and 30 days after discharge in the acutely admitted older medical patients. Despite a low level of mobility during hospitalization, functional performance improved significantly during hospitalization, without further improvement.

Exercise and organ transplantation.

Life‐saving treatment of disease by organ transplantation has become increasingly important. Annually over 35 000 transplantations of vital organs are carried out world‐wide and the demand for knowledge regarding exercise in daily life for transplant recipients is growing. The present review describes whole‐body and organ reactions to both acute exercise and regular physical training in persons who have undergone heart, lung, liver, kidney, pancreas or bone marrow transplantation. In response to acute exercise, the majority of cardiovascular, hormonal and metabolic changes are maintained after transplantation. However, in heart transplant recipients organ denervation reduces the speed of heart rate increase in response to exercise. Furthermore, lack of sympathetic nerves to transplanted organs impairs the normal insulin and renin responses to exercise in pancreas and kidney transplant recipients, respectively. In contrast, surgical removal of sympathetic liver nerves does not inhibit hepatic glucose production during exercise, and denervation of the lungs does not impair the ability to increase ventilation during physical exertion. Most studies show that physical training results in an improved endurance and strength capacity in almost all groups of transplant recipients, which is of importance for their daily life. With a little precaution, organ transplant recipients can perform exercise and physical training and obtain effects comparable with those achieved in the healthy population of similar age.