Prevention of injurious falls and fractures in an aged population
Falling accidents are the commonest group of accidents in the aged. Osteoporosis is common in old age. Fractures are usually consequences of falls of persons with osteoporotic bones. Falls of persons with nonosteoporotic bones lead to minor injuries or other major injuries than fractures. The costs of treatments of fractures and other injuries due to falls are high. Physical disabilities due to fractures and other major injuries in the aged are usually long-lasting, and may lead to the need of continuous care by important others or by social and health services.
The most effective results of prevention of fractures and other injurious falls in the aged living at home have been obtained when narrowly or broadly focused actions are individually directed at extrinsic or intrinsic risk factors in critically selected risk groups. Narrowly focused programs have included physical exercise guided by a physiotherapist or a nurse, removal of hazard factors at home and reduction of psycho-pharmaceuticals. Broad programs with effective results have included multiprofessional comprehensive geriatric assessment and an individually implemented prevention directed at many risk factors.
The overall aim of this research program was to implement intervention to prevent fractures and other injurious falls in an aged population, to assess the effects of the intervention and to draw conclusions about the effectiveness of the intervention. The intervention was implemented in home-dwelling persons aged 65 years or over, living in Pori, whose cognitive and physical abilities were good, and who had fallen during the previous 12 months. A randomised, controlled design was used. The preventive intervention was broad, consisting of multiprofessional assessments and individually tailored functions according to the assessments and aimed at preventing both intrinsic and extrinsic risk factors. Continuous individual counselling and guidance, and continuous physical group activities based on findings in the assessments were included in the preventive program. The main focus in prevention was on muscle strength, balance, eye vision, medications, depression and treatment and prevention of osteoporosis. A reduction of hazard factors in homes was included in the program. The control program consisted of counselling and guidance (only once) after a comprehensive assessment. Measures of effects consisted of changes in risk factors, incidences of fractures and other injurious falls, physical, cognitive, physic and social functional abilities and quality of life. Use of social and health care services and deaths due to injurious falls were measured, too. The implementation of the study started in February 2003 and the intervention and data collection phase lasted until March, 2005. The analyzing and reporting phase of this study will last until 2010.
19th Nordic Congress of Gerontology
Sirkka-Liisa Kivelä
Marika Salminen
BERZELIUS SYMPOSIUM 77, November 6-7, 2008, Stockholm, Sweden