An individually-tailored multifactorial intervention program for older fallers in a middle-income developing country: Malaysian Falls Assessment and Intervention Trial (MyFAIT)

BMC Geriatrics

Maw Pin Tan²  Phillip JH Poi²  Keith D Hill³  Karuthan Chinna⁴  Ee Ming Khoo¹  Pey June Tan⁵ 

[1] Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;Health Promotion Division, National Ageing Research Institute, Parkville, Melbourne, Victoria, Australia;Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;Ageing and Age-Associated Disorders Research Group, Health and Translational Medicine Cluster, University of Malaya, Kuala Lumpur, Malaysia

关键词: Quality of life;    Fear of falling;    Randomized controlled trial;    Asians;    Aged;    Accidental falls;   

Others  :  848355
DOI  :  10.1186/1471-2318-14-78

 received in 2014-03-24, accepted in 2014-06-06,  发布年份 2014

【 摘 要 】

Background

In line with a rapidly ageing global population, the rise in the frequency of falls will lead to increased healthcare and social care costs. This study will be one of the few randomized controlled trials evaluating a multifaceted falls intervention in a low-middle income, culturally-diverse older Asian community. The primary objective of our paper is to evaluate whether individually tailored multifactorial interventions will successfully reduce the number of falls among older adults.

Methods

Three hundred community-dwelling older Malaysian adults with a history of (i) two or more falls, or (ii) one injurious fall in the past 12 months will be recruited. Baseline assessment will include cardiovascular, frailty, fracture risk, psychological factors, gait and balance, activities of daily living and visual assessments. Fallers will be randomized into 2 groups: to receive tailored multifactorial interventions (intervention group); or given lifestyle advice with continued conventional care (control group). Multifactorial interventions will target 6 specific risk factors. All participants will be re-assessed after 12 months. The primary outcome measure will be fall recurrence, measured with monthly falls diaries. Secondary outcomes include falls risk factors; and psychological measures including fear of falling, and quality of life.

Discussion

Previous studies evaluating multifactorial interventions in falls have reported variable outcomes. Given likely cultural, personal, lifestyle and health service differences in Asian countries, it is vital that individually-tailored multifaceted interventions are evaluated in an Asian population to determine applicability of these interventions in our setting. If successful, these approaches have the potential for widespread application in geriatric healthcare services, will reduce the projected escalation of falls and fall-related injuries, and improve the quality of life of our older community.

Trial registration

ISRCTN11674947

【 授权许可】

   
2014 Tan et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]United Nations: World Population Ageing 2009. New York: United Nations: Department of Economic and Social Affairs, Population Division. Report number: ESA/P/WP/212; 2009:9-15.
• [2]Ahmad N, Norzareen M: Women of the sandwich generation in Malaysia. Eur J Soc Sci 2010, 13(2):171-178.
• [3]Health Profile: Malaysia [http://www.worldlifeexpectancy.com/country-health-profile/malaysia webcite]
• [4]Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C: Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 1999, 353(9147):93-97.
• [5]Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE: Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012, 9:CD007146.
• [6]Tromp AM, Smit JH, Deeg DJ, Bouter LM, Lips P: Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. J Bone Miner Res 1998, 13(12):1932-1939.
• [7]Lamb SE, Jørstad-Stein EC, Hauer K, Becker C: Development of a common outcome data set for fall injury prevention trials: the prevention of Falls Network Europe consensus. J Am Geriatr Soc 2005, 53(9):1618-1622.
• [8]Lord SR, Sherrington C, Menz HB: Falls In Older People: Risk Factors and Strategies for Prevention. Printed in the United Kingdom at the University Press, Cambridge: Cambridge University Press; 2001.
• [9]The prevention of falls in later life. A report of the Kellogg international work group on the prevention of falls by the elderly Dan Med Bull 1987, 34(Suppl 4):1-24.
• [10]Rizawati M, Mas Ayu S: Home environment and fall at home among the elderly in Masjid Tanah Province. JUMMEC 2008, 11(2):72-82.
• [11]Zijlstra GA, van Haastregt JC, van Rossum E, van Eijk JT, Yardley L, Kempen GI: Interventions to reduce fear of falling in community-living older people: a systematic review. J Am Geriatr Soc 2007, 55(4):603-615.
• [12]Court-Brown CM, Aitken SA, Ralston SH, McQueen MM: The relationship of fall-related fractures to social deprivation. Osteoporos Int 2011, 22(4):1211-1218.
• [13]Horton K, Dickinson A: The role of culture and diversity in the prevention of falls among older Chinese people. Can J Aging 2011, 30(1):57-66. doi:10.1017/S0714980810000826
• [14]American Geriatrics S: Summary of the updated American geriatrics society/British geriatrics society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 2011, 59(1):148-157.
• [15]Czerwinski E, Bialoszewski D, Borowy P, Kumorek A, Bialoszewski A: Epidemiology, clinical significance, costs and fall prevention in elderly people. Ortop Traumatol Rehabil 2008, 10(5):419-428.
• [16]Eggermont LHPPBWJHJRNLSG: Depressive symptoms, chronic pain, and falls in older community-dwelling adults: the MOBILIZE Boston study. J Am Geriatr Soc 2012, 60(2):230-237.
• [17]Halil M, Ulger Z, Cankurtaran M, Shorbagi A, Yavuz BB, Dede D, Ozkayar N, Ariogul S: Falls and the elderly: Is there any difference in the developing world?: A cross-sectional study from Turkey. Arch Gerontol Geriatr 2006, 43(3):351-359.
• [18]Reuter SE, Massy-Westropp N, Evans AM: Reliability and validity of indices of hand-grip strength and endurance. Aust Occup Ther J 2011, 58(2):82-87.
• [19]Peters MJH, van Nes SI, Vanhoutte EK, Bakkers M, van Doorn PA, Merkies ISJ, Faber CG: Revised normative values for grip strength with the Jamar dynamometer. J Peripher Nerv Syst 2011, 16(1):47-50.
• [20]Duncan PW, Weiner DK, Chandler J, Studenski S: Functional reach: a new clinical measure of balance. J Gerontol 1990, 45(6):M192-M197.
• [21]Schoene D, Wu SMS, Mikolaizak AS, Menant JC, Smith ST, Delbaere K, Lord SR: Discriminative ability and predictive validity of the timed up and go test in identifying older people who fall: systematic review and meta-analysis. J Am Geriatr Soc 2013, 61(2):202-208.
• [22]Large J, Gan N, Basic D, Jennings N: Using the timed up and go test to stratify elderly inpatients at risk of falls. Clin Rehabil 2006, 20(5):421-428.
• [23]Levy AH, McCulley TJ, Lam BL, Feuer WJ: Estimating visual acuity by character counting using the Snellen visual acuity chart. Eye (Lond) 2005, 19(6):622-624.
• [24]Elliott DB, Whitaker D, Bonette L: Differences in the legibility of letters at contrast threshold using the Pelli-Robson chart. Ophthalmic Physiol Opt 1990, 10(4):323-326.
• [25]Costa MF, Moreira SMCF, Hamer RD, Ventura DF: Effects of age and optical blur on real depth stereoacuity. Ophthalmic Physiol Opt 2010, 30(5):660-666.
• [26]Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, Cheshire WP, Chelimsky T, Cortelli P, Gibbons CH, Goldstein DS, Hainsworth R, Hilz MJ, Jacob G, Kaufmann H, Jordan J, Lipsitz LA, Levine BD, Low PA, Mathias C, Raj SR, Robertson D, Sandroni P, Schatz I, Schondorff R, Stewart JM, van Dijk JG: Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011, 21(2):69-72.
• [27]El Haber N, Hill KD, Cassano AM, Paton LM, Macinnis RJ, Cui JS, Hopper JL, Wark JD: Genetic and environmental influences on variation in balance performance among female twin pairs aged 21–82 years. Am J Epidemiol 2006, 164(3):246-256.
• [28]Norton PJ: Depression Anxiety and Stress Scales (DASS-21): Psychometric analysis across four racial groups. Anxiety, Stress Coping 2007, 20(3):253-265.
• [29]Sim J, Bartlam B, Bernard M: The CASP-19 as a measure of quality of life in old age: evaluation of its use in a retirement community. Qual Life Res 2011, 20(7):997-1004.
• [30]Hauer KA, Kempen GIJM, Schwenk M, Yardley L, Beyer N, Todd C, Oster P, Zijlstra GAR: Validity and sensitivity to change of the falls efficacy scales international to assess fear of falling in older adults with and without cognitive impairment. Gerontology 2011, 57(5):462-472.
• [31]Wood BM, Nicholas MK, Blyth F, Asghari A, Gibson S: The utility of the short version of the Depression Anxiety Stress Scales (DASS-21) in elderly patients with persistent pain: does age make a difference? Pain Med 2010, 11(12):1780-1790.
• [32]Hyde M, Wiggins RD, Higgs P, Blane DB: A measure of quality of life in early old age: the theory, development and properties of a needs satisfaction model (CASP-19). Aging Ment Health 2003, 7(3):186-194.
• [33]Delbaere K, Close JCT, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR: The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age Ageing 2010, 39(2):210-216.
• [34]Robertson MC, Campbell AJ, Gardner MM, Devlin N: Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. J Am Geriatr Soc 2002, 50(5):905-911.
• [35]Taylor D, Hale L, Schluter P, Waters DL, Binns EE, McCracken H, McPherson K, Wolf SL: Effectiveness of Tai Chi as a community-based falls prevention intervention: a randomized controlled trial. J Am Geriatr Soc 2012, 60(5):841-848.
• [36]Mackenzie L, Byles J, Higginbotham N: Reliability of the Home Falls and Accidents Screening Tool (HOME FAST) for identifying older people at increased risk of falls. Disabil Rehabil 2002, 24(5):266-274.
• [37]Tan MP, Kenny RA: Cardiovascular assessment of falls in older people. Clin Interv Aging 2006, 1(1):57-66.
• [38]Vind AB, Andersen HE, Pedersen KD, Jørgensen T, Schwarz P: An outpatient multifactorial falls prevention intervention does Not reduce falls in high-risk elderly Danes. J Am Geriatr Soc 2009, 57(6):971-977.
• [39]Huang AR, Mallet L, Rochefort CM, Eguale T, Buckeridge DL, Tamblyn R: Medication-related falls in the elderly: causative factors and preventive strategies. Drugs Aging 2012, 29(5):359-376.
• [40]Russell MA, Hill KD, Day LM, Blackberry I, Schwartz J, Giummarra MJ, Dorevitch M, Ibrahim JE, Dalton AC, Dharmage SC: A randomized controlled trial of a multifactorial falls prevention intervention for older fallers presenting to emergency departments. J Am Geriatr Soc 2010, 58(12):2265-2274.
• [41]Batchelor FA, Hill KD, Mackintosh SF, Said CM, Whitehead CH: Effects of a multifactorial falls prevention program for people with stroke returning home after rehabilitation: a randomized controlled trial. Arch Phys Med Rehabil 2012, 93(9):1648-1655.
• [42]Day LM: Fall prevention programs for community-dwelling older people should primarily target a multifactorial intervention rather than exercise as a single intervention. J Am Geriatr Soc 2013, 61(2):284-285.
• [43]Batchelor F, Hill K, Mackintosh S, Said C: What works in falls prevention after stroke?: a systematic review and meta-analysis. Stroke 2010, 41(8):1715-1722.
• [44]de Negreiros CK, Perracini MR, Soares AT, de Cristo SF, Sera CTN, Tiedemann A, Sherrington C, Filho WJ, Paschoal SMP: Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil). BMC Geriatr 2013, 13:27.
• [45]Jagnoor J, Keay L, Ivers R: A Slip and a Trip?. Injury: Falls in older people in Asia; 2013.
• [46]Edwards NC: Preventing falls among seniors: the way forward. J Safety Res 2011, 42(6):537-541.
• [47]Batchelor FA, Hill KD, Mackintosh SF, Said CM, Whitehead CH: The FLASSH study: protocol for a randomised controlled trial evaluating falls prevention after stroke and two sub-studies. BMC Neurol 2009, 9:14.
• [48]Lee H-C, Chang K-C, Tsauo J-Y, Hung J-W, Huang Y-C, Lin S-I: Effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults with risk of falls. Arch Phys Med Rehabil 2013, 94(4):606.
• [49]Kwan MM-S, Close JCT, Wong AKW, Lord SR: Falls incidence, risk factors, and consequences in Chinese older people: a systematic review. J Am Geriatr Soc 2011, 59(3):536-543.