[Effect of a multidimensional intervention for prevention of falls in the eldery]

Effects of case management based on preventing falls in older people: A systematic review

BACKGROUND

Falls among older adults can lead to negative consequences with physical, functional, social, and psychological functioning, and a high prevalence of mortality. However, it is still unclear whether case management can reduce the number of falls in this population.

AIMS

The aims of this review were to analyze the effects of case management on preventing falls and reducing risk factors for falls in older people.

METHODS

A systematic review was conducted, searching for and synthesizing clinical trials involving case management in older people who had falls or risk for fall outcomes. Two authors extracted data using predefined data fields, and risk of bias was assessed by the Physiotherapy Evidence Database (PEDro) scale.

RESULTS

Twelve studies were included in the final review. Case management in older people did not significantly reduce the number of falls, falls per person, or severity of falls compared to control groups. Adherence to recommendations in case management ranged from 25% to 88%.

LINKING EVIDENCE TO ACTION

There is limited evidence of reduced rates of falls and specific risk factors for falls among people who received case management interventions. Randomized trials with good quality are needed.

Effects of the nursing intervention Fall prevention in older adults with arterial hypertension using NANDA-I, NIC, and NOC

PURPOSE

To measure the effects of the NIC intervention fall prevention on the magnitude of the NANDA-I Risk for falls' risk factors and of NOC indicators related to falls in older adults with arterial hypertension.

BACKGROUND

Nurses can use nursing taxonomies to provide effective care in preventing falls in specific populations.

METHODS

Clinical, randomized, open, parallel, and multicenter trial following the CONSORT recommendations for nonpharmacological trials. The clinical trial was registered. The research was conducted with 118 older adults allocated to intervention and control groups and matched by sex and age. The intervention was conducted in the participants' homes in three different moments and consisted of nursing activities belonging to the NIC Fall prevention and implemented with the aid of a protocol with operational definitions.

FINDINGS

Three months after the intervention, there was a significant intergroup difference in the frequency of Risk for falls and of the following factors/conditions: cluttered environment, unfamiliar setting, exposure to unsafe weather-related condition, insufficient anti-slip material in the bathroom, history of falls, acute illness, orthostatic hypotension, hearing impairment, and impaired vision. There was also a positive change in the magnitude of the following NOC indicators: risk control, cognitive orientation, knowledge: fall prevention, safe home environment, comfort level, vision compensation behavior, and leisure participation.

CONCLUSIONS

The NIC intervention Fall prevention was effective in modifying risk factors belonging to Risk for falls and NOC indicators related to falls in older adults.

IMPLICATIONS FOR NURSING PRACTICE

The tested intervention is important and should be instituted, mainly by nurses from primary care services who make home visits to older adults.

[Functional physical condition after a multi-component community intervention of active aging: Pragmatic clinical trial]

OBJECTIVE

The objective is to assess the effectiveness of a multicomponent program of active aging in the improvement of the functional physical condition of patients older than 65years old with social risk.

MATERIAL AND METHODS

Pragmatic clinical trial non-blinded.

SETTING

Community activity; primary care and public education center.

PARTICIPANTS

Patients older than 65years and diagnosed with social risk. The patients who attended at the health center and fulfilled the inclusion criteria were selected consecutively (n=102).

INTERVENTIONS

The patients were randomized into the intervention group or to the control group. The intervention included two weekly sessions of 1h of exercise during 4months, monthly health education sessions, and three days of social activities. The control group received the regular tips. The physical conditions were evaluated before and at the end the study.

RESULTS

Eighty of the patients completed the study. Their middle age was 71.5±5 years old, and 91.3% of them were women. There was no significant differences between both groups. After the intervention, all the test for physical qualities improved in the intervention group; in the 6-minutes walk test the patients improved their mark in a 98% from the baseline marks, with an average increase of 65±35m. Flexibility improved in the 60% of the patients (95%CI: 50-70); strength increased an 84% (95%CI: 76-92), and dynamic balance increased a 79% (95%CI: 70-88). In control group improve some test marks but it had no statistical significance.

CONCLUSIONS

The socio-motor intervention program coordinated between health services and educational centers improves the functional physical condition of the elderly with social risk.