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A home-based, carer-enhanced exercise program improves balance and falls efficacy in community-dwelling older people with dementia

  • Morag E. Taylor (a1) (a2), Stephen R. Lord (a3) (a4), Henry Brodaty (a5) (a6) (a7), Susan E. Kurrle (a2), Sarah Hamilton (a1), Elisabeth Ramsay (a1), Lyndell Webster (a1), Narelle L. Payne (a1) and Jacqueline C. T. Close (a1) (a8)...

Abstract

Background:

Older people with dementia are at increased risk of physical decline and falls. Balance and mood are significant predictors of falls in this population. The aim of this study was to determine the effect of a tailored home-based exercise program in community-dwelling older people with dementia.

Methods:

Forty-two participants with mild to moderate dementia were recruited from routine health services. All participants were offered a six-month home-based, carer-enhanced, progressive, and individually tailored exercise program. Physical activity, quality of life, physical, and psychological assessments were administered at the beginning and end of the trial.

Results:

Of 33 participants (78.6%) who completed the six-month reassessment ten (30%) reported falls and six (18%) multiple falls during the follow-up period. At reassessment, participants had better balance (sway on floor and foam), reduced concern about falls, increased planned physical activity, but worse knee extension strength and no change in depression scores. The average adherence to the prescribed exercise sessions was 45% and 22 participants (52%) were still exercising at trial completion. Those who adhered to ≥70% of prescribed sessions had significantly better balance at reassessment compared with those who adhered to <70% of sessions.

Conclusions:

This trial of a tailored home-based exercise intervention presents preliminary evidence that this intervention can improve balance, concern about falls, and planned physical activity in community-dwelling older people with dementia. Future research should determine whether exercise interventions are effective in reducing falls and elucidate strategies for enhancing uptake and adherence in this population.

Copyright

Corresponding author

* Correspondence should be addressed to: Morag Taylor, Neuroscience Research Australia, Barker Street, Randwick, NSW, 2031, Australia. Phone: +61293991852; Fax: +61293991204. Email: m.taylor@neura.edu.au.

References

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Baker, N. L., Cook, M. N., Arrighi, H. M. and Bullock, R. (2011). Hip fracture risk and subsequent mortality among Alzheimer's disease patients in the United Kingdom, 1988-2007. Age and Ageing, 40, 4954.
Bedard, M., Molloy, D. W., Squire, L., Dubois, S., Lever, J. A. and O'donnell, M. (2001). The zarit burden interview: a new short version and screening version. Gerontologist, 41, 652657.
Bridle, C., Spanjers, K., Patel, S., Atherton, N. M. and Lamb, S. E. (2012). Effect of exercise on depression severity in older people: systematic review and meta-analysis of randomised controlled trials. British Journal of Psychiatry, 201, 180185.
Brodie, M. A. et al. (2015). Wearable pendant device monitoring using new wavelet-based methods shows daily life and laboratory gaits are different. Medical and Biological Engineering and Computing. doi: 10.1007/s11517-015-1357-9.
Burton, E. et al. (2015). Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis. Clinical Interventions in Aging, 10, 421434.
Close, J. C. et al. (2014). Can a tailored exercise and home hazard reduction program reduce the rate of falls in community dwelling older people with cognitive impairment: protocol paper for the i-FOCIS randomised controlled trial. BMC Geriatrics, 14, 89.
Delbaere, K., Close, J. C., Taylor, M., Wesson, J. and Lord, S. R. (2013). Validation of the iconographical falls efficacy scale in cognitively impaired older people. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 68, 10981102.
Delbaere, K., Hauer, K. and Lord, S. R. (2010). Evaluation of the incidental and planned activity questionnaire for older people. British Journal of Sports Medicine, 44, 10291034.
Delbaere, K., Smith, S. T. and Lord, S. R. (2011). Development and initial validation of the iconographical falls efficacy scale. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 66, 674680.
Forbes, D., Forbes, S. C., Blake, C. M., Thiessen, E. J. and Forbes, S. (2015). Exercise programs for people with dementia. Cochrane Database of Systematic Reviews, 4, CD006489.
Gruber-Baldini, A. L. et al. (2003). Cognitive impairment in hip fracture patients: timing of detection and longitudinal follow-up. Journal of the American Geriatrics Society, 51, 12271236.
Jongenelis, K. et al. (2005). Diagnostic accuracy of the original 30-item and shortened versions of the geriatric depression scale in nursing home patients. International Journal of Geriatric Psychiatry, 20, 10671074.
Jung, M.-C. and Hallbeck, M. S. (2004). Quantification of the effects of instruction type, verbal encouragement, and visual feedback on static and peak handgrip strength. International Journal of Industrial Ergonomics, 34, 367374.
Lamb, S. E., Jorstad-Stein, E. C., Hauer, K. and Becker, C. (2005). Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. Journal of the American Geriatrics Society, 53, 16181622.
Logsdon, R. G., Gibbons, L. E., Mccurry, S. M. and Teri, L. (1999). Quality of life in Alzheimer's disease: patient and caregiver reports. Journal of Mental Health and Aging, 5, 2132.
Lord, S. R., Menz, H. B. and Tiedemann, A. (2003). A physiological profile approach to falls risk assessment and prevention. Physical Therapy, 83, 237252.
Lord, S. R., Ward, J. A. and Williams, P. (1996). Exercise effect on dynamic stability in older women: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 77, 232236.
Mioshi, E., Dawson, K., Mitchell, J., Arnold, R. and Hodges, J. R. (2006). The Addenbrooke's cognitive examination revised (ACE-R): a brief cognitive test battery for dementia screening. International Journal of Geriatric Psychiatry, 21, 10781085.
Perneger, T. V. (1998). What's wrong with Bonferroni adjustments. British Medical Journal, 316, 12361238.
Pitkäla, K. H. et al. (2013a). Effects of the finnish alzheimer disease exercise trial (FINALEX): a randomized controlled trial. JAMA Internal Medicine, 173, 894901.
Pitkälä, K., Savikko, N., Poysti, M., Strandberg, T. and Laakkonen, M. L. (2013b). Efficacy of physical exercise intervention on mobility and physical functioning in older people with dementia: a systematic review. Experimental Gerontology, 48, 8593.
Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W. and Ferri, C. P. (2013). The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer's and Dementia, 9, 6375.e62.
Sherrington, C., Tiedemann, A., Fairhall, N., Close, J. C. and Lord, S. R. (2011). Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bulletin, 22, 7883.
Suttanon, P. et al. (2013). Feasibility, safety and preliminary evidence of the effectiveness of a home-based exercise programme for older people with Alzheimer's disease: a pilot randomized controlled trial. Clinical Rehabilitation, 27, 427438.
Taylor, M. E., Delbaere, K., Lord, S. R., Mikolaizak, A. S., Brodaty, H. and Close, J. C. (2014). Neuropsychological, physical, and functional mobility measures associated with falls in cognitively impaired older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 69, 987995.
Taylor, M. E., Delbaere, K., Lord, S. R., Mikolaizak, A. S. and Close, J. C. T. (2013). Physical impairments in cognitively impaired older people: implications for risk of falls. International Psychogeriatrics, 25, 148156.
Taylor, M. E., Lord, S. R., Delbaere, K., Mikolaizak, A. S. and Close, J. C. T. (2012). Physiological fall risk factors in cognitively impaired older people: a one-year prospective study. Dementia and Geriatric Cognitive Disorders, 34, 181189.
Vreugdenhil, A., Cannell, J., Davies, A. and Razay, G. (2012). A community-based exercise programme to improve functional ability in people with Alzheimer's disease: a randomized controlled trial. Scandinavian Journal of Caring Sciences, 26, 1219.
Wesson, J. et al. (2013). A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia. BMC Geriatrics, 13, 89.
Yardley, L., Kirby, S., Ben-Shlomo, Y., Gilbert, R., Whitehead, S. and Todd, C. (2008). How likely are older people to take up different falls prevention activities? Preventive Medicine, 47, 554558.

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A home-based, carer-enhanced exercise program improves balance and falls efficacy in community-dwelling older people with dementia

  • Morag E. Taylor (a1) (a2), Stephen R. Lord (a3) (a4), Henry Brodaty (a5) (a6) (a7), Susan E. Kurrle (a2), Sarah Hamilton (a1), Elisabeth Ramsay (a1), Lyndell Webster (a1), Narelle L. Payne (a1) and Jacqueline C. T. Close (a1) (a8)...

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