Skip to main content Accessibility help
×
Home
Hostname: page-component-7ccbd9845f-w45k2 Total loading time: 1.479 Render date: 2023-02-01T20:06:57.582Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

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

Published online by Cambridge University Press:  03 October 2016

Morag E. Taylor*
Affiliation:
Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, Sydney, Australia Cognitive Decline Partnership Centre, Sydney Medical School, The University of Sydney, Sydney, Australia
Stephen R. Lord
Affiliation:
School of Public Health and Community Medicine, UNSW, Sydney, Australia Falls and Balance Research Group, Neuroscience Research Australia, UNSW, Sydney, Australia
Henry Brodaty
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry, Medicine, UNSW, Sydney, Australia Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia Centre for Healthy Brain Ageing, School of Psychiatry, Medicine, UNSW, Sydney, Australia
Susan E. Kurrle
Affiliation:
Cognitive Decline Partnership Centre, Sydney Medical School, The University of Sydney, Sydney, Australia
Sarah Hamilton
Affiliation:
Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, Sydney, Australia
Elisabeth Ramsay
Affiliation:
Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, Sydney, Australia
Lyndell Webster
Affiliation:
Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, Sydney, Australia
Narelle L. Payne
Affiliation:
Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, Sydney, Australia
Jacqueline C. T. Close
Affiliation:
Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, Sydney, Australia Prince of Wales Clinical School, Medicine, UNSW, Sydney, Australia
*
*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.

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.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
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.Google Scholar
Lord, S. R., Menz, H. B. and Tiedemann, A. (2003). A physiological profile approach to falls risk assessment and prevention. Physical Therapy, 83, 237252.Google ScholarPubMed
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Perneger, T. V. (1998). What's wrong with Bonferroni adjustments. British Medical Journal, 316, 12361238.CrossRefGoogle Scholar
Pitkäla, K. H. et al. (2013a). Effects of the finnish alzheimer disease exercise trial (FINALEX): a randomized controlled trial. JAMA Internal Medicine, 173, 894901.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Taylor supplementary material

Figure S1

Download Taylor supplementary material(PDF)
PDF 32 KB
Supplementary material: PDF

Taylor supplementary material

Table S1

Download Taylor supplementary material(PDF)
PDF 16 KB
30
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

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

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

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

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

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

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *