A community-based experimental investigation is proposed to assess the impact of physical and cognitive activity on the vulnerability for falls among adults, age sixty and over. Exercise and cognitive-behavioral programs, which have been suggested in the literature to buffer against falling but which have never been tested experimentally, have been chosen for the present study to meet the needs of the elderly in reducing their vulnerability for falls and associated injuries. If these intervention strategies prove successful, then preventive programs can be easily administered at senior centers and retirement facilities. Risk factors associated with falls that have been identifeid in prospective studies are imparied proprioception and environmental perception, self-imposed confinement and inactivity, decreased muscular strength, slowed reaction times, and certain medications. The present proposal is designed to evaluate experimentally two approaches in addressing risk factors to falls: 1) a physical activity program to improve balance, strength, response time, and gait; 2) a cognitive-behavioral program to lower the fear of falling, to increase self-confidence, and to break the self-imposed confinement of the home. for each of the two programs, four classes of approximately 15 participants will be taught three times per week for twelve months. A third group will function as an information control group by receiving the same information on decreasing the risks of falls as the treatment groups (no regular classes will be held.) At senior centers, 150 older adults who sign up for research programs on falls, will be matched on age and sex and randomly assigned to one of the three groups. After 6, 12, 18 and 24 months certain physiological and psychological risk factors associated with falling will be assessed. Falls and associated injuries will be monitored with brief, monthly questionnaires over the twenty-four month period of the study. While lowering the frequency of falls and concommitant injuries is the main goal of the proposed investigation, decreased fear of falling, increased self-confidence, imporved perception of health, improved balance, strength, and response speed and gait, are equally important outcomes. These factors represent more sensitive measures of change related to fall than falls per se, which are a very serious albeit relatively infrequent outcome. In sum, it is hypothesized that for participants in the physical and cognitive activity programs there will be a decrease in the risk factors associated with falls as well as a decrease in falls and in falls do occur the severity of the falls will be decreased.
| Feltner, M E; MacRae, P G; McNitt-Gray, J L (1994) Quantitative gait assessment as a predictor of prospective and retrospective falls in community-dwelling older women. Arch Phys Med Rehabil 75:447-53 |
| Reinsch, S; MacRae, P; Lachenbruch, P A et al. (1992) Attempts to prevent falls and injury: a prospective community study. Gerontologist 32:450-6 |
