BACKGROUND: Physical activity may be both a risk and protective factor for falls and fall-related fractures. Despite its positive effects on muscle and bone health, physical activity also increases exposure to situations where falls and fractures occur. This paradox could possibly be explained by frailty status. Therefore, the aim of this study was to investigate the associations between physical activity and both falls and fractures, and to determine whether frailty modifies the association of physical activity with falls, and fractures.METHODS: Data of 311 community-dwelling participants aged 75 years or older from the Longitudinal Aging Study Amsterdam, who participated in a three-year longitudinal study with five nine-monthly measurements between 2015/2016 and 2018/2019. Their mean age was 81.1 (SD 4.8) years and frailty was present in 30.9% of the participants. Physical activity in minutes per day was objectively assessed with an inertial sensor (Actigraph) for seven consecutive days. Falls and fractures were assessed every nine months using self-report during an interview over a follow-up period of three years. Frailty was determined at baseline using the frailty index. Associations were estimated using longitudinal logistic regression analyses based on generalized estimating equations.RESULTS: No association between physical activity and falls was found (OR = 1.00, 95% CI: 0.99-1.00). Fall risk was higher in frail compared to non-frail adults (OR = 2.21, 95% CI: 1.33-3.68), but no effect modification was seen of frailty on the association between physical activity and falls. Also no relation between physical activity and fractures was found (OR = 1.00, 95% CI: 0.99-1.01). Fracture risk was higher in frail compared to non-frail adults (OR = 2.81, 95% CI: 1.02-7.75), but also no effect modification of frailty was present in the association between physical activity and fractures.CONCLUSIONS: No association between physical activity and neither falls nor fractures was found, and frailty appeared not to be an effect modifier. However, frailty was a risk factor for falls and fractures in this population of older adults. Our findings suggest that physical activity can be safely recommended in non-frail and frail populations for general health benefits, without increasing the risk of falls.
MULTIFILE
Background: Falls in stroke survivors can lead to serious injuries and medical costs. Fall risk in older adults can be predicted based on gait characteristics measured in daily life. Given the different gait patterns that stroke survivors exhibit it is unclear whether a similar fall-prediction model could be used in this group. Therefore the main purpose of this study was to examine whether fall-prediction models that have been used in older adults can also be used in a population of stroke survivors, or if modifications are needed, either in the cut-off values of such models, or in the gait characteristics of interest. Methods: This study investigated gait characteristics by assessing accelerations of the lower back measured during seven consecutive days in 31 non fall-prone stroke survivors, 25 fall-prone stroke survivors, 20 neurologically intact fall-prone older adults and 30 non fall-prone older adults. We created a binary logistic regression model to assess the ability of predicting falls for each gait characteristic. We included health status and the interaction between health status (stroke survivors versus older adults) and gait characteristic in the model. Results: We found four significant interactions between gait characteristics and health status. Furthermore we found another four gait characteristics that had similar predictive capacity in both stroke survivors and older adults. Conclusion: The interactions between gait characteristics and health status indicate that gait characteristics are differently associated with fall history between stroke survivors and older adults. Thus specific models are needed to predict fall risk in stroke survivors.
Background Fall prevention programs have been proven effective in reducing falls and fall-related injuries in specific target groups and settings. However, implementing these programs on a larger scale often requires adjustments for feasibility. This study assessed the effectiveness of a nationally implemented fall prevention intervention compared to usual care in community-dwelling older adults. Methods This single-blinded, multicentre randomized controlled trial included 264 community-dwelling non- and pre-frail adults, aged 65 years or older with an increased fall risk. The intervention group participated in the In Balance intervention and the control group received general physical activity recommendations. Primary outcomes were the number of falls and fall-related injuries over 12 months. Secondary outcomes included the Timed Up and Go and Four Stage Balance Test, and the 36-Item Short Form Health Survey. We imputed missing data by multiple imputation, and analysed outcomes using generalized linear- and linear mixed-effects models. Analyses were done for the total group and stratified for frailty status. Results The mean number of falls per person over 12 months was not statistically different between the intervention and control group (respectively 1.67 (SE 0.24) and 1.98 (0.37); incidence rate ratio 0.85 (95% CI 0.51-1.43)), nor the mean number of fall-related injuries (respectively 0.70 (SE 0.11) and 0.97 (0.18); incidence rate ratio 0.73 (95% CI 0.44-1.19)). Secondary outcomes also showed no significant differences between group, frailty status and over time. Conclusions Although the number of falls and fall-related injuries was lower among In Balance participants, and balance, mobility, physical function, and emotional well-being improved, these differences were not statistically significant. Impact statement The implemented In Balance program appears to be less effective than a priori assumed, possibly due to insufficient adherence to the program in practice.
Het hoofddoel van het FRIEND-project is om tot succesvolle implementatie van integrale valpreventie-interventies in de wijk te komen. Aan de hand van actiegericht onderzoek streven we naar inzicht en realisatie van succesvolle implementatiestrategieën, waarbij specifiek wordt ingegaan op interprofessionele samenwerking en op het werven en behouden van ouderen voor deze valpreventie-interventies (VPI’s). Dit is belangrijk omdat de potentie van bewezen effectieve VPI’s niet wordt bereikt doordat deze in bepekte mate daadwerkelijk worden geïmplementeerd. Door een betere implementatie in de dagelijkse praktijk kunnen VPI’s een belangrijke bijdrage leveren aan het behoud van (fysieke) zelfredzaamheid van thuiswonende ouderen. De huidige implementatie van bestaande effectieve VPI’s is niet optimaal door o.a. onvoldoende aansluiting bij de wensen en behoeften van ouderen en onvoldoende samenwerking tussen de professionals in de wijk. Het nu ook niet goed kunnen betrekken van deze stakeholders, zou ten koste gaan van effectiviteit van de door ons ontwikkelde implementatiestrategieën. Extra tijdsinvestering is daarom noodzakelijk om ouderen en professionals te bereiken en te motiveren, daarnaast om activiteiten zo vorm te geven dat ze passen bij de wensen en behoeften van betrokkenen t.a.v. de Corona-maatregelen en de actuele omstandigheden. Het uitgangspunt blijft om zoveel mogelijk vast te houden aan het oorspronkelijke onderzoeksplan. Echter, hebben sommige onderzoeksactiviteiten meer tijd gekost en zal dat de komende periode ook zo zijn doordat meer moeite gedaan moet worden voor werving, er extra maatregelen worden genomen bij fysieke ontmoetingen, er meerdere scenario’s uitgedacht worden en er mogelijk meerdere sessies georganiseerd moeten worden. Daarnaast zullen we door de opgedane vertraging later dan oorspronkelijk gepland, starten met de echte implementatie in de wijk. De budget-neutrale verlenging die is geboden zal worden ingezet om de monitoring zo dicht mogelijk bij de oorspronkelijk periode van 48 maanden te laten zijn. De op te leveren resultaten zijn onveranderd t.o.v. het oorspronkelijke voorstel.
