PICKING THE RIGHT COMMUNITY BASED FALL PREVENTION PROGRAM
OK, the senior centers are still closed for the most of the country, but we all hope they will start opening soon.
They have so many programs there , and each program is touted to be better than others, but how does one go about picking something that will help you stay safe on your feet? Every senior center offers something for preventing falls, but does it work? Is it supported by scientific evidence? What if there are several programs offered that are supported by evidence, do they all work the same for different people, or does one program work best for some and other for others? How does one go about deciding this information? Do physicians know how to recommend the best community based fall prevention program that one can take at a local senior center (when they finally open them, let’s hope soon already?) Till recently there was no evidence supported methodology for picking the right fall prevention program for older adults. Recent review article by Dr Atanelov, MD published in the Journal of Cardiac and Pulmonary Rehabilitation (1) summarized multiple studies on fall prevention programs at different senior centers and generated an algorithm that can be used by laymen and physicians based on the evidence for the different studies on how to pick best program for each and every patient.
Why are community based programs important for preventing falls? First of all because this is not physical therapy, these programs don’t go through your insurance, that means there are no insurance co-pays, no doctor and/or physical therapist visits, no prescriptions to worry about. Second of all these programs are very reasonably priced, usually under $20-$50 for the whole course, much less than the copays for physical therapy usually (depending on insurance of course). Finally, these programs are currently part of the Center for Disease Control recommendations on their guideline for physicians for prevention of falls in older adults called the STEADI: Stopping Elderly Accidents, Deaths and Injuries algorithm for fall risk screening, assessment, and intervention (2), however the CDC algorithm currently lacks any direction on which programs to select for a given patient at risk of falls.
Work by Dr Atanelov and Corey Hamel fills the gap by creating a simple to use algorithm based on the available published evidence, efficacy demonstrated in randomized controlled studies and prevalence of these programs nationally. Fall reduction efficacy was deemed to be appropriate only if study demonstrated reduction in falls, recurrent falls or falls rate as a primary outcome in a randomized controlled study. National prevalence at SCs was estimated directly from date from SCs when such data was available (3) or inferred based on their approximate relative national prevalence (4).
OK, so how does it work?
Simple! If the patient can’t walk around outdoors independently we recommend signing up for the OTAGO exercise program which can be safely performed at home and does show reduction in falls. Notably, this program can only be performed by a licensed physical therapist who has additional training in the OTAGO protocol. If the patient can walk outdoors, but has limited exercise capacity (e.g. gets short of breath or tires easily) perhaps choosing Tai Ji Quan would be preferred. This program does not have to be delivered by a physical therapist, but again a licensed practitioner should be used. It should be noted that this program is NOT the same as the traditional Tai Chi. If the patient walks about independently outdoors without endurance deficits we recommend signing up for Stepping On, a program that combines education, exercise and group behavior modification techniques. Each of these programs have been shown in high quality studies to help reduce falls in older adults and should be utilized.
One last important pointer: preventing falls is complex and we usually recommend working with a fall prevention specialist to help properly diagnose and treat the many different conditions that may result in falls to have a lasting significant reduction in fall rate. Community based programs described above should be utilized as an adjunct, not as a primary intervention to help prevent falls.
~Adapted from https://www.steadystridesmd.com/blog/2020/8/12/picking-the-right-community-based-fall-prevention-program
Hamel C, Atanelov L, Community-Based Programs to Prevent the Risk of Elderly Falls: Mini Review J Card Pulm Rehabil 2020 Jun 8; 4(1):129
STEADI: Stopping Elderly Accidents, Deaths and Injuries https://www.cdc.gov/steadi/pdf/STEADI-Algorithm-508.pdf
Hamel C, Hekmatjah N, Hakakian B, Banooni M, Lalezari J, et al. 2019. Evidence-Based Community Fall Prevention Programs at Senior Centers Near 10 US Academic Centers. J Am GeriatrSoc 67: 1484-1488
Smith M, Towne S, Herrera-Venson A, Cameron K, Horel SA, et al. (2018) Delivery of fall prevention interventions for at-risk older adults in rural areas: Findings from a national dissemination. Int J Environ Res Public Health 15: 2798