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Falls and Bone Health News - March 2015

Exercise for reducing fear of falling in older people living in the community

Many older people are afraid of falling, more so after experiencing a fall. Fear of falling can have a serious impact on an older person's health and life as it often reduces their physical and social activities.

In research conducted by Denise Kendrick et. al, it was hoped to ascertain whether exercise, in the form of a planned, structured, repetitive physical activity aimed at improving physical fitness, helps to reduce fear of falling. Types of exercise interventions include balance training, strength and resistance training and three-dimensional (3D) exercises, such as dance or Tai Chi. Exercise can be provided in various ways. It can involve group sessions where participants are taught in a class by an instructor or individuals may be provided with exercise instruction booklets, DVDs or tapes to enable them to exercise on their own without supervision.

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Occupational Therapy in the prevention and management of falls in adults -2015 COT Guidelines

This year, the College of Occupational Therapists published its guidance entitled, Occupational Therapy in the prevention and management of falls in adults. The aim of this practice guideline is to provide specific evidence-based recommendations that describe the most appropriate care or action to be taken by occupational therapists working with adults who have fallen, are at risk of falling or are fearful of falling. The recommendations are intended to be used alongside the therapist’s clinical expertise in their assessment of need and implementation of interventions. The practitioner is, therefore, ultimately responsible for the interpretation of this evidence-based guideline in the context of their specific circumstances and service users.

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Cost-effectiveness of a home-exercise program among older people after hospitalisation

Older people who have been recently discharged from hospital are at increased risk of falls and deterioration in physical functioning. A study published by the Journal of the American Medical Directors' Association describes an investigation in the cost-effectiveness of a 12-month home-exercise program for older adults following hospitalisation.

An economic evaluation was conducted alongside a randomised controlled trial. The analysis was conducted from the health and community service provider perspective. A total of 340 people aged 60 years and older, with a recent hospital admission, were randomised into exercise and usual care control groups. Incremental costs per extra person showing improvement in mobility performance (using the Short Physical Performance Battery), per person indicating improvement in health (self-reported using a 3-point Likert scale) and per quality-adjusted life year (QALY) gained (utility measured using the EQ-5D) were estimated. Uncertainty was represented using cost-effectiveness acceptability curves. Subgroup analyses for participants with better cognition (above the median MMSE score of 28) also were undertaken.

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