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Characteristics and effectiveness of fall prevention programs in nursing homes: A systematic review and meta-analysis of randomized controlled trials
S54
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
S. Gillain a , F. Lekeu a , V. Wojtasik a , D. Maquet b , M. Dramé c , J. Petermans a a Geriatric Department, University of Liège, Liège, Belgium b Mobility Sciences Unit, University of Liège, Liège, Belgium c University of Reims Champagne-Ardenne, Faculty of Medicine, EA 3797, France Introduction.– It is still difficult to predict which MCI patients will develop AD. This work shows that an accelerometer could help the clinician to early identify gait parameters that predict AD conversion. Methods.– Gait parameters measured in simple task (ST) and in dual task (DT) (counting backward) were studied in MCI subjects followed up from 2007 to 2011.At baseline (2007), gait parameters were assessed with an accelerometer (Locometrix® ). Patients were considered as converters when they developed AD (between 2007 and 2011); and non-converters if not. Baseline gait parameters were compared between these two groups using Mann-Whitney non-parametric U-Test. Results.– In all, 23 MCI patients were studied. Among them 15 experienced conversion into AD. In ST, gait speed was 1.29 m/s in the NC group versus 1.15 m/s in C group, and cadence was 0.95 into NC versus 0.89 cycle/s into C. In DT, gait speed was 1.18 m/s into NC versus 1.01 m/s into C, and cadence was 0.89 versus 0.80 cycle/s into NC and symmetry (which expresses the similarity between left strides to right strides) was 201 in NC and 220 in C. All these comparisons present a P-value < 0.05. Conclusions.– In our population, gait parameters obtained with an accelerometer (especially the gait speed and the cadence) could predict the risk to develop AD in the MCI patients. http://dx.doi.org/10.1016/j.eurger.2013.07.175 P112
Hip and knee replacement in patients with neurodegenerative disease: A nationwide register-based case-control study E. Jämsen a,b,c , M. Peltola a,b,c , A. Eskelinen a,b,c , T. Puolakka a,b,c , M.U.K. Lehto a,b,c a Coxa, Hospital for Joint Replacement, Tampere, Finland b University of Tampere, Finland c National Institute for Welfare and Health, Tampere, Finland Introduction.– Hip and knee replacements are effective in alleviating pain and restoring function also in the oldest patients with late-stage osteoarthritis. Neurodegenerative diseases, however, may limit pa-tients’ capability to recover from surgery and increase the risk of postoperative complications. Methods.– The PERFECT database, created for monitoring outcomes of joint replacements by combining data from several nationwide Finnish health registers, covers all hip and knee replacements performed for primary osteoarthritis in Finland. It keeps record of postoperative complications and reoperations and also includes comprehensive comorbidity data. For this study, we included patients who were issued drug reimbursement for treatment of Alzheimer’s disease or Parkinson’s disease. For each of these patients, we selected three carefully matched controls. Results.– In 1998–2009, 1688 primary hip and knee replacements were performed in patients with neuro-degenerative disease (ca. 0.2% of all hip and knee replacements). Compared to their controls, patients with neurodegenerative disease had longer perioperative hospitalization (12 vs. 9 days, P < 0.001) and were more frequently still hospitalized 3 months after surgery (4.6% vs. 1.4%, P < 0.001). They also had more hip dislocations (risk ratio 1.34, 95% confidence interval 1.00–1.78) but there was no difference in the rates of postoperative infection and revision surgeries or in 1-year mortality. In longer follow-up pa-tients with Alzheimer’s disease had increased mortality (risk ratio 1.96, 1.79–2.14).
Conclusions.– Neurodegenerative diseases are associated with higher risk for hip dislocation and prolon-ged hospitalization following primary hip and knee replacement. Otherwise, hip and knee replacements appear relatively safe even in this vulnerable patient group. http://dx.doi.org/10.1016/j.eurger.2013.07.176 P113
Characteristics and effectiveness of fall prevention programs in nursing homes: A systematic review and meta-analysis of randomized controlled trials E. Vlaeyen , J. Coussement , G. Leysens , E. Van der Elst , K. Delbaere , D. Cambier , K. Denhaerynck , E. Dejaeger , S. Boonen , K. Milisen ∗,1 University Leuven, Leuven, Belgium ∗ Corresponding author. Introduction.– Falls frequently occur in nursing homes and often lead to serious injuries, psychological consequences and a significant economic burden. Methods.– A systematic review and meta-analyses on a clearly defined subgroup of nursing homes (“residential facilities providing 24-hour-a-day surveillance, personal care and limited care for persons who are typically elderly and infirm”) to determine characteristics and effectiveness of fall prevention programs on fall-related outcomes. MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, SportDiscus and reference lists of relevant articles were systematically screened. Protocol registered on PROSPERO (no. CRD42011001687). Results.– The search resulted in two individual RCTs and 12 cluster RCTs, involving 23 294 residents. There were seven single, one multiple and six multifactorial fall prevention programs. Overall meta-analysis showed significantly less recurrent fallers in the intervention groups (four studies, RR = 0.79, confidence interval (CI) = 0.65–0.97) but no significant effect on number of falls (ten studies, RR = 0.93, 95% CI = 0.76–1.13) or fallers (six studies, RR = 0.97, CI = 0.84–1.11). A preplanned subgroup analysis for different types of intervention showed that multifactorial interventions had a beneficial effect on the number of falls (four studies, RR = 0.67, CI = 0.55–0.82) and recurrent fallers (four studies, RR = 0.79, CI = 0.65–0.97), but not on the number of fallers (4 studies, RR = 0.938, CI = 0.75–1.16). Conclusions.– Multifactorial fall prevention interventions in a defined subgroup of nursing homes may reduce falls and the number of recurrent fallers. 1 On
behalf of the Center of Expertise for Fall & Fracture Prevention Flanders. http://dx.doi.org/10.1016/j.eurger.2013.07.177 P114
Impact of a 6-month training by whole body vibration on functional and motor abilities among nursing home residents observed over a 12-months period F. Buckinx a , C. Beaudart a , M. Demonceau b , D. Maquet b , J.-M. Crielaard b , J.-Y. Reginster a , O. Bruyère a,b a Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium b Department of Motricity Sciences, University of Liège, Liège, Belgium
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
S. Gillain a , F. Lekeu a , V. Wojtasik a , D. Maquet b , M. Dramé c , J. Petermans a a Geriatric Department, University of Liège, Liège, Belgium b Mobility Sciences Unit, University of Liège, Liège, Belgium c University of Reims Champagne-Ardenne, Faculty of Medicine, EA 3797, France Introduction.– It is still difficult to predict which MCI patients will develop AD. This work shows that an accelerometer could help the clinician to early identify gait parameters that predict AD conversion. Methods.– Gait parameters measured in simple task (ST) and in dual task (DT) (counting backward) were studied in MCI subjects followed up from 2007 to 2011.At baseline (2007), gait parameters were assessed with an accelerometer (Locometrix® ). Patients were considered as converters when they developed AD (between 2007 and 2011); and non-converters if not. Baseline gait parameters were compared between these two groups using Mann-Whitney non-parametric U-Test. Results.– In all, 23 MCI patients were studied. Among them 15 experienced conversion into AD. In ST, gait speed was 1.29 m/s in the NC group versus 1.15 m/s in C group, and cadence was 0.95 into NC versus 0.89 cycle/s into C. In DT, gait speed was 1.18 m/s into NC versus 1.01 m/s into C, and cadence was 0.89 versus 0.80 cycle/s into NC and symmetry (which expresses the similarity between left strides to right strides) was 201 in NC and 220 in C. All these comparisons present a P-value < 0.05. Conclusions.– In our population, gait parameters obtained with an accelerometer (especially the gait speed and the cadence) could predict the risk to develop AD in the MCI patients. http://dx.doi.org/10.1016/j.eurger.2013.07.175 P112
Hip and knee replacement in patients with neurodegenerative disease: A nationwide register-based case-control study E. Jämsen a,b,c , M. Peltola a,b,c , A. Eskelinen a,b,c , T. Puolakka a,b,c , M.U.K. Lehto a,b,c a Coxa, Hospital for Joint Replacement, Tampere, Finland b University of Tampere, Finland c National Institute for Welfare and Health, Tampere, Finland Introduction.– Hip and knee replacements are effective in alleviating pain and restoring function also in the oldest patients with late-stage osteoarthritis. Neurodegenerative diseases, however, may limit pa-tients’ capability to recover from surgery and increase the risk of postoperative complications. Methods.– The PERFECT database, created for monitoring outcomes of joint replacements by combining data from several nationwide Finnish health registers, covers all hip and knee replacements performed for primary osteoarthritis in Finland. It keeps record of postoperative complications and reoperations and also includes comprehensive comorbidity data. For this study, we included patients who were issued drug reimbursement for treatment of Alzheimer’s disease or Parkinson’s disease. For each of these patients, we selected three carefully matched controls. Results.– In 1998–2009, 1688 primary hip and knee replacements were performed in patients with neuro-degenerative disease (ca. 0.2% of all hip and knee replacements). Compared to their controls, patients with neurodegenerative disease had longer perioperative hospitalization (12 vs. 9 days, P < 0.001) and were more frequently still hospitalized 3 months after surgery (4.6% vs. 1.4%, P < 0.001). They also had more hip dislocations (risk ratio 1.34, 95% confidence interval 1.00–1.78) but there was no difference in the rates of postoperative infection and revision surgeries or in 1-year mortality. In longer follow-up pa-tients with Alzheimer’s disease had increased mortality (risk ratio 1.96, 1.79–2.14).
Conclusions.– Neurodegenerative diseases are associated with higher risk for hip dislocation and prolon-ged hospitalization following primary hip and knee replacement. Otherwise, hip and knee replacements appear relatively safe even in this vulnerable patient group. http://dx.doi.org/10.1016/j.eurger.2013.07.176 P113
Characteristics and effectiveness of fall prevention programs in nursing homes: A systematic review and meta-analysis of randomized controlled trials E. Vlaeyen , J. Coussement , G. Leysens , E. Van der Elst , K. Delbaere , D. Cambier , K. Denhaerynck , E. Dejaeger , S. Boonen , K. Milisen ∗,1 University Leuven, Leuven, Belgium ∗ Corresponding author. Introduction.– Falls frequently occur in nursing homes and often lead to serious injuries, psychological consequences and a significant economic burden. Methods.– A systematic review and meta-analyses on a clearly defined subgroup of nursing homes (“residential facilities providing 24-hour-a-day surveillance, personal care and limited care for persons who are typically elderly and infirm”) to determine characteristics and effectiveness of fall prevention programs on fall-related outcomes. MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, SportDiscus and reference lists of relevant articles were systematically screened. Protocol registered on PROSPERO (no. CRD42011001687). Results.– The search resulted in two individual RCTs and 12 cluster RCTs, involving 23 294 residents. There were seven single, one multiple and six multifactorial fall prevention programs. Overall meta-analysis showed significantly less recurrent fallers in the intervention groups (four studies, RR = 0.79, confidence interval (CI) = 0.65–0.97) but no significant effect on number of falls (ten studies, RR = 0.93, 95% CI = 0.76–1.13) or fallers (six studies, RR = 0.97, CI = 0.84–1.11). A preplanned subgroup analysis for different types of intervention showed that multifactorial interventions had a beneficial effect on the number of falls (four studies, RR = 0.67, CI = 0.55–0.82) and recurrent fallers (four studies, RR = 0.79, CI = 0.65–0.97), but not on the number of fallers (4 studies, RR = 0.938, CI = 0.75–1.16). Conclusions.– Multifactorial fall prevention interventions in a defined subgroup of nursing homes may reduce falls and the number of recurrent fallers. 1 On
behalf of the Center of Expertise for Fall & Fracture Prevention Flanders. http://dx.doi.org/10.1016/j.eurger.2013.07.177 P114
Impact of a 6-month training by whole body vibration on functional and motor abilities among nursing home residents observed over a 12-months period F. Buckinx a , C. Beaudart a , M. Demonceau b , D. Maquet b , J.-M. Crielaard b , J.-Y. Reginster a , O. Bruyère a,b a Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium b Department of Motricity Sciences, University of Liège, Liège, Belgium