Interventions based on exercise and physical environment for preventing falls in cognitively impaired older people living in long-term care facilities: A systematic review and meta-analysis

Background: Fall incidents occur frequently in institutionalized older people with cognitive impairment and their consequences are more serious than in the general aging population. It is needed to know which interventions... [ view full abstract ]

Background:
Fall incidents occur frequently in institutionalized older people with cognitive impairment and their consequences are more serious than in the general aging population. It is needed to know which interventions tailored to prevent falls guarantee their effectiveness. The purpose of this systematic review is to report the effectiveness of interventions based on exercise and/or physical environment for reducing falls in cognitively impaired older adults living in long-term care facilities.
Method:
Until July 2014, a literature search was conducted using main databases and specialized sources. Randomized controlled trials assessing the effectiveness of fall prevention interventions, which used exercise or physical environment among elders with cognitive impairment living in long-term care facilities, were selected. Two independent reviewers checked the studies eligibility and evaluated their methodological quality. If it was adequate, data were gathered.
Results:
Fourteen studies with 3539 participants using exercise and/or physical environment by a single or combined approach were included. Evidence was insufficient to demonstrate the effectiveness of a single modality. Gathered data from studies which used both interventions showed a significant reduction of fall rate (RaR=0.61, IC95% 0.53-0.70) and fall risk (RR=0.79, CI95% 0.66-0.93). Not recurrent fall risk neither injury reduction were proved.
Conclusion:
Intervention programs which include both exercise and physical environment can lead to a reduction of falls in institutionalized and cognitively impaired older adults. However, further research is needed.
Application to Practice:
Occupational therapists and physical therapists would consider the application of these interventions, from a combined approach, to prevent falls in that population.