Expanding upon a fall prevention research program originating in New Zealand, a Chicago home health agency has been able to reduce falls among assisted living residents by more than 50%.
Adopting research from a fall prevention trial program run by the Otago Medical School in Dunedin, New Zealand, the CEO of Chicago-based company Simply Home Health was able to produce a 54% reduction in falls for seniors at an Illinois assisted living facility, and plans expand his research in the coming year.
New Zealand trials
The project uses ankle weights to strengthen five key muscle groups in the leg, all of which serve critical functions not only for movement, but for fall prevention as well—upper leg (hamstring), the hips (abductors), rear ankle flexor (calf), front ankle flexor and the front upper leg (quads).
In addition to using the ankle cuff weights, the initial New Zealand program also used methods to prove compliance and motivate the 1000 community-dwelling seniors in the study to make the three-day-a-week exercise part of their new and improved lifestyles. Those in the test group were required to fill out and mail in exercise diaries, while the clinicians who trained them made several follow up visits and phone calls to monitor progress.
Using information obtained from the diaries, phone calls and face-to-face follow-ups, clinicians advised participants when they could safely add the “Level 2” exercise routines, which would call for an increase to the size of the ankle weights.
In one of the trials conducted in West Auckland, 240 men and women over age 75 were studied. Meanwhile during the trial, a nurse conducted five visits—in weeks 1, 2, 4, 8 and 24—and made weekly phone calls. With 212 seniors in the exercise program and 119 in usual care, the trial produced a 46% reduction in falls in its first year of experiment.
Acknowledging this success and with plans to achieve similar results stateside was Simply Home Health CEO Robert Kunio, who at the time was chief operating officer of SimplyRehab, a company that employs therapists to work in the therapy department of nursing homes.
Bringing it all back home
In November 2010, Kunio asked for a research partner to experiment with a supervised group a version of the Otago program in an assisted living facility operated by Bradley, Illinois-based BMA Management: Heritage Woods Supportive Living facility in Bolingbrook, Ill.
Four months later in March 2011, the two companies began their trial, recruiting a total of 23 residents with a history of falls or a fear of falling. The average age of all participants was 79 years old.
Different from the New Zealand study, Kunio and his team eliminated the need for high-paid nurses and therapists, instead experimenting with various processes that would measure changes in strength, which could then be used to progress the size of the ankle weight or add to the Level 2 routines.
“Through extensive trial and error, I arrived at a monthly timed performance test and a set of rules that allowed us to increase the weights at just the right place,” said Kunio in a brief during the LeadingAge Illinois conference Monday. “The rules enabled us to avoid injuries by increasing the weights too quickly and also avoid strength plateaus by increasing them too slowly.”
Kunio’s team also determined that the maximum “safe limit’” on the size of the ankle weights was 2.5% of a person’s body weights, after several people who exceeded this limits experienced groin pulls when doing certain routines.
As the study progressed, several residents in the control group who had suffered falls requested to join the test group, while some residents from the test group moved to another facility operated by the same management company.
As a result of the migration between groups, both the control group and test group became smaller over the course of the study’s 12-month course. To account for the movement of seniors, Kunio created an “opportunity to fall” weighting factor in efforts to normalize the data. This factor is the total person-months of all participants in the exercise program, as compared to the total person-months of all those who were not in the group exercise program.
While the “raw numbers” for fall and hospital visit metrics showed 72% fewer falls and fall-related hospital visits for the test group compared to the control group. However, when weighted with the “opportunity to fall” factor, researchers revealed that study participants in the program experienced 54% fewer falls and fall-related hospital visits.
“The combination of physical therapy and controlled progressive resistance was effective in reducing falls in this age group,” Kunio says. “It reinforced what was demonstrated in New Zealand about the need to target five muscle groups and the need to steadily increases the resistance of the exercise as the participant’s strength increases.”
A $30 billion problem
Falls are the leading cause of both fatal and non-fatal injuries among the elderly, according to the Center for Disease Control, which notes that one out of three adults age 65 and older experiencing a fall each year. The associated costs in treating falls is also concerning, even if the consequences are not fatal.
In 2012 alone, 2.4 million non-fatal falls among older adults were treated in emergency departments and more than 722,000 of these individuals were hospitalized, notes the CDC. That year, the direct medical costs of falls were $30 billion.
For senior housing providers, falls keep residents out of the community and continue to be a growing area of focus in resident programming and activities. With the initial study already under his belt, Kunio and his team have already begun a skilled nursing facility-based study, integrating the project into the restorative program at the Liebermann Center for Health and Wellness in Skokie.
“The cost of treating fall-related injuries among the elderly continues to be a significant part of the U.S. health care budget with the root cause of 85% to 90% of these falls being the loss of muscle mass and strength that occurs in all sedentary older people,” Kunio said in his report. “As human being’s age, the rate at which they lose mass in an inactive skeletal muscle increases and the frequency of the exercise needed to stop or reverse this loss needs to be increased.”
Written by Jason Oliva