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Icon: Multifaceted InterventionsMultifaceted Interventions: Multifactorial Fall Prevention Program

Salminen, et al.

This multifaceted fall intervention consisted of a geriatric fall risk assessment with counseling and guidance in fall prevention; home hazards assessment and modification; group and home-based exercise; group lectures on topics related to fall prevention; and monthly participation in a psychosocial group.

The intervention did not reduce falls overall. However, falls were decreased 41 percent in participants who had experienced 3 or more falls in the previous year and 50 percent in participants with more symptoms of depression.

Population

Participants were seniors aged 65 or older who lived in the community or in housing that provided occasional assistance, had no or little cognitive impairment, and had experienced at least 1 fall in the past year. Eighty-four percent of participants were female.

Geographic Locale

Pori, Finland

Focus

Assess and address each participant’s specific fall risk factors, improve physical fitness, provide information and counseling on fall prevention, assess and modify home hazards, and provide psychological support.

Program Setting

The fall risk assessment, counseling, and group exercise classes were conducted in the Pori Health Center or at home for those participants living in assisted housing. Lectures and psychosocial groups were held in a senior center. The home-based exercises and home assessment were carried out in participants’ homes.

Content

A geriatrician assessed each participant for medical factors that could increase their risk of falling such as disorders affecting balance and gait, the use of psychoactive medications, depression, and poor eyesight. If needed, referrals were made to an ophthalmologist for vision correction and to the primary care physician for follow-up on recommended medication changes. All participants who were not already taking calcium and vitamin D supplements were prescribed 500 mg calcium and 400 IU of vitamin D per day.

A public health nurse provided oral and written information about reducing personal fall risk factors as well as facts about safe environments, healthy diets, calcium and vitamin D supplements, and the use of hip protectors.

Trained nursing students conducted home hazard assessments using a detailed form. Participants were given oral and written instructions for safety modifications. A follow-up of the home modifications was made 1 year later.

A physical therapist led a group exercise class every 2 weeks. This included:

  • 5 minutes of warm-up
  • 15 minutes of balance, coordination, and weight-shifting exercises. Each exercise was performed for 45 seconds followed by 30 seconds of rest.
  • 20 minutes of circuit training for muscle strength. Two to 4 circuits were performed with 3 to 5 minutes of rest between circuits.
  • 5 to 10 minutes of cool-down

The intensity of the exercises was increased progressively over time, based on the physical therapist’s judgment of each person’s fitness level.

Participants also performed similar exercises at home 3 times a week. Participants received written information on performing home exercises based on the physical therapist’s judgment of their physical condition.

Once a month, a lecture was given by a health professional on various topics including causes of falling, fall prevention, medications that can increase fall risk, nutrition, exercise, and home hazards.

Also once a month, participants attended a psychosocial group that provided recreational activities (e.g., discussing various topics such as news headlines, a musical performance, memory disorders, or exercise; reading poetry) and psychological support.

Duration

  • 45-minute fall risk assessment
  • 45-minute home hazard assessment
  • 45-minute information and counseling session
  • 45- to 50-minute group exercise class once every 2 weeks plus 25 minutes of exercise at home 3 times per week
  • 1-hour health lecture once a month
  • 1-hour psychosocial group session once a month

Delivered by

A geriatrician conducted the fall risk assessment; a trained public health nurse provided information and counseling on fall prevention; trained nursing students conducted the home hazards assessment and psychosocial group sessions; a physical therapist facilitated the group exercise sessions; and various health professionals (e.g., geriatricians, public health nurses, physical therapists, dieticians, podiatrists) gave lectures on topics related to falling.

Minimum Level of Training Needed

Risk assessments can be conducted by a trained nurse with referrals, if needed, to a general practitioner who specializes in geriatrics. Exercise groups can be supervised by a well-trained volunteer or physical therapy student.

Key Elements

  • Individual risk factor assessment, treatment, and/or referral by a physician
  • Exercise classes led by a trained physical therapist or physical therapy student, combined with at-home exercises tailored to each participant
  • Exercise intensity must increase progressively over time
  • Monthly lectures by various health professionals on topics related to falling, followed by a question and answer period
  • Individual guidance on fall prevention
  • Home hazards assessment and written safety recommendations
  • Monthly psychosocial group sessions

Available Materials

Materials are available only in Finnish.

Study Citation

Salminen MJ, Vahlberg TJ, Salonoja MT, Aarnio PTT, Kivelä SL. Effect of a risk-based multifactorial fall prevention program on the incidence of falls. Journal of the American Geriatrics Society. 2009 Apr;57(4):612-9.

Supplemental articles

Sjösten NM, Salonoja M, Piirtola M, Vahlberg T, Isoaho R, Hyttinen H, Aarnio P, Kivelä SL. A multifactorial fall prevention programme in homedwelling elderly people: A randomized-controlled trial. Public Health. 2007 Apr;121(4):308-18.

Sjösten NM, Salonoja M, Piirtola M, Vahlberg TJ, Isoaho R, Hyttinen HK, Aarnio PT, Kivelä SL. A multifactorial fall prevention programme in the community-dwelling aged: Predictors of adherence. European Journal of Public Health. 2007 Oct;17(5):464-70.

Vaapio S, Salminen M, Vahlberg T, Isoaho R, Aarnio P, Kivelä S-L. Effects of risk-based multifactorial fall prevention on health-related quality of life among the communitydwelling aged: A randomized controlled trial. Health and Quality of Life Outcomes. 2007 Apr;5:20-7.

Salminen M, Vahlberg T, Sihvonen S, Piirtola M, Isoaho R, Aarnio P, Kivelä SL. Effects of risk-based multifactorial fall prevention on maximal isometric muscle strength in community-dwelling aged: A randomized controlled trial. Aging Clinical and Experimental Research. 2008 Oct;20(5):487-93.

Salminen M, Vahlberg T, Sihvonen S, Sjösten N, Piirtola M, Isoaho R, Aarnio P, Kivelä SL. Effects of risk-based multifactorial fall prevention on postural balance in the community-dwelling aged: A randomized controlled trial. Archives of Gerontology and Geriatrics. 2009 Jan-Feb;48(1):22-7.

Contact

Practitioners interested in using this intervention may contact the principal investigator for more information:

Marika J. Salminen, PhD
Family Medicine
Lemminkäisenkatu 1
FI-20014
University of Turku
Turku, Finland
E-mail: majosa@utu.fi

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