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Effect of a multifactorial fall-and-fracture risk assessment and management program on gait and balance performances and disability in hospitalized older adults: a controlled study

Trombetti, A. ; Hars, M. ; Herrmann, F. ; Rizzoli, R. ; Ferrari, S.

In: Osteoporosis International, 2013, vol. 24, no. 3, p. 867-876

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    Titre
    • Effect of a multifactorial fall-and-fracture risk assessment and management program on gait and balance performances and disability in hospitalized older adults: a controlled study
    Auteur
    • Trombetti, A.. Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva 14, Switzerland
    • Hars, M.. Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva 14, Switzerland
    • Herrmann, F.. Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva 14, Switzerland
    • Rizzoli, R.. Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva 14, Switzerland
    • Ferrari, S.. Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva 14, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • Osteoporosis International, 2013, vol. 24, no. 3, p. 867-876. Springer-Verlag
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:319179
    Summary
    Summary: This controlled intervention study in hospitalized oldest old adults showed that a multifactorial fall-and-fracture risk assessment and management program, applied in a dedicated geriatric hospital unit, was effective in improving fall-related physical and functional performances and the level of independence in activities of daily living in high-risk patients. Introduction: Hospitalization affords a major opportunity for interdisciplinary cooperation to manage fall-and-fracture risk factors in older adults. This study aimed at assessing the effects on physical performances and the level of independence in activities of daily living (ADL) of a multifactorial fall-and-fracture risk assessment and management program applied in a geriatric hospital setting. Methods: A controlled intervention study was conducted among 122 geriatric inpatients (mean ± SD age, 84 ± 7years) admitted with a fall-related diagnosis. Among them, 92 were admitted to a dedicated unit and enrolled into a multifactorial intervention program, including intensive targeted exercise. Thirty patients who received standard usual care in a general geriatric unit formed the control group. Primary outcomes included gait and balance performances and the level of independence in ADL measured 12 ± 6days apart. Secondary outcomes included length of stay, incidence of in-hospital falls, hospital readmission, and mortality rates. Results: Compared to the usual care group, the intervention group had significant improvements in Timed Up and Go (adjusted mean difference [AMD] = −3.7s; 95% CI = −6.8 to −0.7; P = 0.017), Tinetti (AMD = −1.4; 95% CI = −2.1 to −0.8; P < 0.001), and Functional Independence Measure (AMD = 6.5; 95%CI = 0.7-12.3; P = 0.027) test performances, as well as in several gait parameters (P < 0.05). Furthermore, this program favorably impacted adverse outcomes including hospital readmission (hazard ratio = 0.3; 95% CI = 0.1-0.9; P = 0.02). Conclusions: A multifactorial fall-and-fracture risk-based intervention program, applied in a dedicated geriatric hospital unit, was effective and more beneficial than usual care in improving physical parameters related to the risk of fall and disability among high-risk oldest old patients