Do Fall Prevention Programs Work?

Abstract 

This assignment is about reviewing whether the fall prevention programs work. According to the literature review, older adults who are exposed to intervention programs record a small number of falls as compared to those that do not know . Consequently, the effectiveness of the fall intervention programs depends on the follow-up activities. The trainers need to carry out monitoring and evaluation programs to ensure that the older adults are following the training and programs. The hazard awareness program is important because it helps the individuals to be aware of the risks and how to avoid them. Home modification helps in reducing the fall risks. 

Introduction 

Most of the f alls occur among the aged people of 65 years old and above. These falls require medical attention because some can cause serious injuries. The increasing falls among the older people has attracted the need of having intervention programs that help in improving the safety of the older people. As the population of the older people increases, the cost of medical care increases. One of the ways of reducing the medical cost is by implementing prevention programs among the older people and their immediate caregivers . The multifactorial intervention approach is the most preferred approach to preventing falls. This prevention measures the safety of exercises, mobility, and home assessment and prevention. More than one study has evaluated the effectiveness of the intervention in reducing the falls although some of the studies show that the intervention program does not reduce the falls. The effectiveness of the intervention program depends on how it is implemented . One of the recent home-based exercise training programs is the Otago exercise program (OEP). This program aims at reducing falls among the older adults . Studies indicate that 30% of people aged 65 years old and above experience fall every year (Oscar. & Petra., 2010, p. 3) . These falls are linked to the low quality of life and poor functioning of home-based care services. A falls prevention program is effective in reducing falls and injuries that are related to falls in older people who are at the highest risk. The 30% fall that occurs annually can be reduced by implementing suitable prevention programs among the older people living in the communities (Oscar. & Petra., 2010, p. 3) . The injuries that are caused lead to permanently reduced mobility, admission to long-term care, increased health cost, and increase the elderly mortality. Victims of fallers fear to fall and isolate themselves socially and do not prefer engaging in mobility activity. 

Falls are one of the leading factors that cause serious injuries and hospitalization of older adults in the society. Fall prevention programs are important in helping them stay safe and reduce the falling risks. In America, every 11 seconds an older adult is usually rushed into the emergency room for treatment as a result of falling (Oscar. & Petra., 2010, p. 2) . The rate is higher for seniors who have not being taught about fall prevention measures. This is why it is important to implement different strategies for preventing falls among the older adults to reduce the number of risks associated with falls . The National Council on Aging did a research and found out that there are prevention programs that are most successful. 

The first intervention program is improving balance. Lack of balance is the main factor that causes fall among this population. Stable balancing and encouraging strong leg muscles is important is preventing falls because weak leg muscles increase the risk of falling (Dadgari, et al., 2016, p. 26340) . Therefore, older adults are encouraged to exercise to strengthen the muscles and to improve stability. Exercising simply improves balance and reduces the risk of falls. 

The second program is Otago exercise program. These programs involve individual exercises that have been prescribed by the physical therapist for older adults who are frail. This is unlike the improving balance intervention program that is suitable for all senior adults. This program is suitable for 80 plus years old individuals. This program has been effective in reducing fall rates by 35% in the US (Dadgari, et al., 2016, p. 26340) . Before an individual begins any form of exercise, it is important to get a referral from a physical therapist. A therapist will suggest the best exercise for an individual. 

Stepping on intervention program is aimed at increasing the self-confidence of older adults. Research has shown that lack of confidence is a contributing factor to the increasing number of falls among the seniors. This program involves teaching the individuals on ways of building confidence and highlighting hazards that would lead to the falls . Studies indicate that individuals become safer is they are aware of the fall risks and learn how to avoid them. 

Lastly, it is the Tai Chi intervention program. It involves walking and balance training program that controls movement. It highly improves balance among the older adults and has high records of success. The program is involving, and its benefits are long-lasting because it helps in strengthening the muscles and the joints. 

The fall intervention program is usually designed to improve the general physical health, to strengthen the muscles, to improve the stability and to make the individuals aware of the sources of hazards and risks that could cause fall. Fall prevention programs are effective in reducing the rate of falls among the older adults in the society (Kajii, et al., 2014, p. 190) . However. Monitoring and follow up activities are needed to make sure that the program is well taught, and the individuals are practicing the recommended exercises and home modifications. Even though there are some studies indicating that fall prevention programs are not effective , the programs are effective in reducing the rate of falls. 

Literature Review 

Research shows that approximately 30% of the older people of 65 years and older fall every year. The effects of fall under minor injuries to severe injuries that will need long-term medical intervention. Serious injuries require an emergency response and immediate care from the physicians. Consequently, falls can lead to psychological torture of fear of falling, limited mobility, and reduced exercise activities. Factors that increase the risk of falling include limited visual strength, chronic diseases, medication, and limited muscle strength (Dadgari, et al., 2016, p. 26340) . Older people have limited strength and balancing power when moving around. They are vulnerable to falls. Research by Dadgari et al. (2016) indicates that the fall intervention programs help in reducing falls among the older people in the community. The study suggested OEP as the best intervention program for older adults who have limited access to various equipment. The introduction of this program was to help those who were economically challenged since it does not require a lot of money, effort and time (Dadgari, et al., 2016, p. 26340) . This was after analyzing the previous intervention methods and found out that they were costly and strenuous for some people. Therefore, to meet the demands of the public, the prevent falls intervention programs had to meet the criteria of the majority of the elder people. The home-based training has proven to reduce the elderly fall among those who have been trained as compared to those who have not undergone the training (Dadgari, et al., 2016, p. 26340) . Even though they were some drawbacks associated with the intervention, especially limited cooperation from the elders who are being trained . The strength of this intervention relies on the commitment of the elderly community (Dadgari, et al., 2016, p. 26340) . Consequently, the effectiveness of the intervention program was based on monitoring and evaluation programs that include follow up activities. This is done by professionals who pay home visits to the elderly community to see how the family is going on. Lack of follow up activities is one of the reasons as to why some of the fall intervention programs are not effective. Importance of follow up activities is to help the older adults to continue exercising and practicing what was taught by the physical therapist. Sometimes the intervention programs may fail to work because of negligence that comes with the absence of supervision (GJ, du, van, & M, 2007, p. 6) . The older people tend to forget easily and would prefer resting rather than involving in exercises and in activities that involve movement. Follow up activities also help the older adults that have fallen before to fight the spirit of fear. Building back their confidence through the intervention programs will help them regain self-confidence. After falling , they tend to withdraw from social interactions and reduce mobility which could lead to other health complications. This will automatically increase the medical cost of the patient. 

On a contrary research by Oscar J. et al. (2010), suggests that multifactorial fall prevention programs are not effective in reducing falls among older persons. The study was carried out by a controlled group and a group that was exposed to the fall intervention program. The fall in both categories was similar. There was no notable difference between the two groups (Oscar. & Petra., 2010, p. 5) . This shows that the multifactorial fall intervention program was not effective and the study recommended a systematic assessment to follow up the program to make sure that the intervention program is effective . The trials done in this study indicated a poor performance in preventing fall among the elderly in the community (Oscar. & Petra., 2010) . The elderly need fall intervention measures because they are at a very high risk of falls because of their limited mobility and stamina. Effective intervention program helps in reducing medical cost because the program helps in reducing the falls. 

Fall prevention measures tend to face a considerable challenge. The falls are none fatal, but they can increase even after intervention programs have been involved . Research shows that females have a high fall rate as compared to males of the same age group. Fatal fall is uncommon although they can happen (Oscar. & Petra., 2010, pp. 4-6) . The falls can also lead to serious injuries that need an emergency response from the physicians. As a result, the medical bill goes high. The fall prevention measures need to be properly implemented to make sure that positive results are achieved . This is why some intervention programs like the multifactorial have failed to work. Also, the prevention measures should be affordable to the targeted group. If the intervention program needs expensive equipment, it should be targeted to families that are financially able (Kajii, et al., 2014, p. 186) . The middle-class individuals will work best with programs that do not require much financial investment because they may not be able to implement the program . 

A similar research carried out by Wijhui z en, Dommelen and Hopman-Rock (2007) found out that multifactor intervention program does not decrease elderly fall living within the community. This study also found out that the multifactor intervention program was effective among the senior women (GJ, du, van, & M, 2007, p. 7) . Multiple factors influence the increased rate of fall; these factors include environment, health, and physical activities. Due to these factors, multifactorial intervention approach was considered to be the best approach to reduce the fall risks (GJ, du, van, & M, 2007, p. 6) . The intervention aimed at transferring safety to the hands of the individuals. This would help in reducing medical cost and empowering the elderly to take care of them . In the long run, the falls would have reduced . However, the intervention program was not effective enough to reduce the number of falls among the senior citizens in the community. This research found out that the intervention program worked well among the women but not men. The female participants responded well to the multifactorial intervention program as compared to men. A more suitable intervention is needed that is suitable for both women and men (GJ, du, van, & M, 2007, p. 7) . Without such, the falls intervention program will become less effective and will not meet its desired objective. A good intervention program should fit both the males and females because they are all vulnerable to falls. Targeting one gender will not be helpful in reducing the fall risks because the society is made up of both genders . An intervention program that is not meeting the needs of the audience should not be implemented in the society (GJ, du, van, & M, 2007, p. 8) . The two studies have provided evidence that the multifactorial fall intervention is not effective enough to reduce falls among the older adults . But this does not mean that the intervention programs are not effective . This is one of the intervention programs that has been evaluated, and the researchers have concluded that it does not reduce the fall rates among the older adults in the society. 

In another study carried out by Siegrist, M. et al. (2016), found out that intervention programs are effective in reducing the rate of fall among the older adults. The targeted complex exercise intervention program was effective in reducing falls among the senior people of age 65 years and above. During the study, there was a group of people that were trained on prevention measures about home care and how to prevent falls while the control group was not exposed to the fall prevention program (Siegrist, et al., 2016, p. 366) . After one year of close monitoring, the trained group recorded a minimal number of falls while the other group recorded a high number of falls . The group that was not trained on how to prevent falls recorded high numbers of fall-related injuries and some injuries needed emergency response. This provides evidence that the intervention programs are effective and they help in solving the fall problem. There is a need for training to improve the knowledge among the elderly about different ways of preventing falls and how to avoid risks. Knowing what causes falls is a significant step towards reducing the rate of falls . Lack of knowledge can lead to high rates of falls and lead to the increased medical costs. The elderly who have experienced falls in the recent past have a fear of falling again (Siegrist, et al., 2016, p. 368) . Therefore, they tend to restrict themselves from social and physical activities that are important for their health. Annual training is significant in ensuring that the older adults have the right training and can overcome the fall-related fears. There should be a balance between the physical activities and rest . Lack of exercising will increase health risks for the individuals (Siegrist, et al., 2016, p. 368) . The best intervention program should encourage the individuals to exercise and to mingle with other people in the community. The intervention programs are not meant to replace the physical activities but encourage their home-based safety and reduce the cost of medication. 

A similar research carried out by Kamei Tomoko et al. (2014) evaluated the potential of the home hazard modification program (HHMP) in reducing fall rates among the older adults . This is a program that has been tested and found to be effective. It has a great potential of reducing fall rates among the elderly individuals. After monitoring the different groups for one year, the final result proved that the HHMP has the potential of reducing falls among the elderly people. The program reduced the rate of fall with 30% which is a good percentage (Siegrist, et al., 2016, p. 189) . Once the training continues annually, it will be able to reduce the rate of falls and encourage health status among the elderly (Kajii, et al., 2014, p. 186) . The group of people that were exposed to training recorded a limited number of falls as compared to the group that was not trained in the prevention program. The effectiveness of the intervention programs has been discussed in more than one study. There is a direct connection between training the elderly and reducing the number of falls. HHMP was found to be effective, and it utilized the home equipment that is readily available in many homes (Kajii, et al., 2014, p. 187) . Indoor falls are most common among the home-based elderly individuals because of limited monitoring by a professional. Prevention falls programs increase the awareness of the safety precautions and help the individuals to take care of themselves at home. The importance of such knowledge and training cannot be ignored because it helps in reducing falls and fall-related injuries. In addition to reducing the fall risks, individuals who were trained showed a positive result in the mental and physical assessment (GJ, du, van, & M, 2007, p. 8) . The program includes an emphasis on the physical and mental activities that help in boosting the strength of the individuals. The intervention programs help in boosting the health status of the individuals. The hazard intervention program creates awareness on important equipment like a non-slip rug, grab bars, non-slip tape on the stairs, and automatic floor lighting (Kajii, et al., 2014, p. 188) . The training teams in the study provided the groups with information on safety and how to avoid risks by modifying the home. Most of the equipment in the HHMP program is endorsed by the trained physicians who have sufficient knowledge on how to improve the safety of the 65 years old and above individuals. 

Discussion and Conclusion 

In the community-dwelling older adults, fall prevention programs reduce falls as compared to the older adults who do not have this intervention. There is rich literature that supports the intervention programs to be initiated by the elderly individuals (Oscar. & Petra., 2010, p. 5) . This is because some of the intervention programs are effective and have been tested and found to have been reducing the fall rates. Consequently, the effectiveness of the intervention program depends on the monitoring and evaluation programs (GJ, du, van, & M, 2007, p. 8) . Follow up activities help in ensuring that the individuals are practicing what was taught . If there are difficulties, the physician can recommend an alternative intervention program that is suitable for the individuals. Training the individuals is not enough in reducing the falls because the individuals can fail to implement the safety measures if there are no follow up activities. The individuals tend to forget the risk and safety awareness education (Siegrist, et al., 2016, p. 368) . Some will even give up because they lack the motivation to continue exercising and being cautious of different hazards. As a result, some intervention programs will be considered as a failure. For example, the multifactorial intervention program was not effective in reducing the fall risks due to the lack of follow up activities. Consequently, expensive intervention programs are not effective because of the cost of equipment. A program like Otago Exercise Program is an affordable intervention program for the home-based exercise training program (Dadgari, et al., 2016, p. 26340) . It is cost effective and easy to apply at home. The home hazard modification program has equally been effective. Training the individuals on the risks and possible hazards that increase the indoor falls is beneficial. The program suggests home modification like installing non-slippery floors and mats on the staircase and installing bars that provide grip to the individuals. Installing these equipment helps in reducing the fall risk be enhancing safety indoors . Research has shown that the HHMP intervention program reduces fall risk among the older adults. Older adults who have no exposure to the intervention programs record high rates of falls. This increases the cost of medication because some fall-related injuries require long-term medical intervention (Siegrist, et al., 2016, p. 369) . The intervention program is meant to reduce the fall-related injuries that could lead to serious injuries and increase the cost of medication among the older adults. Also, home-based intervention is beneficial in reducing congestion in hospitals since the number of patients is increasing every year. 

References 

Dadgari, A., Hamid, T. A., Hakim, M. N., Chaman, R., Mousavi, S. A., Hin, L. P., & Dadvar, L. (2016). Randomized Control Trials on Otago Exercise Program (OEP) to Reduce Falls Among Elderly Community Dwellers in Shahroud, Iran. Iran Red Crescent Med J. , 26340. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948256/ 

GJ, W., du, B. P., van, D. P., & M, H.-R. (2007). Effect evaluation of a multifactor community intervention to reduce falls among older persons. The Hague, Leeuwarden: Netherlands Health Research and Development Council. Retrieved from: https://openaccess.leidenuniv.nl/bitstream/handle/1887/13471/03.pdf?sequence=7 

J., O., & M., P. J. (2010). Multifactorial Intervention to Reduce Falls in Older People at High Risk of Recurrent Falls. JAMA Internal Medicine , 1-10. Retrieved from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/225753 

Kajii, T. K., Yamamoto, Y., Irie, Y., Kozakai, R., Sugimoto, T., Chigira, A., & Niino, N. (2014). The effectiveness of a home hazard modification program for reducing falls in urban community-dwelling older adults: A randomized controlled trial. JAPAN JOURNAL OF NURSING SCIENCE , 184-197. DOI: 10.1111/jjns.12059 

Siegrist, M., Freiberger, E., Geilhof, B., Salb, J., Hentschke, C., Landenberger, P., Blank, W. A. (2016). Fall Prevention in a Primary Care Setting: The Effects of a Targeted Complex Exercise Intervention in a Cluster Randomized Trial. Dtsch Arztebl Int. , 365-372. doi: HYPERLINK "https://dx.doi.org/10.3238%2Farztebl.2016.0365" \t "pmc_ext" 10.3238/arztebl.2016.0365