Lou E. Jensen, René Padilla; Effectiveness of Interventions to Prevent Falls in People With Alzheimer’s Disease and Related Dementias. Am J Occup Ther 2011;65(5):532-540. doi: 10.5014/ajot.2011.002626.
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A systematic review was conducted to determine the effectiveness of interventions to prevent falls in people with Alzheimer’s disease (AD) and related dementias. Twelve research reports met inclusion criteria. Studies reported on three types of intervention: (1) exercise- and motor-based interventions, (2) nursing staff–directed interventions, and (3) multidisciplinary interventions. Strategies were offered as single or multifaceted intervention programs. All types of intervention resulted in benefit, although the evidence for effectiveness is tentative because of the studies’ limitations. More research is needed to better understand appropriate dosages of intervention. No evidence was found for the effectiveness of prevention programs accessed as part of occasional respite care. Occupational therapy was seldom involved in the interventions researched. Because effective fall prevention programs are embedded in people’s daily routines and encouraged participation in occupation, the contribution occupational therapy practitioners can make to the care of people with AD has yet to be fully realized.
Individualized exercise programs may have the most positive effects on the balance of people with mixed dementia of moderate severity (Christofoletti et al., 2008; Tilly & Reed, 2008).
Group exercise that addresses balance, range of motion, strengthening, and other biomechanical approaches has also been shown to be beneficial in improving balance, thus indirectly reducing falls (Ries et al., 2010; Santana-Sosa et al., 2008).
Embedding physical training focused on improving gait, strength, balance, and flexibility in occupation-based intervention has some effect on reducing falls (Hauer et al., 2006; Oliver et al., 2007). Occupation-based exercise has potential to allow people with dementia to use implicit memory systems to tap into past routines (Mirolsky-Scala & Kraemer, 2009).
No evidence exists that exercise interventions accessed occasionally as part of respite programs are effective in reducing falls of people with AD and related dementias (Mackintosh & Sheppard, 2005).
Close supervision and participation in activity-based intervention may be effective in reducing the number of falls of high-risk patients with dementia (Detweiler et al., 2005).
Enhanced fall risk education for nursing staff that includes documenting any falls that take place and reflecting on possible preventative measures for each incident is likely to reduce falls of nursing home residents, most of whom have cognitive impairments (Bouwen et al., 2008).
A dedicated staff member who serves as a fall prevention aide can significantly decrease the number of falls (Shimada et al., 2009).
Very few increased costs are associated with implementing multidisciplinary intervention programs in inpatient settings (Stenvall et al., 2007).
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