Fall Prevention for Older Adults with Alzheimer’s Dementia

Fall Prevention for Older Adults with Alzheimer’s Dementia

Introduction

The purpose of my capstone project was to develop a fall prevention exercise program for the participants of the Loving Touch Adult Day care in Charlotte, NC that could be integrated into their daily exercise routine at the facility.

Adult day cares are used as an alternative to institutionalizing. These individuals need 24/7 care for medical or safety reasons and would otherwise be institutionalized if their caregivers were unable to provide the care needed for them. Loving Touch adult day care requested I re-vamp their daily exercise plan for their participants.

After talking to my committee members, I decided to focus on training the RN staff of the adult day care. I originally planned to lead an exercise class for the participants however, training the RN staff would provide them with the tools to continue the program so that they can incorporate it into their daily exercise routine at the facility. The RNs and CNAs currently lead a group exercise regimen 2x/day for 30 minutes that include a mosh posh of exercises they put together from various online websites. I also wanted to provide materials for the caregivers of the participants in an effort to prevent falls in the homes as well.

After speaking with the director of the adult day care, Joyce Freeman, I discovered that ~85% of their participants have Alzheimer’s dementia and they also became a certified Alzheimer’s unit during the development of this project. Therefore, I focused on balance exercises particularly for this population.

 

Project Development

My interest in this topic began after I developed a health promotion and wellness proposal that focused on doing a strength exercise program for older adults in a skilled nursing facility in Pitt County, NC that would help combat the risk factors associated with physical inactivity. You can read the proposal here.

Additionally, in the EBP II class I developed a critically appraised topic. My PICO question was, “In older adults with a history of falls and living in long-term care facilities, is moderate intensity exercise more effective than no prescribed exercise program for reducing fall risks?” I still targeted institutionalized older adults but I focused more on balance exercises that could possibly reduce the risk of falls for community dwelling older adults who are at risk of falling.

Research has found that physical inactivity and sedentary lifestyles is an issue among all ages especially for the elderly, more specifically, those in long term care facilities. The risk of injury, including falls and fractures, is also greater among older people with impaired cognitive functioning.¹ Therefore, I wanted to focus on fall prevention for those with dementia specifically Alzheimer’s dementia in order to reflect the population at the adult day care.

Purpose and Products

Falls in older adults are a significant contributor to functional decline, institutionalization, and economic burden. Community-dwelling older adults with Alzheimer disease (AD) and other dementias fall 2 to 3 times more than their cognitively intact age-matched peers. 1-3 Individuals with AD and other dementias are more likely to be hospitalized for and experience greater morbidity and mortality associated with falls.²

The etiology of falls in individuals with dementia is complex and multifactorial. Although balance ability is not the sole determinant of fall risk, it correlates with fall risk in community-dwelling older adults with dementia.^2,4

Balance exercise programs have been shown to be effective in improving balance and reducing falls in older adults without cognitive deficits but have not been well studied in individuals with Alzheimer’s disease.^2-4 Historically, those with cognitive impairments were excluded from research studies because of the assumption that they would not be able to fully participate.² I was able to develop an updated Evidence table with the most recent evidence about balance exercise programs that focus on fall reduction for those with dementia or cognitive impairments. Therefore, my new PICO question is: In older adults with dementia and a history of falls, are balance exercises more effective than no prescribed balance exercise program for reducing fall risks? I narrowed my search to studies that focused on group training to help me develop my group exercise program.

I developed a PowerPoint presentation entitled, “Fall Prevention for Older Adults with Alzheimer’s Dementia” with a corresponding “Balance Exercise Handout” that was presented and demonstrated to the RN staff of the adult day care. The exercises were based on the Otago exercise program and modified for those with AD.

The Otago exercise program is one of the best documented falls prevention programs that demonstrated a 40% reduction in falls for older community-dwelling older adults over a 1-year period for those in the intervention group.³ It was originally developed as a home-exercise program but has also been proven to be more effective for improving functional balance, muscle strength and physical health when performed in a group which is why I modified the exercises for this particular population.⁴

My committee members also gave me the idea to make an educational caregiver Brochure about fall prevention and home safety that was adapted by the STEADI program from the Centers for Disease and Control Prevention website.⁵ This was used to educate the caregivers about their role in preventing falls for their loved-ones.

Evaluation

A Health Literacy Assessment was done for the PowerPoint presentation, Balance Exercise handout, and caregiver brochure to ensure readability of the information presented. Before developing the exercise program, I did a verbal pre-assessment with the assistant director of the adult day care to adapt the program based on their needs. After the presentation, the staff completed a written post-assessment feedback evaluation form. Provided is a summary of the pre and post-assessment  feedback form.

Reflection

This project provided me with the opportunity to think about how I could provide physical therapy outside of the four walls of my facility and provide services to those in the community who otherwise, would not have gotten it. My supervisor at work has since requested that I develop a general patient brochure about fall safety tips and prevention that we will use at our facility. I look forward to developing further projects of this nature in the community.

Acknowledgments

I would like to thank my committee members Joselynn Freeman, Assistant Director of Loving Touch Day Care for helping me adapt this program to meet the needs of the participants and staff of the facility; Courtney Jeffries, PT, DPT, NCS who has supported me since I started this tDPT journey and took time out of her very busy schedule to assist me. I also like to thank my advisor, Prue Plummer and also KMac who was instrumental in the development of this project. I’d like to thank the staff of the Loving Touch Daycare whose feedback was invaluable in the development of the exercise program. Last but not least, I would like to thank my husband, Terrance, who proofread most of the information and listened to me practice my presentation multiple times.

Resources

 

1. Lazowski DA, Ecclestone NA, Myers AM, Paterson DH, Tudor-Locke C, Fitzgerald C, Jones G, Shima N & Cunningham DA. (1999). A Randomized Outcome Evaluation of Group Exercise Programs in Long-Term Care Institutions. Journal of Gerontology, 54, M621-M628
2. Ries JD, Hutson J, Maralit LA, Brown MB. Group balance training specifically designed for individuals with alzheimer disease: Impact on berg balance scale, timed up and go, gait speed, and mini-mental status examination. J Geriatr Phys Ther. 2015.
3. Campbell A, Robertson MC. Otago exercise programme to prevent falls in older adults. Otago Medical School, University of Otago. 2003.
4. Kyrdalen IL, Moen K, Røysland AS, Helbostad JL. The otago exercise program performed as group training versus home training in Fall‐prone older people: A randomized controlled trial. Physiotherapy Research International. 2014;19(2):108-116.
5. Make STEADI Part of Your Medical Practice. http://www.cdc.gov/homeandrecreationalsafety/Falls/steadi/index.html?s_cid=tw_injdir154. Updated April 10, 2015. Accessed April 12, 2015

Capstone Resources

Additional resources are listed on the evidence table and PowerPoint presentation