Documentation of Fall Incidents and Application of a Fall Prevention Programme for Seniors in Northern Greece
Condition: Elderly; Accidental Falls; Prevention; Exercise
Study type: Interventional

Summary: 
      Due to the aging of the earth's population in the coming years, strategies for preventing
      falls in the elderly are of increasing research interest. Injuries due to falls have a direct
      impact on the quality of life of the elderly and are associated with very high costs for the
      healthcare system. However, few organized fall prevention interventions have been implemented
      in Greece, unlike other EU countries. The systematic recording of falls, the information and
      education of older people about injury prevention and the participation of older people in
      organized fall coping strategies in Greece are almost non-existent. Group exercise programs
      have proven to be effective in reducing falls. The OTAGO exercise program has shown that it
      can effectively reduce the number of falls in the elderly by up to 54%. However, its
      widespread implementation by a government agency in Greece such as the Elderly Day Care
      Centers (EDCC) has not yet been possible.
    

Detailed description: 
      Background: Falls in the elderly are a global health problem as they are associated with
      serious injuries and chronic disability. About 30% of seniors over 65 experience one or more
      falls each year. Any fall can lead to injury, a long period of immobilization, a decline in
      the functional level of the elderly, a negative psychological impact and often the elderly
      can even end up in death. The causes of the falls are multifactorial and are related both to
      the effects of aging on the human body and to environmental factors. Due to the aging of the
      earth's population in the coming years, strategies for preventing falls in the elderly are of
      increasing research interest. Injuries due to falls have a direct impact on the quality of
      life of the elderly and are associated with very high costs for the healthcare system.
      However, few organized fall prevention interventions have been implemented in Greece in
      contrast to other EU countries. The systematic recording of falls, the information and
      education of older people about injury prevention and the participation of older people in
      organized fall coping strategies in Greece are almost non-existent. Group exercise programs
      have proven to be effective in reducing falls. The combination of balance exercises and
      strengthening of the core and lower limbs seems to have a positive effect on the elderly in
      avoiding falls. The OTAGO exercise program has shown that it can effectively reduce the
      number of falls in the elderly by up to 54%. However, its widespread implementation by a
      state body has not yet been possible.

      Aim: The purpose of this study is to record the incidence of falls in older people, to inform
      and educate them on prevention and to study the effect of specialized therapeutic exercise in
      relation to the usual physiotherapeutic care in reducing the number of falls. Senior people
      will be selected from the Elderly Day Care Centers for this purpose.

      Methods / Design: About 150 elderly people over 65 are expected to participate in this study.
      Participants will be recruited from 15 Day Care Centers, which will be divided into two
      groups (intervention and control). All participants will be informed and trained in fall
      prevention through lectures at the Day Care Center, as well as through the distribution of
      appropriate audiovisual material. Subsequently, the participants of the intervention group
      will follow a 6-month OTAGO group exercise program, where seniors will perform exercises
      three times a week. The control group participants will receive a leaftlet with general
      exercise (not falls prevention specific). The history of falls, fear of falling, balance and
      functional ability of participants will be assessed before, during and after the
      intervention, and will be re-examined 6 months after the intervention.

      Expected results: The results of this research will give a first glimpse of the magnitude of
      the problem of falls in older people in Greece, as data will be collected on the number of
      episodes, the factors that cause them, the outcome of falls, etc. The effectiveness of
      targeted exercise programs and in particular of OTAGO in reducing the number of falls and
      improving the balance and functional capacity of older people will also be explored.
    

Intervention name(s): Experimental; Control
Intervention type(s): Other; Other
Intervention description(s): Training will address issues such as: environmental security, identifying hazards that can lead to a fall, psychological support, getting up from a fall, standing techniques and calling for help.
The exercise program will last for six months and will be based on the OTAGO exercise program, which includes five exercise groups: general warm-up, muscle strengthening exercises, balance exercises, range of motion and stretching exercises. The program will be performed individually or in groups of two people at most and will be conducted once a week in one of the 5 outpatient clinics under the supervision of a specialized OTAGO trainer, while seniors should repeat the exercises twice a week alone at home and also walk twice a week for at least half an hour.; Information / Education about falls The participants in this group will receive the same information - education as the participants of the 1st group.
They will be given a leaflet with general gentle exercises (not fall prevention specific) for the home.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: An assessor-blind randomized control trial with a duration of six months and a 6-month follow up will be performed in 150 seniors with a history of a previous fall. The participants will be allocated into two groups of 75 persons each (one intervention group and one control group). The first group will receive consulting about home modification for home safety related to fall prevention and training on how to avoid a fall and how to act if a fall occurs. Additionally, the first group participants will follow a fall prevention exercise program based on the OTAGO exercise program. The second group (control group) will receive only the consulting and training part excluding the fall prevention exercise program.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment