The effect of daily exercise on fall frequency in elderly nursing home residents with dementia: a pilot study

Abstract

Background: Inactivity and falls are common problems in psychogeriatric care facilities. Physical activity is a frequently mentioned factor, which can reduce the risk of falling in the elderly. Therefore, an exercise program could be beneficial for this population. Up until now, there is insufficient evidence of the effect of exercise programs on the number of falls in elderly nursing home residents with dementia. Aim: This study aims to assess whether a five day a week exercise program of eight weeks decreases the number of falls in elderly with dementia residing in nursing homes, in comparison with a control group. Methods: The pilot study, a pre and post-test cluster randomized controlled trial was conducted on two locked dementia care units in a nursing home. Sixteen people with dementia of multiple etiologies, that met the following criteria were included; Functional Ambulation Classification score ≥3, fallen once or more in the previous eight weeks and been able to follow instructed movements. The intervention group received for eight weeks a 40-minute daily exercise program on weekdays. The Wilcoxon Signed Rank test between T0 and T1 was performed to see if there was a significant change in the number of falls within groups. The Mann-Whitney U test was performed on the difference in the number of fall incidents between T0 and T1 to see if there was a significant change in number of falls between groups. Results: The control group had a statistically non-significant (p=0.180) reduction of fall incidents with a medium effect size (r=-0.387). The intervention group had a statistically significant (p=0.039) reduction of fall incidents with a large effect size (r=-0.595). There was no statistically significant greater decrease in fall incidents for the intervention group, compared to the control group. Conclusion: There are signs that the decrease in number of falls is a direct result of the executed exercise program. This should interpret with care because of the low power of this study. Clinical Relevance: The evidence suggests that nursing homes resident with dementia might not fall more due to participating in the exercise group. A larger study with fall frequent nursing home residents with dementia is needed to test if the exercise program is effective or not.