Effects of case management based on preventing falls in older people: A systematic review.

BACKGROUND: Falls among older adults can lead to negative consequences with physical, functional, social, and psychological functioning, and a high prevalence of mortality. However, it is still unclear whether case management can reduce the number of falls in this population. AIMS: The aims of this review were to analyze the effects of case management on preventing falls and reducing risk factors for falls in older people. METHODS: A systematic review was conducted, searching for and synthesizing clinical trials involving case management in older people who had falls or risk for fall outcomes. Two authors extracted data using predefined data fields, and risk of bias was assessed by the Physiotherapy Evidence Database (PEDro) scale. RESULTS: Twelve studies were included in the final review. Case management in older people did not significantly reduce the number of falls, falls per person, or severity of falls compared to control groups. Adherence to recommendations in case management ranged from 25% to 88%. LINKING EVIDENCE TO ACTION: There is limited evidence of reduced rates of falls and specific risk factors for falls among people who received case management interventions. Randomized trials with good quality are needed.

Effects of a cognitive stimulation program on physical and cognitive dimensions in community-dwelling faller older adults with cognitive impairment: study protocol.

BACKGROUND: Cognitive functioning is an important dimension among the elderly. Cognitive maintenance is vital for aging due to its association with autonomy and independence. Considering the importance of preventive programs in older adults' health, this study aims to share an intervention protocol of a falls prevention program for community-dwelling faller older adults with cognitive impairment. METHODS: This is the protocol of an experimental and longitudinal study, consisting of cognitive stimulation associated with physical exercise in a 16-week fall prevention program. For cognitive intervention, the APG Cognitive Training Protocol will be used. Participants will be assessed pre-and post-intervention and will be randomly allocated to experimental or control groups. The screening protocol is composed of the TUG, FES-I, LAWTON & BRODY, ACE-R, GAI and fall survey instruments, focusing on the assessment of balance and mobility, fear of falling, performance on IADL, cognitive and anxiety tracking, respectively. DISCUSSION: This study can determine the long-term effects of multimodal cognitive training, providing evidence for its replication in the provision of care for the elderly. The objective is to promote improvements in the cognitive performance, mobility and balance of the elderly, with a focus on reducing the number of falls, fractures, hospitalizations and institutionalization, serving as an alternative to interrupt the cycle of falls. TRIAL REGISTRATION: The research was approved by the Research Ethics Committee with Human Beings at the Federal University of São Carlos, CAAE: 3654240.9.0000.5504 and Brazilian Registry of Clinical Trials (REBEC) RBR-3t85fd, registered on the 25th of September, 2020.

Effects of Aquatic Physical Exercise on Motor Risk Factors for Falls in Older People During the COVID-19 Pandemic: A Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to assess the effects of aquatic training on motor risk factors for falls in older people during the COVID-19 pandemic. METHODS: A randomized controlled trial was carried out with older people, divided into an aquatic training group (ATG) (n = 24) and a control group (CG) (n = 25). Muscle strength was assessed by the 5-Times Sit-to-Stand Test, mobility by the simple and dual-task Timed Up and Go Test, and postural stability through stabilometric data (force platform). The CG received monthly calls to monitor general health. The ATG carried out training lasting 16 weeks, with two 1-hour sessions per week. RESULTS: Both groups improved muscular strength and cognitive-motor tasks, and they performed a dual task with fewer errors in the secondary task after 16 weeks regardless of the pandemic and COVID-19 diagnosis. There was a significant decrease in the area of center of pressure displacement in the tandem posture with eyes closed in the CG. When analyzing participants who adhered at least 50% to the intervention, the ATG significantly reduced the number of steps on the Timed Up and Go Test performance. Both groups improved muscular strength and cognitive-motor tasks and increased the cognitive task cost. In the CG, there was a significant decrease in the mean amplitude of the anteroposterior center of pressure displacement in the feet together with eyes open. CONCLUSION: We found that aquatic physical exercise presented positive effects on some potentially modifiable motor risk factors for falls (mobility and muscle strength) regardless of the COVID-19 pandemic and COVID-19 diagnosis, especially among people who adhered to the intervention.

Immediate physiological effects of listening to music before physical exercise in institutionalized older people with dementia / Efeitos fisiológicos imediatos de ouvir música antes do exercício físico em idosos com demência institucionalizados / Efectos fisiológicos inmediatos de escuchar música antes del ejercicio en ancianos institucionalizados con demencia

ABSTRACT The evolution of dementia is strongly related to cognitive, motor, and functional changes and to the presence of cardiovascular diseases. Disturbances vary according to phase of dementia and can limit instrumental and basic activities of daily living. The aim of this study was to analyze the immediate physiological effects of listening to music before physical exercise in institutionalized older people with moderate to advanced dementia. A randomized trial was conducted with 18 institutionalized older people with dementia (mean age was 79 years old, 52.6% were female), who were divided into a Training with Music Group (TWMG) and a Training without Music Group (TWtMG). The evaluation included heart rate (HR), blood pressure (BP) and HR variability (HRV). The assessment was conducted in a closed environment or in places with minimal visual and auditory stimulation. The TWMG was submitted to stimuli with music for 15 minutes and physical exercises for 30 minutes to improve/maintain their global mobility. The TWtMG performed the same physical exercises, however without music before physical exercise. The interventions lasted 12 weeks, and were performed individually once a week. In the TWMG, we observe a decrease in diastolic BP in the third session. In the sixth week, the HR increased after the session in both groups. TWMG improved HRV in the third session, with a difference between groups only after the session. After the sixth session, HRV values improved in both groups. In conclusion, listening to music before physical exercise is associated with positive effects in people with dementia, as it tends to maintain and improve physiological factors.

RESUMO A evolução da demência está fortemente relacionada a alterações cognitivas, motoras e funcionais e à presença de doenças cardiovasculares. Os acometimentos variam de acordo com a fase da demência e podem limitar atividades instrumentais e básicas de vida diária. Novos tipos de tratamentos em instituições de longa permanência são necessários para melhorar o desempenho fisiológico dos idosos com demência e a qualidade de vida dos idosos. O objetivo do estudo foi analisar os efeitos fisiológicos imediatos de escutar música antes da prática de exercício físico em idosos institucionalizados com demência moderada a avançada. Um ensaio randomizado foi realizado com 18 idosos com média de idade de 79 anos, 52,6% eram do sexo feminino, institucionalizados com demência, que foram divididos em Grupo de Treinamento com Música (TWMG) e Grupo de Treinamento Sem Música (TWtMG). A avaliação incluiu um questionário sociodemográfico, frequência cardíaca (FC), pressão arterial (PA) e variabilidade da FC (VFC), avaliada por dispositivo de biofeedback cardiovascular (cardioEmotion). A avaliação ocorreu em ambiente fechado ou em lugares cujo estímulo visual e auditivo fosse o menor possível. Os participantes do TWMG foram submetidos a estímulos com música durante 15 minutos e a uma série de exercícios físicos por 30 minutos, a fim de melhorar/manter sua mobilidade global. O TWtMG realizou a mesma série de exercícios físicos, com a mesma duração e progressões, porém não foi submetido às músicas antes do exercício físico. As intervenções tiveram duração de 12 semanas e realizadas individualmente, uma vez por semana. No TWMG, houve diminuição da PA diastólica na terceira sessão. Na sexta semana, houve aumento da FC após a sessão em ambos os grupos. O TWMG melhorou a VFC na terceira sessão, com diferença entre os grupos somente após a sessão. Após a sexta sessão, a VFC melhorou em ambos os grupos. Como conclusão, escutar música antes do exercício físico associa-se a efeitos positivos em pessoas com demência, pois tende a manter e melhorar as respostas fisiológicas.

RESUMEN La evolución de la demencia está asociada con las alteraciones cognitivas, motoras y funcionales y con la presencia de enfermedades cardiovasculares. La manifestación varía según la etapa de la demencia y puede limitar las actividades instrumentales y básicas de la vida diaria. Se necesitan nuevos tipos de tratamiento en los centros de cuidados a largo plazo para mejorar el desempeño fisiológico de las personas mayores con demencia y su calidad de vida. El objetivo de este estudio fue analizar los efectos fisiológicos inmediatos de escuchar música antes de la práctica de ejercicio físico en ancianos institucionalizados con demencia de moderada a avanzada. Se realizó un ensayo aleatorizado con 18 ancianos institucionalizados con demencia, con edad media de 79 años, el 52,6% eran mujeres, y se dividieron a los participantes en Grupo de Entrenamiento con Música (TWMG) y Grupo de Entrenamiento sin Música (TWtMG). La evaluación se compuso de un cuestionario sociodemográfico, frecuencia cardíaca (FC), presión arterial (PA) y variabilidad de la FC (VFC), evaluada por el dispositivo de biofeedback cardiovascular (CardioEmotion). La evaluación tuvo lugar en un ambiente cerrado o en lugares donde la estimulación visual y auditiva fue lo más mínimo posible. Los participantes del TWMG recibieron estímulos con música durante 15 minutos y una serie de ejercicios físicos durante 30 minutos, con el fin de mejorar/mantener su movilidad global. El TWtMG realizó la misma serie de ejercicios físicos, con la misma duración y progresiones, pero no recibió estímulos con música antes del ejercicio físico. Las intervenciones tuvieron una duración de 12 semanas y se realizaron de forma individual, una vez por semana. La PA diastólica disminuyó en el TWMG en la tercera sesión. La FC aumentó después de la sesión en ambos grupos, en la sexta semana. El TWMG mejoró la VFC en la tercera sesión, con diferencias entre los grupos solamente después de la sesión. La VFC mejoró en ambos grupos después de la sexta sesión. Se concluye que escuchar música antes del ejercicio tuvo efecto positivo en personas con demencia pues mantuvo y mejoró sus respuestas fisiológicas.