Studying fall prevention among veterans

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Carol Sorgen

Falls and their consequences are a serious medical concern for older adults. Complications following falls are the leading cause of deaths due to injury among them, and are the most common cause of nonfatal injuries and hospitalization for trauma.

Even if an individual who falls does not sustain an injury, impaired balance among older adults often results in an overall lessening of physical activity and less ability to function satisfactorily both independently and in social situations.

Older veterans may be at even greater risk for falls due to their high rate of co-existing medical conditions. The VA Medical Center has made research into fall prevention a high priority, but effective programs only reduce falls by 30 percent.

Now the center, located at 10 N. Greene St., is conducting a study to determine whether a combination of interventions will help reduce falls better among older veterans.

This research may lead to new and effective interventions that could reduce fall risk, injury-related hospitalization and death. It is hoped that it can also be implemented at other VA Centers, as well as throughout the community.

What exercise is best?

Tai chi is currently considered to be one of the most effective fall prevention exercise interventions, and is endorsed by the Centers for Disease Control and Prevention (CDC). However, there are few studies comparing tai chi with other methods to help prevent falls.

While tai chi may generally improve balance, decrease fall risk, and improve lower body strength, it may not improve gait and mobility, and does little to improve the negotiation of obstacles — which is one of the largest contributors to a fall.

The majority of falls occur during walking, with slips and trips being the most common causes. Investigators believe that targeted interventions that focus on improving stepping and walking ability may be more effective at improving balance and reducing falls.

The VA Medical Center study will compare tai chi to a multimodal balance intervention (MMBI) program that will focus on standing balance, walking, stepping, strength training and recovery from a slip.

Six months of classes

Participants will be randomly assigned to one of two groups. Those in one group will attend an hour-long class three times a week that will consist of balance work, a supervised obstacle course, and lower extremity and core strengthening.

Over the six months of class, the exercises will gradually increase in difficulty to challenge balance. A skilled instructor will lead each class, and one to two assistants will be present to assist with fall risk prevention.

Participants in the second group will attend an hour-long supervised tai chi class three times a week. All tai chi classes will be taught in a group setting by an experienced instructor.

The emphasis during the class will be on standing movements, body alignment, weight shift and changes of direction. Movements will be adapted as the class progresses to increase the difficulty of weight shift and change in direction over time so that participants’ balance is continually challenged throughout the six months. Chairs or hand rails will be available for the participants to use as needed for balance recovery.

Who is eligible for the study?

The investigators plan to enroll 56 veterans over the age of 65 who live in the community. They will be randomly divided between the two types of classes. Participants must have had a fall in the last year and be at high risk for another fall.

The investigators will follow all participants for six months after completion of the exercise program to examine differences in fall rates between the groups.

For more information, or to see if you qualify for the study, call Dr. Leslie Katzel at (410) 605-7248 or email Leslie.Katzel@va.gov, or call Jeffrey Beans at (410) 605-7000, ext. 4168, or email jeffrey.beans@va.gov.