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Background and Purpose: Exercise-based interventions, such as the Otago Exercise Program (OEP), are effective in preventing falls in the older adult. Previous studies evaluating the OEP have determined falls, lower limb strength, or balance outcomes but with lack of assessment of hand grip strength. The objective of this study is to evaluate the effect of OEP on hand grip strength alongside mobility and balance outcomes. Methods: This was a single-center, prospective, and single-blind randomized controlled trial conducted at the University Malaya Medical Centre. Patients older than 65 years presenting to the hospital emergency department or geriatric clinic with 1 injurious fall or 2 falls in the past year and with impaired functional mobility were included in the study. The intervention group received a modified OEP intervention (n = 34) for 3 months, while the control group received conventional care (n = 33). All participants were assessed at baseline and 6 months. Results: Twenty-four participants in both OEP and control groups completed the 6-month follow-up assessments. Within-group analyses revealed no difference in grip strength in the OEP group (P = 1.00, right hand; P =.55, left hand), with significant deterioration in grip strength in the control group (P =.01, right hand; P =.005, left hand). Change in grip strength over 6 months significantly favored the OEP group (P =.047, right hand; P =.004, left hand). Significant improvements were also observed in mobility and balance in the OEP group. Conclusions: In addition to benefits in mobility and balance, the OEP also prevents deterioration in upper limb strength. Additional benefits of exercise interventions for secondary prevention of falls in term of sarcopenia and frailty should also be evaluated in the future. [ABSTRACT FROM AUTHOR]

With advancing age, the postural control mechanism becomes less efficient because of changes in its individual components. Gait and balance impairment has been identified as the second leading cause for falls in the older people. As noted, the recommended tests focus on the clinical measures of balance, as availability of computerised balance machines in Malaysia is very limited and involves high cost. Present finding indicates an abbreviated set of clinical measures of balance incorporating static and dynamic components could be recommended when assessing balance and mobility performance. Sit to Stand, Timed Up and Go test (dual task), Functional Reach test and Step Test are a useful abbreviated suite of clinical measures of balance and mobility when assessing among older adult populations. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effectiveness of an individualized home-based exercise program that included specific turning exercises in improving turning performance in adults identified as having unsteadiness during turning. Design: A single-blind (assessors) randomized controlled trial was conducted with 68 community-dwelling Malaysians aged 50 yrs and older, who had abnormal turning performance (outside of age and sex, normal limits on the Step/Quick Turn Test [180-degree turn task on the NeuroCom Balance Master with long plate]). The intervention group received a 1 6-wk home exercise program that included two turning exercises, whereas the control group maintained their usual activities. Results: Significant group x time effects were found using two-way repeated-measures analysis of variance for turning and balance/mobility measures. The intervention group significantly improved relative to the control group for (1) sway when turning 180 degrees Step/Quick Turn, F1,65 = 8.070, P= 0.006; (2) time to perform 180-degree turn Step/Quick Turn, F1,65 = 8.216, P= 0.006; (3) Timed Up and Go (single task), F1,65 = 6.647, P= 0.01 2; (4) Timed Up and Go (dual task), F1,65 = 8.301, P= 0.005; and (5) static stance sway, F1,65 = 10.491, P= 0.002. Conclusions: An individualized home exercise program that included specific exercises to improve turning ability was effective in improving turning performance in adults older than 50 yrs. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of an individually-tailored multifactorial intervention in reducing falls among at risk older adult fallers in a multi-ethnic, middle-income nation in South-East Asia., Design: Pragmatic, randomized-controlled trial., Setting: Emergency room, medical outpatient and primary care clinic in a teaching hospital in Kuala Lumpur, Malaysia., Participants: Individuals aged 65 years and above with two or more falls or one injurious fall in the past 12 months., Intervention: Individually-tailored interventions, included a modified Otago exercise programme, HOMEFAST home hazards modification, visual intervention, cardiovascular intervention, medication review and falls education, was compared against a control group involving conventional treatment., Primary and Secondary Outcome Measures: The primary outcome was any fall recurrence at 12-month follow-up. Secondary outcomes were rate of fall and time to first fall., Results: Two hundred and sixty-eight participants (mean age 75.3 ±7.2 SD years, 67% women) were randomized to multifactorial intervention (n = 134) or convention treatment (n = 134). All participants in the intervention group received medication review and falls education, 92 (68%) were prescribed Otago exercises, 86 (64%) visual intervention, 64 (47%) home hazards modification and 51 (38%) cardiovascular intervention. Fall recurrence did not differ between intervention and control groups at 12-months [Risk Ratio, RR = 1.037 (95% CI 0.613-1.753)]. Rate of fall [RR = 1.155 (95% CI 0.846-1.576], time to first fall [Hazard Ratio, HR = 0.948 (95% CI 0.782-1.522)] and mortality rate [RR = 0.896 (95% CI 0.335-2.400)] did not differ between groups., Conclusion: Individually-tailored multifactorial intervention was ineffective as a strategy to reduce falls. Future research efforts are now required to develop culturally-appropriate and affordable methods of addressing this increasingly prominent public health issue in middle-income nations., Trial Registration: ISRCTN Registry no. ISRCTN11674947., Competing Interests: The authors have declared that no competing interests exist.

Background: In line with a rapidly ageing global population, the rise in the frequency of falls will lead to increased healthcare and social care costs. This study will be one of the few randomized controlled trials evaluating a multifaceted falls intervention in a low-middle income, culturally-diverse older Asian community. The primary objective of our paper is to evaluate whether individually tailored multifactorial interventions will successfully reduce the number of falls among older adults., Methods: Three hundred community-dwelling older Malaysian adults with a history of (i) two or more falls, or (ii) one injurious fall in the past 12 months will be recruited. Baseline assessment will include cardiovascular, frailty, fracture risk, psychological factors, gait and balance, activities of daily living and visual assessments. Fallers will be randomized into 2 groups: to receive tailored multifactorial interventions (intervention group); or given lifestyle advice with continued conventional care (control group). Multifactorial interventions will target 6 specific risk factors. All participants will be re-assessed after 12 months. The primary outcome measure will be fall recurrence, measured with monthly falls diaries. Secondary outcomes include falls risk factors; and psychological measures including fear of falling, and quality of life., Discussion: Previous studies evaluating multifactorial interventions in falls have reported variable outcomes. Given likely cultural, personal, lifestyle and health service differences in Asian countries, it is vital that individually-tailored multifaceted interventions are evaluated in an Asian population to determine applicability of these interventions in our setting. If successful, these approaches have the potential for widespread application in geriatric healthcare services, will reduce the projected escalation of falls and fall-related injuries, and improve the quality of life of our older community., Trial Registration: ISRCTN11674947.