Lack of Exercise May Cause Falls in the Elderly

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Lack of Exercise May Cause Falls in the Elderly
Problem Section
Falls are a major source of death and injury in elderly people. For example, they cause 90% of hip fractures and the current cost of hip fractures in the US is estimated to be about 10 billion dollars (Kato, Izumi, Hiramatsu, & Shogenji, 2006). Ensuring patient safety is one of the main reasons given for use of restraints. However, according to Jech (2006), the use of physical restraints is unlikely to prevent falls. Physical restraints, such as tie-down restraints, wheelchair belts, or bed rails are used to keep the patient safe, to keep patients from wandering off, falling, or if they are being combative. Also, it does not necessarily follow that using restraints in anticipation of harm is beneficial (Berzlanovich, Schöpfer, & Keil 2012). Direct detrimental effects of restraints have been reported by Kato, Izumi, Hiramatsu & Shogenji (2006) including death by strangulation, hypoxic encephalopathy secondary to strangulation, skin abrasions, psychological distress, and decreased socialization. Indirect effects of physical restraints are caused primarily by prolonged immobilization and decreased physical functioning pressure sores, flexion contractures, pneumonia, and biochemical and physiological changes. Use of physical restraints to prevent the patient's disruption of therapy, for example, intravenous lines and nasogastric tubes, often is seen in the acute-care setting. Approximately half of the patients who die in these settings have been physically restrained; many die with the restraints still in place (Berzlanovich, Schöpfer, & Keil, 2012) & (Jech, 2006). Clearly the high morbidity and mortality associated with physical restraints raises questions about their usefulness. Maybe instead of restraining the patients we should consider another alternative to prevent falls. Exercise has been suggested to be a better tool to reduce falls. Literature Review

An exercise program was developed to increase balance, mobility, and muscle strength in the lower extremities, and also to increase the self-efficacy for fall prevention (Kato, Izumi, Hiramatsu, & Shogenji 2006). The possible causative factors are decreased muscle strength in the lower extremities, decreased LACK OF EXERCISE MAY CAUSE FALLS IN THE ELDERLY 3 balance, and decreased cognition (Asakawa et al., 1996; Hiramatsu & Izumi, 1998; Kiely, Kiely, Burrows & Lipsitz, 1998; Kurita, Katayama, Morita, Kurita, & Inoue, 1997). In previous studies, the most effective exercise programs for fall prevention included a combination of muscle strengthening and balance. A randomized controlled trial study examining the effects of exercise on people with dementia that indicates exercise appears to effect the progression of dementia and to improve ability in some activities of daily living for aged care residents with dementia (Zadelhoff, Verbeek, Widdershoven, Rossum, & Abma 2011). Specifically, significant improvements were measured in the Self Helping Skill and Sociability for those who participated in the exercise program (Kato, Izumi, Hiramatsu, & Shogenji, 2006). The results also suggest that regular structured social interaction either by social visit or other activity does indeed improve the Sociability of people with dementia (Zadelhoff, Verbeek, Widdershoven, Rossum, & Abma 2011).These findings have implications for further research indicating that the inclusion of a regular exercise program may have an effect overall on the nursing resources required for care as well as the quality of life of residents and their careers, (Stevens & Killeen, 2006). In the past, restraint use approached 84% in some nursing homes (Berzlanovich, Schöpfer & Keil, 2012). In 1980s, about 40% of all US nursing home residents were physically restrained (Berzlanovich, Schöpfer & Keil, 2012). According to the literature the overall...
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