Overview
Falls are a frequent cause of hospitalisation of older adults with Alzheimer's disease (AD) and dementia; they have a threefold risk of falling compared with cognitively intact older people, with an annual incident of about 60-80%.
One reason for frequent falling is postural instability.
We would like to explore the feasibility of using the modified Otago Exercise Programme (mOEP) to reduce falls risk and improve postural stability in older adults with mild cognitive impairment.
The OEP is a evidenced-based intervention that reduces falls and falls risk in older adults, but its efficacy in older adults with mild to moderate cognitive impairments is limited.
Research
This research has been completed. And has resulted in a the following publications:
Publications
Mesbah, N., Perry, M., Hill, K. D., Kaur, M., & Hale, L. (2017). Postural stability in older adults with Alzheimer disease. Physical Therapy, 97(3), 290-309. doi: 10.2522/ptj.20160115
Mesbah, N. (2019). Postural stability in older adults with mild to moderate cognitive impairment and Alzheimer's disease (Thesis, Doctor of Philosophy). University of Otago. Retrieved from http://hdl.handle.net/10523/9295
About the research
An exponential rise in the number of older adults with cognitive impairment is predicted. Postural instability and resultant falls are known problems for this population group.
This study explored the understanding of the possible factors which might reduce postural stability in people with mild to moderate cognitive impairment. Results will inform the development or modification of the intervention and also inform a fully-powered RCT to investigate the efficacy of this modified OEP intervention programme.
If successful, the use of this intervention might lead to significant health benefits for vulnerable older adults especially reducing the risk of falls.
Stage one
The previous study (UoO ethics number: H14/035) was a parallel mixed methods study.
1) In the qualitative study, we explored with older adults (n=8) and their care givers (n=6), their opinion of how they thought they would best engage in an exercise programme to assist their postural stability. Participants said that it was important for exercise to be fun, include cognitive activities and be of short duration. There was a mixed opinion as to whether group or individual exercise would be more suitable. We have thus modified the OEP to take these factors into account. This study will explore the acceptance of this modified exercise programme (mOEP) by the target population, and what improvements and changes are required.
2) The quantitative section evaluated the validity and ease of administration of outcome measures of postural stability in older people with mild –moderate cognitive impairment, and thus identified the most suitable outcome to be used in this present study.
Stage two
This case series will explore the feasibility and acceptability of delivering the modified Otago Exercise programme (OEP) for older adults with mild to moderate cognitive impairment to reduce falls risk and improve postural stability.
This case series will address the following objectives:
1. The feasibility and acceptability (overall programme design) of delivering the modified OEP for older adults with mild to moderate cognitive impairment.
2. Adherence to the programme over a 10 week period.
3. The viability and success of the recruitment process.
4. Safety of the exercise programme.
5. The potential benefits of the programme on falls risk and postural stability.
Supervisory team
This research was part of a PhD undertaken by Normala Mesbah and primarily supervised by Professor Leigh Hale, Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago (Primary Supervisor). For further information on the project: leigh.hale@otago.ac.nz
Dr Meredith Perry, Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago
Dr Debra Waters, Senior Lecturer in Epidemiology, Department of Preventive and Social Medicine, University of Otago
Professor Keith Hill, Head of School, School of Physiotherapy and Exercise Science, Curtin University, Australia (Advisor)