Abstract
Objectives
The Sunbeam trial significantly reduced falls in long-term aged care (LTC) residents.
The current study's primary objective was to undertake subgroup analysis of the Sunbeam
trial, to determine whether the intervention was effective for reducing falls in LTC
residents with mild-moderate cognitive impairment/dementia. Secondary objectives were
to determine intervention effects on cognitive and physical function.
Design
Subgroup analysis of a cluster randomized controlled trial (RCT).
Setting and Participants
Permanent residents of LTC in Australia who participated in the Sunbeam trial with
Addenbrooke's Cognitive Examination-Revised (ACE-R) scores <83 (Mini-Mental State
Examination >14 = main trial inclusion criteria).
Methods
Of 221 participants, 148 had an ACE-R <83 and were included in this study. Sixteen
LTC residences (clusters) were randomized to receive either the Sunbeam program or
usual care. The Sunbeam program involved two 1-hour sessions/week of tailored and
progressive resistance and balance training for 25 weeks followed by a maintenance
program (two 30-min sessions/week of nonprogressive exercise for 6 months). Assessments
were conducted at baseline, 6 months, and 12 months. Falls were recorded using routinely
collected data from the LTC incident management systems.
Results
Rate of falls (50%) and risk of falls (31%), multiple falls (40%), and injurious falls
(44%) were reduced in the intervention group. The intervention group had significantly
better balance (static and dynamic) and sit-to-stand ability when compared with the
control group at 6 months and significantly better dynamic balance at 12 months. There
were no serious adverse events.
Conclusions and Implications
The Sunbeam Program significantly reduced falls and improved physical performance
in cognitively impaired LTC residents. This is a novel and important finding, as many
previous studies have excluded people with cognitive impairment/dementia and inconsistent
findings have been reported when this population has been studied. Our findings suggest
that progressive resistance and balance exercise is a safe and effective fall prevention
intervention in LTC residents with mild-moderate cognitive impairment/dementia.
Keywords
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Article info
Publication history
Published online: February 20, 2022
Footnotes
J.H. and M.E.T. are joint senior authors.
M.E.T. is partially funded by the Centre for Research Excellence in the Prevention of Fall-related Injuries, Australian National Health and Medical Research Council (NHMRC). K.D. is an NHMRC leadership fellow. This work does not represent the views of the NHMRC and the NHMRC did not play any role in the study. HUR Health and Fitness Equipment provided in kind support with the use of the resistance training equipment for this trial and contributed funds toward some travel expenses for research assistants. Feros Care and Domain Principal Group donated funds to support masked assessors. It was agreed a priori that none of these supporters would have any influence over the study design, the decision to submit the results of the research for publication, or the preparation of this manuscript.
The authors declare no conflicts of interest.
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© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
