Commentary |
Falls exercise interventions and reduced falls rate: Always in the patient's interest?
King's College London, Institute of Gerontology, Melbourne House, 46 Aldwych London WC2B 4LL, UK
Address correspondence to: A. H. Laybourne. Tel: (020) 7848 2767; Fax: (020) 7848 1866. Email: anne.laybourne{at}kcl.ac.uk
Falls are a leading cause of mortality and morbidity in older adults. Physical, psychological and social consequences include injury, fall-related fear and loss of self-efficacy. In turn, these may result in decreased physical activity, reduced functional capacity, and increased risk of institutionalisation. Falls prevention exercise programmes (FPEP) are now widespread within the National Health Service, often part of multifactorial interventions, and are designed to minimise impairments that impact physical function, such as strength and balance. Assessment of the clinical efficacy of FPEPs has therefore focused on the measurement of physical function and rate of falls. Whilst important, this approach may be too narrow to capture the highly variable and multidimensional responses that individuals make to a fall and to a FPEP. We argue that the current focus may miss a paradoxical lack of or even deleterious impact on quality of life, despite a reduction in physical performance-related falls risk. We draw upon the Selective Optimisation and Compensation (SOC) model, developed by Paul and Margret Baltes, to explore how this paradox may be a result of the coping strategies adopted by individuals in response to a fall.
Keywords: falls prevention, activity restriction, quality of life, elderly, selective optimisation and compensation
Received 3 August 2007; accepted in revised form 24 September 2007.