Construction And Application Of An Intervention Program Based On The Relationship Between Fatigue And Falls Risk In The Elderly

Purpose To understand the current situation of fatigue and falls risk in the elderly,to explore the internal relationship between fatigue and falls risk,to verify the role of balance function and falls efficacy in the relationship between the two,and to construct and apply intervention program based on the relationship between fatigue and falls risk in the elderly.The above provides theoretical guidance and clinical basis for reducing the falls risk in the elderly.Method 1.Research on the relationship between fatigue and falls risk in the elderly: A cross-sectional study was conducted among 400 older adults who visited the outpatient department of a Grade A hospital in Beijing from August 23,2020 to February 1,2021.The research tools included general information questionnaire,Self-Rated Fall Risk Questionnaire(FRQ),Fatigue Scale-14(FS-14),Mini-Mental State Examination(MMSE),Geriatric Depression Scale-15(GDS-15),Self-rating Anxiety Scale(SAS),Falls Efficacy Scale International(FES-I),Social Support Rating Scale(SSRS),Timed Up and Go Test(TUGT),Five-Times Sit-to-Stand Test(FTSST)and so on.Structural equation modeling(SEM)was used to verify the hypothetical theoretical model.2.Construction of an intervention program based on the relationship between fatigue and falls risk in the elderly: Pub Med,The Cochrane Library,Embase,CNKI and other databases were searched to find randomized controlled studies focusing on balance function and falls efficacy in the elderly,respectively.Stata 16.0 software was used for network meta-analysis.Integrating the results of the network meta-analysis,based on the intervention method with the best effect on balance function and fall efficacy,the first draft of the intervention program suitable for the elderly in China was formed.Twelve experts were selected for Delphi consultation to revise the intervention program to determine the final intervention program.3.Research on the application of an intervention program based on the relationship between fatigue and falls risk in the elderly: Using a randomized controlled study design,72 older adults were randomly assigned to a control or intervention group,with 36 older adults in each group.The elderly in the control group received health education,and the elderly in the intervention group received an intervention program based on the relationship between fatigue and falls risk in the elderly.The primary outcome was falls risk in older adults,and the secondary outcomes were fatigue,balance function and falls efficacy,assessed on the first day of enrollment,12 weeks of intervention,and 24 weeks of intervention.Data analysis was completed with SPSS 26.0 software according to the principle of intention-to-treat analysis.Result1.Research on the relationship between fatigue and falls risk in the elderly: The elderly had higher fatigue and falls risk.Fatigue,falls risk,balance function and falls efficacy correlated with each other(P < 0.05).The overall fit index of the theoretical model was assumed to be good: χ~2/df = 2.35,CFI = 0.960,TLI = 0.948,RMSEA = 0.059(90% CI = 0.047~0.072),SRMR = 0.046.The relationship between fatigue and falls risk included direct effects(β = 0.624,S.E.= 0.061,95% CI = 0.462~0.711)and indirect effects(β = 0.219,S.E.= 0.042,95% CI = 0.168~0.340).There were three specific mediation pathways,I: mediated by balance function(β = 0.075,S.E.= 0.023,95% CI = 0.036~0.126),II: mediated by falls efficacy(β = 0.129,S.E.= 0.038,95% CI = 0.060~0.207);III: mediated by balance function and falls efficacy in a chain(β = 0.015,S.E.= 0.007,95% CI = 0.006~0.037).2.Construction of intervention program based on the relationship between fatigue and falls risk in the elderly: Thirty-two randomized controlled studies on balance function in the elderly were included with good consistency(P > 0.05)The network meta-analysis(NMA)showed that the Lifestyle Integrated Functional Exercise Program(LiFE program)had the highest probability of the best efficacy(SUCRA = 81.8,PrBest = 37.8%,Mean Rank = 5.5).Thirty randomized controlled studies on falls efficacy in the elderly were included with good consistency(P > 0.05).The network meta-analysis(NMA)showed that Motor imagery(MI)therapy had the highest probability of the best efficacy(SUCRA = 94.4,PrBest = 68.9%,Mean Rank = 2.2).Based on the LiFE Program and motor imagination therapy,a first draft of the intervention program suitable for the elderly in China was formed.Though two rounds of expert consultation,the recovery rate of each round reached 100%,and Cr > 0.70,CV < 0.25 and Mj > 3.5 met the index requirements of the construction program,and the final intervention program was determined.3.Research on the application of intervention programs based on the relationship between fatigue and falls risk in the elderly: Before intervention,there was no statistical difference in general information and outcome indicators between the two groups of older adults(P > 0.05),which were comparable at baseline.Repeated-measures ANOVA showed that time and group had an interaction on falls risk,fatigue,balance function and falls efficacy in the elderly(P < 0.05).The comparison between the groups found that the changes in the falls risk,fatigue,balance function and falls efficacy scores of the elderly in the intervention group were significantly better than those in the control group after 12 weeks of intervention and 24 weeks after intervention(P < 0.05).The intra-group comparison found that the falls risk,fatigue and balance function scores of the elderly in the intervention group were significantly different before the intervention,12 weeks after the intervention and 24 weeks after the intervention(P < 0.05).There were statistically significant differences in falls efficacy scores between the 12 and 24 weeks of intervention and the baseline scores before the intervention(P < 0.05),but there was no difference between 12 and 24 weeks of intervention(P > 0.05).Conclusion Older people had higher risk of fatigue and falls risk.There were direct and indirect effects between fatigue and falls risk,and balance function and falls efficacy played a chain mediating effect in the relationship between the two,providing theoretical guidance for the formulation of intervention programs to reduce the falls risk in the elderly.Taking balance function and falls efficiency as intervention targets,an intervention program based on the relationship between fatigue and falls risk in the elderly was formed,covering lifestyle functional exercise program(LiFE program)and motor imagination therapy.The intervention program was simple and convenient,achieved the purpose of reducing the falls risk to a certain extent,and had good efficacy and safety,providing an empirical basis for the development of intervention research suitable for the elderly in China to reduce the falls risk.