Older adults have higher rates of emergency department admissions when compared to their younger counterparts. Mobility is the ability to move around but also encompasses the environment and the ability to adapt to it. Walking aids can be used to improve mobility and prevent falls. According to international guidelines, they must be available in Geriatric Emergency Department. This study aims to evaluate the effectiveness of a program of training and provision of walking aids (WA), associated or not with telemonitoring, on mobility, quality of life, fear of falling, and risk of falls up to 3 months in older adults cared for in an emergency department.
A randomized clinical trial will be carried out in the emergency department of Hospital Sírio-Libanês. Participants will be randomized and allocated into three intervention groups, as follows: A) Walking aid group; B) Walking aid and telemonitoring group; C) Control group. Patients will undergo a baseline evaluation encompassing sociodemographic and clinical data, mobility in life spaces (Life Space Assessment), gait speed, muscle strength, functionality (Barthel Index, Katz index, and Lawton-Brody Scale), quality of life (Euro Quality of Life Instrument-5D), fear of falling (Falls Efficacy Scale International), history of falls, cognition (10-Point Cognitive Screener) and mood (15-point Geriatric Depression Scale) before the intervention. Gait time and fear of falling will be assessed again after the intervention. Finally, mobility in life spaces, functionality, quality of life, fear of falling, history of falls, cognition, and mood will be assessed 3 months after discharge from the geriatric emergency department through a telephone interview.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
153
A physiotherapist will identify the mobility needs and will indicate the most appropriate walking aid (cane or walker).
Telemonitoring will occur every two weeks for three months after the emergency department discharge, through video call (about 15 minutes). On these opportunities, the importance of using mobile devices and the guidance on safe gait will be reinforced.
Participants will receive verbal guidance and printed material with guidance on safe walking and fall prevention.
Hospital Sírio Libanês
São Paulo, São Paulo, Brazil
Life-Space Assessment (LSA)
LSA is a scale which allows the characterization of mobility in life-spaces specifically frequency, need for mobility aids and the help of third party in the last 4 weeks
Time frame: At baseline and after completion of the 3 and 6 months intervention to assess change
Falls Efficacy Scale International (FES-I)
Assesses fear of falling
Time frame: At baseline, immediately after the intervention and after completion of the 3 and 6 months intervention to assess change
Timed Up and Go test (TUG)
TUG evaluate mobility, balance, gait, and risk of falling
Time frame: At baseline and immediately after the intervention
One-minute sit-to-stand test
Functional capacity assessment by sit and stand completely in a chair (as often as possible during 1 minute)
Time frame: At baseline and after completion of the 3 and 6 months intervention to assess change
Katz index
Katz index is a scale which evaluate basic activities of daily living
Time frame: At baseline and after completion of the 3 and 6 months intervention to assess change
Barthel index
Barthel index is a scale which evaluates the autonomy for self-care, in addition to mobility
Time frame: At baseline and after completion of the 3 and 6 months intervention to assess change
Lawton-Brody scale
Lawton-Brody scale evaluate Instrumental activities of daily living
Time frame: At baseline and after completion of the 3 and 6 months intervention to assess change
Euro Quality of Life Instrument-5D (EQ-5D)
EQ-5D evaluate quality of life in five health dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, and self-rated health on a visual analog scale
Time frame: At baseline and after completion of the 3 and 6 months intervention to assess change
Geriatric Depression Scale (GDS-15)
Assesses mood disorders
Time frame: At baseline and after completion of the 3 and 6 months intervention to assess change
10-Point Cognitive Screener (10-CS)
10-CS consists of a brief cognitive screening which evaluate temporal orientation, verbal fluency and three-word recall
Time frame: At baseline and after completion of the 3 and 6 months intervention to assess change
Fall History
Fall history evaluate occurrence of falls (including data location, associated injuries, need for special care after the fall) and the total number of falls
Time frame: At baseline and after completion of the 3 and 6 months intervention to assess change
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