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International Journal of Trend in Scientific Research and Development (IJTSRD)
Volume 5 Issue 2, January-February 2021 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470
@ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 255
A Study to Assess the Effectiveness of Balance Exercise on
Risk of Fall Prevention among Older People in Selected Old
Age Homes at Purba Medinipur, West Bengal - Pilot Study
Debojita Chatterjee
Tutor, Brainware University, Kolkata, West Bengal
ABSTRACT
Introduction: Balance exercise is an important element that prevent fall in
older age people observed throughout theworld.balance trainingprogramme
for old age people, including multi-task exercises,wasdesignedanddeveloped
based on well-established principles of exercise and on the knowledge that
balance control relies on the interaction of several physiological systems, as
well as interaction with environmental factors and the performed task.
Objective: This study aims to assess the effectiveness of balance exercises on
fall prevention among older people.
Methods: The research design selected for this study was experimental
research design. The investigator used Randomized control trial to select a
sample of 88 (exprimental-44 and control -44) of oldagepeopleforthisstudy.
In this study socio-demographic data tool, POMA (Tinetti performance
oriented mobility assessment) were used to measure and observe the study
accurately. Fall rate was measured with the POMA tool. Data were analyzed
through descriptive and inferencial statistic.
Results: In the group 1 i.e. experimental group, 8 (18.2%) caseswerehighfall
risk, 13 (29.5%) medium fall risk and 23 (52.3%) low fall risk. In the control
group (group 2), 29 (65.9%) were high fall risk, 10 (22.7%) medium fall risk
and 5 (11.4%) low fall risk. In the experimental group the high fall risk is very
low and low fall risk is very high in comparison to control group. The
difference was highly significant (p=0.000). This implied the balance exercise
on fall prevention is highly effective.
Conclusion: This study concluded that significant increasing the strength,
prevent fall and maintaining the balance among older people in a 4 week
balance exercise program.
KEYWORDS: Balance exercise, Fall prevention
How to cite this paper: Debojita
Chatterjee "A Study to Assess the
Effectiveness of Balance Exercise on Risk
of Fall Prevention among Older People in
Selected Old Age Homes at Purba
Medinipur, West Bengal - Pilot Study"
Published in
International Journal
of Trend in Scientific
Research and
Development(ijtsrd),
ISSN: 2456-6470,
Volume-5 | Issue-2,
February 2021,
pp.255-266, URL:
www.ijtsrd.com/papers/ijtsrd38386.pdf
Copyright © 2021 by author(s) and
International Journal ofTrendinScientific
Research and Development Journal. This
is an Open Access article distributed
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CommonsAttribution
License (CC BY 4.0)
(http://creativecommons.org/licenses/by/4.0)
INTRODUCTION
According to WHO falls are prominent among the external
causes of unintentional injury. TheyarecodedasE880-E888
in International Classification of Disease-9 (ICD-9), and as
W00-W19 in ICD-10, which include a wide range of falls
including those on the same level, upper level, and other
unspecified falls. Falls are commonly defined as
“inadvertently coming to rest on the ground, floor or other
lower level, excluding intentional change in position to rest
in furniture, wall or other objects”. Older people tend to
describe a fall as a loss of balance, whereas health care
professionals generally refer to events leading to injuries
and ill health. Therefore, the operational definition of a fall
with explicit inclusion and exclusion criteria, is highly
important1..
According to the World Health Organization (WHO) global
report on falls prevention, people aged 65 years and above
fall about 28%–35% in each year and this proportion
increases as age and frailty level increase. The prevalence of
falls in India, above the age of 60 years, reported to range
14%–53%1.
According to Population Census 2011 there are nearly 104
million older people (aged 60 years or above) in India; 53
million females and 51 million males. According to the 2011
Census, 9.5 per cent of Odisha's population consists of the
old age people, which is higher than the national average.
Increasing age neuro muscular deficits may result in
impaired physical performance and an increased risk for
falls. Prominent intrinsic fall-risk factors are age-related
decreases in balance and strength. Thus, the objective of the
present trial is to assess the effects of a fall prevention
program1.
BACKGROUND OF THE STUDY:-
Population aging is occurring at differing rates between
countries. Japan is the “oldest” country in the world, with
26% of its population aged over 60 years. Many developed
countries already have more than 15% of their population
aged greater than 60 years, and are expected to exceed 20%
by 2050. In contrast, many developing countriesinAsia such
as Malaysia, Thailand, Indonesia,Cambodia,Vietnamand the
Philippines have less than 10% of their population aged
IJTSRD38386
International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
@ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 256
more than 60 years. However, Asia is home to 60% of the
world’s population, and has the fastest aging population of
any region in the world. There is a need for a strong
preventive approach to minimize the risk of falls and
associated injuries as countries’ aging populations grow2.
RESEARCH HYPOTHESIS:
H1: There will be a significant difference between post-test
score and pre-test score after giving balance exercise
on prevention of fall.
H2: There will be a significant association between level of
balance and gait test score of older people with their
selected demographic variables.
ASSUMPTION:-
The study is based on the following assumption.
Balance exercise is animportantmeasuretopreventfall.
Old age people (60-80)years may have someknowledge
on balance exercise.
Balance exercise programme may be improve the
muscle strength.
DELIMITATIONS:-
The present study is delimited to:
Old age people (60-80 years) residing in old age home
Purba Medinipur.
Those who are able to understand bengali language.
Period of data collection 1 month
METHODOLOGY
RESEARCH APPROACH AND DESIGN
Research approach used for this study was quantitative
approach based on using statistical techniques to evaluate
the effectiveness of balance exercise on risk of fall
prevention among older people.
INDEPENDENT VARIABLE:-
“The presumed cause is referred to as the independent
variable.” The independent variable is the condition or
characteristic manipulated by the researcher. An
independent variable is a stimulus or activity that is
manipulated or varied by the researcher to create an
effect on the dependent variable.
In this study the independent variable is balance
exercise.
DEPENDENT VARIABLE:-
“The presumed effect is referred to as the dependent
variable.” The dependent variable usuallyisthevariable
the researcherisinterestedinunderstanding,explaining
or predicting.
Dependent variable is response, behavior or outcome
that the researcher wants to predict or explain.
In this study the dependent variable is fall prevention.
POPULATION, SAMPLE AND SAMPLING TECHINQUE
This study was conducted in in selected older age home at
purba medinipur, west bengal. (Amar seva sanga Old age
Home, Santosh Promoda Old Age Home). The selection of
sample done by using simple random sampling based on
envelope computer generated list of old age people (60 -80
yrs) in old age home. For the present study consist of 88 old
age people. (Experimental group- 44 and control group-44).
Figure No 1: Schematic Diagram of Research Design
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@ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 257
SELECTION CRITERIA:-
Inclusion criteria:-
1. Older people of both gender.
2. The older people age 60 yr to 80 yr.
3. The older people who were available during the period of study.
4. The older people who were willing to participate in the study.
Exclusion criteria:-
1. The people who were critically ill. history of CVA , fracture, parkinson disease, cardiovascular disease, cataracts, hearing
loss, dizziness, depression and Alzheimer's disease.
2. People with restricted limb movement.
DATA COLLECTION METHOD & TOOL:-
In this study socio demographic data tool, Tinetti performance oriented mobility assessment are used to observe the study
accurately. Based on the objectives of the study, socio demographic data tool, Tinetti performance oriented mobility
assessment is prepared to evaluate the risk of fall prevention among old age people.
The tool is composed of section A: socio demographic data tool and section B: Tinetti performance oriented mobility
assessment. Second draft of tool was selected.
SECTION A: SOCIO DEMOGRAPHIC DATA TOOL:-
The investigator constructed this tool to collect the demographic data of the study subjects and to identify the influence of
sample characteristics with the evaluated the risk of fall prevention. It consists of 8 items, which composed of age, sex,marital
status, educational status, occupational status, BMI, health insurance.
SECTION B: Tinetti performance oriented mobility assessment
Description: The Tinetti assessment tool is an easily administered task-oriented test that measures an older adult’s gait and
balance abilities.
Equipment needed: Hard armless chair
Stopwatch or wristwatch
15 ft walkway
Time: 10-15 minutes
Scoring: A three-point ordinal scale, ranging from 0-2. “0” indicates the highest level of impairment and “2” the individuals
independence.
Total Balance Score = 16
Total Gait Score = 12
Total Test Score = 28
Interpretation: 25-28 = low fall risk
19-24 = medium fall risk
< 19 = high fall risk
PILOT STUDY:-
After obtaining the permission of the old age home pilot study was carried out at vivekananda oldagehome,purba medinipur,
west bengal. This old age home to find the feasibility of the study on10olderpeople.Thesubjectsforthepilotstudyprossessed
the same characteristic as that of the sample for the main study.Theparticipant where informedaboutthepurpose ofthestudy
and consent was taking from the participated and the investigator did not faced any kind of problem. Based on the outcomeof
the study this pilot study was feasible and continued the main study.
DATA COLLECTION:-
Date collection was carried out from 27/7/2020 to 28/8/2020 after getting CTRI registration number. Formal written
permission was taken from the authority of old age home, purba medinipur, west Bengal to conduct main study. Researcher
collects the data by explaining the purpose of the study to each subject. Computergeneratedrandom numberlistusedtoselect
the sample from the population as per inclusion criteria.Informedconsentwastaken.Thesamplesweregiven balanceexercise
for daily 2 time, with each training session lasting 5 mints to the experimental group and routine work ware given to control
group.
DATA COLLECTION PROCEDURE:-
Permission was obtained from the authority of old age home (Amar seva sanga).
Informed consent was obtained from the individual older people.
Pre test was done by using POMA tool to assess effectiveness of fall prevention among both group.
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@ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 258
Balance exercise was given daily 2 time, with each training session lasting 5 min among experimental group for 4 weeks.
Post test was conducted with the same tool after 4 weeks among both the group.
After post test data were analyzed.
ETHICAL CONSIDERATION:-
Permission was obtained from the regional authority for conducting this study.
A formal permission taken from the authority of the selected older age home, purbe medinipur, west benagl.
Permission was obtained from institutional ethical committee in KIMS, PBMH, KIIT University, Bhubaneswar.
Figure No.3: SCHEMATIC REPRESENTATION OF RESEARCH Figure
ANALYSIS AND INTERPRETATION
Findings related to demographic characteristics of participants
Section-1: Characteristics of Socio-demographic variables of the older people.
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Table no-1.1: Frequency and percentage distribution of age in experimental and control group
Table 1.1 Age distribution
Variable Classification
Group 1
(n=44)(Experimental)
Group 2 (n=44)(Control) Total (n=88)
X2, p
No. % No. % No. %
Age
60-70 22 50 28 63.6 50 56.8 X2=1.667
p=0.197
71-80 22 50 16 36.4 38 43.2
Table 1.1: shows that out of 88 sample subjects, 50 (56.8%) and 38 (43.2%) were in the age group of 60-70 years and 71-80
years age group. In the exprimental group , the sample is distributed equally among 60-70 and 71-80 years age group whilein
control group the corresponding proportion are 63.3% and 36.4%. The distribution of age in the experimental and control
group did not have significant association (p=0.197). The difference may be due to chance because of sampling fluctuation.
Graph 1 Bar diagram showing the percentage distribution of age group
Table no-1.2: Frequency and percentage distribution of gender in experimental and control group
Table 2 Gender distribution
Variable Classification
Group 1 (n=44)(Experimental) Group 2 (n=44)(Control) Total (n=88)
X2, p
No. % No. % No. %
Gender
Male 23 52.3 22 50 45 51.1 X2=0.045
p=0.831
Female 21 47.7 22 50 43 48.9
Table 1.2: shows that the overall sample subjects are evenly distributed according to male and female with 51.1% males and
48.9% females. In the exprimental group and control group the genderdistributionisapproximatelyevenanddid nothaveany
significant association (p=0.831).
Graph 2 Bar diagram showing the percentage distribution of gender group
Table no-1.3: Frequency and percentage distribution of BMI in experimental and control group
Table 3 Distribution of BMI
Variable Classification
Group 1 (n=44)
(Experimental)
Group 2 (n=44)
(Control)
Total (n=88)
X2, p
No. % No. % No. %
BMI
Under weight (<18.5) 5 11.4 3 6.8 8 9.1
X2=0.722
p=0.868
Normal weight (18.5-24.9) 23 52.3 25 56.8 48 54.5
Over weight (25-29.9) 11 25 10 22.7 21 23.9
Obesity (≥30) 5 11.4 6 13.6 11 12.5
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Table 1.3: shows that present distribution of BMI by groups. BMI classified into four groups i.e. under weight (<18.5 kg/m2),
normal weight (18.5-24.9 kg/m 2), over weight (25-29.9 kg/m2) and obese (≥30 kg/m 2). In exprimental group,outof44cases
5 (11.4%) were under weight, 23 (52.3%) were normal weight, 11 (25%) were over weight and 5 (11.4%) were obese. In
control group, out of 44 cases, 3 (6.8%) were under weight, 25 (56.8%) were normal weight,10(22.7%)wereoverweightand
6 (13.6%) were obese. There was no significant association of the BMI with groups(p=0.868).
Graph 3 Bar diagram showing the percentage distribution of BMI group
Table no-1.4: Frequency and percentage distribution of Marital status in experimental and control group
Table 4 Distribution of Marital status
Variable Classification
Group 1 (n=44)
(Experimental)
Group 2 (n=44)
(Control)
Total (n=88)
X2, p
No. % No. % No. %
Marital
status
Married 11 25 8 18.2 19 21.6
X2=0.610
p=0.894
Unmarried 14 31.8 15 34.1 29 33
Divorcee 11 25 12 27.3 23 26.1
Widowed 8 18.2 9 20.5 17 19.3
Table 1.4: shows that present distribution of marital status by groups. In exprimental group, out of 44 cases 11 (25%) were
both in married and divorcee, 14 (31.8%) were unmarried and 8 (18.2%) were widowed. In control grou2, 8 (18.2%) were
married, 15 (34.1%) were unmarried, 12 (27.3%) were divorce and 9 (20.5%) were widowed. There was no significant
association of the marital status with groups (p=0.894).
Graph 4 Bar diagram showing the percentage distribution of Marital status group
Table no-1.5: Frequency and percentage distribution of Education status in experimental and control group
Table 5 Distribution of Educational status
Variable Classification
Group 1 (n=44)
(Experimental)
Group 2 (n=44)
(Control)
Total (n=88)
X2, p
No. % No. % No. %
Illiterate 5 11.4 4 9.1 9 10.2
X2=0.454
p=0.978
Primary School 16 36.4 18 40.9 34 38.6
High School 11 25 10 22.7 21 23.9
Graduate 7 15.9 8 18.2 15 17
Post Graduate 5 11.4 4 9.1 9 10.2
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Table 1.5: shows that overall there were 10.2% post graduate, 17% graduate, 23.9% high school, 38.6% primary school and
10.2% illiterate subjects. The distribution of sample subjects by education did not differsignificantlyinexprimental groupand
control group (p=0.978).
Graph 5 Bar diagram showing the percentage distribution of Educational status group
Table no-1.6: Frequency and percentage distribution of Occupational status in experimental and control group
Table 6 Occupational status by groups
Variable Classification
Group 1 (n=44)
(Experimental)
Group 2 (n=44)
(Control)
Total (n=88)
X2, p
No. % No. % No. %
Occupational
status
Retired with Pension 9 20.5 10 22.7 19 21.6 X2=0.067
p=0.796
Retired without Pension 35 79.5 34 77.3 69 78.4
Table 1.6: shows that the sample of elderly people were divided into two groups, retired with pension and retired without
pension. Only 21.6% of the sample subjects were pension holders and remaining 78.4% were without pension. The
classification as retired with pension and retired without pension did not have significant association with group (p=0.796).
Graph 6 Bar diagram showing the percentage distribution of occupational status group
Table no-1.7: Frequency and percentage distribution of Health insurance in experimental and control group
Variable Classification
Group 1 (n=44)
(Experimental)
Group 2 (n=44)
(Control)
Total (n=88)
X2, p
No. % No. % No. %
Health
insurance
Accidental fall covered 23 52.3 22 50 45 51.1 X2=0.045
p=0.831
21 47.7 22 50 43 48.9
Table 1.7: shows that it is classified into two groups i.e. accident fall covered and not coveredunderhealthinsurance.Outof88
cases, among 45 (51.1%) the accident fall was covered and remaining 43 (48.9%) were not covered under health insurance.
There was no significant association between coverage of accident fall under health insurance and the groups (p=0.831).
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Graph 7 Bar diagram showing the percentage distribution of heath insurance group
Section-2: Effectiveness of balance exercises on prevention of fall among the older people.
Table 2.1: Comparison of pre and post test fall risk within Control Group
Fall risk
Pre test (n=44) Post test (n=44)
No. % No. %
<19 high 29 65.9 29 65.9
19-24 medium 10 22.7 10 22.7
25-28 low 5 11.4 5 11.4
Marginal Homogeneity Test 'p' value 1.000
Table 2.1: shows that indicated that in the pre test condition there were 65.9% cases withhighfall risk,22.7%mediumfall risk
and 11.4% low fall risk in control group. At the post test there was no change in the corresponding proportion (p=1.000).
Graph 8 Bar diagram showing the comparison of pre and post test fall risk within Control group
Table 2.2: Comparison of pre and post test fall risk within
Fall risk
Pre test (n=44) Post test (n=44)
No. % No. %
<19 high 29 65.9 8 18.2
19-24 medium 10 22.7 13 29.5
25-28 low 5 11.4 23 52.3
Marginal Homogeneity Test 'p' value 0.000
Experimental group
Table 2.2 shows that indicated that in the pre test condition there were 65.9% cases with high fall risk, 22.7%mediumfall risk
and 11.4% low fall risk in experimental group. At the post testthatisafteradministeringthebalance exerciseonfall prevention
it was found that the high fall risk as reduced 18.2% and low fall risk has increased to 52.3%. This implied a significant
improvement in reducing the fall risk (p=0.000).
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Graph 9 Bar diagram showing the comparison of pre and post test fall risk within Experimental group
Table 2.3: Comparison of Pre and Post test fall score between groups
Total score
Group 1 (n=44)(Experimental) Group 2 (n=44)(Control)
p' value*
Mean(SD) Median(IQR) Mean(SD) Median(IQR)
Pre test 17.0(4.1) 16(14,19) 16.9(4.1) 16(14,19) 0.778
Post test 23.1(3.0) 24(20,26) 16.9(4.1) 16(14,19) 0.000
Mann-WhitneyU 'p' value
Table 2.3: shows that present comparison of pre test and post test fall score between group 1 and group 2. The mean pre test
score in group 1 was 17.0 ± 4.1 and median score 16 (IQR: 4-1) and the corresponding mean and median of group 2 was 16.9
4.1 and 16 (IQR: 14-19) respectively. There was no significant difference of pre test fall score between the two groups
(p=0.778).
Graph 10 Bar diagram showing the comparison of Pre and Post test fall score between groups
Table 2.4: Comparison of pre test total score between two groups
Descriptive statistics Group 1 (Experimental) Group 2(Control)
N 44 44
Mean 17.0 16.9
SD 4.1 4.1
Q1 (1stQuartile) 14 14
Q2 (Median) 16 16
Q3 (3rdQuartile) 19 19
Mann-Whitney U 'p' value 0.778
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Table 2.4: shows that present comparison of pre test total score between two groups. In exprimental groupmeanpretesttotal
score was 17.0 ± 4.1 and median 16 (IQR: 14-19) and in control group mean total score was 16.9 ± 4.1andmedian16(IQR:14-
19). There was no significant difference in the pre test total score between the two groups (p=0.778).
Graph 11 Bar diagram showing the comparison of pre test total score between two groups
Table 2.5: Comparison of post test total score between two groups
Descriptive statistics Group 1 (Experimental) Group 2(Control)
N 44 44
Mean 23.1 16.9
SD 3.0 4.1
Q1 (1stQuartile) 20 14
Q2 (Median) 24 16
Q3 (3rdQuartile) 26 19
Mann-Whitney U 'p' value 0.000
Table 2.5: shows that present comparison of post-test total score between two groups. In exprimental group mean post-test
total score was 23.1 ± 3.0 and median 24 (IQR: 20-26) and in control group mean total score was 16.9 ± 4.1 and median 16
(IQR: 14-19). The mean and median post test total score was significantly higher in group 1 than group 2 (p=0.000).
Graph 12 Bar diagram showing the comparison of post test total score between two groups
Significant difference between post-test score and pre-test score aftergivingbalance exerciseonpreventionoffall.Inmystudy
H1 is accepted and H2 is rejected.
Section-3: Association between the level of balance and gait test score of fall prevention with their selected
demographic variables.
Table no.3.1: Association of Pre test fall risk by groups
Pre test fall risk
Group 1 (n=44)(Experimental) Group 2 (n=44)(Control) Total (n=88)
X2, p
No. % No. % No. %
<19 high fall risk 29 65.9 29 65.9 58 65.9
X2=0.000
p=1.000
19-24 medium fall risk 10 22.7 10 22.7 20 22.7
25-28 low fall risk 5 11.4 5 11.4 10 11.4
Table 3.1: shows that Pre test fall risk is classified into 3 categories based upon the fall score. The score <19 is termed as high
fall risk, 19-24 as medium fall risk and 25-28 low fall risk. Overall it is found that 58 (65.9%), 20 (22.7%) and 10(11.4%)were
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in high fall risk, medium fall risk and low fall risk respectively. Both the groups did not have any association with pre test fall
risk (p=1.000). This implied both the groups are matched at the pre test level and therefore will give valid comparison of post
test fall risk.
Graph 13 Bar diagram showing the pre test fall risk by groups
Table no.3.2: Association of Post test fall risk by groups
Post test fall score
Group 1 (n=44)(Experimental) Group 2 (n=44)(Control) Total (n=88)
X2, p
No. % No. % No. %
<19 high fall risk 8 18.2 29 65.9 37 42
X2=23.882
p=0.000
19-24 medium fall risk 13 29.5 10 22.7 23 26.1
25-28 low fall risk 23 52.3 5 11.4 28 31.8
Table 3.2: shows that present the association of post test fall risk with groups. Inthegroup1i.e. experimental group,8(18.2%)
cases were high fall risk, 13 (29.5%) medium fall risk and 23 (52.3%) low fall risk. In the control group (group 2), 29 (65.9%)
were high fall risk, 10 (22.7%) medium fall risk and 5 (11.4%) low fall risk. In the experimental group the high fall risk is very
low and low fall risk is very high in comparison to control group. The difference was highly significant (p=0.000). Thisimplied
the balance exercise on fall prevention is highly effective.
Graph 14 Bar diagram showing the post test fall risk by groups
Significant association between level of balance and gait test score of older people with their selected demographic variables.
H2 is accepted and H1 is rejected.
The mean post test score in experimental group was 23.1 ± 3.0 and median score 24 (IQR: 20-26)andthecorrespondingmean
and median of group 2 was 16.9 ± 4.1 and 16 (IQR: 14-19) respectively. There was significant difference of post test fall score
between the two groups (p=0.000). This implied the fall risk has significantly reduced in experimental groups.
DISCUSSION
The present study shows that majority of cases i.e. 56.8%
and 43.2% were 60-70 years and 71- 80 years older people
in exprimental group. 51.1% males and 48.9% female in
expreimental group. Majority of cases i.e. 11.4% under
weight, 52.3% normal weight, 25% over weight and 11.4%
obese in expreimental group. With respect to marital status
i.e. 25% married and divorcee, 31.8% unmarried and 18.2%
widowed in expreimental group. Majority of casesi.e.10.2%
post graduate, 17% graduate, 23.9% high school, 38.6%
primary school and 10.2% illiterate in expreimental group.
Majority of cases i.e. 21.6% pension holders and 78.4%
without pension in expreimental group. Majorityofcasesi.e.
51.1% the accident fall was covered and remaining 48.9%
were not covered under health insurance. Majority of cases
i.e. effectiveness of balance exercise indicated that inthe pre
test condition there were 65.9% cases with high fall risk,
22.7% medium fall risk and 11.4% low fall risk in control
group. Majority of cases i.e effectiveness of balance exercise,
indicated that in the pre test condition there were 65.9%
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cases with high fall risk, 22.7% medium fall risk and 11.4%
low fall risk in experimental group. Majority of cases i.e that
58 (65.9%), 20 (22.7%) and 10 (11.4%) were in high fall
risk, medium fall risk and low fall risk respectively. Majority
of cases i.e that 18.2% cases were high fall risk, 29.5%
medium fall risk and 52.3% low fall risk in exprimental
group. Majority of cases i.e that mean pre testscore was17.0
± 4.1 and median score 16 (IQR: 4-1) respectively in
exprimental group. Majority of cases i.e that mean pre test
total score was 17.0 ± 4.1 and median 16 (IQR: 14-19) in
exprimental group. Majority of cases i.e that mean post-test
total score was 23.1 ± 3.0 and median 24 (IQR: 20-26) in
exprimental group. Majority of cases i.e. that the pre test
score found that 58 (65.9%), 20 (22.7%) and 10 (11.4%)
were in high fall risk, medium fall risk and low fall risk
respectively in exprimental group. Majority of cases i.e. that
the post test score found that 8 (18.2%) cases were high fall
risk, 13 (29.5%) medium fall risk and 23 (52.3%) low fall
risk in exprimental group.
SUMMARY:
The finding of the study revealed that effect of balance
exercise. So, care giver can be trained in use of balance
exercise to provide to the older people .For assessing long
term effect, it is recommended to take up another long term
study by controlling more variables. Further research is
suggested to confirm the finding of the current study.
CONCLUSION
How ironic that twenty five centuries later we are
rediscovering and proving thorough the modern science,
that older people’s frame of mind and perception of disease
predict their treatment success. When we comfort a older
people, we may be doing more than consoling him or her.
The finding of the present study conclude that the results of
the present study support its hypothesis and revealed that
balance exercise were effective in reducing the fall rate and
increase the balance and gait score among 60 to 80 older
people. It was observed by POMA tool. Data were analyzed
through descriptive and inferential statistics.
IMPLICATIONS OF THE STUDY:
The investigator has drawn the following implications from
the findings of this study, which are of vital concern to the
field of nursing practice, nursing education, nursing
administration and nursing research.
Nursing practice:
Nurses are playing a vital role in implementing the balance
exercise among older people for fall prevention.
Nursing Education:
Intervention can be taught to the students to reduce fall
risk among older people.
Nurse educator can use the findings of the study to
introduce the topic as a demonstration as a part of basic
nursing course.
Nursing administration:
With the technological advances and ever growing
challenges of nursing, the nurse administrator have
responsibility to provide the nurses with substantive
continual education and care full observation.
Nursing research:
The result of the study and the intervention can
contribute to the body of nursing knowledge.
Future investigator can use the finding and the
methodology for reference material.
Another study can be done with large samples.
Other researcher can conduct further studies in the
same field can utilize the suggestion and
recommendation.
RECOMMENDATION:
On the basis of this study the following recommendation
have been made.
A similar study can be replicated on large sample in
different setting to strengthen the findings.
Further research can be carried out to identify the
occurrence of fall prevention by adopting different
sampling technique.
A study can be conducted to assess the factors which
improve in balance.
Further research is suggested to confirm the findings of
the current study.
LIMITATIONS:
The study results can not be generalized because of
following reason:
4 weeks observation is too short for the effectiveness of
the therapy.
REFERANCES
[1] Polit Cheryal, Nursing Research, Lippincott Wilkins
publication, 8thedition, 2008.
[2] World health organization (2018).constitution of the
world healthorganizationbasicdocuments,forty-fifth
ediation, supplement, November 2018.
[3] Yves J Gschwind, Reto W Kressig, Andre Lacroix,
Thomas Muehlbauer, Barbara Pfenninger, Urs
Granacher. A best practice fall prevention exercise
program to improve balance, strength / power, and
psychosocial health inolderadults.BMCGeriatr.2013
Oct 9; 13:105.
[4] Miller, Kenneth L, Magel, John Hayes, Joseph. The
Effects of a Home-Based ExerciseProgramonBalance
Confidence, Balance Performance, and Gait in
Debilitated, Ambulatory Community-Dwelling Older
Adults: A Pilot Study. Journal of Geriatric Physical
Therapy. 2010 Nov;33(2):85-91 ·
[5] Sherrington C, Michaleff ZA, Fairhall N, Paul SS,
Tiedemann A, Whitney J et al. Exercisetopreventfalls
in older adults: an updated systematic review.Br J
Sports Med. 2017;Dec;51(24):1750-1758.
[6] Sherrington C, Fairhall NJ,Wallbank GK,TiedemannA,
Michaleff ZA, Howard K et al. Exercise for preventing
falls in older people living in the community.
Cochrane Database Syst Rev. 2019 Jan 31;
1(1):CD012424.
[7] Granacher U, Gollhofer A, Hortobágyi T, Kressig RW,
Muehlbauer T. The importance of trunk muscle
strength for balance, functional performance, and fall
prevention in seniors: a systematic review. Sports
Med. 2013 Jul; 43(7):627-41.
[8] Eckardt N. Lower-extremity resistance training on
unstable surfaces improves proxies of muscle
strength, power and balance in healthyolderadults:a
randomize control trial. BMC Geriatr. 2016 Nov
24;16(1)

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A Study to Assess the Effectiveness of Balance Exercise on Risk of Fall Prevention among Older People in Selected Old Age Homes at Purba Medinipur, West Bengal Pilot Study

  • 1. International Journal of Trend in Scientific Research and Development (IJTSRD) Volume 5 Issue 2, January-February 2021 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470 @ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 255 A Study to Assess the Effectiveness of Balance Exercise on Risk of Fall Prevention among Older People in Selected Old Age Homes at Purba Medinipur, West Bengal - Pilot Study Debojita Chatterjee Tutor, Brainware University, Kolkata, West Bengal ABSTRACT Introduction: Balance exercise is an important element that prevent fall in older age people observed throughout theworld.balance trainingprogramme for old age people, including multi-task exercises,wasdesignedanddeveloped based on well-established principles of exercise and on the knowledge that balance control relies on the interaction of several physiological systems, as well as interaction with environmental factors and the performed task. Objective: This study aims to assess the effectiveness of balance exercises on fall prevention among older people. Methods: The research design selected for this study was experimental research design. The investigator used Randomized control trial to select a sample of 88 (exprimental-44 and control -44) of oldagepeopleforthisstudy. In this study socio-demographic data tool, POMA (Tinetti performance oriented mobility assessment) were used to measure and observe the study accurately. Fall rate was measured with the POMA tool. Data were analyzed through descriptive and inferencial statistic. Results: In the group 1 i.e. experimental group, 8 (18.2%) caseswerehighfall risk, 13 (29.5%) medium fall risk and 23 (52.3%) low fall risk. In the control group (group 2), 29 (65.9%) were high fall risk, 10 (22.7%) medium fall risk and 5 (11.4%) low fall risk. In the experimental group the high fall risk is very low and low fall risk is very high in comparison to control group. The difference was highly significant (p=0.000). This implied the balance exercise on fall prevention is highly effective. Conclusion: This study concluded that significant increasing the strength, prevent fall and maintaining the balance among older people in a 4 week balance exercise program. KEYWORDS: Balance exercise, Fall prevention How to cite this paper: Debojita Chatterjee "A Study to Assess the Effectiveness of Balance Exercise on Risk of Fall Prevention among Older People in Selected Old Age Homes at Purba Medinipur, West Bengal - Pilot Study" Published in International Journal of Trend in Scientific Research and Development(ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2, February 2021, pp.255-266, URL: www.ijtsrd.com/papers/ijtsrd38386.pdf Copyright © 2021 by author(s) and International Journal ofTrendinScientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (CC BY 4.0) (http://creativecommons.org/licenses/by/4.0) INTRODUCTION According to WHO falls are prominent among the external causes of unintentional injury. TheyarecodedasE880-E888 in International Classification of Disease-9 (ICD-9), and as W00-W19 in ICD-10, which include a wide range of falls including those on the same level, upper level, and other unspecified falls. Falls are commonly defined as “inadvertently coming to rest on the ground, floor or other lower level, excluding intentional change in position to rest in furniture, wall or other objects”. Older people tend to describe a fall as a loss of balance, whereas health care professionals generally refer to events leading to injuries and ill health. Therefore, the operational definition of a fall with explicit inclusion and exclusion criteria, is highly important1.. According to the World Health Organization (WHO) global report on falls prevention, people aged 65 years and above fall about 28%–35% in each year and this proportion increases as age and frailty level increase. The prevalence of falls in India, above the age of 60 years, reported to range 14%–53%1. According to Population Census 2011 there are nearly 104 million older people (aged 60 years or above) in India; 53 million females and 51 million males. According to the 2011 Census, 9.5 per cent of Odisha's population consists of the old age people, which is higher than the national average. Increasing age neuro muscular deficits may result in impaired physical performance and an increased risk for falls. Prominent intrinsic fall-risk factors are age-related decreases in balance and strength. Thus, the objective of the present trial is to assess the effects of a fall prevention program1. BACKGROUND OF THE STUDY:- Population aging is occurring at differing rates between countries. Japan is the “oldest” country in the world, with 26% of its population aged over 60 years. Many developed countries already have more than 15% of their population aged greater than 60 years, and are expected to exceed 20% by 2050. In contrast, many developing countriesinAsia such as Malaysia, Thailand, Indonesia,Cambodia,Vietnamand the Philippines have less than 10% of their population aged IJTSRD38386
  • 2. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 256 more than 60 years. However, Asia is home to 60% of the world’s population, and has the fastest aging population of any region in the world. There is a need for a strong preventive approach to minimize the risk of falls and associated injuries as countries’ aging populations grow2. RESEARCH HYPOTHESIS: H1: There will be a significant difference between post-test score and pre-test score after giving balance exercise on prevention of fall. H2: There will be a significant association between level of balance and gait test score of older people with their selected demographic variables. ASSUMPTION:- The study is based on the following assumption. Balance exercise is animportantmeasuretopreventfall. Old age people (60-80)years may have someknowledge on balance exercise. Balance exercise programme may be improve the muscle strength. DELIMITATIONS:- The present study is delimited to: Old age people (60-80 years) residing in old age home Purba Medinipur. Those who are able to understand bengali language. Period of data collection 1 month METHODOLOGY RESEARCH APPROACH AND DESIGN Research approach used for this study was quantitative approach based on using statistical techniques to evaluate the effectiveness of balance exercise on risk of fall prevention among older people. INDEPENDENT VARIABLE:- “The presumed cause is referred to as the independent variable.” The independent variable is the condition or characteristic manipulated by the researcher. An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. In this study the independent variable is balance exercise. DEPENDENT VARIABLE:- “The presumed effect is referred to as the dependent variable.” The dependent variable usuallyisthevariable the researcherisinterestedinunderstanding,explaining or predicting. Dependent variable is response, behavior or outcome that the researcher wants to predict or explain. In this study the dependent variable is fall prevention. POPULATION, SAMPLE AND SAMPLING TECHINQUE This study was conducted in in selected older age home at purba medinipur, west bengal. (Amar seva sanga Old age Home, Santosh Promoda Old Age Home). The selection of sample done by using simple random sampling based on envelope computer generated list of old age people (60 -80 yrs) in old age home. For the present study consist of 88 old age people. (Experimental group- 44 and control group-44). Figure No 1: Schematic Diagram of Research Design
  • 3. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 257 SELECTION CRITERIA:- Inclusion criteria:- 1. Older people of both gender. 2. The older people age 60 yr to 80 yr. 3. The older people who were available during the period of study. 4. The older people who were willing to participate in the study. Exclusion criteria:- 1. The people who were critically ill. history of CVA , fracture, parkinson disease, cardiovascular disease, cataracts, hearing loss, dizziness, depression and Alzheimer's disease. 2. People with restricted limb movement. DATA COLLECTION METHOD & TOOL:- In this study socio demographic data tool, Tinetti performance oriented mobility assessment are used to observe the study accurately. Based on the objectives of the study, socio demographic data tool, Tinetti performance oriented mobility assessment is prepared to evaluate the risk of fall prevention among old age people. The tool is composed of section A: socio demographic data tool and section B: Tinetti performance oriented mobility assessment. Second draft of tool was selected. SECTION A: SOCIO DEMOGRAPHIC DATA TOOL:- The investigator constructed this tool to collect the demographic data of the study subjects and to identify the influence of sample characteristics with the evaluated the risk of fall prevention. It consists of 8 items, which composed of age, sex,marital status, educational status, occupational status, BMI, health insurance. SECTION B: Tinetti performance oriented mobility assessment Description: The Tinetti assessment tool is an easily administered task-oriented test that measures an older adult’s gait and balance abilities. Equipment needed: Hard armless chair Stopwatch or wristwatch 15 ft walkway Time: 10-15 minutes Scoring: A three-point ordinal scale, ranging from 0-2. “0” indicates the highest level of impairment and “2” the individuals independence. Total Balance Score = 16 Total Gait Score = 12 Total Test Score = 28 Interpretation: 25-28 = low fall risk 19-24 = medium fall risk < 19 = high fall risk PILOT STUDY:- After obtaining the permission of the old age home pilot study was carried out at vivekananda oldagehome,purba medinipur, west bengal. This old age home to find the feasibility of the study on10olderpeople.Thesubjectsforthepilotstudyprossessed the same characteristic as that of the sample for the main study.Theparticipant where informedaboutthepurpose ofthestudy and consent was taking from the participated and the investigator did not faced any kind of problem. Based on the outcomeof the study this pilot study was feasible and continued the main study. DATA COLLECTION:- Date collection was carried out from 27/7/2020 to 28/8/2020 after getting CTRI registration number. Formal written permission was taken from the authority of old age home, purba medinipur, west Bengal to conduct main study. Researcher collects the data by explaining the purpose of the study to each subject. Computergeneratedrandom numberlistusedtoselect the sample from the population as per inclusion criteria.Informedconsentwastaken.Thesamplesweregiven balanceexercise for daily 2 time, with each training session lasting 5 mints to the experimental group and routine work ware given to control group. DATA COLLECTION PROCEDURE:- Permission was obtained from the authority of old age home (Amar seva sanga). Informed consent was obtained from the individual older people. Pre test was done by using POMA tool to assess effectiveness of fall prevention among both group.
  • 4. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 258 Balance exercise was given daily 2 time, with each training session lasting 5 min among experimental group for 4 weeks. Post test was conducted with the same tool after 4 weeks among both the group. After post test data were analyzed. ETHICAL CONSIDERATION:- Permission was obtained from the regional authority for conducting this study. A formal permission taken from the authority of the selected older age home, purbe medinipur, west benagl. Permission was obtained from institutional ethical committee in KIMS, PBMH, KIIT University, Bhubaneswar. Figure No.3: SCHEMATIC REPRESENTATION OF RESEARCH Figure ANALYSIS AND INTERPRETATION Findings related to demographic characteristics of participants Section-1: Characteristics of Socio-demographic variables of the older people.
  • 5. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 259 Table no-1.1: Frequency and percentage distribution of age in experimental and control group Table 1.1 Age distribution Variable Classification Group 1 (n=44)(Experimental) Group 2 (n=44)(Control) Total (n=88) X2, p No. % No. % No. % Age 60-70 22 50 28 63.6 50 56.8 X2=1.667 p=0.197 71-80 22 50 16 36.4 38 43.2 Table 1.1: shows that out of 88 sample subjects, 50 (56.8%) and 38 (43.2%) were in the age group of 60-70 years and 71-80 years age group. In the exprimental group , the sample is distributed equally among 60-70 and 71-80 years age group whilein control group the corresponding proportion are 63.3% and 36.4%. The distribution of age in the experimental and control group did not have significant association (p=0.197). The difference may be due to chance because of sampling fluctuation. Graph 1 Bar diagram showing the percentage distribution of age group Table no-1.2: Frequency and percentage distribution of gender in experimental and control group Table 2 Gender distribution Variable Classification Group 1 (n=44)(Experimental) Group 2 (n=44)(Control) Total (n=88) X2, p No. % No. % No. % Gender Male 23 52.3 22 50 45 51.1 X2=0.045 p=0.831 Female 21 47.7 22 50 43 48.9 Table 1.2: shows that the overall sample subjects are evenly distributed according to male and female with 51.1% males and 48.9% females. In the exprimental group and control group the genderdistributionisapproximatelyevenanddid nothaveany significant association (p=0.831). Graph 2 Bar diagram showing the percentage distribution of gender group Table no-1.3: Frequency and percentage distribution of BMI in experimental and control group Table 3 Distribution of BMI Variable Classification Group 1 (n=44) (Experimental) Group 2 (n=44) (Control) Total (n=88) X2, p No. % No. % No. % BMI Under weight (<18.5) 5 11.4 3 6.8 8 9.1 X2=0.722 p=0.868 Normal weight (18.5-24.9) 23 52.3 25 56.8 48 54.5 Over weight (25-29.9) 11 25 10 22.7 21 23.9 Obesity (≥30) 5 11.4 6 13.6 11 12.5
  • 6. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 260 Table 1.3: shows that present distribution of BMI by groups. BMI classified into four groups i.e. under weight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m 2), over weight (25-29.9 kg/m2) and obese (≥30 kg/m 2). In exprimental group,outof44cases 5 (11.4%) were under weight, 23 (52.3%) were normal weight, 11 (25%) were over weight and 5 (11.4%) were obese. In control group, out of 44 cases, 3 (6.8%) were under weight, 25 (56.8%) were normal weight,10(22.7%)wereoverweightand 6 (13.6%) were obese. There was no significant association of the BMI with groups(p=0.868). Graph 3 Bar diagram showing the percentage distribution of BMI group Table no-1.4: Frequency and percentage distribution of Marital status in experimental and control group Table 4 Distribution of Marital status Variable Classification Group 1 (n=44) (Experimental) Group 2 (n=44) (Control) Total (n=88) X2, p No. % No. % No. % Marital status Married 11 25 8 18.2 19 21.6 X2=0.610 p=0.894 Unmarried 14 31.8 15 34.1 29 33 Divorcee 11 25 12 27.3 23 26.1 Widowed 8 18.2 9 20.5 17 19.3 Table 1.4: shows that present distribution of marital status by groups. In exprimental group, out of 44 cases 11 (25%) were both in married and divorcee, 14 (31.8%) were unmarried and 8 (18.2%) were widowed. In control grou2, 8 (18.2%) were married, 15 (34.1%) were unmarried, 12 (27.3%) were divorce and 9 (20.5%) were widowed. There was no significant association of the marital status with groups (p=0.894). Graph 4 Bar diagram showing the percentage distribution of Marital status group Table no-1.5: Frequency and percentage distribution of Education status in experimental and control group Table 5 Distribution of Educational status Variable Classification Group 1 (n=44) (Experimental) Group 2 (n=44) (Control) Total (n=88) X2, p No. % No. % No. % Illiterate 5 11.4 4 9.1 9 10.2 X2=0.454 p=0.978 Primary School 16 36.4 18 40.9 34 38.6 High School 11 25 10 22.7 21 23.9 Graduate 7 15.9 8 18.2 15 17 Post Graduate 5 11.4 4 9.1 9 10.2
  • 7. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 261 Table 1.5: shows that overall there were 10.2% post graduate, 17% graduate, 23.9% high school, 38.6% primary school and 10.2% illiterate subjects. The distribution of sample subjects by education did not differsignificantlyinexprimental groupand control group (p=0.978). Graph 5 Bar diagram showing the percentage distribution of Educational status group Table no-1.6: Frequency and percentage distribution of Occupational status in experimental and control group Table 6 Occupational status by groups Variable Classification Group 1 (n=44) (Experimental) Group 2 (n=44) (Control) Total (n=88) X2, p No. % No. % No. % Occupational status Retired with Pension 9 20.5 10 22.7 19 21.6 X2=0.067 p=0.796 Retired without Pension 35 79.5 34 77.3 69 78.4 Table 1.6: shows that the sample of elderly people were divided into two groups, retired with pension and retired without pension. Only 21.6% of the sample subjects were pension holders and remaining 78.4% were without pension. The classification as retired with pension and retired without pension did not have significant association with group (p=0.796). Graph 6 Bar diagram showing the percentage distribution of occupational status group Table no-1.7: Frequency and percentage distribution of Health insurance in experimental and control group Variable Classification Group 1 (n=44) (Experimental) Group 2 (n=44) (Control) Total (n=88) X2, p No. % No. % No. % Health insurance Accidental fall covered 23 52.3 22 50 45 51.1 X2=0.045 p=0.831 21 47.7 22 50 43 48.9 Table 1.7: shows that it is classified into two groups i.e. accident fall covered and not coveredunderhealthinsurance.Outof88 cases, among 45 (51.1%) the accident fall was covered and remaining 43 (48.9%) were not covered under health insurance. There was no significant association between coverage of accident fall under health insurance and the groups (p=0.831).
  • 8. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 262 Graph 7 Bar diagram showing the percentage distribution of heath insurance group Section-2: Effectiveness of balance exercises on prevention of fall among the older people. Table 2.1: Comparison of pre and post test fall risk within Control Group Fall risk Pre test (n=44) Post test (n=44) No. % No. % <19 high 29 65.9 29 65.9 19-24 medium 10 22.7 10 22.7 25-28 low 5 11.4 5 11.4 Marginal Homogeneity Test 'p' value 1.000 Table 2.1: shows that indicated that in the pre test condition there were 65.9% cases withhighfall risk,22.7%mediumfall risk and 11.4% low fall risk in control group. At the post test there was no change in the corresponding proportion (p=1.000). Graph 8 Bar diagram showing the comparison of pre and post test fall risk within Control group Table 2.2: Comparison of pre and post test fall risk within Fall risk Pre test (n=44) Post test (n=44) No. % No. % <19 high 29 65.9 8 18.2 19-24 medium 10 22.7 13 29.5 25-28 low 5 11.4 23 52.3 Marginal Homogeneity Test 'p' value 0.000 Experimental group Table 2.2 shows that indicated that in the pre test condition there were 65.9% cases with high fall risk, 22.7%mediumfall risk and 11.4% low fall risk in experimental group. At the post testthatisafteradministeringthebalance exerciseonfall prevention it was found that the high fall risk as reduced 18.2% and low fall risk has increased to 52.3%. This implied a significant improvement in reducing the fall risk (p=0.000).
  • 9. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 263 Graph 9 Bar diagram showing the comparison of pre and post test fall risk within Experimental group Table 2.3: Comparison of Pre and Post test fall score between groups Total score Group 1 (n=44)(Experimental) Group 2 (n=44)(Control) p' value* Mean(SD) Median(IQR) Mean(SD) Median(IQR) Pre test 17.0(4.1) 16(14,19) 16.9(4.1) 16(14,19) 0.778 Post test 23.1(3.0) 24(20,26) 16.9(4.1) 16(14,19) 0.000 Mann-WhitneyU 'p' value Table 2.3: shows that present comparison of pre test and post test fall score between group 1 and group 2. The mean pre test score in group 1 was 17.0 ± 4.1 and median score 16 (IQR: 4-1) and the corresponding mean and median of group 2 was 16.9 4.1 and 16 (IQR: 14-19) respectively. There was no significant difference of pre test fall score between the two groups (p=0.778). Graph 10 Bar diagram showing the comparison of Pre and Post test fall score between groups Table 2.4: Comparison of pre test total score between two groups Descriptive statistics Group 1 (Experimental) Group 2(Control) N 44 44 Mean 17.0 16.9 SD 4.1 4.1 Q1 (1stQuartile) 14 14 Q2 (Median) 16 16 Q3 (3rdQuartile) 19 19 Mann-Whitney U 'p' value 0.778
  • 10. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 264 Table 2.4: shows that present comparison of pre test total score between two groups. In exprimental groupmeanpretesttotal score was 17.0 ± 4.1 and median 16 (IQR: 14-19) and in control group mean total score was 16.9 ± 4.1andmedian16(IQR:14- 19). There was no significant difference in the pre test total score between the two groups (p=0.778). Graph 11 Bar diagram showing the comparison of pre test total score between two groups Table 2.5: Comparison of post test total score between two groups Descriptive statistics Group 1 (Experimental) Group 2(Control) N 44 44 Mean 23.1 16.9 SD 3.0 4.1 Q1 (1stQuartile) 20 14 Q2 (Median) 24 16 Q3 (3rdQuartile) 26 19 Mann-Whitney U 'p' value 0.000 Table 2.5: shows that present comparison of post-test total score between two groups. In exprimental group mean post-test total score was 23.1 ± 3.0 and median 24 (IQR: 20-26) and in control group mean total score was 16.9 ± 4.1 and median 16 (IQR: 14-19). The mean and median post test total score was significantly higher in group 1 than group 2 (p=0.000). Graph 12 Bar diagram showing the comparison of post test total score between two groups Significant difference between post-test score and pre-test score aftergivingbalance exerciseonpreventionoffall.Inmystudy H1 is accepted and H2 is rejected. Section-3: Association between the level of balance and gait test score of fall prevention with their selected demographic variables. Table no.3.1: Association of Pre test fall risk by groups Pre test fall risk Group 1 (n=44)(Experimental) Group 2 (n=44)(Control) Total (n=88) X2, p No. % No. % No. % <19 high fall risk 29 65.9 29 65.9 58 65.9 X2=0.000 p=1.000 19-24 medium fall risk 10 22.7 10 22.7 20 22.7 25-28 low fall risk 5 11.4 5 11.4 10 11.4 Table 3.1: shows that Pre test fall risk is classified into 3 categories based upon the fall score. The score <19 is termed as high fall risk, 19-24 as medium fall risk and 25-28 low fall risk. Overall it is found that 58 (65.9%), 20 (22.7%) and 10(11.4%)were
  • 11. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 265 in high fall risk, medium fall risk and low fall risk respectively. Both the groups did not have any association with pre test fall risk (p=1.000). This implied both the groups are matched at the pre test level and therefore will give valid comparison of post test fall risk. Graph 13 Bar diagram showing the pre test fall risk by groups Table no.3.2: Association of Post test fall risk by groups Post test fall score Group 1 (n=44)(Experimental) Group 2 (n=44)(Control) Total (n=88) X2, p No. % No. % No. % <19 high fall risk 8 18.2 29 65.9 37 42 X2=23.882 p=0.000 19-24 medium fall risk 13 29.5 10 22.7 23 26.1 25-28 low fall risk 23 52.3 5 11.4 28 31.8 Table 3.2: shows that present the association of post test fall risk with groups. Inthegroup1i.e. experimental group,8(18.2%) cases were high fall risk, 13 (29.5%) medium fall risk and 23 (52.3%) low fall risk. In the control group (group 2), 29 (65.9%) were high fall risk, 10 (22.7%) medium fall risk and 5 (11.4%) low fall risk. In the experimental group the high fall risk is very low and low fall risk is very high in comparison to control group. The difference was highly significant (p=0.000). Thisimplied the balance exercise on fall prevention is highly effective. Graph 14 Bar diagram showing the post test fall risk by groups Significant association between level of balance and gait test score of older people with their selected demographic variables. H2 is accepted and H1 is rejected. The mean post test score in experimental group was 23.1 ± 3.0 and median score 24 (IQR: 20-26)andthecorrespondingmean and median of group 2 was 16.9 ± 4.1 and 16 (IQR: 14-19) respectively. There was significant difference of post test fall score between the two groups (p=0.000). This implied the fall risk has significantly reduced in experimental groups. DISCUSSION The present study shows that majority of cases i.e. 56.8% and 43.2% were 60-70 years and 71- 80 years older people in exprimental group. 51.1% males and 48.9% female in expreimental group. Majority of cases i.e. 11.4% under weight, 52.3% normal weight, 25% over weight and 11.4% obese in expreimental group. With respect to marital status i.e. 25% married and divorcee, 31.8% unmarried and 18.2% widowed in expreimental group. Majority of casesi.e.10.2% post graduate, 17% graduate, 23.9% high school, 38.6% primary school and 10.2% illiterate in expreimental group. Majority of cases i.e. 21.6% pension holders and 78.4% without pension in expreimental group. Majorityofcasesi.e. 51.1% the accident fall was covered and remaining 48.9% were not covered under health insurance. Majority of cases i.e. effectiveness of balance exercise indicated that inthe pre test condition there were 65.9% cases with high fall risk, 22.7% medium fall risk and 11.4% low fall risk in control group. Majority of cases i.e effectiveness of balance exercise, indicated that in the pre test condition there were 65.9%
  • 12. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD38386 | Volume – 5 | Issue – 2 | January-February 2021 Page 266 cases with high fall risk, 22.7% medium fall risk and 11.4% low fall risk in experimental group. Majority of cases i.e that 58 (65.9%), 20 (22.7%) and 10 (11.4%) were in high fall risk, medium fall risk and low fall risk respectively. Majority of cases i.e that 18.2% cases were high fall risk, 29.5% medium fall risk and 52.3% low fall risk in exprimental group. Majority of cases i.e that mean pre testscore was17.0 ± 4.1 and median score 16 (IQR: 4-1) respectively in exprimental group. Majority of cases i.e that mean pre test total score was 17.0 ± 4.1 and median 16 (IQR: 14-19) in exprimental group. Majority of cases i.e that mean post-test total score was 23.1 ± 3.0 and median 24 (IQR: 20-26) in exprimental group. Majority of cases i.e. that the pre test score found that 58 (65.9%), 20 (22.7%) and 10 (11.4%) were in high fall risk, medium fall risk and low fall risk respectively in exprimental group. Majority of cases i.e. that the post test score found that 8 (18.2%) cases were high fall risk, 13 (29.5%) medium fall risk and 23 (52.3%) low fall risk in exprimental group. SUMMARY: The finding of the study revealed that effect of balance exercise. So, care giver can be trained in use of balance exercise to provide to the older people .For assessing long term effect, it is recommended to take up another long term study by controlling more variables. Further research is suggested to confirm the finding of the current study. CONCLUSION How ironic that twenty five centuries later we are rediscovering and proving thorough the modern science, that older people’s frame of mind and perception of disease predict their treatment success. When we comfort a older people, we may be doing more than consoling him or her. The finding of the present study conclude that the results of the present study support its hypothesis and revealed that balance exercise were effective in reducing the fall rate and increase the balance and gait score among 60 to 80 older people. It was observed by POMA tool. Data were analyzed through descriptive and inferential statistics. IMPLICATIONS OF THE STUDY: The investigator has drawn the following implications from the findings of this study, which are of vital concern to the field of nursing practice, nursing education, nursing administration and nursing research. Nursing practice: Nurses are playing a vital role in implementing the balance exercise among older people for fall prevention. Nursing Education: Intervention can be taught to the students to reduce fall risk among older people. Nurse educator can use the findings of the study to introduce the topic as a demonstration as a part of basic nursing course. Nursing administration: With the technological advances and ever growing challenges of nursing, the nurse administrator have responsibility to provide the nurses with substantive continual education and care full observation. Nursing research: The result of the study and the intervention can contribute to the body of nursing knowledge. Future investigator can use the finding and the methodology for reference material. Another study can be done with large samples. Other researcher can conduct further studies in the same field can utilize the suggestion and recommendation. RECOMMENDATION: On the basis of this study the following recommendation have been made. A similar study can be replicated on large sample in different setting to strengthen the findings. Further research can be carried out to identify the occurrence of fall prevention by adopting different sampling technique. A study can be conducted to assess the factors which improve in balance. Further research is suggested to confirm the findings of the current study. LIMITATIONS: The study results can not be generalized because of following reason: 4 weeks observation is too short for the effectiveness of the therapy. REFERANCES [1] Polit Cheryal, Nursing Research, Lippincott Wilkins publication, 8thedition, 2008. [2] World health organization (2018).constitution of the world healthorganizationbasicdocuments,forty-fifth ediation, supplement, November 2018. [3] Yves J Gschwind, Reto W Kressig, Andre Lacroix, Thomas Muehlbauer, Barbara Pfenninger, Urs Granacher. A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health inolderadults.BMCGeriatr.2013 Oct 9; 13:105. [4] Miller, Kenneth L, Magel, John Hayes, Joseph. The Effects of a Home-Based ExerciseProgramonBalance Confidence, Balance Performance, and Gait in Debilitated, Ambulatory Community-Dwelling Older Adults: A Pilot Study. Journal of Geriatric Physical Therapy. 2010 Nov;33(2):85-91 · [5] Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J et al. Exercisetopreventfalls in older adults: an updated systematic review.Br J Sports Med. 2017;Dec;51(24):1750-1758. [6] Sherrington C, Fairhall NJ,Wallbank GK,TiedemannA, Michaleff ZA, Howard K et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019 Jan 31; 1(1):CD012424. [7] Granacher U, Gollhofer A, Hortobágyi T, Kressig RW, Muehlbauer T. The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: a systematic review. Sports Med. 2013 Jul; 43(7):627-41. [8] Eckardt N. Lower-extremity resistance training on unstable surfaces improves proxies of muscle strength, power and balance in healthyolderadults:a randomize control trial. BMC Geriatr. 2016 Nov 24;16(1)