Fall incident in elderly is not properly happened and should be prevent.

The impact of falls in

elderly not only on physical effect but also on psychology and material. Falls incident in elderly
in specific institution like a residence not only gives a negative impact for elderly but also for the
employee dan the owner of the residence. The aim of this research in a period of time is to
identify the exact intervention,effective and efficient to reduce the fall risk in elderly in
community. In specific the aim of this research is to find out the influence of intervention such as
education and intensity exercised to the elderly toward the fall risk in elderly. The design of this
research is pre experimental design with the approach of one group pre test post test without a
comprasion group. The research took placed in BPSTW Ciparay, which is one of the
Government Technique Unit at the Social Department Jawa Barat Province, which bring out the
function for care and Social Protections For Neglected Elderly and Cultivation of Pahlawan
Grave Park. The population for this research was elderly in BPSTW Ciparay. Elderly who filled
the inclusive criteria as a sample was 65 peope ( 1 person drop out ), selected with the capacity
of mental intellectual and Timed Up and Go Test and then after get a treatment like prevention of
fall programme (education and intensity exercised) for about four weeks dan after that we cross
checked using Timed Up and Go Test. The result of experiment using Wilcoxon Signed Rank
Test showed the p value 0,000 less than the alpha value (0,05), meaning that there were an
influence between the fall prevention programme and the fall risk in elderly of BPSTW Ciparay.
The outcome of the research is to be useful for elderly in general and specific and for the
manager of BPSTW Ciparay in order to reduce the fall risk in elderly so they can maintain their
autonomy to endure their daily life living and fulfilling their optimal quality of life.
A. Background
Falls in elderly is one of the health issue which very often underrated in wide society. Hill.
Schwarz and Winbolt (2009, in Nay, R & Garratt 2009, hal. 190) declared that falls caused
various injury for elderly such as a broken bones, head injury and major laceration
especially those in community. Falls not only impact of increasing the health problem or
illness complication but also impact for economy aspect and social living elderly. One of
the main caused of hospitalitation in elderly and primary factor of death in elderly for age
over 65 years old (Davis 1995, taken from Tideiksaar 2002, page 3), falls should be identify
as a health problem and should get fully attention and taking care of.

A systematic review has done by Rubenstein and Josephson (2006), they said that changing
of organs or bodys system in elderly included as intrinsic factor caused of falling.
Another terms use by WHO (2007) helps to describe another factor cause of falling which
originated from the changes of physical condition of elderly caused by aging process or else
comorbidity was biological factor.
Falls happened caused by multifactorial which influence the elderly. Other than the aging
process, another factors,like environment such as a wet floor, slippery, or scattered objects
on the floor and endangered the elderly, poor of lighthing, highly staircase, lack of care
instruments or safety rail, floors with a differences of high and other things have the chance
to increase the risk of falls. WHO (2007) declared that social and economy condition in
elderly is one the main caused of falls in elderly. Elderly with a minimum income, poor of
knowledge and limitation to access the health service higher chance of fall risk than those
with better social and economy conditions.
Falls can be prevented by identifiying the existence of many factors,internal nor external.
The identify process using an instrument (screening tools) which full fledged, such as
Modified Falls-Efficacy Scale (MFES). The Morse Falls Scale Assesment, the Falls Risk for
Older People in the Community (FROP-Com) tool, Get-Up and Go Test dan the Short Falls
Efficacy Scale International (Short FESI) which has been used to identify the symptom fear
of falling. The outcome of the assessment usually categorized elderly according to the level
of falls risk from each individual. According to that level, the prevention intervention or
countermeasures of falls incident can be managed and imply to the elderly.
There were several programs to prevent falls, they consist from various intervention, the one
which full fledged and implied in a country or admitted as a local or institutional. Australia
is one of the country which applied several programme in a state level nor national. Stay
On Your Feet program assigned in New South Wales states. The aim of this programmes is
to increase independently of elderly to help them to endure their daily living and at the end
can lower the fall risk (National Public Health Parnership 2005, page 7-9).
One of the meta analysis to the results of the research about the prevention intervention of
falls which has been done by Sherington et al (2008) concluded that exercise proved can
lower the fall risk as much as 17%. The research by Chang et al (2004) identified that

prevention of fall in elderly was multifactorial and gave more effective results and
interventios taking form like an exercise can help lower the falls incident in elderly. Asih
(2011) troughout her article Falls prevention framework for older people in the community
in Indonesia submitted several interventions that can be applied for elderly in Indonesias
community throughout literature study and previous research in developing country such as
Indonesia. The intervention was the enchancement of knowledge throughout education and
strength exercises and balanced with sports and gymnastic for elderly. Those interventions
admitted as an intervention that suggested to be applied in health services as multifactorial
interventions by National Institute for Clinical Excellence (2004).
Social Hall Protections Tresna Werdha Ciparay Bandung and Cultivation of Pahlawan Grave
Park (BPSTW) in one of Technique Social Service in Social Service Jawa Barat Province
which doing the function of social service in care fields and social protections for neglected
elderly and Cultivation of Pahlawan Grave Park. According to BPSTW files in 2013
available information that there were 150 elderly in BPSTW got the serviced. Those having
a differences of health status. The health status is needed to classify between the healthy
elderly or independent elderly which placed in residence.
Preliminary studies has been done with five of elderly in BPSTW Ciparay on August. 2013,
gave the information that 3 from 5 elderly suffers from falls before and during a stay in the
residence. Those who suffers from falls declared that they suffers from disruption of vision,
weakness of leg muscles and stumble from the objects on the floor. The results of interview
showed that symptoms fear of falling in 2 from 3 elderly happened to those who suffers
from falling. Based on the observation by the researcher according to the functional ability,
2 of elderly without a history of falls, it get a conclution that eventhough they havent had a
history of falls and not having symptoms fear of falling, they have a fall risk factor within
them. Other than that, based on the observation that has been done environment at BPSTW
Ciparay was not freely from hazard caused falling in elderly. It showed in several residences
thas not be equipped with a rail for elderly to hold on to help the elderly to walk to the rest
room, their bedroom, slippery floors and all the way walk to the hall way which rocky and
potholed.
B. Purpose

The general purpose of the research is to find out the influence of the prevention falls
programme in the form of education and strength muscle exercises to the fall risk elderly in
BPSTW Ciparay Bandung.
C. Method
Based on the set of problems and the purpose to accomplish, the design for this research
using pre eksperimental design with the approach one group pre test post test without using
the groups for standard of comparison. On this research we will identify the influence of
prevention of falls programme in the form of education and strength muscle exercises to the
fall risk elderly in BPSTW Ciparay.
The scemes of implementations were :

Determination of respondents as a sample based of inclusif criteria which has been d

Scheme 3.1 Research Design

D. Result

1. Result of the research

Intellectual mental capacity elderly in BPSTW Ciparay Bandung
a. Mini Mental State Exam (MMSE)
Tabel 1 Result of Mini Mental State Exam (MMSE), r=65

MMSE
Normal
Possibility having
cognitive
disturbance
Client
with
cognitive
disturbanceKlien
mengalami
gangguan Kognitif
Total

f
27

%
41.5

27

41.5

11

16.9

65

100,0

The chart shows that 41,5% of respondent have the possibility with cognitive disturbance
and 16,9% of respondent with cognitive disturbance.
b. Short Portable Mental Status Questionnaire (SPMSQ)
Tabel 2 Result of Short Portable Mental Status Questionnaire (SPMSQ), r=65

SPMSQ
Unimpaired intellectual function
Mild intellectual damaged function
Moderate intellectual damaged function
Severe intellectual damaged function
Total

F
29
14
13
9
65

%
44.61
21.54
20.00
13.85
100,0

The chart shows that 21.54% of respondent have a mild intellectual damaged function,
20.00% of respondent have a moderate intellectual damaged function and 13.85 % have a
severe intellectual damaged function.
2. Fall risk elderly in BPSTW Ciparay Bandung
a. Fall of risk owned the elderly in BPSTW Ciparay before doing the prevention fall
programme in form of education and strength muscle exercise.
Tabel 3 Fall of risk owned the elderly in BPSTW Ciparay before doing the prevention fall
programme in form of education and strength muscle exercise.
Timed up and go test f
%
Normal
15
23.1
Good
mobility, 14
21.5
mobility
without
helps, has an ability to
do outdoor activity,
going
out
by

Timed up and go test

themselves from home
Mobility disturbance,
need a tools to help
out, has no ability to
do activity outdoor
Total

36

55.4

65

100,
0

From the charts has known that sebanyak 55.4% of respondent have mobility disturbance,
need a tools to help and has no ability to do outdoors activity by themselves, otherwise
21.5% have a good mobility without any helps and has ability to do outdoors activity and
go out by themselves.
b. The fall risk owned the elderly in BPSTW Ciparay after the prevention of falls
programme in form of education and strength muscle exercise.
c. Tabel 4 Fall risk owned the elderly in BPSTW Ciparay after the prevention of falls
programme in form of education and strength muscle exercise.
Timed
up
and go test
Normal

14

21.88

Good
mobility,
mobility
without
helps, has an
ability to do 27
outdoor
activity,
going out by
themselves
from home
Mobility
disturbance,
need a tools
to help out, 23
has no ability
to do activity
outdoor
Total

64

42.19

35.94

100,0

The charts showed that according to the result of data from Timed Up and Go Test after
the intervention of education for the prevention of fall risk and strength muscle exercise
there were 35.94% of respondent have a disturbance mobility, in needs of tools to help,
has no ability to do outdoors activity and go out by themselves, and there were 42,19%
have a good mobility, has the ability to mobile without helps and can do outdoors activity

by themselves . one of respondent has taken out from the assessment post intervention
(drop out) because of stroke.
3. The influence of prevention of falls programme to the fall risk owned by the elderly in
BPSTW Ciparay
Tabel 5 The influence of prevention of falls programme to the fall risk owned by the elderly

in BPSTW Ciparay
(Waktu * Kelompok Crosstabulation)

Waktu

Kelompok

Total

Normal

Count

Pre- Posttest test

Total

15

29

14

% within
51.7 48.3
Waktu

100.0

Good
Count
14 27
mobilityk,
% within
mobility
Waktu
without helps,
ability to do
34.1 65.9
outdoor
activity,
go
out
by
themselves

41

Mobility
Count
36 23
disturbance in
% within
need of tools
Waktu
to
help
mobility, has
no ability to
61.0 39.0
do
outdoor
activity, cant
go out by
themselves

59

Count

129

65

64

% within
50.4 49.6
Waktu

100.0

100.0

100.0

The charts showed the changed of a normal cathegory. From 51,7% of respondent become
48,3%, good mobilitiy increase from 34,1% becoe 65,9% dan respondent of cathegory with
disturbance mobility decrease throughout 22%; from 61,0% become 39%. The reduction of the
result of post test from normal cathegory is possible caused by the existing of drop out of
respondent by the time collecting data post intervention.

The test that has been done using Wilcoxon Signed Rank Test shows that p value was 0,000 less
than alpha value (0,05) so it can be concluded that there was a changing of time reaction (timed
up and go test) before and after intervention.
E. Discussion
The respondent of this research involved 65 respondents before implemented the
intervention and 64 respondents after the intervention (1 person drop out). Soon after
implemented the intervention of prevention of falls programme in form of education and
strength muscle exercises which consists into 28 respondent of male and 37 respondent of
female. Elderly who excluded from the research were : 25 elderly who lived at the clinic,
having illness and 60 eldery with motoric limitation. We will discuss moreover about the
research
1. Mental capacity intellectual elderly in BPSTW Ciparay Bandung
The research from 65 elderly respondent in BPSTW Ciparay Bandung from having
implementation of prevention of falls programme in form of education and strength
muscle exercises to the fall risk owned by elderly in BPSTW Ciparay Bandung, so long
before that were doing the assessment (screening respondent) in order to set up the
intervention groups, in this case considered to adjust the treatment and the condition of
elderly, includes their health physic and mental cognitive capacity from the elderly as a
respondent.
The first steps that has been doing on this research was respondent screening using Mini
Mental State Exam format (MMSE). The test was designed so all health profession can
easily done it or to whom has been trained and got the instruction to use it. MMSE is
one of brief mental status examination and easily applied and proven as trusted
instruments and valid to detect and followed the development of cognitive disturbance
which related with neurodegenerative. The result, MMSE become a method to check
mental status which has been used around the world and has been translated to some
languages and used as a screening primary cognitive on several epidemiology study for
a big scale of dementia. The test has been used worldwide on clinical practices and has
known as cognitive screening instruments which has been proved with the Diagnostic
Interview Schedule (DIS), in National Institute of Mental Health ECA study and with
their list saying that MMSE as one of appraiser for cognitive function which
recommended to diagnose Alzheimer disease criteria, which has been developed by

National Institute of Neurological and Communication Disorders and Stroke consortium

and the Alzheimers Disease and Related Disorders Association (McKhann dkk,1984).
The biggest weakness of MMSE was the limitation or the lack of ability to evaluate
several several cognitive capability that has ben obstructed. MMSE is consider relative
unsensitive toward mild cognitive descency (especially individual highly educated).
Although the boundaries has decreased the benefit of MMSE, the test is consider
become a valuable instrument to evaluate the cognitive decreased (Rush, 2000).
The result of MMSE that has been doing to elderly in BPSTW Ciparay showed that
41,5% respondent has the possibility experiencing cognitive disturbance and 16,9%
experiencing cognitive disturbance. Cognitive disturbance is significantly hamper the
cognitive function to someone in order to do their social living in community. For the
elderly in BPSTW Ciparay the sign and symptom of cognitive disturbance it was very
dominant shows that the decreased of memory capability ( short term and ong term
memory) and decreased of motoric coordination. Those things was very influencing for
elderly to do social interaction with their fellow or with the health care employee and
social worker around BPSTW Ciparay.
Continued examination taken placed to complete studies toward mental-intellectual
capacity for elderly in the research is using Short Portable Mental Status Questionnaire
(SPMSQ). SPMSQ is used to detect is there any cognitive disturbance such as
orientation, long terms memory and mathematic ability (Pfeiffer, 1975 in Lueckenotte,
2000). SPMSQ examination usually recommend to measure of elderly dementia status.
The result of SPMSQ on this research showed that 21.5% respondent suffers from mild
damaged for their intellectual function, 20.00% suffers from moderate damaged and
16,9% suffers from intellectual function with severe damaged. The severe intellectual
function damaged showed that elderly has a sign and symptom of dementia, but none of
the respondent on this research suffers with intellectual impairment condition since they
were born. The sign and symptom which shows if there any damaged on the intellectual
function from the respondent on this research, such as decreased of a long terms
memory or short terms memory. It firmly support the result of MMSE saying that almost
half of the respondent has a chanced suffering from cognitive disturbance and some of
the respondent suffers from cognitive disturbance.

The Meta-analys research has been done by Muir et al (2012) toward 27 of the earlier
research about the disturbance of cognitive function and the fall risk showed there were
a correlation between the cognitive function disturbance with the fall risk in elderly.
Some of the research showed that the decrease of cognitive function related with the
incident of falls, severe injury and broken bones in eldery which taken placed in
community. More over, Muir et all declared that mild cognitive function disturbance has
a chance to increase the fall risk in elderly.
Based on that statement the results of examination for mental intellectual capacity for
elderly in BPSTW Ciparay said that they potential with the falling.
2. The fall risk for elderly in BPSTW Ciparay Bandung before the prevention of falling
programme in form with education and strength muscle exercise.
Data from table 5.3 showed that almost 55,4% respondent suffers from mobilitation
disturbance, in need of walker and has no ability to do activity outdoors or in their own
house,otherwise only 21.5% with a good mobility, mobile without any help and has the
ability to do activity or going out from their house. Mobilitation disturbance usually
happen to those with the decrease of motoric ability. Elderly with the difficulties to
maintance their balanced and showed suffering with the decrease of muscle strength.
The decrease function happened throughout the aging process in elderly. changing on the
physic in elderly can caused the fall risk in elderly. On of the systematic review which
has been done by Rubenstein and Josephson (2006) declared that the changing of organs
or body system in elderly become an intrinsic factor for falling. The other term used by
WHO (2007) is to describe the risk factors of falling which come from the changing of
physic condition in elderly caused by the aging process or co-morbidity as biological
factor.
The intrinsic factor or biology factor in elderly which increase the fall risk in elderly in
BPSTW Ciparay toward the research were identified by the implementation of Timed
Up and Go Test. The examination has been done by asking the respondent sitting down
upright on the chair with two feets towards to the front (both hands site on the side of the
chair). The cross examiner said Go and at the same time they used stop watch. If the
elderly feel exhausted, they suggested to stop (do not sitting down) and if they feel much
better they can continue to walk. Theres no limitation time for elderly to accomplish the
test. The ability of elderly to walk (mobilitation) without any helps or with limitation

become one of grader variable. Other than that, the dependent of elderly using help for
doing their outdoor activity consider as one of variable which showed that they were
potentially at risk of falling.
3. The fall risk in elderly at BPSTW Ciparay after the prevention risk of fall programme in
form of education and strength muscle exercise.
Data from table 4 shows that throughout the Timed Up and Go Test which has been done
to the respondent soon after getting the treatment or intervention in form of education
and strength muscle exercise. There were 35.94% respondent suffers from the
mobilitation disturbance, need of walker, no outdoors activity alone and 42.19% suffers
with mobility, mobility without helps, can do outdoors activity alone. Those data giving
a descripton that the ability of elderly for mobilitation has been increased and the impact
is proportion with the risk factors of falling in elderly.
There were many kind of intervention to prevent the risk of fall in elderly. those
intervention

are

sports

(muscle

strength,

balanced,

pliancy),

environment

modification,medication management, visus corrections, giving away vitamin D and

health education. Some of those intervention has been test the effectiveness in order to
lower falling incident or lower the falling risk in elderly (Asih, 2011).
Some of the prevention of fall intervention could be done at the same time, by doing that
we called it multiple intervention with multifactorial.
The differences is at the early examination before settled intervention (ACSOHC, 2009)
where the elderly in multifactorial interventions will get the prevention intervention of
falls based on the existence of risk factor from the elderly which has been known after
the examination, other than that the earlier examination from multiple interventions
(initial assessment) has not been done.
The characteristic of intervention for the research was multiple interventions whereas the
researcher combined two intervention which is education and sports in form of strength
muscle exercise to cope the falling risk in eldery. Education intervention has been done
by used several session and many form of seminar, discussion and reply question leads
by the lecturer with facilitator. The information has been made in booklet and spread
among the respondent. One of the research measure the effectiveness of intervention like
the increase of knowledge about falling in elderly declared that fall incident can reduced
become 31% (Clemson, 2004). Although the research is not comparing te number

incident of fall before and after education intervention but the result shows that the total
percentage of elderly with mobility disturbance, in need of walker, no outdorrs activity
alone.
The next intervention is exercise for the strength of muscle which has been done for 4
weeks with orientated on Stay Safe Stay Active Daily Exercise Program (National
Center for Injury Prevention and Control, 2008). The aim of the exercise is to increase
the strength of muscle and the balancing so it gives motivation for elderly to do daily
activites safe and independen.
The result of Timed Up and Go Test in the research showed that strength muscle
exercise has been rise the ability of respondent to mobilitation.
4. The influence of prevention of falling programme toward the fall risk for elderly in
BPSTW Ciparay.
Table 5 showed the increase of percentage value in elderly with a good mobility for
about 31,8% ,where the interventions has not been done the result was 34,1% and after
intervention was about 65,9%. The changing influence on the percentage value for
elderly with categories suffering from mobilitation disturbance where the intervention
has been done , is about 39,0%. The result using Wilcoxon Signed Rank test showed that
p value 0,000 less than alpha value (0,05) so Ho rejected and we can say that the
influence prevention of falling programme in form of education and strength muscle
exercise for elderly in BPSTW Ciparay seen throughout the changing for better in
elderly ability to mobile. It was finally lower the fall risk and the opposite will increase
the ability and desire of elderly to do daily activity safely and independently.