Nurses defend exercise scheme for elderly patients criticised for failing to prevent falls and causing depression.

Elderly care nurses have defended a nurse-led exercise programme that has been criticised for failing to prevent falls in older people and even causing depression in those with poor cognition.

Two trained gerontology nurses tailored the excersise scheme to meet the needs of care home residents in New Zealand.

It was based on residents' daily tasks and HCAs were trained to implement it over six months.

A study of the excersise scheme in 41 homes and involving 682 residents then looked at whether its implementation had improved subjects' mobility and functioning and resulted in fewer falls.

The study results showed that the group which received the programme deteriorated a little less than a control group that received only social visits, but there was no impact on preventing falls.

The researchers admitted that compliance with the excersise scheme may have been poor and they noted that trials with more successful results had been better resourced and more intensive.

'To be successful, such interventions may need a higher intensity of activity and more effective reinforcement by care workers,' they concluded.

Specialist nurses say that such a programme alone should not be expected to prevent falls as falls prevention requires a multi-factorial approach, including medication reviews, podiatry, nutrition monitoring and eye tests.

Linda Nazarko, nurse consultant in intermediate and unscheduled care at Ealing PCT, said: 'Muscle strength is important but one intervention does not cut it because everyone in care has more than one problem affecting them.'

Loretta Anthony, falls nurse specialist at King's College Hospital, London, agreed. 'I don't think a single intervention works – you need multiple approaches to make a difference,' she said.

She added that the Abbreviated Mental Test used in the study to assess residents' cognitive ability 'is not the most reliable test to use'.

BMJ (2008) 337: a1445