Fall prevention programme for postoperative older adults at a private hospital

To provide a comprehensive overview of economic evaluations of falls prevention programs and to evaluate the methodology and quality of these studies. Systematic review of economic evaluations on falls prevention programs. Studies (N=31) of community-dwelling older adults (n=25), of older adults living in residential care facilities (n=3), and of both populations (n=3) published before May 2017. Adults aged 60 and older. Information on study characteristics and health economics was collected. Study quality was appraised using the 20-item Consensus on Health Economic Criteria. Economic evaluations of falls prevention through exercise (n = 9), home assessment (n = 6), medication adjustment (n = 4), multifactorial programs (n = 11), and various other programs (n = 13) were identified. Approximately two-thirds of all reported incremental cost-effectiveness ratios (ICERs) with quality-adjusted life-years (QALYs) as outcome were below the willingness-to-pay threshold of $50,000 per QALY. All studies on home assessment and medication adjustment programs reported favorable ICERs, whereas the results of studies on exercise and multifactorial programs were inconsistent. The overall methodological quality of the studies was good, although there was variation between studies. The majority of the reported ICERs indicated that falls prevention programs were cost-effective, but methodological differences between studies hampered direct comparison of the cost-effectiveness of program types. The results imply that investing in falls prevention programs for adults aged 60 and older is cost-effective. Home assessment programs (ICERs < $40,000/QALY) were the most cost-effective type of program for community-dwelling older adults, and medication adjustment programs (ICERs < $13,000/QALY) were the most cost-effective type of program for older adults living in a residential care facility. J Am Geriatr Soc 66:2197-2204, 2018.

Purpose: The purpose of the Collaborative Falls Prevention exercise programme is the integration of Physiotherapy led falls prevention exercise classes with education sessions delivered by professionals from community programmes for older adults. The optimisation of partnership working between Physiotherapists and local community agencies enabled statutory and community service providers to connect and share information for the benefit of the older adult living in the community, whilst reducing their risk of falls. Background: The Falls Management exercise programme (FaME) reduces falls by 26 – 54% depending on population and duration. Falls destroy confidence, increase isolation and reduce independence, with around 1 in 10 older adults who fall becoming afraid to leave their home in case they fall again. A combination of age friendly environments and targeted approaches is needed to support older adults to remain physically active and reduce their risk of falls and fracture. COVID-19 had a huge impact on the rehabilitation needs of older adult and has affected their re-engagement in community based activities. The aim of our programme was to re-engage with the older adult at risk of falling by establishing access to HSE Falls Prevention exercise classes and incorporating a social element to the classes with information and an introduction to local existing community services.. A direct referral pathway enabled all Enhanced Community Care (ECC)services including Integrated Care Programme for Older persons (ICPOP), Integrated Falls Prevention team, primary care and acute services and GPs to refer older adults at risk of falls living in the community into this collaborative programme. Aims: Implement Physiotherapy led, 24 week structured falls management exercise programme (FaME) for older adults at risk of falls. Establish partnerships between the HSE ECC ICPOP programmes, Primary Care, GPs, Acute services with existing local services in the community for the older adult. Re-engage the older adult back into attending classes and local activities in their community by establishing a seamless transition between rehabilitation and community services for the older adult. Outcome measurements: A total of 1404 attendances at the Falls Prevention exercise programmes from September 2022 to July 2023. 35% improvement in confidence and reduced fear of falling. 50% improvement in balance measurements. Timed up and go measurement for falls risk showed that 50% of participants were at risk of falls prior to attending the programme and this reduced to 10% of participants in the falls risk category post completion of the programme. 65% improvement in strength and balance measurements. Eight different community agencies delivered information sessions on their services, enabling a smooth onward transition for the participants of the Falls Prevention programme to different community programmes. Collectively there were huge gains from integrating health and social care services. This initiative enabled services to work collaboratively for the benefit of older adults, so that they could access the high-quality care and support they need at a time and place that is appropriate to them, espousing the Sláintecare principles of ‘Right Care, Right Place, Right Time’.

China launched its long-term care insurance (LTCI) program for older adults in 2016. Although the scheme has shown some promising outcomes, little is known about whether it improves subjective well-being. This study explored this topic among older persons with a disability and identified the underlying mechanisms associated with the channel of this effect using data from a national survey. The LTCI program was shown to improve the subjective well-being among older persons with a disability and this effect increased over time. The LTCI program has great positive effect among women and those who lived alone compared to their counterparts. Mechanism analysis revealed that the main channel by which the LTCI program has positive effect occurred through the satisfaction of long-term care needs and improved self-reported health. This study suggests promising benefits of the LTCI program for older Chinese adults.

The role of memory in supporting adolescents' sense of place and past is not well understood, but older adults offer a wealth of life stories and wisdom that they can share with younger generations. This in-depth pilot study positioned Australian high school students as oral historians to interview older Australians about their lives. Oral historian training and materials were provided, and pre- and post-intervention measures of adolescents' sense of everyday Australian history, well-being, and social connection were collected for an intervention school group (n = 17) and a waitlist control school group (n = 12). In-depth supplementary memory and well-being data were also collected for six participating older adults. In the intervention condition, scaffolded memory interviews took place during weekly aged care visits across one school term and were followed by an intergenerational celebration and memory book presentation. As hypothesised, older adults imbued their stories with life lessons for adolescents. Although no quantitative changes in participants' well-being emerged, qualitative data revealed the emergence of rich interpersonal relationships and bonding between adolescents and older adults. There were also benefits of the programme for older adults' reports of generativity and adolescents' understanding of everyday Australian history. The findings demonstrate the social and academic benefits of scaffolded intergenerational memory conversations and represent a scalable educational model and materials with downstream community benefits.

Translation of a Motor Learning Walking Rehabilitation Program Into a Group-Based Exercise Program for Community-Dwelling Older Adults

Objective To study the effects of fall prevention program for the community-dwelling older adults. Falling is a significant risk factor for older adults, impacting their physical and mental health and causing social and economic burdens on themselves and their families. Methods A randomized controlled trial was conducted with 60 older adults aged 60 years and older attending the elderly schools in Chanthaburi province, Thailand. Two elderly schools were randomly selected from 24 schools using a lottery method, then were randomly assigned to either the intervention or the control trial setting. Eligible older adults from each elderly school were randomly selected to participate in the study using a computer generator. There were 30 participants in each group. The experimental group engaged in fall prevention program training for 2 h per session per week for 6 weeks. The control group attended usual health-related activities of the school. Outcome measures before and after the intervention included: questionnaires used to assess knowledge and behaviors of fall prevention, the Fear of Falling test (Short FES-I), the Timed Up and Go Test (TUGT), and the Thai Falls Risk Assessment Test (Thai-FRAT). Results The independent t -tests revealed significant differences between the experimental group and the control group. Post-intervention showed that the experimental group demonstrated better knowledge ( t = 5.94, P &lt; 0.001) and behaviors related to the fall prevention program knowledge ( t = 4.63, P &lt; 0.001), reduced fear of falling ( t = –4.72, P &lt; 0.001), improved walking and balance ( t = –4.85, P &lt; 0.001) and lowered risk of falling ( t = –4.02, P &lt; 0.001) than the control group. Conclusions The fall prevention program could benefit the older adults dwellings in the community by increasing their knowledge and fall prevention behaviors, reducing their fear of falling and fall risk and improving their walking and balance, which would enhance their quality of life.

This study developed, implemented and tested the effectiveness of a music-with-movement exercise programme in improving the pain situations of older adults with chronic pain. A pilot randomized controlled trial. This was a pilot randomized controlled trial. The intervention was an 8-week music-with-movement exercise (MMEP) programme for older adults with chronic pain recruited in elders' community centres. The control group received the usual care and a pain management pamphlet. Outcome variables were pain intensity, pain self-efficacy and pain interference, depression and loneliness. Seventy-one participants joined this study. Pain intensity was significantly reduced between the experimental group compared to the control group. The experimental group participants reported significant improvements in pain self-efficiency, pain interference and reduced loneliness and depressive symptoms. However, no significant difference was observed between groups.

Background: Exercise interventions are pivotal in geriatric rehabilitation; however, the comparative efficacy of specialized modalities, such as equipment-assisted Pilates and core stabilization programs, remains an area requiring robust investigation. This randomized controlled analysis aimed to compare the effects of a structured equipment-assisted Pilates program against a comprehensive core stabilization program in community-dwelling older adults. Methodology: A prospective, single-blinded randomized controlled trial was conducted with 120 participants aged 65 and older, randomly assigned to either the Pilates or Core Stabilization group for a 12-week intervention. Primary outcomes included the Timed Up and Go (TUG) test and Berg Balance Scale (BBS). Secondary outcomes included the 6-Minute Walk Test (6MWT), the SF-36 Health Survey, and the EQ-5D questionnaire. Data were collected at baseline, post-intervention, and 3-month follow-up. Statistical analysis utilized ANCOVA to assess between-group differences in change scores, with significance set at p &lt; 0.05. Results: Both equipment-assisted Pilates and core stabilization programs demonstrated significant improvements in primary and secondary functional outcomes (p&lt;0.001). The Pilates group showed a statistically significant greater improvement in dynamic balance (TUG) and physical functioning (SF-36) compared to the core stabilization group (p &lt; 0.05). Conversely, the core stabilization group exhibited slightly larger, though not statistically significant, gains in static balance (BBS) and endurance (6MWT). Conclusion: Equipment-assisted Pilates appears to offer superior benefits for dynamic functional mobility and perceived physical health in older adults, while core stabilization programs provide comparable improvements in overall balance and endurance.

Limits of stability and falls during a multicomponent exercise program in faller older adults: A retrospective cohort study

Stakeholder involvement in the design of a patient-centered comparative effectiveness trial of the “On the Move” group exercise program in community-dwelling older adults

Exercise programs have been found to have substantial benefits for older persons, but implementing these programs with frail homebound seniors is challenging. The project team aimed to evaluate an in-home exercise program for older adults--the Victorian Order of Nurses' for Canada's SMART (Seniors Maintaining Active Roles Together)® (VON SMART®) In-Home Exercise Program- in which the exercises are led by trained volunteers. The majority of volunteers were females who exercise regularly. Over half of the volunteers were 60 years of age or older, and over half had had prior health or fitness training. Volunteers reported receiving multiple benefits from performing their role as an exercise leader. From January to August, 2009, a total of 59 volunteers, seven Site Coordinators, and 33 home-bound older (mean age: 80 years; SD: 8.8) clients from eight VON sites and one partner organization participated in the evaluation. Data collection included pre-post quantitative measures of participants' physical function, satisfaction surveys of participants, follow up semi-structured interviews of participants, feedback surveys of volunteers and site coordinators, and a focus group interview of site coordinators. The Chair Stand test (p<0.001), the Reaching Forward test (p=0.028), the Activities Balance Confidence Scale (p=0.02), as well as measures of activities of daily living (ADL) inside the home (p=0.001) and outside the home (p=0.009) showed significant improvement. This evaluation showed that the exercises improved participants' strength, flexibility, balance, and ability to perform ADL. This study provides additional evidence of the benefits of in-home exercise for frail seniors, and supports a role for volunteers in delivering these programs. The volunteers reported receiving social benefits of meeting new people, being able to see the difference they helped make in others, as well as personal physical benefits from exercising more.

Decreased retinal capillary density as a beneficial response to 24-week high-speed circuit resistant training in healthy older adults

Introduction Uptake of fall-prevention programs by older adults prior to the COVID-19 pandemic was low. We identified a pre-pandemic need to develop an online, fall-prevention exercise program for community-dwelling older adults. Purpose The purpose of this qualitative study was to obtain recommendations from experts on exercise for fall prevention, fall prevention, and online education to inform the development of an online, fall-prevention exercise program for community-dwelling adults aged 65 years and older. Methods Three virtual focus groups were held to obtain recommendations from: 1) exercise experts (n = 4) on design of an exercise program intended to reduce falls among community-dwelling older adults, 2) fall-prevention experts (n = 6) on key considerations for fall prevention and transitioning to an online fall-prevention program, and 3) online education experts (n = 5) on online technical/design considerations. Data were analyzed using directed content analysis. Results Collectively, the experts recommended designing an online program that: 1) contained strengthening, balance, and stretching exercises; 2) was beta tested in older adults; 3) replicated a group dynamic; 4) included an instructional designer; 5) provided tailored feedback to participants; 6) made exercises portable/accessible across devices; 7) offered computer training; 8) monitored safety and exercise performance; 9) included strategies to sustain participant behavior; and 10) was delivered by health or fitness professionals. Conclusion This study generated expert recommendations to inform the development of an online, fall-prevention exercise program. Implementation of these recommendations has the potential to expand the reach of fall-prevention programs and protect the health and safety of older adults in a post-COVID-19 world.

The mission of the Administration for Community Living (ACL) is to maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers. In direct alignment with this mission is ACL’s support of evidence-based falls prevention programs in communities throughout the United States. Since 2014, the Administration on Aging (AoA), part of ACL, has invested nearly $14 million in entities such as state agencies, nonprofits, and universities to expand access to proven community-based falls prevention programs. The initiatives supported by ACL/AoA bring to bear two primary goals—(1) to significantly increase the number of older adults and older adults with disabilities at risk for falls who participate in evidence-based community programs to reduce falls and falls risks; and (2) to implement innovative funding arrangements, including contracts, partnerships, and collaborations with one or more sustainability partners to support these programs during and beyond the grant period. Support from ACL/AoA has significantly increased the availability of evidence-based falls prevention programs in funded communities, as well as enhanced the network’s sustainable delivery infrastructure to promote continued access to these critical programs beyond the scope of grant funding. This article highlights the successful rollout of ACL/AoA’s falls prevention initiative.

Background: Health promotion education in elderly is the most important key to successful implementation of fall prevention program in primary care practice. The Ministry of Public Health in Thailand has encouraged the hospital in community to use the self-health records which were found to enhance healthy behaviors.&#x0D; Objective: To compare the knowledge and attitudes on fall prevention among elderly patients and their caregivers before and after the education program that employed using self-health records and receiving the counseling from nurses and pharmacists.&#x0D; Methods: This embedded mixed methods study was designed by using the structured questionnaires including demographic data and measuring the knowledge and attitude on fall prevention for quantitative arm (143 elderly patients and 42 caregivers). The open-ended questions about the advantages and disadvantages of self-health records were used in qualitative part among 106 elderly patients and 29 caregivers after 6 months of using their records.&#x0D; Results: Knowledge and attitude scores were statistically higher in all parts, including appropriate use of the medications, following vaccination schedule, and getting information about fall prevention from their primary care physicians. All participants in qualitative study required to have their self-health records to improve their understanding about their medications and health information.&#x0D; Conclusions: Self-health records and receiving the counseling from nurses and pharmacists not only enhances the knowledge and attitude toward fall prevention program in older adults but also helps patients to communicate with the specialists about their health information.