Falls Prevention in Older Adults with Cardiovascular Disease: Systematic Review

BACKGROUND Falls and fractures are the leading cause of unintentional injury among older adults, resulting in increased mortality and morbidity, and reduced physical function and quality of life. In-person exercise programs aimed at improving strength, balance, and postural control have demonstrated benefits in physical function and a reduction in fall risk among older adults. Technology-driven approaches can enhance the accessibility of fall prevention resources, making them more accessible. In particular, digitally delivered programs offer the opportunity to balance risks and benefits during times of social distancing, while promoting community engagement and potentially enhancing physical function. OBJECTIVE The overall aim of this review was to determine the reach, implementation, safety, and effectiveness of digitally delivered group exercise programs with a focus on improving physical function. METHODS Medline via PubMed, Cochrane Registry of Controlled Trials (CENTRAL), and EMBASE databases were searched for this review. The search was initially conducted in November 2022 and updated in July 2024. Randomized controlled trials, non-randomized trials, and single arm pilot studies at least six weeks in duration and reporting digitally delivered exercise for presumptively healthy older adults taught by a qualified instructor in real-time (not videotaped) were included. Interventions specifically for clinical subpopulations (i.e. cardiac rehabilitation, Parkinson’s, COPD, etc.) were excluded, although common diseases of older age (hypertension, diabetes, osteoporosis) were included. The review was preregistered via INPLASY (#3773) RESULTS 4242 studies were screened by title and abstract, with 76 studies progressing to full-text screening. Of these, 23 (30%) met all inclusion criteria. Sixteen (70%) studies reported physical outcomes (i.e. balance, strength, function, etc.). Fourteen (88%) of these reported improvements following the intervention. Twenty (87%) reported one or more observations regarding safety and/or program usability. Most studies were conducted injury-free, or with no greater than minor injuries, and with high adherence to the exercise sessions and overall study compliance. Furthermore, most studies indicated a high level of acceptance of the digital delivery mechanism(s). CONCLUSIONS Overall, these findings demonstrate partial effectiveness in improving physical function, high attendance, participant enjoyment, and safety of digitally delivered exercise programs for older adults taught in real-time. CLINICALTRIAL INPLASY (#3773)

To evaluate the effects of cycling progressive resistance training combined with balance exercises on walking speed, balance, fatigue, fear of falling, depression, and quality of life in patients with multiple sclerosis. In this prospective randomized controlled trial, 45 patients were randomized into two exercise training (n = 30) groups and one control (n = 15) group. The patients in training group 1 (n = 15) underwent progressive resistance training on a bicycle ergometer and balance exercise, whereas group 2 (n = 15) patients received a home-based lower-limb strengthening and balance exercise. Outcome measures, including the duration of exercise, tolerated maximum workload, timed up and go test, Dynamic Gait Index, functional reach, Falls Efficacy scale, 10-m walk test, Fatigue Severity Scale, Beck Depression Inventory, and Short Form 36 scores, were assessed initially and at 8 wks. After dropouts, the whole study group consisted of 20 women and 13 men (mean age, 37.9 +/- 10.43 yrs). In training group 1, duration of exercise, tolerated maximum workload, timed up and go test, Dynamic Gait Index, functional reach, falls efficacy scale, 10-m walk test, Fatigue Severity scale, and Beck Depression Inventory scores, and in group 2, the mean duration of exercise, tolerated maximum workload, and Falls Efficacy scale scores were significantly improved after the training program (P < 0.05). There were no significant improvements in any of the outcome measurements in the control group (P > 0.05). In between-group comparisons, improvements in outcome measures of group 1 patients were significantly higher than those in other groups, except for 10-m walking test. Group 1 patients showed statistically significant improvement in physical functioning and role-physical functioning scales of the Short Form 36 (P < 0.01 and P < 0.05, respectively), and group 2 patients showed statistically significant improvement in only physical functioning scale of Short Form 36 (P < 0.05) after 8 wks. Specific exercise programs, including cycling progressive resistance training, may improve balance, fatigue, and depression and reduce fear of falling in patients with multiple sclerosis without worsening multiple sclerosis signs and symptoms.

Aim: This case study reports on the planning and implementation of a fall risk assessment and prevention activity for older adults offered in multiple community settings by health professional faculty and students. Background: In the US, the percentage of adults 65 and older who fell was more than 29% in 2018. Among states, Arkansas ranks 48th with 35.2% of older adults reporting a fall (CDC Behavioral Risk Factor Surveillance System, 2018). The desired outcomes of the interprofessional service learning (SL) project were to (1) Improve student understanding of and satisfaction with interdisciplinary learning, (2) Increase the number of older adults assessed for fall risk, (3) provide personalized fall prevention interventions, and (4) Increase uptake of fall prevention strategies by older adults. Methods: Four senior centers in Northwest Arkansas hosted a fall prevention awareness day planned and implemented by faculty in the departments of nursing, public health, physical therapy, exercise science, dietary, and social work in two universities. Materials from the Centers for Disease Control and Prevention (CDC) Stopping Elderly Accidents Deaths and Injuries (STEADI) initiative were used to train students as part of a SL opportunity. Results: Students completed fall screenings, risk assessments, and referrals on 49 older adults in the four senior activity and wellness centers. Conclusions: Based on our experience, an interprofessional education (IPE) activity focused on fall prevention in older adults is feasible. We recommend planning for the event far enough in advance that the experience can be included in the curriculum for students in the various disciplines. We also recommend that students be actively involved in the planning and implementation of the event.

‘Believe the positive’ aggregation of fall risk assessment methods reduces the detection of risk of falling in older adults

This study compared the effect of periodized versus nonperiodized (NP) resistance training (RT) on physical function and health outcomes in older adults. Forty-one apparently healthy untrained older adults (women = 21, men = 20; 70.9 ± 5.1 yr; 166.3 ± 8.2 cm; 72.9 ± 13.4 kg) were recruited and randomly stratified to a NP, block periodized, or daily undulating periodized training group. Outcome measures were assessed at baseline and after a 22-wk × 3 d·wk RT intervention, including; anthropometrics, body composition, blood pressure and biomarkers, maximal strength, functional capacity, balance confidence, and quality of life. Thirty-three subjects satisfied all study requirements and were included in analyses (women = 17, men = 16; 71.3 ± 5.4 yr; 166.3 ± 8.5 cm; 72.5 ± 13.7 kg). The main finding was that all three RT models produced significant improvements in several physical function and physiological health outcomes, including; systolic blood pressure, blood biomarkers, body composition, maximal strength, functional capacity and balance confidence, with no between-group differences. Periodized RT, specifically block periodization and daily undulating periodized, and NP RT are equally effective for promoting significant improvements in physical function and health outcomes among apparently healthy untrained older adults. Therefore, periodization strategies do not appear to be necessary during the initial stages of RT in this population. Practitioners should work toward increasing RT participation in the age via feasible and efficacious interventions targeting long-term adherence in minimally supervised settings.

Addressing the Need for New Models of Care for Older Adults Receiving Long-term Dialysis

Falls are the leading cause of accidental death in older adults that result from a complex interplay of risk factors. Recently, the need for person-centered approach utilizing personalization, prediction, prevention, and participation, known as the P4 model, in fall prevention has been highlighted. Features of mobile technology make it a suitable technological infrastructure to employ such an approach. This narrative review aims to review the evidence for using mobile technology for personalized fall risk assessment and prevention since 2017 in older adults. We aim to identify lessons learned and future directions for using mobile technology as a fall risk assessment and prevention tool. Articles were searched in PubMed and Web of Science with search terms related to older adults, mobile technology, and falls prevention. Atotal of 23 articles were included. Articles were identified as those examining aspects of the P4 model including prediction (measurement of fall risk), personalization (usability), prevention, and participation. Mobile technology appears to be comparable to gold-standard technology in measuring well-known fall risk factors including static and dynamic balance. Seven applications were developed to measure different fall risk factors and tested for personalization, and/or participation aspects, and 4 were integrated into a falls prevention program. Mobile health technology offers an innovative solution to provide tailored fall risk screening, prediction, and participation. Future studies should incorporate multiple, objective fall risk measures and implement them in community settings to determine if mobile technology can offer tailored and scalable interventions.

Background There is a need for comprehensive programs that address both the physical and psychosocial aspects of fall prevention for the elderly. Objective This study assessed the efficacy of the exercise regimen on various health metrics for elderly community dwellers. Methods Forty-four participants were divided into experimental and control groups. The experimental group adhered to a 9-step core exercise regimen for fall prevention, practicing three times a week for 30 minutes across 10 weeks, while the control group maintained their regular daily activities without any specific exercise program. Before and after the intervention, participants underwent the timed up-and-go t est to evaluate the physical function, the berg balance scale (BBS) and one-legged stance test (OLST) for balance assessment, the activity-specific balance confidence scale for fall-related self-efficacy, and measures for health-related quality of life. Results Participants in the experimental group showed significant improvements in physical function (p = .04, Cohen’s effect size (d) = 0.2). and balance ability on BBS (p < .01, d = 0.2) and OLST (p < .01, d = 1.3) compared to the control group. Furthermore, there was a notable enhancement in the quality of life indicators for this group, especially in areas such as physical function (p = .04, d = 0.2), physical-role limitation (p = .04, d = 0.2), mental health (p = .01, d = 0.3), vitality (p = .02, d = 0.4), body pain (p = .04, d = 0.5), and general health (p = .04, d = 0.4). Conclusion These findings highlight the potential of the fall prevention exercise program in improving physical health aspects, but its influence on specific psychosocial elements remains to be determined.

This prospective longitudinal study with a minimum 2‐year follow‐up assessed the long‐term outcome of a group of patients with chronic discogenic low back pain who had failed to improve with comprehensive nonoperative care and who were subsequently treated with intradiscal electrothermal therapy (IDET). Previous reports of patient outcomes at 1 year after IDET have demonstrated statistically significant improvement. The study group was comprised of 58 patients with chronic symptoms of more than 6 months who failed to improve with nonoperative care and subsequently underwent IDET. Visual analogue scale (VAS) pain scores, SF‐36 scores, and sitting tolerance times were collected pretreatment and at 6, 12, and 24 months. The entire study group demonstrated a significant improvement in pain as demonstrated by statistically significant improvement in VAS scores and bodily pain SF‐36 scores. The IDET‐treated group demonstrated a significant improvement in physical function as noted by statistically significant improvement in sitting tolerance times and physical function SF‐36 scores. Bodily pain and physical function scores demonstrated significant improvement between the 1‐year and 2‐year observation points. Additionally, quality of life improvement was demonstrated by a statistically significant improvement in all the SF‐36 subscales. The authors concluded that a cohort of patients with chronic discogenic low back pain who had failed to improve with comprehensive nonoperative care demonstrated a statistically significant improvement in pain, physical function, and quality of life at 2 years after IDET.

Prospective longitudinal study with a minimum 2-year follow-up. To assess the long-term outcome of a group of patients with chronic discogenic low back pain who had failed to improve with comprehensive nonoperative care and who were subsequently treated with intradiscal electrothermal therapy (IDET). Previous reports of patient outcomes at 1 year after IDET have demonstrated statistically significant improvement. The study group comprised 58 patients with chronic symptoms of more than 6 months who failed to improve with nonoperative care and subsequently underwent IDET. VAS pain scores, SF-36 scores, and sitting tolerance times were collected pretreatment and at 6, 12, and 24 months. Mean duration of pre-IDET symptoms was 60.7 months. The minimum follow-up at data collection was 24 months. The study group (n = 58) demonstrated a significant improvement in pain as demonstrated by statistically significant improvement in VAS scores and bodily pain SF-36 scores. The IDET-treated group demonstrated a significant improvement in physical function as noted by statistically significant improvement in sitting tolerance times and physical function SF-36 scores. Bodily pain and physical function scores demonstrated significant improvement between the 1- and 2-year observation points. Additionally, quality of life improvement was demonstrated by a statistically significant improvement in all the SF-36 subscales. A cohort of patients with chronic discogenic low back pain who had failed to improve with comprehensive nonoperative care demonstrated a statistically significant improvement in pain, physical function, and quality of life at 2 years after IDET.

Falls are a leading cause of injury and mortality among older adults. While multiple strategies are effective at reducing fall risk, uptake is low. Understanding how older adults think about fall risk and prevention activities can inform outreach initiatives and engagement. We systematically searched PubMed, SCOPUS and Google Scholar for articles published between January 2015 and April 2023. Studies were eligible if they reported on knowledge or perception of fall risk and/or prevention among community-dwelling older adults. We included 53 studies from 20 different countries. Over half of the studies used qualitative methods, 19 used quantitative, and three used mixed methods. Most of the older adults could identify some fall risk factors and the consequences of falls. However, many older adults did not view themselves as at-risk for falls. Some older adults consider falls an inevitable part of ageing, while others believe that falls can be prevented. Cultural context may play a role in shaping these beliefs. Several studies reported on older adults' experiences and the perceived barriers and facilitators of participating in fall prevention activities. Improving the accuracy of older adults' perceptions of their own fall risk and highlighting the fact that many falls are preventable are two key messages that may help motivate older adults to take action to prevent falls. Older adults cite their healthcare provider as a trusted source of prevention information, and clinicians can leverage this opportunity to inform and motivate older adult patients about fall prevention.

Category:Sports; AnkleIntroduction/Purpose:Achilles tendon rupture is a common injury in the adult population. The role of operative and non-operative management remains controversial with the development of functional rehabilitation programs. The purpose of this study is to evaluate and compare the patient-reported outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS) after operative and non-operative treatment of acute Achilles rupture. PROMIS is a valid, reliable, and effective tool to evaluate patient outcomes after treatment for Achilles ruptures. Our hypothesis is that there is no significant difference in PROMIS scores between patients undergoing operative compared to non-operative treatment of Achilles rupture.Methods:Under an IRB-approved protocol, Achilles rupture was identified using ICD 9 and ICD10 codes of 727.67 and S86.0. Patients who underwent Achilles tendon primary repair were identified using CPT code 27650 (Repair, primary open or percutaneous, ruptured Achilles tendon). Revision Achilles repair and chronic Achilles ruptures were excluded. All patients treated non-operative underwent a strict functional rehabilitation protocol. We included patients treated between 1/1/2015 and 11/30/2022. PROMIS physical function (PF), pain interference (PI), and depression scores were routinely collected prospectively during the initial office visit and follow-up appointments. A distribution-based method used to determine the minimal clinically important difference (MCID), which was 1/2 standard deviation of each PROMIS domain. A medical records review was performed to collect patient demographic data. Statistical analysis was used to compare preoperative and postoperative scores and significance was indicated when P< 0.05.Results:216 patients were included (115 Nonoperative, 101 Operative). Patients treated operatively were statistically younger than those treated surgically (35.6±12.3 vs 45.1±15; p< 0.001) with lower BMI (27.8±4.3 vs. 29.5±5.3; p=0.004). Sex distribution among the groups were similar (p=0.933). Both treatment groups improved PROMIS PF, PI, and depression scores (p < 0.001). The mean PF improvement is significantly greater in the operative group (13.2±13.9 vs. 9.5±12.5; p=0.042). There is no statistical difference in the Achilles tendon re-rupture rate between both treatment groups (operative: 2% vs. 4.3%; p=0.344). There was no difference in mean PROMIS PI change (p=0.134) and PROMIS depression (p=0.201). There is no difference in the number of patients that achieve MCID for PF, PI, depression among both treatment groups at the 6-months follow-up period.Conclusion:In patients with Achilles tendon rupture, operative management may lead to statistically significant improvements in patient-reported physical function. However, nonoperative management was associated with similar overall rates of rerupture, PROMIS PI and depression outcomes, and chances of meeting MCID as those who underwent operative intervention. Both operative and nonoperative management of Achilles tendon rupture are successful treatment options and lead to significant improvement in physical function, pain interference, and depression PROMIS scores. However, there may still be some benefit to performance and function with operative intervention.

Falls among older adults are a growing public health concern in Saudi Arabia. The Otago Exercise Program (OEP) is an evidence-based intervention aimed at reducing fall risk in this population. This study assessed the knowledge and attitudes of Saudi Arabian physical therapists toward the OEP and examined potential gender-based differences. A cross-sectional survey was conducted between November 2023 and April 2024, involving 120 licensed physical therapists from Saudi Arabia, recruited via Email and social media. The survey captured sociodemographic data, knowledge, and attitudes regarding the OEP. Responses were analyzed using descriptive statistics, chi-square tests, and Cramér's V to assess the strength of associations, with a significance level set at p < 0.05. Most physical therapists reported knowledge of the OEP's clinical effectiveness (36.7%), cultural compatibility (35.0%), and fall prevention benefits (28.3%). Gender was not significantly associated with knowledge of clinical effectiveness (χ² = 3.84, p = 0.57), contraindications (χ² = 4.44, p = 0.48), cost-effectiveness (χ² = 4.15, p = 0.52), or fall prevention in older adults (χ² = 2.44, p = 0.78), with moderate effect sizes observed (Cramer's V = 0.233 to 0.467). Attitudes toward the OEP were generally positive, with 51.7% supporting its use in regular aging care and 45.0% expressing confidence in delivering the program. There were no significant gender differences in understanding the OEP's recommendations (χ² = 7.45, p = 0.11) or confidence in program delivery (χ² = 7.62, p = 0.10), although strong association effects were noted (Cramer's V = 0.696 and 0.680, respectively). This study highlights the strong knowledge and positive attitudes of Saudi physical therapists toward the OEP, underscoring its potential for integration into national healthcare strategies to improve geriatric care and reduce fall-related risks. The findings emphasize the importance of continuous professional development to address knowledge gaps and optimize the implementation of evidence-based fall prevention programs.

Effect of Tai Chi Exercise on Fall Prevention in Older Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials

PurposeFalls and frailty in the older adults are a considerable public health and socioeconomic problem. Physical activity has an important role in delaying degenerative ageing processes and preserving the neuromuscular system’s plasticity. Multicomponent exercise programmes could improve strength (stability), balance, mobility (flexibility) and walking speed; especially if they are carried out for at least some extend of time. Exercise programmes for fall and frailty prevention in community-dwelling older adults should include muscle performance, balance challenging and functional exercises. Slovenia has a long tradition of implementing community organized and structured exercise programmes in Health promotion centres and Healthy clubs. We are establishing new approach of frailty and falls prevention in our elderly population.Project descriptionWith the collaboration of professionals in the field of sport recreation, health and fitness we constructed new exercise approach called vAdBeCeDa®. According to the WHO guidelines of physical activity and sedentary behaviour and the latest World guidelines for fall prevention and management for older adults, the programme is an addition to the existing Slovenian functional exercise programme called Health Promoting Sport Program ABC®. ABC programme focused especially on developing strength in fundamental movement patterns and influencing aerobic capacity. The supplement includes warm-up exercises adapted to the specific needs and functional status of the elderly, progressive balance-training programme for 12 training units and a set of static stretching exercises with support, due to poor balance. Functional and physical fitness is assed pre and post intervention with Slovenian version of senior fitness test (Jakovljević & Knific, 2015). Programme will be implemented in existing network of Health promotion centres (HPC) and in Healthy clubs (HC) all over the country, where all elderly population could practice on the Slovenian health insurance costs.ConclusionsThe results from many longitudinal studies on effects of multicomponent exercise programmes are encouraging, given that maintenance of physical fitness has a successful, prolonged effect on fall and frailty prevention in older adults. All countries should pursue a lifelong physical activity for elderly, which is achievable with community approach and good collaboration between health and sport sector.