Fall Prevention Exercise Research Articles

A 10-week judo-based exercise programme improves physical functions such as balance, strength and falling techniques in working age adults

BackgroundFalls and fall-related injuries are major threats not only for older adults but also for younger age groups such as working-age adults. It has been shown that it is possible to reduce the risk of falls and fall-related injuries, to some extent. However, interventions aiming at reducing both the risk of falls and mitigating fall-related injuries through teaching safe falling techniques are still sparsely investigated. The aim with this study was to investigate the effect of a 10-week workplace-based judo inspired exercise programme (Judo4Balance). The measures in the study include physical functions, fall-related self-efficacy and safe falling techniques.MethodsA total of 142 working-age adults participated in this non-randomised controlled study. The participants were allocated to the Judo4Balance group (n = 79), or to a waiting list control group (n = 63). The mean age was 47 years (18–68). The recruitment period was from May 2018 to October 2019. A total of 128 participants were included in the analysis. Logistic Regression models were used to analyse the outcomes: physical function, balance and fall-related self-efficacy as well as falling techniques (backwards and forwards).ResultsAt the 10-week follow-up, the results displayed significant differences between the two groups in all measurements, except for the fall-related self-efficacy with OR = 1.8. Techniques for falling forwards and backwards displayed the highest OR = 124.1 and OR = 98.9. Physical function and balance showed OR = 3.3 and OR = 6.4.ConclusionsThis exercise programme under study displayed significant differences in strength, balance and safe falling techniques between the groups. It is suggested that these functions, which were studied here, can effectively be trained in working-age adults by using the Judo4Balace exercise programme. Thus, it may be beneficial to further investigate and include training in proper falling techniques when designing fall prevention exercise programmes. Furthermore, it may be a novel way of addressing fall-related injuries, which are of utmost importance to prevent in near future.Trial registrationNCT04294342. Registered 4 March 2020 - The Impact of Specifically Adapted Judo-based Training Program on Risk Factors for Falls Among Adults - Full Text View - ClinicalTrials.gov

E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial

ObjectiveTo test whether StandingTall, a home based, e-health balance exercise programme delivered through an app, could provide an effective, self-managed fall prevention programme for community dwelling older people.DesignAssessor blinded, randomised...

Participants’ perspectives of a fall prevention exercise program in older Arab Americans: A focus group study

Background and objective: Physical exercise is an important intervention to maintain health, reduce falls and improve quality-of-life outcomes in older adults. Falls are the leading cause of fatal and non-fatal injuries, and the use of Tai Chi exercise is well-supported by the general older population. Currently, there is little evidence to support the acceptance of Tai Chi by Arab Americans who have no cultural ties to Tai Chi. It is important to understand the perspective of participants in order to gain insight into the attitudes and opinions of the target group. Purpose: To explore participants' perspectives in a small group setting about the implementation of a culturally sensitive Tai Chi fall prevention group exercise program.Methods: Participants were eight older Arab American women who completed a 12-week Tai Chi fall prevention exercise program at a non-for-profit Arab community center. A semi-structured interview and focus group study was conducted with the participants and was audiotaped. The audio recordings were translated into English, transcribed, and analyzed for emergent themes.Results: Participants’ views of the program were positive. The key elements that contributed to the positive outcomes reported by participants were the characteristics of Tai Chi, the Tai Chi instructor, and the use of bilingual staff as a facilitator. The data showed three themes of self-reported benefits, including prevention awareness, physical benefits and mental health benefits, and two program-related factors: program barriers and promoters.Conclusions: Findings indicated that the Tai Chi program implemented in a culturally sensitive manner can be accepted by older Arab American women. Collaborating with a community-based organization and using bilingual staff from the same culture are key factors to promote the success of the program.

A ‘case-mix’ approach to understand adherence trajectories for a falls prevention exercise intervention: A longitudinal cohort study

ObjectiveWe identified adherence-based case-mixes from participants’ longitudinal adherence to falls prevention exercise interventions over 12 months. Second, we identified modifiable baseline predictors (cognition, mobility and functional status) based on participants' case-mix adherence trajectories. Study design and outcome measuresThis study was a 12-month longitudinal secondary analysis of data from 172 participants who received the Otago Exercise Program (OEP) in a randomized controlled trial. Adherence to the OEP was ascertained monthly via self-report. Case-mixes, groups of individuals who followed similar adherence trajectories, were visually defined using 12-month longitudinal trajectories; we used latent class growth modeling. Baseline predictors of adherence were examined for the following categories: 1) cognition, 2) mobility and 3) functional status. ResultsFour distinct case-mixes were identified. The “non-adherent” case-mix (18 %) was distinguished by a non-adherent and decreasing adherence trajectory over time. The “low adherence” case-mix (45 %) did not have complete adherence or consistent adherence over the 12-month follow-up. The “moderate adherence” case-mix (27 %) was characterized by a stable (i.e., non-variable) adherence trajectory with a slightly increasing pattern at midpoint. The “high adherence” case-mix (10 %) demonstrated consistent and high adherence over the 12-month follow-up. For individuals with “moderate adherence”, the Digit Symbol Substitution Test (DSST) significantly predicted adherence (relative risk ratio (RRR) = 1.12 (0.95 CI: 1.0–1.26); p = 0.049). For individuals with “high adherence”, the Digits Forward minus Digits Backward (RRR = 0.43 (0.95 CI: 0.23−0.79); p = 0.002) and Instrumental Activities of Daily Living (RRR = 0.36 (0.95 CI: 0.16−0.81); p = 0.01) significantly predicted adherence. ConclusionsCognitive profile and activities of daily living at baseline may predict the longitudinal pattern of adherence.

The Influence of Body Fat Distribution on Postural Balance and Muscle Quality in Women Aged 60 Years and Over.

The aim of this study was to investigate the influence of body fat distribution on postural balance and lower-limb muscle quality in women aged 60 years and over. Two hundred and twenty-two volunteers took part in this cross-sectional analysis. Participants underwent body fat distribution assessment using dual-energy x-ray absorptiometry and were classified as nonobese, gynoid obese, or android obese. Postural balance was assessed during quiet standing, with and without vision restriction, using a force platform. Specific torque was defined as the ratio of knee extensors peak torque (evaluated by an isokinetic dynamometer) to the lean mass of the same limb (evaluated by dual-energy x-ray absorptiometry). Compared with nonobese participants, both obese groups exhibited higher range of postural sway along the anteroposterior and mediolateral axes (P < .05). However, there were no differences between participants with gynoid and android obesity. The android obese group exhibited greater speed of postural sway in the condition without vision restriction than both nonobese (P = .040) and gynoid obese (P = .004) groups. Regarding muscle quality, only participants with gynoid obesity (P = .004) presented lower specific torque than their nonobese peers. These results may be clinically useful when designing falls prevention exercises targeting the obese population.

Life after falls prevention exercise \u2013 experiences of older people taking part in a clinical trial: a phenomenological study

BackgroundThere is little evidence about the lived experience of older people who have completed a falls prevention exercise programme and their life beyond their intervention.MethodA phenomenological interview study with 23 participants (12 females), mean age 81 years (range 74–93 years), residing in their own homes across England, who had participated in a falls prevention exercise intervention within the Prevention of Falls Injury Trial (PreFIT). The aims were to explore their experiences of:being in a clinical trial involving exercise.exercise once their falls prevention intervention had finished.Interpretative data analysis was informed by van Manen’s (1997) framework for phenomenological data.ResultsAnalysis of interviews about experiences of participating in PreFIT and what happened once the falls intervention ended identified five themes: Happy to help; Exercise behaviours; “It keeps me going”; “It wasn’t a real fall”; and Loss. Participants did not continue their specific exercises after they had completed the intervention. They preferred walking as their main exercise, and none reported preventing falls as a motivator to continue exercising. Participant experiences suggest that they have their own ideas about what constitutes a fall and there is disparity between their interpretation and the definition used by healthcare professionals and researchers.ConclusionDespite good intentions and perceived benefits, on-going participation in falls prevention exercises beyond a structured, supervised intervention was not a priority for these older people. Promoting continuation of falls prevention exercises post-intervention is just as challenging as promoting uptake to and adherence during exercise programmes.

Design characteristics and inclusion of evidence-based exercise recommendation in fall prevention community exercise programs for older adults in Canada: a national descriptive self-report study

BackgroundTraining balance through exercise is an effective strategy to reduce falls in community-dwelling older adults. Evidence-based fall prevention exercise recommendations have been proposed, specifying that exercise programs should: (1) provide a high challenge to balance, (2) be offered for a least three hours per week, (3) be provided on an ongoing basis. Community exercise programs have the potential to deliver effective fall prevention exercise; however, current design characteristics and whether they include the recommendations is not known. This study described design characteristics of fall prevention community exercise programs for older adults (50 years and older) across Canada, and explored whether these programs included the three evidence-based exercise recommendations.MethodsInstructors of fall prevention community exercise programs completed electronic self-report questionnaires following a modified Dillman recruitment approach. Questions explored program characteristics, exercise content, target population, and program and instructor demographic information. Using a previously developed coding scheme based on recommendations, exercises were coded for balance challenge.ResultsOne hundred fourty completed eligible questionnaires were analyzed (74% response rate). One hundred thirty-three programs (95%) included the challenge recommendation by prescribing mostly moderate or high challenge balance exercises, 16 programs (11%) included at least three hours of exercise a week, and 59 programs (42%) were offered on an ongoing basis. Eight programs (6%) included all three recommendations.ConclusionsMost programs included at least one recommendation for effective fall prevention exercise. Future studies should examine organizational barriers and facilitators to incorporating evidence-based exercise recommendations and explore the use of mixed home/in-class strategies to include the recommendations.

Bingocize® beyond the numbers: Motivations and perceptions of a multicomponent health promotion program among older adults living in long-term care

Physical activity (PA) participation among older adults remains the lowest of any demographic, with even lower participation rates in long-term care facilities (LTCFs). While fall risk decreases when individuals engage in PA programs focused on fall prevention, enrollment in such programs remains low. The purpose of this feasibility study was to pilot questions for development of a participant survey used to explore the perceptions and motivations of older adults currently enrolled in a health promotion program called Bingocize®. The program combines fall prevention exercises with the familiar game of bingo. Study participants included a convenience sample of four older adults currently residing in a LTCF. A phenomenological qualitative research approach using video recorded interviews was chosen for the exploratory study. Results revealed that older adults viewed the overall program as enjoyable, identifying social aspects such as intergenerational connection with program facilitators as motivation for participation. Focusing attention on these factors may assist future implementation of the intervention and to promote higher levels of participation in fall prevention programs centered on PA.

The Effects of Community-based Fall Prevention Exercise Program on Lower Extremity Muscle Strength, Balance Ability and Fall Efficacy in Older Adults

The Effects of Community-based Fall Prevention Exercise Program on Lower Extremity Muscle Strength, Balance Ability and Fall Efficacy in Older Adults

치매노인의 낙상예방 운동프로그램이 체중분포지수와 낙상위험도에 미치는 영향

The purpose of this study was to investigate the effects of fall prevention exercise program on weight distribution index and fall risk in elderly people with dementia.,The subjects of this study were 20 people who had experience of falling in a public health center in Gyeonggi-do. The group A was conducted a muscle strength and co-ordinated exercise program, and the group B was conducted a frequency vibration exercise program.,The data of the study were analyzed using SPSS(Version 20.0) statistical program, and the comparison of the difference between before and after each group was analyzed through paired T-test to find out the degree of weight distribution index and fall risk improvement of the exercise program.,The relationship between each variable was analyzed by Pearsons Correlation, and the significance level=.05 for all statistical analysis was set as follows.,The results of the pre- and post-test of the muscle strength and coherence exercise program in Group A were not statistically significant in both weight distribution index (t=.399, p=.699) and fall risk (t= -2.193, p=.056).,The results of the B group frequency vibration exercise program were statistically significant in both the weight distribution index (t=4.492, p=.002*) and the fall risk (t= -3.939, p=.003*).

Transitions from healthcare to self-care: a qualitative study of falls service practitioners' views on self-management

Purpose The aim of this study was to understand the views of falls service practitioners regarding: their role in supporting self-management of falls prevention; and a transition pathway from National Health Service (NHS) exercise-based falls interventions to community-run exercise programmes. Method Semi-structured interviews were conducted with physiotherapists, nurses, and rehabilitation assistants (n = 8) who worked in an NHS falls service. Data were analysed using thematic analysis. Results Certain aspects of supporting patients in self-management were deemed to be within or beyond the scope of falls service practitioners. Challenges in supporting transition to community-run programmes included: practitioner awareness and buy in; patient buy in; and patient suitability/programme availability. Conclusion Practitioners sought to be patient-centred as a means to engage patients in self-management of falls prevention exercises. Time-limited intervention periods and waiting list pressures were barriers to the promotion of long-term self-management approaches. A disconnect between falls service interventions and community-run programmes hindered willing practitioners from supporting patients in transitioning. Unless falls risk and prevention is seen by healthcare providers as a long-term condition which requires person-centred support from practitioners to develop self-management approaches, then falls services may only be able to offer short-term measures which are potentially not long lasting. IMPLICATIONS FOR REHABILITATION Falls rehabilitation practitioners need to take a person-centred approach to engage patients in self-management of falls prevention exercises. Providing information and signposting to exercise opportunities such as community-run programmes following falls service interventions should be viewed as being within the scope of the role of falls service practitioners. Rehabilitation practitioners should consider viewing falls risk as a long-term condition, to promote longer-term behavioural change approaches to ongoing engagement of exercise for falls prevention.

Comparative effectiveness of exercise interventions for preventing falls in older adults: A secondary analysis of a systematic review with network meta-analysis.

Systematic reviews have established that exercise reduces falls in older adults, however the most effective types of exercise are not known. This secondary analysis determined the comparative effectiveness of fall prevention exercise approaches. All fall prevention exercise interventions for older adults were identified from an existing search from inception until April 2017. Interventions were coded using a framework of 25 exercise types. Two reviewers independently screened studies, extracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis (NMA) were conducted. P-scores were used to rank exercise combinations. One hundred and sixty-nine studies were included. NMA was conducted on 73 studies (30,697 participants) for the outcome of number of fallers. The exercise combination ranked with the greatest likelihood of being most effective relative to no exercise was: anticipatory control, dynamic stability, functional stability limits, reactive control and flexibility (p-score=0.95). This exercise combination also significantly reduced number of fallers compared to 16 other combinations. No exercise combination had a significantly greater effect on reducing number of fallers more than this combination. This analysis identified components of effective fall prevention exercise. The results can inform evidence-informed exercise recommendations and be used to design effective programs.

Reflections of older people about their experience of fall prevention exercise in the community- a qualitative study exploring evidence-based practice

BackgroundEvidence-based practice (EBP) ensures that clinicians use effective interventions to achieve desired outcomes, thereby contributing to the best quality of care. The perspective of the participants is fundamental in EBP, as they have their own individual and meaningful rationale for participating in fall prevention. This study aims to explore community-dwelling older people reflections about their reflections about EBP in physiotherapy based on their experiences of a fall prevention exercise program.MethodsWe conducted semi-structured interviews with 16 community-dwelling older people (men = 7; women = 9). Data were analyzed using thematic analysis.ResultsThe analysis revealed three themes: 1) the tension between knowing and doing, 2) the power of the therapist-participant relationship and the process of putting knowledge into action, and 3) research is interwoven with successful therapy and is an integral component of it. EBP was considered as a collective negotiation and learning process of creating knowledge for clinical practice. The negotiation between different types of knowledge must be performed in a transparent dialogue and through interactive collaboration between the persons involved. The participants appreciated that the research findings indicate that practice gives results.ConclusionsEBP was understood and utilized as a seal of approval and a “guarantee of high quality” treatment, and its effects varied based on older people’s preferences, needs, and skills. The therapist’s relational competence appeared to be crucial for the negotiation of various sources of knowledge relative to the older people’s preferences.

Improvement in trunk kinematics after treadmill-based reactive balance training among older adults is strongly associated with trunk kinematics before training

Reactive balance training (RBT) is an emerging fall prevention exercise intervention for older adults. To better understand factors that influence improvements after RBT, the goal of this study was to identify key factors that strongly associate with training-induced improvements in reactive balance. This study is a secondary analysis of data from a prior study. Twenty-eight residents of senior housing facilities participated, including 14 RBT participants and 14 Tai Chi participants (controls). Before and one week after training, participants completed balance and mobility tests and a reactive balance test. Reactive balance was operationalized as the maximum trunk angle in response to standardized trip-like perturbations on a treadmill. Bivariate (Pearson) correlation was used to identify participant characteristics before RBT and measures of performance during RBT that associated with training-induced changes in maximum trunk angle. Maximum trunk angle before reactive balance training exhibited the strongest association with training-induced changes in maximum trunk angle among RBT participants (r2 = 0.84; p < .001), but not among Tai Chi participants (r2 = 0.17; p = .138). Measures of performance during RBT, based upon perturbation speed, also associated with RBT-induced improvements in maximum trunk angle. These results help clarify the characteristics of individuals who can benefit from RBT, and support the use of treadmill perturbation speed as a surrogate measure of training-induced improvements in trunk kinematics.

S0413 The Cost-Effectiveness of Implementing an Exercise Program for Fall and Fracture Prevention in Adults Aged 65 and Older on Proton Pump Inhibitor Therapy

INTRODUCTION: National guidelines recommend implementing an exercise program in community-dwelling adults ≥ 65 years old to decrease risk of falling. Proton pump inhibitors (PPI) are not currently recognized as contributing risk factors for falls in these guidelines. However, observational studies have linked PPI use with increased falls and fractures. In 2013, 7,000,000 people over the age of 65 were using PPIs. We studied the economic effects of fall prevention programs in PPI users over 65 and hypothesize that these programs will produce significant healthcare savings. METHODS: Using previously published data, we developed a cost-benefit model to predict various outcomes associated with a fall and fracture in the elderly (Figure 1). We incorporated three exercise programs: Tai Chi, Stepping On, and the Otago. We conducted sensitivity analysis using different Odds Ratios (OR)s for falls in PPI users to determine the threshold of effectiveness of the interventions. We then compared the average cost of each program to the relative reduction in cost associated with a fall and fracture to determine the financial benefit to elderly patients taking PPI therapy. RESULTS: Based on prior studies, adults over 65 have a 30% chance of falling annually with a 33.4% likelihood of seeking medical care. Sensitivity analysis was performed for OR for PPI use and falling ranging from 1.2 to 3.77 (P-value = 0.05). The annual expected cost of falls and fractures in adults over 65 on PPI therapy ranged from $10,317.35 to $18,766.28. Cost of the exercise programs ranged from $112.70 to $336.82 annually, with an anticipated fall reduction ranging from 31-55% based on the literature. Using a range of ORs for PPI use and fall/fracture rate, the model suggests a net financial benefit when reduction of falls is greater than 5% (Figure 3). Individual benefits achieved from exercise programs ranged from $3,198.38 to $10,208.76 (Figure 2). The annual net financial benefit of these programs in the US population of PPI users over age 65 ranges from $18 to $85 billion in savings (Figure 3). CONCLUSION: With modest fall reduction returns above 5%, implementing a fall prevention exercise program in patients over 65 on PPI therapy offers an effective means of reducing the overall financial impact of falls and fractures both individually and on a national level. Formal exercise programs including Tai Chi, Stepping On, and the Otago are highly recommended for these patients.Figure 1.: This figure illustrates our financial model of the costs attributable to falling in a population of PPI users over age 65.Figure 2.: This figure represents the average annual financial benefit of implementing one of three exercise programs to reduce fall and fracture risk in elderly patients over the age of 65 in comparison between PPI and non-PPI users.Figure 3.: This figure represents sensitivity analysis conducted on different odds ratios (OR) between PPI and falling rate. For all OR’s, there was an expected annual benefit when the exercise program implemented conferred a fall reduction greater than 5%.

Canan Outdoor Multisurface Terrain Enhance the Effects of Fall Prevention Exercise in Older Adults? A Randomized Controlled Trial

Walking on complex surface conditions in outdoor environments is important for active aging. This study aimed at examining whether fall prevention exercise integrated with an outdoor multisurface terrain compared with indoor solid ground was more beneficial for older adults. Twenty-two older nursing home residents were randomly assigned to outdoor multisurface terrain (n = 11, 79.5 ± 2.1 years) or indoor solid ground (n = 11, 78.8 ± 5.2 years) groups. Training occurred five times per week (30 min) for 3 weeks. The following performance test outcomes were measured: 10 m walk test (10 mWT), multisurface terrain walk test (MTWT), 2 min walk test (2 MWT), timed up and go test (TUGT), single-leg standing test with eyes open (SLSTEO), single-leg standing test with eyes closed (SLSTEC), and closed cycles test (CCT). Compared with baseline, the outdoor multisurface terrain training significantly improved performance in all tests (p < 0.01). The improvements of the outdoor multisurface terrain group after intervention were significantly higher than those of the indoor solid group in the 10 mWT (p = 0.049), MTWT (p = 0.02), and 2 MWT (p = 0.000). Exercise combined with outdoor multisurface terrain training may be an efficacious approach and a feasible environmental intervention for fall prevention in older adults.

Tailored Exercise and Home Hazard Reduction Program for Fall Prevention in Older People With Cognitive Impairment: The i-FOCIS Randomized Controlled Trial.

The evidence to support effective fall prevention strategies in older people with cognitive impairment (CI) is limited. The aim of this randomized controlled trial (RCT) was to determine the efficacy of a fall prevention intervention in older people with CI. RCT involving 309 community-dwelling older people with CI. The intervention group (n = 153) received an individually prescribed home hazard reduction and home-based exercise program during the 12-month study period. The control group (n = 156) received usual care. The primary outcome was rate of falls. Secondary outcomes included faller/multiple faller status, physical function, and quality of life. Participants' average age was 82 years (95% CI 82-83) and 49% were female. There was no significant difference in the rate of falls (incidence rate ratio [IRR] 1.05; 95% confidence interval [95% CI] 0.73-1.51). A sensitivity analysis, controlling for baseline differences and capping the number of falls at 12 (4 participants), revealed a nonsignificant reduction in fall rate in the intervention group (IRR 0.78; 95% CI 0.57-1.07). Analyses of secondary outcomes indicated the intervention significantly reduced the number of multiple fallers by 26% (RR 0.74; 95% CI 0.54-0.99) when adjusting for baseline differences. There was a differential impact on falls in relation to physical function (interaction term p-value = .023) with a significant reduction in fall rate in intervention group participants with better baseline physical function (IRR 0.60; 95% CI 0.37-0.98). There were no significant between-group differences for other secondary outcomes. This intervention did not significantly reduce the fall rate in community-dwelling older people with CI. The intervention did reduce the fall rate in participants with better baseline physical function. Australian and New Zealand Trials Registry ACTRN12614000603617.

Feasibility of a novel Judo4Balance - fall preventive exercise programme targeting community-dwelling older adults.

Objectives:It is of utmost importance to investigate risk factors for falls and learning techniques for falling safely. Therefore, the aim of this study was to assess the feasibility of a novel judo-inspired exercise intervention for community-dwelling older adults.Methods:We included 28 participants, 60–88 years of age, in this study. In three different settings, the feasibility of carrying out a full-scale study was evaluated by the following: the study process, resource management and scientific aspects. The outcome measures evaluated were physical performance, fall related self-efficacy and fall techniques (backwards and forwards) among the older adults.Results:The intervention was judged to be feasible in the different settings used in this study. Some changes regarding duration of the intervention were suggested as being important. Significant improvements were seen in the selected outcome measures, physical performance (p=.030) and fall techniques (p=<.001). A corresponding difference was not found for fall related self- efficacy (p=.113).Conclusions:This study confirms the judo inspired exercise programme, Judo4Balance, to be a feasible intervention for active older adults. This study will provide a safe and thoroughly planned protocol for the planned study and provides indication of appropriate setting depending on the target group.

Combining cognitive stimulation therapy and fall prevention exercise (CogEx) in older adults with mild to moderate dementia: a feasibility randomised controlled trial

BackgroundPeople living with dementia (PLwD) have a high fall risk as cognitive impairment compromises control of gait and balance. Fall prevention exercises that are effective in healthy older adults may not work for PLwD. Cognitive stimulation therapy (CST) has been shown to improve global cognition in PLwD. A programme which combines cognitive (CST) with physical exercises may reduce falls in PLwD. The aim of this study was to assess the feasibility of undertaking a full scale randomised controlled trial to test the effectiveness of CogEx in decreasing falls in PLwD. Specific objectives included recruitment strategy, data collection, outcome measures, intervention fidelity and facilitator/participant experience.MethodsA mixed methods feasibility randomised controlled trial recruited people from residential aged care. Inclusion criteria were ≥ 65 years old, Montreal Cognitive Assessment (MoCA) score of 10 to 26 and able to participate in a group. Participants were randomised to CST or CST combined with strength and balance exercises (CogEx). Both CST and CogEx groups were for an hour twice a week for 7 weeks. Descriptive statistics were used to report pre- and post-intervention outcome measures (MoCA, Geriatric Depression Scale–15, Quality of Life-Alzheimer’s Disease, Alzheimer’s Disease Assessment Scale—Cognitive 11, Brief Balance Evaluation Systems Test and Short Form Physical Performance Battery) and attendance. Qualitative analysis of participant focus groups and facilitator interviews used a conventional approach. Sessions were video recorded and exercise completion documented.ResultsThirty-six residents were screened with 23 participants randomised to intervention (CogEx, n = 10) or control (CST, n = 13). The assessments took 45 min to 1.5 h, and there was repetition between two cognitive measures. Ten facilitators completed training with the manualised programme. Exercises were combined into the hour-long CST session; however, limited balance training occurred with participants exercising predominantly in sitting. The facilitators felt the participants engaged more and were safer in sitting.ConclusionsThe results demonstrated that while fall prevention exercises could be scheduled into the CST structure, the fidelity of the combined programme was poor. Other components of the study design need further consideration before evaluation using a randomised controlled trial is feasible.Trial registrationanzctr.org.au (ACTRN12616000751471) 8 Jun 2016, Australian New Zealand Clinical Trials Registry.

Community care staff attitudes towards delivering a falls prevention exercise intervention to community care clients.

Millions of older people world-wide receive community care services in their home to assist them to live independently. These services often include personal care, domestic assistance and social support which are delivered by non-university trained staff, and are frequently long term. Older people receiving community care services fall 50% more often than individuals of similar age not receiving services. Yet, few ongoing community care services include exercise programs to reduce falls in this population. We conducted an earlier study to examine the feasibility of community care staff delivering a falls prevention program. A critical finding was that while some of the assessment and support staff responsible for service delivery delivered the falls prevention exercise program to one or two clients, others delivered to none. Therefore, the aim of this qualitative sub-study was to understand reasons for this variation. Semi-structured interviews were conducted with 25 participating support staff and assessors from 10 community care organisations. Staff who had successfully delivered the intervention to their clients perceived themselves as capable and that it would benefit their clients. Older clients who were positive, motivated and wanted to improve were perceived to be more likely to participate. Staff who had worked at their organisation for at least 5years were also more likely to deliver the program compared to those that had only worked up to 2years. Staff that did not deliver the intervention to anyone were more risk averse, did not feel confident enough to deliver the program and perceived their clients as not suitable due to age and frailty. Experienced staff who are confident and have positive ageing attitudes are most likely to deliver falls prevention programs in a home care organisation.