Fall Reduction Research Articles

IMPLEMENTATION OF A VIRTUAL FALL PREVENTION PROGRAM IN OLDER VETERANS

Abstract Though virtual platforms have increased in popularity few studies have explored the implementation and benefit of a virtually-based fall prevention program. MOVing FREEly (Multicomponent Otago Virtual Falls Reduction Exercise and Education program) is a VA-based fall prevention program delivered entirely over a virtual care platform. The MOVing FREEly program is six-weeks long and includes both education in fall-risk reduction and evidence-based fall prevention exercises. Process measures captured implementation considerations, feasibility and effectiveness of the program. 27 participants who were older (mean 75 years), mostly male (89.0%), white (85.2%) and moderate or high risk of falling completed the program. 70% were new to the virtual platform. Attendance for education and exercise classes was > 80% with little attrition. There was improvement in the Falls Efficacy Scale-International short form and statistically significant improvement in 30 second sit-to-stand and single leg balance tests. Process measures indicated that 40% of participants needed extra help at the start of each class to sign-on to the virtual visit, which was provided by program facilitators. By the fourth class, all participants were self-sufficient in their ability to navigate the virtual platform. Additional considerations such as electronic health record documentation and coding; clinic setup, referral management and virtual appointment scheduling; patient privacy and health emergency planning were necessary for the start-up and sustainability of the program. Virtual fall prevention programs are feasible and effective but require careful logistical planning and considerations. Implementation considerations from this program can guide future telerehabilitation research and clinical efforts.

Blood pressure variability associated with falls in nursing home residents.

High variations in serially measured blood pressures (BPs) portend a variety of adverse clinical events including dementia, cardiovascular sequelae and frailty. In this study, systolic blood pressure variability (BPV) was examined for its association with fall frequency and time to next fall among older adults living in nursing homes. BP values and falls over time were extracted from medical records of nursing home residents aged ≥65 years over a 10-month period. BPV was measured as the standard deviation of 17 to 20 systolic values, and its correlation with falls and time to next fall were evaluated according to quartile values. One hundred patient charts were analyzed with nearly 2000 BP data points. All older adults had at least one fall incident. Higher BPV was related to more falls, shorter time between the first and second fall and fewer average days between falls. Subgroups of high BP and different diagnoses affected this association between BPV and falls. People who fall often show a high variability in BP; as the number of falls increases, the BPV also increases. This study suggests that BPV may be marker for patients who might benefit from more aggressive application of fall reduction strategies. Geriatr Gerontol Int 2024; 24: 1315-1319.

Assessing the Effectiveness of a Non-Punitive Fall Prevention Program.

Our single-center, quality improvement project evaluated the impact of a fall reduction plan while using a Just Culture Algorithm that included weekly fall reviews involving front line staff using a non-punitive structure. The project has shown successful results. Prior to starting the program, data at this institution indicated falls were higher than the national fall rate of 3-5 per 1000 patient days. To achieve the goal of reducing the fall rate to below 3.1, an interdisciplinary fall committee was formed, consisting of nurses, nursing leaders, patient care technicians, pharmacists, and physical therapists. The committee operated in a non-punitive format and included all staff members directly involved in fall-related incidents. Protocols for implementing an evidence-based prevention program were developed to (1) address environmental concerns, (2) educate clinical workers and patients' families, (3) enforce interventions, (4) conduct weekly non-punitive, round table discussions, and (5) provide leadership support. Measures were implemented to proactively prevent falls. Data was collected and reported to all departments monthly. Following implementation of the program, results showed a statistically significant decrease in average fall rates per 1000 patient days from pre-intervention (4.05) to post-intervention (2.54) (P = .0001). Results showed improvement below the national average (3-5 falls per 1000 patient days), resulting in cost savings for the institution due to fewer falls. Inpatient medical-surgical and progressive care units had a noteworthy decline in the total number of falls, with notable estimated cost savings. Preventative interventions have shown effective results with compassionate, non-punitive leadership, an interdisciplinary team, and continuous follow-up education. Heeding to the Just Culture Algorithm as the foundation of weekly reviews, staff were empowered to engage in fall reduction strategies. A comprehensive weekly fall review program with ongoing staff education and transparent data reporting yielded a significant, sustained reduction in patient falls, with a substantial cost savings in excess of $1.6 million dollars over the life of the program.

Falls reduction and sustainability

Falls reduction and sustainability

Engaging wheelchair and scooter users in the co-design of an mHealth application for fall prevention and management: thematic analysis of focus group research

This study aimed to explore the potential of a mobile health (mHealth) application (app) to support the delivery of a fall prevention and management program, Individualized Reduction of FaLLs (iROLL), for people with spinal cord injury (SCI) and multiple sclerosis (MS) who use wheelchairs and scooters (WC/S) full-time by seeking end-users’ input into the functioning and ongoing design of the iROLL-O + mobile app. Two focus group discussions included nine adults with SCI or MS who used a WC/S for at least 75% of mobility, who experienced at least one fall in the past three years and have internet and access to an internet-capable device. One group had prior iROLL experience (n = 4); while the other had none (n = 5). The focus groups examined the app’s usefulness, accessibility, appearance, and ease of use. The participants with prior iROLL experience also discussed how the app would enhance their experience with the program. Thematic analysis revealed five app-related themes: perceived usefulness, perceived usability, accessibility, appearance, and enhancement of the iROLL experience, with participants providing actionable suggestions for improvement. Participants with previous exposure to the iROLL program emphasized the app’s potential to facilitate flexible access to the program and expand its reach to a wider audience. The iROLL-O + app was perceived positively, especially with respect to the enhancement of users’ access and experience with the program. Focus group findings will inform ongoing app development for optimized usability and reduced likelihood of technology abandonment. IMPLICATIONS FOR REHABILITATION End-users’ impressions of the Individual Reduction of faLLs Online application (iROLL-O + app) highlight the potential for integrating mHealth apps in fall prevention and management education efforts, offering a promising and accessible avenue to support the delivery of tailored programs. The study notes that the app facilitates flexible access and wider reach to the program, indicating the importance of incorporating features that enhance accessibility and accommodate the diverse needs of individuals who use wheelchairs and scooters. Actionable suggestions provided by participants underscore the importance of a user-centered design approach in developing rehabilitation-related mobile apps.

Medication Use and Falls Risk in Older Adults: Insights from our Integrated Care Programme for Older Person’s Service

Abstract Background Falls pose a critical public health challenge for the elderly, often resulting in severe injuries and complications. Some medications have been identified as potential risk factors for falls in this demographic. The National Integrated Care Programme for Older People has prioritised the development of specialised services targeting frailty, dementia, and falls management to address this concern. Methods We conducted a retrospective chart review of older adults to explore the relationship between medication use and falls risk. Data on recurrent falls, polypharmacy (defined as concurrent use of five or more medications), and fall frequency were extracted from medical records. Logistic regression analysis assessed the association between STOPPfall medication use and falling risk, calculating odds ratios and p-values to determine significance. Results The study cohort comprised 71 older adults, with a median age of 84 years (range 66-95 years), of whom 69% were female. Among the participants, 79% reported experiencing recurrent falls, highlighting the prevalence of this issue within the sample. Additionally, a substantial proportion (90.1%) exhibited polypharmacy, indicating the commonality of multiple medication use among the elderly population studied. Antihypertensives were prescribed to 42 patients (59%), antidepressants to 26 patients (37%), opioids to 15 patients (21%), benzodiazepines to 12 patients (17%), and antiepileptic drugs to 4 patients (6%). Logistic regression analysis demonstrated a significant association between the use of STOPPfall medications and the risk of falling, with an odds ratio (OR) of 1.84 (95% CI: 1.11-4.23, p =0.044). Conclusion These findings underscore the importance of medication review and optimization in fall prevention strategies. Targeted interventions to reduce potentially harmful medication use identified by STOPPfall criteria may aid in fall reduction among older adults. Further research is needed to explore the efficacy of such interventions.

Effects of vitamin D supplementation on cardiac biomarkers: Results from the STURDY trial

ObjectivesIn observational studies, older adults with low serum vitamin D levels are at higher risk of cardiovascular disease (CVD), but randomized trials have failed to demonstrate reduction in CVD risk from vitamin D supplementation, possibly because the doses of vitamin D supplements tested were too low. Our objective was to determine if higher doses of vitamin D supplementation reduce high-sensitivity cardiac troponin (hs-cTnI) and N-terminal pro-b-type natriuretic peptide (NT-proBNP), markers of subclinical CVD. MethodsThe Study to Understand Fall Reduction and Vitamin D in You (STURDY) was a double-blind, randomized, response-adaptive trial that tested the effects of 4 doses of vitamin D3 supplementation (200, 1000, 2000, 4000 IU/day) on fall risk among older adults with low serum 25-hydroxyvitamin D concentrations (10–29 ng/mL). Hs-cTnI and NT-proBNP levels were measured at baseline, 3-, 12-, and 24-month follow-up visits. For this ancillary study, we used data from the original trial and compared participants by treatment group: low-dose (200 IU/day) or high-dose (1000+ IU/day). The effects of vitamin D dose on biomarkers were assessed via mixed effects tobit models. ResultsAmong 688 participants (mean age of 76.5) hs-cTnI increased in both the low- and high-dose groups by 5.2 % and 7.0 %, respectively; likewise, NT-proBNP increased by 11.3 % and 9.3 %, respectively. Compared to the low-dose, high-dose vitamin D supplementation did not affect hs-cTnI (1.6 %-difference; 95 % CI: -5.3, 8.9) or NT-proBNP (-1.8 %-difference; 95 % CI: -9.3, 6.3). ConclusionsCompared to low-dose vitamin D supplementation, doses ≥1,000 IU/ day did not affect markers of subclinical CVD in older adults with low serum vitamin D levels.

Evaluating FREDeX (Falls Reduction and Empathy Development eXperience) – a novel simulation training program for healthcare workers

Abstract Purpose: Care after falls constitutes a substantial cost to the Australian health system. The Falls Reduction and Empathy Development Experience (FREDeX), a hybrid simulation training program, was designed in rural NSW. This paper initiates a multi-pronged evaluation of FREDeX. Methodology: Pre- and post-training survey data was collected from voluntary FREDeX trainees. Surveys included validated empathy, compassion, and person-centred-care assessment tools, as well as questions about workshop quality and open-ended response questions. Findings: There was significant improvement in trainees' empathy, compassion, and person-centred care scores. Trainees expressed positivity about FREDeX, noting facilitators and challenges of the program, and implications for professional practice. FREDeX enhanced empathy, aiding better patient understanding, communication, and personalised care. Implications: Significant evidence has emerged demonstrating the efficacy of virtual reality and other simulation training for empathy and compassion in clinical contexts. FREDeX enhances soft skills through a hybrid simulation training approach, proving to be engaging and educational. It is valuable for the delivery of person-centred care, and a compelling program based on effectiveness and ease of implementation. Originality and value: FREDeX has demonstrated implications for improving empathy and compassion in rural and urban healthcare professionals and enables more person-centred care. The positive outcomes from FREDeX suggest broader adoption of hybrid simulation training may enhance soft skills and healthcare quality, emphasising the potential of technology-driven learning for health workforce capacity. Limitations: While this evaluation demonstrates the value of FREDeX, further evaluation will seek to bridge the gap between demonstrated improvements in assessed metrics of care ability and direct improvements to patient care, by assessing fall rates, harm assessments, and clinical notes for participating facilities. This will endeavour to determine changes in fall prevalence and improvement in management and care for falls.

Translation, extension, and evaluation of usability, usefulness, and safety of a fall prevention and management program for people living with spinal cord injury and multiple sclerosis who use wheelchairs or scooters full time.

Falls are prevalent among people living with Multiple Sclerosis (PwMS) and Spinal Cord Injury (PwSCI) who use wheelchairs or scooters (WC/S) full time, however, there is a scarcity of evidence-based fall prevention and management programs. To describe the systematic translation of an in-person fall prevention and management program (Individualized Reduction Of FaLLs - iROLL) for PwMS to an online platform, extending its scope to include PwSCI, and to evaluate the preliminary useability, usefulness, and safety of the intervention. iROLL was systematically translated to an online platform (iROLL-O). PwMS and PwSCI who use a WC/S full time, experienced at least one fall within the past 36 months, and could transfer independently or with minimal to moderate assistance, enrolled in iROLL-O. Usability, usefulness, and safety were evaluated through 1:1 semi-structured interviews, gathering feedback on: perceived impact of the intervention on falls and functional mobility, program experiences, adverse events, and recommendations for improvement. Five participants successfully completed the iROLL-O program. No safety concerns were raised by participants. Themes emerging from the semi-structured interviews included: (1) barriers and facilitators to program access, (2) motivation for participation, (3) program outcomes, and (4) program content and structure. Participants reported reduced concerns about falling, enhanced functional mobility skills, and highlighted the supportive nature of synchronous group meetings for learning. No adverse events occurred during the implementation of iROLL-O and participants found the program to be useable and useful. Further testing is needed to examine efficacy among a large and diverse population.

Associations of Hypertension and Orthostatic Hypotension With Subclinical Cardiovascular Disease.

Orthostatic hypotension is associated with cardiovascular disease. It remains unclear if low standing blood pressure or high seated blood pressure is responsible for this association. We compared associations of orthostatic hypotension and hypertension with high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide. We performed a secondary analysis of the Study to Understand Fall Reduction and Vitamin D in You, a randomized controlled trial funded by the National Institute on Aging, between July 2015 and May 2019. Participants were community-dwelling adults, 70 years or older. Blood tests for high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide were drawn at visits concurrent with blood pressure measurements. Secondary analysis occurred in 2023. We determined associations between blood pressure phenotypes and cardiac biomarkers. Of 674 participants (mean age 76.5 ± 5.4 years, 43% female, 17.2% Black race), 29.1% had prior cardiovascular disease. Participants with seated hypertension had 10.1% greater high-sensitivity cardiac troponin I (95% confidence interval = 3.8-16.9) and 11.0% greater N-terminal pro-B-type natriuretic peptide (4.0-18.6) than those without seated hypertension. Participants with standing hypertension had 8.6% (2.7-14.9) greater high-sensitivity cardiac troponin I and 11.8% greater N-terminal pro-B-type natriuretic peptide (5.1-18.9) than those without standing hypertension. Hypotensive phenotypes were not associated with either biomarker. Both seated and standing hypertension were associated with greater high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide, but hypotensive phenotypes were not. Hypoperfusion may not be the principal mechanism behind subclinical cardiac injury among older adults with orthostatic hypotension.

Using Human-Centered Design to Decrease the Risk of Toileting in Hospitals for Patients and Clinicians

Patient falls are common injuries in hospitals, and many occur surrounding a patient’s need to use the bathroom. In this study, we used the TripTech Method to design and evaluate early-stage design concepts for fall prevention and reduction of occupational injury associated with toileting falls. Nurse participants saw an opportunity in getting their patients to engage in their own recovery in increase the potential for cooperation, and also desired tools which could make the process physically easier for staff and patients which were also accessible when needed. Participants also discussed concerns about higher-tech tools, including affordability issues which could lead to further healthcare disparity. Overall, our research demonstrates how human-centered methods are valuable in focusing design efforts on the most pressing challenges experienced by users to avoid wasted investment in ineffective or unwanted technology.

Pulmonary rehabilitation with balance training for fall reduction in chronic obstructive pulmonary disease: a randomized controlled trial

Background and objectivesAvailable evidence suggests that adults with chronic obstructive pulmonary disease (COPD) performed substantially worse than healthy controls on many balance measures and balance training can improve the balance measures in this population. We conducted this study to determine the effects of incorporating balance training into pulmonary rehabilitation (PR) on the incidence of falls at 12 months follow-up in high fall risk adults with COPD.MethodsWe conducted a prospective international multi-center randomized controlled trial. Eligible participants were adults with COPD at a high risk of future falls and were randomly assigned (1:1) to the intervention or control group. The intervention included personalized balance training for a targeted total of 90 min per week. Both the intervention and control groups received usual PR (2–3 times per week for 8–12 weeks). The primary outcome was the incidence of falls at 12-month follow-up using monthly fall diary calendars. Negative binomial regression or recurrent events models were used to examine the effects of the intervention on fall events. Multiple imputations were performed to deal with missing values.ResultsOf 258 participants who were enrolled in the trial, 178 provided falls information (intervention group = 91, control group = 87) and were included in the main analysis. Forty-one participants (45%) experienced at least one fall event in the intervention group and 33 (38%) in the control group (p = 0.34). The mean incidence of falls at 12 months was similar between the two groups (128 versus 128 per 100 person-years; mean difference: 0.30, 95% CI: -0.76 to 1.36 per 100 person-years). The results are robust after multiple imputations for missing data (n = 67).ConclusionsPR incorporating balance training compared to PR alone did not reduce the incidence of falls over the 12-month period in high fall risk adults with COPD.Trial registrationThe study was registered with ClinicalTrials.gov (NCT02995681) on 14/12/2016.

Reflections on the challenges of conducting an international multicentre randomized controlled trial of balance training in addition to pulmonary rehabilitation and its impact on fall incidence in people with COPD

BackgroundPulmonary rehabilitation (PR) is accepted as standard care for individuals with COPD. We conducted an international, multi-centred randomized controlled trial (RCT) to determine if adding balance training to PR would reduce the incidence of falls in people with COPD. While there have been many trials investigating the effectiveness of PR, few have involved international collaboration. Successful execution of rehabilitation trials requires a significant investment of time, staffing, and resources. With the recent completion of the Balance Training for Fall Reduction in COPD RCT, we report on the design, implementation, and execution of our trial using project management phases. We also highlight our lessons learned for consideration in future multi-centre rehabilitation trials.MethodsThis was a retrospective review of the planning, preparation, timelines, and personnel training involved in the execution of this study using four of the five project management phases described by Farrell et al. in 2010: (1) initiation, (2) planning, (3) execution, and (4) monitoring and controlling. We report descriptive statistics as percentages and counts and summarize our lessons learned.ResultsTen outpatient PR programs in three continents participated. Thirty-one personnel worked on the trial across all sites. Enrolment began in January 2017 and was suspended in March 2020 due to the COVID-19 pandemic. Approximately 1275 patients were screened, 455 (36%) were eligible, 258 (57%) consented, 243 (53%) participated, and 130 (61%) completed the 12-month follow-up assessment. Lessons learned through our experience included (1) ensuring awareness of funder policies and considering the impact on collaborating sites; (2) preparing for the possibility of human resource and program disruptions; (3) anticipating site dropout and having a contingency plan in place; (4) planning and monitoring process measure data before, during, and after trial initiation; (5) ensuring frequent and consistent communication with and between collaborating sites; (6) maximizing features of database platform to ensure data set completeness and controlled data access; and (7) identifying strategies for increasing patient engagement in a high-demand study.ConclusionsWe identify seven lessons learned through our experience conducting an international, multicentre rehabilitation-based RCT. These lessons can provide guidance to other trialists conducting studies with similar logistics and may assist with future trial planning and implementation.

Technoeconomic Analysis for Deployment of Gait-Oriented Wearable Medical Internet-of-Things Platform in Catalonia

The Internet of Medical Things (IoMT) extends the concept of eHealth and mHealth for patients with continuous monitoring requirements. This research concentrates on the use of wearable devices based on the use of inertial measurement units (IMUs) that account for a gait analysis for its use in three health cases, equilibrium evaluation, fall prevention and surgery recovery, that impact a large elderly population. We also analyze two different scenarios for data capture: supervised by clinicians and unsupervised during activities of daily life (ADLs). The continuous monitoring of patients produces large amounts of data that are analyzed in specific IoMT platforms that must be connected to the health system platforms containing the health records of the patients. The aim of this study is to evaluate the factors that impact the cost of the deployment of such an IoMT solution. We use population data from Catalonia together with an IoMT deployment model for costs from the current deployment of connected devices for monitoring diabetic patients. Our study reveals the critical dependencies of the proposed IoMT platforms: from the devices and cloud cost, the size of the population using these services and the savings from the current model under key parameters such as fall reduction or rehabilitation duration. Future research should investigate the benefit of continuous monitoring in improving the quality of life of patients.

Clinical effectiveness and cost-effectiveness of a multicomponent frailty management program “Say No To Frailty” in Singapore: A cluster-randomized controlled trial protocol

BackgroundA 12-week multicomponent frailty management program - Say No To Frailty (SNTF) consisting of interactive talks and fitness exercises led by a trained program leader has shown feasibility and positive health outcomes in community-living older adults with frailty and pre-frailty in Singapore. This study aims to evaluate the clinical- and cost-effectiveness of SNTF on physical functions, self-confidence, community participation, quality of life and fall reduction in the local community setting. MethodsThis study will use the cluster-randomization method to randomly allocate 12 participating centres into three arms. Centres under two intervention arms will conduct the same SNTF program but led by a program leader with different training backgrounds (an Allied Health Professional (AHP) v.s. a non-AHP), whereas centres under the control arm will continue their usual care without an additional intervention. Eligible participants at each participating centre will be recruited via the convenience sampling method in the community setting. Primary outcome measure (frailty level) and secondary outcome measures (e.g., physical functions, self-confidence, community participation, quality of life) will be conducted by the blinded assessors at baseline, immediate, 3 months and 9 months post-intervention. Fall data will be collected during the one-year study period. Outcomes between and within groups will be compared and analysed using STATA to evaluate the clinical effectiveness. Program costs and relevant healthcare costs during the follow-up phase will be recorded for cost-effectiveness analysis. ConclusionThis study will provide significant insights into conducting SNTF for Singapore community-living older adults with frailty and pre-frailty on clinical- and cost-effectiveness.Australia New Zealand Clinical Trials Registry: ACTRN12621001673831.

A clinical study to evaluate the efficacy of Aaditya Pak Guduchi Tail Shiroabhyanga in management of Khalitya (Baldness)

Introduction: In today’s corporate life, prime importance is given to our appearance, personality and beauty. Hair plays an important role in making body externally beautiful, healthy and good looking. Long hair makes a person mentally enthusiastic and healthy. Who are mostly suffering from this problem is the total population. Susceptibility of hair fall is more in male than in females. Methodology: Present study is carried out to know the traditional Ayurvedic treatment for Khalitya. For Khalitya Shiroabhyanga is one of the best choices of management for its prime role in maintaining hair growth and preventing Khalitya. Massage (Abhyanga) greatly improves the blood circulation, thus increasing the health of hair and also scalp. Result: The present study showed significant reduction in hair fall, dryness. Aaditya Pak Guduchi Tail was found effective in Khalitya along with significant effect on associated complaints. Conclusion: It also proves that Aaditya Pak Guduchi Tail is effective for use as Shiroabhyanga along with local application for scalp and hairs.

Effects of music therapy in reducing falls among patients with dementia in a long-term facility: a cohort study

Background/Aims Music therapy as an intervention can reduce stress, pain, depression, isolation and anxiety without the risk of side effects associated with pharmacological interventions. Individuals with dementia are at a higher risk of falls compared to older adults with no dementia. The aim of this study was to evaluate the effect of music therapy in reducing the number of falls among patients with dementia in a long-term care facility. Methods The Morse Fall Scale was used pre-intervention and post-intervention to assess at-risk patients. Patient's attendance in music therapy and falls were tracked daily. The music sessions took place three times a week for 30 minutes. Two groups consisting of 13 patients each were included. Results There was a highly significantly higher numbers of falls reported pre-intervention (t(26)=4.108, P<0.001 at P=0.000, 95% confidence interval 0.78–2.33) compared to fall rates post-intervention (t(26)=2.842, P<0.01 at P=0.009, 95% confidence interval 0.08–0.51). A total of 80% reported no falls post-intervention compared to 62.9% reporting falls pre-intervention. Conclusions The study demonstrated that supervised music therapy is effective on fall reduction in people with dementia. Implications for practice Music sessions can be implemented in care homes for people with dementia to help reduce falls.

Impact of Specialized Occupational Therapy Interventions on Fall Reduction and Length of Stay on a Geriatric Psychiatric Unit

Impact of Specialized Occupational Therapy Interventions on Fall Reduction and Length of Stay on a Geriatric Psychiatric Unit

Livestream, group movement program for people living with cognitive impairment and care partners: A randomized clinical trial.

There are few widely-available, evidence-based options to support quality of life (QOL) for people living with Alzheimer's disease and related dementias. We performed a randomized, controlled trial with a Waitlist control group to determine whether an online, livestream, mind-body, group movement program (Moving Together, 1 hour, 2 days/week, 12 weeks) improves QOL in people with cognitive impairment (PWCI) or care partners (CPs) and explore mechanisms of action. The primary outcome for both participants was self-reported QOL. Secondary outcomes and potential mediators included mobility, isolation, well-being, cognitive function, and sleep in PWCI and burden, positive emotions, caregiver self-efficacy, stress management, and sleep in CPs. Blinded assessors collected outcome data at baseline, 12, and 24 weeks. We assessed adverse events including falls through monthly check-in surveys and collected qualitative data through evaluation surveys. Intention-to-treat analyses used linear mixed models to compare mean change over time between groups and calculated standardized effect sizes (ESs). Ninety-seven dyads enrolled (PWCI: age 76 ± 11 years, 43% female, 80% non-Hispanic White; CPs: age 66 ± 12 years, 78% female, 71% non-Hispanic White); 15% withdrew before 12 weeks and 22% before 24 weeks. PWCI self-reported significantly better QOL from baseline to 12 weeks in the Moving Together group compared to the Waitlist group (ES = 0.474, p = 0.048) and CPs self-reported improved ability to manage stress (ES = 0.484, p = 0.021). Improvements in participant self-reported QOL were mediated by improvements in their self-reported well-being and CP-reported ability to manage stress. Results were similar when the Waitlist group participated in the program (QOL ES = 0.663, p = 0.006; stress management ES = 0.742, p = 0.002) and were supported by qualitative data. Exploratory analyses suggested possible fall reduction in PWCI. There were no study-related serious adverse events. Online programs such as Moving Together offer a scalable strategy for supporting high QOL for PWCI and helping CPs manage stress. ClinicalTrials.gov NCT04621448. The approval of new medications that slow cognitive decline in people living with Alzheimer's disease and related disorders (ADRD) has raised hope and excitement. However, these medications do not appear to impact quality of life, which is often considered by patients and care partners to be the most important outcome.In this randomized clinical trial, we found that an evidence-based, online, livestream, mind-body, group movement program significantly and meaningfully improves self-rated quality of life in people with ADRD and helps care partners manage stress. Mediation analyses revealed that the key drivers of improvements in participants' quality of life were improvements in their feelings of well-being and care partners' ability to manage stress. Exploratory analyses also suggested a 30% reduction in falls.These results are important because they suggest that an online program, which is available now and can be performed by people from the comfort of home or other location of choice, could be recommended as a complement or alternative to new therapies to help maximize quality of life for people living with ADRD and their care partners.

Efficacy and Safety of Skin Radiance Collagen on Skin and Hair Matrix: A Placebo-Controlled Clinical Trial in Healthy Human Subjects.

Collagen supplements are rising in the market as collagen has been demonstrated to be an important protein in the human aging process. Also, it is safe and easily absorbed in the body. Hence the aim of this study was to examine the effectiveness and safety of a collagen and antioxidant-rich treatment compared to a placebo in relation to various skin and hair indicators in healthy adult human subjects. Forty healthy adult non-pregnant/non-lactating women (aged 38-50 years) provided their informed consent in writing before their participation. Skin Radiance Collagen (SRC) treatment and a placebo were assessed for efficacy before application on Day 1, and post-application on Days 28 and 56, to measure changes in skin elasticity, hydration, brightness, pigmentation; texture, wrinkles, dryness, smoothness, fine lines, changes in the crow's feet region; as well as hair strength and hair fall. It was observed after 56 days that therapy with SRC, compared to placebo, produced a substantial effect on reduction of wrinkle depth and fine lines by 48.11% and 39%, respectively, with p-value <0.01 in the test group. There was a 15.69% improvement in skin hydration observed and 28% reduction in hair fall with p-value <0.01. SRC, a combination of collagen with hyaluronic acid (HA), biotin, and vitamins C and E, showed a significant improvement in skin and hair health, including improvements in skin elasticity, skin hydration, reduction in crow's feet area wrinkles and fine lines, hair fall, and decrease in roughness, leading to improved skin texture. Vitamin C in the formulation also acts as a collagen builder for the body and helps in preventing oxidative stress in the body. The test treatment SRC was found to be efficacious and safe in healthy human adult subjects.