Self-management tasks to improve mobility and reduce fall risk are not leading to lower research participation in older adults

Recruitment strategies and reach of a digital fall-prevention intervention for community-dwelling older adults

Background

To have an impact on the population's health, preventive interventions have to reach a large proportion of the intended population. Digital solutions show potential for providing wider access to fall preventive exercise. However, there is a lack of knowledge about how to reach the target group. The aim of this study was to describe the recruitment process used in the Safe Step randomised controlled trial and the characteristics of the participants reached.

Methods

Several recruitment methods, both digital and non-digital, were adopted to reach the intended sample size. Sociodemographic parameters from the baseline questionnaire were used to describe participant characteristics. The characteristics were also compared to a representative sample of older adults in the Swedish population.

Results

In total, 1628 older adults were recruited. Social media proved to be the most successful recruitment strategy, through which 76% of the participants were recruited. The participants reached had a mean age of 75.9 years, lived in both urban and rural locations, were already frequent users of the Internet and applications (smartphone/tablet) (79.9%), had higher education (71.9%), and a large proportion were women (79.4%). In comparison with the general population participants in the Safe Step study were more highly educated (p < 0.001), women in the study more frequently lived alone (p < 0.001) and men more often reported poorer self-rated health (p = 0.04). Within the study, men reported a faster deteriorating balance (p = 0.003) and more prescribed medication (p < 0.001) than women.

Conclusion

Recruitment via social media is a useful strategy for reaching older adults, especially women and frequent users of the Internet, for a fully self-managed and digital fall prevention exercise intervention. This study underlines that a range of interventions must be available to attract and suit older adults with different functional statuses and digital skills.

Feasibility study by a single-blind randomized controlled trial of self-management of mobility with a gait-speed feedback device by older persons at risk for falling

This single-blind randomized pilot study explored feasibility and safety of a self-management fall prevention program, hypothesizing that older persons can comply with this program, while it does not result in more (injurious) falls, or a decrease in mental wellbeing as an adverse effect of being focused on falls prevention. Eighty-six persons, community-dwelling or home for the aged (mean age 80.3 years [SD: 6.3], 56 women (65.1%)) participated. The intervention group measured their gait speed by using the Mobility Feedback Device (MFD) weekly for 6 months. The control group was monitored for the outcomes without an intervention. Change scores involving health perception and mental wellbeing (Medical Outcomes Study 20-item short form (MOS-20)) were compared between groups. Feasibility was assessed by drop-out rate and compliance to measure gait speed. Safety was assessed by fall incidence during follow-up. MOS-20 decreased significantly in the control group (p = 0.024) but remained stable in the intervention group. Drop-out rate was low (9.3%), and compliance was good. Fall incidence was the same for both groups (p = 0.155). The self-management fall prevention program is feasible and safe in a community-dwelling and home for the aged population, making it worthwhile to further explore self-management fall-prevention studies.

Evaluation of Implementing a Home-Based Fall Prevention Program among Community-Dwelling Older Adults

We aimed to describe and evaluate the implementation of a home-based exercise program among community-dwelling adults aged ≥65 years. In an observational study, the twelve-week program was implemented in a community setting. The implementation plan consisted of dialogues with healthcare professionals and older adults, development of an implementation protocol, recruitment of participants, program implementation, and implementation evaluation. The dialogues consisted of a Delphi survey among healthcare professionals, and of individual and group meetings among older adults. The implementation of the program was evaluated using the framework model RE-AIM. In the dialogues with healthcare professionals and older adults, it was found that negative consequences of a fall and positive effects of preventing a fall should be emphasized to older adults, in order to get them engaged in fall prevention activities. A total of 450 older adults enrolled in the study, of which 238 started the program. The process evaluation showed that the majority of older adults were recruited by a community nurse. Also, a good collaboration between the research team and the local primary healthcare providers was accomplished, which was important in the recruitment. Future fall prevention studies may use this information in order to translate an intervention in a research project into a community-based program.