Systematic review and meta-analysis of fear of falling and fall-related efficacy in a widely disseminated community-based fall prevention program

Factors Associated With Incident and Recurrent Falls Among Men Enrolled in Evidence-Based Fall Prevention Programs: An Examination of Race and Ethnicity

We examined factors associated with incident (one) and recurrent (2+) falls among 7207 non-Hispanic White (NHW) (89.7%), non-Hispanic Black (NHB) (5.0%), and Hispanic (5.3%) men ages ≥60 years with ≥1 chronic conditions, enrolled in an evidence-based fall program. Multinomial and binary regression analyses were used to assess factors associated with incident and recurrent falls. Relative to zero falls, NHB and Hispanic men were less likely to report incident (OR = 0.55, p < .001 and OR = 0.70, p = .015, respectively) and recurrent (OR = 0.41, p < .001 and OR = 0.58, p < .001, respectively) falls. Men who reported fear of falling and restricting activities were more likely to report incident (OR = 1.16, p < .001 and OR = 1.32, p < .001, respectively) recurrent and (OR = 1.46, p < .001 and OR = 1.71, p < .001, respectively) falls. Men with more comorbidities were more likely to report recurrent falls (OR = 1.10, p < .001). Compared to those who experienced one fall, men who reported fear of falling (OR = 1.28, p < .001) and restricting activities (OR = 1.31, p < .001) were more likely to report recurrent falls. Findings highlight the importance of multi-component interventions to prevent falls.

Self-efficacy as a mediator between frailty and falls among community-dwelling older citizens

Frailty is one of the most challenging issues among older adults, and the relationship between frailty and falls has already been assessed numerous times in literature. In the present study, we explored the mediating role of self-efficacy related to falls (FSe) in the relationship between frailty and fall risk. In a cross-sectional design, 1080 community-dwelling older adults from Rotterdam (Netherlands) and Valencia (Spain) completed a questionnaire and data were then analyzed via mediation analysis using a bootstrapping approach. Results show that higher frailty is associated with higher fall incidence, and higher FSe is a partial mediator of this association, with a confidence interval for the indirect effect of 0.131-0.247. Moreover, results showed gender differences in FSe levels; women had lower FSe scores. Deepening research on the construct of FSe may give potential explanations that account for the emerged gender differences, and it could be more targeted in fall prevention programs.

Optimizing a Technology-Based Body and Mind Intervention to Prevent Falls and Reduce Health Disparities in Low-Income Populations: Protocol for a Clustered Randomized Controlled Trial

BACKGROUND

The lack of health care coverage, low education, low motivation, and inconvenience remain barriers to participating in fall prevention programs, especially among low-income older adults. Low-income status also contributes to negative aging self-perceptions and is associated with a high perceived barrier to care. Existing fall prevention intervention technologies do not enable participants and practitioners to interact and collaborate, even with technologies that bring viable strategies to maintain independence, prevent disability, and increase access to quality care. Research is also limited on the use of technology to enhance motivation and help individuals align their perception with physiological fall risk. We developed a novel, 8-week Physio-Feedback Exercise Program (PEER), which includes (1) technology-based physio-feedback using a real-time portable innovative technology-the BTrackS Balance Tracking System, which is reliable and affordable, allows for home testing, and provides feedback and tracks balance progression; (2) cognitive reframing using the fall risk appraisal matrix; and (3) peer-led exercises focusing on balance, strength training, and incorporating exercises into daily activities.

OBJECTIVE

This study consists of 3 aims. Aim 1 is to examine the effects of the technology-based PEER intervention on fall risk, dynamic balance, and accelerometer-based physical activity (PA). Aim 2 is to examine the effects of the PEER intervention on fall risk appraisal shifting and negative self-perceptions of aging. Aim 3 is to explore participants' experiences with the PEER intervention and potential barriers to accessing and adopting the technology-based PEER intervention to inform future research.

METHODS

This is an intention-to-treat, single-blinded, parallel, 2-arm clustered randomized controlled trial study. We will collect data from 340 low-income older adults at baseline (T1) and measure outcomes after program completion (T2) and follow-up at 3 months (T3) and 6 months (T4). Participants will be enrolled if they meet all the following inclusion criteria: aged ≥60 years, cognitively intact, and able to stand without assistance. Exclusion criteria were as follows: a medical condition precluding exercise or PA, currently receiving treatment from a rehabilitation facility, plan to move within 1 year, hospitalized >3 times in the past 12 months, and does not speak English or Spanish.

RESULTS

As of August 2023, the enrollment of participants is ongoing.

CONCLUSIONS

This study addresses the public health problem by optimizing a customized, technology-driven approach that can operate in low-resource environments with unlimited users to prevent falls and reduce health disparities in low-income older adults. The PEER is a novel intervention that combines concepts of physio-feedback, cognitive reframing, and peer-led exercise by motivating a shift in self-estimation of fall risk to align with physiological fall risk to improve balance, PA, and negative aging self-perception.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05778604; https://www.clinicaltrials.gov/ct2/show/study/NCT05778604.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51899.

Levels of Accelerometer-Based Physical Activity in Older Adults With a Mismatch Between Physiological Fall Risk and Fear of Falling

We examined the associations between levels of accelerometer-based physical activity and the mismatch of physiological fall risk and fear of falling (FOF) in community-dwelling older adults. We assessed 123 participants who received 7-day wrist-worn accelerometry. Physiological fall risk was assessed using the portable BTrackS™ balance system and FOF was assessed using a short version of the Falls Efficacy Scale-International. Participants were categorized into four groups: rational (low FOF/normal balance), irrational (high FOF/normal balance), incongruent (low FOF/poor balance), and congruent (high FOF/poor balance). One third of older adults had a mismatch between their FOF and actual fall risk. Accelerometer-based moderate to vigorous physical activity (MVPA) was significantly different in the irrational group compared to the rational group (p = 0.023) and the congruent group compared to the rational group (p = 0.032). Encouraging older adults to improve MVPA may prevent them from shifting from rational to irrational or congruent groups, thereby reducing the risk of injurious falls. [Journal of Gerontological Nursing, 49(6), 41-49.].

Feasibility and Effectiveness of a Novel Intervention Integrating Physical Therapy Exercise and Dance Movement Therapy on Fall Risk in Community-Dwelling Older Women: A Randomized Pilot Study

This pilot study presents a novel fall prevention intervention that integrates physical therapy exercise (PTE) and dance movement therapy (DMT) to address both physical and emotional fall risk factors, as well as factors influencing adherence to treatment. The aim of this study was to examine the feasibility and effectiveness of the intervention in a sample of eight older women (median = 86 [81.25-90.75] years) from a day center for senior citizens. The intervention, based on the Otago Exercise Program and DMT techniques, aimed to address the emotional experience during physical exercise. Participants were randomly assigned to either a PTE+DMT intervention group (n = 5) or a PTE control group (n = 3). A pre-post intervention battery of physical and emotional fall risk assessments, therapist-patient bond, and home exercise adherence was conducted. Non-parametric tests results showed significant improvement in the PTE+DMT group in measures of balance and fear of falling compared to the PTE group. However, no other significant differences were found between the groups in terms of falls-related psychological concerns, self-perceived health status, therapist-patient bond, and home exercise adherence. These findings demonstrate the feasibility and potential benefits of an intervention that integrates both physical and emotional aspects to reduce fall risk in older adults, and provide a basis for further studies and modifications in the research protocol.

Developing online fall prevention program: Older adult recommendations`

Falls are a critical public health problem for older adults making expanded access of evidence-based fall prevention programs to this population a priority. Online delivery could improve the reach of these needed programs, however associated benefits and challenges remain poorly explored. This focus group study was undertaken to gather older adults' perceptions regarding the transition of face-to-face fall prevention programs to online formats. Content analysis was used to identify their opinions and suggestions. Older adults had concerns related to technology, engagement, and interaction with peers that they valued during face-to-face programs. They provided suggestions they felt would improve the success of online fall prevention programs, especially including synchronous sessions and getting input during program development from older adults.

Investigating Factors Associated with Fear of Falling in Community-Dwelling Older Adults through Structural Equation Modeling Analysis: A Cross-Sectional Study

The scientific literature mentions the existence of factors associated with fear of falling in older adults. However, the direct and indirect paths of its predictors have not yet been fully explored. This study aimed to analyze the socioeconomic, clinical, and health factors directly and indirectly associated with fear of falling in community-dwelling older adults. This is a cross-sectional study conducted in older adults (n = 410 - 70.11 ± 7.22 years). Clinical and health-condition data were collected, as were data on fear of falling using the Falls Efficacy Scale International-Brazil (FES-I Brazil). It was found that being female and having a higher number of self-reported morbidities, worse physical performance, and a higher number of depressive symptoms were directly associated with greater fear of falling. Regarding indirect associations, physical inactivity, mediated by a greater number of morbidities, worse physical performance, and a greater number of depressive symptoms, was associated with greater fear of falling. In addition, worse self-rated health, mediated by a greater number of depressive symptoms, as well as older age, mediated by worse physical performance, were associated with the outcome. This study provides information on the predictors directly and indirectly associated with fear of falling, expanding current understanding of this relationship.

Rising From the Floor in Persons With Parkinson's Disease

Although considerable research has targeted fall prevention among older adults with Parkinson's disease (PD), less is known about their ability to rise from the floor. The aim of the current exploratory study was to examine the relationship between floor rise and physical performance tests. A cross-sectional design was used. Twenty community-dwelling older adults with PD (mean age = 74.8 years, SD = 9.5 years) performed a standardized floor rise test and physical performance assessments in a structured task circuit. Mean time to rise from the floor was 14.9 seconds (SD = 7.6 seconds). Fourteen (70%) participants used a quadruped strategy to rise to stand. Supine-to-stand performance time was significantly correlated with all physical performance measures. Findings serve as a catalyst for nursing and rehabilitation professionals to examine floor rise ability, prevent adverse effects of a critical fall, and instruct fall recovery techniques in clinical settings. [Journal of Gerontological Nursing, 49(1), 50-54.].

Self-reported symptom causes of mobility difficulty contributing to fear of falling in older adults

BACKGROUND

Self-reported symptom causes of mobility difficulty that contribute to  fear of falling (FOF) in older adults has not been fully explored as an area for intervention.

AIMS

Identify the prevalence of self-reported symptoms causing mobility difficulties and to examine the difference in FOF by symptom category.

METHODS

Conduct a secondary data analysis of a population-based cohort of community-dwelling older adults, ≥ 70 years, enrolled in the MOBILIZE Boston study. The analysis included 242 older adults reported difficulty walking ¼ mile (0.4 km) and/or climbing one flight of stairs. Participants identified the main symptom cause of the mobility difficulty from a list of 32 symptoms, grouped into five categories. FOF was measured using the Tinetti Falls Efficacy Scale.

RESULTS

Pain was the primary symptom causing mobility difficulty (38%), followed by endurance (21%), weakness (13%), balance (9%), and other (3%). Although a greater proportion of participants who identified balance as the primary symptom category had significantly higher FOF compared to others, there was a greater number overall who reported pain as their main symptom who also had FOF. Therefore, pain contributed to a higher relative burden of FOF in the population than did balance symptoms.

DISCUSSION

Various symptoms affect mobility and are associated with FOF, a known fall risk factor. Many older adults identify pain as the main cause of their mobility difficulty and report FOF.

CONCLUSIONS

Improving pain symptoms for older adults may improve mobility and reduce fear of falling, potentially averting further decline in mobility and independence.

A Collaborative Implementation Strategy to Increase Falls Prevention Training Using the Age-Friendly Health Systems Approach

Falls in the home and in community environments are the leading cause of injuries and long-term disabilities for the aging population. The purpose of this study was to examine outcomes of a partnership among an academic institution, government agency, community organizations, and emergency management services to implement a falls prevention training program using an Age-Friendly Health Systems approach. In this prospective study, partners identified gaps in services and targeted and non-targeted delivery areas for implementation of an evidence-based falls prevention intervention addressing the 4Ms of Age-Friendly Health Systems—Mobility, Medications, Mentation, and What Matters. Descriptive statistics were calculated for program implementation and participant demographic variables, and paired t-test analysis compared scores for self-assessed general health and falls efficacy prior to and after program participation. Twenty-seven falls prevention classes were implemented, with over half (52%) in targeted areas. A total of 354 adults aged 50 and older participated, with N = 188 participants (53%) completing the program by attending at least five of eight sessions. Of completers, 35% resided in targeted areas. The results showed a statistically significant improvement in falls efficacy by program completers in targeted and non-targeted areas. However, there was no statistically significant difference in self-rated health. Overall, the findings of this study indicate that collaboration to deliver falls prevention training can be effective in reaching at-risk older adults. By mobilizing collaborative partnerships, limited resources can be allocated towards identifying at-risk older adults and improving community-based falls prevention education.

Functional Reach and Gait Speed Improvement in A Matter of Balance Participants

BACKGROUND

Falls among older adults are the most common cause of hospital admissions. A Matter of Balance may reduce these falls by improving balance, flexibility, gait speed, and agility.

OBJECTIVE

The study aimed to measure functional reach and gait speed among adults older than 65 years following A Matter of Balance. It was hypothesized that functional reach scores would increase and gait speed scores would decrease.

METHODS

This was an interventional study with the primary outcomes of functional reach (measured by the Functional Reach test) and gait speed (measured by the Timed Up and Go test). A one-tailed paired t test was used to compare pre- and postprogram functional reach mean differences. A one-tailed Wilcoxon signed-rank test was used for comparing median differences of pre- and postprogram gait speed. Characteristics of participants who improved scores were compared with those who did not improve, using two-tailed independent-samples t tests and two-tailed Pearson's χ2. Effect sizes were computed for tests significant beyond p < .05.

RESULTS

Mean functional reach increased by 0.6 inches (SD = 2.21, p = .002; d = 0.2). Median gait speed decreased by 1.25 s (interquartile range = 2.39, p < .001; r = .76). Improvement was not attributable to differences of age, sex, health status, preexisting conditions, or delivery site.

CONCLUSIONS

Following A Matter of Balance, functional reach and gait speed improved. Adults older than 65 years should be encouraged to participate in the program, as it may reduce their fall risk.

A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults

OBJECTIVE

Fear of falling (FOF) contributes to activity restriction and institutionalization among older adults, and exercise interventions are linked to reduction in FOF. Adhering to exercise principles and adapting optimal exercise parameters are fundamental to optimizing the effectiveness of exercise interventions. The purpose of this review was to describe FOF exercise interventions in community-dwelling older adults, evaluate the extent to which these interventions followed the exercise principles and reported exercise parameters, and quantify the effect of these interventions on reducing FOF.

METHODS

Randomized controlled trials (RCTs) of FOF exercise interventions in older adults (≥65 years) were identified from 4 databases. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale. A random-effect model was used in the meta-analysis.

RESULTS

Seventy-five RCTs were included in this review. With regard to reporting exercise principles, specificity was reported in 92% of trials, progression in 72%, reversibility in 32%, overload in 31%, diminished return in 21%, and initial value in 8%. For exercise parameters, 97% of RCTs reported exercise type; 89%, frequency; and 85%, time. Only 25% reported the intensity. The pooled effect of exercise interventions on FOF among all included studies was a standard mean difference of -0.34 (95% CI = -0.44 to -0.23).

CONCLUSION

This study showed a significant small to moderate effect size of exercise interventions in reducing FOF among community-dwelling older adults. Most exercise principles and intensity of exercises were not adequately reported in included trials.

IMPACT

These inadequate reports could undermine efforts to examine the optimal dosage for exercise prescription. More attention must be given to designing and reporting components of therapeutic exercise programs to facilitate evidence-based practice.

Evaluation of Implementing TOM: A Group-Based Fall Prevention Programme among Community-Dwelling Older Adults in The Netherlands

There is strong evidence that effective fall prevention elements exist, but the implementation into society remains difficult. The aim of the current study is to describe and evaluate the implementation of the fall prevention programme "Thuis Onbezorgd Mobiel" (TOM). This novel approach combines effective components into a multidisciplinary group-based programme for adults aged 65 years or older with an increased risk of falling. To investigate the impact on several health-related outcomes such as subjective health, quality of life, physical functioning, and falls, we applied a quasi-experimental pre-post design including a follow-up period. A total of 164 older adults subscribed to the programme: 80 were eligible to start and 73 completed it. The impact analysis revealed a significant improvement in subjective health, physical functioning, and quality of life directly after participating in the programme. The impact on subjective health and quality of life persisted six months after the programme. Important facilitators for the implementation of the programme were social contact and clear communication. Lack of a concrete follow-up was seen as an important barrier. The results of the current research help guide further implementation of effective fall prevention interventions in practice.

On the Move clinic: A fall prevention nurse practitioner-driven model of care

Falls in older adults are common and interventions to reduce associated morbidity and mortality remain difficult to implement. This quality improvement project evaluated On the Move, a new clinic designed to provide tailored recommendations to reduce falls risk, based on an adaptation of CDC's STEADI: a falls risk screening, assessment and intervention guide. 89 participants were referred by primary care and emergency services. A nurse practitioner assessed modifiable physical, behavioral and environmental risk factors and utilized motivational interviewing and education to guide participants in developing an intervention plan. A physical therapist assessed gait/balance, the need for ongoing PT services and provided brief counseling. Participants received a 6-week phone call and 12-week follow up visit. Measurements, including 30-second chair stands, Timed Up and Go, 4-Item Dynamic Gait Index, and Activities-Specific Balance Confidence Scale all showed significant improvement. Participants made behavioral changes to reduce risk, and plans to continue exercise.

Matter of Balance Classes Through Physical Therapist Fall Risk Assessment

BACKGROUND

Falls remain the leading cause of injury-related death for 65 years and older. Matter of Balance is a well-documented community-based program designed to reduce participants' fear of falling. However, Matter of Balance classes' effect on physical measures remains less well studied.

OBJECTIVE

The objective of this study was to evaluate the effects of the Matter of Balance program on balance, strength, and fall risk.

METHODS

This is a single-group pretest-posttest evaluation of balance and strength in community participants enrolled in 8-week Matter of Balance classes. Physical therapist assessments of the Functional Reach Test and five times sit-to-stand test at week 1 and week 8 were compared.

RESULTS

A total of 33 class participants were studied. The average improvement in the Functional Reach Test was M = 1.33 (SD = 1.6) inches and the five times sit-to-stand test was M = -3.24 (SD = 3.42) seconds; p < .05.

CONCLUSIONS

Matter of Balance classes resulted in improvement in both balance and strength. This study's findings support Matter of Balance classes' efficacy as a community-based program that can reduce a participant's physical risk for falls.

Association of fear of falling with frailty in community-dwelling older adults: A cross-sectional study

This study aimed to describe frailty and fear of falling and examine the cross-sectional association between frailty and fear of falling in community-dwelling older adults in China. We recruited 165 older adults from five selected communities in the five districts of Changchun, Jilin Province. Participants were asked to complete a demographic questionnaire, the Short Falls Efficacy Scale-International, and the Tilburg Frailty Indicator. We found that 60% of our participants were frail and that 81% reported a fear of falling. Using binary logistic regression, we found that the participants with fear of falling were 7.2 times more likely to be frail. These findings suggest that fear of falling should be regularly screened in clinical practice to help identify older adults with greater risks of frailty. Future longitudinal studies of larger sample size are needed to confirm the association. Moreover, frailty prevention programs that include strategies to reduce the fear of falling should be tested among community-dwelling older adults.