What are the effects of exercise interventions for preventing falls in older people living in the community? - A Cochrane Review summary with commentary

Home-based strength and balance exercises for fall prevention among older individuals of advanced age: a randomized controlled single-blind study

OBJECTIVE

This research was to explore the effectiveness, safety, and adherence of home-based strength and balance exercises for fall prevention among the self-reliant individuals of advanced age and analyzed the beneficial components.

METHOD

This randomized controlled single-blind study included 124 individuals aged 80 years and over(mean age 84.4±3.2 years). The test group (n=63) performed strength and balance exercises facilitated by sports video training (≥ 3 sessions a week, ≥ 30 minutes per session), while the control group (n=61) maintained their daily routines. We conducted a comprehensive geriatric assessment (self-care ability, muscle strength, mobility, cognition, and psychological status) at baseline and 12 months later and dynamic posture mapping for balance and gait.

RESULTS

The test group had a decreased risk of falls compared to the control group (25.4%vs.44.3%, respectively; RR = 0.747; 95% CI: 0.551-0.975; p = 0.027). There was no statistically significant difference in the fall rate between the two groups (0.48 falls per person-year vs. 0.67 falls per person-year, respectively; IRR: 0.708; 95% CI: 0.394-1.275; p = 0.251). The composite equilibrium score (SOTcom) for vestibular and integrated balance on the Sensory Organization Test (SOT) increased in the test group, while SOTcom decreased in the control group. In the test group, there was a significant improvement in the indexes pertaining to response time, movement speed, directional control, and endpoint offset in some directions. Adherence was better in the test group, with 54.0% exercised ≥ 3 times per week and 28.6% exercised 1-2 times per week on average.

CONCLUSION

Home-based strength and balance exercises improved balance and reduced the risk of falls among the individuals of advanced age. The video-guided, remotely monitored regimen demonstrated effectiveness, safety, and compliance, although scope for improvement remains.

Physical Activity and Falls From Midlife: Patterns and Bidirectional Associations

INTRODUCTION

The relationship between physical activity behavior and subsequent falls in adults from midlife to older age is unclear. Falls and fall-related injuries could lessen physical activity participation. This study examined patterns and bidirectional associations between physical activity and falls from midlife to older age.

METHODS

In the Australian Longitudinal Study on Women's Health, women born 1946-1951 (n=11,759, mean age: 56 years at baseline in 2004) self-reported weekly physical activity amounts (0, 1-<150, 150-<300, ≥300 minutes/week) and noninjurious and injurious falls every 3 years between 2004 survey and 2019 survey. Bidirectional prospective 3-year associations between physical activity and falls were examined using generalized estimating equations to estimate ORs and 95% CIs, adjusting for directed acyclic graph-informed covariates. Analyses were conducted in 2023.

RESULTS

Participation in any amount of physical activity was associated with a reduced risk of injurious falls (OR1-<150 min=0.87; 95% CI=0.80, 0.96; OR150-<300 min=0.87; 95% CI= 0.79, 0.96; OR≥300 min=0.85; 95% CI=0.78, 0.93) in the next 3 years, compared with women with no physical activity. Women who reported noninjurious falls had lower odds of undertaking ≥300 minutes/week of physical activity 3 years later (OR=0.84; 95% CI=0.77, 0.92), compared with women without falls. Women who reported injurious falls had lower odds of subsequently undertaking various amounts of physical activity (OR=0.83, 95% CI=0.75, 0.91 for 1-<150; OR=0.82, 95% CI=0.74, 0.90 for 150-<300; OR=0.83, 95% CI=0.76, 0.90 for ≥300 minutes/week).

CONCLUSIONS

The prospective bidirectional association between physical activity and falls supports addressing falls by promoting activity and highlighting the impact of injurious falls on reduced physical activity participation.

Associations of Adverse Childhood Experiences With Falls and Fall Risk Factors Among Middle-Aged and Older Adults in China

INTRODUCTION

This study examined the associations of adverse childhood experiences (ACEs) with falls and fall risk factors and investigated whether fall risk factors mediate the association between ACEs and falls.

METHODS

This population-based cross-sectional study included 9,961 participants aged ≥45 years from the 2014 Life History Survey and the 2015 follow-up survey of the China Health and Retirement Longitudinal Study. Data analysis was performed from April 3 to May 7, 2024. Logistic regression models were used to assess the associations of the cumulative number of ACEs with falls and fall risk factors, as well as each ACE type. The Karlson-Holm-Breen method was used to examine the total (direct and indirect) effect of fall risk factors mediating the association between each ACE type and falls.

RESULTS

Associations of the cumulative number of ACEs with falls and specific fall risk factors were observed. Seven of the 12 ACEs were associated with falls, including physical abuse, household mental illness, witnessed domestic violence, bullying, parental death, sibling death, and parental disability. Corresponding fall risk factor patterns totally or partly mediated the associations between the 6 ACE types (excluding parental death) and falls. Pain and depressive symptoms were the dominant contributors.

CONCLUSIONS

ACEs were associated with falls and specific fall risk factors. Pain and depressive symptoms predominantly mediated the association between each type of ACE and falls. Early identification and targeted treatment of pain and depressive symptoms are critical for reducing fall incidence of ACEs-exposed individuals in later life.

Understanding the Health Benefits of Tai Chi Practice for Managing Pain After Breast Cancer Treatment

This short review summarizes a recent U.S.-based study in which researchers evaluated the impact of tai chi mind-body exercises on health outcomes of breast cancer survivors. The researchers examined the efficacy of a tai chi intervention for managing aromatase inhibitor arthralgia in patients with breast cancer. They concluded that mind-body-related practices likely contributed to improved health outcomes. Nurses can guide patients about the impact that mind-body practices may have on the health and well-being of breast cancer survivors.

The effectiveness of progressions of difficulty during an exercise program to improve balance and gait in older individuals: A randomized clinical trial

BACKGROUND

Little is discussed about the effectiveness and systematization of progressions of difficulty during balance exercises. Exercise progression provides continuous stimulation and assists physical therapists in offering challenges to patients.

OBJECTIVE

To investigate the effectiveness of an exercise program with systematic progression of difficulty for older individuals.

METHODS

Randomized clinical trial, with 22 older individuals allocated to experimental (EG, N = 12) or control (CG, N = 10) group. In EG, individuals performed an exercise program with progressions of difficulty for 12-weeks (2 days/week, 1 h/session). In the control group the participants performed the same program without progressions of difficulty. The Berg Balance Scale (BBS), Timed up and Go (TUG), and modified Dynamic Gait Index (mDGI) were assessed after and before the 24 exercise sessions. An intention-to-treat approach and multiple imputation by chained equations were utilized. Raw data were transformed into standardized individual differences (SID) and analyzed using one-way ANCOVA to test group effects, with baseline and age as covariates. A one-sample t-test was used to compare SIDs against zero. Effect sizes were estimated using partial eta squared (ηp²) and Cohen's d.

RESULTS

ANCOVA revealed no significant group effect across any of the variables. Baseline values emerged as significant predictor of changes in BBS (P = 0.038, ηp²=0.219), TUG (P = 0.042, ηp²=0.210), and mDGI (P < 0.001, ηp²=0.545), suggesting a substantial differences among participants with lower baseline values. Age also emerged as a significant predictor of change for mDGI (P = 0.002, ηp²=0.431). Comparison with zero-value produced significant differences for BBS and mDGI, indicating increases in post-intervention for both groups.

CONCLUSION

Applying progressions of difficulty to the exercises, did not lead to greater improvements than not applying them. CLINICAL TRIAS: https://ensaiosclinicos.gov.br/rg/RBR-8dpxgcf.

Exercise for Postmenopausal Bone Health - Can We Raise the Bar?

PURPOSE OF REVIEW

This review summarises the latest evidence on effects of exercise on falls prevention, bone mineral density (BMD) and fragility fracture risk in postmenopausal women, explores hypotheses underpinning exercise-mediated effects on BMD and sheds light on innovative concepts to better understand and harness the skeletal benefits of exercise.

RECENT FINDINGS

Multimodal exercise programs incorporating challenging balance exercises can prevent falls. Emerging clinical trial evidence indicates supervised progressive high-intensity resistance and impact training (HiRIT) is efficacious in increasing lumbar spine BMD and is safe and well-tolerated in postmenopausal women with osteoporosis/osteopenia. There remains uncertainty regarding durability of this load-induced osteogenic response and safety in patients with recent fractures. Muscle-derived myokines and small circulating extracellular vesicles have emerged as potential sources of exercise-induced muscle-bone crosstalk but require validation in postmenopausal women. Exercise has the potential for multi-modal skeletal benefits with i) HiRIT to build bone, and ii) challenging balance exercises to prevent falls, and ultimately fractures. The therapeutic effect of such exercise in combination with osteoporosis pharmacotherapy should be considered in future trials.

Preventing Falls in Older Adults After Upper Limb Fractures: A Scoping Review

OBJECTIVE

The objective was to identify and describe fall prevention strategies in upper limb fracture rehabilitation for older people using recent fall prevention guidelines as a standard.

METHODS

A systematic search was conducted in 9 electronic databases (PubMed/MEDLINE, EBSCOhost, Cochrane Library, Lilacs, SPORTDiscus, CINAHL, Web of Science, AgeLine, and SciELO), gray literature, and in bibliographic and citation searching of selected articles between May and December 2022 and updated between February and March 2024. Two independent reviewers screened citations for inclusion. Data extraction was performed by 1 reviewer and verified by a second reviewer. A frequency of strategies and content analysis syntheses were conducted.

RESULTS

A broad search strategy was used, initially identifying 25,945 articles and including 6 randomized clinical trials. The gray literature search identified 18 records. Five studies included forearm fractures, 1 upper limb fracture, and no study exclusively on rehabilitation after humerus fractures. None of the studies provided comprehensive multifactorial fall risk assessments to guide tailored interventions. Assessments mainly focused on gait and balance. Exercise was the most offered intervention alone or in combination with education. Exercise programs were aligned with recommendations to include progressive balance and functional exercises overall. However, the frequency of ≥3 times weekly was less frequently offered. The gray literature showed a lack of fall prevention-specific information after upper limb fractures and mostly called attention to fall prevention after hip fractures.

CONCLUSION

Upper limb fracture rehabilitation in older adults, considered at high risk of falling, did not include comprehensive and tailored multifactorial fall assessment and intervention. Unequivocally, exercise programs were overall aligned with recent recommendations and were the most frequent intervention. There is a crucial gap for humerus fractures. This study can help align the treatment of upper limb fractures with updated fall prevention recommendations and impact future research, guiding and influencing implementation in clinical practice.

IMPACT

There is an urgent need to implement comprehensive and tailored multifactorial fall assessments and interventions in rehabilitation programs for older adults recovering from upper limb fractures. Guidelines should direct this work to enhance clinical practice.

Remote versus face-to-face fall risk assessment in home dwelling older adults: a reliability study

BACKGROUND

Falls are a leading cause of severe injury and death in older adults. Remote screening of fall risk may prevent falls and hence, advance health and wellness of older adults. While remote health care is becoming a common practice, we question if remote evaluation of fall risk is as reliable as face-to-face (FTF).

OBJECTIVE

To assess the inter-tester reliability of synchronized remote and FTF fall risk assessment.

METHODS

This inter-format, inter-rater reliability study included 48 home dwelling older adults aged 65 and over. Five valid functional and balance tests were conducted: 30 Second Sit-to-Stand (STS), MiniBESTest, Timed up and go (TUG), 4-Meter Walk (4MWT), and Berg Balance Scale (BBS). Instructions were provided via videoconferencing, and two physiotherapists scored performance simultaneously, one remotely, and one in the room. Inter-rater reliability between remote and FTF scores was analyzed using intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), minimal detectable change (MDC95) and Bland and Altman analysis.

RESULTS

Excellent ICCs were found for STS, MiniBESTest, TUG, and BBS (0.90-0.99), and moderate for 4MWT (0.74). SEM and MDC95 values were STS (0.37,1.03 repetitions), MiniBESTest (1.43,3.97 scores), TUG (1.22,3.37 seconds), 4MWT (0.17,0.47 m/second), and BBS (1.79,4.95 scores). The Bland and Altman analysis showed excellent agreement between remote and FTF assessments of the STS. All other tests showed low to moderate agreement. Mean difference ± SD and 95%LOA were as follows: STS (-0.11 ± 0.52), (-1.13,0.91) repetitions, MiniBESTest (0.45 ± 1.98), (-3.43,4.32) scores, TUG (-0.35 ± 1.54), (-3.37,2.67) seconds, 4MWT (-0.08 ± 0.22), (-0.35,0.51) meter/second, and BBS (0.04 ± 2.53), (-4.93,5.01) scores.

CONCLUSIONS

The findings support the responsible integration of remote fall risk assessment in clinical practice, enabling large-scale screenings and referrals for early intervention to promote healthy aging and fall prevention.

An intergenerational service-learning approach to improve hand function in older adults

Homebound older adults are at greater risk for functional impairments, social isolation, and loss of independence. Adequate hand function is needed to perform many daily activities, yet is understudied, particularly in the homebound population. The purpose of this study was to pilot test an intergenerational program in which pre-health college students were trained to deliver hand exercises to homebound older adults receiving Meals on Wheels (MOW) services. Eight MOW clients (mean age: 80.1 ± 12.9y) and 17 students completed the program. Students visited clients 2×/week for 6 weeks and engaged in hand exercises and meaningful conversations. Measures of hand strength, dexterity, self-reported function, self-efficacy, depression, and social isolation were taken before and after the program. Clients and students also completed a post-program experience survey. Significant improvements in pinch strength were observed, and 75% of clients reported better upper limb mobility after training. Survey feedback was positive with clients saying they enjoyed interacting with college students, while students praised the hands-on nature of the program and engagement with older adults. Results from this pilot study demonstrate an intergenerational approach to deliver hand training is feasible and underscores the value of using such models to increase access to care for homebound older adults.

Physical Therapy Management of Fall Risk in Community-Dwelling Older Adults: An Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association - Geriatrics

APTA-Geriatrics, an Academy of the American Physical Therapy Association, appointed a guideline development group (GDG) to develop a clinical practice guideline (CPG) synthesizing the evidence for physical therapy management of fall risk in community-dwelling older adults. The GDG consisted of five physical therapists with clinical expertise in the management of fall risk in older adults and methodological expertise in evidence-based document development. The CPG includes a systematic review of existing literature, and stringent methodology developed by the American Physical Therapy Association to form the evidence-based recommendations. The CPG content, including methodology, recommendations and algorithm were externally reviewed by clinical providers and academicians with expertise in fall risk management for older adults. These recommendations are intended to assist physical therapists and physical therapist assistants who are engaged in fall risk management for community-dwelling older adults.

Effects of dance interventions on cognitive function, balance, mobility, and life quality in older adults: A systematic review and Bayesian network meta-analysis

BACKGROUND

Physical inactivity in older adults is strongly associated with a variety of health problems that may lead to cognitive decline and impaired physical and mental health. The aim of this study was to investigate the effectiveness of five different dances on cognitive function and quality of life in older adults.

METHODS

seven databases were systematically searched. Two reviewers independently completed the screening, quality assessment and data extraction of the study. Standardized mean differences (SMDs) were calculated using the Network package in Stata software and network meta-analyses (NMAs) were conducted using Bayesian consistency models using the GeMTC package in R software.

RESULTS

The NMA consisted of 28 studies involving 1967 older adults aged 60 years or older, focusing on five different types of dance interventions. The results of the NMA showed that only ballroom dancing significantly improved cognitive function (SMD = 0.89, 95 % confidence interval [CI] (0.07, 1.70)), whereas tango and folk dancing significantly improved balance (SMD = 1. 62, 95 % CI (0.50, 2.76), (SMD = 1.43, 95 % CI (0.15, 2.81)), while tango and self-created dance enhanced mobility (SMD = -1.42, 95 % CI (-2.60, -0.25), (SMD = -1.20, 95 % CI (-2.10, -0.37)). Furthermore, square dancing was the only intervention that significantly improved mental health (SMD = 1.11, 95 % CI (0.03, 2.31)).

CONCLUSION

Ballroom dancing and square dancing appear to be the most effective interventions for improving cognitive ability and mental health, respectively, while tango shows promise as an intervention for improving balance and mobility.

Effectiveness of the Safe Step Digital Exercise Program to Prevent Falls in Older Community-Dwelling Adults: Randomized Controlled Trial

BACKGROUND

Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling up the interventions remain challenges. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population.

OBJECTIVE

This study aims to assess the effectiveness of the Safe Step app, a self-managed, unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control groups, study attrition, and adherence to the Safe Step exercise program.

METHODS

Community-dwelling individuals, aged 70 years or older, who had experienced falls or a decline in balance in the past year were randomized to either an exercise group using the Safe Step app combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted for 1 year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio of fall rate and the risk ratio (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively.

RESULTS

In total, 1628 people were enrolled in the study, 79% were women, and the mean age was 75.8 (SD 4.4) years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person-year in the exercise group and 2.41 in the control group; incidence rate ratio 0.92, 95% CI 0.76-1.11; P=.37). The risk of experiencing at least 1 fall was significantly lower (11%) in the exercise group compared to the control group (53% vs 59.6%; RR 0.89, 95% CI 0.80-0.99; P=.03). No differences were observed regarding the risk of 2 or more falls (34.1% in the exercise group, 37.1% in the control group; RR 0.92, 95% CI 0.79-1.06; P=.23). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20%) participants from the exercise group and 63 (8%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7%, 13.4%, 8.6%, and 9.1% at 3, 6, 9, and 12 months, respectively.

CONCLUSIONS

Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03963570; https://clinicaltrials.gov/study/NCT03963570.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2019-036194.

Evaluation of content validity and feasibility of the World Falls Guidelines' three key questions to identify falls among older adult users of home care services in Norway

BACKGROUND

Falls among older adults (65 + years) is an important issue in municipal home care. Screening using the World Falls Guidelines' three key questions (3KQ) is recommended to identify older adults at increased fall risk, but the 3KQ has not been formally tested by healthcare practitioners (HCPs) working in Norwegian municipal home care. The aim of this study was to evaluate the content validity and the feasibility of the 3KQ among HCPs in home care services.

METHODS

Participants were 10 multidisciplinary HCPs working in home care and in low-threshold services of Oslo, Norway. We evaluated the content validity of the 3KQ through individual think-aloud interviews. Next, feasibility was evaluated as follows: We trained HCPs in how to use the 3KQ. HCPs then screened older adults using the 3KQ during a six-week test period, and took pocket-notes of older adults' answers. We conducted two focus groups to explore HCPs' experiences with using the 3KQ. We analysed interview data using reflexive thematic analysis.

RESULTS

Content validity evaluation revealed that HCPs found the 3KQ easy to understand, and potentially timesaving. They experienced the tool as applicable among home care users, and it was particularly useful among new users. Still, HCPs emphasised the necessity of their training on how to best ask the questions and determine appropriate actions based on users' responses. We identified three main themes from the feasibility evaluation: (1) Promoting awareness and action: using the 3KQ helps put falls on the agenda in municipal home care, (2) Obtaining reliable answers: integrating the 3KQ into daily practice is important, and (3) Unlocking insights: the 3KQ as a gateway to supplementary information from users. Most older adults had increased fall risk according to the 3KQ.

CONCLUSIONS

The 3KQ appears feasible for Norwegian municipal home care and may be of value for HCPs who screen new users and users of low-threshold services. Integrated use of the 3KQ may enhance awareness, promote reliable answers, and provide supplementary information useful for decision-making. The study findings may benefit HCPs and managers in home care services, and other stakeholders in implementing fall prevention guidelines in primary care.

TRIAL REGISTRATION

Open Science Framework Identifier https://doi.org/10.17605/OSF.IO/2JFHV . Registered: 11th January 2023.

Psychoeducation for fall prevention among community-dwelling older people: A scoping review

Community-dwelling older people (CDOP) face important risks of falling, a leading cause of chronic pain and transitions into long-term disability. While exercise-based interventions are widely studied for fall prevention, psychoeducation may play an important preventive role. Nevertheless, psychoeducation for fall prevention remains underexplored. This study aimed to describe existing psychoeducation for fall prevention among CDOP, identify its key components, and derive recommendations to inform future interventions. Using a scoping review design, we selected 20 studies with focus on psychoeducation for fall prevention. Findings revealed that all selected studies incorporated at least one of the four psychoeducation elements described by Anderson et al. Key aspects including mode of delivery, intervention facilitator, and educational resources are described, but literature lacks convergence. Moreover, theory-based psychoeducation programs and integration of technology and interactive delivery methods are underexplored. Implications for the design of a psychoeducation program for fall prevention in CDOP are discussed.

Effects of high-intensity interval training on physical morphology, cardiopulmonary function, and metabolic indicators in older adults: a systematic review and meta-analysis

Background

Despite the growing attention towards the efficacy of high-intensity interval training (HIIT) on older adult health, a consensus regarding the pleiotropic effects of HIIT in this population is yet to be reached. Previous studies have predominantly focused on specific outcomes or particular groups, lacking comprehensive analysis.

Objective

We aimed to conduct a systematic evaluation of the impact of HIIT on body composition, cardiopulmonary function, and metabolic parameters in older adults.

Methods

The databases searched included PubMed, Web of Science, Cochrane Library, Scopus, WanFang, and other relevant sources from the inception of the database until July 2023. Randomized controlled trials (RCTs) on the effects of HIIT on body shape, cardiopulmonary function, and metabolic parameters in the older adult were searched.

Results

A total of 87 RCTs meeting the criteria were included, involving 4,213 older adult people. Meta-analysis results showed that HIIT significantly improved body fat percentage (BF%) [MD: -1.63%, p = 0.005], maximal oxygen uptake (VO2max) [MD: 2.46 mL min-1 kg-1, p < 0.00001], maximal heart rate (HRmax) [MD: 2.83 beats min-1, p = 0.02], and high-density lipoprotein (HDL) levels [MD: 0.04 mmol L-1, p = 0.002]. However, for systolic blood pressure (SBP) [MD: 0.49 mmHg, p = 0.60], resting heart rate (HRrest) [MD: -0.95 BPM -1, p = 0.24], triglycerides (TG) [tendency for MD: -0.02 mmol L-1, p = 0.61], low-density lipoprotein (LDL) [MD: -0.04 mmol L-1, p = 0.27] had no significant effect. Sensitivity analysis found that HIIT significantly improved waist circumference (WC) [MD: -1.89 cm, p = 0.17], diastolic blood pressure (DBP) [MD: -0.63 mmHg, p = 0.23], respiratory exchange rate (RER) [MD: 0.01, p = 0.20], total cholesterol (TC) [MD: 0.10 mmol L-1, p = 0.14], and fasting plasma glucose (FPG) [MD:-0.20 mmol L-1, p = 0.08], but the results lacked robustness. There was no significant improvement in DBP [MD: -0.63 mmHg, p = 0.23] and body mass index (BMI) [MD: -0.36 kg m-2, p = 0.06].

Conclusions

HIIT has shown certain potential and advantages in improving the physical health of the older adult, especially in cardiopulmonary function. However, more high-quality studies are needed to confirm the effects of HIIT on the physical health of the older adult in the future. It also provides a reference for the clinical practice and family health management of HIIT in the older adult and the development of HIIT guidelines.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/myprospero, identifier CRD42023460252.

Determinants of Qigong, Tai Chi, and Yoga Use for Health Conditions: A Systematic Review Protocol

INTRODUCTION

Mind-body movement interventions such as qi gong, tai chi, and yoga are recommended in clinical practice guidelines to improve outcomes for several health conditions. However, use of these interventions for health conditions, or the integration of these interventions within healthcare settings, is low. A systematic synthesis of implementation determinants (i.e., barriers and facilitators) is needed to increase adoption. Similarly, determinants may influence other implementation outcomes, such as scalability or sustainability of these interventions in a healthcare system or community organization. Thus, in conducting this review we aim to identify determinants of qi gong, tai chi, and yoga use for health conditions. The secondary aim is to evaluate whether barriers and facilitators differ by intervention type, health condition, implementation setting, or implementation outcome.

METHODS AND ANALYSIS

We conducted a comprehensive search of electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, PsycInfo) through May 2024 and a grey literature search (Google Scholar, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the WHO Clinical Trials database) through March 2025. We will include original research articles in English that identify barriers and facilitators to adoption of qi gong, tai chi, and yoga by adults with health conditions. Study quality will be assessed using the Mixed Methods Appraisal Tool. We will code each article using a codebook informed by the Consolidated Framework for Implementation Research (CFIR), a comprehensive taxonomy of implementation determinants. Findings will be presented as a narrative synthesis. We will report on how barriers and facilitators may relate to intervention type (qi gong, tai chi, yoga), health condition (e.g., low back pain, fall prevention), implementation settings (e.g., primary care clinic, community organization) or implementation outcome (e.g., adoption, sustainability).

ETHICS AND DISSEMINATION

Ethics approval will not be obtained for this review of published, publicly accessible data. The results from this systematic review will be disseminated through conference presentations and journal publications.

Risk factors and socioeconomic determinants of falls among older adults

Background

Falls are included in this category due to their high prevalence among people over 60 years of age. The aim of this study is to analyze the relationship between the frequency of falls and selected socioeconomic factors.

Methods

The study was conducted among 351 patients of a rehabilitation clinic and center. The research method was a structured diagnostic survey using the Falls Risk Assessment Tool (FRAT) to collect data on fall incidence and associated risk factors.

Results

A significant relationship was found between the age of the participants, their level of education (p = 0.00015), and the type of work previously performed (p = 0.00039) and the frequency of falls. The frequency of falls increased with age, and falls were more common among less educated individuals and those who previously performed physical work. A significant relationship was also found between marital status (p = 0.00039), material status (p = 0.004), and the number of people in the household (p = 0.002) and the frequency of falls. Falls were most frequent among widowed individuals and those with poorer financial situations. People living alone and those living in households with more than two members experienced falls more often.

Conclusions

These findings suggest that educational background and financial constraints may contribute to fall risk, emphasizing the need for targeted fall prevention programs among vulnerable populations.

Strategies for person-centredness at meeting places arranging group exercises for community-dwelling older persons- A focus group study from a stakeholder perspective

BACKGROUND

Health-promotive interventions targeting older persons are important for active and healthy ageing. Hence, physical group exercises for community-dwelling older persons are arranged by various stakeholders via meeting places within the municipalities. Increased knowledge of how group exercises via meeting places can be arranged to promote health for the older population is needed. Therefore, the aim was to explore involved stakeholders' experiences of group exercises for older persons arranged via meeting places in municipalities in relation to health promotion.

METHODS

Six focus group interviews were conducted online with 25 stakeholders from seven municipalities in Sweden. The stakeholders were managers of prevention units, municipal coordinators for physical activity, group exercise leaders, stakeholders from study associations, sports associations and private stakeholders, and non-profit stakeholders who arranged group exercises via the meeting places. The data was analysed using focus group methodology, where the focus of the analysis was to obtain the stakeholders' collective understanding of the topic.

FINDINGS

The analysis resulted in two main themes and seven categories. In the main theme Strategies to strengthen empowerment and exercise habits among older persons, the stakeholders highlighted strategies on an individual level. Strategies of importance to attract new participants and supporting them in maintaining their exercise habits, empowering them through social belonging, adapting to older persons through responsiveness and evaluation, facilitating participation in decision-making, and enabling older persons to lead group exercises. The other main theme, Strategies to strengthen the arrangement of group exercises over time, highlighted strategies on an organisational level concerning financial resources, supportive environments, the importance of human resources, competence development as well as collaboration.

CONCLUSIONS

Person-centredness emerges in health-promoting strategies both at the individual and organisational level. The study contributes to an understanding of how person-centredness is significant when working with health-promotive interventions for healthy ageing. Thus, a potential implication is to use a person-centred approach in the encounter with older persons and in the organisation when arranging group exercises for community-dwelling older persons.

The everydayness of falling: consequences and management for adults with cerebral palsy across the life course

PURPOSE

To explore the cause, influences and consequences of falling for adults with cerebral palsy (CP) across their life course, and how this is managed.

MATERIALS AND METHODS

We used interview data from a multimethod UK study exploring the effects of ageing with CP and healthcare across the life course. Twenty-six participants were recruited and interviewed using various digital platforms to maximise inclusive participation in the UK. Follow-up email semi-structured interviews were conducted to further explore experiences of falls. Transcribed interviews were analysed thematically.

RESULTS

Falling and fear of falling (FoF) is problematic for over half of the participants in the sample. They perceived falls and FoF as limiting their participation, autonomy and independence in employment, social and cultural activities. Participants used their own management strategies, due to limited specialist interventions or practitioner knowledge to manage or prevent falls. Practices, such as the use of a wheelchair or avoiding activities prompted changes to relationships and identity.

CONCLUSIONS

Falling for adults with CP happens earlier in life compared to the general population. Adults with CP may benefit from specialist falls prevention services to help maintain muscle strength and balance. Research is needed to evaluate effective interventions for people with CP.

Evaluation of fear of falling, balance, and kinesiophobia in earthquake survivors: A comparative study between older and young adults

Objectives

This study aims to evaluate fear of falling, balance, and kinesiophobia among survivors of the earthquake that occurred in Türkiye on February 6th, 2023 and to identify potential predictors of fear of falling and impaired balance.

Patients and methods

In this single-center, cross-sectional study, a total of 260 Kahramanmaraş earthquake survivors (105 males, 155 females; median age: 44.0 years; range, 18 to 91 years) between May 08, 2024 and July 08, 2024 were included. The sociodemographic data including age, sex, body mass index (BMI), marital status (single, married, widow), education status (years), monthly income (Turkish Lira [TL]), smoking status (never smoked, smoking before the earthquake or started smoking after the earthquake), alcohol intake (never, regular use of alcohol before the earthquake, or started alcohol consumption after the earthquake) of the participants were recorded. Comorbidities were evaluated using the modified Charlson Comorbidity Index (CCI), anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), post-traumatic stress disorder (PTSD) using the National Stressful Events Survey for PTSD-Short Scale (NSESSS-PTSD), sleep disorders using the Jenkins Sleep Evaluation Scale (JSS), fear of falling using the Falls Efficacy Scale (FES), functional balance using the Berg Balance Scale (BBS), and kinesiophobia using the Tampa Scale for Kinesiophobia (TSK).

Results

Of the survivors (n=260), 4.6% and 33.8% experienced loss of first-degree relatives and house damage, respectively. The FES and TSK scores were higher, while the BBS score was lower in older adults (n=56) compared to younger counterparts (n=204) (p<0.001). Multivariate linear regression analysis revealed that increased age affected the BBS (β=-0.124; 95% CI: -0.263 - -0.185; p<0.001) and FES scores (β=0.404; 95% CI: 0.255 - 0.451; p<0.001). The PTSD-SS score had a significant effect on the FES score (β=0.915; 95% CI: 0.734 - 1.110; p<0.001).

Conclusion

The Kahramanmaraş earthquake caused detrimental effects. Older people were more affected in terms of balance, fear of falling, and kinesiophobia. Increased age and post-traumatic stress are significantly associated with fear of falling following the earthquake. As a potential risk factor for fear of falling, post-traumatic stress should be managed properly in survivors of such disasters, particularly in those at older age.

A multiple correspondence analysis of the fear of falling, sociodemographic, physical and mental health factors in older adults

Fear of falling (FoF) is a disabling condition due to different factors. The present study assessed potential FoF predictors, among sociodemographic, physical, and mental health domains, and explored their structural patterns. This cross-sectional study is part of the Physical Activity Promotion & Domestic Accidents Prevention (PAP & DAP) project, and was targeted to a sample of 229 independent older people (M 14.0%, F 86.0%) aged over 60 (mean 70.5 ± 5.96), both normal and overweight (median BMI 25.8 kg/m2, Interquartile Range 5.24). Standardized tools were used to assess the variables: the Short Falls Efficacy Scale International for the FoF; an information questionnaire for the socio-demographic variables, the presence of diseases, and previous falls; the International Physical Activity Questionnaire for the PA level; the Senior Fitness Test for physical fitness data; the Short Form 12 questionnaire for variables in the mental domain; and the Psychological Well-Being Scale 24 for the psychological well-being. Correlation/regression analyses were used to explore relationships between FoF and the considered variables. A Multiple Correspondence Analysis (MCA) was conducted to show graphical patterns projected into space dimensions. A percentage of 59.0 of the sample showed moderate/high concern of falling. The multiple regression model showed the following variables being significant predictors (p < 0.05) of the FoF: BMI (coeff 0.44, SE 0.104), musculoskeletal disease (1.55, 0.681), upper body strength (0.33, 0.117), mobility and balance (0.76, 0.320), perceived physical health (- 0.21, 0.047), and self-acceptance (- 0.52, 0.190). MCA evidenced two dimensions: the first one explained 41.8% of the variance and was described mostly by FoF (square residuals 0.721), gender (0.670), leg strength (0.617), perceived mental health (0.591), musculoskeletal diseases (0.572), and PA level (0.556); the second dimension (12.3% of the variance), was characterized mainly by perceived physical health (0.350), life objectives (0.346), education (0.301), upper body strength (0.278), and living in family/alone (0.260). The pattern elicited by MCA was characterized by older subjects with moderate/high FoF having low education or no occupation, being overweight and inactive, suffering from different diseases, having low physical fitness, and declaring low perceived physical and mental health. These results suggest that interventions aimed at reducing FoF should be addressed to this specific profile of older people.

Exercise reduces the risk of falls in women with polypharmacy: secondary analysis of a randomized controlled trial

Polypharmacy has previously been found to increase and exercise interventions to reduce the risk of falls and fall-related injuries. In this study, women who had four or more regular medications benefitted the most from the exercise intervention and had the lowest fall risk compared to the reference group. Fall injuries among older people cause significant health problems with high societal costs. Previously, some exercise interventions have been found to reduce the number of falls and related injuries. We studied how different levels of medication use affect the outcome of an exercise intervention in terms of preventing falls. This exercise RCT involved 914 women born in 1932-1945 and randomly assigned to the intervention (n = 457) and control (n = 457) groups. Both groups participated in functional tests three times during the study. Baseline self-reported prescription drug use was trichotomized: 0-1, 2-3, and ≥ 4 drugs/day (i.e. polypharmacy group). We used Poisson regression for follow-up fall risk and Kaplan-Meier survival analysis for fractures. During follow-up, 1380 falls were reported, 739 (53.6%) resulting in an injury and pain and 63 (4.6%) in a fracture. Women with polypharmacy in the intervention group had the lowest fall risk (IRR 0.713, 95% CI 0.586-0.866, p = 0.001) compared to the reference group that used 0-1 medications and did not receive the intervention. Overall, the number of medications associated with the fall incidence was only seen in the intervention group. However, the number of medications was not associated with fractures in either of the groups. Weaker functional test results were associated with polypharmacy in the control group. The most prominent decrease in fall risk with exercise intervention was seen among women with polypharmacy. Targeting these women might enhance fall prevention efficacy among the aging population.Trial Registration: The study has been registered in ClinicalTrials.gov. Trial registration number NCT02665169. Register date 27/01/2016.

Temporal trends in the burden of vertebral fractures caused by falls in China and globally from 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

This study aimed to estimate temporal trends in the burden of vertebral fractures (VFs) caused by falls by gender and age in China and globally from 1990 to 2021.

METHODS

Data concerning the characteristics of VFs caused by falls in China and worldwide, with a focus on metrics in incidence, prevalence and years lived with disability (YLDs) and their age-standardised rates, were sourced from the Global Burden of Disease (GBD) Study 2021. Joinpoint regression analysis was used to identify periods with significant changes. The average annual percentage change (AAPC) was calculated to reflect the temporal trends from 1990 to 2021. We utilised the age-period-cohort (APC) model to assess the effects of age, period, and cohort on the burden of VFs in China.

RESULTS

From 1990 to 2021, the age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR) and age-standardised YLD rate (ASYR) of VFs caused by falls exhibited an overall increase in China, whereas a general decline was observed globally. Furthermore, the ASIR, ASPR and ASYR were higher for males than females in China and worldwide. In 2021, across all age groups, the disease burden of VFs was primarily observed among the elderly population, particularly in the older female population, both in China and globally. The impact of age, period, and cohort on the incidence, prevalence, and YLDs exhibited variations in China.

CONCLUSION

The burden of VFs in China remains significant, particularly among older females. Given the considerable size of the elderly population and the ageing of the Chinese population, VFs remain critical public issues. Therefore, continued efforts must be made to address the health consequences of VFs caused by falls.

Risk and Preventive Measures Among Older Adults in Nursing Homes in Saudi Arabia: An Exploratory Study on Falls

BACKGROUND

Falls among older adults are a pervasive and significant concern worldwide. A practice guideline has been developed to address the prevention of falls and their resulting consequences in hospital and long-term care settings.

AIM

The study aimed to assess the fall down rate and preventive tools among older adult patients in nursing homes.

METHODS

A cross-sectional study was conducted on randomly selected older adult patients by using a questionnaire with the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool in nursing homes at the Ministry of Human Resource and Social Development.

RESULTS

Among 323 older adult patients, most of them (73.1%) were male, 23.8% were from Makkah, and the age ranged from 60 to 90 years and older. Results showed that 64.8% had a psychiatric disorder, 41.8% had hypertension, 38.4% had diabetes, 38.1% had movement disorders, 11.3% had heart diseases, and 1.5% had no chronic conditions. The mean STEADI tool score was 3.5 out of 12, and of the 323 older adult patients, 51.7% had a low risk to fall and 48.3% had a high risk to fall. Of the 13 interventions used to prevent falls, the most used intervention was rehabilitative physical therapy, followed by providing patient facilities and muscle strengthening exercises.

CONCLUSIONS

The level of falls was markedly low, and a significant correlation was observed between the risk of falling and the participants' region of residence.

Association of lower-limb strength with different fall histories or prospective falls in community-dwelling older people: a systematic review and meta-analysis

BACKGROUND

Fall is a major health threat to older people. The lower-limb power and rate of torque or force development (RTD or RFD) are prominently affected by aging and are crucial for maintaining postural balance. However, there have been inconsistent findings regarding the association of such aspects of lower-limb strength with falls among community-dwelling older adults. Comprehensive synthesis and appraisal are needed to examine what deficits in lower-limb rapid force generation could identify the fallers (i.e., those with a fall history or prospective falls).

METHODS

This systematic review searched six databases, including PubMed, Web of Science, EMBASE, Scopus, CINAHL, and Cochrane CENTRAL. Meta-analysis was conducted to aggregate standardized mean differences (SMD) or odds ratios (OR). The quality of evidence regarding each strength parameter's ability to identify fallers was assessed using the GRADE approach.

RESULTS

Twenty observational studies with 8,231 community-dwelling older adults were included (mean age: 73.5 years; male to female ratio: approximately 6:1). Moderate quality of evidence showed that the lower average leg-press power (SMD & 95% CI: -0.17 [-0.23, -0.12]; OR & 95% CI: 0.84 [0.79, 0.89]) and lower peak sit-to-stand power (Cohen's d = 0.41) could predict prospective falls in older adults, especially the injurious/recurrent falls. Low quality of evidence showed that the lower peak sit-to-stand power could also discern fall history (SMD & 95% CI: -0.58 [-0.96, -0.20]). Conversely, low to very low quality of evidence showed that the RTD of a single muscle group could not predict prospective falls and was generally unable to identify fall history in older adults. DISCUSSIONS AND CONCLUSION: The decline of entire lower-limb power appears a good indicator of prospective falls in community-dwelling older adults. Tests of entire lower-limb power required the cumulative and coordinated contractions of more leg muscles, possibly explaining why they could identify the fallers whereas the RTD or power of a single muscle group could not. Future studies are warranted to determine cut-point values of the entire lower-limb power measurements in fall-risk assessment and explore rapid force generation of a single muscle group in predicting the injurious falls among older adults.

TRIAL REGISTRATION

Registration No.: CRD42021237091.

A Comprehensive, Home-Based, Fall Prevention Initiative: Preliminary Data From the Raise'Age Program

BACKGROUND

Although falls among older adults pose substantial health risks and are often preventable, many fallers do not seek medical care. The Raise'Age program addresses this challenge by offering proactive fall prevention for older adults who require "lift assistance" but are not taken to hospital. The program includes (i) screening by emergency medical services (EMSs), (ii) referrals for a comprehensive geriatric assessment, (iii) in-home evaluations by a mobile geriatric team (MGT), and (iv) referrals to primary care physicians (PCPs). Here, we outline the program's design, development, and implementation.

METHODS

The program's activity in 2023 was assessed with regard to the number of EMS fall reports, the reports' completeness, the program's eligibility, and acceptance by physicians and patients, in-home assessments, adherence to geriatric follow-up programs, and coordination delays.

RESULTS

In 2023, the Raise'Age program received 959 reports, accounting for 48% of lift assistances by paramedics. Of these, 37% of the reports were reviewed for eligibility. Reports were often archived due to irrelevance, a recent hospital stay, or difficulty contacting PCPs. Among eligible reports, 77% were approved for in-home evaluations, and the remainder were referred to a geriatrician or scheduled for hospital admission. The median processing time was 26 days. Of 228 patients eligible for home visits, 150 accepted the intervention. Visit acceptance rates were higher when a PCP endorsed the program. Follow-up was provided to 36% of the patients- primarily via teleconsultation. Finally, 15.6% of the patients for whom a lift assistance report was sent to the MGT completed the Raise'Age program.

CONCLUSIONS

The Raise'Age program demonstrates that EMS screening and collaboration with MGTs are feasible, although some patients may decline the services offered. Continuous evaluations and interventions by MGTs and referrals to community-based medical and social services effectively address the needs of older adults.

Effects of Walking-Only Intervention on Physical Function, Fall-Related Outcomes, and Health-Related Quality of Life in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

This study aimed to determine the effects of walking-only intervention (walking was the only exercise in which people participated) on physical function, fall-related outcomes, and health-related quality of life in community-dwelling older adults. We conducted a systematic search across five electronic databases, assessing risk of bias using Minds Manual for Guideline Development. Meta-analyses were performed, and pooled standardized mean differences were calculated. Nine studies (a total of 1,309 participants) were included, showing that walking-only interventions improved walking endurance (standardized mean difference: 1.11, 95% confidence interval: [0.08, 2.15]) and health-related quality of life (standardized mean difference: 0.71, 95% confidence interval: [0.18, 1.25]). However, there were no significant improvements in other outcomes. The certainty of the evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation approach for all outcomes was graded as very low, primarily due to significant inconsistency and imprecision. Our results suggest that walking-only intervention can be effective for enhancing walking endurance and health-related quality of life for community-dwelling older adults. Further studies are required to investigate the effects of walking-only intervention. This need stems from the limited number of randomized controlled trials, heterogeneous intervention settings and results, and the very low certainty of the evidence.

Sentinel fracture: the necessity of improved post-fracture care

Fragility fractures caused by osteoporosis, the most common metabolic bone disease, place a significant burden on affected individuals and impose substantial economic costs. A fragility fracture implies an imminent elevated risk for subsequent fractures, particularly in the short term. Therefore, osteoporosis must be addressed in the event of a sentinel fracture, if not already previously treated. Regardless of whether the fracture is treated conservatively or surgically, post-fracture care is particularly important. Early mobilization followed by fall risk assessment and the initiation of adequate bone-specific medication are essential milestones in preventing subsequent fractures. Monitoring patients increases adherence to bone-specific medication and fall prevention strategies. Comprehensive post-fracture care is important and should be performed by a multidisciplinary team. Coordinated care models, such as the fracture liaison service (FLS), have shown enhancements in the initiation of and adherence to secondary prevention of fragility fractures. Despite recommendations by several guidelines including that published by the Austrian Society for Bone and Mineral Research, only one fracture liaison service has been implemented in Austria.

Exploring the Feasibility of a 5-Week mHealth Intervention to Enhance Physical Activity and an Active, Healthy Lifestyle in Community-Dwelling Older Adults: Mixed Methods Study

BACKGROUND

Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA).

OBJECTIVE

The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot.

METHODS

Our study used a mixed methods approach to evaluate the MIA app's acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based.

RESULTS

The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6%. Analysis showed general satisfaction with the app's workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants.

CONCLUSIONS

The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515.

Digital interactive experience- and game-based fall interventions for community-dwelling healthy older adults: a cross-disciplinary systematic review

Introduction

Falls pose significant health risks to older adults, impacting their quality of life. Preventive strategies are crucial, as research shows that fall prevention interventions can effectively reduce fall risks. However, these interventions often suffer from low adherence and uptake. Digital, interactive interventions, incorporating experience-, and game-related aspects, offer a promising solution, making this topic inherently cross-disciplinary.

Objective

This review aims to assess the current landscape of digital interactive experience and game-based fall interventions for community-dwelling, healthy older adults. It focuses on integrating Human Movement Science and User Experience & Game Design perspectives, emphasizing the cross-disciplinary nature of this research.

Methods

We employed a cross-disciplinary literature search framework, searching the databases ACM-DL, IEEE-Xplore, ScienceDirect, PubMed, Scopus, and Web of Science. The review focused on healthy community-dwelling older adults (50+), including those at risk of falling. Excluded were studies involving chronic diseases, non-age-related impairments, other age groups, or individuals receiving care. Only digital, interactive fall prevention interventions without commercial software were considered. Studies published between 2000-2024 were included. A qualitative thematic synthesis was conducted, focusing on four categories: Objectives (O), Design and Development (D), Types of Intervention (T), and Evaluation Methods (E).

Results

The search yielded 2,747 results, with 59 articles included in the final synthesis. Objectives were mainly driven by a combination of HMS and UXG rather than a single aspect. In Design and Development it was observed that concept-based design was scarce, with most being procedure-based. Descriptions of interventions frequently lacked specificity, particularly in-depth experience-related terminology and exercise descriptions. Evaluation methods were found to be more frequently informed by both HMS and UXG, although only four studies used a mixed-method approach to explore their interplay. Among included articles, most aspects incorporated both HMS and UXG across all four categories: O(n = 37), D(n = 37), T(n = 54), and E(n = 21).

Conclusion

The review underscores the importance of digital interactive experience- and game-based fall prevention interventions. It highlights the need for enhanced cross-disciplinary collaboration between HMS and UXG to address gaps, such as the lack of a shared thesaurus and standardized guidelines, which are vital for improving transparency, reproducibility, and the refinement of these interventions.

Intervention to systematize fall risk assessment and prevention in older hospitalized adults: a mixed methods study

BACKGROUND

Fall-prevention interventions are efficient but resource-requiring and should target persons at higher risk of falls. We need to ensure that fall risk is systematically assessed in everyday practice. We conducted a quality improvement (QI) intervention to systematize fall risk assessment and prevention in older adults hospitalized on general internal medicine wards. We evaluated the efficacy of the intervention in a pre-post intervention study and assessed its feasibility and acceptability through a mixed methods process evaluation, which results are reported in here.

METHODS

The QI intervention was conducted between 09/2022 and 10/2023 and targeted the nursing staff and residents in two tertiary hospitals of two different language and cultural regions of Switzerland. The intervention comprised an oral presentation, an e-learning, and reminder quizzes. We conducted a process evaluation including 25 interviews and a survey sent to all participants to assess feasibility and acceptability of the intervention. Quantitative data were analyzed descriptively and qualitative data with a mixed deductive and inductive approach. Results were integrated through meta-inferences.

RESULTS

Among 544 clinicians, 59% completed the e-learning, 74% found the intervention useful, and 25% reported an increase in interprofessional team working. A rewarding system was deemed motivating by 33% of clinicians. Main implementation barrier was the high workload. A concise and clear content as well as regular reminders were perceived as facilitators.

CONCLUSIONS

A concise and multimodal QI intervention with regular reminders seemed to be feasible and well-accepted. Future QI intervention projects should consider the barriers and facilitators identified in this project to improve quality of care in older hospitalized adults.

TRIAL REGISTRATION

The conducted research was not pre-registered.

The effectiveness of digital technology-based Otago Exercise Program on balance ability, muscle strength and fall efficacy in the elderly: a systematic review and meta-analysis

OBJECTIVE

To explore the impact of the digital implementation of the Otago Exercise Program (OEP) on balance ability (static and dynamic), muscle strength, and fall efficacy in elderly people; and analyze different potential influencing factors in subgroups to find the most suitable training plan.

METHODS

EBSCO, PubMed, Web of Science, and China Knowledge Network databases (core) were searched up to August 1, 2023. Experimental studies of implementing OEP based on digital technology to improve outcomes related to falls in the elderly were included. Bias risks were assessed using the Cochrane collaboration tool. Meta-analysis was performed to assess the pooled effect of balance ability (static and dynamic), muscle strength, and fall efficacy using a random effects model. Subgroup analyses were conducted to examine the potential modifying effects of different factors (e.g., training period, frequency, duration, age).

RESULTS

Twelve articles were included from the literature, including 10 randomized controlled trials, one single-group quasi-experimental study, and one case report. Digital technologies used in the studies were categorized into three types: (1) online interventions (Zoom, WeChat), (2) recorded videos (via computers, TVs, DVDs), and (3) wearable technologies (motion sensors, augmented reality systems). The implementation of OEP based on digital technology showed significantly improved on static balance (SMD = 0.86, 95% CI 0.35-1.37), dynamic balance (SMD = 1.07, 95% CI 0.90-1.24), muscular strength (SMD = 0.43, 95% CI 0.17-0.69), and fall efficacy (SMD=-0.70, 95% CI -0.98, -0.41); Subgroup analysis by period '≥12 weeks', frequency '≥3 times/week', and duration '≤45 minutes per session', respectively, showed significant improvements on static balance (SMD = 0.73, 95% CI 0.21-1.25; SMD = 0.86, 95% CI 0.35-1.37; SMD = 1.10, 95% CI 0.31-1.89), dynamic balance (SMD = 1.08, 95% CI 0.88-1.28; SMD = 1.01, 95% CI 0.93-1.27; SMD = 1.07, 95% CI 0.89-1.25), muscle strength (SMD = 0.43, 95% CI 0.10-0.75; SMD = 0.54, 95% CI 0.30-0.77; SMD = 0.53, 95% CI 0.19-0.87), and fall efficacy (SMD=-0.75, 95% CI -1.39, -0.11; SMD=-0.70, 95% CI -0.98, -0.41; SMD=-0.74, 95% CI -1.10, -0.39).

CONCLUSIONS

OEP implemented through digital technology effectively enhances static and dynamic balance, muscle strength, and self-efficacy in older adults. A training regimen of 12 weeks or more, with sessions occurring three or more times per week for 30 to 45 min, appears to be an effective approach for improving these outcomes based on the available evidence from the included studies. Future research should prioritize specific digital technologies and target populations, employing high-quality research designs to further explore these interventions, and consider new technologies such as wearables, to assess changes in fall prevalence.

Age Is Not Just a Number: The Intersection of Age, Orthopedic Injuries, and Worsening Outcomes Following Low-Energy Falls

BACKGROUND

The purpose of this study is to stratify the age at which older adults are most likely to sustain injuries and major complications resulting from low-energy falls so that fall prevention strategies may be targeted to more susceptible age groups.

METHODS

A consecutive series of 12 709 patients older than 55 years enrolled in an orthopedic trauma registry from October 2014 to April 2021 were reviewed for demographic factors, hospital quality measures, and outcomes. Patients were grouped by age brackets in 5-year intervals. Comparative analyses were conducted across age groups with an additional post hoc analysis comparing the 75- to 79-year-old cohort with others. All statistical analyses were conducted utilizing a Bonferroni-adjusted alpha.

RESULTS

Of the 12 709 patients, 9924 patients (78%) sustained a low-energy fall. The mean age of the cohort was 75.3 (range: 55-106) years and the median number of complications per person was 1.0 (range: 0-7). The proportion of females increased across each age group. The mean Charlson Comorbidity Index increased across each age group, except in the cohort of 90+ years of age. There was a varied distribution of fractures among age groups with the incidence of hip fractures most prominently increasing with age. Complication rates varied significantly between all age groups. Between the ages of 70 to 74 years and 80 to 84 years, there was a 2-fold increase in complication rate, and between the ages of 70 to 74 years and 75 to 79 years, there was a near 2×/1.5×/1.4× increase in inpatient, 30-day, and 1-year mortality rate, respectively. When controlling for confounding demographic variables between age groups, the rates of complications and mortality still differed.

CONCLUSIONS

Fall prevention interventions, while applicable to all older adult patients, could improve outcomes by offering additional resources particularly for individuals between 70 and 80 years of age. These additional resources can help minimize excessive hospitalizations, prolonged lengths of stay, and the detrimental complications that frequently coincide with falls. Although hip fractures are the most common fracture as patients get older, other fractures still occur with frequency, and fall prevention strategies should account for prevention of these injuries as well.

Effectiveness and cost-effectiveness of a single home-based fall prevention program: a prospective observational study based on questionnaires and claims data

BACKGROUND

Fall prevention programmes are essential interventions in societies with aging populations. This study assessed the fall rate and other health outcomes, as well as the cost-effectiveness of a home-based fall prevention programme for community-dwelling older people. In a single home visit, trained physical or occupational therapists performed fall risk assessments, eliminated environmental risk factors, and provided tailored exercises.

METHODS

A prospective, longitudinal observational study was performed with participants of a fall prevention programme who agreed to be followed-up over one year. Baseline data included self-reported falls one month and one year before the intervention. Participants were monitored through bi-monthly telephone calls, assessing their number of falls, fear of falling (using the Falls Efficacy Scale-International (FES-I), quality of life (using the EuroQuol-5 Dimensions-5 Levels, EQ-5D-5L), and physical activity (in minutes per week). Statistical analysis of the data used a Generalized Estimating Equations (GEE) Poisson-Modell for number of falls and a Linear Mixed Model (LMM) for fear of falling, quality of life and physical activity. In addition, health insurance claims data were used to compare the number of medically treated falls in the year before and after the intervention, as well as the related healthcare spending. Cost-effectiveness of the programme versus usual care was estimated as cost per prevented medically treated fall.

RESULTS

Overall, 639 person-years of observation time were analyzed. Participants had a mean age of 81.8 years (+/- 5.2) and 59% were female. On average, the fall rate decreased from 1.35 to 1.02 per person-year, or -23.9% (95%CI from -35.92 to -9.67), fear of falling decreased by -1.27 points (95%CI from -1.50 to -1.05), quality of life improved by -0.88 points (95%CI from -1.09 to -0.68), and physical activity increased by 9.87 min per day (95%CI from 5.65 to 14.09). Analysis of claims data showed a 48.0% reduction (95%CI from 30.5% to 61.0%) in medically treated falls. The average cost per prevented medically treated fall was estimated at approximately 1,353 USD, with a 50% probability of the intervention being cost saving.

CONCLUSIONS

This fall prevention programme with a single home visit was found to be effective and cost effective. Health policies should establish such a model as a reimbursed standard care to assist in combatting the increasing burden of falls on individuals and societies.

Middle-Aged and Young People's Perspectives on Healthy Aging Through Exercise: Environmental, Psychosocial, and Individual Factors With the Photovoice Method

The aim of this study is to examine the individual's perspective on healthy aging through exercise. Individuals aged 18-60 years who have been physically active for at least one year were included in this study. The study focused on the exercise behaviors of young and middle-aged individuals through photographs. The photovoice method was used to discover how healthy aging affects exercise behaviors in physically active individuals. Content analysis was used to analyze photographs and the photovoice of the participants. Environmental, psychosocial, and individual themes emerged with the interpretation of the data. According to the results of this study, environmental, psychosocial, and individual factors have been found to be effective for healthy aging. The contribution of exercise to personal development was beneficial in strengthening the network of interpersonal relationships and improving physical and mental health in young and middle-aged adults. Exercise programs should not be monotonous, and individuals should not depend on a single location for exercise.

Rehabilitative good clinical practice in the treatment of osteoporosis: a comprehensive review of clinical evidences

PURPOSE

Clinical practice guidelines (CPGs) are essential for guiding rehabilitation interventions. However, CPGs specifically addressing rehabilitation for osteoporosis patients remain scarce in the literature. This review aims to present, compare, and summarize recent guidelines and evidence, highlighting best practices in osteoporosis rehabilitation management.

MATERIALS AND METHODS

A total of 19 guidelines were identified following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Three independent appraisers assessed the quality of each CPG using the Appraisal of Guidelines for Research and Evaluation version II (AGREE II) instrument. Standardized domain and overall quality scores were calculated, and intraclass correlation coefficients (ICCs) were used to assess the level of agreement among the appraisers.

RESULTS

Agreement among appraisers for AGREE II scores ranged from moderate to very good (ICC = 0.60 to 0.90). The quality of the included CPGs varied significantly, with AGREE sub-scores ranging from 48.25% to 75.73%. The Level of Evidence (LoE) and Grade of Recommendation (GoR) differed across the guidelines included in this review. Information on exercise types, intensity, frequency, duration, and contraindications were inconsistent among CPGs.

CONCLUSIONS

Recommendations regarding exercise parameters were often vague and inconsistent between CPGs, necessitating critical evaluation by healthcare providers when making clinical decisions.

ExerG - an exergame-based training device for the rehabilitation of older adults: a functional model usability study

BACKGROUND

Exergames are interactive technology-based exercise programs. By combining physical and cognitive training components, they aim to preserve independence in older adults and reduce their risk of falling. This study explored whether primary end users (PEU, healthy older adults and patients with neurological and geriatric diagnoses) and secondary end users (SEU, health professionals) evaluated the ExerG functional model to be usable, providing a positive experience and therefore acceptable.

METHODS

We conducted a multi-methods study using several assessments to quantify usability and enjoyment outcomes, along with semi-structured interviews to gain an in-depth understanding of the users' experiences. Descriptive statistics were used for quantitative outcome measures. For qualitative data, a thematic analysis (TA) using an inductive, data-driven approach was carried out to develop themes for each user group.

RESULTS

We interviewed 20 PEUs (13 healthy older adults, 7 patients) and 22 SEUs at two rehabilitation centres in Austria and Switzerland. Users' scores of over 70 on the System Usability Scale denoted good usability. On the Physical Activity Enjoyment Scale-16, both PEU groups rated the ExerG highly. Our TA approach identified four themes per user group. Themes from both PEU groups confirmed their enjoyment of training with the ExerG, however more variety and greater challenges were requested. Whilst the patient group appreciated the security given by the harness system, the healthy older adults reported feeling restricted. SEU themes reflected their approval of this novel training device, although a desire for increased difficulty and more individualisation was expressed. Clear instructions and an easy-to-use harness system were acknowledged and useful feedback for the developers emerged.

CONCLUSIONS

The ExerG is usable, offers a positive experience, and can therefore be regarded as an acceptable solution for the combined physical and mental training of older adults. Our findings contribute to the ongoing development of the ExerG, which will be a welcome addition to current training options for this target group. Further research is needed to confirm its effectiveness in preserving or improving functional independence in daily life and reducing the risk of falling.

Postural Responses in Trauma-Experienced Individuals

Background: Balance and proprioception are essential elements in postural control and injury prevention. Proprioception, the body's sense of position and movement, is closely tied to balance, which depends on input from the visual, vestibular, and somatosensory systems. This article explores the link between trauma experiences and proprioceptive dysfunction, emphasizing how heightened muscle tone, dissociation, and altered sensory processing contribute to balance issues and the risk of injury. Method: The study included 48 participants, aged 18-25. Participants completed the Emotional Regulation Scale, Dissociative Experiences Scale II, and Childhood Trauma Questionnaire, after which they had to stand on a BTrackS Balance Plate while being exposed to images that are designed to evoke emotions from the OASIS image set. The balance plate software calculated outcomes of the participants' postural sway (total sway, sway area, root mean square (RMS) to the mediolateral (ML) and anteroposterior (AP) way, and excursion to ML and AP ways). Results: Dissociative experience shows significant correlation with RMS ML when viewing positive pictures (rτ = 0.207, p = 0.045) and when viewing negative pictures again; scores with RMS ML (rτ = 0.204, p = 0.049) but also with RMS AP (rτ = 0.209, p = 0.042) and with Excursion ML (rτ = 0.200, p = 0.049) were significant. Experiences of physical abuse affected certain indicators of postural sway when viewing positive images compared to participants with no such experience (sway area: U = 374.50, p = 0.027; RMS AP: U = 383.50, p = 0.016; Excursion ML: U = 397.00, p = 0.007). Similarly, physical neglect affected postural sway during viewing of negative images (sway area: U = 366.50, p = 0.003; RMS AP: U = 371.00, p = 0.004; Excursion ML: U = 347.00, p = 0.034; and Excursion AP: U = 353.00, p = 0.010). Conclusions: The study highlights that dissociation disrupts balance in trauma survivors, especially under emotional stress which highlights the potential for motor-based treatments.

Regular physical activity improves physical function and health-related quality of life among middle-aged and older women who suffered a fragility fracture-a population-based cohort

Fragility fractures are a major problem in our aging society leading to early death and loss of independence for activities of daily living. Physical activity in a long-term follow-up of Portuguese women over 50 years with a fragility fracture was associated with better physical function and quality of life.

PURPOSE

To evaluate the long-term impact of physical activity on physical function and health-related quality of life (HRQoL) in women ≥ 50 years old who suffered a fragility fracture.

METHODS

We evaluated the association of physical activity with physical function and HRQoL in women ≥ 50 years old who self-reported at least one low-impact fracture ≥ 40 years old from the EpiDoC cohort, a population-based cohort. Self-reported data regarding sociodemographics, clinical, and lifestyle behaviors were collected through a semi-structured questionnaire at baseline during a face-to-face clinical interview. During a long-term follow-up, a phone interview was conducted to evaluate physical activity (using a non-validated scale developed for the EpiDoC study), physical function (Health Assessment Questionnaire), and HRQoL (European Quality of Life - 5 Dimension). Women were divided into three groups according to the frequency of physical activity (non-frequent = 0 times/week, frequent = 1-2 times/week, or very frequent =  ≥ 3 times/week). The association of physical activity frequency (non-frequent, frequent, and very frequent) with physical function and HRQoL over time was assessed through linear mixed models considering varying intercepts for each woman.

RESULTS

This study followed 323 post-fracture women, during a mean follow-up of 3.9 ± 3.5 years. Frequent (β =  - 0.1419 [- 0.2783, - 0.0064]) and very frequent (β =  - 0.1908 [- 0.2944, - 0.0881]) physical exercise were associated with improvements in physical function relative to non-frequent physical exercise adjusted for BMI, multimorbidity, hospitalizations, alcohol and smoking habits, and the number of fragility fractures at baseline. As for HRQoL, a positive association was found for exercise frequency, specifically frequent (β = 0.1305 [0.0646, 0.1958]) and very frequent (β = 0.1354 [0.0856, 0.1859]) suggesting improvements for HRQoL, in this follow-up period.

CONCLUSIONS

These findings based on longitudinal data with long-term follow-up suggest that regular physical activity is associated with better function and HRQol among middle-aged and older post-fracture osteoporotic Portuguese women.

FallFitness exercise program provided using the train-the-trainer approach for community-dwelling older adults: a randomized controlled trial

BACKGROUND

Falls and fall-related injuries remain a global challenge and threat to the health of older adults. Specific strength and balance exercises are effective in preventing falls among community-dwelling older adults. Nevertheless, provision of evidence-based fall prevention interventions to a broad population represents a healthcare challenge, indicating that new models for promoting exercise among community-dwelling older adults need to be addressed. Here, we aimed to evaluate the effects of a peer-led group-based exercise intervention provided using the train-the-trainer approach and targeting physical performance, activity level, handgrip strength, quality of life, fall-related self-efficacy, fear of falling, and falling techniques compared with a control group at 8-week follow-up.

METHODS

This randomized controlled trial (RCT) included trainers and participants who were recruited from four collaborating regional organizations for retired persons. The intervention was planned to be provided in five municipalities in Sweden, depending on the location of the registered trainers. Eligible participants included adults aged ≥ 60 years who could walk independently and understand written and oral information in Swedish. The FallFitness multicomponent exercise program delivered weekly strength, balance, and falling techniques over eight weeks. It was evaluated using the train-the-trainer approach. Fourteen older adults were eligible for trainer education, and 101 participants were randomly allocated for the FallFitness exercise (n = 50) or a control group (n = 51).

RESULTS

After 8 weeks of peer-led training, the short multicomponent exercise program significantly improved the physical activity levels (p = 0.036) and backward and sideways falling techniques (p < 0.001) compared to those in the control group. Fear of falling significantly decreased in the exercise group (p = 0.009). Other outcomes in this study showed to be non-significant.

CONCLUSIONS

The multicomponent exercise program provided in eight sessions using the train-the-trainer approach may be effective in promoting physical activity and the learning of motor skills and safe landing strategies. Furthermore, the FallFitness exercise program may reduce the fear of falling and may be both time- and cost-effective.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT06265480 (20240208).

Risk Factors for Falls in Community-Dwelling Older Adults During the Novel Coronavirus Pandemic in Japan: A Prospective Cohort Study

This study aimed to test the hypothesis that knowledge derived from indirect assessments can be used to identify fall risk factors during a period of social distancing. A baseline survey of 1953 community-dwelling older adults was conducted in May 2020, with a follow-up survey performed in May 2023 to assess the situation 3 years later. In total, 339 individuals were followed from baseline to follow-up. Baseline age, sex, Questionnaire for Change of Life, Frailty Screening Index, and Questionnaire for Medical Checkup of Old-Old (QMCOO) scores and subscales were used to determine fall predictors. In addition, history of falls in the past year was assessed at follow-up (outcome). The participants were categorized into fall (n = 78) and non-fall (n = 261) groups. Using binary logistic regression analysis, items that showed significant differences in a between-group comparison were analyzed, and age and history of falls, which were sub-items of the QMCOO, were identified as predictors of falls. Although special assessments may be required during periods of social distancing, we believe that it is important for these assessments to continue being performed as they are performed during normal times.

Falls prevention interventions for community-dwelling older adults: systematic review and meta-analysis of benefits, harms, and patient values and preferences

BACKGROUND

About 20-30% of older adults (≥ 65 years old) experience one or more falls each year, and falls are associated with substantial burden to the health care system, individuals, and families from resulting injuries, fractures, and reduced functioning and quality of life. Many interventions for preventing falls have been studied, and their effectiveness, factors relevant to their implementation, and patient preferences may determine which interventions to use in primary care. The aim of this set of reviews was to inform recommendations by the Canadian Task Force on Preventive Health Care (task force) on fall prevention interventions. We undertook three systematic reviews to address questions about the following: (i) the benefits and harms of interventions, (ii) how patients weigh the potential outcomes (outcome valuation), and (iii) patient preferences for different types of interventions, and their attributes, shown to offer benefit (intervention preferences).

METHODS

We searched four databases for benefits and harms (MEDLINE, Embase, AgeLine, CENTRAL, to August 25, 2023) and three for outcome valuation and intervention preferences (MEDLINE, PsycINFO, CINAHL, to June 9, 2023). For benefits and harms, we relied heavily on a previous review for studies published until 2016. We also searched trial registries, references of included studies, and recent reviews. Two reviewers independently screened studies. The population of interest was community-dwelling adults ≥ 65 years old. We did not limit eligibility by participant fall history. The task force rated several outcomes, decided on their eligibility, and provided input on the effect thresholds to apply for each outcome (fallers, falls, injurious fallers, fractures, hip fractures, functional status, health-related quality of life, long-term care admissions, adverse effects, serious adverse effects). For benefits and harms, we included a broad range of non-pharmacological interventions relevant to primary care. Although usual care was the main comparator of interest, we included studies comparing interventions head-to-head and conducted a network meta-analysis (NMAs) for each outcome, enabling analysis of interventions lacking direct comparisons to usual care. For benefits and harms, we included randomized controlled trials with a minimum 3-month follow-up and reporting on one of our fall outcomes (fallers, falls, injurious fallers); for the other questions, we preferred quantitative data but considered qualitative findings to fill gaps in evidence. No date limits were applied for benefits and harms, whereas for outcome valuation and intervention preferences we included studies published in 2000 or later. All data were extracted by one trained reviewer and verified for accuracy and completeness. For benefits and harms, we relied on the previous review team's risk-of-bias assessments for benefit outcomes, but otherwise, two reviewers independently assessed the risk of bias (within and across study). For the other questions, one reviewer verified another's assessments. Consensus was used, with adjudication by a lead author when necessary. A coding framework, modified from the ProFANE taxonomy, classified interventions and their attributes (e.g., supervision, delivery format, duration/intensity). For benefit outcomes, we employed random-effects NMA using a frequentist approach and a consistency model. Transitivity and coherence were assessed using meta-regressions and global and local coherence tests, as well as through graphical display and descriptive data on the composition of the nodes with respect to major pre-planned effect modifiers. We assessed heterogeneity using prediction intervals. For intervention-related adverse effects, we pooled proportions except for vitamin D for which we considered data in the control groups and undertook random-effects pairwise meta-analysis using a relative risk (any adverse effects) or risk difference (serious adverse effects). For outcome valuation, we pooled disutilities (representing the impact of a negative event, e.g. fall, on one's usual quality of life, with 0 = no impact and 1 = death and ~ 0.05 indicating important disutility) from the EQ-5D utility measurement using the inverse variance method and a random-effects model and explored heterogeneity. When studies only reported other data, we compared the findings with our main analysis. For intervention preferences, we used a coding schema identifying whether there were strong, clear, no, or variable preferences within, and then across, studies. We assessed the certainty of evidence for each outcome using CINeMA for benefit outcomes and GRADE for all other outcomes.

RESULTS

A total of 290 studies were included across the reviews, with two studies included in multiple questions. For benefits and harms, we included 219 trials reporting on 167,864 participants and created 59 interventions (nodes). Transitivity and coherence were assessed as adequate. Across eight NMAs, the number of contributing trials ranged between 19 and 173, and the number of interventions ranged from 19 to 57. Approximately, half of the interventions in each network had at least low certainty for benefit. The fallers outcome had the highest number of interventions with moderate certainty for benefit (18/57). For the non-fall outcomes (fractures, hip fracture, long-term care [LTC] admission, functional status, health-related quality of life), many interventions had very low certainty evidence, often from lack of data. We prioritized findings from 21 interventions where there was moderate certainty for at least some benefit. Fourteen of these had a focus on exercise, the majority being supervised (for > 2 sessions) and of long duration (> 3 months), and with balance/resistance and group Tai Chi interventions generally having the most outcomes with at least low certainty for benefit. None of the interventions having moderate certainty evidence focused on walking. Whole-body vibration or home-hazard assessment (HHA) plus exercise provided to everyone showed moderate certainty for some benefit. No multifactorial intervention alone showed moderate certainty for any benefit. Six interventions only had very-low certainty evidence for the benefit outcomes. Two interventions had moderate certainty of harmful effects for at least one benefit outcome, though the populations across studies were at high risk for falls. Vitamin D and most single-component exercise interventions are probably associated with minimal adverse effects. Some uncertainty exists about possible adverse effects from other interventions. For outcome valuation, we included 44 studies of which 34 reported EQ-5D disutilities. Admission to long-term care had the highest disutility (1.0), but the evidence was rated as low certainty. Both fall-related hip (moderate certainty) and non-hip (low certainty) fracture may result in substantial disutility (0.53 and 0.57) in the first 3 months after injury. Disutility for both hip and non-hip fractures is probably lower 12 months after injury (0.16 and 0.19, with high and moderate certainty, respectively) compared to within the first 3 months. No study measured the disutility of an injurious fall. Fractures are probably more important than either falls (0.09 over 12 months) or functional status (0.12). Functional status may be somewhat more important than falls. For intervention preferences, 29 studies (9 qualitative) reported on 17 comparisons among single-component interventions showing benefit. Exercise interventions focusing on balance and/or resistance training appear to be clearly preferred over Tai Chi and other forms of exercise (e.g., yoga, aerobic). For exercise programs in general, there is probably variability among people in whether they prefer group or individual delivery, though there was high certainty that individual was preferred over group delivery of balance/resistance programs. Balance/resistance exercise may be preferred over education, though the evidence was low certainty. There was low certainty for a slight preference for education over cognitive-behavioral therapy, and group education may be preferred over individual education.

CONCLUSIONS

To prevent falls among community-dwelling older adults, evidence is most certain for benefit, at least over 1-2 years, from supervised, long-duration balance/resistance and group Tai Chi interventions, whole-body vibration, high-intensity/dose education or cognitive-behavioral therapy, and interventions of comprehensive multifactorial assessment with targeted treatment plus HHA, HHA plus exercise, or education provided to everyone. Adding other interventions to exercise does not appear to substantially increase benefits. Overall, effects appear most applicable to those with elevated fall risk. Choice among effective interventions that are available may best depend on individual patient preferences, though when implementing new balance/resistance programs delivering individual over group sessions when feasible may be most acceptable. Data on more patient-important outcomes including fall-related fractures and adverse effects would be beneficial, as would studies focusing on equity-deserving populations and on programs delivered virtually.

SYSTEMATIC REVIEW REGISTRATION

Not registered.

Balance training in older adults enhances feedback control after perturbations

Background

As we age, avoiding falls becomes increasingly challenging. While balance training can mitigate such challenges, the specific mechanisms through which balance control improves remains unclear.

Methods

We investigated the impact of balance training in older adults on feedback control after perturbations, focusing on kinematic balance recovery strategies and muscle synergy activation. Twenty older adults aged over 65 underwent short-term (one session) and long-term (3-weeks, 10 sessions) balance training, and their recovery from unpredictable mediolateral perturbations was assessed. Perturbations consisted of 8° rotations of a robot-controlled platform on which participants were balancing on one leg. We measured full-body 3D kinematics and activation of 15 leg and trunk muscles, from which linear and rotational kinematic balance recovery responses and muscle synergies were obtained.

Results

Our findings revealed improved balance performance after long-term training, characterized by reduced centre of mass acceleration and (rate of change of) angular momentum. Particularly during the later stage of balance recovery the use of angular momentum to correct centre of mass displacement was reduced after training, decreasing the overshoot in body orientation. Instead, more ankle torque was used to correct centre of mass displacement, but only for perturbations in medial direction. These situation and strategy specific changes indicate adaptations in feedback control. Activation of muscle synergies during balance recovery was also affected by training, specifically the synergies responsible for leg stiffness and ankle torques. Training effects on angular momentum and the leg stiffness synergy were already evident after short-term training.

Conclusion

We conclude that balance training in older adults refines feedback control through the tuning of control strategies, ultimately enhancing the ability to recover balance.

Community emergency medical services approaches to fall prevention: a systematic review

BACKGROUND

Falls are a leading cause of morbidity and mortality among older adults in the USA. Current approaches to fall prevention often rely on referral by primary care providers or enrolment during inpatient admissions. Community emergency medical services (CEMS) present a unique opportunity to rapidly identify older adults at risk for falls and provide fall prevention interventions in the home. In this systematic review, we seek to assess the efficacy and qualitative factors determining success of these programs.

METHODS

Studies reporting the outcomes of fall prevention interventions delivered by EMS were identified by searching the electronic databases PubMed, Embase, Web of Science Core Collection, CINAHL and the Cochrane Central Register of Controlled Trials through 11 July 2023.

RESULTS

35 studies including randomised and non-randomised experimental trials, systematic reviews and qualitative research primarily from Western Europe, the USA, Australia and Canada were included in our analysis. Current fall prevention efforts focus heavily on postfall referral of at-risk community members. CEMS fall prevention interventions reduced all-cause and fall-related emergency department encounters, subsequent falls and EMS calls for lift assist. These interventions also improved patient health-related quality of life, independence with activities of daily living, and secondary health outcomes.

CONCLUSIONS

CEMS programmes provide an opportunity for direct, proactive fall prevention on the individual level. Addressing barriers to implementation in the context of current emergency medical systems in the USA is the next step toward widespread implementation of these novel fall prevention interventions.

A scoping review of safe mobility behaviour in fall prevention: implications for people with Parkinson's disease

PURPOSE

Falls are a major concern for people with Parkinson's disease (PwPD) due to associated motor and non-motor impairments. Promoting safe mobility behaviour may be an effective fall prevention intervention, however this concept is poorly articulated in the literature. The aim of this scoping review was to map out the definition and concepts of safe mobility behaviour to draw implications for PwPD.

MATERIALS AND METHODS

The Joanna Briggs Institute methodology for scoping reviews was followed. Studies involving older adults (aged ≥ 65 years) and/or PwPD that sought to define, describe, and/or explain this concept were included.

RESULTS

Of the 21,936 records retrieved, 124 publications were included. No studies defined safe mobility behaviour. However, its performance was described as a combination of observable actions and cognitive processes. Mobility behaviour was influenced by an interaction between the person, environment, and task performance.

CONCLUSION

We propose a definition for safer mobility behaviour as any protective action and associated functional cognitive process used to reduce the likelihood of a fall during mobility-related activities. It is unique to each person and occurs across a continuum of safer to riskier behaviour. Future research developing and testing interventions targeting safer mobility behaviour for PwPD is warranted.

Tai chi improves balance performance in healthy older adults: a systematic review and meta-analysis

Background

Previous research has indicated that tai chi exercise can effectively enhance balance performance in patients; however, its impact on healthy individuals remains uncertain. Therefore, this meta-analysis aims to investigate the effects of different intensities and styles of tai chi exercise on the balance performance of healthy older adult individuals.

Methods

A targeted search method was employed to identify studies investigating the impact of tai chi exercise on balance in older adults across a range of databases, including Web of Science, PubMed, Cochrane Central, EBSCO, CHKI, and Embase. The studies were conducted in accordance with the PRISMA and PERSiST guidelines, and two independent reviewers were responsible for the search, screening of results, extraction of data, and assessment of study quality. A random-effects model was employed to calculate the weighted mean difference (WMD) and 95% confidence interval (CI).

Results

2000 participants who met inclusion criteria were included in analyses across 28 trials. The findings indicated that tai chi can enhance the balance performance of healthy older adults, as demonstrated by the Timed Up and Go test (WMD = -1.04, 95% CI: -1.36 to-0.72, p < 0.00001, I2 = 71%), functional Reach test (FR) (WMD = 2.81, 95% CI: 1.60 to 4.02, p < 0.00001, I2 = 56%), and Berg Balance Scale (WMD = 2.55, 95% CI: 1.19 to 3.91, p = 0.0002, I2 = 88%), as well as other balance tests such as SLS (WMD = 5.03, 95% CI: 3.08 to 6.97, p < 0.00001, I2 = 85), and GS (WMD = 0.09, 95% CI: 0.05 to 0.12, p < 0.00001, I2 = 54%). Subgroup analyses showed that tai chi exercise for both ≤12 and > 12 weeks was statistically significant (< 0.01, respectively) for balance performance in healthy older adults, especially for tai chi exercise performed more than twice a week (WMD = -1.03, 95% CI: -1.35 to -0.72, p < 0.00001) and for more than 45 min each time (WMD = -1.11, 95% CI: -1.58 to-0.63, p < 0.00001) tai chi exercise had greater benefits on TUG time, FR distance and BBS in healthy older adults. In addition, compared to Sun-style tai chi, Yang-style tai chi was more effective.

Conclusion

The tai chi exercise positively affects the balance performances of healthy older adults. Engaging in short-term (≤12 weeks) exercise for more than two 45-min sessions per week has been found to produce more pronounced effects. The effectiveness of Yang-style tai chi is superior to that of Sun-style tai chi.

Systematic review registration

PROSPERO ID is CRD42024532577 https://www.crd.york.ac.uk/prospero/.

Among people on osteoporosis medication, loss of appendicular or total body lean mass is an independent risk factor for hip and major osteoporotic fractures

People with prior lean mass loss had a ~ 10% higher risk of MOF and ~ 22-26% higher risk of hip fracture, and the results were similar in people on anti-osteoporosis medications. Loss of lean mass is associated with increased fracture risk. Patients should be encouraged to pursue strategies to prevent loss of lean mass.

BACKGROUND

Sarcopenia increases fracture risk. If the risk persists after starting osteoporosis medication, patients may need to be encouraged to pursue strategies to prevent loss of lean mass.

OBJECTIVE

To estimate the effects of loss in appendicular lean mass (ALM) or total body lean mass (TBLM) on subsequent fracture risk and effect modification with anti-osteoporosis medication use.

METHODS

We conducted a registry-based cohort study linked to population-based data. We identified individuals ≥ 40 years of age with two DXA assessments ≥ 1 year apart and minimum 0.5 years of observation. ALM and TBLM were estimated from weight, sex, and percent fat from DXA (R2 = 0.91 and 0.84 vs total body DXA, respectively). We report hazard ratios (HR) from Cox regression models estimating time to first incident major osteoporotic fracture (MOF) and hip fracture, adjusted for fracture risk; osteoporosis medication was included as an interaction term and used to stratify analyses.

RESULTS

We included 21,249 individuals (mean 67 [SD 10] years, 95% female, 37% on osteoporosis medication). The mean follow-up was 7 years (SD 4). A total of 1868 and 548 people had incident MOF and hip fracture, respectively. People with prior ALM loss (HR per SD 1.09, 95% CI 1.04-1.15) or TBLM loss (HR per SD 1.09, 95% CI 1.42-1.14) had a higher risk of MOF. Hip fracture risk was greater in people with prior ALM loss (HR per SD 1.22, 95% CI 1.12-1.33) and TBLM loss (HR per SD 1.26, 95% CI 1.16-1.38). There were no interactions with anti-osteoporosis medication use (all p > 0.3). When restricted to people on anti-osteoporosis medication, each SD in ALM or TBLM loss was associated with 8-9% increased MOF risk and 18-23% increased hip fracture risk.

CONCLUSIONS

Loss of lean mass is associated with increased fracture risk among individuals on anti-osteoporosis medication. Patients should be encouraged to pursue strategies to prevent sarcopenia.

Facilitators and barriers in the implementation of a fall prevention program based on physical activity for elderly people living in the community: A qualitative study

BACKGROUND

Physical activity is recognized as beneficial for older individuals in preventing falls. Achieving high adherence to exercise programs among the elderly poses challenges for administrations and healthcare systems. This study explored the facilitators and barriers perceived by both the participants and nurse trainers involved in an exercise program aimed at preventing falls in primary healthcare.

METHODS

Sixteen semi-structured interviews with elderly people who had participated in the Otago Exercise Program and a focus group of nurse trainers of this program were conducted between October 2018 and September 2019 in primary health care centers in Lleida, Spain. Interviews were transcribed and analyzed using inductive thematic analysis with Atlas.ti 8 software.

RESULTS

Analysis revealed five overarching categories and 17 subcategories. Key facilitators included personal motivation, the perceived benefits of exercise, and the supportive role of nurse trainers. Primary barriers encompassed factors such as the excessive duration of the program, not considering personal preferences for individual or group participation, and differences in physical condition among group participants.

CONCLUSIONS

To increase participation and adherence to exercise programs, it is necessary to consider the important role of the nursing professionals that recommend program enrolment and the participants' personal motivations. The program with group sessions is a model that is easy to integrate into Primary Healthcare centers, which must always take into account the preferences and physical conditions of the participants.

Home-Based, Low-Intensity, Gamification-Based, Interactive Physical-Cognitive Training for Older Adults Using the ADDIE Model: Design, Development, and Evaluation of User Experience

Background

Declines in physical and cognitive function are natural biological processes, leading to an increased risk of falls. Promising evidence suggests that combined physical-cognitive exercise has beneficial effects in improving both physical and cognitive health. Although moderate-to-high exercise intensity is commonly recommended, it might be impractical for older adults facing physical limitations or contraindications. Thus, low-intensity exercise is a viable option. The main barriers to engaging in exercise in older adults include transportation, time, motivation, and enjoyment. To overcome these challenges, a home-based, gamification-based training system may provide an effective approach to enhance exercise adherence.

Objective

This study aimed to develop and evaluate the usability of a low-intensity, gamification-based, interactive physical-cognitive exercise for older adults in a home-based setting.

Methods

The prototype of a game-based physical-cognitive exercise was created following the ADDIE model (analysis, design, development, implementation, and evaluation) and assessed for user experience in older adults. A total of 15 older adults engaged in the game-based physical-cognitive exercise at home for 60 minutes per day, 3 days per week, for 4 weeks. The usability of the game-based training system was evaluated using the system usability scale (SUS) after completion of a 4-week training program. As for satisfaction, the 8-item Physical Activity Enjoyment Scale (PACES) questionnaire was used to assess participants' enjoyment level after 1 week and 4 weeks of training. Descriptive statistics were used to illustrate the SUS score. A Wilcoxon signed-rank test was used to compare the PACES scores between the first week and the end of the 4-week period, with significance set at P<.05.

Results

As for experts' consensus, the game-based training consisted of 3 games: Ocean Diver, Road Runner, and Moving and Memorizing. The games had 3 levels of difficulty: beginner, intermediate, and advanced. A computer vision-based system was selected as the delivery platform for a home setting. The total SUS score for all participants was mean 87.22 (SD 5.76), indicating the user's perception of the usability of a system ranging from good to excellent. At the end of the 4-week training, the total PACES score was significantly greater than the first week, suggesting an improvement in enjoyment (first week: mean 44.93, SD 3.99 vs fourth week: mean 50.53, SD 4.70; P=.001).

Conclusions

The prototype of low-intensity, gamification-based, interactive physical-cognitive training was designed and developed using the ADDIE model, which included both experts and end users in the process. The findings showed that the exergame prototype was a usable and practical approach for a home-based setting, enhancing older adults' enjoyment and motivation. Further research is warranted to determine the effectiveness of such gamification-based training in promoting physical and cognitive functions.