Development of a lifestyle-integrated physical exercise training and home modification intervention for older people living in a community with a risk of falling (Part 1): the FIT-at-Home fall prevention program

Health Support for At-Risk Older Adults during COVID-19

Older adults are highly susceptible to COVID-19 infection and at the highest risk for severe disease and death. Yet, older adults lacked access to accurate and easy-to-use COVID-19 information and support early in the pandemic. This prospective, experimental cohort study sought to examine whether older adults could be engaged during the pandemic through a community partner and if a low-touch intervention, designed with health literacy best practices, could positively impact COVID-19 knowledge, mitigation behaviors, telehealth/doctor visits, exercise, and loneliness. A senior resource kit was distributed to older adults sheltering at home through food assistance program agents from October 2020 to February 2021; the kit was developed using health literacy best practices. Simple random assignment was used to divide program participants into treatment and control groups. Both groups received senior kits, but the treatment group also received telephonic health coaching. The primary outcome was COVID-19 knowledge and mitigation behaviors as derived from self-reported surveys at baseline and after four months. Secondary outcomes included a telehealth or doctor visit, exercise frequency, and a loneliness score (3-Item Loneliness Scale). Health literacy was assessed using the BRIEF screening tool. Ninety-eight older adults consented to participate in the study and 87 completed the study (88.7% completion rate). Participants had moderate clinical risk, one-third preferred the Spanish language, and 52% were categorized as having inadequate or marginal health literacy. Significant changes were found for increasing COVID-19 mitigation behaviors and the frequency of exercise across the cohort, but not for COVID-19 knowledge, telehealth visits, or decreasing loneliness. Conclusions: Partnering with a trusted entity in the community is a feasible and important strategy to reach older adults during a lockdown and provide them with easy-to-read health information and resources. If the time horizon had been longer, improvements in other outcome variables may have been achieved.

Views, experiences and attitudes of community-living older people towards the FIT-at-Home fall prevention programme: A qualitative interview study / Sichtweisen, Erfahrungswerte und Einstellungen von sturzgefährdeten Menschen im höheren Lebensalter zum FIT-at-Home-Sturzpräventionsprogramm: Eine qualitative Interviewstudie

Background

For older people, poor balance and strength as well as environmental hazards are a major risk factor for falls. A lifestyle-integrated home-based physical exercise training and home modification intervention were developed for older people at risk of falling.

Aim

This study aimed to examine older people's perceptions of the FIT-at-Home fall prevention intervention in order to further develop the intervention's content, procedures and mode of delivery.

Methods

We conducted semi-structured interviews with individuals who participated in the falls prevention programme using the problem-centred interview method. The interviews were analysed in a deductive-inductive approach following Mayring's qualitative content analysis.

Results

Seven themes emerging from the data described different facets of older people's perceptions towards the intervention. Findings suggested that the participants accepted the FIT-at-Home intervention. Overall, the individuals regard the intervention as feasible and practicable. From the older people's view, it was an advantage that the exercises could be implemented at any time without additional aids or equipment in-house and it was not necessary to visit the occupational therapy practice. Older people's experiences showed that feelings of success have a positive effect on the willingness to exercise. A perceived barrier influencing the implementation of exercises among older people was their own laziness, their general state of health and illnesses, their daily mood or meteor sensitivity.

Conclusion

The FIT-at-Home intervention comprising balance and strength exercises and home modification is feasible and acceptable for community-living older people. Older people's feedback will help us to further refine the intervention.

A feasibility study of a home-based lifestyle-integrated physical exercise training and home modification for community-living older people (Part 2): the FIT-at-Home fall prevention program

PURPOSE

This study was conducted in a home-based context where trained occupational therapists delivered progressive physical exercise training and home modification intervention for preventing falls, namely the FIT-at-Home intervention. We assessed the feasibility of the intervention's content and mode of delivery from the occupational therapists' perspective as well as the feasibility of study procedures.

METHODS

We used a mixed-methods approach, which generated qualitative data from 14 OTs' after delivering the intervention via interviews and quantitative data of the study procedures via questionnaires and documentation sheets.

RESULTS

In total, 16 of the 17 older people completed the intervention. Of 9 recorded falls, no serious physical problems occurred. Qualitative data suggested that the intervention content and mode was feasible. Only minor adaptations to the program are needed based on the users' feedback. The main benefit was seen in the fact that simple exercises can be integrated into everyday life for older people with restricted mobility.

CONCLUSION

The FIT-at-Home intervention comprising lifestyle-integrated balance and strength exercises and home safety is feasible for occupational therapists to deliver. The findings will help to further refine the intervention and study procedures.Implications for rehabilitationFalling is a frequent and serious health problem for many community-living older people, and the incidence of injurious falls increases with advancing age.Home visiting programs comprising physical exercise training and home modification appear to be beneficial for older people with poor health, functional limitations, and limited mobility.This study indicates that it is feasible to introduce lifestyle-integrated balance and strength exercises, performed as part of daily routine for older people at risk of falling.Behavioural self-management strategies have the potential to improve the implementation of exercises during the course of rehabilitation treatment and afterward.