Provision of choice and participation in falls prevention strategies is challenging for people with dementia. This study outlines development of a discussion tool to aid engagement of people with dementia and their caregivers in falls prevention strategies. The tool is based on a literature review of falls prevention and dementia care (1990–2016) and decision aid principles and was trialed over 6 months. A total of 25 community-dwelling people with dementia (M age = 80 years, SD = 7.7, 52% male) and their caregivers (M age = 73 years, SD = 12.3, 36% male) underwent falls risk assessment and evaluation of their preparedness to change falls risk behaviors. Most commonly rated, and prioritized for intervention, high falls risk factors were impaired balance/mobility (92%), polypharmacy (60%), and incontinence (56%). This discussion tool facilitated collaboration between people with dementia, their caregivers, and health professionals, to increase uptake of acceptable and feasible evidence-based falls prevention strategies.
Claudia Meyer, Sophie Hill, Keith D. Hill and Briony Dow
Marie-Louise Bird, Keith Hill, Madeleine Ball and Andrew D. Williams
This research explored the balance benefits to untrained older adults of participating in community-based resistance and flexibility programs. In a blinded randomized crossover trial, 32 older adults (M = 66.9 yr) participated in a resistance-exercise program and a flexibility-exercise program for 16 weeks each. Sway velocity and mediolateral sway range were recorded. Timed up-and-go, 10 times sit-to-stand, and step test were also assessed, and lower limb strength was measured. Significant improvements in sway velocity, as well as timed up-and-go, 10 times sit-to-stand, and step test, were seen with both interventions, with no significant differences between the 2 groups. Resistance training resulted in significant increases in strength that were not evident in the flexibility intervention. Balance performance was significantly improved after both resistance training and standing flexibility training; however, further investigation is required to determine the mechanisms responsible for the improvement.
Susan Williams, Claudia Meyer, Frances Batchelor and Keith Hill
The objective of this study was to determine whether improved balance outcomes achieved in a randomized controlled trial (RCT) using balance screening to identify mild balance dysfunction and home exercises could be translated into community settings. Community-dwelling people aged over 65 who expressed concerns about their balance, had less than two falls in the preceding 12 months, and who had mild balance impairment on screening were given an individualized home-based balance and strengthening exercise program with intermittent home-visit support by a physiotherapist. Of 71 participants assessed (mean age 77.3 years, 76% female), 58 (82%) completed the six-month intervention. Twenty six percent of participants regained balance performance within normal limits—similar to those achieved in the previous RCT. Successful results from a previous RCT were able to be translated into community settings, with a similar magnitude of effect on balance and mobility.
Claudia Meyer, Susan Williams, Frances Batchelor and Keith Hill
The aim was to identify barriers and opportunities facing community health physiotherapists in delivering a home-based balance exercise program to address mild balance dysfunction and, secondly, to understand the perspectives of older people in adopting this program.
Focus groups, written surveys, and data recording sheets were used with nine older people and five physiotherapists. Focus groups were audio taped, transcribed, and coded independently by two researchers.
Thematic content analysis was undertaken. Emerging themes were: engaging in preventive health (various benefits, enhancing independence); adoption of strategies (acceptable design and implementation feasibility); exercising in context (convenience, practicality, and safety); and broader implementation issues (program design, proactive health messages, and a solid evidence base).
The views of older people and physiotherapists were sought to understand the adoption of a previously successful home-based program for mild balance dysfunction. Understanding the unique context and circumstances for individuals and organizations will enhance adoption.
Keith Hill, Robyn Smith, Marcia Fearn, Mary Rydberg and Rachael Oliphant
This study evaluated health benefits of a supported physical activity program for 116 older carers (mean age 64.4 [SD = 7.9], 85% women). Participants undertook a 6-month center-based physical activity program (strength training, yoga, or Tai Chi). Eighty-eight participants (76%) completed the program. Multivariate repeated-measures ANOVA identified overall significant improvement postint-ervention (p = .004). Univariate analyses revealed significant improvements for balance, strength, gait endurance, depression, and SF-36 (physical component; p < .05). There was no change in the Zarit Carer Burden Scale (p > .05). Change in performance scores did not differ significantly between those with higher and lower attendance at classes, although there was significantly greater improvement in gait endurance and balance (p < .05) in those attending classes run twice weekly than in those attending once-weekly classes. In conclusion, a carer physical activity program, providing additional carer support to facilitate participation, can achieve high levels of involvement by carers and significant health benefits.
Simone Pettigrew, Elissa Burton, Kaela Farrier, Anne-Marie Hill, Liz Bainbridge, Gill Lewin, Phil Airey and Keith Hill
Older people are less likely to engage in strength training than their younger counterparts, despite the substantial benefits of this form of exercise for preventing and addressing age-related physical decline. In many countries, strength training programs are available for older people yet are undersubscribed. The aim of this study was to identify the factors influencing older people’s participation in strength training at gyms and fitness centers to provide insights into potentially effective recruitment and retention strategies for this population. A total of 79 individuals from four stakeholder groups (seniors, fitness center instructors and managers, health practitioners, and those involved in policy) were interviewed to identify and explicate relevant factors. A detailed typology was developed that provides insights into potential strategies at five ecological system levels: intrapersonal, interpersonal, organizational, social, and policy. The typology can be used as a tool for identifying opportunities to encourage strength training participation among older people.
Elissa Burton, Kaela Farrier, Gill Lewin, Simone Pettigrew, Anne-Marie Hill, Phil Airey, Liz Bainbridge and Keith D. Hill
Regular participation in resistance training is important for older people to maintain their health and independence, yet participation rates are low. The study aimed to identify motivators and barriers to older people participating in resistance training. A systematic review was conducted including quantitative, qualitative, and mixed-method studies. Searches generated 15,920 citations from six databases, with 14 studies (n = 1,937 participants) included. In total, 92 motivators and 24 barriers were identified. Motivators specific to participating in resistance training included preventing deterioration (disability), reducing risk of falls, building (toning) muscles, feeling more alert, and better concentration. Looking too muscular and thinking participation increased the risk of having a heart attack, stroke, or death, despite the minimal likelihood of these occurring, were barriers. The analysis indicates that increasing participation in resistance training among older people should focus on the specific benefits valued by older people and the dissemination of accurate information to counter misperceptions.
Cecilie Thøgersen-Ntoumani, Nikos Ntoumanis, Hannah Uren, Afroditi Stathi, Catrina Wold and Keith D. Hill
The aim of the current study was to explore perceptions of group-based walking and gather suggestions to inform the development of a group-based walking intervention among older adults in retirement villages. Twenty-four physically inactive residents (16 female, 8 male; age range: 69–88) and four managers from four retirement villages were interviewed. Inductive thematic analysis revealed six broad themes: lack of motivation, values versus constraints, fears and confidence, need for structure, creating a sense of belonging, and the physical environment as a double-edged sword. Proposed intervention strategies included using trained walk leaders, using small groups, planning for flexibility, setting attainable goals, creating a routine, creating opportunities for sharing experiences, and planning a variety of walks. Group-based walking programs may be used to promote physical activity but careful planning of such programs is needed to make them appealing and feasible to a diverse group of residents.
Lucy McPhate, Emily M. Simek, Terry P. Haines, Keith D. Hill, Caroline F. Finch and Lesley Day
Group exercise has been shown to be effective in preventing falls; however, adherence to these interventions is often poor. Older adults’ preferences for how these programs can be delivered are unknown.
To identify older people’s preferences for how group exercise programs for falls prevention can be delivered.
A two-wave, cross-sectional, state-wide telephone survey was undertaken. Respondents were community-dwelling men and women aged 70+ in Victoria, Australia.
Open-ended questions were asked to elicit information regarding respondent preferences of the program, which were analyzed using a framework approach.
Ninetyseven respondents completed the follow-up survey. The results indicate that older adults most frequently report the short-term advantages and disadvantages when describing their preferences for group exercise, such as enjoyment, social interaction, and leader qualities. Longer-term advantages such as falls prevention were described less frequently.
This study indicates the importance of interpersonal skills, and that the opportunity for social interaction should not be overlooked as a positive feature of a group exercise program.
Lesley Day, Margaret J. Trotter, Alex Donaldson, Keith D. Hill and Caroline F. Finch
The study aim was to evaluate the implementation of group- and home-based exercise falls prevention programs delivered through community health agencies to community-dwelling older people. Interviews with program staff were guided by the Diffusion of Innovations theory. Highly consistent themes emerged for the two types of programs. Both had high overall compatibility, high relative advantage, good observability and high inherent trialability—all factors known to strengthen implementation. The level of complexity and low financial compatibility emerged as the strongest potential inhibitors to program implementation in the context examined. The two main factors contributing to complexity were the need to challenge balance safely across a broad range of capability, and practical considerations associated with program delivery.A range of strategies to provide more technical support for exercise program leaders to tailor balance challenge for exercise program leaders may enhance implementation of falls prevention exercise programs.