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Emma Renehan, Claudia Meyer, Rohan A. Elliott, Frances Batchelor, Catherine Said, Terry Haines, and Dianne Goeman

the effectiveness of community-based falls prevention programs, particularly multifactorial programs ( Gillespie et al., 2012 ). Home-based exercise programs, including strength and balance components (e.g., The Otago Exercise Programme) have also been shown to reduce both the risk and rate of falls

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Claudia Meyer, Sophie Hill, Keith D. Hill, and Briony Dow

each year, depending on the type of dementia ( Allan, Ballard, Rowan, & Kenny, 2009 ). People with dementia are also at six times the risk of injury related to falls, compared with people without dementia ( Asada et al., 1996 ). There has been little focus on the uptake of falls prevention strategies

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Lauren M. Robins, K.D. Hill, Lesley Day, Lindy Clemson, Caroline Finch, and Terry Haines

This paper describes why older adults begin, continue, and discontinue group- and home-based falls prevention exercise and benefits and barriers to participation. Telephone surveys were used to collect data for 394 respondents. Most respondents reported not participating in group- (66%) or home-based (78%) falls prevention exercise recently. Reasons for starting group-based falls prevention exercise include health benefits (23–39%), health professional recommendation (13–19%), and social interaction (4–16%). They discontinued because the program finished (44%) or due to poor health (20%). Commonly reported benefits were social interaction (41–67%) and health (15–31%). Disliking groups was the main barrier (2–14%). Home-based falls prevention exercise was started for rehabilitation (46–63%) or upon health professional recommendation (22–48%) and stopped due to recovery (30%). Improvement in health (18–46%) was the main benefit. These findings could assist health professionals in prescribing group-based falls prevention exercise by considering characteristics of older adults who perceive social interaction to be beneficial.

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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.

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Fuzhong Li, Peter Harmer, Karin A. Mack, David Sleet, K. John Fisher, Melvin A. Kohn, Lisa M. Millet, Junheng Xu, Tingzhong Yang, Beth Sutton, and Yvaughn Tompkins

Background:

This study was designed to develop an evidence- and community-based falls prevention program—Tai Chi: Moving for Better Balance.

Methods:

A mixed qualitative and quantitative approach was used to develop a package of materials for program implementation and evaluation. The developmental work was conducted in 2 communities in the Pacific Northwest. Participants included a panel of experts, senior service program managers or activity coordinators, and older adults. Outcome measures involved program feasibility and satisfaction.

Results:

Through an iterative process, a program package was developed. The package contained an implementation plan and class training materials (ie, instructor’s manual, videotape, and user’s guidebook). Pilot testing of program materials showed that the content was appropriate for the targeted users (community-living older adults) and providers (local senior service organizations). A feasibility survey indicated interest and support from users and providers for program implementation. A 2-week pilot evaluation showed that the program implementation was feasible and evidenced good class attendance, high participant satisfaction, and interest in continuing Tai Chi.

Conclusions:

The package of materials developed in this study provides a solid foundation for larger scale implementation and evaluation of the program in community settings.

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Anne H. Laybourne, Simon Biggs, and Finbarr C. Martin

One third of adults over 65 yr old fall each year. Wide-ranging consequences include fracture, reduced activity, and death. Research synthesis suggests that falls-prevention programs can be effective in reducing falls by about 20%. Strength and balance training is the most efficacious component, and the assumed method of effect is an improvement in these performance domains. There is some evidence for this, but the authors have previously proposed an alternative method, activity restriction, leading to a reduction in subsequent falls through a reduction in exposure. The aim of this study was to examine physical activity in older fallers, applying a theory of adaptation, to ascertain predictors of habitual physical activity. Referrals to hospital- and community-based exercise programs were assessed for (a) habitual walking steps and (b) coping strategies, falls self-efficacy, social support, and balance mobility. There was no average group change in physical activity. There was high interindividual variability. Two coping strategies, loss-based selection and optimization, best explained the change in physical activity between baseline and follow-up. Notwithstanding some limitations, this work suggests further use of adaptation theory in falls research. A potential application is the creation of a profiling tool to enable clinicians to better match treatment to patient.

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Lucy McPhate, Emily M. Simek, Terry P. Haines, Keith D. Hill, Caroline F. Finch, and Lesley Day

Background:

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.

Objective:

To identify older people’s preferences for how group exercise programs for falls prevention can be delivered.

Design:

A two-wave, cross-sectional, state-wide telephone survey was undertaken. Respondents were community-dwelling men and women aged 70+ in Victoria, Australia.

Methods:

Open-ended questions were asked to elicit information regarding respondent preferences of the program, which were analyzed using a framework approach.

Results:

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.

Conclusions:

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.

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Den-Ching A. Lee, Lesley Day, Caroline F. Finch, Keith Hill, Lindy Clemson, Fiona McDermott, and Terry P. Haines

This paper examines whether involvement in an observational study may prompt participants to change their exercise behaviors. Data were collected from 394 older community dwellers in Victoria, Australia using a baseline survey, and 245 of these participated in a follow-up survey one year later. Survey domains were drawn from constructs of relevant health behavior models. Results showed that the proportion of respondents who were currently participating in exercises to prevent falls at follow-up was 12% higher than at baseline (Wilcoxon p value < .001). Twenty-nine percent reported they had changed their perceptions about falls and their risk of falls, with comments focused on threat appraisal. Forty-four percent reported having taken strategies to reduce their risk of falling, with comments based on implementation of different preventive strategies. Respondents who held favorable views toward exercises for the prevention of falls appear to change their behaviors that might address falls when participating in observational studies.

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Ro DiBrezzo, Barbara B. Shadden, Blake H. Raybon, and Melissa Powers

Loss of balance and falling are critical concerns for older adults. Physical activity can improve balance and decrease the risk of falling. The purpose of this study was to evaluate a simple, low-cost exercise program for community-dwelling older adults. Sixteen senior adults were evaluated using the Senior Fitness Test for measures of functional strength, aerobic endurance, dynamic balance and agility, and flexibility. In addition, measures of height, weight, resting blood pressure, blood lipids, and cognitive function were obtained. Participants then attended a 10-week exercise class including stretching, strengthening, and balance-training exercises. At the completion of the program, significant improvements were observed in tests measuring dynamic balance and agility, lower and upper extremity strength, and upper extremity flexibility. The results indicate that exercise programs such as this are an effective, low-cost solution to improving health and factors that affect falling risk among older adults.

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Mohsen Shafizadeh, Jane Manson, Sally Fowler-Davis, Khalid Ali, Anna C. Lowe, Judy Stevenson, Shahab Parvinpour, and Keith Davids

falls prevention because there are opportunities for maintaining mobility and reducing falls risk based on “perception of affordances” (information extracted from surrounding objects and space). There are several reasons for taking this approach. First, natural indoor or outdoor environments in everyday