Optimizing and Implementing a Community-Based Group Fall Prevention Program: A Mixed Methods Study.

Falls and fall-related injuries among older adults are associated with decreased health. Therefore, fall prevention programs (FPPs) are increasingly important. However, the translation of such complex programs into clinical practice lacks insight into factors that influence implementation. Therefore, the aim of this study was to identify how to optimize and further implement a widely used group-based FPP in the Netherlands among participants, therapists and stakeholders using a mixed methods study. FPP participants and therapists filled out a questionnaire about their experiences with the FPP. Moreover, three focus groups were conducted with FPP participants, one with therapists and one with other stakeholders. Data were analysed according to the thematic analysis approach of Braun and Clarke. Overall, 93% of the 104 FPP participants were satisfied with the FPP and 86% (n = 12) of the therapists would recommend the FPP to older adults with balance or mobility difficulties. Moreover, six themes were identified regarding further implementation: (1) recruiting and motivating older adults to participate; (2) structure and content of the program; (3) awareness, confidence and physical effects; (4) training with peers; (5) funding and costs; and (6) long-term continuation. This study resulted in practical recommendations for optimizing and further implementing FPPs in practice.

The (cost-)effectiveness of an implemented fall prevention intervention on falls and fall-related injuries among community-dwelling older adults with an increased risk of falls: protocol for the in balance randomized controlled trial.

BACKGROUND: Falls and fall-related injuries among older adults are a serious threat to the quality of life and result in high healthcare and societal costs. Despite evidence that falls can be prevented by fall prevention programmes, practical barriers may challenge the implementation of these programmes. In this study, we will investigate the effectiveness and cost-effectiveness of In Balance, a fourteen-week, low-cost group fall prevention intervention, that is widely implemented in community-dwelling older adults with an increased fall risk in the Netherlands. Moreover, we will be the first to include cost-effectiveness for this intervention. Based on previous evidence of the In Balance intervention in pre-frail older adults, we expect this intervention to be (cost-)effective after implementation-related adjustments on the target population and duration of the intervention. METHODS: This study is a single-blinded, multicenter randomized controlled trial. The target sample will consist of 256 community-dwelling non-frail and pre-frail adults of 65 years or older with an increased risk of falls. The intervention group receives the In Balance intervention as it is currently widely implemented in Dutch healthcare, which includes an educational component and physical exercises. The physical exercises are based on Tai Chi principles and focus on balance and strength. The control group receives general written physical activity recommendations. Primary outcomes are the number of falls and fall-related injuries over 12 months follow-up. Secondary outcomes consist of physical performance measures, physical activity, confidence, health status, quality of life, process evaluation and societal costs. Mixed model analyses will be conducted for both primary and secondary outcomes and will be stratified for non-frail and pre-frail adults. DISCUSSION: This trial will provide insight into the clinical and societal impact of an implemented Dutch fall prevention intervention and will have major benefits for older adults, society and health insurance companies. In addition, results of this study will inform healthcare professionals and policy makers about timely and (cost-)effective prevention of falls in older adults. TRIAL REGISTRATION: Netherlands Trial Register: NL9248 (registered February 13, 2021).