CONNECT 60+: A Wellness Program for Older Adults Delivered From a Community Hub.

BACKGROUND: Community hubs offer a pragmatic approach to address the wellness needs for older adults at risk of social isolation and declining physical activity. OBJECTIVE: The current study evaluated the effectiveness of a wellness program delivered from a community hub (either in person or online) on exercise and social connections of community-dwelling older adults living in Australia during a time of social isolation imposed by COVID-19. METHODS: A single group pre-post quasi-experimental study was conducted online and in person from a community hub. The 9-week program (CONNECT60+) was designed using a community-based participatory approach. It consisted of weekly group exercises led by a health professional and a wellness activity that aligned with active ageing guidelines, such as education, book club, and nature walks. Participants were encouraged to complete daily wellness activities and record these in a workbook. Data were gathered at pretest and 10-week post-test using questionnaires. RESULTS: A total of 47 participants completed the program. Most participants were aged between 64 and 74 years (61.7%), and 82.9% were female. Thirty-five participants (74.5%) attended the program in person, and 12 (25.5%) attended online from home. Preliminary findings showed participants prioritized social connections during the week and increased the duration (median [interquartile range] minutes) of exercise completed per week (pretest: 285 minutes (inter-quartile range, 246-567 minutes); post-test: 346 minutes (interquartile range, 150-415 minutes); P < .01). CONCLUSIONS: The study endorsed the wellness program delivered in person and online from a community hub to enable older adults to complete wellness activities, including exercise and socially connecting during a time of self-isolation due to the COVID-19 pandemic.

Older adults' experiences of a community wellness program (Connect 60+) that focused on physical activity and social connections: a qualitative exploratory study.

BACKGROUND: Being physically active and socially connected is positively associated with healthy aging. Older adults living in the community may be at risk of social isolation and reduced physical activity, especially in recent times due to COVID-19. There are many programs that offer opportunities for evidence-based physical activity or social connection; however, there is a lack of programs that include both. The objective of this study was to explore the lived experience of older adults who participated in Connect 60+ - a program that promoted exercise and social activities - delivered from a community hub that could be attended either in person or online. METHODS: A qualitative study that used descriptive phenomenology was conducted. A purposive sample of 13 older adults (age ≥65years) was recruited to take part in semistructured telephone interviews to discuss barriers and enablers to program engagement. Data were analysed using thematic analysis. RESULTS: The overarching theme was that participating in Connect 60+ was an enjoyable and encouraging experience for participants. The program enabled them to increase their physical activity and build social connections within their community. The main themes that enabled engagement were: (1) an enabling program design, (2) developing new connections in the community, and (3) experiencing motivation to engage. A few barriers were identified, including difficulties connecting online and lack of male attendance. CONCLUSIONS: Wellness programs delivered in community hubs may facilitate older adults to increase their engagement in both physical and social activity. The program appeared to impact positively on participants' motivation, with some participants reporting that they had sustained their behaviour changes since program completion. To address identified barriers, easy to use online technology is recommended, and strategies to promote male attendance.

Community care staff attitudes towards delivering a falls prevention exercise intervention to community care clients.

Millions of older people world-wide receive community care services in their home to assist them to live independently. These services often include personal care, domestic assistance and social support which are delivered by non-university trained staff, and are frequently long term. Older people receiving community care services fall 50% more often than individuals of similar age not receiving services. Yet, few ongoing community care services include exercise programs to reduce falls in this population. We conducted an earlier study to examine the feasibility of community care staff delivering a falls prevention program. A critical finding was that while some of the assessment and support staff responsible for service delivery delivered the falls prevention exercise program to one or two clients, others delivered to none. Therefore, the aim of this qualitative sub-study was to understand reasons for this variation. Semi-structured interviews were conducted with 25 participating support staff and assessors from 10 community care organisations. Staff who had successfully delivered the intervention to their clients perceived themselves as capable and that it would benefit their clients. Older clients who were positive, motivated and wanted to improve were perceived to be more likely to participate. Staff who had worked at their organisation for at least 5 years were also more likely to deliver the program compared to those that had only worked up to 2 years. Staff that did not deliver the intervention to anyone were more risk averse, did not feel confident enough to deliver the program and perceived their clients as not suitable due to age and frailty. Experienced staff who are confident and have positive ageing attitudes are most likely to deliver falls prevention programs in a home care organisation.

Can community care workers deliver a falls prevention exercise program? A feasibility study.

BACKGROUND: Almost half of older people receiving community care fall each year and this rate has not improved in the last decade. Falls prevention programs targeted at this group are uncommon, and expensively delivered by university trained allied health professionals. PURPOSE: To investigate the feasibility of community care workers delivering a falls prevention exercise program to older clients, at low or medium risk of falling, as part of an existing service provision. PATIENTS AND METHODS: Community care workers from 10 community care organizations participated in the training for, and delivery to their clients of, an 8-week evidence-based falls prevention exercise program. Community care workers included assessment staff (responsible for identifying the need for community care services through completing an assessment) and support workers (responsible for providing support in the home). Clients were surveyed anonymously at the completion of the intervention and workers participated in a semi-structured interview. RESULTS: Twenty-five community care workers participated in the study. The falls prevention program was delivered to 29 clients, with an average age of 82.7 (SD: 8.72) years and consisting of 65.5% female. The intervention was delivered safely with no adverse events recorded, and the eligibility and assessment tools were completed by the majority of community care workers (93.1%). Assessment staff found it difficult to find time to deliver the intervention. Support workers were able to complete the intervention within their current service delivery period, with the initial assessment taking a small amount of additional time. Support workers reported enjoying the additional responsibility afforded by delivering the falls prevention program and seeing changes in their clients. The majority of clients (82%) reported enjoying the exercises, with 59% reporting that they felt it made a positive change in their health. Clients completed the exercises on average 4.8 (SD: 2.2) days per week. CONCLUSION: Community care workers who have completed appropriate training are able to deliver a falls prevention exercise program to their clients as part of their current services. Further research is required to determine whether the program reduces the rate of falls for community care clients and whether integration of a falls prevention program into an existing service is cost-effective.

Falls prevention in community care: 10 years on.

BACKGROUND: A million older people living in Australia receive community care services each year due to experiencing functional or mental health difficulties. This group may be at greater risk of falling than similar-aged people not receiving services. However, there is limited falls prevention research for this population. PURPOSE: The aim of this study was to identify the falls prevalence rates of older people from 10 Australian community care organizations and compare current falls prevention data to a study 10 years prior that utilized the same 10 organizations. This study also identified factors associated with falling for this population. PATIENTS AND METHODS: This is a cross-sectional descriptive study, in which 5,338 questionnaires were mailed to a random sample of community care recipients aged ≥65 years. RESULTS: A total of 1,991 questionnaires were returned (37.3%), with 47.7% of respondents having fallen in the previous year, and 32.7% in the month prior to completing the questionnaire, similar to 10 years prior. Community care clients had a 50% higher falls rate than that reported for similar-aged people not receiving services, and this remained unchanged over the last 10 years. Eighty-six per cent of fallers had fallen once or twice, and 60% reported being injured. Thirty-six per cent of respondents reported not being able to get up independently, and only 27.4% of fallers were referred to a falls prevention program (significantly fewer than 10 years ago; 95% CI: 0.821-6.366, p=0.01). Balance issues (odds ratio [OR]: 2.06, 95% CI: 1.288-3.290, p=0.003) and perceived risk of falling in the future being "definite" (OR: 6.42, 95% CI: 1.890-21.808, p=0.003) or "unsure" (OR: 3.31, 95% CI: 1.144-9.544, p=0.027) were risk factors associated with falling. In contrast, individuals referred to a falls prevention intervention had a 47% reduced likelihood of having fallen (95% CI: 0.281-0.988, p=0.046). CONCLUSION: Community care clients should have their falls risk routinely assessed, and at-risk individuals be offered falls prevention advice and referral to fall prevention programs.