Stepping On This program was created in Australia (Clemson et al., 2004) and used content experts trained by occupational and physical therapists (two master trainers) to deliver a series of seven weekly 2-hour educational seminars on fall risk prevention. A 3-day seminar and training are required to become a master trainer. The educational series is followed by a home visit 6 weeks later and a 1-hour booster session 3 months after the final session. Examples of educational topics include medication management, home safety, safe movement and exercise (based on the Otago exercises, described later in the Homebound section), and pedestrian safety. The Wisconsin Institute for Healthy Aging, which first made this program available in the United States, granted licenses for the program in 22 states as of 2017 (https://wihealthyaging.org/national-stepping-on). This website can be checked to see if the program is offered in a particular state. A Matter of Balance A Matter of Balance (Healy et al., 2008) is a fall prevention program designed for community-dwelling older adults who want to live more independently. The program contains eight 2-hour sessions of evidence-based workshops that have been shown to improve falls and fear of falling with exercise and self- efficacy activities (Haynes, League, & Neault, 2014), help older adults set realistic goals for increasing activity, assist participants in decreasing environmental fall risk factors in their home, and increasing strength and balance through exercise. This program is endorsed by NCOA. Educational sessions are led by volunteer lay leaders called coaches , who are trained by master trainers. Essential components of the program include group discussion, problem solving, skill building, assertiveness training, exercise training, shared practical solutions, and a more positive cognitive approach to challenges. Resources on this program can be found at http://www.mainehealth.org/mob. Tai chi Tai chi has been incorporated into balance and fall prevention for some time. One form of tai chi, called Tai Ji Quan : Moving for Better Balance, is an evidence-based fall prevention program that delivers a therapeutic exercise program using martial arts movements in two 1-hour sessions per week for a minimum of 24 weeks (Ory et al., 2015). Sessions begin with warm-up exercise, move to a mix of various core tai chi forms and mini therapeutic movements, then end with a brief cool-down period. The target audience of participants is community-dwelling older adults with a mild level of mobility difficulty, such as occasional use of a cane, and who need improvements in ankle ROM, leg strength, balance, and gait and who may have a fall history. Classes emphasize self-initiated, coordinated movement while shifting the center of gravity and performing eye–head–hand coordination elements. Instructors must complete a 2-day training and three 1-day follow-up courses. According to the NCOA 2015 National Falls Prevention Action Plan (Cameron et al., 2015) Tai Ji Quan is now in 21 states, with 1,330 leaders trained, and more than 4,000 older adults who have participated. Resources can be found at http://tjqmbb.org/ FallProofTM Balance and Mobility This program was developed in California by Debra J. Rose, an expert in motor control and balance in older adults. This intensive program was designed for older adults with moderate to high risk for falls and has been effective in fall prevention based on ameliorating or modifying risk factors for falls (Rose, 2010). The program focuses on four core components: 1. Volitional and nonvolitional control of the center of gravity. 2. Sensory reception and integration skills. 3. Selection and scaling of postural control strategies. 4. Development of a flexible and adaptable gait pattern. Strengthening and stretching of the upper and lower extremities is incorporated into classes as well. Instructors are licensed in an intensive 4-month process, content is standardized, and both intrinsic and extrinsic fall risk factors are addressed throughout
the sessions. Classes are 1-hour sessions, twice a week for 24 weeks. The program can be presented in one-on-one community settings or in group settings. Program resources can be found at www.fallproof.org SAIL: Stay Active and Independent for Life Another promising fall prevention program known as SAIL (Stay Active and Independent for Life) targets older adults with a mild level of mobility difficulty who need improvements in strength, balance, and fitness (York, Shumway-Cook, Silver, & Morrison, 2011). SAIL is endorsed by the Administration for Community Living and is a public domain program, which means there are no initial or renewal fees. The program is located in Washington State where leaders can be trained online or in person. Leaders typically have a clinical or exercise science background. Classes are 1-hour sessions offered three times per week in community settings. The exercise guidebook can be ordered for free from the Washington State Department of Health (http://here.doh. wa.gov). More than 1,000 older adults in Washington State have completed this program. NoFalls NoFalls is a multifactorial fall prevention program developed in Australia that consists of 15 weeks of 1-hour balance and exercise classes. These classes are supplemented with daily home exercise. Along with exercise, this program removes home hazards and provides interventions for vision correction. Reduction in injurious falls has been greatest in participants who received exercise and vision correction, but fall reduction with NoFalls also has occurred with the exercise component alone (Fitzharris, Day, Lord, Gordon, & Fildes, 2010. FallsTalk/FallsScape These interventions are evidenced-based programs offered separately or in combination to anyone who has experienced a fall or loss of balance, regardless of mobility status or fitness level. The FallsTalk intervention involves a personal interview in- home or in the community to identify individual fall risk factors, then is followed up by an additional interview, daily personal reflections, and three brief weekly check-in calls. FallsScape uses each individual’s mobility, environment, and functional status to create personalized interactive multimedia training sessions and vignettes. Adding the multimedia training has been shown to improve program results (Schepens, Panzer, & Goldberg, 2011). Resources can be found at http://www.fallscape.org/ Enhance Fitness Enhance Fitness (EF) is an evidence-based group exercise program based in the community that helps older adults become more physically active (Belza, Snyder, Thompson, & LoGerfo, 2010). EF is taught three times a week in 1-hour sessions by certified trainers. Sessions involve exercises for cardiovascular endurance, strength training, dynamic and static balance, posture, and flexibility. Since 1999, EF has been taught in 41 states and has reached more than 59,000 adults (Petrescu- Prahova, Eagen, Fishleder, & Belza, 2017). YMCA Moving for Better Balance This YMCA program is an evidence-based 12-week program endorsed by the NCOA and CDC for fall prevention. Community-dwelling adults 60 years of age and older can participate in the small group setting of 10 to 15 adults for twice-a-week 1-hour sessions. Participants are asked to practice at home for 30-minutes once a week, also. Classes target social, mental, and physical well-being through tai chi-based exercise, education, and social support. A YMCA membership is not required, although local YMCA organizations should be checked for availability and whether they have a Y-certified Moving for Better Balance instructor (http://ymca.net). In addition to an evidence-based fall prevention program, the trained clinician also should address individual impairments or fall risk factors that are not specifically targeted by the prescribed program. Most proven programs include balance, gait, strengthening, and mobility activities, but older adults may have additional areas that need attention. These could include
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