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.
recommended for use. The full description of the development of this guideline can be found in the Resources section (Avin et al., 2015). The three guidelines recommended includes the National Collaborative Centre for Nursing and Supportive Care, Prevention of Falls in Older Adults by the AGS/BGS, and evidence-based guidelines for the secondary prevention of falls in older adults by Moreland and colleagues (2003). Interventions were categorized as having evidence that was good, fair, no recommendation against, ineffective intervention, or insufficient evidence to recommend. Interventions were then categorized by fall history, including: 1. Fit older person who has not fallen. 2. Adults at risk for falls. 3. Those experiencing single or recurrent falls. Next, the interventions were assessed by living environment of the older adults to include: 1. Community-dwelling older adults. 2. Long-term care. 3. Hospital based care. 4. Homebound older adults. Recommended interventions will be discussed based on the four living environments, beginning with community-dwelling, fit older adults. Community-dwelling, fit older adults For community-dwelling, fit older adults good evidence exists that supports multifactorial programs that include activities aimed at addressing all fall risk factors with special attention paid to improving balance, gait, strength, endurance and correcting home safety hazards, footwear, and possibly flexibility (although the evidence is not as strong for flexibility; Gillespie et al., 2012). Several exercise programs incorporate exercises and education proven to decrease future falls. The frequency of most programs is at least two to three times per week with recommended daily home exercise for more active adults. The AGS/BGS clinical practice guideline also recommends that any exercise program for fall prevention should take into account the physical capabilities and health profile of the individual and should be prescribed by qualified health professionals. The AGS/ BGS also recommends that the exercise program be reviewed, progressed, and adjusted as appropriate. These programs should be recommended if they are available in the more fit older adults’ community. Fair evidence exists to support group or individual exercise programs including the following formally organized programs, which are described below: ● Stepping On. ● A Matter of Balance. ● Tai chi. ● Fall Proof. ● SAIL (Stay Active and Independent for Life). ● NoFalls. ● FallsTalk/FallsScape. ● Enhance Fitness. ● YMCA Moving for Better Balance. 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.
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