TianMa Xu
Health and Social Sciences Cluster, Singapore Institute of Technology
This paper addresses the current challenges associated with implementing falls prevention and frailty management programs for older adults in the community setting. Falls and frailty are closely linked to various ageing-related health issues. While extensive research has been conducted on falls and frailty in older adults, these areas have often been studied in isolation from each other over the past few decades. Although evidence-based fall prevention and frailty management programs have been well-established in well-developed countries, barriers to implementing condition-specific interventions, such as manpower shortages, space constraints, and lack of public awareness and funding, still exist. Additionally, some evidence-based programs have shown limited clinical effectiveness when implemented in overseas contexts. Effective programs that target both fall prevention and frailty management remain limited. Currently, there’s a growing trend of adopting a combined approach in designing and implementing programs that address both falls and frailty in the older adult population. Encouraging future research studies in this area is crucial to support the translation of evidence into practice for fall prevention and frailty management.
[1] Fried, L.P., et al., Frailty in older adults: evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2001. 56(3): p. M146-M157. https://doi.org/10.1093/gerona/56.3.M146
[2] Dent, E., et al., Physical frailty: ICFSR international clinical practice guidelines for identification and management. The Journal of Nutrition, Health & Aging, 2019. 23: p. 771-787. https://doi.org/10.1007/s12603-019-1273-z
[3] Kojima, G., Frailty as a predictor of future falls among community-dwelling older people: a systematic review and meta-analysis. Journal of the American Medical Directors Association, 2015. 16(12): p. 1027-1033. https://doi.org/10.1016/j.jamda.2015.06.018
[4] World Health Organization, WHO global report on falls prevention in older age. 2008, World Health Organization: Geneva, Switzerland.
[5] Dent, E., et al., The Asia-Pacific clinical practice guidelines for the management of frailty. Journal of the American Medical Directors Association, 2017. 18(7): p. 564-575. https://doi.org/10.1016/j.jamda.2017.04.018
[6] Salari, N., et al., Global prevalence of falls in the older adults: a comprehensive systematic review and meta-analysis. Journal of Orthopedic Surgery and Research, 2022. 17(1): p. 334. https://doi.org/10.1186/s13018-022-03222-1
[7] Cheng, M.H. and S.F. Chang, Frailty as a risk factor for falls among community dwelling people: Evidence from a meta-analysis. Journal of Nursing Scholarship, 2017. 49(5): p. 529-536. https://doi.org/10.1111/jnu.12322
[8] Friedman, S.M., et al., Falls and fear of falling: which comes first? A longitudinal pre-diction model suggests strategies for primary and secondary prevention. Journal of the American Geriatrics Society, 2002. 50(8): p. 1329-1335.https://doi.org/10.1046/j.1532-5415.2002.50352.x
[9] Montero-Odasso, M., et al., World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing, 2022. 51(9): p. afac205. https://doi.org/10.1093/ageing/afac205
[10] Xu, T., et al., Testing the Effects of a Multicomponent Frailty Management Program for Community-Dwelling Older Adults in Singapore: A Feasibility Study. Journal of Aging and Physical Activity, 2023. 1(aop): p. 1-11. https://doi.org/10.1123/japa.2022-0084
[11] Felix, H.C., et al., Barriers and facilitators to senior centers participating in translational re-search. Research on Aging, 2014. 36(1): p. 22-39. https://doi.org/10.1177/0164027512466874
[12] Lim, W.S., et al., Translating the science of frailty in Singapore: results from the national frailty consensus discussion. Ann Acad Med Singap, 2019. 48(1): p. 25-31.
[13] Clemson, L., et al., The Effectiveness of a Community-Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial. Journal of the American Geriatrics Society, 2004. 52(9): p. 1487-1494. https://doi.org/10.1111/j.1532-5415.2004.52411.x
[14] Campbell, A. and M. Robertson, Otago Exercise Programme to prevent falls in older people: a home-based, individually tailored strength and balance retraining program. Otago, NZ: Accident Compensation Corporation, 2003.
[15] Li, F., et al., Tai Chi and fall reductions in older adults: a randomized controlled trial. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2005. 60(2): p. 187-194. https://doi.org/10.1093/gerona/60.2.187
[16] Sherrington, C., et al., Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review.British Journal of Sports Medicine, 2020. 54(15): p. 885-891. https://doi.org/10.1136/bjsports-2019-101512
[17] Sherrington, C., et al., Evidence on physical activity and falls prevention for people aged 65+ years: systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. International Journal of Behavioral Nutrition and Physical Activity, 2020. 17: p. 1-9. https://doi.org/10.1186/s12966-020-01041-3
[18] Hill, K.D., et al., What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials. BMC Geriatrics, 2018. 18: p. 1-21. https://doi.org/10.1186/s12877-017-0683-1
[19] Chen, C.Y., P. Gan, and C.H. How, Approach to frailty in the elderly in primary care and the community. Singapore Medical Journal, 2018. 59(5): p. 240. https://doi.org/10.11622%2Fsmedj.2018052
[20] Apóstolo, J., et al., Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 2018. 16(1): p. 140. https://doi.org/10.11124/JBISRIR-2017-003382
[21] Mahoney, J.E., et al., Improving fidelity of translation of the stepping on falls prevention program through root cause analysis. Frontiers in Public Health, 2016. 4: p. 217435. https://doi.org/10.3389/fpubh.2016.00251
[22] Tan, P.J., et al., Pragmatic multicentre steppedwedge cluster randomised trial to investigate the effectiveness of community-based falls prevention programme for older adults with falls risk in Singapore: a protocol paper. BMJ Open, 2023. 13(6): p. e072029. https://doi.org/10.1136/bmjopen-2023-072029
[23] Xu, T., Implementing the Stepping On program in Singapore: An experience sharing, in 2023 Joint Conference of the Australia and New Zealand Falls Prevention Society & World Falls Congress. 2023, November 27-28: Perth, Australia.
[24] Xu, T., Can a multicomponent frailty management program reduce falls in community-living older adults? , in 2023 Joint Conference of the Australia and New Zealand Falls Prevention Society & World Falls Congress. 2023, November 27-28: Perth, Australia.
[25] Bryan, R.L., M.W. Kreuter, and R.C. Brownson, Integrating adult learning principles into training for public health practice. Health Promotion Practice, 2009. 10(4): p. 557-563. https://doi.org/10.1177/1524839907308117
[26] Xu, T., et al., Clinical effectiveness and cost-effectiveness of a multicomponent frailty management program “Say No To Frailty” in Singapore: A cluster-randomized controlled trial protocol. (Manuscript submitted for publication).
[27] Xu, T., et al., Stepping On after Stroke falls-prevention programme for community stroke survivors in Singapore: A feasibility study. British Journal of Occupational Therapy, 2020. 84(6): p. 366-375. https://doi.org/10.1177/0308022620946640
[28] Izquierdo, M., et al., International exercise recommendations in older adults (ICFSR): expert consensus guidelines. The Journal of Nutrition, Health & Aging, 2021. 25(7): p. 824-853. https://doi.org/10.1007/s12603-021-1665-8
Copyright © 2024 TianMa Xu
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