1 General introduction | 11 levels and 3) if necessary, a medical evaluation to consider chronic conditions and use of medication (53). Based on these assessments, older adults can receive a multifactorial intervention that meet their specific needs, which almost always contains an exercise-based training program (39, 52, 53). Some widely implemented and recognized exercise-based fall prevention training interventions in the Netherlands include the Nijmegen Falls Prevention Program (54), the In Balance program (55), and the Otago Exercise Program (56), see Table 1.1 for an overview of these fall prevention interventions. These three interventions are included in the chain approach of fall prevention in the Netherlands (57). This multifactorial chain approach involves identifying older adults with a low, moderate or high fall risk, screening for fall risk factors, targeted interventions (such as the Nijmegen Falls Prevention Program, In Balance or Otago), and follow-up exercise programs (57). Table 1.1. Overview of widely implemented fall prevention interventions in the Netherlands. Intervention Nijmegen Falls Prevention Program In Balance Otago Exercise program Target group Non-frail Non- and pre-frail Frail Duration Five weeks, 2 times a week 14 weeks, first 4 weeks 1 time a week, last 10 weeks 2 times a week 12 weeks, 2 times a week Group/individual Group Group Group/individual Content Balance and strength exercises Combination of increasing awareness with balance and strength exercises Balance and strength exercises Recognition Strong indications of effectiveness Initial indications of effectiveness Well-founded Effectiveness Approximately 46% reduction in the number of falls The effectiveness of the current intervention is unknown Approximately 35% reduction in the number of falls and fall-related injuries Reference (54) (55) (56) Figure adapted from (58).
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