7 Optimizing and implementing a community-based group fall prevention program | 131 INTRODUCTION Falls and fall-related injuries can have significant consequences for older adults (67). About 30% of all adults of 65 years or older experience at least one fall per year (273). As a result, 10% are treated at the emergency department for fall-related injuries (274). Besides physical injuries, falls can result in fear of falling and a reduced quality of life (126, 131, 275). Moreover, falls are associated with high healthcare costs (274). Due to the ageing population, the number of falls and related injuries is expected to increase even further (123, 274). Fall prevention programs (FPPs) have been shown to reduce the number of falls and injuries in adults of 65 years or older (46). Many of these programs are based on exercise and differ in content and target group. Although the optimal characteristics of successful FPPs remain unclear, programs that incorporate multiple components (e.g. strength and balance) and contain high dose and challenging balance exercises seem to be more effective (46, 179). An example of such a FPP is the Otago Exercise Program (OEP) for community-dwelling older adults who can individually exercise safely (276). This is a globally implemented intervention that contains individually-tailored strength-, balance- and mobility exercises (276). These exercises last 30 minutes, participants must exercise three times a week and are encouraged to walk outside at least twice a week (276). Another example is the home-based eHealth intervention StandingTall (277). This intervention consists of a balance training by individually-tailored exercise prescription to improve balance by a tablet at home (277). Participants are encouraged to exercise at least 120 min per week for 2 years (277). A third FFP example is the Stepping On program which aims to improve self-efficacy and include exercises focusing on improving balance, strength, and encourages behaviour that stimulates safety and mobility (such as emphasizing the influence of medication on the risk of falls and practicing mobility techniques in an outdoor location) (278). Stepping On includes weekly two hour sessions conducted for seven weeks (278). Although the FFPs described above differ in content, they all have demonstrated efficacy. Another FPP that is frequently used in the Netherlands is the ‘In Balance’ program (55) that is based on the core elements of fall prevention, such as multicomponent interventions including balance, functional and resistance exercises (137). In Balance is a 14-week group FPP that aims to reduce falls by increasing awareness, balance and strength in adults of 65 years or older with an increased risk of falling. The first four weeks comprise counselling- and educational meetings once per week. These educational meetings cover topics regarding fall prevention to increase knowledge about preventing falls, and to increase awareness of fall risk and balance disruption. The last ten weeks comprise two one-hour exercise sessions per week. Exercises are derived from principles of Tai Chi and are mainly focused on physical
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