158 | Chapter 8 The primary aim of my thesis was to assess the (cost-)effectiveness of the In Balance fall prevention intervention and evaluate how its implementation can be further optimized. In addition, we initially investigated associations between falls and fall-related injuries on the one hand and physical activity and functional status on the other hand. Below follows a brief summary of this thesis per chapter, followed by general considerations regarding my findings with respect to the aims and within the general context of fall prevention. SUMMARY OF THE MAIN FINDINGS Chapter 1 consists of an overall introduction to this thesis. This chapter outlines that fall prevention interventions can help older adults to maintain their independence, maintain or improve daily life functioning, enhance their quality of life, and reduce the (economic) burden on healthcare systems if interventions are (cost-)effective. This was the rationale for our primary aim to evaluate the In Balance fall prevention intervention. Moreover, the interplay between falls and fall-related injuries, physical activity, and functional status among older adults is still not completely clear, which we initially investigated in this thesis. The aim of Chapter 2 was to investigate the associations between physical activity and both falls and fall-related fractures, and to assess whether frailty modifies the association between physical activity and falls and fractures. Data of 311 community-dwelling participants aged 75 years or older was used who participated in five nine-monthly waves between 2015/2016 and 2018/2019 of the Longitudinal Aging Study Amsterdam study (96). No statistically significant association between physical activity and falls or fractures was found, and frailty was not found to be an effect modifier. Although we did not show a statistically significant association between physical activity and falls, healthcare providers should always consider this risk for older adults when recommending physical activity. In Chapter 3, we described the study protocol of a randomized controlled trial that aimed to investigate the effectiveness and cost-effectiveness from a societal perspective of the In Balance fall prevention program in comparison with regular physical activity recommendations among community-dwelling older adults with an increased fall risk. The In Balance intervention is a fourteen-week, low-cost group fall prevention intervention, that is already widely implemented in the Netherlands. This study was a single-blinded, multicenter randomized controlled trial. The target sample consisted of 264 community-dwelling non-frail and pre-frail adults of 65 years or older with an increased risk of falls. The intervention group followed the In Balance fall prevention program, which includes an educational component and physical exercises. The physical exercises are based on Tai Chi principles and focus on balance and strength. The control group received general written physical activity recommendations.
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