8 General discussion and summary | 161 over the follow-up period than the In Balance group. Moreover, it is possible that there was some selection bias in our study towards older adults who were healthier and more aware of their health status. It could be that we included a relatively fit group of older adults in the study that already were physically active. Physical activity was measured to ensure that increased activity would not obscure the intervention’s effects by potentially raising fall risk. A hypothesis is that older adults who are more physically active are also at greater risk of falling due to increased time at risk (301, 302). Therefore, it is important to measure that time at risk as well, in order to make an accurate assessment of the effect of the intervention. However, as no changes in activity were observed, this issue did not arise. Table 8.1. Mean amount of physical activity in hours per day (defined as the total duration of walking, stair walking and cycling periods combined) for the In Balance group and the control group for the three measurement moments. In Balance group Control group Baseline (mean hours/day (SE)) 1.43 (0.06) 1.43 (0.06) Month 4 (mean (SE)) 1.41 (0.06) 1.50 (0.09) Month 12 (mean (SE)) 1.32 (0.06) 1.45 (0.07) Functional status In Chapter 4, we found low correlations between the SPPB and gait quality and quantity, two instruments that measure functional status. It is possible that the two instruments measure two different aspects of functional status. The SPPB only shows a snapshot of one’s functional status at one moment in time, and therefore may be considered to be a proxy for capacity. Gait quality and quantity was determined over seven days, making them measures for performance. Functional status may be better understood by combining these measures. In our study, secondary outcomes primarily included snapshots of functional status, reflecting capacity rather than performance. As described above, improvements in such balance and strength capacity measures may not necessarily translate into changes of performance in daily behaviour, or ultimately in fewer falls. An alternative measure worth considering could have been intrinsic capacity (i.e., the composite of all the physical and mental capacities of an individual), which encompasses multiple capacity domains and aims to capture functional ability and healthy aging through its interaction with external factors (303). Future research could examine the effects of a fall prevention intervention on such measures of capacity in terms of functional ability and their potential implications. Additionally, further investigation into the implementation of In Balance could focus on strategies for translating capacity improvements into behavioural changes, fostering better functional outcomes.
RkJQdWJsaXNoZXIy MjY0ODMw