164 | Chapter 8 active engagement with and promotion of existing local exercise facilities, may further support sustainable lifestyle changes. Frailty status It is important to ensure that the right individuals are matched with the appropriate intervention. In Chapter 5, we described that the effectiveness of the In Balance fall prevention program varied based on participants’ frailty status. Non-frail participants in the intervention group experienced a non-significant 20% reduction in falls compared to the control group, while the reduction among pre-frail participants was 13%. These findings confirm the importance of also including non-frail older adults in fall prevention programs, which in line with recommendations to target the general community, including non-frail older adults. It is possible that non-frail older adults already have a higher baseline level of functional status, balance, and strength, or have less comorbidities, allowing them to benefit more from the exercises in the program (29). The In Balance intervention, which includes exercises to prevent frailty progression, can be effective for both non-frail and pre-frail participants by training balance, strength and mobility (319). Targeting fall prevention programs at both non-frail and frail older adults increases the potential impact of such programs because a larger population is targeted (179). After the start of our trial, the World Fall Guidelines were published including a classification of fall risk groups into either low-medium-high fall risk. In the Netherlands, these classification recommendations from these World Fall Guidelines were adopted and is the current standard in the Dutch healthcare pathway to determine whether, and if so, which fall prevention intervention is suitable for an older adult. We therefore explored how the risk classification relates to the frailty classification used in our study (40, 50, 320). In this study, we explored eligibility amongst others based on frailty status. However, during the course of the study, a classification based on fall risk was introduced in the Netherlands. While fall risk and frailty status are separate classifications, we checked to what extent these concepts overlap. Frieds frailty criteria consist of 5 components: unintentional weight loss, exhaustion, low physical activity, low walking speed and low grip strength (29). When meeting zero, one, or two or more criteria, someone is classified as respectively non-frail, pre-frail and frail (29). The classification in fall risk according to the World Fall Guidelines consists of several components, including questions about fall and injury history, concern of falling, having difficulties with moving, walking or maintaining balance and the four meter walk test (40, 50, 320). We found differences between the fall risk and frailty classifications (Table 8.2), suggesting that the fall risk and frailty classification may be better suited to different purposes: fall risk classification for identifying those at risk of falls, and frailty classification for assessing broader health status. Further research could explore how these classifications align or diverge in frail
RkJQdWJsaXNoZXIy MjY0ODMw