8 General discussion and summary | 171 than MBvO instructors, so when In Balance is provided by MBvO instructors the intervention costs are lowered possible making the In Balance intervention more cost-effective than shown here. However, an important requirement is that there is no difference in performance between physical and exercise therapists and MBvO instructors, and thus that effects are similar. MBvO instructors are specialized in exercise for older adults, though they have less extensive training and medical knowledge than physio- and exercise therapists. Further research is essential to determine whether MBvO instructors can deliver fall prevention interventions that meet both quality and safety benchmarks and is as effective as provided by a physio- or exercise therapist. To ensure they can play a more substantial role in implementation of programs such as In Balances, training and clear guidelines are necessary. It is suggested to adapt the In Balance class size for less experienced instructors, for example by including eight to ten participants instead of twelve (340). Moreover, those instructors could follow an additional training to become certified and experienced to provide In Balance (340). These instructors could also help with enrolling and instructing participants in In Balance (341). There is a considerable challenge in providing fall prevention interventions such as In Balance to the growing population of adults aged 65 and older. A potential solution to meet this increasing demand could be to train other professionals with a secondary vocational education background, specifically in health or movement-related fields, to participate in the In Balance instructor training. However, it is important to ensure that the quality of the intervention is maintained, for example with certificated quality marks. Reablement A trending concept associated with fall prevention programs is ‘reablement’. Reablement includes activities that allow older adults to retain, relearn or restore capabilities required to independently perform their daily activities (342). Given the ageing population and the increasing pressure on healthcare systems, many older adults have to live longer in their homes (343). Reablement principles can alleviate some of the demands on healthcare resources (344). In line with this, the concept of intrinsic capacity can enhance reablement approaches by focusing on the individual’s overall functional ability in interaction with their environment (303). To enhance the effectiveness of reablement in fall prevention programs, interventions should incorporate elements that promote functional skills, social engagement, and environmental modifications (345). For example, TOM (Thuis Onbezorgd Mobiel, translated as: home carefree mobility) includes the In Balance intervention, and additionally emphasizes the importance of nutrition and social engagement (346). Furthermore, having opportunities for social interaction, as In Balance does, can help combat isolation and enhance motivation for maintaining an active lifestyle, thus improving functional ability and supporting the individual’s intrinsic capacity (347).
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