8 General discussion and summary | 173 activity programs (353). Additionally, many components of the chain approach are covered by basic health insurance (353). Given the societal benefits of fall prevention, such as reducing societal costs related to falls, and improving quality of life and daily functioning of older adults, financing ideally should come from a combination of health insurers and government sources, such as municipalities (49, 354). Health insurers have a vested interest in preventing falls as it can lead to long-term cost savings by reducing medical treatments and hospital admissions (354). Additionally, as also shown in Chapter 7 an own contribution of the participants could be considered to enhance participant engagement and motivation, provided that it does not create a barrier to participate to the intervention (355). This blended funding approach could ensure the sustainability and wider adoption of fall prevention programs (228). CONCLUSION This thesis has provided new insights towards sustainable implementation of In Balance for cost-effective fall prevention. Although the In Balance fall prevention intervention reduced the number of falls and injuries compared to general physical activity recommendations, these differences were not statistically significant. Overall, participants and therapists indicated benefits of the program, and highlight the need and desire for prolongation of exercises. Fall prevention exercise programs such as In Balance should not be prescribed as a stand-alone 14-week exercise intervention, but as a foundation for initiating and maintaining regular exercise. Besides, the findings of this thesis showed no significant associations between physical activity and falls or fractures in neither robust nor frail older adults. Additionally, gait quality and quantity variables have shown a low correlation with the SPPB, suggesting that these measures may provide complementary insights on an older person’s functional status when used alongside the SPPB. Promoting sustained activity is essential for both achieving and preserving the health benefits of fall prevention interventions. Future research should focus on evaluating the full chain approach with structural follow-up programs to assess the long-term (cost-)effectiveness of fall prevention exercise interventions.
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