Development of a lifestyle-integrated physical exercise training and home modification intervention for older people living in a community with a risk of falling (Part 1): the FIT-at-Home fall prevention program

ABSTRACT:

Purpose

In this paper, we report on the development and refinement of a progressive physical exercise training and home modification intervention for older people with a risk of falling located in Germany by using the United Kingdom's Medical Research Council framework.

Methods

The process was iterative and six phases of development emerged: (1) establishing an intervention development group, (2) identifying the evidence on interventions, (3) identifying a theory to underpin the intervention, (4) designing the intervention components, (5) drafting the intervention manual and training course, and (6) piloting and refining of intervention components.

Results

The result was an evidence-based, theory-informed, and user-endorsed intervention: FIT-at-Home. This intervention comprised nine individual sessions over 12 weeks and two follow-up booster sessions delivered by trained occupational therapists. A feasibility study demonstrated the acceptance and feasibility of intervention delivery. Users responses were generally favorable and included recommendations about the intervention manual, mode of delivery of the home hazard assessment, and producing a manual for older people.

Conclusions

We developed a feasible home-based lifestyle-integrated physical exercise training and home modification intervention for older people with a risk of falling by using a systematic approach. Implications include how this intervention could enrich occupational therapy fall prevention strategy in older people living at home.

IMPLICATIONS FOR REHABILITATION

• Falls in older people represent a major public health concern and occupational therapists in rehabilitation practice are encouraged to apply evidence-based interventions that reduce the risk of falls in older people living in a community.

• Many physical and environmental fall risks are modifiable by lifestyle changes such as physical exercise training, home safety assessment, and home modification. We developed a home-based balance and strength exercise training and home modification intervention that aims to improve strength, balance, and home safety.

• This study indicates that older people, at risk of falling, with functional limitations, and limited mobility, who participated in the FIT-at-Home intervention, felt that exercising at home suited them best.

Keywords:

• Intervention development
• falls prevention
• older people
• home-based
• home modification
• exercises

Acknowledgements

We would like to acknowledge the contribution of all the OTs and older people with risk of falling that participated in the development of FIT-at-Home. Grateful thanks to Gabriele Ruf (GR) and Nicole Colsman (NC) for their advice, guidance, and comments on the intervention manual and delivery. We would like to thank Lindy Clemson from the Ageing, Work, and Health Research Unit, Faculty of Health Sciences, University of Sydney, for supporting the study. We also extend grateful thanks to Björn Slaug and Susanne Iwarsson from the Active and Healthy Ageing Research Group, Faculty of Medicine, Lund University, Sweden, and Hans-Werner Wahl from the Network Aging Research Group, Institute of Psychology, Heidelberg University, Germany, and Frank Oswald from the Interdisciplinary Ageing Research Institut of Social Pedagogy and Adult Education, Faculty of Educational Sciences, Goethe University Frankfurt, Germany.

Disclosure statement

The authors declare that they have no competing interest. The feasibility study was supported by a research grant of the University of Applied Sciences, Department of Social Sciences, Saarbrücken, Germany