The (cost-)effectiveness of an implemented fall prevention intervention on falls and fall-related injuries among community-dwelling older adults with an increased risk of falls: protocol for the in balance randomized controlled trial

Abstract

Background Falls and fall-related injuries among older adults are a serious threat to the quality of life and result in high healthcare and societal costs. Despite evidence that falls can be prevented by fall prevention programmes, practical barriers may challenge the implementation of these programmes. In this study, we will investigate the effectiveness and cost-effectiveness of In Balance, a fourteen-week, low-cost group fall prevention intervention, that is widely implemented in community-dwelling older adults with an increased fall risk in the Netherlands. Moreover, we will be the first to include cost-effectiveness for this intervention. Based on previous evidence of the In Balance intervention in pre-frail older adults, we expect this intervention to be (cost-)effective after implementation-related adjustments on the target population and duration of the intervention. Methods This study is a single-blinded, multicenter randomized controlled trial. The target sample will consist of 256 community-dwelling non-frail and pre-frail adults of 65 years or older with an increased risk of falls. The intervention group receives the In Balance intervention as it is currently widely implemented in Dutch healthcare, which includes an educational component and physical exercises. The physical exercises are based on Tai Chi principles and focus on balance and strength. The control group receives general written physical activity recommendations. Primary outcomes are the number of falls and fall-related injuries over 12 months follow-up. Secondary outcomes consist of physical performance measures, physical activity, confidence, health status, quality of life, process evaluation and societal costs. Mixed model analyses will be conducted for both primary and secondary outcomes and will be stratified for non-frail and pre-frail adults. Discussion This trial will provide insight into the clinical and societal impact of an implemented Dutch fall prevention intervention and will have major benefits for older adults, society and health insurance companies. In addition, results of this study will inform healthcare professionals and policy makers about timely and (cost-)effective prevention of falls in older adults. Trial registration Netherlands Trial Register: NL9248 (registered February 13, 2021).

The public health burden of geriatric trauma: Analysis of 2,688,008 hospitalizations from Centers for Medicare and Medicaid Services inpatient claims

“…With a rapidly expanding population of geriatric patients increasingly active into their later years, the incidence of falls will likely continue to rise and place added demands on the US health care system. Extrapolating from existing and ongoing research, injury prevention efforts directed at the populations at risk can return meaningful savings in health care mortality and morbidity, as well as cost 21–23 . In addition to community-based efforts (including primary care practices), 24,25 these injury prevention efforts must be targeted not only at trauma centers but also at nontrauma centers, as they provide care to a substantial number of these patients.…”

“…Extrapolating from existing and ongoing research, injury prevention efforts directed at the populations at risk can return meaningful savings in health care mortality and morbidity, as well as cost. [21][22][23] In addition to community-based efforts (including primary care practices), 24,25 these injury prevention efforts must be targeted not only at trauma centers but also at nontrauma centers, as they provide care to a substantial number of these patients. These policies should likely include financial incentives for all hospitals to implement injury prevention efforts directed at their populations at risk.…”

Fall status and risk factors in older Chinese adults: A cross‐sectional study

“…However, screening (King et al., 2018) for the risk of falls and interventions for preventing falls should also be actively carried out for inpatients, which not only would reduce the risk of patient injury but also would reduce the occurrence of adverse events. For patients, fall prevention interventions can reduce pain and family medical costs (Peng et al., 2019; Van Gameren et al., 2021) and improve quality of life. The study (Heinrich et al., 2010) reviewed the financial burden of falls in older adults, ranging from about 2044 to 25,955 USD per fallen person.…”

Effect of Ankle Weights as a Frailty Prevention Strategy in the Community-Dwelling Elderly: A Preliminary Report

“…Instructor-led gymnastics classes are reportedly safer and more effective than self-directed efforts and self-assessment, and are better able to improve physical function than home-based exercise programs [ 2 , 4 ]. In addition, classes that add nutritional counseling and other services [ 5 ] and programs such as the “In Balance program” in the Netherlands [ 6 ], which includes an educational component and physical exercises focused on balance and muscle strength, are considered to be more effective. However, widespread implementation of these classes is unlikely in the near future because of systemic shortfalls in facilities, staffing, and funding, and insufficient performance as per the Cost Performance Index.…”