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Implementation of Falls Management Exercise (FaME) falls prevention programme among community-dwelling older adults.
Sally Hoodless1,2,3, Jodi Ventre4,5,6,7, Sarah K Smith4,5,6
1Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Jean McFarlane. Oxford Road, Manchester, M13 9PY, UK. sally.hoodless@postgrad.manchester.ac.uk.
Background:
A common cause of injury, disability, mortality, and health-related costs, falls affect a third of adults aged 65 years and older. Falls Management Exercise (FaME) is an evidence-based, progressive falls prevention programme, shown to significantly reduce falls and concerns about falls among community-dwelling older adults. Despite the proven benefits of FaME, there are inconsistencies in implementation fidelity and programme delivery. Variances in attendance, adherence and dose, required to ensure efficacy, can negatively impact real-world effectiveness of FaME. This scoping review aims to address the paucity of evidence synthesis on FaME implementation. Identifying key characteristics relating to intervention delivery, implementation and behaviour change strategies, participant uptake, adherence, meeting of effective dose, attrition, and fidelity.
Methods:
Adopting an approved methodology for conducting scoping reviews, seven electronic databases were searched using the Population, Context and Concept inclusion criteria. These relate to; older adults (≥60 years), 'community-dwelling' and FaME. From an initial 10,888 papers, 26 research papers (13 studies), were included in the full text review, of which ten papers (six studies) used technology in delivering FaME.
Results:
Key themes: challenges in meeting recruitment target and uptake of FaME, particularly underserved ethnic and socioeconomic populations; significantly fewer older men participating in FaME when compared to older women; issues of poor adherence and meeting of effective dose, especially with home-based exercise components; high rates of attrition and the value of Instructor qualities in delivering FaME. Studies which included technology-assisted implementation reported increased participation by older men, with programmes performing better in terms of adherence, attrition and exercise dose.
Conclusions:
With digital health technologies showing promising effects on persistent challenges to adherence, dose, and attrition, technology-assisted implementation of FaME has potential to effectively support a wider uptake of FaME among community-dwelling older adults who decline or withdraw participation. Further research is needed to increase our understanding of under-served community-dwelling older adults experiences, and perceptions about FaME and falls prevention. We need to further explore the acceptability of technology-assisted implementation of FaME, and feasibility for supporting a wider roll-out of FaME across the United Kingdom.
Clinical Trial Registration:
Not applicable.
