Theory Behind the Program Debbie Rose, Ph.D. Co-Director, Center for Successful Aging California State University, Fullerton

Falls are a Serious Public Health Problem! 32% of community-residing older adults fall at least once per year. Serious injuries are reported in 24% who fall. Approximately 50% of nursing home residents fall per year and 9% sustain serious injuries. Estimated that 250,000 hip fractures occur annually in the U.S. as a direct result of falls. Figure expected to double by year 2040.

Falls are Costly! Annual direct and indirect costs of falls estimated to range from $75 to 100 billion. Immediate need for intervention programs specifically designed to reduce the incidence of falls among older adults.

Distinguishing Features First……….. The Program adopts a contemporary, theory-based approach

Task Demands Environment Individual Capabilities Surface Type Visual Flow Seated Standing Moving Single Multiple Strength ROM Sensory Loss Cognition Lighting Cardiovascular

Distinguishing Features Second…. The FallProof program adopts a multidimensional assessment and programming approach

Multidimensional Assessment Carefully chosen set of tests used to identify changes in multiple body systems (e.g., motor, sensory, cognitive) Results used to select specific types and levels of exercises that target the source of the impairment(s). Administered prior to start of program and at regular intervals thereafter.

Multidimensional Programming Program is comprised of FIVE major exercise components: Center of Gravity Control Proactive and reactive postural strategy Multisensory Gait Pattern Enhancement and Variation Strength and Flexibility Ensures targeted approach to targeting specific impairments is achieved.

Distinguishing Features Third…. The program can be effectively implemented across a wide range of functional levels and age groups.

Broad Application Exercises are systematically progressed from very low level to high level of balance challenge, Exercises progressed from seated to standing to moving environments. Difficulty of exercise can be increased or decreased by manipulating task and/or environmental demands.

Distinguishing Features Fourth…. The effectiveness of the FallProof program has been scientifically tested and documented.

Proven Effectiveness Effectiveness of program tested in multiple sites throughout Southern California More than 20 outreach programs currently serve older adults at moderate to high risk for falls. Significant improvements in multiple dimensions of balance and balance-related self-confidence demonstrated as early as 8 weeks into program.

The “Systems” Approach Considers motor behavior to be result of how well each body system is functioning as well as demands imposed by task and environment. As number of intrinsic systems exceed critical threshold of function, ability to accomplish daily tasks is compromised.

The “Systems” Approach Older adults cease to engage in activities perceived to increase risk for falls. Self-imposed restrictions reduce exposure to falls in short-term but lead to reduced self-confidence and severe deconditioning in long-term. Hastens onset of physical frailty and increases fall risk.

F all ProofProgram F all Proof Program Structured group program that has been successfully implemented in multiple community and residential care facilities. Short-term and long-term efficacy of program has been demonstrated

Task Demands Environment Individual Capabilities Surface Type Visual Flow Seated Standing Moving Single Multiple Strength ROM Sensory Loss Cognition Lighting Cardiovascular

An important GOAL of the program is to CHALLENGE but NOT exceed the individual’s intrinsic capabilities