Falls Prevention Program for Elderly in Singapore

• Falls and fall-related injuries are a serious health concern for older adults in Singapore, necessitating early intervention.
• Previous research indicates that exercise interventions can improve functional outcomes and reduce falls in older adults generally.
• The effectiveness of multi-domain, multi-component fall prevention programs for elderly individuals at high risk of falls in the community is uncertain.
• Variation in falls risk factors among high falls risk older adults complicates the tailoring of multicomponent interventions.
• Aims to evaluate an enhanced version of the SAFE program, known as Steps to Avoid Falls in the Elderly.
• The SAFE-TECH intervention is designed for older adults in the community at high risk of falls and uses wearable sensors and questionnaire-based features to select candidates and tailor the program.

Methods

• SAFE-TECH is a 12-month randomized controlled trial involving 400 older adults at high risk of falling.
• Participants will be randomly assigned to either an intervention or a control group in a 1:1 ratio.
• Assessments will occur at baseline, 3rd month, and 12th month, evaluating functional status, physical performance, cognitive status, quality of life, and medical history.
• Monthly phone calls will monitor fall status, healthcare utilization, physical activity, and exercise self-efficacy.
• The intervention group will participate in a tailored, multi-domain, multi-component falls prevention program.
• The active intervention will last 12 weeks, focusing on exercises for strength, balance, coordination, flexibility, and aerobic endurance.
• Weekly educational sessions on falls risk include personalized feedback based on participant's falls risk assessments and environmental checklist.

Discussion

• SAFE-TECH seeks to improve falls prevention programs by individualizing interventions and exercises.
• The prevalence of falls among older adults worldwide is 26.5%(23.4–29.8%), with Singapore reporting 18.4% in community-dwelling older adults, and 4.6% being recurrent fallers.
• Falls contribute to 85% of geriatric trauma cases in the emergency department.
• Previous Steps to Avoid Falls in the Elderly Study (SAFE) found high fall-risk populations are heterogeneous with varied risk factors, including muscle weakness, balance impairments, and environmental hazards.
• SAFE-TECH enhances falls prevention by quantifying baseline falls risk using wearable sensor technology and a statistical model with machine learning.
• The study will evaluate effectiveness in reducing fallers and injurious falls over 12 months in a randomized controlled trial.
• Additional outcomes will be assessed, including mobility and cost-effectiveness.
• The study adheres to SPIRIT guidelines.
• The study design involves a single-blinded, multisite, two-arm, parallel-group RCT, with 400 community-dwelling older adults aged 60-95 years in Singapore.

Design process

• SAFE-TECH exercises are modified from SAFE and OTAGO, developed through expert consultations.
• Clinicians and allied healthcare professionals reviewed exercises for intensity and suitability for the health needs, physical capabilities, and cultural context of older adults in Singapore.
• Education material content and delivery were designed based on available literature and reviewed by local experts.

Hypothesis

• The study aims to reduce the number of fallers among community-dwelling older adults in the intervention arm compared to the control arm over 12 months.

Recruitment

• SAFE-TECH participants will be recruited from the TARGET Cohort.
• TARGET is a longitudinal observational study on falls and fracture risks, known as Targeted Assessment and Recruitment of Geriatrics for Effective Fall Prevention Treatments
• TARGET recruits community-dwelling older Singapore citizens or permanent residents aged 60+ from a nationally representative random sample.
• Inclusion requires speaking one of Singapore's four official languages or a Mandarin dialect.
• Participants must answer six or more questions correctly from the 10-item Abbreviated Mental Test Singapore.
• Participants should be able to walk for 5 minutes, with or without aids, and not experiencing chest discomfort, breathlessness, dizziness, or profuse sweating during the assessment.
• The TARGET data collection includes information on demographics, cognitive status, functional, biomechanical, and psychosocial characteristics of community-dwelling older adults above 60 years old.
• Data is collected via six inertial measurement unit (IMU) sensors (ZurichMOVE) affixed to designated anatomical locations.
• Cut-off risk score is evaluated from 50% of the available data.

Exclusion Criteria

• The total sample size required is 400 participants (200 in each arm), assuming a 20% drop-out rate. Exclusion criteria include significant morbidity such as:
• Congestive heart failure or myocardial infarction in the past 6 months.
• Stroke (Intracranial hemorrhage) or concussion in the past 6 months.
• End-stage renal disease requiring dialysis or severe asthma/COPD.
• Lower limb fractures in the past 6 months.
• Amputation or current participation in physical exercise trials.
• Completing fewer than 3 minutes of the 5-min gait assessment.

Randomisation

• Participants will be randomly allocated to intervention and control groups in a 1:1 ratio using a computer-generated random number schedule with a fixed block size of 4
• Allocations are performed by an investigator blinded to recruitment and assessments, with allocations inaccessible to the study team and interviewers
• Interviewers conducting baseline, outcome assessments, and follow-up calls will be blinded to participant's group allocations.

Intervention

• Participants in the intervention group will join the 12-month SAFE-TECH falls prevention program, divided into a 3-month supervised active phase and a 9-month unsupervised maintenance phase
• Conducted in the community, consisting of 24 sessions twice a week for three months, lasting 120 mins and including options for free transportation.
• Caregivers are invited to facilitate the participants in the intervention program on a voluntary basis with their informed consent.
• Exercise components cover strength, balance, flexibility, coordination, and endurance.
• Education emphasizes managing fall risk factors such as polypharmacy, nutrition, pain, and environmental hazards.
• Each PT and PT aide will facilitate a maximum of 5 participants in a smaller group.

Control

• Given educational materials (i.e., falls prevention booklet) and advised to continue their current lifestyle that is the current standard of care for older adults.

Study Measures

• SAFE-TECH participants will undergo a baseline assessment, collecting their socio-demographic characteristics, functional status, physical performance, fall history, cognitive impairment, quality of life, healthcare utilization and medical history.
• Monthly follow-up calls collect data on fall status, circumstances of falls, healthcare utilization, physical activity, and exercise frequency.