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Introduction

Despite evidence supporting the effectiveness of exercise-based fall prevention interventions, implementing these programmes in practice remains challenging. Peer-led exercise programmes have demonstrated effectiveness in delivering fall prevention education to older adults. Therefore, this study aimed to explore older adults’ experiences of being trained and serving as peer leaders in a group-based fall prevention exercise programme, focusing on the skills and qualities required for leadership. Additionally, the study sought to identify facilitators and barriers influencing training and the programme’s long-term implementation.

Materials and methods

Participants were recruited from a randomised controlled trial. Two focus group interviews were conducted with 13 participants from the exercise arm of the randomised controlled trial (nine females and four males). Data were analysed using inductive qualitative content analysis.

Results

Five main categories and nine subcategories emerged, capturing key aspects of the study aim. The categories were: (a) education to prepare fall fitness peer-led trainers; (b) peer-led trainer characteristics and roles during training sessions; (c) physical training environment; (d) psychosocial environment; and (e) prerequisites for the long-term sustainability of the FallFitness programme.

Conclusions

The ‘train-the-trainer’ approach for peer-led fall prevention interventions was found to be effective, highlighting the value of integrating theoretical and practical components in training. Participant feedback will inform future improvements to the FallFitness programme, ensuring its continued implementation and effectiveness.

BACKGROUND: As the older population grows rapidly, the incidence of falls and fall-related injuries is rising, underscoring the urgent need for systematic, evidence-based fall prevention.

OBJECTIVE: This study aimed to examine the implementation of the World Falls Guidelines for falls prevention in a region of Sweden, with particular attention to the implications of anchoring and developing a knowledge support tool within policy and practice.

METHODS: A participatory research design was employed, involving five diverse settings: primary care, hospital care, homecare, municipal social services and pensioners' organizations. Data collection included workshops, field notes and written material. Early implementation processes focused on anchoring and developing, aligning with the i-PARIHS framework. The data were analysed using a framework analysis.

RESULTS: The anchoring process revealed a lack of managerial support at the appropriate organizational level, which hindered cross-sectoral collaboration. Further, the developing process refined the content structure to better address the needs of both professionals and older adults. Seven themes were mapped by using i-PARIHS framework: (i) Innovation-adoption and adaptation, risk assessment; (ii) Recipients-intermediate managerial decision-making; (iii) Context-collaboration and resources, documentation and information sharing and accessibility and outreach and (iv) Facilitation-project or process.

CONCLUSION: Successful implementation requires anchoring and organizational alignment across all levels, with particular emphasis on the engagement of intermediate management. While the primary challenges emerge at the organizational (meso) level, they are closely interconnected with both micro-level and macro-level influences. Coordinated efforts across all levels are therefore essential for effective implementation strategies.

BACKGROUND: Falls threaten the health and well-being of older adults. While studies have presented effective fall prevention exercises, determining how to deliver these interventions in a way that ensures engagement and long-term sustainability is challenging. Additionally, understanding how older adults perceive and are motivated to participate in such programs is critical for broad public health promotion. This study aimed to explore older adults' experiences and perceptions regarding participation in a newly developed 8-week peer-led group-based exercise program, FallFitness.

METHODS: Participants were recruited from a randomized controlled trial (RCT) exploring a newly developed 8-week peer-led group-based exercise program. A total of 2 focus groups were conducted post intervention, comprising ten participants (8 women and 2 men) from the exercise arm of the RCT. Inductive and conventional qualitative content analysis was performed.

RESULTS: From the interviews, 5 main categories and 6 subcategories capturing the study aim are presented. Main categories included: a) social interaction and community, more than just exercise, b) increased motivational drive and self-efficacy, c) group exercise as fun, safe, and inclusive activity, d) enhanced collaboration between healthcare providers and retirement organizations for fall prevention, and e) professional peer-led trainers.

CONCLUSION: Peer-led, well-designed group-based exercise programs can holistically support physical, emotional, and social well-being. Programs that include enjoyable, multicomponent elements, both physically and mentally stimulating, can enhance participants' motivation and adherence. Additionally, the group setting is thought to promote meaningful social interaction, which is widely recognized as important for overall well-being. From a public health perspective, collaborative models for fall prevention involving older adults as a "golden resource" should be established.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT06265480 (2024-02-08).

Background

Physical inactivity is a major public health concern worldwide. Psychological distress is linked to physical inactivity, which increases the risk of several diseases. Women tend to be more physically inactive than men. Moreover, physical inactivity increases with age in both sexes. Therefore, this study aimed to investigate the association between psychological distress and physical inactivity in adults aged ≥ 65 years, the role of psychosocial factors and explore sex-based differences.

Methods

This study included 14,213 older adults, comprising 7,069 women (52%) (median age = 75 years), who responded to a survey questionnaire sent to a random population sample in Mid-Sweden in 2022. The response rate in the population aged ≥ 65 years was 61%. The association between psychological distress as defined by the Kessler-6 and physical inactivity (< 150 min/week of physical activity) was analyzed using binary logistic regression, adjusting for sex, age, country of birth, educational level, and psychosocial factors.

Results

Overall, 30% of the participants reported psychological distress, and 45% were physically inactive. Psychological distress and physical inactivity were significantly associated (p < 0.001), being more common among women (p < 0.001). In the fully adjusted model, the Odds Ratio (OR) for physical inactivity was 1.46 (95% confidence interval (CI) 1.43–1.50) for women and 1.70 (95% CI: 1.65–1.74) for men regarding moderate psychological distress and 2.87 (95% CI: 2.72–3.04) for women and 2.43 (95% CI: 2.28–2.58) for men regarding serious psychological distress. Not participating in social activities in the last 12 months was associated with physical inactivity in both women and men.

Conclusions

Psychological distress is significantly associated with physical inactivity among older adults. Participation in social activities was identified as an essential factor in addressing physical inactivity. Social connections and physical inactivity are important factors to consider when supporting older adults’ mental health. Public health interventions should promote and raise awareness of physical and mental health as well as the social dimensions of aging, while also considering age and sex-based differences.

Purpose: Falls pose a significant health risk to older adults, often resulting in adverse outcomes. Despite the recognition of effective interventions, the psychological aspect of fear of falling (FoF) remains under-addressed. The Fear of Falling Questionnaire-Revised (FFQ-R) (15 and 6-item) was developed to assess FoF. However, no Swedish version is available, necessitating its translation and evaluation of psychometric testing. This study aimed to translate the FFQ-R (15 and 6-item) and examine the psychometric properties of the Swedish versions in healthy community-dwelling adults aged ≥ 60 years.

Patients and Methods: This study used a cross-sectional design to translate and assess the psychometric properties of the FFQ-R(S) (15 and 6-item) for healthy community-dwelling older adults. Translators, experts, and community-dwelling older adults participated in the process. Confirmatory factor analysis was used to assess the fit of the model. Scale reliability was measured with ordinal α.

Results: The translation resulted in minor changes and demonstrated satisfactory content validity. Confirmatory factor analysis showed that the FFQ-R(S) model, with four latent factors and 15 items, was not analyzable due to non-convergence. For the two- factors and six items, FFQ-R(S), the ordinal α values for the scales’ harm outcome (HO) and degree of threat (DT), measuring reliability, were 0.70 and 0.88, respectively. The confirmatory factor analysis yielded mixed fit indices, where values of standardized root mean square residual, comparative fit index, and Tucker–Lewis index suggested a good fit of the model to the sample, whereas the χ2 test and the value of root mean square error of approximation indicated a lesser good fit.

Conclusion: The Swedish version of the 6-item FFQ-R demonstrates acceptable psychometric properties. Moreover, the six items align with the two factors, DT and HO. Based on these findings, we recommend using the Short FFQ-R(S) (6-item) to assess FoF in primary fall prevention efforts for community-dwelling older adults.

Purpose

To gain a deeper understanding of the development of a joint vision for Close Care, its obstacles and opportunities, in the region of Sörmland based on national health and social services reforms.

Design/methodology/approach

Seven semi-structured interviews were conducted with thirteen stakeholders. Documentation from the process was used to enhance the findings. A qualitative content analysis was performed.

Findings

Stakeholders described Close Care as entailing “person centeredness, cooperation, and resource sharing” but found it “too abstract”. Participation in developing the vision varied, with experiences of “external pressure” and low “readiness for organisational change”. Views on a regional vision’s “relevance and usability” differed. Participants highlighted several opportunities for the Close Care vision, such as: “a stepping-stone for implementation”, “harmonises with other health care visions” and “forming a cross municipal and regional network”. They also noted obstacles like “symbolic alienation”, “cognitive complexity”, “short-term economic reality” and “uncertainty around implementation”.

Practical implications

Opportunities and obstacles for the vision of Close Care can inform complex healthcare reforms that require stakeholder cooperation.Social implicationsUnderstanding Close Care may enable health system stakeholders to more effectively cooperate around the citizens’ needs.

Originality/value

Research on common ground has mainly focused on national or international policy levels and individual hospitals, professionals or patients. This study offers insights on regional and municipal cooperation in health care driven by a common vision.

BACKGROUND: Depression is common in older adults and is related to reduced quality of life and functional ability as well as increased mortality and morbidity. Current guidelines recommend psychological treatments for the treatment of depression in adults. Studies show that about 30% of older adults with depression in Sweden receive pharmacological treatment and about 3% receive psychological treatment. However, a majority receive no treatment at all. There is a need for effective and scalable psychological treatment options for older adults with depression in primary care. Behavioural activation is an extensively evaluated, effective, and relatively simple treatment for depression that can be delivered by health care professionals without comprehensive training in psychological treatment.

METHODS: We will conduct a randomised controlled 2-armed parallel group multicentre trial comparing treatment as usual in primary care to a five-session telephone-delivered behavioural activation treatment as add on to treatment as usual. The current trial is open labelled. In all, 250 older adults (≥ 65 years) with depression will be recruited from primary healthcare centres in three Swedish regions. The primary outcome is depressive symptoms measured with the Montgomery Åsberg Depression Rating Scale - Self rating version (MADRS-S) after treatment and at 3- and 6-month follow-up. Secondary outcomes include depression diagnoses, activity level (self-rated and measured with accelerometer), and self-rated anxiety, daily functioning, quality of life, self-efficacy, and loneliness.

DISCUSSION: There is a need for fully powered studies of brief behavioural activation for older adults with depression delivered by telephone in a primary care context. This study has the potential to improve first-line treatment of depression in older adults in primary care, consequently reducing morbidity and mortality within this population. Increasing the availability and accessibility to effective psychological treatment for depression in older adults is needed to meet future demographic changes.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT06284889 . Registered February 28, 2024.

Background: Falls and fall-related injuries remain a global challenge and threat to the health of older adults. Specific strength and balance exercises are effective in preventing falls among community-dwelling older adults. Nevertheless, provision of evidence-based fall prevention interventions to a broad population represents a healthcare challenge, indicating that new models for promoting exercise among community-dwelling older adults need to be addressed. Here, we aimed to evaluate the effects of a peer-led group-based exercise intervention provided using the train-the-trainer approach and targeting physical performance, activity level, handgrip strength, quality of life, fall-related self-efficacy, fear of falling, and falling techniques compared with a control group at 8-week follow-up.

Methods: This randomized controlled trial (RCT) included trainers and participants who were recruited from four collaborating regional organizations for retired persons. The intervention was planned to be provided in five municipalities in Sweden, depending on the location of the registered trainers. Eligible participants included adults aged ≥ 60 years who could walk independently and understand written and oral information in Swedish. The FallFitness multicomponent exercise program delivered weekly strength, balance, and falling techniques over eight weeks. It was evaluated using the train-the-trainer approach. Fourteen older adults were eligible for trainer education, and 101 participants were randomly allocated for the FallFitness exercise (n = 50) or a control group (n = 51).

Results: After 8 weeks of peer-led training, the short multicomponent exercise program significantly improved the physical activity levels (p = 0.036) and backward and sideways falling techniques (p < 0.001) compared to those in the control group. Fear of falling significantly decreased in the exercise group (p = 0.009). Other outcomes in this study showed to be non-significant.

Conclusions: The multicomponent exercise program provided in eight sessions using the train-the-trainer approach may be effective in promoting physical activity and the learning of motor skills and safe landing strategies. Furthermore, the FallFitness exercise program may reduce the fear of falling and may be both time- and cost-effective.

AIMS: The aims of this study were (i) to evaluate the effects of using an m-health tool on self-care behaviour at 3 and 12 months and (ii) to explore the experiences and perceptions of heart failure (HF) patients about the m-health tool.

METHODS AND RESULTS: In this pre-post interventional study with a mixed-method analysis, 71 patients diagnosed with HF [49% female, mean age 76.7 years, New York Heart Association (NYHA) II 31%, NYHA III 69%] were enrolled and had the m-health tool installed in their home for 1 year. The tool consisted of a pre-programmed tablet including a weighing scale and interactive education about HF self-care. At baseline, and at 3 and 12 months, self-care was assessed using the European Heart Failure Self-care Behaviour (EHFScB-9) Scale, an eight-item self-administered questionnaire assessing the experiences of the m-health tool. The mean EHFScB-9 at baseline was 63.8 ± 2.8 and it improved to 67.6 ± 7.6 after 3 months (P < 0.05). After 1 year, the score had decreased to 63.2 ± 7.1 (P = 0.68). Most patients rated the tool as 'good', both at 3 months (92%) and after 12 months (93%). Some found the system to be unnecessary to some degree, and this number increased between 3 and 12 months (P < 0.001). Most patients felt that m-health increased their feelings of security, and 85% responded that the system increased their family members' sense of security.

CONCLUSION: The m-health tool significantly improved patients' self-care behaviour after 3 months, but this effect did not persist after 1 year. For achieving long-term effects and outcomes, additional and regularly updated self-care support may be needed.

REGISTRATION: ClinicalTrials.gov: NCT04955600.