Engineering improved balance confidence among older adults with complex health care needs: learning from the muscling up against disability study.
Swinton, Paul Alan
Keogh, Justin W. L.
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HETHERINGTON, S., HENWOOD, T., SWINTON, P., KEOGH, J., GARDINER, P., TUCKETT, A. and ROUSE, K. 2018. Engineering improved balance confidence among older adults with complex health care needs: learning from the muscling up against disability study. Archives of physical medicine and rehabilitation [online], 99(8), pages 1525-1532. Available from: https://doi.org/10.1016/j.apmr.2018.03.004
Objective: To investigate the associations of balance confidence with physical and cognitive markers of wellbeing among older adults receiving government-funded aged care services, and whether progressive resistance plus balance training could positively influence change. Design: Intervention study. Setting: Community-based older-adult-specific exercise clinic. Participants: Older adults (N=245) with complex care needs who were receiving government aged care support. Intervention: 24 weeks of twice-weekly progressive resistance plus balance training carried out under the supervision of accredited exercise physiologists. Main Outcome Measures: The primary measure was the Activity-specific Balance Confidence score. Secondary measures included the Short Physical Performance Battery, fall history, hierarchical timed balance tests, Geriatric Anxiety Index, Geriatric Depression Score, FRAIL scale and EuroQol 5D 3L. Results: At baseline, higher physical performance (r = 0.54, p < .01) and quality of life (r = 0.52, p < .01) predicted better balance confidence. In contrast, at baseline, higher levels of frailty predicted worse balance confidence (r = -0.55, p < .01). Change in balance confidence following the exercise intervention was accompanied by improved physical performance (+12%) and decreased frailty (-11%). Baseline balance confidence was identified as the most consistent negative predictor of change scores across the intervention. Conclusions: This study shows that reduced physical performance and quality of life, and increasing frailty, are predictive of poor balance confidence among older adults with aged care needs. However, when a targeted intervention of resistance and balance exercise is implemented, that reduces frailty and increases physical performance, balance confidence will also improve. Given the influence of balance confidence on a raft of wellbeing determinants, including the capacity for positive physical and cognitive change, this study offers important insight to those looking to reduce falls among older adults.