Minimizing Fall-Related Injury in Older Adults: a motor learning approach

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PROJECT SUMMARY Falls are the leading cause of accidental injury and death among older adults. Fall related injuries occur when the impact force of the fall is greater than tissue strength. An alternative approach to current practice is teaching older adults protective movements that reduce the impact force when they to fall. This high risk/high reward approach is fundamentally different from traditional approaches in injury prevention. There is evidence that teaching safe landing strategies (i.e. movement patterns) can significantly reduce hip impact forces and head acceleration in young adults. Recent pilot data suggests that older adults can learn to fall so that they minimize their impact forces and head acceleration. However, the sample was limited to older adults with minimal risk of falls. Consequently it is not clear if older adults at risk of falls can safely learn to fall safely. The ultimate goal of this innovative proposal is to set the stage for the development of a novel approach to reduce fall related injuries in older adults. The immediate goal of this proposed R21 is to determine the feasibility of Falling Safely Training program in an at-fall risk older adult group, the key measureable stages of FAST mastery, and, most importantly, the effect size, compared to Otago Exercise Program (an evidence- based fall risk reduction program) controls, to inform a larger future trial. The current investigation, is a necessary step, to determine if teaching older adults at risk of falls in a standardized progressive program is safe (Aim 1), and whether at risk older adults can learn to fall with reduced head acceleration and hip impact forces (Aim 2). 28 participants will be randomized into one of two groups (fall training or balance training). All participants will perform standardized sideway falls and have their hip impact and head acceleration quantified utilizing validated techniques. Participants will undergo 8 standardized progressive training sessions, undergo baseline and post training assessments and a 3-month follow-up session. Consistent with the principles of motor learning, learning will be quantified with changes in hip impact force and head acceleration following training, and 3-month retention. The overall goal of this project is to systematically determine whether training older adults to fall safely has potential utility as a strategy to reduce fall-related injuries which can be combined with current fall prevention efforts.