Optimizing a technology-based body and mind intervention to prevent falls and reduce health disparities in low-income populations

项目总结/摘要 福尔斯和害怕摔倒（FOF）是种族多样性地区受伤、残疾和住院的主要原因。 低收入老年人（LOA）。缺乏动力、资源有限、教育程度低和不便仍然存在 参与预防跌倒计划的障碍。超过一半的老年人有适应不良的跌倒风险 评估（FRA），一种在感知跌倒风险（FOF水平）和 生理跌倒风险（平衡性能），可能会妨碍身体活动（PA）。以帮助解决 适应不良的FRA;我们开发了一个跌倒风险评估矩阵，一个对FOF（Mind）水平进行分类的图形网格 和平衡水平（身体）分为四个象限：1）合理的FRA（低FOF和正常平衡），2） 不一致的FRA（低FOF，尽管平衡差），3）不合理的FRA（高FOF，尽管平衡正常），和4） 一致的FRA（高FOF和差平衡）。我们开发了一种新颖的，8周的基于技术的，个性化的， 家庭生理反馈锻炼计划（PEER），其包括：a）使用实时生理反馈， 便携式创新技术-BTrackS平衡系统：BBS; B）基于小说的认知重构 跌倒风险评估矩阵;以及c）以平衡和力量训练为重点的同伴主导运动。我们的R 03 研究结果支持BBS技术用于筛选适应不良LOA的可行性和可接受性 FRA强调减少久坐时间和增加中度至剧烈体力活动的重要性 （MVPA）帮助从适应不良转向适应性FRA的时间。关键的是，我们发现我们的LOA中没有一个 在我们的研究之前，他们曾经评估过跌倒风险和FOF，他们的数据显示， FOF和对衰老的负面自我认知。在我们发表的试点研究中，我们发现， 同伴干预在动态平衡方面有显著改善，降低了跌倒风险， 不适应性转变;然而，我们有限的LOA样本（占总数的40%）阻止了强有力的 在这个群体中的有效性。我们使用了一个随机分组对照试验， 干预将提供在低收入的独立生活社区/单位在奥兰多，佛罗里达州通过我们的 与社区和公共卫生组织建立伙伴关系。我们将在基线（T1）收集数据， 测量项目完成后（T2）、3个月（T3）和6个月（T4）随访时的结局。低收入 如果老年人（n=340）年龄≥60岁，认知功能完好，能够站立， 援助.我们的目标是1）检查基于技术的同伴干预对跌倒风险的影响，动态 平衡和基于加速度计的身体活动; 2）检查干预对跌倒风险的影响 评估转移和消极的自我认知老化;和3）探讨参与者的经验， 干预和潜在的障碍，以获取和采用技术为基础的同行干预。本研究 通过优化技术驱动的定制方法来解决公共卫生问题， 在资源匮乏的环境中运行，用户数量不受限制，以防止福尔斯跌倒并减少健康差异。

PROJECT SUMMARY/ABSTRACT Falls and fear of falling (FOF) are the leading cause of injury, disability, and hospitalization in racially diverse low-income older adults (LOA). Lack of motivation, limited resources, low education, and inconvenience remain barriers to participate in fall prevention programs. More than half of older adults have maladaptive fall risk appraisal (FRA), a condition in which there is a discrepancy between perceived fall risk (levels of FOF) and physiological fall risk (balance performance) which may impede physical activity (PA). To help address maladaptive FRA; we developed a fall risk appraisal matrix, a graphical grid categorizing levels of FOF (Mind) and levels of balance (Body) into four quadrants: 1) rational FRA (low FOF and normal balance), 2) incongruent FRA (low FOF despite poor balance), 3) irrational FRA (high FOF despite normal balance), and 4) congruent FRA (high FOF and poor balance). We developed a novel, 8-week technology-based, individualized, in-home Physio-fEedback Exercise pRogram (PEER), which includes a) physio-feedback using a real-time portable innovative technology—the BTrackS Balance System: BBS; b) cognitive reframing based on a novel fall risk appraisal matrix; and c) peer-led exercise by focusing on balance and strength training. Our R03 findings support the feasibility and acceptability of using BBS technology on screening LOA with maladaptive FRA, highlight the importance of reducing sedentary time and increasing moderate to vigorous physical activity (MVPA) time to help shift from maladaptive to adaptive FRA. Critically, we found that none of our LOA had ever had their fall risk and FOF assessed before our study and their data reveal a strong relationship between FOF and negative self-perceptions of aging. In our published pilot study, we found that the technology-based PEER intervention had significant improvements in dynamic balance, reduced fall risk, and facilitated maladaptive to adaptive shifting; however, our limited sample of LOA (40% of total) prevents strong conclusions about effectiveness in this group. We use a clustered randomized controlled trial, and the intervention will be offered at the low-income independent living communities/units in Orlando, FL through our partnership with community-based & public health organizations. We will collect data at baseline (T1) and measure outcomes after program completion (T2), follow up at 3-months (T3), and 6-months (T4). Low-income older adults (n=340) will be enrolled if they are ≥60 years old, cognitive intact, and able to stand without assistance. We aim to 1) examine the effects of the technology-based PEER intervention on fall risk, dynamic balance, and accelerometer-based physical activity; 2) examine the effects of the intervention on fall risk appraisal shifting and negative self-perceptions of aging; and 3) explore participants’ experiences with the intervention and potential barriers to access and adoption of technology-based PEER intervention. This study addresses the public health problem with the optimization of a technology - driven tailored approach that can operate in low-resource environments with unlimited users to prevent falls and reduce health disparities.