Understanding Dance for Falls Prevention

Background to the Project:

Every year in the United Kingdom (UK), falls among older people cost the National Health Service (NHS) over £2.3 billion. When including costs of other services such as social care needed due to hip fractures from falls, the total yearly cost in the UK increases to £4.4 billion. These figures show just how expensive falls can be for healthcare systems.

However, the problem is not just about the money. Falls have a huge impact on older people's lives, often related to fear of falling, and can lead to problems such as reduced independence in everyday activities, lower quality of life, and social isolation. As the number of older adults increases, these issues are expected to get worse.

This means there is a need for proactive measures to prevent falls. This is important to help older people live better lives, as well as to make best use of healthcare resources. One of the most effective ways to reduce falls is exercise, especially exercises that improve balance and muscle strength. The main thing that makes exercise programmes successful is whether or not people can stick to the exercise programme once started.

Scientific Rationale:

All the causes of falls in older people are not fully understood because they can be triggered by many different factors. There are also many different programmes and strategies for preventing falls, and these can include things like exercise, medication review, and balance training. Some programmes use a combination of these methods.

Exercise focussing on strength and balance in particular has been shown to reduce fall rates by almost one-third. The Otago and Falls Management Exercise (FaME) programmes are two examples of exercise regimes that have been proven to be effective.

Even though the advice to be physically active exists, not everyone participates in exercises that challenges their balance. Research in Australia showed that older people were not likely to take part in exercises that help improve balance and strength, even though these exercises could reduce their risk of falls.

One type of exercise that's gaining attention is Tai Chi, a form of exercise that helps with balance and strength. It has been shown to reduce fall rates by up to 37%. Tai Chi involves structured movements that are controlled and flowing, and work in all directions, making it great for improving movement control and balance.

Dance is another form of exercise that challenges balance. Like Tai Chi, it involves continuous, controlled movement, but it also includes elements of social interaction and cognitive (thinking) challenges, which could help reduce fall risk in different ways. Some studies have shown that dance can improve physical strength and function, but more research is needed to determine how effective it is specifically for preventing falls.

While there's some uncertainty about how best to use dance for fall prevention, experts agree that dance is worth investigating further. One challenge is that dance programmes can vary a lot, in a way that Tai Chi does not, making it harder to draw conclusions about dance being able to reduce falls. New research frameworks, like the Rehabilitation Treatment Specification System (RTSS), can help researchers to describe exactly how dance interventions are thought to work and what they aim to improve.

In addition to studying the effectiveness of dance programmes, it's important to consider how dance instructors lead these sessions and how older people feel about participating. Understanding the motivations of older adults who choose dance to reduce fall risk will give us better insight into how to improve these programmes.

Dance for Strength and Balance Programme:

In the Older Person's Assessment Unit, we've been running a dance programme called Dance for Strength and Balance (DSAB) for older adults at risk of falling. This programme was jointly created with the Breathe Arts Health Research charity and funded by Guy's \& St. Thomas' Charity, offering an alternative to traditional strength and balance exercises.

Physiotherapists compared this dance programme with a traditional strength and balance group, and found no significant difference in four measures of physical ability and falls risk, although the traditional group did show more improvement in one test. Despite this, people who participated in the dance programme reported positive experiences.

However, there is still some hesitation in the healthcare community about using dance for fall prevention since more research is needed to prove its effectiveness. This is where this project comes in, aiming to continue testing and refining the programme to make it better and easier to understand.

The investigators are in a unique position because we have hands-on experience in designing, running, and evaluating a dance programme for older people at risk of falling. What's still missing from the research is more detailed feedback from the participants and dance instructors. There is a need to understand why older people choose dance, what benefits they feel they're getting, and how instructors adapt the programme for their needs. Also, as dance might not be an exercise type that everybody wants to do, the investigators also want to hear from those that choose not to take part in the dance classes about why they made their choice.

Aim of the Study The goal is to explore the effectiveness of dance programmes for fall prevention and to understand the experiences and perceptions of older adults who participate in them.