An Investigation of the Effectiveness of A Matter of Balance/Volunteer Lay Leader Model (AMOB/VLL): Findings from a Community Senior Center

Research has consistently shown that older people are vulnerable to falls and have a fear of falling. One low-cost community-based education program, A Matter of Balance/Volunteer Lay Leader Model (AMOB/VLL), has demonstrated promise in reducing falls in this population. This article presents findings from a secondary analysis of program outcome indicators. The analysis suggests positive outcomes from the program, including enhanced fall prevention self-efficacy, increased knowledge of participants, and positive participant feedback. These initial findings will provide important baseline data for funding to continue the AMOB/VLL program.     

Is the self-perception of the built neighborhood associated with fear of falling in community-dwelling older adults?

IntroductionCharacteristics of a built neighborhood may aggravate agravett to fear of falling in older adults and this knowledge are important to contribute to developing strategies aimed at reducing fear of falling and their consequences.ObjectiveTo verify the association between self-perception of built neighborhood characteristics and fear of falling in community-dwelling older adults.Materials and MethodsThis was a cross-sectional study including 308 community-dwelling older adults. The outcome was fear of falling evaluated through Falls Efficacy Scale International. Older adults were classified with high fear of falling when they obtained values ≥ 23 points and classified as low fear of falling with score < 23 point. The built neighborhood variables were evaluated by the adapted Neighborhood Environment Walkability Scale. Multivariable logistic regression was performed to verify associations between the variables.ResultsThe prevalence of fear of falling was 48.40%. Significant negative associations were observed between residing near a bus stop, outdoor gyms, safe places to walk during the day, and positive associations between garbage accumulation and/or open sewers and high crime rates and fear of falling.ConclusionThe association between self-perceived characteristics of built neighborhoods and fear of falling points to the need for improvements in urban infrastructure, especially public spaces, in order to reduce fear of falling in community-dwelling older adults.     

Evaluating the effectiveness of a home-based fall risk reduction program for rural community-dwelling older adults

BACKGROUND: We investigated the effectiveness of a low-cost, multifactor fall risk reduction program in a group of rural community-dwelling older adults. The goal of the program was to provide health care workers and communities with a primary prevention tool that can be used to teach seniors about fall-related risks. The long-term goal of this program is to reduce the incidence of falling among community-dwelling older adults. METHODS: Complete data were collected on 37 community-dwelling subjects, aged 67 to 90, who participated in a 10-week fall risk reduction program. The subjects were randomly assigned to an intervention group or to a control group. The intervention group received fall risk education, home-based exercise programming, nutrition counseling, and environmental hazards education. Both groups completed a variety of physiologic, psychometric, and environmental fall-related risk assessments before and after the intervention period. RESULTS: The intervention group showed statistically significant improvement in balance, bicep endurance, lower extremity power, reduction of environmental hazards, falls efficacy, and nutritious food behavior during the study period. CONCLUSIONS: The low-cost, home-based fall risk reduction program for community-dwelling older adults was effective in reducing some of the studied fall-related risk factors over a 10-week period.     

Falls in community-dwelling older adults with heart failure: A retrospective cohort study

BackgroundWhile heart failure (HF) in older adults is associated with fall risk, little is known about this in the U.S.ObjectiveTo examine the independent effect of functional impairments related to HF on falls among community-dwelling older adults in the U.S.MethodsA retrospective cohort study was conducted with 17,712 community-dwelling older adults aged 65 and above with (n = 1693) and without HF, using mixed-effects logistic regression to examine the association between HF and falls.ResultsHF patients had 14% greater odds of falling than those without HF. Moreover, HF patients with functional difficulties in mobility, large muscle difficulty, instrumental activities of daily living difficulty, poor vision, and urinary incontinence demonstrated an increased likelihood of falling.ConclusionCommunity-dwelling older adults with HF and functional difficulties have a higher fall risk than those without HF, indicating that fall prevention programs should be developed, tested, and implemented for this population.     

Association between Fear of Falling (FOF) and all-cause mortality

ObjectiveTo longitudinally investigate the effect of fear of falling on all-cause mortality.MethodsData from the KLoSA from 2006 to 2016 was used and 10,219 middle aged and older adults were included for analysis. The association between fear of falling and all-cause mortality was analyzed by Cox proportional hazard model with controlling for demographic characteristics, number of chronic conditions, depressive symptoms and fall experience.ResultsOf the 10,219 individuals at baseline 2006, those with fall experience for 2 years were 411 participants (4.2 %) and about 18.5 % of these participants (n: 76) died. In terms of FOF, 14.83 % of participants (1,515/10,219) reported serious fear for falling. Adjusted hazard ratio (HR) of all-cause mortality shows those who are very afraid of falling had a significantly increased risk of mortality compared with those without a FOF (HR 1.861, 95 % CI 1.589–2.179, P-value:.0001).ConclusionThis study shows a statistically significant association between fear of falling and all-cause mortality in a Korean middle aged and aged population.     

Selective Attentional Processing to Fall-Relevant Stimuli Among Older Adults Who Fear Falling

Fear of falling is known to affect more than half of community-dwelling older adults over 60 years of age. This fear is associated with physical and psychological effects that increase the risk of falling. The authors' theory is that attentional processing biases may exist in this population that serve to perpetuate fear of falling and subsequently increase fall risk. As a starting point in testing this proposition, the authors examined selective attentional processing bias to fall-relevant stimuli among older adults. Thirty older adult participants (M _age = 70.8 ± 5.8), self-categorized to be Fearful of Falling (FF, n = 15) or Non-Fearful of Falling (NF, n = 15) completed a visual dot-probe paradigm to determine detection latencies to fall-threatening and general-threat stimuli. Attentional processing was defined using three index scores: attentional bias, congruency index, and incongruency index. Bias indicates capture of attention, whereas congruency and incongruency imply vigilance and disengagement difficulty, respectively. Both groups showed an attentional bias to fall-threat words but those who were fearful of falling also showed an incongruency effect for fall-threat words. These findings confirm that selective attentional processing profiles for fall-relevant stimuli differ between older adults who exhibit fear of falling and those who do not have this fear. Moreover, in accordance with current interpretations of selective attentional processing, the incongruency effect noted among fall-fearful older adults presents a possibility for a difficulty disengaging from fall-threatening stimuli.     

Agreement and predictive power of six fall risk assessment methods in community-dwelling older adults

A large number of fall risk assessment methods are available with a variety of performances for screening the risk of falling in older adults, but their agreement for assessing the risk of falling remains unknown. This observational prospective cohort study describes the agreement and predictive power of methods to classify the risk of falling in older adults using prospective data and published cut-off values. Fifty-two participants aged 74 years (interquartile range 69–80) were assessed using the Berg Balance Scale, polypharmacy, Falls Risk Assessment Score, Fall Risk Assessment Tool, Fall Efficiency Scale, and Posturography. Nine participants (17 %) reported at least one fall after six months. Cochran’s test showed different proportions of participants classified as at high risk of falling among all methods (Q = 69.560, p < 0.001). A slightly better-then-chance agreement was estimated between all FRA methods (Light’s κ = 0.074, 95%CI [0.021; 0.142]). We found both global and pairwise agreement levels that question the agreement among fall risk assessment methods for screening community-dwelling older adults.     

Falls and fear of falling among older adults in an assisted-living facility: A qualitative and foundational study for intervention development in a developing country

BackgroundFalls and fear of falling (FOF) have serious adverse effects for older adults. Culturally-specific and environmentally-tailored interventions may help address the problems of falls and FOF. No such interventions are however available for use in the African context.ObjectiveTo explore falls and FOF among older adults in an assisted-living facility, as a foundation for developing interventions to address falls and FOF.MethodsThis qualitative study involved purposefully recruiting nine older adults and four caregivers at an assisted-living facility in Southeast Nigeria. Focus group discussions were conducted separately for older adults and the caregivers. Data were analysed using an Inductive Approach.ResultsFour themes emerged: incidence of falls and fear of falling; factors associated with falls and fear of falling; health implications of falls and fear of falling; and coping strategies to deal with falls and fear of falling. Older adults were experiencing a high prevalence of falls and FOF perceived to be caused by both cultural/environmental/institutional-related factors (poorly lit environment at night; poor ambulatory surfaces; unwillingness to accept age-related changes in physical capacity; poor disposition towards walking aids; poor treatment of injuries; misconceptions; poor physical activity participation; and external perturbation) and intrinsic factors (psychological/emotional, concentration/attention, socio-demographic and morbidity-related).ConclusionThe older adults were experiencing a high prevalence of falls and FOF which has a multifactorial origin of common and cultural/societal/institutional/environmental-related factors. The need for a multicomponent and culturally and environmentally-specific interventions to address falls and FOF in this sample is thus highlighted.     

Differences and similarities of physical activity determinants between older adults who have and have not experienced a fall: Testing an extended health belief model

PurposeExperiencing a fall can be a detrimental experience for older adults and may affect an individual’s beliefs about participating in future physical activity (PA) behavior. The purpose of this study was to identify if determinants of PA differ between older adults who have a history of a fall (HF) and those with no history of a fall (NHF) within the Health Belief Model (HBM), expanded through the constructs of intention and habit.Materials and MethodsParticipants (N = 667) were community-dwelling older adults who completed online measures of original HBM determinants (beliefs, barriers, self-efficacy, cues, and perceived threat variables) related to participating in PA in addition to past PA behavior and intention.ResultsNovel findings include perceived barriers significantly predicted intention to participate in PA among those with a HF but not among those with NHF, and past PA behavior predicted decreased perceived threat of falling among both groups. The model also supported cues to predict physical activity habit.ConclusionsPerceived barriers (time constraints and bodily pain) deterred PA intentions among those with a HF, suggesting the importance of intervention planning to reduce/resolve these barriers for this group. Past PA was negatively associated with perceived threat of falling, which signposts the importance of providing a safe environment for older adults to engage in PA. The study also provides formative notes for interpreting and further investigating perceived threat and its antecedents (susceptibility and seriousness) in addition to cues, which generally have been omitted in previous studies that employ the HBM.     

Selective attentional processing to fall-relevant stimuli among older adults who fear falling

Fear of falling is known to affect more than half of community-dwelling older adults over 60 years of age. This fear is associated with physical and psychological effects that increase the risk of falling. The authors' theory is that attentional processing biases may exist in this population that serve to perpetuate fear of falling and subsequently increase fall risk. As a starting point in testing this proposition, the authors examined selective attentional processing bias to fall-relevant stimuli among older adults. Thirty older adult participants (M(age) = 70.8 ± 5.8), self-categorized to be Fearful of Falling (FF, n = 15) or Non-Fearful of Falling (NF, n = 15) completed a visual dot-probe paradigm to determine detection latencies to fall-threatening and general-threat stimuli. Attentional processing was defined using three index scores: attentional bias, congruency index, and incongruency index. Bias indicates capture of attention, whereas congruency and incongruency imply vigilance and disengagement difficulty, respectively. Both groups showed an attentional bias to fall-threat words but those who were fearful of falling also showed an incongruency effect for fall-threat words. These findings confirm that selective attentional processing profiles for fall-relevant stimuli differ between older adults who exhibit fear of falling and those who do not have this fear. Moreover, in accordance with current interpretations of selective attentional processing, the incongruency effect noted among fall-fearful older adults presents a possibility for a difficulty disengaging from fall-threatening stimuli.     

Relationship between exercise capacity and depressive symptoms in community-dwelling older adults

BackgroundDepressive symptoms cannot be ignored when exercise intervention is performed. The purpose of this study was to clarify the association between depressive symptoms and exercise capacity in community-dwelling older adults.MethodsIn this cross-sectional study, we analyzed 110 community-dwelling older adults (mean age [standard deviation] = 70.7 [4.0] years old; women: 55 %). Depressive symptoms were measured using a Japanese version of the Geriatric Depression Scale. We evaluated exercise capacity by measuring distance (2MWD) during a 2-minute walk test. Linear regression models were applied to analyze the association between 2MWD and depressive symptoms.ResultsThe results suggest that depressive symptoms are associated with low 2MWD (beta = −5.87, 95 % confidence interval = −11.18 to −0.57, p < 0.05) even after adjusting for age, gender, Body Mass Index, cigarette smoking, alcohol consumption, pain severity, and the number of comorbidities.ConclusionsThe results indicated that depressive symptoms are associated with decreased exercise capacity in older adults.     

Exploring the relationship between fear of falling and neuroticism: a cross-sectional study in community-dwelling women over 70

BACKGROUND: Fear of falling in older adults has been associated with generalised anxiety and may lead to avoidance of activities, with a further negative impact on future falls. Individual differences in personality associated with anxiety have not been previously examined in relation to fear of falling. Current assessment measures and interventions designed to reduce fear of falling in older adults do not take into account perceptions of anxiety associated with individual differences in personality. AIM: To determine whether the core personality trait dimension of neuroticism can predict fear of falling in a community-dwelling sample of women > or = 70 years of age. METHODS: Cross-sectional data from 1,691 UK, community-dwelling female participants aged > or = 70 years were examined using multiple and logistic regression analysis. Fear of falling was measured on a 6-point Likert scale. Neuroticism was measured using the Eysenck personality inventory. RESULTS: The significant independent odds ratios (OR) of predicting fear of falling were: neuroticism (OR 1.47 per SD increase, P<0.001), history of falling (OR 1.57, P<0.001), experience of fracture (OR 1.78, P = 0.014), need to use both arms to push up to rise from a chair (OR 1.56, P = 0.001), poor subjective general health, as measured by the SF12 (OR 1.63 per SD decrease, P<0.001) and living alone (OR 1.31, P = 0.031). CONCLUSIONS: Neuroticism seems to be an important psychological factor in the experience of fear of falling in community-dwelling older women. It may be relevant for inclusion in current assessment measures and for consideration in the design of interventions to reduce fear of falling.     

Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention--a randomised controlled trial

OBJECTIVES: To determine the effectiveness of multifactorial intervention to prevent falls in cognitively intact older persons with recurrent falls. DESIGN: Randomised controlled trial of multifactorial (medical, physiotherapy and occupational therapy) post-fall assessment and intervention compared with conventional care. SETTING: Accident & Emergency departments in a university teaching hospital and associated district general hospital. SUBJECTS: 313 cognitively intact men and women aged over 65 years presenting to Accident & Emergency with a fall or fall-related injury and at least one additional fall in the preceding year; 159 randomised to assessment and intervention and 154 to conventional care. Outcome measures: primary outcome was the number of falls and fallers in 1 year after recruitment. Secondary outcomes included injury rates, fall-related hospital admissions, mortality and fear of falling. RESULTS: There were 36% fewer falls in the intervention group (relative risk 0.64, 95% confidence interval 0.46-0.90). The proportion of subjects continuing to fall (65% (94/144) compared with 68% (102/149) relative risk 0.95, 95% confidence interval 0.81-1.12), and the number of fall-related attendances and hospital admissions was not different between groups. Duration of hospital admission was reduced (mean difference admission duration 3.6 days, 95% confidence interval 0.1-7.6) and falls efficacy was better in the intervention group (mean difference in Activities Specific Balance Confidence Score of 7.5, 95% confidence interval 0.72-14.2). CONCLUSION: Multifactorial intervention is effective at reducing the fall burden in cognitively intact older persons with recurrent falls attending Accident & Emergency, but does not reduce the proportion of subjects still falling.     

Association between food insecurity and fall-related injury among adults aged ≥65 years in low- and middle-income countries: The role of mental health conditions

PurposeWe investigated the association between food insecurity and fall-related injury among older adults from six low- and middle-income countries (LMICs), and the extent to which this association is mediated by mental health.MethodsCross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Fall-related injury referred to those that occurred in the past 12 months. Multivariable logistic regression analysis and mediation analysis were conducted to assess associations.ResultsData on 14,585 adults aged ≥65 years [mean (SD) age 72.5 (11.5) years; 54.9% females] were analyzed. After adjustment for potential confounders, severe food insecurity (versus no food insecurity) was associated with 1.95 (95%CI = 1.11–3.41) times higher odds for fall-related injury. Moderate food insecurity was not significantly associated with fall-related injury (OR = 1.34; 95%CI = 0.81–2.25). The mediation analysis showed that 37.3%, 21.8%, 17.7%, and 14.0% of the association between severe food insecurity and fall-related injury was explained by anxiety, sleep problems, depression, and cognition, respectively.ConclusionSevere food insecurity was associated with higher odds for injurious falls among older adults in LMICs, and a large proportion of this association may be explained by mental health complications. Interventions to improve mental health among those who are food insecure and a strong focus on societal and government efforts to reduce food insecurity may contribute to a decrease in injurious falls.     

‘Believe the positive’ aggregation of fall risk assessment methods reduces the detection of risk of falling in older adults

ObjectivesScreening programs for fall prevention in older adults may include several assessment methods. This study investigated the validity of aggregating fall risk assessment methods for stratifying the risk of falling in older adults.MethodsThis secondary data analysis included 52 community-dwelling residents aged [median (interquartile range)] 74 (69–80) years. Fall occurrences were registered prospectively for six months, with 9 (17%) participants reporting at least one fall during follow-up. The fall risk assessment included the Berg Balance Scale (BBS); polypharmacy (POLY); Falls Risk Assessment Score (FRAS); Fall Risk Assessment Tool (FRAT-up); Falls Efficacy Scale (FES); and posturography with the Wii Balance Board (WBB). Aggregation of methods’ results was performed according to the risk classification (‘high risk’ or ‘low risk’) assigned by their respective cut-off values under the ‘believe the positive’ (BP) strategy.ResultsAggregating 1 (POLY), 2 (+BBS), 3 (+FES), 4 (+FRAT-up), 5 (+FRAS), and 6 (+BBS) methods resulted in a monotonic decrease of several validity indices including (index [95% confidence interval]) diagnostic odds ratio (10.82 [2.38—54.28] to 0.59 [0.12—2.09]) and accuracy (0.67 [0.54—0.78] to 0.20 [0.11—0.31]).ConclusionsAggregating fall risk assessment methods—BBS, POLY, FRAS, FRAT-up, FES, WBB—under the BP strategy does not increase the validity of stratification of the risk of falling in older adults.     

Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission

BACKGROUND: The aim of this study was to assess the impact of fear of falling on the health of older people. METHODS: A total of 528 subjects (mean age 77 years) were recruited from two hospitals in Sydney, Australia, and followed for approximately 12 months. Eighty-five subjects died during follow-up, and 31 were admitted to an aged care institution. Tinetti's Falls Efficacy Scale (FES) was successfully administered to 418 subjects as part of the baseline assessment. Among those with baseline FES scores, ability to perform 10 activities of daily living (ADLs) was assessed at baseline and follow-up in 307 subjects, and SF-36 scores were assessed at baseline and follow-up in 90 subjects recruited during the latter part of the study. Falls during follow-up were identified using a monthly falls calendar. RESULTS: Compared with those with a high fall-related self-efficacy (FES score = 100), those with a low fall-related self-efficacy (FES score < or = 75) had an increased risk of falling (adjusted relative risk 2.09, 95% confidence interval [CI] 1.31-3.33). Those with poorer fall-related self-efficacy had greater declines in ability to perform ADLs (p < .001): the total ADL score decreased by 0.69 activities among persons with low FES scores (< or =75) but decreased by only 0.04 activities among persons with FES scores of 100. Decline in ADLs was not explained by the higher frequency of falls among persons with low FES scores. SF-36 scores (particularly scores on the Physical Function and Bodily Pain subscales) tended to decline more among persons with poor fall-related self-efficacy. Nonfallers who said they were afraid of falling had an increased risk of admission to an aged care institution. CONCLUSIONS: Fear of falling has serious consequences for older people. Interventions that successfully reduce fear of falling and improve fall-related self-efficacy are likely to have major health benefits.     

Risk factors for falls and fall-related injuries in adults 85 years of age and older

Falls are a leading cause of morbidity and mortality in older adults. No previous studies on risk factors for falls have focused on adults 85 years and older, the most rapidly growing segment of adults. We examined demographic, health, and behavioral risk factors for falls and fall-related injuries in adults 65 years and older, with a particular focus on adults 85 years and older. We analyzed self-reported information from the Behavioral Risk Factor Surveillance System (BRFSS) for 2008. Data was available for 120,923 people aged 65 or older and 12,684 people aged 85 or older. Of those aged 85 or older, 21.3% reported at least one fall in the past 3 months and 7.2% reported at least one fall related injury requiring medical care or limiting activity for a day or longer. Below average general health, male sex, perceived insufficient sleep, health problems requiring assistive devices, alcohol consumption, increasing body mass index and history of stroke were all independently associated with a greater risk of falls or fall related injuries. The greater risk of falling in those 85 years and older appeared to be due to the deterioration of overall health status with age; among those with excellent overall health status, there was no greater risk of falling in adults 85 years and older compared to those 65-84 years of age. Our results suggest that those with risk factors for falls and fall-related injuries may be appropriate targets for evidence-based fall prevention programs.     

Cross-sectional and longitudinal risk factors for falls, fear of falling, and falls efficacy in a cohort of middle-aged African Americans

PURPOSE: The purpose of this study is to cross-sectionally and longitudinally identify risk factors for falls, fear of falling, and falls efficacy in late-middle-aged African Americans. DESIGN AND METHODS: We performed in-home assessments on a probability sample of 998 African Americans and conducted two annual follow-up interviews. Multiple logistic regression modeled the associations with falls (any fall or injurious fall) during 2 years prior to the baseline interview, and baseline fear of falling and falls efficacy with 2-year prospective risks for falling and fear of falling. RESULTS: The most consistent association for all outcomes was depressive symptoms. Age was associated with increased risk of prior and prospective falls. Lower-body functional limitations were associated with prior falls, baseline fear of falling, and low falls efficacy, whereas low ability with one-leg stands prospectively predicted fear of falling. The greatest prospective risk for incident falls was having had a prior fall (odds ratio = 2.51), and the greatest prospective risk for fear of falling was having been afraid of falling at baseline (odds ratio = 8.14). IMPLICATIONS: Falls, fear of falling, and low falls efficacy are important issues for late-middle-aged as well as older persons. Interventions should focus on younger adults and attend especially to lower-body function and depressive symptoms as well as building self-efficacy for safe exercise, dealing with falls risks, and managing falls themselves.     

A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults

OBJECTIVES: To test the efficacy of a multicomponent intervention to reduce functional difficulties, fear of falling, and home hazards and enhance self-efficacy and adaptive coping in older adults with chronic conditions. DESIGN: A prospective, two-group, randomized trial. Participants were randomized to a treatment group or no-treatment group. SETTING: Urban community-living older people. PARTICIPANTS: Three hundred nineteen community-living adults aged 70 and older who reported difficulty with one or more activities of daily living. INTERVENTION: Occupational and physical therapy sessions involving home modifications and training in their use; instruction in strategies of problem-solving, energy conservation, safe performance, and fall recovery techniques; and balance and muscle strength training. MEASUREMENTS: Outcome measures included self-rated functional difficulties with ambulation, instrumental activities of daily living, activities of daily living, fear of falling, confidence performing daily tasks, and use of adaptive strategies. Observations of home hazards were also conducted. RESULTS: At 6 months, intervention participants had less difficulty than controls with instrumental activities of daily living (P=.04, 95% confidence interval (CI)=-0.28-0.00) and activities of daily living (P=.03, 95% CI=-0.24 to -0.01), with largest reductions in bathing (P=.02, 95% CI=-0.52 to -0.06) and toileting (P=.049, 95% CI=-0.35-0.00). They also had greater self-efficacy (P=.03, 95% CI=0.02-0.27), less fear of falling (P=.001, 95% CI=0.26-0.96), fewer home hazards (P=.05, 95% CI=-3.06-0.00), and greater use of adaptive strategies (P=.009, 95% CI=0.03-0.22). Benefits were sustained at 12 months for most outcomes. CONCLUSION: A multicomponent intervention targeting modifiable environmental and behavioral factors results in life quality improvements in community-dwelling older people who had functional difficulties, with most benefits retained over a year.     

Protective and Risk Factors for Physical Activity and Falls Among Oldest-Old Adults Enrolled in an Evidence-Based Fall Risk Reduction Program

This study is an examination of protective and risk factors associated with weekly physical activity and number of falls among oldest-old participants enrolled in A Matter of Balance/Volunteer Lay Leader (AMOB/VLL) model. Poisson mixed regression models were used to assess potential protective (falls efficacy and self-rated health) and risk (pain, fatigue, and health interference) factors for weekly physical activity and number of falls from baseline to post-intervention after controlling for sex, race/ethnicity, age, education, living alone, and number of chronic conditions. Weekly physical activity and number of falls improved significantly from baseline to post-intervention. Falls efficacy scores and self-rated health (as protectors) as well as fatigue, health interference scores, and pain (as risk factors) at baseline were significantly related to weekly physical activity and number of falls among oldest-old participants. Findings indicate that program elements of AMOB/VLL are effective in improving physical activity and reduce falls among the oldest-old population.