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Full-Text Articles in Geriatrics

Improving Health And Wellness In Patients With Frailty Traits, Jessica Lyndsay Moore, Cassandra Nelson Apr 2024

Improving Health And Wellness In Patients With Frailty Traits, Jessica Lyndsay Moore, Cassandra Nelson

Spring 2024 Virtual OTD Capstone Symposium

Frailty is an age-related syndrome characterized by impairments in strength, endurance, mobility, and cognitive function (Panayi et al., 2019). Studies show that frailty increases vulnerability during stressful events such as hospitalization and is linked to poor recovery (Peeler et al., 2022). In addition to poor recovery, frail patients are at risk for increased dependence, reduced occupational performance, and reduced occupational engagement (Kawaguchi et al., 2017). Purpose: This capstone project aimed to improve health and wellness in individuals with frailty traits by implementing a comprehensive program focused on improving strength, functional capacity, nutrition intake, stress management, cognitive health, and social wellness.


Care For Caregivers: Exploring Occupational Therapy's Role In Caregiver Support, Mariah Mendez, Amy Lyons-Brown, Negin Zare Apr 2024

Care For Caregivers: Exploring Occupational Therapy's Role In Caregiver Support, Mariah Mendez, Amy Lyons-Brown, Negin Zare

Spring 2024 Virtual OTD Capstone Symposium

Care for Caregivers explores the challenges of spousal and remote caregivers to determine how occupational therapy can assist through program development.


Healthy Seniors: Supporting Chronic Condition Management Through Educational And Motivational Materials., Megan Wiggs, Helen Carey Oct 2023

Healthy Seniors: Supporting Chronic Condition Management Through Educational And Motivational Materials., Megan Wiggs, Helen Carey

Fall 2023 Virtual OTD Capstone Symposium

Within the United States, the older adult population is rising and facing a growing number of chronic conditions (Mirza et al., 2020). Chronic conditions are associated with an increase in hospitalizations, functional decline, and healthcare spending. Largely, chronic conditions are managed under primary care physicians and treatment is not put into place until an exacerbation and hospitalization occurs (Mirza et al., 2020). Thus, a cruel cycle is created in which an individual undergoes functional decline, worsening of the condition, and decreasing quality of life and well-being. The older adult population wishes to age in place and manage their health; however, …


The Role Of Repetitive Transcranial Magnetic Stimulation (Rtms) V. Electroconvulsive Therapy (Ect) In Geriatric Depression Treatment: Efficacy & Tolerability, Madeleine Sarro Aug 2023

The Role Of Repetitive Transcranial Magnetic Stimulation (Rtms) V. Electroconvulsive Therapy (Ect) In Geriatric Depression Treatment: Efficacy & Tolerability, Madeleine Sarro

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Background

  • Geriatric depression, or depression in a population over the age of 60, is a highly debilitating mental health condition with a prevalence of 25% versus 10% in the general population.1, 2 Increasing prevalence is expected in the next 30 years with a rise in the population size for adults over 60 from 12% to 22%.3
  • Limiting variables in the treatment of geriatric depression include polypharmacy, intolerable adverse effects, medical comorbidities, drug resistance and atypical symptom presentation.2-7
  • Due to uniformity in underlying pathophysiology, current treatment guidelines for geriatric depression are the same as for the general population. …


A Website To Prepare Older Adults For Driving Cessation, Shelbi Picard, Steven M. Gerardi, Elizabeth Deluca Aug 2023

A Website To Prepare Older Adults For Driving Cessation, Shelbi Picard, Steven M. Gerardi, Elizabeth Deluca

Summer 2023 Virtual OTD Capstone Symposium

Driving cessation, or the complete discontinuation of operating a vehicle, can result in a loss of independence and a decrease in life satisfaction (Chihuri, et al., 2016). This loss of independence is linked to a lack of knowledge on alternative options on community mobility (Liddle, et al., 2014). This leads to drivers to not want to stop driving when they are no longer safe to drive. Although there are some resources on driving cessation available online for guiding older adults in transition from driving to non-driving, they are not consolidated in one place for ease of understanding.


Implementation Of Tai Chi Among Individuals With Dementia In Long-Term Memory Care, Patricia I. Cordova, Lisa Griggs-Stapleton, Kim Broussard Aug 2023

Implementation Of Tai Chi Among Individuals With Dementia In Long-Term Memory Care, Patricia I. Cordova, Lisa Griggs-Stapleton, Kim Broussard

Summer 2023 Virtual OTD Capstone Symposium

This project focused on a dementia population within long-term care, where increased disablement occurs. A Tai Chi program was implemented into the daily routine of individuals in a long-term memory care facility to improve dynamic sitting balance for the performance of daily occupations.


The Importance Of Addressing Sleep As An Occupation Within Assisted Living Communities, Brittany Kiattitananan, Kendra Orcutt, Lisa Griggs-Stapleton Aug 2023

The Importance Of Addressing Sleep As An Occupation Within Assisted Living Communities, Brittany Kiattitananan, Kendra Orcutt, Lisa Griggs-Stapleton

Summer 2023 Virtual OTD Capstone Symposium

Around 40-70% of older adults have difficulty sleeping (Sheth & Thomas, 2019). This poster presents an occupation-based sleep intervention program developed for residents of an assisted living community and serves to inform OT practitioners on addressing sleep in their own practice.


Guidebook For Occupational Therapy For End-Of-Life Care, Shannon Sudrla, Mary Smith, Alexandria Cannata, Anna Norene Carlson May 2023

Guidebook For Occupational Therapy For End-Of-Life Care, Shannon Sudrla, Mary Smith, Alexandria Cannata, Anna Norene Carlson

Spring 2023 Virtual OTD Capstone Symposium

Patients at the end-of-life (EoL) experience functional decline in response to terminal illness and the active dying process, inhibiting participation and engagement in meaningful daily activities. Occupational therapy practitioners (OTP) are equipped to address patients’ occupational needs and desires despite their declining capacities; however, the absence of occupational therapy (OT) services in EoL care leaves patients’ occupational needs unmet, directly affecting their quality of life. The literature demonstrates the need for enhanced education and training among occupational therapy students (OTS) and practitioners to better prepare them to work with terminally ill patients who face progressive functional decline and imminent death. …


Impact Of Geriatric Mini-Fellowship On Prescribing Practice Of The Pmg Primary Care Providers, Madalyn Kuhlenberg, Sharon Leigh Jan 2023

Impact Of Geriatric Mini-Fellowship On Prescribing Practice Of The Pmg Primary Care Providers, Madalyn Kuhlenberg, Sharon Leigh

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2023

No abstract provided.


Transportation As A Barrier To Healthcare Access For Older Adults Of Low Socioeconomic Status, Yanira Barajas, Susan Macdermott, Jazminne Orozco Arteaga Aug 2022

Transportation As A Barrier To Healthcare Access For Older Adults Of Low Socioeconomic Status, Yanira Barajas, Susan Macdermott, Jazminne Orozco Arteaga

Summer 2022 Virtual OTD Capstone Symposium

The older adult population of those in the age group 65+ is one of the fastest growing populations in the following years. This project sought to identify what barriers older adults of low socioeconomic status face when trying to access transportation to healthcare appointments. The project also sought to understand what barriers healthcare professionals saw when their senior clients tried using transportation as well as what opportunities occupational therapists have to address the barriers if any. There was a theme of disconnect which appeared between healthcare professionals and their senior clients across multiple healthcare disciplines. This project was able to …


Supporting Rural Seniors Aging In Place Using Telehealth, Angel Alexander Gomez, Susan Macdermott Aug 2022

Supporting Rural Seniors Aging In Place Using Telehealth, Angel Alexander Gomez, Susan Macdermott

Summer 2022 Virtual OTD Capstone Symposium

Background: The United States is witnessing a demographic shift in that the number of Americans aged 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060; the percentage of the 65 and older age group will increase from 16 % to 23 % (Administration for Community Living, 2018). In this ever-growing population, the American Association of Retired Persons (AARP) 2018 survey found that 76% of Americans over the age of 50 would prefer to remain in their current residence and 77% would like to continue living in their community as long as …


Wellness Promotion Through Leisure Activity Among Community-Dwelling Older Adults, Gabriela Morrell-Zucker Apr 2022

Wellness Promotion Through Leisure Activity Among Community-Dwelling Older Adults, Gabriela Morrell-Zucker

Spring 2022 Virtual OTD Capstone Symposium

The purpose of this capstone project is to analyze the outcomes of an occupation-based wellness program which aims to address the problem of a lack of wellness promotion programs for community-dwelling older adults. Through structured programming older-adults demonstrated increased participation in leisure activities contributing to positive health and wellness. As the older adult population continues to grow, there is a need to engage community-dwelling older adult populations in wellness promotion through leisure activities. For this purpose, a quantitative approach examines the outcomes of program development from older adults' perspectives through a the CHAMPS Older Adult Physical Activity Questionnaire.


Nonpharmacological Practices For Reducing Agitation In Persons With Dementia, Meghan L. Farkas Jan 2022

Nonpharmacological Practices For Reducing Agitation In Persons With Dementia, Meghan L. Farkas

Commonwealth Scholars Program

1 in 11 people aged 45 years and older experience subjective cognitive decline, with nearly a third identifying a decline in the ability to participate in social activities, work, or volunteering. There are twelve modifiable risk factors that can either increase or decrease an individual's possibility of developing Dementia. This can include excessive alcohol consumption, head injury, air pollution, lower education level, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and infrequent social contact. These modifiable risk factors may prevent or delay up to 40% of dementias. Furthermore, many risk factors cluster around inequalities, which occur particularly in Black, …


Medication Usage In Independent Living: A Continuing Care Retirement Community Aging In Place Initiative, Aarti Deshpande, Carrie B Rubenstein, Ruth Benfield, Lee Burnside Jan 2022

Medication Usage In Independent Living: A Continuing Care Retirement Community Aging In Place Initiative, Aarti Deshpande, Carrie B Rubenstein, Ruth Benfield, Lee Burnside

All Poster Presentations

Purpose: The purpose of the study was to identify medication use concerns in this community.

Background: In this study, Swedish Geriatric Medicine Fellow partnered with this community to identify medication use concerns in this population.

Continuing Care Retirement Communities (CCRCs) are intended to support residents as they age in place. These communities tend to be well resourced but less studied. This survey attempts to identify medication use concerns in this population. Mirabella CCRC has 324 Independent living (IL) residents, 82 of which are couples. The average age is 85 years. The current cost of an IL unit is from $4673- …


Incorporating Reminiscence Therapy Into Traditional Ot Practice For Adults With Adrd Residing In A Snf/Ltc, Natasha Menard, Becki Cohill, Susan Macdermott, Karen Park Apr 2021

Incorporating Reminiscence Therapy Into Traditional Ot Practice For Adults With Adrd Residing In A Snf/Ltc, Natasha Menard, Becki Cohill, Susan Macdermott, Karen Park

Spring 2021 Virtual OTD Capstone Symposium

As the population diagnosed with Alzheimer’s disease and related dementias (ADRD) raises from 5.3 to 12.7 million over the next three decades, this calls for a demand for treatments to address this population (Alzheimer’s Association, 2021; Atchinson & Dirette, 2017). While traditional practice often focuses on symptom management, the inclusion of functional activities alone does not fully address the negative side effects of ADRD (Kok et al., 2013; Lepore et al., 2017; Mayo Clinic, 2019). Both occupational therapy (OT) and reminiscence therapy have been shown to be effective methods to treat the ADRD population separately, but there is limited evidence …


Understanding Successful Aging For Well-Elderly Adults Through Leisure And Social Participation, May Rose Lazarte, Karen Park, Becki Cohill, Susan Macdermott Apr 2021

Understanding Successful Aging For Well-Elderly Adults Through Leisure And Social Participation, May Rose Lazarte, Karen Park, Becki Cohill, Susan Macdermott

Spring 2021 Virtual OTD Capstone Symposium

The Centers for Disease Control and Prevention (CDC) reported by the year 2050, about 26% of the population would be 60 years of age or older (CDC, 2020). As Baby Boomers (individuals born between 1946-1964) enter the Third Age, defined by lifestyle choice, consumption, and preservation of youthfulness, more and more individuals are given the opportunity to age in place and participate in new/refined lifestyles (Hostetler, 2011). Although, research has proven older adults, who are now in their later years in life, are prone to experience social isolation, loneliness, depression, anxiety, and social stressors (Valtorta et al., 2018). Older adults …


An Exploratory Study Of Older Adults’ Emotions To Social Isolation And Their Coping Activities During Covid-19 Pandemic, Letrice Samuels, Michele Kekeh, Muge Akpinar-Elci Apr 2021

An Exploratory Study Of Older Adults’ Emotions To Social Isolation And Their Coping Activities During Covid-19 Pandemic, Letrice Samuels, Michele Kekeh, Muge Akpinar-Elci

College of Health Sciences Posters

Amidst the COVID-19 pandemic, older adults are advised to remain in their homes and personal spaces since they are at greater risk for COVID-19 related illnesses, hospitalizations, and deaths. Health professionals and caregivers are concerned that preventative measures, especially social isolation, may have long-term psychological and age-related effects among older adults. A survey prepared by the Center for Global Health at Old Dominion University, in collaboration with Healthy Chesapeake Inc., assessed social isolation, associated emotions, and daily coping activities of older adults in Chesapeake, Virginia. The target population included senior residents of the Cambridge Square Apartments, where Healthy Chesapeake Inc. …


How Does Direct Volunteering Affect The Onset Of Alzheimer’S Dementia In Elderly Patients With Preexisting Cardiac Comorbidities?, Sneha R. Gade Jan 2021

How Does Direct Volunteering Affect The Onset Of Alzheimer’S Dementia In Elderly Patients With Preexisting Cardiac Comorbidities?, Sneha R. Gade

Undergraduate Research Posters

Alzheimer's Dementia is a disease that affects memory, thinking, and behavior. The Alzheimer's Association reported Alzheimer's as the sixth-leading cause of death in the United States, and a cure does not exist. Donepezil, a cholinesterase inhibitor drug, is frequently prescribed to treat Alzheimer's disease. Still, patients must continuously take the medication for years to receive any measurable improvement in quality of life after developing Alzheimer's Dementia. Further, research shows prolonged use of Donepezil can lead to other health problems, such as QTc prolongation, for cardiac disease patients. Therefore, the effectiveness of non-drug interventions, such as volunteering to prevent the disease's …


Increasing Engagement In The Occupation Of Camping For Older Adults, Brittney Grant, Susan Macdermott, Becki Cohill, Karen Park Dec 2020

Increasing Engagement In The Occupation Of Camping For Older Adults, Brittney Grant, Susan Macdermott, Becki Cohill, Karen Park

Fall 2020 Virtual OTD Capstone Symposium

Older adults report they disengage from adventurous leisure activities as they age, such as camping, because it becomes more physically difficult to complete and it is challenging to find peers willing to participate. A study was developed to determine strengths and challenges (if any) older adults (65+) experience while participating in the occupation of camping. Mixed methods virtual surveys (n=64) and semi structured interviews (n=19) were implemented to develop qualitative and quantitative data. The results were categorized into five themes: barriers and challenges affecting participation in camping, camping for socialization, upgrade in accommodation for increased “creature comforts”, camping as a …


Understanding The Impact Of Social Distancing On Older Adults And Senior Organizations To Better Adapt Towards A New Normal, Salina Jivan Aug 2020

Understanding The Impact Of Social Distancing On Older Adults And Senior Organizations To Better Adapt Towards A New Normal, Salina Jivan

San Marcos, Summer 2020

COVID-19 brought about social distancing mandates that posed as a new barrier to meaningful social participation in the community. The purpose of this project was to understand the impact of social distancing on older adults and senior organizations to better inform the role of OT in helping seniors adapt towards a new normal within the community. A qualitative study and needs assessment were performed through phone interviews with seniors and organizations that support them from around the United States. Themes highlighted seniors desire for social contact and cautious return to the community once mandates are lifted. Both seniors and organizations …


Animal-Assisted Therapy And Quality Of Life Of Patients With Dementia, Karissa D. Thomson, Kayla Collins, Mary P. Shotwell Apr 2020

Animal-Assisted Therapy And Quality Of Life Of Patients With Dementia, Karissa D. Thomson, Kayla Collins, Mary P. Shotwell

Spring 2020 Virtual OTD Capstone Symposium

The aim of this quantitative study was to examine the effects animal-assisted therapy (AAT) had on people diagnosed with dementia living in a nursing home. The study examined the effects AAT had on depression, blood pressure, social interaction and how these factors impact quality of life (QOL). The study was conducted once a week for one hour on Thursdays for 6 weeks. 7 participants were included in the study and further broken down into two groups based upon their level of cognition as measured by the Mini Mental State Examination. The Beck’s depression inventory (BDI) and the World Health Organization …


The Health Benefits Of Visual Art Activities In The Geriatric Population, Melody Au-Yeung, Abraham Avila, Jason Bandong, Hy Ia, Naureen Imam, Kayla Wilcox Apr 2020

The Health Benefits Of Visual Art Activities In The Geriatric Population, Melody Au-Yeung, Abraham Avila, Jason Bandong, Hy Ia, Naureen Imam, Kayla Wilcox

San Marcos, Spring 2020

Purpose: The purpose of this poster presentation is to assess the efficacy of visual art therapy on the physical and mental health of the geriatric population.

Description: The potential impact of art therapy on cognition and dementia is a growing field of research in the rehabilitative world. Some researchers have found support for certain mediums, such as ceramic painting, while others have explored multimodal treatment programs that integrate art into physical activities. Combining physical activity with an arts and crafts program could posit a significant impact on ADL function and quality of life in older adults. As a …


Addressing Barriers To Physical Activity In Vermont's Geriatric Population, Stephanie Udawatta Jan 2020

Addressing Barriers To Physical Activity In Vermont's Geriatric Population, Stephanie Udawatta

Family Medicine Clerkship Student Projects

A wide array of barriers exist which prevent many geriatric patients from engaging in regular physical activity. This project addresses the barriers unique to Vermont's population of geriatric patients and explores potential solutions.


Implementation Of A Volunteer Based Hospital Visitation Program For Older Adults, Mariana R. Kuperman, Md, Mph, Kristine Swartz, Md, Elizabeth Collins, Md, Jennifer Kim, Bs Jun 2019

Implementation Of A Volunteer Based Hospital Visitation Program For Older Adults, Mariana R. Kuperman, Md, Mph, Kristine Swartz, Md, Elizabeth Collins, Md, Jennifer Kim, Bs

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

Hospital Elder Life Program (HELP)¹: a multi faceted, volunteer led, hospital based program has been shown to:

  • Reduce the incidence of delirium
  • Decrease length of stay
  • Reduce hospital costs

Implementation of such a program requires upfront investment.

A smaller, volunteer based visitation program for older adults was started to provide support for the allocation of hospital resources in delirium prevention and establishment of HELP in this institution.

This research aims to investigate the program’s implementation and impact on delirium specific outcomes.


Optimizing Psychosocial Care Of Older Adults With Cancer: An Early Assessment And Intervention Model, Lora Rhodes, Lcsw, Andrew Chapman, Do, Facp Nov 2018

Optimizing Psychosocial Care Of Older Adults With Cancer: An Early Assessment And Intervention Model, Lora Rhodes, Lcsw, Andrew Chapman, Do, Facp

Department of Medical Oncology Posters

Background

Jefferson Multidisciplinary Senior Adult Oncology Center

History

  • Established September 2010
  • First multidisciplinary geriatric oncology evaluation center in the tristate area

Demographics

  • 890 patients evaluated to date
  • All tumor types
  • Age 70 and above & Pre-transplant (Bone Marrow) evaluation age 65 and above

Format

  • Consultative service
  • Two sessions weekly
  • Average evaluation time: two hours

Multidisciplinary Team

  • Navigator, Medical Oncologist, Geriatrician, Pharmacist, Nutritionist, Social Worker
  • As needed: Psychiatry, Rehab Medicine, Radiation Oncology, Surgery


Implementation Of A Volunteer-Based Hospital Program For Older Adults, Elizabeth Collins, Md, Kristine Swartz, Md Jun 2018

Implementation Of A Volunteer-Based Hospital Program For Older Adults, Elizabeth Collins, Md, Kristine Swartz, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

  • A multi-faceted, volunteer-led, hospital-based program1has been shown to: •Reduce the incidence of delirium •Decrease hospital length of stay •Reduce hospital costs.
  • Implementation of such a program requires upfront investment.
  • A smaller, volunteer-based visitation program for older adults may provide support for the allocation of more hospital resources in delirium prevention and establishment of a formal Hospital Elder Life Program1in this institution.
  • This research aims to investigate: •If the implementation of a visitation program is feasible at this hospital •Volunteer experience with the program.


A Sensory-Based Program To Enhance Occupational Performance For Dementia, Naomi Grace Wong, Jacob Joseph Gantan, Ivy Annahi Torres-Flores, Heather Anne August Jan 2018

A Sensory-Based Program To Enhance Occupational Performance For Dementia, Naomi Grace Wong, Jacob Joseph Gantan, Ivy Annahi Torres-Flores, Heather Anne August

Student Research Posters

Dementia is a neurological disease, causing behavioral and cognitive symptoms, that progressively impairs an individual’s ability to engage in meaningful activities. Progressive deterioration associated with dementia impacts occupational performance and independence and quality of life. Sensory based interventions, such as drumming groups, have been hypothesized to be a non-pharmacological intervention for individuals with dementia. The purpose of this study was to analyze the effects of a sensory based intervention program, in this case participation in a drumming group, on functional engagement during self-feeding for individuals with dementia. Researchers gathered data over the course of two days using the Functional Behavior …


Evaluating The Effectiveness Of Abilities Care Approach™ Training, Michelle E. D'Amato, Sophie E. Miller, April Perez, Carmen Joaquin, Louiza Alexandria Villarina Oct 2017

Evaluating The Effectiveness Of Abilities Care Approach™ Training, Michelle E. D'Amato, Sophie E. Miller, April Perez, Carmen Joaquin, Louiza Alexandria Villarina

Student Research Posters

Approximately 50% of US nursing home residents have a diagnosis of dementia. Abilities Care Approach® was created by occupational therapists (OTs) to promote quality dementia care for residents in skilled nursing facilities (SNFs). Certified nursing assistants (CNAs) are often the primary caregiver for residents with dementia. To ensure carryover of ACA principles, ACE dementia training was targeted towards CNAs. The purpose of this study was to evaluate Abilities Care Experts®(ACE) training program which provides CNAs with an occupation-based dementia care approach by focusing on the importance of occupational engagement and knowledge of dementia stages. Results indicated that ACE trained CNAs …


Age-Related Changes In Visual Processing Speed: A Pilot Study Using The Motor-Free Visual Perception Test- 4 (Mvpt-4), Lauren Gollnick, Kassidy Ha, Stephanie Pawek, Zoe Studer, Amber Zadravecz Oct 2017

Age-Related Changes In Visual Processing Speed: A Pilot Study Using The Motor-Free Visual Perception Test- 4 (Mvpt-4), Lauren Gollnick, Kassidy Ha, Stephanie Pawek, Zoe Studer, Amber Zadravecz

Student Research Posters

Evidence reveals that visual processing speed decreases with age. The Motor-Free Visual Perception Test- Third Edition (MVPT-3) has an age-normed Response Time Index that measures visual processing speed. In 2015, a new version, Motor-Free Visual Perception Test- Fourth Edition (MVPT-4), was published. The new MVPT-4 does not yet demonstrate its utility in measuring visual processing speed. The purpose of this study was to explore if differences in visual processing speed between younger adults ages 20-35 years and older adults ages 70 years and older could be detected using the new MVPT-4. Results revealed a significant difference between older and younger …


Fall Risk Reduction Using Lifestyle-Integrated Functional Exercise (Life), Kayla Comer, Tiffany Huang, Kelly Schmidt, Matthew Tong Oct 2017

Fall Risk Reduction Using Lifestyle-Integrated Functional Exercise (Life), Kayla Comer, Tiffany Huang, Kelly Schmidt, Matthew Tong

Student Research Posters

As the population and longevity of older adults’ increases, the prevalence of falls is becoming an ever-growing issue. One in three adults aged 65 years and older experience a fall each year. Falls in older adults may lead to sedentary behavior, decreased independence, and lower quality of life. Evidence has shown that traditional exercise programs emphasizing strength and balance exercises can decrease the fall risk in older adults, but may be difficult to sustain over time. Emerging evidence suggests that exercises that are integrated into daily life may have a more lasting effect in reducing fall risk in older adults. …