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A Matter of Balance Moves Online to Address Fear of Falling

Early Reports indicate participants benefit from participating remotely

By Jennifer Davis, October 2020

In recent months, news of the Covid-19 pandemic seems to have usurped all media coverage of public health concerns, and when it comes to older persons, for good reason. Adults 65 and older are particularly vulnerable, accounting for 30 to 40 percent of Covid- 19 cases and more than 80 percent of deaths according to the Centers for Disease Control (CDC).

This reality is certainly sobering, but it doesn’t mean that other risks to healthy aging are somehow less important now. CDC data also show falls remain the leading cause of fatal and nonfatal injuries among older adults. It stands to reason then that many older persons fear falling. This fear can cause them to restrict activities, which ironically make them more likely to fall due to muscles weakening from lack of movement. But what might matter even more is that this fear keeps individuals from doing many of the things that brought pleasure in life.

A Matter of Balance is a program that has been shown by research to significantly reduce fear of falling among participants who complete the program. But, MOB was halted by organizations like Elder Services of the Merrimack Valley and the North Shore (ESMV) in the wake of Covid-19 restrictions. How could ESMV continue to offer a program that relied on in-person participation? For the folks at ESMV the question became, how could they not find a way to continue MOB for those who could benefit from the program?

Fortunately, professionals at MaineHealth, home of MOB who collaborate with ESMV were on it. They developed a virtual adaptation of the program and asked ESMV to be part of a pilot. ESMV’s online MOB workshop started on July 23 and included eight sessions, plus a session zero to review Zoom tips and etiquette, and to make sure everyone knew how to use the platform. ESMV was the first organization in the world to start MOB remotely.

Jane’s Story

Seventy-six-year-old Jane was among the first graduates of the virtual MOB program. A retired public-school learning specialist, she and her husband continue to enjoy active lives, which include involvement in community and church activities, as well as caring for older neighbors. Although she is constantly on the go and walks several miles, twice a week, she has a fear of falling.

“My fear of falling comes from knowing that I have osteopenia,” says Jane. “I’m not afraid to the point that I won’t do anything. I think that’s ridiculous, but I’d like to take steps now to learn how to reduce my risk for falls and fractures.”

Osteopenia indicates a loss of bone mass. It also puts an individual at risk for developing osteoporosis, which occurs when the body loses too much bone, makes too little bone, or both, according to the National Osteoporosis Foundation.

Jane’s fear was enough to get her involved in a Bone Builders program offered by her local senior center. Bone Builders is designed to combat osteoporosis with progressive weight-bearing exercises, which research shows help reduce the onset or progression of osteoporosis. It was through her involvement with Bone Builders that Jane learned about MOB.

“When I was involved with Bone Builders, I learned that the senior center was going to offer a program called A Matter of Balance,” explains Jane. “And they asked if anyone would be interested? It was January, and I signed up. I was looking forward to it. But then came the pandemic.

I got a call from an MOB Coach saying that ESMV was going to offer the program online and would I be willing to try it out?

I didn’t have any reservations. I had just joined an online book club so I was familiar with the Zoom platform. I thought what do I have to lose? This is going to be interesting to exercise online. How are we going to do it?”

Jane goes on to say, “It worked well because the Coaches would tell us ahead of time what the setup would be and what they wanted us to look like – what our position should be in a chair and so forth. And they were also very good at being available for questions about how to set up Zoom – where to have the laptop so that it was in the right position.

I never felt vulnerable or at risk during the classes. All exercises were done in a chair, and they recommended a chair with arms. The Coaches modeled the exercises, which was very helpful. We did upper body movement and stretching and then foot movement – like a dance, and they kept upping the number of repetitions. I realized that I need to do more stretching because stretching was an important part of the program.”

To ensure safety, the MOB virtual Coaches included a moderator whose sole purpose was to monitor the participants’ screens. The moderator had the phone number, address, and an emergency contact for each participant in case of a fall or other emergency. The Coaches also took part in a training hosted by MaineHealth to review the adaptations made for MOB remote delivery.

Jane concludes, “I would recommend MOB. The videos and presentations were well done. And I enjoyed and benefited from the class discussions.”

Jane’s experience reflects data collected from the pilot program, which looks very similar to that collected from the in-person program. According to Crystal Polizzotti, CDP, Healthy Aging Program Manager at ESMV, “Participants feel more confident incorporating weekly exercises routines, they make minor home modifications to prevent falls, and feel more comfortable talking about their fear of falling, as well as being more assertive about asking for help when they need it.”

MOB has moved into a second phase pilot. ESMV has reached out to six partners for the next round and the partners have just started scheduling workshops. All guidance and adjustments to the virtual MOB come directly from MaineHealth who is hoping to reach 200 participants through the pilots, which will produce enough data to allow all current MOB Coaches to start running MOB virtually by January 2021.