Falls — and the fear of falling — are the leading cause of injury, disability and hospitalization among racially diverse, low-income older adults, according to the U.S. Centers for Disease Control and Prevention.

To help address this critical issue and reduce disparities, a team of University of Central Florida researchers is partnering with the City of Orlando on a $2.3 million project funded by the National Institutes of Health (NIH), National Institute on Minority Health and Health Disparities.

The project seeks to address the public health problem and prevent falls with the optimization of technology that is low-cost and portable.

The work will help ensure older adults can “age in place,” and supports the City Beautiful Livable Orlando: An Age-Friendly Initiative Action Plan 2022-2025, which, as one of its primary goals, prioritizes the development of affordable housing options and services to help older residents safely stay in their homes.

“As the population of our city ages and residents are living healthier, more active and longer lives, it’s important we ensure Orlando is a well-designed, livable community that promotes health and sustains economic growth, creating happier and healthier residents of all ages,” says Orlando Mayor Buddy Dyer. “We are excited to work with UCF on this grant as it will play a significant part in understanding how we can improve the health and safety of our older adult population and better implement age-friendly initiatives, especially in underserved neighborhoods.”

Innovative Approach

With the new funding, Ladda Thiamwong, an associate professor at the College of Nursing and the project’s principal investigator, will work with an intradisciplinary team of experts to roll out a large-scale pilot in low-income, senior communities in Central Florida of an fall assessment intervention they’ve developed and tested.

“The primary goal is to prevent falls,” Thiamwong says. “With this real-world testing, we hope to be able to prove it works and is sustainable in order to scale up and prevent falls in more communities.”

The researchers’ Physio-Feedback and Exercise, or PEER, intervention program was successfully tested as part of an NIH-funded two-year technology study. Their work has also been published in Research in Gerontological Nursing.

The researchers showed that their intervention, which uses technology to help reduce people’s fear of falling and improve their balance, was feasible, safe, and improved balance, muscle strength and fall risk.

The technology resembles a small scale and links to a computer. It can be easily transported to rural or low-income communities to provide immediate physio-feedback.

The immediate part is important, Thiamwong says.

“Older adults trust the results more when it is immediate,” she says. “It begins a conversation and empowers them to do something about it, and with the technology able to show improvement over time, it is also encouraging.”

Perception versus Reality

For more than half of older adults, their perception of their fall risk and actual physical fall risk are not aligned, Thiamwong says.

She says a fear of falling is just as risky as poor balance as it may limit their physical activity.

To address this, the researchers’ intervention includes a fall risk appraisal matrix that categorizes participants into quadrants looking at both their fear and balance.

The objective is to bring all participants to low fear and normal balance by the end of the eight-week intervention.

The program includes cognitive reframing to reduce fear and both a group- and home-based exercise program led by a trained peer coach to improve balance.

“Social support from peers is important to build connections and hopefully continue to keep the physical activity going even after the intervention,” Thiamwong says.

Critical Collaboration

The researchers say collaboration with an interdisciplinary team is critical to address older adults falling and other healthcare challenges.

Thiamwong  began her collaborations with the one of the  project’s co-investigators, College of Health Professions and Sciences Pegasus Professor Jeffrey Stout, after seeing some of his publications on aging research shortly after she joined UCF.

Stout, who is director of the college’s School of Kinesiology and Rehabilitation Sciences, says the collaborations have developed into a research partnership that has been very successful.

“There is a great potential for collaboration between programs and faculty expertise in different colleges at UCF,” Stout says. “Interdisciplinary collaboration is important because it allows different fields to share knowledge and ideas, which can lead to new breakthroughs.”

One of the ways UCF fosters interdisciplinary collaboration is through research clusters, such as the Disability, Aging and Technology cluster that Thiamwong and project co-investigator Joon-Hyuk Park, an assistant professor in the Department of Mechanical and Aerospace Engineering, are a part of. The team has been successful in conducting NIH- and UCF-funded studies.

“The cluster is an excellent facilitator to promote interdisciplinary research,” Park says. “The most challenging questions we, as researchers and scientists, seek to address these days can’t be tackled from one discipline, especially when it comes to human science to understand human behavior and study instrumentations. We need expertise from various fields.”

Nichole Lighthall, an assistant professor of psychology and project co-investigator, says that many factors influence older adults’ fall risk, including physical health, socioeconomic status, as well as psychological motivations and feelings.

“In addition, if you want to launch a fall-risk intervention that involves technology, you have to consider factors like older adults’ ability to use the technology and cost effectiveness,” she says.

“It’s easy to see how problems like this require a team of experts that understand each factor and know how to conduct science across traditional disciplinary boundaries,” she says. “It’s a truly excellent team and an important problem we are trying to solve.”

Research Team

Thiamwong received her doctoral degree in nursing from Mahidol University in Thailand.

She joined UCF in 2016. She’s an expert in healthy aging, fall prevention and gerontological nursing. She is leading a UCF research team in implementing preventive interventions to transform practice, especially for older adults with limited resources.

Stout received his doctorate in exercise physiology from the University of Nebraska – Lincoln. He joined UCF in 2012. He’s an expert in physical assessments, such as body composition, handgrip strength and physical activity in aging populations, and he has published several studies examining the relationship between psychological and physical variables and the risk of falling.

Park received his doctorate in mechanical engineering from Columbia University. He joined UCF in 2019. He’s an expert in engineering wearable sensors and assistive technologies. His role in the project is to apply his knowledge and experience in wearables-based physical activity monitoring and assessment.

Rui Xie is an assistant professor in the Department of Statistics and Data Science, which is in UCF’s College of Sciences. He received his doctorate in statistics from the University of Georgia. He joined UCF in 2019.  Xie is an expert in designing study designs that are appropriate for collecting data, while minimizing the risk of bias and ensuring the validity of the results, as well as data analysis and result interpretation.

“I was inspired to join this research team because I was fascinated by the multidimensional and multidomain data the team plans to collect in the project,” Xie says. “I felt that my skills and experience in data analysis and modeling could be of great value to the research.”

Lighthall received her doctorate in gerontology from the University of Southern California. She joined UCF in 2015. She’s an expert in cognition and emotion across the adult lifespan, with a specific focus on age-related changes to decision processing and behavior. She is helping to determine the cognitive and motivational factors that impact older adults’ fear of falling by guiding the team’s measurement of these psychological factors.

Vicki Loerzel ’07, a Beat M. and Jill L. Kahli Endowed Professor in Oncology and an associate professor in UCF’s College of Nursing, received her doctorate in nursing from UCF. She joined UCF in 2005. She’s an expert in qualitative research and randomized clinical trials, aging populations, and health disparities, with experience in technology-based intervention development and testing.

“Interdisciplinary collaboration is important because one person cannot know it all or do it all,” she says. “You need the different perspectives and experiences from other disciplines to make your own work more complete and more relevant. Without the teamwork of experts from different disciplines, your work and ideas will get stale very quickly.”