Preventing falls among older fallers : Study protocol for a two-phase pilot study of the multicomponent LIVE LiFE program

Background: Falls reflect sentinel events in older adults, with significant negative consequences. Although fall risk factors have been identified as intrinsic (e.g., muscle weakness, balance problems) and extrinsic (e.g., home hazards), most prevention programs target only intrinsic factors. We present the rationale and design of a home-based multicomponent fall prevention program - the LIVE LiFE program - for community-living older adults. The program adapts and expands the successful Lifestyle Intervention Functional Exercise (LiFE) program by adding home safety, vision contrast screening, and medication review. The specific aims of the study are to (1) adapt the LiFE program to a US context and expand it into a multicomponent program (LIVE LiFE) addressing intrinsic and extrinsic fall risks, (2) examine feasibility and acceptability, and (3) estimate program impact on multiple outcome measures to prepare for an efficacy trial. Methods: The study involves two phases: an open-label pilot, followed by a two-group, single-blinded randomized pilot trial. Eligible participants are community-living adults 70+ years reporting at least one injurious fall or two non-injurious falls in the previous year. Participants are randomized in a 2:1 ratio to the program group (LIVE LiFE, n = 25) or the control group (written fall risk assessment, n = 12). The open-label pilot participants (n = 3) receive the program without randomization and are assessed based on their experience, resulting in a stronger emphasis on the participant's personal goals being integrated into LIVE LiFE. Fall risk and balance outcomes are assessed by the Timed Up and Go and the 4-Stage Balance Test at 16 weeks. Additional outcomes are incidence of falls and near falls, falls efficacy, fear of falling, number of home hazards, and medications assessed at 16 weeks. Incidence of falls and near falls, program adherence, and satisfaction are assessed again at 32 weeks. Discussion: By expanding and adapting the evidence-based LiFE program, our study will help us understand the feasibility of conducting a multicomponent program and estimate its impact on multiple outcome measures. This will support moving forward with an efficacy trial of the LIVE LiFE program for older adults who are at risk of falling. Trial registration: ClinicalTrials.gov, NCT03351413. Registered on 22 November 2017

Pilot Outcomes of a Multicomponent Fall Risk Program Integrated Into Daily Lives of Community-Dwelling Older Adults

Objectives: To evaluate whether a fall prevention intervention reduces fall risk in older adults who have previously fallen. Design: Randomized controlled pilot trial. Setting: Participants’ homes. Intervention: LIVE-LiFE, adapted from Lifestyle-Intervention Functional Exercise (LiFE) integrates strength and balance training into daily habits in eight visits over 12 weeks. The adaptations to LiFE were to also provide (a) US$500 in home safety changes, (b) vision contrast screening and referral, and (c) medication recommendations. Control condition consisted of fall prevention materials and individualized fall risk summary. Measurement: Timed Up and Go (TUG) and Tandem stand. Falls efficacy, feasibility, and acceptability of the intervention. Results: Sample (N = 37) was 65% female, 65% White, and average 77 years. Compared with the control group, each outcome improved in the intervention. The LIVE-LiFE intervention had a large effect (1.1) for tandem stand, moderate (0.5) in falls efficacy, and small (0.1) in the TUG. Conclusion: Simultaneously addressing preventable fall risk factors is feasible

Radiocarbon chronology of Iron Age Jerusalem reveals calibration offsets and architectural developments

Reconstructing the absolute chronology of Jerusalem during the time it served as the Judahite Kingdom’s capital is challenging due to its dense, still inhabited urban nature and the plateau shape of the radiocarbon calibration curve during part of this period. We present 103 radiocarbon dates from reliable archaeological contexts in five excavation areas of Iron Age Jerusalem, which tie between archaeology and biblical history. We exploit Jerusalem’s rich past, including textual evidence and vast archaeological remains, to overcome difficult problems in radiocarbon dating, including establishing a detailed chronology within the long-calibrated ranges of the Hallstatt Plateau and recognizing short-lived regional offsets in atmospheric 14C concentrations. The key to resolving these problems is to apply stringent field methodologies using microarchaeological methods, leading to densely radiocarbon-dated stratigraphic sequences. Using these sequences, we identify regional offsets in atmospheric 14C concentrations c. 720 BC, and in the historically secure stratigraphic horizon of the Babylonian destruction in 586 BC. The latter is verified by 100 single-ring measurements between 624 to 572 BC. This application of intense 14C dating sheds light on the reconstruction of Jerusalem in the Iron Age. It provides evidence for settlement in the 12th to 10th centuries BC and that westward expansion had already begun by the 9th century BC, with extensive architectural projects undertaken throughout the city in this period. This was followed by significant damage and rejuvenation of the city subsequent to the mid-eight century BC earthquake, after which the city was heavily fortified and continued to flourish until the Babylonian destruction