OTAGO Exercise Program and Motivational Interviewing

The objective of this study is to evaluate the feasibility and impact of OTAGO instructors who are trained in motivational interviewing communication approach to facilitate older adult's uptake of the OTAGO exercises. This study will create the basis for future trials that will explore the impact of behavior change interventions on other fall prevention strategies.

We propose a single-arm quasi-experimental trial with older adults with high fall risks. The study intervention consists of OTAGO visits by study staff (MI-trained OTAGO instructor) over 6 months to improve older adults' engagement in fall prevention behaviors with a focus on OTAGO exercises. Participants will be followed for additional 6 months for the total study duration of 12 months.

Inclusion criteria

• Age ≥60
• At high fall risk: At least one "Yes" to 1) had a fall in the past year; 2) answer "difficult" to the question "do you find it hard to stand without using your hands"; 3) worry about falling
• Able to converse audibly and coherently in English
• Ambulatory with or without assistive device use
• Self-report challenges navigating the environment outside of the home
• At least one "some or much difficulty" or "unable to do" to:Walking one block?; Stepping up onto a curb?; Getting out of a straight back chair? Climbing one flight of stairs? Getting out of the house

Exclusion criteria

• o Receiving ongoing physical therapy with a primary focus on improving balance and strength of lower extremities

• Experiencing acute health issues such as fracture, pain, or infection that prohibits them from participating in exercises
• Able to stand on one foot for more than 10 seconds without holding onto something
• 6-item Callahan cognitive assessment over the phone: Patients with scores of 2 or less, positive for dementia criteria, will be excluded.
• Patients participating in other studies that may impact fall-related behavior change.
• Participants engaged in routine moderate or vigorous physical activities that require lower extremity balance and strength (e.g., >100 minutes/week for more than 3 months)