The effect of cognitive and cognitive-motor training on falls in older people

The intervention involves home-based cognitive or motor+cognitive training in community dwelling older people. Participants will be randomised to one of 3 arms for a 12-month intervention duration. Arm 1 involves cognitive training (seated computer games) for 120 minutes per week . Arm 2 involves cognitive-motor training (playing computer games with the feet while standing and stepping) for 120 minutes per week. Arm 3 is the no-intervention control. The training interventions (arms 1 and 2) involve home-based training with a custom built system of software (user interface and games), operating on a supplied personal computer and response device (touch pad for arm 1 or stepping mat for arm 2). Following a 1-hour session of instruction and safety check with a trained research assistant, participants will be asked to undertake training unsupervised in their home. Participants will receive a follow-up home visit at 4 weeks (~1 hour) to ensure safe use and progression of training and discuss any issues related to using the program (with the exception of those participants who were deemed safe at the first visit, are fully compliant in the first 4 weeks and report that they do not require a second visit, for whom a telephone call will replace the 4 week home visit). Upon trial commencement, arm 1 and 2 participants will be instructed to gradually increase their training dose from 40 min per week (week 1,2), to 60 min (week 3,4), 80 min (week 5,6), 100 min (week 7, 8) and 120 min from week 9 onwards. The training will be recommended to be split over 3 or 4 sessions during the week and compliance will be monitored via data transfer to a web application. Participants not engaging in the minimum weekly training dose (80 mins) for 2 consecutive weeks will be contacted by telephone to discuss any issues and to encourage adherence. Intensity and progression of intensity of training will be adjusted as performance improves and the participant moves through the inbuilt game levels. Support will be provided by telephone and additional home visits from the research staff may be requested for those experiencing difficulty. Intervention group participants will also receive a custom-designed 10-page booklet containing health-related information relevant to older adults (e.g. healthy eating, exercise, hydration, mental health, bone and joint health).