Jacob J. Sosnoff

Background: Fall-related head impact is the leading mechanism of traumatic brain injury in older adults, with risk increasing with age. Yet the mechanisms underlying this age-related vulnerability remain unclear. This study examined whether protective responses associated with head-impact avoidance differ between older and young adults.,Methods: In this cross-sectional study, 25 older female aged 73.1 (5.2) years and 11 young female aged 26.4 (2.7) years underwent experimentally induced backward falls. Each fall was divided into five sequential movement events for event-based analysis. Kinematic and kinetic variables across these events were compared among older adults with and without head impact and young adults without head impact using linear mixed-effects models.,Findings: Older adults who avoided head impact entered hip contact with greater hip flexion (62.3°) than young adults (40.4°) and older adults who experienced head impact (47.9°; all p < .05). Both older groups generated greater accelerating head impulse immediately after hip contact than young adults, and older adults who avoided head impact showed larger braking impulse prior to head impact.,Interpretation: Head-impact avoidance during backward falls in older adults was associated with a sequence of responses: a mechanically advantageous posture at hip contact requiring substantial hip flexion, and the capacity to generate head braking impulse late in the fall descent. The main age-related difference appeared to be the ability to react to the momentum transfer to the head after hip contact. Training these descent-phase responses may provide an additional route to head-injury prevention when falls cannot be avoided.

Background/Objectives: There is limited empirical evidence on the feasibility of inclusive, community-based exercise programs for older adults with long-term mobility disabilities. This pilot study investigated the feasibility and preliminary effectiveness of a community-based high-intensity functional training (HIFT) intervention. Methods: This single-group pre–post feasibility trial was delivered across four community-based HIFT facilities. Thirteen participants enrolled, and 10 (mean age 69.8 ± 6.7 years; 60% female) completed baseline assessments, two onboarding sessions, and thrice-weekly group-based workouts across 16 weeks. Physical function was assessed using the Canadian Occupational Performance Measure (COPM), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, Modified Falls Efficacy Scale (MFES), and standardized tests of mobility, balance, and strength. Exploratory outcomes included body mass index (BMI), waist circumference, work capacity, and quality of life (QOL). Results: Recruitment, retention, and attendance rates were 38%, 77%, and 58% (80% including make-up sessions), respectively. The intervention was safe and well-tolerated, with one fall-related adverse event. Self-reported functional outcomes demonstrated small to large effects, with large improvements in participant-identified functional activities (d = 1.03–1.54) and fall efficacy (d = 0.97), and a small effect for standardized physical function (d = 0.36) Endurance improved substantially (d = 1.01), while mobility, balance, and strength outcomes reflected maintenance or small to moderate gains (d = 0.08–0.55). BMI remained stable (d = 0.05), work capacity increased with moderate to large effects (d = 0.61–1.43), and QOL improved modestly (d = 0.20). Exit interviews reinforced high acceptability, highlighting individualized adaptations, supportive trainers, and the group-based context as motivating contextual factors. Conclusions: A community-based HIFT program is feasible and acceptable for older adults with mobility disabilities.