Objectives: The Sunbeam trial significantly reduced falls in long-term aged care (LTC) residents. The current study's primary objective was to undertake subgroup analysis of the Sunbeam trial, to determine whether the intervention was effective for reducing falls in LTC residents with mild-moderate cognitive impairment/dementia. Secondary objectives were to determine intervention effects on cognitive and physical function.

Design: Subgroup analysis of a cluster randomized controlled trial (RCT).

Setting and participants: Permanent residents of LTC in Australia who participated in the Sunbeam trial with Addenbrooke's Cognitive Examination-Revised (ACE-R) scores <83 (mini-mental state examination>14 = main trial inclusion criteria).

Methods: Of 221 participants, 148 had an ACE-R <83 and were included in this study. sixteen ltc residences (clusters) randomized to receive either the sunbeam program or usual care. involved two 1-hour sessions week of tailored progressiveresistance balance training for 25 weeks followed by a maintenance (two 30-min nonprogressive exercise 6 months). assessments conducted at baseline, 6 months,12 months. falls recorded using routinely collected data from incident management systems.

Results: Rate of falls (50%) and risk of falls (31%), multiple falls (40%), and injurious falls (44%) were reduced in the intervention group. The intervention group had significantly better balance (static and dynamic) and sit-to-stand ability when compared with the control group at 6 months and significantly better dynamic balance at 12 months. There were no serious adverse events.

Conclusions and implications: The Sunbeam Program significantly reduced falls and improved physical performance in cognitively impaired LTC residents. This is a novel and important finding, as many previous studies have excluded people with cognitive impairment/dementia and inconsistent findings have been reported when this population has been studied. Our findings suggest that progressive resistance and balance exercise is a safe and effective fall prevention intervention in LTC residents with mild-moderate cognitive impairment/dementia.