Daily Fiber Supplement May Improve Brain Function in Older Adults, Study Finds

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Experts explain why the gut-brain relationship is so important

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A daily fiber supplement may improve brain function, new research finds.
In just 12 weeks, researchers found that those who received a daily fiber supplement were performing better in tests assessing brain function.
Experts explain the findings.

Everyone wants to know how to improve their gut health and their brain health. But, what if a daily pill could have a positive effect on both? New research shows that something as simple as a fiber supplement could be used to improve brain function in older adults.

A study published in Nature Communications looked at how fiber might play a role in brain health. Researchers recruited 36 pairs of twins—72 individuals in total—over the age of 60. Each twin received either a placebo or a 7.5-gram fiber supplement (which the study specifies as a prebiotic, which is a type of fiber that feeds the good bacteria, a.k.a probiotics, in your gut) every day for 12 weeks. In addition, all participants performed resistance exercises and ate a protein supplement daily throughout the study.

After 12 weeks, researchers found that the prebiotic supplement had led to significant changes in the participants’ gut microbiomes. In particular, participants taking the supplement saw a significant increase in the number of beneficial bacteria, called Bifidobacteria, in their gut

Within just 12 weeks, researchers also found that those taking fiber supplements were performing better in tests assessing brain function, including the Paired Associates learning test which is a key assessment for early Alzheimer’s, together with tests of reaction time and processing speed.

So, how does gut bacteria impact cognitive performance? The brain and gut send messages to one another that can positively or negatively impact each other, says Melissa Prest, D.C.N., R.D.N., national media spokesperson for the Academy of Nutrition and Dietetics and member of the Prevention Medical Review Board. “When our gut microbiome is disrupted, it can lead to various neurological disorders,” such as dementia, she notes. This is because the brain functions best in an environment free from inflammation and free from toxins that are both produced and cleared by the body, explains Amit Sachdev, M.D., director of the Division of Neuromuscular Medicine at Michigan State University.

Research has found that people who consume higher amounts of dietary fiber are less likely to develop dementia, says Prest. “While the direct link between fiber and dementia is still being investigated, some reasons why fiber may play a role in reducing the development of dementia include the reduction in blood pressure which protects against vascular dementia, and a healthier gut microbiome which lessens inflammation and protects the brain from developing dementia,” she explains.

More specifically, research supports that a meal plan rich in fiber (such as Mediterranean, MIND, and DASH diets) may help prevent cognitive decline and dementia, says Keri Gans, M.S., R.D., registered dietitian and author of The Small Change Diet. Still, keep in mind that forestalling dementia requires using the brain throughout your life, maintaining a healthy body, and avoiding habits that harm the brain, notes Dr. Sachdev.

The bottom line

So, why does this study make a difference? Well, finding an improvement in cognition by fueling the gut microbiome with a prebiotic confirms what other studies have previously reported about the brain-gut axis, says Prest. “Building and maintaining a healthy gut microbiome may be the key to improving age-related changes in cognition.”

Adding more fiber to your daily diet is an easy step in the right direction for better brain health later in life, says Gans. If you want to start loading up on fiber at mealtime, Prest recommends aiming for 25-30 grams of fiber a day. “You can do this by making half of your grain choices whole grains and choosing more fruits in vegetables during meals and snacks,” she suggests.

Dietary supplements are products intended to supplement the diet. They are not medicines and are not intended to treat, diagnose, mitigate, prevent, or cure diseases. Be cautious about taking dietary supplements if you are pregnant or nursing. Also, be careful about giving supplements to a child, unless recommended by their healthcare provider.

Older adults with low creatinine, cystatin C-based eGFR at higher risk for poor outcomes

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Key takeaways:

Overall, 9,654 patients died of cardiovascular events and 841 died due to kidney failure in the study.
Counting initial events only, there were 51,096 hospitalizations.

Older adults with low eGFR based on creatinine and cystatin C levels may be at higher risk for adverse events compared with those who have low eGFR based on creatinine level, data show.

“In routine clinical practice, GFR is usually estimated from serum creatinine level (eGFRcr),” lead researcher Edouard L. Fu, PhD, of the department of medical epidemiology and biostatistics at Karolinska Institute in Stockholm, wrote in a study published in the Annals of Internal Medicine.

Woman outside smiles. — Overall, 9,654 patients died of cardiovascular events and 841 were due to kidney failure. *Source: Adobe Stock.*

While an eGFRcr below 60 mL/min/1.73 m² may be common in older adults, Fu and his colleagues wrote, “levels of 60 mL/min/1.73 m² or lower are less strongly associated with adverse outcomes in older adults than in young persons … leading to debate about the appropriateness of the current GFR threshold to define CKD in older adults.”

Researchers conducted a population-based cohort study in Stockholm from 2010 to 2019 that included 82,154 adults aged 65 years or older who underwent outpatient creatinine and cystatin C testing between 2010 and 2019. Investigators compared the associations between eGFR based on creatinine level and eGFR based on creatinine and cystatin C levels (eGFRcr-cys). Patients were followed until outcome occurrence, death or study conclusion.

Primary outcomes were hazard ratios for all-cause mortality, cardiovascular mortality, kidney failure involving replacement therapy, incidence rate ratios for repeated hospitalization, infection, myocardial infarction or stroke, heart failure and AKI.

Overall, 31,219 patients died during follow-up. Of these, there were 9,654 cardiovascular deaths and 841 patients who progressed to kidney failure with renal replacement therapy and died. Counting initial events only, there were 51,096 hospitalizations; 26,754 involving infections; 16,074 due to heart failure; 8,549 related to myocardial infarction or stroke and 5,014 because of AKI.

Findings showed the associations between eGFRcr-cys and outcomes were monotonic, while associations for eGFRcr had a U-shaped pattern, indicating that low eGFRcr-cys was more strongly tied to adverse outcomes compared to low eGFRcr. Researchers found the adjusted hazard ratios for all-cause mortality were 1.2 for eGFRcr-cys and 1 for eGFRcr when comparing 60 mL/min/1.73 m²vs. 80 mL/min/1.73 m². These results were similar within study subgroups, including patients with a urinary albumin-creatinine ratio below 30 mg/g.

“Low eGFRcr-cys was more strongly associated with a broad range of outcomes than low eGFRcr among older patients, including all-cause and cardiovascular mortality and many specific types of hospitalizations,” Fu, also of the pharmacoepidemiology and pharmacoeconomics divisions at Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues wrote. An “eGFRcr above 90 mL/min/1.73 m² was associated with higher risk, but not eGFRcr-cys or eGFRcys, suggesting the risk may be driven by low creatinine generation and low muscle mass rather than high GFR itself.”

Playing an Instrument Linked to Better Brain Health in Older Adults

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Engaging in musical activities throughout one’s life may hold the key to maintaining cognitive sharpness in older age, suggests a groundbreaking study conducted by experts at the University of Exeter. Published findings from the ongoing PROTECT study shed light on the profound relationship between musicality and brain health, offering insights into the potential benefits of playing instruments or participating in choirs as individuals age.

The Harmony of Research: PROTECT Study Insights

Led by scientists at the University of Exeter, the PROTECT study stands as a pioneering endeavor, welcoming individuals aged 40 and above to contribute invaluable data for over a decade. With a cohort surpassing 25,000 participants, the study delves into the intricate interplay between lifestyle choices and cognitive well-being.

In their latest analysis, researchers scrutinized the musical experiences of over a thousand adults aged 40 and above, discerning the impact of musical engagement on cognitive vitality. By juxtaposing participants’ musical backgrounds with cognitive test results, the team aimed to unravel the nuances of how musical pursuits influence brain health as individuals age.

Key Findings: Music as a Melody of Cognitive Resilience

The results, resounding with promise, underscore the profound benefits of musical engagement on cognitive acuity, particularly in older adults. Among the key revelations, playing a musical instrument emerged as a potent catalyst for bolstering memory and enhancing executive function—the ability to tackle complex tasks with finesse.

Professor Anne Corbett, spearheading dementia research at the University of Exeter, elucidates, “Our PROTECT study has given us a unique opportunity to explore the relationship between cognitive performance and music in a large cohort of older adults. Overall, we think that being musical could be a way of harnessing the brain’s agility and resilience, known as cognitive reserve.”

Tuning into Lifelong Musicality

As the findings reverberate through the halls of scientific inquiry, they advocate for the integration of musical education into public health initiatives geared towards safeguarding brain health. Encouraging older adults to rediscover the joy of music in later life may serve as a pivotal strategy in fostering cognitive resilience and mitigating the risk of cognitive decline.

While acknowledging the need for further investigation, Professor Corbett emphasizes the potential of music group activities as a cornerstone of healthy aging initiatives. By embracing the transformative power of music, individuals can embark on a harmonious journey towards nurturing brain health and enriching their lives.

Echoes of Experience: Insights from Stuart Douglas

Stuart Douglas, a seasoned accordion player hailing from Cornwall, embodies the enduring synergy between music and cognitive vitality. Reflecting on his lifelong musical odyssey, Douglas attests to the profound impact of music on his cognitive well-being.

“I learnt to play the accordion as a boy living in a mining village in Fife,” Douglas reminisces. “These days I still play regularly, and playing in the band also keeps my calendar full, as we often perform in public. We regularly play at memory cafes so have seen the effect that our music has on people with memory loss, and as older musicians ourselves we have no doubt that continuing with music into older age has played an important role in keeping our brains healthy.”

Embracing the Overture of Cognitive Wellness

As the curtains rise on a new era of cognitive wellness, the resonance of music emerges as a timeless symphony of resilience and renewal. From the ivory keys of a piano to the spirited melodies of a choir, the transformative power of music invites individuals to embark on a harmonious journey towards vibrant brain health and enriched lives.

In the intricate tapestry of existence, let us heed the timeless refrain of melody and rhythm, embracing music as a beacon of hope and rejuvenation in the symphony of life.

Older Adults Want Medicare, Insurance to Cover Obesity Drugs

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Weight-loss drugs should be covered by Medicare and by other health insurance, according to a poll of US adults aged 50-80 years.

Among more than 2600 polled, 83% say that health insurance should cover prescription weight-loss drugs that have been approved by the US Food and Drug Administration (FDA), and 76% say Medicare should cover such drugs. However, only 30% would be willing to pay higher Medicare premiums to have these medications covered.

Among the 27% of respondents who say they are overweight, 63% are interested in taking such medications, as are 45% of those with diabetes, regardless of weight.

The University of Michigan (U-M) National Poll on Healthy Aging was published online on December 13, 2023.

High Awareness

The findings come at a time when injectable glucagon-like peptide 1 receptor agonists (GLP-1 RAs), such as Ozempic, Wegovy, Zepbound, and Mounjaro, are receiving a lot of public attention, the university noted.

Overall, 64% of survey respondents had heard of at least one prescription medication used for weight management.

By brand name, 61% had heard of Ozempic, approved for the treatment of type 2 diabetes but prescribed off label for weight loss; 18% had heard of Wegovy; and 13% had heard of the anorexiant drug phentermine.

Very few respondents (3% for each) had heard of the GLP-1 RA Saxenda, Qsymia (phentermine plus the anticonvulsant topiramate), and the opiate antagonist Contrave.

Zepbound, the obesity-specific form of the diabetes drug Mounjaro, received FDA approval after the poll was taken and was not included in survey questions.

Among respondents who had heard of at least one prescription medication used for weight management, 58% had heard about them through the news (eg, TV, magazines, newspapers) and 53% had heard about them from an advertisement on TV, the internet, or radio. Only 11% heard about them from their healthcare provider.

Respondents more likely to be interested in taking a prescription medication for weight management included women, those aged 50-64 years, Black persons, Hispanic persons, those with household incomes of less than $60,000 annually, those with lower levels of education, those in fair or poor physical or mental health, and those with a health problem or disability limiting their daily activities.

Spotty Coverage

The GLP-1 RAs can cost more than $12,000 a year for people who pay out of pocket, the university noted.

A Medicare Part D law passed in 2003 prohibits Medicare from covering medications for weight loss, although currently it can cover such drugs to help people with type 2 diabetes manage their weight.

Medicaid covers the cost of antiobesity drugs in some states.

Most private plans and the Veterans Health Administration cover them, but with restrictions due to high monthly costs for the newer medications.

The American Medical Association recently called on insurers to cover evidence-based weight-loss medications.

The strong demand for these medications, including for off-label purposes by people willing to pay full price, has created major shortages, the university noted.

“As these medications grow in awareness and use, and insurers make decisions about coverage, it’s crucial for patients who have obesity or diabetes, or who are overweight with other health problems, to talk with their healthcare providers about their options,” said poll director Jeffrey Kullgren, MD, MPH, MS, a primary care physician at the VA Ann Arbor Healthcare System and associate professor of internal medicine at U-M.

Other weight-management strategies that respondents think should be covered by health insurance include sessions with a registered dietitian or nutritionist (85%); weight-loss surgery (73%); gym or fitness facility memberships (65%); apps or online programs to track diet, exercise, and/or behavior change (58%); and sessions with a personal trainer (53%).

The randomly selected nationally representative household survey of 2657 adults was conducted from July 17 to August 7, 2023, by NORC at the University of Chicago for the U-M Institute for Healthcare Policy and Innovation. The sample was subsequently weighted to reflect population figures from the US Census Bureau. The completion rate was 50% among those contacted to participate. The margin of error is ±1 to 5 percentage points for questions asked of the full sample and higher among subgroups.

The poll is based at the U-M Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine, the University of Michigan’s academic medical center.

Exercise, Mindfulness Don’t Boost Healthy Older Adults’ Cognition

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“We aren’t saying, ‘Don’t exercise’ or, ‘Don’t practice mindfulness,’ ” Eric J. Lenze explains. “But we had thought we might find a cognitive benefit in these older adults. We didn’t.” (Ground Picture/Shutterstock)

Exercise and mindfulness failed to boost older adults’ cognitive function in a recent study.

Researchers studied the cognitive effects of exercise, mindfulness training, or both for up to 18 months in older adults who reported age-related changes in memory but had not been diagnosed with any form of dementia. The findings appear in JAMA.

“We know beyond any doubt that exercise is good for older adults, that it can lower risk for cardiac problems, strengthen bones, improve mood, and have other beneficial effects—and there has been some thought that it also might improve cognitive function,” says first author Eric J. Lenze, professor and head of the psychiatry department at Washington University School of Medicine in St. Louis.

“Likewise, mindfulness training is beneficial because it reduces stress, and stress can be bad for your brain. Therefore, we hypothesized that if older adults exercised regularly, practiced mindfulness, or did both there might be cognitive benefits—but that’s not what we found.”

Lenze and his colleagues still want to see whether there may be some cognitive effects over a longer time period, so they plan to continue studying this group of older adults to learn whether exercise and mindfulness might help prevent future cognitive declines. In this study, however, the practices did not boost cognitive function.

“So many older adults are concerned about memory,” says senior author Julie Wetherell, a professor of psychiatry at the University of California, San Diego. “It’s important for studies like ours to develop and test behavioral interventions to try to provide them with neuroprotection and stress reduction as well as general health benefits.”

The researchers studied 585 adults ages 65 through 84. None had been diagnosed with dementia, but all had concerns about minor memory problems and other age-related cognitive declines.

“Minor memory problems often are considered a normal part of aging, but it’s also normal for people to become concerned when they notice these issues,” says Lenze, who also directs Washington University’s Healthy Mind Lab. “Our lab’s principal aim is to help older people remain healthy by focusing on maintaining their mental and cognitive health as they age, and we were eager to see whether exercise and mindfulness might offer a cognitive boost in the same way that they boost other aspects of health.”

All study participants were considered cognitively normal for their ages. The researchers tested them when they enrolled in the study, measuring memory and other aspects of thinking. They also conducted brain-imaging scans.

The participants were randomly assigned to one of four groups: a group in which subjects worked with trained exercise instructors; a group supervised by trained experts in the practice of mindfulness; a group that participated in regular exercise and mindfulness training; and a group that did neither, but met for occasional sessions focused on general health education topics. The researchers conducted memory tests and follow-up brain scans after six months and again after 18 months.

At six months and again at 18 months, all of the groups looked similar. All four groups performed slightly better in testing, but the researchers believe that was due to practice effects as study subjects retook tests similar to what they had taken previously. Likewise, the brain scans revealed no differences between the groups that would suggest a brain benefit of the training.

Lenze says the study’s findings don’t mean exercise or mindfulness training won’t help improve cognitive function in any older adults, only that those practices don’t appear to boost cognitive performance in healthy people without impairments.

“We aren’t saying, ‘Don’t exercise’ or, ‘Don’t practice mindfulness,’” Lenze explains. “But we had thought we might find a cognitive benefit in these older adults. We didn’t. On the other hand, we didn’t study whether exercise or mindfulness might benefit older adults who are impaired due to dementia or to disorders such as depression. I don’t think we can extrapolate from the data that these practices don’t help improve cognitive function in anyone.”

Lenze says the researchers recently received funding from the National Institutes of Health (NIH) to continue following the group of adults who participated in this study.

“They are still engaging in exercise and mindfulness,” he says. “We didn’t see improvements, but cognitive performance didn’t decline either. In the study’s next phase, we’ll continue following the same people for five more years to learn whether exercise and mindfulness training might help slow or prevent future cognitive declines.”

The study had support from the National Institute on Aging, the National Center for Complementary and Integrative Health, the NIH Office of Behavioral and Social Science Research, and the McKnight Brain Research Foundation. Additional funding came from the Taylor Family Institute for Innovative Psychiatric Research.

High-Dose Flu Vaccine Promising for Mortality Benefits in Older Adults

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Danish pilot study lays groundwork for larger trial looking for better CV outcomes

A Danish feasibility study that tested a high-dose quadrivalent influenza vaccine versus a standard dose hinted at morbidity and mortality benefits, researchers reported.

In the DANFLU-1 study, there was a 48.9% reduction in the risk of all-cause mortality and a 64% reduction in the incidence of hospitalization for influenza or pneumonia for high-dose versus standard-dose vaccination. Also, hospitalization for cardiorespiratory complaints — a combination of any cardiovascular or respiratory illnesses — was reduced by 12% with the high-dose vaccine, according to Tor Biering-Sørensen, MD, PhD, MPH, of the University of Copenhagen.

Less than 1% of patients in both trial arms died in the 14 days after being vaccinated against influenza, and there were no significant differences in serious adverse events between the high-dose and standard-dose groups, he reported in a presentation at the European Society of Cardiology (ESC) meeting.

However, Biering-Sørensen emphasized that “this is just a hypothesis-generating finding because this was just a pilot trial that was not powered for outcomes.” The open-label DANFLU-1 enrolled about 12,000 patients (median age 71.7; 47.1% women), and a study with a larger patient population is needed to support the results, he added.

“That study is now being planned,” Biering-Sørensen told MedPage Today. “We know that to have a definitive result we will have to enroll 208,000 Danish citizens to have sufficient power to assess whether the high-dose vaccine will reduce outcomes for pneumonia or influenza, and also to see if the high dose will reduce the risk of cardiovascular outcomes.”

High-dose vaccines contain 60 μg of hemagglutinin antigen for each strain, while standard-dose vaccines contain 15 μg, and “high-dose vaccines are approved for adults aged 65 years and older in most countries, and for those 60 years and older in some countries,” he explained in an ESC press release. ” However, only a few countries offer older adults a high-dose vaccine by default. Thus, high-dose vaccines are not widely implemented despite accumulating evidence of additional protection against influenza infection and influenza-related morbidity compared with standard-dose vaccines.”

Biering-Sørensen noted that he would use the high dose for his patients now because “we already know that the high dose protects at least 25% greater than the standard dose against influenza. We know that the high dose can prevent against the influenza, but we cannot yet say that the high dose prevents hospitalization.”

Amit Khera, MD, a spokesperson for the American Heart Association, told MedPage Today that “in the United States, the high dose is generally recommended for the elderly because there is a better immune response.” Previous research has that the flu vaccine was tied to a lower risk of fatal and nonfatal cardiovascular events within a year. Khera is at the University of Texas Southwestern Medical School in Dallas.

He reiterated that the DANFLU-1 “was underpowered to show which dose prevented outcomes.” Also, patients in the trial were “all-comers” over age 65, “but not necessarily those with cardiovascular disease.”

Khera, who was not involved in the study, said that he offered high-dose influenza vaccine to his elderly patients, and that the current trial “does remind us that vaccine is feasible, it is safe, and whether the high dose or low dose is the right dose, it doesn’t take away the necessity to vaccinate our vulnerable patients.”

The trial was integrated into the Danish vaccination program, with only one study visit at the time of vaccination, and registry-based follow-up occurring after. Enrollment began in October 2021, and was completed within the next 2-3 weeks, with 11,463 patients enrolled in the first 15 days of the trial.

Biering-Sørensen explained at a ESC press conference that “conducting an innovative pragmatic randomized trial in Denmark using administrative health registries as the primary data source was feasible. Integrating an influenza vaccine trial into the official Danish vaccination program was also feasible. The next step is to conduct a fully powered trial of high-dose versus standard-dose quadrivalent influenza vaccine in older adults.”

Afraid of Falling? For Older Adults, the Dutch Have a Cure

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A course teaching older people how to fall, and not to fall, in Leusden, the Netherlands.

LEUSDEN, Netherlands — The shouts of schoolchildren playing outside echoed through the gymnasium where an obstacle course was being set up.

There was the “Belgian sidewalk,” a wooden contraption designed to simulate loose tiles; a “sloping slope,” ramps angled at an ankle-unfriendly 45 degrees; and others like “the slalom” and “the pirouette.”

They were not for the children, though, but for a class where the students ranged in age from 65 to 94. The obstacle course was clinically devised to teach them how to navigate treacherous ground without having to worry about falling, and how to fall if they did.

“It’s not a bad thing to be afraid of falling, but it puts you at higher risk of falling,” said Diedeke van Wijk, a physiotherapist who runs WIJKfysio and teaches the course three times a year in Leusden, a bedroom community just outside Amersfoort, in the center of the country.

The Dutch, like many elsewhere, are living longer than in previous generations, often alone. As they do, courses that teach them not only how to avoid falling, but how to fall correctly, are gaining popularity.

From left, Riet van Velzen, 79, Ria Kocks, 78, Nanda Silkens, 79, Loes Bloemdal, 80, and Hans Kuhn, 85, learning a better way to stand up and sit down.

Ben Koops, 82, navigating an obstacle called the “tilting shelf.”

This one, called Vallen Verleden Tijd course, roughly translates as “Falling is in the past.” Hundreds of similar courses are taught by registered by physio- and occupational therapists across the Netherlands.

Yet falling courses — especially clinically tested ones — are a fairly recent phenomenon, according to Richard de Ruiter, of the Sint Maartenskliniek in Nijmegen, the foundation hospital that developed this particular course.

Virtually unheard-of just a decade ago, the courses are now common enough that the government rates them. Certain forms of Dutch health insurance even cover part of the costs.

While the students are older, not all of them seemed particularly frail. Herman van Lovink, 88, arrived on his bike. So did Annie Houtveen, 75. But some arrived with walkers and canes, and others were carefully guided by relatives.

Ms. Kuhn walking in the gym’s schoolyard.

Falling can be a serious thing for older adults. Aging causes the bones to become brittle, and broken ones do not heal as readily.

Today, 18.5 percent of the Dutch population — roughly 3.2 million people — is 65 or older, according to official statistics. In 1950, about the time some of the younger course participants were born, people 65 or older made up just 7.7 percent of the population.

Across the Netherlands, 3,884 people 65 or older died as result of a fall in 2016, a 38 percent increase from two years earlier.

Experts say the rise in fatalities reflects the overall aging of the population, and also factors such as the growing use of certain medications or general inactivity.

“It’s same as with young children: More and more old people have an inactive lifestyle,” said Saskia Kloet, a program manager at VeiligheidNL, an institution that offers similar courses.

Even inactivity in one’s 30s or 40s could lead to problems later in life, she noted.

Like many people her age, Hans Kuhn, 85, worried that her daily routine — and the ability to live alone — would end if she ever lost her balance and fell.

She has lived in her house for decades, and alone since her partner died years ago. Its steeply winding staircase is equipped with a motorized chair on a rail to help reach upper floors. “I only use it when I have to bring lots of heavy things upstairs,” said Ms. Kuhn, herself a retired physiotherapist.

Ms. Kuhn’s entire house is a study in efficiency and simple modifications that can make all the difference for an older person. Hand grips are installed in just the right places, as well as ramps to accommodate her two walkers.

There is a stationary exercise bike to keep her moving, and a weight machine made from a big can of beans and string to maintain her upper body strength.

Even as she feels herself grow frailer and less flexible, she knows how to stay fit. “My main problem is I’m very afraid of falling,” she said.

Ms. Kuhn’s bedroom, right, and home trainer. The house is a study in simple modifications that can make all the difference for an older person.

Ms. Kuhn exercising at home with a self-made weight system made out of a rope and a can of beans.

So she joined the course, which meets twice a week. On Tuesdays, the students build confidence by walking and re-walking the obstacle course. Thursdays are reserved for the actual falls.

In order to learn, the students start by approaching the mats slowly, lowering themselves down at first. Over the weeks, they learn to fall.

“Naturally, they are not interested in courses on falling at first, but once they see that they can do it, then it’s fun,” Ms. Kloet said. “But there is also a very important social aspect.”

Indeed, seeing one another helplessly sprawled across the gym mats gave way to giggling and plenty of dry comments, knowing jokes, general ribbing and hilarity.

“Stop your chattering,” Ms. van Wijk warned a group of well-dressed women who were supposed to be concentrating on the correct way to let themselves fall onto the foot-thick blue mat.

“I would,” said Loes Bloemdal, 80, laughing. “But I have no one to talk with all day.”

Ms. Silkens, right, and Frans Poss, 94, left, training on how to fall and get up.

The students start by lowering themselves down onto the mats slowly. Over the weeks, they learn to fall.

In preparing their bodies for a possibly apocalyptic event, the students appeared to forget about their age.

Mr. van Lovink, the cyclist, asked if they would learn standing on one leg. “Why would you want to do that?” replied Ms. van Wijk.

“To be able to put on my pants,” Mr. van Lovink said seriously, but to the amusement of his classmates.

Ms. van Wijk advised them all to always sit when putting on their pants.

“That’s the power of physiotherapy with geriatrics,” she said. “You practice the things you know you can do, and not the things you can’t.”

Afraid of Falling? For Older Adults, the Dutch Have a Cure

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The shouts of schoolchildren playing outside echoed through the gymnasium where an obstacle course was being set up.

From left, Riet van Velzen, 79, Ria Kocks, 78, Nanda Silkens, 79, Loes Bloemdal, 80, and Hans Kuhn, 85, learning a better way to stand up and sit down.

Ben Koops, 82, navigating an obstacle called the “tilting shelf.”

Virtually unheard-of just a decade ago, the courses are now common enough that the government rates them. Certain forms of Dutch health insurance even cover part of the costs.

Ms. Kuhn walking in the gym’s schoolyard. Credit Jasper Juinen for The New York Times