INTEGRATED LIFESTYLE MEDICINE AND HEALTH LITERACY TRAINING FOR DUAL FALL AND DEMENTIA PREVENTION AMONG OLDER ADULTS IN RURAL THAILAND: A COMMUNITY-BASED PEER EDUCATION RESEARCH AND DEVELOPMENT STUDY

Background: Thailand’s ageing population faces rising burdens of falls and dementia, major causes of disability and healthcare costs. Limited health literacy and rural healthcare access, especially in Health Region 8, heighten these risks. Community‑based, lifestyle‑focused interventions offer a promising path toward sustainable, peer‑led health promotion. Objective: This study aimed to develop and evaluate an integrated lifestyle medicine and health liter‑ acy training program for elderly health coaches to manage dementia and fall risks among communi‑ ty-dwelling older adults. Methods: A four-phase community-based quasi-experimental research and development study with a nonrandomized pre-post intervention design was implemented over 12 months across seven northeast‑ ern Thai provinces. The study included 6,227 participants in four groups: coaches (n=1,007) and risk participants (n=5,220), each stratified by falling risk alone or combined with dementia risk. The inte‑ grated lifestyle medicine and health literacy program was delivered through two modalities: intensive coach training, followed by implementation of peer education. Outcomes included the Timed Up and Go (TUG) test, Mini-Cog assessment, flexibility and strength tests, and knowledge assessments. Statistical analysis employed Wilcoxon signed-rank tests and Linear Mixed Models using R version 4.5.1. Results: Significant improvements were observed across the total participants (n=6,227, all p < 0.001): TUG improved by 2.05 seconds (95% CI: -2.14 to -1.96), Mini-Cog by 1.11 points (95% CI: 1.08 to 1.15), flexibility by 0.45 points, strength by 4.49 repetitions, and knowledge by 1.56 points. Subgroup analyses showed consistent benefits across all four groups, with combined-risk participants demon‑ strating the most significant improvements (TUG: -2.3 seconds; Mini-Cog: +1.2 points). Conclusion: The integrated program effectively improved both fall risk and cognitive function through sustainable peer education, with participants at combined risk showing the most significant benefits. Comparable outcomes between coaches and peer-educated participants validate scalability. These find‑ ings support integrating dual-prevention interventions into Thailand’s national healthy aging strategies and primary care systems as a cost-effective model for addressing multiple age-related risks in re‑ source-limited settings.