Views about Falls and Fall Prevention from Older Adults at Senior Centers - PowerPoint PPT Presentation

1 / 25
About This Presentation
Title:

Views about Falls and Fall Prevention from Older Adults at Senior Centers

Description:

They don't call the doctor and say, Gee, this new medicine is making me dizzy. ... 'A one-time deal is not very effective because you don't catch all the audiences ... – PowerPoint PPT presentation

Number of Views:97
Avg rating:3.0/5.0
Slides: 26
Provided by: healt60
Category:

less

Transcript and Presenter's Notes

Title: Views about Falls and Fall Prevention from Older Adults at Senior Centers


1
Views about Falls and Fall Prevention from Older
Adults at Senior Centers
  • Richard H. Fortinsky, Ph.D.
  • Center on Aging
  • University of Connecticut Health Center
  • Farmington, CT
  • Presented at the Joint Conference of the National
    Council on the Aging and the American Society on
    Aging
  • March 18, 2006

2
Important Note
  • Please do not cite or quote material from this
    presentation slide set without prior permission.
    Dr. Fortinsky can be reached at
    fortinsky_at_uchc.edu.
  • Thank you very much.

3
Acknowledgments
  • Funded by the U.S. Administration on Aging
  • Part of Evidence-Based Prevention initiative
  • Organizational Partners Roles
  • North Central CT Area Agency on Aging grantee
  • Yale University School of Medicine fall
    prevention interventionists
  • Dorothy Baker, PhD, RNCS Margaret Gottschalk,
    PT, MS Luann Bianco, BA
  • Nine Senior Centers settings for intervention
  • Center on Aging, UConn Health Center evaluation
  • Christine Unson, PhD Patricia Trella, MA Enid
    Zayas, BA

4
Background
  • Falls occur annually to one-third of people aged
    65 and older one-half of those aged 85 and
    older.
  • Demonstrated risk factors for falls, representing
    the evidence base for interventions, are
    preventable.
  • In the early 1990s, the Yale FICSIT randomized
    controlled trial found an in-home individualized,
    risk factor-focused intervention to be
    efficacious.
  • Our projectStep by Step Thoughtful Fall
    Preventionseeks to incorporate the Yale FICSIT
    intervention model into the fabric of ongoing
    Senior Center (SC) activities and programs.
  • Tinetti ME, et al, N Engl J Med 1994 331821-827

5
Step by Step Multi-factorialFall Risk Assessment
Protocols
  • Postural hypotension supine and standing blood
    pressure checks
  • Multiple medications review of all current
    prescription and OTC medications
  • Balance functional reach test, unilateral
    stance test
  • Gait mobility timed get up and go test
  • Feet shoes sensation test and shoe inspection
  • Home hazards self-reported checklist
  • Vision newspaper print size check
  • Based on the Yale FICSIT trial implementation
    in SCs guided by the Yale University School of
    Medicine partners for Step by Step

6
Background
  • First activity conducted in all 9 SCs was a group
    discussion with regular users.
  • Objectives of the group discussions
  • Learn about the extent to which falls were a
    factor in the lives of participants.
  • Learn their views on how fall prevention
    activities might be developed or enhanced in
    their SCs, and obstacles that might be
    encountered.
  • Not an effort to achieve consensus, but to
    determine range of opinions and experiences.

7
Sample Selection Composition
  • SCs located in cities and towns in greater
    Hartford, CT region.
  • SC directors were asked to invite 10-15 people
    identified as members or regular users to
    participate in group discussions.
  • Purpose was explained as to discuss falls and
    fall prevention.
  • 109 community-dwelling adults participated
  • 86 women 23 men
  • Age range (estimated) early 60s to late 80s
  • 29 Hispanic participants (2 SCs)
  • 11 African-Americans (one SC)

8
Discussion Group Logistics
  • First 3 conducted December 2003-Janaury 2004
    next 6 conducted January-February 2005.
  • Discussion guide was developed in line with
    objectives intent was to cover all questions in
    the same order with all groups in 60-90 minutes.
  • Two groups conducted in English and Spanish.
  • Spanish and English translation done throughout
    discussion using bilingual research or clinical
    staff members
  • Discussion group leader (RF for 8 EZ for 1)
    requested and obtained unanimous verbal assent to
    audiotape discussions in all 9 groups.

9
Discussion Group Data Analysis Steps
  • Verbatim transcripts were produced from
    audiotapes bilingual research staff transcribed
    and translated Spanish language discussion
    components into English.
  • Two research team members (CU and PT)
    independently read transcripts and searched for
    concepts using two domains of fall experiences
    and strategies for promoting fall prevention in
    SCs.

10
Discussion Group Data Analysis Steps
  • Ethnograph software and manual coding
    techniques were used.
  • Initial coding process led to theme
    identification based on comment frequency.
  • Third analysis team member (RF) joined others to
    review themes included and excluded from results.
  • Consensus reached by all 3 team members to yield
    results.

11
Results Falls in the Lives of Older Adults
  • Falls are common and are of concern.
  • Several participants in all groups shared fall
    stories, non-injurious and injurious.
  • Concern voiced when falls resulted in personal
    injury, and among non-fallers when other SC users
    suffered injuries (broken bones lacerations)
  • her life has changed so drastically now, that I
    thought to myself, like in an instant you fall
    and everything is different
  • Yet caution was expressed about being too afraid
    of falls.
  • ...you dont want to live your life and youre
    afraid to walk out because youre scared its
    slippery.

12
Results Falls in the Lives of Older Adults
  • What do you think might be some of the reasons
    that people fall?
  • Personal preoccupation and rushing around
  • we do one thing and are thinking about what
    were going to do nextuntil we fall down and
    then we say, Oh, well, I shouldnt have done
    that.
  • Personal declining physical function
    discrepancy between intentions and capabilities
  • My body is 86 years old, my heads about 30, so
    I think I can do all these things..and
    sometimesyou dont stop and think that your body
    isnt going with your mind.
  • We cant do what we used to do at 16, and we
    have to admit that.

13
Results Falls in the Lives of Older Adults
  • What do you think might be some of the reasons
    that people fall?
  • Home-related most responses were related to
    small pets, rugs, furniture, wires, clutter,
    and basement stairs (mostly going downstairs).
  • Theres a rug we have that we trip over almost
    every day.
  • There are small cords all over the house and
    sometimes I almost trip on them.
  • Missed the last step at the bottom of basement
    stairs.
  • External environment-related icy sidewalks and
    front door steps, uneven pavement, insufficient
    lighting and worn carpeting in public
    establishments.

14
Results Falls in the Lives of Older Adults
  • When prompted by evidence-based risk factors,
    footwear yielded discussion in nearly every
    group.
  • Open-toe or no-back shoes or slippers dont
    hold your foot like they are supposed to they
    slip off causing loss of balance or tripping.
  • If you have incorrect fitting for your feet, you
    dont walk properly.
  • Participants often noted link between two risk
    factors medications and loss of balance
  • I was taking a medication last year and noticed
    I was losing my balance
  • Certain medications (may) elevate blood pressure
    or lower it and that difference can cause them to
    lose their balance and fall.

15
Results Strategies for Avoiding Falls
  • Being aware and careful mindful of their
    actions, was a common strategy
  • The most important thing is to think about it.
    Dont stand on chairs and tables, go and get a
    little stepladder. Look where youre going and
    just think about what youre doing. Be a little
    methodical in planning things.
  • when you are walking, look where you are going
    to put your footin the 36 years that I have
    lived in America, I have never fallen
    (participant at a Hispanic Senior Center).

16
Results Strategies for Avoiding Falls
  • Specific behavioral changes mentioned
  • holding onto railings on stairs, going down
    stairs backwards or sideways
  • clearing paths of tripping hazards
  • finding safer yet fashionable, comfortable shoes
  • avoiding household tasks requiring climbing
    (changing light bulbs hanging curtains)
  • Exercise and walking commonly mentioned
  • Walk or exercise keeps your mobility higher
    and less prone to fall. And if you do fall,
    youre a little more limber and youre not apt to
    break something.

17
Results Strategies for Avoiding Falls
  • Fewer groups elaborated on strategies for
    addressing multiple medications.
  • Physician communication primary theme
  • Seniors dont tell the doctors when theyre on
    the new medication and its making them dizzy or
    lightheaded. They keep taking the medicine.
    They dont call the doctor and say, Gee, this
    new medicine is making me dizzy.
  • Youve got to mention it (side effect) to the
    doctor because the doctor is not going to think
    about it.
  • Using only one pharmacy and asking pharmacist for
    medication side effects also were mentioned

18
Results Strategies for Avoiding Falls
  • Final set of strategies discussed less often, but
    in detail when discussed home modification
    strategies.
  • Bathroom modifications often mentioned
  • I have a senior friend who when she saw my
    walk-in (shower) stall got rid of her bathtub.
    Took it right out, had a plumber come in, and put
    in a walk-in stall like I have with the
    handlebars and everything.
  • Reducing living areas to one floor, including
    laundry room, mentioned less often.

19
Results Promoting Fall Prevention in SCs
  • Participants were asked how any fall prevention
    activity might be introduced, to learn their
    views on how the SC worked and could attract
    interest in activities.
  • Individual assessment with a nurse was
    intentionally NOT the sole focus of this
    discussion.
  • Two areas of results Program content and
    publicity suggestions potential obstacles to
    success.

20
Results Promoting Fall Prevention in SCs
  • Program content most common topics
  • Increased awareness about falls
  • I think just making people aware of the things
    we talked about this morningwould make them do
    things with their lives a little differently.
  • Exercise classes (or different level of exercise,
    mostly lower, where classes already were offered)
  • Balance classes, such as tai-chi
  • Instructions on how to fall and get up off the
    floor
  • Medications combined lecture format followed by
    individual consultation

21
Results Promoting Fall Prevention in SCs
  • Program format and timing
  • Seminars on specific topics by well-known
    speakers
  • A one-time deal is not very effective because
    you dont catch all the audiences and plus people
    forget once they go back to their habits.
  • Include handouts at any activity
  • Its critical that we do have a handout with
    stuff, or if only a list of things, preventive
    things.
  • Use examples of personal experience in talks
  • Health fair as fall prevention kickoff activity
  • Timing coordinate around lunch and bingo,
    dominoes (at Hispanic SC) hold in the morning.

22
Results Promoting Fall Prevention in SCs
  • Publicity
  • Add fun and food to any event
  • Use SC newsletter to publicize any activity,
    including specific fall risk information
  • We could start with a little factoid of the
    month every month, a little paragraph in the
    newsletter.
  • Use local broadcast media to disseminate
    information abut the dangers of falling
  • Notable suggestion
  • Why dont we put crutches up on the wall and a
    wheelchair and say Dont let this happen to
    you!?

23
Results Promoting Fall Prevention in SCs
  • Obstacles to success
  • Often the same group of people who participate in
    any offered scheduled activities hard to get
    interest by more persons due to competing
    interests.
  • People come to the SC to participate in specific
    activities and not others (e.g., bingo, cards).
  • Less frequent but notable broader concern about
    negative image of SC in the community
  • I would start by stop calling it senior. I
    know people that are between 55-65 that just
    wont join because they think its a stigma.

24
Results Promoting Fall Prevention in SCs
  • Special obstacle male participation
  • Two focus groups men uninterested in activities
    offered by SCs or in exercise.
  • If you gave a talk (at the SC) on hunting and
    fishing, they might listen.
  • Some men (say) Why should I go out and
    exercise? I am content with my fat body the way
    it is. I cut the grasswhy do I need exercise?
    (female participant).

25
Conclusions
  • Falls are a common occurrence and source of
    concern among older adults across racial and
    ethnic groups who are members of, or who
    regularly attend, SCs.
  • SCs hold great potential for introducing or
    enhancing activities aimed at preventing falls,
    by raising awareness and addressing
    evidence-based risk factors.
  • Important obstacles to success in program
    implementation should be anticipated based on
    views from study participants
Write a Comment
User Comments (0)
About PowerShow.com