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Falls and Examples of EvidenceBased Programs for Falls

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Up to 30% of community dwelling adults fall each year ... Describe and question the struggle to make a change ... Learning builds on previous experience and knowledge ... – PowerPoint PPT presentation

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Title: Falls and Examples of EvidenceBased Programs for Falls


1
Falls and Examples of Evidence-Based Programs for
Falls
  • Angela Deokar, MPH, CHES
  • Kentucky Department for Public Health
  • Osteoporosis Prevention and Education Program

2
Topics to Cover
  • Define accidental fall
  • Discuss falls in community-dwelling older adults
    and associated complications
  • Provide an overview of multi-factorial risk and
    prevention components
  • Discuss fear of falling and how it relates to
    falls
  • Provide examples of two evidence-based falls
    programs
  • Matter of Balance offered in Kentucky
  • Stepping On being researched in Wisconsin

3
Definition of a Fall
  • An accidental fall is defined as an event which
    results in a person coming to rest inadvertently
    on the ground or other lower levels, and other
    than as a consequence of the following
    sustaining a violent blow loss of consciousness
    sudden onset of paralysis, as in a stroke an
    epileptic seizure. (Kellogg 1987)

4
Falls
  • Leading cause of injury and death for older
    adults
  • Up to 30 of community dwelling adults fall each
    year
  • Of those who fall, as many as half may suffer
    moderate to severe injuries that reduce mobility
    and independence
  • About 50 percent of older adults hospitalized for
    hip fracture never regain their previous level of
    function
  • Falls or fear of falling may contribute other
    complications and perpetuates a vicious cycle

5
Vicious Cycle
6
Falls
  • Falls are
  • Common
  • Predictable
  • Preventable
  • Falls are not a natural part of aging!

7
Falls
  • 1/2 to 2/3 of falls occur around the home
  • A majority of falls occur during routine
    activities
  • Falls usually are not caused by just one issue.
    Its a combination of things coming together -
    multifactorial
  • A large portion of falls are preventable!

8
(No Transcript)
9
Falls are Multi-Factorial
  • Behavioral
  • Biological
  • Environmental
  • Prevention usually emphasizes
  • Participating in a regular exercise program
  • Making home safety improvements
  • Reviewing medications
  • Checking vision

Risk Factors
10
CDCs Building Blocks for Falls Prevention
Programs
  • Education about falls and risk factors
  • Exercises that improve balance, strength and
    mobility
  • Medication review and management
  • Vision exam
  • Home safety assessment and modifications

11
Protect Your BonesWays to Make Your Home Safer
12
Protect Your Bones Ways to Make Your Home Safer
Remove all small rugs. They can make you trip.
5
12
Use non-slip mats in the bathtub or shower. Have
grab bars put in next to your toilet and in the
bathtub or shower.
13
(No Transcript)
14
Fear of Falling
  • 1/3 to 1/2 of older adults acknowledge fear of
    falling
  • It is reasonable to be concerned about falls -
    safety is important
  • Fear of falling is associated with
  • decreased satisfaction with life
  • increased frailty
  • depression
  • decreased mobility and social activity
    (inactivity)
  • Fear of falling is a risk factor for falls

15
Matter of Balance
  • Designed to reduce the fear of falling and
    increase the activity levels of older adults who
    have concerns about falls.
  • Research by the Roybal Center for Enhancement of
    Late-Life Function at Boston University.
  • Studied effect of program on fear of falling and
    associated activity restriction in older adults
  • Based on Cognitive Restructuring (Bandura and
    Lachman, 1997)
  • Tennsdedt, S., Howland, J., Lachman, M.,
    Peterson, E., Kasten, L. Jette, A. (1998). A
    randomized, controlled trail of a group
    intervention to reduce fear of falling and
    associated activity restriction in older adults.
    Journal of Gerontology, Psychological Sciences,
    54B (6), P384-P392.

16
Cognitive Restructuring
  • Method of turning negative thoughts into positive
    thoughts
  • Define barriers, obstacles when engaging in a new
    behavior
  • Identify strategies for overcoming the barriers
  • Plan realistic/feasible experiences so one can
    experience success

17
Who can benefit from A Matter of Balance?
  • Designed to benefit community-dwelling older
    adults who
  • Are concerned about falls
  • Have sustained a fall in the past
  • Restrict activities because of concerns about
    falling
  • Are interested in improving flexibility, balance
    and strength
  • Are age 60 or older, ambulatory and able to
    problem-solve

18
A Matter of Balance Class
  • During 8 two-hour sessions, participants learn
  • To view falls and fear of falling as controllable
  • To set realistic goals for increasing activity
  • To change their environment to reduce fall risk
    factors
  • To promote exercise to increase strength and
    balance

19
A Matter of Balance
  • What Happens During Sessions?
  • Facilitated by two leaders
  • Group discussion
  • Problem-solving
  • Skill building
  • Assertiveness training
  • Sharing practical solutions
  • Videotapes with peers who model behaviors
  • Exercise training

20
Maine Partnership for Healthy Aging Project Lay
Leader Model
  • Model Program Adaptations
  • Classes taught by volunteer lay leaders, called
    coaches, instead of healthcare professionals
  • Healthcare connection via guest therapist
  • Participant workbook developed and coach manual
    modified
  • Exercises modified
  • Maintaining Fidelity
  • Two day coach training based on original MOB
    leader manual
  • Master Trainer observes coaches during training
    and while leading a MOB/VLL class
  • Use of a mentor model - new volunteer is paired
    with an experienced coach
  • Communication, support and sharing outcomes

21
A Matter of Balance Lay Leader Model
22
Outcomes of Lay Leader Model
  • Participant Outcomes
  • 97 - more comfortable talking about fear of
    falling
  • 97 - feel comfortable
    increasing activity
  • 99 - plan to continue exercising
  • 98 - would recommend A Matter of Balance
  • who agree to strongly agree
  • Comments
  • I am more aware of my surroundings. I take time
    to do things and dont hurry.
  • I have begun to exercise and am looking forward
    to a walking program.
  • I have more pep in not being afraid.

23
Participants Report
  • Increased confidence in taking a walk, climbing
    stairs, carrying bundles without falling
  • More confidence that they can increase their
    strength, find ways to reduce falls, and protect
    themselves if they do fall
  • An increase in the amount they exercise on a
    regular basis
  • Fewer falls after taking MOB

24
A Matter of Balance/Volunteer Lay LeaderOutcomes
Healy, T. C., Peng, C., Haynes, P., McMahon, E.,
Botler, J. Gross, L. (2008). The Feasibility
and Effectiveness of Translating A Matter of
Balance into a Volunteer Lay Leader Model.
Journal of Applied Gerontology, 27 (1), 34-51.
(Significant Outcomes in Bold)
25
A Matter of Balance in Kentucky
  • Master training held in May 2007
  • Trained 21 Master Trainers in Area Agencies on
    Aging and Health Departments
  • Planning another Master Training on August
    13th-14th, 2008, in Elizabethtown
  • Goals Create a coordinated system of delivering
    and evaluating A Matter of Balance in KY and
    improving geographic accessibility to the courses
  • Request for Partners coming out soon
  • Emphasis on community collaboration, ability to
    implement and sustain the program

26
Video
  • A Matter of Balance Fear of Falling

27
  • Reducing Falls
  • Building Confidence
  • An Effective Program for Older People.

28
Stepping On
  • Identified as a multi-factorial program in CDC
    Compendium
  • Based on research by Clemson conducted in
    Australia

The effectiveness of a community based program
for reducing the incidence of falls among the
elderly A randomized trial. Clemson, L.,
Cumming, R.G., Kendig, H., Twible, R. (1999)
Journal of American Geriatrics Society
29
Outcomes
  • Randomized trial in Australia
  • Intervention group experienced a 31 reduction in
    falls
  • Maintained confidence to avoid a fall
  • Used more protective behavioral practices

30
Stepping On Underlying Concepts
  • Decision-making is a process (5 stages)
  • Story telling to facilitate learning confidence
  • Self-efficacy (Bandura 1997,1986,1997)
  • Learning and older adults as learners
  • Sustaining and follow-through with safety
    behaviors

31
Decision-Making as a Process
  • Appraising the challenge
  • Surveying the alternatives
  • Weighing the alternatives
  • Deliberating about commitment
  • Adhering despite negative feedback

Janis and Mann (1977)
32
Story Telling
  • Facilitate confidence and learning
  • Participants
  • Explore negative events
  • Describe and question the struggle to make a
    change
  • Reaffirm the positive and what they could do in
    the future
  • Re-tell and recreate their stories with a sense
    of personal control

Fitzgerald, 2001
33
Learning and Older Adults as Learners
  • Think creatively about opportunities
  • Learning for an older adult is best when
  • It is self-paced- benefit from breaks
  • Optimistic and positive feedback
  • Visual aids and practical examples
  • Learning builds on previous experience and
    knowledge
  • Learning must go both ways and leaders must
    recognize that participants bring their own
    unique perspective, life stage and knowledge
  • Review principles of adult education

34
Follow-Through with Safety Behaviors
  • Sustaining prevention strategies depends on
  • 1. Level of support social, peer and
    organizational
  • 2. Ease of complying cost, effort, complexity,
    intrusiveness. Older adults will spend if they
    view it on a path that has a link with a goal.
  • 3. Technical competence and interpersonal skills
    of professional
  • 4. Opportunity and willingness for personal goal
    setting Having an overarching goal and breaking
    it into smaller steps
  • 5. Feedback about success reporting back on
    exercise or home safety check or how they used
    different cues to prompt exercise like the start
    of a TV show or by leaving their exercise manual
    and or weights out on the table

Cole, Berger and Garrity, 1998
35
Bringing Stepping On to the U.S.
  • Aging and Disability Resource Center of Kenosha
    County, WI
  • Several projects, including funding from CDC in
    2007 to
  • Translate the Stepping-On fall prevention
    intervention for older adults into a program
    package that can be delivered to community-based
    organizations for implementation with older
    adults
  • Prepare a final program package that can be
    broadly disseminated

36
Original Australian Study vs. Implementation in
Wisconsin
  • Original study
  • Led by OT
  • No lay leader
  • Home visit by OT
  • Booster session 3 months after completion
  • WI implementation
  • Led by health professional (OT, RN, dietician,
    educator)
  • Lay co-leader
  • No home visit
  • Booster classes 2, 4 and 6 months after
    completion

37
WI Train-the-Trainer
  • Lead Trainer
  • Licensed health professional, trains Master
    Trainers
  • Master Trainers
  • Licensed health professional, trains Leaders and
    Peer Leaders
  • Leader (delivers program)
  • Licensed health professional or health educator
    with knowledge of fall prevention
  • Peer Leader (delivers program)
  • Older adult who can effectively deliver the
    program with another trained Leader

38
Bringing Stepping On to the U.S.
  • May be ready to disseminate beyond Wisconsin by
    end of 2008

39
The Safety of Seniors Act
  • The Safety of Seniors Act
  • Now titled Public Law 110-202, the act will
    develop education strategies to raise awareness
    about elder falls, encourage research to identify
    at-risk populations and evaluate falls
    interventions, and support demonstration
    projects.
  • Thirty national policy organizations are now
    calling on Congress to provide 20.7 million in
    FY 2009 for the Centers for Disease Control to
    fund these initiatives.

40
Challenge and Opportunity for Kentucky
  • evidence-based interventions are particularly
    strong when the fall prevention intervention
    includes both health care and community
    programming components working collaborativelyWha
    t we dont know is how to effectively integrate
    community interventions that link the unique fall
    prevention contributions of health care and aging
    (services)
  • Testimony Lynn Beattie at the Falls Prevention
    Briefing to Congress on May 7, 2008

41
Collaboration
  • When spider webs unite they can tie up a lion
  • Ethiopian Proverb

42
Manuals
  • Matter of Balance coach manual
  • Matter of Balance exercises
  • Stepping On leader manual

43
Thank you to
  • Patti League, Partnership for Healthy Aging
    (Maine)
  • Sandy Cech, Kenosha County Aging and Disability
    Resource Center (Wisconsin)
  • for resources used in this presentation
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