Evidence-Based Multifactorial Interventions to Prevent Falls

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Evidence-Based Multifactorial Interventions to
Prevent Falls
C4A Fall Prevention Conference, San Jose, CA.
April 14, 2008
Debra J. Rose, Ph.D. Co-Director, Fall Prevention
Center of Excellence California State University,
Fullerton www.stopfalls.org
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Components of Multifactorial Fall Prevention
Programs

• Screening and/or Assessment (with or without
  medical exam)
• Physical Activity (Exercise)
• Home Assessment and Modification
• Medical Management
• Vision Assessment and/or correction postural
  hypotension medication assistive device, etc
• Fall Risk Education/ Behavior Change

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Evidence-Based Research

• Single vs Multiple Intervention Strategies
• General vs Tailored Approaches
• Different Target Audiences (Or Not)
• Different Methods of Delivery
• Different Intervention Settings
• Different Providers

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Physical Activity (Exercise)

• Effective as a Stand-Alone Strategy
• Core component of most successful multifactorial
  approaches
• Exercise strategy differs as function of fall
  risk

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Stand-Alone Intervention Strategies

• Single modes of exercise include tai chi,
  strength training, walking.
• Multiple modes may include aerobic endurance,
  strength, flexibility, balance, and mobility.
• Fall risk and/or fall incidence rates lowered
  irrespective of type BUT not to same extent.
• Few head-to-head comparisons to date.

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Home Modifications

• Successful programs
• Include financial or manual assistance
• Hire trained health care professionals (OTs) to
  perform initial assessments
• Target older adults who are ready for change
  (e.g., Fall history, increased understanding of
  risk)
• Are combined with education and counseling about
  how to decrease risk

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Fall Risk Education/ Behavior Change

• Insufficient evidence to evaluate as a
  stand-alone intervention.
• Often included as part of a multi-component
  strategy.
• Accurate perception of fall risk not always
  evident.
• Timing of program is important.
• Education of consumer and service provider
  important.

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Fall Risk Education/ Behavior Change

• Can take many forms.
• Trained peer volunteers are well received by
  seniors.
• First step in continuum of injury prevention.
• Must raise awareness about importance of
  preventing falls.
• Must change notions that falls cannot be
  prevented and change behavior to increase
  long-term adherence.

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Multifactorial Approaches

• Require a multidisciplinary team approach
• Can be labor and resource intensive depending on
  complexity
• Most effective when targeted to high risk older
  adults at individual vs community level
• Intervention strategies need to specifically
  target identified risk factors

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There is NO One-Size-Fits-All Fall Prevention
Program
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Low-Risk Fall Prevention Programs

• Primary goal is to prevent onset of pathology
  and/or disability
• Many activity choices available (single vs
  multimodal exercise less structured lifestyle
  activity)
• Fall risk education component may be helpful
  addition for purpose of raising awareness.
• Self-assessment of home desirable

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Examples of Programs1,2

• Low- Moderate Risk
• Enhance Fitness (Community-based Group SS)
• Tai Chi Moving for Better Balance
  (Community-based Group SS)
• Matter of Balance (Community-based Group MF)
• Osteofit (Community-based Group MF)

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Moderate Risk Fall Prevention Programs

• Comprehensive assessment of fall risk factors
  desirable.
• Benefit from programs that specifically target
  identified physical risk factors.
• Specific balance and gait activities selected on
  basis of comprehensive evaluation of system
  impairments

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Examples of Programs

• Moderate High Risk
• Fallproof (Community-based Group plus
  home-based program MF)
• Stepping On (Community-based Group MF US
  replication in progress)
• Step-By-Step (Community-based Group MF Pilot
  phase of development)

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High Risk Fall Prevention Programs

• Carefully tailored and prioritized exercise
  program, usually as part of an individualized or
  staged multifactorial intervention strategy.
• Individually designed program that progresses
  from low to moderate intensity over longer
  duration.
• Couple exercise program with behavior skills
  training component and monitoring.

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Examples of Programs

• High-Risk
• FaME (Falls Management Exercise Group plus
  home-based program SS)
• Otago Programme (Home-based exercise SS)
• SAIL (Strategies and Actions for Independent
  Living Home-based MF)
• InSTEP (Increasing Stability through Evaluation
  and Practice Community-based, Group MF Pilot
  phase of development)

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Changing Behavior3

• Recommended Strategies
• Secure social support from family and friends
• Promote participants self-efficacy and perceived
  competence
• Providing older adults with active choices that
  are tailored to their personal needs and
  preferences
• Negotiate realistic and measurable goals, action
  plans, and health contracts to promote adherence
• Educate participants about actual risks of
  intervention
• Provide regular and accurate performance
  feedback.

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Marketing Strategies4

• ProFANE Network recommends the following
• Promote benefits of intervention relative to
  improving balance and reducing fall risk
• Foster self-management skills (active vs passive
  role)
• Match intervention to needs, preferences, and
  capabilities
• Market program in a manner that is highly valued
  by older adults.

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Sustainability5

• What is sustainability?
• Why is it important?
• What is the best pathway to follow to ensure
  sustainability?
• Pathway 1 Redefine scope of FP activities or
  program
• Pathway 2 Creative use available resources

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Selected References

• Multifactorial and Physical Activity Programs for
  Fall Prevention Fact Sheet (2008). Available at
  http//www.stopfalls.org/grantees_info/index.shtml
  
• Preventing Falls What Works (2008). Available
  at www.cdc.gov/ncipc/preventingfalls
• 3. WHO Global Report on Falls Prevention in Older
  Age (2007). Available at http//www.who.int/agei
  ng/projects/falls_prevention_older_age/en/index.ht
  ml
• Yardley L et al. (2007). J Active Aging
  Sept/Oct 46-52.
• Basner E. et al. (2008). Pathways to sustaining
  fall prevention activities. Available at
  http//www.stopfalls.org/grantees_info/files/Susta
  inabilityTA_Brief.pdf