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Evidence-Based Multifactorial Interventions to Prevent Falls

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The Fall Prevention Center of Excellence is ... Screening and/or Assessment (with or without medical exam) Physical Activity (Exercise) ... Medical Management ... – PowerPoint PPT presentation

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Title: Evidence-Based Multifactorial Interventions to Prevent Falls


1
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
2
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

3
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

4
Physical Activity (Exercise)
  • Effective as a Stand-Alone Strategy
  • Core component of most successful multifactorial
    approaches
  • Exercise strategy differs as function of fall
    risk

5
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.

6
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

7
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.

8
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.

9
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

10
There is NO One-Size-Fits-All Fall Prevention
Program
11
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

12
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)

13
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

14
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)

15
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.

16
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)

17
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.

18
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.

19
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

20
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
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