Participation in Two Evidence-Based Falls Prevention Programs by Adults Aging With a Long-Term Disability: Case-Control Study of Reach and Effectiveness

2018 ◽  
Vol 31 (10_suppl) ◽  
pp. 39S-67S ◽  
Author(s):  
Thomas J. Eagen ◽  
Salom M. Teshale ◽  
Angelica P. Herrera-Venson ◽  
Anne Ordway ◽  
Joe Caldwell
Keyword(s):  
Older Adults ◽  
Fear Of Falling ◽  
Prevention Programs ◽  
Preliminary Evidence ◽  
Case Control ◽  
Falls Prevention ◽  
Evidence Based ◽  
Activity Restriction ◽  
Increased Risk

Objective: Adults aging with a long-term disability (LTD) are at an increased risk for falls. The Older Americans Act Title III-D and Prevention and Public Health Fund (PPHF) support several organizations to deliver falls prevention evidence-based programs designed to reduce risk factors; however, little is understood about the reach and effectiveness of these fall prevention programs for those with LTD compared to those without LTD. This study compared the reach and effectiveness of two evidence-based falls prevention programs between older adults with and without LTD. Method: Using a matched case-control design, 105 LTD older adults enrolled in A Matter of Balance (AMOB) or Stepping On were matched to 315 non-LTD older adults on age, sex, race, and education. Results: On average, LTD older adults attended a higher number of class sessions and were significantly more likely to complete the program compared with the matched-sample of non-LTD older adults. LTD older adults were equally likely as non-LTD older adults to report significant reductions in self-reported fear of falling, falls-related activity restriction, and improvement in falls self-efficacy following completion of the programs. Discussion: These findings provide preliminary evidence for the effectiveness of these evidence-based falls prevention programs for LTD older adults; however, more research is needed to extend these findings.

scholarly journals PARTICIPATION IN TWO EVIDENCE-BASED FALLS PREVENTION PROGRAMS AMONG OLDER ADULTS WITH AND WITHOUT A DISABILITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S123-S124
Author(s):  
Thomas J Eagen ◽  
Ellen McGough ◽  
Tracy Mroz ◽  
Deborah Kartin ◽  
Anjum Hajat ◽  
...  
Keyword(s):  
Older Adults ◽  
Program Effectiveness ◽  
Fear Of Falling ◽  
Prevention Programs ◽  
Falls Prevention ◽  
Original Research ◽  
Evidence Based ◽  
National Council ◽  
Activity Restriction ◽  
Using Data

Abstract Older adults with a disability are at greater risk for falls and injury due to falling compared to those without a disability. Evidence-based falls prevention programs (EBFPPs) have been developed and disseminated broadly, however individuals with disabilities were excluded from original research on effectiveness. Using data from the National Falls Prevention Database from the National Council on Aging, we compared the reach and effectiveness of two EBFPPs, A Matter of Balance (MOB) or Stepping On, between those with and without a disability. Program reach was measured using attendance percentage. Program effectiveness was measured using change in fear of falling (FOF), fall-related activity restriction (FAR), and falls self-efficacy (FSE) post-program. A total of 12,667 participants were analyzed. Participants were, on average, 76 years old (M = 76.18, SD = 9.86), largely female (75%), well educated (80% some college or higher), and white (90%). Nearly half self-reported a disability (40%). Older adults with a disability were as likely to attend (M = 0.88, SD = 0.14) the program compared to those without a disability (M = 0.88, SD = 0.14, p =.30). Older adults with a disability reported greater FOF and FAR and lower FSE compared to participants without a disability at baseline. Significant improvements were made across effectiveness measures, irrespective of disability status. MOB and Stepping On are effective programs, well attended by older adults with and without disabilities, however older adults with a disability continued to report higher FOF and FAR, and lower FSE compared to those without a disability.

scholarly journals Home Safety Evaluation Model for Older Adults With Recurrent Falls

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 265-265
Author(s):  
Willy Marcos Valencia ◽  
Kimberly Cabrera ◽  
Vincent Hsu
Keyword(s):  
Older Adults ◽  
Fear Of Falling ◽  
Evaluation Model ◽  
Safety Evaluation ◽  
Falls Prevention ◽  
Home Safety ◽  
Recurrent Falls ◽  
History Of ◽  
The Impact

Abstract Recurrent falls are a major threat in older adults. Home environment can be a hazard, but it is potentially modifiable/reversible. In Miami VA, occupational therapists conduct home safety evaluations (HSE) to ascertain the need for modifications to reduce falls risk. We reviewed the cohort of high-risk, recurrent falls patients evaluated at our Falls Prevention Clinic (FPC) between August 2017 to November 2019, to evaluate the impact of HSE. We identified 48 Veterans, age 76.5±6.9 years, of whom 15 (31.3%) reported 1-2 falls/year, 18 (37.5%) reported 3-4 falls/year, and 15 (31.3%) reported ≥5 falls/year. Twenty-eight (58.3%) were offered a HSE. Within these subjects, 74.2% reported falling at least once within their home, 43.8% had fear of falling, 5 (17.9%) had a history of substance or alcohol abuse. We observed that 29 (60.4%) would benefit from the addition of grab bars and 26 (54.2%) could benefit from toilet adjustments. Twelve (25.0%) were recommended to install bed rails. Only 15 (31.3%) Veterans agreed to all recommendations, 25 (52.1%) declined due to preference, and 8 (16.7%) declined for other reasons. Only 8 (16.7%) of these Veterans lived alone. Another factor is that 11 (22.9%) Veterans were renting and 32 (66.7%) owned their homes. Addressing and improving environmental hazards may ameliorate the risk for recurrent falls. Our next steps are to evaluate the extent of home modifications, and the long-term changes in falls/year. Further research needs to determine the long-term efficacy and cost-effectiveness of HSE, and how it can be more accessible to the community.

scholarly journals Leveraging ACL Funding to Implement an Evidence-Based Falls Prevention Program in Three GWEPs

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 368-369
Author(s):  
Ellen Flaherty ◽  
Nina Tumosa
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Rhode Island ◽  
Systems Of Care ◽  
Health Resources ◽  
Prevention Programs ◽  
Falls Prevention ◽  
Evidence Based ◽  
Community Based ◽  
Falls Risk

Abstract Primary care practices have a robust capacity to screen older adults for falls risk and refer them to evidence-based falls prevention programs delivered by Community Based Organizations (CBOs). However, due to a difference in the culture and nature of the work done in these two systems of care, there is often a lack of coordination and communication. Dartmouth has worked to bridge this gap for the past five years through our Health Resources and Services Administration (HRSA)-funded Geriatric Workforce Enhancement Program (GWEP). GWEP goals include the promotion of Age-Friendly Health Systems by focusing on the 4 Ms: What Matters Most, Medication, Mentation and Mobility. GWEPs commonly operationalize the Mobility component via falls risk screening and prevention programs. Though CBOs are well suited to deliver falls prevention programs, implementing, disseminating and sustaining community-based falls prevention programs in an environment of cost containment, limited funds for community-based services and workforce issues is challenging. Previous Administration for Community Living (ACL) grant funding enabled us to develop the Dartmouth Falls Prevention Training Center (D-TC) using our expertise in training and community-based implementation of evidence-based interventions. The D-TC offers training and implementation support to primary care and CBOs on screening, referring and capacity-building for falls prevention programs. We will discuss challenges and successes implementing the Dartmouth falls prevention model with two additional GWEP grantees, Baystate and the University of Rhode Island. Benefits of leveraging ACL and HRSA funding to achieve synergistic goals to reduce falls in older adults will be explored.

Dissemination and Implementation of Evidence-Based Falls Prevention Programs: Reach and Effectiveness

2021 ◽  
Author(s):  
Jennifer S Brach ◽  
Gardenia Juarez ◽  
Subashan Perera ◽  
Kathleen Cameron ◽  
Jennifer L Vincenzo ◽  
...  
Keyword(s):  
Fall Prevention ◽  
Fear Of Falling ◽  
Prevention Programs ◽  
Falls Prevention ◽  
Community Living ◽  
Data Repository ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Injurious Falls ◽  
Before And After

Abstract Background Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we describe the implementation of evidence-based falls prevention programs by Administrative for Community Living grantees during 2014-2019. Methods Forty-four grantees contributed to the national data repository. Data components include workshop information, participant information, attendance records, and organizational data. Data were collected before and after implementation of the evidence-based fall prevention programs. Results Ten different programs were offered in 35 states with the most common settings being senior centers (25.3%), residential facilities (16.8%), health care organizations (12.5%), and faith-based organizations (11.1%). Individuals who participated in the programs (n=85,848) had an age of 75.5±9.7 years, were primarily female (79.7%) and the majority (86.2%) reported at least some fear of falling. At the post-program assessment, 31.8% reported less fear of falling, 21.6% reported fewer falls, and 10.1% reported fewer injurious falls (all p<0.0001). Conclusions Evidence-based fall prevention programs implemented by Administration for Community Living grantees reached over 85,000 older adults. Participation in the evidence-based fall prevention programs resulted in improved confidence, decreased fear of falling, and fewer falls and injurious falls. Future efforts should focus on reaching specific underserved minorities and examining the effectiveness of individual programs.

scholarly journals Using Inclusive Design to Develop a Tele–Tai Chi Intervention for Older Adults With Long-Term Mobility Disability

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 599-600
Author(s):  
Tracy Mitzner ◽  
Elena Remillard ◽  
Kara Cohen ◽  
Jordan Chen
Keyword(s):  
Older Adults ◽  
Tai Chi ◽  
Target Population ◽  
Evidence Based ◽  
Exercise Interventions ◽  
Software Developer ◽  
Master Trainer ◽  
Evidence Based Programs ◽  
To Receive

Abstract Tele-technologies may be able to increase access to evidence-based exercise interventions for adults aging with long-term mobility disabilities. This population experiences substantial barriers in attending such programs in person, including lack of transportation to classes, inaccessible buildings where classes are held, and lack of appropriate modifications offered for this population of older adults. It is critical to overcome such barriers to ensure this population has an opportunity to receive the benefits of evidence-based programs. In this study we are translating an in-person evidence-based tai chi intervention, Tai Chi for Arthritis, to an online platform using videoconferencing software for those aging with long-term mobility disabilities. We will describe our approach of including users from the target population and industry representatives (videoconferencing software developer, Tai Chi for Arthritis program developer as well as local master trainer) in the adaptation of the intervention and present the key findings from doing so.

Postscript: starting oral contraceptives (25 May, page 41)

1992 ◽  
Vol 30 (14) ◽  
pp. 56.1-56
Keyword(s):  
Breast Cancer ◽  
Oral Contraceptives ◽  
Contraceptive Use ◽  
Causal Relation ◽  
Case Control ◽  
Term Pregnancy ◽  
Oral Contraceptive Use ◽  
Increased Risk ◽  
The Uk

In our article on oral contraceptives (OCs) we state that ‘oral contraceptives increase the risk of breast cancer with long-term use but reduce the risk of endometrial and ovarian cancer’. Some commentators have questioned the breast cancer risk. The UK National Case-Control (UKNCC) study, which looked at oral contraceptive use in women with breast cancer diagnosed before age 36, found a trend for increased risk associated with duration of use.1 ‘The simplest and most plausible explanation’, say the authors of the study, ‘must be that there is a substantial causal relation between prolonged use and breast cancer in young women.’ The increased risk seems to be associated particularly with OC use before the first full-term pregnancy.2 Several studies found no excess risk in OC users aged 45 or over, few of whom had taken the pill before their first pregnancy.3–5 In the UKNCC study the relative risk of breast cancer was 1.43 after 4–8 years’ use and 1.74 after more than 8 years’ use. In broad terms this means that three women in 1000 who use oral contraceptives for 4 or more years might be expected to be under treatment for breast cancer by age 36, compared with two per 1000 non-users.

scholarly journals Irish occupational therapists use of evidenced-based falls prevention programmes

2019 ◽  
Vol 48 (1) ◽  
pp. 17-30 ◽  
Author(s):  
Kim Lombard ◽  
Laura Desmond ◽  
Ciara Phelan ◽  
Joan Brangan
Keyword(s):  
Older Adults ◽  
Occupational Therapists ◽  
Exercise Programme ◽  
Falls Prevention ◽  
Evidence Based ◽  
Snowball Sampling ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Content Type ◽  
Prevention Programmes

Purpose As one ages, the risk of experiencing a fall increases and poses a number of serious consequences; 30 per cent of individuals over 65 years of age fall each year. Evidence-based falls prevention programmes demonstrate efficacy in reducing the rate and risk of falls among older adults, but their use in Irish occupational therapy practice is unknown. This study aims to investigate the implementation of falls prevention programmes by occupational therapists working with older adults in Ireland. Design/methodology/approach A cross-sectional survey was used to gather data on the use of falls prevention programmes among occupational therapists working with older adults in any clinical setting across Ireland. Purposeful, convenience and snowball sampling methods were used. The Association of Occupational Therapists of Ireland acted as a gatekeeper. Descriptive statistics and summative content analysis were used to analyse quantitative and qualitative data, respectively. Findings In all, 85 survey responses were analysed. Over 85 per cent of respondents reported “Never” using any of the evidence-based falls prevention programmes. The “OTAGO” Exercise Programme was the most “Frequently” used programme (9.5 per cent, n = 7); 29 respondents reported using “in-department” developed falls prevention programmes and 14 provided additional comments regarding current falls prevention practices in Ireland. Originality/value In the absence of Irish data on the subject, this study provides a benchmark to describe the use of evidence-based falls programmes by Irish occupational therapists with older adults.

scholarly journals 328 An Integrated Approach to Fear of Falling

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Eleanor Murphy ◽  
Petra McLoughlin ◽  
Fiona O'Sullivan ◽  
Ciara Connellan
Keyword(s):  
Older Persons ◽  
Fear Of Falling ◽  
Exercise Program ◽  
Integrated Approach ◽  
Home Exercise ◽  
Activity Restriction ◽  
Home Based ◽  
Increased Risk ◽  
Occupational Therapy Interventions ◽  
The Impact

Abstract Background Fear of falling (FOF) is a known risk factor for falls and subsequent activity restriction which has implications for quality of life and frailty level in older persons.1 The Integrated Care Team for Older Persons in Sligo provides home-based rehabilitation for the acutely frail older adult. We noted that fear of falling was a commonly identified problem in our referral group following comprehensive geriatric assessment (CGA). Our study aims to characterise interventions required. Methods Descriptive study from CGA of acutely frail older adults with a FOF in all referrals to ICTOP from June to December 2018. Results Of the 52 patients studied, 67% reported a FOF with a higher incidence in females (81% vs 45%). Increasing age was associated with a greater likelihood of FOF with 0% reported at 70-74years (n=4) and 86% at 90-95 years (n=7). There was a 1.6 times increased risk of FOF associated with cerebral vascular disease and 1.26 with mental health issues. The median Rockwood Clinical Frailty score was 6 with a median TUG of 28 seconds. Of those with a FOF, 100% received falls education, a home exercise program and advice on acquiring a pendant alarm. A mobility aid was provided in 63% and additional functional aids in 71%. Major housing adaption advice was given in 50% and additional equipment signposting and purchasing advice in 66%. Transport advice was provided in 49% of cases and onward referrals to ophthalmology and orthotics were provided in 9% and 11% respectively. There were only 2 readmissions with a fall within 30 days. Conclusion A significant cohort of ICTOP referrals report a fear of falling. Specific physiotherapy and occupational therapy interventions aim to reduce the impact of this and our low rate of readmissions due to falls indicates the success of this program.

scholarly journals EXPERIENCES AND FACILITATORS OF FALLS PREVENTION AMONG ETHNICALLY DIVERSE OLDER ADULTS: A QUALITATIVE STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S854-S854
Author(s):  
Ladda Thiamwong ◽  
Norma E Conner
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Fall Risk ◽  
Fear Of Falling ◽  
Ethnically Diverse ◽  
Role Identity ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Facilitators And Barriers ◽  
And Behaviors

Abstract Background: Falls increase as people age and decrease the quality of life. Even though fall interventions have received great attention, fall incidence rates have still arisen. In order for older adults to reap the benefits of evidence-based fall interventions, a challenge of implementation in the real world and right context must be met. Understanding experiences, facilitators, and barriers of fall prevention among four major ethnic groups in the Unites States could be extremely valuable. Objective: The aim of this study was to describe experiences and highlight facilitators and barriers on fall and fear of falling interventions among ethnically diverse community-dwelling older adults. Methods: Four ethnically specified (African American, Asian, Hispanic and Non-Hispanic White) focus groups were conducted. A total of 28 older adults and four family caregivers were interviewed. Interviews covered experiences on falls and fear of falling, attitudes, factors, consequences, risk assessment, and interventions. Data were organized and analyzed with the NViVo software. Results: Falls related experiences and behaviors were multifaceted and varied. Three themes related to falls experiences and behaviors were identified, 1) falls prevention versus fear of falling amplification; 2) role identity, culture and family considerations; and 3) take care of you, take care of me. Facilitators of fall prevention were integration of individual learning within a group meeting, providing appropriate assistive devices and promoting environmental safety. Barriers were inconsistent fall risk assessments, low fall risk awareness and acknowledgment, and balance and visual impairment.

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