Community Fall Prevention Programs Research Articles

Implementation of a Multicomponent Otago-Based Virtual Fall Reduction, Education, and Exercise Program (MOVing FREEly) in Older Veterans.

The COVID-19 pandemic limited access to community fall prevention programs, thus establishing the need for virtual interventions. Herein, we describe the feasibility, effectiveness, and acceptability of a virtual, multicomponent fall prevention program (MOVing FREEly). A team of clinical falls prevention experts developed a six-week multicomponent fall prevention exercise and education class for older community-dwelling adults at risk of falling. Feasibility was measured through class attendance; effectiveness was measured through changes in performance measures, self-report of falling risk, and concern about falling; acceptability was assessed through questionnaires completed immediately upon program completion and at a three-month follow up. A total of 32 patients participated in the MOVing FREEly program. Attendance for education and exercise classes on average was greater than 80% with little attrition. Patient reported reduced concern of falling, improvement in the falls efficacy scale-international (FES-I) short form, and had statistically significant improvement in 30 s sit-to-stand and single-leg balance tests. The program was well received by participants, saving them significant time and costs of travel. A virtual, multicomponent fall prevention program is feasible and acceptable and effective as reducing falling risk. Future studies can explore the ability of this program to reduce falling incident and injury.

Syndromic Surveillance Data for Accidental Fall Injury.

Fall injuries (FI) are a priority for public health planning. Syndromic surveillance (SS) is used to detect outbreaks, environmental exposures, and bioterrorism in real time. Since information is gathered on patients, the utility of using this system for FI should be evaluated. Strategies to integrate FI medical and SS data were compared using a cohort versus case control (CC) study design. The CC study was accurate 77.7% (57.7-91.3) of the time versus 100% for a cohort design. The CC study design found FI increased for older age groups, female gender, November, and December months. Dates with any freezing temperature had a higher case fatality rate. Repeat acute care visits increased the risk of FI diagnosis by over 6% and trended upward with each visit (R=.333, p<.001). The CC diagnostic quality of FI were better for age and gender than for area. The CC study found the indicators of increased risk of FI including freezing temperature, repeat acute care visits, older age groups, female gender, November, and December months. A gradient of increasing odds of FI with the number of acute care visits provides proof that community fall prevention programs should focus on those most likely to fall. A CC design of SS data can quickly identify indicators of FI with a lower accuracy but with less cost than a full cohort study, thus providing a method to focus local public health interventions.

Statewide Prevalence of Stepping on, Tai Chi, and a Matter of Balance Community Fall Prevention Programs at Maryland Senior Centers in 2017 and 2020

Study background: Older adults suffer from fall-related injuries and deaths at disproportionate rates. One recommendation by the Center for Disease Control and Prevention to help prevent falls is that patients utilize Community Fall Prevention Programs (CFPPs). Little is known about the offering of these programs at Senior Centers (SCs).

DEVELOPING A COMMUNITY-BASED COMPREHENSIVE FALLS PREVENTION PROGRAM IN COLLABORATION WITH PRIMARY CARE

Reducing falls in older adults requires a comprehensive screening program, a systems approach to refer those at risk and an evidence based community falls prevention programs. The Dartmouth Centers for Healthy & Aging has been the recipient of 2 Association of Community Living (ACL) Falls Prevention grants. This has enabled the development of a robust program for falls screening both in primary care and through community based balance screening events called “Balance Days”. At risk individuals receive coaching, based on the principles of motivational interviewing, focusing on enrolling in either “Matter of Balance” or “Tai Chi Quan: Moving for Better Balance”. Through the ACL grant we have built significant capacity across New England for these programs. This talk will focus on the “secret sauce” of implementing a robust community based falls prevention program in partnership with primary care.

Evidence-Based Community Fall Prevention Programs at Senior Centers Near 10 US Academic Centers.

The Centers for Disease Control and Prevention recommends that patients at risk of falling engage in evidence-based community fall prevention programs (EBCFPPs). EBCFPPs are often delivered in senior centers (SCs). This is the first independent assessment of availability of EBCFPPs in SCs. Cross-sectional study of four types of EBCFPPs in the 25-mile radius of 10 US academic centers (ACs). SCs. SCs. None. Number and types of EBCFPPs offered at SCs. Across the 10 ACs, 249 SCs were sampled. Of the SCs, 35% offered zero, 54% offered at least one, 9% offered at least two, and 2% offered at least three EBCFPPs. Tai Chi of any type was offered in 59.8%, A Matter of Balance was offered in 8.9%, Stepping On was offered in 8.0%, and Staying Active and Independent for Life was offered in 1.2% of SCs sampled. SCs near Columbia University offered all four of the programs, while those near the University of Utah, Johns Hopkins University, and Seattle University only offered three of the programs. In univariate analysis, the number of local SCs was significantly associated with quantity of EBCFPPs (odds ratio [OR] = 2.2; 95% confidence interval [CI] = 1.9-2.6; P < .001), but not with diversity of EBCFPPs (OR = 1.0; 95% CI = 1.0-1.1; P = .13). In multivariate regression, city, sex distribution, and average household income did not correlate with the overall number or the diversity of EBCFPPs, whereas locales with more SCs offered more EBCFPPs (OR = 2.2; 95% CI = 1.7-2.9; P < .001). A significant number of SCs still do not offer any EBCFPPs. From those that do, few offer a diversity of these programs. Opportunities exist to increase access to EBCFPPs in SCs.

Fall Prevention Among Community-Dwelling Older Adults: Current Guidelines and Older Adult Responses.

Older adults are vulnerable to falls that result in injury and disability, making fall prevention a national priority. The purpose of the current study was to evaluate community-dwelling older adults' perceptions about falls and fall prevention activities to guide interventions. Participants had high awareness of falls and believed that they could reduce their risk of falling. Approximately three fourths of participants reported taking actions to reduce risk of falling; however, participation in community fall prevention programs was low. The survey used provides a method to help nurses identify targets for fall prevention interventions to reduce this physical health disparity in vulnerable older populations. [Journal of Gerontological Nursing, 44(9), 21-29.].

Ten years of EMS Fall Calls in a Community: An Opportunity for Injury Prevention Strategies.

Objective:To determine whether fall calls, lift assists, and need for transport to the hospital over the past 10 years in one emergency medical services (EMS) system have altered coincident with demographic changes and to estimate health-care cost for lift assists.Methods:We conducted a retrospective chart review of EMS fall-related care. The HealthEMS database for a suburban community surveyed was queried from March 1, 2007, to March 1, 2017. Fall-related calls in patients 60 years or older were identified and determined to be either lift assists (calls that do not result in transport) or fall calls that resulted in transport to the hospital.Results:Of the 38 237 EMS care responses in patients 60 years or older, 11.5% were related to falls. Fall calls increased by 268% over the past 10 years (P = .0006), yet the number of transports to the hospital significantly decreased over time (P = .02). Lift assists increased significantly (P = .0003), nearly doubling over the decade. At the same time, fall calls that did not result in transport to the hospital cost the community an estimated US$1.5 million over a 10-year period.Discussion:There has been a dramatic shift in fall-related calls to EMS in older individuals with more frequent calls for lesser acuity needs. Utilization of EMS for lift assists has substantial financial consequences and diverts care from calls that need immediate triage and transport to care.Conclusion:Future work to reduce the frequency and increase the impact of EMS lift assists could have a significant cost benefit and provide opportunity for enrollment in appropriate community services and fall prevention programs.

A statewide baseline inventory of evidence-based fall prevention programs for older adults.

BackgroundThe Massachusetts (MA) Department of Public Health engaged the Injury Prevention Center at Boston Medical Center to develop a statewide baseline (2012) inventory of evidence-based (EB) community falls prevention programs for community-dwelling older adults.MethodsA web-based survey of organizations (n = 825) serving older adults was deployed in two parts. The Directors’ survey determined if a falls prevention program had been offered in 2012, the salience (rating of importance) of falls prevention for the organization, and intention to offer future falls prevention programming. A falls prevention program offered in 2012 triggered a second survey of Director-designated Coordinators to obtain information on programs’ dates and locations. For the last program offered, data were collected on the number of participants, the training and occupations of program facilitators, and program funding. The last programs served as a cross-sectional sample of all programs offered during 2012.ResultsResponse rates were 55 % (N = 457) and 86 % (N = 112) for the Directors’ and Coordinators’ surveys, respectively. The mean salience score for falls prevention was 3.68, on a 1–5 (most salient) scale; 12 % of respondents indicated offering ≥1 evidence-based program during 2012. We documented 107 EB programs, the majority of which (83 %) were offered by public agencies that serve older adults.ConclusionsInfrastructure for deployment of EB falls prevention programs is developing in MA, despite the absence of institutionalized funding, legislative mandates, widespread referrals from healthcare providers, or health insurance reimbursement.

An Introduction to the Centers for Disease Control and Prevention's Efforts to Prevent Older Adult Falls.

An Introduction to the Centers for Disease Control and Prevention's Efforts to Prevent Older Adult Falls.

Community Fall Prevention Programs: Comparing Three InSTEP Models by Level of Intensity

The Fall Prevention Center of Excellence designed three progressive-intensity fall prevention program models, Increasing Stability Through Evaluation and Practice (InSTEP), to reduce risk in community-dwelling older adults. Each model included physical activity, medical risk, and home safety components and was implemented as a 12-week program for small class sizes (12–15 people) in community and senior centers. Change in fall rates and fall risk factors was assessed using a battery of performance tests, self-reports of function, and fall diaries in a 3-group within-subjects (N = 200) design measured at baseline, immediately postintervention, and at 3 and 9 months postintervention. Overall, participants experienced a reduction in falls, improved self-perception of gait and balance, and improved dynamic gait function. The medium-intensity InSTEP model signifcantly (p = .003) reduced self-reported falls in comparison with the other models. InSTEP is a feasible model for addressing fall risk reduction in community-dwelling older adults.

Community Fall Prevention Programs: Comparing Three InSTEP Models by Level of Intensity

The Fall Prevention Center of Excellence designed three progressive-intensity fall prevention program models, Increasing Stability Through Evaluation and Practice (InSTEP), to reduce risk in community-dwelling older adults. Each model included physical activity, medical risk, and home safety components and was implemented as a 12-week program for small class sizes (12-15 people) in community and senior centers. Change in fall rates and fall risk factors was assessed using a battery of performance tests, self-reports of function, and fall diaries in a 3-group within-subjects (N = 200) design measured at baseline, immediately postintervention, and at 3 and 9 months postintervention. Overall, participants experienced a reduction in falls, improved selfperception of gait and balance, and improved dynamic gait function. The medium-intensity InSTEP model significantly (p = .003) reduced self-reported falls in comparison with the other models. InSTEP is a feasible model for addressing fall risk reduction in community-dwelling older adults.

Significant risk of falls in older cancer patients

Significant risk of falls in older cancer patients

Evidence of the Psychometric Qualities of a Simplified Version of the Activities-specific Balance Confidence Scale for Community-Dwelling Seniors

Filiatrault J, Gauvin L, Fournier M, Parisien M, Robitaille Y, Laforest S, Corriveau H, Richard L. Evidence of the psychometric qualities of a simplified version of the Activities-specific Balance Confidence scale for community-dwelling seniors. Objective To evaluate the validity, reliability, and item hierarchy of a modified version of the Activities-specific Balance Confidence (ABC) scale using an item-response theory framework and integrating modifications aimed at increasing user-friendliness and promoting better congruence of the scale with public health falls prevention strategies. Design Cross-sectional study. Setting Community-based. Participants Two hundred community-dwelling seniors involved in an effectiveness study of a falls prevention program. Participants were recruited by community-based organizations. Interventions Not applicable. Main Outcome Measure Balance confidence. Results The modified ABC scale (called ABC-Simplified [ABC-S] scale) has high internal consistency (reliability index, .86) and good convergent validity (statistically significant associations with perceived balance; performances on the one-leg stance, tandem stance, tandem walking, functional reach, and lateral reach [on the right side] tests; fear of falling; and occurrence of falls in the previous 12mo). Analyses also showed differing degrees of difficulty across items, allowing for a determination of the scale’s item hierarchy. Conclusions The ABC-S scale is a valid and reliable measure for the assessment of balance confidence among community-dwelling seniors. The fact that this measure was validated with high-functioning seniors makes it particularly well-suited for identifying community-dwelling seniors who are beginning to lose confidence in their balance and who could benefit from community falls prevention programs.

転倒予防教室参加者における教室参加前の転倒予防対策実施状況

Fall prevention programs for community-dwelling elderly people are carried out as part of disability-postponing programs in Japanese municipalities. This study examined how to design a fall prevention program for community health fair based on the characteristics of fall prevention strategies adopted by community-dwelling elderly women before attending community fall prevention programs. One hundred and four community-dwelling elderly women (71.7 +/- 6.3 years old) who were attending community fall prevention programs for the first time were asked about their strategies for fall prevention. Age, regular attendance at outpatient programs, the Tokyo Metropolitan Institute of Gerontology Index, and Timed Up&Go were determined as factors related to whether or not the women had strategies for fall prevention. Sixty-four participants had their own strategies for fall prevention. Multiple logistic regression analysis showed that age (OR = 1.10, 95% CI:1.00-1.21) and regular attendance at outpatient programs (OR = 4.77, 95% CI:1.75-12.98) were significantly related to having fall prevention strategies. Timed Up&Go (OR = 1.42, 95% CI: 0.95-2.13) had a weak relationship to having such strategies (P = 0.085). The most common strategy was behavior such as lifting the toe when walking (n=38, 59.4%), followed by doing regular exercise (n=16, 25.0%). Few of the participants modified their environment (n=2, 3.1%). Community fall prevention programs for community-dwelling elderly women can motivate participants to develop interdisciplinary and comprehensive practices for fall prevention.

Falls-prevention programs for older ambulatory community dwellers: from public health research to health promotion policy.

Falls result in significant morbidity and mortality among the elderly. The purpose was to review the public health research literature on falls prevention among community-dwelling older adults and derive evidence-based implications for health promotion policy. CINAHL, COCHRANE, EMBASE, MEDLINE, and PUBMED databases were used to search the research literature concerning falls epidemiology, injury mechanisms, and falls-prevention strategies published during 1966-2003. Falls affect one in three older adults living in the community and result in significant fall-related injuries that constitute an important and costly public health problem. There are numerous, but potentially modifiable, determinants of falls. Several community falls-prevention programs have been shown to reduce the incidence of falls and fall-related injuries. The review suggests that there is compelling evidence from public health research to support health promotion policy for making societal investments in community falls-prevention programs.