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

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Journal of Aging and Health
Authors:
Thomas John Eagen at University of Washington
Thomas John Eagen
Mulugeta Demelash Teshale at Wolaita Sodo University
Mulugeta Demelash Teshale
Angelica P. Herrera-Venson
Angelica P. Herrera-Venson
Angelica P. Herrera-Venson
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Anne Ordway
Anne Ordway
Anne Ordway
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Abstract and Figures

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.
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https://doi.org/10.1177/0898264318808918
Journal of Aging and Health
2019, Vol. 31(10S) 39S –67S
© The Author(s) 2018
Article reuse guidelines:
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DOI: 10.1177/0898264318808918
journals.sagepub.com/home/jah
Article
Participation in Two
Evidence-Based Falls
Prevention Programs
by Adults Aging With a
Long-Term Disability:
Case-Control Study of
Reach and Effectiveness
Thomas J. Eagen, PhD, MPH1,2 , Salom M. Teshale,
PhD1, Angelica P. Herrera-Venson, DrPH2,
Anne Ordway, PhD1, and Joe Caldwell, PhD2
Abstract
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
1University of Washington, Seattle, USA
2National Council on Aging, Arlington, VA, USA
Corresponding Author:
Thomas J. Eagen, Department of Rehabilitation Medicine, University of Washington, 1959 NE
Pacific St., Seattle, WA 98195, USA.
Email: teagen1@uw.edu
808918JAHXXX10.1177/0898264318808918Journal of Aging and HealthEagen et al.
research-article2018
... The programs were offered in a variety of locations with senior centers, residential facilities, and health care organizations being the most common. The program participants were more representative of the U.S. population (22) than previous reports of EBFPPs which included primarily White females with at least a high school education (8,(23)(24)(25). In previous reports of EBFPPs, 85%-92% of participants were female, 85%-100% White, and 96%-99% high school graduates (8,(23)(24)(25). ...
... The program participants were more representative of the U.S. population (22) than previous reports of EBFPPs which included primarily White females with at least a high school education (8,(23)(24)(25). In previous reports of EBFPPs, 85%-92% of participants were female, 85%-100% White, and 96%-99% high school graduates (8,(23)(24)(25). Our sample which was 79% female, 83% White, and 89% high school graduates was more representative of the U.S. population of individuals 65 years of age and older which is 55% female, 77% White, and 92% high school graduates although some overrepresentation of females still persists. ...
... This effort is unique in that the EBFPPs were implemented by ACL grantees at various sites across the United States. In these nonresearch real-world settings, the EBFPPs produced positive results that were similar to the original efficacy studies (8,(23)(24)(25), thus supporting the robustness of the programs. As a group, the EBFPPs resulted in improved confidence in fall-related activities, decreased fear of falling, and fewer falls and injurious falls. ...
Dissemination and Implementation of Evidence-Based Falls Prevention Programs: Reach and Effectiveness
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  • Jul 2021
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.
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... Understanding the mechanisms of injury and their devastating consequences has driven advancements in preventive measures and research aimed at minimizing the effects of secondary injury (3,(5)(6)(7). The primary injury to the spinal cord can be attributed to various mechanisms, such as contusion, distraction, laceration, or acute compression, with the severity dependent on the magnitude of force applied and the underlying condition of the cord and nerve roots (3,8). ...
A Canadian national survey of the medical management of acute traumatic spinal cord injury
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  • Mar 2025
Background The management of patients with acute traumatic spinal cord injury (SCI) remains a significant challenge, with ongoing debate surrounding the optimal targets for mean arterial pressure (MAP), spinal cord perfusion pressure (SCPP), and hemoglobin (Hb) transfusion thresholds. This study aimed to identify areas of consensus and discordance in the management strategies employed by Canadian healthcare providers caring for patients with acute SCI. Methods A comprehensive multi-stage survey was developed and administered to healthcare providers actively involved in the management of acute SCI, including neurosurgeons, orthopedic surgeons, intensive care specialists, trauma surgeons, and emergency medicine physicians. The survey assessed preferences related to MAP, SCPP, and Hb transfusion thresholds, as well as opinions on the need for future research in this area. Results A total of 71 healthcare providers completed the survey, with a 100% completion rate. The majority of participants were from neurosurgery (38.1%), intensive care (31.0%), and orthopedics (25.4%). While 75.7% of participants routinely set a MAP target, only 7.1% set an SCPP target. The most common Hb transfusion threshold was <7 g/dL (50.7%) for patients with neurological deficits, with the majority (62.3%) maintaining this threshold for all patients. A significant proportion (15.9%) would consider transfusing based on clinical status alone, regardless of the Hb level. Two-thirds of participants (66.7%) believed the current equipoise in transfusion targets warrants a randomized controlled trial (RCT), and 79.5% of these respondents indicated a willingness to enroll patients. Conclusions This survey highlights the significant variability in the management of acute traumatic SCI, particularly regarding MAP, SCPP, and Hb transfusion thresholds among Canadian healthcare providers. The findings underscore the need for the development of evidence-based guidelines and the implementation of multicenter RCTs to establish best practices and optimize the care of this complex patient population.
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... Several previous studies have demonstrated the efficacy of the AMOB program in preventing falls among older adults [28,[40][41][42][43][44]. Consistent with these findings, we observed significant enhancements in fall efficacy and balance after interventions among the community participants. ...
Empowering Older Adults in Underserved Communities—An Innovative Approach to Increase Public Health Capacity for Fall Prevention
Article
Full-text available
  • Oct 2023
Although evidence-based programs have been effective for fall prevention in many communities, older adults living in underserved areas cannot access these services due to the shortage of providers and trainers. In this cross-sectional study, a multi-agency approach was adopted for integrating an evidence-based program, A Matter of Balance (AMOB), into the public health curriculum at a rurally placed university. We assessed student learning as well as the community benefits of fall prevention among those who participated in the AMOB program. Eighty-four percent of the students reported intentions of using AMOB training in their future careers. The average of the items for the effectiveness of “Classroom Training” and “Community Training” provided by the students (n = 25) ranged from 3.52 to 4.32 and 3.48 to 4.36, on a Likert scale (1 = Strongly Disagree to 5 = Strongly Agree), respectively. Older adults who participated in the fall prevention community workshops showed increased confidence in reducing falls, protecting themselves from falling, and becoming steadier on their feet after the training (p < 0.05). Our study demonstrates the value of integrating evidence-based programs such as AMOB in a university curriculum to address rural health disparities related to falls.
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... Balance deterioration may increase the falling rate, given that balance and postural control deficit has been identified as one of the main factors of falls [1][2][3][4]. Being able to measure this decline helps identifying the individuals with higher risk of falls and taking subsequently the necessary preventive measures such as specific rehabilitation programs to minimize this risk. Moreover, assessing balance permits measuring the effects of the exercises proposed in a certain therapy. ...
Balance Measurement Using Microsoft Kinect v2: Towards Remote Evaluation of Patient with the Functional Reach Test
Article
Full-text available
  • Jun 2021
To prevent falls, it is important to measure periodically the balance ability of an individual using reliable clinical tests. As Red Green Blue Depth (RGBD) devices have been increasingly used for balance rehabilitation at home, they may also be used to assess objectively the balance ability and determine the effectiveness of a therapy. For this, we developed a system based on the Microsoft Kinect v2 for measuring the Functional Reach Test (FRT); one of the most used balance clinical tools to predict falls. Two experiments were conducted to compare the FRT measures computed by our system using the Microsoft Kinect v2 with those obtained by the standard method, i.e., manually. In terms of validity, we found a very strong correlation between the two methods (r = 0.97 and r = 0.99 (p < 0.05), for experiments 1 and 2, respectively). However, we needed to correct the measurements using a linear model to fit the data obtained by the Kinect system. Consequently, a linear regression model has been applied and examining the regression assumptions showed that the model works well for the data. Applying the paired t-test to the data after correction indicated that there is no statistically significant difference between the measurements obtained by both methods. As for the reliability of the test, we obtained good to excellent within repeatability of the FRT measurements tracked by Kinect (ICC = 0.86 and ICC = 0.99, for experiments 1 and 2, respectively). These results suggested that the Microsoft Kinect v2 device is reliable and adequate to calculate the standard FRT.
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... Protective measures such as improved safety equipment are reducing the effects of car accidents, sports-related injury, and falls. [4][5][6][7] Early delivery of specialized medical and surgical care is now routine in high-resource settings. 1 This care comprises immediate spinal immobilization with simultaneous consideration of airway, breathing and circulatory demands, hemodynamic augmentation, and expedient neurologic and radiographic evaluation for early surgical intervention. ...
Early Management of Acute Spinal Cord Injury—Part I: Initial Injury to Surgery
Article
Full-text available
  • Sep 2019
Acute spinal cord injury is a devastating event associated with substantial morbidity worldwide. The pathophysiology of spinal cord injury involves the initial mechanical trauma and the subsequent inflammatory response, which may worsen the severity of neurologic dysfunction. Interventions have been studied to reduce the extent of primary injury to the spinal cord through preventive measures and to mitigate secondary insult through early specialized care. Management, therefore, is multifold, interdisciplinary, and begins immediately at the time of injury. It includes the trauma triage, acute management of the circulatory and respiratory systems, and definitive treatment, mainly with surgical decompression and stabilization.
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Equitable outreach: leveraging a university-community partnership for fall prevention training with older adults in rural Texas
Article
  • Oct 2024
Older Texans living in rural areas may face challenges in accessing resources and services not felt by their urban counterparts, especially related to fall risk reduction. In a state the size of Texas, entities wishing to serve these individuals encounter barriers due to the vast geography that must be covered to reach rural communities. This paper explores a novel partnership between a university and a community organization to work toward rural equity in fall risk reduction education in Texas. We apply the Interactive and Contextual Model of Community-University Collaboration to describe efforts to gain entry into rural communities, develop and sustain the partnership, recognize outcomes, and resolve threats. Through shared decision-making and co-creation, we show how university-community partnerships can be a powerful tool for promoting rural equity and ensuring older, rural Texans have access to fall risk reduction education.
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Adoption, Implementation, and Maintenance of Evidence-Based Falls Prevention Programs
Article
  • Sep 2024
  • J APPL GERONTOL
We evaluate the implementation of evidence-based falls prevention programs (EBFPPs) of the Administration for Community Living (ACL) Grantees by (1) describing adoption; (2) evaluating implementation through participant adherence; and (3) describing program maintenance. Secondary data analysis of a national data repository included forty-four ACL grantees spanning 31 states who were funded between September 2014 and December 2019 and provided information on over 80,000 older adult participants. Descriptive statistics including frequencies, percentages, and means were used to describe adoption, implementation (adherence), and maintenance of EBFPPs. Senior centers were the most common organizations to adopt EBFPPs. Most programs were maintained at their respective organizational site through repeat offerings, with several programs (60%) being offered greater than 10 times. Information regarding adoption, implementation, and maintenance of EBFPPs is valuable in identifying the best programs suited for different organizations and their clientele, which can inform policy for scaling and sustaining EBFPPs across the nation.
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Simulation Versus Written Fall Prevention Education in Older Hospitalized Adults: A Randomized Controlled Study
Article
  • Mar 2022
Using a randomized controlled, non-blinded, two-group design, differences in fall risk assessment, post-discharge sustainable fall risk changes, fall events and re-hospitalization were examined in 77 older adults who received a simulation (n = 36) or written (n = 41) education intervention. Between-group differences and changes in pre- versus post-fall risk assessment scores were examined using Pearson's chi-square, Wilcoxon rank sum or Fisher's exact tests (categorical variables) and two-sample t-tests (continuous variables). There were no statistically significant differences between groups in demographic characteristics. Patients who received simulation education had higher fall risk post-assessment scores than the written education group, p = .022. Change in fall risk assessment scores (post-vs.-pre; 95% confidence intervals) were higher in the simulation group compared to the written education group, 1.43 (0.37, 2.50), p = .009. At each post-discharge assessment, fall events were numerically fewer but not significantly different among simulation and education group participants. There were no statistically significant between-group differences in re-hospitalization.
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Systematic review and meta-analysis of fear of falling and fall-related efficacy in a widely disseminated community-based fall prevention program
Article
  • Aug 2020
  • ARCH GERONTOL GERIAT
Background Fear of falling restricts mobility and increases fall risk among older adults. Fall-related efficacy (i.e. the confidence to perform activities without falling), a construct related to fear of falling, has also been associated with active living and fall prevention. This study statistically synthesized the program effects of A Matter of Balance Volunteer Lay Leader (AMOB/VLL) model, designed to improve fall-related efficacy and promote daily activities among community-dwelling older adults. Methods Research articles and doctoral dissertations that examined the effect of the AMOB/VLL on fear of falling and fall-related efficacy were searched from multiple databases. A random effect model was used to compute mean weighted effect sizes, 95% CIs, and heterogeneity (I2). Bias was examined through a funnel plot and Egger’s test. Factors associated with heterogeneity were also explored. Results Seventeen AMOB/VLL studies involving 3,860 participants were identified. The pooled effects of the 13 studies with sufficient information for effect size calculation, were -0.29 (95% CI: -0.40, -0.19) for fear of falling and 0.51 (95% CI: 0.42, 0.60) for fall-related efficacy. Effect sizes differed partially due to outcome measures of fall-related efficacy. Covariate adjustment and study quality were not associated with differences in effect sizes. No substantial evidence of asymmetry and publication bias was found. Conclusion This study provides evidence supporting AMOB/VLL as an effective intervention for reducing fear of falling and improving fall-related efficacy. A greater consistency in outcome measures is needed to optimally capture changes in fear of falling and fallrelated efficacy among community-dwelling older adults.
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The Community‐Academic Aging Research Network: A Pipeline for Dissemination
Article
  • Feb 2020
Background/objectives: The Community-Academic Aging Research Network (CAARN) was created to increase the capacity and effectiveness of Wisconsin's Aging Network and the University of Wisconsin to conduct community-based research related to aging. The purpose of this article is to describe CAARN's infrastructure, outcomes, and lessons learned. Design: Using principles of community-based participatory research, CAARN engages stakeholders to participate in the design, development, and testing of older adult health interventions that address community needs, are sustainable, and improve health equity. Setting: Academic healthcare and community organizations. Participants: Researchers, community members, and community organizations. Intervention: CAARN matches academic and community partners to develop and test evidence-based programs to be distributed by a dissemination partner. Measurements: Number of partnerships and funding received. Results: CAARN has facilitated 33 projects since its inception in 2010 (30 including rural populations), involving 46 academic investigators, 52 Wisconsin counties, and 1 tribe. These projects have garnered 52 grants totaling 20millioninextramuraland20 million in extramural and 3 million in intramural funding. Four proven interventions are being prepared for national dissemination by the Wisconsin Institute for Healthy Aging: one to improve physical activity; one to reduce bowel and bladder incontinence; one to reduce sedentary behavior; and one to reduce falls risk among Latinx older adults. Additionally, one intervention to improve balance using a modified tai chi program is being disseminated by another organization. Conclusion: CAARN's innovative structure creates a pipeline to dissemination by designing for real-world settings through inclusion of stakeholders in the early stages of design and by packaging community-based health interventions for older adults so they can be disseminated after the research has been completed. These interventions provide opportunities for clinicians to engage with community organizations to improve the health of their patients through self-management.
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Deaths from Falls Among Persons Aged ≥65 Years - United States, 2007-2016
Article
Full-text available
  • May 2018
Deaths from unintentional injuries are the seventh leading cause of death among older adults (1), and falls account for the largest percentage of those deaths. Approximately one in four U.S. residents aged ≥65 years (older adults) report falling each year (2), and fall-related emergency department visits are estimated at approximately 3 million per year.* In 2016, a total of 29,668 U.S. residents aged ≥65 years died as the result of a fall (age-adjusted rate† = 61.6 per 100,000), compared with 18,334 deaths (47.0) in 2007. To evaluate this increase, CDC produced age-adjusted rates and trends for deaths from falls among persons aged ≥65 years, by selected characteristics (sex, age group, race/ethnicity, and urban/rural status) and state from 2007 to 2016. The rate of deaths from falls increased in the United States by an average of 3.0% per year during 2007-2016, and the rate increased in 30 states and the District of Columbia (DC) during that period. In eight states, the rate of deaths from falls increased for a portion of the study period. The rate increased in almost every demographic category included in the analysis, with the largest increase per year among persons aged ≥85 years. Health care providers should be aware that deaths from falls are increasing nationally among older adults but that falls are preventable. Falls and fall prevention should be discussed during annual wellness visits, when health care providers can assess fall risk, educate patients about falls, and select appropriate interventions.
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Medical Costs of Fatal and Nonfatal Falls in Older Adults: Medical Costs of Falls
Article
Full-text available
  • Mar 2018
Objectives: To estimate medical expenditures attributable to older adult falls using a methodology that can be updated annually to track these expenditures over time. Design: Population data from the National Vital Statistics System (NVSS) and cost estimates from the Web-based Injury Statistics Query and Reporting System (WISQARS) for fatal falls, quasi-experimental regression analysis of data from the Medicare Current Beneficiaries Survey (MCBS) for nonfatal falls. Setting: U.S. population aged 65 and older during 2015. Participants: Fatal falls from the 2015 NVSS (N=28,486); respondents to the 2011 MCBS (N=3,460). Measurements: Total spending attributable to older adult falls in the United States in 2015, in dollars. Results: In 2015, the estimated medical costs attributable to fatal and nonfatal falls was approximately 50.0billion.Fornonfatalfalls,Medicarepaidapproximately50.0 billion. For nonfatal falls, Medicare paid approximately 28.9 billion, Medicaid 8.7billion,andprivateandotherpayers8.7 billion, and private and other payers 12.0 billion. Overall medical spending for fatal falls was estimated to be $754 million. Conclusion: Older adult falls result in substantial medical costs. Measuring medical costs attributable to falls will provide vital information about the magnitude of the problem and the potential financial effect of effective prevention strategies.
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Adherence and Attrition in Fall Prevention Exercise Programs for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis
Article
Full-text available
  • Aug 2017
Fall prevention exercise programs have been reported to be effective in minimizing falls in older adults. However, adherence and attrition in exercise programs remain a challenge. This study reviewed the evidence on how levels of adherence and attrition in fall prevention exercise programs may affect magnitude of effect of fall risk reduction in community-dwelling older adults. A systematic review and meta-analysis of randomized controlled trials on fall prevention exercise programs for community-dwelling older adults aged 65+ years published between 2005 and 2016 from six databases were undertaken. Twenty articles met inclusion criteria. Results showed that program adherence >80% may result in greater fall risk reduction compared to lower levels of adherence. A possible inverse relationship exists between attrition levels and effect sizes of fall prevention exercise programs. Future studies should properly report falls/fallers and a consensus on a standardized measure for reporting adherence to fall prevention exercise programs is recommended.
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Research on the Translation and Implementation of Stepping On in Three Wisconsin Communities
Article
Full-text available
  • Jun 2017
Objective Falls are a leading cause of injury death. Stepping On is a fall prevention program developed in Australia and shown to reduce falls by up to 31%. The original program was implemented in a community setting, by an occupational therapist, and included a home visit. The purpose of this study was to examine aspects of the translation and implementation of Stepping On in three community settings in Wisconsin. Methods The investigative team identified four research questions to understand the spread and use of the program, as well as to determine whether critical components of the program could be modified to maximize use in community practice. The team evaluated program uptake, participant reach, program feasibility, program acceptability, and program fidelity by varying the implementation setting and components of Stepping On. Implementation setting included type of host organization, rural versus urban location, health versus non-health background of leaders, and whether a phone call could replace the home visit. A mixed methodology of surveys and interviews completed by site managers, leaders, guest experts, participants, and content expert observations for program fidelity during classes was used. Results The study identified implementation challenges that varied by setting, including securing a physical therapist for the class and needing more time to recruit participants. There were no implementation differences between rural and urban locations. Potential differences emerged in program fidelity between health and non-health professional leaders, although fidelity was high overall with both. Home visits identified more home hazards than did phone calls and were perceived as of greater benefit to participants, but at 1 year no differences were apparent in uptake of strategies discussed in home versus phone visits. Conclusion Adaptations to the program to increase implementation include using a leader who is a non-health professional, and omitting the home visit. Our research demonstrated that a non-health professional leader can conduct Stepping On with adequate fidelity, however non-health professional leaders may benefit from increased training in certain aspects of Stepping On. A phone call may be substituted for the home visit, although short-term benefits are greater with the home visit.
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Falls and Fall Injuries Among Adults Aged ?65 Years - United States, 2014
Article
Full-text available
  • Sep 2016
Falls are the leading cause of fatal and nonfatal injuries among adults aged ?65 years (older adults). During 2014, approximately 27,000 older adults died because of falls; 2.8 million were treated in emergency departments for fall-related injuries, and approximately 800,000 of these patients were subsequently hospitalized.* To estimate the numbers, percentages, and rates of falls and fall injuries among older adults by selected characteristics and state, CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey. In 2014, 28.7% of older adults reported falling; the estimated 29.0 million falls resulted in 7.0 million injuries. Known effective strategies for reducing the number of older adult falls include a multifactorial clinical approach (e.g., gait and balance assessment, strength and balance exercises, and medication review). Health care providers can play an important role in fall prevention by screening older adults for fall risk, reviewing and managing medications linked to falls, and recommending vitamin D supplements to improve bone, muscle, and nerve health and reduce the risk for falls.
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Implementing exercise programs to prevent falls: systematic descriptive review
Article
Full-text available
  • Dec 2016
Background The United States Preventive Services Task Force recommends exercise to prevent falls in community-dwelling adults aged ≥ 65 years at increased fall risk. However, little is known about how best to implement exercise programs in routine care when a patient’s need for exercise is identified within the healthcare system. Methods Using a qualitative approach, we reviewed the literature to determine how exercise programs to prevent falls are implemented from the vantage point of a health care setting. We synthesized descriptive information about each program with data on program features and implementation difficulties and facilitators. Results We found that programs sponsored by primary care providers (PCPs) or specialists may help with recruitment into exercise programs. PCPs have the opportunity to identify people at risk and promote participation since most older adults regularly visit, and inquire about exercise from, their physicians. In terms of referral options, both home-based and group-based exercise programs have been shown effective in preventing falls; however, each approach carries strengths and limitations. Home-based programs can include participants who are reluctant or unable to attend group classes and can be individually tailored, but provide less opportunity for supervision and socialization than classes. Adherence to programs can be encouraged, and attrition minimized, through positive reinforcement. Successful programs ranged in expense for exercise sessions: a weekly class combined with exercises at home cost < 2perparticipantperweek,whilefrequentindividualsessionscost>2 per participant per week, while frequent individual sessions cost > 100 per participant per week. Conclusions With increasing attention to population-based health management in the United States, clinicians and health system leaders need a deeper understanding of how to link patients in their healthcare systems with appropriate community programs. This review identifies key characteristics of successful fall prevention exercise programs that can be used to determine which local options conform to clinical evidence. In addition, we highlight tradeoffs between program options, such as home versus group exercise programs, to allow referrals to be tailored to local conditions and patient preferences. Finally, our work highlights the key role of the PCP in recruiting patients to participate in exercise programs, and identifies options, such as registries, to support referrals to the community.
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Predictors of and health- and fall-related program outcomes resulting from complete and adequate doses of a fall risk reduction program
Article
  • Oct 2016
Falls are dangerous and costly for older adults. The A Matter of Balance/Volunteer Lay Leader (AMOB/VLL) program is an evidence-based fall risk reduction program that could help reduce this burden. This study introduced a door-through-door transportation program to improve program delivery (N = 126). Characteristics predicting completion of all eight AMOB/VLL sessions were identified using logistic regression. Individual growth models were employed to determine the immediate, intermediate, and long-term goal outcomes resulting from receiving an adequate dose of the program (five to eight sessions). Self-restriction of activities due to fear of falling (OR 5.04, 95 % CI 1.86–13.69) and a lower frequency of moderate and vigorous physical activity (OR 1.14, 95 % CI 1.04–1.27) were significantly predictive of receiving a complete dose. Three outcome goals were significant, including (1) immediate—improved self-efficacy of managing medications and treatments, (2) intermediate—reduced activity limitations, and (3) intermediate—reduced physical disability. Self-restriction of activities due to a fear of falling and physical activity levels may be simple and effective screening questions to prevent AMOB/VLL attrition. In our study, those who did receive the program improved on a specific type of self-efficacy and on self-reported physical functioning.
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Transitioning from hospitals to the community: perspectives of rehabilitation patients with neurological disorders and their service providers
Article
Purpose: To identify the contextual factors that influence community participation in rehabilitation outpatients from the perspectives of patients and their service providers. Method: Five focus groups with rehabilitation outpatients (n?=?22) and three focus groups with occupational and physical therapists (n?=?17) were conducted. Two independent coders thematically analyzed the transcribed data. Results: Patients and their providers identified three common personal factors (personal interests, personal values, and finances) and four major categories of environmental factors (products and technology; support and relationships; attitudes; and services, systems, and policies) that have great influence on patients' participation in the community. Additionally, some patients perceived the impacts of fear of falling and climate on their participation, whereas some service providers reported that age, adaptability, and successful experiences could determine the patients' participation in the community. Conclusions: This study synthesized and contrasted perspectives from both rehabilitation outpatients and their service providers to identify the contextual factors that enable or restrict patients from participating in the community. Both patients and service providers identified numerous personal and environmental factors associated with participation, thus highlighting areas that can be addressed in rehabilitation outpatient programs and considered in policy development. Implications for Rehabilitation Community participation is an outcome of dynamic interactions among multiple factors and is highly environmentally and culturally sensitive. Both personal and environmental factors have substantial impacts on rehabilitation patients' participation outcomes. Rehabilitation practitioners and policy-makers need to incorporate perspectives from both patients and providers when developing interventions targeting to improve patients' community participation.
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Self-reported incidence and age of onset of chronic co-morbid medical conditions in adults aging with long-term physical disability
Article
  • Feb 2016
Background: Adults with long-term disability are living longer and may experience accelerated aging. More information is needed to understand the incidence of chronic comorbid medical conditions in this population. Objective: To examine the incidence, prevalence, age of onset and predictors of five chronic conditions in a sample of adults with long-term physical disability. Methods: Longitudinal self-report surveys were mailed to 1594 adults with multiple sclerosis, muscular dystrophy, post-polio syndrome or spinal cord injury twice, 3.5 years apart. Survey questions assessed demographics (date of birth, sex, income, disability type, height/weight), self-reported diagnosis of coronary heart disease, hypertension, arthritis, diabetes and cancer, and health behaviors (alcohol use, smoking, physical activity). Results: Over the course of the study, the most commonly reported new onset chronic comorbid medical condition was arthritis (percent incidence = 14%), followed by hypertension (9%) and cancer (7%). Report of a new condition was greatest in adults aged between 56 and 65 years, and risk factors included greater BMI, waist circumference, and the presence of another chronic comorbid medical condition at baseline. Conclusions: Chronic comorbid medical conditions are prevalent in persons with long-term physical disability. Midlife appears to be the period of greatest risk for onset of a new condition, and risk for incidence increases in the presence of other chronic comorbid medical conditions. Modifiable risk factors include BMI and waist circumference. Future research should explore whether changes in modifiable factors at midlife or earlier (e.g., diet, exercise) would help prevent or delay onset of comorbid conditions in this population.
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