Views about Falls and Fall Prevention from Older Adults at Senior Centers

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Views about Falls and Fall Prevention from Older
Adults at Senior Centers

• Richard H. Fortinsky, Ph.D.
• Center on Aging
• University of Connecticut Health Center
• Farmington, CT
• Presented at the Joint Conference of the National
  Council on the Aging and the American Society on
  Aging
• March 18, 2006

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Important Note

• Please do not cite or quote material from this
  presentation slide set without prior permission.
  Dr. Fortinsky can be reached at
  fortinsky_at_uchc.edu.
• Thank you very much.

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Acknowledgments

• Funded by the U.S. Administration on Aging
• Part of Evidence-Based Prevention initiative
• Organizational Partners Roles
• North Central CT Area Agency on Aging grantee
• Yale University School of Medicine fall
  prevention interventionists
• Dorothy Baker, PhD, RNCS Margaret Gottschalk,
  PT, MS Luann Bianco, BA
• Nine Senior Centers settings for intervention
• Center on Aging, UConn Health Center evaluation
• Christine Unson, PhD Patricia Trella, MA Enid
  Zayas, BA

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Background

• Falls occur annually to one-third of people aged
  65 and older one-half of those aged 85 and
  older.
• Demonstrated risk factors for falls, representing
  the evidence base for interventions, are
  preventable.
• In the early 1990s, the Yale FICSIT randomized
  controlled trial found an in-home individualized,
  risk factor-focused intervention to be
  efficacious.
• Our projectStep by Step Thoughtful Fall
  Preventionseeks to incorporate the Yale FICSIT
  intervention model into the fabric of ongoing
  Senior Center (SC) activities and programs.
• Tinetti ME, et al, N Engl J Med 1994 331821-827

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Step by Step Multi-factorialFall Risk Assessment
Protocols

• Postural hypotension supine and standing blood
  pressure checks
• Multiple medications review of all current
  prescription and OTC medications
• Balance functional reach test, unilateral
  stance test
• Gait mobility timed get up and go test
• Feet shoes sensation test and shoe inspection
• Home hazards self-reported checklist
• Vision newspaper print size check
• Based on the Yale FICSIT trial implementation
  in SCs guided by the Yale University School of
  Medicine partners for Step by Step

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Background

• First activity conducted in all 9 SCs was a group
  discussion with regular users.
• Objectives of the group discussions
• Learn about the extent to which falls were a
  factor in the lives of participants.
• Learn their views on how fall prevention
  activities might be developed or enhanced in
  their SCs, and obstacles that might be
  encountered.
• Not an effort to achieve consensus, but to
  determine range of opinions and experiences.

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Sample Selection Composition

• SCs located in cities and towns in greater
  Hartford, CT region.
• SC directors were asked to invite 10-15 people
  identified as members or regular users to
  participate in group discussions.
• Purpose was explained as to discuss falls and
  fall prevention.
• 109 community-dwelling adults participated
• 86 women 23 men
• Age range (estimated) early 60s to late 80s
• 29 Hispanic participants (2 SCs)
• 11 African-Americans (one SC)

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Discussion Group Logistics

• First 3 conducted December 2003-Janaury 2004
  next 6 conducted January-February 2005.
• Discussion guide was developed in line with
  objectives intent was to cover all questions in
  the same order with all groups in 60-90 minutes.
• Two groups conducted in English and Spanish.
• Spanish and English translation done throughout
  discussion using bilingual research or clinical
  staff members
• Discussion group leader (RF for 8 EZ for 1)
  requested and obtained unanimous verbal assent to
  audiotape discussions in all 9 groups.

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Discussion Group Data Analysis Steps

• Verbatim transcripts were produced from
  audiotapes bilingual research staff transcribed
  and translated Spanish language discussion
  components into English.
• Two research team members (CU and PT)
  independently read transcripts and searched for
  concepts using two domains of fall experiences
  and strategies for promoting fall prevention in
  SCs.

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Discussion Group Data Analysis Steps

• Ethnograph software and manual coding
  techniques were used.
• Initial coding process led to theme
  identification based on comment frequency.
• Third analysis team member (RF) joined others to
  review themes included and excluded from results.
  
• Consensus reached by all 3 team members to yield
  results.

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Results Falls in the Lives of Older Adults

• Falls are common and are of concern.
• Several participants in all groups shared fall
  stories, non-injurious and injurious.
• Concern voiced when falls resulted in personal
  injury, and among non-fallers when other SC users
  suffered injuries (broken bones lacerations)
• her life has changed so drastically now, that I
  thought to myself, like in an instant you fall
  and everything is different
• Yet caution was expressed about being too afraid
  of falls.
• ...you dont want to live your life and youre
  afraid to walk out because youre scared its
  slippery.

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Results Falls in the Lives of Older Adults

• What do you think might be some of the reasons
  that people fall?
• Personal preoccupation and rushing around
• we do one thing and are thinking about what
  were going to do nextuntil we fall down and
  then we say, Oh, well, I shouldnt have done
  that.
• Personal declining physical function
  discrepancy between intentions and capabilities
• My body is 86 years old, my heads about 30, so
  I think I can do all these things..and
  sometimesyou dont stop and think that your body
  isnt going with your mind.
• We cant do what we used to do at 16, and we
  have to admit that.

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Results Falls in the Lives of Older Adults

• What do you think might be some of the reasons
  that people fall?
• Home-related most responses were related to
  small pets, rugs, furniture, wires, clutter,
  and basement stairs (mostly going downstairs).
• Theres a rug we have that we trip over almost
  every day.
• There are small cords all over the house and
  sometimes I almost trip on them.
• Missed the last step at the bottom of basement
  stairs.
• External environment-related icy sidewalks and
  front door steps, uneven pavement, insufficient
  lighting and worn carpeting in public
  establishments.

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Results Falls in the Lives of Older Adults

• When prompted by evidence-based risk factors,
  footwear yielded discussion in nearly every
  group.
• Open-toe or no-back shoes or slippers dont
  hold your foot like they are supposed to they
  slip off causing loss of balance or tripping.
• If you have incorrect fitting for your feet, you
  dont walk properly.
• Participants often noted link between two risk
  factors medications and loss of balance
• I was taking a medication last year and noticed
  I was losing my balance
• Certain medications (may) elevate blood pressure
  or lower it and that difference can cause them to
  lose their balance and fall.

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Results Strategies for Avoiding Falls

• Being aware and careful mindful of their
  actions, was a common strategy
• The most important thing is to think about it.
  Dont stand on chairs and tables, go and get a
  little stepladder. Look where youre going and
  just think about what youre doing. Be a little
  methodical in planning things.
• when you are walking, look where you are going
  to put your footin the 36 years that I have
  lived in America, I have never fallen
  (participant at a Hispanic Senior Center).

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Results Strategies for Avoiding Falls

• Specific behavioral changes mentioned
• holding onto railings on stairs, going down
  stairs backwards or sideways
• clearing paths of tripping hazards
• finding safer yet fashionable, comfortable shoes
• avoiding household tasks requiring climbing
  (changing light bulbs hanging curtains)
• Exercise and walking commonly mentioned
• Walk or exercise keeps your mobility higher
  and less prone to fall. And if you do fall,
  youre a little more limber and youre not apt to
  break something.

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Results Strategies for Avoiding Falls

• Fewer groups elaborated on strategies for
  addressing multiple medications.
• Physician communication primary theme
• Seniors dont tell the doctors when theyre on
  the new medication and its making them dizzy or
  lightheaded. They keep taking the medicine.
  They dont call the doctor and say, Gee, this
  new medicine is making me dizzy.
• Youve got to mention it (side effect) to the
  doctor because the doctor is not going to think
  about it.
• Using only one pharmacy and asking pharmacist for
  medication side effects also were mentioned

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Results Strategies for Avoiding Falls

• Final set of strategies discussed less often, but
  in detail when discussed home modification
  strategies.
• Bathroom modifications often mentioned
• I have a senior friend who when she saw my
  walk-in (shower) stall got rid of her bathtub.
  Took it right out, had a plumber come in, and put
  in a walk-in stall like I have with the
  handlebars and everything.
• Reducing living areas to one floor, including
  laundry room, mentioned less often.

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Results Promoting Fall Prevention in SCs

• Participants were asked how any fall prevention
  activity might be introduced, to learn their
  views on how the SC worked and could attract
  interest in activities.
• Individual assessment with a nurse was
  intentionally NOT the sole focus of this
  discussion.
• Two areas of results Program content and
  publicity suggestions potential obstacles to
  success.

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Results Promoting Fall Prevention in SCs

• Program content most common topics
• Increased awareness about falls
• I think just making people aware of the things
  we talked about this morningwould make them do
  things with their lives a little differently.
• Exercise classes (or different level of exercise,
  mostly lower, where classes already were offered)
• Balance classes, such as tai-chi
• Instructions on how to fall and get up off the
  floor
• Medications combined lecture format followed by
  individual consultation

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Results Promoting Fall Prevention in SCs

• Program format and timing
• Seminars on specific topics by well-known
  speakers
• A one-time deal is not very effective because
  you dont catch all the audiences and plus people
  forget once they go back to their habits.
• Include handouts at any activity
• Its critical that we do have a handout with
  stuff, or if only a list of things, preventive
  things.
• Use examples of personal experience in talks
• Health fair as fall prevention kickoff activity
• Timing coordinate around lunch and bingo,
  dominoes (at Hispanic SC) hold in the morning.

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Results Promoting Fall Prevention in SCs

• Publicity
• Add fun and food to any event
• Use SC newsletter to publicize any activity,
  including specific fall risk information
• We could start with a little factoid of the
  month every month, a little paragraph in the
  newsletter.
• Use local broadcast media to disseminate
  information abut the dangers of falling
• Notable suggestion
• Why dont we put crutches up on the wall and a
  wheelchair and say Dont let this happen to
  you!?

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Results Promoting Fall Prevention in SCs

• Obstacles to success
• Often the same group of people who participate in
  any offered scheduled activities hard to get
  interest by more persons due to competing
  interests.
• People come to the SC to participate in specific
  activities and not others (e.g., bingo, cards).
• Less frequent but notable broader concern about
  negative image of SC in the community
• I would start by stop calling it senior. I
  know people that are between 55-65 that just
  wont join because they think its a stigma.

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Results Promoting Fall Prevention in SCs

• Special obstacle male participation
• Two focus groups men uninterested in activities
  offered by SCs or in exercise.
• If you gave a talk (at the SC) on hunting and
  fishing, they might listen.
• Some men (say) Why should I go out and
  exercise? I am content with my fat body the way
  it is. I cut the grasswhy do I need exercise?
  (female participant).

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Conclusions

• Falls are a common occurrence and source of
  concern among older adults across racial and
  ethnic groups who are members of, or who
  regularly attend, SCs.
• SCs hold great potential for introducing or
  enhancing activities aimed at preventing falls,
  by raising awareness and addressing
  evidence-based risk factors.
• Important obstacles to success in program
  implementation should be anticipated based on
  views from study participants