preventing falls: how to develop community-based fall prevention programs for older adults

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Preventing Falls:How to Develop Community-basedFall Prevention Programs or Older Adults

2008 Injury Prevention

·



Preventing Falls:

How to Develop Community-basedFall Prevention Programs or Older Adults

National Center or Injury Prevention and Control

Atlanta, Georgia

2008



Tis document is a publication o theNational Center or Injury Prevention and Controlo the Centers or Disease Control and Prevention:

Centers for Disease Control and Prevention Julie L. Gerberding, MD, MPH, Director

Coordinating Center for Environmental Health and Injury PreventionHenry Falk, MD, MPH, Director

National Center for Injury Prevention and Control

Ileana Arias, PhD, Director

Division of Unintentional Injury PreventionDavid Wallace, MSEH, Acting Director

Home and Recreation Injury Prevention TeamMichael Ballesteros, PhD, eam Leader

Acknowledgements

We acknowledge and appreciate the contributions o National Center or Injury Preventionand Control staf Judy Stevens, PhD, Michael Ballesteros, PhD, Michele Huitric, MPH,

Amanda arkington, MC, Jane Mitchko, MEd, CHES, and Leslie Dorigo, MA. Tis project

was assisted by Macro International Inc. Carol Freeman, BA, served as the Macro projectdirector, Sally York, MN, RNC, and Mary E. Miller, MA, served as writer/editors andLucinda Austin served as project assistant. Cover and text design by Monika Gullett, MA.

We thank Tom Snyder, BA, MDiv, Ilene F. Silver, MPH, and Jane Mahoney, MDor their thorough review and valuable suggestions.

Suggested Citation: National Center or Injury Prevention and Control. Preventing Falls:How to Develop Community-based Fall Prevention Programs or Older Adults. Atlanta, GA:

Centers or Disease Control and Prevention, 2008.



Chapter 1 Introduction Why all prevention is important ........................................................1Understanding the risk actors or alls among older adults .................2Eective interventions can prevent older adult alls .............................3Purpose o this guide...........................................................................4

Chapter 2 Planning an Eective Fall Prevention Program

Key steps in developing a all prevention program ...............................8 Who can deliver eective all prevention program components.........10 Where to conduct all prevention program components ...................11

Chapter 3 The Important Role o Partnerships in FallPrevention Programs

How to develop partnerships ............................................................13How to maintain partnerships ..........................................................15Partnership web resources .................................................................16

Chapter 4 Education: The Foundation o Eective FallPrevention Programs

Provider education ............................................................................17Public education ...............................................................................18Education web resources ...................................................................19

Chapter 5 The 5 Building Blocks o Eective Community-basedFall Prevention Programs

Building Block 1 Education programs or older adults andtheir caregivers ..............................................................................22

Building Block 2: Progressive exercise programs to improvemobility, strength, and balance .....................................................24

Building Block 3: Medication review and management .....................30Building Block 4: Vision exams and vision improvement ..................33Building Block 5: Home saety assessment and

home modication........................................................................36

Contents



Chapter 6 Evaluating Your Fall Prevention ProgramMethods or conducting evaluation ...................................................42The stages o evaluation ....................................................................47Determining which stage to use ........................................................51Evaluation web resources ..................................................................52

Chapter 7 Promoting Your Fall Prevention Program Conducting a successul campaign ....................................................53 Working with the media ...................................................................57

Promotional web resources ................................................................58

Chapter 8 Sustaining Your Fall Prevention ProgramEstablish your vision .........................................................................59Build collaboration ...........................................................................59 Advocate or support.........................................................................59Find unding .....................................................................................60

Appendices Appendix A: Sample Individual Falls Risk Assessment ......................62 Appendix B: Identiying Partners Worksheet .....................................64 Appendix C: Sample Fall Prevention Brochure ..................................66 Appendix D: Sample Fall Prevention Presentation .............................69 Appendix E: Sample Exercises...........................................................72 Appendix F: Sample Medication Review Form .................................75 Appendix G: Sample Home Fall Prevention Saety Checklist ............77 Appendix H: Sample Program Evaluation Tool .................................86

Appendix I: Sample Pitch Letter ......................................................90 Appendix J: Key Points ....................................................................92 Appendix K: Sustainability Plan Template.........................................94



Injury Prevention

1

Your community-based organization (CBO) plays an

important role in promoting the health and well being

o the residents in your community. Many o the services

provided by CBOs like yours help people o all ages

maintain healthy liestyles and improve their overall

quality o lie. Now, with the help o this new publication,

Preventing Falls: How to Develop Community-based Fall

Prevention Programs for Older Adults, your organization

can reach out to the older members o your communityand ulfll an increasingly important need or eective,

community-based all prevention programs.

Why all prevention is important

Falls are a major threat to the health and independence o olderadults, people aged 65 and older. Each year in the United States,nearly one-third o older adults experience a all.

Falls can be devastating. About one out o ten alls among olderadults result in a serious injury, such as a hip racture or headinjury, that requires hospitalization. In addition to the physical andemotional pain, many people need to spend at least a year recoveringin a long-term care acility. Some never return to their homes.

Falls can be deadly. Falls are the leading cause o injury deathsamong older adults. The rate o all-related deaths among olderadults in the United States has risen signicantly over the pastdecade. In 2004, alls were responsible or 14,900 deaths.

Chapter 1 Introduction



Falls are costly. Fall-related injuries among older adults, especially among older women, are associated with substantial economic costs.In 2000, direct medical costs or atal and nonatal all injuries totaled$19 billion. As the number o older adults increases dramatically overthe next ew decades, so will the economic burden o alls.

Falls are preventable. The opportunity to help reduce alls amongolder adults has never been better. Today, there are eective allprevention interventions that can be used in community settings. By oering eective all prevention programs in our communities, wecan reduce alls and help older adults live better, longer lives.

Understanding the risk actors or alls amongolder adults

Falls are not an inevitable consequence o aging, but alls do occurmore oten among older adults because all risk actors increase withage and are usually associated with health and aging conditions.These risk actors include:

Biological risk actors

Mobility problems due to muscle weakness or balance•

•

•

•

problemsChronic health conditions such as arthritis and strokeVision changes and vision lossLoss o sensation in eet

Behavioral risk actors

Inactivity •

•

•

Medication side eects and/or interactions Alcohol use

Environmental risk actors

Home and environmental hazards (clutter, poor lighting, etc.)•

•

•

Incorrect size, type, or use o assistive devices (walkers, canes,crutches, etc.)Poorly designed public spaces



Chapter 1

Usually two or more risk actors interact to cause a all (such as poor

balance and low vision, which can cause a trip and all going up asingle step). Home or environmental risk actors play a role in abouthal o all alls.

Understanding these risk actors is the rst step to reducing olderadult alls. Over the past two decades, researchers around the worldhave used descriptive studies to identiy risk actors and randomizedcontrolled trials to test all interventions. The results o thesestudies show that reducing all risk actors signicantly reducesalls among community-dwelling older adults—those people living

independently in the community.

Many older adults, as well as their amily members and caregivers,are unaware o actors or behaviors that put them at risk o alling,and are also unaware o what actions they can take to reduce theirrisk. Fall risk actor assessment is rarely a part o an older adult’sroutine health care, even i they have had a all or all injury. Allolder adults should be encouraged to seek an individual all risk assessment rom their healthcare provider, especially older adults with a history o alls and/or with mobility or balance impairments

who are at highest risk or alls. A sel-administered risk assessment orm or older adults can beuseul when the results are discussed with a healthcare provider whocan help modiy or manage identied risk actors.

Appendix A shows an example o a all risk assessment developed by the Washington State Department o Health’s Injury and ViolencePrevention Program or individuals to use when discussing allprevention with a healthcare proessional.

Eective interventions can prevent older adult allsEective all interventions reduce all risk actors through eitherexercise alone or by combining exercise with other risk reductionapproaches such as medication review and management, visionscreening and correction, education, and saer living environments.

The Centers or Disease Control and Prevention (CDC) hasreviewed and identied community-based all preventioninterventions that have strong scientic evidence o eectiveness.



Introduction

These interventions have been summarized and compiled in

Preventing Falls: What Works. A CDC Compendium o Eective Community-based Interventions rom Around the World , thecompanion publication to this document.

CDC would like to help CBOs move these proven allinterventions into communities to protect the health andindependence o older adults.

Purpose o this guide

CDC developed this guide or communities and CBOs, so they can begin developing eective all prevention programs. The mainpurpose o this guide is to:

Dene the key elements o what makes all prevention•

•

programs eective Provide inormation to communities and CBOs on how todevelop eective older adult all prevention programs

This guide is intended to be used by CBO decisionmakers, programmanagers, and partners in organizations that serve independent

living, community-dwelling older adults, such as:Public health departments•

•

•

•

•

•

•

•

•

Healthcare organizations that provide individual healthcare, individual or group community programs, andhome-based servicesHospital outpatient and community programsSenior and community centersParks and recreation programsEmergency medical servicesFaith-based and parish nurse services and programs

Home-based services (e.g., home health, meal-delivery services, chore services) Area Agencies on Aging



Chapter 1

•

•

•

Independent/retirement living, residential, and senior housing acilities/settings or older adults who live independently Nonprot organizations that provide direct services toolder adults Universities/community colleges that oer or work withcommunity programs or community-dwelling older adults

Note: The interventions and programs in this guide are not designed or hospital inpatients, assisted living residents, Alzheimer’s care programs and acilities, or nursing home residents, all o whom require programs

and interventions that are specifcally designed or their increased railty and all risk.



Introduction

Notes:



Injury Prevention

7

When planning your all prevention program, remember that the

most eective programs address many o the risk actors describedin Chapter 1. An eective all prevention program should be oeredby trained healthcare proessionals and include education aboutalls and all risk actors. (See the chart on page 10 or a list o proessionals.) The main components that should be part o your allprevention program include the ollowing:

Education about older adult all risk actors and prevention

strategies or older adults, amilies, and caregivers. Inormation can be communicated on an individual, one-on-one basis, orin a group setting.

Exercise that can be oered through group classes orindividually. Exercise programs can be oered in acommunity setting, at home with supervision, or in aprogram that combines group classes or one-on-one training with home-based exercise. Appropriate types o exercises thateectively reduce alls in older adults include:

Tai Chi•

•

•

Strengthening exercises combined with balance training

Balance exercises Medication review by a pharmacist or healthcare proessional, with medication adjusted or modied by a physician ornurse practitioner.Vision assessment and vision correction by an optometristor ophthalmologist. Home saety assessment including home modicationsas needed.

Chapter 2 Planning an Eective

Fall Prevention Program



These building blocks o an eective all prevention program arediscussed in more detail in Chapter 5, but keep them in mindduring the planning process or your program.

Key steps in developing a all prevention program

Follow this nine-step process in planning your all prevention program.

Step 1. Assess your community’s needs.Beore deciding what type o all prevention program to develop,use the ollowing checklist to assess your community’s needs and

identiy appropriate resources: What are the all prevention program needs in your

community? What related programs or services are currently being oeredby other organizations? What are your organization’s current and uture goals andresources or providing services to independent older adultsin your community?How much support or starting a all prevention program isthere at all levels o your organization—rom the board anddirector, to the sta, volunteers, and older adult clients? What community resources exist that could provide servicesto address older adult all risk actors? What community resources and organizations arepotential partners?

Step 2. Establish your program’s purpose, goals, and objectives. Develop a purpose statement and determine the goals and objectiveso your program. Ask questions such as, “Why are we developingthis program?” and “What do we hope to accomplish both short

term and long term?” Your purpose and goals should be specic,realistic, and clearly stated. Goals should be quantitative withobjectives that can be easily measured. Think o the goal as adestination and the objectives as methods o getting you to yourgoal. With a clear set o objectives, you can easily measure thesuccess o your program during the evaluation phase. With a solidpurpose, concrete goals, and action-oriented objectives, you canbuild an eective all prevention program or older adults.



Chapter 2

Step 3. Determine what risk actors your program will address. There are two types o eective all prevention programs: singleintervention and multiaceted intervention programs:

Single intervention programs

Exercise is the only intervention that by itsel reduces allsamong older adults. Many organizations have developedgroup and/or individualized exercise programs or olderadults that improve strength and balance. You can developan exercise program by using the inormation in this guide

and working with trained proessionals in your community.See Chapter 5 on page 21 or examples o eective exerciseprograms and related resources.

Multifaceted intervention programs

A multiaceted intervention combines exercise with otherintervention components to reduce all risk actors. Such aprogram might include exercise, vision assessment, andall prevention education. To create the most eective allprevention program, begin with exercise and incorporate at

least one other intervention component.

Step 4. Collaborate with partners to address additional risk actors. Partnering with other organizations can help you developa more comprehensive and eective all prevention program.Chapter 3 will provide more detail on how to identiy and work with all prevention partners.

Step 5. Decide who will implement the various programcomponents. The ollowing chart shows which healthcare providersand other proessionals can deliver each type o intervention.

9



Planning An Eective Fall Prevention Program

10

Who Can Deliver Fall Prevention Program Components?

Program components P h y s i c i a n

O p t o m e t r i s t

N u r s e P r a c t i t i o n e r / P A

P h a r m a c i s t

R e g i s t e r e d N u r s e

P h y s i c a l T h e r a p i s t

O c c u p a t i o n a l

T h e r a p i s t

S o c i a l W o r k e r

C e r t i f e d E x e r c i s e

I n s t r u c t o r

E x e r c i s e S c i / P h y s E d

D e g r e e

T a i C h i I n s t r u c t o r

Education

Group * * * *

Individual * * * *

Assessment

Gait * *

Balance; simple * * * * * * *

Balance; in-depth * * * *

Strength * * * * * * *

Exercise

1:1 balance alone * * *

1:1 strength with balance training *

Group class * *

Individualized exercise/PT

Tai Chi * *

Medication

Medication review *

Medication management

Vision

Basic assessment * *

Detailed assessment

Vision correction

Home Saety

Assessment * * * *

Basic modifcation** *

Skilled modifcation**

Other

Assistive device training

* Additional specialized education and training required** Basic modifcation includes clutter/throw rug removal, rearrange urniture; skilled modifcation includes grab bars, ramps, electrical work.

Note: Partnerships may acilitate delivering multiaceted programs in community settings.



Chapter 2

Program components H o m e

P h y s i c i a n O f c e

H o s p i t a l / C l i n i c

( o

u t p a t i e n t )

P T F a c i l i t y

P h a r m a c y

S e n i o r / C o m m u n i t y /

R e c C e n t e r

G

y m / F i t n e s s C e n t e r /

R e c C e n t e r

S e n i o r H o u s i n g

F a c i l i t y

Education

Group

Individual

Assessment

Gait

Balance; simple

Balance; in-depth

Strength

Exercise

1:1 balance alone

1:1 strength with balance training

Group class

Individualized exercise/PT

Tai Chi

Medication

Medication review

Medication management

Vision

Basic assessment

Detailed assessment

Vision correction Home Saety

Assessment

Basic modifcation**

Skilled modifcation**

Other

Assistive device training

** Basic modifcation includes clutter/throw rug removal, rearrange urniture; skilled modifcation includes grab bars, ramps,electrical work.

Note: Partnerships may acilitate delivering multiaceted programs in community settings.

Where to Conduct Fall Prevention Program Components

Step 6. Find a location to conduct the program. Whenconsidering what type o program to develop, consider the types o places where a program can be held. The ollowing chart providessuggestions or each type o all prevention component.



Planning An Eective Fall Prevention Program

12

Step 7. Evaluate your program. Evaluation helps determine whether a program is appropriate and eective. The results o theevaluation will guide you in maintaining or modiying any aspectso the program and tell you i the program is worth continuing.Chapter 6 will help you develop evaluation strategies to documentyour program’s eectiveness.

Step 8. Promote your program. Making the community aware o your all prevention program is crucial to its success. No matter thesize o your outreach eort, Chapter 7 will help you in developing

a campaign to publicize your program and provide you with tips on working with your local media.

Step 9. Sustain your program. To sustain your program, you willneed to review and make modications. This means keeping sighto your goals and maintaining momentum in buildingcollaborations, advocating or support, and seeking new sources o unding. Chapter 8 will help guide you through this process.



Injury Prevention

13

Chapter 3 The Important Role o

Partnerships in FallPrevention Programs

Because alls are the result o multiple all risk actors, it may

be dicult or your organization, on its own, to develop acomprehensive program. By collaborating with other community organizations and proessionals that specialize in dierent typeso services or older adults, such as healthcare, exercise, homesaety assessment, and education, you can make your programmore comprehensive and eective. For example, a public healthor healthcare organization may partner with a senior services orparks and recreation organization to create a program that includes

exercise and all prevention education.

Collaborating with other CBOs can provide additional resources,outreach channels, or reerral sources or your program. Becauseo its many benets, collaboration can be essential in developingyour program.

How to develop partnerships

Assess your current situation. Planning your preventionprogram involves a careul analysis o your organizationalresources and needs, including sta, unding, acilities,technology, and expertise. This inormation claries when a

potential partnership with another organization can supportyour program goals.

Identiy potential partners. Partnerships should bemutually benecial. Identiy organizations that share yourmission o improving health and saety or older adults orthat have a vested interest in reducing alls among olderadults. Determine how a collaboration will mutually supportshort- and long-term goals.



Develop your “pitch” or partnership. Ater strategically selecting potential partners, develop your “pitch,” or sellingpoints, or partnership. This will vary based on the resources,needs, and priorities o each organization. Showcase thebenets or your potential partners.

Create your messages and materials. Develop messagepoints—short, concise statements that refect your mainmessages. These are useul or internal and externalcommunications, as well as or presentations to partners.

For these messages:

• Develop themes or adapt materials that will engage yourpotential partners.

• Produce materials (computer-generated presentations,fyers, etc.) that will eectively convey your messages.

• Pretest your materials among potential partners.• Develop a method or tracking partnerships and other

outreach eorts.

Make contact. Whenever possible, deliver your partnership

proposal in person. Consider bringing at least one otherperson, because dierent communication styles anddemeanors can infuence an encounter. Sharing the workloadand presentation delivery reduces the pressure o thinking onyour eet. However, make sure that your team speaks withone voice, based on the messages you develop. Deliveringmixed messages creates conusion and weakens your credibility.

Seal the deal. Being credible and oering incentives areimportant, but these may not be enough to seal the deal. Use

your passion to make potential partners believe they shouldbe involved.

• Describe how your programs and services can make adierence.

• Share inormation about the burden o alls and all injuries.• Underscore how your community will benet rom your

eorts and how others are getting involved.



Chapter 3

•

Remind potential partners o their strengths and howeven seemingly small contributions can help preventinjury and death.

• Conrm how the proposed partnership is mutually benecial.

• Be specic about what you are asking them to contributeand do.

How to maintain partnerships

Relationships need to be maintained. While commitment isimportant, so is continuing to review your resources, needs, andexpectations as the program evolves. Involving local organizations will be an ongoing eort, so remember to engage as many acets o your community as you can, including:

• Hospitals and healthcare centers• Local and state government ocials and oces• Faith-based organizations• Civic organizations• Senior citizen groups• Commercial establishments serving older adults• Clubs that may have a large older-adult membership (such as

the Veterans o Foreign Wars)• Universities or colleges that oer academic programs or

services or older adults

Never orget the power o the phrase “thank you.” Acknowledgepartnership agreements promptly. Look or creative ways to convey your gratitude to partners oten and thank them publicly. See Appendix B or an inventory orm that can be useul or identiying

community resources and potential program partners.



The Important Role o Partnerships in Fall Prevention Programs

16

Partnership web resourcesThe National Council on Aging’s Partnering to Promote

Healthy Aging: Creative Best Practice Community Partnerships

www.healthyagingprograms.org/content.asp?sectionid=92&ElementID=160

Falls Free: A National Falls Prevention Action Plan www.healthyagingprograms.org/content.asp?sectionid=98

Caliornia Blueprint For Falls Prevention

www.archstone.org/publications2292/publications_show.htm?doc_id=246660

Queensland, Australia Statewide Action Plan: Falls Preventionin Older People 2002-2006

www.health.qld.gov.au/phs/Documents/shpu/13693.pd

WA State Dept. o Health Report - Falls Among Older Adults:Strategies or Prevention

www.doh.wa.gov/hsqa/emstrauma/injury/pubs/FallsAmongOlderAdults.pd

Health care & public health partnerships

repositories.cdlib.org/cgi/viewcontent.cgi?article=1003&context=iha

Community Toolbox or Public Health Partnershipsctb.ku.edu/WST/initiatives_show.jsp?initiative_id=44

Partnership sel-assessment tool www.cacsh.org/psat.html



Injury Prevention

17

Increasing awareness about all risk actors and ways to reduce all

risk is crucial in helping older adults, their amilies, caregivers, andservice providers to eectively prevent alls.

There are two types o audiences or all prevention education: theproessionals who will implement the all prevention program andolder adults and their caregivers.

People in your community who are qualied to provide public andproessional all prevention education sessions include:

• Healthcare proessionals• Public health proessionals• Senior service providers• Emergency medical service proessionals

Provider education

Provider education is necessary to inorm healthcare andsenior service providers about the current state o knowledge in allprevention or older adults. Key aspects o proessionaleducation include:

• National, state, and county data on atal and nonatalall injuries and healthcare costs. National and some statedata are available rom CDC’s National Center or Injury Prevention and Control. Additional state and county datamay be available rom health departments, local emergency services, and re departments. Data on cost o alls may beavailable rom local hospitals.

Chapter 4 Education: The Foundation

o Eective FallPrevention Programs



Inormation about all risk actors among older adults (seethe web resources at the end o this chapter). Inormation about eective all prevention interventions(see the web resources at the end o this chapter and theCompendium). Tools and resources to train proessional sta to deliverall prevention inormation tailored to their audience(see the web resources at the end o each chapter and theCompendium).

•

•

•

Public educationPublic education includes communicating theimportance o all prevention to the generalpublic and directly inorming older adults how tomaintain a healthy liestyle that reduces the risk o alls. When promoting your all preventionprogram, you will also be creating awarenessor the necessity o all prevention in yourcommunity. You can nd more inormation in

Chapter 7 about promoting all prevention andyour all prevention program.

Educating older adults about individual risks andmethods o prevention is an important buildingblock o every all prevention program. Moreinormation on educating older adults aboutthe risk o alls and all prevention activities willollow in the next chapter.

Fall Intervention Studies that Include Education

Stay Active, Stay Sae (Barnett, et al.)The Otago Exercise Program (Campbell, et al., Robertson, et al.)Tai Chi: Moving or Better Balance (Li, et al.)Australian Group Exercise Program (Lord, et al.)Simplied Tai Chi (Wol, et al.)Home Visits by an Occupational Therapist (Cumming, et al.)Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.)Stepping On (Clemson, et al.)PROFET (Prevention o Falls in the Elderly Trial) (Close, et al.)The NoFalls Intervention (Day, et al.)

The SAFE Health Behavior and Exercise Intervention(Hornbrook, et al.)

Yale FICSIT (Frailty and Injuries: Cooperative Studies oIntervention Techniques) (Tinetti, et al.)

A Multiactorial Program (Wagner, et al.)

For more details, refer to the companion publication,Preventing Falls: What Works. A CDC Compendium of Effective Community-based Interventions from Around the World



Chapter 4

Education web resourcesCDC’s “What You Can Do To Prevent Falls” and

“Home Saety Checklist” brochures or older adults www.cdc.gov/ncipc/duip/allsmaterials.htm

CDC Falls Prevention page www.cdc.gov/ncipc/duip/preventadultalls.htm

Center o Excellence or Fall Prevention www.stopalls.org

National Institute on Aging, AgePage: Preventing

Falls and Fractures www.niapublications.org/agepages/PDFs/preventing_Falls_and_Fractures.pd

The American Geriatrics Society Guideline or the Prevention o Falls in Older Persons

www.americangeriatrics.org/products/positionpapers/abstract.shtml

Center or Healthy Aging Falls Free Electronic News www.healthyagingprograms.org

Caliornia Blueprint or Falls Prevention

www.archstone.org/publications2292/publications_show.htm?doc_id=246660

National Saety Council www.nsc.org/issues/allstop.htm

“Getting Up From a Fall” handout rom the American Academy o Orthopaedic Surgeons

orthoino.aaos.org/topic.cm?topic=A00098



Notes:

Education: The Foundation o Eective Fall Prevention Programs



Injury Prevention

21

The most eective all prevention programs address many o the risk

actors described in Chapter 1. Based on your resources, you canstart your program using one building block and then expand itseectiveness by adding more blocks over time.

The ve main building blocks o an eective community-based allprevention program are:

Education about alls and all risk actors.

Exercises that improve mobility, strength, and balance,and that are taught by trained, nationally certied exerciseinstructors or physical therapists. Exercise programs include:

Tai ChiIndividualized exercise sessionsGroup exercise classes Home exercise programs with supervision until the olderadult can exercise independently

Medication review to identiy side eects or druginteractions that may contribute to alls. The reviews shouldbe conducted by pharmacists or healthcare providers.Medication management—adjustments to or changes inmedications—should be provided by physicians.

Vision exams by trained healthcare proessionals with visioncorrection by an optometrist or ophthalmologist.

Home saety assessment and home modifcation by occupational therapists or other healthcare proessionals withspecialized training, to identiy and modiy home hazardsthat can increase older adults’ risk o alling.

•

•

•

•

Chapter 5 The 5 Building Blocks o

Eective Community-basedFall Prevention Programs



Building Block 1: Education programs or olderadults and their caregivers

When developing a all prevention program, it is important toinclude an educational component. While education alone has notproven to eectively reduce alls among older adults, it is typically combined with one o the other building blocks. Education orolder adults and their caregivers can be delivered to individuals orto groups. Individual education sessions may work better or people who are hearing or vision impaired or have special needs. Sessions

should be tailored to the attention span and cognitive ability o older adults. Visual aids such as brochures, act sheets, and checklists will help acilitate the education session.

Group sessions provide the benets o social interactions. Inormalgroup discussions that include sharing personal experiences may reduce anxiety and increase motivation to adopt new behaviors.Group teaching saves time and helps spread the inormation morequickly to more people.

Tips or developing an eective education component

Education should be delivered by trained proessionals.

Education should include problem solving and goal settingon the part o the learner.

The length o the education session should depend onthe individual characteristics o the older adult, such asconcentration, hearing or visual impairment, etc.

Group vs. individual education may be determined based on which other bulding block is being oered in combination.

Visual aids are valuable tools in increasing comprehension. Materials should be designed with a high contrast

background and large lettering.

Materials should refect literacy levels and be culturally appropriate.

Presentations and materials should not contain abbreviationsand jargon.

Education is most eective when oered on an ongoing basis.



Chapter 5

There is a wealth o educational materials available on the Internet. You can nd visual aids, including posters, videos and presentations,brochures, and checklists, or you can develop your own materials.See Appendices C and D or an example o a brochure and apresentation. A set o all prevention posters is also available throughthe CDC website listed below. Use the ollowing websites oradditional education materials.

Education web resources

CDC’s “What You Can Do To Prevent Falls” and “Home Saety Checklist” brochures or older adults

www.cdc.gov/ncipc/pub-res/toolkit/brochures.htm

CDC Falls Prevention page www.cdc.gov/ncipc/duip/preventadultalls.htm

Center o Excellence or Fall Prevention www.stopalls.org

National Institute on Aging, AgePage: Preventing Falls and Fractures

www.niapublications.org/agepages/PDFs/preventing_Falls_and_

Fractures.pd The American Geriatrics Society Guideline or the Prevention o

Falls in Older Persons www.americangeriatrics.org/products/positionpapers/abstract.shtml

Center or Healthy Aging Falls Free Electronic News www.healthyagingprograms.org

Caliornia Blueprint or Falls Prevention www.archstone.org/publications2292/publications_show.htm?doc_id=246660

American Academy of Orthopaedic Surgeons orthoino.aaos.org/menus/saety.cm

National Saety Council www.nsc.org/issues/allstop.htm



The 5 Building Blocks o Eective Community-Based Fall Prevention Programs

24

Building Block 2: Progressive exercise programs toimprove mobility, strength, and balance

Among older adults, strength and balance exercises, such as Tai Chi,can reduce alls by improving mobility, strength, and balance. Theseprograms ocus on exercises that are specically designed or adaptedor older adults.

Tips or developing an eective exercise component

To be sae and eective, older adult exercise

programs (one-on-one or group classes) mustbe taught by one or more o the ollowingproessionals:

• Nationally certied tness/exerciseinstructors with specialized training in working with older adults. Because exerciseinstructors are not licensed, having anational certication or accreditation is theminimum qualication requirement orteaching all prevention exercise programs

to older adults.• Exercise science/physiology proessionals

with a bachelor’s degree or master’s degreein this eld.

• Physical therapists.• Occupational therapists.• Recreational therapists with a bachelor’s

or master’s degree.• Tai Chi instructors, masters or grand

masters, who have completed a Tai Chicourse taught by a Tai Chi master or grand master, have a national certifcation in older adult physical activity, and have experiencein teaching exercise to older adults.

• Physical, occupational, and recreationaltherapy assistants who are under the directsupervision o a physical, occupational, orrecreational therapist.

Fall Intervention Studies that Include Exercise

Stay Active, Stay Sae (Barnett, et al.)The Otago Exercise Program (Campbell, et al., Robertson, et al.)Tai Chi: Moving or Better Balance (Li, et al.)Australian Group Exercise Program (Lord, et al.)Veterans Aair Group Exercise Program (Rubinstein, et al.)Simplied Tai Chi (Wol, et al.)Home Visits by an Occupational Therapist (Cumming, et al.)Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.)Stepping On (Clemson, et al.)The NoFalls Intervention (Day, et al.)The SAFE Health Behavior and Exercise Intervention

(Hornbrook, et al.)Yale FICSIT (Frailty and Injuries: Cooperative Studies o

Intervention Techniques) (Tinetti, et al.)A Multiactorial Program (Wagner, et al.)

For more details, refer to the companion publication,Preventing Falls: What Works. A CDC Compendium of Effective Community-based Interventions from Around the World



Chapter 5

PROGRAMS IN ACTIONStay Active and Independent or Lie (SAIL):A strength and balance ftness class or adults 65+

The SAIL program combines health inormation with exercises specically designedto saely and easily improve endurance, strength, and balance in adults aged 65and older. The program was researched and developed as a community-based allprevention program by the Washington State Department o Health.

The SAIL program helps older adults to stay active and independent. It helps toprevent alls, through group exercise classes that meet or 1 hour, three times aweek. The classes are held at community sites, such as senior centers, parks and

recreation acilities, and community tness centers that oten work in partnershipwith community healthcare and senior service organizations to oer the program.Classes are led by certied tness instructors who have attended the 2-day SAILInstructor Training Program, which was designed by physical therapists and aregistered nurse.

The program name and its key messages were developed through older adult ocusgroups to emphasize a specic description o the program and its positive benets:

• “It works…you’ll be stronger, have better balance, eel better, and this will helpyou stay independent, active, and prevent alls.”

• “It’s sae…the instructors are experienced and skilled, and exercises have been

tested with seniors.”• “It’s un…you’ll meet other seniors and make new riends.”

The SAIL class exercises are designed to be done either sitting or standing, andat individually adjustable paces. The class includes aerobic and balance exercises,strength training with wrist and ankle weights, and fexibility exercises. Theclass participants also receive brief “Fitness Checks” when they start the classesor measuring progress and improvement ater they start the classes. Thesemeasurements o walking speed and arm and leg strength, are repeated every3 to 6 months throughout the year, enabling class participants to monitor theirindividual progress. In addition to the exercises, health inormation is includedin the classes, which addresses topics such as exercising saely, medication andhome saety, and ootwear and oot care. The education inormation is providedin a booklet published by the Washington State Department of Health: “StayActive and Independent or Lie: An Inormation Guide or Adults 65+.” All classparticipants receive a ree copy o the booklet.

For more inormation contact:

www.cdc.gov/ncipc/profles/core_state/wa/deault.htm or

www.doh.wa.gov/hsqa/emstrauma/injury/pubs/deault.htm#senioralls




26

All proessionals who teach exercise to older adults must havea current CPR/AED certication.

To be eective in reducing alls, exercises must be perormedat least twice weekly on an ongoing basis and progress indiculty throughout the program.

Ideally, the exercise classes should be oered on an ongoingbasis or long-term attendance. Short-term programs that havea set number o sessions should provide written instructions soparticipants can continue to do the exercises at home.

Participants should be taught the exercises under the directsupervision o a trained exercise instructor or physical oroccupational therapist, either in one-on-one home sessions or ingroup sessions, beore perorming them independently at home.

Evaluate how the program instructor delivers the exerciseprogram. Use process evaluation methods to ensure that theexercises are being taught properly and consistently. Also,obtain eedback rom the program participants.

Base program content on current published materialsspecically developed or older adults by exercise science,physical therapy, or Tai Chi proessionals.

Assess older adults’ strength, balance, and tness at thebeginning and end o each new exercise program.

Limit the number o participants in group classes to no morethan 15 to allow the instructor the ability to closely observeand supervise participants during the class session.

The National Council on Aging’s Center or Healthy

Aging has developed a detailed checklist or all preventionprograms in Evidence-based Healthy Aging Programming:Tools and Checklists at healthyagingprograms.org/content.asp?sectionid=32&ElementID=439

Appendix E provides examples o strengthening and balanceexercises rom the Stay Sae Stay Active Daily Exercise Program. Additional exercise examples can be ound in the Preventing Falls:What Works. A CDC Compendium o Eective Community-based Interventions rom Around the World.



Chapter 5

Exercise program web resourcesCDC Physical Activity Resources www.cdc.gov/nccdphp/dnpa/physical

National Council on Aging: Center or Healthy Aging, 2005.Evidence-based Healthy Aging Programming: Toolsand Checklists

www.healthyagingprograms.org

International Curriculum Guidelines or Preparing Physical Activity Instructors o Older Adults

www.seniortness.net/international_curriculum_guidelines_or_preparing_physical_activity_instructors_o_older_adults.htm

Growing Stronger: Strength Training or Older Adults—a webbased strength training exercise program

www.cdc.gov/nccdphp/dnpa/physical/growing_stronger

National Institutes of Health: NIH Publication No. 01-4256, 2001 Exercise: A Guide rom the National Institute on Aging

www.nia.nih.gov/HealthInormation/Publications/ExerciseGuide

National Council on Aging: Center or Healthy Aging,Issue Brie #2, Winter 2004 Designing Sae and EectivePhysical Activity Programs

www.healthyagingprograms.com/resources/IssueBrie_PhysicalActivity.pd

National Council on Aging: Center or Healthy Aging,Issue Brie #4, Fall 2005 Keeping Current on Research and Practice in Physical Activity or Older Adults

www.healthyagingprograms.com/resources/IssueBrie_KeepCurrentPA.pd

National Council on Aging: Center or Healthy Aging, Moving Ahead: Strategies and Tools to Plan, Conduct and MaintainEective Community-based Physical Activity Programs orOlder Adults

www.healthyagingprograms.com/resources/PRC-HAN_conerence_monograph.pd




28

American College o Sports Medicine’s Physical Activity Guidelines or adults over age 65

www.acsm.org/AM/Template.cm?Section=Home_Page&TEMPLATE=/CM/HTMLDisplay.cm&CONTENTID=7764#Over_65_or_50_64

Human Kinetics’ Senior Fitness Test Manual and Sotware:manual and sotware or testing and tracking unctionalftness measures in older adults

www.humankinetics.com/products/showproduct.cm?isbn=9780736033589

American Council on Exercise and AARP Fitness Resources www.aarptness.com

Exercise and Older Adultsnihseniorhealth.gov/exercise/toc.html

Reerences

Berg K. Balance and its measure in the elderly: A review.Physiother , Canada. 1989:41;240-246.

Chang JT, Morton SC, Rubenstein LZ, et al. Interventions orthe prevention o alls in older adults: Systematic review andmeta-analysis o randomized clinical trials. Br Med Journal .2004:328;680-683.

Cotton, RT. Exercise or older adults: American Council onExercise’s guide or ftness proessionals. Human Kinetics:Champaign, IL;1998.

Dunkin, A. All you need to know about back pain.

Arthritis Foundation: Atlanta, GA;2002.Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming

RG, Rowe BH. Interventions or preventing alls in elderly people. Cochrane Database Syst Rev . 2003:4;CD000340.

Herdman, S. Vestibular Rehabilitation. F.A. Davis Company:Philadelphia, PA;2000.



Chapter 5

Haas EN ed; Handbook o Injury and Violence Prevention Atlanta GA, Springer 2007 Author o chapter. Chapter 3:Interventions to prevent alls among older adults. In: Haas,EN, ed. Handbook o Injury and Violence Prevention. Atlanta, GA:Springer;2007.

Nelson M, et al. Physical activity and public health in olderadults: Recommendations rom the American College o SportsMedicine and the American Heart Association. Am J Sports Med. 2007:39(8);1435-1445.

Nelson, ME. Strong women stay young . Bantam Books:New York, NY;2000.

Podsaidlo D, Richardson S. The timed up and go: A test o basic unctional mobility or rail elderly persons. Journal o the

Am Geriatr Soc . 1991:39;142-148.

Rikli RE, Jones CJ. Senior ftness test manual human kinetics :Champaign, IL;2001.

Rose, D. Fall Proo: A comprehensive balance and mobility training program human kinetics : Champaign, IL;2003.

Shumway-Cook A, Brauer S, Woollacott M. Predicting theprobability o alls in community-dwelling older adults using the“Timed Up and Go Test.” Phys Ther . 2000:80;896-903.

Tinetti ME. Perormance-oriented assessment o mobility problemsin elderly patients. J Am Geriatr Soc . 1986:34;119-126.




30

Building Block 3: Medication review andmanagement

The purpose o medication review and management is to identiy and eliminate medication side eects and interactions, such asdizziness or drowsiness, that can increase the risk o alls.

Many older adults are unaware that their daily medications may increase their all risk. Aging aects the absorption, distribution,metabolism, and elimination o medications. Age can alsoincrease sensitivity to potential side eects. Older adults may get

prescriptions rom multiple doctors. Fall risk increases with the totalnumber o prescription and over-the-counter medications.

Psychoactive medications (drugs that alter brain unction) increaseall risk. These include antidepressants, tranquilizers, antipsychotics,antianxiety drugs, and sleep medications. Other medicationsthat may cause problems include those prescribed to treat seizuredisorders, blood pressure-lowering medications, cholesterol-loweringmedications, heart medications, and painkillers. A medication review checklist is included in Appendix F.

Drug side eects that can contribute to alling include blurredvision, hypotension leading to dizziness and lightheadedness,sedation, decreased alertness, conusion and impaired judgment,delirium, compromised neuromuscular unction, and anxiety.Review and modication o the medication regimen by a healthcareprovider can requently reverse or minimize these eects.

Clinical practice recommendations include medication reviews by healthcare providers or older adults who have allen.

Fall Intervention Studiesthat Include MedicationReview and Management

PROFET (Prevention o Falls in theElderly Trial) (Close, et al.)

Yale FICSIT (Frailty and Injuries:Cooperative Studies o InterventionTechniques) (Tinetti, et al.)

A Multifactorial Program (Wagner, et al.)

For more details, refer tothe companion publication,Preventing Falls: What Works. ACDC Compendium of EffectiveCommunity-based Interventionsfrom Around the World



Chapter 5

PROGRAMS IN ACTIONCaliornia Department o Aging’s Medication Management Program

The Medication Management Program is an evidence-based, ederally undedprogram under Title IIID o the Older Americans Act. Funds are distributed toCaliornia Area Agencies on Aging to provide a wide variety o community-basedservices and inormation at multipurpose senior centers, at congregate meal sites,through home delivered meal programs and at other appropriate sites.

The purpose o the Medication Management Program is to improve the qualityo lie or older adults and prevent premature institutionalization by workingwith them to manage their use o over the counter and prescription medications,

vitamin, mineral, and herbal supplements.

The target population or this program included individuals aged 60 years andover who live in an area o greatest economic need, who live in a medicallyunderserved area o the region, or who have a chronic medical conditions that canimprove with education and non-medical intervention.

The ollowing are examples o the community-based activities and partnerships inthis program:

• Pharmacists’ or pharmacy students’ presentations on how older adults can managetheir medications, drug-nutrient interactions, and supplements. The presentation mayinclude a personalized medication review to identify expired medications, answer

client questions, and counsel older adults to assure they understand, are followingdirections, and taking medications properly. The pharmacists also encourage olderadults to communicate with their doctors so they will be better informed about whatmedicines are being prescribed, why, and what results and/or side effects to expect.

• Partnerships with community-based organizations to provide “Rx Check Up” clinics.

• Distribution of passport size books for older adults to keep records of healthand medications. Older adults can take the books with them to share with theirdoctors and pharmacist.

• Distribution of brochures related to medication management.

• Distribution of pill minders in various languages to help older adults manage

their prescriptions.• Information provided at Senior Health Fairs, through an Info Van, and through

the Inormation and Assistance Program.

• Automated medication dispensers for frail and/or blind clients in their home.

For more inormation, visit www.aging.ca.gov/html/programs/medication_management.html




32

Tips or developing an eective medication review and management component

Medication reviews are recommended or older people takingour or more medications and those taking any psychoactivemedications.

Medication reviews can be done in screening clinics,hospital programs, home visits by home health proessionals,pharmacies, and doctors’ oces.

Medication reviews can be done by a pharmacist or ahealthcare provider. Coordinated medication managementthat involves changing or reducing types or dosages o medications, should be done by the older adult’shealthcare provider.

Medication review and management may include assessingthe need or vitamin D and calcium supplements as well asosteoporosis treatment.

The amount and requency o alcohol use should be includedin a medication review.

Medication review and managementweb resources

National Institutes o Health Senior Healthnihseniorhealth.gov/takingmedicines/toc.html

American Geriatrics Society Clinical Guidelines or Preventiono Falls in Older Persons

www.americangeriatrics.org/products/positionpapers/Falls.pd

Medications and alls in the elderly www.pharmacists.ca/content/cpjpds/julaug04/July-August-FocusonPatientCareRevised.pd

“10 questions to ask your doctor or pharmacist about your medications”

www.a4aa.com/Ten_Questions_to_Ask_Your_Doctor_or_Pharmacist_Outreach__2_.pd



Chapter 5

Building Block 4: Vision exams and visionimprovement

Vision changes and vision loss associated with aging are commonall risk actors among older adults. Vision loss can contributeto alls by disturbing balance and by obscuring tripping andslipping hazards.

Many vision conditions, such as cataracts, glaucoma, and maculardegeneration, are gradual and painless. However, i these conditions are diagnosed early, they can be managed to minimize vision loss.

Older adults may have diculty learning about and/or accessingcommunity programs that oer vision care services. CBOs canplay an important role by providing inormation about andencouraging regular vision exams and care, and by reerring olderadults to community vision care services and resources.

Tips or developing an eective vision component

Limited basic or simple vision screening can be perormedby trained healthcare proessionals such as physicians, nurse

practitioners, physicians’ assistants, registered nurses, andoccupational therapists. However, basic vision screeningdoes not identiy all types o vision problems that need tobe corrected.

Comprehensive vision exams must be perormed usingspecialized equipment. Thereore, these must be done by anoptometrist or ophthalmologist.

Medicare provides coverage or dilated eye exams, which areconsidered comprehensive vision exams.

Fall Prevention InterventionStudies that Include VisionAssessment

PROFET (Prevention o Falls in theElderly Trial) (Close, et al.)

The NoFalls Intervention (Day, et al.)A Multifactorial Program (Wagner, et al.)

For more details, refer tothe companion publication,Preventing Falls: What Works. ACDC Compendium of EffectiveCommunity-based Interventionsfrom Around the World




34

PROGRAMS IN ACTIONVision Loss Resources

Vision Screening, Resource, and Education

Vision Loss Resources is an independent nonprot 501 C(3) agency inMinneapolis, Minnesota. Its mission is to assist people who are blind or visuallyimpaired achieve their ull potential and to enrich the lives o all persons aectedby blindness, vision loss, or hearing loss. Vision Loss Resources provides programsto enhance independent living and educate the community about vision loss.

Programs include:

• In-home assessment with service and resource plan development• In-home vision evaluation for adaptive vision aids• Hearing assessments with advocacy and resources for adaptive equipment• Volunteers for assisting vision impaired clients to live independently• Peer counseling and support and growth groups• Leisure opportunities at the Vision Loss Resources’ Community Center• Life skills classes, training, and resources for maintaining independence• Community and professional education about vision loss and resources• Outreach and special projects providing resources and services for individuals

and groups, with emphasis on special needs and cultural diversity.

For more inormation, Vision Loss Resources can be contacted by phone

at 612.871.2222, on the web at www. visionlossresources.com, ore-mail at [email protected]

Vision care is provided primarily by the ollowing proessionals:

Optometrists examine people’s eyes to diagnose visionproblems and eye diseases, test patients’ visual acuity,depth, and color perception, and test their ability to ocusand coordinate their eyes. They prescribe eyeglasses

and contact lenses and provide vision therapy andlow vision rehabilitation.

Ophthalmologists are physicians who perorm detailed,comprehensive, and dilated vision exams and eye surgery.Like optometrists, they examine eyes and prescribe eyeglassesand contact lenses. They also diagnose and treat eye diseasesand injuries.



Chapter 5

Dispensing opticians t and adjust eyeglasses and, in somestates, may t contact lenses according to prescriptions written by ophthalmologists or optometrists.

Local Area Agencies on Aging and state ophthalmology and optometry associations can provide inormationabout community vision programs or older adults, orvision screening and/or exams, and nancial assistance orvision needs.

Ater the age o 60, vision assessments are recommended at

least every 2 years, and more requently i an eye conditionhas been diagnosed.

Detailed eye exams by an optometrist or ophthalmologist arerecommended at least once every 2 years or managing visionconditions and or corrective eye procedures, medications,and eyeglass prescriptions.

Vision web resources

National Institutes o Health Senior Health: Vision conditions

and low vision topicsnihseniorhealth.gov/listotopics.html

Medicare benefts or vision exams and vision care www.medicare.gov

The American Academy o Ophthalmology www.aao.org

The American Optometric Association www.aoa.org

Opticians Association o America www.oaa.org/index.shtml

National Eye Institute: Glaucoma—Resources or Patientsand the Public

www.ski.org/Colenbrander/Images/Low_Vision_Exam.pd catalog.nei.nih.gov/productcart/pc/viewCat_L.asp?idCategory=78




36

Building Block 5: Home saety assessment andhome modifcation

Environmental actors play a part in approximately hal o all allsthat occur at home. Falls can be caused by slipping and trippinghazards, poor lighting, or the lack o needed home modicationssuch as bathroom grab bars, handicapped showers, stair railings,and ramps.

A home saety assessment can identiy actors that may put anindividual at risk or alling. Many older adults can benet rom

home saety assessments, but those with a history o alls and/or with mobility or balance diculties have the greatest need orsuch an assessment. Home assessments can be combined with orincluded with other direct one-on-one services that are provided by community service programs to residents in their homes.

A sel-administered home saety assessmentchecklist can be helpul i there is a plan orollow-up review with a trained proessional toollow up and i inormation and reerrals to

home modication programs and resources areprovided. A Home Fall Prevention Checklist isprovided in Appendix G.

Older adults may have diculty learningabout and/or accessing home saety and homemodication inormation and resources. Local Area Agencies on Aging (AAA) can provideinormation and reerrals to local homemodication programs. AAA can also provideinormation about state and ederal programsthat oer services and nancial assistance tolow-income seniors.

For an older adult who has been injured in a all, Medicare may cover a home saety assessment and home modication i it isperormed by an occupational or physical therapist. The seniormust meet the home health reimbursement criteria, and thesehome services must be prescribed by a doctor, nurse practitioner,or physician assistant.

Adult Fall Prevention Interventions withHome Saety Assessment & ModifcationResearch Study Components

Home Visits by an Occupational Therapist (Cumming, et al.)

Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.)Stepping On (Clemson, et al.)PROFET (Prevention o Falls in the Elderly Trial) (Close, et al.)The NoFalls Intervention (Day, et al.)The SAFE Health Behavior and Exercise Intervention

(Hornbrook, et al.)Yale FICSIT (Frailty and Injuries: Cooperative Studies o

Intervention Techniques) (Tinetti, et al.)A Multiactorial Program (Wagner, et al.)

For more details, refer to the companion publication,Preventing Falls: What Works. A CDC Compendium of Effective Community-based Interventions from Around

the World



Chapter 5

PROGRAMS IN ACTIONPitt County Council on Aging: SPICE or Lie

Senior Saety, Prevention, Intervention, and Community Education

This North Carolina all prevention program’s target population is low-incomeolder adults, aged 60+, who are at high risk or loss o independence due to adecreased ability to unction within the home. Fall risk actors typicallyaddressed include:

• Home and environmental safety• Medications• Vision• Mobility• Lighting

Reerrals or the program are called into the Pitt County Council on Aging (PCCOA)or are identied by PCCOA social workers. I the individual meets the criteriaor the SPICE program and grant unding is available, a reerral is sent to theprogram’s lead occupational therapist (OT). The OT then urther assesses eligibilityand sets up an appointment or a home visit to perorm a home modication andall risk assessment.

SPICE makes use o two assessment tools that are standardto the program:

• A fall interview questionnaire to assess the individual• A home safety modication assessment tool

Once the needs are identied, each low-income older adult who qualies or theall prevention/home saety program is educated about all prevention strategiesand provided with the necessary equipment and home modications. Whennecessary, reerrals or additional services are made to other service providers andagencies. Reerral sources are varied (physicians, home health providers, agingnetwork providers, etc.) and are continuing to increase as the community becomesmore aware o the program. Community partnerships and involvement are criticalelements o this program’s success.

To contact the Pitt County Council on Aging, please call(252) 752-1717




38

Occupational therapists can conduct environmental assessments,assess how the older adult interacts with their home environment,and suggest adaptations or modications that can help olderadults with limited physical unction or low vision prevent allsand live independently.

Tips or developing an eective home saety component

Home saety assessments and modications are mosteective when they are done in the home by anoccupational therapist and when they include education,

recommendations, and a ollow-up home visit to assess theneed or additional modications.

Home assessments and modications by an occupationaltherapist are especially eective in reducing alls amongolder adults who have already had a all.

Occupational therapists are specically trained to helpindividuals adapt their living environments to theirphysical needs, so they can perorm their daily activities asindependently and saely as possible. Occupational therapists

are also trained to provide education to older adults, theiramily members, and caregivers.

Trained proessionals such as a Certied Aging in PlaceSpecialist (certied by the National Association o HomeBuilders), registered nurses, and physical therapists can alsoeectively carry out home assessments and modications, incollaboration with occupational therapists.

In addition to home modications, some older adults may need to use personal assistive saety and mobility devices.

An occupational or physical therapist can provide thetraining needed to use these devices properly.



Chapter 5

Home saety web resources American Occupational Therapy Association’s Fact Sheet on

Occupational Therapy and Prevention o Falls www.aota.org/Consumers/WhatisOT/FactSheets/Conditions/39478.aspx

CDC’s “Check or Saety: A Home Fall Prevention Checklist orOlder Adults” brochure

www.cdc.gov/ncipc/duip/allsmaterial.htm

National Resource Center on Supportive Housing and

Home Modifcation www.homemods.org

Home Saety Council: State o Home Saety’s Facts About Saety in the Home

homesaetycouncil.org/state_o_home_saety/sohs_2004_p017.pd

Home Saety Checklist (in English, Spanish, Chinese, Italian,Russian, Tagalog)

www.aging.ca.gov/resources/home_housing/home_saety_checklist.html

Ladder Saety Inormation Sheetsorthoino.aaos.org/act/thr_report.cm?Thread_

ID=92&topcategory=Injury%20Prevention




40

Notes:



Injury Prevention

41

CDC’s National Center or Injury Prevention and Control

has developed recommended approaches or evaluatinginjury prevention programs, and these can be adaptedor all prevention programs. This chapter summarizes the key elements o these approaches. More complete and detailedinormation can be ound in Demonstrating Your Program’s Worth:

A Primer on Evaluation or Programs to Prevent Unintentional Injury The ull text o this publication can be ound in pd or html ormatat www.cdc.gov/ncipc/pub-res/demonstr.htm.

With objective evaluation, program managers and sta can:

•

Show that their program is beneting the community • Show unding agencies that their program is successul• Produce acts and gures to demonstrate positive outcomes• Share the results in publications and presentations to be more

likely to receive continued unding

Evaluation should begin while the program is in the earliestdevelopment stages, not ater the program is complete. Evaluationis an ongoing process that begins as soon as someone decides todevelop and implement a program; it continues throughout the lieo the program; and it ends with a nal assessment o how well theprogram met or is meeting its goals. Goal setting is crucial to theevaluation o your program whether you measure the numbero participants who complete an exercise program or the percentchange in participants’ knowledge about all risk actors.

Chapter 6 Evaluating Your




The earlier evaluation begins, the ewer mistakes are made and thegreater the likelihood o success. In act, or an injury preventionprogram to show success, evaluation must be an integral part o itsdesign and operation and evaluation activities must be part o theprogram activities.

I a program is well designed and well run, evaluating the nalresults will be a straightorward task o analyzing inormation thatis gathered while the program is in operation. The results will beextremely useul, not only to your own program, but to othercommunity partners, similar organizations, and injury preventionprograms.

The ollowing sections will help clariy:

• Why evaluation is worth the resources and eort involved• How to conduct an evaluation, and• How to incorporate evaluation into all prevention programs.

These guidelines will help program managers conduct basicevaluations. Reer to Appendix H or a complete programevaluation checklist.

Methods or conducting evaluation

There are two methods o program evaluation:

• Qualitative methods (inormation or opinions collected innarrative orm, such as through open-ended questions orinterviews)

• Quantitative methods (inormation collected objectively orin number orm through tracking, counting, or measuring)

The basic inormation in this chapter provides enough inormationor you to conduct simple evaluations. However, some organizationsmay choose to hire an evaluation consultant. The Demonstrating Your Program’s Worth: A Primer on Evaluation or Programs to Prevent Unintentional Injury publication also provides detailed inormationto enable you to communicate with, hire, and supervise evaluationconsultants.



Chapter 6

Summary o qualitative evaluation methods—personal interview

Method:

Personal interviews

Purpose:

1. To have individual, open-ended discussion on a range o issues.2. To obtain in-depth inormation rom individuals about their perceptions and concerns.

Number o People to Interview or Events to Observe:

The larger and more diverse the target population, the more people must be interviewed.

Resources Required:

Trained interviewers•Written guidelines or interviewer•Recording equipment•A transcriber•A private location•

Advantages:

Can be used to discuss sensitive subjects that the interviewee may be reluctant to•discuss in a group.Can probe individual experience in depth.•Can be done by telephone.•

Disadvantages:

Time consuming to conduct interviews and analyze data.•Transcription can be time-consuming and expensive.•

One-on-one interviews can lead participants to bias their answers toward• “socially acceptable” responses.



Evaluating Your Fall Prevention Programs

44

Summary o qualitative evaluation methods—ocus group

Method:

Focus Groups

Purpose:

1. To have an open-ended group discussion on a range o issues.2. To obtain in-depth inormation about perceptions and concerns rom a group.

Number o People to Include:

4 to 8 participants per group.

Resources Required:

Trained moderator(s)•Appropriate meeting room•Audio and/or visual recording equipment•

Advantages:

Can interview many people at once.•Response rom one group member can stimulate ideas o another.•

Disadvantages:

Individual responses can be infuenced by group.•Transcription can be expensive.•Participants choose to attend and may not be representative o target population.•Because of group pressure, participants may give “socially acceptable” responses.•Focus groups are harder to coordinate than individual interviews.•



Chapter 6

Summary o qualitative evaluation methods—participant-observation

Method:

Participant-Observation

Purpose:

To see rsthand how an activity operates.

Number o Events to Observe:The number o events to observe depends on the purpose. To evaluate people’s behaviorduring a meeting may require observing only one event (meeting). However, to see i grabbars are installed correctly may require observing many events (installations).

Resources Required:

Trained observers•

Advantages:

Provides rsthand knowledge o a situation.•

Can discover problems the people involved are unaware o (e.g., that their own actions•in particular situations cause others to react negatively).Can determine whether products are being used properly (e.g., whether a walking device•is being adjusted and used correctly).Can produce inormation rom people who have diculty verbalizing their points o view.•

Disadvantages:

Can aect the activity being observed.•Can be time consuming.•Can be labor intensive.•




46

Summary o quantitative evaluation methods—counting system

Method:

Counting systems

Purpose:

1. To record the number o contacts with program participants (e.g., number o peopleattending each exercise class).

2. To record the number o contacts with people outside the program (e.g., number omeetings with partners).

3. To record the number o items a program distributes or receives (e.g., brochures andact sheets).

4. To measure changes in people’s knowledge, attitudes, belies, or behaviors by collectingthe same inormation at the beginning and end o the program.

5. To estimate the amount spent on delivering your program.



Chapter 6

The stages o evaluationThere are our stages o program evaluation:

• Formative• Process• Impact• Outcome

The appropriate time to conduct each stage and the most suitable methods to useare outlined below.

Stage 1: Formative evaluation

What it shows:

• Whether proposed messages are likely to reach, to be understood by, and to be acceptedby the people you are trying to serve (e.g., shows the strengths and weaknesses oproposed educational materials).

• How people in the target population get inormation (e.g., which newspapers they read orradio stations they listen to).

• Whom the target population respects as a spokesperson (e.g., a physician or local celebrity).

• Details that program developers may have overlooked about materials, strategies, or wayso distributing inormation (e.g., that seniors have diculty reaching the location whereclasses are being held).

When to use:

• During the development o a new program.• When an existing program 1) is being modied, 2) has problems with no obvious

solutions, or 3) is being used in a new setting, with a new population, or to target a newproblem or behavior.

Why it is useul:• Allows programs to make revisions beore the ull eort begins.• Maximizes the likelihood that the program will succeed.

Methods to use:

• Qualitative methods such as personal interviews with open-ended questions, ocusgroups, and participant observation.

(For details, see page 25 o Demonstrating Your Program’s Worth: A Primer on Evaluation for Programs to Prevent Unintentional Injury )




48

Stage 2: Process evaluation

What it shows:

• How well a program is working (e.g., how many people are participating in the programand how many people are not).

• Identies early any problems that occur in reaching the target population.• Allows programs to evaluate how well their plans, procedures, activities, and materials

are working and to make adjustments beore logistical or administrative weaknessesbecome entrenched.

When to use:

• As soon as the program begins operation.

Why it is useul:

• Allows programs to make revisions beore the ull eort begins.• Maximizes the likelihood that the program will succeed.

Methods to use:

• Quantitative methods, such as:

– Tracking direct contacts with all who are served by the program (older adults whohave had direct contact with the program, the nature o the direct contacts, numbero educational brochures distributed).

– Tracking indirect contacts (through health care providers, adult children o olderadults, or other organizations who are sharing inormation with older adults).




Chapter 6

Stage 3: Impact evaluation

What it shows:

• The degree to which a program is meeting its intermediate goals (e.g., how awarenessabout the value o exercise or home saety has changed among program participants).

• Changes in the target population’s knowledge, attitudes, belies, or measurableall risk actors.

When to use:

When the program is being implemented and has made contact with at least one person•or one group o people in the target population.

Why it is useul:

Allows management to modiy materials or move resources rom a nonproductive to a•productive area o the program.Tells programs whether they are moving toward achieving their goals.•

Methods to use:

Baseline measurement: measuring the target population’s knowledge, attitudes,•

belies, behaviors, or health risk actor (such as muscle strength or balance) beorebeginning the program or receiving services, using surveys and/or objective participantassessments.Progress measurement: measuring the target population’s knowledge, attitudes, belies,•behaviors or health risk actors (such as muscle strength or balance) at a predeterminedamount o time such as at the end o a 3-month exercise class or at regular intervalsin an ongoing program. Measurements can be made using surveys and/or objectiveparticipant assessments.





50

Stage 4: Outcome evaluation

What it shows:

• The degree to which the program has met its ultimate goals (e.g., how much an exerciseand education program has improved a person’s ability to carry out daily activities andreduce all risks).

When to use:

For ongoing programs (e.g., group exercise classes oered throughout the year) at•

appropriate intervals.For one-time programs (e.g., a 6-month program to conduct home saety assessments•and distribute home modication equipment or devices) when program is complete.

Why it is useul:

Allows programs to learn rom their successes and ailures and to incorporate what they•have learned into the program or into their next project.Provides evidence o success or use in uture budget development and requests•or unding.

Methods to use:

Generally the same methods used in impact evaluation are used in•outcome evaluation.




Chapter 6

Determining which stage to use To nd out which stage o evaluation your program is ready or,answer the questions below. Then ollow the directions providedater the answer.

Q. Does your program meet any of the following criteria?

• It is just being planned and you want to determine how bestto operate.

• It has some problems you do not know how to solve.• It has just been modied and you want to know whether the

modications work.• It has just been adapted or a new setting, population,

problem, or behavior.

I yes to any o the our criteria, begin ormative evaluation.

I no to all criteria, read the next question.

Q. Your program is now in operation. Do you have informationon who is being served, who is not being served, and how muchservice you are providing?

I yes, read the next question.I no, begin process evaluation. You may also be ready or impactevaluation. Read the next question.

Q. Your program has completed at least one encounter withone member or one group in the target population(e.g., completed one exercise class). Have you measured the results of that encounter?

I yes, read the next question.

I no, you are ready or impact evaluation. I you believe you havehad enough encounters to allow you to measure your success inmeeting your overall program goals, read the next question.

Q. Is your program complete?

I yes, you are ready or outcome evaluation.

I no, reread the above questions or reer to the publicationin Demonstrating Your Program’s Worth: A Primer on Evaluation or Programs to Prevent Unintentional Injury . I you are stilluncertain, consult a proessional.




52

Evaluation web resourcesThompson NJ, McClintock HO. Demonstrating Your

Program’s Worth: A Primer on Evaluation or ProgramsTo Prevent Unintentional Injury. Atlanta: Centers orDisease Control and Prevention, National Center or Injury Prevention and Control, 1998; revised March 2000.

www.cdc.gov/ncipc/pub-res/demonstr.htm

British Columbia Research Institute or Children’s & Women’sHealth, Injury Prevention Program Evaluation Manual

www.injuryresearch.bc.ca/Publications/Reports/ProgEvalMan%20

Report.pd

National Council on Aging’s Evidence-based Healthy Aging Programming: Tools and Checklists

healthyagingprograms.org/content.asp?sectionid=32&ElementID=439

CDC Evaluation Working Group: resources for project evaluation www.cdc.gov/eval/resources.htm

RE-AIM Evaluation Framework www.re-aim.org/2003/commleader.html

Basic Guide to Outcomes Based Evaluation or Nonproft

Organizations with Very Limited Resources www.managementhelp.org/evaluatn/outcomes.htm



Injury Prevention

53

Publicizing your all prevention program to older adults, the media,

and others in the community will be critical to its success. Thischapter provides tips and techniques that you can use to engage yourcommunity in all prevention by:

• Conducting a successul community outreach campaign• Working with the media

Conducting a successul campaign

The word “campaign” applies to a public health education eort o any size. Even i you are only developing a fyer to announce your

new home-based exercise program or older adults, you still needto determine the who, what, when, where, how, and why o gettingthe fyer written, designed, printed, and distributed so that it willeectively reach your target audience.

This section provides an overview o campaign development, romconcept through evaluation. For more detailed inormation on thetheory and application o health communication, visit the CDCNational Center or Health Marketing website shown at the end o this section.

The eight steps outlined below will help you make the best useo your limited time and resources in developing a successulcommunity outreach campaign.

Chapter 7 Promoting Your




Step 1: Assess your current situation. Take a realistic look at yourcommunity and ask pertinent questions.

Is your community concerned about all prevention or willyou need to lay some educational groundwork?

Do you believe your local media (radio, TV, newspaper, websites) would support your campaign?

What resources do you have that can help your eorts?

Would a campaign be easier to mount i you partnered with

other organizations in your community who serve older adults?Step 2: Set your campaign goal and objectives. Identiy the goalsand objectives or your outreach campaign. A goal is the overallhealth improvement you hope to achieve, such as reducing allsamong older adults in your community. An objective is a specifcoutcome that you can use to measure progress toward your goal.

Set realistic and measurable objectives. For example:

Double the enrollment o your exercise classes or seniors.

Increase the percentage o older adults served by yourorganization who have installed grab bars or railings.

Step 3: Identiy the target audiences your campaign should reach. Identiy the groups o people you need to reach to meetthe goal you set in Step 2. Learn as much as you can about them.Remember that the needs, belies, values, and expectations o targetaudiences vary.

Do the older adults you wish to reach see themselves as activeand youthul?

Are they committed to living independently?

Should you reach out to adult children o older adults orhealthcare providers in your campaign?

The more you know about your target audience, the more eectively you can tailor your promotional eorts. For example, the Internetmay not be an eective way to reach certain groups o older adults.



Chapter 7

Step 4: Develop your messages or the campaign. Messages canbe inormative and convey new acts, or be persuasive and alterattitudes or change behavior. Sometimes they are both.

Many messages begin by raising awareness about an issue orprogram so people can agree with it, understand it, believe it,and then eventually act on it.

Consider gender, culture, and age groups. Messages aimedat people aged 60 to 70 should be ramed dierently romthose or individuals over 70. I the older adults you want

to reach perceive themselves as youthul, they may ignorea message about the health problems o aging. A messageocused on “staying healthy and independent” may generatemore positive response than one ocused on “preventing hipractures and other injuries.”

Pretest your messages with a sample o the audience and seei your message appeals to them.

Use audience eedback to make adjustments beore launchingyour campaign.

Step 5: Identiy message outlets. Decide how you can deliver yourmessage most eectively. Answers to the ollowing questions canhelp you identiy the best outlets or your message.

Where does your audience get inormation that they trust? Isit rom the media, their peers, their physicians, or children?

Where does your audience spend time? Do they spend timeat senior centers, libraries, or aith-based organizations suchas churchs or synagogues?

Partnerships oer unique opportunities to reach complementary target audiences. Healthcare providers can publicize your allprevention program to older adults. Providers also can directly reerhigh-risk adults to your program. When asking a partner to help with promotional activities, emphasize the connection between their work and your program goal. See Appendix I or a sample letter tohealthcare providers to solicit reerrals.



Promoting Your Fall Prevention Programs

56

Step 6: Develop an action plan or the campaign. Create anaction plan that demonstrates good time and resource management. While it can be simple or complex, at a minimum your action planshould identiy:

Major activities and tasks

Target date or completing each task

The person responsible or ensuring that each task iscompleted

Step 7: Develop and pretest campaign materials. In developingmaterials, pay attention to reading level, print size, and languages.

Keep your wording simple and direct.

Consider design as well as content. For example, older adultsmay preer larger type.

Pretest any materials you develop as part o your campaign with members o your target audience group and makemodications based on their eedback.

This crucial step can make the dierence between success and ailurein a community outreach campaign.

Step 8: Implement, evaluate, and modiy your campaign. Asyou carry on your outreach campaign, determine i you are movingtoward your goal. I not, investigate the reasons why.

See what barriers are preventing the message rom reachingthe target audience.

Determine what you can do to remove these obstacles.

Use what you learn to improve your campaign.



Chapter 7

Working with the media You can use media such as local newspapers, radio, and televisionstations, to enhance your promotion activities. The media hasa mandate to be o public service, so they should welcome theopportunity to make the community aware o your organization’s allprevention program. See your relationship with the media as oneo mutual advantage; you provide useul and timely inormation ortheir audiences, and they provide public access and outreach or you.

Start with your local telephone directory and create a list o

media names and contact inormation or local reporters,especially the health reporter.

Check with your library or bookstore to nd mediadirectories that list daily and weekly newspapers, televisionstations, radio stations, newswire services, Internetnews outlets, magazines, newsletters, and business tradepublications in your community. Some examples o mediadirectories include Bacon’s MediaSource and the News Media Yellow Book. (These web links can be ound at the end o

this section.) Don’t overlook community newspapers as potential news outlets.

Local organizations such as aith-based, and senior citizengroups that publish their own newsletters may be eager topublicize your prevention program.

Develop key points to include in the media materials.Highlight the importance o your all prevention program.I you’re hosting a community event, oer key points toguest speakers in advance so they can include them in their

remarks. Appendix J has key points that include acts andnational statistics about alls among older adults. For agreater eect, try to include statistics about alls among olderadults in your state or community. These statistics may beavailable rom state and county health departments andlocal hospitals.



Promoting Your Fall Prevention Programs

58

Promotional web resourcesCDC National Center or Health Marketing www.cdc.gov/healthmarketing

CISIONus.cision.com

News Media Yellow Book www.leadershipdirectories.com/products/nmyb.htm



Injury Prevention

59

Chapter 8 Sustaining Your


Create a written sustainability plan to provide a road map to guideyou and your program’s community partners as you work onsustainability eorts.

The process o creating a written sustainability plan can strengthencommunity partners’ commitment and understanding o the eortsneeded to keep your program operating and improving. A tangibledocument that describes your sustainability plan helps you and yourcommunity partners monitor progress on sustainability eorts. Indeveloping your plan, consider the ollowing:

Establish your vision

Determine the vision o your program. A common vision uniesall o your program’s sustainability eorts. Write it down andshare it with all involved. Keeping your vision in sight will serve tostrengthen your program’s sustainability.

Build collaboration

Continue to look or new community partners who possess unique

skills and resources that will contribute to your program. Expandingyour base o support is crucial to sustaining your program andproviding its benets to the older adults in your community.

Advocate or support

Seek advocates or your program among business leaders, otherCBOs, and government representatives who will speak up and takeaction on behal o your program.



Integrate your program into community healthcare and seniorservices by linking with senior service providers, the healthdepartment, healthcare organizations, and the local Area Agency on Aging; they can provide ongoing community support and reerrals.

Find unding

Secure diversied unding streams rom public and private sourcesto increase your program’s sustainability. Sources o unding include:

• Medicare•

Health Maintenance Organizations• Private or managed care insurers• Private organizations• Federal/state/local government or agency • Local, state, or national (public or private) grant unders• Program participant ees

Use your program evaluation results to promote sustainability.Study your program goals and evaluation results to identiy areasor improvement or change that might make your program

more sustainable.Demonstrate the benets o your program. Share your evaluationresults with your target audience, the community, your partners,your current and potential unding sources, and stakeholders.

See Attachment K or a template to help you create a sustainability plan or your all prevention program.



Appendix A Sample IndividualFalls Risk Assessment



My Falls-Free Plan

As we grow older, gradual health changes and some medications can cause falls, but many falls can be prevented.

Use this to learn what to do to stay active, independent, and falls-free.

The more “Yes” answers you have, the greater your chance of having a fall. Be aware of what can cause falls, and take

care of yourself to stay independent and falls-free!

Name: ____________________________ Date: _______

Reviewed by: _________________

This material is in the public domain and may be reproduced without permission. If you use or adapt this

material, please credit the Washington State Department of Health, Injury & Violence Prevention Program.

Check “Yes” if you experience

this (even if only sometimes )What to do if you checked “Yes”No Yes

Talk with your doctor(s) about your falls and/or concerns.

Show this checklist to your doctor(s) to help understand and treatyour risks, and protect yourself from falls.

Review your medications with your doctor(s) and your pharmacist

at each visit, and with each new prescription.

Ask which of your medications can cause drowsiness, dizziness,

or weakness as a side effect.

Talk with your doctor about anything that could be a medication

side effect or interaction.

Tell your doctor(s) if you have any pain, aching, soreness, stiffness

weakness, swelling, or numbness in your legs or feet—don’t

ignore these types of health problems.

Tell your doctor(s) about any difficulty walking to discuss treatmen

Ask your doctor(s) if physical therapy or treatment by a medicalspecialist would be helpful to your problem.

Ask your doctor for training from a physical therapist to learn wha

type of device is best for you, and how to safely use it.

Ask your doctor for a physical therapy referral to learn exercises

to strengthen your leg muscles.

Exercise at least two or three times a week for 30 min.

Tell your doctor, and ask if treatment by a specialist or physical

therapist would help improve your condition.

Review all of your medications with your doctor(s) or pharmacist

if you notice any of these conditions.

Schedule an eye exam every two years to protect your eyesight

and your balance.

Schedule a hearing test every two years.

If hearing aids are recommended, learnhow to use them to help

protect and restore your hearing, which helps improve and protect

your balance.

Ask your doctor(s) what types of exercise would be good for

improving your strength and balance.

Find some activities that you enjoy and people to exercise with

two or three days/week for 30 min.

Limit your alcohol to one drink per day to avoid falls.

See your doctor(s) as often as recommended to keep your health

in good condition.

Ask your doctor(s) what you should do to stay healthy and active

with your health conditions.

Report any health changes that cause weakness or illness as soon

as possible.

Have you had any falls in the last

six months?

Do you take four or more

prescription or over-the-counter

medications daily?

Do you have any difficulty walking

or standing?

Do you use a cane, walker, orcrutches, or have to hold ontothings when you walk?

Do you have to use your arms to

be able to stand up from a chair?

Do you ever feel unsteady on your

feet, weak, or dizzy ?

Has it been more than two years

since you had an eye exam?

Has your hearing gotten worse

with age, or do your family or

friends say you have a hearing

problem?

Do you usually exercise less than

two days a week? (for 30 minutes

total each of the days you exercise)

Do you drink any alcohol daily?

Do you have more than three

chronic health conditions? (such

as heart or lung problems, diabetes,

high blood pressure, arthritis, etc.

Ask your doctor(s) if you are unsure.)

Appendix A – Risk Assessment

63



Appendix B Identifying PartnersWorksheet



Appendix B – Identifying Potential Partners

Community Partners/ Resources

Fall Prevention Intervention Components

Education

• Group• Individual

Assessment

• Gait• Balance; simple• Balance; in-depth• Strength

Exercise

• 1:1 balance alone• 1:1 strength withbalance training

• Group class• Individualizedexercise/PT

• Tai Chi

Medication

• Medicationreview• Medicationmanagement

Vision

• Basicassessment• Detailedassessment

• Visioncorrection

Home Safety

• Assessment• Basicmodification**

• Skilledmodification**

Other

• Assistivedevicetraining

Area Agency onAging

Communityhealth careproviders

Communityhospital (s)

outpatientprograms andservices

EMS/TraumaInjury PreventionCoordinator

Fire Depts.

Gym/fitnesscenter

HealthDepartment

Home healthagency

Homemodificationresources

Library system

Local serviceorganization(s)

Other resources

Parks andrecreation

Pharmacy

Physical/occupat

ional therapyclinics

University/ CommunityCollege

YMCA

65



Appendix C Sample Fall PreventionBrochure



Appendix C – Sample Fall Prevention Brochure



Appendix D Sample Fall PreventionPresentation



Preventing

Falls What YOU Can Do

To Prevent FallsMany falls can be prevented.

By making some changes, YOUcan lower your chances of falling.

Four Things

YOUCan Do ToPrevent

Falls

Begin a regular exercise program.

Have your healthcareprovider reviewyour medicines.

Have your vision checked.

Make your home safer…

1

2

3

4

FLOORS: Look at the floor in each room.Q: When you walk

through a room,do you have to

walk aroundfurniture?

Ask someone to movefurniture so your pathis clear.

Q: Do you have throwrugs on the floor?

Remove rugs or use a

non-slip backing sorugs won’t slip.

Q: Are there papers,books, towels,magazines, shoes,boxes, blankets or other objects onthe floor?

Pick up things on thefloor. Always keepobjects off the floor.

“Last Saturday our son helped usmove our furniture. Now all the

rooms have clear paths.”

STAIRS AND STEPS:Look at the stairs you use bothinside and outside your home.

Q: Are you missinga light over thestairway?

Have an electricianput in an overheadlight at the top andbottom of the stairs.

Photo courtesy of Jake Pauls

Q: Is the carpet onthe steps looseor torn?

Make sure carpet isfirmly attached toevery step.

Q: Are the handrails loose or broken?

Fix loose rails or put in new ones. Make surehandrails are on both sides of the stairs.

BEDROOMS:Look at all your bedrooms.

Q: Is the light near thebed hard to reach?

Place a lamp close to the

bed where it’s easy to reach.

Q: Is the path from your bed to the bathroomdark?

Put in a night-light so youcan see where you’rewalking. Some night-lightsgo on by themselves after dark.

Appendix D – Fall Prevention PPT Thumbnails



BATHROOMS:Look at all your bathrooms.

Q: Is the tub or shower floor slippery?

Put a non-slip rubber mat or self-stick strips on the floor of thetub or shower.

Q: Do you need some support when you get in and out of the tub or up from the toilet?

Have a carpenter put grab barsinside the tub and next to the toilet.

KITCHEN:Look at your kitchen and eating area.

Q: Are the things you useoften on high shelves?

Move items in your cabinets.Keep things you use often onthe lower shelves (abovewaist level).

Q: Is your step stoolunsteady?

If you must use a step s tool, getone with a bar to hold on to.Never use chairs as step stools.

Other Things

YOUCan Do ToPrevent

Falls

Get up slowly after yousit or lie down.

Wear shoes both insideand outside the house.

Avoid going barefoot or wearing slippers.

Improve the lighting in your home. Put in brighter bulbs.Fluorescent bulbs are brightand cost less to use.

It’s safest to have uniformlighting in a room. Addlighting to dark areas.

Hang lightweight curtains or shades to reduce glare.

More Safety Tips Exercise regularly. Exercise

makes you stronger andimproves your balance andcoordination.

Have your vision checked atleast once a year by an eyedoctor. Poor vision canincrease your risk of falling.

Keep emergency numbersin large print near eachphone.

You CanPrevent

Falls“Making changes in our home to prevent fallsis good for us and good for our granddaughter when she comes to visit.”

For more information, contact:Centers for Disease Control and Prevention

National Center for Injury Prevention and Control1.800.CDC.INFO

www.cdc.gov/injury

Department of Health and Human ServicesCenters for Disease Control and Prevention

Appendix D – Fall Prevention PPT Thumbnails



Appendix E Sample Exercises



Appendix F Sample MedicationReview Form



Appendix F – Fall Prevention Medication Review Checklist

Patient Name: ______________________Review Date: _______

Number of medicat ions pat ient was taking: ________

Please indicate which of the following recommendat ions were made/act ions taken when

reviewing the above patient’s medication intake.□ Decrease number of medications, if possible (especially if taking more than four

medications).Notes:

□ Investigate lower dosages of medications, especially psychotropic drugs, diuretics and

cardiovascular drugs.Notes:

□ Consider withdrawal of digoxin:

In patients with stable CHF If CHF is due to valvular disease or hypertension If there is no response to digoxin after one month with decreased heart size, or

increased exercise capacityNotes:

□ Stop or decrease number of psychotropic medications

Neuroleptics (i.e., Phenothiazines, Butyrophenones) Sedative/hypnotics (i.e., Barbiturates, Hydroxyzine)

- Antidepressants (i.e., Tricyclic Antidepressants, Selective Serotonin Uptake Inhibitors(SSRIs)

- BenzodiazepinesNotes:

□ Avoid combination of certain drugs

• Narcotics with psychotropics• More than one psychotropic

Notes:

Court esy of the Michigan Fall Prevent ion Proj ectMichigan Department of Community Health

76



Appendix G Sample Home FallPrevention Safety Checklist



P

Appendix G – Sample Home Fall Prevention Safety Checklist



P

P



Appendix H Sample ProgramEvaluation Tool



Appendix H – Program Evaluation Checklist

Program Evaluation Checklist

This is a checklist of tasks that organizations developing fall preventionprograms can follow to make sure no evaluation steps are omitted duringprogram development, operation, and completion.

1. Program Development As soon as you or someone in your organization has the idea for a fallprevention program, begin evaluation.

Investigate to make sure an effective program similar to the one youenvision does not already exist in your community.

If a similar program does exist and if it is fully meeting the needs of yourproposed target population, modify your ideas for the program so that youcan fill a need that is not being met.

Decide where you will seek financial support.

Find out which federal, state, or local government agencies give grants forthe type of program you envision.

Find out which businesses and community groups are likely to support yourgoals and provide funds to achieve them.

Decide where you will seek non-financial support.

Find out which federal, state, or local government agencies providetechnical assistance for the type of program you envision.

Find out which businesses and community groups support your goals and arelikely to provide technical assistance, staff, or other non-financial support.

Develop an outline of a plan for your fall prevention program. Include in theoutline the methods you will use to provide the program service toparticipants and the methods you will use to evaluate your program’simpact and outcome.

Evaluate the outline. For example, conduct personal interviews or focusgroups with a small number of the people you will try to reach with your fallprevention program. Consult people who have experience with programssimilar to the one you envision, and ask them to review your plan. Modifyyour plan on the basis of evaluation results.

87




Develop a plan to enlist financial and non-financial support from all theagencies, businesses, and community organizations you have decided arelikely sources of support. Use the outline of your plan for the injuryprevention program to demonstrate your commitment, expertise, andresearch.

Evaluate the plan for obtaining support. For example, conduct personalinterviews with business leaders in your community. Modify your plan on thebasis of evaluation results.

Put your plan for obtaining support into action.

Keep track of all contacts you make with potential supporters.

If unexpected problems arise while you are seeking support, re-evaluateyour plan or the aspect of your plan that seems to be the source of theproblem. For example, if businesses are contributing much less than youhad good reason to expect, then seek feedback from businesses that arecontributing and those that are not. Or if you did not receive grant funds forwhich you believed you were qualified, contact the funding agency to findout why your proposal was rejected. Modify your plan according to your re-evaluation results, and continue seeking support.

When you have enough support for your program, expand on the outline of your plan for the fall prevention program. Include in the design amechanism for evaluating the program’s impact and outcome.

Evaluate your program’s procedures, materials, and activities. For example,conduct focus groups within your target population. Modify the plan on thebasis of evaluation results.

Develop forms to keep track of program participants, program supporters,and all contacts with participants, supporters, or other people outside theprogram.

Measure the target population’s knowledge, attitudes, beliefs, andbehaviors that relate to your program goals. The results are your baselinemeasurements.

88




2. Program Operation

Put your program into operation.

Track all program-related contacts (participants, supporters, or others).Track all items either distributed to or collected from participants.

As soon as the program has completed its first encounter with the targetpopulation, assess any changes in program participants’ knowledge,attitudes, beliefs, and (if appropriate) behaviors.

Continue tracking and assessing program-related changes in participantsthroughout the life of the program. Keep meticulous records.

If unexpected problems arise while the program is in operation, re-evaluate(using qualitative methods) to find the cause and solution. For example,your records might show that not as many people as expected are

responding to your program’s message, or your assessment of programparticipants might show that their knowledge is not increasing. Modify theprogram on the basis of evaluation results.

Evaluate ongoing programs (e.g., exercise and education classes) at suitableintervals to see how well the program is meeting its goal of reducing fallrelated morbidity and mortality.

3. Program Completion

Use the data you have collected throughout the program to evaluate howwell the program met its goals: to increase behaviors that prevent falls and,consequently, to reduce the rate of falls and fall injuries.

Use the results of this evaluation to justify continued funding and supportfor your program.

If appropriate, publish the results of your program in a scientific journal.

This tool was based on guidel ines fr om the Demonstrating Your Program's Wort h, A Pri meron Evaluati on for Programs to Prevent Unintent ional Inj ury (CDC NCIPC, 2000), a book

designed to help program staff understand the processes involved in planning, designing,and implementing evaluation of programs to prevent unintentional injuries.

www.cdc.gov/ncipc/pub-res/demonstr.htm

89

http://www.cdc.gov/ncipc/pub-res/demonstr.htm





Appendix I Sample Pitch Letter



Appendix I – Sample Letter to Health Care Referral Source

[Title][Name of organization][Address]

Dear [Name]:

Our organization needs your help in preventing falls among older adults—the leadingcause of injury deaths and nonfatal injuries for persons aged 65 and older. We areoffering a [free/low-cost] fall prevention [exercise class, counseling, home visits, etc.]to individuals whose current health status places them at increased risk of falling.Please recommend our service, described in more detail below, to your patients whowould benefit from it.

Our program is [name and description of program; program details. For example:

“Stay Safe, Stay Active,” an evidence-based exercise program for older adults at riskof falling due to lower limb weakness, poor balance, slow reaction time, or acombination of these symptoms. We will hold 37 weekly classes of moderate exercise,

led by a trained fitness instructor, beginning March 1, from 9 to 10 a.m., at the YMCAat 321 Main Street, Anytown. We will also provide participants with fall preventionstrategies and exercises to do at home. Participants will improve their balance andcoordination, muscle strength, reaction time, and aerobic capacity while reducingtheir likelihood of falling or being injured in a fall.]

The Centers for Disease Control and Prevention has identified this intervention aseffective in preventing falls.

More than one-third of people aged 65 and older fall each year. Help your patientsmaintain their health and independence by learning how to avoid falls. Please call meat [telephone number] if you would like further information. [Recommended step:

(Program) fliers to distribute to high-risk patients are available.]

Sincerely,

[Your name and title]

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Appendix J Key Points



Appendix J – Key Points Regarding Falls Among Older Adults

Healt h Consequences of Falls (age 65+)

• Falls are a major threat to the health and independence of older adults.

• Each year in the United States, nearly one-third of older adults experience afall.

• Falls are the leading cause of injury deaths and the most common cause ofnonfatal injuries and hospital admissions for persons aged 65 and older.

• In 2004, more than 14,900 people aged 65 or older died of a fall-related injury.Another 1.85 million were treated in emergency departments for nonfatalinjuries related to falls.

• About one out of ten falls among older adults results in a serious injury (such asa hip fracture or head injury) that requires hospitalization.

• In 2004, one adult died from a fall every 35 minutes. Every hour, 211 olderadults were treated in emergency rooms for fall-related injuries.

• In 2000, direct medical costs totaled $179 million for fatal falls and $19 billionfor nonfatal fall injuries.

• In [your state/community], falls account for [X percentage] of emergency room

visits by people aged 65 or older.

• In [your state/community], falls account for [X percentage] of hospital

admissions for injuries among older adults.

• In [your state/community], falls account for [X percentage] of deaths among

older adults.

(Contact your local hospital, agency on aging or county or state healthdepartment for statistics on fall-related injuries and deaths.)

Biological risk factors Mobility problems due to muscle weakness or balance problems Chronic health conditions such as arthritis and stroke Vision changes and vision loss Loss of sensation in feet

Behavioral ri sk f actors Inactivity Medication side effects and/or interactions Alcohol use

Environmental ri sk factors Home and environmental hazards (clutter, poor lighting, etc.) Incorrect size, type, or use of assistive devices (walkers, canes, crutches, etc.) Poorly designed public spaces

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Appendix K Sustainability PlanTemplate



Appendix K – Template for Developing a SUSTAINABILITY PLAN

***********************************************************************Sustainability Plan for {Your Program Name}

Program SummaryDescribe what your program offers, who it serves, when it operates, how i t is funded and who your communit y part ners are.

Vision What is t he program’s vision? What result s do you hope to achieve, and what are t he act ivi t ies t hat wil l lead to the desir ed result s? Who wil l benef it ?

CollaboratorsWho are your part ners? What are t heir roles, what resources do they cont ri bute, and how do t hey f igure in your sustainabil it y plan?

AdvocatesWho are your support ers? What are t heir goals and how are they providing help?

Current Funding SourcesWho is providing funding for your program? How long wil l t hey cont inue t heir cont ri but ions?

New Potential Funding Sources List possible funders who could provide addit ional support . Describe a plan t o approach potent ial funders. Get addit ional referrals for both publ ic and pri vat e funders t hrough part ners.

Program Offerings State specif ical ly how t he program addresses t he needs of t he older adult part icipant s, part ners, and the communit y. Remember t o include how your program incorporates effect ive int ervent ion components t o achieve it s goals.

ManagementInclude how you are managing your program’s f iscal resources Describe