Planned Community Change:

Older Adult Fall Prevention Program

Kent County, Michigan Ferris State University ~ NURS 340 ~ Spring

Semester 2012 Cheryl Howard, Joan Kronlein, Danielle Williams, Natalie

Russell

Introduction: Kent County, MichiganKent County Facts• Covers 864 square miles• County seat is Grand Rapids• Has 5 large health care

organizations• Has 8 colleges & universities• Total population is 602,600

(6.1% of Michigan's population)• Racial stats: white 80%, black 9%,

hispanic 9% and asian 2%• Age 65 & older is 11% of

population

Photo source: www.infomi.com/county/kent

(MPHI, 2011) (U.S.Census Bureau, 2012)

Kent County Health Problem High rate of unintentional injuries in Kent

County Higher rates of fatal falls in Kent County

compared to Michigan and the United States

Higher rates of fatal falls in Kent County among residents 65+ years old compared to other age groups

Higher rate of older homes built before 1939 in Kent County compared to Michigan

(Gray-Micelli, 2008), (Merrett, Stephens & Gruneir, 2011), (CCFP, 2010) (MDCH, 2009), (MPHI, 2011), (Onboard Informatics,

2010)

Health Problem

• Falls were the leading cause of fatal injury in 2009.• 89% of fatal falls occur among residents 65+ years

old.• In 2009 of the 90 fatalities reported due to a fall,

79 (87.8%) were part of the 65 and older age group.

• In 2009 of the 90 falls reported, the distribution between males and females is almost equal, 47 female, 43 male.

• Falls are leading cause of death due to unintentional injury among older adults which can be prevented by addressing risk factors(Healthy People 2020, 2012) (MPHI, 2011)

Analysis of the Problem

Analysis of the Problem

History of recent falls Vision/hearing

impairment Assistive device use Gait/balance

impairment Orthostatic Hypotension Tripping Hazards Use of 5+ Medications Uneven/slippery

surfaces

Contributing Factors to Falls Inappropriate footwear Non-sturdy

furniture/equip Health conditions Poor lighting Foot Problems

(Gray-Micelli, 2008), (Merrett, Stephens & Gruneir, 2011), (CCFP, 2010)

Critical ThinkingWhat explains the difference between

data and comparison to benchmarks?Older, obese individuals living in

older homes and unable to afford repairs to prevent falls….explains the difference!

( Obesity - Kent County=29%, National benchmark=25%)( Higher rate of death from unintentional injuries than in

Michigan)

Problem StatementThere is an increased risk of fall related injury and

death among Kent County, Michigan residents aged 65+ years old related to risk factors of individual health & environment as demonstrated by…

(Gray-Micelli, 2008), (Merrett, Stephens & Gruneir, 2011), (CCFP, 2010)• "Unintentional injuries" is 5th leading cause of death in Kent County &

higher than Michigan rate (MDCH, 2009).• 89% of fatal falls in Kent county occur among residents 65+ years old;

fatal fall rates increase directly with age (MPHI, 2011). • Fatal fall related injuries in Kent County is almost double rate of U.S.

and Michigan (MPHI, 2011). • Homes built in 1939 or earlier in Kent County has higher rate than in

state of Michigan (Onboard Informatics, 2010)• Falls are leading cause of death due to unintentional injury among

older adults; death & injuries can be prevented by addressing risk factors (Healthy People 2020, 2012).

Relevant Change Model: HPMThe Revised Health Promotion Model

(HPM) for the individual…• Prior Related Behavior

o perceived benefits and barrierso perceived self-efficacyo activity related affect

• Personal Factorso interpersonal influences: norms, social support, modeling o situational influences: options, demands, aesthetics

• Commitment to a Plan of Actiono Immediate competing demands & preferences

• Results in Health Promoting Behavior [for the individual] (Pender et al., 2011)

Community Change ModelsCommunity Ecological Model

“Emphasize[s] the social, institutional, and cultural contexts of people-environment relations” (Pender, Murdaugh, and Parsons, 2011, p. 71).

Social Marketing Model“Attempt[s] to increase the attractiveness of

the desired behavior so that consumers will desire the new behavior” (Pender, Murdaugh, and Parsons, 2011, p. 79).

Potential Barriers• Lack of funding• Lack of community

participation• Lack of motivation or

participation of at-risk population

• Perceptions of inconvenience, expense, difficulty, time-consuming nature of particular action

(Pender, Murdaugh & Parsons, 2011)

Existing Community Resources for Problem1. Area Agency on Aging of Western Michigan (AAAWM) Fall Prevention awareness activities•Balance Class at Priority Health•Written materials distributed by AAAWM• Last one held in 2010

2. No other fall prevention resources found in Kent County(AAAWM, 2010)

Potential Local Resources & Community Partners Charitable Organizations Community

Organizations Government Senior Programs Health and Medical

(AAAWM, n.d.), (Alliance for Health, 2012), (CCWG, 2012), (Info MI, 2012) (Kent County, 2012), (MPHI, 2011), (MSHDA, 2012), (Senior Meals, 2011)

Relevant Evidence Based Practice:Primary PreventionEffectiveness of Media Campaigns Widely recognized as useful public health tools Messages motivate change

Increase knowledge of risks More effective behavior change by inducing

feelings about consequences (Appollonio & Malone, 2009)

Kent County Fall Prevention Program

Relevant Evidence Based Practice:Secondary PreventionSingle intervention approaches• Health and risk assessment with referral• Polypharmacy assessment with med management• Home hazard assessment with modifications• Individual or group exercise programs• Vision assessment with correction• Educational programMulti-factorial approaches• Combination of some or all

single interventions(Costello and Edelstein, 2008)

Evidence Based Practice: SummaryEffectiveness of Falls Prevention Programs1. Increases with a history of previous fall2. Involves medication/vision screens3. Exercise is key4. Includes home assessment and/or modifications5. Multi-factorial approach recommended

Effectiveness of Media Campaigns6. Increases when effects of unchanged health

behavior are understood by public(Appollonio & Malone, 2009)(Costello and Edelstein, 2008)

Evidence Based Practice:Conclusions for Kent County

Kent County setting is similar to EBP community setting.

Fall prevention program fits with community needs and interests… has been a previous prevention activity at Area

Agency on Aging of West Michigan in Kent County Kent County Michigan Public Health Institute

Workgroup has identified high rate fall related fatalities as a health concern

Interventions: HOWFunding possibilities • Grants• Donations• Fundraisers• Charitable Organizations• FoundationsSupport & Collaboration• Health Care Organizations• Other community partners

Interventions: WHO• TARGET POPULATION: the elderly citizens

of Kent county ages 65 and older• INTERVENTION STAFF: nurse manager,

direct contact nurse leader and direct care nursing staff

• PROGRAM PARTNERS: health care facilities, senior service agencies, community and charitable organizations, government agencies

Interventions: WHY To improve quality and

length of life in older adults

To prevent unintentional injuries for older adults

To prevent and decrease older adult deaths due to falls

( Pender, Murdaugh, & Parsons, 2011) (US Department of Health and Human Services,

2012)

Interventions: WHATKent County Older Adult Fall Prevention

Program1.Media Campaign: billboards, newspapers,

community flyers, TV, radio, internet, local magazine advertisement Awareness promotion Fall prevention education Promote access to fall prevention program

2.Multi-Factorial Program Activities Fall screening and education Community exercise and balance class Medication screening & referral Vision screening & referral In home fall risk assessment and modifications

Interventions: WHERE1.Base of Operation

Area Agency on Aging of Western Michigan Senior Center

Health care facility in Kent County Stand alone office space

2. Media Campaign: throughout Kent County3. Direct Service Activities

Individual homesHospitals, clinics & doctors officesCommunity CentersChurches & schoolsArea Agency on Aging of Western Michigan Senior

Center

Interventions: WHENStrategic Planning• PLANNING: January 9, 2012

oAssessment of internal & external environmentoReview of mission statement, philosophy, goals

& objectiveso Identification of strategies

• IMPLEMENTATION: August 1, 2012• EVALUATION OF PROGRAM:

oQuarterlyo Yearly(Clyne, 2011)

Evaluation: Desired Outcomes

1. Decrease in percentage of fatal falls occurring in target group (currently 89% of fatal falls in Kent county occur among residents 65+) (MPHI, 2011).

2. Decrease rate of fall related injuries in Kent County to a rate lower than the MI and US.

3. 100% of individuals that receive medical care for fall related injuries will be offered fall prevention education and screening

4. Increased participation with community fall prevention screenings from baseline (currently zero).

5. Seniors age 65+ years residing in homes built before 1939 will be offered fall prevention education, screening and in home assessment.

6. intervention for at least one fall risk factor for client’s accepting in home assessment and home modification AEB(a) decrease of a modifiable risk factor(b) education provided directed toward non-modifiable risk factor.

Intervention Evaluation: Time FrameProgram participants will receive post-

intervention follow-up • Immediately after intervention• 3 months• 6 months

(Merrett et al., 2011)

Intervention Evaluation: MethodAt each client interaction• Fall Assessment• Four validated assessment tools:

used to identify improvements or declines in target population1. Berg Balance Scale (Berg et al)2. Timed Up and Go (Podsiadlo &

Richardson)3. Activities-specific Balance

Confidence (Myers et al)4. Reintegration to Normal Living

Index-Postal (Daneski et al)(Merrett et al., 2011)

Evaluation: MethodContinued… If supporting evidence

suggests interventions are effective, measurement of increases in the percent of population adopting or avoiding at risk behaviors could be utilized as indicators.

Conclusion• In conclusion, Kent County has an increase

risk of falls within the elderly population because of health and environmental problems which will be addressed through individual and community interventions aimed at decreasing risk factors through social media, and single and multifactorial approaches.

• Please feel free to email or post to the presentation discussion link questions about the material. Thank you, Group 3

ReferencesAAAWM. (n.d.). Kent county services. Retrieved from Area Agency on Aging of West Michigan website:

http://www.aaawm.org/ services/ kentAAAWM. (2010). Fall prevention awareness activities. Retrieved from Area Agency on Aging of Western Michigan

website: http://www.aaawm.org/ organizational_news/ 20100902/ Fall_Prevention_Awareness_ActivitiesAlliance for Health. (2012). About. Retrieved from http://afh.org/Appollonio, D. E., & Malone, R. E. (2009). Turning negative into positive: Public health mass media campaigns and

negative advertising. Health Education Research, 24(3), 483-495. doi:10.1093/ her/ cyn046CCFP. (2010, June 24). Clinical approach. Retrieved from Connecticut Collaboration for Fall Prevention website:

http://www.fallprevention.org/ pages/ clinicians.htmCCWG. (2012). Working together. Retrieved from Kent County Community Collaboration Work Group website:

http://www.ccwg.info/ default.htmClyne, M. E. (2011). Strategic planning, goal-setting, and marketing. In P. Yoder-Wise, Leading and managing in

nursing (5th ed., pp. 309-323). St. Louis, MO: Elsevier Mosby.Costello, E., & Edelstein, J. E. (2008). Update on falls prevention for community-dwelling older adults: Review of

single and multifactorial intervention programs. Journal of Rehabilitation Research and Development, 45(8), 1135-1152. doi:10.1682/ JRRD.2007.10.0169

Gray-Micelli, D. (2008, January). Nursing standard of practice protocol: Fall prevention. Retrieved from Hartford Institute for Geriatric Nursing website: http://consultgerirn.org/ topics/ falls/ want_to_know_more

Healthy People 2020. (2012, February 8). Older Adults. Retrieved from U.S. Department of Health and Human Services website: http://healthypeople.gov/ 2020/ topicsobjectives2020/ objectiveslist.aspx?topicId=24#6378

Healthy People 2020. (2012, March 1). Injury and violence prevention. Retrieved from U.S. Department of Health and Human Services website: http://healthypeople.gov/ 2020/ topicsobjectives2020/ objectiveslist.aspx?topicId=24#6378

ReferencesInfo MI. (2012). Kent County Michigan organization directory. Retrieved from http://www.infomi.com/ dir/ org/

community.php?county=KentKent County. (2012). Access Kent. Retrieved from http://www.accesskent.com/Merret, A., Thomas, P., Stephens, A., Moghabghab, R., & Gruneir, M. (2011). A collaborative Approach to Fall

Prevention. Canadian Nurse, 107(8), 24-29.MDCH. (2009). Death and crude death rates. Retrieved from http://www.mdch.state.mi.us/ pha/ osr/ chi/ Deaths/

leadUS/ COUS.asp?DxId=1&CoName=Kent&CoCode=41Michigan Public Health Institute [MPHI]. (2011). Kent County 2001 community health needs assessment and health

profile. Retrieved from http://www.kentcountychna.org/ pdfs/ KentCoCHNA_Final.pdfMPHI. (2012). Kent county: Working together for a healthier tomorrow. Retrieved from Michigan Public Health

Institute website: http://www.kentcountychna.org/ about.htmlMSHDA. (2012). Home improvement. Retrieved from Michigan State Housing Development Authority website:

http://www.michigan.gov/ mshda/ 0,4641,7-141-49317---,00.htmlNational Information Health Center. (2012, February 11). Lower your risk of falling. Retrieved from U.S. Department

of Health & Human Services website: http://www.healthfinder.gov/ prevention/ ViewTopicFull.aspx?topicID=17Onboard Informatics. (2010). Kent County, Michigan. Retrieved from City-data.com website: http://www.city-

data.com/ county/ Kent_County-MI.htmlPender, N., Murdaugh, C., & Parsons, M. A. (2011). Health promotion in nursing practice (6th ed.). Upper Saddle

River, New Jersey: Pearson.Senior Meals Program, Inc. (2011). Senior pantry. Retrieved from http://www.seniormealsonwheels.org/ senior-pantryU.S. Census Bureau. (2012, January 31). Kent County, Michigan [State & county quick facts]. Retrieved from

http://quickfacts.census.gov/ qfd/ states/ 26/ 26081.html