Falls Risk Assessment Tool (FRAT) 65+
Robert Callahan, Joseph Ferreri, Jena LaLone, Lauren Salato, and Emma Whittle
HLH 380
Fall 2013
11/25/2013
Source: http://www.myvisiontest.com/img/upload/falling_man.jpg
Overview
Be able to list three risk factors of falls that
exist within a household
Know some individual behaviors that increase
the likelihood of falls
What are the benefits of resistance training in
older adults?
What barriers exist within a community that
could increase the chance of older adults
falling?
The Problem: Falls among Adults 65+
Adults who fall once are three times more likely to fall again within a year (O’Loughlin,1993)
In 2010, the direct cost of falls was $30 billion (Centers for Disease and Control and Prevention, 2013)
Internationally, falls among adults ages 65 and older are the leading cause of fatal injuries (Carlson, York, & Primomo, 2011)
Approximately 22,000 older adults died from unintentional fall injuries in 2010 (Centers for Disease Control and Prevention, 2013)
PRECEDE PROCEED: Epidemiological
Phase
35% of individuals over the age of 65 fall at least once each year (Harvard Women’s Health Watch, 2009)
90% of fall-related injuries are hip fractures (Hosseini and Hosseini, 2008)
Individuals who fall and do not receive help can experience symptoms such as pneumonia, hypothermia, pressure sores, and dehydration (Yoshida-Intern, 2007)
Psychological effects include increased fear of falling and loss of confidence (Hosseini and Hosseini, 2008).
Source: http://lanzonemorgan.com/blog/wp-
content/uploads/2013/09/Fall-Waring.jpg
Ecological Model
Level I: Innate Factors
Intrinsic Factors: muscle weakness and disability (Hosseini and Hosseini, 2008).
Impaired vision, hearing problems, hypertension, cognitive impairment, dizziness, and neurological problems, such as Parkinson’s Disease (Hosseini and Hosseini, 2008).
According to the CDC, falls death rates were 40% higher among men than women, but falls-related injuries were two times higher for women as to men (2013)
Blacks and Hispanics have lower rates of falls as to Whites (Centers for Disease Control and Prevention, 2013)
Ecological Model cont’d.
Level II: Individual Behaviors
Decreased muscle strength along with impaired balance are both risk factors for falls
Proper physical exercise also improves balance, mobility and reaction time, all of which are crucial factors to preventing falls (Days, 2002)
As people age they lose confidence in their ability to perform daily activities and begin to require more assistance with daily activates (Days, 2002).
Elders tend to complete daily tasks at a higher rate than necessary or capable and experience a fall
The misuse of medications can cause side effects such as dizziness and numbness which can lead to impairment
Ecological Model cont’d.
Level III: Social, Family, and Community Networks
Having family and friends support and care for elders can be key to
reducing the risk of falling by having someone physically present
Community support is important because young adults and
teenagers can look after the elders within a neighborhood
Caregivers can help share the responsibilities of an elder, making
their tasks less stressful and taxing
Members of a community can help make the neighborhoods safer
by repairing poorly conditioned sidewalks and assembling hand
railings at local facilities
Ecological Model cont’d.
Level IV: Living and Working Conditions
Poor working conditions include long hours, poor lighting, and
limited walking space
Unsafe living conditions include clutter, throw carpets or rugs, and
many stairs
Elders with wheelchairs face many barriers to transportation within
the home and workplace
Inadequate lighting and space can cause an elder to fall as they
have decreased coordination and balance to adjust to these
changes
Ecological Model cont’d.
Level V: Broad Social, Cultural, Economic, Health, Environmental Conditions and Policies at the Global, National, State, and Local Levels
Barriers: access to health care, funds to afford health care
Elders who live independently are more likely to experience a fall and not be able to reach a family member for at least 4 hours (Centers for Disease Control and Prevention, 2013)
Hospital visits require transportation which can be limited for older adults who no longer drive and need assistance
Older adults can experience falls when doing everyday living activities such as getting the mail
Poor environmental conditions include the lack or poor quality of sidewalks or pathways
Conclusion
Bone density plays an influential role in a person’s ability to fall without
sustaining an injury and reduces the risks of developing osteoporosis later
on in life (World Health Organization, 2007).
The general focus of this campaign is to help educate adults 65 and older
how to improve their health and enhance quality of life.
We decided to focus on certain topics such as living conditions in
households, intake of medications, and intrinsic factors such as muscular
weakness, balance and coordination
Population
Cortland County, New York
Adults ages 65 years and older
14.1% of the Cortland County population (United States Census Bureau, 2013)
Those from that age group that attend the Cortland County YMCA located on Tompkins Street
Target Audience # 1: Cortland
County Elders
Elders, 65 years and older
Elders would be considered our primary
audience.
We are trying to directly reach the elderly
population
Target Audience #1: Channels and Strategies
To reach our primary audience we choose 3
channels:
Community Channel- Using brochures that will be
placed in doctors offices, barber shops, and
grocery stores
Mass Media- Our PSA would be played on the
radio and on the TV during the most common times
between 5 and 7 pm.
Organizational Channel- We would use posters and
flyers to promote our educational program at the
YMCA.
Target Audience # 2: Family and Friends
The secondary Audience is friends and
family
Although we are not looking to make
changes among these populations, we are
looking to educate friends and family, who
can help us reach our primary audience.
Target Audience #2: Channels and Strategies
Community Channel- Our brochures and flyers will be placed around the community where family member and friends can view them.
Mass Media Channel- Our PSA can be viewed by family and friends who watch TV and listen to the radio
Organizational Channel- Flyers and posters that are informing people on the educational program can be seen by family or friends and passed on to elders.
All three of these channels can be viewed by our secondary audience where they can then pass on the information to the elders that they know.
Overview FRAT 65+ Campaign
Education via Cortland County Family YMCA:
- resistance training (physical therapist)
- modifying conditions in a household (occupational
therapist)
30 second radio PSA that addresses the issue of hazardous
conditions in households; promotes HCR Home Care
Paper brochure on intake of medications is to be included in
doctor’s offices
Creative Brief
Intended Audience: Tone:
- Adults 65+ in Cortland County, NY - Light, emotional, poise
- Caregivers, family, and friends
Objectives/Key Promise: Media:
Raise awareness about home - Public Service Announcement
modifications, resistance training, - Brochures
and medication intake - Poster
Obstacles: Openings:
- Embarrassment from previous falls - Cortland YMCA
- Different general state of health - Radio
- Doctor’s Visit
Creative Considerations:
- Language: English Supporting Reason:
- Health disparities such as - Reducing mortality rates among
socio-economic status and language barrier those who fall
will be considered
The Health Issue
Internationally, falls among adults ages 65 and older are the
leading cause of fatal injuries (Carlson, York, & Primomo,
2011).
FRAT 65+ Goals and Objectives
To reduce/prevent falls among the elders aged 65+
Increase awareness of what behaviors increase the risk for falling including climbing, reaching and bending (Kronfol, pp. 2)
Increase knowledge of risk of drug combinations that can increase the risk of falling
Promoting exercise to improve balance, mobility and reaction time (Days, 2002).
Promote the importance of a healthy diet rich in calcium (World Health Organization, 2007).
Promote hiring trained health and social service professionals to assist elder with tasks which require balance and muscle strength (Bookman & Kimbrel, 2011).
Target Audiences
Primary- Male and female elders aged 65+
Secondary- Friends and family members of elders, trained health
and social service professionals hired by families as additional
caregivers
Key Messages
Primary Audience
Remove clutter or hazards around the home
Taking proper dosage of medication(s)
Work to improve body strength and balance to have the coordination needed to walk/live independently
Secondary Audience
Make sure the elder’s home is safe to live in independently
Be aware of the side effects of medication(s) elders are taking
Be there for physical and mental support so elders do not feel isolated or helpless
Channels & Strategies
Mass Media
TV is heavily relied on by elders in their homes because they
have the time and opportunity, especially after retirement
(Robinson et al., 2004 cited by Mares & Woodward, 2006).
Community
Brochures can be strategically placed at grocery stores and
doctor’s offices. These are common places both audiences
visit to get the necessary food and health care services they
may need.
Organizational
Posters are a beneficial tool in helping implement a health
campaign. Spreading awareness to elders, family members,
and caregivers plays an influential role in reducing the risk of
falls.
Materials Developed
Mass Media
A 30 second Public Service Announcement (PSA) describing
the potential hazardous living conditions that can contribute
to falls in the home - this PSA will be aired via TV and radio
throughout all hours during the day along with prime time
hours, such as the morning and evening news
Community
A brochure that discusses tips and facts on medication use
that can be available to the primary and secondary
audiences in the community
Organizational
Posters and flyers that will be placed around the community
advertising dates and times for FRAT 65+ education classes
at the Cortland County YMCA
Evaluation
For those who have participated in the campaign, 10% of those participants will have a better understanding of how to reduce falls
While the FRAT 65+ campaign is being carried out, administering surveys and interviews to the participants will allow us to measure our effects
After the two-year campaign is complete, surveys and interviews will be conducted in order to determine whether or not the amount of falls decreased
Baseline data will be collected from physicians’ and clinics as well as the adults 65 and older that attend the YMCA and their caregivers, before the implementation of the campaign
The Social Cognitive Theory
Reciprocal Determinism- Increasing awareness of how multiple factors such as how some of medications can distort coordination and combined with environmental hazards increase the chances of a fall occurring.
Behavioral Capability- The implementation of free clinics and classes focused on the importance of actively aging and a health diet rich in calcium
Expectations- Reducing the number of falls that occur in Cortland elders aged 65+ as well as reducing fractures caused by falls among older adults, increasing confidence in not falling and increasing knowledge on the importance of activity aging and eating a healthy diet in rich in calcium.
Self-efficacy- Address that some elders may require assistance with their daily living activities which may require the hiring of caregivers
Observational Learning- Classes and clinics that are utilized in the FRAT 65+ campaign include group program based Tai Chi-type exercises or dynamic balance and strength training as well as floor coping strategies, nutrition programs, low intensity exercises, aerobic programs, water exercises and walking routes
Reinforcements- In order for there to be a proper implementation of the elderly fall prevention program it is critical to make sure elders have access to affordable care, which includes governmental assistance.
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