Dr. Marcia Ory, PhD, MPH Doris Howell, MPH Alyson Zollinger, MPH Program on Healthy Aging Texas A&M Health Science Center Aging in Texas Conference Houston,

Dr. Marcia Ory, PhD, MPHDoris Howell, MPHAlyson Zollinger, MPHProgram on Healthy AgingTexas A&M Health Science Center

Aging in Texas ConferenceHouston, TXJune 2013

NEW PROGRAMS IN TEXAS FOR FALLS PREVENTION

THE PROBLEM: NATIONALLY

Falls are a threat to the lives, independence, and health of older adults.

Every 18 seconds in the U.S., an older adult is ends up in an emergency department as a result a fall.

Every 35 minutes an older adult dies as a result of the injuries from a fall.

Several older adults develop a fear of falling (those who have fallen & those who have not).

Fear can cause older adults to limit their activities—leading to lead to reduced mobility & physical fitness—increasing future risk of falling.

THE PROBLEM: TEXAS

Falls are a threat to the lives, independence, and health of older Texans

Fall-related hospital charges related to hip fractures exceeded $500 million statewide.

The average hospitalization lasts approximately 6 days

The total charges of fall-related hospitalizations for all adults over age 50 years were >$1.9B

The average charge was approximately $37,000 per individual hospitalized from a fall

TEXAS A&M PROGRAM ON HEALTHY AGING: PROPOSED ACTIVITIES

Increase capacity to deliver falls-risk reduction programs

• Provide information to community leaders on community-based programs and trained lay leaders.

• Provide information on STEADI to primary care doctors serving older adults.

• Provide information on PT-based Otago program and trained PTs.

• Provide information on falls risk screening and referral to all certified CHWs and offered certified training to CHWs.

• Provide TA to State Falls Coalition Program on expanding programs and partnerships.

• Provided TA to State Falls Coalition Program on expanding programs and partnerships

Increase exposure to information on EB programs

• Inform older Texans about available falls-risk reduction programs and clinical practices

• Increase the engagement of older adults in community-wide falls reduction programs.

• Get older adults to recruit family members and friends

• Identify older adults who can get trained as lay leaders

Impact, Sustainability & Scalability of Multi-Component

Falls Prevention Programs

•Focus on three state-wide injury programs

•- Colorado•- New York•- Oregon

•Determine the impact of fall prevention interventions•- Community & home-based

programs•- Physician screening and

referrals•- System changes

Policies, Programs, and Partners for Falls Prevention

• Focus on national and community levels

• - Collaboration between Texas A&M and North Carolina

• Document falls prevention policies

• - 4 State Case Studies• NC, TX, Hawaii, NH

• Examine barriers and facilitators associated with Otago

• Facilitate uptake of evidence-based programs through the use of CHWs

TEXAS A&M: CDC- FUNDED SPECIAL INTEREST PROJECTS

PROGRAM ON HEALTHY AGING ACTIVITIES NEXT STEPS

Evidence-Based Program (EBP) Resource Exchange

A Texas A&M Physicians Group 1115 Health Transformation Program

Facilitate the expansion of the

types and location of evidence-based program delivery

sites

Unify Resources and Provide

Training, Technical Assistance and

Evaluation

Create Cost Savings for a

Growing Aging Population

For further information contact:Doris Howell, Project [email protected].

New Physical Activity Programs for Fall Prevention in Texas

Developing, Implementing, and Disseminating a Falls Prevention Curriculum for Community Health Workers

Q&A

CASE EXAMPLES

AND DISCUSSIO

N

New Physical Activity Programs for Fall Prevention in Texas

Presentation Overview

Fit & Strong!• Program Descriptions• Implementation

“New” Texercise• Program Description• Implementation

Future Directions

Q&A

AcknowledgementThe evaluation of Fit & Strong! was funded with a pilot grant from the Community Research Center for Senior Health at Scott & White Healthcare with additional funding from St. Joseph’s Healthy Communities.

The evaluation of the Texercise program was funded through the Texas Department of Aging and Disability Services.

Fit & Strong!

Fit & Strong! Program Background

Implementation & Evaluation September 2012 – August 2013

Modified original program to utilize lay leader model

Texas A&M Health Science Center awarded grant from the Community Research Center for Senior Health (CRC-SH) to implement Fit & Strong! program in Texas

Fit & Strong!: existing evidence-based physical activity/behavioral change program created by the Center for Research on Health and Aging at the University

of Illinois

Fit & Strong! Program ComponentsParticipant Engagement• Physical Activity 60 min• Education 30 min

Trained facilitators• Classes led by 2 trained facilitators

Program Length• Eight week program• 3 days each week for 90 minutes

Demonstrated Benefits of Participation• Confidence in ability to exercise• Lower-extremity stiffness & pain• Improved physical activity

Fit & Strong! Program Modifications

Traditional Fit & Strong!

Class Leaders: Physical Therapists/Certified Exercise Instructors

Population: Targeted older adults with

osteoarthritis

Setting: Urban

Texas Fit & Strong!

Class Leaders: Lay Leaders

Population: All older adults

Setting: Peri-Urban & Rural

Fit & Strong! Implementation

2012 Spring

• Selection of Fit & Strong! program

2012 Summer

• Lay Leader Training

• Participants recruited

• 5 sites identified

2013MILESTONES• 12 total classes• 180+ participants

• Building Infrastructure• Master Training of program

leaders• First train-the trainer session

conducted for dissemination and sustainability

Fit & Strong! Implementation

Obstacles• Time Commitment

(3x/wk)• Identifying

“qualified” Lay Leaders

• Equipment

Successes• High Response

from Communities• Overall Satisfaction

from Participants• Health and

Functional Improvements

Fit & Strong! Can Make a Difference*Fit & Strong! Makes a Difference

Calculate % improvement:baseline-post/baseline

*Preliminary analyses from first three classes held in Bryan, College Station, and Navasota in the Brazos Valley in 2012

Improvements in:• Confidence in exercise• Lower-body stiffness and

pain• Physical Activity

Adverse Effects:No negative effects reported

Fit & Strong! : What People are Saying

70 years old and Fit and Strong.  What more could I ask for?  The Fit and Strong program has become an essential to my everyday living.  It has infiltrated my every movement and thought. 

What a difference eight solid weeks of exercises has made me what I am today—limber; tension-reduced neck and shoulders; mindful of my every step; conscious of my eating habits.  You cannot ask for a more information, action packed program taught by people who are in the know. 

I have taken the course twice and hope to continue for a third, fourth, etc. times.  It has changed me and I am better for it.

-Fit & Strong! Participant

Texercise

Fit For The Health of It!

New Texercise Program Background

Implementation for evaluation September 2012 – August 2013

Creation of structured Texercise program incorporating behavioral change principles

Texas A&M Health Science Center awarded RFI in 2012 to evaluate Texercise program

DADS seeking evidence-based status for existing program

New Texercise Program Components

Participant Engagement• Physical activity 30-45 min• Education focusing on physical activity and nutrition topics

Trained Facilitators• 1 trained facilitator

Program Length• 12 Week Program• 2 x/wk for 90 min each

Potential Benefits of Participation• Increased self-efficacy (pre/post)• Improved physical activity and nutrition behaviors• Improved mobility (TUG)

New Texercise Program: What People Are Saying About the Program

“Due to the lack of physical activity opportunities for the elderly, transportation, and distance to PA opportunities, the Texercise program is a great fit for rural residents.

There is much more to the program than solely physical activity. There is a social component.

The program is not too intensive. It allows participants to maintain physical activity.”

-Robert Shaw, Executive Director of the Madison Health Resource Commission

Texercise Program Modifications

Traditional Texercise

Duration: 12 weeks

Class Leaders: Varied, no training

Class format: Unstructured PA &

education

New Texercise

Duration: 10 weeks (2 weeks recruitment)

Class Leaders: Trained

Class format: Structured PA & education

New Texercise Program Implementation

2012• Begin research• Identify EBP’s PA

Programs• What works?

2012• Develop

Manual• Facilitator

Training• Identify Sites

2013• Facilitator

Trainings• Fidelity Checks• Program

Support• Reporting

New Texercise Program Implementation

Obstacles• 10 Week Commitment• Fidelity (program adherence

among facilitators)• Mixing of existing program

with “new” program

Successes• Participants enjoy

interaction• Focuses on both nutrition

and physical activity• Time flexibility-2

days/week, rather than 3 days/week

• Appropriate for both urban and rural areas

• Feasible for community adoption (e.g. no equipment requirements)

New Texercise Program Products

Structured Program Implementation Manual

Facilitator Training Protocol

Review of Texercise History and Reach

Report on Stakeholders Perceptions

Published Manuscript on Outcomes

Future Direction of Programs

Fit & Strong• Expansion into other communities• Adaptation for specific populations (i.e. Cancer)

Texercise• Development of online training• Offer the New Texercise program in communities

Both Programs• Offer programs as complementary programs to other

evidence-based programs (AMOB, CDSMP, DSMP)

Question & Answer

DEVELOPING, IMPLEMENTING, AND DISSEMINATING A FALLS PREVENTION CURRICULUM FOR COMMUNITY HEALTH WORKERSDoris Howell, MPH

Julie St. John, MA, MPH, CHWI, DrPH

Christopher E. Beaudoin, PhD

Tiffany E. Shubert, PhD, MPT

Cherie Rosemond, PT, PhD

Marcia G. Ory, PhD, MPH

Matthew Smith, PhD, MPH, CHES

This project was funded by the Centers for Disease Control and Prevention, Prevention Research Center, Special Interest Project—cooperative agreement number 5U48DP001P240. Materials were created by the grantee and any sub-grantees thereof, and does not necessarily reflect the official position of the CDC. The CDC makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership.

Acknowledgement

Background & Objective

Background

• Policies, Programs, and Partners for Fall Prevention (PPPFP) study incorporates

• multi-level intervention approaches to address fall prevention• PPPFP uses several dissemination research methodologies—

including training Community Health Workers (CHWs) to deliver fall prevention messages

Objective

• Discuss the development, implementation, & dissemination of the falls prevention CHW curriculum

The Solution: CHWs

Community Health

Workers

Frontline workers

Liaisons

Facilitators

Trusted

Paid or volunteers

Same attributes

The Strategy: Why Utilize CHWs in Fall Prevention?

The bottom line• CHWs often interact with older adults• CHWs are generally trusted by older adults

The result• CHWs are a natural avenue to help older adults to prevent

& reduce falls & related injuries • State-wide & national searches did not yield a current,

comprehensive, fall prevention curriculum for CHWs• This finding lead to the development of a CHW, evidence-

based, fall-prevention curriculum

Curriculum Development

Researched current fall prevention curricula

Identified best practice

strategies to incorporate in

CHW curriculum

Outlined key concepts to teach CHWs regarding fall prevention &

reduction

Brain-stormed “fall prevention”

concepts & curriculum outline with groups of

CHWs

Incorporated ideas and word

choices from brain-storming sessions into the curriculum development

Curriculum Development

Involved core group of certified CHWs & CHW instructors in curriculum

development (in English & Spanish)

Fall prevention experts

reviewed & revised

curriculum to check content &

accuracy

Pilot tested curriculum with CHWs (English

& Spanish)

Refined curriculum based on

feedback from content experts & pilot testing with CHWs

Disseminated curriculum through in-

person and on-line trainings (English & Spanish)

CHW Fall Prevention Curriculum Framework & Purpose

Utilized best practice models:• Training CHWs• Adult learning theory• Message tailoring

Overall Purpose of Curriculum:• CHWs receiving the trainings implement the

information to connect at-risk older adults to medical services & evidence-based community fall prevention programs

Curriculum Objectives

Explain why preventing and reducing falls and injuries among older people is especially important

Increase awareness of risk factors for falling inside and outside the home

Develop and augment observation, reporting, and communication skills to reduce fall and injury risk factors

Describe ways to help prevent or manage client falls

Curriculum Objectives

Develop falls prevention plans

Explain and discuss different approaches to changing health behaviors

Teach health behavior change strategies to CHWs and residents

CHWs & residents apply behavior change strategies to falls prevention and reduction

Curriculum OutlineSession 1: Ways to Prevent Falls and Related Injuries in Older Adults-

the Role of Fall Prevention

Welcome & introduction (pre-test)

Facts on falls (statistics, falls are predictable & preventable)

Individual & environmental fall risk factors

Summary of identification & reduction of fall risk factors

Closing (post-test & evaluation)

Curriculum OutlineSession 2: Learning Skills to Reduce Falls and Related Injuries

Welcome & introduction (pre-test)

Risk factor review & managing falls

Using communication skills to reduce older adults’ risks for falling

Identifying fall prevention resources in your community

Closing (post-test & evaluation)

Curriculum OutlineSession 3: Helping Older Adults Change Their Health Behaviors to

Prevent Falls and Related Injuries: Health Behavior Change Theories

Welcome & introduction (pre-test)

Theories of health behavior change

Review of fall risk factors, strategies for managing falls, & tailored communication

Applying behavior change concepts to falls prevention & reduction

Working with residents/CHWs to implement behavioral changes to prevent falls

Closing (post-test & evaluation)

Dissemination

The curriculum was first offered online in Texas—providing CEUs

as part of the state CHW recertification process.

Curriculum was adapted & disseminated to North Carolina

for in-person training.

Curriculum made available nationally via the online formats.

Implications & Innovations

Innovation:• CHWs actively involved in all phases of the

project (research, curriculum input, development, pilot-testing, training conduction, & dissemination)

• Combined multiple evidence-based practices & strategies (fall prevention, CHW training, message tailoring, CBPR)

Implications: • CHW-tailored curriculum can reach larger

proportions of high-risk older adults outside of healthcare settings through evidence-based fall prevention strategies via message tailoring & utilization of CHWs

Questions & ReferencesQuestions?

References• National Council on Aging (NCOA) & Paraprofessional Healthcare

Institute (PHI) (2010). Fall Prevention Awareness: Enhanced Training Curriculum for Home Health Aides. Funded by the U.S. Department of Labor’s Employment and Training Administration—DOL502(e). http://phinational.org/training/resources/phi-curricula/fall-prevention-awareness

• Centers for Disease Control and Prevention (2012). Falls Among Older Adults: An Overview. http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

• Minnesota Falls Prevention. “Know your Medications.” http://www.mnfallsprevention.org/consumer/medications.html

Question & Answer