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Preventing Falls in Older Persons Living in the Community

Preventing Falls in Older Persons Living in the Community. using Constructs of the H ealth Belief Model. “Falls prevention is a challenge to population aging.” WHO. Falls are the second leading cause of accidental or unintentional injury deaths in older persons .(WHO, 2007) .

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Preventing Falls in Older Persons Living in the Community

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  1. Preventing Falls in Older Persons Living in the Community using Constructs of the Health Belief Model

  2. “Falls prevention is a challenge to population aging.” WHO

  3. Falls are the second leading cause of accidental or unintentional injury deaths in older persons.(WHO, 2007)

  4. In 2000, direct medical costs for fatal and nonfatal fall injuries in the United States totaled over $19 billion (CDC, 2008). For older persons, falls result in increased dependence, loss of autonomy, confusion, immobilization, depression, and restriction in daily activities.

  5. Falls are associated with admission to a nursing care facility. • Falling without serious injury increases the risk of skilled nursing facility placement by three-fold. • Falling with a serious injury increases SNF placement by ten-fold.

  6. Healthy People 2020older adults: objective 11 Reduce the rate of emergency department visits due to falls among older adults • 2007 – 5,235.1 ed visits per 100,000 • 13,580 ed visits per 100,000 >85 years • Target for 2020 – 10% improvement – 4,711.6 ed visits per 100,000

  7. Risks for falling • Previous falls • Balance, gait, and strength impairment • Use of specific medications • Female gender • White race • Visual impairment • Tremor • Incontinence • Limitations in activities of daily living • Environmental hazards

  8. Screening All older persons who are under the care of a health professional (or their caregivers) should be asked at least once a year about falls, frequency of falling, and difficulties in gait or balance (AGS & BGS, 2011, p. 149-150).

  9. Interventions

  10. single • Cardiac pacing • Vision improvement • Home modifications • Medication reduction • Physical therapy or exercise

  11. Multifactorial/targeted • Balance, gait, and strength training such as tai chi • Modifying the home to promote safe performance of ADLs • Treating vision impairment • Minimizing medications • Managing postural hypertension • Managing heart rate and rhythm • Correcting vitamin D deficiency • Managing foot and footware problems

  12. What’s the problem?

  13. Health Belief Model • 1950’s • Hochbaum, Rosenstock, and Kegels • Developed in response to the failure of a free TB health screening program • Most used theory in health education and health promotion • Used to explore a variety of short and long-term health behaviors, including sexual risk behaviors and transmission of HIV/AIDS

  14. Original Theoretical Constructs

  15. Perceived seriousness • Belief about the seriousness or severity of a disease • Based on medical information or knowledge

  16. Perceived susceptibility • One’s opinion of chances of getting a condition • Prompts men who have sex with men to use condoms in an effort to decrease susceptibility to HIV infection.

  17. Perceived benefits • People adopt healthier behaviors when they believe the behavior will decrease their risk of developing a disease • Plays an important role in adoption of secondary prevention behaviors • Colon cancer screening • BSE

  18. Perceived barriers • One’s perception of the tangible and psychological obstacles or costs in the way of him/her adopting a new behavior • The most significant construct in determining behavior change • Hispanic women seeking pap tests • Painful • Not knowing where to go

  19. Cues to Action • Strategies to activate readiness • Examples include illness of a family member, media reports, mass media campaigns, advice from others, reminder postcards from a health care provider, of health warning labels on a product

  20. Self-efficacy • Added to the four original constructs in 1988 • The belief in one’s own ability to do something (Bandura, 1977) • A significant factor in not performing BSE is fear of being unable to perform it correctly • Exercise self-efficacy and exercise barriers are the strongest predictors of whether one practices behaviors to prevent osteoporosis

  21. Application “I pass with relief from the tossing sea of Cause and Theory to the firm ground of Result and Fact.” Winston Churchill

  22. Health Belief Model

  23. Theory in action: activity Using the HBM, brainstorm to identify strategies to address • Perceptions of seriousness • Perceptions of susceptibility • Perceived Benefits • Perceived Barriers • Self-efficacy that might be used to develop a falls prevention program for older persons living in the community.

  24. References • Champion, V.L. & Scott, C.R. (1997). Reliability and validity of breast cancer screening belief scales in African American women. Nursing Research, 46(6), 331-337. • Chen, J. Y., Fox, S.A., Cantrell, C.H., Stockdale, S.E., & Kagawa-Singer, M. (2007). Health disparities and prevention: racial ethnic barriers to flu vaccinations. Journal of Community Health, 32(1), 5-21. • Glanz, K. & Rimer, B.K. (2005). Theory at a Glance: A Guide for Health Promotion Practice. National Institute of Health.

  25. Gozum, S. Karayurt, O, Kav, S., & Platin, N. (2010). Effectiveness of peer education for breast cancer screening and health beliefs in eastern Turkey. Cancer Nursing, 33(3), 213-220. • Hayden, J.A. (2009) Health belief model. In Introduction to Health Behavior Theory. Burlington, MA: Jones & Bartlett. • Turner, l.W., Hunt, S.B., DiBresso, R., & Jones, C. (2004). Design and implementation of an osteoporosis prevention program using the health belief model. American Journal of Health Studies, 19(2), 115-121.

  26. American Geriatrics Society and British Geriatrics Society. Panel on Prevention of Falls in Older Persons (2011). Summary of the updated American Geriatrics Society and British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society, 59 (1), 148-157. • Centers for Disease Control and Prevention (CDC). (2008). Self reported falls and fall-related injuries among persons aged >65 years – United States, 2006. Morbidity and Mortality Weekly Report, 57(9), 225-229. • Mahoney, J. E. (2010). Why multifactorial fall-prevention interventions may not work. Archives of Internal Medicine, 170(13), 1117-1119. • Nardi, D. A., & Petr, J. M. (2003). Community health and wellness needs assessment. Clifton Park, NY: Delmar Learning. • Tinetti, M. E., & Kumar, C. (2010) The patient who falls. The Journal of the American Medical Association, 303(3), 258-266. doi: 10.1001/jama.2009.2024 • U.S. Department of Health and Human Services. (n.d.) Healthy People 2020. Washington, D.C. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020 • World Health Organization (WHO). (2007). WHO global report on falls prevention in older age. Geneva, Switzerland: Author. Retrieved from http://www.who.int/ageing/publications/Falls-prevention7March.pdf • Yamashita, T., Jeon, H., Bailer, A. J., Nelson, I. M., & Mehdizadeh, S. (2011). Fall risk factors in community dwelling elderly who receive medicaid supported home and community cased care services. Journal of Aging and Health, 23(4), 682-703. doi: 10.1177/0898264310390941

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