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Planned Community Change:

Ferris State University ~ NURS 340 ~ Spring Semester 2012 Cheryl Howard , Joan Kronlein, Danielle Williams, Natalie Russell. Planned Community Change:. Older Adult Fall Prevention Program Kent County, Michigan . (MPHI , 2011) ( U.S.Census Bureau, 2012).

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Planned Community Change:

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  1. Ferris State University ~ NURS 340 ~ Spring Semester 2012 Cheryl Howard, Joan Kronlein,Danielle Williams, Natalie Russell Planned Community Change: Older Adult Fall Prevention Program Kent County, Michigan

  2. (MPHI, 2011) (U.S.Census Bureau, 2012) Introduction: Kent County, Michigan Kent County Facts • Covers 864square 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

  3. Health Problem 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)

  4. Analysis of the 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 reporteddue 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)

  5. 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)

  6. Critical Thinking What 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)

  7. Problem Statement There is an increased risk of fall related injury and death amongKent County, Michigan residents aged65+ 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).

  8. Relevant Change Model: HPM The Revised Health Promotion Model (HPM)for the individual… • Prior Related Behavior • perceived benefits and barriers • perceived self-efficacy • activity related affect • Personal Factors • interpersonal influences:norms,social support, modeling • situational influences: options, demands, aesthetics • Commitment to a Plan of Action • Immediate competing demands & preferences • Results in Health Promoting Behavior [for the individual](Pender et al., 2011)

  9. Community Change Models Community 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).

  10. 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)

  11. Existing Community Resources for Problem 1. 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)

  12. 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)

  13. Relevant Evidence Based Practice:Primary Prevention Effectiveness 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

  14. Relevant Evidence Based Practice:Secondary Prevention Single 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 program Multi-factorial approaches • Combination of some or all single interventions (Costello and Edelstein, 2008)

  15. Evidence Based Practice: Summary Effectiveness of Falls Prevention Programs • Increaseswith a history of previous fall • Involves medication/vision screens • Exercise is key • Includes home assessment and/or modifications • Multi-factorial approach recommended Effectiveness of Media Campaigns • Increases when effects of unchanged health behavior are understood by public (Appollonio & Malone, 2009)(Costello and Edelstein, 2008)

  16. 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

  17. Interventions: HOW Funding possibilities Grants Donations Fundraisers Charitable Organizations Foundations Support & Collaboration Health Care Organizations Other community partners

  18. Interventions:WHO TARGET POPULATION: the elderly citizensof 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

  19. 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)

  20. Interventions: WHAT Kent County Older Adult Fall Prevention Program • Media Campaign: billboards, newspapers, community flyers, TV, radio, internet, local magazine advertisement • Awareness promotion • Fall prevention education • Promote access to fall prevention program • 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

  21. Interventions: WHERE 1.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 County 3. Direct Service Activities • Individual homes • Hospitals, clinics & doctors offices • Community Centers • Churches & schools • Area Agency on Aging of Western Michigan Senior Center

  22. Interventions:WHEN Strategic Planning • Planning: January 9, 2012 • Assessment of internal & external environment • Review of mission statement, philosophy, goals & objectives • Identification of strategies • Implementation: August 1, 2012 • Evaluation of program: • Quarterly • Yearly (Clyne, 2011)

  23. Evaluation: Desired Outcomes • Decrease in percentage of fatal falls occurring in target group (currently 89% of fatal falls in Kent county occur among residents 65+) (MPHI, 2011). • Decrease rate of fall related injuries in Kent County to a rate lower than the MI and US. • 100% of individuals that receive medical care for fall related injuries will be offered fall prevention education and screening • Increased participation with community fall prevention screenings from baseline (currently zero). • Seniors age 65+ years residing in homes built before 1939 will be offered fall prevention education, screening and in home assessment. • 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.

  24. Intervention Evaluation: Time Frame Program participants will receive post-intervention follow-up • Immediately after intervention • 3 months • 6 months (Merrett et al., 2011)

  25. Intervention Evaluation: Method At each client interaction • Fall Assessment • Four validated assessment tools: used to identify improvements or declines in target population • Berg Balance Scale (Berg et al) • Timed Up and Go (Podsiadlo & Richardson) • Activities-specific Balance Confidence (Myers et al) • Reintegration to Normal Living Index-Postal (Daneski et al) (Merrett et al., 2011)

  26. Evaluation: Method Continued… • 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.

  27. 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

  28. References AAAWM. (n.d.). Kent county services. Retrieved from Area Agency on Aging of West Michigan website: http://www.aaawm.org/‌services/‌kent AAAWM. (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_Activities Alliance 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/‌cyn046 CCFP. (2010, June 24). Clinical approach. Retrieved from Connecticut Collaboration for Fall Prevention website: http://www.fallprevention.org/‌pages/‌clinicians.htm CCWG. (2012). Working together. Retrieved from Kent County Community Collaboration Work Group website: http://www.ccwg.info/‌default.htm Clyne, 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

  29. References Info MI. (2012). Kent County Michigan organization directory. Retrieved from http://www.infomi.com/‌dir/‌org/‌community.php?county=Kent Kent 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=41 Michigan Public Health Institute [MPHI]. (2011). Kent County 2001 community health needs assessment and health profile. Retrieved from http://www.kentcountychna.org/‌pdfs/‌KentCoCHNA_Final.pdf MPHI. (2012). Kent county: Working together for a healthier tomorrow. Retrieved from Michigan Public Health Institute website: http://www.kentcountychna.org/‌about.html MSHDA. (2012). Home improvement. Retrieved from Michigan State Housing Development Authority website: http://www.michigan.gov/‌mshda/‌0,4641,7-141-49317---,00.html National 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=17 Onboard Informatics. (2010). Kent County, Michigan. Retrieved from City-data.com website: http://www.city-data.com/‌county/‌Kent_County-MI.html Pender, 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-pantry U.S. Census Bureau. (2012, January 31). Kent County, Michigan [State & county quick facts]. Retrieved from http://quickfacts.census.gov/‌qfd/‌states/‌26/‌26081.html

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