Fall Prevention Education Class for Community Dwelling Older Adults in Randolph County

Fall Prevention Education Class for Community Dwelling Older Adults

Jason Albright SPT

Introduction

It was midnight and the room was dark.  She was returning from the bathroom when the corner of a glass nightstand knocked her off balance.  She reached for the bed to catch herself, but missed and fell at the foot of the bed.  She attempted to get up, but felt a sharp pain in her hip.  She didn’t know what to do except try to get up to her feet.  After several attempts, she realized she wasn’t strong enough.  What was she to do?  The phone in the kitchen would be too difficult to get to.  It seemed as though her only option was to wait for her daughter to check in on her.  It didn’t take long for the cold to set in, so she pulled a blanket off the bed.  She tried to fall asleep, but the pain in her hip was most uncomfortable.   The daughter finally arrived at 9 that morning.  She found her mother lying on the floor shivering and in obvious pain.  The daughter quickly called 911, and the mother was rushed to the hospital.

The mother had sustained a hip fracture that was thought to be the cause of the fall.  When she was ready for discharge, the daughter was willing to make a place for the mother at her house.  After a few days of caring for her mother as well as her three elementary through middle-school aged kids, it became clear that the burden was too much.  The mother would have to go to a nursing home to get the care she needed.  She was only supposed to stay a few weeks, but those weeks became months and those months became years.  As the months passed, it became progressively clear that my grandmother was not the person I remembered her as.

My grandmother’s experience served as a catalyst that would ultimately direct me towards physical therapy with a desire to help older adults avoid falls and the consequences that follow.

Overview

I knew from the start of this program that I wanted to develop a fall prevention program, and many of my optional assignments related to an aspect of fall prevention.  This past fall, our Health and Wellness class gave me the opportunity to work through the details of establishing a fall prevention program.  The end result was a proposal that explains who, what, when, where, and how to begin a fall prevention program.

In our Evidenced Based II class last fall, I focused my research on interventions that are used to prevent falls.  This lead to an evidence table that answered the PICO question,

“For a community dwelling patient that is 60+yrs old, and deconditioned with increased fall risk, would a general group exercise class with fall prevention education or a multifactorial intervention approach decrease fall risk more in 6-8wks?”

Along with the research paper, I produced a summary paper to briefly explain my findings in the literature review.

For my capstone, I originaly intented to combine an education and exercise class for ~6 weeks.  After talking with my advisor and one committee member (Carol Giuliani) at that time, I realized that the exercise portion would need more time than the semseter allowed to complete.  Thus, I decided to focus solely on the education portion.   The next step was to determine where I would hold the class.  I reached out to the Randolph-Asheboro YMCA because I knew from previously working there, they have a high population of older adults.  After The YMCA agreed to partner with me, I asked Robin Hatch (Director of Fitness and Wellness) to join my committee.   A flyer was then made to advertise for the class at the YMCA.

I then performed another literature search for consequences, causes, prevention strategies, techniques to decrease injury risk when falling, and techniques to get up from a fall.  This yielded a second evidence table, that can be found here.*  From the evidence gathered, I planned on teaching 4 consecutive classes. However, due to the scheduling of the YMCA and the due dates of this project, I condensed the material to two 1 hour sessions.

Presentation

The powerpoint corresponded with a handout, so that participants could follow along easily, make notes if needed, and take home for future reference.  The presentation incorporated brainstorming sessions that helped create discussion and a chance to learn from each other.  It also included demonstrations on how base of support affects center of mass, as well as techniques to decrease injury when falling, and how to get up after a fall.  I incorporated a skit of an older lady (portrayed very gracefully by my mother) who demonstrated as many fall risk factors that we could fit in.  I then asked the participants to identify the risks they noticed which allowed for discussion.

There were many other handouts that were available to participants, that many individuals helped me obtain.  Vicki Mercer and Carol Giuliani gave me brochures from the CDC on “What You Can Do to Prevent Falls” and “Home Modification Checklist”.  These brochures can be found on the CDC website.  I also provided a handout containing the most recent data on falls for North Carolina, that I obtained from attending a Fall Summit Conference.  Lastly, Carol Giuliani provided me with a basic home exercise handout.

Evaluation

To assess the participants comprehension of the material I created a 12 question quiz that I distributed before and after the class.  The quiz incorporated multiple choice, true/false, and short answer questions.  On the pre-test the average score was 76.5%.  Questions 9 and 10 were short answer and the most frequently missed.  The answers ranged from greatest to least as Doctor, PCP, neurologists, ear doctor, orthopedic surgeon, nursing home and PT.   While seeing your doctor isn’t a wrong answer, I was looking for participants to answer that the doctor would recommend or refer depending on the condition.  The post test average score was 94.2%, and all but one person (that didn’t attend the first presentation) answered questions 9 and 10 correctly.

Feedback

Lastly, I distributed a survey to get feedback on how the material was presented, and left space for any suggestions or comments.  The majority of the feedback I received from the participants was that the pace was just right, and the terminology was easy to understand.  Many reported they liked the discussions, skit, and demonstrations.  A few reported they thought the recap/review of the previous weeks presentation was great, however one person thought it was too repititious.   One person reported they would have liked more time to cover the material.  Another suggested that I should include more on how to decrease falls risks in people with dementia.

Reflection

 After completing my capstone, I have several aspects I would change.  The first, is that I would give more time to advertise and promote the class.  The first presentation had 21 participants, while the second part of the presentation had 11.  Second, I would have planned to hold the class on a day when the YMCA had Senior Day, which I feel would draw more of a crowd.  Third, I would get participants to register before hand and provide their phone numbers so I could give reminder calls.  A reminder call should help participants return to following sessions.  Fourth, I would like to hold a fall/balance screen before the next class to help promote the class.  Finally, I would increase the time or number of sessions to allow for better discussion of the material and demonstrations.

Special Thanks

 I’d like to give a special thanks to Carol Giuliani for going out of her way multiple times, taking me to the Falls Summit of NC, giving a plethora of advice, and helping me to print and organize the handouts.  I’d also like to thank Robin Hatch and the Randolph-Asheboro YMCA for allowing me to present in their facility.  I’d like to thank my mother who did an excellent job performing in the skit, as well as helping the presentations run smoothly.   Lastly, I’d like to thank Vicki Mercer for giving brochures from the CDC to pass out.