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Matter of Balance Report Written by Amanda Walker

Purpose of Class A Matter of Balance (MoB) is a course designed to help participants identify risk factors for falls, manage concerns about falls, and learn how to prevent falls. MoB is an Evidence-Based Program, which means that it is based on research and has been proven to provide health benefits to participants. Because this is an evidence-based course, participants are required to attend at least 5 of the 8 classes to benefit from the material. Course participants will learn that falls and fear of falling are controllable. Participants will also learn to set realistic goals to increase activity, to change their environment to reduce fall risk factors, and to exercise to increase their strength and balance. Each two-hour session covers a different topic about falls and includes group discussion activities, information and resource sharing, and facilitator-lead exercises. Some weeks may even feature a special guest like a healthcare professional. All in all, MoB is a comprehensive course aimed to increase health and safety in the lives of adults.

Planning Process Thanks to support from AmeriCorps and the City of Seattle, the PNA Village will deliver a Fall Prevention program for our members in 2014-15. AmeriCorps Volunteer Coordinator and Fall Prevention Lead will attend “A Matter of Balance” training and become a certified trainer in September 2014. The plan is to present the course to village members in the Winter 2015, and again in the Spring 2015. A communication plan was written to plan out the various steps in advertising the class, reserving rooms, scheduling guest speakers, scheduling participants, and coordinating with Senior Services. (See Appendix I.) After the initial training the AmeriCorps member received additional coaching in class facilitation and presentation skills from a Village volunteer who specializes in trainings. The AmeriCorps member studied the Lay Leader handbook and met with the coach every week for two months before she was to present the course. The AmeriCorps member also observed 3 classes of a Matter of Balance course already in progress, to gauge how a typical class should run. Village members were given priority when signing up; non-village members were placed on a waiting list until a specified date, per each session, about 2 weeks before the course started. All promotional material said the course was capped at 15, but once 15 was reached there were some people who really wanted to join and they were admitted to the course. Since the class did not fill up 15 spaces with village members, the people on the waiting list made it into the course. Session 1 had 17 people registered and session 2 had 17 people registered.

Presenters This course was presented by newly trained lay leader and AmeriCorps member from the PNA Village, Amanda Walker and Rocky Jorgensen a Registered Nurse assigned from Senior Services. Rocky Jorgensen is part of the Enhance Wellness program with Senior Services. Luckily each session had the opportunity for special “health expert” guests to present. The health experts were Cindy Coffin-Greenig, a Physical Therapist and Village Volunteer; and Lisa Stuebing, a personal trainer specializing in senior fitness. The special guests each presented for 30 to 40 minutes in the later classes of both session 1 and session 2. Lisa presented during the 5th class in session 1 and the 6th class in session2, while Cindy presented in 8th class in session 1 and the 7th class in session 2. They were able to bring expertise and a fresh face to the course that the participants really appreciated and learned from.

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Course Agenda A Matter of Balance emphasizes practical strategies to reduce fear of falling and increase activity levels. Participants learn to:

view falls and fear of falling as controllable

set realistic goals to increase activity

change their environment to reduce fall risk factors

exercise to increase strength and balance.

Session 1 classes will be presented on Tuesdays, March 3, 10, 17, 24, 31 and April 7, 14, 21 from 12:15pm to 2:15pm, located at the PNA Center. Session 2 classes will be presented Thursdays May 7, 14, 21, 28 and June 4, 11, 18, 25 from 10:30am to 12:30pm, located at the Greenwood Senior Center.

Topics and learning goals covered during each session:

Class 1: Introduction to the Program Goals

Explain how class will work, welcome group members, and make them feel comfortable

Introduce group members to the concept of helpful and unhelpful beliefs about falls and concerns about falling

Class 2: Exploring Thoughts and Concerns About Falling Goals

Learn that there are different ways to think about falls and concerns about falls

Realize the importance of recognizing our core beliefs about falls before we are able to change them

Class 3: Exercise and Fall Prevention Goals

Understand the importance of exercise in preventing falls

Identify the barriers to exercise for older adults

Identify which exercises are best suited for fall prevention

Experience MoB exercises as an example of activity well suited for fall prevention Class 4: Assertiveness and Fall Prevention Goals

Recognize three important physical risk factors for falls: low blood pressure, leg weakness, and poor flexibility and balance

Understand exercises that can be used to prevent falls due to low blood pressure, leg weakness, and poor flexibility/balance

Recognize the relationship between assertive behavior and fall prevention Class 5: Managing Concerns About Falling Goals

Learn how to use Personal Action Planners to staret an exercise program

Learn about balance exercises that can be used as part of an individualized exercise program

Recognize misconceptions and unhelpful thoughts about falling and the effect those thoughts have on feelings and actions

Learn how to shift from self-defeating thoughts to self-motivating thoughts

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Class 6: Recognizing Fall-ty Habits Goals

Review goals for MOB class and plan topics for next few classes

Determine which activities are and are not fall risk-taking behaviors

Prioritize risk-taking behaviors to be addressed and changed

Identify thoughts that help change behavior

Learn ways to shift from negative to positive or helpful thinking Class 7: Recognizing Fall Hazards in the Home and Community Goals

Recognize potential fall hazards often present in the home and community

Identify strategies to reduce physical hazards in the home and community

Recognize the relationship between assertive behavior and fall prevention Class 8: Practicing No Fall-ty Habits/Putting It All Together Goals

Practice assertiveness skills in locating and using resources for fall prevention and seeking help after a fall

Model and practice behaviors in order to eliminate risk-taking behaviors

Review material discussed during the class

Recognize physical and psychological changes that have resulted from participating in a Matter of Balance and how they have affected fear of falling.

Each 2 hour class covers a different topic surrounding falls and is comprised of group discussion activities, information and resource sharing, and facilitator lead exercises. A Matter of Balance is what is known as an Evidence-Based Program, this means that it is based on research and has been proven to help prevent the occurrence of falls in older adults. Because this is an evidence-based course, attendance of at least 80% of the classes is required for the participants to benefit from the material.

Participants There were a total of 34 participants who started the MoB course with 26 completing the course and the post survey. Session 1 had a completion rate of 65% and Session 2 had a completion rate of 88%, see table 1. The participants were made up of 20 Village members, 13 Greenwood Senior Center members and 1 nonaffiliated community member. All participants were over the age of 60 and ranging from 65 to 91, the median age was 76 and the average age was 78. Despite the average and median skewing older, the younger the participant the more likely they were to complete the course, see table 2. More participants in the older bracket ended up either dropping out or not completing the course, while the younger brackets had a higher rate of completion. Of the 34 participants, only 3 were men, all 3 completed the course. 25 of the participants lived alone while 9 lived with one other person. Only one participant lived 13 miles from the center, indicating that most of the participants lived in the Phinney area or a nearby neighborhood, all in about a 5 mile radius of the presentation sites. All but 4 of the 34 participants considered themselves Caucasian, non-Hispanic.

Table 1 Number of Participants

Number who Completed

Percent who Completed

Session

1 17 11 65%

2 17 15 88%

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Table 2 Number of Participants

Number who Completed

Percent who Completed

Age Group

< 65 1 1 100%

65-74 13 12 92%

75-84 12 10 83%

85+ 8 3 38%

Appendix II shows the full results of the demographics for Session 1 and Session 2.

Outcomes Participant were asked to fill out a survey during the first class. The pre survey consisted of 4 demographic questions and 7 questions about their thoughts and perceptions concerning falls. The same seven question were on the post survey which was given at the last class, or earlier if the participant indicated that they could not attend the final class. Member’s names were connected to the responses to determine if there was any change between the two surveys. Upon completion and analysis there was demonstrated learning, an improvement in at least one question from pre to post survey, in all participants who completed the course. This was determined by tracking each participants’ answer from the pre survey to the post survey. The analysis below is from the sessions as a whole looking at the 26 participants who completed the MoB course. In looking at an the amount of exercise a participant was engaged in, it seems that participants who were already exercising 3 or more times each week were more likely to complete the program, with an 83% completion rate, while people who were exercising less than 3 times each week were less likely to complete the program. See table 3.

Table 3 Number of Participants

Number who Completed

Percent who Completed

Amount of exercise per week

n = 34 n = 26

<3 times/week 10 6 60%

3+ times/week 24 20 83%

Of the 26 participants who completed the course 11 participants attended all 8 classes in the series, while 35% of participants attended 7 of the 8 classes. All but one person attended the recommended 5 classes, the number of classes did not seem to alter that participant’s learning from the material, as the participant showed improvement in 3 of the 7 questions with no change among the other 4 questions. Participants were encouraged to attend as many classes as they could. See table 4

Table 4 Number of Participants

Number of all Participants

Percent who Completed

Classes attended n = 26

4+ Classes 1 26 100%

5+ Classes 3 25 96%

6+ Classes 2 22 85%

7+ Classes 9 20 77%

8 Classes 11 11 42%

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Table 5, 6 and 7 outline the changes in responses from the pre-survey to the post survey. In all but one area, at least 50% of participants indicated an improvement in their thoughts about falls. Most notably the 62% increase in participants’ feeling that they would be able to protect themselves if they were to fall since completing the MoB course. In looking at the participants opinion of them becoming steadier on their feet there was only a 31% increase with most participants not changing their answer between the pre and post survey. This question also had the largest decrease with 12% of participants feeling that perhaps they couldn’t become steadier on their feet. Perhaps more emphasis could be put on the benefits to exercise and how it can help with the issue of steadiness in older adults.

Changes from Baseline to end of Program. Table 5

How sure are you that… Number Percent

I can find a way to get up if I fall n = 26

Increase 14 54%

No Change 11 42%

Decrease 1 4%

I can find a way to reduce falls

Increase 15 58%

No Change 10 38%

Decrease 1 4%

I can protect myself if I fall

Increase 16 62%

No Change 8 31%

Decrease 2 8%

I can increase my physical strength

Increase 14 54%

No Change 11 42%

Decrease 1 4%

I can become steadier on my feet

Increase 8 31%

No Change 15 58%

Decrease 3 12%

On the question about concerns of falls interfering with social activities the decrease is a more desirable outcome. The way the question is worded, in increase shows that participants are more concerned or fearful about falls and thus alter their behavior. 31% of participants indicated that they were less concerned about falls after completing the MoB course. See table 6.

Changes from Baseline to end of Program. Table 6

To what extent has your concern about falling interfered with your normal social activities

Number

Percent

Increase 3 12%

No Change 15 58%

Decrease 8 31%

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There was not a large increase in exercising from the pre to post survey, only 4 participants indicated an increase in their exercise. Most of the participants stayed within the “no change” category. This could be indicative of the results from table 3, showing that a majority of the participants were already exercising or walking 3 or more times per week, and thus there was no change from pre to post survey. See table 7.

Changes from Baseline to end of Program. Table 7

How often are you walking or exercising now?

Number Percent

Increase 4 15%

No Change 19 77%

Decrease 3 8%

Overall the results show that participants are learning from the Matter of Balance course. The majority of the results show that participants either improved in their score or did not change from the pre to post survey. Despite the few decreases from pre to post results it would seem that the Matter of Balance course does facilitate growth and a change in opinion concerning falls for older adults. See Appendix III for results from the pre and post survey for both sessions.

Recommendations 2015 was the first year the Village AmeriCorps member was required to present the A Matter of Balance course, therefore all promotional material, documentation, and planning material were created this year. Initially the AmeriCorps member was planning to present A Matter of Balance in January, however she was hospitalized at the end of September and was out for 3 weeks, thus pushing all plans back by about a month. The lay leader training was in September and ultimately it was about 5 months between training and the presentation of the course. It is suggested that the next AmeriCorps present A Matter of Balance sooner so that there isn’t such a large gap between training and presenting. When prospective participants call about the class it should be explained that the class is like a support group for people who have fears or concerns about falling, with an exercise component and information sharing to combat the negative thoughts around falling. In the first session 5 people dropped out because the course was too slow, repetitive, or they already had access to similar programing in their assisted living facility. While some attrition is to be expected, giving as much information as possible is important to avoid sign-ups from people who may not need the course. Also is it suggested that the AmeriCorps member and the co-facilitator make time to plan who will present which topics for each class. A short phone call the day before each class was a solution the two co-facilitators made between Session 1 and Session 2. Trying to figure it out before or during class was not very successful. Taking time to really learn the material will make for a more successful course, the participants will appreciate it and so will the co-presenter.

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Appendix I: Fall Prevention Program Communication Plan Objective Method Implementer Deliverable Date

1. Training Receive training in Matter of Balance

Vol. Coor. & Senior Services

Receive training materials and certification

Sept.2014x

2. Communication plan

Generate interest in a Fall Prevention course.

Gauge member interest in Fall Prevention course, best days/time to schedule

“More information” article in Blog and village newsletter

Ad placed on Village webpage

Vol. Coor. & Newsletter

Vol. Coor.

Vol. Coor

Anna Maria-webmaster

Fall/Winter Village newsletter article

Article in PNA Review

Survey monkey to members-best times

Blog & newsletter article

Change Village Website

Sept.2014x

Nov 2014x

Oct.2014x

Dec 2014x

3. Planning/scheduling Get rooms booked for Session 1 (Mar-Apr) and Session 2 (May-Jun)

Contact SS letting them know when MoB will be presented

Notify members when MoB will be presented

Observe some MoB classes, to see how a typical class should go.

Vol. Coor & Emily/Cat/Terry

Vol.Coor

Vol. Coor & MSSTs

Senior Services &Vol. Coor

Room confirmations

Email SS

Email/mail members, post online, flyer, and newsletter

Attending the classes on specific dates

Dec. 2014x

Dec 2014x

Jan-Febx 2015

Feb 2015x

4. Coordination with guest speakers

Contact and confirm their interest in presenting with MoB

Vol. Coor.

Lisa Stuebing(Coach)

Cindy Coffin-Greenig (PT)

Email

In-person meetings

Jan 2015x

5. Present MoB Get members registered and confirmed for MoB; Wait list

Vol. Coor.

At least 16 members registered for each session

Feb 2015x

March-June 2015

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Assemble materials from Senior Services and present MoB

Vol. Coor & Senior Services Vol.

All materials present at sessions

6. Collect and assemble data

Hand out surveys to MoB participants

Beginning survey

Ending survey

Report data for AmeriCorps Outcomes

A/C Q2

A/C Q3

A/C Q4 – leave data for 9/15 report

Vol. Coor Survey results

Collect from 100% participants

Submit data for quarterly reports

July 2015 3/16/15x 6/13/15x

Appendix II

Session 1 Participants

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Session 2 Participants

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Appendix III

Session 1 Pre-survey Results

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Session 1: Post-survey Results

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Session 2 Pre-survey Results

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Session 2 Post Survey Results

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