Falls Risk Assessment Tool (FRAT) 65+

Robert Callahan, Joseph Ferreri, Jena LaLone, Lauren Salato, and Emma Whittle

HLH 380

Fall 2013

11/25/2013

Source: http://www.myvisiontest.com/img/upload/falling_man.jpg

Overview

Be able to list three risk factors of falls that

exist within a household

Know some individual behaviors that increase

the likelihood of falls

What are the benefits of resistance training in

older adults?

What barriers exist within a community that

could increase the chance of older adults

falling?

The Problem: Falls among Adults 65+

Adults who fall once are three times more likely to fall again within a year (O’Loughlin,1993)

In 2010, the direct cost of falls was $30 billion (Centers for Disease and Control and Prevention, 2013)

Internationally, falls among adults ages 65 and older are the leading cause of fatal injuries (Carlson, York, & Primomo, 2011)

Approximately 22,000 older adults died from unintentional fall injuries in 2010 (Centers for Disease Control and Prevention, 2013)

PRECEDE PROCEED: Epidemiological

Phase

35% of individuals over the age of 65 fall at least once each year (Harvard Women’s Health Watch, 2009)

90% of fall-related injuries are hip fractures (Hosseini and Hosseini, 2008)

Individuals who fall and do not receive help can experience symptoms such as pneumonia, hypothermia, pressure sores, and dehydration (Yoshida-Intern, 2007)

Psychological effects include increased fear of falling and loss of confidence (Hosseini and Hosseini, 2008).

Source: http://lanzonemorgan.com/blog/wp-

content/uploads/2013/09/Fall-Waring.jpg

Ecological Model

Level I: Innate Factors

Intrinsic Factors: muscle weakness and disability (Hosseini and Hosseini, 2008).

Impaired vision, hearing problems, hypertension, cognitive impairment, dizziness, and neurological problems, such as Parkinson’s Disease (Hosseini and Hosseini, 2008).

According to the CDC, falls death rates were 40% higher among men than women, but falls-related injuries were two times higher for women as to men (2013)

Blacks and Hispanics have lower rates of falls as to Whites (Centers for Disease Control and Prevention, 2013)

Ecological Model cont’d.

Level II: Individual Behaviors

Decreased muscle strength along with impaired balance are both risk factors for falls

Proper physical exercise also improves balance, mobility and reaction time, all of which are crucial factors to preventing falls (Days, 2002)

As people age they lose confidence in their ability to perform daily activities and begin to require more assistance with daily activates (Days, 2002).

Elders tend to complete daily tasks at a higher rate than necessary or capable and experience a fall

The misuse of medications can cause side effects such as dizziness and numbness which can lead to impairment

Ecological Model cont’d.

Level III: Social, Family, and Community Networks

Having family and friends support and care for elders can be key to

reducing the risk of falling by having someone physically present

Community support is important because young adults and

teenagers can look after the elders within a neighborhood

Caregivers can help share the responsibilities of an elder, making

their tasks less stressful and taxing

Members of a community can help make the neighborhoods safer

by repairing poorly conditioned sidewalks and assembling hand

railings at local facilities

Ecological Model cont’d.

Level IV: Living and Working Conditions

Poor working conditions include long hours, poor lighting, and

limited walking space

Unsafe living conditions include clutter, throw carpets or rugs, and

many stairs

Elders with wheelchairs face many barriers to transportation within

the home and workplace

Inadequate lighting and space can cause an elder to fall as they

have decreased coordination and balance to adjust to these

changes

Ecological Model cont’d.

Level V: Broad Social, Cultural, Economic, Health, Environmental Conditions and Policies at the Global, National, State, and Local Levels

Barriers: access to health care, funds to afford health care

Elders who live independently are more likely to experience a fall and not be able to reach a family member for at least 4 hours (Centers for Disease Control and Prevention, 2013)

Hospital visits require transportation which can be limited for older adults who no longer drive and need assistance

Older adults can experience falls when doing everyday living activities such as getting the mail

Poor environmental conditions include the lack or poor quality of sidewalks or pathways

Conclusion

Bone density plays an influential role in a person’s ability to fall without

sustaining an injury and reduces the risks of developing osteoporosis later

on in life (World Health Organization, 2007).

The general focus of this campaign is to help educate adults 65 and older

how to improve their health and enhance quality of life.

We decided to focus on certain topics such as living conditions in

households, intake of medications, and intrinsic factors such as muscular

weakness, balance and coordination

Population

Cortland County, New York

Adults ages 65 years and older

14.1% of the Cortland County population (United States Census Bureau, 2013)

Those from that age group that attend the Cortland County YMCA located on Tompkins Street

Target Audience # 1: Cortland

County Elders

Elders, 65 years and older

Elders would be considered our primary

audience.

We are trying to directly reach the elderly

population

Target Audience #1: Channels and Strategies

To reach our primary audience we choose 3

channels:

Community Channel- Using brochures that will be

placed in doctors offices, barber shops, and

grocery stores

Mass Media- Our PSA would be played on the

radio and on the TV during the most common times

between 5 and 7 pm.

Organizational Channel- We would use posters and

flyers to promote our educational program at the

YMCA.

Target Audience # 2: Family and Friends

The secondary Audience is friends and

family

Although we are not looking to make

changes among these populations, we are

looking to educate friends and family, who

can help us reach our primary audience.

Target Audience #2: Channels and Strategies

Community Channel- Our brochures and flyers will be placed around the community where family member and friends can view them.

Mass Media Channel- Our PSA can be viewed by family and friends who watch TV and listen to the radio

Organizational Channel- Flyers and posters that are informing people on the educational program can be seen by family or friends and passed on to elders.

All three of these channels can be viewed by our secondary audience where they can then pass on the information to the elders that they know.

Overview FRAT 65+ Campaign

Education via Cortland County Family YMCA:

- resistance training (physical therapist)

- modifying conditions in a household (occupational

therapist)

30 second radio PSA that addresses the issue of hazardous

conditions in households; promotes HCR Home Care

Paper brochure on intake of medications is to be included in

doctor’s offices

Creative Brief

Intended Audience: Tone:

- Adults 65+ in Cortland County, NY - Light, emotional, poise

- Caregivers, family, and friends

Objectives/Key Promise: Media:

Raise awareness about home - Public Service Announcement

modifications, resistance training, - Brochures

and medication intake - Poster

Obstacles: Openings:

- Embarrassment from previous falls - Cortland YMCA

- Different general state of health - Radio

- Doctor’s Visit

Creative Considerations:

- Language: English Supporting Reason:

- Health disparities such as - Reducing mortality rates among

socio-economic status and language barrier those who fall

will be considered

The Health Issue

Internationally, falls among adults ages 65 and older are the

leading cause of fatal injuries (Carlson, York, & Primomo,

2011).

FRAT 65+ Goals and Objectives

To reduce/prevent falls among the elders aged 65+

Increase awareness of what behaviors increase the risk for falling including climbing, reaching and bending (Kronfol, pp. 2)

Increase knowledge of risk of drug combinations that can increase the risk of falling

Promoting exercise to improve balance, mobility and reaction time (Days, 2002).

Promote the importance of a healthy diet rich in calcium (World Health Organization, 2007).

Promote hiring trained health and social service professionals to assist elder with tasks which require balance and muscle strength (Bookman & Kimbrel, 2011).

Target Audiences

Primary- Male and female elders aged 65+

Secondary- Friends and family members of elders, trained health

and social service professionals hired by families as additional

caregivers

Key Messages

Primary Audience

Remove clutter or hazards around the home

Taking proper dosage of medication(s)

Work to improve body strength and balance to have the coordination needed to walk/live independently

Secondary Audience

Make sure the elder’s home is safe to live in independently

Be aware of the side effects of medication(s) elders are taking

Be there for physical and mental support so elders do not feel isolated or helpless

Channels & Strategies

Mass Media

TV is heavily relied on by elders in their homes because they

have the time and opportunity, especially after retirement

(Robinson et al., 2004 cited by Mares & Woodward, 2006).

Community

Brochures can be strategically placed at grocery stores and

doctor’s offices. These are common places both audiences

visit to get the necessary food and health care services they

may need.

Organizational

Posters are a beneficial tool in helping implement a health

campaign. Spreading awareness to elders, family members,

and caregivers plays an influential role in reducing the risk of

falls.

Materials Developed

Mass Media

A 30 second Public Service Announcement (PSA) describing

the potential hazardous living conditions that can contribute

to falls in the home - this PSA will be aired via TV and radio

throughout all hours during the day along with prime time

hours, such as the morning and evening news

Community

A brochure that discusses tips and facts on medication use

that can be available to the primary and secondary

audiences in the community

Organizational

Posters and flyers that will be placed around the community

advertising dates and times for FRAT 65+ education classes

at the Cortland County YMCA

Evaluation

For those who have participated in the campaign, 10% of those participants will have a better understanding of how to reduce falls

While the FRAT 65+ campaign is being carried out, administering surveys and interviews to the participants will allow us to measure our effects

After the two-year campaign is complete, surveys and interviews will be conducted in order to determine whether or not the amount of falls decreased

Baseline data will be collected from physicians’ and clinics as well as the adults 65 and older that attend the YMCA and their caregivers, before the implementation of the campaign

The Social Cognitive Theory

Reciprocal Determinism- Increasing awareness of how multiple factors such as how some of medications can distort coordination and combined with environmental hazards increase the chances of a fall occurring.

Behavioral Capability- The implementation of free clinics and classes focused on the importance of actively aging and a health diet rich in calcium

Expectations- Reducing the number of falls that occur in Cortland elders aged 65+ as well as reducing fractures caused by falls among older adults, increasing confidence in not falling and increasing knowledge on the importance of activity aging and eating a healthy diet in rich in calcium.

Self-efficacy- Address that some elders may require assistance with their daily living activities which may require the hiring of caregivers

Observational Learning- Classes and clinics that are utilized in the FRAT 65+ campaign include group program based Tai Chi-type exercises or dynamic balance and strength training as well as floor coping strategies, nutrition programs, low intensity exercises, aerobic programs, water exercises and walking routes

Reinforcements- In order for there to be a proper implementation of the elderly fall prevention program it is critical to make sure elders have access to affordable care, which includes governmental assistance.

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