By 2060, there will be about 98 million older persons, more than twice their number in 2014. People 65+ represented 14.5% of the population in the year 2014 but are expected to grow to be 21.7% of the population by 2040 (HHS, 2017). Fortunately, falls are preventable and/or modifiable. Healthcare providers can play an important role in preventing these falls but older adult receptiveness is necessary for successful prevention. A cross sector evaluation of an older adult program to prevent falls can give insight into improvements to patient care that can increase patient receptiveness and adherence. Limited evidence exists on the extent to which older adults were receptive to or took follow-up action on the referral made by their primary care provider.
The intent of this evaluation is to 1) Assess barriers and facilitating factors to the adoption of the U.S. Centers for Disease Control and Prevention (CDC) STEADI intervention components among older adults and 2) Identify ways the resulting information can be integrated into the CDC STEADI intervention practices used by hospital system outpatient practitioners in order to increase receptiveness and adoption by older adults at risk of falling.
The qualitative framework for understanding older adult receptiveness to fall prevention interventions included the development of evidence-based instruments and a blended theoretical framework. Twenty-one patients over the age of 65 participated in telephone interviews to respond to the questions. The resulting 450 pages of transcripts were analyzed using thematic content analysis. Coding began with 40 categories based on four health behavior theories. An iterative process was used to categorize and characterize patient responses, reduce categories contingent upon lack of content, and add emerging categories based on inductive review.
Core opportunities for the hospital system to consider emerged from the qualitative evaluation. Based on the evaluation, the hospital system has an opportunity to emphasize the evidence-based practices of the CDC STEADI initiative and redesign current practices. CDC and NNPHI convened a site visit to share core findings and better understand the current hospital system practices and activities relating to the redesign opportunities. Participants during the site visit included the CEO and administration, nearly 40 clinical staff and 100 physician providers. Discussions revealed opportunities to redesign relevant practices to increase falls prevention effectiveness based on the core findings.
Jennifer J. Edwards, PhD, GCIS1, Brittany Bickford, MPH1, Gwen Bergen, PhD, MPH2, Yvonne Johnston, DrPH, MPH, MS, RN, FNP3, Aaron Alford, PhD, MPH, PMP1, Chelsea Reome, MPA3, Jessica Wehle, MPH1, Mary McFadden3
1National Network of Public Health Institutes; 2Centers for Disease Control and Prevention; 3Broome County Health Department
This project is funded by U.S. Centers for Disease Control (CDC) and Prevention Cooperative Agreement OT13-1302; and CDC National Center for Injury Prevention and Control, State Falls Prevention Program Supplement CE11-11010501SUPP15.
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