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.
Outpatient Falls Prevention Qualitative Evaluation
The E2A team conducted a program evaluation of evidence-informed falls prevention at outpatient clinical sites in upstate New York. The team utilized 25 qualitative interviews from seven clinical sites to identify factors that impact patient receptiveness to fall prevention recommendations. This evaluation helped improve population health and medical care for older adults through knowledge of facilitators and barriers to fall prevention recommendations. E2A led project management for the revision of clinical protocols in order to help providers better engage older adult patients in fall prevention. The cross-sector collaborative process involved the collaborative efforts of NNPHI, Broome County Health Department in New York, and United Health Services Hospitals (UHS).
Falls Prevention x Substance Use in Emergency Departments
E2A is in the process of conducting a feasibility study regarding emergency departments’ (ED) capacity to conduct falls risk outcomes evaluations. The quantitative outcomes evaluations are intended to consider falls related screenings, risk assessment, substance use, and referrals. E2A will be partnering with a professional organization of emergency medical physicians to convene a 5-8 person expert panel regarding data opportunities and challenges in conducting this type of outcomes evaluation. In collaboration with an NNPHI member institute, E2A will also engage in qualitative data collection among 20-25 practicing physicians in EDs regarding organizational capacity and receptivity, operations, and environment to collect and analyze the necessary data.
Falls Prevention in Native American Communities
The E2A team is conducting a capacity assessment of Indian Health Service and tribal health facilities. The team is guiding the evaluation design, instrument development, and leading technical advisement aligned with the CDC STEADI Initiative. The evaluation includes online survey data collection from outpatient clinical staff at approximately 50 facilities nationwide, with seven participants per facility. The assessment also involves qualitative interview data collection from 10 clinical provider participants. Findings will help expand knowledge of factors that affect clinical provider and facility implementation of evidence-informed falls prevention for Native American elders. The cross sector collaborative process involves collaboration between NNPHI, Seven Directions Center for Indigenous Public Health, and Indian Health Service.
Mobility Tool Assessment
The E2A team is designing a qualitative assessment that considers the effectiveness of the CDC mobility tool, MyMobility Plan – A Plan to Stay Independent. Just as older adults plan for retirement, CDC also recommends they plan how they will navigate daily activities as their mobility decreases. In collaboration with NNPHI member institutes, E2A will lead the assessment that considers the clarity and reliability of the mobility tool components that include self, home, and neighborhood. The approach will utilize interviews and focus groups to determine any gaps or opportunities to strengthen the tool as it undergoes testing and development. Participants will include 20-25 mobility tool recipients in rural communities and in Native American communities.
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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This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award (NOFO OT18-1802, titled Strengthening Public Health Systems and Services through National Partnerships to Improve and Protect the Nation’s Health) totaling $525,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.