A Matter of Balance: Managing Concerns about Falls

1. Sponsored by The National Council on the Aging and CareSource Healthy Aging Briefing Series A Matter of Balance: Managing Concerns about Falls WELCOME This session will begin promptly at 1:30pm ESTPlease mute your phone Personal introductions are not necessaryThe moderator will be on the line shortly

2. A Matter of Balance: Managing Concerns about Falls Volunteer Lay Leader Model April 20, 2006 Peggy Haynes, MPA Elaine McMahon, MS, RN MaineHealth’s Partnership for Healthy Aging Portland, ME

3. Session Objectives • Identify a practical, community-based strategy to address falls and fear of falling • Understand the importance of fall prevention for older adults • Identify strategies for broad-based program dissemination

4. Falls: Epidemiology of the Problem • Major cause of injury and death for older adults • Falls are the leading cause of injury hospitalization in Maine* *Healthy Maine 2010 • 1/3 to 1/2 of older adults acknowledge fear of falls • Fear of falling is associated with: • depression • decreased mobility and social activity • increased frailty • increased risk for falls as a result of deconditioning

5. Why fall interventions? Falls in older adults are: • Common • Morbid • Predictable • Preventable

6. Administration on Aging Grant • 2003 AoA launched a three year public/private partnership to increase older people’s access to programs that have proven to be effective in reducing their risk of disease, disability and injury. • Grant Goals: • Test whether a volunteer lay leader model is successful as compared with original research • Maintain fidelity to the original MOB curriculum • Share our approach with others in Maine and around the country • AoA Grant #90AM2780

7. A Matter of BalanceVolunteer Lay Leader Model Partners: • Southern Maine Agency on Aging • MaineHealth’s Partnership for Healthy Aging • Maine Medical Center Division of Geriatrics • University of Southern Maine, School of Social Work • Guided by a Project Advisory Committee • A Matter of Balance participant and coach • AARP Maine • City of Portland • Maine Center for Disease Control and Prevention • Maine Nutrition Network • Maine Office of Elder Services • Maine State Housing Authority • New England Rehabilitation Hospital • Osher Lifelong Learning Institute • University of New England, Geriatric Education Center

8. A Matter of BalanceOriginal Model • Research by the Roybal Center for Enhancement of Late-Life Function at Boston University.* • Designed to reduce the fear of falling and increase the activity levels of older adults who have concerns about falls. Tennsdedt, S., Howland, J., Lachman, M., Peterson, E., Kasten, L. & Jette, A. (1998). A randomized, controlled trail of a group intervention to reduce fear of falling and associated activity restriction in older adults. Journal of Gerontology, Psychological Sciences, 54B (6), P384-P392.

9. A Matter of Balance:Managing Concerns About Falls Designed to benefit community-dwelling older adults who: • Are concerned about falls • Have sustained a fall in the past • Restrict activities because of concerns about falling • Are interested in improving flexibility, balance and strength • Are age 60 or older, ambulatory and able to problem-solve. Eight 2-hour classes designed to help participants learn: • To view falls and fear of falling as controllable • To set realistic goals for increasing activity • To change their environment to reduce fall risk factors • To promote exercise to increase strength and balance

10. A Matter of BalanceVolunteer Lay Leader Model Model Program Adaptations: • Classes taught by volunteer lay leaders instead of healthcare professionals • Participant workbook developed and coach manual modified • Exercises modified • Healthcare connection via guest therapist Participants recruited through: • Community organizations’ newsletters • Outreach presentations to: • Aging network • Community centers & faith-based organizations • Clubs, libraries, social gatherings • Physician practices • Housing coordinators

11. Maintaining Fidelity • Original research curriculum used • Two day coach training based on original A Matter of Balance leader manual • Health care professionals and master trainers observe volunteer coaches during: • two day training • a MOB/VLL class • Use of a mentor model – new volunteers are paired with an experienced coach

12. A Matter of Balance Outcomes Participant Outcomes • 97 % - more comfortable talking about fear of falling • 97 % - feel comfortable increasing activity • 99 % - plan to continue exercising • 98 %- would recommend A Matter of Balance * % who agree to strongly agree

13. Outcomes:Participant Comments • I am more aware of my surroundings. I take time to do things and don’t hurry. • Although I still fear falling, the course helped me to cope with the fear so that it does not limit my life and keeps me aware of ways to avoid falling—so far so good! • I have more pep in not being afraid. • A Matter of Balance program made me realize that I’m responsible for me. It raised my self-esteem.

14. Dissemination Phases • Initial phase: York & Cumberland County • First eighteen months: design, develop and demonstrate • During the second half of year two: Request for Partner process identified Master Trainer sites statewide • During year three: add Master Trainer sites statewide, prepare national dissemination, work with NHCOA for Spanish translation

15. Request for Partners

16. Dissemination with Statewide Partners Master Trainer Sites Master Trainers Sites: • Agencies on Aging • Regional Hospitals • Healthy Maine Partnerships • YMCA Responsibilities: A Master Trainer is responsible for recruiting and teaching the curriculum to coaches and providing guidance and support, sponsoring classes, and recruiting participants.

17. Dissemination Activity • 14 Master Trainer sites have been established in Maine with 31 Master trainers • 617 older adult participants • 114 volunteer coaches trained statewide

18. A Matter of Balance Research Report March 2006

19. MOB Original Research MOB Volunteer Lay Leader Significant Outcomes 6 Weeks • Falls Management*** • Falls Efficacy** 6 Months • Falls Management* 12 months • Falls Management** • Falls Efficacy** *p<.05 **p<.01 ***p<.001 6 Weeks • Falls Management*** • Falls Efficacy* • Falls Control*** • Exercise Level *** • Social Activity*** 6 Months • Falls Management*** • Falls Efficacy*** • Falls Control* • Exercise Level ** • Monthly Falls* 12 Months • Falls Management** • Exercise level***

20. Preliminary State Wide Findings Comparison of First and Last Class • Falls Management*** • Modified PACE ** • Falls control – Overcome Fear NS • Social Activity - NS N=65

21. Cost to Implement • Supplies • Training • Marketing • Sponsorship

22. A Matter of Balance Class Sites Master Trainers and Coach Training Sites A Matter of Balance Facilitator Training Dissemination Profile

23. MaineHealth’s PARTNERSHIP FOR HEALTHY AGING is pleased to offer A MATTER OF BALANCE M A N A G I N G C O N C E R N S A B O U T FA LLS Volunteer Lay Leader Model Master Trainer Session Wednesday, June 7 and Thursday, June 8, 2006 Hilton Garden Inn 5 Park Street • Freeport, Maine For more information please e-mail PFHA@mmc.org

24. A Matter of BalanceVolunteer Lay Leader Model For more information please contact: Partnership for Healthy Aging 465 Congress Street, Suite 301 Portland, Maine 04101 (207) 775-1095 pfha@mmc.org