Falls are the leading cause of injury and death among those age 65 and older. The incorporation of an innovative evidence-based falls prevention program in homebound older adults needs to be implemented in order to prevent serious consequences related to falls. In fact, “Nationally, falls were the leading cause of non-fatal injuries for those 65 and older and corresponded to 800,000 hospitalizations and 2.8 million emergency department (ED) visits in 2014. That’s a hospitalization every 40 seconds and an ED visit every 11 seconds.” (Wisconsin Institute for Healthy Aging,2013). Homebound older adults are among the most vulnerable population to falls due to complex variations in their health status, social isolation, and living environments. The utilization of a “Stepping On” fall prevention program will provide classes that help build the participants confidence to manage their health behaviors to reduce the risk of falls and maintain active and fulfilling lives.
Introduction
The Frederick County Department of Aging partnered with Hood College Nursing Program, and Hood College Social Work program to conduct the Stepping On project to connect homebound seniors to educational and recreational services. Stepping On is an evidence based fall prevention program that empowers older adults to carry out health behaviors in order to reduce the risk of falls. It is a community workshop offered once a week for seven weeks teaching older adults’ balance exercises, and specific education on how to prevent falls. Over the course of seven weeks, each nursing student was paired with a social work student and one client. Workshop leaders consisted of professionals such as physical therapists, nutritionists, and the falls risk coordinators who are knowledgeable, and experienced in working with the selected population. The program is conducted through the use of iPads and the web based platform called “ZOOM”. This application allows the participant to connect to a class consisting of other homebound individuals and an instructor. The participants were able to see and talk to the instructor and other class participants throughout the session. During the pre-assessment phase the nursing students assessed the client using the Johns Hopkins Falls Risk Assessment Tool to determine their fall risk score. The assessment tool asked questions based on age, fall history, elimination, medications, patient care equipment, mobility, and cognition. The client is given this tool at the beginning and end of the program to determine the extent of a change in falls risk and biopsychosocial status. In addition to the assessment tool, the client receives an exercise log each week. The instructor teaches how to correctly practice the exercises and how often they should record and practice the exercises during the week. After each week the nursing student collects the exercise log and turns this into the Frederick County Department of Aging in order to keep track of the client’s progress. To evaluate the effectiveness of the Stepping On program, each participant was reassessed using the John Hopkins’ Fall Risk Assessment Tool and through focused assessments on a weekly basis. Each fall risk score was compared with the score given prior to the program start date and subjective observations were shared with the program leaders.
METHODS
The search strategy for this research project was assisted by databases assessable through the Hood College library website. Employment of the well-known nursing databases such as CINAHL, Cumulative Index of Nursing and Allied Health Literature, Health Source, and PubMed assisted in the research process. Among the various databases and research articles, the common theme of the need for a falls prevention program such as “Stepping On” in older adults remained consistent. Keywords such as “prevention of falls” and “older adults” were used in the search process to narrow down potential articles and sources. Eliminating all articles written less than 5 years ago and only focusing on more current nursing practice allowed the search to become even more specific and credible. Five research articles were used to assess the need to improve prevention of falls in older adults, compile data, and review outcomes necessary to complete this evidence-based research project.
Evaluation
Compared to current evidence based research; Stepping On is a falls prevention program that has been shown to be an effective program. Among the research articles and studies used in this research project, there was minimal variation in the outcomes and conclusions. All of the articles demonstrated a need for a Stepping On Falls Prevention Program in older adults. One of the main studies by Peterson et al. (2015), showed that stepping on was effective in reducing the number of falls by 37% from 6 months before the program began to 6 months after the program ended. Similarly, Guse et al.(2015), found a “significant population-level reduction in discharges for fall injuries requiring hospitalization or an emergency department visit in both the enhanced support system and the standard support communities over the control communities, indicating that a community-wide effect can be achieved.” In addition to the program being effective, a study completed by Taing & McKay (2017), received positive feedback from the participants indicating that 94% of participants felt they had better strength and balance. However among these studies, the conclusions mentioned that more research is needed to identify barriers and facilitators that influence the successful adoption of this program. Along with these consistent findings, a study completed by Mahoney et al.(2017), offered interventions to improve the Stepping on Program by incorporating the Delphi toolkit in the planning process which outlines the key interventions for the program to be successful. The level of evidence in the controlled trials used is strong enough to support the Stepping On Program to homebound older adults. By implementing this evidence based project there is no foreseen harm or burden placed on homebound older adults. In fact, an improved quality of life, decrease risk of falls ,and decrease in isolation have occurred in the research studies previously completed.
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