A Feasibility Study of Multi-Component Fall Prevention for Homebound Older Adults Facilitated by Lay Coaches and Using a Tablet-Based,Gamified Exercise Application

Abstract

Although homebound older adults face high risk for falls, they are unable to utilize community-based fall prevention programs due to their mobility limitations. In this article, we report a feasibility study of a four-session, multicomponent fall prevention program for low-income homebound older adults using pre, post, mixed-method design. The manualized program was delivered by lay coaches who were trained and supervised by a physical therapist. The program also used an iPad-based gamified strength and balance exercise app (called KOKU) that was operable without the need to connect to the internet. Participants (N = 28) in this study were highly receptive to the program and approved all components: psychoeducation, the KOKU app, home-safety checks, safe ambulation training, and medication review. The study showed that a brief, multi-component fall prevention program for homebound older adults is feasible and acceptable. Further research is needed to evaluate its effectiveness.

Keywords

homebound older adults falls fall prevention exercise training home-safety check medication review

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References

Alliance for Physical Therapy Quality and Innovation. (2019). Congress is taking action to grow the physical therapy workforce. https://www.aptqi.com/congress-is-taking-action-to-grow-the-physical-therapy-workforce/

Arkkukangas

Cederbom

Tonkonogi

Umb Carlsson

. (2020). Older adults’ experiences with mHealth for fall prevention exercise: Usability and promotion of behavior change strategies. Physiotherapy Theory & Practice. Advance online publication. https://doi.org/10.1080/09593985.2020.1712753

Arkkukangas

Söderlund

Eriksson

Johansson

A. C.

(2018). One-year adherence to the Otago exercise program with or without motivational interviewing in community-dwelling older adults. Journal of Aging and Physical Activity, 26(3), 390–395. https://doi.org/10.1123/japa.2017-0009

Boongird

Keesukphan

Phiphadthakusolkul

Rattanasiri

Thakkinstian

(2017). Effects of a simple home-based exercise program on fall prevention in older adults: A 12-month primary care setting, randomized controlled trial. Geriatrics & Gerontology International, 17(11), 2157–2163. https://doi.org/10.1111/ggi.13052

Campbell

A. J.

Robertson

M. C.

(2003). Otago exercise programme to prevent falls among older adults. https://www.livestronger.org.nz/assets/Uploads/acc1162-otago-exercise-manual.pdf

Centers for Disease Control and Prevention. (2017). Important facts about falls. https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Choi

N. G.

Choi

B. Y.

DiNitto

D. M.

Marti

C. N.

Kunik

M. E.

(2019). Fall-related emergency department visits and hospitalizations among community-dwelling older adults: Examination of health problems and injury characteristics. BMC Geriatrics, 19(1), Article 303. https://doi.org/10.1186/s12877-019-1329-2

Choi

N. G.

Sullivan

J. E.

Marti

C. N.

(2019). Low-income homebound older adults receiving home-delivered meals: Physical and mental health conditions, incidence of falls and hospitalisations. Health & Social Care in the Community, 27(4), e406–e416. https://doi.org/10.1111/hsc.12741

Gell

N. M.

Wallace

R. B.

LaCroix

A. Z.

Mroz

T. M.

Patel

K. V.

(2015). Mobility device use in older adults and incidence of falls and worry about falling: Findings from the 2011-2012 National Health and Aging Trends Study. Journal of the American Geriatrics Society, 63(5), 853–859. https://doi.org/10.1111/jgs.13393

10.

Helbostad

J. L.

Taraldsen

Granbo

Yardley

Todd

C. J.

Sletvold

(2010). Validation of the Falls Efficacy Scale–International in fall-prone older persons. Age & Ageing, 39(2), Article 259. https://doi.org/10.1093/ageing/afp224

11.

Hoffman

G. J.

Alexander

N. B.

Langa

K. M.

Tinetti

Min

L. C.

(2018). Underreporting of fall injuries of older adults: Implications for wellness visit fall risk screening. Journal of the American Geriatrics Society, 66(6), 1195–1200. https://doi.org/10.1111/jgs.15360

12.

Keall

M. D.

Pierse

Howden-Chapman

Guria

Cunningham

C. W.

Baker

M. G.

(2017). Cost-benefit analysis of fall injuries prevented by a programme of home modifications: A cluster randomised controlled trial. Injury Prevention, 23, 22–26. https://doi.org/10.1136/injuryprev-2015-041947.18

13.

Kendrick

Kumar

Carpenter

Zijlstra

G. A.

Skelton

D. A.

Cook

J. R.

Stevens

Belcher

C. M.

Haworth

Gawler

S. J.

Gage

Masud

Bowling

Pearl

Morris

R. W.

Iliffe

Delbaere

(2014). Exercise for reducing fear of falling in older people living in the community. Cochrane Database of Systematic Reviews, 24(11), Article CD009848. https://doi.org/10.1002/14651858.CD009848.pub2

14.

Kroenke

Spitzer

R. L.

Williams

J. B.

(2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

15.

Kunigkeit

Stock

Müller

(2018). Cost-effectiveness of a home safety intervention to prevent falls in impaired elderly people living in the community. Archives of Osteoporosis, 13(1), Article 122. https://doi.org/10.1007/s11657-018-0535-4

16.

Lally

Benjamin Gardner

(2013). Promoting habit formation. Health Psychology Review, 7(Suppl. 1), S137–S158. https://doi.org/10.1080/17437199.2011.603640

17.

Lamb

S. E.

Jorstad-Stein

E. C.

Hauer

Becker

(2005). Development of a common outcome data set for fall injury prevention trials: The Prevention of Falls Network Europe consensus. Journal of the American Geriatrics Society, 53(9), 1618–1622. https://doi.org/JGS53455

18.

Landreville

Guerette

(1998). Psychometric properties of a modified version of the Treatment Evaluation Inventory for assessing the acceptability of treatments for geriatric depression. Canadian Journal on Aging / La Revue Canadienne du Vieillissement, 17(4), 414–424. https://doi.org/10.1017/S071498080001268X

19.

Manemann

S. M.

Chamberlain

A. M.

Boyd

C. M.

Miller

D. M.

Poe

K. L.

Cheville

Weston

S. A.

Koepsell

E. E.

Jiang

Roger

V. L.

(2018). Fall risk and outcomes among patients hospitalized with cardiovascular disease in the community. Circulation: Cardiovascular Quality and Outcomes, 11(8), Article e004199. https://doi.org/10.1161/CIRCOUTCOMES.117.004199

20.

Miller

K. L.

Magel

J. R.

Hayes

J. G.

(2010). The effects of a home-based exercise program on balance confidence, balance performance, and gait in debilitated, ambulatory community-dwelling older adults: A pilot study. Journal of Geriatric Physical Therapy, 33(2), 85–91.

21.

Müller

Lautenschläger

Dörge

Voigt-Radloff

(2019). A feasibility study of a home-based lifestyle-integrated physical exercise training and home modification for community-living older people (Part 2): The FIT-at-Home fall prevention program. Disability & Rehabilitation. Advance online publication. https://doi.org/10.1080/09638288.2019.1700564

22.

Nandy

Parsons

Cryer

Underwood

Rashbrook

Carter

Eldridge

Skelton

Taylor

Feder

, & Falls Prevention Pilot Steering Group. (2005). Development and preliminary examination of the predictive validity of the Falls Risk Assessment Tool (FRAT) for use in primary care. Journal of Public Health, 27(1), 129–130. https://doi.org/10.1093/pubmed/fdh132

23.

National Council on Aging. (n. d.). Evidence-based falls prevention programs. https://www.ncoa.org/healthy-aging/falls-prevention/falls-prevention-programs-for-older-adults-2/

24.

Nowell

L. S.

Norris

J. M.

White

D. E.

Moules

N. J.

(2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16, 1–13. https://doi.org/10.1177/1609406917733847

25.

Portz

J. D.

Bayliss

E. A.

Bull

Boxer

R. S.

Bekelman

D. B.

Gleason

Czaja

(2019). Using the Technology Acceptance Model to explore user experience, intent to use, and use behavior of a patient portal among older adults with multiple chronic conditions: Descriptive qualitative study. Journal of Medical Internet Research, 21(4), Article e11604. https://doi.org/10.2196/11604

26.

Prochaska

J. O.

Velicer

W. F.

(1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38–48.

27.

Resnick

Zimmerman

S. I.

Orwig

Furstenberg

A. L.

Magaziner

(2000). Outcome Expectations for Exercise Scale: Utility and psychometrics. Journal of Gerontology: Psychological & Social Sciences, 55(6), S352–S356. https://doi.org/10.1093/geronb/55.6.s352

28.

Rubenstein

L. Z.

Vivrette

Harker

J. O.

Stevens

J. A.

Kramer

B. J.

(2011). Validating an evidence-based, self-rated Fall Risk Questionnaire (FRQ) for older adults. Journal of Safety Research, 42(6), 493–499. https://doi.org/10.1016/j.jsr.2011.08.006

29.

Shenton

A. K.

(2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22, 63–75.

30.

Sherrington

Fairhall

N. J.

Wallbank

G. K.

Tiedemann

Michaleff

Z. A.

Howard

Clemson

Hopewell

Lamp

S. E.

(2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 1(1), Article CD012424. https://doi.org/10.1002/14651858.CD012424.pub2

31.

Shubert

T. E.

Smith

M. L.

Goto

Jiang

Ory

M. G.

(2017). Otago exercise program in the United States: Comparison of 2 implementation models. Physical Therapy, 97(2), 187–197. https://doi.org/10.2522/ptj.20160236

32.

Stanmore

E. K.

Mavroeidi

de Jong

L. D.

Skelton

D. A.

Sutton

C. J.

Benedetto

Munford

L. A.

Meekes

Bell

Todd

(2019). The effectiveness and cost-effectiveness of strength and balance Exergames to reduce falls risk for people aged 55 years and older in UK assisted living facilities: A multi-centre, cluster randomised controlled trial. BMC Medicone, 17(1), Article 49. https://doi.org/10.1186/s12916-019-1278-9

33.

Stevens

J. A.

Phelan

E. A.

(2013). Development of STEADI: A fall prevention resource for health care providers. Health Promotion Practice, 14(5), 706–714. https://doi.org/10.1177/1524839912463576

34.

Szanton

S. L.

Xue

Q. L.

Leff

Guralnik

Wolff

J. L.

Tanner

E. K.

Boyd

Thorpe

R. J.

Bichai

Gitlin

L. N.

(2019). Effect of a biobehavioral environmental approach on disability among low-income older adults: A randomized clinical trial. Journal of the American Medical Association Internal Medicine, 179(2), 204–211. https://doi.org/10.1001/jamainternmed.2018.6026

35.

Taylor

M. E.

J. C. T.

Lord

S. R.

Kurrle

S. E.

Webster

Savage

Delbaere

(2020). Pilot feasibility study of a home-based fall prevention exercise program (StandingTall) delivered through a tablet computer (iPad) in older people with dementia. Australasian Journal on Ageing, 39(3), e278–e287. https://doi.org/10.1111/ajag.12717

36.

VanRavenstein

Brotherton

Davis

(2020). Investigating the feasibility of using telemedicine to deliver a fall prevention program: A pilot study. Journal of Allied Health, 49(3), 221–227.

37.

Wagner

E. H.

(1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice, 1(1), 2–4.

38.

Watanabe

J. H.

(2016). Medication use, falls, and fall-related worry in older adults in the United States. Consultant Pharmacist, 31(7), 385–393. https://doi.org/10.4140/TCP.n.2016.385

39.

World Health Organization. (2010). World Health Organization Disability Assessment Schedule 2.0: 12-item version, interviewer-administered. https://www.who.int/classifications/icf/WHODAS2.0_12itemsINTERVIEW.pdf

40.

Xiang

Chen

Kim

(2020). Trajectories of homebound status in Medicare beneficiaries aged 65 and older. The Gerontologist, 60(1), 101–111. https://doi.org/10.1093/geront/gnz023

41.

Yang

Zhang

Zou

(2016). Diabetes mellitus and risk of falls in older adults: A systematic review and meta-analysis. Age & Ageing, 45(6), 761–767. https://doi.org/10.1093/ageing/afw140