Activity Restriction and Fall Risk After Participation in a Community-Based Fall Prevention Program

Abstract

Date Presented 4/21/2018

Of concern to practitioners is understanding the relationship between sustaining a fall and the impact on ability to engage in meaningful occupations. This study explored the correlation between fall risk and perceived activity participation.

Primary Author and Speaker: Shannon Martin

BACKGROUND AND PURPOSE: Stepping On is a community-based, multifactorial falls prevention program for older adults that has been recommended by the Centers for Disease Control and Prevention (CDC) as an effective intervention for community-dwelling older adults (Stevens & Burns, 2015). Although the Stepping On program has been established as an effective intervention to reduce fall risk in older adults in Australia, there continues to be a need to understand the efficaciousness of this comprehensive fall prevention intervention in other communities (Clemson et al., 2004; Leland et al., 2012).

The literature widely supports the connections among fall risk, fear of falling, and activity restriction in older adults (Chase et al., 2012; Leland et al., 2012). However, little research has examined the correlation between participation in a multifactorial fall prevention program and activity restriction. The primary objective of this translational research study was to examine the effectiveness of the Stepping On falls prevention program in a local community. Additionally, this study aimed to identify correlations among fall risk, standardized balance assessments, and perceived activity participation.

METHOD: This study used a convenience sample of participants recruited through activity calendars, flyers, and mailings at three sites for Stepping On workshops in the fall of 2016. Three local community centers with established populations of older adults agreed to host the Stepping On workshops as part of their comprehensive and tailored activity programming. Inclusion criteria were men and women aged 65 or older who had fallen in the past year or were at risk of falling; resided in the community; were able to walk without the help of another person and did not use a walker, scooter, or wheelchair most of the time for indoor mobility; spoke English as a primary language; and demonstrated ability to follow directions.

Three outcome measures were used to assess fall risk, balance, mobility, strength, and endurance: the Timed Up and Go (TUG), the 30-s chair stand test, and the four-stage balance test. These measures were selected on the basis of their clinical utility and recent inclusion in the CDC STEADI tool kit (https://www.cdc.gov/steadi) as recommended standardized functional assessment tools. The Survey of Activities and Fear of Falling in the Elderly (SAFFE) was selected as an additional outcome measure to assess fear of falling and activity restriction; subtests measure activity level, fear of falling, activity restriction, and worry level.

Data were analyzed using IBM SPSS Statistics Version 22 (IBM Corp., Armonk, NY). Pretest and posttest scores were compared using paired samples t tests. Pearson correlation was used to examine correlations between scores on the fall risk and balance measures and the SAFFE subtests.

RESULTS: Results on the fall risk assessments did not show significant differences at 7-wk posttest. A significant reduction in fear of falling and a significant increase in activity restriction were found postintervention. Moderate to strong correlations were found between fall risk measures and SAFFE subtests for fear of falling, activity level, and worry level.

CONCLUSION: Participation in a multifactorial fall prevention program has the potential to decrease fear of falling. Future research will be beneficial in further understanding the impact of Stepping On on activity restriction.

References

Chase, C. A., Mann, K., Wasek, S., & Arbesman, M. (2012). Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. American Journal of Occupational Therapy, 66, 284–291. https://doi.org/10.5014/ajot.2012.005017

Clemson, L., Cumming, R. G., Kendig, H., Swann, M., Heard, R., & Taylor, K. (2004). The effectiveness of a community-based program for reducing the incidence of falls in the elderly: A randomized trial. Journal of the American Geriatrics Society, 52, 1487–1494. https://doi.org/10.1111/j.1532-5415.2004.52411.x

Leland, N. E., Elliott, S. J., O’Malley, L., & Murphy, S. (2012). Occupational therapy in fall prevention: Current evidence and future directions. American Journal of Occupational Therapy, 66, 149–160. https://doi.org/10.5014/ajot.2012.002733

Stevens, J. A., & Burns, E. R. (2015). A CDC compendium of effective fall interventions: What works for community-dwelling older adults (3rd ed.). Atlanta: Centers for Disease Control and Prevention.