Chương Trình Giảm Ngã Cho Người Cao Tuổi: Tập Thể Dục và Kiểm Tra An Toàn Nhà Ở

Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2020 Introducing Exercise and Home Safety Check to Decrease Falls in Older Adults Alie Theresa Massicot-Gray Walden University Follow this and additional works at: https://scholarworks.edu/dissertations Part of the Nursing Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact ScholarWorks@waldenu. Walden University College of Health Sciences This is to certify that the doctoral study by Alie Massicot-Gray has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made.

Review Committee Dr. Mary Verklan, Committee Chairperson, Nursing Faculty Dr. Margaret Harvey, Committee Member, Nursing Faculty Dr. Sue Bell, University Reviewer, Nursing Faculty Chief Academic Officer and Provost Sue Subocz, Ph.

Walden University 2020 Abstract Introducing Exercise and Home Safety Check to Decrease Falls in Older Adults by Alie Massicot-Gray MS, SUNY Downstate Medical Center, 2010 BS, CUNY - Medgar Evers College, 2006 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University November 2020 Abstract The lack of education related to causes of, complications from, and interventions for falls is associated with the high rate of falls and fall-related injuries in older adults (OAs) beginning at age 65. The purpose of this project was to develop a fall prevention program that included components of the Stopping Elderly Accidents Deaths & Injuries Algorithm to increase fall prevention awareness and reduce falls in OAs at one community senior center. The project practice question asked whether introducing a fall prevention program that focused on exercise and home safety checks to educate OAs could decrease the rate of falls. The development of the fall prevention program was guided by the Roy Adaptation Model and The Health Belief Model.

The sources of evidence were acquired from the Walden University databases and the Centers for Disease Control and Prevention website. The education workshop was held for 1-hour. The pretest and posttest design utilized the Fall Risk Self-Assessment 12-Item Questionnaire results for de-identified data collection from 30 OAs. The project results, analyzed using descriptive statistics, found that there were only 2 occurrences in the month following the fall prevention program, a decrease from 15 for the year before the program.

Results showed that a fall prevention program focused on exercise and a home safety check demonstrated a trend in decreasing the rate of falls. Continuing to monitor the fall rate over the next year will determine the long-term effectiveness of the educational program. The social change implications are for community senior centers to provide an evidence-based fall prevention program that decreases the rate of falls in OAs to enhance their quality of life. Introducing Exercise and Home Safety Check to Decrease Falls in Older Adults by Alie Massicot-Gray MS, SUNY Downstate Medical Center, 2010 BS, CUNY - Medgar Evers College, 2006 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University November 2020 Dedication I dedicate this quality improvement project to all my lovely grandparents and great-grandmother, who inspired me to seek a quality of life for older adults.

Acknowledgments I would like to acknowledge the entire staff of Walden University who supported me throughout my journey as a DNP student. My special thanks to my dedicated Chair, Dr. Verklan, for continuous guidance, support, and inspiration to complete my project. I would also like to thank my preceptor and the entire staff at the project site for accommodating me during my practicum rotations.

I would like to thank my husband, Dwight Gray, for believing in me and providing all the love and support that I needed to succeed. I am grateful to my children and my grandchildren, whom I drew strength from to complete my ultimate educational journey. Table of Contents List of Tables .iv List of Figures .v Section 1: Nature of the Project .3 Nature of the Doctoral Project .7 Section 2: Background and Context .9 Concepts, Models, and Theory .9 Relevance to Nursing Practice .14 Local Background and Context.15 Role of the DNP Student.16 Role of the Project Team .18 Section 3: Collection and Analysis of Evidence .20 Practice-Focused Question.21 i Sources of Evidence.21 Review of Findings. 38 Analysis and Synthesis .40 Section 4: Findings and Recommendations .42 Findings and Implications.

44 Data Outcome Report. 44 Implementation of the STEADI program. 46 Rate of Falls Post-Implementation. 49 Comparison of Pre and Post Test Scores.

54 ii Contribution of the Doctoral Project Team .54 Strengths and Limitations of the Project.59 Section 5: Dissemination Plan .61 Analysis of Self. 62 As the Practitioner. 63 As the Scholar .68 Appendix A: Fall Risk Self-Assessment Tool .75 Appendix B: Home Safety Check.77 Appendix D: Actions to Prevent Falls .78 iii List of Tables Table 1. Fall Risk Self-Assessment Tool: Rate of Falls Pre-Implementation.

Fall Risk Self-Assessment Tool: Rate of Falls Post-Implementation.50 iv List of Figures Figure 1. Fall prevention procedure. Rate of falls pre and post implementation .51 v 1 Section 1: Nature of the Project Introduction According to the Centers for Disease Control and Prevention (CDC, 2017a), a substantial number of older adults (OAs) began to experience falls beginning at 65 years of age in the United States, and lower than 50% disclosed the incident to their primary care physician. Only 1 out of 4 OAs reported falls, and 1 out of 5 falls resulted in hip and head injuries, with a reported death every 20 minutes due to injuries related to the fall (CDC, 2017a).

During the aging process, adaptation to physiological changes occurs and becomes a challenge that leads to physical decline (McEwen & Wills, 2014). The New York City Hospitals have provided emergent care to at least 21,000 OAs, with 16,000 admissions related to falls annually (New York City Department of Health and Mental Hygiene [NYCDOHMH], 2015). Older adults who have not gained the awareness of a home safety check or understand the impact of daily exercise have been at risk for falling and face deterioration in their health. Falls in older adults lead to fear of further falls, weakness, and inability to complete daily tasks (CDC, 2017a).

The nature of the DNP project was to develop a fall prevention program to educate OAs at a community-based senior center. In this section, I discuss the problem statement, purpose, nature of the doctoral project, and the significance. Problem Statement Falls have been a major public health crisis among community-residing OAs and have a detrimental impact on their health. The primary cause of disability and death in 2 OAs have been due to fall-related injuries (CDC, 2017a).

At a community-based senior center, I assessed a substantial number of OAs with gait-balance issues who required assistive devices such as walkers, canes, and wheelchairs to assist with ambulation. Some of the OAs were witnessed to experience falls and near-missed falls due to a severe gait- balance problem. The community-senior center did not have available data on the rate of falls for the OAs at the center because the issue of falls has never been addressed. Recent data were collected on 30 OAs at the center to identify their risk factors for falls.

About 50% of the OAs were at moderate risk of falls, whereas the other 50% had an elevated risk for falls. The organization did not have any program in place to prevent falls for OAs. Their risk factors included prior falls, gait-balance impairments, and environmental hazards within their home (Marcum, Caffarelli, & Seil, 2014). Because OAs who have fallen are often fearful of further falls, they may decrease their daily activities, which leads to progressive physical weakness and further falls (CDC, 2017a).

A community-based senior center was an appropriate place to conduct a fall prevention program because the OAs spend most of their time at the center. Exercise and a home safety check have significantly reduced falls and maintain the quality of life (QOL) for OAs. The direct annual medical cost used to treat fall-related injuries has been $31 billion (CDC, 2017a). Because falls have persisted in OAs, the direct medical cost could increase to $54 billion by 2020 (A.

Increased senior center involvement in fall prevention measures could reduce health care spending and 3 decrease injuries related to falls. New York City has 250 senior centers and has been providing programs and services for over 29,680 OAs daily (Stringer, 2017). Purpose As an advanced practice nurse (APN), I have embarked on relevant research findings to create a quality improvement project (QIP) that could effectively decrease falls in OAs. The goal of the doctoral project was to implement components of the Stopping Elderly Accidents, Deaths & Injuries (STEADI) algorithm to reduce falls in OAs at one community senior center.

The STEADI is an excellent tool used by the CDC (2017a) specifically to reduce falls in OAs and could be used by senior centers for all their members. The STEADI program allowed the senior center to identify their members who were at risk for falls and implement evidence-based practice (EBP) interventions to prevent falls. I assessed the OAs’ rate of falls pre- and post-implementation of the monthly use of the STEADI program to determine if the rate of falls was reduced. The senior center provided an opportunity for me to determine the rate of falls in 30 OAs before deciding the implementation of the STEADI program.

The outcome that this project was expected to provide was an opportunity for the senior center to decrease the rate of falls for its members and maintain their QOL. Nature of the Doctoral Project A QIP was implemented to address the incidences of falls in OAs. Public health agencies, such as community senior centers, who have been providing EBP activities, should become engaged in actions that prevent falls and complicated injuries in OAs. The 4 goal of the QIP project was to improve the incidence of fall rates in OAs at a senior center.

A fall prevention program was developed using a before-and-after design with components of the STEADI algorithm. The components of the STEADI program that were used included the delivery of a fall prevention class that focused on exercise and a home safety check. The OAs were given a validated Fall Risk Self-Assessment (FRSA) checklist used in the STEADI algorithm by the CDC that was developed by the VA Greater Los Angeles Healthcare System Geriatric Research Education & Clinical Center (GRECC) and Affiliates (CDC, 2017a). The FRSA checklist was used as a screening tool and contained a 12-item questionnaire that obtains information related to the OAs’ risk for falls.

The questionnaire provided a total possible score of 14 points; however, OAs who scored 4 points or over were considered at risk for falling. Because the tool was used as a pre-score analysis of the OAs’ risk for falls, it also determined which OAs would be included in the fall prevention program. The OAs were given brochures to take home to provide reinforcement on the education provided. The OAs were reevaluated within 30 days to determine the effectiveness of the program.

They completed the 12-item questionnaire that collected data on the post-score analysis of the OAs’ risk for falls. The OAs who experienced falls within the past 30 days were reevaluated and encouraged to continue in the fall prevention program. The project generated a better understanding of the incidence of falls in OAs and how exercise and a home safety check provided a positive impact. The data were analyzed by relying on comparative descriptive statistics 5 to compare the pre-fall data and the post-fall data.

Descriptive statistics provided an opportunity to gain new information to better explain a phenomenon (Grove, Burns, & Gray, 2013).