Twelve month follow up of a falls prevention program in older adults from diverse populations in Australia: A qualitative study

Abstract

Several randomised trials demonstrate that multi dimensional falls prevention programs are effective in reducing falls in older adults. There is a need to examine the impact of these programs in real life settings where diverse populations exist. The aim of this study was to examine the acceptability and impact on sustained participation in falls prevention activities of a combined exercise and education falls prevention program. A semi structured telephone interview was conducted with 23 participants 12 months following the completion of a 15 week falls prevention program tailored to diverse communities in Victoria, Australia and provided in both a group and home based format. Reported benefits of the falls prevention program included physical improvements in joint flexibility, mobility and balance and enjoyment derived from both the exercises and socialisation. Recall of the educational component was minimal as were ongoing behavioral changes to reduce the risk of falling other than exercise. Participation in sustained exercise for falls prevention following the completion of the program was also inconsistent. Future improvements of such programs could focus upon ensuring the exercises prescribed are sufficiently challenging for each individual in order to be of physical benefit, altering the educational style to be goal directed and more enjoyable, and integrating further strategies to support sustained participation in falls prevention behavioral changes. Linking participants with alternate ongoing exercise opportunities or potential sources of ongoing support may be advantageous in enhancing long term participation in exercise for falls prevention following cessation of the program.

Introduction

Fall-related injury in older adults is a major and growing public health issue. In Australia an estimated one in three older persons living at home experiences a fall annually (CHA, 2010, Gill et al., 2005) with falls accounting for $648.2 million per year in hospital care (Bradley, 2012a) and exceeding $1 billion per year in indirect costs (Moller, 2003). It has been estimated that there were nearly 11,000 more people aged 65 years and older admitted to hospital due to a fall in 2008–2009 than the age-standardised rate in 1999–2000 (Bradley, 2012b). Unless current trends in fall injuries can be reduced, these figures can be expected to increase disproportionately in comparison to the aging population.

Various interventions have been identified as effective means of reducing fall rates and/or risk of falling. These include group exercise, home based exercise, home safety assessment and modification interventions and multifactorial interventions (Gillespie et al., 2012). Although the evidence relating to the provision of educational materials alone for preventing falls is inconclusive (Gillespie et al., 2012), patient education to reduce known falls risk factors has frequently been included as a component of effective multi component interventions (Clemson et al., 2004, Huang et al., 2010, Robson et al., 2003). It is also widely held that ongoing participation in health behaviors to prevent falls, such as exercise, is necessary in order to sustain the beneficial effects of these strategies in the long term (Sherrington, Tiedemann, Fairhall, Close, & Lord, 2011).

Previous research regarding the effectiveness, acceptability, and sustained participation in falls prevention programs have resulted predominantly from studies stipulating rigid inclusion criteria and enforcing strict conditions of participation that may not reflect the practical conditions of real life falls prevention programs. In particular, the ability to speak English is often a requirement of such trials with 22 randomized trials investigating the efficacy of falls prevention interventions in a recent Cochrane review excluding participants who did not speak English (Gillespie et al., 2012). Similarly, another systematic review of 24 studies investigating older people's perceptions of facilitators and barriers to participation in falls prevention interventions identified that only three studies examined the health promotion needs of non English speaking groups (Bunn, Dickinson, Barnett-Page, Mcinnes, & Horton, 2008). Culturally and linguistically diverse populations (CALD) are an important component of communities in many developed countries and especially amongst older adults. In Australia, in 2006, 21% of those over the age of 65 were born in non English speaking countries (AIHW, 2007). It is recognised that the health care needs and responses of these populations are likely to differ from the remainder of the population due to intrinsic medical differences, higher life expectancies, varying cultural preferences and reduced English language proficiencies (AIHW, 2002, Omeri and Raymond, 2009). Consequently, there is a need to evaluate the effectiveness, acceptability, and sustained participation in falls prevention programs in real life settings where diverse populations exist.

This study examines the acceptability and impact on sustained participation in falls prevention activities of a mixed exercise and education falls prevention program, referred to as the Making a Move program, that was offered to a diverse community population in Victoria, Australia. This study investigates why people participated in the Making a Move program, how they felt about it, and how they perceive it affected them and their health behaviors since they completed this program. It further investigates the impact of CALD status and how the Making a Move program was offered (group based versus home based) on these outcomes.