Assessing Older Adults’ Readiness for Adopting Fall Prevention Recommendations Using the Transtheoretical Stages of Change

Abstract

Objectives: Reducing fall risk requires older adults (age 65+) to adopt effective prevention strategies. This study has three aims: 1) understand Stage of Change (SOC) for three fall prevention strategies; 2) determine strategies older adults’ use; and 3) understand which characteristics relate to readiness to take action. Methods: A survey of 1063 older adults assessed fall risk, SOC, and use of fall prevention strategies. Data analysis included descriptive statistics and regression analysis. Results: The most common SOC for older adults by strategy was action for overall fall prevention (61%), contemplation for medication management (45%), and preparation and action for strength/balance (29% each). Believing falls are preventable was most strongly related to being in a Change stage (e.g., action, maintenance) for overall fall prevention (Risk Ratio: 1.4, 95% CI: 1.1, 1.7). Discussion: Health promotion can focus on increasing knowledge of evidence-based fall prevention strategies to encourage older adults to take action.

Keywords

strength and balance exercise medication unintentional falls older adults

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References

Ambrose

A. F.

Paul

Hausdorff

J. M.

(2013). Risk factors for falls among older adults: A review of the literature. Maturitas, 75(1), 51–61. https://doi.org/10.1016/j.maturitas.2013.02.009

Bhasin

Gill

T. M.

Reuben

D. B.

Latham

N. K.

Ganz

D. A.

Greene

E. J.

Dziura

Basaria

Gurwitz

J. H.

Dykes

P. C.

McMahon

Storer

T. W.

Gazarian

Miller

M. E.

Travison

T. G.

Esserman

Carnie

M. B.

Goehring

Fagan

Peduzzi

(2020). A randomized trial of a multifactorial strategy to prevent serious fall injuries. New England Journal of Medicine, 383(2), 129–140. https://doi.org/10.1056/nejmoa2002183

Britten

Addington

Astill

(2017). Dancing in time: Feasibility and acceptability of a contemporary dance programme to modify risk factors for falling in community dwelling older adults. BMC Geriatrics, 17(1), 83–102. https://doi.org/10.1186/s12877-017-0476-6

Burbank

P. M.

Reibe

Padula

C. A.

Nigg

(2002). Exercise and older adults: Changing behavior with the transtheoretical model. Orthopaedic Nursing, 21(4), 51–63. https://doi.org/10.1097/00006416-200207000-00009

Burns

Lee

Hodge

Pineau

Welch

Zhu

(2022). Validation and comparison of fall screening tools for predicting future falls among older adults. Archives of Gerontology and Geriatrics, 101(4), Article 104713. https://doi.org/10.1016/j.archger.2022.104713

By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel . (2019). American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674-694. https://doi.org/10.1111/jgs.1576

Centers for Disease Control and Prevention . (n.d.). Steadi: Older adult fall prevention. Retrieved January 31, 2019, from: https://www.cdc.gov/steadi/index.html

Centers for Disease Control and Prevention . (2014). 2014 Behavioral risk factor surveillance system survey (BRFSS). United States Department of Health and Human Services. https://www.cdc.gov/brfss.

Centers for Disease Control and Prevention . (2017a). Talking about fall prevention with your patients. National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention. https://www.cdc.gov/steadi/pdf/Talking_about_Fall_Prevention_with_Your_Patientsprint.pdf.

10.

Centers for Disease Control and Prevention . (2017b). SAFE: Medication review framework. National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention. https://www.cdc.gov/steadi/pdf/STEADI-FactSheet-SAFEMedReview-508.pdf.

11.

Centers for Disease Control and Prevention . (2019b). Algorithm for fall risk screening, Assessment, and intervention. National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention. https://www.cdc.gov/steadi/pdf/steadi-algorithm-508.pdf.

12.

Centers for Disease Control and Prevention . (2019b). Pharmacy Care (STEADI-Rx). National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention. https://www.cdc.gov/steadi/steadi-rx.html.

13.

Centers for Disease Control and Prevention National Center for Health Statistics. (2024b). National vital statistics system, mortality 1999-2020 on CDC WONDER online Database, released in 2021. Data are from the multiple cause of death files, 1999-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the vital statistics cooperative program. United States Health and Human Services. Retrievd July 23, 2024, from. https://wonder.cdc.gov/ucd-icd10.html

14.

Centers for Disease Control and Prevention National Center for Health Statistics. (2024a). National vital statistics system, mortality 2018-2022 on CDC WONDER online Database, released in 2024. Data are from the multiple cause of death files, 2018-2022, as compiled from data provided by the 57 vital statistics jurisdictions through the vital statistics cooperative program. United States Health and Human Services. Retrievd July 23, 2024. from: https://wonder.cdc.gov/ucd-icd10-expanded.html

15.

Clemson

Singh

M. A. F.

Bundy

Cumming

R. G.

Manollaras

O’Loughlin

Black

(2012). Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): Randomized parallel trial. British Medical Journal, 5(1), 13. https://doi.org/10.1136/bmj.e4547

16.

Cumming

R. G.

Thomas

Szonyi

Salkeld

O'Neill

Westbury

Frampton

(1999). Home visits by an occupational therapist for assessment and modification of environmental hazards: A randomized trial of falls prevention. Journal of the American Geriatrics Society, 47(12), 1397–1402. https://doi.org/10.1111/j.1532-5415.1999.tb01556.x

17.

Eckstrom

Parker

E. M.

Lambert

G. H.

Winkler

Dowler

Casey

C. M.

(2017). Implementing STEADI in academic primary care to address older adult fall risk. Innovation in Aging, 1(2), igx028. https://doi.org/10.1093/geroni/igx028

18.

Eckstrom

Vincenzo

J. L.

Casey

C. M.

Gray

Cosley

Caulley

Parulekar

Rasheed

Sanon

Demiris

Zimbroff

De Lima

Phelan

(2024). American geriatrics Society response to the World falls guidelines. Journal of the American Geriatrics Society, 72(6), 1669–1686. https://doi.org/10.1111/jgs.18734

19.

Elias

A. M.

Ogunwale

A. N.

Pepin

M. J.

Bailey

J. C.

Adams

A. D.

Colón-Emeric

C. S.

Vognsen

J. D.

Schmader

K. E.

Pavon

J. M.

(2020). High prevalence of fall-related medication use in older veterans at risk for falls. Journal of the American Geriatrics Society, 68(2), 438–439. https://doi.org/10.1111/jgs.16233

20.

Galazzi

Lusignani

Chiarelli

M. T.

Mannucci

P. M.

Franchi

Tettamanti

Reeve

Nobili

(2016). Attitudes towards polypharmacy and medication withdrawal among older inpatients in Italy. International Journal of Clinical Pharmacy, 38(2), 454–461. https://doi.org/10.1007/s11096-016-0279-4

21.

Gillespie

L. D.

Robertson

M. C.

Gillespie

W. J.

Sherrington

Gates

Clemson

Lamb

S. E.

(2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2012(9), 35. https://doi.org/10.1002/14651858.cd007146.pub3

22.

Gillespie

R. J.

Harrison

Mullan

(2018). Deprescribing medications for older adults in the primary care context: A mixed studies review. Health Science Reports, 1(7), Article e45. https://doi.org/10.1002/hsr2.45

23.

Guirguis-Blake

J. M.

Michael

Y. L.

Perdue

L. A.

Coppola

E. L.

Beil

T. L.

(2018). Interventions to prevent falls in older adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 319(16), 1705–1716. https://doi.org/10.1001/jama.2017.21962

24.

Henry

Haddad

Bergen

(2024). Older adult and healthcare provider beliefs about fall prevention strategies. American Journal of Lifestyle Medicine, 18(1), 108–117. https://doi.org/10.1177/15598276221100431

25.

Hill

K. D.

Day

Haines

T. P.

(2014). What factors influence community-dwelling older people’s intent to undertake multifactorial fall prevention programs? Clinical Interventions in Aging, 9(1), 2045–2053. https://doi.org/10.2147/cia.s72679

26.

Hutton

Frame

Maggo

Shirakawa

Mulligan

Waters

(2009). The perceptions of physical activity in an elderly population at risk of falling: A focus group study. New Zealand Journal of Physiotherapy, 37(2), 85–92.

27.

Jagnoor

Keay

Jaswal

Kaur

Ivers

(2014). A qualitative study on the perceptions of preventing falls as a health priority among older people in Northern India. Injury Prevention, 20(1), 29–34. https://doi.org/10.1136/injuryprev-2012-040707

28.

Karlsson

M. K.

Magnusson

von Schewelov

Rosengren

B. E.

(2013). Prevention of falls in the elderly—a review. Osteoporosis International, 24(3), 747–762. https://doi.org/10.1007/s00198-012-2256-7

29.

Kim

Yoshida

Suzuki

(2014). Falls and fractures in participants and excluded non‐ participants of a fall prevention exercise program for elderly women with a history of falls: 1‐year follow‐up study. Geriatrics and Gerontology International, 14(2), 285–292. https://doi.org/10.1111/ggi.12095

30.

Kohn

Belza

Petrescu-Prahova

Miyawaki

C. E.

(2016). Beyond strength: Participant perspectives on the benefits of an older adult exercise program. Health Education & Behavior, 43(3), 305–312. https://doi.org/10.1177/1090198115599985

31.

Kosma

Ellis

(2010). Establishing construct validity of a stages-of-change algorithm for physical activity. American Journal of Health Promotion, 25(2), e11–e20. https://doi.org/10.4278/ajhp.090914-quan-296

32.

Lee

(2017). The CDC’s STEADI Initiative: Promoting older adult health and independence through fall prevention. American Family Physician, 96(4), 220–221.

33.

Lord

S. R.

Castell

Corcoran

Dayhew

Matters

Shan

Williams

(2003). The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: A randomized, controlled trial. Journal of the American Geriatrics Society, 51(12), 1685–1692. https://doi.org/10.1046/j.1532-5415.2003.51551.x

34.

Marcus

B. H.

Rakowski

Rossi

J. S.

(1992). Assessing motivational readiness and decision making for exercise. Health Psychology, 11(4), 257–261. https://doi.org/10.1037/0278-6133.11.4.257

35.

Martin

Tamblyn

Benedetti

Ahmed

Tannenbaum

(2018). Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: The D-Prescribe randomized clinical trial. Journal of the American Medical Association, 320(18), 1889–1898. https://doi.org/10.1001/jama.2018.16131

36.

Martin

Tannenbaum

(2017). A realist evaluation of patients’ decisions to deprescribe in the EMPOWER trial. British Medical Journal Open, 7(4), Article e015959. https://doi.org/10.1136/bmjopen-2017-015959

37.

Montero-Odasso

van der Velde

Martin

F. C.

Petrovic

Tan

Ryg

Aguilar-Navarro

Alexander

N. B.

Becker

Blain

Bourke

Cameron

I. D.

Camicioli

Clemson

Delbaere

Duan

Duque

Dyer

Freiberger

(2022). World guidelines for falls prevention and management for older adults: A global initiative. Age and Ageing, 51(9), afac205. https://doi.org/10.1093/ageing/afac205

38.

Moreland

Kakara

Henry

(2020). Trends in nonfatal falls and fall-related injuries among adults aged≥ 65 years—United States, 2012–2018. Morbidity and Mortality Weekly Report, 69(27), 875–881. https://doi.org/10.15585/mmwr.mm6927a5

39.

New South Wales Department of Health . (2010). New South Wales fall prevention baseline survey: 2009 report. NSW State Health Publication. https://www.health.nsw.gov.au/surveys/other/Publications/falls-prevention-survey.pdf.

40.

Panel on Prevention of Falls in Older Persons American Geriatrics Society and British Geriatrics Society . (2011). Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society, 59(1), 148–157. https://doi.org/10.1111/j.1532-5415.2010.03234.x

41.

Powell-Cope

Quigley

P. A.

Besterman-Dahan

Lind

J. D.

(2014). Perceived benefits of group exercise among individuals with peripheral neuropathy. Western Journal of Nursing Research, 36(7), 855–874. https://doi.org/10.1177/0193945914523493

42.

Prochaska

J. O.

Velicer

W. F.

(1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38–48. https://doi.org/10.4278/0890-1171-12.1.38

43.

Reeve

Low

L. F.

Hilmer

S. N.

(2016). Beliefs and attitudes of older adults and carers about deprescribing of medications: A qualitative focus group study. British Journal of General Practice, 66(649), e552–e560. https://doi.org/10.3399/bjgp16x685669

44.

Robins

L. M.

Hill

K. D.

Day

Clemson

Finch

Haines

(2016). Older adult perceptions of participation in group and home-based falls prevention exercise. Journal of Aging and Physical Activity, 24(3), 350–362. https://doi.org/10.1123/japa.2015-0133

45.

Rubenstein

L. Z.

Josephson

K. R.

(2006). Falls and their prevention in elderly people: What does the evidence show? Medical Clinics, 90(5), 807–824. https://doi.org/10.1016/j.mcna.2006.05.013

46.

Sandlund

Pohl

Ahlgren

Skelton

D. A.

Melander-Wikman

Bergvall-Kåreborn

Lundin-Olsson

(2018). Gender perspective on older people’s exercise preferences and motivators in the context of falls prevention: A qualitative study. BioMed Research International, 2018(3), 6865156. https://doi.org/10.1155/2018/6865156

47.

Shaver

A. L.

Clark

C. M.

Hejna

Feuerstein

Wahler

R. G.

Jr. Jacobs

D. M.

(2021). Trends in fall‐related mortality and fall risk increasing drugs among older individuals in the United States, 1999–2017. Pharmacoepidemiology and Drug Safety, 30(8), 1049–1056. https://doi.org/10.1002/pds.5201

48.

Sherrington

Fairhall

N. J.

Wallbank

G. K.

Tiedemann

Michaleff

Z. A.

Howard

Clemson

Hopewell

Lamb

S. E.

(2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 1(8), Article 12424. https://doi.org/10.1002/14651858.CD012424.pub2

49.

Siegrist

Freiberger

Geilhof

Salb

Hentschke

Landendoerfer

Linde

Halle

Blank

W. A.

(2016). Fall prevention in a primary care setting: The effects of a targeted complex exercise intervention in a cluster randomized trial. Deutsches Ärzteblatt International, 113(21), 365–372. https://doi.org/10.3238/arztebl.2016.0365

50.

Stevens

J. A.

Burns

(2015). A CDC compendium of effective fall interventions: What works for community-dwelling older adults. National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention. https://www.cdc.gov/falls/pdf/CDC_Falls_Compendium-2015-a.pdf.

51.

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

52.

Stevens

J. A.

Sleet

D. A.

Rubenstein

L. Z.

(2018). The influence of older adults’ beliefs and attitudes on adopting fall prevention behaviors. American Journal of Lifestyle Medicine, 12(4), 324–330. https://doi.org/10.1177/1559827616687263

53.

Swann

A. A.

Matthews

C. E.

Ebbeling

C. B.

Moore

C. G.

Cunningham

J. E.

Fulton

Hebert

J. R.

(2005). The effect of social desirability and social approval on self-reports of physical activity. American Journal of Epidemiology, 161(4), 389–398. https://doi.org/10.1093/aje/kwi054

54.

United States Department of Health and Human Services . (2005). Theory at a glance: A guide for health promotion practice (2nd ed.). National Institute of Health. https://cancercontrol.cancer.gov/sites/default/files/2020-06/theory.pdf.

55.

Zimmerman

G. L.

Olsen

C. G.

Bosworth

M. F.

(2000). A 'stages of change' approach to helping patients change behavior. American Family Physician, 61(5), 1409–1416.

56.

Zou

(2004). A modified Poisson regression approach to prospective studies with binary data. American Journal of Epidemiology, 159(7), 702–706. https://doi.org/10.1093/aje/kwh090

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