Richard C. Palmer

Prevention of falls in older people living in the community

The number of people living into older age (≥65 years) is rising rapidly. Older people are more likely to fall and this has adverse consequences for their quality of life and that of their families. Falls also pose a substantial financial burden on healthcare systems . Extensive research from systematic reviews and meta-analyses has established effective approaches for reducing falls among older people, although uncertainties and controversy remain. The evidence suggests that exercise based and tailored interventions are the most effective way to reduce falls and associated healthcare costs among older people in the community. This review integrates current knowledge on assessment and management strategies to prevent falls in older people living in the community. It summarizes known risk factors for falls in this population and presents assessment strategies that can be used to assess the risk of falls. It discusses the management of risks and interventions to reduce falls among older people in the community, as well as future directions and promising approaches. A fall is an event during which a person inadvertently comes to rest on the ground or other lower level.1 According to the World Health Organization, 28-35% of older people (≥65 years) fall each year globally and prevalence increases with age.1 Falls are the main cause of injury, injury related disability, and death in older people.2 The severity of resulting injuries varies, and 40-60% of falls result in major lacerations, fractures, or traumatic brain injuries.3 A longitudinal study found that 68% of people who fell reported some injury; healthcare was needed in 24% of cases, functional decline was reported by 35%, and social and physical activities were impaired for more than 15%.4 Close to 95% of all hip fractures are caused by falls; 95% of patients with a hip fracture are …

Colorectal Cancer Screening Preferences Among African Americans: Which Screening Test is Preferred?

African Americans are diagnosed at late stages and suffer disproportionately higher mortality rates from colorectal cancer (CRC). Increasing their participation in CRC screening can help reduce these disparities. In-depth personal interviews were conducted with 60 African Americans to understand if CRC test preferences exist and to identify what attributes of screening tests influence test preferences. Most individuals interviewed preferred colonoscopy as compared to FOBT. Previous participation in CRC screening influenced how individuals made decisions about CRC screening. Enabling individuals without CRC screening experience to first complete FOBT might prepare them to later participate in colonoscopy screening.

Development and evaluation of a web-based breast cancer cultural competency course for primary healthcare providers.

BackgroundTo develop and evaluate a continuing medical education (CME) course aimed at improving healthcare provider knowledge about breast cancer health disparities and the importance of cross-cultural communication in provider-patient interactions about breast cancer screening.MethodsAn interactive web-based CME course was developed and contained information about breast cancer disparities, the role of culture in healthcare decision making, and demonstrated a model of cross-cultural communication. A single group pre-/post-test design was used to assess knowledge changes. Data on user satisfaction was also collected.ResultsIn all, 132 participants registered for the CME with 103 completing both assessments. Differences between pre-/post-test show a significant increase in knowledge (70% vs. 94%; p < .001). Ninety-five percent of participants agreed that the web based training was an appropriate tool to train healthcare providers about cultural competency and health disparities.ConclusionThere was an overall high level of satisfaction among all users. Users felt that learning objectives were met and the web-based format was appropriate and easy to use and suggests that web-based CME formats are an appropriate tool to teach cultural competency skills. However, more information is needed to understand how the CME impacted practice behaviors.

Recruiting and Engaging Older Men in Evidence-Based Health Promotion Programs: Perspectives on Barriers and Strategies

Evidence-based health promotion programs are effective at reducing health risks and healthcare costs among older adults, but few men participate in the programs. This mixed methods study aimed to gain insight into the barriers to recruiting and engaging older men in evidence-based health promotion programs offered by the Healthy Aging Regional Collaborative of South Florida (HARC). Fourteen program coordinators participated in a focus group to identify barriers and strategies to improve male participation, and 49 instructors participated in a survey to triangulate the findings. Themes among barriers to male participation included women outnumbering men in the implementation sites and programs, conflict between male gender roles and the programs, and preference for other activities. Themes among strategies included public support of programs by male community leaders, program advertisements featuring males, and adapting program content. Survey results supported themes identified in the focus group. Nearly 78% of the survey respondents agreed that the perception of exercise programs as feminine was a barrier and over 90% of the survey respondents believed program advertisements featuring men would increase male participation. Findings indicate that health promotion programs and recruiting strategies need to be tailored to the unique needs and preferences of older men to improve participation.

Intermediate outcomes of a chronic disease self-management program for Spanish-speaking older adults in South Florida, 2008-2010.

Introduction The prevalence and negative health effects of chronic diseases are disproportionately high among Hispanics, the largest minority group in the United States. Self-management of chronic conditions by older adults is a public health priority. The objective of this study was to examine 6-week differences in self-efficacy, time spent performing physical activity, and perceived social and role activities limitations for participants in a chronic disease self-management program for Spanish-speaking older adults, Tomando Control de su Salud (TCDS). Methods Through the Healthy Aging Regional Collaborative, 8 area agencies delivered 82 workshops in 62 locations throughout South Florida. Spanish-speaking participants who attended workshops from October 1, 2008, through December 31, 2010, were aged 55 years or older, had at least 1 chronic condition, and completed baseline and post-test surveys were included in analysis (N = 682). Workshops consisted of six, 2.5-hour sessions offered once per week for 6 weeks. A self-report survey was administered at baseline and again at the end of program instruction. To assess differences in outcomes, a repeated measures general linear model was used, controlling for agency and baseline general health. Results All outcomes showed improvement at 6 weeks. Outcomes that improved significantly were self-efficacy to manage disease, perceived social and role activities limitations, time spent walking, and time spent performing other aerobic activities. Conclusion Implementation of TCDS significantly improved 4 of 8 health promotion skills and behaviors of Spanish-speaking older adults in South Florida. A community-based implementation of TCDS has the potential to improve health outcomes for a diverse, Spanish-speaking, older adult population.

Cost analysis of a community-based fall prevention program being delivered in South Florida.

The aim of this study was to measure the costs of delivering a fall prevention program by community agencies in South Florida. Cost data were collected from agencies participating in the delivery of Matter of Balance workshops in South Florida. Cost information included both initial implementation and ongoing workshop delivery costs. Average costs for implementation per program completer were

Breast cancer screening practices of safety net clinics: Results of a needs assessment study

325 during the first year in which the program was offered and

Factors associated with the completion of falls prevention program

176 during the second year of the program. Matter of Balance is a relatively inexpensive fall prevention program. This has implications for the further dissemination and sustainability of evidence-based programs for elderly individuals.

Implementation Cost Analysis of a Community-Based Exercise Program for Seniors in South Florida

BackgroundFor low income and uninsured populations, safety net clinics are an important source of health care, including preventive services such as mammography screening. However, little is known about how well breast health is coordinated within the safety net clinic environment and what barriers patients encounter.MethodsA needs assessment was conducted among eight community-based safety net clinics located in Montgomery County, Maryland to learn about breast cancer referral and screening procedures. Structured in-depth interviews were conducted with clinic staff during the summer of 2008.ResultsSafety net clinics reported that they routinely identified women who need mammography screening and referred women to mammography screening facilities. However, clinics were not aware of the limited number of free or low cost mammography screening slots available in the county or the waiting time to receive mammography services. Overall, screening barriers were common in the safety net system and only a few procedures were in place to help women overcome these barriers.ConclusionSafety net clinics face multiple barriers in providing and coordinating breast cancer screening services for low income or uninsured patients. These barriers prevent the efficient allocation of mammography screening services and prevent underserved women from accessing an important preventive health service.

Implementation of an Evidence-Based Exercise Program for Older Adults in South Florida

Falls and fear of falling can affect independence and quality of life of older adults. Falls prevention programs may help avoiding these issues if completed. Understanding factors that are associated with completion of falls prevention programs is important. To reduce fear of falling and increase activity levels, a Matter of Balance (MOB) and un Asunto de Equilibrio (ADE) workshops were offered to 3420 older adults in South Florida between 1 October 2008 and 31 December 2011. Workshops were conducted in English or Spanish over eight, 2-hour sessions. Participants completed a demographic and a pre-post questionnaire. Factors associated with program completion were identified using logistic regression. For MOB, females were more likely to complete the program (OR = 2.076, P = 0.02). For ADE, females, moderate and extreme interference by falls in social activities were found to affect completion (OR = 2.116, P = 0.001; OR = 2.269, P = 0.003 and OR = 4.133, P = 0.008, respectively). Different factors predicted completion of both programs. Awareness of these factors can help lower the attrition rates, increase benefits and cost effectiveness of program. Future research needs to explore why certain groups had a higher likelihood of completing either program.