01

Fall Prevention
- Safe and full participation in activities and
control over one’s ability to remain with the home
and community are priorities for older adults.
Cynde Kae D. Panares
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Overview
Apply the evidence on fall prevention interventions to occupation-based interventions.
Explain the role of occupational therapy in an interdisciplinary, health promotion approach
to fall prevention.
Evaluate the advantages and disadvantages of various fall prevention interventions in
different communitysettings.
Synthesize fall prevention guidelines to design a locally relevant falls prevention program
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Introduction
The authors present two examples of successful
community-based fall prevention programs designed
and implemented by occupational therapy personnel
Fall Prevention in a
to provide this outcome.
Rural Senior Center
The first example describes a brief student-led
an overview of Area Health Education
program, and
Centers and the project setting is
the second is an ongoing program integrated provided
within a local office on aging in suburban
Maryland.
description of the needs assessment,
program planning, program
implementation, and program
evaluation for a fall prevention
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Western Maryland Area Health Education Center (WMAHEC)

“Interdisciplinary Prevention in Rural Communities.”

followed by a second course focusing on evaluation methods, entitled

“Interdisciplinary Team Research: Applied Outcomes Research by
Interdisciplinary Teams.”

Overview of STEADY As You Go

the Project
The interdisciplinary planning team consisted of one student each from
occupational therapy, physical therapy, and respiratory therapy

Area Health Education Centers

(AHECs)
 sociodemographic, cultural, and geographic characteristics 05

the majority had low incomes, most were over 70 years old, and a
substantial minority had chronic conditions such as arthritis, visual
impairments, and hypertension

Appalachian culture, particularly as they relate to health behaviors

Needs
distributed a brief questionnaire to senior center clients to assess their
attitudes and beliefs about falling

Assessment
The team discovered that many clients were concerned about falling and
interested in reducing their risks.
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The team relied heavily on constructs from the

Health Belief Model (HBM)
Ajzen’s Theory of Planned Behavior
Transtheoretical model
Ecology of human performance (EHP)

The planning team set the following four major goals:

Program
To raise awareness among seniors regarding strategies to
prevent falling.
To alter dangerous behaviors in the everyday life of seniors

Planning
To promote seniors’ safety in homes and activities
To minimize the risk of seniors falling indoors and outdoors
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A total of 17 participants attended the
one-hour module, which was followed by
lunch.

Program
Implementation
STEADY As You Go
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The STEADY acronym provided a unifying theme for much of the program.

The acronym functioned as a simplified framework for an occupation-based

educational component.
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The evaluation team first established that the evaluation’s purpose was to
determine the program’s impact on three outcomes:
consumer satisfaction,
participants’ fall prevention behaviors, and
senior center program enhancements

Program
Qualitative data were collected in a brief focus group with 14 of the original
participants and in two 30-minute individual interviews with two members
of the senior center’s staff.

Evaluation Quantitative data were collected via a written questionnaire administered to

the same 14 participants
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First, consumer satisfaction was determined to

be high, based on qualitative data from the

Results of the interviews and focus group.

Second, the impact on participants’ behavior was

Evaluation evaluated in terms of the five HBM subscales

using data from the focus group and
questionnaire.
Finally, the program’s impact on enhancements
to the senior center was less favorable.
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First, the importance of “buy-in” among the

facility staff is critical in creating momentum
from the program. This could be facilitated
through close collaboration with staff during the
program planning phase, and periodic follow-up
to monitor compliance with recommendations
and offer resources and support, possibly
Recommendations including an on-site environmental evaluation.
Second, many older adults are highly motivated
to adopt simple behavior changes to reduce their
risk of falling and are eager to learn new
strategies.
Moreover, while the program might be more
effective in an expanded multi-session format.
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The Howard County Office on Aging (HCOOA)

originally funded one full-time occupational
therapist through a 3-year grant from the Horizon
Foundation.
At the HCOOA, the occupational therapist
spearheaded the development of a new fall
Aging in Place prevention program as part of the countywide
Aging in Place Initiative
Initiative The occupational therapist was responsible for
fostering agency collaborations with a
comprehensive geriatric assessment team,
conducting home evaluations and direct client
interventions, providing staff education to
facilitate collaborative interdisciplinary efforts,
and educating the public in multiple community
venues.
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the program addressed falls prevention in a

multifactorial way as part of a larger health
promotion strategy
The HCOOA is the local agency that plans,
advocates, develops, and coordinates programs
and services for seniors and their family
Aging in Place members.
Clients were provided with assistive devices and
Initiative trained in their proper use; home modifications
were performed to enhance safety and functional
mobility; and referrals for more intensive
rehabilitation were made where appropriate.
by maximizing functional independence and
safety, clients enjoyed a higher quality of life and
autonomy
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began with the in-home evaluation and service

plan provided to new clients.
In these occupational therapy evaluations, clients
were often found to be capable of functioning at
a higher level of independence with appropriate
interventions, and therefore needed fewer

Aging in Place supportive services.

In these occupational therapy evaluations, clients

Initiative were often found to be capable of functioning at

a higher level of independence with appropriate
interventions, and therefore needed fewer
supportive services.
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the occupational therapy evaluation and

intervention provided through the Aging in Place
Initiative aimed to optimize the match between
the client and his/her environment by modifying
both the environment and the person, in order to
maximize functional independence and minimize

Aging in Place the need for supportive services.

the occupational therapist’s presence

Initiative contributed to significant improvements in the

program’s cost-effectiveness.