Intervention Assignment

HS 490 Health Promotion

Directions

The following pages guide you on each step of this assignment. You
will look for intervention resources on web sites, class readings, class
notes and peer reviewed journals (Research Notes 1-3). You will pull
it all together and create an evidence-based intervention plan based
on your findings (Pulling it All Together) and include references
cited using APA format. You may type directly on these pages, but it is
not required. I put the assignment in boxes to make it easier to follow
but it may be easier for you to create a word document with all the
assignment components.

Total Point Value- 100 points

 Website Review -10 points

 Intervention Research Readings- 10 points
 Research Articles-Peer Reviewed 45 points
 Pulling it All Together- 30 points
 Writing-spelling, grammar, APA – 5 pts.

Please submit on Canvas. Due April 17th 10 pm

Intervention Assignment
NAME: Rylee Peterson #1 Intervention
Website Review- 10 pts.
Briefly describe:
The health topic addressed is fall prevention among those who are 65 years and older in the
Latah County community. The primary town in this region in which strategies for fall
prevention would be included is Moscow, Idaho. The main fall prevention tactics are in
residential facilities (e.g. the Good Samaritan society) or physical therapy clinics in this area
and primarily consist of exercise classes. The exercise class that is available for Latah County
is called Fit and Fall Proof. Because of this, the Fit and Fall Proof website is included below.
The NCOA is a national level of prevention that educates older adults through articles and
personal stories. Its primary goal is to change older adults’ perception of falls.

Website Names and Links:

Fit and Fall Proof: Exercise Classes for Older Adults

https://www.idahopublichealth.com/community/fitandfallproof

National Council on Aging: Falls Prevention for Older Adults

https://ncoa.org/older-adults/health/prevention/falls-prevention

General Purpose of the Website

(e.g., what type of information presented, what populations are addressed?)

Fit and Fall Proof:

On this site, there is primarily information on where classes on fall prevention are in Northern
Central Idaho (Areas such as Lewiston and Moscow) and how much they cost (most are free
but there are a few that cost money). There are also links listed on the side that provide
information on the program or fall prevention techniques in brochure format. This is for older
adults and is primarily trying to provide information about why they should come to classes. It
is more towards the action step of fall prevention than just providing information.

NCOA:

The NCOA website offers lots of resources for older adults to look through to find fall
prevention mechanisms. It offers articles about why PT works to prevent falls, what
environmental hazards exist in their houses, and steps to take to stop falls from occurring. It
primarily takes the information route and tries to educate and empower older adults. The
target audience can either be older adults, providers, or caretakers, as there are different
tabs for all three. There is also a tool on this site that can be used to assess fall risk.

What did you learn about effective interventions for your topic? Answer the
questions below and add additional comments.

Fit and Fall Proof:

The resources available within this site is primarily information and class times and locations.
There are video links in another tab that provide at home exercise courses and there are
PDFs informing the audience about common environmental home hazards. This website is
focused on the activity level of older adults. This shows me that exercise classes are effective
in fall prevention. The top recommended intervention on this site is an exercise class.

NCOA:

There are quite a few tools available with this resource. Not only is the text in an easy-to-read
size, but there are different means of intervention for healthcare providers, caregivers, and
older adults. There is a plethora of articles on falls, a fall risk survey, a link to fall signaling
(think Life Alert), and stories about fall prevention. There is no access to direct classes or
videos, although there is a list of evidence-based intervention programs. It is a good
directory, although I am not sure how helpful this intervention would be by itself.

For my topic, I learned that there are two primary interventions among fall prevention for
older adults: information on how to remove environmental hazards and exercise class
programs. Another factor worth noting is that medication mixing information is available
through the NCOA, which can help inform older adults on their own medication needs.
Outside of that, there is not much besides more information. Another mechanism of fall
prevention could be to use a cane or other walking aid, but that was not discussed after
exploring these sites.

Critical thinking and relation to your health promotion topic

1. The most focused on intervention activities that are appropriate for fall prevention are
primarily environmental assessments and exercise classes. The environment, medications,
and physical health of an older adult are the biggest factors that impact their prevalence of
falls. Anything regarding these three factors is appropriate for the project.

2. Useful tools and resources for fall prevention are exercise classes, paper brochures that
can be handed out at the doctor’s office, referrals for environmental hazard analysis from a
qualified person, education for the doctor and older adult on medication mixing, and walking
aids.

3. Fit and Fall Proof:

https://www.idahopublichealth.com/communityhealth/fitandfallproof/pdf/2021-fitness-for-
older-adults-brochure.pdf This is an online PDF designed for older adults that informs them
about falls and how the exercise classes may help them.

https://www.idahopublichealth.com/communityhealth/fitandfallproof/pdf/check-for-safety-fall-
brochure.pdf

This PDF is a checklist that is aimed for older adults to help them identify and remove home
hazards that may lead to a fall.

NCOA:

https://ncoa.org/evidence-based-programs
This is helpful for older adults, as it provides information/allows older adults to find a program
that works for them. While this is helpful, it is not an exhaustive list, and Idaho prevention
classes appear to be left out.

https://ncoa.org/article/how-physical-activity-helps-rural-older-adults-stay-strong-and-steady

This link leads to an article that is written through the National Council on Aging. It is
beneficial as it can reach older adults who live in rural communities. It is a good example of
what the other articles are like, and provides good, understandable information.

#2 Intervention Research Readings- 10 pts.

General Intervention Considerations- Answer the following using lectures and
readings. 1 paragraph for each. Each answer worth 5 points. 1= mostly incomplete
2=1/2 complete, 3=3/4 complete, 4- complete, 5-exceptional

1. Read the Spectrum of Prevention- from the Prevention Institute-what levels (at least
2) of prevention are most important for your topic/population/ and location? The
type/level of change desired will direct you to types of interventions that will have the
most impact.

Education for providers is very important for the Latah County area—especially since there
are fewer practices than there would be in a larger city. If providers have proper knowledge
and begin to think about fall screening during annual checkups, they may be able to prevent
falls through thorough medication checks, or they can refer older adults to proper physical
therapist options that can improve strength and muscle coordination. Physician knowledge on
medications that increase the risk of falls can also lead to better prescriptions that do not
have poor effects when they are mixed.

Community education is also crucial for fall prevention in the region. Although classes are not
usually the best option, having the community be aware that there are older adult times in
the gyms where they are able to work out for free or a reduced cost can be a good
community incentive if it were implemented. Through having people available at those times
to help older adults with their fall risk by introducing exercises, the community could be
educated. There can also be a sense of community among older adults where falls can be
talked about freely but also prevention can be talked about without a sense of judgment. The
community ensuring that older adults are aware that they can decrease their rate of falls
could lead to a change that is needed.

2. Discuss what you learned about the predisposing, enabling, and reinforcing
factors from your project assessment are most related to the health behaviors most
in need of change for your project? Cite literature to support your answer. (It’s fine
to use a citation from the assessment)

Predisposing

There are quite a few things that need to be changed by means of predisposing factors. From
the prior assessment assignment, the primary predisposing factors are activity levels, age,
environmental factors, medications, fear of falling, fall prevention tactics, and whether
someone lives alone. Falls also occur more often in older adult care homes, although that is
not the focus of this project/case study. Of these factors, the things that can be changed
include an older adult’s environment/tripping hazards, their activity levels, and their
medications. Other things could be walking aid use and attitude towards falls. In the previous
assessment assignment, another predisposing factor was fear of falling. Those who fear
falling tend to fall more due to that anxiety leading to a decrease in the physical activity that
has proven itself vital to fall prevention (Schoene D, et. al).

Enabling

Classes in Latah County such as Fit and Fall Proof, the NCOA’s fall risk assessment, and
physical therapy clinics are all wonderful enabling factors. While these resources are
available for many, those who are not able to drive and those who do not have internet
access would not benefit from these programs. The advertisement for fall prevention classes
in older adults is not something that appears to be prevalent in the region so it cannot be an
enabling factor.

Reinforcing factors

The biggest group that can be champions for the reinforcing factors are physicians, physical
therapists, and occupational therapists. If fall prevention is talked about with patients and
older adults by people that they respect, they may be more likely to seek aid and find a
means of getting to exercise classes or analyzing their environmental hazards.

#3 RESEARCH ARTICLES– PEER REVEIWED- 1 of 3

3 peer reviewed research articles that describe interventions are required. Use
original research, not review articles or websites. Do not include assessment
literature. 15 pt. each 45-pt. total
APA Citation of article

Taylor, D., Hale, L., Schluter, P., Waters, D. L., Binns, E. E., McCracken, H., McPherson, K., &
Wolf, S. L. (2012). Effectiveness of tai chi as a community-based falls prevention
intervention: A randomized controlled trial. Journal of the American Geriatrics Society,
60(5), 841–848. https://doi.org/10.1111/j.1532-5415.2012.03928.x.

Participants or population reached.

Older adults in New Zealand with at least 1 fall factor (Taylor et al., 2012)

Describe the intervention and its effectiveness.

 Briefly describe the intervention – what did they do? What was unique or most
interesting to you?

In this intervention there were three main groups: there was the control group, which
consisted of low-level exercise, there was the Tai Chi group that practiced one day a week,
and there was the Tai Chi group that practiced two days a week. These classes lasted for
twenty weeks at one hour per class with the instructors having experience in teaching. The
typical outline of this class included 7 minutes of walking to warm up and then the
participants were able to either sit or stand with aid for the rest of the time. There were no
exercises that specifically worked on balance but there was stretching, resistance training,
and light cardiovascular exercise.

To me the most interesting aspect of this study’s intervention was that there was nothing
that specifically targeted balance. I think that it was interesting because people tend to
equate good balance to better walking and a decrease in falls, but this study did not even
monitor that.
  What did you learn about the effectiveness of the intervention?

This intervention did not show a difference between Tai Chi and light exercise in a regard to
fall prevention, however all three groups did show a significant reduction in the monthly rate
of falls. This shows that any of these interventions were effective, but that there was no
significant difference between them.

- If a health behavior theory was identified, briefly discuss which one was used and how it
shaped the intervention?

From my read through of this intervention there was no mention of a health behavior theory.

 What were the main conclusions about the interventions reached by the author(s) and
what were the limitations of the interventions? (Most peer reviewed papers will cite the
limitations of the findings).

The intervention concluded that Tai Chi and Low-Level exercise are both effective in the
prevention of falls. Limitations could be that there was not enough Tai Chi done weekly and
that there may not have been an exercise program with a high enough intensity to determine
a difference between the two.

One thing that the authors noted was that after the study at the 12-month follow-up, the falls
were still decreased.

Critical thinking and relation to your project

 What did you learn from this research/intervention that can be applied to you project?

If there was any doubt in my mind about exercise classes as being effective in the reduction
of falls prevention, I now know that any movement—even if it does not include balance
training—can be effective in the reduction of falls. I can apply the exercise aspect to my
project, although I am not sure that classes have been helping since the rate of falls is still
increasing despite the creation of programs meant to aid older adults. I know that exercise
helps--I just must attempt to think up a new idea that can allow a larger group of people to
have access to this form of prevention.

 What would you need to do to adapt the intervention to fit your population and why?

To adapt the results of this study to the older adult community in Latah County, the biggest
issue is likely getting people to show up. There are classes but they are not well advertised,
and there is information and assessments, they are just on unfamiliar terrain. In a rural region
like Latah, the best thing that I think an intervention could have is simplicity—whether that be
a simple means of accessing information, advertisements that are easy to read, or affordable
occupational therapists or physical therapists that can do in-home visits for older adults who
are having a hard time with transportation. Being spread out with relatively low access to
hospitals can strain the community, and technology for older adults—especially those in rural
regions—can sometimes be too difficult to navigate to access information. Something that I
think could help the older adults would be videos on safe at-home chair exercises that they
can participate in that pop up on a Facebook feed or appear on television commercials.

#3 RESEARCH ARTICLES– PEER REVEIWED- 2 of 3

APA Citation of Article

Kamei, T., Kajii, F., Yamamoto, Y., Irie, Y., Kozakai, R., Sugimoto, T., Chigira, A., & Niino, N.
(2015). Effectiveness of a home hazard modification program for reducing falls in urban
community-dwelling older adults: A randomized controlled trial. Japan Journal of Nursing
Science, 12(3), 184–197. https://doi.org/10.1111/jjns.12059

Participants or population reached.

The participants of this study are Japan community dwellers who were 65 years of age or
older. The inclusion factors were that they were cleared to exercise and live alone by a
physician, and the exclusion factors were cognitive disorders such as dementia or poor
physical function (Kamei et al., 2015).

Describe the intervention and its effectiveness.

 Briefly describe the intervention – what did they do? What was unique or most
interesting to you?

This is a home hazard modification program where older adults take four fall prevention
programs with information on food and nutrition, home fall risk factors, foot care, and
exercise. The programs last two hours each. The control group received only this information
and the home hazard modification program added education and practice in home safety
through a model of a home and identification of the hazards.

The thing about this intervention that I found interesting was that they discussed foot self-care in both groups. I
think that and properly fitting shoes are things that people tend to overlook in a study. I am interested to see if
proper footwear education for older adults would impact falls if it were discussed by itself.

 What did you learn about the effectiveness of the intervention?

At the 52-week mark of the study, the home hazard modification group showed a 10%
reduction in overall falls. For those 75 and older saw a significant reduction in falls even
within 12 weeks (Kamei et. al., 2015).

 If a health behavior theory was identified, briefly discuss which one was used and how
it shaped the intervention?

In this study there was no identified health behavior theory although they did measure overall
awareness of fall prevention.

 What were the main conclusions about the interventions reached by the author(s) and
what were the limitations of the interventions? (Most peer reviewed papers will cite the
limitations of the findings).

This shows that this form of class can have a reduction in falls prevention. This prevention
mechanism also showed an increase in awareness of falls prevention.

The limitations of this study are that the older adults were only recruited from the Tokyo
region and that there was a higher number of women in the study than men. This can make
the effects of this study different for different populations.

Critical thinking and relation to your project

 What did you learn from this research/intervention that can be applied to you project?

From this intervention, something that I can apply to my project is that many older adults
could benefit from being able to recognize home hazards. While education such as this is not
as effective as exercise courses, it can still have an impact on the prevention of falls among
older adults.

 What would you need to do to adapt the intervention to fit your population and why?

I would need to adapt these findings to those in a rural region in Idaho rather than an urban
area in Japan. I think that the benefits of this form of education could be helpful, but I would
have to consider a different outline of a model home and use that rather than the typical
home in Tokyo. I also think that I would need to try and find a way to encourage older adults
to attend these courses.

#3 RESEARCH ARTICLES– PEER REVEIWED 3 of 3

APA Citation

Cumming, R. G., Thomas, M., Szonyi, G., Salkeld, G., O’Neill, E., Westbury, C., & Frampton, G.
(1999). and Modification of EnGronmental Haiards : A Randomized Trial of Falls
Prevention. Journal of American Geriatrics Society, 47, 1397–1402, Accessed April 18,
2023.

Participants or population reached.

The population that is reached are adults 65 years and older who were selected from a
certain hospital ward. They are from the nation on Australia (Cumming et al., 1999).

Describe the intervention and its effectiveness.

 Briefly describe the intervention – what did they do? What was unique or most
interesting to you?

This intervention involves a home visit from an occupational therapist who has been
practicing for two years. She would go to the subjects’ homes and conduct her routine exam
and use a specific form for records. These visits usually took one hour. She ended her visit
with recommendations and gave instructions on how to decrease the home hazards. After a
couple weeks she would then call the home again and make sure that the house changes
were made.

The thing that was the most interesting to me was that there was an occupational therapist
used, for that is the career that I will be going to graduate school for next year. This study
seemed like the basic thing that would be performed upon physician recommendation, so I
was curious to use it to see the effectiveness of one of the more common solutions to falls
among older adults.

 What did you learn about the effectiveness of the intervention?

This intervention was only effective for those who had one or more falls during the year but
did decrease falls overall. The results can be interpreted as effective, although it could be due
to the occupational therapists’ visits and encouragement of behavior change rather than the
environmental modification itself.

 If a health behavior theory was identified, briefly discuss which one was used and how
it shaped the intervention?

There was no health behavior theory that I identified in this paper.

 What were the main conclusions about the interventions reached by the author(s) and
what were the limitations of the interventions? (Most peer reviewed papers will cite the
 limitations of the findings).

The main conclusion about the intervention that was reached by the authors was that the
intervention group had fewer falls away from home and at home when compared to the
control group. This can be because an occupational therapist provides resources and
information on how to live with any unchangeable hazards safely. One possible limitation that
was listed referred to the control group not receiving any form of home visit, which could
show that awareness from the intervention group had an impact. They also conclude that an
occupational therapist home visit has the potential to impact falls more than home hazard
modification alone.

Critical thinking and relation to your project

 What did you learn from this research/intervention that can be applied to you project?

In my project, something that I can apply to my project is that having a home visit is most
likely better than just having home modifications. I think that this change is good to know if I
were to create my own intervention.

 What would you need to do to adapt the intervention to fit your population and why?

In my population in Latah County there are not many occupational therapists—in a brief
Google search, there are only four and they are all in Moscow, Idaho. Having a home visit
from an occupational therapist may not be feasible in the smaller towns. For towns like this, I
would adapt my recommendations to simply having the older adult find a friend who is willing
to come over and assess their house with them. In that way, the adult may still get a nice feel
for community while still increasing their awareness.

Pulling it All Together- Intervention Plan - 30 pts

1. What level of prevention is the focus of your intervention: primary, secondary, or tertiary?
Are the intervention efforts focused on: individuals (one to one), groups, community,
population (policy, systems, environments, information campaigns, or street/direct
action/advocacy?

The focus on intervention is on the primary level, although many older adults do not realize
that they are at risk of falling until they have already experienced one, which can sometime
make the prevention more of a secondary level. The interventions are through groups, as even
education comes from classes where older adults are able to socialize and feel community in
light of a common struggle.

2. Intervention Types and Strategies – 3 intervention types and strategies- 10 pt. each-
30 pts.

Selected interventions to decrease the number of falls in older adults: 1) educational activities,
2) health status evaluations/assessments, and 3) behavior modification activities.

Educational activities

- Educate older adults on fall awareness through having them point out a tripping
hazards that they see in a fake home (Kamei et al., 2015). This can be through a
social support system, a game-like ad on a website such as Facebook, an
 occupational therapist’s office, or an in-home visit from a physical therapist,
occupational therapist, or physician.

- Educate footwear providers/orthopedic specialists on proper shoe fitting for older

adults. Have them learn how to teach this to older adults or answer questions if
asked (Kamei et. al., 2015).

- Have occupational therapists, nurses, or other healthcare provider offices hand out
educational brochures on things older adults can do to prevent falls.

- Have occupational therapists or any available healthcare providers go to in-home

visits for older adults who are concerned about their fall prevention and ensure that
they provide information or answer any questions that older adults have (Cumming
et.al, 1999).

Health Status Evaluations/Assessments

- Encourage older adults to attend regular physician appointments and discuss fall risk
and where to further go for aid through billboards or advertisements in stores.

- Have occupational therapists or any available healthcare providers (since this is a

small region) go to in-home visits for assessments of fall hazards in the house
(Cumming et. al., 1999).

- Visit the NCOA site to determine falls risk for older adults. This can be available to
anyone who has internet access.

- Create a coordinated care plan for physician’s offices that allows for proper
evaluations and follow-through of the steps when someone is at a higher risk for
falling (Eckstrom et. al., 2021).

Behavior Modification Activities

- Encourage attendance of classes (in Moscow region, this is Fit and Fall Proof) that aid
in the prevention of falls (Taylor et.al., 2012).

- Have occupational therapists follow up with patients to make sure that they have
followed through with the recommended fall prevention tactics (Cumming
et.al.,1999).

- Encourage physicians to assess older adults for fall prevention strategies such as
physical therapy, occupational therapy, or to join the physician for fall prevention
strategy conversations (Eckstrom et. al., 2021).

- Encourage older adults and their primary care providers to review their medications
and ensure that they do not pose a greater fall risk when combined (Eckstrom et. al.,
2021).

- Recommend vitamin D supplementation for older adults—especially if they are

showing signs of deficiency (Eckstrom et.al., 2021).

3. Potential for Success- 5 pts (critical thinking questions)

a. Discuss why your intended approaches would work (e.g., how do they impact
predisposing, enabling, or reinforcing factors?) Write no more than two paragraphs and
cite for support.
 These intended approaches would work through assessing and realizing certain fall risks
among older adults, and encouraging a behavior change that will decrease the risks or
equip older adults with strategies to overcome the hazards that may appear with day-to-
day life. According to the CDC program STEADI’s Coordinated Care plan, the best way to
care for older adults who have been assessed for greater risks of falls is a comprehensive
set of tools including many of the different intervention strategies that are listed above.

b. Discuss sustainability of the intervention plan- what will help this work continue? Think
about reinforcing factors in the community- organizations, leaders, schools, etc.

The sustainability of these potential intervention plans is relatively low. This is because it may
not be feasible for older adults to attain transportation to a physician to talk about fall risk.
Older adults in the more rural regions of Latah County are even less likely to be able to travel
further distances for a doctor. Another struggle could be cost effectiveness. Without proper
funding for these programs, physicians are less likely to spend the time to implement these
programs. If this were to be implemented, I would recommend that insurances and Medicare
are required to cover fall prevention for older adults (in the way that certain prenatal cares are
required to be included in all insurance plans), as I can imagine the costs of this
comprehensive program would be virtually unaffordable for older adults who are living off a
retirement income.

Reinforcing factors of this county could be programs that are free, incentives through being
able to socialize with other older adults, family units who encourage their parents to attend
classes to help them, and, in Moscow, a relatively walkable community (although Moscow
could benefit from evening out their sidewalks).

Sources

Cumming, R. G., Thomas, M., Szonyi, G., Salkeld, G., O’Neill, E., Westbury, C., & Frampton, G.
(1999). and Modification of EnGronmental Haiards : A Randomized Trial of Falls
Prevention. Journal of American Geriatrics Society, 47, 1397–1402.

Eckstrom, E., Parker, E. M., Shakya, I., & Lee, R. (2021). Steadi coordinated care plan .
Retrieved April 19, 2023, from https://www.cdc.gov/steadi/pdf/Steadi-Coordinated-Care-
Final-4_24_19.pdf

Kamei, T., Kajii, F., Yamamoto, Y., Irie, Y., Kozakai, R., Sugimoto, T., Chigira, A., & Niino, N.
(2015). Effectiveness of a home hazard modification program for reducing falls in urban
community-dwelling older adults: A randomized controlled trial. Japan Journal of Nursing
Science, 12(3), 184–197. https://doi.org/10.1111/jjns.12059.

Schoene D, Heller C, Aung YN, Sieber CC, Kemmler W, Freiberger E. (2019) A systematic
 review on the influence of fear of falling on quality of life in older people: is there a role
for falls?. Clin Interv Aging. 14:701-719. Retrieved Mach 7, 2023, from
https://doi.org/10.2147/CIA.S197857.

Taylor, D., Hale, L., Schluter, P., Waters, D. L., Binns, E. E., McCracken, H., McPherson, K., &
Wolf, S. L. (2012). Effectiveness of tai chi as a community-based falls prevention
intervention: A randomized controlled trial. Journal of the American Geriatrics Society,
60(5), 841–848. https://doi.org/10.1111/j.1532-5415.2012.03928.x