Distinct forms of balance and mobility impairments in people of advanced age increase the risk of falling. Nowadays, researchers and practitioners distinguish several interventions that may potentially help reduce that risk and improve patient outcomes. Strategies are usually chosen depending on the overall health status of the patient, his or her individual characteristics, cost-effectiveness, and so on. The key intervention selected for the given evidence-based improvement project will focus on cognitive-behavioral change in older adults.
According to Zhao and Wang (2016), physical exercise can “improve motor function, the ability to balance, the ability to walk, and the stability and posture of the elderly” (p. 28). Therefore, the effectiveness of physical activity programs in the prevention of falls in older adults cannot be overestimated. However, to achieve better outcomes, the intervention should also address such fall-related factors as attitudes and environmental factors. The suggested program will thus aim to teach patients to modify those factors.
In their empirical study, Cho et al. (2015) used a behavioral intervention that consisted of eight two-hour sessions, which participants attended once a week for two months. The early sessions focused on “individual behavior and mindsets with an emphasis on decreasing the fear of falling and increasing participants’ confidence to prevent falls,” while the later sessions were about instructing individuals on environmental aspects of falls and modification of physical environment in order to “reduce risk factors for falling and learn exercises to increase balance and strength” (Cho et al., 2015, p. 2). Since the intervention proved to be efficient in fall reduction, it can be advisable to implement the same program structure in the selected setting.
The physical training workshops will take place in the long-term care unit and will be delivered by two trained and certified coaches who will use detailed manuals and instructional videos to ensure the course fidelity (Cho et al., 2015). The sessions will be conducted in multiple forms, including group discussions, lectures, and practical activities. The size of the class will comprise 8-12 older adults.
The average cost of group-based interventions for the high-risk population is the US $423, while multi-factorial interventions are almost twice as expensive and cost nearly $721 (Church, Goodall, Norman, & Haas, 2012). The total amount of expenditures may include training and instruction materials and technologies, as well as payment for coaches’ time. Additional costs of approximately US $400 per person may be required for staff training. Moreover, a few thousand dollars can be invested in the development of a more activity-friendly environment for the residents of the long-term care facility.
Nevertheless, the suggested intervention can still be considered cost-effective because it allows reducing additional costs associated with falls during the hospital stay, which on average may be nearly $13.000 higher per one individual compared to older patients who have no injuries due to falls (Bouldin et al., 2013). Additionally, such an intervention can help reduce costs related to the low quality of life through the elimination of the fear of falling, as well as depression and mobility restrictions associated with it (Church et al., 2012).
The expected measurable outcomes of the intervention should be as follows: increased participants’ engagement in physical activity; improved flexibility and balance; increased falls efficacy in the course participants (including individuals of the low, medium, and high risk); and reduced mean numbers of falls in the selected setting. The baseline/pre-intervention and post-intervention data will be compared after eight weeks of running the course.
References
Bouldin, E. D., Andresen, E. M., Dunton, N. E., Simon, M., Waters, T. M., Liu, M., … Shorr, R. I. (2013). Falls among adult patients hospitalized in the United States: Prevalence and trends. Journal of Patient Safety, 9(1), 13-17.
Cho, J., Smith, M. L., Ahn, S., Kim, K., Appiah, B., & Ory, M. G. (2015). Effects of an evidence-based falls risk-reduction program on physical activity and falls efficacy among oldest-old adults. Frontiers in Public Health, 2, 1-9.
Church, J., Goodall, S., Norman, R., & Haas, M. (2012). The cost-effectiveness of falls prevention interventions for older community-dwelling Australians. Australian and New Zealand Journal of Public Health, 36(3), 241-248.
Zhao, Y., & Wang, Y. (2016). Tai Chi as an intervention to reduce falls and improve balance function in the elderly: A meta-analysis of randomized controlled trials. Chinese Nursing Research, 3(1), 28-33.