1. A Coaching Intervention for Fear of Falling in Community-Dwelling Older Adults Helen W. Lach, PhD, RN, GCNS – BC Sutthida Phongphanngam, MSN Saint Louis University

2. Disclosures National Institute of Nursing Research - Grant / Research support National Institute of Nursing Research - Grant / Research support HRSA – Grant/ Research support (GEC) HRSA – Grant/ Research support (GEC)

3. Fear of Falling Increasing interest as cause of excess disability Increasing interest as cause of excess disability Causes excess restriction of activities Causes excess restriction of activities Precipitates downward spiral - reduced social contact and isolation, depression, physical and functional decline, increased fall risk Precipitates downward spiral - reduced social contact and isolation, depression, physical and functional decline, increased fall risk

4. Downward Spiral of Fear of Falling – Excess Disability Downward Spiral of Fear of Falling – Excess Disability Fear of Falling Restricts activity Fear of Falling Restricts activity Physical capability reduced Physical capability reduced Restricts more activity Restricts more activity More impaired physical ability More impaired physical ability

5. Staying Active Study Purpose: Purpose: Help older adults with fear of falling develop realistic appraisals of falls and maintain/increase activity levels Help older adults with fear of falling develop realistic appraisals of falls and maintain/increase activity levels Intervention Intervention Enhanced Matter of Balance class Enhanced Matter of Balance class ***6 Months of monthly telephone coaching ***6 Months of monthly telephone coaching Control: alternate content (i.e. memory, self- esteem, advance directives (Senior Skills) Control: alternate content (i.e. memory, self- esteem, advance directives (Senior Skills)

6. Matter of Balance Educational class incorporating health behavior approaches with mild stretching and strengthening exercises Educational class incorporating health behavior approaches with mild stretching and strengthening exercises 9 week program 9 week program History of successful outcomes History of successful outcomes

7. Addressing Fear and SE Modeling – group process, video Modeling – group process, video Persuasion –group process, coach Persuasion –group process, coach Skill Mastery Skill Mastery Exercise practice Exercise practice Assignments Assignments Reinterpretation of beliefs Reinterpretation of beliefs Realistic appraisals of falls Realistic appraisals of falls Identifying alternative approaches to activities Identifying alternative approaches to activities

8. Coaching Monthly phone calls Monthly phone calls Address goals set in class Address goals set in class Flexible in addressing key concerns of participant (changes due to injury, illness, family situations) Flexible in addressing key concerns of participant (changes due to injury, illness, family situations) Readdress issues from class, referral to community resources, support, problem solving, match actions to participant goals Readdress issues from class, referral to community resources, support, problem solving, match actions to participant goals

9. Additional Health Coaching 6 monthly phone calls 6 monthly phone calls Addressed goals developed during Matter of Balance class (exercise goal, activity goal, behavior goal, home safety goal) Addressed goals developed during Matter of Balance class (exercise goal, activity goal, behavior goal, home safety goal) Coaching to promote problem solving, use of community resources, address benefits and barriers to making changes Coaching to promote problem solving, use of community resources, address benefits and barriers to making changes

10. Inclusion/Exclusion Self-reported fear of falling + Self-reported fear of falling + Change in activities Change in activities OR OR Difficulty with balance Difficulty with balance Independent mobility Independent mobility Read/write English Read/write English Able to attend classes Able to attend classes No cognitive impairment No cognitive impairment No depression No depression No significant visual impairment No significant visual impairment No physical condition limiting ability to participate in exercises No physical condition limiting ability to participate in exercises

11. Measurement of Fear of Falling Single Measure of Presence of FOF Single Measure of Presence of FOF Falls Self-Efficacy International (confidence in completing daily activities without falling) Falls Self-Efficacy International (confidence in completing daily activities without falling) Fear of Falling Questionnaire (fear and appraisals of harm from falling) Fear of Falling Questionnaire (fear and appraisals of harm from falling) SF-12 SF-12 Activity Participation Activity Participation

12. Baseline Characteristics I = 26, C= 19 Age 72.96 + 6.4 Age 72.96 + 6.4 Education (years)13.81 + 3.0 Education (years)13.81 + 3.0 Female97.7% Female97.7% Widowed 72.1% Widowed 72.1% White 88.4% White 88.4% # Chronic conditions5.7 +2.4 # Chronic conditions5.7 +2.4 Living alone76.7% Living alone76.7%

13. Baseline Characteristics Falls past 6 months30.1% Falls past 6 months30.1% Injuries from falls14.6% Injuries from falls14.6% Balance –TUG scores11.31 + 4.51* Balance –TUG scores11.31 + 4.51* ADL total 7.82 + 2.2 ADL total 7.82 + 2.2 IADL total11.45 + 2.9 IADL total11.45 + 2.9 * Intervention group > control group

14. Baseline Activity Measures ADL total 7.82 + 2.2 ADL total 7.82 + 2.2 IADL total11.45 + 2.9 IADL total11.45 + 2.9 Life Space Frequency 36.84 + 7.51 Life Space Frequency 36.84 + 7.51 % Activity compared % Activity compared to prior 0.69 +0.25 to prior 0.69 +0.25 Instrumental 0.77 + 0.24 Instrumental 0.77 + 0.24 Social 0.64 + 0.33 Social 0.64 + 0.33 Low-demand Leisured 0.78 + 0.30* Low-demand Leisured 0.78 + 0.30* High-demand Leisure 0.45 + 0.42 High-demand Leisure 0.45 + 0.42 Control > Intervention, p =.045

15. Adherence and Evaluation Intervention Group Intervention Group 100% reported class met/exceeded expectations 100% reported class met/exceeded expectations Instructor rating 3.6/4 on being knowledgeable and presenting well Instructor rating 3.6/4 on being knowledgeable and presenting well Average of 8/9 classes attended Average of 8/9 classes attended Control Class Control Class 100% reported class met/exceeded expectations 100% reported class met/exceeded expectations Instructor ratings also good Instructor ratings also good Average 5/6 classes attended Average 5/6 classes attended

16. Goals Set by Participants Explore alternate ways to do activities so they feel safer (i.e. move things that are hard to reach, slowing down, chair exercises) Explore alternate ways to do activities so they feel safer (i.e. move things that are hard to reach, slowing down, chair exercises) Increase activities (use bus transportation available, increase assertiveness in asking for help, add new activity that fits ability – gardening, exercise) Increase activities (use bus transportation available, increase assertiveness in asking for help, add new activity that fits ability – gardening, exercise) Maintain activities already have (plan way to keep getting to church, exercise) Maintain activities already have (plan way to keep getting to church, exercise)

17. 1- 10 Rating of Fear of Falling

18. Falls Self-Efficacy

19. Fear of Falling - FFQ

20. SF-12

21. Issues to Explore Selection of participants? Selection of participants? Robustness of intervention? Robustness of intervention? Goals from class as focus? Goals from class as focus? Sensitivity of measures to change? Sensitivity of measures to change? Trajectories of fear of falling – current exploration of patterns of response Trajectories of fear of falling – current exploration of patterns of response

22. Acknowledgements Research Team (Diana Sundara, Jamie Opsal Joanne Schneider, Lisa Willoughby) and consultants (Jean Wyman and Elizabeth Peterson) Research Team (Diana Sundara, Jamie Opsal Joanne Schneider, Lisa Willoughby) and consultants (Jean Wyman and Elizabeth Peterson) Study Participants Study Participants Funding from NINR -- NR1550792 Funding from NINR -- NR1550792