2. A Matter of Balance/Volunteer lay Leader Model Patti League, RN A Matter of Balance Program Manager MaineHealth’s Partnership for Healthy Aging Portland, Maine

3. Objectives Describe A Matter of Balance Identify the role that behavior change plays in addressing the fear of falling Identify the steps to become involved and increase awareness of A Matter of Balance in Ohio

4. Why Falls, Why Now? A Growing Public Health Crisis  Falls are the leading cause of unintentional injury and death among those over 65.  Deaths from falls rose 42% between 2000 and 2006.  Every 29 minutes, an older adult dies from a fall.  Every 15 seconds an older adult is treated in an ED for a fall-related injury.  $28.2 billion is spent annually on treating older adults for falls.  972 Ohioans over 65 died in 2010 from a fall Centers for Disease Control and Prevention

7. What is a fall? A fall is anytime that you find yourself on a supporting or lower surface and it was NOT your plan to be there.

8. Falls and Older Adults Who will fall? In the Community  1 in 3 age 65 and older fall each year  1 in 2 age 80 and older fall each year  6 in 10 will fall again

9. Falls are:  Common  Predictable largely  Preventable Everyone has a role to play and can make a difference within their own sphere of influence. Take one step to make a difference today!

10. What do we know about falls? 1/2 to 2/3 of falls occur around the home 75% of falls occur around the home often during routine activities Falls don’t “just happen”. Often, more than one underlying cause or risk factor is involved in a fall. It’s a combination of things coming together. Falls are not a natural part of aging!

11. Risk Factors for Falls Multifactorial Etiology Sedentary or immobilized or deconditioned Deficits balance, gait and transfers Polypharmacy = 4+ scripts on regular basis Postural hypotension Sensory deficits: vision, hearing, feet, cognition Environmental factors hazards including inappropriate footwear, rugs, grab bars, lighting Unsafe fit, use or repair of assistive device Fear of Falling

12. Falls and Fear of Falling 1/3 to 1/2 of older adults acknowledge fear of falling Fear of falling is associated with:  Depression  decreased mobility and social activity  increased frailty  increased risk for falls as a result of deconditioning

13. Research by the Roybal Center for Enhancement of Late-Life Function at Boston University 1 Designed to reduce the fear of falling and increase the activity levels of older adults who have concerns about falls. 2003-2006 AoA launched a three year public/private partnership to increase older people’s access to programs that have proven to be effective in reducing their risk of disease, disability and injury. Grant #90AM2780. Lay Leader Model was created and validated. 1.Tennsdedt, S., Howland, J., Lachman, M., Peterson, E., Kasten, L. & Jette, A. (1998). A randomized, controlled trail of a group intervention to reduce fear of falling and associated activity restriction in older adults. Journal of Gerontology, Psychological Sciences, 54B (6), P384-P392. A Matter of Balance

14. A Matter of Balance Class Designed to benefit community-dwelling older adults who: Are concerned about falls Have sustained a fall in the past Restrict activities because of concerns about falling Are interested in improving flexibility, balance and strength Are age 60 or older, ambulatory and able to problem- solve During 8 two-hour classes, participants learn: To view falls and fear of falling as controllable To set realistic goals for increasing activity To change their environment to reduce fall risk factors To promote exercise to increase strength and balance

15. Cognitive Restructuring (Bandura and Lachman, 1997) Cognitive Restructuring – method of turning negative thoughts into positive thoughts Define barriers and obstacles when engaging in a new behavior Identify strategies for overcoming the barriers Plan realistic/feasible experiences so you can experience success

16. Interventions are focused on: Changing misconceptions Teaching skills that promote self-confidence in one’s abilities (self-efficacy) Instilling the belief that one’s efforts will make a difference (outcome expectations) Encouraging positive adaptive responses in the face of difficulties (attributions) BA Harris 2008

17. A Matter of Balance What Happens During Sessions? Group discussion Problem-solving Skill building Assertiveness training Sharing practical solutions Videos Exercise training Making a Plan: Physical activity, environment, behavior

19. A Matter of Balance Volunteer Lay Leader Model Model Program Adaptations:  Classes taught by volunteer lay leaders, called coaches, instead of healthcare professionals  Participant workbook developed and coach manual modified  Exercises modified to be safely taught by coaches  Healthcare connection via guest healthcare professional Maintaining Fidelity:  Two-day coach training based on original MOB leader manual  Master Trainer observes coaches during training and while leading a MOB/VLL class  Use of a mentor model - new volunteer is paired with an experienced coach  Communication, support and sharing outcomes

20. Dissemination of A Matter of Balance/Volunteer Lay Leader Model 2013 38 States >900 Master Trainers > 35,000 participants served Ongoing support for Master Trainers and program support

21. A Matter of Balance/Volunteer Lay Leader Outcomes 6 weeks6 months12 months Falls Efficacy*** Falls Efficacy ** Falls Management*** Falls Control **Falls Control * Exercise level *** modified PACE Exercise level * modified PACE Exercise level NS PACE Concern about falling interfering with Social Activities ** Concern about falling interfering with Social Activities * Concern about falling interfering with Social Activities + Monthly Falls NSMonthly Falls*** + Marginal p=.0516 *p<.05 **p<.01 ***p<.001 (Significant Outcomes in Bold) Healy, T. C., Peng, C., Haynes, P., McMahon, E., Botler, J. & Gross, L. (2008). The Feasibility and Effectiveness of Translating A Matter of Balance into a Volunteer Lay Leader Model. Journal of Applied Gerontology, 27 (1), 34-51.

28. What participants are saying: “I am already noticing a difference in my physical being. I am sure I am a little more mobile than I had been and plan to continue these exercises. Hopefully I’ll be jumping over the moon soon.” “I seem to be more aware of every situation for my safety. I now `stop, look and listen’ to my surroundings.” “I'm more aware of my surroundings and am more assertive in asking for help and pointing out fall risks in my environment and taking steps to change things.” “More positive about going out - confident about trying something new.”

29. Putting the Puzzle Together

30. What can be done? Local, state and national collaboration that brings:  Broad awareness to the issue Falls are not an inevitable part of aging  Training and education to providers and the community  Evidence-based programs, services and resources to older adults targeting prevention through risk reduction – must be accessible to those at most risk  A Menu of Options: A Matter of Balance, Tai Chi, CDSMP  Provide seamless transitions to community programs from health care and vice versa  Refer to community programs,

31. Community Connections Connect with any group serving older adults: senior centers, community groups, faith based organizations, meal sites Senior Living-sr. housing, assisted living, retirement communities Link in with healthcare providers- Physicians, nurses, PTs, OTs, hospital trauma teams, let them help recruit their patients Connect with first Responders-They know who is falling: perhaps a message to leave behind after a call for a pick up Hold classes where seniors come together Senior housing, senior centers, fire stations, libraries, community centers, meal sites, retirement communities, AARP offices, community spaces (with privacy), faith based organizations, hospitals, physician practices…..

32. Facing the Challenge Together  Growing older population  Limited resources Opportunities for Success Increase awareness  Self management-FPAD  Screenings- STEADI  Interventions-EBPs  Public Policy Utilize effective programs Creative partnerships Innovative collaborations

33. Guam Hawaii Northern Marianas AK MT ID WA CO WY NV CA NMAZ MN KS TX IA WI IL KY TN IN OH MI ALMS AR LA GA FL SC WV VA NC PA VT RI ME NH OR UT SD ND MO OK NE NY CT MA NJ MD DE MOB Lay Leader Model Master Trainer Sites by State A Matter of Balance (MOB) Lay Leader Model Master Trainer Sites by State 500 Master Trainer Sites in 38 States, the District of Columbia

34. A New Day Greetings from Maine

35. Contact Information MaineHealth’s Partnership for Healthy Aging 110 Free Street Portland, ME 04101 207-661-7120 A Matter of Balance www.mainehealth.org/MOB Patti League leagup@mainehealth.org Ohio Master Trainers http://www.mainehealth.org/mh_body.cfm?id=5195