One-third of older adults fall every year in the United States. Many accidental falls can be prevented through fall risk assessment and evidence-based interventions. The interventions may include advice for exercise, medication adjustment, blood pressure management, environmental modifications, and improving vision. However, older adults do not consistently follow these recommendations for a number of reasons, including their perceptions about falls and fall prevention. Emerging evidence indicates that a recommendation alone is not sufficient to engage patients in fall prevention. Yet, studies that explore alternate ways to improve patients? engagement with fall prevention are rare. Reframing fall prevention in a behavior change context, specifically through Motivational Interviewing (MI), holds strong potential to positively impact fall prevention efforts. MI can address emotional barriers and individual?s unique values as well as cognitive and physical limitations. While individualized fall prevention strategies are emerging, MI intervention has not been tested as follow-up care after fall prevention recommendations have been provided to moderate-to-high fall-risk clinic patients. Dr. Kiyoshi-Teo is driven to discover and implement patient-oriented behavior change interventions to ensure safety and quality of life of older adults. Thus, the overall goal of this application is two-folds: 1) gain further training to advance skills related to behavior change, mixed-methods, and patient-oriented research, and 2) use mixed-methods research to evaluate how MI impacts patient engagement and fall risks. The training and proposal goals align with the mission of the NINR and the goal of the K23 patient-oriented research funding opportunity. She will use new skills gained during the K23 training to conduct the proposed study and to develop future studies to improve the health outcomes of older adults through behavior change. The training activities include formal coursework/workshop, immersive experience with the mentors (Drs. Eckstrom, Cohen, and Winters-Stone), conferences, and other opportunities at Oregon Health & Science University (OHSU) and other institutions. OHSU is an ideal training environment and has provided Dr. Kiyoshi-Teo with protected research time for the past 5 years. The study aims of this randomized control trial with longitudinal follow-up are: 1) evaluate the impact of MI through self-reported and physiologic measures using a quantitative approach, 2) evaluate the process by which MI engages older adults in fall prevention behavior changes using a qualitative approach, and 3) evaluate the feasibility of the proposed MI intervention. We will recruit and randomize150 patients from OHSU Internal Medicine and Geriatrics Clinic. Participants are enrolled in the study for 12 months and may have up to nine study encounters through phone contacts or study visits. Narrative transcriptions for purposively selected participants will be analyzed for the qualitative analysis.
Emerging evidence indicates that a recommendation alone is not sufficient to engage patients in fall prevention. Using both quantitative and qualitative approaches, the goal of this randomized controlled trial is to evaluate the impact of Motivational Interviewing as an innovative but plausible way to engage patients in fall prevention. The training and research proposed in this K23 application will provide a solid foundation for future mixed-methods and patient-oriented research to improve the quality of life and safety for older adults.
