Falls are a major threat to the lives, health, and independence of older adults. An expected increase in falls corresponding to a growing aging population threatens to burden an already strained healthcare system. However, falls are preventable. Increasing evidence supports the effectiveness of exercise-based prevention programs such as Tai Chi to improve strength, balance, and mobility, which reduce the risk of falling. Tai Chi: Moving for Better Balance is an evidence-based fall prevention program that targets older adults at risk of falling. The program has also undergone community evaluation with good potential for widespread adoption. However, the extent to which such an evidence-based program can be disseminated via healthcare providers is unknown. While patients are often being counseled on measures to reduce the risk of falling, including physical activity, healthcare professionals often lack adequate information regarding interventions demonstrated to be effective;others might have the information but do not use it in their work with patients. This proposed study addresses this research-to-clinical-practice issue in healthcare settings. On the basis of our prior work, we propose a dissemination project to assess the potential public health impact of delivering the Tai Chi: Moving for Better Balance program through local healthcare providers: primary care physicians, nurse practitioners, and physical therapists. Utilizing a twice weekly (90 minutes per session), 4-month, single-group design, we will conduct an initiation, process, and outcome evaluation of our program with respect to Reach (participation rate of patients), Effectiveness (improvement in functional ability and quality of life, reductions in fall incidence), Adoption (participation rates of healthcare providers), Implementation (degree to which intervention components are delivered as intended), and Maintenance (sustainability of the program among providers who make referrals to the program and among patients who receive the program). To better understand the translational process, we will also address issues such as program fidelity evaluation and facilitators/barriers. It is expected that outcomes from this dissemination study will increase understanding of the impact of community-wide diffusion of an evidence-based, community-evaluated Tai Chi fall prevention program on providers and older adult patients, with the ultimate objective of implementing and sustaining community-based exercise programs to meet Healthy People 2010 goals for preventing and reducing injuries and enhancing life independence among older adults.

Public Health Relevance

In the U.S.A, more than one of every three adults aged 65 and older falls each year. Fall-related injuries cause significant premature mortality, disability, loss of independence, and early admission to nursing homes. This study will determine whether an evidence-based Tai Chi fall prevention program can be disseminated through healthcare provider referrals of older patients who are at risk of falling. If shown to be successful in regard to the degree of adoption of the program by healthcare professionals and the program's reach into the target population, the proposed work will provide an effective, low-cost, easy-to-implement fall prevention program that could be accessed through a simple provider referral process and delivered in a general community setting to address the problem of falls among older adults.

National Institute of Health (NIH)
National Center for Injury Prevention and Control (NCIPC)
Research Demonstration and Dissemination Projects (R18)
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Special Emphasis Panel (ZCE1-JXS (10))
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Thierry, Joann
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Oregon Research Institute
United States
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Li, Fuzhong; Harmer, Peter; Stock, Ronald et al. (2013) Implementing an evidence-based fall prevention program in an outpatient clinical setting. J Am Geriatr Soc 61:2142-9