Falls are the leading cause of injury deaths, severe nonfatal injuries, and hospital admissions in older adults. In 1994 the cost of seniors' fall injuries was 20.2 billion, these costs are significant to individuals and to society. At-risk seniors benefit from multi-factorial fall prevention interventions; however, such services, where available, often fail to change underlying behaviors. Previous work suggests that a multimedia exposure to fall-provoking situations can 'prime' the at-risk individual; increasing their awareness of actions they can take to prevent falls. The proposed Behavioral Intervention may increase motivation, involvement and compliance in fall-prevention programs. The Intervention will consist of an interactive DVD including common fall-provoking situations, and instructional software for standardized administration. A Guided-Discovery process using an Anchored Instruction approach will focus attention on the risks inherent in these situations. In this Phase I effort our primary focus will be to test and refine the Intervention through a program of technical development consisting of concurrent Alpha testing with normal and at-risk senior volunteers, as well as software and multimedia development activities. A prospective pilot study of the prototype Intervention will be conducted with 80 at-risk older adults, who will be randomly assigned to intervention or control groups. Both groups will be interviewed during an initial visit and the intervention group will receive the Behavioral Intervention. Subjects will be followed for 4 weeks and return for a follow-up visit. They will be re-interviewed and the control group will view a fall-prevention lecture. From the pilot study data, behavioral and cognitive outcomes and technical adequacy of MBI will be evaluated. The Behavioral Intervention to Prevent Falls in Older Adults is an innovative technique that may be utilized as a stand-alone behavioral intervention, as well as an adjunct to other Fall-Prevention approaches. This technology would provide a novel approach to address the neglected cognitive and behavioral aspects of Fall-Prevention. Millions of at-risk seniors in home, long term care, and out- or in-patient medical settings could benefit from enhanced fall-risk awareness and prevention programs could emerge in many under-served communities nationwide.
