Falls are the leading cause of injury-related deaths in older persons and a major cause of morbidity, leading to disability and institutionalization. Preliminary data suggest that these problems may be disproportionately great in low-income African American elderly persons. Yet most interventions, having been developed for European American elders, are neither culturally based nor proven effective in African American populations. The objective of this two-phase proposal is to pilot test and develop a feasible home-based intervention to prevent functional decline and repeated falls among elderly inner-city African Americans who have suffered a fall. A multi-factorial risk abatement strategy will focus on major risk factors for falls, including problems with gait, mobility, balance, use of inappropriate medications, impaired vision and hearing, and environmental hazards. Phase I involves: 1) developing the protocol, including culturally competent educational approaches; 2) testing the protocol in a controlled environment with 60 participants; and 3) evaluating the reliability of the performance of specially trained community interventionists working with nurses. In Phase II, we will assess the feasibility of carrying out the multi-factorial intervention in the community and evaluate the impact of the intervention on fall risk factor abatement and functional decline through a randomized controlled trial. Two hundred elderly persons discharged from participating urban emergency departments after treatment of a fall will be randomly assigned to intervention or control groups. The control group will be counseled regarding a """"""""usual care"""""""" walking program. The intervention group will have a home hazard evaluation, counseling interventions for fall risk factors, and participate in an exercise program three times weekly. Standardized outcome evaluations will be blinded to group status and will assess gait, balance, strength, vision, hearing, use of medication and home hazards. The results of this study will be used to create a final intervention proposal to evaluate the interventions' effectiveness in preventing falls and disability. Our ultimate goal is to develop an effective system of public health outreach and follow-up preventive care among low-income elderly African Americans who have suffered a fall.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG016333-02
Application #
6149929
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Program Officer
Hollingsworth, Charles G
Project Start
1999-02-15
Project End
2002-01-31
Budget Start
2000-02-01
Budget End
2001-01-31
Support Year
2
Fiscal Year
2000
Total Cost
$785,716
Indirect Cost
Name
University of Pennsylvania
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Stineman, Margaret G; Strumpf, Neville; Kurichi, Jibby E et al. (2011) Attempts to reach the oldest and frailest: recruitment, adherence, and retention of urban elderly persons to a falls reduction exercise program. Gerontologist 51 Suppl 1:S59-72
Sullivan-Marx, Eileen M; Mangione, Kathleen K; Ackerson, Theimann et al. (2011) Recruitment and retention strategies among older African American women enrolled in an exercise study at a PACE program. Gerontologist 51 Suppl 1:S73-81
Lavizzo-Mourey, R; Cox, C; Strumpf, N et al. (2001) Attitudes and beliefs about exercise among elderly African Americans in an urban community. J Natl Med Assoc 93:475-80