The Reach and Effectiveness of National Evidence-based Falls Prevention Programs Among Underrepresented Community-dwelling Older Adults.

Abstract

Older adults with a disability and racial minorities experience a disproportionate number of falls compared to those without a disability and non-minorities. Funding is available to support evidence-based falls prevention programs (EBFPP), however these high-risk populations are underrepresented in research examining program effectiveness. The purpose of this research was to examine the reach, effectiveness, and contributing factors in two EBFPP in these underrepresented populations. A Matter of Balance (MOB) and Stepping On were examined using data from the National Falls Prevention Database. Inclusion criteria included: aged 50 years or older, attended MOB or Stepping On program, and complete data. Program reach was defined as attendance percentage and program completion. Program effectiveness was defined as a significant change in falls risk factors: fear of falling (FOF), fall-related activity restriction (FAR), and falls self-efficacy (FSE). Results showed no significant difference in program reach by disability status. Older adults with disabilities were as likely to attend (M = 0.88, SD = 0.14) the program compared to those without disabilities (M = 0.88, SD = 0.14, p =.30). Racial minorities were slightly less likely to attend (M = 0.87, SD = 0.15) the program compared to non-minorities (M = .88, SD = 0.14, p <.05). Program effectiveness was high, with significant improvements in FOF, FAR, and FSE post-program. Despite improvements, older adults with a disability reported significantly higher FOF and FAR and significantly lower FSE at post-program compared to those without a disability. There were significant within-group differences by minority status. Both racial minority and non-minority participants significantly reduced FOF, FAR, and FSE post-program. Factors positively contributing to increased effectiveness across the sample included: lower age, higher education, improved general health, receiving a health care referral, and attending MOB. In summary, MOB and Stepping On are two effective EBFPP that are able to reach community-dwelling older adults, however differences in effects remain by disability status. Representation of racial minorities in the programs remained low compared to national averages. Future research is needed to study access and enrollment of older adults with a disability and racial minorities in federally supported falls prevention programs.