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PROPOSAL

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Erin Blanchard

on 12 December 2012

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Transcript of PROPOSAL

Does "Stay Well at Home" affect the health and attitude of adult volunteers? Erin H. Blanchard, B.S.
California State University, Fullerton
Department of Kinesiology Introduction Review of Literature Methods:
Instruments Methods: Program Overview Methods: Participants Methods: Program Overview (continued) -IRB and informed consent

-Eligibility Criteria:

-Program recipients: 20 older adults (≥75 years) who are aging with one or more disabilities that limit their access to community-based fall risk reduction programs.

-Peer mentors: 10-20 adults (≥ 40 years) -Health History Questionnaire (HHQ)
-Composite Physical Function (CPF) Scale (Rikli & Jones, 2001; Rose, 2010)

-Short Physical Performance Battery (SPPB) (Guralnik, Ferrucci, Simonsick, Salive, & Wallace, 1994)

-Falls Behaviour (FaB) Scale for Older Persons (Clemson, Cumming, & Heard, 2003)

-Peer mentors and program participants will be assessed at baseline (week zero), midway (week 12) and post intervention (week 24) Four Components of the SWAH Program
1- fall risk screening & assessment
2- individually tailored & progressive exercise program
3- home assessment & modification
4- In-home and telephone-coaching aimed at developing awareness, behaviors, and attitudes to preventing falls Four Phase Approach:
1 – In-home visits x twice weekly (Weeks 1 -4)
2 – In-home visits x once weekly + 1 phone call (Weeks 5-8)
3 – Twice Weekly phone calls (Weeks 9- 12)
4 – Once weekly phone calls (Weeks 13-24) -1/3 of older adults 65 years and older fall each year.

-In 2009, 2.2 million older adults in the U.S. were seen in emergency departments for fall-related injuries
-Approximately 1/2 of those injured were hospitalized.

-Money spent on fall-related injuries:
-$19 billion in 2000
-$54.9 billion projected by 2020 Dorgo, Robinson, and Bader, 2009 Pérula et al., 2012 Castro et al 2011 Buman et al 2011 The effectiveness of a peer-mentored older adult fitness program on perceived physical, mental, and social function. Objective: Compared peer mentors and trained professionals effectiveness of administering an exercise program for older adults

Participants: sixty older adults age 60 or older

Design: Participants randomized into a peer mentored (PM) intervention group or a student mentored (SM) intervention group where they participated in a 14-week intervention program.

Measures: Functional Fitness Testing Battery, questionnaire about their perceived program enjoyment, program benefits, and effectiveness of student or peer mentors.

Results: Increase in phyiscal fitness measures for both groups. The PM group scored higher in measures of perceived program benefits. The PM group scored higher on effectiveness, and the retention rate was higher in the PM group over the 14-week intervention period.

** Peer mentors are effective at delivering exercise interventions, and are particularly beneficial over trained professionals in promoting long-time adherance to exercise. Effectiveness of a Multifactorial Intervention Program to Reduce Falls Incidence Among Community-Living Older Adults Objective: To determine the effectiveness of a multifactorial intervention program to prevent falls among older adults as compared with a brief intervention.

Participants: People over 70 years old (N=404), who are residents in the community.

Design: Participants were randomized to either 1 of the 2 groups: intervention group (IG), of a multifactorial nature (individual advice, information leaflet, physical exercise workshop, and home visits), or control group (CG) (brief individual advice and information leaflet).

Measures: Fall rates and risk of falling.

Results: 15.71% reduction in fall rate in the IG and only a 6.64% reduction in fall rate for the CG

** Multifactorial interventions significantly reduced fall rate in older adults.
Physical Activity Program Delivery by Professionals Versus Volunteers: The TEAM Randomized Trial ObJective: To test a telephone-based physical activity advice delivered by professional staff versus trained volunteer peer mentors.

Participants: Twelve volunteer peer mentors and 181 initially inactive adults ages 50 years and older

Design: Participants were randomized to: (1) telephone-based physical activity advice delivered by professional staff, (2) telephone-based physical activity advice delivered by trained volunteer peers, or (3) an attention-control arm of staff-delivered telephone support for nutrition.

Measures: Moderate-intensity or more vigorous physical activity (MVPA)was assessed at baseline, 6, and 12 months with the Community Healthy Activities Model Program for Seniors (CHAMPS) Questionnaire, with accelerometry validation (Actigraph) in a randomly selected subsample.

Results: At 6 and 12 months, both physical activity arms significantly increased MVPA relative to the control arm.

** This study demonstrates that trained peer volunteers can effectively promote physical activityincreases through telephone-based advice. Objective: This study examined whether tailored support from older peer volunteers could improve initiation and long-term maintenance of physical activity behavior

Participants: Seven peer volunteers and 81 sedentary adults were recruited.

Design: Participants were randomized to 2 16-week, group-based programs: (I) peer-delivered, theory-based support for physical activity behavior change; or (2) an intervention typically available in community settings (basic education, gym membership, and pedometer for self-monitoring),

Measures: Moderate-to-vigorous physical activity (MVPA) was assessed via daily self-report logs at baseline, at the end of the intervention (16 weeks), and at follow-up (18 months), with accelerometry validation (RT3) in a random subsample.

Results: At the conclusion of the study (18 months), the group supplemented with peer support had significantly more MVPA.

** Using trained peer volunteers has great potential to be adapted and delivered inexpensively in community settings. Peer Volunteers Improve Long-Term Maintenance of Physical Activity With Older Adults Rationale -Growing population of older adults in the United States

-Research has indicated that older adults benefit more from exercise interventions, particularly multifactorial exercise interventions, in terms of fall rate reduction.

-Research has also indicated that peer mentors are a viable solution for community programs that need cost-effective ways to deilver exercise programs.

-Although there is research regarding how participants benefit from peer-delivered exercise programs, there are none examinine the effect of the exercise programs that he peer mentors deliver on the peer mentors themselves.

-THEREFORE: The purpose of this study is to examine the effect of a peer-mentored multifactorial physical activity intervention program on the health and attitude of peer mentors themselves. Hypothesis When compared to baseline (Week Zero), peer mentors who administer the multifactorial Stay Well at Home program will demonstrate a significant improvement in physical function and awareness and practice of fall protective behaviors immediately following the in-home intervention phase (Week 12), and again at the completion of the step-down phase (Week 24). Methods:
Peer Mentor Training -Conducted by CSA personnel
-2 Training Days
1 - Pre-intervention: Full Day
Lead & progress exercises, cover discussion topics, home safety, goal setting, and problem solving techniques
2 - Week 5: Half-day refresher
Review program, address any problems, practice phone coaching Methods:
Statistical Analysis -Data screened for normality and extreme observations (outliers)

-Descriptive statistics related to participant characteristics, compliance, falls

-Repeated Measures of Analysis of Variance (RM ANOVAs)
-SPPB
-FaB
-CPF
-Tukey Wholly Significant Difference (HSD) tests

-SPSS (Version 19)
-Alpha level of 0.05 Dorgo, S. , Robinson, K. , & Bader, J. (2009). The effectiveness of a peer-mentored older adult fitness program on perceived physical, mental, and social function. Journal of the American Academy of Nurse Practitioners, 21(2), 116-122. Pérula, L. , Varas-Fabra, F. , Rodríguez, V. , Ruiz-Moral, R. , Fernández, J. , et al. (2012). Effectiveness of a multifactorial intervention program to reduce falls incidence among community-living older adults: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 93(10), 1677-1684. Castro, C. , Pruitt, L. , Buman, M. , & King, A. (2011). Physical activity program delivery by professionals versus volunteers: The team randomized trial. Health Psychol,30(3), 285-294. Buman, M. , Giacobbi, J. , Dzierzewski, J. , Morgan, A. , McCrae, C. , et al. (2011). Peer volunteers improve long-term maintenance of physical activity with older adults: A randomized controlled trial. Journal of Physical Activity & Health, 8(8), S257. Works CitedBuman, M. , Giacobbi, J. , Dzierzewski, J. , Morgan, A. , McCrae, C. , et al. (2011). Peer volunteers improve long-term maintenance of physical activity with older adults: A randomized controlled trial. Journal of Physical Activity & Health, 8(8), S257.Centers for Disease Control and Prevention. (2011). Falls: older adults. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/falls/index.html.Castro, C. , Pruitt, L. , Buman, M. , & King, A. (2011). Physical activity program delivery by professionals versus volunteers: The team randomized trial. Health Psychol,30(3), 285-294.Clemson, L., Cumming, R. G., & Heard, R. (2003). The development of an assessment toevaluate behavioral factors associated with falling. American Journal of Occupational Therapy 57, 380-388.Day, L., Fildes, B., Gordon, I., Fitzharris, M., Flamer, H., & Lord, S. (2002). Randomised factorial trial of fall prevention among older people living in their own homes. British Medical Journal. 325, 128-131.Dorgo, S. , King, G. , & Brickey, G. (2009). The application of peer mentoring to improve fitness in older adults. Journal of Aging & Physical Activity, 17(3), 344-361.Dorgo, S. , Robinson, K. , & Bader, J. (2009). The effectiveness of a peer-mentored older adult fitness program on perceived physical, mental, and social function. Journal of the American Academy of Nurse Practitioners, 21(2), 116-122.Dorgo, S., King, G., Bader, J., & Limon, J. (2011). Comparing the effectiveness of peer mentoring and student mentoring in a 35-week fitness program for older adults. Archives of Gerontology and Geriatrics, 52(3), 344-9.Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. Journal of Forensic Science 1996;41(5):733–46.trial. The Gerontologist 1994;34(1):16–23.Hanks, R., Rapport, L., Wertheimer, J., & Koviak, C. (2012). Randomized controlled trial of peer mentoring for individuals with traumatic brain injury and their significant others. Archives of Physical Medicine and Rehabilitation, 93, 1297-1304.Gillespie, L., Robertson, M., Gillespie, W., Lamb, S., Gates, S., Cumming, R. G., & Rowe, B. H. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev, CD007146.Guralnik, J. M., Ferrucci, L., Simonsick, E. M., Salive, M. E., & Wallace, R. B. (1994). A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology, 49(2), M85-M94.Jeppesen, K., & Bahner, D. (2012). Teaching bedside sonography using peer mentoring: a prospective randomized trial. Journal of Ultrasound Medicine,31(3), 455-459.Lin, M. , Wolf, S. , Hwang, H. , Gong, S. , Chen, C. , et al. (2007). A randomized, controlled trial of fall prevention programs and quality of life in older fallers. Journal of the American Geriatrics Society, 55(4), 499-506.Pérula, L. , Varas-Fabra, F. , Rodríguez, V. , Ruiz-Moral, R. , Fernández, J. , et al. (2012). Effectiveness of a multifactorial intervention program to reduce falls incidence among community-living older adults: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 93(10), 1677-1684.Pynoos, J. , Rose, D. , Rubenstein, L. , Choi, I. , & Sabata, D. (2006). Evidence-based interventions in fall prevention. Home Health Care Services Quarterly, 25(1/2), 55-73.Rand Report (2003). Evidence report and evidence-based recommendations: fall prevention interventions in the Medicare population. Contract number 500-98-0281. Southern California Evidence-Based Practice Center. Works Cited
 
Buman, M. , Giacobbi, J. , Dzierzewski, J. , Morgan, A. , McCrae, C. , et al. (2011). Peer volunteers improve long-term maintenance of physical activity with older adults: A randomized controlled trial. Journal of Physical Activity & Health, 8(8), S257.
 
Centers for Disease Control and Prevention. (2011). Falls: older adults. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/falls/index.html.
 
Castro, C. , Pruitt, L. , Buman, M. , & King, A. (2011). Physical activity program delivery by professionals versus volunteers: The team randomized trial. Health Psychol,30(3), 285-294.
 
Clemson, L., Cumming, R. G., & Heard, R. (2003). The development of an assessment toevaluate behavioral factors associated with falling. American Journal of Occupational Therapy 57, 380-388.
 
Day, L., Fildes, B., Gordon, I., Fitzharris, M., Flamer, H., & Lord, S. (2002). Randomised factorial trial of fall prevention among older people living in their own homes. British Medical Journal. 325, 128-131.
 
Dorgo, S. , King, G. , & Brickey, G. (2009). The application of peer mentoring to improve fitness in older adults. Journal of Aging & Physical Activity, 17(3), 344-361.
 
Dorgo, S. , Robinson, K. , & Bader, J. (2009). The effectiveness of a peer-mentored older adult fitness program on perceived physical, mental, and social function. Journal of the American Academy of Nurse Practitioners, 21(2), 116-122.
 
Dorgo, S., King, G., Bader, J., & Limon, J. (2011). Comparing the effectiveness of peer mentoring and student mentoring in a 35-week fitness program for older adults. Archives of Gerontology and Geriatrics, 52(3), 344-9.
 
Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. Journal of Forensic Science 1996;41(5):733–46.trial. The Gerontologist 1994;34(1):16–23.
 
Hanks, R., Rapport, L., Wertheimer, J., & Koviak, C. (2012). Randomized controlled trial of peer mentoring for individuals with traumatic brain injury and their significant others. Archives of Physical Medicine and Rehabilitation, 93, 1297-1304.
 
Gillespie, L., Robertson, M., Gillespie, W., Lamb, S., Gates, S., Cumming, R. G., & Rowe, B. H. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev, CD007146.
 
Guralnik, J. M., Ferrucci, L., Simonsick, E. M., Salive, M. E., & Wallace, R. B. (1994). A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology, 49(2), M85-M94.
 
Jeppesen, K., & Bahner, D. (2012). Teaching bedside sonography using peer mentoring: a prospective randomized trial. Journal of Ultrasound Medicine,31(3), 455-459.
 
Lin, M. , Wolf, S. , Hwang, H. , Gong, S. , Chen, C. , et al. (2007). A randomized, controlled trial of fall prevention programs and quality of life in older fallers. Journal of the American Geriatrics Society, 55(4), 499-506.
 
Pérula, L. , Varas-Fabra, F. , Rodríguez, V. , Ruiz-Moral, R. , Fernández, J. , et al. (2012). Effectiveness of a multifactorial intervention program to reduce falls incidence among community-living older adults: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 93(10), 1677-1684.
 
Pynoos, J. , Rose, D. , Rubenstein, L. , Choi, I. , & Sabata, D. (2006). Evidence-based interventions in fall prevention. Home Health Care Services Quarterly, 25(1/2), 55-73.
Rand Report (2003). Evidence report and evidence-based recommendations: fall prevention interventions in the Medicare population. Contract number 500-98-0281. Southern California Evidence-Based Practice Center.
 
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