Standing Strong in Tribal Communities: Assessing Elder Falls Disparity

在部落社区中站稳脚跟：评估老年人的落差差异

基本信息

批准号：
10395952
负责人：
Carla Jean Herman
金额：
$ 54.15万
依托单位：
UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-21 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10395952
关键词：
Address Adult American Indians Assisted Living Facilities Automobile Driving Centers for Disease Control and Prevention (U.S.)Chronic Disease Collaborations Communities Community Health Community Networks Consultations Control Groups Education Effectiveness Elderly Equilibrium Evidence based intervention Fall prevention Family Feasibility Studies Focus Groups Fostering Frequencies General Population Geography Goals Health Health Sciences Health Status Health Surveys Home Injury Intervention Knowledge Language Leadership Long-Term Care for Elderly Measures Modeling New Mexico Outcome Participant Physical therapy Pilot Projects Population Prevention program Prevention strategy Principal Investigator Pueblo Race Randomized Recording of previous events Rehabilitation therapy Reporting Reservations Risk Risk Management Risk Reduction Role SF-12 Self Efficacy Self Management Services Skilled Nursing Facilities Social Network Training Training and Education United States Indian Health Service Universities Visit Work Zuni aged aging in place arm barrier to care base community engagement comorbidity compare effectiveness education research evidence base exercise program experience fall injury fall risk falls family structure follow-up health care disparity health care quality health disparity improved innovation intervention program native elder novel physical conditioning physical therapist preference preservation prevention service preventive intervention programs rehabilitative care rural area screening skills social engagement standard of care telehealth treatment as usual tribal community tribal member

Address Adult American Indians Assisted Living Facilities Automobile Driving Centers for Disease Control and Prevention (U.S.)Chronic Disease Collaborations Communities Community Health Community Networks Consultations Control Groups Education Effectiveness Elderly Equilibrium Evidence based intervention Fall prevention Family Feasibility Studies Focus Groups Fostering Frequencies General Population Geography Goals Health Health Sciences Health Status Health Surveys Home Injury Intervention Knowledge Language Leadership Long-Term Care for Elderly Measures Modeling New Mexico Outcome Participant Physical therapy Pilot Projects Population Prevention program Prevention strategy Principal Investigator Pueblo Race Randomized Recording of previous events Rehabilitation therapy Reporting Reservations Risk Risk Management Risk Reduction Role SF-12 Self Efficacy Self Management Services Skilled Nursing Facilities Social Network Training Training and Education United States Indian Health Service Universities Visit Work Zuni aged aging in place arm barrier to care base community engagement comorbidity compare effectiveness education research evidence base exercise program experience fall injury fall risk falls family structure follow-up health care disparity health care quality health disparity improved innovation intervention program native elder novel physical conditioning physical therapist preference preservation prevention service preventive intervention programs rehabilitative care rural area screening skills social engagement standard of care telehealth treatment as usual tribal community tribal member

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项目摘要

Program Director/Principal Investigator (Last, First, Middle): Shah, Vallabh O and Herman Carla Native elders are essential to preserving the culture and history of tribal communities, but fall-related injuries can jeopardize their ability to age in place. The Zuni Pueblo is geographically isolated with limited access to rehabilitative and supportive services. Home health physical therapy services are unavailable at the Pueblo. Therefore, Zuni elders must choose between leaving their community and social network for rehabilitative care or remain in the community with unmet needs, and increased risk of not regaining their prior level of function. We propose to culturally tailor the traditional Physical Therapy delivered Otago Exercise Program (OEP), to evaluate its effectiveness in reducing falls risk and to empower elders and their families to engage in preventing falls in their community. Native Zuni CHRs will deliver OEP using novel consultation and telehealth with a Physical Therapist. The CHRs offer important advantage of speaking “Shiwi” (Zuni tribal language) and understanding Zuni traditions, family structures, and elders’ preferences for receiving health information. Our overall objective is to compare the effectiveness of a CHR-delivered, culturally-adapted OEP fall prevention program to the standard of care education-based fall risk management. Our disparity driven aims are: Aim 1: Foster a sustainable multi-directional, participatory collaboration between the Zuni’s tribal leadership, stakeholders, Zuni Indian Health Services, and University of New Mexico Health Sciences Center to enhance fall prevention training, education, and research; Aim 2: To culturally adapt the evidence-based OEP for use with the Zuni elder population. Approach: We will train CHRs to utilize the CDC STEADI toolkit for fall risk screening and education and CHRs will culturally adapt the education and OEP with input from Zuni elders; Aim 3: To compare the effectiveness of the adapted OEP to an education-based fall risk management usual care program in improving strength and balance and reducing falls risk. Approach: Screen 400 Zuni elders, aged 65yrs and older, to identify 200 elders with elevated fall risk. Randomize 200 Zuni elders at risk for falls into a 6-month OEP intervention versus education-based control; and Aim 4: To compare the effectiveness of the adapted OEP to an education-based fall risk management program in improving overall health status, self-management of daily activities, and social engagement. Approach: We will administer SF-12 Health Survey and Short Form PROMIS measures Self-Efficacy for Managing Daily Activities and Ability to Participate in Social Roles and Activities to all randomized participants, at baseline and 6 months, and during the final follow up visit at 12 months.

项目总监/首席调查员（最后，第一，中间）：Shah，Vallabh O和Herman Carla 当地长者对于维护部落社区的文化和历史至关重要，但与跌倒有关的伤害可以危害他们的老化能力。 Zuni Pueblo在地理上是孤立的，访问有限康复和支持服务。家庭健康物理治疗服务在Pueblo无法获得。因此，Zuni长者必须在离开社区和社交网络以进行康复护理之间做出选择或留在社区中有未满足的需求，并增加了不重新获得其先前功能水平的风险。我们建议在文化上量身定制传统物理疗法提供的奥塔哥运动计划（OEP），以便评估其在降低跌倒风险中的有效性，并赋予长老及其家人的能力落入他们的社区。本地Zuni Chrs将使用新颖的咨询和远程医疗提供OEP 物理治疗师。 CHRS提供了讲“ shiwi”（Zuni部落语言）和的重要优势了解Zuni传统，家庭结构和长者对接收健康信息的偏好。我们的总体目的是比较由CHR延伸，适应文化的OEP预防的有效性计划基于护理教育的秋季风险管理的计划。我们的差异驱动的目标是：目标1：培养可持续的多向，参与合作 Zuni的部落领导，利益相关者，Zuni Indian Health Services和新墨西哥大学健康科学中心，以增强秋季预防培训，教育和研究；目标2：在文化上适应基于证据的OEP，可用于Zuni老年人口。方法：我们将训练CHRS利用CDC Steadi工具包用于秋季风险筛查和教育以及CHRS将在文化上适应教育和OEP Zuni长老的输入；目标3：将适应的OEP与基于教育的跌倒风险进行比较管理常规护理计划，以改善力量和平衡并降低跌倒风险。方法：屏幕 400名Zuni长老，年龄在65岁及以上，以识别200名Zuni长老跌倒风险升高。随机化200个Zuni长老面临6个月OEP干预与基于教育的控制的风险；和目标4：比较适应于基于教育的秋季风险管理计划改善整体的OEP的有效性健康状况，日常活动的自我管理和社会参与。方法：我们将管理SF-12 健康调查和简短的Promis衡量自我效能感，以管理日常活动和能力在基线和6个月以及在最终的后续访问12个月。