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：
10599890
负责人：
Carla Jean Herman
金额：
$ 54.04万
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/10599890
关键词：
Address Adult American Indians Assisted Living Facilities Automobile Driving Chronic Disease Collaborations Communities Community Health Community Networks Consultations Control Groups Disparity Disparity population Education Effectiveness Elderly Equilibrium Evidence based intervention Fall prevention Family Feasibility Studies Focus Groups Fostering Frequencies General Population Geography Geriatric Assessment 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 Research Reservations Risk Risk Management Risk Reduction Role SF-12 Self Efficacy Self Management Services Skilled Nursing Facilities Social Network Training Tribal Elders Tribes United States Indian Health Service Universities Visit Work Zuni access disparities aged aging in place arm barrier to care community engagement comorbidity compare effectiveness empowerment 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

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/首席研究员（最后、第一、中间）：Shah、Vallabh O 和 Herman Carla 土著长者对于保护部落社区的文化和历史至关重要，但与跌倒相关的伤害可能会祖尼普韦布洛人地理位置偏僻，交通有限。普韦布洛不提供康复和支持服务。因此，祖尼老人必须在离开社区和社交网络进行康复护理之间做出选择或者留在社区，但需求未得到满足，并且无法恢复先前功能水平的风险增加。我们建议根据文化量身定制传统物理疗法奥塔哥锻炼计划 (OEP)，以评估其在降低跌倒风险方面的有效性，并赋权老年人及其家人参与预防原住民 Zuni CHR 将通过新颖的咨询和远程医疗提供 OEP。物理治疗师拥有会说“Shiwi”（祖尼部落语言）和了解祖尼传统、家庭结构以及长辈接收健康信息的偏好。总体目标是比较 CHR 提供的、适应文化的 OEP 跌倒预防的有效性基于护理教育的跌倒风险管理标准计划。我们的差异驱动目标是：目标 1：促进可持续的多方向、参与性合作祖尼部落领导层、利益相关者、祖尼印第安人健康服务中心和新墨西哥大学健康中心科学中心加强跌倒预防培训、教育和研究；目标 2：在文化上适应用于 Zuni 老年人口的基于证据的 OEP 方法：我们将培训 CHR 使用 CDC。用于跌倒风险筛查和教育的 STEADI 工具包和 CHR 将在文化上调整教育和 OEP，目标 3：比较调整后的 OEP 与基于教育的跌倒风险的有效性管理常规护理计划，以提高力量和平衡能力并降低跌倒风险。 400 名 65 岁及以上的祖尼老人，以确定 200 名跌倒风险较高的老人，随机抽取 200 名祖尼老人。面临 6 个月 OEP 干预与基于教育的控制的风险；目标 4：比较改编后的 OEP 与基于教育的跌倒风险管理计划在提高整体水平方面的有效性健康状况、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 衡量管理日常活动的自我效能和能力所有随机参与者在基线和 6 个月以及期间参与社会角色和活动 12 个月后进行最后一次随访。