Older Adults' Perceptions of Clinical Fall Prevention Programs: A Qualitative Study

Objective. To investigate motivational factors and barriers to participating in fall risk assessment and management programs among diverse, low-income, community-dwelling older adults who had experienced a fall. Methods. Face-to-face interviews with 20 elderly who had accepted and 19 who had not accepted an invitation to an assessment by one of two fall prevention programs. Interviews covered healthy aging, core values, attributions/consequences of the fall, and barriers/benefits of fall prevention strategies and programs. Results. Joiners and nonjoiners of fall prevention programs were similar in their experience of loss associated with aging, core values they expressed, and emotional response to falling. One difference was that those who participated endorsed that they “needed” the program, while those who did not participate expressed a lack of need. Conclusions. Interventions targeted at a high-risk group need to address individual beliefs as well as structural and social factors (transportation issues, social networks) to enhance participation

Gender-Specific Characteristics of Individuals With Depressive Symptoms and Coronary Heart Disease

Objective In individuals with depressive symptoms and coronary heart disease (CHD), little is known about gender-specific characteristics that may inform treatments and outcomes. This study sought to identify characteristics that distinguish men from women with both conditions. Methods By cross-sectional design, 1951 adults with CHD and elevated depressive symptoms completed questionnaires to measure anxiety, hostility, perceived control, and knowledge, attitudes, and beliefs about CHD. Gender differences were evaluated by multivariable logistic regression. Results Women were more likely to be single (odds ratio [OR] 3.61, P \u3c .001), to be unemployed (OR 2.52, P \u3c .001), to be poorly educated (OR 2.52, P \u3c .001), to be anxious (OR 1.14, P \u3c .01), and to perceive lower control over health (OR 1.34, P \u3c .01) than men. Conclusion Women with CHD and depressive symptoms have fewer resources, greater anxiety, and lower perceived control than men. In women, targeting modifiable factors, such as anxiety and perceived control, is warranted

Using the Stages of Change Model to Choose an Optimal Health Marketing Target

Background: In the transtheoretical model of behavior change, “stages of change” are defined as Precontemplation (not even thinking about changing), Contemplation, Preparation, Action, and Maintenance (maintaining the behavior change). Marketing principles suggest that efforts should be targeted at persons most likely to “buy the product.” Objectives: To examine the effect of intervening at different stages in populations of smokers, with various numbers of people in each “stage of change.” One type of intervention would increase by 10% the probability of a person moving to the next higher stage of change, such as from Precontemplation to Contemplation. The second type would decrease by 10% the probability of relapsing to the next lower stage, such as from Maintenance to Action, and also of changing from Never Smoker to Smoker. Nine hypothetical interventions were compared with the status quo, to determine which type of intervention would provide the most improvement in population smoking. Methods: Three datasets were used to estimate the probability of moving among the stages of change for smoking. Those probabilities were used to create multi-state life tables, which yielded estimates of the expected number of years the population would spend in each stage of change starting at age 40. We estimated the effect of each hypothetical intervention, and compared the intervention effects. Several initial conditions, time horizons, and criteria for success were examined. Results: A population of 40-year-olds in Precontemplation had a further life expectancy of 36 years, of which 26 would be spent in the Maintenance stage. In a population of former and current smokers, moving more persons from the Action to the Maintenance stage (a form of relapse prevention) decreased the number of years spent smoking more than the any other intervention. In a population of 40-year-olds that included Never Smokers, primary smoking prevention was the most effective. The results varied somewhat by the choice of criterion, the length of follow-up, the initial stage distribution, the data, and the sensitivity analyses. Conclusions: In a population of 40-year-olds, smokers were likely to achieve Maintenance without an intervention. On the population basis, targeting quitters and never-smokers was more effective than targeting current smokers. This finding is supported by some principles of health marketing. Additional research should target younger ages as well as other health behaviors

Older Adults\u27 Perceptions of Clinical Fall Prevention Programs: A Qualitative Study

Objective: To investigate motivational factors and barriers to participating in fall risk assessment and management programs among diverse, low-income, community-dwelling older adults who had experienced a fall. Methods: Face-to-face interviews with 20 elderly who had accepted and 19 who had not accepted an invitation to an assessment by one of two fall prevention programs. Interviews covered healthy aging, core values, attributions/consequences of the fall, and barriers/benefits of fall prevention strategies and programs. Results: Joiners and nonjoiners of fall prevention programs were similar in their experience of loss associated with aging, core values they expressed, and emotional response to falling. One difference was that those who participated endorsed that they “needed” the program, while those who did not participate expressed a lack of need. Conclusions: Interventions targeted at a high-risk group need to address individual beliefs as well as structural and social factors (transportation issues, social networks) to enhance participation

Diffusion of Cardiopulmonary Resuscitation Training to Chinese Immigrants with Limited English Proficiency

Cardiopulmonary resuscitation (CPR) is an effective intervention for prehospital cardiac arrest. Despite all available training opportunities for CPR, disparities exist in participation in CPR training, CPR knowledge, and receipt of bystander CPR for certain ethnic groups. We conducted five focus groups with Chinese immigrants who self-reported limited English proficiency (LEP). A bilingual facilitator conducted all the sessions. All discussions were taped, recorded, translated, and transcribed. Transcripts were analyzed by content analysis guided by the theory of diffusion. The majority of participants did not know of CPR and did not know where to get trained. Complexity of CPR procedure, advantages of calling 9-1-1, lack of confidence, and possible liability discourage LEP individuals to learn CPR. LEP individuals welcome simplified Hands-Only CPR and are willing to perform CPR with instruction from 9-1-1 operators. Expanding the current training to include Hands-Only CPR and dispatcher-assisted CPR may motivate Chinese LEP individuals to get trained for CPR

Assessment of chest pain onset and out-of-hospital delay using standardized interview questions: the REACT Pilot Study. Rapid Early Action for Coronary Treatment (REACT) Study Group

OBJECTIVE: To determine the consistency of responses to a standardized 2-part key question (Key-Q) about acute symptom onset in patients presenting with chest pain when measured using alternative questions (Qs) about symptom perception and decisions to seek treatment. METHODS: A structured patient interview was performed at 3 university teaching hospitals and 1 community hospital. Convenience samples of adult patients presenting to these EDs with chest pain were asked specific questions related to their symptoms and recognition of illness. Information obtained included the 2-part Key-Q: What are the symptoms that brought you here today? and When did those symptoms start? The alternative Qs (in order of use) were as follows: Q1 = When did your very first symptom or sensation begin? ; Q2 = When did your symptoms lead you to think something was wrong or that you were ill? ; Q3 = When did your symptoms become serious enough for you to seek medical care? ; and Q4 = When did you actually call 9-1-1/emergency medical services (EMS) or go to the hospital? The documented ED arrival time, demographic variables, and whether the patient arrived by ambulance were obtained from the medical record. Patients also were queried regarding potential barriers to seeking medical care and their cardiac risk factors. RESULTS: Of the 135 patients surveyed, 9 were unsure of the date and time of symptom onset. For the 126 patients with analyzable data, the mean (+/- SD) patient age was 62 +/- 16 years, and 59% were male. The general sequence of events reported from acute symptom onset until hospital care was Q1/Key-Q--\u3eQ2--\u3eQ3--\u3eQ4--\u3eED arrival. The median differences and interquartile ranges (IQRs) in minutes between Q times and the Key-Q response were: Q1 = 0 (0-0); Q2 = 30 (0-210); Q3 = 140 (30-720); Q4 = 265 (90-1,215); and ED arrival = 340 (120-1,230). The interval from the Key-Q response until calling 9-1-1/EMS or going to the hospital was shorter for those who used an ambulance and for those who did not consult a physician first. The interval from the Key-Q response until considering symptoms to be serious was shorter for those with a family history of heart disease, but longer for non-white patients. CONCLUSION: The Key-Q elicited a response recalled near the time of first symptoms and generally before the patient had concluded something was wrong or that he or she was ill. Measurement of the out-of-hospital delay in chest pain patients using the Key-Q appears promising

Coordinating Care for Falls via Emergency Responders: A Feasibility Study of a Brief At-Scene Intervention

Falls account for a substantial portion of 9-1-1 calls, but few studies have examined the potential for an emergency medical system role in fall prevention. We tested the feasibility and effectiveness of an emergency medical technician (EMT)-delivered, at-scene intervention to link elders calling 9-1-1 for a fall with a multifactorial fall prevention program in their community. The intervention was conducted in a single fire department in King County, Washington and consisted of a brief public health message about the preventability of falls and written fall prevention program information left at scene. Data sources included 9-1-1 reports, telephone interviews with intervention department fallers and sociodemographically comparable fallers from three other fire departments in the same county, and in-person discussions with intervention department EMTs. Interviews elicited faller recall and perceptions of the intervention, EMT perceptions of intervention feasibility, and resultant referrals. Sixteen percent of all 9-1-1 calls during the intervention period were for falls. The intervention was delivered to 49% of fallers, the majority of whom (75%) were left at scene. Their mean age (N=92) was 80±8 years; 78% were women, 39% had annual incomes under $20K, and 34% lived alone. Thirty-five percent reported that an EMT had discussed falls and fall prevention (vs. 8% of comparison group, P<0.01); 84% reported that the information was useful. Six percent reported having made an appointment with a fall prevention program (vs. 3% of comparison group). EMTs reported that the intervention was worthwhile and did not add substantially to their workload. A brief, at-scene intervention is feasible and acceptable to fallers and EMTs. Although it activates only a small percent to seek out fall prevention programs, the public health impact of this low-cost strategy may be substantial