Outcomes associated with scale-up of the Stepping On falls prevention program: A case study in redesigning for dissemination.

INTRODUCTION: Translating complex behavior change interventions into practice can be accompanied by a loss of fidelity and effectiveness. We present the evaluation of two sequential phases of implementation of a complex evidence-based community workshop to reduce falls, using the Replicating Effective Programs Framework. Between the two phases, workshop training and delivery were revised to improve fidelity with key elements. METHODS: Stepping On program participants completed a questionnaire at baseline (phase 1: n = 361; phase 2: n = 2219) and 6 months post-workshop (phase 1: n = 232; phase 2: n = 1281). Phase 2 participants had an additional follow-up at 12 months (n = 883). Outcomes were the number of falls in the prior 6 months and the Falls Behavioral Scale (FaB) score. RESULTS: Workshop participation in phase 1 was associated with a 6% reduction in falls (RR = 0.94, 95% CI 0.74-1.20) and a 0.14 improvement in FaB score (95% CI, 0.11- 0.18) at 6 months. Workshop participation in phase 2 was associated with a 38% reduction in falls (RR = 0.62, 95% CI 0.57-0.68) and a 0.16 improvement in FaB score (95% CI 0.14-0.18) at 6 months, and a 28% reduction in falls (RR = 0.72, 95% CI 0.65-0.80) and a 0.19 score improvement in FaB score (95% CI 0.17-0.21) at 12-month follow-up. CONCLUSIONS: Effectiveness can be maintained with widespread dissemination of a complex behavior change intervention if attention is paid to fidelity of key elements. An essential role for implementation science is to ensure effectiveness as programs transition from research to practice.

Lighten UP! A community-based group intervention to promote psychological well-being in older adults.

OBJECTIVES: Aging is often characterized by declines in physical and mental health and increased risk for depression and social isolation. A protective factor that has been found to effectively moderate these phenomena is psychological well-being. The aim of his study was to pilot test a novel group intervention (Lighten UP! program) for the promotion of psychological well-being in older adults living in the community. METHODS: Lighten UP! is an eight-week program consisting of 90-minute group session designed to teach participants to identify and savor positive experiences across multiple domains of eudaimonic well-being. It was delivered to a sample of 103 men and women aged 60 or over, that were assessed pre- and post-intervention with Ryff's Psychological Well-being Scale (PWB), Life Satisfaction scale, Geriatric Depression Scale, Symptom Questionnaire, and items measuring sleep complaints and social well-being. RESULTS: At the end of the eight weeks, participants reported significantly increased PWB, life satisfaction, and social well-being along with lower levels of depression and fewer physical symptoms and sleep complaints. These gains were particularly robust for individuals with lower pre-program levels of PWB. CONCLUSIONS: This pilot investigation suggests the feasibility of a short group program for enhancing well-being in older adults. Future controlled investigations with long-term follow-up assessment are needed to confirm the effectiveness and sustained benefits of the Lighten UP!

Kenosha County falls prevention study: a randomized, controlled trial of an intermediate-intensity, community-based multifactorial falls intervention.

OBJECTIVES: To decrease the rate of falls in high-risk community-dwelling older adults. DESIGN: Randomized, controlled trial. SETTING: Community-based. PARTICIPANTS: Three hundred forty-nine adults aged 65 and older with two falls in the previous year or one fall in the previous 2 years with injury or balance problems. INTERVENTION: Subjects received two in-home visits from a trained nurse or physical therapist who assessed falls risk factors using an algorithm. The intervention consisted of recommendations to the subject and their primary physician, referrals to physical therapy and other providers, 11 monthly telephone calls, and a balance exercise plan. Control subjects received a home safety assessment. MEASUREMENTS: The primary outcome was rate of falls per year in the community. Secondary outcomes included all-cause hospitalizations and nursing home admissions per year. RESULTS: There was no difference in rate of falls between the intervention and control groups (rate ratio (RR)=0.81, P=.27). Nursing home days were fewer in the intervention group (10.3 vs 20.5 days, P=.04). Intervention subjects with a Mini-Mental State Examination (MMSE) score of 27 or less had a lower rate of falls (RR=0.55; P=.05) and, if they lived with someone, had fewer hospitalizations (RR=0.44, P=.05), nursing home admissions (RR=0.15, P=.003), and nursing home days (7.5 vs 58.2, P=.008). CONCLUSION: This multifactorial intervention did not decrease falls in at-risk community-living adults but did decrease nursing home utilization. There was evidence of efficacy in the subgroup who had an MMSE score of 27 or less and lived with a caregiver, but validation is required.