1. Managing Concerns About Falls
A MATTER OF BALANCE:
Managing Concerns About Falls
Volunteer Lay Leader Model
Master Trainer:
Nicole Peritore

2. ICE-BREAKER
Make a Choice Activity
More ideas in your book

3. PLAN FOR TODAY Overview of A Matter of Balance Materials
(Books and coaching tips)
Coach handbook
Q & A
Evaluation

4. OVERVIEW: A Matter of Balance Volunteer Lay Leader Model

5. OBJECTIVES:
Explain what the Matter of Balance Program is about and describe how to conduct the 8 week program in your county
Review and practice A Matter of Balance’s learning activities and physical exercises
Prepare agents to lead an effective program in their county

6. https://my.mmc.org/media/PartnershipHealthAging/FallsTestimonial/

7. WHAT DO WE KNOW ABOUT FALLS?
1 in 3 community dwelling adults fall each year
Less than 50% tell their doctor
Falls are a leading cause of injury and death for older adults
Falls: 1/3 of 65 yrs >; ½ of 80 yrs>
50% of those fall repeatedly
Most falls do not cause physical injury
•One out of three adults age 65 and older falls each year,1 but less than half talk to their healthcare providers about it.
•Among older adults (those 65 or older), falls are the leading cause of injury death. They are also the most common cause of nonfatal injuries and hospital admissions for trauma.2

8. Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.5,6
Falls are the most common cause of traumatic brain injuries (TBI).7 In 2000, TBI accounted for 46% of fatal falls among older adults.3

9. WHAT DO WE KNOW ABOUT FALLS?
Falls usually aren’t caused by just one issue. It’s a combination of things coming together.
A majority of falls occur during routine activities
A large portion of falls are preventable!
Most falls are on the same level or from a standing height (tripping while walking)
Falls: poor eyesight, balance, slow reflexes etc. Can be intrinsic-related to the person or extrinsic- related to the environment.
•Most fractures among older adults are caused by falls.8 The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.9
•Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling.10

10. Where seniors fall
1/2 to 2/3 of falls occur around the home

11. WHAT DO WE KNOW ABOUT FALLS?
Falls are :
Common
Predictable
Preventable
Falls are not a natural part
of aging!
Elaine

12. WHAT DO WE KNOW ABOUT FEAR OF FALLING?
It is reasonable to be concerned about falls - safety is important
1/3 to 1/2 of older adults acknowledge fear of falling
Fear of falling is associated with:
decreased satisfaction with life
increased frailty
depression
decreased mobility and social activity
Fear of falling is a risk factor for falls

13. VICIOUS CYCLE: Fall Muscle De-conditioning or increased frailty
Fear of Falling
Decrease in Activity/
Increased isolation
Unsteady Gait

14. KSPAN KY Safety and Prevention Alignment Network

15. WHAT IS A MATTER OF BALANCE?
A Matter of Balance is a program:
based upon research conducted by the Roybal Center for Enhancement of Late-Life Function at Boston University
designed to reduce the fear of falling and increase the activity levels of older adults who have concerns about falls

16. A MATTER OF BALANCE: MANAGING CONCERNS ABOUT FALLS
During 8 two-hour classes,
participants learn:
To view falls and fear of falling as controllable
To set realistic goals for increasing activity
To change their environment to reduce fall risk factors
To promote exercise to increase strength and balance
It is a structured group intervention consisting of
8 two-hour sessions, which utilizes a variety of activities to address physical,
social, and cognitive factors affecting fear of falling.
Early sessions focus on changing attitudes and self-efficacy before attempting changes
in actual behavior.
During 8 two-hour classes, participants learn to:
view falls and fear of falling as controllable (involve changing behavior the focus on building falls self-efficacy- the belief that one can engage in an activity with out falling)
set realistic goals for increasing activity (to instill adaptive beliefs such as greater perceived control, greater confidence in one’s abilities, and more realistic assessment of failures.
change their environment to reduce fall risk factors- home safety eval
promote exercise to increase strength and balance

17. A MATTER OF BALANCE: MANAGING CONCERNS ABOUT FALLS
What Happens During Classes?
Group discussion
Problem-solving
Skill building
Assertiveness training
Exercise training
Videotapes
Sharing practical solutions

18. WHO COULD BENEFIT FROM A MATTER OF BALANCE?
Anyone who:
is concerned about falls
has sustained a fall in the past
restricts activities because of concerns about falling
is interested in improving flexibility, balance and strength
is age 60 or older, ambulatory and able to
problem-solve.

19. A MATTER OF BALANCE OUTCOMES
Comments:
I am more aware of my surroundings. I take time to do things and don’t hurry.
I have begun to exercise and am looking forward to a walking program.
I have more pep in not being afraid.
Participant Outcomes
97 % - more comfortable talking about fear of falling
97 % - feel comfortable increasing activity
99 % - plan to continue exercising
98 %- would recommend A Matter of Balance
In 2001, the National Council on the Aging selected A Matter of Balance as one of seven exemplary programs for senior centers and other facilities as part of a landmark national survey of 628 community-based programs. The program was also featured at the 2002 NCOA/ASA Joint Convention in Denver.
A Matter of Balance is a program:
based upon research conducted by the Roybal Center for Enhancement of Late-Life Function at Boston University.
designed to reduce the fear of falling and increase the activity levels of seniors who have concerns about falls
6 Months
Falls Management***
Falls Efficacy***
Exercise Level **
Monthly Falls*
12 Months
Falls Management**

20. PARTICIPANTS REPORT:
Increased confidence in taking a walk, climbing stairs, carry bundles without falling
More confidence that they can increase their strength, find ways to reduce falls, and protect themselves if they do fall
An increase in the amount they exercise on a regular basis

21. ROLE OF THE COACH
Review the Matter of Balance session and select the activities for the day
Arrive early to get organized
Share the day’s goals
Encourage lots of discussion & problem-solving
Lead the exercises
Connect with each participant
Review what has been learned and set the stage for the next session.
Have fun !

22. STRETCH BREAK!
Deep Breathing
Good Morning Stretch
Shoulder Rolls

23. OVERVIEW OF MATERIALS 3 Main sources of information
Participant Workbook
Coach Handbook
Healthcare Provider Handbook
We are goin to go through these materials so that you are familiar with your Handbook and know what resources it holds for you.
We also will review the participant workbook, so that you have a feel for what information will be provided by your participants and how your guidence will make the class effective and fun.

24. PARTICIPANT WORKBOOK Activities that are done throughout the class
How do you want to manage them?

25. Healthcare Provider Handbook
Share about the class
Overview and review of some activities

26. COACH HANDBOOK Tab 1 – Orientation Review of primary responsibilities
Preparation
Use of materials
Facilitation of learning discussions
Facilitation of exercises
Clarification
Promote reflection
Consideration for Participants
Monitor and coach
Promoting socialization
Preparation – prepare yourself for an effective class, know your material, as you are working today and even as you are doing the classes there is space for you to take notes, these are great places to write reminders etc.
Use of Materials – make sure to follow the program materials – we do this so that we have consistant classes, it is evidence based and has been proven to work! Ie the activities and there for a reason
Learning discussions – active discussion is an important concept in the program, it through sharing experiences and talking abour skills that there is full understanding – if topic strays, and it probably will at some point,m gently move back on topic
Exercises – demonstrate all exercises, we will go over them today, you have already done a few of them – this is an opportunity for group learning and even sharing encourage participation off at their own level
Clarifaction – encourage questions and read about current issues, clarify misunderstandings ( there are many if them) to the best of your ability, do not make stuff up – contact us for questions that you have that you cannot answer
Promoting reflection – examine their own experiences and reflect on how to apply them to discussion ideeas that are raises through the sessions – called cognitive restructuring
Consideration – reinforce their responces – acknowledge limitations and encourage growth
Monitoring – observe the oarticipants – I sthere someone who does not particpate as much, try to involve him or her more
Socialization - encourage the particpates to get to know each other – if you arein a elderly home situation they may or may not really know each other – encourage conversation

27. COACH HANDBOOK (II) Icon Review Videos Equipment/Supplies Refreshments
The coach’s handbook was created to help you the coach make the class efficient and effective
Icons – there are different icons to assist in knowing what you may need to bring, use, discuss etc.
Video – 2 videos that are used by this program: Fear of Falling – used in session 1 to really introduce the concepts of reducing fear of falling and ways to reduce the risks and Exercise its never too late: addresses some of the fears about exercise
Equipment/ Supplies – name tags for each participant and coach for all sessions – makers and tape – flip chart for discussions etc – TV/ DVD player ( if you need a VHS) – attendance sheet, pencils, and participant workbooks you can use transpariences and overheads if you want/
Refreshments – each session should have refreshments – different ways that this could work – you ask local areas, in a home migt provide something – ask participants to group and provide

28. THE LEARNING METHOD
A Matter of Balance uses various media and techniques
Videos
Coach presentations
Learning discussions
Learning exercises
Physical exercises
Healthcare connection

29. MEETING ROOM SET UP
Room for discussion and exercises
“U” Shape

30. THE ADULT LEARNER
Treat Learners the Way We All Would Like to Be Treated
We all have years of experience
We have values, beliefs, and opinions we hold dear
Style and pace of living has changed
Relate new information to old
Gravity influences our actions
Respect our opinions
We self-direct
Individual differences increase
Problem- centered orientation to learning

31. TIPS FOR WORKING WITH OLDER ADULTS
Not a homogeneous group
Be aware of ageist attitudes
Terms
Focus on strengths of individuals/group
Be inclusive and non judgmental
Be aware of communication difficulties
Be aware of fears and concerns
Pay attention to learning and teaching style
Encourage social interaction
Learn from elders - they are EXPERTS

32. STAGES OF CHANGE Pre-contemplation Contemplation Preparation Action
Not even thinking about change
Contemplation
Thinking about change
Preparation
Planning to change
Action
Starts new behavior
Maintenance
Continues new behavior
Relapse
Resumes unhealthy behavior

33. BEFORE YOU START THE 1ST SESSION
Handbook!!
Set up the room properly
Check and double check your materials
Work with your co- instructor
Smile

34. SESSION 1 Lots of discussion this session 1st class survey / PAR-Q
Fear of Falling video
Reference pages (!)

35. SESSION 2 May have new people joining
Still learning about the group dynamic
Recognizing fear and confidence building thoughts
FEAR
Handout 2.2

36. SESSION 3 2nd Video Introduction to exercise
PAR-Q should be completed / forms returned

37. BENEFITS OF EXERCISE
Almost anyone, at any age, will benefit their health by doing some type of activity
Being active will assist in independence
Can prevent / delay onset of some diseases
Help feel better and enjoy life more

38. PAR-Q AND YOU
PAR –Q stands for Physical Activity Readiness Questionnaire
Aids in deciding if you need doctors evaluation before starting programs
Participant agreement
Page 26/27 in coaches handouts

39. EXERCISES
Endurance exercise
Strengthening exercise
Balance
Stretching

40. HELPFUL WEBSITES American College of Sports Medicine
Centers for Disease Control and Prevention
The President’s Council on Physical Fitness and Sports

41. SESSION 4 Assertiveness and Fall Prevention
Define assertiveness
Discussion of risk factors for falls
What is assertive behavior
Handout 4.1 (Practical Suggestions)

42. SESSION 5 Managing Concerns About Falling
Personal Action Planners
Role Playing
Handout 5.1

43. SESSION 6 Recognizing Fall-ty Habits
Midcourse review
Identifying problematic behaviors
What are the risks that we take?
Use of Handout 5.4/Handout 6.1
Handout 6.2

44. SESSION 7 Recognizing Fall Hazards in the Home and Community
Home visit/ room inspection
Strategies for reducing physical hazards
Good Session for Healthcare Provider

45. SESSION 8 Practicing No Fall-ty Habits and Overview
Last session
Review of entire program
Handout 8.1

46. QUESTIONS?

47. Phone: (859) 257-3802 Email: nicole.peritore@uky.edu
CONTACT INFORMATION
Nicole Peritore, Master Trainer University of Kentucky Kinesiology and Health Promotion
Phone: (859)