Graduation Year

2013

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

School of Aging Studies

Major Professor

Jerri D. Edwards

Co-Major Professor

Megan C. Janke

Keywords

balance, elderly, falling, fear of falling, gait

Abstract

The effectiveness of the A Matter of Balance (MOB) program, a multifactorial falls prevention intervention, is uncertain. Although targeting multiple risk factors of falling at the same time seems reasonable and desirable, in that falls are often caused by several risk factors, results from previous studies investigating the effects of multifactorial falls prevention interventions are inconsistent. In addition, research shows that single factor interventions (e.g., exercise) can produce the same effects. The cost-effectiveness of multifactorial falls prevention interventions has varied across studies (e.g., Jenkyn, Hoch, & Speechley, 2012; Tinetti, Baker, et al., 1994). Despite the fact that the American Geriatrics Society and British Geriatrics Society (2001) have incorporated multifactorial falls prevention interventions into geriatric practice guidelines, more studies are needed to better understand the effects of the MOB program on falls and risk factors for falling among older adults.

The MOB program aims to reduce fear of falling by increasing self-efficacy and perceived control (Tennstedt et al., 1998). This program provides exercises to enhance older adults' physical capacities, lessons to teach seniors fall-related risk factors, and methods to enhance self-efficacy. Previous studies mainly focused on the effects of the MOB program on fear of falling and falls efficacy. However, falls, fear of falling, and physical frailty (e.g., poor balance) are all correlated. Little is known about the effects of the MOB program on falls and related physical risk factors. Meanwhile, fear of falling and falls efficacy are two constructs often used to delineate psychological consequences of falling, but there has been confusion about these two constructs. As a result, researchers have been using measures developed for falls efficacy to assess fear of falling in error. Previous study also shows that both fear of falling and falls efficacy need to be examined after intervention with separate appropriate measures(e.g., Valentine, Simpson, Worsfold, & Fisher, 2011). Nevertheless, in the research of the MOB program, studies often examined either fear of falling or falls efficacy, but not both (e.g., Tennstedt et al., 1998; Zijlstra et al., 2009). Therefore, whether the MOB program could improve both fear of falling and falls efficacy is uncertain.

This dissertation includes three studies to examine the effects of the MOB program. The first study explores whether the program could effectively prevent falls and improve physical risk factors (i.e., mobility, walking speed, and postural control) among older adults. The second study examines the psychometric properties of a modified fear of falling measure and the effects of the program on fear of falling and falls-efficacy. The third study investigates whether the effects of the MOB program on falls, mobility, walking speed, and postural control can be maintained across five months. Three studies using a comparison group design were conducted to examine each objective. Data were collected at baseline (Time 1), the conclusion of the program (Time 2), and at a 3-month follow-up (Time 3).

Overall, the studies in this dissertation show that older adults can improve their mobility, walking speed, postural control, fear of falling, and falls efficacy by participating in the MOB program but the program did not affect the total number of falls. The results also showed that older adults who received the MOB program reached their highest performance on mobility and walking speed immediately at the end of the program. However, their performance on postural control continued to improve and was the best at the 3-month follow-up.

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