IHP 670 Module 2 Needs Assessment Paper Example

Falls in Alder County: A Needs Assessment for Older Adult Fall Prevention

[Student Name]

Southern New Hampshire University

IHP 670: Program Design, Planning and Evaluation

Module Two Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Falls in Alder County: A Needs Assessment for Older Adult Fall Prevention

A program should begin with an honest picture of the problem it aims to address. This needs assessment documents how often older adults in Alder County fall, who is most affected, what falls cost, what older adults themselves say and what services already exist. It will guide the design of a falls prevention program funded by a new state grant.

Sources and Methods

Five sources fed the assessment: county estimates from the state's behavioral risk factor survey, emergency department and hospital discharge data for fall injuries over three years, death certificates, a mailed and online survey completed by 310 adults aged 65 and older and three focus groups with 42 older adults in two towns and one rural township. An inventory of programs and providers was compiled with the Area Agency on Aging.

How Often Falls Happen

About 30% of county adults aged 65 and older reported a fall in the past year, roughly 19,000 people, and about 11% reported a fall that caused an injury. Bergen et al. (2016) reported that nearly three in ten Americans over 65 said they had fallen at least once during the prior year in 2014, amounting to roughly 29 million falls and 7 million fall injuries. Alder County's rate is slightly above that national figure.

Serious Consequences

Over the past three years, falls among older adults caused an average of 2,900 emergency visits, 610 hospital admissions, including about 190 hip fractures, and 38 deaths a year. The age-adjusted fall death rate of about 59 per 100,000 exceeds the state rate of 52. Nearly a third of admitted patients were discharged to a nursing facility rather than home.

Table 1. Fall Burden Among Adults 65 and Older, Annual Averages

Note. Composite county data; national figures from Bergen et al. (2016).

What Falls Cost

Florence et al. (2018) estimated that fatal and nonfatal falls among older adults generated about $50 billion in medical spending in the United States in 2015, most of it paid by Medicare and Medicaid, with hospital care accounting for the largest share. Applying average costs per emergency visit and admission from that analysis to Alder County's counts suggests local medical costs of roughly $30 million a year, before counting lost independence, caregiver time and long-term care.

Who Is Most Affected

Rates were highest among adults over 80, women, people living alone and residents of the county's three rural townships, where fall admission rates were 40% higher than in the county seat. Survey respondents taking four or more medications and those reporting fear of falling were also more likely to report a fall. Rural residents described long distances to services and limited public transportation.

Risk Factors in the Population

Several known risk factors are common in the county's older population. Survey data suggest that about 38% take four or more prescription medications, 21% report difficulty with balance or walking, 18% report vision problems that affect daily activities and 29% live alone. Many risk factors can be modified: strength and balance improve with exercise, medications can be reviewed and adjusted, homes can be made safer and vision can be corrected. The prevalence of these modifiable factors reinforces the case for a program that combines exercise with clinical screening and referral.

What Older Adults Said

Forty-six percent of survey respondents said they worried about falling, and a quarter said that worry kept them from activities they enjoyed. In focus groups, participants expressed strong interest in group exercise classes held close to home, especially tai chi, but little interest in lectures. Many said they had never been asked about falls by a doctor. Several noted they would attend if classes were at the senior center and a friend came too.

How Much Could Be Prevented

Stevens and Lee (2018) modeled the effect of health care providers screening older patients for fall risk and managing it through exercise referral, medication review and other interventions, and estimated that such clinical management could prevent a substantial number of falls and avert large medical costs nationally. Their modeling suggests that combining clinical screening with community programs has more potential than either alone.

Stakeholder Perspectives

Interviews with twelve stakeholders, including senior center directors, primary care physicians, emergency physicians, the Area Agency on Aging director and a home health agency manager, added professional perspectives. Physicians said they rarely screened for fall risk because they had nowhere to refer patients. Senior center directors reported waiting lists for any exercise class and asked for trained instructors. Emergency physicians described repeat visits by the same patients after falls, suggesting an opportunity for referral at discharge.

Assets

The county has nine senior centers, a YMCA with a large older adult membership, two hospital systems with primary care networks, an active Area Agency on Aging and a volunteer driver program. Senior center directors expressed willingness to host classes, and one hospital system has begun screening patients for fall risk in two primary care clinics.

Gaps

Only one evidence-based falls program currently operates in the county, a single class serving about 30 people a year. No tai chi program designed for fall prevention exists. Most primary care clinics do not screen for fall risk, and those that do have nowhere to refer patients. Rural townships have no programs at all.

Priorities

The assessment points to three priorities: evidence-based exercise programs delivered close to home, starting in rural townships and senior centers; a referral link from primary care screening to those programs; and attention to fear of falling and social connection, which older adults themselves emphasized.

Limitations

Self-reported falls are likely undercounted, the survey's respondents may be healthier than average and hospital data miss falls treated only in clinics. The cost estimate applies national averages to local counts and should be read as approximate.

Conclusion

Falls are common, costly and unevenly distributed among Alder County's older adults, and the county has almost no evidence-based programs to prevent them. Older adults want nearby group exercise, and existing assets can host it. These findings give the planned program a clear mandate and a starting point.

References

Bergen, G., Stevens, M. R., & Burns, E. R. (2016). Falls and fall injuries among adults aged 65 years and older: United States, 2014. MMWR: Morbidity and Mortality Weekly Report, 65(37), 993-998. https://doi.org/10.15585/mmwr.mm6537a2

Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693-698. https://doi.org/10.1111/jgs.15304

Stevens, J. A., & Lee, R. (2018). The potential to reduce falls and avert costs by clinically managing fall risk. American Journal of Preventive Medicine, 55(3), 290-297. https://doi.org/10.1016/j.amepre.2018.04.035