Hlth 416_ Assignment 2
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Queens University *
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Health Science
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Apr 3, 2024
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docx
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HLTH 416 -Assignment 2: Program Design & Evaluation (Group 12) 1) The intended population for this intervention program is elderly residents living in long-
term care homes in Kingston, Ontario. Specifically, we aim to reduce their risk of serious injury and death due to falls. The physiological decay of the elderly adult may lead to a reduction in balance and an increased risk of falling, making them an appropriate target. For instance, intrinsic factors associated with aging, such as degenerative processes in the nervous and muscular system, can lead to muscle weakness and instability (Silva et al., 2016). Kuhnow et al. (2022) further supports this, suggesting that elderly individuals are the most vulnerable to falls due to age-related changes in bone density and muscle mass. Older adults struggle with balance and decreased range of motion, evidenced by the 80% who require support persons or devices when trying to stand alone (Kuhnow et al., 2022). As falls are the leading cause of death and injury in this population, it is an important outcome to reduce. Our intervention setting is Kingston, Ontario, where more than 18% of the population is over the age of sixty-five (City of Kingston, n.d.). With this growing population of older adults in Kingston, 40% of long-term care home admissions in adults aged 65 and over can be related to
a fall (Community Foundations, 2017). Further, falling in long-term care homes has been one of the leading causes of injury and death for the elderly across Canada, with approximately 50% of residents experiencing a fall each year (Kuhnow et al., 2022). As such, long-term care homes are an ideal target for intervention, as they can reduce falls by increasing the number of trained staff,
keeping walkways clear and well-lit, and offering exercise programs to improve balance and strength (Hawaii Pacific University, 2023). Evident through the high rates of falls reported in nursing homes is the association of falls with frailty in older adults.
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2) As the body ages, it undergoes natural changes such as persistent reductions in body density and a loss of muscle tissue (Padilla Colón et al., 2018). As such, older adults often experience restricted mobility, poor balance and less accurate detection of body position, all of which increase the risk of falls and corresponding injuries and deaths. With a focus on physical activity, this intervention will provide elderly adults with the opportunity to engage in strength and balance activities that will help to minimize the loss of bone density and muscle mass, thereby combatting natural age-related changes. Specifically, it has been found that engaging in just three hours of physical activity per week helps to maintain or improve muscular strength, mobility and balance, thereby reducing the risk of falls in elderly individuals by 21% (Langhammer et al., 2018). Despite this, only 15.2% of seniors aged 65–79 currently meet the physical activity guidelines (Government of Canada, 2020). This further suggests that there is an urgent need to improve physical activity among older adults, making this behaviour an ideal target for intervention. Ultimately, being physically active has unparalleled effects in reducing the risk of falls among older adults and is vital to maintaining health and independence as we age. Thus, this campaign encourages residents in long-term care homes to reap health benefits by
making physical activity part of their daily lives. It also encourages them to do so by educating friends, family and care home staff on the most effective methods and the importance and risks of physical exercise. The support provided by incorporating interpersonal components will motivate participants to continue. This is evident as Lacroix et al. (2017) found that supervised groups of elderly individuals performed exercises and improved balance at a higher quality and rate than unsupervised groups. This underlines that individual cognitive factors might also play a
role as a form of motivation for older adults providing support for a multi-level intervention
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3)
Logic Model to Address Fall-Related Injury and Death in Long-Term Care Homes in Kingston
Inputs
Outputs
Outcomes
Resources Activities Participation Short term
Medium-term
(behaviour) Long-term (health
outcome)
-Funding -Time
-Research evidence
-Materials (posters, signs)
-Equipment (bands, weights, balls,
yoga mats)
-Volunteer and Staff Support
Individual Level
To increase
physical
activity among
older adults
living in long-
term care
homes in
Kingston. By the year 2030,
the number of older
adults in long-term
care homes who
experience a
serious injury or
death due to a fall
will be reduced by
25%.
HP team will conduct a communication
campaign (exercise programs, posters,
success stories) to educate elderly residents
about the importance of physical activity in
reducing the risk of injury and falls. Approximately 80% of all
residents in each Long-Term Care
home will see/hear this campaign.
Older adults will have increased
knowledge about the importance
of regular physical activity and
feel more positively about
participating in exercise programs. Interpersonal Level
HP team will educate family members and
friends on the importance of physical
activity, mobility and the risk of falls. Approximately 2-4 family
members/friends of each resident
will be educated on the
importance of physical activity,
mobility, and falls. Older adults are likely to engage in
physical activity programs because
of encouragement from peers who
have gained PA knowledge.
Organizational Level
HP team will partner with REEVED Up in
Kingston to work with the residents in long-
term care homes and teach the staff in each
care home how to give advice, demonstrate
exercises, and learn the risks.
Approximately 80% of staff in
each long-term care home will be
educated on the risks of falls,
ways to promote proper exercise
and how to help residents. Care-home staff will have the
knowledge and skills to assist
with, give advice on and
demonstrate exercises and
associated risks.
Assumptions: 1.
Older adults who are not physically active are more likely to experience serious injuries and death due to falls.
2.
Long-term care workers and family members want to help older adults decrease their fall risks.
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References City of Kingston. (n.d.) Seniors. https://www.cityofkingston.ca/resident/seniors#:~:text=Here%20in%20Kingston%2C
%20about%2018,over%20the%20age%20of%2085
Community Foundations. (2017). Kingston & Area’s Vital Signs
. https://communityfoundations.ca/wp-content/uploads/2019/08/
Kingston_vital_signs_2017_WEB.pdf Government of Canada. (2020). Aging and chronic diseases: A profile of Canadian seniors.
https://www.canada.ca/en/public-health/services/publications/diseases-conditions/aging-
chronic-diseases-profile-canadian-seniors-report.html
Hawaii Pacific University. (2023). Fall Prevention Strategies in Nursing Homes.
https://online.hpu.edu/blog/fall-prevention-strategies
Kuhnow, J., Hoben, M., Weeks, L. E., Barber, B., & Estabrooks, C. A. (2022). Factors Associated with Falls in Canadian Long Term Care Homes: a Retrospective Cohort Study. Canadian geriatrics journal: CGJ
, 25
(4), 328–335. https://doi.org/10.5770/cgj.25.623
Lacroix, A., Hortobagyi, T., Beurskens, R., & Granacher, U. (2017). Effects of supervised vs. unsupervised training programs on balance and muscle strength in older adults: a systematic review and meta-analysis. Sports medicine
, 47, 2341-2361. https://link.springer.com/article/10.1007/s40279-017-0747-6 Langhammer, B., Bergland, A., & Rydwik, E. (2018). The Importance of Physical Activity Exercise among Older People. BioMed research international
, 2018
, 7856823. https://doi.org/10.1155/2018/7856823
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Padilla Colón, C. J., Molina-Vicenty, I. L., Frontera-Rodríguez, M., García-Ferré, A., Rivera, B. P., Cintrón-Vélez, G., & Frontera-Rodríguez, S. (2018). Muscle and Bone Mass Loss in the Elderly Population: Advances in diagnosis and treatment. Journal of Biomedicine (Sydney, NSW)
, 3
, 40–49. doi: 10.7150/jbm.23390
Silva, W. F. L. T., Rica, R. L., Ramalho, B., Machado, A. F., Ceschini, F., Júnior, F. L. P., ... & Bocalini, D. S. (2016). Fall determinants and associated factors in older people. International journal of sports science
, 6(4), 146-152. doi: 10.5923/j.sports.20160604.03