Engaging older adults in fall prevention using Motivational Interviewing (MI)

项目摘要 在美国，每年有三分之一的老年人跌倒。许多意外的福尔斯跌倒可以通过以下方法预防： 跌倒风险评估和循证干预措施。干预措施可能包括建议锻炼， 药物调整、血压管理、环境改造和改善视力。 然而，老年人并没有始终如一地遵循这些建议，原因有很多，包括 他们对福尔斯和跌倒预防的看法。新出现的证据表明， 不足以让患者参与预防跌倒。然而，探索改善患者生活质量的替代方法的研究 预防跌倒的方法很少。特别是在行为改变背景下重新制定跌倒预防措施， 通过动机访谈（MI），具有很大的潜力，积极影响跌倒预防工作。m1可以 解决情感障碍和个人独特的价值观以及认知和身体限制。而 个体化的跌倒预防策略正在出现，MI干预尚未作为后续护理进行测试 跌倒后预防建议已提供给中度至高度跌倒风险的门诊患者。博士 Kiyoshi-Teo致力于发现和实施以患者为导向的行为改变干预措施，以确保 老年人的安全和生活质量。因此，本申请的总体目标是双重的：1）进一步获得 培训，以提高与行为改变，混合方法和以患者为导向的研究相关的技能，以及2） 使用混合方法研究来评估MI如何影响患者参与和跌倒风险。培训和 提案目标与NINR的使命和K23面向患者的研究基金目标一致 机会她将使用在K23培训期间获得的新技能开展拟定研究， 开展未来的研究，通过行为改变改善老年人的健康状况。培训 活动包括正式的课程/研讨会，与导师的沉浸式体验（埃克斯特罗姆博士，科恩， 和温特斯-斯通），会议和其他机会，在俄勒冈州健康与科学大学（OHSU）和 其他机构。OHSU是一个理想的培训环境，并为Kiyoshi-Teo博士提供了保护 过去5年的研究时间。这项随机对照试验的研究目的是纵向随访， 是：1）通过自我报告和生理测量，使用定量 方法，2）评估MI使老年人参与跌倒预防行为改变的过程， 定性方法，3）评价拟议MI干预的可行性。我们将招募和 随机选择150名来自OHSU内科和老年病诊所的患者。参加者参加了 研究为期12个月，并可能通过电话联系或研究访视进行多达9次研究接触。 将对有目的地选择的参与者的叙述性描述进行定性分析。

PROJECT SUMMARY One-third of older adults fall every year in the United States. Many accidental falls can be prevented through fall risk assessment and evidence-based interventions. The interventions may include advice for exercise, medication adjustment, blood pressure management, environmental modifications, and improving vision. However, older adults do not consistently follow these recommendations for a number of reasons, including their perceptions about falls and fall prevention. Emerging evidence indicates that a recommendation alone is not sufficient to engage patients in fall prevention. Yet, studies that explore alternate ways to improve patients’ engagement with fall prevention are rare. Reframing fall prevention in a behavior change context, specifically through Motivational Interviewing (MI), holds strong potential to positively impact fall prevention efforts. MI can address emotional barriers and individual’s unique values as well as cognitive and physical limitations. While individualized fall prevention strategies are emerging, MI intervention has not been tested as follow-up care after fall prevention recommendations have been provided to moderate-to-high fall-risk clinic patients. Dr. Kiyoshi-Teo is driven to discover and implement patient-oriented behavior change interventions to ensure safety and quality of life of older adults. Thus, the overall goal of this application is two-folds: 1) gain further training to advance skills related to behavior change, mixed-methods, and patient-oriented research, and 2) use mixed-methods research to evaluate how MI impacts patient engagement and fall risks. The training and proposal goals align with the mission of the NINR and the goal of the K23 patient-oriented research funding opportunity. She will use new skills gained during the K23 training to conduct the proposed study and to develop future studies to improve the health outcomes of older adults through behavior change. The training activities include formal coursework/workshop, immersive experience with the mentors (Drs. Eckstrom, Cohen, and Winters-Stone), conferences, and other opportunities at Oregon Health & Science University (OHSU) and other institutions. OHSU is an ideal training environment and has provided Dr. Kiyoshi-Teo with protected research time for the past 5 years. The study aims of this randomized control trial with longitudinal follow-up are: 1) evaluate the impact of MI through self-reported and physiologic measures using a quantitative approach, 2) evaluate the process by which MI engages older adults in fall prevention behavior changes using a qualitative approach, and 3) evaluate the feasibility of the proposed MI intervention. We will recruit and randomize150 patients from OHSU Internal Medicine and Geriatrics Clinic. Participants are enrolled in the study for 12 months and may have up to nine study encounters through phone contacts or study visits. Narrative transcriptions for purposively selected participants will be analyzed for the qualitative analysis.