Standing Strong in Tribal Communities: Assessing Elder Falls Disparity

项目主任/首席调查员(最后、第一、中间)：Shah、Vallabh O和Herman Carla 土著长老对于保护部落社区的文化和历史至关重要，但与跌倒有关的伤害可能会 危及他们就地老化的能力。祖尼普韦布洛在地理上与世隔绝，进入的通道有限 康复和支持性服务。普韦布洛不提供家庭健康物理治疗服务。 因此，祖尼老人必须在离开社区和社会网络进行康复护理之间做出选择。 或者留在需求未得到满足的社区，并增加无法恢复其先前功能的风险。 我们建议对传统物理疗法提供的奥塔戈锻炼计划(OEP)进行文化定制，以 评估其在降低跌倒风险和增强老年人及其家人参与预防方面的有效性 坠落在他们的社区里。当地的Zuni CHRS将使用新的会诊和远程医疗提供OEP， 理疗师。CHRS提供了说“Shiwi”(祖尼部落语言)的重要优势 了解祖尼人的传统、家庭结构和长辈接受健康信息的偏好。我们的 总体目标是比较CHR提供的、适应文化的OEP预防跌倒的有效性 方案以护理标准教育为主，以跌倒风险管理为主。 我们的差距驱动目标是：目标1：促进可持续的、多方向的、参与性的合作 祖尼部落领导层、利益相关者、祖尼印第安人健康服务机构和新墨西哥大学健康学院 科学中心加强预防跌倒的培训、教育和研究；目标2：从文化上适应 为祖尼老年人口使用的循证牛津英语学习方案。方法：我们将培训社区卫生服务人员利用疾病预防控制中心 STEADI用于跌倒风险筛查和教育的工具包和CHRS将在文化上调整教育和OEP 来自祖尼长老的意见；目标3：将调整后的OEP的有效性与基于教育的跌倒风险进行比较 管理日常护理计划，以提高力量和平衡，减少跌倒的风险。方法：筛选 400名65岁及以上的祖尼老人，以确定200名跌倒风险升高的老人。随机抽查200名祖尼长老 陷入为期6个月的OEP干预与基于教育的控制的风险；目标4：比较 将OEP调整为以教育为基础的跌倒风险管理计划在提高整体水平方面的有效性 健康状况、日常活动的自我管理和社会参与。方法：我们将管理SF-12 健康调查和简表PROMIS测量管理日常活动的自我效能和能力 在基线、6个月和期间，参与所有随机参与者的社会角色和活动 12个月后的最后一次随访。

Program Director/Principal Investigator (Last, First, Middle): Shah, Vallabh O and Herman Carla Native elders are essential to preserving the culture and history of tribal communities, but fall-related injuries can jeopardize their ability to age in place. The Zuni Pueblo is geographically isolated with limited access to rehabilitative and supportive services. Home health physical therapy services are unavailable at the Pueblo. Therefore, Zuni elders must choose between leaving their community and social network for rehabilitative care or remain in the community with unmet needs, and increased risk of not regaining their prior level of function. We propose to culturally tailor the traditional Physical Therapy delivered Otago Exercise Program (OEP), to evaluate its effectiveness in reducing falls risk and to empower elders and their families to engage in preventing falls in their community. Native Zuni CHRs will deliver OEP using novel consultation and telehealth with a Physical Therapist. The CHRs offer important advantage of speaking “Shiwi” (Zuni tribal language) and understanding Zuni traditions, family structures, and elders’ preferences for receiving health information. Our overall objective is to compare the effectiveness of a CHR-delivered, culturally-adapted OEP fall prevention program to the standard of care education-based fall risk management. Our disparity driven aims are: Aim 1: Foster a sustainable multi-directional, participatory collaboration between the Zuni’s tribal leadership, stakeholders, Zuni Indian Health Services, and University of New Mexico Health Sciences Center to enhance fall prevention training, education, and research; Aim 2: To culturally adapt the evidence-based OEP for use with the Zuni elder population. Approach: We will train CHRs to utilize the CDC STEADI toolkit for fall risk screening and education and CHRs will culturally adapt the education and OEP with input from Zuni elders; Aim 3: To compare the effectiveness of the adapted OEP to an education-based fall risk management usual care program in improving strength and balance and reducing falls risk. Approach: Screen 400 Zuni elders, aged 65yrs and older, to identify 200 elders with elevated fall risk. Randomize 200 Zuni elders at risk for falls into a 6-month OEP intervention versus education-based control; and Aim 4: To compare the effectiveness of the adapted OEP to an education-based fall risk management program in improving overall health status, self-management of daily activities, and social engagement. Approach: We will administer SF-12 Health Survey and Short Form PROMIS measures Self-Efficacy for Managing Daily Activities and Ability to Participate in Social Roles and Activities to all randomized participants, at baseline and 6 months, and during the final follow up visit at 12 months.