Standing Strong in Tribal Communities: Assessing Elder Falls Disparity

项目负责人/主要研究者（最后一位、第一位、中间一位）：Shah、Vallabh O和赫尔曼卡拉 土著长者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 危及他们在原地养老的能力祖尼普韦布洛在地理上与世隔绝， 康复和支持服务。普韦布洛没有家庭保健理疗服务。 因此，祖尼族长者必须在离开社区和社交网络接受康复护理之间作出选择 或留在社区，需求得不到满足，无法恢复以前的功能水平的风险增加。 我们建议在文化上量身定制传统的奥塔哥运动计划（OEP）， 评估其在减少福尔斯跌倒风险方面的有效性，并授权长者及其家人参与预防 福尔斯在他们的社区。本地祖尼社区保健中心将使用新的咨询和远程保健提供OEP， 物理治疗师人权中心提供了讲“Shiwi”（祖尼部落语言）的重要优势， 了解祖尼族的传统、家庭结构和老年人接受健康信息的偏好。我们 总体目标是比较CHR提供的、文化适应的OEP跌倒预防的有效性 计划以护理教育为基础的跌倒风险管理标准。 我们的目标是：目标1：促进可持续的多方向，参与性合作， 祖尼部落领导人、利益相关者、祖尼印第安人卫生服务机构和新墨西哥州卫生大学 科学中心，以加强跌倒预防培训，教育和研究;目标2：文化适应 用于祖尼老年人群的循证OEP。方法：我们将培训社区卫生服务中心利用疾病预防控制中心 STEADI跌倒风险筛查和教育工具包以及CHR将在文化上调整教育和OEP， 来自祖尼族长者的意见;目的3：比较适应性OEP与基于教育的跌倒风险的有效性 管理日常护理项目，提高力量和平衡能力，降低福尔斯跌倒风险。方法：屏幕 400名年龄在65岁及以上的祖尼族老人，以确定200名跌倒风险升高的老人。随机抽取200名祖尼长老 有福尔斯风险的儿童接受为期6个月的OEP干预与基于教育的对照;目标4：比较 适应OEP的有效性，以教育为基础的跌倒风险管理计划，在改善整体 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 在基线和6个月时，以及在治疗期间，所有随机化受试者参与社会角色和活动 12个月时进行最终随访。

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.