Enhancing Motivation for Physical Activity to Reduce the Risk of Falls

在社区居住的老年人中，意外跌倒是一个常见的、严重的和有可能预防的公共卫生问题。在美国，2001年每10万人中跌倒相关伤害的年发生率为4616例，2008年上升至5252例。2000年，每10万人中每年因跌倒死亡的人数为29.3人，2006年上升到41.86人。随着年龄的增长，老年人特别容易跌倒。跌倒的后果对个人和社区都很严重，对老年人的健康产生负面影响。潜在的后果包括骨折、害怕摔倒、进急诊室、医院和疗养院、依赖、精神错乱、无法动弹、抑郁和死亡。可改变的跌倒危险因素包括肌肉无力、步态问题和平衡问题。虽然研究人员已经证明了预防跌倒的体育活动的积极作用，但大多数老年人仍然久坐不动，跌倒的几率继续增加。老年人参加有规律的体育活动和健身活动的频率低于年轻人；生活在农村社区的贫困老年人之间的差距更大。虽然在过去几十年里，关于预防跌倒的原因、风险因素和有效身体活动的知识呈指数级增长，但弥合研究与实践之间的差距仍然是一项挑战。作为解决研究与实践之间差距的策略，拟议的研究将利用一个经过验证的理论，即健康动机理论，来解决行为改变与体育活动指导相结合的问题。拟议的试点干预研究的目标人群包括农村社区居住的老年人，这是该领域研究不足的人群。跌倒风险（平衡）和身体活动模式的创新措施将包括具有远程灵敏度的加速度计。本初步研究的主要目的包括(a)检查健康动机干预的可接受性和可行性，以及(b)对健康动机干预的有效性进行初步测试，以增加环境资源、行为改变过程变量、身体活动的行为结果和减少跌倒风险的健康结果（增加平衡和力量）。这项拟议的研究是一个研究项目的第一步，该项目的重点是预防老年人跌倒和虚弱。

Unintentional falls among community-dwelling older adults are a common, serious and potentially preventable public health problem. In the United States, the annual incidence of fall related injuries per 100,000 persons was 4616 in 2001, rising to 5252 in 2008. The annual incidence of fall related deaths per 100,000 persons was 29.3 in 2000, rising to 41.86 in 2006. Older adults are particularly vulnerable to falls as they age. The consequences of falls are significant to both individuals and communities exerting a negative impact on the health of older adult populations. Potential consequences include fractures, fear of falling, emergency room, hospital and nursing home admissions, dependence, confusion, immobilization, depression, and death. Significant modifiable fall risk factors include muscle weakness, gait problems, and balance problems. While researchers have demonstrated the positive effects of fall preventive physical activity, the majority of older adults remain sedentary and the rate of falls continues to increase. Older adults participate in regular physical activity and fitness activities less often than younger populations; disparities are greater among older adults who are poor and living in rural communities. While knowledge about causes, risk factors, and efficacious physical activity to prevent falls has grown exponentially in the last several decades, bridging the gap between research and practice continues to be a challenge. As a strategy to address the gap between research and practice, the proposed study will utilize a tested theory, the wellness motivation theory, to address behavioral change in combination with instruction for physical activity. The target population of the proposed pilot intervention study includes rural community dwelling older adults, an understudied population in this field. Innovative measures of fall risk (balance) and physical activity patterning will include an accelerometer with remote sensitivity. Primary aims of the proposed pilot study include (a) examining acceptability and feasibility of the wellness motivation intervention, and (b) pilot testing the efficacy of the wellness motivation intervention to increase contextual resources, behavioral change process variables, the behavioral outcome of physical activity, and health outcome of fall risk reduction (increased balance and strength). The proposed study is the first step in a program of research focusing on the prevention of falls and frailty among older adults.