Date of Graduation

Summer 8-13-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Sara Horton-Deutsch



Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk.

Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also reduces resource utilization at the acute care hospital microsystem of care level, reduces organizational operating costs and optimizes trauma patient flow from a broader, systems-based approach.

Intervention: This project improved the screening, referral, and enrollment of at-risk community-dwelling older adults into an evidence-based fall prevention program from a baseline of zero persons to ten persons per month by August 2021. The project occurred in three phases; (1) adult family medicine physician (AFMP) training and education on the existence of a quality gap, (2) AFMP education and training to address upstream, pre-fall determinants of health in older persons using the Centers for Disease Control and Prevention's Stop Elderly Accidents, Deaths and Injuries (STEADI) Fall Risk Factors Checklist (2020), and (3) enrollment of the target population into an online fall prevention program, A Matter of Balance (AMOB), in the Spring of 2021.

Measures: Process measures included self-reported or observed improvement in participants health status, fall-related confidence, or functional ability. Outcome measures included the percent of persons aged 60 years and older screened and referred by AFMP’s. Balancing measures included; (1) the percent of health plan members in the target population that had an eye exam in the last two years, and (2) fall prevention trainer fidelity to the AMOB program curriculum.

Results: This project saw a 65% attrition rate prior to program commencement secondary to technology limitations of participants. The remaining participant's self-reported and observed health status, fall-related confidence, and functional ability were evaluated at baseline and completion of the virtual program. At AMOB conclusion, 100% of participants reported a decreased fear of falling, 97.5% made environmental hazard reduction changes, 99.5% increased their physical activity and planned to continue exercising, and 100% would recommend the program to other older adults.

Conclusion: Reducing falls will improve upstream determinants of health, reduce resource utilization at the hospital microsystem of care level, reduce hospital operational costs, and optimize trauma patient flow from a broader, systems-based approach.

Keywords: Aging, exercise, fall prevention, falls, injury prevention, older adults