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You are here: Home Modules Main Case Examples The Fall Prevention and the Elderly Program A socio-ecological assessment of fall prevention
A socio-ecological assessment of fall prevention Print E-mail

When decisions were being made about whether to deal with this particular health concern (falls prevention and the elderly), and whether or not to apply a MIP approach to it, the Public Health Unit and its research partners considered the following issues:

A socio-ecological assessment of fall prevention: What we did and should have done

Ontario Public Health PractionersInitially we took an epidemiological and behavioural approach to falls prevention. We were interested in both intrinsic and extrinsic risk factors for falls, but the dominant literature focused on day-to-day extrinsic factors (Moyer, Aminzadeh, and Edwards, 1997; Srinivasan, O’Fallon, and Dearry, 2003) such as tripping hazards and stairs without handrails . The use of home-hazard checklists was encouraged to identify such risks. There was only a handful of studies describing the link between falls and more remote environmental determinants, such as housing and building code policies (Lockett, Willis, and Edwards, in review; Saegert et al., 2003).

Qualitative studies (Edwards, 2000) conducted by our team early in our work included focus groups and in-depth interviews. Looking back, participants hinted at more distant influences on falls but our semi-structured interview schedules focused on more immediate risk factors. Rather than exploring relationships among risk factors at different levels of the system, we focused on the fall and seniors’ perceptions of their risk of falling. A socio-ecological systems perspective might have led us to uncover the breadth of organizational and policy influences on behaviour change and led us to discuss with stakeholders such as public housing authorities, landlords and the Federation of Landlords and Tenants how housing regulations affect environmental hazards and the risk of falls.

Some of our initial studies documented interventions that used two community action strategies. One was recruiting, training and supporting community organizers (Edwards and Aminzadeh, 1998; Edwards et al., 1995) the other was setting up a regional fall-prevention coalition (Moyer et al., 1997). Subsequent analysis of data from those studies have shown us a wide range of influences on falls and risky behaviour. Seniors told us their landlords wouldn’t let them install grab bars in their bathtubs, because of rental policies that did not permit modifications to the building. Building owners claimed the installation of grab bars would reduce property values because they’re viewed as equipment for the disabled. These anecdotes uncovered a need for changes to municipal housing policy. They also showed us the importance of shifting the perception of grab bars as a marker of declining independence to them being an everyday essential safety feature that should installed in all homes for use by all ages.

Thus, our early work conceptualized falls prevention as something influenced by immediate risk factors and that’s what we aimed to change. We gave little thought to the need to change other levels of the system, such as organizations and policies. We didn’t target housing authorities or the owners of apartment buildings to modify their buildings, nor did we examine the role of provincial building codes. Understanding and tackling those levels of the socio-ecological system is a more prominent feature of our recent research. Essentially, we’ve turned the problem upside down and are looking for ways to modify the environment to support behavioural choices such as increasing physical activity (stronger seniors are less likely to fall). To do that, we’re working with new partners such as the Canadian Standards Association, Canada Mortgage and Housing Corporation and the National Research Council and with researchers with expertise in areas such as biomedical and civil engineering and architecture.

Last Updated on Monday, 01 June 2009 07:55