About Linda Bowers
What is PrimeTime Health?
It's a program administered through the Pennsylvania Area Agencies on Aging whose mission is to help older adults learn and maintain good health habits.
What led PrimeTime Health to focus on fall prevention?
In 1996, the Pennsylvania Department of Aging sent surveys to Area Agencies on Aging across the state asking PrimeTime Health Coordinators to identify what they saw as the most pressing-and unaddressed-health problem among older adults. The responses overwhelmingly ranked falls and the need for fall prevention and screening as the top concern. So we set about developing a quality fall prevention program.
How did the FRIENDS program develop?
In 1997, the PrimeTime Health Program partnered with KePRO (which was then the Medicare Quality Review Organization for Commonwealth of Pennsylvania) to convene a statewide Fall Prevention Task Force. The Task Force established six work groups, each of which focused on a component of a program that became the Fall Risk Initiative: Establishing New Directions for Safety (FRIENDS).
Who was involved?
A total of 30 different organizations served on the Task Force. In particular, Judy Karoullas of KePRO was instrumental in designing the bulk of the manual.
What are the goals of the program?
Our long-range goal is to promote fall prevention through screening and education. The program was designed to help older adults become aware of their risk of falling, and to take an active role in decreasing their risk by learning about and taking advantage of available community resources.
A related goal was to help older adults-and the organizations that serve them-realize that it's never too late for older adults to make meaningful lifestyle changes to lessen the danger of falls.
What are the essential components?
The Department of Aging supplies FRIENDS packages to organizations that were interested in holding a fall risk screening. Organizations publicize and prepare for the sessions, carry out the screenings, and provide counseling and referrals. Three months later, participants receive a follow-up brochure, which includes a postcard that they are to send to the Department of Aging. This postcard gives the Department information on what steps the individual has taken to decrease their fall risk.
What does the package consist of?
The centerpiece is the 23-page program manual, which includes background on fall prevention and the danger of falls, as well as detailed instructions for carrying out the screenings and participant education. Another important component is a series of large-print educational handouts on fall-related topics.
What does the screening consist of?
There are two main components: upon arriving at the site, participants complete a screening form consisting of 10 yes/no questions about fall risks (such as dizziness, incontinence, medications).
The second part is a test of three skills to check balance and: "Timed Get Up and Go," "Reach Test" and "One Leg Stand." (For more about these tests, see the Program Manual.) Participants receive their results on the spot, and those who rate medium or high risk are given a copy of the results to take to their health care provider.
How about the educational component?
Participants are provided with informative materials related to their particular risk factors. [Click here to view the collection of handouts.] At this time, screeners can also make referrals to resources in the community, such as exercise programs, Alcoholics Anonymous, incontinence treatment programs, etc. It's important to have a thorough list of resources at hand, to motivate participants on the spot as they receive their results.
What is the follow-up procedure?
As participants fill out their screening questionnaire, they self-address a brochure with detachable postcard. After three months, the brochures are mailed out, requesting that participants report lifestyle changes and steps taken since the screening session-a short series of questions about whether they have spoken to a doctor about their risk level; started an exercise program; had their eyes checked, and so forth. The results from a particular site are also provided to the hosts, to allow them to focus on the specific risk factors of their target population in subsequent educational events.
How was the response to the postcard mailing?
Very good-44% of participants returned the cards, which is higher than we predicted. The response to date has been very successful.
What kind of orientation and training did you develop for the volunteers?
Site coordinators are provided with the manual, which walks them through the program step by step, from planning to follow-up. All volunteers receive instructional materials in advance. They attend at least one meeting before the day of the event, at which time they are briefed on the basics of the issue of falls among older adults, and are given full instructions on conducting the screening.
What types of organizations choose to host a screening session?
Screenings are held at senior centers, senior housing facilities, hospitals, doctors' offices and other community organizations, as part of their outreach mission. Health fairs and Senior EXPOs also turned out to be good venues.
How did you promote the program?
One advantage of partnering with other organizations when you establish the program in your area is that you then already have a built-in group who will use and promote the program-that's a good start. Individual sites use posters and flyers, distributed at senior centers, grocery and drug stores, libraries, worship places, etc. The manual also contains sample press releases and a sample promotional poster.
Were you successful in using volunteers?
Yes. Of course, the organizations that held the sessions provided many of the screeners--nurses, physical therapists, physician's office and home health staff. But you don't need a medical background to administer the tests-as long as an individual can operate a stopwatch, he or she can do them.
What's the biggest challenge in using volunteer screeners?
Probably the paperwork! Site coordinators must follow the correct procedures so that we end up with usable data--for example, little but vital steps like filling in the identifying information on the screening forms. Following safety measures is also very important-for example, to have a spotter at all times during the testing. So far, we have not had any reports of falling or injuries during the screening process.
Did any other unexpected challenges come up?
We distributed a set of fall-prevention and strengthening exercises-but found that these can be difficult to do alone, because of the need to read and follow the steps at the same time. Giving a reference to an exercise program is more effective. In particular, we referred at risk persons to our PEPPI Program.
What's PEPPI?
The Peer Exercise Program Promotes Independence (PEPPI) is another program of the Pennsylvania Department of Aging and partners. PEPPI established exercise programs in community locations such as senior centers, fitness centers and senior housing facilities. One unique feature of PEPPI is that older volunteers lead classes. Sessions include weight resistance/strength training, walking and educational programming-all designed with the needs of older adults in mind.
Can you give us a quick rundown on the data you collected?
Pennsylvania State University's Statistical Consulting Center handles the data entry from both the screening forms and the follow-up postcards. According to FRIENDS data collected from 10,473 participants at 423 screening sites as of December 31, 2002, 3.7% of individuals were classified as "high" risk, 45% as "moderate" risk, and 52% as "lower" risk. Of the screened participants, the most frequently reported risk factor was the use of prescription and non-prescription medications (86%). Other highly reported risk factors included feelings of unsteadiness while standing and walking (58%), and the need to rush to the bathroom (57%).
Of all participants who provided follow up, 86% took at least one preventative action as a result of the screening. The most commonly reported preventative actions taken were having eyes checked (57%), regularly exercising (56%), and discussing medications with a physician (51%).
A Summary Report of data collected from January 1998 through December 2002 is available upon request from The Pennsylvania State University Statistical Consulting Center at scc@stat.psu.edu
If an organization wants to adopt the FRIENDS program in their community, what's the procedure?
If you would like to examine the materials, the manual and handouts are available to download here on this site. (A list of other necessary materials is in the manual.) We do ask that if you reproduce the materials, you credit the Pennsylvania Department of Aging.
Can you offer suggestions for organizations who would like to set up the FRIENDS program in their state or community?
Talk to the heads of your organization-involve the major people in the aging network for your state, such as your state Department on Aging, the local Health Department, etc. If you have an active osteoporosis foundation in your area, they might also opt to participate. And it doesn't have to all come out of one agency-different organizations can contribute different pieces.
  Linda Bowers
Linda Bowers was until recently the State of Pennsylvania's PrimeTime Health Coordinator. Her accomplishments within that position include developing program objectives and guidelines, designing marketing strategy and training materials, and serving as liaison to other community resources. Under her guidance, PrimeTime Health was recognized by the National State Units on Aging as a Best Practices Program. She has also served as a Vocational Rehabilitation Specialist, Volunteer Program Administrator and Wellness Program Director for the state Department of Welfare. Bowers was the writer and editor of an employee wellness newsletter for 32,000 employees.
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