DNP 740 Week 5 Levels of Prevention and Health Promotion Example

A Whole-County Strategy and a High-Risk Strategy for Falls: Primary, Secondary and Tertiary Prevention for Older Adults, Framed as Staying Strong Rather Than Avoiding Falls

[Student Name]

University of Phoenix

DNP/740: Clinical Prevention and Population Health

Week 5 Assignment

[Instructor Name]

[Date]

The county and figures are composites written for a model paper.

Over the past four weeks I defined our county's 8,200 community-dwelling adults aged 65 and older as my population, built a profile showing more than 600 fall-related ambulance calls a year, traced the concentration of those calls in two remote townships to housing, income, distance and isolation, and designed a screening and surveillance plan. This paper asks where prevention effort belongs. It sorts the options into primary, secondary and tertiary prevention, argues for a mix weighted toward the whole older population, and proposes health promotion messages that older adults in our county are likely to accept.

Two Strategies for One Population

Rose (1985) observed that when many people carry a modest risk they can generate more cases than the few people whose risk is very high, because the large number of people at modest risk contributes most of the total. He called this the difference between treating sick individuals and changing the conditions of a sick population, and he noted the cost of the population strategy: each person gains little, so individuals may see little reason to take part. Falls fit his pattern. In our profile, adults 85 and older had the highest rate of ambulance calls, yet adults aged 65 to 84 made more calls in total because there are four times as many of them. Screening only residents over 85 would leave most of the county's falls untouched.

Ranking Options by Reach

Frieden (2010) arranged public health interventions in a five-tier pyramid. At the base are changes in socioeconomic conditions, then changes to the context that make the healthy choice the default, then long-lasting protective interventions, then clinical care, and at the top counseling and education. Interventions near the base reach more people and demand less individual effort, while those near the top depend on each person acting on advice. Most fall prevention in our county now sits at the top of the pyramid, as leaflets in the clinic waiting room and a talk at the senior center once a year. The pyramid suggests that clearing winter paths, fixing stair rails and bringing classes to where people already gather will reach more residents than advice alone.

Primary Prevention

Primary prevention stops falls before they happen among people who have not been injured. Its core offer is exercise. Sherrington et al. (2019) pooled 108 randomized trials with more than 23,000 community-dwelling older adults and found a 23% lower rate of falls with exercise, rated as high-certainty evidence; programs built mainly on balance and functional exercises showed the clearest effect, and tai chi may also help. Because the benefit holds for people at ordinary risk, exercise can be offered countywide rather than rationed to those who screen positive. Our primary offer therefore includes weekly balance and strength classes in the county seat and in both townships, a home exercise option for residents who cannot travel, and volunteer-led walking groups in good weather.

Primary prevention also includes changes to the environment that make falls less likely for everyone. The county road crew can add township church lots and the post office steps to the winter sanding route. The volunteer fire department has offered to install stair rails, grab bars and outdoor lights in homes where owners cannot afford them, following the home modification approach described in our determinants paper. Pharmacists at the two county pharmacies can flag new prescriptions for sedatives in customers over 65, which reaches people before any fall occurs. None of these depends on a clinician visit, which matters in townships where many residents have not seen one in over a year.

Secondary Prevention

Secondary prevention finds people whose risk is already raised, or who have fallen without serious injury, and intervenes early. The screening plan from last week sits here. A positive answer to one of the three screening questions leads to a gait and balance check and, when risk is confirmed, a multifactorial assessment covering medications, vision, feet, footwear, blood pressure on standing and the home. Ganz and Latham (2020) recommend that clinicians focus such assessment on people who have fallen or who have gait and balance problems, and pair it with exercise and medication review. Lift-assist calls, in which crews help an uninjured person off the floor, are among our clearest signals of raised risk, so each will trigger a referral with the resident's consent.

Tertiary Prevention

Tertiary prevention limits the harm of a fall that has already caused injury and prevents the next one. After a hip fracture, the priorities are rehabilitation, a review of bone health and a plan for the return home. Our profile showed 29 hip fracture admissions a year, and discharge planners at the regional hospital will now send a notice to the clinic's fall prevention nurse, who calls within a week and schedules a home visit within 30 days. A second tertiary aim is preventing long lies, in which a person who cannot get up waits hours for help. For residents living alone, the area agency on aging will add a daily check-in call, and the meal program drivers will report any client who does not answer the door.

Where the Weight Should Fall

Given Rose's argument and the Cochrane evidence, I propose that about half of the program's staff time go to primary prevention, mainly classes and home repairs, a third to secondary prevention and the remainder to tertiary follow-up. This weighting reverses the county's current pattern, in which nearly all effort begins after an ambulance call. It also serves equity: the primary offer is placed deliberately in the townships where calls are concentrated, rather than in the county seat where attendance would be easiest.

Health Promotion Messages

How the program is described will shape who takes part. Yardley et al. (2006) held focus groups and interviews with 66 older adults and found that most understood fall prevention as removing hazards, using walking aids and doing less. Only one participant knew that exercise could lower fall risk. Many saw fall advice as common sense, relevant only to people older or frailer than themselves, and even patronizing. The authors suggested messages about the positive benefits of better balance. Our materials will therefore speak of staying strong, keeping your balance and keeping your independence, and will avoid the word "faller." Class names will follow the same logic: the township sessions will be called Strong and Steady rather than fall prevention.

Messages will come from trusted sources. In the townships, that means the pastors, the fire chief and neighbors who have taken the classes, not only clinic posters. Printed material will be written at a sixth-grade reading level, use large type and include photographs of local residents. Short spots on the county radio station before the winter months will remind listeners about free rail installation and the class schedule. Because many residents doubt that falls are preventable, each message will include one concrete benefit, such as being able to carry groceries up the porch steps.

Measuring Each Level

Each level will have its own measures so progress is visible. For primary prevention, the program will count class enrollment by township, homes modified and path sites added to the sanding route. For secondary prevention, it will track the share of positive screens completing a gait check and multifactorial assessment. For tertiary prevention, it will record the share of hip fracture patients seen at home within 30 days and the number of long lies reported by ambulance crews. These measures feed the evaluation plan in the final week.

Conclusion

Falls in our county are common across the whole older population, not only among the oldest, so a strategy that reaches everyone will prevent more of them than one that waits for a positive screen. Exercise is the core primary offer because the evidence for it is strong, and environmental changes extend its reach. Screening and multifactorial assessment form the secondary level, and follow-up after injury forms the tertiary level. Messages about strength and independence, carried by trusted local voices, will decide whether residents take part. Next week I will select the specific evidence-based programs that will deliver these levels.

References

Frieden, T. R. (2010). A framework for public health action: The health impact pyramid. American Journal of Public Health, 100(4), 590-595. https://doi.org/10.2105/AJPH.2009.185652

Ganz, D. A., & Latham, N. K. (2020). Prevention of falls in community-dwelling older adults. New England Journal of Medicine, 382(8), 734-743. https://doi.org/10.1056/NEJMcp1903252

Rose, G. (1985). Sick individuals and sick populations. International Journal of Epidemiology, 14(1), 32-38. https://doi.org/10.1093/ije/14.1.32

Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2019(1), Article CD012424. https://doi.org/10.1002/14651858.CD012424.pub2

Yardley, L., Donovan-Hall, M., Francis, K., & Todd, C. (2006). Older people's views of advice about falls prevention: A qualitative study. Health Education Research, 21(4), 508-517. https://doi.org/10.1093/her/cyh077