title: Health indicators associated with falls among middle-aged and older women enrolled in an evidence-based program.
abstract: BACKGROUND
  Evidence-based fall prevention programs primarily attract older women, who are increasingly burdened by fall-related injuries. However, little is known about the relationship between older female participants' baseline health status and self-reported falls over the course of fall prevention interventions. Using data from A Matter of Balance/Volunteer Lay Leader Model (AMOB/VLL) workshops, this study examines female participants' sociodemographics and health indicators associated with self-reported falls at baseline and postintervention.
  
  
  METHODS
  Data were analyzed from 837 older women (M = 76.2 years) collected during the statewide AMOB/VLL dissemination in Texas. Longitudinal Poisson regression models, using the generalized estimating equation method, were used to investigate the associations of personal characteristics and health indicators with and reductions in the number of self-reported falls from baseline to postintervention.
  
  
  RESULTS
  Approximately 21% of participants reported falling at baseline, and the number of reported falls significantly decreased from baseline to postintervention (β = -0.443). At baseline, more unhealthy physical days (β = 0.022), more unhealthy mental days (β = 0.018), and lower Falls Efficacy Scale scores (β = -0.052) were significantly associated with more falls reported at baseline. More falls at baseline was also associated with worse program attendance (β = -0.069). Greater improvements in Falls Efficacy Scale Scores (β = -0.069) and decreases in unhealthy physical health days (β = 0.026) over the course of the intervention were significantly associated with greater reductions in reported falls at postintervention, respectively.
  
  
  CONCLUSIONS
  Findings have implications for identifying at-risk older women upon enrollment, expanding the reach of AMOB/VLL, and leveraging AMOB/VLL to refer participants to other evidence-based exercise, disease management, and mental health interventions.
authors.affiliation: Department of Health Promotion and Behavior, The University of Georgia College of Public Health, Athens, Georgia. Electronic address: health@uga.edu.
authors.forename: Matthew Lee
authors.initials: ML
authors.lastname: Smith
authors.affiliation: Department of Epidemiology and Biostatistics, Texas A&M Health Science Center School of Public Health, College Station, Texas.
authors.forename: Luohua
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Health Promotion and Behavior, The University of Georgia College of Public Health, Athens, Georgia.
authors.forename: Lindsay P
authors.initials: LP
authors.lastname: Prizer
authors.affiliation: Division of Health Systems Management and Policy, The University of Memphis School of Public Health, Memphis, Tennessee.
authors.forename: SangNam
authors.initials: S
authors.lastname: Ahn
authors.affiliation: Department of Statistics, Texas A&M University, College Station, Texas.
authors.forename: Shuai
authors.initials: S
authors.lastname: Chen
authors.affiliation: Baylor Scott & White Health, Texas A&M Health Science Center School of Public Health, College Station, Texas.
authors.forename: Jinmyoung
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Health Promotion and Behavior, The University of Georgia College of Public Health, Athens, Georgia.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Graham
authors.affiliation: Texas A&M Health Science Center School of Public Health, College Station, Texas.
authors.forename: Marcia G
authors.initials: MG
authors.lastname: Ory
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D004856:Postural Balance; D015397:Program Evaluation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D057566:Self Report; D011795:Surveys and Questionnaires; D013781:Texas