Decreasing Risk of Falls through Community-Based Interventions
My research focuses on falls and mobility impairment among geriatric patients. This research began with studies on risk factors for falls, progressed to looking at interventions to prevent falls, and most recently to dissemination research on how to effectively implement, disseminate, and sustain evidence-based falls prevention program. Collectively, my research provides comprehensive analysis regarding assessments, interventions, and sustainable programs to prevent a geriatric syndrome that is responsible for high morbidity and mortality and substantial health care costs.
Working with the State of Wisconsin Dept. of Health and Family Services, Injury Prevention Section, we developed a clinically-based falls prevention tool that could be applied in the community setting by a trained health professional. The algorithm incorporated the clinical decision-making of the UW Falls Prevention Clinic. We found in a randomized, controlled trial that this intervention, called Sure Step, reduced nursing home days for older adults at high risk for falls, and in a subset with lower Mini-Mental State Examination scores, it reduced falls as well. This was due to having a caregiver in the home, who helped to carry out the recommendations of the health professional.
Our research in falls prevention has led us to take the approach of targeting different interventions to different subgroups. For example, our referral-based multifactorial intervention, Sure Step, is effective for cognitively-impaired older adults at risk for falls, if directed to a patient-caregiver dyad. For cognitively intact elders, a small-group multifactorial intervention program, Stepping On, out of Australia, is effective. Working with the State of Wisconsin and Wisconsin's Aging Network, we began to disseminate these programs across Wisconsin. Our experience with dissemination of Stepping On led us to formulate key questions regarding dissemination. Using a Delphi Consensus with international experts, we have identified key elements of the Stepping On program. Our dissemination research evaluated the effect of dissemination of Stepping On in rural versus urban settings, and utilizing a health professional versus a non-health professional leader. This research has shown that the program is adaptable to rural and urban settings and it is possible to maintain fidelity with non-health professional leaders. We have developed and implemented a training program for Stepping On that is now being used nationally.
A key interest nationally is the role of cognition in falls risk. We have identified that among older adults with a history of falls, falls risk increases with each unit decrease in MMSE. In addition, we have identified that the falls risk associated with cognitive impairment is mediated in part by risky behaviors, in particular by engagement in ADLs and IADLs in ways that are risky. Thus, increased risk-taking behavior in part explains the association between cognitive dysfunction and falls.
My current work includes development and testing of a cultural and linguistic translation of Stepping On for Latino seniors, and development of an online falls prevention intervention, in collaboration with colleagues in Industrial Engineering. In addition, my work with the Aging Network led me to create the Community-Academic Aging Research Network (CAARN). Funded by the NIH, CAARN helps researchers from across the University of Wisconsin to connect with community partners in Wisconsin's counties, to develop and test new community-based interventions to improve the health and independence of older adults.
Kramer, B. J., Cleary, J., & Mahoney, J. (In Press). Enhancing palliative care for low-income elders with chronic disease: Feasibility of a hospice consultation model. Journal of Social Work in End-of-life and Palliative Care.
Fischer, B. L., Gleason, C. E., Gangnon, R. E., Janczewski, J., Shea, T., & Mahoney, J. E. (2014). Declining cognition and falls: Role of risky performance of everyday mobility activities. Physical Therapy. Advance online publication.
View publication via DOI: DOI:10.2522.ptj.20130195
Clemson, L., Swann, M., & Mahoney, J. (2011). Stepping On: Building Confidence and Reducing Falls in Older Adults (Leader Manual, 3rd North American Edition). Cedar Falls, Iowa: Freiburg Press Inc.
Mahoney, J.E. (2010). Why multifactorial fall-prevention interventions may not work: Comment on "Multifactorial intervention to reduce falls in older people at high risk of recurrent falls". Archives of Internal Medicine, 170(13), 1117-9.
View publication via DOI: DOI:10.1001/archinternmed.2010.193
Schmitz, A., Silder, A., Heiderscheit, B.C., Mahoney, J., & Thelen, D.G. (2009). Differences in lower extremity muscular activation during walking between healthy older and young adults. Journal of Electromyography and Kinesiology, 19, 1085-1091.
View publication via DOI: DOI:10.1016/j.jelekin.2008.10.008
Kiehn, K., Mahoney, J., Jones, A.N., & Hansen, K.E. (2009). Vitamin D supplement intake in elderly fallers. Journal of the American Geriatrics Society, 57(1), 176-177.
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View publication via DOI: DOI:10.1111/j.1532-5415.2009.02065.x
Gleason, C., Gangnon, R., Fischer, B., & Mahoney, J. (2009). Increased risk for falling associated with subtle cognitive impairment: Secondary analysis of a randomized clinical trial. Dementia and Geriatric Cognitive Disorders, 27(6), 557-563.
View publication via DOI: DOI:10.1159/000228257
Hook, M.L., Heidrich, S.M., & Mahoney, J.E. (2008). Beliefs about fall risk and fall prevention behavior in high-risk community dwelling older adults. Paper presented at the National State of the Science Conferences, Washington, DC, October, 2008.
Hook, M.L., Mahoney, J.E., & Heidrich, S.M. (2007). Exploring relationship between risk representation, prevention, and falling in high risk elders using the Common Sense Model. Poster presented at the 60th Annual Scientific Meeting of the Gerontological Society of America, San Francisco, CA.
Mahoney, J.E., Shea, T.A., Przybelski, R., Jaros, L., Gangnon, R., Cech, S., & Schwalbe, A. (2007). Kenosha County falls prevention study: a randomized, controlled trial of an intermediate-intensity, community-based multifactorial falls intervention. J. Am. Geriatr. Soc., 55(4), 489-98.
View publication via DOI: DOI:10.1111/j.1532-5415.2007.01144.x
Mahoney, J.E., Glysch, R.L., Guilfoyle, S.M., Hale, L.J., & Katcher, M.L. (2005). Trends, risk factors, and prevention of falls in older adults in Wisconsin. W.M.J., 104(1), 22-8.
Elliott, M.E., Drinka, P.J., Krause, P., Binkley, N.C., & Mahoney, J.E. (2004). Osteoporosis assessment strategies for male nursing home residents. Maturitas, 48, 225-233.
View publication via DOI: DOI:10.1016/j.maturitas.2003.11.005
Callen, B.L., Mahoney, J.E., Grieves, C.B., Wells, T.J., & Enloe, M. (2004). Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatr. Nurs., 25(4), 212-7.
View publication via DOI: DOI:10.1016/j.gerinurse.2004.06.016
Callen, B.L., Mahoney, J.E., Wells, T.J., Enloe, M., & Hughes, S. (2004). Admission and discharge mobility of frail hospitalized older adults. Medsurg. Nurs., 13(3), 156-63, quiz 164.
Gunter-Hunt, G., Mahoney, J.E., & Sieger, C.E. (2002). A comparison of state advance directive documents. The Gerontologist, 42, 51-60.
View publication via DOI: DOI:10.1093/geront/42.1.51
Gray, S.L., Mahoney, J., Blough, T. (2001). Medication compliance in elderly patients receiving home health services following hospital discharge. Ann. Pharmacother., 35, 539-45.
View publication via DOI: DOI:10.1345/aph.10295
Elliott, M.E., Drinka, P.J., Krause, P., Mahoney, J.E., & Binkley, N.C. (2001). Osteoporosis in institutionalized male veterans: Common but under-recognized. J. Bone Miner. Res., 16(Suppl 1), M349.
Gray, S.L., Hisrich, M., & Mahoney, J. (2000). Psychotropic medication use in older patients referred for evaluation of falls. Ann. Pharmacother., 34, 265.
View publication via DOI: DOI:10.1345/aph.19011
Mahoney, J.E., Eisner, J., Havighurst, T., Gray, S., & Palta, M. (2000). Problems of older adults living alone after hospitalization. J. Gen. Int. Med., 15, 611-19.
View publication via DOI: DOI:10.1046/j.1525-1497.2000.06139.x
Mahoney, J. (2000). Improving recovery of function after hospitalization. J. Am. Geriatr. Soc., 48, 1730-31.
Mahoney, J.E, Sager, M.A., & Jalaluddin, M. (1999). Use of an ambulation assistive device predicts functional decline associated with hospitalization. J. Gerontology Medical Sciences, 54A, M83-M88.
View publication via DOI: DOI:10.1093/gerona/54.2.M83
Hansen, K., Mahoney, J., & Palta, M. (1999). Risk factors for lack of recovery of ADL independence after hospital discharge. J. Am. Geriatr. Soc., 47, 360-365.
Gray, S.L., Mahoney, J., & Blough, D. (1999). Adverse drug events in elderly patients receiving home health services. Ann. Pharmacother., 3, 1147-1153.
Mahoney, J.E. (1999). Falls in the elderly: Office-based evaluation, prevention, and treatment. Cleveland Clinic Journal of Medicine, 66, 181-189.
Mahoney, J.E. (1999). Gender differences in hallway ambulation by older adults hospitalized for medical illness. Wisc. Med. J., 8, 40-43.
Mahoney, J.E. (1998). Immobility and falls. Clinics in Geriatric Medicine, 14(4), 699-726.
Mahoney, J.E., Sager, M.A., & Jalaluddin, M. (1998). New walking dependence associated with hospitalization for acute medical illness: Incidence and significance. J. Gerontology Medical Sciences, 53A, M307-312.
View publication via DOI: DOI:10.1093/gerona/53A.4.M307
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