NR 538 Week 6 Community Input Summary Example

Community Input Summary: Fourteen Older Adults at One Senior Center Listening Session, Six From the Same Apartment Building, What They Said About Falling and Getting Help, and Who Was Not in the Room

Student Name

College of Nursing, Chamberlain University

NR 538: Population Health I: Assessment and Analysis of Data

Instructor Name

Month Day, Year

Community Input Summary: Fourteen Older Adults at One Senior Center Listening Session, Six From the Same Apartment Building, What They Said About Falling and Getting Help, and Who Was Not in the Room

The Session

As part of the county's assessment of serious fall risk among older adults, the health department held a listening session at the senior center in the county seat on a weekday morning in March. The time and place were chosen with the senior center's director. The session was advertised in the senior center newsletter, on the local radio station and through the Area Agency on Aging's meal delivery drivers. Fourteen older adults attended, aged 67 to 91. Six lived in the same senior apartment building two blocks from the center. Nine were women. All spoke English. Twelve drove or were driven by family; two walked from the apartment building. A county public health nurse facilitated, and a volunteer took notes. The session lasted 75 minutes. Participants were told at the start that their names would not be recorded and that a summary would be shared with them. The facilitator used four open questions: What makes falling a worry for you or people you know? What happens when someone here falls? What would help? What gets in the way of that help?

What Was Said

Four themes came up repeatedly. They are reported with an indication of how many people raised each, because a theme raised by one person and one raised by ten carry different weight.

Fear of the floor, more than of the fall. Nine participants described fear of falling and being unable to get up, often more than fear of injury. Three knew someone who had lain on the floor for hours. One participant who lives alone said the phone stays in a pocket at all times "because the floor is where you die out here."

Reluctance to call the ambulance. Seven participants said they or people they knew had delayed calling for help after a fall because they did not want to "make a fuss," feared being taken to the hospital or worried about the cost. Two said that when the crew came, they were helped up kindly and nobody followed up afterward.

Winter and outdoor falls. Six participants, all of whom lived in houses rather than the apartment building, described falls on icy steps, in barns or while carrying firewood. None of the apartment residents raised outdoor falls, which reflects where they live.

Wanting something to happen after a fall. Eight participants said that the missing step was what happened after a fall: a visit, a phone call or someone checking the house. Several mentioned an exercise class that had been offered at the center until its instructor retired two years ago.

Who Was in the Room, and Who Was Not

The session's participants were mobile enough to reach the center on a weekday morning, English-speaking and connected to the center or its newsletter. Six of fourteen came from one building, so its residents' experience, indoor living with an elevator and neighbors nearby, is overrepresented. Several groups likely at high risk were absent. Homebound older adults could not attend by definition. Men living alone on farms, who make up a noticeable share of the county's lift-assist calls, were represented by one participant. Older adults in the county's small Spanish-speaking community, mostly parents of dairy workers, were not reached by the advertising. Residents of the two assisted living facilities were not invited, since their falls are managed by staff.

Community engagement guidance emphasizes that who participates shapes what is heard and that engagement should be designed to reach those least likely to come to a public meeting (Wallerstein et al., 2018). This session reached the most connected older adults. Its findings are real but partial, and this summary tries to say which parts of the county they describe. It would be easy to present fourteen voices as the voice of the county's older adults, particularly when their concerns fit the data. The fit is encouraging, but it does not make the participants representative, and the groups that were missing are the ones whose experience the data also capture least well.

How Far the Findings Can Be Carried

The themes can be carried to connected, mobile older adults in and near the county seat, and they are consistent with the county's data. The reluctance to call the ambulance fits the pattern of lift-assist callers who call only after repeated falls. The wish for follow-up after a fall points directly at a gap in the county's services. The fear of lying on the floor for hours is well documented among older adults living alone, and social isolation is associated with a range of poorer health outcomes in older adults (National Academies of Sciences, Engineering, and Medicine [NASEM], 2020).

The themes cannot be carried to homebound adults, to farm households or to the Spanish-speaking community without asking them. The outdoor and winter falls theme, raised only by house dwellers, suggests that the experience of more isolated rural residents differs, and they may be the group with most at stake.

Filling the Gaps

Three steps will reach the missing groups before the assessment is completed. First, with the ambulance service's agreement and each person's consent at the time of a call, a public health nurse will telephone 15 older adults who recently had a lift-assist call, including farm residents, and ask the same four questions. Second, the Area Agency on Aging's meal delivery drivers, who see homebound older adults daily, will be interviewed as a group about the falls they see. Third, a bilingual community health worker will hold a small conversation with Spanish-speaking older adults at the church where many families gather on Sundays.

Using the Input

The input changes the assessment in two ways. It adds a need the data could not show clearly: nothing happens after a fall that does not lead to hospitalization. And it adds a barrier the data could not show at all: reluctance to call for help. Both will be carried into the priority ranking of needs. The summary, with its limits, will be shared with participants and with the senior center, so that the people who gave their time can see what was done with what they said.

References

National Academies of Sciences, Engineering, and Medicine. (2020). Social isolation and loneliness in older adults: Opportunities for the health care system. The National Academies Press. https://doi.org/10.17226/25663

Wallerstein, N., Duran, B., Oetzel, J. G., & Minkler, M. (Eds.). (2018). Community-based participatory research for health: Advancing social and health equity (3rd ed.). Jossey-Bass.