As of October 1, 2009, a total of 3,092 unique participants were recruited throughout Texas. These participants averaged 77 years of age (15% were aged ≥85); most were women (83%) and were high school graduates (82%). A high proportion of disadvantaged seniors enrolled in the programs (30% were from a racial/ethnic minority group and 40% had incomes ≤$15,000/y). Of the 3,092 participants, 87% had baseline data, 56% had postintervention data, and 51% had both.
Before assessing program effects, we conducted a bivariate analysis to examine the potential existence of significant differences between those participants who had baseline data only versus those with both baseline and postintervention data. A few differences emerged. More participants who had complete data at both time periods, and thus were included in the multivariate analysis, were non-Hispanic white (73% vs 64%), had attended college (58% vs 50%), and reported fewer unhealthy days (4.8 vs 5.9).
The Texas Association of Area Agencies on Aging sponsored 4 centralized master trainings. All participating sites were encouraged to send people in their AAA region to become certified, making them eligible to train lay leaders at their local site. As a large state with a commitment to preventing falls for seniors, Texas now has more trainers than any other state delivering AMOB/VLL. Of the 98 people trained as master trainers, 83 were still actively training. Of the 402 people trained to be lay leaders, 278 were still active. Given these data, the Texas Falls Prevention Coalition leaders recognized lay leader attrition as a problem. Local AAA sites now give more attention to recruitment and retention planning; their goal is to achieve higher retention of volunteer lay leaders and provide support services more efficiently.
As of October 1, 2009, 227 AMOB/VLL classes had been delivered at 146 unique sites. The most frequent implementation sites were senior centers (77 classes) and residential facilities (63 classes). Other sites included faith-based organizations (23 classes), health care organizations (12 classes), and workplaces (7 classes). Programs retained most participants: 76% of class participants completed at least 5 of 8 sessions. The average class size was 15 participants, which was larger than the ideal class size of 8 to 12 participants.
Twenty-six of the 28 AAAs contracted with the Texas Association of Area Agencies on Aging to deliver the AMOB/VLL program, for a potential reach of 236 of 254 Texas counties (). Each participating AAA agreed to hold a minimum of 6 classes, resulting in approximately 100 participants each. Through this infrastructure, AAAs conducted 227 classes in the 2-year timeframe or an average of nearly 9 classes for the participating AAAs. However, we noted substantial variation in the number of classes delivered; the highest-yield AAA site conducted 31 classes, and 5 sites offered no classes. Although the intent was to expand the program statewide, we found a clustering of programs in more populated areas of the state and limited penetration in the least populated areas.
Figure 1 Geographic reach of A Matter of Balance/Volunteer Lay Leader model in Texas. This map illustrates the sequential uptake of Area Agencies on Aging in the delivery of A Matter of Balance/Volunteer Lay Leader model during the 2 years (2007-2009) of this (more ...)
|For the delivery of A Matter of Balance/Volunteer Lay Leader model at Area Agency on Aging (AAA) sites, the number of participants in each region were 219 for Alamo, 248 for Bexar County, 205 for Brazos Valley, 98 for Capital, 163 for Central Texas, 323 for Coastal Bend, 0 for Concho Valley, 62 for Dallas County, 0 for Deep East Texas, 7 for East Texas, 33 for Golden Crescent, 0 for Harris County, 95 for Heart of Texas, 1 for Houston-Galveston, 158 for Lower Rio Grande Valley, 296 for North Central Texas, 35 for North Texas, 21 for Panhandle, 0 for Permian Basin, 29 for Rio Grande, 0 for South East Texas, 8 for South Plains, 3 for South Texas, 91 for TEXOMA, 205 for Tarrant County, and 48 for West Central Texas.|
|For year 1, sites existed in most AAA regions. In addition to those sites, the Pan Handle, Concho Valley, Golden Crescent, South Plains, South Texas, Tarrant County, and TEXOMA regions were added in year 2. Classes were not offered in ARK-TEX or Middle Rio Grande regions.|
Results were uniformly positive for AMOB/VLL participants (). Adjusted for key covariates (age, sex, race/ethnicity, self-assessed health), these multivariate analyses show strong effects of the intervention on falls efficacy. Other outcome variables showed more modest effects, including number of days physically active and reductions in health interference. An effect was found for physically unhealthy days but not for mentally unhealthy days.
Effectiveness of A Matter of Balance/Volunteer Lay Leader Fall-Prevention Program, Texas, 2007-2009