For physical therapist Jennifer Nash, fall prevention among older citizens is a passion – and so is teaching her doctor of physical therapy students.

Combining these two passions has resulted in a valuable community partnership and a productive service-learning course, leading to Nash receiving the Office of Community Engagement 2021 Service-Learning Faculty Award.

“Preventing falls is a very important issue to me, and I’m so pleased my work in this area is being acknowledged,” said Nash, an assistant professor of physical therapy. “About one in four older adults experience injury falls a year, so this is a significant problem.”

Given that approximately 400,000 Nevadans are 65 years or older, falls are not only a prevalent issue but also a costly one. The Centers for Disease Control and Prevention estimates that falls cost the state approximately $300 million a year in health-related costs.

Stepping On

To address this issue, Nash partnered with Nevada Goes Falls Free Coalition, a nonprofit dedicated to preventing falls, to develop a cohort-based, three-year, service-learning and research project,  “Implementation of the ‘Stepping On’ Program for Older Adults in Southern Nevada.”

The Stepping On project seeks to implement an evidence-based, multidisciplinary fall prevention initiative while directly supporting the academic learning of students enrolled in Nash’s DPT 790 and 798 classes. 

In the early phases, Nash’s students produced a project summary and applied for grant funding to cover the cost of Stepping On class materials and participant supplies. During the next phase of the project, students participated in Stepping On leadership training provided by the Nevada Goes Falls Free Coalition.

The three-day training focused on strategies and techniques related to implementing the Stepping On program, leading to  all students becoming certified Stepping On leaders, and enabling them to conduct fall prevention programs with seniors in Nevada.

During the second year, the students worked directly with the Nevada Goes Falls Free Coalition to hold fall-risk screening events in the community.

Elders identified with increased fall risks at these events were invited to participate in a seven-week Stepping On class in coordination with community partners, including the Downtown Senior Center in Henderson, the Cleveland Clinic Lou Ruvo Center, and the Osher Lifelong Learning Institute, with Nash’s students leading the courses.

During this experience, the student leaders helped participants learn to critically analyze fall stories in order to identify safer strategies to navigate in their homes and the community. Students also provided participants with exercises to improve their strength and balance, and hosted guest experts, including a pharmacist, a vision expert, and a community safety expert, to supplement the Stepping On curriculum.

Applying the information

Three months after the initial course, the students conducted follow-up Stepping On sessions, allowing participants to share how they had applied the knowledge gained during their initial involvement. Students listened to participants detail the successful fall prevention strategies they had employed.

In the last year of the project, students compiled and synthesized their learning experiences and outcomes into formal written and oral presentations.

“There were many participants with gait impairments and neurological pathologies that I had only seen in textbooks,” one student reported. “Getting to see these people in person is much more helpful in learning and understanding how these individuals function.”

Another student commented on how the program offered lessons in social responsibility.

“I think this screening event helped me realize how important the Stepping On fall prevention program truly is,” a second student said. “This program provides great tools to help older adults be able to live their best life and implement different strategies to help them prevent potentially life-altering falls.”

Positive Impact

In fact, the impact of this program was positive for all stakeholders, Nash said. Students improved communication skills, attained skills to provide in their future communities, and enhanced their ability to work as a team to produce a program that facilitated greater peer discussion.

The impact on community partners was notable, too, Nash said. The Cleveland Clinic now has an additional workforce to effectively meet the community's need for fall screenings, and the Downtown Senior Center in Henderson and the Osher Lifelong Learning Institute are now able to provide this program for their members.

Additionally, the Nevada Goes Fall Free Coalition was able to further its mission to reduce the incidence of falls in Nevada through a sustainable, evidence-based fall prevention program.

But, Nash noted, perhaps the most important outcome was the reduced fall risk among elders living in Southern Nevada. Not only did no falls occur in the participants during the Stepping On program, but participants experienced significant improvements in nearly all key measures relative to fall risk.

And, one area where there was no significant improvement – the Geriatric Depression Scale or Falls Efficacy Scale – actually served to identify an opportunity for Nash’s future cohorts.

“Evidence-based fall prevention programs are solving community problems and will continue to increase opportunities of UNLV's physical therapy program to collaborate with community partners to address our community’s un-met needs, both locally and in the rural areas of this great state,” Nash said.

UNLV’s office of community engagement established four university-wide awards in 2016 to recognize campus individuals for their exceptional community engagement in the areas of service-learning, community-based research, faculty/staff community outreach, and student service.