Date of Award




Document Type


Degree Name

Doctor of Public Health (DrPH)


Department of Health Policy, Management and Behavior

Content Description

1 online resource (viii, 73 pages)

Dissertation/Thesis Chair

Julia F. Hastings

Committee Members

Alice McDonnell


Balance, Community Setting, education, exercise, Fall Prevention, Older Adult, Falls (Accidents) in old age, Older people, Retirement communities

Subject Categories

Public Health | Public Health Education and Promotion | Sustainability


Falls have been an identified public health and social problem since the 1980’s and now recognized as a global health problem in many of the developed nations. The National Council on Aging and the Centers for Disease Control and Prevention acknowledge many evidence-based fall prevention programs. However, there are identified concerns to the programs; for example, a lack of sustained programming for older adults in the community setting. The literature review on fall prevention interventions identifies that few programs are sustained after two years, primarily due to a lack of funding and a lack of interest by older adults. However, the literature review also identifies factors to a sustainable program such as program collaboration with an organization that has the infrastructure in place for ongoing fall prevention programming. A Balance and Fall Prevention Program began in 2015 for independent older adults residing at an active adult (60+) retirement community in Dallas, Pennsylvania. The retirement community administration collaborated with the Misericordia University graduate physical therapy department to provide the program which continues in 2021. The program initially utilized the Otago Exercise Program (OEP) of strength and exercises delivered by graduate students as well as an educational component facilitated by both Masonic Village at Dallas and Misericordia University. The program format changed in 2016 to a customized patient-centered care program. The study was a quasi-experimental prospective design using a One-Group Pretest/Posttest with no control group. The Senior Fitness Test measurements from 2015 to 2019 were analyzed using the paired-sample t-tests to compare the means of the pre and post data. The paired-sample t-test identified the positive correlations of each exercise. The t-test results also identified the exercise tests that were statistically significant. The participants who completed three, four or five years of program were compared to the participants who completed one or two years of programming. The results were favorable; older adults can maintain and/or improve their balance and strength as they age three, four and five years. There is statistical significance in improvement in eight of ten exercises for participants who completed three, four or five years. The one and two year participants did show improvement however few measurements were statistically significant. The fear of falling by participants who completed one, two, three, four or five years of programming declined the longer the participants stayed with the programming. The McNemars’s Test results illustrated that the change in the proportion of ‘no’ to fear of falling following the intervention was statistically significant for those participants who completed three, four or five years of programming. As a final point, the administration of a program, a comfortable location for exercise, a flexible program format, equipment and motivational tools for participants were identified as factors to consider for a sustainable program.