Self-management can mitigate common foot problems; however, community-dwelling older adults without diabetes rarely receive foot care self-management training. This two-group pilot study examined feasibility and preliminary efficacy of the novel, nurse-led 2 Feet 4 Life intervention. Twenty-nine adults ( M age 76 years ± 6.6 years) from two senior centers completed the study (90.6% retention rate). Intervention dosage was one hour/week for four consecutive weeks. Study procedures were safe and feasible. Intervention group participants found the intervention acceptable and valuable. Observed between-group effect sizes were the following: knowledge (4.339), self-efficacy (3.652), behaviors (3.403), pain (0.375) and foot health (0.376). Large effect sizes were observed within-groups and within their interaction for knowledge (1.316), behaviors (8.430), pain (9.796), and foot health (3.778). Effect sizes suggest the intervention impacted foot care outcomes between groups and within individuals over seven months’ time. Fully powered studies are indicated to test the intervention in diverse samples with more complex foot problems.

Falls are a major source of death and disability in older adults; little data, however, are available about the etiology of falls in community-dwelling elders. Sensor systems installed in independent and assisted living residences of 105 older adults participating in an ongoing technology study were programmed to record live videos of probable fall events. Sixty-four fall video segments from 19 individuals were viewed and rated using the Falls Video Assessment Questionnaire. Raters identified that 56% (n=36) of falls were due to an incorrect shift of body weight and 27% (n=17) from losing support of an external object, such as an unlocked wheelchair or rolling walker. In 60% of falls, mobility aids were present in the room or in use at the time of the fall. Use of environmentally-embedded sensors provides a mechanism for real-time fall detection and, ultimately, may supply information to clinicians for fall prevention interventions.

PURPOSE: Foot problems can adversely impact foot function and quality of life. Foot problems are often overlooked, particularly in populations with limited health care access. Little is known about the foot health of Haitian immigrants who live and work in the bateyes (rural sugarcane villages) of the Dominican Republic. These immigrant workers may experience foot problems that could affect foot function and the ability to work and provide for their families. DESIGN: Cross-sectional, exploratory, descriptive study design. SUBJECTS AND SETTING: A convenience sample of adults was recruited from an ongoing community-based participatory research project evaluating a mobile hypertension screening and treatment clinic program in 11 Dominican batey communities. METHODS: Foot health was assessed using the Foot Problems Checklist, a 24-item survey instrument developed for this study based on a review of the literature and foot clinician expertise. A certified foot care nurse recorded foot health data on the Foot Problems Checklist via visual and physical inspection. RESULTS: Study participants were 25 females and 16 males, aged 18 to 90 years, and all had at least one foot health problem. The most common foot problems were calluses (78%), dry skin (76%), thick nails (59%), jagged nails (29%), long/overgrown nails (17%), and skin fissures (12%). CONCLUSIONS: While the foot problems we observed were not considered serious, they could become progressively debilitating and be prevented with proper self-management guided by appropriate knowledge and skills and available supplies. We recommend the development and testing of foot care self-management interventions deliverable via mobile clinics to increase access and improve foot health outcomes.

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT REQUEST OF AUTHOR.] Foot problems are prevalent, impact over 30% of older adults, and can lead to loss of function, falls, and hospitalization. This pilot intervention study, based on Social Cognitive Theory, evaluated the feasibility, acceptability and preliminary efficacy of the 2 Feet 4 Life foot care self-management intervention on foot care knowledge, self-efficacy, self-management behaviors, foot pain and foot health. Thirty-two non-diabetic, community-dwelling older adults were recruited from two senior centers. One community center was randomized to receive the Intervention; the other served as Control. Within the Control group, participants were randomized into two subgroups: True Control and Bias Control. The 2 Feet 4 Life intervention consisted of one hour sessions for four consecutive weeks. Assessments occurred at baseline, one month, four months and seven months. Study recruitment and retention goals were met (90.6% retention rate). The intervention was safely and accurately implemented within the anticipated timelines. Although some participants reported difficulties with select vocabulary used on one or more the patient-reported outcome tools, participants found the intervention content valuable and session length and frequency acceptable. Modest improvements in foot care knowledge, foot care behaviors, and foot health were observed in the Intervention group. Based on our analysis, the estimated between group effect size of 2 Feet 4 Life intervention appears to be large for foot care knowledge, self-efficacy, and behaviors. Our findings suggest that the patient-reported and provider-reported outcome tools used in this study require further refinement and psychometric testing. Future fully powered studies need to include diverse samples of older adults with greater variability in foot health and foot pain.

No abstract