Editor’s Note: This is one of a series of profiles of the Wisconsin Idea in action. See past profiles we have published.

Worries about money and losing our health — not to mention fear of death — can all rush in as we age. But with one-third of elderly Americans suffering falls every year, the simple fear of falling again is what often ends up changing lives. For many, this path leads to long-term nursing care, as family members worry about a loved one living at home safely.

“It’s a huge quality-of-life issue,” says Jane Mahoney, a professor in the School of Medicine and Public Health. “On the one hand, if you go into a nursing home, you may be at less risk of falling, but it might be because you’re sitting in a wheelchair all day. And I know from my clinical experience that it’s so important for older adults to stay where they are, because that’s who they are.”

Professor Jane Mahoney, center, along with Wisconsin Care registered nurse Beth Wunderlin, in red, and physical therapist Beth Lee, in black, pay a visit to patient Robert Kreil. Mahoney helped create Sure Step, a falls assessment program for the elderly now used by nurses and health care workers in several Wisconsin counties

Photo: Jeff Miller

That’s why Mahoney has devoted the last 15 years to studying the factors that put people at risk for falls and developing interventions that can reduce the risk while allowing people to stay active. Along the way, she’s become a seasoned researcher, the author of several scientific papers and a nationally recognized expert in her field.

Yet, it wasn’t until she joined forces in 2001 with the Kenosha County Division of Aging and its director LaVerne Jaros that Mahoney feels her research truly began to yield results. Six years after coming together to test a falls prevention program, called Sure Step, with Kenosha County’s elderly, her unusual team of UW–Madison researchers and aging services professionals is now bringing Sure Step to counties throughout Wisconsin. And they’re continuing to study its effectiveness in real-world settings — an approach called community-based participatory research. In Mahoney’s view, there’s a huge need for it.

“We do a lot of great research on campus, but then we don’t see it go into practice, or else it goes into practice but it just falls flat,” she says. “So, there’s a much stronger recognition now of the need for a whole level of research that looks at how to implement and sustain programs. And you really can’t do that without community participation.”

Community involvement is particularly critical to preventing falls. Mahoney estimates that half of older adults with the problem never consult a doctor. And while only 10 percent of falls are serious enough to warrant a hospital stay, the subtler effects are felt much more widely.

“The injury part is certainly horrendous, but to me an even bigger problem is the decline I see in people,” says Terry Shea, a physical therapist with UW Hospital and Clinics and Mahoney’s longtime collaborator. “They stop their social activities, they stop going out and about. Their quality of life seems to go downhill, all because they’re afraid of falling.”

To help combat this, in the late 1990s Shea and Mahoney created Sure Step for patients in their homes. Following a detailed protocol, a nurse or other health care professional evaluates the patient’s risk of falling and all the possible contributing factors, including eyeglasses, gait and medications. A list of interventions — such as physical therapy or a new prescription — is then drawn up and shared with patients and their doctors. Patients also receive monthly follow-up phone calls for a year.

Sure Step is based on a successful falls intervention program at UW Hospitals and Clinics, but Mahoney and Shea didn’t know if it would work, as designed, outside the clinic. After finishing a pilot study in five Wisconsin counties, including Kenosha, the pair prepared to conduct a full-blown randomized trial of Sure Step’s effectiveness. Needing a community partner, they convinced Jaros to sign on.

“That was our first real involvement in research, and it was a very new experience for us,” Jaros says with a chuckle. Although Jaros had rolled out countless programs for seniors over the years, she and her staff were still taken aback by the meticulous planning and strict adherence to protocol that research requires. The rapid pace at which Mahoney and Shea fired off new ideas and questions also took some getting used to, says nurse Sandy Cech, who was hired by Jaros along with physical therapist Alice Schwalbe to help do the research.

“I can literally feel my brain stretching at times to keep up with them,” Cech jokes.

But the biggest surprise of all was the control group, which wouldn’t receive the Sure Step intervention. With half of the 349 Kenosha County adults in the study assigned to it, Jaros didn’t like the idea that they would receive little for their trouble. And yet, giving them too much might confound the study’s results. In the end, Mahoney compromised by offering them a home-safety assessment.

“I really learned from LaVerne that when you do research in the community, you have an obligation to think about what you’re doing for the control group,” Mahoney says.

The agency’s strong community ties helped in other ways, as well. Respected by those who provide aging services, the agency played a pivotal role in recruiting study participants. Its connections also came in handy when Sure Step identified a patient need, such as a different type of shoe. Most importantly, the Kenosha staff’s perspective frequently provided a reality check, says Mahoney.

“I really appreciated what they knew that I didn’t know: how to integrate a community program,” she says. “I learned to listen to them when they said, ‘Jane, this isn’t going to work or this is going to work.’”

“That’s one thing I’ve always admired about Jane,” says Cech. “She will ask you what you think about things.”

By the time the study ended in June 2004, the Kenosha staff had learned a lesson, too: the value of “evidence-based” practices that are demonstrated to work through careful study.

“Because of this study, we really appreciate the importance of having something grounded in research,” says Jaros.

Published this spring in the Journal of the American Geriatrics Society, the research found that Sure Step significantly reduced falls in patients with mild cognitive impairments, among other results. But that’s hardly the end of the story. With support from the Wisconsin Partnership Fund, the same team is now training health care professionals throughout Wisconsin in the Sure Step intervention.

Mahoney and her colleagues are also exploring the feasibility of adapting an Australian falls-prevention program that is given in groups, with an eye toward distribution nationwide.

For now, of one thing Mahoney is certain: “Working with Kenosha has been such a good experience on both sides. … They’ve come to believe in evidence-based practice. And for me, it has been a chance to see how you can take research into action.”