Family Independence in Implementing Family Health Tasks to Reduce the Risk of Fall in East Pentadio Village, Gorontalo Regency

Independence is a condition in which a person who has the will and ability tries to fulfill the demands of his life in a legal, reasonable and responsible manner for everything he does. The family has a very big role in the safety of the elderly, especially in preventing falls. The purpose of this study is that the public can find out the importance of family independence in carrying out family health tasks to reduce the risk of falling. There are five family health tasks that must be considered, including being able to recognize family health problems, being able to make appropriate action decisions, being able to provide care to sick family members, being able to modify the environment, and being able to take advantage of public health service facilities. It can be concluded that after counseling the family and the elderly have understood the task of family health, once a day the family teaches tandem walking to the elderly to reduce the risk of falling in the elderly in Pentadio Timur Village, Gorontalo Regency.


INTRODUCTION
Independence is very important to take care of himself in meeting basic human needs. Although it is difficult for younger family members to accept parents complete and slow daily activities. Family activities in carrying out health and balance functions between family members cannot be separated from the five tasks in family health care, namely; able to recognize their health problems, able to make the right decisions to address their health, able to perform nursing actions for family members who need nursing assistance, able to modify the environment so as to support efforts to improve health, able to take advantage of existing health care facilities.
The family is the smallest unit of society consisting of the head of the family and several people who gather and live in one place under one roof in a state of interdependence (Ishwaran, 2019;Azis, 2020). The family has an important influence on the formation of an individual's identity, health status and feelings of self-worth. A vital support system for individuals is the family, where the family functions to meet the needs The family is an important point in efforts to achieve optimal public health because it is related to health problems, has a main function in society and institutions that concern people's lives (Frey & Stutzer, 2010;Azetsop, 2011;Allender et al., 2013). The role of the family as a group can carry out activities to prevent, maintain, cause, improve or ignore health problems that exist in the group/family. The family plays a role as a decision maker in maintaining the health of family members, which means that the family is a determining factor in the health and illness of family members, which will have an impact on the emergence of various health problems for family members (Leventhal & Ian, 2012). The family is the leading health service unit in improving the health status of the community. If every family is healthy, a healthy community will also be created. Health problems experienced by one family member can affect other family members, affecting the family system, local community and even the global community. Thus, the health and independence of the family is the main key to the development of public health.
The family has a very big role in the safety of the elderly, especially in preventing falls. Families also need to know the factors that can make the elderly experience falls by providing exercises to minimize the incidence of falls in the elderly (Clemson et al., 2004;Elley et al., 2008;Ambrose et al., 2013;Scheffer et al., 2008). In previous studies, there were several exercises that were recommended to reduce balance disorders, including Swiss Ball exercises, regular exercises, otago home exercises and tandem walking exercises. The provision of tandem walking exercises is better than swiss ball exercises as evidenced by the comparison of the percentage results that there is an increase in walking speed in tandem walking exercises by 33.17% while in swiss ball exercises only 15.64 %.
Falls are an event that is often experienced by the elderly during the aging process. According to Akosile et al. (2018) Falls in the elderly can increase morbidity, mortality, disability, impaired social function, and decreased quality of life. The risk of falling in the elderly can be caused by many things and is classified into 5 categories. The first is the environment (folded carpets, bathroom without handles, stairs insecurity, lack of lighting, shoe condition), the second is drugs (antidepressants, sleeping pills, and hypnotics), the third is health conditions due to disease or aging (blurry eyes, balance). and the four nutrients (calcium and vitamin-D).
Tandem walking is an exercise performed by walking in a straight line in the position of the heel of the foot touching the toes of the other 3-6 meters, this exercise can improve balance to reduce the risk of falling. Training with tandem walking has been shown to be better than Swiss Ball training in reducing the risk of falling (Gaur et al, 2012).
Families have the primary responsibility for initiating and coordinating services provided by health care professionals (Nedjat-Haiem et al., 2017;Seeley & Lindeke, 2017). Families can practice health care to prevent disturbances or care for sick family members. There are 5 family health tasks that can be an indicator of family independence including being able to recognize the problems experienced by family members, families can decide on the right action for family members, provide simple care for sick family members, modify the environment both physically and psychologically and utilize health services (Mubarak, et al., 2012). Based on the results of the interview, it was found that the family did not understand the 5 functions of family duties and it was found that the elderly had fallen from the bathroom. One of the efforts to increase family independence to reduce the risk of falling, families must know the five functions of family duties. Tandem walking exercise is an alternative that is very easy to teach to families and easy to do by the elderly so that families can direct and control the elderly in doing this exercise at home. This exercise can prevent the risk of falling in the elderly, so it is very good to do in the elderly.

RESULTS AND DISCUSSION
The mechanism for implementing community service activities includes the following stages: (1) Division of community service groups; (2) Consultation with supervising lecturers; (3) Preparation of tools and materials for extension activities Materials for preparation and counseling for families and the elderly include: (a) Preparation of counseling materials to be provided; (b) The implementation mechanism in the form to be used in the extension; (c) Providing material on family independence against the risk of falling in the elderly; (d) Question and answer session; (e) Activity documentation The form of community service activities carried out by Lecturers and Students is counseling about family independence in carrying out family health tasks to reduce the risk of falling in the East Pentadio Village, Kab. Gorontalo. The method of activities carried out in this activity is a percentage using leaflets, lectures, discussions, demonstrating tandem walking to reduce the risk of falling, documentation, and the attached attendance list.
The implementation of this service will be carried out on Tuesday 27 April 2021. The stages of achieving the target results are described according to a sequence of implementation methods with several modifications according to field conditions and are further described in detail below.
Lecturers and students held a meeting with the Head of the Pentadio Timur Village, Kab. Gorontalo regarding preparation for placement of service students and things that need to be known about the situation and conditions of the place that will be used as a place of counseling. The stages of implementing outreach activities on family independence education in carrying out family health tasks to reduce the risk of falling in Pentadio Timur Village, Kab. Gorontalo.
After counseling about family independence in carrying out family health tasks and holding a tandem walk demonstration for the elderly at the East Pentadio village resident's house, the family and the elderly were very enthusiastic about following the tandem walk that was taught. For 3 days taught tandem walking and five family health tasks, the elderly every day do a tandem walk guided by the family, it is proven by 3 out of 5 family heads who have understood the five family health tasks to reduce the risk of falling in the elderly, namely by teaching tandem walking. Before the family counseling was carried out, they did not know the five family health tasks, especially in dealing with the risk of falling in the elderly, as evidenced by the fact that there were 3 elderly at risk of falling and one of the elderly had a history of falling from the bathroom.
The East Pentadio Village Head is very supportive and expresses his gratitude because the Muhammadiyah University of Gorontalo has carried out this activity, all series of activities have been carried out with good results because families and the