[Facilitators and barriers for older people to take part in fall prevention programs: A review of literature]

American Geriatrics Society response to the World Falls Guidelines

Falls are a major cause of preventable death, injury, and reduced independence in adults aged 65 years and older. The American Geriatrics Society and British Geriatrics Society (AGS/BGS) published a guideline in 2001, revised in 2011, addressing common risk factors for falls and providing recommendations to reduce fall risk in community-dwelling older adults. In 2022, the World Falls Guidelines (WFG) Task Force created updated, globally oriented fall prevention risk stratification, assessment, management, and interventions for older adults. Our objective was to briefly summarize the new WFG, compare them to the AGS/BGS guideline, and offer suggestions for implementation in the United States. We reviewed 11 of the 12 WFG topics related to community-dwelling older adults and agree with several additions to the prior AGS/BGS guideline, including assessment and intervention for hearing impairment and concern for falling, assessment and individualized exercises for older adults with cognitive impairment, and performing a standardized assessment such as STOPPFall before prescribing a medication that could potentially increase fall risk. Notable areas of difference include: (1) AGS continues to recommend screening all patients aged 65+ annually for falls, rather than just those with a history of falls or through opportunistic case finding; (2) AGS recommends continued use of the Timed Up and Go as a gait assessment, rather than relying on gait speed; and (3) AGS recommends clinical judgment on whether or not to check an ECG for those at risk for falling. Our review and translation of the WFG for a US audience offers guidance for healthcare and other providers and teams to reduce fall risk in older adults.

[Measuring the impact of a multimodal intervention on falls and the fear of falling]

Falls are common among the elderly, and can have serious consequences: fracture, hospitalization, loss of independence, institutionalization and death. However, falls are not inevitable, and they can be prevented. The "autonomy prevention" kit (Equilibr'Age workshops, occupational therapy advice) has helped to reduce the number of falls and improve people's quality of life. The program will now be rolled out to a wider public.

Falling into an identity crisis: Integrating identity into the assessment and management of falls in older adults

OBJECTIVES

This article examines the psychological effects of falls for older adults through the lens of identity and suggests these may be integrated in the assessment and management of older patients within acute care and rehabilitation settings post-fall. An illustrative vignette is described to demonstrate this approach.

CONCLUSION

Falls in older adults are complex phenomena which can lead to an identity threat, sometimes manifest as psychological symptoms and poor engagement in post-fall rehabilitation. A psychiatric formulation which incorporates an older person's self-identity and agency may inform interventions to address psychological and behavioural sequelae of falls.

A qualitative study of older adults' facilitators, barriers, and cues to action to engage in falls prevention using health belief model constructs

BACKGROUND AND OBJECTIVES

Falls are the leading cause of fatal and nonfatal injuries among older adults. Decreasing falls is highly dependent on engagement in fall prevention activities. The Health Belief Model (HBM) theoretical framework was used to explore older adults' perceptions about falls prevention.

RESEARCH DESIGN AND METHODS

An informed grounded theory approach was applied. Four focus groups were conducted using semi-structured interview guides based on the HBM with 27 community-dwelling older adults (average age = 78 years). Deductive content analysis was used to apply constructs of the HBM to the data and explain the findings.

RESULTS

Potential reasons for not engaging in falls prevention included lack of self-perceived severity, susceptibility, and self-efficacy with a subtheme of lack of information about falls prevention from medical providers. Potential facilitators included older adults' knowledge and current engagement in falls prevention and socializing while engaging in falls prevention. Participants recommended cues to action to improve engagement in falls prevention from family, friends, physicians, pharmacists, and insurance companies; and using various modes to deliver cues to action, including print, audiovisual, online, and reminders.

DISCUSSION AND IMPLICATIONS

In this study, the HBM was used to understand older adults' potential barriers, facilitators, and cues to action to support engagement in falls prevention. Engagement in fall prevention behaviors could be improved by addressing barriers such as lack of knowledge, and lack of self-perceived severity and susceptibility to falls. Reinforcing the benefits of fall prevention, and promoting cues to action to engage in falls prevention may also support engagement.

Impact of the abandonment of assistive technologies for mobility on the incidence of serious falls in older adults living at home: Results of the ECOCAT study

Purpose

To examine the impact of discontinuing the use of assistive technology for mobility (ATM) devices on the 6-months incidence of falls in older adults (OA) living at home.

Materials and methods

A medico-socioeconomic survey was performed to collect information on the quality of life and well-being of older adults, before and 6 months after being loaned an ATM device. Personal data (medical, social, and economic) were collected via a geriatric survey.

Results

In all, 102 OA participated in the study. Over the 6-months observation period, 17 (n = 81) serious falls were recorded among participants who were using their ATM device optimally; in those who discontinued device use, 12 falls (n = 21) were recorded (57.1%; p = 0.001). Factors significantly associated with falls at home were living in an urban area (odds ratio [OR]: 11.46; 95% confidence interval [CI]: 1.48; 88.98; p = 0.020), an Instrumental Activities of Daily Living Scale score > 4 (OR: 34.04; 95% CI: 1.59; 727.86; p = 0.024), and discontinuation of ATM device use (OR: 17.41; 95% CI: 2.59; 117.02; p = 0.003).

Conclusion

Discontinuation of ATM device use was associated with an increased risk for serious falls.

Social Marketing Intervention to Engage Older Adults in Balance Workshops for Fall Prevention: A Multicenter Quasi-Experimental Protocol Study

Background: Falls affects one of three people after 65 years old, and it can lead to serious consequences. Scientific evidence point out that physical exercise is the most efficient way to prevent falls among older adults.

Objective: The main objective of this study is to determine if a social marketing program can increase the attendance rate of people aged 60 and over at group balance workshops.

Methods: This quasi-experimental multicenter study is being conducted in three French Regions (Loire, Haute-Loire and Rhône) over a period of 18 months. The Social Marketing Campaign will be done in three ways. Firstly, a Communication Campaign will take place in the two Test Areas but not in the Control Area. Secondly, flyers have been designed to be distributed by local partners. Finally, conferences for older people will be organized in the areas of intervention in order to reach the target audience for the program. The study will include people aged 60 and older who want to participate in the Balance Program.

Results: The Crédit Agricole Loire/Haute-Loire Foundation funded the study and the Jean Monnet University of Saint-Etienne reviewed it. The Ethics Committee of the University Teaching Hospital of Saint-Etienne approved and peer-reviewed it on September 6, 2019, under Reference Number IRBN622019/CHUSTE.

Conclusion: The results of this first study will demonstrate whether or not social marketing for promoting group balance workshops in the elderly will increase their attendanceship in adapted physical activity sessions, especially those that prevent falls.

Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT04136938, identifier NCT04136938.

Older Adults' Experience With Fall Prevention Recommendations Derived From the STEADI

The Centers for Disease Control and Prevention (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI) toolkit is a national effort to prevent falls among older adults. Studies have been conducted on implementation of the STEADI, but no studies have investigated older adults' adherence to or perceptions of fall prevention recommendations delineated within the STEADI algorithm. Semistructured interviews were conducted with a purposive sample of older adults 6 months after attending a falls risk assessment. Seventy-nine percent accurately recalled their fall risk, 57% followed one or more recommendations, and 32% did not recall at least one recommendation correctly. The most common recommendation recalled and adhered to was exercise. No participants recalled or adhered to recommendations including medication review, taking time changing positions, vision check, podiatrist visit, or physical therapy. Thirty-two percent fell. Of these, 55.6% did not follow any recommendations. Interview transcripts were analyzed using comparative methodology following the tenets of thematic analysis. Three themes emerged: participating in fall prevention, barriers to following recommendations, and providers can encourage people to prevent falls. An unexpected facilitator to participation in fall prevention efforts emerged-older adults' perception that they were positively influencing society by participating in research and working with students and the university. This finding provides an opportunity for providers of health education to address the growing public health issue of falls among older adults while also creating opportunities for students to engage in community service and interdisciplinary service learning.

[Improving fall prevention in the elderly]

The prevention of falls in the elderly requires action on several levels. Firstly, it is essential to identify those at risk of a fall. They must then be encouraged to do appropriate physical and sports activities, a factor of prevention. Social workers have a major role to play in supporting elderly people and encouraging them to participate in such programmes.