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Pock EML, Lohrmann C, Hoffmann M, Schwarz CM, Schoberer D. Evaluation of the usefulness and understandability of information leaflets on fall prevention from the perspective of hospital patients and their relatives. Health Info Libr J 2024. [PMID: 38686953 DOI: 10.1111/hir.12531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 09/11/2023] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Falls are a major problem among adults over 60 years. Multiple preventive measures must be taken. Written information leaflets can support the knowledge transfer and positively influence recall of the information provided. OBJECTIVE The aim was to ensure usefulness and understandability of the information leaflets on home fall prevention from the target groups' perspective. METHODS A cross-sectional survey study with a feedback questionnaire for patients and relatives was conducted at a university hospital in Austria. Quantitative data analysis and qualitative content analysis according to Schreier were performed. RESULTS The majority (63.9%) of patients rated the overall impression as "very good". 44.2% of the relatives rated it as "very good" and 23% as "good". The question "appealing design" was the only one with a statistically significant difference between patients and relatives. Subgroup analysis has shown a statistically significant difference between educational groups regarding the questions "easy to read" and "easy to understand". CONCLUSION It could be shown that the information leaflets were already well tailored to the target group. The few comments regarding understandability were considered to improve the content of the information leaflets. A further evaluation regarding the benefit of the fall prevention leaflets in discharge management should be performed.
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Affiliation(s)
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Magdalena Hoffmann
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Safety and Sustainability in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Christine Maria Schwarz
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
- Research Unit for Safety and Sustainability in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Daniela Schoberer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
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Crawley MR, Chapman AJ, Koestner A, Pounders S, Krech L, Lypka M, Fisk C, Iskander G. Fall Risk Identification Throughout the Continuum of Care for Elderly Trauma Patients: An Injury Prevention Initiative. Injury 2022; 53:3715-3722. [PMID: 36075779 DOI: 10.1016/j.injury.2022.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 08/06/2022] [Accepted: 08/29/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Falls are the second leading cause of trauma-related deaths worldwide. Identifying fall risk patients and initiating interventions reduces injuries and mortality, particularly in the elderly. The primary aim of this retrospective study was to identify missed opportunities for fall risk identification and intervention for geriatric trauma patients. PATIENTS AND METHODS In this retrospective observational cohort study, the trauma registry was queried to identify geriatric patients admitted for a fall over 36 months. The electronic medical record (EMR) was reviewed to evaluate patients' fall risk in the 12 months prior to the index fall admission. The EMR was also queried for repeat falls within 12 months after discharge, and to determine if fall prevention education was provided at discharge. RESULTS 597 patients met inclusion criteria; 68.3% were female. 64.7% were at risk for falling in the year before admission. 2% had documented fall prevention education at discharge. 32% of patients fell again within a year of discharge and 19.4% were readmitted for a repeat fall. Patients at high risk for falls (on the Hester-Davis scale) were significantly more likely to be readmitted (p = 0.005) and expire within six months (p = 0.033) than moderate risk patients. Mortality at 12 months post-admission for all patients was 19.4%. CONCLUSION This large study demonstrated that geriatric trauma patients admitted for a fall were already at risk for falling in the 12 months prior to admission. This is a novel finding that presents a substantial prevention opportunity for healthcare systems. Education and implementation of proven techniques to prevent falls as soon as at-risk patients are identified has the potential to change the course for a patient who may not only fall, but also fall again. This proactive approach could significantly impact the fall epidemic in our elderly population.
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Affiliation(s)
- Meaghan R Crawley
- Spectrum Health Butterworth Hospital, Trauma Services, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Alistair J Chapman
- Spectrum Health Butterworth Hospital, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA; Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Amy Koestner
- Spectrum Health Butterworth Hospital, Trauma Services, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Steffen Pounders
- Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Laura Krech
- Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA.
| | - Matthew Lypka
- Spectrum Health Office of Research and Education, Biostatistics Core, 15 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Chelsea Fisk
- Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Gaby Iskander
- Spectrum Health Butterworth Hospital, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
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Kania T, Pandya S, Demissie S, Abdelhalim D, Governo C, Hawkins S, Younan D, Atanassov K, Gave A. Physical exam is not an accurate predictor of injury in geriatric patients with low-energy blunt trauma - A retrospective cohort study. Ann Med Surg (Lond) 2022; 81:104503. [PMID: 36147051 PMCID: PMC9486729 DOI: 10.1016/j.amsu.2022.104503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background When evaluating trauma patients, many centers perform computed tomography of the head, cervical spine, chest, abdomen, and pelvis, the so-called “pan-scan.” Here, we evaluate the utility of physical exam against pan-scan in geriatric patients who sustained ground-level falls. Methods We performed a single-centered retrospective cohort review of consecutive patients from the trauma registry of a large, urban Level 1 trauma center. Inclusion criteria were registration during the 2019 calendar year, age ≥65, mechanism of fall from either sitting or standing, and performance of “pan-scan” at time of assessment. The sensitivity, specificity, positive and negative predictive values of the physical exam for significant injuries were calculated. The effect of such injuries on disposition from the emergency department and hospital were determined. Results An initial query for patients age ≥65 yielded 1280 patients. After exclusion of patients who did not undergo pan-scan or who had GCS <14, 751 patients were included in analysis. Median age was 84 years old. 351 patients had at least one injury identified on pan-scan. Physical exam was determined to have a sensitivity of 0.69 when compared to pan-scan as a gold standard. Patients with injury identified on CT scan had significantly more admissions, mortalities, and ICU and OR requirements. Conclusion Approximately half of all patients were found to have at least one injury on pan-scan. Physical examination was insensitive at identifying such injuries which ultimately altered patient management, disposition, and outcomes. Pan-scan is recommended in this vulnerable population. A selective approach to CT scan may not be appropriate for elderly patients with low-energy blunt falls. Approximately half of all elderly patients who fall from sitting or standing have at least one traumatic injury. Traumatic injuries alter the hospital course and disposition of elderly fall patients. Physical exam is neither sensitive nor specific enough to detect these injuries.
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Affiliation(s)
- T. Kania
- Staten Island University Hospital/Hofstra Northwell Zucker School of Medicine, United States
- Corresponding author.475 Seaview Ave. Staten Island, NY, 10305, United States.
| | - S. Pandya
- Staten Island University Hospital/Hofstra Northwell Zucker School of Medicine, United States
| | - S. Demissie
- Staten Island University Hospital/Hofstra Northwell Zucker School of Medicine, United States
| | - D. Abdelhalim
- Touro College of Osteopathic Medicine, United States
| | - C. Governo
- Staten Island University Hospital/Hofstra Northwell Zucker School of Medicine, United States
| | - S. Hawkins
- Hackensack University Medical Center, United States
| | - D. Younan
- Staten Island University Hospital/Hofstra Northwell Zucker School of Medicine, United States
| | - K. Atanassov
- Staten Island University Hospital/Hofstra Northwell Zucker School of Medicine, United States
| | - A. Gave
- Hackensack Meridian Health JFK University Medical Center, United States
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4
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Adebero T, Bobos P, Somerville L, Howard J, Vasarhelyi EM, Lanting B, Hunter SW. Implementation of falls risk evaluation at one-year after total hip arthroplasty: a cross-sectional study. Arch Physiother 2022; 12:16. [PMID: 35836298 PMCID: PMC9284763 DOI: 10.1186/s40945-022-00141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Research has demonstrated an increased risk of falls after total hip arthroplasty (THA). Yet, people’s knowledge on falls risk factors and how falls prevention strategies are being used after THA have not been examined. If a person’s knowledge of falls and self-efficacy about falls prevention strategies is low this would indicate a pressing need for interventions to lessen risk. The study objectives were: 1) to determine the falls knowledge and what fall prevention strategies people used after (THA) and 2) to determine the outcomes of a falls risk assessment at 12-months after unilateral THA. Methods Overall, 108 people completed the Falls Risk for Older People – Community Setting (FROP-Com) scale, a falls questionnaire (covered occurrence of falls, knowledge on falls risk factors, falls prevention strategies implemented after THA surgery), 6-m Walk Test (6mWT), 30-Second Chair Stand Test (30CST), Timed-up and Go (TUG) Test, and Activities-specific Balance Confidence Scale (ABC). Results Twenty-five (23.2%) people fell at least once in the 12 months after THA. Scores on the FROP-Com ranged from 2–20 with an average of 8.2 ± 3.6 indicating a mild falls risk. The importance of falling compared to other health concerns was rated as moderate to high (6.8 ± 2.9) and the majority of participants (n = 98, 90.7%) believed falls can be prevented after THA. Total scores on the ABC scale ranged from 30.6% to 100.0% with an average score of 84.4 ± 15.5%, indicating high function. Only 47 people (43.5%) reported receiving falls prevention education. A total of 101 falls prevention strategies were completed by 67 people (62%), the most common strategy was environmental modifications (e.g., installation of grab bars) at 37.4%, while exercise was mentioned by only 2%. The majority of people had functional deficits in 30CST (62%) and TUG (76.9%) at 12-months after unilateral THA. Conclusions Almost a quarter of the sample had experienced a fall in the 12-months after THA and functional deficits were common. The majority of the sample had proactively implemented falls prevention strategies after the surgery. Yet importantly, people after THA had limited exposure to falls prevention education and implemented a limited range of prevention strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s40945-022-00141-6.
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Affiliation(s)
- Tony Adebero
- Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada
| | - Pavlos Bobos
- Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, ON, Canada
| | - Lyndsay Somerville
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - James Howard
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Edward M Vasarhelyi
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Brent Lanting
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Susan W Hunter
- Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada. .,School of Physical Therapy, University of Western Ontario, London, ON, Canada.
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5
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Ng CP, Singh DKA, Tan MP, Kumar S. Malaysian older persons' perceptions about falls and their desired educational website characteristics: A qualitative study. PLoS One 2022; 17:e0270741. [PMID: 35797335 PMCID: PMC9262233 DOI: 10.1371/journal.pone.0270741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Falls is a common and debilitating condition among the older population, intensifying the need to educate older persons about falls. Technology advancement enables effective and efficient delivery of falls education to the older population. However, there is paucity of information on the perception of Malaysian older population on falls and their preferred website characteristics such as font size, design, layout, colour, navigation, and use of graphics or videos. Physiological changes in vision, cognition and psychomotor skills can affect how the older persons use the website. As Malaysia is a multicultural country, the needs of the website characteristics and falls perception of older persons may differ greatly. The aim of this study was to explore the perceptions of the older persons about falls and their desired website characteristics. Twenty-five community-living older persons (n = 25) of age 60 years and above were involved in the focus group discussions. NvivoTM software was used for data management and thematic analysis was undertaken. Emerging themes included ’Perceptions of falls in older persons’, ’Actions taken when falls occurred’, ’Perceived prevention strategies for falls’ and ’End user requirements for falls educational website’. Falls were perceived as both an avoidable and a non-avoidable incident. Although the participants mentioned physical activity and home hazard modifications as strategies to prevent falls, they mainly discussed self-initiated precautionary approaches in falls prevention. Regarding desired website characteristics, the participants emphasized on easily readable text, appealing design, clear information, use of images/videos, and simple website navigation. Special requirements for colour selection and multi-language options were also raised. The delivery of falls education through website can be made possible by understanding the perception of older persons about falls and their requirements for the website. This is especially important as ethnic and cultural influences may play a role on their perceptions about falls and desired website characteristics.
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Affiliation(s)
- Cheah Ping Ng
- Physiotherapy Programme & Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme & Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- * E-mail:
| | - Maw Pin Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Saravana Kumar
- UniSA Allied Health and Human Performance, City East Campus, University of South Australia, Adelaide, South Australia, Australia
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6
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Nugent K, Payne MW, Viana R, Unger J, Hunter SW. A concern for falling impacts quality of life for people with a lower limb amputation. Int J Rehabil Res 2022; 45:253-259. [PMID: 35754349 DOI: 10.1097/mrr.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this web-based survey study was to comprehensively evaluate subdomains of concern for falling and its association with quality of life (QoL) among people with lower-limb amputations (PLLA). Forty-eight adults (mean 61.8 ± 11.6 years) with a major (i.e. transtibial or transfemoral) amputation participated. Individuals were currently using a prosthesis for ambulation, completed a prosthetic rehabilitation program, had functional use of English and had access to an internet-connected device (e.g. laptop). Five standardized scales assessed a concern for falling: Modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Activities-specific Balance Confidence (ABC) Scale, Prosthetic Limb Users Survey - Mobility (PLUS-M), Consequences of Falling Scale and Perceived Ability to Manage Falls Scale. QoL was evaluated using the WHO QoL-100 questionnaire. Spearman correlation analysis evaluated the relationship between the five concerns for falling scales. Five independent linear regression modeling evaluated the association of each concern for falling measure on QoL. Strong statistically significant correlations were found between mSAFFE and PLUS-M (rs = -0.87; P < 0.05). Three scales were significantly associated with QoL: mSAFFE [-1.16 (95% CI, -2.04 to -0.29)], ABC [0.36 (95% CI, 0.11-0.61)] and PLUS-M [0.50 (95% CI, 0.05-0.95)]. This is the first study to evaluate multiple concerns for falling subdomains among PLLA. Concern for falling should be addressed in prosthetic rehabilitation to improve community re-integration and QoL.
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Affiliation(s)
- Kristin Nugent
- University of Western Ontario, Faculty of Health Sciences, School of Physical Therapy
| | - Michael W Payne
- Department of Physical Medicine and Rehabilitation, Parkwood Research Institute and.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, Schulich School of Medicine and Dentistry
| | - Ricardo Viana
- Department of Physical Medicine and Rehabilitation, Parkwood Research Institute and.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, Schulich School of Medicine and Dentistry
| | - Janelle Unger
- University of Western Ontario, Faculty of Health Sciences, School of Physical Therapy.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, Schulich School of Medicine and Dentistry
| | - Susan W Hunter
- University of Western Ontario, Faculty of Health Sciences, School of Physical Therapy.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, Schulich School of Medicine and Dentistry
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Severance JJ, Rivera S, Cho J, Hartos J, Khan A, Knebl J. A Collaborative Implementation Strategy to Increase Falls Prevention Training Using the Age-Friendly Health Systems Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105903. [PMID: 35627440 PMCID: PMC9141549 DOI: 10.3390/ijerph19105903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 12/10/2022]
Abstract
Falls in the home and in community environments are the leading cause of injuries and long-term disabilities for the aging population. The purpose of this study was to examine outcomes of a partnership among an academic institution, government agency, community organizations, and emergency management services to implement a falls prevention training program using an Age-Friendly Health Systems approach. In this prospective study, partners identified gaps in services and targeted and non-targeted delivery areas for implementation of an evidence-based falls prevention intervention addressing the 4Ms of Age-Friendly Health Systems—Mobility, Medications, Mentation, and What Matters. Descriptive statistics were calculated for program implementation and participant demographic variables, and paired t-test analysis compared scores for self-assessed general health and falls efficacy prior to and after program participation. Twenty-seven falls prevention classes were implemented, with over half (52%) in targeted areas. A total of 354 adults aged 50 and older participated, with N = 188 participants (53%) completing the program by attending at least five of eight sessions. Of completers, 35% resided in targeted areas. The results showed a statistically significant improvement in falls efficacy by program completers in targeted and non-targeted areas. However, there was no statistically significant difference in self-rated health. Overall, the findings of this study indicate that collaboration to deliver falls prevention training can be effective in reaching at-risk older adults. By mobilizing collaborative partnerships, limited resources can be allocated towards identifying at-risk older adults and improving community-based falls prevention education.
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Affiliation(s)
- Jennifer Jurado Severance
- Department of Internal Medicine and Geriatrics, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.K.); (J.K.)
- Correspondence: ; Tel.: +1-817-735-0469
| | - Solymar Rivera
- Department of Rehabilitation and Health Services Research, University of North Texas, Denton, TX 76203, USA;
| | - Jinmyoung Cho
- Center for Applied Health Research, Baylor Scott & White Research Institute, Temple, TX 76502, USA;
| | - Jessica Hartos
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Amal Khan
- Department of Internal Medicine and Geriatrics, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.K.); (J.K.)
| | - Janice Knebl
- Department of Internal Medicine and Geriatrics, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.K.); (J.K.)
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Nugent K, Payne MW, Viana R, Hunter SW. The reliability of four standardized concern for falling scales among adults with a major lower extremity amputation. PM R 2022; 15:437-444. [PMID: 35150095 DOI: 10.1002/pmrj.12785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION More than 52.4% of people with a lower extremity amputation (PLEA) will fall at least once each year. Previously established standardized scales which evaluate a concern for falling (CFF) were primarily developed among community dwelling older adults. The reliability of commonly used scales to evaluate a CFF among PLEA is needed. OBJECTIVE To evaluate test-retest relative and absolute reliability, and agreement of the Modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Falls Efficacy Scale - International (FES-I), Consequences of Falling (COF) Scale, Perceived Control Over Falling (PCOF) Scale, and Perceived Ability to Manage Falls (PAMF) Scale among PLEA. DESIGN Web-based cross-sectional repeated measures study. SETTING Rehabilitation hospital. PARTICIPANTS Regularly scheduled appointments (N = 22, mean age ± SD, 63.5 ± 12.9 years) with a transtibial or transfemoral level amputation, completed a prosthetic rehabilitation program, and at minimum of one year using a prosthesis for ambulation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Initial and re-test scores on the mSAFFE, FES-I, COF, PAMF, and PCOF. RESULTS Intraclass correlation coefficients (ICC) demonstrated excellent relative reliability of the mSAFFE [ICC = 0.92 (95% CI: 0.82-0.97)], good relative reliability of the FES-I [ICC = 0.87 (95% CI: 0.70-0.94)], and fair relative reliability of the COF [ICC = 0.78 (95% CI: 0.53-0.90)] and PAMF [ICC = 0.73 (95% CI: 0.46-0.88)] scales. The ICC value of the PCOF scale could not be validly calculated and was not further analyzed. Calculated SE of measurement values for the mSAFFE, FES-I, COF, and PAMF scales were small in magnitude and Bland-Altman graphs demonstrated good agreement of initial and re-test scores for all scales. CONCLUSION This study provides initial evidence on the suitability and reliable use of the mSAFFE, FES-I, COF, and PAMF scales within this population. Further evaluation of the validity of these scales is needed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kristin Nugent
- Faculty of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
| | - Michael W Payne
- Schulich School of Medicine & Dentistry, Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada
| | - Ricardo Viana
- Schulich School of Medicine & Dentistry, Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada
| | - Susan W Hunter
- Faculty of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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9
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Heng H, Slade SC, Jazayeri D, Jones C, Hill AM, Kiegaldie D, Shorr RI, Morris ME. Patient Perspectives on Hospital Falls Prevention Education. Front Public Health 2021; 9:592440. [PMID: 33796493 PMCID: PMC8007862 DOI: 10.3389/fpubh.2021.592440] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/19/2021] [Indexed: 12/02/2022] Open
Abstract
Hospital falls remain an intractable problem worldwide and patient education is one approach to falls mitigation. Although educating patients can help their understanding of risks and empower them with prevention strategies, patient experiences of hospital falls education are poorly understood. This study aimed to understand the perspectives and preferences of hospitalized patients about falls prevention education. Three focus groups were conducted in Australian hospitals. A phenomenological approach was used to explore patient perspectives and data were analyzed thematically. The focus groups revealed that most people did not realize their own risk of falling whilst an inpatient. Experiences of falls prevention education were inconsistent and sometimes linked to beliefs that falls were not relevant to them because they were being cared for in hospital. Other barriers to falls mitigation included poor patient knowledge about hospital falls risk and inconsistencies in the delivery of falls prevention education. A strong theme was that individualized, consistent education, and small interactive groups were helpful.
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Affiliation(s)
- Hazel Heng
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, VIC, Australia
| | - Susan C. Slade
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, VIC, Australia
| | - Dana Jazayeri
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, VIC, Australia
| | | | - Anne-Marie Hill
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Debra Kiegaldie
- Healthscope Ltd, Melbourne, VIC, Australia
- Faculty of Health Science, Youth and Community Studies, Holmesglen Institute, Melbourne, VIC, Australia
| | - Ronald I. Shorr
- Geriatric Research Education and Clinical Center (GRECC), Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, United States
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
| | - Meg E. Morris
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, VIC, Australia
- Healthscope Ltd, Melbourne, VIC, Australia
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Naseri C, McPhail SM, Haines TP, Morris ME, Shorr R, Etherton-Beer C, Netto J, Flicker L, Bulsara M, Lee DCA, Francis-Coad J, Waldron N, Boudville A, Hill AM. Perspectives of older adults regarding barriers and enablers to engaging in fall prevention activities after hospital discharge. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1710-1722. [PMID: 32337796 PMCID: PMC7513672 DOI: 10.1111/hsc.12996] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/04/2020] [Accepted: 03/18/2020] [Indexed: 05/05/2023]
Abstract
Older adults recently discharged from hospital are at high risk of functional decline and falls. A tailored fall prevention education provided at hospital discharge aimed to improve the capacity of older adults to engage in falls prevention activities. What remains unknown are the factors affecting behaviour change after hospital discharge. This study identified the perceived barriers and enablers of older adults to engagement in fall prevention activities during the 6-month period post-discharge. An exploratory approach using interpretative phenomenological analysis focused on the lived experience of a purposive sample (n = 30) of participants. All were recruited as a part of an RCT (n = 390) that delivered a tailored fall prevention education program at three hospital rehabilitation wards in Perth, Australia. Data were collected at 6-month post-discharge using semi-structured telephone surveys. Personal stories confirmed that some older adults have difficulty recovering functional ability after hospital discharge. Reduced physical capability, such as experiences of fatigue, chronic pain and feeling unsteady when walking were barriers for participants to safely return to their normal daily activities. Participants who received the tailored fall education program reported positive effects on knowledge and motivation to engage in fall prevention. Participants who had opportunities to access therapy or social supports described more positive experiences of recovery compared to individuals who persevered without assistance. A lack of physical and social support was associated with apprehension and fear toward adverse events such as falls, injuries, and hospital readmission. The lived experience of participants following hospital discharge strongly suggested that they required more supports from both healthcare professionals and caregivers to ensure that their needs were met. Further research that evaluates how to assist this population to engage in programs that will mitigate the high risk of falls and hospital readmissions is required.
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Affiliation(s)
- Chiara Naseri
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, WA, Australia
| | - Steven M. McPhail
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
| | - Terry P. Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, VC, Australia
| | - Meg E. Morris
- Healthscope & La Trobe Centre for Sport & Exercise Medicine Research, La Trobe University, Melbourne, VC, Australia
| | - Ronald Shorr
- Malcom Randall VA Medical Center, Geriatric Research Education and Clinical Center (GRECC), Gainesville, FL, USA
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christopher Etherton-Beer
- Western Australian Centre for Health & Ageing, University of Western Australia, Royal Perth Hospital Unit, Perth, WA, Australia
| | - Julie Netto
- School of Occupational Therapy and Social Work, Faculty of Health Science, Curtin University, Perth, WA, Australia
| | - Leon Flicker
- Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, WA, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Den-Ching A. Lee
- School of Primary and Allied Health Care, Monash University, Melbourne, VC, Australia
| | - Jacqueline Francis-Coad
- School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Nicholas Waldron
- Department of Geriatric Rehabilitation, Department of Health, Armadale Health Service, Perth, WA, Australia
| | - Amanda Boudville
- Department of Aged Care and Rehabilitation, St John of God Health Care, Midland, WA, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, WA, Australia
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11
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Gell NM, Brown H, Karlsson L, Peters DM, Mroz TM. Bathroom Modifications, Clutter, and Tripping Hazards: Prevalence and Changes after Incident Falls in Community-Dwelling Older Adults. J Aging Health 2020; 32:1636-1644. [PMID: 32776813 DOI: 10.1177/0898264320949773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To describe the prevalence of bathroom modifications, clutter, and tripping hazards in the homes of US older adults and to examine changes after an incident fall. Methods: We used data from the 2015-2017 National Health and Aging Trends Study (n = 7499). Outcomes were the prevalence of bathroom modifications, clutter, and tripping hazards and changes after incident fall. Results: In 2015, 26.5% of community-dwelling older adults had clutter or tripping hazards in the home, and 69.3% had at least one bathroom modification. Compared to nonfallers, older adults with multiple falls were significantly more likely to modify the bathroom. The magnitude of hazard reduction was similar after multiple falls but was not statistically significant. Discussion: Bathroom modifications are common and increase after multiple falls. A single incident fall does not appear to lead to home environment changes to reduce fall risk. Targeting home hazards may be an opportunity to reduce fall risk.
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Tzeng HM, Okpalauwaekwe U, Lyons EJ. Barriers and Facilitators to Older Adults Participating in Fall-Prevention Strategies After Transitioning Home from Acute Hospitalization: A Scoping Review. Clin Interv Aging 2020; 15:971-989. [PMID: 32612356 PMCID: PMC7323788 DOI: 10.2147/cia.s256599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/10/2020] [Indexed: 01/11/2023] Open
Abstract
Purpose Approximately, 14% of older adults aged 65 years and over experience a fall within 1 month post-hospital discharge. Adequate self-management may minimize the impact of these falls; however, research is lacking on why some older adults engage in self-management to prevent falls while others do not. Methods We conducted a scoping review to identify barriers and facilitators to older adults participating in fall-prevention strategies after transitioning home from acute hospitalization. Eligibility criteria were peer-reviewed journal articles published during 2009-2019 which were written in English and contained any of the following keywords or their synonyms: "fall-prevention," "older adults," "post-discharge" and "transition care." We systematically and selectively summarized the findings of these articles using the Joanna Briggs Institute guidelines and the PRISMA-ScR reporting guidelines. Seven bibliographic databases were searched: PubMed/MEDLINE, ERIC, CINAHL, Cochrane Library, Scopus, PsycINFO, and Web of Science. We used the Capability-Opportunity-Motivation-Behavior (COM-B) model of health behavior change as a framework to guide the content, thematic analysis, and descriptive results. Results Seventeen articles were finally selected. The most frequently mentioned barriers and facilitators for each COM-B dimension differed. Motivation factors include such as older adults lacking inner drive and self-denial of being at risk for falls (barriers) and following-up with older adults and correcting inaccurate perceptions of falls and fall-prevention strategies (facilitators). Conclusion This scoping review revealed gaps and future research areas in fall prevention relative to behavioral changes. These findings may enable tailoring feasible fall-prevention interventions for older adults after transitioning home from acute hospitalization.
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Affiliation(s)
- Huey-Ming Tzeng
- The University of Texas Medical Branch, School of Nursing, Galveston, TX, USA
| | - Udoka Okpalauwaekwe
- University of Saskatchewan, College of Medicine, Saskatoon, Saskatchewan S7N 2Z4, Canada
| | - Elizabeth J Lyons
- University of Texas Medical Branch, Department of Nutrition and Metabolism, School of Health Professions, Galveston, TX, USA
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13
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Haines TP, Hill AM. Better Off Doing Falls Prevention “With” Our Patients Rather Than “To” Them? Jt Comm J Qual Patient Saf 2020; 46:127-128. [DOI: 10.1016/j.jcjq.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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de Jong LD, Coe D, Bailey C, Adams N, Skelton DA. Views and experiences of visually impaired older people and exercise instructors about the Falls Management Exercise programme: a qualitative study. Disabil Rehabil 2019; 43:2561-2567. [DOI: 10.1080/09638288.2019.1704894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Lex D. de Jong
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Dorothy Coe
- Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Catherine Bailey
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle, UK
| | - Nicola Adams
- Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Dawn A. Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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15
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Evaluating audio-visual falls prevention messages with community-dwelling older people using a World Café forum approach. BMC Geriatr 2019; 19:345. [PMID: 31818252 PMCID: PMC6902607 DOI: 10.1186/s12877-019-1344-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 11/04/2019] [Indexed: 11/17/2022] Open
Abstract
Background Falls risk increases sharply with older age but many older people are unaware or underestimate their risk of falling. Increased population-based efforts to influence older people’s falls prevention behavior are urgently needed. The aim of this study was to obtain a group of older people’s collective perspectives on newly developed prototypes of audio-visual (AV) falls prevention messages, and evaluate changes in their falls prevention behaviour after watching and discussing these. Methods A mixed-method study using a community World Café forum approach. Results Although the forum participants (n = 38) mostly responded positively to the three AV messages and showed a significant increase in their falls prevention capability and motivation after the forum, the participants collectively felt the AV messages needed a more inspirational call to action. The forum suggested this could be achieved by means of targeting the message and increasing the personal connection. Participants further suggested several alternatives to online falls prevention information, such as printed information in places in the community, as a means to increase opportunity to seek out falls prevention information. Conclusions Falls prevention promotion messages need to be carefully tailored if they are to be more motivating to older people to take action to do something about their falls risk. A wider variety of revised and tailored AV messages, as one component of a community-wide falls prevention campaign, could be considered in an effort to persuade older people to take decisive action to do something about their falls risk. Trial registration This study was registered prospectively: NCT03154788. Registered 11 May 2017.
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16
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Naseri C, McPhail SM, Haines TP, Morris ME, Etherton-Beer C, Shorr R, Flicker L, Bulsara M, Netto J, Lee DCA, Francis-Coad J, Waldron N, Boudville A, Hill AM. Evaluation of Tailored Falls Education on Older Adults' Behavior Following Hospitalization. J Am Geriatr Soc 2019; 67:2274-2281. [PMID: 31265139 DOI: 10.1111/jgs.16053] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Older adults recently discharged from the hospital are known to be at risk of functional decline and falls. This study evaluated the effect of a tailored education program provided in the hospital on older adult engagement in fall prevention strategies within 6 months after hospital discharge. METHODS A process evaluation of a randomized controlled trial that aimed to improve older adult fall prevention behaviors after hospital discharge. Participants (n = 390) were aged 60 years and older with good cognitive function (greater than 7 of 10 Abbreviated Mental Test Score), discharged home from three hospital rehabilitation wards in Perth, Australia. The primary outcomes were engagement in fall prevention strategies, including assistance with daily activities, home modifications, and exercise. Data were analyzed using generalized linear modeling. RESULTS There were 76.4% (n = 292) of participants who completed the final interview (n = 149 intervention, n = 143 control). There were no significant differences between groups in engagement in fall prevention strategies, including receiving instrumental activity of daily living (IADL) assistance (adjusted odds ratio [AOR] = 1.3 [95% confidence interval {CI} = 0.7-2.1]; P = .3), completion of home modifications (AOR = 1.2 [95% CI = 0.7-1.9]; P = .4), and exercise (AOR = 1.3 [95% CI = 0.7-2.2]; P = .3). There was a high proportion of unmet ADL needs within both groups, and levels of participant dependency remained higher at 6 months compared to baseline levels at admission. The proportion of all participants who engaged in exercise following hospital discharge increased by 30%; however, the mean duration of exercise reduced from 3 hours per week at baseline to 1 hour per week at 6-month follow-up (SD = 1.12 hours per week). CONCLUSION Tailored education did not increase older adult engagement in fall prevention strategies after hospital discharge compared to usual care. Further research is required to evaluate older adults' capacity to change their behaviors once they return home from hospital, which may enable a safer recovery of their independence. J Am Geriatr Soc 67:2274-2281, 2019.
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Affiliation(s)
- Chiara Naseri
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
| | - Steven M McPhail
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Terrence P Haines
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Meg E Morris
- Healthscope and La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Melbourne, Victoria, Australia
| | - Christopher Etherton-Beer
- Western Australian Centre for Health and Ageing, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ronald Shorr
- Malcom Randall VA Medical Center, Geriatric Research Education and Clinical Center, Gainesville, Florida.,College of Medicine, University of Florida, Gainesville, Florida
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Julie Netto
- School of Occupational Therapy and Social Work, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
| | - Den-Ching A Lee
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline Francis-Coad
- School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Nicholas Waldron
- Department of Geriatric Rehabilitation, Armadale Health Service, Department of Health, Mount Nasura, Western Australia, Australia
| | - Amanda Boudville
- Department of Aged Care and Rehabilitation, St John of God Health Care, Midland, Western Australia, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
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17
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de Jong LD, Lavender AP, Wortham C, Skelton DA, Haines TP, Hill AM. Exploring purpose-designed audio-visual falls prevention messages on older people's capability and motivation to prevent falls. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e471-e482. [PMID: 30887630 DOI: 10.1111/hsc.12747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/05/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
The number of falls and fall-associated injury rates among older people continues to rise worldwide. Increased efforts to influence older people's falls prevention behaviour are needed. A two-phase exploratory community-based participatory study was conducted in Western Australia. First, three prototype audio-visual (AV) falls prevention messages were designed collaboratively with six older people. Second, the messages' effect on community-dwelling older people's knowledge, awareness and motivation to take action regarding falls prevention was explored using focus groups. Data were analysed using thematic analysis to explore participants' responses to the messages. The participants' (n = 54) perspectives on the AV messages varied widely and stereotypes of ageing appeared to influence these. The presented falls facts (including falls epidemiology statistics) increased some participants' falls risk awareness and falls prevention knowledge. Other participants felt ready-to-use falls prevention information was lacking. Some expressed positive emotions or a personal connection to the messages and suggested the messages helped reduce ageing-related stigma. Strongly opposing viewpoints suggested that other participants identified implicit negative messages about ageing, which reduced their motivation with the messages. Suggestions to improve the message persuasiveness included adding more drama and tailoring messages to appeal to multiple age groups. Overall, the AV falls prevention messages designed in collaboration with older people elicited a divergent range of positive and negative perspectives from their peers, which was conceptualised by the overarching theme 'we all look at things different ways'. Opinions differed regarding whether the messages would appeal to older people. Public campaigns targeting falls prevention should be designed and tailored towards older peoples' differing perspectives about ageing.
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Affiliation(s)
- Lex D de Jong
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Bentley, Perth, WA, Australia
| | - Andrew P Lavender
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Bentley, Perth, WA, Australia
| | - Chris Wortham
- School of Arts and Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Dawn A Skelton
- School of Health and Life Sciences, Centre for Living, Glasgow Caledonian University, Glasgow, UK
| | - Terry P Haines
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Anne-Marie Hill
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Bentley, Perth, WA, Australia
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18
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Shuman CJ, Montie M, Hoffman GJ, Powers KE, Doettl S, Anderson CA, Titler MG. Older Adults' Perceptions of Their Fall Risk and Prevention Strategies After Transitioning from Hospital to Home. J Gerontol Nurs 2019; 45:23-30. [PMID: 30653234 DOI: 10.3928/00989134-20190102-04] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/22/2018] [Indexed: 11/20/2022]
Abstract
Falls are common adverse events following hospital discharge. However, prevention programs are not tailored for older patients transitioning home. To inform development of transitional fall prevention programs, nine older adults designated as being at risk of falls during hospitalization who were recently discharged home were asked about their perceptions of fall risk and prevention, as well as their knowledge and opinion of materials from the Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths & Injuries Initiative. Using the constant comparative method, five themes were identified: Sedentary Behaviors and Limited Functioning; Prioritization of Social Involvement; Low Perceived Fall Risk and Attribution of Risk to External Factors; Avoidance and Caution as Fall Prevention; and Limited Falls Prevention Information During Transition from Hospital to Home. Limited awareness of and engagement in effective fall prevention may heighten recently discharged older adults' risks for falls. Prevention programs tailored to the post-discharge period may engage patients in fall prevention, promote well-being and independence, and link hospital and community efforts. [Journal of Gerontological Nursing, 45(1), 23-30.].
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19
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Hoffman GJ, Liu H, Alexander NB, Tinetti M, Braun TM, Min LC. Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older. JAMA Netw Open 2019; 2:e194276. [PMID: 31125100 PMCID: PMC6632136 DOI: 10.1001/jamanetworkopen.2019.4276] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Falls are common among older adults, particularly those with previous falls and cognitive impairment and in the postdischarge period. Hospitals have financial incentives to reduce both inpatient falls and hospital readmissions, yet little is known about whether fall-related injuries (FRIs) are common diagnoses for 30-day hospital readmissions. OBJECTIVE To compare fall-related readmissions with other leading rehospitalization diagnoses, including for patients at greatest risk of readmission. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of the Hospital Cost and Utilization Project's Nationwide Readmissions Database of nationally representative US hospital discharges among Medicare beneficiaries aged 65 years and older from January 1, 2013, to November 30, 2014. The prevalence and ranking of FRIs compared with other diagnostic factors for 30-day unplanned hospital-wide readmissions were determined, overall and for 2 acute geriatric cohorts, classified by fall injury or cognitive impairment diagnoses observed at the index admission. Analyses were also stratified by patient discharge disposition (home, home health care, skilled nursing facility). Analyses were conducted from February 1, 2018, to February 26, 2018. MAIN OUTCOMES AND MEASURES Unplanned hospital-wide readmission within 30 days of discharge. RESULTS From the database, 8 382 074 eligible index admissions were identified, including 746 397 (8.9%) in the FRI cohort and 1 367 759 (16.3%) in the cognitive impairment cohort. Among the entire 8 382 074-discharge cohort, mean (SD) age was 77.7 (7.8) years and 4 736 281 (56.5%) were female. Overall, 1 205 962 (14.4%) of index admissions resulted in readmission, with readmission rates of 12.9% for those with a previous fall and 16.0% for patients with cognitive impairment. Overall, FRIs ranked as the third-leading readmission diagnosis, accounting for 60 954 (5.1%) of all readmission diagnoses. Within the novel acute geriatric cohorts, FRIs were the second-leading diagnosis for readmission both for patients with an FRI at index admission (10.3% of all readmission diagnoses) and those with cognitive impairment (7.0% of all readmission diagnoses). For those with an FRI at index admission and discharged home or to home health care, FRIs were the leading readmission diagnosis. CONCLUSIONS AND RELEVANCE This study found that posthospital FRIs were a leading readmission diagnosis, particularly for patients originally admitted with a FRI or cognitive impairment. Targeting at-risk hospitalized older adults, particularly those discharged to home or home health care, is an underexplored, cost-effective mechanism with potential to reduce readmissions and improve patient care.
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Affiliation(s)
- Geoffrey J. Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Haiyin Liu
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor
| | - Neil B. Alexander
- Geriatric Research Education and Clinical Care Center (GRECC), VA Medical Center, Ann Arbor, Michigan
- Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor
| | - Mary Tinetti
- Division of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- School of Public Health, Yale University, New Haven, Connecticut
| | - Thomas M. Braun
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Lillian C. Min
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor
- Veterans Affairs Center for Clinical Management and Research (CCMR), VA Medical Center, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor
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20
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Hoffman GJ, Shuman CJ, Montie M, Anderson CA, Titler MG. Caregivers' views of older adult fall risk and prevention during hospital-to-home transitions. Appl Nurs Res 2019; 47:10-15. [PMID: 31113538 DOI: 10.1016/j.apnr.2019.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/15/2019] [Accepted: 03/24/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Geoffrey J Hoffman
- University of Michigan School of Nursing, 400 N. Ingalls, Room 4352, Ann Arbor, MI 48109-5482, United States of America.
| | - Clayton J Shuman
- University of Michigan School of Nursing, United States of America
| | - Mary Montie
- Detroit Medical Center, United States of America
| | | | - Marita G Titler
- University of Michigan School of Nursing, United States of America
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21
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Bernocchi P, Giordano A, Pintavalle G, Galli T, Ballini Spoglia E, Baratti D, Scalvini S. Feasibility and Clinical Efficacy of a Multidisciplinary Home-Telehealth Program to Prevent Falls in Older Adults: A Randomized Controlled Trial. J Am Med Dir Assoc 2019; 20:340-346. [DOI: 10.1016/j.jamda.2018.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022]
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22
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Meyer C, Renehan E, Batchelor F, Said C, Haines T, Elliott R, Goeman D. 'Falls not a priority': insights on discharging older people, admitted to hospital for a fall, back to the community. Aust J Prim Health 2019; 24:66-73. [PMID: 29132500 DOI: 10.1071/py17052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/07/2017] [Indexed: 11/23/2022]
Abstract
Falls are common among older people and a leading cause of injury-related hospitalisation. The immediate post-hospitalisation period is a risky time for further falls. This paper explores discharge strategies from the perspectives of older people hospitalised for a fall and liaison nurses assisting people to return home. Exploratory mixed methods were used. Semi-structured interviews with older people were conducted regarding their experience of the fall and discharge strategies. Quality of life, falls risk and functional capacity were measured by questionnaire. Liaison nurses were also interviewed. Interviews were audio-recorded, transcribed and thematically analysed. Mixed-method synthesis occurred using role-ordered matrix analysis. Older people (n=13) and liaison nurses (n=6) participated. Older persons' quality of life was average and falls risk high. Thematic analysis revealed three key themes: 'falls are not a priority', 'information not given, or given and not retained' and 'reduction in confidence and independence'. Role-ordered matrix analysis identified differences between acute and rehabilitative hospital stays. Older people hospitalised for a fall present a unique opportunity for implementation of falls prevention strategies. However, hospitalisation is often a time of crisis with competing priorities. Timing and relevance are crucial for optimal uptake of falls prevention strategies, with the primary care setting well-placed for their implementation.
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Affiliation(s)
- Claudia Meyer
- Bolton Clarke, 31 Alma Road, St Kilda, Vic. 3182, Australia
| | - Emma Renehan
- Bolton Clarke, 31 Alma Road, St Kilda, Vic. 3182, Australia
| | - Frances Batchelor
- National Ageing Research Institute, 34-54 Poplar Road, Parkville, Vic. 3052, Australia
| | - Catherine Said
- Department of Physiotherapy, Austin Health, 145 Studley Road, Heidelberg, Vic. 3084, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Frankston, Vic. 3199, Australia
| | | | - Dianne Goeman
- Bolton Clarke, 31 Alma Road, St Kilda, Vic. 3182, Australia
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24
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Hunter SW, Higa J, Frengopoulos C, Viana R, Payne MW. Evaluating knowledge of falls risk factors and falls prevention strategies among lower extremity amputees after inpatient prosthetic rehabilitation: a prospective study. Disabil Rehabil 2019; 42:2252-2261. [PMID: 30686062 DOI: 10.1080/09638288.2018.1555721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Falls are prevalent among people with lower extremity amputations. A knowledge of risk factors is important in preventing falls, though no research has evaluated patient understanding of falls in this population. The study objective was to evaluate knowledge of falls risk factors and falls prevention strategies at discharge and 4-months after inpatient prosthetic rehabilitation.Methods: Participants completed a falls questionnaires with four sections: (1) falls during rehabilitation and after discharge, (2) falls self-efficacy using the Activities-specific Balance Confidence scale, (3) knowledge of falls risk factors, and (4) falls prevention strategies. Questionnaire responses were quantified using means and standard deviations or frequencies and percentages. Data were analyzed using paired t-tests for the Activities-specific Balance Confidence scale and the knowledge of falls risk factors, and using chi-square analyses for fall prevention strategies.Results: Twenty-seven individuals (aged 62.6 ± 8.4; 55.6% male) were included. Unsafe or risky behaviours and not paying attention to surroundings were perceived as the top two falls risk factors. Although these factors are modifiable, only 5.9% of participants listed preventative behavioural modifications. No significant differences were found in Activities-specific Balance Confidence scale scores (p = 0.404) or knowledge of falls risk factors (p = 0.361) between discharge and follow-up.Conclusion: This study highlights a gap between knowledge of falls risk factors and the application of knowledge to prevent falls. Follow-up data suggest that lived experience does not affect the knowledge of falls risk factors.IMPLICATIONS FOR REHABILITATIONFalls and falls prevention are an important health concern for those with lower extremityamputations and should be addressed during the rehabilitation process.Balance confidence among individuals with lower extremity amputations is low, indicating that this population is at an increased falls risk and may require intervention to prevent falls.Rehabilitation programs should encourage all forms of falls prevention modifications and strategies, such as behavioural modifications, physical activity and environmental modifications.There is a gap between knowledge of falls risk factors and how to apply this to prevent falls, which may be a target for rehabilitation.
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Affiliation(s)
- Susan W Hunter
- School of Physical Therapy, University of Western Ontario, London, ON, Canada.,Schulich School of Medicine and Dentistry Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON, Canada
| | - Jordan Higa
- Faculty of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada
| | - Courtney Frengopoulos
- Faculty of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada
| | - Ricardo Viana
- Schulich School of Medicine and Dentistry Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON, Canada.,Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, ON, Canada
| | - Michael Wc Payne
- Schulich School of Medicine and Dentistry Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON, Canada.,Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, ON, Canada
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Ott LD. The impact of implementing a fall prevention educational session for community-dwelling physical therapy patients. Nurs Open 2018; 5:567-574. [PMID: 30338102 PMCID: PMC6177546 DOI: 10.1002/nop2.165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 05/14/2018] [Indexed: 11/17/2022] Open
Abstract
AIM The aim of this study was to evaluate the impact of a fall prevention educational session on fall risk knowledge, use of fall prevention interventions and the number of falls in community-dwelling older persons attending physical therapy. DESIGN This pilot study used a mixed method design consisting of a quantitative pretest-posttest quasi-experimental design followed by a qualitative interview. METHOD An educational intervention was given with pre- and posttest questionnaires to determine the outcome measures of: (a) fall risk knowledge; (b) number of participants implementing fall prevention techniques; and (c) the number of falls sustained for 60 days post the educational sessions. The Health Belief Model served as the theoretical underpinnings for development and presentation of two educational sessions. RESULTS Eight of 20 participants completed the fall prevention educational sessions and subsequent evaluation. An increase in fall risk knowledge (p = 0.031) and implementation of fall prevention techniques was noted. One fall was sustained 60 days after therapy discharge.
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Affiliation(s)
- Lynda Dee Ott
- Valdosta State UniversityCollege of Nursing & Health SciencesValdostaGeorgiaUSA
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Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2018; 9:CD005465. [PMID: 30191554 PMCID: PMC6148705 DOI: 10.1002/14651858.cd005465.pub4] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012. OBJECTIVES To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017. SELECTION CRITERIA Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals. DATA COLLECTION AND ANALYSIS One review author screened abstracts; two review authors screened full-text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence. MAIN RESULTS Thirty-five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low-quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.Care facilitiesSeventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low-quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low-quality evidence).There is low-quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%).There is moderate-quality evidence that vitamin D supplementation (4512 participants, 4 studies) probably reduces the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; I² = 62%), but probably makes little or no difference to the risk of falling (RR 0.92, 95% CI 0.76 to 1.12; I² = 42%). The population included in these studies had low vitamin D levels.Multifactorial interventions were tested in 13 trials. We are uncertain of the effect of multifactorial interventions on the rate of falls (RaR 0.88, 95% CI 0.66 to 1.18; 3439 participants, 10 studies; I² = 84%; very low-quality evidence). They may make little or no difference to the risk of falling (RR 0.92, 95% CI 0.81 to 1.05; 3153 participants, 9 studies; I² = 42%; low-quality evidence).HospitalsThree trials tested the effect of additional physiotherapy (supervised exercises) in rehabilitation wards (subacute setting). The very low-quality evidence means we are uncertain of the effect of additional physiotherapy on the rate of falls (RaR 0.59, 95% CI 0.26 to 1.34; 215 participants, 2 studies; I² = 0%), or whether it reduces the risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 83 participants, 2 studies; I² = 0%).We are uncertain of the effects of bed and chair sensor alarms in hospitals, tested in two trials (28,649 participants) on rate of falls (RaR 0.60, 95% CI 0.27 to 1.34; I² = 0%; very low-quality evidence) or risk of falling (RR 0.93, 95% CI 0.38 to 2.24; I² = 0%; very low-quality evidence).Multifactorial interventions in hospitals may reduce rate of falls in hospitals (RaR 0.80, 95% CI 0.64 to 1.01; 44,664 participants, 5 studies; I² = 52%). A subgroup analysis by setting suggests the reduction may be more likely in a subacute setting (RaR 0.67, 95% CI 0.54 to 0.83; 3747 participants, 2 studies; I² = 0%; low-quality evidence). We are uncertain of the effect of multifactorial interventions on the risk of falling (RR 0.82, 95% CI 0.62 to 1.09; 39,889 participants; 3 studies; I² = 0%; very low-quality evidence). AUTHORS' CONCLUSIONS In care facilities: we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. We are uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.In hospitals: we are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. We are uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; we are uncertain of the effect of these interventions on risk of falling.
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Affiliation(s)
- Ian D Cameron
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Suzanne M Dyer
- DHATR Consulting120 Robsart StreetParksideSouth AustraliaAustralia5063
| | - Claire E Panagoda
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health DistrictSt LeonardsNSWAustralia2065
| | - Geoffrey R Murray
- Illawarra Shoalhaven Local Health DistrictAged Care, Rehabilitation and Palliative CareWarrawongAustralia
| | - Keith D Hill
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesGPO Box U1987PerthWestern AustraliaAustralia6845
| | - Robert G Cumming
- Sydney Medical School, University of SydneySchool of Public HealthRoom 306, Edward Ford Building (A27)Fisher RoadSydneyNSWAustralia2006
| | - Ngaire Kerse
- University of AucklandDepartment of General Practice and Primary Health CarePrivate Bag 92019AucklandNew Zealand
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Koru G, Alhuwail D, Jademi O, Uchidiuno U, Rosati RJ. Technology Innovations for Better Fall Risk Management in Home Care. J Gerontol Nurs 2018; 44:15-20. [PMID: 29677381 DOI: 10.3928/00989134-20180412-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Achieving better fall risk management is an integral component of quality home care. The current qualitative study uncovers the challenges and opportunities of home health agencies (HHAs) in achieving better fall risk management. A secondary document analysis was adopted to learn from rich contextual information in fall incident reports recorded in a HHA. Poor engagement of patients and caregivers was a contributing factor in many fall incidents. Patients often fell as a result of not understanding or accepting their physical limitations. For better fall risk management, many incidents highlighted a need for providing complete and thorough care, better coordination of care, higher levels of sociocultural awareness, patient engagement, and caregiver involvement. The results provide evidence regarding the challenges and opportunities for improving fall risk management in home care along with insight about how information technology solutions can support improvement initiatives. [Journal of Gerontological Nursing, 44(7), 15-20.].
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Evaluation of older people's knowledge, awareness, motivation and perceptions about falls and falls prevention in residential aged care homes: a tale of two cities. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18000697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractFalls prevention strategies can only be effective in reducing falls amongst older people if they are adopted and enacted in their daily lives. There is limited evidence identifying what older people in residential aged care (RAC) homes understand about falls and falls prevention, or what may limit or enable their adoption of strategies. This study was conducted in two countries and explored older people's knowledge and awareness of falls and their preferences, opportunities and motivation to undertake falls prevention strategies. A cross-sectional survey was administered to participants (N = 70) aged 65 years and over, living in six RAC homes in Perth, Australia and six RAC homes in Swansea, Wales, United Kingdom. Participants had limited knowledge about intrinsic falls risk factors and strategies to address these and frequently expressed self-blame regarding falling. Almost all (N = 67, 95.7%) participants felt highly motivated to maintain their current functional mobility and independence in everyday tasks. Key preferences for receiving falls prevention messages favoured a positive approach promoting wellness and independence (N = 41, 58.6%) via pictorial posters or brochures (N = 37, 52.9%) and small group discussions preferably with demonstrations (N = 18, 25.7%). Findings from this study may assist organisations and staff to more effectively engage with older people living in RAC about falls prevention and design targeted resources to address the motivations and preferences of this population.
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Naseri C, McPhail SM, Netto J, Haines TP, Morris ME, Etherton-Beer C, Flicker L, Lee DCA, Francis-Coad J, Hill AM. Impact of tailored falls prevention education for older adults at hospital discharge on engagement in falls prevention strategies postdischarge: protocol for a process evaluation. BMJ Open 2018; 8:e020726. [PMID: 29678985 PMCID: PMC5914781 DOI: 10.1136/bmjopen-2017-020726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Older adults recently discharged from hospital have greater incidence of adverse events, functional decline, falls and subsequent readmission. Providing education to hospitalised patients on how to prevent falls at home could reduce postdischarge falls. There has been limited research investigating how older adults respond to tailored falls prevention education provided at hospital discharge. The aim of this study is to evaluate how providing tailored falls prevention education to older patients at the point of, and immediately after hospital discharge in addition to usual care, affects engagement in falls prevention strategies in the 6-months postdischarge period, including their capability and motivation to engage in falls prevention strategies. METHODS AND ANALYSES This prospective observational cohort study is a process evaluation of a randomised controlled trial, using an embedded mixed-method design. Participants (n=390) who have been enrolled in the trial are over the age of 60 years, scoring greater than 7/10 on the Abbreviated Mental Test Score. Participants are being discharged from hospital rehabilitation wards in Perth, Western Australia, and followed up for 6 months postdischarge. Primary outcome measures for the process evaluation are engagement in falls prevention strategies, including exercise, home modifications and receiving assistance with activities of daily living. Secondary outcomes will measure capability, motivation and opportunity to engage in falls prevention strategies, based on the constructs of the Capability Opportunity Motivation Behaviour system. Quantitative data are collected at baseline, then at 6 months postdischarge using structured phone interviews. Qualitative data are collected from a purposive sample of the cohort, using semistructured in-depth phone interviews. Quantitative data will be analysed using regression modelling and qualitative data will be analysed using interpretive phenomenological analysis. ETHICS AND DISSEMINATION Results will be presented in peer-reviewed journals and at conferences worldwide. This study is approved by hospital and university Human Research Ethics Committees.
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Affiliation(s)
- Chiara Naseri
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
| | - Steven M McPhail
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Woolloongabba, Queensland, Australia
| | - Julie Netto
- School of Occupational Therapy and Social Work, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
| | - Terrence P Haines
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Meg E Morris
- Healthscope & La Trobe Centre for Sport & Exercise Medicine Research, La Trobe University, Melbourne, Victoria, Australia
| | - Christopher Etherton-Beer
- Department of Geriatric Medicine, School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Den-Ching A Lee
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline Francis-Coad
- School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
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Jancey J, Wold C, Meade R, Sweeney R, Davison E, Leavy J. A balanced approach to falls prevention: Application in the real world. Health Promot J Austr 2018; 29:199-203. [DOI: 10.1002/hpja.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 01/31/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health; School of Public Health; Curtin University; Perth WA Australia
| | | | - Rachel Meade
- Western Australian Department of Health; Perth WA Australia
| | | | - Erica Davison
- Western Australian Department of Health; Perth WA Australia
| | - Justine Leavy
- Collaboration for Evidence, Research and Impact in Public Health; School of Public Health; Curtin University; Perth WA Australia
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Resnick B, Galik E, Boltz M, Vigne E, Holmes S, Fix S, Zhu S. Physical Activity and Function in Assisted Living Residents. West J Nurs Res 2018; 40:1734-1748. [PMID: 29560808 DOI: 10.1177/0193945918764448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to consider the feasibility, reliability, and validity of MotionWatch 8. A total of 249 residents were recruited from 26 assisted living settings. Data collection included demographics, comorbidities, function (Barthel Index), physical activity (MotionWatch 8), and falls. The mean age of participants was 86.86 ( SD = 7.0), the majority were women 179 (74%) and White ( N = 232, 96%). A total of 86% of participants wore the MotionWatch 8. There were no significant differences in physical activity over 3 days of testing. The MotionWatch 8 findings were significantly associated with activities of daily living (ADL) function. There were no significant differences in ADL function or physical activity between those who did and did not fall. The study provides additional support for the feasibility, reliability, and validity of the MotionWatch 8 and confirms that older adults living in assisted living settings spend the majority of their time in sedentary activity.
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Affiliation(s)
| | | | - Marie Boltz
- 2 Pennsylvania State University, University Park, USA
| | - Erin Vigne
- 1 University of Maryland, Baltimore, MD, USA
| | | | - Steven Fix
- 1 University of Maryland, Baltimore, MD, USA
| | - Shijun Zhu
- 1 University of Maryland, Baltimore, MD, USA
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Lockwood KJ, Harding KE, Boyd JN, Taylor NF. Reasons for readmission to hospital after hip fracture: Implications for occupational therapy. Br J Occup Ther 2018. [DOI: 10.1177/0308022618756000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The aim of this study was to determine the rate of readmission to hospital after hip fracture. The relationship between readmission to hospital and a range of social and functional variables, including receiving a home visit by an occupational therapist prior to discharge from hospital, was explored. Method A retrospective cohort study was conducted of 154 patients returning to community living following hip fracture. Multivariate logistic regression identified variables associated with risk of readmission to hospital. Results One in three patients was readmitted to hospital within 12 months after discharge, with 7% readmitted within 30 days. The most common reason for readmission was another fall. A low level of mobility prior to hip fracture was the strongest independent predictor of risk of readmission to hospital. There was no association between receiving a pre-discharge home visit by an occupational therapist and risk of readmission to hospital. Conclusion Rates of readmission to hospital are high after hip fracture, and falls are the single most common reason for readmission. Interventions provided by occupational therapists, including home visits, should emphasise and incorporate evidence-based falls prevention strategies.
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Affiliation(s)
- Kylee J Lockwood
- Lecturer and PhD candidate, School of Allied Health, La Trobe University, Australia
| | - Katherine E Harding
- Allied Health Senior Research Fellow, Allied Health Clinical Research Office, Eastern Health, Australia
- Adjunct Senior Lecturer, School of Allied Health, La Trobe University, Australia
| | - Jude N Boyd
- Director Occupational Therapy, Eastern Health, Australia
| | - Nicholas F Taylor
- Professor of Allied Health, School of Allied Health, La Trobe University, Australia
- Professor of Allied Health, Allied Health Clinical Research Office, Eastern Health, Australia
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Khong LAM, Berlach RG, Hill KD, Hill AM. Community Peer-Led Falls Prevention Presentations: What Do the Experts Suggest? J Prim Prev 2018; 39:81-98. [PMID: 29322357 DOI: 10.1007/s10935-017-0500-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Falls among older adults are a major problem. Despite considerable progress in falls prevention research, older adults often show low motivation to engage in recommended preventive strategies. Peer-led falls prevention education for older adults may have potential for bridging the research evidence-practice gap, thereby promoting the uptake of falls prevention strategies. We evaluated peer educators' presentations of falls prevention education to community-dwelling older adults in regard to established criteria that were consistent with adult learning principles, the framework of health behaviour change, falls prevention guidelines, and recommendations for providing falls prevention information. We conducted a within-stage mixed model study using purposive and snowball sampling techniques to recruit 10 experts to evaluate video recordings of the delivery of three peer-led falls prevention presentations. Each expert viewed three videos and rated them using a questionnaire containing both open-ended and closed items. There was a good level of expert agreement across the questionnaire domains. Though the experts rated some aspects of the presentations highly, they thought that the presentations were mainly didactic in delivery, not consistently personally relevant to the older adult audience, and did not encourage older adults to engage in the preventive strategies that were presented. Based on the experts' findings, we developed five key themes and recommendations for the effective delivery of peer-led falls prevention presentations. These included recommending that peer educators share falls prevention messages in a more interactive and experiential manner and that uptake of strategies should be facilitated by encouraging the older adults to develop a personalised action plan. Findings suggest that if peer-led falls prevention presentations capitalise on older adults' capability, opportunity, and motivation, the older adults may be more receptive to take up falls prevention messages.
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Affiliation(s)
- Linda A M Khong
- School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA, 6959, Australia.
| | - Richard G Berlach
- School of Education, The University of Notre Dame Australia, PO Box 1225, Fremantle, WA, 6959, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
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Chippendale T. Predicting Use of Outdoor Fall Prevention Strategies: Considerations for Prevention Practices. J Appl Gerontol 2018; 38:775-790. [PMID: 29291679 DOI: 10.1177/0733464817751199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Outdoor falls are just as common as indoor falls, but have received less attention in research and practice. Behavioral strategies play an important role in outdoor fall prevention. The purpose of this study was to examine predictors of strategy use. METHOD Backward stepwise regression was used to study factors associated with use of outdoor fall prevention strategies among a random sample ( N = 120) of community-dwelling seniors. RESULTS Significant negative predictors of strategy use included higher education levels ( p < .01) and living in an urban versus a suburban environment ( p < .01). Concern about falls and number of identified risks were positive predictors ( ps < .05). Differences were found between outdoor fallers and nonfallers in the use of three different types of strategies ( ps < .05). CONCLUSION There are some differences in the profiles of people who use and do not use outdoor fall prevention strategies. Further study of additional factors is warranted.
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Shankar KN, Treadway NJ, Taylor AA, Breaud AH, Peterson EW, Howland J. Older adult falls prevention behaviors 60 days post-discharge from an urban emergency department after treatment for a fall. Inj Epidemiol 2017; 4:18. [PMID: 28626848 PMCID: PMC5474391 DOI: 10.1186/s40621-017-0114-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a common and debilitating health problem for older adults. Older adults are often treated and discharged home by emergency department (ED)-based providers with the hope they will receive falls prevention resources and referrals from their primary care provider. This descriptive study investigated falls prevention activities, including interactions with primary care providers, among community-dwelling older adults who were discharged home after presenting to an ED with a fall-related injury. METHODS We enrolled English speaking patients, aged ≥ 65 years, who presented to the ED of an urban level one trauma center with a fall or fall related injury and discharged home. During subjects' initial visits to the ED, we screened and enrolled patients, gathered patient demographics and provided them with a flyer for a Matter of Balance course. Sixty-days post enrollment, we conducted a phone follow-up interview to collect information on post-fall behaviors including information regarding the efforts to engage family and the primary care provider, enroll in a falls prevention program, assess patients' attitudes towards falling and experiences with any subsequent falls. RESULTS Eighty-seven community-dwelling people between the ages of 65 and 90 were recruited, the majority (76%) being women. Seventy-one percent of subjects reported talking to their provider regarding the fall; 37% reported engaging in falls prevention activities. No subjects reported enrolling in a fall prevention program although two reported contacting falls program staff. Fourteen percent of subjects (n=12) reported a recurrent fall and 8% (7) reported returning to the ED after a recurrent fall. CONCLUSIONS Findings indicate a low rate of initiating fall prevention behaviors following an ED visit for a fall-related injury among community-dwelling older adults, and highlight the ED visit as an important, but underutilized, opportunity to mobilize health care resources for people at high risk for subsequent falls.
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Affiliation(s)
- Kalpana Narayan Shankar
- Department of Emergency Medicine, Boston University Medical Center and Boston University School of Medicine, One Boston Medical Center Place, Dowling 1 South, Boston, MA 02118 USA
- Boston Medical Center Injury Prevention Center, One Boston Medical Center Place, Boston, MA 02118 USA
| | - Nicole J. Treadway
- Department of Emergency Medicine, Boston University Medical Center and Boston University School of Medicine, One Boston Medical Center Place, Dowling 1 South, Boston, MA 02118 USA
- Boston Medical Center Injury Prevention Center, One Boston Medical Center Place, Boston, MA 02118 USA
| | - Alyssa A. Taylor
- Department of Emergency Medicine, Boston University Medical Center and Boston University School of Medicine, One Boston Medical Center Place, Dowling 1 South, Boston, MA 02118 USA
- Boston Medical Center Injury Prevention Center, One Boston Medical Center Place, Boston, MA 02118 USA
| | - Alan H. Breaud
- Boston Medical Center Injury Prevention Center, One Boston Medical Center Place, Boston, MA 02118 USA
| | - Elizabeth W. Peterson
- Department of Occupational Therapy, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL 60612 USA
| | - Jonathan Howland
- Department of Emergency Medicine, Boston University Medical Center and Boston University School of Medicine, One Boston Medical Center Place, Dowling 1 South, Boston, MA 02118 USA
- Boston Medical Center Injury Prevention Center, One Boston Medical Center Place, Boston, MA 02118 USA
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Abstract
Falls are the leading cause of fatal and nonfatal injuries among adults 65 years and older. Each year, one in three older adults experiences a fall, and people who fall are more likely to fall again. According to the National Council on Aging (2017), instituting evidence-based falls prevention programs can significantly decrease falls. The purpose of this article is to describe a pilot study that examined the impact of the Sure Steps Fall Prevention Program on incidence of falls among adults 65 and older living in their home. A convenience sample of 10 community-dwelling participants aged 65 and older was recruited. After the Sure Steps Fall Prevention Program was implemented, participants were contacted by telephone monthly for 1 year. None of the participants reported falls during that time. Based on the findings of this pilot study, the Visiting Nurse Association implemented the Sure Steps Fall Prevention Program into their other four clinical sites.
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Abstract
Purpose of the Study Examine patterns of cane and walker use as related to falls and fall injuries. Hypotheses Among people who fall at home, most do not have an assistive device with them when they fall. Nonusers who fall sustain more severe injuries. Design and Methods This was a cross-sectional study using a self-administered written survey completed by 262 people aged 60 and older who were community dwelling, cognitively intact, and current cane/walker users with a history of falls. They were recruited through clinical practice sites, churches, and senior housing in central Michigan. Outcomes of interest included patterns of device use, reasons for nonuse, device use at time of fall, and fall-related injuries. Results Seventy-five percent of respondents who fell were not using their device at the time of fall despite stating that canes help prevent falls. Reasons for nonuse included believing it was not needed, forgetfulness, the device made them feel old, and inaccessibility. Perceived risk was not high enough to engage in self-protective behavior. However, nonuse led to a significantly higher proportion of falls resulting in surgery than among device users. Among respondents requiring surgery, 100% were nonusers. Most respondents never received a home safety evaluation (68%) and only 50% received training on proper device use. Implications Providers must place increased emphasis on the importance of cane/walker use for injury prevention through patient education to promote personal relevance, proper fitting, and training. New strategies are needed to improve device acceptability and accessibility.
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Affiliation(s)
- Clare Luz
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing
| | - Tamara Bush
- Department of Mechanical Engineering, College of Engineering, Michigan State University, East Lansing
| | - Xiaoxi Shen
- Department of Statistics and Probability, Michigan State University, East Lansing
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Bilik O, Damar HT, Karayurt O. Fall behaviors and risk factors among elderly patients with hip fractures. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Hill AM, Etherton-Beer C, McPhail SM, Morris ME, Flicker L, Shorr R, Bulsara M, Lee DC, Francis-Coad J, Waldron N, Boudville A, Haines T. Reducing falls after hospital discharge: a protocol for a randomised controlled trial evaluating an individualised multimodal falls education programme for older adults. BMJ Open 2017; 7:e013931. [PMID: 28153933 PMCID: PMC5293998 DOI: 10.1136/bmjopen-2016-013931] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Older adults frequently fall after discharge from hospital. Older people may have low self-perceived risk of falls and poor knowledge about falls prevention. The primary aim of the study is to evaluate the effect of providing tailored falls prevention education in addition to usual care on falls rates in older people after discharge from hospital compared to providing a social intervention in addition to usual care. METHODS AND ANALYSES The 'Back to My Best' study is a multisite, single blind, parallel-group randomised controlled trial with blinded outcome assessment and intention-to-treat analysis, adhering to CONSORT guidelines. Patients (n=390) (aged 60 years or older; score more than 7/10 on the Abbreviated Mental Test Score; discharged to community settings) from aged care rehabilitation wards in three hospitals will be recruited and randomly assigned to one of two groups. Participants allocated to the control group shall receive usual care plus a social visit. Participants allocated to the experimental group shall receive usual care and a falls prevention programme incorporating a video, workbook and individualised follow-up from an expert health professional to foster capability and motivation to engage in falls prevention strategies. The primary outcome is falls rates in the first 6 months after discharge, analysed using negative binomial regression with adjustment for participant's length of observation in the study. Secondary outcomes are injurious falls rates, the proportion of people who become fallers, functional status and health-related quality of life. Healthcare resource use will be captured from four sources for 6 months after discharge. The study is powered to detect a 30% relative reduction in the rate of falls (negative binomial incidence ratio 0.70) for a control rate of 0.80 falls per person over 6 months. ETHICS AND DISSEMINATION Results will be presented in peer-reviewed journals and at conferences worldwide. This study is approved by hospital and university Human Research Ethics Committees. TRIAL REGISTRATION NUMBER ACTRN12615000784516.
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Affiliation(s)
- Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Christopher Etherton-Beer
- Royal Perth Hospital Unit, WA Centre for Health and Ageing, School of Medicine & Pharmacology and Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Meg E Morris
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University & Healthscope, Melbourne, Victoria, Australia
| | - Leon Flicker
- Royal Perth Hospital Unit, WA Centre for Health and Ageing, School of Medicine & Pharmacology and Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Ronald Shorr
- Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Den-Ching Lee
- ACH Group, Health and Community Services, Burwood, Victoria, Australia
- Physiotherapy Department, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline Francis-Coad
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Nicholas Waldron
- Armadale Kelmscott Memorial Hospital, Perth, Western Australia, Australia
| | - Amanda Boudville
- St John of God Midland Public Hospital, Midland, Western Australia, Australia
| | - Terry Haines
- Physiotherapy Department, Monash University, Melbourne, Victoria, Australia
- Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
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Khong LAM, Berlach RG, Hill KD, Hill AM. Can peer education improve beliefs, knowledge, motivation and intention to engage in falls prevention amongst community-dwelling older adults? Eur J Ageing 2017; 14:243-255. [PMID: 28936135 DOI: 10.1007/s10433-016-0408-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of the study was to evaluate the effectiveness of delivering a contemporary peer-led falls prevention education presentation on community-dwelling older adults' beliefs, knowledge, motivation and intention to engage in falls prevention strategies. A two-group quasi-experimental pre-test-post-test study using a convenience sample was conducted. A new falls prevention training package for peer educators was developed, drawing on contemporary adult learning and behaviour change principles. A 1-h presentation was delivered to community-dwelling older adults by peer educators trained with the new package (intervention group). Control group participants received an existing, 1-h falls prevention presentation by trained peer educators who had not received the adult learning and behaviour change training. Participants in both groups completed a purpose-developed questionnaire at pre-presentation, immediately post-presentation and at one-month follow-up. Participants' levels of beliefs, knowledge, motivation and intention were compared across these three points of time. Generalised estimating equations models examined associations in the quantitative data, while deductive content analysis was used for qualitative data. Participants (control n = 99; intervention n = 133) in both groups showed significantly increased levels of beliefs and knowledge about falls prevention, and intention to engage in falls prevention strategies over time compared to baseline. The intervention group was significantly more likely to report a clear action plan to undertake falls prevention strategies compared to the control group. Peer-led falls prevention education is an effective approach for raising older adults' beliefs, knowledge and intention to engage in falls prevention strategies.
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Affiliation(s)
- Linda A M Khong
- School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA 6959 Australia
| | - Richard G Berlach
- School of Education, The University of Notre Dame Australia, PO Box 1225, Fremantle, WA 6959 Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
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Alhuwail D, Koru G, Nahm ES. How Can Home Care Patients and Their Caregivers Better Manage Fall Risks by Leveraging Information Technology? J Patient Exp 2016; 3:137-144. [PMID: 28725850 PMCID: PMC5513656 DOI: 10.1177/2374373517690286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES From the perspectives of home care patients and caregivers, this study aimed to (a) identify the challenges for better fall-risk management during home care episodes and (b) explore the opportunities for them to leverage health information technology (IT) solutions to improve fall-risk management during home care episodes. METHODS Twelve in-depth semistructured interviews with the patients and caregivers were conducted within a descriptive single case study design in 1 home health agency (HHA) in the mid-Atlantic region of the United States. RESULTS Patients and caregivers faced challenges to manage fall risks such as unmanaged expectations, deteriorating cognitive abilities, and poor care coordination between the HHA and physician practices. Opportunities to leverage health IT solutions included patient portals, telehealth, and medication reminder apps on smartphones. CONCLUSION Effectively leveraging health IT could further empower patients and caregivers to reduce fall risks by acquiring the necessary information and following clinical advice and recommendations. The HHAs could improve the quality of care by adopting IT solutions that show more promise of improving the experiences of patients and caregivers in fall-risk management.
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Affiliation(s)
- Dari Alhuwail
- Department of Information Science, College of Computing Sciences and Engineering, Kuwait University, Kuwait
| | - Güneş Koru
- Department of Information Systems, University of Maryland, Baltimore County, MD, USA
| | - Eun-Shim Nahm
- School of Nursing, University of Maryland, Baltimore, MD, USA
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Hang JA, Francis-Coad J, Burro B, Nobre D, Hill AM. Assessing knowledge, motivation and perceptions about falls prevention among care staff in a residential aged care setting. Geriatr Nurs 2016; 37:464-469. [DOI: 10.1016/j.gerinurse.2016.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 11/26/2022]
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Hill AM, Ross-Adjie G, McPhail SM, Monterosso L, Bulsara M, Etherton-Beer C, Powell SJ, Hardisty G. Incidence, risk factors and the healthcare cost of falls postdischarge after elective total hip and total knee replacement surgery: protocol for a prospective observational cohort study. BMJ Open 2016; 6:e011139. [PMID: 27412102 PMCID: PMC4947758 DOI: 10.1136/bmjopen-2016-011139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The number of major joint replacement procedures continues to increase in Australia. The primary aim of this study is to determine the incidence of falls in the first 12 months after discharge from hospital in a cohort of older patients who undergo elective total hip or total knee replacement. METHODS AND ANALYSES A prospective longitudinal observational cohort study starting in July 2015, enrolling patients aged ≥60 years who are admitted for elective major joint replacement (n=267 total hip replacement, n=267 total knee replacement) and are to be discharged to the community. Participants are followed up for 12 months after hospital discharge. The primary outcome measure is the rate of falls per thousand patient-days. Falls data will be collected by 2 methods: issuing a falls diary to each participant and telephoning participants monthly after discharge. Secondary outcomes include the rate of injurious falls and health-related quality of life. Patient-rated outcomes will be measured using the Oxford Hip or Oxford Knee score. Generalised linear mixed modelling will be used to examine the falls outcomes in the 12 months after discharge and to examine patient and clinical characteristics predictive of falls. An economic evaluation will be conducted to describe the nature of healthcare costs in the first 12 months after elective joint replacement and estimate costs directly attributable to fall events. ETHICS AND DISSEMINATION The results will be disseminated through local site networks and will inform future services to support older people undergoing hip or knee joint replacement and also through peer-reviewed publications and medical conferences. This study has been approved by The University of Notre Dame Australia and local hospital human research ethics committees. TRIAL REGISTRATION NUMBER ACTRN12615000653561; Pre-results.
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Affiliation(s)
- Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Gail Ross-Adjie
- Centre for Nursing and Midwifery Research, St John of God Murdoch Hospital, Perth, Western Australia, Australia
- School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Steven M McPhail
- Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Leanne Monterosso
- Centre for Nursing and Midwifery Research, St John of God Murdoch Hospital, Perth, Western Australia, Australia
- School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Christopher Etherton-Beer
- School of Medicine and Pharmacology, WA Centre for Health & Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Sarah-Jayne Powell
- Centre for Nursing and Midwifery Research, St John of God Murdoch Hospital, Perth, Western Australia, Australia
| | - Gerard Hardisty
- Centre for Translational Orthopaedic Research, University of Western Australia, Perth, Western Australia, Australia
- Western Orthopaedic Clinic, St John of God Hospital Murdoch and Subiaco, Perth, Western Australia, Australia
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Eriksson JK, Hildingh C, Buer N, Thulesius H. Seniors' self-preservation by maintaining established self and defying deterioration - A grounded theory. Int J Qual Stud Health Well-being 2016; 11:30265. [PMID: 27172511 PMCID: PMC4864830 DOI: 10.3402/qhw.v11.30265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/09/2022] Open
Abstract
The purpose of this classic grounded theory study was to understand how seniors who are living independently resolve issues influenced by visual impairment and high fall risk. We interviewed and observed 13 seniors with visual impairment in their homes. We also interviewed six visual instructors with experience from many hundreds of relevant incidents from the same group of seniors. We found that the seniors are resolving their main concern of “remaining themselves as who they used to be” by self-preservation. Within this category, the strategies maintaining the established self and defying deterioration emerged as the most prominent in our data. The theme maintaining the established self is mostly guided by change inertia and includes living the past (retaining past activities, reminiscing, and keeping the home intact) and facading (hiding impairment, leading to avoidance of becoming a burden and to risk juggling). Defying deterioration is a proactive scheme and involves moving (by exercising, adapting activities, using walking aids, driving), adapting (by finding new ways), and networking by sustaining old support networks or finding new networks. Self-preservation is generic human behavior and modifying this theory to other fields may therefore be worthwhile. In addition, health care providers may have use for the theory in fall preventive planning.
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Affiliation(s)
| | - Cathrine Hildingh
- School of Health and Welfare, Halmstad University, Sweden, Halmstad, Sweden
| | - Nina Buer
- School of Medical Sciences, Örebro University, Örebro, Sweden
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How older adults would like falls prevention information delivered: fresh insights from a World Café forum. AGEING & SOCIETY 2016. [DOI: 10.1017/s0144686x16000192] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTTranslation of falls prevention evidence into practice is problematic. Understanding older adults’ views about falls prevention information could enhance delivery of falls prevention, resulting in better engagement and uptake of recommended activities. The aim of this study was to examine the views and preferences of community-dwelling older adults about seeking and receiving falls prevention information. A community forum using a modified World Café approach was conducted. Participants discussed five topic areas in small groups, under the guidance of table facilitators. Perspectives were captured on paper. Thematic analysis was conducted to identify factors that influence participants’ engagement and uptake of information. Seventy-three older adults participated in the forum covering wide-ranging preferences around falls prevention information. Personal experience was considered the key influence on an older adult's decision to initiate seeking information. While health professionals were often approached, alternative sources such as public libraries, peer educators and seniors’ organisations were also favoured as credible sources of information. Older adults proposed falls prevention information should be delivered with a positive tone, coupled with highly valued qualities of respect, empathy and time to listen to foster motivation to engage in recommended activities. Consumer-focused practical strategies were proposed to potentially improve future design, communication and dissemination of falls prevention information. This improvement could enhance engagement of messages and subsequent uptake of falls prevention recommended strategies.
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Shuman C, Liu J, Montie M, Galinato JG, Todd MA, Hegstad M, Titler M. Patient perceptions and experiences with falls during hospitalization and after discharge. Appl Nurs Res 2016; 31:79-85. [PMID: 27397823 DOI: 10.1016/j.apnr.2016.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/19/2016] [Accepted: 01/28/2016] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this study was to describe hospitalized older adults' (> 60years) perceptions about (1) their fall risks while hospitalized; (2) fall prevention interventions received while hospitalized; and (3) fall prevention discharge instructions. BACKGROUND Little is known about hospitalized older adults' perceptions regarding fall prevention interventions received during hospitalization and fall prevention discharge instructions. METHODS This is a prospective, exploratory study using qualitative methods. RESULTS This paper reports qualitative findings of patients' perspectives on fall prevention interventions during hospitalization and at discharge. Eight major themes supported by multiple minor themes emerged: overall perceptions of falling; overall perceptions of fall prevention interventions while hospitalized; "telling" fall prevention; "doing" fall prevention; effectiveness of fall prevention strategies; personal fall prevention strategies; fall-related discharge instructions; and most effective fall-related discharge instructions. CONCLUSIONS Findings suggest healthcare providers need to more fully engage patients and families in understanding fall prevention interventions and factors contributing to falls during hospitalization and at discharge.
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Affiliation(s)
- Clayton Shuman
- University of Michigan, School of Nursing, Ann Arbor, MI 48109, USA
| | - Jia Liu
- University of Michigan, School of Nursing, Ann Arbor, MI 48109, USA
| | - Mary Montie
- University of Michigan, School of Nursing, Ann Arbor, MI 48109, USA.
| | | | - Molly A Todd
- St. Joseph Mercy-Ann Arbor, Ann Arbor, MI 48106, USA
| | | | - Marita Titler
- University of Michigan, School of Nursing, Ann Arbor, MI 48109, USA
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Tuvemo Johnson S, Martin C, Anens E, Johansson AC, Hellström K. Older Adults' Opinions on Fall Prevention in Relation to Physical Activity Level. J Appl Gerontol 2016; 37:58-78. [PMID: 26769824 DOI: 10.1177/0733464815624776] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The purpose of this study was to explore and describe older adults' opinions regarding actions to prevent falls and to analyze differences in the opinions of highly versus less physically active older adults. An open-ended question was answered by 262 individuals aged 75 to 98 years living in the community. The answers were analyzed using qualitative content analysis, and differences in the categories were compared between highly and less physically active persons. Physical activity was measured according to a five-level scale. The content analysis resulted in eight categories: assistive devices, avoiding hazards, behavioral adaptive strategies, being physically active, healthy lifestyle, indoor modifications, outdoor modifications, and seeking assistance. Behavioral adaptive strategies were mentioned to a greater extent by highly active people, and indoor modifications were more often mentioned by less active older adults. Support for active self-directed behavioral strategies might be important for fall prevention among less physically active older adults.
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Moran L, Francis-Coad J, Patman S, Hill AM. Using a personalized DVD to prescribe an exercise program to older people post-hip fracture enhances adherence to the exercises – A feasibility study. Geriatr Nurs 2015; 36:273-80. [DOI: 10.1016/j.gerinurse.2015.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/19/2015] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
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Lam J, Liamputtong P, Hill K. Falls, falls prevention and the role of physiotherapy and exercise: perceptions and interpretations of Italian-born and Australian-born older persons living in Australia. J Cross Cult Gerontol 2015; 30:233-49. [PMID: 25917600 DOI: 10.1007/s10823-015-9263-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Exercise programmes are effective in reducing falls but few older people consider doing an exercise programme for falls prevention. This paper examines older people's perceptions and experiences of falls, physiotherapy and exercise. Individual interviews were conducted with Australian-born and Italian-born older persons who had ≥1 fall in the past 12 months and completed a community-based physiotherapy programme. Although preventing further falls was considered important, participants were unsure whether falls were preventable. Few described evidence-based approaches such as exercise or medication reviews as strategies to prevent falls. Most participants thought that physiotherapy and exercise were beneficial in improving physical function. A clear explanation on the role of exercise for falls prevention, that many falls are preventable, and understanding of personal motivating and de-motivating factors for exercise for falls prevention are important for clinicians to consider in engaging this group of older people.
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Affiliation(s)
- Julie Lam
- Northern Health, Bundoora, Victoria, Australia,
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[Facilitators and barriers for older people to take part in fall prevention programs: A review of literature]. Rev Epidemiol Sante Publique 2015; 63:105-18. [PMID: 25840864 DOI: 10.1016/j.respe.2014.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 08/02/2014] [Accepted: 10/22/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Falling is the leading cause of accidental death after 65. Fall prevention programs are effective, but they involve few seniors. This article reviewed the literature on facilitators and barriers to participate in such programs. METHODS A literature review was conducted to identify documents in English, German and French published between 1990 and May 2012. Medline database, PsychInfo, Psychological and behavioral sciences and Francis were systematically searched, as were the bibliographies and some journals of public health, gerontology and social sciences. Of 462 documents found, 19 were selected and analyzed. RESULTS Of the 19 articles selected, 12 were on qualitative studies and 7 on literature reviews. Among the barriers to participation in falls prevention programs, documents highlighted the perception of fall as an inevitable event, the inadequate timing of prevention intervention and material difficulties. Conversely, being referred to prevention intervention by a professional, being convinced by the social benefits of interventions and the adequacy of interventions to the needs of beneficiaries were factors facilitating the participation and compliance of the elderly. CONCLUSION This literature review identified three major issues to consider when implementing sustainable and acceptable fall prevention programs: choice of the referring agent, and social representations of falling.
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