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Nan J, Li Z, Zou X, Sun M, Gao J, Jiang Y. Fall risk perception in older adults: A concept analysis. J Clin Nurs 2024. [PMID: 38558421 DOI: 10.1111/jocn.17090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/10/2023] [Accepted: 12/08/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Fall prevention is crucial for older adults. Enhanced fall risk perception can encourage older adults to participate in fall prevention programs. However, there is still no unified definition of the concept of fall risk perception. OBJECTIVE To explore the concept of fall risk perception in older adults. DESIGN A concept analysis. DATA SOURCES The literature was searched using online databases including PubMed, Cochrane Library, Embase, CINAHL Complete, PsycINFO, Web of Science, China National Knowledge Infrastructure, WangFang and SinoMed. Searches were also conducted in Chinese and English dictionaries. The literature dates from the establishment of the database to April 2023. METHODS The methods of Walker and Avant were used to identify antecedents, attributes and consequences of the concept of "fall risk perception" in older adults. RESULTS Eighteen publications were included eventually. The attributes were identified as: (1) dynamic change, with features of continuum and stage; (2) whether falls are taken seriously; (3) a self-assessment of the fall probability, which is driven by individual independence; and (4) involves multiple complex emotional responses. The antecedents were identified as: (1) demographic and disease factors; (2) psychological factors and (3) environmental factors. The consequences were identified as: (1) risk-taking behaviour; (2) risk compensation behaviour; (3) risk transfer behaviour; and (4) emotions. CONCLUSION A theoretical definition of fall risk perception was identified. A conceptual model was developed to demonstrate the theoretical relationships between antecedents, attributes and consequences. This is helpful for the development of relevant theories and the formulation of fall prevention measures based on fall risk perception as the intervention target.
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Affiliation(s)
- Jiang Nan
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Zhuoran Li
- Department of Nursing, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Xueqiong Zou
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Manyao Sun
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Jing Gao
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Yuyu Jiang
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
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Palonen M, Turja T, Castano de la Rosa R, Ilomäki S, Kaasalainen T, Kivimäki Rantanen K, Pelsmakers S, Ruusuvuori J, Valtonen A, Kaunonen M. Learning from fall-related interventions for older people at home: A scoping review. Geriatr Nurs 2023; 54:76-82. [PMID: 37713947 DOI: 10.1016/j.gerinurse.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/17/2023]
Abstract
This scoping review aims to provide a better understanding about the fall-related interventions, and the conditions which stand out as effective in decreasing fall risks of older people at home. A total of 28 peer-reviewed papers were included when they reported interventions with an incidence of falls or fall-risk as a primary outcome for older people, focusing on the home environment, from 8 databases. Qualitative examination was complemented by quantitative risk ratio analysis where it was feasible. The interventions regarding incidence of falls had a mean risk rate of 0.75; moreover, interventions using multiple strategies were found relatively successful. The interventions regarding fall risk had a mean hazard rate of 0.66. A considerable number of no-effect ratios were evident. Combining education, home assessment or improvement, and use of technology with implementation by health service experts appears to be the most promising intervention strategy to reduce falls.
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Affiliation(s)
- Mira Palonen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.
| | - Tuuli Turja
- Faculty of Social Sciences, Unit of Social Research, Tampere University, Tampere, Finland
| | | | - Sakari Ilomäki
- Faculty of Social Sciences, Unit of Social Research, Tampere University, Tampere, Finland
| | - Tapio Kaasalainen
- Faculty of Built Environment, Unit of Architecture, Tampere University, Tampere, Finland
| | | | - Sofie Pelsmakers
- Faculty of Built Environment, Unit of Architecture, Tampere University, Tampere, Finland
| | - Johanna Ruusuvuori
- Faculty of Social Sciences, Unit of Social Research, Tampere University, Tampere, Finland
| | - Annika Valtonen
- Faculty of Social Sciences, Unit of Social Research, Tampere University, Tampere, Finland
| | - Marja Kaunonen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; The Well-being Services County of Pirkanmaa, Hospital services, Tampere, Finland
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Money A, Harris D, Hawley-Hague H, McDermott J, Vardy E, Todd C. Acceptability of physical activity signposting for pre-frail older adults: a qualitative study to inform intervention development. BMC Geriatr 2023; 23:621. [PMID: 37789276 PMCID: PMC10548637 DOI: 10.1186/s12877-023-04202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/28/2023] [Indexed: 10/05/2023] Open
Abstract
Frailty is a medical condition common in older adults characterised by diminished strength and reduced physiologic function in which individuals are more vulnerable to multiple adverse health outcomes. Pre-frailty is an intermediate stage associated with some minor health outcomes. However, the main risk is progression toward moderate/severe frailty. Evidence shows physical activity interventions to be effective in slowing or modifying the progression of frailty. Researchers at the University of Manchester are developing a behaviour change intervention targeting pre-frail older adults, signposting them to group-based physical activity classes known to be effective for delaying/slowing frailty. This paper reports on the initial intervention development work with key stakeholders exploring the practicality of taking forward this intervention and identifying uncertainties to be explored in the feasibility stage. These included issues around physical activity messaging, the use of the term 'frail', identification/recruitment of pre-frail older adults, and the acceptability of behaviour change techniques. There was overwhelming support for a proactive approach to addressing pre-frailty issues. Given that a large proportion of older adults are estimated to be pre-frail, interventions aimed at this group have the potential to support healthy ageing, positively impacting on frailty outcomes and providing wider population health benefits.
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Affiliation(s)
- Annemarie Money
- National Institute for Health and Care Research, Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK.
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
| | - Danielle Harris
- National Institute for Health and Care Research, Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Helen Hawley-Hague
- National Institute for Health and Care Research, Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- Manchester Institute for Collaborative Research on Ageing, The University of Manchester, Manchester, M13 9PL, UK
| | - Jane McDermott
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Emma Vardy
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- Manchester Institute for Collaborative Research on Ageing, The University of Manchester, Manchester, M13 9PL, UK
- Northern Care Alliance NHS Foundation Trust, Salford, M6 8HD, UK
| | - Chris Todd
- National Institute for Health and Care Research, Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- Manchester Institute for Collaborative Research on Ageing, The University of Manchester, Manchester, M13 9PL, UK
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
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Campelo AM, Weisberg A, Sheehan DP, Schneider K, Cossich VRA, Katz L. Physical and Affective Physical Literacy Domains Improved After a Six-Week Exergame Exercise Program in Older Adults: A Randomized Controlled Clinical Trial. Games Health J 2023; 12:366-376. [PMID: 37311178 DOI: 10.1089/g4h.2022.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Introduction: We investigated the effects of an exergames-based exercise program for older adults, and its benefits on their physical literacy (PL) domains, such as physical (mobility skills), affective (motivation and confidence), cognitive (knowledge about physical activity [PA]), and behavioral (daily exertion) when compared with a conventional exercise program and no training (NT) (control). Material and Methods: Forty older adults (mean age 72 years) volunteered and were randomized within three groups-exergame training (ET; n = 15), conventional training (CT; n = 14), and NT (n = 11). ET group performed training sessions based on a commercially available exergame console, while the CT group enrolled in a convention exercise program (aerobic, strength, balance, and flexibility exercises). The training program was conducted three times a week for 6 weeks. The Timed Up and Go Test (TUG), Exercise Confidence Survey (ECS), Motives for Physical Activity Measure-Revised (MPAM-R), Knowledge and Understanding Questionnaire (K&UQ), and total PA tracking (using wearable technology) were used as the study's outcomes. Outcome variables were measured at preintervention (week 0), postintervention (week 6), and at the time of final follow-up (week 9). Results: We observed a reduction in the ET TUG time at postintervention and follow-up. Also, a significant main effect for group and moment of measurement was observed for the Fitness-Health subscore, derived from MPAM-R. The values demonstrated by ET and CT were statistically different (P = 0.01) and a within-group comparison revealed significant differences in the ET from preintervention to both postintervention and follow-up (both, P = 0.01). We did not observe any other significant difference. Conclusion: Our results suggest that a 6-week exergame-based training program may have the potential in improving the physical and affective domains of PL in community-dwelling older adults. The topics related to fitness and health seem to be of interest in this population and programs can make use of them to improve the PL domains.
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Affiliation(s)
- Alexandre Monte Campelo
- Sport Technology Research Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Alanna Weisberg
- Sport Technology Research Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Dwayne P Sheehan
- Faculty of Health, Community and Education, Mount Royal University, Calgary, Canada
| | - Kathryn Schneider
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Victor R A Cossich
- Sport Technology Research Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Larry Katz
- Sport Technology Research Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
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Ortmann N, Haddad YK, Beck L. Special Report from the CDC: Provider knowledge and practices around driving safety and fall prevention screening and recommendations for their older adult patients, DocStyles 2019. JOURNAL OF SAFETY RESEARCH 2023; 86:401-408. [PMID: 37718068 DOI: 10.1016/j.jsr.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Falls and motor-vehicle crashes (MVCs) are leading causes of unintentional injury deaths among older adults (65+) in the United States. Injury prevention resources exist to help healthcare providers reduce fall and MVC risk among older adult patients. However, awareness of these resources among healthcare providers is unclear. METHODS Questions were included in the 2019 DocStyles survey that assessed healthcare provider awareness of three injury prevention resources: (1) the American Geriatrics Society's (AGS's) Clinician's Guide to Assessing and Counseling Older Drivers, (2) the Clinical Assessment of Driving Related Skills (CADReS), and (3) the Centers for Disease Control and Prevention's (CDC) Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. We also explored the circumstances and current practices for counseling older adult patients on fall prevention and driving safety. RESULTS Only 20% of providers reported awareness of any of the injury prevention resources. Providers were more likely to report either screening for fall risk or unsafe driving when an older adult presented with a fall concern (74.5%) or driving concern or recent crash (85.1%), compared to annual screening for fall risk (67.7%) or driving safety (47.7%). More providers reported discussing the increased fall or MVC risk associated with patient medications, referring patient for driving fitness evaluations, or discussing alternative transportation options with the patient after adverse events or patient-initiated concerns compared to routine annual discussions. CONCLUSION Healthcare gaps persist in the screening and assessment of older adult risk factors for falls and unsafe driving. Limited provider awareness of clinical resources related to preventing older adult falls and unsafe driving may be contributing to these healthcare gaps. PRACTICAL APPLICATIONS Improving healthcare provider awareness of these resources could help them identify older adults at risk of a fall or MVC and promote injury prevention efforts in their clinical practices.
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Affiliation(s)
- Neil Ortmann
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA; Cherokee Nation Operational Solutions, Atlanta, GA, USA.
| | - Yara K Haddad
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laurie Beck
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Pettersson B, Lundell S, Lundin-Olsson L, Sandlund M. 'Maintaining balance in life'-exploring older adults' long-term engagement in self-managed digital fall prevention exercise. Eur Rev Aging Phys Act 2023; 20:12. [PMID: 37464299 DOI: 10.1186/s11556-023-00322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Accidental falls are one of the greatest threats to older adults' health and well-being. The risk of falling can be significantly reduced with strength and balance interventions. However, there needs to be further knowledge into how older adults can be supported to achieve a maintained exercise behaviour. Therefore, the aim of this study was to explore factors that enabled older adults to maintain their exercise during a 1-year self-managed digital fall prevention exercise intervention. METHODS This study used a grounded theory methodology. Semi-structured individual interviews were conducted by phone or conference call. Eighteen community-dwelling older adults aged 70 years or more participated. The participants had a self-reported exercise dose of 60 min or more per week during the last three months of participation in a 12-months intervention of self-managed digital fall prevention exercise, the Safe Step randomized controlled trial. Open, axial, and selective coding, along with constant comparative analysis, was used to analyze the data. RESULTS The analysis resulted in a theoretical model. We found that the fall prevention exercise habits of adults were developed through three stages: Acting against threats to one's own identity, Coordinating strategies to establish a routine, and Forming habits through cues and evaluation. The main category of Maintaining balance in life encases the participants transition through the three stages and reflects balance in both physical aspects and in between activities in daily life. The process of maintaining balance in life and desire to do so were mediated both by intrinsic person-dependent factors and the Safe Step application acting as an external mediator. CONCLUSION This study identified three stages of how older adults developed self-managed fall prevention exercise habits, supported by a digital application. The generated theoretical model can inform future interventions aiming to support long-term engagement in digitally supported and self-managed fall prevention interventions.
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Affiliation(s)
- Beatrice Pettersson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 90187, Umeå, Sweden.
| | - Sara Lundell
- Department of Sociology, Umeå University, Umeå, Sweden
| | - Lillemor Lundin-Olsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 90187, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 90187, Umeå, Sweden
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Identity construction in the very old: A qualitative narrative study. PLoS One 2022; 17:e0279098. [PMID: 36520876 PMCID: PMC9754203 DOI: 10.1371/journal.pone.0279098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
People are living longer internationally, with a growing number experiencing very old age (≥95 years). Physical, psychological and social changes can challenge one's sense of self and disrupt existing identities. However, experiences of the very old in society are seldom researched and how they construct identity and negotiate a sense of self is little understood. Our study focuses on participants aged >95 years to understand how identity is conceptualised to negotiate a continued place in society. Qualitative interviews with 23 people were thematically analysed, underpinned by Positioning Theory. Five themes were generated: A contented life; reframing independence; familial positioning; appearance and physical wellbeing; reframing ill health. Participants saw themselves as largely content and, despite their world becoming smaller, found pleasure in small routines. Perceptions of self were reframed to maintain autonomy within narrow parameters. Past relationships and experiences/events were drawn on to make sense of ongoing ways of living. There were tensions around feelings of loss of autonomy and independence, with some valuing these over issues such as safety. This sometimes conflicted with views of others and small acts of resistance and subversion were acted out to maintain some sense of control. However, participants minimised progressive ill health. Findings provide insight into how the very old may utilise identity to negotiate, acquiesce, resist and challenge the world around them.
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Maiers M, Salsbury SA. "Like Peanut Butter and Jelly": A Qualitative Study of Chiropractic Care and Home Exercise Among Older Adults With Spinal Disability. Arthritis Care Res (Hoboken) 2022; 74:1933-1941. [PMID: 33973398 DOI: 10.1002/acr.24636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 03/17/2021] [Accepted: 04/22/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE A mixed-methods, randomized controlled trial comparing short- and long-term chiropractic care and exercise therapy for spinal disability in older adults found no between-group differences in the primary outcome. However, those who received long-term management reported greater improvement in neck pain, self-efficacy, function, and balance. This nested qualitative study explored participants' perceptions of the benefits and drawbacks of chiropractic care and exercise for spine-related outcomes, with an emphasis on understanding what makes treatment for spine-related problems worthwhile. METHODS Of 171 individual interviews conducted after completing study treatment, 50 participants (25 per treatment group) were randomly selected for this analysis. Qualitative descriptive analysis included dual coding of verbatim transcripts by 2 investigators (MM and SAS), which was further distilled into a consensus-derived codebook of themes and organized using NVIVO software. RESULTS Participants described trial interventions as complementary to one another for spine-related disability. Chiropractic care was viewed as improving spinal pain and controlling symptoms, while exercise therapy was noted for its long-term impact on self-efficacy and self-management. These older adults considered changes in pain, global sense of improvement, and improved biomechanical function as making treatment worthwhile. CONCLUSION Older adults valued nonpharmacologic treatment options that aided them in controlling spine-related symptoms, while empowering them to maintain clinical benefit gained after a course of chiropractic spinal manipulation and exercise. The complementary nature of provider-delivered and active care modalities may be an important consideration when developing care plans. This study underscores the importance of understanding participants' values and experiences when interpreting study results and applying them to practice.
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Affiliation(s)
- Michele Maiers
- Northwestern Health Sciences University, Bloomington, Minnesota
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Perceptions of people with Parkinson's and their caregivers of falling and falls-related healthcare services- a qualitative study. PLoS One 2022; 17:e0276588. [PMID: 36288338 PMCID: PMC9604942 DOI: 10.1371/journal.pone.0276588] [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: 08/11/2021] [Accepted: 10/11/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Falls are common in Parkinson's disease, and a recognised research priority. Falls lead to physical and psychological morbidity in people with Parkinson's disease and their caregivers, however, those with cognitive impairment/ dementia and caregivers have often been excluded from previous studies. This qualitative study explored how people with Parkinson's disease and their family caregivers understood and experienced falling and healthcare services relating to falls prevention and management. METHODS A varied and purposive sample of 20 people with Parkinson's disease (40% confirmed or suspected cognitive impairment/ dementia) and 18 caregivers took part in semi-structured interviews. Eight people with Parkinson's disease and their caregivers were interviewed as a dyad, 22 participants were interviewed alone. Interviews were analysed through inductive thematic analysis. RESULTS Four themes were developed: (i) struggling with thoughts and feelings about falling, (ii) recognising and managing risks surrounding falling, (iii) navigating health and care provision for falling, and (iv) changing as a couple due to falling. Different aspects of falls provoked a range of negative emotions and a variety of coping strategies were adopted. Falls and trying to avoid falls burdened a couple in a number of ways; beyond physical health they also affected functioning, physiological wellbeing, and relationships. Dyads analysed falls to understand their aetiology and described working together to manage them. This often happened in the absence of adequate support and advice with little involvement of healthcare professionals. When cognitive impairment/ dementia was present this brought additional challenges to falls management, with caregivers taking on a greater and more frustrating role. CONCLUSION Dyads required relevant falls-related information and the difficulties associated with cognitive decline should be recognised by researchers and healthcare professionals. Dyads required support in attributing reasons for falls, and increased awareness of healthcare professionals' different roles to improve patient- professional communication and facilitate patient-centred care.
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Kingstone T, Chew-Graham CA, Corp N. Interventions to identify and manage depression delivered by 'nontraditional' providers to community-dwelling older adults: A realist review. Health Expect 2022; 25:2658-2679. [PMID: 36068931 DOI: 10.1111/hex.13594] [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: 03/21/2022] [Revised: 06/30/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Mental health problems experienced by older adults (60+ years of age) may remain hidden due to individual and system-level barriers. Opportunities to support early identification and management are therefore crucial. The National Health Service recommends wider public services that are embedded within local communities, but are not traditionally part of the healthcare landscape (i.e., 'nontraditional'), could facilitate engagement with healthcare by members of the public. Evidence for interventions involving Fire and Rescue, Police, Library services and postal workers, as nontraditional providers of mental health services, has not been synthesized previously. This review aims to understand how, why and in what contexts mental health interventions delivered by these nontraditional providers, to older adults, work. METHODS A realist review of interventions to identify and/or manage mental health problems (depression with or without anxiety) experienced by older adults. Systematic, cluster and iterative literature searches were conducted. Intervention evidence was appraised for rigour and explanatory relevance and then coded to inform context-mechanism-outcome configurations (CMOCs). A public advisory group supported our initial evidence search strategy and definition of key terms. This review is registered with PROSPERO (CRD42020212498). RESULTS Systematic searches revealed a dearth of evidence reporting mental health interventions delivered by nontraditional providers. Our scope was adjusted to consider interventions delivered by Fire and Police services only and for wider health and wellbeing concerns (e.g., dementia, falls prevention, mental health crises). Forty-three pieces of evidence were synthesized. Key themes included: legitimizing expanded roles, focusing on risk, intervention flexibility and organization integration; further subthemes are described. Themes map onto CMOCs and inform a preliminary programme theory. Findings were transposed to mental health contexts. CONCLUSIONS Findings highlight challenges and opportunities for Fire and Police services, as nontraditional providers, to deliver interventions that identify and/or manage mental health problems among older adults. Our programme theory explains what could work, how, for whom and also by whom (i.e., which public services). Further empirical evidence is needed to test interventions, understand acceptability and inform implementation. PATIENT OR PUBLIC CONTRIBUTION A public advisory group comprising older adults with lived experience of mental health problems and informal caregivers contributed to the original application, reviewed the scope and informed the approach to dissemination.
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Affiliation(s)
- Tom Kingstone
- School of Medicine, Keele University, Staffordshire, UK.,Research and Innovation Department, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Carolyn A Chew-Graham
- School of Medicine, Keele University, Staffordshire, UK.,Research and Innovation Department, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Nadia Corp
- School of Medicine, Keele University, Staffordshire, UK
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The Otago Exercise Program compared to falls prevention education in Zuni elders: a randomized controlled trial. BMC Geriatr 2022; 22:652. [PMID: 35945496 PMCID: PMC9361667 DOI: 10.1186/s12877-022-03335-6] [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: 04/22/2022] [Accepted: 07/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When a Zuni elder sustains a fall-related injury, the closest tribal skilled nursing facility is 100 miles from the Pueblo and no physical therapy services are available. Thus, fall prevention strategies as a primary intervention to avert injurious falls and preserve aging in place are needed. The objective of the study is to compare the effectiveness of a community health representative (CHR)-delivered, culturally-adapted Otago Exercise Program (OEP) fall prevention program compared to the standard of care education-based fall risk management. METHODS "Standing Strong in Tribal Communities: Assessing Elder Falls Disparity" is mixed-methods research with a randomized controlled trial. The CHRs will be trained to deliver the culturally-adapted OEP trial and offer advantages of speaking "Shiwi" (Zuni tribal language) and understanding Zuni traditions, family structures, and elders' preferences for receiving health information. Focus groups will be conducted to assure all materials are culturally appropriate, and adapted. A physical therapist will train CHRs to screen elders for falls risk and to deliver the OEP to the intervention group and education to the control group. Up to 400 Zuni elders will be screened by the CHRs for falls risk and 200 elders will be enrolled into the study (1:1 random allocation by household). The intervention is 6 months with measurements at baseline, 3, 6 and 12 months. The primary outcome is improved strength and balance (timed up and go, sit to stand and 4 stage balance test), secondary outcomes include falls incidence, self-efficacy using Attitudes to Falls-Related Interventions Scale, Medical Outcomes Study Short Form 12 (SF-12v2) and Self-Efficacy for Managing Daily Activities. DISCUSSION Fall prevention for Zuni elders was identified as a tribal priority and this trial is built upon longstanding collaborations between the investigative team, Zuni tribal leaders, and multiple tribal health programs. Delivery by the CHRs make this model more acceptable, and thus, more sustainable long term. This study has the potential to change best practice for elder care in tribal and rural areas with limited access to physical therapist-delivered fall prevention interventions and aligns with tribal goals to avert fall-related injury, reduce healthcare disparity, and preserve elder's independence. TRIAL REGISTRATION NCT04876729.
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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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Falls Prevention: Adherence, Fear of Falling, Assessment, and Intervention. J Aging Phys Act 2022; 30:569-571. [PMID: 35894987 DOI: 10.1123/japa.2022-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/18/2022]
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High Challenge Exercise and Learning Safe Landing Strategies among Community-Dwelling Older Adults: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127370. [PMID: 35742618 PMCID: PMC9223480 DOI: 10.3390/ijerph19127370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022]
Abstract
There is limited research on optimal exercise programs that effectively decrease falls and fall-related injuries in older populations. This randomized controlled trial (RCT) aimed to explore the effects of a 12-week Judo4Balance program on falling techniques, physical and psychological functions, health status, and physical activity levels among 200 community-dwelling older adults (79% women and 21% men) with a mean age of 72 years. The 200 participants were randomly allocated for the Judo4Balce program (n = 100) or control group (n = 100). The RCT intervention started in mid-January 2020 and was abruptly interrupted because of the COVID-19 pandemic. A restart of the RCT was initiated in September 2021, and the 12-week intervention was offered to two groups. This study reports the results from three points of assessment: baseline, 20-month follow-up, and 12-week postintervention. At 20 months follow-up, the control group had significantly decreased physical activity levels (summer p = 0.002 and winter p = 0.003); similar changes were not seen in the exercise group. In the exercise group, learning falling techniques in 6−9 weeks led to sustained fall competence at 20 months follow-up. Further, significant improvements in physical function (exercise group p = 0.009 and control group p < 0.001) and learning falling techniques (p < 0.001 for both groups) were noted in both groups after the 12-week intervention. This effective, supervised, group-based, high-challenge multicomponent exercise program needs to be further evaluated for possible impact on falls and fall-related injuries.
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Meekes WMA, Leemrijse CJ, Korevaar JC, Stanmore EK, van de Goor LIAM. Implementing Falls Prevention in Primary Care: Barriers and Facilitators. Clin Interv Aging 2022; 17:885-902. [PMID: 35686030 PMCID: PMC9171056 DOI: 10.2147/cia.s354911] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Limited information is available concerning primary care providers’ encountered barriers and facilitators when implementing falls prevention and providing interventions in a real-life setting. This study aimed to identify barriers and facilitators when i) implementing a falls risk assessment strategy at GP practices and among community nurses and ii) providing evidence-based falls prevention interventions in a real-life setting to independently living, frail older people. Methods A researcher’s journal was maintained during the implementation of a falls risk assessment strategy, which entailed notes from informal conversations with GPs, practice nurses and community nurses. After implementation, two online focus groups with GPs, practice and community nurses, physio- and exercise therapists were conducted. Data were thematically analyzed. Results Data were collected from 32 GPs, 13 practice nurses, eight community nurses, nine physiotherapists, and two exercise therapists. The GPs and nurses acknowledged that falls prevention is part of their job, meaningful, and that they have sufficient knowledge and skills to offer falls prevention. Collaboration, a previously implemented care program for older people, resources, reimbursement for interventions, and patients’ motivation, awareness and health issues were considered to be important factors for the implementation of falls prevention. Physio- and exercise therapists described collaboration with different disciplines, receiving sufficient referrals, reimbursements, intensity and set-up of the interventions, and patients’ motivation, expectations, goals, self-confidence, awareness, and health issues as important factors when providing falls prevention interventions. Conclusion This study identified care provider-, context-, patient-, and innovation (strategy)-related barriers and facilitators when implementing falls prevention and providing interventions in primary care. Development of a more successful implementation strategy should focus on intensifying collaboration, reimbursement for interventions, availability of resources, and patients’ lack of motivation and health issues. Hence, falls prevention may become more structurally applied, reducing a major threat for the quality of life of independently living older people.
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Affiliation(s)
- Wytske M A Meekes
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Nivel, Utrecht, Netherlands
| | | | | | - Emma K Stanmore
- School of Health Sciences, University of Manchester, Manchester, UK and Manchester Academic Health Science Centre (MAHSC), Manchester, UK
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Henry A, Haddad Y, Bergen G. Older Adult and Healthcare Provider Beliefs About Fall Prevention Strategies. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Older adults reported about 36 million falls in 2018. Although effective strategies are available to address risk factors and minimize fall risk, little is known about older adults’ and healthcare providers’ awareness of these strategies. This study describes and compares healthcare providers’ and older adults’ beliefs about fall prevention and strategies. Methods: Demographic and fall-related data for older adults were obtained from the 2019 fall cohort of Porter Novelli ConsumerStyles. Similar data from primary care practitioners, nurse practitioners, and physician assistants were gathered from the 2019 cohort of DocStyles. Results: Most providers (91.3%) and older adults (85.1%) believed falls can be prevented. Both providers and older adults were most likely to consider strength and balance exercises (90.7% and 82.8%, respectively) and making homes safer (90.5% and 79.9%, respectively) as strategies that help prevent falls. More providers reported that managing medications (84.2%) and tai chi (45.7%) can prevent falls compared to older adults (24.0% and 21.7%, respectively; P < .0001). Conclusion: More healthcare providers than older adults indicated evidence-based strategies exist to reduce falls. Increased patient and provider communication can increase awareness about the benefits of evidence-based strategies such as tai chi, strength and balance exercises, and medication management.
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Affiliation(s)
- Ankita Henry
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yara Haddad
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gwen Bergen
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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17
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Lees C, O'Brien T, Maganaris C. The use of control - the actions of informal carers on those at risk from falling at home. A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1045-1050. [PMID: 34405481 DOI: 10.1111/hsc.13299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 12/14/2020] [Accepted: 01/07/2021] [Indexed: 06/13/2023]
Abstract
To explore the experiences of informal carers who provide care for frail, older adults who are at risk from falling in their own home. Frail, older adults who fall present a significant challenge for their careers and the health and social care services that support them. Falls can often mean long stays in acute hospital facilities or admission to care homes. Research studies have often investigated the cause and effect of falls in relation to risk, but there has been a limited amount of insight into how informal carers manage those who are at risk from falling in their own home. A qualitative study that used thematic analysis was adopted. Ten informal carers participated in the study. Data were collected via one to one, semi structured interviews in the care recipient's home from February to May 2019. The study applied the COREQ research checklist. Findings highlight that informal carers believed that once a fall had occurred, further falls were inevitable and that falls prevention interventions were of little value. To prevent falls, informal carers would restrict the activity of the care recipient as well as controlling both the environment and the care recipient's movements. A better understanding of the use of control and monitoring of care recipients by informal carers is important. This knowledge will enable the delivery of falls prevention interventions for the frail, adult population that are effective, appropriate and promote the delivery of evidence-based care.
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Kwek VHM, Lim FYQ. Exploring the relationship between perceived susceptibility and severity of falling among older adults in Singapore. Br J Occup Ther 2022. [DOI: 10.1177/03080226211067428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Despite extensive research about improving the effectiveness of falls prevention interventions, at-risk individuals are not always willing recipients. Reasons for rejecting treatments are still poorly understood. Applying the health belief model (HBM), if perceived severity and susceptibility can be understood in the context of falling, this might better inform intervention designs. Method Sixty-two participants were recruited from inpatient wards at a local acute hospital. Participants completed two self-report questionnaires, the Staying Independent Checklist (SIC) and the Falls Efficacy Scale – International (FES-I), measuring perceived susceptibility and severity respectively. Results One-way ANOVA analysis revealed a significant association between FES-I total scores and SIC score categories [ F (1,60) = 6.277, p = .015].Stepwise regression with backward elimination also found that falls history (β = .292, p = .033), sex (β = .269, p = .042), and FIM lower body dressing (β = − .286, p = .035) had significant associations with FES-I scores. Conclusion Level of perceived susceptibility and severity of falling should be considered when determining if falls prevention interventions are relevant, regardless of functional ability and physical health status. Future research to determine the underlying mechanisms which drives health behaviours related to falls prevention should be conducted.
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Affiliation(s)
- Vanessa HM Kwek
- Occupational Therapy, Abilities Beyond Limitations and Expectations Limited, Singapore
| | - Fiona YQ Lim
- Occupational Therapy, Singapore General Hospital, Singapore
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19
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OUP accepted manuscript. Health Promot Int 2022:6597080. [DOI: 10.1093/heapro/daac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Xue T(M, Colón-Emeric CS, Herndon L, Hecker EJ, Berry SD, Little MO, McConnell ES. Strengthening Resident, Proxy, and Staff Engagement in Injury Prevention in Skilled Nursing Facilities. THE GERONTOLOGIST 2021; 62:1112-1123. [PMID: 34971374 PMCID: PMC9451018 DOI: 10.1093/geront/gnab193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Engaging residents, their proxies, and skilled nursing facility (SNF) staff through effective communication has potential for improving fall-related injury prevention. The purpose of this study was to understand how multiple stakeholders develop and communicate fall-related injury prevention plans to enhance sustained implementation. RESEARCH DESIGN AND METHODS Descriptive qualitative study using framework analysis applied to open-ended semistructured interviews (n = 28) regarding experiences of communication regarding fall-related injury prevention, guided by the Patient and Family Engaged Care framework. Participants included residents at high risk of injury and their proxies, nursing assistants, nurses, and a nurse practitioner from 3 SNFs in the Eastern United States (Massachusetts and North Carolina). RESULTS Interdisciplinary teams were viewed as essential for injury prevention. However, the roles of the interdisciplinary team members were sometimes unclear. Communication structures were often hierarchical, which reduced engagement of nursing assistants and frustrated proxies. Practices that enhanced engagement included knowing the residents, active listening skills, and use of strategies for respecting autonomy. Engagement was inhibited by time constraints, lack of proactive communication among staff, and by challenges eliciting the perspectives of residents with dementia. Resident barriers included desire for autonomy, strong preferences, and language differences. DISCUSSION AND IMPLICATIONS Strengthening team meeting processes and cultivating open communication and collaboration could facilitate staff, resident, and proxy engagement in injury prevention planning and implementation. Skill building and targeting resources to improve communication can address barriers related to staff practices, resident characteristics, and time constraints.
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Affiliation(s)
- Tingzhong (Michelle) Xue
- Address correspondence to: Tingzhong (Michelle) Xue, MS, RN, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA. E-mail:
| | - Cathleen S Colón-Emeric
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA,Division of Geriatrics in the Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laurie Herndon
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Emily J Hecker
- Division of Geriatrics in the Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah D Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Milta O Little
- Division of Geriatrics in the Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eleanor S McConnell
- Duke University School of Nursing, Durham, North Carolina, USA,Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
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21
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Cerilo PC, Siegmund LA. Pilot testing of nurse led multimodal intervention for falls prevention. Geriatr Nurs 2021; 43:242-248. [PMID: 34952307 DOI: 10.1016/j.gerinurse.2021.12.002] [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: 10/14/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022]
Abstract
Patient fall-risk awareness, self-efficacy, and engagement in fall-prevention activities are important aspects of fall-prevention. The current pilot study examined the effect of a nurse-led multimodal intervention on hospitalized adults' levels of fall risk awareness, self-efficacy, and engagement in fall prevention. Sixty hospitalized older adults in an acute care setting in Florida participated in the study. There were significant differences [pre-test (M = 19.02, SD=1.152) and post-test (M = 21.71, SD=0.527); t (17.355) = 58, p≤.001] on level of fall risk awareness in fall prevention. There were no significant findings for fall self-efficacy and engagement. Study findings suggested that the higher the fall self-efficacy, the higher the engagement. Future research is needed to examine self-efficacy and engagement for fall prevention in larger diverse cohorts of hospitalized older adults.
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Affiliation(s)
- Perlita C Cerilo
- Nursing Operations Manager, Cleveland Clinic, Weston, Florida 33331, USA.
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Haynes A, Sherrington C, Wallbank G, Wickham J, Tong A, Kirkham C, Manning S, Ramsay E, Tiedemann A. Using self-determination theory to understand and improve recruitment for the Coaching for Healthy Ageing (CHAnGE) trial. PLoS One 2021; 16:e0259873. [PMID: 34797820 PMCID: PMC8604286 DOI: 10.1371/journal.pone.0259873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intervention trials promoting physical activity among older people frequently report low and unrepresentative recruitment. Better understanding of reasons for participation can help improve recruitment. This study explored why participants enrolled in the Coaching for Healthy Ageing (CHAnGE) trial, including how their decision was influenced by recruitment strategies. CHAnGE was a cluster randomised controlled trial testing the effectiveness of a healthy ageing program targeting inactivity and falls. Seventy-two groups of people aged 60+ were recruited from community organisations via informal presentations by the health coaches. METHODS We conducted a secondary thematic analysis of interview data from our wider qualitative evaluation in which 32 purposively sampled trial participants took part in semi-structured interviews about their experiences of CHAnGE. Data relating to recruitment and participation were analysed inductively to identify themes, then a coding framework comprising the core constructs from self-determination theory-autonomy, competence and relatedness-was used to explore if and how this theory fit with and helped to explain our data. RESULTS Recruitment presentations promoted the CHAnGE intervention well in terms of addressing value expectations of structured support, different forms of accountability, credibility, achievability and, for some, a potential to enhance social relationships. Participation was motivated by the desire for improved health and decelerated ageing, altruism and curiosity. These factors related strongly to self-determination concepts of autonomy, competence and relatedness, but the intervention's demonstrated potential to support self-determination needs could be conveyed more effectively. CONCLUSIONS Findings suggest that recruitment could have greater reach using: 1. Strengths-based messaging focusing on holistic gains, 2. Participant stories that highlight positive experiences, and 3. Peer support and information sharing to leverage altruism and curiosity. These theory-informed improvements will be used to increase participation in future trials, including people in hard-to-recruit groups. They may also inform other physical activity trials and community programs.
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Affiliation(s)
- Abby Haynes
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Geraldine Wallbank
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - James Wickham
- School of Biomedical Sciences, Charles Sturt University, Orange, NSW, Australia
| | - Allison Tong
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Catherine Kirkham
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Shona Manning
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Christian Homes Tasmania Inc, Kingston, TAS, Australia
| | - Elisabeth Ramsay
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Kwon J, Lee Y, Young T, Squires H, Harris J. Qualitative research to inform economic modelling: a case study in older people's views on implementing the NICE falls prevention guideline. BMC Health Serv Res 2021; 21:1020. [PMID: 34583685 PMCID: PMC8479997 DOI: 10.1186/s12913-021-07056-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background High prevalence of falls among older persons makes falls prevention a public health priority. Yet community-based falls prevention face complexity in implementation and any commissioning strategy should be subject to economic evaluation to ensure cost-effective use of healthcare resources. The study aims to capture the views of older people on implementing the National Institute for Health and Care Excellence (NICE) guideline on community-based falls prevention and explore how the qualitative data can be used to inform commissioning strategies and conceptual modelling of falls prevention economic evaluation in the local area of Sheffield. Methods Focus group and interview participants (n = 27) were recruited from Sheffield, England, and comprised falls prevention service users and eligible non-users of varying falls risks. Topics concerned key components of the NICE-recommended falls prevention pathway, including falls risk screening, multifactorial risk assessment and treatment uptake and adherence. Views on other topics concerning falls prevention were also invited. Framework analysis was applied for data analysis, involving data familiarisation, identifying themes, indexing, charting and mapping and interpretation. The qualitative data were mapped to three frameworks: (1) facilitators and barriers to implementing the NICE-recommended pathway and contextual factors; (2) intervention-related causal mechanisms for formulating commissioning strategies spanning context, priority setting, need, supply and demand; and (3) methodological and evaluative challenges for public health economic modelling. Results Two cross-component factors were identified: health motives of older persons; and professional competence. Participants highlighted the need for intersectoral approaches and prioritising the vulnerable groups. The local commissioning strategy should consider the socioeconomic, linguistic, geographical, legal and cultural contexts, priority setting challenges, supply-side mechanisms spanning provider, organisation, funding and policy (including intersectoral) and health and non-health demand motives. Methodological and evaluative challenges identified included: incorporating non-health outcomes and societal intervention costs; considering dynamic complexity; considering social determinants of health; and conducting equity analyses. Conclusions Holistic qualitative research can inform how commissioned falls prevention pathways can be feasible and effective. Qualitative data can inform commissioning strategies and conceptual modelling for economic evaluations of falls prevention and other geriatric interventions. This would improve the structural validity of quantitative models used to inform geriatric public health policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07056-1.
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Affiliation(s)
- Joseph Kwon
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, England, S1 4DA.
| | - Yujin Lee
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, England, CV4 7AL
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, England, S1 4DA
| | - Hazel Squires
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, England, S1 4DA
| | - Janet Harris
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, England, S1 4DA
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Meekes WMA, Leemrijse CJ, Weesie YM, van de Goor IAM, Donker GA, Korevaar JC. Falls prevention at GP practices: a description of daily practice. BMC FAMILY PRACTICE 2021; 22:190. [PMID: 34548022 PMCID: PMC8454103 DOI: 10.1186/s12875-021-01540-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND General practitioners (GPs) can be considered the designated professionals to identify high fall risk and to guide older people to fall preventive care. Currently it is not exactly known how GPs treat this risk. This study aims to investigate GPs' daily practice regarding fall preventive care for frail older patients. METHODS Sixty-five GPs from 32 Dutch practices participated in this study for a period of 12 months. When a GP entered specific International Classification of Primary Care-codes related to frailty and/or high fall risk in their Electronic Health Records, a pop-up appeared asking "Is this patient frail?". If the GP confirmed this, the GP completed a short questionnaire about patient's fall history and fear of falling (FOF), and the fall preventive care provided. RESULTS The GPs completed questionnaires regarding 1394 frail older patients aged ≥75. Of 20% of these patients, the GPs did not know whether they had experienced a fall or not. The GPs did not know whether a FOF existed in even more patients (29%). Of the patients with a fall history and/or a FOF (N = 726), 37% (N = 271) received fall preventive care. Two main reasons for not offering fall preventive care to these patients were: I) the patient finds treatment too intensive or too much of a hassle (37%), and II) the GP identified a high fall risk but the patient did not acknowledge this (14%). When patients were treated for high fall risk, the GP and the physiotherapist were the most frequently involved health care providers. The involved health care providers most often treated mobility limitations, cardiovascular risk factors, and FOF. CONCLUSIONS The results from this study show that GPs were frequently not aware of their frail patient's fall history and/or FOF and that the majority of the frail older patients with a fall history and/or FOF did not receive fall preventive care. Developing systematic screening strategies for the primary care setting enhancing the identification of high fall risk and the provision of fall preventive care may improve patients' quality of life and reduce health care costs.
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Affiliation(s)
- Wytske M A Meekes
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, Netherlands.
- NIVEL, Otterstraat 118-124, 3513 CR, Utrecht, Netherlands.
| | | | | | - Ien A M van de Goor
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, Netherlands
| | - Gé A Donker
- NIVEL, Otterstraat 118-124, 3513 CR, Utrecht, Netherlands
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Shaw CA, Gordon JK. Understanding Elderspeak: An Evolutionary Concept Analysis. Innov Aging 2021; 5:igab023. [PMID: 34476301 PMCID: PMC8406004 DOI: 10.1093/geroni/igab023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives Elderspeak is an inappropriate simplified speech register that sounds like baby talk and is used with older adults, especially in health care settings. Understanding the concept of elderspeak is challenging due to varying views about which communicative components constitute elderspeak and whether elderspeak is beneficial or harmful for older adults. Research Design and Methods Rodgers’ evolutionary concept analysis method was used to evaluate the concept of elderspeak through identification of elderspeak’s attributes, antecedents, and consequences. A systematic search using the PubMed, CINAHL, PsycINFO, and Embase databases was completed. Results Eighty-three theoretical or research articles from 1981 to 2020 were identified. Elderspeak characteristics were categorized by semantic, syntactic, pragmatic, paralinguistic, and nonverbal attributes. The primary antecedent to elderspeak is implicit ageism, in which old age cues and signs of functional or cognitive impairment led to simplified communication, usually from a younger caregiver. Research studies varied in reporting whether elderspeak facilitated or interfered with comprehension by older adults, in part depending on the operational definition of elderspeak and experimental manipulations. Exaggerated prosody, a key feature of elderspeak, was found to reduce comprehension. Elderspeak was generally perceived as patronizing by older adults and speakers were perceived as less respectful. In persons with dementia, elderspeak also increases the probability of resistiveness to care, which is an important correlate of behavioral and psychological symptoms of dementia. Discussion and Implications Based on this concept analysis, a new definition of elderspeak is proposed, in which attributes that have been found to enhance comprehension are differentiated from those that do not. Recommendations for consistent operationalization of elderspeak in future research are made.
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Affiliation(s)
- Clarissa A Shaw
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Jean K Gordon
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA
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Mehta J, Knowles K, Wilson E. Prevalence of Falls in Patients Presenting to an Ophthalmic Outpatients Department- A Surveillance Study. Br Ir Orthopt J 2021; 17:134-141. [PMID: 34466777 PMCID: PMC8378087 DOI: 10.22599/bioj.178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Approximately 1 in 3 adults aged 65 and over experience a fall each year. Poor vision is an identified risk factor. The aim of this cross-sectional public health surveillance audit was to determine the prevalence of falls experienced in the previous 12 months by adult patients presenting to an ophthalmology department. Methods: A short questionnaire was given to consecutive patients attending an ophthalmology department at two trusts in the North West to determine whether they had experienced a fall in the previous 12 months, whether they had suffered a fracture, their eye condition and the type of glasses worn. Results: Data was collected for 585 patients (mean age: 69 years, SD: 13.8). Falls in the previous 12 months were reported by 96 (16.4%) patients, and a significant proportion of these were aged 60 years and over (82%, p < 0.0001, one-sample binomial test). Half of the respondents were unaware of their eye health condition for which they were attending the department. Glaucoma was the most prevalent condition in those who had experienced a fall (43%). A significant proportion of the individuals who reported a fall wore single-vision glasses (43%, p < 0.0001, one-sample chi-square test). Conclusion: In an ophthalmology outpatient department, the proportion of older adults who experienced a fall in the previous 12 months was lower than the reported prevalence in the general population. There is a need for health literacy to educate patients about their eye condition, the potential effects on their visual function and, consequently, managing falls risk.
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Affiliation(s)
| | | | - Erin Wilson
- Wirral University Teaching Hospital NHS Foundation Trust, GB
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De Coninck L, Declercq A, Bouckaert L, Vermandere M, Graff MJL, Aertgeert B. Perspectives of older adults with a chronic condition on functioning, social participation and health: a qualitative study. BMC Geriatr 2021; 21:418. [PMID: 34243713 PMCID: PMC8268461 DOI: 10.1186/s12877-021-02365-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
Background Problems with mobility, functioning and social participation make living independently difficult for frail older adults. To continue living independently, therapy adherence is a prerequisite. The causes for non-adherence among older adults are multiple and complex, which is why insight into older adults’ perspectives regarding their functioning is an essential factor to increase therapy adherence. This study investigates the perspectives of older adults on their functioning, social participation and health, and the factors influencing these elements. Methods We conducted a qualitative study on the older adult’s perceived functioning, social participation and health. Fourteen home-dwelling older adults suffering from chronic health issues were purposively selected. Semi-structured interviews were conducted with open-ended questions. Data were analysed following the Basic Logical Model of Abduction and Creswell’s coding method. Results Assistive devices, the older adult’s dwelling and living environment, professional and informal support, and medication are perceived as important determinants for retaining functioning and social participation. Attitude, social influence and personal effectiveness were found to influence whether a person performs or participates in an activity. A person’s attitude is related to the significance the activity has to that person, the activity’s importance, personal wellbeing, the person’s values, and their desire for autonomy. Peers and children have a social influence on the level of activity of the older person. Traditions, in particular religious activities, along with personal effectiveness are motivating factors determining whether a person performs or participates in an activity. Personal effectiveness is linked to the person’s belief in their personal competencies and to the relationship between effort and result. Finally, it appears that the type of coping strategy the older adult adopts, has an influence on their behavior. The participating older adults often used remarkable problem-focused strategies, which had a positive effect on their level of autonomy. Conclusions Older adults have identified barriers and facilitators that influence their level of functioning and social participation. These findings help to create a framework for maintaining and increasing therapy adherence, which may be helpful in facilitating occupational therapists and other healthcare professionals to detect determinants of therapy adherence. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02365-w.
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Affiliation(s)
- Leen De Coninck
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok J, PB 7001, 3000, Leuven, Belgium. .,CEBAM Belgian Centre for Evidence-based Medicine vzw, Kapucijnenvoer 33, blok J, PB 7001, 3000, Leuven, Belgium. .,Department of Occupational Therapy, Artevelde University of Applied Sciences, Voetweg 66, 9000, Ghent, Belgium.
| | - Anja Declercq
- LUCAS Centre for Care Research and Consultancy & CESO Centre for Sociological Research, KU Leuven, Minderbroedersstraat 8, PB 5310, Leuven, Belgium
| | - Leen Bouckaert
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Voetweg 66, 9000, Ghent, Belgium
| | - Mieke Vermandere
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok J, PB 7001, 3000, Leuven, Belgium
| | - Maud J L Graff
- Scientific Institute for Quality of Health Care and Department of Rehabilitation, Donders Center for Cognition, Brain and Behavior, Radboud University Medical Centre, Houtlaan 4, 6525 XZ, Nijmegen, the Netherlands
| | - Bert Aertgeert
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok J, PB 7001, 3000, Leuven, Belgium.,CEBAM Belgian Centre for Evidence-based Medicine vzw, Kapucijnenvoer 33, blok J, PB 7001, 3000, Leuven, Belgium
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28
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Collins CE, Schultz K, Mathew P, Chandra A, Nguyen B, Chen T, Renshaw S, Rose KM, Santry HP. A personalized approach empowering successful aging: Patient perspective on fall prevention education. PM R 2021; 14:786-792. [PMID: 34181824 DOI: 10.1002/pmrj.12663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 04/28/2021] [Accepted: 06/07/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Falls are the leading cause of fatal injury, and the most common cause of nonfatal trauma, among older adults. However, patient perspectives on preferences for obtaining fall education are not well reported. OBJECTIVE To identify components of successful fall prevention education. DESIGN Prospective qualitative study. SETTING Tertiary care center; institutional. PARTICIPANTS Adults aged 65 years or older with a history of falls who received services from inpatient trauma or outpatient geriatric services. INTERVENTIONS One-hour face-to-face semistructured interview. MAIN OUTCOME MEASURE Semistructured interviews sought to determine participants' history of fall education and perceived strengths and weaknesses of various formats of fall education. RESULTS Nearly all participants (9/10) indicated they had not received fall prevention education of any kind. Many participants (6/10) reported that, despite not receiving any formal education about falls, they had either given or received information about falls from other older adults in their communities. Participants indicated that framing fall education as a part of healthy aging would be more desirable and mentioned involving participants' families as part of the education. The majority of participants (7/10) suggested fall education be delivered through in-person discussion with providers, and most (9/10) indicated this would provide a personalized approach with opportunity for questions. Participants specified fall education should consist of both environmental modifications (5/10) and awareness of one's surroundings (4/10). CONCLUSIONS Despite histories of falls, nearly all participants reported they had not received formal fall education. However, many indicated they received fall information informally through their communities. Participants agreed successful fall prevention education would be delivered in an empowering way by a trusted member of the care team.
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Affiliation(s)
- Courtney E Collins
- Department of Surgery, Ohio State University, Columbus, Ohio, USA.,Center for Surgical Health Assessment, Research & Policy, Ohio State University, Columbus, Ohio, USA
| | - Kurt Schultz
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Pawan Mathew
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Arnav Chandra
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bryan Nguyen
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Tiffany Chen
- Department of Family Medicine, Sutter Health, Sacramento, California, USA
| | - Savannah Renshaw
- Department of Surgery, Ohio State University, Columbus, Ohio, USA.,Center for Surgical Health Assessment, Research & Policy, Ohio State University, Columbus, Ohio, USA
| | - Karen M Rose
- College of Nursing, Ohio State University, Columbus, Ohio, USA.,Center for Healthy Aging, Self-Management and Complex Care, Ohio State University, Columbus, Ohio, USA
| | - Heena P Santry
- Department of Surgery, Ohio State University, Columbus, Ohio, USA.,Center for Surgical Health Assessment, Research & Policy, Ohio State University, Columbus, Ohio, USA
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Ahmad Ainuddin H, Romli MH, Hamid TA, SF Salim M, Mackenzie L. An Exploratory Qualitative Study With Older Malaysian Stroke Survivors, Caregivers, and Healthcare Practitioners About Falls and Rehabilitation for Falls After Stroke. Front Public Health 2021; 9:611814. [PMID: 33987161 PMCID: PMC8110702 DOI: 10.3389/fpubh.2021.611814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Studies on rehabilitation for falls after a stroke remain limited despite its impact being profound. This scenario justifies a deeper understanding of why falls in stroke rehabilitation received less attention. Current investigations on the perception of falls and stroke also proved inadequate. Therefore, this study aims to explore the perceptions and experiences of older Malaysian stroke survivors, spousal caregivers, and healthcare practitioners on falls in stroke rehabilitation. Method: A qualitative study of three focus groups with 18 individuals from one community-based stroke rehabilitation center was conducted. The discussions were audio-recorded, video-recorded, transcribed, summarized, and analyzed using thematic analysis. Results: Three themes emerged from the analysis: (i) perceived factors and consequences of falls after stroke, (ii) physical-based interventions predominate in rehabilitation for falls after stroke, and (iii) the role of home hazards in fall prevention is taken for granted. Although, awareness of falls is high, they are regarded as a peripheral issue in stroke. Rehabilitation interventions such as improved functionality are believed to be adequate and can indirectly prevent falls. Other interventions for fall prevention such as home hazards management are relatively less known. Conclusion: There is a need for more attention regarding home environment risk assessment and intervention among healthcare professionals, and more education for clients and caregivers is required. Although, other stroke interventions may also benefit stroke survivors, falls prevention should be a central component in stroke rehabilitation. As this study focused on a specific population, the findings should be validated with larger populations, and in diverse settings.
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Affiliation(s)
- Husna Ahmad Ainuddin
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Centre of Occupational Therapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Selangor, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Selangor, Malaysia
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Selangor, Malaysia
| | - Mazatulfazura SF Salim
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Alsaqer M. Aging and technology: understanding the issues and creating a base for technology designers. J Med Eng Technol 2021; 45:258-283. [PMID: 33847223 DOI: 10.1080/03091902.2021.1891313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The world's population continues to increase, and now we have more aged and aging people than ever before. As people age, many of them develop health problems that impede their independence. Fortunately, the fast pace of contemporary technology provides new ways to overcome health barriers faced by the aged. Considering the countless number of efforts made in aging and technology, the time has come to reorganise and combine the two fields and reveal the most disciplined and innovative technological approaches in a partnership designed to help the elderly. In this paper, age-related health issues are discussed and organised. Then, each health issue is examined in terms of what technological solutions are available to improve the health of the elderly. As a result, a solid base for technology designers is established to encourage them, direct their effort, and enrich their knowledge on solutions for ever-increasing practical applications in the field.
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Affiliation(s)
- Mohammed Alsaqer
- College of Computer Science, King Khalid University, Saudi Arabia
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31
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Jansen CP, Gross M, Kramer-Gmeiner F, Blessing U, Becker C, Schwenk M. [Group-based exercise to prevent falls in community-dwelling older adults : Update of the 2009 recommendations of the German Federal Initiative to Prevent Falls]. Z Gerontol Geriatr 2021; 54:229-239. [PMID: 33825951 PMCID: PMC8096731 DOI: 10.1007/s00391-021-01876-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Abstract
Dieser Beitrag stellt eine Aktualisierung des Empfehlungspapiers der Bundesinitiative Sturzprävention für das körperliche Gruppentraining zur Sturzprävention bei älteren, zu Hause lebenden Menschen aus dem Jahre 2009 unter Berücksichtigung aktueller Evidenz dar. Das aktualisierte Empfehlungspapier zielt darauf ab, die Umsetzung ambulanter Sturzpräventionsgruppen zu fördern sowie konkrete Empfehlungen für deren Einrichtung und Durchführung auszusprechen. Die Empfehlungen beziehen sich auf die Identifikation und Ansprache der Zielgruppe für gruppenbasierte Sturzpräventionsprogramme sowie auf die Programmgestaltung und Qualitätssicherung. Hintergründe zu Finanzierung und Trainer*innen-Ausbildung werden samt einer Auflistung der in Deutschland etablierten Programme ebenfalls dargelegt.
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Affiliation(s)
- Carl-Philipp Jansen
- Netzwerk Alternsforschung, Universität Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Deutschland.,Abteilung für Geriatrie und Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Deutschland
| | - Michaela Gross
- Abteilung für Geriatrie und Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Deutschland
| | - Franziska Kramer-Gmeiner
- Netzwerk Alternsforschung, Universität Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Deutschland
| | - Ute Blessing
- Deutscher Olympischer Sportbund e. V., Frankfurt am Main, Deutschland
| | - Clemens Becker
- Abteilung für Geriatrie und Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Deutschland
| | - Michael Schwenk
- Netzwerk Alternsforschung, Universität Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Deutschland.
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“Someone’s Got My Back”: Older People’s Experience of the Coaching for Healthy Ageing Program for Promoting Physical Activity and Preventing Falls. J Aging Phys Act 2021; 29:296-307. [DOI: 10.1123/japa.2020-0116] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 11/18/2022]
Abstract
The Coaching for Healthy Ageing trial evaluated the impact on physical activity (PA) and falls based on a year-long intervention in which participants aged 60+ receive a home visit, regular health coaching by physiotherapists, and a free activity monitor. This interview study describes the participants’ experiences of the intervention and ideas for improvement. The authors sampled purposively for maximum variation in experiences. The data were analyzed thematically by two researchers. Most of the 32 participants reported that the intervention increased PA levels, embedded activities, and generated positivity about PA. They were motivated by quantified PA feedback, self-directed goals, and person-centered coaching. Social connectivity motivated some, but the intervention did not support this well. The intervention structure allowed participants to trial and embed activities. Autonomy and relatedness were emphasized and should be included in future program theory. The authors identified synergistic effects, likely “essential ingredients,” and potential areas for improving this and similar interventions.
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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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Finnegan S, Bruce J, Seers K. Life after falls prevention exercise - experiences of older people taking part in a clinical trial: a phenomenological study. BMC Geriatr 2021; 21:91. [PMID: 33517904 PMCID: PMC7849142 DOI: 10.1186/s12877-021-02037-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background There is little evidence about the lived experience of older people who have completed a falls prevention exercise programme and their life beyond their intervention. Method A phenomenological interview study with 23 participants (12 females), mean age 81 years (range 74–93 years), residing in their own homes across England, who had participated in a falls prevention exercise intervention within the Prevention of Falls Injury Trial (PreFIT). The aims were to explore their experiences of:
being in a clinical trial involving exercise. exercise once their falls prevention intervention had finished.
Interpretative data analysis was informed by van Manen’s (1997) framework for phenomenological data. Results Analysis of interviews about experiences of participating in PreFIT and what happened once the falls intervention ended identified five themes: Happy to help; Exercise behaviours; “It keeps me going”; “It wasn’t a real fall”; and Loss. Participants did not continue their specific exercises after they had completed the intervention. They preferred walking as their main exercise, and none reported preventing falls as a motivator to continue exercising. Participant experiences suggest that they have their own ideas about what constitutes a fall and there is disparity between their interpretation and the definition used by healthcare professionals and researchers. Conclusion Despite good intentions and perceived benefits, on-going participation in falls prevention exercises beyond a structured, supervised intervention was not a priority for these older people. Promoting continuation of falls prevention exercises post-intervention is just as challenging as promoting uptake to and adherence during exercise programmes. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02037-9.
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Affiliation(s)
- Susanne Finnegan
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
| | - Julie Bruce
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Hawley-Hague H, Tacconi C, Mellone S, Martinez E, Chiari L, Helbostad J, Todd C. One-to-One and Group-Based Teleconferencing for Falls Rehabilitation: Usability, Acceptability, and Feasibility Study. JMIR Rehabil Assist Technol 2021; 8:e19690. [PMID: 33433398 PMCID: PMC7837999 DOI: 10.2196/19690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/31/2020] [Accepted: 08/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background Falls have implications for the health of older adults. Strength and balance interventions significantly reduce the risk of falls; however, patients seldom perform the dose of exercise that is required based on evidence. Health professionals play an important role in supporting older adults as they perform and progress in their exercises. Teleconferencing could enable health professionals to support patients more frequently, which is important in exercise behavior. Objective This study aims to examine the overall concept and acceptability of teleconferencing for the delivery of falls rehabilitation with health care professionals and older adults and to examine the usability, acceptability, and feasibility of teleconferencing delivery with health care professionals and patients. Methods There were 2 stages to the research: patient and public involvement workshops and usability and feasibility testing. A total of 2 workshops were conducted, one with 5 health care professionals and the other with 8 older adults from a community strength and balance exercise group. For usability and feasibility testing, we tested teleconferencing both one-to-one and in small groups on a smartphone with one falls service and their patients for 3 weeks. Semistructured interviews and focus groups were used to explore acceptability, usability, and feasibility. Focus groups were conducted with the service that used teleconferencing with patients and 2 other services that received only a demonstration of how teleconferencing works. Qualitative data were analyzed using the framework approach. Results In the workshops, the health care professionals thought that teleconferencing provided an opportunity to save travel time. Older adults thought that it could enable increased support. Safety is of key importance, and delivery needs to be carefully considered. Both older adults and health care professionals felt that it was important that technology did not eliminate face-to-face contact. There were concerns from older adults about the intrusiveness of technology. For the usability and feasibility testing, 7 patients and 3 health care professionals participated, with interviews conducted with 6 patients and a focus group with the health care team. Two additional teams (8 health professionals) took part in a demonstration and focus group. Barriers and facilitators were identified, with 5 barriers around reliability due to poor connectivity, cost of connectivity, safety concerns linked to positioning of equipment and connectivity, intrusiveness of technology, and resistance to group teleconferencing. Two facilitators focused on the positive benefits of increased support and monitoring and positive solutions for future improvements. Conclusions Teleconferencing as a way of delivering fall prevention interventions can be acceptable to older adults, patients, and health care professionals if it works effectively. Connectivity, where there is no Wi-Fi provision, is one of the largest issues. Therefore, local infrastructure needs to be improved. A larger usability study is required to establish whether better equipment for delivery improves usability.
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Affiliation(s)
- Helen Hawley-Hague
- School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Carlo Tacconi
- Interdepartmental Center for Industrial Research, Health Sciences and Technologies, University of Bologna, Bologna, Italy.,mHealth Technologies s.r.l., Bologna, Italy
| | - Sabato Mellone
- Interdepartmental Center for Industrial Research, Health Sciences and Technologies, University of Bologna, Bologna, Italy.,mHealth Technologies s.r.l., Bologna, Italy.,Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Ellen Martinez
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Lorenzo Chiari
- Interdepartmental Center for Industrial Research, Health Sciences and Technologies, University of Bologna, Bologna, Italy.,mHealth Technologies s.r.l., Bologna, Italy.,Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Jorunn Helbostad
- Department of Neuromedicine and Movement Science, The Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Chris Todd
- School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom.,Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Gross M, Jansen CP, Blessing U, Rapp K, Schwenk M, Becker C. Empfehlungspapier für das körperliche Training zur Sturzprävention als Einzelangebot bei älteren, zu Hause lebenden Menschen. PHYSIOSCIENCE 2020. [DOI: 10.1055/a-1275-7716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Michaela Gross
- Robert-Bosch-Krankenhaus, Abteilung für Geriatrie und Klinik für geriatrische Rehabilitation, Stuttgart, Deutschland
| | - Carl-Philipp Jansen
- Universität Heidelberg, Netzwerk AlternsfoRschung (NAR), Heidelberg, Deutschland
| | - Ute Blessing
- Deutscher Olympischer Sportbund e. V., Frankfurt am Main, Deutschland
| | - Kilian Rapp
- Robert-Bosch-Krankenhaus, Abteilung für Geriatrie und Klinik für geriatrische Rehabilitation, Stuttgart, Deutschland
| | - Michael Schwenk
- Universität Heidelberg, Netzwerk AlternsfoRschung (NAR), Heidelberg, Deutschland
| | - Clemens Becker
- Robert-Bosch-Krankenhaus, Abteilung für Geriatrie und Klinik für geriatrische Rehabilitation, Stuttgart, Deutschland
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Samson M, Davenport K, Rizzo C, Liu SW. Stand Up and Fight Falls: Can a Video Intervention Help Reduce Falls in the Geriatric Population? Cureus 2020; 12:e11508. [PMID: 33354452 PMCID: PMC7744203 DOI: 10.7759/cureus.11508] [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] [Indexed: 11/22/2022] Open
Abstract
Introduction: Falls are a major source of morbidity and mortality in the geriatric population. However, efforts to reduce falls have had limited success. This study examines if a video intervention presented in the ED to patients who have fallen could improve fall education and reduce future falls. Methods: Patients 65 years and older who presented to a large academic ED for a fall between June and December 2017 were identified via triage note for an intercept study. Patients who did not speak English, who were cognitively impaired, or whose condition was too acute (determined by providing physician) were excluded. Sixty-two eligible and consenting patients were shown a six-minute video intervention with recommendations to prevent future falls. Primary objectives include (1) whether patients found the recommendations reasonable to implement and (2) rate of implementation. Secondary aims were (3) perceived health status between patients who followed the recommendations versus those who did not and (4) rates of recurrent falls and ED revisits between the two groups. Data were analyzed using the Newcombe-Wilson Score Method and Fisher's exact two-tailed t-tests. Results: Of 62 patients enrolled, 38 were retained at a six-month follow-up. Ninety-two percent of patients found the video intervention to be a reasonable education tool. At six months, 44.7% of patients implemented behavioral changes discussed in the video, and 21.1% had at least one new fall, with no significant difference between people who implemented video interventions and those who did not (23.5% and 19.0%, difference 0.045, 95% CI [-0.24 to 0.34], p=1.0). The rate of return to the ED at six months for all patients was 31.6%, with no significant difference between the two groups (23.5% versus 38.1%, difference 0.146, 95% CI [-0.18 to 0.43], p=0.49). Difference in the proportion of people feeling the same or better between the two groups was not significant at either the one-month (66.7% versus 75.0%, difference 0.083, 95% CI [-0.21 to 0.34], p=0.75) or six-month follow up (64.7% versus 47.6%, difference 0.171, 95% CI [-0.17 to 0.46], p=0.34). Conclusion: This study found that while most patients find behavioral interventions feasible and reasonable to implement, only half actually make changes to their lives to reduce the risk of falling. This suggests that identifying and limiting barriers to implementation should be a priority in future studies, along with exploring the relationship between interventions and health status, ED revisits, and recurrent falls.
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Affiliation(s)
- Margot Samson
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Kathleen Davenport
- Emergency Medicine, University of North Carolina Hospital, Chapel Hill, USA.,Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Caroline Rizzo
- Emergency Medicine, Massachussetts General Hospital, Boston, USA
| | - Shan W Liu
- Emergency Medicine, Massachusetts General Hospital, Boston, USA.,Emergency Medicine, Harvard Medical School, Boston, USA
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38
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Conde M, Hendry GJ, Woodburn J, Skelton DA. ´Feet are second class citizens`: exploring the perceptions of Scottish and Portuguese older adults about feet, falls and exercise- a qualitative study. J Foot Ankle Res 2020; 13:66. [PMID: 33176825 PMCID: PMC7659063 DOI: 10.1186/s13047-020-00434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/28/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Foot problems are likely to contribute to falls risk in older adults. Foot and ankle exercises may be beneficial, but uptake may be influenced by cultural factors. Few studies have explored the views of older adults from different cultural backgrounds about foot-specific falls risk factors, and foot and ankle falls prevention exercises. Objectives To explore the views of Scottish and Portuguese community-dwelling older adults who have experienced a fall, about any foot risk factors for falls, and foot and ankle exercises. Methods Cross-cultural qualitative study with (n = 6) focus groups exploring the perceptions of Scottish (n = 10, mean age 76 yrs) and Portuguese older adults (n = 14, mean age 66 years) aged, applying thematic analysis. Results One main theme `evolving awareness about feet and falls prevention´ and three subthemes; (i) Feet are often forgotten, (ii) the important role of footwear, (iii) need to look at my feet and do the exercises were identified. Scottish participants had more experience of falls prevention but there was a lack of knowledge surrounding foot-specific falls risk factors, and the role of ankle and foot exercise in the prevention of falls. Portuguese participants exhibited a fatalistic approach to falls. Conclusions Older adults from both nations had little knowledge of foot-specific falls risk factors, being initially unaware of the functional status of their feet and of the role of exercise in foot care and falls management. There were differences between national groups that should be accounted for when developing culturally adequate interventions.
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Affiliation(s)
- Monserrat Conde
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK.
| | - Gordon J Hendry
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK
| | - Jim Woodburn
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK
| | - Dawn A Skelton
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK
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39
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Gross M, Jansen CP, Blessing U, Rapp K, Schwenk M, Becker C. Empfehlungspapier für das körperliche Training zur Sturzprävention als Einzelangebot bei älteren, zu Hause lebenden Menschen. PHYSIOSCIENCE 2020. [DOI: 10.1055/a-1265-1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Michaela Gross
- Robert-Bosch-Krankenhaus, Abteilung für Geriatrie und Klinik für geriatrische Rehabilitation, Stuttgart, Deutschland
| | - Carl-Philipp Jansen
- Universität Heidelberg, Netzwerk AlternsfoRschung (NAR), Heidelberg, Deutschland
| | - Ute Blessing
- Deutscher Olympischer Sportbund e. V., Frankfurt am Main, Deutschland
| | - Kilian Rapp
- Robert-Bosch-Krankenhaus, Abteilung für Geriatrie und Klinik für geriatrische Rehabilitation, Stuttgart, Deutschland
| | - Michael Schwenk
- Universität Heidelberg, Netzwerk AlternsfoRschung (NAR), Heidelberg, Deutschland
| | - Clemens Becker
- Robert-Bosch-Krankenhaus, Abteilung für Geriatrie und Klinik für geriatrische Rehabilitation, Stuttgart, Deutschland
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40
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Worum H, Lillekroken D, Roaldsen KS, Ahlsen B, Bergland A. Reflections of older people about their experience of fall prevention exercise in the community- a qualitative study exploring evidence-based practice. BMC Public Health 2020; 20:1671. [PMID: 33167887 PMCID: PMC7650178 DOI: 10.1186/s12889-020-09630-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based practice (EBP) ensures that clinicians use effective interventions to achieve desired outcomes, thereby contributing to the best quality of care. The perspective of the participants is fundamental in EBP, as they have their own individual and meaningful rationale for participating in fall prevention. This study aims to explore community-dwelling older people reflections about their reflections about EBP in physiotherapy based on their experiences of a fall prevention exercise program. METHODS We conducted semi-structured interviews with 16 community-dwelling older people (men = 7; women = 9). Data were analyzed using thematic analysis. RESULTS The analysis revealed three themes: 1) the tension between knowing and doing, 2) the power of the therapist-participant relationship and the process of putting knowledge into action, and 3) research is interwoven with successful therapy and is an integral component of it. EBP was considered as a collective negotiation and learning process of creating knowledge for clinical practice. The negotiation between different types of knowledge must be performed in a transparent dialogue and through interactive collaboration between the persons involved. The participants appreciated that the research findings indicate that practice gives results. CONCLUSIONS EBP was understood and utilized as a seal of approval and a "guarantee of high quality" treatment, and its effects varied based on older people's preferences, needs, and skills. The therapist's relational competence appeared to be crucial for the negotiation of various sources of knowledge relative to the older people's preferences.
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Affiliation(s)
- Hilde Worum
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kirsti Skavberg Roaldsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Department of Neurobiology, Health Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Birgitte Ahlsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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41
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Flint J, Morris M, Nguyen AT, Keglovits M, Somerville EK, Hu YL, Stark SL. Fall Prevention Bingo: Effects of a Novel Community-based Education Tool on Older Adults Knowledge and Readiness to Reduce Risks for Falls. AMERICAN JOURNAL OF HEALTH EDUCATION 2020. [DOI: 10.1080/19325037.2020.1822236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jenny Flint
- Washington University in St. Louis School of Medicine
| | | | - An Thi Nguyen
- Washington University in St. Louis School of Medicine
| | | | | | - Yi-Ling Hu
- Washington University in St. Louis School of Medicine
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42
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Underwood F, Latour JM, Kent B. A concept analysis of confidence related to older people living with frailty. Nurs Open 2020; 7:742-750. [PMID: 32257261 PMCID: PMC7113533 DOI: 10.1002/nop2.446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/27/2019] [Accepted: 12/19/2019] [Indexed: 11/25/2022] Open
Abstract
Aim To describe and define a concept of confidence in the context of older people living with frailty, which is important to the worldwide healthy-ageing agenda preventing decline in independence and well-being. Design Concept analysis informed by Walker and Avant's eight-stage approach. Methods Electronic databases (MEDLINE, CINAHL and PsychINFO) from 1994-2018 were searched. Published studies exploring confidence and excerpts of papers referencing older people, frailty and confidence informed the concept analysis. Extracted attributes informed model case and additional case development. Appraisal of antecedents, consequences and empirical referents informed the final concept's construction. Results Three overall defining attributes of confidence were identified in this concept analysis: physical, psychological and social. A central feature is personal control, influencing internal and external factors. These control factors can be enabling factors (positive factors) or dis-enabling factors (negative factors), affecting the frail older persons overall physical health and mental well-being.
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Affiliation(s)
- Frazer Underwood
- Royal Cornwall Hospitals NHS TrustTruroUK
- Faculty of Health: MedicineDentistry and Human ScienceUniversity of PlymouthPlymouthUK
| | - Jos M. Latour
- Faculty of Health: MedicineDentistry and Human ScienceUniversity of PlymouthPlymouthUK
| | - Bridie Kent
- Faculty of Health: MedicineDentistry and Human ScienceUniversity of PlymouthPlymouthUK
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43
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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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44
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Anderson LK, Lane K. Characteristics of falls and recurrent falls in residents of an aging in place community: A case-control study. Appl Nurs Res 2019; 51:151190. [PMID: 31734004 DOI: 10.1016/j.apnr.2019.151190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/20/2019] [Accepted: 09/02/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Falls and fall-related injuries remain an ongoing and serious health problem in older adults. Many clinical and environmental factors have been implicated in falls and recurrent falls, including sleep disturbances, sensory deficits, balance problems, incontinence, comorbid conditions, and certain categories of medications. We undertook this study to determine if there was an association between these factors and falls or recurrent falls in older adult residents of an aging in place community. METHODS Our retrospective case-control study compared residents who did and did not fall in an aging in place community, as well as those who experienced recurrent versus single falls in a single year. RESULTS A total of 50 residents met the criteria for inclusion in this study, with 30 participants (60%) having experienced one or more falls during the observation period. Of the 30 participants who fell, 21 (70%) experienced more than one fall in a single year. Variables associated with falls included marital status and bowel incontinence; variables associated with recurrent falls included self-reported sleep difficulty, balance with sitting to standing and surface-to-surface transfer, use of a walker, and use of antidepressant medications. DISCUSSION Our study supports the existing nursing research that falls, and recurrent falls are the result of multiple, interrelated factors. Further research is needed into preventative measures for both falls and recurrent falls, particularly in the context of aging in place.
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Affiliation(s)
- Linda K Anderson
- University of Missouri Sinclair School of Nursing, United States of America.
| | - Kari Lane
- University of Missouri Sinclair School of Nursing, United States of America
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45
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Lee R, Moreland B. Aging without injury in the United States requires action today. JOURNAL OF SAFETY RESEARCH 2019; 70:272-274. [PMID: 31848005 PMCID: PMC7001090 DOI: 10.1016/j.jsr.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION In 2017, unintentional injuries were the seventh leading cause of death among older adults (age ≥ 65), resulting in over 55,000 deaths. Falls accounted for more than half of these deaths. Given that older adults are the fastest growing age group in the United States, we can anticipate that injuries will become an even greater health concern in the near future. METHODS Aging without injury is possible. There are evidence-based strategies that can reduce falls. However, older adults may not realize that falls can be prevented or they may be afraid to admit their fear of falling or difficulty with walking as these issues may signal their inability to live independently. RESULTS In this commentary, we will highlight what the Centers for Disease Control and Prevention is doing to prevent older adult falls. We also highlight the importance of broadening older adults' awareness about falls to successfully empower them to begin contemplating and preparing to adopt fall prevention strategies that can help them age in place. CONCLUSIONS Older adult falls are common and can result in severe injury and death but they can be prevented. Broadening older adults' awareness about falls can empower them to take the actions necessary to reduce their fall risk. Practical applications: Increasing awareness about falls can help older adults, healthcare providers, and local and state health departments take steps to reduce fall risk.
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Affiliation(s)
- Robin Lee
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 4770 Buford Highway, Atlanta, GA 30341, United States.
| | - Briana Moreland
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 4770 Buford Highway, Atlanta, GA 30341, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, United States
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46
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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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47
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Bertelsen AS, Ryg J, Masud T, Nielsen DS. Wishes and needs of older persons who have experienced a fall: A qualitative study. Nurs Open 2019; 6:1105-1112. [PMID: 31367436 PMCID: PMC6650679 DOI: 10.1002/nop2.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/10/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022] Open
Abstract
AIM The aim of this study was to explore the needs and wishes in everyday life of older persons who have experienced a fall. DESIGN A hermeneutic-phenomenological design with semi-structured interviews. METHOD Interviews were analysed using systematic text condensation. RESULTS Nine patients (5 women, 4 men) were included. The participants were between 67-95 years old. Seven of the nine participants had suffered from recurrent falls. The analysis revealed four themes: "To maintain meaningfulness in everyday life after experiencing a fall", "Contact with professionals can be a prerequisite for feeling well and motivated after a fall", "A need for assistive technology and aids in everyday life" and "Asking for help can be a challenge". Our findings highlight that older-person-centred care and treatment are essential to address the complex variations in needs and wishes of older persons who have experienced a fall.
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Affiliation(s)
| | - Jesper Ryg
- Department of Geriatric MedicineOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Tahir Masud
- Department of Geriatric MedicineOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- Department of Geriatric MedicineNottingham University Hospitals Trust NHSNottinghamUK
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48
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Money AG, Atwal A, Boyce E, Gaber S, Windeatt S, Alexandrou K. Falls Sensei: a serious 3D exploration game to enable the detection of extrinsic home fall hazards for older adults. BMC Med Inform Decis Mak 2019; 19:85. [PMID: 30992072 PMCID: PMC6469143 DOI: 10.1186/s12911-019-0808-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 04/01/2019] [Indexed: 01/20/2023] Open
Abstract
Background Falls are the main cause of death and injury for older adults in the UK. Many of these falls occur within the home as a result of extrinsic falls risk factors such as poor lighting, loose/uneven flooring, and clutter. Falls education plays an important role in self-management education about extrinsic hazards and is typically delivered via information leaflets, falls apps, and educational booklets. Serious games have the potential of delivering an engaging and informative alternative to traditional methods but almost exclusively, these are currently delivered as exergaming applications that focus solely on intrinsic falls risk factors. This study presents ‘Falls Sensei’ a first-person 3D exploration game that aims to educate older adults about extrinsic falls risk factors within the home environment. After presenting Falls Sensei, game usability and older adults’ perceptions and attitudes towards using the game in practice are explored. Methods This study involved 15 community dwelling older adults. After playing the Falls Sensei game, participants completed a Systems Usability Scale (SUS) questionnaire and post task interview, and follow-up interviews three weeks later. Inductive and deductive thematic template analysis, informed by the Unified Theory of Acceptance and Use of Technology model, was used to analyse the think-aloud, post-task and follow-up interview transcripts. Descriptive statistical analysis and one-sampled t-tests were used to analyse log-file data and SUS responses. Results Three high-level themes emerged from the analysis of transcriptions: Performance Expectancy; Effort Expectancy; Social Influence. The SUS score was 77.5/100 which indicates ‘Good’ levels of usability. Interestingly, reported usability of the game increased with participant age. Participants were positive about the usability of the game (p < = 0.05 for 9/10 items). The most memorable fall hazards were those most commonly encountered in the game or those most challenging to participants. Conclusions The results support the use of serious games as an engaging tool for educating older adults about extrinsic falls risk factors. Awareness of home hazard detection was raised by the game, and some older adults became more aware for the need to adapt their own homes after gameplay. Further research would be needed to draw comparisons with established interventions.
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Affiliation(s)
- Arthur G Money
- Department of Computer Science, Brunel University London, Uxbridge, UB8 3PH, UK.
| | - Anita Atwal
- Faculty of Health and Social Care, London South Bank University, London, SE1 0AA, UK
| | - Emily Boyce
- North London Forensic Service, Barnet, Enfield and Haringey Mental Health NHS Trust, Enfield, EN2 8JL, UK
| | - Sophie Gaber
- Department of Neurobiology, Care Sciences & Society, Division of Occupational Therapy, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Susan Windeatt
- CIS Westminster Rehabilitation Service, Gordon Hospital London, CNWL NHS Foundation Trust, SW1V 2RH, London, UK
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49
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Finnegan S, Bruce J, Seers K. What enables older people to continue with their falls prevention exercises? A qualitative systematic review. BMJ Open 2019; 9:e026074. [PMID: 30992291 PMCID: PMC6500202 DOI: 10.1136/bmjopen-2018-026074] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To review the qualitative literature that explores the barriers and facilitators to continued participation in falls prevention exercise after completion of a structured exercise programme. DESIGN A systematic literature review with thematic synthesis of qualitative studies exploring older adults' experiences of continued participation in falls prevention exercise. DATA SOURCES Comprehensive searches were conducted in MEDLINE, PSYCHinfo, AMED, ASSIA, CINAHL and EMBASE from inception until November 2017. Additional studies were identified via searches of reference lists and citation tracking of relevant studies. ELIGIBILITY CRITERIA Qualitative or mixed methods studies exploring experiences of community-dwelling older adults (65 years and over) participation in a falls prevention exercise programme including their experience of ongoing participation in exercise after the completion of a structured exercise programme. DATA EXTRACTION AND SYNTHESIS Key characteristics including aim, participant characteristics, method of data collection, underpinning qualitative methodology and analytical approach were extracted and independently checked. Thematic synthesis was used to integrate findings. RESULTS From 14 studies involving 425 participants, we identified three descriptive themes: identity, motivators/deterrents and nature of the intervention and one overarching analytical theme: agency. CONCLUSIONS Older people have their own individual and meaningful rationale for either continuing or stopping exercise after completion of a structured falls prevention exercise programme. Exploring these barriers and facilitators to continued exercise is key during the intervention phase. It is important that health care professionals get to know the older person's rationale and offer the best evidence-based practice and support to individuals, to ensure a smooth transition from their structured intervention towards longer-term exercise-related behaviour. PROSPERO REGISTRATION NUMBER CRD42017082637.
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Affiliation(s)
- Susanne Finnegan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Julie Bruce
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Kate Seers
- RCN RI, Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
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50
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Stanmore EK, Mavroeidi A, de Jong LD, Skelton DA, Sutton CJ, Benedetto V, Munford LA, Meekes W, Bell V, Todd C. The effectiveness and cost-effectiveness of strength and balance Exergames to reduce falls risk for people aged 55 years and older in UK assisted living facilities: a multi-centre, cluster randomised controlled trial. BMC Med 2019; 17:49. [PMID: 30813926 PMCID: PMC6394073 DOI: 10.1186/s12916-019-1278-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/31/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Falls are the leading cause of fatal and non-fatal unintentional injuries in older people. The use of Exergames (active, gamified video-based exercises) is a possible innovative, community-based approach. This study aimed to determine the effectiveness of a tailored OTAGO/FaME-based strength and balance Exergame programme for improving balance, maintaining function and reducing falls risk in older people. METHODS A two-arm cluster randomised controlled trial recruiting adults aged 55 years and older living in 18 assisted living (sheltered housing) facilities (clusters) in the UK. Standard care (physiotherapy advice and leaflet) was compared to a tailored 12-week strength and balance Exergame programme, supported by physiotherapists or trained assistants. Complete case analysis (intention-to-treat) was used to compare the Berg Balance Scale (BBS) at baseline and at 12 weeks. Secondary outcomes included fear of falling, mobility, fall risk, pain, mood, fatigue, cognition, healthcare utilisation and health-related quality of life, and self-reported physical activity and falls. RESULTS Eighteen clusters were randomised (9 to each arm) with 56 participants allocated to the intervention and 50 to the control (78% female, mean age 78 years). Fourteen participants withdrew over the 12 weeks (both arms), mainly for ill health. There was an adjusted mean improvement in balance (BBS) of 6.2 (95% CI 2.4 to 10.0) and reduced fear of falling (p = 0.007) and pain (p = 0.02) in the Exergame group. Mean attendance at sessions was 69% (mean exercising time of 33 min/week). Twenty-four percent of the control group and 20% of the Exergame group fell over the trial period. The change in fall rates significantly favoured the intervention (incident rate ratio 0.31 (95% CI 0.16 to 0.62, p = 0.001)). The point estimate of the incremental cost-effectiveness ratio (ICER) was £15,209.80 per quality-adjusted life year (QALY). Using 10,000 bootstrap replications, at the lower bound of the NICE threshold of £20,000 per QALY, there was a 61% probability of Exergames being cost-effective, rising to 73% at the upper bound of £30,000 per QALY. CONCLUSIONS Exergames, as delivered in this trial, improve balance, pain and fear of falling and are a cost-effective fall prevention strategy in assisted living facilities for people aged 55 years or older. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov on 18 Dec 2015 with reference number NCT02634736 .
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Affiliation(s)
- Emma K Stanmore
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
- Manchester Academic Health Science Centre, Core Technology Facility, The University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK.
- Manchester University NHS Foundation Trust, Manchester, UK.
| | - Alexandra Mavroeidi
- School of Psychological Sciences & Health University of Strathclyde Graham Hills Building, Glasgow, G1 1QE, UK
| | - Lex D de Jong
- School of Health and Life Sciences, Centre for Living, Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, Glasgow, G4 0BA, UK
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Dawn A Skelton
- School of Psychological Sciences & Health University of Strathclyde Graham Hills Building, Glasgow, G1 1QE, UK
| | - Chris J Sutton
- Manchester University NHS Foundation Trust, Manchester, UK
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Valerio Benedetto
- Lancashire Clinical Trials Unit and Research Support Team, Faculty of Health and Wellbeing, Brook Building, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Luke A Munford
- Manchester Centre for Health Economics, School of Health Sciences, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Wytske Meekes
- Tranzo, Tilburg School of Social and Behavioural Science, University of Tilburg, 5000 LE, Tilburg, The Netherlands
| | - Vicky Bell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Chris Todd
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, Core Technology Facility, The University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
- Manchester University NHS Foundation Trust, Manchester, UK
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