Japanese Community-Living Older Adults’ Perceptions and Solutions Regarding Their Physical Home Environments

This study examined perceived causes of accidental falls, the solutions implemented, and differences in scores on the Falls Efficacy Scale (FES) based on experiences of accidental falls, implementation of solutions, and experiences of problems in participants’ current environments. Data were collected individually from Japanese community-living older adults. Of the 41 participants, 71% experienced accidental falls, 41.5% implemented solutions, and 39.0% experienced problems in their current environments. Some solutions were implemented, including both appropriate and inappropriate ones. The FES scores differed significantly based on experiences of problems in participants’ current environments, suggesting that a consultation-style intervention would contribute toward improved FES scores among clients experiencing problems in their current environments.

Falls prevention for people with dementia: a knowledge translation intervention

Purpose

Strong evidence exists for falls prevention, yet uptake of strategies can be fragmented and limited. For people with dementia, adoption of strategies may be impacted by changes in memory and planning. This paper describes the findings of a knowledge translation intervention for adoption of falls prevention strategies for people with dementia.

Methods

Twenty-five dyads (people with dementia and their caregivers) participated in this mixed method intervention. The Knowledge to Action framework guided: collation of existing evidence into a useable format; identification of individual issues; understanding context; and evaluation of change over time. Demographic details, functional status, dementia severity, activity level, self-efficacy, falls risk and readiness to change behaviour were collected at baseline, 6 and 12 months. Goal setting and action planning using a discussion tool drove implementation.

Results

Falls rates were 5.4 falls per 1000 days for the 12-month period, with no significant change in functional capacity or self-efficacy. There was a non-significant trend towards reduced falls risk. Readiness to change behaviour for falls risk increased from 84% to 96% by 6 months, with most moving from contemplation into action ( n = 16), or preparation into action ( n = 36), with adoption of strategies high (82%).

Conclusion

Engagement with the person with dementia and their caregiver, through identification of their needs and preferences, and enabling choice resulted in high adoption of falls prevention strategies.

Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review

BACKGROUND

Randomised controlled trials (RCTs) of fall prevention conducted in community settings have recently been systematically reviewed.

OBJECTIVE

To augment this review by analysing older people's participation in the trials and engagement with the interventions.

DESIGN

Review of the 99 single and multifactorial RCTs included in the Cochrane systematic review of falls prevention interventions.

SETTING

Community.

PARTICIPANTS

Adults aged 60+/mean age minus one standard deviation of 60+.

METHODS

Calculated aggregate data on recruitment (proportion who accepted the invitation to participate), attrition at 12 month follow-up (loss of participants), adherence (to intervention protocol) and whether adherence moderated the effect of interventions on trial outcomes.

RESULTS

The median recruitment rate was 70.7% (64.2-81.7%, n = 78). At 12 months the median attrition rate including mortality was 10.9% (9.1-16.0%, n = 44). Adherence rates (n = 69) were ≥80% for vitamin D/calcium supplementation; ≥70% for walking and class-based exercise; 52% for individually targeted exercise; approximately 60-70% for fluid/nutrition therapy and interventions to increase knowledge; 58-59% for home modifications; but there was no improvement for medication review/withdrawal of certain drugs. Adherence to multifactorial interventions was generally ≥75% but ranged 28-95% for individual components. The 13 studies that tested for whether adherence moderated treatment effectiveness produced mixed results.

CONCLUSIONS

Using median rates for recruitment (70%), attrition (10%) and adherence (80%), we estimate that, at 12 months, on average half of community-dwelling older people are likely to be adhering to falls prevention interventions in clinical trials.

Strategies Older New Zealanders Use to Participate in Day-To-Day Occupations

Aim:

This exploratory study aimed to uncover the strategies that older adults employ to ameliorate the impact of impairments and barriers to participation.

Method:

Eight participants were interviewed in their own homes, in a town or city in New Zealand.

Findings:

Inductive analysis of data revealed four main categories of strategies: strategies to keep safe, to recruit and accept help, to meet social and biological needs (nutritional and medical), and to conserve financial, material and bodily resources.

Discussion:

The study supports some previous findings of strategies used by older people, and demonstrates that enquiring into the strategies that older people devise and adopt into their own lives is a productive line of inquiry. The strategies described differ from those that occupational therapists recommend, and do not incorporate public health messages about the benefits of physical activity or recommendations about falls prevention.

Conclusion:

The findings suggest that asking older clients about the strategies that they use will uncover valuable information for therapists giving advice or issuing equipment to help older adults to manage in the community.

Representations of Old Age in Falls Prevention Websites: Implications for Likely Uptake of Advice by Older People

Introduction:

The representations of old age in falls prevention websites were explored and considered for their potential impact on older people's uptake of the advice.

Method:

Websites were searched for using the strategy of a previous systematic-style review and evaluated using the principles of discourse analysis.

Findings:

In the analysis of 33 websites, three main subject positions afforded to older readers were identified: (1) Passive recipients: victims of the ageing process, ignorant, ill-informed and vulnerable; (2) Rational learners: responsive to information, rational problem solvers and compliant with prescriptive advice; and (3) Empowered decision makers: actively engaged with and evaluative of information, autonomous and responsible for their course of action.

Discussion:

Falls prevention websites were rarely designed according to evidence-based recommendations concerning fit with positive self-identity and empowerment of active self-management of health. Although the representation of older people as passive and inert was most evident, the image of empowered decision makers was most likely to engage older people in preventing falls.

Conclusion:

Occupational therapists should ensure that they represent older people in a positive and respectful manner in falls prevention information, both that available through the internet and in written form.

Psychosocial issues in Engaging Older People with Physical Activity Interventions for the Prevention of Falls

Dans cet article on présente une vue d’ensemble des facteurs psychosociaux ayant une influence sur la participation des personnes âgées aux interventions concernant l’activité physique et visant la prévention des chutes. On souligne l’importance des facteurs psychosociaux puisque les interventions seront rendues inutiles si elles ne réussissent pas à attirer la participation active des personnes âgées. La théorie du comportement planifié sert de cadre pour un examen de la façon dont les connaissances (un préalable), les attitudes, les normes subjectives (le contexte social) et la perception du contrôle comportemental (la confiance) encouragent ou entravent l’intention d’entre-prendre des activités pour la prévention des chutes. Cette étude est accompagnée de documents qui indiquent la manière dont la perception de soi influence l’intention. On termine par une discussion des recommendations recommendations du réseau européen Prevention of Falls Network Europe concernant l’implication des personnes âgées dans la prévention des chutes.