Perceived balance and self-reported falls: A retrospective cross-sectional study using the National Health and Aging Trend Study

AIMS

To examine how perceived balance problems are associated with self-reported falls in the past month after controlling for known correlates of falls among older adults.

BACKGROUND

Approximately 30% of adults age 65 and older fall each year. Most accidental falls are preventable, and older adults' engagement in fall prevention is imperative. Limited research suggest that older adults do not use the term 'fall risk' to describe their risk for falls. Instead, they commonly use the term 'balance problems'. Yet, commonly used fall risk assessment tools in both primary and acute care do not assess older adults' perceived balance.

DESIGN AND METHOD

The Health Belief Model and the concept of perceived susceptibility served as the theoretical framework. A retrospective, cross-sectional secondary analysis using data from the National Health and Aging Trends Study from year 2015 was conducted. The outcome variable was self-reported falls in the last month.

RESULTS

A subsample of independently living participants (N = 7499) was selected, and 10.3% of the sample reported a fall. Multiple logistic regression analysis revealed that the odds of reporting a fall in the past month was 3.4 times (p < .001) greater for participants who self-reported having a balance problem compared to those who did not. In contrast, fear of falling and perceived memory problems were not uniquely associated with falls. Using a mobility device, reporting pain, poor self-rated health status, depression and anxiety scores were also associated with falling.

CONCLUSION AND IMPLICATIONS

Older adults' perceived balance problem is strongly associated with their fall risk. Perceived balance may be important to discuss with older adults to increase identification of fall risk. Older adults' perceived balance should be included in nursing fall risk assessments and fall prevention interventions. A focus on balance may increase older adults' engagement in fall prevention.

Expanding the Health Belief Model for exploring inpatient fall risk perceptions: A methodology paper

AIMS

Inpatient falls among older adults are a relentless problem, and extant inpatient fall prevention research and interventions lack the older adults' perspectives and experiences of their own fall risk in the hospital. Theory-guided research is essential in nursing, and the purpose of this paper was to describe the process of developing a theoretical framework for a phenomenological nursing study exploring older adults' lived experiences of being at risk for falling in the hospital.

METHOD

Based on philosophical nursing underpinnings, the Health Belief Model (HBM) was selected as the theoretical model. The limitations of the model led to expansion of the model with established concepts associated with accidental falls among older adults.

RESULTS

The HBM was selected as the guiding model due to its ability to capture a broad range of perceptions of a health threat. The HBM was expanded with the concepts of embarrassment, independence, fear of falling, dignity and positivity effect. The addition of these concepts made the theoretical framework more applicable to age-related developmental behaviours of older adult and more applicable to nursing research.

CONCLUSION

The Expanded HBM theoretical framework may guide future nursing research to develop fall prevention interventions to decrease fall rates among hospitalized older adults.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Unbearable suffering while working as a nurse during the COVID-19 pandemic: A qualitative descriptive study

Background

The COVID-19 pandemic resulted in negative consequences for nurse well-being, patient care delivery and outcomes, and organizational outcomes.

Objective

The purpose of this study was to explore the experiences of nurses working during the COVID-19 Pandemic in the United States.

Design

This study used a qualitative descriptive design.

Settings

The setting for this study was a national sample of nurses working during the COVID-19 pandemic in the United States over a period of 18 months.

Participants

Convenience and snowball sampling were used to recruit 81 nurses via social media and both national and state listservs.

Methods

Using a single question prompt, voicemail and emails were used for nurses to share their experiences anonymously working as a nurse during the COVID-19 pandemic. Voicemails were transcribed and each transcript was analyzed using content analysis with both deductive and inductive coding.

Results

The overarching theme identified was Unbearable Suffering. Three additional themes were identified: 1) Facilitators to Nursing Practice During the COVID-19 Pandemic, 2) Barriers to Nursing Practice During the COVID-19 pandemic, with the sub-themes of Barriers Within the Work Environment, Suboptimal Care Delivery, and Negative Consequences for the Nurses; and lastly, 3) the Transitionary Nature of the Pandemic..

Conclusions

The primary finding of this study was that nurses experienced and witnessed unbearable suffering while working during the COVID-19 pandemic that was transitionary in nature. Future research should consider the long-term impacts of this unbearable suffering on nurses. Intervention research should be considered to support nurses who have worked during the COVID-19 pandemic, and mitigate the potential long-term effects.

Tweetable abstract

A study on nurses experiences during the pandemic reveals their unbearable suffering. Read here about the reasons nurses are leaving.

THE MEANING OF EXPERIENCING FEAR OF FALLING AMONG OLDER ADULTS

Fear of falling (FOF) is prevalent among older adults. While the concept has been conceptually defined and factors associated with FOF has been extensively explored in nursing and other health sciences, the experience of this fear is often overlooked. The purpose of this study was to illuminate the phenomena of FOF using the rich descriptions elicited from four (Nf4) older adults. The meaning of these experiences was then interpreted in conjunction with the known and emergent FOF body of literature. Each participant was interviewed twice using videoconferencing as part of a larger study exploring the lived experience of being at risk for falling in the hospital. A total of eight interview transcripts were analyzed using van Manen’s interpretive phenomenological methodology. The philosophical underpinning of this study is the philosophy of caring in nursing outlined by Kari Martinsen. Three major interpretive themes emerged: Loss of Self, Part of my Existence, and Remaining Safe Within the Boundaries of Fear. These themes describe how FOF is the fear of being suspended in time and space and losing connection with oneself both physically and mentally during a fall. The fear becomes a part of one’s existence, ranging from worry to all-consuming panic, and the body becomes unpredictable. FOF means living within invisible boundaries of fear, where feelings of helplessness, uselessness, and isolation are common. Relationships with others can both temper and ignite the FOF, and caregivers must understand the meaning of this experience to improve support of older adults in managing this overwhelming experience.

Main COVID-19 information sources in a culturally and linguistically diverse community in Sydney, Australia: A cross-sectional survey

OBJECTIVE

Describe COVID-19 information-seeking experiences for culturally and linguistically diverse groups in Sydney, Australia.

METHODS

Cross-sectional survey, translated into 11 languages; participants recruited from March 21 to July 9, 2021. Regression models identified factors associated with difficulty finding easy-to-understand COVID-19 information.

RESULTS

Across 708 participants (88% born overseas, 31% poor English proficiency), difficulty finding easy-to-understand COVID-19 information was rated 4.13 for English (95%CI: 3.85-4.41) and 4.36 for non-English language materials (95%CI: 4.07-4.66) (1 easy to 10 hard). Participants who were older (p < 0.001), had inadequate health literacy (p < 0.001), or poor English proficiency (p < 0.001) found it harder to find easy-to-understand English-language COVID-19 information. Those who had greater difficulty finding easy-to-understand non-English COVID-19 information were younger (p = 0.004), had poor English proficiency (p < 0.001), were university-educated (p = 0.05), and had spent longer living in Australia (p = 0.001). They were more likely to rely on friends and family for COVID-19 information (p = 0.02). There was significant variation in information-seeking experiences across language groups (p's < 0.001).

CONCLUSIONS

Easy-to-understand and accessible COVID-19 information is needed to meet the needs of people in culturally and linguistically diverse communities.

PRACTICE IMPLICATIONS

COVID-19 communication efforts must involve working alongside these communities to leverage existing communication channels and tailor messages.

Relying on Myself: The Lived Experience of Being at Risk for Falling in the Hospital Among Older Adults

Inpatient falls are a persistent problem and despite research efforts during the last decade, inpatient fall rates have not significantly decreased. Older adults have an estimated 50% greater inpatient fall rate than younger adults. How older adults perceive their own fall risk affects their adherence to fall prevention recommendations. The aim of this phenomenological study was to gain a deeper understanding of the lived experiences of being at risk for falling in the hospital among older adults aged 65 years and older (N=9). Participants (female=55%, age range=67 – 86) were interviewed twice using video conferencing within two weeks of hospital discharge. The audio-recorded interviews were transcribed, and then analyzed using van Manen’s interpretive phenomenological method. The Health Belief Model expanded with the concepts of independence, fear of falling, embarrassment, dignity, and positivity effect served as the theoretical framework. Five major interpretive themes emerged: Relying on Myself, Managing Balance Problems in an Unfamiliar Environment, Struggling to Maintain Identity, Following the Hospital Rules, and Maintaining Dignity in the Relationships with Nursing Staff. These themes describe how the participants thoughtfully planned their mobilization to avoid falls. This process was influenced by their struggling to remain independent, following the hospital fall prevention rules out of politeness, and experiencing both positive and negative relationships with nursing staff. Hospitalized older adults employed their self-efficacy to manage balance problems in the hospital. These findings have not been previously documented in the literature. Fall prevention interventions supporting hospitalized older adults’ self-management of fall risk are needed.

Older adults' perceptions of their fall risk in the hospital: An integrative review

AIMS AND OBJECTIVES

The objectives of this review are to determine what is currently known about older adults' perceptions of their own fall risk in the hospital and associated factors and explore how perceived fall risk in the hospital is assessed.

BACKGROUND

Every year, up to one million patients suffer an accidental fall in the hospital. Despite research efforts during the last decade, inpatient fall rates have not significantly decreased, and about one third of inpatient falls result in injuries. Limited evidence suggests that assessing hospitalised patients' perceptions of their fall risk and engaging them in their own fall prevention can reduce inpatient falls.

DESIGN

An integrative review.

METHODS

An electronic literature search was conducted in the Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Embase, Google Scholar, OpenGrey, ProQuest Dissertations & Theses Global, PsycINFO and PubMed. Data extraction and quality assessments were independently performed by two reviewers. PRISMA guidelines were followed for reporting this review.

RESULTS

Twenty-two studies met the inclusion criteria. The findings suggest that hospitalised older adults inadequately estimate their own fall risk. Most participants did not perceive themselves as at risk for falling in the hospital. Educational and motivational interventions can change the patients' perceptions of their own fall risk in the hospital and engage them in fall prevention. The desire to remain independent and feeling vulnerable were associated with fall risk, and the relationship with nursing staff may affect how hospitalised patients perceive their own fall risk.

CONCLUSIONS

Hospitalised adults, and specifically older adults, do not adequately estimate their own fall risk. Factors associated with these perceptions must be further explored to develop assessment tools and interventions to decrease inpatient fall rates.

RELEVANCE TO CLINICAL PRACTICE

Nurses' understanding and assessment of hospitalised adults' perception of their own fall risk is important to consider for reducing inpatient falls.

Stroke survivors personal efficacy beliefs and outcomes expectations of tai chi exercise: a qualitative descriptive study

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Laurence B. Emmons Research Award

Background

Strokes are a leading cause of serious long-term disability, often compounded by post-stroke depression. Prior Tai Chi research conducted among stroke survivors has focused mainly on physical functioning yet understanding the potential benefits and challenges of participating in Tai Chi exercise during stroke recovery is limited. Social Cognitive Theory and Complex Systems Biology provided the theoretical framework to examine stroke survivors’ personal efficacy beliefs, behaviour (Tai Chi intervention), and outcome expectations (Figure 1).

Purpose

To describe community-dwelling stroke survivors’ experiences of being in an 8-week Tai Chi intervention, including any benefits or challenges they had, and allow the participants to offer any suggestions for improving how the Tai Chi classes were structured.

Methods

A qualitative descriptive approach was used, with focus group interview data collected from stroke survivors after participation in a Tai Chi intervention. Due to COVID-19, the focus group interview was conducted via on-line video conferencing. The interview was audio-recorded, then transcribed using an online transcription service. Content analysis of the de-identified transcript was conducted using online analysis software with a priori codes based on the theoretical framework, and inductive codes that were added during the analysis process. The transcript was coded independently by two researchers and discussed until consensus was reached. Lincoln and Guba’s criteria were followed to ensure trustworthiness of the data.

Results

Community-dwelling stroke survivors (n = 7) participating in the focus group interviews were on average 68 years old, mainly retired (71%, n = 5), married women (57%, n = 4) with &gt;13 years education (86%, n = 6), reporting depression symptoms (Center for Epidemiological Studies-Depression = 15.9 ± 9.6) with 43% (n = 3) taking anti-depressant medications. The major findings are summarized according to three major themes: Personal Efficacy Beliefs, Tai Chi Intervention Active Ingredients and Outcome Expectations. Personal Efficacy Beliefs centered on the participants’ ability to do the Tai Chi movements. The Tai Chi Intervention Active Ingredients experienced during the classes were evident, apart from ‘natural freer breathing’ which was not discussed or described. Outcome Expectations centered on the physical, mental, and social benefits experienced, challenges encountered, and suggestions for improving the Tai Chi classes.

Conclusion

Social Cognitive Theory underscored stroke survivors’ personal efficacy beliefs, behaviour, and outcome expectations. While Complex Systems Biology highlighted the active ingredients of Tai Chi intervention they experienced. Participation in the 8-week Tai Chi intervention led to perceived holistic (physical, mental, social) benefits post-stroke.

Embarrassment experienced by older adults in relation to accidental falls: A concept analysis

Embarrassment is commonly felt by older adults experiencing a fall, and embarrassment may cause older adults to adopt maladaptive behaviors by not implementing fall prevention strategies. Clarifying the concept of embarrassment for nursing and defining the concept as it relates to accidental falls and fall prevention among older adults was conducted using Walker and Avant's eight-step concept analysis process. The proposed definition of embarrassment experienced by older adults in relation to accidental falls is: The feeling of physical discomfort and exposure in a social situation due to the loss of control and self-esteem, as well as the inconsistency between one's personal identity as an independent and dignified person and the accidental fall or near fall behavior that threatens independence and dignity leading to emotional distress. Nurses recognizing older adults' potential fall-related embarrassment may increase older adults' adherence to fall prevention strategies and improve health outcomes.