How to Perform a Preplanned Process Evaluation for Complex Interventions in Geriatric Medicine: Exemplified With the Process Evaluation of a Complex Falls-Prevention Program for Community-Dwelling Frail Older Fallers

Abstract Background RESPOND is a telephone-based falls prevention program for older people who present to a hospital emergency department (ED) with a fall. A randomised controlled trial (RCT) found RESPOND to be effective at reducing the rate of falls and fractures, compared with usual care, but not fall injuries or hospitalisations. This process evaluation aimed to determine whether RESPOND was implemented as planned, and identify implementation barriers and facilitators. Methods A mixed-methods evaluation was conducted alongside the RCT. Evaluation participants were the RESPOND intervention group (n = 263) and the clinicians delivering RESPOND (n = 7). Evaluation data were collected from participant recruitment and intervention records, hospital administrative records, audio-recordings of intervention sessions, and participant questionnaires. The Rochester Participatory Decision-Making Scale (RPAD) was used to evaluate person-centredness (score range 0 (worst) - 9 (best)). Process factors were compared with pre-specified criteria to determine implementation fidelity. Six focus groups were held with participants (n = 41), and interviews were conducted with RESPOND clinicians (n = 6). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the ‘Capability, Opportunity, Motivation – Behaviour’ (COM-B) behaviour change framework. Results RESPOND was implemented at a lower dose than the planned 10 h over 6 months, with a median (IQR) of 2.9 h (2.1, 4). The majority (76%) of participants received their first intervention session within 1 month of hospital discharge with a median (IQR) of 18 (12, 30) days. Clinicians delivered the program in a person-centred manner with a median (IQR) RPAD score of 7 (6.5, 7.5) and 87% of questionnaire respondents were satisfied with the program. The reports from participants and clinicians suggested that implementation was facilitated by the use of positive and personally relevant health messages. Complex health and social issues were the main barriers to implementation. Conclusions RESPOND was person-centred and reduced falls and fractures at a substantially lower dose, using fewer resources, than anticipated. However, the low dose delivered may account for the lack of effect on falls injuries and hospitalisations. The results from this evaluation provide detailed information to guide future implementation of RESPOND or similar programs. Trial registration This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014).

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Development and Process Evaluation of a 5-Week Exercise Program to Prevent Falls in People after Stroke: The FALLS Program

Stroke Research and Treatment ◽

10.1155/2012/407693 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

H. J. R. van Duijnhoven ◽

D. De Kam ◽

W. Hellebrand ◽

E. Smulders ◽

A. C. H. Geurts ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Clinical Practice ◽

Process Evaluation ◽

Fall Prevention ◽

Health Care Professionals ◽

Exercise Program ◽

Community Dwelling ◽

Falls Prevention ◽

Common Complication

Falls are a common complication after stroke, with balance and gait deficits being the most important risk factors. Taking into account the specific needs and capacities of people with stroke, we developed the FALLS program (FALL prevention after Stroke), based on the “Nijmegen falls prevention program” (a proven-effective 5-week exercise program designed for community-dwelling elderly people). The program was tested in twelve community-dwelling persons with stroke, and a process evaluation was conducted with patients, trainers, health care professionals, and managers. The FALLS program was considered suitable and feasible by people with stroke in the study and relevant health care professionals, and recommendations for implementation in clinical practice have been suggested.

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Developing a falls prevention program for community-dwelling stroke survivors in Singapore: client and caregiver perspectives

Disability and Rehabilitation ◽

10.1080/09638288.2017.1419293 ◽

2017 ◽

Vol 41 (9) ◽

pp. 1044-1054 ◽

Cited By ~ 4

Author(s):

Tianma Xu ◽

Kate O’Loughlin ◽

Lindy Clemson ◽

Natasha A. Lannin ◽

Catherine Dean ◽

...

Keyword(s):

Prevention Program ◽

Community Dwelling ◽

Falls Prevention ◽

Stroke Survivors

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Steady As You Go (SAYGO): A Falls-Prevention Program for Seniors Living in the Community

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.1017/s0714980800004529 ◽

2003 ◽

Vol 22 (2) ◽

pp. 207-216 ◽

Cited By ~ 23

Author(s):

Ellie Robson ◽

Joy Edwards ◽

Elaine Gallagher ◽

Dorothy Baker

Keyword(s):

Treatment Group ◽

Rural Areas ◽

Prevention Program ◽

Community Intervention ◽

Target Population ◽

Community Dwelling ◽

Falls Prevention ◽

Control Group ◽

Community Trial

ABSTRACTThis study was an implementation and community trial of a new falls-prevention program for seniors called Steady As You Go (SAYGO). The program, designed in the Capital Health region of Alberta, integrated the knowledge gained from successful falls-prevention research into a brief community intervention. SAYGO included a multifactorial, risk-abatement approach, as well as a cognitive-behavioural and environmental focus. The target population was relatively healthy and mobile, community-dwelling seniors. The randomized community trial was conducted in urban and rural areas in Alberta, with 660 seniors participating. Seniors who completed the program made significant reductions in eight of the nine risk factors addressed in the program. Over a 4-month follow-up period, the proportion of seniors who fell was lower in the treatment group (17%) than in the control group (23%). Among those seniors who had reported a fall in the previous year, a significantly lower proportion of those in the treatment group experienced a fall in the follow-up period (20%) as compared to those in the control group (35%).

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Implementing a Community-Based Falls-Prevention Program: From Drawing Board to Reality

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.3138/cja.26.3.213 ◽

2007 ◽

Vol 26 (3) ◽

pp. 213-225 ◽

Cited By ~ 17

Author(s):

Johanne Filiatrault ◽

Manon Parisien ◽

Sophie Laforest ◽

Carole Genest ◽

Lise Gauvin ◽

...

Keyword(s):

Prevention Program ◽

Community Dwelling ◽

Falls Prevention ◽

Natural Conditions ◽

Community Based ◽

Multiple Risk Factors ◽

Community Based Organizations ◽

Participation Level ◽

Drawing Board ◽

Area Data

ABSTRACTSeveral studies have demonstrated the efficacy of falls-prevention programs designed for community-dwelling seniors using randomized designs. However, little is known about the feasibility of implementing these programs under natural conditions and about the success of these programs when delivered under such conditions. The objectives of this paper are to (a) describe a multifactorial falls-prevention program (called Stand Up!) designed for independent community-dwelling seniors and (b) present the results of an analysis of the practicability of implementing this program in community-based settings. The program was implemented in the context of an effectiveness study in 10 community-based organizations in the Montreal metropolitan area. Data pertaining to the reach and delivery of the program as well as participation level show that a falls-prevention program addressing multiple risk factors can be successfully implemented in community-based settings.

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Characteristics Associated with Improved Physical Performance among Community-Dwelling Older Adults in a Community-Based Falls Prevention Program

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17072509 ◽

2020 ◽

Vol 17 (7) ◽

pp. 2509

Author(s):

Gabrielle Scronce ◽

Wanqing Zhang ◽

Matthew Lee Smith ◽

Vicki Stemmons Mercer

Keyword(s):

Older Adults ◽

Physical Performance ◽

Prevention Program ◽

Community Dwelling ◽

Falls Prevention ◽

Initial Visit ◽

Cognitive Screening ◽

Community Based ◽

Community Dwelling Older Adults

This was a retrospective analysis of quasi-longitudinal data from an ongoing, community-based falls prevention program. The purpose was to identify participant characteristics predicting improvement on physical performance measures associated with falls risk. Community-dwelling older adults ≥60 years old participated in a community-based implementation of the Otago Exercise Program (OEP). Participants with increased falls risk (n = 353) were provided with individualized exercises from OEP and were invited to return for monthly follow-up. One hundred twenty-eight participants returned for at least two follow-up visits within 6 months of their initial visit (mean time to second follow-up = 93 days with standard deviation = 43 days). Outcome measures assessed at initial and all follow-up visits included Four Stage Balance Test (4SBT), Timed Up and Go test (TUG), and Chair Rise Test (CRT). Distributions were examined, and results were categorized to depict improvement from initial visit (IVT) to second follow-up visit (F2). Key predictor variables were included in multivariable linear or logistic regression models. Improved 4SBT performance was predicted by greater balance confidence. Better TUG performance at F2 was predicted by no use of assistive device for walking, higher scores on cognitive screening, and better IVT TUG performance. Improvement on CRT was predicted by younger age and lower scores on cognitive screening. While improvements on each of the three measures were predicted by a unique combination of variables, these variables tended to be associated with less frailty.

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Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil)

BMC Geriatrics ◽

10.1186/1471-2318-13-27 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 9

Author(s):

Kelem de Negreiros Cabral ◽

Monica Rodrigues Perracini ◽

Aline Thomaz Soares ◽

Francine de Cristo Stein ◽

Celisa Tiemi Nakagawa Sera ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Older People ◽

Usual Care ◽

Prevention Program ◽

Controlled Trial ◽

Community Dwelling ◽

Falls Prevention ◽

Community Dwelling Older People ◽

Randomised Controlled ◽

Care Study

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The design and implementation of a theory-based interdisciplinary falls prevention pilot program for community dwelling older adults

American Journal of Health Studies ◽

10.47779/ajhs.2017.79 ◽

2017 ◽

Vol 32 (4) ◽

Author(s):

Jennifer L. Tripken ◽

Cathy S. Elrod ◽

Susan Bills

Keyword(s):

Risk Factors ◽

Older Adults ◽

Prevention Program ◽

Self Efficacy ◽

Fall Risk ◽

Community Dwelling ◽

Falls Prevention ◽

Metropolitan County ◽

Fall Risk Factors ◽

Community Dwelling Older Adults

The purpose of this research was to describe the development of an interdisciplinary community-based falls prevention program that integrated self-efficacy theory and to evaluate its impact on awarenessof fall risk factors and self-efficacy to engage in behaviors that reduce fall risk. Twenty-three communitydwelling older adults participated in a five-week falls prevention program held at a community centerin a large metropolitan county in the Mid-Atlantic. Positive improvements were demonstrated across alloutcome measures. Our findings indicate that a theory-based interdisciplinary falls prevention programincreased self-efficacy and awareness of falls risk factors in older adults.

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Bedside Ultrasound Measures of Muscle Mass and Frailty Measures in Community-Dwelling Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.861 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 269-269

Author(s):

Kenneth Madden ◽

Boris Feldman ◽

Shane Arishenkoff ◽

Graydon Meneilly

Keyword(s):

Older Adults ◽

Muscle Mass ◽

Frailty Index ◽

Geriatric Medicine ◽

Muscle Thickness ◽

Vancouver General Hospital ◽

Community Dwelling ◽

Point Of Care Ultrasound ◽

Clinical Frailty Scale ◽

Community Dwelling Older Adults

Abstract The age-associated loss of muscle mass and strength in older adults is called sarcopenia, and it is associated with increased rates of falls, fractures, hospitalizations and death. Sarcopenia is one of the most common physical etiologies for increased frailty in older adults, and some recent work has suggested the use of Point-of care ultrasound (PoCUS) measures as a potential measure of muscle mass. The objective of this study was to examine the association of PoCUS measures of muscle thickness (MT) with measures of frailty in community-dwelling older adults. We recruited 150 older adults (age >= 65; mean age 80.0±0.5 years, 66 women, 84 men) sequentially from 5 geriatric medicine clinics (Vancouver General Hospital). We measured lean muscle mass (LMM, by bioimpedance assay) and an ultrasonic measure of muscle quantity (MT, vastus medialis muscle thickness) in all subjects, as well as two outcome measures of frailty (FFI, Fried Frailty Index; RCFS, Rockwood Clinical Frailty Scale). In our models, MT showed an inverse correlation with the FFI (Standardized β=-0.2320±0.107, p=0.032) but no significant correlation with the RCFS (Standardized β = -0.025±0.086, p=0.776). LMM showed no significant association with either FFI (Standardized β=-0.232±0.120, p=0.055) or RCFS (Standardized β = -0.043±0.119, p=0.719). Our findings indicate that PoCUS measures show potential as a way to screen for physical manifestations of frailty and might be superior to other bedside methods such as bioimpedance assay. However, PoCUS measures of muscle thickness will likely miss patients showing frailty in the much broader context captured by the RCFS.

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