scholarly journals 12 Exploring Hospital Discharge as An Opportunity for Falls Prevention Exercise Referral

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
C Buckland ◽  
J Whitney
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Hospital Discharge ◽  
Behaviour Change ◽  
Fall Prevention ◽  
Falls Prevention ◽  
Good Opportunity ◽  
Risk Of Falls ◽  
Exercise Referral ◽  
Sustainability Model

Abstract Topic Proactive prevention is at the core of the NHS Long Term plan and falls prevention is an important public health priority. National guidance recommends that all health professionals have competence in falls assessment and prevention and advise that older adults at risk of falls are considered for strength and balance exercise. With rising numbers of older adults occupying inpatient beds, some clinicians may not have the skills to identify these opportunities to prevent falls. Previously, physiotherapy staff on a respiratory medicine ward were not delivering best practice in falls prevention. Aim Within 3 months, to achieve a 30% increase in older adults at risk of falls, being offered exercise referral at hospital discharge. Intervention Quality improvement methodology including stakeholder engagement and Plan-Do-Study-Act cycles were used to influence behaviour change amongst physiotherapy staff on a respiratory ward. Interventions included training and a documentation sticker. For evaluation, the weekly number of older adults at risk of falls with evidence of offer for falls prevention exercise was collected over 13 weeks and evaluated on a Statistical Process Control chart. Staff confidence scores and cohort data were also recorded and described using descriptive statistics. The NHS Improvement Sustainability Model was used to measure project sustainability. Improvement At baseline, 0/18 (0%) older adults had an offer for fall prevention exercise. Over the intervention period, this increased to 22/37 (59.5%) and demonstrated special cause variation that was confidently assigned to the interventions. There was a 44.5% improvement in staff confidence in offering fall prevention exercise. The project scored 53.7% using the NHS sustainability model. Discussion This project demonstrated favourable behaviour change in falls prevention practice amongst physiotherapy staff on a respiratory ward. There was variability in the improvement possibly as a result of contextual influences of staffing and seasonality. Hospital discharge is a good opportunity to assess falls risk in older adults and offer information and referral for exercise. Wider implementation may be useful to help older adults optimise health outcomes but will depend on organisational stakeholder support to improve sustainability.

scholarly journals EXPERIENCES AND FACILITATORS OF FALLS PREVENTION AMONG ETHNICALLY DIVERSE OLDER ADULTS: A QUALITATIVE STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S854-S854
Author(s):  
Ladda Thiamwong ◽  
Norma E Conner
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Fall Risk ◽  
Fear Of Falling ◽  
Ethnically Diverse ◽  
Role Identity ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Facilitators And Barriers ◽  
And Behaviors

Abstract Background: Falls increase as people age and decrease the quality of life. Even though fall interventions have received great attention, fall incidence rates have still arisen. In order for older adults to reap the benefits of evidence-based fall interventions, a challenge of implementation in the real world and right context must be met. Understanding experiences, facilitators, and barriers of fall prevention among four major ethnic groups in the Unites States could be extremely valuable. Objective: The aim of this study was to describe experiences and highlight facilitators and barriers on fall and fear of falling interventions among ethnically diverse community-dwelling older adults. Methods: Four ethnically specified (African American, Asian, Hispanic and Non-Hispanic White) focus groups were conducted. A total of 28 older adults and four family caregivers were interviewed. Interviews covered experiences on falls and fear of falling, attitudes, factors, consequences, risk assessment, and interventions. Data were organized and analyzed with the NViVo software. Results: Falls related experiences and behaviors were multifaceted and varied. Three themes related to falls experiences and behaviors were identified, 1) falls prevention versus fear of falling amplification; 2) role identity, culture and family considerations; and 3) take care of you, take care of me. Facilitators of fall prevention were integration of individual learning within a group meeting, providing appropriate assistive devices and promoting environmental safety. Barriers were inconsistent fall risk assessments, low fall risk awareness and acknowledgment, and balance and visual impairment.

scholarly journals Manual tracking impairs postural stability in older adults

2017 ◽  
Vol 80 (9) ◽  
pp. 539-548
Author(s):  
Anna Rossiter ◽  
Matthew J Allsop ◽  
Rachael K Raw ◽  
Lindsay Howard ◽  
Raymond J Holt ◽  
...  
Keyword(s):  
Older Adults ◽  
Postural Control ◽  
Postural Sway ◽  
Tracking Error ◽  
Task Demands ◽  
Falls Prevention ◽  
Cognitive Capacity ◽  
Risk Of Falls ◽  
The Relationship ◽  
Manual Performance

Introduction Older adults show increased postural sway and a greater risk of falls when completing activities with high cognitive demands. While dual-task approaches have clarified an association between cognitive processes and postural control, it is unclear how manual ability, which is also required for the successful completion of cognitively demanding tasks (such as putting a key into a lock), affects this relationship. Method Kinematic technology was used to explore the relationship between postural sway and manual control in healthy younger and older adults. Participants ( n = 82) remained standing to complete a visual-motor tracking task on a tablet computer. Root mean square tracking error measured manual performance, and a balance board measured deviations in centre of pressure as a marker of postural sway. Results Older adults displayed poorer manual accuracy and increased postural sway across all testing conditions. Conclusions Cognitive capacity can interact with multiple task demands, and in turn affect postural sway in older adults. Improving our understanding of factors that influence postural control will assist falls-prevention efforts and inform clinical practice.

scholarly journals Implementation of an Opioid and Benzodiazepine Deprescribing Program for Older Adults in an Outpatient Setting

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 906-906
Author(s):  
Lori Armistead ◽  
Jan Busby-Whitehead ◽  
Stefanie Ferreri ◽  
Cristine Henage ◽  
Tamera Hughes ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
At Risk ◽  
Older Adult ◽  
Adult Population ◽  
Primary Care Providers ◽  
The United States ◽  
Outpatient Setting ◽  
Care Providers ◽  
Risk Of Falls

Abstract The United States spends $50 billion each year on 2.8 million injuries and 800,000 hospitalizations older adults (age 65 years and older) incur as the result of falls. Chronic use of central nervous system (CNS)-active medications, such as opioid and/or benzodiazepine (BZD) medications, increases the risk of falls and falls-related injuries in this older adult population. This Centers for Disease Control and Prevention (CDC)-funded randomized control trial uses electronic health record (EHR) data from primary care outpatient clinics to identify older adult patients at risk for falls due to chronic opioid or BZD use. The primary program aim is to test the efficacy of a targeted consultant pharmacist service to reduce the dose burden of these medications in the targeted population. Impact of this intervention on the risk of falls in this population will also be assessed. Licensed clinical pharmacists will review at-risk patients’ medical records weekly and make recommendations through the EHR to primary care providers for opioid or BZD dose adjustments, alternate medications, and/or adjunctive therapies to support deprescribing for approximately 1265 patients in the first two cohorts of intervention clinics. One thousand three hundred eighty four patients in the control clinics will receive usual care. Outcome measures will include reduction or discontinuation of opioids and BZDs and falls risk reduction as measured by the Stop Elderly Accidents, Death and Injuries (STEADI) Questionnaire. Primary care provider adoption of pharmacists’ recommendations and satisfaction with the consult service will also be reported.

scholarly journals Actions of the fall prevention protocol: mapping with the classification of nursing interventions

2017 ◽  
Vol 25 (0) ◽  
Author(s):  
Vanessa Cristina Alves ◽  
Weslen Carlos Junior de Freitas ◽  
Jeferson Silva Ramos ◽  
Samantha Rodrigues Garbis Chagas ◽  
Cissa Azevedo ◽  
...  
Keyword(s):  
Fall Prevention ◽  
Environmental Safety ◽  
Risk Identification ◽  
Mapping Method ◽  
Falls Prevention ◽  
Nursing Interventions ◽  
Safety Control ◽  
Risk Of Falls ◽  
Prevention Protocol

ABSTRACT Objective: to analyze the correspondence between the actions contained in the fall prevention protocol of the Ministry of Health and the Nursing Interventions Classification (NIC) by a cross-mapping. Method: this is a descriptive study carried out in four stages: protocol survey, identification of NIC interventions related to nursing diagnosis, the risk of falls, cross-mapping, and validation of the mapping from the Delphi technique. Results: there were 51 actions identified in the protocol and 42 interventions in the NIC. Two rounds of mapping evaluation were carried out by the experts. There were 47 protocol actions corresponding to 25 NIC interventions. The NIC interventions that presented the highest correspondence with protocol actions were: fall prevention, environmental-safety control, and risk identification. Regarding the classification of similarity and comprehensiveness of the 47 actions of the protocol mapped, 44.7% were considered more detailed and specific than the NIC, 29.8% less specific than the NIC and 25.5% were classified as similar in significance to the NIC. Conclusion: most of the actions contained in the protocol are more specific and detailed, however, the NIC contemplates a greater diversity of interventions and may base a review of the protocol to increase actions related to falls prevention..

Assessing gait parameters with accelerometer-based methods to identify older adults at risk of falls: a systematic review

2018 ◽  
Vol 9 (4) ◽  
pp. 435-448 ◽  
Author(s):  
S. Gillain ◽  
M. Boutaayamou ◽  
C. Beaudart ◽  
M. Demonceau ◽  
O. Bruyère ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
At Risk ◽  
Gait Parameters ◽  
Risk Of Falls

scholarly journals Tailored Education Increased Capability and Motivation for Fall Prevention in Older People After Hospitalization

2021 ◽  
Vol 9 ◽  
Author(s):  
Chiara Naseri ◽  
Steven M. McPhail ◽  
Meg E. Morris ◽  
Terry P. Haines ◽  
Christopher Etherton-Beer ◽  
...  
Keyword(s):  
Older People ◽  
Social Control ◽  
Hospital Discharge ◽  
Fall Prevention ◽  
Falls Prevention ◽  
Bivariate Analysis ◽  
Prevention Strategies ◽  
Recent Trial ◽  
Mental Test Score ◽  
The Impact

Recently hospitalized older people are at risk of falls and face barriers to undertaking fall prevention strategies after they return home from hospital. The authors examined the effects of tailored education delivered by physiotherapists on the knowledge (capability) and the motivation of older people to engage in fall prevention after hospital discharge. Utilizing data gathered from a recent trial, data was analyzed from 390 people who were 60 years and over without impaired cognition (>7/10 abbreviated mental test score) and discharged from three Australian hospitals. Motivation and capability were measured at baseline in the hospital and at 6-months after hospital discharge by blinded assistants using structured surveys. Bivariate analysis using generalized linear modeling explored the impact of education on the capability and motivation. Engagement in fall prevention strategies was entered as an independent variable during analysis to determine associations with capability and motivation. The education significantly improved capability [−0.4, 95% CI (−0.7, −0.2), p < 0.01] and motivation [−0.8, 95% CI (−1.1, −0.5), p < 0.01] compared with social-control at the time of hospital discharge. In contrast, social-control participants gained capability and motivation over the 6-months, and no significant differences were found between groups in capability [0.001, 95% CI (−0.2, 0.2), p = 0.9] and motivation [−0.01, 95% CI (−0.3, 0.3), p = 0.9] at follow-up. Tailored fall prevention education is recommended around hospital discharge. Participants still needed to overcome barriers to falls prevention engagement post hospitalization. Thus, tailored education along with direct clinical services such as physiotherapy and social supports is warranted for older people to avoid falls and regain function following hospitalization.

scholarly journals 111 Disparities between Actual and Perceived Fall Risk Affect Participation in 5 Fall Prevention Interventions

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv18-iv27
Author(s):  
Pey June Tan ◽  
Silvia Sim ◽  
Noor Hafizah Ismail ◽  
Jagadish Mallya ◽  
Angelique Chan ◽  
...  
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Fall Risk ◽  
Help Seeking ◽  
Fear Of Falling ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Risk Level ◽  
Prevention Interventions ◽  
Aware Group

Abstract Introduction Older adults have been found to under- or overestimate their fall risk. However, no studies have investigated implications on help-seeking behaviours in falls prevention. This study examines how disparities between actual and perceived fall risk affects participation in 5 fall prevention interventions among community-dwelling older adults in Singapore. Methods This was a cross-sectional survey of a nationally representative sample of community-dwelling adults aged ≥60 years in Singapore identified by stratified random sampling. Having previous falls in the past 12 months (faller/non-faller) indicated actual fall risk. Level of fear-of-falling (cut-off ≥23 on 16-item Falls Efficacy Scale International) was used as perceived fall risk (high/low). Four profiles based on combinations of actual and perceived risk were associated with participation in 5 fall prevention interventions in a multiple logistic regression. The model was adjusted for age, gender, ≥2 comorbidities and knowledge that the intervention is to prevent falls. Results Final analysis included 549 older adults (mean age 70.6±6.9 years, 61% females). Majority (46%) were in the Vigorous group (no falls, low fear), 35% Anxious (no falls, high fear), 11% Frail Aware (falls, high fear) and 8% Stoics (falls, low fear). Only those in Anxious and Frail Aware group were significantly more likely to have talked to a healthcare professional on strategies to avoid falls [OR 1.8 (1.1-3.1) and 3.2 (1.6-6.4) respectively] and made home modifications [OR 1.9 (1.3-2.8) and 2.0 (1.1-3.6)] after adjustments. No association was found for participation in exercise, medication review and falls education. Discussion Individual profiles with high fear-of-falling component have different help-seeking behaviours compared to those with low fear regardless of history of falls. However, individuals in Frail Aware group have higher likelihood to uptake the interventions compared to Anxious group. Future research should examine other drivers of behaviour that will influence participation in other interventions.

Twin Contributors to the Physiology of Ambulatory Wellbeing and Falls Prevention in Ageing Populations

2021 ◽  
pp. 1-20
Author(s):  
Catherine Hayes
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Falls Prevention ◽  
Community Based ◽  
Fall Injuries ◽  
Health And Wellbeing ◽  
Physiological Processes ◽  
Normal Ageing ◽  
Societal Challenge

Being able to theoretically underpin the gerontology of ageing is a fundamental part of designing and constructing bespoke research and care interventions for the exploration of fall prevention in practice. Within the context of home care and community-based settings being able to integrate fall prevention into the integrated care that older people receive, their ambulation, health, and wellbeing, and subsequently their longevity in senior years, can be extended and sustained in terms of quality and satisfaction. This chapter contextualises and frames falls and fall injuries as a societal challenge by deconstructing the characteristic physiological processes of senescence and identifying key areas for fundamental address in the prevention of falls ‘in situ'. The chapter's focus is predominantly aligned to those processes of natural senescence aligned with normal ageing processes, alongside those pathologies which constitute abnormal pathological processes, which occur more often in older adults as a consequence of these processes of senescence.

scholarly journals 111 Tripper: Trying to Reduce Inappropriate Prescribing in Patients Who are Elderly and At Risk of Falls

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
A O'Kane ◽  
N McGarry ◽  
J Baillie ◽  
R Plumb
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
At Risk ◽  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
Beers Criteria ◽  
Risk Area ◽  
Discharge Letter ◽  
Risk Of Falls ◽  
History Of

Abstract Background Falls in older adults are common, and a major cause of mortality and morbidity. Polypharmacy is associated with a greater number of falls and is prevalent but preventable. The American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults are used worldwide. This project focused on Table 3 of the 2019 Beers Criteria which recommends an explicit list of PIMs to be avoided in older adults with a history of falls. Aims To increase documented discussion about PIMs on discharge letters for elderly patients at risk of falls over a 6-week period. Method A retrospective review was undertaken to define baseline data on falls, PIMs and documented discussion of PIMs on discharge letters. Stickers for Kardexes were introduced to highlight PIMs for review. A table documenting discussion of PIMs was incorporated to discharge letter templates. Data was then collected on falls, PIMs and documented discussion of PIMs on discharge letters over a 6-week period. Results: Of patients discharged over 10 weeks, 44% had a history of falls. Of patients with a history of falls, 73% were taking at least one PIM pre-admission. Following intervention, the median percentage of discharge letters with documented discussion of PIMs increased from 4% to 30%. Following intervention, there was a greater average reduction in prescribed PIMs on discharge in patients with a history of falls. Discussion We confirmed a significant burden of falls and PIMs in our patient population. QIP intervention increased documentation of PIM discussion and reduced the volume of PIMs prescribed on discharge. Communicating PIM discussion on discharge letters encourages deprescribing; informs primary care and future admissions; and promotes patient centred decision-making in this important risk area. Further work includes collecting feedback from primary care and introducing a PIMs review table to discharge letter templates throughout the hospital.

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