Determinants of Fall Prevention Guideline Implementation in the Home- and Community-Based Service Setting

2020 ◽  
Author(s):  
Lisa A Juckett ◽  
Alicia C Bunger ◽  
Shannon E Jarrott ◽  
Holly I Dabelko-Schoeny ◽  
Jessica Krok-Schoen ◽  
...  
Keyword(s):  
Older Adult ◽  
Fall Prevention ◽  
Fall Risk ◽  
Adult Population ◽  
Guideline Implementation ◽  
Implementation Strategies ◽  
Semistructured Interview ◽  
Community Based ◽  
Prevention Guideline ◽  
Prevention Guidelines

Abstract Background and Objectives Home- and community-based service (HCBS) recipients often possess multiple fall risk factors, suggesting that the implementation of evidence-based fall prevention guidelines may be appropriate for the HCBS setting. The purpose of this exploratory study was to examine the determinants of fall prevention guideline implementation and the potential strategies that can support implementation in HCBS organizations. Research Design and Methods Semistructured interview and focus group data were collected from 26 HCBS professionals representing the home-delivered meals, personal care, and wellness programs. Qualitative codes were mapped to the Consolidated Framework for Implementation Research by means of directed content analysis. The Consolidated Criteria for Reporting Qualitative research checklist was used to report the findings of this study. Results We identified 7 major determinants of guideline implementation: recipient needs and resources, cosmopolitanism, external policy and incentives, networks and communication, compatibility, available resources, and knowledge/beliefs. Strategies to support guideline implementation included the involvement of recipient and caregiver feedback, building fall prevention networks, and conducting educational meetings for HCBS staff. Discussion and Implications Falls and fall-related injuries will continue to plague the older adult community unless innovative approaches to fall prevention are developed and adopted. The implementation of fall prevention guidelines in the HCBS setting can help mitigate fall risk among a highly vulnerable older adult population and may be facilitated through the application of multifaceted implementation strategies.

scholarly journals Perceptions of Care Among Older Adults Identified as Fall Risk During a Hospital Stay

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 139-139
Author(s):  
Barbara King
Keyword(s):  
Older Adults ◽  
Hospital Stay ◽  
Older Adult ◽  
Fall Prevention ◽  
Fall Risk ◽  
Medical Center ◽  
Academic Medical Center ◽  
Common Strategy ◽  
Open Coding ◽  
Perceptions Of Care

Abstract In-hospital falls are a significant clinical, legal and regulatory problem. The Centers for Medicare and Medicaid no longer reimburse hospitals for falls that result in injury, adding increase pressure on acute care settings to prevent falls. Additionally, evidence-based practice recommendations for fall prevention in hospitals do not exist, thus leaving administrators to create their own programs. One common strategy used by hospital providers to prevent falls is to restrict patient mobility. Little information on how older adult patients experience fall prevention during a hospital stay has been published. The purpose of this study was to understand perceptions of care among older adults identified as fall risk during a hospital stay. This qualitative study utilized inductive content analysis. Older adults (N=20) from a large academic medical center in the Midwest were recruited to participate in one-to one in-depth interviews. Open coding, categorization and abstraction was used to analyze the data. Three main categories were identified that summarized the older adult patient perception of hospitalization: Act of Caring, something they received from staff, provide to staff or provided to self; Being Restricted in movement resulting in either accepting or rejecting the restriction and Being Freed at discharge, often being told “just be careful”. Older adult identified as fall risk described being restricted in movement during a hospital stay. Many passively accepted this restriction even though they felt a lack of movement would be harmful to them. Additional research on the patient experience with fall prevention is needed.

scholarly journals INTEREST GROUP SESSION—HEALTH BEHAVIOR CHANGE: USING DATA ABOUT PATIENT CHARACTERISTICS TO IMPROVE FALL PREVENTION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S566-S566
Author(s):  
Gwen Bergen
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Fall Prevention ◽  
Fall Risk ◽  
Healthcare Providers ◽  
Patient Characteristics ◽  
Health Behavior Change ◽  
Clinical Aspects ◽  
Evidence Based ◽  
Prevention Strategies

Abstract Over one in four U.S. older adults (age 65+) reports falling each year with fall-related medical costs estimated at $50 billion. The American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons recommends that healthcare providers assess and manage their patients’ fall risk. The Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative helps healthcare providers incorporate these guidelines by providing tools on how to screen, assess, and intervene to reduce risk. Evaluations of fall prevention have focused on the clinical process and outcomes. Understanding clinical activities is important in fall prevention but a better understanding of older adult characteristics that increase fall-risk, and attitudes that may affect their adoption of evidence-based interventions could improve the effectiveness of prevention strategies. The five presentations in this session include: 1. Demographic, health and functional characteristics of older adults with increased fall risk. 2. Caregivers of people with chronic conditions or disability as a group with increased fall risk. 3. The most effective and efficient ways of identifying older adults with increased fall risk. 4. Facilitators and barriers to older adults’ adherence to evidence-based fall interventions. 5. Applying knowledge of older adult attitudes to improving an implementation of STEADI-based fall prevention. Multifactorial fall prevention strategies such as STEADI focus on the clinical aspects of fall prevention but their success depends on understanding and incorporating older adult characteristics and attitudes. The information presented in this session can inform fall prevention strategies and improve health.

The Role of the US Trauma Centers in Older Adult Fall Prevention: A National Survey

2021 ◽  
pp. 000313482110475
Author(s):  
Lisa Allee ◽  
Mark Faul ◽  
Prathima Guntipalli ◽  
Peter A. Burke ◽  
Sowmya R. Rao ◽  
...  
Keyword(s):  
Injury Prevention ◽  
Older Adult ◽  
Fall Prevention ◽  
Prevention Program ◽  
Fall Risk ◽  
Screening Tools ◽  
Trauma Centers ◽  
Fall Prevention Program ◽  
American College Of Surgeons

Introduction Approximately 27.5% of adults 65 and older fall each year, over 3 million are treated in an emergency department, and 32 000 die. The American College of Surgeons and its Committee on Trauma (ACSCOT) have urged trauma centers (TCs) to screen for fall risk, but information on the role of TC in this opportunity for prevention is largely unknown. Methods A 29-item survey was developed by an ACSCOT Injury Prevention and Control Committee, Older Adult Falls workgroup, and emailed to 1000 trauma directors of the National Trauma Data Bank using Qualtrics. US TCs were surveyed regarding fall prevention, screening, intervention, and hospital discharge practices. Data collected and analyzed included respondent’s role, location, population density, state designation or American College of Surgeons (ACS) level, if teaching facility, and patient population. Results Of the 266 (27%) respondents, 71% of TCs include fall prevention as part of their mission, but only 16% of TCs use fall risk screening tools. There was no significant difference between geographic location or ACS level. The number of prevention resources (F = 31.58, P < .0001) followed by the presence of a formal screening tool (F = 21.47, P < .0001) best predicted the presence of a fall prevention program. Conclusion Older adult falls remain a major injury risk and injury prevention opportunity. The majority of TCs surveyed include prevention of older adult falls as part of their mission, but few incorporate the components of a fall prevention program. Development of best practices and requiring TCs to screen and offer interventions may prevent falls.

scholarly journals Exploring Older Adult ED Fall Patients’ Understanding of Their Fall: A Qualitative Study

2017 ◽  
Vol 8 (4) ◽  
pp. 231-237 ◽  
Author(s):  
Kalpana N. Shankar ◽  
Devon Taylor ◽  
Caroline T. Rizzo ◽  
Shan W. Liu
Keyword(s):  
Older Adult ◽  
Fall Prevention ◽  
Fall Risk ◽  
Older Patients ◽  
Medical Condition ◽  
Community Dwelling ◽  
Fall Risk Factors ◽  
Variable Level ◽  
Semistructured Interviews ◽  
Prevention Interventions

Objective: We sought to understand older patients’ perspectives about their fall, fall risk factors, and attitude toward emergency department (ED) fall-prevention interventions. Methods: We conducted semistructured interviews between July 2015 and January 2016 of community-dwelling, nondemented patients in the ED, who presented with a fall to an urban, teaching hospital. Interviews were halted once we achieve thematic saturation with the data coded and categorized into themes. Results: Of the 63 patients interviewed, patients blamed falls on the environment, accidents, a medical condition, or themselves. Three major themes were generated: (1) patients blamed falls on a multitude of things but never acknowledged a possible multifactorial rationale, (2) patients have variable level of concerns regarding their current fall and future fall risk, and (3) patients demonstrated a range of receptiveness to ED interventions aimed at preventing falls but provided little input as to what those interventions should be. Conclusions: Many older patients who fall do not understand their fall risk. However, based on the responses provided, older adults tend to be more receptive to intervention and more concerned about their future fall risk, making the ED an appropriate setting for intervention.

scholarly journals “Work Is Like a Therapy That Prevents Aging”

SAGE Open ◽  
2017 ◽  
Vol 7 (1) ◽  
pp. 215824401668723
Author(s):  
Nicole Ruggiano ◽  
Janice O’Driscoll ◽  
Andreja Lukic ◽  
Linda Schotthoefer
Keyword(s):  
Older Adult ◽  
Adult Population ◽  
Later Life ◽  
The United States ◽  
Dade County ◽  
Productive Activity ◽  
Community Based ◽  
Social Trends ◽  
Productive Activities ◽  
Older Adult Population

Diversity among the older adult population is expected to increase significantly. In addition, economic, demographic, and social trends in the United States have led to growing interest in understanding attitudes, behaviors, and plans regarding retirement among middle-aged and older adults. However, there is currently little knowledge about minorities’ interests and expectations for retirement. This community-based participatory study addressed gaps in knowledge by asking a diverse sample of adults about their experiences and expectations for retirement. Data collection involved focus groups with Hispanics, Haitians, African Americans, and immigrants living in Miami-Dade County, Florida. The findings indicate that productive activity in later life was desired by participants across racial and ethnic groups, though higher income participants reported having greater opportunities for pursuing desired productive activities later in life. Implications for policy and services are discussed.

scholarly journals Operationalizing Environmental Indicators for Physical Activity in Older Adults

2007 ◽  
Vol 15 (4) ◽  
pp. 412-424 ◽  
Author(s):  
Scott Strath ◽  
Raymond Isaacs ◽  
Michael J. Greenwald
Keyword(s):  
Physical Activity ◽  
Older Adult ◽  
Traffic Safety ◽  
Traffic Control ◽  
Adult Population ◽  
Environmental Indicators ◽  
Neighborhood Environment ◽  
Semistructured Interview ◽  
Common Category ◽  
Older Adult Population

This qualitative study describes environmental supports and barriers to physical activity in an older adult sample drawn from low- and high-walkable neighborhoods. Thirty-seven individuals age 55 and over were recruited and answered open-ended survey questions, with a subsample invited back to partake in a semistructured interview. Content analysis identified categories and themes linking perceptions of neighborhood-environment characteristics to activity. Emerging categories and themes did not differ across neighborhood walkability, so results are presented for both groups combined. Infrastructure was the most common category identified to encourage activity, specifically, well-maintained sidewalks, bike paths or lanes, and traffic control. Other categories of land use, landscape, and aesthetics were reported. Poorly maintained or missing sidewalks, crosswalks, bike paths or lanes, and traffic safety were categories that discouraged activity. In conclusion, the information obtained is helpful in solidifying which environmental characteristics are important to measure as they relate to activity behavior in an older adult population.

scholarly journals Socially Relevant Approaches to the Detection of Dementia in Minority Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 719-719
Author(s):  
Lana Sargent ◽  
Sarah Lageman ◽  
Leroy Thacker ◽  
Sally Russell ◽  
Marissa Mackiewicz ◽  
...  
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Low Socioeconomic Status ◽  
Low Income ◽  
Adult Population ◽  
Cross Sectional Study ◽  
Cognitive Screening ◽  
Community Based ◽  
Cross Sectional ◽  
Adjusted Scores

Abstract Substantial gaps remain in the scientific literature regarding low-income minority older adult populations with Alzheimer’s disease and related dementias (ADRDs). Access to care and early cognitive screening are often barriers to advancing ADRD detection in low socioeconomic status (SES) minority older adults. Additionally, there is the need for demographically (age, education, sex, race, ethnicity, and income) corrected normative scores in cognitive measures. Our cross-sectional study evaluated the psychometrics of the Mini-Mental State Exam-2 (MMSE-2) and the NIH Toolbox Cognition Battery (NIHTB-CB). The sample consisted of n=80 community-based older adults without a diagnosis of dementia living in low-income high-rise housing units. Acceptability is assessed with a brief 6-item acceptability survey, multiple linear regression is used to get predicted cognitive scores adjusted for age, education, income, ethnicity, race, and sex, and t-test comparison of the adjusted scores found in this study to established norms. Results found a mean age of 73, 70% black, 48% with &lt; 12th-grade education, 51% have a monthly income of &lt; $1,000, and 49% with undiagnosed cognitive impairment (CI) by both measures. When applying demographic adjustments in the NIHTB-CB 1) standard scores; 2) age-corrected scores, and 3) demographically correct scores all remained significant (p &gt; 0.0001). Participants reported high (80-95%) acceptability for the community-based cognitive screening, 18% reported concerns with cultural appropriateness of the questions in the NIHTB-CB as compared to 5% with the MMSE-2. This research lays the foundation for a community-based cognitive screening and care coordination program for the low SES minority older adult population.

scholarly journals Staff and Administrator Perceptions of Fall Risk Management in Home- and Community-Based Service Settings

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 237-238
Author(s):  
Lisa Juckett ◽  
Rachael Poling
Keyword(s):  
Older Adults ◽  
Risk Management ◽  
Fall Prevention ◽  
Fall Risk ◽  
Service Providers ◽  
Internal Communication ◽  
Structured Interviews ◽  
Community Based ◽  
Staff Members ◽  
Prevention Service

Abstract Older adults who receive home- and community-based services (HCBS), such as home-delivered meals and personal care assistance, are at particular risk for falls due to their extremely high prevalence of fall risk factors. HCBS organizations and their staff are well-positioned to implement fall risk screens with HCBS clients and then refer older adults to fall prevention services as needed; however, the extent to which HCBS organizations manage fall risk has yet to be systematically examined. The purpose of this qualitative study was to explore the barriers to and facilitators of implementing fall risk screens and fall prevention service referrals in HCBS organizations. A total of 26 HCBS staff members and administrators participated in semi-structured interviews and focus groups. Qualitative data were examined using directed content analysis guided by the Consolidated Framework for Implementation Research. HCBS staff expressed that strong rapport with clients allowed for them to address fall risk proactively but were concerned that their lack of fall prevention training precluded them from effective fall risk management. HCBS administrators perceived their organization to have reliable internal communication procedures which enhanced fall prevention care coordination but believed their limited connections with fall prevention service providers served as a barrier to referring at-risk clients to appropriate care. Accordingly, HCBS stakeholders are encouraged to develop strategies, such as providing fall prevention coaching and building a network of fall prevention service providers, that account for these barriers and facilitators in future efforts to support effective fall risk management with HCBS clients.

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