Impact of tailored falls prevention education for older adults at hospital discharge on engagement in falls prevention strategies postdischarge: protocol for a process evaluation

Objective: Falls are a significant problem for many older patients after hospital discharge. The purpose of this study was to evaluate the fidelity and impact of a tailored patient fall prevention education programme from the perspective of the educators who delivered the programme. Design: Qualitative sequential design. Setting: Three rehabilitation hospitals in Western Australia. Method: Three experienced physiotherapists trained as ‘educators’ to deliver a tailored fall prevention education programme to 195 older patients prior to hospital discharge, together with monthly telephone follow-up for 3 months after discharge. Educator–patient interactions were recorded in a standardised educator diary. Post-intervention, educators participated in a mini-focus group, providing their perspectives regarding education delivery and its impact on patient abilities to engage in fall prevention strategies. Data were analysed using deductive content analysis. Results: Educators followed up 184 (94%) patients, identifying multiple barriers and enablers affecting patient engagement in planned fall prevention strategies. Key barriers included unresolved medical conditions, reluctance to accept assistance on discharge, delays in assistive service provision, patient beliefs and perceptions about falls and, in some cases, patients’ absolving responsibility for recovery. Enablers were related to programme design, the completion of hospital discharge processes and support networks following discharge. Conclusion: Educators identified several barriers and enablers to programme delivery, receipt and enactment by older patients that contributed to the fidelity of the education programme. The consistent need for more patient support to enable improved enactment of plans and assist with safe recovery long after discharge warrants further attention at policy and health system levels.

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

Frontiers in Public Health ◽

10.3389/fpubh.2021.683723 ◽

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.

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‘My independent streak may get in the way’: how older adults respond to falls prevention education in hospital

BMJ Open ◽

10.1136/bmjopen-2016-012363 ◽

2016 ◽

Vol 6 (7) ◽

pp. e012363 ◽

Cited By ~ 11

Author(s):

Anne-Marie Hill ◽

Jacqueline Francis-Coad ◽

Terry P Haines ◽

Nicholas Waldron ◽

Christopher Etherton-Beer ◽

...

Keyword(s):

Older Adults ◽

Falls Prevention ◽

Prevention Education ◽

The Way

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Depressive symptoms and adverse outcomes from hospitalization in older adults: Secondary outcomes of a trial of falls prevention education

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2014.09.009 ◽

2015 ◽

Vol 60 (1) ◽

pp. 96-102 ◽

Cited By ~ 6

Author(s):

Terry P. Haines ◽

Cylie M. Williams ◽

Anne-Marie Hill ◽

Steven M. McPhail ◽

D. Hill ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Adverse Outcomes ◽

Falls Prevention ◽

Prevention Education ◽

Secondary Outcomes

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Educators’ perspectives about how older hospital patients can engage in a falls prevention education programme: a qualitative process evaluation

BMJ Open ◽

10.1136/bmjopen-2015-009780 ◽

2015 ◽

Vol 5 (12) ◽

pp. e009780 ◽

Cited By ~ 9

Author(s):

Anne-Marie Hill ◽

Steven M McPhail ◽

Jacqueline Francis-Coad ◽

Nicholas Waldron ◽

Christopher Etherton-Beer ◽

...

Keyword(s):

Process Evaluation ◽

Education Programme ◽

Falls Prevention ◽

Prevention Education ◽

Hospital Patients ◽

Qualitative Process Evaluation

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Falls prevention education for older adults during and after hospitalization: A systematic review and meta-analysis

Health Education Journal ◽

10.1177/0017896913499266 ◽

2013 ◽

Vol 73 (5) ◽

pp. 530-544 ◽

Cited By ~ 22

Author(s):

Den-Ching A Lee ◽

Elizabeth Pritchard ◽

Fiona McDermott ◽

Terry P Haines

Keyword(s):

Systematic Review ◽

Older Adults ◽

Meta Analysis ◽

Falls Prevention ◽

Prevention Education

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“We are all one together”: peer educators’ views about falls prevention education for community-dwelling older adults - a qualitative study

BMC Geriatrics ◽

10.1186/s12877-015-0030-3 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 12

Author(s):

Linda Khong ◽

Fiona Farringdon ◽

Keith D Hill ◽

Anne-Marie Hill

Keyword(s):

Older Adults ◽

Qualitative Study ◽

Community Dwelling ◽

Falls Prevention ◽

Peer Educators ◽

Prevention Education ◽

Community Dwelling Older Adults

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

Age and Ageing ◽

10.1093/ageing/afz183.12 ◽

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.

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