What factors influence community-dwelling older people’s intent to undertake multifactorial fall prevention programs?

Abstract Background Evidence-based practice (EBP) ensures that clinicians use effective interventions to achieve desired outcomes, thereby contributing to the best quality of care. The perspective of the participants is fundamental in EBP, as they have their own individual and meaningful rationale for participating in fall prevention. This study aims to explore community-dwelling older people reflections about their reflections about EBP in physiotherapy based on their experiences of a fall prevention exercise program. Methods We conducted semi-structured interviews with 16 community-dwelling older people (men = 7; women = 9). Data were analyzed using thematic analysis. Results The analysis revealed three themes: 1) the tension between knowing and doing, 2) the power of the therapist-participant relationship and the process of putting knowledge into action, and 3) research is interwoven with successful therapy and is an integral component of it. EBP was considered as a collective negotiation and learning process of creating knowledge for clinical practice. The negotiation between different types of knowledge must be performed in a transparent dialogue and through interactive collaboration between the persons involved. The participants appreciated that the research findings indicate that practice gives results. Conclusions EBP was understood and utilized as a seal of approval and a “guarantee of high quality” treatment, and its effects varied based on older people’s preferences, needs, and skills. The therapist’s relational competence appeared to be crucial for the negotiation of various sources of knowledge relative to the older people’s preferences.

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Tailored Exercise and Home Hazard Reduction Program for Fall Prevention in Older People With Cognitive Impairment: The i-FOCIS Randomized Controlled Trial

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa241 ◽

2020 ◽

Author(s):

Morag E Taylor ◽

Jacqueline Wesson ◽

Catherine Sherrington ◽

Keith D Hill ◽

Susan Kurrle ◽

...

Keyword(s):

Older People ◽

Physical Function ◽

Fall Prevention ◽

Controlled Trial ◽

Intervention Group ◽

Community Dwelling ◽

Fall Rate ◽

Randomized Controlled ◽

Community Dwelling Older People ◽

Secondary Outcomes

Abstract Background The evidence to support effective fall prevention strategies in older people with cognitive impairment (CI) is limited. The aim of this randomized controlled trial (RCT) was to determine the efficacy of a fall prevention intervention in older people with CI. Method RCT involving 309 community-dwelling older people with CI. The intervention group (n = 153) received an individually prescribed home hazard reduction and home-based exercise program during the 12-month study period. The control group (n = 156) received usual care. The primary outcome was rate of falls. Secondary outcomes included faller/multiple faller status, physical function, and quality of life. Results Participants’ average age was 82 years (95% CI 82–83) and 49% were female. There was no significant difference in the rate of falls (incidence rate ratio [IRR] 1.05; 95% confidence interval [95% CI] 0.73–1.51). A sensitivity analysis, controlling for baseline differences and capping the number of falls at 12 (4 participants), revealed a nonsignificant reduction in fall rate in the intervention group (IRR 0.78; 95% CI 0.57–1.07). Analyses of secondary outcomes indicated the intervention significantly reduced the number of multiple fallers by 26% (RR 0.74; 95% CI 0.54–0.99) when adjusting for baseline differences. There was a differential impact on falls in relation to physical function (interaction term p-value = .023) with a significant reduction in fall rate in intervention group participants with better baseline physical function (IRR 0.60; 95% CI 0.37–0.98). There were no significant between-group differences for other secondary outcomes. Conclusions This intervention did not significantly reduce the fall rate in community-dwelling older people with CI. The intervention did reduce the fall rate in participants with better baseline physical function. Clinical Trials Registration Number Australian and New Zealand Trials Registry ACTRN12614000603617.

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Supplemental Material for Brain White Matter Tract Integrity and Cognitive Abilities in Community-Dwelling Older People: The Lothian Birth Cohort, 1936

Neuropsychology ◽

10.1037/a0033354.supp ◽

2013 ◽

Keyword(s):

White Matter ◽

Older People ◽

Birth Cohort ◽

Cognitive Abilities ◽

Community Dwelling ◽

White Matter Tract ◽

Brain White Matter ◽

Lothian Birth Cohort ◽

Community Dwelling Older People

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Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-017-0547-8 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 37

Author(s):

Rachael Frost ◽

Celia Belk ◽

Ana Jovicic ◽

Federico Ricciardi ◽

Kalpa Kharicha ◽

...

Keyword(s):

Systematic Review ◽

Health Promotion ◽

Older People ◽

Meta Analysis ◽

Community Dwelling ◽

Community Dwelling Older People ◽

Health Promotion Interventions

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Prioritization and management of calls from older people to GP out-of-hours services

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab021 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Suzanne Smith ◽

Lucia Carragher

Keyword(s):

Older People ◽

Service Provision ◽

Emergency Services ◽

Oldest Old ◽

Community Dwelling ◽

Third Party ◽

Older Person ◽

Out Of Hours ◽

Accident And Emergency ◽

Community Dwelling Older People

Abstract Background Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours services including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. Objective The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. Methods An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. Results Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also reflected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The findings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. Conclusion Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP office hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living.

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Ten‐year trends in lifestyle habits among community‐dwelling older people in Taiwan

Australasian Journal on Ageing ◽

10.1111/ajag.12969 ◽

2021 ◽

Author(s):

Hsiao‐Ting Tsou ◽

Tai‐Yin Wu ◽

Kuan‐Liang Kuo ◽

Sheng‐Huang Hsiao ◽

Sheng‐Jean Huang ◽

...

Keyword(s):

Older People ◽

Community Dwelling ◽

Lifestyle Habits ◽

Community Dwelling Older People

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Frailty Status and All-Cause Mortality in the Community-Dwelling Older People: An Umbrella Review

Innovation in Aging ◽

10.1093/geroni/igaa057.1580 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 488-489

Author(s):

A R M Saifuddin Ekram ◽

Joanne Ryan ◽

Carlene Britt ◽

Sara Espinoza ◽

Robyn Woods

Keyword(s):

Older People ◽

Systematic Reviews ◽

Community Dwelling ◽

Umbrella Review ◽

Frailty Phenotype ◽

Frailty Status ◽

Increased Risk ◽

All Cause Mortality ◽

Community Dwelling Older People ◽

Meta Analyses

Abstract Frailty is increasingly recognised for its association with adverse health outcomes including mortality. However, various measures are used to assess frailty, and the strength of association could vary depending on the specific definition used. This umbrella review aimed to map which frailty scale could best predict the relationship between frailty and all-cause mortality among community-dwelling older people. According to the PRISMA guidelines, Medline, Embase, EBSCOhost and Web of Science databases were searched to identify eligible systematic reviews and meta-analyses which examined the association between frailty and all-cause mortality in the community-dwelling older people. Relevant data were extracted and summarised qualitatively. Methodological quality was assessed by AMSTAR-2 checklist. Five moderate-quality systematic reviews with a total of 374,529 participants were identified. Of these, two examined the frailty phenotype and its derivatives, two examined the cumulative deficit models and the other predominantly included studies assessing frailty with the FRAIL scale. All of the reviews found a significant association between frailty status and all-cause mortality. The magnitude of association varied between individual studies, with no consistent pattern related to the frailty measures that were used. In conclusion, regardless of the measure used to assess frailty status, it is associated with an increased risk of all-cause mortality.

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