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 Falls After Hospital Discharge: A Randomized Clinical Trial of Individualized Multimodal Falls Prevention Education

2019 ◽  
Vol 74 (9) ◽  
pp. 1511-1517 ◽  
Author(s):  
Anne-Marie Hill ◽  
Steven M McPhail ◽  
Terry P Haines ◽  
Meg E Morris ◽  
Christopher Etherton-Beer ◽  
...  
Keyword(s):  
Clinical Trial ◽  
High Risk ◽  
Older People ◽  
Usual Care ◽  
Randomized Clinical Trial ◽  
Hospital Discharge ◽  
Transition Period ◽  
Falls Prevention ◽  
Prevention Education ◽  
Mental Test Score

Abstract Background Older people are at high risk of falls after hospital discharge. The study aimed to evaluate the effect of providing individualized falls prevention education in addition to usual care on falls rates in older people after hospital discharge compared to providing a social intervention in addition to usual care. Methods A randomized clinical trial at three hospitals in Western Australia: participants followed for 6 months after discharge. Baseline and outcomes measured by assessors masked to group allocation. Participants: aged 60 years and over, admitted for rehabilitation. Eligibility included: cognitively able to undertake education (Abbreviated mental test score >7/10). Intervention: tailored education comprising patient video and workbook, structured discussion and goal setting led by trained therapist. Main outcomes: falls in the 6 months after discharge; proportion of participants sustaining one or more falls. Results There were 382 (194 intervention; 188 control) participants (mean age 77.7 [SD 8.7] years). There were 378 falls (fall rate per 1,000 patient-days, 5.9 intervention; 5.9 control) reported by 164 (42.9%) participants in the 6 months following hospital discharge; 188 (49.7%) of these falls were injurious. There were no significant differences in falls rates between intervention and control groups: (adjusted IRR, 1.09; 95% CI [0.78 to 1.52]) or the proportion of participants who fell once or more (adjusted OR, 1.37; 95% CI [0.90 to 2.07]). Conclusions Providing individualized falls prevention education prior to discharge did not reduce falls at home after discharge. Further research is warranted to investigate how to reduce falls during this high-risk transition period.

Fall prevention education for older people being discharged from hospital: Educators’ perspectives

2021 ◽  
pp. 001789692110327
Author(s):  
Jacqueline Francis-Coad ◽  
Den-Ching A Lee ◽  
Terry P Haines ◽  
Meg E Morris ◽  
Steven M McPhail ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Fall Prevention ◽  
Older Patients ◽  
Education Programme ◽  
Prevention Strategies ◽  
Post Intervention ◽  
Prevention Education ◽  
Barriers And Enablers ◽  
Education Delivery ◽  
Fall Prevention Education

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.

scholarly journals Strategies Older New Zealanders Use to Participate in Day-To-Day Occupations

2011 ◽  
Vol 74 (11) ◽  
pp. 509-516 ◽  
Author(s):  
Clare Hocking ◽  
Juanita Murphy ◽  
Kirk Reed
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Older Adults ◽  
New Zealand ◽  
Older People ◽  
Exploratory Study ◽  
Occupational Therapists ◽  
Falls Prevention ◽  
Public Health Messages ◽  
The Impact

Aim: This exploratory study aimed to uncover the strategies that older adults employ to ameliorate the impact of impairments and barriers to participation. Method: Eight participants were interviewed in their own homes, in a town or city in New Zealand. Findings: Inductive analysis of data revealed four main categories of strategies: strategies to keep safe, to recruit and accept help, to meet social and biological needs (nutritional and medical), and to conserve financial, material and bodily resources. Discussion: The study supports some previous findings of strategies used by older people, and demonstrates that enquiring into the strategies that older people devise and adopt into their own lives is a productive line of inquiry. The strategies described differ from those that occupational therapists recommend, and do not incorporate public health messages about the benefits of physical activity or recommendations about falls prevention. Conclusion: The findings suggest that asking older clients about the strategies that they use will uncover valuable information for therapists giving advice or issuing equipment to help older adults to manage in the community.

scholarly journals Acceptability of fall prevention strategies for older people with vision impairment

2018 ◽  
Vol 9 (1) ◽  
pp. 1-9
Author(s):  
Lisa Dillon ◽  
Patricia Duffy ◽  
Anne Tiedemann ◽  
Lisa Keay
Keyword(s):  
Older People ◽  
Fall Prevention ◽  
Vision Impairment ◽  
Prevention Strategies

scholarly journals ‘Falls not a priority’: insights on discharging older people, admitted to hospital for a fall, back to the community

2018 ◽  
Vol 24 (1) ◽  
pp. 66 ◽  
Author(s):  
Claudia Meyer ◽  
Emma Renehan ◽  
Frances Batchelor ◽  
Catherine Said ◽  
Terry Haines ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
Falls Prevention ◽  
Matrix Analysis ◽  
Prevention Strategies ◽  
Structured Interviews ◽  
Falls Risk ◽  
Related Hospitalisation ◽  
A Priority

Falls are common among older people and a leading cause of injury-related hospitalisation. The immediate post-hospitalisation period is a risky time for further falls. This paper explores discharge strategies from the perspectives of older people hospitalised for a fall and liaison nurses assisting people to return home. Exploratory mixed methods were used. Semi-structured interviews with older people were conducted regarding their experience of the fall and discharge strategies. Quality of life, falls risk and functional capacity were measured by questionnaire. Liaison nurses were also interviewed. Interviews were audio-recorded, transcribed and thematically analysed. Mixed-method synthesis occurred using role-ordered matrix analysis. Older people (n = 13) and liaison nurses (n = 6) participated. Older persons’ quality of life was average and falls risk high. Thematic analysis revealed three key themes: ‘falls are not a priority’, ‘information not given, or given and not retained’ and ‘reduction in confidence and independence’. Role-ordered matrix analysis identified differences between acute and rehabilitative hospital stays. Older people hospitalised for a fall present a unique opportunity for implementation of falls prevention strategies. However, hospitalisation is often a time of crisis with competing priorities. Timing and relevance are crucial for optimal uptake of falls prevention strategies, with the primary care setting well-placed for their implementation.

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.

The impact of care recipient falls on caregivers

2013 ◽  
Vol 37 (2) ◽  
pp. 152 ◽  
Author(s):  
Briony Dow ◽  
Claudia Meyer ◽  
Kirsten J Moore ◽  
Keith D. Hill
Keyword(s):  
Older People ◽  
Service Use ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Care Recipient ◽  
Significant Problem ◽  
Zarit Burden Interview ◽  
Care Recipients ◽  
Interview Score ◽  
The Impact

Objective. This study sought to explore the impact of care recipient falls on caregivers. Methods. Ninety-six community-dwelling caregiver−care recipient dyads participated in a 12-month prospective study. Falls and other accidents and service use were recorded. Dyads were assessed at baseline and after each fall. Assessment included the Zarit Burden Interview and a post-accident survey developed for the present study. Focus groups were then conducted to further explore the impact of falls on caregivers. Results. Fifty-four care recipients (56%) experienced falls within the 12 months of the study. There was a significant increase in caregiver burden after the first fall (Zarit Burden Interview score increased from 24.2 ± 14.2 to 27.6 ± 14.5, P < 0.01). Twenty-four percent of caregivers reported that they had altered their usual routine after the fall, mainly not wanting to leave the care recipient alone. However, there was no increase in the number of services used. Focus group discussions highlighted the need for constant vigilance of the care recipient, a lack of knowledge about support services and concerns related to utilising respite care. Conclusion. Falls among care recipients have a significant impact on carers, including an increased fear of falling, prompting the need for even closer vigilance. What is known about the topic? Falls are a significant problem for older people as one in three older people fall each year and injurious falls are the leading cause of injury-related hospitalisation in older people. In Australia falls cost the economy over $500 million per year. What does this paper add? This paper adds a unique perspective to the falls literature, that of the older person’s carer. Falls are a significant problem for community-dwelling carers of older people, contributing to carer burden and impeding the carer’s ability to undertake activities of daily living because of the perceived need for constant vigilance to prevent the person they care for from falling. What are the implications for practitioners? Practitioners should ensure that carers are aware of evidence-based falls-prevention practices and services, such as group and individual exercise programs, home modifications and podiatry, that might assist to prevent falls in the person they care for and therefore reduce the burden of care.

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