scholarly journals Older Adults’ Experience of an Exergaming Intervention to Improve Balance and Prevent Falls: A Nested Explanatory Qualitative Study

2021 ◽  
Vol 11 (24) ◽  
pp. 11678
Author(s):  
Christine Rogers ◽  
Delva Shamley ◽  
Seyi Amosun
Keyword(s):  
Older Adults ◽  
Focus Groups ◽  
Fall Prevention ◽  
Gold Standard ◽  
Fall Risk ◽  
Large Scale ◽  
Exercise Adherence ◽  
Exercise Programme ◽  
Timed Up And Go ◽  
Middle Income

Falls are frequent and life-changing events for older adults worldwide. The ageing phenomenon has arrived in developing countries, which experience tensions between curative and rehabilitative services, combined with an increase in non-communicable diseases. Policies addressing issues of ageing have been poorly implemented, and there are few fall prevention initiatives. Compelling evidence from the Global North supports exercise-based interventions to improve balance and reduce fall risk in older adults. More recently, attention has focused on interactive videogaming, known as exergames, as a novel way to manage fall risk with exercise. Commercially available exergames have inherent appeal for low- and middle-income country contexts, where rehabilitation professionals and resources are scanty. The aim of this study was to explore the feasibility of a large-scale randomized control trial comparing an exergaming intervention with the gold-standard Otago Exercise Programme and a no-intervention arm. Exercise adherence was poor in both intervention arms, and this prompted a shift to mixed methodology to explore the construct of falls and participants’ experience of the exergaming intervention. Focus groups were conducted, and the results were analysed using content analysis. Whereas the results demonstrated improvements in physical outcome measures (e.g., Timed-Up-and-Go, MiniBESTest) related to balance and falls that were encouraging in both the gold-standard and exergaming intervention groups, few participants achieved optimal adherence. Attitudes toward falls and fall prevention were explored, as well as participants’ experiences of the exergaming programme. Consistent with a developing country context, participants acknowledged both intrinsic and extrinsic fall risk factors. Exergaming participants enjoyed the fun and playful aspects of the exercise programme, yet these were not sufficient to maximize adherence. The focus groups described the barriers and facilitators to participation, which included motivation. The focus groups discussed strategies to enhance participation, and these are discussed in the context of exergaming.

scholarly journals Pilot Outcomes of a Multicomponent Fall Risk Program Integrated Into Daily Lives of Community-Dwelling Older Adults

2020 ◽  
pp. 073346482091266
Author(s):  
Sarah L. Szanton ◽  
Lindy Clemson ◽  
Minhui Liu ◽  
Laura N. Gitlin ◽  
Melissa D. Hladek ◽  
...  
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Fall Risk ◽  
Pilot Trial ◽  
Balance Training ◽  
Community Dwelling ◽  
Control Group ◽  
Timed Up And Go ◽  
Daily Lives ◽  
Fall Risk Factors

Objectives: To evaluate whether a fall prevention intervention reduces fall risk in older adults who have previously fallen. Design: Randomized controlled pilot trial. Setting: Participants’ homes. Intervention: LIVE-LiFE, adapted from Lifestyle-Intervention Functional Exercise (LiFE) integrates strength and balance training into daily habits in eight visits over 12 weeks. The adaptations to LiFE were to also provide (a) US$500 in home safety changes, (b) vision contrast screening and referral, and (c) medication recommendations. Control condition consisted of fall prevention materials and individualized fall risk summary. Measurement: Timed Up and Go (TUG) and Tandem stand. Falls efficacy, feasibility, and acceptability of the intervention. Results: Sample ( N = 37) was 65% female, 65% White, and average 77 years. Compared with the control group, each outcome improved in the intervention. The LIVE-LiFE intervention had a large effect (1.1) for tandem stand, moderate (0.5) in falls efficacy, and small (0.1) in the TUG. Conclusion: Simultaneously addressing preventable fall risk factors is feasible.

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 Student-Led Fall Prevention Care Management Reduced Fall Risks at Assisted Living Facilities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 238-238
Author(s):  
Hiroko Kiyoshi-Teo ◽  
Claire McKinley-Yoder ◽  
Erin Lemon ◽  
Olivia Ochoa
Keyword(s):  
Older Adults ◽  
Assisted Living ◽  
Fall Prevention ◽  
Fall Risk ◽  
Care Management ◽  
Assisted Living Facilities ◽  
Care Needs ◽  
Term Care ◽  
Fall Risks ◽  
The Impact

Abstract Older adults in residential care settings are four times more likely than those not living in care facilities to experience falls. Yet, fall prevention efforts at long-term care settings are under-resourced, under-regulated, and under-studied. To address this gap, we developed and studied the impact of a specialty clinical, Fall Prevention Care Management (FPCM), for nursing students to decrease older adults’ fall risks. We enrolled assisted living residents that facility liaison identified as being high fall risk (fall rates or fall risk were not tracked at the study sites) and MOCA ≥15, in 2 assisted living facilities in Northwest USA. Participants received weekly, 1-hour, individual, semi-structured, Motivational Interviewing-based care management visits by same students over 6 visits. Changes in fall risks were measured by the CDC STEADI assessment (unsteadiness & worry), Falls Self-Efficacy Scale International-Short (FESI-S), and Falls Behavioral Scale (FAB). Twenty-five residents completed the study. Students addressed the following (multiple responses possible): emotional needs (n=23), improved motivation to prevent falls (n=21), and individualized education/coaching (i.e., exercise, mobility aids) (n=10-17). FESI-S score improved from 16.0 to 14.4 (p=.001; decreased fear. FAB score improved from 2.94 to 3.10 (p=.05; more frequent fall prevention behaviors). Frequency of those who felt steady while standing or walking increased (24% to 40%, p=.07) and those who did not worry about falling increased (20% to 36%, p=.08). FPCM clinical offered valuable opportunity to address unmet care needs of older adults to reduce fall risks.

scholarly journals Multisensory integration involved in the body perception of community-dwelling older adults

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. Hide ◽  
Y. Ito ◽  
N. Kuroda ◽  
M. Kanda ◽  
W. Teramoto
Keyword(s):  
Older Adults ◽  
Multisensory Integration ◽  
Fall Risk ◽  
Community Dwelling ◽  
The Body ◽  
Risk Of Falling ◽  
Body Perception ◽  
Rubber Hand ◽  
Timed Up And Go ◽  
Community Dwelling Older Adults

AbstractThis study investigates how the multisensory integration in body perception changes with increasing age, and whether it is associated with older adults’ risk of falling. For this, the rubber hand illusion (RHI) and rubber foot illusion (RFI) were used. Twenty-eight community-dwelling older adults and 25 university students were recruited. They viewed a rubber hand or foot that was stimulated in synchrony or asynchrony with their own hidden hand or foot. The illusion was assessed by using a questionnaire, and measuring the proprioceptive drift and latency. The Timed Up and Go Test was used to classify the older adults into lower and higher fall-risk groups. No difference was observed in the RHI between the younger and older adults. However, several differences were observed in the RFI. Specifically, the older adults with a lower fall-risk hardly experienced the illusion, whereas those with a higher fall-risk experienced it with a shorter latency and no weaker than the younger adults. These results suggest that in older adults, the mechanism of multisensory integration for constructing body perception can change depending on the stimulated body parts, and that the risk of falling is associated with multisensory integration.

Audiologist's Role Within the Changing Climate of Fall Prevention: Are We Ready?

2016 ◽  
Vol 1 (8) ◽  
pp. 4-13
Author(s):  
Alaina M. Bassett ◽  
Julie A. Honaker
Keyword(s):  
Older Adults ◽  
Risk Assessment ◽  
Fall Prevention ◽  
Fall Risk ◽  
Reporting System ◽  
Risk Assessments ◽  
Mandated Reporting ◽  
Medicare Beneficiaries ◽  
Medical Settings ◽  
Quality Reporting

This article is aimed to address the vestibular audiologist's role in assessing patient fall risk as tasked by Medicare. With implementation of the Physician's Quality Reporting System (PQRS), audiologists performing standard measures of the vestibular battery must report on measures #154: Falls: Risk assessment and #155: Falls: Plan of care for Medicare beneficiaries. Mandated reporting of this measure includes vestibular audiologists in the multidisciplinary medical management of fall prevention in older adults. In order for audiologists to provide the most relevant care, it is important to evaluate the current fall risk assessments in medical settings, how the implementation of these measures can be structured within the audiology clinic, and challenges audiologist may face with implementation.

A Fall Risk Evaluation and Feedback System for Older Adults

2021 ◽  
Vol 13 (2) ◽  
pp. 105-118
Author(s):  
Isa Jahnke ◽  
Lorraine J. Phillips ◽  
Fatih Demir ◽  
Carmen Abbott ◽  
Marjorie Skubic
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Risk Evaluation ◽  
Feedback System ◽  
Clinical Test ◽  
Validity And Reliability ◽  
Timed Up And Go ◽  
Sociotechnical System ◽  
System Usability Scale ◽  
System Solution

Falls are widespread among older adults causing serious injuries and threatening their quality of life. An approach to estimate fall risk, and to prevent falls, is the Timed-Up-and-Go (TUG) test. The TUG test has established validity and reliability. However, as a clinical test, it is not accessible for personal use. To enhance its reach, the authors developed a prototype called Fall Risk Evaluation and Feedback System (FREFS). The prototype is a Kinect-based depth sensor system with interfaces that support older adults in completing the TUG test and receiving personalized test results. The personalized feedback feature is novel that existing prototypes do not include. This study's goal was to gain knowledge of the user experience of FREFS. This research applied methods of observation, interviews, and collected responses on the System Usability Scale (SUS). Results show participants perceived the system as usable, with SUS score of 84.3, but also revealed issues. First, users were unsure how to deal with the TUG tests results when the results showed high fall risk. Second, clearer instructions and reduction of information overload specifically for these age groups were needed. Third, a communication approach embedded into the system would be required (i.e., a link to a chatbot feature or a button to connect to a real person). Overall, the study demonstrated that such a prototype cannot be fully automated; it needs a sociotechnical system solution that includes human communication.

scholarly journals Towards Using the Instrumented Timed Up-and-Go Test for Screening of Sensory System Performance for Balance Control in Older Adults

Sensors ◽  
2019 ◽  
Vol 19 (3) ◽  
pp. 622 ◽  
Author(s):  
Thomas Gerhardy ◽  
Katharina Gordt ◽  
Carl-Philipp Jansen ◽  
Michael Schwenk
Keyword(s):  
Older Adults ◽  
System Performance ◽  
Fall Risk ◽  
Balance Control ◽  
Sensory System ◽  
Sensory Systems ◽  
Community Dwelling ◽  
Functional Mobility ◽  
Timed Up And Go ◽  
Community Dwelling Older Adults

Background: Decreasing performance of the sensory systems’ for balance control, including the visual, somatosensory and vestibular system, is associated with increased fall risk in older adults. A smartphone-based version of the Timed Up-and-Go (mTUG) may allow screening sensory balance impairments through mTUG subphases. The association between mTUG subphases and sensory system performance is examined. Methods: Functional mobility of forty-one community-dwelling older adults (>55 years) was measured using a validated mTUG. Duration of mTUG and its subphases ‘sit-to-walk’, ‘walking’, ‘turning’, ‘turn-to-sit’ and ‘sit-down’ were extracted. Sensory systems’ performance was quantified by validated posturography during standing (30 s) under different conditions. Visual, somatosensory and vestibular control ratios (CR) were calculated from posturography and correlated with mTUG subphases. Results: Vestibular CR correlated with mTUG total time (r = 0.54; p < 0.01), subphases ‘walking’ (r = 0.56; p < 0.01), and ‘turning’ (r = 0.43; p = 0.01). Somatosensory CR correlated with mTUG total time (r = 0.52; p = 0.01), subphases ‘walking’ (r = 0.52; p < 0.01) and ‘turning’ (r = 0.44; p < 0.01). Conclusions: Supporting the proposed approach, results indicate an association between specific mTUG subphases and sensory system performance. mTUG subphases ‘walking’ and ‘turning’ may allow screening for sensory system deterioration. This is a first step towards an objective, detailed and expeditious balance control assessment, however needing validation in a larger study.

scholarly journals Beneficial Effects of Interactive Physical-Cognitive Game-Based Training on Fall Risk and Cognitive Performance of Older Adults

2020 ◽  
Vol 17 (17) ◽  
pp. 6079
Author(s):  
Kochaphan Phirom ◽  
Teerawat Kamnardsiri ◽  
Somporn Sungkarat
Keyword(s):  
Older Adults ◽  
Cognitive Performance ◽  
Fall Risk ◽  
Intervention Group ◽  
Significant Risk ◽  
Community Dwelling ◽  
Cognitive Outcome ◽  
Timed Up And Go ◽  
Cognitive Improvement ◽  
Risk Factors For Falls

Physical and cognitive declines are significant risk factors for falls. Promising evidence suggests that combined physical-cognitive training would be an effective fall risk reduction and cognitive improvement intervention. However, a limited number of studies have been conducted and findings have been inconclusive. This study investigated the effects of interactive physical-cognitive game-based training on the fall risk and cognitive performance of older adults. Forty participants were randomly allocated to the intervention (n = 20) and control (n = 20) groups. Participants in the intervention group performed a 1 h session, 3 times a week for 12 weeks of the interactive physical-cognitive game-based training program. Fall risk (Physiological Profile Assessment, PPA; and Timed Up and Go, TUG) and cognitive outcome (Montreal Cognitive Assessment, MoCA) were assessed at pre- and post-intervention. Thirty-nine participants (mean age = 69.81 ± 3.78 years) completed the study (97.5%). At the end of the trial, participants in the intervention group demonstrated significant improvement in the PPA fall risk score (p = 0.015), postural sway (p = 0.005), MoCA score (p = 0.001), and TUG-dual task (p = 0.045) compared to controls. In conclusion, the interactive physical-cognitive, game-based training was effective in reducing physiological fall risk and improving cognitive function in community-dwelling older adults.

scholarly journals Building a foundation for utilizing evidence based practice in conjunction with research in baccalaureate nursing program

2020 ◽  
Vol 10 (10) ◽  
pp. 1
Author(s):  
Young-Shin Lee ◽  
Carmen Galang ◽  
Janet E. Hughen
Keyword(s):  
Older Adults ◽  
Nursing Students ◽  
Community Health ◽  
Fall Prevention ◽  
Evidence Based Practice ◽  
Assessment Tools ◽  
Evidence Based ◽  
Timed Up And Go ◽  
Screening Process ◽  
Health Fair

Less is known about the undergraduate nursing students’ ability to conduct beginning research. This study aims to explore and describe nursing students' experiences in planning and implementation of community health fairs; and utilizing evidence based practice integrated with research as a learning outcome. The study using a quantitative and descriptive design was conducted by senior nursing students during diverse community health events as a part of Gerontological nursing clinical. The students utilized three fall assessment tools: Balance and Gait test, Timed Up and Go test, and 10-year Fracture Risk Calculation. A total of 74 students participated in seven community health fair events focused on Fall Prevention. This health fair event was in conjunction with the National Fall Prevention Awareness week. A total of 201 older adults were served during the event by nursing students who provided screening process and related health education. Data were gathered and a group of students volunteered to complete the research process. The students participated in oral presentation in the Annual University Research Student Symposium and had poster presentation in the professional academic conference. Early systematic organized planning of the clinical experience gives students opportunity to integrate evidence based practice into research. Application of varied evidence based assessment tools focused on older adults enables students to understand the health issue in depth and the need for additional services. Health fair experiences improve students’ communication and education skills, reality of health issues of the target population in a community, and evidence based research.

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.

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