Relations among Fall Efficacy, Perception of Fall Risk and Fall Prevention Behavior in the Frail Elderly at Home

Because of population ageing, fall prevention represents a human, economic, and social issue. Currently, fall-risk is assessed infrequently, and usually only after the first fall occurrence. Home monitoring could improve fall prevention. Our aim was to monitor daily activities at home in order to identify the behavioral parameters that best discriminate high fall risk from low fall risk individuals. Microsoft Kinect sensors were placed in the room of 30 patients temporarily residing in a rehabilitation center. The sensors captured the patients’ movements while they were going about their daily activities. Different behavioral parameters, such as speed to sit down, gait speed or total sitting time were extracted and analyzed combining statistical and machine learning algorithms. Our algorithms classified the patients according to their estimated fall risk. The automatic fall risk assessment performed by the algorithms was then benchmarked against fall risk assessments performed by clinicians using the Tinetti test and the Timed Up and Go test. Step length, sit-stand transition and total sitting time were the most discriminant parameters to classify patients according to their fall risk. Coupling step length to the speed required to stand up or the total sitting time gave rise to an error-less classification of the patients, i.e., to the same classification as that of the clinicians. A monitoring system extracting step length and sit-stand transitions at home could complement the clinicians’ assessment toolkit and improve fall prevention.

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An Interactive Home-Based Cognitive-Motor Step Training Program to Reduce Fall Risk in Older Adults: Qualitative Descriptive Study of Older Adults’ Experiences and Requirements (Preprint)

10.2196/preprints.11975 ◽

2018 ◽

Author(s):

Trinidad Valenzuela ◽

Husna Razee ◽

Daniel Schoene ◽

Stephen Ronald Lord ◽

Kim Delbaere

Keyword(s):

Older Adults ◽

Fall Prevention ◽

Technology Use ◽

Fall Risk ◽

Perceived Barriers ◽

Exercise Programs ◽

Home Based ◽

Prevention Interventions ◽

Qualitative Descriptive ◽

At Home

BACKGROUND Falls are a major contributor to the burden of disease in older adults. Home-based exercise programs are effective in reducing the rate and risk of falls in older adults. However, adherence to home-based exercise programs is low, limiting the efficacy of interventions. The implementation of technology-based exercise programs for older adults to use at home may increase exercise adherence and, thus, the effectiveness of fall prevention interventions. More information about older adults’ experiences when using technologies at home is needed to enable the design of programs that are tailored to older adults’ needs. OBJECTIVE This study aimed to (1) explore older adults’ experiences using SureStep, an interactive cognitive-motor step training program to reduce fall risk unsupervised at home; (2) explore program features that older adults found encouraged program uptake and adherence; (3) identify usability issues encountered by older adults when using the program; and (4) provide guidance for the design of a future technology-based exercise program tailored to older adults to use at home as a fall prevention strategy. METHODS This study was part of a larger randomized controlled trial. The qualitative portion of the study and the focus of this paper used a qualitative descriptive design. Data collectors conducted structured, open-ended in-person interviews with study participants who were randomly allocated to use SureStep at home for 4 months. All interviews were audiotaped and ranged from 45 to 60 min. Thematic analysis was used to analyze collected data. This study was guided by Pender’s Health Promotion Model. RESULTS Overall, 24 older adults aged 70 to 97 years were interviewed. Findings suggest older adults are open to use technology-based exercise programs at home, and in the context of optimizing adherence to home-based exercise programs for the prevention of falls, findings suggest that program developers should develop exercise programs in ways that provide older adults with a fun and enjoyable experience (thus increasing intrinsic motivation to exercise), focus on improving outcomes that are significant to older adults (thus increasing self-determined extrinsic motivation), offer challenging yet attainable exercises (thus increasing perceived self-competence), provide positive feedback on performance (thus increasing self-efficacy), and are easy to use (thus reducing perceived barriers to technology use). CONCLUSIONS This study provides important considerations when designing technology-based programs so they are tailored to the needs of older adults, increasing both usability and acceptability of programs and potentially enhancing exercise participation and long-term adherence to fall prevention interventions. Program uptake and adherence seem to be influenced by (1) older adults’ perceived benefits of undertaking the program, (2) whether the program is stimulating, and (3) the perceived barriers to exercise and technology use. Older adults shared important recommendations for future development of technologies for older adults to use at home.

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Effects of a Randomized Controlled Recurrent Fall Prevention Program on Risk Factors for Falls in Frail Elderly Living at Home in Rural Communities

Medical Science Monitor ◽

10.12659/msm.890611 ◽

2014 ◽

Vol 20 ◽

pp. 2283-2291 ◽

Cited By ~ 13

Author(s):

JongEun Yim

Keyword(s):

Risk Factors ◽

Rural Communities ◽

Frail Elderly ◽

Fall Prevention ◽

Prevention Program ◽

Fall Prevention Program ◽

Randomized Controlled ◽

Risk Factors For Falls ◽

Elderly Living ◽

At Home

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Faculty Opinions recommendation of The positive effects of negative work: increased muscle strength and decreased fall risk in a frail elderly population.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1029819.347600 ◽

2005 ◽

Author(s):

H Thomas Robertson

Keyword(s):

Muscle Strength ◽

Frail Elderly ◽

Fall Risk ◽

Elderly Population ◽

Positive Effects ◽

Negative Work

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

Innovation in Aging ◽

10.1093/geroni/igaa057.455 ◽

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.

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

Innovation in Aging ◽

10.1093/geroni/igaa057.767 ◽

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.

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