Promoting Fall Self-Efficacy and Fall Risk Awareness in Older Adults

ABSTRACT

Introduction: This study examined whether participation in a modified version of the “Stepping On” program was effective in increasing fall self-efficacy, static and dynamic balance, and awareness of fall risks in older adults. Design: A mixed methods, one-group, nonexperimental, pretest-posttest design. Participants: Nineteen women aged 65 and older residing in a senior living facility. Intervention: Participants attended a 7-week fall prevention education program focused on group exercises, home hazards, community safety and footwear, and vision and medication management. The program met for 2 h weekly for 7 weeks. Participants were assessed pre- and postintervention using the Modified Falls-Efficacy Scale, Get Up and Go Test, and Romberg Balance Test. In addition, a focus group was facilitated postintervention to determine participants’ awareness of fall risks. Results: While the Modified Falls-Efficacy Scale (MFES) postintervention results were not statistically significant, they did indicate a decreased level of confidence in participants’ ability to avoid a fall postintervention. “Get Up and Go” completion time also increased postintervention, but was not statistically significant. No change in static balance was noted in Romberg Balance Test results. Participants did report an overall increase in awareness of fall risks postintervention. Conclusion: Although results did not support the hypotheses regarding increased fall self-efficacy and static and dynamic balance, participation in the modified “Stepping On” program did lead to an overall increase in awareness of fall risks. Modifying the evidence-based program made it feasible to test in a new community and may have empowered older adults with the knowledge to prevent future falls.     

Older adults' knowledge of pressure ulcer prevention: a prospective quasi-experimental study

hartigan i. , murphy s. & hickey m . (2011) Older adults’ knowledge of pressure ulcer prevention: a prospective quasi‐experimental study. International Journal of Older People Nursing 7 , 208–218
doi: 10.1111/j.1748‐3743.2011.00274.x Aim. To test an evidence base patient education leaflet to evaluate older adults’ knowledge of pressure ulcers and prevention strategies. Background. The increasing population of older adults living in the community managing chronic health conditions are at risk of pressure ulcer development. Education leaflets are a useful adjunct to reinforce healthcare professional’s verbal information to promote healthy lifestyles choices. However, little is known of the effectives of pressure ulcer prevention educational leaflets for older adults. Methods. A quasi‐experimental uncontrolled pre‐test, post‐test study of participants’ knowledge of pressure ulcer and preventative strategies was conducted. Community dwelling older adults (n = 75) were recruited to this study. Older adult’s knowledge was measured pre‐ and postdistribution of an education intervention. A risk assessment scale was recorded to identify whether this cohort of older adults were actually at risk of developing pressure ulcers. Conclusion. The results indicate that an education leaflet enhanced patients’ knowledge relating to pressure ulceration. Printed education materials increase knowledge and understanding which may lend to older adults adopting healthy behaviours. Implications for practice. An education leaflet can help older adults and their carers to be more empowered as active participants in reducing the incidence of pressure ulceration.     

Is fall self-efficacy an independent predictor of recurrent fall events in older adults? Evidence from a 1-year prospective study

Falls, which are prevalent among older adults, may not only cause severe physical injuries, but also lead to low fall self-efficacy (FSE). Low FSE is associated with restricted activity, which putatively increases risk of future falls. However, emerging studies have failed to confirm this association. Furthermore, the interplay between age, gender, and fall history with falls has not been adequately addressed in adults aged 70 years or older. The aims of this secondary analysis were to: (1) prospectively explore the association of FSE and fall events considering age, gender, and fall history, and (2) examine the characteristics of fall events and fall-related outcomes. Forty-seven community-dwelling adults over 70 years of age were followed for about 12 months. During the follow-up, 22 participants with low FSE experienced 119 fall events whereas 25 participants with high FSE reported 106 fall events. Among fallers, 72.3% (n = 34) experienced recurrent fall events. About 15.0% (n = 34) of 225 fall events resulted in injuries and 4.0% of injuries required medical care. FSE was a statistically significant predictor of future fall events (incident rate ratio = 0.96, p = .013) regardless of age, gender, and fall history. Participants with low FSE were more likely than those with high FSE to fall more frequently without noticeable prodromal symptoms and apparent reasons. These findings suggest that FSE is an important protective factor against future fall events. However, interpretation of these results requires caution given the small sample size and effect size.     

Mitigating fall risk: A community fall reduction program

One fourth of all American’s over 65 years of age fall each year. Falls are a common and often devastating event that can pose a serious health risk for older adults. Healthcare providers are often unable to spend the time required to assist older adults with fall risk issues. Without a team approach to fall prevention the system remains focused on fragmented levels of health promotion and risk prevention. The specific aim of this project was to engage older adults from the community in a fall risk assessment program, using the Stopping Elderly Accidents, Deaths & Injuries (STEADI) program, and provide feedback on individual participants’ risks that participants could share with their primary care physician. Older adults who attended the risk screening were taking medications that are known to increase falls. They mentioned that their health care providers do not screen for falls and appreciated a community based screening.     

Comparison of the effects of virtual reality-based balance exercises and conventional exercises on balance and fall risk in older adults living in nursing homes in Turkey

Objectives: There is limited information on effective balance training techniques including virtual reality (VR)-based balance exercises in residential settings and no studies have been designed to compare the effects of VR-based balance exercises with conventional balance exercises in older adults living in nursing homes in Turkey. The objective of our study was to investigate the effects of VR-based balance exercises on balance and fall risk in comparison to conventional balance exercises in older adults living in nursing homes. Methods: A total sample of 18 subjects (65–82 years of age) with fall history who were randomly assigned to either the VR group (Group 1, n = 7) or the conventional exercise group (Group 2, n = 11) completed the exercise training. Results: In both groups, Berg balance score (BBS), timed up & go duration, and left leg stance and tandem stance duration with eyes closed significantly improved with time (p < 0.05), but changes were similar in both groups (p > 0.05) after training, indicating that neither the exercise method was superior. Conclusion: Similar improvements were found in balance and fall risk with VR-based balance training and conventional balance training in older adults living in the nursing home. Both exercise trainings can be preferable by health care professionals considering fall prevention. Appropriate patient selection is essential.     

Cross-cultural Educational Intervention and Fall Risk Awareness

Aims: To determine if a two-visit, personalized falls prevention educational intervention affected awareness of fall risk in community-dwelling older adults in Belize. Secondary aim: to assess new learning in a cross-cultural context and willingness to make lifestyle changes to reduce fall risk. Methods: A US-based team completed fall risk assessments (Short FES-I, mCTSIB, TUG, and 30-s Chair Stand Test), pre- and postintervention questionnaires, and an original postintervention semi-structured interview with eighteen participants. Investigators employed the Fall Risk Awareness Questionnaire (FRAQ) to assess awareness of fall risk. Intervention consisted of an educational class regarding fall risks that took place in a day centre, and a home visit. Questionnaire results were analyzed for statistical significance. Investigators completed thematic analysis of interviews. Results: Mean scores of the FRAQ rose slightly at posttest, but results were not statistically significant. Qualitative analyses revealed themes regarding specific fall risk awareness, barriers to change, and willingness to change. Conclusions: Participants in this sample demonstrated an increase in falls risk awareness after a brief falls prevention program. The sample size and prepost design limited generalizability of the results. Therapists should be aware of cultural competence, health literacy, and personal narrative of participants.     

Editorial Board EOV

Aims: This analysis aims to identify what older adults self-report about engagement in home activities (EHA), if there is a difference between perceived and observed activity performance in the home, and what predicts EHA. Methods: Baseline data were analyzed from a randomized controlled trial of an occupational therapy fall prevention intervention with older adults age 65 and older with a fall within 6 months. A multiple linear regression model was used to compare perceived and observed activity performance. Results: Ninety-two participants (mean age 77.7 ± 7.4) were included. EHA can be predicted (F(6, 85) = 13.86, p < 0.001, R = 0.70, R² = 0.50) by perceived activity performance (p = 0.02), fear of falling (FOF) (p < 0.001), and depression (p = 0.05). Conclusions: Perceived activity performance predicts EHA but observed activity performance does not, indicating clinicians should consider older adults' perceptions. Self-efficacy and awareness may be reasons for differences between perceived and observed activity performance in the home. FOF and depression are also predictors of EHA.     

Predictors of Engagement in Home Activities Among Community-Dwelling Older Adults

Aims: This analysis aims to identify what older adults self-report about engagement in home activities (EHA), if there is a difference between perceived and observed activity performance in the home, and what predicts EHA. Methods: Baseline data were analyzed from a randomized controlled trial of an occupational therapy fall prevention intervention with older adults age 65 and older with a fall within 6 months. A multiple linear regression model was used to compare perceived and observed activity performance. Results: Ninety-two participants (mean age 77.7 ± 7.4) were included. EHA can be predicted (F(6, 85) = 13.86, p < 0.001, R = 0.70, R² = 0.50) by perceived activity performance (p = 0.02), fear of falling (FOF) (p < 0.001), and depression (p = 0.05). Conclusions: Perceived activity performance predicts EHA but observed activity performance does not, indicating clinicians should consider older adults' perceptions. Self-efficacy and awareness may be reasons for differences between perceived and observed activity performance in the home. FOF and depression are also predictors of EHA.     

Short stick exercises for fall prevention among older adults: a cluster randomized trial

Abstract

Purpose: To investigate the effects of short stick exercise (SSEs) on fall prevention and improvement of physical function in older adults. Methods: A cluster randomized trial was conducted in five residential care facilities. The intervention group (n?=?51) practiced SSEs for six months, followed by routine care for six more months. The control group (n?=?54) received ordinary care for 12 months. The primary outcome measure was the number of fallers, taking into account the time to first fall using the Kaplan–Meier method. The secondary outcome measures were physical and mental functions. Results: The number of fallers was significantly lower in the intervention group (n?=?6) than in the control group (n?=?16) during the 12 months. The adjusted hazard ratio for a first fall in the intervention group compared with the control group was 0.15 (CI, 0.03 to 0.74, p?=?0.02). The fall-free period was significantly longer in the intervention group than in controls (mean?±?SD, 10.1?±?3.0 versus 9.0?±?4.1 months, p?=?0.027). The functional reach and sit and reach tests were significantly improved at three and six months. Conclusion: The SSEs appeared effective for fall prevention and improvement of physical function in older adults.

• Implications for Rehabilitation

• The newly developed short stick exercises appear an effective means of reducing falls among older adults in residential care facilities.

• The short stick exercises seem to have an immediate effect on improving physical functions.

• Effects gained by performing the short stick exercises, such as static balance, flexibility and agility may last for six months.

• The short stick exercises were found to be easy for older adults to practice continuously in residential care facilities.

     

A home-based individualized information communication technology training program for older adults: a demonstration of effectiveness and value

Purpose: To demonstrate the effectiveness and value of a home-based information communication technology (ICT) training program for older adults. Methods: Thirteen older adults were provided in-home ICT training by graduate occupational therapy students using an iPad. The breadth and frequency of ICT use, perspectives on technology, and perceived independence were recorded at baseline, during the 3-month training and at follow-up, along with an end-of-study questionnaire. Non-parametric Friedman analysis was conducted to verify trends in the outcome measures. The qualitative data were examined by content analysis. Results: Participants’ breadth of ICT activities showed a significant trend across 6 months. Leisure accounted for the significant increase, while health management and social connections activities increased modestly. A positive trend in participants’ perspectives on technology was evident along with a marginal increase in perceived independence. Participants’ perspectives were thematically categorized as technology experiences, interactions with coach, training approach, and specific activities. As reflection of the training program’s value, 12 of the 13 participants took ownership of the iPad at the end of the study. Conclusion: Building capacity of older adults to utilize the multifaceted potential of ICT is critical in addressing declines in health, impending disabilities, and social isolation.

• Implications for Rehabilitation

• A one-on-one home-based individualized information communication technology (ICT) training program for older adults could result in a progressive increase in the breadth of online activities carried out by them.

• Specifically, the increase in their usage of ICT could be expected in leisure-based online activities.

• Individualized training programs designed based on needs, priorities, and learning style of older adults could have a positive impact on their technological perspectives and intrinsic motivation to adopt ICT.

     

Social support as a moderator in a fall prevention program for older adults

This study examined the moderating effects of social support in a fall prevention program for community-dwelling older adults. Twenty-six Japanese older adults age 65 and older participated in a 2-month exercise program and were measured in anthropometrical, physical, and psychological functioning at baseline, 2 months (intervention termination), and 5 months (3 months after intervention termination). Analyses indicated that the program did not improve participants' body mass index, balance, or walking speed. However, participants'falls self-efficacy significantly increased from baseline to intervention termination and was maintained at a higher level at the 5-month postintervention follow up. This efficacy-improving effect was prominent in the participants who had received less social support at baseline. The findings emphasized the importance of considering participants' social resources and targeted intervention outcomes when evaluating the effect of exercise.     

Effects of Combined Balance and Resistance Exercise on Reducing Knee Pain in Community-Dwelling Older Adults

ABSTRACT

The effects of a combined balance and resistance exercise program on knee joint pain (KJP) in community-dwelling older adults were determined. Twenty-eight participants with KJP were divided into an exercise group (EXG: n = 14, 77 ± 4 year) and a control group (n = 14, 77 ± 4 year). The EXG participated in 12 weeks of community-based training. The training program consisted of balance exercise and lower body resistance exercise using body weight. The EXG demonstrated significant improvements in KJP (46%), lower extremity muscular strength (5–26%), Chair Stand (27%), Up and Go (9%), and Functional Reach (17%).     

Static and Dynamic Balance After Ankle Plantarflexor Fatigue in Older Adults

Aims: The purpose of this study was to evaluate how fatigue of the ankle plantarflexors would affect both static and dynamic standing balance in a healthy older population. Understanding how conditions of muscle fatigue may effect balance control of older adults may lend insight to rehabilitation strategies useful for the screening and prevention of fall risks. Methods: 18 healthy older adults (mean age = 74.67 years) were randomly divided into either a fatigue group or a control group. Baseline measurements were collected using the NeuroCom Smart® Balance Master's limits of stability (LOS) test and the sensory organization test (SOT). Participants in the control group rested for 5 min after the baseline testing and then repeated the tests, while participants in the fatigue group repeated the tests after performing heel raises until they became fatigued. Results: LOS parameters decreased after muscle fatigue but were significant only for the interaction of directional control (DCL). The findings for SOT were nonsignificant. Conclusion: This research suggests that plantarflexor fatigue may have a negative effect on the DCL of an older adult when challenging their LOS and therefore may decrease their ability to avoid a fall.     

Achieving self-management goals among low income older adults with functional limitations

Although self-management interventions can improve symptoms and disease among older adults, there is a dearth of literature on how self-management behaviors may improve factors related to the older adults’ physical function. To fill this gap in the literature, we describe the patient-directed self-management goals in nursing visits that relate to physical function as part of a multi-component program. We analyze the self-management goals and outcomes of 367 low- income older adults with functional limitations who participated in the CAPABLE program: a program to reduce the health effects of impaired physical function in low-income older adults. We focus on the following self-management goals that participants chose with the nurses: pain management, depressive symptoms, incontinence, fall prevention, and communication with healthcare providers. The majority of participants chose pain (50%) or fall prevention (51%) as goals and partially or fully met their goals. Improvements across these areas may lead to improved physical function.     

Developing a falls prevention program for community-dwelling stroke survivors in Singapore: client and caregiver perspectives

Purpose: Drawing on the perspectives of stroke survivors, family members and domestic helpers, this study explores participants’ experiences of self-perceived fall risk factors after stroke, common fall prevention strategies used, and challenges to community participation after a fall.

Methods: Semi-structured interviews were conducted in Singapore with community-dwelling stroke survivors with a previous fall (n?=?9), family caregivers (n?=?4), and domestic helpers (n?=?4) who have cared for a stroke survivor with a previous fall. Purposive sampling was used for recruitment; all interviews were audio-recorded with permission and transcribed. Thematic analysis was conducted using NVivo (v10) software.

Results: All participants shared their self-perceived intrinsic and extrinsic fall risk factors and main challenges after a fall. For stroke participants and family caregivers, motivational factors in developing safety strategies after a previous fall(s) include social connectedness, independent living and community participation. For family caregivers and domestic helpers, the stroke survivor’s safety is their top priority, however this can also lead to over-protective behavior outside of the rehabilitation process.

Conclusions: Reducing the risk of falls in community-dwelling stroke survivors seems to be more important than promoting community participation among caregivers. The study findings highlight that a structured and client-centered fall prevention program targeting stroke survivors and caregivers is needed in Singapore.

• Implications for rehabilitation

• Falls after stroke can lead to functional decline in gait and mobility and restricted self-care activities.

• Community-dwelling stroke survivors develop adaptive safety strategies after a fall and want to be socially connected. However, caregivers see the safety of the stroke survivors as their top priority and demonstrate over-protective behaviors.

• Fall prevention programs for community-dwelling stroke survivors should target both stroke survivors and their caregivers.

• A structured and client-centered fall prevention program targeting at multiple risk factors post-stroke is needed for community-living stroke survivors.

     

Investigating Older Adults’ Expressed Needs Regarding Falls Prevention

Abstract

Aims: The purpose of this study was to explore perceptions regarding falls prevention programs for community-dwelling older adults offered in a specific geographic area. Method: The investigators conducted focus groups with 44 community-dwelling older adults in four locations. Focus group discussions were transcribed, coded, and analyzed by all investigators. Results: Themes included what people want, why people fall, what people do, impact of falls, and barriers to falls prevention participation. Older adults wanted falls prevention programs to include socialization among peers, various types of education, balance training, convenience in times and locations where falls prevention programs are offered, affordability, and independence and autonomy for decision-making. Participants believed they fell due to inattention and the aging process, and they made lifestyle changes and tried to recognize their own ability accordingly. Older adults believed the impact of falls on lifestyle was far-reaching and drastic. The main barrier to falls prevention participation was motivation, mitigated by other priorities. The Person-Environment-Occupation (PEO) Model provided a framework for considering occupational impact when addressing older adults’ concerns regarding falls. Conclusions: Occupational therapists can be key contributors to falls prevention programing by developing programs that focus on current perceptions and barriers in programing and the expressed wants and needs of community-dwelling older adults.     

Effectiveness of the fall prevention intervention in older adults with arterial hypertension: randomized clinical trial

ObjectiveTo evaluate the effectiveness of the nursing intervention Fall Prevention in reducing falls in older adults with arterial hypertension.MethodsPilot clinical trial, with 118 participants with arterial hypertension from a city in the Northeast of Brazil. Participants were allocated by simple randomization into two groups: intervention (n = 58) and control (n = 60). The intervention was carried out at the participants' homes and consisted of guidelines for modifying environmental and behavioral risk factors for falls. A protocol with nursing activities associated with the Fall Prevention intervention proposed in the Nursing Interventions Classification (NIC) taxonomy was used. The outcome was the self-reported occurrence of falls.ResultsThere was a significant difference between the groups in the frequency of self-reported falls (p=0.38) with fewer falls occurring in the intervention group. Sixteen participants fell, of which 5.1% attributed the fall to difficulty walking, 6.8% fell in the living room, 3.4% had a sprain, and 6.8% reported to be afraid to fall again.ConclusionThe nursing intervention Fall Prevention was effective in reducing the occurrence of falls in older adults with arterial hypertension. These findings contribute to the advancement of clinical protocols for the prevention of falls in older adults, as the educational intervention investigated is applicable to different sociodemographic and cultural scenarios.     

Outdoor Fall Experiences: An Exploratory Study of Urban and Suburban Dwelling Older Adults

Abstract

Aims: Outdoor falls can result in significant challenges to the health and well-being of older adults. Therefore, factors associated with outdoor fall risk warrant attention in research and clinical practice. The purpose of this exploratory study was to compare the outdoor fall experiences of urban and suburban residents with an eye towards considerations for prevention practices. Methods: A convenience sample of community dwelling older adults was recruited. Qualitative analysis of open-ended responses from a survey was used to explore and compare and contrast the outdoor fall experiences of suburban and urban dwellers. Results: Both similarities and differences in the causes and locations of outdoor falls were identified. Conclusions: Preliminary results from this exploratory study suggest differences between the outdoor falls of urban and suburban dwelling older adults. A larger scale study to confirm the findings is warranted given the implications for planning community-based occupational therapy-led outdoor fall prevention programs.     

Efficacy of supervised Tai Chi exercises versus conventional physical therapy exercises in fall prevention for frail older adults: a randomized controlled trial

Purpose: To compare the effectiveness of supervised Tai Chi exercises versus the conventional physical therapy exercises in a personalized rehabilitation program in terms of the incidence and severity of falls in a frail older population. Method: The participants were frail older adults living in the community, admitted to the day hospital program in Sherbrooke, Quebec, Canada (n = 152). They were randomized to receive a 15-week intervention, either by supervised Tai Chi exercises (n = 76) or conventional physical therapy (n = 76). Fall incidence and severity were assessed using both the calendar technique and phone interviews once a month during 12 months following the end of the intervention. Other variables were collected at baseline to compare the two groups: age, comorbidity, balance, sensory interaction on balance, and self-rated health. Results: Both interventions demonstrated a protective effect on falls but Tai Chi showed a greater one (RR = 0.74; 95% CI = 0.56–0.98) as compared to conventional physical therapy exercises. Conclusions: Supervised Tai Chi exercises as part of a rehabilitation program seem to be a more effective alternative to the conventional physical therapy exercises for this specific population.

Implications for Rehabilitation

• Seniors who have fallen have a 50% chance of falling again during the following year, leading them to reduce their outings and thus decrease their social activities.

• Frail older people could benefit more from an individualized intervention than the regular group program generally used in a Tai Chi intervention.

• Tai Chi exercises seems to be a good alternative to regular physiotherapy exercises as a part of a multidisciplinary intervention in preventing a subsequent fall over a 12-month period.

     

Responsiveness of the Box and Block Test with Older Adults in Rehabilitation

Aims: Study the responsiveness of the Box and Block Test (BBT) with older adults in rehabilitation. Methods: For a larger study on the responsiveness of several outcome measures, 264 older adults were recruited in rehabilitation units (RU) and day hospitals (DH) and assessed four times during their rehabilitation. For the present study, only the data for participants who had an impairment in at least one upper extremity were used (n = 87). The standardized response mean (SRM) and Guyatt Index (GI) were calculated. Analyses by sub-group were also performed. Results: The BBT's responsiveness coefficients were moderate (SRM: 0.59; GI: 0.60). They were higher for participants treated in a RU (0.80 and 0.69) and participants who had had a stroke (0.67 and 0.83). Conclusion: The BBT can detect changes in dexterity in older adults undergoing rehabilitation, especially those being treated in a RU and those who have had a stroke.