Older African American women's beliefs, attitudes, and behaviors about breast cancer

Breast cancer poses a greater risk for African American than Caucasian women due to persistent health disparities. To reduce mortality risk, culturally specific knowledge is needed to support and encourage regular breast cancer screening and risk-reduction behaviors in older African American women. The specific aims of this study were to identify social, cultural, and behavioral factors associated with regular participation in breast cancer screening and risk-reduction behaviors; examine health beliefs that may influence regular participation in breast cancer screening and risk-reduction behaviors; and identify perceived facilitators and barriers to regular breast cancer screening and risk-reduction behaviors. African American women older than 65 (N = 57) participated in six focus groups. Analysis of focus group data revealed six major themes: Being Blessed, Cancer as a Death Sentence, Fear/Fear of Disfigurement, Avoiding Finding Out, Beliefs About Breast Cancer, and Tending to One's Family. These themes could be used by health care providers to develop culturally relevant educational initiatives to promote breast health practices and risk-reduction behaviors in this vulnerable population, thus helping reduce breast cancer disparities.     

Characteristics of individuals who fell while receiving home health services

BACKGROUND AND PURPOSE: Many patients receiving home health services are at risk for falling, but fall risk factors have not been previously investigated in this population. A retrospective record review was used to describe individuals who fell while being served by a home health agency. SUBJECTS: The 98 individuals who fell while receiving home health services were compared with a random sample of 98 subjects served by the home health agency during the same period who did not report falling. METHODS: Subjects were compared by age, sex, days of receiving home health services, number of falls prior to admission to the home health agency, diagnosis, medication category, home health services received, and type of health care coverage. In the group with falls, causes of falls and interventions were described. RESULTS: The group with falls had comorbidities of neurological and cardiovascular impairment, took more medications associated with increased risk of falling, and had almost 3 times the number of falls prior to admission than the group without falls. DISCUSSION AND CONCLUSION: Home care providers should consider medical history, medication usage, and fall history as risk factors for falls in the home environment.     

跌倒风险管理在预防社区老年人群跌倒中的应用

目的：探讨跌倒风险管理团队在提高社区老年人群防跌倒能力中的效果。方法：将60例社区老年人群随机分为管理组和对照组各30例。对照组老年人进行日常小区的娱乐健身活动,管理组除对照组的活动外,还接受跌倒风险管理：疾病筛查、药物指导、健康教育、功能训练、家居环境的改造。分别于初评时、干预第4周及第8周3个时期对受试者进行Tinetti步态和平衡测试、修订版跌倒效能量表（MFES）测试。结果：干预后第4周、第8周,管理组Tinetti步态和平衡测试均较干预前明显提高（P<0.01）,但干预4周和8周时差异无统计学意义,干预后第4周、第8周,管理组MFES评分均不断提高（P<0.01）,对照组干预前后2种评分差异均无统计学意义,干预后各时间点管理组以上2种评分均更高于对照组（P<0.01）。结论：及早发现有跌倒风险的社区老年人群,给予及时跌倒风险管理干预,能提高社区老年人群的防跌倒能力,缓解恐惧跌倒的心理,提高生活质量。     

医疗失效模式与效应分析在预防社区脑卒中跌倒中的应用

[目的]运用医疗失效模式与效应分析(HFMEA)方法对社区防跌倒管理流程进行改进并实施,以有效规避脑卒中患者跌倒高危因素,降低脑卒中患者跌倒发生率。[方法]选取2016年1-12月静安区某社区卫生服务中心管理的脑卒中患者163名。首先,进行脑卒中患者跌倒风险调查,了解跌倒发生情况,并进行多因素分析筛选跌倒高危因素;然后,采用HFMEA 方法,将上述调查对象随机分为二组,实施6个月干预,并对二组脑卒中患者首次入户随访时间、跌倒风险因素及跌倒次数进行评价。[结果]调查对象一年内跌倒发生率为31.29%,行走辅助用具、视力对日常的影响、对外界反应能力、脚无力是跌倒的独立危险因素,见表3。二组在首次入户干预时间、跌倒风险评估总分、跌倒次数方面存在显著差异 (P<0.05),见表4。[结论]运用医疗失效模式与效应分析(HFMEA)方法改进并实施社区防跌倒管理流程和控制方案,可降低跌倒风险,减少跌倒发生。     

Preventive Care in the Emergency Department: Should Emergency Departments Institute a Falls Prevention Program for Elder Patients? A Systematic Review

OBJECTIVE: To perform a systematic review of the emergency medicine literature to assess the appropriateness of an intervention to identify, counsel, and refer emergency department (ED) patients >64 years old who are at high risk for falls. METHODS: The systematic review was facilitated through the use of a structured template, a companion explanatory piece, and a grading and methodological scoring system based on published criteria for critical appraisal. A reference librarian did two PubMed searches using the following: ED visits, patients >64 years old, falls, high risk, and effectiveness of intervention. Emergency Medical Abstracts, Science Citation Index, and the Cochrane Collaboration database were searched. Two team members reviewed the abstracts and selected pertinent articles. References were screened for additional pertinent articles. RESULTS: Twenty-six articles were reviewed. None were ED-based primary or secondary falls prevention in older patients. One randomized controlled trial of an intervention to decrease subsequent falls in elder community-dwelling patients who presented with a fall showed a structured interdisciplinary approach significantly reducing the number of falls. Two ED-based studies showed it was possible to identify ED patients at risk for falls. CONCLUSIONS: Based on one randomized controlled trial demonstrating a significant reduction in the risk of further falls, the burden of suffering caused by falls, and other studies demonstrating the value of interventions to reduce the risk of falling, the authors recommend that EDs conduct research to evaluate the effectiveness of clinical interventions to identify, counsel, and refer ED patients >64 years old who are at high risk for an unintentional fall.     

Feasibility and effectiveness of a nurse-led community exercise programme for prevention of falls among frail elderly people: a multi-centre controlled trial.

OBJECTIVE: To determine whether an exercise programme provided by public health nurses is effective in improving physical function and psychological status in elderly people, in reducing falls and risk factors for falls in elderly people, and whether the intervention is a feasible programme within the community. DESIGN: Controlled intervention trial. SUBJECTS: Participants included 144 persons in the intervention group and 124 persons in the control group, who were living at home, aged over 65 years, and with 5 or more risk factors for falls identified using the questionnaire for fall assessment (Suzuki). METHODS: For participants in the intervention group, an exercise programme was provided by public health nurses. This comprised a weekly exercise class of 2 hours for 17 weeks, supplemented by daily home exercises. Number of risk factors, physical function and psychological status were compared between the intervention and control groups before and after intervention. The number of further falls during the intervention was also compared between the 2 groups. RESULTS: The programme significantly improved physical function and emotional status, and reduced the number of falls and risk factors for falls. The excellent adherence rate represented broad acceptance of the intervention. CONCLUSION: The intervention programme was effective and feasible to operate in the community.     

Effects of a multifactorial fall prevention program on balance,gait, and fear of falling in post-stroke inpatients

[Purpose] This study investigated the effects of a multifactorial fall prevention program on balance, gait, and fear of falling in stroke patients. [Subjects] Twenty-five stroke patients were divided randomly into multifactorial fall prevention program group (n=15) and control treadmill group (n=10). [Methods] All interventions were applied for 30 min, five times per week, for five weeks. The fall prevention program included interventions based on the “Step Up to Stop Falls” initiative and educational interventions based on the Department of Health guidelines. For those in the treadmill group, the speed was increased gradually. The Korean falls efficacy scale and Korean activities-specific balance confidence scale were used to assess fear of falling. To assess balance and walking ability, the Korean performance-oriented mobility assessment scale and the 10-m and 6-minute walk tests were used. [Results] The fall prevention program interventions were found to be very effective at improving gait, balance, and fear of falling compared with the treadmill intervention and therefore seem appropriate for stroke patients. [Conclusion] A multifactorial fall prevention program is effective at improving balance, gait ability, and fear of falling. It is a more specific and broad intervention for reducing falls among inpatients in facilities and hospitals.Key words: Multifactorial fall prevention, Balance, Gait ability     

The efficacy of a multidisciplinary falls prevention clinic with an extended step-down community program

Sze P-C, Cheung W-H, Lam P-S, Lo HS-D, Leung K-S, Chan T. The efficacy of a multidisciplinary falls prevention clinic with an extended step-down community program.

Objective

To investigate the efficacy of a falls prevention clinic and a community step-down program in reducing the number of falls among community-dwelling elderly at high risk of fall.

Design

Prospective cohort.

Setting

Community.

Participants

Community-dwelling elderly (N=200) were screened for risk of fall; 60 were identified as being at high risk and were referred to the intervention program.

Intervention

Twelve sessions of a once-a-week falls prevention clinic, including fall evaluation, balance training, home hazard management program, and medical referrals, were provided in the first 3 months. The community step-down program, including falls prevention education, a weekly exercise class, and 2 home visitations, was provided in the following 9 months.

Main Outcome Measures

Fall rate, injurious fall, and its associated medical consultation were recorded during the intervention period and the year before intervention. Balance tests included the Berg Balance Scale (BBS), Sensory Organization Test, and limits of stability test; fear of falling, as evaluated using the Activities-specific Balance Confidence (ABC) scale, was measured at baseline and after the training in the falls prevention clinic.

Results

Significant reductions in fall rate (74%), injurious falls (43%), and fall-associated medical consultation (47%) were noted. Significant improvement in balance scores (BBS, P<.001; endpoint excursion in limits of stability test, P=.004) and fear of falling (ABC scale, P=.001) was shown.

Conclusions

The programs in the falls prevention clinic were effective in reducing the number of falls and injurious falls. The community step-down programs were crucial in maintaining the intervention effects of the falls prevention clinic.     

A single home visit by an occupational therapist reduces the risk of falling after hip fracture in elderly women: a quasi-randomized controlled trial.

OBJECTIVE: To assess the effectiveness of a single home visit by an occupational therapist in the reduction of fall risk after hip fracture in elderly women. DESIGN: Quasi-randomized controlled trial. PARTICIPANTS: Ninety-five women aged 60 years or older, living in the community, who sustained a fall-related hip fracture. METHODS: The women were allocated alternately to intervention or control groups. All the women underwent a multidisciplinary programme targeted at fall prevention during in-patient rehabilitation. Additionally, the intervention group received a home visit by an occupational therapist a median of 20 days after discharge. Falls were recorded at a 6-month follow-up. RESULTS: Thirteen of the 50 women in the control group sustained 20 falls during 9231 days, whereas 6 of the 45 women in the intervention group sustained 9 falls during 8970 days. After adjustment for observation periods, Barthel Index scores, and body height, a significantly lower proportion of fallers was found in the intervention group: the odds ratio was 0.275 (95% confidence interval 0.081-0.937, p=0.039). CONCLUSION: A single home visit by an occupational therapist after discharge from a rehabilitation hospital significantly reduced the risk of falling in a sample of elderly women following hip fracture.     

Efectividad de los ejercicios de equilibrio entre los adultos mayores en Depok,Indonesia

ObjectiveFalls are a serious problem for older adults. Balance impairment is one of the most significant reasons why adults fall from a standing position. This study aims to investigate the effect of an eight-week postural balance exercise intended to reduce the risk of falls among older adults in a community in Depok City, Indonesia.MethodThis quasi-experimental study employed a pre- and post-test design using a control group. The study involved an intervention group of 30 respondents and a control group of a further 30 respondents. The sample was selected using multistage random sampling. The data were analyzed using a t-test.ResultsThe balance exercise significantly affected the respondents’ postural balance and reduced their risk of falling. There were significant differences between the two groups (intervention group and control group) in postural balance (p < 0.001) and the risk of suffering a fall (p = 0.023).ConclusiónBalance exercises can be utilized as one of the preventive efforts to maintain postural balance and reduce the risk of falls among older adults. Future studies may consider the variation of age to more accurately determine the effectiveness of this balance exercise.     

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.     

Recommendations and reality: perceived patient, provider, and policy barriers to implementing routine HIV screening and proposed solutions

In 2006, the Centers for Diseases Control and Prevention (CDC) released recommendations calling for routine HIV testing to be offered to those ages 13 to 64 as a standard of general health care. This recommendation included a plan to conduct HIV testing as part of a general consent. The reasoning and evidence for this recommendation is supported by experts, patients, and sponsored screenings by the CDC. The rationale behind this approach includes that knowledge of one's HIV status helps (1) infected individuals adopt risk-reduction behaviors and access to life-prolonging treatment and (2) uninfected individuals maintain behaviors that reduce their risk of becoming infected. This article discusses the perceived patient, provider, and policy barriers to implementing routine HIV screening and proposed solutions that can be part of a nurse-led contribution to develop and adopt innovative, patient-centered care models that can address the need for screening.     

Fear of falling,falls efficacy,and health outcomes in older people following hip fracture

Purpose : This study sought to determine whether fear of falling and falls efficacy independently contribute to the prediction of health outcomes after a fall, controlling for length of stay in hospital, prefall activity problems, and history of falls.

Method : Eighty-two older people ( ≥65 years) admitted to hospital as a result of a fall, with proximal femoral fracture, were interviewed to assess variables of interest. At two months after initial interview, participants ( n =57) were re-interviewed in their own home, and their functional limitation and further fall events were assessed. Regression analyses were carried out to determine the ability of the variables assessed in hospital to predict functional limitation and further falls post discharge.

Results : Perceived risk of falling and falls efficacy did not explain variance in functional limitation when added to a model containing biomedical factors. In the prediction of further falls, addition of falls efficacy and worry over further falls to a model containing biomedical factors resulted in a statistically reliable improvement, although falls efficacy was not independently associated with outcome.

Conclusions : Assessing worry over further falls in hospital may help to identify older people with hip fracture at risk of poor health outcomes.     

Effectiveness of home visit falls prevention strategy for Taiwanese community-dwelling elders: randomized trial

The purpose of this research was to examine the effect of a multifactorial intervention to prevent falls by increasing self-efficacy to prevent falls, improving the knowledge of medication safety, and decreasing the number of environmental risks in older persons dwelling in the community. A sample of 120 cognitively intact residents of this community who were 65 years of age and older were recruited into a two-group pretest-post-test experimental design and randomly assigned to an experimental group and a comparison group (60 in each group). The intervention was delivered, and data were collected during three home visits in a 4-month period. (1) Experimental subjects improved their fall self-efficacy, environmental safety, and knowledge of medication safety significantly (p < 0.01) as compared with those in the comparison group at post-test; (2) the incidence of falls was reduced at post-test in both groups compared to pretest scores, and the falling was more serious in the comparison group at post-test compared to that in the experimental group. The results can help community health professionals to individualize their interventions to the specific needs of the elderly, thus helping to prevent falls among community-dwelling elders.     

Lower urinary tract symptoms, incontinence and falls in elderly people: time for an intervention study

Falls in older people constitute a common health hazard, which has attracted much attention and research. There are many evidence-based interventions, which have been shown to reduce the subsequent risk of falls. There is good evidence for an association between the risk of falling and the presence of urinary incontinence in older people, but incontinence has not been routinely included in interventions targeted to reduce falls. This article reviews the evidence for current falls intervention and the association between falls and urinary incontinence, making the case for an intervention study.     

Predictors of falls in a high risk population: results from the prevention of falls in the elderly trial (PROFET)

Objectives: The prevention of falls in the elderly trial (PROFET) provides evidence of the benefits of structured interdisciplinary assessment of older people presenting to the accident and emergency department with a fall. However, the service implications of implementing this effective intervention are significant. This study therefore examined risk factors from PROFET and used these to devise a practical approach to streamlining referrals from accident and emergency departments to specialist falls services.

Methods: Logistic regression analysis was used in the control group to identify patients with an increased risk of falling in the absence of any intervention. The derived predictors were investigated to see whether they also predicted loss to follow up. A second regression analysis was undertaken to test for interaction with intervention.

Results: Significant positive predictors of further falls were; history of falls in the previous year (OR 1.5 (95%CI 1.1 to 1.9)), falling indoors (OR 2.4 (95%CI 1.1 to 5.2)), and inability to get up after a fall (OR 5.5 (95%CI 2.3 to 13.0)). Negative predictors were moderate alcohol consumption (OR 0.55 (95%CI 0.28 to 1.1)), a reduced abbreviated mental test score (OR 0.7 (95%CI 0.53 to 0.93)), and admission to hospital as a result of the fall (OR 0.26 (95%CI 0.11 to 0.61)). A history of falls (OR 1.2 (95%CI 1.0 to 1.3)), falling indoors (OR 3.2 (95%CI 1.5 to 6.6)) and a reduced abbreviated mental test score (OR 1.3 (95%CI 1.0 to 1.6)) were found to predict loss to follow up.

Conclusions: The study has focused on a readily identifiable high risk group of people presenting at a key interface between the primary and secondary health care sectors. Analysis of derived predictors offers a practical risk based approach to streamlining referrals that is consistent with an attainable level of service commitment.

     

Using the Care Dependency Scale for fall risk screening

AIM: This paper is a report of a study conducted to estimate the sensitivity and specificity of the Care Dependency Scale as a measure of risk of falling for individuals in hospital and nursing home settings. BACKGROUND: Falls and their consequences are common problems in hospitals and nursing homes and nurses should assess the potential risks of their patients. Items in fall risk scales resemble a general nursing assessment, which leads to redundant assessment procedures. It would be beneficial to have a single generic instrument for general assessment and fall risk screening. METHODS: Standardized questionnaires were used in a cross-sectional study in 2004 and data were gathered from 9943 German nursing home residents and hospital patients (response rate 77.1%). Sensitivity and specificity of all Care Dependency Scale scores were calculated for fall risk. Relationships between the 15 scale items and falls were described using odds ratios and logistic regression analysis. FINDINGS: Patients with falls in hospitals were more care dependent than those without falls. Sensitivity and specificity values showed that with the Care Dependency Scale a differentiation is possible between the falls group and the no-falls group. High odds ratios and logistic regression analysis suggest that the Care Dependency Scale item 'Avoidance of danger' indicated fall risk. Nursing home residents with and without falls had similar care dependency scores. CONCLUSION: Nursing assessment in hospitals could be simplified by using the Care Dependency Scale for fall risk screening. Its value in fall risk screening in nursing homes requires further testing.