Implementation of a community pharmacy-based falls prevention program

Background

Falls are the leading cause of fatal and nonfatal unintentional injury among older adults in the United States. Multifaceted falls prevention programs, which have been reported to reduce the risk for falls among older adults, usually include a medication review and modification component. Based on a literature search, no randomized trials that have examined the effectiveness of this component have been published.

Objective

The aim of this article was to report on a retrospective process evaluation of data from a randomized, controlled trial conducted to examine the effectiveness of a medication review intervention, delivered through community pharmacies, on the rate of falls among community-dwelling older adults.

Methods

Patients were recruited through 32 pharmacies in North Carolina. Participants were community-dwelling older adults at high risk for falls based on age (≥65 years), number of concurrent medications (≥4), and medication classes (emphasis on CNS-active agents). The process evaluation measured the recruitment of patients into the study, the process through which the intervention was delivered, the extent to which patients implemented the recommendations for intervention, and the acceptance of pharmacists' recommendations by prescribing physicians.

Results

Of the 7793 patients contacted for study participation, 981 (12.6%) responded to the initial inquiry. A total of 801 (81.7%) participated in an eligibility interview, of whom 342 (42.7%) were eligible. Baseline data collection was completed in 186 of eligible patients (54.4%), who were randomly assigned to the intervention group (n = 93) or the control group (n = 93). Pharmacists delivered a medication review to 73 of the patients (78.5%) in the intervention group, with 41 recommendations for changes in medication, of which 10 (24.4%) were implemented. Of the 31 prescribing physicians contacted with pharmacists' recommendations, 14 (45.2%) responded, and 10 (32.3%) authorized the changes.

Conclusions

Based on the findings from the present study, coordination of care between community pharmacists and prescribers needs to be improved for the realization of potential beneficial effects of medication management on falls prevention.     

Evaluation of a peer-led falls prevention program for older adults

Waters DL, Hale LA, Robertson L, Hale BA, Herbison P. Evaluation of a peer-led falls prevention program for older adults.

Objective

To evaluate measures of strength and balance and falls incidence in participants attending fall prevention exercise classes taught by volunteer peer leaders, paid professional (Age Concern Otago group), or a comparison class (comparison group).

Design

Quasi-experimental evaluation with 12-month follow-up.

Setting

Community.

Participants

Older adults with increased fall risk (N=118; mean age, 75.5y; age range, 65–94y), with 23% drop out at 12 months.

Intervention

Peer-led group (n=52) and Age Concern Otago (n=41) weekly 1-hour strength and balance classes adapted from a home-based nurse/physical therapist–administered program and comparison group (n=25) 1-hour weekly seated exercise classes.

Main Outcome Measures

Timed Up and Go test, 30-second chair stand, functional reach, step touch, Single Leg Stand, and balance confidence at baseline, 10 weeks, and 6 and 12 months. Falls diaries collected monthly for 12 months. Continued exercise participation questionnaire at 6 and 12 months.

Results

At baseline, the peer-led group achieved normative standards on most tests and performed significantly better than the Age Concern Otago and comparison groups (overall P<.05). The Age Concern Otago group reached normative standards on most tests at 10 weeks. Functional improvements were similar in the peer-led group and Age Concern Otago groups from 10 weeks to 12 months, and all functional measures were significantly greater than in the comparison group (overall P<.02). Poisson regression showed a tendency for a 27% decrease in falls for the peer-led group compared with the comparison group (incidence rate ratio [IRR], .73; 95% confidence interval, .48–1.1; P=.07). Continued participation in strength and balance classes at 12 months was greater in the peer-led group and Age Concern Otago groups compared with the comparison group.

Conclusions

This peer-led model maintained measures of strength and balance and was superior to seated exercise. People in the Age Concern Otago group chose to continue these classes over other activities, whereas the comparison group had discontinued exercise classes by 12 months. Peer-led classes may decrease the fall incidence, although larger studies are needed to confirm this finding.     

Reliability and Internal Consistency of the Activities-Specific Balance Confidence Scale

ABSTRACT

The Activities-specific Balance Confidence Scale (ABC) was developed to assess balance confidence. While several researchers have used the ABC to measure balance confidence, its psychometric properties are reported by only a few studies. The purpose of this study was to evaluate the ABC's test–retest reliability and internal consistency among a sample of community dwelling older adults. Forty-four subjects aged 65 and older who lived independently in a senior living community participated in the study. Each participant completed the ABC on two separate test days, 6 months apart. Test–retest reliability revealed an intraclass correlation coefficient of 0.879 (95% CI, 0.779–0.934). Internal consistency measured by cronbach's α was 0.973 for both baseline and six-month data. The ABC demonstrated good test–retest reliability and strong internal consistency among a sample of community dwelling older adults; however, internal consistency may be exceedingly high, indicating item redundancy.     

Visual impairment and falls: a register study

Aim. The aim of this register study was to investigate falls and fall injuries of inpatients 65 years and over to determine whether a causal factor of visual impairment was documented. Background. All Organisation for Economic Cooperation and Development (OECD) countries have an increasing older population with falls and fall injuries becoming a major problem. A visual impairment can be an independent risk factor for falls but can also occur in combination with other intrinsic and extrinsic risk factors. Design. A retrospective non‐randomised register study. Methods. In 2004, all documented falls of inpatients aged 65 years and over were examined. Medical records and eye clinic records were scrutinised to identify whether any visual impairment have been documented. Conclusion. The majority of falls occurred between the hours of 24:00–06:00 and the inpatients most often affected were those with a visual impairment. The falls occurred in connection with movement when the inpatient was unaccompanied. Documentation in records at the medical clinic was defective and subjectively perceived visual impairment was not documented at all. Both subjective and objective visual impairment occurred in all eye clinic records. Relevance to clinical practice. Visual impairment along with the ageing process are features affecting falls and the hospital environment needs to be adapted by improving the use of strong, contrasting colours and providing good lighting for older inpatients with visual impairment during the night time period. Hospital safety for older people with visual impairment is a concern if falls are to be reduced. Healthcare professionals need to undertake individual risk assessments to establish the degree of visual impairment of the older person so that appropriate interventions can be implemented to reduce the incidence of falls and fall injuries.     

老年人参与身体活动对改善健康、生活质量和福祉效果的系统综述

目的 以世界卫生组织的相关重要文件作为研究的理论基础,建立老年人身体活动和康复活动架构,对老年人参与身体活动的健康和康复效果进行系统综述。方法 采用主题检索方式,检索Web of Science、PubMed、EBSCO、Google Scholar、中国知网和万方数据库建库至2021年6月30日与身体活动领域老年人身体活动和健康、生活质量相关的文献,提取文献内容,对老年人参与身体活动改善健康、生活质量和福祉的效果进行综述。结果 研究涉及的老年人参与的身体活动类别有有氧活动、发展肌肉的活动、发展骨骼的活动、平衡性活动和综合活动。老年人参与身体活动改善健康和康复效果,主要体现在改善身体健康和心理健康、促进社会适应和活动行为与营养;健康和康复影响主要体现在提高健康寿命,改善生活质量和福祉。在改善身体健康方面,老年人参与身体活动可以改善体适能、慢性疾病和身体功能;在改善心理健康方面,可以改善认知功能、情绪、人格特质和睡眠等。影响老年人身体活动参与和健康、康复效果的因素主要有个人因素和环境因素。结论 老年人参与所有形式的身体活动都可以提供健康效益,可促进健康老龄化,改善身体健康和心理健康,促进社会适应和活动行为与营养,提高健康寿命,改善生活质量和福祉。身体活动是一项健康相关服务,应促进老年人科学合理的身体活动,将身体活动与康复服务结合,促进老年人的健康、功能、福祉和生活质量。     

Study on the quality of life and its related factors for older adults in communities in Beijing,China

Objectives: To describe the quality of life (QOL) of adults ≥60 years of age in communities in Beijing and explore demographic, clinical, and psychological factors associated with QOL. Methods: This was a cross-sectional study. A total of 363 older adults were recruited, in which 313 completed the questionnaires. Depressive symptoms were measured with the Self-Rating Depression Scale (SDS) and QOL was analyzed with the 36-item shor t form (SF-36). The t-test and Mann-Whitney U tests were used to compare QOL by gender and age group. Factors associated with QOL were determined using multiple linear regression. Results: Among 313 older adults, depressive symptoms were observed to be prevalent to the extent of 16.6％. Overall, participants had higher QOL in the domains of social role functioning and emotional role functioning, with lower QOL in the domains of physical functioning and general health perceptions. There were no significant differences in QOL between women and men. However, there were significant differences between different age groups, with older adults having better mental QOL than younger adults. Better physical QOL was associated with less depressive symptoms, having a partner, and younger age (R2 = 28.7％). Better mental QOL was associated with less depressive symptoms, less chronic disease, and older age (R2 = 34.7％). Conclusions: With aging, physical QOL was lower and mental QOL was better. Less depressive symptoms, having a spouse or par tner, and young–old age asser t positive influence on physical QOL of the older adults; and less depressive symptoms, no chronic disease, and older age asser t positive influence on mental QOL.     

社区康复对脑卒中患者功能和生存质量的远期疗效观察

目的：应用功能综合评定量表(FCA)和WHO生存质量测定简式量表(WHOQOL-BREF)中文版研究社区康复（CBR）对脑卒中患者功能和生存质量(QOL)的远期疗效。方法：80例脑卒中患者随机分为社区康复组(40例)和对照组(40例),社区康复组进行康复治疗和随访,对照组只进行随访。于入组时、5个月末和17个月末,采用FCA、WHOQOL-BREF中文版对两组患者进行评定。结果：入组时两组患者FCA和WHOQOL-BREF评分差异无显著意义（P＞0.05）,治疗5个月后,社区康复组和对照组的FCA和WHOQOL-BREF评分比较,康复组效果优于对照组（P＜0.05）,17个月后康复组有进一步提高（P＜0.05）,而对照组改善不明显（P＞0.05）。结论：社区康复治疗对提高脑卒中患者FCA和WHOQOL-BREF作用显著;社区康复治疗介入时间越早,脑卒中患者功能和生存质量恢复的作用越明显。     

Long-term follow-up of exercise interventions aimed at preventing falls in older people living in the community: a systematic review and meta-analysis

BackgroundFall-related injuries are the leading cause of accident-related mortality for older adults, with 30% of those aged 65 years and over falling annually. Exercise is effective in reducing rate and risk of falls in community-dwelling adults; however, there is lack of evidence for the long-term effects of exercise.ObjectivesTo assess the long-term effect of exercise interventions on preventing falls in community-dwelling older adults.Data SourcesSearches were undertaken on MEDLINE, EMBASE, AMED, CINAHL, psycINFO, the Physiotherapy Evidence Database (PEDro) and The Cochrane Library from inception to April 2017.Study selectionRandomised controlled trials (RCTs), cohort studies or secondary analyses of RCTs with long-term follow-up (>12 months) of exercise interventions involving community-dwelling older adults (65 and over) compared to a control group.Data extraction/ Data synthesisPairs of review authors independently extracted data. Review Manager (RevMan 5.1) was used for meta-analysis and data were extracted using rate ratio (RaR) and risk ratio (RR).ResultsTwenty-four studies (7818 participants) were included. The overall pooled estimate of the effect of exercise on rate of falling beyond 12-month follow-up was rate ratio (RaR) 0.79 (95% confidence interval (CI) 0.71 to 0.88) and risk of falling was risk ratio (RR) 0.83 (95% CI 0.76 to 0.92) Subgroup analyses revealed that there was no sustained effect on rate or risk of falling beyond two years post intervention.ConclusionsFalls prevention exercise programmes have sustained long-term effects on the number of people falling and the number of falls for up to two years after an exercise intervention.Systematic review registration numberCRD42017062461.     

Predicting posthospital recovery of physical function among older adults after lower extremity surgery in a short-stay skilled nursing facility

This study describes the posthospital recovery of physical function among 131 older adults after lower extremity surgery in a short-stay skilled nursing facility (SNF), and identifies admission factors predicting physical function at discharge. Multiple regression analyses found that older adults with low baseline physical function, pressure ulcer, malnutrition, memory loss upon admission, and not enough physical therapy had poor physical function at the time of discharge from the facility. This study generated the following recommendations for nurses working in short-stay SNFs: (1) screen all posthospital residents at admission with predictors to identify people at risk for physical functional decline, (2) design and implement targeted nursing and rehabilitation interventions to improve physical function, and (3) develop discharge plans that provide ongoing monitoring and interventions for community or nursing home nurses.     

Pain and quality of life among older people with rheumatoid arthritis and/or osteoarthritis: a literature review

The aim of this study was to review the research literature on pain and quality of life (QoL) and the relationship between these variables among people aged 75 years and above with rheumatoid arthritis and/or osteoarthritis. A Medline and CINAHL search was carried out using MeSH terms rheumatoid arthritis, osteoarthritis, QoL and pain in various combinations. Seventeen articles were identified that met the requirements for methodological quality and inclusion criteria. No study focused only on respondents aged 75 years or over. The studies had varying representation of this age group. Pain was common in both groups and was found to increase with age and disease duration among those with rheumatoid arthritis but not among those with osteoarthritis. Increased pain could lead to depression. Pain, functional limitation and increased age were found to decrease QoL among those with rheumatoid arthritis and osteoarthritis alike. Social support was found to buffer against negative effects on QoL among those with osteoarthritis while no moderating effects were found in rheumatoid arthritis. Increased age was found to relate to pain (rheumatoid arthritis) and decrease QoL (both rheumatoid arthritis and osteoarthritis). It is, however, hard to draw any firm conclusions about older people's pain and QoL because of the lack of studies including respondents aged 75 years or over. Thus, research about pain and QoL, especially focusing on the old and the very elderly with rheumatoid arthritis/osteoarthritis, is needed. It also seems justified to say that nursing care should especially focus on older people and that these people should be assessed for their level of pain, functional limitations and QoL especially in the case of having rheumatoid arthritis and/or osteoarthritis.     

Associations of Uncertainty With Psychological Health and Quality of Life in Older Adults With Advanced Cancer

ContextOlder adults with advanced cancer face uncertainty related to their disease and treatment.ObjectivesTo evaluate the associations of uncertainty with psychological health and quality of life (QoL) in older adults with advanced cancer.MethodsSecondary cross-sectional analysis of baseline data from a national clustered geriatric assessment trial. Patients 70 years and older with advanced cancer considering a new line of chemotherapy were recruited. We measured uncertainty using the modified nine-item Mishel Uncertainty in Illness Scale. Dependent variables included anxiety (Generalized Anxiety Disorder-7), depression (Generalized Depression Scale-15), distress (distress thermometer), QoL (Functional Assessment of Cancer Therapy—General), and emotional well-being (Functional Assessment of Cancer Therapy—General subscale). We used multivariate linear regression analyses to evaluate the association of uncertainty with each dependent variable. We conducted a partial least squares analysis with a variable importance in projection (VIP) plot to assess the contribution of individual variables to the model. Variables with a VIP <0.8 were considered less influential.ResultsWe included 527 patients (median age 76 years; range 70–96). In multivariate analyses, higher levels of uncertainty were significantly associated with greater anxiety (β = 0.11; SE = 0.04), depression (β = 0.09; SE = 0.02), distress (β = 0.12; SE = 0.02), as well as lower QoL (β = ?1.08; SE = 0.11) and emotional well-being (β = ?0.29; SE = 0.03); the effect sizes were considered small. Uncertainty items related to disease and treatment were most strongly associated with psychological health and QoL scores (all VIP >0.8).ConclusionUncertainty among older patients with advanced cancer is associated with worse psychological health and QoL. Tailored uncertainty management strategies are warranted.     

老年膝骨关节炎患者自我管理的社区干预模式及效果分析

目的设计并实施膝关节骨关节炎(KOA)自我管理干预模式,探讨其对患者关节功能及生活质量的影响。方法2011年10 月~2012 年4 月抽取与唐山市老年人口比例匹配的两个社区,对自愿参加的老年KOA患者按社区分为干预组(n=50)和对照组(n=50)。干预组接受专业设计的KOA自我管理课程,每次1.5~2 h,每周1 次,共6 次。对照组发放膝骨关节炎自我管理手册。6 个月后采用骨关节炎指数评估表(WOMAC)、关节炎生活质量测量问卷(AIMS2-SF)、自行设计的一般情况调查表进行调查。结果干预后,干预组WOMAC评分下降,干预前后下降值优于对照组(P<0.05);AIMS2-SF 评分提高,提高值优于对照组(P<0.05)。结论KOA自我管理项目能有效改善患者的关节功能及症状,提高患者的生活质量。     

Prolonged grief symptoms related to loss of physical functioning: examining unique associations with medical service utilization

Purpose: Prolonged grief, a severe and chronic form of grieving most commonly studied in the context of bereavement, may have relevance to losses associated with chronic illness (e.g. grief related to loss of functioning or loss of a planned future). The purpose of the present study is to examine the unique associations between prolonged grief symptoms and service utilization patterns. Methods: An online self-report assessment battery was administered among a sample of 275 older adults with at least one chronic illness that caused significant physical impairment. Results: Even after statistically controlling for relevant physical health (e.g. severity of physical limitations, somatic symptoms, number of chronic illnesses) and psychosocial variables (e.g. social support, depression/anxiety), more severe prolonged grief symptoms were associated with a greater number of emergency room visits, overnight stays in the hospital and total nights in the hospital. Conclusions: These findings highlight the importance of screening for prolonged grief symptomatology with older individuals with a debilitating chronic illness.

• Implications for Rehabilitation

• Recent evidence suggests that prolonged grief may have relevance for losses associated with physical illness.

• The present study shows that prolonged grief reactions related to physical illness (e.g. grieving the loss of functioning) are uniquely associated with increased hospital-based service utilization.

• Given the relevance of prolonged grief reactions in this population, practitioners may wish to assess for these symptoms.

• Future clinical research should focus on developing interventions to target prolonged grief symptoms associated with these losses.

     

The effect of motivational interviewing on physical activity level among older adults: a systematic review and meta-analysis

Abstract

Aim: To determine the reported effect of randomized controlled trials (RCTs) using Motivational Interviewing (MI) to advance physical activity among older adults.

Methods: We searched for RCTs in MEDLINE, EMBASE, CINAHL, AgeLine, PsycINFO and Cochrane Library from inception until March, 2019. Identified trials that used MI for improving physical activity in community-dwelling older adults (≥65?years).

Results: From 5616 citations identified from the search, we included three trials (four publications). There was no evidence of a significant difference between the effect of MI and usual care on physical activity in older adults (Standard Mean Difference (SMD) -0.02, 95% Confidence Interval (CI) 0.05 to 0.46, I² 16%; 3 trials; 84 participants).

Conclusion: There is insufficient evidence to support the effect of MI on improving physical activity among older adults. There is a need for more high quality trials to show that MI is beneficial in older adults who are physically inactive.     

Fear of Falling: A Qualitative Study Among Community-Dwelling Older Adults

The aim of this qualitative study was to uncover why older adults experience the fear of falling and discover the perceived consequences older adults fear. Seven participants between 61 and 88 (M = 75.4, SD = 9.1) years were interviewed. It was identified that participants developed the fear of falling after they had fallen or as they aged. Six themes related to the fear of falling were revealed, including Physical Injury, the Feeling Experienced when Falling, Becoming an Invalid or Burden, Losing Independence and Being Institutionalized, A Long Lie, and Being Confined to a Wheelchair or Unable to Walk. The results from this study indicated that older adults fear the consequences of falling. However, they fear not only physical injury as a result of the fall, but the injury's consequences that may precipitate the individual becoming more dependent on others and experiencing life altering events.     

Effectiveness of a Matter of Balance Program Within an Assisted Living Community

Abstract

Aims: Given the incidence of falls among individuals in senior living communities, this study examined the effectiveness of the Matter of Balance (MOB) program in reducing falls risk and improving walking speed and participant perceptions of effectiveness. Methods: A mixed methods study was conducted with 24 participants in a single 2-h MOB class each week for 8?weeks. Pre and post-measures were the Mini-Balance Evaluation Systems Test (Mini-BESTest) and the 10-Meter Walk Test. Focus group and individual interviews were completed after program completion. Results: Total scores on the Mini-BESTest improved pre-to-post intervention (p?=?0.008) as did anticipatory balance scores (p?=?0.004). Walking speed slightly increased. Conclusions: This study’s results indicate the benefits the MOB program may have in senior living communities; however, additional research is warranted to determine the influence of the program on the reduction of falls risk and clinically meaningful improvements in walking speed.     

Fall-Related Self-efficacy in Instrumental Activities of Daily Living is Associated with Falls in Older Community-Living People

ABSTRACT

Introduction: The aim of this study was to identify fall risk factors in community-living people 75 years or older. Methods: From a random selection of 525 older adults, a total of 378 (72%) individuals participated in the study. Mean age was 81.7 years (range 75–101 years). A study-specific questionnaire including self-reported fall history for the past 6 months, the Falls-Efficacy Scale (Swedish version: FES(S)) and EuroQol 5 Dimensions (EQ5D) was used. Logistic regression analysis was conducted to find risk factors for falls. Results: The strongest significant predictor of falls was scoring low on FES(S) in instrumental activities of daily living (IADL), with an odds ratio of 7.89 (95% confidence interval 2.93–21.25). One fifth had experienced one or more falls during the past 6 months. Both fall-related self-efficacy and health-related quality of life were significantly lower among fallers. Conclusion: Our results imply that identifying community-living older adults with an increased risk of falling should include a measure of fall-related self-efficacy in IADL.