Screening,education, and associated behavioral responses to reduce risk for falls among people over age 65 years attending a community health fair

BACKGROUND AND PURPOSE: Because of the high risk of falling and the recognition that falling is a "geriatric syndrome," screening for risk of falls has become popular at community health fairs. The purposes of this study were to determine whether health fair screening and educational intervention would result in behaviors that could reduce the risk of falls and to determine whether adoption of risk-reduction behaviors differed between people over age 65 years screened as being at high risk for falls and those screened as being at lower risk for falls. SUBJECTS AND METHODS: The Berg Balance Test was used to classify fall risk in 68 individuals aged 57 to 89 years who were attending a community health fair. A score of 45 or lower led to a categorization of the person being at high risk for falls. All subjects were provided recommendations intended to reduce fall risk. Participants were interviewed by telephone 30 days after the screening to assess implementation of these recommendations. RESULTS: Seventy-two percent of the participants reported implementing at least one risk-reduction behavior. The high-risk group was more likely to implement risk-reduction behaviors than the low-risk group. DISCUSSION AND CONCLUSION: Screening and education in a health fair setting appear to promote behaviors that could reduce fall risk among elderly people. Future study with a control group that does not receive an educational intervention is needed to draw more definite conclusions about the value of this health promotion activity for fall prevention.     

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.     

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.     

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.     

Assessment of postural stability disorders in older adults treated at a health resort

Background. Falls are a common and often devastating occurrence for the elderly in both home and institutional settings. The main purpose of our study was to assess disorders of postural stability in elderly patients undergoing health resort treatment, recruited at the sanatorium in Swieradów Zdrój, Poland. Material and methods. Thirty two older adults between the ages of 67 and 84 years were enrolled. All subjects completed a questionnaire pertaining to their fall history, subjective feeling of unsteadiness, activity level, medical status and use of assistive devices and/or medications. The Berg Balance Test (BBT), consisting of 14 functional subtests, was used to measure balance abilities and identify individuals with a higher risk of falling. Results. The mean score on the BBT for all these older adults was 42. The lowest number of points was obtained by those persons who showed all the risk factors for falls: postural instability, previous falls, and no physical activity (26 +/- 15.5). The highest number of points was obtained by persons who had only one risk factor (45.3 +/- 4.5) or no risk factors (49.5 +/- 5.8). 41% of our study group had a higher risk of falling (score 40), while in 19% of the patients the risk of incurring a fall was 100% (score 36). Conclusions. Among health resort patients over the age of 65, there is a decline in balance abilities and more propensity to fall. Testing of balance and fall prevention programs should become a standard part of the treatment program at health resorts for the elderly.     

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.     

Measuring fall program outcomes

Nurses help to ensure patient safety, which includes preventing falls and fall related injuries. The aging Veteran population, like the general population, is at risk for falls and fall related injuries whether at home, in hospitals or in long term care facilities. Nurses are leading practice innovations to systematically assess patients' risk for falls and implement population based prevention interventions. To determine the effectiveness of programs, data can be analyzed using a variety of statistical measures to determine program impacts. Thus, data analysis of fall rates by type of fall and severity of fall related injury can help facilities examine the effectiveness of their interventions and program outcomes. Examples of actual fall prevention programs and their approaches to measurement are showcased in this article.     

Fall prevention in frail elderly nursing home residents: a challenge to case management: part II

Parts I and II of this article examine the impact of a falls prevention program on the fall incidents among the residents in a nursing home. It was hypothesized that a diagnostic, therapeutic, and preventive approach should be used for nursing home residents identified as being at high risk for falls in order to reduce the number of fall incidents and to improve quality of life for this vulnerable population. The program effectively targeted both intrinsic and extrinsic factors to reduce risks facing the residents. The effectiveness of the program was evaluated by examining changes in the rate of falls after the program was implemented. The results identified that a multifaceted program, one that utilized multiple personalized interventions, was effective in reducing the falls rate of frail (those with complex medical and psychosocial problems) nursing home residents, and that muscle-strengthening interventions may be beneficial for this vulnerable population. Program outcomes verified that case managers can impact quality of life for frail elderly nursing home residents by promoting their independence and safety, and postponing problems resulting from inactivity. Part I (LCM, Nov-Dec 2001) discussed the background and process of a falls program and factors contributing to the occurrence of falls. This month we examine the interdisciplinary team approach to assessment, method, and implementing strategies for an effective fall prevention program. Tools used for prevention, monitoring, and investigation of falls are also detailed.     

Fall prevention in frail elderly nursing home residents: a challenge to case management: part I

Parts I and II of this article examine the impact of a falls prevention program on the fall incidents among the residents in a nursing home. It was hypothesized that a diagnostic, therapeutic, and preventive approach should be used for nursing home residents identified as being at high risk for falls in order to reduce the number of fall incidents and to improve quality of life for this vulnerable population. The program effectively targeted both intrinsic and extrinsic factors to reduce risks facing the residents. The effectiveness of the program was evaluated by examining changes in the rate of falls after the program was implemented. The results identified that a multifaceted program, one that utilized multiple personalized interventions, was effective in reducing the falls rate of frail (those with complex medical and psychosocial problems) nursing home residents, and that muscle-strengthening interventions may be beneficial for this vulnerable population. Program outcomes verified that case managers can impact quality of life for frail elderly nursing home residents by promoting their independence and safety, and postponing problems resulting from inactivity. Part I discusses the background and process of a falls program and factors contributing to the occurrence of falls. Part II will examine the interdisciplinary team approach to assessment, method, and implementing strategies for an effective fall prevention program. Tools used for prevention, monitoring, and investigation of falls will be detailed in Part II.     

护理风险管理预防住院跌倒高危患者跌倒的实践及成效

目的探讨护理风险管理预防住院跌倒高危患者跌倒的实践及效果。方法 2010年1～12月对4230例跌倒高危患者采用常规预防跌倒管理方法,2011年1～12月对4900例跌倒高危患者采用预防跌倒风险管理。比较实施预防跌倒风险管理前后患者跌倒及跌倒损伤发生率,护士跌倒评估能力、防跌倒知识及跌倒处理能力达标率情况。结果实施护理风险管理后,跌倒高危患者跌倒及跌倒损伤发生率较实施前明显下降,护士跌倒评估能力、防跌倒知识及跌倒处理能力达标率较实施前明显提高。结论 防跌倒护理风险管理能有效预防患者跌倒,提升护理人员预防跌倒知识及能力,从而提高护理质量管理。     

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.     

Facteurs prédictifs de la chute chez l''hémiplégique vasculaire en centre de médecine physique

OBJECTIVES: To determine factors predicting falls by patients with vascular hemiplegia to establish a program aimed at preventing falls in this population. METHODS: A comparative prospective study performed over 19 months with 44 patients older than 16 years who had had a cerebral vascular accident (CVA, stroke) and were consequently admitted to the Centre Richelie. The exclusion criteria were represented by CVA history, evidence of another form of encephalic lesion, and subsequent admission to hospital after hemiplegia or for follow-up. Assessment consisted of taking note of the mechanism of the fall, possible lesions, and number of falls and analyzing follow-up after the return home. Also included for all patients was information on 20 variables that could be risk factors for fall. RESULTS: The patients' average age was 60.43+/-13.43 years and 20 had had at least one fall (mean 2.2), which allowed us to determine a "falling" group and a control group. Statistical analysis revealed the following factors considered to predict falls: large amount of time prior to hospitalization and lengthy hospitalization, low functional independence measure for entering and leaving, the existence of sensitivity disorders, spatial neglect, failed seated and standing equilibrium, and sedative treatment. In most cases, whatever their nature, falls occurred during transfers (68% of cases). Most often, the post-fall lesions were minor. However, in one case, a femur neck fracture necessitated osteosynthesis. One-third of the patients had a fall at home (as opposed to 5% of the control group). CONCLUSION: Our results confirm those in the literature. The predictive factors for falls in patients with hemiplegia are therefore well established and essentially correlate with the CVA. This consideration must lead to implementation of a prevention program including material-based as well as human measures.     

Effects of a multifactorial falls prevention program for people with stroke returning home after rehabilitation: a randomized controlled trial

Batchelor FA, Hill KD, Mackintosh SF, Said CM, Whitehead CH. Effects of a multifactorial falls prevention program for people with stroke returning home after rehabilitation: a randomized controlled trial.ObjectivesTo determine whether a multifactorial falls prevention program reduces falls in people with stroke at risk of recurrent falls and whether this program leads to improvements in gait, balance, strength, and fall-related efficacy.DesignA single blind, multicenter, randomized controlled trial with 12-month follow-up.SettingParticipants were recruited after discharge from rehabilitation and followed up in the community.ParticipantsParticipants (N=156) were people with stroke at risk of recurrent falls being discharged home from rehabilitation.InterventionsTailored multifactorial falls prevention program and usual care (n=71) or control (usual care, n=85).Main Outcome MeasuresPrimary outcomes were rate of falls and proportion of fallers. Secondary outcomes included injurious falls, falls risk, participation, activity, leg strength, gait speed, balance, and falls efficacy.ResultsThere was no significant difference in fall rate (intervention: 1.89 falls/person-year, control: 1.76 falls/person-year, incidence rate ratio=1.10, P=.74) or the proportion of fallers between the groups (risk ratio=.83, 95% confidence interval=.60–1.14). There was no significant difference in injurious fall rate (intervention: .74 injurious falls/person-year, control: .49 injurious falls/person-year, incidence rate ratio=1.57, P=.25), and there were no significant differences between groups on any other secondary outcome.ConclusionsThis multifactorial falls prevention program was not effective in reducing falls in people with stroke who are at risk of falls nor was it more effective than usual care in improving gait, balance, and strength in people with stroke. Further research is required to identify effective interventions for this high-risk group.     

Recurrent falls among community-dwelling older Koreans: prevalence and multivariate risk factors

This study was conducted to determine the risk factors for nonfallers versus fallers (1+ falls) and nonfallers/one-time fallers versus recurrent fallers (2+ falls) using the Resident Assessment Instrument-Home Care (RAI-HC(?)). Community-dwelling Koreans 65 and older (N = 411) comprised the sample. Multivariate logistic regression was used to determine the factors predictive of fallers and recurrent fallers. Eight predictive factors were statistically significant with regard to recurrent falls: unsteady gait, low scores related to performance of activities of daily living (ADLs) and instrumental ADLs (IADLs), high pain scores, number of housing environmental hazards, use of an assistive device, fear of falling, and reduced vision. Based on the findings, it is important to assess the risk factors for recurrent falls and develop differentiation strategies that help prevent recurrent falls, including management of gait problems, pain control, use of appropriate assistive devices, a fear management program, regular eye examinations, making improvements to ADLs and IADLs, and creating a safer home environment. In addition, using a standardized tool such as the RAI-HC would help assess multivariate fall risk factors to facilitate comparisons across different community care settings.     

肿瘤患者化疗后居家跌倒预防自我管理体验的质性研究

目的探究肿瘤患者化疗后居家跌倒预防自我管理的真实体验,明确肿瘤患者化疗后实施居家跌倒预防自我管理的阻碍及促进因素,为构建肿瘤患者化疗后居家跌倒预防自我管理干预策略提供参考依据。方法采用目的抽样方法,2018年11月—12月对武汉市某三级甲等医院肿瘤内科20例化疗后肿瘤患者进行半结构式深入访谈,并运用Nancy现象学7步分析法进行资料分析。结果肿瘤患者化疗后在进行居家跌倒预防自我管理时,存在居家跌倒预防自我管理认识不足、居家跌倒预防技能欠缺以及自我管理行为依从性差的问题;阻碍患者主动实施居家跌倒预防自我管理的因素包括患者对疾病预后及治疗效果的无望感、居家跌倒预防自我管理信息支持不足、客观条件受限,而家属/医护人员的支持监督、对个人健康及家庭的责任感是其主动实施居家跌倒预防自我管理的行为动力。结论肿瘤患者化疗后居家跌倒预防自我管理能力及自我管理行为依从性欠缺,迫切需要构建相关策略以提升其居家跌倒预防自我管理能力,减少不良事件发生。     

The risk factors related to falling in elderly females

The purpose of this study was to explore the relationship between muscle strength and functional mobility and falls in women aged 65 and over. Thirty-one female subjects with a mean age of 69.57 +/- 4.89 years (65-78) were enrolled in the study. Demographic properties, body mass index, comorbid medical conditions, smoking, the number of medications taken, and fall characteristics were recorded. Knee flexor and extensor strength of the dominant extremity was measured by Biodex isokinetic system, and physical capacity was assessed with a 6-minute walk test. Cognitive status was evaluated by the Mini-Mental State Examination, and disability in daily activities was determined with the Barthel Index. Twelve subjects (38.7%) reported experiencing a fall in the previous year. Eight (25.8%) had experienced a fall outside the home and 4 (12.9%) inside the home. Nine subjects had fallen once, 2 subjects twice, and 1 subject had fallen 3 times. Six (19.4%) subjects reported a fracture after falling. Muscle strength of the knee extensors and flexors and work capacity was similar between those who had fallen and those who had not. The risk factors related to falling were evaluated, but no related factor was determined. Fear of falling was found to be high in patients who had fallen in the previous year. In conclusion, knee extensor and flexor strength are not significant factors in falls or the risk of falling for elderly women, particularly those who are able to function independently. Balance tests in current use are not effective predictors of falls in older adults who live independently and who do not have any significant health problem. These results suggest that there may be a significant interactive effect of the many causal factors that we need to address. Further study is needed to develop new assessment tools for active elderly people to help prevent falls and fall-related injuries.     

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 ( &#85 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.