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.     

The Falls Risk Awareness Questionnaire: development and validation for use with older adults

Falling is a significant cause of disability and death among older adults, and assessing awareness of risk factors is the first step to developing falls intervention programs. Older adults who had fallen in the past were more aware of risk factors for falls, and may be receptive to fall risk information following a fall. This may be an opportune time for health care professionals to provide education on risks for falls to prevent further injury. The Falls Risk Awareness Questionnaire (FRAQ) was validated in a range of patients and practice settings, and after further testing, the FRAQ may play an important role in identifying specific differences in the knowledge of risk factors.     

Knowledge of risk factors for falling reported by patients with Parkinson disease.

This study examined awareness of the risk factors for falling among a group of community dwelling patients with Parkinson disease (PD) using the Falls Risk Awareness Questionnaire (FRAQ). A cross-sectional survey of 28 patients who attended a Movement Disorders Clinic for treatment of PD was used. FRAQ is a 28-item self-administered survey that assesses the knowledge and perception of risk factors for falling. Demographic, medical, and medication data were gathered from both the participants and clinic charts. Twenty-three (82%) of the participants reported falls in the past; seven (30%) had fallen within the past month. Nineteen (68%) of the participants felt they were at risk for further falls. When asked to list potential risk factors for falling, only 14% could identify medication as a risk factor. Persons with PD are at substantial risk of falling, yet many appear to be unaware of common risk factors, especially medication use.     

Catching Quality Before It Falls: Preventing Falls and Injuries in the Adult Emergency Department

ProblemAlthough hospital falls and injuries are a significant patient safety concern, research is limited regarding falls and injuries in the emergency department. The purpose of this quality improvement project is to identify and implement evidence-based interventions to prevent patient falls and injuries in the emergency department.MethodsLiterature was reviewed to identify best practices for fall prevention in the emergency department. Data sources included Journal Storage, PubMed, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Database of Systematic Reviews. A retrospective chart review and root cause analysis was completed on fall-related risk reports over a 19-month period at a specific emergency department. Multifactorial fall prevention interventions were implemented in March 2017, which included nursing educational sessions, patient education handout, and high-fall-risk patient identification signs.ResultsPost-implementation, zero falls were sustained in April 2017. The average number of falls between April and December 2017 was 5.2 falls/month. Completion of the fall-risk assessment tool ranged between 47 to 90 percent. The patient education handout was provided up to 40 percent of the time. The use of fall risk signs outside patient rooms occurred up to 43 percent of the time.DiscussionThe emergency department is a unique environment with complex patient populations. Multifactorial interventions should be used to identify and prevent patient falls and injuries. Multiple change strategies and leadership support are essential to sustain changes. Future research should be conducted regarding the use of fall risk assessments and fall prevention strategies specific to the emergency department.     

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.     

The circumstances of falls among people with Parkinson's disease and the use of Falls Diaries to facilitate reporting

Purpose. Falls are common in Parkinson's disease (PD). Falls Diaries are one way of recording fall frequency and the surrounding circumstances; completing them encourages recall, and their content focuses intervention. We reviewed the diaries completed by people with PD during a randomized controlled trial (RCT) of fall prevention to ascertain the key circumstances surrounding falls.

Method. We asked independently mobile, cognitively intact people with a diagnosis of PD to maintain a Falls Diary throughout a six-month RCT. We sent monthly diary sheets on which to answer questions about the ‘Location’, ‘Fall-related activity’, ‘Perceived cause’, ‘Landing’ and ‘Consequences’ of every fall. We coded responses and counted frequencies.

Results. Of the 142 RCT participants (mean age 72 years; mean years since diagnosis 8), 135 completed the trial and their diary. We excluded 11 (8%) for missing data and/or unintelligible writing. The 124 remaining diaries recorded 639 falls: 80% happened at home, commonly in bedrooms, living areas, kitchens and gardens. Fallers had been ambulant in 45% of events, standing in 32% and transferring in 21%. Six ‘activity-cause combinations’ accounted for 55% of falls (tripping 13%; freezing, festination and retropulsion 11%; and postural instability when bending or reaching 9%, transferring 8%, walking 7% and washing or dressing 7%). Misjudgement and distraction played a part in 12% of falls described.

Conclusions. Of over 600 falls surveyed, most happened at home, provoked by postural instability, tripping and freezing. Environmental adaptation and cognitive training should be trialled in falls prevention in PD, plus or minus traditional movement rehabilitation. Most participants completed Falls Diaries successfully. We advocate diary use, with follow-up interviews, in research and clinically. People with handwriting difficulty may require a typed diary, proxy diarist or interview.     

Masculinity and preventing falls: insights from the fall experiences of men aged 70 years and over

Purpose: To explore men’s fall experiences through the lens of masculine identities so as to assist health professionals better engage men in fall prevention programs.

Methods: Twenty-five men, aged 70–93 years who had experienced a recent fall, participated in a qualitative semi-structured interview. Men’s willingness to engage in fall prevention programs taking account of individual contexts and expressions of masculinity, were conceptualised using constant comparative methods.

Results: Men’s willingness to engage in fall prevention programs was related to their perceptions of the preventability of falls; personal relevance of falls; and age, health, and capability as well as problem-solving styles to prevent falls. Fall prevention advice was rarely given when men accessed the health system at the time of a fall.

Conclusions: Contrary to dominant expectations about masculine identity, many men acknowledged fall vulnerability indicating they would attend or consider attending, a fall prevention program. Health professionals can better engage men by providing consistent messages that falls can be prevented; tailoring advice, understanding men are at different stages in their awareness of fall risk and preferences for action; and by being aware of their own assumptions that can act as barriers to speaking with men about fall prevention.

• Implications for rehabilitation

• Men accessing the health system at the time of the fall, and during rehabilitation following a fall represent prime opportunities for health professionals to speak with men about preventing falls and make appropriate referrals to community programs.

• Tailored advice will take account of individual men’s perceptions of preventability; personal relevance; perceptions of age, health and capability; and problem-solving styles.

     

Predictive Abilities of Balance Confidence and Fear of Falling Measures on Falls in Polio Survivors

Purposes: To determine 1) predictors of falls in adult survivors of polio and 2) if Activities-specific Balance Confidence (ABC) scale or Falls Efficacy Scale-International (FES-I) better predicted falls in this population. Methods: 415 participants completed anonymous on-line surveys, including fall history, walking status, ABC scale, FES-I, and Geriatric Depression Scale-15. Logistic and linear regressions and receiver operating curve analyses performed. Results: 69% and 81% of participants reported falls and fear of falling (FoF) (yes/no), respectively. Walking status significantly predicted falls in overall model. ABC significantly predicted falls in people who walk by separate logistic regressions. FES-I, reported FoF, and in-community walking status predicted fall frequency by linear regression. Conclusions: ABC, FES-I, and reported FoF are related to falling, especially in polio survivors who walk, with the ABC scale better predicting falls. Measures used were unhelpful in fall prediction for people who primarily use wheelchairs for locomotion.     

Falls among stroke survivors: an online survey on perceptions and approaches among physiotherapists in Flanders

Objective.?To describe physiotherapists' perceptions of fall risk and appropriate fall prevention interventions in rehabilitating stroke patients.

Method.?A web-based survey addressed to physiotherapy units on a stroke unit, general neurology department or rehabilitation ward/centre in Flanders.

Results.?Hospital response rate was 66.3%. Sixty-five physiotherapy units were taken into account. About 84.6% recognised falls among stroke patients as an essential problem and 73.8% thought falls interfered with the outcome. About 56.9% agreed with the need of a standardised fall assessment at the beginning of the treatment and only 36.9% reported that on their department stroke patients are screened on risk of falling. The most used fall risk assessments are: Berg Balance scale and Tinetti-test. The most popular fall prevention measures are: specific exercises for balance, gait and functional abilities (100%), informative education (92.3%) and adapting or intensifying the treatment after a fall (81.5%).

Conclusions.?Physiotherapy units acknowledge falls as an essential threat, implying a need for risk screening and prevention. However, results reveal that perception of the necessity of such screening is lower and that the performance is even less. This discrepancy underlines the necessity of guidelines and education of therapists working with stroke patients.     

Development,implementation, and evaluation of a comprehensive fall risk program

Purpose. The purpose was to develop and implement I'M SAFE, a comprehensive patient fall‐risk assessment tool linked to a tiered‐intervention falls prevention program. Design and Method. A fall‐risk evaluation tool was incorporated into electronic nurse documentation along with risk‐specific nursing interventions. Results. Intrinsic fall rates declined significantly (preimplementation: .67 falls/1,000 patient days; postimplementation: .51 falls/1,000 patient days, p= .015) and has been sustained 2 years following implementation. Practice Implications. The I'M SAFE tool identifies patients at increased risk for falls. When linked to a multidisciplinary fall prevention program, the incidence of preventable falls can be reduced. The program's impact has persisted across two facilities.     

Increasing Intent to Vaccinate for Seasonal Influenza

ABSTRACT

Background: The community college student is not currently armed with the resources or prevention information regarding influenza. Less than twenty percent of the college population receives influenza immunization annually.

Purpose: The purpose of the project was to evaluate if an evidenced-based influenza and vaccine education intervention will affect nursing students’ intent to vaccinate for influenza by increasing knowledge of the influenza vaccine using Zingg and Siegrist’s Knowledge Scale.

Methods: Participants were recruited voluntarily from their attendance at orientation for incoming nursing students on a specific date and time. Utilizing a computer survey, all seventy-seven participants completed an online pretest before an educational intervention, and then, the results were compared following the educational intervention with a posttest. Parametric tests such as a paired t-test, Pearson’s correlation coefficient, one-way analysis of variance (ANOVA), and percent change were utilized to determine whether an educational intervention was effective in improving influenza knowledge and whether there was a change in vaccination intention.

Outcomes and Results: The educational intervention in this project resulted in enhancement of influenza knowledge. The implications of this project demonstrated the value of providing an educational intervention to improve knowledge, intent, and willingness to vaccinate for influenza for nursing students at a community college.     

‘I don't want to impose on anybody’: Older people and their families discuss their perceptions of risk,cause and care in the context of falls

Background

Falls in hospitalised patients remain an ongoing challenge for healthcare systems internationally. Limited research exists on the perspectives of older people on falls risk, cause and care.

Objectives

This study explored the experiences of patients and their families after a fall in a healthcare facility.

Methods

Semi-structured interviews were conducted with patients and families to explore the experience of having a fall. Data were analysed thematically.

Results

The themes that emerged from the 14 interviews included the following: explanations; physical environment; communication; experiences of care; perceptions of risk; ageism; feelings towards the fall; and independence and dignity.

Conclusions

This research emphasises the diversity in older people's experiences after experiencing a fall. Falls prevention should be incorporated as one part of healthy, dignified ageing.

Implications for practice

Falls prevention and management strategies should be multifactorial, including enhanced communication with the patient and their families. When engaging in education and awareness, falls prevention should be positioned as one component of independent and dignified healthy ageing.     

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.     

Effectiveness and Acceptability within a Skilled Nursing Facility Setting

ABSTRACT

Aims: The program evaluated the effectiveness and acceptability of the Stepping On protocol (Clemson L, Swann M, Mahoney J. (2011). Stepping On: Building confidence and reducing falls in older adults (3rd ed.). Cedar Falls, IA: Freiberg Press Inc.) in reducing fall risk in older adults when delivered in a skilled nursing facility (SNF). Method: Stepping On was delivered by an occupational therapist to participants (n = 11) over 7 weeks followed by a 3-month session (Clemson et al., 2011). Results: Through comparison of pre and post data (n = 7) and 3-month outcomes (n = 4), trends revealed an overall increase in the use of protective behaviors and self-perceived physical health. Trends showed sustained outcomes at all measures, with exception of a decline in fall efficacy. The program was well received by participants and staff at the SNF with high satisfaction rates. Conclusion: Stepping On has the potential to be an effective fall prevention program for older adults with trends towards fall prevention while providing needed support to current and past SNF residents, and community members.     

Perceptions of older people living in the community about their fear of falling

Purpose. A fear of falls is widespread amongst older Australians. It increases the risk of falls and can lead to restriction of activity. The aim of this study was to gain insight into the precursors of a fear of falls and the experiences associated with this fear.

Methods. Using a qualitative, phenomenological method, individual, semi-structured interviews were conducted with 9 community-based participants who reported moderate to high levels of fear of falling.

Results. Most participants did not fear falling until they had experienced a fall themselves. The fear of falls was described as a negative experience, often linked with incapacitation, fear of dependence and having to leave their home. Participants chose to avoid falls by ‘taking care’. Five themes emerged from data analysis: activity levels; view of the future; perceptions of fall experiences; fall avoidance; and development of fear of falls.

Conclusions. The results indicated that factors other than a fear of falling resulted in a restriction of activities for these participants; therefore, it cannot be assumed that a fear of falls alone results in reduction of activity. Fear of falls, in combination with other potential issues that could restrict activities, should be taken into account in the development of fall-prevention programs in order to ensure clients' needs are being met.     

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.