Development of a fall prevention program for elderly Japanese people

The purpose of this study was to develop a fall prevention program adapted to the individual risks of elderly patients in a long‐term care facility by increasing the caregiving skills and motivation of the staff members. The fall prevention program was created by synthesizing information based on evidence‐based practice and action research methodology was chosen to complete the development of the program. There were 31 participating patients in the intervention ward and 20 patients in the control ward. The Generalized Self‐efficacy Scale and the Social Support Scale were used to evaluate fall prevention skills the motivation of the staff members. The fall prevention program helped to reduce injuries from 41.9% to 9.7% among the elderly participants and to increase emotional support and self‐efficacy among the staff members. Empowerment was considered to be a driving force. The fall prevention program was shown to be acceptable for use among elderly individuals in a long‐term care facility.     

Preventing falls in acute care: an innovative approach

Falls among elderly individuals have been significant sources of disability and death. Falls have affected as many as 10% of older adults during an acute care inpatient stay. The acute care environment has contributed to elderly patient falls. Additionally, manifestations of acute illness, polypharmacy, and medication side effects have been risk factors for falls in the acute care setting. Individualized fall prevention strategies, initial patient assessments, and ongoing patient reassessments have been linked to a decrease in falls in the acute care setting. Approaches to fall prevention have included identification of high-risk patients, communication among staff and family members about an individual's risk of falls, and both case-specific and universal interventions for fall prevention. The purpose of this article is to describe a fall prevention program instituted in an acute care setting in southern Arizona that has produced encouraging results. Moreover, this article addresses individualizing interventions through a continuous clinical feedback loop, which provides patient care areas with relevant information about their patients who fell and recommendations for improving fall prevention.     

计划行为理论在老年患者跌倒健康教育中的应用效果

目的 探讨计划行为理论在老年患者跌倒健康教育中的应用效果。 方法 选取在我院老年科住院的老年患者258例,采用随机数字表法将患者随机分为对照组和干预组各129例。对照组给予常规预防跌倒护理,干预组应用预防计划行为理论预防老年患者跌倒。分别于干预前及干预4周后,应用护理结局分类指标评价2组患者干预前后各项行为得分。 结果 干预4周后,干预组患者跌倒预防护理结局得分优于对照组(P＜0.001)。 结论 计划行为理论能有效改善老年患者预防跌倒健康教育效果。     

Development of an exercise program for fall prevention for elderly persons in a long-term care facility

Aim: The purpose of this study was to develop an exercise program for elderly individuals in a long‐term care facility. Developed through the synthesis of evidence‐based nursing with the use of available research related to falls and exercise, the program was designed to increase balance, mobility, and muscle strength in the lower extremities in order to prevent falls and improve the self‐efficacy of the patients. Methods: We developed an exercise program consisting of a warm‐up, static stretching, muscle strengthening in the lower extremities, toe exercises, proprioceptive neuromuscular facilitation, and cool‐down. The study design was a prospective clinical trial. The intervention period was 3 months, with the outcomes measured before and after intervention and 3 months after cessation of the intervention. The 30 participants were elderly residents of a long‐term care facility, 16 of whom were in the intervention group and 14 of whom were in the control group. The outcome values were mobility, muscle strength in the lower extremities, postural sway, fall efficacy, and the number of fallers and falls. The Friedman test was used to analyze the effectiveness of the outcomes. Results: The intervention group showed increased balance, maintained mobility, and showed a decreased number of fallers and falls, although the muscle strength and fall efficacy did not increase. No training‐related medical problems occurred. Conclusion: The exercise program was shown to be acceptable to use for the prevention of falls among elderly individuals in a long‐term care facility.     

Insight: a mental health prevention intervention

Modern health care systems are grasping the financial benefit of illness prevention programs. In mental illness prevention, psychiatric and mental health nurses are challenged to demonstrate efficacy in meeting the needs of the public and maintaining its position as one of the core mental health professions. The Center of Advanced Nursing Practice's Evidence-Based Practice Model provided the framework for guiding a pilot study intervention program, Insight, that facilitated a depression prevention program for women by an advanced practice nurse. Preliminary findings support the efficacy of Insight in a community setting and with program modifications.     

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.     

A feasible method to enhance and maintain the health of elderly living in long-term care facilities through long-term, simplified tai chi exercises

Practicing Tai Chi offers the potential to enhance the physical and mental health of older adults. Identifying a feasible way to encourage regular Tai Chi practice is essential if Tai Chi is to be promoted as a long-term, daily activity for elderly care facility residents. The purpose of this study was to test the effectiveness and feasibility of using an audiovisual, simplified Tai Chi exercise module to enhance and maintain the health of long-term care facility residents. A quasi-experimental, one-group, time-series design was used. Data were collected six times (twice before the intervention; four times after intervention started) at three-month intervals. Fifty-one elderly male subjects were recruited by convenience sampling. A 50-minute Simplified Tai-Chi Exercise Program (STEP) was implemented in two small groups three times a week for 12 months. During the first six-month period, participants received guidance from an actual instructor. During the second six-month period, guidance was delivered via a video tape and displayed on a television screen. Results indicated that participants' physical health (cardio-respiratory function, lower body flexibility, and hand-gripping strength) and mental health (quality of sleep) had both improved significantly six months after intervention started, with improvements maintained throughout the end of the 12-month study (all p values < .05). Instructor-led STEP training followed by practice using appropriate audiovisual aids represents a feasible and effective method to implement a long-term activity program in long-term elderly care facilities.     

The POWERPLAY workplace physical activity and nutrition intervention for men: Study protocol and baseline characteristics

Many health promotion programs hold little “manly” appeal and as a consequence fail to influence men's self-health practices. That said, the workplace can provide an important delivery point for targeted health promotion programs by supporting positive aspects of masculinity. The purpose of this article is to, a) describe the intervention design and study protocol examining the feasibility of a gender-sensitive workplace health promotion intervention focusing on physical activity and healthy eating in male-dominated rural and remote worksites, and b) report baseline findings. This study is a non-randomized quasi-experimental intervention trial examining feasibility and acceptability, and estimated intervention effectiveness. The POWERPLAY program was developed through consultations with men and key workplace personnel, and by drawing on a growing body of men's health promotion research. The program includes masculine print-based messaging, face-to-face education sessions, friendly competition, and self-monitoring concerning physical activity and healthy eating. Male participants (N = 139) were recruited from four worksites in northern British Columbia, Canada. Baseline data were collected via computer assisted telephone interview (CATI) survey which assessed physical activity, dietary behavior and workplace environment. This protocol will also be used to collect follow-up data at 6 months. A process evaluation, using semi-structured interviews, will be undertaken to assess feasibility and acceptability among participants and worksites. Study outcomes will guide intervention refinement and further testing in a sufficiently powered randomized control trial.     

Effects of a Community-based Fall Prevention Exercise Program on Activity Participation

This study was conducted to identify the effects of a fall-prevention exercise program on the participation and static balance of elderly persons in daily life roles. [Subjects] Ten participants over 65 years of age (75.29±2.93) who were healthy community-dwellers (two men and eight women) were recruited. [Methods] The participants exercised three times a week for eight weeks. The exercise program was based on the fitness and mobility exercise (FAME) protocol. The outcome measures were changes in activity participation level and the fall index. [Results] After the exercise, the activity participation level significantly increased, and the fall index significantly decreased. [Conclusion] A fall prevention exercise program can have a positive effect on participation and static balance in older adults.Key words: Exercise, Fall, Participation     

Addressing Depression in a Long-term Care Setting: A Phase II Pilot of Problem-solving Treatment

PurposeThis was a Phase II pilot study of a problem-solving treatment (PST) to address subsyndromal depression in residents of long-term care facilities. Our goal was to demonstrate PST implementation feasibility and to identify PST’s potential for reducing depressive symptoms in this geriatric health care setting.MethodsEligible participants were randomized to receive a PST treatment (six 1-hour sessions) or a social contact comparison (6 “friendly” visits) after an initial baseline assessment. Follow-up assessments occurred 7 weeks later (after treatment) and 2 months posttreatment. The basic analytic approach was based on an intention-to-treat analysis.FindingsWe enrolled 21 elderly subjects in the PST group and 16 elderly subjects in the social contact comparison group. The PST group experienced a decline in depression scores compared with the social contact group. Although not statistically significant (likely due to the small sample size), PST was associated with decreased depressive symptom scores for those who were able to complete the intervention. Implementation proved to be difficult in terms of study recruitment and intervention acceptance and adherence.ImplicationsThese study findings point to the potential benefits of an integrated mental health component in long-term care, involving rehabilitation professionals who are already working with the older adults in both postacute/short-stay and long-stay settings.     

Mitigating fall risk: A community fall reduction program

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

Sensible treatment of obesity in rural youth (STORY): design and methods

Project STORY is a 3-arm, randomized, planning and feasibility study assessing the effectiveness of two behavioral weight management interventions in an important and at-risk population, overweight children and their parents in medically underserved rural counties. Participants will include 90 parent-child dyads from rural counties in north central Florida. Families will be randomized to one of three conditions: (a) a Family-Based Behavioral Group Intervention, (b) a Parent-Only Behavioral Group Intervention, and (c) a waitlist control condition. Child and parent participants will be assessed at baseline (month 0), post-treatment (month 4) and follow-up (month 10). Assessment and intervention sessions will be held at Cooperative Extension offices within each local participating county. The primary outcome measure is change in child body mass index (BMI) z-score. Additional key outcome measures include child dietary intake, physical activity, self-esteem, body image, and parent BMI. The goals of the study are to (a) assess the feasibility of recruitment in rural settings, (b) develop and evaluate training protocol for group leaders, (c) determine strategies to increase adherence to monitoring and goal setting protocol, (d) evaluate strategies for participant retention, (e) assess the relative cost-effectiveness of the interventions, (f) assess the acceptability of the intervention to families and Cooperative Extension administrators and personnel, and (g) if successful, estimate the sample size needed for a full-scale trial. This research has potential implications for medically underserved rural communities with limited resources and preventive health care services. If successful, a Parent-Only intervention program may provide a cost-effective and practical intervention for families in underserved rural communities.     

Oral health 4 life: Design and methods of a semi-pragmatic randomized trial to promote oral health care and smoking abstinence among tobacco quitline callers

Smokers are at high risk for oral disease. As a result, they represent an important target group for population-level, public oral health promotion efforts. While dental health professionals often address smoking with their patients, no systematic efforts have been made to offer smokers an intervention to improve their use of oral health care. This paper details the rationale, design, and methods of a large, semi-pragmatic, randomized clinical trial designed to address this gap. Participants are recruited via the Oregon, Nebraska and Louisiana state-sponsored tobacco quitlines and randomized to receive standard quitline care versus standard care plus a multi-modal oral health promotion program (Oral Health 4 Life) integrated within the quitline services. All participants are followed for 6 months to assess the impact of the intervention on smoking abstinence and utilization of professional dental care. In addition, the study will assess the cost of the intervention and provide practical guidance to states on whether the intervention is financially feasible to implement, should the intervention be effective. This study protocol may be useful to others interested in promoting oral health among smokers, those interested in partnering with tobacco quitlines to extend standard services to address other high risk health behaviors among smokers, or those interested in semi-pragmatic trial design.     

Prevention, detection and intervention with delirium in an acute care hospital: a feasibility study

Background. The prevalence of delirium in acute care hospitals ranges from 5–86%. Delirious patients are at greater risk of negative health outcomes and their care is often more costly. Aim. To determine the feasibility of a full‐scale trial to test the effectiveness of an intervention designed to improve delirium prevention, detection and intervention in an acute care hospital. Design. A delirium prevention protocol was designed by an interdisciplinary group of clinicians and implemented on intervention unit patients who passed a mental status screen, were at high risk for delirium according to the modified NEECHAM scale, and met other eligibility criteria. These patients were reviewed at daily interdisciplinary team meetings and team recommendations were placed in the patient’s chart. On the usual care unit, physicians were notified if their patients were at high risk, but the delirium protocol was not implemented. Methods. The delirium protocol was pilot tested with 35 high risk patients on an Acute Care for Elders (ACE) unit. Outcomes were compared to 35 high risk patients on a similar medical unit without the delirium protocol. Results. The main outcome examined whether there is a difference in average day 3 modified NEECHAM scores comparing the intervention and control groups. The mean modified NEECHAMs on day 3 were not statistically significantly different (intervention group 3.76 and control group 3.24) (P= 0.368). Baseline NEECHAM scores did not correlate well with development of delirium (P = 0.204). A history of confusion during a previous hospitalization was the strongest predictor of developing delirium during the current hospitalization. Conclusion. This pilot study was not powered to detect an effect of the intervention, however, feasibility for a fully powered trial was established. Relevance to clinical practice. Completion of the NEECHAM screen every shift was not considered burdensome for either nurses or patients and may help identify acute delirium.     

A failed fall prevention study in an acute care setting: Lessons from the swamp

Designing and implementing fall intervention studies in acute care settings presents researchers with a number of challenges. To date, there are no fall prevention interventions that have unequivocal empirical support in these settings. Based on the best available evidence a multistrategy fall prevention program was implemented using a pretest-post-test design over a 12-month period. The results indicated no reduction in the fall rate. Contrary to the expected result, the fall rate increased post the implementation of the multistrategy fall prevention program. To assist other researchers understand the contextual and methodological barriers to conducting fall prevention research in acute care settings, this paper discusses the difficulties experienced in this study.     

Developing and testing a self medication protocol in the acute environment.

This study aimed to develop and test strategies, and demonstrate the feasibility and desirability of a self-medication program in an acute care hospital setting. Ten patients admitted with an acute exacerbation of their asthma were recruited to test the protocol. Although the use of the protocol was more time-consuming than the previous nurse administered process, patients and staff found it worthwhile. The outcome of the study is a protocol that could be used with a larger sample of patients, in the acute environment.     

住院老年患者对跌倒认知的质性研究

目的了解住院老年患者对跌倒的认知情况,为制定针对性的护理措施提供依据。方法采取目的抽样法于2011年11月至2012年4月选择在北京市某三级甲等医院干部病房、内分泌科和神经内科住院的16例老年患者为研究对象,进行半结构式深入访谈,访谈提纲包括患者的一般资料以及关于跌倒认知的问题,现场录音,按现象学研究的方法整理分析资料。结果通过阅读、分析、反思和分类,提炼出4个主题：（1）住院老年患者普遍认为随着年龄的增长,跌倒发生率日益增高;（2）跌倒事件给老年患者带来身体的伤害和心理的恐惧;（3）住院老年患者对引起跌倒的危险因素和发生跌倒后的处置方法认知不全面;（4）老年患者有各自预防跌倒的方法,但希望护士能够提供更具个性化的健康指导。结论护士应该重视和强化老年患者对跌倒的认知,为住院老年患者提供个性化的健康教育和人性化护理,切实提高预防跌倒的效果。     

Qualitative evaluation of a stress management intervention for elderly caregivers at home: a constructivist approach

The purpose of this project was to evaluate, using a constructivist qualitative design, an individual stress management intervention based on a stress-coping model and intended for family caregivers of elderly persons within the current context of the shift to ambulatory care. This nursing intervention comprised seven weekly encounters with caregivers following their elderly family member's discharge from hospital and a follow-up visit one month after. The aim of the qualitative evaluation was to document the feasibility and acceptability of the content of the intervention, its relevance in terms of process and structure, and the benefits to the principal stakeholders. This action research project was a case study of four participants. The assessment instruments included an intervention analysis grid, a diary, and a semistructured interview guide with the participants. Data analysis drew on Guba and Lincoln's (1989) method which made it possible to refine the intervention. Results underscored that certain implementation conditions must be respected in order to ensure the intervention's acceptability and feasibility. Above all, it must remain flexible and the nurse must possess the requisite clinical skills and theoretical knowledge. It is important also to screen judiciously for caregivers likely to benefit from the intervention. The pertinence of using a circular intervention model rather than a linear approach to stress management was highlighted as well.     

Reducing falls in a Definitive Observation Unit: an evidence-based practice institute consortium project

Fall prevention poses a major challenge to healthcare personnel. Fall prone patients must be accurately identified and staff must adhere to evidence-based practices that have distinct value for preventing falls. This article describes a Definitive Observation Unit (DOU) and its evidence-based fall-prevention protocol based on nationally recognized standards. Despite the adoption of the protocol, fall occurrence rates remained above California Nursing Outcomes Coalition benchmarks. There were variations among nurses, physicians and physical therapists in regard to the value of fall prevention program components such as pre-formatted orders, physical therapy referrals and documentation.This authors report results of a study using an evidence-based practice (EBP) framework for evaluating an interdisciplinary, multifactorial fall prevention protocol. Results indicated that staff champions and resources are essential elements for changing practices that are vital to fall reduction.     

Prevention in occupational health care--a societal challenge]

The metabolic syndrome, increasingly appearing amongst the elderly and recently in younger people with a most sudden increase in the age group < 30 years, is one of the main threats to European health in this century. Early diagnosis is the most efficient way to manage and to prevent metabolic syndrome from developing. Recent studies have convincingly demonstrated that lifestyle intervention, addressing diet and exercise, reduced the risk of developing diabetes and metabolic syndrome. The challenges today are to develop and implement efficient strategies to identify those on risk and to implement prevention management programs for clinical practice. Company medical officers could play an important role while identifying persons with increased risk for the metabolic syndrome, because they are addressing patients and healthy working persons but also reaching persons who normally are not reached by the health-care system. The occupational medical health promotion has the structural requirement to implement preventive intervention also by using its influence to establish healthy workplaces. Implementing managed prevention programs in the occupational medical care setting will enable prevention of the metabolic syndrome without consuming large resources. This process will be challenging and must be sustainable requiring many partners but resulting in a profitable chance for occupational health care.