Four Smart Steps: Fall Prevention for Community-Dwelling Older Adults.

Aim: This case study reports on the planning and implementation of a fall risk assessment and prevention activity for older adults offered in multiple community settings by health professional faculty and students. Background: In the US, the percentage of adults 65 and older who fell was more than 29% in 2018. Among states, Arkansas ranks 48th with 35.2% of older adults reporting a fall (CDC Behavioral Risk Factor Surveillance System, 2018). The desired outcomes of the interprofessional service learning (SL) project were to (1) Improve student understanding of and satisfaction with interdisciplinary learning, (2) Increase the number of older adults assessed for fall risk, (3) provide personalized fall prevention interventions, and (4) Increase uptake of fall prevention strategies by older adults. Methods: Four senior centers in Northwest Arkansas hosted a fall prevention awareness day planned and implemented by faculty in the departments of nursing, public health, physical therapy, exercise science, dietary, and social work in two universities. Materials from the Centers for Disease Control and Prevention (CDC) Stopping Elderly Accidents Deaths and Injuries (STEADI) initiative were used to train students as part of a SL opportunity. Results: Students completed fall screenings, risk assessments, and referrals on 49 older adults in the four senior activity and wellness centers. Conclusions: Based on our experience, an interprofessional education (IPE) activity focused on fall prevention in older adults is feasible. We recommend planning for the event far enough in advance that the experience can be included in the curriculum for students in the various disciplines. We also recommend that students be actively involved in the planning and implementation of the event.

Background/Objectives: Falls in nursing homes significantly affect residents' health and quality of life. Although considerable progress has been made in fall prevention strategies in acute care settings and community environments, research on fall risk assessment methods and prevention strategies in nursing homes remains scarce. Nursing homes provide long-term care for residents with high levels of dependency, presenting unique challenges in managing fall risks. Nevertheless, unlike hospitals, nursing homes face operational constraints, such as limited resources and staffing. These factors necessitate a tailored approach to fall risk management. This study aimed to summarize the current knowledge of fall risk assessment and prevention methods in nursing homes, clarify practical insights for implementation, and identify research gaps based on studies published over the past five years. Methods: This narrative review targeted studies published between 2019 and 2024 on fall risk assessment and prevention methods in nursing homes. A literature search was conducted using the PubMed and CINAHL databases, combining keywords such as "Accident Prevention", "Fall Risk Assessment", "Nursing Homes", "Long-Term Care", and "Aged". The inclusion criteria allowed the inclusion of peer-reviewed academic articles on fall risk assessment or prevention interventions in long-term care facilities published in English within the past five years. Studies focusing on community-dwelling older adults, hospitalized older adults, and review articles were excluded. Results: This review analyzed 55 studies; among them, 27 studies focused on fall risk assessment and 28 focused on fall prevention. Regarding fall risk assessment, widely used tools, such as the Morse Fall Scale, which is also utilized in medical settings, have been extensively examined. In addition, new predictive methods utilizing electronic health records (EHR) and wearable devices have been introduced. However, the limited number of reports highlights the potential challenges in developing indicators that consider the unique characteristics and feasibility of LTC facilities. Regarding fall prevention, studies have examined indirect approaches, such as environmental modifications, and direct interventions, such as exercise programs. Furthermore, staff education and organizational initiatives are crucial in implementing preventive measures. However, most studies have been conducted in experimental settings, with limited empirical research available to assess the practical applications of these strategies in real-world nursing home environments. Conclusions: Fall risk assessments in nursing homes lack practical indicators tailored to the specific characteristics of long-term care facilities. Although various digital technologies have been explored for fall prevention, empirical studies that validate their real-world applicability are lacking.

Background: Community-dwelling older adults' falls represent a significant public health problem, and prevention is an important step to reducing healthcare costs and improving older adult's quality of life. According to Kochera (2002), 78% of all injuries that occurred from elderly falls happened in the community. Despite the fact that community-dwelling older adults have a higher risk for falls, there is less focus on fall prevention for this group. With the shift in the models of healthcare delivery from institutional to community settings; it is imperative that clinicians begin to understand fall prevention from the views of community-dwelling older adults. This project explored the perspectives of fall experience from five community-dwelling older adults to gain in-depth understanding of their views and experiences. Methods: This qualitative descriptive project utilized face-to-face semi-structured interview with probes to explore the views of five community-dwelling older adults who have experienced a fall within the last 12 months. A six-phase process of thematic analysis was used to guide data analysis and generation. Results: 31 codes that were collated into seven themes described participants' perceived etiology of falls and the implication for perceived quality of life following their fall experiences. Strength and Limitations: This project provides additional information that can be shared with clinicians in community settings to continue the dialogue and strengthen fall prevention and reduction strategies for community-dwelling older adults, finding should be interpreted in light of the small sample size. Significance and Implications: The study confirmed some existing evidence on the etiologies of community-dwelling older adult's falls and perceived quality of life about their experience of falls. It also offers new information about community-dwelling older adult's perception of the causes of their falls along with their perceived quality of life.

IntroductionFall rates and fall-related injuries among community-dwelling older adults (≥65 years) are expected to increase rapidly, due to the aging population worldwide. Fall prevention programs (FPPs), consisting of strength and balance exercises, have been proven effective in reducing fall rates among older adults. However, these FPPs have not reached their full potential as most programs are under-enrolled. Therefore, this study aims to identify promising strategies that promote participation in FPPs among community-dwelling older adults.MethodsThis is an exploratory qualitative study. Previously, barriers and facilitators for participation in FPPs by older adults had been identified. Next, six strategies had been designed using the Intervention Mapping approach: (1) reframing; (2) informing about benefits; (3) raising awareness of risks; (4) involving social environment; (5) offering tailored intervention; (6) arranging practicalities. Strategies were validated during semi-structured interviews with community-dwelling older adults (n = 12) at risk of falling. Interviews were audio-recorded, transcribed, and analyzed following a qualitative thematic methodology, with a hybrid approach.ResultsAll strategies were considered important by at least some of the respondents. However, two strategies stood out: (1) reframing ‘aging’ and ‘fall prevention’: respondents preferred to be approached differently, taking a ‘life course’ perspective about falls, and avoiding confronting words; and (2) ‘informing about benefits’ (e.g., ‘living independently for longer’); which was mentioned to improve the understanding of the relevance of participating in FPPs. Other strategies were considered important to take into account too, but opinions varied more strongly.DiscussionThis study provides insight into potential strategies to stimulate older adults to participate in FPPs. Results suggest that reframing ‘aging’ and ‘fall prevention’ may facilitate the dialogue about fall prevention, by communicating differently about the topic, for example ‘staying fit and healthy’, while focusing on the benefits of participating in FPPs. Gaining insight into the strategies’ effectiveness and working mechanisms is an area for future research. This could lead to practical recommendations and help professionals to enhance older adults’ participation in FPPs. Currently, the strategies are further developed to be applied and evaluated for effectiveness in multiple field labs in a central Dutch region (Utrecht).

To the Editor: Nearly one-third of community-dwelling older adults aged 65 and older fall each year, and about 10% of these falls result in a serious injury, rendering falls a common and potentially devastating health problem.1 Cognitive assessments are currently a part of the multi-factorial fall risk assessment recommended by the American and British Geriatric Societies’ Clinical Practice Guideline for Prevention of Falls in Older Persons;2 however, there is a need for reliable, valid and time-efficient screening tools. The aim of this study was to determine whether a brief, telephone-administered screening for dementia, the Memory Impairment Screen by Telephone (MIS-T),3 could be used to determine fall risk over one year in a large sample of community-dwelling older adults.

A third of community-dwelling adults over the age of 65 years fall each year, making falls a significant concern for the elderly. Older people living in community-dwellings account for 73% of fall-related hospitalisations in older populations. Little is known about identifying, reaching at-risk people, and delivering these interventions in rural communities. Our aim was two-fold. To test the utility of a student-led program in identifying community-dwelling elderly people at high risk for falls in a rural and remote setting. To determine client satisfaction with the falls prevention program. Rural and remote community settings in Queensland, Australia. Forty community-dwelling older adults from the MMM 4 and 6 regions. This pilot study utilised a cross-sectional design and convenience sampling approach. A validated falls risk self-reported checklist and a screening checklist for general practitioners were used to identify older adults at risk of falling. During the home visit, participants were assessed for their cognition, balance and home safety. A client satisfaction survey was completed via telephone 3 months following the home visits. Several risk factors for falls were identified, including unsafe use of equipment, absence of Medi alerts, insufficient supervision, lack of support, inappropriate footwear, behavioural concerns and environmental hazards. Most participants reported that the home assessment was valuable and made their homes safer. An innovative student-led placement model has the potential to provide much-needed access to falls prevention services and minimise falls among community-dwelling older adults in rural and remote locations.

BackgroundFalling has high incidence and reoccurrence rates and is an essential factor contributing to accidental injury or death for older adults. Enhancing the participation of community-dwelling older adults in fall-prevention programs is crucial. Understanding fall-prevention beliefs will be beneficial for developing a community-based fall-prevention program. The aim of the present study was to identify the distinct types of subjective views on the fall-prevention beliefs of community-dwelling older adults aged 80 years and older by applying the Q method.MethodsThe Q method was adopted to investigate the pattern of perception on fall-prevention beliefs. Forty-two older adults aged 80 − 92 years from a community care center in Northern Taiwan were recruited and requested to complete a Q-sorting. A series of Q-sorts was performed by the participants to rank 30 statements into a normal distribution Q-sort grid. The Q-sorts were subjected to principal component analysis by using PQMethod software Version 2.35.ResultsFour statistically independent perspectives were derived from the analysis and reflected distinct viewpoints on beliefs related to fall prevention. Participants in the Considerate perspective believed that health problems caused by falling were serious and fall prevention could decrease the burden they place on their family. Participants in the Promising perspective believed that existing health problems could cause a fall and that fall prevention contributed to their well-being. Participants in the Adaptable perspective perceived low barriers to execute fall prevention and displayed self-confidence and independence in preventing falls. Participants in the Ignorance perspective believed that they could not prevent falls and perceived barriers to fall prevention.ConclusionsBy combining theoretical constructs and the Q methodology approach, this study identified four distinct perspectives on fall prevention among community-dwelling older adults. Critical reflection on older adult personal perspectives and interpretations of the required responsive approach is a key element for appropriating fall-prevention support.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0307-1) contains supplementary material, which is available to authorized users.

PurposeFalls and frailty in the older adults are a considerable public health and socioeconomic problem. Physical activity has an important role in delaying degenerative ageing processes and preserving the neuromuscular system’s plasticity. Multicomponent exercise programmes could improve strength (stability), balance, mobility (flexibility) and walking speed; especially if they are carried out for at least some extend of time. Exercise programmes for fall and frailty prevention in community-dwelling older adults should include muscle performance, balance challenging and functional exercises. Slovenia has a long tradition of implementing community organized and structured exercise programmes in Health promotion centres and Healthy clubs. We are establishing new approach of frailty and falls prevention in our elderly population.Project descriptionWith the collaboration of professionals in the field of sport recreation, health and fitness we constructed new exercise approach called vAdBeCeDa®. According to the WHO guidelines of physical activity and sedentary behaviour and the latest World guidelines for fall prevention and management for older adults, the programme is an addition to the existing Slovenian functional exercise programme called Health Promoting Sport Program ABC®. ABC programme focused especially on developing strength in fundamental movement patterns and influencing aerobic capacity. The supplement includes warm-up exercises adapted to the specific needs and functional status of the elderly, progressive balance-training programme for 12 training units and a set of static stretching exercises with support, due to poor balance. Functional and physical fitness is assed pre and post intervention with Slovenian version of senior fitness test (Jakovljević & Knific, 2015). Programme will be implemented in existing network of Health promotion centres (HPC) and in Healthy clubs (HC) all over the country, where all elderly population could practice on the Slovenian health insurance costs.ConclusionsThe results from many longitudinal studies on effects of multicomponent exercise programmes are encouraging, given that maintenance of physical fitness has a successful, prolonged effect on fall and frailty prevention in older adults. All countries should pursue a lifelong physical activity for elderly, which is achievable with community approach and good collaboration between health and sport sector.

To evaluate the impact of implementing an evidence-based fall prevention intervention in community senior centers. We used a single-group design to evaluate the Tai Ji Quan: Moving for Better Balance (TJQMBB) program's adoption, population reach, implementation, effectiveness, and maintenance among 36 senior centers in 4 Oregon counties between 2012 and 2016. The primary outcome measure, as part of the effectiveness evaluation, was number of falls as ascertained by self-report. Trained TJQMBB instructors delivered the program to community-dwelling older adults for 48 weeks, with a 6-month postintervention follow-up. TJQMBB was adopted by 89% of the senior centers approached and reached 90% of the target population. The program resulted in a 49% reduction in the total number of falls and improved physical performance. Participation was well maintained after the program's completion. The average cost-effectiveness ratio for the 48-week program implementation was $917 per fall prevented and $676 per fall prevented for multiple falls. TJQMBB is an effective public health program that can be broadly implemented in community senior centers for primary prevention of falls among community-dwelling older adults.

Falls and fall-related injuries in community-dwelling older adults are a growing global health concern. Despite effective exercise-based fall prevention programs (FPPs), low enrollment rates persist due to negative connotations associated with falls and aging. This study aimed to investigate whether positive framing in communication leads to a higher intention to participate in an FPP among community-dwelling older adults. We conducted a two-sequence randomized crossover study. We designed two flyers, a standard flyer containing standard terminology regarding FPPs for older adults, and a reframed flyer highlighting fitness and activity by reframing 'fall prevention' as an 'exercise program' and 'old' as 'over 65 years'. With a Mann-Whitney U test, we investigated group differences regarding the intention to participate between the flyers. A sensitivity analysis and subgroup analyses were performed. We conducted qualitative thematic analysis on open-ended answers to gain a deeper understanding of participants' intention to participate. In total, we included 133 participants. Findings indicated a significantly higher intention to participate in the reframed flyer (median = 4; interquartile range = 1-6) compared to the standard flyer (median = 2; interquartile range = 1-4) (p = 0.038). Participants favored more general terms such as 'over 65 years' over 'older adults'. Older adults who were female, not at high fall risk, perceived themselves as not at fall risk, and maintained a positive attitude to aging showed greater receptivity to positively-framed communications in the reframed flyer. Additionally, already being engaged in physical activities and a lack of practical information about the FPP appeared to discourage participation intentions. The results in favor of the reframed flyer provide practical insights for designing and implementing effective (mass-)media campaigns on both (inter)national and local levels, as well as for interacting with this population on an individual basis. Aging-related terminology in promotional materials hinders engagement, underscoring the need for more positive messaging and leaving out terms such as 'older'. Tailored positively framed messages and involving diverse older adults in message development are essential for promoting participation in FPPs across various population subgroups to promote participation in FPPs among community-dwelling older adults.

The prevalence of falls among older adults living in the community is ~30% each year. The impacts of falls are not only confined to the individual but also affect families and the community. Injury from a fall also imposes a heavy financial burden on patients and their families. Currently, there are different reports on the risk factors for falls among older adults in the community. A retrospective analysis was used in this study to identify risk factors for falls in community-dwelling older adults. This research aimed to collect published studies to find risk factors for falls in community-dwelling older adults. We searched for literature from the founding of PubMed, EMBASE, the Cochrane Library, the Web of Science, the China National Knowledge Infrastructure (CNKI), the China Science and Technology Periodicals Database (VIP), and the Wanfang database until September 2022. The studies were selected using inclusion and exclusion criteria. We collected information from relevant studies to compare the impact of potential risk factors such as age, female gender, fear of falling, history of falls, unclear vision, depression, and balance disorder on falls among community-dwelling older adults. A total of 31 studies were included with 70,868 community seniors. A significant risk factor for falls in the community of older adults was dementia (2.01, 95% CI: 1.41-2.86), age (1.15, 95% CI: 1.09-1.22), female gender (1.52, 95% CI: 1.27-1.81), fear of falling (2.82, 95% CI: 1.68-4.74), history of falls (3.22, 95% CI: 1.98-5.23), vision unclear (1.56, 95% CI: 1.29-1.89), depression (1.23, 95% CI: 1.10-1.37), and balance disorder (3.00, 95% CI: 2.05-4.39). This study provides preliminary evidence that falls among community-dwelling older adults are associated with factors such as age, female gender, fear of falling, history of falls, unclear vision, depression, and balance disorders. The results of this research may help improve clinician awareness, risk stratification, and fall prevention among community-dwelling older adults. identifier INPLASY2022120080.

The Fall Prevention Center of Excellence designed three progressive-intensity fall prevention program models, Increasing Stability Through Evaluation and Practice (InSTEP), to reduce risk in community-dwelling older adults. Each model included physical activity, medical risk, and home safety components and was implemented as a 12-week program for small class sizes (12-15 people) in community and senior centers. Change in fall rates and fall risk factors was assessed using a battery of performance tests, self-reports of function, and fall diaries in a 3-group within-subjects (N = 200) design measured at baseline, immediately postintervention, and at 3 and 9 months postintervention. Overall, participants experienced a reduction in falls, improved selfperception of gait and balance, and improved dynamic gait function. The medium-intensity InSTEP model significantly (p = .003) reduced self-reported falls in comparison with the other models. InSTEP is a feasible model for addressing fall risk reduction in community-dwelling older adults.

The Fall Prevention Center of Excellence designed three progressive-intensity fall prevention program models, Increasing Stability Through Evaluation and Practice (InSTEP), to reduce risk in community-dwelling older adults. Each model included physical activity, medical risk, and home safety components and was implemented as a 12-week program for small class sizes (12–15 people) in community and senior centers. Change in fall rates and fall risk factors was assessed using a battery of performance tests, self-reports of function, and fall diaries in a 3-group within-subjects (N = 200) design measured at baseline, immediately postintervention, and at 3 and 9 months postintervention. Overall, participants experienced a reduction in falls, improved self-perception of gait and balance, and improved dynamic gait function. The medium-intensity InSTEP model signifcantly (p = .003) reduced self-reported falls in comparison with the other models. InSTEP is a feasible model for addressing fall risk reduction in community-dwelling older adults.

We attempted to determine whether multimedia fall prevention education using different instructional strategies increases older adults' knowledge of fall threats and their fall prevention behaviors. Fifty-three community-dwelling older adults were randomized to iwo educational groups or a control group. Multimedia-based educational interventions to increase fall threats knowledge and encourage fall prevention behaviors had two tailoring strategies: (1) improve content realism for individual learners (authenticity group) and (2) highlight program goals and benefits while using participants' content selections (motivation group). Knowledge was measured at baseline and 1-mo follow-up. Participants recorded prevention behaviors for 1 mo. Intervention group participants showed greater knowledge gains and posttest knowledge than did control group participants. The motivation group engaged in more prevention behaviors over 1 mo than did the other groups. Tailoring fall prevention education by addressing authenticity and motivation successfully improved fall threats knowledge. Combining motivational strategies with multimedia education increased the effectiveness of the intervention in encouraging fall prevention behaviors.

Persons living with dementia have an elevated risk of falling and chronic pain. This study investigates the relationship of pain medication use with falls among community-dwelling adults based on their cognitive status. We analysed a nationally representative sample of community-dwelling Medicare beneficiaries (n = 7,491) who completed cognitive assessments used for dementia classification in the 2015US National Health and Aging Trends Study. We performed survey-weighted logistic regression to investigate differential associations between pain medication use and a recent fall by cognitive status: no dementia, possible dementia and probable dementia, controlling for sociodemographic and health characteristics. About 16.5% of the analytic sample was classified as possible dementia (8.3%) and probable dementia (8.2%). Pain medication use was associated with a recent fall among those with probable dementia [odds ratio (OR) = 1.86, 95% confidence interval (CI): 1.14, 3.03], controlling for sociodemographic and health characteristics. Taking medication for pain 2 days a week or more (OR = 2.14, 95% CI: 1.20, 3.81) was associated with falls among those with probable dementia. Bothersome pain and worry about falling down were also associated with falls among participants with no dementia and possible dementia, respectively. Differential risk factors for falls by cognitive status imply the need for tailored pain management and fall prevention strategies. The provision of fall prevention programmes stressing balance training and medication use is important regardless of cognitive status in community-dwelling older adults. Future research should explore other modifiable factors associated with the risk of falls among community-dwelling adults.