Abstract
Recently hospitalized older people are at risk of falls and face barriers to undertaking fall prevention strategies after they return home from hospital. The authors examined the effects of tailored education delivered by physiotherapists on the knowledge (capability) and the motivation of older people to engage in fall prevention after hospital discharge. Utilizing data gathered from a recent trial, data was analyzed from 390 people who were 60 years and over without impaired cognition (>7/10 abbreviated mental test score) and discharged from three Australian hospitals. Motivation and capability were measured at baseline in the hospital and at 6-months after hospital discharge by blinded assistants using structured surveys. Bivariate analysis using generalized linear modeling explored the impact of education on the capability and motivation. Engagement in fall prevention strategies was entered as an independent variable during analysis to determine associations with capability and motivation. The education significantly improved capability [−0.4, 95% CI (−0.7, −0.2), p < 0.01] and motivation [−0.8, 95% CI (−1.1, −0.5), p < 0.01] compared with social-control at the time of hospital discharge. In contrast, social-control participants gained capability and motivation over the 6-months, and no significant differences were found between groups in capability [0.001, 95% CI (−0.2, 0.2), p = 0.9] and motivation [−0.01, 95% CI (−0.3, 0.3), p = 0.9] at follow-up. Tailored fall prevention education is recommended around hospital discharge. Participants still needed to overcome barriers to falls prevention engagement post hospitalization. Thus, tailored education along with direct clinical services such as physiotherapy and social supports is warranted for older people to avoid falls and regain function following hospitalization.
Highlights
The problem of falls and associated ongoing costs for healthcare are recognized to be serious among older people who have recently been discharged home from hospital [1, 2]
There were no significant differences in characteristics between the two groups (Table 1)
Education group participants maintained capability and motivation when surveyed at the 6-month follow-up (T3), whereas, those in control gained capability and motivation during their post hospitalization recovery at home, leading to no significant differences between education and control groups at 6-months (T3)
Summary
The problem of falls and associated ongoing costs for healthcare are recognized to be serious among older people who have recently been discharged home from hospital [1, 2]. Reduced knowledge about falls risks and low motivation affect the engagement of older people in fall strategies, such as exercise [12, 13] To address this need, we recently implemented a novel education program that was designed based on the COM-B model [14]. We recently implemented a novel education program that was designed based on the COM-B model [14] It aimed to reduce falls in older people by encouraging uptake of fall prevention strategies once they returned home from hospital. It is important to evaluate the constructs of the model that underpinned the education program which may help to explain the lack of uptake of falls prevention behavior in these people. It may assist in the refinement of the education program for future use
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