The Effects of Self-Efficacy-Based Fall Prevention Program among Elderly in Phibunmangsahan Town Municipality, Ubon Ratchathani Province, Thailand

Long-Term Effectiveness of a Multifactorial Fall and Fracture Prevention Program in Bavarian Nursing Homes: An Analysis Based on Health Insurance Claims Data

Falls prevention education between older adults and healthcare providers during transition from hospital to community-living

Falls are a serious global public health issue affecting individuals of all ages, resulting in serious injuries, fatalities, and extended hospital stays. While knowledge and attitude of healthcare staff toward fall prevention are understood to impact patient safety, less well known are the type and content of fall prevention surveys used to identify nurses’ knowledge of fall prevention. Until now, no study has systematically reviewed the universe of existing tests, surveys, and programs used to assess fall prevention knowledge. This systematic review aims to describe existing tests and surveys used to assess the knowledge and attitudes of healthcare staff and nurses regarding fall prevention. Electronic databases PubMed, CINAHL, Scopus, Medline, ScienceDirect, and Psych Info were searched for English articles investigating existing surveys and tests of fall prevention knowledge among healthcare staff from 2005 to August 2024, focusing on studies in healthcare workers working in medical centers, working with adults >65 y.o. Of the 565 studies identified, twelve met the inclusion criteria: eight examined fall prevention knowledge, attitude, self-efficacy tests, and questionnaires among nurses and nursing students, and four examined fall prevention knowledge programs. One study examined the efficacy of a fall prevention program. Across all studies, various types of knowledge/self-efficacy questionnaires were utilized with overlapping content on fall definition, information on falls, teamwork, and reporting falls. Also, the educational studies suggested the importance of using fall prevention programs which include various components: online and in-person lectures, posters, and staff support, highlighting the need for continuous training rather than once for improved results. Overall, understanding the knowledge and attitudes of healthcare staff, especially nurses, toward fall prevention is crucial for improving patient safety and reducing adverse events in healthcare settings. Future research should include an assessment tool that considers all the components of behavioral change and captures all overlapping questions in one questionnaire, as well as including them in frequent training.

This study describes the development and implementation of a large-scale primary fall and fracture prevention programme in Hong Kong and its effect on increasing the awareness and knowledge of fall and fracture prevention among older people. The effect of promotion of community participation is also investigated in the implementation of this primary prevention programme. The programme includes educational seminars, a train-the-trainers programme and a staff training programme. The effect of the educational seminars is shown by the increase in the knowledge and awareness of fall and fracture prevention among these participants (p < 0.01), while that of the train-the-trainers programme and staff-training programme is confirmed by the continuous expansion and continuation of the fall and fracture prevention programme in the community. The experience from this primary prevention programme has given us direction for future implementation of a more comprehensive prevention programme in our community.

Falls and fall-related injury are emerging issues for older Aboriginal people. Despite this, it is unknown whether older Aboriginal people access available fall prevention programs, or whether these programs are effective or acceptable to this population. To investigate the use of available fall prevention services by older Aboriginal people and identify features that are likely to contribute to program acceptability for Aboriginal communities in New South Wales (NSW), Australia. A questionnaire was distributed to Aboriginal and mainstream health and community services across NSW to identify the fall prevention and healthy ageing programs currently used by older Aboriginal people. Services with experience in providing fall prevention interventions for Aboriginal communities, and key Aboriginal health services that delivered programs specifically for older Aboriginal people, were followed up and staff members were nominated from within each service to be interviewed. Service providers offered their suggestions as to how a fall prevention program could be designed and delivered to meet the health and social needs of their older Aboriginal clients. Of the 131 services that completed the questionnaire, four services (3%) had past experience in providing a mainstream fall prevention program to Aboriginal people; however, there were no programs being offered at the time of data collection. From these four services, and from a further five key Aboriginal health services, 10 staff members experienced in working with older Aboriginal people were interviewed. Barriers preventing services from offering appropriate fall prevention programs to their older Aboriginal clients were identified, including limited funding, a lack of available Aboriginal staff, and communication difficulties between health services and sectors. According to the service providers, an effective and acceptable fall prevention intervention would be evidence based, flexible, community-oriented and social, held in a familiar and culturally safe location and delivered free of cost. This study identified a gap in the availability of acceptable fall prevention programs designed for, and delivered to, older Aboriginal people in NSW. Further consultation with older Aboriginal people is necessary to determine how an appropriate and effective program can be designed and delivered. Terminology: The authors recognise the two distinctive Indigenous populations of Australia: Aboriginal and Torres Strait Islander people. Because the vast majority of the NSW Aboriginal and Torres Strait Islander population is Aboriginal (95.4%)1, this population will be referred to as 'Aboriginal' in this manuscript.

Intervention and Documentation Reduce Exposure From Falls

Older adults are often reluctant to engage in fall prevention activities. To understand how older adults respond to fall prevention and identify attributes that affect their responses to fall prevention. Qualitative content analysis of Fall Prevention Motivational Interviewing conversations that were conducted as an intervention for a fall prevention study in the USA. We report the methods, results and discussions using the COnsolidated criteria for REporting Qualitative research checklist. Conversations from 30 participants were analysed. Participants showed various responses to fall prevention from acceptance and engagement to ambivalence to denial or giving up. Three attributes affecting how they responded to fall prevention were as follows: (a) their perception of fall risks, (b) their perception about fall prevention strategies and (c) self-identity. If participants perceived that their fall risks were temporary or modifiable, they were more likely to engage in fall prevention. If participants perceived that their fall risks were permanent or unmodifiable, they seemed to have difficulty accepting fall risks or gave up engaging in fall prevention strategies. Participants were more willing to adopt fall prevention strategies that involved minor adjustments but expressed more resistance to adopting strategies that required major adjustments. Further, their response to accepting or not accepting fall prevention was influenced by their perception of whether the fall risks and fall prevention strategies aligned with their self-identity. Findings underscore the importance of understanding older adults' self-identify and perceptions about fall prevention. Exploring older adults' self-identity and perceptions about fall prevention can be useful to support their engagement in fall prevention.

Purpose: This study investigates the perspectives of rehabilitation therapists on the implementation of fall prevention programmes with community-dwelling stroke survivors in the Singapore context, and elicits recommendations to adapt the Stepping On programme with stroke survivors.Method: Qualitative data were elicited during 4 focus groups with 23 rehabilitation therapists (15 occupational therapists [OTs]; 8 physiotherapists [PTs]) who had received training to deliver the original Stepping On programme, and had experienced delivery of fall-prevention intervention programmes locally. Collected data were analysed using thematic analysis method.Results: Three themes emerged from the focus groups describing: (a) limitations of existing falls prevention intervention for stroke clients; (b) the need to adapt the Stepping On programme to use with stroke clients; and (c) challenges in implementing fall prevention programmes in the stroke context. A series of new components were suggested to be included as part of the Stepping On after stroke (SOAS) programme, including involvement of family members and caregivers, and tailored community reintegration sessions (such as taking public transport and shopping).Conclusions: Rehabilitation therapists describe challenges in addressing fall prevention within a stroke context, and findings highlight the need for a structured, stroke-specific fall prevention programme rather than a more general approach to education and training. Contextual components identified provide valuable inputs towards the development of a culturally relevant fall prevention programme for stroke survivors in Singapore.Implications for RehabilitationStroke survivors living in the community are at a high risk of falls.A structured and culturally relevant fall prevention programme for community-living stroke survivors is needed.Falls prevention for community-living stroke survivors should be multi-dimensional and targeting the modifiable risk factors for falls in this group.Both stroke survivors and caregivers should be involved in any fall prevention after stroke programmes.

Stroke outpatients have a high risk of falling. However, fall prevention measures in the community are insufficient to effectively reduce the fall rate among outpatients with stroke. We aimed to determine the correlation between fall prevention knowledge and behavior among outpatients with stroke and provide new strategies for community fall prevention. We recruited 124 patients with stroke who were followed up in the outpatient department of a tertiary hospital in Zhuhai, China. Patients were assessed using a general information questionnaire, a fall prevention knowledge questionnaire for patients with stroke, and the Stroke Fall Prevention Behavior Scale. IBM SPSS 22.0 software was used for statistical analysis. The median fall prevention knowledge was 82.76 (68.97, 93.10) points, out of 100. The mean (SD) score for fall prevention behavior was 2.90 (0.52; range, 1-4) points. Fall prevention knowledge scores were positively related to those fall prevention behavior (Spearman r = 0.454, P < .01). Levels of fall prevention knowledge among outpatients with stroke were adequate, and this population had medium to high levels of fall prevention behavior. Better knowledge was accompanied with better prevention of falls. However, whether enriching the knowledge could lead to improvement of fall prevention is still undetermined.

Falls in older people can cause poor quality of life and even death in residential care facilities which has raised the question if an evidence-based practice falls prevention program would have an impact on the incidence of falls and improvement in quality measures in 8 weeks using a self-efficacy scale. An 8-week pilot study was conducted on a long term care unit in a skilled/long term care facility to determine if the confidence and knowledge levels of nursing staff would improve after evidence-based practice fall prevention education. Data was collected using a self-efficacy scale adopted from the IOWA model. Mean confidence levels were determined pre and post survey based on the 17 item questionnaire of a participant sample of 4. Results suggested that there is a significant statistical correlation between the increase in confidence and knowledge of evidence-based fall prevention and the educational intervention, but no correlation to the decrease in fall rate due to changes in decisions of recommended fall prevention interventions. It is argued that the ability to utilize recommended interventions by nursing staff would have allowed for evidence-based practice interventions to be implemented and would have had an impact on the rate of falls. Key Practitioners Message Falls among older people can be life-threating encounters. Healthcare workers in skilled and long-term care facilities can reduce these life threating encounters by fall prevention programs that assist to improve the quality of care and quality of life of the older people they serve. This paper will identify the significance of evidence-based practice measures as it relates to falls prevention, describe the target population and proposal for a falls prevention program for a skilled/long-term care facility, theoretical framework associated with the basis of the falls prevention program, synthesis of literature, practice recommendations, project setting, the mission, vision, and objectives of the project, the project description, project evaluation and data analysis implications for nursing and healthcare, and plans for dissemination.

Effects of a health-belief-model-based osteoporosis- and fall-prevention program on women at early old age

AimFall rates and fall-related injuries among community-dwelling older adults (≥65 years) will likely increase due to the rapidly aging population worldwide. Therefore, fall prevention has become an international priority. Fall prevention programs (FPPs), consisting of strength and balance exercises, have been proven effective in reducing the number of falls among older adults. However, in practice, professionals find it difficult to enroll participants for FPPs. Therefore, this study aims to identify effective strategies that promote engagement in FPPs among older adults.MethodsBased on previously identified barriers and facilitators for participation in FPPs by older adults, six strategies were designed using Intervention Mapping: 1) reframing; 2) informing about benefits; 3) raising awareness of risks; 4) involving social environment; 5) offering tailored intervention; 6) arranging practicalities. Strategies were presented and validated during semi-structured interviews with older adults (n = 12) at risk of falling. Interviews were recorded, transcribed and analyzed following a hybrid qualitative thematic method.ResultsAnalysis showed that reframing 'aging’ and 'fall prevention' is important. Within this strategy, themes emerged related to respondents’ preference to be approached differently, taking a ‘life course’ perspective about falls, and avoiding confronting terms. Furthermore, the strategy 'informing about benefits' (e.g. ‘living independently for longer') could contribute to understanding the relevance of participating in FPPs. Other strategies were considered important to take into account too, but were less emphasized.ConclusionThis study provides insight into possible strategies to stimulate older adults to participate in FPPs. Reframing ‘aging’ and 'fall prevention' may facilitate the conversation about fall prevention, which can be achieved by communicating differently about the topic, for example ‘staying fit and healthy’, while focusing on the benefits of participating in an FPP. Developing practical recommendations about how to apply the strategies, is an area for future research, as this could help health and social care 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).Funding sourceThis research was co-funded by Regieorgaan SIA, part of the Netherlands Organization for Scientific Research (NWO).

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.

Despite recognition as a serious public health problem, older adults falls increased 30% between 2007-2016. Numerous evidence-based fall prevention programs exist, but may have inadequate reach. Pharmacists are highly trained and accessible clinicians who have potential to counsel on fall prevention. This study describes the reach of a fall prevention outreach conducted by a large national pharmacy chain in partnership with local area agencies on aging (AAAs). On August 7, 2018, the pharmacy chain held an outreach during which older patients were incentivized to speak with pharmacists about their fall risk and prevention strategies. In Ohio, AAAs provided pharmacists additional support and availability of AAA fall prevention programs. A random sample of pharmacists was sent a follow-up survey to assess the program’s reach, except in Ohio where all pharmacists received the survey. Response rates were 41% (N=111) and 59% (N=160) in Ohio and non-Ohio states, respectively. We estimate that pharmacists discussed fall prevention with an additional 57,642 on 8/7/2018. The difference in older patients counseled on fall prevention on 8/7/2018 vs. a typical day was significantly greater (p=0.03) for Ohio pharmacists (µ=9.28) compared to non-Ohio pharmacists (µ=5.94). The majority of pharmacists in Ohio and non-Ohio states were moderately or extremely confident in their ability to discuss fall prevention with older patients (69.82% vs. 72.72%) and play an important role in fall prevention (59.75% vs. 54.54%). This study demonstrates the feasibility of utilizing community pharmacists, in partnership with AAAs, to reach large numbers of older adults to counsel on fall prevention.

BackgroundFalls in older people represent a major age-related health challenge facing our society. Novel methods for delivery of falls prevention programs are required to increase effectiveness and adherence to these programs while containing costs. The primary aim of the Information and Communications Technology-based System to Predict and Prevent Falls (iStoppFalls) project was to develop innovative home-based technologies for continuous monitoring and exercise-based prevention of falls in community-dwelling older people. The aim of this paper is to describe the components of the iStoppFalls system.MethodsThe system comprised of 1) a TV, 2) a PC, 3) the Microsoft Kinect, 4) a wearable sensor and 5) an assessment and training software as the main components.ResultsThe iStoppFalls system implements existing technologies to deliver a tailored home-based exercise and education program aimed at reducing fall risk in older people. A risk assessment tool was designed to identify fall risk factors. The content and progression rules of the iStoppFalls exergames were developed from evidence-based fall prevention interventions targeting muscle strength and balance in older people.ConclusionsThe iStoppFalls fall prevention program, used in conjunction with the multifactorial fall risk assessment tool, aims to provide a comprehensive and individualised, yet novel fall risk assessment and prevention program that is feasible for widespread use to prevent falls and fall-related injuries. This work provides a new approach to engage older people in home-based exercise programs to complement or provide a potentially motivational alternative to traditional exercise to reduce the risk of falling.