Evidence-based Fall Prevention Program Research Articles

Factors Associated With Incident and Recurrent Falls Among Men Enrolled in Evidence-Based Fall Prevention Programs: An Examination of Race and Ethnicity.

We examined factors associated with incident (one) and recurrent (2+) falls among 7207 non-Hispanic White (NHW) (89.7%), non-Hispanic Black (NHB) (5.0%), and Hispanic (5.3%) men ages ≥60years with ≥1 chronic conditions, enrolled in an evidence-based fall program. Multinomial and binary regression analyses were used to assess factors associated with incident and recurrent falls. Relative to zero falls, NHB and Hispanic men were less likely to report incident (OR = 0.55, p < .001 and OR = 0.70, p = .015, respectively) and recurrent (OR = 0.41, p < .001 and OR = 0.58, p < .001, respectively) falls. Men who reported fear of falling and restricting activities were more likely to report incident (OR = 1.16, p < .001 and OR = 1.32, p < .001, respectively) recurrent and (OR = 1.46, p < .001 and OR = 1.71, p < .001, respectively) falls. Men with more comorbidities were more likely to report recurrent falls (OR = 1.10, p < .001). Compared to those who experienced one fall, men who reported fear of falling (OR = 1.28, p < .001) and restricting activities (OR = 1.31, p < .001) were more likely to report recurrent falls. Findings highlight the importance of multi-component interventions to prevent falls.

Developing Community-Level Implementation Networks to Connect Older Adults to Evidence-Based Falls Prevention Programs.

Background: Evidence-based falls prevention programs are available in many communities, but participation in such programs remains low. This study aimed to develop community-based referral networks of organizations to facilitate the uptake of evidence-based falls prevention programs through engaging older adults at risk for falls with the RememberingWhen™ program and connecting them to evidence-based programs in Midwestern communities. Methods: Guided by the Practical, Robust Implementation and Sustainability Model (PRISM), referral networks were developed in two Midwestern communities (urban and micropolitan) through a seven-step community engagement plan: establishing and operationalizing the State-level Advisory Board (SAB), identifying falls prevention resources, conducting community assessments, developing Local Advisory Groups (LAG), operationalizing the LAG, developing referral network and protocols, and implementing the network. Semistructured interviews guided by the RE-AIM framework were conducted with members of the SAB, LAG, administrators and staff from organizations that participated in networks, and older adult participants. Results: After participating in the development of referral networks, participants felt they learned important skills that they can use to develop additional collaborations and networks in the future, emphasized the benefits of building community capacity among organizations with common missions. Interview data yielded strategies on enhancing the referral network's reach, impact, adoption, implementation efficiency, and maintenance. Conclusion: Future sustainability studies of such networks should explore identified challenges and strategies to sustain efforts. Results highlight the importance of ongoing funds to support the efforts of organizational networks in communities.

Falls prevention and frailty management in community-living older adults: Current challenges in community practices

This paper addresses the current challenges associated with implementing falls prevention and frailty management programs for older adults in the community setting. Falls and frailty are closely linked to various ageing-related health issues. While extensive research has been conducted on falls and frailty in older adults, these areas have often been studied in isolation from each other over the past few decades. Although evidence-based fall prevention and frailty management programs have been well-established in well-developed countries, barriers to implementing condition-specific interventions, such as manpower shortages, space constraints, and lack of public awareness and funding, still exist. Additionally, some evidence-based programs have shown limited clinical effectiveness when implemented in overseas contexts. Effective programs that target both fall prevention and frailty management remain limited. Currently, there’s a growing trend of adopting a combined approach in designing and implementing programs that address both falls and frailty in the older adult population. Encouraging future research studies in this area is crucial to support the translation of evidence into practice for fall prevention and frailty management.

USING MULTIPLE METHODOLOGIES TO EVALUATE GERIATRIC WORKFORCE DEVELOPMENT PROGRAMS: A FALL PREVENTION EXAMPLE

This paper highlights an effective model for evaluating geriatric workforce enhancement professional development programs, using multiple methodologies (i.e., quantitative and qualitative). An adaptation of Kirkpatrick's (1994; 2010) model of evaluation was implemented to assess the evidence-based fall prevention program delivered at a Program for All Inclusive Care for the Elderly site. The purpose of this paper is to describe the program's design, data collection activities and instruments, and findings, and also suggest strategies for successfully replicating the approach.

Adapting Evidence-Based Falls Prevention Programs for Remote Delivery - Implementation Insights through the RE-AIM Evaluation Framework to Promote Health Equity.

COVID-19 disproportionally impacted the health and well-being of older adults-many of whom live with chronic conditions-due to their higher risk of dying and being hospitalized. It also created several secondary pandemics, including increased falls risk, sedentary behavior, social isolation, and physical inactivity due to limitations in mobility from lock-down policies. With falls as the leading cause of preventable death and hospitalizations, it became vital for in-person evidence-based falls prevention programs (EBFPPs) to pivot to remote delivery. In Spring 2020, many EBFPP administrators began re-designing programs for remote delivery to accommodate physical distancing guidelines necessitated by the pandemic. Transition to remote delivery was essential for older adults and persons with disabilities to access EBFPPs for staying healthy, falls and injury free, out of hospitals, and also keeping them socially engaged. We collaborated with the Administration on Community Living (ACL), the National Council on Aging (NCOA), and the National Falls Prevention Resource Center (NFPRC), for an in-depth implementation evaluation of remotely delivered EBFPPs. We examined the process of adapting and implementing four EBFPPs for remote delivery, best practices for implementing the programs remotely within the RE-AIM evaluation framework. This enhances NFPRC's ongoing work supporting dissemination, implementation, and sustainability of EBFPPs. We purposively sampled organizations for maximum variation in organization and provider type, geographic location, and reach of underserved older populations (Black, Indigenous, or other People of Color (BIPOC), rural, disabilities). This qualitative evaluation includes provider-level data from semi-structured interviews (N = 22) with program administrators, staff, and leaders. The interview guide included what, why, and how adaptations were made to EBFPP interventions and implementation strategies using Wiltsey-Stirman (2019) adaptations framework (FRAME), reach, and implementation outcomes (acceptability, feasibility, fidelity, and costs; Proctor et al., 2011), focusing on equity to learn for whom these programs were working and opportunities to address inequities. Findings demonstrate remote EBFPPs made planned and fidelity-consistent adaptations to remote delivery in partnership with researchers and community organizations, focusing on participant safety both in program content and delivery. Supports using and accessing technology were needed for delivery sites and leaders to facilitate engagement, and improved over time. While remote EBFPP delivery has increased access to EBFPPs for some populations from the perspective of program administrator, leaders, and staff (e.g., caregivers, rural-dwellers, persons with physical disabilities), the digital divide remains a barrier in access to and comfort using technology. Remote-delivered EBFPPs were acceptable and feasible to delivery organizations and leaders, were able to be delivered with fidelity using adaptations from program developers, but were more resource intensive and costly to implement compared to in-person. This work has important implications beyond the pandemic. Remote delivery has expanded access to groups traditionally underserved by in-person programming, particularly disability communities. This work will help answer important questions about reach, accessibility, feasibility, and cost of program delivery for older adults and people with disabilities at risk for falls, those living with chronic conditions, and communities most vulnerable to disparities in access to health care, health promotion programming, and health outcomes. It will also provide critical information to funders about elements required to adapt EBFPPs proven effective in in-person settings for remote delivery with fidelity to achieve comparable outcomes.

Using an academic-community partnership model to deliver evidence-based falls prevention programs in a metropolitan setting: A community case study.

Prevention is an effective approach for mitigating the negative health outcomes associated with falls in older adults. The Administration for Community Living (ACL) has sponsored the implementation of evidence-based falls prevention programs (EBFPPs) across the United States through cooperative agreement grants to decrease the health and economic burden of falls. Marymount University received two of these grants to deliver three EBFPPs into the northern Virginia region. This community case study describes the development of a collaboration between a university and community-based organizations to adopt and implement multiple evidence-based programming in an area where none previously existed. Through an academic-community partnership, EBFPPs were introduced to and implemented by senior-focused organizations. Target adopters were senior and community centers, multi-purpose senior services organizations, recreational organizations, and residential facilities serving older adults. The three EBFPPs were (1) Stay Active and Independent for Life (SAIL), (2) a Matter of Balance (MOB) and (3) Otago Exercise Program (OEP). Key interdependent project elements included: (1) fostering ongoing community organization collaboration, (2) introducing programs in the community, (3) growing and sustaining delivery sites, (4) preparing trained program leaders, and (5) building community demand for the programs. From August 2016-June 2022, 5,857 older adults participated in one of the three EBFPPs. SAIL classes were offered at 33 sites and MOB workshops at 31 with over 70% of them occurring at community or senior centers. OEP was offered at 4 sites. Factors that influenced the implementation of these programs included having: key advocates at host organizations, programs embedded into site workflows, sufficient capacity and workforce, engaged invested partners, and flexibility in working with a complex set of agencies and systems with different administrative structures. By connecting academic faculty with various community members from multiple sectors, new initiatives can be successfully implemented. Results from this ACL-funded project indicate that using an academic-community partnership model to build relationships and capacity for ongoing delivery of health promotion programming for older adults is feasible and effective in delivering EBFPPs. In addition, academic-community partnerships can develop a strong network of invested partners to foster continued support of fall prevention activities.

Developing online fall prevention program: Older adult recommendations.

Falls are a critical public health problem for older adults making expanded access of evidence-based fall prevention programs to this population a priority. Online delivery could improve the reach of these needed programs, however associated benefits and challenges remain poorly explored. This focus group study was undertaken to gather older adults' perceptions regarding the transition of face-to-face fall prevention programs to online formats. Content analysis was used to identify their opinions and suggestions. Older adults had concerns related to technology, engagement, and interaction with peers that they valued during face-to-face programs. They provided suggestions they felt would improve the success of online fall prevention programs, especially including synchronous sessions and getting input during program development from older adults.

Cost of Inpatient Falls and Cost-Benefit Analysis of Implementation of an Evidence-Based Fall Prevention Program

There is insufficient research on the costs of patient falls in health care systems, a leading source of nonreimbursable adverse events. To report the costs of inpatient falls and the cost savings associated with implementation of an evidence-based fall prevention program. In this economic evaluation, a matched case-control study used the findings from an interrupted time series analysis that assessed changes in fall rates following implementation of an evidence-based fall prevention program to understand the cost of inpatient falls. An economic analysis was then performed to assess the cost benefits associated with program implementation across 2 US health care systems from June 1, 2013, to August 31, 2019, in New York, New York, and Boston, Massachusetts. All adults hospitalized in participating units were included in the analysis. Data analysis was performed from October 2021 to November 2022. Evidence-based fall prevention program implemented in 33 medical and surgical units in 8 hospitals. Primary outcome was cost of inpatient falls. Secondary outcome was the costs and cost savings associated with the evidence-based fall prevention program. A total of 10 176 patients who had a fall event (injurious or noninjurious) with 29 161 matched controls (no fall event) were included in the case-control study and the economic analysis (51.9% were 65-74 years of age, 67.1% were White, and 53.6% were male). Before the intervention, there were 2503 falls and 900 injuries; after the intervention, there were 2078 falls and 758 injuries. Based on a 19% reduction in falls and 20% reduction in injurious falls from the beginning to the end of the postintervention period, the economic analysis demonstrated that noninjurious and injurious falls were associated with cost increases of $35 365 and $36 776, respectively. The implementation of the evidence-based fall prevention program was associated with $14 600 in net avoided costs per 1000 patient-days. This economic evaluation found that fall-related adverse events represented a clinical and financial burden to health care systems and that the current Medicare policy limits reimbursement. In this study, costs of falls only differed marginally by injury level. Policies that incentivize organizations to implement evidence-based strategies that reduce the incidence of all falls may be effective in reducing both harm and costs.

The Stroll Safe outdoor falls prevention program: Participant experiences in eight community sites

Background and objectivesOutdoor falls can negatively impact the quality of life of community-dwelling older adults. Although there are differences in risk factors for indoor and outdoor falls, none of the existing evidence-based fall prevention programs specifically targets outdoors falls. To fill this gap, the Stroll Safe program was developed. The purpose of this study was to explore participant's experiences in the Stroll Safe program Research design and methodsIn this qualitative study, we conducted focus groups at eight community program sites with Stroll Safe program participants. Thematic analysis, with both deductive and inductive coding were used. Researcher triangulation was employed to increase trustworthiness of the findings ResultsFour major themes emerged from the data, including (1) Precipitants of behavioral change, (2) Behavioral change, (3) Program design, and 4) Enjoyment of program experience. Several sub-themes were also uncovered Discussion and implicationsAlthough the qualitative findings are consistent with the quantitative findings from the efficacy trial, the results also reveal benefits that were not captured by the quantitative analysis. In addition, the findings related to the influence of the group leader and program design can be used to guide future implementation science studies.

FEASIBILITY OF FALLS PREVENTION PROGRAMS IMPLEMENTATION BASED ON ACADEMIC-COMMUNITY PARTNERSHIPS

Abstract The Northern Virginia (NoVa) region is diverse in age, race, ethnicity, economic status, health status, culture, and language. Based on state data, it is estimated that 28.7% of the 75,000 older adults in NoVa will experience at least one fall annually. Since 2014, the Administration for Community Living (ACL) has sponsored implementation of evidence-based fall prevention programs (EBFPPs). The aims of this study are to 1) describe the EBFPP participants and delivery sites and 2) report initial effectiveness. Marymount University (MU) received two cooperative agreement grants (2016, 2018) from the ACL to implement in NoVa three EBFPPs: 1) Stay Active and Independent for Life (SAIL), 2) A Matter of Balance (MOB), and 3) Otago Exercise Program (OEP). The Northern Virginia Falls Prevention Alliance was formed and a Regional Training Office was built. The data source is the ACL national falls database. From 2016–2022, over 5,000 older adults were reached, over 400 EBFPP leaders were trained, and programs were delivered at 60 sites. Data analysis indicates that falls decreased from 20% to 15%. Those participating in MOB showed the greatest decline in falls (from 34% to 14%). Fall injuries declined from 11% to 7% and ED visits decreased from 3% to 1%. Preliminary analysis indicates beneficial impact: this academic-community partnership has reached people at low risk of falling (SAIL), and had an impactful decline in falls for individuals at moderate to high risk (MOB). Future research will investigate program outcome differences based on other demographics and delivery models.

SCALING UP A FALL PREVENTION PROGRAM IN RURAL COMMUNITIES: FEASIBILITY AND LESSONS LEARNED

Abstract In North Dakota, 28% of adults over age 65 report falling each year, resulting in substantial morbidity and mortality. Evidence-based fall prevention programs can benefit quality of life and maintenance of daily living activities, particularly for community-dwelling older adults. The Stepping On fall prevention program, a national evidence-based program, is designed to educate older adults about risk factors for falls, safety strategies, and coping behaviors. The program consists of seven weekly community-based workshops conducted in a small-group setting by two trained facilitators. The Stepping On program was introduced in North Dakota in March 2012. Since that time, 132 workshops have taken place in rural communities across the state, serving 1,502 participants. The number of workshops and participants steadily grew between 2012 and 2019. In the year 2012-13, 127 individuals participated in ten workshops. By 2019, before the program was suspended during the pandemic, 199 individuals participated in 16 workshops; 24 workshops had previously been held in 2018. The current study discusses the implementation process as the program scaled up and expanded to more locations. The feasibility and sustainability of conducting the program in isolated rural areas, challenges encountered, and lessons learned will also be discussed. It is important that residents in rural communities have access to evidence-based programs like Stepping On so they can experience the benefits.

UNDERSTANDING MOTIVATIONS FOR PARTICIPATING IN EVIDENCE-BASED FALL PREVENTION PROGRAMS ON ZOOM

Abstract The pivot to remote delivery of NCOA evidence-based programs has increased participant reach due to eliminating geographic or transportation barriers. Despite the convenience of participation in one’s own home, challenges for helping patients adhere to behavior change remain. This paper will present data from one community-based organization’s NCOA evidence-based falls prevention program implementation of Bingocize, Tai Chi, Otago, and SAIL on Zoom. Across all programs, only 36% of people who registered for workshops attended the first session. Participants, on average, only attended 27% of the sessions in a given workshop. To explore the barriers and facilitators to attendance in order to encourage patients to change health behavior, we used a mixed-methods approach to evaluate reasons for suboptimal adherence among n=735 participants across the 4 programs. We performed sub-group analysis to examine barriers and facilitators by the self-reported attendance rate. We conducted semi-structured interviews with n=14 participants, focusing on those who had less than 50% attendance for the workshop they registered for, and also received n=234 survey responses. For participants who attended &amp;gt;50% of workshop sessions, class enjoyment was the most cited facilitator of attendance. However, for those who attended &amp;lt; 50% of workshop sessions, email reminders were the most cited attendance facilitator. Results from this project provide critical information about specific barriers that different sub-groups of older adults face regarding participation in NCOA evidence-based programs to develop strategies to help motivate patients for health behavior change.

Review of National Council on Aging Fall Prevention Programs for the Home Health Setting

Falls are a major concern for community-dwelling older adults and receive substantial attention from community agencies, clinicians, and researchers. A review process completed by the Administration for Community Living has identified 16 evidence-based fall prevention programs listed by the National Council on Aging. Although most of the programs are designed for group settings in the community, four have evidence supporting their effectiveness in the home setting. These are CAPABLE, FallScape, FallsTalk, and the Otago Exercise Program. We reviewed the literature about these four programs and identified positive outcomes in addition to reduction in fall risk. Although the results varied among the programs, potential benefits include improvement in activities of daily living, decreased Medicare expenditure, increased fall awareness and implementation of behaviors to reduce fall risk, decreased pain, and improved balance. These factors should be considered by community agencies looking to select programs to address falls for older adults.

Feasibility of a Small Group Otago Exercise Program for Older Adults Living with Dementia.

Older adults with dementia experience more frequent and injurious falls than their cognitively-intact peers; however, there are no evidence-based fall-prevention programs (EBFPP) for this population. The Otago Exercise Program (OEP) is an EBFPP for older adults that has not been well-studied in people with dementia. We sought to explore the feasibility of group delivery of OEP in an adult day health center (ADHC) for people with dementia. We collected demographic data, Functional Assessment Staging Tool (FAST), and Mini Mental State Exam (MMSE) scores for seven participants with dementia. Pre- and post-test data included: Timed-Up-and-Go (TUG), 30-Second Chair-Stand (30s-CST), Four-Stage-Balance-Test (4-SBT), and Berg Balance Scale (BBS). We implemented a supervised group OEP, 3x/week × 8 weeks. Most participants required 1:1 supervision for optimal challenge and participation. Five participants completed the program. All had moderately severe to severe dementia based upon FAST; MMSE scores ranged from mild to severe cognitive impairment. Four of five participants crossed the threshold from higher to lower fall risk in at least one outcome (TUG, 30s-CST, 4-SBT, or BBS), and four of five participants improved by >Minimal Detectible Change (MDC90) score in at least one outcome. The group delivery format of OEP required significant staff oversight for optimal participation, making the program unsustainable.

Leveraging ACL Funding to Implement an Evidence-Based Falls Prevention Program in Three GWEPs

Primary care practices have a robust capacity to screen older adults for falls risk and refer them to evidence-based falls prevention programs delivered by Community Based Organizations (CBOs). However, due to a difference in the culture and nature of the work done in these two systems of care, there is often a lack of coordination and communication. Dartmouth has worked to bridge this gap for the past five years through our Health Resources and Services Administration (HRSA)-funded Geriatric Workforce Enhancement Program (GWEP). GWEP goals include the promotion of Age-Friendly Health Systems by focusing on the 4 Ms: What Matters Most, Medication, Mentation and Mobility. GWEPs commonly operationalize the Mobility component via falls risk screening and prevention programs. Though CBOs are well suited to deliver falls prevention programs, implementing, disseminating and sustaining community-based falls prevention programs in an environment of cost containment, limited funds for community-based services and workforce issues is challenging. Previous Administration for Community Living (ACL) grant funding enabled us to develop the Dartmouth Falls Prevention Training Center (D-TC) using our expertise in training and community-based implementation of evidence-based interventions. The D-TC offers training and implementation support to primary care and CBOs on screening, referring and capacity-building for falls prevention programs. We will discuss challenges and successes implementing the Dartmouth falls prevention model with two additional GWEP grantees, Baystate and the University of Rhode Island. Benefits of leveraging ACL and HRSA funding to achieve synergistic goals to reduce falls in older adults will be explored.

Review of NCOA Evidence Based Fall Prevention Strategies for the Home Health Setting

<h3>Objective(s)</h3> To evaluate the effectiveness of National Council on Aging (NCOA) evidence based fall prevention programs that can be completed in the home setting. <h3>Data Sources</h3> We conducted searches of PEDRo, CINAHL, PubMed and Scopus using combinations of the following search terms: fall prevention, community, intervention, exercise, physical therapy, evidence based, home. <h3>Study Selection</h3> Criteria were chosen to capture all studies that included NCOA fall prevention programs that can be implemented in the home setting. Inclusion criteria identified studies from peer-reviewed journals including NCOA fall prevention programs with elements allowing for individualized training and implementation. Studies with only community based, group provision were excluded. <h3>Data Extraction</h3> For articles included in this review, the following information was extracted: type of study, methodological quality review, level of evidence, number of subjects, outcome measures used, interventions, primary positive and negative results, and setting. <h3>Data Synthesis</h3> Four NCOA evidence based fall prevention programs were identified as appropriate to be provided in the home setting: CAPABLE, FallScape, FallsTalk and the Otago Exercise Program. Data extracted from included articles demonstrated improvements with falls efficacy, reduction in the number of falls, and increased recognition of fall risk. <h3>Conclusions</h3> Falls are a concern for older adults with expensive medical care and a loss of independence for the individual. With our analysis, 4 NCOA programs can be reasonably provided in the home setting. Only one program (CAPABLE) is specifically designed to be implemented in the home setting. While there is strong evidence of the effectiveness of these programs, more work is recommended to determine the best practices for provision of home programs. This work is relevant with the COVID-19 pandemic limiting community interventions. <h3>Author(s) Disclosures</h3> The authors declare no conflicts of interest.

A Technological-Based Platform for Risk Assessment, Detection, and Prevention of Falls Among Home-Dwelling Older Adults: Protocol for a Quasi-Experimental Study.

BackgroundAccording to the United Nations, it is estimated that by 2050, the number of people aged 80 years and older will have increased by 3 times. Increased longevity is often accompanied by structural and functional changes that occur throughout an individual’s lifespan. These changes are often aggravated by chronic comorbidities, adopted behaviors or lifestyles, and environmental exposure, among other factors. Some of the related outcomes are loss of muscle strength, decreased balance control, and mobility impairments, which are strongly associated with the occurrence of falls in the elderly. Despite the continued undervaluation of the importance of knowledge on fall prevention among the elderly population by primary care health professionals, several evidence-based (single or multifaceted) fall prevention programs such as the Otago Exercise Program (OEP) have demonstrated a significant reduction in the risk of falls and fall-related injuries in the elderly within community settings. Recent studies have strived to integrate technology into physical exercise programs, which is effective for adherence and overcoming barriers to exercise, as well as improving physical functioning.ObjectiveThis study aims to assess the impact of the OEP on the functionality of home-dwelling elderly using a common technological platform. Particularly, the impact on muscle strength, balance, mobility, risk of falling, the perception of fear of falling, and the perception of the elderly regarding the ease of use of technology are being examined in this study.MethodsA quasi-experimental study (before and after; single group) will be conducted with male and female participants aged 65 years or older living at home in the district of Porto. Participants will be recruited through the network COLABORAR, with a minimum of 30 participants meeting the study inclusion and exclusion criteria. All participants will sign informed consent forms. The data collection instrument consists of sociodemographic and clinical variables (self-reported), functional evaluation variables, and environmental risk variables. The data collection tool integrates primary and secondary outcome variables. The primary outcome is gait (timed-up and go test; normal step). The secondary outcome variables are lower limb strength and muscle resistance (30-second chair stand test), balance (4-stage balance test), frequency of falls, functional capacity (Lawton and Brody - Portuguese version), fear of falling (Falls Efficacy Scale International - Portuguese version), usability of the technology (System Usability Scale - Portuguese version), and environmental risk variables (home fall prevention checklist for older adults). Technological solutions, such as the FallSensing Home application and Kallisto wearable device, will be used, which will allow the detection and prevention of falls. The intervention is characterized by conducting the OEP through a common technological platform 3 times a week for 8 weeks. Throughout these weeks, the participants will be followed up in person or by telephone contact by the rehabilitation nurse. Considering the COVID-19 outbreak, all guidelines from the National Health Service will be followed. The project was funded by InnoStars, in collaboration with the Local EIT Health Regional Innovation Scheme Hub of the University of Porto.ResultsThis study was approved on October 9, 2020 by the Ethics Committee of Escola Superior de Enfermagem do Porto (ESEP). The recruitment process was meant to start in October, but due to the COVID-19 pandemic, it was suspended. We expect to restart the study by the beginning of the third quarter of 2021.ConclusionsThe findings of this study protocol will contribute to the design and development of future robust studies for technological tests in a clinical context.Trial RegistrationISRCTN 15895163; https://www.isrctn.com/ISRCTN15895163International Registered Report Identifier (IRRID)PRR1-10.2196/25781

Dissemination and Implementation of Evidence-Based Falls Prevention Programs: Reach and Effectiveness.

Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we describe the implementation of evidence-based fall prevention programs (EBFPPs) by Administration for Community Living grantees during 2014-2019. Forty-four grantees contributed to the national data repository. Data components include workshop information, participant information, attendance records, and organizational data. Data were collected before and after implementation of the EBFPPs. Ten different programs were offered in 35 states with the most common settings being senior centers (25.3%), residential facilities (16.8%), health care organizations (12.5%), and faith-based organizations (11.1%). Individuals who participated in the programs (N = 85 848) had an age of 75.5 ± 9.7 years and were primarily female (79.7%), and the majority (86.2%) reported at least some fear of falling. At the postprogram assessment, 31.8% reported less fear of falling, 21.6% reported fewer falls, and 10.1% reported fewer injurious falls (all p < .0001). EBFPPs implemented by Administration for Community Living grantees reached over 85 000 older adults. Participation in the EBFPPs resulted in improved confidence, decreased fear of falling, and fewer falls and injurious falls. Future efforts should focus on reaching specific underserved minorities and examining the effectiveness of individual programs.

Clinical-Community Connections: Incorporating Evidence-Based Programs for Improved Patient Outcomes.

Incorporating evidence-based community programs into clinical care recommendations and goals may help bridge the clinic-to-community transition for older adults. Engagement in evidence-based programs can help older adults manage chronic conditions and reduce fall risk through behavior change and self-management following a clinical episode of care. This paper describes evidence-based fall prevention and physical activity programs, provides resources to locate programs, and strategies to match older adults to the right programs.

Increased Mobility and Fall Reduction: An Interdisciplinary Approach on a Hematology-Oncology and Stem Cell Transplantation Unit.

Patients in the hematology-oncology and stem cell transplantation (SCT) setting are at high risk for functional decline and falls related to prolonged hospitalizations and inactivity during inpatient treatment. After underperforming on the Press Ganey National Database of Nursing Quality Indicators benchmark for falls in 2018, staff on a hematology-oncology and SCT unit implemented a practical and evidence-based fall prevention program. Fall rates from 2018 to 2019 ranged from 3.4 to 4.8 falls per 1,000 patient days. After the introduction of the unit-based gym program, early mobility increased and falls decreased to 2.57 per 1,000 patient days.