Fall Prevention Education Research Articles

Fall Risk Identification Throughout the Continuum of Care for Elderly Trauma Patients: An Injury Prevention Initiative

IntroductionFalls are the second leading cause of trauma-related deaths worldwide. Identifying fall risk patients and initiating interventions reduces injuries and mortality, particularly in the elderly. The primary aim of this retrospective study was to identify missed opportunities for fall risk identification and intervention for geriatric trauma patients. Patients and methodsIn this retrospective observational cohort study, the trauma registry was queried to identify geriatric patients admitted for a fall over 36 months. The electronic medical record (EMR) was reviewed to evaluate patients’ fall risk in the 12 months prior to the index fall admission. The EMR was also queried for repeat falls within 12 months after discharge, and to determine if fall prevention education was provided at discharge. Results597 patients met inclusion criteria; 68.3% were female. 64.7% were at risk for falling in the year before admission. 2% had documented fall prevention education at discharge. 32% of patients fell again within a year of discharge and 19.4% were readmitted for a repeat fall. Patients at high risk for falls (on the Hester-Davis scale) were significantly more likely to be readmitted (p = 0.005) and expire within six months (p = 0.033) than moderate risk patients. Mortality at 12 months post-admission for all patients was 19.4%. ConclusionThis large study demonstrated that geriatric trauma patients admitted for a fall were already at risk for falling in the 12 months prior to admission. This is a novel finding that presents a substantial prevention opportunity for healthcare systems. Education and implementation of proven techniques to prevent falls as soon as at-risk patients are identified has the potential to change the course for a patient who may not only fall, but also fall again. This proactive approach could significantly impact the fall epidemic in our elderly population.

The Otago Exercise Program compared to falls prevention education in Zuni elders: a randomized controlled trial

BackgroundWhen a Zuni elder sustains a fall-related injury, the closest tribal skilled nursing facility is 100 miles from the Pueblo and no physical therapy services are available. Thus, fall prevention strategies as a primary intervention to avert injurious falls and preserve aging in place are needed. The objective of the study is to compare the effectiveness of a community health representative (CHR)-delivered, culturally-adapted Otago Exercise Program (OEP) fall prevention program compared to the standard of care education-based fall risk management.Methods“Standing Strong in Tribal Communities: Assessing Elder Falls Disparity” is mixed-methods research with a randomized controlled trial. The CHRs will be trained to deliver the culturally-adapted OEP trial and offer advantages of speaking “Shiwi” (Zuni tribal language) and understanding Zuni traditions, family structures, and elders’ preferences for receiving health information. Focus groups will be conducted to assure all materials are culturally appropriate, and adapted. A physical therapist will train CHRs to screen elders for falls risk and to deliver the OEP to the intervention group and education to the control group. Up to 400 Zuni elders will be screened by the CHRs for falls risk and 200 elders will be enrolled into the study (1:1 random allocation by household). The intervention is 6 months with measurements at baseline, 3, 6 and 12 months. The primary outcome is improved strength and balance (timed up and go, sit to stand and 4 stage balance test), secondary outcomes include falls incidence, self-efficacy using Attitudes to Falls-Related Interventions Scale, Medical Outcomes Study Short Form 12 (SF-12v2) and Self-Efficacy for Managing Daily Activities.DiscussionFall prevention for Zuni elders was identified as a tribal priority and this trial is built upon longstanding collaborations between the investigative team, Zuni tribal leaders, and multiple tribal health programs. Delivery by the CHRs make this model more acceptable, and thus, more sustainable long term. This study has the potential to change best practice for elder care in tribal and rural areas with limited access to physical therapist-delivered fall prevention interventions and aligns with tribal goals to avert fall-related injury, reduce healthcare disparity, and preserve elder’s independence.Trial registrationNCT04876729

Implementation of falls risk evaluation at one-year after total hip arthroplasty: a cross-sectional study

BackgroundResearch has demonstrated an increased risk of falls after total hip arthroplasty (THA). Yet, people’s knowledge on falls risk factors and how falls prevention strategies are being used after THA have not been examined. If a person’s knowledge of falls and self-efficacy about falls prevention strategies is low this would indicate a pressing need for interventions to lessen risk. The study objectives were: 1) to determine the falls knowledge and what fall prevention strategies people used after (THA) and 2) to determine the outcomes of a falls risk assessment at 12-months after unilateral THA.MethodsOverall, 108 people completed the Falls Risk for Older People – Community Setting (FROP-Com) scale, a falls questionnaire (covered occurrence of falls, knowledge on falls risk factors, falls prevention strategies implemented after THA surgery), 6-m Walk Test (6mWT), 30-Second Chair Stand Test (30CST), Timed-up and Go (TUG) Test, and Activities-specific Balance Confidence Scale (ABC).ResultsTwenty-five (23.2%) people fell at least once in the 12 months after THA. Scores on the FROP-Com ranged from 2–20 with an average of 8.2 ± 3.6 indicating a mild falls risk. The importance of falling compared to other health concerns was rated as moderate to high (6.8 ± 2.9) and the majority of participants (n = 98, 90.7%) believed falls can be prevented after THA. Total scores on the ABC scale ranged from 30.6% to 100.0% with an average score of 84.4 ± 15.5%, indicating high function. Only 47 people (43.5%) reported receiving falls prevention education. A total of 101 falls prevention strategies were completed by 67 people (62%), the most common strategy was environmental modifications (e.g., installation of grab bars) at 37.4%, while exercise was mentioned by only 2%. The majority of people had functional deficits in 30CST (62%) and TUG (76.9%) at 12-months after unilateral THA.ConclusionsAlmost a quarter of the sample had experienced a fall in the 12-months after THA and functional deficits were common. The majority of the sample had proactively implemented falls prevention strategies after the surgery. Yet importantly, people after THA had limited exposure to falls prevention education and implemented a limited range of prevention strategies.

Video-based fall prevention education for cognitively impaired inpatients: a pilot study

Video-based fall prevention education for cognitively impaired inpatients: a pilot study

Implementing Patient Falls Education in Hospitals: A Mixed-Methods Trial.

Patient education is key to preventing hospital falls yet is inconsistently implemented by health professionals. A mixed methods study was conducted involving a ward-based evaluation of patients receiving education from health professionals using a scripted conversation guide with a falls prevention brochure, followed by semi-structured qualitative interviews with a purposive sample of health professionals involved in delivering the intervention. Over five weeks, 37 patients consented to surveys (intervention n = 27; control n = 10). The quantitative evaluation showed that falls prevention education was not systematically implemented in the trial ward. Seven individual interviews were conducted with health professionals to understand the reasons why implementation failed. Perceived barriers included time constraints, limited interprofessional collaboration, and a lack of staff input into designing the research project and patient interventions. Perceived enablers included support from senior staff, consistent reinforcement of falls education by health professionals, and fostering patient empowerment and engagement. Recommended strategies to enhance implementation included ensuring processes were in place supporting health professional accountability, the inclusion of stakeholder input in designing the falls intervention and implementation processes, as well as leadership engagement in falls prevention education. Although health professionals play a key role in delivering evidence-based falls prevention education in hospitals, implementation can be compromised by staff capacity, capability, and opportunities for co-design with patients and researchers. Organisational buy-in to practice change facilitates the implementation of evidence-based falls prevention activities.

Assessment of self-reported practice of nurses towards fall prevention and its associated factors in an Ethiopian hospital; cross-sectional study

Back groundFalls are a frequent, serious, and increasing public health issues that can significantly change the patients' level of functioning and quality of life. Nurses are at the front position in the efforts to prevent hospital falls. Thus, the main purpose of this study was to assess the level of nurses’ practice on prevention of falls and its associated factors. MethodAn institution based cross-sectional study was conducted among 371 nurses. Data were collected using pretested and self administered English version questionnaire. EPI info version 3.5.3 was used for data entry and SPSS version 20 for analysis. Binary and multiple logistic regression models were fitted to identify associated factors. An adjusted odds ratio with 95% confidence interval was computed. ResultOverall, 44% of the participants have good practice regarding falls prevention. Educational qualification [bachelor (AOR = 1.9, CI: 1.11, 3.46), master (AOR = 3.2, CI: 1.83, 5.68)], work experience (AOR = 1.92, CI: 1.25, 3.41), number of falls experienced [2 falls (AOR = 2.82, CI: 1.44, 4.52), ≥3 falls (AOR = 3.52, CI: 3.11, 5.76)] and fall prevention education (AOR = 3, CI: 1.43, 5.21) were significantly associated with practice of fall prevention. ConclusionPractice of the nurses regarding prevention of falls was found to be inadequate. Having higher educational status, being more experienced, having previous experience of patient fall and education about falls prevention were positively associated with fall prevention practice of nurses. Developing educational programs that include fall prevention through the academic curriculum and continuing educational programs are some of the steps to improve nurse's practice regarding prevention of falls.

Providing Accessible Fall Prevention Education for Older Adults With Low Vision

This study modified the educational content of an evidence-based fall prevention intervention to make it visually accessible for older adults with low vision. We piloted the intervention on 9 older adults receiving low vision rehabilitation services. Following the intervention, participants demonstrated increased comprehension of the content, perceived a greater understanding of fall prevention strategies, and reported high satisfaction with the intervention's accessibility. Individuals with low vision may have difficulty reading and comprehending printed educational materials. Modifying print materials to improve readability may result in greater understanding of the educational content.

The Effects of the Fall Prevention Education Using the Kirkpatrick Model : For the Students Majoring in Housing Design

Due to rapid increase of population aging, the number of older people who have experienced falls is continuously increasing. Falls are preventable unlike other geriatric diseases, but since it is difficult for older people to improve their environments by themselves, housing designers should be familiar with how to design housing environments for preventing falls. Therefore, this study intends to systematically verify educational effects of a fall prevention education by using the Kirkpatrick model using the same educational program by the previous study. This study was designed as a quasi-experience study, and the education was conducted for the students majoring in housing design. As a result of analyzing the responses of 100 students who faithfully participated in this survey, the education was found to be effective in education satisfaction, learning comprehension, and field application, which correspond to the 1-3 level education effect of the Kirkpatrick’s model. Namely, students

Interprofessional education to implement patient falls education in hospitals: Lessons learned.

The aim of this study was to design, deliver and evaluate an interprofessional education programme for healthcare professionals on how to implement a modified version of the safe recovery programme to prevent falls in hospitalized patients. Mixed methods design incorporating pre- and post education surveys and individual semi-structured interviews. Thirty-four health professional participants attended a 1-h face-to-face or Zoom® interprofessional education session to learn how to deliver an evidence-based patient falls prevention education strategy, the modified Safe Recovery Programme. A 1-hour education session was insufficient to build full confidence to deliver the Safe Recovery Programme. There was no statistically significant change in participant views on interprofessional collaboration. Participants recommended prior consultation and preparation before delivery of IPE, with additional opportunities for discussion and feedback during implementation with patients. The findings highlight the importance of interprofessional education for evidence-based interventions in hospitals. Health professionals value education that is timely, interactive, realistic and engaging.

Interventions for preventing falls in Parkinson's disease.

Interventions for preventing falls in Parkinson's disease.

A Collaborative Implementation Strategy to Increase Falls Prevention Training Using the Age-Friendly Health Systems Approach.

Falls in the home and in community environments are the leading cause of injuries and long-term disabilities for the aging population. The purpose of this study was to examine outcomes of a partnership among an academic institution, government agency, community organizations, and emergency management services to implement a falls prevention training program using an Age-Friendly Health Systems approach. In this prospective study, partners identified gaps in services and targeted and non-targeted delivery areas for implementation of an evidence-based falls prevention intervention addressing the 4Ms of Age-Friendly Health Systems—Mobility, Medications, Mentation, and What Matters. Descriptive statistics were calculated for program implementation and participant demographic variables, and paired t-test analysis compared scores for self-assessed general health and falls efficacy prior to and after program participation. Twenty-seven falls prevention classes were implemented, with over half (52%) in targeted areas. A total of 354 adults aged 50 and older participated, with N = 188 participants (53%) completing the program by attending at least five of eight sessions. Of completers, 35% resided in targeted areas. The results showed a statistically significant improvement in falls efficacy by program completers in targeted and non-targeted areas. However, there was no statistically significant difference in self-rated health. Overall, the findings of this study indicate that collaboration to deliver falls prevention training can be effective in reaching at-risk older adults. By mobilizing collaborative partnerships, limited resources can be allocated towards identifying at-risk older adults and improving community-based falls prevention education.

Is it a Macho Thing? Older Adults’ Perceptions of Gender Differences inFall Prevention Class Participation

Perceptions that women are in greater need of fall prevention might impact their participation in programs. This study aimed to understand gender differences in motivating factors and experiences in a fall prevention program. Thirty-four adults (18 men and 16 women) aged 60 years or older participated in focus groups after 12 weeks of fall prevention exercises and education. Six main themes emerged. It might be a macho thing represented an overarching theme of why men might not participate in fall prevention as readily as women. Personal experience as a motivator, Get my balance back, and Challenges/Successes were common themes for men and women. Both genders realized the benefits of the program; however, men emphasized the importance of personal outcomes (Being part of something bigger), whereas women highlighted group outcomes (Socialization). These findings can guide the future messaging and marketing of fall prevention programs for older adults.

“Adapted” Motivational Interviewing to Engage Hospital Nurses in Fall Prevention Education

Hospital nurses often experience challenges when teaching older adults about fall prevention strategies. The goal of this project was to provide evidence-based training to hospital nurses to facilitate patient engagement with fall prevention measures. Methods: An “Adapted” Motivational Interviewing (MI) for fall prevention (AMIFP) training in acute care was developed and introduced to nurses as part of a Veterans Affairs-Nursing Academic Partnership (VANAP) initiative. Pre/post surveys were completed by 61 nurses (71% response rate) at an acute care hospital in the United States. Results: After the single AMIFP training, nurses reported having increased knowledge about patient engagement related to fall prevention. Moreover, feelings of confidence related to using some MI skills for fall prevention increased after training. Conclusion: Even a brief AMIFP training for nurses can have a positive impact on improving hospital nurses’ knowledge and attitudes to engage patients in fall prevention education.

Healthcare professional perspectives on barriers and enablers to falls prevention education: A qualitative study

In hospitals, patient falls prevention education is frequently delivered by nurses and allied health professionals. Hospital falls rates remain high globally, despite the many systems and approaches that attempt to mitigate falling. The aim of this study was to investigate health professional views on the enablers and barriers to providing patient falls education in hospitals. Four focus groups with 23 nursing and allied health professionals were conducted at 3 hospitals. Three researchers independently coded the data and findings were analysed thematically with a descriptive qualitative approach to identify and develop themes according to barriers and enablers. Barriers included (i) limited interprofessional communication about patient falls; (ii) sub-optimal systems for falls education for patients and health professionals, and (iii) perceived patient-related barriers to falls education. Enablers to providing patient falls education included: (i) implementing strategies to increase patient empowerment; (ii) ensuring that health professionals had access to effective modes of patient education; and (iii) facilitating interprofessional collaboration. Health professionals identified the need to overcome organisational, patient and clinician-related barriers to falls education. Fostering collective responsibility amongst health professionals for evidence-based falls prevention was also highlighted.

The effect of fall prevention education on fear of falling in patients with scheduled total knee arthroplasty: a quasi-experimental study

ABSTRACT The aim of this study is to determine the effect of fall prevention education given to patients with scheduled total knee arthroplasty (TKA) on their fear of falling in the postoperative period. The study had a quasi-experimental design. The study sample included 70 patients. Data were gathered with a patient characteristics form and the Falls Efficacy Scale-International (FES-I) at face to face interviews. The intervention group was given a brochure and face-to-face education about fall prevention before surgery. Activities such as the first mobilization, assisted walking, climbing stairs, getting out of bed and sitting in bed after the surgery were demonstrated and performed. Patients were followed up to 16 weeks after surgery. The mean age of the control and intervention groups, respectively; 62.26 ± 6.38 and 59.46 ± 7.33. The fear of falling scores before the operation and in the postoperative 6th-8th weeks were high in the intervention group (40.17 ± 8.32 and 31.71 ± 7.83 respectively) and the control group (44.14 ± 8.86 and 40.91 ± 8.43 respectively). The fear of falling scores in the postoperative 14th-16th weeks were high in the control group (37.2 ± 9.03) and moderate in the intervention group (26.42 ± 5.59). The scores for FES-I in the 6th-8th weeks and 14th-16th weeks after surgery were very significantly lower in the intervention group than in the control group(p < .001). The results of the study showed that the patients experienced a great fear of falling before and after surgery. It can be said that the education given reduces the fear of falling significantly and in the early period.

Designing and evaluating falls prevention education with residents and staff in aged care homes: a feasibility study

PurposeThe purpose of this study was to co-design a falls prevention education programme with aged care home residents and staff and evaluate its feasibility. The intention of providing the education programme was to assist residents to stay safe and mobile whilst reducing their risk of falling.Design/methodology/approachA two-phase mixed methods participatory design using a resident (n = 6) and care staff (n = 5) consumer engagement panel, pre- and post-programme resident (n = 35) survey and semi-structured care staff interviews (n = 8) was undertaken in two countries.FindingsA poster, brochure, video and staff education guide featuring 12 safety messages depicting fall prevention behaviours were co-designed. Residents, supported by staff, perceived the falls prevention education programme as enjoyable and informative, but there were no significant differences in capability, opportunity or motivation. However, several residents were observed enacting fall prevention behaviours such as “If I feel unwell, I'll ring the bell” and waiting for staff assistance. Challenges to programme demand, acceptability and implementation which may have impacted residents' exposure and engagement with the programme were identified, along with recommendations to improve feasibility.Practical implicationsWhen developing falls prevention education programmes partnering with residents and staff, providing choices to meet personal and aesthetic preferences along with frequent, shorter duration learning opportunities are important for translating education messages into actions.Originality/valueThe use of bespoke resources, novel rhymes, positive messages emphasising safety and co-designing with residents themselves was a welcomed point of programme difference.

Nurses' perceptions of fall risk factors and fall prevention strategies in acute care settings in Saudi Arabia.

AimThis study aimed to explore nurses’ perceptions of the factors associated with falls and of fall prevention strategies in acute care settings in Saudi Arabia.DesignThis is a cross‐sectional, correlational, descriptive study.MethodsData were collected from 102 nurses using a survey on the risk factors and prevention strategies of injurious falls.ResultsWe found that impaired balance and muscle strength, limited mobility, and an inability to follow safety instructions were reported as the top factors in falls. Multidisciplinary fall prevention strategies are effective in reducing the prevalence of falls. Nurses with higher levels of education had higher perceptions towards the risk factors of falls. Formal patient safety training, including fall prevention education programmes, were shown to reduce falls by making nurses more aware of fall risk factors and prevention strategies. The findings of this study can be used to inform managers about factors that may contribute to falls in acute care settings.

Development and Effects of a Person-Centered Fall Prevention Program for Older Adults with Dementia in Long-Term Care Hospitals: For Older Adults with Dementia and Caregivers in Long-Term Care Hospitals

This study examined the effects of a person-centered fall prevention program for older adults with dementia in long-term care hospitals. A nonequivalent control group pretest-posttest design was used. The study sample included 42 older adults with dementia (experimental group: 21, control group: 21) and 42 caregivers (experimental group: 21, control group: 21). The program comprised 48 sessions held over 12 weeks and included exercise intervention with resistance and balance, dance walking (45~60 min, three times/week), cognitive and emotional intervention (35~50 min, once per week), and person-centered fall prevention education (10 min, once per week). The program for caregivers consisted of six educational sessions (i.e., fall prevention competency enhancement and person-centered care strategy education, 80 min, once per week) for six weeks. Data were collected before participation and 12 weeks after program completion from February 18 to May 12, 2019. Data analysis was conducted using the chi-square test, t-test, and Mann-Whitney U test with SPSS/WIN 21.0. The experimental group of older adults with dementia showed significant improvement in physical and cognitive functions, and a decrease in depression, and behavioral and psychological symptoms, when compared with the control group. caregivers in the experimental group exhibited significant improvement in fall-related knowledge and person-centered care of older adults with dementia compared to the control group. The study findings indicate that this program was effective as a nursing intervention for fall prevention among older adults with dementia in long-term care hospitals.

Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults

With the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking. To perform a systematic review of clinical practice guidelines for falls prevention and management for adults 60 years or older in all settings (eg, community, acute care, and nursing homes), evaluate agreement in recommendations, and identify potential gaps. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses statement methods for clinical practice guidelines on fall prevention and management for older adults was conducted (updated July 1, 2021) using MEDLINE, PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, PEDro, and Epistemonikos databases. Medical Subject Headings search terms were related to falls, clinical practice guidelines, management and prevention, and older adults, with no restrictions on date, language, or setting for inclusion. Three independent reviewers selected records for full-text examination if they followed evidence- and consensus-based processes and assessed the quality of the guidelines using Appraisal of Guidelines for Research & Evaluation II (AGREE-II) criteria. The strength of the recommendations was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation scores, and agreement across topic areas was assessed using the Fleiss κ statistic. Of 11 414 records identified, 159 were fully reviewed and assessed for eligibility, and 15 were included. All 15 selected guidelines had high-quality AGREE-II total scores (mean [SD], 80.1% [5.6%]), although individual quality domain scores for clinical applicability (mean [SD], 63.4% [11.4%]) and stakeholder (clinicians, patients, or caregivers) involvement (mean [SD], 76.3% [9.0%]) were lower. A total of 198 recommendations covering 16 topic areas in 15 guidelines were identified after screening 4767 abstracts that proceeded to 159 full texts. Most (≥11) guidelines strongly recommended performing risk stratification, assessment tests for gait and balance, fracture and osteoporosis management, multifactorial interventions, medication review, exercise promotion, environment modification, vision and footwear correction, referral to physiotherapy, and cardiovascular interventions. The strengths of the recommendations were inconsistent for vitamin D supplementation, addressing cognitive factors, and falls prevention education. Recommendations on use of hip protectors and digital technology or wearables were often missing. None of the examined guidelines included a patient or caregiver panel in their deliberations. This systematic review found that current clinical practice guidelines on fall prevention and management for older adults showed a high degree of agreement in several areas in which strong recommendations were made, whereas other topic areas did not achieve this level of consensus or coverage. Future guidelines should address clinical applicability of their recommendations and include perspectives of patients and other stakeholders.

Effects of multimedia-based fall prevention education on the knowledge, attitudes, or behaviors of patients.

Patient safety is regarded as a critical quality monitoring indicator for medical institutions. The effects of a multimedia-based patient education intervention on knowledge, attitudes, and behaviors regarding fall prevention were observed. The study had a quasi-experimental research design and enrolled 140 participants. Seventy participants in the experimental group received multimedia-based patient education and a health education leaflet, while those in the control group received only the health education leaflet. A structured questionnaire was used for data collection at baseline, and a posttest was applied after the intervention. The participants were predominantly treated in the gastroenterology department (45.7%), followed by the pulmonology department (33.6%). A total of 86.4% of patients had not experienced a fall within 3 months. After the intervention, the average scores for all variables in the experimental group were higher than those in the control group. The results indicate that attitudes, knowledge, and behaviors regarding fall prevention among patients in the pulmonology department were higher than those among patients in the gastroenterology department; the differences were statistically significant. The individualized health education content was of substantial significance for patients with different disease backgrounds and facilitated changes in their knowledge, attitudes, and behaviors regarding falls. Multimedia-based patient education influenced inpatients' knowledge, attitudes, and behaviors for preventing falls.