Fall Prevention Research Articles

Predictors of nursing home conveyances to emergency department

BackgroundWith increasing rates of patient conveyances from nursing homes to emergency departments worldwide, we aim to examine factors causing high rates of conveyances from nursing homes to the emergency department (ED) of an acute tertiary hospital.MethodsThis was a prospective study involving presentation of ED attendances from nursing home residents during out-of-hours over a 23-month period from April 2020 to February 2022. Data was collected from a standardized manual form used by the Emergency Department to document nursing home conveyances.ResultsA total of 338 pre-conveyance forms were reviewed. The most common reasons for conveyances to ED were neurological symptoms (16%), unstable hemodynamics (12%), fever (11%) and falls (10%). The peak conveyances occurred between 1600 and 1900 h on weekends. Respiratory rate, oxygenation requirements and high National Early Warning Score (NEWS) were significantly associated with increased conveyances to the emergency department. When the components of NEWS were analyzed individually, decision for ambulance conveyance to emergency department was significantly associated with respiratory rate (p < .001), oxygen saturation (p < .001), and the use of oxygen supplementation (p < .005).ConclusionsUnstable hemodynamics and falls were among the leading factors for nursing home conveyances to the emergency department, which highlights the need to implement better fall prevention strategies and standardized parameters monitoring in nursing homes. Future research should focus on outcomes of conveyances and the characteristics of nursing home with higher conveyance rates. This would aid to assess the appropriateness of conveyances and to identify strategies to decrease preventable conveyances.

Self-management experiences in fall prevention among community-dwelling older adults in China: a descriptive qualitative study

Background Falls are the most common injuries in older adults, and fall prevention is one of the primary measures to achieve healthy aging. Self-management refers to the measures taken by individuals to avoid various adverse factors and health damage to protect and promote their health. This study aimed to explore the factors and measures of self-managed fall prevention among community-dwelling older adults. Methods A qualitative study based in two communities under the jurisdiction of Ninghua Street and Shanghai Street was conducted in Fuzhou, China. Semi-structured and face-to-face individual interviews were conducted with 15 community-dwelling older adults. Interviews were conducted by the first and second authors who had participated in qualitative training and were audio-recorded and transcribed. The data were analysed deductively with content analysis. Results The research revealed two themes with associated sub-themes: 1) influencing factors of self-managed fall prevention, and 2) promoting self-managed measures to prevent falls. Conclusions Individual, social support, community advocacy, and road condition influenced self-managed fall prevention. Active exercise, adjusting home environment and clothing, and multi-channel acquisition of self-managed fall prevention knowledge can reduce the incidence of falls among older adults. Identifying these experiences will help older adults improve their awareness of preventing falls, take responsibility for themselves, and reduce the incidence of falls. Trial registration Chinese Clinical Trial Register: ChiCTR2200060705; reg. date: June 8, 2022.

Evaluating an Online Game Room for Fall Prevention Education in Long-Term Care Facilities

Evaluating an Online Game Room for Fall Prevention Education in Long-Term Care Facilities

Adoption, Implementation, and Maintenance of Evidence-Based Falls Prevention Programs.

We evaluate the implementation of evidence-based falls prevention programs (EBFPPs) of the Administration for Community Living (ACL) Grantees by (1) describing adoption; (2) evaluating implementation through participant adherence; and (3) describing program maintenance. Secondary data analysis of a national data repository included forty-four ACL grantees spanning 31 states who were funded between September 2014 and December 2019 and provided information on over 80,000 older adult participants. Descriptive statistics including frequencies, percentages, and means were used to describe adoption, implementation (adherence), and maintenance of EBFPPs. Senior centers were the most common organizations to adopt EBFPPs. Most programs were maintained at their respective organizational site through repeat offerings, with several programs (60%) being offered greater than 10 times. Information regarding adoption, implementation, and maintenance of EBFPPs is valuable in identifying the best programs suited for different organizations and their clientele, which can inform policy for scaling and sustaining EBFPPs across the nation.

A Temporospatial Analysis of Activity Patterns for Fall Risk Assessment in Older Adults with Comorbid Type 2 Diabetes.

This study explores how daily activities, including duration and location within the home, affect fall risk in older adults with type 2 diabetes. Body-worn cameras on 26 participants provided data on activity (e.g. exercise), time and location (kitchen, living room). Demographics and health factors were considered to understand their influence. By visualising activity patterns, this study aimed to identify behaviours linked to falls to inform personalised fall prevention strategies and digital technologies for independent living.

Lower-limb inter-joint coordination during balance recovery after trips

BackgroundTrips are one of the most common external perturbations that can lead to accidental falls. Knowledge about postural control attributes of balance recovery after trips could help reveal the biomechanical causes for trip-induced falls and provide implications for fall prevention interventions. Research questionThe objective of the present study was to examine coordinated lower-limb movements during balance recovery after trips. MethodsOne hundred and twenty-three volunteers participated in an experimental study. They were tripped unexpectedly by a metal pole when walking on a linear walkway at their self-selected speed. Lower-limb inter-joint coordination quantified by continuous relative phase measures, including the mean of the absolute relative phases (MARP) and the deviation phase (DP), was analyzed during the execution of the first recovery step after unexpected trips. ResultsCompared to unsuccessful balance recovery, smaller MARPknee-ankle and DPknee-ankle of successful recovery were observed with distal inter-joint coordination on the swing side. Inter-joint coordination of the stance limb did not significantly differ between successful and unsuccessful recovery conditions. These findings indicate that the control of the swing limb’s distal joints is crucial for regaining balance after trips. SignificanceAn implication derived from this study is that greater in-phase coordination and smaller coordination variability in distal joints of the swing limb could be considered as potential targets for interventions aimed at preventing trip-induced accidental.

The Immediate Effects of a Single 20-Minute Session of Transcranial Direct Current Stimulation (tDCS) on Muscle Strength in Older Adults

The older population often experiences a gradual age-related decline in the primary motor cortex, leading to muscle weakness that can harm their physical performances. Exercise could improve physical performance and prevent falling in older adults. However, the decrease in motor function and motor skills in older adults reduces the efficiency of fall prevention. Transcranial Direct Current Stimulation (tDCS) is a non-invasive intervention aimed at improving muscle strength in various conditions by utilizing transcranial direct current stimulation applied to the primary motor cortex (M1). Pre- and post-studies were conducted to demonstrate the effects of a single 20-minute session of tDCS alone, as well as to assess any potential side effects. Sixteen older individuals, both male and female, aged 65 years or older, with or without underlying diseases, were assessed for leg and hand grip strength, followed by physical performance tests. Subsequently, they underwent stimulation of the primary motor cortex through the placement of anodal tDCS (a-tDCS) over the left M1 for 20 min. Immediate effects were evaluated within 24 h, and side effects were recorded for up to 2 weeks after the stimulation. The results demonstrated that a single session of tDCS led to a significant increase in leg strength by 13 kg (5.9 to 20.1 kg, p &lt; 0.01). There was also a significant correlation observed with hand grip strength (r = 0.68, p &lt; 0.01). All physical performance tests, except the fastest speed in the 10-meter walk test, showed statistically significant improvements (p &lt; 0.01). Participants reported no serious side effects, and the intervention will now be incorporated into prospective clinical studies involving older populations to compare its effectiveness with other treatments. HIGHLIGHTS A single session of tDCS led to a significant increase in leg strength. A single session of tDCS, with a significant correlation observed with hand grip strength. Physical performance tests showed statistically significant improvements after a single session of tDCS. Participants reported no serious side effects. This intervention will now be incorporated into prospective clinical studies involving older populations to compare its effectiveness with other treatments. GRAPHICAL ABSTRACT

Translation, extension, and evaluation of usability, usefulness, and safety of a fall prevention and management program for people living with spinal cord injury and multiple sclerosis who use wheelchairs or scooters full time.

Falls are prevalent among people living with Multiple Sclerosis (PwMS) and Spinal Cord Injury (PwSCI) who use wheelchairs or scooters (WC/S) full time, however, there is a scarcity of evidence-based fall prevention and management programs. To describe the systematic translation of an in-person fall prevention and management program (Individualized Reduction Of FaLLs - iROLL) for PwMS to an online platform, extending its scope to include PwSCI, and to evaluate the preliminary useability, usefulness, and safety of the intervention. iROLL was systematically translated to an online platform (iROLL-O). PwMS and PwSCI who use a WC/S full time, experienced at least one fall within the past 36 months, and could transfer independently or with minimal to moderate assistance, enrolled in iROLL-O. Usability, usefulness, and safety were evaluated through 1:1 semi-structured interviews, gathering feedback on: perceived impact of the intervention on falls and functional mobility, program experiences, adverse events, and recommendations for improvement. Five participants successfully completed the iROLL-O program. No safety concerns were raised by participants. Themes emerging from the semi-structured interviews included: (1) barriers and facilitators to program access, (2) motivation for participation, (3) program outcomes, and (4) program content and structure. Participants reported reduced concerns about falling, enhanced functional mobility skills, and highlighted the supportive nature of synchronous group meetings for learning. No adverse events occurred during the implementation of iROLL-O and participants found the program to be useable and useful. Further testing is needed to examine efficacy among a large and diverse population.

Effects of Physical Therapy Integrated with Dance/Movement Therapy on Heart Rate Variability and Fall-Related Variables: A Preliminary Controlled Trial

AbstractFalls among older adults are influenced by both physical and psychological risk factors. This pilot study specifically examined the impact of integrating Dance/Movement Therapy (DMT) into a regimen of physical therapy exercises (PTE) for fall prevention. The primary objectives included examining the effect of post-PTE+DMT intervention on heart rate variability (HRV), a psychophysiological marker, and fall risk factors. Additionally, this study aimed to examine correlations between HRV and levels of fall risk. Eight community-dwelling older adults (median = 83 [interquartile ranges: 80.5–85.75]) from a day center for senior citizens were randomly assigned to either a PTE+DMT group or a PTE group. A post intervention battery of HRV, physical and psychological fall risk assessments, was conducted. The results of nonparametric analysis demonstrated the potential impact of the PTE+DMT intervention in improving balance and self-efficacy measures related to falls when compared to participation in PTE alone. No statistically significant differences were observed between the groups in term of HRV and other physical and psychological fall risk factors. The emerging trends in the associations between HRV, fall risk, and balance levels suggest the potential utility of HRV as an objective psychophysiological marker for assessing fall risk levels. Moreover, the results underscore the potential advantages of interventions that integrate both physical and psychological components to mitigate fall risk in older adults, emphasizing the intricate mind–body connection.The ClinicalTrials.gov ID: NCT05948735, July 7, 2023.

Perceived Usefulness of Robotic Technology for Patient Fall Prevention.

Technology has the potential to prevent patient falls in healthcare settings and to reduce work-related injuries among healthcare providers. However, the usefulness and acceptability of each technology requires careful evaluation. Framed by the Technology Acceptance Model (TAM) and using the Adaptive Robotic Nursing Assistant (ARNA) to assist with patient ambulation, the present study examined the perceived usefulness of robots in patients' fall prevention with implications for preventing associated work-related injuries among healthcare providers. Employing an experimental design, subjects were undergraduate nursing students (N = 38) and one external subject (not a nursing student) who played the role of the patient. Procedures included subjects ambulating a simulated patient in three ways: (a) following the practice of a nurse assisting a patient to walk with the patient wearing a gait belt; (b) an ARNA-assisted process with the gait belt attached to ARNA; (c) an ARNA-assisted process with a subject walking a patient wearing a harness that is attached to ARNA. Block randomization was used with the following experimental scenarios: Gait Belt (human with a gait belt), "ARNA + Gait Belt" (a robot with a gait belt), and "ARNA + Harness" (a robot with a harness). Descriptive statistics and a multiple regression model were used to analyze the data and compare the outcome described as the Perceived Usefulness (PU) of a robot for patient walking versus a human "nurse assistant" without a robot. The independent variables included the experimental conditions of "Gait Belt," "ARNA + Gait Belt," and "ARNA + Harness," the subject's age, race, and previous videogame playing experience. Results indicated that PU was significantly higher in the Gait Belt + ARNA and Harness + ARNA conditions than in the Gait Belt condition (p-value <.01 for both variables). In examining potential influencing factors, the effects of race (White, African American, and Asian), age, and previous video-playing experience were not statistically significant (p-value >.05). Results demonstrated that using robot technology to assist in walking patients was perceived by subjects as more useful in preventing falls than the gait belt. Patient fall prevention also has implications for preventing associated work-related injuries among healthcare providers. Understanding the effects of a subject's perceptions can guide further development of assistive robots in patient care. Robotic engineers and interdisciplinary teams can design robots to accommodate worker characteristics and individual differences to improve worker safety and reduce work injuries.

Exploring Demographic and Cognitive Predictors of Self-Management in Quasi-Randomized Fall Prevention Intervention for Older Adults With and Without Traumatic Brain Injury.

Changes in health behavior are key to maintaining health, safety, and independence of older adults. The purpose of this study was to explore factors impacting training in self-management and behavior change in older adults with and without traumatic brain injury (TBI), informing efforts to improve safety and independent function. Forty-one older adults, 19 with TBI, completed a self-regulation intervention (mental contrasting with implementation intentions; MCII) to promote fall prevention behavior change. Participant outcomes were related to single and recurring behavior changes; implementation outcomes were measured as modifications to treatment. Although participants with TBI performed more poorly on tests of neurocognitive function, there were no differences in behavior change rates following MCII, suggesting the treatment worked similarly for participants with and without TBI. Across both groups, those with higher executive function scores were more likely to complete recurring behavior changes. Participants with higher stress, higher Fall Risk Scores, or history of TBI were more likely to need modifications to treatment. This quasi-experimental pilot study describes cognitive and psychosocial predictors that may be critical for participation and success in health behavior change and self-management of fall prevention for older adults with and without TBI.

Exercise for fall prevention in older adults

Background: Global population aging has significantly increased fall-related incidents among older adults, which is associated with major health risks and challenges for healthcare systems. Falls are a leading cause of injury, disability, and mortality in South Korea, which has shown rapid expansion of the elderly population. Development of effective fall-prevention strategies, including exercise-based interventions is important to address this issue.Current Concepts: Exercise-based fall prevention programs include several key types such as strength and functional movement training and balance exercises. Strength training includes resistance exercises and weightbearing activities to enhance muscle strength, which is essential for stability and fall prevention. Balance exercises improve stability and coordination, including standing on one leg and heel-to-toe walking. Functional movement training includes exercises that simulate daily activities and help individuals to improve their ability to safely perform routine tasks. Programs such as the Otago Exercise Program integrate these elements and offer a comprehensive approach to fall prevention. Such regimens combined with training in safe falling techniques are important to reduce fall risk and improve outcomes. Assessment tools, including the timed up-and-go and senior fitness tests, are useful to identify at-risk individuals and tailor interventions accordingly.Discussion and Conclusion: An effective fall prevention exercise program requires a multifaceted approach that combines various exercise types and focuses on improving muscle strength, balance, flexibility, and functional skills, as well as safe falling and floor recovery techniques. Tailoring these interventions to individual needs and regular risk assessments can enhance their usefulness.

Unveiling human biomechanics: insights into lower limb responses to disturbances that can trigger a fall.

Slip-related falls are a significant concern, particularly for vulnerable populations such as the elderly and individuals with gait disorders, necessitating effective preventive measures. This manuscript presents a biomechanical study of how the lower limbs react to perturbations that can trigger a slip-like fall, with the ultimate goal of identifying target specifications for developing a wearable robotic system for slip-like fall prevention. Our analysis provides a comprehensive understanding of the natural human biomechanical response to slip perturbations in both slipping and trailing legs, by innovatively collecting parameters from both the sagittal and frontal plane since both play pivotal roles in maintaining stability and preventing falls and thus provide new insights to fall prevention. We investigated various external factors, including gait speed, surface inclination, slipping foot, and perturbation intensity, while collecting diverse data sets encompassing kinematic, spatiotemporal parameters, electromyographic data, as well as torque, range of motion, rotations per minute, detection, and actuation times. The biomechanical response to slip-like perturbations by the hips, knees, and ankles of the slipping leg was characterized by extension, flexion, and plantarflexion moments, respectively. In the trailing leg, responses included hip flexion, knee extension, and ankle plantarflexion. Additionally, these responses were influenced by gait speed, surface inclination, and perturbation intensity. Our study identified target range of motion parameters of 85.19°, 106.34°, and 95.23° for the hips, knees, and ankles, respectively. Furthermore, rotations per minute values ranged from 17.85 to 51.10 for the hip, 21.73 to 63.80 for the knee, and 17.52 to 57.14 for the ankle joints. Finally, flexion/extension torque values were estimated as -3.05 to 3.22 Nm/kg for the hip, -1.70 to 2.34 Nm/kg for the knee, and -2.21 to 0.90 Nm/kg for the ankle joints. This study contributes valuable insights into the biomechanical aspects of slip-like fall prevention and informs the development of wearable robotic systems to enhance safety in vulnerable populations.

Staff perspectives on fall prevention activities in long-term care facilities for older residents: "Brief but often" staff education is key.

Falls are a serious health problem in long-term care facilities (LTCFs), affecting more than 50% of residents. A key role of LTCF staff is to assess fall risks and implement fall prevention activities. Understanding the barriers and facilitators is key to successful implementation. This descriptive qualitative study involving four LTCF facilities (varied provider types and sizes) in southwest Ireland. We recruited a convenience sample of 17 LTCF staff, who participated in semi-structured online 1:1 interviews (n = 7) or small group interviews (n = 10). The data were analysed using Braun and Clarke's reflective thematic analysis. The participants included two directors of nursing, three therapists, one ward manager, one general practitioner, five nurses and five healthcare assistants. Six main themes were identified, reflecting factors that influenced fall prevention: a need for sufficient staff and appropriate skill mix; fall policy, documentation and leadership; equipment and safe environments; person-centred care; staff knowledge, skills and awareness in falls prevention; and staff communication and collaborative working. A wide range of approaches that supported LTCF staff to overcome barriers were identified, including audits and feedback, falls champions, fall prevention leaders, daily communication (e.g., safety pauses) and staff collaboration. Formal multidisciplinary meetings and identification systems to highlight residents at high risk of falling were not considered helpful. Staff suggested that education should be briefer, ongoing and practice-based ("brief but often") to promote ownership and responsibility. LTCF staff identified several approaches to prevent falls in LTCFs as part of usual care, rather than lengthy, formal meetings and training. The potential role of families in fall prevention was under-appreciated and should be investigated further.

Qualitative Comparative Analysis of exercise interventions for fall prevention in residential aged care facilities

BackgroundExercise interventions are highly effective at preventing falls in older people living in the community. In residential aged care facilities (RACFs), however, the evidence for effectiveness is highly variable, warranting exploration of drivers of successful trials. This study aims to identify the conditions of randomised controlled trials (RCTs) that are associated with reducing falls in RACFs and test whether it can explain the variability.MethodsRCTs testing exercise interventions in RACFs compared to usual care, reporting rate or risk of falls from the 2018 Cochrane Collaboration review and a search update to December 2022 were included. Two authors independently extracted and coded trial conditions and outcomes according to a theory developed from prior Intervention Component Analysis. Trial outcomes were coded as successful or unsuccessful based on point estimates for the rate or risk ratio for falls, or p value. Qualitative Comparative Analysis (QCA), utilising Boolean minimisation theory, was conducted to determine the key conditions driving trial success. A subgroup meta-analysis and the GRADE approach was applied to the final theory.ResultsEighteen trials undertaken in 11 countries with 2,287 residents were included. Participants were predominately ambulant females aged 70 to 80 with cognitive impairment. Most interventions were fully supervised or supervised at the start of the intervention. QCA identified two configurations as drivers of successful exercise falls prevention programs: (i) group exercise that is moderate or low intensity, or (ii) for independent ambulatory residents, exercise for more than 1 h per week. The combination of configuration (i) and (ii) had consistency and total coverage scores of 1, indicating all trials were explained. This combination was associated with a reduction in falls (rate ratio 0.45, 95%CI 0.34 to 0.59; risk ratio 0.66, 95%CI 0.53 to 0.82; low certainty evidence).ConclusionTo successfully reduce falls in RACFs, exercise programs should provide continuous supervised moderate-intensity group exercise. For programs that mostly include independent ambulatory residents, exercise for at least 80 min per week should be provided. As many current residents are frail, tailored exercise is likely necessary and an individualised dose may be required. Future trials should test exercise interventions for less mobile residents.

The role of anti-osteoporosis drugs in fall risk

Osteoporosis is a common skeletal disease characterized by reduced bone mass and micro-architectural deterioration, which leads to an increased risk of fractures. A significant concern associated with osteoporosis is the risk of falls, which can result in fractures and other related complications. This review examines the role of anti-osteoporosis drugs in the prevention of falls, focusing on pharmacological interventions that have shown promise in reducing the incidence of falls in osteoporotic patients. Falls in older people often lead to fractures, decreased mobility and reduced quality of life. Given that individuals with osteoporosis are more susceptible to fractures, it is essential to explore therapeutic strategies aimed at mitigating fall risk in this population. Anti-osteoporosis drugs have been developed primarily to improve bone mineral density and strength. The most extensively explored in this sense is probably vitamin D. Several meta-analyses have indicated that vitamin D could reduce the risk of falling compared with placebo. For this nutrient, important in vitro and experimental research data are available showing, overall, a positive effect on muscle. However, there is emerging evidence that large bolus doses and/or high levels of vitamin D may increase the risk of falls. Denosumab, a monoclonal antibody against RANKL (receptor activator of nuclear factor-кB ligand), is widely used to treat osteoporosis, and its influence on falls, although supported by a recent systematic review, is currently under investigation. Understanding the relationship between anti-osteoporosis medications and fall prevention is critical in comprehensive management of osteoporosis. Although these drugs are primarily used to improve bone health, their influence on falls is an intriguing topic. KEY WORDS: Falls, denosumab, vitamin D, romosozumab.

Identifying opportunities for community EMS fall prevention

BackgroundFalls are a leading cause of morbidity and mortality among older adults in the United States. Current fall prevention interventions rely on provider referral or enrollment during inpatient admissions and require engagement and independence of the patient. Community emergency medical services (CEMS) are a unique opportunity to rapidly identify older adults at risk for falls and provide proactive fall prevention interventions in the home. We describe the demographics and treatment characteristics of the older adult population most likely to benefit from these interventions. Materials and methodsWe linked 2019 Healthcare Cost and Utilization Project Massachusetts State Emergency Department (ED) and State Inpatient Databases with American Hospital Association survey data to query ED encounters and inpatient admissions for adults age ≥55 with ED encounters for fall-related injury between July 1, 2019 and December 31, 2019. Univariable descriptive statistics assessed participant characteristics and bivariable tests of significance compared diagnoses, disposition, and hospital characteristics between older adults with and without an EMS encounter in the six months prior to the presenting fall. ResultsOf 66,027 older adults who presented with a fall to a Massachusetts ED in July-December 2019, 7,942 (11%) had a prior encounter with EMS in the preceding six months, most of which included an injury diagnosis (99%). Compared to older adults without previous EMS encounters, those with previous EMS encounters were more often in poorer health (17% vs. 10% with multiple or complex comorbidities, p < 0.001) and of lower socioeconomic status (12% vs. 8% in lowest neighborhood income quartile, p < 0.001; 10% vs. 6% enrolled in Medicaid, p < 0.001) compared to those without a prior EMS encounter. ConclusionsA significant proportion of older adults presenting to the ED with fall related injury have encounters with EMS in the preceding months. These participants are predisposed to poorer health and economic outcomes worsened by their fall and thus demonstrate a population that would benefit from CEMS fall prevention programs.

Exercise and Sports Science Australia updated position statement on exercise for preventing falls in older people living in the community

BackgroundsFalls affect a significant number of older Australians and present a major challenge to health care providers and health systems with over 380 older Australians hospitalised for a fall each day. ObjectivesThis statement seeks to inform and guide exercise practitioners and health professionals in safe and effective prescription of exercise to prevent falls amongst community-dwelling older people. Exercise prescription to prevent fallsExercise is crucial for preventing falls in older age. Research evidence has identified that programmes which include functional balance and muscle strength training are the most effective in preventing falls. It is also important for exercise to be progressively challenging, ongoing and of sufficient dose to maximise its benefits in reducing falls. Additional (non-exercise) interventions are necessary for people with complex medical conditions, recent hospitalisation and/or particular risk factors not improved by exercise. People at a higher risk of falls may need greater support to undertake safe and effective fall prevention exercise. SummaryGlobal guidelines for fall prevention and management recommend that all older adults should receive advice about exercise to prevent falls. Qualified exercise professionals are well placed to prescribe and supervise functional balance and muscle strength training to older people with varied functional abilities, including those with co-morbidities.

240 Does fall prevention also have to hinder physical activity?

Abstract Purpose Physical activity is effective for preventing falls and improves physical and mental health, increase function and quality of life. Regarding people at high risk of falling, such as residents at nursing homes, global guidelines recommend individually adapted exercise programs to prevent falls. These guidelines are not followed. We aimed to map out physical activity among people living at a nursing home. To our knowledge, this is the first study measuring physical activity 24 hours per day among residents at a nursing home. Method In this pilot study, persons who lived at one nursing home and could walk without a walking aid wore an Inertial Measurement Unit for 24 hours per day for 3 months. Main outcome measure was steps per day. For each participant, the mean steps per day during the period was calculated and for the total group, the median value of the mean steps per day was calculated. Results The participants (n = 5), three women and 2 men, 72 to 98 years old, walked in a median of 65 steps per day (10-356). Conclusion In Sweden, instead of following guidelines, technical solutions that monitor if a person tries to move are introduced at nursing homes, often in the form of web cameras. This means that falls are prevented by hindering physical activity and making sure the residents do not move at all. Our study shows that people living in nursing homes can have a very low level of physical activity. We call on all responsible organizations to initiate activities and efforts that enable rather than hinder physical activity. For example, use technology that promotes physical activity, build gyms located in nursing homes, use Virtual Reality to make the bike ride seem to take place outside in a beautiful landscape, and employ physiotherapists who can do balance-training exercises on an everyday basis.

A Case Study for Training Interprofessional Teams in Addressing the Social Determinants of Health in Older Adults.

This case study addresses the interwoven nature of the social determinants of health, fall prevention, older adults, and home healthcare as a topic for teaching interprofessional education across professional development or academic settings. The case study challenges interprofessional learners to dissect and discuss the profile of the patient and other stakeholders, care team decisions, evidence-based research, and the considerations of significant variables on the implications for clinical reasoning and practice. Interprofessional education that includes case studies leads to the development of better skills related to clinical assessments and problem-solving. Sample facilitation questions and extensive research and resources are provided to assist those preparing to implement and facilitate the case study during an interprofessional education training session. We concluded our article by encouraging practitioners to share teaching strategies through publication so we can strengthen interprofessional education learning, as this contributes to stronger, more effective interprofessional education experiences, a need highlighted in the literature.