Fall Risk Awareness Research Articles

Describing Older Adults' Awareness of Fall Risk Using Situation Awareness Research Techniques: A Pilot Study.

The purpose of the current study was to evaluate efficacy of techniques adapted from situation awareness research for describing how older adults perceive and understand fall risk factors in the context of daily routine. Eleven older adults watched a video of an older woman performing daily activities. Thirteen intrinsic, extrinsic, and behavioral fall risks were embedded throughout the scenario. The video was periodically frozen/blanked from view while participants answered questions about their understanding of the situation and associated story elements. Participants perceived a variety of fall risk factors but did not necessarily interpret them as indicating fall risk. Many fall risks held non-fall meaning for participants (e.g., newspapers on the floor meant the woman liked to read). Although four participants readily identified a fall risk situation, seven did not until they were explicitly asked to consider safety. Study techniques were effective for describing situation awareness of fall risk and several suggestions for improvement are described. [Res Gerontol Nurs. 2016; 9(4):161-166.].

Cross-cultural Educational Intervention and Fall Risk Awareness

ABSTRACTAims: To determine if a two-visit, personalized falls prevention educational intervention affected awareness of fall risk in community-dwelling older adults in Belize. Secondary aim: to assess new learning in a cross-cultural context and willingness to make lifestyle changes to reduce fall risk. Methods: A US-based team completed fall risk assessments (Short FES-I, mCTSIB, TUG, and 30-s Chair Stand Test), pre- and postintervention questionnaires, and an original postintervention semi-structured interview with eighteen participants. Investigators employed the Fall Risk Awareness Questionnaire (FRAQ) to assess awareness of fall risk. Intervention consisted of an educational class regarding fall risks that took place in a day centre, and a home visit. Questionnaire results were analyzed for statistical significance. Investigators completed thematic analysis of interviews. Results: Mean scores of the FRAQ rose slightly at posttest, but results were not statistically significant. Qualitative analyses revealed themes regarding specific fall risk awareness, barriers to change, and willingness to change. Conclusions: Participants in this sample demonstrated an increase in falls risk awareness after a brief falls prevention program. The sample size and prepost design limited generalizability of the results. Therapists should be aware of cultural competence, health literacy, and personal narrative of participants.

Development and Evaluation of an Online Fall-Risk Questionnaire for Nonfrail Community-Dwelling Elderly Persons: A Pilot Study.

Introduction. Falls are frequent in older adults and may have serious consequences but awareness of fall-risk is often low. A questionnaire might raise awareness of fall-risk; therefore we set out to construct and test such a questionnaire. Methods. Fall-risk factors and their odds ratios were extracted from meta-analyses and a questionnaire was devised to cover these risk factors. A formula to estimate the probability of future falls was set up using the extracted odds ratios. The understandability of the questionnaire and discrimination and calibration of the prediction formula were tested in a cohort study with a six-month follow-up. Community-dwelling persons over 60 years were recruited by an e-mail snowball-sampling method. Results and Discussion. We included 134 persons. Response rates for the monthly fall-related follow-up varied between the months and ranged from low 38% to high 90%. The proportion of present risk factors was low. Twenty-five participants reported falls. Discrimination was moderate (AUC: 0.67, 95% CI 0.54 to 0.81). The understandability, with the exception of five questions, was good. The wording of the questions needs to be improved and measures to increase the monthly response rates are needed before test-retest reliability and final predictive value can be assessed.

골다공증 여성의 골절위험도와 낙상예방행위와의 관계에 미치는 낙상위험지각의 매개효과

Purpose: This study aims to establish a theoretical framework for the fall prevention behavior improvement program by verifying the associations between fracture risk, fall risk perception, and fall prevention behaviors in women with osteoporosis. Methods: A survey was conducted in 122 women who were diagnosed as osteoporosis by having T-score of the femur bone density below -2.5 standard deviation from the bone density examination performed in 2 orthopedic clinics located in B metropolitan city between July 2014 and September 2014. The risk of fracture, level of fall risk perception, and fall prevention behaviors were measured. Results: Fall risk perception had a complete mediating effect on the relationship between the fracture risk and fall prevention behaviors in women with osteoporosis. Conclusion: The perception of fall risk is important to enhance fall prevention behaviors in women with osteoporosis, and the development of various education programs to improve awareness of fall risk is needed.

Fall risk awareness in older community-dwelling people in northern Sweden: a qualitative study with focus groups

Fall risk awareness in older community-dwelling people in northern Sweden : A qualitative study with focus groups

Pharmacist consultations: simplifying daily drug regimens and providing education on fall risk for older adults.

To evaluate whether a medication review by a pharmacist in the community can simplify an older adult's daily drug regimen and improve awareness of medication-related fall risk. Pre- and posttest with follow-up design. Senior centers, senior housing facilities, and community centers in Massachusetts. Older adults who attended a pharmacy outreach program at a community center. Participants engaged in a one-time, face-to-face, medication therapy management (MTM) session. The pharmacists made recommendations to simplify daily drug regimens for best therapeutic results. The participants were educated regarding the influence that medications may have on fall risk. For the 75 participants, daily dose regimens were significantly reduced. From the presurvey to the follow-up surveys, there was a significant increase of participants taking medication three times or fewer per day (73% to 85%) versus those participants taking medications more than three times per day (P = 0.041). Through MTM consultations, participants' awareness that medications may be a contributing factor to fall risk was increased from 28% in the presurvey to 56% in the postsurvey (P = 0.0018). A pharmacist consultation can simplify the daily drug regimen. Furthermore, consultant pharmacists can educate patients regarding the risk that medications may have on falls.

Awareness of medication-related fall risk: a survey of community-dwelling older adults

Background: Falling is a serious health problem among older adults. The objective of this study was to assess older adults’ awareness of medications associated with increased fall risk and to evaluate the impact of pharmacist counseling on the risk of medication-related falls. Methods: Data were collected using an online questionnaire with four items to determine pharmacist counseling encounter, fall history, and number of medications taken; two items to collect demographic information; and 15 knowledge-based items to determine medication-related fall risk awareness. Participants were communitydwelling adults aged 60 years and older. Results: Two hundred and six older adults (mean age = 69.07 years, SD = 5.59) participated in the study by completing all or part of the questionnaire. The number of older adults who reported having fallen within the last five years was 90 (43.7%). The knowledge-based portion of the questionnaire was completed by 162 participants. One hundred and nineteen (73.5%) questionnaire respondents scored <70% on the knowledge assessment (mean score 49.3%, SD = 26.8). The 12 respondents (7.6%) who reported having received pharmacist counseling regarding medication-related fall risk scored significantly higher on the knowledge assessment compared to the 145 respondents who did not (mean score 61.66% versus 48.09%, p = 0.01). Conclusions: A majority of community-dwelling older adults lacked knowledge of medications associated with an increased risk of falling. Though most participants were never counseled by a pharmacist, those who had been counseled demonstrated greater awareness. Thus, pharmacist counseling of older adults regarding medications and fall risk should be promoted.

Assessing practice relating to fall risk management among nurses in an acute ward setting: a best practice implementation report

Background Falls are a leading cause of major preventable adverse events in public hospitals. In 2009, Waikato District Health Board (DHB) implemented a Fall Risk Management Process requiring routine assessment using a standardised framework for all patients within 12 hours of admission. Objectives The aim of this project was to audit current practice in relation to the utilisation of the Fall Risk Management Process, implement a plan of action based on findings, and to re-audit practice post-implementation to identify change and to inform further work. Methods An evidence-based audit on fall risk and prevention, identified from the JBI PACES programme, was done on 21 sets of inpatient notes using retrospective note review, an intervention of education, identification and self-directed learning was instigated and a re-audit post-implementation was completed. Results There were better outcomes in most criteria with the completion of a fall risk assessment on transfer having the greatest improvement. Documentation around patient and family education for patients at high risk of a fall was lacking; this does not imply that this had not occurred. Some criteria highlighted differences between certain audit criterion and DHB policy. Conclusions The findings show that focused education can have an immediate impact on clinical practice by creating an environment with enhanced awareness of fall risk. We have identified where further work can be done to improve documentation and have identified areas to be considered within the ‘Fall’ policy. The challenge will be in sustaining the change in practice related to falls.

Translation, cultural adaptation and evaluation of the psychometric properties of the Falls Risk Awareness Questionnaire (FRAQ): FRAQ-Brazil

ObjectiveThis study aimed to translate and culturally adapt the Falls Risk Awareness Questionnaire (FRAQ) for the elderly Brazilian population as well as to evaluate the internal consistency and reliability of this instrument. MethodThe study used internationally accepted guidelines for the cross-cultural adaptation process. The questionnaire in its final Portuguese version was then applied to 120 elderly people to assess the measurement properties. The participants were interviewed twice in the first assessment (examiners 1 and 2 at an interval of 30to60minutes) and again after 2 to 7 days by examiner 1. The internal consistency was assessed with Cronbach' s alpha coefficient. To evaluate the reliability of the intra- and inter-evaluators, the Kappa coefficient for categorical variables was used; for numeric variables, the intra-class correlation coefficient (2-way mixed model) and the respective 95% confidence intervals were used in addition to the concordance test of Bland and Altman. ResultsThe Brazilian version of the FRAQ was obtained while maintaining a semantic, idiomatic, cultural and conceptual equivalence. The internal consistency was α=0.95, while for intra-examiner reliability, an intrarater correlation coefficient (ICC-3,1) of 0.91 was obtained with an intra-class correlation Kappa coefficient of 0.89 and a Bland and Altman mean difference (bias) of -0.52. Regarding the inter-examiner reliability, the ICC=0.78, Kappa=0.76 and bias=0.12. ConclusionsThe translation and cultural adaptation of the FRAQ for the elderly Brazilian population was successfully performed. The instrument demonstrated excellent reliability and internal consistency, thus making it useful for assessing the perception of the risk of a fall among elderly Brazilians.

Fall scenarios In causing older women's hip fractures

Objective.Falls and fall-related injuries among older women constitute a major public health problem with huge costs for the society and personal suffering. The aim of this study was to describe and illustrate how a number of circumstances, conceptualized as a scenario, that were related to the individual, the environment, and the ongoing occupation contributed to a fall that led to a hip fracture among women. The sample included 48 women over 55 years old. Methods.Interviews were conducted during home visits and the analysis provided a descriptive picture of circumstances in the shape of a scenario related to the risk of falling. A number of scenarios were developed based on the data and named to provide an understanding of the interplay between the individual, the environment, and the ongoing occupation at the time of the fall. Results.By applying the concept of a scenario, occupational therapists can increase the awareness of fall risks among older people, and are relevant also for interior designers, architects, and town planners to consider when designing the local environment as well as furniture and other objects.

Promoting Fall Self-Efficacy and Fall Risk Awareness in Older Adults

ABSTRACTIntroduction: This study examined whether participation in a modified version of the “Stepping On” program was effective in increasing fall self-efficacy, static and dynamic balance, and awareness of fall risks in older adults. Design: A mixed methods, one-group, nonexperimental, pretest-posttest design. Participants: Nineteen women aged 65 and older residing in a senior living facility. Intervention: Participants attended a 7-week fall prevention education program focused on group exercises, home hazards, community safety and footwear, and vision and medication management. The program met for 2 h weekly for 7 weeks. Participants were assessed pre- and postintervention using the Modified Falls-Efficacy Scale, Get Up and Go Test, and Romberg Balance Test. In addition, a focus group was facilitated postintervention to determine participants’ awareness of fall risks. Results: While the Modified Falls-Efficacy Scale (MFES) postintervention results were not statistically significant, they did indicate a decreased level of confidence in participants’ ability to avoid a fall postintervention. “Get Up and Go” completion time also increased postintervention, but was not statistically significant. No change in static balance was noted in Romberg Balance Test results. Participants did report an overall increase in awareness of fall risks postintervention. Conclusion: Although results did not support the hypotheses regarding increased fall self-efficacy and static and dynamic balance, participation in the modified “Stepping On” program did lead to an overall increase in awareness of fall risks. Modifying the evidence-based program made it feasible to test in a new community and may have empowered older adults with the knowledge to prevent future falls.

Breaking the Fall

: The Helping Hands program is a nurse-directed falls prevention program designed to support a hospital-wide culture of safety and reduce harm from falls. : Patient falls and the associated morbidity and mortality represent a significant risk for patients and healthcare facilities. Age-adjusted fatalities from falls increased significantly from 1993 to 2003. By 2020, the annual cost of injuries from falls is expected to exceed $40 billion. : Components of the Helping Hands falls prevention program worked synergistically to support the development of a culture of safety at Robert Wood Johnson University Hospital. The program consisted of nursing assessment of fall risk with the Johns Hopkins Fall Risk Assessment Tool; reviews of fall risk and intervention efficacy; creation of communication mechanisms, reporting processes, and change champion roles; engagement of patients and families in falls prevention; increased public awareness of fall risk through signage; nursing interventions; and utilization of nursing performance improvement analysts. : Over 3 years, 65% (N = 7,900) of more than 12,000 patients assessed were at risk of falling. Most falls caused no or little harm, and at 3 years of follow-up, total falls decreased by 16.6 %, and severe falls accounted for 0.009 % (n = 2) of all falls. : The data offer a hopeful perspective on the role of nursing engagement in developing a hospital-wide culture of safety and protecting patients from permanent harm caused by fall events.

Fall-Prevention Policies in Pediatric Sleep Laboratories

Despite the extensive awareness and prevention strategies of fall risks for adults and children during hospitalization, little information is available on the occurrence, cause, and consequences of falls in sleep laboratories. A patient fall is defined as any sudden unexpected descent from a standing, sitting, or other position, with or without injury to the patient. Patient falls constitute the most common adverse events reported in hospitals, representing nearly 40% of all incident reports and occur during as many as 13% of hospital admissions.1

Achieving 100% National Certification Rates for Registered Nurses on a Pediatric Inpatient Unit

and clinical data, a fall risk assessment tool was developed. Factors were categorized according to low, moderate, or high risk for association with a fall, with appropriate interventions for each level. The fall risk assessment and prevention program involved hospital-wide education. A self-learning module with case presentations was provided, as well as unit-based education and competency assessment to assure consistent utilization of the program. Program evaluation using incident reports and chart review at quarterly intervals is being conducted. Findings: An evidence-based fall risk assessment and prevention program was implemented. The program increased staff and parent awareness of fall risk and interventions to prevent falls. Conclusion/Discussion: Ongoing evaluation of the data will guide necessary revisions to the fall assessment and prevention program. As a result of this research, nurses will better understand the causes of falls in children versus adults and tailor interventions for the pediatric population to decrease risk and injury.

Knowledge of Risk Factors for Falling Reported by Patients with Parkinson Disease

This study examined awareness of the risk factors for falling among a group of community dwelling patients with Parkinson disease (PD) using the Falls Risk Awareness Questionnaire (FRAQ). A cross-sectional survey of 28 patients who attended a Movement Disorders Clinic for treatment of PD was used. FRAQ is a 28-item self-administered survey that assesses the knowledge and perception of risk factors for falling. Demographic, medical, and medication data were gathered from both the participants and clinic charts. Twenty-three (82%) of the participants reported falls in the past; seven (30%) had fallen within the past month. Nineteen (68%) of the participants felt they were at risk for further falls. When asked to list potential risk factors for falling, only 14% could identify medication as a risk factor. Persons with PD are at substantial risk of falling, yet many appear to be unaware of common risk factors, especially medication use.

Older people enhancing self‐efficacy in fall‐risk situations

A falls prevention programme based on Bandura’s self‐efficacy theory was evaluated using qualitative interviews. This programme aimed to enhance older people’s self‐efficacy in fall‐risk situations. The mastery‐building component of the programme was the key factor distinguishing it from other falls prevention programmes. It was also one of the most successful aspects of the programme for increasing self‐efficacy in community mobility activities. Seven of the eight participants experienced increased self‐efficacy in at least some daily activities, particularly those practised during the programme. Awareness of fall risks and how to minimise these increased. Participants took action to reduce environmental hazards and reported increased activity participation. Occupational therapists recognise the importance of self‐efficacy as a useful concept in occupational therapy practice due to its emphasis on self‐perception of capabilities within the context of specific activities. However, an understanding of self‐efficacy has not yet been integrated into occupational therapy practice. This study found that Bandura’s self‐efficacy theory was easily translated into practice and was readily applicable to the area of falls prevention among older people. The findings of this study support the inclusion of activity participation and mastery experiences being a primary focus of falls prevention programmes.