Multifactorial Fall Prevention Research Articles

Pharmacist intervention is associated with fewer serious falls over 3 months among older fallers at a day hospital: A quasi-experimental study

ObjectivesSome drugs increase the risk of falls, including serious falls. The objective of this quasi-experimental study was to determine whether the intervention of a clinical pharmacist among older outpatients receiving a multifactorial fall prevention program at a geriatric day hospital dedicated to older patients with a recent history of falls was effective in preventing serious falls over a 3-month follow-up, compared with usual care. Study designQuasi-experimental study in 296 consecutive older outpatients, including 85 with pharmacist intervention (the intervention group) and 148 without (the control group). Main outcome measuresThe main outcome was the occurrence of at least one serious fall within 3 months of follow-up. Covariates included age, sex, body mass index, grip strength, history of falls, Mini-Mental State Examination score, use of ≥3 drugs associated with risk of falls, frailty, and disability. ResultsFewer participants in the intervention group experienced at least one serious fall than in the control group (5 (5.9 %) versus 23 (15.5 %), P = 0.029), which persisted after adjustment for potential confounding factors (OR = 0.30 [95CI:0.11–0.84], P = 0.022). No significant effect was found on the indicence of all falls. Pharmacist intervention allowed more frequent therapeutic optimizations of antithrombotics (OR = 3.69 [95CI: 1.66–8.20]), proton pump inhibitors (OR = 3.34 [95CI: 1.31–8.50]), benzodiazepines (OR = 3.15 [95CI: 1.06–9.36]) and antidepressants (OR = 3.87 [95CI: 1.21–12.35]). ConclusionsAmong older fallers receiving a multifactorial fall prevention program at a day hospital, a clinical pharmacist intervention was associated with fewer incident serious falls over 3 months of follow-up.

BE-EMPOWERed program: Belgian study Enhancing the uptake and the Effectiveness of a Multifactorial fall Prevention intervention in older community-dwelling persons.

Background: 24 to 40% community-dwelling older persons (65+) fall annually, of which 21 to 45% fall recurrently. There is evidence for the use of a multifactorial fall prevention intervention. However, recent pragmatic trials, conclude that there is no effect on rate of falls. A possible explanation for these differences in results is the poor implementation of recommendations. This project aims to enhance the uptake and the effectiveness of a multifactorial fall prevention intervention in older community-dwelling persons in Flanders, Belgium.
 Methods: The BE-EMPOWERed project consists of three phases: 1) preparation, 2) development and 3) evaluation. The preparation phase is completed and it consisted of several sub studies: [1] a systematic review on implementation strategies, [2] a systematic review on influencing factors and [3] a qualitative study analyzing the context of the community setting. 
 Both reviews are registered in PROSPERO (CRD42020187450, CRD42022295988). Searches were performed in five databases and mapped following PRISMA guidelines. The Mixed Method Appraisal Tool was used to assess methodological quality. The implementation strategies were described following the recommendations for specifying and reporting implementation strategies and the Taxonomy of Behavioral Change Methods. For the review on influencing factors, the determinants were categorized using ‘The Integrated Checklist of Determinants of practice’ (TICD checklist).
 The contextual analysis consisted of semi-structured interviews and focus group interviews with healthcare professionals, local policy makers and older persons. The TICD checklist was used to obtain more insights into the context. The interviews were verbatim transcribed, analyzed using the Qualitative Analysis Guide of Leuven and coded in NVivo.
 
 Results: In the systematic review on implementation strategies fifteen studies were included, describing more than 38 implementation strategies. The most frequently used strategies at the level of the older person were tailoring, personalize risk, active learning and participation. At the level of the environment, technical assistance, peer education, participatory problem solving, forming coalitions and increasing stakeholders influence were most often described.
 The review on influencing factors consisted of 25 studies. In total, 37 barriers and 32 facilitators were identified. Most frequently mentioned factors were availability of necessary resources, knowledge and motivation, compatibility with current practice and professional interaction.
 The results of the contextual analysis showed the need to integrate a multifactorial fall prevention intervention into the life of the older persons, to increase awareness and knowledge, to create a shared vision and responsibility, to implement a multifactorial fall prevention intervention into an organized structure and to increase collaboration and communication.
 Based on the insights of the systematic reviews and contextual analysis the BE-EMPOWERed program is currently being developed. The BE-EMPOWERed program will consist of implementation strategies at different levels of the context (e.g. group program for older persons, training and support of group leaders, workshops for healthcare professionals and implementation plan for local policy makers). In 2023 this program will be pilot tested in one primary care area in Flanders.
 Conclusion: Understanding the existing structures, norms, policies and other determinants allowed us to identify potential barriers and to proactively tailor the implementation strategies and the intervention.

BRINGING COMMUNITY-BASED FALLS PREVENTION PROGRAM TO IMPROVE GLOBAL HEALTH (BRIGHT)

Abstract Older adults in low- and middle-income countries (LMICs) experience a disparate burden of non-communicable diseases (NCDs) and barriers to accessing health care. Unintentional injuries are among the major NCDs, and falls are the second leading cause of these injuries and deaths. Falls were reported in up to 50% of older people living in Asia, including Thailand. There is a lack of community-based multifactorial fall prevention interventions that target both older adults and the primary care systems. We aimed to culturally adapt the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) for Thai older adults and explore the feasibility, appropriateness, and acceptability of using STEADI by trained community health workers (CHWs) and care managers (CMs). STEADI consists of three steps: screening, assessing, and intervening. In Step a, CHWs screened fall risk using three key questions and found that all of participants had fall risk, then CHWs screened with a Stay Independent questionnaire (range 0-14) and found that 100% have high fall risk (total scores 9.7± 2.4). In Step b, CMs assessed risk factors and CHWs assessed home hazards. They found that 50% had poor balance, 70% took 4+ medications, 75% fell on the walkway, and 70% had no bathroom modifications. In Step c, individual participants received fall prevention interventions and participants attended all sessions. Our results indicated that STEADI delivered by CHWs and CMs is feasible and acceptable for older adults. The mean scores of acceptability, appropriateness, and feasibility were 19.20,18.80, and 18.60 out of 20 totals, respectively.

Reducing care home falls: a real-world data validation of a multifactorial falls-intervention digital application

BackgroundOne in three adults over the age of 65 and one in two adults over the age of 80 will experience a fall a year. Falls account for a considerable cost burden for the National Health Services. Preventing falls in elderly care homes is a significant public health policy goal in the United Kingdom. The 2004 National Institute for Health and Care Excellence Clinical Guideline (CG21) recommends risk detection and multifactorial fall prevention interventions. Digital technology allows individualised monitoring and interventions. However, there is no certainty of the impact of multifactorial interventions on the rate of falls.MethodsA mixed methods Real-World Validation incorporating a retrospective multi-centre case–control study using real-world data and qualitative study to assess the effectiveness of a falls prevention application in 32 care homes in the Northwest of England. The study aims to assess if a multifactorial fall-prevention digital App reduces falls and injurious falls in care homes. The primary outcome measures were the rate of patient falls per 1000 occupied bed days in care homes for 12 months. A digital multifactorial risk assessment and a tailored fall prevention plan linking each risk factor with the appropriate preventive interventions were implemented/reviewed monthly.For the intervention group two datasets were used. The first set was data recorded in the App on falls and resulting injury levels, multifactorial risk assessments, and number of falls. Sociodemographic variables (gender and age) of care homes residents were also collected for this group. Data for the first twelve months of use of the intervention were collected for early adopter intervention homes. Less than twelve months data was obtainable from care home adopting the intervention later in the study. The second dataset was constituted by intervention and comparable control anonymised data extracted from the care home residents' registries from Borough 1 Council and Borough 2 Clinical Commissioning Group, including quantitative data on the number of falls, number of injurious falls, and outcomes, with emergency room and hospital records for Borough 2.For the qualitative study, twelve video interviews conducted by Safe Steps were analysed thematically to identify user perceptions of various aspects of the App including need, development, implementation, use and benefits.ResultsThe secondary outcome was the rate of injurious falls per 1000 occupied bed days. There were 2.23 fewer falls per 1000 occupied bed days in the Intervention group (M = 6.46, SD = 3.65) compared with Control (M = 8.69, SD = 6.38) (t(2.67) = -2.686, p = 0.008). The intervention had 3.5 fewer low harm injurious falls ratio per 1000 occupied bed days (M = 3.14, SD = 4.08) (M = 6.64, SD = 6.22) (t(144) = -3588, p < 0.01). There were significant differences between Intervention and Control on injurious falls resulting in ambulance calls (t(31.18) = -3.09, p = 0.04); and patients arriving at Accident & Emergency (t(17.25) = -3.71, p = 0.002).Thematic analysis of the video interviews identified the following six themes: Alleviation of staff workload; the impact of falls on both the individual and on the health care system; achievement of health outcome benefits, including reduced hospital visits for falls and improved quality of life for the patients living in care homes; the improvement over paper-based risk assessments for staff; the uniqueness of the person-centred approach of the App; and the ability of the approach to track patients across boundaries in the health and social care system.ConclusionsIn this real-world validation, the implementation of a multifactorial fall-prevention digital app was associated with a significant reduction in falls and injurious falls, and was perceived to be highly beneficial by care home residents, staff, management and care commissioners where the approach was implemented.

Talking about falls: a qualitative exploration of spoken communication of patients’ fall risks in hospitals and implications for multifactorial approaches to fall prevention

BackgroundInpatient falls are the most common safety incident reported by hospitals worldwide. Traditionally, responses have been guided by categorising patients’ levels of fall risk, but multifactorial approaches are now recommended....

Influencing factors of interprofessional collaboration in multifactorial fall prevention interventions: a qualitative systematic review

BackgroundWith the ageing population worldwide, falls are becoming a severe and growing health problem. Interprofessional multifactorial fall prevention interventions (FPIs) have effectively prevented falls in community-dwelling older adults. However, the implementation of FPIs often fails due to a lack of interprofessional collaboration. Therefore, gaining insight into the influencing factors of interprofessional collaboration in multifactorial FPI’s for older adults living in the community is essential. Consequently, our aim was to provide an overview of factors influencing interprofessional collaboration in multifactorial FPIs for community-dwelling older adults.MethodsThis qualitative systematic literature research was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Pubmed, CINAHL, and Embase electronic databases have been systematically searched for eligible articles, with a qualitative design. The quality was appraised using the Checklist for Qualitative Research by the Joann Briggs Institute. The findings were inductively synthesized using a meta-aggregative approach. Confidence in the synthesized findings was established using the ConQual methodology.ResultsFive articles were included. Analysis of the included studies resulted in 31 influencing factors for interprofessional collaboration, which were labelled as findings. These findings were summarized in ten categories and combined into five synthesized findings. Results showed that communication, role clarity, information sharing, organization, and interprofessional aim influence interprofessional collaboration in multifactorial FPIs.ConclusionsThis review provides a comprehensive summary of findings on interprofessional collaboration, specifically in the context of multifactorial FPIs. Knowledge in this area is considerably relevant given the multifactorial nature of falls, which demands an integrated, multidomain approach, including both health and social care. The results can be utilized as a fundament for developing effective implementation strategies aiming to improve interprofessional collaboration between health and social care professionals working in multifactorial FPIs in the community.

Contextual determinants influencing the implementation of fall prevention in the community: a scoping review.

Successful implementation of multifactorial fall prevention interventions (FPIs) is essential to reduce increasing fall rates in community-dwelling older adults. However, implementation often fails due to the complex context of the community involving multiple stakeholders within and across settings, sectors, and organizations. As there is a need for a better understanding of the occurring context-related challenges, the current scoping review purposes to identify what contextual determinants (i.e., barriers and facilitators) influence the implementation of FPIs in the community. A scoping review was performed using the Arksey and O'Malley framework. First, electronic databases (Pubmed, CINAHL, SPORTDiscus, PsycINFO) were searched. Studies that identified contextual determinants that influence the implementation of FPIs in the community were included. Second, to both validate the findings from the literature and identify complementary determinants, health and social care professionals were consulted during consensus meetings (CMs) in four districts in the region of Utrecht, the Netherlands. Data were analyzed following a directed qualitative content analysis approach, according to the 39 constructs of the Consolidated Framework for Implementation Research. Fourteen relevant studies were included and 35 health and social care professionals (such as general practitioners, practice nurses, and physical therapists) were consulted during four CMs. Directed qualitative content analysis of the included studies yielded determinants within 35 unique constructs operating as barriers and/or facilitators. The majority of the constructs (n = 21) were identified in both the studies and CMs, such as "networks and communications", "formally appointed internal implementation leaders", "available resources" and "patient needs and resources". The other constructs (n = 14) were identified only in the . Findings in this review show that a wide array of contextual determinants are essential in achieving successful implementation of FPIs in the community. However, some determinants are considered important to address, regardless of the context where the implementation occurs. Such as accounting for time constraints and financial limitations, and considering the needs of older adults. Also, broad cross-sector collaboration and coordination are required in multifactorial FPIs. Additional context analysis is always an essential part of implementation efforts, as contexts may differ greatly, requiring a locally tailored approach.

Implementation fidelity of a multifactorial in-hospital fall prevention program and its association with unit systems factors: a single center, cross-sectional study

BackgroundFalls are a common, costly global public health burden. In hospitals, multifactorial fall prevention programs have proved effective in reducing falls’ incidence; however, translating those programs accurately into daily clinical practice remains challenging. This study’s aim was to identify ward-level system factors associated with implementation fidelity to a multifactorial fall prevention program (StuPA) targeting hospitalized adult patients in an acute care setting.MethodsThis retrospective cross-sectional study used administrative data on 11,827 patients admitted between July and December 2019 to 19 acute care wards at the University Hospital Basel, Switzerland, as well as data on the StuPA implementation evaluation survey conducted in April 2019. Data were analysed using descriptive statistics, Pearson’s coefficients and linear regression modelling for variables of interest.ResultsThe patient sample had an average age of 68 years and a median length of stay of 8.4 (IQR: 2.1) days. The mean care dependency score was 35.4 points (ePA-AC scale: from 10 points (totally dependent) to 40 points (totally independent)); the mean number of transfers per patient -(e.g., change of room, admission, discharge) was 2.6 (range: 2.4– 2.8). Overall, 336 patients (2.8%) experienced at least one fall, resulting in a rate of 5.1 falls per 1’000 patient days. The median inter-ward StuPA implementation fidelity was 80.6% (range: 63.9–91.7%). We found the mean number of inpatient transfers during hospitalisation and the mean ward-level patient care dependency to be statistically significant predictors of StuPA implementation fidelity.ConclusionWards with higher care dependency and patient transfer levels showed higher implementation fidelity to the fall prevention program. Therefore, we assume that patients with the highest fall prevention needs received greater exposure to the program. For the StuPA fall prevention program, our results suggest a need for implementation strategies contextually adapted to the specific characteristics of the target wards and patients.

Analyzing a Multifactorial Fall Prevention Program Using ARIMA Models.

Preventing inpatient falls is challenging for hospitals to improve and often leads to patient injury. To describe multifactorial patient-tailored interventions and to evaluate whether they were associated with a sustained decline in total and injury falls. A multifactorial fall prevention program was instituted over the course of several years. An interrupted time series design was used to assess the effect of each intervention on total and injury fall rates. ARIMA models were built to assess the step and ramp change. Total fall rates decreased from 4.3 to 3.6 falls per 1000 patient days (16.28% decrease), and injury fall rates decreased from 1.02 to 0.8 falls per 1000 patient days (21.57% decrease). All the interventions contributed to fall reduction, with specific interventions contributing more than others. Using multiple interventions that are sustained long enough to demonstrate success reduced the total fall rate and injury fall rate.

Efficacy of a multiple-component and multifactorial personalized fall prevention program in a mixed population of community-dwelling older adults with stroke, Parkinson's Disease, or frailty compared to usual care: The PRE.C.I.S.A. randomized controlled trial.

BackgroundFall risk in the elderly is a major public health issue due to the injury-related consequences and the risk of associated long-term disability. However, delivering preventive interventions in usual clinical practice still represents a challenge.AimTo evaluate the efficacy of a multiple-component combined with a multifactorial personalized intervention in reducing fall rates in a mixed population of community-dwelling elderly compared to usual care.DesignRandomized Controlled Trial (NCT03592420, clinicalTrials.gov).SettingOutpatients in two Italian centers.Population403 community-dwelling elderly at moderate-to-high fall risk, including subjects with Parkinson's Disease and stroke.MethodsAfter the randomization, the described interventions were administered to the intervention group (n = 203). The control group (n = 200) received usual care and recommendations to minimize fall risk factors. In addition, each participant received a fall diary, followed by 12 monthly phone calls. The primary endpoint was the total number of falls in each group over 12 months, while the secondary endpoints were other fall-related indicators recorded at one year. In addition, participants' functioning was assessed at baseline (T1) and 3-month (T3).Results690 falls were reported at 12 months, 48.8% in the intervention and 51.2% in the control group, with 1.66 (± 3.5) and 1.77 (± 3.2) mean falls per subject, respectively. Subjects with ≥ 1 fall and ≥2 falls were, respectively, 236 (58.6%) and 148 (36.7%). No statistically significant differences were observed between groups regarding the number of falls, the falling probability, and the time to the first fall. According to the subgroup analysis, no significant differences were reported. However, a statistically significant difference was found for the Mini-BESTest (p = 0.004) and the Fullerton Advanced Balance Scale (p = 0.006) for the intervention group, with a small effect size (Cohen's d 0.26 and 0.32, respectively), at T1 and T3 evaluations.ConclusionsThe intervention was ineffective in reducing the number of falls, the falling probability, and the time to the first fall at 12 months in a mixed population of community-dwelling elderly. A significant improvement for two balance indicators was recorded in the intervention group. Future studies are needed to explore different effects of the proposed interventions to reduce falls and consequences.

Engagement of older adults in STRIDE's multifactorial fall injury prevention intervention.

Evidence-based multifactorial fall prevention interventions in clinical practice have been less effective than expected. One plausible reason is that older adults' engagement in fall prevention care is suboptimal. This was a post-hoc analysis of 2403 older adults' engagement in a multifactorial fall prevention intervention in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) pragmatic trial. Based on the direct clinical care level of the Patient and Family Continuum of Engagement (CE) framework, three indicators of progressively interactive engagement were assessed: (1) Consultation (receiving information), (2) Involvement (prioritizing risks), and (3) Partnership (identifying prevention actions). Drop off at each step was determined as well as predictors of engagement. The participants' engagement waned with increasingly interactive CE domains. Although all participants received information about their positive fall risk factors (consultation) and most (51%-96%) prioritized them (involvement), fewer participants (33%-55%) identified fall prevention actions (partnership) for most of their risk factors, except for strength gait or balance problems (95%). More participants (70%) identified home exercises than other actions. Finally, fall prevention actions were identified more commonly among participants who received two visits compared to one (OR=2.33 [95% CI, 2.06-2.64]), were ≥80 years old (OR=1.83 [95% CI, 1.51-2.23]), and had fewer fall risk factors (OR=0.90 [95% CI, 0.83-0.99]). The drop-off in participants' engagement based on the level of their interaction with clinicians suggests that future multifactorial fall prevention interventions need to be more focused on interactive patient-clinician partnerships that help older adults increase and maintain fall prevention actions. Our analyses suggest that more frequent contact with clinicians and more monitoring of the implementation and outcomes of Fall Prevention Care Plans could potentially improve engagement and help older adults maintain fall prevention actions.

Feasibility of a new multifactorial fall prevention assessment and personalized intervention among older people recently discharged from the emergency department

Falls among older people occur frequently and are a leading cause of Emergency department (ED) admissions, disability, death and rising health care costs. Multifactorial fall prevention programs that are aimed to target the population at risk have shown to effectively reduce the rate of falling and fall-related injuries in community-dwelling older people. However, the participation of and adherence to these programs in real life situation is generally low. To test the feasibility of a transitionally organized fall prevention assessment with accompanying personalized intervention initiated at the ED. A process evaluation, of a non-randomized controlled pilot trial for implementing a transitionally organized multifactorial fall prevention intervention, was performed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to gain insight into the barriers and facilitators of implementation. Older fallers (>70yrs) presenting at the ED were selected based on ZIP-code and after obtaining informed consent, data for the evaluation was collected through questionnaires and interviews. Furthermore, feedback was collected from the healthcare providers. The consent was obtained by 24 (70%) of the patients approached directly at the ED and 17 (26%) of the patients approached later by phone. Adherence to the protocol by the participants, clinical assessors and family practice were all more than 90%. After three months, nine (26%) of the participants had at least one recurrent fall: three (20%) patients in the intervention group and six (32%) in the control group. ED presentation due to a fall in older persons provides a window of opportunity for optimizing adherence to a multifactorial fall prevention program as willingness to participate was higher when the patients were approached at the ED during their stay. Implementing a transitionally organized multidisciplinary fall prevention program was successful with a high protocol adherence. NTR NL8142, November 8, 2019.

Optimizing Post-Acute Care Patient Safety: A Scoping Review of Multifactorial Fall Prevention Interventions for Older Adults.

Accidental falls are preventable adverse events for older post-acute care (PAC) patients. Yet, due to the functional and medical care needs of this population, there is little guidance to inform multidisciplinary prevention efforts. This scoping review aims to characterize the evidence for multifactorial PAC fall prevention interventions. Of the 33 included studies, common PAC intervention domains included implementing facility-based strategies (e.g., staff education), evaluating patient-specific fall risk factors (e.g., function), and developing an individualized risk profile and treatment plan that targets the patient's constellation of fall risk factors. However, there was variability across studies in how and to what extent the domains were addressed. While further research is warranted, health system efforts to prevent accidental falls in PAC should consider a patient-centered multifactorial approach that fosters a culture of safety, addresses individuals' fall risk, and champions a multidisciplinary team.

"What is Effective for Fall Prevention Among Individuals Post- Stroke? A Systematic Review"

Background: Falls are a significant concern for people post-stroke. Interventions that effectively prevent or reduce the number of falls should be well documented and appraised for effectiveness. Therefore, our study aimed to identify and appraise the literature on interventions aimed at preventing or reducing falls among people post-stroke.Methods: A comprehensive literature search was conducted in five databases. Two independent reviewers screened the literature search results to include relevant studies. Subsequently, reviewers extracted the data using a standardized form, and the quality of studies was assessed using a critical appraisal tool.Results: 26 studies met the selection criteria and were included in our review. We identified eight categories for preventing and reducing falls. These categories were: electrotherapy, multifactorial fall prevention programs, educational programs, multifaceted stroke telerehabilitation, virtual reality, vitamin-D supplements, rehabilitation instruments, and physical activities.Conclusion: The evidence for these interventions varied between studies, with no single intervention superior to others. The current review findings indicate that there is limited evidence to recommend one fall intervention to be generalized among people post-stroke. Further studies involving large sample sizes and different fall outcomes are needed to make valuable recommendations for clinical practice.

Development of a Screening Tool for Feet/Footwear- Related Influences on Fall Risk

The effectiveness of multifactorial fall risk assessment and intervention strategies is well documented. Although identifying feet/footwear-related influences on fall risk is a vital fall risk assessment component, few evidence-based resources or screening tools are available. To address this need, we developed the Screening Tool for Feet/Footwear-Related Influences on Fall Risk. Our tool is designed for older adults who are identified as at risk for falling, based on the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Algorithm for Fall Risk Screening, Assessment, and Intervention. Tool development was informed by results of our systematic review of lower-limb factors associated with balance and falls. Our initial tool was evaluated by an external group of 9 interprofessional content experts. Those experts recommended modification of 8 items and rated the tool’s clarity as 81.2/100, appeal as 79.1/100, and clinical feasibility as 76.1/100. After incorporating recommended changes, we completed a modified Delphi study using 8 new interprofessional experts (average years of experience: 19.3). During Phase 1, Delphi participants recommended we combine items with similar treatment recommendations, add a question about orthoses, and increase the specificity of 9 items. This refinement resulted in a 20-item screening tool, which met approval after two rounds of consensus voting. Approval was defined based on the Item Content Validation Index, percentage of agreement > 80% on each item. The high level of agreement illustrates the tool’s content validity. Using our tool, an older adult’s feet/footwear-related risk factors can be identified and incorporated into an effective multifactorial fall prevention intervention.

Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation

ObjectivesTo determine the clinical and cost effectiveness of a multifactorial fall prevention programme compared with usual care in long term care homes.DesignMulticentre, parallel, cluster randomised controlled trial.SettingLong term care homes...

Falls prevention in China: time for action

Falls prevention in China: time for action

Falls, Fear of Falling, and Preventive Measures in Huntington's Disease: The Perspectives of Individuals with Huntington's Disease and Caregivers inLong-Term Care.

Falls are common in Huntington's disease (HD), which can have serious consequences and may therefore lead to fear of falling (FoF). There is little knowledge about falls or FoF in individuals with HD or about formal and informal caregivers' fear about falls in individuals with HD. To explore prevalence of falls, FoF and fall preventive measures both those applied and those not included in managing falls in individuals with HD and their formal and informal caregivers, and to identify the relationship between FoF and, anxiety, awareness and cognitive functioning respectively. In a multi-center observational cross-sectional study, care-independent and -dependent individuals with HD and their formal and informal caregivers were recruited from six Dutch nursing homes specialized in HD. The participants were assessed by means of questionnaires enquiring about falls, FoF, awareness of fall risk, cognition, anxiety and fall preventive measures. For all included 158 individuals with HD, the fall prevalence over the last 30 days was 28.8%. The prevalence of FoF in individuals with HD, formal caregivers and informal caregivers was 47.6%, 25.6%, and 63.5%, respectively, for care-independent individuals with HD and 46.9%, 26.3%, and 62.0%, respectively, for care-dependent individuals with HD. Anticipatory awareness of fall risks and gender are predictors of FoF in care-independent individuals with HD, though not in the care-dependent group. A combination of fall preventive measures is used in most individuals with HD. Fall prevalence is high and FoF is common in individuals with HD and their caregivers. Gender and anticipatory awareness are risk factors for FoF. In addition to the use of individual multifactorial fall prevention strategies, it is important to support both formal and informal caregivers in coping with falls.

Physical Therapists as Partners for Community Fall Risk Screenings and Referrals to Community Programs.

Objectives: Physical therapists (PTs) are integral team members in fall prevention in clinical settings; however, few studies have investigated PTs' engagement in pro-bono community-based falls prevention. Therefore, we aimed to describe the characteristics of PTs and physical therapist assistants (PTAs) in the United States who conduct community-based fall screenings, the reach of screenings, their knowledge and utilization of the Centers for Disease Control and Prevention's fall-risk screening toolkit (STEADI, Stopping Elderly Accidents, Deaths, and Injuries), and therapists' knowledge and referrals to evidence-based programs (EBPs) and community resources.Methods: A cross-sectional survey distributed to a convenience sample of PTs/PTAs in the United States through news-blasts, and social media.Results: Four hundred and forty-four therapists who worked with older adults completed the survey. Approximately 40% of the respondents (n = 180) conduct screenings, most frequently annually. People who screen tend to be PTs with >20 years of experience, work in outpatient/wellness or academia, and be involved in the least amount of direct patient care. The majority (n = 344, 77.5%) of survey respondents were somewhat to very familiar with the STEADI, and ~84% (n = 114) of respondents who were very familiar with the STEADI (n = 136) use the toolkit to conduct community-based, pro-bono fall risk screenings. Twenty-six percent (n = 14) out of the 53 PTAs who responded to the survey conduct falls screenings in the community. Of the PTs/PTAs who conduct community-based fall screenings (n = 180), ~ 75% (n = 136) are aware of and refer older adults to EBPs. Over half also refer to Silver Sneakers and/or senior centers.Discussion: PTs and PTAs are key partners in evidence-based multifactorial fall prevention in the community. Data helps inform community organizations that most PTs who engage in community-based fall risk screening utilize the STEADI toolkit and refer to community-based programs. Community organizations seeking PT partners to engage in fall risk screenings and promote referrals to local resources or EBPs will likely have the most success collaborating with local physical therapy education programs or physical therapy clinic managers.

Multifactorial Falls Prevention Programme Compared to Routine Care in Long Term Older Care Residents (FinCH): A Multi-Centre Cluster Randomised Controlled Trial with Economic Evaluation

Background: Falls are three times more common for care home residents than for similarly aged people living at home, often causing hospital admission and death. The Guide to Action for Care Homes (GtACH) is a multifactorial programme designed to prevent falls in care homes. Methods: A multi-centre, cluster (care home) randomised controlled trial to evaluate the clinical and cost-effectiveness of the GtACH programme compared to usual care. The primary health outcome was fall rate between 91 and 180 days from randomisation. Secondary outcomes included dependency (Barthel ADL Index) and activity (Physical Activity Measure – Residential Care Homes (PAM-RC)) at 90, 180, 270 and 360 days from randomisation. Cost effectiveness was estimated adopting a UK National Health Service and personal social services perspective, measuring health-related quality of life using quality adjusted life years (QALYs) derived from the EQ-5D-5L-Proxy and DEMQOL-Proxy-U until 12 months post-randomisation. Findings: 84 care homes were randomised (39 GtACH, 45 usual care). 1657 residents consented and provided baseline measures, mean age 85 years, 32% men. GtACH training was delivered to 1051 staff (71%). Primary RCT outcome data were available for 630 GtACH participants and 712 usual care participants. The unadjusted Incidence Rate Ratio for falls between 91-180 days was 0.57 (95% CI 0.45-0.71, p<0.01) in favour of the GtACH programme (GtACH: 6 falls/1000 residents versus 10.4/1000 in usual care). Barthel ADL Indices and PAM-RC scores were similar between groups at all-time points. The incremental cost was £108 (95% CI -271.06, 487.58), incremental QALYs gained were 0.024 (95% CI 0.004, 0.044) and 0.005 (95% CI -0.019, 0.03) for EQ-5D-5L-P and DEMQOL-P-U respectively. The incremental costs per EQ-5D-5L-P and DEMQOL-P-U based QALY were £4,544 and £20,889 respectively. Interpretation: The GtACH programme reduced the fall rate and was cost-effective, without reducing activity or increasing dependency. Trial Registration: Trial registration number: ISRCTN34353836. Protocol V6 14 November 2017 Funding: This work was funded by NIHR HTA (Project number 13/115/29). Declaration of Interest: Profs Logan, Armstrong, Gladman, Gordon, Leighton, Mountain, Sach have nothing to disclose. Drs Horne, Allen, Clark, Conroy, Darby, Fox, Irvine, McCartney, Robinson, Wilson, Sims, have nothing to disclose. Mrs Godfrey and Robertson have nothing to disclose. Ethical Approval: The trial was not initiated before the protocol, informed consent forms and participant information sheets received approval / favourable opinion from the Research Ethics Committee (REC), and the National Health Service (NHS) Research & Development (RD the principles of Good Clinical Practice, and the Department of Health Research Governance Framework for Health and Social care, 2005