Developing and Implementing a Senior Community Based Fall Prevention and Home Safety Program

Purpose This study was conducted in a home-based context where trained occupational therapists delivered progressive physical exercise training and home modification intervention for preventing falls, namely the FIT-at-Home intervention. We assessed the feasibility of the intervention’s content and mode of delivery from the occupational therapists’ perspective as well as the feasibility of study procedures. Methods We used a mixed-methods approach, which generated qualitative data from 14 OTs’ after delivering the intervention via interviews and quantitative data of the study procedures via questionnaires and documentation sheets. Results In total, 16 of the 17 older people completed the intervention. Of 9 recorded falls, no serious physical problems occurred. Qualitative data suggested that the intervention content and mode was feasible. Only minor adaptations to the program are needed based on the users’ feedback. The main benefit was seen in the fact that simple exercises can be integrated into everyday life for older people with restricted mobility. Conclusion The FIT-at-Home intervention comprising lifestyle-integrated balance and strength exercises and home safety is feasible for occupational therapists to deliver. The findings will help to further refine the intervention and study procedures. Implications for rehabilitation Falling is a frequent and serious health problem for many community-living older people, and the incidence of injurious falls increases with advancing age. Home visiting programs comprising physical exercise training and home modification appear to be beneficial for older people with poor health, functional limitations, and limited mobility. This study indicates that it is feasible to introduce lifestyle-integrated balance and strength exercises, performed as part of daily routine for older people at risk of falling. Behavioural self-management strategies have the potential to improve the implementation of exercises during the course of rehabilitation treatment and afterward.

This study describes the development and implementation of a large-scale primary fall and fracture prevention programme in Hong Kong and its effect on increasing the awareness and knowledge of fall and fracture prevention among older people. The effect of promotion of community participation is also investigated in the implementation of this primary prevention programme. The programme includes educational seminars, a train-the-trainers programme and a staff training programme. The effect of the educational seminars is shown by the increase in the knowledge and awareness of fall and fracture prevention among these participants (p < 0.01), while that of the train-the-trainers programme and staff-training programme is confirmed by the continuous expansion and continuation of the fall and fracture prevention programme in the community. The experience from this primary prevention programme has given us direction for future implementation of a more comprehensive prevention programme in our community.

BackgroundFall prevention programmes are essential interventions in societies with aging populations. This study assessed the fall rate and other health outcomes, as well as the cost-effectiveness of a home-based fall prevention programme for community-dwelling older people. In a single home visit, trained physical or occupational therapists performed fall risk assessments, eliminated environmental risk factors, and provided tailored exercises.MethodsA prospective, longitudinal observational study was performed with participants of a fall prevention programme who agreed to be followed-up over one year. Baseline data included self-reported falls one month and one year before the intervention. Participants were monitored through bi-monthly telephone calls, assessing their number of falls, fear of falling (using the Falls Efficacy Scale-International (FES-I), quality of life (using the EuroQuol-5 Dimensions-5 Levels, EQ-5D-5L), and physical activity (in minutes per week). Statistical analysis of the data used a Generalized Estimating Equations (GEE) Poisson-Modell for number of falls and a Linear Mixed Model (LMM) for fear of falling, quality of life and physical activity. In addition, health insurance claims data were used to compare the number of medically treated falls in the year before and after the intervention, as well as the related healthcare spending. Cost-effectiveness of the programme versus usual care was estimated as cost per prevented medically treated fall.ResultsOverall, 639 person-years of observation time were analyzed. Participants had a mean age of 81.8 years (+/- 5.2) and 59% were female. On average, the fall rate decreased from 1.35 to 1.02 per person-year, or -23.9% (95%CI from -35.92 to -9.67), fear of falling decreased by -1.27 points (95%CI from −1.50 to -1.05), quality of life improved by -0.88 points (95%CI from −1.09 to -0.68), and physical activity increased by 9.87 min per day (95%CI from 5.65 to 14.09). Analysis of claims data showed a 48.0% reduction (95%CI from 30.5% to 61.0%) in medically treated falls. The average cost per prevented medically treated fall was estimated at approximately 1,353 USD, with a 50% probability of the intervention being cost saving.ConclusionsThis fall prevention programme with a single home visit was found to be effective and cost effective. Health policies should establish such a model as a reimbursed standard care to assist in combatting the increasing burden of falls on individuals and societies.

007 Participation in ‘stepping on’ fall prevention program reduces falls and frailty in older community dwellers

BackgroundFractures associated with bone fragility in older adults signal the potential for secondary fracture. Fragility fractures often precipitate further decline in health and loss of mobility, with high associated costs for patients, families, society and the healthcare system. Promptly initiating a coordinated, comprehensive pharmacological bone health and falls prevention program post-fracture may improve osteoporosis treatment compliance; and reduce rates of falls and secondary fractures, and associated morbidity, mortality and costs.Methods/designThis pragmatic, controlled trial at 11 hospital sites in eight regions in Quebec, Canada, will recruit community-dwelling patients over age 50 who have sustained a fragility fracture to an intervention coordinated program or to standard care, according to the site. Site study coordinators will identify and recruit 1,596 participants for each study arm. Coordinators at intervention sites will facilitate continuity of care for bone health, and arrange fall prevention programs including physical exercise. The intervention teams include medical bone specialists, primary care physicians, pharmacists, nurses, rehabilitation clinicians, and community program organizers.The primary outcome of this study is the incidence of secondary fragility fractures within an 18-month follow-up period. Secondary outcomes include initiation and compliance with bone health medication; time to first fall and number of clinically significant falls; fall-related hospitalization and mortality; physical activity; quality of life; fragility fracture-related costs; admission to a long term care facility; participants’ perceptions of care integration, expectations and satisfaction with the program; and participants’ compliance with the fall prevention program. Finally, professionals at intervention sites will participate in focus groups to identify barriers and facilitating factors for the integrated fragility fracture prevention program.This integrated program will facilitate knowledge translation and dissemination via the following: involvement of various collaborators during the development and set-up of the integrated program; distribution of pamphlets about osteoporosis and fall prevention strategies to primary care physicians in the intervention group and patients in the control group; participation in evaluation activities; and eventual dissemination of study results.Study/trial registrationClinical Trial.Gov NCT01745068Study ID numberCIHR grant # 267395

Occupational therapists have been involved in Community Mental Health Centers (CMHCs) since 2016 in Turkey. To the best of our knowledge, no data about occupational therapists' practices in CMHCs is available in the extant research literature. Therefore, this study aimed to investigate the clinical practices, challenges, and job satisfaction of occupational therapists working for CMHCs in Turkey. We conducted a cross-sectional survey study in which 28 volunteer occupational therapists working in CMHCs participated. The participants filled out the Sociodemographic and Professional Experience Information Form and the Job Satisfaction Scale. Occupational therapists were experienced practitioners implementing various occupational therapist practices in community mental health and they were generally satisfied with their job. The challenges facing Occupational therapists were communicating with caregivers, motivating the client, enabling the client to perform occupational participation. Collaborative teamwork and participation in training about community mental health were found as the important factors contributing to occupational therapist professionals' job satisfaction. Investigating the professional behaviors of Occupational therapists, an emerging health profession in Turkey, is important for the development of the profession. The education and supervision specially adapted for community mental health and the supportive teamwork seem to be significant for the job satisfaction of community mental health Occupational therapists.

Falls account for a substantial portion of 9-1-1 calls, but few studies have examined the potential for an emergency medical system role in fall prevention. We tested the feasibility and effectiveness of an emergency medical technician (EMT)-delivered, at-scene intervention to link elders calling 9-1-1 for a fall with a multifactorial fall prevention program in their community. The intervention was conducted in a single fire department in King County, Washington and consisted of a brief public health message about the preventability of falls and written fall prevention program information left at scene. Data sources included 9-1-1 reports, telephone interviews with intervention department fallers and sociodemographically comparable fallers from three other fire departments in the same county, and in-person discussions with intervention department EMTs. Interviews elicited faller recall and perceptions of the intervention, EMT perceptions of intervention feasibility, and resultant referrals. Sixteen percent of all 9-1-1 calls during the intervention period were for falls. The intervention was delivered to 49% of fallers, the majority of whom (75%) were left at scene. Their mean age (N = 92) was 80 ± 8 years; 78% were women, 39% had annual incomes under $20K, and 34% lived alone. Thirty-five percent reported that an EMT had discussed falls and fall prevention (vs. 8% of comparison group, P < 0.01); 84% reported that the information was useful. Six percent reported having made an appointment with a fall prevention program (vs. 3% of comparison group). EMTs reported that the intervention was worthwhile and did not add substantially to their workload. A brief, at-scene intervention is feasible and acceptable to fallers and EMTs. Although it activates only a small percent to seek out fall prevention programs, the public health impact of this low-cost strategy may be substantial.

Twelve month follow up of a falls prevention program in older adults from diverse populations in Australia: A qualitative study

ABSTRACTIntroductionFalls are a major health risk for older Australians, causing most injury‐related hospitalisations and deaths in this age group. Despite growth in Australia's older culturally and linguistically diverse (CALD) population, limited data exist on the availability and suitability of falls prevention programmes for this group. This study examines the availability and suitability of such programmes for CALD populations in local government areas (LGAs) in Greater Sydney, NSW.MethodsAn audit of publicly available demographic data and falls prevention programme offerings from 20 LGAs was conducted, based on language diversity and Socio‐Economic Indexes for Areas (SEIFA)—Index of Relative Socio‐Economic Disadvantage (IRSD) score. Seven LGAs with the highest and lowest SEIFA‐IRSD scores, plus seven LGAs with the most and least linguistic diversity were included. Data are presented using column charts to identify trends.ResultsFewer programmes were found in areas of greater disadvantage and higher linguistic diversity. Least disadvantaged areas offered more programmes, whilst the most disadvantaged and linguistically diverse areas offered fewer. Only one programme was offered in a language other than English, in a least disadvantaged LGA (Ku‐Ring‐Gai). These trends suggest that programme availability does not align with community needs.ConclusionsDisparities exist in falls prevention programme availability across LGAs, with fewer programmes in areas of higher disadvantage and linguistic diversity, highlighting access inequities for older CALD populations.So What?Older CALD populations in high‐need LGAs have reduced access to falls prevention programmes, signalling a need for targeted, culturally and linguistically appropriate health promotion initiatives.

IntroductionPoststroke individuals have a high incidence of falls during the first months after discharge. The factors contributing to falls in poststroke patients are multifaceted, with balance deficits being the most prominent. Fall-related self-efficacy has also been identified as a key factor influencing the effectiveness of fall prevention interventions. Additionally, family members play a crucial role in fall prevention by providing support, supervision and assistance with mobility and daily activities. While previous studies support the potential benefits of a fall prevention programme for poststroke individuals, further evidence is needed to confirm their effectiveness. Building on the positive outcomes of self-management (SM) interventions in reducing falls across diverse populations, this study aims to evaluate the effects of an individual and family SM (IFSM) fall prevention programme on balance ability and fall-related self-efficacy among poststroke individuals.Methods and analysisThis study will be a two-arm, single-blind, pre–post test randomised controlled trial. The target sample will consist of 60 poststroke adults with moderate severity and their primary family members. The intervention group will receive the IFSM fall prevention programme, which consists of 10 weekly sessions. The main components of the programme are exercise, home environment assessment, assistive technology, medication review and safety during daily activities. The control group will receive usual care but will not participate in any specific intervention. Primary outcomes—balance ability and fall-related self-efficacy—will be assessed at baseline and week 8 after discharge. Secondary outcomes will include the number of falls and fall-related injuries.Ethics and disseminationEthical approval was obtained from the Research Ethics Committees of the Faculty of Nursing, Chiang Mai University and the Affiliated Hospital of Guizhou Medical University. The results will be disseminated to poststroke individuals and their families through workshops; to healthcare professionals via professional training and meetings; and to researchers via conferences and publications.Trial registration numberNCT06577662.

Background: Cognitive impairment is a common and debilitating consequence of stroke. In the multidisciplinary rehabilitation team, occupational therapists play an important role in improving the daily functioning of people who have had a stroke. However, the effectiveness of interventions used by occupational therapists for cognitive impairment post-stroke has not been systematically reviewed. The current practice patterns, including the theoretical approaches, assessments, and interventions used, of Australian occupational therapists who work in this area are not known and the congruence between clinical practice and research evidence has not been studied. Objectives: This study aimed to (1) identify the best available research evidence for the effectiveness of interventions used by occupational therapists for cognitive impairment post-stroke; (2) survey current Australian occupational therapy practice with clients who have cognitive impairment after stroke; and (3) examine the congruence between research evidence and clinical practice in this area. Method: The study conducted a systematic review following the Cochrane Collaboration Methodology to identify research evidence and a survey to investigate current practice. To locate articles that met the inclusion criteria of the systematic review, electronic databases were searched, 11 of the major occupational therapy journals were hand-searched and reference lists of related articles were examined. Two independent reviewers separately evaluated the methodological quality of included trials. The primary outcome of interest in this review was basic activities of daily living functioning. The secondary outcomes were instrumental activities of daily living functioning, community integration, and specific cognitive functions. A self-administered, purpose-designed online survey was used to investigate current Australian occupational therapists’ practice with people who have cognitive impairment after stroke. The survey covered five subsections: participants’ demographic characteristics; theoretical approaches used; assessments used; interventions used; and research utilisation. Results: Six randomised controlled trials met the inclusion criteria of the systematic review. Two of the four studies which assessed functional outcomes after intervention for cognitive impairment found a treatment effect in favour of the intervention group. The intensive combination of remedial and compensatory interventions used in one study and a predominantly compensatory intervention used in the other produced a significant improvement in participants’ general cognitive function and basic activities of daily living. The results of the other two studies which assessed functional outcomes but contained fewer intervention sessions and used remedial interventions only showed no difference between experimental and control groups. Three studies examined the effect of remedial interventions on specific domains of cognitive function, including attention and memory. Each study used several outcome measures to evaluate participants’ cognitive function and the results were varied in each study; some outcome measures showed treatment effects in favour of the experimental group, while the others showed no significant results. Due to the diverse study characteristics and results, the effectiveness of interventions used by occupational therapists for cognitive impairment remains inconclusive. A total of 102 responses were obtained for the survey. A client-centred approach was used by participants more often than other theoretical approaches when treating people with cognitive impairment post-stroke. The Mini-Mental State Examination and the Lowenstein Occupational Therapy Cognitive Assessment were the most frequently used cognitive screening test and cognitive assessment battery, respectively. Interventions involving functional activities were used more frequently than compensatory techniques or remedial exercises. Participants relied more on colleagues’ opinions and past experience than on research literature when making intervention decisions. The congruency between the results of the systematic review and the survey were discussed in terms of theoretical approaches, assessments, and interventions used. While a large proportion of survey participants frequently used a client-centred approach, no research evidence was found to support the effectiveness of this approach. Some assessments were consistently used in both research and clinical settings, for example, the Mini-Mental State Examination and Barthel Index. This consistency facilitates the transferability of research results to the clinical setting and enables comparisons to be made between research studies which use the same outcome measures. For the interventions that were found to be effective, some survey participants reported using similar interventions in their practice, such as paper and pencil exercises or functional tasks. However, the interventions used by survey participants were not identical to those used in research, differing in terms of both content and dose. Overall conclusions: In this thesis, gaps were found in the available research evidence, as well as between the available evidence and clinical practice. Suggestions for overcoming these gaps were discussed.

Evidence of the Psychometric Qualities of a Simplified Version of the Activities-specific Balance Confidence Scale for Community-Dwelling Seniors

Objectives: To describe the effectiveness of recruitment strategies used for a randomised trial of a fall prevention program. Methods: Community‐residing persons (n = 310) aged 70 years or older and at risk of falling were recruited using promotional materials, health professional referrals, media, community presentations, mail outs, and friends/relatives. Mail and telephone recruitment strategies were able to be compared to actual recruitment yields, with costs reported for each. Results: Mail outs by organisations had response rates between 3.1 and 7.7%, with recruitment yields between 1.8 and 4.4%. Local media editorials were low cost and useful. Gender and physical status of participants varied according to the recruitment method, with multisources producing a reasonably representative sample. Conclusions: Databases and mail outs using personalised letters were the most effective recruitment strategies for a community‐based preventive program. This study contributes to the expanding evidence of the kinds of recruitment that are more effective, considering the context of the study and the intervention.

The purpose of the present study was to analyse the effectiveness and cost-effectiveness of a multifactorial fall prevention programme in nursing home residents in a real-world setting. The adjusted relative risk of a femoral fracture was 0.82 (95% CI 0.72-0.93) in residents exposed to the fall and fracture prevention programme compared to residents from the control group. Given a willingness-to-pay of 50,000 EUR per year free of femoral fractures from a payer perspective the probability that the intervention is cost-effective was 83%.

Watch your step: Helping patients avoid falls