Background and Objectives: Fear of falling is a substantial barrier to walking and has been associated with increased fall risks. This study examines neighbourhood environmental risk factors related to fear of outdoor falling in middle-aged and older adults. Research Design and Methods: A total of 394 participants aged 50 years or older living independently in the community were recruited between 2013 and 2014 from an integrated health care network serving Central Texas. Fear of outdoor falling and perceived neighbourhood environmental variables were assessed using self-reported questionnaires. Logistic regression identified perceived neighbourhood environmental variables associated with fear of outdoor falling. Results: Sixty-nine (17.9%) of 385 participants reported having a fear of outdoor falling. Compared to those who did not report a fear of outdoor falling, those who reported having a fear of outdoor falling were more likely to be adults aged 65 years or older (odds ratio [OR] = 2.974, 95% confidence interval [CI] = 1.247–7.094), be female (OR = 4.423, 95% CI = 1.830–10.689), have difficulty with walking for a quarter of a mile (OR = 2.761, 95% CI = 1.124–6.782), and have had a fall in the past year (OR = 4.720, 95% CI = 1.472–15.137). Among the neighbourhood environmental characteristics examined, low traffic speed on streets (OR = 0.420, 95% CI = 0.188–0.935), drainage ditches (OR = 2.383, 95% CI = 1.136–5.000), and broken sidewalks (OR = 3.800, 95% CI = 1.742–8.288) were associated with the odds of having a fear of outdoor falling. Discussion and Implications: In addition to the individual factors, findings from this study suggest the importance of addressing the environmental risk factors in identifying and reducing fear of outdoor falling among middle-aged and older adults.
(Edited publisher abstract)
Background and Objectives: Fear of falling is a substantial barrier to walking and has been associated with increased fall risks. This study examines neighbourhood environmental risk factors related to fear of outdoor falling in middle-aged and older adults. Research Design and Methods: A total of 394 participants aged 50 years or older living independently in the community were recruited between 2013 and 2014 from an integrated health care network serving Central Texas. Fear of outdoor falling and perceived neighbourhood environmental variables were assessed using self-reported questionnaires. Logistic regression identified perceived neighbourhood environmental variables associated with fear of outdoor falling. Results: Sixty-nine (17.9%) of 385 participants reported having a fear of outdoor falling. Compared to those who did not report a fear of outdoor falling, those who reported having a fear of outdoor falling were more likely to be adults aged 65 years or older (odds ratio [OR] = 2.974, 95% confidence interval [CI] = 1.247–7.094), be female (OR = 4.423, 95% CI = 1.830–10.689), have difficulty with walking for a quarter of a mile (OR = 2.761, 95% CI = 1.124–6.782), and have had a fall in the past year (OR = 4.720, 95% CI = 1.472–15.137). Among the neighbourhood environmental characteristics examined, low traffic speed on streets (OR = 0.420, 95% CI = 0.188–0.935), drainage ditches (OR = 2.383, 95% CI = 1.136–5.000), and broken sidewalks (OR = 3.800, 95% CI = 1.742–8.288) were associated with the odds of having a fear of outdoor falling. Discussion and Implications: In addition to the individual factors, findings from this study suggest the importance of addressing the environmental risk factors in identifying and reducing fear of outdoor falling among middle-aged and older adults.
(Edited publisher abstract)
Subject terms:
falls, older people, communities, risk, environmental factors, prevention;
... their care environment is and overarching design principles for creating more supportive environments for people with dementia in hospital. The programme evaluation found that making the physical environment more dementia friendly resulted in a range of positive outcomes on falls, incidence of violence and aggression, staff sickness and absence. However, it is acknowledged that, as yet, too few staff
This publication describes the work of 23 NHS trusts that took part in the latest phase, dementia care, of the King’s Fund’s Enhancing the Healing Environment (EHE) programme. The projects were run in mental health and community units and acute trusts. Their outcomes show how relatively straightforward and inexpensive changes to the design and fabric of the care environment can have a considerable and positive impact on the wellbeing of people with dementia. The publication is divided into three parts: Part one sets out the scope and purpose of the publication; part two describes the findings and outcomes from the latest stage of the programme; and part three contains five key resources. These include the EHE assessment tool designed to help carers and staff assess how dementia friendly their care environment is and overarching design principles for creating more supportive environments for people with dementia in hospital. The programme evaluation found that making the physical environment more dementia friendly resulted in a range of positive outcomes on falls, incidence of violence and aggression, staff sickness and absence. However, it is acknowledged that, as yet, too few staff understand the impact of the environment on people with dementia.
Subject terms:
hospitals, building design, challenging behaviour, care homes, dementia, falls, environmental factors;
Nursing and Residential Care, 12(10), October 2010, pp.482-486.
Publisher:
MA Healthcare Ltd.
Place of publication:
London
More than 400,000 older people in England attend A&E departments following an accident each year. This article explains how advances in technology, such as nurse call systems, could prevent injury and limit long-term physical impairment which result from falls. The article discusses risk factors such as environment, balance impairment; muscle weakness, unhelpful drug combinations and sleep
More than 400,000 older people in England attend A&E departments following an accident each year. This article explains how advances in technology, such as nurse call systems, could prevent injury and limit long-term physical impairment which result from falls. The article discusses risk factors such as environment, balance impairment; muscle weakness, unhelpful drug combinations and sleep disturbances. These risk factors can result in psychological problems such as fear of falling and loss of confidence, loss of mobility leading to social isolation, and an increase in dependency. The use of equipment such as wandering alarms and monitors and protective clothing such as hip protectors are discussed. The article concludes by promoting an emphasis on prevention by training care staff, which can shift the focus from treatment to living in a safe environment.
Subject terms:
older people, alarm systems, assistive technology, care homes, falls, environmental factors;
British Journal of Occupational Therapy, 79(3), 2016, pp.133-143.
Publisher:
Sage
Introduction: The potential of environmental assessment and modification to reduce falls has recently received attention within the gerontology literature. Research investigating the clinical effectiveness of this intervention in falls prevention reports conflicting results. Discrepancies are due to variation in the risk profile of study participants and the health care background of the person providing the environmental intervention or the intensity of the intervention provided.
Method: The purpose of this paper is to compare and contrast two systematic reviews, which include meta-analyses, of environmental interventions for falls prevention in community dwelling older people, using the critical appraisal skills programme tool for systematic reviews.
Finding:s Both reviews found that: environmental assessment and modification was effective in falls prevention; intervention was effective with high but not low risk participants; and that high intensity environmental assessment was effective, whereas low intensity intervention was not. Environmental interventions which were delivered by occupational therapists were deemed high intensity, probably because their underpinning theoretical frameworks focus on the impact of the environment on function.
Conclusion: The authors discuss possible reasons why occupational therapist led environmental assessment and modification is clinically effective in falls prevention, for people at high risk of falls, whereas non occupational therapist led intervention is not.
(Edited publisher abstract)
Introduction: The potential of environmental assessment and modification to reduce falls has recently received attention within the gerontology literature. Research investigating the clinical effectiveness of this intervention in falls prevention reports conflicting results. Discrepancies are due to variation in the risk profile of study participants and the health care background of the person providing the environmental intervention or the intensity of the intervention provided.
Method: The purpose of this paper is to compare and contrast two systematic reviews, which include meta-analyses, of environmental interventions for falls prevention in community dwelling older people, using the critical appraisal skills programme tool for systematic reviews.
Finding:s Both reviews found that: environmental assessment and modification was effective in falls prevention; intervention was effective with high but not low risk participants; and that high intensity environmental assessment was effective, whereas low intensity intervention was not. Environmental interventions which were delivered by occupational therapists were deemed high intensity, probably because their underpinning theoretical frameworks focus on the impact of the environment on function.
Conclusion: The authors discuss possible reasons why occupational therapist led environmental assessment and modification is clinically effective in falls prevention, for people at high risk of falls, whereas non occupational therapist led intervention is not.
(Edited publisher abstract)
Subject terms:
falls, prevention, home care, assessment, occupational therapists, risk assessment, intervention, comparative studies, systematic reviews, environmental factors;
Disability and Rehabilitation: Assistive Technology, 9(2), 2014, pp.128-135.
Publisher:
Taylor and Francis
Place of publication:
London
This paper affirms the importance of lighting as a technology in the context of people with sight loss. Its importance lies in the ability of appropriate lighting interventions to support independent living and to reduce the likelihood of falls and accidents. The concept of “assistive lighting” is introduced with a set of tenets by which the merits of different lighting interventions can
(Publisher abstract)
This paper affirms the importance of lighting as a technology in the context of people with sight loss. Its importance lies in the ability of appropriate lighting interventions to support independent living and to reduce the likelihood of falls and accidents. The concept of “assistive lighting” is introduced with a set of tenets by which the merits of different lighting interventions can be considered. The tenets are derived from research on lighting and sight loss, including a thorough review of the literature; and consultation in the period from 2008 to 2010 with over 80 rehabilitation workers and occupational therapists in the United Kingdom. They affirm the need for lighting to be appropriate, sufficient, even, adjustable, sustainable and energy efficient, simple and adaptable. Examples of different lighting interventions are provided and these are considered in relation to the tenets. One of the key outcomes of the research was publication of a guide to good practice on lighting interventions for people with sight loss.
Implications for Rehabilitation: 1) Assistive lighting has important implications for rehabilitation in relation to people with sight loss; 2) Simple lighting interventions carry the potential for improving the independence and quality of life of people with sight loss and can reduce the risk of accidents; 3) The tenets by which options for lighting interventions can be considered can assist rehabilitation officers and occupational therapists in their work; 4) Lighting can be considered as a factor of increasing importance within the broader context of universal design.
(Publisher abstract)
International Journal of Geriatric Psychiatry, 15(10), October 2000, pp.883-886.
Publisher:
Wiley
Falls in the elderly are a leading cause of disability, distress, admissions to supervised care and death. The current study examined environmental hazards in the home environments of cognitively impaired elderly people. The authors hypothesized that a substantial number of hazards would be identified and that they would be significantly associated with the number of falls.
Falls in the elderly are a leading cause of disability, distress, admissions to supervised care and death. The current study examined environmental hazards in the home environments of cognitively impaired elderly people. The authors hypothesized that a substantial number of hazards would be identified and that they would be significantly associated with the number of falls.
Subject terms:
mental health problems, needs, occupational therapy, older people, risk, cognitive impairment, dementia, falls, environmental factors;
Background: Falls are the most common reason for ambulance callouts resulting in non-conveyance. Even in the absence of injury, only half of those who fall can get themselves up off the floor, often remaining there over an hour, increasing risk of complications. There are recognized techniques for older people to learn how to get up after a fall, but these are rarely taught. The aim of this study transcribed and analysed systematically using the Framework approach. A stakeholder group of falls experts and service users advised during analysis. Results: The data highlighted three areas contributing to an individual’s capability to get-up following a fall: the environment (physical and social); physical ability; and degree of self-efficacy (attitude and beliefs about their own ability). These factors fell within the wider context of making a decision about needing help, which included what training and knowledge each person already had to manage their fall response. Staff described how they balance their responsibilities, prioritising the individual’s immediate needs; this leaves limited time to address capability in the aforementioned three areas. Paramedics, routinely responding to falls, only receive training on getting-up techniques from within their peer-group. Therapists are aware of the skillset to breakdown the getting-up process, but, with limited time, select who to teach these techniques to. Conclusion: Neither therapists nor ambulance service staff routinely teach strategies on how to get up, meaning that healthcare professionals largely have a reactive role in managing falls. Interventions that address the environment, physical ability and self-efficacy could positively impact on peoples’ capability to get up following a fall. Therefore, a more proactive approach would be to teach people techniques to manage these aspects of future falls and to provide them easily accessible information.
(Edited publisher abstract)
Background: Falls are the most common reason for ambulance callouts resulting in non-conveyance. Even in the absence of injury, only half of those who fall can get themselves up off the floor, often remaining there over an hour, increasing risk of complications. There are recognized techniques for older people to learn how to get up after a fall, but these are rarely taught. The aim of this study was to develop an understanding of attitudes of older people, carers and health professionals on getting up following a fall. Methods: A qualitative focus group and semi-structured interviews were conducted with 28 participants, including community-dwelling older people with experience of a non-injurious fall, carers, physiotherapists, occupational therapists, paramedics and first responders. Data were transcribed and analysed systematically using the Framework approach. A stakeholder group of falls experts and service users advised during analysis. Results: The data highlighted three areas contributing to an individual’s capability to get-up following a fall: the environment (physical and social); physical ability; and degree of self-efficacy (attitude and beliefs about their own ability). These factors fell within the wider context of making a decision about needing help, which included what training and knowledge each person already had to manage their fall response. Staff described how they balance their responsibilities, prioritising the individual’s immediate needs; this leaves limited time to address capability in the aforementioned three areas. Paramedics, routinely responding to falls, only receive training on getting-up techniques from within their peer-group. Therapists are aware of the skillset to breakdown the getting-up process, but, with limited time, select who to teach these techniques to. Conclusion: Neither therapists nor ambulance service staff routinely teach strategies on how to get up, meaning that healthcare professionals largely have a reactive role in managing falls. Interventions that address the environment, physical ability and self-efficacy could positively impact on peoples’ capability to get up following a fall. Therefore, a more proactive approach would be to teach people techniques to manage these aspects of future falls and to provide them easily accessible information.
(Edited publisher abstract)
Subject terms:
skills, attitudes, older people, falls, carers, health professionals, qualitative research, staff views, environmental factors, self-determination, environment;
Background: Approximately 30 per cent of people over 65 years of age living in the community fall each year. This is an update of a Cochrane review first published in 2009.Objective: To assess the effects of interventions designed to reduce the incidence of falls in older people living in the community. Search methods: this review searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (February 2012), CENTRAL (The Cochrane Library2012, Issue 3), MEDLINE (1946 to March 2012), EMBASE (1947 to March 2012), CINAHL (1982 to February 2012), and online trial registers. Selection criteria: Randomised trials of interventions to reduce falls in community-dwelling older people. Main results: this review included 159 trials with 79,193 participants. Most trials compared a fall prevention intervention with no intervention or an intervention not expected to reduce falls. The most common interventions tested were exercise as a single intervention (59 trials) and multifactorial programmes (40 trials). Findings: Group and home‐based exercise programmes, usually containing some balance and strength training exercises, effectively reduced falls, as did Tai Chi. Overall, exercise programmes aimed at reducing falls appear to reduce fractures. Multifactorial interventions assess an individual's risk of falling, and then carry out treatment or arrange referrals to reduce the identified risks. Overall, current evidence shows that this type of intervention reduces the number of falls in older people living in the community but not the number of people falling during follow‐up. These are complex interventions, and their effectiveness may be dependent on factors yet to be determined. Interventions to improve home safety appear to be effective, especially in people at higher risk of falling and when carried out by occupational therapists. An anti‐slip shoe device worn in icy conditions can also reduce falls. Taking vitamin D supplements does not appear to reduce falls in most community‐dwelling older people, but may do so in those who have lower vitamin D levels in the blood before treatment. Some medications increase the risk of falling. Three trials in this review failed to reduce the number of falls by reviewing and adjusting medications. A fourth trial involving family physicians and their patients in medication review was effective in reducing falls. Gradual withdrawal of a particular type of drug for improving sleep, reducing anxiety, and treating depression (psychotropic medication) has been shown to reduce falls. Cataract surgery reduces falls in women having the operation on the first affected eye. Insertion of a pacemaker can reduce falls in people with frequent falls associated with carotid sinus hypersensitivity, a condition which causes sudden changes in heart rate and blood pressure. In people with disabling foot pain, the addition of footwear assessment, customised insoles, and foot and ankle exercises to regular podiatry reduced the number of falls but not the number of people falling. The evidence relating to the provision of educational materials alone for preventing falls is inconclusive.
(Edited publisher abstract)
Background: Approximately 30 per cent of people over 65 years of age living in the community fall each year. This is an update of a Cochrane review first published in 2009.Objective: To assess the effects of interventions designed to reduce the incidence of falls in older people living in the community. Search methods: this review searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (February 2012), CENTRAL (The Cochrane Library2012, Issue 3), MEDLINE (1946 to March 2012), EMBASE (1947 to March 2012), CINAHL (1982 to February 2012), and online trial registers. Selection criteria: Randomised trials of interventions to reduce falls in community-dwelling older people. Main results: this review included 159 trials with 79,193 participants. Most trials compared a fall prevention intervention with no intervention or an intervention not expected to reduce falls. The most common interventions tested were exercise as a single intervention (59 trials) and multifactorial programmes (40 trials). Findings: Group and home‐based exercise programmes, usually containing some balance and strength training exercises, effectively reduced falls, as did Tai Chi. Overall, exercise programmes aimed at reducing falls appear to reduce fractures. Multifactorial interventions assess an individual's risk of falling, and then carry out treatment or arrange referrals to reduce the identified risks. Overall, current evidence shows that this type of intervention reduces the number of falls in older people living in the community but not the number of people falling during follow‐up. These are complex interventions, and their effectiveness may be dependent on factors yet to be determined. Interventions to improve home safety appear to be effective, especially in people at higher risk of falling and when carried out by occupational therapists. An anti‐slip shoe device worn in icy conditions can also reduce falls. Taking vitamin D supplements does not appear to reduce falls in most community‐dwelling older people, but may do so in those who have lower vitamin D levels in the blood before treatment. Some medications increase the risk of falling. Three trials in this review failed to reduce the number of falls by reviewing and adjusting medications. A fourth trial involving family physicians and their patients in medication review was effective in reducing falls. Gradual withdrawal of a particular type of drug for improving sleep, reducing anxiety, and treating depression (psychotropic medication) has been shown to reduce falls. Cataract surgery reduces falls in women having the operation on the first affected eye. Insertion of a pacemaker can reduce falls in people with frequent falls associated with carotid sinus hypersensitivity, a condition which causes sudden changes in heart rate and blood pressure. In people with disabling foot pain, the addition of footwear assessment, customised insoles, and foot and ankle exercises to regular podiatry reduced the number of falls but not the number of people falling. The evidence relating to the provision of educational materials alone for preventing falls is inconclusive.
(Edited publisher abstract)
Subject terms:
systematic reviews, falls, prevention, intervention, evaluation, outcomes, older people, health education, physical exercise, independent living, environmental factors, randomised controlled trials;
British Journal of Occupational Therapy, 80(12), 2017, pp.735-744.
Publisher:
Sage
Introduction: Given the impact falls can have on older people and their families, many health and social care services are focused on preventing falls and implementing interventions to reduce future falls. FallCheck is a web app that supports identification of home-hazards and directs users towards self-management strategies to reduce risk of falling. Method: A survey by clinical experts by people at risk of falls. It has further potential as an effective tool to support environmental/behavioural change to reduce risk of falls. Conclusion: FallCheck was developed from a sound evidence-base to support home-hazard modification as an effective intervention component within a multifactorial intervention to prevent falls. Health and social care professionals found it had good acceptability
(Edited publisher abstract)
Introduction: Given the impact falls can have on older people and their families, many health and social care services are focused on preventing falls and implementing interventions to reduce future falls. FallCheck is a web app that supports identification of home-hazards and directs users towards self-management strategies to reduce risk of falling. Method: A survey by clinical experts of a beta version of FallCheck was conducted, producing quantitative and qualitative data including issues and attributes identified by respondents. Thirty-six individuals signed up to take part in the study, and 27 respondents took part in the final evaluation survey. Findings: Testing by health and social care professionals found there is scope for using the app as a digital self-assessment tool by people at risk of falls. It has further potential as an effective tool to support environmental/behavioural change to reduce risk of falls. Conclusion: FallCheck was developed from a sound evidence-base to support home-hazard modification as an effective intervention component within a multifactorial intervention to prevent falls. Health and social care professionals found it had good acceptability for use in practice, justifying further testing of the usability and effectiveness of the app in supporting behavioural changes and environmental modifications with people at risk of falling and carers.
(Edited publisher abstract)
Subject terms:
falls, intervention, computer apps, evaluation, prevention, self-assessment, risk, behaviour change, environmental factors, home safety, home help;