The aim of this study was to look at safety deficiencies found during fifteen investigations of falls among older people living in a naturally occurring retirement community in Ontario. Rather than viewing each case study from the more traditional person-centred perspective, a six step systems approach, the Senior Falls Investigation Methodology (SFIM), adapted from a technique commonly used for industrial or transportation accidents, was developed by the authors to identify common patterns of safety deficiencies and causes. The falls were found to be the result of latently unsafe conditions, decisions and actions over a diverse set off circumstances, which if not identified and removed could cause falls for other older people in the future. Compelling evidence was generated that causes of falling
The aim of this study was to look at safety deficiencies found during fifteen investigations of falls among older people living in a naturally occurring retirement community in Ontario. Rather than viewing each case study from the more traditional person-centred perspective, a six step systems approach, the Senior Falls Investigation Methodology (SFIM), adapted from a technique commonly used for industrial or transportation accidents, was developed by the authors to identify common patterns of safety deficiencies and causes. The falls were found to be the result of latently unsafe conditions, decisions and actions over a diverse set off circumstances, which if not identified and removed could cause falls for other older people in the future. Compelling evidence was generated that causes of falling are systemic and develop over time and are best assessed by a systems approach such as SFIM which will expand the focus away from the individual faller and towards the multi-layered and supervisory causes. This will lead to improved prevention and management programs. While this study concentrated on older people living at home, the SFIM technique shows potential for use in hospitals and residential homes also.
Aging and Mental Health, 9(3), May 2005, pp.255-261.
Publisher:
Taylor and Francis
This study examines the relationship between fear of falling and depressive symptoms as well as the role of participation in physical activity and fall efficacy in the linkage between the fear of falling and depression. A sample of 100 residents living in nursing homes in Hong Kong were interviewed. Using multiple regression models, it was found that elderly persons who had greater fear of falling tended to report depressive symptoms more frequently after controlling socio-demographic and physical health status variables. In addition, activity involvement and fall efficacy acted as mediators and moderators in the link between the fear of falling and depression.
This study examines the relationship between fear of falling and depressive symptoms as well as the role of participation in physical activity and fall efficacy in the linkage between the fear of falling and depression. A sample of 100 residents living in nursing homes in Hong Kong were interviewed. Using multiple regression models, it was found that elderly persons who had greater fear of falling tended to report depressive symptoms more frequently after controlling socio-demographic and physical health status variables. In addition, activity involvement and fall efficacy acted as mediators and moderators in the link between the fear of falling and depression.
... For residents, outcome measures included function, physical activity (survey and actigraphy), mood, behaviour, and adverse events (falls and hospitalisation). Main outcome measures for nursing assistants included knowledge, beliefs, and performance of function focused care.
Results: There were significant improvements in the amount and intensity of physical activity (by survey and actigraphy) and physical function in the treatment group. In addition, there was a significant decrease in the number of residents who fell during the treatment period with those in the treatment sites having fewer falls (28% vs. 50% in the control group). Nursing assistants were also observed to be providing a greater percentage of function focused care during resident care interactions in the treatment group at 6 months
(Edited publisher abstract)
Purpose: This study tests the impact of Function-Focused Care for the Cognitively Impaired Intervention on nursing home residents with dementia and the nursing assistants who care for them.
Design and Methods: This was a cluster-randomised controlled trial using repeated measures. A total of 103 cognitively impaired residents and 77 nursing assistants were recruited from four nursing homes. For residents, outcome measures included function, physical activity (survey and actigraphy), mood, behaviour, and adverse events (falls and hospitalisation). Main outcome measures for nursing assistants included knowledge, beliefs, and performance of function focused care.
Results: There were significant improvements in the amount and intensity of physical activity (by survey and actigraphy) and physical function in the treatment group. In addition, there was a significant decrease in the number of residents who fell during the treatment period with those in the treatment sites having fewer falls (28% vs. 50% in the control group). Nursing assistants were also observed to be providing a greater percentage of function focused care during resident care interactions in the treatment group at 6 months following the completion of baseline measures.
Implications: This study provides some evidence that nursing home residents with severe cognitive impairment can safely and successfully be engaged in physical and functional activities.
(Edited publisher abstract)
This American study used a retrospective, pre/post with comparison group design. The study estimated residents' propensity to fall from demographics, comorbidities, and reimbursement in the pre-period. The matched sample included 1,130 fallers and 1,130 non-fallers who were residents of a large, multifacility long-term-care chain. Cost estimates were based on information in the Minimum Data Set and were defined as hospital and LTCF reimbursements. Fall-related costs were estimated as the difference between changes in costs for fallers and non-fallers from the pre- to post-period. Fallers were substantially more likely to suffer fractures and hospitalizations in the post-period than were non-fallers. Fall-related LTCF and hospital costs were $6,259 per resident per year. About 60% of this amount was attributable to higher hospitalisation costs. Fallers were more likely to be discharged to hospitals or to die.
This American study used a retrospective, pre/post with comparison group design. The study estimated residents' propensity to fall from demographics, comorbidities, and reimbursement in the pre-period. The matched sample included 1,130 fallers and 1,130 non-fallers who were residents of a large, multifacility long-term-care chain. Cost estimates were based on information in the Minimum Data Set and were defined as hospital and LTCF reimbursements. Fall-related costs were estimated as the difference between changes in costs for fallers and non-fallers from the pre- to post-period. Fallers were substantially more likely to suffer fractures and hospitalizations in the post-period than were non-fallers. Fall-related LTCF and hospital costs were $6,259 per resident per year. About 60% of this amount was attributable to higher hospitalisation costs. Fallers were more likely to be discharged to hospitals or to die.
Subject terms:
long term care, older people, hospital admission, residents, care homes, costs, falls;
... on the three areas: prevention of falls and promotion of independence, for people living in their own home or in a care home; response to falls when they happen in the community, either for someone living at home or in a care home; and following attendance at hospital due to a fall. It also highlights key themes identified from the review and how the affected service users, service providers and commissioners. The review identified examples of good practice but also found a lack of co-ordination and communication between health, social care and voluntary services could often be a barrier to delivering good quality care. The report has been informed by evidence from six individual falls services, the views of staff and older people. It makes eight recommendations for the Welsh Government, health boards and local authorities. The include a National Falls Framework for Wales, to standardise the approach to preventing, treating and reabling older people who are at risk of falling or have already fallen The report will be relevant for service providers, commissioners and service users.
(Edited publisher abstract)
Based on a review of integrated care for older people who are at risk of experiencing a fall in Wales, this report highlights learning for staff and for health and social care managers. It focuses on services to help people avoid a fall and how to support people who have had a fall, providing examples of desirable and undesirable pathways through the health and care system. It focuses on the three areas: prevention of falls and promotion of independence, for people living in their own home or in a care home; response to falls when they happen in the community, either for someone living at home or in a care home; and following attendance at hospital due to a fall. It also highlights key themes identified from the review and how the affected service users, service providers and commissioners. The review identified examples of good practice but also found a lack of co-ordination and communication between health, social care and voluntary services could often be a barrier to delivering good quality care. The report has been informed by evidence from six individual falls services, the views of staff and older people. It makes eight recommendations for the Welsh Government, health boards and local authorities. The include a National Falls Framework for Wales, to standardise the approach to preventing, treating and reabling older people who are at risk of falling or have already fallen The report will be relevant for service providers, commissioners and service users.
(Edited publisher abstract)
Subject terms:
integrated care, falls, prevention, independence, good practice, care homes, residents, hospital admission, reablement, person-centred care;
... strategies. It also includes a Care Home Falls Prevention Wheel which identifies 8 key areas that together can support best practice.
(Edited publisher abstract)
This practice guide, funded by the Welsh Government, explores what works well in supporting care home residents to remain mobile and to reduce their risk of falling. It draws on the experiences of care home staff attending events in Wales to share their expertise and stories of good practice. The guide includes examples on how care home practitioners can support residents to navigate safely around the home; how they can help residents feel motivated to get out of their chair and engage in physical activity, and how they can encourage residents to drink or eat properly. It also shows how staff have to consider how they help get the balance between reducing the risks of falling with the rights of these individuals to make choices. The guide highlights a number of creative individual strategies. It also includes a Care Home Falls Prevention Wheel which identifies 8 key areas that together can support best practice.
(Edited publisher abstract)
Subject terms:
older people, care homes, residents, falls, prevention, nutrition, hydration, good practice;
... residents of extra care housing supplied by 3 extra care providers (Audley Retirement, Extra Care Charitable Trust, and Retirement Security Limited). The outcomes that were examined include: the length of stay; whether extra care housing can be considered a ‘home for life’; the changing health characteristics of residents; the number of falls; and patterns of inpatient hospital stays. Data from
Extra care housing combines purpose-built and ergonomically designed housing for older people with onsite flexible care that adapts to residents’ changing needs. This study used longitudinal data in order to examine a number of outcomes relating to health status, usage of health services, and usage of institutional accommodation for extra care residents. The study used data on almost 4,000 residents of extra care housing supplied by 3 extra care providers (Audley Retirement, Extra Care Charitable Trust, and Retirement Security Limited). The outcomes that were examined include: the length of stay; whether extra care housing can be considered a ‘home for life’; the changing health characteristics of residents; the number of falls; and patterns of inpatient hospital stays. Data from the British Household Panel Survey (BHPS) and the English Longitudinal Study of Ageing (ELSA) were used to compare the outcomes with similarly matched residents living in the community. The findings show that, compared to those living in the community, those in extra care housing have improved health outcomes and are about half as likely to enter institutional accommodation. The report argues that extra care accommodation can be a ‘home for life’, which can successfully adapt to residents’ changing health and social care needs. It concludes with a number of recommendations for policy-makers and providers of extra care housing.
Subject terms:
long term outcomes, longitudinal studies, older people, residents, cost effectiveness, extra care housing, falls, health needs;
... residents of extra care housing supplied by 3 extra care providers (Audley Retirement, Extra Care Charitable Trust, and Retirement Security Limited). The outcomes that were examined include: the length of stay; whether extra care housing can be considered a ‘home for life’; the changing health characteristics of residents; the number of falls; and patterns of inpatient hospital stays. Data from
Extra care housing combines purpose-built and ergonomically designed housing for older people with onsite flexible care that adapts to residents’ changing needs. This study used longitudinal data in order to examine a number of outcomes relating to health status, usage of health services, and usage of institutional accommodation for extra care residents. The study used data on almost 4,000 residents of extra care housing supplied by 3 extra care providers (Audley Retirement, Extra Care Charitable Trust, and Retirement Security Limited). The outcomes that were examined include: the length of stay; whether extra care housing can be considered a ‘home for life’; the changing health characteristics of residents; the number of falls; and patterns of inpatient hospital stays. Data from the British Household Panel Survey (BHPS) and the English Longitudinal Study of Ageing (ELSA) were used to compare the outcomes with similarly matched residents living in the community. This executive summary includes the key findings and policy recommendations from this research. It finds that, compared to those living in the community, those in extra care housing have improved health outcomes and are about half as likely to enter institutional accommodation. It argues that extra care accommodation can be a ‘home for life’, which can successfully adapt to residents’ changing health and social care needs.
Subject terms:
long term outcomes, longitudinal studies, older people, residents, cost effectiveness, extra care housing, falls, health needs;
British Medical Journal, 18.10.08, 2008, pp.912-915.
Publisher:
British Medical Association
This study aimed to assess the effectiveness of an activity programme in improving function, quality of life, and falls in older people in residential care. Participants were 682 people aged 65 years or over in 41 low level dependency residential care homes in New Zealand. Three hundred and thirty residents were offered a goal setting and individualised activities of daily living activity programme by a gerontology nurse, reinforced by usual healthcare assistants; 352 residents received social visits. Outcome measures used were function (late life function and disability instruments, elderly mobility scale, FICSIT-4 balance test, timed up and go test), quality of life (life satisfaction index, EuroQol), and falls (time to fall over 12 months). Secondary outcomes were depressive symptoms
This study aimed to assess the effectiveness of an activity programme in improving function, quality of life, and falls in older people in residential care. Participants were 682 people aged 65 years or over in 41 low level dependency residential care homes in New Zealand. Three hundred and thirty residents were offered a goal setting and individualised activities of daily living activity programme by a gerontology nurse, reinforced by usual healthcare assistants; 352 residents received social visits. Outcome measures used were function (late life function and disability instruments, elderly mobility scale, FICSIT-4 balance test, timed up and go test), quality of life (life satisfaction index, EuroQol), and falls (time to fall over 12 months). Secondary outcomes were depressive symptoms and hospital admissions. Four hundred and seventy three (70%) participants completed the trial. The programme had no impact overall. However, in contrast to residents with impaired cognition (no differences between intervention and control group), those with normal cognition in the intervention group may have maintained overall function and lower limb function. In residents with cognitive impairment, the likelihood of depression increased in the intervention group. No other outcomes differed between groups. A programme of functional rehabilitation had minimal impact for elderly people in residential care with normal cognition but was not beneficial for those with poor cognition.
Subject terms:
intervention, long term care, quality of life, randomised controlled trials, residents, activities of daily living, care homes, falls;
Reports on a project, hosted by a primary care trust to, provide older residents in nursing and residential care homes in Sheffield with hip protectors if they were at risk of falling. During the project it became apparent that care home staff had little knowledge of hip protectors, and felt unable to take steps to prevent falls. The project then extended its scope to raise the awareness
Reports on a project, hosted by a primary care trust to, provide older residents in nursing and residential care homes in Sheffield with hip protectors if they were at risk of falling. During the project it became apparent that care home staff had little knowledge of hip protectors, and felt unable to take steps to prevent falls. The project then extended its scope to raise the awareness of falls-risk assessment and prevention strategies, and develop structures through which best practice could be shared between homes.