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New horizons in falls prevention
- Authors:
- LORD Stephen R., et al
- Journal article citation:
- Age and Ageing, 47(4), 2018, p.492–498.
- Publisher:
- Oxford University Press
Falls pose a major threat to the well-being and quality of life of older people. Falls can result in fractures and other injuries, disability and fear and can trigger a decline in physical function and loss of autonomy. This article synthesises recent published findings on fall risk and mobility assessments and fall prevention interventions and considers how this field of research may evolve in the future. Fall risk topics include the utility of remote monitoring using wearable sensors and recent work investigating brain activation and gait adaptability. New approaches for exercise for fall prevention including dual-task training, cognitive-motor training with exergames and reactive step training are discussed. Additional fall prevention strategies considered include the prevention of falls in older people with dementia and Parkinson’s disease, drugs for fall prevention and safe flooring for preventing fall-related injuries. The review discusses how these new initiatives and technologies have potential for effective fall prevention and improved quality of life. It concludes by emphasising the need for a continued focus on translation of evidence into practice including robust effectiveness evaluations of so that resources can be appropriately targeted into the future. (Edited publisher abstract)
All those who wander are not lost: walking with purpose in extra care, retirement and domestic housing
- Authors:
- BARRETT Julie, EVANS Simon, PRITCHARD-WILKES Vanessa
- Publisher:
- University of Worcester. Association for Dementia Studies
- Publication year:
- 2020
- Pagination:
- 18
- Place of publication:
- Worcester
Sets out the findings from a mixed methods study exploring walking with purpose in extra care, retirement and domestic housing settings, along with the perceptions and responses of staff and family carers. The term ‘wandering’ has become a label with negative overtones in the context of dementia care and suggests aimlessness, whereas in fact there is often a purpose or aim behind this activity. In recognition of this, the term ‘walking with purpose’ is used in this study while also acknowledging that this includes ‘wandering’ as a normal and valuable human activity. The study indicates that, although residents who walk with purpose constitute a minority of people living in retirement and extra care housing schemes, managing walking with purpose can be a challenge for management and staff and can occupy a disproportionate amount of their time. The findings emphasise the importance of: getting to know the resident, finding out their motivations and reasons for walking and trying to accommodate their wishes; ensuring staff receive appropriate training in understanding and addressing walking with purpose; ensuring the design of the physical environment supports the way-finding abilities of people living with dementia. Example design recommendations that emerged from this study include: gardens and outdoor spaces must be secure and enclosed; provide safe indoor and outdoor walking routes with frequent places to rest and interesting things to see and do along the way; design features to assist with way-finding. The paper also supports the use of assistive technology devices such as contact ID wrist bands, door sensors, speaking door sensors, GPS trackers and alarm mats. (Edited publisher abstract)
Perceptions of older people in Ireland and Australia about the use of technology to address falls prevention
- Authors:
- MACKENZIE Lynette, CLIFFORD Amanda
- Journal article citation:
- Ageing and Society, 40(2), 2020, pp.369-388.
- Publisher:
- Cambridge University Press
Falls are common events with serious consequences for older people. With an ageing population and increasing health-care costs, information and communication technologies (ICT) will have a potential role in future health-care delivery. However, research on technology acceptance in health care for older people is limited and its application to falls prevention is unknown. The aims of this study were to explore and describe the perceptions of community-dwelling Australian and Irish older people about their current use of technology, and the potential use of technology for falls prevention. Qualitative data were collected from three focus groups conducted in and around Limerick in Ireland, and three in the Sydney area, Australia. A total of 35 older people participated. Data were analysed using thematic analysis. Four themes emerged from the data: (a) perceptions of vulnerability to falls, (b) preferences for exercise interventions, (c) participation in and ownership of technology, and (d) perceptions about applications of technology for falls prevention. As the use of technology is an instrumental activity of daily living, health professionals need to assess the capacity of older people to adopt these technologies, and provide falls prevention interventions to accommodate the technology skills of older people. Some participants were reluctant to embrace technology and barriers to the effective use of technology to assist in preventing falls may conflict with future health service trends. (Publisher abstract)
A pilot randomized trial of an intervention to enhance the health-promoting effects of older adults’ activity portfolios: the Engaged4Life Program
- Authors:
- MATZ-COSTA Christina, et al
- Journal article citation:
- Journal of Gerontological Social Work, 61(8), 2018, pp.792-816.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The purpose of this study was to evaluate the feasibility and outcomes of the Engaged4Life program, an intervention to encourage inactive community-dwelling older adults to embed physical activity, cognitive activity, and social interaction into their everyday lives in contexts that are personally meaningful and natural for them. Fifteen participants were randomized to the intervention group (technology-assisted self-monitoring of daily activity via pedometers and daily tablet-based surveys; psychoeducation + goal-setting via a 3-hour workshop; and peer mentoring via phone 2×/week for 2.5 weeks) and 15 to the control (technology-assisted self-monitoring only). Recruitment was shown to be feasible and efficient, but not able to reach the target for men. Retention rate was 83% and participants manifested high adherence and engagement with the intervention. Though this pilot trial was not powered to demonstrate significant differences between groups, daily steps increased by 431 (11% increase) from baseline to Week 4 for the intervention (p < .05), but decreased by 458 for the control, for a net difference of 889 steps (p < .05). Findings were sustained at Week 8 (p < .01). In a future trial, difficulties in recruiting men, barriers due to the technology-intensive design, and the optimization of secondary outcome measures should be addressed. (Edited publisher abstract)
Promoting supported ambulation in persons with advanced Alzheimer’s disease: a pilot study
- Authors:
- LANCIONI Giulio E., et al
- Journal article citation:
- Disability and Rehabilitation: Assistive Technology, 13(1), 2018, pp.101-106.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Purpose: This study assessed the effects of an intervention programme, which combined the use of a walker with assistive technology, on the ambulation and indices of positive involvement of persons with advanced Alzheimer’s disease. A social validation assessment of the programme was also carried out. Method: The study included 10 participants with moderate to severe Alzheimer’s disease and inability to walk independently. During baseline, the participants sat in their chair or were provided with a walker. During the intervention, the participants were provided with the walker and assistive technology, which delivered (a) preferred stimulation contingent on step responses and (b) encouragements to ambulate if needed. Results: The participants’ mean step frequencies were between 17 and 45 per session during the baseline and between 83 and 127 per session during the intervention. Sessions lasted 3 min. Most participants also had an increase in indices of positive involvement during the intervention sessions, thus showing an interest in those sessions. The social validation assessment showed that staff personnel rated the programme favourably. Conclusions: A programme combining the use of a walker with assistive technology may be a practical resource for improving ambulation and positive involvement of persons with advanced Alzheimer’s disease. Implications for rehabilitation: 1) A programme based on relatively simple technology combined to a walker device may support ambulation in participants with advanced Alzheimer’s disease who are no longer able to walk independently; 2) The same programme may also help increase the indices of positive involvement (i.e., improve the general attention/activity and mood) of most participant; 3) The staff’s positive ratings of the program suggest that there may be a favourable attitude toward the acceptance and application of the programme in daily contexts. (Edited publisher abstract)
Promoting health and wellbeing in later life: interventions in primary care and community settings
- Authors:
- FROST Helen, HAW Sally, FRANK John
- Publisher:
- Scottish Collaboration for Public Health Research and Policy
- Publication year:
- 2010
- Pagination:
- 157p.
- Place of publication:
- Edinburgh
In Scotland, the population of older people is expected to rise and it will become increasingly difficult to maintain independent living for older people in their own homes or provide adequate pensions and social security systems. Disability and ill health in older people has been shown to be strongly linked to socioeconomic position. The aim of this review is to provide an overview of the evidence for interventions that prevent or delay physical disablement in later life with a view to informing policy makers and developing equitable intervention strategies. A search was conducted to find information relevant to research, interventions, policies and programmes delivered in Scotland or internationally that aim to impact on health and reduce inequalities in older people. The key policies and frameworks that have been published internationally and in Scotland relevant to the care of an increasingly ageing population are discussed. Specific interventions are then considered under the following categories: complex interventions; interventions to prevent falls and fractures; physical activity and exercise interventions; nutritional interventions; information and communication technology interventions; interventions to prevent social isolation and loneliness; and medication review.
Potential technological solutions to promote mental well-being in older age
- Authors:
- COOK Glenda, et al
- Journal article citation:
- Generations Review, 20(3), July 2010, Online only
- Publisher:
- British Society of Gerontology
Using a multi-national Appreciative Inquiry (AI) design, the strategies that older people adopt to maintain their well-being were examined. Fifty-nine people participated in the study, from the countries of Australia, Germany, South Africa and United Kingdom. Participants described their experiences of mental well-being in relation to: social isolation and loneliness; social worth; self-determination; and security. The authors the reflected on the participants experiences, literature and research to identify potential technologies that may have assisted participants to enhance their self-reported strategies to promote their mental well-being.
Safe2walk: safe walking for people with dementia
- Authors:
- READ Sheridan, COLQUHOUN Simon, BURTON Jason
- Journal article citation:
- Journal of Dementia Care, 18(2), March 2010, pp.14-16.
- Publisher:
- Hawker
People with dementia walk for many reasons – leisure, exercise, or a way of seeking something familiar. However, one consequence of dementia is that people may become disoriented when walking, resulting in hospital admissions, emotional distress and even mortality. Evidence suggests when people with dementia are missing for more than 12 hours there is a 50% chance of finding them injured or dead. This article examines lessons learned from research using assistive technology to support independent outdoor walking, where a mobile phone equipped with a GPS unit designed for 6 to 10 year olds was tested on walkers, and the opinions of their carers’ were recorded. Findings were mixed, with 55% of carers reporting no increase in confidence in allowing the person they cared for to go out alone, 15% reported a definite increase in confidence. A third said their stress levels had not reduced at all during the trial, and the same number reported a reduction in stress. In conclusion, the authors suggest that it is important when introducing new technology to carefully manage expectations otherwise disappointments and stress may result in rejection of the technology.
Interventions in community settings that prevent or delay disablement in later life: an overview of the evidence
- Authors:
- FROST Helen, HAW Sally, FRANK John
- Journal article citation:
- Quality in Ageing and Older Adults, 13(3), 2012, pp.212-230.
- Publisher:
- Emerald
A literature review was undertaken to identify reviews and meta-analyses published between 1999 and 2009 on interventions aimed at preventing disablement in community-dwelling older people. This article presents an overview of the conclusions and quality of the 62 reviews selected for inclusion, and summarises the evidence for interventions. The selected reviews covered the following types of interventions: preventative home visits, integrated service delivery/case management and comprehensive geriatric assessment, falls prevention, exercise, nutritional needs, medication review, telecare/telehealth, social integration interventions, and vision screening. The authors discuss the findings and their implications for policies for healthy ageing. They report that the review identified areas of conflicting evidence and unknown effectiveness, partly due to lack of standardisation of outcome measures and poor research design, but that there are some promising interventions, such as integrated care delivery programmes, and there is evidence to support the implementation of exercise interventions, particularly for prevention of falls.
'The billion dollar question': embedding prevention in older people's services: 10 'high impact' changes
- Authors:
- ALLEN Kerry, GLASBY Jon
- Publisher:
- University of Birmingham. Health Services Management Centre
- Publication year:
- 2010
- Pagination:
- 19p., bibliog.
- Place of publication:
- Birmingham
There is a need to invest more fully and strategically in both prevention and rehabilitation for older people, to help them stay healthier, more independent and more socially included for longer and to recover these capacities as fully as possible when they do require hospital treatment. While there is growing recognition that only a more preventative agenda will be sufficient to respond to current and future pressures, there is much less clarity about how to do this in practice. This paper seeks to identify the most promising ‘10 high impact changes’ with regards to prevention in older people’s services. The paper draws on two main sources. The first is an EU review of prevention and long-term care in older people’s services across 14 European counties known as Interlinks. The second key source is a recent review of the social and economic benefits of adult social care, commissioned by the Department of Health and Downing Street. This paper identifies and reviews the following 10 prevention strategies: promoting healthy lifestyles; vaccination; screening; falls prevention; housing adaptations and practical support; telecare and technology; intermediate care; reablement; partnership working; and personalisation.