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New horizons in falls prevention and management for older adults: a global initiative
- Author:
- MONTERO-ODASSO Manuel
- Journal article citation:
- Age and Ageing, 50(5), 2021, pp.1499-1507.
- Publisher:
- Oxford University Press
Background: falls and fall-related injuries are common in older adults, have negative effects both on quality of life and functional independence and are associated with increased morbidity, mortality and health care costs. Current clinical approaches and advice from falls guidelines vary substantially between countries and settings, warranting a standardised approach. At the first World Congress on Falls and Postural Instability in Kuala Lumpur, Malaysia, in December 2019, a worldwide task force of experts in falls in older adults, committed to achieving a global consensus on updating clinical practice guidelines for falls prevention and management by incorporating current and emerging evidence in falls research. Moreover, the importance of taking a person-centred approach and including perspectives from patients, caregivers and other stakeholders was recognised as important components of this endeavour. Finally, the need to specifically include recent developments in e-health was acknowledged, as well as the importance of addressing differences between settings and including developing countries. Methods: a steering committee was assembled and 10 working Groups were created to provide preliminary evidence-based recommendations. A cross-cutting theme on patient’s perspective was also created. In addition, a worldwide multidisciplinary group of experts and stakeholders, to review the proposed recommendations and to participate in a Delphi process to achieve consensus for the final recommendations, was brought together. Conclusion: in this New Horizons article, the global challenges in falls prevention are depicted, the goals of the worldwide task force are summarised and the conceptual framework for development of a global falls prevention and management guideline is presented. (Edited publisher abstract)
Barriers to preventive care utilization among Hong Kong community-dwelling older people and their views on using financial incentives to improve preventive care utilization
- Authors:
- LIAO Qiuyan, et al
- Journal article citation:
- Health Expectations, 24(4), 2021, pp.1242-1253. Online only
- Publisher:
- Wiley
Background: Financial incentive is increasingly used as a mean to promote preventive care utilization (PCU), but the current Elderly Health Care Voucher Scheme (EHCVS) in Hong Kong is ineffective for encouraging PCU. Objective: To explore the older people's barriers to PCU and their views on financial incentive, including EHCVS, for improving private PCU. Design and setting: Focus-group discussions were conducted in community elderly centres located in five districts of Hong Kong. Participants: Community-dwelling older people aged 60 years or above. Results: Lack of understanding about preventive care and low awareness of the need for preventive care were key factors for the low motivation for PCU. Uncertainty over the level of service fee charged and concerns over service quality hindered the choice of using the private service providers under the current EHCVS. Financial incentives specific for preventive care services were thought to be cues to actions and guides for service promotion. However, some flexibility in service coverage and a set time limit of the financial incentives were preferred to accommodate individual needs. Conclusions: Apart from promoting knowledge of preventive care, official monitoring for service fee and quality is important for empowering older people to choose private service providers for preventive care. Financial incentives for preventive care services should be more specific to cue service promotion and uptake of preventive care while maintaining flexibility to accommodate individual needs. Patient or public contribution: Participants were recruited using purposive sampling with the coordination of community elderly centres. Data were analysed using thematic coding. (Edited publisher abstract)
Determinants of fall prevention guideline implementation in the home- and community-based service setting
- Authors:
- JUCKETT Lisa A., et al
- Journal article citation:
- Gerontologist, 61(6), 2021, pp.942-953.
- Publisher:
- Oxford University Press
Background and Objectives: Home- and community-based service (HCBS) recipients often possess multiple fall risk factors, suggesting that the implementation of evidence-based fall prevention guidelines may be appropriate for the HCBS setting. The purpose of this exploratory study was to examine the determinants of fall prevention guideline implementation and the potential strategies that can support implementation in HCBS organizations. Research Design and Methods: Semistructured interview and focus group data were collected from 26 HCBS professionals representing the home-delivered meals, personal care, and wellness programs. Qualitative codes were mapped to the Consolidated Framework for Implementation Research by means of directed content analysis. The Consolidated Criteria for Reporting Qualitative research checklist was used to report the findings of this study. Results: We identified 7 major determinants of guideline implementation: recipient needs and resources, cosmopolitanism, external policy and incentives, networks and communication, compatibility, available resources, and knowledge/beliefs. Strategies to support guideline implementation included the involvement of recipient and caregiver feedback, building fall prevention networks, and conducting educational meetings for HCBS staff. Discussion and Implications: Falls and fall-related injuries will continue to plague the older adult community unless innovative approaches to fall prevention are developed and adopted. The implementation of fall prevention guidelines in the HCBS setting can help mitigate fall risk among a highly vulnerable older adult population and may be facilitated through the application of multifaceted implementation strategies. (Edited publisher abstract)
Interventions promoting physical activity among older adults: a systematic review and meta-analysis
- Authors:
- GRANDE Guilherme D., et al
- Journal article citation:
- Gerontologist, 60(8), 2020, pp.e583-e599.
- Publisher:
- Oxford University Press
Background and Objectives: Frequent participation in physical activity (PA) has benefits across the lifespan but is particularly important for older adults. PA levels are either measured by objective or self-reported survey methods. Objective PA measurement is used to increase accuracy. This systematic review investigated the effect of physical activity-based interventions on objectively measured PA levels among community-dwelling adults aged 60 years and older. Research Design and Methods: Literature searches were conducted in five electronic databases and four clinical trial registries. Randomized controlled trials investigating the effect of physical activity–based interventions on objectively measured PA levels (e.g., accelerometers or pedometers) in community-dwelling adults aged 60 years and older compared with no/minimal intervention were considered eligible. Data were pooled using the most conservative estimates reported from each study using the standardized mean difference (SMD). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the overall quality of the evidence. Results: Fourteen published trials and 3 ongoing trials were identified. There were significant effects favoring physical activity–based interventions compared with minimal intervention at short-term (less than or equal to 3 months) (SMD: 0.30, 95% CI: 0.17 to 0.43) and intermediate-term (more than 3 months and less than 12 months; SMD: 0.27, 95% CI: 0.06 to 0.49) follow-ups. The quality of evidence was moderate according to GRADE (downgraded for risk of bias). Discussion and Implications: Our findings suggest that physical activity–based interventions may increase objectively measured PA levels in community-dwelling older adults. Further studies are still needed to identify the optimal dose, intensity, and mode of delivery of physical activity–based interventions. (Edited publisher abstract)
A systematic review of education for the prevention of HIV/AIDS among older adults
- Authors:
- MILASZEWSKI Dorota, et al
- Journal article citation:
- Journal of Evidence-Based Social Work, 9(3), June 2012, pp.213-230.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This literature review examined articles focused on primary prevention of HIV/AIDS for adults aged 50 and over. A total of twenty one English language articles were included. Three major challenges were identified in providing HIV/AIDS education for older adults include health professionals' ageism, older adults' reluctance to discuss sexuality, and their misconception of their HIV risk. Clinical guidelines for social workers, nurses, and physicians identified the importance of sharing information and assessing risk, considering cultural diversity, and devising creative delivery strategies. Three models of HIV/AIDS education include group education programmes delivered by social workers or other health professionals, peer education models, and one-on-one early intervention models including HIV/AIDS testing. The authors concluded that additional outreach and research on HIV/AIDS prevention among older adults is required.
Falls after discharge from hospital: is there a gap between older peoples’ knowledge about falls prevention strategies and the research evidence?
- Authors:
- HILL Anne-Marie, et al
- Journal article citation:
- Gerontologist, 51(5), October 2011, pp.653-662.
- Publisher:
- Oxford University Press
This study explored whether older people were prepared to engage in appropriate falls prevention strategies after discharge from hospital in Swan Districts hospital, Perth, Australia. Three hundred and thirty three older patients about to be discharged from hospital were surveyed about their knowledge regarding falls prevention strategies. Participants were asked to suggest strategies to reduce their falls risk at home after discharge, and their responses were compared with reported research evidence for falls prevention interventions. Strategies were classified into 7 categories: behavioural; support while mobilising; approach to movement; physical environment; visual; medical; and activities or exercise. Although exercise has been identified as an effective falls risk reduction strategy, only about 3% of participants suggested engaging in exercises. Falls prevention was most often conceptualised by participants as requiring one or two strategies for avoiding an accidental event, rather than engaging in sustained multiple risk reduction behaviours. Overall, patients had low levels of knowledge about appropriate falls prevention strategies. The authors concluded that health care workers should design and deliver falls prevention education programmes specifically targeted to older people discharged from hospital.
Preventing falls: how to monitor risk and intervene
- Author:
- -
- Journal article citation:
- Nursing and Residential Care, 13(2), February 2011, pp.82-84.
- Publisher:
- MA Healthcare Ltd.
- Place of publication:
- London
Highlights what care homes can do to prevent falls in their older residents. The article looks at possible risks and preventive interventions such as physical exercise.
How balance can overcome barriers
- Author:
- CARTER Kathy
- Journal article citation:
- Quality in Ageing, 9(1), March 2008, pp.41-44.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
Balance is key to improving the quality of life for older patients. This article looks at barriers to participation which exist in different forms in all areas of fitness and exercise, and are of an emotional or practical nature. The article also highlights the BalanceMaster machine, a piece of equipment that helps with balance and confidence.
Change of approach needed in fracture prevention
- Author:
- HAIRON Nerys
- Journal article citation:
- Nursing Times, 29.1.08, 2008, pp.23-24.
- Publisher:
- Nursing Times
New research suggests that the NHS approach to fracture prevention should shift its focus from osteoporosis to preventing falls. The analysis says that falling is the strongest single risk factor for fracture. This article summarises the research findings and also highlights NICE (2004) guidance on assessing and preventing falls in older people.
Developing an integrated falls prevention strategy
- Author:
- PIGFORD Christine
- Journal article citation:
- Nursing Times, 9.10.07, 2007, pp.30-31.
- Publisher:
- Nursing Times
This article describes the development of an integrated falls prevention strategy within Sunderland teaching PCT. It outlines the setting up of a group to implement the recommendations of the National Service Framework for Older People, and describes the development of two risk assessment tools.