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Improving local service delivery to prevent falls in community-dwelling older adults: translating research to practice
- Authors:
- GAGEN Travis M., BULZACCHELLI Maria T.
- Journal article citation:
- Gerontologist, 61(6), 2021, pp.819-825.
- Publisher:
- Oxford University Press
Unintentional falls are the leading cause of both fatal and nonfatal injuries among Americans 65 years of age and older and place an enormous burden on the health care system. As the population continues to age, preventing falls will be increasingly important for reducing morbidity, mortality, and medical costs. Evidence-based fall prevention interventions for older adults exist, but widespread adoption of these interventions is needed. Local health departments, Area Agencies on Aging, first responders, and health care professionals can all play important roles in implementing fall prevention programs. This article presents a conceptual model for local delivery of fall prevention programs for community-dwelling older adults. This model can serve as a guide for translating existing fall prevention research into practice. (Edited publisher abstract)
Does the ‘Otago exercise programme’ reduce mortality and falls in older adults?: a systematic review and meta-analysis
- Authors:
- THOMAS Susie, MACKINTOSH Shylie, HALBERT Julie
- Journal article citation:
- Age and Ageing, 39(6), November 2010, pp.681-687.
- Publisher:
- Oxford University Press
A systematic review with meta-analysis was conducted to evaluate the effectiveness of a strength and balance retraining programme designed to prevent falls in older people living in the community, the Otago exercise programme. The meta-analysis included seven trials, involving 1503 participants. Outcomes of interest included risk of death, number of falls, number of injurious falls and compliance to the exercise programme. The Otago exercise programme was found to significantly reduced the risk of death over 12 months, and significantly reduced fall rates. There was no significant difference in the risk of a serious or moderate injury occurring as the result of a fall . Of the 747 participants who remained in the studies at 12 months, 274 (36.7%) were still exercising three or more times per week.
Community care staff attitudes towards delivering a falls prevention exercise intervention to community care clients
- Authors:
- BURTON Elissa, et al
- Journal article citation:
- Health and Social Care in the Community, 29(2), 2021, pp.416-424.
- Publisher:
- Wiley
Millions of older people world‐wide receive community care services in their home to assist them to live independently. These services often include personal care, domestic assistance and social support which are delivered by non‐university trained staff, and are frequently long term. Older people receiving community care services fall 50% more often than individuals of similar age not receiving services. Yet, few ongoing community care services include exercise programs to reduce falls in this population. We conducted an earlier study to examine the feasibility of community care staff delivering a falls prevention program. A critical finding was that while some of the assessment and support staff responsible for service delivery delivered the falls prevention exercise program to one or two clients, others delivered to none. Therefore, the aim of this qualitative sub‐study was to understand reasons for this variation. Semi‐structured interviews were conducted with 25 participating support staff and assessors from 10 community care organisations. Staff who had successfully delivered the intervention to their clients perceived themselves as capable and that it would benefit their clients. Older clients who were positive, motivated and wanted to improve were perceived to be more likely to participate. Staff who had worked at their organisation for at least 5 years were also more likely to deliver the program compared to those that had only worked up to 2 years. Staff that did not deliver the intervention to anyone were more risk averse, did not feel confident enough to deliver the program and perceived their clients as not suitable due to age and frailty. Experienced staff who are confident and have positive ageing attitudes are most likely to deliver falls prevention programs in a home care organisation. (Edited publisher abstract)
Cost-effectiveness of a preventive self-care health management program for community-dwelling older adults: a randomised controlled trial
- Authors:
- WONG Arkers Kwan Ching, WONG Frances Kam Yuet, SO Ching
- Journal article citation:
- Age and Ageing, 50(2), 2021, pp.440-446.
- Publisher:
- Oxford University Press
Objective: To examine the cost-effectiveness of a preventive self-care health management program for community-dwelling older adults as compared to usual care. Design/Intervention: A cost-effectiveness analysis was executed alongside a randomised controlled trial. Nurse case managers provided interventions, including holistic assessment, empowerment of self-care, preventive health behaviours and self-efficacy with co-produced care planning, supported by nursing students. The control group received social control calls. Participants/Setting: Community-dwelling older adults were randomly assigned to the intervention (n = 271) or control (n = 269) group. The intervention was conducted in collaboration with 11 community centres under four non-government organisations in various districts of Hong Kong. Measurements: Cost and quality-adjusted life years (QALYs) were collected pre (baseline, 0 months) and post intervention (3 months) and 3 months after completion of the program (6 months). Incremental cost-effectiveness ratios between the groups were calculated, dividing the difference in cost by the difference in QALYs. Results: Analysis showed that the net incremental QALY gain was 0.0014 (3 months) and 0.0033 (6 months) when the intervention group was compared to the control group. The probability of being cost-effective at 6 months was 53.2% and 53.4%, based on the cost-effectiveness thresholds recommended by both the National Institute for Health and Clinical Excellence ($200,000/QALYs) and the World Health Organization (Hong Kong gross domestic product/capita, HK$381,780). Conclusions: The results provide some evidence to suggest that the addition of a home-based, preventive self-care health management program may have effects on cost outcomes for community-dwelling older adults in Hong Kong. (Edited publisher abstract)
Non‐pharmacological interventions to prevent hospital or nursing home admissions among community‐dwelling older people with dementia: a systematic review and meta‐analysis
- Authors:
- LEE Den‐Ching A., TIRLEA Loredana, HAINES Terry P.
- Journal article citation:
- Health and Social Care in the Community, 28(5), 2020, pp.1408-1429.
- Publisher:
- Wiley
Older people with dementia more frequently experience episodes of hospital care, transferal to nursing home and adverse events when they are in these environments. This study synthesised the available evidence examining non‐pharmacological interventions to prevent hospital or nursing home admissions for community‐dwelling older people with dementia. Seven health science databases of all dates were searched up to 2 December 2019. Randomised controlled trials and comparative studies investigating non‐pharmacological interventions for older people with dementia who lived in the community were included. Meta‐analyses using a random‐effect model of randomised controlled trials were used to assess the effectiveness of interventions using measures taken as close to 12 months into follow‐up as reported. Outcomes were risk and rate of hospital and nursing home admissions. Risk ratio (RR) or rate ratios (RaR) with 95% confidence interval were used to pool results for hospital and nursing home admission outcomes. Sensitivity analyses were conducted to include pooling of results from non‐randomised trails. Twenty studies were included in the review. Community care coordination reduced rate of nursing home admissions [(2 studies, n = 303 people with dementia and 86 patient–caregiver dyads), pooled RaR = 0.66, 95% CI (0.45, 0.97), I2 = 0%, p = .45]. Single interventions of psychoeducation and multifactorial interventions comprising of treatment and assessment clinics indicated no effect on hospital or nursing home admissions. The preliminary evidence of community care coordination on reducing the rate of nursing home admissions may be considered with caution when planning for community services or care for older people living with dementia. (Publisher abstract)
Effectiveness of multifactorial interventions in preventing falls among older adults in the community: a systematic review and meta-analysis.
- Authors:
- LEE Seon Heui, YU Soyoung
- Journal article citation:
- International Journal of Nursing Studies, early cite 7 March 2020,
- Publisher:
- Elsevier
Background: Falls often cause unexpected injuries that older adults find difficult to recover from (e.g., hip and other major fractures, intracranial bleeding); therefore, fall prevention and interventions are of particular significance. Objectives: This study aimed to examine the effectiveness of multifactorial fall prevention interventions among community-dwelling older adults and compare subgroups that differed in terms of their degree of fall risk and the intensity and components of interventions. Methods: An exhaustive systematic literature search was undertaken using the following databases: Ovid-Medline, Ovid-Embase, and the Cochrane Central Register of Controlled Trials (Central). Two investigators independently extracted data and assessed the quality of the studies by examining the risk of bias. This study conducted a meta-analysis of randomized controlled trials that had been published up to March 31st, 2019, using Review Manager. Results: Of 1,328 studies, 45 articles were relevant to this study. In total, 29 studies included participants in the high-risk group, 3 in the frail group, and 13 in the healthy older adult group. Additionally, 28 and 17 studies used active and referral multifactorial interventions, respectively. Multifactorial interventions included the following components: exercise, education, environmental modification, medication, mobility aids, and vision and psychological management. Multifactorial interventions significantly reduced fall rates in the high-risk (risk ratio 0.66; 95% confidence interval 0.52–0.84) and healthy groups (risk ratio 0.72; 95% confidence interval 0.58–0.89), when compared to the control group. Active multifactorial interventions (risk ratio 0.64; 95% confidence interval 0.51–0.80) and those featuring exercise (risk ratio 0.66; 95% confidence interval 0.54–0.80) and environmental modification also showed significantly reduced fall rates (risk ratio 0.65; 95% confidence interval 0.54–0.79) compared to usual care. Multifactorial interventions had a significantly lower number of people who experienced falls during the study period compared to usual care in the healthy group (risk ratio 0.77; 95% confidence interval 0.62–0.95). Active multifactorial interventions (risk ratio 0.73; 95% confidence interval 0.60–0.89) and those featuring exercise (risk ratio 0.79; 95% confidence interval 0.66–0.95) and environmental modification (risk ratio 0.80; 95% confidence interval 0.68–0.95) had a significantly lower number of people who experienced falls compared to those receiving usual care. Conclusions: Active multifactorial interventions had positive effects on fall rates and the number of people experiencing falls. Thus, healthcare workers, including nurses, should be involved in planning fall prevention programs so that older adults can be provided with optimal care; multifactorial interventions that include exercise and environmental modification are particularly effective in reducing falls. (Edited publisher abstract)
Moving healthcare closer to home: summary
- Author:
- MONITOR
- Publisher:
- Monitor
- Publication year:
- 2015
- Pagination:
- 12
- Place of publication:
- London
Summarises the findings of a project examining examples where provision of non-elective care moved from an acute hospital to the community. The Five Year Forward View has encouraged efforts to deliver more healthcare out of acute hospitals and closer to home, with the aim of providing better care for patients, cutting the number of unplanned bed days in hospitals and reducing net costs. Drawing on the lessons from a set of case studies, this analysis shows that: well-designed schemes to move healthcare closer to home can deliver benefits in the long term; it is difficult, however, to cut costs across a local health economy in the short run; and better data and improved pricing would help. The paper is part of a suite of materials developed to support providers and commissioners making decisions about schemes to move healthcare currently provided in acute hospitals to community-based settings. (Edited publisher abstract)
Establishing and implementing best practice to reduce unplanned admissions in those aged 85 years and over through system change [Establishing System Change for Admissions of People 85+ (ESCAPE 85+)]: a mixed-methods case study approach
- Authors:
- WILSON Andrew, et al
- Journal article citation:
- Health and Social Care Delivery Research, 3(37), 2015, Online only
- Publisher:
- National Institute for Health Research
- Place of publication:
- London
The number of unplanned hospital admissions has been rising steadily in England over the last decade, especially for people aged 85 years and over. However, across the country, rates of change in admissions for this age group vary widely, and in some localities have declined. It seems some places have been more successful than others in avoiding the need for admission, either by preventing medical crises developing or by offering alternative care at home or in the community. This study focused on three sites where admission rates for people aged 85 years and over had risen most sharply and three where they had declined. The research team examined NHS data and conducted interviews with over 140 participants from health- and social care organisations to understand how strategies and services had been developed and implemented. They found that sites that had been successful in reducing admissions had done so by providing alternatives to short-stay admissions, including better-developed community services which worked closely with each other, the hospital and general practitioner services. These sites had fewer problems with access to general practitioner services and less pressure on emergency departments. They had also been more successful in developing strategies to include a full range of health- and social care organisations and, most importantly, had consistent, strong leadership and shared values. The main output of this work is a set of recommendations aimed at commissioners of services for older people, and includes an examination of their impact in a site not previously involved in the research. (Edited publisher abstract)
Right care, first time: services supporting safe hospital discharge and preventing hospital admission and readmission
- Author:
- AGE UK
- Publisher:
- Age UK
- Publication year:
- 2012
- Pagination:
- 28p.
- Place of publication:
- London
Older people represent the main in-patient group, at any one time occupying more than two-thirds of acute hospital in-patient beds. Providers and commissioners need to put in place cost-effective, community based services, which can both prevent the need for hospital admission and safely reduce length of stay for older people. A hospital admission can occur when an older person has reached breaking point because of a combination of problems that have been building up before admission: social circumstances (such as living alone or having caring responsibilities) or general frailty. The aim of this publication is to disseminate examples of positive practice in avoiding hospital admission, supporting safe discharge and preventing readmission for older people. This publication highlights 5 examples of local Age UK services, charting the ‘pathway’ of prevention from identifying older people in the local community who may be at risk, to supporting people who are in A&E, and ensuring that discharge from in-patient care is safe and well co-ordinated.
Technology innovation enabling falls risk assessment in a community setting
- Authors:
- SCANAILLA Cliodhna, et al
- Journal article citation:
- Ageing International, 36(2), June 2011, pp.217-213.
- Publisher:
- Springer
- Place of publication:
- New York
Falls risk is currently assessed in a clinical setting by expert physiotherapists, geriatricians, or occupational therapists following the occurrence of an injurious fall. Advances in technology may enabling community-based practitioners to perform tests that previously required expensive technology or expert interpretation. Gait and balance impairment is one of the most common risk factors for falls. This paper reviews the current technical and non-technical gait and balance assessments, discusses how low-cost technology can be applied to objectively administer and interpret these tests in the community, and reports on recent research where body-worn sensors have been used. It also discusses the barriers to adoption in the community and proposes ethnographic research as a method to investigate solutions to these barriers.