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Falls in older people with sight loss: a review of emerging research and key action points
- Author:
- THOMAS POCKLINGTON TRUST
- Publisher:
- Thomas Pocklington Trust
- Publication year:
- 2013
- Pagination:
- 20
- Place of publication:
- London
Draws on recent research to summarise what is known about falls and falls prevention amongst older people with sight loss. It explores the implications of research findings for action to address and reduce the risk of falls among older people with sight loss and suggests key issues for health and social care professionals to consider when working with older people, many of whom may have sight loss, and for sight loss specialists to consider when addressing individuals’ risks of falls. (Publisher abstract)
The evaluation of a Fall Management programme in a nursing home population
- Authors:
- BURLAND Elaine, et al
- Journal article citation:
- Gerontologist, 53(5), 2013, pp.828-838.
- Publisher:
- Oxford University Press
Purpose of the Study: This study evaluates a nursing home Fall Management programme to see if residents’ mobility increased and injurious falls decreased. Design and Methods: Administrative health care use and fall occurrence report data were analysed from 2 rural health regions in Manitoba, Canada, from June 1, 2003 to March 31, 2008. A quasiexperimental, pre-post, comparison group design was used to compare rates of three outcomes, falls, injurious falls, and falls resulting in hospitalisation, by RHA (programme vs nonprogramme nursing homes) and period (preprogram vs postprogram). Data collectors entered occurrence report information into spreadsheets. This was supplemented with administrative health care use data. Results: The programme appears to have benefited residents—falls trended upward, injurious falls remained stable, and hospitalised falls decreased significantly (0.036–0.021 per person-year [ppy]; p = .043). Compared with nonprogramme residents in the postperiod, both groups had the same fall rate, but programme residents had significantly fewer injurious falls (0.596–0.746 ppy; p = .02) and hospitalised falls (0.02–0.041 ppy; p = .023). Implications: These results are among a small body of literature showing that Fall Management was associated with improved outcomes in programme nursing homes from pre- to postperiod and compared with nonprogramme nursing homes. This research provides some support for the benefits of being proactive and implementing injury prevention strategies universally and pre-emptively before a resident falls, helping to minimise injuries while keeping residents mobile and active. Larger scale research is needed to identify the true effectiveness of the Fall Management programme and generalisability of results. (Publisher abstract)
New jobs old roles: working for prevention in a whole-system model of health and social care for older people
- Authors:
- SMITH Naomi, BARNES Marian
- Journal article citation:
- Health and Social Care in the Community, 21(1), 2013, pp.79-87.
- Publisher:
- Wiley
The ‘Partnerships for Older People Projects’ programme provided government funding for local and health authorities to pilot prevention and intervention services in partnership with the voluntary sector and older people between 2006 and 2009. This evaluation of a pilot in southern England used a Theory of Change approach to gather and reflect on data with different groups involved in the delivery of this model of prevention. This whole-system model, although complex and challenging to implement, was considered overall to have been a success and provided significant learning for partners and stakeholders on the challenges and benefits of working across professional and sectoral boundaries. New posts were created as part of the model – two of these, recruited to and managed by voluntary sector partners, were identified as ‘new jobs’, but echoed ‘old roles’ within community and voluntary sector based health and social care. The authors reflect on the parallels of these roles with previously existing roles and ways of working and reflect on how the whole-system approach of this particular pilot enabled these new jobs to develop in appropriate and successful ways.
Evidence, insight, or intuition? Investment decisions in the commissioning of prevention services for older people
- Authors:
- MILLER Robin, et al
- Journal article citation:
- Journal of Care Services Management, 7(4), 2013, pp.119-127.
- Publisher:
- Taylor and Francis
English adult social care commissioners are expected to make ‘evidence based’ decisions on how best to invest public sector funding. This study explores the types of evidence that commissioners use in relation to prevention services for older people and the other factors that influence their investment decisions. A study of local authority Directors of Adult Social Services (DASSs) was used to identify three local prevention interventions. Semi-structured interviews with leads for these interventions explored the evidence and other factors that influenced the investment process. Commissioners drew on a variety of published evidence, in particular that deriving from central government and its regional representative bodies, and third sector organizations with specialist knowledge. Local evidence was also generated through the undertaking of pilots and gathering of performance data. Alongside these ‘rational’ decision-making processes were strong political, personal, and relational dimensions related primarily to the influence of elected members and the hierarchical power of DASSs. Capturing experiential evidence and knowledge of service users and frontline practitioners, being clear about expected impacts and monitoring accordingly, and using recognized evaluation tools would provide further local evidence and enable better comparison and sharing across local authorities. (Publisher abstract)
Reducing hospital bed use by frail older people: results from a systematic review of the literature
- Authors:
- PHILP Ian, et al
- Journal article citation:
- International Journal of Integrated Care, 13(4), 2013, Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: Numerous studies have been conducted in developed countries to evaluate the impact of interventions designed to reduce hospital admissions or length of stay (LOS) amongst frail older people. A systematic review of the recent international literature (2007-present) was carried out to help improve understanding about the impact of these interventions. Methods: The following databases were systematically searched: PubMed/Medline, PsycINFO, CINAHL, BioMed Central and Kings Fund library. Studies were limited to publications from the period 2007-present and a total of 514 studies were identified. Results: A total of 48 studies were included for full review consisting of 11 meta-analyses, 9 systematic reviews, 5 structured literature reviews, 8 randomised controlled trials and 15 other studies. Interventions were classified into those which aimed to prevent admission, interventions in hospital, and those which aimed to support early discharge. Conclusions: Reducing unnecessary use of acute hospital beds by older people requires an integrated approach across hospital and community settings. A stronger evidence base has emerged in recent years about a broad range of interventions which may be effective. Local agencies need to work together to implement these interventions to create a sustainable health care system for older people. (Edited publisher abstract)
Changes in falls prevention policies in hospital in England and Wales
- Authors:
- HEALEY Frances, TREML Jonathan
- Journal article citation:
- Age and Ageing, 42(1), 2013, pp.106-109.
- Publisher:
- Oxford University Press
Background: In 2007, the National Patient Safety Agency (NPSA) published ‘Slips trips and falls in hospital’ and ‘Using bedrails safely and effectively’. Objectives: This observational study aimed to identify changes in local policies in hospitals in England and Wales following these publications. Method: policies in place during 2006 and 2009 were requested from 50 randomly selected acute hospital trusts and their content was categorised by a single reviewer using defined criteria. Results: Thirty-seven trusts responded. Trusts with an inpatient falls prevention policy increased from 65 to 100%, the use of unreferenced numerical falls risk assessments reduced from 50 to 19%, and trusts with a bedrail policy increased from 49 to 89%. It was concerning to find that by 2009 advice on clinical checks after a fall was available in only 51% of trusts, and only 46% of trust policies included specific guidance on avoiding bedrail entrapment gaps. Conclusions: The observed changes in policy content were likely to have been influenced not only by the NPSA publications but also by contemporaneous publications from the Royal College of Physicians' National Audit of Falls and Bone Health, and the Medicines and Healthcare products Regulatory Agency. Most areas of local policy indicated substantial improvement, but further improvements are required. (Publisher abstract)
The role of Tai Chi, cultural dancing, playing a musical instrument and singing in the prevention of chronic disease in Chinese older adults: a mind–body meditative approach
- Authors:
- SUN Jing, et al
- Journal article citation:
- International Journal of Mental Health Promotion, 15(4), 2013, pp.227-239.
- Publisher:
- Taylor and Francis
Older adults with chronic diseases have a high level of depression and poor mental health status. Previous public health interventions have attempted to reduce chronic disease-related health risks including depression and to improve mental health, but have had limited success. This study examined whether 15 months of regular participation in Tai Chi (TC) exercise, dancing, instrument playing and singing, as part of a mind–body meditative approach (MBMA), improves brain executive function, psychological functioning and mental health in Chinese older adults. Results indicated that the MBMA programme improved participants' executive function, psychological functioning, mental health and resilience, compared with a control group. These findings indicate that MBMA activities may be adopted as lifestyle approaches to promote mental health in different areas as follows: (1) TC and dancing have the biggest effect for reducing the prevalence of depression and for improving their mental health and resilience in older people with chronic conditions and (2) playing a musical instrument and singing have moderate effect for reducing depression symptoms and promoting mental health. The findings of the study suggest that there are mental health promotion implications relating to exercise type and minimal exercise dosage for older adults. Cultural dancing and TC may be a form of physical activity that is more likely to appeal to older people, when they are most at risk of being overweight or obese, of suffering from depression and/or of experiencing a decline in brain function. TC has been found to be highly effective in preventing depression and promoting brain executive function, and appears to be a form of physical activity that appeals to older people. Dancing, in combination with TC and singing, may be highly effective in protecting older adults from metabolic syndrome and brain function decline and in promoting a positive quality of life including psychological health. Playing a musical instrument may be used as an alternative method for maintaining good mental health in healthy people and for promoting mental health in people suffering from stress and its related depression and anxiety. (Publisher abstract)
Older people's prevention services: comparing perspectives of local authorities and the third sector
- Author:
- NATIONAL INSTITUTE FOR HEALTH RESEARCH. School for Social Care Research
- Publisher:
- NIHR School for Social Care Research
- Publication year:
- 2013
- Pagination:
- 4
- Place of publication:
- London
Third sector organisations (TSOs) have historically played a significant role in the delivery of adult social care. Often seen to be associated with qualities such as strong community links, access to disadvantaged groups and innovative practice, TSOs remain a popular choice with local authority commissioners as providers of preventative services. This study explored the views of nine locally commissioned TSOs and two national organisations which provide preventative services for older people. Senior managers were interviewed about their views of the purpose of such services, how the TSO understood their impacts, and their experience of being commissioned by the public sector. The results were added to previous research with local authorities to build a picture of the local authority and third sector relationship. The research identifies positive aspects within the current arrangements, but also gaps in respect of setting and understanding of outcomes and a reliance on personal relationships within the commissioning process. (Edited publisher abstract)
Understanding contextual factors in falls in long-term care facilities
- Authors:
- SIXSMITH Andrew, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 14(3), 2013, pp.160-166.
- Publisher:
- Emerald
Purpose – Despite the growing area of research involving falls in the residential care setting, the link between contextual and environmental factors in falls is poorly understood. This paper aims to draw upon existing research being undertaken in long-term care (LTC) in Metro Vancouver, Canada, with a particular focus on identifying contextual factors contributing to fall events. Design/methodology/approach – This paper presents the results of a qualitative observational analysis of video-captured data collected through a network of high-quality video systems in two LTC facilities. The research comprised workshops involving experienced researchers who reviewed six video sequences of fall events. The outcome of the workshops was a written narrative summarising the discussion and researchers’ interpretation of fall sequences. Findings – The analysis indicates that there are a broad range of environmental, behavioral and situational factors that contribute to falls in LTC. This suggests that a limited conceptualisation of a fall as an outcome of the person's impairment and environmental hazards fails to convey the complexity of potential contributory factors typical of most fall incidents. Research limitations/implications – Broadening our understanding of falls provides the potential to make recommendations for falls prevention practice across multiple levels, including the individual, social and organisational context. Originality/value – The paper evaluates the potential of video-based data in fall analysis and points to the development of a case study approach to analysing fall incidents to capture the complex nature of contributory factors beyond research that focuses solely on intrinsic and extrinsic risk factors. (Publisher abstract)
Falls: assessment and prevention of falls in older people: CG161
- Author:
- NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE
- Publisher:
- National Institute for Health and Care Excellence
- Publication year:
- 2013
- Pagination:
- 315
- Place of publication:
- Manchester
Falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year. This clinical guideline is for healthcare and other professionals and staff who care for older people who are at risk of falling. It provides evidence and recommendations on the assessment and prevention of falls in older people. It extends and replaces ‘Falls: assessment and prevention of falls in older people’ (NICE clinical guideline 21; 2004), by including additional recommendations about preventing falls in people admitted to hospital (inpatients). This document includes all the recommendations, details of how they were developed, and summaries of the evidence they were based on. (Edited publisher abstract)