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Dent E, Dalla Via J, Bozanich T, Hoogendijk EO, Gebre AK, Smith C, Zhu K, Prince RL, Lewis JR, Sim M. Frailty increases the long-term risk for fall and fracture-related hospitalizations and all-cause mortality in community-dwelling older women. J Bone Miner Res 2024; 39:222-230. [PMID: 38477757 PMCID: PMC11240159 DOI: 10.1093/jbmr/zjad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 03/14/2024]
Abstract
Frailty is associated with declines in physiological capacity across sensory, neurological, and musculoskeletal systems. An underlying assumption is that the frailer an individual, the more likely they are to experience falls and fractures. We examined whether grades of frailty can assess the long-term risk of hospitalized falls, fractures, and all-cause mortality in 1261 community-dwelling older women (mean age [SD] of 75.1 [2.7] yr) over 14.5 yr. Frailty was operationalized using a frailty index (FI) of cumulative deficits from 33 variables across multiple health domains (physical, mental, comorbidities) at baseline. The total score across these variables was summed and divided by 33 to obtain the FI. Participants were graded as fit (FI ≤ 0.12), mildly frail (FI > 0.12-0.24), moderately frail (FI > 0.24-0.36), or severely frail (FI > 0.36). Fall-related (n = 498), any fracture-related (n = 347), and hip fracture-related hospitalizations (n = 137) and deaths (n = 482) were obtained from linked health records. Associations between FI grades and clinical outcomes were analyzed using multivariable-adjusted Cox-proportional hazard models including age, treatment (calcium/placebo), BMI, smoking history, socioeconomic status, plasma vitamin D (25OHD) status plus season obtained, physical activity, self-reported prevalent falls in the last 3 mo, and self-reported fractures since the age of 50 yr. At baseline, 713 (56.5%), 350 (27.8%), 163 (12.9%), and 35 (2.8%) of women were classified as fit, mildly frail, moderately frail, and severely frail, respectively. Women with mild, moderate, and severe frailty had significantly higher hazards (all P < .05) for a fall-related (46%, 104%, 168%), any fracture-related (88% for moderate, 193% for severe frailty), hip fracture-related hospitalizations (93%, 127%, 129%), and all-cause mortality (47%, 126%, 242%). The FI identified community-dwelling older women at risk for the most serious falls and fractures and may be incorporated into risk assessment tools to identify individuals with poorer clinical prognosis.
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Affiliation(s)
- Elsa Dent
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia 5000, Australia
| | - Jack Dalla Via
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia 6027, Australia
| | - Trent Bozanich
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia 6027, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, VU University Medical Center, Amsterdam UMC, 1081 HV, Amsterdam, Netherlands
- Ageing and Later Life Research Program, Amsterdam Public Health Research Institute, Amsterdam UMC, 1081 HV, Amsterdam, Netherlands
| | - Abadi K Gebre
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia 6027, Australia
| | - Cassandra Smith
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia 6027, Australia
- Medical School, The University of Western Australia, Perth, Western Australia 6009, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health , St Albans, Victoria 3021, Australia
| | - Kun Zhu
- Medical School, The University of Western Australia, Perth, Western Australia 6009, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia
| | - Richard L Prince
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia 6027, Australia
- Medical School, The University of Western Australia, Perth, Western Australia 6009, Australia
- School of Public Health, Curtin University, Perth, Western Australia 6102, Australia
| | - Joshua R Lewis
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia 6027, Australia
- Medical School, The University of Western Australia, Perth, Western Australia 6009, Australia
- School of Public Health, Sydney Medical School, The University of Sydney, Hospital at Westmead, Sydney, New South Wales 2006, Australia
| | - Marc Sim
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia 6027, Australia
- Medical School, The University of Western Australia, Perth, Western Australia 6009, Australia
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Hartley P, Forsyth F, Rowbotham S, Briggs R, Kenny RA, Romero-Ortuno R. The use of the World Guidelines for Falls Prevention and Management's risk stratification algorithm in predicting falls in The Irish Longitudinal Study on Ageing (TILDA). Age Ageing 2023; 52:afad129. [PMID: 37463283 PMCID: PMC10353759 DOI: 10.1093/ageing/afad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND the aim of this study was to retrospectively operationalise the World Guidelines for Falls Prevention and Management (WGFPM) falls risk stratification algorithm using data from The Irish Longitudinal Study on Ageing (TILDA). We described how easy the algorithm was to operationalise in TILDA and determined its utility in predicting falls in this population. METHODS participants aged ≥50 years were stratified as 'low risk', 'intermediate' or 'high risk' as per WGFPM stratification based on their Wave 1 TILDA assessments. Groups were compared for number of falls, number of people who experienced one or more falls and number of people who experienced an injury when falling between Wave 1 and Wave 2 (approximately 2 years). RESULTS 5,882 participants were included in the study; 4,521, 42 and 1,309 were classified as low, intermediate and high risk, respectively, and 10 participants could not be categorised due to missing data. At Wave 2, 17.4%, 43.8% and 40.5% of low-, intermediate- and high-risk groups reported having fallen, and 7.1%, 18.8% and 18.7%, respectively, reported having sustained an injury from falling. CONCLUSION the implementation of the WGFPM risk assessment algorithm was feasible in TILDA and successfully differentiated those at greater risk of falling. The high number of participants classified in the low-risk group and lack of differences between the intermediate and high-risk groups may be related to the non-clinical nature of the TILDA sample, and further study in other samples is warranted.
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Affiliation(s)
- Peter Hartley
- Address correspondence to: Peter Hartley. Tel.: (+44) 1223 331841.
| | - Faye Forsyth
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Scott Rowbotham
- Department of Physiotherapy, The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, King’s Lynn, UK
| | - Robert Briggs
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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Yong YM, Wand AP. Falling into an identity crisis: Integrating identity into the assessment and management of falls in older adults. Australas Psychiatry 2022; 30:588-591. [PMID: 35684969 DOI: 10.1177/10398562221106687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This article examines the psychological effects of falls for older adults through the lens of identity and suggests these may be integrated in the assessment and management of older patients within acute care and rehabilitation settings post-fall. An illustrative vignette is described to demonstrate this approach. CONCLUSION Falls in older adults are complex phenomena which can lead to an identity threat, sometimes manifest as psychological symptoms and poor engagement in post-fall rehabilitation. A psychiatric formulation which incorporates an older person's self-identity and agency may inform interventions to address psychological and behavioural sequelae of falls.
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Affiliation(s)
- Yun Ming Yong
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Jara Unit, Older People's Mental Health, 170496Concord Centre for Mental Health, Concord Hospital, Concord, NSW, Australia
| | - Anne Pf Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Jara Unit, Older People's Mental Health, 170496Concord Centre for Mental Health, Concord Hospital, Concord, NSW, Australia
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Baixinho CRSL, Dixe MDACR, Madeira C, Alves S, Henriques MA. Interobserver analysis of safety practices and behaviors adopted by elderly people to prevent falls. Rev Lat Am Enfermagem 2020; 28:e3268. [PMID: 32491125 PMCID: PMC7266635 DOI: 10.1590/1518-8345.3209.3268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/07/2020] [Indexed: 01/10/2023] Open
Abstract
Objective: determine the psychometric properties of the safety practices and behaviors
dimension of the Scale of Practices and Behaviors of Institutionalized
Elderly People to Prevent Falls in a sample of elderly people with cognitive
decline. Method: methodological study, with a quantitative approach, to assess the
psychometric properties of the mentioned scale in a sample with 102 elderly
people with cognitive decline who lived in two long-term care institutions
for the public in this age group. Internal consistency evaluation was
carried out by calculating the Cronbach’s alpha coefficient; interobserver
reliability was expressed by Cohen’s kappa coefficient; and temporal
stability, by obtaining Spearman correlation. Compliance with all ethical
procedures was observed. Results: the dimension of safety practices and behaviors showed α = 0.895 for its 11
items. Seven out of the 11 items reached good to excellent agreement among
the experts for interobserver reliability. Kappa index values indicated that
the instrument is valid and reliable. Safety practices and behaviors were
influenced by institutionalization time, being at least 85 years old, and
gait skills. Conclusion: the results pointed out that the instrument has good reproducibility and is
valid and reliable, which allows its use in clinical practice in elderly
people with cognitive decline as well as in research.
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Affiliation(s)
| | | | - Carla Madeira
- Medicina, Hospital de VIla Franca de Xira, Vila Franca de Xira, VFX, Portugal
| | - Silvia Alves
- Unidade de Cuidados Intensivos, Hospital de VIla Franca de Xira, Vila Franca de Xira, VFX, Portugal
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de Jong LD, Lavender AP, Wortham C, Skelton DA, Haines TP, Hill AM. Exploring purpose-designed audio-visual falls prevention messages on older people's capability and motivation to prevent falls. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e471-e482. [PMID: 30887630 DOI: 10.1111/hsc.12747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/05/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
The number of falls and fall-associated injury rates among older people continues to rise worldwide. Increased efforts to influence older people's falls prevention behaviour are needed. A two-phase exploratory community-based participatory study was conducted in Western Australia. First, three prototype audio-visual (AV) falls prevention messages were designed collaboratively with six older people. Second, the messages' effect on community-dwelling older people's knowledge, awareness and motivation to take action regarding falls prevention was explored using focus groups. Data were analysed using thematic analysis to explore participants' responses to the messages. The participants' (n = 54) perspectives on the AV messages varied widely and stereotypes of ageing appeared to influence these. The presented falls facts (including falls epidemiology statistics) increased some participants' falls risk awareness and falls prevention knowledge. Other participants felt ready-to-use falls prevention information was lacking. Some expressed positive emotions or a personal connection to the messages and suggested the messages helped reduce ageing-related stigma. Strongly opposing viewpoints suggested that other participants identified implicit negative messages about ageing, which reduced their motivation with the messages. Suggestions to improve the message persuasiveness included adding more drama and tailoring messages to appeal to multiple age groups. Overall, the AV falls prevention messages designed in collaboration with older people elicited a divergent range of positive and negative perspectives from their peers, which was conceptualised by the overarching theme 'we all look at things different ways'. Opinions differed regarding whether the messages would appeal to older people. Public campaigns targeting falls prevention should be designed and tailored towards older peoples' differing perspectives about ageing.
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Affiliation(s)
- Lex D de Jong
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Bentley, Perth, WA, Australia
| | - Andrew P Lavender
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Bentley, Perth, WA, Australia
| | - Chris Wortham
- School of Arts and Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Dawn A Skelton
- School of Health and Life Sciences, Centre for Living, Glasgow Caledonian University, Glasgow, UK
| | - Terry P Haines
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Anne-Marie Hill
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Bentley, Perth, WA, Australia
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Shuman CJ, Montie M, Hoffman GJ, Powers KE, Doettl S, Anderson CA, Titler MG. Older Adults' Perceptions of Their Fall Risk and Prevention Strategies After Transitioning from Hospital to Home. J Gerontol Nurs 2019; 45:23-30. [PMID: 30653234 DOI: 10.3928/00989134-20190102-04] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/22/2018] [Indexed: 11/20/2022]
Abstract
Falls are common adverse events following hospital discharge. However, prevention programs are not tailored for older patients transitioning home. To inform development of transitional fall prevention programs, nine older adults designated as being at risk of falls during hospitalization who were recently discharged home were asked about their perceptions of fall risk and prevention, as well as their knowledge and opinion of materials from the Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths & Injuries Initiative. Using the constant comparative method, five themes were identified: Sedentary Behaviors and Limited Functioning; Prioritization of Social Involvement; Low Perceived Fall Risk and Attribution of Risk to External Factors; Avoidance and Caution as Fall Prevention; and Limited Falls Prevention Information During Transition from Hospital to Home. Limited awareness of and engagement in effective fall prevention may heighten recently discharged older adults' risks for falls. Prevention programs tailored to the post-discharge period may engage patients in fall prevention, promote well-being and independence, and link hospital and community efforts. [Journal of Gerontological Nursing, 45(1), 23-30.].
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Peach T, Pollock K, van der Wardt V, das Nair R, Logan P, Harwood RH. Attitudes of older people with mild dementia and mild cognitive impairment and their relatives about falls risk and prevention: A qualitative study. PLoS One 2017; 12:e0177530. [PMID: 28542315 PMCID: PMC5438143 DOI: 10.1371/journal.pone.0177530] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 04/29/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To explore the perceptions of older people with mild dementia and mild cognitive impairment, and their family carers, about falling, falls risk and the acceptability of falls prevention interventions. DESIGN Qualitative study involving thematic analysis of semi-structured interviews with patient and relative dyads. PARTICIPANTS AND SETTING 20 patient/ relative dyads recruited from Memory Assessment Services and Falls Prevention Services in the United Kingdom. RESULTS The findings are presented under four key themes: attitudes to falls, attitudes to falls prevention interventions, barriers and facilitators, and the role of relatives. Participants' attitudes to falls interventions were varied and sometimes conflicting. Some worried about falls, but many resisted identifying themselves as potential 'fallers', even despite having fallen, and rejected the idea of needing the help that structured interventions signify. Participants preferred to focus on coping in the present rather than anticipating, and preparing for, an uncertain future. Falls prevention interventions were acknowledged to be valuable in principle and if required in the future but often felt to be not necessary or appropriate at present. CONCLUSIONS This study of how persons with cognitive impairment, and their relatives, view falls risk and prevention mirror findings relating to the wider population of older persons without dementia. Participants did not generally see falls prevention interventions as currently relevant to themselves. The challenge for clinicians is how to present interventions with understanding and respect for the older person's identity. They must identify and address goals that patients and relatives value. Simplistic or paternalistic approaches will likely fail. Individualised interventions which focus on maintaining independence and preserving quality of life are more likely to be acceptable by supporting a positive self-image for patients and their relatives.
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Affiliation(s)
- Tamsin Peach
- Nottingham CityCare Partnership, Nottingham, United Kingdom
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - Veronika van der Wardt
- Division of Rehabilitation and Ageing, School of Medicine, University Nottingham, Nottingham, United Kingdom
| | - Roshan das Nair
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Rowan H Harwood
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Boyles M. Embodying Transition in Later Life: "Having a Fall" as an Uncertain Status Passage for Elderly Women in Southeast London. Med Anthropol Q 2016; 31:277-292. [PMID: 27380715 DOI: 10.1111/maq.12320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 03/21/2016] [Accepted: 06/02/2016] [Indexed: 11/28/2022]
Abstract
In their (2014 report, the charity AgeUK states that one-third of older people (over 3 million) fall each year. This article takes a focused look at falling by describing four women's accounts of "having a fall" in Walworth, southeast London, which sheds light on the experience of personal and corporeal change in later life. While some experiential studies of falling have made reference to a loss of embodied control and changes in identity, these aspects have not been explored in sufficient depth. Attending closely to the embodied experience of falling for older women in the context of everyday activity reveals the uncertainty surrounding what it actually signifies and the powerful effect this uncertainty has on their everyday lives and sense of self. This in-depth phenomenological account speaks to important gaps in the literature on falls, given the current research emphasis on the management of falls risk.
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Affiliation(s)
- Miriam Boyles
- Institute of Health and Society, Newcastle University
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Bergeron CD, Friedman DB, Messias DKH, Spencer SM, Miller SC. Older women's responses and decisions after a fall: The work of getting “back to normal”. Health Care Women Int 2016; 37:1342-1356. [DOI: 10.1080/07399332.2016.1173039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
ABSTRACTFalling in later life continues to be a critical issue in gerontology research, health professional practice and ageing health policy. However, much research in the area of fall risk and fall prevention neglects the meaning of the experiences of older people themselves. This humanistic interpretive phenomenological study explored the meaning of the experience of anticipating falling from the perspective of older people in order to foster a more person-focused approach to fall risk assessment and fall prevention. Individual semi-structured interviews were conducted with nine participants over the age of 65 living independently in the community. Follow-up interviews with two key informants were completed to inform the emerging interpretations. For older participants residing in the community, the experience of anticipating falling meant confronting their embodied lived-identity in the context of ageing. Experiential learning shaped how participants understood the meaning of falling, which constituted tacit, pathic knowledge of vulnerability and anxiety with respect to falling. Findings emphasise the importance of critically reflecting on the social experience of anticipating falling to develop effective and relevant fall prevention interventions, programmes and policies. A lifeworld-led approach to fall risk assessment and fall prevention resonates with these findings, and may encourage health-care providers to adopt a sustained focus on embodied lived-identity and quality of life when engaging older people in fall prevention activities.
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What is the evidence of the experience of having a fall across the life course? A qualitative synthesis. Disabil Health J 2014; 7:273-84. [PMID: 24947568 DOI: 10.1016/j.dhjo.2014.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alleviating the economic and human impacts of falls and fear of falling are critical health and social care issues. Despite some proven effectiveness of a number of falls prevention intervention programmes, uptake remains low and attrition high. There is a need for greater understanding of social, cultural and individual, life course positioning of falling, actual or perceived. OBJECTIVE To address the question: what is the evidence of the experience of having a fall across the life course? METHOD A qualitative evidence synthesis with key electronic databases searched from 1990 to 2011 using terms related to the experience of falls and falling. Selected papers presented data from the perspective of the person who had fallen. Synthesis included collaborative coding of 'incidents' related to falling, theoretical sampling of studies to challenge emerging theories, and constant comparison of categories to generate explanations. RESULTS The initial focus was to access and assess the evidence for the experiences of a fall across the life course but the authors' systematic search revealed that the vast majority of the published literature focuses on the experience of a fall in later life. Only 2 of the 16 studies included, provided perspectives of falling from a life stage other than that of older adults. However older adults' perceptions of their falls experiences are likely to be influenced by lifelong attitudes and beliefs about falling and older age. Synthesis identified that a falls incident or fear of falling induces explicit or implicit 'Fear.' Consequences are related to notions of 'Control' and 'Social standing.' Recovery work involves 'Adaptation,' 'Implications,' 'Social standing' and 'Control.' 'Explanation' is sought. CONCLUSIONS How and why people make sense of falling across the life course should have positive impacts on developing falls intervention programmes that people will want to engage with and adhere to.
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Nyman SR, Ballinger C, Phillips JE, Newton R. Characteristics of outdoor falls among older people: a qualitative study. BMC Geriatr 2013; 13:125. [PMID: 24245830 PMCID: PMC3835551 DOI: 10.1186/1471-2318-13-125] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/12/2013] [Indexed: 12/02/2022] Open
Abstract
Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people.
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Affiliation(s)
- Samuel R Nyman
- Bournemouth University Dementia Institute and Psychology Research Centre, School of Design, Engineering & Computing, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset BH12 5BB, UK.
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McDermott S. Crime risk associated with disability. Disabil Health J 2012; 5:211-2. [PMID: 23021730 DOI: 10.1016/j.dhjo.2012.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 01/18/2012] [Indexed: 11/19/2022]
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Elliott SJ, Ivanescu A, Leland NE, Fogo J, Painter JA, Trujillo LG. Feasibility of Interdisciplinary Community-Based Fall Risk Screening. Am J Occup Ther 2012; 66:161-8. [DOI: 10.5014/ajot.2012.002444] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. This pilot study examined the feasibility of (1) conducting interdisciplinary fall risk screens at a communitywide adult fall prevention event and (2) collecting preliminary follow-up data from people screened at the event about balance confidence and home and activity modifications made after receiving educational information at the event.
METHOD. We conducted a pilot study with pre– and posttesting (4-mo follow-up) with 35 community-dwelling adults ≥55 yr old.
RESULTS. Approximately half the participants were at risk for falls. Most participants who anticipated making environmental or activity changes to reduce fall risk initiated changes (n = 8/11; 72.7%) during the 4-mo follow-up period. We found no significant difference in participants’ balance confidence between baseline (median = 62.81) and follow-up (median = 64.06) as measured by the Activities-specific Balance Confidence scale.
CONCLUSION. Conducting interdisciplinary fall risk screens at an adult fall prevention event is feasible and can facilitate environmental and behavior changes to reduce fall risk.
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Affiliation(s)
- Sharon J. Elliott
- Sharon J. Elliott, DHS, GCG, OTR/L, BCG, FAOTA, is Adult Therapy Services Coordinator, Therapeutic Life Center, PO Box 2163, Greenville, NC 27836;
| | - Andrada Ivanescu
- Andrada Ivanescu, PhD, is Assistant Professor, Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, NC
| | - Natalie E. Leland
- Natalie E. Leland, PhD, OTR/L, BCG, is Assistant Professor, Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry and Davis School of Gerontology, University of Southern California, Los Angeles
| | - Jennifer Fogo
- Jennifer Fogo, PhD, OTR, is Director, Postprofessional Programs, School of Occupational Therapy, University of Indianapolis, Indianapolis, IN
| | - Jane A. Painter
- Jane A. Painter, EdD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, College of Allied Health Sciences, East Carolina University, Greenville, NC
| | - Leonard G. Trujillo
- Leonard G. Trujillo, PhD, OTR/L, FAOTA, is Chair, Department of Occupational Therapy, and Associate Professor, College of Allied Health Sciences, East Carolina University, Greenville, NC
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Abstract
BACKGROUND Age-related weakness, or sarcopenia, has been related to functional disability, falls, frailty and mortality. Although it is one of the most common symptoms older adults link to their functional abilities, to date, no studies have explored older adults' perceptions of weakness and its association with ageing. AIMS AND OBJECTIVES To understand the meaning of weakness for older adults' and their perceptions of its association with ageing. DESIGNS A qualitative descriptive design involved in-depth interviews with 13 community-dwelling older adults. RESULTS Weakness was described primarily in two ways: (i) inability and (ii) inward turning. The extreme of weakness, as giving up and giving in, which older adults applied to others, not themselves, prompted them to engage in several efforts at staying strong. These included motivating self-talk, achieving balance, keeping busy and active, and self-validating as a strong person. Older adults' perceptions of the association between weakness and ageing were variable and characterized by considerable ambiguity. IMPLICATIONS FOR PRACTICE Nurses must be alert to both the visible and subtler dimensions of weakness. It is important to engage older adults in active strategies that enhance muscle strength while capitalizing on their self-motivating and validating efforts at staying strong.
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Affiliation(s)
- Kathy L Rush
- School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada.
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Psychosocial issues in Engaging Older People with Physical Activity Interventions for the Prevention of Falls. Can J Aging 2011; 30:45-55. [DOI: 10.1017/s0714980810000759] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RÉSUMÉDans cet article on présente une vue d’ensemble des facteurs psychosociaux ayant une influence sur la participation des personnes âgées aux interventions concernant l’activité physique et visant la prévention des chutes. On souligne l’importance des facteurs psychosociaux puisque les interventions seront rendues inutiles si elles ne réussissent pas à attirer la participation active des personnes âgées. La théorie du comportement planifié sert de cadre pour un examen de la façon dont les connaissances (un préalable), les attitudes, les normes subjectives (le contexte social) et la perception du contrôle comportemental (la confiance) encouragent ou entravent l’intention d’entre-prendre des activités pour la prévention des chutes. Cette étude est accompagnée de documents qui indiquent la manière dont la perception de soi influence l’intention. On termine par une discussion des recommendations recommendations du réseau européen Prevention of Falls Network Europe concernant l’implication des personnes âgées dans la prévention des chutes.
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Lin SF, Lee JW, Modeste N, Johnson EG. Attitudes and Beliefs Predicting Taiwanese Older Adults’ Intentions to Attend Strength and Balance Training Programs. J Appl Gerontol 2010. [DOI: 10.1177/0733464810385815] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
While strength and balance training (SBT) programs are effective in preventing falls, older adults rarely participate. A cross-sectional study design was used to explore factors that influence their decisions to attend SBT programs. Questionnaires were collected that measured theory of planned behavior constructs from 221 community-dwelling Taiwanese older women between the age of 55 and 94. Results suggest that (a) benefits of SBT programs such as increasing independence in daily life, (b) participation approval and involvement from the older adults’ family members, and (c) SBT programs conducted in familiar places strengthened potential participants’ positive attitude, subjective norm, and perceived behavioral control, respectively. Health care professionals should consider incorporating these factors in the recruitment materials or the actual design of SBT programs to enhance older adults’ decision to attend and increase the recruitment rate of such programs.
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