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Jones DL, Robinson M, Selfe TK, Barnes L, Dierkes M, Shawley-Brzoska S, Myers DJ, Wilcox S. Prepandemic Feasibility of Tele-Exercise as an Alternative Delivery Mode for an Evidence-Based, Tai Ji Quan Fall-Prevention Intervention for Older Adults. J Aging Phys Act 2024; 32:508-519. [PMID: 38604606 DOI: 10.1123/japa.2023-0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/15/2023] [Accepted: 02/03/2024] [Indexed: 04/13/2024]
Abstract
There is a critical need for fall-prevention interventions to reach medically underserved, hard-to-reach, rural older adults. The evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program reduces falls in older adults. This pre-COVID-19 pandemic study assessed the feasibility and impact of a 16-week tele-TJQMBB intervention in older adults. Instructors led six tele-TJQMBB classes via Zoom for 52 older adults (mean age ± SD 68.5 ± 7.7 years) at one academic and four community sites. Nearly all (97%) planned sessions were delivered. Average attendance was 61%. There were no adverse events. Fidelity was fair to good (mean 67%). Forty-one percent of sessions experienced technical disruptions. Participants improved their gait speed, balance, lower-extremity strength, and body mass index. Tele-TJQMBB was feasible with a positive impact on outcomes. This study was the first step toward establishing an additional delivery mode that could potentially expand TJQMBB's reach and maintenance.
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Affiliation(s)
- Dina L Jones
- Department of Orthopaedics, Division of Physical Therapy, Injury Control, Injury Control Research Center, West Virginia University, Morgantown, WV, USA
| | - Maura Robinson
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Terry Kit Selfe
- Academic Research Consulting and Services, University of Florida, Gainesville, FL, USA
| | - Lucinda Barnes
- Mountaineer Doctor Television, West Virginia University, Morgantown, WV, USA
| | - McKinzey Dierkes
- Division of Physical Therapy, Clinical Translational Science Institute, West Virginia University, Morgantown, WV, USA
| | - Samantha Shawley-Brzoska
- Office of Health Services Research, Department of Social & Behavioral Sciences, West Virginia University, Morgantown, WV, USA
| | - Douglas J Myers
- School of Public and Population Health, Boise State University, Boise, ID, USA
| | - Sara Wilcox
- Department of Exercise Science and Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Li ML, Kor PPK, Sui YF, Liu JYW. Health maintenance through home-based interventions for community-dwelling older people with sarcopenia during and after the COVID-19 pandemic: A systematic review and meta-analysis. Exp Gerontol 2023; 174:112128. [PMID: 36804363 PMCID: PMC9941010 DOI: 10.1016/j.exger.2023.112128] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND The COVID-19 pandemic has greatly impacted people's lifestyles and changed the delivery of health interventions, especially interventions for community-dwelling older people with sarcopenia. OBJECTIVE To summarize the components and explore the effectiveness of home-based interventions for improving sarcopenia and other health-related outcomes among community-dwelling older people with sarcopenia. DESIGN Systematic review and meta-analysis. METHODS The Cochrane Library, Scopus, EMBASE, Web of Science, CINAHL, Medline (via PubMed), and PsycINFO were searched for relevant papers published from January 1, 2010 to March 29, 2022. Only papers written in English were included. The modified version of Cochrane's risk-of-bias tool was used to assess the risks of bias in the included studies. The template for intervention description and replication checklist was used to summarize the intervention components. The mean difference (MD) or standard mean difference with a 95 % confidence interval (CI) was used to determine the effect size of studies using the same or different measuring methods. Random-effects models were in meta-analyses to pool the effects of home-based interventions on the included outcomes. RESULTS After detailed screening and exclusion, 11 randomized controlled trials including 1136 older people with sarcopenia were included in our analyses. Three categories of home-based interventions were identified: exercise interventions, nutritional interventions, and combined exercise and nutritional interventions. The overall analysis of the outcomes (e.g., appendicular skeletal muscle mass index, lean mass, body fat mass, handgrip strength, and gait speed), showed that the effects of home-based exercise interventions were inconclusive. Compared with passive controls, home-based exercise interventions significantly improved knee extension strength (MD = 0.56 kg, 95 % CI: 0.09, 1.03, p = 0.020) and reduced the time required to complete the Timed Up and Go Test (MD = -1.41 s, 95 % CI: -2.28, -0.54, p = 0.001). Home-based nutritional interventions were effective in improving appendicular skeletal muscle mass (MD = 0.25 kg, 95 % CI: 0.02, 0.49, p = 0.030), gait speed (MD = 0.06 m/s, 95 % CI: 0.03, 0.09, p = 0.0001), and quality of life in terms of both the physical component summary (MD = 13.54, 95 % CI: 0.73, 26.34, p = 0.040) and mental component summary scores (MD = 8.69, 95 % CI: 2.98, 14.41, p = 0.003). CONCLUSION Home-based exercise interventions have the potential to improve muscle strength and physical function, while home-based nutritional interventions are effective in increasing muscle mass, physical function, and quality of life. Both of these can be applied at home during and after the COVID-19 pandemic to alleviate sarcopenia and improve health-related outcomes in community-dwelling older people.
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Affiliation(s)
- Meng-Li Li
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong, China.
| | - Patrick Pui-Kin Kor
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong, China.
| | - Yu-Fang Sui
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong, China.
| | - Justina Yat-Wa Liu
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong, China.
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Lach HW, Noimontree W, Peterson EW, Jones DL. Developing online fall prevention program: Older adult recommendations`. Geriatr Nurs 2023; 50:255-259. [PMID: 36809701 DOI: 10.1016/j.gerinurse.2023.02.005] [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: 11/24/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/21/2023]
Abstract
Falls are a critical public health problem for older adults making expanded access of evidence-based fall prevention programs to this population a priority. Online delivery could improve the reach of these needed programs, however associated benefits and challenges remain poorly explored. This focus group study was undertaken to gather older adults' perceptions regarding the transition of face-to-face fall prevention programs to online formats. Content analysis was used to identify their opinions and suggestions. Older adults had concerns related to technology, engagement, and interaction with peers that they valued during face-to-face programs. They provided suggestions they felt would improve the success of online fall prevention programs, especially including synchronous sessions and getting input during program development from older adults.
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Affiliation(s)
- Helen W Lach
- Trudy Busch School of Nursing, Saint Louis University, 3525 Caroline Mall, St. Louis, MO 63104, United States of America.
| | | | - Elizabeth W Peterson
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, United States of America
| | - Dina L Jones
- Department of Orthopaedics, Division of Physical Therapy, and Injury Control Research Center, West Virginia University, Morgantown, United States of America
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Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, Aguilar-Navarro S, Alexander NB, Becker C, Blain H, Bourke R, Cameron ID, Camicioli R, Clemson L, Close J, Delbaere K, Duan L, Duque G, Dyer SM, Freiberger E, Ganz DA, Gómez F, Hausdorff JM, Hogan DB, Hunter SMW, Jauregui JR, Kamkar N, Kenny RA, Lamb SE, Latham NK, Lipsitz LA, Liu-Ambrose T, Logan P, Lord SR, Mallet L, Marsh D, Milisen K, Moctezuma-Gallegos R, Morris ME, Nieuwboer A, Perracini MR, Pieruccini-Faria F, Pighills A, Said C, Sejdic E, Sherrington C, Skelton DA, Dsouza S, Speechley M, Stark S, Todd C, Troen BR, van der Cammen T, Verghese J, Vlaeyen E, Watt JA, Masud T. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 2022; 51:afac205. [PMID: 36178003 PMCID: PMC9523684 DOI: 10.1093/ageing/afac205] [Citation(s) in RCA: 273] [Impact Index Per Article: 136.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/26/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. OBJECTIVES to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. METHODS a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. RECOMMENDATIONS all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. CONCLUSIONS the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.
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Affiliation(s)
- Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Nathalie van der Velde
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Finbarr C Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Maw Pin Tan
- Centre for Innovation in Medical Engineering (CIME), Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sara Aguilar-Navarro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Neil B Alexander
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan; Veterans Administration Ann Arbor Healthcare System Geriatrics Research Education Clinical Center, Ann Arbor, MI, USA
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Hubert Blain
- Department of Geriatrics, Montpellier University hospital and MUSE, Montpellier, France
| | - Robbie Bourke
- Department of Medical Gerontology Trinity College Dublin and Mercers Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney. Department of Medicine (Neurology) and Neuroscience and Mental Health, Sydney, NSW, Australia
| | - Richard Camicioli
- Department of Medicine (Neurology), Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Lindy Clemson
- Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
- Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia; School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Leilei Duan
- National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Gustavo Duque
- Research Institute of the McGill University HealthCentre, Montreal, Quebec, Canada
| | - Suzanne M Dyer
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Ellen Freiberger
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute for Biomedicine of Aging, Nürnberg, Germany
| | - David A Ganz
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Fernando Gómez
- Research Group on Geriatrics and Gerontology, International Association of Gerontology and Geriatrics Collaborative Center, University Caldas, Manizales, Colombia
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Orthopaedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David B Hogan
- Brenda Strafford Centre on Aging, O’BrienInstitute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan M W Hunter
- School of Physical Therapy, Faculty of Health Sciences, Elborn College, University of Western Ontario, London, ON, Canada
| | - Jose R Jauregui
- Ageing Biology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nellie Kamkar
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Rose-Anne Kenny
- Department of Medical Gerontology Trinity College Dublin and Mercers Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Sarah E Lamb
- Faculty of Health and Life Sciences, Mireille Gillings Professor of Health Innovation, Medical School Building, Exeter, England, UK
| | | | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, England, UK
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Louise Mallet
- Department of Pharmacy, Faculty of Pharmacy, McGill University Health Center, Université de Montréal, Montreal, QC, Canada
| | - David Marsh
- University College London, London, England, UK
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Rogelio Moctezuma-Gallegos
- Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Mexico City, Mexico
- Geriatric Medicine Program, Tecnologico de Monterrey, School of Medicine and Health Sciences. Monterrey, Nuevo León, Mexico
| | - Meg E Morris
- Healthscope and Academic and Research Collaborative in Health (ARCH), La Trobe University, Australia
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium
| | - Monica R Perracini
- Master’s and Doctoral programs in Physical Therapy, Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, Brazil
| | - Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Alison Pighills
- Mackay Institute of Research and Innovation, Mackay Hospital and Health Service, Mackay, QLD, Australia
| | - Catherine Said
- Western Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
- Melbourne School of Health Sciences The University of Melbourne, Parkville, Australia
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Dawn A Skelton
- School of Health and Life Sciences, Research Centre for Health (ReaCH), Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland, UK
| | - Sabestina Dsouza
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Susan Stark
- Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Bruce R Troen
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University of Buffalo; Research Service, Veterans Affairs Western New York Healthcare System, Buffalo, New York, USA
| | - Tischa van der Cammen
- Department of Human-Centred Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joe Verghese
- Division of Geriatrics, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jennifer A Watt
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tahir Masud
- Department of Geriatric Medicine, The British Geriatrics Society, Nottingham University Hospitals NHS Trust, Nottingham, England, UK
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Alberto SN, Ansai JH, Janducci AL, Florido JVB, Novaes ADC, Caetano MJD, Rossi PG, Tavares LRC, Lord SR, Gramani-Say K. A Case Management Program at Home to Reduce Fall Risk in Older Adults (the MAGIC Study): Protocol for a Single-Blind Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e34796. [PMID: 35700005 PMCID: PMC9237774 DOI: 10.2196/34796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/04/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Individual case management programs may be particularly effective in reducing fall risk as they can better identify barriers and facilitators to health recommendations. Objective This paper describes the protocol for a single-blind, parallel-group randomized controlled trial that aims to investigate the effectiveness and cost-effectiveness of a home-based multifactorial program targeting fall risk factors among people aged 60 years and over who have fallen at least twice in the past 12 months (the MAGIC trial). Methods Older people with a history of at least 2 falls in the last year will be divided into 2 groups. The intervention group will receive case management at home for reducing the risk of falls, including a multidimensional assessment, explanation of fall risk factors, and elaboration and monitoring of an individualized intervention plan based on the identified fall risk factors, personal preferences, and available resources. The control group will be monitored once a month. Assessments (clinical data, fall risk awareness, physical and mental factors, safety at home, feet and shoes, and risk and rate of falls) will be carried out at baseline, after 16 weeks of the intervention, and at the posttrial 6-week and 1-year follow-up. After 16 weeks of the intervention, satisfaction and adherence to the intervention will also be assessed. Economic health will be evaluated for the period up to the posttrial 1-year follow-up. Results Data collection started in April 2021, and we expected to end recruitment in December 2021. This case management program will address multifactorial assessments using validated tools and the implementation of individualized intervention plans focused on reducing fall risk factors. Conclusions This trial may provide reliable and valuable information about the effectiveness of case management for increasing fall risk awareness and reducing fall risk in older people. Trial Registration Brazilian Clinical Trials Registry (ReBec) RBR-3t85fd; https://ensaiosclinicos.gov.br/rg/RBR-3t85fd International Registered Report Identifier (IRRID) DERR1-10.2196/34796
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Affiliation(s)
| | - Juliana Hotta Ansai
- Department of Gerontology, Federal University of São Carlos, São Carlos, Brazil
| | - Ana Luísa Janducci
- Department of Gerontology, Federal University of São Carlos, São Carlos, Brazil
| | | | | | | | - Paulo Giusti Rossi
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | | | - Stephen Ronald Lord
- Australia and School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Karina Gramani-Say
- Department of Gerontology, Federal University of São Carlos, São Carlos, Brazil
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Views, experiences and attitudes of community-living older people towards the FIT-at-Home fall prevention programme: A qualitative interview study / Sichtweisen, Erfahrungswerte und Einstellungen von sturzgefährdeten Menschen im höheren Lebensalter zum FIT-at-Home-Sturzpräventionsprogramm: Eine qualitative Interviewstudie. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2021. [DOI: 10.2478/ijhp-2021-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
For older people, poor balance and strength as well as environmental hazards are a major risk factor for falls. A lifestyle-integrated home-based physical exercise training and home modification intervention were developed for older people at risk of falling.
Aim
This study aimed to examine older people's perceptions of the FIT-at-Home fall prevention intervention in order to further develop the intervention's content, procedures and mode of delivery.
Methods
We conducted semi-structured interviews with individuals who participated in the falls prevention programme using the problem-centred interview method. The interviews were analysed in a deductive-inductive approach following Mayring's qualitative content analysis.
Results
Seven themes emerging from the data described different facets of older people's perceptions towards the intervention. Findings suggested that the participants accepted the FIT-at-Home intervention. Overall, the individuals regard the intervention as feasible and practicable. From the older people's view, it was an advantage that the exercises could be implemented at any time without additional aids or equipment in-house and it was not necessary to visit the occupational therapy practice. Older people's experiences showed that feelings of success have a positive effect on the willingness to exercise. A perceived barrier influencing the implementation of exercises among older people was their own laziness, their general state of health and illnesses, their daily mood or meteor sensitivity.
Conclusion
The FIT-at-Home intervention comprising balance and strength exercises and home modification is feasible and acceptable for community-living older people. Older people's feedback will help us to further refine the intervention.
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Pillay J, Riva JJ, Tessier LA, Colquhoun H, Lang E, Moore AE, Thombs BD, Wilson BJ, Tzenov A, Donnelly C, Émond M, Holroyd-Leduc J, Milligan J, Keto-Lambert D, Rahman S, Vandermeer B, Tricco AC, Straus SE, Thomas SM, Mitchelmore BR, Rolland-Harris E, Hartling L. Fall prevention interventions for older community-dwelling adults: systematic reviews on benefits, harms, and patient values and preferences. Syst Rev 2021; 10:18. [PMID: 33422103 PMCID: PMC7797084 DOI: 10.1186/s13643-020-01572-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 12/23/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND An estimated 20-30% of community-dwelling Canadian adults aged 65 years or older experience one or more falls each year. Fall-related injuries are a leading cause of hospitalization and can lead to functional independence. Many fall prevention interventions, often based on modifiable risk factors, have been studied. Apart from the magnitude of the benefits and harms from different interventions, the preferences of older adults for different interventions as well as the relative importance they place on the different potential outcomes may influence recommendations by guideline panels. These reviews on benefits and harms of interventions, and on patient values and preferences, will inform the Canadian Task Force on Preventive Health Care to develop recommendations on fall prevention for primary care providers. METHODS To review the benefits and harms of fall prevention interventions, we will update a previous systematic review of randomized controlled trials with adaptations to modify the classification of interventions and narrow the scope to community-dwelling older adults and primary-care relevant interventions. Four databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Ageline), reference lists, trial registries, and relevant websites will be searched, using limits for randomized trials and date (2016 onwards). We will classify interventions according to the Prevention of Falls Network Europe (ProFANE) Group's taxonomy. Outcomes include fallers, falls, injurious falls, fractures, hip fractures, institutionalization, health-related quality of life, functional status, and intervention-related adverse effects. For studies not included in the previous review, screening, study selection, data extraction on outcomes, and risk of bias assessments will be independently undertaken by two reviewers with consensus used for final decisions. Where quantitative analysis is suitable, network or pairwise meta-analysis will be conducted using a frequentist approach in Stata. Assessment of the transitivity and coherence of the network meta-analyses will be undertaken. For the reviews on patient preferences and outcome valuation (relative importance of outcomes), we will perform de novo reviews with searches in three databases (MEDLINE, PsycInfo, and CINAHL) and reference lists for cross-sectional, longitudinal quantitative, or qualitative studies published from 2000. Selection, data extraction, and risk of bias assessments suitable for each study design will be performed in duplicate. The analysis will be guided by a narrative synthesis approach, which may include meta-analysis for health-state utilities. We will use the CINeMa approach to a rate the certainty of the evidence for outcomes on intervention effects analyzed using network meta-analysis and the GRADE approach for all other outcomes. DISCUSSION We will describe the flow of literature and characteristics of all studies and present results of all analyses and summary of finding tables. We will compare our findings to others and discuss the limitations of the reviews and the available literature. SYSTEMATIC REVIEW REGISTRATION This protocol has not been registered.
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Affiliation(s)
- Jennifer Pillay
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - John J. Riva
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Laure A. Tessier
- Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, Canada
| | - Heather Colquhoun
- Occupational Science and Occupational Therapy Department, University of Toronto, Toronto, Canada
| | - Eddy Lang
- Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
| | - Ainsley E. Moore
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | | | - Brenda J. Wilson
- Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada
| | - Amanda Tzenov
- Memorial University of Newfoundland, St. John’s, Canada
| | | | - Marcel Émond
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | | | - Jamie Milligan
- Schlegel Specialist in Mobility and Falls, Schlegel-UW Research Institute for Aging, Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Diana Keto-Lambert
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Sholeh Rahman
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Andrea C. Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Sonia M. Thomas
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | | | | | - Lisa Hartling
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
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8
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Dedeyne L, Dupont J, Koppo K, Verschueren S, Tournoy J, Gielen E. Exercise and Nutrition for Healthy AgeiNg (ENHANce) project - effects and mechanisms of action of combined anabolic interventions to improve physical functioning in sarcopenic older adults: study protocol of a triple blinded, randomized controlled trial. BMC Geriatr 2020; 20:532. [PMID: 33302879 PMCID: PMC7727134 DOI: 10.1186/s12877-020-01900-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 11/12/2020] [Indexed: 01/06/2023] Open
Abstract
Background The Exercise and Nutrition for Healthy AgeiNg (ENHANce) project aims to assess the combined effects of exercise and nutritional interventions to prevent loss of skeletal muscle mass and function with ageing, and to determine the underlying mechanisms of action. Methods One hundred eightycommunity-dwelling sarcopenic individuals (≥ 65 years) are allocated in a randomized controlled trial (RCT) in a 1:1 ratio into five groups for a 12-week intervention period, followed by a 12-week follow-up period: 1) exercise intervention +protein placebo +omega-3 fatty acids placebo; 2) protein +omega-3 fatty acids placebo; 3) exercise intervention +protein +omega-3 fatty acids placebo; 4) exercise intervention +protein +omega-3 fatty acids; 5) protein placebo +omega-3 fatty acids placebo. All interventions are in line with recommendations of expert groups such as the American College of Sports Medicine and the PROT-AGE study group and individualized to the physical capabilities and nutritional intake of each participant. Sarcopenia is diagnosed by the assessment of gait speed, handgrip strength (Jamar handheld dynamometer), chair stand test and muscle mass (DXA) according to the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Participants, researchers and statisticians are blinded to omega-3 fatty acids and protein treatment. Compliance to the exercise program, protein and omega-3 fatty acids interventions is objectively measured, by monitoring movement by an activity monitor, determining nitrogen content in urine and analyzing the fatty acid composition of the red blood cell membrane. The primary outcome of the RCT is the change in Short Physical Performance Battery (SPPB) score. Secondary endpoints are, among others, changes in muscle mass, strength and function, objective compliance to interventions, changes in muscle and blood biomarkers related to sarcopenia, cognition, quality of life and falls. Discussion This RCT in well-defined sarcopenic older adults assesses the effects of combined anabolic interventions, including the additive effects of omega-3 fatty acids supplements, compared to single or placebo interventions. Compliance with the exercise intervention and with the intake of nutritional supplements is measured objectively. Also, blood and muscle samples will be used to explore the underlying determinants that contribute to the mechanism of action of anabolic interventions. Trial registration Clinicaltrials.gov: NCT03649698, retrospectively registered at 28 August 2018, first participant was randomized 16 February 2018.
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Affiliation(s)
- Lenore Dedeyne
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Jolan Dupont
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Geriatric medicine, UZ Leuven, Leuven, Belgium
| | - Katrien Koppo
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | | | - Jos Tournoy
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Geriatric medicine, UZ Leuven, Leuven, Belgium
| | - Evelien Gielen
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Geriatric medicine, UZ Leuven, Leuven, Belgium
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9
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Barmentloo LM, Olij BF, Erasmus V, Smilde D, Schoon Y, Polinder S. Personal preferences of participation in fall prevention programmes: a descriptive study. BMC Geriatr 2020; 20:185. [PMID: 32466747 PMCID: PMC7254764 DOI: 10.1186/s12877-020-01586-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/19/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Participation in fall prevention programmes is associated with lower risk of injurious falls among older adults. However participation rates in fall prevention interventions are low. The limited participation in fall prevention might increase with a preference based approach. Therefore, the aims of this study are to a) determine the personal preferences of older adults regarding fall prevention and b) explore the association between personal preferences and participation. METHODS We assessed the personal preferences of older adults and the association between their preferences, chosen programme and participation level. Nine different programmes, with a focus on those best matching their personal preferences, were offered to participants. Twelve weeks after the start of the programme, participation was assessed by questionnaire. Logistic regression was performed to test the association between preferences and participation and an ANOVA was performed to assess differences between the number of preferences included in the chosen programme and participation level. RESULTS Of the 134 participants, 49% preferred to exercise at home versus 43% elsewhere, 46% preferred to exercise alone versus 44% in a group and 41% indicated a programme must be free of charge while 51% were willing to pay. The combination of an external location, in a group and for a fee was preferred by 27%, whereas 26% preferred at home, alone and only for free. The presence of preferences or the extent to which the programme matched earlier preferences was not associated with participation. CONCLUSION Despite the fact that preferences can vary greatly among older adults, local programmes should be available for at least the two largest subgroups. This includes a programme at home, offered individually and for free. In addition, local healthcare providers should cooperate to increase the accessibility of currently available group programmes.
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Affiliation(s)
- Lotte M Barmentloo
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Branko F Olij
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - Vicki Erasmus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - Dini Smilde
- GENERO foundation, Rotterdam, the Netherlands
| | - Yvonne Schoon
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
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10
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Evaluating audio-visual falls prevention messages with community-dwelling older people using a World Café forum approach. BMC Geriatr 2019; 19:345. [PMID: 31818252 PMCID: PMC6902607 DOI: 10.1186/s12877-019-1344-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 11/04/2019] [Indexed: 11/17/2022] Open
Abstract
Background Falls risk increases sharply with older age but many older people are unaware or underestimate their risk of falling. Increased population-based efforts to influence older people’s falls prevention behavior are urgently needed. The aim of this study was to obtain a group of older people’s collective perspectives on newly developed prototypes of audio-visual (AV) falls prevention messages, and evaluate changes in their falls prevention behaviour after watching and discussing these. Methods A mixed-method study using a community World Café forum approach. Results Although the forum participants (n = 38) mostly responded positively to the three AV messages and showed a significant increase in their falls prevention capability and motivation after the forum, the participants collectively felt the AV messages needed a more inspirational call to action. The forum suggested this could be achieved by means of targeting the message and increasing the personal connection. Participants further suggested several alternatives to online falls prevention information, such as printed information in places in the community, as a means to increase opportunity to seek out falls prevention information. Conclusions Falls prevention promotion messages need to be carefully tailored if they are to be more motivating to older people to take action to do something about their falls risk. A wider variety of revised and tailored AV messages, as one component of a community-wide falls prevention campaign, could be considered in an effort to persuade older people to take decisive action to do something about their falls risk. Trial registration This study was registered prospectively: NCT03154788. Registered 11 May 2017.
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11
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Evers SMAA, Dorresteijn TAC, Wijnen BFM, van Haastregt JCM, Kempen GIJM, Zijlstra GAR. Economic evaluation of a home-based programme to reduce concerns about falls in frail, independently-living older people. Expert Rev Pharmacoecon Outcomes Res 2019; 20:641-651. [PMID: 31502897 DOI: 10.1080/14737167.2019.1666714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Concerns about falls, or fear of falling, are frequently reported by older people and can have serious consequences. Aim of this study was to evaluate the cost-effectiveness of a home-based, cognitive behavioral programme for independently-living, frail older people in comparison with usual care from a societal perspective. Methods: This economic evaluation was embedded in a randomized-controlled trial with a follow-up of 12-months. In the trial 389 people aged 70 years or older were allocated to usual care (n = 195) or the intervention group (n = 194). The intervention group received a home-based, cognitive behavioral programme. Main outcome measures were concerns about falls and Quality Adjusted Life Years (QALYs). Results: Average total costs per participant in the usual care group were 8,094 Euros and 7,890 Euros for participants in the intervention group. The intervention group showed a significant decrease in concerns about falls and a non-significant increase in QALYS in comparison with the usual care group. The probability that the intervention was cost-effective was 75% at a willingness to pay of 20,000 Euros per QALY. Discussion: The programme is likely to be cost-effective, and therefore a useful addition to current geriatric care, particularly for those persons who are not able or willing to attend group programmes. Trial registration: NCT01358032.
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Affiliation(s)
- Silvia M A A Evers
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands.,Department of Public Mental Health Centre for economic evaluations, Trimbos Institute, Netherlands Institute of Mental Health and Addiction , Utrecht, The Netherlands
| | - Tanja A C Dorresteijn
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
| | - Ben F M Wijnen
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands.,Department of Public Mental Health Centre for economic evaluations, Trimbos Institute, Netherlands Institute of Mental Health and Addiction , Utrecht, The Netherlands.,Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre , Maastricht, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
| | - G A Rixt Zijlstra
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
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12
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Kesgin F, Suddick K, Heesen C, Wright J. Developing a fall prevention program: what are the views and opinions of people with multiple sclerosis? Disabil Rehabil 2019; 43:1065-1073. [PMID: 31430203 DOI: 10.1080/09638288.2019.1652700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE Falls are common in people with multiple sclerosis (MS), yet there are a few targeted fall prevention programs. Existing programs report a high dropout rate and a low adherence, which may be due to a mismatch between program characteristics and participants preferences. To clarify a possible discrepancy, this study investigates the views and opinions of persons with MS on fall prevention programs. METHODS Two focus groups (n = 11) were conducted with people with MS who have a history of falls, near falls or who are concerned about their balance/falling risk. The data were analyzed using a qualitative content analysis with an inductive approach. RESULTS Participants preferred short-term programs taking place in rehabilitation clinics, or physiotherapy or occupational therapy practices. They believed that the awareness for fall prevention needs to be raised among healthcare professionals. Participants expected better consultation from physio and occupational therapists regarding mobility aids and home modification. The participants wanted the programs to be practical, in-person and in groups. Online interventions were strongly rejected. Further, participants wanted balance/strength exercises and the inclusion of falling techniques in programs. The competence of knowing and accepting capacity may be an important factor in preventing falls. CONCLUSIONS Investigating the views and opinions of persons with MS on fall prevention programs gave important information which can be used to inform the development of such programs.IMPLICATIONS FOR REHABILITATIONPeople with multiple sclerosis (MS) prefer short-term fall prevention programs that are practical, in-person and in groups. Online interventions were strongly rejected.People with MS want balance/strength exercises and falling techniques included within fall prevention programs.People with MS believe that awareness regarding falls prevention needs to be raised among healthcare professionals. Also, services regarding mobility aids and home modification from physio and occupational therapists are currently unsatisfactory.People with MS believe that competence in knowing and accepting their capacity to engage in activities may be a decisive factor in preventing falls.
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Affiliation(s)
- Firat Kesgin
- School of Health Professions, University of Brighton, Eastbourne, UK
| | - Kitty Suddick
- School of Health Professions, University of Brighton, Eastbourne, UK
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Jonathan Wright
- School of Health Professions, University of Brighton, Eastbourne, UK
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13
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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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14
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Schnock KO, P Howard E, Dykes PC. Fall Prevention Self-Management Among Older Adults: A Systematic Review. Am J Prev Med 2019; 56:747-755. [PMID: 30885516 DOI: 10.1016/j.amepre.2018.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 01/03/2023]
Abstract
CONTEXT Adequate self-management could minimize the impact of falls in older adults. The efficacy of fall prevention self-management interventions has been widely studied, yet little is known about why some older adults engage in fall prevention self-management actions and behaviors, whereas others do not. Through a systematic review of fall prevention self-management studies, this study identified characteristics and the personal, social, and environmental factors of older adults who engage in self-management actions and behaviors. EVIDENCE ACQUISITION Medical and nursing literature related to fall prevention self-management was searched in PubMed, Embase, and CINAHL (1997-2017), and relevant publications were selected by three researchers to assess whether the papers included subject characteristics and their fall prevention self-management actions and behaviors. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) was used by the researchers to assess the quality of the included studies and to determine the significance of the extracted characteristics. EVIDENCE SYNTHESIS Searching literature through 2017, a total of 972 papers were identified, and 28 papers remained after removing those that did not meet inclusion criteria. Nine papers that addressed subject characteristics in relation to the study outcomes were included in a sub-analysis. The authors identified the following characteristics of older adults who participated in fall prevention self-management actions and behaviors: younger males, not living alone and with self-reported good health, having greater fear of falling and high fall prevention self-efficacy, and possessing high motivation for engagement with self-management activities. CONCLUSIONS The systematic literature review revealed the personal characteristics of older adults who engage in fall prevention self-management actions and behaviors.
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Affiliation(s)
- Kumiko O Schnock
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Elizabeth P Howard
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Patricia C Dykes
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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15
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Valenzuela T, Razee H, Schoene D, Lord SR, Delbaere K. An Interactive Home-Based Cognitive-Motor Step Training Program to Reduce Fall Risk in Older Adults: Qualitative Descriptive Study of Older Adults' Experiences and Requirements. JMIR Aging 2018; 1:e11975. [PMID: 31518251 PMCID: PMC6716489 DOI: 10.2196/11975] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/08/2018] [Accepted: 11/10/2018] [Indexed: 12/21/2022] Open
Abstract
Background Falls are a major contributor to the burden of disease in older adults. Home-based exercise programs are effective in reducing the rate and risk of falls in older adults. However, adherence to home-based exercise programs is low, limiting the efficacy of interventions. The implementation of technology-based exercise programs for older adults to use at home may increase exercise adherence and, thus, the effectiveness of fall prevention interventions. More information about older adults’ experiences when using technologies at home is needed to enable the design of programs that are tailored to older adults’ needs. Objective This study aimed to (1) explore older adults’ experiences using SureStep, an interactive cognitive-motor step training program to reduce fall risk unsupervised at home; (2) explore program features that older adults found encouraged program uptake and adherence; (3) identify usability issues encountered by older adults when using the program; and (4) provide guidance for the design of a future technology-based exercise program tailored to older adults to use at home as a fall prevention strategy. Methods This study was part of a larger randomized controlled trial. The qualitative portion of the study and the focus of this paper used a qualitative descriptive design. Data collectors conducted structured, open-ended in-person interviews with study participants who were randomly allocated to use SureStep at home for 4 months. All interviews were audiotaped and ranged from 45 to 60 min. Thematic analysis was used to analyze collected data. This study was guided by Pender’s Health Promotion Model. Results Overall, 24 older adults aged 70 to 97 years were interviewed. Findings suggest older adults are open to use technology-based exercise programs at home, and in the context of optimizing adherence to home-based exercise programs for the prevention of falls, findings suggest that program developers should develop exercise programs in ways that provide older adults with a fun and enjoyable experience (thus increasing intrinsic motivation to exercise), focus on improving outcomes that are significant to older adults (thus increasing self-determined extrinsic motivation), offer challenging yet attainable exercises (thus increasing perceived self-competence), provide positive feedback on performance (thus increasing self-efficacy), and are easy to use (thus reducing perceived barriers to technology use). Conclusions This study provides important considerations when designing technology-based programs so they are tailored to the needs of older adults, increasing both usability and acceptability of programs and potentially enhancing exercise participation and long-term adherence to fall prevention interventions. Program uptake and adherence seem to be influenced by (1) older adults’ perceived benefits of undertaking the program, (2) whether the program is stimulating, and (3) the perceived barriers to exercise and technology use. Older adults shared important recommendations for future development of technologies for older adults to use at home.
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Affiliation(s)
- Trinidad Valenzuela
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.,Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Husna Razee
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Stephen Ronald Lord
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia.,Falls, Balance and Injury Research Centre, Neuroscience Research Australia, The University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia.,Falls, Balance and Injury Research Centre, Neuroscience Research Australia, The University of New South Wales, Sydney, Australia
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16
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Dedeyne L, Dewinter L, Lovik A, Verschueren S, Tournoy J, Gielen E. Nutritional and physical exercise programs for older people: program format preferences and (dis)incentives to participate. Clin Interv Aging 2018; 13:1259-1266. [PMID: 30050293 PMCID: PMC6055836 DOI: 10.2147/cia.s159819] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose A growing number of studies in older people have been examining the beneficial effects of non-pharmacological interventions, such as physical exercise (PE) and nutritional supplementation, to target age-related syndromes such as sarcopenia and frailty. This study evaluated interpersonal, intrapersonal, and community (dis)incentives, concepts of motivation, and preferred program formats toward a PE or nutritional program in older people, with or without frailty or risk of sarcopenia. Methods A questionnaire was developed and filled in by 115 community-dwelling older adults (≥65 years of age) after content (n=7 experts) and face validation (n=8 older adults). We assessed 1) the agreement with a statement (a statement with which ≥70% of the participants agree or strongly agree is considered as a common statement), 2) concepts of motivation by an exploratory factor analysis, and 3) program preferences by nonparametric Wilcoxon or Friedman’s analysis of variance and post hoc Wilcoxon signed-rank tests. Results Intrapersonal motivators (eg, health benefits) were the most common motivators to participate in a PE or nutritional program. Identified concepts to participate in a PE intervention were intrinsic health beliefs, fear of falling or injuries, influence of significant others and environment, and (para)medical encouragement (Cronbach’s alpha: 0.75; 72% variance explained). Intrinsic health beliefs, influence of significant others and (para)medical encouragement were identified as concepts that motivate older people to participate in a nutritional intervention (Cronbach’s alpha: 0.77; 78% variance explained). No favorability of exercise location was identified; however, older people preferred protein supplement intake in a tablet form compared to liquid or powder form and in a pulsed timing compared with a spread intake. Conclusion Program preferences of older people toward nutritional interventions need to be taken into account in future clinical trials and implementation programs, to increase recruitment and adherence to interventions.
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Affiliation(s)
- Lenore Dedeyne
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven - University of Leuven, Leuven, Belgium,
| | - Louise Dewinter
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven - University of Leuven, Leuven, Belgium,
| | - Aniko Lovik
- L-BioStat, KU Leuven - University of Leuven, Leuven, Belgium
| | - Sabine Verschueren
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven - University of Leuven, Leuven, Belgium, .,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium,
| | - Evelien Gielen
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven - University of Leuven, Leuven, Belgium, .,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium,
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17
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Evaluation of older people's knowledge, awareness, motivation and perceptions about falls and falls prevention in residential aged care homes: a tale of two cities. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18000697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractFalls prevention strategies can only be effective in reducing falls amongst older people if they are adopted and enacted in their daily lives. There is limited evidence identifying what older people in residential aged care (RAC) homes understand about falls and falls prevention, or what may limit or enable their adoption of strategies. This study was conducted in two countries and explored older people's knowledge and awareness of falls and their preferences, opportunities and motivation to undertake falls prevention strategies. A cross-sectional survey was administered to participants (N = 70) aged 65 years and over, living in six RAC homes in Perth, Australia and six RAC homes in Swansea, Wales, United Kingdom. Participants had limited knowledge about intrinsic falls risk factors and strategies to address these and frequently expressed self-blame regarding falling. Almost all (N = 67, 95.7%) participants felt highly motivated to maintain their current functional mobility and independence in everyday tasks. Key preferences for receiving falls prevention messages favoured a positive approach promoting wellness and independence (N = 41, 58.6%) via pictorial posters or brochures (N = 37, 52.9%) and small group discussions preferably with demonstrations (N = 18, 25.7%). Findings from this study may assist organisations and staff to more effectively engage with older people living in RAC about falls prevention and design targeted resources to address the motivations and preferences of this population.
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18
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Potential analysis for research on occupational therapy-led physical exercise programmes and home environment adaptation programmes to prevent falls for elderly people living at home / Potenzialanalyse zu ergotherapeutischen körperlichen Trainingsprogrammen und Wohnraumanpassungen zur Vermeidung von Stürzen bei zu Hause lebenden älteren Menschen. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2016. [DOI: 10.1515/ijhp-2016-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
In Germany, four to five million community-dwelling people aged 65 years or older fall every year. The presented potential analysis evaluates the potential of occupational therapy-led physical exercise programs and home environment adaptations to reduce the frequency of falling and as well as intrinsic and extrinsic risk factors for falling of older people living at home.
Methods
The potential analysis was compiled according to a method guideline (p.11-22) available as follows: http://www.cochrane. de/news/leitfaden-f%C3%BCr-gesundheitsfachberufe-mai-2013. The research question of fall prevention was considered as very relevant for health care and specified according to the PICOS-system. A Cochrane review was systematically searched and the body of evidence was assessed using the GRADE-system. In addition, studies after the search period of the Cochrane review were identified using the search strategy of this review. Both the studies within and after the review were assessed regarding their transferability to the German health care context.
Corpus of evidence
A Cochrane review from 2012 revealed that occupational therapy-led physical exercise programs reduced the frequency of falling of older people living at home (7 studies, 951 participants, 0.68 RaR; 95%-KI [0.58-0.80]), the number of fallers (6 studies, 714 participants, 0.78 RaR, 95%-KI [0.64-0.94]) and the fractures (6 studies, 810 participants, 0.34 RaR, 95%-KI [0.18-0.63]). Further studies showed that home environment adaptation programs significantly reduced the number of falls (4 studies, 1443 participants, 0.69 RaR, 95%-KI [0.55-0.86]) and the number of fallers (5 studies, 1153 participants, 0.79 RaR, 95%-KI [0.70-0.91]). However, direct implementation into the German healthcare context is not recommendable.
Implication for research
It is recommended (1) to manualise identified home environment adaptation programmes for the German healthcare context and (2) to pilot-test the physical exercise programmes ‘LiFE’ with regard to theoretical framework, acceptance, applicability and feasibility and to examine both interventions as part of a feasibility study. If this trial results in a feasible treatment programme well accepted by patients and their treating occupational therapists, a large-scaled randomized clinical trial in terms of comparative effectiveness research may follow.
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Hill AM, Francis-Coad J, Haines TP, Waldron N, Etherton-Beer C, Flicker L, Ingram K, McPhail SM. 'My independent streak may get in the way': how older adults respond to falls prevention education in hospital. BMJ Open 2016; 6:e012363. [PMID: 27466244 PMCID: PMC4964303 DOI: 10.1136/bmjopen-2016-012363] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The aim of the study was to determine how providing individualised falls prevention education facilitated behaviour change from the perspective of older hospital patients on rehabilitation wards and what barriers they identified to engaging in preventive strategies. DESIGN A prospective qualitative survey. METHODS Older patients (n=757) who were eligible (mini-mental state examination score>23/30) received falls prevention education while admitted to eight rehabilitation hospital wards in Western Australia. Subsequently, 610 participants were surveyed using a semistructured questionnaire to gain their response to the in-hospital education and their identified barriers to engaging in falls prevention strategies. Deductive content analysis was used to map responses against conceptual frameworks of health behaviour change and risk taking. RESULTS Participants who responded (n=473) stated that the education raised their awareness, knowledge and confidence to actively engage in falls prevention strategies, such as asking for assistance prior to mobilising. Participants' thoughts and feelings about their recovery were the main barriers they identified to engaging in safe strategies, including feeling overconfident or desiring to be independent and thinking that staff would be delayed in providing assistance. The most common task identified as potentially leading to risk-taking behaviour was needing to use the toilet. CONCLUSIONS Individualised education assists older hospital rehabilitation patients with good levels of cognition to engage in suitable falls prevention strategies while on the ward. Staff should engage with patients to understand their perceptions about their recovery and support patients to take an active role in planning their rehabilitation.
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Affiliation(s)
- Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Jacqueline Francis-Coad
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Terry P Haines
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
- Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
| | - Nicholas Waldron
- Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, Western Australia, Australia
- Health Strategy and Networks, Strategic System, Policy & Planning, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, Royal Perth Hospital Unit, School of Medicine & Pharmacology and Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- WA Centre for Health and Ageing, Royal Perth Hospital Unit, School of Medicine & Pharmacology and Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Katharine Ingram
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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How older adults would like falls prevention information delivered: fresh insights from a World Café forum. AGEING & SOCIETY 2016. [DOI: 10.1017/s0144686x16000192] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTTranslation of falls prevention evidence into practice is problematic. Understanding older adults’ views about falls prevention information could enhance delivery of falls prevention, resulting in better engagement and uptake of recommended activities. The aim of this study was to examine the views and preferences of community-dwelling older adults about seeking and receiving falls prevention information. A community forum using a modified World Café approach was conducted. Participants discussed five topic areas in small groups, under the guidance of table facilitators. Perspectives were captured on paper. Thematic analysis was conducted to identify factors that influence participants’ engagement and uptake of information. Seventy-three older adults participated in the forum covering wide-ranging preferences around falls prevention information. Personal experience was considered the key influence on an older adult's decision to initiate seeking information. While health professionals were often approached, alternative sources such as public libraries, peer educators and seniors’ organisations were also favoured as credible sources of information. Older adults proposed falls prevention information should be delivered with a positive tone, coupled with highly valued qualities of respect, empathy and time to listen to foster motivation to engage in recommended activities. Consumer-focused practical strategies were proposed to potentially improve future design, communication and dissemination of falls prevention information. This improvement could enhance engagement of messages and subsequent uptake of falls prevention recommended strategies.
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Dorresteijn TAC, Zijlstra GAR, Ambergen AW, Delbaere K, Vlaeyen JWS, Kempen GIJM. Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial. BMC Geriatr 2016; 16:2. [PMID: 26739339 PMCID: PMC4704266 DOI: 10.1186/s12877-015-0177-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/17/2015] [Indexed: 11/05/2022] Open
Abstract
Background Concerns about falls are common among older people. These concerns, also referred to as fear of falling, can have serious physical and psychosocial consequences, such as functional decline, increased risk of falls, activity restriction, and lower social participation. Although cognitive behavioral group programs to reduce concerns about falls are available, no home-based approaches for older people with health problems, who may not be able to attend such group programs are available yet. The aim of this study was to assess the effectiveness of a home-based cognitive behavioral program on concerns about falls, in frail, older people living in the community. Methods In a randomized controlled trial in the Netherlands, 389 people aged 70 years and older, in fair or poor perceived health, who reported at least some concerns about falls and related activity avoidance were allocated to a control (n = 195) or intervention group (n = 194). The intervention was a home-based, cognitive behavioral program consisting of seven sessions including three home visits and four telephone contacts. The program aims to instill adaptive and realistic views about fall risks via cognitive restructuring and to increase activity and safe behavior using goal setting and action planning and was facilitated by community nurses. Control group participants received usual care. Outcomes at 5 and 12 months follow-up were concerns about falls, activity avoidance due to concerns about falls, disability and falls. Results At 12 months, the intervention group showed significant lower levels of concerns about falls compared to the control group. Furthermore, significant reductions in activity avoidance, disability and indoor falls were identified in the intervention group compared with the control group. Effect sizes were small to medium. No significant difference in total number of falls was noted between the groups. Conclusions The home-based, cognitive behavioral program significantly reduces concerns about falls, related activity avoidance, disability and indoor falls in community-living, frail older people. The program may prolong independent living and provides an alternative for those people who are not able or willing to attend group programs. Trial registration ClinicalTrials.gov, NCT01358032. Registered 17 May 2011
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Affiliation(s)
- Tanja A C Dorresteijn
- Department of Health Services Research - Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - G A Rixt Zijlstra
- Department of Health Services Research - Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Antonius W Ambergen
- Department of Methodology and Statistics, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Kim Delbaere
- Neuroscience Research Australia, University of New South Wales, P.O. Box 1165, Randwick, NSW, 2031, Australia.
| | - Johan W S Vlaeyen
- Research Group Health Psychology, University of Leuven, Tiensestraat 102, 3000, Leuven, Belgium. .,Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Gertrudis I J M Kempen
- Department of Health Services Research - Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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Crane PK, Gibbons LE, McCurry SM, McCormick W, Bowen JD, Sonnen J, Keene CD, Grabowski T, Montine TJ, Larson EB. Importance of home study visit capacity in dementia studies. Alzheimers Dement 2015; 12:419-26. [PMID: 26602628 DOI: 10.1016/j.jalz.2015.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/31/2015] [Accepted: 10/14/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The importance of home research study visit capacity in Alzheimer's disease (AD) studies is unknown. METHODS All evaluations are from the prospective Adult Changes in Thought study. Based on analyses of factors associated with volunteering for a new in-clinic initiative, we analyzed AD risk factors and the relevance of neuropathologic findings for dementia comparing all data including home visits, and in-clinic data only. We performed bootstrapping to determine whether differences were greater than expected by chance. RESULTS Of the 1781 people enrolled during 1994-1996 with ≥1 follow-up, 1369 (77%) had in-clinic data, covering 61% of follow-up time. In-clinic data resulted in excluding 76% of incident dementia and AD cases. AD risk factors and the relevance of neuropathologic findings for dementia were both different with in-clinic data. DISCUSSION Limiting data collection in AD studies to research clinics alone likely reduces power and also can lead to erroneous inferences.
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Affiliation(s)
- Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Laura E Gibbons
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Susan M McCurry
- Department of Psychosocial & Community Health, University of Washington, Seattle, WA, USA
| | - Wayne McCormick
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - James D Bowen
- Department of Neurology, Multiple Sclerosis Center, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Joshua Sonnen
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Thomas Grabowski
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Thomas J Montine
- Department of Pathology, University of Washington, Seattle, WA, USA
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What Are the Characteristics of Home Exercise Programs That Older Adults Prefer?: A Cross-Sectional Study. Am J Phys Med Rehabil 2015; 94:508-21. [PMID: 25802951 DOI: 10.1097/phm.0000000000000275] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the preferences of older adults toward the structure and delivery of home exercise programs for the prevention of falls as well as the perceived benefits of and barriers to program adherence. METHODS A two-wave cross-sectional telephone survey of community-dwelling older adults was conducted in Victoria, Australia. Respondents were categorized as current, previous, or nonparticipants of a home exercise program in the last 6 yrs. Thematic analysis of open-response questions examining the preferences of current and previous participants toward participation in, and delivery of, home exercise programs for falls preventions was performed. RESULTS A total of 245 respondents completed the follow-up survey. The respondents were classified as current (n = 54), previous (n = 22), or nonparticipants (n = 169) of a home exercise program in the last 6 yrs. Program adherence was influenced by the perceived effect of programs on physical and mental health, participant autonomy, and how well the program structure complemented individual exercise and lifestyle preferences. CONCLUSIONS Adherence to home exercise programs for falls prevention is influenced by personal preferences toward program structure and delivery as well as perceived benefits of and barriers to program participation. To optimize participant adherence, service providers need to consider personal preferences and some flexibility in the program being delivered.
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Zijlstra GAR, Du Moulin MFMT, van Haastregt JCM, de Jonge M, Kempen GIJM, van der Poel A. [Managing concerns about falls in older people: evaluation of the implementation of an evidence-based program]. Tijdschr Gerontol Geriatr 2013; 44:272-84. [PMID: 24218167 DOI: 10.1007/s12439-013-0045-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A cognitive behavioral program reduced concerns about falling and related avoidance behavior among older community-dwelling adults in a randomized controlled trial. In the current study we examined the effects and acceptability of the program after nation-wide implementation into home care organizations in The Netherlands. METHODS In a one-group pretest-posttest study with data collection before the start of the program and at 2 and 4 months, the effects and acceptability of the program were assessed in 125 community-dwelling older people. The outcomes of the effect evaluation included concerns about falls, related avoidance behavior, falls, fall-related medical attention, feelings of anxiety, symptoms of depression, and loneliness. RESULTS Pretest-posttest analyses with the Wilcoxon signed-rank test and the paired t-test showed significant improvements at 4 months for concerns about falls, activity avoidance, number of falls in the past 2 months, feelings of anxiety, and symptoms of depression. No significant differences were shown for the other outcomes. DISCUSSION After implementation in home care organizations, the outcomes indicate positive program effects on concerns about falls, avoidance behavior, and falls in community-dwelling older people. Given the similarity in results, i.e. between those of the previously performed randomized controlled trial and those of the current pretest-posttest study, we conclude that the program can be successfully implemented in practice. This article is an adjusted, Dutch version of Zijlstra GA, van Haastregt JC, Du Moulin MF, de Jonge MC, van der Poel A, Kempen GI. Effects of the implementation of an evidenc-based program to manage concerns about falls in older adults. The Gerontologist 2013;53(5):839-849; doi: 10.1093/geront/gns142.
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Affiliation(s)
- G A R Zijlstra
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands,
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Hill AM, Etherton-Beer C, Haines TP. Tailored education for older patients to facilitate engagement in falls prevention strategies after hospital discharge--a pilot randomized controlled trial. PLoS One 2013; 8:e63450. [PMID: 23717424 PMCID: PMC3662677 DOI: 10.1371/journal.pone.0063450] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 03/29/2013] [Indexed: 11/19/2022] Open
Abstract
Background The aims of the study were to evaluate the effect of providing tailored falls prevention education in hospital on: i) engagement in targeted falls prevention behaviors in the month after discharge: ii) patients’ self-perceived risk and knowledge about falls and falls prevention strategies after receiving the education. Methods A pilot randomized controlled trial (n = 50): baseline and outcome assessments conducted by blinded researchers. Participants: hospital inpatients 60 years or older, discharged to the community. Participants were randomized into two groups. The intervention was a tailored education package consisting of multimedia falls prevention information with trained health professional follow-up, delivered in addition to usual care. Outcome measures were engagement in falls prevention behaviors in the month after discharge measured at one month after discharge with a structured survey, and participants’ knowledge, confidence and motivation levels before and after receiving the education. The feasibility of providing the intervention was examined and falls outcomes (falls, fall-related injuries) were also collected. Results Forty-eight patients (98%) provided follow-up data. The complete package was provided to 21 (84%) intervention group participants. Participants in the intervention group were significantly more likely to plan how to safely restart functional activities [Adjusted odds ratio 3.80, 95% CI (1.07, 13.52), p = 0.04] and more likely to complete other targeted behaviors such as completing their own home exercise program [Adjusted odds ratio 2.76, 95% CI (0.72, 10.50), p = 0.14] than the control group. The intervention group was significantly more knowledgeable, confident and motivated to engage in falls prevention strategies after receiving the education than the control group. There were 23 falls (n = 5 intervention; n = 18 control) and falls rates were 5.4/1000 patient days (intervention); 18.7/1000 patient days (control). Conclusion This tailored education was received positively by older people, resulted in increased engagement in falls prevention strategies after discharge and is feasible to deliver to older hospital patients. Trial registration The study was registered with the Australian New Zealand Clinical Trials Registry; ACTRN12611000963921 on 8th November 2011.
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Affiliation(s)
- Anne-Marie Hill
- School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
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Dorresteijn TAC, Rixt Zijlstra GA, Van Haastregt JCM, Vlaeyen JWS, Kempen GIJM. Feasibility of a nurse-led in-home cognitive behavioral program to manage concerns about falls in frail older people: a process evaluation. Res Nurs Health 2013; 36:257-70. [PMID: 23533013 DOI: 10.1002/nur.21534] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 11/07/2022]
Abstract
Concerns about falls and related avoidance of activities are common problems among older people living in the community. In this study we examined the feasibility and acceptability of AMB-Home (the Dutch in-home version of A Matter of Balance), a nurse-led in-home cognitive behavioral program developed for frail community-living older people with concerns about falls and related activity avoidance. The multicomponent program consisted of seven individual sessions, including three home visits and four telephone contacts. Data were collected from eight nurses and 194 participants. Generally, the program was considered acceptable and feasible by both the nurses and the participants. When AMB-Home turns out to be effective, the implementation of a fine-tuned version of this in-home program in regular health care, would be a natural next step.
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Affiliation(s)
- Tanja A C Dorresteijn
- CAPHRI School for Public Health and Primary Care and Department of Health Services Research, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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