1
|
Vandervelde S, Van den Bosch N, Vlaeyen E, Dierckx de Casterlé B, Flamaing J, Belaen G, Tuand K, Vandendriessche T, Milisen K. Determinants influencing the implementation of multifactorial falls risk assessment and multidomain interventions in community- dwelling older people: a systematic review. Age Ageing 2024; 53:afae123. [PMID: 38952187 DOI: 10.1093/ageing/afae123] [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: 12/18/2023] [Revised: 05/08/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Multifactorial falls risk assessment and multidomain interventions are recommended by the World guidelines for falls prevention and management. To successfully implement these interventions, it is important to understand determinants influencing the implementation. METHODS A literature search was conducted for this systematic review on the 3 December 2021 and updated on the 3 April 2023 in five databases: PubMed (including MEDLINE), EMBASE (via Embase.com), Cochrane Central Register of Controlled Trials (via Cochrane Library), Web of Science Core Collection and CINAHL (via EBSCO). Studies were included if they reported on determinants influencing the implementation of a multifactorial falls risk assessment and/or multidomain interventions in community-dwelling older people. Editorials, opinion papers, systematic reviews and studies focusing on one population (e.g. Parkinson) were excluded. Two researchers independently screened the articles on title, abstract and full text. The quality was evaluated based on a sensitivity analysis. 'The Comprehensive Integrated Checklist of Determinants of practice' was used to categorise the determinants. RESULTS Twenty-nine studies were included. Determinants were classified as barriers (n = 40) and facilitators (n = 35). The availability of necessary resources is the most reported determinant. Other commonly reported determinants are knowledge, intention/beliefs and motivation at the levels of older people and healthcare professionals, fitting of the intervention into current practice, communication, team and referral processes and financial (dis)incentives. CONCLUSIONS Mapping of the barriers and facilitators is essential to choose implementation strategies tailored to the context, and to enhance the uptake and effectiveness of a multifactorial falls risk assessment and/or multidomain interventions.
Collapse
Affiliation(s)
- Sara Vandervelde
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Centre of Expertise for Falls and Fracture Prevention Flanders, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
| | - Natalie Van den Bosch
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
| | - Ellen Vlaeyen
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Centre of Expertise for Falls and Fracture Prevention Flanders, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
- Hasselt University, Faculty of Medicine and Life Sciences, Agoralaan, 3590 Diepenbeek, Belgium
| | - Bernadette Dierckx de Casterlé
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
| | - Johan Flamaing
- KU Leuven, Department of Public Health and Primary Care, Gerontology and Geriatrics, Kapucijnenvoer 7 bus 7001 3000 Leuven, Belgium
- KU Leuven, University Hospital Leuven, Department of Geriatric Medicine, Herestraat 49 3000 Leuven, Belgium
| | - Goedele Belaen
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Centre of Expertise for Falls and Fracture Prevention Flanders, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
| | - Krizia Tuand
- KU Leuven Libraries, 2Bergen - Learning Centre Désiré Collen, Herestraat 49, 3000 Leuven, Belgium
| | - Thomas Vandendriessche
- KU Leuven Libraries, 2Bergen - Learning Centre Désiré Collen, Herestraat 49, 3000 Leuven, Belgium
| | - Koen Milisen
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Centre of Expertise for Falls and Fracture Prevention Flanders, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
- KU Leuven, University Hospital Leuven, Department of Geriatric Medicine, Herestraat 49 3000 Leuven, Belgium
| |
Collapse
|
2
|
Fernández MG, Pantiga MM, Fernández CP, Muñoz LA, Guerrero CG. Fall assessment and intervention among community-dwelling older people in a primary health care center in Spain: a best practice implementation project. JBI Evid Implement 2024:02205615-990000000-00108. [PMID: 38916444 DOI: 10.1097/xeb.0000000000000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
INTRODUCTION The implementation of fall prevention programs in the community is complex. Although there is solid scientific evidence that supports the effectiveness of such programs, there are multiple barriers that should be addressed using multifaceted strategies. AIMS The aim of this project was to increase compliance with evidence-based recommendations regarding fall risk screening and preventive interventions among older adults in a primary health care setting. METHODS This project used a pre-/post-implementation clinical audit based on the JBI Evidence Implementation Framework. Eight audit criteria were derived from JBI evidence summaries. The sample size was 62 patients aged 70 years or older. Data collection methods included a review of medical records and a questionnaire. A baseline audit was conducted and five barriers to best practice were identified. Strategies were then developed to increase compliance with the evidence-based recommendations, guided by JBI's Getting Research into Practice (GRiP) analysis. A follow-up audit was conducted in July 2022 to evaluate changes in compliance with best practices. RESULTS The baseline audit showed 0% compliance with best practice recommendations for seven out of eight audit criteria. Five barriers were identified: (1) absence of fall risk screening tools, (2) lack of fall prevention intervention protocols, (3) insufficient reporting of fall episodes in the records, (4) need for staff training, and (5) high staff turnover. Following the implementation of a fall risk assessment and intervention protocol, along with staff training, seven out of eight audit criteria increased from 0% to between 22.6% and 100%. CONCLUSIONS This evidence-based implementation project improved nursing practice in relation to compliance with best practice interventions to prevent falls. SPANISH ABSTRACT http://links.lww.com/IJEBH/A229.
Collapse
Affiliation(s)
- María García Fernández
- Health Service of the Principality of Asturias, Oviedo, Spain
- Spanish Centre for Evidence-Based Healthcare: A JBI Centre of Excellence, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Laura Albornos Muñoz
- Spanish Centre for Evidence Based Healthcare: A JBI Centre of Excellence, Nursing and Health Care Research Unit (Investén-isciii), Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Instituto de Salud Carlos III, Madrid, Spain
| | | |
Collapse
|
3
|
Vincenzo JL, Bergen G, Casey CM, Eckstrom E. Reframing Fall Prevention and Risk Management as a Chronic Condition Through the Lens of the Expanded Chronic Care Model: Will Integrating Clinical Care and Public Health Improve Outcomes? THE GERONTOLOGIST 2024; 64:gnae035. [PMID: 38666718 PMCID: PMC11149378 DOI: 10.1093/geront/gnae035] [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: 11/20/2023] [Indexed: 06/05/2024] Open
Abstract
Falls are a leading cause of morbidity and mortality among adults aged 65 years and older (older adults) and are increasingly recognized as a chronic condition. Yet, fall-related care is infrequently provided in a chronic care context despite fall-related death rates increasing by 41% between 2012 and 2021. One of the many challenges to addressing falls is the absence of fall-focused chronic disease management programs, which improve outcomes of other chronic conditions, like diabetes. Policies, information systems, and clinical-community connections help form the backbone of chronic disease management programs, yet these elements are often missing in fall prevention. Reframing fall prevention through the Expanded Chronic Care Model (ECCM) guided by implementation science to simultaneously support the uptake of evidence-based practices could help improve the care of older adults at risk for falling. The ECCM includes seven components: (1) self-management/develop personal skills, (2) decision support, (3) delivery system design/re-orient health services, (4) information systems, (5) build healthy public policy, (6) create supportive environments, and (7) strengthen community action. Applying the ECCM to falls-related care by integrating health care delivery system changes, community resources, and public policies to support patient-centered engagement for self-management offers the potential to prevent falls more effectively among older adults.
Collapse
Affiliation(s)
- Jennifer L Vincenzo
- Department of Physical Therapy and Center for Implementation Research, Fayetteville, Arkansas, USA
| | - Gwen Bergen
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Colleen M Casey
- Department of Internal Medicine, Providence Senior Health, Portland, Oregon, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
4
|
Koh VJW, Matchar DB, Chan AWM, Lee JML, Lai WX, Rosario D, George A, Ho V, Ismail NHB, Lien CTC, Merchant RA, Tan SM, Wong CH, Xu T. Reducing Falls Among Community-Dwelling Older Adults From Clinicians' Perspectives: A Systems Modeling Approach. Innov Aging 2023; 7:igad077. [PMID: 37694132 PMCID: PMC10484166 DOI: 10.1093/geroni/igad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Indexed: 09/12/2023] Open
Abstract
Background and Objectives Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programs in randomized controlled trials demonstrate effectiveness in reducing falls; however, the translation of research into the community remains challenging. Although there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West. As such, this study aims to engage stakeholders in uncovering the factors that facilitate or inhibit implementing community-based fall prevention programs in Singapore, with a focus on the interrelationship between those factors. Research Design and Methods Health care professionals familiar with fall prevention programs were invited to discuss the enablers and challenges to the implementation. This effort was facilitated using a systems modeling methodology of Group Model Building (GMB) to share ideas and create a common conceptual model of the challenges. The GMB employs various engagement techniques to draw on the experiences and perceptions of all stakeholders involved. Results This process led to the development of a Causal Loop Diagram (CLD), a qualitative conceptual model of the dynamic relationships between the barriers and facilitators of implementing fall prevention programs. Results from the CLD show that implementation is influenced by two main drivers: health care provider factors that influenced referrals, and patient factors that influenced referral acceptance and long-term adherence. Key leverage points for potential interventions were identified as well. Discussion and Implications The overall recommendation emphasized closer coordination and collaboration across providers to ensure sustainable and effective community-based fall prevention programs. This has to be supported by a national effort, involving a multidisciplinary stakeholder advisory group. These findings generated would be promising to guide future approaches to fall prevention.
Collapse
Affiliation(s)
- Vanessa Jean Wen Koh
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - David B Matchar
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
- Department of Medicine (General Internal Medicine), Duke University Medical Center, Durham, North Carolina, USA
| | - Angelique Wei-Ming Chan
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - June May-Ling Lee
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - Wei Xuan Lai
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
| | - Dulcie Rosario
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - Anne George
- Rehabilitation Services, Changi General Hospital, Singapore, Singapore
| | - Vanda Ho
- Department of Geriatric Medicine, National University Hospital, Singapore, Singapore
| | | | | | - Reshma A Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | | | - Chek Hooi Wong
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
| | - Tianma Xu
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| |
Collapse
|
5
|
van Scherpenseel MC, te Velde SJ, Veenhof C, Emmelot-Vonk MH, Barten JA. Contextual determinants influencing the implementation of fall prevention in the community: a scoping review. FRONTIERS IN HEALTH SERVICES 2023; 3:1138517. [PMID: 37249947 PMCID: PMC10210634 DOI: 10.3389/frhs.2023.1138517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/07/2023] [Indexed: 05/31/2023]
Abstract
Background Successful implementation of multifactorial fall prevention interventions (FPIs) is essential to reduce increasing fall rates in community-dwelling older adults. However, implementation often fails due to the complex context of the community involving multiple stakeholders within and across settings, sectors, and organizations. As there is a need for a better understanding of the occurring context-related challenges, the current scoping review purposes to identify what contextual determinants (i.e., barriers and facilitators) influence the implementation of FPIs in the community. Methods A scoping review was performed using the Arksey and O'Malley framework. First, electronic databases (Pubmed, CINAHL, SPORTDiscus, PsycINFO) were searched. Studies that identified contextual determinants that influence the implementation of FPIs in the community were included. Second, to both validate the findings from the literature and identify complementary determinants, health and social care professionals were consulted during consensus meetings (CMs) in four districts in the region of Utrecht, the Netherlands. Data were analyzed following a directed qualitative content analysis approach, according to the 39 constructs of the Consolidated Framework for Implementation Research. Results Fourteen relevant studies were included and 35 health and social care professionals (such as general practitioners, practice nurses, and physical therapists) were consulted during four CMs. Directed qualitative content analysis of the included studies yielded determinants within 35 unique constructs operating as barriers and/or facilitators. The majority of the constructs (n = 21) were identified in both the studies and CMs, such as "networks and communications", "formally appointed internal implementation leaders", "available resources" and "patient needs and resources". The other constructs (n = 14) were identified only in the . Discussion Findings in this review show that a wide array of contextual determinants are essential in achieving successful implementation of FPIs in the community. However, some determinants are considered important to address, regardless of the context where the implementation occurs. Such as accounting for time constraints and financial limitations, and considering the needs of older adults. Also, broad cross-sector collaboration and coordination are required in multifactorial FPIs. Additional context analysis is always an essential part of implementation efforts, as contexts may differ greatly, requiring a locally tailored approach.
Collapse
Affiliation(s)
- M. C. van Scherpenseel
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - S. J. te Velde
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - C. Veenhof
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - M. H. Emmelot-Vonk
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | - J. A. Barten
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
6
|
Toto PE, Alchin T, Yanes C, Park J, Fields BE. Implementing CAPABLE With Care Partners Through an Area Agency on Aging: Identifying Barriers and Facilitators Using the Consolidated Framework for Implementation Research. THE GERONTOLOGIST 2023; 63:428-438. [PMID: 35797990 DOI: 10.1093/geront/gnac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Community Aging in Place, Advancing Better Living for Elders (CAPABLE) is an evidence-based intervention to promote aging in place. Although CAPABLE has been implemented in more than 40 community sites, wide variation in implementation exists. Guided by the Consolidated Framework for Implementation Research (CFIR), this study sought to determine key barriers and facilitators that may influence CAPABLE implementation with older adult and care partner dyads through an area agency on aging (AAA). RESEARCH DESIGN AND METHODS A formative evaluation was completed using qualitative data from the pilot of a Hybrid Trial Type 1 study implementing CAPABLE in an AAA. Multiple sources of data were collected, including 2 focus groups, field notes, a tracking log, and meetings with CAPABLE interventionists. Data were analyzed using a framework method and validated through a negative case analysis approach in NVivo 12 Pro. RESULTS Fourteen dyads enrolled in the pilot and 6 completed the CAPABLE intervention. Key themes aligned with 10 constructs from 5 domains of the CFIR. Facilitators included adaptability of the intervention, cost, networks and communication, and knowledge and belief of individuals. Barriers included intervention complexity, client needs and resources, and executing the planned process. DISCUSSION AND IMPLICATIONS Results enhance understanding of contextual factors that can influence the implementation of CAPABLE with care partners. Strategies to overcome barriers include simplifying recruitment materials and targeting older adults with recent onset of disability. The CFIR is a valuable resource for planning and evaluation of the implementation of evidence-based interventions to promote aging in place.
Collapse
Affiliation(s)
- Pamela E Toto
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tucker Alchin
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caylee Yanes
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Junha Park
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Beth E Fields
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
7
|
Estabrooks PA, Glasgow RE. Developing a dissemination and implementation research agenda for aging and public health: The what, when, how, and why? Front Public Health 2023; 11:1123349. [PMID: 36815160 PMCID: PMC9939692 DOI: 10.3389/fpubh.2023.1123349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/13/2023] [Indexed: 02/09/2023] Open
Affiliation(s)
- Paul A. Estabrooks
- Department of Health and Kinesiology, College of Health, University of Utah, Salt Lake City, UT, United States
| | - Russell E. Glasgow
- ACCORDS Dissemination & Implementation Science Program and Department of Family Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, United States
| |
Collapse
|
8
|
Carpenter CR, Southerland LT, Lucey BP, Prusaczyk B. Around the EQUATOR with clinician-scientists transdisciplinary aging research (Clin-STAR) principles: Implementation science challenges and opportunities. J Am Geriatr Soc 2022; 70:3620-3630. [PMID: 36005482 PMCID: PMC10538952 DOI: 10.1111/jgs.17993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/25/2022] [Accepted: 07/04/2022] [Indexed: 12/24/2022]
Abstract
The Institute of Medicine and the National Institute on Aging increasingly understand that knowledge alone is necessary but insufficient to improve healthcare outcomes. Adapting the behaviors of clinicians, patients, and stakeholders to new standards of evidence-based clinical practice is often significantly delayed. In response, over the past twenty years, Implementation Science has developed as the study of methods and strategies that facilitate the uptake of evidence-based practice into regular use by practitioners and policymakers. One important advance in Implementation Science research was the development of Standards for Reporting Implementation Studies (StaRI), which provided a 27-item checklist for researchers to consistently report essential elements of the implementation and intervention strategies. Using StaRI as a framework, this review discusses specific Implementation Science challenges for research with older adults, provides solutions for those obstacles, and opportunities to improve the value of this evolving approach to reduce the knowledge translation losses that exist between published research and clinical practice.
Collapse
Affiliation(s)
- Christopher R Carpenter
- Department of Emergency Medicine and Emergency Care Research Core, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Lauren T Southerland
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Brendan P Lucey
- Department of Neurology, Washington University in St Louis School of Medicine, St. Louis, Missouri, USA
| | - Beth Prusaczyk
- Department of Medicine Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
9
|
McMahon SK, Greene EJ, Latham N, Peduzzi P, Gill TM, Bhasin S, Reuben DB. Engagement of older adults in STRIDE's multifactorial fall injury prevention intervention. J Am Geriatr Soc 2022; 70:3116-3126. [PMID: 35924574 PMCID: PMC9669158 DOI: 10.1111/jgs.17983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/29/2022] [Accepted: 07/04/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Evidence-based multifactorial fall prevention interventions in clinical practice have been less effective than expected. One plausible reason is that older adults' engagement in fall prevention care is suboptimal. METHODS This was a post-hoc analysis of 2403 older adults' engagement in a multifactorial fall prevention intervention in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) pragmatic trial. Based on the direct clinical care level of the Patient and Family Continuum of Engagement (CE) framework, three indicators of progressively interactive engagement were assessed: (1) Consultation (receiving information), (2) Involvement (prioritizing risks), and (3) Partnership (identifying prevention actions). Drop off at each step was determined as well as predictors of engagement. RESULTS The participants' engagement waned with increasingly interactive CE domains. Although all participants received information about their positive fall risk factors (consultation) and most (51%-96%) prioritized them (involvement), fewer participants (33%-55%) identified fall prevention actions (partnership) for most of their risk factors, except for strength gait or balance problems (95%). More participants (70%) identified home exercises than other actions. Finally, fall prevention actions were identified more commonly among participants who received two visits compared to one (OR = 2.33 [95% CI, 2.06-2.64]), were ≥80 years old (OR = 1.83 [95% CI, 1.51-2.23]), and had fewer fall risk factors (OR = 0.90 [95% CI, 0.83-0.99]). CONCLUSIONS The drop-off in participants' engagement based on the level of their interaction with clinicians suggests that future multifactorial fall prevention interventions need to be more focused on interactive patient-clinician partnerships that help older adults increase and maintain fall prevention actions. Our analyses suggest that more frequent contact with clinicians and more monitoring of the implementation and outcomes of Fall Prevention Care Plans could potentially improve engagement and help older adults maintain fall prevention actions.
Collapse
Affiliation(s)
| | - Erich J. Greene
- Department of Biostatistics, Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Nancy Latham
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Peter Peduzzi
- Department of Biostatistics, Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Thomas M. Gill
- Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Shalender Bhasin
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | | |
Collapse
|
10
|
Ganz DA, Yuan AH, Greene EJ, Latham NK, Araujo K, Siu AL, Magaziner J, Gurwitz JH, Wu AW, Alexander NB, Wallace RB, Greenspan SL, Rich J, Volpi E, Waring SC, Dykes PC, Ko F, Resnick NM, McMahon SK, Basaria S, Wang R, Lu C, Esserman D, Dziura J, Miller ME, Travison TG, Peduzzi P, Bhasin S, Reuben DB, Gill TM. Effect of the STRIDE fall injury prevention intervention on falls, fall injuries, and health-related quality of life. J Am Geriatr Soc 2022; 70:3221-3229. [PMID: 35932279 PMCID: PMC9669115 DOI: 10.1111/jgs.17964] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 05/29/2022] [Accepted: 06/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Falls are common in older adults and can lead to severe injuries. The Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) trial cluster-randomized 86 primary care practices across 10 health systems to a multifactorial intervention to prevent fall injuries, delivered by registered nurses trained as falls care managers, or enhanced usual care. STRIDE enrolled 5451 community-dwelling older adults age ≥70 at increased fall injury risk. METHODS We assessed fall-related outcomes via telephone interviews of participants (or proxies) every 4 months. At baseline, 12 and 24 months, we assessed health-related quality of life (HRQOL) using the EQ-5D-5L and EQ-VAS. We used Poisson models to assess intervention effects on falls, fall-related fractures, fall injuries leading to hospital admission, and fall injuries leading to medical attention. We used hierarchical longitudinal linear models to assess HRQOL. RESULTS For recurrent event models, intervention versus control incidence rate ratios were 0.97 (95% confidence interval [CI], 0.93-1.00; p = 0.048) for falls, 0.93 (95% CI, 0.80-1.08; p = 0.337) for self-reported fractures, 0.89 (95% CI, 0.73-1.07; p = 0.205) for adjudicated fractures, 0.91 (95% CI, 0.77-1.07; p = 0.263) for falls leading to hospital admission, and 0.97 (95% CI, 0.89-1.06; p = 0.477) for falls leading to medical attention. Similar effect sizes (non-significant) were obtained for dichotomous outcomes (e.g., participants with ≥1 events). The difference in least square mean change over time in EQ-5D-5L (intervention minus control) was 0.009 (95% CI, -0.002 to 0.019; p = 0.106) at 12 months and 0.005 (95% CI, -0.006 to 0.015; p = 0.384) at 24 months. CONCLUSIONS Across a standard set of outcomes typically reported in fall prevention studies, we observed modest improvements, one of which was statistically significant. Future work should focus on patient-, practice-, and organization-level operational strategies to increase the real-world effectiveness of interventions, and improving the ability to detect small but potentially meaningful clinical effects. CLINICALTRIALS gov identifier: NCT02475850.
Collapse
Affiliation(s)
- David A. Ganz
- Department of Medicine, David Geffen School of Medicine at UCLA; Los Angeles, CA
- Geriatric Research, Education and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Anita H. Yuan
- Department of Medicine, David Geffen School of Medicine at UCLA; Los Angeles, CA
| | - Erich J. Greene
- Yale Center for Analytical Sciences, Department of Biostatistics; Yale School of Public Health; New Haven, CT
| | - Nancy K. Latham
- Boston Claude D. Pepper Older Americans Independence Center; Research Program in Men’s Health: Aging and Metabolism; Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Katy Araujo
- Yale Claude D. Pepper Older Americans Independence Center; Yale University; New Haven, CT
| | - Albert L. Siu
- Icahn School of Medicine at Mount Sinai, New York, NY
- Geriatric Research, Education and Clinical Center, James J. Peters VA Healthcare System, Bronx, NY
| | - Jay Magaziner
- University of Maryland School of Medicine, Baltimore, MD
| | - Jerry H. Gurwitz
- Meyers Health Care Institute, a joint endeavor of Reliant Medical Group, Fallon Health, and UMass Chan Medical School, Worcester, MA
| | - Albert W. Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Neil B. Alexander
- University of Michigan; Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | | | - Susan L. Greenspan
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh PA
| | - Jeremy Rich
- HealthCare Partners Institute for Applied Research and Education, El Segundo, CA
| | - Elena Volpi
- University of Texas Medical Branch Claude D. Pepper Older Americans Independence Center; Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX
| | | | | | - Fred Ko
- Icahn School of Medicine at Mount Sinai, New York, NY
- Geriatric Research, Education and Clinical Center, James J. Peters VA Healthcare System, Bronx, NY
| | - Neil M. Resnick
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh PA
| | | | - Shehzad Basaria
- Boston Claude D. Pepper Older Americans Independence Center; Research Program in Men’s Health: Aging and Metabolism; Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Rixin Wang
- Yale Center for Medical Informatics, New Haven, CT
| | - Charles Lu
- Yale Center for Medical Informatics, New Haven, CT
| | - Denise Esserman
- Yale Center for Analytical Sciences, Department of Biostatistics; Yale School of Public Health; New Haven, CT
| | - James Dziura
- Yale Center for Analytical Sciences, Department of Biostatistics; Yale School of Public Health; New Haven, CT
| | | | - Thomas G. Travison
- Boston Claude D. Pepper Older Americans Independence Center; Research Program in Men’s Health: Aging and Metabolism; Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA
| | - Peter Peduzzi
- Yale Center for Analytical Sciences, Department of Biostatistics; Yale School of Public Health; New Haven, CT
| | - Shalender Bhasin
- Boston Claude D. Pepper Older Americans Independence Center; Research Program in Men’s Health: Aging and Metabolism; Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - David B. Reuben
- Department of Medicine, David Geffen School of Medicine at UCLA; Los Angeles, CA
| | - Thomas M. Gill
- Yale Claude D. Pepper Older Americans Independence Center; Yale University; New Haven, CT
| |
Collapse
|
11
|
Reuben DB, Evertson LC, Jackson-Stoeckle R, Epstein-Lubow G, Spragens LH, Haggerty KL, Serrano KS, Jennings LA. Dissemination of a successful dementia care program: Lessons to facilitate spread of innovations. J Am Geriatr Soc 2022; 70:2686-2694. [PMID: 35678747 PMCID: PMC9489616 DOI: 10.1111/jgs.17900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/12/2022] [Accepted: 04/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the effectiveness of innovations to improve the care of persons with dementia, there has been limited diffusion of these into widespread clinical practice. We aimed to identify common barriers and address them directly in the initial phase of dissemination of a successful dementia care program. METHODS Description of and early experience with a dissemination strategy of the UCLA Alzheimer's and Dementia Care Program to health care systems nationwide. We measured site-identified goals for the program and indicators of success, number of adopting sites, and participants in their programs. RESULTS From January 2019 to December 2021, 80 sites expressed interest in adopting the program, 14 (18%) sites adopted it, and 10 of these sites have begun caring for patients. Another 4 sites have implemented the program as part of a randomized clinical trial. To date, over 1690 persons living with dementia and their caregivers have received Alzheimer's and Dementia Care (ADC) care at 14 adopting sites. Key lessons from the early dissemination efforts include the importance of identifying a strong product champion at the adopting site, creating a business case for adoption, training of clinical staff and adapting the model to fit local cultures and workflow, as well as recognizing the likely long length of time needed for the decision to adopt and implementation process. CONCLUSIONS Despite many obstacles to dissemination, with local champions and technical assistance, successful innovations in dementia care can be implemented in diverse health systems. The ability to adopt sites to bring the program to full scale and achieve comparable outcomes to the original program remains to be determined.
Collapse
Affiliation(s)
- David B. Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles
| | - Leslie Chang Evertson
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles
| | | | | | | | | | - Katherine Sy Serrano
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles
| | - Lee A. Jennings
- Section of Geriatrics, University of Oklahoma Health Sciences Center
| |
Collapse
|
12
|
Marsden E, Craswell A, Taylor A, Barnett A, Wong PK, Wallis M. Translation of the geriatric emergency department intervention into other emergency departments: a post implementation evaluation of outcomes for older adults. BMC Geriatr 2022; 22:290. [PMID: 35392828 PMCID: PMC8988321 DOI: 10.1186/s12877-022-02999-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Increasing numbers of older adults with complex health deficits presenting to emergency departments has prompted the development of innovative models of care. One such model designed to reduce poor outcomes associated with acute healthcare, is the Geriatric Emergency Department Intervention. This intervention is a nurse-led, physician-championed, Emergency Department intervention that improves the health outcomes for frail older adults in the emergency department. Methods This quantitative cohort study aimed to evaluate the healthcare outcomes and costs associated with the implementation of the Geriatric Emergency Department Intervention (GEDI) for adults aged 70 years and over at two hospital sites that implemented the model using the integrated-Promoting Action on Research Implementation in Health Services (i-PARHIS) framework. Hospital A was large teaching hospital located in the tropical north of Australia. Hospital B was a medium sized teaching hospital near Brisbane, Queensland Australia. The effect of the intervention was examined in two ways. Outcomes were compared between: 1) all patients in the pre- and post- implementation periods, and 2) patients seen or not seen by the Geriatric Emergency Department Intervention team in the post-implementation period. The outcomes measured were disposition (discharged home, admitted); emergency department length of stay; hospital length of stay; all cause in-hospital mortality within 28 days; time to re-presentation up to 28 days post-discharge; emergency department and in-hospital costs. Survival analyses were used for the primary and secondary outcome variables and a Cox survival model was used to estimate the associations between variables and outcomes. Multiple regression models were used to examine other secondary outcomes whilst controlling for a range of confounders. Results The Geriatric Emergency Department Intervention was successfully translated into two different emergency departments. Both demonstrated an increased likelihood of discharge, decreased emergency department length of stay, decreased hospital costs for those who were admitted, with an associated reduction in risk of mortality, for adults aged 70 years and over. Conclusions The Geriatric Emergency Department Intervention was successfully translated into new sites that adapted the model design. Improvement in healthcare outcomes for older adults presenting to the emergency department was demonstrated, although this was more subtle than in the original model setting.
Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02999-4.
Collapse
Affiliation(s)
- Elizabeth Marsden
- Sunshine Coast Hospital and Health Service, Sunshine Coast University Hospital, 4 Doherty Street, Birtinya, QLD, 4575, Australia
| | - Alison Craswell
- University of the Sunshine Coast, Sunshine Coast Health Institute, 4 Doherty Street, Birtinya, QLD, Australia.
| | - Andrea Taylor
- Sunshine Coast Hospital and Health Service, Sunshine Coast University Hospital, 4 Doherty Street, Birtinya, QLD, 4575, Australia
| | - Adrian Barnett
- Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, Qld, 4059, Australia
| | - Pan-Kar Wong
- Gold Coast Hospital and Health Service, Gold Coast University Hospital, 1 Hospital Blvd, Gold Coast, Qld, 4215, Australia
| | - Marianne Wallis
- University of the Sunshine Coast, Sunshine Coast Health Institute, 4 Doherty Street, Birtinya, QLD, Australia.,Southern Cross University, Southern Cross Drive, Bilinga, QLD, 4225, Australia
| |
Collapse
|
13
|
Callahan KE. Challenges and Facilitators in Implementing a Focus on Function in Structured Clinical Settings. THE PUBLIC POLICY AND AGING REPORT 2021; 32:13-18. [PMID: 35127104 PMCID: PMC8803265 DOI: 10.1093/ppar/prab028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Kathryn E Callahan
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA,Address correspondence to: Kathryn E. Callahan, MD, MS, Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 USA. E-mail:
| |
Collapse
|
14
|
Weems JA, Rhodes S, Powers JS. Dementia Caregiver Virtual Support-An Implementation Evaluation of Two Pragmatic Models during COVID-19. Geriatrics (Basel) 2021; 6:geriatrics6030080. [PMID: 34449649 PMCID: PMC8395853 DOI: 10.3390/geriatrics6030080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
Caregivers of people with Alzheimer's and related dementias (ADRD) require support. Organizations have pivoted from traditional in-person support groups to virtual care in the face of the COVID-19 pandemic. We describe two model programs and their pragmatic implementation of virtual care platforms for ADRD caregiver support. A mixed methods analysis of quantitative outcomes as well as a thematic analysis from semi-structured interviews of facilitators was performed as part of a pragmatic quality improvement project to enhance delivery of virtual support services for ADRD caregivers. Implementation differed among individual organizations but was well received by facilitators and caregivers. While virtual platforms can present challenges, older adults appreciated the strength of group facilitators and reported enhanced connectedness related to virtual support. Barriers to success include the limitations of virtual programming, including technological issues and distractions from program delivery. Virtual support can extend outreach, addressing access and providing safe care during a pandemic. Implementation differs among organizations; however, some elements of virtual support may be long-lasting.
Collapse
Affiliation(s)
- Jacy A. Weems
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN 37212, USA;
| | - Shana Rhodes
- Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN 37212, USA;
| | - James S. Powers
- Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN 37212, USA;
- Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center, Nashville, TN 37232, USA
- Correspondence:
| |
Collapse
|