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Robinson K, Logan P, Tucker C, Finlayson J, van der Wardt V, Kilby A, Knowles S, Vanhegan S, Hodgson S, Lidstone N. What are the views of adults with an intellectual disability (AWID), carers and healthcare professionals on a community falls management programme for AWID: a qualitative interview study in the UK. BMJ Open 2024; 14:e069588. [PMID: 38307531 PMCID: PMC10836373 DOI: 10.1136/bmjopen-2022-069588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/21/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES The aim of this study was to refine a draft of the ACTiON FALLS LD programme based on the views of adults with an intellectual disability (AWID), carers and healthcare professionals (HCPs). DESIGN, SETTING AND PARTICIPANTS The semistructured interview study included HCP as well as AWID and carers supporting AWID living in the community. Community settings included sheltered living, supported living, AWID living at home with family carers or independently. The interview study explored the first draft of the ACTiON FALLS LD programme as well as the wider falls management for AWID. Interviews with AWID were developed to include a range of approaches (eg, case studies, pictures) to support inclusive participation. Individual interviews were digitally recorded and transcribed. Researcher notes were used during interviews with AWID. All data were analysed using the principles of framework analysis. RESULTS 14 HCP, 8 carers and 13 AWID took part in the interview process. Five key themes were identified: programme components, programme design, programme approach, who would use the programme and programme delivery. CONCLUSIONS The views of AWID, HCP and carers showed the need to consider the impact of risk perception, anxiety and fear of falling in the adaption of the ACTiON FALLS programme. The programme needs to be accessible and support the inclusion of AWID in managing falls and ultimately fulfil the requirement for a proactive and educational tool by all.
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Affiliation(s)
- Katie Robinson
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
- Research and Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Phillipa Logan
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
- Nottingham CityCare Partnership CIC, Nottingham, UK
| | | | - Janet Finlayson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Veronika van der Wardt
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
- University of Marburg, Department of General Practice, Marburg, Germany
| | - Alice Kilby
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | | | - Stuart Hodgson
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Nicola Lidstone
- Research and Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Suen J, Kneale D, Sutcliffe K, Kwok W, Cameron ID, Crotty M, Sherrington C, Dyer S. Critical features of multifactorial interventions for effective falls reduction in residential aged care: a systematic review, intervention component analysis and qualitative comparative analysis. Age Ageing 2023; 52:afad185. [PMID: 37993405 PMCID: PMC10665139 DOI: 10.1093/ageing/afad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/10/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Multifactorial fall prevention trials providing interventions based on individual risk factors have variable success in aged care facilities. To determine configurations of trial features that reduce falls, intervention component analysis (ICA) and qualitative comparative analysis (QCA) were undertaken. METHODS Randomised controlled trials (RCTs) from a Cochrane Collaboration review (Cameron, 2018) with meta-analysis data, plus trials identified in a systematic search update to December 2021 were included. Meta-analyses were updated. A theory developed through ICA of English publications of trialist's perspectives was assessed through QCA and a subgroup meta-analysis. RESULTS Pooled effectiveness of multifactorial interventions indicated a falls rate ratio of 0.85 (95% confidence interval, CI, 0.65-1.10; I2 = 85%; 11 trials). All tested interventions targeted both environmental and personal risk factors by including assessment of environmental hazards, a medical or medication review and exercise intervention. ICA emphasised the importance of co-design involving facility staff and managers and tailored intervention delivery to resident's intrinsic factors for successful outcomes. QCA of facility engagement plus tailored delivery was consistent with greater reduction in falls, supported by high consistency (0.91) and coverage (0.85). An associated subgroup meta-analysis demonstrated strong falls reduction without heterogeneity (rate ratio 0.61, 95%CI 0.54-0.69, I2 = 0%; 7 trials). CONCLUSION Multifactorial falls prevention interventions should engage aged care staff and managers to implement strategies which include tailored intervention delivery according to each resident's intrinsic factors. Such approaches are consistently associated with a successful reduction in falls, as demonstrated by QCA and subgroup meta-analyses. Co-design approaches may also enhance intervention success.
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Affiliation(s)
- Jenni Suen
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University of South Australia, Bedford Park, Australia
| | - Dylan Kneale
- EPPI Centre, UCL Social Research Institute, University College London, London WC1H 0NS, United Kingdom
| | - Katy Sutcliffe
- EPPI Centre, UCL Social Research Institute, University College London, London WC1H 0NS, United Kingdom
| | - Wing Kwok
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and the University of Sydney, St Leonards, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University of South Australia, Bedford Park, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Suzanne Dyer
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University of South Australia, Bedford Park, Australia
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Lage I, Braga F, Almendra M, Meneses F, Teixeira L, Araújo O. Older People Living Alone: A Predictive Model of Fall Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6284. [PMID: 37444131 PMCID: PMC10341723 DOI: 10.3390/ijerph20136284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
Falls in older people are a result of a combination of multiple risk factors. There are few studies involving predictive models in a community context. The aim of this study was to determine the validation of a new model for predicting fall risk in older adults (65+) living alone in community dwellings (n = 186; n = 117) with a test-retest reliability study. We consider in the predictive model the significant factors emerged from the bivariate analysis: age, zone, social community resources, physical exercise, self-perception of health, difficulty to keep standing, difficulty to sit and get up from a chair, strain to see, use of technical devices, hypertension and number of medications. The final model explained 28.5% of the risk of falling in older adults living alone in community dwellings. The AUC = 0.660 (se = 0.065, IC 95% 0.533-0.787, p = 0.017). The predictive model developed revealed a satisfactory discriminatory performance of the model and can contribute to clinical practice, with respect to the evaluation of risk of falling in this frailty group and preventing falls.
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Affiliation(s)
- Isabel Lage
- School of Nursing, University of Minho, 4710-057 Braga, Portugal; (I.L.); (F.B.)
| | - Fátima Braga
- School of Nursing, University of Minho, 4710-057 Braga, Portugal; (I.L.); (F.B.)
- Nursing Research Centre, University of Minho, 4710-057 Braga, Portugal
| | - Manuela Almendra
- School of Nursing, University of Minho, 4710-057 Braga, Portugal; (I.L.); (F.B.)
- Nursing Research Centre, University of Minho, 4710-057 Braga, Portugal
| | - Filipe Meneses
- School of Engineering, University of Minho, 4710-057 Braga, Portugal
- Centro de Computação Gráfica, 4800-058 Guimarães, Portugal
- Algoritmi Research Centre, University of Minho, 4710-057 Braga, Portugal
| | - Laetitia Teixeira
- ICBAS, University of Porto, 4050-313 Porto, Portugal
- CINTESIS@RISE, ICBAS, University of Porto, 4050-313 Porto, Portugal
| | - Odete Araújo
- School of Nursing, University of Minho, 4710-057 Braga, Portugal; (I.L.); (F.B.)
- Nursing Research Centre, University of Minho, 4710-057 Braga, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3045-043 Coimbra, Portugal
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Leighton PA, Darby J, Allen F, Cook M, Evley R, Fox C, Godfrey M, Gordon A, Gladman J, Horne J, Robertson K, Logan P. A realist evaluation of a multifactorial falls prevention programme in care homes. Age Ageing 2022; 51:6872690. [PMID: 36469088 PMCID: PMC9721241 DOI: 10.1093/ageing/afac263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/17/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND falls in care homes are common, costly and hard to prevent.Multifactorial falls programmes demonstrate clinical and cost-effectiveness, but the heterogeneity of the care home sector is a barrier to their implementation. A fuller appreciation of the relationship between care home context and falls programme delivery will guide development and support implementation. METHODS this is a multi-method process evaluation informed by a realist approach.Data include fidelity observations, stakeholder interviews, focus groups, documentary review and falls-rate data. Thematic analysis of qualitative data and descriptive statistics are synthesised to generate care home case studies. RESULTS data were collected in six care homes where a falls programme was trialled. Forty-four interviews and 11 focus groups complemented observations and document review.The impact of the programme varied. Five factors were identified: (i) prior practice and (ii) training may inhibit new ways of working; (iii) some staff may be reluctant to take responsibility for falls; (iv) some may feel that residents living with dementia cannot be prevented from falling; and, (v) changes to management may disturb local innovation.In some care homes, training and improved awareness generated a reduction in falls without formal assessments being carried out. CONCLUSIONS different aspects of the falls programme sparked different mechanisms in different settings, with differing impact upon falls.The evaluation has shown that elements of a multifactorial falls programme can work independently of each other and that it is the local context (and local challenges faced), which should shape how a falls programme is implemented.
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Affiliation(s)
- Paul A Leighton
- Lifespan and Population Health, School of Medicine (LPH), University of Nottingham, Nottingham UK
| | - Janet Darby
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK
| | - Frances Allen
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK
| | - Marie Cook
- College of Health and Psychology, University of Derby, Derby UK
| | - Rachel Evley
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK
| | - Chris Fox
- College of Medicine and Health, University of Exeter, Exeter UK.,Norfolk and Suffolk NHS Foundation Trust, Norwich UK
| | | | - Adam Gordon
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK
| | - John Gladman
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK.,Nottingham University Hospitals NHS Trust, Nottingham UK.,NIHR Nottingham Biomedical Research Centre, Queens Medical Centre, Nottingham UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham UK
| | - Jane Horne
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK
| | - Kate Robertson
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham UK
| | - Pip Logan
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK
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5
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Ziebart C, Dewan N, MacDermid J. Content validity of the comprehensive home fall hazard checklist, an observational study. Medicine (Baltimore) 2022; 101:e31781. [PMID: 36451495 PMCID: PMC9704902 DOI: 10.1097/md.0000000000031781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
One strategy to reduce the number of falls in older adults is through home hazards assessment checklists. The comprehensive home fall hazard checklist (CHFHC) was designed to guide individuals through their home, assessing fall hazards. The checklist systematically prompts the individuals to check 10 general locations in the house The purpose of this study was to assess the content validity of the comprehensive home fall hazard checklist. A 4-point ordinal Likert rating scale was used to evaluate the content validity of each of the 74 items on the checklist. The relevance and clarity of each item was assessed. Nine experts rated the content validity of each test in relation to the 5 tasks in the rating protocol. The item content validity index, and the scale content validity index were determined, and a kappa rating was calculated. Three of the 74 items on the CHFHC were determined to be not relevant receiving a content validity index of 0.78 or less. All of the items were ranked as being quite clear or highly clear, with all items receiving at least 0.78 on the content validity index. The Kappa score indicates expert agreement. The content validity index was determined to be excellent, with high ratings for both relevance and clarity for 71 of 74 items on the CHFHC.
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Affiliation(s)
- Christina Ziebart
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- * Correspondence: Christina Ziebart, Faculty of Health Science, Western University, London, ON N6G 1H1, Canada (e-mail: )
| | - Neha Dewan
- Department of Health Sciences, Lakehead University, Thunder Bay ON, Canada
| | - Joy MacDermid
- Physical Therapy and Surgery, Western University, London, ON, Canada
- Roth|McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada
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Flannery C, Dennehy R, Riordan F, Cronin F, Moriarty E, Turvey S, O'Connor K, Barry P, Jonsson A, Duggan E, O'Sullivan L, O'Reilly É, Sinnott SJ, McHugh S. Enhancing referral processes within an integrated fall prevention pathway for older people: a mixed-methods study. BMJ Open 2022; 12:e056182. [PMID: 35985777 PMCID: PMC9396121 DOI: 10.1136/bmjopen-2021-056182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Multifactorial interventions, which involve assessing an individual's risk of falling and providing treatment or onward referral, require coordination across settings. Using a mixed-methods design, we aimed to develop a process map to examine onward referral pathways following falls risk assessment in primary care. SETTING Primary care fall risk assessment clinics in the South of Ireland. PARTICIPANTS Focus groups using participatory mapping techniques with primary care staff (public health nurses (PHNs), physiotherapists (PT),and occupational therapists (OT)) were conducted to plot the processes and onward referral pathways at each clinic (n=5). METHODS Focus groups were analysed in NVivo V.12 using inductive thematic analysis. Routine administrative data from January to March 2018 included details of client referrals, assessments and demographics sourced from referral and assessment forms. Data were analysed in Stata V.12 to estimate the number, origin and focus of onward referrals and whether older adults received follow-up interventions. Quantitative and qualitative data were analysed separately and integrated to produce a map of the service. RESULTS Nine staff participated in three focus groups and one interview (PHN n=2; OT n=4; PT n=3). 85 assessments were completed at five clinics (female n=69, 81.2%, average age 77). The average number of risk factors was 5.4 out of a maximum of 10. Following assessment, clients received an average of three onward referrals. Only one-third of referrals (n=135/201, 33%) had data available on intervention receipt. Primary care staff identified variations in how formally onward referrals were managed and barriers, including a lack of client information, inappropriate referral and a lack of data management support. CONCLUSION Challenges to onward referral manifest early in an integrated care pathway, such as clients with multiple risk factors sent for initial assessment and the lack of an integrated IT system to share information across settings.
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Affiliation(s)
- Caragh Flannery
- School of Public Health, University College Cork, Cork, Ireland
| | - Rebecca Dennehy
- School of Public Health, University College Cork, Cork, Ireland
| | - Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Finola Cronin
- Corks Falls Prevention Service, Health Service Executive, Naas, Ireland
| | - Eileen Moriarty
- School of Public Health, University College Cork, Cork, Ireland
- National Services for Older Persons Team, Health Service Executive, Naas, Ireland
| | - Spencer Turvey
- Cork Kerry Community Healthcare, Health Service Executive, Naas, Ireland
| | - Kieran O'Connor
- Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Patrick Barry
- Acute Medicine and Geriatric Medicine, Cork University Hospital Group, Cork, Ireland
| | | | - Eoin Duggan
- Geriatric Medicine, Mercy University Hospital, Cork, Ireland
- Mercers Institute for Successful Ageing, Saint James's Hospital, Dublin, Ireland
| | - Liz O'Sullivan
- Cork Kerry Community Healthcare HSE South, Health Service Executive, Dublin, Ireland
| | - Éilis O'Reilly
- School of Public Health, University College Cork, Cork, Ireland
| | - Sarah-Jo Sinnott
- Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
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7
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Albasha N, McCullagh R, Cornally N, McHugh S, Timmons S. Implementation strategies supporting fall prevention interventions in a long-term care facility for older persons: a systematic review protocol. BMJ Open 2022; 12:e055149. [PMID: 35623755 PMCID: PMC9150148 DOI: 10.1136/bmjopen-2021-055149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Falls are common among older people in long-term care facilities (LCFs). Falls lead to significant morbidity, mortality and reduced quality of life among residents. Fall prevention interventions have been shown to reduce falls in LCFs. However, this may not always translate to effectiveness in real-world situations. We will conduct a systematic review (SR) to identify the implementation strategies used in fall prevention interventions in LCF, describing the effectiveness of strategies in terms of key implementation outcomes and fall reduction. METHODS AND ANALYSIS The search will include scientific papers in electronic databases, including PubMed, CINAHL, Embase, PsycINFO, Scopus and Web of Science, and published theses. The SR will consider all original research that empirically evaluated or tested implementation strategies to support fall prevention interventions in LCF, published in English or Arabic between 1 January 2001 and 31 December 2021, where data are presented on the implementation strategy (eg, audit and feedback, champions) and/or implementation outcome (eg, fidelity). Clinical trials, quasi-experimental studies and quality improvement studies will be eligible for inclusion. Two researchers will complete abstract screening, data abstraction and quality assessments independently. The screening process will be presented using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Data will be extracted into a standardised table, including the country, year, authors, type of study, primary clinical outcome (falls rate and/or risk reduction as available), implementation strategy and implementation outcomes. Implementation strategies will be defined and categorised using the Expert Recommendation for Implementing Change Taxonomy. Implementation outcomes will be defined and categorised using the Implementation Outcomes Taxonomy, and clinical outcomes of the intervention effectiveness for falls preventions will be reported as formulated in each study, with a final narrative synthesis of data. ETHICS AND DISSEMINATION Ethical approval is not required for this study, and the results will be disseminated via peer-reviewed journals and presented at international conferences. PROSPERO REGISTRATION NUMBER CRD42021239604.
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Affiliation(s)
- Neah Albasha
- Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
- Rehabilitation Department, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ruth McCullagh
- School of Clinical Therapies, University College Cork, Cork, Ireland
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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Lapp L, Egan K, McCann L, Mackenzie M, Wales A, Maguire R. Decision Support Tools in Adult Long-Term Care Facilities: A Scoping Review (Preprint). J Med Internet Res 2022; 24:e39681. [PMID: 36066928 PMCID: PMC9490521 DOI: 10.2196/39681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/14/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Digital innovations are yet to make real impacts in the care home sector despite the considerable potential of digital health approaches to help with continued staff shortages and to improve quality of care. To understand the current landscape of digital innovation in long-term care facilities such as nursing and care homes, it is important to find out which clinical decision support tools are currently used in long-term care facilities, what their purpose is, how they were developed, and what types of data they use. Objective The aim of this review was to analyze studies that evaluated clinical decision support tools in long-term care facilities based on the purpose and intended users of the tools, the evidence base used to develop the tools, how the tools are used and their effectiveness, and the types of data the tools use to contribute to the existing scientific evidence to inform a roadmap for digital innovation, specifically for clinical decision support tools, in long-term care facilities. Methods A review of the literature published between January 1, 2010, and July 21, 2021, was conducted, using key search terms in 3 scientific journal databases: PubMed, Cochrane Library, and the British Nursing Index. Only studies evaluating clinical decision support tools in long-term care facilities were included in the review. Results In total, 17 papers were included in the final review. The clinical decision support tools described in these papers were evaluated for medication management, pressure ulcer prevention, dementia management, falls prevention, hospitalization, malnutrition prevention, urinary tract infection, and COVID-19 infection. In general, the included studies show that decision support tools can show improvements in delivery of care and in health outcomes. Conclusions Although the studies demonstrate the potential of positive impact of clinical decision support tools, there is variability in results, in part because of the diversity of types of decision support tools, users, and contexts as well as limited validation of the tools in use and in part because of the lack of clarity in defining the whole intervention.
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Affiliation(s)
- Linda Lapp
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Kieren Egan
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Lisa McCann
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Moira Mackenzie
- Digital Health & Care Innovation Centre, Glasgow, United Kingdom
| | - Ann Wales
- Digital Health & Care Innovation Centre, Glasgow, United Kingdom
| | - Roma Maguire
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
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9
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Wabe N, Siette J, Seaman KL, Nguyen AD, Raban MZ, Close JCT, Lord SR, Westbrook JI. The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities: a retrospective cohort study using routinely collected data. BMC Geriatr 2022; 22:271. [PMID: 35365078 PMCID: PMC8973529 DOI: 10.1186/s12877-022-02973-0] [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: 12/17/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Peninsula Health Falls Risk Assessment Tool (PH-FRAT) is a validated and widely applied tool in residential aged care facilities (RACFs) in Australia. However, research regarding its use and predictive performance is limited. This study aimed to determine the use and performance of PH-FRAT in predicting falls in RACF residents. METHODS A retrospective cohort study using routinely-collected data from 25 RACFs in metropolitan Sydney, Australia from Jul 2014-Dec 2019. A total of 5888 residents aged ≥65 years who were assessed at least once using the PH-FRAT were included in the study. The PH-FRAT risk score ranges from 5 to 20 with a score > 14 indicating fallers and ≤ 14 non-fallers. The predictive performance of PH-FRAT was determined using metrics including area under receiver operating characteristics curve (AUROC), sensitivity, specificity, sensitivityEvent Rate(ER) and specificityER. RESULTS A total of 27,696 falls were reported over 3,689,561 resident days (a crude incident rate of 7.5 falls /1000 resident days). A total of 38,931 PH-FRAT assessments were conducted with a median of 4 assessments per resident, a median of 43.8 days between assessments, and an overall median fall risk score of 14. Residents with multiple assessments had increased risk scores over time. The baseline PH-FRAT demonstrated a low AUROC of 0.57, sensitivity of 26.0% (sensitivityER 33.6%) and specificity of 88.8% (specificityER 82.0%). The follow-up PH-FRAT assessments increased sensitivityER values although the specificityER decreased. The performance of PH-FRAT improved using a lower risk score cut-off of 10 with AUROC of 0.61, sensitivity of 67.5% (sensitivityER 74.4%) and specificity of 55.2% (specificityER 45.6%). CONCLUSIONS Although PH-FRAT is frequently used in RACFs, it demonstrated poor predictive performance raising concerns about its value. Introducing a lower PH-FRAT cut-off score of 10 marginally enhanced its predictive performance. Future research should focus on understanding the feasibility and accuracy of dynamic fall risk predictive tools, which may serve to better identify residents at risk of falls.
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Affiliation(s)
- Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
| | - Joyce Siette
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, Australia
| | - Karla L Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Amy D Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,St Vincent's Clinical School, UNSW Medicine, UNSW, Sydney, NSW, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | | | - Stephen R Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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10
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Peryer G, Kelly S, Blake J, Burton JK, Irvine L, Cowan A, Akdur G, Killett A, Brand SL, Musa MK, Meyer J, Gordon AL, Goodman C. Contextual factors influencing complex intervention research processes in care homes: a systematic review and framework synthesis. Age Ageing 2022; 51:6540144. [PMID: 35231097 PMCID: PMC8887840 DOI: 10.1093/ageing/afac014] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Indexed: 12/20/2022] Open
Abstract
Background Care homes are complex settings to undertake intervention research. Barriers to research implementation processes can threaten studies’ validity, reducing the value to residents, staff, researchers and funders. We aimed to (i) identify and categorise contextual factors that may mediate outcomes of complex intervention studies in care homes and (ii) provide recommendations to minimise the risk of expensive research implementation failures. Methods We conducted a systematic review using a framework synthesis approach viewed through a complex adaptive systems lens. We searched: MEDLINE, Embase, CINAHL, ASSIA databases and grey literature. We sought process evaluations of care home complex interventions published in English. Narrative data were indexed under 28 context domains. We performed an inductive thematic analysis across the context domains. Results We included 33 process evaluations conducted in high-income countries, published between 2005 and 2019. Framework synthesis identified barriers to implementation that were more common at the task and organisational level. Inductive thematic analysis identified (i) avoiding procedural drift and (ii) participatory action and learning as key priorities for research teams. Research team recommendations include advice for protocol design and care home engagement. Care home team recommendations focus on internal resources and team dynamics. Collaborative recommendations apply to care homes’ individual context and the importance of maintaining positive working relationships. Discussion Researchers planning and undertaking research with care homes need a sensitive appreciation of the complex care home context. Study implementation is most effective where an intervention is co-produced, with agreed purpose and adequate resources to incorporate within existing routines and care practices.
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Affiliation(s)
- Guy Peryer
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
- NIHR Applied Research Collaboration, East of England, England, UK
| | - Sarah Kelly
- Cambridge Public Health, University of Cambridge, East Forvie Site, Cambridge CB2 0SZ, UK
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0AH, UK
| | - Jessica Blake
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jennifer K Burton
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - Lisa Irvine
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Andy Cowan
- Cambridge Public Health, University of Cambridge, East Forvie Site, Cambridge CB2 0SZ, UK
| | - Gizdem Akdur
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
- NIHR Applied Research Collaboration, East of England, England, UK
| | - Sarah L Brand
- St Luke's Campus, Heavitree Road, University of Exeter, Exeter EX1 2LU, UK
- NIHR Applied Research Collaboration, South West Peninsula, England, UK
| | - Massirfufulay Kpehe Musa
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Julienne Meyer
- National Care Forum/Care for Older People, School of Health Sciences, Division of Nursing, City, University of London, London, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
- NIHR Applied Research Collaboration, East of England, England, UK
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11
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Logan PA, Horne JC, Allen F, Armstrong SJ, Clark AB, Conroy S, Darby J, Fox C, Gladman JR, Godfrey M, Gordon AL, Irvine L, Leighton P, McCartney K, Mountain G, Robertson K, Robinson K, Sach TH, Stirling S, Wilson EC, Sims EJ. A multidomain decision support tool to prevent falls in older people: the FinCH cluster RCT. Health Technol Assess 2022; 26:1-136. [PMID: 35125131 PMCID: PMC8859771 DOI: 10.3310/cwib0236] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Falls in care home residents are common, unpleasant, costly and difficult to prevent. OBJECTIVES The objectives were to evaluate the clinical effectiveness and cost-effectiveness of the Guide to Action for falls prevention in Care Homes (GtACH) programme. DESIGN A multicentre, cluster, parallel, 1 : 1 randomised controlled trial with embedded process evaluation and economic evaluation. Care homes were randomised on a 1 : 1 basis to the GtACH programme or usual care using a secure web-based randomisation service. Research assistants, participating residents and staff informants were blind to allocation at recruitment; research assistants were blind to allocation at follow-up. NHS Digital data were extracted blindly. SETTING Older people's care homes from 10 UK sites. PARTICIPANTS Older care home residents. INTERVENTION The GtACH programme, which includes care home staff training, systematic use of a multidomain decision support tool and implementation of falls prevention actions, compared to usual falls prevention care. OUTCOMES The primary trial outcome was the rate of falls per participating resident occurring during the 90-day period between 91 and 180 days post randomisation. The primary outcome for the cost-effectiveness analysis was the cost per fall averted, and the primary outcome for the cost-utility analysis was the incremental cost per quality adjusted life-year. Secondary outcomes included the rate of falls over days 0-90 and 181-360 post randomisation, activity levels, dependency and fractures. The number of falls per resident was compared between arms using a negative binomial regression model (generalised estimating equation). RESULTS A total of 84 care homes were randomised: 39 to the GtACH arm and 45 to the control arm. A total of 1657 residents consented and provided baseline measures (mean age 85 years, 32% men). GtACH programme training was delivered to 1051 staff (71% of eligible staff) over 146 group sessions. Primary outcome data were available for 630 GtACH participants and 712 control participants. The primary outcome result showed an unadjusted incidence rate ratio of 0.57 (95% CI 0.45 to 0.71; p < 0.01) in favour of the GtACH programme. Falls rates were lower in the GtACH arm in the period 0-90 days. There were no other differences between arms in the secondary outcomes. Care home staff valued the training, systematic strategies and specialist peer support, but the incorporation of the GtACH programme documentation into routine care home practice was limited. No adverse events were recorded. The incremental cost was £20,889.42 per Dementia Specific Quality of Life-based quality-adjusted life-year and £4543.69 per quality-adjusted life-year based on the EuroQol-5 dimensions, five-level version. The mean number of falls was 1.889 (standard deviation 3.662) in the GtACH arm and 2.747 (standard deviation 7.414) in the control arm. Therefore, 0.858 falls were averted. The base-case incremental cost per fall averted was £190.62. CONCLUSION The GtACH programme significantly reduced the falls rate in the study care homes without restricting residents' activity levels or increasing their dependency, and was cost-effective at current thresholds in the NHS. FUTURE WORK Future work should include a broad implementation programme, focusing on scale and sustainability of the GtACH programme. LIMITATIONS A key limitation was the fact that care home staff were not blinded, although risk was small because of the UK statutory requirement to record falls in care homes. TRIAL REGISTRATION This trial is registered as ISRCTN34353836. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Philippa A Logan
- School of Medicine, University of Nottingham, Nottingham, UK
- Community Rehabilitation Team, Nottingham CityCare Partnership, Nottingham, UK
- National Institute for Health Research Applied Research Collaboration East Midlands, Leicester General Hospital, Leicester, UK
- National Institute for Health Research Nottingham Biomedical Research Centre, Queen's Medical Centre, Nottingham, UK
| | - Jane C Horne
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Frances Allen
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Allan B Clark
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Simon Conroy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Janet Darby
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Chris Fox
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - John Rf Gladman
- School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health Research Applied Research Collaboration East Midlands, Leicester General Hospital, Leicester, UK
- National Institute for Health Research Nottingham Biomedical Research Centre, Queen's Medical Centre, Nottingham, UK
- Health Care of the Elderly Directorate, Nottingham University Hospitals, Nottingham, UK
| | - Maureen Godfrey
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health Research Applied Research Collaboration East Midlands, Leicester General Hospital, Leicester, UK
- National Institute for Health Research Nottingham Biomedical Research Centre, Queen's Medical Centre, Nottingham, UK
- Medical School, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Lisa Irvine
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Karen McCartney
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Gail Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Kate Robertson
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Katie Robinson
- School of Medicine, University of Nottingham, Nottingham, UK
- Health Care of the Elderly Directorate, Nottingham University Hospitals, Nottingham, UK
| | - Tracey H Sach
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Susan Stirling
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Erika J Sims
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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12
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Bath PM, Skinner CJC, Bath CS, Woodhouse LJ, Korovesi AAK, Long H, Havard D, Coleman CM, England TJ, Leyland V, Lim WS, Montgomery AA, Royal S, Avery A, Webb AJ, Gordon AL. Dietary nitrate supplementation for preventing and reducing the severity of winter infections, including COVID-19, in care homes (BEET-Winter): a randomised placebo-controlled feasibility trial. Eur Geriatr Med 2022; 13:1343-1355. [PMID: 36385690 PMCID: PMC9668238 DOI: 10.1007/s41999-022-00714-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Infections cause considerable care home morbidity and mortality. Nitric oxide (NO) has broad-spectrum anti-viral, bacterial and yeast activity in vitro. We assessed the feasibility of supplementing dietary nitrate (NO substrate) intake in care home residents. METHODS We performed a cluster-randomised placebo-controlled trial in UK residential and nursing care home residents and compared nitrate containing (400 mg) versus free (0 mg daily) beetroot juice given for 60 days. Outcomes comprised feasibility of recruitment, adherence, salivary and urinary nitrate, and ordinal infection/clinical events. RESULTS Of 30 targeted care homes in late 2020, 16 expressed interest and only 6 participated. 49 residents were recruited (median 8 [interquartile range 7-12] per home), mean (standard deviation) age 82 (8) years, with proxy consent 41 (84%), advance directive for hospital non-admission 8 (16%) and ≥ 1 doses of COVID-19 vaccine 37 (82%). Background dietary nitrate was < 30% of acceptable daily intake. 34 (76%) residents received > 50% of juice. Residents randomised to nitrate vs placebo had higher urinary nitrate levels, median 50 [18-175] v 18 [10-50] mg/L, difference 25 [0-90]. Data paucity precluded clinical between-group comparisons; the outcome distribution was as follows: no infection 32 (67%), uncomplicated infection 0, infection requiring healthcare support 11 (23%), all-cause hospitalisation 5 (10%), all-cause mortality 0. Urinary tract infections were most common. CONCLUSIONS Recruiting UK care homes during the COVID-19 pandemic was partially successful. Supplemented dietary nitrate was tolerated and elevated urinary nitrate. Together, infections, hospitalisations and deaths occurred in 33% of residents over 60 days. A larger trial is now required. TRIAL REGISTRATION ISRCTN51124684. Application date 7/12/2020; assignment date 13/1/2021.
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Affiliation(s)
- Philip M. Bath
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, South Block D Floor, Nottingham, NG7 2UH UK ,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH Nottinghamshire UK
| | - Cameron J. C. Skinner
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, South Block D Floor, Nottingham, NG7 2UH UK
| | - Charlotte S. Bath
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, South Block D Floor, Nottingham, NG7 2UH UK
| | - Lisa J. Woodhouse
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, South Block D Floor, Nottingham, NG7 2UH UK
| | | | - Hongjiang Long
- School of Biosciences, University of Nottingham, Sutton Bonington, LE12 5RD UK
| | - Diane Havard
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, South Block D Floor, Nottingham, NG7 2UH UK
| | - Christopher M. Coleman
- Division of Infection, Immunity and Microbes, School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH UK
| | - Timothy J. England
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, South Block D Floor, Nottingham, NG7 2UH UK ,Department of Stroke, University Hospitals of Derby and Burton, Derby, DE22 3NE UK
| | | | - Wei Shen Lim
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB UK
| | - Alan A. Montgomery
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Simon Royal
- University of Nottingham Health Service, Cripps Health Centre, University Park, Nottingham, NG7 2QW UK
| | - Amanda Avery
- School of Biosciences, University of Nottingham, Sutton Bonington, LE12 5RD UK
| | - Andrew J. Webb
- Clinical Pharmacology, School of Cardiovascular Medicine and Sciences, Kings College London and British Heart Foundation Centre of Research Excellence, St Thomas’ Hospital, London, SE1 7EH UK
| | - Adam L. Gordon
- Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Derby, DE22 3NE Derbyshire UK ,NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK
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13
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Logan PA, Horne JC, Gladman JRF, Gordon AL, Sach T, Clark A, Robinson K, Armstrong S, Stirling S, Leighton P, Darby J, Allen F, Irvine L, Wilson ECF, Fox C, Conroy S, Mountain G, McCartney K, Godfrey M, Sims E. Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation. BMJ 2021; 375:e066991. [PMID: 34876412 PMCID: PMC8649897 DOI: 10.1136/bmj-2021-066991] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine the clinical and cost effectiveness of a multifactorial fall prevention programme compared with usual care in long term care homes. DESIGN Multicentre, parallel, cluster randomised controlled trial. SETTING Long term care homes in the UK, registered to care for older people or those with dementia. PARTICIPANTS 1657 consenting residents and 84 care homes. 39 were randomised to the intervention group and 45 were randomised to usual care. INTERVENTIONS Guide to Action for Care Homes (GtACH): a multifactorial fall prevention programme or usual care. MAIN OUTCOME MEASURES Primary outcome measure was fall rate at 91-180 days after randomisation. The economic evaluation measured health related quality of life using quality adjusted life years (QALYs) derived from the five domain five level version of the EuroQoL index (EQ-5D-5L) or proxy version (EQ-5D-5L-P) and the Dementia Quality of Life utility measure (DEMQOL-U), which were self-completed by competent residents and by a care home staff member proxy (DEMQOL-P-U) for all residents (in case the ability to complete changed during the study) until 12 months after randomisation. Secondary outcome measures were falls at 1-90, 181-270, and 271-360 days after randomisation, Barthel index score, and the Physical Activity Measure-Residential Care Homes (PAM-RC) score at 91, 180, 270, and 360 days after randomisation. RESULTS Mean age of residents was 85 years. 32% were men. GtACH training was delivered to 1051/1480 staff (71%). Primary outcome data were available for 630 participants in the GtACH group and 712 in the usual care group. The unadjusted incidence rate ratio for falls between 91 and 180 days was 0.57 (95% confidence interval 0.45 to 0.71, P<0.001) in favour of the GtACH programme (GtACH: six falls/1000 residents v usual care: 10 falls/1000). Barthel activities of daily living indices and PAM-RC scores were similar between groups at all time points. The incremental cost was £108 (95% confidence interval -£271.06 to 487.58), incremental QALYs gained for EQ-5D-5L-P was 0.024 (95% confidence interval 0.004 to 0.044) and for DEMQOL-P-U was 0.005 (-0.019 to 0.03). The incremental costs per EQ-5D-5L-P and DEMQOL-P-U based QALY were £4544 and £20 889, respectively. CONCLUSIONS The GtACH programme was associated with a reduction in fall rate and cost effectiveness, without a decrease in activity or increase in dependency. TRIAL REGISTRATION ISRCTN34353836.
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Affiliation(s)
- Pip A Logan
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
- Nottingham CityCare Partnership, Nottingham, UK
- NIHR Applied Research Collaboration - East Midlands, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Jane C Horne
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - John R F Gladman
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
- NIHR Applied Research Collaboration - East Midlands, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Adam L Gordon
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
- NIHR Applied Research Collaboration - East Midlands, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Tracey Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Katie Robinson
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sarah Armstrong
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Sue Stirling
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Paul Leighton
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Janet Darby
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Fran Allen
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | | | - Ed C F Wilson
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Chris Fox
- Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | - Karen McCartney
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | | | - Erika Sims
- Norwich Medical School, University of East Anglia, Norwich, UK
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Rommerskirch-Manietta M, Braunwarth JI, Quasdorf T, Manietta C, Rodrigues-Recchia D, Reuther S, Rossmann C, Acet S, Roes M. Organizational Capacity Building in Nursing Facilities to Promote Resident Mobility: A Systematic Review. J Am Med Dir Assoc 2021; 22:2408-2424.e12. [PMID: 34653383 DOI: 10.1016/j.jamda.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/10/2021] [Accepted: 09/18/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The objective of the present systematic review was to investigate the effects of organizational capacity building interventions on the environment, nursing staff capacity, and mobility of residents in nursing facilities. DESIGN Systematic review. SETTING AND PARTICIPANTS Nursing facilities, staff, and residents. METHODS We conducted a systematic review according to the methods of the Cochrane Collaboration. The systematic review was prospectively registered in the PROSPERO database of systematic reviews (registration number CRD42020202996). We searched for studies in MEDLINE (via PubMed), CINAHL (via EBSCO), the Physiotherapy Evidence Database (PEDro), and the Cochrane Library (07/20). A narrative synthesis was conducted because of the high heterogeneity of the included studies. RESULTS We identified 6747 records and included 14 studies in our review. We clustered the 14 interventions into 3 different categories (environmental modification, nursing staff capacity, and multifactorial interventions). Three studies assessed outcomes at the nursing staff level, and all studies reported outcomes at the resident level. We found highly heterogeneous and inconsistent effects of organizational capacity building on increasing nursing staff capacity and/or resident mobility. CONCLUSIONS AND IMPLICATIONS The findings emphasize the need for further research focusing on an international understanding and definition of organizational capacity building. Additionally, research and intervention development for organizational capacity building interventions to promote resident mobility are needed while applying the framework of the Medical Research Council. Furthermore, studies should assess outcomes regarding the environment and nursing staff to better understand if and how environmental structures and nursing staff capacity effect resident mobility.
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Affiliation(s)
- Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, North Rhine-Westphalia, Germany; Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, North Rhine-Westphalia, Germany.
| | - Jana Isabelle Braunwarth
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, North Rhine-Westphalia, Germany; Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, North Rhine-Westphalia, Germany
| | - Tina Quasdorf
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, North Rhine-Westphalia, Germany; Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, North Rhine-Westphalia, Germany
| | - Christina Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, North Rhine-Westphalia, Germany; Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, North Rhine-Westphalia, Germany
| | - Daniela Rodrigues-Recchia
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, North Rhine-Westphalia, Germany; Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, North Rhine-Westphalia, Germany
| | - Sven Reuther
- Städtische Seniorenheime Krefeld, Department Organization and Development, Krefeld, North Rhine-Westphalia, Germany
| | - Christin Rossmann
- Federal Centre for Health Education (BZgA), Köln, North Rhine-Westphalia, Germany
| | - Sule Acet
- Federal Centre for Health Education (BZgA), Köln, North Rhine-Westphalia, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, North Rhine-Westphalia, Germany; Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, North Rhine-Westphalia, Germany
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15
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Buck D, Tucker S, Roe B, Hughes J, Challis D. Hospital admissions and place of death of residents of care homes receiving specialist healthcare services: A systematic review without meta-analysis. J Adv Nurs 2021; 78:666-697. [PMID: 34532884 DOI: 10.1111/jan.15043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 08/09/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
AIM To synthesize evidence on the ability of specialist care home support services to prevent hospital admission of older care home residents, including at end of life. DESIGN Systematic review, without meta-analysis, with vote counting based on direction of effect. DATA SOURCES Fourteen electronic databases were searched from January 2010 to January 2019. Reference lists of identified reviews, study protocols and included documents were scrutinized for further studies. REVIEW METHODS Papers on the provision of specialist care home support that addressed older, long-term care home residents' physical health needs and provided comparative data on hospital admissions were included. Two reviewers undertook study selection and quality appraisal independently. Vote counting by direction of effect and binomial tests determined service effectiveness. RESULTS Electronic searches identified 79 relevant references. Combined with 19 citations from an earlier review, this gave 98 individual references relating to 92 studies. Most were from the UK (22), USA (22) and Australia (19). Twenty studies were randomized controlled trials and six clinical controlled trials. The review suggested interventions addressing residents' general health needs (p < .001), assessment and management services (p < .0001) and non-training initiatives involving medical staff (p < .0001) can reduce hospital admissions, while there was also promising evidence for services targeting residents at imminent risk of hospital entry or post-hospital discharge and training-only initiatives. End-of-life care services may enable residents to remain in the home at end of life (p < .001), but the high number of weak-rated studies undermined confidence in this result. CONCLUSION This review suggests specialist care home support services can reduce hospital admissions. More robust studies of services for residents at end of life are urgently needed. IMPACT The review addressed the policy imperative to reduce the avoidable hospital admission of older care home residents and provides important evidence to inform service design. The findings are of relevance to commissioners, providers and residents.
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Affiliation(s)
- Deborah Buck
- Social Care and Society, University of Manchester, Manchester, UK
| | - Sue Tucker
- Social Care and Society, University of Manchester, Manchester, UK
| | - Brenda Roe
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Jane Hughes
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - David Challis
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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16
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Baixinho CL, Dixe MDA, Henriques MA, Marques-Vieira C, Sousa L. The fear of falls in the caregivers of institutionalized elders. ACTA ACUST UNITED AC 2021; 42:e20200258. [PMID: 34287601 DOI: 10.1590/1983-1447.2021.20200258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/11/2020] [Indexed: 11/21/2022]
Abstract
AIMS To understand how the fear of falls emerges and manifests itself in caregivers of institutionalized elders. METHOD It is a qualitative study, based on the Grounded Theory and carried out with 24 informal caregivers, 5 nurses, 2 physicians and 2 directors of two Portuguese nursing homes. Data collection took place through interviews, participant observation, and documentation analysis, between October 2016 and January 2018. Data was collected and analyzed simultaneously, following the stages of open, axial, and selective coding. RESULTS The comparative analysis of the findings identified the conceptual category "Fear of falls in the caregivers of institutionalized elders". The main category is associated with the categories: maintaining safety, hidden fear of falls, the perceived self-efficacy in the prevention of falls, falls and interpersonal relations, previous experiences, and team support. CONCLUSIONS The fear has an influence on the self-efficacy perceived in the prevention of falls; the quality of the teamwork, in turn, is affected by previous negative experiences and by the support of the team.
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Affiliation(s)
- Cristina Lavareda Baixinho
- Escola Superior de Enfermagem de Lisboa (ESEL), Lisboa, Portugal.,Politécnico de Leiria, Escola Superior de Saúde, Center for Innovative Care and Health Technology. Leiria, Portugal
| | - Maria Dos Anjos Dixe
- Politécnico de Leiria, Escola Superior de Saúde, Center for Innovative Care and Health Technology. Leiria, Portugal.,Politécnico de Leiria. Leiria, Portugal
| | - Maria Adriana Henriques
- Escola Superior de Enfermagem de Lisboa (ESEL), Lisboa, Portugal.,Politécnico de Leiria, Escola Superior de Saúde, Center for Innovative Care and Health Technology. Leiria, Portugal
| | - Cristina Marques-Vieira
- Universidade Católica Portuguesa (UCP), Instituto de Ciências da Saúde, Centro de Investigação Interdisciplinar em Saúde. Lisboa, Portugal
| | - Luis Sousa
- Universidade de Évora, Comprehensive Health Research Centre. Évora, Portugal
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17
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Naccarato A, Wilson CM, Arena SK. Perceptions of Rehabilitation Managers on Implementation of the Home-Based Older Person Upstreaming Prevention (HOP-UP) Program: A Retrospective Qualitative Analysis. Cureus 2021; 13:e14760. [PMID: 34084684 PMCID: PMC8164443 DOI: 10.7759/cureus.14760] [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] [Indexed: 11/19/2022] Open
Abstract
Introduction The purpose of this study was to identify themes and concepts derived from responses of physical therapy clinical leaders related to implementing a prevention-focused, home-based older-adult program known as HOP-UP-PT (Home-Based Older Person Upstreaming Prevention Physical Therapy) into their clinical operations. Methods Following Institutional Review Board approval, a retrospective qualitative analysis of transcribed interviews obtained by six undergraduate students participating in the Oakland University Ideas to Business Program (I2B) was conducted. Students interviewed nine local physical therapy clinical managers throughout Michigan using 12 questions developed by content experts. Questions aimed to ascertain the perceived opportunities and barriers to implementing HOP-UP-PT into each respondent's practice setting, clinic demographics, and suggested price point of a prevention-focused continuing education. Interview data was analyzed using the constant comparative method to identify themes and concepts. Results Sixty-seven percent of respondents (n=6) reported practicing in an outpatient setting; 56% of respondents (n=5) indicated 50% or more of their clients were 65 years and older; and 67% of respondents (n=6) suggested a price point of $200-$500 for an eight-hour HOP-UP-PT training course. Three concepts (community involvement and partnership, administrative barriers to an innovative delivery model, and foundational physical therapy [PT] skills utilized in a novel approach) and eight themes (community altruism, referral source expansion, integrated community relationships, current payment methodology challenges, favorability of clinic setting and type, minimal additional training required, willingness to pay for certification training, and prevention-focused or upstream mindset) were identified. Conclusion Physical therapy clinical managers identified a willingness to expand current rehabilitation models and incorporate prevention-focused care delivery into the existing care delivery approach. However, barriers and opportunities must be addressed in advance of a program roll-out to achieve optimal outcomes and cost savings within the healthcare system.
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Affiliation(s)
| | - Christopher M Wilson
- Rehabilitation Services, Beaumont Health, Troy, USA.,Physical Therapy, Oakland University, Rochester, USA
| | - Sara K Arena
- Physical Therapy, Oakland University, Rochester, USA
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18
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Baixinho CL, Dixe MDA. Practices of caregivers when evaluating the risk of falls in the admission of older adults to nursing homes. Dement Neuropsychol 2020; 14:379-386. [PMID: 33354291 PMCID: PMC7735058 DOI: 10.1590/1980-57642020dn14-040008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Falls are a complex problem for the older population residing in nursing homes. Despite recommendations, many difficulties remain in the evaluation of and systematic information on fall risk factors.
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Affiliation(s)
- Cristina Lavareda Baixinho
- Nursing School of Lisbon, Nursing Research & Development Unit - Lisbon, Portugal.,Center for Innovative Care and Health Technology (ciTechcare) - Leiria, Portugal
| | - Maria Dos Anjos Dixe
- Center for Innovative Care and Health Technology (ciTechcare) - Leiria, Portugal.,Health School, Polytechnic of Leiria - Leiria, Portugal
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19
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Izza MAD, Lunt E, Gordon AL, Gladman JRF, Armstrong S, Logan P. Polypharmacy, benzodiazepines, and antidepressants, but not antipsychotics, are associated with increased falls risk in UK care home residents: a prospective multi-centre study. Eur Geriatr Med 2020; 11:1043-1050. [PMID: 32813154 PMCID: PMC7716922 DOI: 10.1007/s41999-020-00376-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/30/2020] [Indexed: 12/18/2022]
Abstract
Aim
To explore the link between polypharmacy, psychotropic medications, and falls risk in a cohort of UK care home residents. Findings
Polypharmacy and psychotropic drugs are predictive of falls in UK care home residents. Message Deprescribing interventions relating to psychotropic drugs should continue to be encouraged. Purpose Falls and polypharmacy are both common in care home residents. Deprescribing of medications in residents with increased falls risk is encouraged. Psychotropic medications are known to increase falls risk in older adults. These drugs are often used in care home residents for depression, anxiety, and behavioural and psychological symptoms of dementia. However, a few studies have explored the link between polypharmacy, psychotropic medications, and falls risk in care home residents. Methods This was a prospective cohort study of residents from 84 UK care homes. Data were collected from residents’ care records and medication administration records. Age, diagnoses, gender, number of medications, and number of psychotropic medications were collected at baseline and residents were monitored over three months for occurrence of falls. Logistic regression models were used to assess the effect of multiple medications and psychotropic medication on falls whilst adjusting for confounders. Results Of the 1655 participants, mean age 85 (SD 8.9) years, 67.9% female, 519 (31%) fell in 3 months. Both the total number of regular drugs prescribed and taking ≥ 1 regular psychotropic medication were independent risk factors for falling (adjusted odds ratio (OR) 1.06 (95% CI 1.03–1.09, p < 0.01) and 1.39 (95% CI 1.10–1.76, p < 0.01), respectively). The risk of falls was higher in those taking antidepressants (p < 0.01) and benzodiazepines (p < 0.01) but not antipsychotics (p > 0.05). Conclusion In UK care homes, number of medications and psychotropic medications (particularly antidepressants and benzodiazepines) predicted falls. This information can be used to inform prescribing and deprescribing decisions.
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Affiliation(s)
| | - Eleanor Lunt
- School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre - Musculoskeletal Theme, Nottingham, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre - Musculoskeletal Theme, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - John R F Gladman
- School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre - Musculoskeletal Theme, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - Sarah Armstrong
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre - Musculoskeletal Theme, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK.,Nottingham CityCare Partnership, Nottingham, UK
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20
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Gulka HJ, Patel V, Arora T, McArthur C, Iaboni A. Efficacy and Generalizability of Falls Prevention Interventions in Nursing Homes: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2020; 21:1024-1035.e4. [DOI: 10.1016/j.jamda.2019.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 11/28/2022]
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21
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Alipour N, Dastoorpour M, Araban M. Effect of Educational Intervention on Fear of Falling in the Elderly People: A Randomized Cluster Trial. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2020. [DOI: 10.29252/jech.7.3.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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22
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Robinson KR, Jones K, Balmbra J, Robertson K, Horne J, Logan PA. Developing the React to Falls resources to support care home staff in managing falls. J Frailty Sarcopenia Falls 2019; 4:1-10. [PMID: 32300710 PMCID: PMC7155373 DOI: 10.22540/jfsf-04-001] [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] [Accepted: 02/21/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives: Care home residents are falling three times more often than elderly frail people living in their own homes and as such, the management of falls is an important area for care home staff to consider. This paper outlines the development of the ‘React to Falls’ training resources to support care home staff in the management of falls. Methods: The ‘React to Falls’ resources were developed in collaboration with falls prevention researchers, expert clinicians working in the field of falls management in care homes and care home staff and residents. Results: A freely accessible online and paper based resource was developed to meet the needs of different care home settings. Expert clinicians and care homes emphasised the importance of promoting activity and quality life and ensuring the resources were a learning tool that supported positive risk taking. Expert clinicians highlighted the need to convey the importance of continually reacting to reducing risk in the management of falls. Conclusions: This study has developed a set of training resources on falls management to support care home staff to continually react and consider the risks and management of falls. An evaluation of the impact of the resource on care staff behaviour and organisational changes is recommended.
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Affiliation(s)
| | | | - Jane Balmbra
- Nottinghamshire Healthcare NHS Foundation Trust, UK
| | - Kate Robertson
- Division of Rehabilitation, Ageing and Wellbeing, Medical School, University of Nottingham, UK
| | - Jane Horne
- Division of Rehabilitation, Ageing and Wellbeing, Medical School, University of Nottingham, UK
| | - Philippa Anne Logan
- Division of Rehabilitation, Ageing and Wellbeing, Medical School, University of Nottingham, UK.,Nottingham CityCare Partnership, UK
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23
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Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2018; 9:CD005465. [PMID: 30191554 PMCID: PMC6148705 DOI: 10.1002/14651858.cd005465.pub4] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012. OBJECTIVES To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017. SELECTION CRITERIA Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals. DATA COLLECTION AND ANALYSIS One review author screened abstracts; two review authors screened full-text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence. MAIN RESULTS Thirty-five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low-quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.Care facilitiesSeventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low-quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low-quality evidence).There is low-quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%).There is moderate-quality evidence that vitamin D supplementation (4512 participants, 4 studies) probably reduces the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; I² = 62%), but probably makes little or no difference to the risk of falling (RR 0.92, 95% CI 0.76 to 1.12; I² = 42%). The population included in these studies had low vitamin D levels.Multifactorial interventions were tested in 13 trials. We are uncertain of the effect of multifactorial interventions on the rate of falls (RaR 0.88, 95% CI 0.66 to 1.18; 3439 participants, 10 studies; I² = 84%; very low-quality evidence). They may make little or no difference to the risk of falling (RR 0.92, 95% CI 0.81 to 1.05; 3153 participants, 9 studies; I² = 42%; low-quality evidence).HospitalsThree trials tested the effect of additional physiotherapy (supervised exercises) in rehabilitation wards (subacute setting). The very low-quality evidence means we are uncertain of the effect of additional physiotherapy on the rate of falls (RaR 0.59, 95% CI 0.26 to 1.34; 215 participants, 2 studies; I² = 0%), or whether it reduces the risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 83 participants, 2 studies; I² = 0%).We are uncertain of the effects of bed and chair sensor alarms in hospitals, tested in two trials (28,649 participants) on rate of falls (RaR 0.60, 95% CI 0.27 to 1.34; I² = 0%; very low-quality evidence) or risk of falling (RR 0.93, 95% CI 0.38 to 2.24; I² = 0%; very low-quality evidence).Multifactorial interventions in hospitals may reduce rate of falls in hospitals (RaR 0.80, 95% CI 0.64 to 1.01; 44,664 participants, 5 studies; I² = 52%). A subgroup analysis by setting suggests the reduction may be more likely in a subacute setting (RaR 0.67, 95% CI 0.54 to 0.83; 3747 participants, 2 studies; I² = 0%; low-quality evidence). We are uncertain of the effect of multifactorial interventions on the risk of falling (RR 0.82, 95% CI 0.62 to 1.09; 39,889 participants; 3 studies; I² = 0%; very low-quality evidence). AUTHORS' CONCLUSIONS In care facilities: we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. We are uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.In hospitals: we are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. We are uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; we are uncertain of the effect of these interventions on risk of falling.
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Affiliation(s)
- Ian D Cameron
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Suzanne M Dyer
- DHATR Consulting120 Robsart StreetParksideSouth AustraliaAustralia5063
| | - Claire E Panagoda
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health DistrictSt LeonardsNSWAustralia2065
| | - Geoffrey R Murray
- Illawarra Shoalhaven Local Health DistrictAged Care, Rehabilitation and Palliative CareWarrawongAustralia
| | - Keith D Hill
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesGPO Box U1987PerthWestern AustraliaAustralia6845
| | - Robert G Cumming
- Sydney Medical School, University of SydneySchool of Public HealthRoom 306, Edward Ford Building (A27)Fisher RoadSydneyNSWAustralia2006
| | - Ngaire Kerse
- University of AucklandDepartment of General Practice and Primary Health CarePrivate Bag 92019AucklandNew Zealand
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Evans EA, Perkins E, Clarke P, Haines A, Baldwin A, Whittington R. Care home manager attitudes to balancing risk and autonomy for residents with dementia. Aging Ment Health 2018; 22:261-269. [PMID: 27768393 DOI: 10.1080/13607863.2016.1244803] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine how care home managers negotiate the conflict between maintaining a safe environment while enabling the autonomy of residents with dementia. This is important because there is limited research with care home managers; yet, they are key agents in the implementation of national policies. METHOD Semi-structured interviews were conducted with 18 managers from care homes offering dementia care in the Northwest of England. Data were analysed using a thematic analysis approach. RESULTS There were three areas in which care home staff reported balancing safety and risk against the individual needs of residents. First, the physical environment created a tension between safety and accessibility to the outside world, which meant that care homes provided highly structured or limited access to outdoor space. Second, care home managers reflected a balancing act between an individual's autonomy and the need to protect their residents' dignity. Finally, care home managers highlighted the ways in which an individual's needs were framed by the needs of other residents to the extent that on some occasions an individual's needs were subjugated to the needs of the general population of a home. CONCLUSION There was a strong, even dominant, ethos of risk management and keeping people safe. Managing individual needs while maintaining a safe care home environment clearly is a constant dynamic interpersonal process of negotiating and balancing competing interests for care home managers.
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Affiliation(s)
- Elizabeth A Evans
- a Department of Health Services Research, Health & Community Care Research Unit (HaCCRU), Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | - Elizabeth Perkins
- a Department of Health Services Research, Health & Community Care Research Unit (HaCCRU), Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | - Pam Clarke
- a Department of Health Services Research, Health & Community Care Research Unit (HaCCRU), Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | - Alina Haines
- a Department of Health Services Research, Health & Community Care Research Unit (HaCCRU), Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | | | - Richard Whittington
- a Department of Health Services Research, Health & Community Care Research Unit (HaCCRU), Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK.,c Broset Centre for Research & Education in Forensic Psychiatry, St. Olav's Hospital , Trondheim , Norway
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25
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Wylie G, Menz HB, McFarlane S, Ogston S, Sullivan F, Williams B, Young Z, Morris J. Podiatry intervention versus usual care to prevent falls in care homes: pilot randomised controlled trial (the PIRFECT study). BMC Geriatr 2017; 17:143. [PMID: 28701161 PMCID: PMC5508629 DOI: 10.1186/s12877-017-0541-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/06/2017] [Indexed: 12/02/2022] Open
Abstract
Background Common foot problems are independent risk factors for falls in older people. There is evidence that podiatry can prevent falls in community-dwelling populations. The feasibility of implementing a podiatry intervention and trial in the care home population is unknown. To inform a potential future definitive trial, we performed a pilot randomised controlled trial to assess: (i) the feasibility of a trial of a podiatry intervention to reduce care home falls, and (ii) the potential direction and magnitude of the effect of the intervention in terms of number of falls in care home residents. Methods Informed by Medical Research Council guidance on developing and evaluating complex interventions, we conducted a single blind, pilot randomised controlled trial in six care homes in the East of Scotland. Participants were randomised to either: (i) a three month podiatry intervention comprising core podiatry care, foot and ankle exercises, orthoses and footwear provision or (ii) usual care. Falls-related outcomes (number of falls, time to first fall) and feasibility-related outcomes (recruitment, retention, adherence, data collection rates) were collected. Secondary outcomes included: generic health status, balance, mobility, falls efficacy, and ankle joint strength. Results 474 care home residents were screened. 43 (9.1%) participants were recruited: 23 to the intervention, 20 to control. Nine (21%) participants were lost to follow-up due to declining health or death. It was feasible to deliver the trial elements in the care home setting. 35% of participants completed the exercise programme. 48% reported using the orthoses ‘all or most of the time’. Completion rates of the outcome measures were between 93% and 100%. No adverse events were reported. At the nine month follow-up period, the intervention group per-person fall rate was 0.77 falls vs. 0.83 falls in the control group. Conclusions A podiatry intervention to reduce falls can be delivered to care home residents within a pilot randomised controlled trial of the intervention. Although not powered to determine effectiveness, these preliminary data provide justification for a larger trial, incorporating a full process evaluation, to determine whether this intervention can significantly reduce falls in this high-risk population. Trial registration ClinicalTrials.gov identifier: NCT02178527; Date of registration: 17 June 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0541-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gavin Wylie
- NHS Tayside, Ageing and Health, and School of Nursing & Health Sciences, University of Dundee, Dundee, UK.
| | - Hylton B Menz
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Victoria, Australia
| | - Sarah McFarlane
- NHS Tayside and Nursing & Midwifery Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Simon Ogston
- School of Medicine, University of Dundee, Dundee, UK
| | - Frank Sullivan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Brian Williams
- School of Health and Social Care, Napier University, Edinburgh, UK
| | | | - Jacqui Morris
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
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