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Somerville E, Yan Y, Stark S. A Process Evaluation of a Fall Prevention Intervention Using the RE-AIM Framework. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:278-286. [PMID: 37401744 DOI: 10.1177/15394492231182398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Home hazard removal programs are effective in reducing falls among older adults, but delivery in the United States is limited. OBJECTIVES We completed a process evaluation of the Home Hazard Removal Program (HARP), an intervention delivered by occupational therapists. METHODS Using the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), we examined outcomes using descriptive statistics and frequency distribution. We examined differences between covariates using Pearson correlation coefficients and two-sample t tests. RESULTS 79.1% of eligible older adults participated (reach); they experienced a 38% reduction in fall rates (effectiveness). Ninety percent of recommended strategies were completed (adoption), 99% of intervention elements were delivered (implementation), and 91% of strategies were still used at 12 months (maintenance). Participants received an average of 258.6 minutes of occupational therapy. An average of US$765.83 was spent per participant to deliver the intervention. CONCLUSIONS HARP has good reach, effectiveness, adherence, implementation, and maintenance and is a low-cost intervention.
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Affiliation(s)
| | - Yan Yan
- Washington University in St. Louis, MO, USA
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2
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Krauss MJ, Somerville E, Bollinger RM, Chen SW, Kehrer-Dunlap AL, Haxton M, Yan Y, Stark SL. Removing home hazards for older adults living in affordable housing: A stepped-wedge cluster-randomized trial. J Am Geriatr Soc 2024; 72:670-681. [PMID: 38103187 PMCID: PMC10947940 DOI: 10.1111/jgs.18706] [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: 06/13/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Falls are the leading cause of injury, disability, premature institutionalization, and injury-related mortality among older adults. Home hazard removal can effectively reduce falls in this population but is not implemented as standard practice. This study translated an evidence-based home hazard removal program (HARP) for delivery in low-income senior apartments to test whether the intervention would work in the "real world." METHODS From May 1, 2019 to December 31, 2020, a stepped-wedge cluster-randomized trial was used to implement the evidence-based HARP among residents with high fall risk in 11 low-income senior apartment buildings. Five clusters of buildings were randomly assigned an intervention allocation sequence. Three-level negative-binomial models (repeated measures nested within individuals, individuals nested within buildings) were used to compare fall rates between treatment and control conditions (excluding a crossover period), controlling for demographic characteristics, fall risk, and time period. RESULTS Among 656 residents, 548 agreed to screening, 435 were eligible (high fall risk), and 291 agreed to participate and received HARP. Participants were, on average, 72 years, 67% female, and 76% Black. Approximately 95.4% of fall prevention strategies and modifications implemented were still used 3 months later. The fall rate (per 1000 participant-days) was 4.87 during the control period and 4.31 during the posttreatment period. After adjusting for covariates and secular trend, there was no significant difference in fall rate (incidence rate ratio [IRR] 0.97, 95% CI 0.66-1.42). After excluding data collected during a hiatus in the intervention due to COVID-19, the reduction in fall rate was not significant (IRR 0.93, 95% CI 0.62-1.40). CONCLUSIONS Although HARP did not significantly reduce the rate of falls, this pragmatic study showed that the program was feasible to deliver in low-income senior housing and was acceptable among residents. There was effective collaboration between researchers and community agency staff.
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Affiliation(s)
- Melissa J Krauss
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Emily Somerville
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Rebecca M Bollinger
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Szu-Wei Chen
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Abigail L Kehrer-Dunlap
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Meghan Haxton
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Susan L Stark
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Kehrer-Dunlap AL, Bollinger RM, Holden B, Ances BM, Stark S. Examining the impact of a health report card on follow through with fall risk recommendations: an observational study. BMC Geriatr 2024; 24:166. [PMID: 38365585 PMCID: PMC10873987 DOI: 10.1186/s12877-024-04686-y] [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: 05/15/2023] [Accepted: 01/09/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Increasing older adults' awareness of their personal fall risk factors may increase their engagement in fall prevention. The purpose of this study was to explore the impact of and participant satisfaction with a comprehensive occupational therapy fall risk screening and recommendations for evidence-based fall prevention strategies based on personalized fall risk results for community-dwelling older adults. METHODS Cognitively normal participants (Clinical Dementia Rating = 0) were recruited from an ongoing longitudinal study of memory and aging. Participants completed 2 annual in-home visits, fall risk questionnaires, and 12 months of fall monitoring between visits. Participants received a health report card with their fall risks and tailored recommendations in 6 domains. Participants completed follow-up questions at their next annual in-home visit about the fall risk recommendations and their satisfaction with receiving their fall risk results. RESULTS Two hundred five participants completed 2 annual visits and 12 months of fall monitoring. Of the 6 domains of recommendations provided, participants were most likely to follow through with getting an annual eye exam and reviewing their medications with their doctor or pharmacist. Older adults who fell were significantly more likely to receive recommendations for finding fall prevention classes (p = 0.01) and having a doctor or pharmacist review their medications (p = 0.004). The majority of participants were satisfied receiving their fall risk results (92%) and believed it to be beneficial (90%), though few participants shared their results with their doctor (20%). CONCLUSIONS An occupational therapy fall risk screening and tailored recommendations were not sufficient to encourage follow through with fall risk recommendations. Older adults may benefit from additional support and encouragement to reduce their fall risk. Additional research is needed to examine awareness of fall risks and follow through with fall risk recommendations among community-dwelling older adults.
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Affiliation(s)
- Abigail L Kehrer-Dunlap
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Ave, 63110, St Louis, MO, Box 8505, USA
| | - Rebecca M Bollinger
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Ave, 63110, St Louis, MO, Box 8505, USA
| | - Brianna Holden
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Ave, 63110, St Louis, MO, Box 8505, USA
| | - Beau M Ances
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Susan Stark
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Ave, 63110, St Louis, MO, Box 8505, USA.
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Heller C, Haak M, Schmidt SM, Chiatti C, Ekstam L, Nilsson MH, Slaug B. The Relationship Between Physical Housing Characteristics, Housing Accessibility and Different Aspects of Health Among Community-Dwelling Older People: A Systematic Review. J Aging Health 2024; 36:120-132. [PMID: 37201208 PMCID: PMC10693737 DOI: 10.1177/08982643231175367] [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] [Indexed: 05/20/2023]
Abstract
Objectives: To synthesize the evidence on the relationships between physical housing characteristics or housing accessibility and different aspects of health among community-dwelling people 60 years and older. Methods: A systematic review of recent evidence with a narrative synthesis was conducted. Results: We included 15 studies and found three themes covering physical housing characteristics or housing accessibility that are associated with aspects of health among community-dwelling older adults: (1) interventions by home modifications targeting housing features both at entrances and indoors; (2) non-interventions targeting indoor features; (3) non-interventions targeting entrance features, that is, the presence of an elevator or stairs at the entrance. The overall quality of evidence across studies was assessed as very low. Discussion: The findings highlight the need for studies with a stronger research design and higher methodological quality that address the physical housing environment in relation to health among older adults to strengthen the body of evidence.
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Affiliation(s)
| | - Maria Haak
- Department of Nursing Education and Integrated Health Sciences, Kristianstad University, Kristianstad, Sweden
| | | | | | - Lisa Ekstam
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Maria H. Nilsson
- Department of Health Sciences, Lund University, Lund, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Björn Slaug
- Department of Health Sciences, Lund University, Lund, Sweden
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Lektip C, Chaovalit S, Wattanapisit A, Lapmanee S, Nawarat J, Yaemrattanakul W. Home hazard modification programs for reducing falls in older adults: a systematic review and meta-analysis. PeerJ 2023; 11:e15699. [PMID: 37489124 PMCID: PMC10363339 DOI: 10.7717/peerj.15699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/14/2023] [Indexed: 07/26/2023] Open
Abstract
Objective This study aims to assess the effect of home modification in preventing falls in older adults. Methods A systematic review and meta-analysis of randomized studies were performed. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered prospectively. Five electronic databases were systematically searched for related articles. The titles and abstracts of the articles found using the key search phrases-home modification and falling-were screened using inclusion and exclusion criteria. The Cochrane risk of bias tool was used to evaluate the studies' methodology. Results A total of 12 trials were included. A meta-analysis was conducted using 10 studies with n = 1, 960 participants showing a clinically meaningful 7% reduction in falls (risk ratio = 0.93; 0.87-1). Conclusions Falls can be significantly reduced with the use of home modification interventions that are thorough, well-focused, have an environmental-fit perspective, and have adequate follow-up.
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Affiliation(s)
- Charupa Lektip
- Movement Sciences and Exercise Research Center, Walailak University, Nakhon Si Thammarat, Thailand
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Sirawee Chaovalit
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Apichai Wattanapisit
- School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
- Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | - Sarawut Lapmanee
- Department of Basic Medical Sciences, Faculty of Medicine, Siam University, Bangkok, Thailand
| | - Jiraphat Nawarat
- Movement Sciences and Exercise Research Center, Walailak University, Nakhon Si Thammarat, Thailand
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Weeranan Yaemrattanakul
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Akyurek G, Bilgin N, Kocademir FN, Aslan S, Turk AB. Development of the home environment risk rating scale and investigation of the psychometric properties in the elderly and adult individuals. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-10. [PMID: 37361307 PMCID: PMC10030343 DOI: 10.1007/s10389-023-01885-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
Aim To reduce home accidents, which is one of the critical public health problems, it is necessary to evaluate the home environment first. The aim of this study was to develop the Home Environment Risk Rating Scale (HERRS) and examine its psychometric properties in elderly and adult individuals. Subject and methods This study was conducted on 220 elderly and adult individuals (63.68±10.31 years old, 68.2% female, 31.8% male) living in their homes. The participants completed the Sociodemographic Information Form, Home Environment Conditions Evaluation Form for Falls, and Home and Environment Risk Rating Scale. In addition, psychometric measurement results for horizontal and vertical measurements were analyzed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) methods. Results It was found that the Kaiser-Mayer-Olkin (KMO) value for horizontal and vertical measurements were 0.613 and 0.704, respectively. Results of EFA for horizontal and vertical measurements revealed that five factors together explain 72.033% and three factors together explain 68.368% of the total variance, respectively. The result of CFA for horizontal and vertical measurements demonstrate that the 5-sub-dimension horizontal scale structure and the 3-sub-dimension vertical measurement structure generally fit acceptable in this scale. Cronbach's alpha was satisfactory in all of the measurements (0.73 and 0.80 respectively); the ICCs were good/excellent in all of the measurements (0.99 and 0.90, respectively). Conclusion The results show that HERRS has the potential to examine the risks of the home environment adequately for the home structure of Turkish society in detail and is a valid and reliable test that health professionals can use. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-023-01885-6.
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Affiliation(s)
- Gokcen Akyurek
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Samanpazari/ Altindag, 06100 Ankara, Turkey
| | - Nurten Bilgin
- Department of Physical Therapy and Rehabilitation, Kayseri City Hospital, Kayseri, Turkey
| | | | - Sultan Aslan
- Department of Physical Therapy and Rehabilitation, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Ayşe Betul Turk
- Department of Physical Therapy and Rehabilitation, Ankara City Hospital, Ankara, Turkey
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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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Self-assessment of the home environment to plan for successful ageing: Report from a digital health co-design workshop. PLOS DIGITAL HEALTH 2022; 1:e0000069. [PMID: 36812550 PMCID: PMC9931232 DOI: 10.1371/journal.pdig.0000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/23/2022] [Indexed: 11/19/2022]
Abstract
Many middle aged and older people will need to adapt or modify their home in order to age in place. Arming older people and their families with the knowledge and tools to assess their home and plan simple modifications ahead of time will decrease reliance on professional assessment. The objective of this project was to co-design a tool which enables people to assess their own home environment and make future plans for ageing in the home. We recruited members of the public who were aged 60 or older to attend a series of two co-design workshops. Thirteen participants worked through a series of discussions and activities including appraising different types of tools available and mapping what a digital health tool might look like. Participants had a good understanding of the main types of home hazards in their own homes and the types of modifications which may be useful. Participants believed the concept of the tool would be worthwhile and identified a number of features which were important including a checklist, examples of good design which was both accessible and aesthetically pleasing and links to other resources such as websites which provide advice about to make basic home improvements. Some also wanted to share the results of their assessment with family or friends. Participants highlighted that features of the neighbourhood, such as safety and proximity to shops and cafes, were also important when considering the suitability of their home for ageing in place. Findings will be used to develop a prototype for usability testing.
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Lee MJ, Kim D, Romero S, Hong I, Bliznyuk N, Velozo C. Examining Older Adults' Home Functioning Using the American Housing Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084691. [PMID: 35457557 PMCID: PMC9032742 DOI: 10.3390/ijerph19084691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022]
Abstract
Identifying individuals at risk of experiencing functional difficulty at home would support timely home safety assessment and modification services, which could lead to reducing home incidents such as falls. The objective of this study was to calculate older adults’ functional difficulty at home scores using the 12 physical function items in the American Housing Survey National and Metropolitan Data (AHS). Among the 28,474 older adults selected for this study, we used 19,932 for measurement model development and 8542 for model testing. Confirmatory factor analysis confirmed an adequate fit of the one-dimensional model with all AHS 12 items loading on one latent construct (functional difficulty at home) (RMSEA: 0.034, CFI: 0.990, and TLI: 0.988). Based on our model selection process, we determined that the Graded Response Model was an optimal model for our analysis and separated two detected differential functioning items for each sex. Using the testing dataset, we validated that the estimated functional difficulty scores showed an expected item hierarchy and statistically significant differences in their association with housing and demographic conditions (p < 0.001). Our results demonstrated the process of using the 12 AHS physical function at home items to produce validated scores of older adults’ functional difficulty at home.
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Affiliation(s)
- Mi Jung Lee
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
- Correspondence: (M.J.L.); (I.H.)
| | - Daejin Kim
- Department of Interior Design, Iowa State University, Ames, IA 50011, USA;
| | - Sergio Romero
- Department of Occupational Therapy, University of Florida, Gainesville, FL 32610, USA;
- Veterans Rural Health Resource Center–Gainesville, Office of Rural Health, Gainesville, FL 32601, USA
| | - Ickpyo Hong
- Department of Occupational Therapy, Yonsei University, Wonju 26493, Korea
- Correspondence: (M.J.L.); (I.H.)
| | - Nikolay Bliznyuk
- Department of Agricultural and Biological Engineering, University of Florida, Gainesville, FL 32611, USA;
| | - Craig Velozo
- Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC 29425, USA;
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Fritz BA, King CR, Mehta D, Somerville E, Kronzer A, Ben Abdallah A, Wildes T, Avidan MS, Lenze EJ, Stark S. Association of a Perioperative Multicomponent Fall Prevention Intervention With Falls and Quality of Life After Elective Inpatient Surgical Procedures. JAMA Netw Open 2022; 5:e221938. [PMID: 35275166 PMCID: PMC8917421 DOI: 10.1001/jamanetworkopen.2022.1938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Importance Falls after elective inpatient surgical procedures are common and have physical, emotional, and financial consequences. Close interactions between patients and health care teams before and after surgical procedures may offer opportunities to address modifiable risk factors associated with falls. Objective To assess whether a multicomponent intervention that incorporates education, home medication review, and home safety assessment is associated with reductions in the incidence of falls after elective inpatient surgical procedures. Design, Setting, and Participants This prospective propensity score-matched cohort study was a prespecified secondary analysis of data from the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) randomized clinical trial, which was conducted at a single academic medical center between January 16, 2015, and May 7, 2018. Patients in the intervention group of the present study were enrolled in either arm of the ENGAGES clinical trial. Patients in the control group were selected from the Systematic Assessment and Targeted Improvement of Services Following Yearly Surgical Outcomes Surveys prospective observational cohort study, which created a registry of patient-reported postoperative outcomes at the same single center. The propensity score-matched cohort in the present study included 1396 patients (698 pairs) selected from a pool of 2013 eligible patients. All patients underwent elective surgical procedures with general anesthesia and had a hospital stay of 2 or more days. Data were analyzed from January 2, 2020, to January 11, 2022. Interventions The multicomponent safety intervention (offered to all patients in the ENGAGES clinical trial) included patient education on fall prevention techniques, home medication review by a geriatric psychiatrist (with communication of recommended changes to the surgeon), a self-administered home safety assessment, and targeted occupational therapy home visits with home hazard removal (offered to patients with a preoperative history of falls). Main Outcomes and Measures The primary outcome was patient-reported falls within 1 year after an elective inpatient surgical procedure. The secondary outcome was quality of life 1 year after an elective surgical procedure, which was measured using the physical and mental composite summary scores on the Veterans RAND 12-item health survey (score range, 0-100 points, with 0 indicating lowest quality of life and 100 indicating highest quality of life). Results Among 1396 patients, the median age was 69 years (IQR, 64-75 years), and 739 patients (52.9%) were male. With regard to race, 5 patients (0.4%) were Asian, 97 (6.9%) were Black or African American, 2 (0.1%) were Native Hawaiian or Pacific Islander, 1237 (88.6%) were White, 3 (0.2%) were of other race, and 52 (3.7%) were of unknown race; with regard to ethnicity, 12 patients (0.9%) were Hispanic or Latino, 1335 (95.6%) were non-Hispanic or non-Latino, and 49 (3.5%) were of unknown ethnicity. Adherence to individual intervention components was modest (from 22.9% for completion of the self-administered home safety assessment to 28.2% for implementation of the geriatric psychiatrist's recommended medication changes). Falls within 1 year after surgical procedures were reported by 228 of 698 patients (32.7%) in the intervention group and 225 of 698 patients (32.2%) in the control group. No significant difference was found in falls between the 2 groups (standardized risk difference, 0.4%; 95% CI, -4.5% to 5.3%). After adjusting for preoperative quality of life, patients in the intervention group had higher physical composite summary scores (3.8 points; 95% CI, 2.4-5.1 points) and higher mental composite summary scores (5.7 points; 95% CI, 4.7-6.7 points) at 1 year compared with patients in the control group. Conclusions and Relevance In this cohort study, a multicomponent safety intervention was not associated with reductions in falls within the first year after an elective surgical procedure; however, an increase in quality of life at 1 year was observed. These results suggest a need for other interventions, such as those designed to increase adherence, to lower the incidence of falls after surgical procedures.
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Affiliation(s)
- Bradley A. Fritz
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Christopher R. King
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Divya Mehta
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Emily Somerville
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Alex Kronzer
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Arbi Ben Abdallah
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Troy Wildes
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Michael S. Avidan
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Susan Stark
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
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Chen SW, Somerville E, Devine M, Stark S. A protocol for Removing Environmental Barriers to Independent Living (REBIL): An adapted evidence-based occupational therapy intervention to increase community participation for individuals aging with long-term physical disabilities. Br J Occup Ther 2022; 86:10.1177/03080226221126901. [PMID: 38529197 PMCID: PMC10961972 DOI: 10.1177/03080226221126901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Background People aging with long-term physical disabilities (PAwLTPD) are living longer and experiencing the challenges of aging, including the onset of secondary and age-related health conditions. PAwLTPD are at high risk of falls, fall injuries, diminished functional abilities, and compromised participation. However, no available programs support PAwLTPD to participate safely at home and in the community. The proposed study is to examine the feasibility and efficacy of an adapted intervention: Removing Environmental Barriers to Independent Living (REBIL). Method/Design A single-blinded randomized controlled trial (RCT) will be conducted. Participants who are 45-65 years old; self-report difficulty with ≥2 daily activities; have had a physical disability for ≥5 years; and live within 60 miles of the research lab are eligible. All participants will receive an initial in-home evaluation before randomization. The treatment group will receive REBIL (total five visits), which is tailored. The waitlist control group will be offered the same intervention after 6-month follow-up. Expected outcomes are high acceptability, fidelity, and adherence; low safety risk; improved community participation and daily activities performance; and fewer environmental barriers and fall hazards. Discussion Findings will serve as preliminary evidence for occupational therapy community practice. Outcomes will also inform future large, pragmatic trials. Trial Registration ClinicalTrials.gov identifier NCT04589988.
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Affiliation(s)
- Szu-Wei Chen
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, 4444 Forest Park Ave., St. Louis, MO 63108
| | - Emily Somerville
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, 4444 Forest Park Ave., St. Louis, MO 63108
| | - Megen Devine
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, 4444 Forest Park Ave., St. Louis, MO 63108
| | - Susan Stark
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, 4444 Forest Park Ave., St. Louis, MO 63108
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Ramulu PY, Mihailovic A, E JY, Miller RB, West SK, Gitlin LN, Friedman DS. Environmental Features Contributing to Falls in Persons With Vision Impairment: The Role of Home Lighting and Home Hazards. Am J Ophthalmol 2021; 230:207-215. [PMID: 33951447 DOI: 10.1016/j.ajo.2021.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate whether home hazards and lighting levels are associated with higher fall rates in adults with varying degrees of visual field (VF) damage from glaucoma. METHODS Participants with diagnosed or suspected glaucoma provided three years of prospective falls data via monthly falls diaries. A post-fall telephone questionnaire determined fall locations. Seven home areas were evaluated for hazards and lighting via an in-home assessment. Multivariate models adjusting for relevant confounders, including age, sex, comorbidity, and severity of VF damage, evaluated the influence of hazards and lighting on fall rates in each home region. RESULTS Mean baseline age for the 170 participants was 71.0 (7.6) years and 78 (46%) of participants were female. Fifty-nine participants experienced a total of 83 home falls, with the greatest number of falls occurring on the indoor stairs (n = 24, 29%) and bedroom (n = 17, 21%). Neither the number nor the percentage of hazardous items graded as hazardous was associated with the rate of falls (P > .26). Each 10-fold increase in room lighting was associated with 35% fewer falls in that home region (P = .02). The relation between lighting and the rate of falls did not differ with the degree of visual field damage (P > .3), and a lower fall rate was noted with better lighting even in participants with mild or no VF damage (rate ratio = 0.52/10-fold better lighting; P = 0.01). CONCLUSIONS Fewer home falls were found with better lighting, but not with fewer home hazards. Lighting improvements at home may reduce fall rates in older adults. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
| | | | - Jian-Yu E
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rhonda B Miller
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
| | - Sheila K West
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
| | - Laura N Gitlin
- Johns Hopkins School of Nursing, Baltimore, MD; College of Nursing and Health Professions, Drexel University, Philadelphia, PA
| | - David S Friedman
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD; Massachusetts Eye and Ear, Glaucoma Division, Boston, MA, USA
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13
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Kim D. Understanding How Older Adults Negotiate Environmental Hazards in Their Home. JOURNAL OF AGING AND ENVIRONMENT 2021. [DOI: 10.1080/26892618.2021.1918814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Daejin Kim
- Department of Interior Design, Iowa State University, Ames, IA, USA
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14
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Dean C, Clemson L, Ada L, Scrivener K, Lannin N, Mikolaizak S, Day S, Cusick A, Gardner B, Heller G, Isbel S, Jones T, Mumford V, Preston E. Home-based, tailored intervention for reducing falls after stroke (FAST): Protocol for a randomized trial. Int J Stroke 2021; 16:1053-1058. [PMID: 33568018 DOI: 10.1177/1747493021991990] [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] [Indexed: 11/16/2022]
Abstract
RATIONALE People with stroke experience falls at more than twice the rate of the general older population resulting in high fall-related injuries. However, there are currently no effective interventions that prevent falls after stroke. AIMS To determine the effect and cost-benefit of an innovative, home-based, tailored intervention to reduce falls after stroke. SAMPLE SIZE ESTIMATE A total of 370 participants will be recruited in order to be able to detect a clinically important between-group difference of a 30% lower rate of falls with 80% power at a two-tailed significance level of 0.05. METHODS AND DESIGN Falls after stroke trial (FAST) is a multistate, Phase III randomized trial with concealed allocation, blinded assessment, and intention-to-treat analysis. Ambulatory stroke survivors within five years of stroke who have been discharged from formal rehabilitation to the community and who have no significant language impairment will be randomly allocated to receive habit-forming exercise, home safety, and community mobility training or usual care. STUDY OUTCOMES The primary outcome is the rate of falls over the previous 12 months. Secondary outcomes are the risk of falling (proportion of fallers), community participation, self-efficacy, balance, mobility, physical activity, depression, and health-related quality of life. Health care utilization will be collected retrospectively at baseline and prospectively to 6 and 12 months. DISCUSSION The results of FAST are anticipated to directly influence intervention for stroke survivors in the community.Trial Registration: ANZCTR 12619001114134.
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Affiliation(s)
- Catherine Dean
- Faculty of Medicine, Health and Human Sciences, 7788Macquarie University, Sydney, Australia
| | - Lindy Clemson
- Faculty of Medicine and Health, 4334The University of Sydney, Sydney, Australia
| | - Louise Ada
- Faculty of Medicine and Health, 4334The University of Sydney, Sydney, Australia
| | - Katherine Scrivener
- Faculty of Medicine, Health and Human Sciences, 7788Macquarie University, Sydney, Australia
| | - Natasha Lannin
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Stefanie Mikolaizak
- Faculty of Medicine and Health, 4334The University of Sydney, Sydney, Australia
| | - Sally Day
- Faculty of Medicine and Health, 4334The University of Sydney, Sydney, Australia
| | - Anne Cusick
- Faculty of Medicine and Health, 4334The University of Sydney, Sydney, Australia
| | | | - Gillian Heller
- Faculty of Medicine and Health, 4334The University of Sydney, Sydney, Australia
| | - Stephen Isbel
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Taryn Jones
- Faculty of Medicine, Health and Human Sciences, 7788Macquarie University, Sydney, Australia
| | - Virginia Mumford
- Faculty of Medicine, Health and Human Sciences, 7788Macquarie University, Sydney, Australia
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15
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Ziebart C, Bobos P, Furtado R, MacDermid JC, Bryant D, Szekeres M, Suh N. The Efficacy of Fall Hazards Identification on Fall Outcomes: A Systematic Review With Meta-analysis. Arch Rehabil Res Clin Transl 2021; 2:100065. [PMID: 33543091 PMCID: PMC7853376 DOI: 10.1016/j.arrct.2020.100065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate the efficacy of fall hazards identification programs when compared to no intervention or other fall prevention programs on number of falls, falls incidence, and identifying fall hazards in community-dwelling adults. Data Sources CINAHL, PubMed, EMBASE, Scopus, and PsychINFO were used to identify articles. Study Selection Studies were selected to compare fall hazards identification programs to a control group. Studies were eligible if they were randomized controlled trials and enrolled adults older than 50 years with the incidence rate of falls as an outcome. Data Extraction Study or authors, year, sample characteristics, intervention or comparison groups, number of falls, and number of hazards identified in the intervention and control groups, and follow-up were extracted. The risk of bias assessment was performed using the Cochrane Risk of Bias tool. Quality was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach per outcome. Data Synthesis A total of 8 studies (N=8) and 5177 participants were included. There was a high risk of bias across the studies mostly due to improper blinding of personnel of the outcome assessor. Pooled estimate effects from 5 studies assessing the incidence rate of falls from 3019 individuals indicated no difference between fall hazards identification programs and control (incidence rate ratio=0.98; 95% confidence interval, 0.87-1.10). Conclusions The current study suggests that there may be a benefit for fall hazards programs in reducing incident falls. However, because of a moderate GRADE rating, more large-scale studies with a higher number of falls events and more consistent control groups are required to determine the true effect.
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Affiliation(s)
- Christina Ziebart
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Pavlos Bobos
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada.,Dalla Lana School of Public Health, Institute of Health Policy Management and Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, ON, Canada
| | - Rochelle Furtado
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Dianne Bryant
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
| | - Mike Szekeres
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Nina Suh
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
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16
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Ziebart C, MacDermid J, Bobos P, Furtado R, MacDermid-Watts S, Bryant D, Szekeres M, Suh N. Fall Hazard Identification: A Scoping Review. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2020.1806424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Christina Ziebart
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Joy MacDermid
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Pavlos Bobos
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Rochelle Furtado
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Sara MacDermid-Watts
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada
| | - Dianne Bryant
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Mike Szekeres
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada
| | - Nina Suh
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada
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17
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Tsuchiya-Ito R, Tajima M, Slaug B. Housing Assessment Tools Developed or Adapted for Use in East and Southeast Asia: A Scoping Review. JOURNAL OF AGING AND ENVIRONMENT 2020. [DOI: 10.1080/26892618.2020.1833397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rumiko Tsuchiya-Ito
- Research Department, Institute for Health Economics and Policy, Tokyo, Japan
- Dia Foundation for Research on Ageing Societies, Tokyo, Japan
| | - Miki Tajima
- Dia Foundation for Research on Ageing Societies, Tokyo, Japan
| | - Björn Slaug
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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18
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Taylor ME, Wesson J, Sherrington C, Hill KD, Kurrle S, Lord SR, Brodaty H, Howard K, O’Rourke SD, Clemson L, Payne N, Toson B, Webster L, Savage R, Zelma G, Koch C, John B, Lockwood K, Close JCT. Tailored Exercise and Home Hazard Reduction Program for Fall Prevention in Older People With Cognitive Impairment: The i-FOCIS Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2020; 76:655-665. [DOI: 10.1093/gerona/glaa241] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The evidence to support effective fall prevention strategies in older people with cognitive impairment (CI) is limited. The aim of this randomized controlled trial (RCT) was to determine the efficacy of a fall prevention intervention in older people with CI.
Method
RCT involving 309 community-dwelling older people with CI. The intervention group (n = 153) received an individually prescribed home hazard reduction and home-based exercise program during the 12-month study period. The control group (n = 156) received usual care. The primary outcome was rate of falls. Secondary outcomes included faller/multiple faller status, physical function, and quality of life.
Results
Participants’ average age was 82 years (95% CI 82–83) and 49% were female. There was no significant difference in the rate of falls (incidence rate ratio [IRR] 1.05; 95% confidence interval [95% CI] 0.73–1.51). A sensitivity analysis, controlling for baseline differences and capping the number of falls at 12 (4 participants), revealed a nonsignificant reduction in fall rate in the intervention group (IRR 0.78; 95% CI 0.57–1.07). Analyses of secondary outcomes indicated the intervention significantly reduced the number of multiple fallers by 26% (RR 0.74; 95% CI 0.54–0.99) when adjusting for baseline differences. There was a differential impact on falls in relation to physical function (interaction term p-value = .023) with a significant reduction in fall rate in intervention group participants with better baseline physical function (IRR 0.60; 95% CI 0.37–0.98). There were no significant between-group differences for other secondary outcomes.
Conclusions
This intervention did not significantly reduce the fall rate in community-dwelling older people with CI. The intervention did reduce the fall rate in participants with better baseline physical function.
Clinical Trials Registration Number
Australian and New Zealand Trials Registry ACTRN12614000603617.
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Affiliation(s)
- Morag E Taylor
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia
| | - Jacqueline Wesson
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Susan Kurrle
- Department of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sandra D O’Rourke
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Lindy Clemson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre of Excellence for Population Ageing Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Narelle Payne
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Barbara Toson
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Lyndell Webster
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Roslyn Savage
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Genevieve Zelma
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Cecelia Koch
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Beatrice John
- Department of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Keri Lockwood
- Department of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Jacqueline C T Close
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia
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19
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Wang Y, Li L, Tian S, Wu J, Wang Z. Development and Psychometrics Test of Home Environment Assessment Checklist for Community-Dwelling Older Adults with Dementia. J Alzheimers Dis 2020; 77:1389-1396. [PMID: 32925033 DOI: 10.3233/jad-200241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Home environment is a core domain in the care of community-dwelling older adults with dementia, but there is no suitable instrument to measure it in China. OBJECTIVE To develop and psychometrically test the home environment assessment checklist for community-dwelling older adults with dementia. METHODS A three-step process was performed to develop and test this instrument: 1) based on the evidence-based theory, the checklist was summarized as the main points of evidence from living environment settings among older adults with dementia, 2) the draft tool was assigned to an iterative process of evaluation by a panel of examiners consisting of experts from treatment, nursing and caring, people with dementia and their caregivers, 3) inter-rater reliability and internal consistency were calculated with a sample of 348 caregivers of the older adults with dementia. RESULTS The HEAC consisted of 71 items in domains addressing safety, stability and familiarity, visual cues, and sensory stimulation. Psychometric evaluation showed that this tool demonstrated sound reliability and validity. Content validity was 0.969 which was established by a panel of experts (n = 10). Inter-rater reliability of two researchers was 0.978, and 0.848 for researchers and caregivers. Test-retest reliability was excellent (ICC = 0.757-0.877) in community-dwelling older adults with dementia 2 week apart. CONCLUSION The HEAC is a new tool to help collect the reliable information on the barriers and facilitators of home environment for community-dwelling older adults with dementia and to precipitate the home modification process to improve the quality of care for people with dementia and their caregivers in daily life.
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Affiliation(s)
- Yi Wang
- Intensive Care Unit, Peking University First Hospital, Beijing, China.,School of Nursing, Peking University, Beijing, China
| | - Liyu Li
- School of Nursing, Peking University, Beijing, China
| | | | - Jie Wu
- Fuwai hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
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20
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Keglovits M, Clemson L, Hu YL, Nguyen A, Neff AJ, Mandelbaum C, Hudson M, Williams R, Silianoff T, Stark S. A scoping review of fall hazards in the homes of older adults and development of a framework for assessment and intervention. Aust Occup Ther J 2020; 67:470-478. [PMID: 32648268 DOI: 10.1111/1440-1630.12682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/29/2020] [Accepted: 05/31/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Comprehensive evaluation and intervention provided by occupational therapists is effective in reducing the presence of fall hazards in the homes of older adults. The purpose of this study was to document known environmental hazards and to update a previous content analysis. A secondary goal reviewed a framework for evaluation and practice. METHODS A comprehensive scoping review of published academic articles was performed from 1996 to 2019 to answer: What environmental hazards have been associated with falls in the homes of community-dwelling older adults? Data was extracted in a standardised critical appraisal worksheet and content analysis was conducted. A review of a conceptual framework for assessment and intervention was conducted by international experts (n = 6) in face-to-face interviews. RESULTS Fourteen studies met the inclusion criteria for the scoping study. The studies reported 17 in-home environmental hazards: throw rugs/carpets, clutter, cords/wires, poorly placed light switches, items placed too low, items placed too high, no grab bars, toilet seats too low, uneven floor surfaces, slippery/wet surfaces, snowy/icy surfaces, backless/unsupportive shoes, unsteady stairs, inadequate lighting, inadequate heating/cooling, step stools without railings, and pets. CONCLUSION A comprehensive list of specific fall hazards in and around the homes of older adults and a guiding framework offers occupational therapists an evidence-based foundation for fall prevention efforts.
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Affiliation(s)
- Marian Keglovits
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Lindy Clemson
- Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - Yi-Ling Hu
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - An Nguyen
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Anna J Neff
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Caren Mandelbaum
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Margaret Hudson
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Rebecca Williams
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Tara Silianoff
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Susan Stark
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
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21
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Mackenzie L, Clemson L, Irving D. Fall prevention in primary care using chronic disease management plans: A process evaluation of provider and consumer perspectives. Aust Occup Ther J 2019; 67:22-30. [PMID: 31682030 DOI: 10.1111/1440-1630.12618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Falls are an important issue in primary care. General practitioners (GPs) are in a key position to identify older people at risk of falls on their caseload and put preventative plans into action. Chronic Disease Management (CDM) plans allow GPs to refer to allied health practitioners (AHPs) for evidence-based falls interventions. A previous pilot study reduced falls risk factors using CDM pans with older people at risk of falls. This study aimed to conduct a process evaluation of how the intervention worked in the pilot study for providers and consumers. METHODS This process evaluation used qualitative descriptive methods by interviewing the GPs, AHPs and older people involved in the intervention study. An independent researcher conducted interviews. These were audiotaped, transcribed and analysed using thematic analysis. Data were also collected about the implementation of the programme. RESULTS Two GPs, three occupational therapists, three physiotherapists and eight older people were interviewed. Key themes emerged from the perspectives of providers and consumers. The programme was implemented as intended, adherence to the exercise diaries was variable and the falls calendars were fully completed for three months of follow-up. The programme was implemented as intended. CONCLUSION The pilot CDM falls prevention programme did not identify common barriers attributed to GPs. Older people were amenable to the programme and participated freely. Private AHPs needed to make the CDM items work for their business model. This approach can be rolled out in a larger study and integrated pathways are needed to identify and intervene with older people at risk of falls in primary care.
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Affiliation(s)
- Lynette Mackenzie
- Faculty of Health Sciences, Discipline of Occupational Therapy, The University of Sydney, Lidcombe, NSW, Australia
| | - Lindy Clemson
- Faculty of Health Sciences, Physical Activity, Lifestyle, Ageing and Work Research Group, The University of Sydney, Lidcombe, NSW, Australia
| | - Diana Irving
- Faculty of Health Sciences, Discipline of Occupational Therapy, The University of Sydney, Lidcombe, NSW, Australia
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22
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Sørensen GV, Jørgensen MG, Ryg J, Masud T, Andersen S. Development, feasibility, acceptability, and adjustment of a portable, multifactorial falls risk test battery for community-dwelling older adults. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1674099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Gustav V. Sørensen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Martin G. Jørgensen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tahir Masud
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Nottingham, England
| | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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23
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Clemson L, Stark S, Pighills AC, Torgerson DJ, Sherrington C, Lamb SE. Environmental interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2019; 2019:CD013258. [PMCID: PMC6365117 DOI: 10.1002/14651858.cd013258] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects (benefits and harms) of environmental interventions (such as assistive devices, and reduction of fall hazards in home, outdoors, and public places) for preventing falls in older people living in the community.
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Affiliation(s)
- Lindy Clemson
- The University of SydneyFaculty of Health SciencesEast St. LidcombeLidcombeAustralia1825
| | - Susan Stark
- Washington UniversityParticipation, Environment and Performance Laboratory, Program in Occupational Therapy444 Forest Park Avenue CB 855St LouisUSA63108‐2212
| | - Alison C Pighills
- James Cook UniversityMackay Institute of Research and Innovation, Queensland Health and Division of Tropical Health and MedicineMackayAustralia
| | - David J Torgerson
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO10 5DQ
| | - Catherine Sherrington
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyAustralia2050
| | - Sarah E Lamb
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Windmill RoadOxfordUKOX3 7LD
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24
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Blanchet R, Edwards N. A need to improve the assessment of environmental hazards for falls on stairs and in bathrooms: results of a scoping review. BMC Geriatr 2018; 18:272. [PMID: 30413144 PMCID: PMC6234792 DOI: 10.1186/s12877-018-0958-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 10/19/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Falls occurring on stairs or in bathrooms are associated with a high risk of injuries among older adults. Home environmental assessments are frequently used to guide fall-prevention interventions. The aims of this review were to describe how, where, by whom, and for whom environmental hazard checklists are used, and to examine the characteristics of environmental hazard assessment checklists with specific attention to features of bathrooms and stairs/steps assessed in them. METHODS Studies published before January 5, 2018, were identified using several databases. Publications reporting the use and/or evaluation of environmental hazard checklists were eligible if they assessed bathrooms or stairs/steps in homes of older adults (≥65 years). Content analysis was conducted on publications that provided a complete list of specific environmental hazards assessed. Checklist items related to bathrooms and stairs/steps were extracted and categorized as structural or non-structural and as objective or subjective. RESULTS 1119 studies were appraised. A pool of 136 published articles and 4 checklists from the grey literature were included in this scoping review. Content analysis was conducted on 42 unique checklists. There was no widely used checklist and no obvious consensus definition of either environmental hazards overall or of single hazards listed in checklists. Checklists varied greatly with respect to what rooms were assessed, whether or not outdoor stair/steps hazards were assessed, and how responses were coded. Few checklists examined person-environment fit. The majority of checklists were not oriented towards structural hazards in bathrooms. Although the majority of checklists assessing stair/steps hazards evaluated structural hazards, most features assessed were not related to the construction geometry of stairs/steps. Objective features of bathrooms and stairs/steps that would deem them safe were rarely specified. Rather, adequacy of their characteristics was mostly subjectively determined by the evaluator with little or no guidance or training. CONCLUSION The lack of standard definitions and objective criteria for assessing environmental hazards for falls is limiting meaningful cross-study comparisons and slowing advances in this field. To inform population health interventions aimed at preventing falls, such as building code regulations or municipal housing by-laws, it is essential to include objectively-assessed structural hazards in environmental checklists.
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Affiliation(s)
- Rosanne Blanchet
- School of Nursing, University of Ottawa, 1 Stewart Street, Room 212, Ottawa, ON K1H 8M5 Canada
| | - Nancy Edwards
- School of Nursing, University of Ottawa, 1 Stewart Street, Room 205, Ottawa, ON K1H 8M5 Canada
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Kim D, Portillo M. Fall Hazards Within Senior Independent Living: A Case-Control Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 11:65-81. [DOI: 10.1177/1937586717754185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Daejin Kim
- Department of Interior Design, Iowa State University, IA, USA
| | - Margaret Portillo
- College of Design, Construction and Planning, University of Florida, Gainesville, FL, USA
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Rice LA, Abou L, Denend TV, Peterson EW, Sosnoff JJ. Falls Among Wheelchair and Scooter Users with Multiple Sclerosis—A Review. ACTA ACUST UNITED AC 2018. [DOI: 10.17925/usn.2018.14.2.82] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Falls are increasingly recognized as a threat to the safety, health and well-being of people with multiple sclerosis (MS), and emerging evidence suggests that full time wheelchair and scooter users with MS have unique fall prevention needs. This review is comprised of three parts. Part 1 summarizes findings describing influences on falls among full time wheelchair and scooter users with MS and associated clinical implications. Although further studies are needed, early findings regarding influences on fall risk operating in this specific population highlight the importance of addressing falls that occur during activities of daily living, the high frequency of falls occurring in the bathroom, and both extrinsic (e.g., wet/slippery surfaces) and intrinsic (e.g., muscle spasticity/weakness) contributors to falls. Part 2 of this review describes available evidence regarding interventions to prevent falls in full time wheelchair and scooter users with MS. Because intervention work in this area is limited to one pilot study, Part 3 presents priorities for future research and identifies the need for randomized trials evaluating fall prevention programs that address diverse fall risk factors and allow for development and attainment of individualized fall prevention goals.
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Ward G, Walker-Clarke A, Holliday N. Evaluation of a web-based app to assist home-hazard modification in falls prevention. Br J Occup Ther 2017. [DOI: 10.1177/0308022617726243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gillian Ward
- Reader in Occupational Therapy and Assistive Technologies, Centre for Technology Enabled Health Research, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | | | - Nikki Holliday
- Senior Research Assistant, Centre for Technology Enabled Health Research, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
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Romero S, Lee MJ, Simic I, Levy C, Sanford J. Development and validation of a remote home safety protocol. Disabil Rehabil Assist Technol 2017; 13:166-172. [PMID: 28326967 DOI: 10.1080/17483107.2017.1300345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIM Environmental assessments and subsequent modifications conducted by healthcare professionals can enhance home safety and promote independent living. However, travel time, expense and the availability of qualified professionals can limit the broad application of this intervention. Remote technology has the potential to increase access to home safety evaluations. PURPOSE This study describes the development and validation of a remote home safety protocol that can be used by a caregiver of an elderly person to video-record their home environment for later viewing and evaluation by a trained professional. METHODS The protocol was developed based on literature reviews and evaluations from clinical and content experts. Cognitive interviews were conducted with a group of six caregivers to validate the protocol. RESULTS The final protocol included step-by-step directions to record indoor and outdoor areas of the home. The validation process resulted in modifications related to safety, clarity of the protocol, readability, visual appearance, technical descriptions and usability. CONCLUSIONS Our final protocol includes detailed instructions that a caregiver should be able to follow to record a home environment for subsequent evaluation by a home safety professional. Implications for Rehabilitation The results of this study have several implications for rehabilitation practice The remote home safety evaluation protocol can potentially improve access to rehabilitation services for clients in remote areas and prevent unnecessary delays for needed care. Using our protocol, a patient's caregiver can partner with therapists to quickly and efficiently evaluate a patient's home before they are released from the hospital. Caregiver narration, which reflects a caregiver's own perspective, is critical to evaluating home safety. In-home safety evaluations, currently not available to all who need them due to access barriers, can enhance a patient's independence and provide a safer home environment.
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Affiliation(s)
- Sergio Romero
- a VA Center of Innovation on Disability and Rehabilitation Research (CINDRR) , Gainesville , FL , USA.,b Department of Occupational Therapy , University of Florida , Gainesville , FL , USA
| | - Mi Jung Lee
- a VA Center of Innovation on Disability and Rehabilitation Research (CINDRR) , Gainesville , FL , USA.,b Department of Occupational Therapy , University of Florida , Gainesville , FL , USA
| | - Ivana Simic
- b Department of Occupational Therapy , University of Florida , Gainesville , FL , USA
| | - Charles Levy
- a VA Center of Innovation on Disability and Rehabilitation Research (CINDRR) , Gainesville , FL , USA
| | - Jon Sanford
- c Georgia Institute of Technology , Atlanta , GA , USA
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Mahoney JE, Clemson L, Schlotthauer A, Mack KA, Shea T, Gobel V, Cech S. Modified Delphi Consensus to Suggest Key Elements of Stepping On Falls Prevention Program. Front Public Health 2017; 5:21. [PMID: 28265557 PMCID: PMC5317011 DOI: 10.3389/fpubh.2017.00021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 01/31/2017] [Indexed: 11/18/2022] Open
Abstract
Falls among older adults result in substantial morbidity and mortality. Community-based programs have been shown to decrease the rate of falls. In 2007, the Centers for Disease Control and Prevention funded a research study to determine how to successfully disseminate the evidence-based fall prevention program (Stepping On) in the community setting. As the first step for this study, a panel of subject matter experts was convened to suggest which parts of the Stepping On fall prevention program were considered key elements, which could not be modified by implementers. METHODS Older adult fall prevention experts from the US, Canada, and Australia participated in a modified Delphi technique process to suggest key program elements of Stepping On. Forty-four experts were invited to ensure that the panel of experts would consist of equal numbers of physical therapists, occupational therapists, geriatricians, exercise scientists, and public health researchers. Consensus was determined by percent of agreement among panelists. A Rasch analysis of item fit was conducted to explore the degree of diversity and/or homogeneity of responses across our panelists. RESULTS The Rasch analysis of the 19 panelists using fit statistics shows there was a reasonable and sufficient range of diverse perspectives (Infit MnSQ 1.01, Z score -0.1, Outfit MnSQ 0.96, Z score -0.2 with a separation of 4.89). Consensus was achieved that these elements were key: 17 of 18 adult learning elements, 11 of 22 programming, 12 of 15 exercise, 7 of 8 upgrading exercises, 2 of 4 peer co-leader's role, and all of the home visits, booster sessions, group leader's role, and background and training of group leader elements. The top five key elements were: (1) use plain language, (2) develop trust, (3) engage people in what is meaningful and contextual for them, (4) train participants for cues in self-monitoring quality of exercises, and (5) group leader learns about exercises and understands how to progress them. DISCUSSION The Delphi consensus process suggested key elements related to Stepping On program delivery. These elements were considered essential to program effectiveness. Findings from this study laid the foundation for translation of Stepping On for broad US dissemination.
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Affiliation(s)
- Jane E. Mahoney
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lindy Clemson
- The University of Sydney, Ageing and Occupational Therapy, Sydney, NSW, Australia
| | - Amy Schlotthauer
- Injury Research Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Karin A. Mack
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, GA, USA
| | - Terry Shea
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Vicki Gobel
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sandy Cech
- Greater Wisconsin Agency on Aging Resources, Inc., Madison, WI, USA
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Romli MH, Mackenzie L, Lovarini M, Tan MP, Clemson L. The Clinimetric Properties of Instruments Measuring Home Hazards for Older People at Risk of Falling: A Systematic Review. Eval Health Prof 2016; 41:82-128. [PMID: 29415567 DOI: 10.1177/0163278716684166] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Home hazards are associated with falls among older people living in the community. However, evaluating home hazards is a complex process as environmental factors vary according to geography, culture, and architectural design. As a result, many health practitioners commonly use nonstandardized assessment methods that may lead to inaccurate findings. Thus, the aim of this systematic review was to identify standardized instruments for evaluating home hazards related to falls and evaluate the clinimetric properties of these instruments for use by health practitioners. A systematic search was conducted in the Medline, CINAHL, AgeLine, Web of Science databases, and the University of Sydney Library CrossSearch Engine. Study screening, assessment, and quality ratings were conducted independently. Thirty-six studies were identified describing 19 instruments and three assessment techniques. The clinimetric properties varied between instruments. The Home Falls and Accidents Screening Tool, Home Safety Self-Assessment Tool, In-Home Occupational Performance Evaluation, and Westmead Home Safety Assessment were the instruments with high potential for evaluating home hazards associated with falls. Health practitioners can choose the most appropriate instruments for their practice, as a range of standardized instruments with established clinimetric properties are available.
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Affiliation(s)
- Muhammad Hibatullah Romli
- 1 Occupational Therapy, University of Sydney, NSW, Australia.,2 Faculty of Medicine and Health Sciences, Department of Nursing and Rehabilitation, Universiti Putra Malaysia, Selangor, Malaysia
| | | | - Meryl Lovarini
- 1 Occupational Therapy, University of Sydney, NSW, Australia
| | - Maw Pin Tan
- 3 Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lindy Clemson
- 1 Occupational Therapy, University of Sydney, NSW, Australia
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Yonge AV, Swenor BK, Miller R, Goldhammer V, West SK, Friedman DS, Gitlin LN, Ramulu PY. Quantifying Fall-Related Hazards in the Homes of Persons with Glaucoma. Ophthalmology 2016; 124:562-571. [PMID: 28017422 DOI: 10.1016/j.ophtha.2016.11.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/09/2016] [Accepted: 11/21/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize fall-related hazards in the homes of persons with suspected or diagnosed glaucoma, and to determine whether those with worse visual field (VF) damage have fewer home hazards. DESIGN Cross-sectional study using baseline (2013-2015) data from the ongoing Falls in Glaucoma Study (FIGS). PARTICIPANTS One-hundred seventy-four of 245 (71.0%) FIGS participants agreeing to the home assessment. METHODS Participants' homes were assessed using the Home Environment Assessment for the Visually Impaired (HEAVI). A single evaluator assessed up to 127 potential hazards in 8 home regions. In the clinic, binocular contrast sensitivity (CS) and better-eye visual acuity (VA) were evaluated, and 24-2 VFs were obtained to calculate average integrated VF (IVF) sensitivity. MAIN OUTCOME MEASURES Total number of home hazards. RESULTS No significant visual or demographic differences were noted between participants who did and did not complete the home assessment (P > 0.09 for all measures). Mean age among those completing the home assessment (n = 174) was 71.1 years, and IVF sensitivity ranged from 5.6 to 33.4 dB (mean = 27.2 dB, standard deviation [SD] = 4.0 dB). The mean number of items graded per home was 85.2 (SD = 13.2), and an average of 32.7 (38.3%) were identified as hazards. IVF sensitivity, CS, and VA were not associated with total home hazards or the number of hazards in any given room (P > 0.06 for all visual measures and rooms). The bathroom contained the greatest number of hazards (mean = 7.9; 54.2% of graded items classified as hazardous), and the most common hazards identified in at least 1 room were ambient lighting <300 lux and exposed light bulbs. Only 27.9% of graded rooms had adequate lighting. IVF sensitivity, CS, and VA were not associated with home lighting levels (P > 0.18 for all), but brighter room lighting was noted in the homes of participants with higher median income (P < 0.001). CONCLUSIONS Multiple home fall hazards were identified in the study population, and hazard numbers were not lower for persons with worse VF damage, suggesting that individuals with more advanced glaucoma do not adapt their homes for safety. Further work should investigate whether addressing home hazards is an effective intervention for preventing falls in this high-risk group.
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Affiliation(s)
- Andrea V Yonge
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | | | - Rhonda Miller
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Victoria Goldhammer
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Sheila K West
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - David S Friedman
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Laura N Gitlin
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
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Swenor BK, Yonge AV, Goldhammer V, Miller R, Gitlin LN, Ramulu P. Evaluation of the Home Environment Assessment for the Visually Impaired (HEAVI): an instrument designed to quantify fall-related hazards in the visually impaired. BMC Geriatr 2016; 16:214. [PMID: 27938346 PMCID: PMC5148906 DOI: 10.1186/s12877-016-0391-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 12/06/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To (1) develop and refine the Home Environment Assessment for the Visually Impaired (HEAVI), and (2) determine the interrater reliability of this instrument, which was designed to quantify the number of fall-related hazards in the homes of individuals with visual impairment. METHODS Twenty homes of community-dwelling adults were included in this study. Each home was graded by an occupational therapist (OT) and two non-expert (NE) graders. Seventy-three HEAVI items were evaluated in eight rooms, for a total of 185 potential hazards per home (some items were assessed in multiple rooms). Pairwise and three-way agreement between graders was evaluated at the item, room, and home level using Krippendorff's alpha and intraclass correlation coefficients (ICC). Additionally, the most hazardous home locations and items were determined by comparing the mean and standard deviation of the number of hazards by room and grader. RESULTS Of the 73 items, 45 (62%) demonstrated at least moderate agreement overall and for each OT/NE pair (Krippendorff's alpha >0.4), and remained in the final instrument (a total of 119 potential hazards per home as some items were assessed in multiple rooms). Of these 119 potential hazards, an average of 35.7, 33.2, and 33.3 hazards per home were identified by the OT and NE graders, respectively. Moderate to almost perfect agreement on the number of hazards per home and number of hazards per room, except the dining room, was found (ICCs of 0.58 to 0.93). Bathroom items were most often classified as hazards (>40% of items for all graders). The item classes most commonly graded as hazardous were handrails and lighting (>30% of items). CONCLUSION Our results indicate that NE graders can accurately administer the HEAVI tool to identify fall-related hazards. Items in the bathroom and those related to handrails and lighting were most often identified as hazards, making these areas and items important targets for interventions when addressing falls.
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Affiliation(s)
- Bonnielin K. Swenor
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, 600 N Wolfe St, Wilmer Room 116, Baltimore, MD 21287 USA
| | - Andrea V. Yonge
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, 600 N Wolfe St, Wilmer Room 116, Baltimore, MD 21287 USA
| | - Victoria Goldhammer
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, MD USA
| | - Rhonda Miller
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, 600 N Wolfe St, Wilmer Room 116, Baltimore, MD 21287 USA
| | - Laura N. Gitlin
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, MD USA
| | - Pradeep Ramulu
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, 600 N Wolfe St, Wilmer Room 116, Baltimore, MD 21287 USA
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Tolley L, Atwal A. Determining the Effectiveness of a Falls Prevention Programme to Enhance Quality of Life: An Occupational Therapy Perspective. Br J Occup Ther 2016. [DOI: 10.1177/030802260306600606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Falls are common in older people and become more frequent with advancing age. Falling in older people is associated with mortality, decreased mobility, premature nursing home admissions and a reduced ability to perform activities of daily living. In an attempt to reduce the incidence of falls, the National Service Framework for Older People has emphasised the need to develop falls services that provide support for older people who have fallen and use health promotion initiatives. While there is evidence to suggest that home modifications can reduce falls in older people, there has been little research to evaluate the effectiveness of occupational therapy falls prevention programmes. This paper reports the findings of an evaluation of a multifaceted falls prevention programme, which aimed to determine whether occupational therapy could enhance quality of life by educating people aged 65 years and over about the risk of falls. A pre-intervention and post-intervention non-standardised self-administered questionnaire was completed at week 1 and at week 14. Of the 172 older people attending the falls prevention programme, 78 (45%) completed both questionnaires. The findings from this study suggest that an occupational therapy falls prevention programme can reduce the impact of falls on older people by enhancing confidence to perform activities, which in turn can increase quality of life. However, further research is needed to determine the effectiveness of anxiety management techniques.
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Mackenzie L, Byles J, Higginbotham N. Designing the Home Falls and Accidents Screening Tool (HOME FAST): Selecting the Items. Br J Occup Ther 2016. [DOI: 10.1177/030802260006300604] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Home Falls and Accidents Screening Tool (HOME FAST) was developed as a screening instrument for use in a community preventive care trial for older people. This paper describes the first stage of the development of this screening tool. The objectives of the study were (i) to review existing home safety measures, (ii) to field test an instrument containing a pool of home safety items with the goal of identifying those hazards associated with falls in the home and (iii) to select the items for inclusion in a 25-item tool using an expert panel. The field testing took place in a rural area of Australia, where the pooled checklist was used to evaluate hazards within the homes of 83 older people. No individual hazards were associated with the risk of falls at home and, although participants who had experienced falls had a higher mean number of home hazards (mean = 13.7, SD 8.2), the differences between fallers and non-fallers was not significant. Items relevant to a rural population were indicated through field testing. Further psychometric testing of the HOME FAST and a meaningful method of scoring the checklist are now warranted.
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Zhang L, Yan T, You L, Li K, Gao Y. Social Isolation and Physical Barriers in the Houses of Stroke Survivors in Rural China. Arch Phys Med Rehabil 2016; 97:2054-2060. [PMID: 27485365 DOI: 10.1016/j.apmr.2016.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 06/30/2016] [Accepted: 07/09/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the home barriers and social isolation of stroke survivors in the rural areas of China and to explore which home barriers are associated with social isolation. DESIGN Cross-sectional survey. SETTING Structured interviews and observation in the participants' homes. PARTICIPANTS Community-dwelling stroke survivors in the rural areas of China (N=818). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Physical barriers in rural homes were surveyed using a home fall hazards assessment. Social isolation was identified if ≥2 of the following indicators were observed: low frequency of getting out of the home, lacking leisure activities, and living alone in the previous 3 months. RESULTS The prevalence rates of 18 among 30 home barriers were >20%, and the highest was 93% (lack of handrails in the bathroom). The prevalence of social isolation was 30%. Three home barriers were independently related to social isolation. These were a distant toilet (odds ratio [OR], 2.363; 95% confidence interval [CI], 1.527-3.658; P<.001), unsuitable seating (OR, 1.571; 95% CI, 1.026-2.404; P=.038), and inaccessible light switches (OR, 1.572; 95% CI, 1.064-2.324; P=.023). CONCLUSIONS Many barriers exist in the houses of stroke survivors in rural China. Some of them are related to social isolation. Eliminating or decreasing home barriers could be a feasible and effective approach to reducing social isolation.
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Affiliation(s)
- Lifang Zhang
- School of Nursing, Youjiang Medical College for Nationalities, Baise, China; School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Tiebin Yan
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Liming You
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Kun Li
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Yan Gao
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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Cusick A, Lannin N, Kinnear BZ. Upper limb spasticity management for patients who have received Botulinum Toxin A injection: Australian therapy practice. Aust Occup Ther J 2015; 62:27-40. [PMID: 25649033 DOI: 10.1111/1440-1630.12142] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM To describe Australian physiotherapy and occupational therapy practice for patients who receive upper-limb Botulinum Toxin-A (BoNT-A). METHOD Anonymous online survey asking about practice experience. Convenience sample of 128 BoNT-A experienced occupational therapists and physiotherapists. RESULTS The primary work setting was multidisciplinary inpatient or outpatient rehabilitation services where therapists had automatic referral to BoNT-A patients. Patients expected BoNT-A to improve functional movement, reduce hypertonicity, increase passive range, reduce pain, improve appearance and hand hygiene. Most patients were injected in multidisciplinary public hospital clinics and had median 2 pre-injection (range 0-30) and 8 post-injection (range 0-50) therapy sessions. Biceps, flexor digitorum profundus/superficialis and brachoradialis were most frequently injected. Injectors used therapist assessment information to select sites 68% of the time; only 44% of services had assessment protocols. Standardised therapy assessments examined motor performance, pain and function in that order of frequency. The greater the awareness and perceived relevance of an assessment the more often therapists used it. All therapists set goals, most collaboratively, and these mirrored patient expectations. The most common treatments were stretch, task-specific functional training, strength training and home programmes. CONCLUSION While trends in Australian assessment, goals and treatment practice were observed, greater consistency could be achieved if therapy practice guidelines existed. The gap is exacerbated by the absence of Australian BoNT-A organisation and process of care spasticity management guidelines. This creates an environment where practice variability is inevitable. Recommendations to improve local service quality are made.
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Affiliation(s)
- Anne Cusick
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
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Ritchey KC, Meyer D, Ice GH. Non-therapist identification of falling hazards in older adult homes using digital photography. Prev Med Rep 2015; 2:794-7. [PMID: 26844151 PMCID: PMC4721441 DOI: 10.1016/j.pmedr.2015.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Evaluation and removal of home hazards is an invaluable method for preventing in-home falls and preserving independent living. Current processes for conducting home hazard assessments are impractical from a whole population standpoint given the substantial resources required for implementation. Digital photography offers an opportunity to remotely evaluate an environment for falling hazards. However, reliability of this method has only been tested under the direction of skilled therapists. Ten community dwelling adults over the age of 65 were recruited from local primary care practices between July, 2009 and February, 2010. In-home (IH) assessments were completed immediately after a photographer, blinded to the assessment form, took digital photographs (DP) of the participant home. A different non-therapist assessor then reviewed the photographs and completed a second assessment of the home. Kappa statistic was used to analyze the reliability between the two independent assessments. Home assessments completed by a non-therapist using digital photographs had a substantial agreement (Kappa = 0.61, p < 0.001) with in-home assessments completed by another non-therapist. Additionally, the DP assessments agreed with the IH assessments on the presence or absence of items 96.8% of the time. This study showed that non-therapists can reliably conduct home hazard evaluations using digital photographs.
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Affiliation(s)
- Katherine C. Ritchey
- Department of Geriatrics and Gerontology, Ohio University Heritage College of Osteopathic Medicine Health Sciences Center, Athens, OH, United States
| | - Deborah Meyer
- Department of Interdisciplinary Health Studies, Ohio University College of Health Sciences and Professions, Athens, OH, United States
| | - Gillian H. Ice
- Department of Social Medicine and Director of Global Health, Ohio University Heritage College of Osteopathic Medicine Health Sciences Center, Athens, OH, United States
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Désormeaux-Moreau M, Dumont C, Aubin G, Larivière N. [Home safety and severe mental disorders: Developing an evaluation tool]. The Canadian Journal of Occupational Therapy 2015; 82:129-40. [PMID: 26281436 DOI: 10.1177/0008417414561998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Home safety evaluation is an important issue within the context of current perspectives on accommodation for people with a serious mental illness who favour a more independent way of life. PURPOSE This paper describes the development and content validation of the Evaluation de la sécurité a domicile et de la gestion des risques (ESGR), an occupational therapy assessment tool for people with a serious mental illness. METHOD The ESGR was developed from scientific knowledge and clinical experience. Assessing content validity was done in two phases and involved the consultation of 11 experts. FINDINGS In its current form, the ESGR includes 67 items organized into three categories (environment, occupation, person). IMPLICATIONS According to the experts consulted, there is a clinical interest in using the ESGR to support occupational therapists in the assessment of home safety for people with serious mental illness. The statements are clear and representative of the concept and the target audience.
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Ebeling PR, Daly RM, Kerr DA, Kimlin MG. Building healthy bones throughout life: an evidence-informed strategy to prevent osteoporosis in Australia. Med J Aust 2015; 199:S1-S46. [PMID: 25370432 DOI: 10.5694/j.1326-5377.2013.tb04225.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 12/02/2012] [Indexed: 12/14/2022]
Abstract
Osteoporosis imposes a tremendous burden on Australia: 1.2 million Australians have osteoporosis and 6.3 million have osteopenia. In the 2007–08 financial year, 82 000 Australians suffered fragility fractures, of which > 17 000 were hip fractures. In the 2000–01 financial year, direct costs were estimated at $1.9 billion per year and an additional $5.6 billion on indirect costs. Osteoporosis was designated a National Health Priority Area in 2002; however, implementation of national plans has not yet matched the rhetoric in terms of urgency. Building healthy bones throughout life, the Osteoporosis Australia strategy to prevent osteoporosis throughout the life cycle, presents an evidence-informed set of recommendations for consumers, health care professionals and policymakers. The strategy was adopted by consensus at the Osteoporosis Australia Summit in Sydney, 20 October 2011. Primary objectives throughout the life cycle are: to maximise peak bone mass during childhood and adolescence to prevent premature bone loss and improve or maintain muscle mass, strength and functional capacity in healthy adults to prevent and treat osteoporosis in order to minimise the risk of suffering fragility fractures, and reduce falls risk, in older people. The recommendations focus on three affordable and important interventions — to ensure people have adequate calcium intake, vitamin D levels and appropriate physical activity throughout their lives. Recommendations relevant to all stages of life include: daily dietary calcium intakes should be consistent with Australian and New Zealand guidelines serum levels of vitamin D in the general population should be above 50nmol/L in winter or early spring for optimal bone health regular weight-bearing physical activity, muscle strengthening exercises and challenging balance/mobility activities should be conducted in a safe environment.
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Affiliation(s)
- Peter R Ebeling
- NorthWest Academic Centre, University of Melbourne, and Western Health, Melbourne, VIC, Australia.
| | - Robin M Daly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, VIC, Australia
| | - Deborah A Kerr
- Curtin Health Innovation Research Institute and School of Public Health, Curtin University, Perth, WA, Australia
| | - Michael G Kimlin
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Can a tailored exercise and home hazard reduction program reduce the rate of falls in community dwelling older people with cognitive impairment: protocol paper for the i-FOCIS randomised controlled trial. BMC Geriatr 2014; 14:89. [PMID: 25128411 PMCID: PMC4138412 DOI: 10.1186/1471-2318-14-89] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 08/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rate of falls in community dwelling older people with cognitive impairment (CI) is twice that of a cognitively intact population, with almost two thirds of people with CI falling annually. Studies indicate that exercise involving balance and/or a home hazard reduction program are effective in preventing falls in cognitively intact older people. However the potential benefit of these interventions in reducing falls in people with CI has not been established.This randomised controlled trial will determine whether a tailored exercise and home hazard reduction program can reduce the rate of falls in community dwelling older people with CI. We will determine whether the intervention has beneficial effects on a range of physical and psychological outcome measures as well as quality of life of participants and their carers. A health economic analysis examining the cost and potential benefits of the program will also be undertaken. METHODS AND DESIGN Three hundred and sixty people aged 65 years or older living in the community with CI will be recruited to participate in the trial. Each will have an identifiable carer with a minimum of 3.5 hours of face to face contact each week.Participants will undergo an assessment at baseline with retests at 6 and 12 months. Participants allocated to the intervention group will participate in an exercise and home hazard reduction program tailored to their cognitive and physical abilities.The primary outcome measure will be the rate of falls which will be measured using monthly falls calendars. Secondary outcome measures will include the risk of falling, quality of life, measures of physical and cognitive function, fear of falling and planned and unplanned use of health services. Carers will be followed up to determine carer burden, coping strategies and quality of life. DISCUSSION The study will determine the impact of this tailored intervention in reducing the rate of falls in community dwelling older people with CI as well as the cost-effectiveness and adherence to the program. The results will have direct implications for the design and implementation of interventions for this high-risk group of older people. TRIAL REGISTRATION The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry - ACTRN12614000603617.
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Clemson L, Donaldson A, Hill K, Day L. Implementing person-environment approaches to prevent falls: a qualitative inquiry in applying the Westmead approach to occupational therapy home visits. Aust Occup Ther J 2014; 61:325-34. [PMID: 24825447 DOI: 10.1111/1440-1630.12132] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIMS Despite evidence of the effectiveness of home safety interventions for preventing falls, there is limited uptake of such interventions within community services. Therefore, as part of a broader translational project, we explored issues underlying the implementation of an evidence-based home safety fall prevention intervention. METHOD We conducted in-depth interviews with eight occupational therapists and two programme coordinators engaged to deliver a home safety fall prevention intervention. Six community health centres within two metropolitan regions of Melbourne, Australia participated. The RE-AIM framework and Diffusion of Innovations theory underpinned the interviews which examine the enablers and barriers to implementing a home safety fall prevention intervention and integrating it into routine community preventive practice. Analysis involved thematic and content analysis. RESULTS Investment in the home safety for fall prevention intervention was supported and valued by coordinators and therapists alike, and a number of themes emerged which influenced implementation of this intervention. These included issues of: compatibility with organisational processes, individual practitioner practices and skills, a prevention approach, and client expectations; relative advantage in terms of flexibility of the process, client engagement and regional capacity building; complexity of implementing the intervention; and observability related to the invisible nature of fall prevention outcomes. CONCLUSION Implementation of this home safety fall prevention intervention was influenced by a range of interrelated organisational, practitioner and client related factors. The findings from this project provide insights into, and opportunities to increase the sustainable implementation of the home safety fall prevention intervention into practice.
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Affiliation(s)
- Lindy Clemson
- Ageing, Work and Health Research Unit, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales
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Ebeling PR, Daly RM, Kerr DA, Kimlin MG. Building healthy bones throughout life: an evidence‐informed strategy to prevent osteoporosis in Australia. Med J Aust 2013. [DOI: 10.5694/mjao12.11363] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Peter R Ebeling
- NorthWest Academic Centre, University of Melbourne, and Western Health, Melbourne, VIC
| | - Robin M Daly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, VIC
| | - Deborah A Kerr
- Curtin Health Innovation Research Institute and School of Public Health, Curtin University, Perth, WA
| | - Michael G Kimlin
- Faculty of Health, Queensland University of Technology, Brisbane, QLD
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Vu TV, Mackenzie L. The inter-rater and test-retest reliability of the Home Falls and Accidents Screening Tool. Aust Occup Ther J 2012; 59:235-42. [DOI: 10.1111/j.1440-1630.2012.01012.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Tuong-Vi Vu
- Occupational Therapy, Specialist Mental Health Services for Older People; Braeside Hospital; Prairiewood; NSW; Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Health Sciences; The University of Sydney; Lidcombe; NSW; Australia
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Andrade AD, Cifuentes P, Oliveira MC, Anam R, Roos BA, Ruiz JG. Avatar-mediated home safety assessments: piloting a virtual objective structured clinical examination station. J Grad Med Educ 2011. [PMID: 23205205 PMCID: PMC3244322 DOI: 10.4300/jgme-d-11-00236.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Avatars and virtual worlds offer medical educators new approaches to assess learners' competency in home-safety assessments that are less time-consuming and more flexible than traditional home visits. We sought to evaluate the feasibility and acceptability of implementing an avatar-mediated, 3-dimensional (3-D) home simulation as a virtual objective structured clinical examination station for geriatric medicine fellows. METHODS We developed a 3-D home simulation in the virtual world Second Life (Linden Lab, San Francisco, CA) containing 50 safety hazards that could affect the safety of an elderly person at home. Eight geriatric medicine fellows participated in a 16-station objective structured clinical examination, with one station assigned to the 15-minute 3-D virtual world simulation, where the fellow's "home visit" was performed by navigating his or her avatar in the virtual world simulation. The fellows were instructed to find the home safety hazards in the simulated environment and then provide specific written recommendations. Two reviewers independently scored the fellows' written findings against an inventory-based checklist. RESULTS The geriatric medicine fellows scored a mean of 43% ± SD 9 on the inventory-based checklist. The scoring of the 2 reviewers showed a high interrater reliability (88%). Six of the 8 participants (75%) rated the simulation as "excellent." Four of the 5 women (80%) and none of the 3 men (20%) participating in the virtual objective structured clinical examination needed navigation assistance in the 3-D virtual house. CONCLUSION The 3-D, avatar-based, virtual geriatric home safety objective structured clinical examination is a practical and acceptable alternative to the traditional home safety visits in an objective structured clinical examination setting.
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Pynoos J, Steinman BA, Nguyen AQD. Environmental assessment and modification as fall-prevention strategies for older adults. Clin Geriatr Med 2010; 26:633-44. [PMID: 20934614 PMCID: PMC6036911 DOI: 10.1016/j.cger.2010.07.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article discusses the role of home assessment and environmental modification in reducing the risk of falls and helping older adults and persons with disabilities live in the community. This article reviews the research on the efficacy of home environmental assessment and modification. Researchers agree that integrated risk-management programs that emphasize on multiple interventions, including professional home-hazard assessment, along with home modifications are most effective for improving function and reducing falls. Important steps for implementing home modifications for persons at risk of falling are discussed, including exploring fall-risk factors and the effects of home modifications, identifying what changes are needed through home assessments, identifying sources of payment, and finding qualified installers and products.
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Affiliation(s)
- Jon Pynoos
- Fall Prevention Center of Excellence, Andrus Gerontology Center, University of Southern California, 3715 McClintock Avenue, Room 228, Los Angeles, CA 90089-0191, USA.
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Fabre JM, Ellis R, Kosma M, Wood RH. Falls Risk Factors and a Compendium of Falls Risk Screening Instruments. J Geriatr Phys Ther 2010. [DOI: 10.1519/jpt.0b013e3181ff2a24] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Iwarsson S, Horstmann V, Carlsson G, Oswald F, Wahl HW. Person--environment fit predicts falls in older adults better than the consideration of environmental hazards only. Clin Rehabil 2009; 23:558-67. [PMID: 19403554 DOI: 10.1177/0269215508101740] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test the hypotheses that the empirical consideration of objective person-environment fit in the home environment is a stronger predictor of indoor falls among older adults than the assessment of environmental barriers only, and that perceived aspects of home play a role as predictors for falls. DESIGN Survey study with data collection at home visits, followed up by self-reports about falls at home visits one year later. SETTING Urban districts in Sweden, Germany, Latvia. PARTICIPANTS Eight hundred and thirty-four single-living, older adults (75-89 years), in ordinary housing. MEASUREMENTS An assessment of objective person-environment fit in the home environment (housing enabler), a self-rating of the perceived home environment (usability in my home) and retrospective self-reports on indoor falls. RESULTS The participants reporting falls tended to be frailer than the non-fallers. The number of environmental barriers in the home was similar for the fallers and non-fallers; the magnitude of person-environment fit problems was higher among the fallers. The person-environment fit problem variable was a stronger fall predictor (odds ratio (OR) = 1.025; P=0.037) than number of environmental barriers (n.s.), even after controlling for confounders. Fallers also experienced lower usability of their home. CONCLUSION The results suggest that much of the inconclusiveness of the data in the relationship between environmental hazards and falls in the previous falls literature could be due to the neglect of person-environment fit assessment. The effectiveness of environmental interventions based on the notion of person-environment fit compared with traditional home hazard checklists remains to be tested.
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Affiliation(s)
- Susanne Iwarsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
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Clemson L, Mackenzie L, Ballinger C, Close JCT, Cumming RG. Environmental interventions to prevent falls in community-dwelling older people: a meta-analysis of randomized trials. J Aging Health 2009; 20:954-71. [PMID: 18815408 DOI: 10.1177/0898264308324672] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. This study seeks to determine the efficacy of environmental interventions in reducing falls in community-dwelling older people. Method. A systematic review and meta-analysis of randomized trials was performed. Results. Pooled analysis of six trials (N = 3,298) demonstrated a 21% reduction in falls risk (relative risk [RR] = 0.79; 0.65 to 0.97). Heterogeneity was attributable to the large treatment effect of one trial. Analysis of a subgroup of studies with participants at high risk of falls (four trials, n = 570) demonstrated a clinically significant 39% reduction of falls (RR = 0.61; 0.47 to 0.79), an absolute risk difference of 26% for a number needed to treat four people. Discussion. Home assessment interventions that are comprehensive, are well focused, and incorporate an environmental-fit perspective with adequate follow-up can be successful in reducing falls with significant effects. The highest effects are associated with interventions that are conducted with high-risk groups.
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Bowman J, Lannin N, Cook C, McCluskey A. Development and psychometric testing of the Clinician Readiness for Measuring Outcomes Scale. J Eval Clin Pract 2009; 15:76-84. [PMID: 19239585 DOI: 10.1111/j.1365-2753.2008.00957.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND If allied health professionals are to begin measuring outcomes routinely, a change in attitudes and behaviour is necessary. However, individuals need to be ready to change and often move through several stages before practice change is observed. AIM To develop and test the psychometric properties of a questionnaire that determines clinicians' readiness to measure outcomes. METHODS A study of instrument development, validation and reliability. Ten expert allied health professionals were involved in content validity testing. A further 396 allied health professionals completed the questionnaire to establish content and construct validity, internal consistency and temporal reliability (or stability). Of these 396 allied health professionals, 70 participated in the temporal reliability assessment. Content validity was established using the Content Validity Index (CVI). Construct validity was determined using confirmatory factor analysis (CFA) and internal consistency was ascertained using Cronbach's alpha. Temporal reliability was confirmed using intraclass correlation coefficients (ICC 3,1). RESULTS A 30-item questionnaire was developed, reflecting the five stages of change from the Transtheoretical Model of Change, and commonly cited barriers to outcome measurement. Content validity was excellent (CVI = 0.96). Using CFA, a two-factor model provided best fit. Based on CFA results, four items were dropped resulting in a 26-item questionnaire (range 26-156). Internal consistency reliability was excellent (alpha = 0.94). Temporal (stability) reliability ICC (3,1) was very good (r = 0.86, P = 0.0001). CONCLUSIONS The final 26-item questionnaire takes 10 minutes to complete and 5 minutes to score. The Clinician Readiness for Measuring Outcomes Scale provides educators with useful information about clinician readiness and helps identify strategies for affecting behaviour change.
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Affiliation(s)
- Julia Bowman
- School of Biomedical and Health Sciences, College of Health and Science, University of Western Sydney, Australia.
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Fisher GS, Baker A, Koval D, Lishok C, Maisto E. A field test of the Cougar Home Safety Assessment (version 2.0) in the homes of older persons living alone. Aust Occup Ther J 2007. [DOI: 10.1111/j.1440-1630.2006.00604.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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