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Ragione B, Rothburd L, Drucker T, Eckardt S, Eckardt PA. Screening for Risk of Fall-Related Inpatient Trauma in a US Acute Care Setting. Cureus 2024; 16:e63199. [PMID: 38933346 PMCID: PMC11203275 DOI: 10.7759/cureus.63199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Falls during hospitalization are a leading cause of preventable trauma-related injuries. Factors associated with fall risk include an unfamiliar environment, changes in health status, and efficacy based on the home environment. Assessing fall efficacy with an individualized prevention plan can decrease falls. The primary aim of this study was to estimate the effect of implementing a fall efficacy screening and intervention on reducing patient falls. Methods The study utilized a quasi-experimental, cross-sectional design with a convenience sample of patients admitted to an in-patient adult medical unit within a community hospital over a twelve-month period. Sampling times included pre-implementation, immediately post-implementation, and a second post-implementation phase. The intervention consisted of an admission fall efficacy screening tool and an individualized educational initiative. Statistical analysis included descriptive statistics of central tendency and dispersion, along with inferential statistics using independent sample t-tests, chi-square tests, correlations, and binary logistic regression. Results Among the study participants (n=2,074), the total sample had an average age of 67.7 (+/- 17.4) years and had mean scores of 13.3 (6.9) on the Short Falls Efficacy Scale-International and 51.8 (20.3) on the Morse Fall Scale. Fifty-two percent of the study population were female; 16.2% of the patients were diagnosed with cerebrovascular accident (CVA) or CVA-like symptoms. Fall rates decreased with a rate of change of -4.15% after efficacy screening and intervention. Males demonstrated higher efficacy in avoiding falls compared to females (t(828) = 3.369, p <0.001). Patients with a CVA diagnosis demonstrated higher efficacy scores compared to non-CVA patients (t(2071) = -3.348, p <0.001). FES risk groups (OR of 5.632, 95% CI (2.171-7.892)) and age over 65 (OR 1.21, 95% CI (1.006-1.442)) were significant predictors of a fall when patients with a primary CVA diagnosis were omitted from the sample (p= 0.022 and 0.046 respectively). Conclusion The findings suggest that efficacy screening may be associated with decreased falls for acute care non-CVA inpatient populations over 65 years of age. Further research into the predictive utility of fall efficacy screening in acute care CVA and non-CVA hospitalized patient populations aged 65 years and above is recommended.
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Affiliation(s)
- Barbara Ragione
- Nursing Quality Improvement, Good Samaritan University Hospital, West Islip, USA
| | | | | | - Sarah Eckardt
- Process Improvement, Northwell Health, Huntington, USA
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Francisco L, Duarte J, Godinho AN, Zdravevski E, Albuquerque C, Pires IM, Coelho PJ. Sensor-based systems for the measurement of Functional Reach Test results: a systematic review. PeerJ Comput Sci 2024; 10:e1823. [PMID: 38660214 PMCID: PMC11042010 DOI: 10.7717/peerj-cs.1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/26/2023] [Indexed: 04/26/2024]
Abstract
The measurement of Functional Reach Test (FRT) is a widely used assessment tool in various fields, including physical therapy, rehabilitation, and geriatrics. This test evaluates a person's balance, mobility, and functional ability to reach forward while maintaining stability. Recently, there has been a growing interest in utilizing sensor-based systems to objectively and accurately measure FRT results. This systematic review was performed in various scientific databases or publishers, including PubMed Central, IEEE Explore, Elsevier, Springer, the Multidisciplinary Digital Publishing Institute (MDPI), and the Association for Computing Machinery (ACM), and considered studies published between January 2017 and October 2022, related to methods for the automation of the measurement of the Functional Reach Test variables and results with sensors. Camera-based devices and motion-based sensors are used for Functional Reach Tests, with statistical models extracting meaningful information. Sensor-based systems offer several advantages over traditional manual measurement techniques, as they can provide objective and precise measurements of the reach distance, quantify postural sway, and capture additional parameters related to the movement.
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Affiliation(s)
- Luís Francisco
- School of Technology and Management, Polytechnic University of Leiria, Leiria, Portugal
| | - João Duarte
- School of Technology and Management, Polytechnic University of Leiria, Leiria, Portugal
| | | | - Eftim Zdravevski
- Faculty of Computer Science and Engineering, University of Sts. Cyril and Methodius, Skopje, North Macedonia
| | - Carlos Albuquerque
- Child Studies Research Center (CIEC), University of Minho, Braga, Portugal
- Higher School of Health, Polytechnic Institute of Viseu, Viseu, Portugal
- Nursing School of Coimbra (ESEnfC), Health Sciences Research Unit: Nursing (UICISA: E), Coimbra, Portugal
| | - Ivan Miguel Pires
- Instituto de Telecomunicações, Escola Superior de Tecnologia e Gestão de Águeda, Universidade de Aveiro, Águeda, Portugal
| | - Paulo Jorge Coelho
- School of Technology and Management, Polytechnic University of Leiria, Leiria, Portugal
- Institute for Systems Engineering and Computers at Coimbra (INESC Coimbra), Coimbra, Portugal
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Kiyoshi-Teo H, De Lima B, Cohen DJ, Dieckmann N, Winters-Stone K, Eckstrom E. Motivational Interviewing for Fall Prevention (MI-FP) pilot study: Older Adults' readiness to participate in fall prevention. Geriatr Nurs 2023; 54:246-251. [PMID: 37847939 PMCID: PMC10841512 DOI: 10.1016/j.gerinurse.2023.09.017] [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: 06/28/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/19/2023]
Abstract
Older adults' readiness to participate in fall prevention behaviors is largely unknown. We evaluated the feasibility of recruitment for a fall prevention intervention and participants' readiness to participate in fall prevention activities. Patients ≥ 65 years at high fall risk were recruited. Feasibility of recruitment was assessed by reaching the goal sample size (200), and recruitment rate (50%). Surveys assessed participants' readiness to participate in fall prevention activities (confidence to manage fall risks [0-10 scale; 10 most confident] and adherence to fall prevention recommendations). We recruited 200 patients (46.3% of eligible patients), and 185 completed surveys. Participants reported high confidence (range 7.48 to 8.23) in addressing their risks. Their adherence to clinician recommendations was mixed (36.4% to 90.5%). We nearly met our recruitment goals, and found that older adults are confident to address their fall risks, but do not consistently engage in fall prevention recommendations.
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Affiliation(s)
- Hiroko Kiyoshi-Teo
- Assistant Professor, School of Nursing, Oregon Health & Science University, U.S.A..
| | - Bryanna De Lima
- Data Analyst, Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, U.S.A
| | - Deborah J Cohen
- Professor, Department of Family Medicine, Oregon Health & Science University, U.S.A
| | - Nathan Dieckmann
- Associate Professor, School of Nursing, Oregon Health & Science University, U.S.A
| | | | - Elizabeth Eckstrom
- Professor, School of Medicine, Chief of Geriatrics, Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, U.S.A
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Pitluk Barash M, Shuper Engelhard E, Elboim-Gabyzon M. Feasibility and Effectiveness of a Novel Intervention Integrating Physical Therapy Exercise and Dance Movement Therapy on Fall Risk in Community-Dwelling Older Women: A Randomized Pilot Study. Healthcare (Basel) 2023; 11:healthcare11081104. [PMID: 37107938 PMCID: PMC10137670 DOI: 10.3390/healthcare11081104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/15/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023] Open
Abstract
This pilot study presents a novel fall prevention intervention that integrates physical therapy exercise (PTE) and dance movement therapy (DMT) to address both physical and emotional fall risk factors, as well as factors influencing adherence to treatment. The aim of this study was to examine the feasibility and effectiveness of the intervention in a sample of eight older women (median = 86 [81.25-90.75] years) from a day center for senior citizens. The intervention, based on the Otago Exercise Program and DMT techniques, aimed to address the emotional experience during physical exercise. Participants were randomly assigned to either a PTE+DMT intervention group (n = 5) or a PTE control group (n = 3). A pre-post intervention battery of physical and emotional fall risk assessments, therapist-patient bond, and home exercise adherence was conducted. Non-parametric tests results showed significant improvement in the PTE+DMT group in measures of balance and fear of falling compared to the PTE group. However, no other significant differences were found between the groups in terms of falls-related psychological concerns, self-perceived health status, therapist-patient bond, and home exercise adherence. These findings demonstrate the feasibility and potential benefits of an intervention that integrates both physical and emotional aspects to reduce fall risk in older adults, and provide a basis for further studies and modifications in the research protocol.
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Affiliation(s)
- Michal Pitluk Barash
- The Graduate School of Creative Art Therapies, Faculty of Social Welfare & Health Sciences, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | - Einat Shuper Engelhard
- The Graduate School of Creative Art Therapies, Faculty of Social Welfare & Health Sciences, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
- The Graduate School of Creative Art Therapies, Faculty of Humanities & Social Sciences, Kibbutzim College of Education, Tel Aviv 6250769, Israel
| | - Michal Elboim-Gabyzon
- Physical Therapy Department, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel
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Effects of an exercise program combining unsupervised home exercises and supervised group-based exercises on fall-related variables in older adults: a randomized controlled trial. Eur Geriatr Med 2023; 14:59-67. [PMID: 36515868 DOI: 10.1007/s41999-022-00724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim was to measure the effects of the home exercises supported with supervision on the fall-related variables in older people. METHODS Seventy-five individuals over the age of 65 were enrolled. They were allocated to a "minimally supervised home exercise group" (group 1) or a "home exercise group" (group 2). Falls efficacy, fear of falling (FOF), fall risk, functional mobility, balance performance, and depression were assessed using the Falls Efficacy Scale International (FES-I), visual analog scale (VAS-FOF), the Elderly Falls Screening Test (EFST), the Timed Up and Go Test (TUGT), Tinetti's Balance Performance Oriented Mobility Assessment (BPOMA), and the Geriatric Depression Scale Short Form (GDS-SF), respectively. Participants performed a four-day weekly exercise program for eight weeks. Group 1 was supervised one day per week on a group basis. RESULTS Results are based on 75 subjects (group 1 n = 37, group 2 n = 38). Analysis of variance revealed significant interactions only for FES-I, VAS-FOF, TUGT, and BPOMA. The difference between groups was significant only for TUGT score; group 1 had better scores at 8 weeks and 6 months. FES-I, VAS-FOF, and BPOMA were significantly improved in both groups. EFST and GDS improved in the total sample but not at the group level. CONCLUSION Supervised home exercise seems to be superior only for functional mobility (TUGT). Further studies with a larger sample are needed to draw conclusions about depression and fall risk. The intervention was feasible and atendible. TRIAL REGISTRATION ClinicalTrials.gov" NCT05337839. Retrospectively registered.
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Norouzi Z, Ghoochani BZ, Kaveh MH, Sokout T, Asadollahi A, Abyad A. Psychometric Properties of the Falls Efficacy Scale-International, Cut-off Points, and Validating its Short Version Among Iranian Older People. Oman Med J 2023; 38:e460. [PMID: 36873798 PMCID: PMC9975788 DOI: 10.5001/omj.2023.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/28/2022] [Indexed: 11/03/2022] Open
Abstract
Objectives Older people have a fear of falling, which is far more difficult than falling itself. We measured the extent of this feeling using a short and valid Falls Efficacy Scale-International (FES-I) 7-item questionnaire for the aging community in Iran. Methods The present psychometric work deals with outlining the validation and translation of FES-I (short version) among 9117 Persian-speaking elderly people with a mean age of 70.2±8.3 years (54.1% female and 45.9% male) in July 2021. Investigations were performed on confirmatory factor analysis, exploratory factor analysis, internal consistency, and construct validity along with test-retest reliability, receiver operating characteristic analysis, inter-rater, and convergent validity. Results 72.4% of the subjects were living alone, 92.9% required support in activities of daily living, and 93.0% experienced falling in the past two years. A one-factor solution was assigned by exploratory factor analysis for FES-I. Thus, this model was proved by the confirmatory factor analysis with valid fit indices. Based on Cronbach's alpha, intra-cluster correlation coefficient, and McDonald's omega (≥ 0.80), internal consistency was confirmed. The exact cut-off value was represented by the receiver operating characteristic analysis for male/female and between with/without fear of falling among older samples with higher measures of specificity and sensitivity. Moreover, a significant effect of age, aging in place, loneliness, hospitalization rate, frailty, and sense of anxiety (effect size ≥ 0.80, p ≤ 0.05) on fear of falls was detected using analysis of variance. Conclusions The psychometric properties of the original scale were preserved by the Persian version of FES-I seven items as a self-reported measure of fear of falling. It could be assuredly a measure in both community and clinical settings. The possible uses and limitations of the Iranian FES-I were also discussed.
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Affiliation(s)
- Zahra Norouzi
- Department of Health Promotion and Gerontology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahareh Zeynalzadeh Ghoochani
- Department of Occupational Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Kaveh
- Department of Health Promotion and Gerontology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Sokout
- Aging Psychology, Director of Farzanegan Daily Caring Foundation, Shiraz, Iran
| | - Abdolrahim Asadollahi
- Department of Health Promotion and Gerontology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.,The Middle East Longevity Institute in Abyad Medical Centre, Azmi Street, Tripoli, Lebanon.,The Middle East Academy for Medicine of Aging, Azmi Street, Tripoli, Lebanon
| | - Abdulrazzak Abyad
- The Middle East Academy for Medicine of Aging, Azmi Street, Tripoli, Lebanon
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Nascimento MDM, Gouveia ÉR, Gouveia BR, Marques A, França C, Freitas DL, Campos P, Ihle A. Exploring Mediation Effects of Gait Speed, Body Balance, and Falls in the Relationship between Physical Activity and Health-Related Quality of Life in Vulnerable Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14135. [PMID: 36361009 PMCID: PMC9655035 DOI: 10.3390/ijerph192114135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
The present study aimed to examine whether gait speed (GS), body balance (BB), and falls mediated the relationship between physical activity (PA) and health-related quality of life (HRQoL) in community-dwelling older adults. This is a cross-sectional study that included 305 men and 314 women (69.5 ± 5.6 years), residing in the Autonomous Region of Madeira, Portugal. HRQoL and PA were assessed using the SF-36 and Baecke Questionnaires, respectively. While BB was obtained by the Fullerton Advance Balance (FAB) scale, GS by the 50-foot (15 m) walk test, and the frequency of falls was obtained by self-report. According to the analyses, when GS and BB were placed concomitantly as mediators, the direct effect revealed by the model revealed a non-significant relationship between PA and falls. Thus, in the context of falls, GS and BB partially mediated the association between PA and HRQoL in approximately 29.7%, 56%, and 49.2%, respectively. The total HRQoL model explained a variance of 36.4%. The results can help to understand the role that GS, BB, and falls play in the relationship between PA and HRQoL of the vulnerable older adult population.
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Affiliation(s)
- Marcelo de Maio Nascimento
- Department of Physical Education, Federal University of Vale do São Francisco, Petrolina 56304-917, Brazil
| | - Élvio Rúbio Gouveia
- Department of Physical Education and Sport, University of Madeira, 9020-105 Funchal, Portugal
- LARSYS, Interactive Technologies Institute, 9020-105 Funchal, Portugal
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland
| | - Bruna R. Gouveia
- LARSYS, Interactive Technologies Institute, 9020-105 Funchal, Portugal
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland
- Regional Directorate of Health, Secretary of Health of the Autonomous Region of Madeira, 9004-515 Funchal, Portugal
- Saint Joseph of Cluny Higher School of Nursing, 9050-535 Funchal, Portugal
| | - Adilson Marques
- CIPER, Faculty of Human Kinetics, University of Lisbon, 1495-751 Lisbon, Portugal
- ISAMB, Faculty of Medicine, University of Lisbon, 1649-020 Lisbon, Portugal
| | - Cíntia França
- Department of Physical Education and Sport, University of Madeira, 9020-105 Funchal, Portugal
- LARSYS, Interactive Technologies Institute, 9020-105 Funchal, Portugal
| | - Duarte L. Freitas
- Department of Physical Education and Sport, University of Madeira, 9020-105 Funchal, Portugal
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - Pedro Campos
- LARSYS, Interactive Technologies Institute, 9020-105 Funchal, Portugal
- Department of Informatics Engineering and Interactive Media Design, University of Madeira, 9020-105 Funchal, Portugal
| | - Andreas Ihle
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland
- Department of Psychology, University of Geneva, 1205 Geneva, Switzerland
- Swiss National Centre of Competence in Research LIVES—Overcoming Vulnerability: Life Course Perspectives, 1015 Lausanne, Switzerland
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Yang Y, Wang K, Liu H, Qu J, Wang Y, Chen P, Zhang T, Luo J. The impact of Otago exercise programme on the prevention of falls in older adult: A systematic review. Front Public Health 2022; 10:953593. [PMID: 36339194 PMCID: PMC9631473 DOI: 10.3389/fpubh.2022.953593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
Objective To improve the quality of life of older adult in their later years, by increasing the physical activity participation of older adult, the occurrence of falls accident scores in older adult can be prevented. This paper comprehensively summarizes the origin, development, participation forms, and fitness effects of the Otago exercise program (OEP). Methods Using PubMed, web of science, CNKI, dimensional spectrum, and other databases, search for research papers from 2005 to April 2021 by using keywords such as Otago project exercise; aged, Fall; Cognitive function, Balance ability, Lower limb strength, Fall efficiency, and so on. PEDro Scale was used to check the quality of the literatures. Results A total of 34 papers were included after searching for kinds of literature related to the subject of this paper and after careful review by researchers. Conclusions Otago exercise programme is beneficial to improve the cognitive function of older adult, enhance their lower limb muscle strength and dynamic and static balance ability, and then improve the gait stability and posture control ability of older adult, which has significant positive benefits for the prevention of falls in older adult. OEP is helpful to improve the falling efficiency of older adult, help older adult overcome the fear of falling, and form a positive emotion of "exercise improves exercise," to reduce the harm caused by sedentary behavior and the incidence of depression and improve their subjective wellbeing. Although OEP has significant positive effects on improving the health and physical fitness of older adult, preventing falls, and restoring clinical function, the corresponding neural mechanism for preventing falls is not very clear. At the same time, how OEP can be combined with emerging technologies to maximize its benefits needs to be further discussed in the future.
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Affiliation(s)
- Yi Yang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Kun Wang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Hengxu Liu
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Jiawei Qu
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Yan Wang
- School of Physical Education, Sichuan Agricultural University, Yaan, China
| | - Peijie Chen
- Leisure College of Shanghai Institute of Physical Education, Shanghai, China
| | - TingRan Zhang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China,*Correspondence: TingRan Zhang
| | - Jiong Luo
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China,Jiong Luo
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Lin WQ, Lin L, Yuan LX, Pan LL, Huang TY, Sun MY, Qin FJ, Wang C, Li YH, Zhou Q, Wu D, Liang BH, Lin GZ, Liu H. Association between meteorological factors and elderly falls in injury surveillance from 2014 to 2018 in Guangzhou, China. Heliyon 2022; 8:e10863. [PMID: 36254282 PMCID: PMC9568828 DOI: 10.1016/j.heliyon.2022.e10863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction With rapid increase in the aging population, falls injuries have become an important public health problem. However, limited data have been reported on the associations between meteorological factors and falls injuries in the elderly. This study assessed the epidemiology of falls injuries and explored this association in the elderly in Guangzhou, China. Methods Data on elderly falls injury cases and meteorological variables from 2014 to 2018 in Guangzhou were collected from the Guangzhou Injury Monitoring System and Guangzhou Meteorological Bureau, respectively. The monthly average data on falls injuries and meteorological factors were applied to the data analysis. These correlations were conducted using Pearson correlation analysis. A multiple linear regression model was used to estimate the effects of meteorological factors on falls injuries in the elderly in Guangzhou, China. Results Accounting for 49.41% of causes of elderly injury were falls in the Guangzhou Injury Monitoring System from 2014 to 2018, which occupied first place for five consecutive years. The monthly number of elderly falls injury cases was lowest in April and highest in December, and had a positive correlation with monthly mean wind speed (r = 0.187, P < 0.01) and a negative correlation with monthly atmospheric pressure (r = -0.142, P < 0.05). A multiple linear regression model was constructed (F = 10.176, P < 0.01), which explained 23.7% of the variances (R 2 = 0.237). Monthly mean wind speed (β = 76.85, P < 0.01) and monthly mean atmospheric pressure (β = -3.162, P < 0.01) were independent factors affecting monthly elderly falls injuries. Conclusions Falls are the primary cause of injury among elderly people in Guangzhou, China. Meteorological factors are related to falls injuries in the elderly population. Decreasing activity during high wind and low atmospheric pressure weather may help reduce the number of elderly falls injury cases.
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Affiliation(s)
- Wei-Quan Lin
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou 510440, China,Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Lin Lin
- School of Public Health, Guangzhou Medical University, Guangzhou 511436, China
| | - Le-Xin Yuan
- Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou 510440, China
| | - Le-Le Pan
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Guangdong Province, Guangzhou 511400, China
| | - Ting-Yuan Huang
- Department of Prevention and Control of Chronic Noncommunicable Diseases, Center for Disease Control and Prevention of Guangzhou, Guangzhou 510440, China
| | - Min-Ying Sun
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou 510440, China,Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Fa-Ju Qin
- Department of Prevention and Control of Chronic Noncommunicable Diseases, Center for Disease Control and Prevention of Guangzhou, Guangzhou 510440, China
| | - Chang Wang
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou 510440, China
| | - Yao-Hui Li
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou 510440, China
| | - Qin Zhou
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou 510440, China
| | - Di Wu
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China,Department of Prevention and Control of Chronic Noncommunicable Diseases, Center for Disease Control and Prevention of Guangzhou, Guangzhou 510440, China
| | - Bo-Heng Liang
- Department of Prevention and Control of Chronic Noncommunicable Diseases, Center for Disease Control and Prevention of Guangzhou, Guangzhou 510440, China
| | - Guo-Zhen Lin
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou 510440, China
| | - Hui Liu
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou 510440, China,Corresponding author.
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Kiyoshi-Teo H, Izumi S(S, Stoyles S, McMahon SK. Older Adults’ Biobehavioral Fall Risks Were Affected by the COVID-19 Pandemic: Lessons Learned for Future Fall Prevention Research to Incorporate Multilevel Perspectives. Innov Aging 2022; 6:igac033. [PMID: 36161144 PMCID: PMC9495495 DOI: 10.1093/geroni/igac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives Examining the impact of coronavirus disease 2019 (COVID-19) pandemic on fall risks may provide insight into how multilevel factors as described in National Institute of Nursing Research's (NINR’s) draft strategic plan can guide future fall prevention research. This article describes the affect of COVID-19 on fall risks from the perspective of older adults who live in assisted living facilities (ALFs), and explores the needs and approaches to implement fall prevention interventions at individual, social, community, and policy levels. Research Design and Methods Exploratory survey study. Participants from a fall prevention study at 2 ALFs in Oregon were invited to the study. Survey questions asked about COVID experience, and changes in fall risks and day-to-day activities in Spring 2020. Quantitative responses were analyzed using descriptive statistics and Cohen’s d effect sizes. Qualitative responses were analyzed using conventional content analysis. Results Thirteen participants (age: M = 87.08, standard deviation = 6.52) responded. More participants reported feeling unsteady compared to pre-COVID data (38% vs. 62%), while the proportion of those worried about falling remained the same at 38%. Participants reported negligible decreases in importance of fall prevention and small decreases in confidence of fall prevention (Cohen’s d = −0.13 and −0.21, respectively). The themes related to the affect of COVID on fall risks were: not to worry about fall risks but be cautious and physical activity is important, but it’s hard during COVID. Impact of COVID on day-to-day activities were: varying degrees of concern for COVID, lack of social and community support, and finding unique ways to cope with COVID. Discussion and Implications These individual-level perspectives suggest that older adults were at increased risk for falling. Results exemplify the influence of broader-level factors (e.g., social, community, and policy) on individual biobehavioral factors (e.g., fall risks and health behaviors), and illustrate the value of examining multilevel factors in future fall prevention research.
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Affiliation(s)
- Hiroko Kiyoshi-Teo
- School of Nursing, Oregon Health and Science University , Portland, Oregon , USA
| | | | - Sydnee Stoyles
- School of Nursing, Oregon Health and Science University , Portland, Oregon , USA
| | - Siobhan K McMahon
- School of Nursing, University of Minnesota , Minneapolis, Minnesota , USA
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Paiva EPD, Costa MAD, Souza TC, Almeida MCD, Silva MCMND, Loures FB. Association between falls in older adults and prevention group. Rev Bras Enferm 2022; 75Suppl 4:e20200207. [PMID: 35674544 DOI: 10.1590/0034-7167-2020-0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 01/18/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to assess the effectiveness of guidelines on fall prevention in a group of older adults in Primary Health Care. METHODS a cross-sectional study, carried out with older adults selected by a simple random sample (274; N=1,234). Data covered sociodemographic and socioeconomic variables, marital status, health conditions, factors associated with falls and participation in the prevention group. Student's t test was used, and dichotomous variables were used by the chi-square test. The project met ethical requirements. RESULTS sample with female profile (61.7%), married, with low education, mean age of 71.69 years. The factors associated with falls identified were female sex, medicalization and participation in the prevention group. There was no protective association between participation in a fall prevention group in older adults and a decrease in the number of falls. CONCLUSIONS based on evidence, a personalized intervention during the nursing visit is suggested as a strategy to prevent falls.
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Affiliation(s)
| | | | - Tamara Costa Souza
- Universidade Federal de Juiz de Fora. Juiz de Fora, Minas Gerais, Brazil
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12
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Elkjaer M, Primdahl J, Mogensen CB, Brabrand M, Gram B. The quality of life of older adults acutely admitted to the emergency department: A cross-sectional study. Nurs Open 2022; 9:2130-2138. [PMID: 35488717 PMCID: PMC9190686 DOI: 10.1002/nop2.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/25/2022] [Accepted: 04/03/2022] [Indexed: 11/09/2022] Open
Abstract
AIM To investigate perceptions of individual QoL among acutely admitted older adults and explore whether homecare and readmission were associated with QoL. DESIGN A cross-sectional study at three Danish Emergency Departments. METHODS Semi-structured interviews, using the Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQol-DW) (range 0-100) with patients ≥65 years, were conducted from August 2018 to July 2019. The differences between patients receiving homecare (yes/no) and readmission (yes/no) were tested using linear regression analyses with bootstrap procedures. RESULTS Overall, we included 406 patients, of whom 38% received homecare. The mean SEIQoL-DW-score was 76 (SD = 19). The most important areas of individual QoL were Family, Social activities, Health, Everyday life and Leisure activities. Receiving homecare was associated to a significantly lower QoL score: -8 (SE = 2) and a significantly lower score in the categories Family and Health. There was no association between readmission and QoL.
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Affiliation(s)
- Mette Elkjaer
- Department of Emergency Medicine, University Hospital of Southern Denmark, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Christian B Mogensen
- Department of Emergency Medicine, University Hospital of Southern Denmark, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mikkel Brabrand
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Bibi Gram
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Research Unit of Health Sciences, University Hospital of Southern Denmark, Esbjerg, Denmark
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13
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Lytras D, Sykaras E, Iakovidis P, Kasimis K, Myrogiannis I, Kottaras A. Recording of Falls in Elderly Fallers in Northern Greece and Evaluation of Aging Health-Related Factors and Environmental Safety Associated with Falls: A Cross-Sectional Study. Occup Ther Int 2022; 2022:9292673. [PMID: 35082561 PMCID: PMC8759840 DOI: 10.1155/2022/9292673] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/05/2021] [Accepted: 12/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Elderly falls constitute a global problem with huge social and economic aspects. Fall risk factors are both intrinsic (physical and psychological) and extrinsic (related with environmental safety). AIM To record both intrinsic and extrinsic risk factors and their correlation in elderly fallers in order to suggest specific guidelines for their medical care and environmental modification inside and outside the home. METHOD The study involved 150 elderly fallers (median age 70 (67-74)), who completed a record containing information on known risk factors related to their health status, as well as information on the conditions and causes that led to the fall. Each fall was considered an independent event, while measurements were performed regarding balance, strength, their functional ability, and the fear of a possible fall. Descriptive analysis and frequency analysis were used to record the health and activity status of the participants as well as the fall-related environmental factors. Severity of each fall event across a variety of locations was examined using the Kruskal-Wallis one-way analysis of variance. Multiple linear regression was applied to examine the effect of the mean values of functional tests and medical records on the number of fall events. RESULTS In the span of 12 months, a total of 304 fall events were recorded. Regarding location, 77.6% occurred indoors; more frequent were the bedroom (28.6%) and the bathroom (28%). The interior stairs (10.5%), the kitchen (4.9%), and the living room (3.3%) were the less frequent locations. Concerning danger, falling on the interior stairs caused the longest hospitalization, followed by the kitchen and the bathroom. Extrinsic factors that led to both indoor and outdoor falls were the administration of psychotropic medication, poor space ergonomics, lack of basic safety standards, and poor lighting conditions. Vision problems and dizziness resulted in more falls than other intrinsic factors. Furthermore, reduced performance in the FICSIT-4 test and the 30-Second Chair Stand Test, as well as high scores in the CONFbal-GREEK questionnaire and the Short FES-I, shows a linear relationship with an increased number of falls. CONCLUSIONS Ergonomic interventions can help prevent indoor elderly falls. Poor construction and lack of adequate lighting mainly cause outdoor falls. Regular eye examinations, management of vertigo, improvement of the balance and strength of the lower limbs, and reduction of fear of impending falls are the intrinsic factors that help prevent falls the most.
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Affiliation(s)
- Dimitrios Lytras
- Department of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, 57001 Thermi Thessaloniki, Greece
| | - Evaggelos Sykaras
- Department of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, 57001 Thermi Thessaloniki, Greece
| | - Paris Iakovidis
- Department of Physiotherapy, Faculty of Health Sciences International Hellenic University-Alexander Campus, P.O. Box 141, 57 400 Sindos, Thessaloniki, Greece
| | - Konstantinos Kasimis
- Department of Physiotherapy, Faculty of Health Sciences International Hellenic University-Alexander Campus, P.O. Box 141, 57 400 Sindos, Thessaloniki, Greece
| | - Ioannis Myrogiannis
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece
| | - Anastasios Kottaras
- Department of Physiotherapy, Faculty of Health Sciences International Hellenic University-Alexander Campus, P.O. Box 141, 57 400 Sindos, Thessaloniki, Greece
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14
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Paiva EPD, Costa MAD, Souza TC, Almeida MCD, Silva MCMND, Loures FB. Associação entre quedas em idosos e grupo de prevenção. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2020-0207pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivos: avaliar a efetividade das orientações sobre prevenção de quedas em um grupo de idosos na Atenção Básica à Saúde. Métodos: estudo transversal, realizado com idosos selecionados por amostra aleatória simples (274; N=1.234). Os dados abrangeram variáveis sociodemográficas, socioeconômicas, estado civil, condições de saúde, fatores associados a quedas e participação no grupo de prevenção. Utilizou-se a técnica estatística descritiva teste t de Student, e as variáveis dicotômicas, pelo Teste do Qui-Quadrado. O projeto atendeu às exigências éticas. Resultados: amostragem com perfil feminino (61,7%), casados, apresentando baixa escolaridade, idade média de 71,69 anos. Os fatores associados a quedas identificados foram sexo feminino, medicalização e participação no grupo de prevenção. Não houve associação protetora entre realização de grupo de prevenção de quedas em idosos e diminuição do número de quedas. Conclusões: baseado nas evidencias, sugere-se uma intervenção personalizada durante a visita de enfermagem como estratégia para prevenção das quedas.
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15
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Paiva MMD, Lima MG, Barros MBDA. [Falls and health-related quality of life: influence of frequency and location type of falls]. CIENCIA & SAUDE COLETIVA 2021; 26:5099-5108. [PMID: 34787202 DOI: 10.1590/1413-812320212611.3.29902019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 11/03/2019] [Indexed: 11/22/2022] Open
Abstract
This article aims to evaluate health-related quality of life (HRQOL) according to the frequency and characteristics of falls in the elderly. A cross-sectional study was carried out with data from a household health survey conducted in 2014 and 2015, in Campinas, SP. The dependent variables were the SF-36 domains and, the independent ones, the occurrence and the characteristics of the falls. The mean and mean differences of the SF-36 scores were estimated by simple and multiple linear regression. The study reveals that the impact on HRQOL depends significantly on the characteristics of falls. Larger declines and a greater number of SF-36 domains were observed in the elderly who suffered three or more falls (compared to those with one or two falls), reporting falls from fainting/dizziness (compared to falls due to tripping), those who fell at home (versus falls occurring elsewhere) and reported falling limitation in daily activities. Only in the falls with these characteristics did the domain of emotional aspects be affected. The impact on HRQoL, including emotional aspects, depends on the characteristics of the falls that need to be considered in prevention actions and in the control of the consequences of falls in the quality of life of the elderly.
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Affiliation(s)
- Mariana Mapelli de Paiva
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil. .,Instituto Federal do Norte de Minas Gerais, Campus Almenara. Almenara MG Brasil
| | - Margareth Guimarães Lima
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
| | - Marilisa Berti de Azevedo Barros
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
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16
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Ren J, Li G, Zhang L, Zhang N, Ren J. Hypothetical Interventions for Falls Among Older Adults: An Application of the Parametric G-Formula. Front Med (Lausanne) 2021; 8:732136. [PMID: 34568390 PMCID: PMC8457044 DOI: 10.3389/fmed.2021.732136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: Falls, which have a higher incidence and mortality due to accidental injuries, are a major global health challenge. The effects of lifestyle factor, health indicator, psychological condition, and functional status interventions on the risk of falls are unknown and the conventional regression model would not adjust for the confounders. This study aimed to evaluate the 4-year risk of falls on the basis of these hypothetical interventions among Chinese older adults. Methods: Data were obtained from 9,692 aged 65 years and over older adults in the China Health and Retirement Longitudinal Study wave, from 2011 to 2015. We used the parametric g-formula to evaluate the risk of falls on the basis of independent hypothetical interventions of sleep duration, social activities, smoking status, drinking status, body mass index (BMI), systolic blood pressure (SBP), vision, depression, activities of daily living (ADL), and their different joint intervention combinations. Results: During the follow-up of 4 years, we documented 1,569 falls. The observed risk of falls was 23.58%. The risk ratios (95% confidence intervals [CIs]) of falls under the intensive hypothetical interventions on increasing sleep duration, participating in more social activities, quit smoking and drinking, reducing BMI and SBP, better vision, alleviating depressive symptoms, and improving ADL capability were 0.93 (0.87–0.96), 0.88 (0.79–0.92), 0.98 (0.95–1.03), 0.97 (0.95–1.02), 0.92 (0.86–1.03), 0.93 (0.87–1.04), 0.86 (0.74–0.91), 0.91 (0.85–0.96), and 0.79 (0.74–0.85), respectively. The feasible and intensive joint hypothetical intervention reduced the 4-year fall risk by 22% (95% CI: 0.52–0.91) and 33% (95% CI: 0.56–0.72), respectively. Conclusions: Hypothetical interventions for increasing sleep duration, participating in more social activities, better vision, alleviating depressive symptoms, and improving ADL capability help protect older adults from falls. Our findings suggest that a combination of lifestyle factors, health indicators, psychological conditions, and functional status may prove to be an effective strategy for preventing falls among older adults.
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Affiliation(s)
- Jiaojiao Ren
- Department of Preventive Medicine, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Guangyou Li
- Department of Preventive Medicine, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Liju Zhang
- Department of Preventive Medicine, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Na Zhang
- Department of Preventive Medicine, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Juan Ren
- Department of Preventive Medicine, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
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17
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Soh SLH, Tan CW, Thomas JI, Tan G, Xu T, Ng YL, Lane J. Falls efficacy: Extending the understanding of self-efficacy in older adults towards managing falls. J Frailty Sarcopenia Falls 2021; 6:131-138. [PMID: 34557612 PMCID: PMC8419849 DOI: 10.22540/jfsf-06-131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 11/04/2022] Open
Abstract
Falls efficacy is a widely studied construct. The understanding of falls efficacy has evolved over time. Falls efficacy was initially perceived to be suitably used as a measure of fear of falling. However, further research suggested that falls efficacy and fear of falling are distinct constructs, and therefore, would be inappropriate to be used as a proxy. Instead, some researchers posited that falls efficacy is synonymous with balance confidence. Falls efficacy has been conventionally understood as the perceived ability of individuals to perform activities without losing balance or falling. A recently conducted systematic review by the authors on existing falls efficacy related measures had revealed a fresh perspective of recognising falls efficacy as a perceived ability to manage a threat of a fall. Falls efficacy, with a broadened interpreted construct, relates to the individual’s perceived self-efficacy of performing necessary actions needed in different scenarios, including pre-fall, near-fall, fall-landing and completed fall. The conventional interpretation of falls efficacy needs a rethinking of perspective. An extended understanding of falls efficacy would provide an integral approach towards improving the agency of individual to deal with falls and would enhance person-centred care.
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Affiliation(s)
- Shawn Leng-Hsien Soh
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore.,Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Musselburgh, United Kingdom
| | - Chee-Wee Tan
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Janet I Thomas
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Musselburgh, United Kingdom
| | - Gideon Tan
- Department of Sport and Exercise Science, School of Sports, Health and Leisure, Republic Polytechnic, Singapore
| | - Tianma Xu
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Yoke Leng Ng
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore.,Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Judith Lane
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Musselburgh, United Kingdom
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18
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Sumner J, Chong L, Bundele A, Wei Lim Y. Co-Designing Technology for Aging in Place: A Systematic Review. THE GERONTOLOGIST 2021; 61:e395-e409. [PMID: 32506136 PMCID: PMC8437501 DOI: 10.1093/geront/gnaa064] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is a growing interest to involve older adults in the co-design of technology to maintain their well-being and independence. What remains unknown is whether the beneficial effects of co-designed solutions are greater than those reported for non co-designed solutions. The aim of this study was to evaluate the effects and experiences of co-designed technology that support older adults to age in place. RESEARCH DESIGN AND METHODS We conducted a systematic review to (a) investigate the health and well-being outcomes of co-designed technology for older adults (≥60 years), (b) identify co-design approaches and contexts where they are applied, and (c) identify barriers and facilitators of the co-design process with older adults. Searches were conducted in MEDLINE, EMBASE, CINAHL, Science Citation Index (Web of Science), Scopus, OpenGrey, and Business Source Premiere. RESULTS We identified 14,649 articles and included 34 projects. Four projects reported health and well-being outcomes; the effects were inconsistent. Co-design processes varied greatly and in their intensity of older adult involvement. Common facilitators of and barriers to co-design included the building of relationships between stakeholders, stakeholder knowledge of problems and solutions, and expertise in the co-design methodology. DISCUSSION AND IMPLICATIONS The effect of co-designed technology on health and well-being was rarely studied and it was difficult to ascertain its impact. Future co-design efforts need to address barriers unique to older adults. Evaluation of the impact of co-designed technologies is needed and standardization of the definition of co-design would be helpful to researchers and designers.
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Affiliation(s)
- Jennifer Sumner
- Yong Loo Lin School of Medicine, Department of Medicine, National University of Singapore, Singapore
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Lin Siew Chong
- Yong Loo Lin School of Medicine, Department of Medicine, National University of Singapore, Singapore
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Anjali Bundele
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Yee Wei Lim
- Yong Loo Lin School of Medicine, Department of Medicine, National University of Singapore, Singapore
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
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19
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Law RJ, Langley J, Hall B, Burton C, Hiscock J, Williams L, Morrison V, Lemmey AB, Lovell-Smith C, Gallanders J, Cooney J, Williams NH. Promoting physical activity and physical function in people with long-term conditions in primary care: the Function First realist synthesis with co-design. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this decline; however, the best approach is uncertain.
Objectives
To develop a programme theory to explain the mechanisms through which interventions improve physical activity and physical function in people with long-term conditions in different primary care contexts, and to co-design a prototype intervention.
Data sources
Systematic literature searches of relevant databases with forwards and backwards citation tracking, grey literature searches and further purposive searches were conducted. Qualitative data were collected through workshops and interviews.
Design
Realist evidence synthesis and co-design for primary care service innovation.
Setting
Primary care in Wales and England.
Participants
Stakeholders included people with long-term conditions, primary care professionals, people working in relevant community roles and researchers.
Methods
The realist evidence synthesis combined evidence from varied sources of literature with the views, experiences and ideas of stakeholders. The resulting context, mechanism and outcome statements informed three co-design workshops and a knowledge mobilisation workshop for primary care service innovation.
Results
Five context, mechanism and outcome statements were developed. (1) Improving physical activity and function is not prioritised in primary care (context). If the practice team culture is aligned to the elements of physical literacy (mechanism), then physical activity promotion will become routine and embedded in usual care (outcome). (2) Physical activity promotion is inconsistent and unco-ordinated (context). If specific resources are allocated to physical activity promotion (in combination with a supportive practice culture) (mechanism), then this will improve opportunities to change behaviour (outcome). (3) People with long-term conditions have varying levels of physical function and physical activity, varying attitudes to physical activity and differing access to local resources that enable physical activity (context). If physical activity promotion is adapted to individual needs, preferences and local resources (mechanism), then this will facilitate a sustained improvement in physical activity (outcome). (4) Many primary care practice staff lack the knowledge and confidence to promote physical activity (context). If staff develop an improved sense of capability through education and training (mechanism), then they will increase their engagement with physical activity promotion (outcome). (5) If a programme is credible with patients and professionals (context), then trust and confidence in the programme will develop (mechanism) and more patients and professionals will engage with the programme (outcome). A prototype multicomponent intervention was developed. This consisted of resources to nurture a culture of physical literacy, materials to develop the role of a credible professional who can promote physical activity using a directory of local opportunities and resources to assist with individual behaviour change.
Limitations
Realist synthesis and co-design is about what works in which contexts, so these resources and practice implications will need to be modified for different primary care contexts.
Conclusions
We developed a programme theory to explain how physical activity could be promoted in primary care in people with long-term conditions, which informed a prototype intervention.
Future work
A future research programme could further develop the prototype multicomponent intervention and assess its acceptability in practice alongside existing schemes before it is tested in a feasibility study to inform a future randomised controlled trial.
Study registration
This study is registered as PROSPERO CRD42018103027.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Beth Hall
- Library and Archives Services, Bangor University, Bangor, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Julia Hiscock
- School of Health Sciences, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Health Sciences, Bangor University, Bangor, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew B Lemmey
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | - Jennifer Cooney
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Nefyn H Williams
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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20
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Law RJ, Langley J, Hall B, Burton C, Hiscock J, Williams L, Morrison V, Lemmey A, Lovell-Smith C, Gallanders J, Cooney JK, Williams N. 'Function First': how to promote physical activity and physical function in people with long-term conditions managed in primary care? A study combining realist and co-design methods. BMJ Open 2021; 11:e046751. [PMID: 34315792 PMCID: PMC8317101 DOI: 10.1136/bmjopen-2020-046751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by the programme theory. DESIGN Realist synthesis combining evidence from a wide range of rich and relevant literature with stakeholder views. Resulting context, mechanism and outcome statements informed co-design and knowledge mobilisation workshops with stakeholders to develop a primary care service innovation. RESULTS A taxonomy was produced, including 13 categories of physical activity interventions for people with long-term conditions. ABRIDGED REALIST PROGRAMME THEORY Routinely addressing physical activity within consultations is dependent on a reinforcing practice culture, and targeted resources, with better coordination, will generate more opportunities to address low physical activity. The adaptation of physical activity promotion to individual needs and preferences of people with long-term conditions helps affect positive patient behaviour change. Training can improve knowledge, confidence and capability of practice staff to better promote physical activity. Engagement in any physical activity promotion programme will depend on the degree to which it makes sense to patients and professions, and is seen as trustworthy. CO-DESIGN The programme theory informed the co-design of a prototype intervention to: improve physical literacy among practice staff; describe/develop the role of a physical activity advisor who can encourage the use of local opportunities to be more active; and provide materials to support behaviour change. CONCLUSIONS Previous physical activity interventions in primary care have had limited effect. This may be because they have only partially addressed factors emerging in our programme theory. The co-designed prototype intervention aims to address all elements of this emergent theory, but needs further development and consideration alongside current schemes and contexts (including implications relevant to COVID-19), and testing in a future study. The integration of realist and co-design methods strengthened this study.
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Affiliation(s)
- Rebecca-Jane Law
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | | | - Beth Hall
- Library and Archives Services, Bangor University, Bangor, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Julia Hiscock
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew Lemmey
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | | | - Nefyn Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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21
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Cezar NODC, Ansai JH, Oliveira MPBD, da Silva DCP, Gomes WDL, Barreiros BA, Langelli TDCO, de Andrade LP. Feasibility of improving strength and functioning and decreasing the risk of falls in older adults with Alzheimer's dementia: a randomized controlled home-based exercise trial. Arch Gerontol Geriatr 2021; 96:104476. [PMID: 34260986 DOI: 10.1016/j.archger.2021.104476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the effects of a Home-based multimodal exercise program for older people with Alzheimer's disease (AD-HOMEX) on muscle strength, mobility, the risk of falls and functioning. MATERIALS AND METHODS A trial with a blinded assessor was conducted involving 40 older people with mild to moderate AD randomized to an intervention group (IG) or control group (CG). The IG participated in a 16-week protocol with three 60-minute sessions per week. The sessions were performed at the participant's home by a physiotherapist and involved progressive individualized physical exercises. Muscle strength (5X Sit-to-Stand Test [5XSTS], 30-Second Chair Stand test, isokinetic and hand-grip dynamometer), functioning (DAFS-R and ADL-Q), mobility and the risk of falls (TUG) were assessed at baseline and after training. Intention-to-treat analysis was adopted. RESULTS There was a significant group-evaluation time interaction for the 5XSTS (p = 0.011). The IG demonstrated an improved performance on the 5XSTS (p = 0.020) and a reduced risk of falls (p = 0.000), whereas the CG exhibited a worse functional limitation (p = 0.008) after 16 weeks. The CG had an increased risk of falls (p = 0.006) and worse performance on the ADL-Q (p = 0.047) at the follow-up evaluation. An improvement in the IG and worsening in the CG were found regarding transition patterns between severity levels of functional limitation based on the ADL-Q. CONCLUSIONS Home-based physical exercise for older people with mild to moderate AD is an effective strategy that decreases the risk of falls and improves strength and functioning.
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Affiliation(s)
- Natália Oiring de Castro Cezar
- Department of Physical Therapy, Federal University of São Carlos; Department of Gerontology, Federal University of São Carlos.
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The Effect of Different Exercise Training Types on Functionality in Older Fallers. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Lees C, O'Brien T, Maganaris C. A mirror image: experiences of informal carers caring for frail, older persons at risk from falling. Br J Community Nurs 2021; 26:64-68. [PMID: 33539239 DOI: 10.12968/bjcn.2021.26.2.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Falls can lead to social isolation, anxiety and depression for those who fall, although little is known about how informal carers manage those at risk from falling at home. This study aimed to explore the experiences of informal carers who care for frail, older people at risk from falling at home. A qualitative study using thematic analysis was conducted for this purpose. Data were collected via one-to-one, semi-structured interviews. Informal carers experienced social isolation, significant adjustments to their working lives, a fear of further falls, tiredness, anxiety and depression. These findings mirror previous observations, which have found that falling is a predictor of both physical and psychological changes, although in those who fall rather than those who care for them. This highlights the need for both health and social care services to identify the impact of care recipient falls on the informal carer.
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Affiliation(s)
- Carolyn Lees
- Senior Lecturer, Liverpool John Moores University
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24
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Vikström S, Grönstedt HK, Cederholm T, Franzén E, Seiger Å, Faxén-Irving G, Boström AM. A health concept with a social potential: an interview study with nursing home residents. BMC Geriatr 2020; 20:324. [PMID: 32887570 PMCID: PMC7487501 DOI: 10.1186/s12877-020-01731-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 08/23/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A qualitative, interview-based study was embedded in a randomized intervention trial, the Older People Exercise and Nutrition (OPEN) study. Participants in the OPEN study were encouraged to conduct sessions of sit-to-stand (STS) exercises combined with Oral Nutritional Supplements (ONS) intake. The aim was to describe the older persons' perceptions and experiences of being given the daily opportunity to perform the STS exercise and drink ONS. METHODS In-depth interviews were conducted in six nursing homes with the participants using a semi-structured interview guide. One or two individual interviews were performed with each included participant. Twenty-three NH residents (16 women and 7 men) participated in the qualitative study. Their ages ranged between 76 and 96 years, and their Mini Mental State Examination (MMSE) scored between 8 and 29. The transcribed interviews and field notes written during the visits were analyzed inductively following a constant comparative method described in Grounded Theory. RESULTS The exercise and nutritional intervention was described as highly practical by the NH residents, who claimed it also had a social aspect as they felt acknowledged and empowered to engage others in the combined intervention. Experiences of the intervention ranged from neutral to mainly positive and could be sorted into 5 categories: 1. Perceived hopes and expectations, 2. Health-related driving forces, 3. Appreciated daily activities, 4. A concept easy to perform and integrate into daily life, 5. A beneficial health concept for all. The intervention created perceived benefits on various health aspects due to participants feeling energized and stronger. An overall theme was identified as A health concept with a social potential, as participants feel acknowledged and strong enough to help others. CONCLUSIONS The intervention was described by participants as a health concept that could potentially be beneficial for a broader spectrum of NH residents. The findings indicate that health concepts, such as STS/ONS, might contribute to a more meaningful day for older people, even vulnerable NH residents approaching the end of life. TRIAL REGISTRATION ClinicalTrials.govIdentifier: NCT02702037 . Date of trial registration February 26, 2016.
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Affiliation(s)
- Sofia Vikström
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden.
- Stockholms Sjukhem R&D unit, Stockholm, Sweden.
- Openlab, Stockholm, Sweden.
| | - Helena K Grönstedt
- Stockholms Sjukhem R&D unit, Stockholm, Sweden
- Allied Health Professionals, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Tommy Cederholm
- Department of Geriatric Medicine, Uppsala University Hospital, Uppsala, Sweden
- Karolinska University Hospital, Theme Aging, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Erika Franzén
- Stockholms Sjukhem R&D unit, Stockholm, Sweden
- Allied Health Professionals, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Science and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Åke Seiger
- Department of Neurobiology, Care Science and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Gerd Faxén-Irving
- Stockholms Sjukhem R&D unit, Stockholm, Sweden
- Department of Neurobiology, Care Science and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Anne-Marie Boström
- Stockholms Sjukhem R&D unit, Stockholm, Sweden
- Karolinska University Hospital, Theme Aging, Stockholm, Sweden
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
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Dermody G, Whitehead L, Wilson G, Glass C. The Role of Virtual Reality in Improving Health Outcomes for Community-Dwelling Older Adults: Systematic Review. J Med Internet Res 2020; 22:e17331. [PMID: 32478662 PMCID: PMC7296414 DOI: 10.2196/17331] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/05/2020] [Accepted: 04/10/2020] [Indexed: 01/27/2023] Open
Abstract
Background Virtual reality (VR) delivered through immersive headsets creates an opportunity to deliver interventions to improve physical, mental, and psychosocial health outcomes. VR app studies with older adults have primarily focused on rehabilitation and physical function including gait, balance, fall prevention, pain management, and cognition. Several systematic reviews have previously been conducted, but much of the extant literature is focused on rehabilitation or other institutional settings, and little is known about the effectiveness of VR apps using immersive headsets to target health outcomes among community-dwelling older adults. Objective The objective of this review was to evaluate the effectiveness of VR apps delivered using commercially available immersive headsets to improve physical, mental, or psychosocial health outcomes in community-dwelling older adults. Methods Peer-reviewed publications that included community-dwelling older adults aged ≥60 years residing in residential aged care settings and nursing homes were included. This systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness evidence. The title of this review was registered with JBI, and the systematic review protocol was registered with the International Prospective Register of Systematic Reviews. Results In total, 7 studies that specifically included community-dwelling older adults were included in this review. VR apps using a head-mounted display led to improvements in a number of health outcomes, including pain management, posture, cognitive functioning specifically related to Alzheimer disease, and a decreased risk of falls. A total of 6 studies reported a statistically significant difference post VR intervention, and 1 study reported an improvement in cognitive function to reduce navigational errors. Only one study reported on the usability and acceptability of the interventions delivered through VR. While one study used a distraction mechanism for pain management, none of the studies used gaming technology to promote enjoyment. Conclusions Interventions to improve health outcomes through VR have demonstrated potential; however, the ability to synthesize findings by primary outcome for the older adult population is not possible. A number of factors, especially related to frailty, usability, and acceptability, also need to be explored before more substantial recommendations on the effectiveness of VR interventions for older adults can be made. Trial Registration PROSPERO CRD42019143504; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143504
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Affiliation(s)
- Gordana Dermody
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | | | - Courtney Glass
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
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Cederbom S, Bjerk M, Bergland A. A qualitative study exploring physical therapists' views on the Otago Exercise Programme for fall prevention: a stepping stone to "age in place" and to give faith in the future. Physiother Theory Pract 2020; 38:132-140. [PMID: 32090667 DOI: 10.1080/09593985.2020.1731895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: One of the most effective interventions to prevent falls is exercise. A commonly used program that prevents falls is the Otago Exercise Programme (OEP). Despite this, user-based knowledge of its applicability in real-world settings for older adults who are dependent on formal care in their homes is lacking. Purposes: To explore how physical therapists (PTs) experience the applicability of the OEP in clinical practice for home-dwelling older adults who are dependent on formal home care and to determine their beliefs regarding the benefits of the OEP for living longer at home. Methods: Semi-structured interviews were conducted with 17 physical therapists. Data were analyzed using qualitative thematic analysis. Results: The OEP was described by PTs to be applicable in clinical practice. Their experience was that the OEP seemed to be meaningful and to have a strong relationship with everyday activities. The OEP improved physical function, mood, self-efficacy, and participation in social activities in older adults, as well as provided faith in the future. Conclusion: The OEP is suitable for use in a primary care setting, and according to the perceptions of physical therapists, the OEP contributes to older adults' capability to live longer at home.
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Affiliation(s)
- Sara Cederbom
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Maria Bjerk
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Effects of A "Modified" Otago Exercise Program on the Functional Abilities and Social Participation of Older Adults Living in the Community-The AGA@4life Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041258. [PMID: 32075307 PMCID: PMC7068357 DOI: 10.3390/ijerph17041258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 11/17/2022]
Abstract
Strength and balance exercises form part of multifactorial programs to reduce the risk of falling and promote active ageing. The aim of this study was to evaluate the effect of a strength and balance exercise program, adapted from the traditional Otago Exercise Program (OTAGO) into a technological system. A non-randomized experimental study enrolled 34 participants (83.24 ± 6.89 years) from a daycare center in Portugal, who were distributed into an intervention group (IG; 18 participants) and a control group (CG; 16 participants). The IG underwent a "modified" OTAGO incorporated in a technological system using pressure and inertial sensors, feedback, and Exergames for 8 weeks, 3 times a week. The CG continued their regular activities. Outcome measures were evaluated at baseline and after 8 weeks of intervention. After the program, differences were observed between the groups in handgrip strength (p = 0.03), step test (p = 0.03), 4stage balance test "modified" (p < 0.001) and activities and participation profile related to mobility (PAPM) (p < 0.001). The IG showed positive results in the self-efficacy for exercise (p = 0.03), PAPM (p = 0.00) and all functional tests, except for timed up and go (p = 0.35). No significant changes were observed in the CG. The results support this intervention program as a good exercise solution to improve functional abilities, social participation, and self-efficacy, reducing the risk of falling.
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Bjerk M, Brovold T, Davis JC, Skelton DA, Bergland A. Health-related quality of life in home care recipients after a falls prevention intervention: a 6-month follow-up. Eur J Public Health 2020; 30:64-69. [PMID: 31169888 DOI: 10.1093/eurpub/ckz106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Falls in older adults are an increasingly important public health concern due to the expanding older population and contribute considerably to the global burden of disease. Home care recipients have a high incidence of falls and a low level of health-related quality of life (HRQOL). In this understudied group of older adults, exercise interventions could prevent falls, promote HRQOL and enable healthy ageing in the longer term. METHODS The study is a single-blinded parallel-group randomized controlled trial, lasting 3 months with a follow-up at 6 months, conducted in primary care. The objective was to explore the effects of a falls prevention exercise programme post-intervention at a 6-month follow-up in home care recipients 67+ years with a history of falls. The Otago Exercise Programme lasting 3 months was performed. The primary outcome was HRQOL measured by the Short Form 36 Health Survey (SF-36). Linear mixed regression models and structural equation models were employed. RESULTS At 6-month follow-up, the intervention group scored significantly higher on SF-36's physical component summary compared with the controls; 3.0 points, 95% confidence interval (CI) = 0.4, 5.6. This effect was mediated by an increased probability of maintaining exercise in the post-intervention period; odds ratio = 2.3 (CI = 1.1, 5.1). Exercising was associated with a 7.1-point increase in physical component summary (CI = 3.2, 10.9). CONCLUSION A falls prevention exercise programme can improve physical HRQOL in home care recipients post-intervention. The exercise programme also led to longer-term changes in exercise behaviour mediating this effect.
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Affiliation(s)
- Maria Bjerk
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Therese Brovold
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia, Vancouver, BC, Canada
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Astrid Bergland
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Conde M, Hendry G, Skelton DA. The Footfall Programme: participant experiences of a lower limb, foot and ankle exercise intervention for falls prevention - an exploratory study. J Frailty Sarcopenia Falls 2019; 4:78-90. [PMID: 32300722 PMCID: PMC7155362 DOI: 10.22540/jfsf-04-078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Despite growing evidence that foot and ankle exercise programmes are effective for falls prevention, little is known about older adults' views and preferences of programme components for long-term maintenance. The aims of this study were to explore the experiences and acceptability of Scottish and Portuguese older adults of undertaking a home-based foot, ankle and lower limb exercise intervention. METHODS Ten Scottish (mean age 76 years, 7 female) and fourteen Portuguese (mean age 66 years, 12 female) community-dwelling older adults undertook the programme for one week, followed by focus group discussions (2-6 people per group), guided by a semi-structured interview guide. Data was analysed using thematic analysis. RESULTS Seven themes were identified:Assessment, Group exercise taster, Home based exercise; Footfall programme kit, Midweek phone call, Reasons for participation and the Research Process. Programme components, support telephone calls and research procedures were generally well accepted by participants and they valued having a contribution to the design. They preferred a blended home and intermittent group-based programme format for motivation and progression and recommended changes to some of the exercises and equipment to reduce barriers to participation. Some cultural differences emerged, including importance of the functional assessments for Portuguese participants, time issues and difficulty in completion of the exercise diary, reflecting lower literacy levels. CONCLUSIONS Participants found the programme acceptable but preferred a blended home and occasional group-based programme for adherence and motivation. A strong educational component to improve health literacy and simple paperwork completion to avoid data loss in future studies with Portuguese older adults is important.
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Affiliation(s)
- Monserrat Conde
- School of Health & Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Gordon Hendry
- School of Health & Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Dawn A. Skelton
- School of Health & Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
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Bjerk M, Brovold T, Davis JC, Bergland A. Evaluating a falls prevention intervention in older home care recipients: a comparison of SF-6D and EQ-5D. Qual Life Res 2019; 28:3187-3195. [PMID: 31364036 DOI: 10.1007/s11136-019-02258-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Health-related quality of life (HRQOL) is an important outcome in economic evaluations of health care interventions for older adults. The aim of this study was to compare two commonly used preference-based utility measures, SF-6D and EQ-5D, to provide knowledge on their applicability when evaluating falls prevention interventions in primary health care. METHODS The study is a secondary analysis of longitudinal data from a randomised controlled trial, which included 155 older home care recipients participating in a falls prevention intervention in Norway. HRQOL was measured by SF-6D and EQ-5D. Physical function was measured by Berg Balance Scale, 4-m walk test, 30-s sit-to-stand and Falls Efficacy Scale International. Assessments were performed at baseline, 3 months and 6 months. The agreement between SF-6D and EQ-5D was examined using Bland-Altman plots and Spearman correlations. Elasticities from regression analysis were employed to compare the instruments' responsiveness. RESULTS SF-6D and EQ-5D were strongly correlated (0.71), but there were differences in the instruments' agreement and domains of HRQOL covered. Participants with a higher mean HRQOL and/or better physical function scored generally higher on EQ-5D. Participants with a lower mean HRQOL and/or poorer physical function achieved a relatively higher score on SF-6D. EQ-5D was more responsive to changes in physical function compared to SF-6D. CONCLUSIONS SF-6D and EQ-5D have both similarities and differences regarding sensitivity, domains covered and responsiveness to changes when evaluating a falls prevention intervention. Selecting the appropriate instrument depends on the characteristics of the participants and the intervention being evaluated.
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Affiliation(s)
- Maria Bjerk
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway.
| | - Therese Brovold
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia Okanagan, Kelowna, Canada
| | - Astrid Bergland
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway
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Bjerk M, Brovold T, Skelton DA, Liu-Ambrose T, Bergland A. Effects of a falls prevention exercise programme on health-related quality of life in older home care recipients: a randomised controlled trial. Age Ageing 2019; 48:213-219. [PMID: 30615055 DOI: 10.1093/ageing/afy192] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 12/09/2018] [Accepted: 11/23/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND falls have serious consequences for quality of life (QOL) and contribute substantially to the global burden of disease. Home care is an important arena to address falls prevention and QOL, but this vulnerable group of older adults is underrepresented in health research. This study explores the effects of a falls prevention exercise programme on health-related quality of life (HRQOL), physical function and falls self-efficacy in older fallers receiving home care. METHODS the study design is a parallel-group randomised controlled trial. The intervention group performed a falls prevention programme based on the Otago Exercise Programme (OEP). The control group received usual care. 155 participants were recruited from primary health care in six Norwegian municipalities. Local physiotherapists supervised the programme. The primary outcome, HRQOL, was measured by the Short-Form 36 Health Survey (SF-36). Secondary outcomes were Berg Balance Scale (BBS), 30-s sit to stand (STS), 4-m walk test, instrumental activities of daily living and Falls Efficacy Scale International. RESULTS intention-to-treat analysis showed that, compared to the control group, the intervention group improved on SF-36's physical component summary as well as BBS. However, the intervention group also demonstrated a decline in the mental health subscale of SF-36. Per-protocol analyses showed significant improvements in all physical subscales of SF-36, STS and BBS scores in the intervention group compared with the control group. CONCLUSION a falls prevention exercise programme based on OEP significantly improved physical HRQOL and balance in older adults receiving home care. TRIAL REGISTRATION ClinicalTrials.gov. NCT02374307. First registration, 16 February 2015.
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Affiliation(s)
- Maria Bjerk
- Department of Physiotherapy, OsloMet—Oslo Metropolitan University, PO Box 4 St. Olavs Plass, Oslo, Norway
| | - Therese Brovold
- Department of Physiotherapy, OsloMet—Oslo Metropolitan University, PO Box 4 St. Olavs Plass, Oslo, Norway
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Astrid Bergland
- Department of Physiotherapy, OsloMet—Oslo Metropolitan University, PO Box 4 St. Olavs Plass, Oslo, Norway
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Atler KE, Schmid AA, Klinedinst TC, Grimm LA, Marchant TP, Marchant DR, Malcolm MP. The Relationship between Quality of Life, Activity and Participation among People with Type 2 Diabetes Mellitus. Occup Ther Health Care 2018; 32:341-362. [PMID: 30380958 DOI: 10.1080/07380577.2018.1522017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The cross-sectional study investigated the relationship between quality of life, activity, and participation in 93 adults with type 2 diabetes mellitus at a primary care center. Moderately strong correlations were found between quality of life and leisure/work, outdoor and social activities, but not with domestic activities. Leisure/work, outdoor, and social activities accounted for 18% of the variance in the quality of life variables. In a follow-up model, age, depression, and falls efficacy accounted for another 51% of the variance in total quality of life. Findings provide support for the expansion of occupational therapy's role in diabetes self-management, to incorporate leisure, social, and community activities and fall risk management interventions.
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Affiliation(s)
- Karen E Atler
- a Occupational Therapy Department , Colorado State University , Fort Collins , CO , USA
| | - Arlene A Schmid
- a Occupational Therapy Department , Colorado State University , Fort Collins , CO , USA
| | - Tara C Klinedinst
- a Occupational Therapy Department , Colorado State University , Fort Collins , CO , USA
| | - Laura A Grimm
- a Occupational Therapy Department , Colorado State University , Fort Collins , CO , USA
| | - Tasha P Marchant
- b Family Medicine Center , University of Colorado Health , Fort Collins , CO , USA
| | - David R Marchant
- b Family Medicine Center , University of Colorado Health , Fort Collins , CO , USA
| | - Matt P Malcolm
- c Occupational Therapy Department, Colorado School of Public Health , Colorado State University , Fort Collins , CO , USA
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Bjerk M, Brovold T, Skelton DA, Bergland A. Associations between health-related quality of life, physical function and fear of falling in older fallers receiving home care. BMC Geriatr 2018; 18:253. [PMID: 30348098 PMCID: PMC6198355 DOI: 10.1186/s12877-018-0945-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls and injuries in older adults have significant consequences and costs, both personal and to society. Although having a high incidence of falls, high prevalence of fear of falling and a lower quality of life, older adults receiving home care are underrepresented in research on older fallers. The objective of this study is to determine the associations between health-related quality of life (HRQOL), fear of falling and physical function in older fallers receiving home care. METHODS This study employed cross-sectional data from baseline measurements of a randomised controlled trial. 155 participants, aged 67+, with at least one fall in the previous year, from six Norwegian municipalities were included. Data on HRQOL (SF-36), physical function and fear of falling (FES-I) were collected in addition to demographical and other relevant background information. A multivariate regression model was applied. RESULTS A higher score on FES-I, denoting increased fear of falling, was significantly associated with a lower score on almost all subscales of SF-36, denoting reduced HRQOL. Higher age was significantly associated with higher scores on physical function, general health, mental health and the mental component summary. This analysis adjusted for sex, education, living alone, being at risk of or malnourished, physical function like balance and walking speed, cognition and number of falls. CONCLUSION Fear of falling is important for HRQOL in older fallers receiving home care. This association is independent of physical measures. Better physical function is significantly associated with higher physical HRQOL. Future research should address interventions that reduce fear of falling and increase HRQOL in this vulnerable population. TRIAL REGISTRATION ClinicalTrials.gov. NCT02374307 . First registration, 16 February 2015. First enrolment of participants, February 2016.
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Affiliation(s)
- Maria Bjerk
- Department of Physiotherapy, OsloMet – Oslo Metropolitan University, PO Box 4 St. Olavs plass, 0130 Oslo, Norway
| | - Therese Brovold
- Department of Physiotherapy, OsloMet – Oslo Metropolitan University, PO Box 4 St. Olavs plass, 0130 Oslo, Norway
| | - Dawn A. Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Astrid Bergland
- Department of Physiotherapy, OsloMet – Oslo Metropolitan University, PO Box 4 St. Olavs plass, 0130 Oslo, Norway
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