Falls risk score removal does not impact inpatient falls : a stepped-wedge, cluster-randomised trial
- Jellett, Joanna, Williams, Cylie, Clayton, Diana, Plummer, Virginia, Haines, Terry
- Authors: Jellett, Joanna , Williams, Cylie , Clayton, Diana , Plummer, Virginia , Haines, Terry
- Date: 2020
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 29, no. 23-24 (2020), p. 4505-4513
- Full Text: false
- Reviewed:
- Description: Aims and objectives: To investigate the impact of removing a falls risk screening tool from an overall falls risk assessment programme on the rate of falls, injurious falls and completion of falls prevention activities by staff. Background: Falls in older patients are common adverse events in hospital settings. Screening and assessing individual patients for risk of falls are a common, but controversial element of falls prevention strategies in hospitals. Design: A stepped-wedge, cluster-randomised controlled trial using a disinvestment approach. Methods: This trial was carried out according to the Consolidated Standards of Reporting Trials (CONSORT). All patients were admitted to 20 health service wards (9 units) over the 10-month study period. The control condition contained a falls risk screening tool element, a full falls risk factor assessment and intervention provision section. In the intervention condition, only the full falls risk factor assessment and intervention provision section was applied, and the falls risk screening tool element was removed. Fall rates were extracted from hospital level data, files were audited for tool completion, and nurses surveyed about tool use. Results: There did not appear to be an impact on the falls rate per month when the risk screening tool component was removed (incidence rate ratio (IRR) = 0.84—favours intervention, 95%CI = 0.67 to 1.05, p =.14) nor on the falls rate with serious injury (IRR = 0.90, 95%CI = 0.26 to 3.09, p =.87). There was a thirty-six second reduction of time per patient reported by staff to complete paperwork (p <.001). There was no difference in the proportion of patients for whom the tool was completed, nor the number of falls prevention interventions identified for implementation. Conclusion: Removing the falls risk screening tool section did not negatively impact falls and reduced time spent completing falls prevention paperwork. Relevance to clinical practice: Falls prevention is an important issue in health services. Removal of a screening risk tool is unlikely to impact falls. This has the potential to reduce nursing administration time that may be otherwise redirected to individual approaches to falls prevention. © 2020 John Wiley & Sons Ltd
Evaluation of knowledge translation and workforce development through targeted exercise for falls prevention education programs for exercise physiologists
- Authors: Pascoe, Deborah
- Date: 2015
- Type: Text , Thesis , PhD
- Full Text:
- Description: There is a wealth of evidence supporting the positive effects of exercise for falls prevention. The problem that faces researchers, policy makers, accreditation bodies and higher education providers is how to best translate this information to allied health practitioners to ensure they are providing the best evidence-based practice to their clients. One in three community dwelling older people over the age of 65 years fall every year and this figure increases to one in two people over the age of 80 years. As a profession, exercise physiologists (EPs) are responsible for providing exercise for the prevention, maintenance and treatment of chronic disease and complex medical conditions, including prescribing exercise for falls prevention. The incidence of falls, chronic disease and complex medical conditions increases with age and as Australia moves towards an ever ageing population, the cost burden of health care for older people and falls is exploding. Exercise physiology and exercise science professionals have an opportunity to become champions of exercise for falls prevention and assist in ameliorating the ever increasing burden of falls in Australia. By targeting the exercise physiology profession and providing methods to translate the research evidence, there is great potential to build workforce capacity to deliver falls prevention exercise programs. But how best to target the profession of exercise physiology? Advances can be made by targeting undergraduate and post-graduate university programs or as part of mandated professional continuing education programs which focuses on both the future and current exercise physiology workforce respectively. A scoping study conducted across two States in Australia (New South Wales and Victoria) established that at the time, the current level of knowledge of undergraduate human movement and exercise and sports science students and post graduate exercise rehabilitation/exercise physiology students, was inadequate with regard to falls risk and exercise prescription for fall prevention in older people. These results highlighted the need for the development and widespread implementation of an evidence-based “exercise for falls prevention” curriculum for future exercise professionals. The UniFPEP curriculum was developed to provide evidence-based teaching and learning resource materials to enhance learning beyond current levels by translating the latest research evidence regarding falls risk and exercises for falls prevention to produce a discipline leading curriculum. The curriculum was designed to enhance exercise science and exercise rehabilitation students’ learning outcomes through the provision of online lectures and learning materials to supplement and strengthen the delivery of face-to-face lectures, practical classes and self-directed learning tasks. The UniFPEP curriculum was implemented at the University of Ballarat and following completion students’ knowledge outcomes and self-reported confidence to prescribe exercise for older people and for falls prevention were significantly increased. The results indicated that a significant change in knowledge and confidence can be achieved during a 2-3 week educational period during a normal university semester. More importantly, these changes were retained 13 weeks after completion of the UniFPEP curriculum. Following evaluation of the UniFPEP the curriculum was reviewed and prepared as a workforce continuing education program (CEP) (Fit+Fall=Free). This was implemented and evaluated as a clustered controlled trial to compare two different delivery modes: face-to-face and online, to a control group of exercise physiology professionals. The Fit+Fall=Free CEP showed significant improvements in the knowledge and confidence of EPs in prescribing exercise for older people and exercise prescription for falls prevention for both the face-to-face (F2F) and Online delivery modes. The F2F delivery of the Fit+Fall=Free CEP provided the greatest long-term impact with the increases being maintained at a significant level six months post workshop.
- Description: Doctor of Philosophy
- Authors: Pascoe, Deborah
- Date: 2015
- Type: Text , Thesis , PhD
- Full Text:
- Description: There is a wealth of evidence supporting the positive effects of exercise for falls prevention. The problem that faces researchers, policy makers, accreditation bodies and higher education providers is how to best translate this information to allied health practitioners to ensure they are providing the best evidence-based practice to their clients. One in three community dwelling older people over the age of 65 years fall every year and this figure increases to one in two people over the age of 80 years. As a profession, exercise physiologists (EPs) are responsible for providing exercise for the prevention, maintenance and treatment of chronic disease and complex medical conditions, including prescribing exercise for falls prevention. The incidence of falls, chronic disease and complex medical conditions increases with age and as Australia moves towards an ever ageing population, the cost burden of health care for older people and falls is exploding. Exercise physiology and exercise science professionals have an opportunity to become champions of exercise for falls prevention and assist in ameliorating the ever increasing burden of falls in Australia. By targeting the exercise physiology profession and providing methods to translate the research evidence, there is great potential to build workforce capacity to deliver falls prevention exercise programs. But how best to target the profession of exercise physiology? Advances can be made by targeting undergraduate and post-graduate university programs or as part of mandated professional continuing education programs which focuses on both the future and current exercise physiology workforce respectively. A scoping study conducted across two States in Australia (New South Wales and Victoria) established that at the time, the current level of knowledge of undergraduate human movement and exercise and sports science students and post graduate exercise rehabilitation/exercise physiology students, was inadequate with regard to falls risk and exercise prescription for fall prevention in older people. These results highlighted the need for the development and widespread implementation of an evidence-based “exercise for falls prevention” curriculum for future exercise professionals. The UniFPEP curriculum was developed to provide evidence-based teaching and learning resource materials to enhance learning beyond current levels by translating the latest research evidence regarding falls risk and exercises for falls prevention to produce a discipline leading curriculum. The curriculum was designed to enhance exercise science and exercise rehabilitation students’ learning outcomes through the provision of online lectures and learning materials to supplement and strengthen the delivery of face-to-face lectures, practical classes and self-directed learning tasks. The UniFPEP curriculum was implemented at the University of Ballarat and following completion students’ knowledge outcomes and self-reported confidence to prescribe exercise for older people and for falls prevention were significantly increased. The results indicated that a significant change in knowledge and confidence can be achieved during a 2-3 week educational period during a normal university semester. More importantly, these changes were retained 13 weeks after completion of the UniFPEP curriculum. Following evaluation of the UniFPEP the curriculum was reviewed and prepared as a workforce continuing education program (CEP) (Fit+Fall=Free). This was implemented and evaluated as a clustered controlled trial to compare two different delivery modes: face-to-face and online, to a control group of exercise physiology professionals. The Fit+Fall=Free CEP showed significant improvements in the knowledge and confidence of EPs in prescribing exercise for older people and exercise prescription for falls prevention for both the face-to-face (F2F) and Online delivery modes. The F2F delivery of the Fit+Fall=Free CEP provided the greatest long-term impact with the increases being maintained at a significant level six months post workshop.
- Description: Doctor of Philosophy
Comparison of two fall risk assessment tools (FRATs) targeting falls prevention in sub-acute care
- Wong Shee, Anna, Phillips, Bev, Hill, Keith
- Authors: Wong Shee, Anna , Phillips, Bev , Hill, Keith
- Date: 2012
- Type: Text , Journal article
- Relation: Archives of Gerontology and Geriatrics Vol. 55, no. 3 (November 2012 2012), p. 653-659
- Full Text: false
- Reviewed:
- Description: FRATs are designed to identify both persons at high risk of falls and to allow for cost-effective targeting of fall prevention strategies. This study compares two FRATs (BHS FRAT and TNH-STRATIFY) for accuracy of predicting falls and targeting of fall prevention strategies in a sub-acute hospital. Comparisons of retrospective audit data over two periods (use of the BHS-FRAT; post TNH-STRATIFY implementation) were used in the evaluation (n=362). Inter-rater reliability of the TNH-STRATIFY was evaluated from independent assessment by two nurses for 30 sub-acute patients and using intraclass correlation coefficient (ICC2,1). Event rate (ER) and standard measures of predictive accuracy were calculated for both FRATs. The proportions of patients with documented fall prevention strategies addressing identified fall risk factors were compared between audit phases. The TNH-STRATIFY had high inter-rater reliability (ICC2,1=0.96). The BHS-FRAT and TNH-STRATIFY demonstrated poor predictive accuracy using recommended high risk cut-off scores, with low specificityER (0.07 and 0.13 respectively) and very low Youden IndexER (0.04 and 0.07 respectively), although these measures improved using modified cut-off scores. Positive and negative predictive values were moderate for the BHS-FRAT (0.51, 0.64) and TNH-STRATIFY (0.52, 0.61). The falls rate and proportion of recurrent fallers did not change between audit phases. Implementation rates for prevention strategies for key risk factors were higher following implementation of the TNH-STRATIFY. The results indicated that the TNH-STRATIFY, combined with associated nursing care plan falls documentation, improved the targeting of prevention strategies for key risk factors such as cognitive impairment, incontinence and mobility impairment.
- Description: C1
Patterns of comorbidity in community-dwelling older people hospitalised for fall-related injury: A cluster analysis
- Vu, Trang, Finch, Caroline, Day, Lesley
- Authors: Vu, Trang , Finch, Caroline , Day, Lesley
- Date: 2011
- Type: Text , Journal article
- Relation: BMC Geriatrics Vol. 11, no. 45 (2011), p. 1-10
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Background: Community-dwelling older people aged 65+ years sustain falls frequently; these can result in physical injuries necessitating medical attention including emergency department care and hospitalisation. Certain health conditions and impairments have been shown to contribute independently to the risk of falling or experiencing a fall injury, suggesting that individuals with these conditions or impairments should be the focus of falls prevention. Since older people commonly have multiple conditions/impairments, knowledge about which conditions/impairments coexist in at-risk individuals would be valuable in the implementation of a targeted prevention approach. The objective of this study was therefore to examine the prevalence and patterns of comorbidity in this population group. Methods: We analysed hospitalisation data from Victoria, Australia's second most populous state, to estimate the prevalence of comorbidity in patients hospitalised at least once between 2005-6 and 2007-8 for treatment of acute fall-related injuries. In patients with two or more comorbid conditions (multicomorbidity) we used an agglomerative hierarchical clustering method to cluster comorbidity variables and identify constellations of conditions. Results: More than one in four patients had at least one comorbid condition and among patients with comorbidity one in three had multicomorbidity (range 2-7). The prevalence of comorbidity varied by gender, age group, ethnicity and injury type; it was also associated with a significant increase in the average cumulative length of stay per patient. The cluster analysis identified five distinct, biologically plausible clusters of comorbidity: cardiopulmonary/metabolic, neurological, sensory, stroke and cancer. The cardiopulmonary/metabolic cluster was the largest cluster among the clusters identified. Conclusions: The consequences of comorbidity clustering in terms of falls and/or injury outcomes of hospitalised patients should be investigated by future studies. Our findings have particular relevance for falls prevention strategies, clinical practice and planning of follow-up services for these patients.
- Authors: Vu, Trang , Finch, Caroline , Day, Lesley
- Date: 2011
- Type: Text , Journal article
- Relation: BMC Geriatrics Vol. 11, no. 45 (2011), p. 1-10
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Background: Community-dwelling older people aged 65+ years sustain falls frequently; these can result in physical injuries necessitating medical attention including emergency department care and hospitalisation. Certain health conditions and impairments have been shown to contribute independently to the risk of falling or experiencing a fall injury, suggesting that individuals with these conditions or impairments should be the focus of falls prevention. Since older people commonly have multiple conditions/impairments, knowledge about which conditions/impairments coexist in at-risk individuals would be valuable in the implementation of a targeted prevention approach. The objective of this study was therefore to examine the prevalence and patterns of comorbidity in this population group. Methods: We analysed hospitalisation data from Victoria, Australia's second most populous state, to estimate the prevalence of comorbidity in patients hospitalised at least once between 2005-6 and 2007-8 for treatment of acute fall-related injuries. In patients with two or more comorbid conditions (multicomorbidity) we used an agglomerative hierarchical clustering method to cluster comorbidity variables and identify constellations of conditions. Results: More than one in four patients had at least one comorbid condition and among patients with comorbidity one in three had multicomorbidity (range 2-7). The prevalence of comorbidity varied by gender, age group, ethnicity and injury type; it was also associated with a significant increase in the average cumulative length of stay per patient. The cluster analysis identified five distinct, biologically plausible clusters of comorbidity: cardiopulmonary/metabolic, neurological, sensory, stroke and cancer. The cardiopulmonary/metabolic cluster was the largest cluster among the clusters identified. Conclusions: The consequences of comorbidity clustering in terms of falls and/or injury outcomes of hospitalised patients should be investigated by future studies. Our findings have particular relevance for falls prevention strategies, clinical practice and planning of follow-up services for these patients.
Determining policy-relevant formats for the presentation of falls research evidence
- Finch, Caroline, Day, Lesley, Donaldson, Alex, Segal, Leonie, Harrison, James
- Authors: Finch, Caroline , Day, Lesley , Donaldson, Alex , Segal, Leonie , Harrison, James
- Date: 2009
- Type: Text , Journal article
- Relation: Health Policy Vol. 93, no. 2-3 (2009), p. 207-213
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
- Reviewed:
- Description: Objectives: Population modelling holds considerable promise for identifying the most efficient and cost-effective falls prevention measures, but the outcomes need to be in a readily useable form. This paper describes an iterative, collaborative process undertaken by researchers and falls prevention policy officers to develop such a format for falls prevention intervention evidence. Methods: The researchers developed a draft template that underwent several iterations and improvements, through three collaborative consultations with policy officers. Results: Although the researchers initially identified many key information needs, active engagement with policy officers ensured that policy requirements were met and that the value of the reporting formats for policy decision-making was maximised. Importantly, they highlighted the need to articulate underlying modelling assumptions clearly. The resulting formats, with complete data, were given to policy officers to inform their local jurisdictional policy decisions. Conclusions: There is strong benefit in researchers and policy officers collaborating to develop optimal formats for presenting scientific evidence to inform policy decisions. Such a process can reduce concerns of researchers that evidence is not incorporated into policy decisions. They also meet policy officers' needs for evidence to be provided in a way that can directly inform their decision-making processes. © 2009 Elsevier Ireland Ltd. All rights reserved.
- Description: 2003008200
- Day, Lesley, Hoareau, Effie, Finch, Caroline, Harrison, James, Segal, Leonie, Bolton, Tom, Bradley, Clare, Boufous, Soufiane, Ullah, Shahid, National Injury Prevention Injury Working Group
- Authors: Day, Lesley , Hoareau, Effie , Finch, Caroline , Harrison, James , Segal, Leonie , Bolton, Tom , Bradley, Clare , Boufous, Soufiane , Ullah, Shahid , National Injury Prevention Injury Working Group
- Date: 2009
- Type: Text , Technical report
- Full Text: false
- Description: The ageing of the population is one of the major transformations being experienced in Australia, with falls a significant threat to safety, health and independence. There is now substantial evidence regarding effective interventions for preventing falls among older people living independently in the community. The aim of this project was to develop and apply a framework for epidemiological modelling of the population level impact of proven interventions on future fall rates, providing a powerful policy-setting tool for prevention. We used the Cochrane review to source current best efficacy evidence from randomised controlled trials which have provided evidence of minimising the incidence of falls among older people living in the community. Six interventions defined in that review as most promising for community dwelling older people were modelled. Additionally, one other intervention not in the Cochrane review, expedited cataract removal, was also modelled. Occupational therapy delivered home hazard assessment and modification for those with recent fall history, as modelled here, represents the best falls prevention investment. Cardiac pacing is a good falls prevention investment over the medium term, although is unlikely to have a major impact on population level hospital admission rates. The relative cost-effectiveness of psychotropic medication withdrawal appears high, although some implementation issues would need to be addressed and further costs included. Multi-disciplinary multi-factorial risk management represents good clinical practice for high risk individuals, but is not relatively cost-effective for widespread implementation. Tai chi programs may represent good value for falls prevention resources, if local circumstances allow the cost per participant to be substantially lower than modelled here. Predicted reductions in national fall-related hospital admission rates for people aged 65 years and over ranged from 0.4% to 4.6% for five of the six falls prevention strategies implemented over a one year period. These reductions, however, suggest that substantial investment in falls prevention will be required to have large effects on the fall-related hospitalisation rates. In addition, the costeffectiveness of a number of the modelled interventions could be improved by variations to the implementation processes such as measures to increase uptake, or decrease the cost per participant. The framework developed provides the potential for the research evidence base to better guide policy and practice with respect to reducing falls and future fall-related hospitalisation rates.
Staying active, staying strong : Pilot evaluation of a once-weekly, community-based strength training program for older adults
- Bates, Amanda, Donaldson, Alex, Lloyd, Beverley, Castell, Sally, Krolik, Patricia, Coleman, Renee
- Authors: Bates, Amanda , Donaldson, Alex , Lloyd, Beverley , Castell, Sally , Krolik, Patricia , Coleman, Renee
- Date: 2009
- Type: Text , Journal article
- Relation: Health Promotion Journal of Australia Vol. 20, no. 1 (2009), p. 42-47
- Full Text:
- Reviewed:
- Description: Issue addressed: Little is known about the effectiveness of once-weekly strength training programs for older adults based in community settings. This pilot study evaluated such a program to assess changes in the functional fitness of participants. Methods: A pre-test/post-test within subjects study design was used with new participants in the 10-week Staying Active, Staying Strong (SASS) program (all aged 50+ years). The Seniors Fitness Test (SFT) and SF-36 were used to assess functional fitness and health-related quality of life respectively. Perception of physical ability was assessed using a study-specific questionnaire. Pre- and post-test SFT and SF-36 scores were compared using paired t-tests. Frequency of responses was used to describe participant perceptions. Results: 110 evaluation participants (mean age 68.2 years; 85% female), 49% of those who completed the pre-test, also completed the post-test. Evaluation participants significantly improved their strength (assessed using arm curls and sit-to-stand); endurance (two-minute step test); flexibility (sit and reach, back scratch); and agility/dynamic balance (eight-foot up and go). SF-36 physical-functioning domain scores also significantly improved. Most participants reported improved strength, fitness, mobility, general well-being and confidence in performing daily activities. Conclusion: Weekly, community-based strength training programs show promise in improving the functional capacity, including the strength, of older adults. More thorough evaluation is now required to confirm these findings.
- Description: 2003008182
- Authors: Bates, Amanda , Donaldson, Alex , Lloyd, Beverley , Castell, Sally , Krolik, Patricia , Coleman, Renee
- Date: 2009
- Type: Text , Journal article
- Relation: Health Promotion Journal of Australia Vol. 20, no. 1 (2009), p. 42-47
- Full Text:
- Reviewed:
- Description: Issue addressed: Little is known about the effectiveness of once-weekly strength training programs for older adults based in community settings. This pilot study evaluated such a program to assess changes in the functional fitness of participants. Methods: A pre-test/post-test within subjects study design was used with new participants in the 10-week Staying Active, Staying Strong (SASS) program (all aged 50+ years). The Seniors Fitness Test (SFT) and SF-36 were used to assess functional fitness and health-related quality of life respectively. Perception of physical ability was assessed using a study-specific questionnaire. Pre- and post-test SFT and SF-36 scores were compared using paired t-tests. Frequency of responses was used to describe participant perceptions. Results: 110 evaluation participants (mean age 68.2 years; 85% female), 49% of those who completed the pre-test, also completed the post-test. Evaluation participants significantly improved their strength (assessed using arm curls and sit-to-stand); endurance (two-minute step test); flexibility (sit and reach, back scratch); and agility/dynamic balance (eight-foot up and go). SF-36 physical-functioning domain scores also significantly improved. Most participants reported improved strength, fitness, mobility, general well-being and confidence in performing daily activities. Conclusion: Weekly, community-based strength training programs show promise in improving the functional capacity, including the strength, of older adults. More thorough evaluation is now required to confirm these findings.
- Description: 2003008182
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