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Results for 'falls'

Results 1 - 10 of 25

Preventive social care: is it cost effective?

CURRY Natasha
2006

This paper attempts to pull together and review key pieces of evidence about the cost effectiveness of prevention. The findings, which reflect a paucity of quantified information about the effectiveness of preventive interventions, suggest that there is a strong financial case for reducing hospitalisation (particularly through falls) and for reducing the rate of institutionalisation by maintaining independence. Small-scale trials show that small interventions could prevent falls and reduce the rate of institutionalisation. However, establishing a direct causal relationship between such interventions and long-term financial savings has proved problematic although. There is a lack of consensus over the cost effectiveness of intermediate care although there is evidence that it is cost effective when targeting specific groups/illnesses/events such as stroke and falls. Evidence for secondary stroke prevention services is perhaps the strongest, and most widely quantified, body of research. There is some evidence that primary prevention strategies (such as smoking cessation and reduced salt intake) have potential to reduce the incidence of stroke. The paper makes a series of recommendations, calling for a greater focus on low-level interventions, particularly where there is qualitative evidence that they are valued by service users; implementation of promising interventions, even if not supported by robust evidence, accompanying by formal evaluation during roll-out; development of standard outcome measures of prevention; targeting resources to ensure greatest impact; and greater integration between health and social care services as a drive to shift services towards the preventive end of the spectrum.

Review of integrated care: focus on falls

HEALTHCARE INSPECTORATE WALES
2019

Based on a review of integrated care for older people who are at risk of experiencing a fall in Wales, this report highlights learning for staff and for health and social care managers. It focuses on services to help people avoid a fall and how to support people who have had a fall, providing examples of desirable and undesirable pathways through the health and care system. It focuses on the three areas: prevention of falls and promotion of independence, for people living in their own home or in a care home; response to falls when they happen in the community, either for someone living at home or in a care home; and following attendance at hospital due to a fall. It also highlights key themes identified from the review and how the affected service users, service providers and commissioners. The review identified examples of good practice but also found a lack of co-ordination and communication between health, social care and voluntary services could often be a barrier to delivering good quality care. The report has been informed by evidence from six individual falls services, the views of staff and older people. It makes eight recommendations for the Welsh Government, health boards and local authorities. The include a National Falls Framework for Wales, to standardise the approach to preventing, treating and reabling older people who are at risk of falling or have already fallen The report will be relevant for service providers, commissioners and service users.

Dance to Health 'Phase 1 roll-out [test and learn]' evaluation: first report

SHEFFIELD HALLAM UNIVERSITY. Sport Industry Research Centre
2019

An evaluation of the Dance to Health falls prevention dance programme. The evaluation investigates whether Dance to Health is an effective and cost-effective way to address older people’s falls and whether the programme helps older people in danger of falling overcome lost confidence, reduced independence and increased isolation. The evaluation used a mixed methods approach that included quantitative, qualitative and econometric research. Primary outcome measures included the impact on falls, positive side-effects (mentally and physically), patient pull, attendance and adherence, fidelity to existing falls prevention programmes and cost effectiveness. The findings show that Dance to Health is helping older people in danger of falling overcome lost confidence, reduced independence and increased isolation. There was a 44 percent reduction in the number of falls, positive improvements in participants' physical and mental wellbeing, including improved Timed Up and Go (TUG) times and reduced fear of falling. Additionally, based on the analysis conducted, there is a potential cost saving of over £149m over a 2-year period, of which £120m is a potential cost saving for the NHS. Dance to Health's fidelity to existing physiotherapy programmes was also confirmed. The evidence suggests that Dance to Health offers the health system a more effective and cost-effective means to address the issue of older people's falls.

Interventions to improve adherence to exercise therapy for falls prevention in community-dwelling older adults: systematic review and meta-analysis

HUGHES Katie J., et al
2019

Background: exercise therapy is highly recommended for falls prevention in older adults; however, poor exercise adherence may limit treatment effectiveness. Objective: to assess the effectiveness of interventions to improve exercise adherence for community-dwelling adults (aged over 65 years), at risk of falling. Methods: eight databases were searched to identify randomised/quasi-randomised trials. The Capability, Opportunity, Motivation model of behaviour (COM-B) was used to categorise the identified adherence interventions. Studies with similar interventions that provided adherence outcome data per group were analysed to establish pooled intervention effect. Protocol registration with Propsero: (CRD42016033677). Results: of the 20 trials included (n = 4419), five provided data per group for adherence outcome. Meta-analysis of four studies (n = 482), containing interventions exploring the way exercise is delivered, demonstrated significantly better adherence in the intervention group (n = 166 experimental, n = 161 control Fixed effects model (FEM), SMD = 0.48 95% CI [0.26–0.70] P < 0.0001 I2 = 0%, very low GRADE evidence). Within this limited evidence base, interventions using telecommunication and the integration of exercise into activities of daily living appear most promising when delivering exercise at home. Meta-analysis to explore the effect that these interventions to improve adherence had on balance (n = 166 experimental, n = 161 control Random-effects model (REM), SMD = 0.82, 95% CI [−1.20–2.84] P = 0.43 I2 = 52%) and gait (n = 59 experimental, n = 56 control REM, SMD = 0.29, 95% CI [−1.62–2.20] P = 0.77 I2= 48%), found no statistically significant effect. Conclusions: adherence to exercise can be positively influenced; however, insufficient data exists to support any single intervention that also achieves effective outcomes for balance and gait.

A menu of interventions for productive healthy ageing: for pharmacy teams working in different settings

PUBLIC HEALTH ENGLAND
2019

This guide lists interventions that pharmacy teams working in different healthcare settings can use to support older people to improve the quality of their lives. It includes evidence-based interventions on: preventing and reducing falls; increasing levels of physical activity; maintaining a healthy weight and preventing malnutrition; reducing the risk of social isolation and loneliness; reducing the risk of dementia; supporting people diagnosed with dementia; delaying the progress of dementia and reducing the need for medicines. For each area the guide includes the rationale for intervention, a list of suggested interventions and evidence of impact. The guidance will also be useful for pharmaceutical and medical committees, local authorities, clinical commissioning groups and local NHS England teams.

Economic evaluations of falls prevention programs for older adults: a systematic review

OLIJ Branko F., et al
2018

Objectives: To provide a comprehensive overview of economic evaluations of falls prevention programs and to evaluate the methodology and quality of these studies. Design: Systematic review of economic evaluations on falls prevention programs. Setting: Studies (N=31) of community‐dwelling older adults (n=25), of older adults living in residential care facilities (n=3), and of both populations (n=3) published before May 2017. Participants: Adults aged 60 and older. Measurements: Information on study characteristics and health economics was collected. Study quality was appraised using the 20‐item Consensus on Health Economic Criteria. Results: Economic evaluations of falls prevention through exercise (n = 9), home assessment (n = 6), medication adjustment (n = 4), multifactorial programs (n = 11), and various other programs (n = 13) were identified. Approximately two‐thirds of all reported incremental cost‐effectiveness ratios (ICERs) with quality‐adjusted life‐years (QALYs) as outcome were below the willingness‐to‐pay threshold of $50,000 per QALY. All studies on home assessment and medication adjustment programs reported favorable ICERs, whereas the results of studies on exercise and multifactorial programs were inconsistent. The overall methodological quality of the studies was good, although there was variation between studies. Conclusion: The majority of the reported ICERs indicated that falls prevention programs were cost‐effective, but methodological differences between studies hampered direct comparison of the cost‐effectiveness of program types. The results imply that investing in falls prevention programs for adults aged 60 and older is cost‐effective. Home assessment programs (ICERs < $40,000/QALY) were the most cost‐effective type of program for community‐dwelling older adults, and medication adjustment programs (ICERs < $13,000/QALY) were the most cost‐effective type of program for older adults living in a residential care facility.

Occupational therapy fall prevention interventions for community-dwelling older adults: a systematic review

ELLIOTT Sharon, LELAND Natalie E.
2018

Objective: Accidental falls among community-dwelling older adults are preventable and increase the risk of morbidity, hospitalization, and institutionalization. We updated and broadened a 2008 systematic review examining the evidence for the effectiveness of fall prevention interventions in improving fall-related outcomes, occupational performance, quality of life, and health care facility readmissions for community-dwelling older adults., Method: Literature published from 2008 to 2015 from five electronic databases was searched and analysed, Results: Fifty articles met the inclusion criteria and were critically appraised and synthesized-37 provided Level I; 5, Level II; and 8, Level III evidence. Analysis was organized into four intervention themes: single component, multicomponent, multifactorial, and population based. Mixed evidence was found for single-component and multifactorial interventions, strong evidence was found for multicomponent interventions, and moderate evidence was found for population-based interventions., Conclusion: These findings can inform the delivery and integration of fall prevention interventions from acute care to community discharge.

Living well for longer: the economic argument for investing in the health and wellbeing of older people in Wales

EDWARDS Rhiannon Tudor, et al
2018

This report, commissioned by Public Health Wales, explores the economic case for investing in older people in Wales to support people to live longer in good health in older age. It looks at investing in older people as assets, highlighting the importance of their contribution to the economy in Wales and the importance of housing and enabling independence in later life. It then draws on the results of rapid reviews of international and UK evidence to show the relative cost-effectiveness and return on investment on preventing loneliness and social isolation; caring for older carers; and preventing falls. It concludes that enabling people to work for longer, facilitating volunteering and supporting working parents through care of grandchildren brings many economic returns in terms of improving wellbeing; reducing loneliness, and supporting formal and wider community services. In addition co-production enables older people to remain active in the community and provides intergenerational benefits within the community and public sector services. The report concludes that Wales should focus investment on: fully integrated health and care services; maintaining physical and mental well being in older age, with a focus on reducing social isolation and loneliness; maintaining services to promote prevention (particularly falls prevention), rehabilitation and reablement; investment in sustainable homes, transport and communities; and support for informal carers.

Small but significant: the impact and cost benefits of handyperson services

ADAMS Sue
2018

An evaluation of the impacts and cost benefits of handyperson services carrying out small repairs and minor adaptations in the home for older people. It looks at how handyperson service fit into the current policy landscape summarises current evidence on their impact and cost effectiveness. It then provides an in depth evaluation of the of Preston Care and Repair handyperson service, with analysis of outputs, outcomes and examines the cost benefits in relation to falls prevention. The evaluation involved data analysis of jobs completed, a survey of users of the service and interviews with staff and service users. It reports that during the 9 month evaluation period 1,399 jobs were carried out in the homes of 697 older people, which exceeded outcome targets. Of people using the service, 46 percent were over 80 years and 72 percent were older people living alone. Older people also valued the service. Ninety-six percent of those surveyed said that the Preston Care and Repair handyperson service made them less worried about their home and 100 percent said that they would recommend the service to others. Analysis of the falls prevention impact on a small number of higher risk cases, found that for every £1 spent on the handyperson service the saving to health and care was £4.28. Other health and social care related outcomes included a risk reduction for hospital admission risk reduction and faster discharge to home, improved wellbeing, safer independent living, and reduced isolation. The report illustrates the impacts of handyperson services cover health, housing and social care aims and objectives. They also offer a cost effective solution with significant cost benefits and a high rate of return on investment, both financial and social.

Cognitive behavioural therapy for fear of falling and balance among older people: a systematic review and meta-analysis

LIU Tai-Wa, et al
2018

Background: fear of falling is prevalent among older people and associated with various health outcomes. A growing number of studies have examined the effects of interventions designed to reduce the fear of falling and improve balance among older people, yet our current understanding is restricted to physiological interventions. Psychological interventions such as cognitive behavioural therapy (CBT) have not been reviewed and meta-analysed. Objective: to perform a systematic review and meta-analysis evaluating the effects of CBT on reducing fear of falling and enhancing balance in community-dwelling older people. Method: randomised controlled trials (RCTs) addressing fear of falling and balance were identified through searches of six electronic databases, concurrent registered clinical trials, forward citation and reference lists of three previous systematic reviews. Results: a total of six trials involving 1,626 participants were identified. Four studies used group-based interventions and two adopted individual intervention. Intervention period ranged from 4 to 20 weeks, and the number and duration of face-to-face contact varied. Core components of the CBT intervention included cognitive restructuring, personal goal setting and promotion of physical activities. The risk of bias was low across the included studies. Our analysis suggests that CBT interventions have significant immediate and retention effects up to 12 months on reducing fear of falling, and 6 months post-intervention effect on enhancing balance. Conclusions: CBT appears to be effective in reducing fear of falling and improving balance among older people. Future researches to investigate the use of CBT on reducing fear of falling and improving balance are warranted.

Results 1 - 10 of 25

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News

Moving Memory

Moving Memory Practice example about how the Moving Memory Dance Theatre Company is challenging perceived notions of age and ageing.

Chatty Cafe Scheme

Chatty Cafe Scheme Practice example about how the Chatty Cafe Scheme is helping to tackle loneliness by bringing people of all ages together

Oomph! Wellness

Oomph! Wellness Practice example about how Oomph! Wellness is supporting staff to get older adults active and combat growing levels of social isolation

KOMP

KOMP Practice example about how KOMP, designed by No Isolation is helping older people stay connected with their families

LAUGH research project

LAUGH research project Practice example about a research project to develop highly personalised, playful objects for people with advanced dementia
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