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Results for 'falls'

Results 1 - 10 of 34

Falls Management Exercise implementation toolkit

NIHR CLAHRC. East Midlands, NATIONAL INSTITUTE FOR HEALTH RESEARCH
2020

This toolkit provides a suite of resources that commissioners can use to plan, implement and monitor the Falls Management Exercise (FaME) programme. FaME is an evidence-based tailored strength and balance exercise programme that has been shown to reduce the rate of falls, increase physical activity levels and improve wellbeing. The toolkit is an output of the PhISICAL study (Physical activity Implementation Study In Community-dwelling AduLts). Sections of the toolkit cover: Building the case for implementing FaME which includes evidence summaries for commissioners, a costing tool, a business case and real life case studies from FaME class participants; Planning the implementation of FaME, which includes an implementation Gantt chart, a service specification, example delivery models, videos, logic model and key learning from the PhISICAL study; Implementing the programme, which includes sample promotional materials and templates; and Monitoring, evaluation and quality improvement, which provides quality assurance guidance and suggested monitoring tools and schedule.

Quick guide: falls prevention and management in care homes

NHS ENGLAND. North
2019

A guide to help care home staff to manage and prevent falls and risk of fractures, with an emphasis on person centred care and continuous improvement. It looks a preventing falls through activity and exercise; risk factors in falls, risk assessment and screening, management following a fall, and the importance of education. The guide includes key references to national falls prevention in care homes best practice and NICE quality standards. It also provides links to wider resources and tools. The resource can be used to benchmark existing policies and procedures with care homes to ensure the care given reflects evidence-based practice.

Effectiveness of multifactorial interventions in preventing falls among older adults in the community: a systematic review and meta-analysis.

LEE Seon Heui, YU Soyoung
2020

Background: Falls often cause unexpected injuries that older adults find difficult to recover from (e.g., hip and other major fractures, intracranial bleeding); therefore, fall prevention and interventions are of particular significance. Objectives: This study aimed to examine the effectiveness of multifactorial fall prevention interventions among community-dwelling older adults and compare subgroups that differed in terms of their degree of fall risk and the intensity and components of interventions. Methods: An exhaustive systematic literature search was undertaken using the following databases: Ovid-Medline, Ovid-Embase, and the Cochrane Central Register of Controlled Trials (Central). Two investigators independently extracted data and assessed the quality of the studies by examining the risk of bias. This study conducted a meta-analysis of randomized controlled trials that had been published up to March 31st, 2019, using Review Manager. Results: Of 1,328 studies, 45 articles were relevant to this study. In total, 29 studies included participants in the high-risk group, 3 in the frail group, and 13 in the healthy older adult group. Additionally, 28 and 17 studies used active and referral multifactorial interventions, respectively. Multifactorial interventions included the following components: exercise, education, environmental modification, medication, mobility aids, and vision and psychological management. Multifactorial interventions significantly reduced fall rates in the high-risk (risk ratio 0.66; 95% confidence interval 0.52–0.84) and healthy groups (risk ratio 0.72; 95% confidence interval 0.58–0.89), when compared to the control group. Active multifactorial interventions (risk ratio 0.64; 95% confidence interval 0.51–0.80) and those featuring exercise (risk ratio 0.66; 95% confidence interval 0.54–0.80) and environmental modification also showed significantly reduced fall rates (risk ratio 0.65; 95% confidence interval 0.54–0.79) compared to usual care. Multifactorial interventions had a significantly lower number of people who experienced falls during the study period compared to usual care in the healthy group (risk ratio 0.77; 95% confidence interval 0.62–0.95). Active multifactorial interventions (risk ratio 0.73; 95% confidence interval 0.60–0.89) and those featuring exercise (risk ratio 0.79; 95% confidence interval 0.66–0.95) and environmental modification (risk ratio 0.80; 95% confidence interval 0.68–0.95) had a significantly lower number of people who experienced falls compared to those receiving usual care. Conclusions: Active multifactorial interventions had positive effects on fall rates and the number of people experiencing falls. Thus, healthcare workers, including nurses, should be involved in planning fall prevention programs so that older adults can be provided with optimal care; multifactorial interventions that include exercise and environmental modification are particularly effective in reducing falls.

Economic evaluation of a falls prevention exercise program among people With Parkinson's disease

FARAG Inez, et al
2016

Objective: The aim of this study was to determine the cost‐effectiveness of a 6‐month minimally supervised exercise program for people with PD. Methods: An economic analysis was conducted alongside a randomized, controlled trial in which 231 people age 40 years and over with PD were randomized into a usual care control group or an exercise group. Cost‐effectiveness was estimated using incremental cost per fall prevented (using falls calendars) as the primary analysis and cost per extra person avoiding mobility deterioration (defined as an improvement or no change in the 12‐point Short Physical Performance Battery Score between baseline and 6 month). A cost‐utility analysis using the Short Form‐6D was also performed. Uncertainty was represented using cost‐effectiveness scatter plots and acceptability curves. Planned subgroup analyses for the low‐disease‐severity group were also undertaken. Results: All results are reported in Australian dollars ($A). The average cost of the intervention was $A1,010 per participant. Incremental cost‐effectiveness of the program relative to usual care was $A574 per fall prevented, $A9,570 per extra person avoiding mobility deterioration, and $A338,800 per quality‐adjusted life year gained. The intervention had an 80% probability of being cost‐effective, relative to the control, at a threshold of $A2,000 per fall prevented. Subgroup analyses for the low‐disease‐severity group indicate the program to be dominant, that is, less costly and more effective than usual care for all health outcomes. Conclusion: The exercise intervention appeared cost‐effective with regard to fall prevention in the whole sample and cost saving in the low disease severity group, when compared with usual care.

Efficacy and generalizability of falls prevention interventions in nursing homes: a systematic review and meta-analysis

GULKA Heidi J, et al
2020

Objectives: To determine the efficacy of fall intervention programs in nursing homes (NHs) and the generalizability of these interventions to people living with cognitive impairment and dementia. Design: Systematic review and meta-analysis. Setting and Participants: NH residents (n = 30,057) living in NHs defined as residential facilities that provide 24-hours-a-day surveillance, personal care, and some clinical care for persons who are typically aged ≥65 years with multiple complex chronic health conditions. Methods: Meta-analysis of falls prevention interventions on number of falls, fallers, and recurrent fallers. Results: Thirty-six studies met inclusion criteria for the systematic review. Overall, fall prevention interventions reduced the number of falls [risk ratio (RR) = 0.73, 95% confidence interval (CI) = 0.60-0.88], fallers (RR = 0.80, 95% CI = 0.72-0.89), and recurrent fallers (RR = 0.70, 95% CI = 0.60-0.81). Subanalyses revealed that single interventions have a significant effect on reducing fallers (RR = 0.78, 95% CI = 0.69-0.89) and recurrent fallers (RR = 0.60, 95% CI = 0.52-0.70), whereas multiple interventions reduce fallers (RR = 0.69, 95% CI = 0.39-0.97) and multifactorial interventions reduce number of falls (RR = 0.65, 95% CI = 0.45-0.94). Conclusions and Implications: Exercise as a single intervention reduced the number of fallers and recurrent fallers by 36% and 41%, respectively, in people living in NHs. Other effective interventions included staff education and multiple and multifactorial interventions. However, more research on exercise including people with cognitive impairment and dementia is needed to improve the generalizability of these interventions to the typical NH resident.

Perceptions of older people in Ireland and Australia about the use of technology to address falls prevention

MACKENZIE Lynette, CLIFFORD Amanda
2020

Falls are common events with serious consequences for older people. With an ageing population and increasing health-care costs, information and communication technologies (ICT) will have a potential role in future health-care delivery. However, research on technology acceptance in health care for older people is limited and its application to falls prevention is unknown. The aims of this study were to explore and describe the perceptions of community-dwelling Australian and Irish older people about their current use of technology, and the potential use of technology for falls prevention. Qualitative data were collected from three focus groups conducted in and around Limerick in Ireland, and three in the Sydney area, Australia. A total of 35 older people participated. Data were analysed using thematic analysis. Four themes emerged from the data: (a) perceptions of vulnerability to falls, (b) preferences for exercise interventions, (c) participation in and ownership of technology, and (d) perceptions about applications of technology for falls prevention. As the use of technology is an instrumental activity of daily living, health professionals need to assess the capacity of older people to adopt these technologies, and provide falls prevention interventions to accommodate the technology skills of older people. Some participants were reluctant to embrace technology and barriers to the effective use of technology to assist in preventing falls may conflict with future health service trends.

Home modifications to reduce injuries from falls in the Home Injury Prevention Intervention (HIPI) study: a cluster-randomised controlled trial

KEALL Michael D, et al
2015

Background: Despite the considerable injury burden attributable to falls at home among the general population, few effective safety interventions have been identified. This study tested the safety benefits of home modifications, including handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, edging for outside steps, and slip-resistant surfacing for outside areas such as decks and porches. Methods: This study is a single-blind, cluster-randomised controlled trial of households from the Taranaki region of New Zealand. To be eligible, participants had to live in an owner-occupied dwelling constructed before 1980 and at least one member of every household had to be in receipt of state benefits or subsidies. This study randomly assigned households by electronic coin toss to either immediate home modifications (treatment group) or a 3-year wait before modifications (control group). Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes. The primary outcome was the rate of falls at home per person per year that needed medical treatment, which was derived from administrative data for insurance claims. Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested. To account for clustering at the household level, this stanalysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised estimating equations. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000779279. Findings: Of 842 households recruited, 436 (n=950 individual occupants) were randomly assigned to the treatment group and 406 (n=898 occupants) were allocated to the control group. After a median observation period of 1148 days (IQR 1085–1263), the crude rate of fall injuries per person per year was 0·061 in the treatment group and 0·072 in the control group (relative rate 0·86, 95% CI 0·66–1·12). The crude rate of injuries specific to the intervention per person per year was 0·018 in the treatment group and 0·028 in the control group (0·66, 0·43–1·00). A 26% reduction in the rate of injuries caused by falls at home per year exposed to the intervention was estimated in people allocated to the treatment group compared with those assigned to the control group, after adjustment for age, previous falls, sex, and ethnic origin (relative rate 0·74, 95% CI 0·58–0·94). Injuries specific to the home-modification intervention were cut by 39% per year exposed (0·61, 0·41–0·91). Interpretation: The findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population. Further research is needed to identify the effectiveness of particular modifications from the package tested.

Interventions for preventing falls in older people living in the community (review)

GILLESPIE Lesley D., et al
2012

Background: Approximately 30 per cent of people over 65 years of age living in the community fall each year. This is an update of a Cochrane review first published in 2009.Objective: To assess the effects of interventions designed to reduce the incidence of falls in older people living in the community. Search methods: this review searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (February 2012), CENTRAL (The Cochrane Library2012, Issue 3), MEDLINE (1946 to March 2012), EMBASE (1947 to March 2012), CINAHL (1982 to February 2012), and online trial registers. Selection criteria: Randomised trials of interventions to reduce falls in community-dwelling older people. Main results: this review included 159 trials with 79,193 participants. Most trials compared a fall prevention intervention with no intervention or an intervention not expected to reduce falls. The most common interventions tested were exercise as a single intervention (59 trials) and multifactorial programmes (40 trials). Findings: Group and home‐based exercise programmes, usually containing some balance and strength training exercises, effectively reduced falls, as did Tai Chi. Overall, exercise programmes aimed at reducing falls appear to reduce fractures. Multifactorial interventions assess an individual's risk of falling, and then carry out treatment or arrange referrals to reduce the identified risks. Overall, current evidence shows that this type of intervention reduces the number of falls in older people living in the community but not the number of people falling during follow‐up. These are complex interventions, and their effectiveness may be dependent on factors yet to be determined. Interventions to improve home safety appear to be effective, especially in people at higher risk of falling and when carried out by occupational therapists. An anti‐slip shoe device worn in icy conditions can also reduce falls. Taking vitamin D supplements does not appear to reduce falls in most community‐dwelling older people, but may do so in those who have lower vitamin D levels in the blood before treatment. Some medications increase the risk of falling. Three trials in this review failed to reduce the number of falls by reviewing and adjusting medications. A fourth trial involving family physicians and their patients in medication review was effective in reducing falls. Gradual withdrawal of a particular type of drug for improving sleep, reducing anxiety, and treating depression (psychotropic medication) has been shown to reduce falls. Cataract surgery reduces falls in women having the operation on the first affected eye. Insertion of a pacemaker can reduce falls in people with frequent falls associated with carotid sinus hypersensitivity, a condition which causes sudden changes in heart rate and blood pressure. In people with disabling foot pain, the addition of footwear assessment, customised insoles, and foot and ankle exercises to regular podiatry reduced the number of falls but not the number of people falling. The evidence relating to the provision of educational materials alone for preventing falls is inconclusive.

'The billion dollar question': embedding prevention in older people's services: 10 'high impact' changes

ALLEN Kerry, GLASBY Jon
2010

There is a need to invest more fully and strategically in both prevention and rehabilitation for older people, to help them stay healthier, more independent and more socially included for longer and to recover these capacities as fully as possible when they do require hospital treatment. While there is growing recognition that only a more preventative agenda will be sufficient to respond to current and future pressures, there is much less clarity about how to do this in practice. This paper seeks to identify the most promising ‘10 high impact changes’ with regards to prevention in older people’s services. The paper draws on two main sources. The first is an EU review of prevention and long-term care in older people’s services across 14 European counties known as Interlinks. The second key source is a recent review of the social and economic benefits of adult social care, commissioned by the Department of Health and Downing Street. This paper identifies and reviews the following 10 prevention strategies: promoting healthy lifestyles; vaccination; screening; falls prevention; housing adaptations and practical support; telecare and technology; intermediate care; reablement; partnership working; and personalisation.

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.

Results 1 - 10 of 34

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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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