scholarly journals Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls

2010 ◽  
Vol 39 (6) ◽  
pp. 710-716 ◽  
Author(s):  
L. Irvine ◽  
S. P. Conroy ◽  
T. Sach ◽  
J. R. F. Gladman ◽  
R. H. Harwood ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Older People ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Prevention Programme ◽  
Day Hospital ◽  
Risk Of Falls ◽  
Community Dwelling Older People

scholarly journals Does the shoe really fit? Characterising ill-fitting footwear among community dwelling older adults: an observational cross-sectional study

2019 ◽  
Author(s):  
Brian O'Rourke ◽  
Mary E Walsh ◽  
Rachael Brophy ◽  
Shanice Vallely ◽  
Niamh Murphy ◽  
...  
Keyword(s):  
Older Adults ◽  
Older People ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Day Hospital ◽  
Extrinsic Factors ◽  
Shoe Size ◽  
Risk Of Falls ◽  
Risk Factors For Falls ◽  
At Home

Abstract Background Falls in older people are common and can result in loss of confidence, fear of falling, restriction in activity and loss of independence. Causes of falls are multi-factorial and include extrinsic factors such as unsafe footwear. Inappropriate footwear may increase the risk of falls. There is a paucity of research assessing the footwear characteristics among older people who are at high risk of falls, internationally and in the Irish setting. The aim of this study was to examine the proportion of older adults attending a geriatric day hospital in Ireland who were wearing incorrectly sized shoes. Methods A consecutive sample of 111 older adults aged 60 years and over attending a geriatric day hospital in a large Irish teaching hospital was recruited. Demographic data including age, mobility, medications, use of glasses, social support, footwear worn at home and falls history were recorded. Shoe size and foot length were measured in millimetres using an internal shoe gauge and SATRA shoe size stick, respectively. Subjects’ self-reported shoe size was recorded. Footwear was assessed using the Footwear Assessment Form (FAF). A Timed Up and Go (TUG) score was recorded. Participation was assessed using the Nottingham Extended Activities of Daily Living (NEADL) Scale. Those with shoes fitting on at least one foot were compared to those with ill-fitting footwear on both feet using Chi-square tests, T-tests or Mann–Whitney U tests. Results 72% of participants were wearing footwear that did not fit correctly on both feet according to our definition based on previous literature. Only 6% were wearing footwear that fitted correctly on both feet. 67% wore slippers at home. 90% had shoes with smooth, partly worn or fully worn sole treading. Participant age, TUG score and NEADL score were not associated with ill-fitting footwear. Conclusions Wearing incorrectly fitting shoes and shoes with unsafe features is common among older adults attending geriatric day services. The large number of participants who reported wearing slippers at home is also an important finding. Ill-fitting footwear and slippers are risk factors for falls thus warranting further investigation to help guide future falls prevention services at day hospitals.

scholarly journals Does the shoe really fit? Characterising ill-fitting footwear among community dwelling older adults: an observational cross-sectional study

2019 ◽  
Author(s):  
Brian O'Rourke ◽  
Mary E Walsh ◽  
Rachael Brophy ◽  
Shanice Vallely ◽  
Niamh Murphy ◽  
...  
Keyword(s):  
Older Adults ◽  
Older People ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Day Hospital ◽  
Extrinsic Factors ◽  
Shoe Size ◽  
Risk Of Falls ◽  
Risk Factors For Falls ◽  
At Home

Abstract Background Falls in older people are common and can result in loss of confidence, fear of falling, restriction in activity and loss of independence. Causes of falls are multi-factorial and include extrinsic factors such as unsafe footwear. Inappropriate footwear may increase the risk of falls. There is a paucity of research assessing the footwear characteristics among older people who are at high risk of falls, internationally and in the Irish setting. The aim of this study was to examine the proportion of older adults attending a geriatric day hospital in Ireland who were wearing incorrectly sized shoes. Methods A consecutive sample of 111 older adults aged 60 years and over attending a geriatric day hospital in a large Irish teaching hospital was recruited. Demographic data including age, mobility, medications, use of glasses, social support, footwear worn at home and falls history were recorded. Shoe size and foot length were measured in millimetres using an internal shoe gauge and SATRA shoe size stick, respectively. Subjects’ self-reported shoe size was recorded. Footwear was assessed using the Footwear Assessment Form (FAF). A Timed Up and Go (TUG) score was recorded. Participation was assessed using the Nottingham Extended Activities of Daily Living (NEADL) Scale. Those with shoes fitting on at least one foot were compared to those with ill-fitting footwear on both feet using Chi-square tests, T-tests or Mann–Whitney U tests. Results 72% of participants were wearing footwear that did not fit correctly on both feet according to our definition based on previous literature. Only 6% were wearing footwear that fitted correctly on both feet. 67% wore slippers at home. 90% had shoes with smooth, partly worn or fully worn sole treading. Participant age, TUG score and NEADL score were not associated with ill-fitting footwear. Conclusions Wearing incorrectly fitting shoes and shoes with unsafe features is common among older adults attending geriatric day services. The large number of participants who reported wearing slippers at home is also an important finding. Ill-fitting footwear and slippers are risk factors for falls thus warranting further investigation to help guide future falls prevention services at day hospitals.

scholarly journals Health-promoting and preventive interventions for community-dwelling older people published from inception to 2019: a scoping review to guide decision making in a Swedish municipality context

2020 ◽  
Vol 78 (1) ◽  
Author(s):  
Saranda Bajraktari ◽  
Marlene Sandlund ◽  
Magnus Zingmark
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Older People ◽  
Nordic Countries ◽  
Community Dwelling ◽  
Preventive Interventions ◽  
Positive Effects ◽  
Scoping Reviews ◽  
Health Promoting ◽  
Community Dwelling Older People

Abstract Background Despite the promising evidence of health-promoting and preventive interventions for maintaining health among older people, not all interventions can be implemented due to limited resources. Due to the variation of content in the interventions and the breadth of outcomes used to evaluate effects in such interventions, comparisons are difficult and the choice of which interventions to implement is challenging. Therefore, more information, beyond effects, is needed to guide decision-makers. The aim of this review was to investigate, to what degree factors important for decision-making have been reported in the existing health-promoting and preventive interventions literature for community-dwelling older people in the Nordic countries. Methods This review was guided by the PRISMA-ScR checklist (Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews), the methodological steps for scoping reviews described in the Arksey and O′Malley’s framework, and the Medical Research Council’s (MRC) guidance on complex interventions. Eligible studies for inclusion were randomised controlled trials (RCTs) concerning health promotion or primary prevention for community-dwelling older people implemented in the Nordic countries. Additionally, all included RCTs were searched for related papers that were reporting on additional factors. Eligible studies were searched in seven databases: PubMed, SCOPUS, CINAHL, Academic Search Elite, PsycINFO, SocINDEX, and SPORTDiscus. Results Eighty-two studies met the inclusion criteria (twenty-seven unique studies and fifty-five related studies). Twelve studies focused on fall prevention, eleven had a health-promoting approach, and four studies focused on preventing disability. All interventions, besides one, reported positive effects on at least one health outcome. Three studies reported data on cost-effectiveness, three on experiences of participants and two conducted feasibility studies. Only one intervention, reported information on all seven factors. Conclusions All identified studies on health-promoting and preventive interventions for older people evaluated in the Nordic countries report positive effects although the magnitude of effects and number of follow-ups differed substantially. Overall, there was a general lack of studies on feasibility, cost-effectiveness, and experiences of participants, thus, limiting the basis for decision making. Considering all reported factors, promising candidates to be recommended for implementation in a Nordic municipality context are ‘Senior meetings’, ‘preventive home visits’ and ‘exercise interventions’ on its own or combined with other components.

scholarly journals Modelling long-term cost-effectiveness of health promotion for community-dwelling older people

2019 ◽  
Vol 16 (4) ◽  
pp. 395-404 ◽  
Author(s):  
Magnus Zingmark ◽  
Fredrik Norström ◽  
Lars Lindholm ◽  
Synneve Dahlin-Ivanoff ◽  
Susanne Gustafsson
Keyword(s):  
Health Promotion ◽  
Cost Effectiveness ◽  
Older People ◽  
Community Dwelling ◽  
Community Dwelling Older People

The Iconographical Falls Efficacy Scale (IconFES) in community-dwelling older people—a longitudinal validation study

2020 ◽  
Author(s):  
Mei Ling Lim ◽  
Kimberley S van Schooten ◽  
Kylie A Radford ◽  
Jasmine Menant ◽  
Stephen R Lord ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older People ◽  
Female Gender ◽  
Community Dwelling ◽  
Activity Restriction ◽  
Cut Points ◽  
Injurious Falls ◽  
High Concern ◽  
Risk Of Falls ◽  
Community Dwelling Older People

Abstract Background This study aimed to develop cut-points for the 30-item and 10-item Iconographical Falls Efficacy Scale (IconFES) in community-dwelling older people and evaluate the psychometric properties, including construct and predictive validity with respect to falls and reduced physical activity over 1 year. Methods Eight hundred and one participants completed the IconFES and underwent physical, psychological and cognitive measures at baseline. Physical activity was recorded at baseline and 12 months using an activity monitor, and 1-year fall incidence was collected using monthly falls calendars. Results Using receiver-operating characteristic curves and the Youden’s index for history of falls, physiological fall risk and depressive symptoms, cut-points were defined to differentiate between low and high concern about falling (30-item: <53; 10-item: <19). For the 30-item IconFES, we additionally defined cut-points for low (≤40), moderate (41–58) and high (≥59) concern about falling. Groups based on these cut-points differed significantly: low coordinated stability, executive function and amount of daily walking, and high level of disability (30-item version) and female gender (low/high 30-item version). Although there were some inconsistencies across IconFES classifications, high concern about falling predicted having had multiple falls or multiple/injurious falls, low amount of daily walking and low movement intensity at 12 months. Conclusions The developed IconFES cut-points were sensitive to variables associated with concern about falling and predicted fall incidence and physical activity restriction after 12 months. Applying these cut-points appears useful to identify older people with high concern about falling, who are at higher risk of falls and activity curtailment.

scholarly journals Development and internal validation of a risk prediction model for falls among older people using primary care electronic health records

2021 ◽  
Author(s):  
Noman Dormosh ◽  
Martijn C Schut ◽  
Martijn W Heymans ◽  
Nathalie van der Velde ◽  
Ameen Abu-Hanna
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Older People ◽  
Prediction Model ◽  
Community Dwelling ◽  
Receiver Operating Curve ◽  
Free Text ◽  
Medical Conditions ◽  
History Of ◽  
Community Dwelling Older People

Abstract Background Currently used prediction tools have limited ability to identify community-dwelling older people at high risk for falls. Prediction models utilizing Electronic Heath Records (EHR) provide opportunities but up to now showed limited clinical value as risk stratification tool; because of among others the underestimation of falls prevalence. The aim of this study was to develop a fall prediction model for community-dwelling older people using a combination of structured data and free text of primary care EHR and to internally validate its predictive performance. Methods EHR data of individuals aged 65 or over. Age, sex, history of falls, medications and medical conditions were included as potential predictors. Falls were ascertained from the free text. We employed the Bootstrap-enhanced penalized logistic regression with the least absolute shrinkage and selection operator to develop the prediction model. We used 10-fold cross-validation to internally validate the prediction strategy. Model performance was assessed in terms of discrimination and calibration. Results Data of 36,470 eligible participants were extracted from the dataset. The number of participants who fell at least once was 4,778 (13.1%). The final prediction model included age, sex, history of falls, two medications and five medical conditions. The model had a median area under the receiver operating curve of 0.705 (IQR 0.700-0.714) . Conclusions Our prediction model to identify older people at high risk for falls achieved fair discrimination, and had reasonable calibration. It can be applied in clinical practice as it relies on routinely collected variables and does not require mobility assessment tests.

scholarly journals Assessing the scalability of an integrated falls prevention service for community-dwelling older people: a mixed methods study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Susan Calnan ◽  
Karen Lee ◽  
Sheena McHugh
Keyword(s):  
Older People ◽  
Hospital Admissions ◽  
Assessment Tool ◽  
Scale Up ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Online Questionnaire ◽  
Qualitative Feedback ◽  
Prevention Service ◽  
Community Dwelling Older People

Abstract Background There is growing acknowledgement of the need for a phased approach to scaling up health interventions, beginning with an assessment of ‘scalability’, that is, the capacity of an individual intervention to be scaled up. This study aims to assess the scalability of a multi-component integrated falls prevention service for community-dwelling older people and to examine the applicability of the Intervention Scalability Assessment Tool (ISAT). The ISAT consists of 10 domains for consideration when determining the scalability of an intervention, and each domain comprises a series of questions aimed at examining readiness for scale-up. Methods Multiple methods were used sequentially as recommended by the ISAT: a review of policy documents, results from a service evaluation and falls-related literature; one-to-one interviews (n = 11) with key stakeholders involved in management and oversight of the service; and a follow-up online questionnaire (n = 10) with stakeholders to rate scalability and provide further feedback on reasons for their scores. Results Three of the ISAT domains were rated highly by the participants. Analysis of the qualitative feedback and documents indicated that the issue of falls prevention among older people was of sufficient priority to warrant scale-up of the service and that the service aligned with national health policy priorities. Some participants also noted that benefits of the service could potentially outweigh costs through reduced hospital admissions and serious injuries such as hip fracture. The remaining domains received a moderate score from participants, however, indicating considerable barriers to scale-up. In the qualitative feedback, barriers identified included the perceived need for more healthcare staff to deliver components of the service, for additional infrastructure such as adequate room space, and for an integrated electronic patient management system linking primary and secondary care and to prevent duplication of services. Conclusions Plans to scale up the service are currently under review given the practical barriers that need to be addressed. The ISAT provides a systematic and structured framework for examining the scalability of this multi-component falls prevention intervention, although the iterative nature of the process and detailed and technical nature of its questions require considerable time and knowledge of the service to complete.

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