scholarly journals A modelling-based economic evaluation of primary-care-based fall-risk screening followed by fall-prevention intervention: a cohort-based Markov model stratified by older age groups

2019 ◽  
Vol 49 (1) ◽  
pp. 57-66 ◽  
Author(s):  
Matthew Franklin ◽  
Rachael Maree Hunter
Keyword(s):  
Risk Assessment ◽  
Cost Effectiveness ◽  
Fall Prevention ◽  
Fall Risk ◽  
Care Pathway ◽  
Cost Effective ◽  
Older Age ◽  
Fall Risk Assessment ◽  
Prevention Intervention ◽  
Fall Prevention Intervention

Abstract Background fall-risk assessment with fall-prevention intervention referral for at-risk groups to avoid falls could be cost-effective from a care-payer perspective. Aims to model the cost-effectiveness of a fall-risk assessment (QTUG compared to TUG) with referral to one of four fall-prevention interventions (Otago, FaME, Tai Chi, home safety assessment and modification) compared to no care pathway, when the decision to screen is based on older age in a primary care setting for community-dwelling people. Methods a cohort-based, decision analytic Markov model was stratified by five age groupings (65–70, 70–75, 65–89, 70–89 and 75–89) to estimate cost per quality-adjusted life years (QALYs). Costs included fall-risk assessment, fall-prevention intervention and downstream resource use (e.g. inpatient and care home admission). Uncertainty was explored using univariate, bivariate and probabilistic sensitivity analyses. Results screening with QTUG dominates (>QALYs; <costs) screening with TUG irrespective of subsequent fall-prevention intervention. The QTUG-based care pathways relative to no care pathway have a high probability of cost-effectiveness in those aged 75–89 (>85%), relative to those aged 70–74 (~10 < 30%) or 65–69 (<10%). In the older age group, only a 10% referral uptake is required for the QTUG with FaME or Otago modelled care pathways to remain cost-effective. Conclusion the highest probability of cost-effectiveness observed was a care pathway incorporating QTUG with FaME in those aged 75–89. Although the model does not fully represent current NICE Falls guidance, decision makers should still give careful consideration to implementing the aforementioned care pathway due to the modelled high probability of cost-effectiveness.

scholarly journals The (cost-)effectiveness of an implemented fall prevention intervention on falls and fall-related injuries among community-dwelling older adults with an increased risk of falls: protocol for the in balance randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maaike van Gameren ◽  
Daniël Bossen ◽  
Judith E. Bosmans ◽  
Bart Visser ◽  
Sanne W. T. Frazer ◽  
...  
Keyword(s):  
Older Adults ◽  
Cost Effectiveness ◽  
Fall Prevention ◽  
Controlled Trial ◽  
Cost Effective ◽  
Community Dwelling ◽  
Prevention Intervention ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Fall Prevention Intervention

Abstract Background Falls and fall-related injuries among older adults are a serious threat to the quality of life and result in high healthcare and societal costs. Despite evidence that falls can be prevented by fall prevention programmes, practical barriers may challenge the implementation of these programmes. In this study, we will investigate the effectiveness and cost-effectiveness of In Balance, a fourteen-week, low-cost group fall prevention intervention, that is widely implemented in community-dwelling older adults with an increased fall risk in the Netherlands. Moreover, we will be the first to include cost-effectiveness for this intervention. Based on previous evidence of the In Balance intervention in pre-frail older adults, we expect this intervention to be (cost-)effective after implementation-related adjustments on the target population and duration of the intervention. Methods This study is a single-blinded, multicenter randomized controlled trial. The target sample will consist of 256 community-dwelling non-frail and pre-frail adults of 65 years or older with an increased risk of falls. The intervention group receives the In Balance intervention as it is currently widely implemented in Dutch healthcare, which includes an educational component and physical exercises. The physical exercises are based on Tai Chi principles and focus on balance and strength. The control group receives general written physical activity recommendations. Primary outcomes are the number of falls and fall-related injuries over 12 months follow-up. Secondary outcomes consist of physical performance measures, physical activity, confidence, health status, quality of life, process evaluation and societal costs. Mixed model analyses will be conducted for both primary and secondary outcomes and will be stratified for non-frail and pre-frail adults. Discussion This trial will provide insight into the clinical and societal impact of an implemented Dutch fall prevention intervention and will have major benefits for older adults, society and health insurance companies. In addition, results of this study will inform healthcare professionals and policy makers about timely and (cost-)effective prevention of falls in older adults. Trial registration Netherlands Trial Register: NL9248 (registered February 13, 2021).

To Assess the Fall Risk among the Elderly in selected Urban Area Kachery, Thrissur

2021 ◽  
pp. 295-298
Author(s):  
Ann Mariya P.R ◽  
Delna Mary George ◽  
Elsamol Francis ◽  
Thasni R.A ◽  
Twinkle Joseph ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Urban Area ◽  
Elderly People ◽  
Fall Prevention ◽  
Fall Risk ◽  
Elderly Person ◽  
The Elderly ◽  
Previous Knowledge ◽  
Fall Risk Assessment

To assess the fall of risk among the elderly in selected urban area of Thrissur. Objectives a) To assess the fall risk among the elderly people in selected urban area of Kachery, Thrissur. b) To associate fall risk score with selected demographic variables. c) To correlate fall risk assessment questionnaire score and modified fall prevention checklist for personal risk factors score among elderly individuals. d) To teach the elderly people about fall prevention exercise. Methodology: Non-experimental descriptive research design is adopted in this study. We selected 60 samples through random sampling technique. Standardized fall risk assessment questionnaire built by national aging research institute and modified fall prevention checklist for personal risk factors built by Hamilton county was used to collect the data. Tool was administered by interview method for assessing fall risk. Fall preventive intervention module developed, validated and administered following data collection. The data collected were analyzed by using descriptive and inferential statistics. Result: The demographic profile of elderly people shows that 46.66% belongs to age group between 60-70 years and most of them 58.33% were females. The majority 73.33% of elderly person are at low risk for fall and 26.66% are at high risk for fall in questionnaire and 81.67% of elderly are low risk for fall, 18.33% are risk and there is no elderly person high risk for fall in checklist. The overall fall risk is high among elderly individual alone in home and low in elderly in nuclear families. The risk for fall among elderly based on previous history of fall shows that elderly with visual impairment those who don’t have previous knowledge about fall prevention and elderly age between 91-100 is high risk for fall. The risk for fall based on ability to perform ADL in elderly shows those who living alone in the home high risk for fall. There is significant association between score with selected variables like age, previous knowledge about fall prevention, elderly residing in their home alone. We found that there is perfect positive correlation r=1 between fall risk assessment, questionnaires and checklist score. Discussion: At the end of the study the investigator found that the risk for fall based on the assessment of fall history among elderly people shows that, there is significant association between age (p=0.0273) that is, age group between 91-100 years are high risk for fall. Previous knowledge about fall prevention shows that, elderly without previous knowledge about fall prevention is at high risk for fall (p= 0.03074). In sensory impairment that is, elderly having visual impairment (p=0.998) having risk for fall. The risk for fall among elderly people based on their ability to perform activities of daily living shows that, elderly residing in their home alone shows more risk for fall.

scholarly journals Predicting Falls Risk in Hospital; KPJ Seremban Experience

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Maygala A ◽  
Primuhasa Putra SHA ◽  
Aziz AR ◽  
Ainol MR ◽  
Zainah J ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Patient Safety ◽  
Fall Prevention ◽  
Fall Risk ◽  
Assessment Tool ◽  
Healthcare Providers ◽  
Extended Period ◽  
Risk Assessment Tool ◽  
Contributing Factors ◽  
Fall Risk Assessment

Introduction: Falls may result in injuries, prolonged hospitalization, increase in morbidity and mortality, incur cost to the individual and the healthcare system and increase potential litigation. Various hospital fall prevention programs such as Morse Fall Scale Assessment Tool have been implemented in the last decade; however most of the program had no sustained effects on falls reduction over extended period of time. Benchmarking from private hospitals showed patients fall increased by 27% in 2008 as compared to 2007 (MPC report, 2008). There were 25 cases of falls in 2008 at KPJ Seremban Specialist Hospital. The objective of this program is to comply with The Joint Commission’s National Patient Safety Goals 9, “reduce the risk of patient harm resulting from falls” and to formulate evidence based best clinical practice recommendations on assessment and prevention of falls in the hospital for all inpatients, outpatients, customers and staffs within hospital premises. Materials and Methods: Contributing factors were identified based on the retrospective analysis of falls from 1st.January 2008 to 30th September 2008. A fall risk assessment tool identified as KPJ FRAT (KPJ Fall Risk Assessment Tool) for inpatient was developed and various other strategies to reduce the risk of falls throughout the hospital premises were identified. Points of engagement for inpatient assessment using KPJ FRAT were on admission, transfer in or when there is a change in patients’ condition. A prospective descriptive study was done and data was collected from 1st January 2009 till 31st December 2009 through interview with patients, healthcare providers and review of adverse event reports and medical records. Results: No of inpatients during this study were 37058 and there were 13 falls. The post implementation data reflects for every 1000 inpatient days the fall rate decreased to 4.3 falls. Conclusion: The use of KPJ FRAT and Fall Prevention program implemented throughout KPJ SSH has reduced the incidence of falls significantly by 48%. This might be due to increase awareness among the staff, hospital wide policy to report all cases and the formation of patient safety committee to formulate policy and reinforce the implementation processes. Limitation of the study include under reporting and heavy workload.

scholarly journals ABILITY OF THE PHYSIOLOGICAL PROFILE ASSESSMENT TO CLASSIFY FALLER TYPE: A PROSPECTIVE COHORT STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S471-S471
Author(s):  
Deborah A Jehu ◽  
Jennifer C Davis ◽  
Kristin Velsey ◽  
Winnie Cheung ◽  
Teresa Liu-Ambrose
Keyword(s):  
Older Adults ◽  
Risk Assessment ◽  
Fall Prevention ◽  
Fall Risk ◽  
Vancouver General Hospital ◽  
Community Dwelling ◽  
Medical Attention ◽  
Physiological Profile ◽  
Fall Risk Assessment ◽  
Physiological Profile Assessment

Abstract Accurately identifying older adults who will experience subsequent falls is important for the provision of secondary fall prevention. The purpose of this study was to determine the accuracy of the Physiological Profile Assessment (PPA) – a valid and reliable fall-risk assessment [1] – in predicting subsequent falls over a 12-month period in older adults who sought for medical attention after an index fall. Seven hundred thirty-seven community-dwelling adults, aged 70 years and older, who were seen at the Vancouver General Hospital Fall Prevention Clinic, completed the PPA at their initial visit. Falls over the subsequent 12 months were tracked prospectively via monthly falls calendars. All individuals received geriatric care at baseline. Binary logistic regressions were performed to determine the accuracy of classifying two prospective faller types: 1) no additional falls; 2) one or more additional fall(s). Baseline PPA, age, and sex were entered as independent variables. During the 12 month observation period, 345 participants had no additional falls (Age:81.3±6.6yrs;Female=251) and 392 fell one or more times (Age:82.3±6.5yrs;Female=230). The classification accuracy was 51.3% for those who had no additional falls and 64.8% for those with one or more additional fall(s) (Overall:58.5%;χ2=29.0;PPA:β=-0.21;Age:β=-0.01;Sex:β=-60). The PPA was not able to accurately differentiate between those who did and did not subsequently fall. Fall-risk assessment sensitivity and specificity should be improved in older adults seeking medical attention following an index fall to inform secondary fall prevention. [1] Lord SR, et al., 2003. Phys Ther.

scholarly journals PREVENTING FALLS AMONG OLDER FALLERS: LIVE-LIFE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S913-S913
Author(s):  
Sarah L Szanton ◽  
Lindy Clemson ◽  
Minhui Liu ◽  
Laura N Gitlin ◽  
David L Roth ◽  
...  
Keyword(s):  
Fall Prevention ◽  
Fall Risk ◽  
Pilot Trial ◽  
Balance Training ◽  
Primary Care Providers ◽  
Control Group ◽  
Care Providers ◽  
Timed Up And Go ◽  
Prevention Intervention ◽  
Fall Prevention Intervention

Abstract OBJECTIVES: To evaluate whether a fall prevention intervention, adapted from the LiFE program, reduces fall risk in older adults who have previously fallen. DESIGN: Randomized controlled pilot trial SETTING: Participants’ homes INTERVENTION: LIVE-LIFE is an occupational therapy delivered fall prevention intervention that integrates strength and balance training into daily habits in 8 visits over 12 weeks. The intervention also provides 1) up to $500 in home safety changes prioritized by the participants 2) vision contrast screening and referral, and 3) personalized fall risk medication recommendations to Primary Care Providers (PCP) from a Pharmacist. This multi-component intervention was compared to a control condition consisting of CDC fall prevention materials and an individualized fall risk summary. MEASUREMENT: Primary outcome: Fall risk measured by Timed Up and Go (TUG) and Tandem stand. Secondary outcomes: Falls efficacy, feasibility and acceptability of the intervention. RESULTS: The sample of 37 people was 65% female, 65% white and an average 77 years old. Two were lost to follow up (95% retention). Compared to the control group, the mean of each outcome improved in the intervention. The LIVE-LiFE intervention had a large effect size (1.1) for amount of time study participants could hold a tandem stand, a moderate effect (0.5) in falls efficacy, and a small effect (0.1) in the TUG. CONCLUSION: LIVE-LIFE was acceptable to participants, feasible to provide, and averaged large to small effect sizes. Simultaneously addressing preventable fall risk factors is feasible and should be investigated due to the growing population at risk for falls.

The meaning of the experience of anticipating falling

2014 ◽  
Vol 35 (9) ◽  
pp. 1839-1863 ◽  
Author(s):  
JAMES A. SHAW ◽  
DENISE M. CONNELLY ◽  
CAROL L. MCWILLIAM
Keyword(s):  
Risk Assessment ◽  
Older People ◽  
Health Care Providers ◽  
Fall Prevention ◽  
Fall Risk ◽  
Phenomenological Study ◽  
Later Life ◽  
Care Providers ◽  
Structured Interviews ◽  
Fall Risk Assessment

ABSTRACTFalling in later life continues to be a critical issue in gerontology research, health professional practice and ageing health policy. However, much research in the area of fall risk and fall prevention neglects the meaning of the experiences of older people themselves. This humanistic interpretive phenomenological study explored the meaning of the experience of anticipating falling from the perspective of older people in order to foster a more person-focused approach to fall risk assessment and fall prevention. Individual semi-structured interviews were conducted with nine participants over the age of 65 living independently in the community. Follow-up interviews with two key informants were completed to inform the emerging interpretations. For older participants residing in the community, the experience of anticipating falling meant confronting their embodied lived-identity in the context of ageing. Experiential learning shaped how participants understood the meaning of falling, which constituted tacit, pathic knowledge of vulnerability and anxiety with respect to falling. Findings emphasise the importance of critically reflecting on the social experience of anticipating falling to develop effective and relevant fall prevention interventions, programmes and policies. A lifeworld-led approach to fall risk assessment and fall prevention resonates with these findings, and may encourage health-care providers to adopt a sustained focus on embodied lived-identity and quality of life when engaging older people in fall prevention activities.

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