Falls prevention education for older adults during and after hospitalization: A systematic review and meta-analysis (original) (raw)
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International Journal of Evidence-Based Healthcare, 2009
The authors concluded that some evidence existed for the effectiveness of certain multifactorial interventions for fall prevention in older acute-care patients, particularly those that increased patient education or targeted fall risk factors. Recommendations for further research accurately reflected the limitations presented in this review. The authors' conclusion reflected the evidence presented and their cautious interpretation is likely to be reliable. Authors' objectives To evaluate the effectiveness of interventions to reduce the incidence of falls in older patients in acute-care hospital settings. Searching MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Current Contents, PsycINFO and ProQuest Dissertations and Theses (for unpublished studies) were searched for English-language studies from 1998 to 2008. Reference lists of retrieved articles were searched for additional studies. Study selection Randomised Controlled Trials (RCTs) of interventions to assess or minimise the risk of falling compared to standard practice or no intervention in patients aged at least 65 years in acute-care hospitals were eligible for inclusion in the review. The outcome of interest was the number of patient falls in hospital. The included trials were conducted in Australia, UK and Sweden. Interventions comprised exercise, patient education, Vitamin D supplementation, a targeted risk factor reduction plan and multifactorial programmes. The comparators were usual care, although this was not well defined in all trials. There was substantial variation within the included trials in terms of patient case mix, treatment of study groups, intervention delivery, methods of reporting falls, data analysis techniques, follow-up and definitions of acute care. Two reviewers selected the studies for inclusion. Assessment of study quality Methodological quality of the studies was assessed using Joanna Briggs Institute checklist (JBI SUMARI). The authors did not state how many reviewers carried out quality assessment. Data extraction Data were extracted independently by two reviewers on the number of falls or relative risks (RR) and incidence rate ratios (IRR) along with 95% confidence intervals (CI). Disagreements were resolved by discussion. Methods of synthesis Results were synthesised narratively and grouped by the type of intervention examined. Results of the review Seven RCTs were included in the review. Two trials were cluster randomised (matched by wards). One trial was doubleblinded. Positive intervention effects were reported in four trials. A one-to-one patient education package (part of a multifactorial intervention) on risk factors and goal setting for falls
Evaluation of Tailored Falls Education on Older Adults' Behavior Following Hospitalization
Journal of the American Geriatrics Society, 2019
BACKGROUNDOlder adults recently discharged from the hospital are known to be at risk of functional decline and falls. This study evaluated the effect of a tailored education program provided in the hospital on older adult engagement in fall prevention strategies within 6 months after hospital discharge.METHODSA process evaluation of a randomized controlled trial that aimed to improve older adult fall prevention behaviors after hospital discharge. Participants (n = 390) were aged 60 years and older with good cognitive function (greater than 7 of 10 Abbreviated Mental Test Score), discharged home from three hospital rehabilitation wards in Perth, Australia. The primary outcomes were engagement in fall prevention strategies, including assistance with daily activities, home modifications, and exercise. Data were analyzed using generalized linear modeling.RESULTSThere were 76.4% (n = 292) of participants who completed the final interview (n = 149 intervention, n = 143 control). There wer...
Injury Prevention
ObjectiveTo determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and hospital admissions in older adults presenting to the ED with a fall.DesignSystematic review and meta-analyses of randomised controlled trials (RCTs).Data sourcesFour health-related electronic databases (Ovid MEDLINE, CINAHL, EMBASE, PEDro and The Cochrane Central Register of Controlled Trials) were searched (inception to June 2018).Study selectionRCTs of multifactorial falls prevention interventions targeting community-dwelling older adults (≥60 years) presenting to the ED with a fall with quantitative data on at least one review outcome.Data extractionTwo independent reviewers determined inclusion, assessed study quality and undertook data extraction, discrepancies resolved by a third.Data synthesis12 studies involving 3986 participants, from six countries, were eligible for inclusion. Studies were of variable ...
BMJ open, 2017
Older adults frequently fall after discharge from hospital. Older people may have low self-perceived risk of falls and poor knowledge about falls prevention. The primary aim of the study is to evaluate the effect of providing tailored falls prevention education in addition to usual care on falls rates in older people after discharge from hospital compared to providing a social intervention in addition to usual care. The 'Back to My Best' study is a multisite, single blind, parallel-group randomised controlled trial with blinded outcome assessment and intention-to-treat analysis, adhering to CONSORT guidelines. Patients (n=390) (aged 60 years or older; score more than 7/10 on the Abbreviated Mental Test Score; discharged to community settings) from aged care rehabilitation wards in three hospitals will be recruited and randomly assigned to one of two groups. Participants allocated to the control group shall receive usual care plus a social visit. Participants allocated to the...
BMJ open, 2018
Older adults recently discharged from hospital have greater incidence of adverse events, functional decline, falls and subsequent readmission. Providing education to hospitalised patients on how to prevent falls at home could reduce postdischarge falls. There has been limited research investigating how older adults respond to tailored falls prevention education provided at hospital discharge. The aim of this study is to evaluate how providing tailored falls prevention education to older patients at the point of, and immediately after hospital discharge in addition to usual care, affects engagement in falls prevention strategies in the 6-months postdischarge period, including their capability and motivation to engage in falls prevention strategies. This prospective observational cohort study is a process evaluation of a randomised controlled trial, using an embedded mixed-method design. Participants (n=390) who have been enrolled in the trial are over the age of 60 years, scoring gre...
Age and ageing, 2018
older adults are known to have increased falls rates and functional decline following hospital discharge, with substantial economic healthcare costs. This systematic review aimed to synthesise the evidence for effective falls prevention interventions in older adults recently discharged from hospital. literature searches of six databases of quantitative studies conducted from 1990 to June 2017, reporting falls outcomes of falls prevention interventions for community-dwelling older adults discharged from hospital were included. Study quality was assessed using a standardised JBI critical appraisal tool (MAStARI) and data pooled using Rev-Man Review Manager®. sixteen studies (total sample size N = 3,290, from eight countries, mean age 77) comprising 12 interventions met inclusion criteria. We found home hazard modification interventions delivered to those with a previous falls history (1 study), was effective in reducing the number of falls (RR 0.63, 95%CI 0.43, 0.93, Low GRADE evidenc...
The Journals of Gerontology: Series A, 2019
Background Older people are at high risk of falls after hospital discharge. The study aimed to evaluate the effect of providing individualized falls prevention education in addition to usual care on falls rates in older people after hospital discharge compared to providing a social intervention in addition to usual care. Methods A randomized clinical trial at three hospitals in Western Australia: participants followed for 6 months after discharge. Baseline and outcomes measured by assessors masked to group allocation. Participants: aged 60 years and over, admitted for rehabilitation. Eligibility included: cognitively able to undertake education (Abbreviated mental test score >7/10). Intervention: tailored education comprising patient video and workbook, structured discussion and goal setting led by trained therapist. Main outcomes: falls in the 6 months after discharge; proportion of participants sustaining one or more falls. Results There were 382 (194 intervention; 188 control)...
BMJ, 2008
Objective To evaluate the effectiveness of multifactorial assessment and intervention programmes to prevent falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings. Design Systematic review of randomised and quasirandomised controlled trials, and meta-analysis. Data sources Six electronic databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007, reference lists of included studies, and previous reviews. Review methods Eligible studies were randomised or quasi-randomised trials that evaluated interventions to prevent falls that were based in emergency departments, primary care, or the community that assessed multiple risk factors for falling and provided or arranged for treatments to address these risk factors. Data extraction Outcomes were number of fallers, fall related injuries, fall rate, death, admission to hospital, contacts with health services, move to institutional care, physical activity, and quality of life. Methodological quality assessment included allocation concealment, blinding, losses and exclusions, intention to treat analysis, and reliability of outcome measurement. Results 19 studies, of variable methodological quality, were included. The combined risk ratio for the number of fallers during follow-up among 18 trials was 0.91 (95% confidence interval 0.82 to 1.02) and for fall related injuries (eight trials) was 0.90 (0.68 to 1.20). No differences were found in admissions to hospital, emergency department attendance, death, or move to institutional care. Subgroup analyses found no evidence of different effects between interventions in different locations, populations selected for high risk of falls or unselected, and multidisciplinary teams including a doctor, but interventions that actively provide treatments may be more effective than those that provide only knowledge and referral. Conclusions Evidence that multifactorial fall prevention programmes in primary care, community, or emergency care settings are effective in reducing the number of fallers or fall related injuries is limited. Data were insufficient to assess fall and injury rates.
Educating hospital patients to prevent falls: protocol for a scoping review
BMJ Open
IntroductionFalls prevention in hospitals is an ongoing challenge worldwide. Despite a wide variety of recommended falls mitigation strategies, few have strong evidence for effectiveness in reducing falls and accompanying injuries. Patient education programmes that promote engagement and enable people to understand their heightened falls risk while hospitalised are one approach. The aim of this scoping review is to examine the content, design and outcomes of patient education approaches to hospital falls prevention. As well as critiquing the role of patient education in hospital falls prevention, strategies that can be used in clinical practice shall be recommended.Methods and analysisThe analysis will apply the methodological framework developed by Arksey and O’Malley and refined by the Joanna Briggs Institute. An initial limited search of Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed will be completed to identify keywords and index terms. A developed...