[The care in the prevention of falls in elderly people: Meta-summary of qualitative articles].
Ontology highlight
ABSTRACT: Objective
To summarize the qualitative evidence on the role of care providers in the prevention of falls of persons over 65 years of age in centres and in the community.Design
Meta-summary of qualitative evidence following the aggregation method.Data sources
Extensive manual search of 16 databases (CINAHL, Pubmed/Medline, Embase, PsycInfo, Cochrane Library, PeDRO, Opengrey (Reports), Cuiden, Cuidatge, Enfispo, Medes, Lilacs, Teseo, Dissertation and Thesis Global and Ibecs), in English, French, Spanish and Portuguese; no time limit.Selection of studies
Selection and blind critical appraisal by pairs. A first relevance and relevance screening and a second critical appraisal screening were carried out. A total of 4170 articles were located; 41 qualitative articles were critically appraised and 31 were selected.Data extraction
Data regarding author, year, study design, location, participants (number, age, sex and occupation), study methods and findings were extracted.Results
The analysis revealed four major themes: precipitating factors, preventive models, feelings and decision-making process. It also highlights the difficult act of ethical balance, the role of the institution in prevention and the fragmentation of care, as keys to successful implementation.Conclusions
The findings show the complexity of fall prevention and the need to incorporate care providers' opinions in preventive models.
SUBMITTER: Abad-Corpa E
PROVIDER: S-EPMC8111575 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC10727475 | biostudies-literature
Project description:ObjectiveDespite consistent evidence for the positive impact of contingency planning for falls in older people, implementation of plans often fail. This is likely due to lack of recognition and knowledge about perspectives of older people about contingency planning. The objective of this research was to explore the perspectives of older people living in the community about use of contingency planning for getting help quickly after a fall.MethodA systematic literature search seeking qualitative research was conducted in April 2014, with no limit placed on date of publication. Medline, EMBASE, Ageline, CINAHL, HealthSource- Nursing/Academic Edition, AMED and Psych INFO databases were searched. Three main concepts were explored and linked using Boolean operators; older people, falls and contingency planning. The search was updated until February 2016 with no new articles found. After removal of duplicates, 562 articles were assessed against inclusion and exclusion criteria resulting in six studies for the meta-synthesis. These studies were critically appraised using the McMaster critical appraisal tool. Bespoke data extraction sheets were developed and a meta-synthesis approach was adopted to extract and synthesise findings.FindingsThree themes of 'a mix of attitudes', 'careful deliberations' and 'a source of anxiety' were established. Perspectives of older people were on a continuum between regarding contingency plans as necessary and not necessary. Levels of engagement with the contingency planning process seemed associated with acceptance of their risk of falling and their familiarity with available contingency planning strategies.ConclusionAvoiding a long lie on the floor following a fall is imperative for older people in the community but there is a lack of knowledge about contingency planning for falls. This meta-synthesis provides new insights into this area of health service delivery and highlights that implementation of plans needs to be directed by the older people rather than the health professionals.
| S-EPMC5451003 | biostudies-literature
Project description:BackgroundFalls in elderly people are a major health burden, especially in the long-term care environment. Yet little objective evidence is available for how and why falls occur in this population. We aimed to provide such evidence by analysing real-life falls in long-term care captured on video.MethodsWe did this observational study between April 20, 2007, and June 23, 2010, in two long-term care facilities in British Columbia, Canada. Digital video cameras were installed in common areas (dining rooms, lounges, hallways). When a fall occurred, facility staff completed an incident report and contacted our teams so that we could collect video footage. A team reviewed each fall video with a validated questionnaire that probed the cause of imbalance and activity at the time of falling. We then tested whether differences existed in the proportion of participants falling due to the various causes, and while engaging in various activities, with generalised linear models, repeated measures logistic regression, and log-linear Poisson regression.FindingsWe captured 227 falls from 130 individuals (mean age 78 years, SD 10). The most frequent cause of falling was incorrect weight shifting, which accounted for 41% (93 of 227) of falls, followed by trip or stumble (48, 21%), hit or bump (25, 11%), loss of support (25, 11%), and collapse (24, 11%). Slipping accounted for only 3% (six) of falls. The three activities associated with the highest proportion of falls were forward walking (54 of 227 falls, 24%), standing quietly (29 falls, 13%), and sitting down (28 falls, 12%). Compared with previous reports from the long-term care setting, we identified a higher occurrence of falls during standing and transferring, a lower occurrence during walking, and a larger proportion due to centre-of-mass perturbations than base-of-support perturbations.InterpretationBy providing insight into the sequences of events that most commonly lead to falls, our results should lead to more valid and effective approaches for balance assessment and fall prevention in long-term care.FundingCanadian Institutes for Health Research.
| S-EPMC3540102 | biostudies-literature
Project description:BackgroundElderly people are at high risk of falls due to decreased muscle strength. So far, there is currently no officially approved medication for treating muscle strength loss. The active vitamin D analogues are promising but inconsistent results have been reported in previous studies. The present study was to meta-analyze the effect of active vitamin D analogues on muscle strength and falls in elderly people.MethodsThe protocol was registered with PROSPERO (record number: CRD42021266978). We searched two databases including PubMed and Cochrane Library up until August 2023. Risk ratio (RR) and standardized mean difference (SMD) with 95% confidence intervals (95% CI) were used to assess the effects of active vitamin D analogues on muscle strength or falls.ResultsRegarding the effects of calcitriol (n= 1), alfacalcidol (n= 1) and eldecalcitol (n= 1) on falls, all included randomized controlled trials (RCT) recruited 771 participants. Regarding the effects of the effects of calcitriol (n= 4), alfacalcidol (n= 3) and eldecalcitol (n= 3) on muscle strength, all included RCTs recruited 2431 participants. The results showed that in the pooled analysis of three active vitamin D analogues, active vitamin D analogues reduced the risk of fall by 19%. Due to a lack of sufficient data, no separate subgroup analysis was conducted on the effect of each active vitamin D analogue on falls. In the pooled and separate analysis of active vitamin D analogues, no significant effects were found on global muscle, hand grip, and back extensor strength. However, a significant enhancement of quadriceps strength was observed in the pooled analysis and separate analysis of alfacalcidol and eldecalcitol. The separate subgroup analysis on the impact of calcitriol on the quadriceps strength was not performed due to the lack to sufficient data. The results of pooled and separate subgroup analysis of active vitamin D analogues with or without calcium supplementation showed that calcium supplementation did not affect the effect of vitamin D on muscle strength.ConclusionsThe use of active vitamin D analogues does not improve global muscle, hand grip, and back extensor strength but improves quadriceps strength and reduces risk of falls in elderly population.
| S-EPMC10867111 | biostudies-literature
Project description:BackgroundFalls are a major threat to older people's health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people's experiences of outdoor falls to develop understanding of how they may be prevented.MethodsWe conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses.ResultsForty-four adults aged 65 - 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week.ConclusionsThis exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people.
| S-EPMC3835551 | biostudies-literature
Project description:AimsTo provide a comprehensive collection of evidence on the effectiveness of exercise interventions to prevent falls and support clinical decision-making.DesignA systematic literature review and meta-analysis of randomized controlled trails were performed by combining trials from published systematic reviews and more recent ones from a separate literature search.Data sourcesThe literature search was performed using PubMed, CINAHL, Cochrane Databases, and Google Scholar dating January 2007 - March 2018.Review methodsComparable studies were pooled using the random-effects model. The GRADE approach was used to judge the evidence.ResultsExercises with a balance component or with technical devices reduced falls significantly, however, with low confidence in the evidence. The evidence indicated that exercises conducted longer than 6 months were beneficial. In frail residents, exercise interventions seemed to have substantially negative effects on falls.ConclusionsExercise interventions with technical devices, those with a balance component, and those performed longer than 6 months are recommended in long-term care settings. Frail residents need special attention when performing exercises due to their increased risk of falling.ImpactExercises with a balance component and exercises carried out with technical devices have beneficial effects, whereas exercises performed longer than 6 months are more effective than short-term performances. No significant reduction or decrease in the number of falls was found for exercise in cognitively impaired residents. In frail residents, however, the number of fall events increased substantially as a result of exercise interventions. The results of this review are useful for clinical decision-makers in long-term care facilities with regard to the planning and performance of exercise interventions for residents.
| S-EPMC6972676 | biostudies-literature
Project description:Introduction One of the known risk factors for fall incidents is the use of specific medications, fall-risk-increasing drugs (FRIDs). However, to date, there is uncertainty related to the effectiveness of deprescribing as a single intervention in falls prevention. Thus, a comprehensive update of the literature focusing on all settings in which older people receive healthcare and all deprescribing interventions is warranted to enhance the current knowledge. Methods and analysis This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was performed in Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PsycINFO (2 November 2020). We will also search in trial registers. We will include randomised controlled trials, in which any deprescribing intervention is compared with usual care and reports falls as an outcome. Both title and abstract screening and full-text screening will be done by two reviewers. The Cochrane Collaboration revised tool of Risk of Bias will be applied to perform risk of bias assessment. We will categorise the results separately for every setting. If a group of sufficiently comparable studies will be identified, we will perform a meta-analysis applying random effects model. We will investigate heterogeneity using a combination of visual inspection of the forest plot along with consideration of the χ2 test and the I2 statistic results. We have prespecified several subgroup and sensitivity analyses. Ethics and dissemination Ethics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations. Furthermore, this systematic review will inform the recommendations of working group of polypharmacy and FRIDs of the anticipated World’s Falls Guidelines. PROSPERO registration number CRD42020218231.
| S-EPMC8572380 | biostudies-literature
Project description:OBJECTIVES:The prevention of falls in the elderly trial (PROFET) provides evidence of the benefits of structured interdisciplinary assessment of older people presenting to the accident and emergency department with a fall. However, the service implications of implementing this effective intervention are significant. This study therefore examined risk factors from PROFET and used these to devise a practical approach to streamlining referrals from accident and emergency departments to specialist falls services. METHODS:Logistic regression analysis was used in the control group to identify patients with an increased risk of falling in the absence of any intervention. The derived predictors were investigated to see whether they also predicted loss to follow up. A second regression analysis was undertaken to test for interaction with intervention. RESULTS:Significant positive predictors of further falls were; history of falls in the previous year (OR 1.5 (95%CI 1.1 to 1.9)), falling indoors (OR 2.4 (95%CI 1.1 to 5.2)), and inability to get up after a fall (OR 5.5 (95%CI 2.3 to 13.0)). Negative predictors were moderate alcohol consumption (OR 0.55 (95%CI 0.28 to 1.1)), a reduced abbreviated mental test score (OR 0.7 (95%CI 0.53 to 0.93)), and admission to hospital as a result of the fall (OR 0.26 (95%CI 0.11 to 0.61)). A history of falls (OR 1.2 (95%CI 1.0 to 1.3)), falling indoors (OR 3.2 (95%CI 1.5 to 6.6)) and a reduced abbreviated mental test score (OR 1.3 (95%CI 1.0 to 1.6)) were found to predict loss to follow up. CONCLUSIONS:The study has focused on a readily identifiable high risk group of people presenting at a key interface between the primary and secondary health care sectors. Analysis of derived predictors offers a practical risk based approach to streamlining referrals that is consistent with an attainable level of service commitment.
| S-EPMC1726177 | biostudies-literature
Project description:ObjectivesTo determine the clinical and cost effectiveness of a multifactorial fall prevention programme compared with usual care in long term care homes.DesignMulticentre, parallel, cluster randomised controlled trial.SettingLong term care homes in the UK, registered to care for older people or those with dementia.Participants1657 consenting residents and 84 care homes. 39 were randomised to the intervention group and 45 were randomised to usual care.InterventionsGuide to Action for Care Homes (GtACH): a multifactorial fall prevention programme or usual care.Main outcome measuresPrimary outcome measure was fall rate at 91-180 days after randomisation. The economic evaluation measured health related quality of life using quality adjusted life years (QALYs) derived from the five domain five level version of the EuroQoL index (EQ-5D-5L) or proxy version (EQ-5D-5L-P) and the Dementia Quality of Life utility measure (DEMQOL-U), which were self-completed by competent residents and by a care home staff member proxy (DEMQOL-P-U) for all residents (in case the ability to complete changed during the study) until 12 months after randomisation. Secondary outcome measures were falls at 1-90, 181-270, and 271-360 days after randomisation, Barthel index score, and the Physical Activity Measure-Residential Care Homes (PAM-RC) score at 91, 180, 270, and 360 days after randomisation.ResultsMean age of residents was 85 years. 32% were men. GtACH training was delivered to 1051/1480 staff (71%). Primary outcome data were available for 630 participants in the GtACH group and 712 in the usual care group. The unadjusted incidence rate ratio for falls between 91 and 180 days was 0.57 (95% confidence interval 0.45 to 0.71, P<0.001) in favour of the GtACH programme (GtACH: six falls/1000 residents v usual care: 10 falls/1000). Barthel activities of daily living indices and PAM-RC scores were similar between groups at all time points. The incremental cost was £108 (95% confidence interval -£271.06 to 487.58), incremental QALYs gained for EQ-5D-5L-P was 0.024 (95% confidence interval 0.004 to 0.044) and for DEMQOL-P-U was 0.005 (-0.019 to 0.03). The incremental costs per EQ-5D-5L-P and DEMQOL-P-U based QALY were £4544 and £20 889, respectively.ConclusionsThe GtACH programme was associated with a reduction in fall rate and cost effectiveness, without a decrease in activity or increase in dependency.Trial registrationISRCTN34353836.
| S-EPMC8649897 | biostudies-literature