Process evaluation of a nurse-led multifactorial intervention protocol for risk screening and assessment of fall problems among community-dwelling older persons: a pilot-study.

ABSTRACT

This pilot study investigated the feasibility of a nurse-led fall prevention strategy in community-dwelling older persons. The sample included 126 subjects (mean age = 76 years) who could rise from a chair and transfer independently. During a home visit, a research nurse identified individuals at risk a history of >or= 2 falls in the previous year or difficulties in gait and/or balance. Patients not at risk received an educational leaflet. Older persons at risk received an evaluation of risk factors for falling. Whenever problems were identified, the nurses gave specific advice and subjects were referred to their general practitioner (GP). After one month, adherence to these recommendations was evaluated. Twenty-seven individuals showed an increased risk of falling (21.4%). The mean number of risk factors per person was 3.4 (SD=1.2). Noncompliance with one or more of the fall prevention recommendations was 58.3%. Differentiated by type of recommendations, a high degree of compliance was observed for recommendations related to gait and balance, use of medication, orthostatic hypotension, urge-incontinence, environment and behavior (81.8%-100%). While most individuals followed the recommendation to consult their GP (66.7%-80%), most of the GP's failed to propose any further measures to prevent falls. Screening, evaluation of risk factors, giving advice and follow-up required on average 3.1 (SD=0.8), 29.4 (SD=15.1), 15.8 (SD=11.0) and 13.1 (SD=3.9) minutes, respectively. Of those subjects who were not at risk, 76.1% had read the leaflet and 74.6% of those considered it useful. This study provides preliminary evidence for the feasibility in terms of time investment to integrate a nurse-led multifactorial fall intervention in current care for older persons living at home. However, further investigation to increase compliance with recommendations and more insight in the GP's role relating to the management of patients at risk for falls is needed.