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Purpose: Individuals identified as high fall risk are expected to have high concern about falling. However, perception and individual factors that influence concern about falling have yet to be thoroughly studied. We aimed to understand factors that influence concern about falling among older adults with increased risk for falling. Patients and Methods: This was a secondary analysis of a clinical trial among community-dwelling older adults (age ≥65 years old) at high risk for falls (n = 178). Descriptive and regression analyses were used. We analyzed the relationship between participants' baseline concern about falling - categorized into three groups: low (7-8), moderate (9-13), and high (≥14) - and factors that may impact their concern. Exploratory factors included age, sex, self-reported health status and confidence to address fall risks, fall risk scores, and physical performance measures. Results: Among these individuals, 15.2% reported low concern about falling. On average, individuals in higher concern about falling groups had higher fall risk scores (low [5.7], moderate [6.4], and high [8.0]; p < 0.001). Our regression model showed that the odds of being in a higher concern group increased by 21% for every one unit increase in fall risk score and increased by 67% for every one unit increase toward poorer health rating. Conversely, for every one unit increase in self-reported confidence, the odds of being in a higher concern group decreased by 27.5%. Conclusion: Knowledge of older adults' fall risk, health status, and concerns about falling can be used to assist in the personalization of fall prevention interventions for a more holistic approach.
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Acidentes por Quedas , Nível de Saúde , Vida Independente , Autorrelato , Humanos , Acidentes por Quedas/prevenção & controle , Masculino , Idoso , Feminino , Idoso de 80 Anos ou mais , Fatores de Risco , Medição de Risco , Avaliação GeriátricaRESUMO
Purpose: Identify the prevalence and prevalence differences of fall risk factors by sex, clinic rurality, and race/ethnicity among older adults (≥65 years old) receiving outpatient rehabilitation. Patients and Methods: Our secondary analysis used Electronic Health Record data of 108,751 older adults attending outpatient rehabilitation (2018-2022) within a large health system across 7 states and completed the Stay Independent Questionnaire. The mean age was 73.3 (±6.36), 58.1% were female, 84.3% were non-Hispanic White, and 88.8% attended an urban clinic. Fall risks were identified via the Centers for Disease Control and Prevention's Stay Independent Questionnaire. Results: Older adults had a high prevalence of fall risks (44.3%), including history of falls (34.9%). The most prevalent fall-risk factors were impaired strength, gait, and balance. Compared to males, females had a higher prevalence of reporting a fall (4.3%), a fall with injury (9.9%), worrying about falling 9.1%), rushing to the toilet (8.5%), trouble stepping onto a curb (8.4%), taking medicine for sleep or mood (6.0%), feeling sad or depressed (5.3%), and feeling unsteady (4.6%). Males reported a higher prevalence of losing feeling in feet (9.4%), ≥1 fall in the past year (8.1%), and using hands to stand up (4.4%). Compared to White older adults, Native American/Alaska Natives had the highest prevalence of fall history (43.8%), Hispanics had the highest prevalence of falls with injury (56.1%), and Hispanics and Blacks had a higher prevalence of reporting 11/12 Stay Independent Questionnaire risk factors. Conclusion: Older adults receiving outpatient rehabilitation have a high prevalence of fall risks, including falls and difficulties with strength, balance, or gait. Findings indicate that rehabilitation providers should perform screenings for these impairments, including incontinence and medication among females, loss of feeling in the feet among males, and all Stay Independent Questionnaire -related fall risk factors among Native American/Alaska Natives, Hispanics, and Blacks.
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Acidentes por Quedas , Autorrelato , Humanos , Acidentes por Quedas/estatística & dados numéricos , Idoso , Masculino , Feminino , Fatores de Risco , Idoso de 80 Anos ou mais , Prevalência , Fatores Sexuais , Pacientes Ambulatoriais/estatística & dados numéricos , Estados Unidos/epidemiologia , Equilíbrio Postural , Inquéritos e QuestionáriosRESUMO
Falls are a leading cause of morbidity and mortality among adults aged 65 years and older (older adults) and are increasingly recognized as a chronic condition. Yet, fall-related care is infrequently provided in a chronic care context despite fall-related death rates increasing by 41% between 2012 and 2021. One of the many challenges to addressing falls is the absence of fall-focused chronic disease management programs, which improve outcomes of other chronic conditions, like diabetes. Policies, information systems, and clinical-community connections help form the backbone of chronic disease management programs, yet these elements are often missing in fall prevention. Reframing fall prevention through the Expanded Chronic Care Model (ECCM) guided by implementation science to simultaneously support the uptake of evidence-based practices could help improve the care of older adults at risk for falling. The ECCM includes seven components: (1) self-management/develop personal skills, (2) decision support, (3) delivery system design/re-orient health services, (4) information systems, (5) build healthy public policy, (6) create supportive environments, and (7) strengthen community action. Applying the ECCM to falls-related care by integrating health care delivery system changes, community resources, and public policies to support patient-centered engagement for self-management offers the potential to prevent falls more effectively among older adults.
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Acidentes por Quedas , Acidentes por Quedas/prevenção & controle , Humanos , Idoso , Doença Crônica/prevenção & controle , Gestão de Riscos/métodos , Saúde PúblicaRESUMO
Background: While relationships and connectedness among organizations have been included in implementation theories, models, and frameworks, the increased attention to health equity in implementation science raises the urgency of understanding the role of relationships external to the implementing organization. This paper addresses this gap through an exploration of the role of external relationships in community-based, equity-focused interventions. Methods: This study focuses on an equity-focused, community-based COVID-19 vaccination intervention in Arkansas, drawing upon long-term community-engaged relationships among University of Arkansas for Medical Sciences and the Hispanic and Marshallese Islander communities. We used an exploratory qualitative descriptive design to examine barriers and facilitators to implementation of COVID-19 vaccination events analyzing in-depth qualitative interviews with implementation team members (n = 17). Results: All participants described pre-existing relationships among the implementing organization, partner organizations, and communities as a key implementation determinant for this equity-focused program. At the inter-organizational level, external relationships included formal connections and informal relationships among staff (e.g., communication channels from prior partnerships). At the individual level, strong external relationships with the community were facilitators leveraging long-term engagement, community familiarity, and staff from the communities of focus. Strong external relationships facilitated program reach in underserved communities through three mechanisms: (1) reduced time required to establish functional working relationships among partners; (2) accessibility and cultural congruence of health services; and (3) increased trust among community members. Barriers to implementation also existed in external relationships, but had less influence than facilitators. Conclusions: Achieving health equity in implementation science requires greater understanding of external relationships as implementation determinants. This exploratory study makes a significant contribution to the literature by describing the types of external relationships that facilitate equitable implementation and identifying the mechanisms through which they may work. We argue that approaches to community engagement drawn from community-engaged research approaches may be useful, as these processes require investment in building/maintaining formal and informal organizational and interpersonal relationships. Further research is needed to understand connections among external relationships and other implementation determinants.
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BACKGROUND AND OBJECTIVES: The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was used to describe the implementation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Initiative (2018-2021) for screening and assessing all older adults ≥65 years for falls risk across 34 outpatient rehabilitation clinics within a large health system. RESEARCH DESIGN AND METHODS: We described the Implementation process and strategies. Using Electronic Health Records (EHRs), we identified Reach, Adoption, and Maintenance of screenings and physical assessments to identify fall risk among older adults. RESULTS: STEADI Implementation strategies included health system mandates, EHR revisions, email instructions, educational sessions and resources, clinical leads and champions, and chart audits. Reach: 76.4% (50,023) had a completed screening, and 44.1% screened at risk for falls. Adoption: Clinic-level adoption varied, with most performing screenings. Profession-level adoption was highest for physical therapists (PTs; 94.2% initiated, 80.6% completed) and lowest for speech-language pathologists (SLPs; 79.8% initiated, 55.9% completed). Reach and Adoption of functional outcomes measures (FOM): PTs completed an FOM on 59.5% of at-risk patients, occupational therapists on 11.6%, and SLPs on 7.9%. Maintenance: All measures declined 1%-10% annually between 2018 and 2021. DISCUSSION AND IMPLICATIONS: STEADI screening and FOMs were implemented systemwide in 34 outpatient rehabilitation clinics, reaching over 50,000 older adults. Screening adoption rates varied by clinic. PTs had the highest adoption rate. All adoption rates declined over time. Future research should consider an implementation science approach with input from key partners before implementation to identify barriers and develop strategies to support STEADI in outpatient rehabilitation.
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Avaliação de Resultados em Cuidados de Saúde , Pacientes Ambulatoriais , Humanos , IdosoRESUMO
Falls are a major cause of preventable death, injury, and reduced independence in adults aged 65 years and older. The American Geriatrics Society and British Geriatrics Society (AGS/BGS) published a guideline in 2001, revised in 2011, addressing common risk factors for falls and providing recommendations to reduce fall risk in community-dwelling older adults. In 2022, the World Falls Guidelines (WFG) Task Force created updated, globally oriented fall prevention risk stratification, assessment, management, and interventions for older adults. Our objective was to briefly summarize the new WFG, compare them to the AGS/BGS guideline, and offer suggestions for implementation in the United States. We reviewed 11 of the 12 WFG topics related to community-dwelling older adults and agree with several additions to the prior AGS/BGS guideline, including assessment and intervention for hearing impairment and concern for falling, assessment and individualized exercises for older adults with cognitive impairment, and performing a standardized assessment such as STOPPFall before prescribing a medication that could potentially increase fall risk. Notable areas of difference include: (1) AGS continues to recommend screening all patients aged 65+ annually for falls, rather than just those with a history of falls or through opportunistic case finding; (2) AGS recommends continued use of the Timed Up and Go as a gait assessment, rather than relying on gait speed; and (3) AGS recommends clinical judgment on whether or not to check an ECG for those at risk for falling. Our review and translation of the WFG for a US audience offers guidance for healthcare and other providers and teams to reduce fall risk in older adults.
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Acidentes por Quedas , Avaliação Geriátrica , Geriatria , Guias de Prática Clínica como Assunto , Acidentes por Quedas/prevenção & controle , Humanos , Idoso , Estados Unidos , Avaliação Geriátrica/métodos , Medição de Risco , Sociedades Médicas , Vida Independente , Idoso de 80 Anos ou mais , Fatores de Risco , Feminino , MasculinoRESUMO
BACKGROUND: Obesity among United States nursing home (NH) residents is increasing. These residents have special care needs, which increases their risk for falls and falls with injuries. NH are responsible for ensuring the health of their residents, including minimizing falls. However, given the special care needs of residents with obesity, different factors may be important for developing programs to minimize falls among this group. AIM: We aimed to identify NH characteristics associated with falls and falls with injuries among residents with obesity. METHOD: We used resident assessment data and logistic regression analysis. RESULTS: We found that rates of falls and falls with injuries among residents with obesity varied significantly based on for-profit status, size, acuity index, obesity rate among residents, and registered nurse hours per patient day. CONCLUSION: Recommendations are made as to how NH may be able to lower risk for falls and falls with injuries among their residents with obesity.
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Casas de Saúde , Obesidade , Humanos , Estados Unidos , Fatores de Risco , Obesidade/complicações , Obesidade/epidemiologiaRESUMO
Background: Evidence-Based Quality Improvement (EBQI) involves researchers and local partners working collaboratively to support the uptake of an evidence-based intervention (EBI). To date, EBQI has not been consistently included in community-engaged dissemination and implementation literature. The purpose of this paper is to illustrate the steps, activities, and outputs of EBQI in the pre-implementation phase. Methods: The research team applied comparative case study methods to describe key steps, activities, and outputs of EBQI across seven projects. Our approach included: (1) specification of research questions, (2) selection of cases, (3) construction of a case codebook, (4) coding of cases using the codebook, and (5) comparison of cases. Results: The cases selected included five distinct settings (e.g., correction facilities, community pharmacies), seven EBIs (e.g., nutrition promotion curriculum, cognitive processing therapy) and five unique lead authors. Case examples include both community-embedded and clinically-oriented projects. Key steps in the EBQI process included: (1) forming a local team of partners and experts, (2) prioritizing implementation determinants based on existing literature/data, (3) selecting strategies and/or adaptations in the context of key determinants, (4) specifying selected strategies/adaptations, and (5) refining strategies/adaptations. Examples of activities are included to illustrate how each step was achieved. Outputs included prioritized determinants, EBI adaptations, and implementation strategies. Conclusions: A primary contribution of our comparative case study is the delineation of various steps and activities of EBQI, which may contribute to the replicability of the EBQI process across other implementation research projects.
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Objectives: To develop and test implementation strategies to support implementing the Centers for Disease Control and Preventions' Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative for falls prevention and falls risk management in a novel setting, outpatient physical therapy. Design: A feasibility implementation study engaging key partners involved in or affected by the implementation throughout the study. Setting: Five outpatient physical therapy clinics embedded in a health system. Participants: Key partners (physical therapists, physical therapist assistants, referring physicians, administrative clinic staff, older adults, and caregivers) involved in or affected by the implementation (N=48) will participate in surveys and interviews to identify barriers and facilitators prior to implementation and post implementation. Twelve key partners representing at least 1 of each group will participate in evidence-based quality improvement panels to identify which barriers and facilitators are most important and feasible to address and to assist in choosing and designing implementation strategies to support the uptake of STEADI in outpatient rehabilitation. STEADI will be implemented in 5 outpatient physical therapy clinics as a standard of care for the â¼1200 older adults attending those clinics annually. Outcomes: Primary outcomes include clinic- and provider-level (physical therapists and physical therapist assistant) adoption and fidelity to STEADI screening, multifactorial assessment, and falls risk interventions for older adults (65 years or older) attending outpatient physical therapy. Key partners' perceived feasibility, acceptability, and appropriateness of STEADI in outpatient physical therapy will also be measured using validated implementation science questionnaires. Exploratory clinical outcomes of older adults' falls risk pre- and post rehabilitation will be investigated.
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Prior work, primarily focusing on habitual gait velocity, has demonstrated a cost while walking when coupled with a cognitive task. The cost of dual-task walking is exacerbated with age and complexity of the cognitive or motor task. However, few studies have examined the dual-task cost associated with maximal gait velocity. Thus, this cross-sectional study examined age-related changes in dual-task (serial subtraction) walking at two velocities. Participants were classified by age: young-old (45-64 years), middle-old (65-79 years), and oldest-old (≥80 years). They completed single- and dual-task walking trials for each velocity: habitual (N = 217) and maximal (N = 194). While no significant Group × Condition interactions existed for habitual or maximal gait velocities, the main effects for both condition and age groups were significant (p < .01). Maximal dual-task cost (p = .01) was significantly greater in the oldest-old group. With age, both dual-task velocities decreased. Maximal dual-task cost was greatest for the oldest-old group.
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Cognição , Marcha , Humanos , Idoso de 80 Anos ou mais , Estudos Transversais , Caminhada/psicologiaRESUMO
The primary objective was to quantify the influences of care delivery teams on the outcomes of patients with multimorbidity. Electronic medical record data on 68,883 patient care encounters (i.e., 54,664 patients) were extracted from the Arkansas Clinical Data Repository. Social network analysis assessed the minimum care team size associated with improved care outcomes (i.e., hospitalizations, days between hospitalizations, and cost) of patients with multimorbidity. Binomial logistic regression further assessed the influence of the presence of seven specific clinical roles. When compared to patients without multimorbidity, patients with multimorbidity had a higher mean age (i.e., 47.49 v. 40.61), a higher mean dollar amount of cost per encounter (i.e., $3,068 v. $2,449), a higher number of hospitalizations (i.e., 25 v. 4), and a higher number of clinicians engaged in their care (i.e., 139,391 v. 7,514). Greater network density in care teams (i.e., any combination of two or more Physicians, Residents, Nurse Practitioners, Registered Nurses, or Care Managers) was associated with a 46-98% decreased odds of having a high number of hospitalizations. Greater network density (i.e., any combination of two or more Residents or Registered Nurses) was associated with 11-13% increased odds of having a high cost encounter. Greater network density was not significantly associated with having a high number of days between hospitalizations. Analyzing the social networks of care teams may fuel computational tools that better monitor and visualize real-time hospitalization risk and care cost that are germane to care delivery.
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INTRODUCTION/OBJECTIVES: New variants of the SARS-CoV-2 virus that causes COVID-19 will continue to develop and spread globally. The Omicron variant identified in November 2021 has many lineages. Variants spread quickly and can infect previously vaccinated individuals, prompting the Centers for Disease Control and Prevention to update vaccination recommendations. While ~230 million Americans received the initially-recommended vaccine sequence, booster uptake has been much lower; less than half of fully vaccinated individuals report receiving a booster. Racial disparities also mark patterns of COVID-19 vaccination booster uptake. This study explored willingness and motivations to get a COVID-19 booster among a diverse sample of participants. METHODS: We used convenience sampling to recruit participants 18 years of age or older who attended a community vaccine event. We conducted informal interviews during the recommended 15-min post-vaccination wait time with 55 participants who attended vaccine events at Marshallese and Hispanic community locations and comprised the recruitment pool for individual interviews. Using a qualitative descriptive design, we conducted in-depth follow-up interviews with 9 participants (Marshallese n = 5, Hispanic n = 4) to explore willingness and motivations to get boosted. We used rapid thematic template analysis to review informal interview summaries and formal interviews. The research team resolved data discrepancies by consensus. RESULTS: Participants reported high willingness to get boosted, especially if boosters were recommended in the future to protect against serious illness and mitigate the spread of COVID-19. This finding underscores how essential including recommendations to get a COVID-19 booster from trusted sources in health messaging and educational campaigns may be for increasing booster uptake. Participants described their preference for receiving future COVID-19 boosters, reporting that they would attend similar vaccine events, especially those held at faith-based organizations and facilitated by the same community partners, community health workers, and research staff. This finding shows how community engagement can overcome barriers to vaccination (ie, transportation, language, and fear of discrimination) by providing services in preferred community locations with trusted community partners. CONCLUSIONS: Findings document high willingness to get a COVID-19 booster, emphasize the role of recommendations from trusted sources in motivating booster uptake, and highlight the importance of community engagement to address disparities in vaccination coverage and reach.
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Vacinas contra COVID-19 , COVID-19 , Adolescente , Adulto , Humanos , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Hispânico ou Latino , Idioma , SARS-CoV-2 , Estados Unidos/epidemiologia , Vacinação , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Imunização SecundáriaRESUMO
BACKGROUND: Marshallese and Hispanic communities in the United States have been disproportionately affected by COVID-19. Identifying strategies to reach late vaccine adopters is critical for ongoing and future vaccination efforts. We utilized a community-engaged approach that leveraged an existing community-based participatory research collaborative of an academic healthcare organization and Marshallese and Hispanic faith-based organizations (FBO) to host vaccination events. METHODS: Bilingual Marshallese and Hispanic study staff conducted informal interviews with 55 participants during the 15-minute post-vaccination observation period and formal semi-structured interviews with Marshallese (n = 5) and Hispanic (n = 4) adults post-event to assess the implementation of community vaccine events at FBOs, with a focus on factors associated with the decision to attend and be vaccinated. Formal interview transcripts were analyzed using thematic template coding categorized with the socio-ecological model (SEM). Informal interview notes were coded via rapid content analysis and used for data triangulation. RESULTS: Participants discussed similar factors influencing attitudes and behaviors toward receiving the COVID-19 vaccine. Themes included: (1) intrapersonal - myths and misconceptions, (2) interpersonal - protecting family and family decision-making, (3) community - trust of community location of events and influence of FBO members and leaders, (4) institutional - trust in a healthcare organization and bilingual staff, and (5) policy. Participants noted the advantages of vaccination delivery at FBOs, contributing to their decision to attend and get vaccinated. CONCLUSIONS: The following strategies may improve vaccine-related attitudes and behaviors of Marshallese and Hispanic communities not only for the COVID-19 vaccine but also for other preventive vaccinations: 1) interpersonal-level - develop culturally-focused vaccine campaigns targeting the family units, 2) community-level - host vaccination events at convenient and/or trusted locations, such as FBOs, and engage community and/or FBO formal or lay leaders as vaccine ambassadors or champions, and 3) institutional-level - foster trust and a long-term relationship with the healthcare organization and provide bilingual staff at vaccination events. Future research would be beneficial to investigate the effects of replicating these strategies to support vaccine uptake among Marshallese and Hispanic communities.
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Vacinas contra COVID-19 , COVID-19 , Humanos , Adulto , Estados Unidos , Participação da Comunidade , COVID-19/prevenção & controle , Participação dos Interessados , Hispânico ou Latino , VacinaçãoRESUMO
BACKGROUND: Despite the benefits of physical activity (PA), especially related to aging, physical therapists do not perform regular PA prescriptions secondary to various barriers, including lack of tools. Therefore, we developed the Inventory of Physical Activity Barriers (IPAB). OBJECTIVE: Explore potential solutions that could address the current lack of PA prescription among United States-based physical therapists treating patients 50 years and older. METHOD: A convergent parallel mixed-method design consisting of focus groups and self-report questionnaires. Descriptive statistics were used for all quantitative variables. Focus groups were thematically coded. RESULTS: The 26 participants had 8.6 years (SD = 6.4) of clinical experience, 88.4% (n = 23) reported they regularly have PA conversations with patients, 65.4% (n = 17) regularly assess PA levels, and 19.2% (n = 5) regularly provide PA prescriptions. We identified three themes: 1) opportunities and challenges related to PA prescriptions; 2) lack of standardization in PA assessments and interventions; and 3) implementation potential for innovative solutions that address the current informal PA assessments and interventions. CONCLUSION: Physical therapists are amenable to incorporating innovative solutions that support physical activity prescription behavior. Therefore, we recommend the continued development and implementation of PA assessment and prescription tools.
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Exercício Físico , Modalidades de Fisioterapia , Humanos , Grupos Focais , Envelhecimento , PrescriçõesRESUMO
INTRODUCTION: Due to coronavirus disease 2019 (COVID-19), many health/wellness programs transitioned from in-person to virtual. This mixed-methods study aims to explore the perceptions of older adults with Parkinson disease (PD) regarding in-person versus virtual-based Parkinson-specific exercise classes (PDEx). OBJECTIVE: Explore experiences, perceptions, and perceived effect of participating in and transitioning from in-person to virtual PDEx in people with Parkinson disease (PwPD). DESIGN: Cross-sectional mixed-methods design using an online survey and focus groups. SETTING: PwPD who participated in an in-person and virtual PDEx (n = 26) were recruited to participate and completed online surveys and focus groups from their home during the COVID-19 pandemic. PARTICIPANTS: PwPD who participated in an in-person and virtual PDEx and agreed to participate completed an online survey (n = 16; male = 8; mean age = 74 years) and focus groups (n = 9; male = 4; mean age = 75 years). INTERVENTIONS: N/A MAIN OUTCOME MEASURES: Participants completed survey questions and participated in focus groups regarding their perceptions, attitudes, and perceived changes in PD-related symptoms since participating in the PDEx, as well as barriers and facilitators to participating in virtual PDEx. RESULTS: Participants felt PDEx was somewhat to very safe and beneficial. In the computer, comfort, and perceptions survey, participants reported perceived improved mobility (63%), balance (75%), and overall health (63%) since participating the PDEx, whereas some participants reported improved mental health (38%). Participants reported minimal difficulty with accessing virtual PDEx. Most participants stated that they would prefer to participate in a combination of in-person and virtual programming. Focus-group participants emphasized that virtual PDEx provided social and emotional support and improved confidence to perform and maintain an exercise regimen. CONCLUSION: PwPD who transitioned from an in-person to a virtual PDEx felt the program was safe, effective, and improved or prevented declines in their mobility and balance. PwPD who transitioned to a virtual PDEx also reported benefits in non-motor symptoms such as social isolation.
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COVID-19 , Doença de Parkinson , Humanos , Masculino , Idoso , COVID-19/epidemiologia , Pandemias , Estudos Transversais , Modalidades de FisioterapiaRESUMO
BACKGROUND AND PURPOSE: The Agency for Healthcare Research and Quality highlights the need for sustainable linkages between clinical and community settings to enhance prevention and improve care of people with chronic conditions. The first step in promoting linkages is understanding the knowledge and use of evidence-based programs by physical therapy (PT) professionals. Therefore, the objective of this study was to describe the knowledge of and referral to evidence-based programs in the community by a convenience sample of PT professionals and to examine the characteristics of those who refer to evidence-based programs. METHODS: A cross-sectional web-based survey containing 36 questions regarding respondents' demographics and evidence-based program knowledge and referral practices was disseminated to a convenience sample of PT professionals via email, news-blasts, social media, and word of mouth. RESULTS AND DISCUSSION: A total of 459 PT professionals completed the survey. Approximately half reported practicing for more than 20 years and 75% are members of the American Physical Therapy Association (APTA). The majority (74%) are aware of evidence-based programs; however, fewer (56%) refer to these programs. Compared with individuals who do not refer to evidence-based programs, individuals who refer are more likely to be involved in PT organizations and be an APTA Geriatrics member. Of the individuals who do not refer to evidence-based programs, 21.5% reported not knowing they existed and 33% reported not knowing where the programs are located. CONCLUSIONS: Most survey respondents reported knowing about evidence-based programs and more than half reported being aware of the evidence-based programs available in their communities. These results indicate many PT professionals already have a knowledge of evidence-based programs to support clinic-community linkages. As survey respondents were a sample of convenience and likely do not represent all PT professionals in the United States, the results should be interpreted with caution. Additional research on a more representative sample is needed to fully understand the current utilization of evidence-based programs, which will enable us to design efforts to improve the clinic to community transition. Improving linkages between PT professionals and community resources has the potential to benefit both patients and clinicians and lessen the burden on the health care system.
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Background: Addressing physical activity (PA) barriers is essential for increasing PA levels in middle-aged and older adults. However, there are no recommendations on selecting PA barrier assessment tools. Objectives: Thus, we aimed to identify and provide clinimetric properties on PA barrier assessment tools that healthcare providers, exercise experts, and public health officials can use to examine potential barriers faced by community-dwelling adults 50 years and older. Methods: We performed a systematic search of the following databases: PubMed, PsycINFO, CINAHL, and Web of Science. Articles were included if they presented clinimetric data on a PA participation barrier assessment tool for community-dwelling participants with a mean age of 50 years and older. The 561 identified articles underwent multiple rounds of blinded reviews. Included articles underwent data extraction for participant characteristics, scoring, constructs, reference tests, and clinimetric properties. Results: The 35 included articles reported on 33 different PA participation barrier assessment tools. Eighteen articles reported on participants with cardiovascular, musculoskeletal, or neurological diagnoses, diabetes, hemodialysis, history of cancer, or mobility limitations. Tools with two or more supporting publications included the Exercise Benefits/Barrier Scale (EBBS), Episode-Specific Interpretations of Exercise Inventory (ESIE), and Inventory of Physical Activity and Barriers (IPAB). Due to differences in methodologies, across-tool comparison was not possible. Conclusion: The EBBS, ESIE, and IPAB are promising tools for community-dwelling adults 50 years and older. However, additional research is warranted to identify the best PA barrier assessment tool among adults 50 years and older.
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Nursing home residents with obesity are at high risk for contracting urinary tract infections. In this research study, we found nursing homes in multi-facility chain organizations, for-profit status, nursing home size, obesity rate of resident population, and market competition were significantly associated with rates of urinary tract infections among residents with obesity.
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Obesity rates in nursing homes (NHs) are increasing. Residents with obesity are at risk for poor outcomes such as pressure injuries (PIs) due to special care needs such as bariatric medical equipment and special protocols for skin care. PIs among resident populations is a sign of poor quality NH care. The purpose of this retrospective observational study was to identify characteristics of NHs with high rates of stage 2-4 PIs among their high-risk residents with obesity. Resident assessment data were aggregated to the NH level. NH structure and process of care and antecedent conditions of the residents and environment measures were used in bivariate comparisons and multivariate logistic regression models to identify associations with NHs having high rates of stage 2-4 PIs among high-risk residents with obesity. We identified three characteristics for which the effect on the odds was at least 10% for clinical significance - for-profit status, large facilities, and the hours of certified nursing assistants (CNAs) per patient day (HRPPD). This study identified several NH characteristics that are associated with higher risk for PIs, which can be targeted with evidence-based interventions to reduce the risk of these adverse safety events occurring.