Disjunction, tension and dissonance within nursing pain care provision for the older hospitalized person: A focused ethnographic insight.

AIMS: This study presents an ethnographic insight into the older hospitalized persons' experiences on how nurses provide pain care provision. The older persons' perceptions of culturally mediated barriers and facilitators are presented. DESIGN: Focused ethnography. METHODS: Multi-site across eight acute care units within two tertiary referral hospitals on the east coast of Australia collected over a one-year period from 2014 to 2015. Semi-structured interviews (n = 12) of older persons (11 hr). Twenty-three (23) semi-structured interviews with nine (9) registered nurses (12 hr 38 min). Participant observation (1,041 hr) during day, night and evening shifts. RESULTS: The older person experienced disjunction within pain assessment by the reliance of nurses on objective measurement gained during functional task completion. Tension emerged during pain management when the older person was not included and/or options provided were not deemed effective. For some older persons this meant they undertook a decision to exclude their nurse from involvement in pain management. A thread woven throughout was a lack of communication, continuity of care and input from the older person. CONCLUSION: This study has implications for the provision of nursing care of the older hospitalized person. Dissonance within pain care provision for the older person occurs during episodes of missed pain care. Understanding and insight is gained into aspects of missed communication opportunities between nurses and the experiences of missed pain care of the older person.

Nurses' Knowledge and Attitude toward Pediatric Pain Management: A Cross-Sectional Study.

BACKGROUND: Pain in infants and children is often poorly assessed and managed. Although there are many studies on this subject, none have been conducted in the Arab world, including the Kingdom of Saudi Arabia, where nurses are largely expatriates. AIMS: To examine the knowledge and attitudes of nurses working with infants and children in the Kingdom of Saudi Arabia regarding pain management. DESIGN: Descriptive cross-sectional survey. SETTINGS: Five government hospitals in Riyadh region of the Kingdom of Saudi Arabia. PARTICIPANTS/SUBJECTS: Registered nurses caring for infants and children. METHODS: A convenience sample of 410 nurses working at five Saudi Arabian government hospitals was surveyed using the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain (PNKAS-Shriners Revision). Data were analyzed using descriptive (frequency, percentage, mean, and standard deviation) and inferential statistics, including Pearson correlation, independent t test, and one-way analysis tests. RESULTS: Poor overall knowledge and attitudes regarding pediatric pain management was evident in this study. The mean correct score achieved by nurses was 18.1 ± 4.0 out of 40 or 45.2% ± 10.0% of a possible score of 100%. A weak but statistically significant correlation was found between years of pediatric nursing experience and total score (r = -0.129, p = .009). CONCLUSIONS: We concluded that intensive education on pediatric pain and its management is urgently needed for nurses working in the Kingdom of Saudi Arabia.

Experiences of the older hospitalised person on nursing pain care: An ethnographic insight.

AIMS AND OBJECTIVES: To present an ethnographic insight into the older hospitalised person (those aged over 65 years) perceptions and experiences of pain care provision by nurses in acute care. BACKGROUND: Pain care provision by nurses remains less than optimal for the older hospitalised person despite numerous evidence-based guidelines. There is a paucity of research providing input from the experiences of the older hospitalised person in relation to their perspectives of pain care provision by nurses in acute care. Pain care research needs more involvement from those older persons with documented diagnoses of dementia, delirium or cognitive impairment, and intellectual disabilities and those in their end stage of palliation. DESIGN: A focused ethnographic study. The consolidated criteria for reporting qualitative research (COREQ) were used to report the findings of this study. METHODS: A focused ethnographic study was conducted in 8 acute care units within 2 large tertiary referral hospitals on the east coast of Australia. Consisting of semi-structured interviews (n = 12) of cognitively intact older persons (11 hr). Twenty-three (23) semi-structured interviews with nine (9) RN participants (12 hr and 38 min). Participant observation period totalled 1,041 hr. RESULTS: The older persons' experiences of receiving pain care were based on a formulaic assessment process focusing on intensity of pain and pain management options provided often lacked their input. The older persons often did not perceive their pain care provision as being of benefit to themselves. The nurses lacked insight and understanding on the nature of pain for the older person. CONCLUSION: Understanding was gained into how the older persons' pain care was hampered due to the lack of appropriate, and meaningful pain care provision and provides insight into why the older hospitalised person continues to experience a less than optimal experience. RELEVANCE TO CLINICAL PRACTICE: Older hospitalised persons can gain continuity of pain care when nurses negotiate with them to repattern or restructure their nursing routines for pain care provision. Older people need inclusion into pain care decisions. All vulnerable older persons require nurses to use an evidence-based pain assessment tool.

Testing psychometric properties of a new instrument 'Promoting Active Ageing in Older People with Mental Disorders Scale' from a cross-sectional study.

BACKGROUND: There is no instrument that measures the promotion of active ageing or the factors that influence the promotion of active ageing in older people with mental disorders living in the community. This study aimed to examine psychometric properties of a new survey instrument. METHODS: A mixed methods exploratory sequential design was used incorporating a cross-sectional survey. The Promoting Active Ageing in Older People with Mental Disorders Scale (PAA-MD) was sent to 579 primary care providers in Yasothon province, Thailand. Construct validity was tested using exploratory factor analysis. The internal reliability was examined using Cronbach's alpha coefficient. RESULTS: The PAA-MD consisted of three sections. Section II found Bartlett's test of sphericity was χ2 (1431) = 26221.167, P < 0.001. Items used theoretical justification to group items into five factors, namely: participation, education, health, leisure, and security. Section III indicated Bartlett's test was χ2 (666) = 23524.074, P < 0.001. Items were grouped into five components, namely: facilitators, barriers, knowledge, skills, resources and support. Internal reliability of sections II and III with Cronbach's alpha was greater than 0.7. The corrected item-total correlation coefficient of all items was greater than 0.30. CONCLUSION: The PAA-MD contains 104 items from three sections. Construct validity was adequate to capture phenomena. Internal reliability revealed good homogeneity.

An assistant workforce to improve screening rates and quality of care for older patients in the emergency department: findings of a pre- post, mixed methods study.

BACKGROUND: Older people who present to the Emergency Department (ED) experience high rates of prevalent and incident delirium. This study aimed to determine whether an assistant workforce in the ED could effectively conduct screening to inform assessment and care planning for older people as well as enhance supportive care activities for prevention of delirium. METHODS: Using a pre-post design, data was collected before and after the introduction of Older Person Technical Assistants (OPTAs) in the ED. OPTA activity was recorded during the intervention period and a medical record audit undertaken prior to and 9 months after implementation. Data were analysed using descriptive statistics for OPTA activities. Weighted Kappa scores were calculated comparing concordance in screening scores between OPTAs and Aged Services Emergency Team Registered Nurses. Changes in the rates of documented screening and supportive care were analysed using Chi-square tests. Focus groups were conducted to explore clinicians' experiences of the OPTA role. RESULTS: Three thousand five hundred fourty two people were seen by OPTAs in 4563 ED Presentations between 1st July 2011 and 2012. The reproducibility of all screening tools were found to be high between the OPTAs and the RNs, with Kappas and ICCs generally all above 0.9. The medical record audit showed significant improvement in the rates of documented screening, including cognition from 1.5 to 38% (p < 0.001) and review of pain from 29 to 75% (p < 0.001). Supportive care such as being given fluids or food also improved from 13 to 49% (p < 0.001) and pressure care from 4.8 to 30% (p < 0.001). This was accomplished with no increase in ED length of stay among this age group. Focus group interviews described mixed responses and support for the OPTA role. CONCLUSIONS: An assistant workforce in an ED setting was found to provide comparable screening results and improve the rates of documented screening and supportive care provided to older people with or at risk of developing delirium in the ED. There is a need for a shared philosophy to the care of older people in the ED. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registration number is ACTRN12617000742370. It was retrospectively registered on 22nd May 2017.

Tai chi and yoga in residential aged care: Perspectives of participants: A qualitative study.

AIMS AND OBJECTIVES: This qualitative study examined the appropriateness and acceptability of 14-week modified tai chi and yoga programmes in an Australian residential aged care (RAC) setting by exploring experiences and perspectives of frail older residents and staff participants. BACKGROUND: Older persons in RAC have limited opportunities for physical activity. Tai chi and yoga are mindfulness-based exercise interventions that have been used to promote physical and psychological health of older adults in community settings. While research on tai chi and yoga interventions in community settings is promising, there is limited research regarding the interventions' appropriateness and acceptability for frail older residents in residential care settings in Australia. DESIGN: Descriptive and qualitative component of a mixed-methods study. METHODS: All residents who participated in the modified yoga and tai chi interventions and staff who supported them were invited. A total of 19 individuals comprising 16 residents and three staff members participated in three focus group interviews. The interviews were audio-recorded, transcribed and analysed thematically using a qualitative descriptive approach. RESULTS: Nine themes that reflected the uniqueness of the programmes' mind-body approach are presented: (a) novel, new and exciting; (b) smoothness, rhythm and flow; (c) slow and mindful; (d) gentle but rewarding; (e) moving whole body; (f) perceived benefits; (g) worthwhile; (h) feeling alive; and (i) calming and relaxing. CONCLUSIONS: The modified programmes of tai chi and yoga was acceptable, appropriate, enjoyable and helpful. Both tai chi and yoga appear to provide appropriate physical exercise and opportunities for older persons to enhance their quality of life through interaction of physical, emotional and intellectual wellness domains. RELEVANCE TO CLINICAL PRACTICE: The 14-week modified programmes of tai chi and yoga could be applied to frail older RAC population to promote health and active ageing.

Promoting active ageing in older people with mental disorders living in the community: An integrative review.

AIM: To critically synthesize the evidence in relation to the promotion of active ageing in older people, including those with mental disorders. BACKGROUND: Approximately 15% of older people aged 60 and above are experiencing a mental disorder. However, they are commonly unrecognized from health care providers. DESIGN: This study is an integrative review. Articles published between January 2002 and March 2017 in English and in Thai were identified through searches of the databases CINAHL, MEDLINE, EMBASE, PsycINFO, and Thai LIS, as well as through manual searching. Methodologically high-quality research articles were included if they addressed the promotion of active ageing and related concepts, the impact of mental disorders on active ageing and related concepts, the perspective of older people regarding active ageing, and issues related to working with older people with mental health problems living in the community. RESULTS: A total of 18 articles were included. The findings show that there is little evidence regarding the promotion of active ageing in older people with mental disorders. Older people with mental disorders were less likely to achieve successful ageing compared with those without mental disorders, suggesting they need support from health care providers. However, there are several barriers to care and working with older people with mental disorders at the community level. CONCLUSION: Of concern is that health professionals focus on the physical health of older people while mental health issues are overlooked.

Home care packages: insights into the experiences of older people leading up to the introduction of consumer directed care in Australia.

This paper reports phase one, conducted from March to June 2015, of a two-phase, qualitative descriptive study designed to explore the perceptions and experiences of older people before and after the introduction of consumer directed care (CDC) to home care packages (HCP) in Australia. Eligible consumers with a local HCP provider were mailed information about the study. Data collection occurred before the introduction of CDC and included face-to-face, in-depth interviews, summaries of interviews, field notes and reflective journaling. Semi-structured questions and 'emotional touchpoints' relating to home care were used to guide the interview conversation. Line-by-line data analysis, where significant statements were highlighted and clustered to reveal emergent themes, was used. Five older people, aged 81 to 91 years, participated in the study. The four emergent themes were: seeking quality and reciprocity in carer relationships; patchworking services; the waiting game; and technology with utility. Continuity of carers was central to the development of a trusting relationship and perceptions of care quality among older consumers. Care coordinators and workers should play a key role in ensuring older people receive timely information about CDC and their rights and responsibilities. Participants' use of contemporary technologies suggests opportunities to improve engagement of HCP clients in CDC.

Emergency department transfers and hospital admissions from residential aged care facilities: a controlled pre-post design study.

BACKGROUND: Older people living in Residential Aged Care Facilities (RACF) are a vulnerable, frail and complex population. They are more likely than people who reside in the community to become acutely unwell, present to the Emergency Department (ED) and require admission to hospital. For many, hospitalisation carries with it risks. Importantly, evidence suggests that some admissions are avoidable. A new collaborative model of care, the Aged Care Emergency Service (ACE), was developed to provide clinical support to nurses in the RACFs, allowing residents to be managed in place and avoid transfer to the ED. This paper examines the effects of the ACE service on RACF residents' transfer to hospital using a controlled pre-post design. METHODS: Four intervention RACFs were matched with eight control RACFs based on number of total beds, dementia specific beds, and ratio of high to low care beds in Newcastle, Australia, between March and November 2011. The intervention consisted of a clinical care manual to support care along with a nurse led telephone triage line, education, establishing goals of care prior to ED transfer, case management when in the ED, along with the development of collaborative relationships between stakeholders. Outcomes included ED presentations, length of stay, hospital admission and 28-day readmission pre- and post-intervention. Generalised estimating equations were used to estimate mean differences in outcomes between intervention and controls RACFs, pre- and post-intervention means, and their interaction, accounting for repeated measures and adjusting for matching factors. RESULTS: Residents had a mean age of 86 years. ED presentations ranged between 16 and 211 visits/100 RACF beds/year across all RACFs. There was no overall reduction in ED presentations (OR = 1.17, p = 0.56) with the ACE intervention. However, when compared to the controls, the intervention group reduced their ED length of stay by 45 min (p = 0.0575), and was 40 % less likely to be admitted to hospital, . The latter was highly significant (p = 0.0012). CONCLUSIONS: Transfers to ED and admission to hospital are common for residents of RACFs. This study has demonstrated that a complex multi-strategy intervention led by nursing staff can successfully reduce hospital admissions for older people living in Residential Aged Care Facilities. By defining goals of care prior to transfer to the ED, clinicians have the opportunity to better deliver care that patients require. Integrated care requires accountability from multiple stakeholders. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registration number is ACTRN12616000588493 It was registered on 6(th) May 2016.

Mum's absence(s): conceptual insights into absence as loss during a loved one's delirium.

AIMS AND OBJECTIVES: To examine qualitative research findings about family experiences of absence or loss during older person delirium, and provide a critical discussion of the similarities and differences in these experiences with conceptual understandings of absence and loss. BACKGROUND: Families who care for older people with chronic illnesses experience many losses. However, the nondeath loss experiences of family during an older loved one's delirium, an acute condition accompanied by marked changes in demeanour, have received little consideration. DESIGN: Discursive position paper. METHODS: The findings from two qualitative research studies about family experiences during an older loved one's delirium are discussed in relation to the concepts of absence and nondeath loss. RESULTS: The uncharacteristic behaviours and cognitive changes that accompany delirium may estrange family who, despite the older person's corporeal presence, sense the profound absence or loss of their loved one. Although the notion of absence, a nondeath loss, is similar to the experiences of family of people with chronic conditions, there are differences that distinguish these encounters. The similarities and differences between absence during delirium and the concepts of psychological absence, nonfinite loss and psychosocial death are discussed. Psychosocial death, reversibility/irreversibility and partial marked change, are suggested as conceptual descriptions for the absence families experience during an older loved one's delirium. CONCLUSIONS: The sense of absence or loss that family may experience during their older loved one's delirium needs to be recognised, understood and addressed by healthcare staff. Understanding or appreciating conceptualisations of absence, as a nondeath loss, may enhance understandings of family member needs during delirium and enable better support strategies. RELEVANCE TO CLINICAL PRACTICE: Conceptualisations of absence enhance understandings of family distress and needs during their older loved one's delirium. The potential for family members to experience their loved one's absence during delirium, a nondeath loss, needs to be considered by healthcare staff. Family experiences of absence during delirium need to be recognised by healthcare staff, acknowledged as a potential source of distress, and considered when involving family in the older person's care. Nurses are ideally placed to respond compassionately and provide appropriate family member re-assurance, support and information during delirium. Information should include possible impacts on family and coping strategies.

Reflexivity and exploring the meaning of delirium through media depictions: Methodological insights from a phenomenological study.

In the course of a phenomenological study that explored the experiences of family members during their older loved one's delirium, a range of delirium experiences depicted in artistic, creative, and linguistic media were reviewed. The search for, and compilation of, media sources for reflection during data analysis is described in this paper. In doing so, the researcher reveals how attentiveness and openness to varied depictions of lived experiences, as well as a valuing attitude toward challenging subjective perspectives, can enhance researcher reflexivity and appreciation of interpretive meanings. Turning to media depictions of delirium offered alternative perspectives on the experience. It challenged the researcher's assumptions, enhanced phenomenological reflection, promoted critique of evolving interpretations, and suggested meanings that might not have otherwise been realized. The approach used is a potent, although often overlooked, way to differentiate the nature of phenomena shared through lived experience data. Media-based methods and their use in phenomenology continue to be explored. Illustrations of how to integrate media sources, as well as discussion about the benefits and alternatives to more common uses, are needed.

Adult family member experiences during an older loved one's delirium: a narrative literature review.

AIMS AND OBJECTIVES: To provide a narrative literature review about family experiences during older person delirium. BACKGROUND: Delirium is a common and serious condition which manifests when older people are unwell. Family members of older people are likely to encounter their loved one and become involved in care during delirium. DESIGN: Narrative literature review. METHODS: Electronic database and Google Scholar(™) searches were conducted using search terms for delirium, family, experience and older people. RESULTS: Though family members are important partners in the care of older people, there has been little exploration of their experiences during delirium. Current literature identifies that family members experience unexpected, rapid and unpredictable changes in their older loved one, absence of the person they know, distress, not knowing about delirium nor how to help, and supportive and unsupportive relationships with health care staff. CONCLUSIONS: Health care staff need understanding about what it means for family to have someone close to them have delirium. Without understanding, it is difficult for staff to respond with compassion, provide support and appropriately include family in the older person's care. There is a need to mitigate family distress and provide support, including information which addresses family concerns. RELEVANCE TO CLINICAL PRACTICE: The distress family members experience, the impact of losing connection to their loved one, and the difficulty family face in sustaining hope for their loved one's return needs to be recognised and addressed by health care staff, particularly nurses, during the older person's care.

Existential Absence: The Lived Experience of Family Members During Their Older Loved One's Delirium.

When older people develop delirium, their demeanor changes; they often behave in ways that are out of character and seem to inhabit another world. Despite this, little is known about the experiences of family members who are with their older loved one at this time. This article reports a phenomenological study that involved in-depth interviews with 14 women whose older loved one had delirium. Analysis and interpretation of the data depict the women's experiences as "Changing family portraits: Sudden existential absence during delirium," capturing the way family members lose the taken-for-granted presence of their familiar older loved one and confront a stranger during delirium.

A multi-organisation aged care emergency service for acute care management of older residents in aged care facilities.

This case study describes a multi-organisation aged care emergency (ACE) service. The service was designed to enable point-of-care assessment and management for older people in residential aged care facilities (RACFs). Design of the ACE service involved consultation and engagement of multiple key stakeholders. The ACE service was implemented in a large geographical region of a single Medicare Local (ML) in New South Wales, Australia. The service was developed over several phases. A case control pilot evaluation of one emergency department (ED) and four RACFs revealed a 16% reduction in presentations to the ED as well as reductions in admission to the hospital following ED presentation. Following initial pilot work, the ACE service transitioned across another five EDs and 85 RACFs in the local health district. The service has now been implemented in a further 10 sites (six metropolitan and four rural EDs) across New South Wales. Ongoing evaluation of the implementation continues to show positive outcomes. The ACE service offers a model shown to reduce ED presentations and admissions from RACFs, and provide quality care with a focus on the needs of the older person.

A game of snakes and ladders: negotiating the 'ups and downs' of endorsement as a nurse practitioner in Australia.

BACKGROUND: Australian legislation supporting the nurse practitioner (NP) role was enacted in 1998. Since then, NPs have played an important advanced practice role within the interdisciplinary healthcare team. However, the literature suggests that transition to the NP role can be challenging. AIM: This paper highlights the complex transition experiences of ten recently endorsed Australian NPs. The convoluted legislative and regulatory requirements that were negotiated by the NPs are presented as narratives. METHODS: Informed by an ethnographic approach, participants were interviewed several times during their first year. Interview transcripts were thematically analysed and aggregated into three narratives representative of key findings. KEY FINDINGS: The findings exemplify the complexity of navigating through a labyrinth of bureaucracy and the extensive negotiations required to appease those who yielded power over their future practice. CONCLUSION: This study raises awareness of the transition experiences of Australian NPs and their challenges and barriers during this time.

Patient and health professional's perceived barriers to the delivery of psychosocial care to adults with cancer: a systematic review.

OBJECTIVE: To explore the barriers experienced and perceived by health professionals and patients in the delivery of psychosocial care to adults with cancer. METHODS: Systematic searches were undertaken using the PsychInfo, Medline and CINAHL electronic databases, up to October 2013. Research reporting health professional or patient experiences and perceptions of barriers to psychosocial care are included in the review. The systematic review includes studies that have non-experimental, exploratory and observational designs, as is appropriate to answer the review question. Included studies were critically appraised. The results of individual quantitative studies were aggregated. Qualitative content analysis was used to analyse the qualitative results. RESULTS: Twenty-five papers met the pre-specified inclusion criteria for the final review. The most commonly perceived barrier for patients relates to receiving adequate support from elsewhere and a lack of perceived need for psychosocial care. Health professionals report barriers at an organisational level most frequently followed by cultural and then individual clinician-related barriers. CONCLUSIONS: Barriers exist on a variety of levels. People with cancer need clear appropriate information and communication about psychosocial services, including information about the role of psychosocial care in addition to existing supports. Interventions that target the complex interplay of individual, organisational and cultural factors need to be developed. Strategies that improve health professional communication skills, identify clear referral pathways, improve acceptability of interventions and clearly identify the need for services could address many of the barriers identified in this review.

Examining clinical supervision as a mechanism for changes in practice: a research protocol.

AIM: This paper describes the research protocol for a study exploring if and how clinical supervision facilitates change in practice relating to psychosocial aspects of care for Health Professionals, who have been trained to deliver a psychosocial intervention to adults with cancer. BACKGROUND: There is a recognized need to implement care that is in line with clinical practice guidelines for the psychosocial care of adults with cancer. Clinical supervision is recommended as a means to support Health Professionals in providing the recommended psychosocial care. DESIGN: A qualitative design embedded within an experimental, stepped wedge randomized control trial. METHODS: The study will use discourse analysis to analyse audio-recorded data collected in clinical supervision sessions that are being delivered as one element of a large randomized control trial. The sessions will be attended primarily by nurses, but including physiotherapists, radiation therapists, occupational therapists. The Health Professionals are participants in a randomized control trial designed to reduce anxiety and depression of distressed adults with cancer. The sessions will be facilitated by psychiatrists experienced in psycho-oncology and the provision of clinical supervision. DISCUSSION: The proposed research is designed specifically to facilitate exploration of the mechanisms by which clinical supervision enables Health Professionals to deliver a brief, tailored psychosocial intervention in the context of their everyday practice. This is the first study to use discourse analysis embedded within an experimental randomized control trial to explore the mechanisms of change generated within clinical supervision by analysing the discourse within the clinical supervision sessions.

Nutrition and hydration in dying patients: the perceptions of acute care nurses.

AIMS AND OBJECTIVES: To explore the perceptions of nurses regarding the provision and nonprovision of medical nutrition and hydration during the end stage of life when death is imminent in the acute care setting. BACKGROUND: When people are dying, they often experience a loss of appetite and desire for drinking which are natural processes at this time. The cessation of eating and drinking challenges both family members and clinical staff. This article builds on previous studies that describe the perceptions of medical doctors and palliative care nurses regarding medical nutrition and hydration during the end stage of life when death is imminent. DESIGN: Qualitative descriptive design. METHODS: This study included three focus group meetings with ten nurses in an acute care setting in medical, oncology and haematology units. An interview schedule was used to guide the discussions. RESULTS: The main theme to emerge from this study was 'finding a comfort space/ambiguous spaces of unrest' that included four subthemes: (1) limited involvement in decision-making, (2) comfort vs. discomfort, (3) uncertainty and (4) the comfort of withdrawing treatment. Finding a comfort space captures the challenges nurses faced when speaking about the concerns of patients and family. In this space, there were ambiguities that created unease and unrest: a reluctance to talk about death; a reluctance to engage with the patient and the family. CONCLUSIONS: Acute care nurses need to be more cognisant of the palliative approach to care and become more engaged with decision-making during the end stage of life when death is imminent. RELEVANCE TO CLINICAL PRACTICE: Nurses in acute care settings need to be involved in decision-making and advocate for patients and family during the dying phase. Nurses in acute care need better understanding about the palliative approach to care and nutrition and hydration for people who are dying.

The influence of tai chi and yoga on balance and falls in a residential care setting: A randomised controlled trial.

Abstract Falls amongst older people is a global public health concern. Whilst falling is not a typical feature of ageing, older people are more likely to fall. Fall injuries amongst older people are a leading cause of death and disability. Many older people do not do regular exercise so that they lose muscle tone, strength, and flexibility which affect balance and predispose them to falls. The management of falls in residential care settings is a major concern with strategies for prevention and monitoring a focus in this setting. Yoga and tai chi have shown potential to improve balance and prevent falls in older adults. They also have potential to improve pain and quality of life. The aim of this study was to determine the feasibility of conducting a three-arm randomised controlled trial (RCT) with frail older people in a residential care setting to test the hypothesis that a 14-week modified tai chi or yoga programme is more effective than usual care activity in improving balance function, quality of life, pain experience and in reducing number of falls. There were no statistically significant differences between the three groups in the occurrence of falls. Yoga demonstrated a slight decrease in fall incidence; quality of life improved for the tai chi group. Only the yoga group experienced a reduction in average pain scores though not statistically significant. The findings of the study suggest it is possible to safely implement modified yoga and tai chi in a residential care setting and evaluate this using RCT design. They show positive changes to balance, pain and quality of life and a high level of interest through attendance amongst the older participants. The results support offering tai chi and yoga to older people who are frail and dependent with physical and cognitive limitations.