Knowledge and Use of Evidence-Based Programs for Older Adults in the Community: A Survey of Physical Therapy Professionals.

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.

Physical Therapists and Physical Therapist Assistants' Knowledge and Use of the STEADI for Falls Risk Screening of Older Adults in Physical Therapy Practice in the United States.

Fall-risk screening and prevention is within the scope of physical-therapy practice. Prior research indicates United States-based physical therapists (PTs) and physical-therapist assistants (PTAs) use the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, and Injuries) toolkit for community-based fall-risk screenings of older adults. However, clinically based fall-risk screenings and knowledge and use of the STEADI by PTs and PTAs is unknown. We conducted a cross-sectional survey distributed to a convenience sample of PTs and PTAs in the United States through email blasts and social media. PTs and PTAs (N = 425) who responded to the survey and worked in clinical settings with older adults were included. Eighty-nine percent of respondents reported conducting clinical fall-risk screening. Approximately 51% were 'familiar' to 'very familiar' with the STEADI, and 21.7% of the overall sample were not familiar at all. Only 26.1% utilize the STEADI for clinical fall-risk screening. Of the respondents who were 'very familiar' with the STEADI (n = 132, 31.1%), 84.1% (n = 111) reported using the STEADI in clinical practice. Seventy-six percent of respondents who use the STEADI implemented it by choice even though the majority (52.1%, n = 63) did not have it embedded in their documentation/workflow. Some PTs/PTAs can and do manage falls using the STEADI, but there is a gap in knowledge and use of the STEADI for falls management among PTs and PTAs in the United States. Further research is needed to identify the tools PTs use for multifactorial-fall screening and management and the impact of PTs' use of the STEADI on patient outcomes.

Clinical-Community Connections: Incorporating Evidence-Based Programs for Improved Patient Outcomes.

Incorporating evidence-based community programs into clinical care recommendations and goals may help bridge the clinic-to-community transition for older adults. Engagement in evidence-based programs can help older adults manage chronic conditions and reduce fall risk through behavior change and self-management following a clinical episode of care. This paper describes evidence-based fall prevention and physical activity programs, provides resources to locate programs, and strategies to match older adults to the right programs.

Trained community providers conduct fall risk screenings with fidelity: an effective model for expanding reach.

Reliable and valid tools are available for health care providers to screen older adults for fall risk. Proficient administration of these tools by lay or community providers (individuals without formal medical training) may be a viable channel to expand the reach of fall risk screenings. However, the ability of community providers to administer screens is not known. This project examines community providers' ability to proficiently administer a fall risk screening following a standardized training. Forty community providers were trained and then performed community screenings. Knowledge and confidence were assessed with pre- and postsurveys. A standardized skills checklist assessed proficiency in fall risk screening administration immediate posttraining and at onsite community screenings. Knowledge and confidence surveys demonstrated improvements pre- and posttraining (p < .001). In all, 66% of participants demonstrated screening skill proficiency at their first onsite screening. With further coaching, 91% participants demonstrated proficiency by their third onsite screening. Participants achieving early proficiency were on average younger. Community providers can reliably administer a fall risk screening algorithm with training and coaching. This is a low-cost model and can extend the reach and dissemination of fall risk screenings, potentially providing early identification and interventions to those at risk of falling.

An effective community-academic partnership to extend the reach of screenings for fall risk.

Older adults should be screened for fall risk annually. Community providers (people without formal medical training who work with older adults in senior centers or aging services) may be a viable group to expand the reach of screenings. Our community-academic partnership developed a program to increase and assess fall risk screenings by community providers. Community sites hosted training workshops and screening events. Community screenings were well attended and received by providers and older adults. With administrative support from the regional fall prevention coalition and technical support from academia, community providers screened 161 older adults from a broad geographic area. Twenty-one community providers completed the training. Knowledge and confidence surveys demonstrated improvements before and after training (P<.001). Skills assessments demonstrated mastery of most skills, but some providers required additional training. Provider feedback indicated screening procedures were complex. Future projects will examine this model using simplified screening procedures.

Physical performance characteristics of assisted living residents and risk for adverse health outcomes.

PURPOSE: Researchers know little about the physical performance ability of residential care/assisted living (RC/AL) residents and its relationship to adverse outcomes such as fracture, nursing home placement, functional decline, and death. The purposes of this article are to (a) describe the functional characteristics of RC/AL residents, (b) examine the relationships between resident- and facility-level characteristics and physical performance, and (c) determine the predictive value of physical performance for adverse outcomes. DESIGN AND METHODS: Data came from 1,791 residents in 189 RC/AL facilities participating in the Collaborative Studies of Long-Term Care. At baseline, residents were tested on four performance measures (grip strength, chair rise, balance, and walking speed), and other resident- and facility-level information was collected. Adverse outcomes were measured over 1 year. RESULTS: Average grip strength was 14 +/- 7 kg, 61% of residents walked <0.6 m/s (M = 0.41 m/s), 26% could perform five chair rises, and only 19% could perform a tandem stand for a least 1 s. Multivariable analyses showed that more cognitive and functional impairment, depressive symptoms and comorbid conditions, and for-profit ownership were associated with poorer physical performance. Controlling for individual characteristics, we found that better performance on the four physical performance measures was associated with a reduced risk of nursing home placement, fracture, and decline in function over 1 year. IMPLICATIONS: Simple performance measures identify modifiable functional deficits and suggest targeted interventions to prolong independent mobility and aging in place in RC/AL facilities.

Are scores on balance screening tests associated with mobility in older adults?

PURPOSE: To examine associations between measures of static and dynamic balance and performance of mobility tasks in older adults. METHODS: A cross-sectional analysis from 95 community dwelling participants (mean age 80.9 years, range 65 -03 years). Participants performed tests of static (tandem stance) and dynamic (360 degrees turn) balance and mobility (walking speed and timed chair rise). Associations among balance and mobility measures were examined using correlation and logistic regression. RESULTS: Static and dynamic balance were moderately associated (r = -.462). Relationships between dynamic balance and mobility were stronger than those between static balance and mobility. The association between dynamic balance and walking speed was particularly strong (r = -.701 ). Using logistic regression, age, and balance performance were significant predictors for outcomes of walking speed (dichotomized to < .0 m/s, >/= .0 m/s), and timed chair rise (dichotomized to 3.6 s). Faster 360 degrees turn times were independently associated with faster walking speed and chair rise time. CONCLUSION: Mobility tasks require both dynamic and static balance. As falls are a major health risk for older adults, including brief assessments of dynamic and static balance in the examination of older adults provides valuable information about physical function and mobility.

Characteristics of stepping over an obstacle in community dwelling older adults under dual-task conditions.

Previous research suggests that older adults may have difficulty attending to simultaneous tasks. This study was conducted to determine how concurrent performance of a secondary cognitive task influences walking and stepping over an obstacle in community dwelling older adults. Twenty-one men and women with a mean age of 73.4 years (S.D.=5.3) participated in the study. Subjects performed a gait task both alone (single-task condition) and in combination with a cognitive task that involved reciting numbers (dual-task condition). In the gait task, each subject walked at his/her fastest speed along a 10-m walkway and stepped over an obstacle designed to simulate a door threshold. Paired t-tests were used to compare gait parameters (10 m gait speed, gait speed during obstacle approach and negotiation, medial-lateral center of pressure excursion and velocity during obstacle negotiation, foot clearance over the obstacle, step length and foot position relative to the obstacle) and cognitive task performance under single and dual-task conditions. Toe-obstacle distance was greater and obstacle-heel distance was reduced under dual-task conditions. Performance of the remaining gait parameters did not change with the addition of a secondary cognitive task. Cognitive task performance decreased under dual-task conditions. These community dwelling older adults demonstrated minimal or no change in measured gait parameters during simultaneous performance of a cognitive task. The observed decrement in cognitive task performance suggests that subjects may have placed a higher priority on gait performance.