Evaluation of the Implementation of Low-Low Hospital Beds With Respect to Fall Frequency and Patient Harms: A Retrospective Analysis.

AIM: To identify whether the introduction of low-low hospital beds resulted in changes in the incidence, associated patient harms and event characteristics of bed-related falls where implemented. DESIGN: This retrospective quality improvement study covered 36 months: 18 months pre-intervention and 18 months post-intervention. METHODS: Our analysis incorporated patient fall data from a hospital in upstate New York. Pre-/post-intervention data covered 18 months on either side of introduction at the units of implementation. Data were sourced from contemporaneously recorded incident reports and the organisation's business intelligence records. Analysis addressed the incidence rate, frequency, patient harm classification and recurrence of bed-related falls, as well as Morse Fall Scale risk classification, patient age, gender and other individualised risk factors. Lastly, we reviewed the presence of individualised interventions, staff assistance during the event, patient census and staffing ratios. Chi-square goodness of fit tests were employed to compare the distribution, and Brunner-Munzel tests the stochastic equality, of the pre- and post-implementation categorical and continuous data. RESULTS: There were no significant differences in the incidence rate of bed-related falls, patient harms or in the need for medical intervention following implementation of the low-low hospital beds. Neither were there any significant differences in the proportion of events resulting in detectable harm or the need for medical intervention post-implementation. The total number of bed-involved falls substantively increased following implementation of the low-low beds, as did the number of events resulting in detectable harms and medical intervention. Among these, substantive increases were noted among events resulting in minor temporary harm and patients referred for diagnostic imaging. The number of events involved patients experiencing recurrent falls of any kind increased significantly post-implementation. CONCLUSION: We found that the introduction of low-low hospital beds preceded no change in the incidence of bed-related falls, associated patient harms or the need for post-event medical intervention where implemented. While data limitations precluded definitive determination with respect to certain event characteristics, several post-implementation changes, including substantive increases in the number of falls occurring during ingress and egress, may suggest a potential for relationship worthy of future study. IMPLICATIONS AND IMPACT: Low-low hospital beds are purported to help reduce the occurrence and severity of bed-related falls, both serious problems in inpatient settings. This study describes null outcomes following an implementation of such beds, with implications for adoption in similar settings. REPORTING METHOD: We adhered to the relevant Enhancing the Quality and Transparency of Health Research guidelines, specifically following the Standards for Quality Improvement Reporting Excellence standards. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement in the design or conduct of the study. Nurses and medical staff were involved in intervention implementation, data collection and the conception, design and conduct of the study.

Lower-limb inter-joint coordination during balance recovery after trips.

BACKGROUND: Trips are one of the most common external perturbations that can lead to accidental falls. Knowledge about postural control attributes of balance recovery after trips could help reveal the biomechanical causes for trip-induced falls and provide implications for fall prevention interventions. RESEARCH QUESTION: The objective of the present study was to examine coordinated lower-limb movements during balance recovery after trips. METHODS: One hundred and twenty-three volunteers participated in an experimental study. They were tripped unexpectedly by a metal pole when walking on a linear walkway at their self-selected speed. Lower-limb inter-joint coordination quantified by continuous relative phase measures, including the mean of the absolute relative phases (MARP) and the deviation phase (DP), was analyzed during the execution of the first recovery step after unexpected trips. RESULTS: Compared to unsuccessful balance recovery, smaller MARPknee-ankle and DPknee-ankle of successful recovery were observed with distal inter-joint coordination on the swing side. Inter-joint coordination of the stance limb did not significantly differ between successful and unsuccessful recovery conditions. These findings indicate that the control of the swing limb's distal joints is crucial for regaining balance after trips. SIGNIFICANCE: An implication derived from this study is that greater in-phase coordination and smaller coordination variability in distal joints of the swing limb could be considered as potential targets for interventions aimed at preventing trip-induced accidental.

Efficacy of the Otago-Exercise-Programme to reduce falls in community-dwelling adults aged 65-80 when delivered as group or individual training: Non-inferiority-clinical-trial.

BACKGROUND: The Otago Exercise Programme is an effective intervention for falls prevention. However, there is limited evidence in relation to studies that compare efficacy for falls prevention when delivered Otago Exercise Programme in a group or individual format in a primary care context. OBJECTIVE: To compare the Otago Exercise Programme delivered as a group vs. individual format for community dwelling older adults, over a one year period. The hypothesis was that neither format would be inferior to the other. METHODS: DESIGN: A four-year multicentre, randomized, non-inferiority clinical trial, with two arms- Otago Exercise Programme group training and individual Otago exercise training. SETTING(S): 21 primary healthcare centers. PARTICIPANTS: A sample size of 728 participants was established. Participants were aged between 65 and 80 years; living in the community; able to walk independently; and agreed to take part in the study and provided signed informed consent. INTERVENTION: The Otago Exercise Programme was delivered mainly by nurses in primary care, with five face to face sessions, and a reinforcement 6 months later. Participants were encouraged to exercise at home between face to face sessions. DATA COLLECTION: at baseline and after 6 and 12 months from October 2017 to 2020. PRIMARY OUTCOME: people who reported at least one fall. SECONDARY OUTCOMES: number of falls, cause of falls, consequences and assistance, adherence and satisfaction. Group allocation was blinded to the researchers involved in analysis. Reporting: Consolidated Standards of Reporting Trials recommendations for the Statement for Randomized Trials of Nonpharmacologic Treatments. RESULTS: Eight hundred twenty-seven participants were randomized (226 were allocated in group training and 272 in individual training). The analysis of the proportion of people who reported at least one fall and number of falls showed no differences between individual and group training. Assessment of the equivalence between the interventions at 12 months showed that the confidence interval for the difference of people who reported at least one fall was found to be within the equivalence limit of 10% considered. However, in those participants with a previous history of falls, group format showed potentially greater benefit. The participants in individual training presented higher scores on the Exercise Adherence Rating Scale test. No differences were found in satisfaction between the groups. CONCLUSIONS: The group Otago Exercise Programme is equivalent to individually delivered Otago Exercise Programme in terms of prevention of falls over a 12-month follow up. Adherence was higher in individual training. IMPLICATIONS: Healthcare professionals could offer either Otago Exercise Programme format dependent on patient preference and be confident that that standardized intervention provides patient benefit. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03320668). Data registration 31/10/2017.

Low handgrip strength is associated with falls after the age of 50: findings from the Brazilian longitudinal study of aging (ELSI-Brazil).

AIM: This study examined the association of low handgrip strength (HGS) for falls in middle-aged adults and older adults every half-decade of life. METHODS: This cross-sectional study was conducted using the public data from the first wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). The participants were allocated into seven age groups 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, and ≥ 80 years. Binary logistic regression analysis was performed to identify the odds ratio (OR) of low HGS to the falls regardless of confounding variables such as sex, balance, gait speed, and total number of health conditions. RESULTS: A total of 8,112 participants aged 50-105 years (median = 62.0 years): 3,490 males (median = 60.0 years) and 4,622 females (median = 63.0 years) attended the study. Altogether, 21.5% of participants experienced at least one fall. HGS gradually decreases over each half-decade of life. In addition, low HGS presented a significative OR (p < 0.05) for falls for age groups, until 80 s, even when considering confounding variables. CONCLUSIONS: Low HGS is associated with falls in middle-aged adults over their 50 s and remained a strong measure of falls across each subsequent half-decade of life, until 80 s.

Considerations across multiple stakeholder groups when implementing fall prevention programs in the acute hospital setting: a qualitative study.

BACKGROUND: Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies. METHODS: Clinicians of different disciplines, patients and their families were recruited from wards at two acute public hospitals. Semi-structured interviews and focus groups were conducted to gain a broad understanding of participants' perspectives about implementing fall prevention programs. Data were analysed using an inductive thematic approach. RESULTS: Data from 50 participants revealed three key themes across the stakeholder groups shaping implementation of acute hospital fall prevention programs: (i) 'Fall prevention is a priority, but whose?' where participants agreed falls in hospital should be addressed but did not necessarily see themselves as responsible for this; (ii) 'Disempowered stakeholders' where participants expressed feeling frustrated and powerless with fall prevention in acute hospital settings; and (iii) 'Shared responsibility may be a solution' where participants were optimistic about the positive impact of collective action on effectively implementing fall prevention strategies. CONCLUSION: Key stakeholder groups agree that hospital fall prevention is a priority, however, challenges related to role perception, competing priorities, workforce pressure and disempowerment mean fall prevention may often be neglected in practice. Improving shared responsibility for fall prevention implementation across disciplines, organisational levels and patients, family and staff may help overcome this.

Influence of dementia-specialized care team on clinical outcomes in a general hospital.

BACKGROUND: Because of the increasing prevalence of dementia in Japan, the government introduced financial incentives for specialized care for dementia at acute care hospitals in 2016. Our hospital then introduced a multidisciplinary collaborative specialized team, referred to as dementia-specialized care team. The aim of this study is to examine the influence of dementia-specialized care team on clinical outcomes for elderly inpatients. METHODS: In this retrospective observational study at a general hospital with 650 beds in Japan, we compared clinical outcomes such as incidence of falls, prescription of hypnotics, length of hospital stay, in-hospital mortality, and discharge destinations in inpatients aged 65 years and older between a two-year pre-intervention period (2014-2015) and a two-year post-intervention period (2017-2018). RESULTS: During the observation period, a total of 34,097 patients were admitted, with 16,237 patients in the pre-intervention period and 17,860 patients in the post-intervention period. The proportion of patients receiving any hypnotics decreased from 21.2 % to 19.2 %, notably with benzodiazepine from 19.8 % to 13.2 %. The incidence of falls from a seated or lying position, particularly at night, was significantly lower (from 0.5 % to 0.2 %) as was the length of hospital stay (from 13.7 days to 13.2 days) during the post-intervention period. CONCLUSION: After the implementation of dementia-specialized care team, favorable outcomes such as a reduction in the use of hypnotics, the incidence of falls, and the length of hospitalization were observed. Introduction of the team and associated incentives may be effective in improving clinical outcomes in elderly inpatients.

Does proprioceptive reweighting contribute to reactive balance strategies during slip-like perturbations? a proof-of-concept in healthy adults.

Falls commonly occur during walking, particularly when struggling to respond to unexpected perturbations. Proprioception plays a significant role in detecting body destabilization even before reactions to perturbations are required. This study investigates the contribution of proprioceptive reweighting strategies to reactive balance during walking. This cross-sectional, proof-of-concept study included fifteen healthy adults (18-40 years). Ankle and back muscle vibrators disrupted proprioceptive input in stance, allowing calculation of the proprioceptive reweighting index. Walk-slip perturbations were then administered on an ActiveStep treadmill. A linear regression model assessed the significance of proprioceptive reweighting in predicting post-slip stability (margin of stability). Participants shifted from an ankle-steered to a central-steered proprioceptive strategy on a foam surface with closed eyes (Difference = 15.70 % (SD=37.87), 95 %CI [0.41, 30.99], p = 0.045). The regression model explained 22.7 % of the variance in pre-touchdown margin of stability, with proprioceptive reweighting on foam significantly contributing to post-perturbation postural control (p < 0.001). Proprioceptive reweighting provides a moderate explanation for the mechanisms of reactive balance, highlighting that the key to effective balance recovery strategies may lie in the person's ability to both detect and respond to imbalances. Further research should explore if these proprioceptive strategies are a matter of directional control and if responses differ in older adults.

Wii Fit Exercise's Effects on Muscle Strength and Fear of Falling in Older Adults With Alzheimer Disease: A Randomized Controlled Trial.

PURPOSE: This study aimed to investigate how Wii Fit exercises affect muscle strength and fear of falling in older adults with Alzheimer's disease. METHOD: The study included a total of 32 volunteers with Alzheimer's disease, aged 65-80 years. These participants were divided into two groups: the exercise group and the control group. The exercise group received a 30-min (one session) twice-weekly exercise program for 6 weeks with games selected from different categories, such as balance and aerobic exercises, with the Nintendo Wii virtual reality device. During this period, the control group did not receive any treatment, and routine medical treatments continued. At baseline and 6 weeks later, Mini-Mental State Examination, knee extension muscle strength, Timed Up and Go Test, and Tinetti Fall Efficacy Scale results were recorded in the exercise and control groups. RESULTS: In intragroup comparison, a statistically significant difference was found in all tests (muscle strength, Timed Up and Go Test, and Tinetti Fall Efficacy Scale) in the exercise group after the exercise program (p < .05), while no significant difference was found in the control group (p > .05). According to the interaction of group and time in the intergroup comparison, there was no difference between the groups (exercise and control group) in muscle strength and Timed Up and Go Test (p > .05), but there was a difference in Tinetti Fall Efficacy Scale (p < .05). CONCLUSIONS: This randomized controlled trial supports the claim that Wii Fit exercises can reduce the fear of falling in older adults with Alzheimer's disease.

Investigating the biomechanics of falls in older adults in long-term care using a video camera: a scoping review.

BACKGROUND: Falls are a worrying and growing phenomenon worldwide that especially affects the elderly. With the development of technology, one way of studying the real-life falls that occur in healthcare settings is by using video cameras. AIMS: To (a) map the patterns of the research on real-life falls among older adults in healthcare settings as assessed with digital video camera supports; and (b) highlight the advances, the evidence produced, and the gaps still present regarding the biomechanics of falls as assessed technologically. METHODS: A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. CINAHL, PubMed and Google Scholar were searched. All studies regarding falls investigated with video cameras among older individuals in healthcare settings published from 1st January 1990 to 1st January 2022 were eligible. Findings were summarised according to the Patterns, Advances, Gaps, Evidence and Recommendations framework for Scoping Reviews. RESULTS: In total, 1943 studies were retrieved, and 16 met the inclusion criteria. Studies were mostly conducted in Canada. They described the real-life falls that occurred mainly in common and living areas of long-term facilities among older individuals, mainly females. Thirteen studies investigated falls through biomechanics, while three provided advances in the reliability of the measures as collected with video cameras. Studies reported that the biomechanics of a fall, reflecting the direction of the fall and protective responses, increase or decrease the likelihood of serious impact. In addition, the direction of the landing after a fall has been determined as having a significant impact on the severity and outcome of the fall. CONCLUSION: The use of video cameras to investigate the biomechanics of falls is a well-established research area that offer interesting insight regarding (a) how to prevent falls and their injuries and (b) the direction of the research in the field of falls.

Cognitive functioning and falls in older people: A systematic review and meta-analysis.

OBJECTIVE: To identify which cognitive functions and specific neuropsychological assessments predict falls in older people living in the community. METHODS: Five electronic databases were searched until 30/08/2022 for studies assessing the association between specific cognitive functions and faller status (prospective and retrospective), in community-dwelling older people. Risk of bias was assessed with the Newcastle-Ottawa Scale. Meta-analyses synthesised the evidence regarding the associations between different neurocognitive subdomains and faller status. RESULTS: Thirty-eight studies (20 retrospective, 18 prospective) involving 37,101 participants were included. All but one study was rated high or medium quality. Meta-analyses were performed with data from 28 studies across 11 neurocognitive subdomains and four specific neuropsychological tests. Poor cognitive flexibility, processing speed, free recall, working memory and sustained attention were significantly associated with faller status, but poor verbal fluency, visual perception, recognition memory, visuo-constructional reasoning and language were not. The Trail Making Test B was found to have the strongest association with faller status. CONCLUSION: Poor performance in neurocognitive subdomains spanning processing speed, attention, executive function and aspects of memory are associated with falls in older people, albeit with small effect sizes. The Trail Making Test, a free-to-use, simple assessment of processing speed and mental flexibility, is recommended as the cognitive screening test for fall risk in older people.

Exercise and Sports Science Australia updated position statement on exercise for preventing falls in older people living in the community.

BACKGROUNDS: Falls affect a significant number of older Australians and present a major challenge to health care providers and health systems with over 380 older Australians hospitalised for a fall each day. OBJECTIVES: This statement seeks to inform and guide exercise practitioners and health professionals in safe and effective prescription of exercise to prevent falls amongst community-dwelling older people. EXERCISE PRESCRIPTION TO PREVENT FALLS: Exercise is crucial for preventing falls in older age. Research evidence has identified that programmes which include functional balance and muscle strength training are the most effective in preventing falls. It is also important for exercise to be progressively challenging, ongoing and of sufficient dose to maximise its benefits in reducing falls. Additional (non-exercise) interventions are necessary for people with complex medical conditions, recent hospitalisation and/or particular risk factors not improved by exercise. People at a higher risk of falls may need greater support to undertake safe and effective fall prevention exercise. SUMMARY: Global guidelines for fall prevention and management recommend that all older adults should receive advice about exercise to prevent falls. Qualified exercise professionals are well placed to prescribe and supervise functional balance and muscle strength training to older people with varied functional abilities, including those with co-morbidities.

Two simple modifications to the World Falls Guidelines algorithm improves its ability to stratify older people into low, intermediate and high fall risk groups.

BACKGROUND: We conducted a secondary analysis of a cohort study to examine the World Falls Guidelines algorithm's ability to stratify older people into sizable fall risk groups or whether minor modifications were necessary to achieve this. METHODS: Six hundred and ninety-three community-living people aged 70-90 years (52.4% women) were stratified into low, intermediate and high fall risk groups using the original algorithm and a modified algorithm applying broader Timed Up and Go test screening with a >10-s cut point (originally >15 s). Prospective fall rates and physical and neuropsychological performance among the three groups were compared. RESULTS: The original algorithm was not able to identify three sizable groups, i.e. only five participants (0.7%) were classified as intermediate risk. The modified algorithm classified 349 participants (50.3%) as low risk, 127 participants (18.3%) as intermediate risk and 217 participants (31.3%) as high risk. The sizable intermediate-risk group had physical and neuropsychological characteristics similar to the high-risk group, but a fall rate similar to the low-risk group. The high-risk group had a significantly higher rate of falls than both the low- [incidence rate ratio (IRR) = 2.52, 95% confidence interval (CI) = 1.99-3.20] and intermediate-risk groups (IRR = 2.19, 95% CI = 1.58-3.03). CONCLUSION: A modified algorithm stratified older people into three sizable fall risk groups including an intermediate group who may be at risk of transitioning to high fall rates in the medium to long term. These simple modifications may assist in better triaging older people to appropriate and tailored fall prevention interventions.

Characteristics of fragility hip fracture-related falls in the older adults: A systematic review.

BACKGROUND AND OBJECTIVES: With the global aging trend, the incidence of falls and hip fractures is projected to rise, leading to an increased associated burden. Over 90% of hip fractures result from falls, yet not all falls cause fractures, suggesting specific fall characteristics may contribute to hip fractures. This review provides insights into fragility hip fracture-related falls among the older adults, aiding in understanding and developing effective fall prevention strategies for this population. METHODS: Searches encompassed PubMed, OVID, EMBASE, Cochrane Library, and Web of Science, supplemented by citation checks. We included non-randomized studies detailing characteristics of fragility hip fracture-related falls in the older individuals, with or without a non-hip fracture control. Evaluated fall characteristics included height, location, direction, time, mechanism, activity during the fall, hip impact, protective responses, walking aid use, and impact surface. Results were analyzed using a narrative synthesis approach. The quality of these studies was assessed using the revised Risk of Bias Assessment tool for Non-randomized Studies 2 (RoBANS2). RESULTS: A total of 30 articles were reviewed, comprising 23 non-case control and 7 case-control studies, with a mean age of 75.6 years. Studies presented varied details on fall characteristics. Hip-fracture related falls typically occur indoors at or around standing height during daytime, often involving sideways or backward motions with inadequate protective responses. Slipping is predominant, yet lost balance and weakness/collapse are notable. Walking precedes many falls, but stationary activities (lack of forward motion, changing positions, sitting or standing still, transfer) also contribute. Low usage of walking aids and impact on hard surfaces are common features of these falls. CONCLUSIONS: This review underscores fall characteristics associated with fragility hip fractures in older adults, highlighting features more aligned with age-related physical frailty than general falls. Such insights can guide healthcare providers in implementing tailored interventions to reduce hip fractures and related challenges.

An observational study of the impact of professional walking aid prescription on gait parameters for individuals with suspected balance impairments.

Background: The primary management strategy for gait impairment is the adoption of a walking aid. However, there are no established criteria upon which to base a decision regarding the need for a walking aid. It appears clinicians prescribe aids based on preference, clinical experience and intuition rather than standardised objective rationale. This may contribute to the inconsistent gait response to walking aids reported in the published literature. Understanding gait changes resulting from gait aid usage may have significant impact on clinical practice by improving confidence of prescribing clinicians and compliance of walking aid usage by patients, maximising the benefits of use, and reducing any risks associated with non-use or inappropriate use, of the walking aid. Research question: Do professionally prescribed walking aids improve gait parameters? Methods: This is a secondary data analysis of a cross-sectional study where participants, identified by healthcare staff requiring a mobility assessment due to potential balance impairment of any cause, walked a 20-m straight walking course under three different walking conditions (no aid, walking stick and 4-wheeled walker). Fifty-eight participants were recruited. Commonly reported spatial and temporal gait parameters were assessed using a validated gait analysis device. Changes in gait parameters across the three conditions were compared, noting the individual's professionally prescribed aid and interpreting changes in parameters towards outcomes of the 'no aid required group'. Results and significance: Gait cycle, cadence, stance, swing and stride length during unaided walking were significantly changed when a walking stick was prescribed (p < 0.05). Stance, swing, double support, stride length, speed, max toe clearance and minimum toe clearance were significantly changed when a 4-wheel walker was prescribed (p < 0.05). Professional walking aid prescription improves some gait parameters. A greater number and magnitude of gait parameter improvements were seen in people requiring a 4-wheel walker than people requiring a walking stick.

Knowledge mapping and research trends of accidental falls in patients with Parkinson's disease from 2003 to 2023: a bibliometric analysis.

Background: Recent years have witnessed a rapid growth in research on accidental falls in patients with Parkinson's Disease (PD). However, a comprehensive and systematic bibliometric analysis is still lacking. This study aims to systematically analyze the current status and development trends of research related to accidental falls in patients with PD using bibliometric methods. Methods: We retrieved literature related to accidental falls in patients with PD published between January 1, 2003, and December 31, 2023, from the Web of Science Core Collection (WoSCC) database. Statistical analysis and knowledge mapping of the literature were conducted using VOSviewer, CiteSpace, and Microsoft Excel software. Results: A total of 3,195 publications related to accidental falls in patients with PD were retrieved. These articles were authored by 13,202 researchers from 3,834 institutions across 87 countries and published in 200 academic journals. Over the past 20 years, the number of published articles and citations has increased annually. The United States and the United Kingdom have the highest number of publications in this field, while Harvard University and Tel Aviv University are the most influential institutions. The Parkinsonism & Related Disorders journal published the highest number of articles, while the Movement Disorders journal had the highest number of citations. The most prolific author is Bloem, Bastiaan R, while the most cited author is Hausdorff, Jeffrey. The main research areas of these publications are Neurosciences, Biomedical, Electrical & Electronic, and Biochemistry & Molecular Biology. Currently, high-frequency keywords related to accidental falls in patients with PD include risk factors, clinical manifestations, and interventions. Prediction and prevention of accidental falls in such patients is a research topic with significant potential and is currently a major focus of research. Conclusion: This study used bibliometric and knowledge mapping analysis to reveal the current research status and hotspots in the field of accidental falls in patients with PD. It also points out directions for future research. This study can provide theoretical support and practical guidance for scholars to further conduct related research.

Clinician acceptability of the ReacStep reactive balance training program for fall prevention.

AIM: To examine if a novel reactive balance training program (ReacStep) designed for clinical settings is acceptable to clinicians prescribing balance and mobility training. METHODS: ReacStep consists of tether-release reactive step training, volitional trip and slip training, and functional strength training. An open survey comprising 11-point visual analog scale items (0 = strongly disagree to 10 = strongly agree) based on the Theoretical Framework of Acceptability was sent to clinicians working in balance and mobility training. Items evaluated the acceptability of ReacStep across seven domains (intervention coherence, perceived efficacy, self-efficacy, ethicality, affective attitude, burden and opportunity cost). RESULTS: Two hundred and seven clinicians (169 Physiotherapists, 22 Exercise Physiologists, 11 Occupational Therapists and five others) completed the survey. Respondents considered ReacStep to have good overall acceptability, intervention coherence, effectiveness, ethicality and self-efficacy (mean acceptability scores >7). However, respondent's ratings of ReacStep's affective attitude, burden and opportunity cost were more variable (mean acceptability scores 2-8) due to concerns about client anxiety, the need for a safety harness and staffing and training requirements. Respondents considered that ReacStep would be more effective and safer to conduct in geriatrics clients compared with neurological clients, and that it would be more appropriate for rehabilitation and private practice settings compared to home settings. CONCLUSIONS: ReacStep was generally acceptable from the perspective of clinicians who prescribe balance and mobility training in various clinical settings, and was deemed more effective and safer for older clients without neurological conditions, and beneficial in outpatient rehabilitation and private practice settings.

Implementing falls prevention patient education in hospitals - older people's views on barriers and enablers.

BACKGROUND: World falls guidelines recommend that hospitalised older patients receive individualised falls prevention education, yet no studies have sought older people's feedback on how best to deliver falls prevention education in hospitals. The objective of the study was to explore the perspectives of older people and their caregivers about barriers and enablers to implementation of a tailored hospital falls education program. METHODS: A qualitative descriptive design was used. Three focus groups and 16 semi-structured interviews were conducted. A purposive sample of older people who had previous hospital admissions and caregivers of older people were selected to review a co-designed patient falls education program (the revised Safe Recovery program). They provided feedback on how to implement the program in hospital settings. Data were thematically analysed taking an deductive-inductive approach. RESULTS: Participants were 37 older people [female n = 24 (64.9%), age range 64 to 89 years] and nine caregivers (female n = 8). The first theme was that the Safe Recovery Program resources were of high quality, enabling strong patient engagement and increased knowledge and awareness about falls prevention in hospitals. The second theme identified practical strategies to enable program delivery in hospital wards. The key enablers identified were: timing of delivery around wellness and the patient's mobility; tailoring messages for each older patient; key staff members being assigned to lead program delivery. Participants recommended that staff assist older patients to set appropriate behavioural goals in relation to preventing falls in hospitals. They also recommended that staff raise older patients' confidence and motivation to take action to reduce the risk of falls. Providing resources in other languages and alternative shorter versions was recommended to enable broad dissemination. CONCLUSIONS: Older people and their caregivers advised that implementing falls education in hospitals can be enabled by using high quality resources, delivering falls education in a timely manner and personalising the education and support to individual needs.

Facilitators and barriers in the implementation of a fall prevention program based on physical activity for elderly people living in the community: A qualitative study.

BACKGROUND: Physical activity is recognized as beneficial for older individuals in preventing falls. Achieving high adherence to exercise programs among the elderly poses challenges for administrations and healthcare systems. This study explored the facilitators and barriers perceived by both the participants and nurse trainers involved in an exercise program aimed at preventing falls in primary healthcare. METHODS: Sixteen semi-structured interviews with elderly people who had participated in the Otago Exercise Program and a focus group of nurse trainers of this program were conducted between October 2018 and September 2019 in primary health care centers in Lleida, Spain. Interviews were transcribed and analyzed using inductive thematic analysis with Atlas.ti 8 software. RESULTS: Analysis revealed five overarching categories and 17 subcategories. Key facilitators included personal motivation, the perceived benefits of exercise, and the supportive role of nurse trainers. Primary barriers encompassed factors such as the excessive duration of the program, not considering personal preferences for individual or group participation, and differences in physical condition among group participants. CONCLUSIONS: To increase participation and adherence to exercise programs, it is necessary to consider the important role of the nursing professionals that recommend program enrolment and the participants' personal motivations. The program with group sessions is a model that is easy to integrate into Primary Healthcare centers, which must always take into account the preferences and physical conditions of the participants.

A case management strategy to reduce falls in older people with a history of falls: A randomized controlled trial.

The present study aimed to determine whether a remotely delivered intervention, based on an individual case management, can reduce falls and their consequences in community-dwelling older people with a history of multiple falls. In this randomized controlled trial, 32 participants were randomized to the intervention group, which comprised a 16-week case management program involving a multidimensional assessment, targeted interventions according to the identified fall risk factors, and development of individualized care plans. The intervention was performed by trained gerontologists, under weekly supervision of professionals with experience in falls. The control group (n = 30) received usual care. Falls were monitored over 12 months with monthly falls calendars and telephone calls. Remotely delivered case management presented an 82 % uptake of recommendations. There was a trend toward a reduced fall incidence in the intervention vs control group, with lower fall, fall injury and fracture rates in the intervention group compared with the control group at both the 16-week and 12-month time-points, with the difference statistically significant for injurious fall rates at 12 months - IRR=0.18 (95 % CI = 0.04 to 0.74).

Identification of medication-related fall risk in adults and older adults admitted to hospital: A machine learning approach.

The study aimed to develop and validate, through machine learning, a fall risk prediction model related to prescribed medications specific to adults and older adults admitted to hospital. A case-control study was carried out in a tertiary hospital, involving 9,037 adults and older adults admitted to hospital in 2016. The variables were analyzed using the algorithms: logistic regression, naive bayes, random forest and gradient boosting. The best model presented an area under the curve = 0.628 in the older adult subgroup, compared to an area under the curve (AUC) = 0.776 in the adult subgroup. A specific model was developed for this sample. The gradient boosting model presented the best performance in the sample of older adults (AUC = 0.71). Models developed to predict the risk of falls based on medications specifically aimed at older adults presented better performance in relation to models developed in the total population studied.