Older adult fall prevention practices among primary care providers at accountable care organizations: A pilot study

Abstract

BackgroundFalls are a serious and common problem among older adults. Low-tech, inexpensive, community-based fall prevention programs have been shown to be both effective and cost effective, however, these programs are not well-integrated into clinical practice.Research designWe surveyed primary care providers at a convenience sample of two accountable care organizations in Massachusetts to assess their beliefs, attitudes, knowledge, and practices relative to fall risk assessment and intervention for their older patients.ResultsResponse rate was 71%. Providers’ beliefs about the efficacy of fall risk assessment and intervention were mixed. Eighty-seven percent believed that they could be effective in reducing fall risk among their older adult patients. Ninety-six percent believed that all older adults should be assessed for fall risk; and, 85% believed that this assessment would identify fall risk factors that could be modified. Nonetheless, only 52% believed that they had the expertise to conduct fall risk assessment and only 68% believed that assessing older adult patients for fall risk was the prevailing standard of practice among their peer providers. Although most providers believed it likely that an evidence-based program could reduce fall risk among their patients, only 14% were aware of the Centers for Disease Control and Prevention’s fall risk assessment algorithm (STEADI Toolkit), and only 15% were familiar with Matter of Balance, the most widely disseminated community fall risk prevention program in Massachusetts.DiscussionNew strategies that more directly target providers are needed to accelerate integration of fall risk assessment and intervention into primary care practice.

A novel telerehabilitation with educational program for caregivers using telelecture is a feasible procedure for fall prevention in elderly people – A pilot study

“…There have been no trials of telerehabilitation focused on preventive rehabilitation for general elderly people. In addition, at present, the quality of the rehabilitation is not secured [32]. The present study suggests that our telerehabilitation system is a feasible option for the rehabilitation of elderly people in rural areas.…”

“…Recent meta analyses and systematic reviews revealed the e cacy of fall prevention intervention in community-dwelling older people [28][29][30][31]. Community-based fall prevention interventions are low cost and low-tech programs, which can achieve a 25-30% reduction in falls per year after the program [32]. Thus, the e cacy of conventional fall prevention intervention has been well recognized.…”

“…Thus, the e cacy of conventional fall prevention intervention has been well recognized. However, interventions are often provided by non-medical specialists or less-integrated staff [32] and face-to-face procedures are required, which would make these interventions di cult to implement in rural areas. To solve this problem, it is crucial to establish standardized telerehabilitation methods.…”

Training and Toolkit Resources to Support Implementation of a Community Pharmacy Fall Prevention Service

“…STEADI offers resources for health care providers to assess and minimize fall-related risk factors such as medications linked to falls, home hazards, sensory impairment, and chronic conditions [8]. While originally developed for use in primary care, engagement has remained low in this setting [9,10]. With rising prescription medication use, polypharmacy, and patients receiving care from numerous providers [11,12], there is a distinct need for the expertise of a pharmacist to help manage medication-related fall risk.…”

A trip to remember

“…Multiple studies have shown that the majority of general practitioners do not specifically assess older patients' risk of falls unless a fall has already occurred (Wenger et al, 2003, Jones et al, 2011, Grant et al, 2015, Kielich et al, 2017, Mackenzie and McIntyre, 2019 and there is a general lack of awareness and use of recognised clinical guidelines and programmes (Jones et al, 2011, Howland et al, 2018. It is, however, reassuring that fall risk screening and fall reduction behaviours among primary care providers can be significantly improved through various interventions (Brown et al, 2005, Wenger et al, 2009, Tricco et al, 2019.…”