Preventing falls in assisted living: Results of a quality improvement pilot study

Zimmerman, Sheryl; Greene, Angela; Sloane, Philip D.; Mitchell, Madeline; Nyrop, Kirsten A.; Walsh, Edith

doi:10.1016/j.gerinurse.2016.09.003

Cited by 12 publications

(13 citation statements)

References 23 publications

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“…The majority of the reports ( n = 15) were older than 5 years [ 17 , 27 , 28 , 30 , 33 – 38 , 41 – 43 , 46 , 47 ]. Seven studies took place in different settings; in a combination of community organization, home of the older persons, senior apartment buildings, and senior centers [ 27 , 28 , 31 , 40 , 41 , 45 , 47 , 48 ], five studies were performed at the home of the older person [ 30 , 32 , 38 , 39 , 42 ], two studies took place in a community or senior center [ 43 , 46 ], one in medical practices [ 29 ], and three studies were performed in the community in general [ 33 – 37 ], in home health agencies [ 17 ], and in an assisted living community [ 44 ]. In total, eight reports used a mixed method design [ 31 , 32 , 37 – 39 , 44 , 45 , 47 ], six had a qualitative design [ 28 – 30 , 41 , 43 , 46 ], three were quantitative descriptive [ 17 , 33 , 36 ], three were non-randomized controlled trials [ 34 , 35 , 48 ], and three reports were randomized controlled trials [ 27 , 40 , 42 ].…”

Section: Resultsmentioning

confidence: 99%

Strategies to implement multifactorial falls prevention interventions in community-dwelling older persons: a systematic review

et al. 2023

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Background One-third of the community-dwelling older persons fall annually. Guidelines recommend the use of multifactorial falls prevention interventions. However, these interventions are difficult to implement into the community. This systematic review aimed to explore strategies used to implement multifactorial falls prevention interventions into the community. Methods A systematic search in PubMed (including MEDLINE), CINAHL (EBSCO), Embase, Web of Science (core collection), and Cochrane Library was performed and updated on the 25th of August, 2022. Studies reporting on the evaluation of implementation strategies for multifactorial falls prevention interventions in the community setting were included. Two reviewers independently performed the search, screening, data extraction, and synthesis process (PRISMA flow diagram). The quality of the included reports was appraised by means of a sensitivity analysis, assessing the relevance to the research question and the methodological quality (Mixed Method Appraisal Tool). Implementation strategies were reported according to Proctor et al.’s (2013) guideline for specifying and reporting implementation strategies and the Taxonomy of Behavioral Change Methods of Kok et al. (2016). Results Twenty-three reports (eighteen studies) met the inclusion criteria, of which fourteen reports scored high and nine moderate on the sensitivity analysis. All studies combined implementation strategies, addressing different determinants. The most frequently used implementation strategies at individual level were “tailoring,” “active learning,” “personalize risk,” “individualization,” “consciousness raising,” and “participation.” At environmental level, the most often described strategies were “technical assistance,” “use of lay health workers, peer education,” “increasing stakeholder influence,” and “forming coalitions.” The included studies did not describe the implementation strategies in detail, and a variety of labels for implementation strategies were used. Twelve studies used implementation theories, models, and frameworks; no studies described neither the use of a determinant framework nor how the implementation strategy targeted influencing factors. Conclusions This review highlights gaps in the detailed description of implementation strategies and the effective use of implementation frameworks, models, and theories. The review found that studies mainly focused on implementation strategies at the level of the older person and healthcare professional, emphasizing the importance of “tailoring,” “consciousness raising,” and “participation” in the implementation process. Studies describing implementation strategies at the level of the organization, community, and policy/society show that “technical assistance,” “actively involving stakeholders,” and “forming coalitions” are important strategies. Trial registration PROSPERO CRD42020187450

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Section: Resultsmentioning

confidence: 99%

Strategies to implement multifactorial falls prevention interventions in community-dwelling older persons: a systematic review

et al. 2023

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“…Prior research shows that regular exercise (defined as structured, repetitive, and purposeful physical activity done to improve or maintain fitness) helps older adults maintain or improve physical function that would otherwise decline (Caspersen et al, 1985; Hatch & Lusardi, 2010; Marshall & Berg, 2010; Sung, 2009), yet the availability of services to ameliorate functional decline—including occupational and/or physical therapy—varies widely depending on community size (Park-Lee et al, 2011). Attesting to the potential for additional services in RC/AL, a recent falls-related intervention study noted a lack of exercises other than those that were chair-based (Zimmerman et al, 2016), demonstrating how little exercise programming has changed in the past 20 years (Mihalko & Wickley, 2003; Wasner & Rimmer, 1997). Contrary to clear evidence that deconditioning resulting from sedentary behavior increases fall risk, literature indicates that RC/AL staff fear that residents will fall unless they remain seated for exercise, which poses a barrier to promoting more challenging activity (Galik, Resnick, Lerner, Hammersla, & Gruber-Baldini, 2015; Gruber-Baldini et al, 2011; Resnick, Galik, Vigne, & Carew, 2016).…”

Section: Discussionmentioning

confidence: 99%

Physical Function, Relocation, and Mortality Outcomes in Residential Care and Assisted Living Residents

et al. 2017

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“…In addition, staff education has been included in multicomponent interventions for fall prevention (Lamb, Jørstad-Stein, Hauer, & Becker, 2005). Despite the evidence that these interventions can decrease fall risk, they are not easily implemented into practice (Zimmerman et al, 2017). Moreover, there continues to be a pervasive belief among nurses, patients, and families that physical activity increases the risk of falling (Shannon, 2018;Tuvemo, Martin, Anens, Johansson, & Hellstr€ om, 2018).…”

Section: Interventions To Decrease Fallsmentioning

confidence: 99%

“…Care is provided by direct care workers, often, but not always, under the supervision of licensed nurses. Approximately 15% to 50% of older adults living in AL communities in the United States experience a fall over a 6-to 24-month period (Williams et al, 2018;Zimmerman et al, 2017). High rates of falls are noted as well in Canadian AL facilities (McGregor et al, 2014;Maxwell et al, 2013Maxwell et al, , 2015.…”

Section: Introductionmentioning

confidence: 99%

Impact of Function Focused Care and Physical Activity on Falls in Assisted Living Residents

et al. 2019

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Background There continues to be a belief among nurses, patients, and families that physical activity increases the risk of falling. Purpose The purpose of this study was to test the hypothesis that controlling for age, function, cognition, medication use, gender, comorbidities, and cognition, residents who are exposed to Function Focused Care for Assisted Living (FFC-AL-EIT) and engage in moderate levels of physical activity would not be more likely to fall. Methods This was a secondary data analysis using data from the first two cohorts of a randomized trial testing FFC-AL-EIT in the United States. Results The study included 381 residents, the majority of whom were female (70%), white (97%), with a mean age of 87.72 (standard deviation = 7.47). Those who engaged in more moderate-intensity physical activity were 1% less likely to fall (odds ratio = .99, p = .03). There was no significant association between exposure to function focused care and falling (odds ratio = 1.58, p = .09). Conclusion There was no indication that those who were exposed to function focused care or those who engaged in moderate-level physical activity were more likely to fall. In fact, engaging in moderate-level physical activity was noted to be slightly protective of falling.

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Preventing falls in assisted living: Results of a quality improvement pilot study

Cited by 12 publications

References 23 publications

Strategies to implement multifactorial falls prevention interventions in community-dwelling older persons: a systematic review

Strategies to implement multifactorial falls prevention interventions in community-dwelling older persons: a systematic review

Physical Function, Relocation, and Mortality Outcomes in Residential Care and Assisted Living Residents

Impact of Function Focused Care and Physical Activity on Falls in Assisted Living Residents

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