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

Abstract

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

Nursing Interventions to Empower Family Caregivers to Manage the Risk of Falling in Older Adults: A Scoping Review

“…Furthermore, referrals to other healthcare professionals extend this comprehensive approach. After identifying specific risk factors, it is vital to ensure that the individual receives the appropriate interventions and support [ 42 , 43 ].…”

Cultural Adaptation and Pilot Testing of the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Program for Older Adults in a Low and Middle-Income Country

“…A recent systematic review of strategies to implement multifactorial fall prevention indicated that the most used implementation strategies at the individual level were tailoring, active learning, personalizing risk, consciousness-raising and participation. [36] Most strategies at the environmental level were technical assistance, use of lay health workers, peer education, increasing stakeholder influence and forming coalitions. [36] Also, the differences between countries (e.g., culture, environment, exercise preference, sunlight exposure, healthcare and social welfare) may influence the success of implementing falls prevention.…”

“…[36] Most strategies at the environmental level were technical assistance, use of lay health workers, peer education, increasing stakeholder influence and forming coalitions. [36] Also, the differences between countries (e.g., culture, environment, exercise preference, sunlight exposure, healthcare and social welfare) may influence the success of implementing falls prevention. [37] A culturally adapted program and systematically implementation have the potential to create a sustainable intervention and improve older adults' engagement in the program and outcomes.…”

Developing and Testing Implementation Strategies to support the Centers for Disease Control and Prevention's Initiative for Falls Risk Management in Outpatient Physical Therapy: A Protocol

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