The Strategies to Reduce Injuries and Develop Confidence in Elders Intervention: Falls Risk Factor Assessment and Management, Patient Engagement, and Nurse Co‐management

Abstract

In response to the epidemic of falls and serious falls-related injuries among older persons, in 2014, the Patient Centered Outcomes Research Institute (PCORI) and the National Institute on Aging funded a pragmatic trial, Strategies to Reduce Injuries and Develop confidence in Elders (STRIDE) to compare the effects of a multifactorial intervention and an enhanced usual care intervention. The STRIDE multifactorial intervention consists of 5 major components delivered by registered nurses in the role of Falls Care Managers (FCM), who co-manage fall risk in partnership with patients and their primary care providers (PCP). The components include: 1) standardized assessment of 8 modifiable risk factors (medications, postural hypotension, feet and footwear, vision, vitamin D, osteoporosis, home safety, and strength, gait, and balance impairment) and the use of protocols and algorithms to generate recommended management of risk factors; 2) explanation of assessment results to the patient (and caregiver when appropriate) using basic motivational interviewing techniques to elicit patient priorities, preferences, and readiness to participate in treatments; 3) co-creation of individualized Falls Care Plans that are reviewed, modified, and approved by patients’ PCPs; 4) implementation of the Falls Care Plan; and 5) ongoing monitoring of response, regularly scheduled re-assessments of fall risk, and revisions of the Falls Care Plan. Custom-designed falls care management software facilitates risk factor assessment, the identification of recommended interventions, clinic note generation, and longitudinal care management. The trial testing the effectiveness of the STRIDE intervention is in progress with results expected in late 2019.

The effect of Baduanjin qigong combined with CBT on physical fitness and psychological health of elderly housebound

“…Results of the joint intervention significantly exceeded that of the CBT or Baduanjin interventions alone ( P < .05). The elderly are susceptible to age-related osteoporosis and are prone to falls, [30,31] and falls are the leading cause of fractures in the elderly. [24] Due to these concerns, elderly housebound may not want to leave their homes.…”

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…Increased falls and fracture risks were reported in patients with combination of sarcopenia and OP [ 483 , 506 , 507 ], but, surprisingly, a synergistic effect has not been observed in community-dwelling older men [ 508 ]. Noticeable, RFs for falls linked with HPI-related morbidity include, in addition to altered muscle status, impaired vision, hemodynamic instability (orthostatic and postprandial hypotension), arrhythmias, mental impairment, depression and anxiety [ 457 , 466 , 468 , 509 , 510 ], as well as the numerous medications used. Strong associations between frailty and an increased propensity to falls, fractures and mortality are well documented [ 483 , 511 , 512 , 513 , 514 , 515 , 516 , 517 , 518 , 519 , 520 ].…”

<p>Barriers and Facilitators to Older Adults Participating in Fall-Prevention Strategies After Transitioning Home from Acute Hospitalization: A Scoping Review</p>

“…3 Recent studies have shown that adequate selfmanagement may minimize the impact of falls in older adults. [9][10][11][12][13][14][15][16] However, research is lacking on why some older adults engage in self-management actions and behaviors to prevent falls while others do not. 15 Research is needed to explore possible barriers and facilitators to engaging older patients in preventing falls post-hospitalization.…”