A Collaborative Implementation Strategy to Increase Falls Prevention Training Using the Age-Friendly Health Systems Approach

Abstract

Falls in the home and in community environments are the leading cause of injuries and long-term disabilities for the aging population. The purpose of this study was to examine outcomes of a partnership among an academic institution, government agency, community organizations, and emergency management services to implement a falls prevention training program using an Age-Friendly Health Systems approach. In this prospective study, partners identified gaps in services and targeted and non-targeted delivery areas for implementation of an evidence-based falls prevention intervention addressing the 4Ms of Age-Friendly Health Systems—Mobility, Medications, Mentation, and What Matters. Descriptive statistics were calculated for program implementation and participant demographic variables, and paired t-test analysis compared scores for self-assessed general health and falls efficacy prior to and after program participation. Twenty-seven falls prevention classes were implemented, with over half (52%) in targeted areas. A total of 354 adults aged 50 and older participated, with N = 188 participants (53%) completing the program by attending at least five of eight sessions. Of completers, 35% resided in targeted areas. The results showed a statistically significant improvement in falls efficacy by program completers in targeted and non-targeted areas. However, there was no statistically significant difference in self-rated health. Overall, the findings of this study indicate that collaboration to deliver falls prevention training can be effective in reaching at-risk older adults. By mobilizing collaborative partnerships, limited resources can be allocated towards identifying at-risk older adults and improving community-based falls prevention education.

Facilitators and Barriers to Implementing the 4Ms Framework of Age-Friendly Health Systems: A Scoping Review

“…In summary, our findings revealed many significant system factors (e.g., infrastructure readiness) that may hinder or support the implementation of the 4Ms Framework of Age-Friendly Health Systems [ 4 , 13 , 14 , 15 , 16 , 17 , 18 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. As an example, a recent review [ 33 ] around the implementation of the streamlining framework (for streamlining cancer multidisciplinary meetings) in the United Kingdom’s national health system identified similar system issues.…”

“…As shown in Table 6 , the most frequently reported barrier theme was the lack of clinician’s buy-in (eight articles, 42.1%), which included six subthemes: (1) clinicians’ concerns about adding extra burden and steps during clinic visits; (2) lack of time to learn about the 4Ms Framework; (3) limited time to implement the 4Ms Framework; (4) lack of full buy-in from clinicians and health systems in eliciting older adults’ goals and values (i.e., “What Matters?”); (5) limited published literature on adoption of the 4Ms Framework; and (6) siloed implementation efforts across settings within a health system leading to limited synergies and scaling of the 4Ms Framework. Within this barrier theme, the most common barrier subtheme was limited time to implement the 4Ms Framework (e.g., limited time available for implementation of the 4Ms [ 18 , 25 ]; limited time available to participate in the monthly grand round [ 13 ]; and limited available time during medical visits [ 23 ]) ( Table 5 ).…”

Effects of Otago Exercise Program on postural control ability in elders living in the nursing home: A systematic review and meta-analysis

“…[6] The reduced postural control ability could induce increased fall rates making elders more susceptible to cause injuries and long-term disabilities. [3] Additionally, the COVID-19 pandemic further exacerbated the social isolation of the elderly, decreasing their likelihood of engaging in physical activity and maintaining motor function, [7] which is especially serious for those living in NHs.…”

“…[1] Deficiencies in balance and muscle strength are a common manifestation of a reduction in postural control ability, and 28% to 35% of elders experience falls each year, contributing to health deterioration and an increase in hospitalization probability. [2,3] Nursing home (NH) has relatively closed spaces, limiting daily activity intensity for the elderly, who may spend almost 79% of their day sedentary, with only 1% moderate-to-vigorous physical activity, causing negative influences on mobility and aerobic endurance. [4,5] Loss of postural control ability and related injuries are of particular concern for elders living in NHs.…”

“…Many studies have demonstrated that exercise is the most effective and convenient method to minimize adverse body changes. [8,9] However, those living in NHs have a greater need for reliable and scientific exercise training programs due to their poor health, [3] and there is still a need for an efficient and systematic exercise program for this population.…”