A protocol for evidence-based targeting and evaluation of statewide strategies for preventing falls among community-dwelling older people in Victoria, Australia

Abstract

BackgroundFalls are a significant threat to the safety, health and independence of older citizens. Despite the now substantial evidence about effective falls prevention interventions, translation into falls reductions has not yet been fully realised. While the hip fracture rate is decreasing, the number and rate of fall-related hospital admissions among older people is increasing. The challenge now is to deliver the most effective interventions efficiently at a population level, and for these interventions to be taken up by older people.ObjectiveTo support the development, and evaluation of, effective falls prevention policy and practice in the state of Victoria, Australia.MethodsThe RE-AIM model (Reach, Efficacy, Adoption, Implementation, Maintenance) was used to identify strategies for an effective programme. Research objectives were developed to support the strategies. These include: (1) identification of subgroups of older people most frequently admitted to hospital for falls; (2) examining the acceptability of established falls interventions; (3) identification of factors that encourage and support relevant lifestyle changes; (4) identifying opportunities to incorporate confirmed interventions in existing programmes and services; (5) developing guidelines for sustainability. The research results will subsequently guide strategy details for the falls prevention plan. RE-AIM will provide the framework for the evaluation structure.Outcome measuresMeasures to monitor the implementation of the selected interventions will be determined for each intervention, based on the five key factors of the RE-AIM model. The overall effect of the falls prevention plan will be monitored by time series analysis of fall-related hospital admission rates for community-dwelling older people.

What Are the Characteristics of Home Exercise Programs That Older Adults Prefer?

“…16 This study formed part of an examination of the likely determinants of intervention Badoption[ in relation to home exercise for falls prevention. This study was approved by the Monash University Human Research Ethics Committee.…”

“…Study sample sizes for the baseline survey were determined on the basis of analyses that were not relevant to this study. 16 The follow-up survey was delivered to a convenience sample of persons who participated in the baseline survey and agreed to participate in the follow-up.…”

“…Prompts were developed from likely barriers and facilitators of home exercise adherence in a proposed theoretical framework on the uptake of falls prevention interventions in the community. 16 Selected sociodemographic and health-related characteristics of current, previous, and nonparticipants in home exercise programs were also collected ( Table 2). Survey responses were recorded by trained research assistants using online survey software (SurveyMonkey BSelect Package[).…”

Getting sports injury prevention on to public health agendas – addressing the shortfalls in current information sources

“…The power of this Cochrane and other systematic reviews of evidence to directly underpin policy decisions cannot be overstated, yet they are not common in sports medicine. The power of active collaborations with policy makers and investment of research effort in developing realistic cost–benefit estimates for both different preventive actions as well as the costs of inaction have also been demonstrated for falls prevention in older people 32–34. Other successful injury prevention information strategies have including the development and validation of injury indicators that could also be used to monitor policy need and success over time 14 15 35…”

Effects of a complex intervention on fall risk in the general practitioner setting: a cluster randomized controlled trial

“…Clinical trials have shown that effective fall prevention interventions include balance training in combination with strength training 1,6,7. In contrast to this evidence, the implementation of broad ranging fall prevention programs is rare, and the challenge remains to deliver the most effective intervention to the right target group of older persons 8…”