Evaluation of Tailored Falls Education on Older Adults' Behavior Following Hospitalization

Abstract

BACKGROUND Older adults recently discharged from the hospital are known to be at risk of functional decline and falls. This study evaluated the effect of a tailored education program provided in the hospital on older adult engagement in fall prevention strategies within 6 months after hospital discharge. METHODS A process evaluation of a randomized controlled trial that aimed to improve older adult fall prevention behaviors after hospital discharge. Participants (n = 390) were aged 60 years and older with good cognitive function (greater than 7 of 10 Abbreviated Mental Test Score), discharged home from three hospital rehabilitation wards in Perth, Australia. The primary outcomes were engagement in fall prevention strategies, including assistance with daily activities, home modifications, and exercise. Data were analyzed using generalized linear modeling. RESULTS There were 76.4% (n = 292) of participants who completed the final interview (n = 149 intervention, n = 143 control). There were no significant differences between groups in engagement in fall prevention strategies, including receiving instrumental activity of daily living (IADL) assistance (adjusted odds ratio [AOR] = 1.3 [95% confidence interval {CI} = 0.7‐2.1]; P = .3), completion of home modifications (AOR = 1.2 [95% CI = 0.7‐1.9]; P = .4), and exercise (AOR = 1.3 [95% CI = 0.7‐2.2]; P = .3). There was a high proportion of unmet ADL needs within both groups, and levels of participant dependency remained higher at 6 months compared to baseline levels at admission. The proportion of all participants who engaged in exercise following hospital discharge increased by 30%; however, the mean duration of exercise reduced from 3 hours per week at baseline to 1 hour per week at 6‐month follow‐up (SD = 1.12 hours per week). CONCLUSION Tailored education did not increase older adult engagement in fall prevention strategies after hospital discharge compared to usual care. Further research is required to evaluate older adults’ capacity to change their behaviors once they return home from hospital, which may enable a safer recovery of their independence. J Am Geriatr Soc 67:2274–2281, 2019

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

“…15 Research is needed to explore possible barriers and facilitators to engaging older patients in preventing falls post-hospitalization. [17][18][19]…”

Effectiveness of nursing care provided for fall prevention: Survival analysis of nursing records in a tertiary hospital

“…Contrary to our expectation, patient education on fall prevention was not effective at reducing fall‐risk based on analyses of cohort and high‐risk day data. The education of hospitalized patients is generally accepted as an effective fall prevention strategy but has been questioned recently (Naseri et al, 2019). Instead of providing patient education only, some researchers have suggested that education together with other fall prevention measures, such as staff training and the use of alarm systems and exercise programs, might contribute to fall prevention (Sosnoff et al, 2015; Taylor, 2015).…”

Tailored Education Increased Capability and Motivation for Fall Prevention in Older People After Hospitalization

“…It also optimizes the capability and motivation of older patients to engage in fall-prevention strategies once home ( 2 , 10 ). This positive change did not translate into improved or long-lasting engagement in falls prevention strategies post hospitalization ( 25 ). This implementation gap was correlated with the finding that fall incidence was not reduced ( 2 ).…”

“…Further, analysis to determine the association between the presence of capability and motivation (as binary data) and engagement in falls prevention strategies was completed. Data from a previous evaluation ( 25 ) regarding the reported engagement of the participants in fall prevention strategies after hospital discharge at 6 months follow-up (T3) was included as an independent variable during analysis, using mixed effects generalized linear modeling with adjustment for falls risk factors. This was completed to identify any association between engagement as behavior change, and the primary outcomes of capability and motivation.…”