Impact of Geriatric Assessment and Self-Management Support on Community-Dwelling Older Adults with Chronic Illnesses

Faul, Anna C.; Yankeelov, Pamela; Rowan, Noell L.; Gillette, Patricia D.; Nicholas, Lionel; Borders, Kevin; Deck, Stacy M.; Pariser, David P.; Wiegand, Mark

doi:10.1080/01634370802609288

Cited by 20 publications

(33 citation statements)

References 21 publications

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“…Although current fall prevention guidelines [9] do not explicitly account for the role of chronic disease or multi-morbidity, clinicians may find this useful to consider when adapting these guidelines for individual patients. Second, the inherent challenges associated with managing multiple conditions require complementary strategies, and self-management approaches for older adults may offer additional opportunities to promote function and independence [34]. Although falls are episodic in nature, fall prevention requires sustained effort – similar to chronic disease management strategies – and many behaviors, such as exercise and medication monitoring, can benefit multiple conditions.…”

Section: Discussionmentioning

confidence: 99%

Chronic disease and falls in community-dwelling Canadians over 65 years old: a population-based study exploring associations with number and pattern of chronic conditions

et al. 2014

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BackgroundFalls and chronic disease are both important health issues in older adults. The objectives of this study were to quantify the prevalence of falls and multi-morbidity (≥2 chronic conditions) in Canadian older adults; examine associations between falls and number of chronic conditions; and explore whether certain patterns of chronic disease were associated with a greater risk of falling.MethodsData were derived from the Canadian Community Health Survey- Healthy Aging. Primary outcomes from 16,357 community-dwelling adults aged 65 years and over were self-reported falls in the previous 12 months and presence of 13 chronic conditions. Prevalence estimates were calculated with normalized sampling weights, and hierarchical cluster analysis was used to identify clusters based on chronic condition patterns, and tested for association to falls with logistic regression.ResultsOverall prevalence of falling and multi-morbidity were 19.8% and 62.0% respectively. Fall risk was significantly greater in individuals with one, two, four, five and six or more chronic conditions relative to those with none (all p < 0.05). A seven-cluster model was selected, including groups with low prevalence of chronic disease, or high prevalence of hypertension and arthritis, visual impairment, hypertension, chronic obstructive pulmonary disease (COPD), diabetes, or heart disease and hypertension. Only the hypertension cluster (Odds Ratio [OR] = 1.2) and COPD cluster (OR = 1.6) were significantly associated with increased falls relative to the low prevalence group.ConclusionsBoth the number and pattern of chronic conditions were related to falls. COPD emerged as a significant predictor of falls despite affecting a smaller proportion of respondents. Continued study is warranted to verify this association and determine how to incorporate consideration of chronic disease and multi-morbidity into fall risk assessments.

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Section: Discussionmentioning

confidence: 99%

Chronic disease and falls in community-dwelling Canadians over 65 years old: a population-based study exploring associations with number and pattern of chronic conditions

et al. 2014

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“…In two of these programs, the care plan was only implemented after final approval by the older person (Looman, Fabbricotti, & Huijsman, ; Looman et al, ; Spoorenberg et al, , ; Uittenbroek et al, ). In seven programs, older people were responsible for implementing activities and recommendations that were established in the care plan (Boult et al, ; Bouman, Van Rossum, Ambergen, Kempen, & Knipschild, ; Boyd et al, ; Faul et al, ; Fleischer et al, ; Ploeg et al, ; Rogerson et al, ; Suijker et al, , ).…”

Section: Resultsmentioning

confidence: 99%

Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review

Stoop

Lette

Gils

et al. 2019

Health Soc Care Community

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In many integrated care programs, a comprehensive geriatric assessment (CGA) is conducted to identify older people's problems and care needs. Different ways for conducting a CGA are in place. However, it is still unclear which CGA instruments and procedures for conducting them are used in integrated care programs, and what distinguishes them from each other. Furthermore, it is yet unknown how and to what extent CGAs, as a component of integrated care programs, actually reflect the main principles of integrated care, being comprehensiveness, multidisciplinarity and person‐centredness. Therefore, the objectives of this study were to: (a) describe and compare different CGA instruments and procedures conducted within integrated care programs for older people living at home, and (b) describe how the principles of integrated care were applied in these CGAs. A scoping review of the scientific literature on CGAs in the context of integrated care was conducted for the period 2006–2018. Data were extracted on main characteristics of the identified CGA instruments and procedures, and on how principles of integrated care were applied in these CGAs. Twenty‐seven integrated care programs were included in this study, of which most were implemented in the Netherlands and the United States. Twenty‐one different CGAs were identified, of which the EASYcare instrument, RAI‐HC/RAI‐CHA and GRACE tool were used in multiple programs. The majority of CGAs seemed to reflect comprehensiveness, multidisciplinarity and person‐centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. This study highlights the high variability of CGA instruments and procedures used in integrated care programs. This overview of available CGAs and their characteristics may promote (inter‐)national exchange of CGAs, which could enable researchers and professionals in choosing from the wide range of existing CGAs, thereby preventing them from unnecessarily reinventing the wheel.

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“…Seventy-seven different checklists were reported, with just one fourth ( n = 19, 25%) used in two or more studies (see Table 2 ). Five checklists (6%) were used in at least five studies (Additional file 3 : Table S2), the Westmead Home Safety Assessment (WeHSA, n = 10) [ 24 , 48 , 55 – 58 , 61 , 68 , 136 , 145 ], Minimum Data Set–Home Care instrument (MDS-HC; n = 7) [ 52 , 54 , 74 , 99 , 106 , 112 , 147 ], Tideiksaar et al checklist (n = 7) [ 5 , 14 , 70 , 94 , 100 , 129 , 140 ], Home Falls and Accidents Screening Tool (HOME FAST; n = 6) [ 27 , 101 – 103 , 110 , 122 ], and Housing Enabler Instrument ( n = 5) [ 80 , 83 , 84 , 118 , 154 ]. A majority of studies ( n = 57, 74%) used “in house” questionnaires.…”

Section: Resultsmentioning

confidence: 99%

A need to improve the assessment of environmental hazards for falls on stairs and in bathrooms: results of a scoping review

Blanchet

Edwards

2018

BMC Geriatr

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BackgroundFalls occurring on stairs or in bathrooms are associated with a high risk of injuries among older adults. Home environmental assessments are frequently used to guide fall-prevention interventions. The aims of this review were to describe how, where, by whom, and for whom environmental hazard checklists are used, and to examine the characteristics of environmental hazard assessment checklists with specific attention to features of bathrooms and stairs/steps assessed in them.MethodsStudies published before January 5, 2018, were identified using several databases. Publications reporting the use and/or evaluation of environmental hazard checklists were eligible if they assessed bathrooms or stairs/steps in homes of older adults (≥65 years). Content analysis was conducted on publications that provided a complete list of specific environmental hazards assessed. Checklist items related to bathrooms and stairs/steps were extracted and categorized as structural or non-structural and as objective or subjective.Results1119 studies were appraised. A pool of 136 published articles and 4 checklists from the grey literature were included in this scoping review. Content analysis was conducted on 42 unique checklists. There was no widely used checklist and no obvious consensus definition of either environmental hazards overall or of single hazards listed in checklists. Checklists varied greatly with respect to what rooms were assessed, whether or not outdoor stair/steps hazards were assessed, and how responses were coded. Few checklists examined person-environment fit. The majority of checklists were not oriented towards structural hazards in bathrooms. Although the majority of checklists assessing stair/steps hazards evaluated structural hazards, most features assessed were not related to the construction geometry of stairs/steps. Objective features of bathrooms and stairs/steps that would deem them safe were rarely specified. Rather, adequacy of their characteristics was mostly subjectively determined by the evaluator with little or no guidance or training.ConclusionThe lack of standard definitions and objective criteria for assessing environmental hazards for falls is limiting meaningful cross-study comparisons and slowing advances in this field. To inform population health interventions aimed at preventing falls, such as building code regulations or municipal housing by-laws, it is essential to include objectively-assessed structural hazards in environmental checklists.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0958-1) contains supplementary material, which is available to authorized users.

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Impact of Geriatric Assessment and Self-Management Support on Community-Dwelling Older Adults with Chronic Illnesses

Abstract: This study demonstrates the value of non-medical intervention strategies for community dwelling older adults with chronic illnesses.

Cited by 20 publications

References 21 publications

Chronic disease and falls in community-dwelling Canadians over 65 years old: a population-based study exploring associations with number and pattern of chronic conditions

Chronic disease and falls in community-dwelling Canadians over 65 years old: a population-based study exploring associations with number and pattern of chronic conditions

Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review

A need to improve the assessment of environmental hazards for falls on stairs and in bathrooms: results of a scoping review

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