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

Abstract

Purpose: Approximately, 14% of older adults aged 65 years and over experience a fall within 1 month post-hospital discharge. Adequate self-management may minimize the impact of these falls; however, research is lacking on why some older adults engage in self-management to prevent falls while others do not. Methods: We conducted a scoping review to identify barriers and facilitators to older adults participating in fall-prevention strategies after transitioning home from acute hospitalization. Eligibility criteria were peer-reviewed journal articles published during 2009-2019 which were written in English and contained any of the following keywords or their synonyms: "fall-prevention," "older adults," "post-discharge" and "transition care." We systematically and selectively summarized the findings of these articles using the Joanna Briggs Institute guidelines and the PRISMA-ScR reporting guidelines. Seven bibliographic databases were searched: PubMed/MEDLINE, ERIC, CINAHL, Cochrane Library, Scopus, PsycINFO, and Web of Science. We used the Capability-Opportunity-Motivation-Behavior (COM-B) model of health behavior change as a framework to guide the content, thematic analysis, and descriptive results. Results: Seventeen articles were finally selected. The most frequently mentioned barriers and facilitators for each COMB dimension differed. Motivation factors include such as older adults lacking inner drive and self-denial of being at risk for falls (barriers) and following-up with older adults and correcting inaccurate perceptions of falls and fall-prevention strategies (facilitators). Conclusion: This scoping review revealed gaps and future research areas in fall prevention relative to behavioral changes. These findings may enable tailoring feasible fall-prevention interventions for older adults after transitioning home from acute hospitalization.

Adverse Events and Their Contributors Among Older Adults During Skilled Nursing Stays for Rehabilitation: A Scoping Review

“…The contributors to adverse events among short-stay SNF residents identified herein were similar to those found for older adults participating in fall-prevention strategies after transitioning home from acute hospitalization. 30 The present study validates the importance of identifying individualized resident care plans during short SNF stays for rehabilitation. These intrinsic factors were inevitably related and thus contributed to singular adverse event incidents, such as falls and medication errors, and contributed additively and synergistically to other adverse events.…”

“…22 Previous studies supported the importance of addressing communication and older adults' engagement in individualized care to improve their safety, prevent falls at home, enhance health quality, and promote self-care among community-dwelling older adults. 10,30,33,34…”

Fall prevention education for older people being discharged from hospital: Educators’ perspectives

“…A recent scoping review that used the COM-B framework as an analytical and descriptive guide identified a wide variation in barriers and enablers to older people participating in fall prevention activities after hospital discharge. A key barrier noted was self-denial of personal fall risk and a key enabler was follow-up with the older person post-discharge (Tzeng et al, 2020). A previous crosssectional study in the USA found that although over 90% of patients who were readmitted to hospital within 30 days of discharge understood their discharge plans, more than half reported experiencing difficulty in self-care, and about one-third of them reported a low anticipatory guidance for resolving these issues after discharge (Greysen et al, 2016).…”

Practice What We Preach: Beginning a Journey to Embrace Patient-Centered Outcomes Research

“…The importance of incorporating community engagement in research on fall prevention has been highlighted in the literature [ 3 ]. Engaging patients and families in the fall prevention process during acute hospital stays is associated with a 15% reduction in falls and a 34% reduction in fall-related injuries [ 11 , 12 ].…”

“…Patient-centered outcomes research can occur in diverse settings and include participants from across the care continuum (e.g., health care providers from primary care, secondary or tertiary settings). [ 1 ] One example is to identify the best way for health care providers to overcome obstacles to providing fall prevention education to community-dwelling older patients when they return home from acute hospitalization [ 3 ].…”