Patterns of health service use before and after a statewide fall prevention initiative for older adults at risk of falls.
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ABSTRACT: Objective
To understand health-care burden from fall-related injury, we investigated patterns of health service use in participants of the Australian statewide Stepping On fall prevention program.Methods
Routinely collected ambulance, emergency, hospital and mortality data for 9163 participants across NSW Local Health Districts between 2009 and 2015 were analysed for patterns in fall-related health service use three years before and after the Stepping On program using negative binomial regression analyses.Results
Overall fall-related health service use increased over the 6-year study period. There was a high period of usage prior to program participation, which decreased postprogram, then appeared to increase again after 12-15 months. Subgroup analysis showed strongest postprogram reductions for women.Conclusions
Patterns of service usage suggest initial program benefits that taper off over time. The results of this observational study need to be interpreted with caution. Investment in ongoing fall prevention programs may be needed for lasting impacts.
SUBMITTER: Paul SS
PROVIDER: S-EPMC10946496 | biostudies-literature | 2022 Dec
REPOSITORIES: biostudies-literature
Publications
Patterns of health service use before and after a statewide fall prevention initiative for older adults at risk of falls.
Paul Serene S SS Taylor Jennifer J Tiedemann Anne A Harvey Lara L Clemson Lindy L Lord Stephen R SR Dolja-Gore Xenia X Close Jacqueline C T JCT Sherrington Catherine C
Australasian journal on ageing 20220301 4
<h4>Objective</h4>To understand health-care burden from fall-related injury, we investigated patterns of health service use in participants of the Australian statewide Stepping On fall prevention program.<h4>Methods</h4>Routinely collected ambulance, emergency, hospital and mortality data for 9163 participants across NSW Local Health Districts between 2009 and 2015 were analysed for patterns in fall-related health service use three years before and after the Stepping On program using negative bi ...[more]
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Project description:BackgroundAbout 1 in 3 adults aged 65 and older falls annually. Exercise interventions are effective in reducing the fall risk and fall rate among older adults. In 2020, startup company Age Bold Inc. disseminated the Bold Fall Prevention Program, aiming to reduce falls among older adults through a remotely delivered, digital exercise program.ObjectiveWe conducted a feasibility study to assess the delivery of the Bold Fall Prevention Program remotely and evaluate the program's impact on 2 primary outcomes-annualized fall rate and weekly minutes of physical activity (PA)-over 6 months of follow-up.MethodsOlder adults at high risk of falling were screened and recruited for the feasibility study via nationwide digital advertising strategies. Self-reported outcomes were collected via surveys administered at the time of enrollment and after 3 and 6 months. Responses were used to calculate changes in the annualized fall rate and minutes of PA per week.ResultsThe remote delivery of a progressive digital fall prevention program and associated research study, including remote recruitment, enrollment, and data collection, was deemed feasible. Participants successfully engaged at home with on-demand video exercise classes, self-assessments, and online surveys. We enrolled 65 participants, of whom 48 (74%) were women, and the average participant age was 72.6 years. Of the 65 participants, 54 (83%) took at least 1 exercise class, 40 (62%) responded to at least 1 follow-up survey at either 3 or 6 months, 20 (31%) responded to both follow-up surveys, and 25 (39%) were lost to follow-up. Among all participants who completed at least 1 follow-up survey, weekly minutes of PA increased by 182% (ratio change=2.82, 95% CI 1.26-6.37, n=35) from baseline and annualized falls per year decreased by 46% (incidence rate ratio [IRR]=0.54, 95% CI 0.32-0.90, n=40). Among only 6-month survey responders (n=31, 48%), weekly minutes of PA increased by 206% (ratio change=3.06, 95% CI 1.43-6.55) from baseline to 6 months (n=30, 46%) and the annualized fall rate decreased by 28% (IRR=0.72, 95% CI 0.42-1.23) from baseline to 6 months.ConclusionsThe Bold Fall Prevention Program provides a feasible strategy to increase PA and reduce the burden of falls among older adults.
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Project description:ObjectiveTo test whether high levels of reported pride are associated with subsequent falls.DesignSecondary analysis of the English Longitudinal Study of Ageing (ELSA) dataset.SettingMulti-wave longitudinal sample of non-institutionalised older English adults.ParticipantsELSA cohort of 6415 participants at wave 5 (baseline, 2010/11), of whom 4964 were available for follow-up at wave 7 (follow-up, 2014/15).Main outcome measuresSelf reported pride at baseline (low/moderate/high) and whether the participant had reported having fallen during the two years before follow-up.ResultsThe findings did not support the contention that "pride comes before a fall." Unadjusted estimates indicate that the odds of reported falls were significantly lower for people with high pride levels compared with those who had low pride (odds ratio 0.69, 95% confidence interval 0.58 to 0.81, P<0.001). This association remained after adjustment for age, sex, household wealth, and history of falls (odds ratio 0.81, 0.68 to 0.97, P<0.05). It was partially attenuated after further adjustment for mobility problems, eyesight problems, the presence of a limiting long term illness, a diagnosis of arthritis or osteoporosis, medication use, cognitive function, and pain and depression (odds ratio 0.86, 0.72 to 1.03, P<0.1). Because the confidence interval exceeded 1 in the final model, it remains possible that pride may not be an independent predictor of falls when known risk factors are considered. People with moderate pride did not have lower odds of having fallen than those with low pride in adjusted models. Participants lost to follow-up did not differ from those retained in terms of key variables, and weighting the analyses to account for selective attrition did not produce different results.ConclusionsContrary to the well known saying "pride comes before a fall," these findings suggest that pride may actually be a protective factor against falling in older adults. Future studies may seek to investigate the mechanisms underpinning this relation.
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Project description:AimEye care practitioners are well-placed in the community to provide falls prevention advice to older adults, but existing literature offers scant insight into whether this occurs in practice. This scoping review aimed to map and synthesize the evidence for community eye care practitioners' awareness and behaviors in falls prevention in older adults, as well as barriers and enablers to implementation of falls evidence.MethodsThis review process was guided by the Arksey and O'Malley framework for scoping reviews and PRISMA-ScR guidelines. MEDLINE, CINAHL Complete, Embase, Web of Science and OpenMD were searched for published and gray literature between January 1990 to October 2024. Data were mapped against the World Falls Guidelines framework of: (i) risk stratification, (ii) assessment, and (iii) management, and a barriers and enablers framework.ResultsA total of 19 sources met the inclusion criteria. Few studies directly captured results from eye care practitioners. The results suggested a gap in implementation of falls guideline evidence. Community eye care practitioners had low levels of awareness about falls, and were not routinely implementing falls history taking, risk stratification and assessment of contrast, visual fields, and stereopsis. Eye care practitioners might not be referring patients for exercise and environmental interventions.ConclusionThe evidence suggests that eye care practitioners have some awareness of falls prevention, but might benefit from better understanding of evidence-based falls guidelines. There appeared to be gaps that exist between evidence and translation into practice. Future studies should explore practitioner experiences and implementation efforts to improve falls prevention in community eye care. Geriatr Gerontol Int 2025; 25: 337-345.
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