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

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 67; no. 11; pp. 2274 - 2281
• Main Authors: Naseri, Chiara, McPhail, Steven M., Haines, Terrence P., Morris, Meg E., Etherton‐Beer, Christopher, Shorr, Ronald, Flicker, Leon, Bulsara, Max, Netto, Julie, Lee, Den‐Ching A., Francis‐Coad, Jacqueline, Waldron, Nicholas, Boudville, Amanda, Hill, Anne‐Marie
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.11.2019; Wiley Subscription Services, Inc
• Subjects: Accidental Falls - prevention & control; Accidental Falls - statistics & numerical data; Activities of Daily Living; Adults; Aged; Australia - epidemiology; Cognitive ability; Cognitive Behavioral Therapy - methods; evaluation studies; Exercise Therapy - methods; fall prevention; Falls; Female; Follow-Up Studies; health behavior change; Health risk assessment; Hospitalization; Humans; Incidence; Injury prevention; Inpatients - statistics & numerical data; Male; Middle Aged; New Zealand - epidemiology; Older people; patient discharge; Patient Education as Topic - methods; Practice Guidelines as Topic - standards; Prevention; Rehabilitation; Retrospective Studies; New Zealand; Australia; evaluation studies; hospitalization; patient discharge; fall prevention; health behavior change
• DOI: 10.1111/jgs.16053
• ISSN: 0002-8614

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