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Fall Prevention Mobile Clinic: A Novel Fall Prevention Program for Community-Dwelling Older Adults

Published online by Cambridge University Press:  04 September 2018

Sonia Singh ,
Ashley Kwon ,
David G. T. Whitehurst ,
Kathleen Friesen ,
Vicky Scott ,
Samar Hejazi  and
Fabio Feldman
Sonia Singh*
Affiliation:
Fraser Health Authority, Surrey, British Columbia Faculty of Medicine, University of British Columbia, Vancouver
Ashley Kwon
Affiliation:
Fraser Health Authority, Surrey, British Columbia
David G. T. Whitehurst
Affiliation:
Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia
Kathleen Friesen
Affiliation:
Fraser Health Authority, Surrey, British Columbia
Vicky Scott
Affiliation:
Centre for Hip Health and Mobility, University of British Columbia, Vancouver
Samar Hejazi
Affiliation:
Fraser Health Authority, Surrey, British Columbia
Fabio Feldman
Affiliation:
Fraser Health Authority, Surrey, British Columbia Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia
*
†La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Sonia Singh Peace Arch Hospital 15221 Russell Ave. White Rock, BC V4B 2R4 <[email protected]>
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Abstract

Causes of falls in older adults are common, multifactorial, and can lead to significant injury. This before-and-after study evaluated the benefits of a Fall Prevention Mobile Clinic (FPMC) in reducing the risk of falling in older adults in British Columbia, Canada. Four hundred seventy-six participants (average age of 83.6 years) enrolled in the study and were followed for 12 months after attending the FPMC. At 12-month follow-up, the mean percentage uptake of fall prevention recommendations was 48.8 per cent (SD = 25.7%), the Timed Up and Go mobility measure improved from a median of 19.04 seconds to 17.45 seconds and the number of participants falling decreased from 64.8 per cent (in the 12 months before attending the clinic) to 55.6 per cent (in the 12 months after attending the clinic) (p = .012). After attending the FPMC, participants acted on recommendations, improved mobility and decreased their risk of future falls.

Résumé

Chez les personnes âgées, les chutes sont associées à des causes courantes et multifactorielles, et peuvent provoquer des blessures importantes. Cette étude avant-après a évalué les impacts d’une clinique mobile de prévention des chutes (Fall Prevention Mobile Clinic [FPMC]) pour la réduction du risque de chutes chez des personnes âgées de Colombie-Britannique (Canada). Quatre cent soixante-seize participants, dont l’âge moyen était de 83,6 ans, ont pris part à cette étude et ont été suivis pendant 12 mois après leur passage à la FPMC. À leur rendez-vous de suivi de 12 mois, le pourcentage moyen d’adoption des recommandations pour la prévention des chutes était de 48,8 % (ÉT : 25,7 %), la performance au test Timed up and Go (une mesure de mobilité) s’était améliorée, passant d’une médiane de 19,04 s à 17,45 s, et le nombre de participants ayant chuté a diminué, passant de 64,8 % (dans les 12 mois précédant le premier RDV à la clinique) à 55,6 % (au cours des 12 mois suivant le premier RDV à la clinique ; p = 0,012). Le FPMC évalué dans cette étude a fourni des recommandations qui ont été prises en compte par les participants; et qui ont amélioré leur mobilité et diminué leur risque de chutes dans l’année suivante.

Keywords

agingfall preventionmobilityolder adultgeriatricsvieillissementprévention des chutesmobilitépersonnes âgéesgériatrie
Type
Research Note/Note de recherché
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 37 , Issue 4 , December 2018 , pp. 482 - 495
Copyright
Copyright © Canadian Association on Gerontology 2018 

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Footnotes

*

Conflict of interest: Sonia Singh has received small amounts of speaker funding over the last 5 years from Amgen and Novartis pharmaceutical companies totaling less than $5,000. She has also received an unrestricted grant in aid of $10,000 for a research project in 2014. She has no other financial or personal conflicts of interest. All other authors have no financial or personal conflicts of interest.

Author contributions: Sonia Singh is the research project lead and was involved in all aspects of the project from the proposal development, protocol development and implementation, data collection, and analysis. Fabio Feldman was involved in the proposal development, creation of the Fall Prevention Mobile Clinic (FPMC) intervention, protocol development and implementation, data collection, and analysis. Ashley Kwon was involved with the protocol development and implementation, data collection, and analysis. David Whitehurst was involved with data collection and analysis. Kathleen Friesen was the primary knowledge user for the project and was involved in the proposal development, protocol development and creation, and implementation of the FPMC intervention. Vicky Scott was involved with the proposal development, protocol development, data collection, and analysis. Samar Hejazi was involved with the data collection and was the primary data analyst. All authors contributed to the writing and editing of the manuscript and approved the final version for submission.

Sponsor’s Role: Canadian Institute for Health Research (CIHR) was the sole financial sponsor of this project.

References

Barger, S. D. (2002). The Marlowe-Crowne affair: Short forms, psychometric structure, and social desirability. Journal of Personality Assessment, 79(2), 286–305.CrossRefGoogle ScholarPubMed
Barnett, A., Smith, B., Lord, S., Williams, M., & Baumand, A. (2003). Community-based group exercise improves balance and reduces falls in at-risk older people: A randomized controlled trial. Age and Ageing, 32(4), 407–414.CrossRefGoogle Scholar
Bischoff-Ferrari, H. A., Dawson-Hughes, B., Staehelin, H. B., Orav, J. E., Stuck, A. E., Theiler, R., … Henschkowski, J. (2009). Fall prevention with supplemental and active forms of vitamin D: A meta-analysis of randomized controlled trials. British Medical Journal, 339(1), B3692.CrossRefGoogle Scholar
British Columbia Injury Research and Prevention Unit. (2015). The economic burden of injury in British Columbia. Retrieved from http://www.injuryresearch.bc.ca/2015-reports/Google Scholar
Campbell, A. J., Robertson, M. C., Gardner, M. M., Norton, R.N., Tilyard, M.W., & Buchnew, D. M. (1997). Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. British Medical Journal, 315(7115), 1065–1069.CrossRefGoogle ScholarPubMed
Campbell, A. J., Robertson, M. C., La Grow, S. J., Kerse, N. M., Sanderson, G. F., Jacobs, R. J., … & Hale, L. A. (2005). Randomised controlled trial of prevention of falls in people aged ≥75 with severe visual impairment: The VIP trial. British Medical Journal, 331(7520), 817–825.CrossRefGoogle Scholar
Canadian Institute for Health Information. (2014). Preventing falls: From evidence to improvement in Canadian Health Care. Retrieved from https://secure.cihi.ca/estore/productFamily.htm?pf=PFC2707&lang=en&media=0Google Scholar
Centers for Disease Control and Prevention. (2014). Data & statistics (WISQARS): Cost of injury report [Data file]. Retrieved from https://wisqars.cdc.gov:8443/costT/Google Scholar
Choi, M., & Hector, M. (2012). Effectiveness of intervention programs in preventing falls: A systematic review of recent 10 years and meta-analysis. The Journal of Post-Acute and Long-Term Care Medicine, 13, 13–21.Google ScholarPubMed
Clemson, L., Fiatarone Singh, M. A., Bundy, A., Cumming, R. G., Manollaras, K., O’Loughlin, P., & Black, D. (2012). Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): Randomised parallel trial. British Medical Journal (Clinical Research Ed), 345(4547), 1–15.Google ScholarPubMed
Close, J., Ellis, M., Hooper, R., Glucksman, E., Jackson, S., & Swift, C. (1999). Prevention of falls in the elderly trial (PROFET): A randomised controlled trial. Lancet, 353(9147), 93–97.CrossRefGoogle ScholarPubMed
Conroy, S., Kendrick, D., Harwood, R., Gladman, J., Coupland, C., Sach, T., … Masud, T. (2010). A multicentre randomized controlled trial of day hospital-based falls prevention programme for a screened population of community-dwelling older people at high risk of falls. Age and Ageing, 39, 704–710.CrossRefGoogle ScholarPubMed
Cumming, R. (2000). Injury epidemiology and older people: Counting and analysing data on falls. Australasian Epidemiologist, 7, 10–12.Google Scholar
Cumming, R. G., Thomas, M., Szonyi, M., Salked, G., O’Neill, E., Westbury, C., & Frampton, G. (1999). Home visits by an occupational therapist for assessment and modification of environmental hazards: A randomized trial of falls prevention. Journal of the American Geriatric Society, 47(12), 1397–1402.CrossRefGoogle ScholarPubMed
Del-Pino-Casado, R., Obrero-Gaitan, E., & Lomas-Vega, R. (2016). The effect of tai chi on reducing the risk of falling: A systematic review and meta-analysis. The American Journal of Chinese Medicine, 44(5), 895–906.CrossRefGoogle ScholarPubMed
Donaldson, M. G., Khan, K. M., Davis, J. C., Salter, A. E., Buchanan, J., McKnight, D., … McKay, H. A. (2005). Emergency department fall-related presentations do not trigger fall risk assessment: A gap in care of high-risk outpatient fallers. Archives of Gerontology and Geriatrics, 41(3), 311–317.CrossRefGoogle Scholar
Fisher, R. J. (1993). Social desirability bias and the validity of indirect questioning. Journal of Consumer Research, 20, 303–315.CrossRefGoogle Scholar
Fitzharris, M. P., Day, L., Lord, S. R., Gordon, I., & Fildes, B. (2010). The Whitehorse no falls trial: Effects on fall rates and injurious fall rates. Age and Ageing, 39, 728–733.CrossRefGoogle ScholarPubMed
Fortinsky, R. H., Iannuzzi-Sucich, M., Baker, D. I., Gottschalk, M. G., King, M. B., Brown, C. J., & Tinetti, M. E. (2004). Fall-risk assessment and management in clinical practice: Views from healthcare providers. Journal of the American Geriatrics Society, 52, 1522–1526.CrossRefGoogle ScholarPubMed
Fraser Health Authority. (2015). Fraser Health: Funded assisted living handbook. Retrieved from https://www.fraserhealth.ca/-/media/Project/FraserHealth/FraserHealth/Health-Topics/Home-and-community-care/AssistedLivingHandbook.pdf?la=en&hash=C3F7B14B80DAC12604E59707A9FC32B4B297243AGoogle Scholar
Fuzhong, L., Harmer, P., & Fitzgerald, K. (2016). Implementing an evidence-based fall prevention intervention in the community senior centers. American Journal of Public Health, 106(11), 2026–2031.Google Scholar
Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherington, C., Gates, S., Clemson, L. M., & Lamb, S. E. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2012 (9). Article no. CD007146. doi: 10.1002/14651858.CD007146.pub3CrossRefGoogle Scholar
Hendrie, D., Hall, S. E., Arena, G., & Legge, M. (2004). Health system costs of falls of older adults in Western Australia. Australian Health Review, 28(3), 363–373.CrossRefGoogle ScholarPubMed
Hill, K. D., Moore, K. J., Dorevitch, M. I., & Day, L.M. (2008). Effectiveness of falls clinics: An evaluation of outcomes and client adherence to recommended interventions. Journal of the American Geriatric Society, 56, 600–608.CrossRefGoogle ScholarPubMed
Hofheinz, M., & Schusterschitz, C. (2010). Dual task interference in estimating the risk of falls and measuring change: A comparative, psychometric study of four measurements. Clinical Rehabilitation, 24(9), 831–842.CrossRefGoogle ScholarPubMed
Howland, J., Lachman, M. E., Peterson, E. W., Cote, J., Kasten, L., & Jette, A. (1998). Covariates of fear of falling and associated activity curtailment. Gerontologist, 38(5), 549–555.CrossRefGoogle ScholarPubMed
Howland, J., Peterson, E. W., Levin, W. C., Fried, L., Porodon, D., & Bak, S. (1993). Fear of falling among the community-dwelling elderly. Journal of Aging Health, 5(2), 229–243.CrossRefGoogle ScholarPubMed
Huang, Z.-G., Feng, Y.-H., Li, Y.-H., & Lv, C.-S. (2017). Systematic review and meta-analysis: Tai chi for preventing falls in older adults. British Medical Journal Open, 7, 1–9.Google ScholarPubMed
Kemmler, W., von Stengel, S., Engelke, K., Haberle, L., & Kalender, W. A. (2010). Exercise effects on bone mineral density, falls, coronary risk factors, and health care costs in older women: The randomized controlled senior fitness and prevention (SEFIP) study. Archives of Internal Medicine, 170(2), 179–185.CrossRefGoogle Scholar
Liu-Ambrose, T., Davis, J. C., Hsu, C. L., Gomez, C., Vertes, K., Marra, C., … Dian, L. (2015). Action seniors! - secondary falls prevention in community-dwelling senior fallers: Study protocol for a randomized controlled trial. Trials, 16, 144.CrossRefGoogle ScholarPubMed
Logan, P. A., Coupland, C. A., Gladman, J. R., Sahota, O., Stoner-Hobbs, V., Robertson, K., … Avery, A. J. (2010). Community falls prevention for people who call an emergency ambulance after a fall: Randomised controlled trial. British Medical Journal: Clinical Research Edition, 340, 2102–2109.CrossRefGoogle ScholarPubMed
Lord, S., & Castell, S. (1994). Physical activity program for older people: Effect on balance, strength, neuromuscular control, and reaction time. Archives of Physical Rehabilitation, 75, 648–652.CrossRefGoogle ScholarPubMed
Lord, S., Clark, R., & Webster, I. (1991). Physiological factors associated with falls in an elderly population. Journal of the America Geriatric Society, 39, 1194–1200.CrossRefGoogle Scholar
Lord, S. R., Menz, H. B., & Tiedemann, A. (2003). A physiological profile approach to falls risk assessment and prevention. Physical Therapy, 83(3), 237–25.Google ScholarPubMed
Lord, S., Sherrington, C., & Menz, H. (2000). Falls in older people: Methodological considerations. Australasian Epidemiologist, 7, 13–17.Google Scholar
Lord, S. R., Tiedemann, A., Chapman, K., Munro, B., Murray, S. M., & Sherrington, C. (2005). The effect of an individualized fall prevention program on fall risk and falls in older people: A randomized, controlled trial. Journal of the American Geriatrics Society, 53, 1296–1304.CrossRefGoogle ScholarPubMed
Lord, S. R., & Ward, J. A. (1994). Age associated differences in sensory-motor function and balance in community dwelling women. Age and Ageing, 23, 452–460.CrossRefGoogle Scholar
Lord, S., Ward, J., & Williams, P. (1994). Physiological factors associated with falls in older community-dwelling women. Journal of the American Geriatric Society, 42, 1110–1117.CrossRefGoogle ScholarPubMed
Moore, M., Williams, B., Ragsdale, S., LoGerfo, J. P., Goss, J. R., Schreuder, A. B., & Phelan, E. A. (2010). Translating a multifactorial fall prevention intervention into practice: A controlled evaluation of a fall prevention clinic. Journal of the American Geriatrics Society, 58, 357–363.CrossRefGoogle ScholarPubMed
Murad, M. H., Elamin, K. B., Elnour, N. O. A., Elamin, M. B., Alkatib, A. A., Fatourechi, M.M., … Montori, V. M. (2011). The effect of vitamin D on falls: A systematic review and meta-analysis. Journal of Clinical Endocrinal Metabolism, 96(10), 2997–3006.CrossRefGoogle ScholarPubMed
Nasreddine, Z., Phillips, N., Bedirian, V., Charbonneau, S., Whitehead, V., Collin, I., … Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatric Society, 53, 695–699.CrossRefGoogle ScholarPubMed
Nolte, S., Elsworth, G., & Osborne, R. (2013). Absence of social desirability bias in the evaluation of chronic disease self-management interventions. Health and Quality of Life Outcomes, 11, 114–122.CrossRefGoogle ScholarPubMed
Palvanen, M., Kannus, P., Piirtola, M., Niemi, S., Parkkari, J., & Jarvinen, M. (2014). Effectiveness of the Chaos Falls Clinic in preventing falls and injuries of home-dwelling older adults: A randomised controlled trial. Injury, 45(1), 265–271.CrossRefGoogle ScholarPubMed
Parachute. (2015). Cost of injury [Data file]. Retrieved from http://www.parachutecanada.org/downloads/research/CostofInjury-2015.pdfGoogle Scholar
Pighills, A. C., Torgerson, D. J., Sheldon, T. A., Drummond, A. E., & Bland, J. M. (2011). Environmental assessment and modification to prevent falls in older people. Journal of the American Geriatrics Society, 59(1), 26–33.CrossRefGoogle ScholarPubMed
Public Health Agency of Canada. (2014). Seniors’ falls in Canada: Second report 2014 [Data file]. Ottawa, ON: Government of Canada. Retrieved from http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/index-eng.php#iGoogle Scholar
Ringe, J. D. (2012). The effect of Vitamin D on falls and fractures. Scandinavian Journal of Clinical and Laboratory Investigation, 72, 73–78.Google Scholar
Rydwik, E., Bergland, A., Forsen, L., & Frandin, K. (2011). Psychometric properties of Timed Up and Go in elderly people: A systematic review. Physical & Occupational Therapy in Geriatrics, 29(2), 102–125.CrossRefGoogle Scholar
Salter, A. E., Khan, K. M., Donaldson, M. G., Davis, J. C., Buchanan, J., Abu-Laban, R. B., … McKay, H. A. (2006). Community-dwelling seniors who present to the emergency department with a fall do not receive guideline care and their fall risk profile worsens significantly: A 6-month prospective study. Osteoporosis International, 17(5), 672–683.CrossRefGoogle Scholar
Sampaio, N. R., Rosa, N. M. D. B., Godoy, A. P. S., Pereira, D. S., Hicks, C., Lord, S. R., & Pereira, L. S. M. (2014). Reliability evaluation of the physiological profile assessment to assess fall risk in older people. Journal of Gerontology & Geriatric Research, 3(5), 179–182.Google Scholar
Sanders, K. M., Hayles, A. L., Kotowicz, M. A., & Nicholson, G. C. (2009). Monitoring falls in cohort studies of community-dwelling older women. Journal of the American Geriatrics Society, 57(4), 733–734.CrossRefGoogle ScholarPubMed
Sanders, K. M., Stuart, A. L., Williamson, E. J., Simpson, J. A., Kotowicz, M. A., Young, D., & Nicholson, G. C. (2010). Annual high-dose oral vitamin D and falls and fractures in older women. Journal of the American Medical Association, 303(18), 1815–1822.CrossRefGoogle ScholarPubMed
Scuffman, P., Chaplin, C., & Legood, R. (2003). Incidence and costs of unintentional falls in older people in the United Kingdom. Journal of Epidemiology and Community Health, 57, 740–744.Google Scholar
Shaw, F. E, Bond, J., Richardson, D. A., Dawson, P., Steen, I. N., McKeith, I. G., & Kenny, R. (2003). Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: Randomised control trial. British Medical Journal, 326(7380), 73–75.CrossRefGoogle Scholar
Shuler, F. D., Schlierf, T., & Wingate, M. (2014). Preventing falls with Vitamin D. West Virginia Medical Journal, 110(3), 10–12.Google ScholarPubMed
Shumway-Cook, A., Brauers, S., & Woolacott, M. (2000). Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go test. Physical Therapy, 80(9), 896–906.Google ScholarPubMed
Shumway-Cook, A., Ciol, M. A., Hoffman, J., Dudgeon, B. J., Yorkston, K., & Chan, L. (2009). Falls in the Medicare population: Incidence, associated factors, and impact on healthcare. Journal of the American Physical Therapy Association, 89(4), 324–332.Google Scholar
Sibley, K. M., Voth, J., Munce, S. E., Straus, S. E., & Jaglal, S. B. (2014). 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. BMC Geriatrics, 14(22), 1–11.CrossRefGoogle ScholarPubMed
Speechley, M., & Tinetti, M. (1991). Falls and injuries in frail and vigorous community elderly persons. Journal of American Geriatric Society, 39(1), 46–52.CrossRefGoogle ScholarPubMed
Stevens, J. A., & Burns, E. R. (2015). A CDC compendium of effective fall interventions: What works for community-dwelling older adults (3rd ed.). Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.Google Scholar
Tinetti, M. E., Doucette, J., Claus, E., & Marottoli, R. (1995). Risk factors for serious injury during falls by older persons in the community. Journal of the American Geriatric Society, 43, 1214–1221.CrossRefGoogle Scholar
Whitehead, C., Wundke, R., Crotty, M., & Finucane, P. (2003). Evidence-based clinical practice in falls prevention: A randomised controlled trial of a falls prevention service. Australian Health Review, 26(3), 88–96.CrossRefGoogle ScholarPubMed
Whitney, J. C., Lord, S. R., & Close, J. C. (2005) Streamlining assessment and intervention in a falls clinic using the Timed Up and Go test and physiological profile assessments. Age and Ageing, 34(6), 567–571.CrossRefGoogle Scholar
Wijlhuizen, G. J., Du Bois, P., Van Dommelen, P., & Hopman-Rock, M. (2007). Effect evaluation of a multifactor community intervention to reduce falls among older persons. International Journal of Injury Control and Safety Promotion, 14(1), 25–33.CrossRefGoogle ScholarPubMed
Woolcott, J. C., Khan, K. M., Mitrovic, S., Anis, A. H., & Marra, C. A. (2011). The cost of fall related presentations to the ED: A prospective, in-person, patient-tracking analysis of health resource utilization. Osteoporosis International, 23, 1513–1519.CrossRefGoogle ScholarPubMed
World Health Organization. (2007). Falls facts sheet. Geneva, CHE: Author. Retrieved from http://www.who.int/mediacentre/factsheets/fs344/en/Google Scholar
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