Falls and fall prevention programmes in developing countries: environmental scan for the adaptation of the Canadian Falls prevention curriculum for developing countries

Problem

Falls in older persons in developing countries are poorly understood, and falls prevention and health promotion programmes for this population are largely lacking.

Methods

A systematic review was carried out of relevant literature on falls and prevention programmes, and falls prevention education, and a scan undertaken of health promotion programmes for older persons in a representative country - South Africa.

Results

Studies on the risk and prevalence of falls are largely retrospective and hospital-based, with varied methodology, including study period, sampling method and sample size. Falls prevalence is based largely on self-reports in studies on general trauma in all age groups. Falls incidence varies from 10.1% to 54%. No reports could be traced on sustained falls prevention or health promotion programmes.

Conclusion

Scant research has been conducted and little preventive education offered on falls in older persons. Adaptation of the Canadian Falls Prevention Curriculum for developing countries will help to fill gaps in knowledge and practice.

Impact on industry

With rapid increase in the populations of older persons in developing countries, research on age related disorders such as falls is required to guide policy and management of falls.     

Implementing the evidence for preventing falls among community-dwelling older people: a systematic review

Problem and objective

The translation of the evidence-base for preventing falls among community-dwelling older people into practice has been limited. This study systematically reviewed and synthesised the effectiveness of methods to implement falls prevention programmes with this population.

Methods

Articles published between 1980 and May 2010 that evaluated the effects of an implementation strategy. No design restrictions were imposed. A narrative synthesis was undertaken.

Results

15 studies were identified. Interventions that involved the active training of healthcare professionals improved implementation. The evidence around changing the way people who fall are managed within primary care practices, and, layperson, peer or community delivered models was mixed.

Impact on industry

Translating the evidence-base into practice involves changing the attitudes and behaviours of older people, healthcare professionals and organisations. However, there is a need for further evaluation on how this can be best achieved.     

Road safe seniors: Screening for age-related driving disorders in inpatient and outpatient settings

Introduction

Older drivers are increasing in number and they often have health conditions that place them at high risk for motor-vehicle crashes (MVC). Screening is underutilized, and is rarely done in hospital settings.

Methods

A convenience sample of 755 older adults completed age related driving disorders screening at University of California, San Diego inpatient and outpatient health centers. Screening included three strength/frailty tests, two vision tests (acuity and fields), and two cognitive tests, based on AMA recommendations. The average age of participants was 72.5; 55.5% were male and 94% English-speaking; 17.8% of older adults failed at least one aspect of screening.

Results

In multivariate analysis, significant associations of failed status were age, male sex, selfrestrictions of driving, and inpatient screening locations. The screening identified one in six adults to be 'high-risk' for age related driving disorders. Screening was effective and feasible in both inpatient and outpatient settings.

Impact on industry

As the driving population ages, industry, government and health car providers need to plan for the management of driving impairments in older adults.     

Increasing self-awareness among older drivers: The role of self-screening

Introduction

Self-screening by older drivers has shown considerable promise for increasing self-awareness about functional abilities associated with safe driving. The purpose of this study was to improve upon existing self-screening instruments by focusing entirely on “health concerns” that affect driving - that is, the symptoms that people experience due to medical conditions and the medications used to treat them - rather than the medical conditions or medications themselves.

Method

A computer-based, easy-to-use self-screening instrument for older drivers was developed to provide individualized feedback intended to increase self-awareness about declines in driving-related abilities, as well as suggestions for behavioral changes or safety tips to maintain safe driving, further evaluation from a physician/health professional, and vehicle modifications to help compensate for driving-related declines.

Results

This paper describes the development of the self-screening instrument and summarizes findings relative to increasing self-awareness among older drivers. This research represents an important first step in improving self-awareness among older drivers through self-screening.     

When evidence is not enough: the challenge of implementing fall prevention strategies

Problem

As the evidence-based movement has advanced in public health, changes in public health practices have lagged far behind creating a science to service gap. For example, science has produced effective falls prevention interventions for older adults. It now is clearer WHAT needs to be done to reduce injury and death related to falls. However, issues have arisen regarding HOW to assure the full and effective uses of evidence-based programs in practice.

Summary

Lessons learned from the science and practice of implementation provide guidance for how to change practices by developing new competencies, how to change organizations to support evidence-based practices, and how to change public health systems to align system functions with desired practices. The combination of practice, organization, and system change likely will produce the public health benefits that are the promise of evidence-based falls prevention interventions.

Impact on public health

For the past several decades, the emphasis has been solely on evidence-based interventions. Public health will benefit from giving equal emphasis to evidence-based implementation.

Impact on Industry

We now have over two decades of research on the effectiveness of fall prevention interventions. The quality of this research is judged by a number of credible international organizations, including the Cochrane Collaboration (http://www.cochrane.org/), the American and British Geriatrics Societies, and the Campbell Collaboration (http://www.campbellcollaboration.org/). These international bodies were formed to ponder and answer questions related to the quality and relevance of research. These developments are a good first step. However, while knowing WHAT to do (an evidence-based intervention) is critical, we also need to know HOW to effectively implement the evidence. Implementation, organization change, and system change methods produce the conditions that allow and support the full and effective use of evidence-based interventions. It is time to focus on utilization of implementation knowledge in public health. Without this focus the vast amount on new evidence being generated on the prevention of falls and related injuries among older adults will have little impact on their health and safety.     

Deprived neighborhoods and risk of road trauma (incidence and severity) among under 25year-olds in the Rhône Département (France)

Introduction

Previous research has shown that there are inequalities with regard to traffic accident risk between different social categories. This study describes the influence of the type of residential municipality (with or without deprived urban areas, “ZUS, zones urbaines sensibles”), used as an indicator of contextual deprivation, on the incidence and severity of road trauma involving people of under 25 years of age in the Rhône.

Method

Injury data were taken from The Rhône Road Trauma Registry. The study covers the 2004–2007 period, with 13,589 young casualties. The incidence of traffic injury of all severities were computed according to the type of municipality and the age, gender, and type of road user. The ratios of the incidences of deprived municipalities, compared with others were calculated. Subsequently the severity factors and incidences according to the severity level (ISS 1–8, ISS 9+) were studied.

Results

For the main types of road users except motorized two-wheeler users, the incidences were higher in the deprived municipalities: the greatest difference was for pedestrians, where the incidences were almost twice those of other municipalities. This excess risk, constituting a health inequality topic rarely considered, was even greater in municipalities with two or three ZUSs. It was essentially observed for minor injuries among motorists, cyclists, and pedestrians.

Conclusions

While the incidence increased among people less than 25 years of age, the severity of road injuries was lower in deprived neighborhoods, contrary to what is suggested by other studies. This lower severity disappeared when taking into account the crash characteristics.

Impact on industry

The incidence of injuries as a pedestrian, cyclist or motorist is higher among young people living in deprived municipalities. These areas should therefore be the targets of dedicated education programs, as well as further investigations about urban planning.     

Validating an evidence-based, self-rated fall risk questionnaire (FRQ) for older adults

Background

Falls are a common, serious, and often unrecognized problem facing older adults. The objective of this study was to provide an initial clinical and statistical validation for a public health strategy of fall risk self-assessment by older adults using a Fall Risk Questionnaire (FRQ).

Methods

Adults age 65 + (n = 40) were recruited at a Los Angeles Veterans Affairs (VA) medical facility and at a local assisted living facility. Participants completed the FRQ self-assessment and results were compared to a “gold standard” of a clinical evaluation of risks using the American/British Geriatrics Society guidelines to assess independent predictors of falls: history of previous falls, fear of falling, gait/balance, muscle weakness, incontinence, sensation and proprioception, depression, vision, and medications. For the comparison, we used an iterative statistical approach, weighing items based on relative risk.

Results

There was strong agreement between the FRQ and clinical evaluation (kappa = .875, p < .0001). Individual item kappa values ranged from .305-.832. After dropping one FRQ item (vision risk) because of inadequate agreement with the clinical evaluation (kappa = .139, p = .321), the final FRQ had good concurrent validity.

Conclusions

The FRQ goes beyond existing screening tools in that it is based on both evidence and clinical acceptability and has been initially validated with clinical examination data. A larger validation with longitudinal follow-up should determine the actual strength of the FRQ in predicting future falls.     

Driving exposure by driver age in Michigan

Background

This study compared driving exposure between two high-crash-risk groups (16–17 and 18-24-year-olds), with a low-crash-risk group (35-64-year-olds). In addition, patterns of association between driving exposure measures and demographic and driving behavior variables were examined.

Methods

Respondent's total miles, minutes, and trips driven were calculated within a 48-hour period, using state-wide survey data collected in 2004 and 2005.

Results

The youngest drivers drove fewer miles and minutes, but a comparable number of trips as the two older groups. Employment and high vehicle access were associated with greater driving exposure for 16-17-year-olds and 18-24-year-olds. Employment, high household income, large household size, and low vehicle access were associated with greater driving exposure for 35-64-year-olds. More driving was done alone than with passengers present and during the day than at night across all ages. There was a positive association between two driving exposure measures (miles and minutes driven) and demographic and driving behavior variables, which did not extend to trips driven.

Discussion

Driving exposure is directly related to stage of life. The entire sample of 16-17-year-old respondents were in high school, which directly influenced their driving times, destinations, and purpose. Those aged 18–24 years displayed driving behavior patterns that were closer to the older drivers, while retaining some differences. The oldest drivers were likely to be shouldering the greatest household responsibilities, and their greater driving exposure may reflect this reality.

Impact on industry

These findings provide new information about driving exposure for two high-risk and one low-risk group of drivers. They also raise concern over potential workplace safety issues related to teens’ higher driving exposure, and concomitant crash risk, related to being employed. Future research should examine this issue more carefully so that evidence based recommendations can be made to enhance the safety of teens who are employed, especially those who are employed as drivers.     

Translation of falls prevention knowledge into action in hospitals: what should be translated and how should it be done?

Introduction

Falls prevention evidence has changed and evolved over time with positive and negative studies revealing that a “one-size fits all” approach is not the solution. Care must be taken to critically appraise the evidence and the potential applicability of that evidence to the specific hospital setting.

Method

A narrative account of the evolution of research evidence in this field is first presented. How this evidence should be applied in clinical practice is challenging, with a lack of translational evidence for the hospital setting we draw on broader theory of translating knowledge to action.

Conclusions

The journey should begin with formation of a management and engagement committee. A review of existing practices and the difference between existing practice and evidence-based practice should be undertaken to identify the “evidence-practice gap.” Engagement with staff is recommended to inform a plan for practice change. Plans for resourcing, targeting, and evaluating these strategies should also be undertaken.

Impact on Industry

This paper will assist hospitals to identify and implement evidence based falls prevention strategies leading to an improvement in patient safety.     

The impact of the BP Baker report

Introduction

This study examined the impact of the British Petroleum (BP) Baker Panel Report, reviewing the March 2005 BP-Texas City explosion, on the field of process safety.

Method

Three hundred eighty-four subscribers of a process safety listserv responded to a survey two years after the BP Baker Report was published.

Results

Results revealed respondents in the field of process safety are familiar with the BP Baker Report, feel it is important to the future safety of chemical processing, and believe that the findings are generalizable to other plants beyond BP-Texas City. Respondents indicated that few organizations have administered the publicly available BP Process Safety Culture Survey. Our results also showed that perceptions of contractors varied depending on whether respondents were part of processing organizations (internal perspective) or government or consulting agencies (external perspective).

Conclusions

This research provides some insight into the beliefs of chemical processing personnel regarding the transportability and generalizability of lessons learned from one organization to another.

Impact on Industry

This study has implications for both organizational scientists and engineers in that it reveals perceptions about the primary mechanism used to share lessons learned within one industry about one major catastrophe (i.e., investigation reports). This study provides preliminary information about the perceived impact of a report such as this one.     

What does it mean to transform knowledge into action in falls prevention research? Perspectives from the Canadian Institutes of Health Research

Introduction

The concept of knowledge translation as defined by the Canadian Institutes for Health Research and the Knowledge to Action Cycle, described by Graham et al (Graham et al., 2006), are used to make a case for the importance of using a conceptual model to describe moving knowledge into action in the area of falls prevention.

Method

There is a large body of research in the area of falls prevention. It would seem that in many areas it is clear what is needed to prevent falls and further syntheses can determine where the evidence is sufficiently robust to warrant its implementation as well as where the gaps are that require further basic research.

Conclusion

The phases of the action cycle highlight seven areas that should be paid attention to in order to maximize chances of successful implementation.     

Using the RE-AIM framework to translate a research-based falls prevention intervention into a community-based program: lessons learned

Problem

Exercise-based research interventions demonstrate reduced risk and rates of falls for community dwelling older adults; however, little is known about effective mechanisms for the translation, implementation, and maintenance of these interventions in community settings.

Method

The RE-AIM framework was used to assess the translatability of an effective exercise-based research intervention in a community setting. Questions included: Reach — Would the target population attend? Effectiveness — What was the adherence and compliance to the program? Were there individual improvements in falls risk factors? Adoption: Would staff at the center adopt the program and offer it past the funding period? Implementation — What adaptations, including optimal frequency and duration, should be made to meet the community needs, still adhere to core elements and achieve similar outcomes? Maintenance — Would the program be sustained by our community partners?

Discussion

The process of translating a controlled research intervention targeting older adults at risk of falls into a community setting was challenging. Licensed professionals developed the infrastructure to safely and effectively deliver the program. The end product was highly appealing program to our target audience, resulted in improved outcomes and was successfully adopted and maintained by the community partner.

Summary

Partnerships between community and healthcare providers are key to successful implementation of falls prevention interventions. Lessons learned from this experience can be applied to the translation of future exercise-based falls prevention interventions.     

The National Falls Free™ Initiative, working collaboratively to affect change

Introduction

Since 2004 the National Council on Aging (NCOA) has been working in collaboration with a growing number of national, state, and local organizations through the Falls Free^© Initiative to address the growing public health issue of falls and fall-related injuries among older adults. Through collaborative leadership, evidence-based interventions, practical lifestyle adjustments, and community partnerships we are working to reduce the number of older adult falls.

Impact on industry

The many activities of the national and state coalitions have brought recognition to the issue of fall prevention, education, and training to providers and greater investment in programs and services resulting in tremendous momentum and community activism. While we have yet to realize an impact on rates of falls, this strategic investment in building the infrastructure needed to affect change is the first step toward reducing the growing number of falls among older adults.     

Evaluating repeated patient handling injuries following the implementation of a multi-factor ergonomic intervention program among health care workers

Objective

The objective of this study was to evaluate repeated patient handling injuries following a multi-factor ergonomic intervention program among health care workers.

Methods

This was a quasi-experimental study which had an intervention group and a non-randomized control group. Data were collected from six hospitals in Saskatchewan, Canada from September 1, 2001 to December 1, 2006.

Results

A total of 1,480 individuals who had a previous injury were eligible for the study. Medium and small size hospitals in the intervention group had significantly fewer repeated injuries than in the control group. Multivariate analysis showed that the intervention group had 38.1% lower odds of having repeated injury compared to the control group, after adjusting for hospital size.

Conclusions

The work-related repeated injury after a multi-factor intervention program was reduced. The synergistic relationships between components of multi-factor intervention and applicability of injury prevention programs to different settings need to be further explored.

Impact on Industry

Implementing a multi-factor program with the right equipment and training can lower the risk of injury among health care workers.     

The effects of minimum legal drinking age 21 laws on alcohol-related driving in the United States

Objective

To examine trends in alcohol consumption and alcohol-related crashes among people younger than 21 in the United States and to review evidence on the effects of minimum legal drinking age (MLDA) laws.

Methods

Trends in alcohol-related crashes and alcohol consumption among young people were examined, and studies on the effects of lowering and raising the drinking age were reviewed.

Results

MLDA laws underwent many changes during the 20th century in the United States. Since July 1988, the MLDA has been 21 in all 50 states and the District of Columbia. Surveys tracking alcohol consumption among high school students and young adults found that drinking declined since the late 1970 s, and most of the decline occurred by the early 1990 s. These were the years when states were establishing, or reinstating, a MLDA-21. Among fatally injured drivers ages 16-20, the percentage with positive BACs declined from 61% in 1982 to 31% in 1995, a bigger decline than for older age groups; declines occurred among the ages directly affected by raising MLDAs (ages 18-20) and among young teenagers not directly affected (ages 16-17). Almost all studies designed specifically to gauge the effects of drinking age changes show MLDAs of 21 reduce drinking, problematic drinking, drinking and driving, and alcohol-related crashes among young people. Yet many underage people still drink, many drink and drive, and alcohol remains an important risk factor in serious crashes of young drivers, especially as they progress through the teenage years. Stepped-up enforcement of MLDA and drinking and driving laws can reduce underage drinking. Recent efforts to lower MLDAs to 18 and issue licenses to drink upon completion of alcohol education have gained local and national media attention. There is no evidence that alcohol education can even partially replace the effect of MLDA-21.

Conclusions

The cause and effect relationship between MLDAs of 21 and reductions in highway crashes is clear. Initiatives to lower the drinking age to 18 ignore the demonstrated public health benefits of MLDAs of 21.

Impact on Industry

Lowering the drinking age to 18 will increase highway crash deaths among young people.     

Reducing fall risk by improving balance control: development, evaluation and knowledge-translation of new approaches

Problem

Falling is a leading cause of serious injury, loss of independence, and nursing-home admission in older adults. Impaired balance control is a major contributing factor.

Methods

Results from our balance-control studies have been applied in the development of new and improved interventions and assessment tools. Initiatives to facilitate knowledge-translation of this work include setting up a new network of balance clinics, a research-user network and a research-user advisory board.

Results

Our findings support the efficacy of the developed balance-training methods, balance-enhancing footwear, neuro-prosthesis, walker design, handrail-cueing system, and handrail-design recommendations in improving specific aspects of balance control.

Impact on Knowledge Users

A new balance-assessment tool has been implemented in the first new balance clinic, a new balance-enhancing insole is available through pharmacies and other commercial outlets, and handrail design recommendations have been incorporated into 10 Canadian and American building codes. Work in progress is expected to have further impact.     

Gasoline prices and traffic safety in Mississippi

Problem

Limited literature suggests that gasoline prices have substantial effects on reducing fatal crashes. However, the literature focuses only on fatal crashes and does not examine the effects on all traffic crashes.

Methods

Mississippi traffic crash data from April 2004–December 2008 from the Mississippi Highway Patrol and regular-grade unleaded gasoline price data from the Energy Information Administration of the U.S. Department of Energy were used to investigate the effects of gasoline prices on traffic safety by age, gender, and race.

Results

Gasoline prices have both short-term and intermediate-term effects on reducing total traffic crashes and crashes of females, whites, and blacks. The intermediate-term effects are generally stronger than the short-term effects. Gasoline prices also have short-term effects on reducing crashes of younger drivers and intermediate-term effects on older drivers and male drivers.

Impact on Industry

Higher gasoline taxes reduce traffic crashes and may result in additional societal benefits.     

A framework for evaluating OSH program effectiveness using leading and trailing metrics

Introduction

Many employers and regulators today rely primarily on a few past injury/ illness metrics as criteria for rating the effectiveness of occupational safety and health (OSH) programs. Although such trailing data are necessary to assess program success, they may not be sufficient for developing proactive safety, ergonomic, and medical management plans.

Methods

The goals of this pilot study were to create leading metrics (company self-assessment ratings) and trailing metrics (past loss data) that could be used to evaluate the effectiveness of OSH program elements that range from primary to tertiary prevention. The main hypothesis was that the new metrics would be explanatory variables for three standard future workers compensation (WC) outcomes in 2003 (rates of total cases, lost time cases, and costs) and that the framework for evaluating OSH programs could be justifiably expanded. For leading metrics, surveys were developed to allow respondents to assess OSH exposures and program prevention elements (management leadership/ commitment, employee participation, hazard identification, hazard control, medical management, training, and program evaluation). After pre-testing, surveys were sent to companies covered by the same WC insurer in early 2003. A total of 33 completed surveys were used for final analysis. A series of trailing metrics were developed from 1999-2001 WC data for the surveyed companies. Data were analyzed using a method where each main 2003 WC outcome was dichotomized into high and low loss groups based on the median value of the variable. The mean and standard deviations of survey questions and 1999-2001 WC variables were compared between the dichotomized groups. Hypothesis testing was performed using F-test with a significance level 0.10.

Results/Discussion

Companies that exhibited higher musculoskeletal disorder (MSD) WC case rates from 1999-2001 had higher total WC case rates in 2003. Higher levels of several self-reported OSH program elements (tracking progress in controlling workplace safety hazards, identifying ergonomic hazards, using health promotion programs) were associated with lower rates of WC lost time cases in 2003. Higher reported exposures to noise and projectiles were also associated with higher rates of WC cases and costs in 2003.

Impact on Industry

This research adds to a growing body of preliminary evidence that valid leading and trailing metrics can be developed to evaluate OSH effectiveness. Both the rating of OSH efforts and the regular trending of past loss outcomes are likely useful in developing data-driven improvement plans that are reactive to past exposures and proactive in identifying system deficiencies that drive future losses.