“Older adults’ capability and motivation for falls preventionfollowing hospital discharge ”

PhD Candidate 2016-2019School of Physiotherapy and Exercise Science

Supervised by Professor Anne-Marie Hill,Professor Steven McPhail, Dr Julie Netto

CHIARA NASERI

3rd GrassRoots Falls Festival 19th-20th September 2019

Falls Incidence in Older People

Generalcommunity

30%Post-

discharge 40%

10% Injuries

54% Injuries

Hill et al, 2011 Mahoney et al, 2000

Campbell et al, 1990 Carpenter et al, 2009

Participants and setting

Patients (n=390) discharged from aged care rehabilitation and stroke units at: • St John of God Midland public hospital • Bentley hospital • Armadale hospital Observed for 6 months post discharge.Enrolled as part of RCT (Hill AM et al, 2017) evaluating rates of falls.

Inclusion criteria• ≥60 years of age• >7/10 in Abbreviated Mental Test Score (AMTS)

Exclusion criteria• Unstable medical condition• Discharged to a Transitional Care Facility or

Residential Care• Required palliative care

Study Design & Framework

(Michie et al., 2011)(Creswell, 2014)

Study Aim

To measure older adults’ capability

and motivation to engage in fall

prevention activities during six

months after hospital discharge

Results: Capability

0 20 40 60 80 100 120

EDUCATION

CONTROL

EDUCATION

CONTROL

EDUCATION

CONTROL

T1T2

T3

Awareness of Other Older Peoples' Risk of Falls After Hospitalisation

1-STRONGLY AGREE 2-AGREE 3-UNSURE 4-DISAGREE 5-STRONGLY DISAGREE

Between group difference at T2AOR -0.4, 95%CI -0.7, -0.2, p<0.01

Results: Motivation

Between group difference at T2AOR -0.8, 95%CI -1.1, -0.5 p<0.01

0 20 40 60 80 100 120

Education

Control

Education

Control

Education

Control

T1T2

T3

Belief in Their Own Fall Risks After Hospitalisation

1-strongly agree 2-agree 3-unsure 4-disagree 5-strongly disagree

Results

Between group difference at T2AOR -1.0, 95%CI -1.2, -0.7 p<0.01

Clinical Implications

Tailored education

prepared for falls prevention earlier in their recovery

can address the problems of reduced falls prevention knowledge

is an effective means of engaging patients and their caregivers in decisions relating to

their health care once they return home from hospital

Older patients may be presented with barriers to engagement in falls prevention

strategies once they return home, that may be unforeseeable at the time of education

delivery at hospital discharge

Research Implications First evaluation of a tailored fall prevention education intervention

The intervention was scalable to existing hospital discharge resources

Patient-centred outcomes improved understanding of how older

patients manage their own health as they transition from hospital to

home

Further research is required to understand the barriers faced by older

adults after discharge home from hospital

AcknowledgementsSupervisors: Anne-Marie Hill, Julie Netto, Steven McPhail

Back to my Best Project Team: Anne-Marie Hill, Ron Shorr, Terry Haines, Chris Etherton-Beer, Steven McPhail, Meg Morris, Leon Flicker, Max Bulsara, Jacqui Francis-Coad, Angel Lee, Nick Waldron, Amanda BoudvilleResearch assistants: Trish Starling and Tammy WeselmanCurtin University: Leo Ng , Elissa Burton, Vin Cavalheri

My colleagues at the Independent Living Centre

Reference List• Campbell AJ, Borrie MJ, Spears GF, et al. Circumstances and consequences of falls experienced by a

community population 70 years and over during a prospective study. Age Ageing. 1990; 19(2), 136-141.• Carpenter CR, Scheatzle MD, D’Antonio, JA, et al. Identification of fall risk factors in older adult emergency

department patients. Acad Emerg Med. 2009; 16. doi: 10.1111/j.1553-2712.2009.00351.x• Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-Associated Disability: “She Was Probably Able to

Ambulate, but I’m Not Sure”. JAMA. 2011;306(16):1782-1793.• Lee D-CA, McDermott F, Hoffmann T, Haines TP. ‘They will tell me if there is a problem’: limited discussion

between health professionals, older adults and their caregivers on falls prevention during and after hospitalization. Health Educ. Res. 2013;28(6):1051-1066.

• Haines T, Day L, Hill K, et al. "Better for others than for me": A belief that should shape our efforts to promote participation in falls prevention strategies. Arch Gerontol Geriatr 2014; 59:136-144

• Hill, A. M., Etherton-Beer, C.,Haines TP. Tailored education for older patients to facilitate engagement in falls prevention strategies after hospital discharge--a pilot randomized controlled trial. PLoS One. 2013; 8(5): e63450

• Hill, A. M., McPhail, S. M., Haines, T. P., Morris, M. E., Etherton-Beer, C., Shorr, R., . . . Boudville, A. (2019). Falls after hospital discharge: a randomized clinical trial of individualized multi-modal falls prevention education. The journals of gerontology: Series A. doi:10.1093/gerona/glz026

• Hill, A. M., Etherton-Beer, C., McPhail, S. M., Morris, M. E., Flicker, L., Shorr, R., . . . Haines, T. (2017). Reducing falls after hospital discharge: a protocol for a randomised controlled trial evaluating an individualised multimodal falls education programme for older adults. BMJ Open, 7(2), e013931.

• Michie, S., van Stralen, M. M., and West, R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011: 6, 42.