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Item type Presentation

Format Text-based Document

Title Perceived Quality of Life Following Falls: Voices ofCommunity-Dwelling Older Adults

Authors Adeniran, Anthony A.

Downloaded 27-May-2018 07:09:25

Link to item http://hdl.handle.net/10755/622108

Perceived Quality of Life Following Falls: Voices of Community-Dwelling Older Adults

Anthony A. Adeniran, DNP, MSN, RN, PCASr. Vice President Operations

Health1st Home Health ServicesDrexel Hill PA, 19026-4505

Sigma Theta Tau International's 28th International Nursing Research CongressDublin, Ireland. July 29, 2017

Objective

Echo the voices of community-dwelling older adults’ experiences of fall, and the impact on their perceived quality of life

Significance Mortality Morbidity

Fractures Soft tissue injuries Trauma

PsychologicalLoss of confidence - fear of fallingRestricted/limited activity

Economics Cost the U.S. over $30billion in direct medical costs. (Stevens, Corso,

Finkelstein, & Miller, 2006).

Where Older-Adults are Likely to fall?

For people 65 years old or older…..

60%30%

10% Home = 60%

Public Places = 30%

Nursing Home = 10%

A1

Slide 4

A1 Adeniran,Rita, 6/11/2017

Etiology and Risks of Falls

Environmental

Behavioral

Socioeconomic

Biological

WHO, 2007

Classification of Falls]

Community-Dwelling:41% environment related13% weakness, balance or gait disorder

8% dizziness or vertigo

Nursing Home:16% environment related26% weakness, balance or gait disorder25% dizziness or vertigo

(Rubenstein, et al.; 1994)

Study Aims

Identify the etiology of falls from the perspectives of community-dwelling older adults who have experienced a fall

Explore Community-Dwelling Older Adults’ perceived quality of life following the experience of falls.

Sigma Theta Tau International's 28th International Nursing Research Congress Dublin, Ireland. July 29, 2017

Method

Design- Descriptive qualitative study

Participants- Medicare eligible CDOA living in the Delaware and Philadelphia counties

Sampling - Purposeful sampling technique

Recruitment Process

N = 42 CDOA called in to a dedicated phone line and were approached to participate in the study

11 prospective participants declined due to lack of energy

3 prospective participants were re-admitted in the hospital

12 prospective participants unable to consent d/t cognitive

impairment

2 prospective participants were uncomfortable to give consent

4 MC eligible, but not 65 years old 5 prospective participants

MD sent to outpatient facility

N = 5 Participants

met the inclusion

criteria and consented to participate

Data Collection and Management

Socio-demographic data

Descriptive statistics

Each interview was audio recorded and transcribed verbatim

Transcribed interviews were de-identified for anonymity and stored in a secured computer

Analysis:THEMATIC ANALYSIS

Thirteen Codes Four Themes Reliance on others

Ageism

Stigma

Stereotypes

Threat to individual autonomy and personal dignity

Burden of adaptive/assistive devices

Injury Carefulness/ Safety conscious

Limitations due to inevitable physiological decline and consequence of falling

Snow/Ice/Steps Loose rugs Poor lightening/Dark room

Environmental hazards (EH)

Irritation Fear and Worries Acceptance and Coping

Psychological Effects

Findings: Perceived Quality Of Life

Voices of Community-Dwelling Older-Adults

Participants voiced feelings of vulnerability in relation to their age, and fall experiences, which significantly affected their perceived quality of life. They expressed sentiments of intrusion by family members, healthcare providers, neighbors and how their reliance on others for support negatively influenced their perceived quality of life

The following are samples of the participants statements, comments captured during the interview

Voices of CDOA “I am tired of people waiting on me, that I need to follow their schedule.

I only get a good shower once a week, I have to rely on my helper to get me into the shower or to take a bath because I broke my ankle the last time I fell- getting into a shower. Only one time a week is not too good and not enough…ehh… but I guess I have no choice- that is my life now, I have to wait...”

“It seems like everyone has advice for you- ehh...you know, my daughter said I can no longer go out on my own, and my neighbor just came in, not even calling and said she was checking on me- I am not a little girl, why is everyone trying to tell me what to do because I fell a few times?”

The fracture was uncomfortable, I got hurt, I was frightened, but umh… I came through it. Now, I am always afraid of falling, um...ehh...it make me worry and more anxious.”

Voices of CDOA When I step out to go to the doctor…ehh, everyone comes out to

remind me to be careful, like I don’t know what I’m doing… I really did not tell them about all the falls that happened, you

know, they always remind me about how brittle my bones are, telling me that was the reason I broke my ankle. When they talk about me, all they talk about is me falling, falling again. You know it is bad when the guy living down the street, he works for the ambulance company, tells me to be careful...so many people in my business.”

I have accepted what it is... I can’t go out alone anymore… I have to go with my daughter or son.”

Voices of CDOA I don’t like it when the nurse thinks that I forget my walker or can’t remember

what she asked me to do, there is a difference between forgetting and not wanting to do something! The walker makes me feel old, embarrassed, and I try using the cane as much as possible. I only use the walker when I think I need it, like… enn… when I’m going outside the house. But the nurse and my daughter believe that I am forgetful, that is why I don’t use the walker, ehhh… they think I’m old.”

I like the cane better, that is easier to use, it is hard to take that walker everywhere you go, see how narrow my hallway, and it is too much trouble to use the walker. I only go to where I can get to…”

I seldom use the cane or walker, I know my doctor wants me to use it all the time ehm… it reminds me of my grandmother and makes me feel like I am getting up there. But I don’t like taking any of those things with me; it doesn’t feel right using the cane or walker. So I sit at home and only go out when someone is with me.”

Voices of CDOA I can tell you that I am very alert about not taking too big a step ...I take

my time with anything I do…. Watching every step I take, when I feel like emm… I’m going to fall, I'll get somewhere and sit down. It is a big change in your life; you do everything not to fall again.”

Whenever I get up or move around, umm… I take more care; I hold the door or something and make sure that I don’t fall again. Isn’t it strange that one has to live this way?”

Oh, yeah. I am very careful to the point that I don’t enjoy or do anything anymore. If I go to the food market somebody has to take me and I have to ride the little cart. It’s i…s terrible.”

“It is frustrating that everything that looks pretty around you is another reason you can fall. I was told to take off my nice rugs, the one down here and them in my bedroom, umm, because I can trip on them. Well, I am going to be careful, I don’t want to remove them.”

Implications for Practice Falls are not an inevitable part of aging Focus on preventing falls in CDOA

patients and prevent future falls from current fallers

Engage and encourage exercise to improve muscle strength and balance

Consider introducing assistive devices respectfully

Make screening for fear of falling and counsel to improve mobility as a standard of every healthcare encounter with CDOA

Support and build confidence and introduce Fall coping strategies as necessary

Putting the Puzzle Together

Future Direction Partnership is Key!

Build capacity awareness to the issue

Ongoing training and education to providers, family and the community

Evidence-based programs, services and resources to older adults and

accessible to those at most risk

Provide seamless transitions to community programs from health care

and vice versa

Respectfully engage & be sensitive to older adults’ need for dignity

Expand research and science of falls and fall prevention

Success is not final, failure is not fatal: it is the courage to continue that counts!!!

Winston Churchill

Questions and Answers

Thank you!

Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013). Risk factors for falls among older adults: A review of the literature. Maturitas, 75(1), 51-61.

Anderson, R. (2007). Thematic Content Analysis: Descriptive Presentation of Qualitative Data. from http://www.wellknowingconsulting.org/publications/pdfs/ThematicContentAnalysis.pdf

Berland, A., Gundersen, D., & Bentsen, S. B. (2012). Patient safety and falls: A qualitative study of home care nurses in Norway. Nursing & Health Sciences, 14(4), 452-457.

Burnard, P. (1991). A method of analysing interview transcripts in qualitative research. Nurse Education Today, 11(6), 461-466.

Castle, N. G., & Sonon, K. E. (2006). A culture of patient safety in nursing homes. Quality & Safety In Healthcare, 15(6), 405-408.

References

Centers for Disease Control and Prevention. (2011). Injury Prevention & Control: Data & Statistics (WISQARSTM). http://www.cdc.gov/injury/wisqars/

Chase, C. A., Mann, K., Wasek, S., & Arbesman, M. (2012). Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. American Journal of Occupational Therapy, 66(3), 284-291.

de Guzman, A., Garcia, J. M. G., Jaun Paulo, S. P., Garcia, M. B., German, R. T., Gerong, M. S. C; & Grajo, A. J. B. (2013). A multinomial regression model of risk for falls: Factors among Filipino elderly in a community setting. Educational Gerontology, 39(9), 669-683.

Fabre, J. M., Ellis, R., Kosma, M., & Wood, R. H. (2010). Falls risk factors and a compendium of falls risk screening instruments. Journal of Geriatric Physical Therapy, 33(4), 184-197.

Greany, J. F., & Di Fabio, R. P. (2010). Models to Predict Fall History and Fall Risk for Community-Dwelling Elderly. Physical & Occupational Therapy in Geriatrics, 28(3), 280-296.

References

Hektoen, L. F., Aas, E., & Lurås, H. (2009). Cost-effectiveness in fall prevention for older women. Scandinavian Journal of Public Health, 37(6), 584-589.

Hu, J., Xia, Q., Jiang, Y., Zhou, P., & Li, Y. (2015). Risk factors of indoor fall injuries in community-dwelling older women: A prospective cohort study. Archives of Gerontology & Geriatrics, 60(2), 259-264.

Kochera, A. (March 2002). Falls amomg older persons and teh role pf the home: An analysis of cost, incidence, and potential savings from home modification Issue in Brief, 56. http://assets.aarp.org/rgcenter/il/inb49_falls.pdf

Madigan, E. A., & Tullai-McGuinness, S. (2004). An examination of the most frequent adverse events in home care agencies. Home Healthcare Nurse, 22(4), 256-262.

Orces, C. H., & Alamgi, H. (2014). Trends in fall-related injuries among older adults treated in emergency departments in the USA. Injury Prevention, 20(6), 421-423.

References

Rosen, T., Mack, K. A., & Noonan, R. K. (2013). Slipping and tripping: Fall injuries in adults associated with rugs and carpets. Journal of Injury and Violence Research, 5(1), 61-69.

Rubenstein, L. Z. (2006). Falls in older people: epidemiology, risk factors and strategies for prevention. Age and Ageing, 35(suppl 2)

Turner, S., Arthur, G., Lyons, R. A., Weightman, A. L., Mann, M. K., Jones, S. J., . . . Lannon, S. (2011). Modification of the home environment for the reduction of injuries. Cochrane Database of Systematic Reviews(2).

World Health Organization. (2007). Global report on falls prevention in older age. Geneva , Switzerland: Available from WHO Web site www.who.int/ageing/publications/Falls_prevention7March.pdf Google Scholar

Stevens, J. A., Corso, P. S., Finkelstein, E. A., & Miller, T. R. (2006). The costs of fatal and non-fatal falls among older adults. Injury Prevention, 12(5), 290-295

Yamashita, T., Noe, D. A., & Bailer, A. J. (2012). Risk Factors of Falls in Community-Dwelling Older Adults: Logistic Regression Tree Analysis. The Gerontologist, 52(6), 822-832.

References