Attitudes to falls and injury prevention: what are the barriers to implementing falls prevention strategies?

Objectives: To ascertain the reasons for not taking up a fall or injury prevention strategy among older people who have sustained a fall and attended an emergency department. Subjects: As part of another trial, we identified 60 people who attended the emergency department of a public hospital with a fall. Main measures: Participants were interviewed to ascertain the reasons for not taking up a falls prevention strategy, their falls-related health state, and the likelihood of them undertaking a falls and injury prevention strategy. Results: A total of 31 (52%) of the participants had considered falls prevention after their fall. There were high levels of reluctance to undertake a strategy with 43 (72%) reluctant to take exercise classes, 10 (59%) reluctant to cease psychotropic medications, 26 (43%) reluctant to have a home safety assessment and 17 (28%) reluctant to take osteoporotic medication. When asked specifically about taking up a strategy to prevent a worsening health state, 19 (63%) of participants would take up exercise, 17 (57%) a home safety assessment, 4 of the 17 (59%) already taking implicated medications would stop and 56 (93%) would begin osteoporotic medication. These decisions did not alter when the goal for treatment was to improve a much worse health state. In participants with a lower starting health state, home safety assessments were viewed more favourably. Conclusions: There were significant obstacles to the implementation of most falls prevention guidelines examined. Treatment for osteoporosis was more acceptable to participants than exercise classes, cessation of psychotropic medication, and having a home safety assessment. Osteoporosis treatment, which had the least resistance, also had the least impact on the participants' lifestyle.

[1]  M. Rogers,et al.  Stage of Exercise Change Model and Attitudes toward Exercise in Older Adults , 2001, Perceptual and motor skills.

[2]  A. Campbell,et al.  Psychotropic Medication Withdrawal and a Home‐Based Exercise Program to Prevent Falls: A Randomized, Controlled Trial , 1999, Journal of the American Geriatrics Society.

[3]  Orthopaedic Surgeons Panel On Falls Prevention.  Guideline for the Prevention of Falls in Older Persons , 2001 .

[4]  B. Marcus,et al.  Application of Theoretical Models to Exercise Behavior among Employed Women , 1994, American journal of health promotion : AJHP.

[5]  R. Cumming,et al.  WITHDRAWN: Interventions for preventing falls in elderly people. , 2009, The Cochrane database of systematic reviews.

[6]  B H Marcus,et al.  The stages of exercise behavior. , 1993, The Journal of sports medicine and physical fitness.

[7]  Valerie M. Simmons,et al.  Effectiveness of water exercise on postural mobility in the well elderly: an experimental study on balance enhancement. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.

[8]  S. Ebrahim,et al.  Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. , 1997, Age and ageing.

[9]  C. Nigg,et al.  Exercise and older adults: changing behavior with the transtheoretical model. , 2002, Orthopedic nursing.

[10]  A. Campbell,et al.  Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women , 1997, BMJ.

[11]  Cindy Farquhar,et al.  3 The Cochrane Library , 1996 .

[12]  R. Withers,et al.  Exercise profile and subsequent mortality in an elderly Australian population , 1977, Australian and New Zealand journal of public health.

[13]  M. Tinetti,et al.  A multifactorial intervention to reduce the risk of falling among elderly people living in the community. , 1994, The New England journal of medicine.

[14]  Michael Fitzharris,et al.  Randomised factorial trial of falls prevention among older people living in their own homes , 2002, BMJ : British Medical Journal.

[15]  M. Crotty,et al.  Falls in community-dwelling older persons following hip fracture: impact on self-efficacy, balance and handicap , 2003, Clinical rehabilitation.

[16]  M. Crotty,et al.  Evidence-based clinical practice in falls prevention: a randomised controlled trial of a falls prevention service. , 2003, Australian health review : a publication of the Australian Hospital Association.

[17]  Cameron Swift,et al.  Prevention of falls in the elderly trial (PROFET): a randomised controlled trial , 1999, The Lancet.

[18]  R. Shigematsu,et al.  Dance-based aerobic exercise may improve indices of falling risk in older women. , 2002, Age and ageing.

[19]  P. G. Thompson,et al.  Recruiting older people to a home safety program , 1997, The Medical journal of Australia.

[20]  Steven L Wolf,et al.  Selected As the Best Paper in the 1990s: Reducing Frailty and Falls in Older Persons: An Investigation of Tai Chi and Computerized Balance Training , 2003, Journal of the American Geriatrics Society.

[21]  R. Cumming,et al.  Quality of life related to fear of falling and hip fracture in older women: a time trade off study. , 2000, BMJ.

[22]  R. Cumming,et al.  Home Visits by an Occupational Therapist for Assessment and Modification of Environmental Hazards: A Randomized Trial of Falls Prevention , 1999, Journal of the American Geriatrics Society.