Research Article: Tailored Education for Older Patients to Facilitate Engagement in Falls Prevention Strategies after Hospital Discharge—A Pilot Randomized Controlled Trial

Date Published: May 23, 2013

Publisher: Public Library of Science

Author(s): Anne-Marie Hill, Christopher Etherton-Beer, Terry P. Haines, Hamid Reza Baradaran. http://doi.org/10.1371/journal.pone.0063450

Abstract

The aims of the study were to evaluate the effect of providing tailored falls prevention education in hospital on: i) engagement in targeted falls prevention behaviors in the month after discharge: ii) patients’ self-perceived risk and knowledge about falls and falls prevention strategies after receiving the education.

A pilot randomized controlled trial (n = 50): baseline and outcome assessments conducted by blinded researchers. Participants: hospital inpatients 60 years or older, discharged to the community. Participants were randomized into two groups. The intervention was a tailored education package consisting of multimedia falls prevention information with trained health professional follow-up, delivered in addition to usual care. Outcome measures were engagement in falls prevention behaviors in the month after discharge measured at one month after discharge with a structured survey, and participants’ knowledge, confidence and motivation levels before and after receiving the education. The feasibility of providing the intervention was examined and falls outcomes (falls, fall-related injuries) were also collected.

Forty-eight patients (98%) provided follow-up data. The complete package was provided to 21 (84%) intervention group participants. Participants in the intervention group were significantly more likely to plan how to safely restart functional activities [Adjusted odds ratio 3.80, 95% CI (1.07, 13.52), p = 0.04] and more likely to complete other targeted behaviors such as completing their own home exercise program [Adjusted odds ratio 2.76, 95% CI (0.72, 10.50), p = 0.14] than the control group. The intervention group was significantly more knowledgeable, confident and motivated to engage in falls prevention strategies after receiving the education than the control group. There were 23 falls (n = 5 intervention; n = 18 control) and falls rates were 5.4/1000 patient days (intervention); 18.7/1000 patient days (control).

This tailored education was received positively by older people, resulted in increased engagement in falls prevention strategies after discharge and is feasible to deliver to older hospital patients.

The study was registered with the Australian New Zealand Clinical Trials Registry; ACTRN12611000963921 on 8th November 2011.

Partial Text

Older people who have been recently discharged from hospital are at high risk of falls and other adverse events [1], [2], [3]. Approximately one third of this population have developed functional decline compared to their pre-admission level of activities of daily living [4], [5]. Up to 40% of patients fall in the first six months after discharge compared with 30% in the general community population [1], [6], [7], [8] and up to 50% of falls during this period result in physical injury [1], [6]. Older people also have over twice the risk of sustaining a hip fracture after a hospital admission, especially in the first four weeks after discharge [9].

The protocol for this trial and supporting CONSORT checklist are available as supporting information; see Checklist S1 and Protocol S1.

This is the first randomized trial to provide a falls prevention multimedia education package with tailored individual follow up for older people at point of hospital discharge. Our study has shown that it is possible to successfully provide education of this nature to a high proportion of participants who enrolled in the study, despite the busy and unpredictable ward environment. Participants were positive in their reaction to the tailored education format [32] which contrasts strongly with previous qualitative studies which reported that older people perceive that falls prevention education is confusing or patronizing [42], [43]. Our results also suggest that participants who received the education developed the capability and motivation to engage in falls prevention behaviors [31]. This is important when designing and evaluating falls prevention education interventions as previous studies have found that older people do not view themselves as personally susceptible to falls [43], have poor levels of knowledge about falls and falls prevention [19], [44] and have low levels of intention to engage in falls prevention programs [45]. A recent national survey found that over 60% of older people are not willing to participate in any type of program to manage concerns about falls [46].

Source:

http://doi.org/10.1371/journal.pone.0063450