Elaine M. Gallagher

Head Over Heels: Impact of a Health Promotion Program to Reduce Falls in the Elderly

The Fit (Falls Intervention Trials) Project was a randomized clinical trial of a program designed to reduce falls and their sequela among older people. The sample consisted of 100 persons who were age 60 and over, who lived in the Capital Region District (Victoria, B.C.) and who had experienced a fall in the preceding three months. The intervention consisted of a comprehensive risk assessment, individualized feedback about identified risks and a motivational video and booklet entitled “Head Over Heels”. Outcome measures included fall incidence, falls self-efficacy, fear of falling, social functioning, health service utilization and quality of life. While there were no statistically significant differences between the intervention and control groups on the key study variables, there were improvements in both groups between the beginning of the study and the six-month follow-up assessment. The paper discusses possible reasons for these findings and their implications for further research.

Steady As You Go (SAYGO): A Falls-Prevention Program for Seniors Living in the Community.

This study was an implementation and community trial of a new falls-prevention program for seniors called Steady As You Go (SAYGO). The program, designed in the Capital Health region of Alberta, integrated the knowledge gained from successful falls-prevention research into a brief community intervention. SAYGO included a multifactorial, risk-abatement approach, as well as a cognitive-behavioural and environmental focus. The target population was relatively healthy and mobile, community-dwelling seniors. The randomized community trial was conducted in urban and rural areas in Alberta, with 660 seniors participating. Seniors who completed the program made significant reductions in eight of the nine risk factors addressed in the program. Over a 4-month follow-up period, the proportion of seniors who fell was lower in the treatment group (17%) than in the control group (23%). Among those seniors who had reported a fall in the previous year, a significantly lower proportion of those in the treatment group experienced a fall in the follow-up period (20%) as compared to those in the control group (35%).

Ethical dilemmas in home care case management.

EXECUTIVE SUMMARY The role of case manager is fraught with challenges in a healthcare environment characterized by rapid aging of the population, a move against institutionalization of seniors, and the need to contain healthcare costs. This study examined experiences of 89 case managers through focus groups in five urban and five rural regions of Canada to identify ethical dilemmas and issues encountered in their role. Overall, the case managers expressed frustration for the lack of support for their work as evidenced by inadequate resources and few agency policies. The analysis of the focus group data revealed four main themes in relation to ethical concerns and dilemmas: (1) issues related to equity, (2) beneficence, (3) non‐maleficence, and (4) autonomy and power imbalances. The situation facing these workers is grave and steps must be taken to provide them with ongoing training, support, and resources to continue in this vital role. System changes that would reduce some of the ethical conflicts experienced by case managers include funding for long‐term care to keep pace with growing demands, better management of client waitlists to ensure that the most needy are given the highest priority, more supportive housing options that provide for some on‐site coordination of services, better opportunities for health promotion, and better interdisciplinary teamwork so that case managers are not left making decisions in the absence of other key service providers.

Emotional, Social, and Physical Health Characteristics of Older Men in Prison.

A competitive survey was carried out in three medium-security Federal prisons in British Columbia, Canada. The purpose was to compare the social, emotional, and physical health characteristics of older and younger inmates. The results showed that when compared with younger inmates, the older men had more contacts with friends and family, more friends in prison, and experienced less stress than the younger men. Aside from problems with vision and hearing, their physical health did not appear to be any worse when compared to that of younger inmates. This was surprising in light of age-related declines in health found in both the general population and in previous research with inmates. The study uncovered several unique problems concerning older prisoners, and a number of policy and program recommendations were generated.

Aging in Canada: State of the Art and Science

Canada shares many similarities with other industrialized countries around the world, including a rapidly aging population. What sets Canada uniquely apart is the collaborative approach that has been enacted in the health care system and the aging research initiatives. Canada has tremendous pride in its publicly funded health care system that guarantees universal coverage for health care services on the basis of need, rather than ability to pay. It is also distinguished as a multicultural society that is officially bilingual. Aging research has developed rapidly over the past decade. In particular, the Canadian Longitudinal Study on Aging is one of the most comprehensive research platforms of its kind and is expected to change the landscape of aging research.

Vulnerability of nursing home residents during relocations and renovations

Abstract Ninety-nine extended care residents were followed over a fourteen month period, in order to compare outcomes associated with relocation and renovations. One group of residents were temporarily moved to other facilities during renovations, two groups were moved internally, and a control group in a similar home experienced neither relocation nor renovations. The groups constituted naturally assembled collectives, but were similar in terms of age, sex, and length of admission. Significant differences were found between the groups, both two weeks and two months after moving. The residents who were moved externally showed a number of improvements; they had significantly higher ADL scores, improved auditory comprehension, decreased pain, fewer incidence reports and reduced doses of PRN medicines. The group of residents who showed the most negative changes were those who were moved inside the home at the outset of the renovations. These residents showed sharp increases in PRN medicine use, diminished ADL functioning, and increased symptoms of pain. While the groups differed two weeks and two months following the move, after 14 months, differences were no longer apparent. The findings highlighted the potential importance of comprehensive preparation, resident choice, and resident perceptions, in the face of multiple stresses.

Home Care or Long-Term Care Facility: Factors that Influence the Decision

ABSTRACT In order to answer the research question–What factors determine if a long-term care client will be cared for at home or in a long-term care facility?–data were collected in five provinces in Canada in urban and rural sites, through focus groups with community care coordinators. A questionnaire provided information about the 89 participants and their workload. Factors are grouped under organizational, system, client, informal provider, formal provider, and case manager factors. Discussion focuses on changes needed to foster more long-term care in the home.

FAMILY CAREGIVER EDUCATION AND SUPPORT PROGRAMS: USING HUMANISTIC APPROACHES TO EVALUATE PROGRAM EFFECTS

This article critiques previous caregiver evaluation efforts and describes the evaluation of an education and support program for family caregivers in British Columbia, Canada. Thirty family caregivers, predominantly adult daughters caring for parents with dementia, participated in one of three facilitator‐led groups offering the Supporting Caregivers in British Columbia program. They met weekly for 2 hr over a 10‐week period. A rich array of qualitative data indicated that caregivers perceived the program to have numerous positive effects on their caregiving, thus demonstrating the importance of learner perspectives and experiences in the evaluation process. The study offers a distinct alternative to experimental and quasi‐experimental designs for evaluating educational programs.

Quality of life associated with adult day centers.

The purpose of this study was to describe the quality of life (QOL) of current adult day center (ADC) clients and their family caregivers in one region of Canada. Semi-structured interviews were conducted with 10 ADC clients and 10 caregivers. Data analysis used a modified constant comparative method. The major categories relating to QOL that emerged in the analysis included Physical Health and Well-Being, Social Networks/Relationships, Aging in Place, Safety, Respite, Activation, Respect and Inclusion, and Adequate Health Care Services. These themes are consistent with those of other studies of QOL of older adults. It was evident that ADCs played an important role in maintaining and improving the QOL of both the older adults and caregivers participating in this study.

Evaluation of an evidence-based education program for health professionals: The Canadian Falls Prevention Curriculum© (CFPC)

INTRODUCTION A staged, mixed methods approach was applied to the development and evaluation of an evidence-based education program for health care professionals and community leaders on how to design, implement and evaluate a fall prevention program. Stages included pre-development, development, pilot testing and impact on practice. The goal of the evaluation was to determine if the Canadian Falls Prevention Curriculum met the needs of the target audience and had an impact on learning and practice. METHODS Methods included a needs assessment, systematic reviews, pre-post tests of learning, follow-up surveys and interviews, and descriptive reports of stakeholder involvement. The needs assessment and systematic review of existing programs indicated that there was a demand for a comprehensive, evidence-based curriculum on fall prevention and that no similar curricula existed. Pre-post test findings showed significant increases in learning and follow-up surveys showed a positive impact on practice. IMPACT ON INDUSTRY Evidence shows that the most effective fall prevention efforts are those that address the multifactorial nature of fall risk, with proven interventions provided by trained clinicians. The Canadian Falls Prevention Curriculum provides evidence-based training for clinicians and community leaders using a public health approach to fall prevention that includes instruction on how to define the problem, assess the risk, examine best practices, implement the program, and conduct evaluation of the programs effectiveness.