Jolanda C. M. van Haastregt

Effects of preventive home visits to elderly people living in the community: systematic review

Abstract Objective: To assess the effects of preventive home visits to elderly people living in the community. Design: Systematic review. Setting: 15 trials retrieved from Medline, Embase, and the Cochrane controlled trial register. Main outcome measures: Physical function, psychosocial function, falls, admissions to institutions, and mortality. Results: Considerable differences in the methodological quality of the 15 trials were found, but in general the quality was considered adequate. Favourable effects of the home visits were observed in 5 out of 12 trials measuring physical functioning, 1 out of 8 measuring psychosocial function, 2 out of 6 measuring falls, 2 out of 7 measuring admissions to institutions, and 3 of 13 measuring mortality. None of the trials reported negative effects. Conclusions: No clear evidence was found in favour of the effectiveness of preventive home visits to elderly people living in the community. It seems essential that the effectiveness of such visits is improved, but if this cannot be achieved consideration should be given to discontinuing these visits.

Interventions to Reduce Fear of Falling in Community‐Living Older People: A Systematic Review

The objective was to assess which interventions effectively reduce fear of falling in community‐living older people. An extensive search for relevant literature comprised a database search of PubMed, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials; expert consultation; and manually searching reference lists from potentially relevant papers. Randomized, controlled trials that assessed fear of falling in community‐living older people were included. Two independent reviewers extracted data from full papers on study characteristics, methodological quality, outcomes, and process characteristics of the intervention. The search identified 599 abstracts, and 19 papers met the inclusion criteria. Seven of those papers were identified using expert consultation. Fifty‐five percent of all validity items and 39% of process characteristic items were fulfilled across the 19 trials. Twelve of the 19 papers were of higher methodological quality. In 11 of these trials, fear of falling was lower in the intervention group than in the control group. Interventions that showed effectiveness were fall‐related multifactorial programs (n=5), tai chi interventions (n=3), exercise interventions (n=2), and a hip protector intervention (n=1). Three of these interventions explicitly aimed to reduce fear of falling. Several interventions, including interventions not explicitly aimed at fear of falling, resulted in a reduction of fear of falling in community‐living older people. Limited but fairly consistent findings in trials of higher methodological quality showed that home‐based exercise and fall‐related multifactorial programs and community‐based tai chi delivered in group format have been effective in reducing fear of falling in community‐living older people.

Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial

Abstract Objective: To evaluate whether a programme of multifactorial home visits reduces falls and impairments in mobility in elderly people living in the community. Design: Randomised controlled trial with 18 months of follow up. Setting: Six general practices in Hoensbroek, the Netherlands. Participants: 316 people aged 70 and over living in the community, with moderate impairments in mobility or a history of recent falls. Intervention: Five home visits by a community nurse over a period of one year. Visits consisted of screening for medical, environmental, and behavioural factors causing falls and impairments in mobility, followed by specific advice, referrals, and other actions aimed at dealing with the observed hazards. Main outcome measures: Falls and impairments in mobility. Results: No differences were found in falls and mobility outcomes between the intervention and usual care groups. Conclusion: Multifactorial home visits had no effects on falls and impairments in mobility in elderly people at risk who were living in the community. Because falls and impairments in mobility remain a serious problem among elderly people, alternative strategies should be developed and evaluated.

Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: Results from Germany, the Netherlands and the UK were satisfactory

Purpose. To carry out a cross-cultural validation of the Falls Efficacy Scale International (FES-I), a 16-item modified version of the Falls Efficacy Scale that was developed to assess both easy and more complex physical and social activities, in a range of languages and different cultural contexts. Method. Data were collected in Germany (n = 94), The Netherlands (n = 193), and the UK (n = 178) in samples of older people living in the community. Four-week FES-I re-test data were collected in Germany and The Netherlands. Descriptive statistics and reliability estimates were computed as well as FES-I sum scores according to age, sex, falls history and fear of falling. Results. Mean inter-item correlations were all above 0.38 and internal reliability estimates were all 0.90 or above. The intra-class correlation coefficients in the German and the Dutch sample were 0.79 and 0.82, respectively. As expected, FES-I scores were associated with age, sex, falls history and fear of falling. In addition, the FES-I discriminated between sub-groups somewhat better than the original ten-item FES scale. Conclusions. The FES-I has been shown to have acceptable reliability and construct validity in different samples in different countries and may be used in cross-cultural rehabilitation research and clinical trials.

Effects of a Multicomponent Cognitive Behavioral Group Intervention on Fear of Falling and Activity Avoidance in Community-Dwelling Older Adults: Results of a Randomized Controlled Trial

OBJECTIVES: To evaluate the effects of a multicomponent cognitive behavioral intervention on fear of falling and activity avoidance in older adults.

Lack of Effectiveness of a Multidisciplinary Fall-Prevention Program in Elderly People at Risk: A Randomized, Controlled Trial

OBJECTIVES: To assess whether a pragmatic multidisciplinary fall‐prevention program was more effective than usual care in preventing new falls and functional decline in elderly people.

Socio-demographic, health-related and psychosocial correlates of fear of falling and avoidance of activity in community-living older persons who avoid activity due to fear of falling

BackgroundFear of falling and avoidance of activity are common in old age and are suggested to be (public) health problems of equal importance to falls. Earlier studies of correlates of fear of falling and avoidance of activity did hardly differentiate between severe and mild levels of fear of falling and avoidance of activity which may be relevant from clinical point of view. Furthermore, most studies focused only on socio-demographics and/or health-related variables and hardly incorporated an extensive range of potential correlates of fear of falling including psychosocial variables. This study analyzes the univariate and multivariate associations between five socio-demographic, seven health-related and six psychosocial variables and levels of fear of falling and avoidance of activity in older persons who avoid activity due to fear of falling.MethodsCross-sectional study in 540 community-living older people aged ≥ 70 years with at least mild fear of falling and avoidance of activity. Chi-squares, t-tests and logistics regression analyses were performed to study the associations between the selected correlates and both outcomes.ResultsOld age, female sex, limitations in activity of daily living, impaired vision, poor perceived health, chronic morbidity, falls, low general self-efficacy, low mastery, loneliness, feelings of anxiety and symptoms of depression were identified as univariate correlates of severe fear of falling and avoidance of activity. Female sex, limitations in activity of daily living and one or more falls in the previous six months correlated independently with severe fear of falling. Higher age and limitations in activity of daily living correlated independently with severe avoidance of activity.ConclusionPsychosocial variables did not contribute independently to the difference between mild and severe fear of falling and to the difference between mild and severe avoidance of activity due to fear of falling. Although knowledge about the unique associations of specific variables with levels of severe fear of falling and avoidance of activity is of interest for theoretical reasons, knowledge of univariate association may also help to specify the concepts for developing interventions and programmes to reduce fear of falling and avoidance of activity in old age, particularly in their early stages of development.

Feelings of Anxiety and Symptoms of Depression in Community-Living Older Persons Who Avoid Activity for Fear of Falling

OBJECTIVES The objectives of this cross-sectional study were to assess the presence of feelings of anxiety and symptoms of depression among older persons who avoid activity for fear of falling and to assess whether feelings of anxiety and symptoms of depression are independently associated with the severity of fear of falling and fear-related activity avoidance. DESIGN This is a cross-sectional study. SETTING Data were collected at two urban areas south of The Netherlands. PARTICIPANTS Participants included 540 community-living people aged 70 years or older who reported fear of falling and associated activity avoidance. MEASUREMENTS Data were collected by means of self-administered questionnaires. RESULTS This study shows that 28.2% and 26.1% of the persons with severe fear of falling had feelings of anxiety and symptoms of depression, respectively. These rates were 28.5% and 22.6% for participants with severe fear-related activity avoidance. Multivariate analyses revealed that participants with severe fear of falling were more likely to have feelings of anxiety and symptoms of depression than those with mild fear of falling. Furthermore, persons who reported severe fear-related activity avoidance were more likely to have feelings of anxiety than mild avoiders. CONCLUSIONS Feelings of anxiety and symptoms of depression are common in persons with severe fear of falling and fear-related activity avoidance. Professional care providers should be alert to underlying anxiety disorders and depression in this category of older persons in the interests of providing optimum treatment.

A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomised controlled trial (RCT)

OBJECTIVE to evaluate the effectiveness of a multifactorial intervention on incidence of falls in psychogeriatric nursing home patients. DESIGN cluster-randomised controlled 12-month trial. SETTING psychogeriatric wards in 12 nursing homes in The Netherlands. PARTICIPANTS psychogeriatric nursing home patients (n = 518). INTERVENTION a general medical assessment and an additional specific fall risk evaluation tool, applied by a multidisciplinary fall prevention team, resulting in general and individual fall prevention activities. MEASUREMENTS falls. RESULTS there were 355 falls in 169.5 patient-years (2.09 falls per patient per year) in the intervention group and 422 falls in 166.3 patient-years (2.54 falls per patient per year) in the control group. Intention-to-treat analysis with adjustment for ward-related and patient-related parameters, and intra-cluster correlation, showed that the intervention group had a significantly lower mean fall incidence rate than the control group (rate ratio = 0.64, 95% CI = 0.43-0.96, P = 0.029). Subgroup analyses showed that fall risk declined further as patients participated longer in the intervention programme. CONCLUSION the introduction of a structured multifactorial intervention to prevent falls in psychogeriatric nursing home patients significantly reduces the number of falls. This reduction is substantial and of high clinical relevance.

Nurse‐led self‐management group programme for patients with congestive heart failure: randomized controlled trial

AIM This paper reports on of the effects of the Chronic Disease Self-Management Programme on psychosocial attributes, self-care behaviour and quality of life among congestive heart failure patients who experienced slight to marked limitation of physical activity. BACKGROUND Most self-management programmes for congestive heart failure patients emphasize the medical aspects of this chronic condition, without incorporating psychosocial aspects of self-management. The programme has been used with various patient groups, but its effectiveness with congestive heart failure patients when led by pairs of cardiac nurse specialists and peer leaders is unknown. METHOD A randomized controlled trial with 12 months of follow-up from start of the programme was conducted with 317 patients. Control group patients (n = 131) received usual care, consisting of regular outpatient checkups. Intervention group patients (n = 186) received usual care and participated in the six-week self-management programme. The programme teaches patients medical, social and emotional self-management skills. Twenty-one classes were conducted in six hospitals in the Netherlands, and data were collected between August 2004 and January 2007. RESULTS Directly after the programme, statistically significant effects were found for cognitive symptom management (P < 0.001), self-care behaviour (P = 0.008) and cardiac-specific quality of life (P = 0.005). No effects were found at 6- and 12-month follow-up. CONCLUSION Further research is necessary to study how long-term effectiveness of the programme with patients with congestive heart failure can be achieved, and how successful adaptations of the programme can be integrated into standard care.