The effect of complex falls prevention interventions on falls in residential aged care settings: A systematic review protocol

The objective of this review is to synthesize the best available evidence on the effectiveness of complex falls prevention interventions on fall reductions in the residential aged care population, implemented at two or more of the following levels: organization, facility or resident. Specifically the review question is: What is the effect of complex falls prevention interventions on falls in residential aged care settings

Can a web-based community of practice be established and operated to lead falls prevention activity in residential care?

The aims of this study were to evaluate establishing and operating a web-based community of practice (CoP) to lead falls prevention in a residential aged care (RAC) setting. A mixed methods evaluation was conducted in two phases using a survey and transcripts from interactive electronic sources. Nurses and allied health staff (n = 20) with an interest in falls prevention representing 13 sites of an RAC organization participated. In Phase 1, the CoP was developed, and the establishment of its structure and composition was evaluated using determinants of success reported in the literature. In Phase 2, all participants interacted using the web, but frequency of engagement by any participant was low. Participatory barriers, including competing demands from other tasks and low levels of knowledge about information communication technology (ICT) applications, were identified by CoP members. A web-based CoP can be established and operated across multiple RAC sites if RAC management support dedicated time for web-based participation and staff are given web-based training

Assessing knowledge, motivation and perceptions about falls prevention among care staff in a residential aged care setting

Falls are a serious problem in residential aged care settings. The aims of the study were to determine the feasibility of surveying care staff regarding falls prevention, and describe care staff levels of knowledge and awareness of residents\u27 risk of falls, knowledge about falls prevention, motivation and confidence to implement falls prevention strategies. A custom designed questionnaire was administered to care staff at one site of a large residential aged care organization in Australia. The survey response was 58.8%. Feedback from staff was used to inform the administration of the survey to the wider organization. Seven (29.2%) care staff reported they were unsure or thought residents were at low risk of falls. Only five (20.8%) care staff were able to suggest more than three preventive strategies. These preliminary findings suggest that education to change care staff behavior regarding falls prevention should target improving care staff knowledge and awareness of falls

Evaluation of older people\u27s knowledge, awareness, motivation and perceptions about falls and falls prevention in residential aged care homes: A tale of two cities

Falls prevention strategies can only be effective in reducing falls amongst older people if they are adopted and enacted in their daily lives. There is limited evidence identifying what older people in residential aged care (RAC) homes understand about falls and falls prevention, or what may limit or enable their adoption of strategies. This study was conducted in two countries and explored older people’s knowledge and awareness of falls and their preferences, opportunities and motivation to undertake falls prevention strategies. A cross-sectional survey was administered to participants (N = 70) aged 65 years and over, living in six RAC homes in Perth, Australia and six RAC homes in Swansea, Wales, United Kingdom. Participants had limited knowledge about intrinsic falls risk factors and strategies to address these and frequently expressed self-blame regarding falling. Almost all (N = 67, 95.7%) participants felt highly motivated to maintain their current functional mobility and independence in everyday tasks. Key preferences for receiving falls prevention messages favoured a positive approach promoting wellness and independence (N = 41, 58.6%) via pictorial posters or brochures (N = 37, 52.9%) and small group discussions preferably with demonstrations (N = 18, 25.7%). Findings from this study may assist organisations and staff to more effectively engage with older people living in RAC about falls prevention and design targeted resources to address the motivations and preferences of this population

Evaluating the impact of operating a falls prevention community of practice on falls in a residential aged care setting

Background/Purpose: Falls are a leading adverse event in residential aged care (RAC) settings with prevention a global aim. The purpose of this study was to determine whether operating a falls prevention community of practice (CoP) delivering evidence-based prevention interventions could change the rate of falls and injurious falls in a RAC setting. Methods: A prospective quasi-experimental pre/post design was conducted. Participants were 13 RAC sites (779 beds) of a single RAC organization, with 20 multidisciplinary staff volunteering as CoP members. Results: Falls rates pre CoP were 10.1/1,000 occupied bed days (OBD) compared with 10.9 /1,000 OBD post CoP operation [coefficient 0.7, 95% CI -33.5, 34.9 (p=0.967)]. This was confounded by identified differences and changes in defining falls between sites. The rate of injurious falls resulting in fractures pre CoP was 0.2/1,000 OBD compared with 0.1/1,000 OBD post CoP; [coefficient -0.3, 95% CI -1.1, 0.4 (p=0.423)]. Conclusion: A falls prevention CoP operating for 18 months was unable to reduce falls rates in that time frame but there was a trend to a reduction in falls resulting in fracture. Additional time for implementation and evaluation of falls prevention interventions will be required in complex settings, such as RAC organizations, in the absence of additional funding. Valid comparisons of falls rates and injurious falls rates within the RAC population require the adoption of standardized definitions to improve reporting reliability

Evaluation of older people's knowledge, awareness, motivation and perceptions about falls and falls prevention in residential aged care homes: a tale of two cities

Falls prevention strategies can only be effective in reducing falls amongst older people if they are adopted and enacted in their daily lives. There is limited evidence identifying what older people in residential aged care (RAC) homes understand about falls and falls prevention, or what may limit or enable their adoption of strategies. This study was conducted in two countries and explored older people's knowledge and awareness of falls and their preferences, opportunities and motivation to undertake falls prevention strategies. A cross-sectional survey was administered to participants (N = 70) aged 65 years and over, living in six RAC homes in Perth, Australia and six RAC homes in Swansea, Wales, United Kingdom. Participants had limited knowledge about intrinsic falls risk factors and strategies to address these and frequently expressed self-blame regarding falling. Almost all (N = 67, 95.7%) participants felt highly motivated to maintain their current functional mobility and independence in everyday tasks. Key preferences for receiving falls prevention messages favoured a positive approach promoting wellness and independence (N = 41, 58.6%) via pictorial posters or brochures (N = 37, 52.9%) and small group discussions preferably with demonstrations (N = 18, 25.7%). Findings from this study may assist organisations and staff to more effectively engage with older people living in RAC about falls prevention and design targeted resources to address the motivations and preferences of this population

Simulated resilience of tropical rainforests to CO2-induced climate change

How tropical forest carbon stocks might alter in response to changes in climate and atmospheric composition is uncertain. However, assessing potential future carbon loss from tropical forests is important for evaluating the efficacy of programmes for reducing emissions from deforestation and degradation. Uncertainties are associated with different carbon stock responses in models with different representations of vegetation processes on the one hand 1, 2, 3, and differences in projected changes in temperature and precipitation patterns on the other hand 4, 5. Here we present a systematic exploration of these sources of uncertainty, along with uncertainty arising from different emissions scenarios for all three main tropical forest regions: the Americas (that is, Amazonia and Central America), Africa and Asia. Using simulations with 22 climate models and the MOSES–TRIFFID land surface scheme, we find that only in one 5 of the simulations are tropical forests projected to lose biomass by the end of the twenty-first century—and then only for the Americas. When comparing with alternative models of plant physiological processes 1, 2, we find that the largest uncertainties are associated with plant physiological responses, and then with future emissions scenarios. Uncertainties from differences in the climate projections are significantly smaller. Despite the considerable uncertainties, we conclude that there is evidence of forest resilience for all three regions