Taking the next step in falls prevention after hospital stay

 

Understanding how and why providing older patients with education to prevent falls and influence behavior has been the focus of Chiara Naseri’s recent research undertaken with older patients from three public hospitals in Perth.

Former WA Health falls specialist Chiara Naseri, who finished her PhD through Curtin University last year, says the clinical recommendations to come from her studies include that older patients require more access to healthcare and transitional support after hospital discharge to enable them to overcome barriers to engage in fall prevention strategies, including exercise.

‘We have evidence that when older people are discharged from hospital, they have impaired function and mobility, reduced knowledge of effective falls prevention strategies, are reluctant to acknowledge their falls risks, and believe that what they are already doing is enough to prevent falls,’ Chiara says.

About half of all older people who are released from hospital go home and experience a fall, many injuring themselves seriously; some are re-admitted to hospital, and some die. Why this happens and what steps can be taken to prevent it from happening was the focus of Chiara’s research, which she spoke about during her presentation at the APA TRANSFORM conference in Adelaide late last year.

Chiara was awarded the Best Early Career Research Paper in the gerontology stream during the TRANSFORM Conference Awards, which were supported by the Physiotherapy Research Foundation (PRF).

Chiara evaluated how a patient education program provided by physiotherapists affected older adults’ engagement in falls prevention strategies during the six months after hospital discharge.

‘More than half of the population from both groups did not receive assistance with their activities of daily living at six months followup—suggesting they may have prematurely returned to their normal daily activities,’ Chiara says. ‘A lot of older people believe that because they’re going back to a familiar environment and a familiar routine, that they can just step back into that after hospital. Unfortunately, what we found with my evaluation was that they simply can’t get back into their normal everyday activities as they expected; that was a real sticking point for them.’ 

She says the results also showed that although there was an increase in the proportion of participants engaging in exercise at six months, the duration had reduced from a mean of three hours at baseline to one hour at six months, which was unlikely to have had a falls prevention effect.

Chiara found that there wasn’t a significant difference between the groups, between control and intervention, in the number of falls prevention strategies that were picked up. This, she says, told her that what is being offered as usual care in the three Perth hospitals sampled was not dramatically different to what was being recommended in the education. 

‘So that’s telling us that whatever is being delivered as usual care is not good enough to prevent falls. We know that. Falls statistics are a pretty blunt instrument to use,’ Chiara says. ‘Knowing the statistics are very valuable for everyone concerned, in hospitals and for research. But we also need to understand the why and the how from the older patient’s perspective, in order to help reduce falls after they return home from hospital.

‘A systematic review completed during my PhD [‘Reducing falls in older adults recently discharged from hospital: a systemic review and meta-analysis’] showed evidencedbased falls prevention interventions that are effective in the general community older population have a different effect in the older post-discharge population. The review revealed that tailoring of the interventions to be personally relevant was an important element in this post-discharge population,’ Chiara says.

Chiara’s research focused on evaluating the education provided as part of a larger NHMRC-funded randomised controlled trial (RCT) delivering tailored falls prevention education, led by Professor Anne-Marie Hill and her team from multiple universities. The education aimed to reduce post-discharge falls by facilitating engagement in fall prevention strategies, Chiara says.

The research was conducted at three public hospitals in Perth—Armadale Rehabilitation Hospital, Bentley Hospital and Midland Hospital (now St John of God Midland Private Hospital)—with 390 older patients recruited and randomised to receive tailored falls prevention education prior to their discharge. They were followed up with monthly telephone coaching over three months, while the control group received a social intervention unrelated to falls education. Both groups received usual care.

‘Many RCTs would stop at providing the falls outcomes, but to understand how and why the tailored falls education may have been effective in changing participants’ falls prevention behaviours, a process evaluation was required.’

Chiara now holds a post-doctorate position at Curtin University and also leads Research and Development for Independent Living Assessment (formally known as Independent Living Centre of WA), a position that enables her to split her time between research and translation to clinical development.

‘It’s a really nice bridge of research and clinical work that I’m doing at the moment, I’m really happy with it. I hope to be able to perhaps look at further investigation of tailored education and effects on exercise participation, and return of normal function and independence in the community,’ she says.
 

Fellowship award

Chiara Naseri has recently been awarded a travel fellowship to travel to Florida, in the US, to collaborate with researchers over there who are trialling rehabilitation technology, health behaviour change techniques, and virtual medical modalities to large patient cohorts.
The travel fellowship, funded by Curtin University, will see Chiara attend the Department of Aging and Geriatric Research in the College of Medicine at the University of Florida, and the Malcom Randall Veterans Affairs (VA) Geriatric Research Education and Clinical Centre (GRECC).
Chiara says the institution is internationally renowned for the ‘interdisciplinary and dynamic research programs spanning public health, social, behavioural and clinical sciences’.
‘The focus of their work is on maximising the health-related quality of life of older adults with disability and prevention of secondary disabilities,’ she says.
Curtin University is seeking to expand its research in ageing through the Curtin Ageing Research Network (CARN), and Chiara was supported by her research supervisor, Professor Anne-Marie Hill, to apply for the fellowship. She is expected to travel to the US later this year.

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