Abstract
Background: Evidence-based multifactorial fall prevention interventions in clinical practice have been less effective than expected. One plausible reason is that older adults' engagement in fall prevention care is suboptimal. Methods: This was a post-hoc analysis of 2403 older adults' engagement in a multifactorial fall prevention intervention in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) pragmatic trial. Based on the direct clinical care level of the Patient and Family Continuum of Engagement (CE) framework, three indicators of progressively interactive engagement were assessed: (1) Consultation (receiving information), (2) Involvement (prioritizing risks), and (3) Partnership (identifying prevention actions). Drop off at each step was determined as well as predictors of engagement. Results: The participants' engagement waned with increasingly interactive CE domains. Although all participants received information about their positive fall risk factors (consultation) and most (51%–96%) prioritized them (involvement), fewer participants (33%–55%) identified fall prevention actions (partnership) for most of their risk factors, except for strength gait or balance problems (95%). More participants (70%) identified home exercises than other actions. Finally, fall prevention actions were identified more commonly among participants who received two visits compared to one (OR = 2.33 [95% CI, 2.06–2.64]), were ≥80 years old (OR = 1.83 [95% CI, 1.51–2.23]), and had fewer fall risk factors (OR = 0.90 [95% CI, 0.83–0.99]). Conclusions: The drop-off in participants' engagement based on the level of their interaction with clinicians suggests that future multifactorial fall prevention interventions need to be more focused on interactive patient-clinician partnerships that help older adults increase and maintain fall prevention actions. Our analyses suggest that more frequent contact with clinicians and more monitoring of the implementation and outcomes of Fall Prevention Care Plans could potentially improve engagement and help older adults maintain fall prevention actions.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 3116-3126 |
| Number of pages | 11 |
| Journal | Journal of the American Geriatrics Society |
| Volume | 70 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 2022 |
Bibliographical note
Funding Information:Supported by the Patient‐Centered Outcomes Research Institute and the National Institute on Aging of the National Institutes of Health (NIH) through a cooperative agreement (5U01AG048270) between the National Institute on Aging and Brigham and Women's Hospital. Dr. McMahon was also supported by grants (KL2TR000113 and UL1TR000114) from the University of Minnesota Clinical and Translational Science Institute, funded by the National Center for Advancing Translational Sciences (NCATS), a component of the NIH. Drs. Greene and Peduzzi were also supported by a CTSA grant (UL1TR000142) from NCATS. Dr. Gill was also supported by the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342). Dr. Bhasin was supported in part by the Boston Claude D. Pepper Older Americans Independence Center (P30AG013679). This paper has not been presented.
Publisher Copyright:
© 2022 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.
Keywords
- Fall Prevention
- Older Adults
- Patient Engagement
- Primary Care