An Australian study, published in BMJ Open, has explored the impact of individualised falls prevention education and how it supports behaviour change, from the perspective of older hospital patients on rehabilitation wards. It also looked at the barriers patients identified to engaging in preventive strategies.
Falls in hospital settings are a substantial problem with incident rates reported in Australia, Europe and the UK of between 3.2 and 17 falls per 1000 patient bed days. Up to 30% of these falls can result in physical injury. Older patients in geriatric or rehabilitation wards are at increased risk of falls compared to other patient populations.
During the trial, 757 participants received the falls prevention education programme. Of these participants, 704 completed a written action plan, where participants were assisted to identify of a number of preventative goals. Goals took the form of practical strategies and were related to each participant’s individual functional mobility in the context of their medical condition and were based on the behaviour modification and motivation messages contained in the Safe Recovery programme.
Examples of frequently set goals by participants who were able to independently complete some or all of their mobility tasks were as follows: (1) use prescribed walking aid when walking and (2) get up slowly and check for dizziness before walking.
Examples of frequently set goals by participants who required assistance of staff to mobilise were as follows: (1) keep the call-bell in reach at all times and (2) ask for help to get from the chair to the bed. Participants in total set 1643 goals for their action plan with a median of 2 (1–3) goals per participant.
The most frequent barriers identified to engaging in safe falls prevention behaviours were their own thoughts and feelings about their recovery, in particular the desire to be independent and autonomous.
Needing to get to a toilet quickly was the key task identified as a barrier to safely undertaking falls prevention strategies with 59 (18.5%) participants identifying that it would be hard to keep to their plan of waiting for help or ringing the bell in this situation.
Participants consistently reported that they gained knowledge from the education programme which was described as “…useful and interesting…” and “…very informative, told me what I needed to know”.
Participants also reflected that the education programme gave them the right amount of confidence, stating that it was “…helpful, makes you feel confident but not over-confident”. Some participants specifically reported that they gained motivation and intended to engage in their planned falls prevention strategies such as “…I will now speak up and ask more.”
The study highlights that educators believed the adult learning principles, which informed the education design, led to programme success. Allowing adults to be self-directive in their learning, acknowledging the experience the adult learner brings to the learning and ensuring content is personally relevant enhance engagement and motivation for learning.
The authors identify that, in the context of falls prevention education, this appeared helpful to overcome previous known barriers, namely that older people see little personal relevance and are reluctant to engage in discussion around falls and their prevention.
The full study can be read here.
Hill A-M, FrancisCoad J, Haines TP, et al. ‘My independent streak may get in the way’: how older adults respond to falls prevention education in hospital. BMJ Open 2016;6:e012363. doi:10.1136/bmjopen-2016- 012363