Reducing Falls Among Community-Dwelling Older Adults From Clinicians' Perspectives: A Systems Modeling Approach.

Autor:	Koh VJW; Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore.; Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore., Matchar DB; Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore.; Department of Medicine (General Internal Medicine), Duke University Medical Center, Durham, North Carolina, USA., Chan AW; Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore.; Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore., Lee JM; Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore., Lai WX; Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore., Rosario D; Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore., George A; Rehabilitation Services, Changi General Hospital, Singapore, Singapore., Ho V; Department of Geriatric Medicine, National University Hospital, Singapore, Singapore., Ismail NHB; Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore., Lien CTC; Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore., Merchant RA; Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore., Tan SM; Rehabilitation Services, Changi General Hospital, Singapore, Singapore., Wong CH; Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore., Xu T; Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore.
Jazyk:	angličtina
Zdroj:	Innovation in aging [Innov Aging] 2023 Jul 20; Vol. 7 (7), pp. igad077. Date of Electronic Publication: 2023 Jul 20 (Print Publication: 2023).
DOI:	10.1093/geroni/igad077
Abstrakt:	Background and Objectives: Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programs in randomized controlled trials demonstrate effectiveness in reducing falls; however, the translation of research into the community remains challenging. Although there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West. As such, this study aims to engage stakeholders in uncovering the factors that facilitate or inhibit implementing community-based fall prevention programs in Singapore, with a focus on the interrelationship between those factors. Research Design and Methods: Health care professionals familiar with fall prevention programs were invited to discuss the enablers and challenges to the implementation. This effort was facilitated using a systems modeling methodology of Group Model Building (GMB) to share ideas and create a common conceptual model of the challenges. The GMB employs various engagement techniques to draw on the experiences and perceptions of all stakeholders involved. Results: This process led to the development of a Causal Loop Diagram (CLD), a qualitative conceptual model of the dynamic relationships between the barriers and facilitators of implementing fall prevention programs. Results from the CLD show that implementation is influenced by two main drivers: health care provider factors that influenced referrals, and patient factors that influenced referral acceptance and long-term adherence. Key leverage points for potential interventions were identified as well. Discussion and Implications: The overall recommendation emphasized closer coordination and collaboration across providers to ensure sustainable and effective community-based fall prevention programs. This has to be supported by a national effort, involving a multidisciplinary stakeholder advisory group. These findings generated would be promising to guide future approaches to fall prevention. Competing Interests: The authors have no conflict of interest to declare. Preliminary findings were presented at the 18th Biennial European Conference of the Society for Medical Decision Making (May 21–23, 2023). (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America.)
Databáze:	MEDLINE
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