Date Presented 4/1/2017
This study demonstrates that occupational therapy fall prevention interventions are beneficial for improving quality of care as part of a coordinated care team within a primary care setting and should further be examined in expanded populations, settings, and interventions.
Primary Author and Speaker: Lydia Royeen
Contributing Authors: Kieran J. Fogarty, Brenda Koverman
PURPOSE: This study identifies if a fall intervention by an occupational therapist decreases fear of falling in a geriatric primary care setting; it begins to establish evidence-based research in primary care. The research question was, Is there an association between fear of falling among a geriatric population and a fall prevention intervention offered by an occupational therapist in a geriatric primary care setting?
BACKGROUND: Falls in the elderly population are the leading cause of injury in persons age >65 yr, and the direct medical care cost of falls was approximately $34 billion in 2013, according to the Centers for Disease Control and Prevention. Fear of falling is an indicator of various negative consequences of the physical, functional, psychological, and social aspects of an individual. These can be addressed through the use of occupational therapy (OT)–based practices.
DESIGN: A quantitative study was conducted in a geriatric primary care setting with cognitively intact, English-speaking individuals age 60+ who were living alone or with family members. Study participants had a fall and/or a near fall within the past year and had not received OT services in the past 2 mo.
METHOD: A pre–post analysis was conducted of the OT intervention, which immediately followed the provider visit within the geriatric primary care office. The intervention components were standardized and nonstandardized. In addition, a two-item open-ended questionnaire was given to the participants. OT was established as a service in the geriatric primary care setting. While obtaining the occupational profile, the occupational therapist identified if a client was eligible. Of the 14 eligible participants, 10 were enrolled in the study. Informed consent was obtained and completed. The Falls Efficacy Scale–International was the pre–post measure; it is a standardized 16-item self-report questionnaire to identify how concerned an individual is about falling during activities of daily living, instrumental activities of daily living, and community engagement activities. Descriptive statistics were performed and a Wilcoxon signed-rank test was conducted using IBM SPSS Statistics Version 23 as the data were nonparametric.
RESULTS: There was a significant (p < .05) association between reduced fear of falling among the geriatric population and a fall prevention intervention offered by an occupational therapist in this geriatric primary care setting. In addition, all study participants identified OT services as beneficial, and the participants’ view of the OT services approach was expanded.
CONCLUSION: In a geriatric primary care setting, it is ideal to have an occupational therapist as part of the interdisciplinary team as they can decrease fear of falling within this population. Limitations of the study include small sample size, single recruitment setting, and lack of long-term effects and outcomes.
IMPACT STATEMENT: This study demonstrates that occupational therapy fall prevention interventions are beneficial for improving quality of care as part of a coordinated care team within a primary care setting and should be further examined in expanded populations, settings, and interventions. This study begins to establish evidence-based research for occupational therapy in the primary care setting.
References
Donnelly, C. A., Brenchley, C. L., Crawford, C. N., & Letts, L. J. (2014). The emerging role of occupational therapy in primary care. Canadian Journal of Occupational Therapy, 81, 51–61. https://doi.org/10.1177/0008417414520683
Lamb, A. J., & Metzler, C. A. (2014). Health Policy Perspectives—Defining the value of occupational therapy: A health policy lens on research and practice. American Journal of Occupational Therapy, 68, 9–14. https://doi.org/10.5014/ajot.2014.681001
Muir, S. (2012). Health Policy Perspectives—Occupational therapy in primary health care: We should be there. American Journal of Occupational Therapy, 66, 506–510. https://doi.org/10.5014/ajot.2012.665001
Ribeiro, O., & Santos, Â. R. (2014). Psychological correlates of fear of falling in the elderly. Educational Gerontology, 41, 69–78. https://doi.org/10.1080/03601277.2014.924272
