Halton Region Health Department, 1151 Bronte Road, Oakville, ON, L6M 3L1, Canada.
McMaster University School of Nursing, 1280 Main St. W., Health Sciences Centre, Room 3N25B, Hamilton, ON, L8S 4K1, Canada.
BMC Geriatr. 2018 Feb 1;18(1):34. doi: 10.1186/s12877-018-0725-3.
Despite evidence for effective fall prevention interventions, measurable reductions in older adult (≥ 65 years) fall rates remain unrealized. This study aimed to describe the perceived barriers to and effective strategies for the implementation of evidence-based fall prevention practices within and across diverse community organizations. This study is unique in that it included community service providers who are not generally thought to provide fall prevention services to older adults, such as retail business, community support, volunteer services, community foundations, recreation centres, and various emergency services.
Interviews and focus groups were conducted with a purposive sampling of providers (n = 84) in varied roles within diverse community-based organizations across disparate geographical settings.
Community service providers experience significant multi-level barriers to fall prevention within and across organizations and settings. The overall challenge of serving dispersed populations in adverse environmental conditions was heightened in northern rural areas. Barriers across the system, within organizations and among providers themselves emerged along themes of Limited Coordination of Communication, Restrictive Organizational Mandates and Policies, Insufficient Resources, and Beliefs about Aging and Falls. Participants perceived that Educating Providers, Working Together, and Changing Policies and Legislation were strategies that have worked or would work well in implementing fall prevention. An unintentional observation was made that several participants in this extremely varied sample identified expanded roles in fall prevention for themselves during the interview process.
Community service providers experience disabling contexts for implementing fall prevention on many levels: their specific geography, their service systems, their organizations and themselves. A systemic lack of fit between the older adult and fall prevention services limits access, making fall prevention inaccessible, unaccommodating, unavailable, unaffordable, and unacceptable. Educating Providers, Working Together, and Changing Policies and Legislation offers promise to create more enabling contexts for community stakeholders, including those who do not initially see their work as preventing falls.
尽管有预防跌倒的有效干预措施，但仍未实现降低老年（≥65 岁）跌倒率的可衡量目标。本研究旨在描述在不同的社区组织中实施基于证据的跌倒预防实践的感知障碍和有效策略。本研究的独特之处在于，它包括社区服务提供者，这些人通常不被认为向老年人提供跌倒预防服务，例如零售业务、社区支持、志愿服务、社区基金会、娱乐中心和各种应急服务。
对不同地理位置的各种社区组织中具有不同角色的服务提供者（n=84）进行了有针对性的访谈和焦点小组。
社区服务提供者在组织内和跨组织的跌倒预防工作中面临着多方面的重大障碍。在北方农村地区，为处于不利环境条件下的分散人群提供服务的整体挑战更为严峻。整个系统、组织内以及服务提供者自身都存在沟通协调有限、组织授权和政策受限、资源不足以及对衰老和跌倒的看法等障碍。参与者认为，教育提供者、共同努力以及改变政策和法规是在实施跌倒预防方面已经奏效或可能奏效的策略。一个非故意的观察结果是，在这个极其多样化的样本中，有几个参与者在访谈过程中为自己确定了在跌倒预防方面的扩展角色。
社区服务提供者在许多层面上都面临着实施跌倒预防的障碍，包括他们的特定地理位置、服务系统、组织以及他们自身。老年人和跌倒预防服务之间系统缺乏适应性限制了获取机会，使跌倒预防变得不可及、不适应、不可用、不可负担和不可接受。教育提供者、共同努力以及改变政策和法规为社区利益相关者创造了更有利的环境提供了希望，包括那些最初认为自己的工作不是预防跌倒的人。
