Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada.
Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada; Centre for Hip Health & Mobility, Vancouver, British Columbia, Canada. Electronic address: https://twitter.com/DrJenniferDav1.
Appl Nurs Res. 2021 Dec;62:151493. doi: 10.1016/j.apnr.2021.151493. Epub 2021 Sep 1.
Falls impose a prominent public health problem among older adults. Falls are preventable through multi-factorial interventions offered by a Falls Prevention Clinic. Yet, adherence to recommendations is often average or low, particularly for lifestyle recommendations. To achieve full health benefits from such a multifactorial intervention, improving adherence is critical.
Our primary objective was to conduct a narrative review to develop a theoretical framework, categorized by intrinsic and extrinsic factors that impact adherence to falls prevention interventions, considering a Falls Prevention Clinic setting.
We conducted a comprehensive literature review of all peer-reviewed manuscripts published between 1998 through August 2020 among older adults (i.e., aged 60 years and older) who fall. We used the following search engines: Pubmed, CINAHL, Embase, MedLine, Cochrane and Google Scholar.
The theoretical framework categorizes two dominate factors (comprised of specific domains) that affect adherence among older adults who fall. Intrinsic factors comprised of three domains included: demographics (age, gender, ethnicity), individual factors (participation, control, behavioural habits) and health factors (physical health, mental state, perceived severity). Extrinsic factors comprised of four domains included: caregiver factors (family dynamics, miscarried helping) medication factors (availability, accessibility, drug handling, reliability), health system (costs, communication, relationship with doctors, attention) and environmental factors (public health policy interventions). Intrinsic factors such as high socioeconomic status, high health literacy, being married and extrinsic factors such as low healthcare cost, better communication and useful policy interventions were associated with greater adherence.
This theoretical model elucidates priority factors to target for promoting adherence to reduce falls, decrease mortality and, lower fall-related healthcare costs.
老年人中跌倒造成了突出的公共卫生问题。通过跌倒预防诊所提供的多因素干预措施可以预防跌倒。然而，建议的依从性通常是中等或低的，尤其是对于生活方式的建议。为了从这种多因素干预中获得全部健康益处，提高依从性至关重要。
我们的主要目的是进行叙述性综述，以制定一个理论框架，根据内在和外在因素对跌倒预防干预措施的依从性进行分类，考虑到跌倒预防诊所的环境。
我们对 1998 年至 2020 年 8 月期间发表的所有关于老年人（即年龄在 60 岁及以上且跌倒的老年人）的同行评审手稿进行了全面的文献综述。我们使用了以下搜索引擎：Pubmed、CINAHL、Embase、MedLine、Cochrane 和 Google Scholar。
该理论框架将影响跌倒老年人依从性的两个主要因素（由特定领域组成）进行了分类。内在因素包括三个领域：人口统计学（年龄、性别、种族）、个体因素（参与、控制、行为习惯）和健康因素（身体健康、精神状态、感知严重程度）。外在因素包括四个领域：照顾者因素（家庭动态、帮助失误）、药物因素（可用性、可及性、药物处理、可靠性）、卫生系统（成本、沟通、与医生的关系、关注）和环境因素（公共卫生政策干预）。内在因素，如高社会经济地位、高健康素养、已婚，以及外在因素，如低医疗保健成本、更好的沟通和有用的政策干预，与更高的依从性相关。
该理论模型阐明了优先考虑的因素，以促进依从性，从而降低跌倒发生率、死亡率和与跌倒相关的医疗保健成本。
