News (June 2006)

Pilot study predicts intention to implement home modifications for fall prevention.

A recent pilot study suggests that the attitudes of older persons toward home modifications, coupled with past behaviors, best predict their intention to implement home modifications for fall prevention. The model suggests that older adults will have a greater intention to implement home modifications if they believe that such modifications will reduce falls, and if they have previously adopted some fall prevention adaptations to their home.

Researchers Hon Keung Yuen and Rickey E. Carter, both from the Medical University of South Carolina, have concluded that the following factors combined can predict the intention to implement home modifications for fall prevention: (1) the belief that home modifications are beneficial; (2) the belief that changes made to the environment can help prevent future falls; and (3) a history of changes made in the home environment.

Studies have shown that there are many reasons older adults do not adhere to recommended home modifications. Some of the reasons for nonadherence involve finances, psycho-social factors, and the person’s residential setting. The reluctance to implement home modifications remains even after some older adults have experienced a fall. The studies also found that the following were not related to adherence/nonadherence to recommended home modifications: (1) sociodemographic attributes of older adults; (2) fall history; (3) fear of falling and fall efficacy; (4) existing medical conditions and number of medications; (5) cognitive and functional abilities; and (6) the number of home hazards.

The study by Yuen and Carter, entitled “A predictive model for the intention to implement home modifications: A pilot study,” appeared in the February 2006 issue of the Journal of Applied Gerontology.

Management of Hip Fracture: The Family Physician's Role

SHOBHA S. RAO, M.D., and MANJULA CHERUKURI, M.D.,
University of Texas Southwestern Medical Center, Dallas, Texas

The incidence of hip fracture is expected to increase as the population ages. One in five persons dies in the first year after sustaining a hip fracture, and those who survive past one year may have significant functional limitation. Although surgery is the main treatment for hip fracture, family physicians play a key role as patients' medical consultants. Surgical repair is recommended for stable patients within 24 to 48 hours of hospitalization. Antibiotic prophylaxis is indicated to prevent infection after surgery. Thromboprophylaxis has become the standard of care for management of hip fracture. Effective agents include unfractionated heparin, low-molecular-weight heparin, fondaparinux, and warfarin. Optimal pain control, usually with narcotic analgesics, is essential to ensure patient comfort and to facilitate rehabilitation. Rehabilitation after hip fracture surgery ideally should start on the first postoperative day with progression to ambulation as tolerated. Indwelling urinary catheters should be removed within 24 hours of surgery. Prevention, early recognition, and treatment of contributing factors for delirium also are crucial. Interventions to help prevent future falls, exercise and balance training in ambulatory patients, and the treatment of osteoporosis are important strategies for the secondary prevention of hip fracture.

Of those who survive one year after hip fracture, only 40 percent can perform all routine activities of daily living and only 54 percent can walk without an aid.1,2 Although surgical repair usually is needed after hip fracture, family physicians play an important role in supporting patients through the treatment process, facilitating rehabilitation and recovery, and initiating secondary prevention strategies.

To view the full-text article please click here

Modifying the home and behavior can reduce fear of falling.

Study results suggest that modifying the home and behavior can ameliorate home hazards and fear of falling.

A recent study in the Journal of the American Geriatrics Society (JAGS) reports that implementing appropriate home modifications and behavior changes among older adults can improve their quality of life.

To view the full-text article please click here