Study In China Designs New Strategy For Fall Prevention Among Older Adults

Maoyi Tian, PhD

A recent study from investigators in China identified several major facilitators and barriers to the implementation of fall prevention for the country’s elder population.

A rapidly-growing elderly population in China has made the issue of falls more apparent at the primary care level, explained study authors Pengpeng Ye, MPH, and Maoyi Tian, PhD, of the Harbin Medical University School of Public Health.

The incidence rate of falls among the Chinese population aged ≥60 years was 3799.4 per 100,000 population in 2019. The mortality rate due to falls was 39.2 per 100,000 population in the same year. Researchers noted several diverse fall prevention programs were previously implemented, but most of them were only implemented in the context of research or were simply too small in scale. Consequently, the new study was viewed as an important topic.

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“The current fall-prevention interventions often told older residents how to prevent falls, rather than listening and responding to their needs, which could be characterized as ‘a program was done for older people’ not ‘a program was done with older people,’” the researchers wrote.

The study targeted factors associated with falls in elderly populations, and aimed to further provide strategies for better implementation of fall prevention.

Research and Methods

The research on fall prevention involved a qualitative study, performed in 3 regions with differing geographic locations and socioeconomic statuses: Chang’an District of Shijiazhuang City from Hebei Province, Beilun District of Ningbo City from Zhejiang Province, and Longhua District of Shenzhen City from Guangdong Province.

The study used 2 groups of participants: fall prevention service professionals and consumers, with professionals including both health administrators from each area’s health commission/bureau and staff members from local Center for Disease Control and Prevention (CDC) and primary health care (PHC) institutions.

Residents aged ≥65 years were eligible if they lived in the selected communities and were willing to provide informed consent. Those with serious medical conditions were excluded from participation. PHC institution administrators conducted in-depth interviews with the research participants, including focus group discussions. Both the study’s interview and discussion guides were crafted based on the Consolidated Framework for Implementation Research (CFIR).

Study Findings

Researchers interviewed a total of 130 participants, who were invited for either in-depth interviews (6 interviews lasting 50 - 70 minutes) or focus group discussions (19 discussions with about 6 participants in each 90-minute session). After interviews were transcribed, the data was analyzed by researchers. Facilitators and barriers contributing to falls were summarized and developed into a recommendation framework.

The 3 major facilitators for fall prevention were listed by researchers as “clear recognition of the challenges and benefits of falls prevention, an adaptive regionally tailored guidance plan, and continuous governmental policy and financial support.”

Researchers listed the 3 primary barriers to prevention as “insufficient confidence in delivering interventions and poor understanding of the magnitude of falls, low recognition of the importance of falls prevention, limited multisectoral collaboration, and weak financial incentives.”

Strategy Design

A framework was designed by the researchers to address barriers identified in the study, with 7 interrelated strategies created in response:

• Data-driven surveillance, to improve lack of understanding of fall prevention needs.
• Audits and feedback, in response to lack of performance assessment, with the individual efforts of clinicians gauged by factors such as number of consultations per year, the number of attendants of each education lecture, and proportion of elderly residents receiving the fall-risk screening.
• A new implementation strategy that seeks to conduct studies to evaluate the effectiveness of a regionally-tailored fall prevention program.
• Empowerment of the community, providing motivation for fall prevention among older people.
• Internal services integration optimizing resources for fall prevention (e.g., fall-related risk information such as poor vision or the intake of multiple medications, applied to provide services in fall risk screening, prediction, and management).
• An external enabling environment to emphasize the potential use of external human resources and financial support agencies (e.g., accessible transport infrastructure reducing the risk of falls would require construction and support from the department of transportation and urban construction rather than the health sectors).

The authors acknowledged that factors were qualitatively identified without causal inference, and that further quantitative surveys may be warranted to triangulate the study’s findings. This study’s findings were designed to reflect the participants’ needs and perspectives on their public health care system.

Tian, Ye, and colleagues concluded their research by adding that the findings have the potential to provide helpful insights for both their country’s primary health care system as well as others experiencing challenges relating to promoting fall prevention for older populations.

The study, “Perceptions of Facilitators and Barriers to Implementation of Falls Prevention Programs in Primary Health Care Settings in China,” was published online by JAMA Network Open.