2011 Annual Conference

Gleeson, Peggy

To gather information on the content and features which are most useful for a fall risk screen, based on the preferences of individual geriatric care workers in different components of a senior care agency in Houston, Texas. This information could guide the development of an integrated fall-risk screening procedure for all geriatric workers.

Thirteen workers were from the agency’s components: Day Center, Case Management, Home Care, and Outreach to Potential Clients.

This was a qualitative study, using a semi-structured interview. Two researchers conducted the interviews; one researcher guided the questions and comments and the other researcher observed and took notes. Each geriatric care worker attended only one interview session. The researcher asked the same open-ended introductory questions and explored different opinions of an ideal fall risk intake form at each of three separate interview sessions. The interviews were tape recorded and then transcribed into a computer verbatim by the primary investigator (PI) to preserve the language of the participants.

Triangulation was used for establishing the reliability of identified emerging themes from the interview. Data coding was performed by the PI and a physical therapist (PT) experienced in qualitative research who did not participate in the interview. The PI and the PT reached consensus on the identified themes through discussion during three scheduled meetings. When no new codes or themes emerged from the interviews, data collection ended. The transcripts were reviewed by two interviewees to assure final agreement on the accuracy. Furthermore, the themes were confirmed by the interviewing researcher who participated in the interview but not in data coding.

Two major themes were identified: (1) factors which are relevant in assessing fall risk and (2) factors which affect the utility of the fall risk screening procedure. Under theme (1) are 6 categories: fall history, physical function, impairments, medications, mental and psychological status, and home environment. Under theme (2) are 3 categories: methods of gathering information for fall risk assessment, features useful to a fall risk assessment form, and actions taken in response to fall risk assessment. The 6 fall risk categories identified in the interviews were combined with 2 other categories identified in the literature review, health status and fear of falling, to produce a universal form for use by different agency components. A 3-step procedure is proposed to improve the effectiveness of fall-risk screening: (1) Initial screening with an outreach worker using a quick question assessment. (2) Follow up with a more comprehensive fall risk assessment. (3) Recommendation of a “what-to-do” action plan is presented for each item based on each question’s response on the comprehensive form.

Integrating all fall-risk categories into a universal form improves the completeness of the form used by different senior care agencies. A 3-step procedure with an integrated follow-up service plan is proposed to improve the utility of the fall risk screening.

The integrated fall-risk screening form and 3-step screening procedure can be easily administered by all geriatric care workers as part of their routine practice for systematically identifying elders at risk of falling. Intervention strategies could then be applied to reduce fall risk.