Hostname: page-component-669899f699-qzcqf Total loading time: 0 Render date: 2025-04-28T04:50:28.008Z Has data issue: false hasContentIssue false
  • English
  • Français

A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions

Published online by Cambridge University Press:  03 November 2008

FRANCES BUNN ,
ANGELA DICKINSON ,
ELAINE BARNETT-PAGE ,
ELIZABETH MCINNES  and
KHIM HORTON
FRANCES BUNN*
Affiliation:
Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK.
ANGELA DICKINSON
Affiliation:
Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK.
ELAINE BARNETT-PAGE
Affiliation:
Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK.
ELIZABETH MCINNES
Affiliation:
Royal College of Nursing Institute, Oxford, UK.
KHIM HORTON
Affiliation:
Division of Health and Social Care, University of Surrey, Guildford, Surrey, UK.
*
Address for correspondence: Frances Bunn, Senior Research Fellow, Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

The prevention of falls is currently high on the health policy agenda in the United Kingdom, which has led to the establishment of many falls-prevention services. If these are to be effective, however, the acceptability of services to older people needs to be considered. This paper reports a systematic review of studies of older people's perceptions of these interventions. The papers for review were identified by searching electronic databases, checking reference lists, and contacting experts. Two authors independently screened the studies and extracted data on the factors relating to participation in, or adherence to, falls-prevention strategies. Twenty-four studies were identified, of which 12 were qualitative. Only one study specifically examined interventions that promote participation in falls-prevention programmes; the others explored older people's attitudes and views. The factors that facilitated participation included social support, low intensity exercise, greater education, involvement in decision-making, and a perception of the programmes as relevant and life-enhancing. Barriers to participation included fatalism, denial and under-estimation of the risk of falling, poor self-efficacy, no previous history of exercise, fear of falling, poor health and functional ability, low health expectations and the stigma associated with programmes that targeted older people.

Keywords

health attitudeshealth-related behaviouradherenceolder peoplefalls preventionsystematic review
Type
Research Article
Information
Ageing & Society , Volume 28 , Issue 4 , May 2008 , pp. 449 - 472
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Allen, A. and Simpson, J. M. 1999. A primary care based falls prevention programme. Physiotherapy Theory and Practice, 15, 2, 121–33.CrossRefGoogle Scholar
Aminzadeh, F. and Edwards, N. 1998. Exploring seniors' views on the use of assistive devices in falls prevention. Public Health Nursing, 15, 4, 297–304.CrossRefGoogle Scholar
Aminzadeh, F. and Edwards, N. 2000. Factors associated with cane use among community dwelling older adults. Public Health Nursing, 17, 6, 474–83.CrossRefGoogle ScholarPubMed
Ballinger, C. and Payne, S. 2000. Falling from grace or into expert hands? Alternative accounts about falling in older people. British Journal of Occupational Therapy, 63, 12, 573–9.CrossRefGoogle Scholar
Boyette, L. W., Sharon, B. F. and Brandon, L. J. 1997. Exercise adherence for a strength training program in older adults. Journal of Nutrition, Health and Aging, 1, 2, 93–7.Google ScholarPubMed
Bruce, D. G., Devine, A. and Prince, R. L. 2002. Recreational physical activity levels in healthy older women: the importance of fear of falling. Journal of the American Geriatric Society, 50, 1, 84–9.CrossRefGoogle ScholarPubMed
Butler, M., Coggan, C. and Norton, R. 1998. A qualitative investigation into the receptivity to hip protective underwear among staff and residents of residential institutions. New Zealand Journal of Medicine, 111, 1075, 383–5.Google ScholarPubMed
Bytheway, B. 1995. Ageism. Open University Press, Buckingham.Google Scholar
Cameron, I. D. and Quine, S. 1994. External hip protectors: likely non-compliance among high risk elderly people living in the community. Archives of Gerontology and Geriatrics, 19, 3, 273–81.CrossRefGoogle ScholarPubMed
Campbell, R., Pound, P., Pope, C., Britten, N., Pill, R. and Morgan, M. 2003. Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Social Science and Medicine, 56, 40, 671–84.CrossRefGoogle ScholarPubMed
Chandler, J. M., Duncan, P. W., Sanders, L. and Sudenski, S. 1996. The fear of falling syndrome: relationship to falls, physical performance and activities of daily living in frail older persons. Topics in Geriatric Rehabilitation, 11, 1, 55–63.CrossRefGoogle Scholar
Chater, K. 1999. Risk and representation: older people and non-compliance. Nursing Inquiry, 6, 2, 132–8.CrossRefGoogle Scholar
Cheal, B. and Clemson, L. 2001. Older people enhancing self-efficacy in fall-risk situations. Australian Occupational Therapy Journal, 48, 2, 80–91.CrossRefGoogle Scholar
Clemson, L., Cusick, A. and Fozzard, C. 1999. Managing risk and exerting control: determining follow through with falls prevention. Disability and Rehabilitation, 21, 12, 531–41.CrossRefGoogle ScholarPubMed
Commonwealth of Australia 2000. National Falls Prevention for Older People Initiative ‘Step Out with Confidence’: A Study into the Information Needs and Perceptions of Older Australians Concerning Falls and Their Prevention. Department of Health and Aged Care, Commonwealth of Australia, Canberra.Google Scholar
Cryer, C. 2001. What Works to Prevent Accidental Injury Among Older People? Health Development Agency, London.Google Scholar
Cumming, R. G., Thomas, M., Szonyi, G., Frampton, G., Salkeld, G. and Clemson, L. 2001. Adherence to occupational therapist recommendations for home modifications for falls prevention. American Journal of Occupational Therapy, 55, 6, 641–8.CrossRefGoogle ScholarPubMed
Cummings, S. R., Kelsey, J., Nevitt, M. and O'Dowd, K. 1985. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiological Reviews, 7, 178–208.CrossRefGoogle ScholarPubMed
Department, of Health 2001. National Service Framework for Older People. Department of Health, London.Google Scholar
Dixon-Woods, M., Fitzpatrick, R. and Roberts, K. 2001. Including qualitative research in systematic reviews: opportunities and problems. Journal of Evaluation in Clinical Practice, 7, 2, 125–33.CrossRefGoogle ScholarPubMed
Easterbrook, L., Horton, K., Arber, S. and Davidson, K. 2001. International Review of Falls in Older People. Report for the Health Development Agency and Department of Trade and Industry (DTI), DTI, London.Google Scholar
Edwards, N., Lockett, D., Aminzadeh, F. and Nair, R. 2003. Predictors of bath grab-bar use among community-living older adults. Canadian Journal on Aging, 22, 2, 217–27.CrossRefGoogle Scholar
Egger, G., Davey-Smith, G. and Altman, D. (eds)2001. Systematic Reviews in Health Care: Meta-analysis in Context. BMJ Books, London.CrossRefGoogle Scholar
Gavin, T. S. and Myers, A. M. 2003. Characteristics, enrolment, attendance, and dropout patterns of older adults in beginner Tai-chi and line-dancing programs. Journal of Aging and Physical Activity, 11, 1, 123–41.CrossRefGoogle Scholar
Giacomini, M. and Cook, D. 2000. User's guide to the medical literature: XXIII. Qualitative research in health care. B. What are the results and how do they help me care for my patients? Evidence Based Medicine Working Group. Journal of American Medical Association, 284, 4, 478–82.Google Scholar
Gillespie, L. D., Gillespie, W. J., Robertson, M. C., Lamb, S. E., Cumming, R. G. and Rowe, B. H. Interventions for preventing falls in elderly people. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD000340. DOI: 10.1002/14651858.CD000340.CrossRefGoogle Scholar
Green, S. and Higgins, J. (eds)2005. Cochrane Handbook for Systematic Reviews of Interventions. Version 4.2.5 (updated May 2005), Available online at http://www.cochrane.org/resources/handbook/hbook.htm [Accessed June 2005].Google Scholar
Grimley Evans, J. 1997. The rationing debate. Rationing healthcare by age: the case against. British Medical Journal, 314, 822.CrossRefGoogle Scholar
Grossman, M. D. and Stewart, A. L. 2003. ‘You aren't going to get better by just sitting around’: physical activity perceptions, motivations, and barriers in adults 75 years of age or older. American Journal of Geriatric Cardiology, 12, 1, 33–7.CrossRefGoogle ScholarPubMed
Harden, A., Garcia, J., Oliver, S., Rees, R., Shepherd, J., Brunton, G. and Oakley, A. 2004. Applying systematic review methods to studies of people's views: an example from public health research. Journal of Epidemiology and Community Health, 58, 9, 794–800.CrossRefGoogle ScholarPubMed
Health Education Board for Scotland 2003. The Construction of the Risks of Falling in Older People: Lay and Professional Perspectives. Health Education Board for Scotland, Edinburgh.Google Scholar
Higgins, J. P. T. and Green, S. (eds)2006. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6. Online Cochrane Library. Available online at http://www.cochrane.org/resources/handbook/hbook.htm [Accessed 6 October 2006].Google Scholar
Hinman, M. R. 1998. Causal attributions of falls in older adults. Physical and Occupational Therapy in Geriatrics, 15, 3, 71–84.CrossRefGoogle Scholar
Horton, K. 2002. Gender and Falls: Older People and Key Family Members' Perspectives. Unpublished PhD thesis, Department of Sociology, University of Surrey, Guildford, Surrey.Google Scholar
Jensen, G. F., Christiansen, C., Boesen, J., Hegedus, V. and Transbol, I. 1982. Epidemiology of postmenopausal spinal and long bone fractures: a unifying approach to postmenopausal osteoporosis. Clinical Orthopaedics, 166, 75–81.CrossRefGoogle Scholar
Lachman, M. E., Howland, J., Tennstedt, S., Jette, A., Assmann, S. and Peterson, E. W. 1998. Fear of falling and activity restriction: the survey of activities of fear of falling in the elderly (SAFE). Journal of Gerontology: Psychological Sciences, 53B, 1, 43–50.CrossRefGoogle Scholar
Lilley, J., Arie, T. and Chilvers, C. 1995. Accidents involving older people: a review of the literature. Age and Ageing, 24, 4, 346–65.CrossRefGoogle ScholarPubMed
Lu-Yao, G. L., Baron, J. A., Barrett, J. A. and Fisher, E. S. 1994. Treatment and survival among elderly Americans with hip fractures: a population-based study. American Journal of Public Health, 84, 8, 1287–91.CrossRefGoogle ScholarPubMed
Magaziner, J., Simonsick, E. M., Kashner, T. M., Hebel, J. R. and Kenzora, J. E. 1989. Survival experience of aged hip-fracture patients. American Journal of Public Health, 79, 3, 274–8.CrossRefGoogle ScholarPubMed
Mays, N. and Pope, C. 1995. Qualitative research: rigour and qualitative research. British Medical Journal, 311, 109–12.CrossRefGoogle ScholarPubMed
McCormack, B. 2003. A conceptual framework for person-centred practice with older people. International Journal of Nursing Practice, 9, 3, 202–9.CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence (NICE ) 2004. Falls: The Assessment and Prevention of Falls in Older People: Clinical Guideline. NICE, London.Google Scholar
Parker, M. J., Twemlow, T. R. and Pryor, G. A. 1996. Environmental hazards and hip fractures. Age and Ageing, 25, 4, 322–5.CrossRefGoogle ScholarPubMed
Parker, M. J., Gillespie, W. J. and Gillespie, L. D. 2005. Hip Protectors for Preventing Hip Fractures in Older People. Cochrane Database of Systematic Reviews 2005, Issue 3. Available online at http://www.cochrane.org/reviews/en/ab001255.html [Accessed 26 September 2007].CrossRefGoogle Scholar
Peersman, G., Harden, A., Oliver, S. and Oakley, A. I. 1998. Reviews of Effectiveness in Health Promotion. Report for the Department of Health, EPPI-Centre, London.Google Scholar
Rejeski, W. J., Brawley, L. R., Ettinger, W., Morgan, T. and Thompson, C. 1997. Compliance to exercise therapy in older participants with knee osteoarthritis: implications for treating disability. Medicine and Science in Sports and Exercise, 29, 8, 977–85.CrossRefGoogle ScholarPubMed
Resnick, B. 2001. A prediction model of aerobic exercise in older adults living in a continuing-care retirement community. Journal of Aging and Health, 13, 2, 287–310.CrossRefGoogle Scholar
Resnick, B. 2002. Testing the effect of the WALC intervention on exercise adherence in older adults. Journal of Gerontological Nursing, 28, 1, 40–9.CrossRefGoogle ScholarPubMed
Resnick, B. and Spellbring, A. M. 2000. Understanding what motivates older adults to exercise. Journal of Gerontological Nursing, 26, 3, 34–42.CrossRefGoogle ScholarPubMed
Ryles, S. M. 1999. A concept analysis for empowerment: its relationship to mental health nursing. Journal of Advanced Nursing, 29, 3, 600–7.CrossRefGoogle ScholarPubMed
Sandelowski, M., Docherty, S. and Emden, C. 1997. Qualitative metasynthesis: issues and techniques. Research in Nursing and Health, 20, 4, 365–71.3.0.CO;2-E>CrossRefGoogle ScholarPubMed
Sharon, B. H., Hennessy, C. H., Brandon, J. and Boyette, L. 1997. Older adults' experiences of a strength training program. Journal of Nutrition, Health and Aging, 1, 2, 103–8.Google ScholarPubMed
Simpson, J. M., Darwin, C. and Marsh, N. 2003. What are older people prepared to do to avoid falling? A qualitative study in London. British Journal of Community Nursing, 8, 4, 152, 154–9.CrossRefGoogle Scholar
Spencer, L., Ritchie, J., Lewis, J. and Dillon, L. 2003. Quality in Qualitative Evaluation: A Framework for Assessing Research Evidence. Government Chief Social Researcher's Office, Cabinet Office, London. Available online at http://www.policyhub.gov.uk/docs/a_quality_framework.pdf [Accessed 26 September 2007].Google Scholar
Stead, M., Wimbush, E., Eadie, D. and Teer, P. 1997. A qualitative study of older people's perceptions of ageing and exercise: the implications for health promotion. Health Education Journal, 56, 1, 3–16.CrossRefGoogle Scholar
Thomas, J., Sutcliffe, K., Harden, A., Oakley, A., Oliver, S., Rees, R., Brunton, V. and Kavanagh, J. 2003. Children and Healthy Eating: A Systematic Review of Barriers and Facilitators. Social Science Research Unit, EPPI Centre, Institute of Education, University of London, London.Google Scholar
Tones, K. 1998. Empowerment for health: the challenge. In Kendall, S. (ed.) Health and Empowerment. Arnold, London, 185–204.Google Scholar
Yardley, L. and Smith, H. 2002. A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. The Gerontologist, 42, 1, 17–23.CrossRefGoogle ScholarPubMed
Yardley, L. and Todd, C. 2005. Encouraging Positive Attitudes to Falls Prevention in Later Life. Help the Aged, London.Google Scholar