Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach.

dc.contributor.author

Lai, Wei Xuan

dc.contributor.author

Chan, Angelique Wei-Ming

dc.contributor.author

Matchar, David Bruce

dc.contributor.author

Ansah, John Pastor

dc.contributor.author

Lien, Christopher Tsung Chien

dc.contributor.author

Ismail, Noor Hafizah

dc.contributor.author

Wong, Chek Hooi

dc.contributor.author

Xu, Tianma

dc.contributor.author

Ho, Vanda Wen Teng

dc.contributor.author

Tan, Pey June

dc.contributor.author

Lee, June May Ling

dc.contributor.author

Sim, Rita Siew Choo

dc.contributor.author

Manap, Normala

dc.date.accessioned

2023-10-01T23:25:10Z

dc.date.available

2023-10-01T23:25:10Z

dc.date.issued

2023-09

dc.date.updated

2023-10-01T23:25:06Z

dc.description.abstract

Background

Falls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors can enable clinicians, researchers, and policymakers to clarify goals in falls intervention in older adults.

Methods

A Group Model Building (GMB) exercise was conducted with researchers and clinicians from academic units and public healthcare institutes in Singapore. The aim of the exercise was to produce a shared visual representation of the causal structure for falls and engage in discussions on how current and future falls intervention programmes can address falls in the older adults, especially in the Asian context. It was conducted in four steps: 1) Outlining and prioritising desirable patient outcomes, 2) Conceptual model building, 3) Identifying key intervention elements of effective falls intervention programmes, 4) Mapping of interventions to outcomes. This causal loop diagram (CLD) was then used to generate insights into the current understanding of falls causal relationships, current efforts in falls intervention in Singapore, and used to identify gaps in falls research that could be further advanced in future intervention studies.

Results

Four patient outcomes were identified by the group as key in falls intervention: 1) Falls, 2) Injurious falls, 3) Fear of falling, and 4) Restricted mobility and life space. A CLD of the reciprocal relationships between risk factors and these outcomes are represented in four sub-models: 1) Fear of falling, 2) Injuries associated with falls, 3) Caregiver overprotectiveness, 4) Post-traumatic stress disorder and psychological resilience. Through this GMB exercise, the group gained the following insights: (1) Psychological sequelae of falls is an important falls intervention outcome. (2) The effects of family overprotectiveness, psychological resilience, and PTSD in exacerbating the consequences of falls are not well understood. (3) There is a need to develop multi-component falls interventions to address the multitude of falls and falls related sequelae.

Conclusion

This work illustrates the potential of GMB to promote shared understanding of complex healthcare problems and to provide a roadmap for the development of more effective preventive actions.
dc.identifier

10.1186/s12877-023-04294-2

dc.identifier.issn

1471-2318

dc.identifier.issn

1471-2318

dc.identifier.uri

https://hdl.handle.net/10161/29075

dc.language

eng

dc.publisher

Springer Science and Business Media LLC

dc.relation.ispartof

BMC geriatrics

dc.relation.isversionof

10.1186/s12877-023-04294-2

dc.subject

Humans

dc.subject

Disease Progression

dc.subject

Fear

dc.subject

Accidental Falls

dc.subject

Causality

dc.subject

Systems Analysis

dc.subject

Aged

dc.subject

Singapore

dc.title

Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach.

dc.type

Journal article

duke.contributor.orcid

Matchar, David Bruce|0000-0003-3020-2108

pubs.begin-page

586

pubs.issue

1

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Medicine

pubs.organisational-group

Pathology

pubs.organisational-group

Medicine, General Internal Medicine

pubs.organisational-group

Institutes and Provost's Academic Units

pubs.organisational-group

University Institutes and Centers

pubs.organisational-group

Duke Global Health Institute

pubs.publication-status

Published

pubs.volume

23

Files

Original bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
Group Model Building on causes and interventions for falls in Singapore insights from a systems thinking approach.pdf
Size:
2.06 MB
Format:
Adobe Portable Document Format
Description:
Published version