Reducing Falls Among Community-Dwelling Older Adults From Clinicians' Perspectives: A Systems Modeling Approach.

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Koh, Vanessa Jean Wen

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Matchar, David B

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Chan, Angelique Wei-Ming

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Lee, June May-Ling

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Lai, Wei Xuan

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Rosario, Dulcie

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George, Anne

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Ho, Vanda

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Ismail, Noor Hafizah Bte

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Lien, Christopher Tsung Chien

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Merchant, Reshma A

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Tan, Shuyan Melissa

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Wong, Chek Hooi

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Xu, Tianma

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Albert, Steven M

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2023-10-01T23:26:56Z

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2023-10-01T23:26:56Z

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2023-01

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2023-10-01T23:26:53Z

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Background and objectives

Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programs in randomized controlled trials demonstrate effectiveness in reducing falls; however, the translation of research into the community remains challenging. Although there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West. As such, this study aims to engage stakeholders in uncovering the factors that facilitate or inhibit implementing community-based fall prevention programs in Singapore, with a focus on the interrelationship between those factors.

Research design and methods

Health care professionals familiar with fall prevention programs were invited to discuss the enablers and challenges to the implementation. This effort was facilitated using a systems modeling methodology of Group Model Building (GMB) to share ideas and create a common conceptual model of the challenges. The GMB employs various engagement techniques to draw on the experiences and perceptions of all stakeholders involved.

Results

This process led to the development of a Causal Loop Diagram (CLD), a qualitative conceptual model of the dynamic relationships between the barriers and facilitators of implementing fall prevention programs. Results from the CLD show that implementation is influenced by two main drivers: health care provider factors that influenced referrals, and patient factors that influenced referral acceptance and long-term adherence. Key leverage points for potential interventions were identified as well.

Discussion and implications

The overall recommendation emphasized closer coordination and collaboration across providers to ensure sustainable and effective community-based fall prevention programs. This has to be supported by a national effort, involving a multidisciplinary stakeholder advisory group. These findings generated would be promising to guide future approaches to fall prevention.
dc.identifier

igad077

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2399-5300

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2399-5300

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https://hdl.handle.net/10161/29076

dc.language

eng

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Oxford University Press (OUP)

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Innovation in aging

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10.1093/geroni/igad077

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Accidental falls

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Fall prevention

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Group model building

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Implementation

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Systems dynamics

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Reducing Falls Among Community-Dwelling Older Adults From Clinicians' Perspectives: A Systems Modeling Approach.

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Journal article

duke.contributor.orcid

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

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igad077

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7

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Medicine

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Pathology

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Medicine, General Internal Medicine

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Institutes and Provost's Academic Units

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University Institutes and Centers

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Duke Global Health Institute

pubs.publication-status

Published

pubs.volume

7

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