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Managing concerns about falls in older people: evaluation of the implementation of an evidence-based program

Zicht op Evenwicht. Evaluatie van een landelijk geïmplementeerde cursus gericht op het verminderen van bezorgdheid om te vallen bij zelfstandig wonende ouderen

  • Published:
Tijdschrift voor Gerontologie en Geriatrie

Abstract

Introduction

A cognitive behavioral program reduced concerns about falling and related avoidance behavior among older community-dwelling adults in a randomized controlled trial. In the current study we examined the effects and acceptability of the program after nation-wide implementation into home care organizations in The Netherlands.

Methods

In a one-group pretest–posttest study with data collection before the start of the program and at 2 and 4 months, the effects and acceptability of the program were assessed in 125 community-dwelling older people. The outcomes of the effect evaluation included concerns about falls, related avoidance behavior, falls, fall-related medical attention, feelings of anxiety, symptoms of depression, and loneliness.

Results

Pretest-posttest analyses with the Wilcoxon signed-rank test and the paired t-test showed significant improvements at 4 months for concerns about falls, activity avoidance, number of falls in the past 2 months, feelings of anxiety, and symptoms of depression. No significant differences were shown for the other outcomes.

Discussion

After implementation in home care organizations, the outcomes indicate positive program effects on concerns about falls, avoidance behavior, and falls in community-dwelling older people. Given the similarity in results, i.e. between those of the previously performed randomized controlled trial and those of the current pretest-posttest study, we conclude that the program can be successfully implemented in practice.

This article is an adjusted, Dutch version of Zijlstra GA, van Haastregt JC, Du Moulin MF, de Jonge MC, van der Poel A, Kempen GI. Effects of the implementation of an evidenc-based program to manage concerns about falls in older adults. The Gerontologist 2013;53(5):839–849; doi:10.1093/geront/gns142

Samenvatting

Inleiding

In een gerandomiseerd onderzoek liet een cognitief gedragsmatige cursus, Zicht op Evenwicht, positieve effecten zien op bezorgdheid om te vallen en gerelateerd vermijdingsgedrag bij zelfstandig wonende ouderen. Het huidige onderzoek richt zich op de effecten en uitvoerbaarheid van deze cursus na (landelijke) implementatie in thuiszorgorganisaties.

Methode

In een pre-experimenteel onderzoek met een voormeting en nametingen na twee en vier maanden is Zicht op Evenwicht geëvalueerd bij 125 zelfstandig wonende ouderen. De effectmaten betroffen bezorgdheid om te vallen, gerelateerd vermijdingsgedrag, valincidenten, medische hulp na een valincident, gevoelens van angst, symptomen van depressie en eenzaamheid.

Resultaten

Met de Wilcoxon signed-rank test en de gepaarde t-test is een significante verbetering waargenomen tussen de voormeting en de laatste nameting voor bezorgdheid om te vallen, gerelateerd vermijdingsgedrag, aantal valincidenten, gevoelens van angst en symptomen van depressie. De andere uitkomsten verschilden in deze analyses niet significant.

Discussie

Ook na implementatie in de thuiszorgorganisaties lijkt de cursus Zicht op Evenwicht een positief effect te hebben bij zelfstandig wonende ouderen, op onder andere bezorgdheid om te vallen, gerelateerd vermijdingsgedrag en valincidenten. Gezien de overeenkomsten met de resultaten uit het gerandomiseerde onderzoek kan worden gesteld dat de cursus succesvol te implementeren is in thuiszorgorganisaties.

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Dankwoord

Onze dank gaat uit naar alle deelnemende thuiszorgorganisaties en cursisten. Tevens zijn we dankbaar voor de inzet en betrokkenheid bij het implementatieproject van: Ineke Voordouw (ZonMw), Marina van Montfort (Orbis GGZ), Iris Verschooten (Orbis Thuiszorg), Alie Fokkens (Stichting Thuiszorg Midden-Gelderland) en Hilda Sombetzki (Meander Thuiszorg). De implementatie van Zicht op Evenwicht is gefinancierd door ZonMw Preventiekracht (projectnummer 120720009).

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Authors and Affiliations

  1. Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

    G. A. R. Zijlstra, J. C. M. van Haastregt & G. I. J. M. Kempen

  2. CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands

    G. A. R. Zijlstra, J. C. M. van Haastregt & G. I. J. M. Kempen

  3. Faculteit Gezondheid, Zuyd Hogeschool, Heerlen, The Netherlands

    M. F. M. T. Du Moulin

  4. Trimbos-Instituut, Utrecht, The Netherlands

    M. de Jonge & A. van der Poel

Authors
  1. G. A. R. Zijlstra
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  2. M. F. M. T. Du Moulin
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  3. J. C. M. van Haastregt
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  4. M. de Jonge
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  5. G. I. J. M. Kempen
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  6. A. van der Poel
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Corresponding author

Correspondence to G. A. R. Zijlstra.

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Zijlstra, G.A.R., Du Moulin, M.F.M.T., van Haastregt, J.C.M. et al. Managing concerns about falls in older people: evaluation of the implementation of an evidence-based program. Tijdschr Gerontol Geriatr 44, 272–284 (2013). https://doi.org/10.1007/s12439-013-0045-1

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  • DOI: https://doi.org/10.1007/s12439-013-0045-1

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