A realist evaluation of a multifactorial falls prevention programme in care homes

Leighton, Paul A.; Darby, Janet; Allen, Frances; Cook, Marie; Evley, Rachel; Fox, Chris; Godfrey, Mrs Maureen; Gordon, Adam; Gladman, John; Horne, Jane; Robertson, Mrs Kate; Logan, Pip

Abstract

BACKGROUND: falls in care homes are common, costly and hard to prevent.Multifactorial falls programmes demonstrate clinical and cost-effectiveness, but the heterogeneity of the care home sector is a barrier to their implementation. A fuller appreciation of the relationship between care home context and falls programme delivery will guide development and support implementation. METHODS: this is a multi-method process evaluation informed by a realist approach.Data include fidelity observations, stakeholder interviews, focus groups, documentary review and falls-rate data. Thematic analysis of qualitative data and descriptive statistics are synthesised to generate care home case studies. RESULTS: data were collected in six care homes where a falls programme was trialled. Forty-four interviews and 11 focus groups complemented observations and document review.The impact of the programme varied. Five factors were identified: (i) prior practice and (ii) training may inhibit new ways of working; (iii) some staff may be reluctant to take responsibility for falls; (iv) some may feel that residents living with dementia cannot be prevented from falling; and, (v) changes to management may disturb local innovation.In some care homes, training and improved awareness generated a reduction in falls without formal assessments being carried out. CONCLUSIONS: different aspects of the falls programme sparked different mechanisms in different settings, with differing impact upon falls.The evaluation has shown that elements of a multifactorial falls programme can work independently of each other and that it is the local context (and local challenges faced), which should shape how a falls programme is implemented.

Citation

Leighton, P. A., Darby, J., Allen, F., Cook, M., Evley, R., Fox, C., Godfrey, M. M., Gordon, A., Gladman, J., Horne, J., Robertson, M. K., & Logan, P. (2022). A realist evaluation of a multifactorial falls prevention programme in care homes. Age and Ageing, 51(12), Article afac263. https://doi.org/10.1093/ageing/afac263

• Journal Article Type: Article
• Acceptance Date: Jul 19, 2022
• Online Publication Date: Dec 5, 2022
• Publication Date: Dec 5, 2022
• Deposit Date: Jul 28, 2022
• Publicly Available Date: Dec 6, 2023
• Journal: Age and Ageing
• Print ISSN: 0002-0729
• Electronic ISSN: 1468-2834
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 51
• Issue: 12
• Article Number: afac263
• DOI: https://doi.org/10.1093/ageing/afac263
• Public URL: https://nottingham-repository.worktribe.com/output/9408411
• Publisher URL: https://academic.oup.com/ageing/article/51/12/afac263/6872690