https://doi.org/10.33698/NRF0288-Arica Mayanglambam Devi, Jasbir Kaur, Kanika Rai, Jyoti Sarin
ABSTRACT:
Background: The frequency of falls increases when age increases and elderly people are the main victim. 2nd largest population of geriatric is standing by India in the world, which is 1/8th of the whole total population of geriatric. Objectives: (i) To develop and implement the information booklet on knowledge and expressed practices to prevent falls among elderly (ii) To assess impact of information booklet on knowledge and expressed practices to prevent falls among elderly (iii) To determine the relationship between the knowledge and expressed practices regarding risk factors and safety measures to prevent falls among elderly. Material and methods: A Quasi Experimental Non-Equivalent Control Group pre-test post-test Design was used and a sample of sixty elderly experiencing fall in last two years were selected using purposive sampling technique and divided into experimental (n=30) and comparison (n=30) group. Intervention in the form of information booklet which contain multifactorial program about diet, exercise and home modication was given to experimental group. Comparison group was allowed to follow routine practice. The data collection tools used were “History of Fall Assessment (In Last Two Years), Interview schedule comprised of 1) Socio-Demographic Data, 2) History of falls and related factors 3) knowledge and expressed Practices related to fall. Participants were interviewed as per interview Schedule before and after implementation of intervention. Results: The ndings of the study showed that the Knowledge and expressed practices score of elderly improved knowledge after implementation of information booklet in experimental group as compared to comparison group. The ndings further showed relationship of knowledge and expressed practices scores showed strong positive relationship 0.65 (0.001**) and 0.80 (0.001**) in experimental and comparison group. Conclusion: The study concluded there was a signicant positive correlation between knowledge and expressed practices among elderly. Information booklet is effective in improving knowledge and expressed practices among elderly.
Keywords: knowledge, expressed practices, risks factors, safety measures, falls.
Corresponding Author:
Kanika Rai Professor
M.M. College of Nursing nehukanu@gmail.com 9872820564
Introduction
Among the impacts and damages to the elderly’s health, it was found that the prevalence of chronic non-communicable diseases and external causes (such as falls and accidents), feature a signicant magnitude and are major causes of morbidity and mortality.1 In this context, it is important to note that the falls occur up to 32% of elderly people aged 65 to 74 years and 51% of elderly people over 85 years.2 In the daily lives of the elderly, many people suffer a lot with a huge burden to the family, health sector, and economy of the country. Many elderly people experience emotional problems such as loss of condence, fear, and anxiety following falls which may lead to lack of motivation to do factors can facilitate or promote the day-to-day normal activities in life.6 Each occurrence of falls. These factors are divided into two major groups: intrinsic, which are inherent to the person and related to the biological and psychosocial changes associated with aging; and extrinsic, which results from the interaction of the elderly with the environment, for example, quality of ooring and lighting in their residences, access to public transportation and recreational areas, among others. However, for being multifactorial events, these factors are related to the ability to maintain the skills needed to perform basic and instrumental activities of daily living, perceived as a requirement to live with independence and autonomy, so it is often difcult to report them separately.3Thus, the high prevalence of falls can have serious consequences on the quality of life of the elderly, which can result in prolonged hospitalization, institutionalization, restriction of activities and mobility, changes in balance and postural control, social isolation, anxiety and depression.4
Falls and fall-induced injuries in elderly people are major public health problems in most of the regions of the world. Fall is dened as “in-advertently coming to rest on the ground, oor or other lower level, excluding intentional change in position to rest in furniture, wall or other objects” .5 Falls in older age may cause disabilities and morbidities; as a result, year 28–35% of people over 65 years and 32–42% of people over 70 years experience falls.[5] Risk factors for falls among elderly people are multifactorial, including complex interaction of biological, b e h a v i o u r a l , e n v i r o n m e n t a l , a n d socioeconomic factors.6
Falls in elderly are the most serious event to have morbidity and mortality. The cause of falling in elderly has various factors, and to prevent falls, it is necessary to promote safety measures programme. The injury level of the people after fall will depend on increase of height and force hit and the surface areas which they hit i.e. hard area or objects which cause to hit. The fear of falling can cause deconditioning, cause to have morbidities, disabilities, and sometimes death and still without a physical cause for falling. Falls can cause fracture, afraid of fall, anxiety and depression, all of these can lead to higher chance of disability.7
Objectives
- To develop and implement the information booklet on knowledge and expressed practices to prevent falls among
- To assess the effectiveness of information booklet on knowledge and expressed practices to prevent falls among elderly
- To determine the relationship between
the knowledge and expressed practices regarding risk factors and safety measures to prevent falls among elderly.
Material and methods
The present study was quantitative with quasi experimental design. It was conducted among elderly population of village Budiyon and Simbla village of Ambala, Haryana. In order to identify the elderly people, every house was visited in sequence and out of them 60 elderly people were selected who had fall within two years. Sixty elderly were selected by purposive sampling technique (n=60). The data was collected by Interview (Self report). Ethical approval to conduct study
Practices contained 18 items scored on a 3- point scale (Most of the time:3, sometime:2 and never:1). Reverse scoring was done for negative items. The maximum score was 54 and a minimum was 18. The score range of 43-54 was categorised as Very good, score range of 31-42 was categorised as good and score range 18-30 was categorised as poor score.
The reliability coefcient for knowledge section and expressed practices section was calculated by KR20 and Cronbach alpha and it was found to be 0.7 and 0.7 respectively. English version of the tools were translated into Hindi. Pre-test was taken on rst day. In experimental group, intervention ( multifactorial programme) was given for 30 minutes with was obtained from Institutional Ethics the help of booklet on 2nd day including Committee [IEC=960] of M.M (Deemed to be University), Mullana. Consent form was taken from the patients regarding their willingness to participate in the research project. Study included those elderly of 60 years and above, who can understand Hindi.
Data was collected through face to face interview (self-report) using an Interview schedule comprising of 1 ) Socio- Demographic Data, 2) History of falls and related factors 3) knowledge and expressed P r a c t i c e s r e l a t e d t o f a l l . S o c i o – Demographic Data section consisted of 13 items, History of Fall Assessment (In Last Two Years) consisted of 8 i tems, Knowledge section had 25 items and a score of one was given for each correct response whereas zero was awarded for each wrong response. Score 18-25 was categorised as very good score, 9-17 score was categorised as good score and 0-8 score was categorised as poor score. Expressed information related to diet, exercise and home modication. Pre-test was taken on rst day. Post-test was taken after 15 days. And in comparison, group, intervention was given after post-test. Data were analysed by using SPSS-20.
Results
Total 60 elderly completed the study. Table – 1 showed that most of elderly were females in both experimental and comparison group. Nearly half of the elderly were in the age group of 60-69 years in the experiment in the comparison group. Above half of the elderly were married. Half of the elderly were under weight and non-literate and most of elderly were unemployed respectively. Most of the elderly in both the experimental and comparison group were having no income.Both the groups were comparable in respect to all socio demographical variables as per chi square test ( p>0.05)
Table 1: Socio demographic profile of the elderly
N=60
| S. No | Selected variables | Experimental group
f(%) |
Comparison group
f(%) |
Chi square/fish er’s exact test
X2 (df) p |
| 1
1.1 1.2 |
Gender:
Male Female |
09(30)
21(70) |
08(26.7)
22(73.3) |
0.08 (1)
0.77 |
| 2
2.1 2.2 2.3 |
Age (in years):
60-69 70-79 80 & above |
16(53.3)
13(43.3) 01(3.3) |
17(56.7)
10(33.3) 03(10) |
1.42 (2)
0.49 |
| 3
3.1 3.2 |
Marital status:
Married DivorcedW/ idow/Separated |
19(63.3)
11(36.7) |
25(83.3)
05(16.7) |
3.07 (1)
0.08 |
| 4
4.1 4.2 4.3 |
BMI:
< 18.5 (Unde-rweight) 18.5 to 24.5 (Healthy) 25 to 29.9 (Overweight) |
15(50.0)
14(46.7) 1( 3.3) |
09(30.0)
16(53.3) 05(16.7) |
4.3 (2) 0.12 |
| 5
5.1 5.2 5.3 |
Education:
Non literate Up toMiddle school certicate High school certicaatend above |
19(63.3)
08(16.7) 03(10.0) |
20(66.7)
05(16.7) 05(16.7) |
1.22 (2) 0.5 |
| 6
6.1 6.2 6.3 |
Occupation: Unemployed Retired
Farmer/Labor |
23(76.7)
02(6.7) 05(16.7) |
22(73.3)
02(6.7) 06(20) |
0.11(2)
0.94 |
| 7
7.1 7.2 7.3 7.4 |
Personal income(in Rs)/Month :
Nil < 10,000 > 10,000 |
23(76.7)
02(6.7) 05(16.7) |
23(76.7)
04(13.3) 03(10.0) |
1.17(2)
0.56 |
Findings presented in Table – 2 showed the personal prole of elderly in both the groups. It depicts that majority of the elderly were non-smokers i.e. 73.3% in experimental group and 90% in comparison group. Majority of the elderly (80% in experimental group and 76.6% in comparison group) were having impaired visual acuity. More than half of elderly were not suffering from any disease (60% experimental group and 53.4% in comparison group). Nearly half of the elderly were taking medications. Majority of the elderly were not using walking aids. Both the groups were comparable in terms of all the personal prole variables as per chi square/Fisher’s exact test (p>0.05)
Table 2: Personal profile of the elderly in experimental and comparison group
N=60
| S. No | Selected variables | Experimen tal group f(%) | Compar ison group
f(%) |
X2 (df) p |
| 1
1.1 1.2 1.3 |
Smoking status
Non smoker Ex smoker (in details) Current smoker |
22(73.3) 03(10.0) 05(16.7) |
27(90) 01(3.3) 02(6.7) |
2.8 (2) 0.25 |
| 2
2.1 2.2 |
Visual acuity
Normal Impaired (whether using any aids/connective devices) |
06(20) 24(80) |
07(23.3) 23(76.7) |
0.09(1) 0.75 |
| 3
3.1 3.2 3.3 3.4 3.5 |
Suffering from any disease
No Hypertension Diabetes Mellitus Arthritis Hypertension with diabetes mellitus |
18(60.0) 05(16.7) 03(10) 01(3.3) 03(10) |
16(53.4) 09(30.0) 04(13.3) ———– 01(3.3) |
2.38(4) 0.66 |
| 4
4.1 4.2 4.3 |
Medications
No Antihypertensive drugs Hypoglycemicagents Analgesic |
16(53.3) 08(26.7) 06(20) 02(6.7) |
13(54.3) 09(30) 04(13.3) ———- |
0.66(3) 0.88 |
| 5 | Use of walking aids
Yes No |
07(23.3) 23(86.7) |
08(26.7) 22(85.3) |
0.09(1) 0.77 |
Table – 3 showed that more than half of the elderly had fall once in last two years in experimental (63.3%) and comparison group (76.7%). More than half of the elderly were fell inside the house in experimental (56.6%) and comparison group (53.3%). More than one-third of them had fall at morning in experimental (36.6%) and comparison group(33.3%).. Less than half of elderly had fall due to slipped while ambulation and one- third of elderly felt pain in both the groups. Maximum number of elderly were not undergone for hospitalization after fall in both groups. Both the groups were comparable in relation to all the variables regarding fall.
Table 3 : History of falls in last two years among elderly in experimental and comparison group N=60
| Sl. No. | Selected variables | Experimental group f(%)
(n=30) |
Comparison group f(%)
(n=30) |
X2(df) p |
| 1 | Fall in last two years | |||
| 1.1 | Once | 19(63.3) | 23(76.7) | 2.3 (3) 0.51 |
| 1.2 | Twice | 05(16.7) | 04(13.3) | |
| 1.3 | Thrice | 04(13.3) | 01( 3.3) | |
| 1.4 | More than three times | 02( 6.7) | 02( 6.7) | |
| 2 | Last time fall
< 1 month ago 1-6 months 7-12 months 1 year |
|||
| 2.1 | 04(13.3) | 05(16.7) | 1.4 (3) 0.7 | |
| 2.2 | 11(36.7) | 07(23.3) | ||
| 2.3 | 04(13.3) | 06(20.0) | ||
| 2.4 | 11(13.3) | 12(40.0) | ||
| 3 | Where did fall occurred | |||
| a. .Outside | 13(43.3) | 14(46.7) | 0.06(1) 0.8 | |
| b. Inside | 17(56.6) | 16(53.3) | ||
| 3.1 | Room | 08(26.7) | 08(26.7) | |
| 3.2 | Kitchen | 01(3.3) | 01( 3.3) | |
| 3.3 | Stairs | 02(6.7) | 03(10.0) | |
| 3.4 | Bathroom | 05(16.7) | 02( 6.7) | |
| 3.5 | Store room | 01(3.3) | 02( 6.7) | |
| 4 | Time
Morning (12am -12 pm) Afternoon (12pm -4pm) Evening time (4pm -8pm) Night time (8pm -12am) |
|||
| 4.1 | 11(36.7) | 10(33.3) | 0.83(3)0.8 | |
| 4.2 | 06(20.0) | 04(13.3) | ||
| 4.3 | 08(26.7) | 09(30 .0) | ||
| 4.4 | 05(16. 6) | 07(23.3) | ||
| 5 | How did fall occurred | |||
| 5.1 | Tripped | 07(23.3) | 08(26.7) | 0.64(4)0.95 |
| 5.2 | Slipped | 12(40 .0) | 13(43.3) | |
| 5.3 | Lost balance /Felt giddy/dizzy | 06(20.0) | 06(20.0) | |
| 5.4 | Not sure | 03(10) | 02( 6.7) | |
| 5.5 | Knee pain | 02(6.7 ) | 01(3.3) | |
| 6 | Activity before fall | |||
| 6.1 | Ambulation | 16(53.3) | 16(53.3) | 1.17(4) |
| 6.2 | Using stairs | 02(6.7) | 04(13.3) | 0.88 |
| 6.3 | Bathing / toilet | 05(16.6) | 03(10.0) | |
| 6.4 | Household work | 03(10) | 03(10 .0) | |
| 6.5 | Using bed | 04(13.3) | 04(13.3) | |
| 7 | Suffered from any | |||
| morbidity/injury after | ||||
| 7.1 | experiencing fall? Bruises/cuts | 4.3(4) 0.36 | ||
| 7.2 | Sprains / Dislocation | 08(26.7) | 7(23.3) | |
| 7.3 | Fracture | 01 (3.3) | 05(16.6) | |
| 7.4 | Loss of consciousness | 04(13.3) | 02( 6.7) | |
| 7.5 | Pain | 01( 3.3) | 02 (6.7) | |
| 09(30 .0) | 06(20 .0) | |||
| 8 | Hospitalization after fall | |||
| Yes | 04 (13.3) | 06(20 .0) | 0.48(1)0.49 | |
| No | 26 (86.7) | 24(80.0) |
Table 4: Post-test responses of elderly in experimental and comparison group
N=30
| S.No. | Statements related to falls | No of elderly gave correct response | |||||
| EXPERIMENTAL | X2(df)p | COMPARISON | X2(df)p | ||||
| Pre-test f(%) | Post-test f(%) | Pre-test f(%) | Post-test f(%) | ||||
| 1 | Fall is Sudden unintentional getting down to the ground. | 17 (56.7) | 26 (86.7) | 6.6(1).009 | 18 (60.0) | 18 (60.0) | – |
| 2 | People 60 years & above age group are more vulnerable for falls. | 15 (50.0) | 20 (66.7) | 1.7(1)0.19 | 10 (33.3) | 10 (33.3) | – |
| 3 | Most of falls occur in Bathroom. | 19 (63.3) | 22 (73.3) | 0.7(1)0.41 | 24 (80.0) | 24 (80.0) | – |
| 4 | The injuries like dislocation, sprains and fractures may occur after fall? | 18 (60.0) | 20 (66.7) | 0.2(1)0.59 | 16 (53.3) | 17 (56.7) | 0.17(1)0.67 |
| 5 | Head injuries are one of the most serious consequence of a fall. | 19 (63.3) | 19 (63.3) | – | 20 (66.7) | 19 (63.3) | 0.07(1)0.78 |
| 6 | Weak muscles and poor balance is the most common risk factor of falls? | 19 (63.3) | 19 (63.3) | – | 15 (50.0) | 13 (43.3) | 0.3(1)0.6 |
| 7 | Ladders is an extrinsic factor for risk of fall. | 11 (36.7) | 13 (43.3) | 0.3(1)0.6 | 16 (53.3) | 13 (43.3) | 1.12(1)0.29 |
| 8 | People suffering from osteoporosis are prone for fracture due to falls. | 16 (53.3) | 20 (66.7) | 1.1(1)0.29 | 24 (80.0) | 24 (80.0) | – |
| 9 | Cataract, decreased nigh t vision and blurred vision are the conditions may cause fall. | 18 (60.0) | 19 (63.3) | 0.07(1)0.79 | 16 (53.3) | 16 (53.3) | – |
| 10 | Age above 60 years, bone problems and weak eyesight indicate high risk for falling. | 14 (46.7) | 17 (56.7) | 0.6(1)0.43 | 15 (50.0) | 16 (53.3) | 0.06(1)0.79 |
| 11 | By making Environment modication falls can be prevented. | 16 (53.3) | 15 (50.0) | 0.06(1)0.79 | 10 (33.3) | 12 (40.0) | 0.2(1)0.59 |
| 12 | High enough sofas and rm to sit down and get up easily are recommended to improve patient safety. | 19 (63.3) | 24 (80.0) | 2.05(1)0.15 | 22 (73.3) | 20 (66.7) | 0.3(1)0.57 |
| 13 | Installing grab barsin bathroom can prevent falls. | 21 (70.0) | 21 (70.0) | – | 23 (76.7) | 22 (73.3) | 0.7(1)0.39 |
| 14 | A rm sole footwear should be used to prevent falls. | 21 (70.0) | 26 (86.6) | 2.5(1)0.12 | 19 (63.3) | 19 (63.3) | – |
| 15 | Handrails on both sideof staircase can prevent falls. | 20 (66.7) | 24 (80.0) | 1.4(1)0.24 | 19 (63.3) | 19 (63.3) | – |
| 16 | 2.5- 3.0 Lof uid per day is to be consumed to stay healthy & active. | 09 (30.0) | 10 (33.3) | 0.07(1)0.78 | 10 (33.3) | 10 (33.3) | – |
| 17 | Regular exercise & increased calcium and vitamin D intake can help to make the bones strong and healthy. | 20 (66.7) | 22 (73.3) | 0.3(1)0.57 | 20 (66.7) | 20 (66.7) | – |
| 18 | Milk, cheese and curdare is rich in calcium. | 08 (26.7) | 11 (36.7) | 4.1(1)0.04 | 17 (56.7) | 16 (53.3) | 0.06(1)0.79 |
| 19 | Pulses are rich sources of protein. | 10 (33.3) | 13 (43.3) | 0.6(1)0.42 | 09 (30.0) | 10 (33.3) | 0.07(1)0.78 |
| 20 | Junk foods should be avoided for maintenance of healthy bones. | 23 (76.7) | 27 (90.0) | 1.9(1)0.16 | 23 (76.7) | 23 (76.7) | – |
| 21 | Immediately after a fall one shoul d remain still on the oor for few minutes. | 17 (56.7) | 16 (53.3) | 0.17(1)0.68 | 22 (76.7) | 23 (76.7) | 0.08(1)0.77 |
| 22 | Walking aids can help a person with poor balance for better walk. | 20(66.7) | 28(93.3) | 6.7(1)0.009 | 23(76.7) | 22(76.7) | 0.08(1)0.77 |
| 23 | The combination of water, electricity, and slippery surfaces makes bathrooms potential danger zones and use of grab bars, non -skid tiles and rm back shoes can prevent from danger. | 21 (70.0) | 20 (66.7) | 0.07(1)0.78 | 13 (43.3) | 12 (40.0) | 0.06(1)0.79 |
| 24 | Benet of doing e xercises are to maintain balance, improve muscle
strength and remain physically active. |
18 (60.0) | 19 (63.3) | 0.07(1)0.79 | 18 (60.0) | 17 (56.7) | 0.06(1)0.79 |
| 25 | Strength & balance training exercise programme is required for prevention of falls. | 20 (66.7) | 20 (66.7) | – | 23 (76.7) | 24 (80.0) | 0.09(1)0.75 |
Table-4 shows that in experimental group there was improvement in the percentage of participants gave correct response in most of the questions asked to assess knowledge during post-test as compared to pre-test. Whereas in comparison group there was no change in the percentage of participants gave correct response in most of the questions asked to assess knowledge during post-test as compared to pre-test.
Table 5 reveals that in pre-test, less than half of elderly had good knowledge regarding risks factors and safety measures to prevent falls whereas in the post-test, more than half of e lderly had good knowledge in experimental group. Table six indicates that mean knowledge score 14.17 from pre-test increased to 16.37 during post-test. This improvement in knowledge score was statistically signicant as per chi square test (p<0.05). There was no change in the level of knowledge in comparison group.
Table 5. Frequency and percentage distribution of pre-test and post-test level of
knowledge of elderly in experimental and comparison group
N=60
| Level of Knowledge | Range of score | Experimental group (n=30)
Pre-test f(%) Post -test f(%) |
Fishre Exact/Chi square
p |
Comparison group (n=30)
Pre-test f(%) Post -test f(%) |
Fishre Exact/Chi square
P |
||
| Very good | 18-25 | 10(33.3) | 12(40) | <.001 | 12(40) | 12(40) | 1 |
| Good | 9-17 | 13(43.3) | 18(60) | 13(43.3) | 13(43.3) | ||
| Poor | 0-8 | 7(23.3) | 0(00) | 5(16.7)) | 05(16.7) | ||
MAXIMUM SCORE= 25 MINIMUM SCORE= 0
Table 6 : Mean pre-test and post-test knowledge score of elderly in experimental and comparison group
N=60
| Group | Range of score | Knowledge Score
Mean ±SD |
| Experimental group Pre test (n=30)
Post test (n=30) |
5–21 12–23 |
14.17±4.69 16.37±3.13 |
| Comparison group Pre test (n=30) Post test (n=30) | 5–21
5–22 |
14.87±4.79
14.67±4.72 |
The data in the Table 7 presents that there was improvement in most of expressed practices during post-test as compared to pre-test among elderly in experimental group. The data shows that during post-test 73.3% elderly always avoid or take limited alcohol or smoke as compared to 70% during pre-test. During post test 60% of elderly were always careful while waking up from bed/chair or moving as compared to 56.7% elderly during pre-test. Further 46% elderly started restricting uid intake at bedtime during post test as compared to 40% elderly during pre- test. There was no change in the practices regarding maintaining weight, taking bright sunlight and not taking medicine in time.
Table 8 presents the expressed practices of comparison group durinf pre and post test. It revealed that that there was no change in expressed practices among elderly during pre-test and post-test.
Table 9 and 10 explains the expressed practices score in experimental and comparison group during pre and post-test. It revealed that in experimental group there was improvement in the expressed mean score of elderly during post-test (37.5) as compared to pre-test (36.9). Twenty percent of participants had very good score during post-test as compared to 16.7% during pre-test. In comparison group there was no change in the expressed score during pre and post-test.
Table 7. Pre-test and post-test expressed practices of elderly in experimental group
N=30
| S.
no. |
Expressed practices | Pre test | Post test | ||||
| Most of
times f(%) |
Some
times f(%) |
Never
f(%) |
Most of
times f(%) |
Some
times (%) |
Never
f(%) |
||
| I
1 2 3 |
Related to mobility
I look side by side while lifting foot above the ground. I took more careful while waking up from bed/chair or moving. I do not usenon-skid shoes. |
13(43.3) 17(56.7) 07(23.3) |
12(40.0) 08(26.7) 10(30.3) |
5(16.7) 5(16.7) 13(43.3) |
14(46.7) 18(60.0) 07(23.3) |
13 (43.3) 11(36.7) 10(30.3) |
03 (10.0) 01(3.3) 13(43.3) |
| II
4
5
6 7 |
Related to Medical consultation
I have gone through any necessary medical/surgical interventions. I have reviewed my medications with our provider some might make feel dizzy or sleepy. I do not take medicine in time. I do not take care regarding doses of medication? |
10(30.3)
19(63.3)
07(23.3) 08(26.7) |
12(40.0)
11(36.7)
12(40.0) 04(13.3) |
08(26.7) – 11(36.7) 18(60.0) |
10(30.3)
20(66.7)
07(23.3) 08(26.7) |
13(43.3)
10(33.3)
12(40.0) 04(13.3) |
07(23.3) – 11(36.7) 18(60.0) |
| III
8 9 10 11 |
Related to diet/nutrition
I don’t take Calcium/Vit D rich diet. I take bright sunlight. I do not take protein rich diet. I have maintained weight. |
03(10.0) 19(63.3) 03(10.0) 02( 6.7) |
12(40.0) 06(20.0) 12(40.0) 12(40.0) |
15(50.0) 05(16.7) 15(50.0) 16(53.3) |
04(13.3) 19(63.3) 02( 6.7) 02( 6.7) |
10(33.3) 06(20.0) 12(40.0) 12(40.0) |
16(53.3) 05(16.7) 16(53.3) 16(53.3) |
| IV
12 13 14 15 16 17 18 |
Related to Personal habits
I have restricted uid intake at bed time. I empty the bladder before bedtime. I do not exercise daily as a routine. I never changed my footwear. I have limited/ avoided intake of alcohol, smoking. I do not walk at morning. I have learnt about safe fall strategy. |
12(40.0) 15(50.0) 01( 3.3) 07(23.3) 21(70.0) 07(23.3) 02( 6.7) |
17(56.7) 14(46.7) 04(13.3) 10(33.3) 04(13.3) 10(33.3) 08(26.7) |
01( 3.3) 01( 3.3) 25(83.3) 13(43.3) 05(16.7) 13(43.3) 20(66.7) |
14(46.7) 16(53.3) 02( 6.7) 07(23.3) 22(73.3) 04(13.3) 02( 6.7) |
16(53.3) 13(43.3) 07(23.3) 10(33.3) 04(13.3) 19(63.3) 14(46.7) |
– 01( 3.3) 21(70.0) 13(43.3) 04(13.3) 07(23.3) 14(46.7) |
Table 8. Pre-test and post-test expressed practices scores of elderly in comparison group
| S.
no. |
Expressed practices | Pre test | Post test | |||||
| Most of
times f(%) |
Some
times f(%) |
Never
f(%) |
Most of
times f(%) |
Some
times (%) |
Never
f(%) |
|||
| I | Related to mobility | |||||||
| 12(40.0) | 03(10.0) | 15(50.0) | 13(43.3) | 02(6.7) | ||||
| 15(50.0) | ||||||||
| 1 | I look side by side while lifting foot above the ground. | |||||||
| 2 | I took more careful while waking up from bed/chair or moving. | 17(56.7) | 09(30.0) | 04(13.3) | 17(56.7) | 10(33.3) | 03(10.0) | |
| 3 | I do not use non-skid shoes. | 08(26.7) | 08(26.7) | 14(46.7) | 08(26.7) | 08(26.7) | 14(46.7) | |
| II 4
5 6 7 |
Related to Medical consultation
I have gone through any necessary medical/surgical interventions. I have reviewed my medications with our provider- some might make feel dizzy or sleepy. I do not take medicine in time. I do not take careregarding doses of medication? |
10(30.3)
20(66.7) 10(33.3) 08(26.7) |
12(40.0)
10(33.3) 10(33.3) 12(40.0) |
08(26.7)
– 10(33.3) 10(33.3) |
10(33.3)
20(66.7) 09(30.0) 07(23.3) |
12(40.0)
10(33.3) 11(36.7) 13(43.3) |
08(26.7)
– 10(33.3) 10(33.3) |
|
| III | Related to diet/nutrition | 06(20.0)
20(66.7) 02( 6.7) 20( 66.7) |
06(20.0)
20(66.7) 02( 6.7) 20(66.7) |
10(33.3)
02( 6.7) 15(50.0) 5(16.7) |
||||
| 10(33.3) | 14(46.7) | 14(46.7) | ||||||
| 8 | I don’t take Calcium/Vit D rich diet. | |||||||
| 9 | I take bright sunlight. | 02( 6.7) | 08(26.7) | 08(26.7) | ||||
| 10 | I do not take protein rich diet. | 15(50.0) | 13(43.3) | 13(43.3) | ||||
| 11 | I have maintained weight. | 5(16.7) | 5(16.7) | 5(16.7) | ||||
| IV | Related to Personal habits | 14(46.7)
17(56.7) 01( 3.3) 02( 6.7) 25(83.3) 09(30.0) 20(66.7) |
15(50.0)
13(43.3) 04(13.3) 11(36.7) 01( 3.3) 17(56.7) 06(20.0) |
14(46.7)
17(56.7) 01( 3.3) 02( 6.7) 25(83.3) 09(30.0) 19(63.3) |
15(50.0)
13(43.3) 06(20.0) 10(33.3) 01( 3.3) 17(56.7) 7(23.3) |
|||
| 01( 3.3) | 01( 3.3) | |||||||
| 12 | I have restricted uid intake at bed time. | |||||||
| 13 | I empty the bladder before bedtime. | – | – | |||||
| 14 | I do not exercise daily as a routine. | 25(83.3) | 23(76.7) | |||||
| 15 | I never changed my footwear. | 17(56.7) | 18(60.0) | |||||
| 16 | I have limited/ avoided intake of alcohol, smoking. | 04(13.3) | 04(13.3) | |||||
| 17 | I do not walk at morning. | 04(13.3) | 04(13.3) | |||||
| 18 | I have learnt about safe fall strategy. | 04(13.3) | 10(13.3) | |||||
Table 9: Pre-test and post-test level of expressed practices of elderly in experimental and comparison group
N=60
| Group | Range of score | Experiment
GroupMean ±SD |
|
| Experimental group | |||
| 26-48 | 36.9±5.98 | ||
| Pre test (n=30) | |||
| Post test (n=30) | 26-50 | 37.5±5.93 | |
| Comparison group | |||
| 26-46 | 37.0±6.10 | ||
| Pre test (n=30) | |||
| Post test (n=30) | 26-46 | 37.0±5.98 |
MAXIMUM SCORE= 54 MINIMUM SCORE= 18
Table 10: Mean pre-test and post-test expressed practices score among elderly in
experimental and comparison group
N=60
| Expressed practices
(score Range ) |
Experimental group (n=30) Pre-test f(%) Post-test f(%) | X2(df)p | Comparison group (n=30) Pre-test f(%) Post-test f(%) | X2(df)p | ||
| Very good(43-54) | 05 (16.7) | 06 (20.0) | 0.45(2) | 06 (20) | 05 (16.7) | 0.11(2) |
| Good(31-42) | 18 (60.0) | 19 (63.3) | 0.79 | 18 (60) | 19 (63.3) | 0.94 |
| Poor(18-30) | 07 (23.3) | 05 (16.7) | 06 (20) | 06 (20) | ||
MAXIMUM SCORE= 54 MINIMUM SCORE= 18
Table 11 indicated that the coefcient of correlation between knowledge and expressed practices score of pre-test showed strong positive relationship (0.65) in experimental group and strong positive relationship (0.80) in comparison group. This correlation is also depicted in gure 1 and 2.
Table 11. Correlation between knowledge and expressed practices to prevent fall among elderly in experimental and comparison group
N=60
| Knowledge | Expressed practices | |
| Experimental group
r(p) |
Comparison group
r(p) |
|
| 0.65(0.001**) | 0.80(0.001**) | |
One-way ANOVA test was applied to nd out the association of knowledge and expressed practices with selected variables. There was a signicant association of knowledge with marital s tatus in experimental group but no signicant association was found in comparison group. On the other hand, there was a signicant association of expressed practices with alcoholic status in comparison group but no signicant association was found in experimental group.
Discussion
The fall is very common among elderly and by educating them regarding safe practices can prevent the fall up to some extent. The present study assessed the impact of information booklet regarding risk factors and safety measures to prevent falls among elderly. Comparison of the knowledge and expressed practices regarding risk factors and safety measures to prevent falls among elderly was done in experimental and comparison group before and after implementation of information booklet. It also attempted to determine the relationship of knowledge and expressed practices of the elderly. In the present study, 43/60 (71.6%) of elderly were females and 17/60 (28.3%) of elderly were males. Also, 33/60 (55%) of elderly were in the age group of 60-69 years, 23/60 (38.3%) elderly were in the age group of 70-79 years and 4/60 (6.6%) of elderly were in age group of 80 and above, 3/60 (5%) of elderly were alcoholics and 57/60 (95%) of elderly were non-alcoholics. The nding is almost consistent with the ndings of Aniket Sirohi et.al which showed that 10% were alcoholics in his study. Further, the results of the present study indicated that 9/60 (15%) of elderly had a fall within less than one month, 18/60 (33%) of elderly had a fall within 1-6 months, 10/60 (16.6%) of elderly had a fall within 7-12 months and 23/60 (38.3%) of elderly had a fall before one year. The result was also consistent with the ndings of Aniket Sirohi et.al who conducted a study of falls among elderly persons in rural area of Haryana in which results showed that among the 456 study participants, the prevalence of falls in the past 12 months was 36.6% (95% condence interval [CI] =32.1–40.0). The prevalence among women was 40.6% (95% CI = 34.5–46.7) and among men was 31.5% (95% CI = 25.0–37.9). In the present study, 8
Tr i p a t h y e t a l . c o n d u c t e d a community-based study among elderly in rural, urban, and slum areas of Chandigarh and reported the prevalence of falls to be 31%.9 D’souza, in a study conducted among community-dwelling elders and old age home residents in Karnataka, reported the prevalence of falls to be 38% in the past 4 years.10 The differences may be due to different study settings. Furthermore, the time span considered for fall history was different in various studies. D’souza reported falls in the past 4 years while Joshi et al. recorded “history of fall” in their study.10,11
The ndings of present study further revealed that 23.3% of elderly were having poor knowledge regarding risk factors and safety measures to prevent falls. In a study conducted by Smitesh Gutta et al. also showed that knowledge regarding prevention of falls among elderly seem poor.12
The information booklet was effective in improving the knowledge and expressed practices related to falls among elderly as the knowledge and expressed practice score improved after post test as compared to pre test in experimental group. Whereas no change was observed in comparison group. There was strong positive correlation of knowledge and expressed practices among elderly.
Conclusion: The information booklet was effective in improving the knowledge and practices related to fall among elderly. Hence the nurses and other health care professionals working with elderly should educate them to prevent and manage falls.
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