Open Access Capstone
Doctor of Occupational Therapy (OTD)
Background: Strong evidence supports medication review and management, health and safety education, and home modifications as a holistic approach to falls prevention. Current research demonstrates that individual interventions reduce the risk of falls yet do not statistically reduce the number of falls (Gallo, Stelmach, Frigeri, & Ahn, 2018). The problem this Capstone project addressed was the limited psychological considerations, awareness of behaviors, confidence, and self-efficacy, as they relate to falls prevention. These psychological factors have not been previously studied in a single study.
Purpose: To determine the relationship or significance of psychological considerations as they relate to fall prevention. Increase older adults understanding of the multifactorial problems of fall risks, behavioral prevention strategies, and how fear can increase fall risk. Does increasing awareness through education, being mindful of the psychological considerations, improve adherence to home modifications with patient-environment interactions for the purpose of falls prevention?
Theoretical Framework: Social Cognitive Theory: occupations are often influenced by what, where, and with whom the activity is performed (Law, 2002). Participation can be positively impacted by an individual’s self-efficacy (Law, 2002). The Transtheoretical Model: Occupational therapy plays a vital role in raising awareness, exploring the value, and facilitating the understanding of this connection and its effect of a person’s everyday life based on understanding and willingness to change. Lawton and Nahemow’s Press Competency Model or Environment Fit: A complex relationship exists between the person, environment, and participation in occupation (Law, 2002; Fange, & Iwarsson, 2007; Oakes, 2015).
Methods: This was a quantitative pre-experimental design 30-day study of 21 community-dwelling adults aged 65 and older with normal to mildly impaired cognition on the 6CIT. A pretest 6CIT, pretest and posttest FaB, ABC, FES-I, and Safe At Home assessments, along with fall risks, modifiable risk factor education, and individualized community resources.
Results: Wilcoxon Signed Rank Test demonstrated statistical significance at the p < 0.05 level, indicating positive OT intervention impact on behaviors, confidence, and self-efficacy on falls prevention. Spearman’s Rank-Order (RHO) Coefficient Test revealed moderate statistical significance for marital status on behaviors and prior number of falls history on self-efficacy. All of the participants had one or more areas of psychological scale improvements and home safety modification recommended. Over 74% were implemented within the 30-day study period, demonstrating improved adherence.
Conclusions: Falls prevention is multifactorial and OT is a necessary service in the development of a truly comprehensive conceptual program model. Those without prior or recurrent falls may temporarily decline in one or more psychological factors when perceived risk is changed to actual risk as a result of OT falls prevention education.
Cindy Hayden, DHEd, OTR/L, CHT
2019 Lisa S. Roberson
Roberson, Lisa S., "Person-environment interactions: The psychological implications of behaviors, confidence, and self-efficacy in falls management." (2019). Occupational Therapy Doctorate Capstone Projects. 46.
IRB Approval Number (if applicable)