title: Implementation of evidence-based falls prevention in clinical services for high-risk clients.
abstract: OBJECTIVE
  The extent to which best practice for falls prevention is being routinely delivered by health care providers for community-dwelling older adults is unclear. We investigated falls prevention practice among Hospital Admission Risk Programs (HARP) that provide and coordinate specialized health care for people at high risk of hospitalization.
  
  
  METHODS
  Cross-sectional survey of all HARP services in Victoria, excluding one paediatric programme (n = 34). The questionnaire focused upon medication review and exercise prescription, as these are the evidence-based falls interventions with a good fit with HARP services.
  
  
  RESULTS
  Completed questionnaires were received from 24 programmes (70.6%) that service 15,250 older clients (60+ years). All except one programme screened for medicine use; however, a lower proportion (65% of those that screen) target falls risk medications. Among the 17 programmes responding to the exercise prescription question, all routinely include strengthening exercises, and almost all (n = 15) include flexibility, endurance training and movement of the centre of gravity. A lesser proportion (71%) includes reducing the need for upper limb support. The majority of services (88%) undertake falls risk assessments, and all of these either make referral appointments for clients or refer to other services that make referral appointments for clients. Follow-up of appointments and the resulting recommendations was high.
  
  
  CONCLUSIONS
  Screening for falls risk medications could be improved and staff training in exercise prescription for balance challenge in this high-risk group may be needed. Although evidence-based falls prevention practice within Victorian HARP services appears strong, the effect on falls risk may not be as high as that achieved in randomized trials.
authors.affiliation: Falls Prevention Research Unit, Monash Injury Research Institute, Monash University, Australia.
authors.forename: Lesley
authors.initials: L
authors.lastname: Day
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Trotter
authors.forename: Keith D
authors.initials: KD
authors.lastname: Hill
authors.forename: Terry P
authors.initials: TP
authors.lastname: Haines
authors.forename: Catherine
authors.initials: C
authors.lastname: Thompson
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004059:Diffusion of Innovation; D055317:Evidence-Based Practice; D006761:Hospitals; D006801:Humans; D008875:Middle Aged; D017751:Safety Management; D011795:Surveys and Questionnaires; D014739:Victoria
keywords: evaluation; evidence-based medicine