Older people's preferences regarding programme formats for managing concerns about falls.

"IntroductionConcerns about falls, often labelled as fear of falling, are frequently reported by community-dwelling older people [1]. Concerns about falls may lead to negative consequences such as activity avoidance [2, 3], physical decline [4], increased fall risk [5, 6], reduced quality of life [7], feelings of depression and anxiety [8] and increased risk of nursing home admission [7]. Certain programmes have the ability to reduce concerns about falls, whether they are primarily or not primarily focused on managing concerns about falls [9]. Nevertheless, among the eligible populations in trials that primarily focused on these concerns, the older people's willingness to take part in (mostly group) programmes was rather low [10–14]. Moreover, drop-out rates of up to 40% among participants who enrolled in a programme are not uncommon [10–17]. This low uptake and high drop-out rate may be caused by various factors—for example, a mismatch between programme requirements and participants' capabilities, or between the programme format and participants' preferences. Clearly, a match between preferences and the programme format may increase uptake and adherence.Yardley et al. studied older people's preferences regarding three fall prevention activities: (i) professionally supervised strength and balance training in a group; (ii) strength and balance training at home following general instructions and (iii) support regarding home modifications. The home-based programmes better suited the respondents' preferences: around 60% indicated their interest for a home-based programme versus 40% for the group-based programme [18]. However, there is hardly any knowledge regarding the willingness of older people to participate in a programme aimed at managing concerns about falls and whether this willingness to participate is related to the format in which the programme is offered—for instance, via telephone, television or Internet.The aim of this study was to explore the preferences of community-dwelling older people regarding six different formats of a programme that primarily focuses on managing concerns about falls. In addition, the associations between format preferences and several demographic, health-related and fall-related characteristics were studied.: MethodsStudy design and participantsA cross-sectional study was carried out in the south of the Netherlands as part of the screening procedure for an RCT. Between March and December 2009, a short questionnaire was mailed to 5,755 community-dwelling people aged ≥70 years. People from the general population were randomly selected to participate in the study by local municipal registry offices. A reminder was sent if the questionnaire was not returned within a fortnight. The Medical Ethics Committee of Maastricht University/Academic Hospital Maastricht approved this study.MeasuresTo assess the willingness of respondents to participate in a programme for managing concerns about falls, the following question was formulated:There are different ways to learn how to manage concerns about falls. A number of possible programme formats, which consist of eight sessions each and are supervised by a community nurse, are presented below. Consider that you are concerned about falling and that you would like to do something about this. In which of the following programme formats would you be willing to participate: (1) in a group (programme with 8–10 persons located in you neighbourhood); (2) at home; (3) by telephone; (4) at home and by telephone (a combination of format 2 and 3); (5) via television or (6) via Internet?For each format, people indicated their willingness to participate by answering with ‘definitely yes’, ‘maybe yes’, ‘maybe no’ or ‘definitely no’.Furthermore, concerns about falls (‘Are you concerned about falling?’) and associated activity avoidance (‘Do you avoid certain activities due to concerns about falls?’) were assessed. Answer options were: ‘never’, ‘almost never’, ‘sometimes’, ‘regularly’, ‘often’ and ‘very often’. These answer options were then arranged in categories of ‘never’ (i.e. never and almost never), ‘sometimes’ and ‘often’ (i.e. regularly till very often). In addition, several socio-demographic and health-related characteristics were assessed: age (70–75, 75–79 or ≥80 years), gender (male or female), living situation (alone or not alone), educational level based on completed education and completed professional courses during lifetime (low, middle or high) [19], perceived general health (good, fair or poor) [20] and falls in the past 6 months (never, once or more than once).Statistical analysesDifferences in age and gender between responders and non-responders to the questionnaire were tested using Student's t-test for age and a Chi-square test for gender. Descriptive analyses were used to obtain insight into the characteristics and preferences of the participants. Prior to the logistic regression analyses answer options of the dependent variable ‘willingness to participate in a specific programme format’ were dichotomised into ‘yes’ (‘definitely yes’ and ‘maybe yes’) and ‘no’ (‘definitely no’ and ‘maybe no’). Univariate logistic regression analyses were performed to identify associations between the characteristics and programme format preference. Multivariate logistic regression analyses, in which all variables were included, were performed to test which of the characteristics were independently associated with preference for a programme format. These analyses were first performed in the total group of responders (n = 2,498) and next in the subgroup of responders who indicated their interest for at least one of the programme formats (n = 931). A 0.05 level of significance was used for all analyses. All data were analysed using SPSS 17.0.: ResultsOf the 5,755 sent questionnaires, 2,997 were returned (response rate: 52.1%). Since 499 questionnaires were incomplete, 2,498 were included in the analyses. Non-responders and those excluded (total: n = 3,257) differed significantly from responders (n = 2,498) regarding age (mean age: 77.6, standard deviation (SD) = 5.7 versus mean age 77.0, SD = 5.3, respectively; P ≤ 0.001) and gender (60.7 versus 56.6% female, respectively; P = 0.02).Table 1 (second column) shows the characteristics of the responders. In short, nearly 45% were male, nearly 40% were aged 70–74 years and more than 50% rated their general health as good. One or more falls were reported by less than 30% of the responders, slightly over 45% reported that they had concerns about falls sometimes till very often and almost 35% reported that they avoided activities sometimes till very often due to concerns about falls.Table 1.Population characteristics, preferences for formats of a programme for managing concerns about falls and univariate and multivariate associations (n = 2,498)Characteristics Preference for intervention formatsaAssociationsNoneAt least oneUnivariateMultivariaten (%)n (%)OR (95% CI)OR (95% CI)Total population2,498 (100.0)1,567 (62.7)931 (37.3)Demographic Gender  Male1,085 (43.4)686 (63.2)399 (36.8)——  Female1,413 (56.6)881 (62.3)532 (37.7)1.04 (0.88–1.22)0.89 (0.73–1.09) Age  70–74 years981 (39.3)661 (67.4)320 (32.6)——  75–79 years784 (31.4)464 (59.2)320 (40.8)1.43 (1.17–1.73)1.26 (1.02–1.55)  ≥ 80 years733 (29.3)442 (60.3)291 (39.7)1.36 (1.11–1.66)0.92 (0.74–1.16) Living situation  Not alone1,481 (59.3)969 (65.4)512 (34.6)——  Alone1,017 (40.7)598 (58.8)419 (41.2)1.33 (1.13–1.56)1.21 (1.00–1.46) Educational level  Low1,354 (54.2)947 (69.9)407 (30.1)——  Middle765 (30.6)408 (53.3)357 (46.7)2.04 (1.70–2.45)2.39 (1.96–2.92)  High379 (15.2)212 (55.9)167 (44.1)1.83 (1.45–2.32)2.26 (1.75–2.91)Health-related Perceived general health  Good1,396 (55.9)925 (66.3)471 (33.7)——  Fair987 (39.5)584 (59.2)403 (40.8)1.36 (1.15–1.60)0.92 (0.76–1.12)  Poor115 (4.6)58 (50.4)57 (49.6)1.93 (1.32–2.83)1.07 (0.69–1.65)Fall-related Falls in the past 6 months  Never1,808 (72.4)1,225 (67.8)583 (32.2)——  Once408 (16.3)217 (53.2)191 (46.8)1.85 (1.49–2.30)1.38 (1.09–1.74)  More than once282 (11.3)125 (44.3)157 (55.7)2.64 (2.05–3.41)1.47 (1.10–1.97) Concerns about falls  (Almost) never1,346 (53.9)990 (73.6)356 (26.4)——  Sometimes797 (31.9)432 (54.2)365 (45.8)2.35 (1.95–2.83)2.03 (1.63–2.54)  Regularly till very often355 (14.2)145 (40.8)210 (59.2)4.03 (3.16–5.14)3.11 (2.22–4.35) Avoidance of activities  (Almost) never1,648 (66.0)1,152 (69.9)496 (30.1)——  Sometimes493 (19.7)249 (50.5)244 (49.5)2.28 (1.85–2.80)1.56 (1.22–2.00)  Regularly till very often355 (14.2)166 (46.5)191 (53.5)2.67 (2.12–3.37)1.46 (1.06–2.03)OR, odds ratio; CI, confidence interval; [—], reference group. Odds ratios with significant results are displayed in bold.aThe dependent variable ‘willingness to participate in a programme for managing concerns about falls’ was dichotomised into preference for programme formats of ‘none’ and ‘at least 1′. ‘None’ implies that respondents answered ‘maybe no’ or ‘definitely no’ for all six formats; ‘at least one’ implies that respondents answered ‘definitely yes’ or ‘maybe yes’ for at least one of the six presented formats.Table 1 also shows that the minority of the responders of the total group (37.3%) were interested in participating in one of the formats. Among the responders who actually reported concerns about falls, the interest to participate in at least one format increased to 45.8% (for those who reported having concerns about falls sometimes) and 59.2% (for those who reported having concerns about falls regularly till very often). There was an overlap in preferences, indicating that some people were willing to participate in multiple programme formats. Only 2.4% would participate in each of the presented formats (not tabulated). Univariate logistic regression analysis showed that older age, status of living alone, higher educational level, poorer perceived general health, more falls in the past 6 months, higher levels of concerns about falls and avo"

"Funding This research was conducted as part of a randomised controlled trial that has been funded by ZonMw—The Netherlands Organisation for Health Research and Development (grant 120610001). Participation of one of the authors was supported by the Odysseus Grant ‘The Psychology of Pain and Disability Research Programme’ funded by the Research Foundation—Flanders, Belgium (FWO Vlaanderen)."