A Narrative Review on the Multidisciplinary Integration of Occupational Therapy and Nursing in Primary Care for Fall Prevention and Home Safety Adaptations Among Elderly Patients
Abstract
Background: Falls among older adults are a critical public health issue, leading to significant morbidity, mortality, and healthcare costs. Primary care is the frontline for managing fall risk, yet traditional siloed approaches often fail to address its multifactorial nature comprehensively. The integration of occupational therapy (OT) and nursing within primary care teams presents a promising model to bridge this gap.
Aim: This narrative review aims to critically synthesize the evidence on the multidisciplinary integration of OT and nursing in primary care for fall prevention and home safety adaptations for elderly patients, examining models, effectiveness, and implementation factors.
Methods: A systematic search of four electronic databases (PubMed, CINAHL, Scopus, PsycINFO) was conducted for literature published between 2010-2024. Peer-reviewed articles, reviews, and key reports were included and analyzed thematically.
Results: Integrated OT-nursing models consistently demonstrate superior outcomes in reducing fall rates, improving functional performance, and enhancing home safety compared to usual care. Key success factors include co-location, interprofessional education, shared assessments, and collaborative care planning. Significant barriers include funding structures, scheduling, and role ambiguity.
Conclusion: Intentional integration of OT and nursing expertise in primary care is highly effective for fall prevention. Future efforts must focus on sustainable implementation strategies, standardized outcome measures, and policy reforms to support team-based care.
Full text article
References
Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013). Risk factors for falls among older adults: a review of the literature. Maturitas, 75(1), 51-61. https://doi.org/10.1016/j.maturitas.2013.02.009
Bates, D. W., & Bitton, A. (2010). The future of health information technology in the patient-centered medical home. Health affairs, 29(4), 614-621. https://doi.org/10.1377/hlthaff.2010.0007
Bruce, J., Hossain, A., Lall, R., Withers, E. J., Finnegan, S., Underwood, M., ... & Lamb, S. E. (2021). Fall prevention interventions in primary care to reduce fractures and falls in people aged 70 years and over: the PreFIT three-arm cluster RCT. Health Technology Assessment (Winchester, England), 25(34), 1. https://doi.org/10.3310/hta25340
Caranda-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., & Arias, I. (2015). A cost–benefit analysis of three older adult fall prevention interventions. Journal of safety research, 52, 65-70. https://doi.org/10.1016/j.jsr.2014.12.007
Chase, J. A. D., Phillips, L. J., & Brown, M. (2017). Physical activity intervention effects on physical function among community-dwelling older adults: a systematic review and meta-analysis. Journal of aging and physical activity, 25(1), 149-170. https://doi.org/10.1123/japa.2016-0040
Chi, N. F., Huang, Y. C., Chiu, H. Y., Chang, H. J., & Huang, H. C. (2020). Systematic review and meta-analysis of home-based rehabilitation on improving physical function among home-dwelling patients with a stroke. Archives of physical medicine and rehabilitation, 101(2), 359-373. https://doi.org/10.1016/j.apmr.2019.10.181
Choi, M., & Hector, M. (2012). Effectiveness of intervention programs in preventing falls: a systematic review of recent 10 years and meta-analysis. Journal of the American Medical Directors Association, 13(2), 188-e13. https://doi.org/10.1016/j.jamda.2011.04.022
Collaborative, I. E. (2023). IPEC core competencies for interprofessional collaborative practice: version 3. Washington, DC: Interprofessional Education Collaborative.
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation science, 4(1), 50. https://doi.org/10.1186/1748-5908-4-50
Elliott, S., & Leland, N. E. (2018). Occupational therapy fall prevention interventions for community-dwelling older adults: A systematic review. The American Journal of Occupational Therapy, 72(4), 7204190040p1-7204190040p11. https://doi.org/10.5014/ajot.2018.030494
Finlayson, K., Chang, A. M., Courtney, M. D., Edwards, H. E., Parker, A. W., Hamilton, K., ... & O’Brien, J. (2018). Transitional care interventions reduce unplanned hospital readmissions in high-risk older adults. BMC health services research, 18(1), 956. https://doi.org/10.1186/s12913-018-3771-9
Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L., & Lamb, S. E. (2012). Interventions for preventing falls in older people living in the community. Cochrane database of systematic reviews, (9). https://doi.org/10.1002/14651858.CD007146.pub3
Hopewell, S., Adedire, O., Copsey, B. J., Boniface, G. J., Sherrington, C., Clemson, L., ... & Lamb, S. E. (2018). Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane database of systematic reviews, (7). https://doi.org/10.1002/14651858.CD012221.pub2
Jhaveri, M. M., Benjamin-Garner, R., Rianon, N., Sherer, M., Francisco, G., Vahidy, F., ... & Savitz, S. (2017). Telemedicine-guided education on secondary stroke and fall prevention following inpatient rehabilitation for Texas patients with stroke and their caregivers: a feasibility pilot study. BMJ open, 7(9), e017340. https://doi.org/10.1136/bmjopen-2017-017340
Kamei, T., Eto, S., Kawada, A., Takahata, Y., Sasaki, A., Uchida, Y., ... & Shimanouchi, S. (2023). Use of comprehensive home care assessment tools for community-dwelling older adults to improve adherence, quality of life, and health outcomes: A systematic review and meta-analysis. Journal of International Nursing Research, 2(1), e2021-0018. https://doi.org/10.53044/jinr.2021-0018
Kondo, K., Noguchi, N., Teshima, R., Tanaka, K., & Lee, B. (2021). Effects of a nurse–occupational therapist meeting on function and motivation in hospitalized elderly patients: A pilot randomized control trial. British Journal of Occupational Therapy, 84(10), 620-627. https://doi.org/10.1177/03080226211008720
Kumar, A., Delbaere, K., Zijlstra, G. A. R., Carpenter, H., Iliffe, S., Masud, T., ... & Kendrick, D. (2016). Exercise for reducing fear of falling in older people living in the community: Cochrane systematic review and meta-analysis. Age and ageing, 45(3), 345-352. https://doi.org/10.1093/ageing/afw036
Latulippe, K., Provencher, V., Boivin, K., Vincent, C., Guay, M., Kairy, D., ... & Giroux, D. (2019). Using an electronic tablet to assess patients’ home environment by videoconferencing prior to hospital discharge: protocol for a mixed-methods feasibility and comparative study. JMIR Research Protocols, 8(1), e11674. https://doi.org/10.2196/11674
Lawton, M. P., & Nahemow, L. (1973). Ecology and the aging process. In C. Eisdorfer & M. P. Lawton (Eds.), The psychology of adult development and aging (pp. 619-674). American Psychological Association.
Liddle, J., Lovarini, M., Clemson, L., Mackenzie, L., Tan, A., Pit, S. W., ... & Willis, K. (2018). Making fall prevention routine in primary care practice: perspectives of allied health professionals. BMC Health Services Research, 18(1), 598. https://doi.org/10.1186/s12913-018-3414-1
Liu, S., Yu, X., Wang, X., Li, J., Jiang, S., Kang, L., & Liu, X. (2021). Intrinsic Capacity predicts adverse outcomes using Integrated Care for Older People screening tool in a senior community in Beijing. Archives of gerontology and geriatrics, 94, 104358. https://doi.org/10.1016/j.archger.2021.104358
Lucas Molitor, W., Feldhacker, D. R., Lohman, H., Lampe, A. M., & Jensen, L. (2022). Occupational therapy and the IMPACT Act: Part 1. A systematic review of evidence for fall prevention and reduction, community discharge and reintegration, and readmission prevention interventions. The American Journal of Occupational Therapy, 76(1), 7601180020. https://doi.org/10.5014/ajot.2022.049044
Miranda-Duro, M. D. C., Nieto-Riveiro, L., Concheiro-Moscoso, P., Groba, B., Pousada, T., Canosa, N., & Pereira, J. (2021). Occupational therapy and the use of technology on older adult fall prevention: a scoping review. International journal of environmental research and public health, 18(2), 702. https://doi.org/10.3390/ijerph18020702
Morris, R. L., Hill, K. D., Ackerman, I. N., Ayton, D., Arendts, G., Brand, C., ... & Barker, A. L. (2019). A mixed methods process evaluation of a person-centred falls prevention program. BMC health services research, 19(1), 906. https://doi.org/10.1186/s12913-019-4614-z
Phelan, E. A., Aerts, S., Dowler, D., Eckstrom, E., & Casey, C. M. (2016). Adoption of evidence-based fall prevention practices in primary care for older adults with a history of falls. Frontiers in Public Health, 4, 190. https://doi.org/10.3389/fpubh.2016.00190
Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., ... & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. Cochrane database of systematic reviews, (1). https://doi.org/10.1002/14651858.CD012424.pub2
Stanmore, E. K., Mavroeidi, A., de Jong, L. D., Skelton, D. A., Sutton, C. J., Benedetto, V., ... & Todd, C. (2019). The effectiveness and cost-effectiveness of strength and balance Exergames to reduce falls risk for people aged 55 years and older in UK assisted living facilities: a multi-centre, cluster randomised controlled trial. BMC medicine, 17(1), 49. https://doi.org/10.1186/s12916-019-1278-9
Sun, R., & Sosnoff, J. J. (2018). Novel sensing technology in fall risk assessment in older adults: a systematic review. BMC geriatrics, 18(1), 14. https://doi.org/10.1186/s12877-018-0706-6
Szanton, S. L., Wolff, J. W., Leff, B., Thorpe, R. J., Tanner, E. K., Boyd, C., ... & Gitlin, L. N. (2014). CAPABLE trial: a randomized controlled trial of nurse, occupational therapist and handyman to reduce disability among older adults: rationale and design. Contemporary clinical trials, 38(1), 102-112. https://doi.org/10.1016/j.cct.2014.03.005
Taylor, D., McCaffrey, R., Reinoso, H., Mathis, M. W., Dickerson, L., Hamrick, J., ... & Klein, C. M. (2019). An interprofessional education approach to fall prevention: preparing members of the interprofessional healthcare team to implement STEADI into practice. Gerontology & Geriatrics Education, 40(1), 105-120. https://doi.org/10.1080/02701960.2018.1530226
Tinetti, M. E., & Kumar, C. (2010). The patient who falls:“It's always a trade-off”. Jama, 303(3), 258-266. doi:10.1001/jama.2009.2024
Tomita, M. R., Saharan, S., Rajendran, S., Nochajski, S. M., & Schweitzer, J. A. (2014). Psychometrics of the Home Safety Self-Assessment Tool (HSSAT) to prevent falls in community-dwelling older adults. The American Journal of Occupational Therapy, 68(6), 711-718. https://doi.org/10.5014/ajot.2014.010801
Wheeler, E., Coogle, C. L., Fix, R. C., Owens, M. G., & Waters, L. H. (2018). Physical and occupational therapy practice improvement following interprofessional evidence-based falls prevention training. Journal of Allied Health, 47(1), 9-18. https://www.jstor.org/stable/48722019
World Health Organization. (2021). Step safely: strategies for preventing and managing falls across the life-course. World Health Organization.
Authors
Copyright (c) 2024 Modhi Saleh Salem Alshammari, Noor Saleh Salem Alshammari, Munifah Saleh Alshammari, Ghadah Abdulaziz Albdah, Sarah Fahad Alotaiby, Rasha Dalbak Yaknl, Entessar Juhayyim Alruwaili, Afrah Jaser Salem Aljaser, Rawan Adel Alghamdi, Noufah Jazim Alruwaili, Amal Mohammed Abdullah Alwabel, Zainab Jaferi Mohammed Asiri, Abdullah Ali Mohamad Al Sahli, Areej Mohammed Saeed Melibari
This work is licensed under a Creative Commons Attribution 4.0 International License.