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1.  Effect of Dissemination of Evidence in Reducing Injuries from Falls 
The New England journal of medicine  2008;359(3):252-261.
Falling is a common and morbid condition among elderly persons. Effective strategies to prevent falls have been identified but are underutilized.
Using a nonrandomized design, we compared rates of injuries from falls in a region of Connecticut where clinicians had been exposed to interventions to change clinical practice (intervention region) and in a region where clinicians had not been exposed to such interventions (usual-care region). The interventions encouraged primary care clinicians and staff members involved in home care, outpatient rehabilitation, and senior centers to adopt effective risk assessments and strategies for the prevention of falls (e.g., medication reduction and balance and gait training). The outcomes were rates of serious fall-related injuries (hip and other fractures, head injuries, and joint dislocations) and fall-related use of medical services per 1000 person-years among persons who were 70 years of age or older. The interventions occurred from 2001 to 2004, and the evaluations took place from 2004 to 2006.
Before the interventions, the adjusted rates of serious fall-related injuries (per 1000 person-years) were 31.2 in the usual-care region and 31.9 in the intervention region. During the evaluation period, the adjusted rates were 31.4 and 28.6, respectively (adjusted rate ratio, 0.91; 95% Bayesian credibility interval, 0.88 to 0.94). Between the preintervention period and the evaluation period, the rate of fall-related use of medical services increased from 68.1 to 83.3 per 1000 person-years in the usual-care region and from 70.7 to 74.2 in the intervention region (adjusted rate ratio, 0.89; 95% credibility interval, 0.86 to 0.92). The percentages of clinicians who received intervention visits ranged from 62% (131 of 212 primary care offices) to 100% (26 of 26 home care agencies).
Dissemination of evidence about fall prevention, coupled with interventions to change clinical practice, may reduce fall-related injuries in elderly persons.
PMCID: PMC3472807  PMID: 18635430
2.  Perspectives of Older Persons on Bathing and Bathing Disability: A Qualitative Study 
Bathing is an important and potentially challenging self-care activity, and disability in bathing is associated with several adverse consequences. Little is known about older persons’ experiences with and perspectives on bathing.
To understand the bathing experiences, attitudes, and preferences of older persons in order to inform the development of effective patient-centered interventions.
Qualitative Study using the Grounded Theory framework.
Twenty-three community-living persons, age ≥ 78 years, identified from the Precipitating Events Project (PEP).
In-depth, semi-structured interviews were conducted in the participant’s home.
Three themes emerged: 1) the importance and personal significance of bathing to older persons, 2) variability in attitudes, preferences, and sources of bathing assistance, and 3) older persons’ anticipation of and responses to bathing disability.
The bathing experiences described by study participants underscore the personal significance of bathing and the need to account for attitudes and preferences when designing bathing interventions. Quantitative disability assessments may not capture the bathing modifications made by older persons in anticipation of disability and may result in missed opportunities for early intervention. Findings from this study can be used to inform the development of targeted, patient-centered interventions that can subsequently be tested in clinical trials.
PMCID: PMC2856710  PMID: 20158554
Baths; Disability; Qualitative; Preferences

Results 1-2 (2)