Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach

BMC Geriatrics

Research

Pey June Tan¹  John Pastor Ansah²  Angelique Wei-Ming Chan³  June May Ling Lee³  Normala Manap³  Noor Hafizah Ismail⁴  Christopher Tsung Chien Lien⁵  Vanda Wen Teng Ho⁶  Rita Siew Choo Sim⁷  Wei Xuan Lai⁷  David Bruce Matchar⁸  Chek Hooi Wong⁹  Tianma Xu^1,10 

[1] Ageing and Age-Associated Disorders Research Group, Health and Translational Medicine Cluster, University of Malaya, Kuala Lumpur, Malaysia;Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA;Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore;Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore, Singapore;Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore;Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore;Department of Medicine, National University Hospital, Singapore, Singapore;Duke-NUS Medical School, Programme in Health Services and Systems Research, 8 College Road, 169857, Singapore, Singapore;Duke-NUS Medical School, Programme in Health Services and Systems Research, 8 College Road, 169857, Singapore, Singapore;Department of Medicine, Duke University, Durham, NC, USA;Singapore-ETH Centre, Future Health Technologies Programme, CREATE Tower, Singapore, Singapore;Geriatric Education and Research Institute, Singapore, Singapore;Health & Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore;

关键词: Group model building;    Systems thinking;    Falls prevention;    Older adults;   

DOI  :  10.1186/s12877-023-04294-2

 received in 2022-12-08, accepted in 2023-09-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundFalls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors can enable clinicians, researchers, and policymakers to clarify goals in falls intervention in older adults.MethodsA Group Model Building (GMB) exercise was conducted with researchers and clinicians from academic units and public healthcare institutes in Singapore. The aim of the exercise was to produce a shared visual representation of the causal structure for falls and engage in discussions on how current and future falls intervention programmes can address falls in the older adults, especially in the Asian context. It was conducted in four steps: 1) Outlining and prioritising desirable patient outcomes, 2) Conceptual model building, 3) Identifying key intervention elements of effective falls intervention programmes, 4) Mapping of interventions to outcomes. This causal loop diagram (CLD) was then used to generate insights into the current understanding of falls causal relationships, current efforts in falls intervention in Singapore, and used to identify gaps in falls research that could be further advanced in future intervention studies.ResultsFour patient outcomes were identified by the group as key in falls intervention: 1) Falls, 2) Injurious falls, 3) Fear of falling, and 4) Restricted mobility and life space. A CLD of the reciprocal relationships between risk factors and these outcomes are represented in four sub-models: 1) Fear of falling, 2) Injuries associated with falls, 3) Caregiver overprotectiveness, 4) Post-traumatic stress disorder and psychological resilience. Through this GMB exercise, the group gained the following insights: (1) Psychological sequelae of falls is an important falls intervention outcome. (2) The effects of family overprotectiveness, psychological resilience, and PTSD in exacerbating the consequences of falls are not well understood. (3) There is a need to develop multi-component falls interventions to address the multitude of falls and falls related sequelae.ConclusionThis work illustrates the potential of GMB to promote shared understanding of complex healthcare problems and to provide a roadmap for the development of more effective preventive actions.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 2

13690_2023_1170_Article_IEq53.gif

Fig. 3

Fig. 12

Fig. 1

Fig. 8

Fig. 11

13690_2023_1170_Article_IEq38.gif

Fig. 9

Fig. 2

13690_2023_1170_Article_IEq142.gif