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Fall prevention: Nursing professor leads study to keep older patients safe, independent

Research Week 2019: Community-based research could help clinicians, care providers offer more personalized care
Hiroko Kiyoshi-Teo, Ph.D., M.S., R.N.
Hiroko “Hiro” Kiyoshi-Teo, Ph.D., M.S., R.N. (OHSU/Kristyna Wentz-Graff)

While some science relies on laboratory work, the community-based research conducted by Hiroko “Hiro” Kiyoshi-Teo, Ph.D., M.S., R.N., is happening in assisted living facilities.

Kiyoshi-Teo, a clinical assistant professor in the OHSU School of Nursing, meets with the staff and residents of such facilities to prevent falls and their serious consequences. According to the National Council on Aging, a quarter of Americans age 65 and older fall each year, and an older adult dies every 19 minutes from a fall.

“Falls are a very sensitive topic for older people,” Kiyoshi-Teo said. “Many are embarrassed and fear the consequences of having a fall, including losing their autonomy. But the interventions we typically recommend to prevent falls -- encouraging people to call for assistance when they want to get up -- don’t promote independence or address people’s hesitancy to address the issue.”

As a result, older adults don’t always follow clinical recommendations to prevent falls. Kiyoshi-Teo’s research explores using a counseling method calling motivational interviewing to help aging adults. Motivational interviewing focuses on a person’s motivations – such as remaining independent – to help them change their behaviors.

Instead of a provider telling assisted living facility residents what they should do, OHSU nursing students involved in Kiyoshi-Teo’s study ask them about their specific goals related to falls and encourage them to share their thoughts about fall prevention.

The students also respectfully acknowledge what facility residents are already aware of and doing to prevent falls. For example, older people often place a hand on a table when they stand up. After affirming what residents already know and do, the students help them identify one or two more things they can do to further improve their safety.

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The study, which started in January 2019 and runs through January 2020, is already having anecdotal success. One participant who used to stay in her room in lieu of asking for help from her facility’s staff has started to accept assistance after students used motivational interviewing approaches to address her fear of falling. She is now walking, exercising and participating in social activities.

Though fall prevention has long been studied, implementing fall-related research isn’t always easy. This study could help clinicians and care providers offer personalized intervention plans for their older patients, Kiyoshi-Teo said.

She became interested in improving health care outcomes when she was a nurse working in Japan in the 2000s. At that time, Kiyoshi-Teo saw hierarchical divisions between nursing and other hospital staff that made meeting patient needs more difficult. Currently, about 30 percent of her time is spent on research, and the remainder is spent teaching OHSU nursing students.

The study is an offshoot of the OHSU School of Nursing’s long-standing partnership with the Gresham Fire Department to address the complex medical needs of the community. The fire department’s ambulance service receives many calls for older adults who have fallen. Kiyoshi-Teo hopes her study can both prevent fall-related injuries and reduce unnecessary emergency medical calls. 

This research is supported by the Hartford Center for Gerontological Excellence at OHSU.

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