Physician persectives on fall prevention in assisted living

Residential care/assisted living (RC/AL) communities are a relatively new focus of aging research. Little data exist on care practices and outcomes in these settings, because they are not regulated in the same manner as nursing homes. Falls are of particular concern among the one million older adult residents of RC/AL communities. This dissertation study provides first data on physician perspectives on fall prevention and monitoring among RC/AL residents with regard to: (a) fall risk assessment, (b) medications review for potential side effects related to falls, and (c) communication and collaboration between primary physicians and RC/AL staff regarding patients at high risk for falls. Data were collected through a questionnaire informed by the Theory of Planned Behavior (TPB), mailed to primary physicians for residents of four RC/AL communities in North Carolina. Physicians expressed strong support for fall risk assessment, medications review, and talking/working with RC/AL staff to reduce fall risk, and they believed these activities could reduce fall risks among RC/AL patients. Physicians assumed full responsibility for medications review but had conflicting beliefs about fall risk assessment -- they thought RC/AL staff had more time and responsibility for this task and that it was easier for them to do, but expressed some reservations about RC/AL staff expertise. Communication and collaboration challenges between physicians and RC/AL staff were also identified by the survey. Further, theory-based models were developed and tested to identify physician beliefs predictive of their self-reported (past) behavior and (future) intention with regard to fall risk assessment, medication review, and talking/working with RC/AL staff. The models were robust, explaining 22-52% of the variance in behavior and 21-46% of the variance in intention. Models also identified specific beliefs that were especially salient for various fall prevention and monitoring activities. This research provides (a) baseline data for on-going discussions of the role of primary physicians in the care of RC/AL residents, (b) contributes to theory-based implementation and dissemination research focused on interventions to influence physician beliefs and behavior, and (c) informs social work practice by drawing attention to coordination and collaboration challenges in the care of the frail older adults in RC/AL communities.