Sophie M. Weiss, BSc1, Csilla Kalocsai, PhD, MPhil2,3, Barbara Liu, MD, FRCPC4,5, Mireille Norris, MD, FRCPC, MHSc4,5
1University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
2Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
3Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
4Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
5Division of Geriatric Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, ON, CanadaDOI: https://doi.org/10.5770/cgj.27.722
ABSTRACT
Background
The literature to date is unable to clearly characterize the appropriateness of virtual care for falls prevention services from the patient perspective. In response to COVID-19, the Falls Prevention Program (FPP) at Sunnybrook Health Sciences Centre was modified to include virtual components. We set out to uncover the experiences of this unique older-adult patient population to inform FPP quality improvement and appropriate incorporation of technology post-pandemic.
Methods
FPP patients during the COVID-19 pandemic (February 2020 – February 2022) and their primary caregivers met inclusion criteria. Out of 18 eligible patients, 10 consented to participate in 20-minute, semi-structured telephone interviews conducted and transcribed by the first author. Inductive coding followed by theme generation occurred through collaborative analysis.
Results
The participants (n=10) were 60% female, mean age 84 years (SD 5.8), 60% living alone, and 70% university educated. We generated three main themes: 1) First Steps First, revealed a common desire for physical and mental support and the perceived essentials of a successful FPP highlighting the importance of program length and individualized attention; 2) Overcoming Obstacles, highlighted participants’ experiences overcoming barriers with technology in the context of an isolating pandemic; and 3) Advancing Care Post-Pandemic, elaborated on the appropriateness of virtual care and delved into the importance of program personalization.
Conclusion
The interviewed older adults revealed agreement on the FPP’s necessity and the importance of increasing program length, one-on-one interaction, and program flexibility for unique patient needs. Incorporating virtual assessment prior to in-person exercises was largely favoured and should be considered as an appropriate use of technology post-pandemic.
KEYWORDS: falls, preventative care, preventative programs, falls prevention program, virtual care, COVID-19 pandemic, geriatric assessment
A fall for a community-dwelling older adult has the potential to be a devastating and life-altering event. Falls increase the risk of sustained morbidity, reduced independence, and are associated with premature death.(1–3) Falls prevention programs (FPPs) are designed to build strength and balance among community-dwelling older adults to help prevent falls and maintain independence.(4,5) Evidence supports the success of these programs and has led to worldwide encouragement to prioritize the implementation of FPPs into primary health-care settings.(1,2)
COVID-19 interfered with many critical outpatient services, including FPPs, while simultaneously increasing the need for these supportive programs by disproportionally impacting geriatric patient populations. Canadians aged 65 and older accounted for 80% of the COVID-19 related deaths during the first 15 months of the pandemic.(6) Many seniors hesitated to seek medical help, leading to delayed access to primary care and in-person services.(6–8) During this period of heightened senior needs, services had to adapt to changing public health restrictions.(3)
The introduction of virtual care into the health-care setting has been widely encouraged and, in many applications, sustained post-pandemic.(9–12) Existing quantitative literature reveals reduced rates of falls in high-risk community-dwelling older adults with the integration of combined telehealth and in-person exercise classes.(2,13) The literature also recognizes the importance of a thorough falls-risk assessment prior to program initiation;(2) however, it is not well understood how effective these assessments are when conducted virtually. An article written by a division of the U.S. Centers for Medicare and Medicaid Services, for example, reported increased need for virtual geriatric assessments with limited understanding of effectiveness.(14) While the literature does not capture the effectiveness of a virtual falls-risk assessment in its entirety, various components have been examined; Watt et al. found a moderate-to-high correlation between video calls and in-person Mini-Mental State Examination and Montreal Cognitive Assessment scores.(15) Furthermore, a randomized controlled trial conducted by Ogawa et al. focused on virtual physical performance assessments in veterans during COVID-19 and found high reliability and generalizability.(16) The effectiveness of virtual falls risk assessments remains uncertain in the literature.
During the pandemic, virtual care was utilized by Sunnybrook Hospital’s FPP in Toronto.(7) A previously in-person FPP was adapted to include initial telephone screening to inform if assessments for FPP eligibility could occur virtually based on: 1) the patient’s access to devices such as a laptop or tablet; 2) familiarity navigating Zoom; and 3) any available family or friends to help set up the required technology. Factors such as cognitive impairment and patient preference were also considered. Following the initial telephone screening, geriatricians and physiotherapists conducted a falls risk assessment (virtually, using Zoom or in-person) to determine eligibility for the FPP. The patients then participated in the FPP including exercise classes and falls prevention education (virtually using Zoom, or through a hybrid model with some in-person components, depending on public-health restrictions at the time of attendance). These modifications are outlined in Figure 1. Throughout the pandemic, the program was modified to best fit continuously changing public health restrictions and staffing shortages, guided by the expertise of the health-care workers involved. The program’s duration was refined from eight to four weeks, featuring a blend of in-person and/or virtual sessions conducted over Zoom. The latter included comprehensive education on falls prevention, nutritional insights, and exercise sessions facilitated by allied health experts. Group sizes were also reduced with the intention to maintain safety for participants both in-person and virtually to allow for physical distancing and ample support with technology, respectively.
|
| ||
|
FIGURE 1 Modifications of Sunnybrook Health Sciences Centre’s Falls Prevention Program due to COVID-19 | ||
Part one of this study was a quantitative data abstraction that characterized the patient population seeking the FPP at Sunnybrook before versus during the pandemic to explore accessibility and inform quality improvement.(17) We found that the population was similarly frail and their ability to access virtual services was maintained, suggesting that virtual care successfully provided falls prevention when in-person access was unsafe.(17) A qualitative study by Kohn et al. explored the adaptations to four falls prevention programs during the pandemic from the perspective of program administrator representatives.(3) They found improved accessibility for some populations (in contrast to limited access for underserved communities), as well as increased cost with sustained feasibility.(3) Yet, we know little about the appropriateness of virtual care for falls prevention from older patients’ perspectives. Our qualitative investigation aims to fill this gap by uncovering the experiences of this unique older-adult patient population, providing insights for FPP quality improvement and the post-pandemic incorporation of virtual care.
A prospective single-centre descriptive qualitative study was conducted to provide a summary of participants’ responses with the goal to inform quality improvement.(18) Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ).(19) The Research Ethics Board approved this study (Project ID: 5190).
Our study focused on community-dwelling older adults enrolled in the Sunnybrook FPP during the COVID-19 pandemic (February 2020–February 2022). Purposive sampling was used. To be eligible, patients had to be 65 or older, at risk of falling, and capable of walking at least 25 metres and safely participating in supervised exercise. Patients attending any program format during this period (virtual, in-person, or hybrid) were included. To recruit participants, we contacted eligible patients (n=18) through a mailed letter with an opt-out option, followed by phone calls. One eligible patient declined due to difficulty hearing, one declined due to hospitalization, and six declined participation without a reported reason. A total of 10 individuals consented to participate. The participant recruitment process is outlined in Figure 2.
|
| ||
|
FIGURE 2 Outline of the participant recruitment process | ||
Out of 18 eligible patients, 10 were interviewed with the option for family members or caregivers to join the interviews (this occurred in 2/10 interviews). Interviews were conducted by phone in April 2022 by the first author (SW), a medical student with no prior relationship with the participants, in collaboration with Sunnybrook FPP geriatricians. The 10 semi-structured interviews aimed to explore participants’ FPP experiences, including feasibility, accessibility, and effectiveness, along with demographic information (see Appendix A). Interviews lasted on average 10–20 minutes; this length of time over the phone was determined to be a reasonable commitment for participants and would yield the highest level of participation while still allowing for flexibility if some participants wished to dedicate more or less time to discussion. Interviews were recorded and transcribed by SW. Relying on inductive analysis, SW and the corresponding author (MN) generated a codebook and coded the first three transcripts using NVivo (QSR International, Melbourne, Australia). SW analyzed the remaining seven interviews, adapting the codebook as needed based on emerging themes, which were finalized through collaborative analysis.
Study participants (n=10) were 60% female, had a mean age of 84 years (SD=5.8), primarily lived alone (60%), and were university educated (70%) (see Table 1A). With respect to living arrangements, 40% of participants reported living in an apartment/condominium, 30% in a house, and 20% in an independent living complex for seniors. Past employment included various positions in business, teaching, and banking. The participants experienced various forms of the program as it continuously evolved during the pandemic. All 10 participants received the initial assessment virtually by phone (conducted by the medical receptionist), followed by Zoom with both a geriatrician and physiotherapist. The exercise portion of the program was delivered in-person to 3/10 participants, virtually to 3/10, and a hybrid including both in-person and virtual session for the remaining 4/10 participants (Table 1B).
TABLE 1A Raw and summarized data characterizing the study sample: Demographics
TABLE 1B Raw and summarized data characterizing the study sample: Program breakdown
Our analysis generated three major themes. Theme 1, First Steps First, revealed a common desire for physical and mental support and the perceived essentials of a successful FPP, highlighting the importance of program length and individualized attention. Theme 2, Overcoming Obstacles, highlighted participants’ experiences overcoming barriers with technology in the context of an isolating pandemic. Theme 3, Advancing Care Post-Pandemic, elaborated on the appropriateness of virtual care and delved into the importance of program personalization. A list of supporting quotations is provided in Table 2.
TABLE 2 Themes and subthemes with a sample of supporting quotes
Participants were motivated to join the FPP primarily to improve both their physical and mental health. Many approached it with optimism, recognizing its importance for their well-being. Their initial drive often stemmed from previous falls or a heightened risk due to frailty and comorbidities. One of our participants highlighted the program’s significance after experiencing multiple falls:
“It is not something I would normally choose to do but I realized the importance of it. I had had four falls before I broke my hip. So, I was pleased to get into a program that addressed balance.” – participant 5
Family members and health-care professionals also played a role, encouraging participation in exercise programs. Beyond physical health, socialization and support for mental well-being were vital, especially during the isolating effects of the pandemic. Several participants emphasized the importance of socializing within the program. Those attending in-person found relief from pandemic isolation, while virtual attendees acknowledged that online interactions could not replicate in-person ones. Many preferred in-person programs for the human connection they offered, although some appreciated the virtual component’s ability to provide socialization during lockdowns. Participant 8 shared:
“I enjoy being able to get out for a little bit and dealing with another person or socialization I guess. Where I am at the moment is under a partial lockdown. And it’s been very, very difficult on everyone.” – participant 8
The pandemic led to the implementation of multiple changes to the FPP, including reducing the number of sessions from eight to four, as well as reducing class sizes to accommodate the evolving pandemic public health restrictions. The interviews revealed a desire for a longer program and for smaller class sizes to be foundational elements of a successful FPP. The FPP aims to educate and help incorporate falls prevention into routine by equipping seniors with daily exercises to continue once the program is complete. The participants who had four sessions revealed that this post-program expectation was difficult to achieve without a longer and more involved program to solidify technique and motivation. Many emphasized that the program was cut too short and that a longer course of care was necessary to achieve long-lasting effects. More individualized attention was also highlighted as essential for both engagement during the sessions and retention of skills necessary to continue exercises independently post-program. The reduction in class size was revealed to carry the beneficial consequence of increased individualized attention which participants speculated was to their advantage and was generally appreciated. A participant summarized:
“I do some of [the exercises now] but not all, and not regularly. Unfortunately. And maybe if [I] participated in the regular program it may have been more incentive to keep going whereas this was just sort of showing us what to do but then all of a sudden it was over […] Now, the downside was that there weren’t as many sessions, but the upside was that it was just one or two of us with one physiotherapist and so you did get a lot of individual attention” – participant 7
Participants recognized that virtual care was providing them with the safety of isolation, reducing the risks associated with a hospital environment for a frail older adult during a pandemic. Alternative perspectives stated that with the appropriate personal protective equipment and vaccinations, attending in-person felt safe and virtual attendance for the purposes of safety was unnecessary. These feelings of safety may also depend on when each participant attended during the evolving pandemic and what levels of in-person protection were available at the time. Two of our study participants show these contrasting views:
“I can see people’s faces on Zoom. And it’s okay. And also timely. I cannot spend time on a commute. To go [to] the hospital and back. [… Also,] because of the pandemic, I don’t like to meet other people in person.” – participant 9
“I did [worry about in-person] at first. And then I figured, I’m protecting myself. I’ve got my shots and I’ve got my masks. So I should be okay. And I was! And they were so very careful in the hospital with hygiene and stuff so I didn’t feel unsafe at any point.” – participant 10
Each participant had varied levels of technology incorporated into their FPP experience based on the level of public health restrictions in place at the time of their attendance. A common barrier associated with virtual program components was a general lack of comfort using the required technology. Some participants elaborated on their adaptation to a virtual environment commenting on how family/community support, as well as prior knowledge on how to navigate technology, eased this transition. For those participating virtually, including the initial FPP assessment and/or the exercise classes, it was found that with time and practice navigating the online FPP, seniors were gaining e-literacy skills in addition to falls prevention skills. A participant explained:
“I was very nervous [for virtual care] at first because I was worried that I wouldn’t join on time or [of] course I always forget either to put the video on or the sound, so the doctor has to remind me, but it isn’t that bad, and I was fine with it once I got used to it.” – participant 10
The pandemic was associated with an exacerbation of senior isolation which was mentioned in several interviews as a significant barrier. Some virtual participants lived with family who provided immediate support with technology, enhancing accessibility and enjoyment. This differed from the participants living alone who were forced to navigate the FPP independently, ultimately hindering accessibility for those less familiar navigating technology. The contrasting experiences can be seen in the following quotations:
“I find [accessing the virtual program] easy, but I don’t know sometimes I need my wife [close] by. Sometimes I have no voice, or the image is not clear, and I have to call my wife to come fix it.” – participant 9
“[My daughter could] not really [help me]. She’s out there. She’s doing her own thing. I have a son as well. He’s good with technology. But they don’t live with me. They’re in the city.” – participant 2
Once barriers associated with navigating technology were overcome, unanimous agreement on the convenience of virtual care prevailed. The main benefit highlighted was the convenience and efficiency that virtual care was able to provide participants. The barriers of arranging, affording, and devoting time towards transportation were all alleviated with the virtual assessments and classes that participants could join from home. The effectiveness of a FPP delivered virtually was felt to be diminished relative to an in-person program. Participants felt safer and more engaged when the physiotherapists were able to guide them in an in-person environment rather than through a screen. However, these reflections were not consistent when it came to the virtual assessments where participants generally agreed that effectiveness was sustained. Virtual care was deemed appropriate for the initial assessment when balancing convenience and effectiveness, but when it came to the exercise classes, the effectiveness and safety of in-person outweighed the convenience of virtual attendance. These participants demonstrated this balance:
“I haven’t had any problems as a result of talking to the doctor by phone. I think it generally has been pretty positive.” – participant 1
“[in-person] the physiotherapist could see more what I was doing and help me if I was doing something incorrectly which made me feel safe and like our time together was helpful. [… she pointed out] different things about the way my feet move because she could see, which was only possible in-person. So overall I think in-person is better rather than if on Zoom.” – participant 10
A shared sentiment expressed by the participants was the special value of attending an in-person program. Virtual care was seen as a temporary solution and not a long-standing change. The human connection that participants felt in-person combated their everyday loneliness and filled their cravings for socialization. This did not translate to a virtual environment. A participant thus concluded:
“I do use Zoom for other things, and I think I would have no problem attending over Zoom, however, I find it is impersonal. You know, I don’t enjoy it. It is not like the real thing.” – participant 4
Depending on the participant’s level of frailty, independence, and their unique personalities, the “perfect” program was framed differently for each participant. This heterogeneity demonstrates the desire and necessity for program personalization. The key step identified by participants to achieve program personalization was extra effort and time spent on communication between participants and program staff. Moments of excellent communication were described as program highlights, whereas moments when communication was missing or of low quality often led to participant frustration and dissatisfaction. Ultimately, many participants voiced that with more communication and consideration for their unique needs, the program would have served them better. This was highlighted well by one of the participants:
“While the [physiotherapist] did all the regular sorts of things, teaching me the exercises, going over them, and watching me while I did them. The occupational therapy was something I really felt I didn’t need. […] it wasn’t valuable for me [...] perhaps when people get into the program, you might want to say, do you want to be in the occupational [therapy] part?” – participant 5
Understanding the lived experiences of the older-adult patient population who attended the FPP at Sunnybrook during COVID-19 helps inform future iterations of the program, including the appropriate incorporation of virtual care post-pandemic.
Our findings reveal that the older adults who experienced a four-week program feel that to adequately support their physical and mental well-being, a longer program is necessary for sustained effect. This unanimous agreement is aligned with the current World Guidelines for Falls Prevention which indicate that an ideal program length consists of sessions occurring three or more times weekly, for 12 weeks, irrespective of individual fall risk.(2) Furthermore, the reduction in class size that occurred due to pandemic restrictions was received positively by the participants, as increased one-on-one attention was important for feelings of safety and a long-lasting improvement in strength and balance. While a systematic review identified no significant difference between group and individualized exercise sessions in terms of their success preventing falls,(20) our study corroborated the World Guidelines for Falls Prevention that recommend smaller group numbers, while also recognizing that the importance of this may depend on individual patient factors such as level of cognitive impairment.(2) Despite the existing quantitative evidence suggesting no clear impact of class size on reducing falls, this study reveals that the patient’s perception of safety and reduced risk of falling is accomplished through one-on-one—rather than group—exercise classes.
The participants’ experiences navigating technology and pandemic-related barriers reveal that those with social support and pre-existing comfort with virtual care were able to find success with a sense of ease relative to those more isolated and unfamiliar with virtual care. Our sample likely represents higher socioeconomic status (SES) geriatric populations, as 70% of participants were university educated and all participants resided in the high-income catchment area of Sunnybrook Hospital.(21) Studies indicate that the success of virtual care is contingent on SES and eHealth literacy, with older populations with higher income and education levels exhibiting greater proficiency in handling the technological aspects of video-based programs and a higher likelihood of receiving support from family.(3,22) Furthermore, underprivileged populations may be less likely to receive a referral, in part due to reduced primary care contact.(23) To bridge gaps in accessibility, outreach and self-referral options may be necessary.
The COVID-19 pandemic prompted the widespread adoption of virtual falls prevention for frail older adult populations including the falls risk assessment and exercise classes. The effectiveness of virtual falls risk assessment remains uncertain in the literature and has not yet been incorporated into the World Guidelines for Falls Prevention. Our study highlights the positive patient experiences with assessments conducted both over phone and Zoom, including both perceived convenience and effectiveness. This supports the potential application of virtual falls assessments both during and post-pandemic. However, caution and professional judgement should guide implementation.
Regarding virtual exercise classes, while not FPP-specific, Fernandez et al. found patients’ perceived benefits of video exercises to be similar to in-person exercise classes.(24) This is comparable to our findings, as participants’ perceived success was more heavily tied to program length and individualized attention rather than the format of delivery (in-person versus virtual); however, participants’ feelings of safety and increased social engagement led to an overall preference for in-person exercises. Similarly, Palazzo et al. conducted qualitative interviews and found that patients with chronic low back pain were attracted to new technology-based forms of rehabilitation; however, patients felt it was not a substitute for the human relationship formed in-person with health-care staff.(22) The current World Guidelines for Falls Prevention recommend the use of telehealth in combination with FPPs in the community.(2) Thus, the virtual exercise classes that occurred during the pandemic were an appropriate temporary substitute; however, with low evidence to support safety and an overall patient preference for in-person, the use of virtual FPP exercise classes should be considered sparingly and primarily in cases where virtual accessibility is safe and meets the needs of the population. Integrating a patient-centred approach into FPP design is crucial, as this is endorsed by the World Guidelines for Falls Prevention (which advocate for personalized interventions for high-risk patients).(2) Our findings demonstrate the need for program personalization, including language support, technology education, and family involvement which is tailored to individual needs. A patient-centred approach can mitigate disadvantages, improve accessibility, and enhance patients’ perceived success and program enjoyment.
This study’s findings may not generalize to FPPs serving lower-SES populations, as our sample was highly educated and lacked a diverse demographic profile. There was a remarkably high response rate, with 10 out of 18 possible participants; however, if technology was a limiting factor for the eight who did not participate, results may contain self-selection bias. Reasons for declining participation included one participant who reported difficulty hearing over the phone, one participant who was in hospital, and six who did not provide a reason (Figure 2). Recall bias and limited perspectives from both family members (two families participated out of the 10 interviews) and health-care workers (no health-care workers were interviewed) are other limitations. Implementing post-program surveys could mitigate recall bias, and seeking alternative perspectives would provide a richer and more equitable understanding of virtual FPPs’ accessibility and effectiveness.
FPPs are a critical outpatient service which protect seniors from increased morbidity and mortality.(1,2) In response to COVID-19, the implementation of virtual care into the Sunnybrook FPP filled a necessary gap when the alternative was cessation of senior support during a time when isolation, loneliness, and frailty were on the rise. Moving forward, we can reflect on the experiences of this unique patient population to understand how FPPs can be modified, and how to appropriately incorporate virtual care to address patients’ diverse needs. Virtual care can be used to screen and assess falls risk, but in-person exercise programs and the human connection they provide are irreplaceable. Overcoming barriers to care requires personalized support, including access to technology and family involvement. It is important to take a patient-centred approach and foster supportive relationships between patients and health-care providers. In a broader application, incorporating virtual care allows for a vast array of outpatient programs to provide essential services when in-person contact is either restricted or less desirable/accessible. Outpatient programs with room for flexibility, patient and family education, and program personalization will allow for the most appropriate incorporation of virtual care specific to the intended patient population. This will ensure a patient-centred approach to senior-friendly quality improvement of important outpatient services.
We would like to acknowledge the pivotal role of Martha Ta who provided administrative support for the study and whose role in launching the virtual falls prevention clinic was key. We would also like to thank and acknowledge the participants and their families for kindly sharing their falls prevention program experiences.
We have read and understood the Canadian Geriatrics Journal’s policy on conflicts of interest disclosure and declare there are none.
Sunnybrook Program to Access Research Knowledge for Black and Indigenous Medical Students
1. World Health Organization. WHO global report on falls prevention in older age. [Internet]. 2008 [cited 2022 Feb 23]. Available from: https://apps.who.int/iris/handle/10665/43811
2. Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing. 2022 Sep 2;51(9):afac205.
Crossref PubMed PMC
3. Kohn MJ, Chadwick KA, Steinman LE. Adapting evidence-based falls prevention programs for remote delivery—implementation insights through the RE-AIM Evaluation Framework to Promote Health Equity. Prev Sci. 2023 Apr 10;1–11.
4. Gardner M, Robertson M, Campbell A. Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials. Br J Sports Med. 2000 Feb 1;34(1):7–17.
Crossref PubMed PMC
5. Bean JF, Vora A, Frontera WR. Benefits of exercise for community-dwelling older adults. Arch Phys Med Rehabil. 2004 Jul 1;85(Suppl 3):S31–S42; quiz S43–S44.
Crossref PubMed
6. Government of Canada SC. Impact of the COVID-19 pandemic on Canadian seniors [Internet]. 2021 [cited 2022 Sep 25]. Available from: https://www150.statcan.gc.ca/n1/pub/75-006-x/2021001/article/00008-eng.htm
7. Senderovich H, Wignarajah S. COVID-19 virtual care for the geriatric population: exploring two sides of the coin. Gerontology. 2022 Mar 16;68(3):289–94.
Crossref
8. Ezzat A, Sood H, Holt J, Ahmed H, Komorowski M. COVID-19: are the elderly prepared for virtual healthcare? BMJ Health Care Inform. 2021 Mar 1;28(1):e100334.
Crossref PubMed PMC
9. Li F, Harmer P, Voit J, Chou LS. Implementing an online virtual falls prevention intervention during a public health pandemic for older adults with mild cognitive impairment: a feasibility trial. Clin Interv Aging. 2021 May 25;16:973–83.
Crossref PubMed PMC
10. Davis JC, Hsu CL, Cheung W, Brasher PMA, Li LC, Khan KM, et al. Can the Otago falls prevention program be delivered by video? A feasibility study. BMJ Open Sport Exerc Med. 2016 Feb 1;2(1):e000059.
Crossref PubMed PMC
11. Dai J, Saleheen S, Ko A, Jahan I, Braidy N, Chan DK. Video-based fall prevention education for cognitively impaired inpatients: a pilot study. Asian J Gerontol Geriatr. 2022 Jun 1;17(1):11–16.
Crossref
12. Shubert TE, Basnett J, Chokshi A, Barrett M, Komatireddy R. Are virtual rehabilitation technologies feasible models to scale an evidence-based fall prevention program? A pilot study using the Kinect camera. JMIR Rehabil Assist Technol. 2015 Nov 5;2(2):e10.
Crossref PubMed PMC
13. Chan JK, Klainin-Yobas P, Chi Y, Gan JK, Chow G, Wu XV. The effectiveness of e-interventions on fall, neuromuscular functions and quality of life in community-dwelling older adults: a systematic review and meta-analysis. Int J Nurs Stud. 2021 Jan 1;113:103784.
Crossref
14. Loewenthal J, DuMontier C, Cooper L, Frain L, Waldman LS, Streiter S, et al. Adaptation of the comprehensive geriatric assessment to a virtual delivery format. Age Ageing. 2021 Mar;50(2):597–98.
Crossref PMC
15. Watt JA, Lane NE, Veroniki AA, Vyas MV, Williams C, Ramkissoon N, et al. Diagnostic accuracy of virtual cognitive assessment and testing: systematic review and meta-analysis. J Am Geriatr Soc. 2021 Jun;69(6):1429–40.
Crossref PubMed
16. Ogawa EF, Harris R, Dufour AB, Morey MC, Bean J. Reliability of virtual physical performance assessments in veterans during the COVID-19 pandemic. Arch Rehabil Res Clin Transl. 2021 Sep 1;3(3):100146.
PubMed PMC
17. Weiss SM, Castelo M, Liu B, Norris M. Virtual fall program assessment for frail Canadian community-dwelling older adults: Examining equitable accessibility. Digit Health. 2023 Jun 7;9:20552076231178410.
18. Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach. 2020 Aug 2;42(8):846–54.
Crossref PubMed
19. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007 Dec 1;19(6):349–57.
Crossref PubMed
20. Sherrington C, Fairhall N, Kwok W, Wallbank G, Tiedemann A, Michaleff ZA, et al. Evidence on physical activity and falls prevention for people aged 65+ years: systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act. 2020 Dec;17(1):144.
Crossref PubMed PMC
21. Government of Canada SC. Census Profile, 2016 Census—M4N [Forward sortation area] and Canada [Country] [Internet]. 2017 [cited 2023 Feb 5]. Available from: https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/prof/details/page.cfm?Lang=E&Geo1=FSA&Code1=M4N&Geo2=PR&Code2=01&SearchText=M4N&SearchType=Begins&SearchPR=01&B1=All&TABID=2&type=0
22. Palazzo C, Klinger E, Dorner V, Kadri A, Thierry O, Boumenir Y, et al. Barriers to home-based exercise program adherence with chronic low back pain: patient expectations regarding new technologies. Ann Phys Rehabil Med. 2016 Apr 1;59(2):107–13.
Crossref PubMed
23. Anaya YB, Mota AB, Hernandez GD, Osorio A, Hayes-Bautista DE. Post-pandemic telehealth policy for primary care: an equity perspective. J Am Board Fam Med. 2022 May 1;35(3):588–92.
Crossref PubMed
24. Fernandez D, Wilkins SS, Melrose RJ, Hall KM, Abbate LM, Morey MC, et al. Physical function effects of live video group exercise interventions for older adults: a systematic review and veteran’s Gerofit group case study. Telemed E-Health. 2023 Jun 1;29(6):829–40.
Crossref
*Prior abstract presentation at the Canadian Geriatric Society 2023 Annual Scientific Meeting and at the University of Toronto Division of Geriatric Medicine Fourth Annual Virtual Research Day 2023.
Correspondence to: Mireille Norris, MD, FRCPC, MHSc, Sunnybrook Women’s College Centre Unit HG39, 2075 Bayview Ave., Toronto, ON Canada M4N 3M5, E-mail: mireille.norris@sunnybrook.ca
COPYRIGHT
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivative license (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use and distribution, provided the original work is properly cited.
Canadian Geriatrics Journal, Vol. 27, No. 2, JUNE 2024