Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach
Abstract Background Falls 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, a...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-023-04294-2 |
| _version_ | 1797556619462049792 |
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| author | Wei Xuan Lai Angelique Wei-Ming Chan David Bruce Matchar John Pastor Ansah Christopher Tsung Chien Lien Noor Hafizah Ismail Chek Hooi Wong Tianma Xu Vanda Wen Teng Ho Pey June Tan June May Ling Lee Rita Siew Choo Sim Normala Manap |
| author_facet | Wei Xuan Lai Angelique Wei-Ming Chan David Bruce Matchar John Pastor Ansah Christopher Tsung Chien Lien Noor Hafizah Ismail Chek Hooi Wong Tianma Xu Vanda Wen Teng Ho Pey June Tan June May Ling Lee Rita Siew Choo Sim Normala Manap |
| author_sort | Wei Xuan Lai |
| collection | DOAJ |
| description | Abstract Background Falls 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. Methods A 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. Results Four 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. Conclusion This 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. |
| first_indexed | 2024-03-10T17:05:24Z |
| format | Article |
| id | doaj.art-f4429f7b707a45a1b4680b8ba77bd17b |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-03-10T17:05:24Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-f4429f7b707a45a1b4680b8ba77bd17b2023-11-20T10:51:20ZengBMCBMC Geriatrics1471-23182023-09-0123111710.1186/s12877-023-04294-2Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approachWei Xuan Lai0Angelique Wei-Ming Chan1David Bruce Matchar2John Pastor Ansah3Christopher Tsung Chien Lien4Noor Hafizah Ismail5Chek Hooi Wong6Tianma Xu7Vanda Wen Teng Ho8Pey June Tan9June May Ling Lee10Rita Siew Choo Sim11Normala Manap12Duke-NUS Medical School, Programme in Health Services and Systems ResearchCentre for Ageing Research and Education, Duke-NUS Medical SchoolDuke-NUS Medical School, Programme in Health Services and Systems ResearchCenter for Community Health Integration, Case Western Reserve UniversityDepartment of Geriatric Medicine, Changi General HospitalDepartment of Continuing and Community Care, Tan Tock Seng HospitalGeriatric Education and Research InstituteHealth & Social Sciences Cluster, Singapore Institute of TechnologyDepartment of Medicine, National University HospitalAgeing and Age-Associated Disorders Research Group, Health and Translational Medicine Cluster, University of MalayaCentre for Ageing Research and Education, Duke-NUS Medical SchoolDuke-NUS Medical School, Programme in Health Services and Systems ResearchCentre for Ageing Research and Education, Duke-NUS Medical SchoolAbstract Background Falls 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. Methods A 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. Results Four 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. Conclusion This 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.https://doi.org/10.1186/s12877-023-04294-2Group model buildingSystems thinkingFalls preventionOlder adults |
| spellingShingle | Wei Xuan Lai Angelique Wei-Ming Chan David Bruce Matchar John Pastor Ansah Christopher Tsung Chien Lien Noor Hafizah Ismail Chek Hooi Wong Tianma Xu Vanda Wen Teng Ho Pey June Tan June May Ling Lee Rita Siew Choo Sim Normala Manap Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach BMC Geriatrics Group model building Systems thinking Falls prevention Older adults |
| title | Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach |
| title_full | Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach |
| title_fullStr | Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach |
| title_full_unstemmed | Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach |
| title_short | Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach |
| title_sort | group model building on causes and interventions for falls in singapore insights from a systems thinking approach |
| topic | Group model building Systems thinking Falls prevention Older adults |
| url | https://doi.org/10.1186/s12877-023-04294-2 |
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