Outputs

Examine patterns of cane and walker use as related to falls and fall injuries. Among people who fall at home, most do not have an assistive device with them when they fall. Nonusers who fall sustain more severe injuries. This was a cross-sectional study using a self-administered written survey completed by 262 people aged 60 and older who were community dwelling, cognitively intact, and current cane/walker users with a history of falls. They were recruited through clinical practice sites, churches, and senior housing in central Michigan. Outcomes of interest included patterns of device use, reasons for nonuse, device use at time of fall, and fall-related injuries. Seventy-five percent of respondents who fell were not using their device at the time of fall despite stating that canes help prevent falls. Reasons for nonuse included believing it was not needed, forgetfulness, the device made them feel old, and inaccessibility. Perceived risk was not high enough to engage in self-protective behavior. However, nonuse led to a significantly higher proportion of falls resulting in surgery than among device users. Among respondents requiring surgery, 100% were nonusers. Most respondents never received a home safety evaluation (68%) and only 50% received training on proper device use. Providers must place increased emphasis on the importance of cane/walker use for injury prevention through patient education to promote personal relevance, proper fitting, and training. New strategies are needed to improve device acceptability and accessibility.

With an aging population and provider shortages, personal care aides (PCAs) hold potential for providing low-cost, high-quality in-home supports and services. They comprise an unprecedented workforce in terms of size and rapid growth. However, this workforce is also characterized by costly high-turnover rates that threaten quality of care and outcomes. It is imperative that measures be taken to improve PCA skills and stabilize their employment. In 2010, a PCA training program was developed titled “Building Training . . . Building Quality” as part of a national demonstration. Key findings were that learners’ skills, employability, and job satisfaction significantly improved, and “intent to stay” was associated with increased confidence in ability to do the job. This report details findings of value to those interested in retaining high-quality PCAs.

Personal care aides (PCAs) are critical to meeting the need for low-cost, high-quality care for frail older adults at home. Developing this workforce entails not only increasing its size but also ensuring that PCAs possess the skills necessary to deliver competent, safe, and respectful care. Yet, no federal PCA competencies or training requirements exist, and state requirements vary widely. In 2010, a 77-hour PCA model training program was developed as part of a national demonstration. However, a key finding of this study was that many enrollees faced serious socio-economic challenges that prevented them from graduating. This report details findings from a survey sent to all non-completers to ascertain reasons for attrition and improve program success. It offers recommendations for future program planners.