Feasibility and efficacy of video-based falls prevention education for cognitively impaired hospital inpatients – a pilot study

INTERVENTION: Brief name: Educational falls prevention video Why: It was a silent video that communicated primarily with universal body language and symbols (ticks and crosses) with the aim of overcoming language barriers that were common to the culturally and linguistically diverse local geriatric population. The main message of the video is to instruct patients to ask for help if they want to get out of bed and ambulate to the toilet. Most inpatient falls in older adults occur around the bed area and in the toilet, when patients attempt to transfer and ambulate without asking for nursing assistance. The visual instruction was strengthened by the scenes of broken bones to arouse emotional memory (emotional scenes are better remembered than ordinary ones). What: Materials: 1. education video as described above 2. Computers on wheels Procedures: Investigators used computers on wheels to play the educational video to patients randomized to the intervention arm. After the video finishes playing, the investigators asked the patient what the video was about and explained the video if they didn't get the message. They asked patients to remember the video's message for the following day. Who provided: Doctors and nurses, both junior and senior, who had been briefed about this project, showed the video to patients. How: face to face education provided to individual patients Where: Bankstown‐Lidcombe hospital, Sydney, NSW, Australia. Tertiary teaching hospital 454 beds. Inpatient setting, on various wards (general medical, surgical, stroke, cardiology, acute geriatric, rehabilitation, psychogeriatric, medical assessment unit). We didn't include mental health, dialysis unit or emergency department. When and How much: The video was played once CONDITION: falls;cognitive impairment;dementia; ; falls ; cognitive impairment ; dementia Injuries and Accidents ‐ Other injuries and accidents Neurological ‐ Alzheimer's disease Neurological ‐ Dementias Neurological ‐ Other neurological disorders SECONDARY OUTCOME: nil[nil] INCLUSION CRITERIA: Patients were included if they score below the recommended cut off on validated screening tools for cognitive impairment (MMSE <24, RUDAS <23, MOCA <26). Delirious patients are included PRIMARY OUTCOME: Primary Outcome: Whether the patient fell during the remainder of their hospital stay. We calculate the falls rate (number of falls per occupied bed day) and falls risk (number of participants who fell) in each group after they received the falls education.; The co‐primary outcome of ‘falls’ was determined by incident reports (IIMS) and corroborated with patient medical records. ; No known adverse events related to these interventions are measured; [Inpatient falls that happened after they received falls education until the participant has been discharged] Primary Outcome: Whether the patient remembered the content of the falls prevention education provided, when asked about it the following day. Investigators would follow patients up the next day to ask "I gave you an instruction to remember yesterday, what was it?" or "I showed you a video yesterday, what was it about?" Remembrance is defined as the patient responding "if I need to go somewhere, I will ask for help" or conveying this idea with other wording. We calculate the proportion of participants that remembered this message in each group.; No instruments are used; No known adverse events related to these interventions are measured; ; [Remembrance is assessed 1 day after falls education is provided]