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Almeida OP, Hankey GJ, Yeap BB, Golledge J, Hill KD, Flicker L. Depression Among Nonfrail Old Men Is Associated With Reduced Physical Function and Functional Capacity After 9 Years Follow-up: The Health in Men Cohort Study. J Am Med Dir Assoc 2017; 18:65-69. [PMID: 27776985 DOI: 10.1016/j.jamda.2016.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
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152
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Hill KD, Wee E, Margelis S, Menz HB, Bartlett J, Bergman NR, McMahon S, Hare DL, Levinger P. Falls in people prior to undergoing total hip or total knee replacement surgery: Frequency and associated factors. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jcgg.2016.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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153
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Meyer C, Dow B, Hill KD, Tinney J, Hill S. " The Right Way at the Right Time": Insights on the Uptake of Falls Prevention Strategies from People with Dementia and Their Caregivers. Front Public Health 2016; 4:244. [PMID: 27853730 PMCID: PMC5090973 DOI: 10.3389/fpubh.2016.00244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 10/17/2016] [Indexed: 12/02/2022] Open
Abstract
Strong evidence exists for effective falls prevention strategies for community-dwelling older people. Understanding the translation of these strategies into practice for people with dementia has had limited research focus. People with dementia desire to have their voice heard, to engage meaningfully in the health-care decision-making process, making it a priority for researchers and practitioners to better understand how to engage them in this process. This paper reports on the qualitative aspects of a series of studies, which aimed to identify the views of people with dementia and their caregivers regarding perceptions of falls prevention and the successes and challenges of adopting falls prevention strategies. Twenty five people with dementia and their caregivers were interviewed in their homes at baseline, and 24 caregivers and 16 people with dementia were interviewed at completion of a 6-month individualized falls prevention intervention. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Five themes were identified at baseline: perceptions of falls; caregivers navigating the new and the unpredictable; recognition of decline; health services – the need for an appropriate message; and negotiating respectful relationships. At 6 months, caregivers and people with dementia decided on “what we need to know” with firm views that the information regarding falls risk reduction needed to be in “the right way … at the right time.” Rather than caregivers and people with dementia being only recipients of knowledge, they felt they were “more than just empty vessels to be filled” drawing on a “variety of resources” within their circle of influence to be able to positively “adapt to change.” The voices of people with dementia and their caregivers add an important dimension to understanding the translation of falls prevention knowledge for this population. Insights from this study will enable community care health professionals to understand that people with dementia and their caregivers can, and wish to, contribute to implementing falls prevention strategies through their resourcefulness and inclusion in the therapeutic partnership.
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Affiliation(s)
- Claudia Meyer
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia; RDNS Institute, St Kilda, VIC, Australia
| | - Briony Dow
- National Ageing Research Institute, Parkville, VIC, Australia; Centre for Health Policy, School of Global and Population Health, University of Melbourne, Parkville, VIC, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University , Perth, WA , Australia
| | - Jean Tinney
- National Ageing Research Institute , Parkville, VIC , Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University , Bundoora, VIC , Australia
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Morello RT, Morris RL, Hill KD, Haines TP, Arendts G, Redfern J, Etherton-Beer CD, Lowthian JA, Brand CA, Liew D, Watts JJ, Barker AL. RESPOND: a programme to prevent secondary falls in older people presenting to the emergency department with a fall: protocol for an economic evaluation. Inj Prev 2016; 23:124-130. [PMID: 28330932 DOI: 10.1136/injuryprev-2016-042169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Falls remain common for community-dwelling older people and impose a substantial economic burden to the healthcare system. RESPOND is a novel falls prevention programme that aims to reduce secondary falls and fall injuries among older people who present to a hospital emergency department (ED) with a fall. The present protocol describes a prospective economic evaluation examining the incremental cost-effectiveness of the RESPOND programme, compared with usual care practice, from the Australian health system perspective. METHODS AND DESIGN This economic evaluation will recruit 528 participants from two major tertiary hospital EDs in Australia and will be undertaken alongside a multisite randomised controlled trial. Outcome and costing data will be collected for all participants over the 12-month trial. It will compare the RESPOND falls prevention programme with usual care practice (current community-based falls prevention practices) to determine its incremental cost-effectiveness according to three intermediate clinical outcomes: (1) falls prevented, (2) fall injuries prevented and (3) injurious falls prevented. In addition, utilities will be derived from a generic quality-of-life measure (EQ-5D-5L) and used to calculate the 'incremental cost per quality-adjusted life years gained'. DISCUSSION The results of this study will provide healthcare decision makers with evidence to assist with setting spending thresholds for preventive health programmes and inform selection of emergency and community service models of care. TRIAL REGISTRATION NUMBER The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684); Pre-results.
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Affiliation(s)
- R T Morello
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - R L Morris
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - K D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - T P Haines
- Department of Physiotherapy, Monash University, Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
| | - G Arendts
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, Western Australia, Australia
| | - J Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - C D Etherton-Beer
- University of Western Australia, Perth, Western Australia, Australia.,Western Australian Institute for Medical Research, Perth, Western Australia, Australia
| | - J A Lowthian
- Pre-Hospital, Emergency and Trauma Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - C A Brand
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - D Liew
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J J Watts
- Centre for Population Health Research, Deakin University, Melbourne, Victoria, Australia
| | - A L Barker
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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155
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Graven C, Brock K, Hill KD, Cotton S, Joubert L. First Year After Stroke: An Integrated Approach Focusing on Participation Goals Aiming to Reduce Depressive Symptoms. Stroke 2016; 47:2820-2827. [PMID: 27738234 DOI: 10.1161/strokeaha.116.013081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 09/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Depression is a common issue after stroke. A focus on assisting people to achieve their personal participation goals may reduce levels of depression. The aim of this study was to investigate the effectiveness of a person-centered, integrated approach on facilitating goal achievement in the first year poststroke on depressive symptoms. METHODS This study was a randomized controlled trial that addressed ways to enhance participation in patient-valued activities and intermittently screen for adverse sequelae postdischarge from rehabilitation. Collaborative goal setting was undertaken in both groups at discharge from inpatient rehabilitation. The control group received standard management as determined by the treating team. In addition, the intervention group received a multimodal approach, including telephone contacts, screening for adverse sequelae, written information, home visits, review of goal achievement, and further referral to relevant health services. The main outcome measure was depressed mood, measured by the 15-item Geriatric Depression Scale. RESULTS One hundred ten participants were recruited. No group differences were identified at baseline on any demographic and clinical variables. Using multiple linear regression analysis, there was a significant difference between the 2 groups with respect to the severity of depressive symptoms at 12 months poststroke (R2=0.366; F (6, 89)=8.57; P<0.005), with the intervention group recording lower depressive scores. CONCLUSIONS This model of community-based rehabilitation proved effective in reducing poststroke depressive symptoms. An integrated approach using pursuit of patient-identified activities should form part of routine poststroke management. CLINICAL TRIAL REGISTRATION URL: http://www.anzctr.org.au. Unique identifier: ACTRN12608000042347.
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Affiliation(s)
- Christine Graven
- From the Rehabilitation Unit, St Vincent's Hospital Melbourne, Victoria, Australia (C.G., K.B.); School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia (K.D.H.); Orygen, The National Centre of Excellence in Youth Mental Health (S.C.) and Melbourne School of Health Sciences (L.J.), The University of Melbourne, Victoria, Australia.
| | - Kim Brock
- From the Rehabilitation Unit, St Vincent's Hospital Melbourne, Victoria, Australia (C.G., K.B.); School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia (K.D.H.); Orygen, The National Centre of Excellence in Youth Mental Health (S.C.) and Melbourne School of Health Sciences (L.J.), The University of Melbourne, Victoria, Australia
| | - Keith D Hill
- From the Rehabilitation Unit, St Vincent's Hospital Melbourne, Victoria, Australia (C.G., K.B.); School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia (K.D.H.); Orygen, The National Centre of Excellence in Youth Mental Health (S.C.) and Melbourne School of Health Sciences (L.J.), The University of Melbourne, Victoria, Australia
| | - Sue Cotton
- From the Rehabilitation Unit, St Vincent's Hospital Melbourne, Victoria, Australia (C.G., K.B.); School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia (K.D.H.); Orygen, The National Centre of Excellence in Youth Mental Health (S.C.) and Melbourne School of Health Sciences (L.J.), The University of Melbourne, Victoria, Australia
| | - Lynette Joubert
- From the Rehabilitation Unit, St Vincent's Hospital Melbourne, Victoria, Australia (C.G., K.B.); School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia (K.D.H.); Orygen, The National Centre of Excellence in Youth Mental Health (S.C.) and Melbourne School of Health Sciences (L.J.), The University of Melbourne, Victoria, Australia
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156
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Toye C, Parsons R, Slatyer S, Aoun SM, Moorin R, Osseiran-Moisson R, Hill KD. Outcomes for family carers of a nurse-delivered hospital discharge intervention for older people (the Further Enabling Care at Home Program): Single blind randomised controlled trial. Int J Nurs Stud 2016; 64:32-41. [PMID: 27684320 DOI: 10.1016/j.ijnurstu.2016.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/07/2016] [Accepted: 09/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hospital discharge of older people receiving care at home offers a salient opportunity to identify and address their family caregivers' self-identified support needs. OBJECTIVES This study tested the hypothesis that the extent to which family caregivers of older people discharged home from hospital felt prepared to provide care at home would be positively influenced by their inclusion in the new Further Enabling Care at Home program. DESIGN This single-blind randomised controlled trial compared outcomes from usual care alone with those from usual care plus the new program. The program, delivered by a specially trained nurse over the telephone, included: support to facilitate understanding of the patient's discharge letter; caregiver support needs assessment; caregiver prioritisation of urgent needs; and collaborative guidance, from the nurse, regarding accessing supports. SETTING AND PARTICIPANTS Dyads were recruited from the medical assessment unit of a Western Australian metropolitan public hospital. Each dyad comprised a patient aged 70 years or older plus an English speaking family caregiver. METHODS The primary outcome was the caregiver's self-reported preparedness to provide care for the patient. Data collection time points were designated as: Time 1, within four days of discharge; Time 2, 15-21days after discharge; Time 3, six weeks after discharge. Other measures included caregivers' ratings of: their health, patients' symptoms and independence, caregiver strain, family well-being, caregiver stress, and positive appraisals of caregiving. Data were collected by telephone. RESULTS Complete data sets were obtained from 62 intervention group caregivers and 79 controls. Groups were equivalent at baseline. Needs prioritised most often by caregivers were: to know whom to contact and what to expect in the future and to access practical help at home. Support guidance included how to: access help, information, and resources; develop crisis plans; obtain referrals and services; and organise legal requirements. Compared to controls, preparedness to care improved in the intervention group from Time 1 to Time 2 (effect size=0.52; p=0.006) and from Time 1 to Time 3 (effect size=0.43; p=0.019). These improvements corresponded to a change of approximately 2 points on the Preparedness for Caregiving instrument. Small but significant positive impacts were also observed in other outcomes, including caregiver strain. CONCLUSIONS These unequivocal findings provide a basis for considering the Furthering Enabling Care at Home program's implementation in this and other similar settings. Further testing is required to determine the generalisability of results.
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Affiliation(s)
- Christine Toye
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia; Centre for Nursing Research, Sir Charles Gairdner Hospital, The Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands Western Australia, 6009, Australia.
| | - Richard Parsons
- School of Pharmacy, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia.
| | - Susan Slatyer
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia; Centre for Nursing Research, Sir Charles Gairdner Hospital, The Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands Western Australia, 6009, Australia.
| | - Samar M Aoun
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Rachael Moorin
- School of Public Health, Curtin University, GPO Box U1987 Perth, Western Australia, 6845, Australia.
| | - Rebecca Osseiran-Moisson
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia.
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157
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Hill KD, Flicker L, LoGiudice D, Smith K, Atkinson D, Hyde Z, Fenner S, Skeaf L, Malay R, Boyle E. Falls risk assessment outcomes and factors associated with falls for older Indigenous Australians. Aust N Z J Public Health 2016; 40:553-558. [DOI: 10.1111/1753-6405.12569] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 03/01/2016] [Accepted: 05/01/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Keith D. Hill
- School of Physiotherapy and Exercise Science; Curtin University; Western Australia
| | - Leon Flicker
- WA Centre for Health & Ageing, Centre for Medical Research; University of Western Australia
- Department of Geriatric Medicine; Royal Perth Hospital; Western Australia
| | | | - Kate Smith
- WA Centre for Health & Ageing, Centre for Medical Research; University of Western Australia
| | - David Atkinson
- Rural Clinical School of Western Australia; University of Western Australia
| | - Zoë Hyde
- WA Centre for Health & Ageing, Centre for Medical Research; University of Western Australia
- School of Medicine and Pharmacology; University of Western Australia
| | - Stephen Fenner
- Department of Psychiatry; Royal Perth Hospital; Western Australia
| | - Linda Skeaf
- WA Centre for Health & Ageing, Centre for Medical Research; University of Western Australia
| | - Roslyn Malay
- WA Centre for Health & Ageing, Centre for Medical Research; University of Western Australia
| | - Eileen Boyle
- School of Physiotherapy and Exercise Science; Curtin University; Western Australia
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158
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Burton E, Lewin G, Pettigrew S, Hill AM, Bainbridge L, Farrier K, Langdon T, Airey P, Hill KD. Identifying motivators and barriers to older community-dwelling people participating in resistance training: A cross-sectional study. J Sports Sci 2016; 35:1523-1532. [DOI: 10.1080/02640414.2016.1223334] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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159
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Abstract
OBJECTIVE To investigate the feasibility, effectiveness, and short-term effects of an exercise intervention using a novel exercise park in improving seniors' balance, physical function, and quality of life. METHOD Randomized controlled trial with pre- and post-intervention design (baseline and 18-week intervention) was used. Outcome measures included measures of balance, strength, and function, as well as quality of life and fear of falling. MANCOVA was used to assess differences between groups (control and exercise intervention) over time. RESULTS Intervention group showed significant improvement on single leg stance ( p = .02, 95% confidence interval [CI] = [-8.35, -0.549]), knee strength ( p < .01, 95% CI = [-29.14, -5.86]), 2-min walk ( p = 0.02, 95% CI = [-19.13, -0.859]), and timed sit to stand ( p = .03, 95% CI = [-2.26, -0.143]) tests. DISCUSSION The exercise park program improved physical function and had high adherence and participation rate. Such intervention has been shown to be safe and therefore might enhance participation in exercise programs for older adults.
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160
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Hunter SW, Batchelor F, Hill KD, Hill AM, Mackintosh S, Payne M. Risk Factors for Falls in People With a Lower Limb Amputation: A Systematic Review. PM R 2016; 9:170-180.e1. [DOI: 10.1016/j.pmrj.2016.07.531] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/06/2016] [Accepted: 07/19/2016] [Indexed: 01/31/2023]
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161
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Haines TP, Hill KD, Bennell KL, Osborne RH. Additional exercise for older subacute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation. Clin Rehabil 2016; 21:742-53. [PMID: 17846074 DOI: 10.1177/0269215507079842] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To evaluate the clinical effectiveness and implementation of a falls prevention exercise programme for preventing falls in the subacute hospital setting. Design: Randomized controlled trial, subgroup analysis. Participants: Patients of a metropolitan subacute/aged rehabilitation hospital who were recommended for a falls prevention exercise programme when enrolled in a larger randomized controlled trial of a falls prevention programme. Methods: Participants in both the control and intervention groups who were recommended for the exercise programme intervention were followed for the duration of their hospital stay to determine if falls occurred. Participants had their balance, strength and mobility assessed upon referral for the exercise programme and then again prior to discharge. Participation rates in the exercise programme were also recorded. Results: Intervention group participants in this subgroup analysis had a significantly lower incidence of falls than their control group counterparts (control: 16.0 falls/1000 participant-days, intervention: 8.2 falls/1000 participant-days, log-rank test: P = 0.007). However few differences in secondary balance, strength and mobility outcomes were evident. Conclusion: This exercise programme provided in addition to usual care may assist in the prevention of falls in the subacute hospital setting.
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Affiliation(s)
- Terry P Haines
- Physiotherapy Department, GARU, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
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162
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Abstract
Objective: To evaluate the effectiveness of a patient education programme for preventing falls in the subacute hospital setting. Design: Randomized controlled trial, subgroup analysis. Participants: Patients of a metropolitan subacute/aged rehabilitation hospital who were recommended for a patient education intervention for the prevention of falls when enrolled in a larger randomized controlled trial of a falls prevention programme. Methods: Participants in both the control and intervention groups who were recommended for the education programme intervention were followed for the duration of their hospital stay to determine if falls occurred. Only participants in the intervention group who were recommended for this intervention actually received it. In addition, these participants completed an evaluation survey at the completion of their education programme. Results: Intervention group participants in this subgroup analysis had a significantly lower incidence of falls than their control group counterparts (control: 16.0 falls/1000 participant-days, intervention: 8.2 falls/1000 participant-days, log-rank test: P = 0.007). However the difference in the proportion of fallers was not significant (relative risk 1.21, 95% confidence interval 0.68 to 2.14). Conclusion: Patient education is an important part of a multiple intervention falls prevention approach for the subacute hospital setting.
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Affiliation(s)
- Terry P Haines
- The University of Queensland and Princess Alexandra Hospital, Queensland, Australia.
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163
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Davies SE, Dodd KJ, Hill KD. Does cultural and linguistic diversity affect health-related outcomes for people with stroke at discharge from hospital? Disabil Rehabil 2016; 39:736-745. [DOI: 10.3109/09638288.2016.1161839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sarah E. Davies
- Physiotherapy Department, Northern Health, Melbourne, Victoria, Australia
- College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Karen J. Dodd
- College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Keith D. Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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164
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Barker AL, Morello RT, Ayton DR, Hill KD, Landgren FS, Brand CA. Development of an implementation plan for the 6-PACK falls prevention programme as part of a randomised controlled trial: protocol for a series of preimplementation studies. Inj Prev 2016; 22:446-452. [PMID: 26932835 DOI: 10.1136/injuryprev-2015-041915] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Inhospital falls cause morbidity, staff burden and increased healthcare costs. It is unclear if the persistent problem of inhospital falls is due to the use of ineffective interventions or their suboptimal implementation. The 6-PACK programme appears to reduce fall injuries and a randomised controlled trial (RCT) was undertaken to confirm effects. This paper describes the protocol for the preimplementation studies that aimed to identify moderators of the effective use of the 6-PACK programme to inform the development of an implementation plan to be applied in the RCT. METHODS The 6-PACK project included five preimplementation studies: (1) a profile of safety climate; (2) review of current falls prevention practice; (3) epidemiology of inhospital falls; (4) acceptability of the 6-PACK programme; and (5) barriers and enablers to implementation of the 6-PACK programme. The Theoretical Domain Framework that includes 12 behaviour change domains informed the design of these studies that involved 540 staff and 8877 patients from 24 wards from six Australian hospitals. Qualitative and quantitative methods were applied with data collected via: structured bedside observation; daily nurse unit manager verbal report of falls; audit of medical records, incident reporting and hospital administrative data; surveys of ward nurses; focus groups with ward nurses; and key informant interviews with senior staff. DISCUSSION Information on contextual, system, intervention, patient and provider level factors is critical to the development of an implementation plan. Information gained from these studies was used to develop a plan applied in the RCT that addressed the barriers and harnessed enablers. TRIAL REGISTRATION NUMBER The RCT is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000332921.
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Affiliation(s)
- Anna L Barker
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Renata T Morello
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Darshini R Ayton
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | | | - Caroline A Brand
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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165
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Haines TP, Hill KD, Vu T, Clemson L, Finch CF, Day L. Does action follow intention with participation in home and group-based falls prevention exercise programs? An exploratory, prospective, observational study. Arch Gerontol Geriatr 2016; 64:151-61. [PMID: 26900893 DOI: 10.1016/j.archger.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Exercise for falls prevention is effective but of limited uptake in real life. The link between intention and behavior is central to many health-behavior models, but has not been examined in the falls prevention exercise context. OBJECTIVE This study examines this relationship and prospectively identifies factors associated with participation in group and home-based falls prevention exercise. DESIGN This was an observational study of community-dwelling adults in Australia >70 years of age with a 12 month follow-up (n=394 commenced baseline assessment, n=247 commenced follow-up). METHODS Intention, and other potential predictive factors examined, were measured at baseline while participation was measured using self-report at 12 month follow-up. RESULTS Between 65% and 72% of our sample at baseline agreed or strongly agreed they would participate in the falls prevention exercise programs. n=27 respondents participated in home-based exercise during follow-up and had intention to do so while n=29 who participated did not have intention. In contrast, n=43 respondents participated in group exercise and had intention to do so compared to 11 who participated but did not intend to at baseline. Perception of personal effectiveness and previous exposure to the exercise intervention were most strongly predictive of future participation. CONCLUSION More people who do not want to participate in home exercise actually participate in home exercise than people who do not want to participate in group exercise that actually do. It may be easier to convince people who do not want to participate in falls prevention exercise to participate in a home program.
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Affiliation(s)
- Terry P Haines
- Physiotherapy Department, School of Primary Health Care, Monash University, Frankston, Victoria 3199, Australia.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia 6845, Australia
| | - Trang Vu
- Australian Centre for Research in Employment and Work, Monash University, Victoria 3800, Australia
| | - Lindy Clemson
- Ageing, Health & Work Research Unit, Faculty of Health Sciences, University of Sydney and Centre of Excellence in Population Ageing Research, Lidcombe, New South Wales 2141, Australia
| | - Caroline F Finch
- Centre for Healthy and Safe Sport, Federation University, Ballarat, Victoria 3353, Australia
| | - Lesley Day
- Monash Injury Research Institute, Monash University, Clayton, Victoria 3800, Australia
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166
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Morello RT, Barker AL, Watts JJ, Haines T, Zavarsek SS, Hill KD, Brand C, Sherrington C, Wolfe R, Bohensky MA, Stoelwinder JU. The extra resource burden of in-hospital falls: a cost of falls study. Med J Aust 2016; 203:367. [PMID: 26510807 DOI: 10.5694/mja15.00296] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/07/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To quantify the additional hospital length of stay (LOS) and costs associated with in-hospital falls and fall injuries in acute hospitals in Australia. DESIGN, SETTING AND PARTICIPANTS A multisite prospective cohort study conducted during 2011-2013 in the control wards of a falls prevention trial (6-PACK). The trial included all admissions to 12 acute medical and surgical wards of six Australian hospitals. In-hospital falls data were collected from medical record reviews, daily verbal reports by ward nurse unit managers, and hospital incident reporting and administrative databases. Clinical costing data were linked for three of the six participating hospitals to calculate patient-level costs. OUTCOME MEASURES Hospital LOS and costs associated with in-hospital falls and fall injuries for each patient admission. RESULTS We found that 966 of a total of 27 026 hospital admissions (3.6%) involved at least one fall, and 313 (1.2%) at least one fall injury, a total of 1330 falls and 418 fall injuries. After adjustment for age, sex, cognitive impairment, admission type, comorbidity and clustering by hospital, patients who had an in-hospital fall had a mean increase in LOS of 8 days (95% CI, 5.8-10.4; P < 0.001) compared with non-fallers, and incurred mean additional hospital costs of $6669 (95% CI, $3888-$9450; P < 0.001). Patients with a fall-related injury had a mean increase in LOS of 4 days (95% CI, 1.8-6.6; P = 0.001) compared with those who fell without injury, and there was also a tendency to additional hospital costs (mean, $4727; 95% CI, -$568 to $10 022; P = 0.080). CONCLUSION Patients who experience an in-hospital fall have significantly longer hospital stays and higher costs. Programs need to target the prevention of all falls, not just the reduction of fall-related injuries.
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Barker AL, Morello RT, Wolfe R, Brand CA, Haines TP, Hill KD, Brauer SG, Botti M, Cumming RG, Livingston PM, Sherrington C, Zavarsek S, Lindley RI, Kamar J. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. BMJ 2016; 352:h6781. [PMID: 26813674 PMCID: PMC4727091 DOI: 10.1136/bmj.h6781] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards. DESIGN Cluster randomised controlled trial. SETTING Six Australian hospitals. PARTICIPANTS All patients admitted to 24 acute wards during the trial period. INTERVENTIONS Participating wards were randomly assigned to receive either the nurse led 6-PACK programme or usual care over 12 months. The 6-PACK programme included a fall risk tool and individualised use of one or more of six interventions: "falls alert" sign, supervision of patients in the bathroom, ensuring patients' walking aids are within reach, a toileting regimen, use of a low-low bed, and use of a bed/chair alarm. MAIN OUTCOME MEASURES The co-primary outcomes were falls and fall injuries per 1000 occupied bed days. RESULTS During the trial, 46 245 admissions to 16 medical and eight surgical wards occurred. As many people were admitted more than once, this represented 31 411 individual patients. Patients' characteristics and length of stay were similar for intervention and control wards. Use of 6-PACK programme components was higher on intervention wards than on control wards (incidence rate ratio 3.05, 95% confidence interval 2.14 to 4.34; P<0.001). In all, 1831 falls and 613 fall injuries occurred, and the rates of falls (incidence rate ratio 1.04, 0.78 to 1.37; P=0.796) and fall injuries (0.96, 0.72 to 1.27; P=0.766) were similar in intervention and control wards. CONCLUSIONS Positive changes in falls prevention practice occurred following the introduction of the 6-PACK programme. However, no difference was seen in falls or fall injuries between groups. High quality evidence showing the effectiveness of falls prevention interventions in acute wards remains absent. Novel solutions to the problem of in-hospital falls are urgently needed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12611000332921.
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Affiliation(s)
- Anna L Barker
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Renata T Morello
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Caroline A Brand
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Terry P Haines
- Physiotherapy Department, Monash University, Allied Health Research Unit, Monash Health, Kingston Centre, Cheltenham, VIC 3195, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA 6102, Australia
| | - Sandra G Brauer
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia
| | - Mari Botti
- School of Nursing and Midwifery, Deakin University, Burwood, VIC 3125, Australia
| | - Robert G Cumming
- School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | | | - Catherine Sherrington
- George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Silva Zavarsek
- Centre for Health Economics, Monash Business School, Monash University, Clayton, VIC 3800, Australia
| | - Richard I Lindley
- George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Jeannette Kamar
- Northern Hospital, Northern Health, Epping, VIC 3076, Australia
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168
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McCrary AW, Malowitz JR, Hornik CP, Hill KD, Cotten CM, Tatum GH, Barker PC. Differences in Eccentricity Index and Systolic-Diastolic Ratio in Extremely Low-Birth-Weight Infants with Bronchopulmonary Dysplasia at Risk of Pulmonary Hypertension. Am J Perinatol 2016; 33:57-62. [PMID: 26171597 PMCID: PMC5319830 DOI: 10.1055/s-0035-1556757] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the left ventricular eccentricity index (EI) and tricuspid valve systolic-diastolic (SD) ratio in infants at risk of bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH). STUDY DESIGN Review of echocardiograms performed on infants born at ≤ 28 weeks' postmenstrual age, categorized into the following three cohorts: BPD and PH (n = 13); BPD only (n = 16); and controls (n = 59). EI was measured from a parasternal short axis 2D image. The SD ratio was measured from the continuous wave Doppler tracing. Groups were compared using Kruskal-Wallis and Wilcoxon rank sum tests. RESULT EI and SD ratios were successfully measured in all infants. There were no differences between controls and BPD cohort. In contrast, the BPD and PH cohort had increased systolic EI (1.46 vs. 1.00-1.01), diastolic EI (1.47 vs. 1.00), and SD ratio (1.12 vs. 0.97-1.00) compared with controls and BPD only cohort (p ≤ 0.01 for all). CONCLUSION The EI and SD ratio may be useful as a screening tool for PH in this population.
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Affiliation(s)
- AW McCrary
- Department of Pediatrics, Duke University Hospital, Durham, NC, 27710, United States
| | - JR Malowitz
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, NC, 27710, United States
| | - CP Hornik
- Department of Pediatrics, Duke University Hospital, Durham, NC, 27710, United States
| | - KD Hill
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, NC, 27710, United States
| | - CM Cotten
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, NC, 27710, United States
| | - GH Tatum
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, NC, 27710, United States
| | - PC Barker
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, NC, 27710, United States
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Shiek Ahmad B, Wark JD, Petty SJ, O'Brien TJ, Gorelik A, Sambrook PN, Hill KD. Changes in balance function with chronic antiepileptic drug therapy: A twin and sibling study. Epilepsia 2015; 56:1714-22. [DOI: 10.1111/epi.13136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Baemisla Shiek Ahmad
- Department of Medicine; University of Melbourne; The Royal Melbourne Hospital; Parkville Victoria Australia
- Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - John D. Wark
- Department of Medicine; University of Melbourne; The Royal Melbourne Hospital; Parkville Victoria Australia
- The Royal Melbourne Hospital Bone and Mineral Medicine; Parkville Victoria Australia
| | - Sandra J. Petty
- Department of Medicine; University of Melbourne; The Royal Melbourne Hospital; Parkville Victoria Australia
- The Florey Institute of Neuroscience and Mental Health; Parkville Victoria Australia
- Ormond College; Parkville Victoria Australia
| | - Terence J. O'Brien
- Department of Medicine; University of Melbourne; The Royal Melbourne Hospital; Parkville Victoria Australia
| | - Alexandra Gorelik
- Department of Medicine; University of Melbourne; The Royal Melbourne Hospital; Parkville Victoria Australia
- Melbourne EpiCentre; The Royal Melbourne Hospital; Parkville Victoria Australia
| | - Phillip N. Sambrook
- Department of Medicine; The University of Sydney; Royal North Shore Hospital; New South Wales Sydney Australia
| | - Keith D. Hill
- National Ageing Research Institute; Parkville Victoria Australia
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
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170
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Mat S, Tan PJ, Ng CT, Fadzli F, Rozalli FI, Khoo EM, Hill KD, Tan MP. Mild Joint Symptoms Are Associated with Lower Risk of Falls than Asymptomatic Individuals with Radiological Evidence of Osteoarthritis. PLoS One 2015; 10:e0141368. [PMID: 26491868 PMCID: PMC4619628 DOI: 10.1371/journal.pone.0141368] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/03/2015] [Indexed: 11/19/2022] Open
Abstract
Osteoarthritis (OA) exacerbates skeletal muscle functioning, leading to postural instability and increased falls risk. However, the link between impaired physical function, OA and falls have not been elucidated. We investigated the role of impaired physical function as a potential mediator in the association between OA and falls. This study included 389 participants [229 fallers (≥2 falls or one injurious fall in the past 12 months), 160 non-fallers (no history of falls)], age (≥65 years) from a randomized controlled trial, the Malaysian Falls Assessment and Intervention Trial (MyFAIT). Physical function was assessed using Timed Up and Go (TUG) and Functional Reach (FR) tests. Knee and hip OA were diagnosed using three methods: Clinical, Radiological and Self-report. OA symptom severity was assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The total WOMAC score was categorized to asymptomatic, mild, moderate and severe symptoms. Individuals with radiological OA and ‘mild’ overall symptoms on the WOMAC score had reduced risk of falls compared to asymptomatic OA [OR: 0.402(0.172–0.940), p = 0.042]. Individuals with clinical OA and ‘severe’ overall symptoms had increased risk of falls compared to those with ‘mild’ OA [OR: 4.487(1.883–10.693), p = 0.005]. In individuals with radiological OA, mild symptoms appear protective of falls while those with clinical OA and severe symptoms have increased falls risk compared to those with mild symptoms. Both relationships between OA and falls were not mediated by physical limitations. Larger prospective studies are needed for further evaluation.
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Affiliation(s)
- Sumaiyah Mat
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pey June Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin Teck Ng
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapare
| | - Farhana Fadzli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Faizatul I. Rozalli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Keith D. Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
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171
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Davies SE, Dodd KJ, Tu A, Zucchi E, Zen S, Hill KD. Does English proficiency impact on health outcomes for inpatients undergoing stroke rehabilitation? Disabil Rehabil 2015; 38:1350-8. [DOI: 10.3109/09638288.2015.1092173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sarah E. Davies
- Physiotherapy Department, Northern Health, Victoria, Australia,
- College of Science, Health and Engineering, La Trobe University, Victoria, Australia,
| | - Karen J. Dodd
- College of Science, Health and Engineering, La Trobe University, Victoria, Australia,
| | - April Tu
- Physiotherapy Department, Northern Health, Victoria, Australia,
| | - Emiliano Zucchi
- Transcultural and Language Services Department, Northern Health, Victoria, Australia, and
| | - Stefania Zen
- Transcultural and Language Services Department, Northern Health, Victoria, Australia, and
| | - Keith D. Hill
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia
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172
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Toye C, Moorin R, Slatyer S, Aoun SM, Parsons R, Hegney D, Maher S, Hill KD. Protocol for a randomised controlled trial of an outreach support program for family carers of older people discharged from hospital. BMC Geriatr 2015; 15:70. [PMID: 26108207 PMCID: PMC4479237 DOI: 10.1186/s12877-015-0065-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Presentations to hospital of older people receiving family care at home incur substantial costs for patients, families, and the health care system, yet there can be positive carer outcomes when systematically assessing/addressing their support needs, and reductions in older people's returns to hospital attributed to appropriate discharge planning. This study will trial the Further Enabling Care at Home program, a 2-week telephone outreach initiative for family carers of older people returning home from hospital. Hypotheses are that the program will (a) better prepare families to sustain their caregiving role and (b) reduce patients' re-presentations/readmissions to hospital, and/or their length of stay; also that reduced health system costs attributable to the program will outweigh costs of its implementation. METHODS/DESIGN In this randomised controlled trial, family carers of older patients aged 70+ discharged from a Medical Assessment Unit in a Western Australian tertiary hospital, plus the patients themselves, will be recruited at discharge (N = 180 dyads). Carers will be randomly assigned (block allocation, assessors blinded) to receive usual care (control) or the new program (intervention). The primary outcome is the carer's self-reported preparedness for caregiving (Preparedness for Caregiving Scale administered within 4 days of discharge, 2-3 weeks post-discharge, 6 weeks post-discharge). To detect a clinically meaningful change of two points with 80 % power, 126 carers need to complete the study. Patients' returns to hospital and subsequent length of stay will be ascertained for a minimum of 3 months after the index admission. Regression analyses will be used to determine differences in carer and patient outcomes over time associated with the group (intervention or control). Data will be analysed using an Intention to Treat approach. A qualitative exploration will examine patients' and their family carers' experiences of the new program (interviews) and explore the hospital staff's perceptions (focus groups). Process evaluation will identify barriers to, and facilitators of, program implementation. A comprehensive economic evaluation will determine cost consequences. DISCUSSION This study investigates a novel approach to identifying and addressing family carers' needs following discharge from hospital of the older person receiving care. If successful, the program has potential to be incorporated into routine post-discharge support. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry: ACTRN12614001174673 .
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Affiliation(s)
- Christine Toye
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, WA, 6845, Australia. .,School of Population Health, The University of Western Australia, Perth, WA, 6009, Australia. .,Department of Research, Silver Chain Group, Osborne Park, Perth, WA, 6017, Australia.
| | - Susan Slatyer
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.
| | - Samar M Aoun
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Richard Parsons
- School of Pharmacy, Curtin University, Perth, WA, 6845, Australia.
| | - Desley Hegney
- School of Nursing and Midwifery, The University of Southern Queensland, Toowoomba, QLD, 4350, Australia. .,School of Nursing, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
| | - Sean Maher
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, 6845, Australia.
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173
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Sales MPR, Polman R, Hill KD, Karaharju-Huisman T, Levinger P. A novel dynamic exercise initiative for older people to improve health and well-being: study protocol for a randomised controlled trial. BMC Geriatr 2015; 15:68. [PMID: 26104031 PMCID: PMC4477416 DOI: 10.1186/s12877-015-0057-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise is an important and effective approach to preventing falls in older people, but adherence to exercise participation remains a persistent problem. A unique purpose-built exercise park was designed to provide a fun but physically challenging environment to support exercise in a community setting. This project is a randomised controlled trial designed to evaluate the effectiveness of an exercise intervention using an exercise park specifically designed for older people in reducing the risk of falls. METHODS/DESIGN This study will be a parallel randomised control trial with pre and post intervention design. One hundred and twenty people aged between 60 and 90 years old will be recruited from Melbourne suburbs and will be randomly allocated to either an exercise park intervention group (EPIG) or a control group (CG). The CG will receive social activities and an educational booklet on falls prevention. The BOOMER balance test will be used as the primary outcome measure. Secondary outcome measures will include hand grip strength, two minute walk test, lower limb strength test, spatio-temporal walking parameters, health related quality of life, feasibility, adherence, safety, and a number of other psychosocial measures. Outcome assessment will be conducted at baseline and at 18 and 26 weeks after intervention commencement. Participants will inform their falls and physical activity history for a 12-month period via monthly calendars. Mixed linear modelling incorporating intervention and control groups at the baseline and two follow up time points (18 weeks and 26 weeks after intervention commencement) will be used to assess outcomes. DISCUSSION This planned trial will be the first to provide evidence if the exercise park can improve functional and physiological health, psychological and well-being. In addition, this study will provide empirical evidence for effectiveness and explore the barriers to participation and the acceptability of the senior exercise park in the Australian older community. TRIAL REGISTRATION This trial is registered with the Australian New Zealand Clinical Trials Registry-Registry No. ACTRN12614000700639 registered on Jul 3rd 2014.
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Affiliation(s)
- Myrla Patricia Reis Sales
- Institute of Sport, Exercise & Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
| | - Remco Polman
- Institute of Sport, Exercise & Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia. .,Department of Psychology, Bournemouth University, Poole House P104a, Talbot Campus, Fern Barrow, Poole, BH12 5BB, UK.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth Western, 6845, Australia.
| | - Tuire Karaharju-Huisman
- Institute of Sport, Exercise & Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
| | - Pazit Levinger
- Institute of Sport, Exercise & Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
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174
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Menz HB, Spink MJ, Landorf KB, Hill KD, Lord SR. Older people's perceptions of a multifaceted podiatric medical intervention to prevent falls. J Am Podiatr Med Assoc 2015; 103:457-64. [PMID: 24297981 DOI: 10.7547/1030457] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Falls are common in older people and are associated with substantial health-care costs. A recent randomized controlled trial of a multifaceted podiatric medical intervention demonstrated a 36% reduction in the fall rate over 12 months. We evaluated the acceptability of and levels of satisfaction with this intervention in the older people who participated in the trial. METHODS Participants allocated to the intervention group (which included a home-based program of foot and ankle exercises, assistance with the purchase of safe footwear when necessary, and provision of prefabricated foot orthoses) completed a structured questionnaire 6 months after they had received the intervention. The questions addressed participants' perceptions of their balance and foot and ankle strength, the perceived difficulty of the exercise program, and the degree of satisfaction with the footwear and orthoses provided. RESULTS Of 153 participants, 134 (87.6%) attended the 6-month follow-up assessment and completed the questionnaire. Most participants perceived improvements in balance (62.7%) and foot and ankle strength (74.6%) after 6 months of performing the exercises, and 86.6% considered the difficulty level of the exercises to be "about right." Most participants reported that they were somewhat or very satisfied with the footwear (92.3%) and orthoses (81.6%) provided. CONCLUSIONS The multifaceted podiatric medical intervention used in this trial was generally perceived to be beneficial and demonstrated high levels of satisfaction among participants. Further research is now required to evaluate the feasibility of implementing the intervention in a range of clinical practice settings.
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Affiliation(s)
- Hylton B Menz
- Lower Extremity and Gait Studies Program, Faculty of Health Sciences, La Trobe University, Bundoora, VIC, Australia
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175
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Daly RM, Duckham RL, Tait JL, Rantalainen T, Nowson CA, Taaffe DR, Sanders K, Hill KD, Kidgell DJ, Busija L. Effectiveness of dual-task functional power training for preventing falls in older people: study protocol for a cluster randomised controlled trial. Trials 2015; 16:120. [PMID: 25872612 PMCID: PMC4379606 DOI: 10.1186/s13063-015-0652-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/13/2015] [Indexed: 11/12/2022] Open
Abstract
Background Falls are a major public health concern with at least one third of people aged 65 years and over falling at least once per year, and half of these will fall repeatedly, which can lead to injury, pain, loss of function and independence, reduced quality of life and even death. Although the causes of falls are varied and complex, the age-related loss in muscle power has emerged as a useful predictor of disability and falls in older people. In this population, the requirements to produce explosive and rapid movements often occurs whilst simultaneously performing other attention-demanding cognitive or motor tasks, such as walking while talking or carrying an object. The primary aim of this study is to determine whether dual-task functional power training (DT-FPT) can reduce the rate of falls in community-dwelling older people. Methods/Design The study design is an 18-month cluster randomised controlled trial in which 280 adults aged ≥65 years residing in retirement villages, who are at increased risk of falling, will be randomly allocated to: 1) an exercise programme involving DT-FPT, or 2) a usual care control group. The intervention is divided into 3 distinct phases: 6 months of supervised DT-FPT, a 6-month ‘step down’ maintenance programme, and a 6-month follow-up. The primary outcome will be the number of falls after 6, 12 and 18 months. Secondary outcomes will include: lower extremity muscle power and strength, grip strength, functional assessments of gait, reaction time and dynamic balance under single- and dual-task conditions, activities of daily living, quality of life, cognitive function and falls-related self-efficacy. We will also evaluate the cost-effectiveness of the programme for preventing falls. Discussion The study offers a novel approach that may guide the development and implementation of future community-based falls prevention programmes that specifically focus on optimising muscle power and dual-task performance to reduce falls risk under ‘real life’ conditions in older adults. In addition, the ‘step down’ programme will provide new information about the efficacy of a less intensive maintenance programme for reducing the risk of falls over an extended period. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12613001161718. Date registered 23 October 2013.
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Affiliation(s)
- Robin M Daly
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia.
| | - Rachel L Duckham
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia.
| | - Jamie L Tait
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia.
| | - Timo Rantalainen
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia.
| | - Caryl A Nowson
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia.
| | - Dennis R Taaffe
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia. .,School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia. .,Edith Cowan University Health and Wellness Institute, Joondalup, Western Australia, Australia.
| | - Kerrie Sanders
- North West Academic Centre, Department of Medicine, University of Melbourne, Sunshine Hospital, St Albans, Victoria, Australia. .,Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.
| | - Dawson J Kidgell
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia.
| | - Lucy Busija
- Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia.
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Khong L, Farringdon F, Hill KD, Hill AM. "We are all one together": peer educators' views about falls prevention education for community-dwelling older adults--a qualitative study. BMC Geriatr 2015; 15:28. [PMID: 25887213 PMCID: PMC4374404 DOI: 10.1186/s12877-015-0030-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/11/2015] [Indexed: 11/10/2022] Open
Abstract
Background Falls are common in older people. Despite strong evidence for effective falls prevention strategies, there appears to be limited translation of these strategies from research to clinical practice. Use of peers in delivering falls prevention education messages has been proposed to improve uptake of falls prevention strategies and facilitate translation to practice. Volunteer peer educators often deliver educational presentations on falls prevention to community-dwelling older adults. However, research evaluating the effectiveness of peer-led education approaches in falls prevention has been limited and no known study has evaluated such a program from the perspective of peer educators involved in delivering the message. The purpose of this study was to explore peer educators’ perspective about their role in delivering peer-led falls prevention education for community-dwelling older adults. Methods A two-stage qualitative inductive constant comparative design was used. In stage one (core component) focus group interviews involving a total of eleven participants were conducted. During stage two (supplementary component) semi-structured interviews with two participants were conducted. Data were analysed thematically by two researchers independently. Key themes were identified and findings were displayed in a conceptual framework. Results Peer educators were motivated to deliver educational presentations and importantly, to reach an optimal peer connection with their audience. Key themes identified included both personal and organisational factors that impact on educators’ capacity to facilitate their peers’ engagement with the message. Personal factors that facilitated message delivery and engagement included peer-to-peer connection and perceived credibility, while barriers included a reluctance to accept the message that they were at risk of falling by some members in the audience. Organisational factors, including ongoing training for peer educators and formative feedback following presentations, were perceived as essential because they affect successful message delivery. Conclusions Peer educators have the potential to effectively deliver falls prevention education to older adults and influence acceptance of the message as they possess the peer-to-peer connection that facilitates optimal engagement. There is a need to consider incorporating learnings from this research into a formal large scale evaluation of the effectiveness of the peer education approach in reducing falls in older adults.
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Affiliation(s)
- Linda Khong
- Institute for Health Research, School of Physiotherapy, The University of Notre Dame Australia, PO Box 1225, Fremantle, Western Australia, 6959, Australia.
| | - Fiona Farringdon
- Institute for Health Research, School of Health Sciences, The University of Notre Dame Australia, PO Box 1225, Fremantle, Western Australia, 6959, Australia.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Anne-Marie Hill
- Institute for Health Research, School of Physiotherapy, The University of Notre Dame Australia, PO Box 1225, Fremantle, Western Australia, 6959, Australia.
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177
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Day L, Hill KD, Stathakis VZ, Flicker L, Segal L, Cicuttini F, Jolley D. Impact of tai-chi on falls among preclinically disabled older people. A randomized controlled trial. J Am Med Dir Assoc 2015; 16:420-6. [PMID: 25769960 DOI: 10.1016/j.jamda.2015.01.089] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the effectiveness of tai-chi in preventing falls among community-dwelling older people. DESIGN Multisite parallel group individually randomized controlled trial. SETTING Melbourne, Australia. PARTICIPANTS Preclinically disabled community-dwelling people 70 + years (n = 503), without major medical conditions or moderate to severe cognitive impairment. INTERVENTION Sixty-minute modified Sun style tai-chi group-based exercise program twice weekly for 48 weeks; control intervention was a seated group-based flexibility exercise program of the same dose. MEASUREMENTS All falls, self-reported using a monthly calendar, analyzed at 24 weeks and 48 weeks. Injurious falls reported in follow-up telephone interviews for each reported fall. RESULTS The adjusted fall incidence rate ratios at 24 and 48 weeks were 1.08 [(95% confidence interval (CI) 0.64-1.81)], and 1.12 (95% CI 0.75-1.67), respectively. A higher proportion of intervention participants ceased attendance in the first 24 weeks (difference 17.9%, 95% CI 9.6-25.8), and the second 24 weeks (2.7%, 95% CI -5.0 to 10.4). Intervention participants who ceased attendance had lower left quadriceps strength (difference 3.3 kg 95% CI 0.15-6.36) and required longer to complete the timed up and go test (difference 1.7 seconds 95% CI 0.22-3.17) at baseline. CONCLUSIONS This study does not support modified Sun style tai-chi as a falls prevention measure among relatively well community-dwelling older people with modified mobility and at increased risk of disability. Insufficient intervention intensity, or low exercise class attendance may have contributed to the lack of effect, as may have attrition bias among the intervention group.
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Affiliation(s)
- Lesley Day
- Falls Prevention Research Unit, Monash Injury Research Institute, Monash University, Melbourne, Australia.
| | - Keith D Hill
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
| | - Voula Z Stathakis
- Falls Prevention Research Unit, Monash Injury Research Institute, Monash University, Melbourne, Australia
| | - Leon Flicker
- Center for Medical Research, University of Western Australia, Perth, Australia
| | - Leonie Segal
- Division of Health Sciences, School of Population Health, University of South Australia, Adelaide, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Damien Jolley
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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178
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Haines TP, Williams CM, Hill AM, McPhail SM, Hill KD, Brauer SG, Hoffmann TC, Etherton-Beer C. Erratum to “Depressive symptoms and adverse outcomes from hospitalization in older adults: Secondary outcomes of a trial of falls prevention education” [Arch. Gerontol. Geriatr. 60 (2015) 96–102]. Arch Gerontol Geriatr 2015. [DOI: 10.1016/j.archger.2015.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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179
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Burton E, Cavalheri V, Adams R, Browne CO, Bovery-Spencer P, Fenton AM, Campbell BW, Hill KD. Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis. Clin Interv Aging 2015; 10:421-34. [PMID: 25709416 PMCID: PMC4330004 DOI: 10.2147/cia.s71691] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective The objective of this systematic review and meta-analysis is to evaluate the effectiveness of exercise programs to reduce falls in older people with dementia who are living in the community. Method Peer-reviewed articles (randomized controlled trials [RCTs] and quasi-experimental trials) published in English between January 2000 and February 2014, retrieved from six electronic databases – Medline (ProQuest), CINAHL, PubMed, PsycInfo, EMBASE and Scopus – according to predefined inclusion criteria were included. Where possible, results were pooled and meta-analysis was conducted. Results Four articles (three RCT and one single-group pre- and post-test pilot study) were included. The study quality of the three RCTs was high; however, measurement outcomes, interventions, and follow-up time periods differed across studies. On completion of the intervention period, the mean number of falls was lower in the exercise group compared to the control group (mean difference [MD] [95% confidence interval {CI}] =−1.06 [−1.67 to −0.46] falls). Importantly, the exercise intervention reduced the risk of being a faller by 32% (risk ratio [95% CI] =0.68 [0.55–0.85]). Only two other outcomes were reported in two or more of the studies (step test and physiological profile assessment). No between-group differences were observed in the results of the step test (number of steps) (MD [95% CI] =0.51 [−1.77 to 2.78]) or the physiological profile assessment (MD [95% CI] =−0.10 [−0.62 to 0.42]). Conclusion Findings from this review suggest that an exercise program may potentially assist in preventing falls of older people with dementia living in the community. However, further research is needed with studies using larger sample sizes, standardized measurement outcomes, and longer follow-up periods, to inform evidence-based recommendations.
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Affiliation(s)
- Elissa Burton
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia ; Research Department, Silver Chain, Perth, WA, Australia
| | - Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Richard Adams
- Community Services, West Gippsland Healthcare Group, Warragul, VIC, Australia
| | - Colleen Oakley Browne
- Falls Prevention for People Living with Dementia Project, Central West Gippsland Primary Care Partnership, Moe, VIC, Australia
| | - Petra Bovery-Spencer
- Falls Prevention for People Living with Dementia Project, Central West Gippsland Primary Care Partnership, Moe, VIC, Australia
| | - Audra M Fenton
- Community Services, West Gippsland Healthcare Group, Warragul, VIC, Australia
| | - Bruce W Campbell
- Allied Health, Latrobe Regional Hospital, Traralgon, VIC, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia ; Preventive and Public Health Division, National Ageing Research Institute, Melbourne, VIC, Australia
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180
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Hill KD, Day L, Haines TP. What factors influence community-dwelling older people's intent to undertake multifactorial fall prevention programs? Clin Interv Aging 2014; 9:2045-53. [PMID: 25473276 PMCID: PMC4251660 DOI: 10.2147/cia.s72679] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate previous, current, or planned participation in, and perceptions toward, multifactorial fall prevention programs such as those delivered through a falls clinic in the community setting, and to identify factors influencing older people’s intent to undertake these interventions. Design and methods Community-dwelling people aged >70 years completed a telephone survey. Participants were randomly selected from an electronic residential telephone listing, but purposeful sampling was used to include equal numbers with and without common chronic health conditions associated with fall-related hospitalization. The survey included scenarios for fall prevention interventions, including assessment/multifactorial interventions, such as those delivered through a falls clinic. Participants were asked about previous exposure to, or intent to participate in, the interventions. A path model analysis was used to identify factors associated with intent to participate in assessment/multifactorial interventions. Results Thirty of 376 participants (8.0%) reported exposure to a multifactorial falls clinic-type intervention in the past 5 years, and 16.0% expressed intention to undertake this intervention. Of the 132 participants who reported one or more falls in the past 12 months, over one-third were undecided or disagreed that a falls clinic type of intervention would be of benefit to them. Four elements from the theoretical model positively influenced intention to participate in the intervention: personal perception of intervention effectiveness, self-perceived risk of falls, self-perceived risk of injury, and inability to walk up/down steps without a handrail (P<0.05). Conclusion Multifactorial falls clinic-type interventions are not commonly accessed or considered as intended fall prevention approaches among community-dwelling older people, even among those with falls in the past 12 months. Factors identified as influencing intention to undertake these interventions may be useful in promoting or targeting these interventions.
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Affiliation(s)
- Keith D Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia ; National Ageing Research Institute, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Lesley Day
- Falls Prevention Research Unit, Monash Injury Research Institute, Monash University, VIC, Australia
| | - Terry P Haines
- Allied Health Research Unit, Southern Health, Cheltenham, VIC, Australia ; Physiotherapy Department, Faculty of Medicine, Nursing, and Health Sciences, Monash University, VIC, Australia
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181
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Morris RL, Brand CA, Hill KD, Ayton DR, Redfern J, Nyman SR, Lowthian JA, Hill AM, Etherton-Beer CD, Flicker L, Hunter PC, Barker AL. RESPOND: a patient-centred programme to prevent secondary falls in older people presenting to the emergency department with a fall-protocol for a mixed methods programme evaluation. Inj Prev 2014; 22:153-60. [PMID: 25392367 DOI: 10.1136/injuryprev-2014-041453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/26/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Programme evaluations conducted alongside randomised controlled trials (RCTs) have potential to enhance understanding of trial outcomes. This paper describes a multi-level programme evaluation to be conducted alongside an RCT of a falls prevention programme (RESPOND). OBJECTIVES (1) To conduct a process evaluation in order to identify the degree of implementation fidelity and associated barriers and facilitators. (2) To evaluate the primary intended impact of the programme: participation in fall prevention strategies and the factors influencing participation. (3) To identify the factors influencing RESPOND RCT outcomes: falls, fall injuries and emergency department (ED) re-presentations. METHODS/DESIGN 528 community-dwelling adults aged 60-90 years presenting to two EDs with a fall will be recruited and randomly assigned to the intervention or standard care group. All RESPOND participants and RESPOND clinicians will be included in the evaluation. A mixed methods design will be used and a programme logic model will frame the evaluation. Data will be sourced from interviews, focus groups, questionnaires, clinician case notes, recruitment records, participant-completed calendars, hospital administrative datasets and audio-recordings of intervention contacts. Quantitative data will be analysed via descriptive and inferential statistics and qualitative data will be interpreted using thematic analysis. DISCUSSION The RESPOND programme evaluation will provide information about contextual and influencing factors related to the RESPOND RCT outcomes. The results will assist researchers, clinicians and policy makers regarding decisions about future falls prevention interventions. Insights gained may be applicable to a range of chronic conditions where similar preventive intervention approaches are indicated. TRIAL REGISTRATION NUMBER This programme evaluation is linked to the RESPOND RCT which is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).
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Affiliation(s)
- R L Morris
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - C A Brand
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - K D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - D R Ayton
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - S R Nyman
- Department of Psychology, Faculty of Science and Technology, Bournemouth University Dementia Institute, Bournemouth University, Poole, Dorset, UK
| | - J A Lowthian
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - A M Hill
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - C D Etherton-Beer
- University of Western Australia, Perth, Western Australia, Australia Department of Psychology Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - L Flicker
- University of Western Australia, Perth, Western Australia, Australia Department of Psychology Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - P C Hunter
- Alfred Health, Melbourne, Victoria, Australia Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - A L Barker
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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182
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Haines TP, Williams CM, Hill AM, McPhail SM, Hill KD, Brauer SG, Hoffmann TC, Etherton-Beer C. Depressive symptoms and adverse outcomes from hospitalization in older adults: secondary outcomes of a trial of falls prevention education. Arch Gerontol Geriatr 2014; 60:96-102. [PMID: 25442784 DOI: 10.1016/j.archger.2014.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 06/25/2014] [Accepted: 09/16/2014] [Indexed: 11/19/2022]
Abstract
Depression is common in older people and symptoms of depression are known to substantially increase during hospitalization. There is little known about predictors of depressive symptoms in older adults or impact of common interventions during hospitalization. This study aimed to describe the magnitude of depressive symptoms, shift of depressive symptoms and the impact of the symptoms of depression among older hospital patients during hospital admission and identify whether exposure to falls prevention education affected symptoms of depression. Participants (n=1206) were older adults admitted within two Australian hospitals, the majority of participants completed the Geriatric Depression Scale - Short Form (GDS) at admission (n=1168). Participants' mean age was 74.7 (±SD 11) years and 47% (n=551) were male. At admission 53% (619 out of 1168) of participants had symptoms of clinical depression and symptoms remained at the same level at discharge for 55% (543 out of 987). Those exposed to the low intensity education program had higher GDS scores at discharge than those in the control group (low intensity vs control n=652, adjusted regression coefficient (95% CI)=0.24 (0.02, 0.45), p=0.03). The only factor other than admission level of depression that affected depressive symptoms change was if the participant was worried about falling. Older patients frequently present with symptoms of clinical depression on admission to hospital. Future research should consider these factors, whether these are modifiable and whether treatment may influence outcomes.
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Affiliation(s)
- Terry P Haines
- Monash University/Monash Health, Allied Health Research Unit, Monash Health Kingston Hospital, Cnr Warrigal and Kingston Rds, Cheltenham, VIC 3192, Australia.
| | - Cylie M Williams
- Allied Health Research Unit, Monash Health Kingston Hospital, Cnr Warrigal and Kingston Rds, Cheltenham, VIC 3192, Australia
| | - Anne-Marie Hill
- The University of Notre Dame Australia, 19 Mouat Street (PO Box 1225), Fremantle, WA 6959, Australia
| | - Steven M McPhail
- Queensland University of Technology/Queensland Health, Australia
| | | | - Sandy G Brauer
- University of Queensland, School of Health & Rehab Sciences, Brisbane, QLD 4072, Australia
| | - Tammy C Hoffmann
- Centre for Research in Evidence-Based Practice, Bond University, Faculty of Health Sciences and Medicine, QLD 4229, Australia
| | - Chris Etherton-Beer
- University of Western Australia, School of Medicine and Pharmacology Royal Perth Hospital Unit, 35 Stirling Highway, Crawley, WA 6009, Australia
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183
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Asmidawati A, Hamid TA, Hussain RM, Hill KD. Home based exercise to improve turning and mobility performance among community dwelling older adults: protocol for a randomized controlled trial. BMC Geriatr 2014; 14:100. [PMID: 25196930 PMCID: PMC4166017 DOI: 10.1186/1471-2318-14-100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 08/14/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Turning is a common activity for older people, and is one of the activities commonly associated with falls during walking. Falls that occur while walking and turning have also been associated with an increased risk of hip fracture in older people. Despite the importance of stability during turning, there has been little focus on identifying this impairment in at risk older people, or in evaluating interventions aiming to improve this outcome. This study will evaluate the effectiveness of a 16 week tailored home based exercise program in older adults aged (50 years and above) who were identified as having unsteadiness during turning. METHODS/DESIGN A single blind randomized controlled trial will be conducted, with assessors blind to group allocation. Study participants will be aged 50 years and above, living in the community and have been identified as having impaired turning ability [outside of age and gender normal limits on the Step Quick Turn (180 degree turn) task on the Neurocom® Balance Master with long plate]. After a comprehensive baseline assessment, those classified as having balance impairment while turning will be randomized to intervention or control group. The intervention group will receive a 16 week individualized balance and strength home exercise program, based on the Otago Exercise Program with additional exercises focused on improving turning ability. Intervention group will attend four visit to the assessment centre over 16 weeks period, for provision, monitoring, modification of the exercise and encourage ongoing participation. Participants in the control group will continue with their usual activities. All participants will be re-assessed on completion of the 16 week program. Primary outcome measures will be the Step Quick Turn Test and Timed-Up and Go test. Secondary outcomes will include other clinical measures of balance, psychological aspects of falls, incidence of falls and falls risk factors. DISCUSSION Results of this study will provide useful information for clinicians on the types of exercises to improve turning ability in older people with increased falls risk and the effectiveness of these exercises in improving outcomes. TRIAL REGISTRATION ACTRN12613000855729.
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Affiliation(s)
- Ashari Asmidawati
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia 6845, Australia
- Institute of Gerontology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Tengku Aizan Hamid
- Institute of Gerontology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rizal M Hussain
- Institute of Gerontology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia 6845, Australia
- Health Promotion Division, National Ageing Research Institute, The Royal Melbourne Hospital, PO Box 2127, Parkville, Melbourne, Victoria 3050, Australia
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184
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Petty SJ, Kantor S, Lawrence KM, Berkovic SF, Collins M, Hill KD, Makovey J, Sambrook PN, O'Brien TJ, Wark JD. Weight and fat distribution in patients taking valproate: a valproate-discordant gender-matched twin and sibling pair study. Epilepsia 2014; 55:1551-7. [PMID: 25124647 DOI: 10.1111/epi.12745] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Chronic treatment with valproate (VPA) is commonly associated with weight gain, which potentially has important health implications, in particular increased central fat distribution. We utilized a VPA-discordant same-sex, twin and matched sibling pair study design to primarily examine for differences in fat distribution between patients with epilepsy treated with VPA compared to their matched twin or sibling control. Weight, blood pressure, and leptin levels were assessed. METHODS Height, weight, waist and hip measurements, exercise, blood pressure (BP), and serum leptin levels were measured. Body composition was measured using dual-energy x-ray absorptiometry (DXA). Abdominal fat was expressed as a percentage of the abdominal region (AFat%); and of whole body fat (WBF); (AFat%WBF). Mean within-pair differences were assessed (VPA-user and nonuser). Restricted maximum likelihood (REML) linear mixed model analysis was fitted to examine associations of anthropometrics, zygosity, gender, menopausal status, VPA dose and duration, with weight and AFat%. RESULTS We studied 19 pairs of VPA-discordant, gender-matched (five male, 14 female) twins and siblings. Mean (standard deviation, SD) duration of therapy for VPA users was 11.0 (7.4) years. There were no statistically significant within-pair differences in age, height, weight, body mass index (BMI), BP, leptin level, WBF, AFat%, or AFat%WBF. For pairs in which VPA-user was treated for >11 years there were statistically significant mean within-pair differences in AFat%, (+7.1%, p = 0.03, n = 10 pairs), mean BP (+11.0 mm Hg, p = 0.006, n = 8 pairs); but not in AFat%WBF. VPA duration was positively associated with weight (estimate +0.98 kg/per year of VPA, p = 0.03); VPA treatment duration and dose were not significantly associated with AFat%. SIGNIFICANCE This study demonstrated a relationship between long-term VPA use and abdominal adiposity (AFat%), which could have significant health implications. We recommend ongoing monitoring of weight, BMI, and blood pressure for patients taking VPA.
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Affiliation(s)
- Sandra J Petty
- Department of Medicine, Melbourne Brain Centre, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia; Ormond College, Parkville, Victoria, Australia
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185
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Barker AL, Cameron PA, Hill KD, Flicker L, Haines TP, Lowthian JA, Waldron N, Arendts G, Redfern J, Forbes A, Brand CA, Etherton-Beer CD, Hill AM, Hunter P, Nyman SR, Smit D. RESPOND--A patient-centred programme to prevent secondary falls in older people presenting to the emergency department with a fall: protocol for a multicentre randomised controlled trial. Inj Prev 2014; 21:e1. [PMID: 24958769 DOI: 10.1136/injuryprev-2014-041271] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Participation in falls prevention activities by older people following presentation to the emergency department (ED) with a fall is suboptimal. This randomised controlled trial (RCT) will test the RESPOND programme, an intervention designed to improve older persons' participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies. DESIGN AND SETTING A RCT at two tertiary referral EDs in Melbourne and Perth, Australia. PARTICIPANTS 528 community-dwelling people aged 60-90 years presenting to the ED with a fall and discharged home will be recruited. People who require an interpreter or hands-on assistance to walk; live in residential aged care or >50 km from the trial hospital; have terminal illness, cognitive impairment, documented aggressive behaviour or a history of psychosis; are receiving palliative care or are unable to use a telephone will be excluded. METHODS Participants will be randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporates (1) a home-based risk factor assessment; (2) education, coaching, goal setting and follow-up telephone support for management of one or more of four risk factors with evidence of effective interventions and (3) healthcare provider communication and community linkage delivered over 6 months. Primary outcomes are falls and fall injuries per person-year. DISCUSSION RESPOND builds on prior falls prevention learnings and aims to help individuals make guided decisions about how they will manage their falls risk. Patient-centred models have been successfully trialled in chronic and cardiovascular disease; however, evidence to support this approach in falls prevention is limited. TRIAL REGISTRATION NUMBER The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).
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Affiliation(s)
- A L Barker
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - P A Cameron
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - K D Hill
- School of Physiotherapy and Exercise Science, Curtin University of Technology, Perth, Western Australia, Australia
| | - L Flicker
- University of Western Australia, Perth, Western Australia, Australia Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - T P Haines
- Department of Physiotherapy, Monash University, and Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
| | - J A Lowthian
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - N Waldron
- Health Networks Branch, System Policy and Planning, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - G Arendts
- University of Western Australia, Perth, Western Australia, Australia Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - J Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - A Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - C A Brand
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - C D Etherton-Beer
- University of Western Australia, Perth, Western Australia, Australia Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - A M Hill
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - P Hunter
- Alfred Health, Melbourne, Victoria, Australia
| | - S R Nyman
- Bournemouth University Dementia Institute and Psychology Department, Faculty of Science and Technology, Bournemouth University, Poole, Dorset, UK
| | - D Smit
- Alfred Health, Melbourne, Victoria, Australia
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186
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Day L, Trotter MJ, Hill KD, Haines TP, Thompson C. Implementation of evidence-based falls prevention in clinical services for high-risk clients. J Eval Clin Pract 2014; 20:255-9. [PMID: 24661470 DOI: 10.1111/jep.12119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The extent to which best practice for falls prevention is being routinely delivered by health care providers for community-dwelling older adults is unclear. We investigated falls prevention practice among Hospital Admission Risk Programs (HARP) that provide and coordinate specialized health care for people at high risk of hospitalization. METHOD Cross-sectional survey of all HARP services in Victoria, excluding one paediatric programme (n = 34). The questionnaire focused upon medication review and exercise prescription, as these are the evidence-based falls interventions with a good fit with HARP services. RESULTS Completed questionnaires were received from 24 programmes (70.6%) that service 15,250 older clients (60+ years). All except one programme screened for medicine use; however, a lower proportion (65% of those that screen) target falls risk medications. Among the 17 programmes responding to the exercise prescription question, all routinely include strengthening exercises, and almost all (n = 15) include flexibility, endurance training and movement of the centre of gravity. A lesser proportion (71%) includes reducing the need for upper limb support. The majority of services (88%) undertake falls risk assessments, and all of these either make referral appointments for clients or refer to other services that make referral appointments for clients. Follow-up of appointments and the resulting recommendations was high. CONCLUSION Screening for falls risk medications could be improved and staff training in exercise prescription for balance challenge in this high-risk group may be needed. Although evidence-based falls prevention practice within Victorian HARP services appears strong, the effect on falls risk may not be as high as that achieved in randomized trials.
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Affiliation(s)
- Lesley Day
- Falls Prevention Research Unit, Monash Injury Research Institute, Monash University, Australia
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187
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Meyer CW, Hill KD. BILATERAL KEY COMPARISON SIM.T-K6.1 ON HUMIDITY STANDARDS IN THE DEW/FROST-POINT TEMPERATURE RANGE FROM -25 °C TO +20 °C. Metrologia 2014; 51:03002. [PMID: 26663952 PMCID: PMC4671276 DOI: 10.1088/0026-1394/51/1a/03002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A Regional Metrology Organization (RMO) Key Comparison of dew/frost point temperatures was carried out by the National Institute of Standards and Technology (NIST, USA) and the National Research Council (NRC, Canada) between December 2014 and April, 2015. The results of this comparison are reported here, along with descriptions of the humidity laboratory standards for NIST and NRC and the uncertainty budget for these standards. This report also describes the protocol for the comparison and presents the data acquired. The results are analyzed, determining degree of equivalence between the dew/frost-point standards of NIST and NRC.
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Affiliation(s)
- C W Meyer
- National Institute of Standards and Technology (NIST), USA
| | - K D Hill
- National Research Council (NRC), Canada
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188
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Dow B, Meyer C, Moore KJ, Hill KD. The impact of care recipient falls on caregivers. AUST HEALTH REV 2013; 37:152-7. [PMID: 23575504 DOI: 10.1071/ah12168] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 10/16/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study sought to explore the impact of care recipient falls on caregivers. METHODS Ninety-six community-dwelling caregiver-care recipient dyads participated in a 12-month prospective study. Falls and other accidents and service use were recorded. Dyads were assessed at baseline and after each fall. Assessment included the Zarit Burden Interview and a post-accident survey developed for the present study. Focus groups were then conducted to further explore the impact of falls on caregivers. RESULTS Fifty-four care recipients (56%) experienced falls within the 12 months of the study. There was a significant increase in caregiver burden after the first fall (Zarit Burden Interview score increased from 24.2±14.2 to 27.6±14.5, P<0.01). Twenty-four percent of caregivers reported that they had altered their usual routine after the fall, mainly not wanting to leave the care recipient alone. However, there was no increase in the number of services used. Focus group discussions highlighted the need for constant vigilance of the care recipient, a lack of knowledge about support services and concerns related to utilising respite care. CONCLUSION Falls among care recipients have a significant impact on carers, including an increased fear of falling, prompting the need for even closer vigilance. WHAT IS KNOWN ABOUT THE TOPIC? Falls are a significant problem for older people as one in three older people fall each year and injurious falls are the leading cause of injury-related hospitalisation in older people. In Australia falls cost the economy over $500 million per year. WHAT DOES THIS PAPER ADD? This paper adds a unique perspective to the falls literature, that of the older person's carer. Falls are a significant problem for community-dwelling carers of older people, contributing to carer burden and impeding the carer's ability to undertake activities of daily living because of the perceived need for constant vigilance to prevent the person they care for from falling. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Practitioners should ensure that carers are aware of evidence-based falls-prevention practices and services, such as group and individual exercise programs, home modifications and podiatry, that might assist to prevent falls in the person they care for and therefore reduce the burden of care.
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Affiliation(s)
- Briony Dow
- National Ageing Research Institute, Royal Melbourne Hospital, Melbourne, Vic 3052, Australia.
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189
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Haines TP, Hill AM, Hill KD, Brauer SG, Hoffmann T, Etherton-Beer C, McPhail SM. Cost effectiveness of patient education for the prevention of falls in hospital: economic evaluation from a randomized controlled trial. BMC Med 2013; 11:135. [PMID: 23692953 PMCID: PMC3668305 DOI: 10.1186/1741-7015-11-135] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 04/19/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital inpatients. Falls can threaten both immediate and longer-term health and independence. There is need to identify cost-effective means for preventing falls in hospitals. Hospital-based falls prevention interventions tested in randomized trials have not yet been subjected to economic evaluation. METHODS Incremental cost-effectiveness analysis was undertaken from the health service provider perspective, over the period of hospitalization (time horizon) using the Australian Dollar (A$) at 2008 values. Analyses were based on data from a randomized trial among n = 1,206 acute and rehabilitation inpatients. Decision tree modeling with three-way sensitivity analyses were conducted using burden of disease estimates developed from trial data and previous research. The intervention was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients. RESULTS The short-term cost to a health service of one cognitively intact patient being a faller could be as high as A$14,591 (2008). The education program cost A$526 (2008) to prevent one cognitively intact patient becoming a faller and A$294 (2008) to prevent one fall based on primary trial data. These estimates were unstable due to high variability in the hospital costs accrued by individual patients involved in the trial. There was a 52% probability the complete program was both more effective and less costly (from the health service perspective) than providing usual care alone. Decision tree modeling sensitivity analyses identified that when provided in real life contexts, the program would be both more effective in preventing falls among cognitively intact inpatients and cost saving where the proportion of these patients who would otherwise fall under usual care conditions is at least 4.0%. CONCLUSIONS This economic evaluation was designed to assist health care providers decide in what circumstances this intervention should be provided. If the proportion of cognitively intact patients falling on a ward under usual care conditions is 4% or greater, then provision of the complete program in addition to usual care will likely both prevent falls and reduce costs for a health service. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register: ACTRN12608000015347.
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Affiliation(s)
- Terry P Haines
- Allied Health Research Unit, Southern Health, Corner of Warrigal and Kingston Roads, Cheltenham, Victoria 3192, Australia
- Physiotherapy Department, School of Primary Health Care, Monash University, McMahons Road, Frankston, Victoria 3199, Australia
| | - Anne-Marie Hill
- School of Physiotherapy, The University of Notre Dame Australia, Mouat Street, Fremantle, Western Australia 6160, Australia
| | - Keith D Hill
- School of Physiotherapy, Curtin University, Kent St, Bentley, Western Australia 6102, Australia
| | - Sandra G Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, Services Road, St Lucia, Queensland 4072, Australia
| | - Tammy Hoffmann
- School of Health and Rehabilitation Sciences, The University of Queensland, Services Road, St Lucia, Queensland 4072, Australia
- Centre for Research in Evidence-Based Practice, Bond University, University Drive, Robina, Queensland 4226, Australia
| | - Christopher Etherton-Beer
- WA Centre for Health & Ageing, Centre for Medical Research and School of Medicine & Pharmacology, University of Western Australia, Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Cnr of Ipswich Road and Cornwall Street, Buranda, Brisbane, Queensland 4102, Australia
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, Queensland 4059, Australia
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190
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Hill KD, Williams SB, Chen J, Moran H, Hunt S, Brand C. Balance and falls risk in women with lower limb osteoarthritis or rheumatoid arthritis. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jcgg.2012.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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191
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Bird ML, Hill KD, Robertson IK, Ball MJ, Pittaway J, Williams AD. Serum [25(OH)D] status, ankle strength and activity show seasonal variation in older adults: relevance for winter falls in higher latitudes. Age Ageing 2013; 42:181-5. [PMID: 22585931 DOI: 10.1093/ageing/afs067] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND seasonal variation exists in serum [25(OH)D] and physical activity, especially at higher latitudes, and these factors impact lower limb strength. This study investigates seasonal variation in leg strength in a longitudinal repeated measures design concurrently with serum vitamin D and physical activity. METHODS eighty-eight community-dwelling independently mobile older adults (69.2 ± 6.5 years) were evaluated five times over a year, at the end of five consecutive seasons at latitude 41.1°S, recruited in two cohorts. Leg strength, serum [25(OH)D] and physical activity levels were measured. Time spent outside was recorded. Monthly falls diaries recorded falls. Data were analysed to determine annual means and percentage changes. RESULTS significant variation in [25(OH)D] (±15%), physical activity (±13%), ankle dorsiflexion strength (±8%) and hours spent outside (±20%) (all P < 0.001) was demonstrated over the year, with maximums in January and February (mid-summer). Low mean ankle strength was associated with increased incidence of falling (P = 0.047). Quadriceps strength did not change (±2%; P = 0.53). CONCLUSION ankle dorsiflexor strength varied seasonally. Increased ankle strength in summer may be influenced by increased levels of outdoors activity over the summer months. Reduced winter-time dorsiflexor strength may predispose older people to increased risk of tripping-related falls, and warrants investigation in a multi-faceted falls prevention programme.
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Affiliation(s)
- Marie-Louise Bird
- School of Human Life Sciences, University of Tasmania, Locked Bag 1320, Launceston, Tasmania 7250, Australia.
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192
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Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2012; 12:CD005465. [PMID: 23235623 DOI: 10.1002/14651858.cd005465.pub3] [Citation(s) in RCA: 254] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010. OBJECTIVES To assess the effectiveness of interventions designed to reduce falls by older people in care facilities and hospitals. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2012); The Cochrane Library 2012, Issue 3; MEDLINE, EMBASE, and CINAHL (all to March 2012); ongoing trial registers (to August 2012), and reference lists of articles. SELECTION CRITERIA Randomised controlled trials of interventions to reduce falls in older people in residential or nursing care facilities or hospitals. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling we used a risk ratio (RR) and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate. MAIN RESULTS We included 60 trials (60,345 participants), 43 trials (30,373 participants) in care facilities, and 17 (29,972 participants) in hospitals.Results from 13 trials testing exercise interventions in care facilities were inconsistent. Overall, there was no difference between intervention and control groups in rate of falls (RaR 1.03, 95% CI 0.81 to 1.31; 8 trials, 1844 participants) or risk of falling (RR 1.07, 95% CI 0.94 to 1.23; 8 trials, 1887 participants). Post hoc subgroup analysis by level of care suggested that exercise might reduce falls in people in intermediate level facilities, and increase falls in facilities providing high levels of nursing care.In care facilities, vitamin D supplementation reduced the rate of falls (RaR 0.63, 95% CI 0.46 to 0.86; 5 trials, 4603 participants), but not risk of falling (RR 0.99, 95% CI 0.90 to 1.08; 6 trials, 5186 participants).For multifactorial interventions in care facilities, the rate of falls (RaR 0.78, 95% CI 0.59 to 1.04; 7 trials, 2876 participants) and risk of falling (RR 0.89, 95% CI 0.77 to 1.02; 7 trials, 2632 participants) suggested possible benefits, but this evidence was not conclusive.In subacute wards in hospital, additional physiotherapy (supervised exercises) did not significantly reduce rate of falls (RaR 0.54, 95% CI 0.16 to 1.81; 1 trial, 54 participants) but achieved a significant reduction in risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 2 trials, 83 participants).In one trial in a subacute ward (54 participants), carpet flooring significantly increased the rate of falls compared with vinyl flooring (RaR 14.73, 95% CI 1.88 to 115.35) and potentially increased the risk of falling (RR 8.33, 95% CI 0.95 to 73.37).One trial (1822 participants) testing an educational session by a trained research nurse targeting individual fall risk factors in patients at high risk of falling in acute medical wards achieved a significant reduction in risk of falling (RR 0.29, 95% CI 0.11 to 0.74).Overall, multifactorial interventions in hospitals reduced the rate of falls (RaR 0.69, 95% CI 0.49 to 0.96; 4 trials, 6478 participants) and risk of falling (RR 0.71, 95% CI 0.46 to 1.09; 3 trials, 4824 participants), although the evidence for risk of falling was inconclusive. Of these, one trial in a subacute setting reported the effect was not apparent until after 45 days in hospital. Multidisciplinary care in a geriatric ward after hip fracture surgery compared with usual care in an orthopaedic ward significantly reduced rate of falls (RaR 0.38, 95% CI 0.19 to 0.74; 1 trial, 199 participants) and risk of falling (RR 0.41, 95% CI 0.20 to 0.83). More trials are needed to confirm the effectiveness of multifactorial interventions in acute and subacute hospital settings. AUTHORS' CONCLUSIONS In care facilities, vitamin D supplementation is effective in reducing the rate of falls. Exercise in subacute hospital settings appears effective but its effectiveness in care facilities remains uncertain due to conflicting results, possibly associated with differences in interventions and levels of dependency. There is evidence that multifactorial interventions reduce falls in hospitals but the evidence for risk of falling was inconclusive. Evidence for multifactorial interventions in care facilities suggests possible benefits, but this was inconclusive.
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Affiliation(s)
- Ian D Cameron
- Rehabilitation Studies Unit, SydneyMedical School Northern, The University of Sydney, Ryde, Australia.
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193
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Suttanon P, Hill KD, Said CM, Williams SB, Byrne KN, LoGiudice D, Lautenschlager NT, Dodd KJ. Feasibility, safety and preliminary evidence of the effectiveness of a home-based exercise programme for older people with Alzheimer's disease: a pilot randomized controlled trial. Clin Rehabil 2012; 27:427-38. [PMID: 23117349 DOI: 10.1177/0269215512460877] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the feasibility and safety of a home-based exercise programme for people with Alzheimer's disease, and to provide preliminary evidence of programme effectiveness in improving balance and mobility and reducing falls risk. DESIGN A randomized controlled trial. SETTING Community. PARTICIPANTS Forty people with mild to moderate Alzheimer's disease (mean age 81.9, SD 5.72; 62.5% female). INTERVENTIONS Participants were randomized to a six-month home-based individually tailored balance, strengthening and walking exercise programme (physiotherapist) or a six-month home-based education programme (control) (occupational therapist). Both programmes provided six home-visits and five follow-up phone calls. MAIN MEASURES Balance, mobility, falls and falls risk were measured at baseline and programme completion. Intention-to-treat analysis using a generalized linear model with group allocation as a predictor variable was performed to evaluate programme effectiveness. Feasibility and adverse events were systematically recorded at each contact. RESULTS Fifty-eight per cent of the exercise group finished the programme, completing an average of 83% of prescribed sessions, with no adverse events reported. Functional Reach improved significantly (P = 0.002) in the exercise group (mean (SD), 2.28 (4.36)) compared to the control group (-2.99 (4.87)). Significant improvement was also observed for the Falls Risk for Older People - Community score (P = 0.008) and trends for improvement on several other balance, mobility, falls and falls risk measures for the exercise group compared to the control group. CONCLUSIONS The exercise programme was feasible and safe and may help improve balance and mobility performance and reduce falls risk in people with Alzheimer's disease.
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Affiliation(s)
- Plaiwan Suttanon
- School of Physiotherapy, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria, Australia.
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194
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Day L, Hill KD, Jolley D, Cicuttini F, Flicker L, Segal V, Stathakis V. Impact of Tai Chi on impairment, functional limitation, and disability among preclinically disabled older people: a randomized controlled trial. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590e.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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195
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Day L, Hill KD, Jolley D, Cicuttini F, Flicker L, Segal V, Stathakis V. IMPACT OF TAI CHI ON IMPAIRMENT, FUNCTIONAL LIMITATION, AND DISABILITY AMONG PRECLINICALLY DISABLED OLDER PEOPLE: A RANDOMIZED CONTROLLED TRIAL. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590e.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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196
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Abstract
Falls are a common health problem for older people, and psychotropic medications have been identified as an important independent fall risk factor. The objective of this paper was to review the literature relating to the effect of psychotropic medications on falls in older people, with a particular focus on evidence supporting minimization of their use to reduce risk of falls. A literature search identified 18 randomized trials meeting the inclusion criteria for the review of effectiveness of psychotropic medication withdrawal studies, including four with falls outcomes. One of these, which targeted reduced psychotropic medication use in the community, reported a 66% reduction in falls, while the other studies demonstrated some success in reducing psychotropic medication use but with mixed effects on falls. Other randomized trials evaluated various approaches to reducing psychotropic medications generally or specific classes of psychotropic medications (e.g. benzodiazepines), but did not report fall-related outcomes. Overall, these studies reported moderate success in reducing psychotropic medication use, and a number reported no or limited worsening of key outcomes such as sleep quality or behavioural difficulties associated with withdrawal of psychotropic medication use. Reduced prescription of psychotropic medications (e.g. seeking non-pharmacological alternatives to their use in place of prescription in the first place or, for those patients for whom these medications are deemed necessary, regular monitoring and efforts to cease use or wean off use over time) needs to be a strong focus in clinical practice for three reasons. Firstly, psychotropic medications are commonly prescribed for older people, both in the community and especially in the residential care setting, and their effectiveness in a number of clinical groups has been questioned. Secondly, there is strong evidence of an association between substantially increased risk of falls and use of a number of psychotropic medications, including benzodiazepines (particularly, the long-acting agents), antidepressants and antipsychotic drugs. Finally, the largest effect of any randomized trial of falls prevention to date was achieved with a single intervention consisting of weaning psychotropic drug users off their medications.
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Affiliation(s)
- Keith D Hill
- Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora, VIC, Australia.
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197
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Abstract
Falls are common at all stages after stroke, occurring in the acute, rehabilitative, and chronic phases. Consequences of falls include death or serious injury, minor injuries, functional limitations, reduced mobility and activity, and fear of falling. These consequences can have implications for independence and quality of life after stroke. The high frequency of falls may be due to a combination of existing falls risk factors prior to the stroke as well as impairments from the stroke, such as decreased strength and balance, hemineglect, perceptual problems, and visual problems. This paper reviews the magnitude of the problem of falls in people with stroke, highlights risk factors, and summarizes the limited randomized controlled trial evidence on falls prevention in this population. There is a need for further high quality research investigating the effectiveness of interventions to reduce falls and injury in people with stroke from onset through to the chronic stage.
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Affiliation(s)
- Frances A Batchelor
- National Ageing Research Institute, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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198
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Batchelor FA, Hill KD, Mackintosh SF, Said CM, Whitehead CH. Effects of a multifactorial falls prevention program for people with stroke returning home after rehabilitation: a randomized controlled trial. Arch Phys Med Rehabil 2012; 93:1648-55. [PMID: 22503739 DOI: 10.1016/j.apmr.2012.03.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 03/22/2012] [Accepted: 03/28/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine whether a multifactorial falls prevention program reduces falls in people with stroke at risk of recurrent falls and whether this program leads to improvements in gait, balance, strength, and fall-related efficacy. DESIGN A single blind, multicenter, randomized controlled trial with 12-month follow-up. SETTING Participants were recruited after discharge from rehabilitation and followed up in the community. PARTICIPANTS Participants (N=156) were people with stroke at risk of recurrent falls being discharged home from rehabilitation. INTERVENTIONS Tailored multifactorial falls prevention program and usual care (n=71) or control (usual care, n=85). MAIN OUTCOME MEASURES Primary outcomes were rate of falls and proportion of fallers. Secondary outcomes included injurious falls, falls risk, participation, activity, leg strength, gait speed, balance, and falls efficacy. RESULTS There was no significant difference in fall rate (intervention: 1.89 falls/person-year, control: 1.76 falls/person-year, incidence rate ratio=1.10, P=.74) or the proportion of fallers between the groups (risk ratio=.83, 95% confidence interval=.60-1.14). There was no significant difference in injurious fall rate (intervention: .74 injurious falls/person-year, control: .49 injurious falls/person-year, incidence rate ratio=1.57, P=.25), and there were no significant differences between groups on any other secondary outcome. CONCLUSIONS This multifactorial falls prevention program was not effective in reducing falls in people with stroke who are at risk of falls nor was it more effective than usual care in improving gait, balance, and strength in people with stroke. Further research is required to identify effective interventions for this high-risk group.
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199
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Day L, Hill KD, Jolley D, Cicuttini F, Flicker L, Segal L. Impact of tai chi on impairment, functional limitation, and disability among preclinically disabled older people: a randomized controlled trial. Arch Phys Med Rehabil 2012; 93:1400-7. [PMID: 22465404 DOI: 10.1016/j.apmr.2012.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 02/29/2012] [Accepted: 03/13/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To test the effect of tai chi on the progression of preclinical disability to manifest disability compared with seated flexibility exercise, and to examine whether tai chi mediates delayed disability by reducing impairments in musculoskeletal, cardiovascular, and neurologic systems, and related functional limitations. DESIGN Multisite parallel group individually randomized controlled trial. SETTING General community. PARTICIPANTS Preclinically disabled community-dwelling people older than 70 years (n=503), without major medical conditions or moderate to severe cognitive impairment. INTERVENTION Modified Sun style tai chi exercise compared with seated flexibility exercise, both programs delivered in groups for 60 minutes twice weekly for 24 weeks. MAIN OUTCOME MEASURES Disability measured with the Late-Life Function and Disability Instrument. Secondary outcomes were impairments and functional limitations of the musculoskeletal, neurologic, and cardiovascular systems. RESULTS There was little change within or between the 2 groups. The mean change in the Disability Frequency Score was 0.3 and 0.1 points (100-point scale) for the intervention and control groups, respectively (adjusted difference -.21; 95% confidence interval [CI] -.99 to .56). The mean change in the Disability Limitation Score was -0.1 and -.04 points for the intervention and control groups, respectively (adjusted difference -0.6; 95% CI -2.31 to 1.11). There was little effect on impairments or functional limitations. A higher proportion of intervention participants ceased attending the exercise program (difference=17.9%, 95% CI 9.6-25.8). Multiple imputation of missing data did not change the results. CONCLUSIONS Modified Sun style tai chi did not have an impact on impairment, functional limitations, or disability in preclinically disabled older people when delivered for 24 weeks. Withdrawal from the exercise classes was high but did not explain the null result. Improved compliance, or a longer or more intensive program, may be required.
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Affiliation(s)
- Lesley Day
- Monash University, Melbourne, Australia.
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200
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Moore KJ, Hill KD, Robinson AL, Haines TP, Haralambous B, Nitz JC. The state of physical environments in Australian residential aged care facilities. AUST HEALTH REV 2012; 35:412-7. [PMID: 22126942 DOI: 10.1071/ah10932] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 03/29/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This paper examines the quality and safety of the physical environment in Australian residential aged care facilities (RACFs). DESIGN Cross-sectional study. One assessor completed environmental audits to identify areas of the physical environment that needed to be addressed to improve the wellbeing and safety of residents. SETTING Nine RACFs participating in a broader falls prevention project were audited. RACFs were located in Queensland, Tasmania or Victoria and were chosen by convenience to represent high level, low level, dementia and psychogeriatric care, regional and metropolitan facilities, small and large facilities and a culturally specific facility. Main outcome measure. An environmental audit tool was adapted from a tool designed to foster older person friendly hospital environments. The tool consisted of 147 items. Results. Across all sites 450 items (34%) required action. This ranged from 21 to 44% across sites. The audit domains most commonly requiring action included signage, visual perception and lighting, and outdoor areas. CONCLUSIONS Although not representative of all residential facilities in Australia, this audit process has identified common environmental problems across a diverse mix of residential care facilities. Results highlight the need for further investigation into the quality of physical environments, and interventions to improve physical environments in Australian RACFs.
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