A protocol for evidence-based targeting and evaluation of statewide strategies for preventing falls among community-dwelling older people in Victoria, Australia
- Authors: Day, Lesley , Finch, Caroline , Hill, Keith , Haines, Terry , Clemson, Lindy , Thomas, Margaret , Thompson, Catherine
- Date: 2011
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 17, no. 2 (2011), p. 1-8
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/546282
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- Description: Background: Falls are a significant threat to the safety, health and independence of older citizens. Despite the now substantial evidence about effective falls prevention interventions, translation into falls reductions has not yet been fully realised. While the hip fracture rate is decreasing, the number and rate of fall-related hospital admissions among older people is increasing. The challenge now is to deliver the most effective interventions efficiently at a population level, and for these interventions to be taken up by older people. Objective: To support the development, and evaluation of, effective falls prevention policy and practice in the state of Victoria, Australia. Methods: The RE-AIM model (Reach, Efficacy, Adoption, Implementation, Maintenance) was used to identify strategies for an effective programme. Research objectives were developed to support the strategies. These include: (1) identification of subgroups of older people most frequently admitted to hospital for falls; (2) examining the acceptability of established falls interventions; (3) identification of factors that encourage and support relevant lifestyle changes; (4) identifying opportunities to incorporate confirmed interventions in existing programmes and services; (5) developing guidelines for sustainability. The research results will subsequently guide strategy details for the falls prevention plan. RE-AIM will provide the framework for the evaluation structure. Outcome measures: Measures to monitor the implementation of the selected interventions will be determined for each intervention, based on the five key factors of the RE-AIM model. The overall effect of the falls prevention plan will be monitored by time series analysis of fall-related hospital admission rates for community-dwelling older people.
Does action follow intention with participation in home and group-based falls prevention exercise programs? An exploratory, prospective, observational study
- Authors: Haines, Terry , Hill, Keith , Vu, Trang , Clemson, Lindy , Finch, Caroline , Day, Lesley
- Date: 2016
- Type: Text , Journal article
- Relation: Archives of Gerontology and Geriatrics Vol. 64, no. (2016), p. 151-161
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: 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. © 2016 Elsevier Ireland Ltd.
Fall Prevention in Australia: Policies and activities
- Authors: Clemson, Lindy , Finch, Caroline , Hill, Keith , Lewin, Gill
- Date: 2010
- Type: Text , Journal article
- Relation: Clinics in geriatric medicine Vol. 26, no. 4 (2010), p. 733-749
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- Description: Fall prevention recommendations and plans have been prolific in Australia since 1986 but Commonwealth recommendations have rarely been acted on from a national perspective and the funds for prevention at a national level have been limited At a state level, although increasing annually funds for fall prevention have also remained as only a low proportion of total health spending Several Australian states have developed their own strategic plans and their activities have developed separately and uniquely although referring to national guidelines This article presents a perspective of Australian fall prevention policy over time provides insights into the current focus, and draws on some specific examples of activities from the 2 most populous Australian states (New South Wales and Victoria) and from our largest geographic state Western Australia
Identifying clusters of falls-related hospital admissions to inform population targets for prioritising falls prevention programmes
- Authors: Finch, Caroline , Stephan, Karen , Shee, Anna Wong , Hill, Keith , Haines, Terry , Clemson, Lindy , Day, Lesley
- Date: 2015
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 21, no. 4 (2015), p. 254-259
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/1058737
- Relation: http://purl.org/au-research/grants/nhmrc/546282
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- Description: Background: There has been limited research investigating the relationship between injurious falls and hospital resource use. The aims of this study were to identify clusters of community-dwelling older people in the general population who are at increased risk of being admitted to hospital following a fall and how those clusters differed in their use of hospital resources. Methods: Analysis of routinely collected hospital admissions data relating to 45 374 fall-related admissions in Victorian community-dwelling older adults aged ≥65 years that occurred during 2008/2009 to 2010/2011. Fall-related admission episodes were identified based on being admitted from a private residence to hospital with a principal diagnosis of injury (International Classification of Diseases (ICD)-10-AM codes S00 to T75) and having a first external cause of a fall (ICD-10-AM codes W00 to W19). A cluster analysis was performed to identify homogeneous groups using demographic details of patients and information on the presence of comorbidities. Hospital length of stay (LOS) was compared across clusters using competing risks regression. Results: Clusters based on area of residence, demographic factors (age, gender, marital status, country of birth) and the presence of comorbidities were identified. Clusters representing hospitalised fallers with comorbidities were associated with longer LOS compared with other cluster groups. Clusters delineated by demographic factors were also associated with increased LOS. Conclusions: All patients with comorbidity, and older women without comorbidities, stay in hospital longer following a fall and hence consume a disproportionate share of hospital resources. These findings have important implications for the targeting of falls prevention interventions for community-dwelling older people. © 2015, BMJ Publishing Group. All right reserved.
Implementing person-environment approaches to prevent falls: A qualitative inquiry in applying the Westmead approach to occupational therapy home visits
- Authors: Clemson, Lindy , Donaldson, Alex , Hill, Keith , Day, Lesley
- Date: 2014
- Type: Text , Journal article
- Relation: Australian Occupational Therapy Journal Vol. 61, no. 5 (2014), p. 325-334
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- Description: Background/aims: Despite evidence of the effectiveness of home safety interventions for preventing falls, there is limited uptake of such interventions within community services. Therefore, as part of a broader translational project, we explored issues underlying the implementation of an evidence-based home safety fall prevention intervention. Method: We conducted in-depth interviews with eight occupational therapists and two programme coordinators engaged to deliver a home safety fall prevention intervention. Six community health centres within two metropolitan regions of Melbourne, Australia participated. The RE-AIM framework and Diffusion of Innovations theory underpinned the interviews which examine the enablers and barriers to implementing a home safety fall prevention intervention and integrating it into routine community preventive practice. Analysis involved thematic and content analysis. Results: Investment in the home safety for fall prevention intervention was supported and valued by coordinators and therapists alike, and a number of themes emerged which influenced implementation of this intervention. These included issues of: compatibility with organisational processes, individual practitioner practices and skills, a prevention approach, and client expectations; relative advantage in terms of flexibility of the process, client engagement and regional capacity building; complexity of implementing the intervention; and observability related to the invisible nature of fall prevention outcomes. Conclusion: Implementation of this home safety fall prevention intervention was influenced by a range of interrelated organisational, practitioner and client related factors. The findings from this project provide insights into, and opportunities to increase the sustainable implementation of the home safety fall prevention intervention into practice.
Investigation of older adults’ participation in exercises following completion of a state-wide survey targeting evidence-based falls prevention strategies
- Authors: Lee, Den-Ching , Day, Lesley , Finch, Caroline , Hill, Keith , Clemson, Lindy , McDermott, Fiona , Haines, Terry
- Date: 2014
- Type: Text , Journal article
- Relation: Journal of Aging and Physical Activity Vol.23, no.2 (2014), p.256-263
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: This paper examines whether involvement in an observational study may prompt participants to change their exercise behaviors. Data was collected from 394 older community dwellers in Victoria, Australia using a baseline survey, and 245 of these participated in a follow-up survey one year later. Survey domains were drawn from constructs of relevant health behavior models. Results showed that the proportion of respondents who were currently participating in exercises to prevent falls at follow-up was 12% higher than at baseline (Wilcoxon p value<0.001). Twenty-nine percent reported they had changed their perceptions about falls and their risk of falls, with comments focused on threat appraisal. Forty-four percent reported having taken strategies to reduce their risk of falling, with comments based on implementation of different preventive strategies. Respondents who held favorable views towards exercises for the prevention of falls appear to change their behaviors that might address falls when participating in observational studies.
Older adult perceptions of participation in group- and home-based falls prevention exercise
- Authors: Robins, Lauren , Hill, Kylie , Day, Lesley , Clemson, Lindy , Finch, Caroline , Haines, Terry
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Aging and Physical Activity Vol. 24, no. 3 (2016), p. 350-362
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
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- Description: This paper describes why older adults begin, continue, and discontinue group-and home-based falls prevention exercise and benefits and barriers to participation. Telephone surveys were used to collect data for 394 respondents. Most respondents reported not participating in group-(66%) or home-based (78%) falls prevention exercise recently. Reasons for starting group-based falls prevention exercise include health benefits (23-39%), health professional recommendation (13-19%), and social interaction (4-16%). They discontinued because the program finished (44%) or due to poor health (20%). Commonly reported benefits were social interaction (41-67%) and health (15-31%). Disliking groups was the main barrier (2-14%). Home-based falls prevention exercise was started for rehabilitation (46-63%) or upon health professional recommendation (22-48%) and stopped due to recovery (30%). Improvement in health (18-46%) was the main benefit. These findings could assist health professionals in prescribing group-based falls prevention exercise by considering characteristics of older adults who perceive social interaction to be beneficial.
The association between physical activity and social isolation in community-dwelling older adults
- Authors: Robins, Lauren , Hill, Keith , Finch, Caroline , Clemson, Lindy , Haines, Terry
- Date: 2018
- Type: Text , Journal article
- Relation: Aging and Mental Health Vol. 22, no. 2 (2018), p. 175-182
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
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- Description: Objectives: Social isolation is an increasing concern in older community-dwelling adults. There is growing need to determine effective interventions addressing social isolation. This study aimed to determine whether a relationship exists between physical activity (recreational and/or household-based) and social isolation. An examination was conducted for whether group- or home-based falls prevention exercise was associated with social isolation. Methods: Cross-sectional analysis of telephone survey data was used to investigate relationships between physical activity, health, age, gender, living arrangements, ethnicity and participation in group- or home-based falls prevention exercise on social isolation. Univariable and multivariable ordered logistic regression analyses were conducted. Results: Factors found to be significantly associated with reduced social isolation in multivariable analysis included living with a partner/spouse, reporting better general health, higher levels of household-based physical activity (OR = 1.03, CI = 1.01–1.05) and feeling less downhearted/depressed. Being more socially isolated was associated with symptoms of depression and a diagnosis of congestive heart failure (pseudo R2 = 0.104). Discussion: Findings suggest that household-based physical activity is related to social isolation in community-dwelling older adults. Further research is required to determine the nature of this relationship and to investigate the impact of group physical activity interventions on social isolation.
‘‘Better for others than for me’’: A belief that should shape our efforts to promote participation in falls prevention strategies
- Authors: Haines, Terry , Day, Lesley , Hill, Keith , Clemson, Lindy , Finch, Caroline
- Date: 2014
- Type: Text , Journal article
- Relation: Archives of Gerontology and Geriatrics Vol. 59, no. (2014), p. 136-144
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
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- Description: Falls are a common occurrence amongst older adults yet participation in prevention strategies is often poor. Although older adults may perceive a strategy works in general, they may not participate because they feel it will not benefit them personally. We aimed to describe how frequently and why older adults identify falls prevention strategies as being ‘‘better for others than for me’’. A cross-sectional survey with n = 394 community-dwelling older adults in Victoria, Australia was undertaken. Participants were provided with detailed descriptions of four evidence-based falls prevention strategies and for each were asked whether they felt that the strategy would be effective in preventing falls for people like them, and then whether they felt that the strategy would be effective for preventing falls for them personally. Follow-up questions asked why they thought the strategy would be more effective for people like them than for them personally where this was the case. We found the ‘‘better for others than for me’’ perception was present for between 25% and 34% of the strategies investigated. Participants commonly said they felt this way because they did not think they were at risk of falls, and because they were doing other activities they thought would provide equivalent benefit. Strategies to promote participation in evidence-based falls prevention strategies may need to convince older adults that they are at risk of falls and that what activities they are already doing may not provide adequate protection against falls in order to have greater effect.