"Are your clients having fun?" The implications of respondents' preferences for the delivery of group exercise programs for falls prevention
- Authors: McPhate, Lucy , Simek, Emily , Haines, Terry , Hill, Keith , Finch, Caroline , Day, Lesley
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Aging and Physical Activity Vol. 24, no. 1 (2016), p. 129-138
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- Description: Background: Group exercise has been shown to be effective in preventing falls; however, adherence to these interventions is often poor. Older adults' preferences for how these programs can be delivered are unknown. Objective: To identify older people's preferences for how group exercise programs for falls prevention can be delivered. Design: A two-wave, cross-sectional, state-wide telephone survey was undertaken. Respondents were community-dwelling men and women aged 70+ in Victoria, Australia. Methods: Open-ended questions were asked to elicit information regarding respondent preferences of the program, which were analyzed using a framework approach. Results: Ninetyseven respondents completed the follow-up survey. The results indicate that older adults most frequently report the short-term advantages and disadvantages when describing their preferences for group exercise, such as enjoyment, social interaction, and leader qualities. Longer-term advantages such as falls prevention were described less frequently. Conclusions: This study indicates the importance of interpersonal skills, and that the opportunity for social interaction should not be overlooked as a positive feature of a group exercise program. © 2016 Human Kinetics, Inc.
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.
Clinician perspectives of the evidence underpinning suicide risk assessment : a mixed methods study
- Authors: Grant, Kellie , Whitwam, Louisa , Martin, Jennifer , White, Jennifer , Haines, Terry
- Date: 2023
- Type: Text , Journal article
- Relation: Australian Social Work Vol. 76, no. 4 (2023), p. 562-574
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- Description: In recent years, suicide risk assessment has become the subject of a vigorous academic debate, due in part to several meta-analyses that have cast doubt on the accuracy of risk categorisation. Little is known about how clinicians make sense of this academic debate. However, it is anticipated that it may pose a tension due to organisational expectations that multidisciplinary health professionals, including social workers, assess and manage suicide risk. As part of a larger mixed methods study to be reported elsewhere, we conducted a qualitative study aiming to explore clinician perspectives on the evidence underpinning suicide risk assessment before and after being presented with the results of two meta-analyses. Findings highlight three modes of reasoning: academic, emotive, and experiential. Perceptions of accuracy of assessing suicide risk at baseline interviews and after hearing the evidence were influenced by heuristics and cognitive biases. IMPLICATIONS Mental health practitioners, including social workers, employed in mental health settings may be more likely to use experiential reasoning to inform their practice in suicide risk assessment. Social work practitioners in general health settings may be more likely to use academic reasoning when making decisions about suicide risk assessment. Further research is required on how social workers and other mental health professionals can best respond to the crisis of suicide. © 2021 Australian Association of Social Workers.
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.
Equity in healthcare resource allocation decision making : a systematic review
- Authors: Lane, Haylee , Sarkies, Mitchell , Martin, Jennifer , Haines, Terry
- Date: 2017
- Type: Text , Journal article , Review
- Relation: Social Science and Medicine Vol. 175, no. (2017), p. 11-27
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- Description: Objective To identify elements of endorsed definitions of equity in healthcare and classify domains of these definitions so that policy makers, managers, clinicians, and politicians can form an operational definition of equity that reflects the values and preferences of the society they serve. Design Systematic review where verbatim text describing explicit and implicit definitions of equity were extracted and subjected to a thematic analysis. Data sources The full holdings of the AMED, CINAHL plus, OVID Medline, Scopus, PsychInfo and ProQuest (ProQuest Health & Medical Complete, ProQuest Nursing and Allied Health Source, ProQuest Social Science Journals) were individually searched in April 2015. Eligibility criteria for selecting studies Studies were included if they provided an original, explicit or implicit definition of equity in regards to healthcare resource allocation decision making. Papers that only cited earlier definitions of equity and provided no new information or extensions to this definition were excluded. Results The search strategy yielded 74 papers appropriate for this review; 60 of these provided an explicit definition of equity, with a further 14 papers discussing implicit elements of equity that the authors endorsed in regards to healthcare resource allocation decision making. Five key themes emerged i) Equalisation across the health service supply/access/outcome chain, ii) Need or potential to benefit, iii) Groupings of equalisation, iv) Caveats to equalisation, and v) Close enough is good enough. Conclusions There is great inconsistency in definitions of equity endorsed by different authors. Operational definitions of equity need to be more explicit in addressing these five thematic areas before they can be directly applied to healthcare resource allocation decisions. © 2016 Elsevier Ltd
Falls risk score removal does not impact inpatient falls : a stepped-wedge, cluster-randomised trial
- Authors: Jellett, Joanna , Williams, Cylie , Clayton, Diana , Plummer, Virginia , Haines, Terry
- Date: 2020
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 29, no. 23-24 (2020), p. 4505-4513
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- Description: Aims and objectives: To investigate the impact of removing a falls risk screening tool from an overall falls risk assessment programme on the rate of falls, injurious falls and completion of falls prevention activities by staff. Background: Falls in older patients are common adverse events in hospital settings. Screening and assessing individual patients for risk of falls are a common, but controversial element of falls prevention strategies in hospitals. Design: A stepped-wedge, cluster-randomised controlled trial using a disinvestment approach. Methods: This trial was carried out according to the Consolidated Standards of Reporting Trials (CONSORT). All patients were admitted to 20 health service wards (9 units) over the 10-month study period. The control condition contained a falls risk screening tool element, a full falls risk factor assessment and intervention provision section. In the intervention condition, only the full falls risk factor assessment and intervention provision section was applied, and the falls risk screening tool element was removed. Fall rates were extracted from hospital level data, files were audited for tool completion, and nurses surveyed about tool use. Results: There did not appear to be an impact on the falls rate per month when the risk screening tool component was removed (incidence rate ratio (IRR) = 0.84—favours intervention, 95%CI = 0.67 to 1.05, p =.14) nor on the falls rate with serious injury (IRR = 0.90, 95%CI = 0.26 to 3.09, p =.87). There was a thirty-six second reduction of time per patient reported by staff to complete paperwork (p <.001). There was no difference in the proportion of patients for whom the tool was completed, nor the number of falls prevention interventions identified for implementation. Conclusion: Removing the falls risk screening tool section did not negatively impact falls and reduced time spent completing falls prevention paperwork. Relevance to clinical practice: Falls prevention is an important issue in health services. Removal of a screening risk tool is unlikely to impact falls. This has the potential to reduce nursing administration time that may be otherwise redirected to individual approaches to falls prevention. © 2020 John Wiley & Sons Ltd
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.
Identifying public healthcare priorities in virtual care for older adults : a participatory research study
- Authors: Pu, Dai , Palmer, Victoria , Greenstock, Louise , Pigott, Cathie , Peeters, Anna , Sanci, Lena , Callisaya, Michele , Browning, Colette , Chapman, Wendy , Haines, Terry
- Date: 2023
- Type: Text , Journal article
- Relation: International Journal of Environmental Research and Public Health Vol. 20, no. 5 (2023), p.
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- Description: There has been increasing adoption and implementation of virtual healthcare in recent years, especially with COVID-19 impacting the world. As a result, virtual care initiatives may not undergo stringent quality control processes to ensure that they are appropriate to their context and meet sector needs. The two objectives of this study were to identify virtual care initiatives for older adults currently in use in Victoria and virtual care challenges that could be prioritised for further investigation and scale-up and to understand why certain virtual care initiatives and challenges are prioritised over others for investigation and scale-up. Methods: This project used an Emerging Design approach. A survey of public health services in the state of Victoria in Australia was first carried out, followed by the co-production of research and healthcare priorities with key stakeholders in the areas of primary care, hospital care, consumer representation, research, and government. The survey was used to gather existing virtual care initiatives for older adults and any associated challenges. Co-production processes consisted of individual ratings of initiatives and group-based discussions to identify priority virtual care initiatives and challenges to be addressed for future scale-up. Stakeholders nominated their top three virtual initiatives following discussions. Results: Telehealth was nominated as the highest priority initiative type for scaling up, with virtual emergency department models of care nominated as the highest priority within this category. Remote monitoring was voted as a top priority for further investigations. The top virtual care challenge was data sharing across services and settings, and the user-friendliness of virtual care platforms was nominated as the top priority for further investigation. Conclusions: Stakeholders prioritised public health virtual care initiatives that are easy to adopt and address needs that are perceived to be more immediate (acute more so than chronic care). Virtual care initiatives that incorporate more technology and integrated elements are valued, but more information is needed to inform their potential scale-up. © 2023 by the authors.
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
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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.
The costs of risk and fear : a qualitative study of risk conceptualisations in allied health resource allocation decision-making
- Authors: Grant, Kellie , White, Jenni , Martin, Jennifer , Haines, Terry
- Date: 2019
- Type: Text , Journal article
- Relation: Health, Risk and Society Vol. 21, no. 7-8 (2019), p. 373-389
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- Description: Over the past several decades, the paradigm of risk has become increasingly salient for understanding how health care is provided. In more recent years, we have seen an expanding body of literature raising concerns of possible harms that a focus on risk may carry. Despite considerable research interest in risk, relatively little is known about the construction of risk in contexts of allied health resource allocation decision-making. This article reports on qualitative research exploring how allied health leaders construct the concept of risk and how this influences resource allocation decision-making. Data are drawn from forums held in August and September 2014, with a total of 59 participants who occupied leadership roles in allied health in Australia. The findings highlight three domains of risk: resource, patient and organisational risk. Some domains of risk received more attention from participants and exerted greater influence on decision-making than others. Relative to the other domains, patient risk was not a core focus. Risk had a distinct emotive element and some domains of risk led participants to focus on catastrophic outcomes. Patient risk did not evoke emotive responses, whereas both resource and organisational risk did. It appears that perceived risk may be costly for health organisations, as it can be a primary driver underpinning resource allocation decisions. We explore the relative lack of attention to patient risk, the role of fear and anxiety in decision-making, and discuss implications of the impact of a focus on risk in wider society. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
Virtual care initiatives for older adults in Australia : scoping review
- Authors: Savira, Feby , Gupta, Adyya , Gilbert, Cecily , Huggins, Catherine , Browning, Colette , Chapman, Wendy , Haines, Terry , Peeters, Anna
- Date: 2023
- Type: Text , Journal article , Review
- Relation: Journal of Medical Internet Research Vol. 25, no. (2023), p.
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- Description: Background: There has been a rapid shift toward the adoption of virtual health care services in Australia. It is unknown how widely virtual care has been implemented or evaluated for the care of older adults in Australia. Objective: We aimed to review the literature evaluating virtual care initiatives for older adults across a wide range of health conditions and modalities and identify key challenges and opportunities for wider adoption at both patient and system levels in Australia. Methods: A scoping review of the literature was conducted. We searched MEDLINE, Embase, PsycINFO, CINAHL, AgeLine, and gray literature (January 1, 2011, to March 8, 2021) to identify virtual care initiatives for older Australians (aged
What are the characteristics of home exercise programs that older adults prefer? A cross-sectional study
- Authors: Simek, Emily , McPhate, Lucy , Hill, Keith , Finch, Caroline , Day, Lesley , Haines, Terry
- Date: 2015
- Type: Text , Journal article
- Relation: American Journal of Physical Medicine & Rehabilitation Vol. 94, no. 7 (2015), p. 508-521
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
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- Description: Objective The aim of this study was to examine the preferences of older adults toward the structure and delivery of home exercise programs for the prevention of falls as well as the perceived benefits of and barriers to program adherence. Methods A two-wave cross-sectional telephone survey of community-dwelling older adults was conducted in Victoria, Australia. Respondents were categorized as current, previous, or nonparticipants of a home exercise program in the last 6 yrs. Thematic analysis of open-response questions examining the preferences of current and previous participants toward participation in, and delivery of, home exercise programs for falls preventions was performed. Results A total of 245 respondents completed the follow-up survey. The respondents were classified as current (n = 54), previous (n = 22), or nonparticipants (n = 169) of a home exercise program in the last 6 yrs. Program adherence was influenced by the perceived effect of programs on physical and mental health, participant autonomy, and how well the program structure complemented individual exercise and lifestyle preferences. Conclusions Adherence to home exercise programs for falls prevention is influenced by personal preferences toward program structure and delivery as well as perceived benefits of and barriers to program participation. To optimize participant adherence, service providers need to consider personal preferences and some flexibility in the program being delivered.
‘‘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
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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.