‘‘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.
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
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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.
The burden of hospitalised fall-related injury in community-dwelling older people in Victoria : A database study
- Authors: Vu, Trang , Day, Lesley , Finch, Caroline
- Date: 2014
- Type: Text , Journal article
- Relation: Australian and New Zealand Journal of Public Health Vol. 38, no. 2 (April 2014), p. 128-133
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Objective: To estimate the burden of hospitalised fall-related injury in community-dwelling older people in Victoria. Methods: We analysed fall-related, person-identifying hospital discharge data and patient-level hospital treatment costs for community-dwelling older people aged 65+ years from Victoria between 1 July 2005 and 30 June 2008, inclusive. Key outcomes of interest were length of stay (LOS)/episode, cumulative LOS (CLOS)/patient and inpatient costs. Results: The burden of hospitalised fall-related injury in community-dwelling older people aged 65+ years in Victoria was 284,781 hospital bed days in 2005-06, rising to 310,031 hospital bed days in 2007-08. Seventy-one per cent of episodes were multiday. One in 15 acute care episodes was a high LOS outlier and 14% of patients had ≥1 episode classified as high LOS outlier. The median CLOS/patient was nine days (interquartile range 2-27). The annual costs of inpatient care, in June 2009 prices, for fall-related injury in community-dwelling people aged 65+ years in Victoria rose from $213 million in 2005-06 to $237 million in 2007-08. The burden of hospitalised fall-related injury in community-dwelling older women, people aged 85+ years and those with comorbidity was considerable. Conclusions: The burden of hospitalised fall-related injury in community-dwelling older people aged 65+ years in Victoria is significantly more than previously projected. Importantly, this study identifies that women, patients with comorbidity and those aged 85+ years account for a considerable proportion of this burden. Implications: A corresponding increase in falls prevention effort is required to ensure that the burden is properly addressed.
Statistical modelling for falls count data
- Authors: Ullah, Shahid , Finch, Caroline , Day, Lesley
- Date: 2010
- Type: Text , Journal article
- Relation: Accident Analysis and Prevention Vol. 42, no. 2 (2010), p. 384-392
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Falls and their injury outcomes have count distributions that are highly skewed toward the right with clumping at zero, posing analytical challenges. Different modelling approaches have been used in the published literature to describe falls count distributions, often without consideration of the underlying statistical and modelling assumptions. This paper compares the use of modified Poisson and negative binomial (NB) models as alternatives to Poisson (P) regression, for the analysis of fall outcome counts. Four different count-based regression models (P, NB, zero-inflated Poisson (ZIP), zero-inflated negative binomial (ZINB)) were each individually fitted to four separate fall count datasets from Australia, New Zealand and United States. The finite mixtures of P and NB regression models were also compared to the standard NB model. Both analytical (F, Vuong and bootstrap tests) and graphical approaches were used to select and compare models. Simulation studies assessed the size and power of each model fit. This study confirms that falls count distributions are over-dispersed, but not dispersed due to excess zero counts or heterogeneous population. Accordingly, the P model generally provided the poorest fit to all datasets. The fit improved significantly with NB and both zero-inflated models. The fit was also improved with the NB model, compared to finite mixtures of both P and NB regression models. Although there was little difference in fit between NB and ZINB models, in the interests of parsimony it is recommended that future studies involving modelling of falls count data routinely use the NB models in preference to the P or ZINB or finite mixture distribution. The fact that these conclusions apply across four separate datasets from four different samples of older people participating in studies of different methodology, adds strength to this general guiding principle. © 2009 Elsevier Ltd. All rights reserved.
Patterns of comorbidity in community-dwelling older people hospitalised for fall-related injury: A cluster analysis
- Authors: Vu, Trang , Finch, Caroline , Day, Lesley
- Date: 2011
- Type: Text , Journal article
- Relation: BMC Geriatrics Vol. 11, no. 45 (2011), p. 1-10
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Background: Community-dwelling older people aged 65+ years sustain falls frequently; these can result in physical injuries necessitating medical attention including emergency department care and hospitalisation. Certain health conditions and impairments have been shown to contribute independently to the risk of falling or experiencing a fall injury, suggesting that individuals with these conditions or impairments should be the focus of falls prevention. Since older people commonly have multiple conditions/impairments, knowledge about which conditions/impairments coexist in at-risk individuals would be valuable in the implementation of a targeted prevention approach. The objective of this study was therefore to examine the prevalence and patterns of comorbidity in this population group. Methods: We analysed hospitalisation data from Victoria, Australia's second most populous state, to estimate the prevalence of comorbidity in patients hospitalised at least once between 2005-6 and 2007-8 for treatment of acute fall-related injuries. In patients with two or more comorbid conditions (multicomorbidity) we used an agglomerative hierarchical clustering method to cluster comorbidity variables and identify constellations of conditions. Results: More than one in four patients had at least one comorbid condition and among patients with comorbidity one in three had multicomorbidity (range 2-7). The prevalence of comorbidity varied by gender, age group, ethnicity and injury type; it was also associated with a significant increase in the average cumulative length of stay per patient. The cluster analysis identified five distinct, biologically plausible clusters of comorbidity: cardiopulmonary/metabolic, neurological, sensory, stroke and cancer. The cardiopulmonary/metabolic cluster was the largest cluster among the clusters identified. Conclusions: The consequences of comorbidity clustering in terms of falls and/or injury outcomes of hospitalised patients should be investigated by future studies. Our findings have particular relevance for falls prevention strategies, clinical practice and planning of follow-up services for these patients.
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
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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.
Modelling the population-level impact of tai-chi on falls and fall-related injury among community-dwelling older people
- Authors: Day, Lesley , Finch, Caroline , Harrison, James , Hoareau, Effie , Segal, Leonie , Ullah, Shahid
- Date: 2010
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 16, no. 5 (2010), p. 321-326
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Objective: To model the population level impact of tai-chi on future rates of falls and fall-related injury in older people as a tool for policy development. Design: An epidemiological and economic model for estimating population-level effectiveness of tai-chi. Setting: Australia, 2009. Patients or subjects: Australian community-dwelling population aged 70+ years, ambulatory and without debilitating conditions or profound visual defects. Intervention: Group-based tai-chi, for 1 h twice weekly for 26 weeks, assuming no sustained effect beyond the intervention period. Main outcome measure: Total falls and fall-related hospitalisation prevented in 2009. Results: Population-wide tai-chi delivery would prevent an estimated 5440 falls and 109 fall-related hospitalisations, resulting in a 0.18% reduction in the fall related hospital admission rate for community-dwelling older people. The gross costs per fall and per fall-related hospital admission prevented were $ A4414 ((sic)3013) and $A220 712 ((sic)150 684), respectively. A total investment of $A24.01 million ((sic)16.39 million), equivalent to 4.2% of the cost of fall-related episodes of hospital care in 2003/4, would be required to provide tai-chi for 31 998 people and achieve this effect. Conclusions: Substantial investment in, and high population uptake of, tai-chi would be required to have a large effect on falls and fall-related hospitalisation rates. Although not accounted for in this study, investment in tai-chi is likely to be associated with additional significant health benefits beyond falls prevention. This approach could be applied to other interventions to assist selection of the most cost effective falls-prevention portfolio for Australia and other countries.
Modelling the impact, costs and benefits of falls prevention measures to support policy-makers and program planners
- Authors: Day, Lesley , Hoareau, Effie , Finch, Caroline , Harrison, James , Segal, Leonie , Bolton, Tom , Bradley, Clare , Boufous, Soufiane , Ullah, Shahid , National Injury Prevention Injury Working Group
- Date: 2009
- Type: Text , Technical report
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- Description: The ageing of the population is one of the major transformations being experienced in Australia, with falls a significant threat to safety, health and independence. There is now substantial evidence regarding effective interventions for preventing falls among older people living independently in the community. The aim of this project was to develop and apply a framework for epidemiological modelling of the population level impact of proven interventions on future fall rates, providing a powerful policy-setting tool for prevention. We used the Cochrane review to source current best efficacy evidence from randomised controlled trials which have provided evidence of minimising the incidence of falls among older people living in the community. Six interventions defined in that review as most promising for community dwelling older people were modelled. Additionally, one other intervention not in the Cochrane review, expedited cataract removal, was also modelled. Occupational therapy delivered home hazard assessment and modification for those with recent fall history, as modelled here, represents the best falls prevention investment. Cardiac pacing is a good falls prevention investment over the medium term, although is unlikely to have a major impact on population level hospital admission rates. The relative cost-effectiveness of psychotropic medication withdrawal appears high, although some implementation issues would need to be addressed and further costs included. Multi-disciplinary multi-factorial risk management represents good clinical practice for high risk individuals, but is not relatively cost-effective for widespread implementation. Tai chi programs may represent good value for falls prevention resources, if local circumstances allow the cost per participant to be substantially lower than modelled here. Predicted reductions in national fall-related hospital admission rates for people aged 65 years and over ranged from 0.4% to 4.6% for five of the six falls prevention strategies implemented over a one year period. These reductions, however, suggest that substantial investment in falls prevention will be required to have large effects on the fall-related hospitalisation rates. In addition, the costeffectiveness of a number of the modelled interventions could be improved by variations to the implementation processes such as measures to increase uptake, or decrease the cost per participant. The framework developed provides the potential for the research evidence base to better guide policy and practice with respect to reducing falls and future fall-related hospitalisation rates.
Linked versus unlinked hospital discharge data on hip fractures for estimating incidence and comorbidity profiles
- Authors: Vu, Trang , Day, Lesley , Finch, Caroline
- Date: 2012
- Type: Text , Journal article
- Relation: BMC Medical Research Methodology Vol. 12, no. 113 (2012), p. 1-8
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Background: Studies comparing internally linked (person–identifying) and unlinked (episodes of care) hospital discharge data (HDD) on hip fractures have mainly focused on incidence overestimation by unlinked HDD, but little is known about the impact of overestimation on patient profiles such as comorbidity estimates. In view of the continuing use of unlinked HDD in hip fracture research and the desire to apply research results to hip fracture prevention, we concurrently assessed the accuracy of both incidence and comorbidity estimates derived from unlinked HDD compared to those estimated from internally linked HDD. Methods: We analysed unlinked and internally linked HDD between 01 July 2005 and 30 June 2008, inclusive, from Victoria, Australia to estimate the incidence of hospital admission for fall-related hip fracture in community-dwelling older people aged 65+ years and determine the prevalence of comorbidity in patients. Community-dwelling status was defined as living in private residence, supported residential facilities or special accommodation but not in nursing homes. We defined internally linked HDD as the reference standard and calculated measures of accuracy of fall-related hip fracture incidence by unlinked HDD using standard definitions. The extent to which comorbidity prevalence estimates by unlinked HDD differed from those by the reference standard was assessed in absolute terms. Results: The sensitivity and specificity of a standard approach for estimating fall-related hip fracture incidence using unlinked HDD (i.e. omitting records of in-hospital deaths, inter-hospital transfers and readmissions within 30 days of discharge) were 94.4% and 97.5%, respectively. The standard approach and its variants underestimated the prevalence of some comorbidities and altered their ranking. The use of more stringent selection criteria led to major improvements in all measures of accuracy as well as overall and specific comorbidity estimates. Conclusions: This study strongly supports the use of linked rather than unlinked HDD in injury research. In health systems where linked HDD are unavailable, current approaches for identifying incident hip fractures may be enhanced by incorporating additional evidence-based criteria.
Key factors influencing implementation of falls prevention exercise programs in the community
- Authors: Day, Lesley , Trotter, Margaret , Donaldson, Alex , Hill, Keith , Finch, Caroline
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Aging and Physical Activity Vol. 24, no. 1 (2016), p. 45-52
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- Description: The study aim was to evaluate the implementation of group-and home-based exercise falls prevention programs delivered through community health agencies to community-dwelling older people. Interviews with program staff were guided by the Diffusion of Innovations theory. Highly consistent themes emerged for the two types of programs. Both had high overall compatibility, high relative advantage, good observability and high inherent trialability-all factors known to strengthen implementation. The level of complexity and low financial compatibility emerged as the strongest potential inhibitors to program implementation in the context examined. The two main factors contributing to complexity were the need to challenge balance safely across a broad range of capability, and practical considerations associated with program delivery. A range of strategies to provide more technical support for exercise program leaders to tailor balance challenge for exercise program leaders may enhance implementation of falls prevention exercise programs. © 2016 Human Kinetics, Inc.
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.
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.
Hospital admissions following presentations to emergency departments for a fracture in older people
- Authors: Boufous, Soufiane , Finch, Caroline , Close, Jacqueline , Day, Lesley , Lord, Stephen
- Date: 2007
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 13, no. 3 (2007), p. 211-214
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- Description: The aim of this paper is to estimate the proportion of older people who are hospitalised following a presentation to an emergency department for hip, pelvic and wrist fractures. The findings indicate that hospitalisation data do not accurately reflect the incidence of low-trauma fractures, particularly wrist and pelvic fractures, in older people.
- Description: C1
- Description: 2003005768
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.
Determining policy-relevant formats for the presentation of falls research evidence
- Authors: Finch, Caroline , Day, Lesley , Donaldson, Alex , Segal, Leonie , Harrison, James
- Date: 2009
- Type: Text , Journal article
- Relation: Health Policy Vol. 93, no. 2-3 (2009), p. 207-213
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Objectives: Population modelling holds considerable promise for identifying the most efficient and cost-effective falls prevention measures, but the outcomes need to be in a readily useable form. This paper describes an iterative, collaborative process undertaken by researchers and falls prevention policy officers to develop such a format for falls prevention intervention evidence. Methods: The researchers developed a draft template that underwent several iterations and improvements, through three collaborative consultations with policy officers. Results: Although the researchers initially identified many key information needs, active engagement with policy officers ensured that policy requirements were met and that the value of the reporting formats for policy decision-making was maximised. Importantly, they highlighted the need to articulate underlying modelling assumptions clearly. The resulting formats, with complete data, were given to policy officers to inform their local jurisdictional policy decisions. Conclusions: There is strong benefit in researchers and policy officers collaborating to develop optimal formats for presenting scientific evidence to inform policy decisions. Such a process can reduce concerns of researchers that evidence is not incorporated into policy decisions. They also meet policy officers' needs for evidence to be provided in a way that can directly inform their decision-making processes. © 2009 Elsevier Ireland Ltd. All rights reserved.
- Description: 2003008200
Community-dwelling older people hospitalised for fall-related injury: characterising high length of stay users
- Authors: Vu, Trang , Finch, Caroline , Day, Lesley
- Date: 2012
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 18, no. Supplement 1 (2012), p. A121
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- Description: Background: Nearly half to 60% of falls in community-dwelling older people aged 65+ years result in physical injuries and 20%–50% of these require medical attention, including emergency department visit and hospitalisation. Fallers who stay in hospital longer than would be expected based on the primary injury diagnosis create an excess financial burden on the health system and represent a priority target group for fall prevention. Objectives: To identify and characterise high-length-of-stay (HLOS) patients among community-dwelling older people aged 65+ years hospitalised for fall-related injury. Methods: We analysed hospital discharge data from Victoria, Australia, to identify and characterise HLOS patients among community-dwelling older people aged 65+ years hospitalised for fall-related injury. We defined an episode as HLOS if the length of stay (LOS) was more than three times the average LOS for a particular diagnosis-related group. Results: Between 2005/06 and 2007/08 6822 patients (14.2% of the study group of which 73.8% were women) had ≥1 episode classified as HLOS. The HLOS patients accounted for 19.9% of episodes and 39.9% of bed days. HLOS patients were similar to non-HLOS patients in terms of indigenous status, in-hospital mortality and ethnicity. However, HLOS patients were older, less likely to be married, less likely to have hospital insurance and more likely to have comorbidity than non-HLOS patients. Significance/Contribution to the Field: This study identifies priority groups for a targeted prevention approach.
Accuracy of evidence-based criteria for identifying an incident hip fracture in the absence of the date of injury: a retrospective database study
- Authors: Vu, Trang , Davie, Gabrielle , Barson, David , Day, Lesley , Finch, Caroline
- Date: 2013
- Type: Text , Journal article
- Relation: BMJ Open Vol. 3, no. 7 (2013), p. 1-6
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Objectives: Hospital discharge data (HDD) in many health systems do not capture the date of injury (DOI); the absence of this date hinders researchers’ ability to distinguish repeat from incident injury admissions. Various approaches using somewhat arbitrary criteria have been explored to increase the accuracy of incident injury identification. However, these approaches have not been validated against a data source which contains DOI. The aim of this study was to determine the accuracy of evidence-based criteria for identifying fall-related incident hip fractures in the absence of DOI using HDD containing DOI as the reference standard. Design: Retrospective database study. Setting: New Zealand. Participants: 8761 patients aged 65+ years admitted for fall-related hip fracture between 1 July 2005 and 30 June 2008, inclusive. Outcome measures: We defined person-identifying HDD containing DOI as the reference standard and calculated measures of the accuracy of evidence-based criteria for identifying fall-related incident hip fractures from HDD not containing DOI. The criteria were principal diagnosis of hip fracture, mechanism of injury indicating a fall, admission type emergency, admission source other than a transfer and presence of hip operation code(s). For a subsequent fall-related hip fracture, additional criteria were time between successive hip fractures ≥120 days, and all external cause-of-injury codes being different to those for the previous hip fracture. Results: The sensitivity and specificity of the criteria for identifying fall-related incident hip fractures from data not containing DOI were 96.7% and 99.3%, respectively, compared with the reference standard. The application of these criteria resulted in a slight underestimation of the percentage of patients with multiple hip fractures. Conclusions: Although it is preferable to have DOI; this study demonstrates that evidence-based criteria can be used to reliably identify fall-related incident hip fractures from the person-identifying HDD when DOI is unavailable.
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.
"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.