Caroline Lukaszyk

Risk factors, incidence, consequences and prevention strategies for falls and fall-injury within older indigenous populations: a systematic review

Objective: To examine the risk factors, incidence, consequences and existing prevention strategies for falls and fall‐related injury in older indigenous people.

Fall-related hospitalisations of older Aboriginal and Torres Strait Islander people and other Australians

Objectives: To compare the socio‐demographic characteristics and type of injury sustained, the use of hospital resources and rates of hospitalisation by injury type, and survival following fall injuries to older Aboriginal people and non‐Indigenous Australian people hospitalised for fall‐related injuries.

Risk factors for falls among older Aboriginal and Torres Strait Islander people in urban and regional communities

To examine associations between fall risk factors identified previously in other populations and falls among Aboriginal people aged 60 years and older, living in New South Wales, Australia.

Participant preferences for an Aboriginal-specific fall prevention program: Measuring the value of culturally-appropriate care

Background Culturally-specific services are central to efforts to improve the health of Aboriginal Australians. Few empirical studies have demonstrated the value of such services relative to mainstream alternatives. Objective To assess the preferences and willingness to pay (WTP) of participants for attending a class and the relative importance of transport, cost and cultural-appropriateness in the choices made by participants. Design A discrete choice experiment (DCE) was conducted alongside a study of a culturally-specific fall-prevention service. Attributes that were assessed were out-of-pocket costs, whether transport was provided and whether the class was Aboriginal-specific. Choices of participants were modelled using panel-mixed logit methods. Results 60 patients completed the DCE. Attending a service was strongly preferred over no service (selected 99% of the time). Assuming equivalent efficacy of fall-prevention programs, participants indicated a preference for services that were culturally-specific (OR 1.25 95% CI: 1.00–1.55) and incurred lower out-of-pocket participant costs (OR 1.19 95% CI 1.11–1.27). The provision of transport did not have a statistically significant influence on service choice (p = 0.57). Discussion and conclusions This represents the first published DCE in the health field examining preferences amongst an Aboriginal population. The results empirically demonstrate the value of the culturally-specific element of a program has to this cohort and the potential that stated-preference methods can have in incorporating the preferences of Aboriginal Australians and valuing cultural components of health services. Note on terminology As the majority of the NSW Aboriginal and Torres Strait Islander population is Aboriginal (97.2%), this population will be referred to as ‘Aboriginal’ in this manuscript.

Where to from here? A quality improvement project investigating burns treatment and rehabilitation practices in India

ObjectiveTo describe the capacity of the Indian healthcare system in providing appropriate and effective burns treatment and rehabilitation services.ResultsHealth professionals involved in burns treatment or rehabilitation at seven hospitals from four states in India were invited to participate in consultative meetings. Existing treatment and rehabilitation strategies, barriers and enablers to patient flow across the continuum of care and details on inpatient and outpatient rehabilitation were discussed during the meetings. Seventeen health professionals from various clinical backgrounds were involved in the consultation process. Key themes highlighted (a) a lack of awareness on burn first aid at the community level, (b) a lack of human resource to treat burn injuries in hospital settings, (c) a gap in burn care training for medical staff, (d) poor hospital infrastructure and (e) a variation in treatment practices and rehabilitation services available between hospitals. A number of opportunities exist to improve burns treatment and rehabilitation in India. Improvements would most effectively be achieved through promoting multidisciplinary care across a number of facilities and service providers. Further research is required to develop context-specific burn care models, determining how these can be integrated into the Indian healthcare system.

First Nation Elders’ perspectives on healthy ageing in NSW, Australia

Objectives: Healthy ageing has been unattainable for many of Australia’s First Nation people, driven by an earlier onset of chronic disease when compared to the general Australian population. Our objective was to examine the perspectives of Australian First Nation people about healthy ageing.

The impact and understanding of childhood drowning by a community in West Bengal, India, and the suggested preventive measures

Our aim was to improve our understanding of the contextual factors contributing to child drowning in rural West Bengal, India.

PA 15-4-1813 Evaluation of a culturally appropriate fall prevention program for older aboriginal people

Fall-related injury amongst older Aboriginal people is a growing health issue yet our recent audit of services identified few Aboriginal-specific fall prevention programs. Informed by stakeholder interviews and Yarning Circles with over 70 older Aboriginal people, a fall prevention program was developed in partnership with Aboriginal community groups. The aim of this study was to evaluate a culturally appropriate fall prevention program for older Aboriginal people. The Ironbark Program is an on-going, weekly, group-based, strength and balance exercise class with an education component held within Yarning Circles. The program was delivered in 6 communities in NSW over a 6 month period from June 2015. A mixed methods approach was used for evaluation; measures of strength and balance were collected to measure changes in physical outcomes, and participants completed questionnaires and interviews to assess program acceptability. Ninety-eight participants (mean age=64, 71% women) registered for the program; 77 (85%) completed baseline and follow-up measurements. Positive ongoing feedback was received, and attendance was good. On average across all sites, there was significant improvement in participant leg strength (time to complete 5 repetition sit-to-stand: 14 s to 11 s, p<0.01), balance (timed single-leg stance: 5.6 s to 7.8 s, p<0.01) and gait speed (timed 4 meter walk: 0.51 m/s to 0.94 m/s, p<0.01), and a significant decrease in BMI (p<0.01). Participants reported both the exercise and yarning components of the program were enjoyable and valuable. The Ironbark program was effective in improving fall-related measures; funding has now been received for a large scale cluster randomized trial to test its effectiveness in preventing falls. Collaboration between Aboriginal community leaders, Aboriginal health and community service providers facilitated development of a unique, culturally appropriate program that addressed a variety of health, social and cultural needs, translating knowledge into action for positive change.

Rehabilitation practices for burn survivors in low and middle income countries: A literature review

OBJECTIVE To systematically review the delivery and effectiveness of rehabilitation for burn survivors in low and middle income countries (LMIC). METHODS We systematically searched the literature through 11 electronic databases and the reference lists of relevant studies. Studies were suitable for inclusion if they were primary research with a focus on burns rehabilitation in LMIC settings describing either service delivery or treatment effectiveness. No time, design or other limitations were applied, except English language. RESULTS Of 226 studies identified, 17 were included in the final review, including 7 from India. The results were summarised in a narrative synthesis as the studies had substantial heterogeneity and small sample sizes, with many relying on retrospective data from non-representative samples with no control groups. Most studies (12) described service delivery and 5 examined the effectiveness of different types of rehabilitation. Multiple studies stressed the need for rehabilitation and multidisciplinary teams for burns management. CONCLUSIONS The published research on burns rehabilitation is very limited and little is known about current practices in LMIC settings. In order to inform policy and service delivery, the effectiveness, feasibility and sustainability of current services needs to be investigated.