Hal Kendig

The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial.

Objectives: To test whether Stepping On, a multifaceted community-based program using a small-group learning environment, is effective in reducing falls in at-risk people living at home. Design: A randomized trial with subjects followed for 14 months. Setting: The interventions were conducted in community venues, with a follow-up home visit. Participants: Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling. Intervention: The Stepping On program aims to improve fall self-efficacy, encourage behavioral change, and reduce falls. Key aspects of the program are improving lower-limb balance and strength, improving home and community environmental and behavioral safety, encouraging regular visual screening, making adaptations to low vision, and encouraging medication review. Two-hour sessions were conducted weekly for 7 weeks, with a follow-up occupational therapy home visit. Measurements: The primary outcome measure was falls, ascertained using a monthly calendar mailed by each participant. Results: The intervention group experienced a 31% reduction in falls (relative risk (RR)=0.69, 95% confidence interval (CI)=0.50–0.96; P=.025). This was a clinically meaningful result demonstrating that the Stepping On program was effective for community-residing elderly people. Secondary analysis of subgroups showed that it was particularly effective for men (n=80; RR=0.32, 95% CI=0.17–0.59). Conclusion: The results of this study renew attention to the idea that cognitive-behavioral learning in a small-group environment can reduce falls. Stepping On offers a successful fall-prevention option.Objectives: To test whether Stepping On, a multifaceted community‐based program using a small‐group learning environment, is effective in reducing falls in at‐risk people living at home.

Perceptions and consequences of ageism: views of older people

This qualitative study examines meanings and experiences of ageism for older Australians. While the concept is widely applied in academic social analysis, the term is not understood or used by many of the informants. They talk freely, however, about negative experiences in ‘being seen as old’ and ‘being treated as old’. Active ageing is viewed as a positive way of presenting and interpreting oneself as separate from the ‘old’ group. Informants recognise that older people as a group experience negative treatment in terms of poor access to transport and housing, low incomes, forced retirement and inadequate nursing home care. While few have experienced overt or brutal ageism, interaction in everyday life involves some negative treatment, occasional positive ‘sageism’, and others ‘keeping watch’ for ones vulnerabilities. Health professionals are a major source of ageist treatment. Some older people limit their lives by accommodating ageism, while others actively negotiate new images of ageing for themselves and those who will be old in the future.

Housing Careers, Life Cycle and Residential Mobility: Implications for the Housing Market

The concept of a housing career provides a useful way of integrating the residential mobility and filtering literatures in understanding the operation of the housing market. Using data from a survey in Adelaide, the paper examines these careers in terms of moves to and from both rental accommodation and home ownership. It shows how the progression of households through the stock is influenced by the circumstances that prompt moves, economic resources, and stage in the family life cycle. The results suggest that acceleration and postponement of advancement along housing careers provide the principal mechanisms by which household demand adjusts to available housing supply over the short term.

Predisposing factors for occasional and multiple falls in older Australians who live at home

This study, which was part of a larger study on the Health Status of Older People conducted in Melbourne, Australia, aimed to identify factors that discriminate between multiple and occasional falls amongst older people living at home. It used a survey of 1000 Australians aged 65 years and over. Subjects were classified as multiple fallers (two or more falls in the past year), occasional fallers (one fall in the past year), or non-fallers. Twenty-nine percent of older people who lived at home reported falling once or more in the previous 12 months. Nearly 20% of older people fell once in the previous 12 months and just under 10% fell more than once. Occasional fallers were more likely to be women (OR 1.75, 95% CI 1.26 to 2.45), to have reported back pain (OR 1.54, 95% CI 1.10 to 2.16) and were nearly twice as likely to have more than three medical conditions compared to non-fallers (OR 1.88, 95% CI 1.22 to 2.90). Multiple fallers were also more likely to be women (OR 1.61, 95% CI 1.03 to 2.51). More multiple fallers (17%) than occasional fallers (9%) reported being very afraid of falling. Intervention strategies should take into account these differing predisposing factors for multiple and occasional falls.

Impacts of illness and disability on the well- being of older people

This study examined ways in which aspects of activity may mediate relationships between physical illness and well-being among older people. Data were from the Health Status of Older People survey of 1000 people aged 65 and over who lived in the community in Melbourne, Australia. After controlling for gender, marital status, and perceived social support, multivariate analyses showed that the major impacts of illness and pain were through their effects on activity limitations, which in turn were related to lowered well-being. Limitations with instrumental activities were associated most with lower positive affect, while perceived activity limitations due to major illness had more impact on increased negative affect and depressive symptoms. However, most older people with major illness still scored highly on well-being, and there was individual variability in well-being. Research on the impacts of illness needs to take more account of impacts on daily living and differences in individual interpretation of illness and disability. Health promotion and treatment can enhance the well-being of older people by maintaining and regaining independence and activity when individuals experience major illness.

Health of Aging Parents and Childless Individuals

This article reviews and presents research findings on the relationships between parenthood and health over the life span. Existing research shows lacunae. The links between reproductive behavior and longevity generally focus on family size rather than contrasting parents and nonparents. Studies of marital status differentials in survival generally confound the effects of parenthood and marital status. Studies of the effects of multiple roles (combining parenthood, marriage, and employment) have the drawback that parenthood is equated with currently having children in the home. The authors provide new evidence on the health of people who have reached old age, contrasting those with and without children, in an attempt to tease out the effects of parenthood, marital status, and gender. Data from Australia, Finland, and the Netherlands are used. Insofar as parenthood effects are found, they pertain to health behaviors (smoking, alcohol consumption, and physical exercise), providing evidence for the social control influences of parenthood.

The health impact of a hearing disability on older people in Australia.

Objectives: A series of studies has proposed that hearing loss has adverse effects for other aspects of health. This article examines the health effects associated with self-reported hearing disability on older people. Methods: The study utilized the 2003 Australian Survey of Disability, Ageing, and Carers (n = 43,233), a weighted population-based survey providing data on self-reported disability and quality of life, to examine hearing disability among older Australians (55 years plus). Results: Of the estimated 654,113 people reporting hearing disability, 71% experienced limited communication and 60% used hearing aids. Compared with population norms, hearing disability at all levels was associated with poorer physical and mental health scores on the SF-12 measure, especially for people with severe or profound hearing loss, thus suggesting a threshold effect at advanced levels of disability. Discussion: Data support emerging literature suggesting a causal relationship between hearing disability and quality of life. Prospective studies to further examine this relationship are indicated.

Foot and leg problems are important determinants of functional status in community dwelling older people.

Purpose. To determine whether foot and leg problems are independently associated with functional status in a community sample of older people after adjusting for the influence of socio-demographic, physical and medical factors. Method. Data were analysed from the Health Status of Older People project, a population-based study involving a random sample of 1000 community-dwelling people aged 65 – 94 years (533 females, 467 males, mean age 73.4 years ± 5.87). A structured interview and brief physical examination were used to investigate the associations between self-reported foot and leg problems and functional status. Functional status was assessed using: (i) timed ‘Up & Go’ test, (ii) self-reported difficulty climbing stairs, (iii) self-reported difficulty walking one kilometer, (iv) self-reported difficulty performing instrumental activities of daily living (IADLs), and (v) self-reported history of one or more falls in the previous 12 months. These associations were then explored after adjusting for socio-demographic, physical and medical factors. Results. Thirty-six percent of the sample reported having foot or leg problems. Univariate analyses revealed that people with foot and leg problems were significantly more likely to exhibit poorer functional status in all parameters measured. After adjusting for socio-demographic, physical and medical factors, foot and leg problems remained significantly associated with impaired timed ‘Up & Go’ performance (OR = 2.15, 95%CI 1.55 – 2.97), difficulty climbing stairs (OR = 3.33, 95%CI 1.98 – 5.61), difficulty walking one kilometer (OR = 3.13, 95%CI 2.09 – 4.69), and history of falling (OR = 1.73, 95%CI 1.26 – 2.37). Conclusions. Foot and leg problems are reported by one in three community-dwelling people aged 65 years and older. Independent of the influence of age, gender, common medical conditions and other socio-demographic factors, foot and leg problems have a significant impact on the ability to perform functional tasks integral to independent living.

To Continue, Modify or Relinquish Driving : Findings from a Longitudinal Study of Healthy Ageing

Background: The number and proportion of drivers among people entering later life continues to rise. More information on patterns of driving for older adults is required to improve service provision and traffic planning. Objectives: To map the changes in driving status for a sample of drivers aged 65 years or older over the period 1994–2000, and to identify factors associated with older people continuing, modifying or relinquishing their status as drivers. Methods: The 752 participants were drawn from the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA) program, a longitudinal study of people aged 65 years and older living in the community. Participants were interviewed or contacted for follow-up in 1994, 1996, 1998 and 2000 on a range of topics including their health, functional independence and driving status. Results: Although the number of recent drivers was smaller as participants died or were admitted to nursing homes over the 6-year data collection period, relatively few participants relinquished driving while remaining in the community. Many drivers reported modifying their driving habits over time, including decisions to restrict their driving to their local area during daylight only. Relationships were explored between driving status and the key variables of age, gender, marital status, instrumental activities of daily living (IADL) independence and self-rated measures of income, health, eyesight and hearing. Multivariate analyses indicated that drivers were more likely to modify their driving habits if they were older, dependent in IADL, and rated their eyesight as poor. Similar factors predicted relinquishing driving, but in addition, women were three times more likely to relinquish driving than men (even when health and disability were taken into account) and people who rated their incomes as ‘comfortable’ were more likely to relinquish driving than those with lower incomes. Conclusions: This study confirmed previous evidence that older drivers self-regulate by modifying their driving behavior as they age. However, since few drivers voluntarily relinquish driving, further research is required to identify ways of supporting older drivers to continue to drive safely.

Cohort profile: The Dynamic Analyses to Optimize Ageing (DYNOPTA) project

National Health and Medical Research Council (410215); NHMRC Fellowships (#366756 to K.J.A. and #316970 to P.B.)