Lesley M. Day

Randomised factorial trial of falls prevention among older people living in their own homes

Abstract Objective: To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people. Design: A randomised controlled trial with a full factorial design. Setting: Urban community in Melbourne, Australia. Participants: 1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half lived alone. Interventions: Three interventions (group based exercise, home hazard management, and vision improvement) delivered to eight groups defined by the presence or absence of each intervention. Main outcome measure: Time to first fall ascertained by an 18 month falls calendar and analysed with survival analysis techniques. Changes to targeted risk factors were assessed by using measures of quadriceps strength, balance, vision, and number of hazards in the home. Results: The rate ratio for exercise was 0.82 (95% confidence interval 0.70 to 0.97, P=0.02), and a significant effect (P<0.05) was observed for the combinations of interventions that involved exercise. Balance measures improved significantly among the exercise group. Neither home hazard management nor treatment of poor vision showed a significant effect. The strongest effect was observed for all three interventions combined (rate ratio 0.67 (0.51 to 0.88, P=0.004)), producing an estimated 14.0% reduction in the annual fall rate. The number of people needed to be treated to prevent one fall a year ranged from 32 for home hazard management to 7 for all three interventions combined. Conclusions: Group based exercise was the most potent single intervention tested, and the reduction in falls among this group seems to have been associated with improved balance. Falls were further reduced by the addition of home hazard management or reduced vision management, or both of these. Cost effectiveness is yet to be examined. These findings are most applicable to Australian born adults aged 70–84 years living at home who rate their health as good.

The reliability and predictive accuracy of the falls risk for older people in the community assessment (FROP-Com) tool

BACKGROUND the Falls Risk for Older People in the Community assessment (FROP-Com) tool was designed for use in targeted multi-factorial falls prevention programmes. It fills the gap between the short screening tools and the longer assessment tools, e.g. the physiological profile assessment (PPA). The aim of this study was to determine the reliability and predictive accuracy of the FROP-Com. METHODS the intra-rater and inter-rater reliability studies were performed with 20 participants each. The prospective study was performed with 344 community-dwelling older people presenting to an emergency department after a fall and being discharged directly home. Following a home-based assessment, including the FROP-Com, Timed Up and Go (TUG) and functional Reach (FR), participants were monitored for falls for 12 months. RESULTS the intra-class correlation coefficient (ICC) for intra-rater reliability and inter-rater reliability for the FROP-Com was 0.93 (95% CI 0.84-0.97) and 0.81 (95% CI 0.59-0.92) respectively. The AUC for the FROP-Com was 0.68 (95% CI 0.63-0.74). At the cut-off 18/19, sensitivity was 71.3% (95% CI 64.4-78.3) and specificity was 56.1% (95% CI 48.9-63.4). The AUC for the TUG was 0.63 (95% CI 0.57-0.69) and for the FR was 0.60 (95% CI 0.54-0.66). CONCLUSION the FROP-Com demonstrated good reliability and a moderate capacity to predict falls.

Development of the Falls Risk for Older People in the Community (FROP-Com) screening tool*

BACKGROUND the aim of this study was to develop a brief screening tool for use in the emergency department (ED), to identify people who require further assessment and management. METHODS this prospective study included 344 community-dwelling older people presenting to an ED after a fall. After direct discharge participants had a home-based assessment performed that included the Falls Risk for Older People in the Community (FROP-Com), a comprehensive, yet simple, multifactorial falls risk assessment tool. They were then monitored for falls for 12 months. The items from the FROP-Com assessment tool predictive of falls in a multifactorial logistic regression were used to develop the FROP-Com screen. RESULTS the items significantly predictive of falls and combined to form the FROP-Com screen were: falls in the previous 12 months, observation of the persons balance and the need for assistance to perform domestic activities of daily living. At the cut-off with the highest Youden index sensitivity was 67.1% (95% CI 59.9-74.3) and specificity was 66.7% (95% CI 59.8-73.6). CONCLUSION the FROP-Com screen has a relatively good capacity to predict falls. It can be used in time-limited situations to classify those at high risk of falls who require more detailed assessment and management.

Childhood poisoning: Access and prevention

Objectives: To investigate the circumstances and means of access to six poisoning agents by children under 5 years of age and to make recommendations for countermeasures and strategies for implementation.

Risk factors for work-related injury among male farmers

Objective: To identify risk factors for serious farm work related injury among men. Methods: A case–control study was conducted in Victoria, Australia. Eligible cases (n = 252) were males aged ⩾16 years injured while working on a farm and scoring 2 or higher on the Abbreviated Injury Scale. Non-fatal injury cases were identified on presentation to hospital. Fatal cases (next of kin) were recruited via the Coroner’s Office. Two age-matched controls per case were recruited by telephone. Data were collected with a structured telephone questionnaire. Logistic regression was used to compare risk factors between cases and controls, adjusting for design factors and average weekly hours worked. Results: The most common external causes of injury were machinery (26%), falls (19%), transport (18%), animals (17%) and being struck by an object (11%). Increased injury risk was observed for being an employee/contractor (odds ratio 1.8, 95% CI 1.2 to 2.7), not having attended farm training courses (1.5, 95% CI 1.0 to 2.1), absence of roll-over protective structures on all/almost all tractors (2.5, 95% CI 1.7 to 3.8), absence of personal protective equipment for chemical use (4.7, 95% CI 1.6 to 13.9) and a low average annual farm income of AUD

Psychological well-being of Australian veterinarians.

5000 or less (2.7, 95% CI 1.3 to 5.6). Decreased injury risk was observed for several health related characteristics and some farm characteristics. Conclusion: We identified some risk factors possibly relevant to farm injury prevention programs. However, other factors were not associated with farm work injury suggesting these may not be as important as previously hypothesised.

The Saskatchewan Farm Injury Cohort: rationale and methodology.

OBJECTIVE To use established psychological scales to measure levels of distress, anxiety and depression in veterinarians, and compare these levels between different veterinary subgroups and other professional groups. METHODS A cohort of veterinarians was identified through contact with veterinary schools in Australia. Participants completed a self-reporting questionnaire that included queries about general health and demographics, psychological well-being, job-specific perceptions of health, dispositional characteristics and social support. RESULTS Of the 2125 respondents who completed the psychological questionnaire, approximately one-third reported poor psychological health. Increasing age, increasing time in current job, increasing years since graduation and male gender was associated with fewer signs of distress, anxiety and depression. Compared with the general population, veterinarians experienced more negative emotions at work, but were similar to other professional groups. CONCLUSIONS Poor psychological health is common in the profession and professional veterinary bodies may wish to consider providing training in dealing with work-related distress, anxiety and depression.

A protocol for evidence-based targeting and evaluation of statewide strategies for preventing falls among community-dwelling older people in Victoria, Australia

The Saskatchewan Farm Injury Cohort (SFIC) is a major new Canadian study that was developed to evaluate potential causes of injury among farmers and their family members. The cohort involves 2,390 farms and 5,492 farm people being followed over a two-year period. The article describes the rationale and methodology for the baseline and longitudinal components of this study. The SFIC is one of the first studies to apply population health theory to the modeling of risks for injury in a defined Canadian population. In doing so, the relative influence of several potential causes of farm injury, including physical, socioeconomic, and cultural factors, will be estimated. Study findings will inform the content and targeting of injury prevention initiatives specific to the farm occupational environment.

An impact evaluation of a falls prevention program among older people

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.

A Randomized Controlled Trial of a Multifactorial Falls Prevention Intervention for Older Fallers Presenting to Emergency Departments

The aim of this evaluation study was to assess the impact of peer-presented education sessions on the falls-related attitude, knowledge and behaviour of older people. The evaluation was undertaken on the Bellarine Peninsula in Victoria, Australia, and adopted a non-randomised pre-test post-test design. Baseline, 3 and 12 months follow-up data were collected for 107 individuals who attended the education sessions and 116 controls, matched by age range and sex. The groups were not strictly equivalent at baseline, with the intervention group having a greater knowledge about falls and falls prevention. Analyses which controlled for baseline differences showed that those who attended the education sessions maintained a greater knowledge of factors that can prevent falls at 12 months follow-up. The intervention group also made more changes in and around their home to prevent falls by 3 and 12 months follow-up. Younger participants who reported a previous history of falls and having taken action to prevent falls were most likely to take additional action. The results can help target this type of education program and suggest that their major benefit may lie in providing those who voluntarily attend with the impetus to take the most effective preventative action.