Margaret A. Steinberg

A sustainable programme to prevent falls and near falls in community dwelling older people: results of a randomised trial

STUDY OBJECTIVE In the causative mechanism of falls among older community dwellers, slips and trips have been found to be significant precursors. The purpose of the two year trial was to assess the effectiveness of multi-component interventions targeting major risk factors for falls in reducing the incidence of slips, trips and falls among the well, older community. DESIGN Four groups with approximately equal numbers of participants were randomly allocated to interventions. The prevention strategies included education and awareness raising of falls risk factors, exercise sessions to improve strength and balance, home safety advice to modify environmental hazards, and medical assessment to optimise health. The interventions combined the strategies in an add on approach. The first intervention group receiving the information session only was regarded as the control. The outcome of interest was the occurrence of a slip, trip or fall, monitored prospectively using a daily calendar diary. PARTICIPANTS AND SETTING Two hundred and fifty two members of the National Seniors Association in the Brisbane district agreed to participate. National Seniors clubs provide a forum for active, community dwelling Australians aged 50 and over to participate in policy, personal development and recreation. MAIN RESULTS Using Coxs proportional hazards regression model, adjusted hazard ratios comparing intervention groups with the control ranged from 0.35 (95% CI 0.17, 0.73) to 0.48 (0.25, 0.91) for slips; 0.29 (0.16, 0.51) to 0.45 (0.27, 0.74) for trips; and 0.60 (0.36, 1.01) to 0.82 (0.51, 1.31) for falls. While calendar monitoring recorded outcome, it was also assessed as a prevention strategy by comparing the intervention groups with a hypothetical non-intervened group. At one year after intervention, reductions in the probability of slips, trips and falls (61(95%CI 54, 66)%; 56 (49, 63)%; 29 (22, 36)% respectively) were demonstrated. CONCLUSIONS This study makes an important contribution to the priority community health issue of falls prevention by showing that effective, sustainable, low cost programmes can be introduced through community-based organisations to reduce the incidence of slips, trips and falls in well, older people.

Home safety assessment in the prevention of falls among older people.

Objective:Home safety assessment was examined as part of a randomised trial of falls prevention interventions among older community dwellers.

Mature Age Employment: Recent Developments in Public Policy in Australia and the UK

Objective: To examine recent policy developments in mature age employment in Australia and the UK. Method: Recent data and policy statements in the UK and Australia, supplemented by the findings from interviews undertaken with government and industry leaders in the UK in October/November 1998, reflecting similar work in Australia, were analysed and compared.

A SIMPLE METHOD FOR EXAMINING POST-ROTATORY NYSTAGMUS

This paper is the report of a preliminary study undertaken to examine how normal five-year-old children respond to spinning with particular reference to post-rotatory nystagmus. A simple method is described.

Does being against euthanasia legislation equate to being anti-euthanasia?

This study investigated issues raised in qualitative data from our previous studies of health professionals and community members, which suggested that being opposed to euthanasia legislation did not necessarily equate to being anti‐euthanasia per se. A postal survey of 1002 medical practitioners, 1000 nurses and 1200 community members was undertaken. In addition to a direct question on changing the law to allow active voluntary euthanasia (AVE), four statements assessed attitudes to euthanasia with or without a change in legislation. Responses were received from 405 doctors (43%), 429 nurses (45%) and 405 community members (38%). Compared with previous studies there was a slight increase in support for a change in the law from medical practitioners, a slight decrease in support from community members and almost no change among nurses. Different interpretations of the results of the four attitude questions are possible, depending on the perspective of the interpreter.

A message to special education from mothers of disabled children

Abstract A conference, organised by the National Womens Advisory Council for women who had given birth to a disabled child, was attended by 150 participants from throughout Australia. The major issues and recommendations relevant to special education are presented in this paper. Issues included the need for accurate and honest information, particularly at birth or diagnosis, as well as the importance of sensitivity, and of skill in counselling, in all professional and community workers at all times. More comprehensive provisions in pre‐school, school and continuing educational services were requested and Governments were asked to look carefully at many problem areas, such as adequate financial support, accessible and cheap transport and the need to establish a ministry for the disabled. Everyone concerned with educational services should become advocates for the disabled and their families, particularly to improve community attitudes towards and services for the disabled.

ASPECTS OF PHYSIOTHERAPY SCREENING AND ITS RELEVANCE IN PRE-SCHOOL AND SPECIAL EDUCATION1

A research project undertaken within the Department of Physiotherapy, University of Queensland (Steinberg, 1973) investigated the feasibility of establishing a pilot clinic for the study and treatment of very young children with minimal cerebral dysfunction. A neurodevelopmental approach to assessment and treatment was emphasised.

Parental Concerns and Priorities in the Education of Disabled Students.

Abstract During a conference organized as part of I.Y.D.P., parents of the disabled from throughout Queensland attempted to identify the primary needs they experienced in coping with a disabled child in the family. Recommendations were made concerning the provision of services which would help to alleviate these needs. Issues and recommendations concerning education, including educational rights, legislative and financial considerations, teacher education, and the adequacy of educational services, are discussed in this paper. The dearth of a range of appropriate post‐school options was of crucial import; provision of continuing education services for disabled school leavers, including minimally handicapped students integrated into regular classes, is seen as an urgent requirement. Co‐operative planning and service provision should be given priority status by special education authorities, tertiary institutions and employment departments and agencies.

THE TEAM APPROACH TO THE DELIVERY OF SUPPORT SERVICES TO TEACHERS IN EDUCATIONAL SETTINGS

As educational services accept responsibility for the provision of appropriate education for a wider range of disabled children, therapists and other support personnel will increasingly be called upon to work in an educational model. Team approaches - multidisciplinary, interdisciplinary or transdisciplinary - provide effective ways of organising staff to service the educational system. The therapists and other support professionals within the teams may work in at least three ways: traditionally; as a consultant; or as a resource person/information source. The advantages and disadvantages of each role are discussed.

PHYSIOTHERAPY ASPECTS OF OVERSEAS DEVELOPMENTS FOR CHILDREN WITH DEVELOPMENTAL DISABILITIES1

This paper describes the findings of a study tour investigating the provision of physiotherapy services for children with developmental disabilities. It was found that early intervention programmes were paramount, particularly in the U.S.A. Major trends, such as the use of transdisciplinary approaches, as well as the specific techniques evolving from them, including task analysis and the use of written behavioural objectives, should be noted and utilised by physiotherapists. Efforts to improve the lifestyle of the children and of their families were studied, including successful family support services in Norway. Finally, several recommendations relating to early intervention and to preschool and school services have been suggested.