Philippa Williams

Physiological factors associated with falls in older community-dwelling women

OBJECTIVE: To determine the prevalence of impaired vision, peripheral sensation, lower limb muscle strength, reaction time, and balance in a large community‐dwelling population of women aged 65 years and over, and to determine whether impaired performances in these tests are associated with falls.

The Effect of a 12‐Month Exercise Trial on Balance, Strength, and Falls in Older Women: A Randomized Controlled Trial

OBJECTIVE: To determine whether a 12‐month program of regular exercise can improve balance, reaction time, neuromuscular control, and muscle strength and reduce the rate of falling in older women.

The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial.

Objectives: To determine whether a 12‐month program of group exercise can improve physical functioning and reduce the rate of falling in frail older people.

Effects of group exercise on cognitive functioning and mood in older women

Abstract: A randomised controlled trial was conducted to determine whether a 12–month program of group exercise had beneficial effects on physiological and cognitive functioning and mood in 187 older community–dwelling women. The exercisers (n= 94) and controls (n= 93) were well matched in terms of the test measures and a number of health and life–style assessments. The mean number of classes attended by the 71 exercise subjects who completed the program was 59.0 (range 26 to 82). At the end of the trial, the exercisers showed significant improvements in reaction time, strength, memory span and measures of wellbeing when compared with the controls. There was also an indication that anxiety had been reduced in the exercisers. Within the exercise group, improvements in memory span were associated with concomitant improvements in both reaction time and muscle strength. Also, within this group, initial mood measures were significantly inversely associated with improvements at retest, which suggests that the program may have normalised mood states in subjects who had high initial depression, anxiety and stress levels, rather than inducing improvements in all subjects. These findings suggest that group exercise has beneficial effects on physiological and cognitive functioning and wellbeing in older people.

The effects of a community exercise program on fracture risk factors in older women.

One hundred and seventy-nine women aged 60–85 years (mean age 71.6 years, SD 5.3 years) were randomly recruited from the community to participate in a 12-month randomized controlled trial to determine whether a program of twice-weekly structured exercise has beneficial effects on three factors associated with osteoporotic fractures: quadriceps strength, postural sway and bone density. At initial testing, there were no significant differences in the strength, sway and bone density measures (assessed at the hip and lumbar spine) between the exerciser and control groups. The exercise classes included strengthening, coordination and balance exercises, and approximately 35 min of each class comprised weight-bearing exercise. The mean number of classes attended for the 68 exercisers who completed the program was 59.8 of the 82 classes (72.9%). At the completion of the trial, the intervention group showed significant improvements in quadriceps strength and sway but not bone mineral density when compared with the control group. Indices of fracture risk, indicated by (i) the sum of standard score results and (ii) the sum of quartile grades of the femoral neck bone density, sway and strength measures, decreased significantly in the exercisers at the end of the trial compared with the controls. In conclusion, the program of general aerobic exercise may have reduced overall fracture risk, even though it did not significantly increase bone density. Further long-term studies are required that include acceptable weight-loaded exercises to determine optimal programs for reducing fracture risk factors by improving bone density as well as strength and balance.

Building ‘community’ for different stages of life: physical and social infrastructure in master planned communities

As cities around the world struggle to cope with increasing populations, major new master planned housing developments are being undertaken to meet the demand for housing. Such urban developments are influencing workforce, household, and community relations, which in turn drive health and well-being outcomes, and affect social capital and labour market participation. This paper reports findings from the first phase of data collection for the Work, Home and Community Project. Fourteen focus groups were conducted with 68 men and women who live and/or work at newly developed master planned communities in South Australia and Victoria. Findings indicate that familiarity, availability, and the enabling of social bridges contribute to the development of community and social capital in these residential areas. For individuals at different stages of life these factors were facilitated or inhibited by specific physical and social infrastructures in the residential area and the workplace. At a time when concerns are being raised about the ability of people to combine work, home, and community these findings shed some light on the physical and social infrastructures that can enable or constrain the building of healthy communities.

Physiologic, health and lifestyle factors associated with femoral neck bone density in older women

Three hundred eleven women aged between 60 and 91 years (mean age 72.2) who were randomly recruited from the community underwent bone density assessments of the femoral neck. Two complementary multivariate techniques were used to assess the relationships between femoral neck bone density and a range of anthropometric, health, and lifestyle measures. Stepwise multiple linear regression analysis revealed age, weight, height, quadriceps strength, and lifelong smoking to be variables that independently and significantly explained part of the variance in femoral neck bone density within the group. Multiple logistic regression revealed that after adjusting for established predictors of bone mineral density, age, height, and weight, reduced quadriceps strength, lifelong smoking, and little childhood activity were significantly associated with low bone density (< 0.70 g/cm2), whereas superior quadriceps strength, nonsmoking, and high levels of current physical activity were significantly associated with high bone density (> 0.84 g/cm2). In contrast, current calcium intake was not significantly associated with bone density. The study findings highlight possible public health initiatives for minimizing age-related femoral neck bone loss in older women.

Effect of water exercise on balance and related factors in older people

Fifteen subjects enrolled to take part in a water exercise programme (mean age = 69.7 years) and 13 control subjects (mean age 72.6 years) underwent assessments of quadriceps and ankle dorsiflexion strength, reaction time, neuromuscular control, body sway, flexibility and joint pain. All subjects were then retested for the same measures after completion of the nine-week programme. The experimental subjects showed improved quadriceps strength and reduced body sway when compared with the control group. There was also a trend towards increased flexibility, improved reaction times and reduced joint pain in the experimental group.

Sleep Quality and Falls in Older People Living in Self- and Assisted-Care Villages

Background: Older people often experience unusual sleeping patterns and a poor quality of night-time sleep. Insufficient sleep has potential effects on cognition and physical functioning and therefore may increase the incidence of falls in older people. Objectives: To determine the extent to which a range of physiological, psychological and health-related factors predict night-time sleep quality of older people living in self-care and assisted-care, and whether poor sleep quality is a risk factor for falls. Methods: 572 people, 81 men and 491 women (mean age 79.7 years, SD 6.4), recruited from self-care retirement villages and assisted-care hostels participated in the cross-sectional study with a subgroup of 169 followed up for falls for 1 year. The main outcome measures were sleep quality and prospective falls. Results: Approximately half of the sample rated their sleep quality as poor or fair. Many measures of health, medication use and mood were significantly associated with ratings of poor night-time sleep quality. Multiple regression analyses revealed poor circulation, use of psychotropic and diuretic medications, negative affect, pain, not having a friend in the village, lower fitness levels and daytime napping were significant and independent predictors of night-time sleep quality in both residential care groups. Napping daily was reported by 28% of the self-care group and 37% of the assisted-care group. Residents across both care levels who napped >30 min during the day, or reported <6 h sleep at night, were three times more likely to suffer multiple falls in the follow-up year when adjusting for health, medication and activity measures. Conclusions: Sleep disturbances were common and associated with a variety of psychological, physiological, health and lifestyle factors. Long daytime naps and short night-time sleep periods were associated with an increased risk of falls.

Conceptualizing Work, Family and Community: A Socio‐Ecological Systems Model, Taking Account of Power, Time, Space and Life Stage

A large body of empirical research now exists about ‘work and family’, much of it in agreement on critical issues. However, it is under‐conceptualized, it over‐researches professional and managerial workers and it under‐attends the larger terrain of work, family and community. This contribution argues the case for a stronger analytical framework around work, family and community and the ways in which they intersect, drawing on concepts commonly used in the field of employment relations. The article utilizes a body of empirical research about work, family and community in Australia to develop Voydanoffs ecological systems model of work, home and community, arguing that it is vital to unpack the ‘black box’ of ‘work’ in a multi‐layered way, to give appropriate weight to various sources of power, and to avoid an individualistic approach to the reconciliation of work, home and community life by locating analysis in a larger social and political context. The contribution proposes a ‘socio‐ecological systems’ model of work, home and community that delineates the four issues of power, time, space and life stage.