Falls Links issue 2 2008fallsnetwork.neura.edu.au/wp-content/uploads/2014/... · St. George Hospital Falls Awareness Day There were many activities conducted to raise awareness about

FALLS LINKS Volume 3 Issue 2 2008

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FALLS LINKS

April has seen a flurry of activity and colour with April Falls Day and other Falls Prevention activities happening throughout the State. A report on some of these activities is on pages 2-6. We are thankful to the Prevention of Falls Network Europe (ProFaNE) for per-mission to reprint an opinion piece by Dr David Oliver on ‘Falls risk assessment tools: False Friends?’, on pages 7-8. The 2008 Falls Prevention Network Meeting is on Wednesday June 4th at The Gallery Function Centre, University of Technology Sydney, a flyer on the meeting is on page 13. Registration forms are available on the website at

http://www.powmri.edu.au/fallsnetwork

WELCOME

Volume 3 issue 2

2008

April Falls Day 2

David Oliver Article 7

Abstracts & Websites 9

2008 Network Meeting 14

ANZFPS Conference 15

Inside this issue:

A/Prof Susan Kurrle (Clinical Director and Senior Staff Specialist, Hornsby Kuring-gai Hospital), Lorraine Lovitt, (Leader, NSW Falls Prevention Program, Clinical Excellence Commission) Margaret Armstrong (Area Falls Prevention Coordinator, NSCCH), Matthew Daly (Chief Executive, NSCCH), Prof Clifford Hughes (CEO, Clinical Excellence Commission).

April Falls Day at Ryde Hospital


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Falls Prevention is Everyone’s Business Northern Sydney Central Coast Health (NSCCH) ‘April Falls Day’ 2008

2008 was the third year that NSCCH celebrated April Falls Day in our hospitals and April Falls Month for community service providers. The purpose was to raise staff awareness of the importance of preventing falls. April Falls Day 2008 was also chosen to launch the new NSCCH Falls Prevention and Management Policy. April Falls Day at each of our 12 public hospitals there were or-ange themed displays where orange clad staff distributed orange goodies – muffins,

sweets, pens, mouse mats, balloons etc, and manned information stalls for staff to learn about what is being done to prevent falls with our new falls policy, and meet their local falls prevention champions. Posters, quizzes and prizes all helped to make the day highly successful. Educa-tion sessions on falls prevention for all staff will be run over April. In-patients on the day received an orange meal placemat containing falls facts and an orange ‘goody bag’ filled with falls prevention information and brochures.

Ryde Hospital was chosen to launch both April Falls Day and the new NSCCH policy and was attended by guests from the Clinical Excellence Commission, POWMRI and those from within our own AHS. Speakers included, NSCCH CE Matthew Daly, Prof Clifford Hughes (CEO Clinical Excellence Commis-sion), Dr Philip Hoyle (NSCCH Director Clinical Governance) , Lorraine Lovitt (Leader, NSW Falls Prevention Program CEC), Assoc Prof. Susan Kurrle (Clinical Director and Senior Staff Specialist, Hornsby Kurin-gai Hospital) and Margaret Arm-strong (NSCCH coordinator, NSW Falls Policy).

Sally Castell and her ‘Motivators’ provided a demonstration of gentle exercise and Tai Chi. Other private Northern Sydney hospitals such as Sydney Adventist Hospital also had April Falls Day to link in with NSCCH activities. There will be also be two community falls seminars in April as part of April Falls Month, at Erina and Ryde Eastwood Leagues Club for community service providers for older people living in the community.

Margaret Armstrong, NSCCH Coordinator, NSW Falls Policy [email protected]

Sydney Adventist Hospital

Sally Castell’s ‘Motivators’

Northern Beaches Falls Prevention Committee at Manly Hospital

Cheryl Baldwin and the Gosford Hospital display

Kristy Williams & Gillian Murphy , OT

Students working with Margaret Armstrong

Orange meal placemat


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APRIL FALLS DAY AT CULCAIRN Culcairn Health Service is a small facility in Culcairn a town 527km south west of Sydney, situated on the Olympic Highway between Wagga Wagga and Albury with great staff giving all they have to better care for our permanent residents and community members. Launching our first April Falls Day -staff awareness on Tues 1st April, turned out to be a great day with 100% compliance of staff from Environmental, Maintenance, Nursing, Managers, Community Health, Hostel and Office all wearing orange shirts (one wore green pertain-ing to the Greenbox).

DVD, CD-ROM, posters, balloons, Policies, displays on Falls prevention, lollies, drinks and much more all helped in making staff think about Falls Prevention and how it is "Everyone's Business". The feedback from staff was fantastic and they will continue work-ing towards bettering their Knowledge and Awareness. Plans for a "Community Forum/open day" targeting the local community on "how to stay on your feet " is also in the pipeline. Robyn Wood EN- Culcairn Health Service

Robyn Wood and Jenny Wadrop

Staff from all departments

Greenbox resources

Information and orange treats


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Manning Hospitals April Falls Day

Manning Hospital was ablaze in yellow on April Falls Day with a number of displays throughout the hospital. These included a general information display in the main hospital foyer, a Falls Prevention video playing in the Outpatients department and there were displays on each of the floors. There was also a prize winning competition for the best falls prevention display and prizes for answering a Falls Prevention Quiz. The winners were announced at the Falls Prevention Committee Meeting held on the day. There was a yellow morning tea. The staff were wholeheartedly involved in in the day. Stephen F. Reilly, Chairperson , Manning Hospital Falls Prevention Committee

HDU Staff with Display

Level 6 wall display

Katie Mckee (OT student) & Deb Lowe (OT-in Charge) with Hospital Foyer display

Yellow Morning Tea for Staff


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St. George Hospital Falls Awareness Day There were many activities conducted to raise awareness about falls prevention at St. George Hospital on the 1 April 2008. Staff were encouraged to wear blue and decorate the wards with posters balloons and streamers. Ward 3S won a prize for the most innovative decoration and haemodialysis was highly commended. Ward 7S won the prize for the most improved or decreased falls rate over 2007 and Leisa Johns guessed how many falls were reported at St. George in 2007. Leisa won a jar containing the same number of jelly beans as were reported falls incidents. A table was manned at the front entrance by nursing and allied health staff including health promotion. Advice and literature was provided to staff and visitors. The highlight of the day was a special afternoon tea provided for the volunteer companion observers. The volunteers were thanked by Leanne Mills Director of Nursing and Dr. Martin Mackertich Director of Clinical services.

Kim Brookes , CNC Aged Care, St George Hospital

CEC April Falls Day The Clinical Excellence Commission (CEC) held an April Falls Day on the 29th April, showcasing a number of falls prevention initiatives from across NSW. Presentations included: • Falls Buster Program from the Bourke St Health Service in Goulburn, presented by the John Gale the Man-

ager of Clinical Services and Sandra Bill the Volunteer Co-ordinator. • The Volunteer Physical Activity Network presented by Niccola Follet, the Health Development Program Co-

ordinator for Physical Activity in the Greater Southern Area Health Service. • Stepping On program which included a testimony from a graduate of this program presented by A/Prof Lindy

Clemson, University of Sydney. • Healthy Older Persons Safety (HOPS), this is a Home Hazard information DVD for Community dwelling

older people and was presented by Melinda Dimarco from the Occupational Therapy Department & Prairie-wood Physical Disability Team, SSWAHS, and Nelly Tiga, NUM, Fairfield Aged Day Care.

• CEC Falls Prevention Trigger DVD ‘Preventing falls and Harm from Falls in older people in Hospital’ presented by Ingrid Hutchinson from the CEC.

These presentations will be available soon on the NSW Falls Prevention network website at: http//:www.powmri.edu.au/fallsnetwork

St George Hospital Ward 3S

Sandra Bill & John Gale, Bourke St Health Service

A/Prof Lindy Clemson University of Sydney


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Opinion Piece: Falls Risk Assessment Tools:False Friends? Dr David Oliver

Reprinted with permission from the Prevention of Falls Network Europe (ProFaNE) I have often wondered why practitioners (and nurses in particular) are so obsessed with finding or using falls risk assessment tools. Frankly, I am not sure that most of them are worth the bother. I am writing this piece because I want to make people question their practice. If it provokes strong reactions, I will be delighted. I say this as the author of one (STRATIFY) still widely used in hospitals and as someone who has systematically reviewed risk assessment tools for institutional falls and the various independent validation studies of STRATIFY. Before making my argument, I need to define my terminology. Of course some falls-related tools and scales (e.g. those around fear of falling or confidence) are descriptive rather than predictive, but I don’t want to discuss these here. In my book, there are 3 kinds of tools or assessments which are often referred to as 'risk assessment tools': a) Tools which are in reality checklists of common risk factors or causes – prompting professionals to identify each one and come up with an action plan. (For an example, look no further than the NICE or AGS/BGS guidelines on the elements of post-fall assessment). I would call these 'risk factor checklists'; b) Tools with continuous scoring which predict and the percentage probability of an event and can be used for population modelling. Prime examples are various critical care early warning scores used to identify physiologically deteriorating patients. Also, tools (such as PARR) to identify the likelihood of patients being admitted/readmitted to hospital. With regard to fracture risk, one could argue that the Black Score is an example of this type of tool. But this approach has rarely been used in predicting falls, though the 'Physiological Profile' Assessment of Lord et al. could be argued to be such a tool. I would call these 'falls risk modelling tools'; c) 'Diagnostic'-type tools which aim to categorise patients as being at 'high', 'intermediate' or 'low' probability of an event. Good current examples are diagnostic algorithms for predicting coronary risk or pulmonary embolism. Most falls risk assessment tools (especially for older people in hospitals and care homes, though occasionally for falls assessment in primary care, e.g. FRAT) follow this model and purport to identify and target 'high risk' patients for preventative interventions. It might be that this approach has been simplistic and misguided and that they would have been better designed more like the tools in b). However, it is these tools – those which supposedly identify patients as 'high' or 'low' risk that I want to discuss. I would call these 'risk prediction or stratification tools'. So why am I increasingly sceptical about the utility of such tools? I think we need to start by considering the prop-erties they require to be any use in fall prevention programmes. Essentially, these are: ease of completion, good inter-rater reliability, and good predictive validity in the population or setting (or at least similar ones) in question. Elements of predictive validity include Specificity (True Positive Rate), Sensitivity (True Negative Rate), Negative and Positive Predictive Value (both of which are reliant on the prevalence of falls in that population), Total Predic-tive Accuracy (i.e. discrimination of fallers and non-fallers). Moreover the tool should value add to professional judgement and discrimination. So moving on from this, what are my objections? i) In reality, many of the tools in use are 'home made' and have never been subjected to prospective validation of any kind and even those (e.g. STRATIFY or Morse Falls Scale) which have been validated in several cohorts are simply not good enough on closer scrutiny. Whilst the 'headline' sensitivity, NPV or specificity might be fairly high in some studies, the PPV is often low, meaning that patients will be indiscriminately targeted for intervention. And this is in populations where the tools have been validated – let alone completely different settings (e.g. extrapolat-ing tools from say acute hospitals to long term care). We now have several recent systematic reviews to confirm this view. ii) In primary care, 30% of people over 65 and 50% over 80 fall at least once a year. In nursing homes 50% of resi-dents fall once a year and 40% twice or more. In hospital around 50% of all falls happen in patients who have already fallen once. We have enough difficulty applying evidence-based preventative interventions to those who have already fallen, without also carrying out risk prediction. In reality a 'falls register' in primary care would include most of the practice population over a certain age and in care homes, most of the residents could be considered at


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high risk. Risk assessment therefore seems an unnecessary step. iii) Many of the variables in risk assessment tools change over time (especially in inpatient care settings) yet the tools are often employed as 'one off' assessments. iv) Assessment might focus the minds of staff on the issue of falls but it is not an intervention in its own right, even when there is fairly accurate risk prediction. Unless this triggers action to modify individual falls risk factors or im-prove overall safety, it is pretty useless knowing that someone is a 'high risk' patient. And of course, the small number of risk factors which tend to make up risk prediction tools are not necessarily synonymous with the causes of falls which we need to identify and address to reduce risk. v) Even for a tool that produces continuous modelling, merely knowing who is at highest risk doesn’t tell you who needs intervention. Just as with critical care or risk of re-admission it may be that those at highest risk are beyond help and it is better to focus on those at moderate risk. vi) If what we are about is providing interventions which work in reducing falls rates, then we need to acknowl-edge that many of the better intervention trials in primary care or institutions didn’t employ formal risk stratify- cation at all and they still worked – focusing instead on people who had already fallen or suffered 'near miss' events. In fact, one paper I recently peer reviewed randomised patients to a nurse-led intervention with formal risk scoring versus one simply using nurses’ best judgement. There was no difference in any outcome. vii) Finally, and most importantly, there is a real danger that risk assessment tools give false reassurance to practi-tioners: Either because their predictive validity isn’t good enough or because there is an assumption that once a tool has been imported and is being filled out we can all rest easy that 'something is being done' to prevent falls. Worse still because of the opportunity cost involved in diverting staff time and energy away from other vital as-pects of care into a potentially ineffective form-filling exercise. In answering my own rhetorical question, of course I realise why people are so attached to using tools. Partly it’s embedded in professional culture with a 'tool for everything'. More importantly, staff will often tell me they are useful in 'raising awareness'. But surely we could raise awareness just as well by employing successful, validated falls prevention programmes which will make a meaningful difference. David Oliver This opinion piece can be found at : http://www.profane.eu.org/phpBB2/viewtopic.php?t=330 Dr David Oliver is Senior Lecturer in Elderly Care Medicine at the University of Reading, and Consultant Physician at the Royal Berkshire NHS Foundation Trust, UK. His principal research interests are in the prevention of falls and fractures and in the delivery of health services for older people, and he has published extensively in these areas. He has recently completed a systematic review for the Department of Health in the UK on prevention of falls and injuries in hospitals and Care Home, and another on the use of falls risk assessment tools in institutions. He is the falls-section editor of Age and Ageing, the National Secretary of the British Geriatric Society, a Member of the RSM Gerontology Committee and the BGS Falls and Bone Health Section, and works with the DoH change agent team, the National Patient Safety Association, the NHS Information Authority. He has also advised the Taiwan Government on training of geriatricians, the Australian Government on their falls guidelines, and recently organised the first international conference on institutional fall prevention. He has also acted as a medical expert witness in a number of cases involving accidental falls and is currently reviewing the NHS litigation authority database of claims for falls. The ProFaNE Online Community is an active working group of Health Care Practitioners, Researchers and Public Health Specialists dedicated to the prevention of falls in Europe and beyond. There are a range of resources available on their website at http://www.profane.eu.org/


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EPIDEMIOLOGY AND RISK FACTORS FOR FALLS

Predictors for Occasional and recurrent falls in community-dwelling older people Gaßmann KG, Uppercut R, Freiberger E; for the IZG Study Group Clinic for Geriatric Medicine, Waldkrankenhaus St. Marien, Rathsberger Str. 57, 91054, Erlangen, Germany, [email protected]. Z. Gerontol. Geriatr. 2008 Mar 11 [Epub ahead of print] BACKGROUND : Little is known about the prevalence of falls and the related risk factors in the general popula-tion of community- living older people in Germany. OBJECTIVES : To assess the prevalence and related predictors of different types of falls in a sample of commu-nity-dwelling 65 years and older people in Germany living in a metropolitan area. Study design and setting prospec-tive cohort study in 622 community dwelling people aged >/=65 years. RESULTS : A total of 107 persons (17.2%) reported falling at least once (occasional fallers), while 36 (5.7%) ex-perienced two or more falls (recurrent fallers) in the last 6 months. Main predictors for all fallers were age (OR 1.8; 95% CI 1.1-3.0), being female (OR 1.7; 95% CI 1.1-2.2), living alone (OR 1.9; 95% CI 1.2-2.9), poor health status (OR 3.3; 95% CI 2.1-5.3), varifocals (OR 1.7; 95% CI 1.0-3.1), disturbance of memory (OR 1.7; 95% CI 1.0-3.0), de-pression (OR 4.8; 95% CI 2.5-9.2), sleep disturbances (OR 2.7; 95% CI 1.7-4.3), incontinence (OR 2.1; 95% CI 1.3-4.9), dizziness (OR 3.0; 95% CI 1.9-5.0), 3 medical conditions or more (OR 3.3; 95% CI 2.1-5.1), lower physical functioning and mobility. Two of the strongest predictors were reported falls (OR 4.9; 95% CI 3.1-7.7) and recur-rent falls (OR 10.0; 95% CI 5.0-20.0) in the last 6 months. CONCLUSION : Older adults living at home should be screened for falls in history and problems in gait and mo-bility in any anamnesis to identify those who are at risk for falls. The 24-h distribution of falls and person-hours of physical activity in the home are strongly

associated among community-dwelling older persons. Wijlhuizen GJ, Chorus AM, Hopman-Rock M.

Department of Physical Activity and Health, TNO Quality of Life, PO Box 2215, 2301 CE Leiden, The Netherlands. Prev. Med. 2008 Feb 9 [Epub ahead of print]

OBJECTIVES: Most research on falls among older persons focuses on health-related factors that affect the ability to maintain balance. The objective of the study is to determine the association between physical activity and occur-rence of falls among community-dwelling older persons. METHODS: The distribution of falls and person-hours of physical activity in the home over 24 h was compared. The falls data (n=501) were extracted from a pooled dataset of three follow-up studies conducted between 1994 and 2005 (n=3587). The 1995 Dutch National Time-Budget Survey provided hour-by-hour information on activities performed by older individuals (n=459) in the home; this sample was representative for the Netherlands. The asso-ciation between the 24-h distribution of falls and physical activity and the risk of falling (the ratio between the distri-bution of falls and physical activity) were determined. Participants were community-dwelling older persons aged 65 years and older. RESULTS: More physical activity was positively associated with more falls (Spearman correlation=.89, p<.000). The risk of falling at night (1 a.m.-6 a.m.) was almost eight times higher compared to 7 a.m.-12 p.m. CONCLUSIONS: Physical activity is strongly associated with the number of falls in the home, measured over 24 h. Older persons may be at increased risk of falling if they are encouraged to become more physically active, or if they often get out of bed at night. Thus in addition to health-related factors, changes in level of physical activity should also be taken into account when estimating a person's risk of falling.

RECENT ABSTRACTS FROM THE RESEARCH LITERATURE


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Anaemia and the Risk of Injurious Falls in a Community-Dwelling Elderly Population Mei Sheng Duh1, Mody, Samir H.2, Lefebvre, Patrick3 , Woodman, Richard C2, Buteau, Sharon3, Catherine Tak Piech2

Affiliations: 1: Analysis Group, Inc., Boston, Massachusetts, USA 2: Ortho Biotech Clinical Affairs, LLC, Bridge-water, New Jersey, USA 3: Groupe d'analyse, Ltée, Montreal, Quebec, Canada Drugs & Aging, Volume 25, Number 4, 2008 , pp. 325-334(10) Abstract: Background: Anaemia in the elderly is associated with a number of health-related functional declines, such as frailty, disability and muscle weakness. These may contribute to falls which, in the elderly, result in serious injuries in perhaps 10% of cases. Objective: To investigate whether anaemia increases the risk of injurious falls in an elderly population. Method: Health insurance claims and laboratory test results data from January 1999 to April 2004 for 47 530 indi-viduals ≥65 years of age enrolled in over 30 managed care plans were analysed. An open-cohort design was em-ployed to classify patients' observation periods by anaemia status (based on the WHO definition) and haemoglobin (Hb) level category. Injurious falls outcomes were defined as an injurious event claim, within 30 days after a fall claim, for fractures of the hip/pelvis/femur, vertebrae/ribs, humerus or lower limbs; Colles' fracture; or head inju-ries/haematomas. Univariate and multivariate (adjusted for age, gender, health plan, history of falls, co-morbidities and concomitant medications) analyses were conducted. Subset analyses based on injurious falls of the hip and head were also conducted. Results: In the univariate analysis, anaemia increased the risk of injurious falls by 1.66 times (95% CI 1.41, 1.95) compared with no anaemia. The incidence of injurious falls increased from 6.5 to 15.8 per 1000 person-years when Hb levels decreased from ≥13 to <10 g/dL (trend test: p < 0.001). Multivariate analysis confirmed that Hb levels were significantly associated with the risk of injurious falls (rate ratio = 1.47, 1.39 and 1.14 for Hb levels of <10, 10-11.9 and 12-12.9 g/dL, respectively, compared with Hb ≥13 g/dL; p < 0.001). Even stronger linear negative trends were observed in the subsets of hip and head injurious falls. Conclusion: Anaemia was significantly and independently associated with a risk increase for injurious falls. Further-more, the risk of injurious falls increased as the degree of anaemia worsened. Correction of anaemia, a modifiable risk factor, warrants further investigation as a means of preventing falls in the elderly. FEAR OF FALLING

Time since falling and fear of falling among community-dwelling elderly Jang SN, Cho SI, Oh SW, Lee ES, Baik HW. Center for Aging and Population Research, Institute of Health and Environment, Seoul National University, Seoul, Korea. Int. Psychogeriatr. 2007 Dec;19(6):1072-83 BACKGROUND: A fall experienced by an elderly person is of special note because it appears to hold a recipro-cal causal association with the fear of falling. This study attempts to determine the temporal relationship between the fear of falling and falling among community-dwelling elderly. METHODS: Data on falls experienced during the previous three years were obtained from 732 community-dwelling elderly people. Participants were also asked to provide detailed information about their most recent fall, including the date, time of day, place, circumstances, consequences of the fall, fear of falling, and activity limitations due to fear of falling. RESULTS: Those who had fallen within the past six months had over four times greater odds of a fear of falling and approximately five times greater odds of activity restriction, compared with those who had not fallen. The as-sociation decreased linearly over time, and became non significant for those who had not fallen during the past 25-36 months. CONCLUSIONS: The experience of a fall is strongly associated with an increased fear of falling, and the associa-tion appears to persist for at least two years. An elderly person who has experienced a fall requires continuous attention to prevent the development of fear as another problem, together with early intervention to counter the fear of falling.


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Fall-related self-efficacy, not balance and mobility performance, is related to accidental falls in chronic stroke survivors with low bone mineral density.

Pang MY, Eng JJ. Affiliation: Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong, China, [email protected]. Osteoporos. Int .2007; ePub. Chronic stroke survivors with low hip bone density are particularly prone to fractures. This study shows that fear of falling is independently associated with falls in this population. Thus, fear of falling should not be overlooked in the prevention of fragility fractures in these patients. INTRODUCTION: Chronic stroke survivors with low bone mineral density (BMD) are particularly prone to fragility fractures. The purpose of this study was to identify the determinants of balance, mobility and falls in this sub-group of stroke patients. METHODS: Thirty-nine chronic stroke survivors with low hip BMD (T-score <-1.0) were studied. Each subject was evaluated for the following: balance, mobility, leg muscle strength, spasticity, and fall-related self-efficacy. Any falls in the past 12 months were also recorded. Multiple regression analysis was used to identify the determinants of balance and mobility performance, whereas logistic regression was used to identify the determinants of falls. RESULTS: Multiple regression analysis revealed that after adjusting for basic demographics, fall-related self-efficacy remained independently associated with balance/mobility performance (R(2) = 0.494, P < 0.001). Logistic regression showed that fall-related self-efficacy, but not balance and mobility performance, was a significant determinant of falls (odds ratio: 0.18, P = 0.04). CONCLUSIONS: Fall-related self-efficacy, but not mobility and balance performance, was the most important determinant of accidental falls. This psychological factor should not be overlooked in the prevention of fragility frac-tures among chronic stroke survivors with low hip BMD. INTERVENTION STUDIES

A randomized controlled trial of fall prevention by a high-intensity functional exercise program for older people living in residential care facilities. Rosendahl E, Gustafson Y, Nordin E, Lundin-Olsson L, Nyberg L.

Affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umea University, Umea, Sweden. [email protected]. Aging Clin Exp Res 2008; 20(1): 67-75. BACKGROUND AND AIMS: Falls are particularly common among older people living in residential care facili-ties. The aim of this randomized controlled trial was to evaluate the effectiveness of a high-intensity functional ex-ercise program in reducing falls in residential care facilities. METHODS: Participants comprised 191 older people, 139 women and 52 men, who were dependent in activities of daily living. Their mean+/-SD score on the Mini-Mental State Examination was 17.8+/-5.1 (range 10-30). Partici-pants were randomized to a high-intensity functional exercise program or a control activity, consisting of 29 ses-sions over 3 months. The fall rate and proportion of participants sustaining a fall were the outcome measures, sub-sequently analysed using negative binominal analysis and logistic regression analysis, respectively. RESULTS: During the 6-month follow-up period, when all participants were compared, no statistically significant differences between groups were found for fall rate (exercise group 3.6 falls per person years [PY], control group 4.6 falls per PY), incidence rate ratio (95% CI) 0.82 (0.49-1.39), p=0.46, or the proportion of participants sustaining a fall (exercise 53%, control 51%), odds ratio (95% CI) 0.95 (0.52-1.74), p=0.86. A subgroup interaction analysis revealed that, among participants who improved their balance during the intervention period, the exercise group had a lower fall rate than the control group (exercise 2.7 falls per PY, control 5.9 falls per PY), incidence rate ratio (95% CI) 0.44 (0.21-0.91), p=0.03. CONCLUSIONS: In older people living in residential care facilities, a high-intensity functional exercise program may prevent falls among those who improve their balance. (Copyright © 2008, Editrice Kurtis)


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Rate of accidental falls in institutionalised older people with and without cognitive impairment halved as a result of a staff-oriented intervention.

Bouwen A, De Lepeleire J, Buntinx F. Affiliation: Department of Katholieke Universiteit, Leuven, Belgium. Age Ageing 2008; ePub. OBJECTIVE: To evaluate the impact of a staff-oriented intervention on the number of accidental falls in residents with and without cognitive impairment. DESIGN: Clustered randomised controlled trial. METHODS: Ten nursing wards from 7 nursing homes were randomised in a control (5 wards) and intervention (5 wards) group. The nurses from the intervention group received multi-faceted training about the occurrence of accidental falls, risk factors for falls and possible environmental modifications. For each fall they were asked to re-cord the relevant risk factors, to keep a fall diary and to evaluate fall causes and possible preventive actions. For all residents, cognition and mobility were evaluated using a Mini-Mental State Examination (MMSE) and a Timed Up and Go Test (TUGT). Fall rates were recorded in an identical way for 6 months before and after the start of the intervention. Main outcome measures: primary outcome measure was the number of participants with at least one accidental fall requiring an intervention by a physician or a nurse during each period of recording. Secondary out-come was the number of falls for each participant during each period of recording. RESULTS: The relative risk of falling at least once in people of the intervention versus the control group adjusted for the pre-intervention results was 0.46 (95% CI: 0.26-0.79). There was no difference between residents with and without cognitive impairment or impaired mobility. In those falling at least once, the difference between the average number of falls in the two intervention arms was not significant (P = 0.10). CONCLUSION: A simple staff-oriented intervention had a substantial effect on the frequency of accidental falls. (Copyright © 2008, Oxford University Press) WEBSITES and REPORTS: Centre for Disease Control and Prevention (CDC) US Department of Health and Human Services This website has a Preventing Falls in Older People area with a number of resources at : http://www.cdc.gov/ncipc/duip/preventadultfalls.htm Some recently added useful resources are:

Preventing Falls: What Works A CDC Compendium of Effective Community-based Inter-ventions from Around the World this document can be downloaded from: http://www.cdc.gov/ncipc/preventingfalls/ This compendium of interventions is designed for public health practitioners and community-based organizations, to help them address the problem of falls among older adults. It describes 14 scientifically tested and proven interventions, and provides relevant details about these interven-tions for organizations who want to implement fall prevention programs. The interventions are grouped into three categories: 1) exercise-based, 2) home modification, and 3) multifaceted. Each intervention description includes a short summary of the research

study and results, as well as a longer section describing the intervention. This document also includes appendices with useful charts and tables, assessment instruments, and evaluation materials.

Preventing Falls: How to Develop Community-based Fall Prevention Programs for Older Adults, this can be downloaded from

http://www.cdc.gov/ncipc/preventingfalls/CDC_Guide.pdf This “how-to” guide is designed for community-based organizations who are interested in devel-oping their own effective fall prevention programs. This guide is designed to be a practical and useful tool, and it provides guidelines on program planning, development, implementation, and evaluation.


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In this document, CDC provides organizations with the building blocks of effective fall prevention programs by pro-viding examples, resources, and tips. This guide also includes helpful information on building and maintaining com-munity partnerships and promoting, evaluating, and sustaining fall prevention programs. The appendices include practical assessments, worksheets, presentations, and templates.

MMWR (Morbidity and Mortality Weekly Report) has a range of reports including ‘Self-reported falls and falls related injuries among persons aged ≥65 years’.

This report is Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5709a1.htm

Improving Strength and Balance: Avoiding Falls in Later Life

Website: http://www.fallsdemo.co.uk This health information package on falls prevention has been produced by the Centre for Health Care of Older People at Barts and The London, Queen Mary's School of Medicine and Dentistry with a helpful input by Health care professionals at the Mile End Hospital (Tower Hamlets Primary Care Trust). The development of this program was supported by the Health Foundation (UK). The package is aimed at older adults, their relatives and carers. It provides detailed and up-to-date information on prevention, causes, consequences and treatment of falls in older people.

COURSES IN INJURY PREVENTION AND FALLS PREVETIONION

Two-day workshop in Injury Prevention

Date: Friday 8 and Monday 11 August, 2008 Venue: The University of Sydney This introductory level course is a two-day workshop covering principles of injury prevention, policy and practice, and injury-specific content. It is offered by the George Institute for Interna-

tional Health to students of Graduate Diploma/Masters/Doctor of Public Health/PhD programs and to external in-dividuals interested in, or working in, injury prevention and control, or related fields. One-semester online course in Injury Epidemiology, Prevention and Control Semester commences: Monday 28 July, 2008 This one-semester online unit teaches students about the principles of injury epidemiology, prevention and con-trol. It provides a basis for the assessment and investigation of injury issues, and the development, implementation and evaluation of injury prevention programs. It offers: - Practical case studies to illustrate injury issues and promote interaction - Online discussions with leading injury control professionals - Content developed by leaders in injury prevention and control throughout Australia. One-semester online course in Falls Prevention and the Older Person Semester commences: Monday 28 July, 2008 This one-semester online unit will teach students about the principles of falls prevention and falls injury prevention in the older person, with a focus on the practical aspects of these principles. If offers: - Content materials developed by leaders in the field of falls prevention - Interactive online discussions, moderated by an expert in the field - Practical case studies to promote learning For more information on the courses above, please go to www.thegeorgeinstitute.org or email us directly via [email protected] or phone (02) 9657 0300 We acknowledge the support of The Australian Government Department of Health and Ageing’s Public Health Edu-cation and Research Program during the development of these courses.


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Registration form and Venue location map are available on our website at http://www.powmri.edu.au/fallsnetwork


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NSW FALLS PREVENTION NETWORK BACKROUND The NSW Falls Prevention Network has existed since 1993. The role of this network has grown since its inception and now includes: • Meetings for discussion of falls related issues; • Dissemination of research findings both local and interna-

tional; • Sharing resources developed and exploration of opportuni-

ties to combine resources in joint initiatives; • Encouragement of collaborative projects and research; • To act as a group to influence policy; • To liaise with NSW Health to provide information on current

State/Commonwealth issues in relation to falls and • Maintenance of resources pertinent to the field The main purpose of the network is to share knowledge, expertise, and resources on falls injury prevention for older people.

'The NSW Falls Prevention Network activities are part of the implementation of the NSW Falls Prevention Policy funded by

the NSW Department of Health

SHARE YOUR NEWS AND

INFORMATION/IDEAS

ON FALLS PREVENTION Do you have any news on Falls Prevention you want to share with others on the net-work, or do you want to report on a pro-ject that is happening in your area. Please email Esther with your information. We also welcome suggestions for articles and information you would like to see in this newsletter.

Send your information to [email protected]

JOINING THE NETWORK To join the NSW Falls Prevention Network listserv : • Send an email to :

[email protected]

• In the body of the message type

subscribe nsw-falls-network on the next line type end • Do not put anything in the subject

line • You will receive an e-mail to con-

firm you have been added to the listserv

• To unsubscribe send an e-mail to the above address and in the body of the message write

unsubscribe nsw-falls-network on the next line type end

If you have any problems contact Esther at [email protected].

THE NETWORK LISTSERV It is great to see the increased activity on the listserv and want to continue to pro-mote this. To send an item to the listserv where all members of the network can see it, send an email to: [email protected] You need to be a subscriber to the listserv to send an email that will be distributed to all members of the on the listserv. Remem-ber to put a short description in the subject line. Recently some posts to the listserv have bounced due to email address changes in the area health services, you need to re-subscribe with your new e-mail address and unsubscribe from your old address follow-ing the Join the Network instructions as shown on this page.

NETWORK INFORMATION

www.powmri.edu.au/

fallsnetwork

Documents

Falls Links issue 2 2008fallsnetwork.neura.edu.au/wp-content/uploads/2014/... · St. George Hospital Falls Awareness Day There were many activities conducted to raise awareness about