Volume 2 Issue 5 2007

FALLS LINKS

Welcome to the fifth issue for 2007.

A report on the recent NSW Area Health Falls Prevention Co-ordinators Workshop held on the 18th & 19th

October is on page 2.

The Southern Hospitals Network of the South Eastern Sydney Illawarra Area

Health Service held their inaugural Falls Forum on Monday 29th October, a

short report and photos are on page 2.

This issue features an article on Home Environmental Hazards and Falls on

pages 3-4.

The ACT Falls Forum will be held on Thursday December 6, at the

University of Canberra. Information on this forum is on page 10.

We hope you find the information in

this issue useful.

Welcome

Welcome 1

Workshop & Forum 2

Home Environmental Hazards and falls

3

Abstracts & Websites 5

New Book 9

Network Information 11

ACT Falls Forum 10

INSIDE THIS ISSUE:

FALLS LINKS

SPECIAL POINTS OF INTEREST:

WORKSHOP & FORUM HOME ENVIRONMENTAL HAZARDS AND FALLS ABSTRACTS & WEBSITES NEW BOOK ACT FALLS FORUM

September/ October 2007

Volume 2 Issue 5

NSW Falls Injury

Prevention Network

NSW Area Health Falls Prevention Co-ordinators Workshop (From l to r) Patsy Bourke (HNEAHS), Kathy Richardson (SESIAHS), Jacaline Kelly (GWAHS), Esther Vance (POWMRI), Jenny Bawden (SWAHS), Sue Weston (GSAHS), Ingrid Hutchinson (CEC), Mary-Clare Maloney (NCAHS), Margaret Armstrong (NSCCAHS), Claire Monger (NSW DOH), Therese Findlay (SSWAHS) and Lorraine Lovitt (CEC).

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FALLS LINKS

NSW Area Health Falls Prevention Co-coordinators Workshop

October 18 and 19, 2007

This workshop provided the NSW Area Falls Prevention Co-ordinators with an opportunity to discuss important aspects of the work they are undertaking in the implementation of the Area Falls Prevention Plans. Each of the workshop sessions was facilitated by a co-ordinator. The program included: developing falls prevention initiatives in the community including health promotion to increase physical activity programs and community awareness; a model to support older people with risk for falls living in the community, which looks at building capacity to meet future demand; falls prevention strategies with General Practitioners working with the Alliance of NSW Divisions; information about the residential care sector and development of residential Care falls prevention guidelines by the Hunter New England Area Health Service Residential Care project; how to support falls prevention initiatives for Aboriginal and Torres Straight Islander communities. At this workshop the co-coordinators were introduced to Dr Wendy Watson from the Injury Risk Management Research Centre (IRMRC) who has just been appointed to conduct the evaluation of the NSW Falls Prevention program. Ms Rebecca Bell, Principal Project Officer, Falls Injury Prevention, Safety and Quality Centre, Queensland Health was a welcome participant and she presented the development of community falls prevention good-practice guidelines, which are currently under expert review prior to being finalised.

Southern Hospitals Network (SHN) Falls Forum

Southern Hospitals Network Falls Working Party of the South Eastern Sydney Illawarra Area Health Service (SESIAHS) organised their inaugural Falls Forum on Monday 29th October 2007 at Wollongong Hospital.

It was hosted by the Clinical Practice Improvement Unit and was partially subsidised by the Division of Population Health. The forum was attended by over 100 participants from a variety of disciplinary backgrounds across SESIH including external participants from residential aged care facilities. The presentations covered the State wide and area falls program perspectives followed by presentations on current developments, innovative research and practical strategies on falls prevention and management in acute, sub-acute, community and residential care settings across Southern Hospitals Network. The program also included group participation in Tai Chi exercise and Strength and Balance assessment activities. The inclusion of quizzes, interactive activities and prizes made for a very successful and enjoyable forum.

Workshop and Forum

Page 2

Denise Tomassini (A/ SHN Clinical Quality Manager), Gaye Sykes (Quality/Accreditation Manager Wollon-gong Hospital), Kathy Richardson (SESIAHS Area Falls Co-ordinator) and Colleen O’Rourke (Health Promo-tions Officer, SHN).

Tai Chi Presentation by Alex Voukelatos, Injury Prevention Program Manager, SSWAHS

Lorriane Lovitt, Leader NSW Falls Program, Clinical Excellence Commission (CEC).

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A range of environmental factors have been impli-cated as being associated with falls in older peo-ple1. A home survey2 of 570 older people found that all had at least one environmental risk factor. Many older people report falls caused by slips or trips around the home1.

The Victorian Injury Surveillance & Ap-plied Research System (VISAR) collected information on falls from 1618 people and found that overall 48% of falls occurred in a private home with 94% of these in a persons own home3. Distribution of falls within the home is shown in Figure 1. This figure shows that 50% of falls were found to occur in the living or bedroom areas, with only 9% occurring in the bath-room. It is of interest to note that 25% of falls were in the garage, often this was found to involve steps and possible clut-ter3.

Possible home hazards include general ones such as slippery floors, loose or rugs or carpets, obstructed walkways, clutter, cords across walkways and pets 1. Furniture that may be too low or high or unstable can also be a hazard. Hazards in the bath-room include slippery surfaces, low toilet seats, shower recess hob, no grab rails for shower, bath or toilet. Stairs can feature a number of hazards such as inadequate handrails, being to steep and treads too narrow and non-contrasting steps. Outdoor hazards included sloping, slippery and uneven pathways, ramps and stairways1.

It has been reported1 that home hazards alone do not lead to falls, but the interaction of the older person (and their intrinsic risk factors for falling) with their environment appears to be important.

A number of home hazards assessment tools have been developed 4-8 and these include the West-mead Home safety Assessment (WeHSA), the Home Falls and Accidents Screening Tool (HOME FAST), the Falls Behavioral Scale (FaB) for the Older person and the Stay on Your feet: your home safety checklist.

The WeHSA4 is a 72 item checklist developed to assess the physical and environmental home haz-ards of people at risk of falling. Hazard informa-tion is recorded relating to external and internal traffic ways, the general environment and specific rooms such as the bathroom. Other possible falls risks such as medication, footwear, seating and personal alarm systems are also included in the assessment. The WeHSA is recommended to be used by an occupational therapist (OT) during a home visit.

The HOME FAST5,6 screening tool was developed to identify environmental hazards in older people

living in the community. It involves a yes/no rat-ing system of 25 items identifying hazardous home items abs functional performance in and around the home. The HOME FAST is useful as an initial tool to identify the nature and extent of potential home hazards.

The FaB7 for the older person is a scale that evaluates behavioral factors which may protect the person against falling. It involves the person circling responses to 30 easy to understand questions about their own behaviors relating to falling. The person can complete the scale on their own or with a support person or health professional. This is a useful tool to identify and reflect on current falls risk behaviors .

Stay on your Feet: your home safety checklist.8 This checklist looks at possible environmental

hazards in the home by using a yes/no checklist for each room as well as light-ing, floor, stairs, steps and ladders checklists. It also has checklists for clothing and foot-wear and walking aids and provides sugges-tions to overcome any identified risks. This checklist can be com-

Home Environmental Hazards and Falls

Figure 1

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pleted by the person on their own or with a health professional.

HomeFront9 is a program the Department of Veter-ans’ Affairs (DVA) has developed to make the homes of eligible veterans and war widows safer from falls and accident hazards. This program is available to all gold and white DVA card holders. This program includes both personal and home hazard risk check-lists. A free HomeFront assessment is available each calendar year and the Department makes a financial contribution towards the cost of recommended items and modifications. The HomeFront assessor also provides information about local community and Government services that are available to assist vet-erans and war widows to remain living in their own home for as long as possible. Modifying the home environment to decrease possi-ble environmental hazards is seen as a cost effective one off intervention1 that may reduce falls in the home environment. There have been a number of randomised controlled trials (RCT) on home assess-ment and modification with falls as an outcome measure1. The findings from these studies have been disparate with a few studies finding a significant re-duction in falls after home modification whereas other studies did not find any significant reduction in falls. Studies targeted to older people considered at increased risk of falls due to recent hospitalization for falls found that there was a significant reduction in falls (both in and outside the home) after an OT visit and home assessment and home modifications, however the OT intervention also included advice on footwear and behavior10.

Home modifications have included ensuring lighting is adequate and night lights are used, all floor surfaces are non-slip, removing or fixing down rugs, and re-pairing upended carpet edges and uneven floor cov-erings , securing all loose cords and keeping them away from walkways, using a cordless telephone, re-pairing unstable furniture , installing grab rails in the bathroom and toilet and using non-slip mats and avoiding using bath oils and talcum powders. Stair safety can be improved by the use of contrast strips on treads and ensuring handrails and banisters are secure and at an appropriate height 1,11. It is also important to ensure that older people who use

mobility aids know how to use and maintain these1.

Studies have found that compliance to suggested home modifications vary from 13% to 90%, this is often due to older people’s view of their health and independence being challenged1. Using a small group sessions ap-proach has often overcome this barrier12.

Environmental hazards particularly around the home play a contributory role in a number of falls in older people. Home hazard reduction is most effective for older people who have a history of falls or have limited mobility.

Please note, this short article has not dealt with envi-ronmental hazards in public places. 1. Lord, S. Sherrington, C. Menz, H. and Close, J. Falls in older

people: risk factors and strategies for prevention.2nd edition Cambridge University Press: UK 2007, Chapters 8 & 14.

2. Stevens M, Holman C & Bennett N. Preventing falls in older people: impact of an intervention to reduce environmental hazards in the home. JAGS 2001; 49:1442-7.

3. Victorian Injury Surveillance and Applied Research System (VISAR). Injuries Among Older People. Hazard (Edition No.19) June 1994 available at: http://www.monash.edu.au/muarc/VISU/hazard/haz19.pdf

4. Clemson, L., Fitzgerald, M., & Heard, R., Content validity of an assessment tool to define home fall hazards: The West-mead Home Safety Assessment. British Journal of Occupational Therapy, 1999, 62:4.

5. Mackenzie, L., Byles, J. and Higginbotham, N. Reliability of the Home Falls and Accidents Screening Tool (HomeFAST) for measuring falls risk for older people. Disability and Reha-bilitation; 2002, 266-74.

6. Mackenzie, L., Byles, J. and Higginbotham, N., Designing the Home Falls and Accidents Screening Tool (HomeFAST): Selecting the items. British Journal of Occupational Therapy 2000,63:260-9.

7. Clemson, L., Cumming, R.G., & Heard, R. The Falls Behav-ioural (FaB) Scale for the Older Person Instruction Manual, Uni-versity of Sydney, 2003.

8. Stay on your feet: your home safety checklist NSW Department of Health 2004, Available at http://www.health.nsw.gov.au/pubs/s/pdf/stay_on_feet.pdf

9. Department of Veterans Affairs, HomeFront , information available at

http://www.dva.gov.au/health/homefront/index.htm 10. Cumming, R.G. Thomas, M. Szonyi G. et al Home visits by

an occupational therapist for assessment and modification of environmental hazards: a randomised trial of falls preven-tion. JAGS 1999; 47:1397-402.

11. VISAR. Preventing Home fall injuries: structural and design issues and solutions. Hazard (Edition No. 59) Summer 2005 available at: http://www.monash.edu.au/muarc/VISU/hazard/haz59.pdf

12. Clemson , L. Cumming, R .G. Kendig H. et al. The effective-ness of a community-based program for reducing the inci-dence of falls in the elderly:a randomized trial. JAGS 2004;52: 1487-94.

Home Environmental Hazards and Falls

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Recent interesting abstracts from the

literature on falls prevention

A student-led demonstration project on fall prevention in a long-term care facility. Bonner A, Macculloch P, Gardner T, Chase CW. Geriatr Nurs 2007; 28(5): 312-8. (Copyright © 2007, Elsevier Publishing) ABSTRACT Falls are a frequent and serious problem facing peo-ple aged 65 and older. The incidence of falls in-creases with greater numbers of intrinsic and extrin-sic risk factors and can be reduced by risk modifica-tion and targeted interventions. Falls account for 70% of accidental deaths in persons aged 75 and older. Mortality due to falls is significantly higher for older adults living in extended care facilities versus those living in the community. Our objective was to evaluate the effectiveness of a fall prevention training program in a long-term care setting. A single-group repeated-measure design was used, guided by the Precede-Proceed framework. A comprehensive review of the literature and a con-cept analysis guided the development of testing and educational materials for all nursing and ancillary facility staff. Preliminary testing provided baseline data on knowledge related to fall prevention. Pre- and posttests, a fall prevention newsletter, and infor-mational brochures were distributed to nursing staff and ancillary personnel at training sessions. Certified nursing assistant (CNA) champions were identified and given peer leadership training. "Quick Tips" fall prevention badges were also distributed to staff. Graduate students led interdisciplinary environ-mental rounds weekly, and new falls were reviewed on a daily basis by the interdisciplinary team. A 60-day posttest evaluated retention of fall prevention knowledge. Fall rates at baseline and for 2 months after the intervention were compared. Preliminary survey data revealed fall prevention learning oppor-tunities, with a pretest mean score of 86.78%. Quali-tative data were coded and revealed specific learning gaps in intrinsic, extrinsic, and organizational causes of falls. The 60-day posttest mean score was 90.69%; a paired t test (t score = -1.050; P = .057) suggested that learning may have taken place; however, differ-ences in scores did not reach statistical significance. The fall rate before training was 16.1%; 30-day post-training fall rate was 12.3%, and 60-day postinterven-tion fall rate was 9%.

Based on the program results, the model was expanded from long-term care to the university hospital system and outpatient clinics in the same community. The col-laboration between a school of nursing and 1 long-term care facility led to the adoption of a significant quality improvement program that was subsequently extended to a local hospital and clinic system. Student-led pro-jects designed to teach community service learning can be meaningful and can lead to changes in patient safety and quality of care. Medication as a risk factor for falls: critical sys-tematic review. Hartikainen S, Lönnroos E, Louhivuori K. J Gerontol A Biol Sci Med Sci 2007; 62(10): 1172-81. (Copyright © 2007, Gerontological Society of America) ABSTRACT BACKGROUND: Falls in older people are associated with poor prognosis. Medication use is a potential cause of falls. Our aim was to systemically review all original articles examining medication use as a risk fac-tor for falls or fall-related fractures in people aged >/=60 years. METHODS: We searched English articles in Medline (1996-2004) indexed under "falls" or "accidental falls" and "pharmaceutical preparations" or specific groups of drugs. We excluded studies not meeting the age crite-rion, not controlled with nonusers of target medicines or nonfallers, or with no clear definition of target medi-cation. RESULTS: Twenty-eight observational studies and one randomized controlled trial met the inclusion crite-ria. The number of participants ranged from 70 to 132,873. The outcome measure was a fall in 22 studies and a fracture in 7 studies. The main group of drugs associated with an increased risk of falling was psycho-tropics: benzodiazepines, antidepressants, and antipsy-chotics. Antiepileptics and drugs that lower blood pres-sure were weakly associated with falls. CONCLUSIONS: Central nervous system drugs, especially psychotropics, seem to be associated with an increased risk of falls. The quality of observational stud-ies needs to be improved, for many appear to lack even a clear definition of a fall, target medicines, or prospec-tive follow-up. Many drugs commonly used by older persons are not systematically studied as risk factors for falls

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Abstracts Continued

Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study van der Velde N, Stricker BH, Pols HAP, van der Cam-men TJM. British Journal of Clinical Pharmacology2007; 63 (2), 232–237 ABSTRACT What is already known about this subject • In observational studies, several drugs have been asso-ciated with an increased fall risk. A meta-analysis in 1999 found a significant association for neuroleptics, antidepressants, sedatives, diuretics, type IA antiarrhyth-mics, and digoxin. • Nevertheless, knowledge on the effect of withdrawal of these drugs on fall risk is scarce. Only one random-ized controlled trial has been carried out in 1999, show-ing a significantly lowered fall risk after withdrawal of sedatives and antidepressants in community-dwelling older persons. What this study adds • This study indicates that withdrawal of all fall-risk-increasing drugs, including both cardiovascular and psy-chotropic drugs, is an effective intervention for lowering of falls incidence. This effect appears to be highest for withdrawal of cardiovascular drugs. Aims Falling in older persons is a frequent and serious clinical problem. Several drugs have been associated with in-creased fall risk. The objective of this study was to iden-tify differences in the incidence of falls after withdrawal (discontinuation or dose reduction) of fall-risk-increasing drugs as a single intervention in older fallers. Methods In a prospective cohort study of geriatric outpatients, we included 139 patients presenting with one or more falls during the previous year. Fall-risk-increasing drugs were withdrawn, if possible. The incidence of falls was assessed within 2 months of follow-up after a set 1 month period of drug withdrawal. Multivariate adjust-ment for potential confounders was performed with a Cox proportional hazards model. Results In 67 patients, we were able to discontinue a fall-risk-increasing drug, and in eight patients to reduce its dose. The total number of fall incidents during follow-up was significantly lower in these 75 patients, than in those who continued treatment (mean number of falls: 0.3 vs. 3.6; P value 0.025). The hazard ratio of a fall during fol-low-up was 0.48 (95% confidence interval (CI) 0.23, 0.99) for overall drug withdrawal, 0.35 (95% CI 0.15,

0.82) for cardiovascular drug withdrawal and 0.56 (95% CI 0.23, 1.38) for psychotropic drug withdrawal, after adjustment for age, gender, use of fall-risk-increasing drugs, baseline falls frequency, comorbidity, Mini-Mental State Examination score, and reason for referral. Conclusions Withdrawal of fall-risk-increasing drugs appears to be effective as a single intervention for falls prevention in a geriatric outpatient setting. The effect was greatest for withdrawal of cardiovascular drugs. Withdrawal of Fall-Risk-Increasing Drugs in Older Persons: Effect on Tilt-Table Test Out-comes van der Velde N, van den Meiracker MH, MD, Pols HAP, Stricker BH, van der Cammen TJM. Journal of the American Geriatrics Society 2007; 55 (5), 734–739. ABSTRACT OBJECTIVES: To determine whether outcomes of tilt-table tests improved after withdrawal of fall-risk-increasing drugs (FRIDs). DESIGN: Prospective cohort study. SETTING: Geriatric outpatient clinic. PARTICIPANTS: Two hundred eleven new, con-secutive outpatients, recruited from April 2003 until December 2004. MEASUREMENTS: Tilt-table testing was per-formed on all participants at baseline. Subsequently, FRIDs were withdrawn in all fallers in whom it was safely possible. At a mean follow-up of 6.7 months, tilt-table testing was repeated in 137 participants. Tilt-table testing addressed carotid sinus hypersensitivity (CSH), orthostatic hypotension (OH), and vasovagal collapse (VVC). Odds ratios (ORs) of tilt-table-test normalization according to withdrawal (discontinuation or dose reduction) of FRIDs were calculated using multivariate logistic regression analy-sis. RESULTS: After adjustment for confounders, the reduction of abnormal test outcomes (ORs) accord-ing to overall FRID withdrawal was 0.34 (95% confi-dence interval (CI)=0.06–1.86) for CSH, 0.35 (95% CI=0.13–0.99) for OH, and 0.27 (95% CI=0.02–3.31) for VVC. For the subgroup of cardiovascular FRIDs, the adjusted OR was 0.13 (95% CI=0.03–0.59) for CSH, 0.44 (95% CI=0.18–1.0) for OH, and 0.21 (95% CI=0.03–1.51) for VVC.

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CONCLUSION: OH improved significantly after with-drawal of FRIDs. Subgroup analysis of cardiovascular FRID withdrawal showed a significant reduction in OH and CSH. These results imply that FRID withdrawal can cause substantial improvement in cardiovascular homeo-stasis. Derangement of cardiovascular homeostasis may be an important mechanism by which FRID use results in falls. Falls and fall-related injuries in older dialysis pa-tients Cook WL, Tomlinson G, Donaldson M, Markowitz SN, Naglie G, Sobolev B, Jassal SV. Clin J Am Soc Nephrol 2006; 1(6): 1197-204 Affiliation: Division of Geriatric Medicine, Faculty of Medicine, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Co-lumbia, Canada. (Copyright © 2006, American Society of Nephrology) ABSTRACT Dialysis patients are increasingly older and more dis-abled. In community-dwelling seniors without kidney disease, falls commonly predict hospitalization, the onset of frailty, and the need for institutional care. Effective fall prevention strategies are available. On the basis of ret-rospective data, it was hypothesized that the fall rates of older (> or =65 yr) chronic outpatient hemodialysis (HD) patients would be higher than published rates for community-dwelling seniors (0.6 to 0.8 falls/patient-year). It also was hypothesized that risk factors for falls in dialysis outpatients would include polypharmacy, dialy-sis-related hypotension, cognitive impairment, and de-creased functional status. Using a prospective cohort study design, HD patients who were > or =65 yr of age at a large academic dialysis unit were recruited. All study participants underwent baseline screening for fall risk factors. Patients were fol-lowed prospectively for a minimum of 1 yr. Falls were identified through biweekly patient interviews in the HD unit. A total of 162 patients (mean age 74.7 yr) were re-cruited; 57% were male. A total of 305 falls occurred in 76 (47%) patients over 190.5 person-years of follow-up (fall-incidence 1.60 falls/person-year). Injuries occurred in 19% of falls; 41 patients had multiple falls. Associated risk factors included age, comorbidity, mean predialysis systolic BP, and a history of falls. In the HD population, the fall risk is higher than in the general community, and fall-related morbidity is high. Better identification of HD

patients who are at risk for falls and targeted fall in-tervention strategies are required. Preventing falls in older adults: New interven-tions to promote more effective change-in-support balance reactions. Maki BE, Cheng KC, Mansfield A, Scovil CY, Perry SD, Peters AL, McKay S, Lee T, Marquis A, Corbeil P, Fernie GR, Liu B, McIlroy WE. J Electomyogr Kinesiol 2007; ePub. Affiliation: Sunnybrook Health Sciences Centre, To-ronto, Canada; University of Toronto, Toronto, Can-ada; Toronto Rehabilitation Institute, Toronto, Can-ada. (Copyright © 2007, Elsevier Publishing) ABSTRACT "Change-in-support" (CIS) balance-recovery reactions that involve rapid stepping or reaching movements play a critical role in preventing falls; however, age-related deficits in the neuro-musculoskeletal systems may impede ability to execute these reactions effec-tively. This review describes four new interventions aimed at reducing fall risk in older adults by promot-ing more effective CIS reactions: (1) balance training, (2) balance-enhancing footwear, (3) safer mobility aids, and (4) handrail cueing systems. The training program uses unpredictable support-surface perturbations to counter specific CIS control problems associated with aging and fall risk. Pilot test-ing has demonstrated that the program is well-tolerated by balance-impaired older adults, and a ran-domized controlled trial is now in progress. The bal-ance-enhancing footwear insole improves control of stepping reactions by compensating for age-related loss of plantar cutaneous sensation. In a clinical trial, subjects wore the insole for 12 weeks with no seri-ous problems and no habituation of the balance-enhancing benefits. The mobility-aid intervention involves changes to the design of pickup walkers so as to reduce impediments to lateral stepping. Finally, work is underway to inves-tigate the effectiveness of handrail cueing in attracting attention to the rail and ensuring that the brain regis-ters its location, thereby facilitating more rapid and accurate grasping.

Abstracts Continued

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Influence of pain and depression on fear of falling, mobility, and balance in older male veterans Bishop MD, Meuleman J, Robinson M, Light KE. J Rehabil Res Dev. 2007; 44(5):675-84. ABSTRACT This study determined the extent to which pain and de-pression influenced changes in fear of falling, mobility, and balance in older veterans with mobility disorders. Data were reviewed from 95 consecutive patients (aged 60 to 95 yr) who attended the Geriatric Gait and Balance Disor-ders Clinic at the Malcom Randall Department of Veterans Affairs Medical Center between 1998 and 2000. All sub-jects performed an individualized exercise program and were assessed four times over 12 weeks with a standard-ized evaluation battery. We used separate hierarchical re-gression models to examine the influence of measures of bodily pain and depression on outcomes (Berg Balance Test, Dynamic Gait Index, and Falls Efficacy Scale). Approximately half of the patients attended all evaluation sessions. Attendance at follow-up visits was a significant predictor of improvement in all outcome measures. Pain was a significant predictor of a decrease in balance and mobility outcome scores but not fear of falling. Thus, com-pleting the program increased the amount of improve-ment, while having pain decreased the amount of improve-ment. These data suggest that targeted interventions for pain and improving adherence to rehabilitation recommendations should be included in the rehabilitation of older veterans with balance or mobility disorders to maximize potential improvements in balance and mobility

Websites

Home Modification Information Clearing House http://www.homemods.info/ The Home Modification and Maintenance (HMM) program delivers an important service to support frail older people, people with a disability and their carers to remain at home. Under this program, there are approximately ninety Home Maintenance and Modification service outlets in NSW. This website features a wealth of information on home mainte-nance and modification including issues of accessibility and safety. There is also an alphabetical listing of annotated web links. National Ageing Research Institute (NARI) <http://www.mednwh.unimelb.edu.au/research/research_falls_service.htm> NARI is involved in research into ageing and improving the quality of life and health of older people. They are cur-rently involved in a number of falls prevention research

projects and there are links to PDFs where avail-able. A recent project is the implementation of a falls risk screen for older people presenting to an emergency department a literature review is avail-able on this topic at : <http://www.mednwh.unimelb.edu.au/research/research_falls_service.htm> Monash University Accident Research Cen-tre (MUARC) http://www.monash.edu.au/muarc/ This site includes the Victorian Injury Surveillance Unit which produces a regular bulletin entitled Hazard that has featured articles on Falls and falls prevention in Older people, this and other re-sources are available at: http://www.monash.edu.au/muarc/VISU/index.html Injury Risk Management Research Centre (IRMRC) http://www.irmrc.unsw.edu.au/ This site has a number of reports including NSW Injury Profile: A Review of Injury Hospitalisations during 1989-1990 to 2003-2004 (September 2006) available at: <http://www.irmrc.unsw.edu.au/documents/Hospitalisation%20report/IRMRC%20Hospitalisation%20Report%20%2006.pdf> Also available are a number of Hospitalisation and Injury Fact Sheets such as Trends in Falls Hospitali-sations in NSW and Trends in Falls related deaths Available at <http://www.irmrc.unsw.edu.au/Publications/factsheets.asp> New at ProFaNE (Prevention of Falls Network Europe) this week are: Guidelines for exercise programming for the frail elderly, Better Ageing Project available at <http://www.profane.eu.org//directory/display_resource.php?resource_id=1654> Scoping Exercise on Fallers Clinics in the UK—SDO Report, this is available at: <http://www.profane.eu.org//directory/display_resource.php?resource_id=1656> National Patient Safety Agency (NPSA) 17: Using Bedrails safely and effectively, this is available at: <http://www.npsa.nhs.uk/health/display?contentId=5685>

Abstracts and Websites

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

majordomo@lists.health.nsw.gov.au • 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 • 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 e.vance@unsw.edu.au.

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 network, or do you want to report on a project 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 e.vance@unsw.edu.au

THE NETWORK LISTSERV It is great to see the increased activity on the listserv and want to continue to promote this. To send an item to the listserv where all members of the network can see it, send an email to:

nsw-falls-network@lists.health.nsw.gov.au

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. Remember to put a short description in the subject line. Recently some posts to the listserv have bounced due to email ad-dress changes in the area health services, you need to re-subscribe with your new e-mail address and unsubscribe from your old address following the Join the Network instructions as shown on this page.

NSW FALLS INJURY PREVENTION NETWORK BACKROUND

The NSW Falls Injury 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 international; • Sharing resources developed and exploration of opportunities to com-

bine 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 re-sources on falls injury prevention for older people. 'The NSW Falls Injury Prevention Network activities are part of

the implementation of the NSW Falls Policy funded by the NSW

Department of Health

NETWORK INFORMATION

For information, suggestions and ideas regarding the network or this newsletter,

contact Esther Vance at e.vance@unsw.edu.au

NSW FALLS INJURY PREVENTION

NETWORK

www.powmri.edu.au/

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