25 results on '"Kurrle, Susan"'
Search Results
2. Tailored Exercise and Home Hazard Reduction Program for Fall Prevention in Older People With Cognitive Impairment: The i-FOCIS Randomized Controlled Trial.
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Taylor ME, Wesson J, Sherrington C, Hill KD, Kurrle S, Lord SR, Brodaty H, Howard K, O'Rourke SD, Clemson L, Payne N, Toson B, Webster L, Savage R, Zelma G, Koch C, John B, Lockwood K, and Close JCT
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- Aged, 80 and over, Australia epidemiology, Efficiency, Organizational, Exercise Movement Techniques, Female, Humans, Incidence, Male, New Zealand epidemiology, Outcome Assessment, Health Care methods, Outcome Assessment, Health Care statistics & numerical data, Physical Functional Performance, Quality of Life, Accidental Falls prevention & control, Accidents, Home prevention & control, Accidents, Home psychology, Cognitive Dysfunction complications, Cognitive Dysfunction physiopathology, Cognitive Dysfunction psychology, Exercise Therapy methods, Independent Living psychology, Independent Living standards, Independent Living statistics & numerical data, Risk Reduction Behavior
- Abstract
Background: The evidence to support effective fall prevention strategies in older people with cognitive impairment (CI) is limited. The aim of this randomized controlled trial (RCT) was to determine the efficacy of a fall prevention intervention in older people with CI., Method: RCT involving 309 community-dwelling older people with CI. The intervention group (n = 153) received an individually prescribed home hazard reduction and home-based exercise program during the 12-month study period. The control group (n = 156) received usual care. The primary outcome was rate of falls. Secondary outcomes included faller/multiple faller status, physical function, and quality of life., Results: Participants' average age was 82 years (95% CI 82-83) and 49% were female. There was no significant difference in the rate of falls (incidence rate ratio [IRR] 1.05; 95% confidence interval [95% CI] 0.73-1.51). A sensitivity analysis, controlling for baseline differences and capping the number of falls at 12 (4 participants), revealed a nonsignificant reduction in fall rate in the intervention group (IRR 0.78; 95% CI 0.57-1.07). Analyses of secondary outcomes indicated the intervention significantly reduced the number of multiple fallers by 26% (RR 0.74; 95% CI 0.54-0.99) when adjusting for baseline differences. There was a differential impact on falls in relation to physical function (interaction term p-value = .023) with a significant reduction in fall rate in intervention group participants with better baseline physical function (IRR 0.60; 95% CI 0.37-0.98). There were no significant between-group differences for other secondary outcomes., Conclusions: This intervention did not significantly reduce the fall rate in community-dwelling older people with CI. The intervention did reduce the fall rate in participants with better baseline physical function., Clinical Trials Registration Number: Australian and New Zealand Trials Registry ACTRN12614000603617., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2021
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3. Pilot feasibility study of a home-based fall prevention exercise program (StandingTall) delivered through a tablet computer (iPad) in older people with dementia.
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Taylor ME, Close JCT, Lord SR, Kurrle SE, Webster L, Savage R, and Delbaere K
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- Aged, Aged, 80 and over, Computers, Handheld, Exercise Therapy, Feasibility Studies, Humans, Postural Balance, Accidental Falls prevention & control, Dementia diagnosis
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Objective: To assess the feasibility and safety of StandingTall-an individually tailored, progressive exercise program delivered through tablet computers-in community-dwelling older people with dementia., Methods: Fifteen community-dwelling older people with dementia (mean age = 83 ± 8 years; Montreal Cognitive Assessment 16 ± 5) received StandingTall for 12 weeks with caregiver assistance. Feasibility and safety were assessed using the System Usability Scale (SUS; scores = 0-100; a priori target >65), Physical Activity Enjoyment Scale (PACES-8; scores = 8-56), adherence (exercise minutes) and adverse events., Results: Mean SUS scores were 68 ± 21/69 ± 15 (participants/caregivers). The mean PACES-8 score was 44 ± 8. In week 2, week 7 and week 12, mean (bias-corrected and accelerated 95% CI) exercise minutes were 37 (25-51), 49 (30-69) and 65 (28-104), respectively. In week 12, five participants exercised >115 minutes. One participant fell while exercising, without sustained injury., Conclusions: StandingTall had acceptable usability, scored well on enjoyment and was feasible for participants. These results provide support for further evaluation of StandingTall in a randomised controlled trial with falls as the primary outcome., (© 2019 AJA Inc.)
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- 2020
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4. White matter hyperintensities are associated with falls in older people with dementia.
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Taylor ME, Lord SR, Delbaere K, Wen W, Jiang J, Brodaty H, Kurrle SE, Stefanie Mikolaizak A, and Close JCT
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- Aged, 80 and over, Cognition physiology, Executive Function physiology, Female, Humans, Independent Living, Magnetic Resonance Imaging, Male, Prospective Studies, Accidental Falls, Brain pathology, Brain physiopathology, Dementia diagnostic imaging, White Matter pathology
- Abstract
White Matter Hyperintensities (WMHs) are associated with impaired gait, balance and cognition and increased fall risk in cognitively healthy older people. However, few studies have examined such relationships in older people with dementia. Understanding the role of WMHs in falls may assist in developing effective fall prevention strategies. We investigated the relationship between baseline WMHs, cognitive and sensorimotor function and prospective falls in older people with dementia. Twenty-eight community-dwelling older people with mild-moderate dementia (MMSE 11-23; ACE-R < 83) underwent magnetic resonance imaging and assessment of sensorimotor and cognitive (global and processing speed) function at baseline. WMHs, were quantified using a fully automated segmentation toolbox, UBO Detector ( https://cheba.unsw.edu.au/group/neuroimaging-pipeline ). Falls were ascertained prospectively for 12-months using monthly calendars with the assistance of carers. The median age of the participants was 83 years (IQR 77-86); 36% were female; 21 (75%) fell during follow-up. Using Generalized Linear Models, larger volumes of total WMHs were found to be significantly associated with poorer global cognitive and sensorimotor function. Using modified Poisson regression, total, periventricular and deep WMHs were each associated with future falls while controlling for age, sex, intracranial volume and vascular risk. Each standard deviation increase in total and periventricular WMH volume resulted in a 33% (RR 1.33 95%CI 1.07-1.66) and 30% (RR 1.30 95%CI 1.06-1.60) increased risk of falling, respectively. When the deep WMH volume z-scores were dichotomized at the median, individuals with greater deep WMH volumes had an 81% (RR 1.81 95% CI 1.02-3.21) increased risk of falling. WMHs were associated with poorer sensorimotor and cognitive function in people with dementia and total, periventricular and deep WMHs were associated with falls. Further research is needed to confirm these preliminary findings and explore the impact of vascular risk reduction strategies on WMHs, functional performance and falls.
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- 2019
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5. Process outcomes of a multifaceted, interdisciplinary knowledge translation intervention in aged care: results from the vitamin D implementation (ViDAus) study.
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Walker P, Kifley A, Kurrle S, and Cameron ID
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- Aged, Aged, 80 and over, Aging drug effects, Assisted Living Facilities trends, Australia epidemiology, Dietary Supplements, Evidence-Based Practice trends, Family psychology, Female, Health Personnel psychology, Health Personnel trends, Homes for the Aged trends, Humans, Male, Retrospective Studies, Translational Research, Biomedical trends, Accidental Falls prevention & control, Aging physiology, Evidence-Based Practice methods, Patient Care Team trends, Translational Research, Biomedical methods, Vitamin D administration & dosage
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Background: Vitamin D supplement use is recommended best practice in residential aged care facilities (RACFs) for the prevention of falls, however has experienced delays in uptake. Following successful international efforts at implementing this evidence into practice, the ViDAus study sought to replicate this success for the Australian context. The aim of this paper is to report on the process outcomes of implementing this intervention., Methods: Forty-one RACFs were engaged in a multifaceted, interdisciplinary knowledge translation intervention. This focused on raising awareness to improve knowledge on vitamin D, and supporting facilities to identify barriers and implement locally devised strategies to improve the uptake of evidence based practice (EBP)., Results: Staff members of participating facilities (n = 509 including nursing, care and allied health staff) were well engaged and accepting of the intervention, though engagement of servicing general practitioners (GPs) (n = 497) and pharmacists (n = 9) was poor. Facilities each identified between three and eight strategies focused on raising awareness, identifying residents to target for vitamin D and creating referral pathways depending upon their own locally identified barriers and capacity. There was variable success at implementing these over the 12-month intervention period. Whilst this study successfully raised awareness among staff, residents and their family members, barriers were identified that hindered engagement of GPs., Conclusions: The intervention was overall feasible to implement and perceived as appropriate by GPs, pharmacists, facility staff, residents and family members. More facilitation, higher-level organisational support and strategies to improve RACF access to GPs however were identified as important improvements for the implementation of vitamin D supplement use., Trial Registration: Retrospectively registered (ANZCTR ID: ACTRN12616000782437 ) on 15 June 2016.
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- 2019
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6. Inaccurate judgement of reach is associated with slow reaction time, poor balance, impaired executive function and predicts prospective falls in older people with cognitive impairment.
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Taylor ME, Butler AA, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, and Close JCT
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- Aged, Aged, 80 and over, Female, Humans, Judgment, Logistic Models, Male, Prospective Studies, Risk Factors, Trail Making Test, Accidental Falls, Cognitive Dysfunction physiopathology, Executive Function, Postural Balance, Reaction Time
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Background: Awareness of physical ability may impact fall risk during everyday tasks. Therefore, we investigated perceived reach (PR; estimation of furthest reach distance), maximal reach (MR) and reach judgement error (RJE), and their relationships with neuropsychological and physical performance, and falls in older people with cognitive impairment (CI)., Methods: Prospective cohort study of 110 (mean age = 82 ± 7 years; female = 52%) older people with mild-moderate CI (MMSE 11-23; Addenbrooke's Cognitive Examination-Revised (ACE-R) < 83). PR, MR and detailed neuropsychological and physical assessments were assessed at baseline. Participants were divided into tertiles based on their absolute RJE. Falls were recorded prospectively over 12 months with the assistance of carers., Results: The populations mean MR was 79 ± 10 cm and PR was 75 ± 13 cm, indicating participants tended to underestimate their reach ability. The large RJE tertile performed significantly poorer in measures of global cognition (ACE-R; OR 0.54 95%CI 0.31-0.95) and executive function (Trail Making Test B; OR 1.84 95%CI 1.00-3.36) and had increased concern about falling (Falls Efficacy Scale-International; OR 2.01 95% CI 1.06-3.79) compared to the minimal RJE tertile. The moderate and large RJE tertile groups had significantly slower hand reaction time and larger postural sway on foam compared to the minimal RJE tertile. Each 1% increase in RJE increased the risk of falls by 2% (RR 1.02 95%CI 1.01-1.03). This relationship withstood adjustment for other fall risk factors (sway on foam, Trail Making Test B and ACE-R)., Conclusions: Inaccurate reach judgement predicts future falls and is associated with poorer global cognitive performance and executive function, increased concern about falling, slower reaction time and poorer balance. Our results offer insight into the disparity between actual and perceived physical capabilities in people with CI, and how this impacts their risk of falling., (Copyright © 2018 Elsevier Inc. All rights reserved.)
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- 2018
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7. Prevalence of vitamin D supplement use in Australian residential aged care facilities in November 2014.
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Walker P, Miller Amberber A, Kurrle S, Kifley A, and Cameron ID
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- Aged, Aged, 80 and over, Australia, Female, Humans, Male, Prevalence, Accidental Falls prevention & control, Calcium, Dietary administration & dosage, Dietary Supplements statistics & numerical data, Homes for the Aged statistics & numerical data, Osteoporosis drug therapy, Vitamin D administration & dosage
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Objective: We sought to establish the prevalence and predictors of adequate vitamin D supplement use, as per current falls prevention guidelines in Australian aged care homes. De-identified medication chart data from November 2014 were collected from pharmacists. The proportion of residents prescribed vitamin D and associations between adequate vitamin D supplementation and state, calcium use and osteoporosis medication use were assessed., Results: The prevalence of adequate vitamin D supplement use (≥800 IU) was 47.1% of residents (95% CI 41.4, 52.8%). There was no significant difference between states (p = 0.3), however there was large variation between individual facilities (15.9-85.0%). Residents were more likely to be prescribed an adequate dose of vitamin D if they were prescribed a calcium supplement (p = 0.0001) or an osteoporosis medication (p = 0.03).
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- 2017
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8. Reaction Time and Postural Sway Modify the Effect of Executive Function on Risk of Falls in Older People with Mild to Moderate Cognitive Impairment.
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Taylor ME, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, and Close JCT
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- Aged, Aged, 80 and over, Female, Humans, Male, Prospective Studies, Risk Factors, Accidental Falls, Cognitive Dysfunction physiopathology, Executive Function physiology, Postural Balance physiology, Reaction Time physiology
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Objectives: To explore the relationship between cognitive performance and falls in older people with mild to moderate cognitive impairment (CI) by investigating the mediational effects of medical, medication, neuropsychological, and physiological factors., Design: Secondary analysis, prospective cohort study., Setting: Community and low-level care., Participants: 177 older people (aged 82 ± 7 years) with mild to moderate CI (MMSE 11-23; ACE-R < 83)., Measurements: Global cognition and six neuropsychological domains (memory, language, visuospatial, processing speed, executive function [EF], and affect) were assessed. Participants also underwent sensorimotor and balance assessments. Falls were recorded prospectively for 12 months., Results: The EF domain was most strongly associated with multiple falls (relative risk [RR]: 1.50, 95% CI: 1.18-1.91). Global cognition was not associated with falls (RR: 1.09, 95% CI: 0.92-1.30). Additional analyses showed that participants with poorer EF (median cutpoint) were more likely to be taking centrally acting medications and were less physically active. They also had significantly worse vision, reaction time, knee extension strength, balance (postural sway, controlled leaning balance), and higher physiological fall risk scores. Participants with poorer EF were 1.5 times (RR: 1.50, 95% CI: 1.03-2.18) more likely to have multiple falls. Mediational analyses demonstrated that reaction time and postural sway reduced the relative risk of EF on multiple falls by 31% (RR: 1.19, 95% CI: 0.81-1.74)., Conclusions: Within this sample of older people with mild to moderate CI, poorer EF increased the risk of multiple falls. This relationship was mediated by reaction time and postural sway,suggesting cognitively impaired older people with poorer EF may benefit from fall prevention programs targeting these mediating factors., (Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)
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- 2017
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9. A home-based, carer-enhanced exercise program improves balance and falls efficacy in community-dwelling older people with dementia.
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Taylor ME, Lord SR, Brodaty H, Kurrle SE, Hamilton S, Ramsay E, Webster L, Payne NL, and Close JC
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- Accidental Falls prevention & control, Aged, Aged, 80 and over, Australia, Caregivers, Female, Home Care Services, Humans, Independent Living, Male, Psychiatric Status Rating Scales, Quality of Life, Treatment Outcome, Accidental Falls statistics & numerical data, Dementia rehabilitation, Exercise Therapy methods, Patient Compliance statistics & numerical data, Postural Balance
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Background: Older people with dementia are at increased risk of physical decline and falls. Balance and mood are significant predictors of falls in this population. The aim of this study was to determine the effect of a tailored home-based exercise program in community-dwelling older people with dementia., Methods: Forty-two participants with mild to moderate dementia were recruited from routine health services. All participants were offered a six-month home-based, carer-enhanced, progressive, and individually tailored exercise program. Physical activity, quality of life, physical, and psychological assessments were administered at the beginning and end of the trial., Results: Of 33 participants (78.6%) who completed the six-month reassessment ten (30%) reported falls and six (18%) multiple falls during the follow-up period. At reassessment, participants had better balance (sway on floor and foam), reduced concern about falls, increased planned physical activity, but worse knee extension strength and no change in depression scores. The average adherence to the prescribed exercise sessions was 45% and 22 participants (52%) were still exercising at trial completion. Those who adhered to ≥70% of prescribed sessions had significantly better balance at reassessment compared with those who adhered to <70% of sessions., Conclusions: This trial of a tailored home-based exercise intervention presents preliminary evidence that this intervention can improve balance, concern about falls, and planned physical activity in community-dwelling older people with dementia. Future research should determine whether exercise interventions are effective in reducing falls and elucidate strategies for enhancing uptake and adherence in this population.
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- 2017
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10. Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomised controlled trial.
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Fairhall N, Sherrington C, Lord SR, Kurrle SE, Langron C, Lockwood K, Monaghan N, Aggar C, and Cameron ID
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- Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Cooperative Behavior, Female, Geriatric Assessment, Humans, Interdisciplinary Communication, Male, Mental Health, Muscle Strength, Muscle, Skeletal physiopathology, New South Wales, Nutrition Assessment, Prospective Studies, Risk Assessment, Risk Factors, Time Factors, Accidental Falls prevention & control, Exercise Therapy, Frail Elderly, House Calls, Patient Care Team
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Background: frail older people have a high risk of falling., Objective: assess the effect of a frailty intervention on risk factors for falls and fall rates in frail older people., Design: randomised controlled trial., Participants: 241 community-dwelling people aged 70+ without severe cognitive impairment who met the Cardiovascular Health Study frailty definition., Intervention: multifactorial, interdisciplinary intervention targeting frailty characteristics with an individualised home exercise programme prescribed in 10 home visits from a physiotherapist and interdisciplinary management of medical, psychological and social problems., Measurements: risk factors for falls were measured using the Physiological Profile Assessment (PPA) and mobility measures at 12 months by a blinded assessor. Falls were monitored with calendars., Results: participants had a mean (SD) age of 83.3 (5.9) years, 68% were women and 216 (90%) completed the study. After 12 months the intervention group had significantly better performance than the control group, after controlling for baseline values, in the PPA components of quadriceps strength (between-group difference 1.84 kg, 95% CI 0.17-3.51, P = 0.03) and body sway (-90.63 mm, 95% CI -168.6 to -12.6, P = 0.02), short physical performance battery (1.58, 95% CI 1.02-2.14, P ≤ 0.001) and 4 m walk (0.06 m/s 95% CI 0.01-0.10, P = 0.02) with a trend toward a better total PPA score (-0.40, 95% CI -0.83-0.04, P = 0.07) but no difference in fall rates (incidence rate ratio 1.12, 95% CI 0.78-1.63, P = 0.53)., Conclusion: the intervention improved performance on risk factors for falls but did not reduce the rate of falls., Trial Registration: ACTRN12608000250336., (© The Author 2013. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@ oup.com.)
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- 2014
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11. Wearing hip protectors does not reduce health-related quality of life in older people.
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Schaafsma FG, Kurrle SE, Quine S, Lockwood K, and Cameron ID
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- Aged, Aged, 80 and over, Female, Humans, Male, Patient Compliance, Accidental Falls, Hip Fractures prevention & control, Protective Devices, Quality of Life
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- 2012
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12. A simple tool predicted probability of falling after aged care inpatient rehabilitation.
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Sherrington C, Lord SR, Close JC, Barraclough E, Taylor M, O'Rourke S, Kurrle S, Tiedemann A, Cumming RG, and Herbert RD
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- Aged, Aged, 80 and over, Area Under Curve, Cohort Studies, Female, Humans, Male, Patient Discharge, Predictive Value of Tests, Probability, Rehabilitation Centers, Risk Assessment, Accidental Falls, Aftercare, Hospitalization
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Objective: To develop and internally validate a falls prediction tool for people being discharged from inpatient aged care rehabilitation., Study Design and Setting: Prospective cohort study. Possible predictors of falls were collected for 442 aged care rehabilitation inpatients at two hospitals., Results: One hundred fifty participants fell in the 3 months after discharge from rehabilitation (34% of 438 with follow-up data). Predictors of falls were male gender (odds ratio [OR] 2.32, 95% confidence interval [CI]=1.00-4.03), central nervous system medication prescription (OR 2.04, 95% CI=1.00-3.30), and increased postural sway (OR 1.93, 95% CI=1.00-3.26). This three-variable model was adapted for clinical use by unit weighting (i.e., a score of 1 for each predictor present). The area under the receiver operating characteristic curve (AUC) for this tool was 0.69 (95% CI=0.64-0.74, bootstrap-corrected AUC=0.69). There was no evidence of lack of fit between prediction and observation (Hosmer-Lemeshow P=0.158)., Conclusion: After external validation, this simple tool could be used to quantify the probability with which an individual will fall in the 3 months after an aged care rehabilitation stay. It may assist in the discharge process by identifying high-risk individuals who may benefit from ongoing assistance or intervention., (Copyright © 2011 Elsevier Inc. All rights reserved.)
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- 2011
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13. Effectiveness of a multifactorial intervention to reduce physical restraints in nursing home residents.
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Koczy P, Becker C, Rapp K, Klie T, Beische D, Büchele G, Kleiner A, Guerra V, Rissmann U, Kurrle S, and Bredthauer D
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- Accidental Falls statistics & numerical data, Aged, Aged, 80 and over, Cluster Analysis, Disability Evaluation, Durable Medical Equipment, Female, Germany epidemiology, Humans, Incidence, Male, Prognosis, Protective Devices, Restraint, Physical statistics & numerical data, Accidental Falls prevention & control, Nursing Homes, Restraint, Physical adverse effects
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Objectives: To evaluate the effectiveness of a multifactorial intervention to reduce the use of physical restraints in residents of nursing homes., Design: Cluster-randomized controlled trial., Setting: Forty-five nursing homes in Germany., Participants: Three hundred thirty-three residents who were being restrained at the start of the intervention., Intervention: Persons responsible for the intervention in the nursing homes attended a 6-hour training course that included education about the reasons restraints are used, the adverse effects, and alternatives to their use. Technical aids, such as hip protectors and sensor mats, were provided. The training was designed to give the change agents tools for problem-solving to prevent behavioral symptoms and injuries from falls without using physical restraints., Measurements: The main outcome was the complete cessation of physical restraint use on 3 consecutive days 3 months after the start of the intervention. Secondary outcomes were partial reductions in restraint use, percentage of fallers, number of psychoactive drugs, and occurrence of behavioral symptoms., Results: The probability of being unrestrained in the intervention group (IG) was more than twice that in the control group (CG) at the end of the study (odds ratio=2.16, 95% confidence interval=1.05-4.46). A partial reduction of restraint use was also about twice as often achieved in the IG as in the CG. No negative effect was observed regarding medication or behavioral symptoms. The percentage of fallers was higher in the IG., Conclusion: The intervention reduced restraint use without a significant increase in falling, behavioral symptoms, or medication., (© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.)
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- 2011
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14. Development of a tool for prediction of falls in rehabilitation settings (Predict_FIRST): a prospective cohort study.
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Sherrington C, Lord SR, Close JC, Barraclough E, Taylor M, Oâ Rourke S, Kurrle S, Tiedemann A, Cumming RG, and Herbert RD
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- Aged, Cognition, Cohort Studies, Female, Humans, Inpatients, Male, Middle Aged, Postural Balance, Predictive Value of Tests, Prospective Studies, Rehabilitation Centers, Risk Factors, Accidental Falls prevention & control, Risk Assessment methods
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Objective: To develop and internally validate a simple falls prediction tool for rehabilitation settings., Design: Prospective cohort study., Participants: A total of 533 inpatients., Methods: Possible predictors of falls were collected from medical records, interview and physical assessment. Falls during inpatient stays were monitored., Results: Fourteen percent of participants fell. A multivariate model to predict falls included: male gender (odds ratio (OR) 2.70, 95% confidence interval (CI) 1.57-4.64), central nervous system medications (OR 2.50, 95% CI 1.47-4.25), a fall in the previous 12 months (OR 2.21, 95% CI 1.07-4.56), frequent toileting (OR 2.14, 95% CI 1.27-3.62) and tandem stance inability (OR 2.00, 95% CI 1.11-3.59). The area under the curve for this model was 0.74 (95% CI 0.68-0.80). The Predict_FIRST tool is a unit weighted adaptation of this model (i.e. 1 point allocated for each predictor) and its area under the curve was 0.73 (95% CI 0.68-0.79). Predicted and actual falls risks corresponded closely., Conclusion: This tool provides a simple way to quantify the probability with which an individual patient will fall during a rehabilitation stay.
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- 2010
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15. Preventing falls in elderly people living in hospitals and care homes.
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Cameron ID and Kurrle S
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- Aged, Homes for the Aged, Hospitalization, Humans, Accidental Falls prevention & control
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- 2007
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16. The perils of pet ownership: a new fall-injury risk factor.
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Kurrle SE, Day R, and Cameron ID
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- Age Distribution, Aged, Aged, 80 and over, Animals, Animals, Domestic, Cats, Cohort Studies, Dogs, Follow-Up Studies, Fractures, Bone therapy, Goats, Humans, Incidence, Middle Aged, New South Wales, Risk Assessment, Sex Distribution, Accidental Falls statistics & numerical data, Fractures, Bone epidemiology, Fractures, Bone etiology
- Abstract
Objective: To describe fall-related injuries due to pets in an older population., Design: Case series., Participants and Setting: Patients aged 75 years and over presenting to the emergency department of a metropolitan hospital in northern Sydney over 18 months, with a fracture directly related to their pet., Main Outcome Measures: Type of fracture; circumstances of injury., Results: 16 cases (mean patient age, 81 years) are described; 13 (81%) involved women. Animals of five species were involved, with cats and dogs being the most common pet hazard., Conclusions: Pets are a potential environmental hazard in the occurrence of fall-related injuries in older people, with dogs and cats most likely to be involved. Women appear more likely than men to be injured.
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- 2004
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17. Predictors of adherence with the recommended use of hip protectors.
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Kurrle SE, Cameron ID, and Quine S
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- Aged psychology, Aged, 80 and over, Australia, Cohort Studies, Female, Forecasting, Humans, Accidental Falls, Hip Fractures prevention & control, Patient Compliance, Protective Devices
- Abstract
Background: Hip protectors can prevent many hip fractures in older persons at high risk for falling. Few published studies have investigated the use of hip protectors in community-dwelling older persons, and the level of adherence with their use, and predictors of adherence in this setting, are not clear. The aim of this study was to report the predictors of adherence and the level of adherence with the use of hip protectors in frail community-dwelling older women., Methods: This cohort study of the intervention group of a randomized, controlled trial recruited participants from aged care health services in urban areas of northern Sydney, Australia. Participants were 302 women who were 74 years or older (mean age, 83 years) and who had 2 or more falls or 1 fall requiring hospital admission in the previous year and who lived in their own homes. The main outcome measure was adherence with the use of hip protectors., Results: Adherence was approximately 53% during the 2 years of the study, and hip protectors were worn at the time of 51% of falls. The significant independent predictors of nonadherence with hip protector use were lower self-efficacy for hip protector use (odds ratio [OR], 0.51; 95% confidence interval [CI],.33 to.79), higher number of perceived barriers to hip protector use (OR, 0.52; 95% CI, .38 to.72), and lower self-rated health (OR, 0.71; 95% CI, .55 to.93)., Conclusions: Three easily measured factors independently predicted subsequent adherence with hip protector use. These findings may form the basis for strategies to improve adherence with the use of hip protectors and with other types of treatment or preventive strategies in older persons.
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- 2004
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18. Older People with Dementia Have Reduced Daily-Life Activity and Impaired Daily-Life Gait When Compared to Age-Sex Matched Controls.
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Taylor, Morag E., Brodie, Matthew A., van Schooten, Kimberley S., Delbaere, Kim, Close, Jacqueline C.T., Payne, Narelle, Webster, Lyndell, Chow, Jessica, McInerney, Garth, Kurrle, Susan E., Lord, Stephen R., Montero-Odasso, Manuel, and Perry, George
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OLDER people ,DEMENTIA ,WALKING speed ,MEMORY bias ,PHYSICAL activity - Abstract
Understanding the characteristics of physical activity and daily-life gait in older people with dementia may help identify those at risk of negative health outcomes and inform targeted interventions. Questionnaires are often used to assess physical activity but may be more affected by recall bias in people with dementia and provide little information about daily-life gait characteristics. The aim of the study was to assess differences in daily-life activity levels and gait characteristics between community-dwelling older people with mild to moderate dementia (n = 45; mean age 81±6 years, 42% female) and age-sex matched (1:2) cognitively-healthy controls (n = 90). Participants wore a tri-axial accelerometer (DynaPort MoveMonitor, McRoberts) on their lower back for 7 days and were assessed on neuropsychological and physical performance. Compared to age-sex matched controls, participants with dementia demonstrated reduced daily-life activity (fewer steps per day, fewer and shorter walking bouts, and lower daily walk time) and walking intensity (reduced speed, stride length and cadence). Participants with dementia also had significantly increased within-walk variability (stride time) and less regular gait (higher sample entropy). Within the group of participants with dementia, higher daily-life activity levels were associated with greater self-reported physical activity and better executive function. Fallers (1+ falls past year) with dementia had significantly reduced daily-life activity and walking speed when compared to non-fallers with dementia. In conclusion, people with dementia are less active in daily-life and present with significant impairments across multiple gait domains when compared to age-sex matched controls. These findings highlight opportunities for targeted interventions and support further research to examine interventions aimed at addressing these deficits. [ABSTRACT FROM AUTHOR]
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- 2019
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19. Reaction Time and Postural Sway Modify the Effect of Executive Function on Risk of Falls in Older People with Mild to Moderate Cognitive Impairment.
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Mikolaizak, A. Stefanie, Taylor, Morag E., Close, Jacqueline C. T., Lord, Stephen R., Delbaere, Kim, and Kurrle, Susan E.
- Abstract
Objectives: To explore the relationship between cognitive performance and falls in older people with mild to moderate cognitive impairment (CI) by investigating the mediational effects of medical, medication, neuropsychological, and physiological factors.Design: Secondary analysis, prospective cohort study.Setting: Community and low-level care.Participants: 177 older people (aged 82 ± 7 years) with mild to moderate CI (MMSE 11-23; ACE-R < 83).Measurements: Global cognition and six neuropsychological domains (memory, language, visuospatial, processing speed, executive function [EF], and affect) were assessed. Participants also underwent sensorimotor and balance assessments. Falls were recorded prospectively for 12 months.Results: The EF domain was most strongly associated with multiple falls (relative risk [RR]: 1.50, 95% CI: 1.18-1.91). Global cognition was not associated with falls (RR: 1.09, 95% CI: 0.92-1.30). Additional analyses showed that participants with poorer EF (median cutpoint) were more likely to be taking centrally acting medications and were less physically active. They also had significantly worse vision, reaction time, knee extension strength, balance (postural sway, controlled leaning balance), and higher physiological fall risk scores. Participants with poorer EF were 1.5 times (RR: 1.50, 95% CI: 1.03-2.18) more likely to have multiple falls. Mediational analyses demonstrated that reaction time and postural sway reduced the relative risk of EF on multiple falls by 31% (RR: 1.19, 95% CI: 0.81-1.74).Conclusions: Within this sample of older people with mild to moderate CI, poorer EF increased the risk of multiple falls. This relationship was mediated by reaction time and postural sway,suggesting cognitively impaired older people with poorer EF may benefit from fall prevention programs targeting these mediating factors. [ABSTRACT FROM AUTHOR]- Published
- 2017
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20. A home-based, carer-enhanced exercise program improves balance and falls efficacy in community-dwelling older people with dementia.
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Hamilton, Sarah, Ramsay, Elisabeth, Webster, Lyndell, Payne, Narelle L., Taylor, Morag E., Close, Jacqueline C. T., Kurrle, Susan E., Lord, Stephen R., and Brodaty, Henry
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Background: Older people with dementia are at increased risk of physical decline and falls. Balance and mood are significant predictors of falls in this population. The aim of this study was to determine the effect of a tailored home-based exercise program in community-dwelling older people with dementia.Methods: Forty-two participants with mild to moderate dementia were recruited from routine health services. All participants were offered a six-month home-based, carer-enhanced, progressive, and individually tailored exercise program. Physical activity, quality of life, physical, and psychological assessments were administered at the beginning and end of the trial.Results: Of 33 participants (78.6%) who completed the six-month reassessment ten (30%) reported falls and six (18%) multiple falls during the follow-up period. At reassessment, participants had better balance (sway on floor and foam), reduced concern about falls, increased planned physical activity, but worse knee extension strength and no change in depression scores. The average adherence to the prescribed exercise sessions was 45% and 22 participants (52%) were still exercising at trial completion. Those who adhered to ≥70% of prescribed sessions had significantly better balance at reassessment compared with those who adhered to <70% of sessions.Conclusions: This trial of a tailored home-based exercise intervention presents preliminary evidence that this intervention can improve balance, concern about falls, and planned physical activity in community-dwelling older people with dementia. Future research should determine whether exercise interventions are effective in reducing falls and elucidate strategies for enhancing uptake and adherence in this population. [ABSTRACT FROM AUTHOR]- Published
- 2017
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21. Improving Adherence With the Use of Hip Protectors Among Older People Living in Nursing Care Facilities: A Cluster Randomized Trial
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Cameron, Ian D., Kurrle, Susan E., Quine, Susan, Sambrook, Philip N., March, Lyn, Chan, Daniel K.Y., Lockwood, Keri, Cook, Bronwyn, and Schaafsma, Frederieke F.
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PATIENT compliance , *MEDICAL cooperation , *PATIENT participation , *HEALTH self-care , *NURSING home patients , *BONE fracture prevention , *HIP joint injury prevention , *HIP protectors , *OLDER people , *ELDER care , *ANALYSIS of variance , *CHI-squared test , *CLUSTER analysis (Statistics) , *COMPARATIVE studies , *STATISTICAL correlation , *DIAGNOSIS , *ACCIDENTAL falls , *BONE fractures , *HEALTH status indicators , *HIP joint injuries , *HOSPITAL care , *LONG-term health care , *LONGITUDINAL method , *MENTAL health surveys , *NURSING care facilities , *HEALTH outcome assessment , *PATIENT education , *QUALITY of life , *RESEARCH funding , *STATISTICAL sampling , *STATISTICAL hypothesis testing , *STATISTICS , *STATISTICAL power analysis , *DATA analysis , *ACTIVITIES of daily living , *RANDOMIZED controlled trials , *OLD age - Abstract
Objectives: To test different adherent strategies aimed at improving hip protector use among nursing care facility residents. Design, Setting and Participants: A cluster randomized controlled trial with 234 residents older than 75 years from 9 units of 7 nursing care facilities in the Northern Sydney region, Australia. Intervention: Residents were cluster randomized in 3 groups. The first group received hard shell hip protectors without cost (no cost group). The second group received an educational session, a demonstration of the use of hip protectors, and free choice of type of hip protectors without cost (combined group). The third group was the control group who received a brochure about hip protectors. Measurements: Primary outcome was adherence with the use of hip protectors at 3 and 6 months after recruitment. Secondary outcomes were falls, injuries, and fractures. Results: No participants in the control group purchased hip protectors at any stage. At 3 months, 33% of participants in the no cost group and 27% in the combined group wore a hip protector at the time of visit. This declined to 25% and 24% respectively at 6 months. No significant difference was seen in any of the 3 adherence outcomes between the 2 intervention groups. The number of falls or hospitalizations did not differ between groups, with 5 hip fractures reported during the intervention period. Residents were more likely to be adherent if they were female and had greater restriction in daily activities. Conclusion: Providing free hip protectors to older people living in nursing care facilities was necessary to increase initial acceptance and adherence. Nevertheless, after 6 months the achieved level of adherence was not high enough to be associated with a reduction of hip fractures. The provision of educational sessions and demonstrations to nursing staff and participants had no added value in this trial. [Copyright &y& Elsevier]
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- 2011
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22. Walking aid use after discharge following hip fracture is rarely reviewed and often inappropriate: an observational study.
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Thomas, Susie, Halbert, Julie, Mackintosh, Shylie, Cameron, Ian D., Kurrle, Susan, Whitehead, Craig, Miller, Michelle, and Crotty, Maria
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BONE fractures ,PHYSICAL therapists ,FRAIL elderly ,PHYSICAL therapy ,ACCIDENTAL falls - Abstract
Questions: What walking aid prescription occurs at discharge after hip fracture? What changes in walking aid use occur in the following six months? Who initiates changes in walking aids and why? Design: Prospective longitudinal observational study. Participants: 95 community-dwelling older adults who had undergone surgical treatment of a hip fracture. Outcome measures: Range of walking aids prescribed at discharge and participants' recall of advice about progression were recorded. Progression of walking aids was observed fortnightly over 6 months. With any change in walking aid use, an independent physiotherapist determined if it was appropriate and participants reported the reason for the change. Results: Most participants were discharged from their final inpatient setting with a wheeled frame (92%). Eighty-two (86%) participants were not aware of any goals set by the physiotherapist for the first 6 months and 89 (94%) stated that a review time had not been set. Despite this, 78 (82%) participants changed their walking aid, on average 8 weeks (SD 6) after discharge. However, 32% of those who changed their walking aids were using an inappropriate aid or using it incorrectly. Six months after discharge, 40% of participants had not returned to using their pre-morbid indoor aid and 50% their outdoor aid. Conclusion: A review of walking aid by a physiotherapist is rare within six months after discharge following hip fracture. Most patients make their own decision about what walking aid is most appropriate. This has safety implications in a group at high risk of falls. [ABSTRACT FROM AUTHOR]
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- 2010
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23. Frailty in older people: Rehabilitation Treatment Research Examining Separate Settings (FORTRESS): protocol for a hybrid type II stepped wedge, cluster, randomised trial
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Heather Block, Alexandra Annesley, Keri Lockwood, Linda Xu, Ian D. Cameron, Kate Laver, Maria Crotty, Catherine Sherrington, Annette Kifley, Kirsten Howard, Dimity Pond, Tuan A. Nguyen, Susan E. Kurrle, Block, Heather, Annesley, Alexandra, Lockwood, Keri, Xu, Linda, Cameron, Ian D, Laver, Kate, Crotty, Maria, Sherrington, Catherine, Kifley, Annette, Howard, Kirsten, Pond, Dimity, Nguyen, Tuan A, and Kurrle, Susan E
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exercise ,Frailty ,Australia ,transition ,frailty ,older people ,Hospitalization ,aged ,primary care ,nutrition ,Quality of Life ,Humans ,Accidental Falls ,hospital ,Geriatrics and Gerontology ,implementation ,Aged ,Randomized Controlled Trials as Topic - Abstract
Background Frailty in older people is associated with increased risk of falls, longer length of stay in hospital, increased risk of institutionalisation and death. Frailty can be measured using validated tools. Multi-component frailty interventions are recommended in clinical practice guidelines but are not routinely implemented in clinical practice. Methods The Frailty in Older people: Rehabilitation, Treatment, Research Examining Separate Settings (FORTRESS) trial is a multisite, hybrid type II, stepped wedge, cluster, randomised trial with blinded assessment and intention-to-treat analysis being conducted in Australia. The study aims to determine the effectiveness and cost-effectiveness of an embedded individualised multicomponent frailty intervention (commencing in hospital and continuing in the community) on readmissions, frailty and quality of life when compared with usual care. Frail older people admitted to study wards with no significant cognitive impairment, who are expected to return home after discharge, will be eligible to participate. Participants will receive extra sessions of physiotherapy, pharmacy, and dietetics during their admission. A Community Implementation Facilitator will coordinate implementation of the frailty management strategies and primary network liaison. The primary outcome is number of days of non-elective hospital readmissions during 12 month follow-up period. Secondary outcomes include frailty status measured using the FRAIL scale; quality of life measured using the EQ-5D-5L; and time-to-event for readmission and readmission rates. The total cost of delivering the intervention will be assessed, and cost-effectiveness analyses will be conducted. Economic evaluation will include analyses for health outcomes measured in terms of the main clinical outcomes. Implementation outcomes will be collected as part of a process evaluation. Recruitment commenced in 2020 and we are aiming to recruit 732 participants over the three-year duration of the study. Discussion This study will reveal whether intervening with frail older people to address factors contributing to frailty can reduce hospital readmissions and improve frailty status and quality of life. If the FORTRESS intervention provides a clinically significant and cost-effective result, it will demonstrate an improved approach to treating frail patients, both in hospital and when they return home. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000760976p. ANZCTR registered 24 July 2020.
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- 2022
24. Effectiveness of a multifactorial intervention on preventing development of frailty in pre-frail older people: study protocol for a randomised controlled trial
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Catherine Sherrington, Ian D. Cameron, Stephen R. Lord, Beatrice John, Noeline Monaghan, Keri Lockwood, Susan Kurrle, Kirsten Howard, Nicola Fairhall, Fairhall, Nicola, Kurrle, Susan E, Sherrington, Catherine, Lord, Stephen R, Lockwood, Keri, John, Beatrice, Monaghan, Noeline, Howard, Kirsten, and Cameron, Ian D
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Gerontology ,Male ,medicine.medical_specialty ,Blinding ,geriatric assessment ,Health Services for the Aged ,Frail Elderly ,Geriatric Medicine ,Alternative medicine ,law.invention ,Randomized controlled trial ,law ,Residence Characteristics ,Intervention (counseling) ,Outcome Assessment, Health Care ,medicine ,Protocol ,Humans ,Mobility Limitation ,Geriatric Assessment ,Aged ,Protocol (science) ,Geriatrics ,Aged, 80 and over ,business.industry ,General Medicine ,frail elderly ,randomised trial ,Affect ,Mood ,Research Design ,Accidental Falls ,Female ,Older people ,business - Abstract
Introduction Frailty is a major concern due to its costly and widespread consequences, yet evidence of effective interventions to delay or reduce frailty is lacking. Our previous study found that a multifactorial intervention was feasible and effective in reducing frailty in older people who were already frail. Identifying and treating people in the pre-frail state may be an effective means to prevent or delay frailty. This study describes a randomised controlled trial that aims to evaluate the effectiveness of a multifactorial intervention on development of frailty in older people who are pre-frail. Methods and analysis A single centre randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. Two hundred and thirty people aged above 70 who meet the Cardiovascular Health Study frailty criteria for pre-frailty, reside in the community and are without severe cognitive impairment will be recruited. Participants will be randomised to receive a multifactorial intervention or usual care. The intervention group will receive a 12-month interdisciplinary intervention targeting identified characteristics of frailty and problems identified during geriatric assessment. Participants will be followed for a 12-month period. Primary outcome measures will be degree of frailty measured by the number of Cardiovascular Health Study frailty criteria present, and mobility measured with the Short Physical Performance Battery. Secondary outcomes will include measures of mobility, mood and use of health and community services. Ethics and dissemination The study was approved by the Northern Sydney Local Health District Health Research Ethics Committee (1207-213M). The findings will be disseminated through scientific and professional conferences, and in peer-reviewed journals. Trial registration number Australian New Zealand Clinical Trials Registry: ACTRN12613000043730.
- Published
- 2015
25. Can a tailored exercise and home hazard reduction program reduce the rate of falls in community dwelling older people with cognitive impairment: protocol paper for the i-FOCIS randomised controlled trial
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Keith D. Hill, Henry Brodaty, Susan Kurrle, Jacqueline Wesson, Laura N. Gitlin, Catherine Sherrington, Stephen R. Lord, Jacqueline C. T. Close, Lindy Clemson, Kirsten Howard, Sandra D. O'Rourke, Close, J, Wesson, J, Sherrington, C, Hill, Keith, Kurrle, Susan, Lord, S, Brodaty, H, Howard, Kirsten, Gitlin, Laura, O'Rourke, Sandra D, and Clemson, Lindy
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Gerontology ,Male ,medicine.medical_specialty ,Safety Management ,Population ,Psychological intervention ,Poison control ,Pilot Projects ,Intervention ,Suicide prevention ,Fear of falling ,law.invention ,Study Protocol ,Quality of life (healthcare) ,Randomized controlled trial ,law ,Residence Characteristics ,Medicine ,Humans ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Prevention ,Tailored Intervention ,3. Good health ,Exercise Therapy ,Cognitive impairment ,Physical therapy ,Accidental Falls ,Female ,Dementia ,Geriatrics and Gerontology ,medicine.symptom ,business ,Cognition Disorders - Abstract
Background: The rate of falls in community dwelling older people with cognitive impairment (CI) is twice that of a cognitively intact population, with almost two thirds of people with CI falling annually. Studies indicate that exercise involving balance and/or a home hazard reduction program are effective in preventing falls in cognitively intact older people. However the potential benefit of these interventions in reducing falls in people with CI has not been established. This randomised controlled trial will determine whether a tailored exercise and home hazard reduction program can reduce the rate of falls in community dwelling older people with CI. We will determine whether the intervention has beneficial effects on a range of physical and psychological outcome measures as well as quality of life of participants and their carers. A health economic analysis examining the cost and potential benefits of the program will also be undertaken. Methods and design: Three hundred and sixty people aged 65 years or older living in the community with CI will be recruited to participate in the trial. Each will have an identifiable carer with a minimum of 3.5 hours of face to face contact each week. Participants will undergo an assessment at baseline with retests at 6 and 12 months. Participants allocated to the intervention group will participate in an exercise and home hazard reduction program tailored to their cognitive and physical abilities. The primary outcome measure will be the rate of falls which will be measured using monthly falls calendars. Secondary outcome measures will include the risk of falling, quality of life, measures of physical and cognitive function, fear of falling and planned and unplanned use of health services. Carers will be followed up to determine carer burden, coping strategies and quality of life. Discussion: The study will determine the impact of this tailored intervention in reducing the rate of falls in community dwelling older people with CI as well as the cost-effectiveness and adherence to the program. The results will have direct implications for the design and implementation of interventions for this high-risk group of older people. Trial registration: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12614000603617
- Published
- 2014
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