18 results on '"Kurrle, Susan"'
Search Results
2. 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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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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- 2022
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3. Life expectancy of older people living in aged care facilities after a hip fracture.
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Liu, Enwu, Killington, Maggie, Cameron, Ian D., Li, Raymond, Kurrle, Susan, and Crotty, Maria
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LIFE expectancy ,HIP fractures ,OLDER people ,ELDER care ,LONG-term care facilities ,GENDER ,NURSING home patients ,FRAIL elderly - Abstract
To the authors' knowledge, no study has been conducted on life expectancy for aged care facility residents with hip fracture. We assessed life expectancy of 240 residents of aged care facilities in Australia who experienced recent hip fracture treated with surgery. 149 deaths occurred over a mean follow-up of 1.2 years. Being female and having better cognition were associated with longer life expectancy. Increased age was associated with shorter life expectancy. The cumulative mortality rate within three months after hip fracture was 25.0% while the cumulative mortality rate for the whole study period was 62.1%. Life expectancy was 8.2 years, 4.8 years and 2.8 years for 70, 80 and 90-years old female patients. Life expectancy was 3.8 years, 2.2 years and 1.3 years for 70, 80 and 90 years old male patients, respectively. In conclusion, age, gender and cognition level were associated with life expectancy of hip fracture patients living in aged care facilities and their life expectancy was much shorter than that of the general Australian population. [ABSTRACT FROM AUTHOR]
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- 2021
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4. 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, Morag E, Wesson, Jacqueline, Sherrington, Catherine, Hill, Keith D, Kurrle, Susan, Lord, Stephen R, Brodaty, Henry, Howard, Kirsten, O'Rourke, Sandra D, Clemson, Lindy, Payne, Narelle, Toson, Barbara, Webster, Lyndell, Savage, Roslyn, Zelma, Genevieve, Koch, Cecelia, John, Beatrice, Lockwood, Keri, and Close, Jacqueline C T
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OLDER people ,ACCIDENTAL fall prevention ,PHYSICAL mobility ,CLINICAL trial registries ,COGNITION disorders ,CLUSTER randomized controlled trials - 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. [ABSTRACT FROM AUTHOR]- Published
- 2021
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5. 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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6. Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hip fracture? A randomised controlled trial.
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Crotty, Maria, Killington, Maggie, Liu, Enwu, Cameron, Ian D, Kurrle, Susan, Kaambwa, Billingsley, Davies, Owen, Miller, Michelle, Chehade, Mellick, and Ratcliffe, Julie
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COMPARATIVE studies ,CONFIDENCE intervals ,COST effectiveness ,BONE fractures ,HIP joint injuries ,NURSING home patients ,POSTOPERATIVE care ,QUALITY of life ,QUESTIONNAIRES ,STATISTICAL sampling ,BODY movement ,RANDOMIZED controlled trials ,TREATMENT effectiveness ,QUALITY-adjusted life years ,DESCRIPTIVE statistics ,LOG-rank test ,OLD age - Abstract
Objective to determine whether a 4-week postoperative rehabilitation program delivered in Nursing Care Facilities (NCFs) would improve quality of life and mobility compared with receiving usual care. Design parallel randomised controlled trial with integrated health economic study. Setting NCFs, in Adelaide South Australia. Subjects people aged 70 years and older who were recovering from hip fracture surgery and were walking prior to hip fracture. Measurements primary outcomes: mobility (Nursing Home Life-Space Diameter (NHLSD)) and quality of life (DEMQOL) at 4 weeks and 12 months. Results participants were randomised to treatment (n = 121) or control (n = 119) groups. At 4 weeks, the treatment group had better mobility (NHLSD mean difference −1.9; 95% CI: −3.3, −0.57; P = 0.0055) and were more likely to be alive (log rank test P = 0.048) but there were no differences in quality of life. At 12 months, the treatment group had better quality of life (DEMQOL sum score mean difference = −7.4; 95% CI: −12.5 to −2.3; P = 0.0051), but there were no other differences between treatment and control groups. Quality adjusted life years (QALYs) gained over 12 months were 0.0063 higher per participant (95% CI: −0.0547 to 0.0686). The resulting incremental cost effectiveness ratios (ICERs) were $5,545 Australian dollars per unit increase in the NHLSD (95% CI: $244 to $15,159) and $328,685 per QALY gained (95% CI: $82,654 to $75,007,056). Conclusions the benefits did not persist once the rehabilitation program ended but quality of life at 12 months in survivors was slightly higher. The case for funding outreach home rehabilitation in NCFs is weak from a traditional health economic perspective. Trial registration ACTRN12612000112864 registered on the Australian and New Zealand Clinical Trials Registry. Trial protocol available at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 361980 [ABSTRACT FROM AUTHOR]
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- 2019
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7. Medical student attitudes towards older people: a critical review of quantitative measures.
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Wilson, Mark A. G., Kurrle, Susan, and Wilson, Ian
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MEDICAL students , *OLDER people , *ADULTS , *HEALTH occupations students , *AGING , *ATTITUDE (Psychology) - Abstract
Objectives: Further research into medical student attitudes towards older people is important, and requires accurate and detailed evaluative methodology. The two objectives for this paper are: (1) From the literature, to critically review instruments of measure for medical student attitudes towards older people, and (2) To recommend the most appropriate quantitative instrument for future research into medical student attitudes towards older people. Results: A SCOPUS and Ovid cross search was performed using the keywords Attitude and medical student and aged or older or elderly. This search was supplemented by manual searching, guided by citations in articles identified by the initial literature search, using the SCOPUS and PubMed databases. International studies quantifying medical student attitudes have demonstrated neutral to positive attitudes towards older people, using various instruments. The most commonly used instruments are the Ageing Semantic Diferential (ASD) and the University of California Los Angeles Geriatric Attitudes Scale, with several other measures occasionally used. All instruments used to date have inherent weaknesses. A reliable and valid instrument with which to quantify modern medical student attitudes towards older people has not yet been developed. Adaptation of the ASD for contemporary usage is recommended. [ABSTRACT FROM AUTHOR]
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- 2018
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8. Dementia, medication and transitions of care.
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Deeks, Louise S., Cooper, Gabrielle M., Draper, Brian, Kurrle, Susan, and Gibson, Diane M.
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Background: Persons with dementia (PWD) often have complex medication regimens and are at risk of medication problems during the multiple transitions of care experienced as the condition progresses.Objectives: To explore medication processes in acute care episodes and care transitions for PWD and to make recommendations to improve practice.Method: Semi-structured interviews were conducted by two pharmacy researchers from a focused purposive sample of fifty-one participants (carers, health professionals, Alzheimer's Australia staff) from urban and rural Australia. After written consent, the interviews were audio-recorded then transcribed verbatim for face-to-face interviews, or notes were taken during the interview if conducted by telephone. The transcripts were checked for accuracy by the pharmacy researchers. Thematic analysis of the data was undertaken independently by the two researchers to reduce bias and any disagreements were resolved by discussion.Results: Themes identified were: medication reconciliation; no modified planning for care transitions; underutilization of information technology; multiple prescribers; residential aged care facilities; and medication reviews by pharmacists. Sub themes were: access to appropriate staff; identification of dementia; dose administration aids; and staff training.Conclusions: Medication management is sub-optimal for PWD during care transitions and may compromise safety. Suggested improvements included: increased involvement of pharmacists in care transitions; outreach or transitional health care professionals; modified planning for care transitions for individuals over 80 years; co-ordinated electronic records; structured communication; and staff training. [ABSTRACT FROM AUTHOR]- Published
- 2016
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9. Appendicular skeletal muscle in hospitalised hip-fracture patients: development and cross-validation of anthropometric prediction equations against dual-energy X-ray absorptiometry.
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Villani, Anthony Michael, Crotty, Maria, Cameron, Ian D., Kurrle, Susan E., Skuza, Pawel P., Cleland, Leslie G., Cobiac, Lynne, and Miller, Michelle D.
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MUSCULAR atrophy ,ANTHROPOMETRY ,WASTING syndrome ,GERIATRIC assessment ,BODY composition ,BONE fractures ,HIP joint injuries ,QUESTIONNAIRES ,T-test (Statistics) ,MULTIPLE regression analysis ,DATA analysis software ,SKELETAL muscle ,DESCRIPTIVE statistics ,PHOTON absorptiometry ,OLD age ,DIAGNOSIS - Abstract
Background: accurate and practical assessment methods for assessing appendicular skeletal muscle (ASM) is of clinical importance for the diagnosis of geriatric syndromes associated with skeletal muscle wasting.Objectives: the purpose of this study was to develop and cross-validate novel anthropometric prediction equations for the estimate of ASM in older adults post-surgical fixation for hip fracture, using dual-energy X-ray absorptiometry (DEXA) as the criterion measure.Subjects: community-dwelling older adults (aged ≥65 years) recently hospitalised for hip fracture.Setting: participants were recruited from hospital in the acute phase of recovery.Design: validation measurement study.Measurements: a total of 79 hip fracture patients were involved in the development of the regression models (MD group). A further 64 hip fracture patients also recruited in the early phase of recovery were used in the cross-validation of the regression models (CV group). Multiple linear regression analyses were undertaken in the MD group to identify the best performing prediction models. The linear coefficient of determination (R2) in addition to the standard error of the estimate (SEE) were calculated to determine the best performing model. Agreement between estimated ASM and ASMDEXA in the CV group was assessed using paired t-tests with the 95% limits of agreement (LOA) assessed using Bland–Altman analyses.Results: the mean age of all the participants was 82.1 ± 7.3 years. The best two prediction models are presented as follows: ASMPRED-EQUATION_1: 22.28 – (0.069 * age) + (0.407 * weight) – (0.807 * BMI) – (0.222 * MAC) (adjusted R2: 0.76; SEE: 1.80 kg); ASMPRED-EQUATION_2: 16.77 – (0.036 * age) + (0.385 * weight) – (0.873 * BMI) (adjusted R2: 0.73; SEE: 1.90 kg). The mean bias from the CV group between ASMDEXA and the predictive equations is as follows: ASMDEXA – ASMPRED-EQUATION_1: 0.29 ± 2.6 kg (LOA: −4.80, 5.40 kg); ASMDEXA – ASMPRED-EQUATION_2: 0.13 ± 2.5 kg (LOA: −4.77, 5.0 kg). No significant difference was observed between measured ASMDEXA and estimated ASM (ASMDEXA: 16.4 ± 3.9 kg; ASMPRED-EQUATION_1: 16.7 ± 3.2 kg (P = 0.379); ASMPRED-EQUATION_2: 16.6 ± 3.2 kg (P = 0.670)).Conclusions: we have developed and cross-validated novel anthropometric prediction equations against DEXA for the estimate of ASM designed for application in older orthopaedic patients. Our equation may be of use as an alternative to DEXA in the diagnosis of skeletal muscle wasting syndromes. Further validation studies are required to determine the clinical utility of our equation across other settings, including hip fracture patients admitted from residential care, and also with a longer-term follow-up. [ABSTRACT FROM AUTHOR]
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- 2014
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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, Nicola, Sherrington, Catherine, Lord, Stephen R., Kurrle, Susan E., Langron, Colleen, Lockwood, Keri, Monaghan, Noeline, Aggar, Christina, and Cameron, Ian D.
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ACCIDENTAL fall prevention ,RISK factors of falling down ,CONFIDENCE intervals ,EXERCISE ,FRAIL elderly ,HEALTH care teams ,HEALTH outcome assessment ,REGRESSION analysis ,RESEARCH funding ,RANDOMIZED controlled trials ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
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. [ABSTRACT FROM AUTHOR]
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- 2014
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11. Erratum to: 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, Morag E, Wesson, Jacqueline, Sherrington, Catherine, Hill, Keith D, Kurrle, Susan, Lord, Stephen R, Brodaty, Henry, Howard, Kirsten, O'Rourke, Sandra D, Clemson, Lindy, Payne, Narelle, Toson, Barbara, Webster, Lyndell, Savage, Roslyn, Zelma, Genevieve, Koch, Cecelia, John, Beatrice, Lockwood, Keri, and Close, Jacqueline C T
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OLDER people ,ACCIDENTAL fall prevention ,COGNITION disorders ,HAZARDS ,CLUSTER randomized controlled trials - Abstract
These errors have been corrected online. In the article "Tailored Exercise and Home Hazard Reduction Program for Fall Prevention in Older People With Cognitive Impairment: The i-FOCIS Randomized Controlled Trial", a number of the outcomes in Table 3 were incorrectly labelled as "Falls requiring" instead of "Fall-related". [Extracted from the article]
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- 2022
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12. 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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13. Effectiveness of Oral Nutritional Supplementation for Older Women after a Fracture: Rationale, Design and Study of the Feasibility of a Randomized Controlled Study.
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Cameron, Ian D., Kurrle, Susan E., Uy, Cesar, Lockwood, Keri A., Au, Lydia, and Schaafsma, Frederieke G.
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MALNUTRITION ,OLDER people ,BONE fractures ,MORTALITY ,PROTEINS - Abstract
Background: Malnutrition is a problem for many older people recovering from a hip and other major fractures. Oral supplementation with high calorie high protein nutrients is a simple intervention that may help older people with fractures to improve their recovery in terms of rehabilitation time, length of hospital stay and mortality. This paper reports a pilot study to test the feasibility of a trial initiated in a hospital setting with an oral supplement to older people with recent fractures. Method: A randomized controlled trial with 44 undernourished participants admitted to a hospital following a fracture. The intervention group (n = 23) received a high calorie high protein supplement for forty days in addition to their diet of choice. The control group (n = 21) received high protein milk during their hospital stay in addition to their diet of choice and their usual diet when discharged from hospital. Results: All participants were women and their mean age was 85.3 (± 6.1) years. Twenty nine (65%) participants had a hip fracture. At baseline no differences were measured between the two groups regarding their nutritional status, their cognitive ability or their abilities in activities of daily living. There were no significant differences between the intervention and control group with reference to nutritional or functional parameters at 40 day and 4 month followups. Median length of stay in hospital was 18.0 days, with 12 participants being readmitted for a median of 7.0 days. Conclusion: It is feasible to perform a randomised trial in a hospital and community setting to test the effect of an oral high energy high protein supplement for older people. Due to the limited number of participants and incomplete adherence with use of the supplements no conclusion can be drawn about the efficacy or effectiveness of this intervention. [ABSTRACT FROM AUTHOR]
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- 2011
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14. Geriatric consultation services-are wards more effective than teams?
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Cameron, Ian D. and Kurrle, Susan
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GERIATRICS , *OLDER people , *HOSPITAL care , *MORTALITY , *MULTIDISCIPLINARY practices - Abstract
Geriatric consultation teams are one of the models for bringing comprehensive geriatric assessment to vulnerable and frail older people in the acute care hospital setting. While ward-based comprehensive geriatric assessment has been established as effective with reference to improving functional status and other outcomes, the team-based variant remains unproven for outcomes other than mortality in the medium term, as shown in a recent study published in BMC Medicine by Deschodt and colleagues. Further research might establish the effectiveness of the team-based model but, for current clinical practice, the emphasis should be on streaming older people with complex problems needing multidisciplinary assessment and treatment to ward-based models of comprehensive geriatric assessment. [ABSTRACT FROM AUTHOR]
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- 2013
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15. 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
16. An Empirical Comparison of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U in a Post-Hospitalisation Population of Frail Older People Living in Residential Aged Care
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Owen Davies, Maria Crotty, Craig Whitehead, Ian D. Cameron, Susan Kurrle, Michelle Miller, Julie Ratcliffe, Maggie Killington, Tiffany Easton, Enwu Liu, Thomas Flint, Ratcliffe, Julie, Flint, Thomas, Easton, Tiffany, Killington, Maggie, Cameron, Ian, Davies, Owen, Whitehead, Craig, Kurrle, Susan, Miller, Michelle, Liu, Enwu, and Crotty, Maria
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Gerontology ,Male ,Psychometrics ,Residential Care ,residential care ,older people ,0302 clinical medicine ,Surveys and Questionnaires ,Homes for the Aged ,030212 general & internal medicine ,Cognitive decline ,DEMQOL-U ,Aged, 80 and over ,education.field_of_study ,Hip fracture ,DEMQOL-Proxy-U ,030503 health policy & services ,Health Policy ,post-hospitalisation ,General Medicine ,Middle Aged ,health-related quality of life ,EQ-5D-5L ,Convergent validity ,hip fracture ,Female ,medicine.symptom ,Utility Score ,0305 other medical science ,Economics and Econometrics ,Frail Elderly ,Population ,03 medical and health sciences ,EQ-5D ,medicine ,Dementia ,Humans ,education ,Aged ,business.industry ,Economic Evaluation Study ,Hip Fractures ,medicine.disease ,Nursing Homes ,Quality of Life ,Delirium ,business ,Residential Aged Care - Abstract
Objective: To empirically compare the measurement properties of the DEMQOL-U and DEMQOL-Proxy-U instruments to the EQ-5D-5L and its proxy version (CEQ-5D-5L) in a population of frail older people living in residential aged care in the post-hospitalisation period following a hip fracture. Methods: A battery of instruments to measure health-related quality of life (HRQoL), cognition, and clinical indicators of depression, pain and functioning were administered at baseline and repeated at 4 weeks’ follow-up. Descriptive summary statistics were produced and psychometric analyses were conducted to assess the levels of agreement, convergent validity and known group validity between clinical indicators and HRQoL measures. Results: There was a large divergence in mean (SD) utility scores at baseline for the EQ-5D-5L and DEMQOL-U [EQ-5D-5L mean 0.21 (0.19); DEMQOL-U mean 0.79 (0.14)]. At 4 weeks’ follow-up, there was a marked improvement in EQ-5D-5L scores whereas DEMQOL-U scores had deteriorated. [EQ-5D-5L mean 0.45 (0.38); DEMQOL-U mean 0.58 (0.38)]. The EQ-5D and CEQ-5D-5L were more responsive to the physical recovery trajectory experienced by frail older people following surgery to repair a fractured hip, whereas the DEMQOL-U and DEMQOL-Proxy-U appeared more responsive to the changes in delirium and dementia symptoms often experienced by frail older people in this period. Conclusions: This study presents important insights into the HRQoL of a relatively under-researched population of post-hospitalisation frail older people in residential care. Further research should investigate the implications for economic evaluation of self-complete versus proxy assessment of HRQoL and the choice of preference-based instrument for the measurement and valuation of HRQoL in older people exhibiting cognitive decline, dementia and other co-morbidities. Refereed/Peer-reviewed
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- 2016
17. Developing a dementia-specific preference-based quality of life measure (AD-5D) in Australia: a valuation study protocol
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Kim-Huong Nguyen, Susan Kurrle, Wendy Moyle, Julie Ratcliffe, Brendan Mulhern, Sanjeewa Kularatna, Tracy Comans, Megan Corlis, Li Li, Alyssa Welch, Donna Rowen, Comans, Tracy A, Nguyen, Kim-Huong, Mulhern, Brendan, Corlis, Megan, Li, Li, Welch, Alyssa, Kurrle, Susan E, Rowen, Donna, Moyle, Wendy, Kularatna, Sanjeewa, and Ratcliffe, Julie
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Research design ,Gerontology ,Psychometrics ,Cost-Benefit Analysis ,Population ,older people ,03 medical and health sciences ,Health Economics ,0302 clinical medicine ,Quality of life ,Alzheimer Disease ,Surveys and Questionnaires ,quality adjusted life year ,Protocol ,medicine ,Humans ,Dementia ,Prospective Studies ,030212 general & internal medicine ,education ,Retrospective Studies ,Psychiatric Status Rating Scales ,Cost–utility analysis ,education.field_of_study ,Health economics ,business.industry ,030503 health policy & services ,discrete choice experiment ,Australia ,General Medicine ,medicine.disease ,humanities ,Quality-adjusted life year ,Logistic Models ,Caregivers ,Research Design ,Economic evaluation ,Quality of Life ,best worst scaling ,Quality-Adjusted Life Years ,utility weight ,0305 other medical science ,business ,Alzheimer’s disease ,dementia - Abstract
Introduction Generic instruments for assessing health related quality of life may lack the sensitivity to detect changes in health specific to certain conditions, such as dementia. The Quality of Life in Alzheimer's Disease (QOL-AD) is a widely used and well-validated condition-specific instrument for assessing health-related quality of life for people living with dementia, but it does not enable the calculation of quality-adjusted life years, the basis of cost utility analysis. This study will generate a preference based scoring algorithm for a health state classification system-the Alzheimer's Disease Five Dimensions (AD-5D) derived from the QOL-AD.Methods and analysis Discrete choice experiments with duration (DCETT0,) and best worst scaling health state valuation tasks will be administered to a representative sample of 2000 members of the Australian general population via an online survey and to 250 dementia dyads (250 people with dementia and their carers) via face-to-face interview. A multinomial (conditional) logistic framework will be used to analyse responses and produce the utility algorithm for the AD-5D.Ethics and dissemination The algorithms developed will enable prospective and retrospective economic evaluation of any treatment or intervention targeting people with dementia where the QOL-AD has been administered and will be available online. Results will be disseminated through journals that publish health economics articles and through professional conferences. This study has ethical approval. Introduction Generic instruments for assessing health related quality of life may lack the sensitivity to detect changes in health specific to certain conditions, such as dementia. The Quality of Life in Alzheimer's Disease (QOL-AD) is a widely used and well-validated condition-specific instrument for assessing health-related quality of life for people living with dementia, but it does not enable the calculation of quality-adjusted life years, the basis of cost utility analysis. This study will generate a preference based scoring algorithm for a health state classification system-the Alzheimer's Disease Five Dimensions (AD-5D) derived from the QOL-AD. Methods and analysis Discrete choice experiments with duration (DCETTO) and best–worst scaling health state valuation tasks will be administered to a representative sample of 2000 members of the Australian general population via an online survey and to 250 dementia dyads (250 people with dementia and their carers) via face-to-face interview. A multinomial (conditional) logistic framework will be used to analyse responses and produce the utility algorithm for the AD-5D. Ethics and dissemination The algorithms developed will enable prospective and retrospective economic evaluation of any treatment or intervention targeting people with dementia where the QOL-AD has been administered and will be available online. Results will be disseminated through journals that publish health economics articles and through professional conferences. This study has ethical approval. Refereed/Peer-reviewed
- Published
- 2018
18. Effectiveness of a multifactorial intervention on preventing development of frailty in pre-frail older people: study protocol for a randomised controlled trial
- Author
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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
- Subjects
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
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