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Additional file 1: The bidirectional relationship between chronic joint pain and frailty: data from the Investigating Musculoskeletal Health and Wellbeing cohort.

BackgroundFalls in care home residents are common, unpleasant, costly and difficult to prevent. Trial DesignThe objective was to evaluate the clinical and cost effectiveness of the Guide to Action for Falls Prevention Care Homes, GtACH) in which care home staff were trained and supported in the systematic use of a multi-domain decision support tool and identify issues affecting subsequent implementation. A two-arm parallel design, multi-centre, cluster randomised controlled trial of the GtACH programme and usual falls prevention in older care home residents was conducted with embedded process evaluation and economic evaluation. MethodThe study was conducted in care homes from ten UK sites. The primary trial outcome was the rate of falls per resident participant occurring during the 90-day period between 91 days and 180 days post-randomisation. The primary outcome for the cost effectiveness analysis was the cost per fall averted and for the cost utility analysis was the incremental cost per QALY. Secondary outcomes included the rate of falls over days 0-90 and 181-360 post randomisation, activity levels, dependency, and fractures. Care homes were randomised on a 1:1 basis to the GtACH programme or usual care, via a secure web-based randomisation service. Research assistants (RAs), resident participants and staff informants were blind to allocation at recruitment. RAs were blind to allocation at follow up. Data from NHS Digital were extracted blindly. The number of falls per resident was compared between groups using a negative binomial regression model (GEE).Results84 care homes were randomised, 39 to GtACH and 45 to usual care. 1657 residents consented and provided baseline measures, mean age 85 years, 32% men. GtACH training was delivered to 1051 staff (71% of eligible staff) over 146 group sessions. Primary RCT outcome data were available for 630 of the GtACH participants and 712 usual care participants. The primary RCT outcome result showed an unadjusted Incidence Rate Ratio (IRR) of 0.57 (95% CI 0.45-0.71, p

Background: Equality of access to memory assessment services by older adults from ethnic minorities is both an ethical imperative and a public health priority.Objective: To investigate whether timeliness of access to memory assessment service differs between older people of White British and South Asian ethnicity.Design: Longitudinal cohort.Setting: Nottingham Memory Study; outpatient secondary mental healthcare.Subjects: Our cohort comprised 3,654 White British and 32 South Asian older outpatients.Methods: The criterion for timely access to memory assessment service was set at 90 days from referral. Relationships between ethnicity and likelihood of timely access to memory assessment service were analysed using binary logistic regression. Analyses were adjusted for socio-demographic factors, deprivation and previous access to rapid response mental health services.Results: Among White British outpatients, 2,272 people (62.2%) achieved timely access to memory assessment service. Among South Asian outpatients, fourteen people (43.8%) achieved timely access to memory assessment service. After full adjustment, South Asian outpatients had a 0.47-fold reduced likelihood of timely access, compared to White British outpatients (odds ratio 0.47, 95% confidence interval 0.23-0.95, p-value=0.035). The difference became non-significant when restricting analyses to outpatients reporting British nationality or English as first language. Older age, lower index of deprivation and previous access to rapid response mental health services were associated with reduced likelihood of timely access, while gender was not.Conclusions: In a UK mental healthcare service, older South Asian outpatients are less likely to access dementia diagnostic services in a timely way, compared to White British outpatients.

Additional file 2. The original functional comorbidity index: lay out of the original functional comorbidity index.

Additional file 5. Robustness ofd ROC curves: ROC curves of the four different outcome measures with different thresholds (25th, 50th and 75th percentiles as cut-off scores) to present the robustness of the results.

Additional file 6. The ICF framework: the w-FCI embedded in the ICF framework.

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Additional file 1. The Charlson comorbidity index: lay out of the Charlson comorbidity index.

Additional file 3. The Elderly Mobility Scale: content of the Elderly Mobility Scale.

Additional file 4. The Barthel index: content of the Barthel index.