7th Biennial Australia and New Zealand Falls Prevention Conference 2016

Keynote and Plenary Speakers

Professor Jorunn Helbostad, Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology and Clinic for Clinical Services, St. Olav University Hospital, Trondheim Norway

Jorunn L Helbostad is physiotherapist and professor in Human Movement Science. She is the leader the cross disciplinary research group, Geriatrics, Movement and Stroke (GeMS), and is the scientific leader of laboratories for the assessment of movement, neurophysiology and exercise at Department of Neuroscience at the Norwegian University of Science and Technology. Jorunn L Helbostad is a member in the national board for physical activity, and is associate section editor for BMC Geriatrics and Gerontology.

Her main research interests are on mobility at old age with a particular focus on gait, balance, falls and physical activity, and on use of mobile health technology for the purpose of assessment and intervention.  She is also engaged in research on gait and motor control in children with cerebral palsy. She is currently the coordinator of an EU project on prevention of functional decline in young older people by use of mobile health technology and is the principle investigator of an international project on development of a fall risk assessment tool based on monitored behavioural data.

Walking is a challenging balance task!

Gait is the most common human activity with the main purpose of transportation. Gait is also a challenging balance task and most falls in older people are experienced during walking. Numerous studies have been performed to assess gait characteristics and underlying mechanisms related to different populations and age groups. Gait characteristics change with ageing and gait changes have been shown to be associated with increased fall risk and to be an early sign of cognitive decline. While gait has typically been assessed in a controlled lab environment, light weight body worn sensors can now be used to assess gait during everyday life. This may shed a new light on gait control and stability of relevance for falls prevention! The talk will focus on the complexity of gait, gait patterns related to instability, as well as on assessment options for gait.

Professor Ronald Shorr, Director, Geriatric Research Education & Clinical Center, Malcolm Randall VAMC; Research Professor, Department of Epidemiology, University of Florida, USA

Ronald I. Shorr, M.D., M.S., directs the Geriatrics Research Education and Clinical Center (GRECC) at the North Florida/South Georgia Veterans Health System—one of 20 US centers devoted to improving healthcare for older veterans. He is also a Research Professor of Epidemiology at the University of Florida. Dr. Shorr received his MD from Ohio State University (Columbus, Ohio, USA) and completed training Internal Medicine and Geriatrics at the University of Wisconsin and the William S. Middleton VA medical center (Madison, Wisconsin, USA). In addition, he has completed a Master of Science degree in Epidemiology at Case Western Reserve University (Cleveland, Ohio, USA) and a postdoctoral fellowship in Pharmacoepidemiology at Vanderbilt University (Nashville, TN, USA). Dr. Shorr has extensive experience conducting both observational and experimental studies on healthcare safety and quality, particularly in older adult populations. He was the recipient of an NIA Clinical Investigator Award (K08) and has been PI and Co-Investigator on several NIH funded studies on fall prevention in hospitalized patients. He has an also an investigator on several Veterans Affairs sponsored studies related to healthcare quality and safety. He has served on the Editorial Board for the Journals of Gerontology: Medical Science, Journal of Geriatric Pharmacotherapy and Journal of Rehabilitation Research and Development and has been the lead author in publications in JAMA, Annals of Internal Medicine, and the Journal of the American Geriatrics Society. He has been the Chair of the Health Sciences Section of the Gerontological Society of America and The VA liaison for the Research Committee of the American Geriatrics Society.

Dr Lou Atkins, Senior Teaching Fellow, Centre for Behaviour Change, University College London, UK

Dr Lou Atkins is a behaviour change specialist who works on intervention development for health professionals, teams and patients. She is currently Senior Teaching Fellow in the Centre for Behaviour Change (University College London, UK) where she is involved in a number of projects to change health professional behaviour: reducing variation in adenoma detection rates in colonoscopy; reducing cardiovascular disease in people with severe mental illness; and increasing physical activity in people with musculoskeletal disorders. Lou has worked in health services research for over 12 years, managing single and multi-centre studies on a variety of scales and has extensive experience in working with health professionals as part of projects aimed at policy formation and improving health care provision. She is co-author of the book 'The Behaviour Change Wheel – A Guide to Designing Interventions.'

Changing behaviour – some tools of the trade

Changing behaviour can be hard. We are bundles of associations between past events, thoughts, emotions and behaviours that can drive our behaviour in opposition to our goals, intentions and plans. We are creatures of habit, of routines, of desires, urges and impulses. We need to find ways of helping people develop methods for overcoming or changing these when they get in the way of what they want to achieve, for example, healthy behaviours, relationships, work goals, relaxation outside of work? We need to help them increase motivation, capability and opportunities for behaviour change.

Behaviour change is increasingly recognised as central to human wellbeing, social cohesion and sustainability. Changing behaviour is a challenging and complex process, requiring theories, methods and evidence from many academic disciplines. This seminar will look at some tools recently developed in behavioural science to support different stages of behaviour change intervention design including:

Examples will be presented of how these tools have been applied to change health behaviours.

Dr Michele Callisaya, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania Southern Clinical School, Monash University, Clayton, Victoria

Dr Michele Callisaya is a Senior Research Fellow at the Menzies Institute for Medical Research, University of Tasmania and a Clinical Lead Physiotherapist in Aged Care and Rehabilitation at the Royal Hobart Hospital. She received her PhD in 2010 and was awarded an NHMRC Early Career Fellowship (2012-2015 0.6 FTE) to examine the relationship between brain ageing, physical function and falls at Monash University. She returned to the University of Tasmania in 2015 when she was awarded an internationally competitive Select Foundation Senior Research Fellowship where she leads the BRain AgeINg, Mobility and Falls (BRAIN) group. Her research aims to investigate the role of brain structure and function on mobility and falls as well as interventions to prevent these adverse health outcomes in older people.

Thinking on your feet – the interplay between cognition, gait and falls

There is growing awareness that even early changes in cognitive domains such as executive function, processing speed and memory are associated with impaired gait, and that these impairments may interact to increase the risk of falls.

This presentation will review: 1) the underlying brain areas and different cognitive domains associated with impaired gait and falls; 2) the interplay between cognition and gait in increasing falls-risk; 3) the evidence for using single and dual-task gait to assist in understanding the contribution of the brain to falls-risk; and 4) the evidence for therapeutic interventions and strategies to enhance cognition and improve gait in order to reduce falls in older people.

Professor Jacqui Close, Prince of Wales Hospital and Neuroscience Research Australia

Prof Jacqui Close is a consultant in Orthogeriatrics at the Prince of Wales Hospital in Sydney and Clinical Director of the Falls, Balance and Injury Research Centre at Neuroscience Research Australia. Her primary research area is falls in people with cognitive impairment and dementia and particularly the relationship of cognitive function to postural stability, falls and fractures. She also has an epidemiological interest in the impact of falls and injury to health service use and the way in which health services are designed to prevent and manage falls and injury in older people. She sits on a number of State and National committees in relation to Aged Health and is Co-Chair of the ANZ Hip Fracture Registry, and President of the Australian and New Zealand Society of Geriatric Medicine.

Using the brain to achieve physical gain

The evidence to support an effective approach to preventing falls in older people with cognitive impairment remains limited. Simply applying approaches that have been shown to be effective in cognitively intact older people appears not to be effective. In order to engage effectively with older people with dementia it is important to have an understanding of their level of cognitive function as well as involving family and carers in any intervention. This presentation will provide a summary of the evidence to date, highlight the role of functional cognition in the approach to any intervention and provide an update on a large trial being undertaken to prevent falls in people with cognitive impairment.

Professor Ngaire Kerse, Professor and Head of School of Population Health, University of Auckland, NZ

Ngaire Kerse is a GP in Auckland, Professor of General Practice and Primary Health Care and Head of the School of Population Health, University of Auckland. After training in primary care in New Zealand, Australia, and the USA, completing a Geriatric Medicine Fellowship at the University of Pennsylvania, and a PhD at the University of Melbourne, she has built a programme of research throughout New Zealand over the last two decades.

Research areas include promoting activity and function in residential care, residential care organisational culture and outcomes, promoting physical activity in community dwelling older people, activity for depression in the very old, staying upright (preventing falls and injury) in older people in all settings, improving prescribing in primary care, and a large cohort of Māori and non-Māori in advanced age.

Ngaire is a member of expert advisory and steering groups for the Health and Quality Safety Commission on preventing harm from falls, the Ministry of Health on comprehensive assessment techniques and roll out of the InterRAI, and the Integrated Performance and Incentives Framework development. She leads the community Theme (Theme 4) for the Brain Research New Zealand (Centre of Research Excellence) in the University of Auckland and works as a GP at the Auckland City Mission.

Fracture incidence and prediction, Life and Living in Advanced age: A Cohort Study in New Zealand (LiLACS NZ)

Fractures are at highest prevalence in those over age 80 years and cause undue disability. LiLACS NZ is a cohort study of 421 Māori aged 80-90 years and 517 non-Māori aged 85 years (56% and 59% participation rate respectively).Fracture risk factors were ascertained at baseline in 2010. Fractures were ascertained from 1) self-report yearly, and 2) the hospital discharge dataset from 48 month follow up data  available on 498 non-Māori and 379 Māori.

6% Māori and 12% of non-Māori reported fractures (p< 0.001). More women (9.2%) self-reported fracture than men (4.8%)(p 0.007).  Considering hospitalization for fracture 4 year post enrollment incidence was 8.5 percent and 8.8 percent for Māori and 12 % for non-Māori respectively. During the 4 year follow up women (11.9%) had the more fractures and men (3.6% p = 0.023).

Using multiple logistic regression for Māori significant independent predictors of self-retorted fracture included low BMI at age 25, controlled for age, sex and other factors. For non-Māori, significant predictors of self-reported fractures, were female gender, falls and the ratio of falls per activity level. Predictors of 4yr hospitalizations from fracture were the ratio of falls per amount of activity (p 0.039), and, prior fracture, taking antiepileptics for Maori and maternal hip fracture, prior fracture, activity level, and taking antidepressants for non-Maori.

 Conclusions: fractures are common in octogenarians and some risk factors are malleable to better management and lifestyle change

Professor Hylton B Menz, NHMRC Senior Research Fellow, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Victoria, Australia

Professor Hylton Menz is a podiatrist who graduated with first class Honours and the University Medal from La Trobe University in 1993, and completed his PhD focusing on gait patterns, balance and falls at the University of NSW in 2002. He is currently a National Health and Medical Research Council of Australia Fellow, and Leader of the Lower Extremity and Gait Studies Program at La Trobe University. Professor Menz's broad research disciplines are human movement, rehabilitation and rheumatology, with a particular focus on musculoskeletal foot problems in older people. His research extends from laboratory-based biomechanical studies through to analysis of epidemiological datasets and the conduct of clinical trials.

Professor Menz has published over 200 papers in podiatry, gerontology, rheumatology and biomechanics journals, and he is Editor-in-Chief of the Journal of Foot and Ankle Research. He has won several awards for his research, including the Young Tall Poppy Award by the Australian Institute for Policy and Science, the La Trobe University Excellence in Research Award, first prize in the British Medical Association Book Awards for his textbook Foot Problems in Older People: Assessment and Management, and a Fulbright Senior Scholarship to Harvard University. Professor Menz's current research focuses on the epidemiology and management of foot disorders in older people, with a particular emphasis on osteoarthritis.

Preventing falls from the ground up: the role of the podiatrist

Foot problems affect one in four older people, and have a significant impact on mobility and health-related quality of life in this age-group. Foot problems have also been identified as a risk factor for falls, which suggests that podiatry may have a role to play in falls prevention. This presentation will provide an overview of foot and footwear risk factors for falls, discuss the development of footwear to optimise balance, and present the findings of two randomised trials which have evaluated the effectiveness of multifaceted podiatry interventions for preventing falls.

Associate Professor Anna Barker, Head of the Health Services Research Unit, Leader of the Falls and Bone Health Team, Monash University, VIC

A/Prof Barker is a physiotherapist and experienced clincal researcher. She is the Head of the Health Services Research Unit and Leader of the Falls and Bone Health team in the Department of Epidemiology and Preventive Medicine, Monash University.

She is responsible for the development and undertaking of clinical research and health service evaluations realted to ageing conditions high on the national research priority agenda. She is a NHMRC Career Development Fellow and also an executive member of the Australia and New Zealand Falls Prevention Society.

A/Prof Barker has developed an international reputation for her contributions to falls prevention research. She has led several multi-centre trials including the 6-PACK project—the largest falls prevention trial ever to be undertaken and published in the BMJ. Currently she is leading the ASPREE-Fracture sub-study that will test if daily low-dose aspirin can reduce fracture and fall risk in more than 16,000 healthy older people. The project brings together leading researchers in the field of osteoporosis from the Mayo clinic and 3 Australian universities. She recently completed the RESPOND project that focuses on secondary fall prevention in older people presenting to the ED. The RESPOND program is designed to improve older persons' participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies.

A/Prof Barker supervises a growing list of post-docs, PhD and honours students who are undertaking innovative falls prevention and healthy ageing projects. She maintains strong links with industry stakeholders, having led collaborative projects with the Australian Commission on Safety and Quality in Health Care, Victorian Department of Health and Human Services and Victorian Managed Insurance Authority. Through her role on the executive committee of the Australia and New Zealand Falls Prevention Society A/Prof Barker leads the Society's 'Translating Research into Policy and Practice' committee. This committee includes falls prevention researchers, policy leaders and health service stakeholders who will develop and undertake a targeted program of knowledge translation and consultation activities that aim to drive-up knowledge translation and practice change and support policy review in falls prevention.

RESPOND - Does a patient-centred telephone program achieve improved falls prevention for older people presenting to the ED with a Fall: Outcomes of a multi-centre RCT

Participation in falls prevention activities by older people following presentation to the ED with a fall is suboptimal. The RESPOND program is designed to improve older persons' participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies. This randomised controlled trial (RCT) tested the effectiveness of RESPOND for preventing secondary falls in older people presenting to the ED with a fall. Five-hundred and forty-three community-dwelling people aged 60-90 years presenting to the ED with a fall and discharged home were recruited from two tertiary referral EDs in Melbourne and Perth, Australia. People who required an interpreter or hands-on assistance to walk; lived in residential aged care or >50 kilometres from the trial hospital; had a terminal illness, cognitive impairment, documented aggressive behaviour or history of psychosis; were receiving palliative care; or were unable to use a telephone were excluded. Participants were randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporated: (1) home-based risk factor assessment; (2) education, coaching, goal setting, and follow-up telephone support for management of one or more of four risk factors with evidence of effective intervention; and (3) healthcare provider communication and community linkage delivered over six months. Data collection for the co-primary outcomes of falls and fall injuries in the 12 months following recruitment was completed in June 2016. Results of the RCT will be presented including impacts on participation in falls prevention activities, falls and fall injuries; and implementation fidelity of the RESPOND program during the trial.

Trial registration. The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684)

Dr Cathy Said, Director of Physiotherapy Research, Austin Health Senior Research Fellow, The University of Melbourne Adjunct Associate Professor, La Trobe University

Dr Said is currently the Director of Physiotherapy Research at Austin Health, Senior Research Fellow at The University of Melbourne and adjunct Associate Professor at La Trobe University. She has over 20 years of experience working in neurological and aged care rehabilitation as a physiotherapist, and her research interests' focus on gait and balance disorders in older people or people with neurological disorders. She has received approximately $2 million in NHMRC funding as a Chief Investigator, and her current projects include Optimising rehabilitation outcomes in frail older adults and Can real time biofeedback of foot clearance data be used to assist with gait rehabilitation following stroke?

MOVE: Physical Activity and Falls in Older People During Inpatient Rehabilitation

Older people with a variety of health conditions are often admitted for inpatient rehabilitation to improve mobility, but it is yet not known how to optimize their recovery. This presentation will discuss a recent large, Australian randomized controlled trial that examined the impact of increased physical activity on mobility and falls in older people undergoing inpatient rehabilitation.

Lillemor Lundin-Olsson PT, PhD, Professor, Department of Community Medicine and Rehabilitation; Unit of Physiotherapy Umea University Sweden

Lillemor Lundin-Olsson's overall research theme is identification of fall risk factors and fall prevention strategies in old age. She has evaluated field measurements of gait, balance, and staff judgement as predisposing factors that identify persons prone to falling both among community living independent older people and frail older people, including people with dementia. A special focus has been the interactions between gait and cognitive function. Professor Lundin-Olsson has contributed to an increased awareness of the importance to observe dual task-walking. In order to facilitate self-management to decrease the risk of falling, she has also initiated the development of a mobile application, Safe Step, in a participatory action research project including older people and researchers with different backgrounds. In randomized controlled trials she has evaluated effects of fall prevention programs and exercise programs among frail older people in residential care settings.

Exercise like an athlete – is that feasible for people with dementia?

The majority of residents in long-term care facilities spend most of their waking time in sedentary activities even if they are able to ambulate independently. In long-term care facilities it is recommended both to increase overall daily physical activity level and to create a personalized exercise program with moderate to high intensity as part of the health care plan for every resident. Dementia includes cognitive as well as motor impairments that can lead to difficulties in performing activities in daily life and affected individuals are in need of support to do their exercise. The High-Intensity Functional Exercise (HIFE) program contains balance and lower-limb strength training through task-specific weight-bearing movements that can be tailored to the resident and progressively challenge the resident's physical capacity based on similar exercise principles as for athletes. It is a program that is developed for older people in which the exercise leader can select the exercises from five categories depending on the resident's walking ability. Personalized exercise programs are performed in small groups led by physiotherapists. HIFE has been evaluated with focus on activities of daily living, balance, gait, and depressive symptoms as well as attendance rate and motivational level during the exercise. The residents' and the physiotherapists' experiences has also been illuminated.