Falls Links
December 2021 | Issue 6
Welcome to our newsletter
Upcoming Events
Save the Date!
NSW Fall Prevention and Healthy Ageing Network 2022 Annual Falls Forums
Friday May 27th, 2022
Wesley Conference Centre, Sydney
10th Biennial Australian & New Zealand Falls Prevention Conference
20-22 November 2022
Perth Convention Centre, Perth, WA
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Program Highlight
Healthy and Active for Life Online is a free 10-week online healthy lifestyle program for adults aged 60 years and over, and Aboriginal people aged 45 years and over. The program is currently available state-wide and consists of:
- Weekly online learning modules and handouts covering topics such as healthy eating and falls prevention
- Online exercise programs and an exercise manual and logbook for participants to complete daily
- Regular phone coaching to support and motivate participants throughout the program
The Centre for Population Health are currently conducting a randomised control trial to evaluate the new Healthy and Active for Life Online program.
"This is an exciting opportunity for us to evaluate the effectiveness of an online program in the older community. We would love your support in promoting this study among your networks, family and friends! Please find attached some promotional assets. If you would like some printed flyers, please contact the team via MOH-ActiveAgeing@health.nsw.gov.au. Please find some further information about the program and study below."
About the study:
The Healthy and Active for Life Online study is open to older adults across NSW who live independently in the community, can mobilise in their home without a walking frame and who currently do not participate in a regular exercise program.
Participants who register for the study will either be placed into the Healthy and Active for Life Online program described above, or will receive a set of educational resources. All participants will be asked to complete a survey before their intervention and another survey 12 months later.
Participants who complete both surveys will receive a $30 gift voucher.
To chat to one of our team members please email MOH-ActiveAgeing@health.nsw.gov.au.
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Reactive Balance Training - ReacStep
Exercise, especially balance training has been shown to be effective in reducing falls. However, many fall situations at home and in the community involve unexpected hazards, which normal exercise training may not adequately address. Reactive balance training is a task-specific approach to directly train the postural and stepping responses to unexpected incidents such as trips and slips. Through repeated exposure to perturbations, this training enhances the neuromuscular system to detect a perturbation and restore balance via rapid reactive stepping.
Systematic review evidence has shown that reactive balance training improves balance recovery skills and reduces falls in daily life by up to 46-48% in older adults and people with Parkinson’s disease. This is especially promising as the fall reductions achieved in reactive balance training have been attained in low dose (e.g. 4 hours/year) and have been compared favourably with standard exercise interventions.
One limitation of reactive balance training, however, was the low clinical feasibility. Many studies used sophisticated perturbation and safety equipment which were not accessible in normal clinical settings. Therefore, researchers at Neuroscience Research Australia have developed a novel reactive balance training program “ReacStep” based on scientific evidence and low-cost equipment. ReacStep uses simple tools to practice reactive stepping as well as ‘intentional’ practice of trip and slip recovery which particularly useful for those with fear of falling or gait/balance impairment.
Dr Yoshi Okubo and Prof Stephen Lord at Neuroscience Research Australia are seeking volunteers to complete a 15-minute anonymous survey about the perceived feasibility of a novel reactive balance training program for clinicians (e.g. PTs, OTs, EPs, etc.) dealing with fall prevention.
Your feedback will provide valuable insight into refining the ReacStep program. One lucky respondent will be selected at random to win a $100 gift card.
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Research Update
Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial
Luliano S, Poon S, Robbins J, Bui M, Wang X, De Groot L et al. Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial BMJ 2021; 375 :n2364
https://doi.org/10.1136/bmj.n2364
Abstract
Objective To assess the antifracture efficacy and safety of a nutritional intervention in institutionalised older adults replete in vitamin D but with mean intakes of 600 mg/day calcium and <1 g/kg body weight protein/day.
Study type: Two year cluster randomised controlled trial.
Setting: 60 accredited residential aged care facilities in Australia housing predominantly ambulant residents.
Participants: 7195 permanent residents (4920 (68%) female; mean age 86.0 (SD 8.2) years).
Intervention Facilities were stratified by location and organisation, with 30 facilities randomised to provide residents with additional milk, yoghurt, and cheese that contained 562 (166) mg/day calcium and 12 (6) g/day protein achieving a total intake of 1142 (353) mg calcium/day and 69 (15) g/day protein (1.1 g/kg body weight). The 30 control facilities maintained their usual menus, with residents consuming 700 (247) mg/day calcium and 58 (14) g/day protein (0.9 g/kg body weight).
Main outcome measures Group differences in incidence of fractures, falls, and all cause mortality.
Results Data from 27 intervention facilities and 29 control facilities were analysed. A total of 324 fractures (135 hip fractures), 4302 falls, and 1974 deaths were observed. The intervention was associated with risk reductions of 33% for all fractures (121 v 203; hazard ratio 0.67, 95% confidence interval 0.48 to 0.93; P=0.02), 46% for hip fractures (42 v 93; 0.54, 0.35 to 0.83; P=0.005), and 11% for falls (1879 v 2423; 0.89, 0.78 to 0.98; P=0.04). The risk reduction for hip fractures and falls achieved significance at five months (P=0.02) and three months (P=0.004), respectively. Mortality was unchanged (900 v 1074; hazard ratio 1.01, 0.43 to 3.08).
Conclusions Improving calcium and protein intakes by using dairy foods is a readily accessible intervention that reduces the risk of falls and fractures commonly occurring in aged care residents.
Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000228785.
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Effects of gait adaptability training on falls and fall-related fractures in older adults: a systematic review and meta-analysis
Nørgaard JE, Jorgensen MG, Ryg J, Andreasen J, Danielsen MB, Steiner DK, Andersen S. Effects of gait adaptability training on falls and fall-related fractures in older adults: a systematic review and meta-analysis. Age Ageing. 2021 Nov 10;50(6):1914-1924.
https://doi.org/10.1093/ageing/afab105
Abstract
Objective: falls among older adults are common and can have devastating consequences. A novel task-specific exercise modality, gait adaptability training (GAT), has shown promising preventive effects. This systematic review and meta-analysis synthesise the evidence regarding GATs effect on falls and fall-related fractures in community-dwelling older adults.
Methods: electronic databases (PubMed, EMBASE, CINAHL, CENTRAL) were systematically searched from inception to 18 June 2020. Additional sources include searches of trial registrations, manual screening of reference lists and requests to experts. We included randomised controlled trials (RCTs) evaluating the effect of GAT on falls with at least 6-month follow-up among community-dwelling people aged 60+ years. Two reviewers independently screened studies against eligibility criteria, extracted relevant information and appraised studies for bias. Random-effects meta-analytic models were employed to pool effect estimates.
Results: eleven studies with 1,131 participants were included. A meta-analysis in which an outlier study was excluded showed that GAT reduces fall rates by 42% (incidence rate ratio 0.58, 95% confidence interval [CI] 0.39-0.81, I2 = 0.00%; moderate certainty; seven RCTs). Moreover, proportion with fall-related fractures and proportion of fallers was reduced by 81% (risk ratio [RR] 0.19, 95% CI 0.06-0.56, I2 = 0.00%; very low certainty; two RCTs) and 43% (RR 0.57, 95% CI 0.4-to 0.8, I2 = 47.08%; low certainty; 11 RCTs), respectively.
Conclusions: our results show that GAT significantly reduces the number of falls and prevents fall-related fractures in older community dwellers. GAT is a promising and feasible exercise modality; however, studies of high quality should be conducted to support a robust conclusion.
Protocol registration: PROSPERO; CRD42020191051.
Keywords: accident prevention; accidental falls; exercise; gait adaptability training; older people; systematic review.
ABOUT US
Our vision is to lead the way in fall prevention and other healthy ageing initiatives by harnessing expert knowledge and being collaborative in all we do.
We work closely with researchers, policy makers, health practitioners and community service providers in the development and promotion of healthy ageing services and programs with a focus on preventing falls and fall-related injury.
Our purpose is to support practitioners to improve the lives of older Australians through healthy ageing initiatives with a focus on preventing falls and fall-related injuries.
SHARE YOUR NEWS
Do you have any news on Falls Prevention or healthy ageing that you want to share with others on the network, or report on a project that is happening in your area. We also welcome suggestions for articles and information you would like to see in this newsletter. Send your news and suggestions to: fallsnetwork@neura.edu.au
Contact Us:
Telephone +61 2 9399 1063
Email fallsnetwork@neura.edu.au
Our mailing address is:
NSW Falls Prevention Network
Neuroscience Research Australia
PO Box 1165
Randwick NSW 2031
Copyright © NSW Falls Prevention and Healthy Ageing Network
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