Year: 2009

Staff: Irene Blackberry and Xiaoping Lin

Summary: The ‘No Falls’ peer education program commenced in October 2006 as part of the Whole of Community Falls Prevention Projects – Phase 3 funding from the Victorian Department of Human Services (DHS) to a partnership between the Inner South East Partnership in Community and Health (ISEPICH) and Kingston Bayside Primary Care Partnerships (KBPCP). The project developed a ‘No Falls’ peer education program among other falls prevention initiatives. The ‘No Falls’ project targeted older people in the five municipalities of Bayside, Kingston, Glen Eira, Stonnington and Port Phillip. The steering committee of the three year falls project has supported the lead agency, Bentleigh Bayside Community Health (BBCH), to engage the National Ageing Research Institute (NARI) to conduct an evaluation of the ‘No Falls’ peer education program. The aim of the evaluation project was to identify the strengths, weaknesses, opportunities and threats of the ‘No Falls’ peer education program.

The methods comprised: 

• A literature review on peer education in falls prevention and other health conditions relevant to older people

• Benchmarking of best peer education practice

• Consultations with peer educators, program participants and project staff.

Key findings from this study:

• Limited good quality evidence on the effectiveness of peer education alone in changing the health behaviour of older people compared to other types of intervention or usual care. The benefit of a peer education model was seen in community-based programs to increase awareness of risk factors and peer education was widely accepted among older people of English speaking background.

• No specific benchmarking available for a peer education model

• All focus group attendees had congruent understanding of the primary aim of peer education; that was to increase awareness of falls risk factors among older people in the community. Peer education was widely accepted, based on focus group feedback; however, although difficult to generalise, some CALD groups might prefer having health professional delivered education sessions.

Funding source: Bentleigh Bayside Community Health

Year: 2008 - 09

Staff: Keith Hill, Kirsten Moore, Marcia Fearn, Betty Haralambous and Sue Hunt (NARI), Terry Haines (Monash University/Southern Health), Jenny Nitz and Stephanie Fu (University of Queensland), Andrew Robinson, Sharon Andrews, Brendan Churchill and Emma Lea (University of Tasmania)

Summary: This project involved a multi-disciplinary partnership of three research/training organisations, and nine residential aged care facilities across three states. The residential aged care facilities included a mix of high and low care, small and large facilities, metropolitan and regional facilities, facilities with a specific CALD focus, and those with patient populations that are considered to be more challenging in implementation of falls prevention practice (e.g. dementia specific, and psychogeriatric units). The methodology used an action research approach to support implementation of falls minimisation evidence based practice guidelines, with the aim of achieving a range of improved outcomes for residents, carers / families, and staff. Key elements of the project included:

• Auditing current practice in falls prevention within each facility, and developing a plan to work towards achieving best practice in target areas identified in the audit;

• Using an action learning approach to support staff engagement in project activities and practice change, and to inform options for which specific activities are implemented within each facility and how this may occur;

• Implementing a range of activities to support improved practice in falls prevention within each residential care facility;

• Providing funding for resources to support falls prevention within each facility, including funding for environmental modifications and high-low or low-low beds;

• Providing staff training and resident / family information on ways to reduce falls risk within residential care facilities;

To assist other aged care facilities to implement evidence based falls prevention practice change, a website resource was developed which includes guidelines on implementing an interactive falls prevention training expo for staff. Click below to access these resources:

• Falls prevention training expo
• Working together to prevent falls in residential care: Resourse Package

Funding source: Australian Government Department of Health and Ageing under the Encouraging Best Practice in Residential Aged Care (EBPRAC) Program.

Reports: The final report can be downloaded here...

Year: 2008 - 09

Staff: Keith Hill, Karen Borschmann, Kirsten Moore, Marlena Klaic, Amanda Bingham, Xiaoping Lin, Frances Batchelow (NARI), Ecosse Lamoureux and Eva Fenwick (Centre for Eye Research Australia-CERA).

Summary: This collaborative project between NARI and the Centre for Eye Research Australia (CERA) addressed vision related needs for older people in low-level residential care. The project involved three facilities; one in Geelong and two in Melbourne. The project had the following aims: 1. To quantify the magnitude of vision impairment among people in residential care facilities; 2. To quantify the extent of environmental factors influencing safety, function and quality of life in residential care settings; 3. To develop a collaborative approach with each facility’s key staff members, residents and carers to determine a framework for improving outcomes related to these problems in each setting; 4. To implement a targeted intervention plan to address individual and facility factors influencing vision and the environment to improve resident’s safety, function and quality of life in the participating facilities, and 5. To evaluate the effectiveness of the intervention program.

Interventions included: referral for further assessment where indicated; provision of corrective lenses for those with correctable visual impairments; environmental modification to address factors affecting function and safety; staff training about screening and management / referral options for residents with visual impairment (including consideration of environmental factors for residents with impaired vision) and information for residents and carers to maximise vision and environmental safety.

This project was successful in raising awareness of vision impairment, environmental issues and education needs relating to these topics within low level residential aged care facilities. Whilst only three facilities were involved in the study, it has raised a range of issues that need to be considered more broadly in residential care. Routine vision assessment and support for residents who may not be able to afford new glasses needs to be given attention, particularly given the strong connection between vision, mobility and quality of life. The need for additional staff training and attention to environmental issues was also identified. This project has evaluated a range of strategies for addressing vision impairment and environmental issues that could be beneficial for residential aged care facilities to implement. Project activities have also been used to trigger a range of additional related activities within participating facilities that may facilitate sustained change in practice for older residents with vision impairment.

Funding source: Eye Health Demonstration Grants Program, Australian Government Department of Health and Ageing

Reports: The final report can be downloaded here...

Year: 2008

Staff: Kirsten Moore, Courtney Hempton, Pauline Galvin, Keith Hill, Emma Renehan, Amanda Hill

Summary: Since 2000 the Victorian Government Department of Human Services (DHS) has funded a range of falls prevention projects across acute, sub-acute, and residential care settings. In this five-month review, over 100 DHS-funded projects across 31 Primary Care Partnerships were analysed. The aim of the review was to explore enablers and barriers of effective falls prevention projects, and identify effective strategies and models that have been integrated into existing health promotion frameworks, and sustained in policy and practice. Available project documentation from all projects was analysed, and in-depth interviews conducted for a subset of projects. An expert advisory panel oversaw the review, and the Victorian Falls Prevention Network and Victorian Falls Clinic Coalition were consulted.

The review of projects to prevent falls among older people in Victoria 2000-2007 was provided to DHS to identify successful and sustainable strategies for the prevention of falls among older people, and consequently inform future initiatives and funding directions.

Findings of the project were presented at the 3rd Australian and New Zealand Falls Prevention Conference 2008, Melbourne 12-14 October; (Click here )

Funding source: Victorian Government Department of Human Services

Year: 2007-08

Staff: Irene Blackberry, Pauline Galvin, Keith Hill, Amanda Bingham, Melissa Russell, Gihan de Mel, Teng Liaw (School of Rural Health, The University of Melbourne), James Taylor (Sandringham Hospital)

Summary: This project aims to implement an evidence based falls risk screen for older people who present to an Emergency Department (ED). The 3-item falls risk screen was developed from a validated assessment tool, the Falls Risk for Older People in the Community (FROP-COM). The project also involves generating best practice guidelines for falls prevention in the ED based on review of the literature on falls prevention in the ED setting. Implementation of the falls risk screen is currently underway in two metropolitan and two rural EDs namely Austin Health, Goulburn Valley Health, Sandringham and District Memorial Hospital and Bairnsdale Regional Health Service in Victoria. A scoping meeting has been undertaken with each hospital ED staff to investigate local enablers and barriers to the implementation of such a screen, and to map local referral pathways for identified high falls risk patients. Resources to support implementation such as educational tools and guides to using the screen are currently being developed. The project will evaluate outcomes associated with newly implemented falls risk screen using medical record audits, patient interviews and staff focus groups.

Funding source: Australian Government Department of Health and Ageing

Reports:

• Final Report
• Literature Review
• Best Practice Falls Prevention Guidelines for the Emergency Department

Resources:

• FROP-Com Screen
• FROP-Com Screen User Guidelines

Education Resources:

• Preventing Falls in older people presenting to an Emergency Department
  • Powerpoint Presentation without audio option - Click here..
  • Presentation with audio option - Click here..

Disemination Workshops :

• Workshop Plan -
• Workshop Flyer -

Latest Newsletter :

• Issue 5 February 2007 -
• Issue 4 November 2007 -

Year: 2007-08

Staff: Keith Hill, Briony Dow, Belinda Bilney (LaTrobe University), Kirsten Moore, Carmel Morgan (Mecwa), Cheryl Hines (Carer’s Choice), Claudia Meyer, Amanda Bingham, Olivia Ng (City of Melbourne), Guy Walter (City of Moonee Valley)

Overview: Carer wellbeing and overall health of care recipients can be compromised by adverse events such as falls by the care recipient. Falls are a common problem for older people, particularly those with physical and or cognitive co-morbidities such as stroke, Parkinson’s disease, and dementia. The majority of people receiving informal and formal care and respite services have one or more physical and / or cognitive impairment, which will predispose them to falls. Falls in frail older people being supported at home has been reported as a contributory factor in up to 40% of admissions to nursing homes / long term care facilities (Tinetti et al, 1997). Additionally, changes in environment have been shown to increase falls in “at risk” older people (Friedman et al, 1995). Anecdotally, there appears to be potential risk of increased falls when a care recipient goes into an unfamiliar environment, such as when having respite care in a residential care facility, and then again needing to make adjustments the home environment and circumstances following the respite care episode (either as a planned or emergency residential respite care episode). There is little documentation of the frequency, circumstances or consequences of these adverse events, or preventive actions utilised. Furthermore, there has been no research investigating the magnitude of falls among older care recipients, exploration of current falls prevention activities and how these could be enhanced, to inform preventive strategies. This project will meet these needs by collecting detailed falls data through falls calendars, reviewing falls data from episodes of residential respite care, and through focus groups with older carers, and developing and disseminating resources for use by older carers, carer support organisations, residential care facilities providing episodic residential respite care, and other interested stakeholders. Improved understanding and greater safety focus is likely to reduce incidence of these adverse events for care recipients, improve quality of life and other key outcomes for the carer, and perhaps help sustain the caring role for longer than would otherwise be possible.

Aims:

To evaluate frequency, characteristics and consequences of falls and other adverse events (accidents) for care recipients (at home and in transitions to/from residential care respite episodes);

To determine the impact of adverse events for both the carer and the care recipient;

To identify knowledge and perceptions of older carers about falls/other adverse events, and ways to minimise their occurrence; and

To develop and implement a dissemination plan to promote project outcomes and strategies to improve health outcomes for older carers and their care recipients

Funding source: Australian Government Department of Health and Ageing

Note: This report is also included under "Falls Prevention Research - Clinical Trials "

Year: 2002-06

Staff: Keith Hill, Irene Blackberry, Melissa Russell, Melita Giumarra, Fiona Bremner, Sue Williams, Terry Sullivan, Sarah Tarquinio

Summary: The primary aim of this project is to evaluate the effectiveness of a targeted multi-factor intervention in improving health and well being of older people who present to an Emergency Department (ED) following a fall. It also aims to identify those within this high-risk population most likely to benefit from the intervention program.

The project will also involve validation of the Falls Risk for Older People - Community Setting (FROP-Com).

The project is currently underway at the Royal Melbourne, Western, Sunshine, Northern, Williamstown, Sandringham and Austin Hospitals.

Funding source: Victorian Department of Human Services and the Australian Government Department of Veteran Affairs

Reports: For more details, link to the Information Sheet here ....  For preliminary analysis details, link to the Preliminary Analysis data sheet here...

View the FROP-Com and Guidelines

Update: In 2010 the NARI Fall Research Team reviewed the FROP-Com and Guidelines to reflect work by Russell 2008 and Murray 2005 identifying mild, moderate and high falls risk (previously two graded categories of risk). The falls risk gradings have been modified accordingly and other basic formatting changes made.

Click here for the amended FROP-Com

Click here for the amended Guidelines

Year: 2002-current

Staff: Willeke Walsh (Masters candidate), Keith Hill, Kim Bennell (University of Melbourne)

Summary: A two-stage falls risk assessment is being investigated in the acute hospital setting for reliability, accuracy of predicting falls risk, and change in falls risk during hospitalisation.

Year: 2004-05

Staff: Keith Hill, Kirsten Moore, Marcia Fearn

Summary: NARI worked with three Falls Clinics to identify strategies to improve engaging Falls Clinic clients in activities identified as likely to minimise future risk of falling for the individual, thereby improving client safety.

Falls Clinic clients were surveyed when they were referred to the Clinics, to obtain their perceptions about what they considered the Clinic could achieve, and what falls prevention activities they had previously tried. After the first assessment at the Clinics, clients were surveyed again about their perceptions of the assessment process, outcomes, and whether they considered they would undertake the recommended falls prevention activities. Clinic staff then completed a questionnaire with clients at 6 week and 6 month re-assessments to determine compliance with recommended interventions, and factors limiting compliance. Seventy five percent of clients complied fully with interventions. Results highlighted a range of client and system factors limiting compliance in the remaining 25% of clients. A framework for engaging Falls Clinic clients in recommended falls prevention activities was developed based on the study outcomes.

Funding source: The Safety Innovations In Practice Program (MK III), Australian Safety and Quality Council.

Reports: The final report "Improving Falls Clinic client engagement in falls prevention activities" is available here...

Year: 2002-04

Staff: Keith Hill, Kirsten Moore

Summary: This project trialed the use of the Falls Clinic Minimum Data Set (MDS) developed in a previous NARI project, "Evaluation of Falls Clinics and development of a measurement and outcomes framework & Review of Movement Disorder Clinics". The summary for this earlier study is shown below....

The aim of the trial was to evaluate the utility of the MDS in identifying key outcomes for Falls Clinics. A common MDS of outcome measures will foster multi-centre research by providing comparable data across clinics.

Fourteen Victorian Falls Clinics participated in a 12-month data collection period collecting MDS measures at initial and 6-month follow-up assessments for 254 Falls Clinic clients. There was a significant reduction in the number of falls (64% reduction) and falls causing injuries (75% reduction). In addition, there were small but significant improvements in most of the secondary outcome measures, including balance, gait and mobility, leg strength, fear of falling, and reduced number of medications taken. The issue of client compliance with recommended interventions was also measured, and although compliance was overall fairly high (74%) there were some types of recommendations that warranted further investigation of factors that could be barriers to client engagement.

Funding source: Victorian Department of Human Services

Reports: Final report "Evaluation of a Minimum Data Set for Victorian Falls Clinics" is available here... or at the Victorian Government Health Information website, link here ....

Year: 2002-03

Staff: Keith Hill, Freda Vrantsidis, Marcia Fearn, Melissa Russell, Samantha Arnot, Donna White, Jenny Schwarz, Anne McGann, Michelle Kronberg, David Thorburn, Aileen Kalogeropoulos

Summary: This project aimed to institute a multi-factorial falls prevention program in two "high care" residential aged care facilities. The project ran for approximately 9 months, with a 2 month baseline/resource development period, a 4 month intervention period and a 3 month follow up period to monitor issues associated with sustainability. The intervention phase incorporated a physical activity/exercise program, an environmental audit, an education component for staff, residents and families, an action research process, a medical intervention with GP's and the introduction of a falls risk assessment. Throughout the project duration an emphasis was placed on identifying strategies to enhance longer term entrenchment of these falls prevention initiatives into routine practice. This short duration multi-factorial falls prevention program established a range of initiatives in the two residential aged care facilities which resulted in a range of positive outcomes, including reduced falls and falls injuries.

Funding source: Victorian Department of Human Services

Year: 2002-03

Staff: Keith Hill, Kirsten Moore

Summary: An evaluation was undertaken to examine the outcomes for patients who had used a multidisciplinary service to manage their movement disorder. Retrospective data was collected for 31 patients who were admitted to the Brighton Rehabilitation Centre's movement disorder in-patient ward and 320 out-patients who attended the Elsternwick Private Hospital's Movement Disorder Clinic. Outcome measures used were tools that were routinely completed by treating clinicians and included the Unified Parkinson's Disease Rating Scale, the Parkinson's Disease Questionnaire (PDQ-39) and the Webster Parkinson's disease rating scale.

Year: 2001-03

Staff: Keith Hill, Freda Vrantsidis

Summary: This project involved the evaluation of four acute hospital falls prevention projects. The methodology included developing evaluation guidelines for evaluating hospital based falls prevention projects, evaluation of common project components such as falls risk assessment and staff training, evaluation of falls and falls injury outcomes, and a workshop addressing falls risk assessment in hospital settings.

Common components of the four projects included falls risk assessments and staff training. There was a wide reach of staff training achieved by all projects. Falls risk screening processes were well accepted and instituted for long term use in two of the four hospital projects. Further work was planned by the other two hospitals. There were also mixed outcomes in relation to falls and injury outcomes. However there was a reduction in falls rates in 3 of the 4 hospitals when comparing data from the first six months of the project to the second six months of the project. A range of barriers and facilitators were identified and recommendations made to assist future hospital falls prevention programs. Evaluation guidelines were also developed to evaluate hospital falls prevention projects as well as a hospital falls risk assessment framework for best practice.

Funding source: Victorian Department of Human Services

Year: 2001-02

Staff: Keith Hill, Kirsten Moore, Freda Vrantsidis, Maree Nihill

Summary: An evaluation of the outcomes that can be achieved by Falls Clinics was undertaken. A literature review examined current research evidence of the benefits of Falls Clinics. Data was also collected for 163 patients who attended one of three Victorian Falls Clinics. A significant reduction in falls was found from admission to discharge. The evaluation also included an audit of outcome measurements used by all Victorian Falls Clinics to inform the development of a Minimum Data Set.

Funding source: Victorian Department of Human Services

Reports: Final report "Evaluation of Falls Clinics and development of a measurement and outcomes framework & Review of Movement Disorder Clinics" is available here...

Year: 2001-02

Staff: Keith Hill, Freda Vrantsidis, Aileen Kalogeropoulos, Robyn Smith, MECRS staff

Summary: This multidisciplinary, multi-factorial project built on the activities of a previous project conducted at the Melbourne Extended Care & Rehabilitation Service (MECRS), see details below ....

Project activities included a validation study of a falls risk assessment tool and the hospital wide introduction of the tool, workforce training (SPLATT Attack Expo and Advanced Falls Prevention Training), action research and a number of multidisciplinary specific interventions.

For further information about the SPLATT Attack: Falls Prevention Expo, go to the Education / Current education programs section of our web site., link here ....

Funding source: Victorian Department of Human Services

Reports: Final report "Preventing adverse events in sub-acute care: Changing practice to prevent falls" is available here ....   Please note some appendices and photos only available in hard copy from NARI.

Year: 2000-01

Staff: Keith Hill, Freda Vrantsidis, Robyn Smith, Belinda Gilsenan, Elizabeth Kerr, Stella Kravtsov, Donna White, Jenny Schwarz (MECRS), June Lines (Brentine SRS)

Summary: This was a multiple risk strategy falls prevention program for older people in seven Supported Residential Service (SRS) facilities in the Western Metropolitan Region of Melbourne. Interventions included physical activity, resident and staff education, falls risk assessment, environmental audit, medical intervention and falls incident report analysis.

Funding source: Victorian Department of Human Services

Reports: Final report "Falls prevention in Supported Residential Services in the Western Metropolitan Region of Melbourne" is available here ....  Please note some appendices and photos only available in hard copy from NARI.

Year: 2000-01

Staff: Keith Hill, Freda Vrantsidis, Robyn Smith, MECRS staff

Summary: This was a short term multi-disciplinary, multi-factorial falls prevention project for in-patients in the sub-acute setting of the Melbourne Extended Care & Rehabilitation Service (MECRS). Interventions included a falls incident audit, workplace training (the development and implementation of the innovative SPLATT Attack Expo --link to description - Education\Available Education Programs\SPLATT Attack: Falls Prevention Expo--), the development of a risk assessment tool, an environmental audit, action research and a range other activities.

Funding source: Victorian Department of Human Services

Reports: Final report "Falls prevention in the sub-acute inpatient setting at Melbourne Extended Care and Rehabilitation Service (MECRS)" is available here ....  Please note some appendices and photos only available in hard copy from NARI.