Ageing baby boomers: will falls prevention need to change as the ageing population changes? Professor Keith Hill, Head, School of Physiotherapy and Exercise Science Keith.Hill@Curtin.edu.au Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Monash Seminar September 2016
Outline Changing demographics Potential impact of the Baby Boomers growing old Exercise to reduce risk of falling - current evidence and gaps (community) Participation and adherence Potential new avenues Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
Reluctant to see Dr Does not seek additional advice (2nd opinion, internet ) Generally low level of focus on preventive health???
Health problems associated with ageing likely to increase: Falls Dementia Osteoporosis... Australian Bureau of Statistics estimates Major focus on (1) ageing well (2) health promotion and prevention (3) improving outcomes and quality of life for those with health problems
Baby boomers who are they? Baby boomers are people born during the demographic post World War II baby boom approximately between the years 1946 and 1964. This includes people who are between 70 and 52 years old in 2016, respectively. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J file:///j:/generations%20chart.pdf
Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
Where have they come from? Have lived through and created many of the achievements of: the civil rights movement the sexual revolution universalisation of education and health-care Have benefited from: postwar prosperity technological advances Starting The Innovation Age: Baby Boomers perspectives Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J on what it takes to age well (2016) - tacsi.org.au
What is likely to be different? Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
Positives Education Health literacy Tech savvy Affluent What is likely to be different? Questioning (second opinion but not??reluctance to change / research) universal behaviours Benefit from health promotion messages over past 20 years Strong desire for independence Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Negatives??Ability to adapt to rapidly changing technology
Being tech savvy now does not mean being tech savvy in 15 years time. "There are some very tech-savvy older people around, but there is clearly a large cohort of people who feel excluded by technology. They find it a bit impenetrable" Footer text - slideshow title Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Source: Ian Hosking University of Cambridge engineering design centre
Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Baby-boomers health
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One in three older people fall each year 10% of falls cause serious injury Leading cause of injury related hospitalisations among older people in Australia (99,704 fall related hospitalisations 2012-13) (AIHW 2015) 10% of bed days for older people attributable to falls (AIHW 2012) Direct costs to the health care system in Australia was $648million in 2007-8 Costs predicted to triple by 2050 if rates of falls not reduced
There is good research (at least one randomised trial) evidence that a number of single interventions can reduce falls / injuries: exercise (home exercise; tai chi, group exercise) cataract extraction / change multifocal glasses to 2 sets of glasses psychotropic medication withdrawal / medication review home visits by Occupational Therapists improved post hospital discharge follow-up approaches to support client uptake in recommended interventions vitamin D and calcium supplementation (in low vit D cases) cardiac pacemaker for carotid sinus hypersensitivity foot exercise, footwear and orthoses multiple interventions based on a falls risk assessment have also been shown to be effective (including in high falls risk groups, eg older fallers presenting to ED) COCHRANE REVIEW: Gillespie et al, 2012 (159 trials with 79,193 participants)
Cochrane review: Gillespie et al 2012 (159 trials with 79,193 participants) Key elements of successful exercise interventions: Moderate balance component Moderate intensity (Sherrington et al, 2008, 2011) Group exercise programs Home exercise programs (often prescribed by a physiotherapist Tai Chi- (note: different types of Tai Chi may have different effects) Foot and ankle exercise as part of podiatric multifaceted program (Spink et al, 2011)
54 RCTs (all settings, though most in community) Exercise that provides moderate to high challenges to balance abilities should include: i) movements that reduce the base of support (e.g., standing with both legs close together, standing on one leg), ii) movement of the center of gravity (e.g., control of the body's position while standing, reaching, or stepping), and iii) the above movements without upper limb support Sherrington et al 2011 16
Randomly selected sample (>5,000 participants, 61% response rate) Merom et al, Prev Med, 2012; 55:613-7
12 week weight bearing (home based) exercise program (3 times / week) vs seated resistance exercise vs social visit Loss of up to 50% of balance gains in the subsequent 12 weeks after ceasing exercise Vogler et al, 2012, Arch Phys Med Rehabil; 93: 1685-91
(Nyman and Victor, Age and Ageing, 2012) Reviewed 99 randomised trial in 2009 Cochrane review (falls prevention in the community) Adherence rates (n = 69) were: 80% for vitamin D/calcium supplementation; 70% for walking and class-based exercise; 52% for individually targeted exercise; approximately 60-70% for fluid/nutrition therapy and interventions to increase knowledge; 58-59% for home modifications; Adherence to multifactorial interventions was generally 75% but ranged 28-95% for individual components. Home-exercises on average 11 times per month CONCLUSIONS: Using median rates for recruitment (70%), attrition (10%) and adherence (80%), we estimate that, at 12 months, on average half of community-dwelling older people are likely to be adhering to falls prevention interventions in clinical trials.
Sample with disabling foot pain and increased falls risk Intervention=foot & ankle exercise, footwear subsidy, and orthoses provision Intervention group had 36% fewer falls, p<0.05 Spink M et al,,.bmj. 2011 Jun 16;342:
At risk sample falls or injurious fall in past 12/12 Intervention=Lifestyle Integrated Functional Exercise Compared LiFE program vs structured exercise program vs control 31% reduction in falls (LiFE vs control, p<0.05)
Exercise parks for older people (Finland: Lappset) Recent study at Victoria University (18 weeks): Significant balance, strength and mobility improvements 87% completed program, 80% adherence http://www.lappset.com/global/en/ Pro_Play/The_Elderly_.iw3 Sales M et al, J Ageing & Health, IN PRESS
Uses Kinect system Dr Frances Batchelor, NARI
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Issues to consider: Acceptability Dexterity Charging Computer link for download and over time comparisons Current study: Elissa Burton, Curtin University
What might we have to do differently Health and care system Medical and health professional training Geriatrics / gerontology focus +/-Training re cohort factors Individual level Uptake and sustainability of health promoting behaviours
Multiple options - interactive Internet Apps / health reminders Performance monitors (Fit-bit HR ) Facebook /. Health professionals trusted source of information (?? may change) Peer education Other new modes of information delivery
Highly multicultural generation Volunteering Life-long learning Travel but diversity Others..
Multiple modes of consumer access to quality information Choice / variety Person centred care Technology Behaviour change focus YES There will be some generational differences Some will create challenges, some will present opportunities Important considerations for future generations of health and care professionals