Ageing baby boomers: will falls prevention need to change ... · 12 week weight bearing (home...
Transcript of Ageing baby boomers: will falls prevention need to change ... · 12 week weight bearing (home...
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Professor Keith Hill,
Head, School of Physiotherapy and Exercise Science
Ageing baby boomers: will falls prevention need to change as the ageing population changes?
Monash Seminar – September 2016
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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
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• Reluctant to see Dr• Does not seek additional advice (2nd
opinion, internet…)• Generally low level of focus on
preventive health
???
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Health problems associated with ageing likely to increase:
◦ Falls ◦ Dementia◦ Osteoporosis◦ ....
Major focus on (1) ageing well (2) health promotion and prevention (3) improving outcomes and quality of
life for those with health problems
Australian Bureau of Statistics estimates
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Baby boomers – who are they?
file:///J:/Generations%20Chart.pdf
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.
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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 on what it takes to age well (2016) - tacsi.org.au
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What is likely to be different?
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Positives
Education
Health literacy
Tech savvy
Affluent
Questioning (second opinion / research)
Benefit from health promotion messages over past 20 years
Strong desire for independence
What is likely to be different?
Negatives
??Ability to adapt to rapidly changing technology
??reluctance to change behaviours
but not universal
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Footer text - slideshow title
"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"
Being tech savvy now does not mean being tech savvy in 15 years time….
Source: Ian Hosking – University of Cambridge engineering design centre
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Baby-boomers health
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30.07.2010Footer text - slideshow title
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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
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COCHRANE REVIEW: Gillespie et al, 2012 (159 trials with 79,193 participants)
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)
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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 multi-faceted program (Spink et al, 2011)
Key elements of successful exercise interventions: Moderate balance
component Moderate intensity(Sherrington et al, 2008, 2011)
Cochrane review: Gillespie et al 2012 (159 trials with 79,193 participants)
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16Sherrington 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
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Randomly selected sample (>5,000 participants, 61% response rate)
Merom et al, Prev Med, 2012; 55:613-7
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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
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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
(Nyman and Victor, Age and Ageing, 2012)
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.
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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:
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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)
Clemson L et al BMJ 2012 Aug 7;345:e4547
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Exercise parks for older people (Finland: Lappset)
Recent study at Victoria University (18 weeks):◦ Significant balance, strength
and mobility improvements◦ 87% completed program,
80% adherencehttp://www.lappset.com/global/en/Pro_Play/The_Elderly_.iw3
Sales M et al, J Ageing & Health, IN PRESS
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Uses Kinect system
Dr Frances Batchelor, NARI
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30.07.2010Footer text - slideshow title
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Issues to consider:◦ Acceptability◦ Dexterity◦ Charging◦ Computer link for download and
over time comparisons
Current study: Elissa Burton, Curtin University
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What might we have to do differently…
Health and care systemMedical and health
professional training• Geriatrics / gerontology
focus+/-Training re cohort factors
Individual levelUptake and
sustainability of health promoting behaviours
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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
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Highly multicultural generation
Volunteering
Life-long learning
Travel
Others…..
but diversity…
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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
• Multiple modes of consumer access to quality information
• Choice / variety• Person centred care• Technology• Behaviour change focus