Professor Kim Delbaere

Own Your Balance

Research investigating the impacts of cognitive behavioural therapy and balance programs on fear of falling, funded by Mindgardens.

Falls and fear of falling affect many older people and can impose limitations upon daily activities. Over one third of community dwelling older people fall each year with about 15% of falls being injurious. However, two thirds of older people express a fear of falling during common daily activities, making it more common than falls itself. Fear of falling has been associated with needless restriction in physical and social activities, and subsequent deterioration of health and wellbeing.

Previous research has suggested that fear of falling can be reduced through cognitive behavioural therapy (CBT) and balance exercise programs. However, these face-to-face treatments are resource intensive and not readily accessible to people. Furthermore, the effects of these treatments on fear of falling are small and often do not last beyond the duration of the program.

By utilising technology and providing tailored physical activity guidance we are aiming to reduce a fear of falling in an accessible, efficient and lasting way.

A thee-arm randomised clinical trial will be conducted in 189 community-dwelling older adults with a substantial concern of falling. Participants will be randomly allocated into one of three groups in order to test whether a self-managed CBT intervention, alone or in combination with a graded balance activity program, can reduce concerns about falling in older adults when compared to usual care.

We are collaborating with the Black Dog institute to provide a home-based cognitive behavioural therapy program that addresses a fear of falling. We will also be utilising our cutting-edge balance program StandingTall to provide a graded balance program.

 

Related studies:
https://www.neura.edu.au/project/reducing-fear-of-falling-and-activity-avoidance-in-older-adults-with-disproportionate-levels-of-fear-of-falling/
https://www.neura.edu.au/project/standingtall-plus-a-multifactorial-program-to-prevent-falls-in-older-people/

https://www.neura.edu.au/project/standing-tall/

Training to prevent falls in older people

To date, no studies have examined the potential for cognitive or cognitive-motor training to prevent falls in older people, despite good evidence of fall-related cognitive and physical improvements following both intervention types. Building on our initial work, we have developed and validated a home-based computerised training intervention that can be delivered identically, either while seated (cognitive) or while standing and undertaking balance exercises (cognitive+motor). Our project will also uncover cognitive-motor interactions and their neural pathways related to falls, via state-of-the-art imaging techniques that measure brain structure and functional changes. This intervention addresses both physical and cognitive fall risk factors. It holds promise for a cost-effective fall prevention strategy with multiple health benefits for older people.

Standing Tall: a novel technology-based balance exercise program

An unsupervised, home-based balance exercise program delivered through a tablet computer to prevent falls in older adults.

StandingTall is an engaging balance training program that is designed specifically for use by older people. It was developed using the latest insights in geriatric and translational neuroscience, and employs mobile (tablet) technology to deliver an effective method for improving balance and reducing fall risk. StandingTall includes: effective, individually-tailored exercise prescription to improve balance ability and reduce fall risk in older people; and behavioural change techniques to enhance exercise uptake and long-term adherence, with optimal usability for older people to use independently at home. By combining technology with research in fall prevention, StandingTall provides a radically new solution to support older adults to stay independent for longer and lower healthcare-related costs caused by falls.

The StandingTall team, led by Professor Kim Delbaere, has worked with over 1500 community-dwelling older people since 2015, implementing a home-based balance exercise program delivered through a tablet computer.

A conclusive randomised controlled trial in 503 individuals aged 70+ over 2 years showed a 16% lower falls rate, and a 20% lower rate of injurious falls over 2-years in the intervention group compared to controls. Particularly encouraging were the unprecedented adherence rates. 80% of participants continued to use the program for 6 months, 68% for 1 year and 52% remained to engage with the program for 2 years. Participant response to the program was highly positive, and feedback received is being used to further improve future versions of the program.

The first StandingTall trial has paved the way for future research projects, furthering our understanding of healthy ageing and reducing the risk of falls across the community. A follow-on study, StandingTall-Plus, which added a brain training element, is now at its tail end. We are also testing StandingTall with a psychological program aimed at improving confidence in daily activities that involve balance in our Own Your Balance study. We have had the opportunity to use StandingTall in other research areas including Aboriginal and Māori communities, Parkinson’s Disease, Cardiovascular Health, home and residential aged care, and within a multinational implementation study across select health districts in New South Wales, Victoria, and Northern England.

We are now working with collaborators to redevelop StandingTall to improve our user experience and include a larger range of exercise activities.

If you would like to read the full results published in the British Medical Journal, you can access the paper at the following website: https://doi.org/10.1136/bmj.n740

International implementation study of StandingTall

An international alliance lays the groundwork for the widespread implementation of StandingTall. This study targets a major need for older people for whom falls are a real risk that can have debilitating impacts on quality of life. It has been developed with major input from all partners and constitutes a valuable, collaborative partnership between researchers, experts in health promotion, health care providers and policy makers. Our partners for this project are the NSW Office of Preventive Health, Ministry of Health; the Clinical Excellence Commission; and the Agency for Clinical Innovation; two NSW Local Health Districts; i.e. Northern NSW and mid-North Coast; Austin Health, Uniting and the Northern Health Science Alliance in the United Kingdom. PLEASE NOTE: recruitment has finished for Australia.

The study aims to accelerate the implementation of StandingTall. It will address the final steps needed to scale up this innovative technology for widespread use by older people across Australia and England with prospects for further international translation. The overall aim of this international project is to establish integrated processes and pathways to deliver StandingTall to older people and to provide ongoing support as required. The project provides scope for further broad scale implementation and a model for incorporating StandingTall into existing health services and routine care.

For more information:

If in the UK, email: StandingTaller@manchester.ac.uk

If in Australia, please be aware that recruitment has finished for all Australian sites. If you are already participating and need to contact us, please phone: 02 9399 1113 or email: standingtaller@neura.edu.au.

StandingTall-Plus: a multifactorial program to prevent falls in older people

A cutting-edge research study on the effectiveness of a multifaceted program including balance exercise, brain training and cognitive behavioural therapy towards reducing falls.

For our next research study, called “StandingTall-Plus”, we have added a cutting-edge brain training program to our original StandingTall program. The main goal is to help people think faster on their feet during daily activities. We are also collaborating with the Black Dog Institute to offer online cognitive behavioural therapy to address depressive thoughts and low mood.

Falls in older people are often caused by a concomitant decline across three domains: mobility, cognition and affect; or in other words, across moving – thinking – feeling domains. The aim of this trial is to test a program that is individually tailored to various physical, cognitive and affective aspects (as opposed to medical pathologies) by taking a multifactorial profile approach to fall prevention. The use of technology will ensure that is easily accessible to do in the home and engaging to continue over a long period.

A randomised controlled trial will be conducted in 518 community-dwelling older adults at high-risk of falls. All participants will be assessed using a comprehensive test battery of known falls risk factors across physical, cognitive and affective domains. This will then be used to offer each participant a fully tailored program that is suited to their abilities and circumstances. Our primary aim is to reduce the number of falls over a 12-month follow-up period when compared to a health promotion program.

We hypothesise that our program will improve balance, cognitive function and mood, increase physical activity levels and reduce falls in older people, when compared to a health promotion program. This trial addresses a key gap in the understanding of falls interventions and application of personalized medicine and will provide direct evidence about the cost and effectiveness of a tailored multifaceted “best-bet” solution.

Cardiovascular health: Exercise management for people with Peripheral Arterial Disease and Intermitt

An engaging self-management program and scalable intervention using mobile technology to enhance healthy ageing and reduce fall risk in people with intermittent claudication: a randomised trial.

Cardiovascular disease is the leading cause of death and hospital admissions in Australia. Intermittent claudication is an intense cramping leg pain triggered by exercise and a common symptom of Peripheral Arterial Disease. It often causes functional decline, high health service use and loss of independence. Vascular interventions are often used to treat peripheral arterial disease, but are expensive and have limited durability. There is strong evidence that supervised exercise mitigates symptoms and reduces surgery rates. However, compliance and motivation with existing programs is poor (>40% dropout) due to beliefs that exercise-induced pain is harmful.

Supported by the UNSW Medicine Neuroscience, Mental Health and Addiction Theme and SPHERE Clinical Academic Group, we have developed a scalable self-management program for peripheral arterial disease delivered through mobile technology. Our program includes evidence-based standing balance exercises, pain management and interval walking components. It provides individually-tailored tools to empower older people suffering from intermittent claudication to lead more active lives, manage their pain and thereby improving their health outcomes long-term.

Koori Active and Healthy Ageing Project

“Healthy ageing is your mind staying young” – Koori Growing Old Well Study participant

 

Healthy Ageing calls for cognitively, physically and socially active lifestyles. The current project seeks to recognise existing community strengths but work to enhance participation and engagement, provide new resources specific to healthy ageing and develop an accessible platform for rolling out this intervention to diverse older people and communities, enabling widespread benefit. We will trial a cutting-edge approach to advance healthy ageing with implications for many Australians to benefit, particularly older Aboriginal people.

The project examines how to implement evidence based healthy ageing programs in urban and regional Aboriginal communities. Elders play a vital role in Indigenous communities, providing leadership, caring for family, and transmitting cultural knowledge and practices. However, the health, well-being and quality of life of the increasing numbers of older Indigenous people, are threatened by high rates of dementia, falls and depression. Novel culturally-safe approaches are needed to better engage and support Indigenous peoples in terms of healthy ageing. This research will develop and evaluate effective, culturally appropriate, and accessible strategies to promote healthy ageing in Aboriginal communities. It will also investigate whether and how resilience related to social and cultural cohesion can protect well-being in Indigenous communities.

Neuro-rehabilitation to prevent freezing in Parkinson’s Disease

An engaging self-managed neuro-rehabilitation program using eHealth technologies to improve mobility and enhance independence in people with Parkinson’s disease:

Parkinson’s disease is a multi-systems neurodegenerative disease with the severity of clinical symptoms (including postural instability, gait dysfunction an falls). With the population aging, the number of people affected by Parkinson’s disease is expected to double every 25 years presenting an increasing burden on health service and society as a whole. Falls are a common and devastating event in individuals with Parkinson’s disease and often precipitated by excessive gait variability, postural instability and freezing of gait.

Visual, attentional, haptic and auditory stimuli have been used to improve gait dysfunction in people with Parkinson’s disease. The aim of this project is to develop and evaluate a self-managed program using mHealth technology to improve mobility in people suffering from Parkinson’s disease. Dr Matthew Brodie was awarded a Michael & Elizabeth Gilbert Scholarship in Parkinson’s Disease Research.

Reducing Fear of Falling and Activity Avoidance in Older Adults with disproportionate levels of fear

Catastrophizing thoughts about falls can trip people up. We are now looking for programs that can help reduce concern about falling in older people.

Falls and fear of falling affect many older adults and can impose limitations upon daily activities. Over one third of community dwelling older adults fall each year with about 15% of falls being injurious. However, over two thirds of older adults express fear of falling during common daily activities, making it more common than falls itself. Fear of falling has been associated with needless restriction in physical and social activities with consequent negative impacts on lower quality of life.

Previous research has suggested that fear of falling can be reduced through cognitive behavioural therapy and balance exercise programs. We are collaborating with Black Dog Institute to investigate the effectiveness of an online cognitive behavioural program (myCompass) versus a health education program for 6 weeks at reducing concerns about falling in community-dwelling older people. The intervention consists of a fully-automated cognitive behavioural therapy program (myCompass) delivered through a tablet or computer in people’s homes with no therapist input, including evidence-based and interactive psychological modules that users can complete via the internet on a tablet or computer in their homes.

Novel methods for fall prediction in older people

Technological advances have enabled less expensive ways to quantify physical fall risk in the homes of older people.

We are exploring whether unobtrusive monitoring of activities of daily living or regular unsupervised directed routine assessments using new sensor-based technologies can predict falls in older adults more accurately.

We are developing and validating a range of mobile apps to assess fall risk factors in research settings and clinical practice; i.e. questionnaires (fear of falling, physical activity, etc), sensorimotor assessments (balance, vision, etc) and cognitive assessments (executive functioning, processing speed, etc.).

We are also working on Smart home IT support for frail elderly people who live alone.

Moving – thinking – feeling

Interrelationships between physical, cognitive and psychological function and falls.

Concomitant impairments in physical, psychological and cognitive function are common in old age. Our previous work has elucidated that addressing these impairments and their interplay are critical to minimize fall risk and achieve healthy ageing. The overall research objective of our ongoing research in this area is to develop a clearer understanding of inter-related underlying mechanisms of the effects across the triad of physical (frailty, balance), psychological (fear of falling, mood), cognitive (executive function, MCI, dementia) and neural (white matter integrity) impairments on falls and healthy ageing.

Health literacy on falls in older people

An informed and engaged older adult who values health promotion, protection, and preparedness is vital to promote uptake and adherence to any health and fall prevention programs.

According to the Australian Bureau of Statistics, about 60 per cent of Australians (15-74 years old) have less than adequate levels of health literacy and only 6% of the population have high health literacy. Health literacy was also found to be lower in old age. The majority of Australians with inadequate health literacy were aged 65 to 74 years. Similarly, in another Australian survey, only 8% of 1454 older adults were aware that balance training can prevent falls, or that falls could be prevented at all. This is indicative of poor health literacy among older Australians related to fall risk and fall prevention. With the increasing complexity of health information and services, health literacy is an issue for older Australians. Health literacy may affect individuals’ understanding of health information and in turn influence their health decisions and uptake of health preventive interventions such as engaging in physical activities to prevent falls.

This project will address a crucial gap in empowering older adults to take care of their own health and increase the uptake and efficacy of evidence-based fall prevention programs. An informed and engaged older adult who values health promotion, protection, and preparedness is vital to promote uptake and adherence to any health and fall prevention programs.

Brain and Brawn in Balance: Disentangling central and peripheral contributions to balance control.

Falls are a major health and economic burden in our aging population. Falls occur when we lose our balance and are unable to recover. What limits our ability to maintain and restore balance? This ability is a complex interaction of rapid central processing of accurate sensory information in the brain and rapid peripheral execution of motor responses by the muscles. When one of these processes is impaired, the interplay between brain and muscle functions might allow for compensation or, contrastingly, may limit improvements of balance. This interplay between central and peripheral functions has been strikingly overlooked, while it may underlie balance problems with ageing and disease, and allows for targeted prevention.

The goal of this project is to determine, through detailed analysis of balance and activity behaviour in daily life, how the interplay of central and peripheral impairments contributes to balance problems. Specifically, the goal of the project will be reached by addressing two major aims: (#1 aim) establish how the interplay of central and peripheral impairments affects balance control, and (#2 aim) identify whether prefrontal brain areas govern this interplay.

Caring for Spirit

The Caring for Spirit project is focused on providing a centralised online source of evidence-based resources and information that are culturally appropriate and appealing to Aboriginal and Torres Strait Islander communities. The team is translating the results of current research into culturally relevant and accessible information, education and training for people living with dementia, their families and carers, as well as for Aboriginal Health Workers.

We have engaged the services of Aboriginal staff, consultants, and graphic and website designers to achieve the appropriate look and feel. Community engagement and approval is essential and we are working with our Aboriginal community partners across NSW, as well as through our diverse networks to ensure national impact. Advice and feedback from these partners will be used to refine the resources. Growing old well is something we all want for our communities, but we also know that many things happen in our lives that could influence this process. A diagnosis of dementia can have an influence on our mind, body and spirit. This project is focused on translating the results of current research to keep our mind, body and spirit well, through education and training. This is important for people living with dementia, their families and carers, as well as for Aboriginal Health Workers. It is anticipated that these resources will contribute to enhancing the lives of Aboriginal and Torres Strait Islander people and their carers who are living with dementia, and contribute to alleviating the high burden of dementia in this population.

Koori Growing Old Well Study

The primary aim of a proposed longitudinal study is to find the reasons for the high dementia rates (three times non-Indigenous rates) in urban/regional Aboriginal people.

Koori Dementia Care Project

The Koori Dementia Care Project (KDCP) aims to inform, educate and build capacity in urban and regional NSW Aboriginal communities, and with associated service providers, about the effects of dementia on older Aboriginal people and their families.

Treating dizziness in older people

Despite effective treatments being available, up to 40% of older people with reported dizziness remain undiagnosed and untreated. A multidisciplinary assessment battery, with new validated assessments of vestibular impairments is required for diagnosing and treating older people with dizziness. This project conducted a randomised-control trial of a multifaceted dizziness intervention based on a multidisciplinary assessment, and developed a multiple profile assessment of dizziness for use in Specialist Clinics.

A RCT of cognitive-only and cognitive-motor training to prevent falls in older people

Dr Daina Sturnieks, Prof Stephen Lord, Dr  Jasmine Menant, Associate Professor Kim Delbaere, Prof Michael Valenzuela

This study aims to investigate the benefits of balance training and brain training on physical functions (balance and mobility), cognitive functions, general health and accidental fall events in people aged 65+ years.

The smartstep training system has been designed to enable you to undertake training in your own home, by playing engaging and enjoyable computer games. The system connects to a TV or computer monitor. The games are played with either a step mat (Figure 1) or a touch pad (Figure 2). These games have been designed to train important balance and cognitive functions, while also being fun. You may recognise some of the games, such as Space Invaders and Tetris (Figure 3).