Dr Morag Taylor

Does rehabilitation impact short and long term outcomes in people with dementia who sustain a hip fr

Older people with cognitive impairment/dementia have a higher prevalence of hip fracture and poorer outcomes after hip fracture when compared to cognitively normal older people. A recent Cochrane review has reported low to very low-quality evidence in relation to the effectiveness of models of care including enhanced rehabilitation strategies for people with cognitive impairment/dementia and that none of the interventions were specifically designed for people with cognitive impairment/dementia. There was some suggestion that enhanced care and rehabilitation may reduce delirium and an orthogeriatric model of care may reduce length of stay. This Cochrane review suggested that research should seek to determine the strategies needed to improve outcomes in people with cognitive impairment/dementia who sustain a hip fracture.

In the Australian and New Zealand Hip Fracture Registry (ANZHFR) annual report there is significant hospital variation in the proportion of patients with cognitive impairment who are offered rehabilitation after a hip fracture. The aim of this study is to use NSW Linked data to examine outcomes (e.g. mortality, admission to residential aged care, readmissions) in people with dementia who do and don’t receive rehabilitation after a hip fracture.

Care provision and outcomes in older people with and without cognitive impairment who sustain a hip

Older people with cognitive impairment/dementia have a higher prevalence of hip fracture and poorer outcomes after hip fracture when compared to cognitively normal older people. A recent Cochrane review has reported low to very low-quality evidence in relation to the effectiveness of models of care including enhanced rehabilitation strategies for people with cognitive impairment/dementia and that none of the interventions were specifically designed for people with cognitive impairment/dementia. There was some suggestion that enhanced care and rehabilitation may reduce delirium and an orthogeriatric model of care may reduce length of stay. This Cochrane review suggested that research should seek to determine the strategies needed to improve outcomes in people with cognitive impairment/dementia who sustain a hip fracture.

The Australian and New Zealand Hip Fracture Registry (ANZHFR) is a clinical audit of hip fracture care. The data collected is used for benchmarking against the national quality indicators for hip fracture and to understand clinical variation between hospitals and states. Describing clinical variation in care provides a strong impetus to improve care. The ANZHFR has presented minimal data comparing people with and without cognitive impairment/dementia (e.g. access to rehabilitation). Understanding clinical variation in care provided to people with and without cognitive impairment/dementia may assist in designing effective intervention strategies for this group of high risk patients. This study will therefore compare care provision and performance against national quality care indicators in people with and without cognitive impairment/dementia who have sustained a hip fracture.

Core competencies for physiotherapists working with people living with dementia: a modified Delphi

Physiotherapists commonly provide care to people living with dementia. However, in Australia, undergraduate training in aged care, including dementia, is not considered core training and there are no competency assessments. We will conduct an international modified e-Delphi to develop consensus-based core competencies for entry-level physiotherapists who care for people with dementia.

Dual task Gait and stepping feasibility study

The dual task gait and stepping study is recruiting 20 older people with dementia who will aim to complete physiotherapy-prescribed stepping and walking exercises while undertaking a secondary task (e.g. naming animals) for 3 months (with the assistance of their caregiver). The main goal is to determine if home-based dual task gait and stepping training is feasible, acceptable and safe for use in older people with dementia.

Randomised control trial of cognitive training for people with mild to moderate dementia (DiCE)

DiCE is a 12-month randomised controlled trial involving older people with dementia who are encouraged to perform cognitive training for 6 months (with the assistance of their carer). DiCE uses the novel smart±step program, which includes games designed to train specific cognitive functions that are important for everyday tasks, physical function and fall prevention. The aim of the study is to determine whether cognitive exercise improves cognitive and/or physical performance.

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.

StandingTall, is currently being trialled in one of our research projects recruiting new participants. If you are interested in finding out more or wish to express interest, please visit this website.

You can find updates about the program’s progress and fall prevention information on the StandingTall website.

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

Cognitive Training Trial

Randomised control trial of cognitive training for people with mild to moderate dementia

Fall Prevention in Older People with Dementia

What factors influence participation and adherence to a fall prevention intervention in community-dwelling older people with dementia?

Understanding and preventing physical and cognitive decline and falls in older people with dementia

Falls and functional decline are common in people with dementia. Falls are more likely to result in injury, death and institutionalisation when compared to older people without dementia. There is limited evidence that falls can be prevented in people with dementia. Strategies aimed at maintaining independence and preventing decline and falls are urgently needed. This research will a) further our understanding of fall risk and functional decline and b) explore novel fall and decline prevention programs, including the use of technology in older people with dementia.