Professor Jacqueline Close

TEAM LEADER PROFILE

Principal Research Fellow, NeuRA Conjoint Professor, UNSW
Consultant Geriatrician, Prince of Wales Hospital

+612 9399 1055


Prof Jacqui Close is a consultant in Orthogeriatrics at the Prince of Wales Hospital in Sydney and Clinical Director of the Falls, Balance and Injury Research Centre at Neuroscience Research Australia. Her primary research area is falls in people with cognitive impairment and dementia and particularly the relationship of cognitive function to postural stability, falls and fractures. She also has an epidemiological interest in the impact of falls and injury to health service use and the way in which health services are designed to prevent and manage falls and injury in older people. She sits on a number of State and National committees in relation to Aged Health and is Co-Chair of the ANZ Hip Fracture Registry, Chair of the ACSQHC Clinical Care Standards Working Group for Hip Fracture and the President of the Australian and New Zealand Society of Geriatric Medicine.

Projects Professor Jacqueline Close is currently involved with

CURRENT PROJECTS

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 will therefore aim to conduct a randomised-control trial of a multifaceted dizziness intervention based on a multidisciplinary assessment, and develop a multiple profile assessment of dizziness for use in Specialist Clinics.

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Treating dizziness in older people

The Sydney Partnership for Health, Education, Research & Enterprise (SPHERE)

The project

Improving time to surgery for older people who have broken a hip.

The problem

National and International Guidelines and Standards of Care suggest that people who fall and fracture their hip should have an operation to fix the hip within 48 hours of presentation to hospital. However data from the ANZ Hip Fracture Registry suggests that many hospitals across Australia and New Zealand struggle to meet this target. The main reasons for delay to surgery are 1) getting access to theatre time, 2) getting medical clearance to proceed with the operation and 3) difficulties managing people on blood thinning agents in preparation for an operation.

The Study

Four major hospitals in NSW will aim to markedly improve their time to surgery for people who have broken a hip – Prince of Wales Hospital, St George Hospital, The Sutherland Hospital and Liverpool Hospital.

Clinicians and managers will work in partnership to identify delays that occur and develop solutions that ultimately ensure that older people with a hip fracture get high quality evidence based care.

GOAL – By the end of 2020, 85% of people will have their surgery within 48 hours

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The Sydney Partnership for Health, Education, Research & Enterprise (SPHERE)

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.

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.

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International implementation study of StandingTall

Care of Older People in Surgery

Each year the number of older people undergoing surgery increases. Although evidence is well established that older age and frailty are associated with greater risk of poorer postoperative outcomes, there is little evidence to date to establish whether outcomes can be improved through geriatric intervention.

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Care of Older People in Surgery

Preventing further falls in people who call an ambulance as a result of a fall – a randomised contro

Many older people suffer a fall and it is not uncommon for older fallers to require paramedic care following such events. Routine transportation to hospital is of questionable value and may not be an effective or efficient use of resources. This randomised controlled offered non-transported fallers a new model of care following fall-related paramedic care.

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Preventing further falls in people who call an ambulance as a result of a fall – a randomised controlled trial

Patterns of use and cost to the ambulance service of fall-related injury in older people

While the pattern of ambulance use have been studied extensively, the associated costs which are influenced by a variety of factors are still being explored. This program of research aims to better understand what is driving costs within the ambulance service, explore pathways to optimise resource use and evaluate models of care to streamline health care provided to older adults.

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Patterns of use and cost to the ambulance service of fall-related injury in older people

Evaluation and comparison of comorbidity measures to predict mortality and morbidity in older popula

This program of research evaluates the performance of commonly used comorbidity measures (Charlson Comorbidity Index, Elixhauser and Multipurpose Australian Comorbidity Scoring System) on the prediction of 30-day and 1-year mortality, 28 day re-admission, and length of stay in an older hip fracture population.

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Evaluation and comparison of comorbidity measures to predict mortality and morbidity in older populations

Causes, consequences and costs of injury-related hospitalisations for people with dementia: identify

This research program explores the influence of dementia on the pattern of hospital admissions, clinical care, health outcomes and economic costs of older people with an injury-related hospitalisation. It provides data on the impact of injury on a person with dementia and the health system more generally.

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Causes, consequences and costs of injury-related hospitalisations for people with dementia: identifying opportunities for prevention and optimising management

Determinants of uptake of home modifications and exercise to prevent falls in community-dwelling old

This research examines the age-specific population prevalence and predictors of uptake of home modifications and exercise to prevent falls in the older population in NSW.

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Determinants of uptake of home modifications and exercise to prevent falls in community-dwelling older people

Preventing Falls in Older Adults with Cognitive Impairement or Dementia (IFOCIS)

The IFOCIS study aims to determine the ability of an individualised exercise and home hazard reduction program to reduce the rates of falls in older people living in the community with cognitive impairment or dementia. To do this, we have two groups– an ‘intervention’ group and a ‘control’ group. The Intervention program involves: an exercise program and a home hazard reduction program delivered by experienced therapists tailored to the participant’s cognitive and physical abilities. Carers are an integral part of the intervention team, as some participants require supervision for exercise sessions. We work with carers to help them understand how to get the best from the participant they are caring for, in terms of their ‘functional cognition’, completing the exercises and preventing falls.

Taking this individual approach means that participants can have very different cognitive abilities and still be included in our study. No other study has done this to date.

All participants will undergo an assessment at baseline with re tests at 6 and 12 months to compare each of these groups on things like strength & balance. The primary outcome is the rate of falls during the 12 month study period which is collected using falls diaries on a monthly basis.

Recruitment for the project is now in the 2nd year. We have enrolled 184 participants and their carers into the trial from the Prince of Wales hospital / NeuRA site and the Hornsby hospital site. We hope to have 360 participants enrolled by the end of 2017. We continue to recruit from Prince of Wales and Hornsby hospital wards and outpatient clinics and other Sydney metropolitan hospital dementia day clinics.

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Preventing Falls in Older Adults with Cognitive Impairement or Dementia (IFOCIS)

Traumatic brain injury in older people

This research explores the trends in hospitalisations, causes and outcomes of traumatic brain injury in older adults in NSW over a twelve-year period 1998/99 to 2010/11

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Traumatic brain injury in older people

Fall-related cervical spine injury in older people

Incidence, circumstances, treatment and outcome of high-level cervical spinal fracture without associated spinal cord injury in New South Wales, Australia over a 12 year period.

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Fall-related cervical spine injury in older people

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.

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

Australian and New Zealand Hip Fracture Registry (ANZHFR)

There are approximately 17,000 new hip fractures in Australia and 4,000 in New Zealand annually. The cost of the event is enormous, both for the individual and their family, as well as the health care system. There is variation in models of hip fracture care within and between States and Territories (Aus) and District Health Boards (NZ). Much of what happens in the acute and rehabilitation settings impacts directly on the longer term outcomes for the person with the fracture. The ANZHFR allows for timely comparison of meaningful data that can be used by providers of care to understand clinical practice, and trigger a case for change in places where improvement can be made.

 

Find out more

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Australian and New Zealand Hip Fracture Registry (ANZHFR)

HIP FRACTURE CARE GUIDE

RESEARCH TEAM

LINDA ROYLANCE Executive Assistant : +612 9399 1124
: l.roylance@neura.edu.au

Elizabeth Armstrong

ELIZABETH ARMSTRONG Senior Research Facility Manager

CHRISTINA NORRIS PhD student

Barbara Toson

BARBARA TOSON Bio-statistician

ASSOCIATE PROFESSOR REBECCA MITCHELL Visiting Senior Research Scientist

LYNDELL WEBSTER Research assistant

Narelle Payne

NARELLE PAYNE Research assistant

JACQUELINE WESSON Research assistant

CECELIA KOCH Research assistant

GENEVIEVE ZELMA Research assistant

ROSLYN SAVAGE Research assistant

Sandra O'Rourke

SANDRA O’ROURKE Research assistant

BEATRICE JOHN Research assistant

PUBLICATIONS

Inaccurate judgement of reach is associated with slow reaction time, poor balance, impaired executive function and predicts prospective falls in older people with cognitive impairment.

Taylor ME, Butler AA, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Close JCT

Inaccurate reach judgement predicts future falls and is associated with poorer global cognitive performance and executive function, increased concern about falling, slower reaction time and poorer balance. Our results offer insight into the disparity between actual and perceived physical capabilities in people with CI, and how this impacts their risk of falling.

Adherence to a multifactorial fall prevention program following paramedic care: Predictors and impact on falls and health service use. Results from an RCT a priori subgroup analysis.

Mikolaizak AS, Lord SR, Tiedemann A, Simpson P, Caplan G, Bendall JC, Howard K, Close J

To identify predictors and impact of adherence to a multifactorial fall-prevention program on falls and health service utilisation. Older adults who adhere to recommendations benefit, regardless of fall-risk profile.

Reaction Time and Postural Sway Modify the Effect of Executive Function on Risk of Falls in Older People with Mild to Moderate Cognitive Impairment.

Taylor ME, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Close JCT

To explore the relationship between cognitive performance and falls in older people with mild to moderate cognitive impairment (CI) by investigating the mediational effects of medical, medication, neuropsychological, and physiological factors. Within this sample of older people with mild to moderate CI, poorer EF increased the risk of multiple falls. This relationship was mediated by reaction time and postural sway,suggesting cognitively impaired older people with poorer EF may benefit from fall prevention programs targeting these mediating factors.

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