Prof 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 Prof Jacqueline Close is currently involved with

CURRENT PROJECTS

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. [ADD LINK TO PROJECT 1] 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.

 

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Australian and New Zealand Hip Fracture Registry (ANZHFR)

HIP FRACTURE CARE GUIDE

RESEARCH TEAM

Linda Roylance

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

Elizabeth Armstrong

ELIZABETH ARMSTRONG Senior Research Facility Manager

Stefanie Mikolaizak

STEFANIE MIKOLAIZAK Postdoctoral Fellow

CHRISTINA NORRIS PhD student

Barbara Toson

BARBARA TOSON Bio-statistician

ASSOC PROF 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

White matter hyperintensities are associated with falls in older people with dementia.

Taylor ME, Lord SR, Delbaere K, Wen W, Jiang J, Brodaty H, Kurrle SE, Stefanie Mikolaizak A, Close JCT

White Matter Hyperintensities (WMHs) are associated with impaired gait, balance and cognition and increased fall risk in cognitively healthy older people. However, few studies have examined such relationships in older people with dementia. Understanding the role of WMHs in falls may assist in developing effective fall prevention strategies. We investigated the relationship between baseline WMHs, cognitive and sensorimotor function and prospective falls in older people with dementia. Twenty-eight community-dwelling older people with mild-moderate dementia (MMSE 11-23; ACE-R < 83) underwent magnetic resonance imaging and assessment of sensorimotor and cognitive (global and processing speed) function at baseline. WMHs, were quantified using a fully automated segmentation toolbox, UBO Detector ( https://cheba.unsw.edu.au/group/neuroimaging-pipeline ). Falls were ascertained prospectively for 12-months using monthly calendars with the assistance of carers. The median age of the participants was 83 years (IQR 77-86); 36% were female; 21 (75%) fell during follow-up. Using Generalized Linear Models, larger volumes of total WMHs were found to be significantly associated with poorer global cognitive and sensorimotor function. Using modified Poisson regression, total, periventricular and deep WMHs were each associated with future falls while controlling for age, sex, intracranial volume and vascular risk. Each standard deviation increase in total and periventricular WMH volume resulted in a 33% (RR 1.33 95%CI 1.07-1.66) and 30% (RR 1.30 95%CI 1.06-1.60) increased risk of falling, respectively. When the deep WMH volume z-scores were dichotomized at the median, individuals with greater deep WMH volumes had an 81% (RR 1.81 95% CI 1.02-3.21) increased risk of falling. WMHs were associated with poorer sensorimotor and cognitive function in people with dementia and total, periventricular and deep WMHs were associated with falls. Further research is needed to confirm these preliminary findings and explore the impact of vascular risk reduction strategies on WMHs, functional performance and falls.

Reducing the burden of dizziness in middle-aged and older people: A multifactorial, tailored, single-blind randomized controlled trial.

Menant JC, Migliaccio AA, Sturnieks DL, Hicks C, Lo J, Ratanapongleka M, Turner J, Delbaere K, Titov N, Meinrath D, McVeigh C, Close JCT, Lord SR

A multifactorial tailored approach for treating dizziness was effective in reducing dizziness handicap in community-living people aged 50 years and older. No difference was seen on the other primary outcomes. Our findings therefore support the implementation of individualized, multifaceted evidence-based therapies to reduce self-perceived disability associated with dizziness in middle-aged and older people.

The role of cognitive function and physical activity in physical decline in older adults across the cognitive spectrum.

Taylor ME, Boripuntakul S, Toson B, Close JCT, Lord SR, Kochan NA, Sachdev PS, Brodaty H, Delbaere K

The aim of this study was to investigate physical decline over 1-year in a cohort of older people across the cognitive spectrum.

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