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Professor Jacqueline Close

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.

Neuropsychological, physical, and functional mobility measures associated with falls in cognitively impaired older adults.

Taylor ME, Delbaere K, Lord SR, Mikolaizak AS, Brodaty H, Close JC

This study identified several risk factors of falls in older people with cognitive impairment, a number of which are potentially modifiable. Future research involving targeted interventions addressing medication use, balance, mood, and functional performance may prove useful for fall prevention in this population.

Systematic review of non-transportation rates and outcomes for older people who have fallen after ambulance service call-out.

Mikolaizak AS, Simpson PM, Tiedemann A, Lord SR, Close JC

Limited but promising evidence shows that appropriate interventions can improve health outcomes of non-transported older people who have fallen. Further studies are needed to explore alternate care pathways and promote more efficient use of health services.

Older fallers attended to by an ambulance but not transported to hospital: a vulnerable population at high risk of future falls.

Tiedemann A, Mikolaizak AS, Sherrington C, Segin K, Lord SR, Close JC

This prospective cohort study describes older non-transported fallers seen by the Ambulance Service of New South Wales (ASNSW), quantifies the level of risk and identifies predictors of future falls and ambulance use. Older, non-transported fallers seen by the ASNSW are a vulnerable population with high rates of chronic health conditions.

Discriminative ability and predictive validity of the timed up and go test in identifying older people who fall: systematic review and meta-analysis.

Schoene D, Wu SM, Mikolaizak AS, Menant JC, Smith ST, Delbaere K, Lord SR

To investigate the discriminative ability and diagnostic accuracy of the Timed Up and Go Test (TUG) as a clinical screening instrument for identifying older people at risk of falling. The findings suggest that the TUG is not useful for discriminating fallers from non-fallers in healthy, high-functioning older people but is of more value in less-healthy, lower-functioning older people. Overall, the predictive ability and diagnostic accuracy of the TUG are at best moderate. No cut-point can be recommended. Quick, multifactorial fall risk screens should be considered to provide additional information for identifying older people at risk of falls.

Physiological fall risk factors in cognitively impaired older people: a one-year prospective study.

Taylor ME, Lord SR, Delbaere K, Mikolaizak AS, Close JC

These findings indicate poor performance on physiological fall risk factors, particularly balance, increases the risk of falls in older cognitively impaired people.

Gait parameter risk factors for falls under simple and dual task conditions in cognitively impaired older people.

Taylor ME, Delbaere K, Mikolaizak AS, Lord SR, Close JC

Physical impairments in cognitively impaired older people: implications for risk of falls.

Taylor ME, Delbaere K, Lord SR, Mikolaizak AS, Close JC

Fall risk in the CIG was significantly increased due to multiple physical impairments. Physical profiles provide a means of quantifying the extent of impairment in older people with cognitive impairment and potential direction for targeting interventions for reducing fall risk.

Gait impairment and falls in cognitively impaired older adults: an explanatory model of sensorimotor and neuropsychological mediators.

Taylor ME, Ketels MM, Delbaere K, Lord SR, Mikolaizak AS, Close JC

to explore the associations between spatiotemporal gait parameters and falls in cognitively impaired older people and to investigate whether sensorimotor and neuropsychological factors mediate the association between gait performance and falls. the findings indicate that slow and variable gait patterns increase the risk of falls in cognitively impaired older adults. Further, the association between gait and falls seems to be mediated in large by reduced sensorimotor functioning. Further research is needed to investigate whether interventions aimed at improving gait and/or sensorimotor fall risk factors, such as strength and balance, can prevent falls in cognitively impaired older adults.

The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study.

Delbaere K, Close JC, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR

this study aimed to perform a comprehensive validation of the 16-item and 7-item Falls Efficacy Scale International (FES-I) by investigating the overall structure and measurement properties, convergent and predictive validity and responsiveness to change. the current study builds on the previously established psychometric properties of the FES-I. Both scales have acceptable structures, good validity and reliability and can be recommended for research and clinical purposes. Future studies should explore the FES-I's responsiveness to change during intervention studies and confirm suggested cut-points in other settings, larger samples and across different cultures.

Older People with Dementia Have Reduced Daily-Life Activity and Impaired Daily-Life Gait When Compared to Age-Sex Matched Controls.

Taylor ME, Brodie MA, van Schooten KS, Delbaere K, Close JCT, Payne N, Webster L, Chow J, McInerney G, Kurrle SE, Lord SR

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.

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.

Slow gait speed is associated with executive function decline in older people with mild to moderate dementia: A one year longitudinal study.

Taylor ME, Lasschuit DA, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Kvelde T, Close JCT

This study aimed to document change in neuropsychological, physical and functional performance over one year and to investigate the relationship between baseline gait speed and cognitive decline in this period in older people with dementia. Older people with mild to moderate dementia demonstrate significant decline in neuropsychological, physical and functional performance over one year. Baseline gait speed is associated with decline in executive function over one year, suggesting shared pathways/pathology between gait and cognition.

Exercise for falls prevention in older people: assessing the knowledge of exercise science students.

Sturnieks DL, Finch CF, Close JC, Tiedemann A, Lord SR, Pascoe DA

Participation in appropriate exercise can help reduce the risk of falls and falls injury in older people. Delivery of population-level exercise interventions requires an expert workforce with skills in development and delivery of group exercise programs and prescription of individually targeted exercise. This study assessed the current knowledge of university exercise science students (as future exercise professionals) across different levels of study. A structured survey designed to assess knowledge in relation to falls in older people and exercise prescription for falls prevention was administered during second, third and fourth year lectures in seven Australian universities. Students' knowledge was assessed as the percent of correct responses. Overall, 566 students completed the survey and knowledge levels increased significantly with study year. Mean knowledge levels were significantly <70%, indicating limited knowledge. They were lowest for falls risk factor questions and highest for issue/cost related questions in second and third year students. Fourth year students had best knowledge about falls interventions and this was the only group and topic with a mean score >70%. In conclusion, knowledge about falls and exercise prescription for falls prevention in current students does not meet a desired competency level of 70% and is therefore insufficient to ensure an adequately equipped future workforce in this area. There is a clear need for the development and widespread delivery of an evidence-based "exercise for falls prevention" curriculum module for exercise professionals.

Relationships between serum vitamin D levels, neuromuscular and neuropsychological function and falls in older men and women.

Menant JC, Close JC, Delbaere K, Sturnieks DL, Trollor J, Sachdev PS, Brodaty H, Lord SR

These findings highlight the associations between vitamin D insufficiency and impairments in physiological and neuropsychological function that predispose older people to fall. The significant relationship between vitamin D insufficiency and falls found in the men may relate to the stronger association found between serum 25OHD levels and dynamic balance measures evident in this male population.

Mild cognitive impairment as a predictor of falls in community-dwelling older people.

Delbaere K, Kochan NA, Close JC, Menant JC, Sturnieks DL, Brodaty H, Sachdev PS, Lord SR

: Incidence of falls in people with cognitive impairment with or without a formal diagnosis of dementia is estimated to be twice that of cognitively intact older adults. This study aimed to investigate whether mild cognitive impairment (MCI) is associated with falls in older people. : The findings indicate that objectively defined MCI is an independent risk factor for injurious or multiple falls in a representative sample of community-dwelling older people. The presence of nonamnestic MCI, based primarily on executive function, was found to be an important factor in increasing fall risk.

Pain and anxiety mediate the relationship between dizziness and falls in older people.

Menant JC, Wong A, Sturnieks DL, Close JC, Delbaere K, Sachdev PS, Brodaty H, Lord SR

To identify medical, psychological, and physiological mediators of the relationship between dizziness and falls in older adults. Suffering from neck and back pain and anxiety were mediators of the relationship between dizziness and falls after controlling for poor sensorimotor function and balance. Older people with dizziness might benefit from interventions targeting these mediators such as pain management and cognitive behavioral therapy.

Angiotensin system-blocking medications are associated with fewer falls over 12 months in community-dwelling older people.

Wong AK, Lord SR, Sturnieks DL, Delbaere K, Trollor JN, Close JC

To investigate relationships between the use of cardiovascular medications, including angiotensin system-blocking medications (ASBMs), orthostatic hypotension (OH), fall risk, and falls in community-dwelling older people. The use of cardiovascular medications in older people did not increase the risk of falls, and the use of ASBMs was associated with lower fall risk. The mechanisms for this apparent protective effect are unclear and appear not to be directly related to muscle strength. More research is required to elucidate the possible protective effects of certain cardiovascular medications in relation to falls in older people.

High arterial pulse wave velocity is a risk factor for falls in community-dwelling older people.

Wong AK, Lord SR, Trollor JN, Sturnieks DL, Delbaere K, Menant J, Brodaty H, Sachdev PS, Close JC

To examine whether arterial stiffness is a risk factor for falls in community-dwelling older people. In community-dwelling older people, high PWV (as a measure of arterial stiffness) was a risk factor for falls after adjusting for potential demographic, anthropometric, disease, and medication confounders. Further research is required to investigate mediators for this association and the effect of lowering arterial stiffness on falls in older people.

Tailored multifactorial intervention to improve dizziness symptoms and quality of life, balance and gait in dizziness sufferers aged over 50 years: protocol for a randomised controlled trial.

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

Exercise for falls prevention in Parkinson disease: a randomized controlled trial.

Canning CG, Sherrington C, Lord SR, Close JC, Heritier S, Heller GZ, Howard K, Allen NE, Latt MD, Murray SM, O'Rourke SD, Paul SS, Song J, Fung VS

To determine whether falls can be prevented with minimally supervised exercise targeting potentially remediable fall risk factors, i.e., poor balance, reduced leg muscle strength, and freezing of gait, in people with Parkinson disease. An exercise program targeting balance, leg strength, and freezing of gait did not reduce falls but improved physical and psychological health. Falls were reduced in people with milder disease but not in those with more severe Parkinson disease.

The association of physical illness and self-harm resulting in hospitalisation among older people in a population-based study.

Mitchell R, Draper B, Harvey L, Brodaty H, Close J

With population ageing, self-harm injuries among older people are increasing. Further examination of the association of physical illness and self-harm among older people is warranted. This research aims to identify the association of physical illness with hospitalisations following self-harm compared to non-self-harm injury among older people. Older people who are experiencing chronic health conditions, particularly tinnitus, malignancies, diabetes and chronic pain may be at risk of self-harm. Targeted screening may assist in identifying older people at risk of self-harm.

Dementia and intentional and unintentional poisoning in older people: a 10 year review of hospitalization records in New South Wales, Australia - CORRIGENDUM.

Mitchell RJ, Harvey LA, Brodaty H, Draper B, Close JC

The authors would like to apologise for a typographical error in the abstract of the above mentioned article. In the results section of the abstract on the first page of the article, the first odds ratio that refers to 'aged care facilities' should be (OR 5.44; 95% CI 4.43-6.67) and the second odds ratio that refers to health service facilities should be (OR 4.56; 95%CI 4.06-5.13).

The influence of dementia on injury-related hospitalisations and outcomes in older adults.

Harvey L, Mitchell R, Brodaty H, Draper B, Close J

People with dementia are disproportionately represented in injury-related hospitalisations, experience longer hospital LOS and have poorer outcomes. Ninety percent of hospitalisations for people with dementia were as a result of a fall, highlighting the importance of developing and implementing effective fall-related preventive strategies in this high risk population.

Hip fracture and the influence of dementia on health outcomes and access to hospital-based rehabilitation for older individuals.

Mitchell R, Harvey L, Brodaty H, Draper B, Close J

Dementia: A risk factor for burns in the elderly.

Harvey L, Mitchell R, Brodaty H, Draper B, Close J

Burns in people with dementia are significant injuries, which have not decreased over the past ten years despite prevention efforts to reduce burns in older people. Targeted prevention education in the home and residential aged care facilities is warranted.