Anne Tiedemann - Academia.edu (original) (raw)

Papers by Anne Tiedemann

BMC public health, 2015

Physical inactivity and falls in older people are important public health problems. Health condit... more Physical inactivity and falls in older people are important public health problems. Health conditions that could be ameliorated with physical activity are particularly common in older people. One in three people aged 65 years and over fall at least once annually, often resulting in significant injuries and ongoing disability. These problems need to be urgently addressed as the population proportion of older people is rapidly rising. This trial aims to establish the impact of a combined physical activity and fall prevention intervention compared to an advice brochure on objectively measured physical activity participation and mobility-related goal attainment among people aged 60 +. A randomised controlled trial involving 130 consenting community-dwelling older people will be conducted. Participants will be individually randomised to a control group (n = 65) and receive a fall prevention brochure, or to an intervention group (n = 65) and receive the brochure plus physical activity pro...

Acta psychiatrica Scandinavica, 2014

To investigate the impact of a 12-week exercise programme in addition to usual care for post-trau... more To investigate the impact of a 12-week exercise programme in addition to usual care for post-traumatic stress disorder (PTSD). An assessor-blinded randomized controlled trial was conducted among 81 participants with a DSM-IV-TR diagnosis of primary PTSD. Participants were recruited after admission to an in-patient programme at a private hospital. Participants were randomized to receive either usual care (n = 42), or exercise in addition to usual care (n = 39). The exercise intervention involved three, 30-min resistance-training sessions/week and a pedometer-based walking programme. Usual care involved psychotherapy, pharmaceutical interventions, and group therapy. Primary outcome was PTSD symptoms assessed via the PTSD checklist-civilian version (PCL-C). Secondary outcomes included symptoms of depression, anthropometry, physical activity, mobility, strength, and sleep quality. Participants had a mean (SD) age of 47.8 years (12.1), 84% male. PTSD symptoms in the intervention group si...

BMJ open, 2014

Falling in older age is a serious and costly problem. At least one in three older people fall ann... more Falling in older age is a serious and costly problem. At least one in three older people fall annually. Although exercise is recognised as an effective fall prevention intervention, low numbers of older people engage in suitable programmes. Health and exercise professionals play a crucial role in addressing fall risk in older adults. This trial aims to evaluate the effect of participation in a fall prevention educational programme, compared with a wait-list control group, on health and exercise professionals' knowledge about fall prevention and the effect on fall prevention exercise prescription behaviour and confidence to prescribe the exercises to older people. A randomised controlled trial involving 220 consenting health and exercise professionals will be conducted. Participants will be individually randomised to an intervention group (n=110) to receive an educational workshop plus access to internet-based support resources, or a wait-list control group (n=110). The two prima...

Metabolism, 2015

Hospital Rd Randwick NSW 2031 +61 415 435 125 s.rosenbaum@unsw.edu.au 2014;75(9):964-974. 5. Curt... more Hospital Rd Randwick NSW 2031 +61 415 435 125 s.rosenbaum@unsw.edu.au 2014;75(9):964-974. 5. Curtis J, Watkins A, Rosenbaum S, Teasdale SB, Kalucy M, Samaras K, Ward PB. Keeping the Body in Mind: an individualised lifestyle and life-skills intervention to prevent antipsychotic-induced weight gain in first episode psychosis. Early Interven Psychiatry 2015; in press. 6. Bruins J, Jörg F, Bruggeman R, Slooff C, Corpeleijn E, Pijnenborg M.

British Journal of Sports Medicine, 2014

Encyclopedia of Exercise Medicine in Health and Disease, 2012

Encyclopedia of Exercise Medicine in Health and Disease, 2012

New South Wales public health bulletin, 2011

Preventing falls and fall-related injuries among older people is an urgent public health challeng... more Preventing falls and fall-related injuries among older people is an urgent public health challenge. This paper provides an overview of the background to and research planned for a 5-year National Health and Medical Research Council Partnership Grant on implementing falls prevention research findings into policy and practice. This program represents a partnership between key Australian falls prevention researchers, policy makers and information technology companies which aims to: (1) fill gaps in evidence relating to the prevention of falls in older people, involving new research studies of risk factor assessment and interventions for falls prevention; (2) translate evidence into policy and practice, examining the usefulness of new risk-identification tools in clinical practice; and (3) disseminate evidence to health professionals working with older people, via presentations, new evidence-based guidelines, improved resources and learning tools, to improve the workforce capacity to pr...

Physical therapy, 2003

The purpose of this perspective article is to describe the use of a physiological profile approac... more The purpose of this perspective article is to describe the use of a physiological profile approach to falls risk assessment and prevention that has been developed by the Falls and Balance Research Group of the Prince of Wales Medical Research Institute, Sydney, Australia. The profile's use for people with a variety of factors that put them at risk for falls is discussed. The Physiological Profile Assessment (PPA) involves a series of simple tests of vision, peripheral sensation, muscle force, reaction time, and postural sway. The tests can be administered quickly, and all equipment needed is portable. The results can be used to differentiate people who are at risk for falls ("fallers") from people who are not at risk for falls ("nonfallers"). A computer program using data from the PPA can be used to assess an individual's performance in relation to a normative database so that deficits can be targeted for intervention. The PPA provides valid and reliable ...

The Journal of rheumatology, 2004

To investigate physiological risk factors for falls in people with self-reported lower limb arthr... more To investigate physiological risk factors for falls in people with self-reported lower limb arthritis. Six hundred eighty-four community-dwelling men and women aged 75-98 years (mean 80.0, SD 4.4), categorized with and without lower limb arthritis, underwent quantitative tests of strength, peripheral sensation, vision, reaction time, balance, and pain. A 12-month history of falls was also obtained. Subjects with self-reported lower extremity arthritis performed significantly worse in tests of knee and ankle muscular strength, lower limb proprioception, postural sway, and leaning balance than subjects without lower extremity arthritis, while being comparable in vision, tactile sensitivity, and reaction time. This pattern of specific impairments was also evident when group results for the arthritis subjects were compared with community normative values and presented as a physiological profile. The arthritis group suffered significantly more falls [relative risk (RR) 1.22, 95% CI 1.03-...

Stroke research and treatment, 2012

Aim. To investigate predictors of adherence to group-based exercise and physical activity partici... more Aim. To investigate predictors of adherence to group-based exercise and physical activity participation among stroke survivors. Methods. 76 stroke survivors participated (mean age 66.7 years). Adherence was the percentage of classes attended over one year. Physical activity was the average pedometer steps/day measured over seven days at the end of the trial. Possible predictors included baseline measures of demographics, health, quality of life, falls, fear of falling, cognition, and physical functioning. Results. Mean class attendance was 60% (SD 29%). Only one variable (slow choice stepping reaction time) was an independent predictor of higher class attendance, explaining 5% of the variance. Participants completed an average of 4,365 steps/day (SD 3350). Those with better physical functioning (choice stepping reaction time, postural sway, maximal balance range, 10-m walk, or 6-min walk) or better quality of life (SF-12 score) took more steps. A model including SF-12, maximal balan...

BMC research notes, 2014

Posttraumatic stress disorder (PTSD) is reportedly associated with lower rates of physical activi... more Posttraumatic stress disorder (PTSD) is reportedly associated with lower rates of physical activity participation despite the known benefits of regular physical activity for improving both mental and physical health. However, no studies have evaluated the validity or feasibility of assessing physical activity within this population resulting in uncertainty around the reported lower rates of physical activity participation. This study aimed to evaluate the feasibility and concurrent validity of the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Actigraph accelerometer (an objective physical activity monitor) among inpatients with PTSD. Fifty-nine adult hospital inpatients with a Diagnostic Statistical Manual Mental Disorder-IV-TR diagnosis of primary PTSD (mean age = 49.9 years; 85% male) participated in the study. Participants were asked to wear an Actigraph accelerometer for seven consecutive days then complete the IPAQ-SF. The Spearman rho correlation c...

Prehospital Emergency Care, 2014

To describe the characteristics of older people who fall and call an emergency ambulance, and the... more To describe the characteristics of older people who fall and call an emergency ambulance, and the operational and clinical impact of the ambulance responses they receive. Methods. A prospective cohort study of people aged ≥65 who had fallen and called for an ambulance was conducted between October 1, 2010 and June 30, 2011. Fall-related data were collected using a project-specific data collection tool. These data were then linked to routinely collected ambulance service clinical records and dispatch data, providing a sequential description of fall-related cases from time of ambulance dispatch through to the end of the prehospital episode of care. Results. There were 1,610 cases eligible for analysis. The median response time was 15 minutes (IQR 10-24) and "long-lies" (>60 minutes on the ground) occurred in 13% of cases. Patients were predominantly female (61%) and community dwelling (82%). Forty-four percent had never previously called an ambulance for a fall, whereas 248 (15%) had called within the past month. The most common patient-reported reasons for falling were loss of balance (30%) and "simple trips" (25%). New injury and/or pain was documented for 1,172 (73%) of patients, and 656 (41%) presented with "abnormal" physiology; only 238 (15%) presented with no new injury/pain and normal physiology. The nontransport rate was 28%. Conclusion. In this population, ambulance services appear to provide timely responses to older people who have fallen, and "long-lies" are relatively uncommon. More than one-quarter of patients were not transported to an emergency department, and repeat use of ambulance resources appears to be common. Opportunities exist to explore alternate pathways and models of care that maximize outcomes for nontransport patients as well as improving operational efficiency of the ambulance service.

Prehospital Emergency Care, 2014

Objectives. To identify patient, clinical, and operational factors associated with nontransport o... more Objectives. To identify patient, clinical, and operational factors associated with nontransport of older people who have fallen and received ambulance care; and to develop a non-transport prediction tool that could be utilized during the dispatch process to rationalize allocation of emergency ambulance resources. Methods. The study was a planned sub-analysis using data collected during a prospective observational cohort study of nonconsecutive emergency responses to older people aged 65 years or more who had fallen between October 1, 2010 and June 30, 2011. The data consisted of routinely collected ambulance dispatch and clinical records, combined with prospectively collected fall-specific information. M issing data were managed using multiple im-putation. M ultivariate logistic regression modeling was undertaken to identify predictors of nontransport. Results are described for original and imputated data sets, presented as odds ratios (OR) with 95%CI (confidence interval). Receiver operating curve (ROC) statistics were generated, with model discrimination determined by the area under the curve (AUC). Results. There were 1,484 cases eligible for this subanalysis of which 419 (28.2%) were recorded as nontransport. M ultivariate regression including dispatch and clinical variables identified a 6-item final model. Younger age group, nonurgent response priority, and presence of a personal alarm were predictors of nontransport, along with clinical variables, including normal vital signs, absence of in-jury, and unchanged functional status post-fall. The AUC was 0.88 (95% CI 0.86-0.90; p < 0.0001) (imputed data AUC 0.86 (95% CI 0.84-0.88)). M ultivariate modeling of dis-patch variables only identified a 3-item final model, which included response nonurgent response priority, younger age, and the presence of a personal alarm. The AUC was 0.68 (95% CI 0.64-0.71; p < 0.0001) (imputed data AUC 0.69 (95% CI 0.66-0.72)). Conclusion. In this population of confirmed older fallers attended to by paramedics, determi-nation of the prehospital transport outcome is greatly influ-enced by on-scene findings resulting from paramedic assess-ment. The presence of new pain, abnormal physiology, and altered function post-fall were strongly associated with in-creased odds of transport. Conversely the presence of a per-sonal alarm and allocation of a nonurgent dispatch priority increased the odds of nontransport. Accurate discrimination between older fallers who were and were not transported us-ing dispatch data only was not possible.

Journal of the American Geriatrics Society, 2000

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2007

Background. An inability to negotiate stairs is a marker of disability and functional decline and... more Background. An inability to negotiate stairs is a marker of disability and functional decline and can be a critical factor in loss of independence in older people. There is limited research on the underlying factors that impair performance in this important activity of daily living. We examined which physical and psychological factors are associated with stair climbing and stair descending performance in older people.

The Journal of Clinical Psychiatry, 2014

Objective: To determine effects of physical activity on depressive symptoms (primary objective), ... more Objective: To determine effects of physical activity on depressive symptoms (primary objective), symptoms of schizophrenia, anthropometric measures, aerobic capacity, and quality of life (secondary objectives) in people with mental illness and explore between-study heterogeneity.

Journal of Clinical Epidemiology, 2011

To develop and internally validate a falls prediction tool for people being discharged from inpat... more To develop and internally validate a falls prediction tool for people being discharged from inpatient aged care rehabilitation. Prospective cohort study. Possible predictors of falls were collected for 442 aged care rehabilitation inpatients at two hospitals. One hundred fifty participants fell in the 3 months after discharge from rehabilitation (34% of 438 with follow-up data). Predictors of falls were male gender (odds ratio [OR] 2.32, 95% confidence interval [CI]=1.00-4.03), central nervous system medication prescription (OR 2.04, 95% CI=1.00-3.30), and increased postural sway (OR 1.93, 95% CI=1.00-3.26). This three-variable model was adapted for clinical use by unit weighting (i.e., a score of 1 for each predictor present). The area under the receiver operating characteristic curve (AUC) for this tool was 0.69 (95% CI=0.64-0.74, bootstrap-corrected AUC=0.69). There was no evidence of lack of fit between prediction and observation (Hosmer-Lemeshow P=0.158). After external validation, this simple tool could be used to quantify the probability with which an individual will fall in the 3 months after an aged care rehabilitation stay. It may assist in the discharge process by identifying high-risk individuals who may benefit from ongoing assistance or intervention.

International Journal of Mental Health Nursing, 2014

The aim of the present study was to: (i) document the prevalence of risk factors for non-communic... more The aim of the present study was to: (i) document the prevalence of risk factors for non-communicable diseases among mental health consumers (inpatients) with various diagnoses; and (ii) audit the frequency of waist circumference (WC) documentation before and after an intervention that involved a single nurse-education session, and change in assessment-form design. The study was undertaken in a private psychiatric hospital in Sydney, Australia. Twenty-five nurses participated in the educational intervention. File audits were performed prior to intervention delivery (n = 60), and 3 months' (n = 60), and 9 months' (n = 60) post-intervention. Files were randomly selected, and demographic (age, diagnosis) and risk factor (WC, body mass index (BMI), smoking status, blood pressure) data were extracted. WC was higher in this cohort compared to published general population means, and only 19% of patients had a BMI within the healthy range. In total, 37% of patients smoked, while 31% were hypertensive. At baseline, none of the audited files reported WC, which increased to 35 of the 60 (58%) files audited at the 3-month follow up. At the 9-month follow up, 25 of the 60 (42%) files audited reported a WC. In the 120 post-intervention files audited, only two patients refused measurement. These results illustrate the poor physical health of inpatients, and suggest that nurse-assessed metabolic monitoring can be enhanced with minimal training.

Gerontology, 2005

However, the other sensorimotor, balance and psychological measures each provided important indep... more However, the other sensorimotor, balance and psychological measures each provided important independent information. The combined set of variables explained 40% of the variance in SMWS (multiple r = 0.63). Conclusions: The fi ndings indicate that in community-dwelling older people, self-selected walking speed is infl uenced not only by lower limb strength but also by balance, reaction time, vision, pain and emotional well-being.

BMC public health, 2015

Physical inactivity and falls in older people are important public health problems. Health condit... more Physical inactivity and falls in older people are important public health problems. Health conditions that could be ameliorated with physical activity are particularly common in older people. One in three people aged 65 years and over fall at least once annually, often resulting in significant injuries and ongoing disability. These problems need to be urgently addressed as the population proportion of older people is rapidly rising. This trial aims to establish the impact of a combined physical activity and fall prevention intervention compared to an advice brochure on objectively measured physical activity participation and mobility-related goal attainment among people aged 60 +. A randomised controlled trial involving 130 consenting community-dwelling older people will be conducted. Participants will be individually randomised to a control group (n = 65) and receive a fall prevention brochure, or to an intervention group (n = 65) and receive the brochure plus physical activity pro...

Acta psychiatrica Scandinavica, 2014

To investigate the impact of a 12-week exercise programme in addition to usual care for post-trau... more To investigate the impact of a 12-week exercise programme in addition to usual care for post-traumatic stress disorder (PTSD). An assessor-blinded randomized controlled trial was conducted among 81 participants with a DSM-IV-TR diagnosis of primary PTSD. Participants were recruited after admission to an in-patient programme at a private hospital. Participants were randomized to receive either usual care (n = 42), or exercise in addition to usual care (n = 39). The exercise intervention involved three, 30-min resistance-training sessions/week and a pedometer-based walking programme. Usual care involved psychotherapy, pharmaceutical interventions, and group therapy. Primary outcome was PTSD symptoms assessed via the PTSD checklist-civilian version (PCL-C). Secondary outcomes included symptoms of depression, anthropometry, physical activity, mobility, strength, and sleep quality. Participants had a mean (SD) age of 47.8 years (12.1), 84% male. PTSD symptoms in the intervention group si...

BMJ open, 2014

Falling in older age is a serious and costly problem. At least one in three older people fall ann... more Falling in older age is a serious and costly problem. At least one in three older people fall annually. Although exercise is recognised as an effective fall prevention intervention, low numbers of older people engage in suitable programmes. Health and exercise professionals play a crucial role in addressing fall risk in older adults. This trial aims to evaluate the effect of participation in a fall prevention educational programme, compared with a wait-list control group, on health and exercise professionals' knowledge about fall prevention and the effect on fall prevention exercise prescription behaviour and confidence to prescribe the exercises to older people. A randomised controlled trial involving 220 consenting health and exercise professionals will be conducted. Participants will be individually randomised to an intervention group (n=110) to receive an educational workshop plus access to internet-based support resources, or a wait-list control group (n=110). The two prima...

Metabolism, 2015

Hospital Rd Randwick NSW 2031 +61 415 435 125 s.rosenbaum@unsw.edu.au 2014;75(9):964-974. 5. Curt... more Hospital Rd Randwick NSW 2031 +61 415 435 125 s.rosenbaum@unsw.edu.au 2014;75(9):964-974. 5. Curtis J, Watkins A, Rosenbaum S, Teasdale SB, Kalucy M, Samaras K, Ward PB. Keeping the Body in Mind: an individualised lifestyle and life-skills intervention to prevent antipsychotic-induced weight gain in first episode psychosis. Early Interven Psychiatry 2015; in press. 6. Bruins J, Jörg F, Bruggeman R, Slooff C, Corpeleijn E, Pijnenborg M.

British Journal of Sports Medicine, 2014

Encyclopedia of Exercise Medicine in Health and Disease, 2012

Encyclopedia of Exercise Medicine in Health and Disease, 2012

New South Wales public health bulletin, 2011

Preventing falls and fall-related injuries among older people is an urgent public health challeng... more Preventing falls and fall-related injuries among older people is an urgent public health challenge. This paper provides an overview of the background to and research planned for a 5-year National Health and Medical Research Council Partnership Grant on implementing falls prevention research findings into policy and practice. This program represents a partnership between key Australian falls prevention researchers, policy makers and information technology companies which aims to: (1) fill gaps in evidence relating to the prevention of falls in older people, involving new research studies of risk factor assessment and interventions for falls prevention; (2) translate evidence into policy and practice, examining the usefulness of new risk-identification tools in clinical practice; and (3) disseminate evidence to health professionals working with older people, via presentations, new evidence-based guidelines, improved resources and learning tools, to improve the workforce capacity to pr...

Physical therapy, 2003

The purpose of this perspective article is to describe the use of a physiological profile approac... more The purpose of this perspective article is to describe the use of a physiological profile approach to falls risk assessment and prevention that has been developed by the Falls and Balance Research Group of the Prince of Wales Medical Research Institute, Sydney, Australia. The profile's use for people with a variety of factors that put them at risk for falls is discussed. The Physiological Profile Assessment (PPA) involves a series of simple tests of vision, peripheral sensation, muscle force, reaction time, and postural sway. The tests can be administered quickly, and all equipment needed is portable. The results can be used to differentiate people who are at risk for falls ("fallers") from people who are not at risk for falls ("nonfallers"). A computer program using data from the PPA can be used to assess an individual's performance in relation to a normative database so that deficits can be targeted for intervention. The PPA provides valid and reliable ...

The Journal of rheumatology, 2004

To investigate physiological risk factors for falls in people with self-reported lower limb arthr... more To investigate physiological risk factors for falls in people with self-reported lower limb arthritis. Six hundred eighty-four community-dwelling men and women aged 75-98 years (mean 80.0, SD 4.4), categorized with and without lower limb arthritis, underwent quantitative tests of strength, peripheral sensation, vision, reaction time, balance, and pain. A 12-month history of falls was also obtained. Subjects with self-reported lower extremity arthritis performed significantly worse in tests of knee and ankle muscular strength, lower limb proprioception, postural sway, and leaning balance than subjects without lower extremity arthritis, while being comparable in vision, tactile sensitivity, and reaction time. This pattern of specific impairments was also evident when group results for the arthritis subjects were compared with community normative values and presented as a physiological profile. The arthritis group suffered significantly more falls [relative risk (RR) 1.22, 95% CI 1.03-...

Stroke research and treatment, 2012

Aim. To investigate predictors of adherence to group-based exercise and physical activity partici... more Aim. To investigate predictors of adherence to group-based exercise and physical activity participation among stroke survivors. Methods. 76 stroke survivors participated (mean age 66.7 years). Adherence was the percentage of classes attended over one year. Physical activity was the average pedometer steps/day measured over seven days at the end of the trial. Possible predictors included baseline measures of demographics, health, quality of life, falls, fear of falling, cognition, and physical functioning. Results. Mean class attendance was 60% (SD 29%). Only one variable (slow choice stepping reaction time) was an independent predictor of higher class attendance, explaining 5% of the variance. Participants completed an average of 4,365 steps/day (SD 3350). Those with better physical functioning (choice stepping reaction time, postural sway, maximal balance range, 10-m walk, or 6-min walk) or better quality of life (SF-12 score) took more steps. A model including SF-12, maximal balan...

BMC research notes, 2014

Posttraumatic stress disorder (PTSD) is reportedly associated with lower rates of physical activi... more Posttraumatic stress disorder (PTSD) is reportedly associated with lower rates of physical activity participation despite the known benefits of regular physical activity for improving both mental and physical health. However, no studies have evaluated the validity or feasibility of assessing physical activity within this population resulting in uncertainty around the reported lower rates of physical activity participation. This study aimed to evaluate the feasibility and concurrent validity of the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Actigraph accelerometer (an objective physical activity monitor) among inpatients with PTSD. Fifty-nine adult hospital inpatients with a Diagnostic Statistical Manual Mental Disorder-IV-TR diagnosis of primary PTSD (mean age = 49.9 years; 85% male) participated in the study. Participants were asked to wear an Actigraph accelerometer for seven consecutive days then complete the IPAQ-SF. The Spearman rho correlation c...

Prehospital Emergency Care, 2014

To describe the characteristics of older people who fall and call an emergency ambulance, and the... more To describe the characteristics of older people who fall and call an emergency ambulance, and the operational and clinical impact of the ambulance responses they receive. Methods. A prospective cohort study of people aged ≥65 who had fallen and called for an ambulance was conducted between October 1, 2010 and June 30, 2011. Fall-related data were collected using a project-specific data collection tool. These data were then linked to routinely collected ambulance service clinical records and dispatch data, providing a sequential description of fall-related cases from time of ambulance dispatch through to the end of the prehospital episode of care. Results. There were 1,610 cases eligible for analysis. The median response time was 15 minutes (IQR 10-24) and "long-lies" (>60 minutes on the ground) occurred in 13% of cases. Patients were predominantly female (61%) and community dwelling (82%). Forty-four percent had never previously called an ambulance for a fall, whereas 248 (15%) had called within the past month. The most common patient-reported reasons for falling were loss of balance (30%) and "simple trips" (25%). New injury and/or pain was documented for 1,172 (73%) of patients, and 656 (41%) presented with "abnormal" physiology; only 238 (15%) presented with no new injury/pain and normal physiology. The nontransport rate was 28%. Conclusion. In this population, ambulance services appear to provide timely responses to older people who have fallen, and "long-lies" are relatively uncommon. More than one-quarter of patients were not transported to an emergency department, and repeat use of ambulance resources appears to be common. Opportunities exist to explore alternate pathways and models of care that maximize outcomes for nontransport patients as well as improving operational efficiency of the ambulance service.

Prehospital Emergency Care, 2014

Objectives. To identify patient, clinical, and operational factors associated with nontransport o... more Objectives. To identify patient, clinical, and operational factors associated with nontransport of older people who have fallen and received ambulance care; and to develop a non-transport prediction tool that could be utilized during the dispatch process to rationalize allocation of emergency ambulance resources. Methods. The study was a planned sub-analysis using data collected during a prospective observational cohort study of nonconsecutive emergency responses to older people aged 65 years or more who had fallen between October 1, 2010 and June 30, 2011. The data consisted of routinely collected ambulance dispatch and clinical records, combined with prospectively collected fall-specific information. M issing data were managed using multiple im-putation. M ultivariate logistic regression modeling was undertaken to identify predictors of nontransport. Results are described for original and imputated data sets, presented as odds ratios (OR) with 95%CI (confidence interval). Receiver operating curve (ROC) statistics were generated, with model discrimination determined by the area under the curve (AUC). Results. There were 1,484 cases eligible for this subanalysis of which 419 (28.2%) were recorded as nontransport. M ultivariate regression including dispatch and clinical variables identified a 6-item final model. Younger age group, nonurgent response priority, and presence of a personal alarm were predictors of nontransport, along with clinical variables, including normal vital signs, absence of in-jury, and unchanged functional status post-fall. The AUC was 0.88 (95% CI 0.86-0.90; p < 0.0001) (imputed data AUC 0.86 (95% CI 0.84-0.88)). M ultivariate modeling of dis-patch variables only identified a 3-item final model, which included response nonurgent response priority, younger age, and the presence of a personal alarm. The AUC was 0.68 (95% CI 0.64-0.71; p < 0.0001) (imputed data AUC 0.69 (95% CI 0.66-0.72)). Conclusion. In this population of confirmed older fallers attended to by paramedics, determi-nation of the prehospital transport outcome is greatly influ-enced by on-scene findings resulting from paramedic assess-ment. The presence of new pain, abnormal physiology, and altered function post-fall were strongly associated with in-creased odds of transport. Conversely the presence of a per-sonal alarm and allocation of a nonurgent dispatch priority increased the odds of nontransport. Accurate discrimination between older fallers who were and were not transported us-ing dispatch data only was not possible.

Journal of the American Geriatrics Society, 2000

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2007

Background. An inability to negotiate stairs is a marker of disability and functional decline and... more Background. An inability to negotiate stairs is a marker of disability and functional decline and can be a critical factor in loss of independence in older people. There is limited research on the underlying factors that impair performance in this important activity of daily living. We examined which physical and psychological factors are associated with stair climbing and stair descending performance in older people.

The Journal of Clinical Psychiatry, 2014

Objective: To determine effects of physical activity on depressive symptoms (primary objective), ... more Objective: To determine effects of physical activity on depressive symptoms (primary objective), symptoms of schizophrenia, anthropometric measures, aerobic capacity, and quality of life (secondary objectives) in people with mental illness and explore between-study heterogeneity.

Journal of Clinical Epidemiology, 2011

To develop and internally validate a falls prediction tool for people being discharged from inpat... more To develop and internally validate a falls prediction tool for people being discharged from inpatient aged care rehabilitation. Prospective cohort study. Possible predictors of falls were collected for 442 aged care rehabilitation inpatients at two hospitals. One hundred fifty participants fell in the 3 months after discharge from rehabilitation (34% of 438 with follow-up data). Predictors of falls were male gender (odds ratio [OR] 2.32, 95% confidence interval [CI]=1.00-4.03), central nervous system medication prescription (OR 2.04, 95% CI=1.00-3.30), and increased postural sway (OR 1.93, 95% CI=1.00-3.26). This three-variable model was adapted for clinical use by unit weighting (i.e., a score of 1 for each predictor present). The area under the receiver operating characteristic curve (AUC) for this tool was 0.69 (95% CI=0.64-0.74, bootstrap-corrected AUC=0.69). There was no evidence of lack of fit between prediction and observation (Hosmer-Lemeshow P=0.158). After external validation, this simple tool could be used to quantify the probability with which an individual will fall in the 3 months after an aged care rehabilitation stay. It may assist in the discharge process by identifying high-risk individuals who may benefit from ongoing assistance or intervention.

International Journal of Mental Health Nursing, 2014

The aim of the present study was to: (i) document the prevalence of risk factors for non-communic... more The aim of the present study was to: (i) document the prevalence of risk factors for non-communicable diseases among mental health consumers (inpatients) with various diagnoses; and (ii) audit the frequency of waist circumference (WC) documentation before and after an intervention that involved a single nurse-education session, and change in assessment-form design. The study was undertaken in a private psychiatric hospital in Sydney, Australia. Twenty-five nurses participated in the educational intervention. File audits were performed prior to intervention delivery (n = 60), and 3 months' (n = 60), and 9 months' (n = 60) post-intervention. Files were randomly selected, and demographic (age, diagnosis) and risk factor (WC, body mass index (BMI), smoking status, blood pressure) data were extracted. WC was higher in this cohort compared to published general population means, and only 19% of patients had a BMI within the healthy range. In total, 37% of patients smoked, while 31% were hypertensive. At baseline, none of the audited files reported WC, which increased to 35 of the 60 (58%) files audited at the 3-month follow up. At the 9-month follow up, 25 of the 60 (42%) files audited reported a WC. In the 120 post-intervention files audited, only two patients refused measurement. These results illustrate the poor physical health of inpatients, and suggest that nurse-assessed metabolic monitoring can be enhanced with minimal training.

Gerontology, 2005

However, the other sensorimotor, balance and psychological measures each provided important indep... more However, the other sensorimotor, balance and psychological measures each provided important independent information. The combined set of variables explained 40% of the variance in SMWS (multiple r = 0.63). Conclusions: The fi ndings indicate that in community-dwelling older people, self-selected walking speed is infl uenced not only by lower limb strength but also by balance, reaction time, vision, pain and emotional well-being.