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Globally, populations are ageing and the estimated number of hip fractures will increase from 1.7 million in 1990 to more than 6 million in 2050. The greatest increase in hip fractures is predicted in Low- and Middle-Income Countries (LMICs), largely in the Asia-Pacific region where direct costs are expected to exceed $US15 billion by 2050. The aims of this qualitative study are to identify barriers to, and enablers of, evidence-informed hip fracture care in LMICs, and to determine if the Blue Book standards, developed by the British Orthopaedic Association and British Geriatrics Society to facilitate evidence-informed care of patients with fragility fractures, are applicable to these settings. This study utilized semi-structured interviews with clinical and administrative hospital staff to explore current hip fracture care in LMICs. Transcribed interviews were imported into NVivo 12 and analysed thematically. Interviews were conducted with 35 participants from 11 hospitals in 5 countries. We identified five themes-costs of care and the capacity of patients to pay, timely hospital presentation, competing demands on limited resources, delegation and defined responsibility and utilization of available data-and within each theme, barriers and enablers were distinguished. We found a mismatch between patient needs and provision of recommended hip fracture care, which in LMICs must commence at the time of injury. This study describes clinician and administrator perspectives of the barriers to, and enablers of, high-quality hip fracture care in LMICs; results indicate that initiatives to overcome barriers (in particular, delays to definitive treatment) are required. While the Blue Book offers a starting point for clinicians and administrators looking to provide high-quality hip fracture care to older people in LMICs, locally developed interventions are likely to provide the most successful solutions to improving hip fracture care. [ABSTRACT FROM AUTHOR]

Background. Chinese older people have approximately half the risk of falling as their white counterparts, but no studies to date have explained why such a disparity exists. Methods. A total of 692 Chinese and 764 white community-dwelling older people participated in a multicohort study conducted in Taiwan, Hong Kong, and Australia. Baseline measurements included sociodemographic, psychological, and physical measures; concern about falling (Falls Efficacy Scale-International scores); and physical activity levels. Falls were monitored prospectively for 12–24 months. Results. The standardized annual fall rates for the 3 Chinese cohorts were 0.26±0.47 in Taiwan, 0.21±0.57 in Hong Kong, and 0.36±0.80 in Australia, which were significantly lower than that of the white cohort at 0.70±1.15. The fall rates for the Taiwan and Hong Kong cohorts were also significantly lower than that of the Australian Chinese cohort. The difference in fall rates was not due to better physical ability in the Chinese cohorts. However, the Chinese cohorts did more planned activity and expressed more concern about falling. Negative binomial regression analysis revealed a significant Cohort × Falls Efficacy Scale-International score interaction. After adjusting for this interaction, Falls Efficacy Scale-International scores, other predictors, and confounders, the incidence rate ratios comparing the cohorts were no longer statistically significant. Conclusions. Low fall rates in Chinese cohorts appear to be due to increased concern about falling as manifest in high Falls Efficacy Scale-International scores. These findings suggest that the Chinese cohorts are more likely to adapt their behaviors to lessen fall risk and that such adaptations are partially lost in Chinese people who have migrated to a “Westernized” country. [ABSTRACT FROM PUBLISHER]

The FES-I is an instrument developed to assess concern about falls. The aim of this study was to develop a Chinese version of the 16-item Falls Efficacy Scale International (FES-I(Ch)) and evaluate its structure, measurement properties and convergent and predictive validity. The FES-I(Ch) was developed following the recommended 10-step protocol. The FES-I(Ch) was then administered to 399 community-dwelling Chinese older people (61-93 years) in conjunction with a range of other socio-demographic, physical, medical and functional measures. Falls were prospectively monitored over 12 months. Sub-samples were reassessed for determination of the FES-I(Ch)'s test-retest and inter-rater reliability. The overall structure and measurement properties of the FES-I(Ch), as evaluated with factor analysis and item-total correlations, was good. Internal consistency was excellent (Cronbach's α=0.94), as was test-retest and inter-rater reliability (ICC(3,1)=0.89 and ICC(2,1)=0.95 respectively). FES-I(Ch) scores were significantly higher in participants with poor physical performance, depression, medical conditions associated with falls and disability indicating acceptable congruent validity. FES-I(Ch) scores did not differ between those who did and did not fall in the 12-month follow-up period. We found that the FES-I(Ch) is a valid and reliable measure of concern about falls in Chinese older people. The relatively high level on concern (high FES-I(Ch) scores) as well as relatively few prospective falls may explain the lack of association between FES-I(Ch) scores and falls in this population. Future studies should explore the FES-I(Ch)'s responsiveness to change over time and during intervention studies., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)