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Ageism is an ongoing pervasive issue that can be difficult to challenge. The aims of this study were to co-design alternative frames about aging in a workshop and to explore the process participants went through using these to challenge ageism in their communities over a three-month period. Participatory action research combined with co-design were used. Full-day workshops involving 27 participants across urban and regional Australia introduced participants to the concept of ageism, framing, engaging with community, and co-designing alternative frames of aging. An online group allowed participants to support each other and continue exploring ideas as they challenged ageism in their communities. After 3 months, follow-up debrief sessions involving activities and semi-structured interviews were conducted. Data from workshops (activities, recordings), online posts, and debrief sessions were analyzed. Participants found the reframing process useful for challenging aging stereotypes in the community. Over the three months they developed an increased awareness of ageism (in self, others, society) and challenged these in different ways, including changing their internal dialogue, challenging others' views on aging, and actively defying stereotypes. Five alternative frames emerged: diversity and human rights; empowerment and support; value/contributions; lifelong learning; intergenerational. The process of creating alternative frames was important and allowed participants to bring their own values andnarratives to the experience. [ABSTRACT FROM AUTHOR]

To investigate stakeholders' perspectives of fall prevention programs for older adults with vision impairment. Twenty-two stakeholders (client facing professionals, service managers, and policy makers), with expertise in fall prevention or vision impairment, from organisations in south-eastern Australia, participated in this study. Individual semi-structured interviews were conducted over-the-phone (n = 19) and face-to-face (n = 3), and analysed deductively using content analysis into the following system level factors for health promotion interventions seen within the behaviour change wheel: Fiscal measures; Guidelines; Communication and marketing; and Service provision. Five key themes were identified: (1) insufficient guidelines or referral pathways; (2) ongoing funding to secure service delivery and best practice implementation; (3) marketing approach: honouring consumer's perceptions of themselves; (4) practical suggestions for program delivery; and (5) incorporation into existing services. Stakeholders considered fall prevention for those with vision impairment as essential in preventative healthcare, but did not have a clear understanding of where to refer or how to deliver a fall prevention service for this population. This study supports the delivery of fall prevention programs in older adults with vision impairment, but highlights the need to incorporate stakeholder perspectives into the design and delivery of such programs to ensure barriers to implementation in real world settings. Older adults with vision impairment are at a high risk of falls but currently have very little access to fall prevention programs. Results support the delivery of fall prevention programs to older adults with vision impairment through existing services, as long as professionals are provided with adequate service delivery guidelines, referral pathways, and fall prevention specific education and professional development opportunities. A variety of service provision, such as group and home-based programs, or using technology, may be cost-effective and improve older adults with vision impairments' adherence to fall prevention programs. [ABSTRACT FROM AUTHOR]

Rationale: People with stroke experience falls at more than twice the rate of the general older population resulting in high fall-related injuries. However, there are currently no effective interventions that prevent falls after stroke. Aims: To determine the effect and cost-benefit of an innovative, home-based, tailored intervention to reduce falls after stroke. Sample size estimate: A total of 370 participants will be recruited in order to be able to detect a clinically important between-group difference of a 30% lower rate of falls with 80% power at a two-tailed significance level of 0.05. Methods and design: F alls a fter s troke t rial (FAST) is a multistate, Phase III randomized trial with concealed allocation, blinded assessment, and intention-to-treat analysis. Ambulatory stroke survivors within five years of stroke who have been discharged from formal rehabilitation to the community and who have no significant language impairment will be randomly allocated to receive habit-forming exercise, home safety, and community mobility training or usual care. Study outcomes: The primary outcome is the rate of falls over the previous 12 months. Secondary outcomes are the risk of falling (proportion of fallers), community participation, self-efficacy, balance, mobility, physical activity, depression, and health-related quality of life. Health care utilization will be collected retrospectively at baseline and prospectively to 6 and 12 months. Discussion: The results of FAST are anticipated to directly influence intervention for stroke survivors in the community. Trial Registration: ANZCTR 12619001114134 [ABSTRACT FROM AUTHOR]

Background and Objectives The translation of reablement programs into practice is lagging despite strong evidence for interventions that maintain function for the person living with dementia as well as improve carer well-being. The aim was to evaluate the implementation of an evidence-based program, Care of People with Dementia in Their Environments (COPE), into health services. Research Design and Methods An implementation-effectiveness hybrid design was used to evaluate implementation outcomes while simultaneously involving a pragmatic pre–post evaluation of outcomes for people with dementia. We report uptake, fidelity to intervention, outcomes for people living with dementia and carers, and beliefs and behaviors of interventionists contributing to successful implementation. Results Seventeen organizations in Australia across 3 health contexts, 38 occupational therapists, and 17 nurses participated in training and implementation. While there were challenges and delays in implementation, most organizations were able to offer the program and utilized different models of funding. Overall, we found there was moderate fidelity to components of the program. Pre–post outcomes for carer well-being and coping (Perceived Change Index, p <.001) and activity engagement of the person living with dementia (p =.002) were significantly increased, replicating previous trial results. What contributed most to therapists implementing the program (Determinants of Implementation Behaviour Questionnaire) was a stronger intent to deliver (p <.001), higher confidence (p <.001), a sense of control in delivery (p =.004), and a belief the program was very useful to their clients (p =.002). Discussion and Implications This study demonstrated that implementation is possible in multiple health systems and beneficial to individuals and their families. [ABSTRACT FROM AUTHOR]

Background: With the introduction of consumer‐directed care in the Australian community aged care sector, there are more opportunities for occupational therapists to provide evidence‐based services that meet consumer needs. There is also an increasing requirement for health professionals to promote their interventions to consumers. Particularly for the implementation of new programs within organisations. However, occupational therapists have historically neglected widely promoting the role of occupational therapy services for older people. This study examines the perceptions of occupational therapists and their managers in promoting their service; the Care of People in their Environment (COPE) Program. Methods: This study utilised a qualitative interpretative description; including 28 in‐depth interviews. Purposeful sampling ensured a variety of occupational therapists from different health contexts. Thematic analysis captured key emergent themes related to promoting occupational therapy interventions and implementation. Results: Many occupational therapists were apprehensive about promoting or selling their services and interventions. Greater levels of confidence in promoting the program were present when the program aligned with traditional models of service delivery and organisational processes. Occupational therapists described having limited opportunity to directly promote the program to consumers as community case managers were mostly the main contact at the organisation. There was limited consideration of promotion strategies and therefore limited enactment of strategies by organisations. Not‐for‐profit and non‐government organisations recognise that the changed community aged care market provided new business opportunities. Conclusion: With changes in the Australian aged care system, occupational therapy has great opportunity to provide diverse, evidence‐based interventions driven by the needs of consumers. Reframing the notion of 'selling', to empowering consumers to be more informed about their options, will allow occupational therapists to build confidence in their promotional skills. Promoting evidence‐based programs will have positive outcomes for the visibility, professional identity and recognition of occupational therapy. [ABSTRACT FROM AUTHOR]

Aims: Implementation of novel interventions occurs within broad organisational contexts, which contain many relationships and moving parts. Efforts need to be made to understand these relationships as they are an important predictor of successful implementation. This study examines the relationships between health professionals involved in the implementation of an evidence-based community program for people with dementia and their carers in Australia, The Care of People with dementia in their Environments program. Methods: This study utilised mixed methods including in-depth interviews and organisational diagrams. Qualitative data from 28 interviews were collected from occupational therapists, nurses and their managers. Recruitment ensured a variety of different organisational contexts were represented. Thematic analysis was used to capture key emergent themes. Findings: The strongest relationships were usually between the occupational therapist and their manager. Strong trusting relationships with managers were instrumental in advocating for the need for reablement programs and the occupational therapy professional role in dementia care. Large teams of occupational therapists were seen to be beneficial in supporting each other in case complexities. Relationships between occupational therapists and nurses were often missing or perceived as weak relationships. A conducive physical environment contributed to stronger more collaborative relationships, where individuals were visible and therefore felt to be more approachable. Conclusion: Our study highlights the additional preparation work that is required of organisations to consider relationships in their strategies for implementation. [ABSTRACT FROM AUTHOR]

Introduction: Comprehensive evaluation and intervention provided by occupational therapists is effective in reducing the presence of fall hazards in the homes of older adults. The purpose of this study was to document known environmental hazards and to update a previous content analysis. A secondary goal reviewed a framework for evaluation and practice. Methods: A comprehensive scoping review of published academic articles was performed from 1996 to 2019 to answer: What environmental hazards have been associated with falls in the homes of community‐dwelling older adults? Data was extracted in a standardised critical appraisal worksheet and content analysis was conducted. A review of a conceptual framework for assessment and intervention was conducted by international experts (n = 6) in face‐to‐face interviews. Results: Fourteen studies met the inclusion criteria for the scoping study. The studies reported 17 in‐home environmental hazards: throw rugs/carpets, clutter, cords/wires, poorly placed light switches, items placed too low, items placed too high, no grab bars, toilet seats too low, uneven floor surfaces, slippery/wet surfaces, snowy/icy surfaces, backless/unsupportive shoes, unsteady stairs, inadequate lighting, inadequate heating/cooling, step stools without railings, and pets. Conclusion: A comprehensive list of specific fall hazards in and around the homes of older adults and a guiding framework offers occupational therapists an evidence‐based foundation for fall prevention efforts. [ABSTRACT FROM AUTHOR]

Introduction: Falls are an important issue in primary care. General practitioners (GPs) are in a key position to identify older people at risk of falls on their caseload and put preventative plans into action. Chronic Disease Management (CDM) plans allow GPs to refer to allied health practitioners (AHPs) for evidence‐based falls interventions. A previous pilot study reduced falls risk factors using CDM pans with older people at risk of falls. This study aimed to conduct a process evaluation of how the intervention worked in the pilot study for providers and consumers. Methods: This process evaluation used qualitative descriptive methods by interviewing the GPs, AHPs and older people involved in the intervention study. An independent researcher conducted interviews. These were audiotaped, transcribed and analysed using thematic analysis. Data were also collected about the implementation of the programme. Results: Two GPs, three occupational therapists, three physiotherapists and eight older people were interviewed. Key themes emerged from the perspectives of providers and consumers. The programme was implemented as intended, adherence to the exercise diaries was variable and the falls calendars were fully completed for three months of follow‐up. The programme was implemented as intended. Conclusion: The pilot CDM falls prevention programme did not identify common barriers attributed to GPs. Older people were amenable to the programme and participated freely. Private AHPs needed to make the CDM items work for their business model. This approach can be rolled out in a larger study and integrated pathways are needed to identify and intervene with older people at risk of falls in primary care. [ABSTRACT FROM AUTHOR]

Background: Falls are common among older people, and General Practitioners (GPs) could play an important role in implementing strategies to manage fall risk. Despite this, fall prevention is not a routine activity in general practice settings. The iSOLVE cluster randomised controlled trial aimed to evaluate implementation of a fall prevention decision tool in general practice. This paper sought to describe the strategies used and reflect on the enablers and barriers relevant to successful recruitment of general practices, GPs and their patients.Methods: Recruitment was conducted within the geographical area of a Primary Health Network in Northern Sydney, Australia. General practices and GPs were engaged via online surveys, mailed invitations to participate, educational workshops, practitioner networks and promotional practice visits. Patients 65 years or older were recruited via mailed invitations, incorporating the practice letterhead and the name(s) of participating GP(s). Observations of recruitment strategies, results and enabling factors were recorded in field notes as descriptive and narrative data, and analysed using mixed-methods.Results: It took 19 months to complete recruitment of 27 general practices, 75 GPs and 560 patients. The multiple strategies used to engage general practices and GPs were collectively useful in reaching the targeted sample size. Practice visits were valuable in engaging GPs and staff, establishing interest in fall prevention and commitment to the trial. A mix of small, medium and large practices were recruited. While some were recruited as a whole-practice, other practices had few or half of the number of GPs recruited. The importance of preventing falls in older patients, simplicity of research design, provision of resources and logistic facilitation of patient recruitment appealed to GPs. Recruitment of older patients was successfully achieved by mailed invitations which was a strategy that was familiar to practice staff and patients. Patient response rates were above the expected 10% for most practices. Many practices (n = 17) achieved the targeted number of 20 or more patients.Conclusions: Recruitment in general practice settings can be successfully achieved through multiple recruitment strategies, effective communication and rapport building, ensuring research topic and design suit general practice needs, and using familiar communication strategies to engage patients.Trial Registration: The trial was prospectively registered on 29 April 2015 with the Australian New Zealand Clinical Trial Registry www.anzctr.org.au (trial ID: ACTRN12615000401550). [ABSTRACT FROM AUTHOR]

Purpose: To explore the feasibility of implementing the Tailored Activity Program with a cohort of people with frontotemporal dementia and their carers (dyads). Methods: The Tailored Activity Program is an occupational therapy based intervention that involves working collaboratively with family carers and prescribes personalized activities for behavioral management in people with dementia. Twenty dyads randomized into the study (Tailored Activity Program: n = 9; Control: n = 11) were assessed at baseline and 4-months. Qualitative analyzes evaluated feasibility and acceptability of the program for the frontotemporal dementia cohort, and quantitative analyzes (linear mixed model analyzes, Spearman's rho correlations) measured the impact of the program on the dyads. Results: The Tailored Activity Program was an acceptable intervention for the frontotemporal dementia dyads. Qualitative analyses identified five themes: "carer perceived benefits", "carer readiness to change", "strategies used by carer to engage person with dementia", "barriers to the Tailored Activity Program uptake/implementation", and "person with dementia engagement". Quantitative outcomes showed an overall reduction of behavioral symptoms (F18.34 = 8.073, p = 0.011) and maintenance of functional performance in the person with dementia (F18.03 = 0.375, p = 0.548). Conclusions: This study demonstrates the potential for using an activity-based intervention such as the Tailored Activity Program in frontotemporal dementia. Service providers should recognize that while people with frontotemporal dementia present with challenging issues, tailored therapies may support their function and reduce their behavioral symptoms. Implications for rehabilitation: The Tailored Activity Program is an occupational therapy based intervention that involves prescribing personalized activities for behavioral management in dementia. The Tailored Activity Program is an acceptable and feasible intervention approach to address some of the unique behavioral and functional impairments inherent in frontotemporal dementia. [ABSTRACT FROM AUTHOR]

Background: Ergonomic education in housework that aims to facilitate behavior change is important for women with upper limb repetitive strain injury. Therapists usually conduct such programs based on implicit reasoning. Making this reasoning explicit is important in contributing to the profession’s knowledge. Aim: To construct a conceptual representation of how occupational therapists make clinical decisions for such program. Method: Based on a constructivist-grounded theory methodology, data were collected through in-depth interviewing with 14 occupational therapists from a major hospital in Singapore. Interviews were audiotaped and transcribed. Data was analyzed with line by line, focused and axial coding with constant data comparison throughout data collection. Results: Therapists made clinical decisions based on their perceptions of their clients’ behavior change in three stages: (i) listen; (ii) try; and (iii) persevere, bearing significant similarities to the transtheoretical theory of change. The study also showed that therapists may not have considered the full range of meanings that their clients attach to housework when interacting with them, a gap that needs to be addressed. Conclusions: The present study indicates the importance of therapists’ understanding of the meanings that their clients attach to housework. Further research needs to address how to achieve this in a time-pressured clinical environment. Implications for Rehabilitation: This study used qualitative research to demonstrate the process of translating therapists’ tacit knowledge into an explicit form. It elucidates the following major implications for practice when therapists conduct ergonomic education to facilitate behavior change in housework for female homemakers with upper limb RSI:The conceptual framework of clinical reasoning constructed from the results can be used to increase therapists’ awareness of how they make clinical decisions during an intervention. This framework can also be used for training new therapists. It is important for therapists to actively listen to their clients. Active listening will enable the therapists to understand and consider the personal meanings that these women attach to housework in order to facilitate a behavior change. Client-therapist interactions to facilitate clients’ willingness to change should become a major focus in such a program. Similar research should be conducted in other clinical areas to develop explicit clinical reasoning frameworks to facilitate learning of novice therapists and reflection of experienced therapists to address any gap in their clinical reasoning. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To determine the impact of exercise or physical training on falls or physical function in people aged 50+ years with visual impairment, compared with control (no intervention or usual care). Methods: An updated systematic review of randomised controlled trials, investigating the effect of exercise or physical activity on falls prevention or physical function in adults aged 50+ with visual impairment. Searches of CINAHL, the Cochrane Register of Controlled Trials (CENTRAL), Embase, and Medline were undertaken. Three trials were identified for the period February 2013 to July 2017 and added to the four in the original review. Results: New trials evaluated yoga, the Otago Exercise Programme in combination with a home safety programme and the Alexander Technique. Meta‐analysis of data from two trials (n = 163) indicated a non‐statistically significant positive impact of exercise on the Chair Stand Test (WMD −1.85 s, 95% CI −4.65 to 0.96, p = 0.20, I2 22%). In this update, two new trials measured falls so meta‐analysis was possible for three trials (n = 539) and revealed no impact on falls (RR 1.05, 95% CI 0.73 to 1.50, p = 0.81, I2 30%). Discussion: Although exercise or physical training can improve physical function in older adults with visual impairment, and diverse strategies are being evaluated, there are no proven falls prevention strategies. In the few studies available, falls are not consistently reported and more work is required to investigate falls prevention in older adults with visual impairment. [ABSTRACT FROM AUTHOR]

Purpose:One of the many difficulties a person with dementia can experience is difficulty with way finding and subsequently getting lost in the community. Prescriptions of assistive technology are a key role for occupational therapists. This study aimed to describe the attitudes and practices of occupational therapists in recommending and using assistive technology for persons with dementia who have difficulties with way finding in the community. Methods:An online survey was distributed to members of Occupational Therapy Australia NSW and included 25 items on demographics, frequency of use of assistive technology and assessment. Results:A total of 85 occupational therapists responded to the survey. Significant differences were identified in the approaches used, the types of assistive technology used and the evaluation of outcomes, between community-based and hospital-based occupational therapists. Over half of the participants had never prescribed any of the assistive devices listed in the survey for people with dementia. The most frequently prescribed assistive devices were low-tech items that were already freely available to carers and other professions. Conclusion:Therapists used a conservative approach to problem solving with their clients with dementia. There is a limited understanding from occupational therapists about available interventions for people with dementia. Implications for RehabilitationThere is limited awareness on how assistive technology might be used to support occupational performance for persons with dementia.This survey suggests that occupational therapists experience barriers in identifying and providing appropriate assistive technology for this group.Access to targeted education and online resources for occupational therapists is recommended to provide better awareness of the types of assistive technology available to assist persons with dementia and their caregivers. [ABSTRACT FROM PUBLISHER]

Background: Despite strong evidence giving guidance for effective fall prevention interventions in community-residing older people, there is currently no clear model for engaging general medical practitioners in fall prevention and routine use of allied health professionals in fall prevention has been slow, limiting widespread dissemination. This protocol paper outlines an implementation-effectiveness study of the Integrated Solutions for Sustainable Fall Prevention (iSOLVE) intervention which has developed integrated processes and pathways to identify older people at risk of falls and engage a whole of primary care approach to fall prevention.Methods/design: This protocol paper presents the iSOLVE implementation processes and change strategies and outlines the study design of a blended type 2 hybrid design. The study consists of a two-arm cluster randomized controlled trial in 28 general practices and recruiting 560 patients in Sydney, Australia, to evaluate effectiveness of the iSOLVE intervention in changing general practitioner fall management practices and reducing patient falls and the cost effectiveness from a healthcare funder perspective. Secondary outcomes include change in medications known to increase fall risk. We will simultaneously conduct a multi-methodology evaluation to investigate the workability and utility of the implementation intervention. The implementation evaluation includes in-depth interviews and surveys with general practitioners and allied health professionals to explore acceptability and uptake of the intervention, the coherence of the proposed changes for those in the work setting, and how to facilitate the collective action needed to implement changes in practice; social network mapping will explore professional relationships and influences on referral patterns; and, a survey of GPs in the geographical intervention zone will test diffusion of evidence-based fall prevention practices. The project works in partnership with a primary care health network, state fall prevention leaders, and a community of practice of fall prevention advocates.Discussion: The design is aimed at providing clear direction for sustainability and informing decisions about generalization of the iSOLVE intervention processes and change strategies. While challenges exist in hybrid designs, there is a potential for significant outcomes as the iSOLVE pathways project brings together practice and research to collectively solve a major national problem with implications for policy service delivery.Trial Registration: Australian New Zealand Clinial Trials Registry ACTRN12615000401550. [ABSTRACT FROM AUTHOR]

Background: The contribution of behavioural changes to functional decline is yet to be explored in primary progressive aphasia (PPA). Objectives: (1) investigate functional changes in two PPA variants [semantic (svPPA) and non-fluent (nfvPPA)], at baseline and after 12 months; (2) investigate baseline differences in behavioural changes between groups, and (3) explore predictors of functional decline after a 12-month period. Methods: A longitudinal study involving 29 people with PPA (18 svPPA; 11 nfvPPA) seen annually in Sydney/Australia was conducted. A total of 114 functional and behavioural assessments were included for within-group (repeated-measures ANOVA; annual rate of change; multiple regression analyses) and between- group analyses (pairwise comparisons). Results: Functional profiles in svPPA and nfvPPA were similar in people with up to 5 years of disease duration. Behavioural changes were marked in svPPA patients (stereotypical behaviour and apathy) but did not predict annual rate of change of functional abilities; global cognitive scores at baseline did. Despite mild behavioural changes in nfvPPA (disinhibition, apathy), these were significant predictors of annual rate of functional change. Conclusions: The presentation and interplay of behavioural changes and functional disability differ in svPPA and nfvPPA. These varying factors should be taken into account when considering prognosis, disease management, and selection of outcome measures for interventions. [ABSTRACT FROM AUTHOR]

Objectives To determine whether an enhanced occupational therapy discharge planning intervention that involved pre- and postdischarge home visits, goal setting, and follow-up (the HOME program) would be superior to a usual care intervention in which an occupational therapy in-hospital consultation for planning and supporting discharge to home is provided to individuals receiving acute care. Design Randomized controlled trial. Setting Acute and medical wards. Participants Individuals aged 70 and older (N = 400). Measurements Primary outcomes: activities daily living ( ADLs; Nottingham Extended Activities of Daily Living) and participation in life roles and activities (Late Life Disability Index ( LLDI)). Results Occupational therapist recommendations differed significantly between groups ( P < .001) ( HOME n = 892 recommendations; control n = 329 recommendations). There was no difference between groups in ADLs (Nottingham Extended Activities of Daily Living scale ( NEADL): β = −0.17, 95% confidence interval ( CI) = −0.99-0.66) or participation ( LLDI-Frequency: β = −0.23, 95% CI = −2.05-1.59; LLDI-Limitation: β = −0.14, 95% CI = −2.86-2.58). Both groups maintained prehospital functional status at 90 days, and there was no difference between groups in the number of people with unplanned readmissions ( HOME 23.5%, n = 43; control 21.9%, n = 37). When groups were combined, being male ( P = .03) or having lower perceived participation because of physical problems ( P = .04) resulted in higher risk of unplanned readmissions. Conclusion HOME discharge planning, which had a strong emphasis on task modification, well-being, and prevention strategies, implemented twice as many occupational therapy recommendations as the in-hospital only consultation, which had a greater emphasis on equipment provision, but HOME did not demonstrate greater benefit in global measures of ADLs or participation in life tasks than in-hospital consultation alone. It is not recommended that home visits be conducted routinely as part of discharge planning for acutely hospitalized medical patients. Further work should develop guidelines for quality in-hospital consultation. [ABSTRACT FROM AUTHOR]

Functional cognition is a relatively new concept in assessment of older adults with mild cognitive impairment or dementia. Instruments need to be reliable and valid, hence we conducted a systematic review of observational assessments of task performance used to estimate functional cognition in this population. Two separate database searches were conducted: firstly to identify instruments; and secondly to identify studies reporting on the psychometric properties of the instruments. Studies were analysed using a published checklist and their quality reviewed according to specific published criteria. Clinical utility was reviewed and the information formulated into a best evidence synthesis. We found 21 instruments and included 58 studies reporting on measurement properties. The majority of studies were rated as being of fair methodological quality and the range of properties investigated was restricted. Most instruments had studies reporting on construct validity (hypothesis testing), none on content validity and there were few studies reporting on reliability. Overall the evidence on psychometric properties is lacking and there is an urgent need for further evaluation of instruments. [ABSTRACT FROM AUTHOR]

Purpose: We aim to provide a systematic review of qualitative research evidence relevant to the experiences and perceptions of program providers and participants from culturally and linguistically diverse (CALD) backgrounds regarding (i) exercise and (ii) fall prevention programs for older people.Method: Using a narrative synthesis approach, we reviewed published journal articles reporting qualitative data. Electronic and manual literature searches were conducted to identify 19 publications that met the inclusion criteria. Of these, 16 discussed exercise and three focused on broader fall prevention programs. However, no studies were identified that explored the perspective of the program providers.Results: An overarching theme emerged identifying the influence of cultural values and perceptions on program participation. Also, identified were motivational, social and environmental influences.Conclusion: Exercise and fall prevention interventions need to be culturally appropriate and utilise the positive influences of social support, especially from physicians and family. While these findings can be used to inform the delivery of programs to these population groups, future studies should focus specifically on experiences and perceptions of older CALD people of fall prevention programs as well as the perspectives of program providers.Implications for RehabilitationProgram participation is influenced by cultural values and motivational, social and environmental factors.The meaning and importance of exercise can vary between and within cultures.Exercise and fall prevention interventions need to be culturally appropriate and utilise the positive influences of social support, especially from physicians and family.Providing information that falls can be prevented and the reasons why behaviours need to change will be more likely to encourage older people from CALD backgrounds to contemplate participation. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this study is to describe the intervention process and results of the Tailored Activities Program (TAP) in two people diagnosed with Frontotemporal Dementia (FTD).Method: TAP is an occupational therapy (OT) community-based intervention program that prescribes personalised activities to reduce difficult behaviours of dementia. The OT works with carers over a 4-month period (assessment, activity prescription and generalisation of strategies). Study measures were collected (blind researcher) pre- and post-intervention: cognition, functional disability, behavioural symptoms and Caregiver Confidence and Vigilance.Results: A 51-year-old woman with behavioural-variant FTD could consistently engage in more activities post-intervention, with scores indicating improvements to behaviour, function and caregiver confidence. A 63-year-old man with semantic variant FTD engaged well in the prescribed activities, with scores reflecting reduced carer distress regarding challenging behaviours and improved caregiver vigilance.Conclusions: TAP is efficacious in FTD, allowing for differences in approach for FTD subtype, where behavioural symptoms are very severe and pervasive.Implications for RehabilitationThe Tailored Activities Program is an intervention which can be tailored to account for unique behavioural and language profiles inherent across frontotemporal dementia (FTD) subtypes.Maintaining a flexible approach when applying an intervention in FTD allows for tailoring to individual case variability within FTD subtypes. [ABSTRACT FROM PUBLISHER]

Purpose: To explore how the meaning of exercise and other factors interact and influence the exercise behaviour of individuals with Parkinson’s disease (PD) enrolled in a 6-month minimally supervised exercise program to prevent falls, regardless of whether they completed the prescribed exercise or not.Method: This qualitative study utilised in-depth semi-structured interviews analysed using grounded theory methodology.Results: Four main themes were constructed from the data: adapting to change and loss, the influence of others, making sense of the exercise experience and hope for a more active future. Participation in the PD-specific physiotherapy program involving group exercise provided an opportunity for participants to reframe their identity of their “active” self. Three new influences on exercise participation were identified and explored: non-motor impairments of apathy and fatigue, the belief in a finite energy quota, and the importance of feedback. A model was developed incorporating the themes and influences to explain decision-making for exercise participation in this group.Conclusion: Complex and interacting issues, including non-motor impairments, need to be considered in order to enhance the development and ongoing implementation of effective exercise programmes for people with PD.Implications for RehabilitationExercise participation can assist individuals to reframe their identity as they are faced with losses associated with Parkinson’s disease and ageing.Non-motor impairments of apathy and fatigue may influence exercise participation in people with Parkinson’s disease.Particular attention needs to be paid to the provision of feedback in exercise programs for people with Parkinson’s disease as it important for their decision-making about continuing exercise. [ABSTRACT FROM PUBLISHER]

Introduction: The use of functional assessments to evaluate patient change is complicated by a lack of consensus as to which assessment is most suitable for use with older adults. Objective: To identify and appraise the properties of assessments used to evaluate functional abilities in older adults. Methods: A systematic review of randomised controlled trials of occupational therapy interventions was conducted up to 2012 to identify assessments used to measure function. Two authors screened and extracted data independently. A second search then identified papers investigating measurement properties of each assessment. Studies from the second search were included if: i) published in English, ii) the assessment was not modified from its original published form, iii) study aim was to evaluate the quality of the tool, iv) and was original research. Translated versions of assessments were excluded. Measurement quality was rated using the COSMIN checklist and Terwee criteria. Results: Twenty-eight assessments were identified from the systematic search of occupational therapy interventions provided to older adults. Assessments were of varied measurement quality and many had been adapted (although still evaluated as though the original tool had been administered) potentially altering the conclusions drawn about measurement quality. Synthesis of best evidence established 15 functional assessments have not been tested in an older adult population. Conclusions: The Functional Autonomy Measurement System (SMAF) appears to be a promising assessment for use with older adults. Only two tools (the SMAF and the Assessment of Motor and Process Skills (AMPS)) were deemed to be responsive to change when applied to older adults. Health professionals should use functional assessments that have been validated with their population and in their setting. There are reliable and valid assessments to capture the functional performance of older adults in community and hospital settings, although further refinement of these assessments may be necessary. [ABSTRACT FROM AUTHOR]

Background Among women with upper limb repetitive strain injury (RSI), occupational therapy interventions include education to facilitate ergonomic practices in housework. From a client-centred perspective, an understanding of women's decision-making about housework is needed to design effective occupational therapy programmes. This study addresses a gap in research in this area by exploring women's views about changing housework habits. Aim The aim was to construct a conceptual representation to explain decision-making in housework by drawing on experiences of a sample of Singapore Chinese women with upper limb RSI from one hand therapy clinic. Methods Based on a constructivist grounded theory methodology, data were collected through in-depth interviewing with 15 women. Interviews were audiotaped and transcribed. Data were analysed with line by line coding, focussed coding and axial coding with constant comparison throughout data collection. Results Decision-making in housework among these women involved three main themes: (i) emotional attachment to housework; (ii) cognitively informed decision; and (iii) emotionally influenced decision. Women with upper limb RSI had to make cognitive decisions for or against a change in housework to manage their condition. However, the women's cognitively informed decisions were shaped by their emotional attachment to housework. As such, they experienced strong emotional barriers to changing their housework practices even when they had cognitively accepted the necessity and possibility of making a change. Conclusions Therapists need to be aware that counselling to address the emotional barriers experienced by women is important during ergonomic education. [ABSTRACT FROM AUTHOR]

Aims: Behaviors of concern and psychological symptoms such as depression, apathy, agitation, wandering, and resistance to care are common in people with dementia and can be challenging for the caregiver to manage. This narrative review summarizes details of interventions found to be effective in reducing behaviors of concern and psychological symptoms. Methods: This review is based on an existing meta-analysis. The published meta-analysis included a large number of studies which ranged in efficacy. Studies were only included in this review if a moderate or large positive effect was found (Cohen's d ≥ 0.40). Information regarding the main aims of the intervention, dose, type of health professional providing the intervention, and the components of the intervention program were extracted. Results: Interventions with a positive effect contained multiple components including caregiver education, skills training, and engagement in meaningful occupations. Several of the interventions were delivered by an occupational therapist or were developed with extensive input from occupational therapists. Conclusion: This paper provides a description of effective interventions and can be utilized to guide the implementation of evidence-based practice in dementia care. [ABSTRACT FROM AUTHOR]

Purpose: To examine how goal setting is used with caregivers of community residing adults and the effect of goal setting practices in improving the outcomes. Methods: A mixed methods systematic review was conducted. The methodological rigour of included studies was critiqued using Cochrane Collaboration's risk of bias assessment tool, Downs and Black checklist and a framework for evaluating qualitative research. Narrative synthesis was created through tabulation and categorisation, visual mapping of the goal setting process, thematic analysis on common goal setting features and critical reflection on the accuracy and robustness of the synthesis. Results: Seventeen studies were included: 10 randomised trials, 5 other quantitative studies and two descriptive studies which incorporated qualitative methods. The trials demonstrated a relatively low risk of bias in contrast to the other studies that had varied methodological rigour. No studies isolated the effect of the goal setting process on outcomes and therefore the effectiveness of goal setting could not be evaluated. However, through a narrative synthesis six prominent features of collaborative goal setting were identified. Conclusions: Despite the fact that goal setting is an important component of client-centred care, and the prominence of client-centred care in healthcare discourse, the review uncovered a surprisingly limited number of studies. Goal setting is an elusive process that is of therapeutic value and warrants further investigation. [ABSTRACT FROM AUTHOR]

Background/aims Despite evidence of the effectiveness of home safety interventions for preventing falls, there is limited uptake of such interventions within community services. Therefore, as part of a broader translational project, we explored issues underlying the implementation of an evidence-based home safety fall prevention intervention. Method We conducted in-depth interviews with eight occupational therapists and two programme coordinators engaged to deliver a home safety fall prevention intervention. Six community health centres within two metropolitan regions of Melbourne, Australia participated. The RE- AIM framework and Diffusion of Innovations theory underpinned the interviews which examine the enablers and barriers to implementing a home safety fall prevention intervention and integrating it into routine community preventive practice. Analysis involved thematic and content analysis. Results Investment in the home safety for fall prevention intervention was supported and valued by coordinators and therapists alike, and a number of themes emerged which influenced implementation of this intervention. These included issues of: compatibility with organisational processes, individual practitioner practices and skills, a prevention approach, and client expectations; relative advantage in terms of flexibility of the process, client engagement and regional capacity building; complexity of implementing the intervention; and observability related to the invisible nature of fall prevention outcomes. Conclusion Implementation of this home safety fall prevention intervention was influenced by a range of interrelated organisational, practitioner and client related factors. The findings from this project provide insights into, and opportunities to increase the sustainable implementation of the home safety fall prevention intervention into practice. [ABSTRACT FROM AUTHOR]

The article discusses occupational therapy research in active aging. Topics discussed include research trends in aging overt the past 20 years from 2014, actions that occupational therapists need to take to thrive in the field of active ageing, and examples of areas with strong research supporting interventions that must be implemented in practice. It concludes that increase in volume of research literature in occupational therapy is positive which must continue.

Abstract: Background: Fall prevention programs may be implemented but not sustained. We conducted a systematic review to identify any theories, models, frameworks, influencing factors or interventions for sustaining fall prevention programs in the community. Methods: Peer-reviewed publications describing, investigating, or evaluating program sustainability were accessed. A narrative review was conducted to compare and synthesize study findings. Results: Nineteen publications were included. Three conceptual frameworks were identified describing how programs may be better sustained. While ongoing financial support and the participation of older people were commonly reported influences, other factors specific to the type of program and setting were also reported. Planning, training, and collaboration between program stakeholders may facilitate sustainable programs. Impact on industry: Organizations can use these findings when planning for sustainable programs. However more robust empirical studies are needed to confirm the value of conceptual frameworks, the critical factors and most effective interventions for sustaining community-based fall prevention programs. [Copyright &y& Elsevier]

Adults with gender-variant childhoods have often lived traumatic lives because of the attitudes and limited understanding that people in their environment had of the concept of gender variance. This study explores the childhoods of transgender adults with the aim to understand their gender-related difficulties as children, in order to identify their needs and the needs of their parents at that time. The authors conducted a semi-structured survey with 110 transgender adults in order to explore their retrospective childhood experiences. Responses were analyzed through content and thematic coding. Their needs most commonly identified as children were for educated authority figures; acceptance and support to discuss their gender variance; freedom of identity expression; validation; and recognition. The needs most commonly allocated to their parents were access to information, education to increase other's awareness, peer support, and access to educated professionals. [ABSTRACT FROM AUTHOR]

The article discusses the occupational therapists partnering with general practitioners to prevent falls in elderly. A model of care is presented where a general practitioner can initiate a chronic disease management plan which involves occupational therapy and physiotherapy services for older people at risk of falls. [ABSTRACT FROM AUTHOR]

Purpose. To examine the validity and reliability of a modified Reintegration to Normal Living Index (mRNL Index) with a sample of community-dwelling adults with mixed diagnoses. Method. Forty-six adults (mean 55.2 ± 20.3 years) were recruited through convenience sampling from outpatient rehabilitation services. They completed the mRNL Index, Community Integration Measure (CIM) and Life Space Assessment (LSA) and were invited to complete them again 2 weeks later. Results. Construct validity of the mRNL Index was confirmed by good fit to the Rasch measurement model. The mRNL Index demonstrated acceptable internal consistency (Cronbach's α == 0.80), as did the Daily Functioning subscale (Cronbach's α == 0.80) and Personal Integration subscale (Cronbach's α == 0.82). Test-retest reliability was also acceptable (intraclass correlation coefficient (3,1) == 0.83, p == .0001). As hypothesised, the LSA did not correlate with the Personal Integration subscale (Spearman rho == 0.08) and moderately correlated to the Daily Functioning subscale (Spearman rho == 0.59). The CIM was moderately correlated with the Personal Integration subscales (Spearman rho == 0.54) and the Daily Functioning subscale (Spearman rho == 0.53), though higher correlation was expected with the latter. Conclusion. Modifications to the phrasing, rating scale and subscales improved the validity of the original RNL Index for a mixed rehabilitation, community-dwelling population. [ABSTRACT FROM AUTHOR]

Discharge planning frequently involves occupational therapy pre-discharge home visiting as one component of intervention. Pre-discharge home visits aim to maximise a person's functional performance within the context of their home and community environment, bridging the transition between hospital and home. The aim of this study was to describe the pre-discharge home visiting practices of occupational therapy departments. This descriptive study used a postal survey which was sent to occupational therapists in 215 public and privately funded hospitals in New South Wales, Australia. The survey enquired about the number of pre-discharge home visits completed per month, who went on visits and time spent on visits. Descriptive statistics were used in analyses. Surveys were returned by occupational therapists from 53 departments, representing a response rate of 25%. Respondents estimated that they conducted approximately 13 pre-discharge home visits per month (range: 1-60). Visits were estimated to take an average of 1 hour and 20 minutes (excluding travel time). Approximately one-quarter of respondents felt that there was pressure to reduce the number of pre-discharge home visits conducted. Using their local hospital records, nine hospital departments estimated that the number of home visits completed per month had reduced by 50% compared with the number of home visits five years previously. Findings suggest a wide variation in current pre-discharge home visiting practice. There is a need for well-designed clinical trials that investigate the effectiveness of these costly and time-consuming visits on functional performance. [ABSTRACT FROM AUTHOR]

With rising longevity, increasing numbers of older people are experiencing changes in their everyday family and social life, changes in their financial status, and a greater number of chronic conditions affecting their health. We took the opportunity to explore these relationships with worry in a group of volunteer community-living elderly (n = 310). Findings showed that that those people under 75 years of age had a higher risk of worrying (OR = 1.8, 95% CI = 1.0-3.1) compared to the older age groups. Women worried more than men and an important finding was that those with chronic health conditions such as arthritis of the hip and knee were more prone to worry than those who were healthy or had acute conditions (OR = 3.5, 95% CI = 1.4-8.9). This latter finding suggests the importance placed on the role of the hip and knee in maintaining functional capacity to perform life skills. [ABSTRACT FROM AUTHOR]

Background: Exercise as a falls prevention strategy is more complex with people at risk than with the general population. The Lifestyle approach to reducing Falls through Exercise (LiFE) involves embedding balance and lower limb strength training in habitual daily routines. Methods: A total of 34 community-residing people aged ≥70 years were randomised either into the LiFE programme or into a no-intervention control group and followed up for six months. Inclusion criteria were two or more falls or an injurious fall in the past year. Results: There were 12 falls in the intervention group and 35 in the control group. The relative risk (RR) analysis demonstrated a significant reduction in falls (RR = 0.23; 0.07–0.83). There were indications that dynamic balance ( P = 0.04 at three months) and efficacy beliefs ( P = 0.04 at six months) improved for the LiFE programme participants. In general, secondary physical and health status outcomes, which were hypothesised as potential mediators of fall risk, improved minimally and inconsistently. Conclusions: LiFE was effective in reducing recurrent falls in this at-risk sample. However, there were minimal changes in secondary measures. The study was feasible in terms of recruitment, randomisation, blinding and data collection. A larger randomised trial is needed to investigate long-term efficacy, mechanisms of benefit and clinical significance of this new intervention. [ABSTRACT FROM AUTHOR]

Objective: This study seeks to determine the efficacy of environmental interventions in reducing falls in community-dwelling older people. Method: A systematic review and meta-analysis of randomized trials was performed. Results: Pooled analysis of six trials (N = 3,298) demonstrated a 21% reduction in falls risk (relative risk [RR] = 0.79; 0.65 to 0.97). Heterogeneity was attributable to the large treatment effect of one trial. Analysis of a subgroup of studies with participants at high risk of falls (four trials, n = 570) demonstrated a clinically significant 39% reduction of falls (RR = 0.61; 0.47 to 0.79), an absolute risk difference of 26% for a number needed to treat four people. Discussion: Home assessment interventions that are comprehensive, are well focused, and incorporate an environmental-fit perspective with adequate follow-up can be successful in reducing falls with significant effects. The highest effects are associated with interventions that are conducted with high-risk groups. [ABSTRACT FROM AUTHOR]

Background: Pre-discharge home visits aim to maximise independence in the community. These visits involve assessment of a person in their own home prior to discharge from hospital, typically by an occupational therapist. The therapist may provide equipment, adapt the home environment and/or provide education. The aims of this study were to investigate the feasibility of a randomised controlled trial in a clinical setting and the effect of pre-discharge home visits on functional performance in older people undergoing rehabilitation. Methods: Ten patients participating in an inpatient rehabilitation program were randomly assigned to receive either a pre-discharge home visit (intervention), or standard practice in-hospital assessment and education (control), both conducted by an occupational therapist. The predischarge home visit involved assessment of the older person's function and environment, and education, and took an average of 1.5 hours. The hospital-based interview took an average of 40 minutes. Outcome data were collected by a blinded assessor at 0, 2, 4, 8 and 12 weeks. Outcomes included performance of activities of daily living, reintegration to community living, quality of life, readmission and fall rates. Results: Recruitment of 10 participants was slow and took three months. Observed performance of functional abilities did not differ between groups due to the small sample size. Difference in activities of daily living participation, as recorded by the Nottingham Extended Activities of Daily Living scale, was statistically significant but wide confidence intervals and low statistical power limit interpretation of results. Conclusion: Evaluation of pre-discharge home visits by occupational therapists in a rehabilitation setting is feasible, but a more effective recruitment strategy for a main study is favored by application of a multi-centre setting. [ABSTRACT FROM AUTHOR]

To test whether Stepping On, a multifaceted community-based program using a small-group learning environment, is effective in reducing falls in at-risk people living at home. A randomized trial with subjects followed for 14 months. The interventions were conducted in community venues, with a follow-up home visit. Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling. The Stepping On program aims to improve fall self-efficacy, encourage behavioral change, and reduce falls. Key aspects of the program are improving lower-limb balance and strength, improving home and community environmental and behavioral safety, encouraging regular visual screening, making adaptations to low vision, and encouraging medication review. Two-hour sessions were conducted weekly for 7 weeks, with a follow-up occupational therapy home visit. The primary outcome measure was falls, ascertained using a monthly calendar mailed by each participant. The intervention group experienced a 31% reduction in falls (relative risk (RR)=0.69, 95% confidence interval (CI)=0.50–0.96; P=.025). This was a clinically meaningful result demonstrating that the Stepping On program was effective for community-residing elderly people. Secondary analysis of subgroups showed that it was particularly effective for men (n=80; RR=0.32, 95% CI=0.17–0.59). The results of this study renew attention to the idea that cognitive-behavioral learning in a small-group environment can reduce falls. Stepping On offers a successful fall-prevention option. [ABSTRACT FROM AUTHOR]

Focuses on a study that deals with the danger in the home involving falls and fractures to the elderly. Introduction; Methods; Results; Discussion.

Falls among older people are highly prevalent, serious and costly, and translation of evidence about falls prevention needs to occur urgently. GPs can identify older people at risk of falling and put preventative measures in place before a fall. Because GPs are key to identifying older people at risk of falls and managing falls risk, this study explored how GPs adapted to the iSOLVE (Integrated SOLutions for sustainable falls preVEntion) process to embed evidence-based falls prevention strategies within primary care, and whether and how they changed their practice. A theoretically informed qualitative study using normalisation process theory was conducted in parallel to the iSOLVE trial to elicit GPs' views about the iSOLVE process. Data were coded and a thematic analysis of interview transcripts was conducted using constant comparison between the data and themes as they developed. In all, 24 of 32 eligible GPs (75%) from general practices located in the North Sydney Primary Health Network, Australia, were interviewed. Six themes were identified: (1) making it easy to ask the iSOLVE questions; (2) internalising the process; (3) integrating the iSOLVE into routine practice; (4) addressing assumptions about patients and fall prevention; (5) the degree of change in practice; and (6) contextual issues influencing uptake. The iSOLVE project focused on practice change, and the present study indicates that practice change is possible. How GPs addressed falls prevention in their practice determined the translation of evidence into everyday practice. Support tools for falls prevention must meet the needs of GPs and help with decision making and referral. Fall prevention can be integrated into routine GP practice through the iSOLVE process to tailor fall risk management. Trial Registry. This trial was registered with the Australian New Zealand Clinical Trial Registry (www.anzctr.org.au; Trial ID: ACTRN12615000401550). Falls among older people are very common, costly and can have serious consequences. GPs can identify older people at risk of falling and put preventative measures in place before a fall. This study identified how GPs changed their practice to address falls prevention as part of their participation in the iSOLVE (Integrated SOLutions for sustainable falls preVEntion) study. We found that GPs could integrate the iSOLVE process into their routine practice and tailor falls risk management for older people at risk. [ABSTRACT FROM AUTHOR]

Background: Falls reflect sentinel events in older adults, with significant negative consequences. Although fall risk factors have been identified as intrinsic (e.g., muscle weakness, balance problems) and extrinsic (e.g., home hazards), most prevention programs target only intrinsic factors. We present the rationale and design of a home-based multicomponent fall prevention program-the LIVE LiFE program-for community-living older adults. The program adapts and expands the successful Lifestyle Intervention Functional Exercise (LiFE) program by adding home safety, vision contrast screening, and medication review. The specific aims of the study are to (1) adapt the LiFE program to a US context and expand it into a multicomponent program (LIVE LiFE) addressing intrinsic and extrinsic fall risks, (2) examine feasibility and acceptability, and (3) estimate program impact on multiple outcome measures to prepare for an efficacy trial.Methods: The study involves two phases: an open-label pilot, followed by a two-group, single-blinded randomized pilot trial. Eligible participants are community-living adults 70+ years reporting at least one injurious fall or two non-injurious falls in the previous year. Participants are randomized in a 2:1 ratio to the program group (LIVE LiFE, n = 25) or the control group (written fall risk assessment, n = 12). The open-label pilot participants (n = 3) receive the program without randomization and are assessed based on their experience, resulting in a stronger emphasis on the participant's personal goals being integrated into LIVE LiFE. Fall risk and balance outcomes are assessed by the Timed Up and Go and the 4-Stage Balance Test at 16 weeks. Additional outcomes are incidence of falls and near falls, falls efficacy, fear of falling, number of home hazards, and medications assessed at 16 weeks. Incidence of falls and near falls, program adherence, and satisfaction are assessed again at 32 weeks.Discussion: By expanding and adapting the evidence-based LiFE program, our study will help us understand the feasibility of conducting a multicomponent program and estimate its impact on multiple outcome measures. This will support moving forward with an efficacy trial of the LIVE LiFE program for older adults who are at risk of falling.Trial Registration: ClinicalTrials.gov, NCT03351413 . Registered on 22 November 2017. [ABSTRACT FROM AUTHOR]

Background: A nested process evaluation, within a randomised controlled trial, will explore relationships between program outcomes and quality of intervention implementation of the Lifestyle-Integrated Functional Exercise Program in older people with vision impairment. The Lifestyle-Integrated Functional Exercise Program is a home-based strength and balance program that has been shown to reduce falls in high risk populations. A pilot study showed positive trends in improvements in physical function in older people with vision impairment after participation in the program. The program will be delivered by Orientation and Mobility Specialists, who are experienced in working with people with vision impairment.Methods: The process evaluation has a mixed methods design. This includes quantitative (fidelity checklist score, number of completed sessions, survey data and a habit formation scale), as well as qualitative (open responses from program staff and semi-structured interviews with study participants) data. Process evaluation measures include program adherence (fidelity), complete delivery (dose delivered), participant receipt (dose received) and participant enactment. Using the Behaviour Change Wheel, a logic model was built to explain the intended inputs, outputs, outcomes and relationships to the behaviour change techniques in the Lifestyle-Integrated Functional Exercise Program in older people with vision impairment.Discussion: The findings of the process evaluation will inform the provision of fall prevention programs in older people with vision impairment by Orientation and Mobility Specialists. To date, there are no proven falls prevention programs which aim to improve physical function and reduce falls in older people with vision impairment. This process evaluation will contribute new knowledge about the implementation of a strength and balance program in this population.Trial Registration: ACTRN12616001186448 . Registered 29 August 2016. [ABSTRACT FROM AUTHOR]

Objectives: Older people from culturally and linguistically diverse (CALD) backgrounds are one of the fastest growing and rapidly ageing population segments in Australia. This qualitative study aims to explore the experiences, needs and challenges that individual program providers encountered in implementing and delivering a fall prevention program for CALD groups and meeting the linguistic, cultural and contextual needs of the program participants. Design: Semi-structured in-depth interviews were conducted with a convenience sample of 24 program providers implementing, delivering or supporting fall prevention programs including Stepping On for CALD groups. Interview transcripts were analysed using thematic analysis. Results: Two major themes emerged: (1) extra layers of complexity are needed in program planning, delivery, recruitment and enabling participation of older people from CALD background and (2) program leaders 'going the extra mile' influences success of the program. Complexity included accommodating the linguistic and sociocultural needs in planning the programs, knowing and using the 'right way' to reach and deliver the program to CALD groups and understanding the nuances of facilitating program participation. While it was important to ensure the acceptability and accessibility of the program for the older people from diverse CALD communities, it was the drive and determination of the program leader and their striving for cultural relevance that made the program possible. Sustainability and wider implementation requires unique support and additional resources. Conclusion: These findings can be used by program providers, policy-makers and health researchers to improve the capacity of fall prevention programs to better respond to the growing diversity in needs and preferences among older populations in Australia and internationally. [ABSTRACT FROM AUTHOR]

Rationale: Evidence-based reablement programs for people with dementia and their caregivers are not routinely implemented in practice. These programs have been shown to be effective in delaying functional decline and improving caregiver wellbeing. Yet, little is known about the experiences of those participating in such programs. Aim: To describe experiences and outcomes of participating in a dementia reablement program, the Care of Persons with dementia in their Environments (COPE), in Australia. Methods: Purposeful sampling was used and semi-structured interviews were completed with people with dementia and their caregivers who received the COPE program in two different states in Australia. The interviews explored the participants' experiences with the program as well as how they are managing after program completion. Thematic analysis was used to identify themes from the interviews. A Likert scale was used to rate the value of the program. Results: Ten dyads (person with dementia and/or their caregiver) were interviewed. Participation in the program was rated (mostly) very valuable. The ongoing collaboration between the therapist and caregiver was considered empowering. The program promoted participation in everyday activities for the person with dementia and appeared to give a 'second chance' to remain in their own homes and communities. Conclusion: Participation in reablement programs (such as the COPE program) has the potential to re-engage people with dementia in meaningful roles and activities in their chosen environments. A therapeutic relationship and individualized intervention approaches tailored to the participants' needs and readiness foster positive experiences and confidence. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates the perspectives of rehabilitation therapists on the implementation of fall prevention programmes with community-dwelling stroke survivors in the Singapore context, and elicits recommendations to adapt the Stepping On programme with stroke survivors. Method: Qualitative data were elicited during 4 focus groups with 23 rehabilitation therapists (15 occupational therapists [OTs]; 8 physiotherapists [PTs]) who had received training to deliver the original Stepping On programme, and had experienced delivery of fall-prevention intervention programmes locally. Collected data were analysed using thematic analysis method. Results: Three themes emerged from the focus groups describing: (a) limitations of existing falls prevention intervention for stroke clients; (b) the need to adapt the Stepping On programme to use with stroke clients; and (c) challenges in implementing fall prevention programmes in the stroke context. A series of new components were suggested to be included as part of the Stepping On after stroke (SOAS) programme, including involvement of family members and caregivers, and tailored community reintegration sessions (such as taking public transport and shopping). Conclusions: Rehabilitation therapists describe challenges in addressing fall prevention within a stroke context, and findings highlight the need for a structured, stroke-specific fall prevention programme rather than a more general approach to education and training. Contextual components identified provide valuable inputs towards the development of a culturally relevant fall prevention programme for stroke survivors in Singapore. Stroke survivors living in the community are at a high risk of falls. A structured and culturally relevant fall prevention programme for community-living stroke survivors is needed. Falls prevention for community-living stroke survivors should be multi-dimensional and targeting the modifiable risk factors for falls in this group. Both stroke survivors and caregivers should be involved in any fall prevention after stroke programmes. [ABSTRACT FROM AUTHOR]

To summarize the effects of rehabilitation interventions to reduce freezing of gait (FOG) in people with Parkinson's disease. A systematic review with meta-analyses of randomized trials of rehabilitation interventions that reported a FOG outcome was conducted. Quality of included studies and certainty of FOG outcome were assessed using the PEDro scale and GRADE framework. Sixty-five studies were eligible, with 62 trialing physical therapy/exercise, and five trialing cognitive and/or behavioral therapies. All meta-analyses produced very low-certainty evidence. Physical therapy/exercise had a small effect on reducing FOG post-intervention compared to control (Hedges' g= −0.26, 95% CI= −0.38 to −0.14, 95% prediction interval (PI)= −0.38 to −0.14). We are uncertain of the effects on FOG post-intervention when comparing: exercise with cueing to without cueing (Hedges' g= −0.58, 95% CI= −0.86 to −0.29, 95% PI= −1.23 to 0.08); action observation training plus movement strategy practice to practice alone (Hedges' g= −0.56, 95% CI= −1.16 to 0.05); and dance to multimodal exercises (Hedges' g= −0.64, 95% CI= −1.53 to 0.25). We are uncertain if physical therapy/exercise, cognitive or behavioral therapies, are effective at reducing FOG. FOG leads to impaired mobility and falls, but the effect of rehabilitation interventions (including physical therapy/exercise and cognitive/behavioral therapies) on FOG is small and uncertain. Until more robust evidence is generated, clinicians should assess FOG using both self-report and physical measures, as well as other related impairments such as cognition, anxiety, and fear of falling. Interventions for FOG should be personalized based on the individual's triggers and form part of a broader exercise program addressing gait, balance, and falls prevention. Interventions should continue over the long term and be closely monitored and adjusted as individual circumstances change. [ABSTRACT FROM AUTHOR]

Purpose: To explore men's fall experiences through the lens of masculine identities so as to assist health professionals better engage men in fall prevention programs. Methods: Twenty-five men, aged 70–93 years who had experienced a recent fall, participated in a qualitative semi-structured interview. Men's willingness to engage in fall prevention programs taking account of individual contexts and expressions of masculinity, were conceptualised using constant comparative methods. Results: Men's willingness to engage in fall prevention programs was related to their perceptions of the preventability of falls; personal relevance of falls; and age, health, and capability as well as problem-solving styles to prevent falls. Fall prevention advice was rarely given when men accessed the health system at the time of a fall. Conclusions: Contrary to dominant expectations about masculine identity, many men acknowledged fall vulnerability indicating they would attend or consider attending, a fall prevention program. Health professionals can better engage men by providing consistent messages that falls can be prevented; tailoring advice, understanding men are at different stages in their awareness of fall risk and preferences for action; and by being aware of their own assumptions that can act as barriers to speaking with men about fall prevention. Men accessing the health system at the time of the fall, and during rehabilitation following a fall represent prime opportunities for health professionals to speak with men about preventing falls and make appropriate referrals to community programs. Tailored advice will take account of individual men's perceptions of preventability; personal relevance; perceptions of age, health and capability; and problem-solving styles. [ABSTRACT FROM AUTHOR]

Purpose: Drawing on the perspectives of stroke survivors, family members and domestic helpers, this study explores participants' experiences of self-perceived fall risk factors after stroke, common fall prevention strategies used, and challenges to community participation after a fall. Methods: Semi-structured interviews were conducted in Singapore with community-dwelling stroke survivors with a previous fall (n = 9), family caregivers (n = 4), and domestic helpers (n = 4) who have cared for a stroke survivor with a previous fall. Purposive sampling was used for recruitment; all interviews were audio-recorded with permission and transcribed. Thematic analysis was conducted using NVivo (v10) software. Results: All participants shared their self-perceived intrinsic and extrinsic fall risk factors and main challenges after a fall. For stroke participants and family caregivers, motivational factors in developing safety strategies after a previous fall(s) include social connectedness, independent living and community participation. For family caregivers and domestic helpers, the stroke survivor's safety is their top priority, however this can also lead to over-protective behavior outside of the rehabilitation process. Conclusions: Reducing the risk of falls in community-dwelling stroke survivors seems to be more important than promoting community participation among caregivers. The study findings highlight that a structured and client-centered fall prevention program targeting stroke survivors and caregivers is needed in Singapore. Falls after stroke can lead to functional decline in gait and mobility and restricted self-care activities. Community-dwelling stroke survivors develop adaptive safety strategies after a fall and want to be socially connected. However, caregivers see the safety of the stroke survivors as their top priority and demonstrate over-protective behaviors. Fall prevention programs for community-dwelling stroke survivors should target both stroke survivors and their caregivers. A structured and client-centered fall prevention program targeting at multiple risk factors post-stroke is needed for community-living stroke survivors. [ABSTRACT FROM AUTHOR]

Background/aim: Increased age and cognitive decline have been linked to difficulties with activities of daily living (ADL) and instrumental activities of daily living (IADL). Cognitive decline can often be signalled by complaints about one's cognition, such as memory. With older Australians living longer, there is an increasing proportion of the population at risk of declined performance in daily tasks. The aim of this study was to identify if subjective memory complaints in later life among older women predict changes in independence in performing ADL and IADL. Methods: Data were from 3721 women born 1921–1926, who completed Surveys 4–6 of the Australian Longitudinal Study on Women's Health. Memory complaints and difficulties on ADL were measured at each survey, using the Memory Complaint Questionnaire and 16 questions regarding specific ADL. Latent growth modelling examined correlations between initial scores on each measure, changes in measures, and the association between memory complaints and changes in ADL and IADL. Results: There was a significant association between baseline scores for subjective memory difficulty and baseline ADL and IADL scores. Initial memory difficulty was also associated with increase in ADL and IADL difficulty. Conclusions: Subjective memory complaints may be a risk factor for decline in performance on ADL. Attention to these concerns may be important in identifying functional decline in older age. [ABSTRACT FROM AUTHOR]

Background/aim: Randomised trials have demonstrated that occupational therapy can delay functional decline, improve quality of life and increase leisure participation in people with dementia. However, surveys conducted with occupational therapists suggest that clinical practice does not reflect the type of intervention shown to be effective in research studies. Case note audits can be used to quantify practice and demonstrate how and where provision of care could improve without the potential bias associated with self‐report. Method: A total of 87 occupational therapy case notes were audited from different service contexts in two states in Australia. The case notes were reviewed against criteria including duration of service, assessments conducted and interventions used. Descriptive statistics were used to present the data and examine associations between intervention, age of the person with dementia and whether or not the person lived alone. Results: Services tended to be short‐term with an average of 2.1 consultations per referral. The most common assessments related to home safety, falls risk and function. Intervention most commonly focussed on referrals to other services, environmental modification advice and assistive device prescription. Conclusion: This audit reveals that current occupational therapy practice for people with dementia focusses on assessment and management of risk and is usually limited to a couple of consultations. Future work should seek to evaluate if such approaches to care are effective for people with dementia. [ABSTRACT FROM AUTHOR]