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BackgroundFalls in older people commonly occur at home. Home assessment and modification (HAM) interventions can be effective in reducing falls; however, there are some concerns over the validity of evaluation findings. Routinely collected data could improve the quality of HAM evaluations and strengthen their evidence base. ObjectiveThe aim of this study is to conduct a systematic review of the evidence of the use of routinely collected data in the evaluations of HAM interventions. MethodsWe searched the following databases from inception until January 31, 2020: PubMed, Ovid, CINAHL, OpenGrey, CENTRAL, LILACS, and Web of Knowledge. Eligible studies were those evaluating HAMs designed to reduce falls involving participants aged 60 years or more. We included study protocols and full reports. Bias was assessed using the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool. ResultsA total of 7 eligible studies were identified in 8 papers. Government organizations provided the majority of data across studies, with health care providers and third-sector organizations also providing data. Studies used a range of demographic, clinical and health, and administrative data. The purpose of using routinely collected data spanned recruiting and creating a sample, stratification, generating independent variables or covariates, and measuring key study-related outcomes. Nonhome-based modification interventions (eg, in nursing homes) using routinely collected data were not included in this study. We included two protocols, which meant that the results of those studies were not available. MeSH headings were excluded from the PubMed search because of a reduction in specificity. This means that some studies that met the inclusion criteria may not have been identified. ConclusionsRoutine data can be used successfully in many aspects of HAM evaluations and can reduce biases and improve other important design considerations. However, the use of these data in these studies is currently not widespread. There are a number of governance barriers to be overcome to allow these types of linkage and to ensure that the use of routinely collected data in evaluations of HAM interventions is exploited to its full potential.

Background falls are common in older people, but evidence for the effectiveness of preventative home adaptations is limited. Aim determine whether a national home adaptation service, Care&Repair Cymru (C&RC), identified individuals at risk of falls occurring at home and reduced the likelihood of falls. Study Design retrospective longitudinal controlled non-randomised intervention cohort study. Setting our cohort consisted of 657,536 individuals aged 60+ living in Wales (UK) between 1 January 2010 and 31 December 2017. About 123,729 individuals received a home adaptation service. Methods we created a dataset with up to 41 quarterly observations per person. For each quarter, we observed if a fall occurred at home that resulted in either an emergency department or an emergency hospital admission. We analysed the data using multilevel logistic regression. Results compared to the control group, C&RC clients had higher odds of falling, with an odds ratio (OR [95% confidence interval]) of 1.93 [1.87, 2.00]. Falls odds was higher for females (1.44 [1.42, 1.46]), older age (1.07 [1.07, 1.07]), increased frailty (mild 1.57 [1.55, 1.60], moderate 2.31 [2.26, 2.35], severe 3.05 [2.96, 3.13]), and deprivation (most deprived compared to least: 1.16 [1.13, 1.19]). Client fall odds decreased post-intervention; OR 0.97 [0.96, 0.97] per quarter. Regional variation existed for falls (5.8%), with most variation at the individual level (31.3%). Conclusions C&RC identified people more likely to have an emergency fall admission occurring at home, and their service reduced the odds of falling post-intervention. Service provisioning should meet the needs of an individual and need varies by personal and regional circumstance. [ABSTRACT FROM AUTHOR]

This article aims to encourage critical reflection about the limitations of the rational choice approach as an explanatory insight to understanding older people's choice-making about their health or social care requirements. It develops an interpretive framework examining how older people engage in the process of choice-making when selecting a care option. Choice-making is conceptualised as a temporal, processual phenomenon, influenced by others, and characterised by an individual's behavioural responses to changing circumstance and lifecourse events. Data are from qualitative interviews with 29 older adults whose choice of care option involved moving to an extra-care setting in Wales (United Kingdom). Transcripts were coded using in-case and constant-comparison approaches, and analysis was undertaken using concepts of engagement and temporality as elements of the choice-making process. Using an inductive approach, a typology of six different 'pathways to choice' of care setting was identified; these findings suggest that choosing a care option in later life is a diverse, interactive and time-bound social phenomenon, inadequately captured by the rational choice approach where it is understood more as an individualised, linear and logical process. Recognising that choice-making evolves through time as part of a process shaped by others means service providers will be better positioned to offer opportunities for more preventative-focused interventions which empower older consumers to make planned and informed choices about care options. [ABSTRACT FROM AUTHOR]

Ageing in place has been promoted by policy makers as the optimal residential solution for later life, premised on older people's reluctance to contemplate relocation, their declining residential mobility and high levels of residential satisfaction. This paper takes a critical perspective to the notion of ageing in place by examining older people's dislikes about, rather than levels of satisfaction with their home and neighbourhood environments, and establishing whether such dislikes influence a desire to move. Analysis of the 2004 Living in Wales Survey shows that despite high levels of residential satisfaction, a significant proportion of older people do wish to move. Logistic regression results indicate this desire is strongly associated with dislikes about their immediate home environment, more than neighbourhood factors. Contemplating a move in later life may be shaped more by a desire to ‘attach’ to people, than to remain in situ to preserve an attachment to place. [ABSTRACT FROM AUTHOR]

In Mauritius, young women's experience of adolescence is changing rapidly. Compared to their parents, they are likely to encounter broader social influences than those provided by the immediate family environment as they spend time in education or in the workplace, and are exposed to global influences of technology, media and travel It is therefore more likely that they will be sexually active before marriage, and as indicators point to rises in premarital conceptions and adolescent childbearing, it becomes increasingly important to recognise the family planning information needs of this group. Although the 1994 Cairo Conference has contributed to the promotion of young women's reproductive rights and health needs in Mauritius, meeting the requirements of young, unmarried women can be difficult, and they are often omitted from large-scale studies addressing contraceptive needs and practices. Using a case study approach, with qualitative and quantitative components, this article explores knowledge of contraceptives and perceptions of problems associated with their use amongst a group of young unmarried Mauritian women. Data are from a village community study completed in 1995 and a pilot study completed in 2002. In contrast to married women, results indicate that although less knowledgeable, young women who have never been married nor used contraception do identify various problems associated with use of supplied methods, including pa in and retention in the body, and are concerned that use may encourage weight gain. [ABSTRACT FROM AUTHOR]

New Zealand has experienced sustained increases in women's labour force participation since the post-war period. When observed across time, work patterns provide insights to the changing overall lifetime attachment of women to the labour market. Using data from the 1995 sample survey New Zealand Women: Family, Employment, Education, we present descriptive findings on the work patterns of women born between 1936 and 1965, and depict these patterns in terms of spells in and out of work. A cohort perspective is taken. We then proceed to summarise the details of these individual work histories using summary measures which can then be co-related with potential explanatory factors. The results show that by the age of 30, successive birth cohorts have experienced: (i) increasing complexities in their work and non-work trajectories; (ii) childbearing continues to depress women's engagement in paid work across time; and (iii) the influence of educational attainment and ethnicity seems to be changing. [ABSTRACT FROM AUTHOR]