Search

Background:Themajority of older people who fall and present to EmergencyDepartments (EDs) are reported not to receive guideline level care to reduce future risk of falls. The aim of this randomized controlled trial was to evaluate whether RESPOND, a 6-month telephone-based patient-centred program had an effect on falls and fall injuries in older people presenting to ED after a fall. Method(s): 541 older fallers who presented to a WA or Victorian ED were recruited (inclusion criteria: discharged home <72 hours, could walk without hands-on assistance, use a telephone, and no cognitive impairment (MMSE>23). Intervention participants (n=263, mean age=73) received the RESPOND intervention, comprising (1) home-based risk assessment; (2) six months telephone-based education, coaching, goal setting and support for evidence-based risk factor management; and (3) linkages to existing services; while controls (n=260, mean age=73) received usual care. Primary outcomes were falls and fall injuries in the 12-month follow-up. Secondary outcomes included ED presentations, hospital admissions, fractures, death, falls risk, falls efficacy and quality of life. Result(s): Falls rate was significantly lower in the RESPOND group (incidence rate ratio 0.65 [95%CI 0.43-0.99]; p=0.042). Although there was no significant difference in fall injuries (p=0.374), the rate of fractures was significantly lower in the RESPOND group (p=0.03).There were no significant group differences in other secondary outcomes. Conclusion(s): The RESPOND falls prevention program reduced falls and fractures, in older people presenting to the ED with a fall. Key learnings for translation include: potential scalability and sustainability of a patient-centred and predominantly telephonebased program.

Today, the near‐Earth space is facing a paradigm change as the number of new spacecraft is literally skyrocketing. Increasing numbers of small satellites threaten the sustainable use of space, as without removal, space debris will eventually make certain critical orbits unusable. A central factor affecting small spacecraft health and leading to debris is the radiation environment, which is unpredictable due to an incomplete understanding of the near‐Earth radiation environment itself and its variability driven by the solar wind and outer magnetosphere. This paper presents the FORESAIL‐1 nanosatellite mission, having two scientific and one technological objectives. The first scientific objective is to measure the energy and flux of energetic particle loss to the atmosphere with a representative energy and pitch angle resolution over a wide range of magnetic local times. To pave the way to novel model‐in situ data comparisons, we also show preliminary results on precipitating electron fluxes obtained with the new global hybrid‐Vlasov simulation Vlasiator. The second scientific objective of the FORESAIL‐1 mission is to measure energetic neutral atoms of solar origin. The solar energetic neutral atom flux has the potential to contribute importantly to the knowledge of solar eruption energy budget estimations. The technological objective is to demonstrate a satellite deorbiting technology, and for the first time, make an orbit maneuver with a propellantless nanosatellite. FORESAIL‐1 will demonstrate the potential for nanosatellites to make important scientific contributions as well as promote the sustainable utilization of space by using a cost‐efficient deorbiting technology.

Researchers seek to learn the degree to which the people of their nations or regions are attaining levels of regular physical activity, but clarity on physical activity levels has been difficult to attain. Age, gender, and other factors produce variations in prevalence estimates within countries, and country-level differences in stages of economic development, transportation systems, and social factors produce variations of these estimates among countries. Self-reported physical activity levels are usually higher than objectively measured physical activity levels, a fact that is complicated by the strengths and weaknesses of each method for measuring physical activity. Still, within and among countries, there are well-documented, significant lessons to be learned from published data about the prevalence of physical activity.

Objective: Evaluations of techniques to promote physical activity usually adopt a randomised controlled trial (RCT). Such designs inform how a technique performs on average but cannot be used for treatment of individuals. Our objective was to conduct the first N-of-1 RCTs of behaviour change techniques with older people and test the effectiveness of the techniques for increasing walking within individuals. Design: Eight adults aged 60–87 were randomised to a 2 (goal-setting vs. active control) × 2 (self-monitoring vs. active control) factorial RCT over 62 days. The time series data were analysed for each single case using linear regressions. Main outcome measures: Walking was objectively measured using pedometers. Results: Compared to control days, goal-setting increased walking in 4 out of 8 individuals and self-monitoring increased walking in 7 out of 8 individuals. While the probability for self-monitoring to be effective in 7 out of 8 participants was beyond chance (p = .03), no intervention effect was significant for individual participants. Two participants had a significant but small linear decrease in walking over time. Conclusion: We demonstrate the utility of N-of-1 trials for advancing scientific enquiry of behaviour change and in practice for increasing older people’s physical activity.

INTRODUCTION: Participation in falls prevention activities by older people following presentation to the emergency department (ED) with a fall is suboptimal. This randomised controlled trial (RCT) will test the RESPOND programme, an intervention designed to improve older persons' participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies. DESIGN AND SETTING: A RCT at two tertiary referral EDs in Melbourne and Perth, Australia. PARTICIPANTS: 528 community-dwelling people aged 60-90 years presenting to the ED with a fall and discharged home will be recruited. People who require an interpreter or hands-on assistance to walk; live in residential aged care or >50 km from the trial hospital; have terminal illness, cognitive impairment, documented aggressive behaviour or a history of psychosis; are receiving palliative care or are unable to use a telephone will be excluded. METHODS: Participants will be randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporates (1) a home-based risk factor assessment; (2) education, coaching, goal setting and follow-up telephone support for management of one or more of four risk factors with evidence of effective interventions and (3) healthcare provider communication and community linkage delivered over 6 months. Primary outcomes are falls and fall injuries per person-year. DISCUSSION: RESPOND builds on prior falls prevention learnings and aims to help individuals make guided decisions about how they will manage their falls risk. Patient-centred models have been successfully trialled in chronic and cardiovascular disease; however, evidence to support this approach in falls prevention is limited. TRIAL REGISTRATION NUMBER: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).

BACKGROUND: Programme evaluations conducted alongside randomised controlled trials (RCTs) have potential to enhance understanding of trial outcomes. This paper describes a multi-level programme evaluation to be conducted alongside an RCT of a falls prevention programme (RESPOND). OBJECTIVES: (1) To conduct a process evaluation in order to identify the degree of implementation fidelity and associated barriers and facilitators. (2) To evaluate the primary intended impact of the programme: participation in fall prevention strategies and the factors influencing participation. (3) To identify the factors influencing RESPOND RCT outcomes: falls, fall injuries and emergency department (ED) re-presentations. METHODS/DESIGN: 528 community-dwelling adults aged 60-90 years presenting to two EDs with a fall will be recruited and randomly assigned to the intervention or standard care group. All RESPOND participants and RESPOND clinicians will be included in the evaluation. A mixed methods design will be used and a programme logic model will frame the evaluation. Data will be sourced from interviews, focus groups, questionnaires, clinician case notes, recruitment records, participant-completed calendars, hospital administrative datasets and audio-recordings of intervention contacts. Quantitative data will be analysed via descriptive and inferential statistics and qualitative data will be interpreted using thematic analysis. DISCUSSION: The RESPOND programme evaluation will provide information about contextual and influencing factors related to the RESPOND RCT outcomes. The results will assist researchers, clinicians and policy makers regarding decisions about future falls prevention interventions. Insights gained may be applicable to a range of chronic conditions where similar preventive intervention approaches are indicated.