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The Getting Grounded Gracefully© program, based on the Awareness Through Movement lessons of the Feldenkrais method, was designed to improve balance and function in older people. Fifty-five participants (mean age 75, 85% women) were randomized to an intervention (twice-weekly group classes over 8 wk) or a control group (continued with their usual activity) after being assessed at baseline and then reassessed 8 wk later. Significant improvement was identified for the intervention group relative to the control group using ANOVA between-groups repeated-measures analysis for the Modified Falls Efficacy Scale score (p = .003) and gait speed (p =.028), and a strong trend was evident in the timed up-and-go (p = .056). High class attendance (88%) and survey feedback indicate that the program was viewed positively by participants and might therefore be acceptable to other older people. Further investigation of the Getting Grounded Gracefully program is warranted. [ABSTRACT FROM AUTHOR]

The 6-item Rowland Universal Dementia Assessment Scale (RUDAS) is a simple, portable multicultural scale for detecting dementia. Items address executive function, praxis, gnosis, recent memory, and category fluency. It can be directly translated to other languages, without the need to change the structure or the format of any item. The RUDAS was administered to 151 consecutive, consenting, culturally diverse community-dwelling subjects of mean age 77 years, 72% of whom had an informant. Subjects were recruited from various clinics and healthcare programs. All were evaluated for cognitive impairment in a blinded manner by experienced clinicians in geriatric medicine. According to Diagnostic and Statistical Manual of Mental Disorder-IV criteria, 40% of the subjects were normal, 22% had cognitive impairment (not otherwise specified), and 38% had dementia; 84% of whom had questionable or mild dementia. In the primary analysis (normal subjects vs. those with definite dementia), the RUDAS accurately identified dementia, with an area under the receiver operating characteristic curve of 0.94 (95% confidence interval, 0.88-0.97); at the published cut point of less than 23/30, the positive likelihood ratio (LR) for dementia diagnosis was 8.77, and the negative likelihood ratio was 0.14. Additional analyses showed that the RUDAS performed less well when subjects with cognitive impairment (not dementia) were included. In all logistic regression models, the RUDAS was an independent predictor of dementia (odds ratio 0.64, 95% confidence interval, 0.52-0.79, primary analysis model), after adjusting for age, sex, years of education, and cultural diversity, none of which were independent predictors. Further studies are needed across the full spectrum of early dementia syndromes, and in additional ethnic minority groups. [ABSTRACT FROM AUTHOR]

Early dementia can be difficult to diagnose in older persons from culturally and linguistically diverse (CALD) backgrounds. The Folstein Mini-Mental State Examination (MMSE), the General Practitioner Assessment of Cognition (GPCOG) and the Rowland Universal Dementia Assessment Scale (RUDAS) were compared in 151 older, community-dwelling persons. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy, while logistic regression was used to evaluate the influence of age, gender, CALD status and years of education. All three instruments were equally accurate in predicting dementia (ROC area under curve 0.92-0.97, p > 0.05 for all comparisons). At the recommended cut-offs, the RUDAS was best for ruling in dementia (positive LR = 8.77), while the GPCOG was best for ruling out dementia (negative LR = 0.03). All three instruments were influenced by concomitant depression. Whereas the MMSE was influenced by CALD status, the RUDAS and GPCOG were not. While the GPCOG combines participant and informant data, the RUDAS is a stand-alone measure specifically designed for, and validated in, multicultural populations. [ABSTRACT FROM AUTHOR]

Falls are a common problem for older people in hospital and can negatively impact on health outcomes. This pilot study aimed to investigate the reliability and predictive accuracy of a newly developed multidisciplinary assessment tool--the 'falls risk for hospitalised older people' (FRHOP) and to compare the prediction accuracy of the FRHOP with the 'St Thomas's risk assessment tool in falling elderly inpatients' (STRATIFY). Forty four patients aged over 65 were recruited from five wards in a sub-acute geriatric hospital. Participants were assessed either once only as part of the prediction study or twice as part of the reliability study. Assessments were conducted by trained project staff including a podiatrist, occupational therapist, physiotherapist and a prosthetist. Incident Report Forms were reviewed after discharge to identify participants who fell during their current hospitalisation for the prediction study. There was a broad range of risk factors identified, with total falls risk scores ranging from 10 to 35 [mean 20.6 (SD 5.8)]. Among the risk factors identified, 48% of participants had one or more foot pathologies and only 18% had footwear that met pre-determined criteria for appropriate footwear. Both retest and inter-rater reliability of the FRHOP were high [ICC (2,1) =0.95 and 0.85 respectively]. Seven participants fell (16%), two falling more than once. Using the total number of risk factors rated as high risk, a cut-off score of four or more yielded a sensitivity of 57% and specificity of 68%. The STRATIFY had a sensitivity of 43% and specificity of 43%. The FRHOP is a reliable falls risk assessment tool with moderate levels of prediction accuracy. Further validation with a larger sample is warranted. [ABSTRACT FROM AUTHOR]

Aim: This study investigated changes in function and quality of life for older adults participating in Living Longer Living Stronger™, a community-delivered strength training program for people aged over 50., Methods: Assessments were conducted at baseline, 4 and 8 months using measures of function, balance, mobility, strength, mental health and quality of life., Results: Thirty-five participants (mean age 66 years, 69% female) completed 4 months of the program; 24 completed 8 months. Using repeated-measures anova, significant improvements were found at 4 and 8 months for step test, gait stride length, 6-minute walk test, timed sit to stand, physical performance test and reported health transition (SF-36). At 4 months (n = 35), vitality (SF-36), quality of life and left shoulder abductor strength significantly improved; at 8 months (n = 24), role physical and mental health (SF-36) and gait velocity significantly improved., Conclusion: The program appears to be an effective community-delivered strength training program., (© 2013 Council on the Ageing Victoria. Australasian Journal on Ageing © 2013 ACOTA.)

The prevalence of dementia is increasing in Australia. Limited research is available on access to Cognitive Dementia and Memory Services (CDAMS) for people with dementia from Culturally and Linguistically Diverse (CALD) communities. This study aimed to determine the barriers and enablers to accessing CDAMS for people with dementia and their families of Chinese and Vietnamese backgrounds. Consultations with community members, community workers and health professionals were conducted using the "Cultural Exchange Model" framework. For carers, barriers to accessing services included the complexity of the health system, lack of time, travel required to get to services, language barriers, interpreters and lack of knowledge of services. Similarly, community workers and health professionals identified language, interpreters, and community perceptions as key barriers to service access. Strategies to increase knowledge included providing information via radio, printed material and education in community group settings. The "Cultural Exchange Model" enabled engagement with and modification of the approaches to meet the needs of the targeted CALD communities.

Aim: This paper describes current practices and gaps identified by Aged Care Assessment Service (ACAS) clinicians in the assessment of cognition of clients of culturally and linguistically diverse (CALD) background in Victoria., Method: A web-based survey, exploring practices and challenges faced by clinicians in assessing CALD clients and their families, was sent to all Victorian ACAS managers to distribute to their teams. Three focus groups were also conducted with ACAS clinicians to further explore these issues., Results: Seventy-nine web-based surveys were returned and 21 ACAS clinicians attended a focus group. Challenges reported included the availability and quality of interpreters, and variability in training received and confidence in assessing cognitive impairment in CALD clients., Conclusion: ACAS clinicians reported that assessment of cognition for those of CALD background was challenging. Based on this feedback, practice tip sheets were developed as educational aids to assist ACAS staff., (© 2013 ACOTA.)

Aim: The aim of this study was to develop the evidence-based Healthy Ageing Quiz (HAQ)., Methods: Phase 1 activities (focus groups with 33 older adults, literature review and discussion with an advisory panel) informed the development of a draft HAQ. Phase 2 involved assessing the quiz's psychometric properties and collecting respondent feedback., Results: Phase 1 provided broad topics for formulating quiz questions. In Phase 2, 297 and 122 respondents returned a quiz for validity and reliability testing respectively (over 70% response rate). The HAQ was found to be both valid (r =-0.7 to 0.6) and reliable (r = 0.8)., Conclusions: The development of the HAQ was guided by the literature and input from older people and experts in healthy ageing. The quiz showed good psychometric properties and was acceptable to respondents. It allows older adults and people approaching old age to evaluate their current lifestyle in order to maximise their chances of ageing well., (© 2012 The Authors. Australasian Journal on Ageing © 2012 ACOTA.)