Webinar Presentation: Wednesday 20th February, 1.00 - 1.40 pm
Professor Anne-Marie Hill, Faculty of Health Sciences, Curtin University Topic:Health professional communication - practical strategies to develop effective communication with patients, families and carers
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NSW Falls Prevention Network Forum Friday 31st May 2019, 9 am - 4 pm
Wesley Conference Centre
Keeping patients on their feet
Reproduced with permission from South Western Sydney LHD Media Unit
A program pioneered at Fairfield Hospital is helping to keep patients at risk of falls on their feet. TheAble and Stable Falls Prevention programwas developed to assist in the reduction of patients having a fall and ending up in the emergency department.
Patients who have experienced a fall are more likely to have another one within the next 12 months. Senior physiotherapist running the program Ms Minh Pham explains prevention is the best chance for the patients to return to their normal lives."The Able and Stable Falls Prevention program is a comprehensive program including gentle balance and strength exercise with education components,” Ms Pham said.
“Our aim is to reduce falls and the risks of them by helping participants improve balance, increase physical activity, improve confidence with a result of reducing the fear of falling, and providing education and advice on modifications around the home to reduce trip hazards.”
The program was developed by Fairfield Hospital staff including members from the aged services emergency team, allied health and the physiotherapy department. Patients are referred to the team from the hospital emergency department, other inpatient acute wards or their local GP. Classes run for nine weeks four times a year with 20 participants who receive individual assessments prior to commencing the program.
“It’s the first of its kind in our District and we have received lots of interest from other hospitals and non-government organisations. To date the program has been adopted by Campbelltown and Camden Hospitals, Royal Prince Alfred Hospital’s Falls Clinic, Liverpool Specialist Aged Care and Anglican Aged Care facilities,” Ms Pham said.
The program has reduced falls, improved balance and strength and increased physical activity levels. All participants were satisfied with the program.
Physiotherapist Sophie Yakimoff and participant Mary Kosdya.
Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization: A Randomized Clinical Trial
Nicolás Martínez-Velilla, Alvaro Casas-Herrero, Fabricio Zambom-Ferraresi, et al JAMA Intern Med. 2019; 179(1):28-36. doi:10.1001/jamainternmed.2018.4869 Importance Functional decline is prevalent among acutely hospitalized older patients. Exercise and early rehabilitation protocols applied during acute hospitalization can prevent functional and cognitive decline in older patients. Objective: To assess the effects of an innovative multicomponent exercise intervention on the functional status of this patient population. Design, Setting, and Participants: A single-center, single-blind randomized clinical trial was conducted from February 1, 2015, to August 30, 2017, in an acute care unit in a tertiary public hospital in Navarra, Spain. A total of 370 very elderly patients undergoing acute-care hospitalization were randomly assigned to an exercise or control (usual-care) intervention. Intention-to-treat analysis was conducted. Interventions: The control group received usual-care hospital care, which included physical rehabilitation when needed. The in-hospital intervention included individualized moderate-intensity resistance, balance, and walking exercises (2 daily sessions). Main Outcomes and Measures: The primary end point was change in functional capacity from baseline to hospital discharge, assessed with the Barthel Index of independence and the Short Physical Performance Battery (SPPB). Secondary end points were changes in cognitive and mood status, quality of life, handgrip strength, incident delirium, length of stay, falls, transfer after discharge, and readmission rate and mortality at 3 months after discharge. Results: Of the 370 patients included in the analyses, 209 were women (56.5%); mean (SD) age was 87.3 (4.9) years. The median length of hospital stay was 8 days in both groups (interquartile range, 4 and 4 days, respectively). Median duration of the intervention was 5 days (interquartile range, 0); there was a mean (SD) of 5 (1) morning and 4 (1) evening sessions per patient. No adverse effects were observed with the intervention. The exercise intervention program provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 2.2 points (95% CI, 1.7-2.6 points) on the SPPB scale and 6.9 points (95% CI, 4.4-9.5 points) on the Barthel Index over the usual-care group. Hospitalization led to an impairment in functional capacity (mean change from baseline to discharge in the Barthel Index of −5.0 points (95% CI, −6.8 to −3.2 points) in the usual-care group, whereas the exercise intervention reversed this trend (1.9 points; 95% CI, 0.2-3.7 points). The intervention also improved the SPPB score (2.4 points; 95% CI, 2.1-2.7 points) vs 0.2 points; 95% CI, −0.1 to 0.5 points in controls). Significant intervention benefits were also found at the cognitive level of 1.8 points (95% CI, 1.3-2.3 points) over the usual-care group. Conclusions and Relevance: The exercise intervention proved to be safe and effective to reverse the functional decline associated with acute hospitalization in very elderly patients. Trial Registration ClinicalTrials.gov identifier: NCT02300896
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