Meet Our Speakers
Associate Professor Anne Tiedemann
The University of Sydney; Faculty of Medicine and Health, Sydney School of Public Health, Institute for Musculoskeletal Health, Sydney, NSW
A/Prof Anne Tiedemann is an NHMRC Career Development Fellow and Principal Research Fellow at the School of Public Health, The University of Sydney. In 2016 she was awarded a National Health and Medical Research Council Research Excellence Award, for the highest ranked 2015 Population Health CDF Level 1 application. Anne has a growing international reputation as an expert on fall prevention in older age and has over 80 peer-reviewed research publications on risk factors for falls in older age and the implementation and evaluation of exercise-based fall prevention interventions. She is a CI on 4 current NHMRC Project grants and one Partnership grant that aim to evaluate new approaches to exercise-based interventions for the prevention of falls and promotion of healthy ageing.
Combining physical activity promotion and fall prevention for healthy ageing
Physical activity is key to maximising health and wellbeing across the lifespan but is particularly crucial in older age due to the increased risk of chronic conditions with increasing age. Physical activity also improves cognition, social connectedness and mental wellbeing and prevents the onset of disability in later life. Balance-specific exercise, a subset of physical activity, is essential for the prevention of falls in older age. Despite these signiﬁcant beneﬁts, older people are the most inactive segment of society with over 70% of Australians aged 75 years and over not suﬃciently active, which highlights a need for more effective strategies to promote uptake and adherence to physical activity and fall prevention programs. This presentation will overview research being undertaken to evaluate the role of health coaching, activity trackers and goal setting for the promotion of physical activity for older people and will report on completed and ongoing trials evaluating the impact of these approaches on falls and physical activity among older community-dwellers.
Associate Professor Anne-Marie Hill
Associate Professor Anne-Marie Hill (PhD, MSc is a research academic in the School of Physiotherapy and Exercise Science at Curtin University. She is an APA titled Gerontological physiotherapist (Australian Physiotherapy Association) a title awarded which recognises her expertise in Geriatrics and Gerontology. She was awarded an NHMRC early career fellowship (2012-2015) after completing her PhD in 2011 and has over 75 published or in press publications. Anne-Marie’s interests are in falls prevention, promotion of physical activity among older populations and translation of evidence into practice in health communities. She has conducted large clinical trials in both hospital and community populations and has over $8 million funding awarded. Three physiotherapists have recently been awarded their Doctorate under her primary supervision. She is now working collaboratively with Aboriginal and Torres Strait Islander researchers and communities focusing on sustainable physical activity programs for older Aboriginal people in WA.
Falls after hospital discharge – providing patient education
Falls are a significant problem for older people recently discharged from hospital. Functional decline, unplanned readmission, increased risk of hip fracture and other adverse events are also known to be associated with this transition period from hospital to home. Interventions to address these problems of transition from hospital to home, especially for older patients with complex needs have had mixed effects and patients themselves also report significant difficulties in managing this transition. Over the past two years a randomised controlled trial has been conducted in WA to evaluate the effect of providing older patients with tailored multimedia falls prevention education in hospital and after discharge on falls rates in the six months following hospital discharge. Results of the trial will be presented and discussed.
Dr Daina Sturnieks
Neuroscience Research Australia, UNSW Medicine, Sydney, NSW
Dr Daina Sturnieks is a Research Fellow at Neuroscience Research Australia (NeuRA), Sydney and Conjoint Senior Lecturer at the School of Medical Sciences UNSW. Daina has a PhD in human biomechanics from the University of Western Australia and is laboratory manager of the Falls, Balance and Injury Research Centre at NeuRA. Her research focuses on understanding sensorimotor and neurocognitive contributions to falls in older people and clinical groups, and trialling novel interventions to prevent falls involving balance, stepping and cognitive exercises. Daina is motivated to translate research to practice, delivering professional development workshops on fall prevention, and holding positions on the NSW Falls Prevention Network Management Committee, NSW Health Active and Healthy website advisory committee, and the Australian and New Zealand Falls Prevention Society Executive Committee.
Training voluntary and reactive stepping for fall prevention
Appropriately timed and directed stepping is crucial for correcting perturbed balance and avoiding a fall. A step may be initiated voluntarily to proactively avoid falling, or induced reactively in response to sudden external perturbations to balance. In any case, a step must have the right timing, direction and size for it to successfully restore balance and there is growing evidence that poor stepping responses contribute to falls and injuries. Training interventions focusing on stepping performance show promise for preventing falls in older people, some evidence suggesting that both reactive and volitional stepping interventions can reduce falls by approximately 50%. This presentation will give an overview of the evidence around step training, highlight current studies and suggest how these might influence the future of fall prevention.
Professor Joe Verghese
Professor of Neurology & Medicine; Chief, Integrated Divisions of Cognitive & Motor Aging and Geriatrics; Murray D Gross Memorial Faculty Scholar in Gerontology; Founding Director, Montefiore-Einstein Center for the Aging Brain; Departments of Neurology and Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
Dr Joe Verghese graduated from St. Johns Medical College, Bangalore, India. He did his postgraduate training in Internal Medicine and Neurology in United Kingdom. He completed his Neurology residency at the Albert Einstein College of Medicine, Bronx, NY. He did fellowship training in Neurophysiology as well as Aging & Dementia in 1999 at the same institution. He received a Master of Science degree in Clinical Research Methods with Distinction from the Albert Einstein College of Medicine in 2001. Dr Verghese is board-Certified in Neurology.
Dr Verghese is Professor of Neurology and Medicine at the Albert Einstein College of Medicine. He is the Chief of the integrated divisions of Cognitive & Motor Aging in the Department of Neurology and Geriatrics in the Department of Medicine. He is the founding Director of the Montefiore-Einstein Center for the Aging Brain, an interdisciplinary cognitive assessment center.
Dr Verghese’s research interest is the effects of disease and aging on mobility and cognition in older adults, and he has over 150 peer-reviewed publications and several federally funded research grants in these areas. His current projects include studying the influence of cognitively stimulating activities on reducing risk of dementia and mobility loss, cognitive control of gait and mobility, and global health studies in dementia.
Fall brain: cognitive and biological perspectives
While many fall prevention strategies targeted against clinical risk factors have been tested, their success in reducing falls has been modest. Current falls research in aging is mostly focused on clinical predictors of falls. Hence, there is a knowledge gap regarding the underlying biological and neural mechanisms of falls. Emerging evidence from our and other studies implicates biological derangements in inflammation, oxidative stress, and vascular pathways in the occurrence of disorders of gait, balance, and cognition, which in turn are major risk factors for falls in older adults. A growing understanding of the relationship between cognitive and mobility processes in aging opens up the possibility of novel interventions to improve mobility and reduce risk of falls.
Professor Lindy Clemson
Professor in Ageing & Occupational Therapy, Faculty of Health Sciences, The University of Sydney , Charles Perkins Centre Active Ageing Research Node Leader, Investigator, ARC Centre of Excellence in Population Ageing Research
Lindy is a recognised international leader in enablement and environmental approaches to community-based falls prevention. She has led the development of three novel and successful fall prevention programs, all implemented world-wide. She has conducted nationally-funded trials to test the efficacy of interventions, including Stepping On, a group-based fall prevention program and the Lifestyle-integrated Functional Exercise (LiFE) program, and has developed assessments and interventions related to environment and behavioural fall risk. Her current work is conducting research to investigate ways to translate evidence into practice and collaborative projects to explore interventions for high-risk groups.
Her work has influenced both policy and practice, and her publications are highlighted in Cochrane Reviews, the Australian and US national fall prevention practice guidelines and in the US compendium of effective community-based falls prevention interventions. Her research expertise includes multi-methodology inquiries, intervention trials and implementation science.
She is Professor of Ageing and Occupational Therapy and an investigator on the Centre of Excellence for Population Ageing Research, the University of Sydney and an Honorary Professor at Nottingham University in the UK.
Integrated solutions for sustainable fall prevention in primary care, the iSOLVE implementation project: Lessons learnt, future directions and challenges ahead
Despite decades of research in fall prevention providing strong evidence for effective interventions in community-residing older people, there is no clear model for widespread implementation in primary care. Less than 30% of health professionals routinely screen for falls and few are asked by general practitioners or referred for intervention, leaving a huge gap of missed opportunity. The iSOLVE project has been developing and testing a package of implementation processes and change strategies in a whole of primary care approach to fall prevention. The study, which uses a blended type-2 hybrid design, is working in partnership with a primary care health network, state fall prevention leaders and fall prevention advocates. The implementation intervention includes GP educational detailing; Decision support tools and fall management tailoring; GP computer systems; Knowledge translation, education and upskilling of local allied health professionals; facilitating referral pathways, and other diffusion and dissemination strategies. Emergent findings from this multi-methodology project are providing an understanding of which active ingredients of the implementation intervention impact on success and where the future challenges are. This both informs decisions on generalisability and provides direction for future sustainability.
Professor Keith Hill
Head of School of Physiotherapy and Exercise Science, Curtin University, Perth, WA
Professor Keith Hill is Head of the School of Physiotherapy and Exercise Science at Curtin University. He is a physiotherapist and senior researcher, with 38 years clinical experience in rehabilitation and aged care, and an extensive recent track record in implementing and completing a range of falls prevention, rehabilitation and physical activity research programs for older people in the community, hospital and residential aged care settings. Professor Hill has 250 peer reviewed publications, and has received over $17million of research funding as a Chief Investigator. He is a Board member and Life Member of the Australian Association of Gerontology, and has been Chair of the Asia Oceania Council of the International Association of Gerontology and Geriatrics for the past four years.
International falls prevention evidence: Gaps and translation issues
Despite strong growth in many aspects of falls prevention research, there remain some key areas where limited research has been undertaken, much of that research is of low to medium quality, and as a result there remains considerable uncertainty regarding what interventions should be implemented and how. This presentation will provide an overview of two important areas where substantial gaps in falls prevention evidence continue to exist – firstly falls prevention in residential care settings; and secondly, falls prevention in Asian countries (community settings focus). A new Cochrane falls prevention review in hospital and residential care settings is currently under review for publication – to update the last review in 2012 (1). Despite the intervening five years, the extent of conclusions able to be drawn to guide practice in improving falls outcomes in residential care settings remains very limited. Factors contributing to the limited evidence, and recommendations for research an practice to reduce falls in residential care settings will be discussed. In contrast to the residential care setting, there is a strong evidence base of effective fall prevention interventions in the community setting. However, despite Asia having 60% of the world’s population, and some of the fastest ageing populations, a disproportionately low 15 (9%) of the 159 randomized controlled trials reported in the most recent (2012) Cochrane review of falls prevention interventions in the community setting were conducted in Asian countries (2). Results of a recent systematic review and meta-analysis of falls prevention RCTs conducted in Asian countries will be presented (3). Results indicate that exercise interventions conducted in Asian countries are effective in reducing falls. Factors influencing uptake and effectiveness of fall prevention interventions between western countries (where most of the falls prevention research has been conducted to date) and Asian countries will be discussed, and considerations discussed that may facilitate improved falls prevention in Asian countries as their populations continue to rapidly age.
Associate Professor Kim Delbaere
Neuroscience Research Australia, Sydney, NSW; Principal Research Scientist, Neuroscience Research Australia; Associate Professor, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW
Kim Delbaere is a Principal Research Scientist (supported by a NHMRC CDF level 2) at Neuroscience Research Australia (NeuRA) and Associate Professor at University of New South Wales, Sydney. She is a physiotherapist with expertise in ageing, falls, fear of falling, cognitive impairment, and the behavioural elements derived from psychology research.
In 2012, Kim Delbaere started her own research group at NeuRA. Her program of research is aimed at examining the underlying mechanisms by which interventions may prevent falls in older people. Her methodological approach has changed how we understand fall risk, through looking at interactions and cumulative effects of physical, psychological, cognitive and neural impairments on falls and healthy ageing. She has applied neuroimaging techniques to provide insights into the nature of brain changes underlying fall risk in old age and has explored determinants for the high prevalence of falls in various clinical populations (e.g. dementia, diabetes, multiple sclerosis). Her current work focuses on technological self-management solutions to deliver tailored interventions. Her interventions combine evidence-based exercise programs with behavioural techniques to enhance long-term exercise adherence and lasting behaviour change. Her approach has potential to have lasting public health benefits by advancing healthy ageing at low cost to the health care sector.
Kim Delbaere has received numerous awards, such as two prestigious NHMRC Achievement Awards for top ranked career development fellowship and a UNSW Faculty of Medicine Dean’s Rising Star award. Kim Delbaere is the Vice-President of the Australian and New Zealand Falls Prevention society, the Secretary of the International Society of Posture and Gait Research (ISPGR) and she sits on the steering committee for the annual European Falls Festival. Kim Delbaere is an Associate Editor of the American Journal of Geriatric Psychiatry and BMC Geriatrics. In her research career, Kim Delbaere has published over 130 well-cited peer-reviewed publications in top ranking “gerontology-geriatrics” and “general medicine” journals. Kim Delbaere has a strong record of achievement in translational health and medical research. She translated her research into clinical assessments and intervention programs, which have been adopted in several best-practice fall prevention guidelines nationally and internationally.
“Standing Tall” – an engaging home-based exercise program using mobile technology for preventing falls
Balance training is effective in reducing falls in older people. However, poor compliance with the recommended dose of two hours of exercise per week calls for new alternatives. This study involves the use of mobile technology for delivering an innovative home-based balance training program that has the potential to be effective, cost-effective, and sustainable.
StandingTall is an engaging balance program that employs mobile tablet technology to deliver an evidence-based method for improving balance and reducing fall risk. It includes: (i) individually-tailored exercise prescription to improve balance ability and reduce fall risk in older people; and (ii) behavioural change techniques to enhance exercise uptake and long-term adherence, with optimal usability for older people to use independently at home. Delivery of the intervention through mobile technology is particularly appropriate for providing the required tailored support to prevent falls effectively in older people.
A total of 510 community-dwelling people aged 70 years or older, were recruited and randomly allocated to an intervention or control group. Intervention participants were asked to complete 2 hours of balance exercises per week through the StandingTall app. Both groups received a health promotion education programme focused on health-related information relevant to older adults. Primary outcome measures include number of fallers and falls rate recorded in weekly fall diaries at 12 months. Supplementary secondary analyses investigatea to what extent the training transferred to other important outcomes such as balance, concern about falling, wellbeing and overall activity levels. Adherence, acceptability, usability and enjoyment were recorded in intervention group participants.
Recent increases in the uptake of smart phones and tablet devices by older people provide a unique and unprecedented opportunity to deliver exercise programs to prevent falls as a self-management program. Mobile technology can deliver a fully-automated personal health program, individualized for content and dose, immediate performance feedback and real-time monitoring.
Professor Lamb is the Director, for Centre for Statistics in Medicine and Foundation Director, Oxford Clinical Trials Research Unit (OCTRU), University of Oxford, Section Head, Statistics and Epidemiology, University of Oxford, Director, Centre for Rehabilitation Research in Oxford, Deputy Director, Oxford Biomedical Research Unit, University of Oxford, Kadoorie Professor of Trauma Rehabilitation, University of Oxford and Professor of Rehabilitation, Warwick Clinical Trials Unit, University of Warwick.
She has a long standing interest in clinical trials, medical statistics and, from a clinical perspective, rehabilitation of musculo-skeletal and chronic conditions. She works with clinicians from a variety of backgrounds to develop pragmatic clinical trial designs to capture the effectiveness and cost-effectiveness of a variety of health technologies. She is the Chief Investigator for a number of trials of rehabilitation interventions, and Head of the Centre for Rehabilitation Research in the Nuffield Department of Orthopaedics, Rheumatology and Musculo-skeletal Sciences at the University of Oxford. Prior to taking up the post of Co-Director of OCTRU, Professor Lamb was the Foundation Director of the Warwick Clinical Trials Unit at the University of Warwick. She continues to work collaboratively with the Warwick Unit.
Professor Lamb has a particular interest in older people, and has served as a member of the American Geriatric Society/ British Geriatric Society Fall Guideline Panel, and more recently, as a member of the NICE guideline panel of hip fracture management. She collaborates with a range of US and European Investigators interested in frailty, sarcopenia and disability in older people.
Future directions for evidence based falls prevention practice
Falls prevention practice is underpinned by a large body of research evidence, which at times provides a conflicting account of effective interventions and confusion about the best way forward. Drawing on data from the first of a new generation of large pragmatic clinical trials and the 2018 updates of the Cochrane Reviews of fall prevention interventions for older people living in the community, this talk will update the evidence picture, highlight the strengths and weaknesses of the existing research base and draw conclusions for research and practice.
Professor Terry Haines
Monash University, School of Primary and Allied Health Care, Melbourne, VIC
Professor Terry Haines is Head of the School of Primary and Allied Health Care at Monash University. In this role he is responsible for a school with 6 departments, over 150 staff, and over 180 research higher degree students. He has a professional background in physiotherapy and health economics, and has worked in research roles imbedded within health services for over 15 years before commencing as the Head of School in 2017. He has previously worked in conjoint roles between the University of Queensland and Princess Alexandra Hospital, and between Monash University and Monash Health.
Prof Haines commenced his research in the area of falls prevention in the hospital setting, leading the first randomised trial to prevent falls in this context. Since then he has gone on to undertake a range of research projects across health care settings. He has now published over 250 peer reviewed manuscripts, supervised 18 PhD students through to completion and attracted over $21 million in research funding. He has twice been awarded the NHMRC Achievement Award (2010, 2014).
Preventing falls in hospitals and aged care facilities: Innovation, policy, practice and negative trials
This presentation will highlight difficulties faced by people who work in health and aged care organisations in trying to prevent falls when there is no one easy answer. It will reflect broadly on how innovations have found their way “in” to becoming a standard component of clinical practice whilst not yet having a strong evidence base, and the complexities this creates in finding solutions for the future. Data mapping of falls prevention activities and their opportunity cost across six large health care organisations will be presented to illustrate how current policy settings are encouraging falls prevention practice in areas with variable evidence supporting their provision. Results from two recent, large randomised trials will be presented, one conducted in the hospital setting, the other in the nursing home setting. The first examines the impact of changing staffing models of allied health practitioners on acute medical and surgical wards on weekends and the impact of doing so on fall rates. The second examines employing general practitioners as members of staff within residential aged care facilities on hospital admissions, fall rates and other resident outcomes. The potential implications of these trials on falls prevention policies will then be discussed.
Associate Professor Vasi Naganathan
Centre for Education and Research on Ageing, Concord Hospital; Faculty of Medicine and Health, University of Sydney, Sydney, NSW
Vasi Naganathan is an academic at the University of Sydney and a consultant Geriatrician at Concord Hospital in Sydney, Australia. His research interests are wide including: health of older men, oral health, falls, fractures and osteoporosis, pharmacology in the older people and the application of evidence-based medicine to older people. He has been a Chief investigator on a number of NHMRC project grants and is the chair of the Australian Scientific and Research Subcommittee.
Vasi is the Deputy Director of the Concord Health and Ageing in Men Project (CHAMP) a longitudinal study on the health of older men.
Falls and Older Men- do we really need to think about things differently in men?
This presentation will discuss what we know about the risk factors for falls and fall related injuries and fall-related hospitalisations from the Concord Health and Ageing in Men (CHAMP) prospective cohort study of older men (n = 1705). Prior history of falls was the most significant predictor of future falls and additional risk factors for falls included age 80 years and older, being single, disability in ADLs, dementia, having 3 or more comorbidities, and reduced visual acuity in an analysis excluding history of falls. Men who were born in a non-English speaking country were at lower risk of falls when followed for 2 years. The strongest risk factor predicting fall injury hospitalisation at 10 years was dementia. A brief review of the falls prevention clinical trials will be presented with a focus on older men. Based on what we know about falls in older men we can ]have a discussion on whether there is any argument for gender specific falls assessment and management strategies.