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Professor Keith Hill,

Head, School of Physiotherapy and Exercise Science

[email protected]

Ageing baby boomers: will falls prevention need to change as the ageing population changes?

Monash Seminar – September 2016


Outline

Changing demographics

Potential impact of the “Baby Boomers” growing old

Exercise to reduce risk of falling - current evidence and gaps (community)

Participation and adherence

Potential new avenues

• Reluctant to see Dr• Does not seek additional advice (2nd

opinion, internet…)• Generally low level of focus on

preventive health

???

Health problems associated with ageing likely to increase:

◦ Falls ◦ Dementia◦ Osteoporosis◦ ....

Major focus on (1) ageing well (2) health promotion and prevention (3) improving outcomes and quality of

life for those with health problems

Australian Bureau of Statistics estimates


Baby boomers – who are they?

file:///J:/Generations%20Chart.pdf

Baby boomers are people born during the demographic post–World War II baby boom approximately between the years 1946 and 1964. This includes people who are

between 70 and 52 years old in 2016, respectively.

https://en.wikipedia.org/wiki/Post%E2%80%93World_War_II_baby_boom


Where have they come from?

Have lived through and created many of the achievements of:

the civil rights movement

the sexual revolution

universalisation of education and health-care

Have benefited from:

postwar prosperity

technological advances

Starting The Innovation Age: Baby Boomers’ perspectives on what it takes to age well (2016) - tacsi.org.au


What is likely to be different?


Positives

Education

Health literacy

Tech savvy

Affluent

Questioning (second opinion / research)

Benefit from health promotion messages over past 20 years

Strong desire for independence

What is likely to be different?

Negatives

??Ability to adapt to rapidly changing technology

??reluctance to change behaviours

but not universal


Footer text - slideshow title

"There are some very tech-savvy older people around, but there is clearly a large cohort of people who feel excluded by technology. They find it a bit

impenetrable"

Being tech savvy now does not mean being tech savvy in 15 years time….

Source: Ian Hosking – University of Cambridge engineering design centre


Baby-boomers health

30.07.2010Footer text - slideshow title

One in three older people fall each year

10% of falls cause serious injury

Leading cause of injury related hospitalisations among older people in Australia (99,704 fall related hospitalisations 2012-13) (AIHW 2015)

10% of bed days for older people attributable to falls (AIHW 2012)

Direct costs to the health care system in Australia was $648million in 2007-8

Costs predicted to triple by 2050 if rates of falls not reduced

COCHRANE REVIEW: Gillespie et al, 2012 (159 trials with 79,193 participants)

There is good research (at least one randomised trial) evidence that a number of single interventions can reduce falls / injuries: exercise (home exercise; tai chi, group exercise) cataract extraction / change multifocal glasses to 2 sets of

glasses psychotropic medication withdrawal / medication review home visits by Occupational Therapists improved post hospital discharge follow-up approaches to support client uptake in recommended

interventions vitamin D and calcium supplementation (in low vit D cases) cardiac pacemaker for carotid sinus hypersensitivity foot exercise, footwear and orthoses

multiple interventions based on a falls risk assessment have also been shown to be effective (including in high falls risk groups, eg older fallers presenting to ED)

Group exercise programs

Home exercise programs (often prescribed by a physiotherapist

Tai Chi- (note: different types of Tai Chi may have different effects)

Foot and ankle exercise as part of podiatric multi-faceted program (Spink et al, 2011)

Key elements of successful exercise interventions: Moderate balance

component Moderate intensity(Sherrington et al, 2008, 2011)

Cochrane review: Gillespie et al 2012 (159 trials with 79,193 participants)

16Sherrington et al 2011

54 RCTs (all settings, though most in community)

Exercise that provides moderate to high challenges to balance abilities should include: i) movements that reduce the base of support (e.g., standing with both legs close together, standing on one leg), ii) movement of the center of gravity (e.g., control of the body's position while standing, reaching, or stepping),

and iii) the above movements without upper limb support

Randomly selected sample (>5,000 participants, 61% response rate)

Merom et al, Prev Med, 2012; 55:613-7

12 week weight bearing (home based) exercise program (3 times / week) vs seated resistance exercise vs social visit

Loss of up to 50% of balance gains in the subsequent 12 weeks after ceasing exercise

Vogler et al, 2012, Arch Phys Med Rehabil; 93: 1685-91

Reviewed 99 randomised trial in 2009 Cochrane review (falls prevention in the community)

Adherence rates (n = 69) were:◦ ≥80% for vitamin D/calcium supplementation; ◦ ≥70% for walking and class-based exercise; ◦ 52% for individually targeted exercise; ◦ approximately 60-70% for fluid/nutrition therapy and

interventions to increase knowledge; ◦ 58-59% for home modifications; ◦ Adherence to multifactorial interventions was generally

≥75% but ranged 28-95% for individual components. Home-exercises on average 11 times per month

(Nyman and Victor, Age and Ageing, 2012)

CONCLUSIONS: Using median rates for recruitment (70%), attrition (10%) and adherence (80%),

we estimate that, at 12 months, on average half of community-dwelling older people are likely to be adhering to falls prevention interventions in clinical trials.

Sample with disabling foot pain and increased falls risk

Intervention=foot & ankle exercise, footwear subsidy, and orthoses provision

Intervention group had 36% fewer falls, p<0.05

Spink M et al,, .BMJ. 2011 Jun 16;342:

At risk sample – falls or injurious fall in past 12/12

Intervention=Lifestyle Integrated Functional Exercise

Compared LiFE program vs structured exercise program vs control

31% reduction in falls (LiFE vs control, p<0.05)

Clemson L et al BMJ 2012 Aug 7;345:e4547

Exercise parks for older people (Finland: Lappset)

Recent study at Victoria University (18 weeks):◦ Significant balance, strength

and mobility improvements◦ 87% completed program,

80% adherencehttp://www.lappset.com/global/en/Pro_Play/The_Elderly_.iw3

Sales M et al, J Ageing & Health, IN PRESS

http://www.lappset.com/global/en/

Uses Kinect system

Dr Frances Batchelor, NARI

30.07.2010Footer text - slideshow title

Issues to consider:◦ Acceptability◦ Dexterity◦ Charging◦ Computer link for download and

over time comparisons

Current study: Elissa Burton, Curtin University

What might we have to do differently…

Health and care systemMedical and health

professional training• Geriatrics / gerontology

focus+/-Training re cohort factors

Individual levelUptake and

sustainability of health promoting behaviours

Multiple options - interactive◦ Internet◦ Apps / health reminders◦ Performance monitors (Fit-bit HR…)◦ Facebook / ….

Health professionals trusted source of information (?? may change)

Peer education

Other new modes of information delivery

Highly multicultural generation

Volunteering

Life-long learning

Travel

Others…..

but diversity…

YES

There will be some generational differences Some will create challenges, some will present

opportunities Important considerations for future generations

of health and care professionals

• Multiple modes of consumer access to quality information

• Choice / variety• Person centred care• Technology• Behaviour change focus

ageing baby boomers: will falls prevention need to change ... · 12 week weight bearing (home...

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