Problems with a great idea: referral by prehospital emergency services to a community-based falls-prevention service.

BACKGROUND AND AIM: Falls are the leading cause of injury in older adults. Identifying people at risk before they experience a serious fall requiring hospitalisation allows an opportunity to intervene earlier and potentially reduce further falls and subsequent healthcare costs. The purpose of this project was to develop a referral pathway to a community falls-prevention team for older people who had experienced a fall attended by a paramedic service and who were not transported to hospital. It was also hypothesised that providing intervention to this group of clients would reduce future falls-related ambulance call-outs, emergency department presentations and hospital admissions. METHODS: An education package, referral pathway and follow-up procedures were developed. Both services had regular meetings, and work shadowing with the paramedics was also trialled to encourage more referrals. A range of demographic and other outcome measures were collected to compare people referred through the paramedic pathway and through traditional pathways. RESULTS: Internal data from the Queensland Ambulance Service indicated that there were approximately six falls per week by community-dwelling older persons in the eligible service catchment area (south west Brisbane metropolitan area) who were attended to by Queensland Ambulance Service paramedics, but not transported to hospital during the 2-year study period (2008-2009). Of the potential 638 eligible patients, only 17 (2.6%) were referred for a falls assessment. CONCLUSION: Although this pilot programme had support from all levels of management as well as from the service providers, it did not translate into actual referrals. Several explanations are provided for these preliminary findings.

Staying safe at home. Home environmental audit recommendations and uptake in an older population at high risk of falling.

AIM: To identify the level of uptake of occupational therapists' home environmental audit recommendations by older community dwellers and the factors that contribute to adherence. DESIGN AND SETTING: Cohort nested within an RCT that compared two models of care for fall prevention located in Brisbane, Australia. PARTICIPANTS: Community-dwelling older people >60 at risk of falls (n = 80). INTERVENTIONS: An environmental audit and recommendations by an occupational therapist. RESULTS: Of the recommendations made, 55% were completed by 6 months. Increasing number of comorbidities was a significant predictor of adherence with recommendations. Recommendations requiring external providers were more likely to be completed than those relying on the client or family member. CONCLUSION: Occupational therapists need to consider a wide range of intrinsic and extrinsic factors, which may contribute to adherence with home modifications.

Factors associated with quality of life and caregiver strain amongst frail older adults referred to a community rehabilitation service: implications for service delivery.

PURPOSE: To identify factors contributing to reduced quality of life and increased caregiver strain in an older population referred to a community rehabilitation team and to recommend service delivery models. METHODS: Analytical cross-sectional study arising from baseline assessments from 107 subjects drawn from a randomised controlled trial of community rehabilitation service delivery models. SETTING: A community rehabilitation team based in Brisbane, Queensland, Australia. MEASURES: Primary outcome variables include quality of life (EQ-5D & VAS) and Carer Strain Index. Predictor variables include participation in functional activities, history of falls, number of medications, number of co-morbidities, depression, environmental hazards, physical function and nutrition. Association between variables assessed using linear regression. RESULTS: Major factors contributing to reduced quality of life were having reduced participation in daily activities, depression, and having poor vision. Having poor nutrition and no longer driving also contributed to poor quality of life. The major factor contributing to increased caregiver strain was reduced participation in daily activities by the older person. CONCLUSIONS: Community rehabilitation services working with older populations must adopt models of care that screen for and address a wide range of factors that contribute to poor quality of life and caregiver strain.