Objectives: To determine whether a 12-month program of group exercise can improve physical functioning and reduce the rate of falling in frail older people.Design: Cluster randomized, controlled trial of 12 months duration.Setting: Retirement villages in Sydney and Wollongong, Australia.Participants: Five hundred fifty-one people aged 62 to 95 (mean+/-standard deviation=79.5+/-6.4) who were living in self- and intermediate-care retirement villages.Measurements: Accidental falls, choice stepping reaction time, 6-minute walk distance postural sway, leaning balance, simple reaction time, and lower-limb muscle strength.Results: Two hundred eighty subjects were randomized to the weight-bearing group exercise (GE) intervention that was designed to improve the ability of subjects to undertake activities for daily living. Subjects randomized to the control arm (n=271) attended flexibility and relaxation (FR) classes (n=90) or did not participate in a group activity (n=181). In spite of the reduced precision of cluster randomization, there were few differences in the baseline characteristics of the GE and combined control (CC) subjects, although the mean age of the GE group was higher than that of the CC group, and there were fewer men in the GE group. The mean number of classes attended was 39.4+/-28.7 for the GE subjects and 31.5+/-25.2 for the FR subjects. After adjusting for age and sex, there were 22% fewer falls during the trial in the GE group than in the CC group (incident rate ratio=0.78, 95% confidence interval (CI)=0.62-0.99), and 31% fewer falls in the 173 subjects who had fallen in the past year (incident rate ratio=0.69, 95% CI=0.48-0.99). At 6-month retest, the GE group performed significantly better than the CC group in tests of choice stepping reaction time, 6-minute walking distance, and simple reaction time requiring a hand press. The groups did not differ at retest in tests of strength, sway, or leaning balance.Conclusions: These findings show that group exercise can prevent falls and maintain physical functioning in frail older people.

Using Quality Improvement project methodology, complex organisational and clinical practice change was broughtabout to improve services for people with co-existing mental health and alcohol and drug misuse. The project describeslocal uptake and adaptation of national and state policy to achieve change that is sustainable within existing resources.Emphasis on engagement of staff and consumers and carers throughout the change was an essential component. Theproject has implications for the introduction of changes in response to other national policy directives.

BACKGROUND:Foot problems are common in older people and are associated with impaired balance and functional ability. Few prospective studies, however, have been undertaken to determine whether foot problems are a risk factor for falls.METHODS:One hundred seventy-six people (56 men and 120 women, mean age 80.1, standard deviation 6.4 years) residing in a retirement village underwent tests of foot and ankle characteristics (including foot posture, range of motion, strength, and deformity) and physiological falls risk factors (including vision, sensation, strength, reaction time, and balance) and were followed for 12 months to determine the incidence of falls.RESULTS:Seventy-one participants (41%) reported falling during the follow-up period. Compared to those who did not fall, fallers exhibited decreased ankle flexibility, more severe hallux valgus deformity, decreased plantar tactile sensitivity, and decreased toe plantarflexor strength; they were also more likely to have disabling foot pain. Discriminant function analysis revealed that decreased toe plantarflexor strength and disabling foot pain were significantly and independently associated with falls after accounting for physiological falls risk factors and age.CONCLUSIONS:Foot and ankle problems increase the risk of falls in older people. Interventions to address these factors may hold some promise as a falls prevention strategy.

Objective: To determine whether a 22 week water exercise program can improve physical functioning in older people.Methods: The controlled study was conducted with 85 water exercise subjects (mean age 71.8 years) and 44 controls (mean age 76.5 years). The outcome measures were leaning balance, quadriceps strength, reaction time and shoulder range of motion.Results: At baseline, the groups were well-matched across most demographic, health and physical performance measures. At retest, the 48 exercise subjects who were available for retest showed significantly improved leaning balance (as measured by tests of maximal balance range and coordinated stability) and shoulder range of motion compared with the controls. The groups did not differ in tests of quadriceps strength and reaction time.Conclusions: These findings show that water exercise can produce benefits with regard to improving balance and flexibility in older people.

Normative data on neuropsychological tests for very old adults living in retirement villages and hostels are under-represented in the literature. This study reports normative data on the Mini-Mental State Examination, Digit Span Forwards, Digit Span Backwards, the Digit Symbol Substitution Test, the Controlled Oral Word Association Test, the Stroop Neuropsychological Screening Test and the National Adult Reading Test. Age and education showed moderate correlations with neuropsychological test performance. For all tests except the Stroop, differences between residents of retirement villages and hostels were explained by age and education. Men performed better on the NART than women, but this difference was eliminated when education was controlled for statistically.