Characteristics of outdoor falls among older people: A qualitative study

Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people

Updated international tuberous sclerosis complex diagnostic criteria and surveillance and management recommendations

Background Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disease affecting multiple body systems with wide variability in presentation. In 2013, Pediatric Neurology published articles outlining updated diagnostic criteria and recommendations for surveillance and management of disease manifestations. Advances in knowledge and approvals of new therapies necessitated a revision of those criteria and recommendations. Methods Chairs and working group cochairs from the 2012 International TSC Consensus Group were invited to meet face-to-face over two days at the 2018 World TSC Conference on July 25 and 26 in Dallas, TX, USA. Before the meeting, working group cochairs worked with group members via e-mail and telephone to (1) review TSC literature since the 2013 publication, (2) confirm or amend prior recommendations, and (3) provide new recommendations as required. Results Only two changes were made to clinical diagnostic criteria reported in 2013: “multiple cortical tubers and/or radial migration lines” replaced the more general term “cortical dysplasias,” and sclerotic bone lesions were reinstated as a minor criterion. Genetic diagnostic criteria were reaffirmed, including highlighting recent findings that some individuals with TSC are genetically mosaic for variants in TSC1 or TSC2. Changes to surveillance and management criteria largely reflected increased emphasis on early screening for electroencephalographic abnormalities, enhanced surveillance and management of TSC-associated neuropsychiatric disorders, and new medication approvals. Conclusions Updated TSC diagnostic criteria and surveillance and management recommendations presented here should provide an improved framework for optimal care of those living with TSC and their families

"They're not including us!" : neighbourhood deprivation and older adults' leisure time physical activity participation

Population ageing and the tendency for older adults to have poorer health status than younger adults have raised concerns about potential increases in the number of elderly suffering disease and disability. Significantly, many health problems experienced in later life are associated with the onset of a more sedentary lifestyle. Increasing older adults' participation in leisure time physical activity (henceforth LTPA) offers an opportunity to reduce the prevalence of preventable morbidity in later life and offset a potential burden of ageing on the public health sector. As a forerunner to the development of strategies to increase older adults' LTPA participation, researchers have investigated the intrapersonal, interpersonal and, to a lesser extent, environmental influences on this health behaviour. Recent findings from studies of the adult population have suggested that neighbourhood deprivation, a measure of the socioeconomic conditions of small areas, may significantly influence LTPA participation. Extending previous findings, this research investigated how neighbourhood deprivation influenced older adults' LTPA participation. A total of 63 older adults were recruited from high- and low-deprivation neighbourhoods in Christchurch, New Zealand. Neighbourhoods were selected because of their relative positions on the New Zealand Deprivation Index and were characterised by the researcher as "East-town", a neighbourhood of high deprivation, and "West-town", a neighbourhood of low deprivation. The research incorporated a cross-sectional, comparative and mixed-methods approach. The methods of enquiry employed in this research included a recall survey, Q method, and semi-structured interviewing. Each method addressed a different aspect of the primary research question and provided data that was used in the creation of an integrated model depicting the influence of neighbourhood deprivation on older adults' LTPA participation. The results derived from the three research methods showed that older adults from the low-deprivation neighbourhood of West-town participated in LTPA more frequently than older adults from the high-deprivation neighbourhood of East-town. East-town was identified as having many physical and social environmental constraints to LTPA and comparatively few facilitators. Alternatively, West-town was found to have many physical and social environmental facilitators to LTPA and relatively few constraints. Neighbourhood attributes which appeared to influence older adults' LTPA participation included appropriateness of leisure provision, neighbourhood attractiveness, walkability, traffic, and perceptions of crime and antisocial behaviour. One implication of this research is that environmental interventions should be considered in attempts to engage older adults in LTPA for health purposes, particularly in high-deprivation neighbourhoods

Advancing an integrated leisure research strategy for New Zealand: an analysis of the perceived research needs and priorities of stakeholders in the arts, outdoor recreation, sport and community recreation sectors

This report describes a programme of research that seeks to advance the development of an integrated leisure research strategy for New Zealand. The research aims to assess current research utilisation and demand for an overarching national strategy, identify key research priorities and themes across the leisure sector, and facilitate greater dialogue between leisure stakeholders. The leisure sector is taken to include the sport, outdoor recreation, arts and community recreation sectors. There have been calls for an integrated leisure research strategy for New Zealand for at least the last decade, although relatively little progress has been made towards this end. While the findings and recommendations of this report do not constitute a leisure research strategy, it is hoped that they will be used to advance the development of a national leisure research strategy following further dialogue with stakeholders. The research which led to this report was divided into two phases. In the first phase, an exploratory survey of leisure sector stakeholders was undertaken to determine current research utilisation and attitudes towards the development and implementation of a sector-wide research strategy. In the second, main, research phase, a survey was again used to identify key research priorities and themes within individual sectors as well as common research themes across the entire sector. A focus group was held with key stakeholders in the second research phase to triangulate the research findings and present initial conclusions. A wide variety of leisure sector stakeholders were consulted during this research, including: national and regional organisations; research producers and research users; public, private, and volunteer-sector groups; senior management, front line staff and volunteers. The diversity of feedback received during data collection suggests that the present research is likely to have relevance to a broad audience across the leisure sector. A number of salient findings were identified during the research. In the first phase, the exploratory survey revealed high levels of research utilisation across the sector and a desire for an increase in the production of relevant research outputs. Respondents to the first survey also indicated their support for the development of a national leisure research strategy. The first phase also highlighted a general consensus among stakeholders that any future strategy be implemented by a centralised government agency, such as Sport and Recreation New Zealand (SPARC). In the second research phase, sector-specific research priorities were identified to account for some of the unique challenges and situations faced by individual sector groups. Thereafter, common research themes were explored to identify overarching research needs that could potentially form the basis of a leisure research strategy. While there were some differences between sectors (the arts sector was notable in this regard), leisure stakeholders identified a number of research themes that were important across the sector. In particular, leisure sector representatives called for more research to identify the benefits and outcomes of leisure participation and understand contemporary leisure behaviour and demand. Feedback from focus group participants was generally supportive of the research findings, and stakeholders were interested in ensuring that the research was widely disseminated, that there was good communication between research producers, and that steps were taken to move from preliminary research to the development of a full leisure research strategy. A number of recommendations are presented at the end of the report to assist the further development and implementation of a national leisure research strategy. It is hoped that the research described in this report represents the first steps towards such a strategy. This will only be achieved, however, through ongoing communication between research-intensive institutions, government agencies and leisure sector stakeholders.We would like to thank Lincoln University, including the Environment, Society and Design Faculty, and Building Research Capacity in the Social Sciences (BRCSS) for supporting this research financially. The research was conducted in association with the Australian and New Zealand Association for Leisure Studies (ANZALS) and we are most appreciative for the advice and support received from ANZALS members in conducting this project. Rachel Batty was involved in the development of Stage 1 of the project, Luke Adams in the production of the database of leisure sector organisations, Helen Davies in data entry and Michelle Collings was partially responsible for the report’s professional appearance. We would like to acknowledge the valuable contributions of all four colleagues. Grant McLean and Andre Van Der Walt of SPARC provided valuable support and advice on the project in relation to the sport and physical activity sector and for this we are most grateful. We thank the participants of the focus group meeting who assembled at the SPARC offices in Wellington: stakeholders broadly representative of national level organisations in the leisure sector. We are also most grateful to the respondents of both of our surveys whose willingness to participate lifted our response rate, particularly in the main survey, to creditable levels