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Physical therapists often prescribe exercises for fall prevention. Understanding the factors influencing the clinical decision-making processes used by expert physical therapists working in specialist fall and balance clinics may assist other therapists in prescribing exercises for fall prevention with greater efficacy. The objective of this study was to describe the factors influencing the clinical decision-making processes used by expert physical therapists to prescribe exercises for fall prevention. This investigation was a qualitative study from a phenomenological perspective. Semistructured telephone interviews were conducted with 24 expert physical therapists recruited primarily from the Victorian Falls Clinic Coalition. Interviews focused on 3 exercise prescription contexts: face-to-face individual therapy, group exercise programs, and home exercise programs. Interviews elicited information about therapist practices and the therapist, patient, and environmental factors influencing the clinical decision-making processes for the selection of exercise setting, type, dosage (intensity, quantity, rest periods, duration, and frequency), and progression. Strategies for promoting adherence and safety were also discussed. Data were analyzed with a framework approach by 3 investigators. Participants described highly individualized exercise prescription approaches tailored to address key findings from physical assessments. Dissonance between prescribing a program that was theoretically correct on the basis of physiological considerations and prescribing one that a client would adhere to was evident. Safety considerations also were highly influential on the exercise type and setting prescribed. Terminology for describing the intensity of balance exercises was vague relative to terminology for describing the intensity of strength exercises. Physical therapists with expertise in fall prevention adopted an individualized approach to exercise prescription that was based on physical assessment findings rather than \"off-the-shelf\" exercise programs commonly used in fall prevention research. Training programs for people who prescribe exercises for older adults at risk of falling should encompass these findings.

Exercise is an effective intervention for the prevention of falls; however, some forms of exercises have been shown to be more effective than others. There is a need to identify effective and efficient methods for training health professionals in exercise prescription for falls prevention. The objective of our study was to compare two approaches for training clinicians in prescribing exercise to prevent falls. This study was a head-to-head randomized trial design. Participants were physiotherapists, occupational therapists, nurses, and exercise physiologists working in Victoria, Australia. Participants randomly assigned to one group received face-to-face traditional education using a 1-day seminar format with additional video and written support material. The other participants received Web-based delivery of the equivalent educational material over a 4-week period with remote tutor facilitation. Outcomes were measured across levels 1 to 3 of Kirkpatrick's hierarchy of educational outcomes, including attendance, adherence, satisfaction, knowledge, and self-reported change in practice. Of the 166 participants initially recruited, there was gradual attrition from randomization to participation in the trial (n = 67 Web-based, n = 68 face-to-face), to completion of the educational content (n = 44 Web-based, n = 50 face-to-face), to completion of the posteducation examinations (n = 43 Web-based, n = 49 face-to-face). Participant satisfaction was not significantly different between the intervention groups: mean (SD) satisfaction with content and relevance of course material was 25.73 (5.14) in the Web-based and 26.11 (5.41) in the face-to-face group; linear regression P = .75; and mean (SD) satisfaction with course facilitation and support was 11.61 (2.00) in the Web-based and 12.08 (1.54) in the face-to-face group; linear regression P = .25. Knowledge test results were comparable between the Web-based and face-to-face groups: median (interquartile range [IQR]) for the Web-based group was 90.00 (70.89-90.67) and for the face-to-face group was 80.56 (70.67-90.00); rank sum P = .07. The median (IQR) scores for the exercise assignment were also comparable: Web-based, 78.6 (68.5-85.1), and face-to-face, 78.6 (70.8-86.9); rank sum P = .61. No significant difference was identified in Kirkpatrick's hierarchy domain change in practice: mean (SD) Web-based, 21.75 (4.40), and face-to-face, 21.88 (3.24); linear regression P = .89. Web-based and face-to-face approaches to the delivery of education to clinicians on the subject of exercise prescription for falls prevention produced equivalent results in all of the outcome domains. Practical considerations should arguably drive choice of delivery method, which may favor Web-based provision for its ability to overcome access issues for health professionals in regional and remote settings. Australian New Zealand Clinical Trials Registry number: ACTRN12610000135011; http://www.anzctr.org.au/ACTRN12610000135011.aspx (Archived by WebCite at http://www.webcitation.org/63MicDjPV).

BackgroundThe nature of disease changes with the nature of societies. Modern chronic diseases that have superseded infections in the Anthropocene era, for example, have come largely from modern environments and lifestyles emanating from this. The concept of healthy living has subsequently changed accordingly.Objective/sThe objective of this article is to examine the determinants of modern chronic disease and the changes that can be made at the individual level to reduce the impact of these.DiscussionThere is a hierarchy of determinants (sometimes incorrectly called ‘causes’) of the major modern chronic dieases. These are summarised under the acronym NASTIE MAL ODOURS and collectively under the term ‘anthropogens’, which are ‘… man-made environments and the lifestyles associated with these, many of which may lead to disease’. Attention to anthropogens in a systems fashion suggest guidelines for modern healthy living.

This study sought to investigate the walking habits of older people from diverse cultural backgrounds, and to identify the factors associated with their walking. Three hundred and thirty three people over the age of 60 years were recruited from seven culturally diverse groups from the Western suburbs of Melbourne, Australia. A survey questionnaire recording physical activity, and various factors related to activity, was interviewer-administered in the participants’ preferred language. Data were analysed using Kruskal–Wallis, χ 2 and Mann–Whitney tests. Forty-seven percent of the participants walked at least 150 min per week, with no significant difference in prevalence between genders or cultural groups. Some cultural differences were found in relation to reasons and locations for walking, and women were more likely than men to report walking in the shopping mall, whilst men were more likely than women to report walking in the park and along walking trails. Those who attained >150 min of walking were more likely to report health and fitness as reasons for walking, to perceive their walking environment as more pleasurable, to use walking trails, and to consider their environment safe and to facilitate social interaction. This study indicates that the continued advocating of walking as a health promoting activity should be central to future campaigns to increase physical activity in this age group. The provision of locations that are accessible, safe, aesthetically pleasing, and encourage social engagement are likely to facilitate older people's participation in walking. For maximum effectiveness, however, strategies may benefit from being tailored to meet specific gender and cultural preferences.

The current qualitative study aimed to understand factors in mobility care to inform practice improvements. Data were collected at three nursing homes in Melbourne, Australia, via interviews with 10 senior staff and 15 residents, focus groups with 18 direct care staff, and observations of 46 mobility events. Thematic and content analysis of data occurred. Findings included factors (a) intrinsic to residents, (b) intrinsic to staff, and (c) extrinsic to residents and staff, such as equipment and organizational factors. A model describing associations between factors and their roles as moderators and mediators of resident mobility was generated. Staff assistance, residents’ mobility effort, and equipment used during mobility were posited as complete or partial mediators of resident mobility outcomes. Barriers that may compromise the quality of mobility care in nursing homes emerged. The model provides direction for improvements in mobility care that integrate safety, mobility optimization, and person- and relationship-centered care. The current qualitative study aimed to understand factors in mobility care to inform practice improvements. Data were collected at three nursing homes in Melbourne, Australia, via interviews with 10 senior staff and 15 residents, focus groups with 18 direct care staff, and observations of 46 mobility events. Thematic and content analysis of data occurred. Findings included factors (a) intrinsic to residents, (b) intrinsic to staff, and (c) extrinsic to residents and staff, such as equipment and organizational factors. A model describing associations between factors and their roles as moderators and mediators of resident mobility was generated. Staff assistance, residents’ mobility effort, and equipment used during mobility were posited as complete or partial mediators of resident mobility outcomes. Barriers that may compromise the quality of mobility care in nursing homes emerged. The model provides direction for improvements in mobility care that integrate safety, mobility optimization, and person- and relationship-centered care. [Res Gerontol Nurs. 2014; 7(6):284–291.]

This systematic review aimed to investigate the impact of staff manual handling practices and physical training interventions on nursing home residents’ ability to transfer on and off furniture. Key words and subject headings were used to search databases for English language studies published after 1994. Ten studies met the inclusion criteria. Studies of physical activity interventions indicated that physical activity training will benefit residents’ transfer ability. One study examined the effect of a safe manual handling program on resident quality care outcomes. Further research is required into the nature and impact of the assistance provided by staff to residents during transfers. Innovative and sustainable approaches to safe manual handling that promote resident mobility are needed.

The research reported in this article investigated the nature and the purpose of older people's social interactions in their local neighbourhood shops. Data were collected through face-to-face interviews with and observation of 11 shoppers, aged 67 years and older, and six shopkeepers. Classic grounded theory analysis method revealed a previously uncharted psycho-social process associated with these interactions entitled by the authors as Civic Socialising; it highlights that older people's interactions in their local neighbourhood shops embody authentication of themselves as individuals and as community members, and their co-construction and co-preservation of the milieu of their local neighbourhood shopping precinct with a view to sustaining their ongoing autonomy. The new conceptual theory Civic Socialising highlights that older people can be proactive, resilient and capable, dimensions integral to human fulfilment, and demonstrates that older people can play an active role in their communities where the environment is enabling. The new conceptual theory Civic Socialising has significance for the way we determine and view older people's social relationships. Crucially, in light of a burgeoning older population world-wide, it is clear that policy makers and social planners must ensure that older people can continue to interact in their communities if ageing in place is to be a satisfying and cost-effective experience. Without such consideration, ageing in place could well create dependency and despondency.