Stair falls, especially during stair descent, are a major problem for older people. Stair fall risk has typically been assessed by quantifying mean differences between subject groups (e.g. older vs. younger individuals) for a number of biomechanical parameters individually indicative of risk, e.g., a reduced foot clearance with respect to the stair edge, which increases the chances of a trip. This approach neglects that individuals within a particular group may also exhibit other concurrent conservative strategies that could reduce the overall risk for a fall, e.g. a decreased variance in foot clearance. The purpose of the present study was to establish a multivariate approach that characterises the overall stepping behaviour of an individual. Twenty-five younger adults (age: 24.5±3.3 y) and 70 older adults (age: 71.1±4.1 y) descended a custom-built instrumented seven-step staircase at their self-selected pace in a step-over-step manner without using the handrails. Measured biomechanical parameters included: 1) Maximal centre of mass angular acceleration, 2) Foot clearance, 3) Proportion of foot length in contact with stair, 4) Required coefficient of friction, 5) Cadence, 6) Variance of these parameters. As a conventional analysis, a one-way ANOVA followed by Bonferroni post-hoc testing was used to identify differences between younger adults, older fallers and non-fallers. To examine differences in overall biomechanical stair descent behaviours between individuals, k-means clustering was used. The conventional grouping approach showed an effect of age and fall history on several single risk factors. The multivariate approach identified four clusters. Three clusters differed from the overall mean by showing both risky and conservative strategies on the biomechanical outcome measures, whereas the fourth cluster did not display any particularly risky or conservative strategies. In contrast to the conventional approach, the multivariate approach showed the stepping behaviours identified did not contain only older adults or previous fallers. This highlights the limited predictive power for stair fall risk of approaches based on single-parameter comparisons between predetermined groups. Establishing the predictive power of the current approach for future stair falls in older people is imperative for its implementation as a falls prevention tool.

Background Stair falls are a major health problem for older people, but presently there are no specific screening tools for stair fall prediction. The purpose of the present study was to investigate whether stair fallers could be differentiated from non-fallers by biomechanical risk factors or physical/psychological parameters and to establish the biomechanical stepping profile posing the greatest risk for a stair fall. Methods Eighty-seven older adults (age: 72.1±5.2 y) negotiated an instrumented seven-step staircase and performed a range of physical/psychological tasks. K-means clustering was used to profile the overall stair negotiation behaviour with biomechanical parameters indicative of fall risk as input. Falls and events of balance perturbation (combined “hazardous events”) were then monitored during a 12-month follow-up. Cox-regression analysis was performed to examine if physical/psychological parameters or biomechanical outcome measures could predict future hazardous events. Kaplan-Meier survival curves were obtained to identify the stepping strategy posing a risk for a hazardous event. Results Physical/psychological parameters did not predict hazardous events and the commonly used Fall Risk Assessment Tool (FRAT) classified only 1/17 stair fallers at risk for a fall. Single biomechanical risk factors could not predict hazardous events on stairs either. On the contrary, two particular clusters identified by the stepping profiling method in stair ascent were linked with hazardous events. Conclusion This highlights the potential of the stepping profiling method to predict stair fall risk in older adults against the limited predictability of single parameter approaches currently used as screening tools.

BackgroundAs well as facilitating patients’ wish to die at home, evaluating quality of care in this setting is essential. Postbereavement surveys with family members represent one assessment method. ‘Care Of the Dying Evaluation’ (CODE) is a 40-item self-completion postbereavement questionnaire, based on the key components of best practice for care of the dying.AimTo assess the validity and reliability of CODE by conducting: cognitive ‘think aloud’ interviews; test–retest analysis; and assessing internal consistency and construct validity of three key composite scales.DesignPostbereavement survey to next-of-kin (NOK).Setting/participants291 NOK to patients who died at home in Northwest England from an advanced incurable illness were invited to complete the CODE questionnaire. Additionally, potential participants were asked to undertake a cognitive interview and/or complete CODE for a second time a month later.Results72 bereaved relatives (24.7% response rate) returned the completed CODE questionnaire, and 25 completed CODE for a second time. 15 cognitive interviews were undertaken. All interviewees found CODE sensitively worded and easy to understand. Minor revisions were suggested to provide additional clarity. Test–retest analysis showed all except one question had moderate or good stability. Although the ENVIRONMENT scale was not as relevant within the home setting, all three key composite scales showed good internal consistency and construct validity.Conclusions‘CODE’ represents a user-friendly, comprehensive outcome measure for care of the dying and has been found to be valid and reliable. CODE could potentially be used to benchmark individual organisations and identify areas for improvement.

The most effective way of exploring and representing the patient's experience is by using a mixed-method approach. In other words, an integrated approach with the use of surveys and more narrative methods, such as patient stories, will effectively define quality and how it should be measured, ensuring that the focus is always on what matters most to patients.

Adults with learning disabilities experiences of using community dental services: Service user and carer perspectives http://researchonline.ljmu.ac.uk/6533/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. what it was like for them when they went to the dentist  Those we asked said that when they went to the dentist they knew that those they saw knew about looking after their teeth  Some of those we talked to though said that certain things needed to be better AbstractThe government alongside other health and social care organisation have identified the need to improve the care provided for people with learning disabilities. This service evaluation aimed to explore the experiences of people with learning disabilities and their carers who accessed community dental services. Adults with learning disabilities (n=4) and their carers (n=6) took part in one to one, face to face semi structured interviews.Generally, participants were satisfied with community dental services and in particular valued the skills and the competence of practitioners. However, when dissatisfaction was expressed this was generally as a result of poor communication and the transition from child to adult dental services. Conclusions are discussed and recommendations are identified.

Introduction: The aim of this literature review is to identify the most common tools used to measure burden in carers of people with Parkinson's Disease (PD), Heart Failure (HF), Multiple Sclerosis (MS) and Chronic Obstructive Pulmonary Disease (COPD).Method: Databases such as Medline, PsycINFO, CINAHL and Academic SearchComplete were searched. Studies in which carer burden was measured were included.Results: Zarit Burden Inventory and Caregiver Reaction Assessment were most commonly used to measure carer burden, regardless of the chronic condition. A wide range of other instruments were also used. Conclusion: Even though a range of tools are available, further improvements are necessary in order to enable healthcare professionals to identify carers experiencing high burden.

Background‘CODE’ is a 40-item self-completion post-bereavement questionnaire, focused on the last days of life and based on key components of best practice for care of the dying. CODE is a shortened, more user-friendly version of an original validated instrument, ‘Evaluating Care and Health Outcomes–for the Dying’ (ECHO-D).AimTo assess the validity and reliability of CODE by conducting: cognitive ‘think aloud’ interviews; test-retest analysis; and assessing internal consistency and construct validity of three key composite sub-scales–‘CARE’; ‘ENVIRONMENT’; and ‘COMMUNICATION’.MethodsA post-bereavement survey was conducted with 291 next-of-kin (NOK) to patients who died at home in Northwest England from advanced incurable illness. All NOK were invited to complete the CODE questionnaire and also asked if willing to undertake a cognitive interview and/or complete CODE for a second time a month later.Test-retest reliability was assessed using: percentage agreement; Kappa statistic and Spearman's correlation co-efficient. For each sub-scale, Cronbach's alpha and item-total correlations were used to assess internal consistency. Confirmatory factor analysis was used to assess construct validity.Results72 bereaved relatives (24.7% response rate) returned the completed CODE questionnaire, and 25 completed CODE for a second time. 15 cognitive interviews were undertaken. All interviewees found CODE sensitively worded and easy to understand. Minor revisions were suggested to provide additional clarity. Test-retest analysis showed all except two questions had moderate or good stability. Although the ENVIRONMENT scale was not perceived as relevant within the home setting, all three sub-scales scales showed good construct validity and internal consistency (Cronbach's alpha>0.79).Conclusions‘CODE’ represents a user-friendly, comprehensive outcome measure for care of the dying. This preliminary data, despite small numbers, builds on previous work with ECHO-D and provides support for CODE's validity and reliability. CODE could potentially be used to benchmark individual organisations and identify areas for improvement.

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