Chan Sieu Gaen. / Year shown on spine: 1997. / Questionnaries in Chinese and English. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references. / Acknowledgement / List of tables --- p.i / Abstract --- p.vi / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.0 --- Demographic changes of the population / Chapter 2.0 --- Falls / Chapter 2.1 --- Significance of the problem / Chapter 2.2 --- Physical consequences of falls / Chapter 2.3 --- Psychological consequences of falls / Chapter 2.4 --- Impact on health services / Chapter 2.5 --- Mortality / Chapter 2.6 --- Economic consequences / Chapter Chapter 2 --- Risk factors for falls --- p.12 / Chapter 2.1 --- Environmental hazards and circumstances of falls / Chapter 2.2 --- Social demographic factors / Chapter 2.3 --- Health status / Chapter 2.4 --- History of falls / Chapter 2.5 --- Mental/Depression / Chapter 2.6 --- Health behavior / Chapter 2.7 --- Bone mass and anthropometric factors / Chapter 2.8 --- Risk factors for multiple falls / Chapter 2.9 --- Fall injuries / Chapter 2.10 --- Additive effects of risk factors / Chapter Chapter 3 --- "Limitation of previous studies, objectives and study methods" --- p.31 / Chapter 3.1 --- Hospital reports and instiutional-based studies / Chapter 3.2 --- Study design / Chapter 3.3 --- Selection of subjects / Chapter 3.4 --- Classification and definition of falls / Chapter 3.5 --- Studies on falls in Hong Kong / Chapter 3.6 --- Hong Kong study / Chapter 3.7 --- Study methods / Chapter 3.8 --- Data collection / Chapter 3.9 --- Data analysis / Chapter Chapter 4 --- Characteristics of respondents and distribution of falls --- p.48 / Chapter 4.1 --- Characteristics of respondents / Chapter 4.2 --- Proportion of fallers and rate of falls / Chapter 4.3 --- Discussion / Chapter Chapter 5 --- Circumstances and consequences of falls --- p.65 / Chapter 5.1 --- Time and place of falls / Chapter 5.2 --- Activity during and reasons for falls / Chapter 5.3 --- Predisposing factors for falls / Chapter 5.4 --- Consequences of falls / Chapter 5.5 --- Discussion / Chapter Chapter 6 --- Characteristics of fallers and nonfallers --- p.85 / Chapter 6.1 --- Sociodemographic characteristics / Chapter 6.2 --- Health status / Chapter 6.3 --- Health behavior / Chapter 6.4 --- Bone mass and body measurements / Chapter Chapter 7 --- Risk factors associated with fallers --- p.99 / Chapter 7.1 --- Risk factors for fallers (including single and multiple) / Chapter 7.2 --- Multiple fallers / Chapter 7.3 --- Risk factors for single and multiple fallers (vs. non- fallers) / Chapter 7.4 --- Comparison of risk factors associated with major injurious falls vs. those with non-major injurious falls / Chapter 7.5 --- Independent predictors of fallers / Chapter 7.6 --- The additive effects of independent risk factors / Chapter Chapter 8 --- Discussion on risk factors associated with falls --- p.131 / Chapter 8.1 --- Social demographic factors and falls / Chapter 8.2 --- Acute illnesses/chronic diseases / Chapter 8.3 --- Medical consultation and hospitalization / Chapter 8.4 --- History of falls / Chapter 8.5 --- Perceived health status and ADL / Chapter 8.6 --- Mental status / Chapter 8.7 --- Health behavior / Chapter 8.8 --- Physical measurement and neuromuscular impairment / Chapter 8.9 --- Vision / Chapter 8.10 --- Medications / Chapter 8.11 --- Fallers with occasional falls/multiple falls / Chapter 8.12 --- Additive effect of risk factors / Chapter Chapter 9 --- Conclusion and recommendations --- p.147 / Chapter 9.1 --- Summary of findings / Chapter 9.2 --- Confirmation of risk factors found in baseline cross-sectional study / Chapter 9.3 --- Limitation of the present study / Chapter 9.4 --- Strength of the present study / Chapter 9.5 --- Recommendations on areas for further research / Chapter 9.6 --- Recommendations on prevention and intervention measures / References --- p.155 / Appendix / Calculation of sample size --- p.1 / Pooled logistic regression analysis on risk factors associated with falls --- p.2 / Baseline questionnaire --- p.3 / First follow-up questionnaire --- p.4 / Fall ascertainment questionnaire --- p.5

Diss. (sammanfattning) Umeå : Univ., 2007. / Härtill 4 uppsatser.

More than 50% of people with MS fall in any six-month period. The importance of developing a suitable falls management programme has been identified by people with MS and professionals. This thesis aimed to develop a model for an MS falls intervention. The studies employed a systematic approach to evaluate the risk factors for falls and to identify the optimal programme content, format and structure. Methods The thesis comprises two sections; the first involving a systematic review and an observational study of falls risk factors (n=148). Part two included a second systematic review to inform programme content, and a nominal group study (n=36) to explore approach, format and structure from the perspective of key stakeholders. Results Part one identified the potential target group (people at key mobility transition stages and those with progressive MS), and mechanisms by which the intervention could act (the identification of specific risk factors associated with falls in MS). These include non-modifiable disease and demographic characteristics (e.g. MS classification and gender), and potentially modifiable clinical characteristics (including balance, mobility, continence issues and medication usage). Part two identified that an MS specific falls programme should address falls and participation-related outcomes, incorporating educational activities and a programme of individually tailored gait, balance and functional training. The programme should use a collaborative approach; supporting participants to achieve sufficient intensity and duration of exercise and to integrate falls prevention strategies into their daily lives. The programme should enable participants to engage flexibly according to individual needs and preferences. Conclusions This thesis has identified specific risk factors associated with accidental falls in MS. The evaluation indicates that the success and sustainability of an MS falls programme requires that it is MS specific, employs a collaborative approach and moves away from the group-based, weekly format common to many generic falls programmes.

Falling significantly affects quality of life, morbidity, and mortality among older adults. We sought to evaluate the prospective association between sedentary time, physical activity, and falling among post-menopausal women aged 50-79 years recruited to the Women's Health Initiative Observational Study between 1993 and 1998 from 40 clinical centers across the United States. Baseline (B) and change in each of the following were evaluated at year 3 (Y3) and year 6 (Y6; baseline n= 93,676; Y3 n= 76,598; Y6 n= 75,428): recreational physical activity (MET-h/wk), sitting, sleeping (min/day), and lean body mass by dual energy X-ray absorptiometry (subset N= 6475). Falls per year (0, 1, 2, >= 3) were assessed annually by self-report questionnaire and then dichotomized as = 1 and = 2 falls/year. Logistic regression models were adjusted for demographics, body mass index, fall history, tobacco and alcohol use, medical conditions, and medications. Higher baseline activity was associated with greater risk of falling at Y6 (18%; p for trend <0.0001). Increasing sedentary time minimally decreased falling (1% Y3; 2% Y6; p < 0.05). Increasing activity up to >= 9 MET-h/wk. (OR: 1.12, 95% CI: 1.03-1.22) or maintaining >= 9 MET-h/wk. (OR: 1.20, 95% CI: 1.13-1.29) increased falling at Y3 and Y6 (p for trend <0.001). Adding lean body mass to the models attenuated these relationships. Physically active lifestyles increased falling among post-menopausal women. Additional fall prevention strategies, such as balance and resistance training, should be evaluated to assist post-menopausal women in reaching or maintaining levels of aerobic activity known to prevent and manage several chronic diseases.

Aim To investigate the epidemiology of unintentional fall-related injuries at home among young and middle-aged adults (25 to 59 years) and to investigate the contribution of alcohol to these injuries. Methods Routinely collected national fall injury data were analysed to describe the incidence and characteristics of falls at home resulting in death or hospital inpatient treatment among this age group in New Zealand. A systematic review of the published literature evaluated the epidemiological evidence quantifying the risk of falls associated with acute and usual alcohol consumption in this age group. A population-based case-control study was conducted in Auckland, New Zealand over a 12-month period. Cases were 335 people aged 25 to 59 years who were admitted to hospital or died as a result of unintentional non-occupational falls at home. Controls were 352 people randomly selected from the electoral roll from the same age group as the cases. The participants or next-of-kin completed a structured interview to ascertain data on personal and lifestyle factors including alcohol consumption. Findings The review of national injury data found that almost a third of unintentional falls resulting in an in-patient admission among working-age people were recorded as occurring at home. For every death there were about 150 in-patient hospital admissions. The systematic review identified only a small number of studies but showed an increased risk of unintentional falls in this age group with increasing exposure to alcohol use. The magnitude of this risk varied considerably across studies with most estimates being relatively imprecise. There was modest evidence of a dose-response relationship with acute alcohol use. The association between usual alcohol use and fall risk was inconclusive. The case-control study revealed that after controlling for confounding, the consumption of two or more standard alcoholic drinks in the preceding six hours relative to none is associated with a significantly increased risk of fall-related injury. Approximately 21% of unintentional non-occupational falls at home in this population was attributed to this risk. No association between hazardous drinking as a usual pattern and falls was found when the analyses were adjusted for confounders. Conclusion A significant proportion of unintentional fall-related injuries among the working-aged New Zealanders occur at home. Consuming two or more drinks in the previous six hours was strongly associated with unintentional non-occupational falls at home that result in admission to hospital or death in this age group. This largely unrecognised problem should be addressed in further research and in falls prevention programmes.

Aim To investigate the epidemiology of unintentional fall-related injuries at home among young and middle-aged adults (25 to 59 years) and to investigate the contribution of alcohol to these injuries. Methods Routinely collected national fall injury data were analysed to describe the incidence and characteristics of falls at home resulting in death or hospital inpatient treatment among this age group in New Zealand. A systematic review of the published literature evaluated the epidemiological evidence quantifying the risk of falls associated with acute and usual alcohol consumption in this age group. A population-based case-control study was conducted in Auckland, New Zealand over a 12-month period. Cases were 335 people aged 25 to 59 years who were admitted to hospital or died as a result of unintentional non-occupational falls at home. Controls were 352 people randomly selected from the electoral roll from the same age group as the cases. The participants or next-of-kin completed a structured interview to ascertain data on personal and lifestyle factors including alcohol consumption. Findings The review of national injury data found that almost a third of unintentional falls resulting in an in-patient admission among working-age people were recorded as occurring at home. For every death there were about 150 in-patient hospital admissions. The systematic review identified only a small number of studies but showed an increased risk of unintentional falls in this age group with increasing exposure to alcohol use. The magnitude of this risk varied considerably across studies with most estimates being relatively imprecise. There was modest evidence of a dose-response relationship with acute alcohol use. The association between usual alcohol use and fall risk was inconclusive. The case-control study revealed that after controlling for confounding, the consumption of two or more standard alcoholic drinks in the preceding six hours relative to none is associated with a significantly increased risk of fall-related injury. Approximately 21% of unintentional non-occupational falls at home in this population was attributed to this risk. No association between hazardous drinking as a usual pattern and falls was found when the analyses were adjusted for confounders. Conclusion A significant proportion of unintentional fall-related injuries among the working-aged New Zealanders occur at home. Consuming two or more drinks in the previous six hours was strongly associated with unintentional non-occupational falls at home that result in admission to hospital or death in this age group. This largely unrecognised problem should be addressed in further research and in falls prevention programmes.

Aim To investigate the epidemiology of unintentional fall-related injuries at home among young and middle-aged adults (25 to 59 years) and to investigate the contribution of alcohol to these injuries. Methods Routinely collected national fall injury data were analysed to describe the incidence and characteristics of falls at home resulting in death or hospital inpatient treatment among this age group in New Zealand. A systematic review of the published literature evaluated the epidemiological evidence quantifying the risk of falls associated with acute and usual alcohol consumption in this age group. A population-based case-control study was conducted in Auckland, New Zealand over a 12-month period. Cases were 335 people aged 25 to 59 years who were admitted to hospital or died as a result of unintentional non-occupational falls at home. Controls were 352 people randomly selected from the electoral roll from the same age group as the cases. The participants or next-of-kin completed a structured interview to ascertain data on personal and lifestyle factors including alcohol consumption. Findings The review of national injury data found that almost a third of unintentional falls resulting in an in-patient admission among working-age people were recorded as occurring at home. For every death there were about 150 in-patient hospital admissions. The systematic review identified only a small number of studies but showed an increased risk of unintentional falls in this age group with increasing exposure to alcohol use. The magnitude of this risk varied considerably across studies with most estimates being relatively imprecise. There was modest evidence of a dose-response relationship with acute alcohol use. The association between usual alcohol use and fall risk was inconclusive. The case-control study revealed that after controlling for confounding, the consumption of two or more standard alcoholic drinks in the preceding six hours relative to none is associated with a significantly increased risk of fall-related injury. Approximately 21% of unintentional non-occupational falls at home in this population was attributed to this risk. No association between hazardous drinking as a usual pattern and falls was found when the analyses were adjusted for confounders. Conclusion A significant proportion of unintentional fall-related injuries among the working-aged New Zealanders occur at home. Consuming two or more drinks in the previous six hours was strongly associated with unintentional non-occupational falls at home that result in admission to hospital or death in this age group. This largely unrecognised problem should be addressed in further research and in falls prevention programmes.

Aim To investigate the epidemiology of unintentional fall-related injuries at home among young and middle-aged adults (25 to 59 years) and to investigate the contribution of alcohol to these injuries. Methods Routinely collected national fall injury data were analysed to describe the incidence and characteristics of falls at home resulting in death or hospital inpatient treatment among this age group in New Zealand. A systematic review of the published literature evaluated the epidemiological evidence quantifying the risk of falls associated with acute and usual alcohol consumption in this age group. A population-based case-control study was conducted in Auckland, New Zealand over a 12-month period. Cases were 335 people aged 25 to 59 years who were admitted to hospital or died as a result of unintentional non-occupational falls at home. Controls were 352 people randomly selected from the electoral roll from the same age group as the cases. The participants or next-of-kin completed a structured interview to ascertain data on personal and lifestyle factors including alcohol consumption. Findings The review of national injury data found that almost a third of unintentional falls resulting in an in-patient admission among working-age people were recorded as occurring at home. For every death there were about 150 in-patient hospital admissions. The systematic review identified only a small number of studies but showed an increased risk of unintentional falls in this age group with increasing exposure to alcohol use. The magnitude of this risk varied considerably across studies with most estimates being relatively imprecise. There was modest evidence of a dose-response relationship with acute alcohol use. The association between usual alcohol use and fall risk was inconclusive. The case-control study revealed that after controlling for confounding, the consumption of two or more standard alcoholic drinks in the preceding six hours relative to none is associated with a significantly increased risk of fall-related injury. Approximately 21% of unintentional non-occupational falls at home in this population was attributed to this risk. No association between hazardous drinking as a usual pattern and falls was found when the analyses were adjusted for confounders. Conclusion A significant proportion of unintentional fall-related injuries among the working-aged New Zealanders occur at home. Consuming two or more drinks in the previous six hours was strongly associated with unintentional non-occupational falls at home that result in admission to hospital or death in this age group. This largely unrecognised problem should be addressed in further research and in falls prevention programmes.

Falls are a relatively frequent occurrence amongst older people. Rates of falls amongst patients in subacute care are substantially higher than amongst people living in the community. Falls have been reported to cause physical and psychological injury, increase the likelihood of being discharged to nursing home, and are associated with longer lengths of stay in hospital. Thus, minimisation of falls in the subacute hospital setting is of high public health importance. (For complete abstract open document)

Diss. (sammanfattning) Umeå : Univ., 2006. / Härtill 4 uppsatser.