Thesis (M.S.)--University of Michigan, 1996. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1996. / Includes bibliographical references.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A ocorrÃncia de quedas constitui sÃrio problema de saÃde em idade mais avanÃada. Dessa forma, os fatores envolvidos devem ser continuamente avaliados com vistas à melhoria da qualidade de vida do idoso. Teve-se como objetivo investigar as circunstÃncias de ocorrÃncia das quedas nos Ãltimos seis meses em idosos com e sem AVE, assim como os fatores intrÃnsecos e extrÃnsecos a eles relacionados. Estudo do tipo caso-controle, realizado em trÃs AssociaÃÃes Beneficentes Cearenses de ReabilitaÃÃo e um Centro de ReferÃncia da AssistÃncia Social na cidade de Fortaleza no perÃodo de janeiro a abril de 2010. Estabeleceram-se um grupo caso e trÃs grupos controles, cada um com quinze idosos, pareados por idade e sexo, com base na ocorrÃncia ou nÃo de quedas nos Ãltimos seis meses e de acidente vascular encefÃlico. Utilizou-se um formulÃrio organizado em quatro partes para a caracterizaÃÃo do paciente, condiÃÃes intrÃnsecas e extrÃnsecas atuais, ocorrÃncia de quedas e fatores ambientais envolvidos. Com a aprovaÃÃo por Comità de Ãtica em Pesquisa, a coleta de dados ocorreu no dia em que o idoso se encontrava na unidade, apÃs esclarecimento dos objetivos e assinatura do Termo de Consentimento Livre e Esclarecido. Os dados obtidos foram analisados pelo Predictive Analysis Software 18.0. Em sua maioria, os grupos foram formados por mulheres, aposentados, com companheiro, baixa renda per capita e escolaridade. Os idosos tiveram uma mÃdia de 1,4 AVE, em um tempo mÃdio de 5,6 anos e hemiparesia como principal sequela. Quanto Ãs variÃveis com associaÃÃo estatÃstica, destacaram-se: Uso de anti-hipertensivos entre os grupos que sofreram quedas independente de ocorrÃncia de AVE; Uso de inibidores da ECA no caso de idosos com AVE com ou sem quedas; AlteraÃÃes nos pÃs entre o grupo caso e indivÃduos sem queda e sem AVE. Com relaÃÃo Ãs variÃveis ForÃa diminuÃda em membros inferiores, Excesso de mÃveis em casa, Dificuldade na marcha e Mobilidade fÃsica prejudicada, encontrou-se associaÃÃo em todos os casos entre o grupo de indivÃduos com AVE e quedas e aqueles sem AVE e sem quedas. Dificuldade na marcha e Mobilidade fÃsica prejudicada tambÃm estiveram estatisticamente associadas entre o grupo caso e indivÃduos sem AVE e com relato de quedas. As variÃveis Ãndice de Barthel, Atividades Instrumentais de Vida DiÃria, Escala GeriÃtrica e de Tinetti, alÃm de ForÃa de preensÃo palmar direita tambÃm apresentaram associaÃÃo estatÃstica entre o grupo caso de indivÃduos com AVE e quedas e aqueles sem AVE, com ou sem quedas. As quedas aconteceram predominantemente no perÃodo da manhÃ, em ambiente iluminado, sem corrimÃo ou objetos, com piso Ãspero e seco, uso de chinelo com solado de borracha. NÃo se constatou ser o AVE um evento associado Ãs quedas, fortalecendo a relaÃÃo causal multifatorial. As variÃveis envolvidas com o evento queda estiveram fortemente relacionadas aos fatores intrÃnsecos envolvidos com o equilÃbrio. Os fatores extrÃnsecos, contudo, podem ser os mais facilmente modificÃveis. Nesse Ãmbito, os profissionais de saÃde devem avaliar rotineiramente todas as variÃveis envolvidas com o evento queda, no intuito de melhorar a qualidade de vida desses indivÃduos. / The falls occurrence represents a serious health problem for aged. Therefore the factors involved must be continuous assess in order to improve the aged life quality. The aim was to investigate the falls occurrence in the last six months at elderly with and without stroke and to identify the intrinsic and extrinsic factors involved. A case-control study carried at three Beneficent Associations of Rehabilitation from Cearà and a Reference Center of Social Worker in Fortaleza city from January to April 2010. A case group and three control groups were established with 15 elderly paired off by sex, age, falls occurrence in the last six months and stroke occurrence. It was used a form organized in four parts with the objective to characterize the patient, actual intrinsic and extrinsic conditions, falls occurrence and environment factors involved. The data were gathered with the Research Ethical Committee approval and when the elderly were enlightened at the collected data unit about the aim of the research, and the patient signing of authorization term. The data obtained was analyzed by Predictive Analysis Software 18.0. The groups were mainly composed by women, retired people, persons with partners, low school grade and low financial income. The elderly with stroke presented an average of 1,4 occurrence in an average period of 5,6 years and the main consequence was hemiparesis. As far as statistical associated variables concern, the followings were here highlighted: Use of antihypertensive among the groups with falls despite the occurrence of a stroke; Use of ACE inhibitor at aged with stroke whom were fallers or not; Foot alterations between the case group and people without falls neither stroke. Besides the variables Decreased strength at lower members, excess of home furniture, Gait difficulty and Impaired physical mobility was found in all association among the fallers participants with stroke and those without stroke neither falls. Gait difficulty and Impaired physical mobility were statistically associated between the case group and people without stroke and fall occurrence. The Barthel index, daily instrumental life activities, Geriatric scale and Tinetti scale, besides right hand grip strength, also found statistical association between the case group and aged without stroke fallers or not. The falls occurred mostly in the morning, in bright environment without handrail or objects, in rough and dry floor, use of rubber slippers. It was not verified to be the stroke an event associated to falls, a fact that strengthens the multifarious cause relation. The variables involved with fall event were strongly related to intrinsic factors involved with the balance issue. The extrinsic factors, however, could be easily modified. Therefore health professionals should routinely assess all fall variables involved in order to improve the life quality of elderly people.

Class of 2012 Abstract / Specific Aims: The purpose of this study was to test an interactive educational program for older adults on preventing accidental falls. Methods: This was a prospective, descriptive study evaluating the helpfulness of an interactive educational program. English speaking residents were recruited from five independent senior living communities in Arizona. The intervention consisted of a 30-minute interactive PowerPoint presentation followed by a 10-minute question and answer session. Information provided during the presentation focused on information from the CDC and the Fall Prevention Center of Excellence. Participants completed an anonymous questionnaire to rate the helpfulness of the program. The primary dependent variable was overall helpfulness of the educational session. Other variables included: intention of changing future behavior related to preventing falls, whether participants would recommend the program to others, participant perception of gained knowledge, change in fear of falling, and interest in meeting with pharmacist to discuss medications. Categorical data was analyzed by calculating frequencies and percentages and continuous data by calculating means and SDs. A t-test for independent groups was used to compare men and women. Main Results: A total of 93 individuals attended the presentations. Out of 81 completed surveys, 5 did not indicate gender, 7 additional did not indicate age, and 6 were over 89 years of age. Demographic data for the men and women was similar. 90% of participants indicated that the program was either "very helpful" or "moderately helpful". 92% of participants responded “absolutely yes” or “likely” that they would recommend the program. No participants strongly disagreed that they had a better understanding of fall risks or medications that increase fall risk. 87% of participants responded “absolutely yes” or “likely” that they plan to increase daily exercise . 42% of participants said it was “not likely” that they plan to make changes in their living environment. Conclusions: An interactive educational program on fall safety and prevention is helpful for older adults. As one of the most widely accessible health care providers, pharmacists and pharmacy students are well suited to provide patient education and improve outcomes. The results of this study provide preliminary data supporting the usefulness of a patient education program on fall safety prevention administered by pharmacy students.

INTRODUÇÃO: Frente ao aumento gradativo de quedas da própria altura com o avançar da idade, torna-se imprescindível conhecer os fatores de risco implicados na sua ocorrência em mulheres na transição e após menopausa, com o intuito de contribuir com estratégias de prevenção e promoção da saúde no cotidiano. OBJETIVO: Estimar a prevalência de quedas referidas e caracterizar a associação entre as quedas com variáveis clínicas e epidemiológicas das mulheres da Estratégia de Saúde da Família do Município de Pindamonhangaba, SP. MÉTODOS: Em estudo com delineamento observacional do tipo transversal vinculado ao Projeto de Saúde de Pindamonhangaba (PROSAPIN), foram utilizados dados secundários randomizados de 875 mulheres com idade entre 35 a 65 anos e investigadas por meio de um inquérito domiciliar e medidas antropométricas. A variável queda foi incluída como dependente, enquanto que as independentes foram representadas pela idade, estado civil, renda, escolaridade, raça, ocupação, histórico ginecológico, doenças crônicas referidas e mensuradas, medicamentos, obesidade (índice de massa corpórea), hábito alimentar, consumo de bebidas alcoólicas, tabagismo, sono, depressão e atividade física habitual. RESULTADOS: Participaram do estudo 749 mulheres com média de 47,7 anos (com desvio padrão de 8,1); a prevalência de quedas da própria altura foi de 17,6 por cento (IC de 14,9 - 20,5), sendo a maioria (54,6 por cento) na pós menopausa. Das mulheres que caíram, a prevalência de recorrência foi de 45,2 por cento. As principais causas foram escorregões (29,4 por cento) e tropeços (19,8 por cento). Após análise multivariada constatou-se associação das quedas com a idade (p=0,018), qualidade do sono ruim (0,007) e comorbidades como a hipertensão arterial (p=0,032) e depressão (p=0,003). As comorbidades hipertensão arterial (p=0,055) e depressão (p=0,001) associaram-se também as quedas recorrentes, bem como restrições às atividades de vida diária (p=0,000). CONCLUSÃO: A maior prevalência de quedas ocorreu após a menopausa e entre os principais fatores associados à sua gênese emergiram a idade, hipertensão arterial, depressão e sono ruim / INTRODUCTION: Faced the gradual increase of falls from height with advancing age, it becomes essential to know the risk factors of the falls on women in transition and after menopause, in order to contribute with strategies for prevention and health promotion in their daily routine. OBJECTIVE: To estimate the prevalence of referred falls and characterize the association between falls and clinical and epidemiological variables of women of the Family Health Strategy of Pindamonhangaba City, SP. METHODS: In a study with observational design of the type cross-sectional linked to Health Project of Pindamonhangaba (PROSAPIN), it was used secondary randomized data from 875 women from 35 to 65 years old and they were investigated through a household survey and anthropometric measurements. The falls were included as a dependent variable and age, marital status, income, education, race, occupation, gynecologic history, chronic disease and those measured, medicines, obesity (body mass index), dietary habits, alcohol consumption, smoking, sleep, depression and physical activity. RESULTS: There were 749 women investigated with average age of 47.7 years (standard deviation 8.1); the prevalence of falls from height was 17.6 percent (95 percentCI: 14.9 - 20.5), the majority (54.2 percent) of the fallers were in the post menopausal. Of the women who fell, the prevalence of recurrence was 45.2 percent. The main causes were slipping (29.4 percent) and setbacks (19.8 percent). After multivariate analysis, it was found an association of falls with age (p=0.018), poor sleep quality (p=0.007) and comorbidities as hypertension (p=0.032) and depression (p=0.003). The comorbidities hypertension (p=0.055) and depression (p=0,001) associated too with recurrent falls, as well restricted the activities of daily living (p=0.000). CONCLUSION: The highest prevalence of falls occurred after the menopause and among the main factors associated its genesis emerged the age, hypertension, depression and bad sleep

Background: Fear of falling is now recognized as an independent fall risk factor due to its prevalence in older adults. Objectives: The purpose of this study was to gain a better understanding of fear of falling levels in community-dwelling older adults before and after attending a fall prevention clinic. Methods: An explanatory sequential mixed methods design was used. The Falls Efficacy Scale-International (FES-I) tool assessed fear of falling levels before and after attending a fall prevention clinic (n=32). Semi-structured interviews were then conducted in a sample of these participants (n=12). Results: There was no statistically significant difference in the before (M=30.44, SD=9.8) and after (M=31.72, SD=8.3) FES-I scores. Three themes emerged from the qualitative analysis: 1. Concerns about falling, 2. Decreased concerns about falling and 3. An increased self-awareness of fall risks. Conclusion: Further use of cognitive-behavioural therapy should be considered in falls risk reduction interventions for community-dwelling older adults with fear of falling.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Este estudo teve como objetivo validar o resultado de enfermagem Comportamento de prevenÃÃo de queda, apresentado pela Nursing Outcomes Classification (NOC). O processo de validaÃÃo focalizou pessoas acometidas por acidente vascular cerebral (AVC) e seus cuidadores, com foco no contexto domiciliar. Estudo do tipo metodolÃgico, realizado em duas etapas (validaÃÃo de conteÃdo e clÃnica) a partir de um instrumento proposto por Vitor (2010), o qual apresentou para o resultado 28 indicadores e definiÃÃes operacionais direcionadas inicialmente à populaÃÃo em geral. Estes foram revistos e organizados em 22 indicadores voltados ao ambiente domiciliar, local onde acontece o tipo mais comum de queda, a da prÃpria altura. A etapa de validaÃÃo de conteÃdo foi iniciada com avaliaÃÃo do instrumento por juÃzes quanto à aparÃncia. Em seguida, 22 especialistas avaliaram os tÃtulos e definiÃÃes de cada indicador, segundo os critÃrios psicomÃtricos de simplicidade, clareza, precisÃo e adequaÃÃo. ApÃs atendimento Ãs sugestÃes dos especialistas, procedeu-se à validaÃÃo clÃnica, precedida por um teste piloto para ajustes à populaÃÃo. Etapa realizada por duas duplas de profissionais treinados, no ambulatÃrio de dois hospitais de referÃncia ao atendimento a pacientes com AVC, com participaÃÃo de 106 pacientes e/ou cuidadores. Uma dupla aplicou o instrumento com as definiÃÃes operacionais e outra aplicou o instrumento contento apenas tÃtulos e escala da NOC. Os dados foram organizados em planilhas e analisados com o software SPSS 22. Para a etapa de validaÃÃo de conteÃdo foi calculado teste binomial, enquanto que, para a etapa clÃnica, utilizaram-se os testes de Friedman para verificar diferenÃa entre avaliadores, anÃlise da diferenÃa mÃnima significante (DMS), Alfa de Cronbach e Coeficiente de CorrelaÃÃo Intraclasse (CCI) para comparaÃÃo das avaliaÃÃes. O projeto foi apreciado por Comità de Ãtica em Pesquisa, aprovado sob os Pareceres n 49.912 e n 392.531; todos os participantes foram orientados quanto aos objetivos e assinatura do Termo de Consentimento. Na validaÃÃo de conteÃdo, a maioria dos especialistas foi de mulheres, mÃdia de 33,1 anos, 9,5 anos de formaÃÃo, doutores, profissionais de InstituiÃÃes de Ensino Superior. Os indicadores que se apresentaram estatisticamente significantes, pelo teste binomial, foram: Prende pequenos tapetes e Controla a inquietaÃÃo, e todos apresentaram-se apropriados ao paciente com AVC (100% e p=1,000). Na etapa clÃnica, houve discreta predominÃncia de homens participantes (51,9%), na maioria idosos, casados, aposentados, com baixa escolaridade e renda, residindo com a famÃlia e com sequelas fÃsicas do AVC, implicando a necessidade de um cuidador. O teste de Friedman indicou diferenÃas entre avaliaÃÃo das duplas em doze indicadores (p <0,05), destes, cinco demonstraram diferenÃas nas mÃdias de postos maiores que a DMS. Todos os indicadores apresentaram-se estatisticamente significantes (p<0,001) e satisfatÃrios segundo o (CCI). Esta etapa foi importante para constataÃÃo da manutenÃÃo ou nÃo de indicadores, que totalizaram 18 ao final. Assim, de forma geral, observou-se que houve maior concordÃncia entre a dupla que utilizou o instrumento com as definiÃÃes de cada indicador. Destaca-se a eficÃcia do processo de construÃÃo de referentes empÃricos e adequaÃÃo a populaÃÃes especÃficas, bem como a necessidade contÃnua de estudos nesta linha de conhecimentos. / This study aimed to validate the nursing outcome Fall prevention behavior from the Nursing Outcomes Classification (NOC). The validation process focused on people with stroke and their caregivers in the home context. This is a methodological study performed in two stages (content and clinical validation) by a tool proposed by Vitor (2010) who presented 28 indicators and operational definitions related to the general population. The tool was revised and organized in 22 indicators towards to the home environment which is the most common place where falls from height happen. The content validity stage was started with assessment by judges about the appearance. Then, 22 specialists evaluated the titles and definitions of each indicator according to psychometric criteria of simplicity, clearness, precision and suitability. After perform the changes suggested by the specialists, the clinical validation was performed at first by a pilot test in order to adjust the tool to the population. This stage was developed with 106 patients and/or caregivers interviewed by two pairs of trained professionals in the ambulatory service of two hospitals that are reference in the care of people with stroke. One pair of evaluators applied the form with the operational definitions while the other pair applied the form with only the titles and NOC scale. The data were organized in sheets and analyzed by the SPSS 22 program through the calculation of the binomial test. The clinical validation stage applied the Friedman test to verify differences among the evaluators, the calculation of the minimum significant difference (MSD), Cronbach alpha and intraclass correlation coefficient (ICC) to compare the evaluatorsâ assessment. The study was approved by an Ethical Committee by the nÂ49.912 and nÂ392.531; all the participants (specialists, patients and caregivers) were oriented about the goals and the Consent Term. At the content stage, the specialists were most female, with age average of 33.1 years old, 9.5 years of graduation, PhD, working in Post-secondary Institutions. The indicators statistically significant by the Binomial test were: Attaches small rugs and Controls restlessness and all of them were appropriated to the patient with stroke (100% and p=1.000). Most participants were male (51.9%), elderly people, married, retired, with low school grade and low income, living with family and with physical sequelae from the stroke, which requires the need of a caregiver. The Friedman test showed differences in the evaluations of the pairs of professionals for twelve indicators (p<0.05), five of them showed difference in the mean rank higher than the MSD. All the indicators showed statistical significance (p<0.001) and the ICC. This stage was important to realize the need of keeping or not the indicators, which were 18 at the end. Thus, it is noted that the tests showed more agreement between de pair that used the tool with the indicators for each definition. It is possible to highlight the efficiency of empirical references construction and its suitability to specific populations, besides the need of continuous researches in this field of study.

This thesis investigates walking patterns in healthy young people and in people with an increased risk of falling, and determines the physiological contributions to walking stability. First, a review of the relevant literature on techniques for assessing walking stability, age-related changes in balance and gait, and the contributions of vision, vestibular function, peripheral sensation and strength was undertaken. In response to a critical analysis of these findings, a new technique and protocol for the assessment of walking stability was developed. This involved measuring and analysing head and pelvis accelerations while subjects walked on a level surface and an irregular surface. Gait patterns were studied in 30 young healthy subjects and two groups known to be at increased risk of falling - 100 subjects over the age of 75, and 30 subjects with diabetic peripheral neuropathy. A series of vision, sensation, strength, reaction time and balance tests were also undertaken to identify subjects??? physiological abilities and risk of falls. Acceleration patterns of the head and pelvis differed according to physiological risk of falling, particularly when walking on the irregular surface. Those with a high risk of falling walked with a reduced velocity, cadence and step length, and exhibited less rhythmic acceleration patterns at the head and pelvis. Gait patterns were significantly associated with leg strength, peripheral sensation and reaction time. It is concluded that subjects with a high physiological risk of falling exhibit characteristic patterns of walking that indicate an impaired ability to control the movement of the pelvis and head, which may predispose to loss of balance.

Purpose: The primary purpose of this project was to determine the effect of aquatic exercise and aquatic exercise combined with an education group program on decreasing both psychosocial and physical fall risk factors in community-dwelling older adults with hip osteoarthritis (OA). Secondary purposes were to 1) describe fall risk, history and nature of falls and near-falls in older adults with hip OA, 2) determine the association of the timed up and go test (TUG) to history of falls and near-falls, 4) explore the relationship of both psychosocial and physical factors to history of falls and near-falls, and 5) evaluate the role of falls-efficacy in predicting balance performance. Methods: Participants were recruited from the community and screened for presence of hip osteoarthritis and fall risk. Baseline fall history and a battery of measures for balance, muscle strength, functional ability and falls-efficacy were administered. Participants were then randomly assigned to one of three groups: Aquatic Exercise, Aquatic Exercise and Education or a Control Group. The interventions were twice per week for 11 weeks. Fall risk factors were measured after 11 weeks. Study 1 described history of falls and near-falls and evaluated the association of the TUG screening test with fall and near-fall history. Study 2 summarized the relationships of physical and psychosocial fall risk factors and identified the primary predictors of fall risk, based on associations with fall history. Study 3 evaluated the randomized controlled clinical trial comparing the impact of the interventions (aquatic exercise and education) on fall risk outcomes. Results: Older adults with hip OA reported a high frequency of falls and near-falls. The TUG, using a cut-off score of 10 sec., was associated with frequent near-fall history. There was a strong association of frequent near-falls to history of actual falls, with the association increasing 7-fold if lower falls-efficacy was present. Falls-efficacy was also an independent predictor of balance impairment. Screening for history of near-falls and falls-efficacy may be important in predicting risk of future falls. The combination of Aquatic Exercise and Education improved falls-efficacy and functional mobility compared to Aquatic Exercise only or no intervention. Aquatic Exercise on its own was not effective in decreasing fall risk factors or improving falls-efficacy. Significance of Findings: The accumulation of both physical and psychosocial risk factors in older adults with hip OA increases their vulnerability to falls and injury. Fall prevention programs for this population should be designed to include both exercise and education to address falls-efficacy and physical fall risk factors.

Purpose: The primary purpose of this project was to determine the effect of aquatic exercise and aquatic exercise combined with an education group program on decreasing both psychosocial and physical fall risk factors in community-dwelling older adults with hip osteoarthritis (OA). Secondary purposes were to 1) describe fall risk, history and nature of falls and near-falls in older adults with hip OA, 2) determine the association of the timed up and go test (TUG) to history of falls and near-falls, 4) explore the relationship of both psychosocial and physical factors to history of falls and near-falls, and 5) evaluate the role of falls-efficacy in predicting balance performance. Methods: Participants were recruited from the community and screened for presence of hip osteoarthritis and fall risk. Baseline fall history and a battery of measures for balance, muscle strength, functional ability and falls-efficacy were administered. Participants were then randomly assigned to one of three groups: Aquatic Exercise, Aquatic Exercise and Education or a Control Group. The interventions were twice per week for 11 weeks. Fall risk factors were measured after 11 weeks. Study 1 described history of falls and near-falls and evaluated the association of the TUG screening test with fall and near-fall history. Study 2 summarized the relationships of physical and psychosocial fall risk factors and identified the primary predictors of fall risk, based on associations with fall history. Study 3 evaluated the randomized controlled clinical trial comparing the impact of the interventions (aquatic exercise and education) on fall risk outcomes. Results: Older adults with hip OA reported a high frequency of falls and near-falls. The TUG, using a cut-off score of 10 sec., was associated with frequent near-fall history. There was a strong association of frequent near-falls to history of actual falls, with the association increasing 7-fold if lower falls-efficacy was present. Falls-efficacy was also an independent predictor of balance impairment. Screening for history of near-falls and falls-efficacy may be important in predicting risk of future falls. The combination of Aquatic Exercise and Education improved falls-efficacy and functional mobility compared to Aquatic Exercise only or no intervention. Aquatic Exercise on its own was not effective in decreasing fall risk factors or improving falls-efficacy. Significance of Findings: The accumulation of both physical and psychosocial risk factors in older adults with hip OA increases their vulnerability to falls and injury. Fall prevention programs for this population should be designed to include both exercise and education to address falls-efficacy and physical fall risk factors.