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Bakgrund: Ett fungerande fallpreventivt arbete är av stor vikt både ur ett individ- och samhällsperspektiv och de mest effektiva fallförebyggande åtgärderna består av träning. Med ett mer digitaliserat samhälle har möjligheten att utöva träning med stöd av digital teknik utvecklats. Vidare forskning behövs för att undersöka hur äldre personer upplever träning med hjälp av digitala medel. Syftet med denna studie är att belysa äldre personers upplevelser och erfarenheter av en intervention där de under ett år erbjudits fallpreventiv träning med hjälp av ett digitalt program kompletterat med stödjande strategier.Metod: Denna kvalitativa studie baseras på en pragmatisk studie som innefattade intervjuer med äldre personer som erbjudits fallpreventiv träning med en applikation (Säkra steg) under ett år. Semistrukturerade telefonintervjuer gjordes med nio personer över 70 år, varav åtta kvinnor och en man. Materialet analyserades utifrån kvalitativ innehållsanalys.Resultat: De äldre personernas upplevelser och erfarenheter skildras i temat “Individuella komponenter ger insikt och stöd för eget ansvar” som sammanfattar de sex kategorier som analysen resulterade i. Det fanns en medvetenhet kring behovet av “att skapa bästa förutsättningar för ett hållbart åldrande” och för att möjliggöra det krävdes en “innehållsrik och värdefull träning”. Deltagarna utvecklade förmågor för “att finna egna strategier för upprätthållande” och “de stödjande strategiernas roll” hade liten inverkan. Deltagarna upplevde att “styrka i kropp och själ skapar en trygg tillvaro”. Det framkom även “luckor att fylla för en bättre upplevelse” vilka kan användas till utveckling av liknande interventioner.Slutsats: Studien har bidragit till ökad förståelse för äldre personers erfarenheter kring kombinationen träning och digitala medel, den stärker även insikten om att äldre är en heterogen grupp där träningen behöver anpassas utifrån varje enskild individ.

Problem: The Centers for Disease Control and Prevention indicates that falls are the “leading cause of injury death and the most common cause of nonfatal injuries and hospital admission for trauma among people ages 65 and older.”1 Falls can have significant economic consequences to the individual and payer sources. To address these consequences, telerehabilitation was hypothesized to be a suitable supplement for fall screening efforts. Several sources concluded that support for synchronous telerehab was underdeveloped in the literature. Purpose: The purpose of this study was to explore the acceptability, feasibility, reliability, and validity of telehealth-delivered fall screening among community-dwelling older adults. Procedures: This investigation implemented an experimental, quantitative, cross-sectional design employing both pretest-posttest control group and quasi-experimental static group comparisons using non-probability sampling. This study assembled a panel of experts to provide content validation for a survey tool developed to quantify an older adult’s behavioral intension to use and attitudes towards a telerehabilitation delivery system. Seven fall screening tools were investigated for agreement among remote and face-to-face raters, and for comparison with the face-to-face reference standard (Mini-BEST). Results: All three null hypotheses were rejected. Results indicate that a telerehabilitation delivery system is a reliable and valid method of screening and determining fall risk in community-dwelling older adults. This study produced a content validated, internally consistent survey instrument designed to determine attitudes and beliefs about telerehabilitation. An experimental design was able to demonstrate a positive significant change in 4 of 7 survey constructs among the intervention group after exposure to telerehabilitation as compared to post-test controls. Overall, no significant difference was calculated between face-to-face or telerehab raters, and both environments produced equivalency with scoring, fall risk classification, and ability to discern fallers from non-fallers. Results from the telerehab STEADI fall risk conclusions were calculated to be concurrently valid with the face-to-face reference standard screening tool, the Mini-BEST. Conclusions: This investigation expanded the array of remote healthcare delivery options for clinicians and clients. Further investigation in residential and community settings are recommended.

Fall injuries are affecting many individuals' physical and psychological well-being, especially among older adults. Moreover, fall accidents are found to be the most common type of work-related accident in various industries. Thus, there is a need for fall prevention exercises supported by a gamified system to ensure user engagement and motivation. The system's usability is also highly relevant to guarantee the acceptance and satisfaction of the users. This study examined the characteristics regarding usability required within such a system with the goal of preventing falls among adults between 45 to 69 years old. The intention was to implement and design a web-based system that incorporates usability and gamification features. The system was developed through an iterative user-centered design approach utilizing user tests in each iteration and conducted in collaboration with Atea and a research team at Mälardalens University. The study revealed that among the user group, simplicity, consistency, and motivation through gamification were all key characteristics of the system. Furthermore, personalization was found to be an important characteristic to ensure a satisfactory user experience. Overall, the thesis contributed to the development of a gamified web-based system for fall injury prevention, focusing on usability.

Introduktion: Fallolyckor är globalt den näst största orsaken till dödsfall på grund av skada. Förutom mänskligt lidande är det även ett mycket dyrt folkhälsoproblem vars prevalens dessutom ökar i många länder på grund av den stigande medellivslängden. Syfte: Syftet var att beskriva hur fysisk aktivitet kan förebygga fallolyckor hos äldre. Frågeställningen ville undersöka vilka former av fysisk aktivitet som gav goda resultat för fallprevention. Metod: Litteraturöversikt valdes som studiedesign. Tio artiklar söktes fram och analyserades med hjälp av checklistorna strobe och consort för att sedan ingå i en tematisk analys. Resultat: Resultatet presenterades enligt fyra teman där studier som visade goda resultat för fallprevention samt studier med mindre tydliga resultat presenterades. Därefter följde relevanta fynd gällande fysiologiska, fysiska, psykologiska och sociala faktorer. Exempel på faktorer som gav goda resultat var stark handgreppstyrka, långsiktig fysisk aktivitet, balanskrävande träning, gruppträning med ledare, socialt stöd, motiverande information samt en trygg miljö. Exempel på faktorer som verkade ge sämre resultat var svag handgreppstyrka, kortsiktig fysisk aktivitet, självständig träning med video, att bo på äldreboende, brist på socialt stöd, transportsvårigheter samt en otrygg miljö. Rädsla för fall var vanligt förekommande, men kunde i flera fall motverkas med hjälp av fysisk aktivitet. Slutsats: Litteraturöversikten visar att utförande av regelbunden fysisk aktivitet inte endast är fallförebyggande utan även förbättrar den fysiska funktionen samt främjar den psykosociala hälsan. För att lyckas med implementeringen bör fysiologiska, fysiska, psykologiska och sociala faktorer tas med i planeringen. / Introduction: Fall accidents are globally the second largest cause of death due to injury. In addition to human suffering, it is an expensive public health problem, which is also increasing in many countries due to the rising life expectancy. Aim: The purpose was to describe how physical activity can prevent fall accidents in the elderly. The question aimed to investigate which exercise that gave good results for fall prevention. Methods: Literature review was chosen as study design. Ten articles were found and analyzed using the checklists strobe and consort to be included in a thematic analysis. Results: The results were presented according to four themes where studies that showed good results for fall prevention and studies with less clear results were presented. Thereafter, relevant findings related to physical and psychological factors followed. Factors that gave good results were strong hand grip strength, long-term physical activity, balance-demanding training, training with leaders, social support, motivational information and a safe environment. Factors that seemed to result in poorer results were weak hand grip strength, short-term physical activity, independent training at home with video instructions, living in retirement homes, lack of social support, transport difficulties and an insecure environment. Fear of falling was common, but in several cases it could be counteracted with physical activity. Conclusion: The review shows that physical activity is not only fall preventive but also improves the physical function and promotes psychosocial health. In order to succeed with the implementation, physical and psychological factors should be included in the planning.

L’ensemble de ce travail doctoral avait pour objectif d’optimiser les effets des programmes d’activités physiques pour prévenir les chutes chez les personnes âgées institutionnalisées. Le contrôle postural et la locomotion étant fondamentaux dans la prévention des chutes, il convient de les stimuler régulièrement par une pratique physique adaptée. Par ailleurs, l’amélioration de la sensibilité cutanée plantaire peut permettre d’améliorer le contrôle postural et la locomotion. Même si les bénéfices potentiels d'une stimulation des afférences cutanées plantaires par la pratique d’exercices pieds nus sont multiples, l’intérêt de cette modalité de pratique des activités physiques à destination des personnes âgées reste à démontrer. Deux groupes de personnes âgées ont ainsi dû suivre le même programme d’activités physiques, pieds-nus pour un groupe et en portant des chaussures pour l’autre groupe. Les principaux résultats ont révélé qu’un programme d’activités physiques pratiqué pieds nus améliorait davantage la sensibilité cutanée plantaire et le contrôle postural qu’un programme pratiqué avec des chaussures. Malgré l’avancée en âge, le système sensori-moteur semble toujours bénéficier d’une certaine plasticité. Ce système sensori-moteur peut être stimulé en sollicitant notamment les mécanorécepteurs cutanés plantaires. Les effets d’un programme d’activités physiques peuvent également être optimisés en plaçant les séances au moment de la journée le plus approprié. En évaluant l’influence du moment de pratique au cours de la journée, nous avons pu montrer qu’un programme d’activités physiques réalisé l’après-midi provoquait des effets positifs plus marqués qu’un programme réalisé le matin. De manière surprenante, le contrôle postural des sujets qui s’entraînaient l’après-midi s’améliorait principalement le matin, au moment de la journée où il est le plus efficace chez les personnes âgées. Ces adaptations seraient en phase avec le moment de la journée où les fonctions cognitives sont également optimales, c’est-à-dire le matin. / The main purpose of these researches was to optimize the effects of physical activity programs to prevent falls among institutionalized older adults. Postural control and gait are essential in preventing falls and should be regularly promoted by an appropriate physical practice. In addition, improving plantar cutaneous sensitivity can improve postural control and gait. Even though there are further potential benefits of stimulating plantar afferences by performing barefoot exercises, the effects of this modality of physical activity for the elderly remains unclear. Two groups of older adults were involved in the same physical activity program, barefoot for one group and while wearing shoes for the other. The main results revealed that a program of physical activity with barefoot exercises improved plantar cutaneous sensitivity and postural control to a greater extent than while wearing shoes. Despite advancement of aging, the sensorimotor system still seems to benefit from plasticity which can be stimulated by exercising barefoot and increasing somatosensory information from the foot. The time of day when people exercise can also influence the optimization of physical performance and enhance the effectiveness of a physical activity program. By assessing the influence of exercising at different times of day, we showed that training in the afternoon provided greater benefits on postural control than morning training. Surprisingly, postural control was mainly improved in the morning and did not improve when participants exercised in the morning. The postural control system would have benefited from an enhanced motor potential (acquired through afternoon training which optimized the musculoskeletal adaptations) only at the time of day when cognitive functions are optimal, i.e., in the morning.

Background: The development of an objective and comprehensive drug-based index of physical function for older adults has the potential to more accurately predict fall risk. Design: the index was developed using 862 adults (ages 57–85) from the National Social Life, Health, and Aging Project (NSHAP) Wave 1 study. The index was evaluated in 70 adults (ages 51–88) from a rehabilitation study of dizziness and balance. Methods: The prevalence among 601 drugs for 1,694 side effects was used with fall history to determine the magnitude of each side effect's contribution towards physical function. This information was used to calculate a Medication-based Index of Physical function (MedIP) score for each individual based on his or her medication profile. The MedIP was compared to the timed up and go (TUG) test as well as drug counts using receiver operating characteristic (ROC) analysis. The associations between various indices of physical function and MedIP were calculated. Results: Within the NSHAP data set, the MedIP was better than drug counts or TUG at predicting falls based on ROC analysis. Using scores above and below the cutpoint, the MedIP was a significant predictor of falls (OR = 2.61 [95% CI 1.83, 3.64]; P < 0.001). Using an external data set, it was shown that the MedIP was significantly correlated with fall number (P = 0.044), composite physical function (P = 0.026) and preferred gait speed (P = 0.043).

A Magnet-recognized academic hospital system experienced an increase in patient falls and patient falls with injury after transitioning to a new electronic health record. The purpose of the project was to evaluate the effectiveness of a system-wide quality improvement practice change. The practice-focused question addressed a Magnet model implementation of a standardized, system-wide, evidence-based Hester Davis Scale (HDS) fall risk assessment and intervention tool and the impact on the nursing-sensitive indicators of patient fall rates and fall rates with injury. Successful implementation and sustained, correct use of the HDS fall risk assessment and targeted fall-prevention-intervention tools added to the evidence of multifactorial fall-intervention-prevention strategies designed to reduce patient falls and patient injury associated with falls. Two models were used to inform the project: the American Nurses Credentialing Center next-generation Magnet model and the Institute for Healthcare Improvement framework for spread. The primary source of evidence was the National Database of Nursing Quality Indicators. A run chart approach to process improvement was determined to be the best method to assess the effectiveness of the HDS Falls Prevention Program for 28 months post implementation. The run chart for patient fall rates and fall with injury rates demonstrated a reduction in falls and sustained improvement over 28 months. The decreases in falls and fall with injury rates of this project have implications for positive social change. Magnet recognition supports the implementation of the evidence-based HDS Fall Reduction Program, thereby improving the quality of life for patients and families and reducing the burden and cost of health care associated with falls.

The assignment from Slottsbro AB was to construct an outdoor activity in modular form, without electronics, mechanics or weights as resistance, targeting seniors. To gain better understanding of what kind of activities seniors need and what problem areas they have, interviews were made with physiotherapists’, researchers and training instructors. Seniors were interviewed and answered questionnaires and observations of various kinds were made to gain further knowledge and inspiration. A literature study was made to gain knowledge of seniors’ health and physiology, fitness and movement exercises and fall prevention. Exercise is a great way for preventing falls, especially functional training, meaning training to manage everyday life. It is particularly balance, leg strength, explosive arm strength and mobility that need to be trained. During the construction phase sketches of various suggestions on equipment or motion exercises were made and were consulted with Slottsbro AB. CAD-models were constructed based on the previous decisions. From these CAD-models prototypes at scale of 1:10 were made in the University workshop. The models were later used to take product pictures outdoors, in order to give an idea of how a full-scale design would look like. Scale models were also used in the compulsory thesis exhibition. To show how the park should be used a stop film was made. It was meant as an illustrative element during the exhibition and final presentation. The modules that were developed were:  A bench with three different seat heights  A balance board  A staircase combined with an inclined plane  Bars in different heights to stand by and do different types of exercises,  Rings attach to rubber bands with different resistance  Windlass, curved pipe and spinning wheels The activity park was named Palaestra which means “training” in Latin. / Projektet från Slottsbro AB gick ut på att konstruera en utomhusaktivitet i modulform utan elektronik, mekanik eller tyngder som motstånd som riktar sig till seniorer. För att få ökad förståelse gällande vad seniorer behöver för aktiviteter och vilka problemområden som finns gjordes intervjuer med sjukgymnaster, forskare och träningsinstruktörer. Seniorer intervjuades samt svarade på enkäter och observationer av olika slag gjordes för att få ytterligare kunskap och inspiration. En litteraturstudie gjordes kring äldres hälsa och fysiologi, träning och rörelseövningar samt fallprevention. Träning är ett bra sätt att förebygga fallolyckor på, och då speciellt funktionell träning, med andra ord träning för att klara vardagen. Det är framförallt balans, benstyrka, explosiv armstyrka och rörlighet som behöver tränas. Under konstruktionsarbetet skissades olika förslag på utrustning eller rörelseövningar upp och konsulterades med uppdragsgivaren. CAD-modeller gjordes på de delar som valts att jobba vidare med. Utifrån dessa togs prototyper i skala 1:10 fram i universitetets verkstad. Modellerna användes senare för att ta produktbilder utomhus, detta för att ge en bild av hur en fullskalig konstruktion skulle se ut. Skalmodellen användes även i den obligatoriska exjobbsutställningen. För att visa hur parken skall användas gjordes en stop motion film. Den användes som ett illustrativt inslag under redovisning och utställning. De moduler som togs fram var:  En bänk med tre olika sitthöjder  En balansbräda  En trappa kombinerad med ett lutande plan  Barrar i olika höjd att stå vid och utföra olika typer av övningar  Ringar fästa i gummiband med olika motstånd  Vindspel, krullrör samt snurrhjul Aktivitetsparken döptes till Palaestra som på latin betyder träning.

Background: Fall injuries are a costly problem for society, with costs ranging up to 14 billion a year. In addition to economic loss accidental falls also creates human value losses and reduced quality of life for its victims. In order to prevent the occurrence of injury related to accidental falls healthcare providers utilize various scientifically developed risk assessment tools, one of them being Downton Fall Risk Index. Method: Empirical, quantitative cross-sectional study. Objective: The purpose of the extended essay was to describe the categories in Downton Fall Risk Index that have a bearing on patients' risk of falling while in hospital and in municipal care, and to illustrate how nurses can use the fall risk assessment tool. Results: Of the 708 participants a total of 73% had a high risk of falling according to Downton Fall Risk Index, of the patients being treated at a hospital 66% had high risk of falling and of the patients being treated in municipal care 87% had high risk of falling. Downton Fall Risk Index indicates that the medication was by far the largest category and included 576 patients (81%), followed by sensory impairment in 474 patients (67%). 335 patients (47%) had fallen previously. Discussion: Previous studies show that among patients being treated in hospitals, between 1.3 to 2.1% will fall. Downton Fall Risk Index indicates that 66% of the group of patients are at high risk of falling. This may be due to the fact that Downton Fall Risk Index focuses too much on medication. It is the nurse’s responsibility to coordinate work around the patient in order to minimize the risk of falling. For example, contact an occupational therapist or an ophthalmologist who can undertake specific actions to reduce patients' risk of falling. Nurses should also use appropriate risk assessment tools to identify risk factors in the patient and then use these to formulate a nursing diagnosis. Conclusion: Downton Fall Risk Index is too sensitive to be used on hospitalized patients, the instrument works better in patients being treated in municipal care. It is important that the nurse can use scientifically designed tool for ensuring good health care for the patient, tools such as the fall risk assessment tool. / Bakgrund: Fallskador är ett dyrt problem för samhället med kostnader som sträcker sig upp mot 14 miljarder kronor om året i Sverige. Förutom ekonomiska förluster skapar fall även humanvärdesförluster och försämrad livskvalitet för den drabbade. För att förhindra uppkomsten av fallskador används inom sjukvården olika vetenskapligt framtagna fallriskbedömningsinstrument, ett av dessa är Downton Fall Risk Index. Metod: Empirisk, kvantitativ tvärsnittsstudie. Syfte: Syftet med fördjupningsarbetet är att beskriva vilka kategorier i Downton Fall Risk Index som har betydelse för patienters fallrisk vid vistelse på sjukhus och vid kommunal vård, samt att belysa hur sjuksköterskan kan använda Fallriskbedömningsinstrument. Resultat: Av de 708 medverkande hade totalt 73% hög risk att falla enligt Downton Fall Risk Index, på sjukhus hade 66% av patienterna hög risk att falla och i kommunal vård hade 87% av patienterna hög risk att falla. Downton Fall Risk Index anger att medicinering var den klart största kategorin och inkluderade 576 av patienterna (81%), därefter kom sensorisk funktionsnedsättning med 474 patienter (67%). 335 patienter (47%) hade fallit tidigare. Diskussion: Tidigare studier visar att på sjukhus faller mellan 1,3-2,1% av patienterna. Downton Fall Risk Index anger att 66% av samma patientgrupp har hög risk för fall. Detta kan bero på att Downton Fall Risk Index fokuserar för mycket på medicinering. Det är sjuksköterskans uppgift att samordna arbetet runt patienten så att fallrisken minimeras. Till exempel ska sjuksköterskan kontakta arbetsterapeuter eller ögonläkare som kan utföra punktinsatser för att minska patientens fallrisk. Sjuksköterskan ska även använda fallriskbedömningsinstrument för att identifiera riskfaktorer hos patienten och sedan använda dessa för att utforma en omvårdnadsdiagnos. Slutsats: Downton Fall Risk Index är alldeles för känsligt för att kunna användas på patienter inneliggande på sjukhus, instrumentet fungerar bättre på patienter inneliggande i kommunal vård. Det är viktigt att sjuksköterskan kan använda vetenskapligt utformade verktyg för att säkerställa en god omvårdnad för patienten, verktyg såsom Fallriskbedömningsinstrument.