Thesis (M. Med. Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 105-115).

Thesis (M. Nurs.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 88-95).

Thesis (Ph. D.)--University of Melbourne, Faculty of Medicine, 1998. / Includes bibliographical references.

Thesis (M.Med.Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 105-115). Also available in print.

Thesis (M. Med. Sc.)--University of Hong Kong, 2005.

Falls are the most frequent cause of injury-related hospitalization and death for people 65 years and older in Canada (Canadian Institute of Health Information, 1998; Langlois et al., 1995; Raina & Torrance, 1996). Studies show the etiology of a falls to be a complex combination of factors that reflect physical, behavioral and social conditions operating alone, or in conjunction with environmental hazards (Speechley & Tinetti, 1991; O'Loughlin et al., 1993). However, the particular role of these factors in relation to falls that result in injury— the subject of this study— is less well understood. Fall-related injuries among frail, older, community-dwelling adults are the focus of this study due to the growing numbers of seniors living in the community who have multiple chronic conditions, the serious consequences of many of these events for this population, and the mounting costs related to treatment. The purpose of this study was to understand the extent and nature of fall-related injuries among frail older adults and to examine the patterns and compounding effects of a wide range of variables representing biological, behavioural, environmental, social and economic risk factors. Differences were examined for risk factors among fallers, nonfallers, injured and non-injured persons. The secondary data used for this study were provided through the University of Victoria Centre on Aging in British Columbia and are based on the Capital Regional District (CRD) Patterns of Care Survey 1995-96 (Centre on Aging, 1996). The data from the CRD Survey are based on interviews with frail community-dwelling seniors represented by two purposefully selected groups. One group consisted of over 3,000 seniors in the CRD receiving publicly-funded home support services in 1995, and the other, a matched sample of 810 seniors screened by age, gender and functional limitations, drawn from the 56,774 seniors in the CRD not receiving home support services. Five hundred and six participants were randomly selected from each group. Of the 1012 respondents to the CRD Survey, 245 reported a fall with an injury, 91 reported falling without an injury and 675 were non-fallers (fall data were missing for one case). Findings showed that 72.9% of those who fell reported being injured as a result of one or more of their falls. This injury rate is considerably higher than that found in other studies that look at the general population of persons aged 65 and over. These differences are explained by the precondition of frailty that defines the population in the CRD Survey. Findings also differ from most other studies in the lack of association found between falls with injury and advanced age or female gender, indicating the strong influence of frailty, regardless of age or gender, for this sample. The results indicate that considerable differences exist in the patterns and combined effect of multiple risk factors between older adults who fall and sustain an injury and those who do not. The findings both confirm and contradict the findings of earlier studies, as well as shedding light on factors not previously studied. This study was conducted from a critical gerontological perspective. This perspective is particularly relevant to the study of seniors’ issues that are influenced by a complex combination of factors— such as fall-related injuries— as it enables an examination of multiple perspectives of the issue within larger social, economic and political contexts. A critical gerontological framework was use in this study to guide the selection of variables, to explain the findings in light of previous knowledge, and to critically examine social policies that influence the ability to implement strategies for prevention. / Graduate

published_or_final_version / Community Medicine / Master / Master of Public Health

Thesis (M.P.H.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 39-43).

published_or_final_version / Nursing Studies / Master / Master of Nursing

Falls risk factor assessment is the first step in the development of appropriate intervention strategies for the prevention of falls. However, few multifactorial, validated falls risk assessments exist which are suitable for use in busy clinical settings. This project aimed to develop a reliable and valid falls risk assessment that was feasible for use in various clinical settings. The QuickScreen Clinical Falls Risk Assessment was developed and evaluated via four methods; a) the test-retest reliability of the measures was assessed with 30 community-dwelling older people, b) the concurrent validity of the measures was assessed by comparison with performance in the Physiological Profile Assessment, c) the predictive validity of the measures was assessed by comparison of performance with prospective falls in two studies involving large samples of community dwelling older people and d) the feasibility of the assessment was evaluated with 40 clinicians who trialled the assessment with their patients. The QuickScreen clinical falls risk assessment consists of eight measures, including previous falls, total medications, psychoactive medications, visual acuity, touch sensation, the sit to stand test, the near tandem stand test and the alternate step test. The test-retest reliability of the assessment measures was acceptable (intraclass correlation coefficients ranged from 0.56 to 0.89) and the assessment measures discriminated between multiple fallers and non-multiple fallers with relative risk values ranging from 1.4 to 2.5. The clinicians that trialled the assessment reported that it was quick and easy to administer and that it assisted in the management of their elderly patients. These results show that the QuickScreen Clinical Falls Risk Assessment has proven validity, test-retest reliability and is practical for use in a variety of clinical settings.