published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Sports Science / Master / Master of Science in Sports Science

published_or_final_version / Community Medicine / Master / Master of Public Health

Background: Falls are one of the most common and serious problems facing the elderly and are known to be associated with significant mortality, morbidity, decreased functioning and premature institutionalization. In Hong Kong, the prevalence of falls among community-dwelling older adults is 19.3%. Moreover, the incidence of falls among older people in institutions is almost three times the fall rates for the community-dwelling elderly. Institutional falls are regarded as common adverse events in hospitalized older patients. Significant mortality, morbidity and healthcare costs associated with institutional falls led institutions to recognize falls as a high-priority safety risk for hospitalized patients. This demonstrated the significance of providing the health care providers with an evidenced-based practice guideline of an effective multifactorial fall prevention programme in order to prevent in-patient falls. Objectives: The objectives of the study are to systematically review and present the best evidence for the effectiveness of multifactorial fall prevention interventions in reducing falls in hospitals, to translate the reviewed evidence and to develop evidence-based practice guidelines for the multifactorial fall prevention programme as well as to develop a plan for implementing and evaluating the multifactorial fall prevention programme. Methods: The relevant literature was searched by several electronic databases. The related literature was then retrieved, reviewed and synthesized. The quality assessment of the studies was performed according to the methodological checklist for controlled trials designed by the Scottish intercollegiate Guideline Network (SIGN). Evidenced-based practice guidelines for the multifactorial fall prevention programme were then synthesized according to the findings of the reviewed literature, while the implementation potential being assessed in terms of transferability, feasibility and the cost-benefit ratio. Results: Five studies were identified according to the inclusion and exclusion criteria set. “Evidence-based guidelines of fall prevention programme for hospitalized older patients” were formulated based on the review of the selected studies. Fourteen recommendations of the evidence-based guidelines are formulated and graded according to the grading system of Scottish Intercollegiate Guidelines Network (SIGN). The evidence-based recommendations can offer nurses and other health care professionals the standards and strategies required for implementing multifactorial fall risk assessment and multifactorial fall prevention interventions, including environmental modifications, knowledge, medication reviews and exercise. A communication plan for various parties in hospitals including a pilot test for determining the feasibility of the innovation and an evaluation plan to determine the effectiveness of the fall prevention programme were subsequently developed. Conclusion: This study reviewed evidence for the effectiveness of the multifactorial fall prevention programme in reducing the incidence of falls, translated the reviewed evidence and developed evidence-based guidelines for a multifactorial fall prevention programme, which can provide the health care practitioners with an evidence-based approach in fall risk assessment and management so as to prevent in-patient falls. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Objective: To evaluate the effectiveness of exercises on fall prevention among community-dwelling elderly. Design: Systematic review of randomized controlled trials. Method: The literature search of articles was conducted through the electronic databases of PubMed, Medline and EMBASE and manual search, and was confined to articles in English language with full text and publications from 2002 to 2012. Randomized controlled trials with exercise as the only intervention which aimed at reducing falls in older people aged 60 or above in community i.e. community-dwelling elderly were included. The primary outcomes were number of fallers, fall rate, time to the first and subsequent falls. Data Extraction: A total of 145 articles were retrieved through the electronic data bases (137 articles) and manual search (8 articles) of which 10 were selected after applying the inclusion criteria. According to the checklist developed by National Institute for Health and Clinical Excellence (NICE) for randomized controlled trials, the overall methodological quality of the 10 studies was rated as good as they had fulfilled 79%-93% of the assessment criteria in the NICE checklist. Results: The studies involved a sample size of 3,138 at the median age of 69 to 83. All the subjects were ambulatory and able to mobilize independently. The duration of exercise interventions ranged from 1.5 months to 12 months at a total of 11-156 hours. Eight studies showed that exercises were effective in fall prevention whereas two studies found no evidence of such effectiveness. The effect of exercises on fall prevention was multifactorial including the duration, frequency and continuity of the exercise programs, the health status of the target population and the individuals’ adherence to the exercise programs. Shorter exercise programs and make-up class arrangement resulted in higher adherence rate. Tailor-made (based on the functional capabilities of the subjects) and progressive (gradual increase of the intensity and challenge of the exercises during the intervention period) nature of the exercise programs also enhanced their effectiveness on the elderly. For the studies in which exercise did not have any positive effect on fall prevention, the subjects were generally older (median age at 81) and frailer (with 3-7 frail attributes). Conclusions: This review suggests exercise may be an effective intervention for fall prevention among community-dwelling elderly. Different types of exercise including strengthening, balance, endurance and weight-bearing exercises as well as Tai Chi may prevent falls. The elderly’s age and health status must be taken into consideration when designing exercise intervention programs for the elderly. Further researches are recommended to determine the optimal type, intensity, frequency and duration of exercises in fall prevention. Observations from the studies provide insights for future researches, such as the fall prevention effect of group and home exercises, tailor-made and progressive exercise programs. In Hong Kong, no randomized controlled trial studies have been conducted to examine different intervention programs on fall prevention. To achieve generalizabilty of the studies in the review, further local researches, particularly well designed and powered randomized controlled trials have to be conducted to assess the effect of different kinds of exercise interventions on fall prevention among the community-dwelling elderly. / published_or_final_version / Public Health / Master / Master of Public Health

Yeung, Pui Yee. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 131-145). / Abstract and some appendixes also in Chinese. / ABSTRACT --- p.i / ABSTRACT (in Chinese) --- p.iii / DECLARATION OF ORIGINALITY --- p.iv / ACKNOWLEDGEMENTS --- p.v / RESEARCH-RELATED PRESENTATIONS AND AWARD --- p.vi / TABLE OF CONTENTS --- p.vii / LIST OF ABBREVIATIONS --- p.xi / LIST OF FIGURES --- p.xii / LIST OF TABLES --- p.xiii / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter CHAPTER 2 --- LITERATURE REVIEW --- p.3 / Chapter 2.1 --- Incidence and prevalence of falls in older people --- p.4 / Chapter 2.1.1 --- Incidence and prevalence in western countries --- p.4 / Chapter 2.1.2 --- Incidence and prevalence in Hong Kong --- p.4 / Chapter 2.2 --- Causes and risk factors for falls --- p.5 / Chapter 2.2.1 --- Causes for falls --- p.5 / Chapter 2.2.2 --- Risk factors for falls --- p.6 / Chapter 2.3 --- Consequences of falls --- p.7 / Chapter 2.3.1 --- Individual perspective --- p.7 / Chapter 2.3.2 --- Impact on health service and society --- p.9 / Chapter 2.4 --- Intervention and prevention strategies --- p.10 / Chapter 2.4.1 --- Effective interventions and preventive approaches --- p.10 / Chapter 2.4.2 --- Areas of uncertainty for interventions and prevention approaches --- p.19 / Chapter 2.5 --- Existing efforts in intervention and prevention --- p.20 / Chapter 2.5.1 --- Worldwide levels and collaborations among various countries --- p.20 / Chapter 2.5.2 --- Current services for falls prevention in Hong Kong --- p.23 / Chapter 2.6 --- Criteria contributing to successful intervention and risks modification --- p.27 / Chapter 2.6.1 --- Identification of elderly fallers at Accident & Emergency Department --- p.28 / Chapter 2.6.2 --- Selection of the proved effective programme to those likely to benefit --- p.29 / Chapter 2.6.3 --- Uptake and adherence of the target fallers to the selected programmes --- p.30 / Chapter 2.7 --- Current gaps in study of services for elderly fallers in Hong Kong --- p.31 / Chapter CHAPTER 3 --- METHODOLOGY --- p.32 / Chapter 3.1 --- Research objectives --- p.33 / Chapter 3.2 --- Operational definition of falls --- p.33 / Chapter 3.3 --- Study design --- p.34 / Chapter 3.3.1 --- Diagrammatic illustration of the study design --- p.35 / Chapter 3.3.2 --- "Subjects, assessors and setting" --- p.37 / Chapter 3.3.3 --- Sources of data collection --- p.38 / Chapter 3.3.4 --- Questionnaire and assessment instruments --- p.39 / Chapter 3.3.5 --- Referrals and interventions --- p.49 / Chapter 3.4 --- Plan of data analysis --- p.52 / Chapter CHAPTER 4 --- RESULT --- p.55 / Chapter 4.1 --- Progression of elderly fallers --- p.56 / Chapter 4.2 --- Characteristics of all elderly fallers presented to A&E --- p.58 / Chapter 4.2.1 --- Demographics --- p.58 / Chapter 4.2.2 --- Rate of hip fracture --- p.58 / Chapter 4.2.3 --- Seasonal variation for occurrence of falls --- p.58 / Chapter 4.2.4 --- Subsequent one-year mortality --- p.59 / Chapter 4.2.5 --- Subsequent one-year occurrence of falls with presentation to A&E --- p.59 / Chapter 4.2.6 --- Subsequent one-year hospitalization and length of stay --- p.59 / Chapter 4.3 --- Profile of elderly fallers who received comprehensive falls assessment --- p.63 / Chapter 4.3.1 --- Demographics --- p.63 / Chapter 4.3.2 --- "Circumstances, consequences and past history of falls" --- p.67 / Chapter 4.3.3 --- Health and functional profile --- p.75 / Chapter 4.4 --- Uptake of interventions or referrals by elderly fallers --- p.89 / Chapter 4.4.1 --- Uptake rate of various interventions or referrals --- p.89 / Chapter 4.4.2 --- Reasons for refusing interventions or referrals --- p.89 / Chapter 4.5 --- Comparison between recurrent fallers and non-recurrent fallers --- p.91 / Chapter 4.5.1 --- Co-morbidity between recurrent fallers and non-recurrent fallers --- p.91 / Chapter 4.5.2 --- Functional profile between recurrent fallers and non-recurrent fallers --- p.91 / Chapter 4.6 --- Comparison between injurious falls and non-injurious falls --- p.93 / Chapter 4.6.1 --- Co-morbidity between fallers with resultant injury and fallers without injury --- p.93 / Chapter 4.6.2 --- Functional profile between fallers with resultant injury and fallers without injury --- p.93 / Chapter 4.7 --- Comparison of the profiles between the elderly fallers and the general older population in Hong Kong --- p.95 / Chapter 4.7.1 --- Comparison in demographics --- p.95 / Chapter 4.7.2 --- Comparison in self-perceived health --- p.95 / Chapter 4.7.3 --- Comparison in lifestyle factors --- p.95 / Chapter 4.7.4 --- Comparison in BMI --- p.96 / Chapter 4.7.5 --- Comparison in morbidity --- p.96 / Chapter 4.7.6 --- Comparison in number of disease --- p.97 / Chapter 4.7.7 --- Comparison in medication use --- p.97 / Chapter 4.8 --- Comparison between fallers attended and those who did not attend the falls assessment clinic in terms of the subsequent one-year results --- p.102 / Chapter 4.8.1 --- Comparison in subsequent one-year mortality --- p.102 / Chapter 4.8.2 --- Comparison in subsequent one-year recurrent falls with presentation to A&E --- p.102 / Chapter 4.8.3 --- Comparison in subsequent one-year hospitalization and LOS --- p.103 / Chapter 4.9 --- Validation of a simple screening tool adopted from the Mr. Os (Hong Kong) study by the result of this study --- p.106 / Chapter CHAPTER --- 5 DISCUSSION --- p.108 / Chapter 5.1 --- Profile of elderly fallers presenting to A&E and its implications to health care planning for the elderly --- p.110 / Chapter 5.1.1 --- Profile of fallers in terms of subsequent one-year results --- p.110 / Chapter 5.1.2 --- Profile of fallers compared with general older population --- p.111 / Chapter 5.1.3 --- Implications on health care planning for the elderly --- p.113 / Chapter 5.2 --- Acceptability of various interventions and referrals by fallers and its implications to health care planning for the elderly --- p.116 / Chapter 5.2.1 --- Uptake rates for various interventions and referrals --- p.116 / Chapter 5.2.2 --- Views towards various interventions and referrals by fallers --- p.117 / Chapter 5.2.3 --- Implications on health care planning for the elderly --- p.117 / Chapter 5.3 --- Discussion of other findings --- p.120 / Chapter 5.3.1 --- Seasonal variation in occurrence of falls --- p.120 / Chapter 5.3.2 --- "Circumstances, consequences and past history of falls" --- p.122 / Chapter 5.3.3 --- Comparison between recurrent fallers and non-recurrent fallers in terms of co-morbidity and functional profile --- p.123 / Chapter 5.3.4 --- Comparison between fallers with resultant injury and fallers without injury in terms of co-morbidity and functional profile --- p.123 / Chapter 5.3.5 --- Comparison between fallers attended and those who did not attend the falls assessment clinicin terms of subsequent one-year results --- p.124 / Chapter 5.3.6 --- Usefulness of the risk profile of recurrent falling adopted from Mr. Os (Hong Kong) Studyin screening the fallers with high risk of falling --- p.125 / Chapter 5.4 --- Limitations --- p.126 / Chapter 5.5 --- Recommendations for further research --- p.128 / Chapter CHAPTER 6 --- CONCLUSION --- p.129 / REFERENCES --- p.131 / APPENDICES / Appendix 1 Assessment Form used in Falls Assessment Clinic --- p.146 / Appendix 2a Scale for Subjective Socioeconomic Status -English version --- p.151 / Appendix 2b Scale for Subjective Socioeconomic Status -Chinese version --- p.152 / Appendix 3a Simple Physical Activity Questionnaire -English version --- p.153 / Appendix 3b Simple Physical Activity Questionnaire -Chinese version --- p.155 / Appendix 4 Modified Barthel Index --- p.157 / Appendix 5 Rating Form for Impairment in IADL --- p.159 / Appendix 6 Mini-Mental State Examination -Cantonese version (CMMSE) --- p.160 / Appendix 7 Geriatric Depression Scale - Four-item short form (GDS-4) --- p.162 / Appendix 8 Berg Balance Scale - short form (BBS short form) --- p.163

Thesis (M Sport Sc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Falling is a common occurrence and one of the most serious problems in the elderly population (65 years and older). Falls account for 70% of accidental deaths in persons aged 75 years and older. Falls can be markers/indicators of poor health and declining function, and are often associated with significant morbidity. More than 90% of hip fractures occur as a result of falls, with most of these fractures occurring in persons over 70 years of age (Fuller, 2000). About one third of people aged 65 years and older fall each year, resulting in a substantial decrease in quality of life in addition to placing a huge burden on current health care systems. The purpose of this study was to determine whether a 12-week exercise intervention programme, consisting of two 30 minute exercise sessions a week, could lower the risk of falling in a group of elderly women. Female subjects (n=22) with an average age of 79.5 years were selected from three retirement homes situated in Stellenbosch, Western Cape, South Africa, according to specific inclusion and exclusion criteria. The subjects included presented no major cardiovascular and pulmonary disease signs and symptoms as recognised by the American College of Sports Medicine (2011); had no serious illnesses or co-morbidities; were mobile with no significant musculoskeletal disorders; had no uncorrected visual or vestibular problems as well as no significant cognitive impairments or major psychological disturbances; were not taking any psychotropic medications or Benzodiazepines that could affect their progress. Subjects also had to be willing to follow the 12-week exercise intervention programme and sign an informed consent document. The selected subjects then underwent a pre- and post-intervention assessment consisting of a subjective rating of their fear of falling, the Fall Risk Assessment: Biodex Balance system, Balance Evaluations Systems Test (BESTest) and the 30-Second Chair Stand Test. Statistica 10 was used to analyse the data. Data was analysed to assess any significant improvements that the exercise intervention had on each fall risk variable tested. The main fall risk variables consisted of: fear of falling, muscular strength, balance, gait and getting up strategies. Statistically significant improvements (p<0.001) were seen in: Fear of falling, muscular strength, balance, gait and getting up strategies after the 12-week exercise intervention programme. This study suggests that exercise intervention has the potential to decrease the risk of falling among elderly women and should play an extremely important role in the prevention of falling amongst this population group. / AFRIKAANSE OPSOMMING: Om te val is ‘n alledaagse gebeurtenis en een van die mees ernstige probleme vir ons bejaarde bevolking (65 jaar en ouer). Insidente van val verklaar tot 70% van toevallige sterftes met betrekking tot persone van 75 jarige ouderdom en ouer. Om te val kan ‘n teken van swak gesondheid en/of ‘n afname in funksionele kapasiteit wees, en is gewoonlik met morbiditeitspatrone gekoppel. Meer as 90% van heupfrakture kom as gevolg van valle voor, waar die meeste van die frakture in persone bo 70 jarige ouderdom voorkom (Fuller, 2000). Minstens een derde van persone bo 65 jaar en ouer val elke jaar, so ‘n val het ‘n noemenswaardige afname in lewenskwaliteit tot gevolg asook ‘n enorme druk wat op huidige gesondheidsorg sisteme geplaas word. Die doel van die studie was om te bepaal of ‘n 12 week oefenintervensieprogram, wat uit twee oefen sessies van 30 minute elk bestaan, die risiko van val vir n groep bejaarde vroue kan verlaag. Vroulike individue (n=22) met ‘n gemiddelde ouderdom van 79.5 jaar uit drie ouetehuise/aftree oorde in Stellenbosch, Wes-Kaap, Suid-Afrika geleë; is volgens bepaalde insluitings- en uitsluitingskriteria geselekteer. Individue wie ingesluit is het geen tekens of simptome van grootskaalse kardiovaskulêre of pulmonêre siekte getoon nie, soos herken deur die “American College of Sports Medicine (2011) ; het aan geen ernstige siektes of ko-morbiditeite gely nie; kon stap met geen merkwaardige muskulo-skeletale afwykings nie; het geen nie-gekorrigeerde visie of vestibulêre probleme asook geen beduidende kognitiewe gestremdhede of ernstige sielkundige steurnisse gehad nie; het nie enige psigotropiese medikasie of Benzodiazepines geneem wat hul kon beinvloed nie. Individue moes bereid gewees het om die 12 week oefenintervensieprogram te volg en moes ook ‘n ingeligte toestemmingsvorm onderteken. Die geselekteerde individue het ‘n pre- en post-intervensie assessering ondergaan wat uit ‘n subjektiewe bepaling van hul vrees vir val bestaan het, die Val Risiko Assessering asook “Biodex Balans System Test, Balance Evaluations Systems Test (BESTest)” asook die 30 Sekonde Stoel-staan Toets. Statistica 10 is gebruik om die data te analiseer. Data was geanaliseer om enige merkwaardige verandering wat die oefenintervensie op elke val risiko veranderlike wat getoets was gehad het, te bepaal. Die belangrikste val risiko veranderlikes het uit: die vrees vir val, spier sterkte, balans, stappatroon en opstaan tegnieke bestaan. Betekenisvolle statistiese veranderinge (p<0.001) is gerapporteer in: die vrees vir val, spiersterkte, balans, stappatroon en opstaan tegnieke na die 12 week oefenintervensieprogram. Die studie bevind dat die intervensieprogram die potensiaal het om die risiko van val onder bejaarde vroue te verminder en behoort ‘n uiters belangrike rol in die voorkoming van val onder die bevolkingsgroep te speel.

One in three American older adults fall every year, making falls the leading cause of nonfatal injury treated in the emergency department (Centers for Disease Control and Prevention [CDC], 2013). Fall-related injuries cost the United States healthcare system nearly $30 billion a year and result in 27,000 deaths per year (Burns, Stevens, & Lee, 2016). The risk of falls increases with age, occurring more often in women than man. Age-related muscle weakness and functional decline contribute to fall risk. Age-related changes in neuroendocrine hormone production and shifts in circadian rhythms promote sleep disorders, affecting nearly two-thirds of older adults. Poor sleep quality over time leads to drowsiness and impaired attention span and judgment. The purpose of this secondary analysis of a previously collected data set was to describe the relationships among frailty, subjective sleep quality, and falls in community-dwelling older adults. This secondary analysis also sought to determine the extent to which frailty and subjective sleep quality predict risk of future falls among community-dwelling older adults. Correlational analyses were performed to determine the nature and significance of the relationship between sleep quality and falls, frailty and falls, and sleep quality and frailty. A multiple regression analysis was performed to determine if sleep quality and frailty combined could predict falls. Frailty was found to account for a small variance in fall risk. However, sleep quality was not significantly related to falls nor was sleep quality predictive of falls. Risk for falls should be assessed at every clinical encounter and efforts to promote restful sleep should be addressed at least annually to reduce the risks of falls, functional decline, and sleep disorders among older adults in the community. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

跌倒和肌肉減少症是威脅老年人身體健康和生命安全的兩個重要問題。肌肉減少症所致的肌肉力量減弱和平衡能力下降是導致老年人跌倒的最主要原因。老年人跌倒最普遍和最嚴重的後果是脆性骨折。跌倒所致的脆性骨折是常見老年病，同時也是導致老年人生活品質下降和死亡的最主要原因之一。高頻低幅振動(LMHFV)是一種非侵入性生物物理干預手段，通過給予全身物理震動刺激，可有效提高肌肉功能和改善骨質。由此推測高頻低幅振動治療有望應用於預防跌倒/骨折及延緩肌肉減少。 / 本研究的目的在於，採用臨床隨機對照研究方法，通過對社區老年人進行高頻低幅振動治療，探索高頻低幅振動治療在預防跌倒/骨折、降低骨折發生率以及延緩肌肉量下降的作用。本研究假設高頻低幅振動治療可有效提高肌肉力量和改善骨質，從而降低骨折風險、跌倒率以及骨折發生率。本研究將分成兩部分進行以驗證此假說。 / 第一部分研究中，710名60歲或以上的社區老年人按社區中心為單位隨機分成振動治療組和對照組。振動治療組給予35Hz，0.3g的振動治療，並以每天20分鐘，每週5 天，持續18 個月；對照組則如常生活而不予振動治療。18個月治療過程中，振動治療組的跌倒率低於對照組46% (p=0.001)。同時，治療組的在平衡力測試中的反應時間、移動速度，和最遠移動距離也都有明顯改善 (所有指標 p<0.001）。在高頻低幅振動治療停止一年後，振動治療組的主導腿和非主導腿肌肉力量仍高於接受振動治療前 (p=0.029, p=0.002)。在平衡力測試中，治療組的反應時間、移動速度以及最遠移動距離也明顯優於對照組 (p=0.001，p=0.014，p=0.007)。在停止治療的一年期間，兩組受試者的肌肉力量，平衡能力以及生活品質均有下降的趨勢，但兩組的下降率並無明顯的差異。 / 第二部分的設計是基於第一部分的研究成果，目的在於更深入研究高頻低幅振動治療對肌肉功能、肌肉量以及肌肉質素的影響。60名社區老人隨機分成對照組和振動治療組。振動治療組給予35Hz，0.3g的高頻低幅振動治療，並以每天20分鐘，每週5天，持續9個月; 對照組則如常生活而不予振動治療。9個月後，治療組的主導腿和非主導腿的肌肉力量明顯高於對照組 (p<0.001，p=0.003)。在用以評估肌肉力量以及平衡力的計時起立坐下測試中，振動治療組用以完成連串起立及坐下動作的時間明顯低於對照組 (p=0.009)。振動治療組的下肢功能尺度問卷評估結果也明顯優於對照組 (p=0.002)。雖然兩組間的身體成份及肌電圖測試結果並無明顯差異，但治療組的肌肉量和肌電圖平均頻率均有上升的趨勢。而且，在兩部分實驗中，受試者對高頻低幅振動治療均有良好的耐受性，目前並沒有發現對受試者身體產生不利影響。因此，高頻低幅振動治療可安全地應用於社區老年人。 / 總括而言研究結果證明高頻低幅振動治療可明顯降低老年人跌倒發生率。9至18個月的振動治療可明顯改善老年人下肢功能和平衡力。在完成為期18個月高頻低幅振動治療後的1年，肌肉功能仍高於對照組，表明高頻低幅振動治療具有長期療效。因此，高頻低幅振動治療應在社區推廣作為老年人跌倒的預防方案之一。 / Fall and sarcopenia are two major problems among elderly. Poor muscle strength and balancing ability resulted from sarcopenia are the major causes of fall incidences. Fragility fracture is one of the most common and serious consequences of falls, which accounts for most of the deaths, as well as morbidity and poor quality of life. Low magnitude high frequency vibration (LMHFV) treatment is a non-invasive biophysical modality to provide a whole-body mechanical stimulation, which was previously shown to improve muscle performance and bone quality implying the potential application for fall/fracture prevention and reducing muscle loss. / The objectives of this study were to conduct prospective randomized controlled clinical trials to investigate the effect of LMHFV treatment on fall/fracture prevention, fracture risks and muscle loss among community elderly. It was hypothesized that LMHFV treatment could enhance muscle performance and bone quality, thus reducing the fracture risks, fall incidence and fracture rate. Two parts of studies were designed to testify the hypotheses. / In the Part I study, a total of 710 community elderly who were aged 60 years or above were recruited and randomized into vibration or control group on center-basis. The subjects in vibration group received LMHFV treatment (35Hz, 0.3g) 20min/day and 5days/week for 18 months, while control group remained sedentary. During the 18-month study period, the vibration group had reported 46% lower fall incidence rate when compared with control group (p=0.001). Significant improvements were found in reaction time, movement velocity and maximum excursion of balancing ability assessment, and also the quadriceps muscle strength (p<0.001 to all). After ceasing the LMHFV for 1 year, the muscle strength of dominant and non-dominant legs in vibration group were still significantly better than the baseline assessed before intervention (p=0.029 and 0.002 respectively), as compared with the control. In balancing ability test, the reaction time, movement velocity and maximum excursion of vibration group also remained significantly improved, as compared with the control group (p=0.001, 0.014 and 0.007 respectively). During the 1 year post-intervention period, both groups had shown a decreasing trend of muscle strength, balancing ability and quality of life but the rate of changes were not significantly different between two groups. / With reference to the results of Part I study, the Part II study was designed to investigate further the effects of LMHFV on muscle performance, mass and quality. 60 community elderly were recruited and randomized into either vibration or control group. Vibration group subjects received LMHFV treatment (35Hz, 0.3g) 20min/day, 5days/week for 9 months, while control group remained sedentary. Significant enhancement of dominant and non-dominant leg muscle strength was observed in the vibration group after 9 months LMHFV (p<0.001 and =0.003 respectively). In the chair rising test assessing muscle power and balancing ability, vibration group showed significantly shorter time needed for sit-to-stand cycles than the control (p=0.009). Significant increase of the lower extremity functional scale was also observed in the vibration group (p=0.002). No significant findings were found in the body composition and vibromyography (VMG) assessment, however, a trend of increasing lean mass and VMG mean frequency were observed. Also, minimal adverse effects were documented in both parts of study; all subjects were well-tolerated for LMHFV treatment. LMHFV is therefore safe and applicable to elderly in the community setting. / LMHFV was demonstrated to reduce fall incidences significantly. Significant effects on improving lower limbs function and balancing ability were observed as early as 9 months after treatment. Enhancement of muscle performance still remained significant 1 year after completion of 18-month LMHFV treatment, indicating strong residual effects of LMHFV. Use of LMHFV in the community as an effective fall prevention program is recommended. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Chi Yu. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 154-167). / Abstracts also in Chinese.

Indiana University-Purdue University Indianapolis (IUPUI) / The life expectancy of humans in today's era have increased to a very large extent due to the advancement of medical science and technology. The research in medical science has largely been focused towards developing methods and medicines to cure a patient after a diagnosis of an ailment. It is crucial to maintain the quality of life and health of the patient. It is of most importance to provide a healthy life to the elderly as this particular demographic is the most severely affected by health issues, which make them vulnerable to accidents, thus lowering their independence and quality of life. Due to the old age, most of the people become weak and inefficient in carrying their weight, this increases the probability of falling when moving around. This research of iterative nature focuses on developing a device which works as a preventive measure to reduce the damage due to a fall. The research critically evaluates the best approach for the design of the Pre-Fall detection system. In this work, we develop two wearable Pre-Fall detection system with reduced hardware and practical design. One which provides the capability of logging the data on an SD card in CSV format so that the data can be analyzed, and second, capability to connect to the Internet through Wifi. In this work, data from multiple accelerometers attached at different locations of the body are analyzed in Matlab to find the optimum number of sensors and the best suitable position on the body that gives the optimum result. In this work, a strict set of considerations are followed to develop a flexible, practical and robust prototype which can be augmented with different sensors without changing the fundamental design in order to further advance the research. The performance of the system to distinguish between fall and non-fall is improved by selecting and developing the most suitable way of calculating the body orientation. The different ways of calculating the orientation of the body are scrutinized and realized to compare the performance using the hardware. To reduce the number of false positives, the system considers the magnitude and the orientation to make a decision.