Thesis (Ph. D.)--University of Oregon, 2003. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 157-170). Also available for download via the World Wide Web; free to University of Oregon users.

Falls among the elderly are a major health issue in Hong Kong. This problem has been worsening and has become a public concern for the aging population. In Hong Kong, over 30,000 community-dwelling older adults have needed hospital admission after falling, and billions of dollars are spent on the related medical costs. The prevalence of recurrent falls is high. However, a lack of concern in helping community-dwelling older adults to prevent recurrent falling currently persists in clinical field. A local study reported that most community-dwelling older adults have a fear of falling (FOF) after an accidental fall. Thus, reducing FOF can reduce the fall rate because FOF and falls are interdependent. A systematic review can show that multi-component psycho-therapeutic intervention is effective in reducing FOF. Therefore, the establishment of a standardized evidence-based practice (EBP) guideline to reduce FOF among community-dwelling older adults via multi-component psycho-therapeutic intervention is necessary. This thesis aims to develop an EBP guideline to reduce FOF among community-dwelling older adults via multi-component psycho-therapeutic intervention. Seven related studies were reviewed and appraised as having a high level of evidence. These studies also reported to have significantly positive effects on the clients. The transferability and feasibility of the proposed program in Hospital A were examined, and the results show that the transferability and feasibility of the proposed program were high. An EBP guideline and an implementation plan were then developed. A pilot test was proposed to determine and solve the difficulties in the implementation process. Then, the guideline was refined. A comprehensive evaluation plan of the proposed program is included in the final chapter. The standardized EBP guideline, which is an evidence-based approach, provides a clear pathway for practitioners to educate community-dwelling older adults in reducing FOF via multi-component psycho-therapeutic intervention. This method contributes to the reduction in the recurrent fall rate and the decrease in related medical costs. / published_or_final_version / Nursing Studies / Master / Master of Nursing

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

To understand how falls occur during walking in older adults, we need to understand how the nervous system maintains stability, and how aging affects walking. Four studies were conducted to better understand the effect of age on gait. Older adults display higher gait variability compared to young adults, possibly because of their slower walking. We compared gait stability at multiple controlled walking speeds. Greater gait variability in healthy elderly existed independent of slower walking. Their diminished strength and flexibility partly explained this difference. To explain slower walking in the elderly, some have suggested that muscle weakness and stiffness may force people to walk slower. Others have suggested that people choose to walk slower to be more stable. We compared dynamic stability of gait at multiple speeds. Healthy older adults also exhibited more stability at slower speeds, yet walked at speeds comparable to young adults despite the lower strength and flexibility. Therefore, weakness and stiffness may not force healthy older adults to walk slower. The goal of the nervous system during walking may be to maintain stability of superior segments. We tested whether superior segments are more stable than inferior segments during walking. Superior segments exhibited less orbital stability during preferred walking speed, in contrast to previous suggestions. This highlighted the importance of trunk control during gait. The effects of aging on the fluctuations in the muscle activity during gait are not well understood. We quantified the stride-to-stride fluctuations of EMG as a measure of muscle activation patterns in state-space. Variability increased with speed except in the gastrocnemius. Orbital stability was less in older adults, suggesting that deviations in the EMG amplitude pattern were not readily corrected. Less local stability was seen in older adults, suggesting that older adults were more sensitive to perturbations. Together, these findings suggest that trunk control is important during gait. Strength and flexibility deficits help explain higher variability and lower stability in older adults. Future work will need to address the effect of strength interventions, neurophysiological decline on gait stability and fall risk.

Thesis (Ph. D.)--University of Texas at Austin, 2007. / Vita. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (Ph. D.)--Oregon State University, 2004. / Printout. Includes bibliographical references. Also available via the World Wide Web.

Thesis (M.S.)--University of Oregon, 2003. / Includes bibliographical references (leaves 39-42). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M.S.)--University of British Columbia, 2004. / Includes bibliographical references (leaves 92-102). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.