Syftet med studien var att undersöka hur fallfrekvensen var fördelad mellan män och kvinnor, hur antalet fall var fördelade i åldersgrupperna över respektive under 80 år, när de flesta fallolyckor i det egna hemmet inträffade och om fallen medförde några konsekvenser.Studien var en retrospektiv registerstudie och inkluderade fall hos personer i eget boende med trygghetslarm och/eller hjälp av nattpatrull. Fallolyckorna registrerades på ett instrument som var speciellt utvecklat för projektet. Data från en sex månaders studie med totalt 510 fall av 213 individer analyserades. Resultatet visade att det var främst äldre personer över 80 år som föll och som hamnade på sjukhus. Fallen inträffade oftast förmiddagar och eftermiddagar. Få fall inträffade mellan klockan 00-09. Kvinnorna föll framförallt under december månad. Antal fall som ledde till sjukhusvård var 4.5 % och av dessa var nästan alla individer över 80 år och flertalet var kvinnor. Av de fall som ledde till sjukhusvård inträffade 39 % vid första och enda fallet. Då många vårdtagare föll ett flertal gånger och antalet fall kunde vara mycket högt bör de fallförebyggande åtgärderna ses över. Downton fallriskindex skulle kunna vara ett komplement till övriga fallpreventioner i hemmet. Studien ger användbar data med möjlighet att till exempel utforma hemtjänstens schema utifrån studieresultatet och på så sätt minska antalet fallolyckor i hemmen.

Bakgrunn Depresjon og demens er blant de to hyppigst forekommende psykiatriske sykdommene blant eldre globalt sett. Depresjon opptrer ofte sammen med demens. Sykdomene er underdiagnostisert. Pårørende kan oppleve stor belastning av å være omsorgsperson. Hensikt Studiens hensikt er a) å undersøke om det finnes en sammenheng mellom depresjon hos hjemmeboende personer som utredes for demens og ulike demografiske variabler som kjønn, sivilstand, alder, kognitiv funksjon og hjelpetilbud før og etter demensutredning, og b) å undersøke om det finnes en sammenheng mellom depresjon hos personer med mistanke demens og pårørendes belastning som omsorgsgiver. Metode Studien baserer seg på informasjon fra klinisk praksis om pasienter utredet for demens av demensteam i 33 kommuner i Norge i løpet av ett år (n=474). Anonymisert informasjon om pasientene og pårørende ble innhentet. Kun pasienter hvor en depresjonsvurdering ble gjennomført i demensutredningen ble inkludert (n=165). Resultat Depresjonsvurdering gjøres i 34.8 % av demensutredningene, og 46.1 % av de undersøkte har symtomer på depresjon (n=74). Pasientene med depresjon skiller seg ikke fra pasientene uten depresjon med hensyn til kjønn, alder, sivilstatus og kognitiv funksjon. Det er ingen sammenheng mellom forekomst av depresjon og det hjelpetilbudet som ytes av det kommunale tjenesteapparat. Det er imidlertid en sammenheng mellom depresjon ved mistanke om demens og belastning hos pårørende (r=0.44). Det er 31.6 % av de deprimerte pasientene som har en alvorlig grad av depresjon og deres pårørende oppgir at de har lett/moderat til alvorlig grad av belastning (n=24). Konklusjon Halvparten av pasientene har symptomer på depresjon. Pasientene med sympomer på depresjon skiller seg ikke ut fra de øvrige pasientene uten depresjon. Det finnes en sammenheng mellom depresjon hos pasientene og belastning hos pårørende.Depresjonsvurdering bør vektlegges mer av de som driver demensutredning i kommunene. / Background Depression and dementia are two of the most prevalent mental disorders among elderly individuals worldwide. Depression and dementia may occur simultaneously, and the disorders are often underdiagnosed. Relatives may experience great stress as caregivers. Aim This study aimed to a) examine whether depression in home-dwelling elderly assessed for dementia is associated with variables such as gender, marital status, age, cognitive function and need for assistance before and after a dementia assessment, and b) to examine if there is a association between depression in elderly undergoing dementia assessment and burden of their caregivers. Method The study is based on information about the patients treated in clinical practice for dementia assessment in 33 municipalities in Norway over the course of one year (n=474). Anonymised information was obtained from patients and their caregivers. The study included only patients who were assessed for depression as part of the dementia assessment (n=165). Results Depression assessments are conducted in 34.8 % of all dementia assessments, and 46.1 % of these patients have symptoms of depression (n=74). Patients with depression do not differ from patients without depression regarding gender, age, marital status and cognitive function.  Services from the community healthcare system do not differ, regardless of whether the patient has signs of depression. Depression is associated with caregiver burden (r = 0.44). In 31.6% of cases the patients had a severe degree of depression and their relatives reported a burden of care that ranged from easy/moderate to severe (n=24). Conclusion Half of the patients who participated in this study had symptoms of depression. Patients with depression do not differ from patients without depression. Depression is associated with caregiver burden. Dementia assessments in municipalities should place greater emphasis on assessments of depression. / <p>ISBN 978-91-86739-23-2</p>

Syfte: Syftet med litteraturöversikten var att beskriva arbetsterapeuters erfarenheter av reablement som tillvägagångsätt i vardagsrehabiliteringen hos hemmaboende äldre personer. Metod: En allmän litteraturöversikt av kvalitativa studier valdes som design för att sammanställa den tidigare forskningen som besvarade studiens syfte. Datainsamling skedde från två databaser inom medicin och hälsa. Data från tio kvalitativa artiklar sammanställdes och analyserades utifrån en kvalitativ innehållsanalys. Resultat: Analysen resulterade i fem kategorier; att kartlägga, bedöma och strävan efter att sätta upp aktivitetsfokuserade mål, att stödja den äldre personen till självständighet och delaktighet i meningsfulla aktiviteter, att följa upp och att motivera till en fortsatt rehabilitering, att samarbeta i ett interdisciplinärt team och att samarbeta med anhöriga samt ett övergripande tema; betydelsen av ett personcentrerat förhållningssätt och att ha en samsyn. Slutsats: Essensen med reablement var att i ett interdisciplinärt samarbete stödja de äldre personernas självständighet och delaktighet i de dagliga aktiviteterna. Arbetsterapeuterna hade en grundläggande roll med att förverkliga ett personcentrerat förhållningsätt och en samsyn i det interdisciplinära teamet inklusive den äldre personen och anhöriga. Enligt arbetsterapeuterna förutsatteförverkligandet en gemensam målsättning, ett välorganiserat interdisciplinärt samarbete med avsatta resurser under en begränsad tid och goda kommunikationsstrategier. / Purpose: The purpose of the literature review was to describe occupational therapists’ experiences of reablement as an approach in everyday rehabilitation of home-dwelling older adults. Method: A general literature review of qualitative studies was chosen as a design to compile the previous research that answered the purpose of the study. Data collection took place from two databases in medicine and health. Data from ten qualitative articles were compiled and was analyzed with a qualitative content analysis. Results: The analysis resulted in five categories; to map, assess and strive to set activity-focused goals, to support the olderperson to independence and participation in meaningful activities, to follow up and motivate to a continued rehabilitation, to collaborate in an interdisciplinary team and to collaborate with relatives and an overarching theme; the importance of a person-centred approach andhaving a consensus. Conclusion: The essence of reablement was to support the older people’sindependence and participation in daily activities in an interdisciplinary collaboration. The occupational therapists had a fundamental role in realizing a person-centered approach and a consensus in the interdiciplinary team including the older person and relatives. According to the occupational therapists, the realization required a common goal, a well-organized interdisciplinary collaboration with allocated resources for a limited time and good communication strategies.

Abstract This study is focused on the self-care of home-dwelling elderly people living in Slovenia. The study has two phases. The purpose of the first phase is to describe the self-care of home-dwelling elderly people living in Slovenia and factors connected to self-care. The purpose of the second phase is to describe the experiences of the elderly people's ability to manage at home. The aim of this study was to produce new knowledge about the self-care of home-dwelling elderly people living in Slovenia and the factors connected with it. The knowledge will be used to develop elderly care and support eldery people who live at home. The knowledge can be also used to educate nurses to care for the elderly people. The study was both quantitative and qualitative. In the quantitative study the sample consisted of 302 home-dwelling elderly people who were clients in domiciliary care. The selection criteria was: aged 75 years or over and the ability to communicate, no hearing problems, no severe mental problem/cognitive disability and gave full consent for their participation. The whole instrument consists of 91 items. A instrument covers background data, types of self-care, self-care orientation, life satisfaction, self-esteem and functional ability. In the qualitative study, 20 interviews were carried out and a qualitative analysis obtained. Data collection methods included open-ended questions concerning the following topics: background data, types of self-care, self-care orientation, life satisfaction, self-esteem and functional ability. Based on factor analyses, four factors were found which described the self-care. All other factors describe elderly people's perceptions concerning either the past or the future. The elderly people who are able to manage their daily activities/routines have a good functional capacity, good family relations, live qualitatively, accept the future healthily and clearly and are satisfied with their life because they can take care of themselves, but their self-esteem is not so high. Those elderly people who do not take care of themselves are abandoned; they are not satisfied with their way of life and have low-esteem. The results are going to be the basis for planning care and nursing care for all caregivers, especially community nurses. On the basis of this result the model of nursing and social care for home - dwelling elderly people living in Slovenia could be planned. / Tiivistelmä Tutkimuksessa selvitetään Sloveniassa asuvien ikääntyneiden itsestä huolenpitoa. Tutkimus on kaksivaiheinen. Ensimmäisen vaiheen tarkoituksena oli kuvata slovenialaisten ikääntyneiden itsestä huolenpitoa ja siihen yhteydessä olevia tekijöitä. Toisen vaiheen tarkoituksena oli kuvailla ikääntyneiden kokemuksia itsestä huolenpidosta. Tutkimuksen tavoitteena oli tuottaa tietoa slovenialaisten ikääntyneiden kotona asuvien itsestä huolenpidosta. Tietoa voidaan käyttää tuettaessa ikääntyneitä asumaan kotona. Lisäksi sitä voidaan käyttää hoitotyöntekijöiden koulutuksessa. Tutkimuksessa käytettiin sekä määrällistä että laadullista lähestymistapaa. Määrällisen tutkimuksen otos oli 302 kotona asuvaa slovenialaista ikääntynyttä. Kriteerinä oli vähintään 75 vuoden ikä ja kommunikaatiokyky. Kyselylomake sisälsi 91 väittämää. Siinä oli taustatietokysymyksiä, itsestä huolenpitoon, itsestä huolenpitoon orientoitumiseen, elämään tyytyväisyyteen, itsearvostukseen ja toimintakykyyn liittyviä kysymyksiä. Laadulliseen tutkimukseen osallistui 20 henkilöä. He olivat antaneet suostumuksena haastatteluun tutkimukseen ensimmäisessä vaiheessa. Haastattelut sisälsivät avoimia kysymyksiä koskien itsestä huolenpitoa. Tulosten mukaan neljä faktoria kuvasi itsestä huolenpitoa muut faktorit kuvasivat ikääntyneiden suhdetta menneisyyteen ja tulevaisuuteen. Niillä ikääntyneillä, jotka hallitsivat päivittäiset toiminnot oli hyvä toimintakyky, hyvät perheenjäsenten väliset suhteet, he olivat elämään tyytyväisiä ja hyväksyivät tulevaisuuden. Heidän itsetuntonsa ei ollut hyvä. Ne ikääntyneet, jotka eivät pitäneet huolta itsestään olivat omapäisesti itsestä huolehtimiseen suhtautuvia. He eivät olleet elämään tyytyväisiä ja heillä oli matala itsetunto. Tutkimus tuloksia tullaan hyödyntämään kehitettäessä ikääntyneiden kotihoitoa. Tulosten perusteella tullaan kehittämään malli miten ikääntyneiden kotona asumista voidaan tukea.

Abstract High age is a distinguished risk factor of falling, but there remains gaps in epidemiological data among very old people. Also, effects of exercise-oriented intervention implemented by geriatric teams is not known. The aims were to describe the incidence and risk factors of falls, the risk of fall-related injuries associated with physical activity, and to investigate the effect of pragmatic exercise intervention on fall risk among a home-dwelling population aged 85 years and older. The target population consisted of home-dwelling citizens of Oulu aged 85 years or more (N = 827). Altogether 555 people (mean age 88 SD ± 3), representing 67% of the population sample, were evaluated by interviews and clinical assessments. Falls and physical activity were monitored via telephone nine times during a 27-month follow-up constituting 1114 person years. Risk factors of falls were determined during an 11-month period before intervention, as were the effects of the intervention during a 16-month period thereafter. Negative binomial regression, pooled logistic regression and Cox regression analyses were used to analyze data. The incidence rates of falls, major soft tissue injuries and fractures were 1039 (95% CI 974–1093), 74 (58–92) and 89 (72–108), respectively. The probability of getting injured was higher in the morning and evening than in the daytime. The contribution of the ongoing activity and the type of falling to the risk of injury was less than that previously reported among younger home-dwellers. The risk factors of falls were a history of recurrent falling, trouble with vision when moving, use of an antipsychotic drug, and feelings of anxiety, nervousness or fear. Exercise other than walking was associated with a reduced risk of injury-causing falls. Pragmatic intervention wasn’t effective in preventing falls, but it was effective in preserving balance performance. Among those with better functional abilities, intervention was effective in reducing the risk of the first four falls. Adherence to recommended interventions was relatively low. In conclusion, the frequency of falls and fall-related fractures increases up to the highest ages. Anxiety-related disorders may be more important risk factors of falls than are drugs commonly used in treatment. Exercise related to everyday activities is safe among the most elderly. The effects of practical exercise intervention are promising, but attention needs to be paid to adherence to exercise in order to improve these effects.

Background: Approximately 48 000 meals are distributed to home-dwelling older adults every day in Sweden. The ability to influence the meals is of great importance for the quality of life and therefore it is important to include the views, needs and wishes of older adults when structuring the food distribution service. Objective: The purpose is to explore the perceptions and acceptability of home delivered meals among home-dwelling older adults and professional caregivers. Methods: The present study was the first qualitative phase of a mixed method study with an exploratory sequential design. Qualitative data was collected from five older adults &gt;65 in five municipalities and two caregivers through interviews. Results: Most of the participants were able to choose from two alternative dishes every day and they were pleased with the selection of dishes most of the time. Overall the menus were considered variated and seasonal and holiday themes were highly valued. The Swedish cuisine was their favorite, however many ethnic dishes were appreciated as well. The meals were considered delicious, however the texture of the vegetables, potatoes and meat was not optimal. Conclusions: Sometimes two alternative dishes were not considered enough. More and a broader selection of dishes might increase older adults feeling of independence but also help meeting expectations of older adults with different cultural backgrounds. Familiar dishes, a conscious choice of condiments, enhanced flavors and improved textures and appearance might compensate for deteriorating senses. Descriptive information about the meals on the menus might also help meeting older adults’ expectations. / Bakgrund: Det levereras cirka 48 000 måltider till äldre i ordinärt boende varje dag i Sverige. Möjligheten att påverka måltiderna är en viktig förutsättning för äldres livskvalitet, därför är det viktigt att inkludera äldres uppfattningar, önskemål och behov vid strukturering av måltidsdistributionen. Syfte: Syftet var att utforska äldres uppfattningar och acceptans av hemlevererade måltider bland äldre och vårdgivare. Metod: Studien var den första kvalitativa fasen av en mixed method studie med en exploratory sequential design. Kvalitativ data samlades in genom intervjuer med fem äldre i fem kommuner samt två undersköterskor. Resultat: De flesta av deltagarna kunde välja mellan två måltidsalternativ varje dag och de var nöjda med måltidsutbudet för det mesta. Överlag ansågs menyerna vara varierande och säsongs-och högtids anpassade rätter var uppskattade. Även om det svenska köket var en favorit, uppskattades etniska rätter också. Måltiderna ansågs goda, men texturen på grönsaker, potatis och kött var inte optimal. Slutsatser: Ibland uppfattades inte två måltidsalternativ som tillräckligt. Fler rätter och ett bredare utbud av rätter skulle kunna öka äldres känsla av självständighet men också möta förväntningar hos äldre från olika kulturer. Välbekanta rätter, medvetna val av tillbehör, förstärkta smaker och optimerade texturer och utseende kan möjligtvis kompensera för nedsatta sinnen. Detaljerad information om maträtterna på menyerna skulle kanske också kunna hjälp till att möta äldres förväntningar.

Abstract The aim of the study was to develop an instrument and to statistically test the main structure of the middle-range nursing theory for the self-care of home-dwelling elderly. Further, connections between the satisfaction with life, self-esteem, functional capacity and self-care behavior styles of older people living at home were studied. According to the theory in question, self-care is a partly conscious, partly subconscious way to function and live, including an emotional aspect. It evolves during a person’s life course. The theory consists of four main types of self-care, which are associated with older person’s past life and future: responsible, formally guided, independent and abandoned self-care. Also, the functional capacity, life satisfaction and self-esteem vary between persons having different self-care behaviour styles. Furthermore, individual factors – turning points of life, habitual ways to react, resources, meanings of the self-care and experiences of getting old – oriented self-care, either into the internal, unambiguous or external, ambiguous direction. The interview data to test the instrument (n = 200) and the theory (n = 179) were collected by structured interviews from home-dwelling older people aged 74 or older around Finland. The interview data of both phases of the study were analysed with descriptive and multivariate statistical methods. Face-validity was used to ensure the content validity of the instrument. The instrument appeared to be reliable and the main structure of the theory was predominantly supported by the data. The main types of self-care and their connections to the self-care orientations were especially confirmed. Also, the connections between self-care behaviour styles, orientations towards the future and experiences of ageing were fairly well confirmed. In addition, connections between different self-care behaviour styles, functional capacity, life satisfaction and self-esteem were found in the study. The study produces new knowledge of the experiences and self-care of older people as well as of the factors connected to it. The results can be used in clinical settings to improve the care of home-dwelling older people. The theory can also be used as a theoretical basis in the education of geriatric care. / Tiivistelmä Tutkimuksen tarkoituksena oli testata Backmanin (2001) kehittämän kotona asuvien ikääntyvien itsestä huolenpidon teorian ydinrakenne, kehittää mittari teorian testaamiseksi ja tutkia itsestä huolenpitoon yhteydessä olevia tekijöitä. Teorian mukaan ikääntyvien itsestä huolenpito on elämänkulun aikana kehittynyt, osittain tietoinen, osittain tiedostamaton tapa toimia ja elää, joka sisältää myös emotionaalisen ulottuvuuden. Teoria koostuu neljästä itsestä huolenpidon päätyypistä: omavastuinen, ulkoapäin ohjautuva, omapäinen ja luovutettu itsestä huolenpito. Jokaisella tyypillä on sille ominainen itsestä huolenpidon tapa, menneisyys ja tulevaisuuteen suuntautuminen. Myös toimintakyky, elämään tyytyväisyys ja itsearvostus vaihtelevat eri tavoin itsestään huolehtivilla ikääntyvillä. Itsestä huolenpitoa suuntaavat yksilölliset tekijät: elämän taitekohtien luonne, reagointitapa, voimavarat, itsestä huolenpidon merkitys ja vanhenemisen kokeminen. Näiden tekijöiden kautta muodostuu kaksi itsestä huolenpidon pääsuuntaa: sisäistetty, selkeä itsestä huolenpito ja ulkokohtainen, selkiytymätön itsestä huolenpito. Haastatteluaineistot mittarin (n = 200) ja teorian (n = 179) testaamiseksi kerättiin strukturoiduilla haastatteluilla 74 vuotta täyttäneiltä kotihoidon asiakkailta eri puolilta Suomea. Haastatteluaineistot analysoitiin tilastollisesti kuvailevilla ja monimuuttujamenetelmillä. Lisäksi mittarin sisältövaliditeettia arvioitiin face-validiteetilla. Mittari osoittautui luotettavaksi tutkittaessa suomalaisten 75 vuotta täyttäneiden kotihoidon asiakkaiden itsestä huolenpitoa ja siihen yhteydessä olevia tekijöitä. Teorian ydinrakenne sai tukea aineistosta erityisesti omavastuisen ja ulkoapäin ohjautuvan itsestä huolenpidon osalta. Myös itsestä huolenpidon eri tapojen yhteyksiä toimintakykyyn, elämään tyytyväisyyteen ja itsearvostukseen pystyttiin tunnistamaan muiden paitsi luovutetun itsestä huolenpidon tavan osalta. Tutkimus tuottaa uutta tietoa ikääntyvien kokemuksista, itsestä huolenpidosta ja siihen yhteydessä olevista tekijöistä. Tieto ja ymmärrys auttavat ikääntyvien kanssa työskenteleviä toteuttamaan yksilöllisempää, ikääntyvien asiakkaiden voimavaroja huomioivaa ja toimintakykyä tukevaa hoitoa. Testattua teoriaa voidaan käyttää myös teoreettisena lähtökohtana terveydenhuollon ammatillisessa koulutuksessa opetettaessa ikääntyvien hoito- ja huolenpitotyötä.

Introduction: Overall meal satisfaction and sensory properties of the food have been seen to impact the nutritional status in older adults living in residential care homes. However, there is a lack of studies focusing on home-dwelling older adults’ perceptions and satisfaction of home delivered meals. Objective: The purpose was to examine home-dwelling older adults’ sensory perceptions and satisfaction of home-delivered meals from the assistant nurses’ perspective. Method: The present study was the quantitative follow-up phase of a mixed method study with an exploratory sequential design. Data was collected through an online survey regarding assistant nurses’ (N=74) experiences of their care recipients satisfaction and perceptions of appearance, odor, flavor and texture of the meals. Result: The nurses reported that most care recipients appreciate the sensory properties of the meals. However, the perceptions of texture and flavor varied considerably as the texture of vegetables were perceived as either hard or soft, and the meat was perceived as either chewy or easy to chew. Moreover, the flavor of the meals were perceived as either tasty or tasteless. Sensory properties were important for the care recipients’ meal experience, and odor (OR= 6.15, p= 0,03,) and flavor (OR= 5.71, p= 0,05) were significant predictors for meal satisfaction. However, satisfaction could not be correlated to type of delivery system. Conclusion: Chewing difficulties and deteriorating smell and taste senses could be a reason for the great variation of the reported perceptions of texture and flavor. To increase older adults’ acceptability, more focus on choice of products and cooking techniques might be a way to improve the texture and flavor of the meals. Furthermore, due to selection bias the result cannot be generalized. / Introduktion: Nöjdhet och måltidens sensoriska egenskaper påverkar äldres nutritionsstatus i särskilt boende. Det finns dock brist på studier om hemmaboende äldres sensoriska uppfattningar och acceptans. Syfte: Syftet var att undersöka hemmaboende äldres sensoriska perceptioner och acceptans av hemlevererade måltider från undersköterskornas perspektiv. Metod: Studien är den andra uppföljande fasen av en mixed method studie med en exploratory sequential design. Kvantitativ data samlades in genom en online enkät med både slutna och öppna frågor om undersköterskors (N=74) erfarenhet av vårdtagarnas nöjdhet samt upplevelser av måltidernas smak, doft, utseende och textur. Resultat: Undersköterskorna rapporterade att de flesta vårdtagarna uppskattar de sensoriska egenskaperna av måltiderna men att upplevelsen av textur och smak varierade betydligt. Texturen på grönsakerna upplevdes antingen som hårda eller mjuka och texturen på köttet upplevdes antingen som segt eller lättuggat. Smaken på måltiderna upplevdes också antingen som god eller inte god. Vidare var sensorisk kvalitet viktig för vårdtagarnas måltidsupplevelse, och doft (OR= 6.15, p= 0,03,) och smak (OR= 5.71, p= 0,05) var signifikanta prediktorer för måltidsnöjdhet, däremot kunde inte nöjdhet korreleras till typ av leveranssystem. Slutsatser: Tuggsvårigheter och försämrade lukt och smaksinnen skulle kunna vara en anledning till den rapporterade variationen i upplevelsen av textur och smak. Mer fokus på råvaror och tillagningsmetoder skulle kunna vara ett sätt förbättra texturen och smaken. Till följd av selektionsbias är inte resultatet generaliserbart.

IntroductionLes chutes et les blessures dues aux chutes représentent un véritable enjeu de santé publique. Les programmes d’exercices physiques axés sur l’équilibre permettent de réduire de 30 à 40% le taux de chutes chez les personnes âgées vivant à leur domicile. Cependant, leur efficacité sur la prévention des traumatismes dus aux chutes n’a pas été établie.Ce travail comporte 2 parties :- Une revue systématique de la littérature et méta-analyse des résultats d’essais contrôlés randomisés (ECR) qui évaluent l’efficacité de l’exercice sur différents types de chutes traumatiques chez les personnes âgées en milieu communautaire. - L’analyse des données de l’ECR multicentrique ‘Ossébo’, qui évalue l’efficacité d’un programme d’exercice physique de prévention de chutes traumatiques chez des femmes âgées.MéthodesRevue systématiqueDes recherches bibliographiques ont été effectuées pour repérer les ECR de prévention des chutes par l’exercice physique, réalisés chez des personnes âgées vivant à leur domicile, et présentant des données sur les chutes traumatiques.Ensuite, on a regroupé les définitions des chutes traumatiques trouvées dans les études sélectionnées en 4 catégories :A/ avec conséquence.B/ avec recours à des soins médicaux. C/ ayant entraîné un traumatisme grave.D/ avec fracture.On a réalisé une méta-analyse (MA) pour chaque catégorie, donc on a calculé un effet global (effet poolé) de l’exercice correspondant au ratio des taux d’incidence dans les 2 groupes par un modèle à effet aléatoire.L’essai OsséboLes participantes à l’essai sont des femmes âgées de 75 à 85 ans, vivant à leur domicile, et ayant des capacités physiques diminuées. Au total, 706 femmes, dans 20 centres en France, ont été randomisées en 2 groupes : le groupe intervention (GI), et le groupe contrôle (GC).L’intervention comprend des ateliers hebdomadaires d’exercice en petits groupes pendant 2 ans, et des exercices au domicile.La survenue de chutes a été enregistrée à l’aide des cartes-calendriers. Les circonstances et les conséquences de la chute étaient demandées en cas de signalement d’une chute, afin de classer la chute (sans conséquence, traumatisme modéré, traumatisme grave).Des bilans ont été effectués à 1 an et 2 ans après l’inclusion, selon le même protocole que le bilan initial, qui comprenait notamment des tests fonctionnels simples.Le critère principal est le taux d’incidence des ‘chutes traumatiques’ (modérée et graves). Des modèles à fragilité (modèles de survie avec un effet aléatoire) ont été utilisés pour modéliser ce taux dans les 2 groupes.L’évolution au cours du temps des capacités physiques, et d’autres facteurs ont été comparés grâce à un modèle marginal avec un effet aléatoire au niveau du centre.RésultatsRevue systématique17 essais totalisant 4305 participants ont été sélectionnés. Toutes les interventions évaluées comprenaient des exercices de l’équilibre. Les résultats de la MA montrent que l’exercice est associé à une réduction du taux de chutes traumatiques dans chacune des catégories considérées, avec un effet poolé de 0.63 (IC95% : 0.51-0.77) pour la catégorie A(10 essais). Le RaR poolé était de 0.70 (0.54-0.92) pour la catégorie B (8 essais), de 0.57 (0.36-0.90) pour la catégorie C (7 essais), et de 0.39 (IC 95% : 0.22-0.66) pour la catégorie C (6 essais). L’essai OsséboOn a recensé 397 chutes traumatiques dans le GC, et 305 dans le GI, correspondant à une réduction significative de 19% du taux de chutes traumatiques (‘hazard ratios’ HR= 0.81 IC95% : (0.67 - 0.99). A 2 ans, les femmes du GI ont des performances significativement meilleures que les femmes du GC sur l’ensemble des tests physiquesDiscussionLes programmes d’exercice destinés à prévenir les chutes sont également efficaces pour réduire les traumatismes dus à la chute, y compris les plus graves. Aussi, il est possible de mettre en place à large échelle un programme efficace d’exercice de prévention des chutes traumatiques de longue durée chez des personnes âgées / Context: Exercise programmes can prevent falls in older community-dwellers. However, evidence that these programmes can also prevent injurious falls was poor.Objectives : Systematic review of evidence of the effect of exercise interventions on injurious fall prevention from randomised controlled trials (RCT).Evaluate the effectiveness of ‘Ossébo’, a multi-centre RCT assessing the effectiveness of a 2-year injurious fall prevention balance training programme.Methods:Systematic reviewThe definitions of injurious falls from included studies were classified into more homogeneous categories. This allowed the estimation of a pooled rate ratio for each injurious falls category based on random effects models. Ossébo trial706 women aged 75-85 years ; home-living with diminished functional capacities were included. The 2 groups were compared for rates of injurious falls with a frailty model. Other outcomes included physical functional capacities, and quality of life indicators. Results:Systematic review17 trials involving 4305 participants were included. Four categories were identified: all injurious falls, falls resulting in medical care, severe injurious falls, and falls resulting in fractures. Exercise had a significant preventive effect in all categories.OsséboThere were 305 injurious falls in the intervention group and 397 in the control group, for a HR of 0.81 (0.67 to 0.99). At 2 years, women in the intervention group had significantly better performances on all physical tests and a better perception of their overall physical function. Conclusion:Fall prevention exercise programmes are effective in preventing injurious falls, and are feasible for long-term, wide-spread dissemination