In the United States, falls are the leading cause of unintentional death with one of every three people 65 years and older falling each year. Falls account for approximately 95% of hip fractures among older adults and falls to the side predominate hip fracture related falls in this population. However, risk factors for side and frequent falls are poorly understood. Furthermore, few data exist to explain differences in bone mineral density among older postmenopausal women. In particular, data regarding the timing of hormone replacement therapy (HRT) among older women is scarce. In the first aim of this dissertation, we examined changes in mobility and balance-related risk factors for side falls as well as differences in these risk factors according to fall status in a population of 107 independent, elderly women (>70 yrs), who were followed over 2 years. We found hip abduction strength decreased (p<.001) in all subjects, with side-fallers exhibiting weaker hip abduction strength (p=.008), greater sway velocity (p=.027), and slower performances on the tandem walk (p=.039) and Get Up and Go (p<.001) compared to non-fallers. For the second study, in the same population, we examined 2-year changes in balance self-efficacy (BSE) and the relationship of BSE to side fall risk factors and falls incidence. Results showed BSE at baseline was predictive of Get Up and Go, hip abduction strength and tandem walk at follow-up (p<.008), but that BSE decreased only among the non-fallers (p=.013). In the third study, we examined 3-yr hip bone mineral density (BMD) changes in women with distinct hormone replacement therapy (HRT) profiles: 1) no hormone replacement therapy (N0HRT), 2) HRT continually since menopause (Continual), 3) HRT begun 10 years after menopause (Late), 4) HRT initiated within 5 years (New), and compared the change in BMD of the hip across HRT groups. Only the NoHRT group lost bone over the 3 years (p=.014). We also assessed BMD of the lateral spine across levels of estrogen use in a sub-sample of participants and found long-term HRT users had significantly higher lateral spine BMD (p=.041) compared to women who had never been on HRT. / Graduation date: 2003

This study was designed to investigate the relationship between retinol intake, bone mineral density, and falls in 101 elderly women aged 72 to 90 years (78.6 yrs. �� 4.3 yrs.). Bone mineral density (BMD) (g/cm��) of the left hip, anterior-posterior lumbar spine (L3), and lateral spine (L3) was measured using dual-energy x-ray absorptiometry. Dietary intake and physical activity were assessed by validated questionnaires (the 100-item Block Food Frequency Questionnaire and the Physical Activity Scale for the Elderly, respectively). Isometric hip abduction strength of the right and left legs was assessed using a hand-held dynamometer. Fall surveillance was collected using a "postcard" system at three-month intervals over a two-year period. Multiple regression analyses were used to show the predictability of retinol, vitamin D, calcium, years past menopause, years on hormone replacement therapy, and physical activity on BMD variables. Together, these variables explained 14% of the variance in total hip BMD at follow-up (R��=0.14, SEE=0.12, p=0.020), 26% of the variance in the anterior-posterior spine BMD at follow-up BMD (R��=0.26, SEE=0.17, p=0.051), and 33% of the variance in lateral spine BMD at follow-up (R��=0.33, SEE=0.10, p=0.009). Two-year changes in hip BMD were poorly predicted using the model with only 5% of total hip BMD variance being explained by the six independent variables (R��=0.05, SEE=0.03, p=0.558). Logistic regression was used to determine whether the likelihood of being a faller vs. a non-faller could be predicted from a model using retinol, vitamin D, average hip strength, and physical activity. It was shown that 11.5% of the variability in fall status could be explained by the model (Cox & Snell's R��=0.115). Using an ROC curve analysis, the model correctly classified 69% of the individuals into the correct "fall category". We conclude that retinol, although not an independent predictor of BMD or fall status, is an important component in the prediction of both BMD and falls. Further interventional research is needed to determine the effects of retinol on BMD and falling. / Graduation date: 2004

No description available.

Background When women have breast pain this usually is not associated with myocardial infarction, which results in that they get less attention and wrong treatment. The nurse has an important role in informing and educating patients and families during hospitalization, which is usually short. Continuous training, written information and repetition for patient and family throughout the hospital stay are of considerable importance to clarify that the patient understands and to reduce the anxiety of being discharged. Aim The aim is to describe nurses' experiences of caring for older women with myocardial infarction. Methods A qualitative method was used. The collection of data was done by six interviews with nurses in geriatric care and elderly care. Dataset has been processed based on a content analysis and divided into subcategories and main categories using meaningful units. Results Not having knowledge of older women with myocardial infarction was expressed as frustrating and nurses described how they were afraid to ask their colleagues. Some of the nurses experienced the opposite, they felt safe in their professional role and had confidence to ask. The nurses experienced difficulties in caring for older women with myocardial infarction because they often had multiple illnesses and was not fully oriented. Perceptions of stress, nervousness and depression were described as part of caring. Making time for reflection was of great importance to cope with stressful care situations. Discussions The results highlight the fact that some nurses experienced stress, it can be difficult to utilize the patient's life world and have a holistic approach in caring when it's a stressful work situation. The study has highlighted different experiences nurses may face in caring for the older woman with myocardial infarction. To get an understanding of these experiences may contribute to a better understanding of what resources are needed to be taken to improve care for these women.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 101-109). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 101-109). Also available on the Internet.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Ces trois etudes, basees sur un scheme d'apprentissage social, visaient le developpement d'instruments d'evaluation et d'intervention aupres de personnes agees vivant dans la communaute. / La premiere etude a demontre qu'une intervention aupres de gens lors de la pre-retraite peut contribue a l'augmentation des attentes d'efficacite de soi, particulierement en ce qui a trait a leur planification d'activites satisfaisantes. Cette recherche a aussi indique l'utilite d'avoir recours a des groupe de pairs comme modele pour promouvoir l'adaptation a la vie de retraite. / La seconde avait pour objet de comparer les attentes sociales de deux groupes de femmes (jeunes, agees) face aux consequences de l'affirmation de soi. Les femmes plus agees choisissaient moins souvent de s'affirmer car elles ne croyaient pas que ceci provoquerait chez les autres les comportements desires. Les plus jeunes etaient plus portes a s'attendre a une reaction negative de la part de leurs amis. Les deux groupes anticipaient une augmentation de leur egard-de-soi suite a la mise en action de comportements affirmatifs. / La troisieme etude utilisait un scheme a cas unique pour evaluer l'effet d'une intervention d'habiletes sociales sur six femmes agees. Il s'agissait de modifier les comportements-cibles individuels par le truchement de techniques behaviorales (tels que repetition, modelage et retroaction); de selectionner des objectifs specifiques a l'environnement natural de chaque sujet; et de faire de la restructuration cognitive. Les resultats obtenus indiquaient l'efficacite du traitement pour ameliorer et maintenir les comportements cibles chez tous les sujets et ce, pour toutes les mesures utilisees a divers intervalles de temps. Cette etude illustre egalement l'application d'une telle methodologie dans un milieu clinique.

The association of functional status with fat-free mass (FFM) was examined cross-sectionally in a sample of 30 frail elderly women $(81.5 pm 7$ years) to evaluate potential outcome indicators for nutritional interventions. FFM, determined using multi-frequency bioelectrical impedance analysis, was lower in this frail group than in previous reports for "younger" elderly females. All measures of muscle strength (handgrip, biceps, quadriceps) were significantly correlated with FFM $ rm (r ge 0.45, p le 0.02),$ while the measures of global function (Timed "Up & Go" Test and walking speed) as well as self-perceived health were not. The measures of muscle strength and global function were found to have good reliability based on measurements taken on two occasions separated by one week $ rm (ICC ge 0.80).$