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Falls among elderly people have been identified as a significant and serious medical problem confronting a growing number of older people. Falls have been found to be a leading cause of disability, distress, admission to supervised care and death among older persons that pose a serious problem to public health. The purpose of this study was to determine the prevalence of and risk factors for falls in the community-dwelling elderly persons in the Umutara province of Rwanda.

Falls among elderly people have been identified as a significant and serious medical problem confronting a growing number of older people. Falls have been found to be a leading cause of disability, distress, admission to supervised care and death among older persons that pose a serious problem to public health. The purpose of this study was to determine the prevalence of and risk factors for falls in the community-dwelling elderly persons in the Umutara province of Rwanda.

One indication of increasing fragility of bone is the accumulation of microscopic cracks, or microdamage, within the bone matrix. Microdamage accumulates in bone of the elderly, when changes in bone material properties and matrix architecture coupled with a decrease in bone repair mechanisms compromise bone integrity. To preserve bone mass and reduce fracture risk, therapeutics such as alendronate are prescribed which increase bone volume fraction by decreasing the rate of bone turnover. However, concerns over adverse effects of prolonged turnover suppression have been reinforced by findings of increased microdamage density with alendronate use. Microdamage formation is not always pathologic, but extensive accumulation of damage can be an indicator of reduced bone quality. The work in this thesis explores the hypothesis that microdamage in bone of lower quality will form more easily and progress more extensively than in bone of higher quality. Microdamage initiation stresses and strains were obtained for trabecular bone from older females, older males, and younger females to determine whether thresholds for damage initiation were lower in older females. Results suggest that the stress threshold for damage initiation in older females may indeed be lower compared with younger females, and that normalized strain thresholds for severe damage formation in older males may be decreased compared with older females. Damage propagation was evaluated as a function of age and sex to determine whether damage in older women progressed more extensively than in younger women or men. Results suggest that bone from older individuals had decreased resistance to crack propagation evidenced by an increased number of severely damaged trabeculae which expanded in area under cyclic loading; however no sex differences were uncovered. Finally, the stress/strain thresholds for damage initiation were investigated in alendronate-treated bone, and results indicate that a decreased stress threshold was needed to initiate damage formation of a linear and severe morphology after one year of treatment. After three years of treatment, however, micromechanical properties recovered, perhaps due to increased matrix mineralization which increased tissue level stiffness.

People aged ≥65 years (older people) have a higher chance of falling than other age groups. However, based on qualitative research, older people do not believe that falls prevention information and strategies have personal relevance. This suggests that older people believe that falls are more likely to happen to other older people than themselves, that is, they might be comparatively optimistic about their chance of falling. It is important to understand comparative optimism about falling as it is a consistent reason given by older people for not participating in falls prevention activity. This thesis used a mixed methods design with a sequential strategy to investigate community-dwelling older people's comparative optimism about falling. Three studies were undertaken, using semi-structured interviews, cognitive interviews and telephone interviews to collect data. The semi-structured interview study, guided by the tenets of grounded theory, aimed to develop an explanation of why older people might be comparatively optimistic. A sampling frame (age, sex and direct and indirect history of falling) was used to guide recruiting respondents. Older people (N = 9) were interviewed about their chance and other older people's chance of falling. Interviews were analysed using the constant comparison method. The cognitive interview study investigated potential problems in survey items in order to refine them for the telephone interview study. Items were developed to measure older people's comparative optimism about falling. Older people (N = 13) were cognitively interviewed, and interviews were content analysed. The telephone interview study aimed to determine whether older people were comparatively optimistic about falling, and whether the direct and indirect experience of falling was associated with comparative optimism. A random sample of older people (N = 389) living in South Australia were telephone interviewed (response rate = 75%). The semi-structured interview study identified that it was a 'threat to identity' for respondents to say they had a chance of falling because of intrinsic risk factors. Respondents used strategies to maintain or protect their identity when discussing their chance of falling in the future or their reasons for falling in the past. In the cognitive interview study, respondents reported difficulty in rating their chance of falling, as they believed falls were unexpected and unpredictable. They reported difficulty in rating other people's chance of falling, as they believed they did not know other people their age, did not have enough information and/or did not know the answer. In the telephone interview study, most respondents believed they had the same chance (42%), or a lower chance (48%) of falling in the next 12 months, than other older people. Having fallen in the last 12 months was significantly associated with a lowered comparative optimism, but knowing other older people who had fallen was not associated with comparative optimism. This is the first quantitative study to report that the majority of a representative sample of community-dwelling older people were comparatively optimistic about their chance of falling. Self-presentation concerns about having a chance of falling support the core category to emerge from the semi-structured interview study. Messages such as 'you can reduce your risk of falls' may be ignored by older people. Alternative messages should promote identities that are relevant to older people, such as being independent, mobile and active, but these messages should be tested in further research. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374964 / Thesis (Ph.D.) - University of Adelaide, School of Psychology and School of Population Health and Clinical Practice, 2009

People aged ≥65 years (older people) have a higher chance of falling than other age groups. However, based on qualitative research, older people do not believe that falls prevention information and strategies have personal relevance. This suggests that older people believe that falls are more likely to happen to other older people than themselves, that is, they might be comparatively optimistic about their chance of falling. It is important to understand comparative optimism about falling as it is a consistent reason given by older people for not participating in falls prevention activity. This thesis used a mixed methods design with a sequential strategy to investigate community-dwelling older people's comparative optimism about falling. Three studies were undertaken, using semi-structured interviews, cognitive interviews and telephone interviews to collect data. The semi-structured interview study, guided by the tenets of grounded theory, aimed to develop an explanation of why older people might be comparatively optimistic. A sampling frame (age, sex and direct and indirect history of falling) was used to guide recruiting respondents. Older people (N = 9) were interviewed about their chance and other older people's chance of falling. Interviews were analysed using the constant comparison method. The cognitive interview study investigated potential problems in survey items in order to refine them for the telephone interview study. Items were developed to measure older people's comparative optimism about falling. Older people (N = 13) were cognitively interviewed, and interviews were content analysed. The telephone interview study aimed to determine whether older people were comparatively optimistic about falling, and whether the direct and indirect experience of falling was associated with comparative optimism. A random sample of older people (N = 389) living in South Australia were telephone interviewed (response rate = 75%). The semi-structured interview study identified that it was a 'threat to identity' for respondents to say they had a chance of falling because of intrinsic risk factors. Respondents used strategies to maintain or protect their identity when discussing their chance of falling in the future or their reasons for falling in the past. In the cognitive interview study, respondents reported difficulty in rating their chance of falling, as they believed falls were unexpected and unpredictable. They reported difficulty in rating other people's chance of falling, as they believed they did not know other people their age, did not have enough information and/or did not know the answer. In the telephone interview study, most respondents believed they had the same chance (42%), or a lower chance (48%) of falling in the next 12 months, than other older people. Having fallen in the last 12 months was significantly associated with a lowered comparative optimism, but knowing other older people who had fallen was not associated with comparative optimism. This is the first quantitative study to report that the majority of a representative sample of community-dwelling older people were comparatively optimistic about their chance of falling. Self-presentation concerns about having a chance of falling support the core category to emerge from the semi-structured interview study. Messages such as 'you can reduce your risk of falls' may be ignored by older people. Alternative messages should promote identities that are relevant to older people, such as being independent, mobile and active, but these messages should be tested in further research. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374964 / Thesis (Ph.D.) - University of Adelaide, School of Psychology and School of Population Health and Clinical Practice, 2009

xiii, 109 p. : ill. / Falls are a significant source of physical, social, and psychological suffering among elderly adults. Falls lead to morbidity and even mortality. Over one-third of adults over the age of 65 years will fall within a calendar year, with almost 10,000 deaths per year attributed to falls. The direct cost of falls exceeds $10 billion a year in the United States. Fall incidents have been linked to multiple risk factors, including cognitive function, muscle strength, and balance control. The ability to properly identify balance impairment is a tremendous challenge to the medical community, with accurate assessment of fall risk lacking. Therefore, the purpose of this study was to assess balance control during gait among young adults, elderly adults, and elderly fallers; determine which biomechanical measures can best identify fallers retrospectively; demonstrate longitudinal changes in elderly adults and prospectively assess fall risk; and provide a method for mapping clinical variables to sensitive balance control measures using artificial neural networks. The interaction of the whole body center of mass (CoM) in relation to the base of support (BoS) assessed static and dynamic balance control throughout gait. Elderly fallers demonstrated reduced balance control ability, specifically a decreased time to contact with the boundary of the BoS, when compared to young adults at heel strike. This decreased time might predispose older adults to additional falls due to an inability to properly respond to perturbations or slips. Inclusion of these balance control measures along with the Berg Balance Scale and spatiotemporal measures demonstrated sensitivity and specificity values of up to 90% when identifying 98 elderly fallers and non-fallers, respectively. Additionally, 27 older adults were followed longitudinally over a period of one year, with only the interaction of the CoM with the BoS demonstrating an ability to differentiate fallers and non-fallers prospectively. As the collection and analysis of these biomechanics measures can be time consuming and expensive, an artificial neural network demonstrated that clinical measures can accurately predict balance control during ambulation. This model approached a solution quickly and provides a means for assessing longitudinal changes, intervention effects, and future fall risk. This dissertation includes both previously published and unpublished co-authored material. / Committee in charge: Dr. Li-Shan Chou, Chair; Dr. Andrew Karduna, Member; Dr. Marjorie Woollacott, Member; Dr. Ronald Stock, Member; Dr. Arthur Farley, Outside Member

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.