Thesis (M. Phil.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 148-159) Also available in print.

Thesis (M.S.)--University of Michigan, 1986.

Thesis (M.S.)--University of Michigan, 1998. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 41-44).

Thesis (M.S.)--University of Michigan, 1991.

Thesis (M.S.)--University of Michigan, 1998. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 41-44).

Thesis (M.S.)--University of Michigan, 1986.

Thesis (M.S.)--University of Michigan, 1991.

Thesis (Ph. D.)--Oregon State University, 2003. / Includes bibliographical references (leaves 111-122).

Submitted by Renata Lopes (renatasil82@gmail.com) on 2018-09-05T17:57:24Z No. of bitstreams: 0 / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-09-06T11:32:55Z (GMT) No. of bitstreams: 0 / Made available in DSpace on 2018-09-06T11:32:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-08-16 / PROQUALI (UFJF) / A fragilidade é uma síndrome biológica frequentemente associada a um risco aumentado de quedas. As quedas desencadeiam condições psicológicas, vinculadas ao componente cognitivo do medo de cair, comumente mensurado por meio do senso de autoeficácia. A redução da autoeficácia para evitar quedas associa-se a restrição de atividades e declínio funcional. Assim, o medo de cair mediado pela restrição de atividades desencadeia uma relação cíclica negativa em direção à fragilidade em idosos. Portanto, o objetivo deste estudo foi identificar a prevalência de fragilidade e os fatores associados em idosos no município de Belo Horizonte; determinar a prevalência nacional de quedas e fatores associados em idosos com e sem condições de fragilidade e estabelecer o ponto de corte no escore de autoeficácia para evitar quedas que melhor diferencie idosos caidores de não caidores e os fatores associados a este ponto de corte em indivíduos com ou sem condições de fragilidade. Estudo de base populacional, que avaliou 8608 idosos comunitários brasileiros com idade ≥ 65 anos. O fenótipo de fragilidade, quedas, autoeficácia relacionada às quedas, aspectos clínicos, funcionais, sócio demográficos, econômicos e a utilização de serviços de saúde foram avaliados. Nas análises multivariadas ajustaram-se modelos de regressão ordinais e de Poisson. Para análise de sensibilidade e especificidade empregou-se a curva ROC. Foram utilizados Intervalos de Confiança de 95% (IC 95%) e α=0,05. Os resultados foram apresentados em três estudos. No primeiro, foi identificada na cidade de Belo Horizonte a prevalência de pré-fragilidade de 46,3% e de fragilidade de 8,7%. Os idosos pré-frágeis e frágeis apresentaram respectivamente maiores e crescentes razão de chances para dependência em atividades instrumentais de vida diária (AIVD); restrição em atividades avançadas de vida diária; utilização de dispositivos auxiliares da marcha; comorbidades; quedas; sintomas depressivos; menor auto eficacia para quedas; hospitalização e idade avançada. No segundo estudo foi observado 11,3% de idosos frágeis, 51,6% de pré-frágeis e 36,9% de não frágeis. A prevalência nacional de quedas e quedas recorrentes em idosos foi de 27,9% e 14,1% e nos idosos frágeis foi de 41,7% e 26,3%. Nos idosos frágeis os fatores associados a um maior número de quedas foram: incontinência fecal, déficit de memória, déficit auditivo, sintomas depressivos, maior número de consultas médicas, ausência de companheiro e não ser proprietário da residência. No terceiro estudo foi identificado o valor da autoeficácia que melhor diferenciou a amostra quanto à ocorrência de quedas igual a ≥23 pontos na FES-I. Foram associados simultaneamente aos idosos com e sem condições de fragilidade dependência em AIVD; déficit de memória; avaliação negativa de saúde; baixa satisfação com a vida e sexo feminino. A presença de comorbidades foi a única condição simultaneamente associada a idosos pré-frágeis e não frágeis. Somente os idosos pré-frágeis apresentaram associação de ≥23 pontos com condições socioeconômicas e número de consultas médicas. Nos idosos não frágeis o ponto de corte autoeficácia foi associado isoladamente a sintomas depressivos e consultas domiciliares. Os resultados identificaram elevados percentuais de fragilidade associados a condições adversas de saúde, assim como elevada prevalência de quedas em idosos frágeis / Frailty is a biological syndrome often associated with an increased risk of falling. Falls induce psychological conditions, commonly translated by the fear of falling. The cognitive component of fear of falling is often measured by means of the sense of self-efficacy. Reduction of self-efficacy to prevent falls is associated with activity restriction and subsequent functional decline. Thus, the fear of falling mediated by activity restriction triggers a cyclical relationship or a negative toward frailty in elderly spiral. Therefore, the aim of this study was to identify the prevalence of frailty and associated factors among elderly in the city of Belo Horizonte; determine the national prevalence of falls and associated factors in elderly patients with and without conditions of fragility and establish a cutoff score for self-efficacy to prevent falls that best differentiate elderly fallers and non-fallers of the factors associated with this cutoff point in individuals with or without conditions of fragility. Study populationbased evaluated 8608 community-dwelling elderly Brazilians aged ≥ 65 years. The phenotype of frailty, falls, self-efficacy related to falls, clinical, functional, sociodemographic, economic aspects and use of health services were evaluated. In multivariate analyzes set of ordinal regression models and Poisson. For analysis of sensitivity and specificity we used the ROC curve. Confidence intervals of 95 % (95 % CI) and α = 0.05 were used. The results were presented in three studies. In the first, was identified in the city of Belo Horizonte the prevalence of pre-frailty of 46.3 % and 8.7% of frailty. The pre-frail and frail, respectively, showed higher and increasing odds ratio for dependency in instrumental activities of daily living (IADL); restrictions on advanced activities of daily living, use of walking aids, comorbidities, falls, depressive symptoms, lower self-efficacy for falls, hospitalization and advanced age. In the second study it was found 11.3% of frail elderly, 51.6 % pre-frail and non-frail 36.9%. The national prevalence of falls and recurrent falls in the elderly was 27.9 % and 14.1% and the frail elderly was 41.7% and 26.3%. In frail elderly factors associated with a larger number of falls were: fecal incontinence, memory deficits, hearing impairment, depressive symptoms, more medical visits, being single and not the owner of the residence. In the third study, the value of self-efficacy that best differentiates the sample according to the occurrence of falls was identified as ≥ 23 points in FES-I. IADL dependence, memory deficit, negative rated health, lower life satisfaction and being female were simultaneously associated in the elderly with and without conditions of fragility. The presence of comorbidities was the only factor simultaneously associated with pre-frail and not-frail elderly. Only the pre-frail elderly showed association of ≥ 23 points with socioeconomic conditions and number of medical visits. In non-frail elderly the point of cutoff of self-efficacy was singly associated with depressive symptoms and home visits. The results showed high rates of frailty associated with adverse health conditions, as well as high prevalence of falls in frail elderly.

In Canada, falls are one of the leading causes of injury and deaths for seniors. These types of injuries can typically be avoided through falls prevention programs, and past studies suggest that these health services have significantly reduced seniors’ falls risk and rates in Canada. Despite the abundance of falls prevention research, practices and programs available in the country, Aboriginal Elders remain overrepresented in fall-related injury and fatality rates. The elevated rates of falls for Aboriginal Elders indicate that current falls prevention programs and standards may not be reaching those most vulnerable to fall hazards and injuries. My thesis is written in the publishable paper format and is comprised of two papers. Using an exploratory case study methodology in paper one, I investigated the social determinants of health that Inuvialuit Elders and LFPPs identify as factors that increase, decrease, or have no effect on the likelihood of an Inuvialuit Elder experiencing a fall. Together, we found that personal health status and conditions, personal health practices and coping skills, physical environments, social support networks, and access to health services increase Inuvialuit Elders likelihood of experiencing a fall, health practices and coping skills and access to health services decrease Inuvialuit Elders likelihood of experiencing a fall, and culture has no affect on the likelihood of Inuvialuit Elders experiencing a fall. In paper two, I used a participatory action research approach informed by postcolonial theory to examine what current falls prevention recommendations are offered by local falls prevention programmers (LFPPs) in order to reduce fall rates among Inuvialuit Elders in Inuvik, Northwest Territories, Canada; and to understand how falls prevention programs for Inuvialuit Elders can be co-created with participants to be culturally safe. In it, I provide the recommended strategies of developing and implementing a culturally safe falls prevention program for Inuvialuit Elders, as suggested by the LFPPs and Inuvialuit Elders who participated in the research. Taken together, the papers in this thesis make it apparent that research concerning falls prevention for Aboriginal Elders and falls prevention programs continues to be influenced by colonial practices. As a result, there is a demonstrated need for program development and research in this area to work towards reducing health disparities and challenging colonial practices.