Falls are the most frequent cause of injury-related hospitalization and death for people 65 years and older in Canada (Canadian Institute of Health Information, 1998; Langlois et al., 1995; Raina & Torrance, 1996). Studies show the etiology of a falls to be a complex combination of factors that reflect physical, behavioral and social conditions operating alone, or in conjunction with environmental hazards (Speechley & Tinetti, 1991; O'Loughlin et al., 1993). However, the particular role of these factors in relation to falls that result in injury— the subject of this study— is less well understood. Fall-related injuries among frail, older, community-dwelling adults are the focus of this study due to the growing numbers of seniors living in the community who have multiple chronic conditions, the serious consequences of many of these events for this population, and the mounting costs related to treatment. The purpose of this study was to understand the extent and nature of fall-related injuries among frail older adults and to examine the patterns and compounding effects of a wide range of variables representing biological, behavioural, environmental, social and economic risk factors. Differences were examined for risk factors among fallers, nonfallers, injured and non-injured persons. The secondary data used for this study were provided through the University of Victoria Centre on Aging in British Columbia and are based on the Capital Regional District (CRD) Patterns of Care Survey 1995-96 (Centre on Aging, 1996). The data from the CRD Survey are based on interviews with frail community-dwelling seniors represented by two purposefully selected groups. One group consisted of over 3,000 seniors in the CRD receiving publicly-funded home support services in 1995, and the other, a matched sample of 810 seniors screened by age, gender and functional limitations, drawn from the 56,774 seniors in the CRD not receiving home support services. Five hundred and six participants were randomly selected from each group. Of the 1012 respondents to the CRD Survey, 245 reported a fall with an injury, 91 reported falling without an injury and 675 were non-fallers (fall data were missing for one case). Findings showed that 72.9% of those who fell reported being injured as a result of one or more of their falls. This injury rate is considerably higher than that found in other studies that look at the general population of persons aged 65 and over. These differences are explained by the precondition of frailty that defines the population in the CRD Survey. Findings also differ from most other studies in the lack of association found between falls with injury and advanced age or female gender, indicating the strong influence of frailty, regardless of age or gender, for this sample. The results indicate that considerable differences exist in the patterns and combined effect of multiple risk factors between older adults who fall and sustain an injury and those who do not. The findings both confirm and contradict the findings of earlier studies, as well as shedding light on factors not previously studied. This study was conducted from a critical gerontological perspective. This perspective is particularly relevant to the study of seniors’ issues that are influenced by a complex combination of factors— such as fall-related injuries— as it enables an examination of multiple perspectives of the issue within larger social, economic and political contexts. A critical gerontological framework was use in this study to guide the selection of variables, to explain the findings in light of previous knowledge, and to critically examine social policies that influence the ability to implement strategies for prevention. / Graduate

Inpatient falls are a leading cause of fatal and serious injuries among hospitalized elderly patients, often with devastating consequences. This quality improvement project was conducted on a geriatric unit in a large southeastern U. S. hospital, following recognition of an increase in the number of falls with several sustained injuries. After an analysis of the previous fall prevention strategies, a panel of stakeholders who formed a falls prevention committee determined that implementing an evidence-based fall risk assessment tool to help identify risk factors, as well as implementing interventions to address those risk factors, would make fall prevention more patient specific and comprehensive. Guided by the IOWA Model, this project was designed to assess the effectiveness of implementing the Morse Fall Scale for a period of 2 months on the geriatric unit. Nurses were educated on the use of the tool and interventions, and 32 (87.5%) shared their perceptions of the effectiveness of the tool using a 5-item questionnaire following tool implementation. Fall rates based on nursing assessments and incident reports were monitored 6 months prior to, 2 months during implementation, and 2 months after the implementation of the MFS ended. The fall rate on the unit decreased by 50% during the implementation of the Morse Fall Scale; 99% of nurses agreed or strongly agreed that the tool was easy to understand, quick to use, identified and increased awareness of fall risks as well as fall prevention strategies, and decreased falls. Nurses leading fall prevention programs supported by evidence can address the serious patient safety issue of falls to decrease the negative impact on patients, families, and health care systems by reducing falls among elderly patients.

Background: People with COPD have significant balance impairments and an increased risk of falls. The psychometric properties of short balance screening tests to inform fall risk assessment in COPD have not been studied. The objective of this study was to compare the validity of four short balance tests suitable for fall risk screening to identify the most optimal screening tool(s). Methods: Participants at least 60 years old with COPD attended a single physical assessment with completion of questionnaires. Correlation coefficients were used to describe relationships between the Brief Balance Evaluation Systems Test (Brief BESTest), Single-Leg Stance (SLS), Timed Up and Go (TUG) and Timed Up and Go Dual-Task (TUG-DT) tests, and other measures of balance, measures of muscle strength, exercise tolerance, functional limitation, disability and prognosis. Independent t-tests or Mann-Whitney U tests were used to examine differences between groups with respect to fall risk. Receiver operating characteristic curves were plotted to examine the ability to of the screening tests to identify individuals with previous falls. Results: Seventy-three participants with COPD completed the study (age 73.0 ± 6.9 years; FEV1 47.0 ± 19.8% predicted). All balance screening tests demonstrated moderate to strong correlations with the Berg Balance Scale (r= 0.47 to 0.80, p<0.05) and Activities-specific Balance Confidence scale (r= 0.44 to 0.61, p<0.05). The Brief BESTest and SLS showed the strongest correlations with other balance measures and demonstrated the most consistent ability to discriminate between fall risk groups. The Brief BESTest was the only screening test that identified individuals who reported a previous fall with acceptable accuracy (AUC= 0.7). Conclusions: The Brief BESTest and SLS show the most promise as balance screening tools for fall risk assessment in older adults with COPD. These results will need to be prospectively confirmed with a larger sample size. / Thesis / Master of Science Rehabilitation Science (MSc)

Falls are a leading cause of injury and death in older adults. Numerous exercise interventions have been explored for fall prevention with their effectiveness being inconsistent. An alternative intervention based on motor learning concepts has potential to help prevent falls. Two separate studies are reported in this thesis. The purpose of the first study was to investigate if older adults exhibit short-term performance adaptation and long-term motor learning with repeated exposures to a simulated trip. While in a safety harness, participants stood on a treadmill that was quickly accelerated to simulate a trip. Improvements in trip recovery performance due to repeated exposures of a simulated trip included arresting the forward rotation of the trunk more quickly, reacting to the perturbation more quickly, and decreasing agonist/antagonist co-contraction. Overall, the results provide evidence for both short-term performance adaptation and motor learning. The purpose of the second study was to investigate if skills obtained from repeated exposure to a simulated trip transfer to recovery from an actual trip. Participants were randomly assigned to either an experimental or control group performing one trip before and after an intervention. The intervention for the experimental group consisted of trip recovery training on a treadmill while the intervention for the control group was walking on a treadmill. Overall, the results suggested beneficial effects of trip recovery training on actual trip recovery. These beneficial effects included decreasing maximum trunk angle, decreasing the time to reach maximum trunk angle, and raising minimum hip height during the initial recovery step. / Master of Science

Falls and related injuries have affected residents in long-term care facilities for many years. It has been well-established that patient fall prevention includes staff education and hourly rounding in addition to adequate risk assessment. These steps, taken together, have the potential to decrease a 52.7% fall rate on the long-term care pilot unit. The purpose of this quality improvement project was to: (a) educate staff on the process of properly performing hourly rounding and (b) and achieve a decreased incidence of falls from the current fall rate. Thus, the practice-focused question for the project addressed whether rounding hourly on patients in a long-term care facility would decrease the numbers of falls and related injuries. The conceptual framework used for this evidence-based project was the Institute for Healthcare Improvement's rapid cycle improvement. A sample size of 40 residents' fall rates were compared for a 6-week period before the intervention of hourly rounding to the fall rates after 6 weeks of full implementation of the rounding process. A Wilcoxon Signed Ranks test (z = -4.169, p < .001) showed that there was a statistically significant improvement in staff knowledge when mean pretest scores (75.9%) were compared to posttest scores (94.5%). Nursing staff were also evaluated on competencies, and 100% of the staff successfully completed the competency checklist on the first attempt. Post project fall rates revealed a decreased fall rate by 22% over a 6-week period post implementation. Nursing leadership should ensure that staff are continually educated on policies being implemented to ensure an effective outcome. Having hourly rounding as a permanent policy can decrease the patient's fall rate and improve patient safety, a positive social change.

published_or_final_version / Community Medicine / Master / Master of Public Health

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

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

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

Thesis (M.S.)--University of Michigan, 1990.