Aim To investigate the epidemiology of unintentional fall-related injuries at home among young and middle-aged adults (25 to 59 years) and to investigate the contribution of alcohol to these injuries. Methods Routinely collected national fall injury data were analysed to describe the incidence and characteristics of falls at home resulting in death or hospital inpatient treatment among this age group in New Zealand. A systematic review of the published literature evaluated the epidemiological evidence quantifying the risk of falls associated with acute and usual alcohol consumption in this age group. A population-based case-control study was conducted in Auckland, New Zealand over a 12-month period. Cases were 335 people aged 25 to 59 years who were admitted to hospital or died as a result of unintentional non-occupational falls at home. Controls were 352 people randomly selected from the electoral roll from the same age group as the cases. The participants or next-of-kin completed a structured interview to ascertain data on personal and lifestyle factors including alcohol consumption. Findings The review of national injury data found that almost a third of unintentional falls resulting in an in-patient admission among working-age people were recorded as occurring at home. For every death there were about 150 in-patient hospital admissions. The systematic review identified only a small number of studies but showed an increased risk of unintentional falls in this age group with increasing exposure to alcohol use. The magnitude of this risk varied considerably across studies with most estimates being relatively imprecise. There was modest evidence of a dose-response relationship with acute alcohol use. The association between usual alcohol use and fall risk was inconclusive. The case-control study revealed that after controlling for confounding, the consumption of two or more standard alcoholic drinks in the preceding six hours relative to none is associated with a significantly increased risk of fall-related injury. Approximately 21% of unintentional non-occupational falls at home in this population was attributed to this risk. No association between hazardous drinking as a usual pattern and falls was found when the analyses were adjusted for confounders. Conclusion A significant proportion of unintentional fall-related injuries among the working-aged New Zealanders occur at home. Consuming two or more drinks in the previous six hours was strongly associated with unintentional non-occupational falls at home that result in admission to hospital or death in this age group. This largely unrecognised problem should be addressed in further research and in falls prevention programmes.

The incidence of falls is common in older adults and becomes more frequent with advancing age. Falls and injuries associated with falls are among the most debilitating and traumatic medical problems encountered by the elderly. There is evidence that indicates there may be a cause and effect relationship between specific gait parameters and falling. If a simple gait test can predict fallers, it could become a valuable tool for identifying individuals at high risk of falling. The purposes of this study were 1) to determine whether performance on the Functional Ambulation Profile (FAP) could accurately predict fallers and non-fallers in a prospective manner and 2) to identify gait parameters within the FAP that would best classify fallers. My hypothesis for this study include 1) the Functional Ambulation Profile (FAP) will accurately predict subjects as fallers and non-fallers and 2) of the five variables that comprise the FAP walking velocity, right and left step length:leg length ratio, step width will be the most powerful predictors of fall status. Two hundred twenty six subjects were evaluated using the GAITRite electronic walkway. Falls surveillance was conducted for 8 months after each participant's specific GAITRite testing date. Average height, weight and BMI were 161.9 �� 8.7 cm, 68.1 �� 16.7 kg, and 25.9 �� 4.1 kg/m��, respectively. Men and women were analyzed separately using analysis of variance, logistic regression and relative operating characteristic curves. There was no difference between fallers and non-fallers for any of the FAP variables for both the men and women. Regression results indicated the overall model for FAP to predict fallers was not statistically significant for either men or women, (p=0.706 and p=0.543, respectively). In addition, none of the five variables that make up the FAP was significant enough to be included in a stepwise logistic model, thus we were unable to develop an alternative model for predicting fallers based on gait variables. A secondary analysis found that the FAP was unable to distinguish multiple fallers (3 or more) from occasional and non-fallers in this same study population. The results of this study indicate that the FAP does not predict falls in independently living men and women over the age of 70. Further, none of the five gait variables that compose the FAP was a significant independent predictor of falls in this same population. Based on the results of this study we conclude that the FAP alone is not sufficient to predict risk of falling among older adults. Because of the complexity of all the physical, psychological and environmental elements that can lead to falling, tests based on only spatial and temporal gait characteristics do not appear to be good fall predictors for independent older adults. / Graduation date: 2003

It is well established that there are many intrinsic and extrinsic risk factors associated with falls in older adults. Less well-known is what risk factors predict falls in more vulnerable populations, such as those with neurological conditions living in long-term care homes or receiving home care services. Furthermore, evidence comparing those with neurological conditions to those without is lacking in the literature. The primary purpose of this thesis was to determine risk factors for falls in long-term care residents and home care clients with no recent history of falls to determine if risk factors differed between individuals with dementia or Parkinson’s disease and those without any neurological conditions. Secondary data analysis was performed on a database of standardized health assessments completed for long-stay home care clients and long-term care residents in Ontario. Within each major diagnostic group, observations were stratified based on ambulatory status (ambulatory vs. non-ambulatory). Bivariate analyses followed by generalized estimating equations were used to determine statistically significant predictors of falls in each group within each care setting. The results of multivariable analyses showed that there is not a distinct set of risk factors associated with falls in home care clients and long-term care residents with dementia or Parkinson’s disease that is systematically different from risk factors associated with falls in clients and residents not diagnosed with any of the neurological conditions in this study. These results suggest that a common set of risk factors may effectively predict falls in all clients and residents with no recent falls history, regardless of certain neurological diagnoses.

The primary area of study for this thesis is the adaptive reuse of the remaining industrial buildings on Chaudire and Albert Islands in Ottawa, Canada. The recently closed paper mills and the obsolete infrastructure from the bygone lumber industry have the opportunity to be reintegrated with the core area of the nations capital. New uses are introduced to the buildings by material activators which engage spatial and programmatic opportunities of building adaptation. The activators include stair cores, classroom blocks, shoring trusses, glass box windows, and a theatre box. The program that they introduce includes office space, residencies for artists and crafts people, a theatre, galleries, a fabrication shop, and a lap pool. The architectural interventions transform the site into a new commercial and cultural enclave within the capital region, and preserve certain heritage characteristics of the existing buildings architecture.

Losing confidence in the ability to maintain balance can be more debilitating than a fall. Therefore, considering the importance of measuring balance confidence, the purpose of this study was to examine the validity and reliability of the ABC-6, a shortened version of the ABC-16, among diverse older adults. Participants were 251 diverse (72.1% African Americans, 62.5% low-income, 61% low-education) older adults (M age = 71.2 years, SD = 8.9). Participants volunteered for a falls risk screening which assessed multiple falls risk factors and balance confidence. The ABC-6 had excellent internal consistency reliability, substantial intraclass correlations, significant moderate to large correlations with physical activity, mobility, balance, and total falls risk, the ability to discriminate between fallers and nonfallers, and it was the only significant predictor of total falls risk. The ABC-6 was a valid and reliable measure of balance confidence and is a suitable measure for use among diverse older adults.

The purposes of this study were to identify and analyze characteristics of patients who fall, the types and circumstances of their falls, and analyze risk factors for fall-related injuries. In this retrospective study of 137 patients who fell between July 1, 2002 and December 31, 2005 at the neurological unit of a medical center located in the south of Taiwan. Data on patient characteristics, fall circumstances, and injuries were collected by reviewing of adverse event reports. Analyses were performed by use of SPSS statistical software. The result of this study found that the average age of patient who fell was 59.6 years. The majority of sex of the patient falls is male (61.3%). Many patients who fell had caregivers taking constant care (84%), and occurred in the patient room (68.6%). The most frequent diseases related to falls were cerebrovascular disease (47.5%). They usually falls happened during 12AM to 8AM (50.4%). Most falls (81%) did not result in severe injury, or disturbances of gait (78.8%). The most common activity performed at time of fall was during ambulation (39.4%), and getting out of bed (29.9%).The study found that significant risk factors for dizziness were correlated with fall injury (P<0.05); location and activity at time of fall were related to fall injury (P<0.05). The logistic regression model revealed that the significant risk factors for fall-related injuries were activity at time of fall sit and trying to pick up something (OR=18.15 with 95% CI of 1.15 to 285.92). The identified factors associated with injury may provide the information on reducing falling injuries for neurological patients, and development of fall intervention programs. The preventive strategies can ensure patient safety, improve health care quality and reduce resource utilization.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Sports Science / Master / Master of Science in Sports Science

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Current winter footwear provides inadequate protection from slip-related injuries on ice, and there is limited research investigating the optimal design of anti-slip devices. This study examined how ice cleat spike height and position in the heel affect slipping. No differences could be observed between spike conditions, but results demonstrated that heel spikes may prevent slips initiated between heel contact and foot-flat and forefoot spikes may be necessary to prevent foot-flat slips. Further analysis compared slip outcomes measured using two slip onset definitions: 1) heel contact, and 2) the first point of increasing positive heel acceleration. Slip onset defined as time of heel contact overestimated the number of slips and slip distances. These results demonstrate that ice cleats have the potential to protect pedestrians from slipping but some styles available to consumers (i.e. heel spikes only) may not be adequate. Choice of slip definition in footwear evaluations can significantly influence study outcomes.